1
|
Fink MA, Gow PJ, McCaughan GW, Hodgkinson P, Chen J, McCall J, Jaques B, Crawford M, Strasser SI, Hardikar W, Brooke-Smith M, Starkey G, Jeffrey GP, Gane E, Stormon M, Evans H, Tallis C, Byrne AJ, Jones RM. Impact of Share 35 liver transplantation allocation in Australia and New Zealand. Clin Transplant 2024; 38:e15203. [PMID: 38088459 DOI: 10.1111/ctr.15203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/31/2024]
Abstract
Patients with high model for end-stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score ≥35 was introduced in February 2016. Waiting list mortality, post-transplant outcomes and intention-to-treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre-Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre-Share 35 group (11.7% vs. 52.2%, OR .120 95% CI .044-.328, P < .001). Post-transplant patient and graft survival were not significantly different between the groups (5-year patient survival 82% vs. 84%, P = .991, 5-year graft survival 82% vs. 76%, P = .543). Intention-to-treat survival was superior in the Share 35 group (HR .302, 95% CI .149-.614, P < .001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post-transplant survival and an improvement in intention-to-treat survival.
Collapse
Affiliation(s)
- Michael A Fink
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
- Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Geoffrey W McCaughan
- University of Sydney, Sydney, New South Wales, Australia
- Liver Injury and Cancer, Centenary Institute, Camperdown, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Hodgkinson
- Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia
| | - John Chen
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - John McCall
- University of Auckland, Auckland, New Zealand
- New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand
| | - Bryon Jaques
- Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michael Crawford
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simone I Strasser
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Winita Hardikar
- Gastroenterology and Clinical Nutrition Department Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Graham Starkey
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Gary P Jeffrey
- Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ed Gane
- University of Auckland, Auckland, New Zealand
- New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand
| | - Michael Stormon
- University of Sydney, Sydney, New South Wales, Australia
- Australian National Liver Transplantation Service, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Helen Evans
- University of Auckland, Auckland, New Zealand
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Caroline Tallis
- Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia
| | - Amanda J Byrne
- Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia
| | - Robert M Jones
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Sultana A, Brooke-Smith M, Ullah S, Figueras J, Rees M, Vauthey JN, Conrad C, Hugh TJ, Garden OJ, Fan ST, Crawford M, Makuuchi M, Yokoyama Y, Büchler M, Padbury R. Prospective evaluation of the International Study Group for Liver Surgery definition of post hepatectomy liver failure after liver resection: an international multicentre study. HPB (Oxford) 2018; 20:462-469. [PMID: 29287736 DOI: 10.1016/j.hpb.2017.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The International Study Group for Liver Surgery (ISGLS) definition of post hepatectomy liver failure (PHLF) was developed to be consistent, widely applicable, and to include severity stratification. This international multicentre collaborative study aimed to prospectively validate the ISGLS definition of PHLF. METHODS 11 HPB centres from 7 countries developed a standardised reporting form. Prospectively acquired anonymised data on liver resections performed between 01 July 2010 and 30 June 2011 was collected. A multivariate analysis was undertaken of clinically important variables. RESULTS Of the 949 patients included, 86 (9%) met PHLF requirements. On multivariate analyses, age ≥70 years, pre-operative chemotherapy, steatosis, resection of >3 segments, vascular reconstruction and intraoperative blood loss >300 ml significantly increased the risk of PHLF. Receiver operator curve (ROC) analysis of INR and serum bilirubin relationship with PHLF demonstrated post-operative day 3 and 5 INR performed equally in predicting PHLF, and day 5 bilirubin was the strongest predictor of PHLF. Combining ISGLS grades B and C groups resulted in a high sensitivity for predicting mortality compared to the 50-50 rule and Peak bilirubin >7 mg/dl. CONCLUSIONS The ISGLS definition performed well in this prospective validation study, and may be the optimal definition for PHLF in future research to allow for comparability of data.
