JAIME ARTHUR PIROLA KRUGER
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
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- Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies(2023) COELHO, Fabricio Ferreira; HERMAN, Paulo; KRUGER, Jaime A. P.; WU, Andrew G. R.; CHIN, Ken-Min; HASEGAWA, Kiyoshi; ZHANG, Wanguang; ALZOUBI, Mohammad; AGHAYAN, Davit L.; SIOW, Tiing-Foong; SCATTON, Olivier; KINGHAM, T. Peter; V, Marco Marino; MAZZAFERRO, Vincenzo; CHIOW, Adrian K. H.; SUCANDY, Iswanto; IVANECZ, Arpad; CHOI, Sung Hoon; LEE, Jae Hoon; GASTACA, Mikel; VIVARELLI, Marco; GIULIANTE, Felice; RUZZENENTE, Andrea; YONG, Chee-Chien; DOKMAK, Safi; FONDEVILA, Constantino; EFANOV, Mikhail; MORISE, Zenichi; BENEDETTO, Fabrizio Di; BRUSTIA, Raffaele; VALLE, Raffaele Dalla; BOGGI, Ugo; GELLER, David; BELLI, Andrea; MEMEO, Riccardo; GRUTTADAURIA, Salvatore; MEJIA, Alejandro; PARK, James O.; ROTELLAR, Fernando; CHOI, Gi Hong; ROBLES-CAMPOS, Ricardo; WANG, Xiaoying; SUTCLIFFE, Robert P.; PRATSCHKE, Johann; LAI, Eric C. H.; CHONG, Charing C. N.; D'HONDT, Mathieu; MONDEN, Kazuteru; LOPEZ-BEN, Santiago; LIU, Rong; FERRERO, Alessandro; ETTORRE, Giuseppe Maria; CIPRIANI, Federica; CHERQUI, Daniel; LIANG, Xiao; SOUBRANE, Olivier; WAKABAYASHI, Go; TROISI, Roberto I.; YIN, Mengqiu; CHEUNG, Tan-To; SUGIOKA, Atsushi; HAN, Ho-Seong; LONG, Tran Cong Duy; FUKS, David; HILAL, Mohammad Abu; CHEN, Kuo-Hsin; ALDRIGHETTI, Luca; EDWIN, Bjorn; GOH, Brian K. P.Background: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes. Methods: This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed. Results: The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hy-pertension, and 170 did not.After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay. Conclusion: Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies. & COPY; 2023 Elsevier Inc. All rights reserved.
- Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis(2020) DUARTE, Vinicius Campos; COELHO, Fabricio Ferreira; VALVERDE, Alain; DANOUSSOU, Divia; KRUGER, Jaime Arthur Pirola; ZUBER, Kevin; FONSECA, Gilton Marques; JEISMANN, Vagner Birk; HERMAN, Paulo; LUPINACCI, Renato MicelliBackground Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle's maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.
- Laparoscopic liver resection: Experience based guidelines(2016) COELHO, Fabricio Ferreira; KRUGER, Jaime Arthur Pirola; FONSECA, Gilton Marques; ARAUJO, Raphael Leonardo Cunha; JEISMANN, Vagner Birk; PERINI, Marcos Vinicius; LUPINACCI, Renato Micelli; CECCONELLO, Ivan; HERMAN, PauloLaparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.