Evaluating surgeon attitudes towards the safety and efficacy of portal vein occlusion and associating liver partition and portal vein ligation: a report of the MALINSA survey

Day, Ryan; Conrad, Claudius; Vauthey, Jean‐Nicolas; Aloia, Thomas A.

doi:10.1111/hpb.12439

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…Insufficient PVE capability could potentially explain why ALPPS is being performed at some centers, and this has been suggested in a recent study. 32 Similarly, despite published reports of 80-100% of patients with CRLM receiving neoadjuvant chemotherapy, 5 34% of ALPPS surgeons surveyed did not routinely recommend neoadjuvant chemotherapy for CRLM. Furthermore, a quarter of the surgeons surveyed would operate even in the context of tumour progression after neoadjuvant chemotherapy, despite published evidence to the contrary.…”

Section: Discussionmentioning

confidence: 99%

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

Buac

Schadde

Schnitzbauer³

et al. 2016

HPB

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Background: ALPPS was developed to induce accelerated future liver remnant (FLR) hypertrophy in order to increase hepatic tumour resectability and reduce the risk of post-operative liver failure. While early studies demonstrated concerning complication rates, others reported favourable results. This inconsistency may be due to variability in surgical indications and technique. Methods: A web-based survey was sent to surgeons participating in the International ALPPS Registry in September of 2014. Questions addressed surgeon demographics and training, surgical indications and technique, and clinical management approaches.Results: Fifty six out of 85 surgeons from 78 centers responded (66%) and half (n = 30) had training in liver transplantation. Forty seven (84%) did not reserve ALPPS solely for colorectal liver metastases (CRLM) and 30 (54%) would perform ALPPS for an FLR over 30%. Neoadjuvant chemotherapy for CRLM was recommended by 37 (66%) respondents. Surgical approaches varied considerably, with 30% not preserving outflow to the middle hepatic vein and 39% believing it necessary to skeletonize the hepatoduodenal ligament. Twenty five (45%) surgeons have observed segment 4 necrosis. Conclusion:There is considerable variability in how ALPPS is performed internationally. This heterogeneity in practice patterns may explain the current incongruity in published outcomes, and highlights the need for standardization.

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Section: Discussionmentioning

confidence: 99%

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

Buac

Schadde

Schnitzbauer³

et al. 2016

HPB

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“…When surgeons face patient complaints, accusations can be dealt with in a peaceful state of mind and with an optimistic attitude to solve the problem [68]. Second, awareness training can reduce the pressure surgeons place on themselves, which can enable surgeons to discover their inner sense of time-pressure, release their dissatisfaction, maintain a peaceful mindset, and improve their sense of professional interest and reduce job burnout at work, so as to help them to develop a more positive, healthy attitude to work and improve their perceptions of and attitudes towards stressful events [69]. In addition, training improves subjects' communication skills, which, in turn, enhances teamwork among healthcare professionals and facilitates the formation of supportive relationships among team members.…”

Section: Fam Improves Safety Attitudesmentioning

confidence: 99%

Focused-Attention Meditation Improves Flow, Communication Skills, and Safety Attitudes of Surgeons

Chen

Liu

Zhou

et al. 2022

IJERPH

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Objective: Patient safety is a worldwide problem and a focus of academic research. Human factors and ergonomics (HFE) is an approach to improving healthcare work systems and processes. From the perspective of the cognitive ergonomics of HFE, the aim of this study is to improve the flow level, communication skills, and safety attitudes of surgeons through focused-attention meditation (FAM) training, thus helping to reduce adverse clinical events. Methods: In total, 140 surgeons were recruited from three hospitals in China and randomly divided into two groups (FAM group and control group). The FAM group received 8 weeks of FAM training, while the control group was on the waiting list and did not receive any interventions. Three scales (WOLF, LCSAS, and SAQ-C) were used to measure the data of three variables (flow, communication skills, and safety attitude), respectively, at two times, before and after the intervention (pre-test and post-test). The incidence of adverse events during the intervention was also collected for both groups. Results: The ANOVA results showed that all three variables had a significant main effect of time and significant interactions between time and group. The independent-sample T-test results showed that the incidence of adverse events during the intervention was significantly lower in the FAM group than in the control group. Conclusions: The intervention of FAM could significantly improve surgeons’ flow levels, communication skills, and safety attitudes, potentially helping to reduce adverse clinical events.

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“…Institutions with the capability to perform RPVE + 4 had statistically significant higher ratings for both likelihood of technical success and likelihood of subsequent hypertrophy as compared to those without in a multicenter survey of surgical preferences 72 . Possible benefits include improved hypertrophy of segments 2 + 3, embolization of the entire tumor bearing liver, and the reduction of potentially challenging surgical resections in the setting segment 4 hypertrophy 69,70 .…”

Section: Pve Techniquementioning

confidence: 97%

Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale, techniques, outcomes and future directions

Madoff

2016

Cancer Biology & Medicine

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The ability to modulate the future liver remnant (FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization (PVE), associating liver partition and portal vein ligation (ALPPS), and the recently reported transhepatic liver venous deprivation (LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.

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Evaluating surgeon attitudes towards the safety and efficacy of portal vein occlusion and associating liver partition and portal vein ligation: a report of the MALINSA survey

Cited by 6 publications

References 14 publications

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

The many faces of ALPPS: surgical indications and techniques among surgeons collaborating in the international registry

Focused-Attention Meditation Improves Flow, Communication Skills, and Safety Attitudes of Surgeons

Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale, techniques, outcomes and future directions

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