Collapse
Affiliation(s)
- Asma Sultana
- Flinders Medical Centre and Flinders University of South Australia, Australia
| | - Mark Brooke-Smith
- Flinders Medical Centre and Flinders University of South Australia, Australia.
| | - Shahid Ullah
- Flinders Medical Centre and Flinders University of South Australia, Australia; South Australian Health and Medical Research Institute, Australia
| | | | | | | | | | - Thomas J Hugh
- Royal North Shore Hospital and University of Sydney, Australia
| | | | | | | | | | | | | | - Robert Padbury
- Flinders Medical Centre and Flinders University of South Australia, Australia
| |
Collapse
|
3
|
Sultana A, Meng R, Piantadosi C, Brooke-Smith M, Chen J, Dolan P, Maddern G, Price T, Padbury R. Liver resection for colorectal cancer metastases: a comparison of outcomes over time in South Australia. HPB (Oxford) 2018; 20:340-346. [PMID: 29187305 DOI: 10.1016/j.hpb.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/08/2017] [Accepted: 10/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the current study was to assess outcomes following liver resection in metastatic CRC (mCRC) in South Australia across two study periods (pre-2006 versus post-2006). METHODS The South Australian (SA) Clinical Registry for mCRC maintains data prospectively on all patients in SA with mCRC diagnosed from 01 February 2006. This data was linked with a prospectively collated database on liver resections for mCRC from 01/01/1992 to 01/02/2006. The primary end point was overall survival. RESULTS 757 patients underwent liver resection for mCRC. Liver resection was performed on 286 patients pre-2006 and 471 patients post-2006. The median age of the study population was 62 years, and this was similar across both eras. Overall survival was significantly better in the post-2006 era (hazard ratio HR = 0.45, p = 0.001). Complications (59% pre-2006 versus 23% post-2006) and transfusion rates (34% pre-2006 versus 2% post-2006) were significantly higher in the pre-2006 era. Repeat liver resection rates were significantly higher in the post-2006 era (1% pre-2006 versus 10% post-2006). CONCLUSIONS Outcomes following liver resection for mCRC have improved over time, with significantly better overall survival in the post-2006 era compared to pre-2006.
Collapse
Affiliation(s)
- Asma Sultana
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - Rosie Meng
- Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Cynthia Piantadosi
- South Australian Metastatic Colorectal Cancer Registry, Flinders Centre for Innovation in Cancer, Bedford Park SA 5049, Australia
| | - Mark Brooke-Smith
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - John Chen
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - Paul Dolan
- Department of HPB Surgery, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
| | - Guy Maddern
- Department of HPB Surgery, Queen Elizabeth Hospital, Woodville, SA 5011, Australia; Discipline of Surgery, University of Adelaide, Adelaide, SA 5005, Australia
| | - Timothy Price
- Department of Medical Oncology, Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Robert Padbury
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia.
| |
Collapse
|
4
|
Chandrasegaram MD, Shah A, Chen JW, Ruszkiewicz A, Astill DS, England G, Raju RS, Neo EL, Dolan PM, Tan CP, Brooke-Smith M, Wilson T, Padbury RTA, Worthley CS. Oestrogen hormone receptors in focal nodular hyperplasia. HPB (Oxford) 2015; 17:502-7. [PMID: 25728618 PMCID: PMC4430780 DOI: 10.1111/hpb.12387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 12/13/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of hormones in focal nodular hyperplasia (FNH) has been investigated with conflicting results. OBJECTIVE The aim of this study was to evaluate oestrogen and progesterone receptor immunohistochemical expression in FNH and surrounding normal liver (control material). METHODS Biopsy materials from FNH and control tissue were investigated using an immunostainer. Receptor expression was graded as the proportion score (percentage of nuclear staining) and oestrogen receptor intensity score. RESULTS Study material included tissue from 11 resected FNH lesions and two core biopsies in 13 patients (two male). Twelve samples showed oestrogen receptor expression. The percentage of nuclear oestrogen receptor staining was <33% in eight FNH biopsies, 34-66% in two FNH biopsies, and >67% in both core biopsies. The better staining in core biopsies relates to limitations of the staining technique imposed by the fibrous nature of larger resected FNH. Control samples from surrounding tissue were available for nine of the resected specimens and all showed oestrogen receptor expression. Progesterone receptor expression was negligible in FNH and control samples. CONCLUSIONS By contrast with previous studies, the majority of FNH and surrounding liver in this cohort demonstrated oestrogen receptor nuclear staining. The implications of this for continued oral contraceptive use in women of reproductive age with FNH remain uncertain given the lack of consistent reported growth response to oestrogen stimulation or withdrawal.
