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Pianngarn I, Lapisatepun W, Kulpanun M, Chotirosniramit A, Junrungsee S, Lapisatepun W. The effectiveness and outcomes of epidural analgesia in patients undergoing open liver resection: a propensity score matching analysis. BMC Anesthesiol 2024; 24:305. [PMID: 39223470 PMCID: PMC11367829 DOI: 10.1186/s12871-024-02697-1] [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: 05/30/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Open liver resection necessitates a substantial upper abdominal inverted-L incision, resulting in severe pain and compromising patient recovery. Despite the efficacy of epidural analgesia in providing adequate postoperative analgesia, the potential epidural-related adverse effects should be carefully considered. This study aims to compare the efficacy and safety of continuous epidural analgesia and intravenous analgesia in open liver resection. METHODS A retrospective study was conducted, collecting data from patients who underwent open liver resection between 2007 and 2017. Propensity score matching was implemented to mitigate confounding variables, with patients being matched in a 1:1 ratio based on propensity scores. The primary outcome was the comparison of postoperative morphine consumption at 24, 48, and 72 hours between the two groups. Secondary outcomes included pain scores, postoperative outcomes, and epidural-related adverse effects. RESULTS A total of 612 patients were included, and after matching, there were 204 patients in each group. Opioid consumption at 24, 48, and 72 hours postoperatively was statistically lower in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). However, there was no significant difference in pain scores (p = 0.422). Additionally, perioperative hypotension requiring treatment, as well as nausea and vomiting, were significantly higher in the epidural analgesia group compared to the intravenous analgesia group (p < 0.001). CONCLUSIONS Epidural analgesia is superior to intravenous morphine in terms of reducing postoperative opioid consumption within the initial 72 h after open liver resection. Nevertheless, perioperative hypotension, which necessitates management, should be approached with consideration and vigilance. TRIAL REGISTRATION The study was registered in the Clinical Trials Registry at www. CLINICALTRIALS gov/ , NCT number: NCT06301932.
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Affiliation(s)
- Isarapong Pianngarn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Worakitti Lapisatepun
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Maytinee Kulpanun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Anon Chotirosniramit
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Sunhawit Junrungsee
- Department of Surgery, Division of Hepatobilliary Pancreatic Surgery, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
- Clinical Surgical Research Center, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand
| | - Warangkana Lapisatepun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Road, T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
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Patel DJ, LeCompte MT, Kim HJ, Gleeson EM. The prognostic role of aspartate transaminase to platelet ratio index on outcomes after nonemergent major hepatectomy. Surgery 2024; 176:763-768. [PMID: 38987095 DOI: 10.1016/j.surg.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/11/2024] [Accepted: 06/02/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Noninvasive screening methods to identify patients preoperatively with abnormal liver texture remain limited. Aspartate transaminase to platelet ratio index has been validated to predict fibrosis in patients with hepatitis C; however, its use as a predictor of postoperative outcomes in patients without viral hepatitis remains unknown. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program dataset to identify patients who underwent a major hepatectomy between 2014 and 2021. We excluded patients who underwent emergent operations, patients with viral hepatitis, and patients with ascites. Aspartate transaminase to platelet ratio index was calculated using the following equation: (aspartate transaminase/40)/(platelet count) × 100. An aspartate transaminase to platelet ratio index ≥0.7 was used to identify patients with significant fibrosis. Univariable analysis was performed to identify factors associated with aspartate transaminase to platelet ratio index ≥0.7, perioperative transfusion, serious morbidity, overall morbidity, and 30-day mortality. Multivariable logistic regression analysis was performed to identify adjusted predictors of these outcomes. RESULTS Of the 8,933 patients who met inclusion criteria, 1,170 (13.1%) patients had an aspartate transaminase to platelet ratio index ≥0.7. A perioperative blood transfusion was administered to 2,497 (28.0%). The number of patients who experienced overall morbidity, serious morbidity, and mortality were 3,195 (35.8%), 2,665 (29.8%), and 238 (2.7%), respectively. Aspartate transaminase to platelet ratio index ≥0.7 was an independent predictor of transfusion (odds ratio: 1.51 [1.32-1.72], P < .001), overall morbidity (1.16 [1.01-1.33], P = .032), and mortality (1.56 [1.12-2.13], P = .006). Transfusion was an independent predictor of overall morbidity (2.50 [2.26-2.76], P < .001), serious morbidity (2.51 [2.26-2.79], P < .001), and mortality (3.28 [2.49-4.33], P < .001). CONCLUSION An aspartate transaminase to platelet ratio index ≥0.7 is associated with perioperative transfusion, overall morbidity, and 30-day mortality. The aspartate transaminase to platelet ratio index may serve as a noninvasive tool to risk stratify patients before elective major hepatectomy.
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Affiliation(s)
- Dhruv J Patel
- Department of Surgery, University of North Carolina at Chapel Hill Medical Center, NC
| | - Michael T LeCompte
- Department of Surgery, Division of Surgical Oncology, University of North Carolina Rex Hospital, Raleigh, NC; Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill Medical Center, NC
| | - Hong Jin Kim
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill Medical Center, NC. https://twitter.com/kimhjUNC
| | - Elizabeth M Gleeson
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill Medical Center, NC.
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Salenger R, Ad N, Grant MC, Bakaeen F, Balkhy HH, Mick SL, Sardari Nia P, Kempfert J, Bonaros N, Bapat V, Wyler von Ballmoos MC, Gerdisch M, Johnston DR, Engelman DT. Maximizing Minimally Invasive Cardiac Surgery With Enhanced Recovery (ERAS). INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241264565. [PMID: 39205530 DOI: 10.1177/15569845241264565] [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: 09/04/2024]
Abstract
We convened a group of cardiac surgeons, intensivists, and anesthesiologists with extensive experience in minimally invasive cardiac surgery (MICS) and perioperative care to identify the essential elements of a MICS program and the relationship with Enhanced Recovery After Surgery (ERAS). The MICS incision should minimize tissue invasion without compromising surgical goals. MICS also requires safe management of hemodynamics and preservation of cardiac function, which we have termed myocardial management. Finally, comprehensive perioperative care through an ERAS program should be provided to allow patients to achieve optimal recovery. Therefore, we propose that MICS requires 3 elements: (1) a less invasive surgical incision (non-full sternotomy), (2) optimized myocardial management, and (3) ERAS. We contend that the full benefit of MICS can be achieved only by also utilizing an ERAS platform.
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Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Niv Ad
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Grant
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, OH, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medicine, NY, USA
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, The Netherlands
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Abbott Northwestern Hospital Allina Health, Minneapolis, MN, USA
| | - Moritz C Wyler von Ballmoos
- Department of Cardiovascular and Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
| | - Marc Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Indianapolis, IN, USA
| | - Douglas R Johnston
- Division of Cardiac Surgery, Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
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Masior Ł, Krasnodębski M, Smoter P, Morawski M, Kobryń K, Hołówko W, Figiel W, Krawczyk M, Wróblewski T, Grąt M. Rescue liver transplantation for post-hepatectomy liver failure- single center retrospective analysis. BMC Surg 2024; 24:224. [PMID: 39107752 PMCID: PMC11301979 DOI: 10.1186/s12893-024-02515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Liver transplantation (LT) is a well-established method applied for the treatment of various liver diseases, including primary and secondary malignancies, as well as acute liver failure triggered by different mechanisms. In turn, liver failure (PHLF) is the most severe complication observed after liver resection (LR). PHLF is an extremely rare indication for LT. The aim of the present study was to assess the results of LT in patients with PHLF. METHODS Relevant cases were extracted from the prospectively collected database of all LTs performed in our center. All clinical variables, details of the perioperative course of each patient and long-term follow-up data were thoroughly assessed. RESULTS Between January 2000 and August 2023, 2703 LTs were carried out. Among them, six patients underwent LT for PHLF, which accounted for 0.2% of all patients. The median age of the patients was 38 years (range 24-66 years). All patients underwent major liver resection before listing for LT. The 90-day mortality after LT was 66.7% (4 out of 6 patients), and all patients experienced complications in the posttransplant course. One patient required early retransplantation due to primary non-function (PNF). The last two transplanted patients are alive at 7 years and 12 months after LT, respectively. CONCLUSIONS In an unselected population of patients with PHLF, LT is a very morbid procedure associated with high mortality but should be considered the only life-saving option in this group.
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Affiliation(s)
- Łukasz Masior
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland.
| | - Maciej Krasnodębski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Piotr Smoter
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Marcin Morawski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Konrad Kobryń
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Wojciech Figiel
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Tadeusz Wróblewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
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Pilz da Cunha G, Coupé VMH, Zonderhuis BM, Bonjer HJ, Erdmann JI, Kazemier G, Besselink MG, Swijnenburg RJ. Healthcare cost expenditure for robotic versus laparoscopic liver resection: a bottom-up economic evaluation. HPB (Oxford) 2024; 26:971-980. [PMID: 38853074 DOI: 10.1016/j.hpb.2024.05.017] [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: 01/25/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Minimally invasive liver surgery (MILS) is increasingly performed via the robot-assisted approach but may be associated with increased costs. This study is a post-hoc comparison of healthcare cost expenditure for robotic liver resection (RLR) and laparoscopic liver resection (LLR) in a high-volume center. METHODS In-hospital and 30-day postoperative healthcare costs were calculated per patient in a retrospective series (October 2015-December 2022). RESULTS Overall, 298 patients were included (143 RLR and 155 LLR). Benefits of RLR were lower conversion rate (2.8% vs 12.3%, p = 0.002), shorter operating time (167 min vs 198 min, p = 0.044), and less blood loss (50 mL vs 200 mL, p < 0.001). Total per-procedure costs of RLR (€10260) and LLR (€9931) were not significantly different (mean difference €329 [95% bootstrapped confidence interval (BCI) €-1179-€2120]). Lower costs with RLR due to shorter surgical and operating room time were offset by higher disposable instrumentation costs resulting in comparable intraoperative costs (€5559 vs €5247, mean difference €312 [95% BCI €-25-€648]). Postoperative costs were similar for RLR (€4701) and LLR (€4684), mean difference €17 [95% BCI €-1357-€1727]. When also considering purchase and maintenance costs, RLR resulted in higher total per-procedure costs. DISCUSSION In a high-volume center, RLR can have similar per-procedure cost expenditure as LLR when disregarding capital investment.
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Affiliation(s)
- Gabriela Pilz da Cunha
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Veerle M H Coupé
- Amsterdam UMC, Location University of Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - Barbara M Zonderhuis
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - G Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands
| | - Marc G Besselink
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Rutger-Jan Swijnenburg
- Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands.
