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Peng Q, Li L, Yang J, Tao K, Zhao X, Wang L, Jiang X. Assessing the Impact of Multidisciplinary Team (MDT) Care on Patients with Liver Cancer/Cirrhosis: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2025; 54:240-251. [PMID: 40225244 PMCID: PMC11992913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 12/18/2024] [Indexed: 04/15/2025]
Abstract
Background Liver cancer and cirrhosis are significant public health challenges with a high global burden. Multidisciplinary Team (MDT) care has gained recognition as a promising approach to improve the management and outcomes of patients with liver cancer and cirrhosis. We aimed to evaluate the effectiveness of MDT care in improving the clinical outcomes, including survival rates, quality of life, and disease progression, in patients with liver cancer and cirrhosis. Methods The search was performed using the keywords of liver cancer and MDT and their combinations in international databases with a time limit for publishing articles from 2010 and 2023. The data were evaluated using a technique of meta-analysis as well as a model called random effects. The I2 test was used to examine the degree of heterogeneity between the studies. STATA was used to analyze the data. Results The analysis of 13 different papers with a total sample size of 8641 individuals revealed that the average scores of the MDT and liver cancer were identical to (0.64), with a confidence interval ranging from (95% 48.5-81.7). Conclusion MDT is effective in the length of treatment and reduction of risk and mortality rates. The negative prognostic factors of not following the MDT decision were not observed.
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Affiliation(s)
- Qin Peng
- Department of Hepatobiliary Pancreatic Splenic Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Lin Li
- Department of Hepatobiliary Pancreatic Splenic Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Jing Yang
- Department of Neonatal Intensive Care Unit, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kaishan Tao
- Department of Hepatobiliary Pancreatic Splenic Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Xian Zhao
- Department of Hepatobiliary Pancreatic Splenic Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Lin Wang
- Department of Hepatobiliary Pancreatic Splenic Surgery, the First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Xiaosong Jiang
- Department of Oncology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Shin JG, Nahmias J, Silver E, Painter R, Sedighim S, Park F, Grigorian A. Evaluating predictors of mortality in octogenarians undergoing urgent or emergent trauma laparotomy. Eur J Trauma Emerg Surg 2024; 50:3311-3317. [PMID: 39414632 PMCID: PMC11666771 DOI: 10.1007/s00068-024-02635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 08/06/2024] [Indexed: 10/18/2024]
Abstract
PURPOSE This study aimed to identify associated risk factors for mortality in octogenarian trauma patients undergoing urgent or emergent laparotomy (UEL). METHODS Trauma patients ages 80-89 years-old undergoing UEL within 6-hours of arrival were included. A multivariable logistic regression analysis was performed to determine associated risk of mortality. RESULTS From 701 octogenarians undergoing UEL, 324 (46.2%) died. Compared to survivors, UEL octogenarians who died had higher rates of cirrhosis (3.5% vs. 1.1%, p = 0.028), injuries to the brain (17.3% vs. 5.6%, p < 0.001), heart (8.6% vs. 1.6%, p < 0.001), and lung (57.4% vs. 23.9%, p < 0.001) and lower rates of functional independence (6.4% vs. 12.6%, p = 0.007). The strongest independent associated patient-related risk factor for death was cirrhosis (OR 8.28, CI 2.25-30.46, p = 0.001). However, undergoing concurrent thoracotomy increased risk of death significantly (OR 16.59, CI 2.07-132.76, p = 0.008). Functional independence was not associated with mortality (p > 0.05). CONCLUSION This national analysis emphasizes the need to identify and manage pre-existing conditions like cirrhosis and not determine futility based on pre-trauma functional status alone. Concurrent thoracotomy for hemorrhage control increases risk of death over 16-fold.
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Affiliation(s)
- Jordan G Shin
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Elliot Silver
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Robert Painter
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Shaina Sedighim
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Flora Park
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, CA, USA.
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, USA.
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Aerts M, Rosseel Z, De Waele E. The Evolution in Non-Alcoholic Fatty Liver Disease Patients' Profile and the Associated Sustainable Challenges: A Multidisciplinary Perspective. Nutrients 2024; 16:1584. [PMID: 38892517 PMCID: PMC11174485 DOI: 10.3390/nu16111584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
The prevalence and incidence of NAFLD is rising due to the obesity pandemic, caused by the widespread availability of ultra-processed foods and the decrease of physical activity. Factors such as socioeconomic status (SES), ethnicity and geographical location are associated with NAFLD, with lower SES correlating with higher incidence, particularly in regions like America or Europe. Beside the quality of food, the quantity also plays a crucial role. The World Health Organization (WHO) recommends a Mediterranean diet with a balanced energy intake. Since no hard medical treatment is available for NAFLD, lifestyle adjustments are key. Patient empowerment by providing relevant information and co-ownership of the therapy will increase the implementation rate and enhance the quality of medical follow-up and medication adherence, as studies report a good adherence to medication among patients who are well-aware of the severity of their disease. Regarding sustainability, patients with NAFLD have a high load of ambulatory follow-up, which, since the COVID-19 pandemic, can be partially provided by teleconsulting. Both patients' lifestyle modifications and healthcare practitioners' therapeutical strategy can decrease the carbon footprint.
