1
|
Tang SC, Xu JH, Yang YF, Shi JN, Lin KY, Kong J, Wang XM, Fan ZQ, Gu WM, Zhou YH, Liu HZ, Liang YJ, Shen F, Lau WY, Zeng YY, Yang T. Impact of Hepatic Pedicle Clamping on Long-Term Survival Following Hepatectomy for Hepatocellular Carcinoma: Stratified Analysis Based on Intraoperative Blood Transfusion Status. Ann Surg Oncol 2024; 31:1812-1822. [PMID: 38038790 DOI: 10.1245/s10434-023-14642-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Hepatic pedicle clamping (HPC) is frequently utilized during hepatectomy to reduce intraoperative bleeding and diminish the need for intraoperative blood transfusion (IBT). The long-term prognostic implications of HPC following hepatectomy for hepatocellular carcinoma (HCC) remain under debate. This study aims to elucidate the association between HPC and oncologic outcomes after HCC resection, stratified by whether IBT was administered. PATIENTS AND METHODS Prospectively collected data on patients with HCC who underwent curative resection from a multicenter database was studied. Patients were stratified into two cohorts on the basis of whether IBT was administered. The impact of HPC on long-term overall survival (OS) and recurrence-free survival (RFS) between the two cohorts was assessed by univariable and multivariable Cox regression analyses. RESULTS Of 3362 patients, 535 received IBT. In the IBT cohort, using or not using HPC showed no significant difference in OS and RFS outcomes (5-year OS and RFS rates 27.9% vs. 24.6% and 13.8% vs. 12.0%, P = 0.810 and 0.530). However, in the non-IBT cohort of 2827 patients, the HPC subgroup demonstrated significantly decreased OS (5-year 45.9% vs. 56.5%, P < 0.001) and RFS (5-year 24.7% vs. 33.3%, P < 0.001) when compared with the subgroup without HPC. Multivariable Cox regression analysis identified HPC as an independent risk factor of OS and RFS [hazard ratios (HR) 1.16 and 1.12, P = 0.024 and 0.044, respectively] among patients who did not receive IBT. CONCLUSIONS The impact of HPC on the oncological outcomes following hepatectomy for patients with HCC differed significantly whether IBT was administered, and HPC adversely impacted on long-term survival for patients without receiving IBT during hepatectomy.
Collapse
Affiliation(s)
- Shi-Chuan Tang
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jia-Hao Xu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Yi-Fan Yang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jia-Ning Shi
- Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kong-Ying Lin
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Kong
- Department of Hepatobiliary, Heze Municiple Hospital, Shandong, China
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong, China
| | - Zhong-Qi Fan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Wei-Min Gu
- The First Department of General Surgery, Fourth Hospital of Harbin, Heilongjiang, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, China
| | - Hong-Zhi Liu
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Wan Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yong-Yi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
- Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- The Liver Disease Research Center of Fujian Province, Fuzhou, China.
| | - Tian Yang
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
2
|
Parra-Membrives P, Lorente-Herce JM, Jiménez-Riera G, Martínez-Baena D. Stroke volume variation does not correlate with central venous pressure during hepatectomy. HPB (Oxford) 2023; 25:518-520. [PMID: 36822927 DOI: 10.1016/j.hpb.2023.01.013] [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: 12/26/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Central venous pressure measurement has been the standard for patient monitoring during hepatectomy to assure low pressure and reduce blood loss. Recently SVV has been employed to monitor preload and guide fluid replacement during liver surgery. The aim of the study is to determine if SVV correlates with CVP values and may replace CVP measurement. METHODS From January 2021 to February 2022 thirty patients undergoing 32 liver resections were included in the study. Repeated paired data of CVP and SVV were determined every 10 minutes throughout liver resection. The Correlation between CVP and SVV values was calculated. Analysis was then stratified by surgical approach, hilar clamping tempus, operative timing and PEEP values. RESULTS A total number of 519 paired SSV/CVP values were recorded. Only a very weak correlation between SSV and CVP was detected (Pearson coefficient -0.122/ p=0.005). The results were unaltered after the stratified analysis by surgical approach, presence of hilar clamping, operative timing and PEEP use, revealing no correlation between SSV and CVP values. CONCLUSION The CVP /SVV values do not show a relevant correlation during liver surgery. CVP measurement is still of value and should not be replaced by SVV monitoring to conduct a safe hepatectomy.
