Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting?

Cawich, Shamir O; Thomas, Dexter; Ramjit, Chunilal; Bhagan, Roderick; Naraynsingh, Vijay

doi:10.1155/2015/570968

Cited by 6 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This produces a situation where patients who are in need of subspecialty services are not able to access these services in a timely fashion. This is evident in patients with colorectal liver metastases; most patients with colorectal liver metastases who are candidates for resection are unable to access these services and so their oncologic treatment is limited to best medical management only [4-5].…”

Section: Discussionmentioning

confidence: 99%

“…This situation extends to laparoscopic liver resections as well. In this environment, laparoscopic liver resections are only performed in Trinidad and Tobago, Jamaica, and the Bahamas [1, 3, 5-6], where there are active hepatobiliary teams (Figure 1). Some of the other Caribbean countries have competent surgeons who may not have formal training in liver resections but possess the necessary advanced laparoscopic skill sets to complete laparoscopic liver resections.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Liver Resection by Distance Mentoring – Trinidad to Barbados: A Report

Griffith

Cawich

Mencia

et al. 2019

Cureus

Self Cite

View full text Add to dashboard Cite

Laparoscopic liver resections require advanced laparoscopic skill sets. In the Caribbean, a unique situation exists where centers of excellence for liver resections exist, but surgeons who are trained in advanced laparoscopic surgery are not available throughout the region. Therefore, many patients who are candidates for liver resection in the Caribbean do not have the opportunity to receive laparoscopic operations. We report a case of distance mentoring using readily available, inexpensive equipment to complete a laparoscopic liver resection, mentored by an expert hepatobiliary surgeon. It may be considered, in special cases, as a way to increase the availability of laparoscopic operations. We acknowledge that there are many limitations to the use of this technology and we discuss the pros and cons of distance mentoring for this purpose.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Liver Resection by Distance Mentoring – Trinidad to Barbados: A Report

Griffith

Cawich

Mencia

et al. 2019

Cureus

Self Cite

View full text Add to dashboard Cite

show abstract

“…Narayansingh et al[24] outlined the unique challenges to healthcare delivery in this setting: (1) many countries are island states that are geographically separated by the Caribbean Sea; (2) there are political barriers since each country is independent and separately governed; (3) each island has distinctly different cultures; and (4) many surgeons, even those with subspecialty training, are required to perform a wide repertoire of general surgical procedures at low volumes. In addition, most of these countries have underfunded health care systems[8], leadership deficiencies[25,26], cultural resistance to multidisciplinary collaboration[8] and limited access to specialists and subspecialists[9,24]. These factors were all obstacles to service centralization in the Anglophone Caribbean.…”

Section: Discussionmentioning

confidence: 99%

“…The hepatobiliary unit in Trinidad and Tobago is the largest referral unit in the English-speaking Caribbean[8-9]. This unit is comprised of two hepatobiliary teams each headed by fellowship-trained hepatobiliary surgeons.…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes after major hepatectomy are acceptable in low-volume centers in the Caribbean

Cawich¹,

Maharaj²,

Naraynsingh³

et al. 2019

WJH

Self Cite

View full text Add to dashboard Cite

BACKGROUND Major hepatectomies are routinely performed because they are often the only curative treatment for metastatic liver disease. There has been a trend to concentrate major hepatectomies in referral hospitals that perform these operations at high volumes. These high volume referral centers are usually located in developed countries, but many patients in developing nations are not able to access these centers because of financial limitations, lack of social support and/or travel restrictions. Therefore, local hospitals are often the only options many of these patients have for surgical treatment of metastatic liver disease. This is the situation in many Caribbean countries. AIM To determine the clinical outcomes after major liver resections in a low-resource hepatobiliary center in the Caribbean. METHODS We prospectively studied all patients who underwent major liver resections over five years. The following data were extracted: patient demographics, diagnoses, ECOG status, operation performed, post-operative morbidity and mortality. Statistical analyses were performed using SPSS ver 16.0 RESULTS There were 69 major liver resections performed by two teams at a mean case volume of 13.8 major resections/year. Sixty-nine major hepatic resections were performed for: colorectal liver metastases 40 (58%), non-colorectal metastases 9 (13%), hepatocellular carcinoma 8 (11.6%), ruptured adenomas 4 (5.8%), hilar cholangiocarcinomas 4 (5.8%), hemangiomata 2 (2.9%), trauma 1 (1.5%) and hepatoblastoma 1 (1.5%). Twenty-one patients had at least one complication, for an overall morbidity rate of 30.4%. There were minor complications in 17 (24.6%) patients, major complications in 11 (15.9%) patients and 4 (5.8%) deaths. CONCLUSION There are unique geographic, political and financial limitations to healthcare delivery in the Caribbean. Nevertheless, clinical outcomes are acceptable in the established, low-volume hepatobiliary centers in the Eastern Caribbean.

show abstract

“…Malignant IVC invasion was initially considered an absolute contraindication to the hanging manoeuvre (30). However, there have been published case reports (29,31,25) and one small series of 7 cases (27), where this manoeuvre was used to perform complex resections facilitating partial IVC resection and reconstruction in patients with malignant invasion. There were good outcomes in all cases, all with R0 resection.…”

Section: Thus Capussotti Et Almentioning

confidence: 99%

Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

Cawich

Thomas

Ragoonanan

et al. 2017

Molecular and Clinical Oncology

Self Cite

View full text Add to dashboard Cite

Abstract. Liver resections are safe when performed by specialized hepatobiliary teams. However, complex liver resections are accompanied by significant perioperative risk and they may require modifications of the conventional surgical techniques. We herein report the case of a 54-year-old male patient who underwent an extended right liver resection with en bloc resection and reconstruction of the inferior vena cava. For this complex resection, a modification of the standard operative technique was required. A modified hanging manoeuvre was performed using two 19Fr nasogastric tubes outside the traditional avascular plane to facilitate resection. This modification of the hanging manoeuvre was proven to be feasible and safe, and it is recommended for inclusion in the armamentarium of hepatobiliary surgeons when complex resections are required.

show abstract

Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting?

Cited by 6 publications

References 18 publications

Laparoscopic Liver Resection by Distance Mentoring – Trinidad to Barbados: A Report

Laparoscopic Liver Resection by Distance Mentoring – Trinidad to Barbados: A Report

Clinical outcomes after major hepatectomy are acceptable in low-volume centers in the Caribbean

Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

Contact Info

Product

Resources

About