Collapse
Affiliation(s)
- Manju D Chandrasegaram
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Division of Surgery, University of AdelaideAdelaide, SA, Australia,Correspondence Manju Chandrasegaram, Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia. E-mail:
| | - Ali Shah
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - John W Chen
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Andrew Ruszkiewicz
- Department of Tissue Pathology, SA Pathology, Royal Adelaide Hospital SiteAdelaide, SA, Australia
| | - David S Astill
- Department of Tissue Pathology, SA Pathology, Flinders Medical Centre SiteAdelaide, SA, Australia
| | - Georgina England
- Department of Tissue Pathology, SA Pathology, Royal Adelaide Hospital SiteAdelaide, SA, Australia
| | - Ravish S Raju
- Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Eu Ling Neo
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Paul M Dolan
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - Chuan Ping Tan
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia
| | - Mark Brooke-Smith
- Hepatobiliary Unit, Royal Adelaide HospitalAdelaide, SA, Australia,Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | - Tom Wilson
- Department of Surgery, Flinders Medical CentreAdelaide, SA, Australia
| | | | | |
Collapse
|
5
|
Brooke-Smith M, Figueras J, Ullah S, Rees M, Vauthey JN, Hugh TJ, Garden OJ, Fan ST, Crawford M, Makuuchi M, Yokoyama Y, Büchler M, Weitz J, Padbury R. Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB (Oxford) 2015; 17:46-51. [PMID: 25059275 PMCID: PMC4266440 DOI: 10.1111/hpb.12322] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition. METHODS Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally. RESULTS Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001). CONCLUSION The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.
Collapse
Affiliation(s)
- Mark Brooke-Smith
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia,Correspondence, Mark Brooke-Smith, Department of Surgery and Specialty Services, Flinders Medical Centre, Bedford Park, SA 5065, Australia. Tel: +61 8 8204 4253. Fax: +61 8 8204 5843. E-mail:
| | | | - Shahid Ullah
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia
| | | | | | | | | | | | | | | | | | - Marcus Büchler
- Department of Surgery, Technische Universität DresdenDresden, Germany
| | - Juergen Weitz
- Department of Surgery, Technische Universität DresdenDresden, Germany
| | - Robert Padbury
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia
| |
Collapse
|
6
|
Smolilo D, Bhandari M, Wilson TG, Brooke-Smith M, Watson DI. Bouveret's syndrome: gastric outlet obstruction caused by a gallstone. ANZ J Surg 2014; 83:996-7. [PMID: 24289055 DOI: 10.1111/ans.12227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David Smolilo
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | | | | | | | | |
Collapse
|
7
|
Barreto SG, Brooke-Smith M, Dolan P, Wilson TG, Padbury RTA, Chen JWC. Cirrhosis and microvascular invasion predict outcomes in hepatocellular carcinoma. ANZ J Surg 2012; 83:331-5. [PMID: 22943449 DOI: 10.1111/j.1445-2197.2012.06196.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Liver resection (LR) and liver transplantation (LT) are two modalities offering potential for cure in patients with hepatocellular carcinoma (HCC). The objective of this study was to evaluate the long-term survival of patients with HCC treated with LT and LR and to analyse variables influencing these outcomes. METHODS Patients referred to the South Australian Liver Transplant Unit and Hepatopancreatobiliary Unit at Flinders Medical Centre from January 1992 to September 2009 with a diagnosis of HCC who underwent LT or LR were included in the study. Histopathological parameters analysed included size, number and grade of tumour, microscopic vascular invasion and presence or absence of cirrhosis in remnant liver. RESULTS Eighty-five patients with a median age of 58 years (range 26-85 years) underwent LT or LR. Median follow-up was 40 months in both groups. Overall, 5-year actuarial survival for all patients with HCC in both groups was 55%. LR patients were significantly older (P < 0.001) than LT patients. Their tumours were larger (P < 001) and more often solitary (P < 0.001) compared with the LT group. In multivariate analysis, age >60 (P < 0.02), histopathological evidence of vascular invasion (P < 0.02) and presence of cirrhosis (P < 0.02) were associated with a significantly reduced survival. Patients without vascular invasion and cirrhosis had an actuarial 5-year survival >70%. CONCLUSIONS Our study indicates that LT (within University of California, San Francisco criteria) and LR can lead to acceptable long-term survival outcomes in patients with HCC. Microscopic vascular invasion and cirrhosis were the most significant prognostic factors impacting on survival.