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Lv H, Jiang X, Huang X, Wang W, Wu B, Yu S, Lan Z, Zhang L, Lao Y, Guo J, Yang N, YangNo N. Nitroglycerin versus milrinone for low central venous pressure in patients undergoing laparoscopic hepatectomy: a double-blinded randomized controlled trial. BMC Anesthesiol 2024; 24:244. [PMID: 39026144 PMCID: PMC11256614 DOI: 10.1186/s12871-024-02631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Conventional anesthesia used to reduce central venous pressure (CVP) during hepatectomy includes fluid restriction and vasodilator drugs, which can lead to a reduction in blood perfusion in vital organs and may counteract the benefits of low blood loss. In this study, we hypothesized that milrinone is feasible and effective in controlling low CVP (LCVP) during laparoscopic hepatectomy (LH). Compared with conventional anesthesia such as nitroglycerin, milrinone is beneficial in terms of intraoperative blood loss, surgical environment, hemodynamic stability, and patients' recovery. METHODS In total, 68 patients undergoing LH under LCVP were randomly divided into the milrinone group (n = 34) and the nitroglycerin group (n = 34). Milrinone was infused with a loading dose of 10 µg/kg followed by a maintenance dose of 0.2-0.5 µg/kg/min and nitroglycerin was administered at a rate of 0.2-0.5 µg/kg/min until the liver lesions were removed. The characteristics of patients, surgery, intraoperative vital signs, blood loss, the condition of the surgical field, the dosage of norepinephrine, perioperative laboratory data, and postoperative complications were compared between groups. Blood loss during LH was considered the primary outcome. RESULTS Blood loss during hepatectomy and total blood loss were significantly lower in the milrinone group compared with those in the nitroglycerin group (P < 0.05). Both the nitroglycerin group and milrinone group exerted similar CVP (P > 0.05). Nevertheless, the milrinone group had better surgical field grading during liver resection (P < 0.05) and also exhibited higher cardiac index and cardiac output during the surgery (P < 0.05). Significant differences were also found in terms of fluids administered during hepatectomy, urine volume during hepatectomy, total urine volume, and norepinephrine dosage used in the surgery between the two groups. The two groups showed a similar incidence of postoperative complications (P > 0.05). CONCLUSION Our findings indicate that the intraoperative infusion of milrinone can help in maintaining an LCVP and hemodynamic stability during LH while reducing intraoperative blood loss and providing a better surgical field compared with nitroglycerin. TRIAL REGISTRATION ChiCTR2200056891,first registered on 22/02/2022.
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Affiliation(s)
- Huayan Lv
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Xiaofeng Jiang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Xiaoxia Huang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Wei Wang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Bo Wu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Shian Yu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Zhijian Lan
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Lei Zhang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Yuwen Lao
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Jun Guo
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Na Yang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
- , No. 365, Renmin East Road, Wucheng District, Jinhua, Zhejiang Province, 321000, People's Republic of China.
| | - Na YangNo
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
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Park JO, Lafaro K, Hagendoorn J, Melstrom L, Gerhards MF, Görgec B, Marsman HA, Thornblade LW, Pilz da Cunha G, Yang FF, Labadie KP, Sham JG, Swijnenburg RJ, He J, Fong Y. Outpatient and Ambulatory Extended Recovery Robotic Hepatectomy: Multinational Study of 307 Cases. J Am Coll Surg 2024; 239:61-67. [PMID: 38770933 DOI: 10.1097/xcs.0000000000001107] [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: 05/22/2024]
Abstract
BACKGROUND For open minor hepatectomy, morbidity and recovery are dominated by the incision. The robotic approach may transform this "incision dominant procedure" into a safe outpatient procedure. STUDY DESIGN We audited outpatient (less than 2 midnights) robotic hepatectomy at 6 hepatobiliary centers in 2 nations to test the hypothesis that the robotic approach can be a safe and effective short-stay procedure. Establishing early recovery after surgery programs were active at all sites, and home digital monitoring was available at 1 of the institutions. RESULTS A total of 307 outpatient (26 same-day and 281 next-day discharge) robotic hepatectomies were identified (2013 to 2023). Most were minor hepatectomies (194 single segments, 90 bi-segmentectomies, 14 three segments, and 8 four segments). Thirty-nine (13%) were for benign histology, whereas 268 were for cancer (33 hepatocellular carcinoma, 27 biliary, and 208 metastatic disease). Patient characteristics were a median age of 60 years (18 to 93 years), 55% male, and a median BMI of 26 kg/m 2 (14 to 63 kg/m 2 ). Thirty (10%) patients had cirrhosis. One hundred eighty-seven (61%) had previous abdominal operation. Median operative time was 163 minutes (30 to 433 minutes), with a median blood loss of 50 mL (10 to 900 mL). There were no deaths and 6 complications (2%): 2 wound infections, 1 failure to thrive, and 3 perihepatic abscesses. Readmission was required in 5 (1.6%) patients. Of the 268 malignancy cases, 25 (9%) were R1 resections. Of the 128 with superior segment resections (segments 7, 8, 4A, 2, and 1), there were 12 positive margins (9%) and 2 readmissions for abscess. CONCLUSIONS Outpatient robotic hepatectomy in well-selected cases is safe (0 mortality, 2% complication, and 1.6% readmission), including resection in the superior or posterior portions of the liver that is challenging with nonarticulating laparoscopic instruments.
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Affiliation(s)
- James O Park
- From the Division of General Surgery, University of Washington, Seattle, WA (Park, Yang, Labadie, Sham)
| | - Kelly Lafaro
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Lafaro, He)
| | - Jeroen Hagendoorn
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands (Hagendoorn)
| | - Laleh Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA (Melstrom, Fong)
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (Gerhards, Marsman)
| | - Burak Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands (Görgec, Pilz da Cunha, Swijnenburg)
| | - Hendrik A Marsman
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (Gerhards, Marsman)
| | - Lucas W Thornblade
- Department of Surgical Oncology, University of California San Fransisco, San Fransisco, CA (Thornblade)
| | - Gabriela Pilz da Cunha
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands (Görgec, Pilz da Cunha, Swijnenburg)
| | - Frank F Yang
- From the Division of General Surgery, University of Washington, Seattle, WA (Park, Yang, Labadie, Sham)
| | - Kevin P Labadie
- From the Division of General Surgery, University of Washington, Seattle, WA (Park, Yang, Labadie, Sham)
| | - Jonathan G Sham
- From the Division of General Surgery, University of Washington, Seattle, WA (Park, Yang, Labadie, Sham)
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands (Görgec, Pilz da Cunha, Swijnenburg)
| | - Jin He
- Division of Hepatobiliary and Pancreatic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Lafaro, He)
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA (Melstrom, Fong)
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8
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Semash K, Dzhanbekov T, Akbarov M, Mirolimov M, Usmonov A, Razzokov N, Primov Z, Gaybullaev T, Yigitaliev S. Implementation of a living donor liver transplantation program in the Republic of Uzbekistan: a report of the first 40 cases. CLINICAL TRANSPLANTATION AND RESEARCH 2024; 38:116-127. [PMID: 38895775 PMCID: PMC11228380 DOI: 10.4285/ctr.24.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/01/2024] [Accepted: 05/05/2024] [Indexed: 06/21/2024]
Abstract
Background Living donor liver transplantation (LDLT) is an effective treatment for patients with end-stage liver disease. This study was performed to evaluate the outcomes of the initial series of LDLT procedures performed in the Republic of Uzbekistan and to demonstrate that liver transplantation is viable under the conditions in this country. Methods Between October 2021 and December 2023, we performed 40 LDLTs. We evaluated both immediate and long-term outcomes. Results Thrombosis of the hepatic artery developed in one case (2.5%). Arterial anastomotic stenoses were diagnosed in three cases (7.5%) and were successfully treated with endovascular balloon vasodilation. Splenic artery steal syndrome arose in three patients (7.5%) and was managed with endovascular embolization of the splenic artery. One patient (2.5%) developed portal vein thrombosis. Portal vein stenosis occurred in two patients (5%) at 10 months posttransplantation and was addressed with endovascular balloon angioplasty, yielding good clinical outcomes. Biliary complications were observed in 45% of the cases, with bile leakages accounting for 89% of these issues and strictures of the biliary anastomoses for 11%. The in-hospital mortality rate was 12.5%. Conclusions Our research findings and analysis of complications align with the international literature, and the results are deemed acceptable during this implementation phase of the liver transplantation program. Accordingly, liver transplantation is feasible in the Republic of Uzbekistan; however, improvements in surgical and therapeutic methods are necessary to minimize the development of both early and late postoperative complications.
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Affiliation(s)
- Konstantin Semash
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
- Department of Faculty and Hospital Surgery and Transplantation, Tashkent Medical Academy, Tashkent, Uzbekistan
- Department of Minimally Invasive Pediatric Surgery, National Children's Medical Center, Tashkent, Uzbekistan
| | - Timur Dzhanbekov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
- Department of Faculty and Hospital Surgery and Transplantation, Tashkent Medical Academy, Tashkent, Uzbekistan
- Department of Minimally Invasive Pediatric Surgery, National Children's Medical Center, Tashkent, Uzbekistan
| | - Mirshavkat Akbarov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
- Department of Faculty and Hospital Surgery and Transplantation, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Miraziz Mirolimov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
| | - Azimjon Usmonov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
| | - Navruz Razzokov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
| | - Ziyodulla Primov
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
| | - Temurbek Gaybullaev
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
- Department of Faculty and Hospital Surgery and Transplantation, Tashkent Medical Academy, Tashkent, Uzbekistan
| | - Sardor Yigitaliev
- Department of HPB Surgery and Liver Transplantation #1, Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan
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9
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De Gasperi A, Petrò L, Amici O, Scaffidi I, Molinari P, Barbaglio C, Cibelli E, Penzo B, Roselli E, Brunetti A, Neganov M, Giacomoni A, Aseni P, Guffanti E. Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist. World J Crit Care Med 2024; 13:92751. [PMID: 38855273 PMCID: PMC11155507 DOI: 10.5492/wjccm.v13.i2.92751] [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: 02/12/2024] [Revised: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024] Open
Abstract
Significant advances in surgical techniques and relevant medium- and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections. To support these outstanding results and to reduce perioperative complications, anesthesiologists must address and master key perioperative issues (preoperative assessment, proactive intraoperative anesthesia strategies, and implementation of the Enhanced Recovery After Surgery approach). Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate. Among postoperative complications, posthepatectomy liver failure (PHLF) occurs in different grades of severity (A-C) and frequency (9%-30%), and it is the main cause of 90-d postoperative mortality. PHLF, recently redefined with pragmatic clinical criteria and perioperative scores, can be predicted, prevented, or anticipated. This review highlights: (1) The systemic consequences of surgical manipulations anesthesiologists must respond to or prevent, to positively impact PHLF (a proactive approach); and (2) the maximal intensive treatment of PHLF, including artificial options, mainly based, so far, on Acute Liver Failure treatment(s), to buy time waiting for the recovery of the native liver or, when appropriate and in very selected cases, toward liver transplant. Such a clinical context requires a strong commitment to surgeons, anesthesiologists, and intensivists to work together, for a fruitful collaboration in a mandatory clinical continuum.
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Affiliation(s)
- Andrea De Gasperi
- Former Head, Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda, Milan 20163, Italy
| | - Laura Petrò
- AR1, Ospedale Papa Giovanni 23, Bergamo 24100, Italy
| | - Ombretta Amici
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Ilenia Scaffidi
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Pietro Molinari
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Caterina Barbaglio
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Eva Cibelli
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Beatrice Penzo
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Elena Roselli
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Andrea Brunetti
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
| | - Maxim Neganov
- Anestesia e Terapia Intensiva Generale, Istituto Clinico Humanitas, Rozzano 20089, Italy
| | - Alessandro Giacomoni
- Chirurgia Oncologica Miniinvasiva, Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda, Milan 20163, Italy
| | - Paolo Aseni
- Dipartimento di Medicina d’Urgenza ed Emergenza, Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda, Milano 20163, MI, Italy
| | - Elena Guffanti
- Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda AR2, ASST GOM Niguarda, Milan 20163, Italy
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10
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Kalil JA, Deschenes M, Perrier H, Zlotnik O, Metrakos P. Navigating Complex Challenges: Preoperative Assessment and Surgical Strategies for Liver Resection in Patients with Fibrosis or Cirrhosis. Biomedicines 2024; 12:1264. [PMID: 38927471 PMCID: PMC11201140 DOI: 10.3390/biomedicines12061264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
This review explores the intricacies of evaluating cirrhotic patients for liver resection while exploring how to extend surgical intervention to those typically excluded by the Barcelona Clinic Liver Cancer (BCLC) criteria guidelines by focusing on the need for robust preoperative assessment and innovative surgical strategies. Cirrhosis presents unique challenges and complicates liver resection due to the altered physiology of the liver, portal hypertension, and liver decompensation. The primary objective of this review is to discuss the current approaches in assessing the suitability of cirrhotic patients for liver resection and aims to identify which patients outside of the BCLC criteria can safely undergo liver resection by highlighting emerging strategies that can improve surgical safety and outcomes.