Collapse
Affiliation(s)
- Pablo Parra-Membrives
- Associate Professor of the Department of Surgery, University of Seville, Spain; Hepatobiliary and Pancreatic Surgery Unit of the General and Digestive Surgery Department, Valme University Hospital, Sevilla, Spain.
| | - José M Lorente-Herce
- Hepatobiliary and Pancreatic Surgery Unit of the General and Digestive Surgery Department, Valme University Hospital, Sevilla, Spain
| | - Granada Jiménez-Riera
- Associate Professor of the Department of Surgery, University of Seville, Spain; Hepatobiliary and Pancreatic Surgery Unit of the General and Digestive Surgery Department, Valme University Hospital, Sevilla, Spain
| | - Darío Martínez-Baena
- Associate Professor of the Department of Surgery, University of Seville, Spain; Hepatobiliary and Pancreatic Surgery Unit of the General and Digestive Surgery Department, Valme University Hospital, Sevilla, Spain
| |
Collapse
|
3
|
Iida H, Maehira H, Mori H, Tani M. Efficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy. Asian J Endosc Surg 2020; 13:505-513. [PMID: 31997578 DOI: 10.1111/ases.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/24/2019] [Accepted: 01/06/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The methods of liver parenchymal transection vary across institutions. In this study, we used a radiofrequency (RF) sealer (Aquamantys) as a hemostatic device during laparoscopic liver transection; we also evaluated the usefulness of RF sealers. METHODS From April 2016 to May 2019, 113 consecutive laparoscopic hepatectomy patients, excluding patients with combined resection of other organs, were examined. Patient characteristics, operative factors, and postoperative complications were compared between the Cavitron ultrasonic surgical aspirator (CUSA) + soft coagulation system (VIO) group; (n = 32) and the CUSA + Aquamantys group; (n = 81). The former underwent liver transection by CUSA and VIO from April 2016 to March 2017, while the latter underwent liver transection using CUSA and Aquamantys from April 2017 to May 2019. RESULTS The median difficulty score was significantly higher in the CUSA + VIO group (5.5 points vs 5.0 points; P = .04). Blood loss per unit area and the liver parenchymal transection speed were not significantly different between the groups. After propensity score matching, blood loss per unit area was similar between the groups, but the parenchymal transection speed of the CUSA + Aquamantys group was significantly higher (0.92 cm2 /min vs 0.64 cm2 /min; P = .017). Postoperative complications were similar between the groups. CONCLUSION In laparoscopic hepatectomy, hemostasis of the transection plane with an RF sealer did not reduce blood loss during parenchymal transection. However, the liver parenchymal transection speed was increased.
Collapse
Affiliation(s)
- Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Japan
| |
Collapse
|
4
|
Xiao L, Wang Z, Zhou L. "Liver parenchyma dissecting-first" method facilitates the Glissonean pedicle approach in anatomical laparoscopic hepatolobectomy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:940. [PMID: 32953740 PMCID: PMC7475421 DOI: 10.21037/atm-20-4674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Anatomical laparoscopic hepatolobectomy (ALH) is a difficult and challenging operation, and avoiding massive hemorrhage during parenchyma transection remains one of its major concern. Glissonean pedicle approach (GPA) has achieved great success in open liver surgery due to its simplicity and reproducibility, but it is difficult to apply in ALH for the limited vision and motion. We thus aimed to introduce a modified method to facilitate the GPA in ALH. Methods In this retrospective study, in 15 patients who underwent ALH (at least 2 couinaud segments), the liver parenchyma was dissected at first (LPDF) adequately under intermittent total inflow control to reveal the Glissonean pedicle (GP) sufficiently for safe and precise transection. The technical details of LPDF for different types of hepatolobectomy and a modified laparoscopic Pringle maneuver are described, and the surgical outcomes are reviewed. Results LPDF was applied in all patients, and intraoperative blood transfusion was not needed. LPDF facilitated GPA in ALH without any severe morbidity or mortality. Conclusions LPDF is a safe and effective technique, it reduces the difficulties in inflow occlusion in GPA and can promote the application of ALH. Further clinical control trails are needed to validate the superiority of LPDF compared with GPA in ALH.
