1
|
Zhang W, Liu J, Li P, Wang X, Tang B. Reversible Fluorescent Probes for Dynamic Imaging of Liver Ischemia-Reperfusion Injury. Acc Chem Res 2024; 57:2594-2605. [PMID: 39164205 DOI: 10.1021/acs.accounts.4c00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
ConspectusHepatic ischemia-reperfusion injury (HIRI) is an inevitable complication of clinical surgeries such as liver resection or transplantation, often resulting in postoperative liver dysfunction, hepatic failure in up to 13% of postresection patients, and early graft failure in 11-18% of liver transplantation patients. HIRI involves a series of biochemical events triggered by abnormal alterations in multiple biomarkers, characterized by short lifespans, dynamic changes, subcellular regional distribution, and multicollaborative regulation. However, traditional diagnosis, including serology, imaging, and liver puncture biopsy, suffers from low sensitivity, poor resolution, and hysteresis, which hinder effective monitoring of HIRI markers. Thus, to address the unique properties of HIRI markers, there is a pressing demand for developing novel detection strategies that are highly selective, transiently responsive, dynamically reversible, subcellular organelle-targeted, and capable of simultaneous multicomponent analysis.Optical probe-based fluorescence imaging is a powerful tool for real-time monitoring of biomarkers with the advantages of high sensitivity, noninvasiveness, rapid analysis, and high-fidelity acquisition of spatiotemporal information on signaling molecules compared with conventional methods. Moreover, with the growing demand for continuous monitoring of biomarkers, probes with reversible detection features are receiving more and more attention. Importantly, reversible probes can not only monitor fluctuations in marker concentrations but also distinguish between transient bursts of markers during physiological events and long-term sustained increases in pathological marker levels. This can effectively avoid false-positive test results, and in addition, reversible probes can be reutilized with green and economical features. Therefore, our team has employed various effective methods to design reversible optical probes for HIRI. We proposed reversible recognition strategies based on specific reactions or interactions to detect dynamic changes in markers. Given the biomarkers' unique signaling in subcellular organelles and the synergistic regulatory properties of multiple markers for HIRI, bifunctional reversible detection strategies are exploited, including organelle-targeted reversible and multicomponent simultaneous detection. With these strategies, we have tailored a variety of high-fidelity fluorescent probes for a series of HIRI markers, including reactive oxygen/nitrogen species (O2•- and ONOO-), ATP, protein (Keap1), mitochondrial DNA, etc. Utilizing the probes, the in situ dynamic imaging detection of the HIRI markers was successfully achieved. While performing the precise examination of the earlier occurrence of HIRI disease and visualizing the real-time monitoring of the disease process, we have also further elucidated the HIRI-associated signaling pathways. It is envisioned that our summarized work will inspire the design of future reversible fluorescent probes and help to improve the clinical diagnosis and therapeutic efficiency of these diseases.
Collapse
Affiliation(s)
- Wen Zhang
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, Shandong, People's Republic of China
| | - Jihong Liu
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, Shandong, People's Republic of China
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Feringa Nobel Prize Scientist Joint Research Center, Institute of Fine Chemicals, Frontiers Science Center for Materiobiology and Dynamic Chemistry, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai 200237, People's Republic of China
| | - Ping Li
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, Shandong, People's Republic of China
- College of Chemistry and Chemical Engineering, Northwest Normal University, Lanzhou 730070, People's Republic China
| | - Xin Wang
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, Shandong, People's Republic of China
| | - Bo Tang
- College of Chemistry, Chemical Engineering and Materials Science, Collaborative Innovation Center of Functionalized Probes for Chemical Imaging in Universities of Shandong, Key Laboratory of Molecular and Nano Probes, Ministry of Education, Institutes of Biomedical Sciences, Shandong Normal University, Jinan 250014, Shandong, People's Republic of China
- Laoshan Laboratory, Qingdao 266237, Shandong, People's Republic of China
| |
Collapse
|
2
|
Davis ES, Seda P, Kolodziej DT, Villa AT, Feng L, DiGioia O, Nayyar A, Jehan FS, Aziz H. The Association Between Low Preoperative Phosphate Levels and Postliver Surgery Outcomes-A Single Center Experience. J Surg Res 2024; 299:145-150. [PMID: 38759329 DOI: 10.1016/j.jss.2024.04.027] [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: 11/20/2023] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Previous research has demonstrated the impact of postoperative phosphate levels on liver regeneration and outcomes after liver resection surgeries, a potential predictor for regenerative success and liver failure. However, little is known about the association between low preoperative serum phosphate levels and outcomes in liver resections. METHODS We performed a retrospective analysis of liver resections performed at our institution. Patients were categorized based on preoperative phosphate levels (low versus normal). Our primary outcome measure was posthepatectomy liver failure. RESULTS A total of 265 cases met the study criteria. 71 patients (26.7%) had low preoperative phosphate levels. The incidence of posthepatectomy liver failure was higher in the low preoperative phosphate group (19.2% versus 12.4%). However, after propensity score matching, rates of posthepatectomy liver failure were similar between low and normal preoperative phosphate cohorts (13% versus 14%, P = 0.83). CONCLUSIONS Low preoperative phosphate levels were not associated with worse postoperative outcomes in this study. Further studies are warranted to investigate this association and its relevance as a clinical prognostic factor for postoperative liver failure.
Collapse
Affiliation(s)
- Erik S Davis
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Peyton Seda
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Aneli T Villa
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Lawrence Feng
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Olivia DiGioia
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Apoorve Nayyar
- Division of Transplant and Hepatobiliary Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Faisal S Jehan
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Hassan Aziz
- Division of Transplant and Hepatobiliary Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| |
Collapse
|
3
|
Azoulay D, Desterke C, Bhangui P, Serrablo A, De Martin E, Cauchy F, Salloum C, Allard MA, Golse N, Vibert E, Sa Cunha A, Cherqui D, Adam R, Saliba F, Ichai P, Feray C, Scatton O, Lim C. Rescue Liver Transplantation for Posthepatectomy Liver Failure: A Systematic Review and Survey of an International Experience. Transplantation 2024; 108:947-957. [PMID: 37749790 DOI: 10.1097/tp.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Rescue liver transplantation (LT) is the only life-saving option for posthepatectomy liver failure (PHLF) whenever it is deemed as irreversible and likely to be fatal. The goals were to perform a qualitative systematic review of rescue LT for PHLF and a survey among various international LT experts. METHODS A literature search was performed from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Population, Intervention, Comparison, Outcome framework, and to this, the authors' experience was added. The international online open survey included 6 cases of PHLF extracted from the literature and submitted to 976 LT experts. The primary outcome was whether experts would consider rescue LT for each case. Interrater agreement among experts was calculated using the free-marginal multirater kappa methodology. RESULTS The review included 40 patients. Post-LT mortality occurred in 8 (20%) cases (7/28 with proven cancer and 1/12 with benign disease). In the long term, 6 of 21 (28.6%) survivors with cancer died of recurrence (median = 38 mo) and 15 (71.4%) were alive with no recurrence (median = 111 mo). All 11 survivors with benign disease were alive and well (median = 39 mo). In the international survey among experts in LT, the percentage agreement to consider rescue LT was 28%-98%, higher for benign than for malignant disease ( P = 0.011). Interrater agreement for the primary endpoint was low, expected 5-y survival >50% being the strongest independent predictor to consider LT. CONCLUSIONS Rescue LT for PHLF may achieve good results in selected patients. Considerable inconsistencies of decision-making exist among LT experts when considering LT for PHLF.
Collapse
Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Christophe Desterke
- University of Medicine Paris Saclay, Le Kremlin-Bicêtre, France
- INSERM Unit UMR1310, Villejuif, France
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Eleonora De Martin
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - François Cauchy
- Department of Hepato-biliary and Pancreatic Surgery and Liver Transplantation, University of Geneva, Geneva, Switzerland
| | - Chady Salloum
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Marc Antoine Allard
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Nicolas Golse
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Philippe Ichai
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Cyrille Feray
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Olivier Scatton
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
- Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Chetana Lim
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
| |
Collapse
|
4
|
Bozkurt E, Sijberden JP, Kasai M, Abu Hilal M. Efficacy and perioperative safety of different future liver remnant modulation techniques: a systematic review and network meta-analysis. HPB (Oxford) 2024; 26:465-475. [PMID: 38245490 DOI: 10.1016/j.hpb.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND In daily clinical practice, different future liver remnant (FLR) modulation techniques are increasingly used to allow a liver resection in patients with insufficient FLR volume. This systematic review and network meta-analysis aims to compare the efficacy and perioperative safety of portal vein ligation (PVL), portal vein embolization (PVE), liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). METHODS A literature search for studies comparing liver resections following different FLR modulation techniques was performed in MEDLINE, Embase and Cochrane Central, and pairwise and network meta-analyses were conducted. RESULTS Overall, 23 studies comprising 1557 patients were included. LVD achieved the greatest increase in FLR (17.32 %, 95% CI 2.49-32.15), while ALPPS was most effective in preventing dropout before the completion hepatectomy (OR 0.29, 95% CI 0.15-0.55). PVL tended to be associated with a longer time to completion hepatectomy (MD 5.78 days, 95% CI -0.67-12.23). Liver failure occurred less frequently after LVD, compared to PVE (OR 0.35, 95% CI 0.14-0.87) and ALPPS (OR 0.28, 95% CI 0.09-0.85). DISCUSSION ALPPS and LVD seem superior to PVE and PVL in terms of achieved FLR increase and subsequent treatment completion. LVD was associated with lower rates of post hepatectomy liver failure, compared to both PVE and ALPPS. A summary of the protocol has been prospectively registered in the PROSPERO database (CRD42022321474).
Collapse
Affiliation(s)
- Emre Bozkurt
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul, Turkey
| | - Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Hyogo, Japan
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| |
Collapse
|
5
|
Merath K, Tiwari A, Court C, Parikh A, Dillhoff M, Cloyd J, Ejaz A, Pawlik TM. Postoperative Liver Failure: Definitions, Risk factors, Prediction Models and Prevention Strategies. J Gastrointest Surg 2023; 27:2640-2649. [PMID: 37783906 DOI: 10.1007/s11605-023-05834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Liver resection is the treatment for a variety of benign and malignant conditions. Despite advances in preoperative selection, surgical technique, and perioperative management, post hepatectomy liver failure (PHLF) is still a leading cause of morbidity and mortality following liver resection. METHODS A review of the literature was performed utilizing MEDLINE/PubMed and Web of Science databases in May of 2023. The MESH terms "liver failure," "liver insufficiency," and "hepatic failure" in combination with "liver surgery," "liver resection," and "hepatectomy" were searched in the title and/or abstract. The references of relevant articles were reviewed to identify additional eligible publications. RESULTS PHLF can have devastating physiological consequences. In general, risk factors can be categorized as patient-related, primary liver function-related, or perioperative factors. Currently, no effective treatment options are available and the management of PHLF is largely supportive. Therefore, identifying risk factors and preventative strategies for PHLF is paramount. Ensuring an adequate future liver remnant is important to mitigate risk of PHLF. Dynamic liver function tests provide more objective assessment of liver function based on the metabolic capacity of the liver and have the advantage of easy administration, low cost, and easy reproducibility. CONCLUSION Given the absence of randomized data specifically related to the management of PHLF, current strategies are based on the principles of management of acute liver failure from any cause. In addition, goal-directed therapy for organ dysfunction, as well as identification and treatment of reversible factors in the postoperative period are critical.