Collapse
Affiliation(s)
- Savio G Barreto
- Hepatopancreatobiliary Unit and South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | | | | | | | | |
Collapse
|
8
|
Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, Fan ST, Nimura Y, Figueras J, Vauthey JN, Rees M, Adam R, DeMatteo RP, Greig P, Usatoff V, Banting S, Nagino M, Capussotti L, Yokoyama Y, Brooke-Smith M, Crawford M, Christophi C, Makuuchi M, Büchler MW, Weitz J. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford) 2011; 13:528-35. [PMID: 21762295 PMCID: PMC3163274 DOI: 10.1111/j.1477-2574.2011.00319.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established. METHODS An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management. RESULTS The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level > 3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH. CONCLUSION The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications.
Collapse
Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - O James Garden
- Department of Clinical & Surgical Sciences, University of EdinburghEdinburgh
| | | | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth HospitalWoodville
| | - Moritz Koch
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - Thomas J Hugh
- Department of Gastrointestinal Surgery, Royal North Shore HospitalHong Kong, China
| | - Sheung Tat Fan
- Department of Surgery, Queen Mary Hospital, University of Hong KongHong Kong, China
| | - Yuji Nimura
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Joan Figueras
- Hepatobiliary and Pancreatic Division of Surgery, ‘Josep Trueta’ Hospital. IDiBGi. University of GironaSpain
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX
| | - Myrddin Rees
- Department of Hepatobiliary Surgery, North Hampshire HospitalBasingstoke, UK
| | - Rene Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-BiliaireVillejuif, France
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Paul Greig
- Department of Surgery, Toronto General Hospital, University of TorontoToronto, ON, Canada
| | - Val Usatoff
- Department of Surgery. Alfred HospitalCandiolo, Turin, Italy
| | - Simon Banting
- Hepatobiliary Surgery, St Vincent's HospitalCandiolo, Turin, Italy
| | - Masato Nagino
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Lorenzo Capussotti
- Division of Surgical Oncology, Institute of Cancer Research and TreatmentCandiolo, Turin, Italy
| | - Yukihiro Yokoyama
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Mark Brooke-Smith
- Hepatopancreatobiliary and Transplant Surgery, Flinders Medical CentreAdelaide
| | | | | | - Masatoshi Makuuchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of TokyoHeidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - Jürgen Weitz
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| |
Collapse
|
9
|
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011; 149:713-24. [PMID: 21236455 DOI: 10.1016/j.surg.2010.10.001] [Citation(s) in RCA: 1480] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 10/18/2010] [Indexed: 12/13/2022]
Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011. [PMID: 21236455 DOI: 10.1016/j.surg.2010.10.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND Posthepatectomy liver failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy liver failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy liver failure. METHODS A literature search on posthepatectomy liver failure after hepatic resection was conducted. Based on the normal course of biochemical liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy liver failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. RESULTS No uniform definition of posthepatectomy liver failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy liver failure as the impaired ability of the liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy liver failure should be graded based on its impact on clinical management. Grade A posthepatectomy liver failure requires no change of the patient's clinical management. The clinical management of patients with grade B posthepatectomy liver failure deviates from the regular course but does not require invasive therapy. The need for invasive treatment defines grade C posthepatectomy liver failure. CONCLUSION The current definition of posthepatectomy liver failure is simple and easily applicable in clinical routine. This definition can be used in future studies to allow objective and accurate comparisons of operative interventions in the field of hepatic surgery.