Collapse
Affiliation(s)
- Liang Xiao
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiming Wang
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ledu Zhou
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Fonouni H, Khajeh E, Ghamarnejad O, Kashfi A, Aydogdu E, Majlesara A, Mohammadi S, Gharabaghi N, Konstantinidis L, Longerich T, Mehrabi A, Kulu Y. Histopathological effects of modern topical sealants on the liver surface after hepatectomy: an experimental swine study. Sci Rep 2019; 9:7088. [PMID: 31068637 PMCID: PMC6506469 DOI: 10.1038/s41598-019-43694-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/27/2019] [Indexed: 12/11/2022] Open
Abstract
The present study aimed to determine the impact of different sealant materials on histopathological changes to the liver surface after liver resection. Thirty-six landrace pigs underwent left anatomical hemihepatectomy and were assigned to a histopathological control group (HPC, n = 9) with no bleeding control, a clinically simulated control group (CSC, n = 9) with no sealant but bipolar cauterization and oversewing of the liver surface, and two treatment groups (n = 9 each) with a collagen-based sealant (CBS) or a fibrinogen-based sealant (FBS) on resection surface. After postoperative day 6, tissue samples were histologically examined. There were no significant differences in preoperative parameters between the groups. Fibrin production was higher in sealant groups compared with the HPC and CSC groups (both p < 0.001). Hepatocellular regeneration in sealant groups was higher than in both control groups. A significantly higher regeneration was seen in the FBS group. Use of sealants increased the degree of fibrin exudation at the resection plane. Increased hepatocellular necrosis was seen in the CBS group compared with the FBS group. The posthepatectomy hepatocellular regeneration rate was higher in the FBS group compared with the CBS group. Randomized studies are needed to assess the impact of sealants on posthepatectomy liver regeneration in the clinical setting.
Collapse
Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Emre Aydogdu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sara Mohammadi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lukas Konstantinidis
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Longerich
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
| |
Collapse
|
6
|
Al-Saeedi M, Fonouni H, Kashfi A, Ghamarnejad O, Majlesara A, Gharabaghi N, Stahlheber O, Kraus TW, Mehrabi A, Kulu Y. Mechanical strength of biliary defect closure after topical sealing: Comparison of four sealants in a porcine model. Asian J Surg 2019; 42:723-730. [PMID: 30600147 DOI: 10.1016/j.asjsur.2018.11.009] [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: 06/21/2018] [Revised: 11/18/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE Biliary leakage is a potential complication of liver resection and is still a concern. The aim of the present study was to evaluate the effectiveness of four routinely used sealants in preventing bile leakage under pressure from an induced perforation of the gallbladder in a porcine model. METHODS Forty Landrace pigs were randomly assigned to one of five groups. These included a control group (n = 8) and one group each for the sealants TachoSil®, TissuCol Duo®, Coseal®, and FloSeal® (n = 8 per group). In the control group, the perforation was left unsealed. To evaluate the biliostatic potential of the sealants, we measured the pressure that was needed to induce leakage (mmHg) and the gallbladder volume (cc) at the time of leakage in each group. RESULTS A significantly higher mean pressure was required to induce leakage in the sealant groups compared with the control group. However, the biliostatic effects were heterogeneous among the sealant groups. Sealants with the highest to lowest effectiveness were TachoSil, Coseal, TissuCol, and FloSeal. The mean gallbladder volume at the time of leakage also varied between sealant groups. CONCLUSION Biliostatic properties are markedly improved by the use of modern sealants compared with using no sealant. However, the advantages and disadvantages of using sealants should be carefully considered in each clinical situation. The effectiveness of the sealants should be evaluated in chronic and clinical studies.
Collapse
Affiliation(s)
- Mohammad Al-Saeedi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Thomas W Kraus
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
| |
Collapse
|
7
|
Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3275284. [PMID: 30410925 PMCID: PMC6205105 DOI: 10.1155/2018/3275284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/16/2018] [Indexed: 12/14/2022]
Abstract
Partial liver resection is a treatment of choice for liver tumors; the range of parenchyma excision varies from a small part of the tissue surrounding the neoplasm up to 70% of the organ. One of the major concerns during liver resection is blood loss. Thulium lasers which are characterized by the length of emission wave corresponding to a peak absorption of water create a new possibility of cutting tissues efficiently with minimal thermal damage and concurrently providing a good hemostasis control. The aim of our study was to evaluate an impact of liver transection with thulium doped fiber laser on an intraoperative bleeding and histopathological changes during postoperative period in swine model. Ten animals were subjected to open surgery partial liver resection and an incision of liver tissue with an all-fiber, diode-pumped, and continuous-wave Tm3+-doped fiber laser emitting 37.4 W of output power at ~1.94 μm wavelength. The macroscopic and histopathological evaluation was performed intraoperatively as well as 7 and 14 days after surgery. Macroscopically almost no bleeding was observed during surgery and no signs of bleeding were stated after 7 and 14 days. Histopathological analysis of the transection margin revealed a thermal damage area ranging in depth from 620.23 ± 23.82 μm on the day of surgery to 1817.70 ± 211.98 μm after 7 days. In the samples taken intraoperatively and after 7 days a superficial zone of carbonization was visibly separated from the deeper changes. After 14 days one 765.35 μm deep zone characterized by a granulation was present. In conclusion, thulium doped fiber laser is efficacious in cutting with a narrow zone of thermal injury and provides a good hemostasis during liver transection, thus being a potential tool for oncotic liver surgery.