Collapse
Affiliation(s)
- Katiuscha Merath
- Division of Surgical Oncology, University of Texas Health Science Center San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Ankur Tiwari
- Division of Surgical Oncology, University of Texas Health Science Center San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Colin Court
- Division of Surgical Oncology, University of Texas Health Science Center San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Alexander Parikh
- Division of Surgical Oncology, University of Texas Health Science Center San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA.
| |
Collapse
|
6
|
Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D’Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, Stättner S. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg 2023; 110:1331-1347. [PMID: 37572099 PMCID: PMC10480040 DOI: 10.1093/bjs/znad233] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
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 used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
Collapse
Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian E Oberkofler
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bobby V M Dasari
- Department of Hepatobiliary–pancreatic and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK
| | - Jan Heil
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rafael Diaz-Nieto
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Adam E Frampton
- Hepatopancreatobiliary Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dominik Geisel
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amelia J Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mickaël Lesurtel
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Damian Mole
- Hepatopancreatobiliary Surgery Unit, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Robert Öllinger
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Stockmann
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille University, Lille, France
- CANTHER Laboratory ‘Cancer Heterogeneity, Plasticity and Resistance to Therapies’ UMR-S1277, Team ‘Mucins, Cancer and Drug Resistance’, Lille, France
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Kortrijk, Belgium
| | - Michelle L DeOliveira
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, the Netherlands
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris Centre Hopital Cochin, Paris, France
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Hassan Malik
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuh N Rahbari
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Georg Göbel
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| |
Collapse
|
7
|
Shi C, Zhang Z, Xu R, Zhang Y, Wang Z. Contribution of HIF-1α/BNIP3-mediated autophagy to lipid accumulation during irinotecan-induced liver injury. Sci Rep 2023; 13:6528. [PMID: 37085612 PMCID: PMC10121580 DOI: 10.1038/s41598-023-33848-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/19/2023] [Indexed: 04/23/2023] Open
Abstract
Irinotecan is a topoisomerase I inhibitor which has been widely used to combat several solid tumors, whereas irinotecan therapy can induce liver injury. Liver injury generally leads to tissue hypoxia, and hypoxia-inducible factor-1α (HIF-1α), a pivotal transcription factor, mediates adaptive pathophysiological responses to lower oxygen condition. Previous studies have reported a relationship between HIF-1α and autophagy, and autophagy impairment is a common characteristic in a variety of diseases. Here, irinotecan (50 mg/kg) was employed on mice, and HepG2 and L-02 cells were cultured with irinotecan (10, 20 and 40 μM). In vivo study, we found that irinotecan treatment increased final liver index, serum aminotransferase level and hepatic lipid accumulation. Impaired autophagic flux and activation of HIF-1α/BNIP3 pathway were also demonstrated in the liver of irinotecan-treated mice. Moreover, irinotecan treatment significantly deteriorated hepatic oxidative stress, evidenced by increased MDA and ROS contents, as well as decreased GSH-Px, SOD and CAT contents. Interestingly, protein levels of NLRP3, cleaved-caspase 1 and IL-1β were enhanced in the liver of mice injected with irinotecan. In vitro study, irinotecan-treated HepG2 and L-02 cells also showed impaired autophagic flux, while HIF-1α inhibition efficaciously removed the accumulated autophagosomes induced by irinotecan. Additionally, irinotecan treatment aggravated lipid accumulation in HepG2 and L-02 cells, and HIF-1α inhibition reversed the effect of irinotecan. Furthermore, HIF-1α inhibition weakened irinotecan-induced NLRP3 inflammasome activation in HepG2 cells. Taken together, our results suggest that irinotecan induces liver injury by orchestrating autophagy via HIF-1α/BNIP3 pathway, and HIF-1α inhibition could alleviate irinotecan-induced lipid accumulation in HepG2 and L-02 cells, which will provide a new clue and direction for the prevention of side effects of clinical chemotherapy drugs.
Collapse
Affiliation(s)
- Congjian Shi
- Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, College of Life Sciences, Fujian Normal University, No.8, Shangsan Road, Fuzhou, 350007, China
| | - Zhenghong Zhang
- Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, College of Life Sciences, Fujian Normal University, No.8, Shangsan Road, Fuzhou, 350007, China
| | - Renfeng Xu
- Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, College of Life Sciences, Fujian Normal University, No.8, Shangsan Road, Fuzhou, 350007, China
| | - Yan Zhang
- Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, College of Life Sciences, Fujian Normal University, No.8, Shangsan Road, Fuzhou, 350007, China
| | - Zhengchao Wang
- Provincial Key Laboratory for Developmental Biology and Neurosciences, Key Laboratory of Optoelectronic Science and Technology for Medicine of Ministry of Education, College of Life Sciences, Fujian Normal University, No.8, Shangsan Road, Fuzhou, 350007, China.
| |
Collapse
|
8
|
van Keulen AM, Büttner S, Erdmann JI, Hagendoorn J, Hoogwater FJH, IJzermans JNM, Neumann UP, Polak WG, De Jonge J, Olthof PB, Koerkamp BG. Major complications and mortality after resection of intrahepatic cholangiocarcinoma: A systematic review and meta-analysis. Surgery 2023; 173:973-982. [PMID: 36577599 DOI: 10.1016/j.surg.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evaluation of morbidity and mortality after hepatic resection often lacks stratification by extent of resection or diagnosis. Although a liver resection for different indications may have technical similarities, postoperative outcomes differ. The aim of this systematic review and meta-analysis was to determine the risk of major complications and mortality after resection of intrahepatic cholangiocarcinoma. METHODS Meta-analysis was performed to assess postoperative mortality (in-hospital, 30-, and 90-day) and major complications (Clavien-Dindo grade ≥III). RESULTS A total of 32 studies that reported on 19,503 patients were included. Pooled in-hospital, 30-day, and 90-day mortality were 5.9% (95% confidence interval 4.1-8.4); 4.6% (95% confidence interval 4.0-5.2); and 6.1% (95% confidence interval 5.0-7.3), respectively. Pooled proportion of major complications was 22.2% (95% confidence interval 17.7-27.5) for all resections. The pooled 90-day mortality was 3.1% (95% confidence interval 1.8-5.2) for a minor resection, 7.4% (95% confidence interval 5.9-9.3) for all major resections, and 11.4% (95% confidence interval 6.9-18.7) for extended resections (P = .001). Major complications were 38.8% (95% confidence interval 29.5-49) after a major hepatectomy compared to 11.3% (95% confidence interval 5.0-24.0) after a minor hepatectomy (P = .001). Asian studies had a pooled 90-day mortality of 4.4% (95% confidence interval 3.3-5.9) compared to 6.8% (95% confidence interval 5.6-8.2) for Western studies (P = .02). Cohorts with patients included before 2000 had a pooled 90-day mortality of 5.9% (95% confidence interval 4.8-7.3) compared to 6.8% (95% confidence interval 5.1-9.1) after 2000 (P = .44). CONCLUSION When informing patients or comparing outcomes across hospitals, postoperative mortality rates after liver resection should be reported for 90-days with consideration of the diagnosis and the extent of liver resection.
Collapse
Affiliation(s)
| | - Stefan Büttner
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam University Medical Center, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, Regional Academic Cancer Center Utrecht, the Netherlands
| | - Frederik J H Hoogwater
- Department of Surgery, section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ulf P Neumann
- Department of Surgery, Maastricht University Medical Center, the Netherlands
| | - Wojciech G Polak
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Jeroen De Jonge
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pim B Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| |
Collapse
|
9
|
Riauka R, Ignatavicius P, Barauskas G. Hypophosphatemia as a prognostic tool for post-hepatectomy liver failure: A systematic review. World J Gastrointest Surg 2023; 15:249-257. [PMID: 36896296 PMCID: PMC9988637 DOI: 10.4240/wjgs.v15.i2.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/01/2022] [Accepted: 11/29/2022] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection. Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.
AIM To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.
METHODS This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. PubMed, Cochrane and Lippincott Williams & Wilkins databases were systematically searched up to March 31, 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF, overall postoperative morbidity and liver regeneration. The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.
RESULTS After final assessment, nine studies (eight retrospective and one prospective cohort study) with 1677 patients were included in the systematic review. All selected studies scored ≥ 6 points according to the Newcastle-Ottawa Scale. Cutoff values of hypophosphatemia varied from < 1 mg/dL to ≤ 2.5 mg/dL in selected studies with ≤ 2.5 mg/dL being the most used defining value. Five studies analyzed PHLF, while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia. Only two of the selected studies analyzed postoperative liver regeneration, with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia. In three studies hypophosphatemia was associated with better postoperative outcomes, while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.
CONCLUSION Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection. However, routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.
Collapse
Affiliation(s)
- Romualdas Riauka
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania
| | - Giedrius Barauskas
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania
| |
Collapse
|
10
|
Ding C, Jia J, Han L, Zhou W, Liu Z, Bai G, Wang Q. Developing and validating a nomogram based on skeletal muscle index and clinical scoring system for prediction of liver failure after hepatectomy. Front Oncol 2023; 13:1036921. [PMID: 36741004 PMCID: PMC9893412 DOI: 10.3389/fonc.2023.1036921] [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: 09/05/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Background and objectives Hepatectomy is the preferred treatment for patients with liver tumors. Post-hepatectomy liver failure (PHLF) remains one of the most fatal postoperative complications. We aim to explore the risk factors of PHLF and create a nomogram for early prediction of PHLF. Methods We retrospectively analyzed patients undergoing hepatectomy at the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University between 2015 and 2022, and the patients were divided into training and internal validation cohorts at an 8:2 ratio randomly. The patients undergoing liver resection from the Affiliated Huaian Hospital of Xuzhou Medical University worked as external validation. Then, a nomogram was developed which was based on multivariate analyses to calculate the risk of PHLF. The area under the ROC curve (AUROC) and Hosmer -Lemeshow test was used to evaluate the prediction effect of the model. Results A total of 421 eligible patients were included in our study. Four preoperative variables were identified after multivariate analysis as follows, ASA (American Society of Anesthesiologists) score, Child-Pugh score, SMI (Skeletal muscle index), and MELD (Model for end-stage liver disease) score as independent predictors of PHLF. The area under the ROC curve of the predictive model in the training, internal, and external validation cohorts were 0.89, 0.82, and 0.89. Hosmer -Lemeshow P values in the training, internal, and external validation cohorts were 0.91, 0.22, and 0.15. The Calibration curve confirmed that our nomogram prediction results were in accurate agreement with the actual occurrence of PHLF. Conclusion We construct a nomogram to predict the grade B/C PHLF of ISGLS (International Study Group of Liver Surgery) in patients who underwent hepatic resection based on risk factors. This tool can provide a visual and accurate preoperative prediction of the grade B/C PHLF and guide the next step of clinical decision-making.
