Should We Be Utilizing More Liver Grafts From Pediatric Donation After Circulatory Death Donors? A National Analysis of the SRTR from 2002 to 2017.

Background: Rates of withdrawal of life-sustaining treatment are higher among critically ill pediatric patients compared to adults. Therefore, livers from pediatric donation after circulatory death (pDCD) could improve graft organ shortage and waiting time for listed patients. As knowledge on the utilization of pDCD is limited, this study used US national registry data (2002-2017) to estimate the prognostic impact of pDCD in both adult and pediatric liver transplant (LT).

Atypical Clinical Presentation of a Newer Generation Anti-Fungal Drug-Resistant Fusarium Infection After a Modified Multi-Visceral Transplant.

BACKGROUND Fusarium spp. infections have become an emerging and lethal threat to the immunocompromised patient population, especially those with neutropenia. Recently there have been increased reports in solid organ transplant recipients.

Patterns of cancer recurrence in localized resected hepatocellular carcinoma.

Background: Tumor resection in non-metastatic hepatocellular carcinoma (HCC) patients with adequate liver reserve offers a potential cure, but has a high 5-year recurrence rate. We analyzed the patterns of cancer relapse after partial hepatectomy to guide post-operative management.

Methods: A total of 144 HCC patients (1996-2011) after partial hepatectomy were reviewed.

Safety and efficacy of sorafenib for the treatment of recurrent hepatocellular carcinoma after liver transplantation.

Introduction: Recurrent hepatocellular carcinoma (HCC) following liver transplantation (LT) carries a poor prognosis. The aim of our study was to assess the safety and efficacy of sorafenib in patients with recurrent HCC following LT.

Methods: A prospectively maintained LT database was retrospectively analyzed for patients with recurrent HCC following LT between 2001 and 2011-34 patients.

Complementary use of resection and radiofrequency ablation for the treatment of colorectal liver metastases: an analysis of 395 patients.

Background: Liver resection and radiofrequency ablation (RFA) are two surgical options in the treatment of patients with colorectal liver metastases (CLM). The aim of this study was to analyze patient characteristics and outcomes after resection and RFA for CLM from a single center.

Methods: Between 2000 and 2010, 395 patients with CLM undergoing RFA (n = 295), liver resection (n = 94) or both (n = 6) were identified from a prospective IRB-approved database.

Multicentre results of stereotactic body radiotherapy for secondary liver tumours.

Background: Surgical resection is the standard treatment for liver metastases, although for the majority of patients this is not possible. Stereotactic body radiotherapy (SBRT) is an alternative local-regional therapy. The purpose of this study was to evaluate the results of SBRT for secondary liver tumours from a combined multicentre database.

Radiologic-histological correlation of hepatocellular carcinoma treated via pre-liver transplant locoregional therapies.

Background: Locoregional therapies (LRTs) are treatments to achieve local control of hepatocellular carcinoma (HCC). Correlation between radiologic response to LRT and degree of induced tumor necrosis is not well understood. The aim of this study was to evaluate different levels of radiologic response after pre-liver transplant (LT) LRT and its correlation with percentage of tumor necrosis on explanted histopathology.

Risk of infection and hernia recurrence for patients undergoing ventral hernia repair with non-absorbable or biological mesh during open bowel procedures.

Background: Ventral hernia repair (VHR) with mesh performed concurrently with colorectal surgery is presumably associated with significant risks of infection and recurrence. The purpose of this study is to evaluate the outcomes of patients undergoing VHR with non-absorbable mesh (NAM) or biological mesh (BM) at the same time as open colorectal surgery.

Methods: A retrospective review of short- and long-term outcomes for 25 patients undergoing repair of VHR with NAM or BM at the same time as an open colorectal procedure from 1991 to 2007 was performed.

The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: risk of infection and recurrence.

Background/objective: The aim was to evaluate the risk of infection and hernia recurrence for patients undergoing repair of ventral hernia (VH) with prosthetic mesh during colorectal resection.

Methods: A retrospective review was performed of long-term outcomes for 40 patients who underwent mesh repair for VH during bowel resection between 2000 and 2007. Patients with recurrence (R) were compared with others (NR) and univariate and multivariate analysis of factors associated with recurrence and infection were determined.

Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis.

Objectives: Liver transplantation (LT) in Milan Criteria (MC) hepatocellular carcinoma (HCC) has excellent outcomes. Pre-transplant loco-regional therapy (LRT) has been used to downstage HCC to meet the MC. However, its benefit in patients with a brief waiting time to transplant remains unclear.

Overlapping sphincter repair: does age matter?

Background: The predictors of the outcomes following anal sphincteroplasty have not been well documented.

Objective: The aim was to evaluate age as a predictor of functional outcome and quality of life after overlapping sphincter repair.

Design: This study is a retrospective review of chart review followed by a prospective evaluation by the use of validated questionnaires.

Multicenter results of stereotactic body radiotherapy (SBRT) for non-resectable primary liver tumors.

Background: An excess of 100 000 individuals are diagnosed with primary liver tumors every year in USA but less than 20% of those patients are amenable to definitive surgical management due to advanced local disease or comorbidities. Local therapies to arrest tumor growth have limited response and have shown no improvement on patient survival. Stereotactic body radiotherapy (SBRT) has emerged as an alternative local ablative therapy.