Collapse
|
8
|
Liver resection for HCC outside the BCLC criteria. Langenbecks Arch Surg 2017; 403:37-44. [PMID: 29199380 DOI: 10.1007/s00423-017-1640-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/21/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE Surgical resection still remains the mainstay of management of hepatocellular carcinoma (HCC). At present, Barcelona clinic liver cancer (BCLC) staging is the most widely used tool to guide treatment; however, criteria for offering surgery as curative treatment are restrictive. We aimed to evaluate short-term and long-term outcomes of HCC after resection, even for patients outside BCLC criteria for resection. METHODS Data was collected from a prospective database from GI and HPB Department, Tata Memorial Hospital, Mumbai. Study period was from June 2010 to June 2015. RESULTS One hundred three patients of HCC were operated during this period, of which 100 underwent complete resection. Patients were staged according to the BCLC classification (BCLC stage A-25, B-64, C-11). Preoperative therapy was administered in 36 (36%) patients. At median follow-up of 21 months, overall 3-year survival for BCLC stages A, B, and C was 55.2, 62.7, and 37.5%, respectively. CONCLUSION In today's era of liver transplantation, resection (especially for larger tumors) may still be the preferred treatment option, considering problems and difficulties in donor availability, cost, and long waiting list for liver transplant. With evolving modern surgical technique, long-term survival benefit can be achieved with acceptable safety in most BCLC stage B and selected BCLC stage C patients and those who either do not fit into the transplant criteria or cannot afford transplant. Carefully designed trials are required to further elucidate these results.
Collapse
|
9
|
Fonouni H, Kashfi A, Majlesara A, Stahlheber O, Konstantinidis L, Gharabaghi N, Kraus TW, Mehrabi A, Oweira H. Hemostatic efficiency of modern topical sealants: Comparative evaluation after liver resection and splenic laceration in a swine model. J Biomed Mater Res B Appl Biomater 2017. [DOI: 10.1002/jbm.b.33937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arash Kashfi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Ali Majlesara
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Oliver Stahlheber
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Lukas Konstantinidis
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Negin Gharabaghi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Thomas W. Kraus
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| | - Hani Oweira
- Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelberg Germany
| |
Collapse
|
10
|
Reflections on multiple strategies to reduce transfusion in cancer patients: A joint narrative. Transfus Apher Sci 2017; 56:322-329. [DOI: 10.1016/j.transci.2017.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
11
|
Gómez-Gavara C, Doussot A, Lim C, Salloum C, Lahat E, Fuks D, Farges O, Regimbeau JM, Azoulay D. Impact of intraoperative blood transfusion on short and long term outcomes after curative hepatectomy for intrahepatic cholangiocarcinoma: a propensity score matching analysis by the AFC-IHCC study group. HPB (Oxford) 2017; 19:411-420. [PMID: 28122668 DOI: 10.1016/j.hpb.2017.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/22/2016] [Accepted: 01/01/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND The impact of intraoperative blood transfusion (IBT) on outcomes following intrahepatic cholangiocarcinoma (IHCC) resection remains to be ascertained. METHODS All consecutive IHCC resected were analyzed. A first cohort (n = 569) was used for investigating short-term outcomes (morbidity and mortality). A second cohort (n = 522) excluding patients dead within 90 days of surgery was analyzed for exploring overall survival (OS) and disease free survival (DFS). Patients who received IBT were compared to those who did not, after using a propensity score matching (PSM) method. RESULTS Among 569 patients, 90-day morbidity and mortality rates were 47% (n = 269) and 8% (n = 47). After PSM, 208 patients were matched. There was an association between IBT and increased overall morbidity and severe morbidity (p = 0.010). However, IBT did not impact 90-day mortality rate (p > 0.999). Regarding long-term outcomes analysis in the second cohort (n = 522), 5-year OS and DFS rates were 39% and 25%. Using PSM, 196 patients were matched and no association between IBT and OS or DFS was found (p = 0.333 and p = 0.491). CONCLUSIONS IBT is associated with an increased risk of morbidity but does not impact on long-term outcomes. Need for IBT should be considered as a surrogate of advanced disease requiring complex resection. Still, restricted transfusion policy should remain advocated for IHCC resection.