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Affiliation(s)
- Jennifer A. Kalil
- Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada; (J.A.K.); (H.P.); (O.Z.)
- Cancer Research Program, McGill University Health Center, Research Institute, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
| | - Marc Deschenes
- Department of Medicine, Division of Gastroenterology & Hepatology & Transplantation, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada;
| | - Hugo Perrier
- Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada; (J.A.K.); (H.P.); (O.Z.)
| | - Oran Zlotnik
- Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada; (J.A.K.); (H.P.); (O.Z.)
- Cancer Research Program, McGill University Health Center, Research Institute, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
| | - Peter Metrakos
- Department of Surgery, Royal Victoria Hospital, McGill University Health Center, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada; (J.A.K.); (H.P.); (O.Z.)
- Cancer Research Program, McGill University Health Center, Research Institute, 1001 Blvd Decarie, Montreal, QC H4A 3J1, Canada
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11
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Tufegdzic B, Lobo C, Kumar A. Postoperative pain management after abdominal transplantations. Curr Opin Anaesthesiol 2024:00001503-990000000-00195. [PMID: 38841992 DOI: 10.1097/aco.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The aim of this review article is to present current recommendations as well as knowledge gaps and controversies pertaining to commonly utilized postoperative pain management after solid organ transplantation in the abdominal cavity. RECENT FINDINGS Postsurgical pain has been identified as one of the major challenges in recovery and treatment after solid organ transplants. Many perioperative interventions and management strategies are available for reducing and managing postoperative pain. Management should be tailored to the individual needs, taking an interdisciplinary and holistic approach and following enhanced recovery after surgery guidelines. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. SUMMARY The optimal pain management regimen has not yet been definitively established, and current scientific evidence does not yet support the endorsement of a certain analgesic approach. This objective necessitates the need for high-quality randomized controlled trials.
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Affiliation(s)
- Boris Tufegdzic
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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12
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Ricci C, Grego DG, Alberici L, Ingaldi C, Togni S, De Dona E, Casadei R. Early Versus Late Drainage Removal in Patients Who Underwent Pancreaticoduodenectomy: A Comprehensive Systematic Review and Meta-analysis of Randomized Controlled Trials Using Trial Sequential Analysis. Ann Surg Oncol 2024; 31:2943-2950. [PMID: 38402268 PMCID: PMC10997728 DOI: 10.1245/s10434-024-14959-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/10/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The superiority of early drain removal (EDR) versus late (LDR) after pancreaticoduodenectomy (PD) has been demonstrated only in RCTs. METHODS A meta-analysis was conducted using a random-effects model and trial sequential analysis. The critical endpoints were morbidity, redrainage, relaparotomy, and postoperative pancreatic fistula (CR-POPF). Hemorrhage (PPH), delayed gastric emptying (DGE), length of stay (LOS), and readmission rates were also evaluated. Risk ratios (RRs) and mean differences (MDs) with a 95% confidence interval (CI) were calculated. Type I and type II errors were excluded, comparing the accrued sample size (ASS) with the required sample size (RIS). When RIS is superior to ASS, type I or II errors can be hypothesized. RESULTS ASS was 632 for all endpoints except DGE and PPH (557 patients). The major morbidity (RR 0.55; 95% CI 0.32-0.97) was lower in the EDR group. The CR-POPF rate was lower in the EDR than in the LDR group (RR 0.50), but this difference is not statistically significant (95% CI 0.24-1.03). The RIS to confirm or exclude these results can be reached by randomizing 5959 patients. The need for percutaneous drainage, relaparotomy, PPH, DGE, and readmission rates was similar. The related RISs were higher than ASS, and type II errors cannot be excluded. LOS was shorter in the EDR than the LDR group (MD - 2.25; 95% CI - 3.23 to - 1.28). The RIS was 567, and type I errors can be excluded. CONCLUSIONS EDR, compared with LDR, is associated with lower major morbidity and shorter LOS.
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Affiliation(s)
- Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
- Department of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Davide Giovanni Grego
- Department of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Togni
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ermenegilda De Dona
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC); Alma Mater Studiorum, University of Bologna, Bologna, Italy
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13
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Moosburner S, Dahlke PM, Neudecker J, Hillebrandt KH, Koch PF, Knitter S, Ludwig K, Kamali C, Gül-Klein S, Raschzok N, Schöning W, Sauer IM, Pratschke J, Krenzien F. From morbidity reduction to cost-effectiveness: Enhanced recovery after surgery (ERAS) society recommendations in minimal invasive liver surgery. Langenbecks Arch Surg 2024; 409:137. [PMID: 38653917 PMCID: PMC11039530 DOI: 10.1007/s00423-024-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Minimal-invasive liver surgery (MILS) reduces surgical trauma and is associated with fewer postoperative complications. To amplify these benefits, perioperative multimodal concepts like Enhanced Recovery after Surgery (ERAS), can play a crucial role. We aimed to evaluate the cost-effectiveness for MILS in an ERAS program, considering the necessary additional workforce and associated expenses. METHODS A prospective observational study comparing surgical approach in patients within an ERAS program compared to standard care from 2018-2022 at the Charité - Universitätsmedizin Berlin. Cost data were provided by the medical controlling office. ERAS items were applied according to the ERAS society recommendations. RESULTS 537 patients underwent liver surgery (46% laparoscopic, 26% robotic assisted, 28% open surgery) and 487 were managed by the ERAS protocol. Implementation of ERAS reduced overall postoperative complications in the MILS group (18% vs. 32%, p = 0.048). Complications greater than Clavien-Dindo grade II incurred the highest costs (€ 31,093) compared to minor (€ 17,510) and no complications (€13,893; p < 0.001). In the event of major complications, profit margins were reduced by a median of € 6,640. CONCLUSIONS Embracing the ERAS society recommendations in liver surgery leads to a significant reduction of complications. This outcome justifies the higher cost associated with a well-structured ERAS protocol, as it effectively offsets the expenses of complications.
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Affiliation(s)
- Simon Moosburner
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Paul M Dahlke
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jens Neudecker
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Karl H Hillebrandt
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Pia F Koch
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sebastian Knitter
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kristina Ludwig
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Can Kamali
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Safak Gül-Klein
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, CCM | CVK, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.
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14
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Liu W, Li G, Jin Y, Feng Y, Gao Z, Liu X, Zhou B, Zheng X, Pei X, Ying Y, Yu Q, Yan S, Hu C. Autologous liver transplantation for unresectable hepatobiliary malignancies in enhanced recovery after surgery model. Open Med (Wars) 2024; 19:20240926. [PMID: 38584830 PMCID: PMC10998668 DOI: 10.1515/med-2024-0926] [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: 10/18/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 04/09/2024] Open
Abstract
Ex vivo liver resection combined with autologous liver transplantation offers the opportunity to treat otherwise unresectable hepatobiliary malignancies and has been applied in clinic. The implementation of enhanced recovery after surgery (ERAS) program improves the outcome of surgical procedures. This is a retrospective single-center study including 11 cases of patients with liver cancer that underwent autologous liver transplantation and received ERAS: cholangiocarcinoma of the hilar region (n = 5), intrahepatic cholangiocarcinoma (n = 3), gallbladder cancer (n = 1), liver metastasis from colorectal cancer (n = 1), and liver metastasis from gastrointestinal mesenchymal tumor (n = 1). There were no deaths within 30 days and major complications occurred in two patients, and four patients were readmitted upon the first month after the surgery. Median hospital stay was 20 days (range 13-44) and median open diet was Day 4 (range 2-9) after surgery and median early post-operative activity was Day 5 (range 2-9) after surgery. In conclusion, autologous liver transplantation is feasible in the treatment of otherwise unresectable hepatobiliary malignancies, and our study showed favorable results with autologous liver transplantation in ERAS modality. ERAS modality provides a good option for some patients whose tumors cannot be resected in situ and offers a chance for rapid recovery.
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Affiliation(s)
- Weifeng Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Guogang Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Yitian Jin
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Yihui Feng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Zhenzhen Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Xingyu Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Xiang Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Xiangru Pei
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yulian Ying
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Yu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Chenlu Hu
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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15
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Yang F, Nie J, Xiao F, Liu J. Impacts of enhanced recovery after surgery nursing interventions on wound infection and complications following bladder cancer surgery: A meta-analysis. Int Wound J 2024; 21:e14781. [PMID: 38531376 PMCID: PMC10965273 DOI: 10.1111/iwj.14781] [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: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 03/28/2024] Open
Abstract
A meta-analysis was executed to comprehensively examine the impacts of enhanced recovery after surgery (ERAS) care interventions on complications and wound infections following bladder cancer (BCa) surgery. Computer searches were carried out in Embase, Google Scholar, Cochrane Library, PubMed, Wanfang and CNKI, from their inception to November 2023, for RCTs regarding perioperative ERAS nursing interventions in patients with BCa. Two independent researchers performed literature screening, extracted data and carried out quality evaluations. Stata 17.0 software was utilized for the analysis of the data. Ultimately, 16 RCTs, involving 1190 patients, were included. The analysis showed that, in comparison with conventional nursing methods, perioperative ERAS nursing application in patients with BCa remarkably decreased the occurrence of wound infections (OR: 0.31, 95% CI: 0.16-0.59) and complications (OR: 0.19, 95% CI: 0.13-0.28). Our study indicates that perioperative care based on the ERAS concept remarkably decreased the occurrence of wound infections and complications following BCa surgery, demonstrating notable nursing efficacy and meriting widespread clinical promotion.
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Affiliation(s)
- Fan Yang
- Department of Urology SurgeryTongji Hospital, Tongji Medical College, Hua Zhong University of Science and TechnologyWuhanHubeiChina
| | - Jin Nie
- Department of Urology SurgeryTongji Hospital, Tongji Medical College, Hua Zhong University of Science and TechnologyWuhanHubeiChina
| | - Fan Xiao
- Department of Urology SurgeryTongji Hospital, Tongji Medical College, Hua Zhong University of Science and TechnologyWuhanHubeiChina
| | - Juan Liu
- Department of Urology SurgeryTongji Hospital, Tongji Medical College, Hua Zhong University of Science and TechnologyWuhanHubeiChina
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16
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Perez MN, Raval MV. Evolution of enhanced recovery for children undergoing elective intestinal surgery. Semin Pediatr Surg 2024; 33:151400. [PMID: 38608432 DOI: 10.1016/j.sempedsurg.2024.151400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Enhanced recovery protocols (ERP) have been widely adopted in adult populations, with over 30 years of experience demonstrating the effectiveness of these protocols in patients undergoing gastrointestinal (GI) surgery. In the last decade, ERPs have been applied to pediatric populations across multiple subspecialties. The objective of this manuscript is to explore the evolution of how ERPs have been implemented and adapted specifically for pediatric populations undergoing GI surgery, predominantly for inflammatory bowel disease. The reported findings reflect a thorough exploration of the literature, including initial surveys of practice/readiness assessments, consensus recommendations of expert panels, and data from a rapidly growing number of single center studies. These efforts have culminated in a national prospective, multicenter trial evaluating clinical and implementation outcomes for enhanced recovery in children undergoing GI surgery. In short, this historical and clinical review reflects on the evolution of ERPs in pediatric surgery and expounds upon the next steps needed to apply ERPs to future pediatric populations.
