The barcelona clinic liver cancer(BCLC)staging system has been approved as guidance for hepatocellular carcinoma(HCC)treatment guidelines by the main Western clinical liver associations.According to the BCLC classific...The barcelona clinic liver cancer(BCLC)staging system has been approved as guidance for hepatocellular carcinoma(HCC)treatment guidelines by the main Western clinical liver associations.According to the BCLC classification,only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver resection.In contrast,patients with intermediate-advanced HCC should be scheduled for palliative therapies,even if the lesion is resectable.Recent studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver resection.Therefore,this classification has been criticised because it excludes many patients who could benefit from curative resection.The aim of this review was to evaluate the role of surgery beyond the BCLC recommendations.Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%.Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50%and 40%,respectively.Although macrovascular invasion is associated with a poor prognosis,liver resection provides better long-term results than palliative therapies or best supportive care.Recently,researchers have identified several genes whose altered expression influences the prognosis of patients with HCC.These genes may be useful for classifying the biological behaviour of different tumours.A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.展开更多
AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of hepatectomy.METHODS:A retrospective analysis of 135 patients with...AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of hepatectomy.METHODS:A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection.RESULTS:PH was present in 44(32.5%)patients.Overall mortality and morbidity were 2.2% and 33.7%,respectively.Median survival time in patients with or without PH was 31.6 and 65.1 mo,respectively(P=0.047);in the subgroup with Child-Pugh class A cirrhosis,median survival was 65.1 mo and 60.5 mo,respectively(P=0.257).Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH.Conversely,median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo,respectively(P=0.035).CONCLUSION:PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients,but resection of 2 or more segments should not be recommended in patients with PH.展开更多
Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional proper...Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations.Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.展开更多
Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segment...Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection(SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot(1957) and Letton and Wilson(1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.展开更多
AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esop...AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal adenocarcinoma.METHODS: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively analyzed.RESULTS: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo later.CONCLUSION: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.展开更多
AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.METHODS This retrospective study analysed 652 patients undergoing surger...AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.METHODS This retrospective study analysed 652 patients undergoing surgery for stage Ⅰ-Ⅳ colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related survival.RESULTS Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients(53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL(median: 409 mg/dL; range: 143-1045 mg/d L). Preoperative fibrinogen values correlated with age(P = 0.003), completeness of tumour resection, potentially curative vs palliative(P < 0.001), presence of systemic metastasis(P < 0.001), depth of tumour invasion p T(P < 0.001), nodes involvement p N(P = 0.001) and CEA serum level(P < 0.001). The mean fibrinogen value(± SD) was 395.6 ± 120.4 mg/d L in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours(P = 0.045). The overall survival and tumourrelated survival were significantly higher in patients with fibrinogen values ≤ 400 mg/d L(P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall(P = 0.313) or tumour-related survival(P = 0.355) after controlling for other risk factors in a multivariate analysis.CONCLUSION Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.展开更多
BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of...BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.展开更多
AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesen...AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection.METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter.RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved.CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.展开更多
Background:We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases(CRLMs)using the win ratio,a novel methodological approach.Methods:CRLM patients u...Background:We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases(CRLMs)using the win ratio,a novel methodological approach.Methods:CRLM patients undergoing curative-intent resection in 2001-2018 were identified from an international multi-institutional database.Patients were paired and matched based on age,number and size of lesions,lymph node status and receipt of preoperative chemotherapy.The win ratio was calculated based on margin status,severity of postoperative complications,90-day mortality,time to recurrence,and time to death.Results:Among 962 patients,the majority underwent open hepatectomy(n=832,86.5%),while a minority underwent laparoscopic hepatectomy(n=130,13.5%).Among matched patient-to-patient pairs,the odds of the patient undergoing laparoscopic resection“winning”were 1.77[WR:1.77,95%confidence interval(CI):1.42-2.34].The win ratio favored laparoscopic hepatectomy independent of low(WR:2.94,95%CI:1.20-6.39),medium(WR:1.56,95%CI:1.16-2.10)or high(WR:7.25,95%CI:1.13-32.0)tumor burden,as well as unilobar(WR:1.71,95%CI:1.25-2.31)or bilobar(WR:4.57,95%CI:2.36-8.64)disease.The odds of“winning”were particularly pronounced relative to short-term outcomes(i.e.,90-day mortality and severity of postoperative complications)(WR:4.06,95%CI:2.33-7.78).Conclusions:Patients undergoing laparoscopic hepatectomy had 77%increased odds of“winning”.Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients.展开更多
