Keno Mentor - Academia.edu (original) (raw)
Papers by Keno Mentor
The researchers wish to thank the following individuals and groups for their invaluable contribut... more The researchers wish to thank the following individuals and groups for their invaluable contribution to this study:
World Journal of Surgery, 2020
The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This met... more The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), ch...
South African Gastroenterology Review, 2016
Pancreaticoduodectomy (PD) is considered one of the most complex procedures within general surger... more Pancreaticoduodectomy (PD) is considered one of the most complex procedures within general surgery and is performed for benign and malignant conditions of the pancreas and peri-ampullary region. Of the three anastomoses involved in reconstruction of the gastrointestinal tract after PD, namely gastro- orduodeno-enteric, bilio-enteric and pancreatico-enteric, the latter has the highest risk of failure and results in significant morbidity and mortality, principally due to septic and vascular complications. Distal pancreatectomy (DP) has historically been perceived as a less extensive and uncomplicated procedure, but today is recognized as having a similar risk profile as PD, predominantly due to post-resectional pancreatic leakage. The risk of death following pancreatic surgery is doubled in patients who develop a pancreatic leak or fistula.
Cancer Immunology Research, 2018
In colorectal liver metastasis, liver-resident NK cells are depleted from the tumor microenvironm... more In colorectal liver metastasis, liver-resident NK cells are depleted from the tumor microenvironment. NK-cell apoptosis is induced by metabolic changes resulting from tumor-derived lactate. Targeting tumor metabolism represents a promising therapeutic avenue to restore liver NK-cell activity. Colorectal cancer is the third most common malignancy worldwide, with 1.3 million new cases annually. Metastasis to the liver is a leading cause of mortality in these patients. In human liver, metastatic cancer cells must evade populations of liver-resident natural killer (NK) cells with potent cytotoxic capabilities. Here, we investigated how these tumors evade liver NK-cell surveillance. Tissue biopsies were obtained from patients undergoing resection of colorectal liver metastasis (CRLM, n = 18), from the tumor, adjacent tissue, and distal resection margin. The number and phenotype of liver-resident NK cells, at each site, were analyzed by flow cytometry. Tumor-conditioned media (TCM) was ge...
Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. T... more Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. Topical haemostatic agents are frequently used to control bleeding during hepatectomy, with multiple products currently available. However, it remains unknown which of these is most effective for achieving haemostasis and improving peri-operative outcomes. A systematic review and random-effects Bayesian network meta-analysis of randomised trials investigating topical haemostatic agents in hepatic resection was performed. Interventions were analysed by grouping into similar products; fibrin patch, fibrin glue, collagen products, and control. Primary outcomes were the rate of haemostasis at 4 and 10 min. Twenty randomized controlled trials were included in the network meta-analysis, including a total of 3267 patients and 7 different interventions. Fibrin glue and fibrin patch were the most effective interventions for achieving haemostasis at both 4 and 10 min. There were no significant diff...
World Journal of Surgery
Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer ope... more Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age ...
American Journal of Transplantation, Dec 28, 2018
Each month, the American Journal of Transplantation will feature Images in Transplantation, a jou... more Each month, the American Journal of Transplantation will feature Images in Transplantation, a journal-based CME activity, chosen to educate participants on current developments in the science and imaging of transplantation. Participants can earn one AMA PRA Category 1 Credit ™ per article at their own pace. This month's feature article is titled: "Establishing portal inflow with diffuse splanchnic venous thrombosis and previous liver transplantation in a patient with JAK 2 mutation." Accreditation and Designation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of John Wiley & Sons, Inc., the American Society of Transplant Surgeons, and the American Society of Transplantation. John Wiley & Sons, Inc. is accredited by the ACCME to provide continuing medical education for physicians, and fulfills the requirements for the American Board of Surgery (ABS) for Maintenance of Certification (MOC). John Wiley & Sons, Inc. designates this journal-based CME activity for a maximum of one AMA PRA Category 1 Credit ™. Physicians should claim credit only commensurate with the extent of their participation in the activity. Statement of Need Portal vein thrombosis (PVT) is a problem not infrequently seen in patients undergoing liver transplantation (LT). There are a number of well-established surgical strategies in practice today to deal with this when encountered. The long-term consequences of some of these strategies, however, are not well described, particularly in the setting of a need for retransplantation. Purpose of Activity This activity seeks to highlight the complexities involved in planning the surgical and perioperative management of a subgroup of patients requiring repeat LT who previously underwent complex surgical strategies for the management of diffuse PVT. Identification of Practice Gap Diffuse (grade 4) PVT was, until recently, considered a contraindication to LT. These patients require a modified surgical strategy that significantly alters the venous physiology and results in postoperative complications that could require further medical management. Additionally, when the underlying pathology causes a hypercoagulable state, anticoagulation therapy in the short-and long-term postoperative period needs to be carefully considered. Not all physicians and surgeons are familiar with recent long-term data showing that outcomes after utilizing these techniques are comparable to those of standard LT. Also, the complex clinical decision-making process when retransplantation is required in this setting is not described in the literature. This activity describes the multidisciplinary decision-making process employed in the management of these patients. The expected complications and rationale for long-term anticoagulation are also outlined. Learning Objectives Upon completion of this educational activity, participants will be able to: • Describe the fundamental principles of techniques of systemic venous inflow into the liver graft. • Apply the evidence for the utilization of these techniques in patient selection. • Compare the potential complications of these techniques to that of standard LT. • Rationalize anticoagulation therapy in the postoperative management of these patients. Target Audience This activity is intended for surgeons and physicians who work with patients who are considered for LT. Disclosures No commercial support has been accepted related to the development or publication of this activity. John Wiley & Sons, Inc. has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.