Collapse
Affiliation(s)
- Cong Ding
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Jianye Jia
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Lei Han
- Department of Radiology, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Wei Zhou
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ziyan Liu
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Genji Bai
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China,*Correspondence: Genji Bai,
| | - Qian Wang
- Department of Radiology, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| |
Collapse
|
11
|
Primavesi F, Stättner S, Maglione M. European guidelines for assessment of liver function before hepatectomy. Br J Surg 2023; 110:166-168. [PMID: 36423075 DOI: 10.1093/bjs/znac383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Florian Primavesi
- Department of General, Visceral and Vascular Surgery, Salzkammergut Hospital, Vöcklabruck, Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Hospital, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Centre of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
12
|
Predictors of Liver Failure in Non-Cirrhotic Patients Undergoing Hepatectomy. World J Surg 2022; 46:3081-3089. [PMID: 36209339 DOI: 10.1007/s00268-022-06742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) is associated with high mortality following liver resection. There have been limited studies evaluating predictors of PHLF and clinically significant PHLF in non-cirrhotic patients. METHODS This was a retrospective cohort study using the National Surgical Quality Improvement Program database (NSQIP) to evaluate 8,093 non-cirrhotic patients undergoing hepatectomy from 2014 to 2018. Primary endpoints were PHLF and clinically significant PHLF (PHLF grade B or C). RESULTS Among all patients, 4.74% (n = 383) developed PHLF and 2.5% clinically significant PHLF (n = 203). The overall 30-day mortality was 1.35% (n = 109), 11.5% (n = 44) in patients with PHLF, and 19.2% in those with clinically significant PHLF. Factors associated with PHLF were: metastatic liver disease (OR = 1.84, CI = 1.14-2.98), trisectionectomy (OR = 3.71, CI = 2.59-5.32), right total lobectomy (OR = 4.17, CI = 3.06-5.68), transfusions (OR = 1.99, CI = 1.52-2.62), organ/space SSI (OR = 2.84, CI = 2.02-3.98), post-operative pneumonia (OR = 2.43, CI = 1.57-3.76), sepsis (OR = 2.27, CI = 1.47-3.51), and septic shock (OR = 5.67, CI = 3.43-9.36). Patients who developed PHLF or clinically significant PHLF had 2-threefold increased risk of perioperative mortality. Post-hepatectomy renal failure (OR = 8.47, CI = 3.96-18.1), older age (OR = 1.04, CI = 1.014-1.063), male sex (OR = 1.83, CI = 1.07-3.14), sepsis (OR = 2.96, CI = 1.22-7.2), and septic shock (OR = 3.92, CI = 1.61-9.58) were independently associated with 30-mortality in patients with clinically significant PHLF. CONCLUSION PHLF in non-cirrhotic patients increased the risk of perioperative mortality and is associated with the extent of hepatectomy and infectious complications. Careful evaluation of the liver remnant, antibiotic prophylaxis, nutritional assessment, and timely management of post-operative infections could decrease major morbidity and mortality following hepatectomy.
Collapse
|
13
|
Willems E, D'Hondt M, Kingham TP, Fuks D, Choi GH, Syn NL, Sucandy I, Marino MV, Prieto M, Chong CC, Lee JH, Efanov M, Chiow AKH, Choi SH, Sutcliffe RP, Troisi RI, Pratschke J, Cheung TT, Wang X, Tang CN, Liu R, Han HS, Goh BKP. Comparison Between Minimally Invasive Right Anterior and Right Posterior Sectionectomy vs Right Hepatectomy: An International Multicenter Propensity Score-Matched and Coarsened-Exact-Matched Analysis of 1,100 Patients. J Am Coll Surg 2022; 235:859-868. [PMID: 36102506 PMCID: PMC9720542 DOI: 10.1097/xcs.0000000000000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of minimally invasive right anterior and right posterior sectionectomy (MI-RAS/MI-RPS) for right-sided liver lesions remains debatable. Although technically more demanding, these procedures might result in faster recovery and lower postoperative morbidity compared with minimally invasive right hemihepatectomy. STUDY DESIGN This is an international multicenter retrospective analysis of 1,114 patients undergoing minimally invasive right hemihepatectomy, MI-RAS, and MI-RPS at 21 centers between 2006 and 2019. Minimally invasive surgery included pure laparoscopic, robotic, hand-assisted, or a hybrid approach. A propensity-matched and coarsened-exact-matched analysis was performed. RESULTS A total of 1,100 cases met study criteria, of whom 759 underwent laparoscopic, 283 robotic, 11 hand-assisted, and 47 laparoscopic-assisted (hybrid) surgery. There were 632 right hemihepatectomies, 373 right posterior sectionectomies, and 95 right anterior sectionectomies. There were no differences in baseline characteristics after matching. In the MI-RAS/MI-RPS group, median blood loss was higher (400 vs 300 mL, p = 0.001) as well as intraoperative blood transfusion rate (19.6% vs 10.7%, p = 0.004). However, the overall morbidity rate was lower including major morbidity (7.1% vs 14.3%, p = 0.007) and reoperation rate (1.4% vs 4.6%, p = 0.029). The rate of close/involved margins was higher in the MI-RAS/MI-RPS group (23.4% vs 8.9%, p < 0.001). These findings were consistent after both propensity and coarsened-exact matching. CONCLUSIONS Although technically more demanding, MI-RAS/MI-RPS is a valuable alternative for minimally invasive right hemihepatectomy in right-sided liver lesions with lower postoperative morbidity, possibly due to the preservation of parenchyma. However, the rate of close/involved margins is higher in these procedures. These findings might guide surgeons in preoperative counselling and in selecting the appropriate procedure for their patients.
Collapse
Affiliation(s)
- Edward Willems
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - Mathieu D'Hondt
- From the Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium (Willems, D'Hondt)
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY (Kingham)
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France (Fuks)
| | - Gi-Hong Choi
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Choi)
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore (Syn)
| | - Iswanto Sucandy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Syn)
| | - Marco V Marino
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL (Sucandy)
| | - Mikel Prieto
- General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy (Marino)
| | - Charing C Chong
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (Chong)
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Lee)
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia (Efanov)
| | - Adrian K H Chiow
- Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore (Chiow)
| | - Sung Hoon Choi
- Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (Choi)
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom (Sutcliffe)
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Division of Hepatopancreatobiliary, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy (Troisi)
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin (Pratschke)
- Berlin Institute of Health, Berlin, Germany (Pratschke)
| | - Tan-To Cheung
- Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Cheung)
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China (Wang)
| | - Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China (Tang)
| | - Rong Liu
- Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Liu)
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea (Han)
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore (Goh)
- Duke-National University of Singapore Medical School, Singapore (Goh)
| |
Collapse
|
14
|
Premature Macrophage Activation by Stored Red Blood Cell Transfusion Halts Liver Regeneration Post-Partial Hepatectomy in Rats. Cells 2022; 11:cells11213522. [DOI: 10.3390/cells11213522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Liver resection is a common treatment for various conditions and often requires blood transfusions to compensate for operative blood loss. As partial hepatectomy (PHx) is frequently performed in patients with a pre-damaged liver, avoiding further injury is of paramount clinical importance. Our aim was to study the impact of red blood cell (RBC) resuscitation on liver regeneration. We assessed the impact of RBC storage time on liver regeneration following 50% PHx in rats and explored possible contributing molecular mechanisms using immunohistochemistry, RNA-Seq, and macrophage depletion. The liver was successfully regenerated after PHx when rats were transfused with fresh RBCs (F-RBCs). However, in rats resuscitated with stored RBCs (S-RBCs), the regeneration process was disrupted, as detected by delayed hepatocyte proliferation and lack of hypertrophy. The delayed regeneration was associated with elevated numbers of hemorrhage-activated liver macrophages (Mhem) secreting HO-1. Depletion of macrophages prior to PHx and transfusion improved the regeneration process. Gene expression profiling revealed alterations in numerous genes belonging to critical pathways, including cell cycle and DNA replication, and genes associated with immune cell activation, such as chemokine signaling and platelet activation and adhesion. Our results implicate activated macrophages in delayed liver regeneration following S-RBC transfusion via HO-1 and PAI-1 overexpression.
Collapse
|
15
|
Ding C, Jia J, Bai G, Zhou W, Shan W. Predictive value of Gd-EOB-DTPA -enhanced magnetic resonance imaging for post-hepatectomy liver failure: a systematic review and meta-analysis. Acta Radiol 2022; 64:1347-1356. [PMID: 36303435 DOI: 10.1177/02841851221134485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Accurate preoperative diagnosis of post-hepatectomy liver failure (PHLF) is particularly important to improve the prognosis of patients. Purpose To evaluate the predictive value of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for post-hepatectomy liver failure. Material and Methods A systematic search was performed in the PubMed, Embase, the Cochrane Library, and Web of Science databases to find relevant original articles published up to December 2021. The included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The bivariate random-effects model was used to assess the diagnostic authenticity. Meta-regression analyses were performed to analyze the potential heterogeneity. Results In total, 13 articles were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the summary receiver operating characteristic curves were 88% (95% confidence interval [CI] = 0.80–0.94), 80% (95% CI = 0.73–0.86), 4.4 (95% CI = 3.3–5.9), 0.14 (95% CI = 0.08–0.25), 31 (95% CI = 17–57), and 0.91 (95% CI = 0.89–0.94), respectively. There was no publication bias and threshold effect in our study. Conclusion Gd-EOB-DTPA-enhanced MRI is a potentially useful for the prediction of PHLF after major hepatectomy.
Collapse
Affiliation(s)
- Cong Ding
- The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Jianye Jia
- The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Genji Bai
- The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wei Zhou
- The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| | - Wenli Shan
- The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, PR China
| |
Collapse
|
16
|
Bozkurt E, Sijberden JP, Hilal MA. What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery? Cancers (Basel) 2022; 14:4268. [PMID: 36077803 PMCID: PMC9454668 DOI: 10.3390/cancers14174268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots' abilities.