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Affiliation(s)
- Maridi Aerts
- Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium;
| | - Zenzi Rosseel
- Department of Pharmacy, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium
- Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium;
| | - Elisabeth De Waele
- Department of Clinical Nutrition, Universitair Ziekenhuis Brussel (UZB), 1090 Brussels, Belgium;
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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Sohal A, Chaudhry H, Dukovic D, Kowdley KV. Outcomes among patients with hepatorenal syndrome based on hospital teaching and transplant status: Analysis of 159 845 hospitalizations. JGH Open 2023; 7:848-854. [PMID: 38162842 PMCID: PMC10757492 DOI: 10.1002/jgh3.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease. This study aimed to examine the impact of hospital teaching/transplant status and availability of liver transplantation on survival among hospitalized patients with HRS in the United States. Methods Patients with HRS were identified from the national inpatient sample 2016-2019. Information was collected regarding patient demographics, hospital characteristics, liver disease etiology, presence of liver disease decompensations, Elixhauser comorbidities, and interventions. Patients were classified as being treated at three hospital groups: non-teaching hospitals (NTHs), teaching non-transplant centers (TNTCs), and teaching transplant centers (TTCs). The relationship between hospital teaching/transplant status and in-hospital mortality and transplant-free mortality was examined using multivariable linear and logistic regression analysis. Results A total of 159,845 patients met the criteria for HRS. Of these, 24% were admitted to NTHs, 50.8% to TNTCs, and 25.2% to TTCs. Admission to a TTC was independently associated with a lower mortality risk compared to admission to non-TTCs (aOR = 0.75, 95% CI: 0.68-0.83, P <0.001). Patients at TTCs had a lower transplant-free mortality risk than those at NTHs (aOR = 0.75, 95% CI: 0.67-0.83, P < 0.001). There was no significant difference in all-cause or transplant-free mortality between TNTCs and NTHs. Conclusion Patients with HRS admitted to TTCs have higher disease severity, but significantly improved outcomes compared to those admitted to NTHs. These data suggest opportunities for increased disease awareness and education among NTHs and support early referral for liver transplant evaluation among hospitalized patients with HRS.
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Affiliation(s)
- Aalam Sohal
- Department of HepatologyLiver Institute NorthwestSeattleWashingtonUSA
| | - Hunza Chaudhry
- Department of Internal MedicineUniversity of CaliforniaFresnoCaliforniaUSA
| | - Dino Dukovic
- Department of MedicineRoss University School of MedicineMiramarFloridaUSA
| | - Kris V. Kowdley
- Department of HepatologyLiver Institute NorthwestSeattleWashingtonUSA
- Department of Medicine, Elson S. Floyd College of MedicineWashington State UniversityPullmanWashingtonUSA
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Lin J, Huang S, Wang J, Cai Z. Multidisciplinary collaboration for the successful treatment of a giant hepatic solitary fibrous tumor protruding into the thorax: A case report. Exp Ther Med 2022; 24:461. [PMID: 35747158 PMCID: PMC9204529 DOI: 10.3892/etm.2022.11388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Solitary fibrous tumors (SFTs) are composed of spindle cells and collagen fibers, and these form rare mesenchymal tumors. SFTs are most frequently observed in intrathoracic sites; however, they may also occur in extrathoracic sites, such as the liver. Unlike the hepatic SFTs (HSFTs) reported in the literature, the SFT detailed in the present case report was a large tumor that originated from the liver, with a dumbbell-shaped growth through the diaphragm into the right thoracic cavity. This posed substantial challenges in both diagnosis and treatment. Thus, the present report outlines the findings of a multidisciplinary team meeting that was used to discuss and develop an optimal and personalized treatment strategy for the patient. Transhepatic arterial embolization was performed to block the major arterial blood supply to the tumor in order to reduce its size. Subsequently, the tumor was fully resected, following the collaboration of the experienced hepatobiliary and thoracic surgeons. Following surgery, the abdominal distension experienced by the patient ceased, and no tumor recurrence was detected at the 1-year follow-up. In conclusion, due to limited previous reports of HSFT treatment using multidisciplinary collaboration, the present study outlined the treatment used for this specific tumor type, and the corresponding literature was reviewed.
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Affiliation(s)
- Jiajun Lin
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Shenfeng Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Jinfei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Zhifang Cai
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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