文摘The barcelona clinic liver cancer(BCLC)staging system has been approved as guidance for hepatocellular carcinoma(HCC)treatment guidelines by the main Western clinical liver associations.According to the BCLC classification,only patients with a small single HCC nodule without signs of portal hypertension or hyperbilirubinemia should undergo liver resection.In contrast,patients with intermediate-advanced HCC should be scheduled for palliative therapies,even if the lesion is resectable.Recent studies report good short-term and long-term outcomes in patients with intermediate-advanced HCC treated by liver resection.Therefore,this classification has been criticised because it excludes many patients who could benefit from curative resection.The aim of this review was to evaluate the role of surgery beyond the BCLC recommendations.Safe liver resection can be performed in patients with portal hypertension and well-compensated liver function with a 5-year survival rate of 50%.Surgery also offers good long-term result in selected patients with multiple or large HCCs with a reported 5-year survival rate of over 50%and 40%,respectively.Although macrovascular invasion is associated with a poor prognosis,liver resection provides better long-term results than palliative therapies or best supportive care.Recently,researchers have identified several genes whose altered expression influences the prognosis of patients with HCC.These genes may be useful for classifying the biological behaviour of different tumours.A revision of the BCLC classification should be introduced to provide the best treatment strategy and to ensure the best prognosis in patients with HCC.
文摘AIM:To analyze the outcome of hepatocellular car-cinoma(HCC)resection in cirrhosis patients,related to presence of portal hypertension(PH)and extent of hepatectomy.METHODS:A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection.RESULTS:PH was present in 44(32.5%)patients.Overall mortality and morbidity were 2.2% and 33.7%,respectively.Median survival time in patients with or without PH was 31.6 and 65.1 mo,respectively(P=0.047);in the subgroup with Child-Pugh class A cirrhosis,median survival was 65.1 mo and 60.5 mo,respectively(P=0.257).Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH.Conversely,median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo,respectively(P=0.035).CONCLUSION:PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients,but resection of 2 or more segments should not be recommended in patients with PH.
文摘Diffusion-weighted imaging(DWI), dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) and perfusion computed tomography(CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations.Nevertheless, the term "functional imaging" is commonly used to describe molecular imaging techniques, as positron emission tomography(PET)CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive "one-step" morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging,therefore these techniques could be used also for posttreatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart frommolecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations,prognostic stratification and post-treatment monitoring.
文摘Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection(SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot(1957) and Letton and Wilson(1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.
文摘AIM: This prospective study evaluated the effectiveness of 90 W argon plasma coagulation (APC) for the ablation of Barrett's esophagus (BE) that is considered to be the main risk factor for the development of esophageal adenocarcinoma.METHODS: The results from 25 patients, observed at the First Department of General Surgery, University of Verona, Italy, from October 2000 to October 2003, who underwent APC for histologically proven BE were prospectively analyzed.RESULTS: The ablation treatment was completed in all the patients but one (96%). The mean number of APC sessions needed to complete ablation was 1.6 (total number: 40). The eradication was obtained in the majority of cases by one session only (60%), two sessions were required in 24% of the cases and three or more in 16%.About 43% of the sessions were complicated. Retrosternal pain (22.5%) and fever (17.5%) were the most frequent symptoms. Only one major complication occurred, it was an hemorrhage due to ulcer formation on the treated esophagus that required urgent endoscopic sclerosis and admission. The follow-up was accomplished in all the patients with a mean period of 26.3 mo and 20 patients (84%) with a follow-up period longer than 24 mo. Only one patient showed a relapse of metaplastic mucosa 12 mo after the completion of ablation. The patient was hence re-treated and now is free from recurrence 33 mo later.CONCLUSION: High power setting (90 W) APC showed to be safe and effective. The effects persist at a mean follow-up period of two years with a comparable cost in term of complications with respect to standard power settings. Further studies with greater number of patients are required to confirm these results and to assess if ablation reduces the incidence of malignant progression.