Collapse
Affiliation(s)
- Emre Bozkurt
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul 34010, Turkey
| | - Jasper P. Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
17
|
Yugawa K, Maeda T, Nagata S, Shiraishi J, Sakai A, Yamaguchi S, Konishi K, Hashimoto K. Impact of aspartate aminotransferase-to-platelet ratio index based score to assess posthepatectomy liver failure in patients with hepatocellular carcninoma. World J Surg Oncol 2022; 20:248. [PMID: 35918753 PMCID: PMC9344632 DOI: 10.1186/s12957-022-02714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) is a life-threatening complication following hepatic resection. The aspartate aminotransferase-to-platelet ratio index (APRI) is a non-invasive model for assessing the liver functional reserve in patients with hepatocellular carcinoma (HCC). This study aimed to establish a scoring model to stratify patients with HCC at risk for PHLF. METHODS This single-center retrospective study included 451 patients who underwent hepatic resection for HCC between 2004 and 2017. Preoperative factors, including non-invasive liver fibrosis markers and intraoperative factors, were evaluated. The predictive impact for PHLF was evaluated using receiver operating characteristic (ROC) curves of these factors. RESULTS Of 451 patients, 30 (6.7%) developed severe PHLF (grade B/C). Multivariate logistic analysis indicated that APRI, model for end-stage liver disease (MELD) score, operating time, and intraoperative blood loss were significantly associated with severe PHLF. A scoring model (over 0-4 points) was calculated using these optimal cutoff values. The area under the ROC curve of the established score for severe PHLF was 0.88, which greatly improved the predictive accuracy compared with these factors alone (p < 0.05 for all). CONCLUSIONS The scoring model-based APRI, MELD score, operating time, and intraoperative blood loss can predict severe PHLF in patients with HCC.
Collapse
Affiliation(s)
- Kyohei Yugawa
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
| | - Shigeyuki Nagata
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Jin Shiraishi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Akihiro Sakai
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kozo Konishi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kenkichi Hashimoto
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| |
Collapse
|
18
|
Papamichail M, Pizanias M, Heaton ND, M P, M P, Nd H. Minimizing the risk of small-for-size syndrome after liver surgery. Hepatobiliary Pancreat Dis Int 2022; 21:113-133. [PMID: 34961675 DOI: 10.1016/j.hbpd.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for-size syndrome (SFSS). DATA SOURCES This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. RESULTS Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. CONCLUSIONS With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.
Collapse
Affiliation(s)
- Michail Papamichail
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK.
| | - Michail Pizanias
- Department of General Surgery, Whittington Hospital, London N19 5NF, UK
| | - Nigel D Heaton
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Papamichail M
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Pizanias M
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| | - Heaton Nd
- Department of Hepato-Pancreato-Biliary Surgery, Royal Blackburn Hospital, Blackburn BB2 3HH, UK; Department of General Surgery, Whittington Hospital, London N19 5NF, UK; Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King's College Hospital NHS Trust, London SE5 9RS, UK
| |
Collapse
|
19
|
Cassese G, Han HS, Al Farai A, Guiu B, Troisi RI, Panaro F. Future remnant Liver optimization: preoperative assessment, volume augmentation procedures and management of PVE failure. Minerva Surg 2022; 77:368-379. [PMID: 35332767 DOI: 10.23736/s2724-5691.22.09541-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Surgery is the cornerstone treatment for patients with primary or metastatic hepatic tumors. Thanks to surgical and anesthetic technological advances, current indications for liver resections have been significantly expanded to include any patient in whom all disease can be resected with a negative margin (R0) while preserving an adequate future residual liver (FRL). Post-hepatectomy liver failure (PHLF) is still a feared complication following major liver surgery, associated with high morbidity, mortality and cost implications. PHLF is mainly linked to both the size and quality of the FRL. Significant advances have been made in detailed preoperative assessment, to predict and mitigate this complication, even if an ideal methodology has yet to be defined. Several procedures have been described to induce hypertrophy of the FRL when needed. Each technique has its advantages and limitations, and among them portal vein embolization (PVE) is still considered the standard of care. About 20% of patients after PVE fail to undergo the scheduled hepatectomy, and newer secondary procedures, such as segment 4 embolization, ALPPS and HVE, have been proposed as salvage strategies. The aim of this review is to discuss the current modalities available and new perspectives in the optimization of FRL in patients undergoing major liver resection.
Collapse
Affiliation(s)
- Gianluca Cassese
- Minimally Invasive and Robotic HPB Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Seoul National University College of Medicine, Department of Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ho-Seong Han
- Seoul National University College of Medicine, Department of Surgery, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Abdallah Al Farai
- Department of Surgical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Boris Guiu
- Department of Radiology, Montpellier University Hospital, Montpellier, France
| | - Roberto I Troisi
- Minimally Invasive and Robotic HPB Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Panaro
- Montpellier University Hospital School of Medicine, Unit of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier-Nimes University, Montpellier, France -
| |
Collapse
|
20
|
OUP accepted manuscript. Br J Surg 2022; 109:455-463. [DOI: 10.1093/bjs/znac017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/06/2021] [Accepted: 01/04/2022] [Indexed: 01/27/2023]
|
21
|
Shibutani K, Okada M, Tsukada J, Hyodo T, Ibukuro K, Abe H, Matsumoto N, Midorikawa Y, Moriyama M, Takayama T. A proposed model on MR elastography for predicting postoperative major complications in patients with hepatocellular carcinoma. BJR Open 2021; 3:20210019. [PMID: 34877453 PMCID: PMC8611681 DOI: 10.1259/bjro.20210019] [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: 03/26/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To develop a model for predicting post-operative major complications in patients with hepatocellular carcinoma (HCC). Methods In all, 186 consecutive patients with pre-operative MR elastography were included. Complications were categorised using Clavien‒Dindo classification, with major complications defined as ≥Grade 3. Liver-stiffness measurement (LSM) values were measured on elastogram. The indocyanine green clearance rate of liver remnant (ICG-Krem) was based on the results of CT volumetry, intraoperative data, and ICG-K value. For an easy application to the prediction model, the continuous variables were converted to categories. Moreover, logistic regression analysis and fivefold cross-validation were performed. The prediction model's discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the calibration of the model was assessed by the Hosmer‒Lemeshow test. Results 43 of 186 patients (23.1%) had major complications. The multivariate analysis demonstrated that LSM, albumin-bilirubin (ALBI) score, intraoperative blood loss, and ICG-Krem were significantly associated with major complications. The median AUC of the five validation subsets was 0.878. The Hosmer-Lemeshow test confirmed no evidence of inadequate fit (p = 0.13, 0.19, 0.59, 0.59, and 0.73) on the fivefold cross-validation. The prediction model for major complications was as follows: -2.876 + 2.912 [LSM (>5.3 kPa)]+1.538 [ALBI score (>-2.28)]+0.531 [Intraoperative blood loss (>860 ml)]+0.257 [ICG-Krem (<0.10)]. Conclusion The proposed prediction model can be used to predict post-operative major complications in patients with HCC. Advances in knowledge The proposed prediction model can be used in routine clinical practice to identify post-operative major complications in patients with HCC and to strategise appropriate treatments of HCC.
Collapse
Affiliation(s)
- Kazu Shibutani
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Jitsuro Tsukada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Tomoko Hyodo
- Department of Radiology, Kindai University school of medicine, Osaka, Japan
| | - Kenji Ibukuro
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hayato Abe
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki Matsumoto
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiko Moriyama
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
22
|
Xu Y, Wei FX. A retrospective study of enteral nutrition on immune and inflammatory factors after liver cancer surgery. Medicine (Baltimore) 2021; 100:e27718. [PMID: 34871264 PMCID: PMC8568385 DOI: 10.1097/md.0000000000027718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/29/2021] [Accepted: 10/20/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT This retrospective study aimed to explore the effect of enteral nutrition (EN) on immune and inflammatory factors after liver cancer surgery (LCS).It was retrospectively conducted on enrolled LCS patients between January 2017 and May 2020. The medical records of 528 patient case records were collected and reviewed. After selection, a total of 80 eligible patient case records were finally included. All those patients received routine diet, and they were allocated to a treatment group (n = 40) and a control group (n = 40). In addition, patients in the treatment group also received EN. The primary outcomes were immune factors (CD4+, CD8+, CD4+/CD8+) and inflammatory factors (interleukin-1, interleukin-6, and tumor necrosis factor-α). The secondary outcomes were postoperative hospital stay (day), time to first bowel sounds (hour), time to first flatus (day), time to first defecation (day), and complications.There were not significant differences in CD4+/CD8+ (P = .34), postoperative hospital stay (P = .39), and time to first bowel sounds (P = .17) between 2 groups. However, there were significant differences in CD4+ (P < .01), CD8+ (P < .01), interleukin-1 (P < .01), interleukin-6 (P < .01), tumor necrosis factor-α (P < .01), time to first flatus (P < .01), and time to first defecation (P < .01) between 2 groups. As for complications, there were not significant differences between 2 groups (P > .05).The results of this study found that EN may benefit for patients after LCS during the recovery period. Future high quality prospective studies are needed to warrant the present conclusion.
Collapse
Affiliation(s)
- Yao Xu
- Department of Clinical Laboratory Diagnosis, School of Clinical Medicine, Jiamusi University, Jiamusi, China
| | - Feng-xiang Wei
- Department of Clinical Laboratory Diagnosis, School of Clinical Medicine, Jiamusi University, Jiamusi, China
- Central Laboratory, Longgang District Maternal and Child Health Hospital, Shenzhen, China
| |
Collapse
|
23
|
Uña-Gorospe J. Determinación de la tasa de aclaramiento hepático segmentario de 99mTc-mebrofenina y su aplicación en la evaluación funcional del remanente hepático futuro tras resección hepática. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remn.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Famularo S, Donadon M, Cipriani F, Ardito F, Iaria M, Carissimi F, Perri P, Dominioni T, Zanello M, Conci S, Molfino S, D'Acapito F, Germani P, Ferrari C, Patauner S, Pinotti E, Sciannamea I, Garatti M, Lodo E, Troci A, Delvecchio A, Floridi A, Bernasconi DP, Fumagalli L, Chiarelli M, Memeo R, Crespi M, Zanus G, Zimmitti G, Antonucci A, Zago M, Frena A, Griseri G, Tarchi P, Ercolani G, Baiocchi GL, Ruzzenente A, Jovine E, Maestri M, Grazi G, Valle RD, Giuliante F, Aldrighetti L, Romano F, Torzilli G. The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study. J Gastrointest Surg 2021; 25:2823-2834. [PMID: 33751404 DOI: 10.1007/s11605-021-04952-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence. METHOD Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence. RESULTS Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41-71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352-2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921-1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921-1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295-0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). CONCLUSION The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.
