Publications by authors named "Ajith K Siriwardena"
Introduction: The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. This study appraises the recommendations made by national/international guidelines for the diagnosis and management of patients with synchronous liver metastases from colorectal cancer.
Methods: A systematic review of national and international guidelines published between 2011 and 2024 was carried out using PubMed, OvidSP and Guidelines International Network databases.
Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis.
HPB (Oxford)
November 2024
Background: Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.
Methods: A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023).
Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study.
Ann Surg
October 2024
Objective: To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD).
Summary Background Data: In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system.
Methods: This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States.
Article Synopsis
- The use of percutaneous cholecystostomy (PC) for treating acute cholecystitis (AC) has increased due to an aging population and supportive guidelines, prompting a need for clearer management protocols.
- An international consensus was developed through a two-round Delphi survey with 27 questions, and participants aimed for a minimum 70% agreement on the management of PCs.
- Out of these, six key recommendations were established, including the timing of PC implementation and the need for cholangiography before PC removal, highlighting the necessity for comprehensive guidelines on PC management in AC patients.
Background: Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.
Objective: This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.
Methods: This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up.
Interobserver Variability in the International Study Group for Pancreatic Surgery (ISGPS)-Defined Complications After Pancreatoduodenectomy: An International Cross-Sectional Multicenter Study.
Ann Surg
November 2024
Objective: To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others.
Background: Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking.
Introduction: Pancreatic neuroendocrine tumors (pNET) exhibit a wide spectrum of clinical behavior, which makes their assessment and management quite challenging. The purpose of this study was to comprehensively assess the existing treatment landscape for patients with pNET.
Materials And Methods: The study was conducted with the support of the ESSO-EYSAC Research Academy in collaboration with the E-AHPBA.
Objective: The ISGPS aims to develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally-invasive pancreatoduodenectomy (MIPD).
Background: Despite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis towards appropriate patient selection according to adequate surgeon and center experience.
Benefits and barriers to accreditation of HPB center and fellowship programs in Europe: a strength-weakness-opportunity-and-threats (SWOT) analysis by an E-AHPBA-ESSO-UEMS ad hoc working committee.
HPB (Oxford)
October 2024
Article Synopsis
- Training in HPB surgery is inconsistent across regions under the E-AHPBA, leading to discussions about the future of accreditation for centers and fellowship programs.
- A mixed-methods study was conducted to gather responses from stakeholders, focusing on identifying strengths, weaknesses, opportunities, and threats (SWOT) related to the accreditation process.
- The findings highlight both positive and negative aspects affecting HPB accreditation and suggest that while formal accreditation isn't currently feasible, there's strong interest in developing a structured system for HPB training that should influence future strategic planning.
Minimally invasive pancreatoduodenectomy is associated with a higher incidence of postoperative venous thromboembolism when compared to the open approach: A systematic review and meta-analysis.
Eur J Surg Oncol
July 2024
Background: Despite the increased use of minimally invasive approaches for pancreatoduodenectomy (PD), the association between surgical approach and venous thromboembolism (VTE) risk is still unknown. This study aims to compare VTE rates following open (OPD) and minimally invasive pancreatoduodenectomy (MIPD).
Method: MEDLINE, Web of Sciences and EMBASE databases were searched to identify eligible studies.
Article Synopsis
- The PUECOF study seeks expert consensus on the best organizational practices for Pancreas Units, involving 30 surgical leaders across 14 countries in a Delphi survey.
- *Surgeons emphasize the importance of multidisciplinary meetings, leadership development, and measurable outcomes, while viewing clinical professionals and patients as key stakeholders.
- *Although the technical aspects of pancreatic surgery will remain unchanged, Pancreas Units could enhance surgeons' workflows, professional growth, and collaborative opportunities, ultimately improving patient outcomes.
Background: A large proportion of patients with colorectal cancer (CRC) presents with synchronous colorectal liver metastases (sCRLM) at diagnosis. Surgical approaches for patients with sCRLM have evolved over the past decades. Simultaneous resection (SR) of CRC and sCRLM for selected patients has emerged as a safe and efficient alternative approach to traditional staged resections.
View Article and Find Full Text PDFBackground: The effect of analgesic modalities on short-term outcomes in acute pancreatitis remains unknown. However, preclinical models have raised safety concerns regarding opioid use in patients with acute pancreatitis.
Objective: This study aimed to assess the association between analgesics, particularly opioids, and severity and mortality in hospitalised patients with acute pancreatitis.
Background: The management of acute necrotizing pancreatitis (ANP) has changed dramatically over the past 20 years including the use of less invasive techniques, the timing of interventions, nutritional management, and antimicrobial management. This study sought to create a core outcome set (COS) to help shape future research by establishing a minimal set of essential outcomes that will facilitate future comparisons and pooling of data while minimizing reporting bias.
Methods: A modified Delphi process was performed through involvement of ANP content experts.
Article Synopsis
- There is currently no standardized training pathway for hepato-pancreato-biliary (HPB) surgery in Europe, prompting a study to assess fellowship training from the perspectives of both fellows and institutions.!* -
- The research involved a web-based survey of 37 fellows and 13 program directors across 32 programs in 13 European countries, revealing that fellowship duration typically spans one to two years and that a significant portion of programs are funded.!* -
- Findings showed considerable variability in the number of surgeries performed by fellows, with a low rate of minimally invasive procedures, indicating a need for greater standardization in the clinical training curriculum for HPB surgery across Europe.!*
Background: Evidence on the value of minimally invasive pancreatic surgery (MIPS) has been increasing but it is unclear how this has influenced the view of pancreatic surgeons on MIPS.
Methods: An anonymous survey was sent to members of eight international Hepato-Pancreato-Biliary Associations. Outcomes were compared with the 2016 international survey.
Background: Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer.
Methods: A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted.