Outcomes in elderly patients undergoing hepatic resection compared to liver transplant for hepatocellular carcinoma

BACKGROUND

Hepatic resection (HR) is an excellent option for patients with hepatocellular carcinoma (HCC). For patients meeting the Milan criteria, a liver transplant (LT) is also a viable option for patients with HCC, especially those with end-stage liver disease. With increasing rates of LTs amongst the elderly, we sought to determine long-term outcomes in patients who underwent HR compared to LTs in this patient population.

METHODS

We queried the national cancer database for elderly patients (≥70 years) diagnosed with HCC between 2004 and 2020. The primary outcome was overall survival (OS) computed using the Kaplan-Meier method and Cox proportional hazard regression. One-to-one propensity score matching was conducted on the basis of clinicodemographic features to account for baseline differences between patients undergoing each procedure.

RESULTS

Of the 5090 patients included, 4674 (91.8%) and 416 (8.2%) patients underwent HR and LT, respectively. Compared with HR patients, patients receiving LT had better OS (p < 0.001) and greater median survival time (65.6 months HR vs. 97.9 months LT, p < 0.001). On multivariable analysis, a LT was independently associated with improved survival (adjusted hazard ratio: 0.61, 95% confidence interval: 0.50-0.76, p < 0.001).

CONCLUSIONS

LT is associated with improved survival for well-selected elderly patients with HCC. Age alone should not be used as the sole parameter for the candidacy of LT in elderly patients.

Association Between Preoperative Angioembolization and Bleeding Complications in Patients With Benign Liver Tumors: Analysis of a National Database

INTRODUCTION

The role of angioembolization (AE) in patients with benign liver diseases is an area of active research. This study aims to assess any difference in liver resection outcomes in patients with benign tumors dependent on utilization of preoperative AE.

METHODS

A retrospective cohort study of patients undergoing elective liver resections for benign liver tumors was performed using the National Surgical Quality Improvement Program database (2014-2019). Only tumors of 5 cm in size or more were included in the analysis. We categorized the patients based on preoperative AE (AE + versus AE -). The primary outcome measured included bleeding complications within 72 h. The secondary outcomes were to determine predictors of bleeding.

RESULTS

After propensity score matching, there were 103 patients in both groups. There was no difference in intraoperative or postoperative blood transfusions within 72 h of surgery (14.6% versus 12.6%; P = 0.68), reoperation (1.9% versus 1.9%; P = 1), or mortality (1.0% versus 0.0%; P = 1) between the two groups. Multivariate regression analysis revealed an open surgical approach (odds ratio [OR]: 4.59 confidence interval [CI]: 2.94-7.16), use of Pringle maneuver (OR: 1.7, CI: 1.26-2.310), preoperative anemia (OR: 2.79, CI: 2.05-3.80), and preoperative hypoalbuminemia (OR: 1.53 [1.14-2.05]) were associated with the need for intraoperative or postoperative blood transfusions within 72 h of surgery.

CONCLUSIONS

Preoperative AE was not associated with reducing intraoperative or postoperative bleeding complications or blood transfusions within 72 h after surgery.

Frailty as a predictor of negative outcomes in trauma patients with rib fractures

BACKGROUND

In patients with rib fractures, adverse outcomes are associated with number of rib fractures; however, studies suggest an association with frailty. We assessed whether frailty, measured using the Canadian Study of Health and Aging clinical frailty scale, was associated with adverse outcomes in this population.

METHODS

Patients ≥50 years admitted for rib fractures from July 2015 to June 2020 were retrospectively scored for frailty. Demographics, comorbidities, injury information, hospital course, and complications were collected. Univariate analyses were performed to assess significant differences between the fit, prefrail, and frail groups. The association between number of rib fractures and frailty with outcomes was determined.

RESULTS

Controlling for age, sex, Injury Severity Score, preadmission anticoagulant, injury mechanism, and comorbidities and nonchest Abbreviated Injury Scores showing significant differences, the number of rib fractures was associated with developing pneumonia (odds ratio = 1.197 [1.076-1.332]; P = .001), hospital length of stay (odds ratio = 1.066 [1.033-1.100], P < .001), mortality (odds ratio = 1.157 [1.048-1.278], P = .004), and discharge to long-term acute care facilities (odds ratio = 1.295 [1.084-1.546], P = .004). Frailty was associated with hospital length of stay (odds ratio = 1.659 [1.059-2.598], P = .027) and discharge to skilled nursing facilities (odds ratio = 5.282 [1.567-17.802], P = .007).

CONCLUSION

In our population, the number of rib fractures was associated with respiratory complications and mortality. Frailty was associated with longer hospitalization and discharge to higher level of care.

[Treatment of non-invasive aspergillosis of maxillary sinus by functional endoscopic sinus surgery]

OBJECTIVE

To evaluate the treatment of non-invasive aspergillosis of the maxillary sinus by using functional endoscopic sinus surgery (FESS) and the correlated factors that affect the treatment.

METHOD

41 cases of local, non-invasive aspergillosis of the maxillary sinus undergone FESS were studied.

RESULT

The period of convalescence of double pathway (via ostium of maxillary sinus and canine fossa) was 4.7 weeks while single pathway (via ostium of maxillary sinus only) was 9.3 weeks. There was significant difference (P < 0.01). The period of convalescence of group using anti-fungal drugs to wash the operative cavity was 6.4 weeks while the group without using drugs was 6.7 weeks. There was no statistic significance (P > 0.05).

CONCLUSION

FESS is effective in treating of non-invasive aspergillosis of the maxillary sinus. The operation of double pathway is superior to that of single pathway. Whether to use antifungal drugs to wash the operative cavity has no obvious effect on the efficacy.