Collapse
Affiliation(s)
- Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- Hepatobiliary and General Surgery Division, Department of Biomedical Science, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Matteo Donadon
- Hepatobiliary and General Surgery Division, Department of Biomedical Science, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Federica Cipriani
- Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Iaria
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Carissimi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Pasquale Perri
- Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Dominioni
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Zanello
- Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS, Bologna, Italy
| | - Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabrizio D'Acapito
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Paola Germani
- Surgical Clinic, University Hospital of Trieste, Trieste, Italy
| | | | - Stefan Patauner
- Department of Surgery, Bolzano Central Hospital, Bolzano, Italy
| | - Enrico Pinotti
- Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy
| | | | - Marco Garatti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Enrico Lodo
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Treviso, Italy
| | - Albert Troci
- Department of Surgery, L. Sacco Hospital, Milan, Italy
| | | | | | - Davide Paolo Bernasconi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy
| | - Luca Fumagalli
- Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy
| | - Marco Chiarelli
- Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy
| | | | - Giacomo Zanus
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Treviso, Italy
| | - Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Mauro Zago
- Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy
| | - Antonio Frena
- Department of Surgery, Bolzano Central Hospital, Bolzano, Italy
| | - Guido Griseri
- HPB Surgical Unit, San Paolo Hospital, Savona, Italy
| | - Paola Tarchi
- Surgical Clinic, University Hospital of Trieste, Trieste, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elio Jovine
- Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS, Bologna, Italy
| | - Marcello Maestri
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - GianLuca Grazi
- Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | | | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy
| | - Fabrizio Romano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Guido Torzilli
- Hepatobiliary and General Surgery Division, Department of Biomedical Science, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| |
Collapse
|
25
|
Uña-Gorospe JA. Determination of the segmental hepatic clearance rate of 99mTc-mebrofenin and its application in the functional assessment of future liver remnant after liver resection. Rev Esp Med Nucl Imagen Mol 2021; 40:385-396. [PMID: 34663555 DOI: 10.1016/j.remnie.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/28/2022]
Abstract
99mTc-mebrofenin hepatobiliary scintigraphy with SPECT/CT (HBS-M) has become an important quantitative method to evaluate global liver function and future liver remnant (FLR) function in patients who are candidates for resective liver surgery. The purpose of this work was to describe the method in the prediction of post-surgical liver failure. The overall liver function and that of the FLR are obtained by analysis of the initial dynamic phase of the scan. Liver volume to be preserved is expressed as a percentage of the total liver volume measured in both CT sections. HBS-M is able to accurately gauge regional liver function abnormalities that could be represented as normal liver tissue parenchyma in the CT study. This technique can provide very valuable prognostic information for the estimation of the postoperative risk of liver failure in all patients who are candidates for resective liver surgery.
Collapse
Affiliation(s)
- Jon Andoni Uña-Gorospe
- Servicio de Medicina Nuclear, Hospital Universitario Nuestra Señora de Candelaria, Carretera del Rosario 145, 38010, Santa Cruz de Tenerife, Canarias, Spain.
| |
Collapse
|
26
|
Child-Turcotte-Pugh Score as a Predictive Factor for Long-Term Survival After Repeat Hepatectomy for Recurrent Liver Metastases of Colorectal Cancer. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00029.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
We aimed to evaluate the changes in liver function after repeat hepatectomy and their relationship with survival of patient with colorectal cancer.
Summary of Background Data
Repeat hepatectomy has been accepted as an effective treatment for recurrent liver metastases; however, how repeat hepatectomy changes the liver function during the follow-up period is not well understood.
Methods
Data regarding patients underwent R0 resections at initial hepatectomy for colorectal cancer with liver metastasis from 2012 to 2017 were retrospectively reviewed. Patients were divided into groups according to the total number of hepatectomies. Overall survival and Child-Turcotte-Pugh score after hepatectomy were analyzed.
Results
Fifty-three patients underwent single hepatectomy and 37 patients underwent repeat hepatectomy. There was no significant difference in the overall survival rates between the 2 groups. At 27 months after the initial hepatectomy, mean Child-Turcotte-Pugh scores of patients with repeat hepatectomy started to become statistically higher than those of patients with single hepatectomy. Overall survival of patients who survived after 27 months from the initial hepatectomy showed a statistical difference between the 2 groups. The total number of liver metastases ≥ 4 and Child-Turcotte-Pugh score ≥ 6 at 27 months after the initial hepatectomy were significant risk factors for overall survival of patient who survived after 27 months from the initial hepatectomy.
Conclusions
Liver function after repeat hepatectomy can be deteriorated after a long-term period. Careful approach and continuous assessment of the liver function after hepatectomy are necessary to maintain long-term survival after repeat hepatectomy.
Collapse
|
27
|
Predictive value of combined computed tomography volumetry and magnetic resonance elastography for major complications after liver resection. Abdom Radiol (NY) 2021; 46:3193-3204. [PMID: 33683428 DOI: 10.1007/s00261-021-02991-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To retrospectively compare the predictive value of computed tomography volumetry (CTV), magnetic resonance elastography (MRE) of the liver, and their combination for major complications after liver resection. METHODS We enrolled 108 consecutive patients who underwent anatomical liver resection for liver tumors and preoperative contrast-enhanced CT and MRE. The future liver remnant (FLR) ratio was calculated by CTV, while the liver stiffness measurement (LSM) was obtained by MRE. FLR ratio alone, LSM alone, and combined FLR ratio and LSM were evaluated to predict major complications (Clavien-Dindo grade ≥ IIIa). Univariate and multivariate analyses of hepatic biochemical parameters and imaging data were performed to identify predictors of major complications. Receiver operating characteristic analyses of FLR ratio, LSM, and their combination were performed, and the sensitivity and specificity were calculated. RESULTS Twenty-two (20.4%) of the 108 patients experienced major complications. According to multiple regression analysis, the FLR ratio (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.91-0.99, p = 0.040) and LSM (OR 1.72, 95% CI 1.01-2.94, p = 0.047) were independent predictors of major complications. The combined FLR ratio and LSM were predictive of major complications, with an area under the curve (AUC) of 0.818, sensitivity of 68.2%, and specificity of 84.9%. The AUC and specificity for combined FLR ratio and LSM were larger than those for FLR ratio (AUC: 0.711, specificity: 80.2%) and LSM (AUC: 0.793, specificity: 80.2%). CONCLUSION Combined CTV and MRE analysis can improve the AUC and specificity for predicting major complications after anatomical liver resection.
Collapse
|
28
|
A novel online calculator based on noninvasive markers (ALBI and APRI) for predicting post-hepatectomy liver failure in patients with hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2021; 45:101534. [PMID: 33067168 DOI: 10.1016/j.clinre.2020.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/12/2020] [Accepted: 09/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Post-hepatectomy liver failure (PHLF) remains the primary cause of in-hospital mortality after hepatectomy. Identifying predictors of PHLF is important to improve surgical safety. We sought to identify the predictive accuracy of two noninvasive markers, albumin-bilirubin (ALBI) and aspartate aminotransferase to platelet count ratio index (APRI), to predict PHLF among patients with hepatocellular carcinoma (HCC), and to build up an online prediction calculator. METHODS Patients who underwent resection for HCC between 2013 and 2016 at 6 Chinese hospitals were retrospectively analyzed. The independent predictors of PHLF were identified using univariate and multivariate analyses; derivative data were used to construct preoperative and postoperative nomogram models. Receiver operating characteristic (ROC) curves for the two predictive models, and ALBI, APRI, Child-Pugh, model for end-stage liver disease (MELD) scores were compared relative to predictive accuracy for PHLF. RESULTS Among the 767 patients in the analytic cohort, 102 (13.3%) experienced PHLF. Multivariable logistic regression analysis identified high ALBI grade (>-2.6) and high APRI grade (>1.5) as independent risk factors associated with PHLF in both the preoperative and postoperative models. Two nomogram predictive models and corresponding web-based calculators were subsequently constructed. The areas under the ROC curves for the postoperative and preoperative models, APRI, ALBI, MELD and Child-Pugh scores in predicting PHLF were 0.844, 0.789, 0.626, 0.609, 0.569, and 0.560, respectively. CONCLUSIONS ALBI and APRI demonstrated more accurate ability to predict PHLF than Child-Pugh and MELD. Two online calculators that combined ALBI and APRI were proposed as useful preoperative and postoperative tools for individually predicting the occurrence of PHLF among patients with HCC.
Collapse
|
29
|
Giustiniano E, Nisi F, Rocchi L, Zito PC, Ruggieri N, Cimino MM, Torzilli G, Cecconi M. Perioperative Management of Complex Hepatectomy for Colorectal Liver Metastases: The Alliance between the Surgeon and the Anesthetist. Cancers (Basel) 2021; 13:cancers13092203. [PMID: 34063684 PMCID: PMC8125060 DOI: 10.3390/cancers13092203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Major high-risk surgery (HRS) exposes patients to potential perioperative adverse events. Hepatic resection of colorectal metastases can surely be included into the HRS class of operations. Limiting such risks is the main target of the perioperative medicine. In this context the collaboration between the anesthetist and the surgeon and the sharing of management protocols is of utmost importance and represents the key issue for a successful outcome. In our institution, we have been adopting consolidated protocols for patients undergoing this type of surgery for decades; this made our mixed team (surgeons and anesthetists) capable of achieving a safe outcome for the majority of our surgical population. In this narrative review, we report the most recent state of the art of perioperative management of hepatic resection of colorectal metastases along with our experience in this field, trying to point out the main issues. Abstract Hepatic resection has been widely accepted as the first choice for the treatment of colorectal metastases. Liver surgery has been recognized as a major abdominal procedure; it exposes patients to a high risk of perioperative adverse events. Decision sharing and the multimodal approach to the patients’ management are the two key items for a safe outcome, even in such a high-risk surgery. This review aims at addressing the main perioperative issues (preoperative evaluation; general anesthesia and intraoperative fluid management and hemodynamic monitoring; intraoperative metabolism; administration policy for blood-derivative products; postoperative pain control; postoperative complications), in particular, from the anesthetist’s point of view; however, only an alliance with the surgery team may be successful in case of adverse events to accomplish a good final outcome.