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Affiliation(s)
- Mallory N Perez
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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17
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Praktiknjo M, Trebicka J. Operating under pressure: Is there a place for preoperative TIPS? JHEP Rep 2024; 6:101034. [PMID: 38425449 PMCID: PMC10899019 DOI: 10.1016/j.jhepr.2024.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Michael Praktiknjo
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology, Infectious Diseases, Universitätsklinikum Münster, Münster, Germany
| | - Jonel Trebicka
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology, Infectious Diseases, Universitätsklinikum Münster, Münster, Germany
- European Foundation for the study of Chronic Liver Failure (EF CLiF), Barcelona, Spain
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18
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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).
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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.
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19
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Yin H. Enhanced Recovery after Surgery (ERAS) in Postoperative Lung Cancer Patients: A Novel Perioperative Strategy for Preventing Venous Thromboembolism and Improving Quality of Life. TOHOKU J EXP MED 2024; 262:201-209. [PMID: 38171722 DOI: 10.1620/tjem.2023.j105] [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] [Indexed: 01/05/2024]
Abstract
This study aimed to assess the impact of enhanced recovery after surgery (ERAS) intervention in preventing venous thromboembolism (VTE) among postoperative lung cancer patients. Conducted from January 2022 to January 2023, the research involved 125 lung cancer patients randomly assigned to either a control group (n = 60) receiving routine care, or an ERAS group (n = 65) which received both routine care and ERAS interventions. The ERAS program comprised a comprehensive series of interventions meticulously implemented throughout the preoperative, intraoperative, and postoperative phases. Thrombotic risk assessment using the Caprini Risk Assessment Model (RAM) was conducted preoperatively and on postoperative day 5 (POD 5), with plasma D-dimer levels measured preoperatively, on POD 1, POD 3, and POD 5. Quality of life and patient satisfaction were assessed at discharge using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer Module 13 (QLQ-LC13) and The Newcastle Satisfaction with Nursing Scale (NSNS), respectively. The ERAS group demonstrated significantly lower Caprini RAM scores on POD 5 compared to the control group, with lower D-dimer levels on POD 3 and POD 5. The incidence of VTE was lower in the ERAS group (1.54%) compared to the control group (11.67%) during hospitalization. At discharge, the ERAS group showed improved quality of life, with higher satisfaction scores for nursing care and their hospital stay. ERAS nursing interventions effectively mitigate thrombotic risk, improve D-dimer levels, enhance postoperative quality of life, and elevate patient satisfaction among individuals undergoing lung cancer surgery.
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Affiliation(s)
- Hui Yin
- Lung Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University
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20
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Sánchez-Pérez B, Ramia JM. Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery? World J Gastrointest Oncol 2024; 16:255-258. [PMID: 38425397 PMCID: PMC10900164 DOI: 10.4251/wjgo.v16.i2.255] [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: 11/07/2023] [Revised: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022. Liver surgery is usually performed in oncological patients (liver metastasis, hepatocellular carcinoma, cholangiocarcinoma, etc.), but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined. Theoretical advantages of ERAS programs are: ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes; a better and faster postoperative recovery should let oncologic teams begin chemotherapeutic regimens on time; prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy. So, ERAS could be another way to improve our oncological results. We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.
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Affiliation(s)
- Belinda Sánchez-Pérez
- Department of General, Digestive and Transplantation Surgery, University Regional Hospital, Málaga 29010, Málaga, Spain
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante 03010, Spain
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21
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Pratt CG, Whitrock JN, Shah SA, Fong ZV. How to Determine Unresectability in Hilar Cholangiocarcinoma. Surg Clin North Am 2024; 104:197-214. [PMID: 37953036 DOI: 10.1016/j.suc.2023.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Hilar cholangiocarcinoma is considered a biologically aggressive disease for which surgical resection remains the only curative treatment. Preoperative evaluation for resectability is challenging given tumor proximity to the porta hepatis, but minimal benefit and increased morbidity precludes recommendation for margin positive resection. This article reviews the determination of unresectability in hilar cholangiocarcinoma through discussion of the preoperative assessment, the intraoperative assessment, and key steps of surgical resection, as well as treatment options for unresectable tumors. Overall, evaluating patients preoperatively for resectability requires a multidisciplinary, holistic, and individualized approach to accurately determine resectability and optimize clinical outcomes for patients with hilar cholangiocarcinoma.
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Affiliation(s)
- Catherine G Pratt
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267-0558, USA. https://twitter.com/CPrattMD
| | - Jenna N Whitrock
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267-0558, USA. https://twitter.com/JennaWhitrockMD
| | - Shimul A Shah
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267-0558, USA; Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, MSB 2006C, ML 0519, Cincinnati, OH 45267-0558, USA. https://twitter.com/shimulshah73
| | - Zhi Ven Fong
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Mayo Clinic College of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
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22
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Imai T, Asada Y, Matsuura K. Enhanced recovery pathways for head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx 2024; 51:38-50. [PMID: 37558602 DOI: 10.1016/j.anl.2023.08.001] [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: 05/30/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The enhanced recovery after surgery (ERAS) pathway is designed to facilitate recovery after surgery by packaging evidence-based protocols specific to each aspect of the perioperative period, including the preoperative, intraoperative, postoperative, and post-discharge periods. The ERAS pathway, which was originally developed for use with colonic resection, is now being expanded to include a variety of surgical procedures, and the ERAS Society has published a consensus review of the ERAS pathway for head and neck surgery with free tissue transfer reconstruction (HNS-FTTR). The ERAS pathway for HNS-FTTR consists of various important protocols, including early postoperative mobilization, early postoperative enteral nutrition, abolition of preoperative fasting, preoperative enteral fluid loading, multimodal pain management, and prevention of postoperative nausea and vomiting. In recent years, meta-analyses investigating the utility of the ERAS pathway in head and neck cancer surgery have also been presented, and all reports showed that the length of the postoperative hospital stay was reduced by the implementation of the ERAS pathway. The ERAS pathway is now gaining traction in the field of head and neck surgery; however, the details of its efficacy remain uncertain. We believe the future direction will require research focused on improving the quality of postoperative patient recovery and patient satisfaction. It will be important to use patient-reported outcomes to determine whether the ERAS pathway is actually beneficial.
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Affiliation(s)
- Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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23
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Pagano D, Li Petri S, di Francesco F, Calamia S, Accardo C, Vella I, Barbàra M, Gruttadauria S. Which Factors Are Associated with Distal Pancreatectomy Outcomes' Optimization with the Application of an Enhanced Recovery After Surgery Program? J Laparoendosc Adv Surg Tech A 2024; 34:106-112. [PMID: 38029364 DOI: 10.1089/lap.2023.0445] [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] [Indexed: 12/01/2023] Open
Abstract
Background: Distal pancreatectomy (DP) represents the best therapeutic option for patients with body-tail pancreatic neoplasms (PNs). The enhanced recovery after surgery protocol is widely used for treating patients with PN to speed up postoperative recovery. This study aims to describe our institute's experience in the application of fast recovery protocol in a cohort of patients treated with DP, identifying predictors facilitating a decrease in the length of hospital stay. Patient and Methods: Were retrospectively enrolled 60 consecutive cases of DP performed from January 2016 to June 2022 in patients treated with enhanced recovery protocol, 25% of them were treated with spleen preserving procedure. Single-variable logistic regression models were used to evaluate the potential association between patient characteristics and the probability of postoperative complications. Standard linear regression models were used for length of stay, number of postoperative days (PODs) from surgery to full bowel function recovery, and PODs to the interruption of intravenous analgesia administration. Results: Thirty-four (57%) patients underwent open surgery and 26 (43%) laparoscopic surgery. Patients who underwent laparoscopic surgery and spleen-preserving procedures experienced a lower complication rate (P = .037), shorter length of stay, and time of analgesic requirements. With single-variable logistic regression models patients treated with laparoscopic surgery had statistically significant higher recovery times in terms of nasogastric tube removal (P = .004) and early enteral nutrition (P = .001). Conclusion: Continual refinement with enhanced recovery protocol for treating PN patients based on perioperative counseling and surgical decision-making is crucial to reduce patient morbidity and time for recovery.
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Affiliation(s)
- Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Sergio Calamia
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Caterina Accardo
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Ivan Vella
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Marco Barbàra
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), UPMC (University of Pittsburgh Medical Center) Italy, Palermo, Italy
- Department of Surgery and Surgical and Medical Specialties, University of Catania, Catania, Italy
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24
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Lo Tesoriere R, Ferrero A. ASO Author Reflections: Advances in Minimally Invasive Liver Surgery: Laparoscopic Liver Tunnel for Challenging Tumor Localizations. Ann Surg Oncol 2024; 31:804-805. [PMID: 37996636 DOI: 10.1245/s10434-023-14624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano Umberto I, Turin, Italy.
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
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25
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Schwenk W, Flemming S, Girona-Johannkämper M, Wendt W, Darwich I, Strey C. [Structured implementation of fast-track pathways to enhance recovery after elective colorectal resection : First results from five German hospitals]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:148-156. [PMID: 37947802 DOI: 10.1007/s00104-023-01986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Multimodal optimized perioperative management (mPOM, fast-track, enhanced recovery after surgery, ERAS) leads to a significantly accelerated recovery of patients with elective colorectal resections. Nevertheless, fast-track surgery has not yet become established in everyday clinical practice in Germany. We present the results of a structured fast-track implementation in five German hospitals. METHODS Prospective data collection in the context of a 13-month structured fast-track implementation. All patients ≥ 18 years undergoing elective colorectal resection and who gave informed consent were included. After 3 months of preparation (pre-FAST), fast-track treatment was initiated and continued for 10 months (FAST). Outcome criteria were adherence to internationally recommended fast-track elements, postoperative complications, functional recovery, and postoperative hospital stay. RESULTS Data from 192 pre-FAST and 529 FAST patients were analyzed. Age, sex, patient risk, location, and type of disease were not different between both groups. The FAST patients were more likely to have undergone minimally invasive surgery (82% vs. 69%). Fast-track adherence increased from 52% (35-65%) under traditional treatment to 83% (65-96%) under fast-track treatment (p < 0.01). The duration until the end of infusion treatment, removal of the bladder catheter, first bowel movement, oral solid food, regaining autonomy, suitability for discharge and postoperative length of stay were significantly lower in the FAST group. Complications, reoperations, and readmission rates did not differ. CONCLUSION Fast-track adherence rates > 75% can also be achieved in German hospitals through structured fast-track implementation and the recovery of patients can be significantly accelerated.
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Affiliation(s)
- Wolfgang Schwenk
- Gesellschaft für Optimiertes perioperatives Management, GOPOM GmbH, Düsseldorf, Deutschland.
