Introduction: Hepatobiliary and pancreatic (HBP) malignancy remains a highly lethal disease, with nearly 70-80% of patients presenting with metastatic or locally advanced disease. Recent chemotherapy for metastatic pancreatic cancer (FOLFIRINOX) improves median survival. Even though this regimen increased survival, since the implementation of the POLST in Korea, paradigm it began to change. We described and analyzed the status of POLST and treatment in the real world and discuss about principle of palliative care focused on HBP malignancy. Method: Between February 2018 and December 2019, we reviewed the terminal stage hepatobiliary and pancreas cancer patient who have already agree with POLST retrospectively. Results: Total 158 patients of HBP malignancy were analyzed. The mean age was 65 years and proportion of hepatocellular carcinoma (HCC), cholangiocarcinoma and pancreatic cancer was 20.2% vs. 37.9% vs 41.9%. Symptoms were reported differently according to the types of cancer, In the case of hepatocellular carcinoma, 70% of patients suffered from abdominal distension due to malignant ascites, and 84% of patients of biliary tract cancer had jaundice and itching sense. Opioid analgesics were significantly used common in 96% of pancreatic cancer. Patients with HCC and biliary tract cancer had a high rate of treatment such as PTBD and PCD even after POLST. Conclusion:In the era of POLST, palliative treatments have become a major issue. Depending on the symptoms associated with the type of cancer, appropriate treatment should be applied and it will be a good way to improve QOL in terminal cancer patients.
Objective: To investigate the feasibility and safety of an alternative robotic living-donor right hepatectomy (RLDRH) technique. Background data: Data for minimally invasive livingdonor right hepatectomy, especially RLDRH, in a relatively large donor cohort have not been reported yet. Methods: From March 2016 to March 2019, 52 liver donors underwent RLDRH. The clinical and perioperative outcomes of RLDRH were compared with those of conventional open donor right hepatectomy (CODRH; n=62) and laparoscopy-assisted donor right hepatectomy (LADRH; n=118). Donor satisfaction with cosmetic results was compared between RLDRH and LADRH using a body image questionnaire. Results: Although RLDRH had a longer operative time (RLDRH, 493.6 min; CODRH, 404.4 min; LADRH, 355.9 min, p< 0.001), its mean estimated blood loss was significantly lower (RLDRH, 109.8 mL; CODRH, 287.1 mL; LADRH, 265.5 mL; p< 0.001). The postoperative complication rates were similar among the three groups (RLDRH, 23.1%; CODRH, 35.5%; LADRH, 28.0%; p=0.420). Regarding donor satisfaction, the body image and cosmetic appearance scores were significantly higher in RLDRH than in LADRH. There was no significant difference in hospital stay among the three groups (p=0.105). After propensity score matching, RLDRH showed a shorter hospital stay and similar complication rate than CODRH. Conclusions: RLDRH resulted in a similar postoperative complication rate and shorter length of hospital stay compared with those of CODRH and provided better body image and cosmetic results compared with those of LADRH. RLDRH is feasible and can be safely performed by expert surgeons in both robotic systems and open hepatectomy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.