Minimally invasive versus open liver resection for hepatocellular carcinoma: a propensity score matching analysis of 224 patients.

PURPOSE: To compare the peri-operative and long-term survival outcomes of minimally invasive liver resection (MILR) (robotic or laparoscopic) with open liver resection (OLR) in patients with hepatocellular carcinoma (HCC). METHODS: Data of patients who underwent liver resection for HCC were reviewed from a prospectively collected database. Outcomes of MILR were compared with those of OLR. A propensity score matching analysis with a ratio of 1:1 was performed to minimise the potential bias in clinical pathological factors. RESULTS: From January 2003 to December 2017, a total of 705 patients underwent liver resection for HCC. Amongst them, 112 patients received MILR and 593 patients received OLR. After propensity score matching, there were 112 patients in each of the MILR and OLR groups. Patients were matched by age, sex, hepatitis status, presence of cirrhosis, platelet count, albumin level, bilirubin level, alkaline phosphatase (ALP) level, alanine transferase (ALT) level, creatinine level, tumour differentiation, tumour size, tumour number, presence of tumour rupture, presence of vascular invasion, extent of liver resection (minor/major) and difficulty score. The 1-, 3- and 5-year overall survival rates were 94.4%, 90.4% and 82.3% in the MILR group vs 95.4%, 80.5% and 71.8% in the open group (p = 0.240). The 1-, 3- and 5-year disease-free survival rates were 81.0%, 63.1% and 55.8% in the MILR group vs 79.1%, 58.1% and 45.7 in the open group (p = 0.449). The MILR group demonstrated significantly less blood loss (p < 0.001), less blood transfusion (p = 0.004), lower post-operative complications (p < 0.001) and shorter hospital stay (p < 0.001) when compared with the OLR group. CONCLUSIONS: Our data shows MILR yielded superior post-operative outcomes to OLR, with comparable survival outcomes.

Treatment-emergent central sleep apnoea managed by CPAP with adjunctive acetazolamide: A case report.

Treatment-emergent central sleep apnoea (TECSA) refers to the emergence of central apnoea during treatment for obstructive sleep apnoea (OSA), most commonly continuous positive airway pressure (CPAP). It has been reported in 8% of OSA patients treated with CPAP and spontaneous resolution rate varies between 60% and 80%. Management options include watchful waiting with continuation of CPAP, bi-level positive pressure ventilation, adaptive servo-ventilation and CPAP with supplemental oxygen. Acetazolamide has been shown to be effective in other forms of central sleep apnoea; its use as adjunct to CPAP in TECSA is sparsely reported. We report a 74-year-old man with severe OSA who developed moderate central apnoea upon CPAP initiation. Subsequent addition of acetazolamide led to gratifying resolution of the TECSA. In TECSA patients with significant symptoms and high central apnoea index, treatment with acetazolamide as adjunct to CPAP may be considered, particularly in patients in whom CPAP adherence is imperative.

Assessing the Validity of Transcutaneous Laryngeal Ultrasonography (TLUSG) After Thyroidectomy: What Factors Matter?

INTRODUCTION: Although transcutaneous laryngeal ultrasound (TLUSG) is an excellent, noninvasive way to assess vocal cord (VC) function after thyroidectomy, some patients simply have "un-assessable" or "inaccurate" examination. Our study evaluated what patient and surgical factors affected assessability and/or accuracy of postoperative TLUSG. METHODS: Five hundred eighty-one consecutive patients were analyzed. All TLUSGs were done by one operator using standardized technique, whereas direct laryngoscopies (DL) were done by an independent endoscopist to confirm TLUSG findings. Their findings were correlated. TLUSG was "unassessable" if ≥1 VC could not be clearly visualized, whereas it was "inaccurate" if the TLUSG and DL findings were discordant. Demographics, body habitus, neck anthropometry, and position of incision were correlated with assessability and accuracy of TLUSG. RESULTS: Twenty-nine (5.0 %) patients had "unassessable" VCs; among the "assessable" patients, 29 (5.3 %) patients had "inaccurate" TLUSG. More than one-third (38.5 %) of VC palsies (VCPs) were "inaccurate." Older age (odds ratio [OR] = 1.055, 95 % confidence interval [CI] 1.016-1.095, p = 0.005), male sex (OR = 13.657, 95 % CI 2.771-67.315, p = 0.001), taller height (OR = 1.098, 95 % CI 1.008-1.195, p = 0.032), and shorter distance from cricoid cartilage to incision (OR = 0.655, 95 % CI 0.461-0.932, p = 0.019) were independent factors for "unassessable" VCs, whereas older age (OR = 1.028, 95 % CI 1.001-1.056, p = 0.040) was the only factor of incorrect assessment. CONCLUSIONS: Older age, male sex, tall in height, and incision closer to the thyroid cartilage were independent contributing factors for unassessable VCs, whereas older age was the only contributing factor for inaccurate postoperative TLUSG. Because more than one-third of VCPs were actually normal, patients labeled as such on TLUSG would benefit from laryngoscopic validation.