Collapse
Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Chen JWC, Bhandari M, Astill DS, Wilson TG, Kow L, Brooke-Smith M, Toouli J, Padbury RTA. Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB (Oxford) 2010; 12:101-8. [PMID: 20495653 PMCID: PMC2826667 DOI: 10.1111/j.1477-2574.2009.00140.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 10/05/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate and simple prognostic criteria based on histopathology following pancreaticoduodenectomy would be helpful in assessing prognosis and considering and evaluating adjuvant therapy. This study analysed the histological parameters influencing outcome following pancreaticoduodenectomy for periampullary malignancy. METHODS A total of 110 pancreaticoduodenectomies were performed from 1998 to 2008. The median age of patients was 69 years (range 20-89 years). The median follow-up was 4.9 years. Of the procedures, 87% (96) were performed for malignancies and the remainder (n= 14) for benign aetiologies. Of the 96 malignancies, 60 were pancreatic adenocarcinoma and the rest were ampullary (14), cholangio (9), duodenal (9) carcinomas and others. Statistical analysis was performed using log-rank and Cox regression multivariate analyses. RESULTS Patients who underwent resection had 1-, 3- and 5-year survival rates of 70%, 46% and 41%, respectively. The 1-, 3- and 5-year survival rates for periampullary cancers other than pancreatic adenocarcinoma were 83%, 69% and 61%, respectively; those for pancreatic adenocarcinoma were 62%, 31% and 27%, respectively (P < 0.003). Poor tumour differentiation (P < 0.02), tumour size >3 cm (P < 0.04), margin <or=2 mm (P < 0.02), nodal involvement (P < 0.003), perineural infiltration (P < 0.0001) and lymphovascular invasion (P < 0.002) were associated with poorer prognosis. In a multivariate analysis, histologically identified perineural infiltration (P < 0.03) and lymphovascular invasion (P= 0.05) were significant factors influencing outcome. Five-year survival was 77% in patients negative for both factors and 15% in patients positive for both (P < 0.0001). In the pancreatic adenocarcinoma subgroup, patients who were negative for both factors had a 5-year survival of 71%, whereas those who were positive for both had a 5-year survival of 16% (P < 0.02). CONCLUSIONS The presence of perineural infiltration and lymphovascular invasion on histopathology is highly significant in predicting 5-year outcomes after pancreaticoduodenectomy for periampullary and pancreatic malignancies.