- Gesellschaft für Optimiertes Perioperatives Management GOPOPM GmbH, Oberlörickerstr. 390b, 40547, Düsseldorf, Deutschland.
| | - Sven Flemming
- Universitätsklinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Wolfgang Wendt
- Viszeralchirurgie / Proktologie, Diakonissenkrankenhaus Dresden, Dresden, Deutschland
| | - Ibrahim Darwich
- Klinik für Allgemein- und Viszeralchirurgie, St. Marien Krankenhaus Siegen, Siegen, Deutschland
| | - Christoph Strey
- Klinik für Allgemein- und Viszeralchirurgie, DRK Krankenhaus Clementinenhaus, Hannover, Deutschland
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26
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Dahlke PM, Benzing C, Lurje G, Malinka T, Raschzok N, Kamali C, Gül-Klein S, Schöning W, Hillebrandt KH, Pratschke J, Neudecker J, Krenzien F. Impact of complexity in minimally invasive liver surgery on enhanced recovery measures: prospective study. BJS Open 2024; 8:zrad147. [PMID: 38242574 PMCID: PMC10799324 DOI: 10.1093/bjsopen/zrad147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/30/2023] [Accepted: 10/31/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Adherence to enhanced recovery after surgery (ERAS) protocols is crucial for successful liver surgery. The aim of this study was to assess the impact of minimally invasive liver surgery complexity on adherence after implementing an ERAS protocol. METHODS Between July 2018 and August 2021, a prospective observational study involving minimally invasive liver surgery patients was conducted. Perioperative treatment followed ERAS guidelines and was recorded in the ERAS interactive audit system. Kruskal-Wallis and ANOVA tests were used for analysis, and pairwise comparisons utilized Wilcoxon rank sum and Welch's t-tests, adjusted using Bonferroni correction. RESULTS A total of 243 patients were enrolled and categorized into four groups based on the Iwate criteria: low (n = 17), intermediate (n = 81), advanced (n = 74) and expert difficulty (n = 71). Complexity correlated with increased overall and major morbidity rate, as well as longer length of stay (all P < 0.001; standardized mean difference = 0.036, 0.451, 0.543 respectively). Adherence to ERAS measures decreased with higher complexity (P < 0.001). Overall adherence was 65.4%. Medical staff-centred adherence was 79.9%, while patient-centred adherence was 38.9% (P < 0.001). Complexity significantly affected patient-centred adherence (P < 0.001; standardized mean difference (SMD) = 0.420), but not medical staff-centred adherence (P = 0.098; SMD = 0.315). Postoperative phase adherence showed major differences among complexity groups (P < 0.001, SMD = 0.376), with mobilization measures adhered to less in higher complexity cases. CONCLUSION The complexity of minimally invasive liver surgery procedures impacts ERAS protocol adherence for each patient. This can be addressed using complexity-adjusted cut-offs and 'gradual adherence' based on the relative proportion of cut-off values achieved.
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Affiliation(s)
- Paul M Dahlke
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Georg Lurje
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Malinka
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Can Kamali
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Safak Gül-Klein
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Karl H Hillebrandt
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Jens Neudecker
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Charité–Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
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27
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Zhou A, Lv X, Wang L, Wang H, Lu M. Effects of fast-track recovery programme on the surgical site wound infection in patients undergoing biliary stones surgery: A meta-analysis. Int Wound J 2024; 21:e14546. [PMID: 38272815 PMCID: PMC10794056 DOI: 10.1111/iwj.14546] [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: 11/10/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 01/27/2024] Open
Abstract
To systematically evaluate the effects of a fast-track recovery programme on perioperative wound infections and postoperative complications in patients undergoing biliary tone surgery, we conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure databases from inception to 29 September 2023 for randomised controlled trials (RCTs) focusing on the application of a fast-track recovery programme in patients undergoing biliary stone surgery. Two researchers independently screened and evaluated the studies based on predefined inclusion and exclusion criteria, and data were subsequently extracted from the included studies. Stata software (version 17.0) was employed for data analysis. Overall, 19 RCTs involving 2363 patients were included, with 1178 patients allocated to the fast-track recovery programme group and 1185 to the conventional care group. The results revealed a significantly lower occurrence of wound infection (3.74% vs. 9.45%, OR = 0.36, 95% CI: 0.25-0.51, p < 0.001) and postoperative complications (11.38% vs. 27.34%, OR = 0.31, 95% CI: 0.25-0.39, p < 0.001) in the fast-track recovery programme group compared to the conventional care group. The available evidence supports the assertion that implementing a fast-track recovery programme in the perioperative period of patients undergoing biliary stone surgery effectively reduces the incidence of wound infections and postoperative complications while facilitating postoperative recovery.
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Affiliation(s)
- Anyi Zhou
- Department of Hepatobiliary Vascular SurgeryJinan City People's HospitalJinanChina
| | - Xiuhong Lv
- Department of Cardiothoracic SurgeryJinan City People's HospitalJinanChina
| | - Le Wang
- Department of PathologyJinan City People's HospitalJinanChina
| | - Huan Wang
- Department of Hepatobiliary Vascular SurgeryJinan City People's HospitalJinanChina
| | - Mingshu Lu
- Department of Hepatobiliary Vascular SurgeryJinan City People's HospitalJinanChina
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28
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Earasi A, Kappus M. Getting your transplant center ready for prime time: Health care system obstacles to prehabilitation. Clin Liver Dis (Hoboken) 2024; 23:e0170. [PMID: 38872771 PMCID: PMC11168849 DOI: 10.1097/cld.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/18/2024] [Indexed: 06/15/2024] Open
Abstract
1_i4s1nhjfKaltura.
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29
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Zhao D, Sun X, Guo X, Jianfeng W. Analysis of effect of colonoscopy combined with laparoscopy in the treatment of colorectal tumors. Technol Health Care 2024; 32:2115-2128. [PMID: 38995811 DOI: 10.3233/thc-230800] [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] [Indexed: 07/14/2024]
Abstract
BACKGROUND Colorectal cancer is one of the most common digestive tract tumors. OBJECTIVE To evaluate the feasibility and safety of laparoscopic colorectal cancer surgery. METHODS This study retrospectively analyzed early postoperative clinical data of 48 patients with colorectal cancer treated in our hospital between 2015 and 2021, of which 21 underwent laparoscopic colorectal surgery, and 27 underwent laparotomy. There was no significant difference in clinical data. Patients were included if they had colorectal cancer (confirmed by colonoscopy and biopsy pathological examination before surgery), were evaluated for possible radical surgery before surgery, and had no intestinal obstruction, tumor invasion of adjacent organs (by digital rectal examination and preoperative abdominal color Doppler ultrasound, CT confirmed) and no other history of abdominal surgery. Using the method of clinical control study, operation time, intraoperative blood loss, postoperative general condition, surgical lymph node removal (postoperative pathology), surgical complications, gastrointestinal function recovery, surgical before and after blood glucose, body temperature, white blood cells, pain visual analog scale (VAS) and other conditions were compared and analyzed to determine feasibility and safety of laparoscopic surgery for colorectal cancer. RESULTS Colorectal cancer was successfully removed by laparoscopic radical resection without any significant problems or surgical fatalities. Age, gender, tumor location, stage, and duration of surgery did not differ between laparoscopic and laparotomy operations. Compared to laparotomy, postoperative eating, bowel movements, and blood sugar levels improved. Variations in the length of surgically removed specimens after VAS measurements revealed open and laparoscopic operations. The overall lymph node count was 10.8 ± 1.6, with no variation between the two techniques. CONCLUSION Laparoscopic colorectal cancer radical surgery is safe and feasible. Also, it has the advantages of minimally invasive surgery. Laparoscopic colorectal cancer radical surgery can comply with the principles of oncology revolutionary.
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Nigam A, Hawksworth JS, Winslow ER. Minimally Invasive Robotic Techniques for Hepatocellular Carcinoma Resection: How I Do It. Surg Oncol Clin N Am 2024; 33:111-132. [PMID: 37945137 DOI: 10.1016/j.soc.2023.06.009] [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] [Indexed: 11/12/2023]
Abstract
The adoption of minimally invasive techniques for hepatocellular resection has progressively increased in North America. Cumulative evidence has demonstrated improved surgical outcomes in patients who undergo minimally invasive hepatectomy. In this review, the authors' approach and methodology to minimally invasive robotic liver resection for hepatocellular carcinoma is discussed.
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Affiliation(s)
- Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 4PHC, Washington, DC 20007, USA
| | - Jason S Hawksworth
- Division of Abdominal Organ Transplantation, Columbia University Irving Medical Center, 622 West 168th Street, PH14-105, New York, NY 20032, USA.
| | - Emily R Winslow
- Department of Transplant Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, 2PHC, Washington, DC 20007, USA
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Zhou H, Liu F, Liu Y, He X, Ma H, Xu M, Wang H, Zhang G, Cai X, Chen JY, Guo L, Chen J. Protocol for the PORT study: short-term perioperative rehabilitation to improve outcomes in cardiac valvular surgery - a randomised control trial. BMJ Open 2023; 13:e074837. [PMID: 38135333 DOI: 10.1136/bmjopen-2023-074837] [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] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Perioperative rehabilitation (PORT) has shown a positive effect on patients undergoing cardiac surgery. However, there are minimal data on the impact of short-term PORT in cardiac surgery, which is associated with higher postoperative morbidity and mortality. The trial will assess the efficacy of short-term PORT in reducing in-hospital mortality, postoperative pulmonary complications and length of stay, compared with the usual care in cardiac surgical patients. METHODS AND ANALYSIS This is a single-centre prospective, randomised, open, controlled trial with a 1:1 ratio. Consecutive 800 adult patients undergoing elective valve surgery will be randomised to either usual care or in-hospital short-term PORT that consists of education, inspiratory muscle training, active cycle of breathing techniques and early mobilisation. The primary outcome of this study will be a composite of in-hospital all-cause mortality, incidence of postoperative pulmonary complications and the ratio of postoperative hospitalisation >7 days. ETHICS AND DISSEMINATION The PORT study was granted by the Medical Research Ethics Committee of Guangdong Provincial People's Hospital in August 2018. Findings will be disseminated to patients, clinicians and commissioning groups through peer-reviewed publication. TRIAL REGISTRATION NUMBER NCT03709511.
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Affiliation(s)
- Haofeng Zhou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xuyu He
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Mingyu Xu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Haochen Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guolin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiangyu Cai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lan Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jimei Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
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Christopher CN, Kang DW, Wilson RL, Gonzalo-Encabo P, Ficarra S, Heislein D, Dieli-Conwright CM. Exercise and Nutrition Interventions for Prehabilitation in Hepato-Pancreato-Biliary Cancers: A Narrative Review. Nutrients 2023; 15:5044. [PMID: 38140303 PMCID: PMC10745391 DOI: 10.3390/nu15245044] [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: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Gastrointestinal (GI) cancers constitute over 25% of global cancer cases annually, with hepato-pancreato-biliary (HPB) cancers presenting particularly poor prognosis and challenging surgical treatments. While advancements in clinical care have improved post-operative outcomes over time, surgery for HPB cancers remains associated with high morbidity and mortality rates. Patients with HPB cancer are often older, diagnosed at later stages, and have a higher prevalence of co-morbid conditions, leading to reduced life expectancy, suboptimal post-operative recovery, and increased recurrence risk. Exercise and nutrition interventions have emerged as safe non-pharmacological strategies to enhance clinical outcomes among cancer survivors, but their potential in the pre-operative period for patients with HPB cancer remains underexplored. This narrative review evaluates existing evidence on exercise and nutritional interventions during pre-operative prehabilitation for HPB cancer populations, focusing on clinically relevant post-operative outcomes related to frailty and malnutrition. We conducted a literature search in PubMed and Google Scholar databases to identify studies utilizing a prehabilitation intervention in HPB cancer populations with exercise and nutritional components. The currently available evidence suggests that incorporating exercise and nutrition into prehabilitation programs offers a critical opportunity to enhance post-operative outcomes, mitigate the risk of comorbidities, and support overall survivorship among HPB cancer populations. This review underscores the need for further research to optimize the timing, duration, and components of pre-operative prehabilitation programs, emphasizing patient-centered, multidisciplinary approaches in this evolving field.