Collapse
Affiliation(s)
- Concepción Gómez-Gavara
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Alexandre Doussot
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Chetana Lim
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Chady Salloum
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - David Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - Olivier Farges
- Department of Hepatobiliary Surgery, AP-HP, Hôpital Beaujon, Clichy, France
| | | | - Daniel Azoulay
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France; INSERM, U955, Créteil, France.
| |
Collapse
|
12
|
Chen JM, Geng W, Zhang S, Liu FB, Zhao HC, Zhao YJ, Wang GB, Xie SX, Geng XP. Randomized clinical trial of BiClamp forceps versus clamp-crushing technique in open liver resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:137-142. [PMID: 28012285 DOI: 10.1002/jhbp.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jiang Ming Chen
- Department of Surgery; Second Affiliated Hospital of Anhui Medical University; No. 678 Furong Road, Jingkai District, Hefei Anhui 230022 China
| | - Wei Geng
- Department of Liver Surgery; Ren Ji Hospital; School of Medicine, Shanghai Jiao Tong University; Shanghai China
| | - Song Zhang
- Department of Surgery; Second Affiliated Hospital of Anhui Medical University; No. 678 Furong Road, Jingkai District, Hefei Anhui 230022 China
| | - Fu Bao Liu
- Department of Surgery; First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Hong Chuan Zhao
- Department of Surgery; First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Yi Jun Zhao
- Department of Surgery; First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Guo Bin Wang
- Department of Surgery; First Affiliated Hospital of Anhui Medical University; Hefei Anhui China
| | - Sheng Xue Xie
- Department of Surgery; Second Affiliated Hospital of Anhui Medical University; No. 678 Furong Road, Jingkai District, Hefei Anhui 230022 China
| | - Xiao Ping Geng
- Department of Surgery; Second Affiliated Hospital of Anhui Medical University; No. 678 Furong Road, Jingkai District, Hefei Anhui 230022 China
| |
Collapse
|
13
|
Xu Y, Chen J, Wang H, Zheng H, Feng D, Zhang A, Leng J, Duan W, Yang Z, Chen M, Shi X, Cai S, Ji W, Jiang K, Zhang W, Chen Y, Gu W, Dong J, Lu S. Perioperative and long-term outcomes of liver resection for hepatitis B virus-related hepatocellular carcinoma without versus with hepatic inflow occlusion: study protocol for a prospective randomized controlled trial. Trials 2016; 17:492. [PMID: 27724929 PMCID: PMC5057253 DOI: 10.1186/s13063-016-1621-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 09/24/2016] [Indexed: 02/06/2023] Open
Abstract
Background The high prevalence of hepatitis B virus (HBV) imposes a huge burden of hepatocellular carcinoma (HCC) in Asia. Surgical resection remains an important therapeutic strategy for HCC. Hepatic inflow occlusion, known as the Pringle maneuver, is the most commonly used method of reducing blood loss during liver parenchymal transection. A major issue with this maneuver is ischemia-reperfusion injury to the remnant liver, and the hemodynamic disturbance it induces in the tumor-bearing liver raises an oncological concern. Given the technical advances in living donor liver transplantation, vascular occlusion in liver resection can be avoided in experienced hands. The aim of this study is to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with hepatic inflow occlusion. Methods/design This study will include eligible patients with HBV-related HCC elected for liver resection. Fifty-seven patients will be enrolled in each randomization arm to detect a 20 % difference in the serum level of total bilirubin on postoperative day 5 (80 % power and α = 0.05). The secondary endpoints include procedural parameters, perioperative liver function and inflammatory response, postoperative morbidity and mortality, and long-term outcomes. Patients will be followed for up to 5 years. Data will be statistically analyzed on an intention-to-treat basis. Discussion This prospective randomized controlled trial is designed to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with vascular occlusion. The clinical implications of these outcomes may change current surgical practice and fill the oncological gaps therein. Trial registration Clinicaltrials.gov identifier NCT02563158. Registered on 28 September 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1621-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yinzhe Xu
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.,Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jiye Chen
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Hongguang Wang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Boston, MA, 02114, USA
| | - Dan Feng
- Division of Standard Operational Management, Institute of Hospital Management, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Aiqun Zhang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Jianjun Leng
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Weidong Duan
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Zhanyu Yang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Mingyi Chen