Collapse
Affiliation(s)
- John W C Chen
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - Mayank Bhandari
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - David S Astill
- Department of Anatomical Pathology, Flinders Medical CentreBedford Park, SA, Australia
| | - Thomas G Wilson
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - Lilian Kow
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - Mark Brooke-Smith
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - James Toouli
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| | - Robert T A Padbury
- Hepatopancreatobiliary Unit, Department of Surgery, Flinders Medical CentreBedford Park, SA, Australia
| |
Collapse
|
12
|
Tonkin DM, Murphy E, Brooke-Smith M, Hollington P, Rieger N, Hockley S, Richardson N, Wattchow DA. Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum 2004; 47:1510-4. [PMID: 15486749 DOI: 10.1007/s10350-004-0620-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Perianal sepsis is traditionally treated by incision and drainage, with packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. METHODS Healing times, analgesic requirements, pain scores, abscess recurrence, and fistula rates were compared between two randomized groups treated with and without packing of perianal abscess cavities. RESULTS Fifty patients were recruited (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The groups were comparable in terms of age and gender distribution, type and size of abscess, and the presence of a fistula at operation. Mean healing times were similar ( P = 0.214). The rate of abscess recurrence was similar ( P = 0.61). Postoperative fistula rates were similar ( P = 0.38). Pain scores at the first dressing change were similar ( P = 0.296). Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance. CONCLUSIONS Our pilot study indicates that perianal abscesses can be managed safely without continued packing of the cavity without any obvious complications.
Collapse
Affiliation(s)
- Darren M Tonkin
- Gastrointestinal Surgery, Flinders Medical Centre, Adelaide, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Sandstrom P, Woods CM, Brooke-Smith M, Saccone GTP, Toouli J, Svanvik J. Highly selective iNOS inhibition and sphincter of Oddi motility in the Australian possum. ACTA ACUST UNITED AC 2004; 181:321-31. [PMID: 15196093 DOI: 10.1111/j.1365-201x.2004.01296.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM Inducible nitric oxide synthase (iNOS) plays a major role in acute pancreatitis. Selective inhibitors of iNOS are being developed as therapeutic agents. Sphincter of Oddi (SO) dysfunction may cause pancreatitis and nitric oxide is necessary for SO relaxation. A new highly selective iNOS inhibitor, AR-C102222AA (AR-C), is evaluated together with the established iNOS inhibitor, L-N(6)-(1-iminoethyl)lysine (L-NIL), and the selective neuronal nitric oxide synthase (nNOS) blocker S-methyl-l-thiocitrulline (SMTC). METHODS In anaesthetized Australian Brush-tailed possums, the effect of topical, i.v. or i.a. administration of these drugs was evaluated on spontaneous SO motility, blood pressure (BP) and pancreatic vascular perfusion. SO motility was recorded by manometry and pancreatic vascular perfusion by laser Doppler fluxmetry. Also, the effect of SMTC and AR-C on electrical field stimulation (EFS)-induced non-cholinergic non-adrenergic (NANC) SO relaxation in vitro was evaluated. RESULTS Infusion of AR-C (0.1-30 micromol kg(-1)) increased SO contraction frequency (P = 0.026) only at the two highest doses. L-NIL infusion (0.15 to 14.7 micromol kg(-1)) also increased SO contraction frequency at 8.8 micromol kg(-1) (P < 0.05) and reduced SO contraction amplitude at the two highest doses (P < 0.05). SMTC injections (0.5 nmol-2.4 micromol) produced a dose-dependent increase in SO contraction frequency (P = 0.009), but no effect was seen on the other parameters. In vitro SMTC (40-400 microm) inhibited EFS-induced NANC relaxation in a dose-dependent manner (P < 0.0005). In contrast AR-C (10-500 microm) had no effect on EFS-induced NANC relaxation (P > 0.05). CONCLUSIONS At low doses, AR-C does not effect SO motility or EFS-induced NO mediated relaxation. However, high doses of AR-C and L-NIL in vivo influenced SO motility by inhibiting nNOS activity and these effects need be considered in relation to therapeutic doses of this agent.
Collapse
Affiliation(s)
- P Sandstrom
- Department of Biomedicine and Surgery, University Hospital of Linkoping, Sweden
| | | | | | | | | | | |
Collapse
|
14
|
Affiliation(s)
- J Toouli
- Flinders University, Adelaide, Australia.
| | | | | | | | | | | | | | | |
Collapse
|