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Affiliation(s)
- Cami N. Christopher
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Dong-Woo Kang
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Rebekah L. Wilson
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Paola Gonzalo-Encabo
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Harvard Medical School, Boston, MA 02115, USA
- Departamento de Ciencias Biomédicas, Área de Educación Física y Deportiva, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28801 Madrid, Spain
| | - Salvatore Ficarra
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, 90133 Palermo, Italy
| | - Diane Heislein
- Department of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Christina M. Dieli-Conwright
- Department of Medical Oncology, Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA; (C.N.C.); (D.-W.K.); (R.L.W.); (P.G.-E.); (S.F.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Kang RA, Ko JS. Living liver donor pain management. Curr Opin Organ Transplant 2023; 28:391-396. [PMID: 37678396 DOI: 10.1097/mot.0000000000001099] [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: 09/09/2023]
Abstract
PURPOSE OF REVIEW Optimal pain control in living liver donors undergoing hepatectomy is strongly recommended considering their unique status as healthy individuals willingly undergoing surgery for the benefit of the recipient. This review aims to examine and evaluate different strategies aimed at ensuring effective postoperative pain management in living liver donors. RECENT FINDINGS Enhanced recovery after surgery (ERAS) protocols have proven effective in optimizing patient outcomes, including in living liver donor hepatectomy. By implementing these protocols, healthcare professionals can enhance postoperative pain control and accelerate recovery. Multimodal analgesia, which combines different techniques and agents, is crucial in pain management for living liver donors. Regional analgesia techniques, such as spinal anesthesia and various peripheral nerve blocks, have shown efficacy in reducing pain and facilitating early recovery. Systemic nonopioid analgesics, including acetaminophen, nonsteroidal anti-inflammatory drugs, ketamine, lidocaine, and dexmedetomidine act synergistically to alleviate pain and reduce inflammation. Minimizing the use of opioids is important to avoid adverse effects, and they should be reserved for rescue medication or breakthrough pain. SUMMARY Applying the principles of ERAS and multimodal analgesia to living liver donors can effectively control pain while promoting early recovery.
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Affiliation(s)
- Ryung A Kang
- Department of Anesthesiology and Pain Management, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Smet H, Martin D, Uldry E, Duran R, Girardet R, Schaefer N, Prior JO, Denys A, Halkic N, Demartines N, Melloul E. Tc-99m mebrofenin hepatobiliary scintigraphy to assess future liver remnant function before major liver surgery. J Surg Oncol 2023; 128:1312-1319. [PMID: 37638473 DOI: 10.1002/jso.27426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/12/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Assessment of liver function is paramount before hepatectomy. This study aimed to assess future liver remnant function (FLR-F) using hepatobiliary scintigraphy (HBS) and to compare it to FLR volume (FLR-V) in the prediction of posthepatectomy liver failure (PHLF). The impact of volume and function gains were also assessed in patients undergoing portal vein embolization (PVE) or liver venous deprivation (LVD). METHODS All consecutive patients undergoing major hepatectomy between 02/2018 and 09/2021 with preoperative HBS were included. FLR-V was expressed as percentage of total liver volume and analyzed using preoperative computed tomography. FLR-V and FLR-F gains after embolization were expressed in percentage. Receiver operating characteristic analysis was performed to compare both methods in predicting PHLF. RESULTS Thirty-six patients were included. PVE and LVD were performed in 4 (11%) and 28 patients (78%), respectively. Overall, PHLF occurred in eight patients (22%). FLR-F gain after embolization showed significant ability to predict PHLF (area under the curve [AUC] = 0.789), with cut-off value of 150% showing a sensitivity of 1.00, a specificity of 0.42, and a negative predictive value of 1.00. CONCLUSION Preoperative HBS shows a high sensitivity to predict PHLF when HBS is performed twice to measure the function gain after venous embolization.
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Affiliation(s)
- Héloïse Smet
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Rafaël Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Raphael Girardet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), Lausanne, Switzerland
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White MJ, Jensen EH, Brauer DG. A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers. Semin Intervent Radiol 2023; 40:536-543. [PMID: 38274223 PMCID: PMC10807965 DOI: 10.1055/s-0043-1777747] [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: 01/27/2024]
Abstract
The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.
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Affiliation(s)
- McKenzie J. White
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric H. Jensen
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David G. Brauer
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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Liu J, Zheng QQ, Wu YT. Effect of enhanced recovery after surgery with multidisciplinary collaboration on nursing outcomes after total knee arthroplasty. World J Clin Cases 2023; 11:7745-7752. [DOI: 10.12998/wjcc.v11.i32.7745] [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: 09/27/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND There is a lack of studies on the effects of enhanced recovery after surgery (ERAS) with multidisciplinary collaboration on the nursing outcomes of total knee arthroplasty (TKA).
AIM To explore the effect of ERAS with multidisciplinary collaboration on nursing outcomes after TKA.
METHODS We retrospectively analyzed the clinical data of 80 patients who underwent TKA at a tertiary hospital between January 2021 and December 2022. The patients were divided into two groups according to the nursing mode: the ERAS group (n = 40) received ERAS with multidisciplinary collaboration, and the conventional group (n = 40) received routine nursing. The following indicators were compared between the two groups: length of hospital stay, hospitalization cost, intraoperative blood loss, hemoglobin level 24 h after surgery, visual analog scale (VAS) score for pain, range of motion (ROM) of the knee joint, Hospital for Special Surgery (HSS) knee score, and postoperative complications.
RESULTS The ERAS group had a significantly shorter length of hospital stay, lower hospitalization cost, less intraoperative blood loss, higher hemoglobin level 24 h after surgery, lower VAS score for pain, higher knee joint ROM, and higher HSS knee score than the conventional group (all P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05).
CONCLUSION Multidisciplinary collaboration with ERAS can reduce blood loss, shorten hospital stay, and improve knee function in patients undergoing TKA.
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Affiliation(s)
- Jing Liu
- Operating Room, Shangrao People's Hospital, Shangrao 334000, Jiangxi Province, China
| | - Qian-Qian Zheng
- Operating Room, Shangrao People's Hospital, Shangrao 334000, Jiangxi Province, China
| | - Yang-Tao Wu
- Operating Room, Shangrao People's Hospital, Shangrao 334000, Jiangxi Province, China
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Gu YX, Wang XY, Chen Y, Shao JX, Ni SX, Zhang XM, Shao SY, Zhang Y, Hu WJ, Ma YY, Liu MY, Yu H. Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol. World J Gastrointest Surg 2023; 15:2191-2200. [PMID: 37969721 PMCID: PMC10642464 DOI: 10.4240/wjgs.v15.i10.2191] [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: 05/27/2023] [Revised: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Rehabilitation of elderly patients with a high body mass index (BMI) after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies. The enhanced recovery after surgery (ERAS) protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications. AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI. METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022. Among them, 99 patients were managed using the traditional perioperative care approach (non-ERAS protocol), while the remaining 99 patients were managed using the ERAS protocol. Relevant indicator data were collected for patients preoperatively, intraoperatively, and postoperatively, and surgical outcomes were compared between the two groups. RESULTS The comparison results between the two groups of patients in terms of age, sex, BMI, underlying diseases, surgical type, and preoperative hospital stay showed no statistically significant differences. However, the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group (4.0 ± 0.9 h vs 7.6 ± 0.9 h). Regarding intraoperative indicators, there were no significant differences between the two groups of patients. However, in terms of postoperative recovery, the ERAS protocol group exhibited significant advantages over the non-ERAS group, including a shorter hospital stay, lower postoperative pain scores and postoperative hunger scores, and higher satisfaction levels. The readmission rate was lower in the ERAS protocol group than in the non-ERAS group (3.0% vs 8.1%), although the difference was not significant. Furthermore, there were significant differences between the two groups in terms of postoperative nausea and vomiting severity, postoperative abdominal distention at 24 h, and daily life ability scores. CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy, including reduced readmission rates, decreased postoperative nausea and vomiting, alleviated abdominal distension, and enhanced functional capacity. While the protocol may not exhibit significant improvement in early postoperative symptoms, it does exhibit advantages in long-term postoperative symptoms and recovery. These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients, as it contributes to improving patients' recovery and quality of life while reducing health care resource utilization.
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Affiliation(s)
- Yue-Xia Gu
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Xin-Yu Wang
- Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, Shanghai 200434, China
| | - Yang Chen
- Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, Shanghai 200434, China
| | - Jun-Xiu Shao
- Department of Nursing, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Shen-Xian Ni
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Xiu-Mei Zhang
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Si-Yu Shao
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Yu Zhang
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Wen-Jing Hu
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Ying-Ying Ma
- Department of Nursing, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Meng-Yao Liu
- Department of Nursing, Shanghai Xuhui Central Hospital, Shanghai 200031, China
| | - Hua Yu
- Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, Shanghai 200434, China
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Mendez E, Puig G, Barquero M, Leon A, Bellafont J, Colomina MJ. Enhanced recovery after surgery: a narrative review on patient blood management recommendations. Minerva Anestesiol 2023; 89:906-913. [PMID: 37307032 DOI: 10.23736/s0375-9393.23.17389-5] [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: 06/13/2023]
Abstract
This review aims to analyze and document the presence of patient blood management (PBM) recommendations in enhanced recovery after surgery (ERAS) guidelines. The aim of ERAS programs is to improve outcomes and optimize patient recovery by reducing the stress response to surgery. PBM programs pursue the objective of improving outcomes by boosting and conserving the patient's own blood. From the early development of ERAS, there was little attention paid to the three pillars of perioperative blood management. Preoperative anemia is an important risk factor in perioperative outcomes and should be diagnosed and treated. Bleeding and unnecessary transfusions should be avoided. We analyzed clinical guidelines for scheduled surgery in adults published by the ERAS Society between 2018 and 2022. The guidelines selected were searched for recommendations related to the three pillars of PBM. We selected 15 ERAS guidelines in programmed surgery in adults. Until 2018, none of the ERAS guidelines analyzed included any recommendations related to pillars I and III of PBM. In 2019, recommendations related to the three pillars of PBM were introduced in the ERAS clinical guidelines for colorectal surgery, gynecology/oncology surgery, and lung resection surgery. However, many ERAS guidelines for surgeries with a high risk of bleeding, such as cardiac surgery, contain no clear recommendations on the management of preoperative anemia. This review shows that the ERAS guidelines published to date make very few recommendations related to PBM. The authors emphasize the need to include the most efficient PBM recommendations in ERAS clinical guidelines, given improved outcomes with a good perioperative management of blood transfusion.
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Affiliation(s)
- Esther Mendez
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain -
| | - Guillermo Puig
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Marta Barquero
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Ariadna Leon
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Javier Bellafont
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
- Department of Anesthesiology and Intensive Care, University of Barcelona, Barcelona, Spain
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Wagner D, Wienerroither V, Scherrer M, Thalhammer M, Faschinger F, Lederer A, Hau HM, Sucher R, Kornprat P. Value of sarcopenia in the resection of colorectal liver metastases-a systematic review and meta-analysis. Front Oncol 2023; 13:1241561. [PMID: 37841447 PMCID: PMC10569723 DOI: 10.3389/fonc.2023.1241561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/07/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Sarcopenia is defined as a decline in muscle function as well as muscle mass. Sarcopenia itself and sarcopenic obesity, defined as sarcopenia in obese patients, have been used as surrogates for a worse prognosis in colorectal cancer. This review aims to determine if there is evidence for sarcopenia as a prognostic parameter in colorectal liver metastases (CRLM). Methods PubMed, Embase, Cochrane Central, Web of Science, SCOPUS, and CINAHL databases were searched for articles that were selected in accordance with the PRISMA guidelines. The primary outcomes were overall survival (OS) and disease-free survival (DFS). A random effects meta-analysis was conducted. Results After eliminating duplicates and screening abstracts (n = 111), 949 studies were screened, and 33 publications met the inclusion criteria. Of them, 15 were selected after close paper review, and 10 were incorporated into the meta-analysis, which comprised 825 patients. No significant influence of sarcopenia for OS (odds ratio (OR), 2.802 (95% confidence interval (CI), 1.094-1.11); p = 0.4) or DFS (OR, 1.203 (95% CI, 1.162-1.208); p = 0.5) was found, although a trend was defined toward sarcopenia. Sarcopenia significantly influenced postoperative complication rates (OR, 7.905 (95% CI, 1.876-3.32); p = 0.001) in two studies where data were available. Conclusion Existing evidence on the influence of sarcopenia on postoperative OS as well as DFS in patients undergoing resection for CRLM exists. We were not able to confirm that sarcopenic patients have a significantly worse OS and DFS in our analysis, although a trend toward this hypothesis was visible. Sarcopenia seems to influence complication rates but prospective studies are needed.