Collapse
Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Correspondence: (E.G.); (F.N.); Tel.: +39-02-8224-7459 (E.G.); +39-02-8224-4115 (F.N.); Fax: +39-02-8224-4190 (E.G. & F.N.)
| | - Fulvio Nisi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Correspondence: (E.G.); (F.N.); Tel.: +39-02-8224-7459 (E.G.); +39-02-8224-4115 (F.N.); Fax: +39-02-8224-4190 (E.G. & F.N.)
| | - Laura Rocchi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Paola C. Zito
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Matteo M. Cimino
- Hepato-Biliary & Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (M.M.C.); (G.T.)
| | - Guido Torzilli
- Hepato-Biliary & Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (M.M.C.); (G.T.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| |
Collapse
|
30
|
Tochii K, Iwata H, Sugimoto T, Takahashi K, Sekino S, Kiyama S, Kimura M, Murase K, Sekino T, Doi K. Two-Stage Portal Vein Ligation Facilitates Liver Regeneration Safely in Rats with Liver Cirrhosis. J INVEST SURG 2021; 35:549-559. [PMID: 33730988 DOI: 10.1080/08941939.2021.1894517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Portal vein (PV) embolization is performed prior to extended hepatectomy for the damaged liver to increase future remnant liver volume and prevent postoperative liver failure. This study examined whether two-stage PV ligation (PVL) increased regeneration and hypertrophy of the future remnant liver compared to conventional PVL, and whether two-stage PVL was safe for damaged liver. METHOD We produced a cirrhotic liver rat model with perioperatively maintained fibrosis. Rats were divided into: Group A (70%PVL), ligation of left branch of PV; Group B (90%PVL), ligation of right and left branches of PV; and Group C (two-stage 90%PVL), two-stage PVL with left branch ligation of PV followed by right branch ligation 7 days later. To evaluate liver regeneration, liver weight ratios, proliferating cell nuclear antigen (PCNA) labeling index (LI), mitotic index (MI), and TdT-mediated dUTP-biotin nick end labeling (TUNEL) LI in the non-ligated caudate lobe were measured. RESULTS Fourteen-day survival rate was 20% in Group B but 100% in Group C. TUNEL LI differed significantly between Groups A and B at 2 and 7 days postoperatively. Weight ratios were significantly higher in Group C than in Groups A and B at 14 days postoperatively. PCNA LI and MI in the non-ligated caudate lobe decreased to preoperative levels by 7 days postoperatively in Groups A and B, but remained elevated until 14 days postoperatively in Group C. CONCLUSION In cirrhotic liver rats, two-stage PVL avoided the lethal liver failure seen with one-stage PVL, and significantly facilitated liver regeneration more than one-stage PVL.
Collapse
Affiliation(s)
- Koya Tochii
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hisashi Iwata
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takuya Sugimoto
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kei Takahashi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Seishiro Sekino
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shigeru Kiyama
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masaki Kimura
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Katsutoshi Murase
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takafumi Sekino
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | |
Collapse
|
31
|
Wassmer CH, Moeckli B, Berney T, Toso C, Orci LA. Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13040637. [PMID: 33562666 PMCID: PMC7916026 DOI: 10.3390/cancers13040637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Hepatocellular carcinoma (HCC) is the most prevalent tumor of the liver and represents the second most common cause of oncological-related deaths worldwide. Despite all progress made in the field, surgical resection or liver transplantation are, at the moment, the only curative therapies available. Liver resection, especially for large, central tumors, are at risk of important bleeding. Significative hemorrhage during HCC resections have been linked to an increased rate of post-operative complications and tumor recurrence. Therefore, hepatic pedicle clamping during surgery has been used in order to reduce the bleeding risks. However, this method induces ischemia/reperfusion injuries, which has also been associated with tumor recurrence. For this reason, we aimed to evaluate if pedicle clamping is indeed associated with tumor recurrence and shorter survival, by performing a systematic review of the literature and meta-analysis. Abstract Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed. We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively. Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = −0.172, 95%CI: −0.298 to −0.047, p = 0.007, I2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2 = 50.7%). This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.
Collapse
Affiliation(s)
| | - Beat Moeckli
- Correspondence: (C.-H.W.); (B.M.); Tel.: +41-7866-82206 (C.-H.W.)
| | | | | | | |
Collapse
|
32
|
Lee DH. Current Status and Recent Update of Imaging Evaluation for Peri-Hilar Cholangiocarcinoma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:298-314. [PMID: 36238748 PMCID: PMC9431946 DOI: 10.3348/jksr.2021.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
간문주변부의 해부학적 복잡성으로 인해 간문주변부 담관암은 그 진단과 치료가 어려운 질환으로 알려져 있다. 간문주변부 담관암이 의심되는 환자에 있어서, 영상 검사는 이상 소견의 발견 및 감별 진단, 종양의 종축 침범 부위의 파악, 인접 혈관 침범과 원격 전이 유무의 파악, 그리고 최종적으로 수술적 절제 가능 유무의 평가에 있어 핵심적인 역할을 하고 있다. 이 종설에서는 간문주변부 담관암의 분류 및 종양의 평가를 위해 권고되는 표준 영상 검사의 기법과 간문주변부 담관암의 전형적인 영상 소견에 대해 기술할 예정이다. 종축 방향의 종양 침범 파악, 인접 혈관 침범 및 원격 전이 유무의 평가에 있어서 각 영상 검사 소견과 그 진단능에 대해 논의할 예정이다. 이후 전통적인 절제 가능성 평가의 개념에 대해 고찰하고, 최근의 경향을 소개한다.
Collapse
Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
33
|
Gavriilidis P, Hammond JS, Hidalgo E. A systematic review of the impact of portal vein pressure changes on clinical outcomes following hepatic resection. HPB (Oxford) 2020; 22:1521-1529. [PMID: 32792308 DOI: 10.1016/j.hpb.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are evolving data correlating elevated post-hepatic resection portal vein pressure (PVP) with risk of developing post-resection liver failure (PLF) and other complications. As a consequence, modulation of PVP presents a potential strategy to improve outcomes following liver resection (LR). The primary aim of this study was to review the existing evidence regarding the impact of post-resection PVP on clinical outcomes in patients undergoing a LR. METHODS Systematic literature searches of electronic databases in accordance with PRISMA were conducted. Changes in PVP and clinical outcomes following liver resection were defined according to the existing literature. RESULTS Ten studies, consisting of 712 patients with a median age 61 (52-68) years, were identified that met the inclusion criteria. Of those, 77% (n = 550) underwent a major LR and 27% (n = 195) of patients had cirrhosis. Following LR, the median (range) PVP increased from 11.4 mmHg (median baseline, range 7.3-16.4) to 15.9 mmHg (7.9-19). The overall median incidence of PLF was 19%. Six of the ten studies found an elevated PVP after LR predicted PLF. One study found elevated PVP after LR predicted mortality after LR. CONCLUSION Elevated PVP following hepatic resection was associated with increased rates of PLF. It was not possible to define a specific threshold PVP for predicting PLF. Modulation of PVP therefore presents a potential strategy to mitigate the incidence of LR. Future studies should standardize on reporting liver remnant and haemodynamics to better characterize clinical outcomes following LR.
Collapse
Affiliation(s)
- Paschalis Gavriilidis
- Department of Hepato-Pancreatic-Biliary Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, England, UK.
| | - John S Hammond
- Department of Hepato-Pancreatic-Biliary Surgery and Transplantation, Freeman Hospital, Newcastle upon Tyne, Engalnd, UK
| | - Ernest Hidalgo
- Department of Hepato-Pancreatic-Biliary Surgery and Transplantation, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
34
|
Ocak İ, Topaloğlu S, Acarli K. Posthepatectomy liver failure. Turk J Med Sci 2020; 50:1491-1503. [PMID: 32718126 PMCID: PMC7605090 DOI: 10.3906/sag-2006-31] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
Liver surgery is one of the most complex surgical interventions with high risk and potential for complications. Posthepatectomy liver failure (PHLF) is a serious complication of liver surgery that occurs in about 10% of patients undergoing major liver surgery. It is the main source of morbidity and mortality. Appropriate surgical techniques and intensive care management are important in preventing PHLF. Early start of the liver support systems is very important for the PHLF patient to recover, survive, or be ready for a liver transplant. Nonbiological and biological liver support systems should be used in PHLF to prepare for treatment or organ transplantation. The definition of the state, underlying pathophysiology and treatment strategies will be reviewed here.
Collapse
Affiliation(s)
- İlhan Ocak
- Department of Critical Care Unit, İstanbul Memorial Hospital, İstanbul, Turkey
| | - Serdar Topaloğlu
- Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Koray Acarli
- Department of Organ Transplantation, Department of Surgery, İstanbul Memorial Hospital, İstanbul, Turkey
| |
Collapse
|
35
|
Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study. HPB (Oxford) 2020; 22:1420-1428. [PMID: 32057681 DOI: 10.1016/j.hpb.2020.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/14/2020] [Accepted: 01/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict post-operative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off. METHODS A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant. RESULTS 98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. CONCLUSION Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.
Collapse
|
36
|
Søreide JA, Deshpande R. Post hepatectomy liver failure (PHLF) - Recent advances in prevention and clinical management. Eur J Surg Oncol 2020; 47:216-224. [PMID: 32943278 DOI: 10.1016/j.ejso.2020.09.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) is a relatively rare but feared complication following liver surgery, and associated with high morbidity, mortality and cost implications. Significant advances have been made in detailed preoperative assessment, particularly of the liver function in an attempt to predict and mitigate this complication. METHODS A detailed search of PubMed and Medline was performed using keywords "liver failure", "liver insufficiency", "liver resection", "postoperative", and "post-hepatectomy". Only full texts published in English were considered. Particular emphasis was placed on literature published after 2015. A formal systematic review was not found feasible hence a pragmatic review was performed. RESULTS The reported incidence of PHLF varies widely in reported literature due to a historical absence of a universal definition. Incorporation of the now accepted definition and grading of PHLF would suggest the incidence to be between 8 and 12%. Major risk factors include background liver disease, extent of resection and intraoperative course. The vast majority of mortality associated with PHLF is related to sepsis, organ failure and cerebral events. Despite multiple attempts, there has been little progress in the definitive and specific management of liver failure. This review article discusses recent advances made in detailed preoperative evaluation of liver function and evidence-based targeted approach to managing PHLF. CONCLUSION PHLF remains a major cause of mortality following liver resection. In absence of a specific remedy, the best approach is mitigating the risk of it happening by detailed assessment of liver function, patient selection and general care of a critically ill patient.
Collapse
Affiliation(s)
- Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Rahul Deshpande
- Department of HPB Surgery, Manchester Royal Infirmary, Manchester, UK
| |
Collapse
|
37
|
Espersen C, Borgwardt L, Larsen PN, Andersen TB, Stenholt L, Petersen LJ. Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review. EJNMMI Res 2020; 10:101. [PMID: 32886289 PMCID: PMC7474046 DOI: 10.1186/s13550-020-00687-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. The purpose of this systematic review was to summarize the existing knowledge on this topic. Methods MEDLINE and Web of Science were searched for studies investigating nuclear medicine imaging methods for the prediction of postoperative liver function in patients undergoing localized, liver-directed treatments. The postoperative endpoints were clinical outcome (morbidity and mortality) as well as measures of postoperative liver function, e.g., liver function assessed by biochemical tests or nuclear imaging. Results A total of 1352 references were identified, of which 82 fulfilled the eligibility criteria and were included in the review. Most studies (n = 63) were retrospective studies. The vast majority of studies assessed [99mTc]Tc-galactosyl serum albumin (GSA) (n = 57) and [99mTc]Tc-mebrofenin (n = 19). Liver resection was entirely or partly major (involved at least three segments) in 78 reports. There were notable variations in the research methodology, e.g., image acquisition, imaging variables, and endpoints. Thirty-seven studies reported on postoperative mortality, of which most reported descriptive data at the patient level. Of the four reports that performed multivariate analyses, two showed significant predictive results of isotope-based preoperative tests. Fifty-two papers presented data on postoperative liver failure. Multivariate predictive analyses were performed in eighteen trials, of which fifteen showed the significant value of nuclear medicine tests. Conclusion There is sparse evidence supporting the significant value of nuclear medicine imaging methods in predicting postoperative mortality. In contrast, a notable number of trials showed a significant prediction of liver failure in multivariate analyses. The research methodology was heterogeneous and exploratory in most trials. Documentation of nuclear medicine tests in this setting awaits the results of properly designed, prospective trials with the standardization of both the nuclear medicine test and endpoints.
