Ajith Siriwardena

• Manchester University NHS Foundation Trust

Introduction The liver is the most frequent site of colorectal metastases. Approximately 20% of patients presents with synchronous metastases1. Lifetime incidence of liver metastases in colorectal cancer patients is 50%. Up to 70% of patients develop hepatic or extrahepatic recurrent disease, often within 2 years of initial presentation2–4. Surgica...

Background Splanchnic vein thrombosis (SpVT) occurs in 17%-23% of acute pancreatitis cases. Serious sequelae include hepatic and bowel ischaemia. However, management with therapeutic anticoagulation remains controversial due to potential bleeding risk. We aim to determine the level of consensus on prognosis, diagnosis, management, and outcomes of S...

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...

Background There has been a progressive increase in the use of percutaneous cholecystostomy (PC) in acute cholecystitis (AC) over the last decades due to population aging, and the support of guidelines (Tokyo Guidelines (TG), World Society of Emergency Surgery (WSES) Guidelines) as a valid therapeutical option. However, there are many unanswered qu...

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 an...

Introduction In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUS liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Mass...

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 patien...

Objective To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others. Summary background data Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and...

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...

Pancreas units represent new organizational models of care that are now at the center of the European debate. The PUECOF study, endorsed by the European–African Hepato-Pancreato-Biliary Association (E-AHPBA), aims to reach an expert consensus by enquiring surgical leaders about the Pancreas Units’ most relevant organizational factors, with 30 surgi...

Background 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 ho...

Objective The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Summary Background Data Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic...

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 metas...

The journal Artificial Intelligence Surgery was established to explore the integration of Artificial Intelligence (AI) in surgery. It originated from the desire to understand the potential of true robotic surgery, as existing robotic systems are tele-manipulators rather than autonomous robots. AI’s role in surgery involves levels of autonomy and a...

Background Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. Methods A modified Delphi approach was us...

Background Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. Methods This project was a multiorganiz...

Objective: To develop and update evidence- and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. Summary background data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guid...

Liver fibrosis is a major cause of death worldwide. As a progressive step in chronic liver disease, fibrosis is almost always diagnosed too late with limited treatment options. Here, we uncover the spatial transcriptional landscape driving human liver fibrosis using single nuclei RNA and Assay for Transposase-Accessible Chromatin (ATAC) sequencing...

Abstract Background Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. Methods This project was a mu...

Background: Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe. Methods: 61 European cente...

Objectives: Approximately 30% of patients present with locally advanced pancreatic cancer (LAPC). For these patients, systemic chemotherapy is the first line treatment option. It is often challenging to accurately assess response to treatment via radiological imaging. Nonetheless, if there is evidence of stable disease, which has not progressed fol...

Background: Irreversible electroporation (IRE) is a non-thermal form of ablation based on the delivery of pulsed electrical fields. It has been used to treat liver lesions, particularly those in proximity to major hepatic vasculature. The role of this technique in the portfolio of treatments for colorectal hepatic metastases has not been clearly d...

Purpose: The risk of postoperative venous thromboembolism (VTE) after liver resection is well recognized, however, the association between surgical approach and VTE risk remains unknown. The aim of this meta-analysis is to compare VTE rates following open (OLR) and minimally invasive (MILR) liver resection. Methods: On 22nd May 2022, MEDLINE, Web...

Purpose: The aim of this study was to investigate the role of 18F-fluorodexyglucose positron emission tomography (FDG-PET/TC) on oncological outcomes in patients submitted to PD for both pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (dCCA). Method: Patients who underwent intention to treat PD from January 2015 to December 2...

Purpose: Up to 30% of patients present with locally advanced pancreatic cancer (LAPC) and systemic chemotherapy is the main treatment. Radiological assessment of response is difficult and thus evidence of stable disease without progression following neoadjuvant chemotherapy is an indication trial dissection. However, resection is not always feasibl...

Introduction: Prehabilitation result in better short-term outcomes after major abdominal surgery. The benefit for patients undergoing pancreatoduodenectomy (PD) is less well established. The aim of this study was to investigate the role of the duration of prehabilitation on perioperative outcomes in patients undergoing PD at a high-volume UK centre...

Background: Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management.