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Banasiewicz T, Kobiela J, Cwaliński J, Spychalski P, Przybylska P, Kornacka K, Bogdanowska-Charkiewicz D, Leyk-Kolańczak M, Borejsza-Wysocki M, Batycka-Stachnik D, Drwiła R. Recommendations on the use of prehabilitation, i.e. comprehensive preparation of the patient for surgery. POLISH JOURNAL OF SURGERY 2023; 95:62-91. [PMID: 38348849 DOI: 10.5604/01.3001.0053.8854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Prehabilitation is a comprehensive preparation of a patient for primarily surgical treatments. Its aim is to improve the patient'sgeneral condition so as to reduce the risk of complications and ensure the fastest possible recovery to full health. Thebasic components of prehabilitation include: improvement of nutritional status, appropriate exercises to improve functioning,psychological support, and help in eliminating addictions. Other important aspects of prehabilitation are: increasinghemoglobin levels in patients with anemia, achieving good glycemic control in patients with diabetes, treatment or stabilizationof any concurrent disorders, or specialist treatment associated with a specific procedure (endoprostheses, ostomyprocedure). This article organizes and outlines the indications for prehabilitation, its scope, duration, and the method to conductit. Experts of various specialties related to prehabilitation agree that it should be an element of surgery preparationwhenever possible, especially in patients with co-existing medical conditions who have been qualified for major procedures.Prehabilitation should be carried out by interdisciplinary teams, including family physicians and various specialists in thetreatment of comorbidities. Prehabilitation requires urgent systemic and reimbursement solutions.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Jarosław Kobiela
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Spychalski
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Patrycja Przybylska
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Karolina Kornacka
- Oddział Chirurgii Ogólnej, Onkologicznej i Kolorektalnej, Wielospecjalistyczny Szpital Miejski im. J. Strusia, Poznań
| | | | - Magdalena Leyk-Kolańczak
- Zakład Pielęgniarstwa Chirurgicznego, Klinika Chirurgii Ogólnej, Endokrynologicznej i Transplantacyjnej, Gdański Uniwersytet Medyczny
| | - Maciej Borejsza-Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Dominika Batycka-Stachnik
- Oddział Kliniczny Chirurgii Serca, Naczyń i Transplantologii, Krakowski Szpital Specjalistyczny im. Św. Jana Pawła II, Kraków
| | - Rafał Drwiła
- Katedra i Zakład Anestezjologii i Intensywnej Terapii, Collegium Medicum Uniwersytet Jagielloński, Kraków
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Ratnasekara V, Weinberg L, Johnston SA, Fletcher L, Nugraha P, Cox DRA, Hu R, Meyer I, Yoshino O, Perini MV, Muralidharan V, Nikfarjam M, Lee DK. Multimodal intrathecal analgesia (MITA) with morphine for reducing postoperative opioid use and acute pain following hepato-pancreato-biliary surgery: A multicenter retrospective study. PLoS One 2023; 18:e0291108. [PMID: 37682837 PMCID: PMC10490836 DOI: 10.1371/journal.pone.0291108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION The optimal analgesic modality for patients undergoing hepato-pancreato-biliary (HPB) surgery remains unknown. The analgesic effects of a multimodal intrathecal analgesia (MITA) technique of intrathecal morphine (ITM) in combination with clonidine and bupivacaine compared to ITM alone have not been investigated in these patients. METHODS We performed a multicenter retrospective study of patients undergoing complex HPB surgery who received ITM, bupivacaine, and clonidine (MITA group) or ITM-only (ITM group) as part of their perioperative analgesia strategy. The primary outcome was the unadjusted oral morphine equivalent daily dose (oMEDD) in milligrams on postoperative day 1. After adjusting for age, body mass index, hospital allocation, type of surgery, operation length, and intraoperative opioid use, postoperative oMEDD use was investigated using a bootstrapped quantile regression model. Other prespecified outcomes included postoperative pain scores, opioid-related adverse events, major complications, and length of hospital stay. RESULTS In total, 118 patients received MITA and 155 patients received ITM-only. The median (IQR) cumulative oMEDD use on postoperative day 1 was 20.5 mg (8.6:31.0) in the MITA group and 52.1 mg (18.0:107.0) in the ITM group (P < 0.001). There was a variation in the magnitude of the difference in oMEDD use between the groups for different quartiles. For the MITA group, on postoperative day 1, patients in the 25th percentile required 14.0 mg less oMEDD (95% CI: -25.9 to -2.2; P = 0.025), patients in the 50th percentile required 27.8 mg less oMEDD (95% CI: -49.7 to -6.0; P = 0.005), and patients in the 75th percentile required 38.7 mg less oMEDD (95% CI: -72.2 to -5.1; P = 0.041) compared to patients in the same percentile of the ITM group. Patients in the MITA group had significantly lower pain scores in the postoperative recovery unit and on postoperative days 1 to 3. The incidence of postoperative respiratory depression was low (<1.5%) and similar between groups. Patients in the MITA group had a significantly higher incidence of postoperative hypotension requiring vasopressor support. However, no significant differences were observed in major postoperative complications, or the length of hospital stay. CONCLUSION In patients undergoing complex HPB surgery, the use of MITA, consisting of ITM in combination with intrathecal clonidine and bupivacaine, was associated with reduced postoperative opioid use and resulted in superior postoperative analgesia without risk of respiratory depression when compared to patients who received ITM alone. A randomized prospective clinical trial investigating these two intrathecal analgesic techniques is justified.
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Affiliation(s)
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia
| | | | - Luke Fletcher
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health, Heidelberg, Australia
| | - Patrick Nugraha
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | | | - Raymond Hu
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | - Ilonka Meyer
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | - Osamu Yoshino
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Marcos Vinius Perini
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia
| | | | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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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.
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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
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Willner A, Teske C, Hackert T, Welsch T. Effects of early postoperative mobilization following gastrointestinal surgery: systematic review and meta-analysis. BJS Open 2023; 7:zrad102. [PMID: 37846641 PMCID: PMC10580147 DOI: 10.1093/bjsopen/zrad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Early postoperative mobilization is considered a key element of enhanced recovery after surgery protocols. The aim of this study was to summarize the effect of early postoperative mobilization following gastrointestinal operations on patient recovery, mobility, the morbidity rate and duration of hospital stay. METHODS A systematic literature search was conducted in December, 2022, using PubMed, Web of Science and the Cochrane Central Register of Controlled Trials. Controlled trials reporting the effects of early postoperative mobilization after gastrointestinal surgery were included. The risk of bias was assessed using a modified Downs and Black tool and the Cochrane Collaboration tool for randomized trials. The outcomes of interest were gastrointestinal recovery (defined passage of first flatus or bowel movements), mobility (step count on postoperative day 3), the morbidity rate and duration of hospital stay. RESULTS After elimination of duplicates, 3678 records were identified, and 71 full-text articles were screened. Finally, 15 studies (eight RCTs) reporting on 3538 patients were included. Most trials evaluated early postoperative mobilization after different gastrointestinal operations, including upper gastrointestinal (n = 8 studies), hepatopancreatobiliary (n = 10 studies) and colorectal resections (n = 10 studies). The investigated early postoperative mobilization protocols, operative techniques (minimally invasive or open) and outcome parameters were heterogeneous between the studies. Early postoperative mobilization seemed to significantly accelerate clinical gastrointestinal recovery (mean difference, hours: -11.53 (-22.08, -0.97), P = 0.03). However, early postoperative mobilization did not significantly improve the morbidity rate (risk ratio: 0.93 (0.70, 1.23), P = 0.59), postoperative mobility of patients (step count mean difference: 1009 (-803, 2821), P = 0.28) or shorten the duration of hospital stay (mean difference, days: -0.25 (-0.99,0.43), P = 0.47) in randomized trials. CONCLUSION There is a large heterogeneity among the study cohorts, operations and interventions. The available evidence currently does not support specific early postoperative mobilization protocols as an isolated element to further reduce the morbidity rate and duration of hospital stay. Further well-designed trials are required to identify effective early postoperative mobilization protocols.
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Affiliation(s)
- Antonie Willner
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of General, Visceral and Thoracic Surgery, St. Elisabethen-Klinikum Ravensburg, Academic Teaching Hospital University of Ulm, Ravensburg, Germany
| | - Christian Teske
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden—Rossendorf (HZDR), Dresden, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Welsch
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Wang D, Liao C, Tian Y, Zheng T, Ye H, Yu Z, Jiang J, Su J, Chen S, Zheng X. Analgesic efficacy of an opioid-free postoperative pain management strategy versus a conventional opioid-based strategy following open major hepatectomy: an open-label, randomised, controlled, non-inferiority trial. EClinicalMedicine 2023; 63:102188. [PMID: 37692074 PMCID: PMC10485032 DOI: 10.1016/j.eclinm.2023.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background Convincing clinical evidence regarding completely opioid-free postoperative pain management using erector spinae plane block (ESPB) in patients undergoing open major hepatectomy (OMH) is lacking. Herein, we aimed to compare the postoperative analgesic efficacy of the visualised continuous opioid-free ESPB (VC-ESPB) and conventional intravenous opioid-based postoperative pain management in hepatocellular carcinoma (HCC) patients undergoing OMH. Methods This open-label, randomised, controlled, non-inferiority trial enrolled patients with HCC undergone open major hepatectomy in Fujian Provincial Hospital and compared the postoperative analgesic efficacy of VC-ESPB (VC-ESPB group) and conventional intravenous opioid-based pain management regimen (conventional group). Patients were randomly assigned (1:1) to VC-ESPB group and conventional group. Patients were not masked to treatment allocation. The VC-ESPB group was treated with intermittent injections of 0.25% ropivacaine (bilateral, 30 mL each side) given every 12 h through catheters placed in the space of erector spinae and an opioid-free intravenous pump (10-mg tropisetron diluted to 100 mL with 0.9% normal saline [NS]) for postoperative pain management. The conventional group did not receive ESPB and was treated with a conventional intravenous opioid-based pump (2.5-μg/kg sufentanil and 10-mg tropisetron diluted to 100 mL with 0.9% NS). Patients in the VC-ESPB group underwent magnetic resonance imaging (MRI) to identify local anaesthetic diffusion after ESPB was performed under ultrasound guidance. The primary outcome was postoperative analgesic efficacy, which was indicated by the cumulative area under the curve (AUC) of the pain visual analogue scale scores (range, 0-10; a higher score indicates more pain) obtained at rest and at movement until 48 h postoperatively after leaving the post-anaesthesia care unit (PACU). Herein, an AUC of 26.5 was set as the noninferiority margin, which needed to be satisfied for both cumulative AUCPACU-48 h at rest and cumulative AUCPACU-48 h at movement. Per protocol participants were included in primary and safety analyses. This trial was registered with ChiCTR.org.cn (ChiCTR1900026583). Findings Between October 30, 2019, and May 1, 2023, 106 patients were enrolled and randomly assigned to the VC-ESPB group (n = 53) and the conventional group (n = 53). After the dropout (n = 5), a total of 101 patients (VC-ESPB group, n = 50; conventional group, n = 51) were analysed. Both the level of cumulative AUCPACU-48 h (at rest: 160.08 ± 38.00 vs. 164.94 ± 31.00; difference [90% CI], -4.861 [-16.308, 6.585]) and cumulative AUCPACU-48 h (at movement: 209.64 ± 28.98 vs. 212.59 ± 33.11; difference [90% CI], -2.948 [-13.236, 7.339]) were similar between the VC-ESPB and control groups within the first postoperative 48 h. The upper limit of the 90% CIs for the difference in cumulative ACUPACU-48 h at rest and at movement did not reach the upper inferiority margin (26.5). During the first postoperative 48 h, the rate of nonsteroidal anti-inflammatory drug rescue analgesia was similar between the VC-ESPB group and conventional group (n = 16, 32.0% vs. n = 11, 21.6%; P = 0.236). Treatment-related death was not observed in the VC-ESPB group (n = 0, 0%) and conventional group (n = 0, 0%). In VC-ESPB group, local site paralysis (n = 1, 2.0%) was observed in one patient and rash (n = 1, 2.0%) was observed in another patient. One patient in the conventional group was observed with rash preoperatively (n = 1, 2.0%). The VC-ESPB group had significantly lower rates of postoperative nausea (n = 2, 4.0%, vs. n = 9, 17.6%, P = 0.028), vomiting (n = 1, 2.0% vs. n = 8, 15.7%, P = 0.031) and lower incidence of major complications (n = 4, 8.0% vs. n = 6, 11.8%; P = 0.033). Interpretation This study demonstrates the noninferiority of VC-ESPB when compared with the conventional opioid-based approach for postoperative pain management after OMH, suggesting that it is feasible to achieve opioid-free postoperative pain management for OMH. Funding The Joint Funds for the Innovation of Science and Technology, Fujian Province, China; the Youth Scientific Research Project of Fujian Provincial Health Commission; the Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare; and the Key Clinical Specialty Discipline Construction Program of Fujian, China.