Collapse
Affiliation(s)
- Caroline Espersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Peter Nørgaard Larsen
- Department of Gastrointestinal Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Trine Borup Andersen
- Department of Clinical Medicine, University of Aalborg, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark
| | - Louise Stenholt
- The Medical Library, Aalborg University Hospital, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark
| | - Lars Jelstrup Petersen
- Department of Clinical Medicine, University of Aalborg, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark.,Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9100, Aalborg, Denmark
| |
Collapse
|
38
|
Yan X, Liu L, Zhang Y, Song T, Liang Y, Liu Z, Bao X, Mao L, Qiu Y. Perioperative Enteral Nutrition Improves Postoperative Recovery for Patients with Primary Liver Cancer: A Randomized Controlled Clinical Trial. Nutr Cancer 2020; 73:1924-1932. [PMID: 32875913 DOI: 10.1080/01635581.2020.1814824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The role of perioperative protein-enriched enteral nutrition for patients with primary liver cancer is unclear. We investigated the efficacy of perioperative protein-enriched enteral nutrition for patients with primary liver cancer followed hepatectomy. METHODS Patients with primary liver cancer that underwent hepatectomy between January 2016 and 2018 were enrolled. Patients in the treatment group was given enteral nutrition (TP-MCT) in addition to the regular diet. The primary outcome measures were duration of hospital stay and length of postoperative hospital stay. Secondary outcome measures included time to first flatus and time to first defecation. RESULTS There was a significant reduction of time to first flatus and time to first defecation in the treatment group, when compared with the control group (time to first flatus: P = 0.001, time to first defecation: P < 0.001). CONCLUSIONS It is found that addition of protein-enriched enteral nutrition (TP-MCT) improved postoperative recovery for patients with primary liver cancer following hepatectomy, with a significant reduction in time to first flatus and time to first defecation.
Collapse
Affiliation(s)
- Xiaopeng Yan
- Department of Hepatopancreatobiliary Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lianxin Liu
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, China
| | - Yamin Zhang
- Department of Hepatobiliary Surgery, Tianjin First Center Hospital, Tianjin, China
| | - Tianqiang Song
- Department of Hepatobiliary, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yingjian Liang
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, China
| | - Zirong Liu
- Department of Hepatobiliary Surgery, Tianjin First Center Hospital, Tianjin, China
| | - Xu Bao
- Department of Hepatobiliary, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Liang Mao
- Department of Hepatopancreatobiliary Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yudong Qiu
- Department of Hepatopancreatobiliary Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
39
|
Teo JY, Ho AFW, Bulluck H, Gao F, Chong J, Koh YX, Tan EK, Abdul Latiff JB, Chua SH, Goh BKP, Chan CY, Chung AYF, Lee SY, Cheow PC, Ooi LLPJ, Davidson BR, Jevaraj PR, Hausenloy DJ. Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial. HPB (Oxford) 2020; 22:1250-1257. [PMID: 32007393 DOI: 10.1016/j.hpb.2019.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Novel hepatoprotective strategies are needed to improve clinical outcomes during liver surgery. There is mixed data on the role of remote ischemic preconditioning (RIPC). We investigated RIPC in partial hepatectomy for primary hepatocellular carcinoma (HCC). METHODS This was a Phase II, single-center, sham-controlled, randomized controlled trial (RCT). The primary hypothesis was that RIPC would reduce acute liver injury following surgery indicated by serum alanine transferase (ALT) 24 h following hepatectomy in patients with primary HCC, compared to sham. Patients were randomized to receive either four cycles of 5 min/5 min arm cuff inflation/deflation immediately prior to surgery, or sham. Secondary endpoints included clinical, biochemical and pathological outcomes. Liver function measured by Indocyanine Green pulse densitometry was performed in a subset of patients. RESULTS 24 and 26 patients were randomized to RIPC and control groups respectively. The groups were balanced for baseline characteristics, except the duration of operation was longer in the RIPC group. Median ALT at 24 h was similar between groups (196 IU/L IQR 113.5-419.5 versus 172.5 IU/L IQR 115-298 respectively, p = 0.61). Groups were similar in secondary endpoints. CONCLUSION This RCT did not demonstrate beneficial effects with RIPC on serum ALT levels 24 h after partial hepatectomy.
Collapse
Affiliation(s)
- Jin Yao Teo
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Andrew F W Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore; SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore
| | | | - Fei Gao
- National Heart Research Institute Singapore, National Heart Centre, Singapore; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
| | - Jun Chong
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore
| | - Ye Xin Koh
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Ek Khoon Tan
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Julianah B Abdul Latiff
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Siew H Chua
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Chung Yip Chan
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Alexander Y F Chung
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Ser Yee Lee
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Peng Chung Cheow
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - London L P J Ooi
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Brian R Davidson
- Division of Surgery and Intervention Science, Royal Free Campus, University College London, UK; Department of Hepato Pancreato Biliary Surgery and Liver Transplantation, Royal Free Hospital Foundation Trust, UK
| | - Prema Raj Jevaraj
- Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, London, UK; Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico.
| |
Collapse
|
40
|
Lee DH, Kim B, Lee ES, Kim HJ, Min JH, Lee JM, Choi MH, Seo N, Choi SH, Kim SH, Lee SS, Park YS, Chung YE. Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 22:41-62. [PMID: 32901457 PMCID: PMC7772383 DOI: 10.3348/kjr.2019.0803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
Collapse
Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
| | | |
Collapse
|
41
|
Coletta D, De Padua C, Parrino C, De Peppo V, Oddi A, Frigieri C, Grazi GL. Laparoscopic Liver Surgery: What Are the Advantages in Patients with Cirrhosis and Portal Hypertension? Systematic Review and Meta-Analysis with Personal Experience. J Laparoendosc Adv Surg Tech A 2020; 30:1054-1065. [PMID: 32707003 DOI: 10.1089/lap.2020.0408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Laparoscopic surgery is a choice of treatment for liver diseases; it can decrease postoperative morbidity and length of hospital stay (LOS). Hepatocellular carcinoma (HCC) in patients with cirrhosis and portal hypertension may benefit from minimally invasive liver resections (MILRs) instead of open liver resections (OLRs). Whether minimally invasive approaches are superior to conventional ones is still a matter of debate. We thus aimed to gather the available literature on this specific topic to achieve greater clarity. Materials and Methods: PubMed, EMBASE and Web of Sciences databases were assessed for studies comparing OLRs versus MILRs for HCC in cirrhotic patients up to February 2020. Data from our surgical experience from June 2010 to February 2020 were also included. Demographic characteristics, liver function, the presence of portal hypertension, tumor number, and tumor size and location were assessed; operative time, need for Pringle maneuver, estimated blood loss (EBL), major or minor hepatectomy performance, and conversion rate were evaluated for operative findings. Postoperative outcomes and liver-related complications, surgical site infection (SSI) rate, blood transfusion (BT) rate, need for reintervention, LOS, in-hospital or 30-day mortality, and radicality of resection were also considered. Meta-analysis was performed employing Review Manager 5.3 software. Results: One thousand three hundred twenty-one patients from 13 studies and our own series were considered in the meta-analysis. At preoperative settings, the OLR and MILR groups differed significantly only by tumor size (4.4 versus 3.0, P = .006). Laparoscopic procedures resulted significantly faster (120.32-330 minutes versus 146.8-342.75 minutes, P = .002) and with lower EBL than open ones (88-483 mL versus 200-580 mL, P < .00001), thus requiring less BTs (7.9% versus 13.2%, P = .02). In terms of overall morbidity, minimally invasive surgeries resulted significantly favorable (19.32% versus 38.04%, P < .00001), as well as for ascites (2.7% versus 12.9% P < .00001), postoperative liver failure (7.51% versus 13.61% P = .009), and SSI (1.8% versus 5.42%, P = .002). Accordingly, patients who had undergone MILRs had significantly shorter postoperative hospitalization than patients who underwent conventional open surgery (2.4-36 days versus 4.2-19 days P < .00001). Both groups did not differ in terms of mortality rate and radicality of resection (OLR 93.8% versus 96.1% laparoscopic liver resection, P = .12). Conclusions: Based on the available evidence in the literature, laparoscopic resections rather than open liver ones for HCC surgery in cirrhotic patients seem to reduce postoperative overall morbidity, liver-specific complications, and LOS. The lack of randomized studies on this topic precludes the possibility of achieving defining statements.
Collapse
Affiliation(s)
- Diego Coletta
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Cristina De Padua
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Parrino
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Valerio De Peppo
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Oddi
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Claudia Frigieri
- Anesthesia and Intensive Care Unit, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Gian Luca Grazi
- HepatoBiliaryPancreatic Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
42
|
Fung AKY, Chong CCN, Lai PBS. ERAS in minimally invasive hepatectomy. Ann Hepatobiliary Pancreat Surg 2020; 24:119-126. [PMID: 32457255 PMCID: PMC7271107 DOI: 10.14701/ahbps.2020.24.2.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.
Collapse
Affiliation(s)
- Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paul B S Lai
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
43
|
Ammar MA, Abdou AMH. Benefits of N-acetylcysteine on liver functions in living donor hepatectomy. Indian J Anaesth 2020; 64:204-209. [PMID: 32346167 PMCID: PMC7179774 DOI: 10.4103/ija.ija_876_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/31/2019] [Accepted: 01/25/2020] [Indexed: 01/17/2023] Open
Abstract
Background and Aims: The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. The aim of this study was to evaluate the post-hepatectomy effect of using N-Acetylcysteine (NAC) infusion in living donors undergoing donor hepatectomy. Methods: In a prospective randomised non-blinded study, 50 healthy donors were enrolled; following hepatectomy patients were randomised into 2 groups: Group NC receiving NAC 150 mg/kg diluted in 100 ml glucose 5% over 40 minutes, followed by NAC 12.5 mg/kg in 500 ml glucose 5% over 4 hours. This was followed by NAC 6.25 mg/kg for 2 post-operative days, Group C (Control group) received ringer acetate infusion at same rate for 2 days. The primary outcome was serum lactate levels. Secondary outcomes were liver function tests, serum creatinine and urine output on intensive care unit (ICU) admission (0 hr.), after 24 hours and 48 hours, length of ICU stay. Results: Our study revealed significant reduction in serum lactate in Group NC at 0, 24 and 48 hours compared to C group (P = 0.017, 0.002, 0.014). INR values showed significant reduction after 48 hours in Group NC compared to Group C (P = 0.049). Total Bilirubin, ALT, and Creatinine, urine output and ICU stay showed no statistical difference between the 2 groups. Conclusion: The NAC protocol is a safe, cost-effective tool for improvement of post hepatectomy liver function and early stabilisation of the metabolic profile.