The researchers wish to thank the following individuals and groups for their invaluable contribut... more The researchers wish to thank the following individuals and groups for their invaluable contribution to this study:
World Journal of Surgery, 2020
The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This met... more The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), ch...
South African Gastroenterology Review, 2016
Pancreaticoduodectomy (PD) is considered one of the most complex procedures within general surger... more Pancreaticoduodectomy (PD) is considered one of the most complex procedures within general surgery and is performed for benign and malignant conditions of the pancreas and peri-ampullary region. Of the three anastomoses involved in reconstruction of the gastrointestinal tract after PD, namely gastro- orduodeno-enteric, bilio-enteric and pancreatico-enteric, the latter has the highest risk of failure and results in significant morbidity and mortality, principally due to septic and vascular complications. Distal pancreatectomy (DP) has historically been perceived as a less extensive and uncomplicated procedure, but today is recognized as having a similar risk profile as PD, predominantly due to post-resectional pancreatic leakage. The risk of death following pancreatic surgery is doubled in patients who develop a pancreatic leak or fistula.
Cancer Immunology Research, 2018
In colorectal liver metastasis, liver-resident NK cells are depleted from the tumor microenvironm... more In colorectal liver metastasis, liver-resident NK cells are depleted from the tumor microenvironment. NK-cell apoptosis is induced by metabolic changes resulting from tumor-derived lactate. Targeting tumor metabolism represents a promising therapeutic avenue to restore liver NK-cell activity. Colorectal cancer is the third most common malignancy worldwide, with 1.3 million new cases annually. Metastasis to the liver is a leading cause of mortality in these patients. In human liver, metastatic cancer cells must evade populations of liver-resident natural killer (NK) cells with potent cytotoxic capabilities. Here, we investigated how these tumors evade liver NK-cell surveillance. Tissue biopsies were obtained from patients undergoing resection of colorectal liver metastasis (CRLM, n = 18), from the tumor, adjacent tissue, and distal resection margin. The number and phenotype of liver-resident NK cells, at each site, were analyzed by flow cytometry. Tumor-conditioned media (TCM) was ge...
Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. T... more Hepatic resection carries a high risk of parenchymal bleeding both intra- and post-operatively. Topical haemostatic agents are frequently used to control bleeding during hepatectomy, with multiple products currently available. However, it remains unknown which of these is most effective for achieving haemostasis and improving peri-operative outcomes. A systematic review and random-effects Bayesian network meta-analysis of randomised trials investigating topical haemostatic agents in hepatic resection was performed. Interventions were analysed by grouping into similar products; fibrin patch, fibrin glue, collagen products, and control. Primary outcomes were the rate of haemostasis at 4 and 10 min. Twenty randomized controlled trials were included in the network meta-analysis, including a total of 3267 patients and 7 different interventions. Fibrin glue and fibrin patch were the most effective interventions for achieving haemostasis at both 4 and 10 min. There were no significant diff...
World Journal of Surgery
Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer ope... more Background Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms. Methods The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management. Results The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age ...
American Journal of Transplantation, Dec 28, 2018
Each month, the American Journal of Transplantation will feature Images in Transplantation, a jou... more Each month, the American Journal of Transplantation will feature Images in Transplantation, a journal-based CME activity, chosen to educate participants on current developments in the science and imaging of transplantation. Participants can earn one AMA PRA Category 1 Credit ™ per article at their own pace. This month's feature article is titled: "Establishing portal inflow with diffuse splanchnic venous thrombosis and previous liver transplantation in a patient with JAK 2 mutation." Accreditation and Designation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of John Wiley & Sons, Inc., the American Society of Transplant Surgeons, and the American Society of Transplantation. John Wiley & Sons, Inc. is accredited by the ACCME to provide continuing medical education for physicians, and fulfills the requirements for the American Board of Surgery (ABS) for Maintenance of Certification (MOC). John Wiley & Sons, Inc. designates this journal-based CME activity for a maximum of one AMA PRA Category 1 Credit ™. Physicians should claim credit only commensurate with the extent of their participation in the activity. Statement of Need Portal vein thrombosis (PVT) is a problem not infrequently seen in patients undergoing liver transplantation (LT). There are a number of well-established surgical strategies in practice today to deal with this when encountered. The long-term consequences of some of these strategies, however, are not well described, particularly in the setting of a need for retransplantation. Purpose of Activity This activity seeks to highlight the complexities involved in planning the surgical and perioperative management of a subgroup of patients requiring repeat LT who previously underwent complex surgical strategies for the management of diffuse PVT. Identification of Practice Gap Diffuse (grade 4) PVT was, until recently, considered a contraindication to LT. These patients require a modified surgical strategy that significantly alters the venous physiology and results in postoperative complications that could require further medical management. Additionally, when the underlying pathology causes a hypercoagulable state, anticoagulation therapy in the short-and long-term postoperative period needs to be carefully considered. Not all physicians and surgeons are familiar with recent long-term data showing that outcomes after utilizing these techniques are comparable to those of standard LT. Also, the complex clinical decision-making process when retransplantation is required in this setting is not described in the literature. This activity describes the multidisciplinary decision-making process employed in the management of these patients. The expected complications and rationale for long-term anticoagulation are also outlined. Learning Objectives Upon completion of this educational activity, participants will be able to: • Describe the fundamental principles of techniques of systemic venous inflow into the liver graft. • Apply the evidence for the utilization of these techniques in patient selection. • Compare the potential complications of these techniques to that of standard LT. • Rationalize anticoagulation therapy in the postoperative management of these patients. Target Audience This activity is intended for surgeons and physicians who work with patients who are considered for LT. Disclosures No commercial support has been accepted related to the development or publication of this activity. John Wiley & Sons, Inc. has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.