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Affiliation(s)
- Danfeng Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chengyu Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Yifeng Tian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Ting Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Huazhen Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Zenggui Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jundan Jiang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jiawei Su
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Shi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaochun Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, Fujian, China
- Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of “Belt and Road”, Fuzhou, China
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef C, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford) 2023; 25:985-999. [PMID: 37471055 DOI: 10.1016/j.hpb.2023.05.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. METHODS This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term "early metachronous metastases" applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with "late metachronous metastases" applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSIONS The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jose M Ramia-Angel
- Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Center, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita Salute San Raffaele University & IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall D'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Lower Austria, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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46
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Jamioł-Milc D, Gudan A, Kaźmierczak-Siedlecka K, Hołowko-Ziółek J, Maciejewska-Markiewicz D, Janda-Milczarek K, Stachowska E. Nutritional Support for Liver Diseases. Nutrients 2023; 15:3640. [PMID: 37630830 PMCID: PMC10459677 DOI: 10.3390/nu15163640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The liver is a key organ that is responsible for the metabolism of proteins, fats, and carbohydrates and the absorption and storage of micronutrients. Unfortunately, the prevalence of chronic liver diseases at various stages of advancement in the world population is significant. Due to the physiological function of the liver, its dysfunction can lead to malnutrition and sarcopenia, and the patient's nutritional status is an important prognostic factor. This review discusses key issues related to the diet therapy of patients with chronic liver diseases, as well as those qualified for liver transplantation and in the postoperative period.
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Affiliation(s)
- Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | - Anna Gudan
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | - Karolina Kaźmierczak-Siedlecka
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Joanna Hołowko-Ziółek
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | | | - Katarzyna Janda-Milczarek
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef K, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. Br J Surg 2023; 110:1161-1170. [PMID: 37442562 PMCID: PMC10416695 DOI: 10.1093/bjs/znad124] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. METHODS This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term 'early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term 'late metachronous metastases' applies to those detected after 12 months. 'Disappearing metastases' applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSION The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Centre, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | | | - Kees Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, Hepatopancreatobiliary Centre, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Centre for Global Health and Medicine, Tokyo, Japan
| | | | - Andres Valdivieso
- Hepatopancreatobiliary Surgery and Liver Transplant, HU Cruces, Bilbao, Spain
| | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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Lv H, Xiong C, Wu B, Lan Z, Xu D, Duan D, Huang X, Guo J, Yu S. Effects of targeted mild hypercapnia versus normocapnia on cerebral oxygen saturation in patients undergoing laparoscopic hepatectomy under low central venous pressure: a prospective, randomized controlled study. BMC Anesthesiol 2023; 23:257. [PMID: 37525100 PMCID: PMC10388477 DOI: 10.1186/s12871-023-02220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Laparoscopic hepatectomy under low central venous pressure (LCVP) is associated with intraoperative organ hypoperfusion, including cerebral hypoperfusion. We hypothesized that a ventilation strategy designed to achieve targeted mild hypercapnia (TMH) (end-tidal carbon dioxide partial pressure [PetCO2] of 45 ± 5 mmHg) rather than targeted normocapnia (TN) (PetCO2 of 30 ± 5 mmHg) would increase regional cerebral oxygen saturation (rSO2) during laparoscopic hepatectomy under LCVP. METHODS Eighty patients undergoing laparoscopic hepatectomy under LCVP were randomly divided into the TMH group (n = 40) and the TN group (n = 40). Mechanical ventilation was adjusted to maintain the PetCO2 within the relevant range. Cerebral oxygenation was monitored continuously using the FORE-SIGHT system before anesthetic induction until the patient left the operating room. Patient and surgical characteristics, rSO2, intraoperative hemodynamic parameters (CVP, mean artery blood pressure [MAP], and heart rate), PetCO2, intraoperative blood gas analysis results, and postoperative complications were recorded. RESULTS No significant differences were observed in CVP, MAP, and heart rate between the two groups during surgery. The rSO2 was significantly lower in the TN group on both the left and right sides during the intraoperative period (P < 0.05), while the TMH group had a stable rSO2. In the TN group, the mean rSO2 decreased most during liver parenchymal transection when compared with the baseline value (P < 0.05). The mean (standard deviation) percentage change in rSO2 from baseline to parenchymal transection was - 7.5% (4.8%) on the left and - 7.1% (4.6%) on the right. The two groups had a similar incidence of postoperative complications (P > 0.05). CONCLUSION Our findings demonstrate that rSO2 is better maintained during laparoscopic hepatectomy under LCVP when patients are ventilated to a PetCO2 of 45 ± 5 mmHg (TMH) than a PetCO2 of 30 ± 5 mmHg (TN). TRIAL REGISTRATION ChiCTR2100051130(14/9/2021).
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Affiliation(s)
- Huayan Lv
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Chang Xiong
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Bo Wu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Zhijian Lan
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Duojia Xu
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Dingnan Duan
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Xiaoxia Huang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Jun Guo
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
| | - Shian Yu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
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Husarova T, MacCuaig WM, Dennahy IS, Sanderson EJ, Edil BH, Jain A, Bonds MM, McNally MW, Menclova K, Pudil J, Zaruba P, Pohnan R, Henson CE, Grizzle WE, McNally LR. Intraoperative Imaging in Hepatopancreatobiliary Surgery. Cancers (Basel) 2023; 15:3694. [PMID: 37509355 PMCID: PMC10377919 DOI: 10.3390/cancers15143694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Hepatopancreatobiliary surgery belongs to one of the most complex fields of general surgery. An intricate and vital anatomy is accompanied by difficult distinctions of tumors from fibrosis and inflammation; the identification of precise tumor margins; or small, even disappearing, lesions on currently available imaging. The routine implementation of ultrasound use shifted the possibilities in the operating room, yet more precision is necessary to achieve negative resection margins. Modalities utilizing fluorescent-compatible dyes have proven their role in hepatopancreatobiliary surgery, although this is not yet a routine practice, as there are many limitations. Modalities, such as photoacoustic imaging or 3D holograms, are emerging but are mostly limited to preclinical settings. There is a need to identify and develop an ideal contrast agent capable of differentiating between malignant and benign tissue and to report on the prognostic benefits of implemented intraoperative imaging in order to navigate clinical translation. This review focuses on existing and developing imaging modalities for intraoperative use, tailored to the needs of hepatopancreatobiliary cancers. We will also cover the application of these imaging techniques to theranostics to achieve combined diagnostic and therapeutic potential.
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Affiliation(s)
- Tereza Husarova
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - William M. MacCuaig
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Isabel S. Dennahy
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Emma J. Sanderson
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Barish H. Edil
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Ajay Jain
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Morgan M. Bonds
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Molly W. McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Katerina Menclova
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Jiri Pudil
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Pavel Zaruba
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Radek Pohnan
- Department of Surgery, Military University Hospital Prague, 16902 Prague, Czech Republic
| | - Christina E. Henson
- Department of Radiation Oncology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lacey R. McNally
- Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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50
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Huang H, Zhou P, Li J, Luo H, Yu L. Enhanced recovery after surgery in primary liver cancer patients undergoing hepatectomy: experience from a large tertiary hospital in China. BMC Surg 2023; 23:185. [PMID: 37386393 DOI: 10.1186/s12893-023-02040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) has significant effects in gastrointestinal surgery, urology, and orthopedic department, but the application of ERAS in liver cancer patients undergoing hepatectomy is less reported. This study aims to identify the effectiveness and safety of ERAS in liver cancer patients undergoing hepatectomy. METHODS Patients who performed ERAS and no-ERAS after hepatectomy due to liver cancer from 2019 to 2022 were prospectively and retrospectively collected, respectively. Preoperative baseline data, surgical characteristics, and postoperative outcomes of patients in ERAS and non-ERAS groups were compared and analyzed. Logistic regression analysis was conducted to identify the risk factors of complications occurrence and prolonged hospital stay. RESULTS In total, 318 patients were included in the study, 150 and 168 individuals in the ERAS group and non-ERAS group, respectively. The preoperative baseline and surgical characteristics between the ERAS and non-ERAS groups were comparable and not statistically different. Postoperative visual analogue scale pain score, the median day of gastrointestinal function recovery postoperative, complications rate, and postoperative hospitalization days were lower in the ERAS group than in the non-ERAS group. In addition, multivariate logistic regression analysis found that the implementation of the ERAS was an independent protective factor for prolonged hospitalization stay and complications occurrence. The rate of rehospitalization after discharge (< 30 days) in the ERAS group was lower than that in the non-ERAS group, but there was no statistical difference between the two groups. CONCLUSIONS The application of ERAS in hepatectomy for patients with liver cancer is safe and effective. It can accelerate gastrointestinal function recovery postoperative, shorten the length of hospital stay, and reduce postoperative pain and complications.
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Affiliation(s)
- Huan Huang
- Center for Nurturing Care Research, School of Nursing, Wuhan University, Wuhan, 430071, China
- Departement of hepatic surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ping Zhou
- Center for Nurturing Care Research, School of Nursing, Wuhan University, Wuhan, 430071, China
| | - Jia Li
- Center for Nurturing Care Research, School of Nursing, Wuhan University, Wuhan, 430071, China
| | - Hongping Luo
- Departement of hepatic surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Liping Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, Wuhan, 430071, China.
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