Collapse
Affiliation(s)
- Mona A Ammar
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr M Hilal Abdou
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
44
|
Shabunin AV, Parfenov IP, Bedin VV, Tavobilov MM, Grekov DN, Drozdov PA, Karpov AA. [Specific complications of liver resection and their prevention]. Khirurgiia (Mosk) 2020:5-12. [PMID: 32271731 DOI: 10.17116/hirurgia20200315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.
Collapse
Affiliation(s)
- A V Shabunin
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Moscow, Russia; Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - I P Parfenov
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Moscow, Russia
| | - V V Bedin
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Moscow, Russia; Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - M M Tavobilov
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Moscow, Russia; Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - D N Grekov
- Russian Medical Academy for Continuing Professional Education of the Ministry of Health of Russia, Moscow, Russia; Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - P A Drozdov
- Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| | - A A Karpov
- Botkin Municipal Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
| |
Collapse
|
45
|
Abreu TBD, Ribeiro ADA, Provenzano LPC, Ribeiro Filho J, Schanaider A. Assessment of remnant liver function and volume after selective ligation of portal vein and hepatic artery in a rat model. Acta Cir Bras 2020; 34:e201901103. [PMID: 31939502 PMCID: PMC6956645 DOI: 10.1590/s0102-865020190110000003] [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: 07/07/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate liver regeneration after selective ligation of portal vein and
hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control
(sham), Group II- isolated selective ligation of the hepatic artery, Group
III- isolated selective ligation of the portal vein and Group IV- combined
ligation of portal vein and hepatic artery. Before procedure and five days
after a 3D CT Scan was performed to analyze the hypertrophy, weight and
function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied
lobe was detected in group IV, the first with an average of 3.99 (p=0.006)
and the last varying from 6.10g to 9.64g (p=0.01). However, total liver
weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was
higher in group III (P<0.001) when compared with groups I, II and IV and
showed no difference between them. The immunohistochemical examination with
PCNA also found higher percentages with statistical significance differences
in rats of groups III and IV. It was possible to confirm a strong
correlation between hypertrophied lobe weight and its imaging volumetric
study. Liver function tests only showed a significant difference in serum
gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein
and hepatic artery and this evidence may improve the knowledge of surgical
treatment of liver injuries, with a translational impact in anima
nobile.
Collapse
Affiliation(s)
- Thiago Boechat de Abreu
- MSc, Department of Surgery, Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Brazil. Conception, design, intellectual and scientific content of the study; acquisition, interpretation and analysis of data; manuscript writing; critical revision
| | - Alexandre de Abreu Ribeiro
- Fellow Master degree, Department of Surgery, Faculty of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Conception, design, intellectual and scientific content of the study; interpretation and analysis of data; critical revision
| | - Lívia Paola Colchete Provenzano
- Fellow Master degree, Department of Surgery, Faculty of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Conception, design, intellectual and scientific content of the study; interpretation and analysis of data; critical revision
| | - Joaquim Ribeiro Filho
- Head and Full Professor, Department of Surgery, Faculty of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Conception, design, intellectual and scientific content of the study; interpretation and analysis of data; critical revision
| | - Alberto Schanaider
- PhD, Assistant Professor, Department of Surgery, Faculty of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Interpretation and analysis of data, critical revision
| |
Collapse
|
46
|
Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
Collapse
Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
| |
Collapse
|
47
|
Chon JY, Moon HY, Han S, Kwak J, Lee JY, Kim ES, Chung HS. Acute mental change as the presenting sign of posthepatectomy hepatic failure: A case report. Medicine (Baltimore) 2019; 98:e18166. [PMID: 31770264 PMCID: PMC6890321 DOI: 10.1097/md.0000000000018166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Hepatectomy is a treatment to increase survival and curability of patients with intrahepatic lesions or malignant tumors. However, posthepatectomy liver failure (PHLF) can occur. This case is a patient showing acute mental change in postanesthetic care unit (PACU) as an uncommon symptom of PHLF after extended right hepatectomy. PATIENT CONCERNS A 68-year-old male patient was admitted for surgery of Klatskin tumor. He had hypertension and atrial fibrillation. His model for end-stage liver disease score was 16 pts. His serum bilirubin and ammonia levels were 4.75 mg/dL and 132.8 mcg/dL, respectively. Other laboratory data were nonspecific. He underwent extended right hepatic lobectomy including segments IV-VIII for 9 hours. Weight of liver specimen was 1028 g which was about 58% of total liver volume based on computed tomographic volumetry. The patient was extubated and moved to the PACU with stable vital sign and regular self-breathing. He could obey verbal commands. Fifteen minutes after admission to the PACU, the patient showed abruptly decreasing mental status and self-breathing. DIAGNOSES Brain computed tomography, blood culture, and sputum culture were performed to diagnose brain lesions and sepsis for evaluating the sudden onset comatous mental status. Results showed nonspecific finding. INTERVENTIONS He was intubated for securing airway and applying ventilatory care. The patient was moved to the intensive care unit. He received intensive conservative therapy including continuous renal replacement therapy and broad-spectrum antibiotics. OUTCOMES The patient's condition was worsened. He expired on postoperative day 3. LESSONS Acute mental change is uncommon and rare as initial symptoms of PHLF. Therefore, clinician may overlook the diagnosis of PHLF in patients with acute mental change after hepatectomy. Thus, clinician should plan an aggressive treatment for PHLF including liver transplantation by recognizing any suspicious symptom, although such symptom is rare.
Collapse
Affiliation(s)
- Jin Young Chon
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital
| | - Hye Young Moon
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital
| | - Jueun Kwak
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital
| | - Ji Young Lee
- Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital
| | - Eun Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sik Chung
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
48
|
Hasanin AS, Mahmoud FM, Soliman HM. Factors affecting acid base status during hepatectomy in cirrhotic patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ashraf S. Hasanin
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Fatma M.A. Mahmoud
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Hossam M. Soliman
- Department of Hepatobiliary Surgery & Liver Transplantation, National Liver Institute, Menoufia University, Egypt
| |
Collapse
|
49
|
Tomassini F, D'Asseler Y, Giglio MC, Lecluyse C, Lambert B, Sainz-Barriga M, Van Dorpe J, Hoorens A, Geboes K, Troisi RI. Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study. HPB (Oxford) 2019; 21:557-565. [PMID: 30314713 DOI: 10.1016/j.hpb.2018.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/20/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Excessive increase of portal flow and pressure following extended hepatectomy have been associated to insufficient growth or function of the future liver remnant (FLR), with the risk of post-hepatectomy liver failure (PHLF). We prospectively assess the influence of liver hemodynamics on FLR regeneration and function in Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). METHODS Twenty-three patients underwent ALPPS; liver hemodynamics were assessed throughout the procedures. Volume and function of the FLR were evaluated by angio-CT and 99mTc-Mebrofenin-scintigraphy. RESULTS The portal vein flow at the end of stage-1 correlated with the increase of the FLR volume (p = 0.002). Patients with portal vein pressure (PVP) < 20 mmHg and hepatic to portal vein gradients (HVPG) < 15 mmHg at the end of ALPPS-1 showed higher FLR regeneration (76.7% vs. 30.6%, p = 0.04) and function (26.7% vs. -0.13%, p = 0.02). FLR regeneration was inversely correlated with baseline FLR/Total Liver Volume (p = 0.002) and FLR/Body Weight (p = 0.02). No correlation was found between volumes and function (p = 0.13). CONCLUSION Liver hemodynamic stress at the end of ALPPS-1 influences the increase of the FLR volume and function, which is higher with PVP < 20 and HVPG < 15 mmHg. Liver volume overestimates liver function and could be imprecise to set stage-2 timing.
Collapse
Affiliation(s)
| | | | - Mariano C Giglio
- Dept. of General, Hepatobiliary and Liver Transplantation Surgery
| | | | | | - Mauricio Sainz-Barriga
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium; Laboratory of Abdominal Transplantation, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | | | | | - Karen Geboes
- Abdominal Oncology, Ghent University Hospital, Belgium
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Federico II University Naples, Italy.
| |
Collapse
|
50
|
Taman HI, Elhefnawy E. Hepatic Protective Effect of Dexmedetomidine after Partial Hepatectomy Surgery: A Prospective Controlled Study. Anesth Essays Res 2019; 13:132-137. [PMID: 31031493 PMCID: PMC6444966 DOI: 10.4103/aer.aer_106_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Inflow occlusion of the portal triad is a common blood loss-reducing method during hepatectomy which may induce ischemic-reperfusion injury of the remaining parts of the liver. Dexmedetomidine is used for reducing ischemic-reperfusion injury in hepatectomy. Aim: The aim of this study was to assess the protective effect of dexmedetomidine on liver after partial hepatectomy using inflow occlusion. Setting and Design: This prospective controlled, double-blinded, randomized study included any patients of either sex with age between 20 and 70 years, those in physical status American Society of Anesthesiologists Classes I and II, and those who were planned for partial hepatectomy. Patients and Methods: Patients with elective hepatectomy were randomized into dexmedetomidine group, which received dexmedetomidine at 0.3 mg/kg/h, and control group, which received a placebo. Statistical Analysis: Statistical analysis was performed using IBM SPSS software version 18. Data were tested using Kolmogorov–Smirnov test, independent t-test or Mann–Whitney U-test, and Chi-square or Fisher's exact test. The statistical significance was considered at P < 0.05. Results: Serum albumin, aspartate aminotransferase, alanine aminotransferase, prothrombin time were higher in control group in comparison to dexmedetomidine group. Hypotension duration was lower in control group in comparison to dexmedetomidine group. Vasoconstrictor usage, amount of blood loss, and colloid, crystalloid, and blood given to patients were higher in control group in comparison to the study group. Conclusions: Dexmedetomidine can protect the liver during hepatic resection surgery with inflow occlusion with decreasing blood loss and need for blood transfusion.
Collapse
Affiliation(s)
- Hani I Taman
- Department of Anesthesia and Surgical Intensive Care, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Emad Elhefnawy
- Department of Anesthesia and Surgical Intensive Care, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|