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Xianjie Shi
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Shouwang Cai
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Wenbin Ji
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Kai Jiang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Wenzhi Zhang
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Yongliang Chen
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Wanqing Gu
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Jiahong Dong
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Shichun Lu
- Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
| |
Collapse
|
14
|
Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery: rationale and surgical technique. Surg Endosc 2016; 31:1354-1360. [PMID: 27444829 DOI: 10.1007/s00464-016-5120-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/12/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND For the treatment of both primary and metastatic liver tumors, laparoscopic parenchyma-sparing surgery is advocated to reduce postoperative liver failure and facilitate reoperation in the case of recurrence. However, atypical and wedge resections are associated with a higher amount of intraoperative bleeding than are anatomical resections, and such bleeding is known to affect short- and long-term outcomes. Beyond the established role of radiofrequency and microwave ablation in the setting of inoperable liver tumors, the application of thermoablative energy along the plane of the liver surface to be transected results in a zone of coagulative necrosis, possibly minimizing bleeding of the cut liver surface during parenchymal transection. METHODS From January 2013 to March 2016, a total of 20 selected patients underwent laparoscopic ultrasound-guided liver resection with thermoablative precoagulation of the transection line. RESULTS During a period of 38 months, 50 laparoscopic thermoablative procedures were performed. Colorectal liver metastases were the most frequent diagnosis. Seventy-two percent of the nodules were removed using parenchymal transection with radiofrequency-precoagulation, while microwave-precoagulation was performed for 20 % of the resected nodules. The remaining 8 % of the nodules were treated by thermoablation alone. The hepatic pedicle was intermittently clamped in six patients. The mean blood loss was 290 mL, and four patients required perioperative transfusions. CONCLUSIONS Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery can get minimal blood loss during parenchymal transection and lower the need for perioperative transfusions, providing a nonquantifiable margin of oncological safety on the remaining liver. Additional results from larger series are advocated to confirm these preliminary data.
Collapse
|
15
|
Blood transfusion is an independent predictor of morbidity and mortality after hepatectomy. J Surg Res 2016; 206:106-112. [PMID: 27916348 DOI: 10.1016/j.jss.2016.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/26/2016] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have indicated that blood transfusion is associated with increased risk of worse outcomes among patients selected for hepatectomy. However, the independent effect of transfusion has not been confirmed. We hypothesize that blood transfusion is an independent factor that affects outcomes in patients undergoing hepatectomy. MATERIALS AND METHODS Patients at tertiary care center who underwent hepatectomy between 2006 and 2013 were identified and linked with the American College of Surgeons National Surgical Quality Improvement Program PUF data set. Multivariable logistic regression analysis was used to estimate the effect of blood transfusion on 30-d mortality and morbidity, adjusted for differences in extent of resection and estimated probabilities of morbidity and mortality. RESULTS Among 522 patients in the study, 48 (9.2%) patients required perioperative blood transfusion within 72 h of resection, and 172 (33%) underwent major hepatectomy. Indications for hepatectomy included metastatic neoplasm (n = 229, 44%), primary hepatic neoplasm (n = 108, 21%), primary extra-hepatic biliary neoplasm (n = 23, 4%), and nonmalignant indications (n = 162, 31%). Eighty-eight (17%) patients had a postoperative morbidity. Blood transfusion was significantly associated with postoperative morbidity (odds ratio [OR] = 4.18, 95% CI = 2.18-8.02, P = 0.0001) and mortality (OR = 14.5, 95% CI = 3.08-67.8, P = 001), after adjustment for the concurrent effect of National Surgical Quality Improvement Program estimated probability of morbidity (OR = 1.15, 95% CI = 0.11-12.2, P = 0.042). The extent of resection was not significantly associated with morbidity (OR = 1.30, 95% CI, 0.74-2.28, P = 0.366) or mortality (OR = 1.14, 95% CI = 0.24-5.50, P = 0.870). CONCLUSIONS Blood transfusion is a highly statistically significant independent predictor of morbidity and mortality after hepatectomy. Judicious use of perioperative transfusion is indicated in patients with benign and malignant indications for liver resection.
Collapse
|