Background
The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed.
Methods
PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates.
Results
Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16–26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] −99 ml, 95 per cent C.I. −182 to −16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD −3.22 days, 95 per cent C.I. −4.38 to −2.06 days).
Conclusion
Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.
Backgrounds/Aims
This study aims to evaluate the perioperative outcomes of minimally-invasive enucleation (MIEn) of the pancreas versus open enucleation (OEn).
Methods
This is a retrospective review of 20 consecutive patients who underwent pancreatic enucleation at a single institution.
Results
Seven patients underwent MIEn, of which 3 were robotic and 4 were laparoscopic. After propensity-adjusted analysis, the only significant difference was a reduced rate of readmissions within 30 days in the MIEn group versus the OEn group [0 vs 4 (30.8%),
p
=0.0464]. There were no conversions to open in the MIEn group, and median operation time was similar in both groups. There was no difference in median EBL in both groups, and none of the patients in our series required blood transfusions. The overall morbidity rate was 45.0% and the major complication (Clavien-Dindo>2) rate was 15%; which was similar between both groups. Seven (35%) patients had a Grade B/C POPF, and there was no significant difference between the two groups for this. The MIEn group had a shorter median length of stay compared to OEn [5 days (range, 3–24) vs 8.5 days (range, 5–42)] this was not significant on propensity-adjusted analysis (
p
=0.3195). There was no post-operative 90-day/in-hospital mortality in all 20 patients.
Conclusions
Our experience demonstrates that MIEn was associated with similar perioperative outcomes and fewer readmissions compared to OEn.
Introduction:
There are limited data to date regarding laparoscopic liver resection (LLR) for spontaneously ruptured hepatocellular carcinoma (srHCC). We performed this study to determine the safety and feasibility of LLR for srHCC.
Materials and Methods:
We conducted a retrospective review of all patients who underwent liver resection for srHCC from 2000 to 2018. A total of five patients underwent LLR for srHCC, and they were matched to 10 patients who underwent open liver resection (OLR) for srHCC to perform a 1:2 comparison. A separate cohort of patients who underwent LLR for non-ruptured HCC (nrHCC) was also compared against the laparoscopic group.
Results:
The comparison between LLR versus OLR for srHCC demonstrated no significant differences in baseline characteristics between both groups. There was also no significant difference in perioperative outcomes such as median operating time, estimated blood loss (EBL), rate of blood transfusion, post-operative median length of stay (LOS), overall complication rates, major morbidity rates and 90-day mortality rates. Comparison between LLR for srHCC and LLR for nrHCC demonstrated no significant differences in baseline characteristics between both groups. There was also no significant difference in key perioperative outcomes such as median operating time, EBL, rate and volume of blood transfusion, median post-operative LOS, morbidity rates or mortality rates.
Conclusion:
LLR may be performed safely in selected cases of srHCC. These patients have comparable perioperative outcomes as those who undergo OLR for srHCC and LLR for nrHCC.
For the most part, use of Asian models does not cause prejudiced respondents to evaluate a product or advertisement more negatively than when white models are used, according to this experiment. The study used Bogardus' social distance scale, among other measures, and sought to test how well use of Asian versus white models affected advertisement recall and credibility, attitudes toward the model, and purchase intentions. There was a very small effect on those moderately (as versus very) prejudiced on some measures when Asian models were used, but by and large there was little effect on respondents as a whole. The study concludes that advertisers need not fear negative reactions from use of nonCaucasian models. *Advertising is more overtly persuasive, more goalaiented, and more frequently repeated than other programming in the media. In order to achieve these aims, various advertising appeals and formats have been adopted to carry the message and to achieve its intended effects on consumer attitudes and product sales. The "language" of advertising reflects diverse social standards and lifestyles so that the audience will want to identify with the subject of the advertisement.'In a complex multiethnic culture such as that of the United States, different subcultural groups have different product preferences and unique patterns of behaving. To reach a broad market in such a culture, many advertisers use models from a variety of ethnic groups (Blacks, Hispanic, AsianAmericans). To date there have been very few studies of how the use of different ethnic models or integrated models in ads impact on advertising effectiveness.' This study reports an experiment in which prejudice levels of the audience were measured and model ethnicity was varied in order to assess their impact on advertising effectiveness, as reflected by ad recall and credibility, attitudes toward the ad, the model in the ad and the brand, and intentions to buy the advertised product.In this paper, we first review other studies of spokesperson effects and the use of ethnic models in advertising. Next we discuss the rela>Hsiuchen Sandra Lai completed her M A at the University of Texas at Austin, where
stage LPD due to cardiac arrest based on autopsy-proven cardiac amyloidosis. Conclusions: LPD with uPG plus RY-GE is associated with excellent clinical outcomes and no DGE. Further investigation is warranted before considering replacement of current reconstruction Methods in pancreaticoduodenectomy.
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