Biological immunomodulators improve the healing rate in surgically treated perianal Crohn's fistulas.

Aim: The role of biological therapy in perianal fistulas associated with Crohn's disease (CD) is uncertain as available data are confused and conflicting. In order to provide some clarity to the issue we have examined a large cohort of patients with perianal fistulas and CD and stratified them according to use of biological agents.

Method: Patients with perianal Crohn's fistulas treated between June 1999 and June 2009 were stratified according to use of biological agents and outcome was examined.

Serum vascular endothelial growth factor level in patients with hepatocellular carcinoma undergoing liver transplantation: experience of a single Western center.

Background: The strongest predictor of tumor relapse after liver transplantation for hepatocellular carcinoma (HCC) is vascular invasion, appreciated only on explant analysis. High serum level of vascular endothelial growth factor (VEGF) is associated with worse outcomes after resection or locoregional therapies but its role in liver transplantation remains undefined.

Objective: We report the first western prospective study exploring serum VEGF in HCC liver transplant patients, correlating pre-operative serum VEGF with poor prognostic histologic features during explant analysis.

Surgeons should not hesitate to perform episioproctotomy for rectovaginal fistula secondary to cryptoglandular or obstetrical origin.

Background: Closure of rectoanovaginal fistula from a cryptoglandular or obstetrical origin can be difficult. Multiple techniques exist and none are perfect. Although episioproctotomy offers the advantage of a simultaneous repair of the sphincter complex, it is a more extensive procedure.

Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program.

Background: The goal of this study was to compare surgical site infection (SSI) rates between laparoscopic (LAP) and open colorectal surgery using the National Surgical Quality Improvement Program (NSQIP) database.

Study Design: We identified patients included in the NSQIP database from 2006 to 2007 who underwent LAP and open colorectal surgery. SSI rates were compared for the 2 groups.

Obstetric and cryptoglandular rectovaginal fistulas: long-term surgical outcome; quality of life; and sexual function.

Purpose: Rectovaginal fistula (RVF) repair can be challenging. Additionally, women may experience sexual dysfunction and psychosocial ramifications even after a successful repair. The aim of this study was to investigate variables looking for predictors of healing/failure and examine long-term quality-of-life (QOL) and sexual function in women with low RVF from obstetrical or cryptoglandular etiology

Methods: From June 1997-2009, 268 women underwent RVF repair.

Analysis of function and predictors of failure in women undergoing repair of Crohn's related rectovaginal fistula.

Purpose: Crohn's-related rectovaginal fistulae have significant impact on quality of life including sexual function. The aim of this study was to obtain long-term follow-up of Crohn's related rectovaginal fistulae to assess variables that influence surgical success and determine its effects on quality of life and sexual function.

Methods: All women with Crohn's-related rectovaginal fistulas who underwent surgical repair from 1997 to 2007 were contacted for long-term follow-up.

Risk of clinical leak after laparoscopic versus open bowel anastomosis.

Purpose: This study was designed to investigate the safety of laparoscopic (Lap) colorectal surgery as reflected by the anastomotic bowel leak (ABL) rate compared with that seen in open surgery.

Methods: Between 2000 and 2007, 1,516 consecutive patients undergoing Lap-colorectal surgery with bowel anastomosis were covariate-adjusted to 3,258 patients undergoing open surgery by pathology and site of anastomosis using the institutional review board-approved laparoscopic, diverticular, Crohn's, and colorectal cancer databases. Of these patients, 643 patients in each group were equally matched by pathology, site of anastomosis, date of surgery, age, gender, and body mass index.

Liver transplantation at Cleveland Clinic.

This review describes our program and its outcomes and then provides an in-depth focuses into many of the unique aspects of our practice that have been important to the success of the program. These include a global appreciation for the impact and various presentations of chronic portal hypertension. We have sought to better understand and describe the various effects it can have on local allograft hemodynamics and graft survival.

Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection.

Purpose: Perineal wound complications have a significant impact on postoperative morbidity after excision of the rectum and anus. The aim of this study is to evaluate factors affecting perineal wound complications after primary closure of the wound following abdominoperineal resection.

Methods: Data were reviewed from all patients who underwent abdominoperineal resection for rectal carcinoma between 1982 and 2007.

Influence of age at ileoanal pouch creation on long-term changes in functional outcomes.

Aim: We reviewed the functional results and quality of life (QOL) of patients who had had an ileoanal pouch (IPAA) for at least 15 years.

Method: Retrospective analysis was undertaken of data accrued prospectively into a pouch database since 1983. Patients who had retained an IPAA for at least 15 years were identified.

Does a laparoscopic approach affect the number of lymph nodes harvested during curative surgery for colorectal cancer?

Background: This study aimed to assess the number of lymph nodes (LNs) harvested after laparoscopic and open colorectal cancer resections.

Methods: Between 1996 and 2007, 431 colorectal cancer patients underwent laparoscopic resection. During the periods of 1996-1997, 2002-2003, and 2006-2007, 243 patients undergoing laparoscopic colorectal cancer resection were matched 1-2 by age, operation, gender, operation date, body mass index (BMI), and tumor stage (TNM) to 486 patients undergoing open surgery.