Background Even though the risk of postoperative venous thromboembolism (VTE) after liver resection is well recognized, the association between surgical approach and VTE risk is unknown. This study aims to compare VTE rates following open liver resection (OLR) and minimally invasive liver resection (MILR). Methods MEDLINE, Web Of Sciences and EMBA...

Patients with colorectal cancer presenting with synchronous liver metastases have less favourable outcomes than those with primary-only disease. There is evidence of different genetic mutational signatures according to the sidedness of the primary tumour. KRAS mutations are key driver mutations in colorectal cancer progression. This post hoc analys...

This volume is dedicated to surgical diseases of the duodenum and small bowel. These organs command attention in their own right, something made possible by the comprehensive 6-volume publication of Gastrointestinal Surgery. The intimate relationship between the duodenum and pancreas means that some overlap with the volume on pancreatic diseases is...

Objectives: Splanchnic venous thrombosis (SpVT) is a complication of acute pancreatitis (AP). There is scarce literature on the prevalence and treatment of SpVT in AP. The aim of this international survey was to document current approaches to the management of SpVT in patients with AP. Methods: An online survey was designed by a group of interna...

Over the last two decades, there have been major advances in imaging, endoscopy, and laparoscopy in the field of gastrointestinal (GI) surgery. GI surgery is the newest super-specialty branch of general surgery where enhanced expertise and high-volume centres have made a difference to the outcomes of complex operations. Surgeons can now do difficul...

Objective: To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. Summary background data: Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure...

Background and aims: Advances in single cell technology have revolutionised our understanding of the liver, enabling genome-wide RNA-profiling of thousands of transcriptomes at single cell resolution. Recent studies utilising single cell RNA sequencing (scRNAseq) have characterised progenitor cell populations, uncovered gene expression zonation of...

Background Differentiating inflammation from bacterial infection in patients with acute pancreatitis can be difficult. Procalcitonin can distinguish infection from inflammation, and algorithms based on procalcitonin measurement can differentiate bacterial sepsis from a systemic inflammatory response. We aimed to test the hypothesis that a procalcit...

Abstract Background: This study provides aglobal overview of the managementofpatients withacutecholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVIDisaninternational, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management...

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on managemen...

Background: This study provides aglobal overview of the managementofpatients withacutecholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVIDisaninternational, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were coll...

Simple Summary This is a single centre cohort of patients undergoing surgery for PH-CCA suggests that routine staging laparoscopy may not be necessary in the pre-operative work-up. Abstract Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscop...

Background Contemporary management of colorectal cancer with synchronous liver metastases is complex. Although there is a large body of cohort data, there is no research exploring patient and clinician perspectives. This study explores the experiences and views of patients following treatment for colorectal cancer with synchronous liver metastases...

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic.

Introduction Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pan...

Background The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. Methods...

Background The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. Objective The present systematic review and meta-analysis aims to compare the efficacy of different analgesic modalities trialled in AP. Methods A systematic search of PubMed, MEDLINE, EMBASE, CENTRAL, SCOPUS and Web of Science conducted up until...

Background The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP. Methods A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines...

Background Pancreatic cancer is currently the fourth most common cause of cancer-related mortality in the economically developed world and is set to become the second most common cause of cancer-related mortality within the next few years. NICE guidance makes a strong recommendation to offer up-front surgery to people with resectable pancreatic can...

Background The present systematic review aimed to compare survival outcomes of invasive intraductal papillary mucinous neoplasms (IIPMNs) treated with adjuvant chemotherapy versus surgery alone and to identify pathologic features that may predict survival benefit from adjuvant chemotherapy. Methods A systematic search of Medline, Pubmed, Scopus, a...

Patients who were SARS-CoV- 2 positive were more likely to have idiopathic AP (34.7% vs 13.9%, p<0.001) with over five times increased risk after adjusting for age, smoking status, body mass index and ethnicity (OR: 5.34, p<0.001). Two patients developed DM and nine patients developed pancreatic exocrine insufficiency (PEI) in the SARS-CoV- 2 posit...

Background Multiple risk scores claim to predict the probability of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. However, it is unclear which scores have undergone external validation, and which score is the most accurate. Objective To identify risk scores for POPF, and assess the clinical validity of these scores. Methods...