文摘AIM To evaluate the clinical significance of the preoperative fibrinogen plasma level as a prognostic marker after surgery for colorectal cancer.METHODS This retrospective study analysed 652 patients undergoing surgery for stage Ⅰ-Ⅳ colorectal cancer between January 2005 and December 2012, at the Division of General Surgery A, University of Verona Hospital Trust, in whom preoperative fibrinogen plasma values were assessed at baseline. Fibrinogen is involved in tumourigenesis as well as tumour progression in several malignancies. Correlations between preoperative plasma fibrinogen values and clinicopathological characteristics were investigated. Univariate and multivariate survival analyses were performed to identify factors associated with overall and tumour-related survival.RESULTS Among the 652 patients, the fibrinogen value was higher than the threshold of 400 mg/dL in 345 patients(53%). The preoperative mean ± SD of fibrinogen was 426.2 ± 23.2 mg/dL(median: 409 mg/dL; range: 143-1045 mg/d L). Preoperative fibrinogen values correlated with age(P = 0.003), completeness of tumour resection, potentially curative vs palliative(P < 0.001), presence of systemic metastasis(P < 0.001), depth of tumour invasion p T(P < 0.001), nodes involvement p N(P = 0.001) and CEA serum level(P < 0.001). The mean fibrinogen value(± SD) was 395.6 ± 120.4 mg/d L in G1 tumours, 424.1 ± 121.4 mg/dL in G2 tumours and 453.4 ± 131.6 mg/dL in G3 tumours(P = 0.045). The overall survival and tumourrelated survival were significantly higher in patients with fibrinogen values ≤ 400 mg/d L(P < 0.001). However, hyperfibrinogenemia did not retain statistical significance regarding either overall(P = 0.313) or tumour-related survival(P = 0.355) after controlling for other risk factors in a multivariate analysis.CONCLUSION Preoperative fibrinogen levels correlate with cancer severity but do not help in predicting patient prognosis after colorectal cancer surgery.
文摘BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
文摘AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection.METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter.RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved.CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.
文摘Background:We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases(CRLMs)using the win ratio,a novel methodological approach.Methods:CRLM patients undergoing curative-intent resection in 2001-2018 were identified from an international multi-institutional database.Patients were paired and matched based on age,number and size of lesions,lymph node status and receipt of preoperative chemotherapy.The win ratio was calculated based on margin status,severity of postoperative complications,90-day mortality,time to recurrence,and time to death.Results:Among 962 patients,the majority underwent open hepatectomy(n=832,86.5%),while a minority underwent laparoscopic hepatectomy(n=130,13.5%).Among matched patient-to-patient pairs,the odds of the patient undergoing laparoscopic resection“winning”were 1.77[WR:1.77,95%confidence interval(CI):1.42-2.34].The win ratio favored laparoscopic hepatectomy independent of low(WR:2.94,95%CI:1.20-6.39),medium(WR:1.56,95%CI:1.16-2.10)or high(WR:7.25,95%CI:1.13-32.0)tumor burden,as well as unilobar(WR:1.71,95%CI:1.25-2.31)or bilobar(WR:4.57,95%CI:2.36-8.64)disease.The odds of“winning”were particularly pronounced relative to short-term outcomes(i.e.,90-day mortality and severity of postoperative complications)(WR:4.06,95%CI:2.33-7.78).Conclusions:Patients undergoing laparoscopic hepatectomy had 77%increased odds of“winning”.Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients.
