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Onoe S, Yokoyama Y, Igami T, Yamaguchi J, Mizuno T, Sunagawa M, Watanabe N, Kawakatsu S, Ando M, Nagino M, Ebata T. Effect of Preoperative Autologous Blood Storage in Major Hepatectomy for Perihilar Malignancy: A Randomized Controlled Trial. Ann Surg 2025; 281:741-747. [PMID: 39328056 DOI: 10.1097/sla.0000000000006547] [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: 09/28/2024]
Abstract
OBJECTIVE To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy. SUMMARY BACKGROUND DATA Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit of major hepatectomy has been controversial. METHODS This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition). RESULTS Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n=68, non-storage group n=70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n=60, non-storage group n=53). Surgical procedures, operative time, and blood loss were not significantly different between the 2 groups. The incidence of PHLF was comparable [blood storage group n=10 (17%), non-storage group n=10 (19%); P =0.760]. There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs 72%, P =0.997) and median duration of hospital stay (25 vs 29 days, P =0.277). CONCLUSIONS Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.
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Affiliation(s)
- Shunsuke Onoe
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Sunagawa
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoji Kawakatsu
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masato Nagino
- Department of Surgery, Daido Hospital, Nagoya, Japan
| | - Tomoki Ebata
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Lapisatepun W, Pipanmekaporn T, Leurcharusmee P, Khorana J, Patumanond J, Lapisatepun W. Development of the liver resection transfusion (LiReT) score to assess the requirement for blood transfusion during open liver surgery. HPB (Oxford) 2025:S1365-182X(25)00551-9. [PMID: 40287298 DOI: 10.1016/j.hpb.2025.04.007] [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: 06/12/2024] [Revised: 11/20/2024] [Accepted: 04/07/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Liver resection involves significant perioperative bleeding and blood transfusions, which may worsen outcomes. Blood products are scarce, and excessive preoperative cross-matching can deplete the blood supply. This study aimed to develop a clinical prediction score to assess the need for perioperative blood transfusions during liver resection. METHODS We conducted a retrospective cohort study using data from patients who underwent liver resections between 2006 and 2021. Independent predictors and a scoring system were analyzed using multivariable logistic regression. The model's effectiveness was assessed by the area under the ROC curve (AuROC) and calibration plots, with internal validation. RESULT Among 1021 patients, 456 (44.7%) required perioperative blood transfusions. Eight predictors were identified: ASA classification >2, preoperative anemia, platelet count <100 × 109/L, albumin <3.5 g/dL, total bilirubin >1.2 mg/dL, GFR <60 ml/min/1.73 m², maximum tumor diameter ≥5 cm, and major liver resection. The LiReT score categorized patients into low, moderate, and high-risk groups and showed good discriminative ability with an AuROC of 0.808 and good calibration. CONCLUSION The LiReT score, with its good predictive accuracy, can guide clinicians in assessing perioperative blood transfusion risk, optimizing cross-matching and resource utilization, and facilitating patient blood management strategies during liver resection.
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Affiliation(s)
| | - Tanyong Pipanmekaporn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University; Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University
| | | | - Jiraporn Khorana
- Department of Surgery, Faculty of Medicine, Chiang Mai University; Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University
| | - Worakitti Lapisatepun
- Department of Surgery, Faculty of Medicine, Chiang Mai University; Clinical Surgical Research Center, Chiang Mai University, Thailand.
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Zhao H, Li B, Li X, Lv X, Guo T, Dai Z, Zhang C, Zhang J. Dynamic three-dimensional liver volume assessment of liver regeneration in hilar cholangiocarcinoma patients undergoing hemi-hepatectomy. Front Oncol 2024; 14:1375648. [PMID: 38706591 PMCID: PMC11067054 DOI: 10.3389/fonc.2024.1375648] [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: 01/24/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Background For patients with hilar cholangiocarcinoma (HC) undergoing hemi-hepatectomy, there are controversies regarding the requirement of, indications for, and timing of preoperative biliary drainage (PBD). Dynamic three-dimensional volume reconstruction could effectively evaluate the regeneration of liver after surgery, which may provide assistance for exploring indications for PBD and optimal preoperative bilirubin value. The purpose of this study was to explore the indications for PBD and the optimal preoperative bilirubin value to improve prognosis for HC patients undergoing hemi-hepatectomy. Methods We retrospectively analyzed the data of HC patients who underwent hemi-hepatectomy in the First Affiliated Hospital of China Medical University from 2012 to 2023. The liver regeneration rate was calculated using three-dimensional volume reconstruction. We analyzed the factors affecting the liver regeneration rate and occurrence of postoperative liver insufficiency. Results This study involved 83 patients with HC, which were divided into PBD group (n=36) and non-PBD group (n=47). The preoperative bilirubin level may be an independent risk factor affecting the liver regeneration rate (P=0.014) and postoperative liver insufficiency (P=0.016, odds ratio=1.016, β=0.016, 95% CI=1.003-1.029). For patients whose initial bilirubin level was >200 μmol/L (n=45), PBD resulted in better liver regeneration in the early stage (P=0.006) and reduced the incidence of postoperative liver insufficiency [P=0.012, odds ratio=0.144, 95% confidence interval (CI)=0.031-0.657]. The cut-off value of bilirubin was 103.15 μmol/L based on the liver regeneration rate. Patients with a preoperative bilirubin level of ≤103.15 μmol/L shown a better liver regeneration (P<0.01) and lower incidence of postoperative hepatic insufficiency (P=0.011, odds ratio=0.067, 95% CI=0.008-0.537). Conclusion For HC patients undergoing hemi-hepatectomy whose initial bilirubin level is >200 μmol/L, PBD may result in better liver regeneration and reduce the incidence of postoperative liver insufficiency. Preoperative bilirubin levels ≤103.15 μmol/L maybe recommended for leading to a better liver regeneration and lower incidence of postoperative hepatic insufficiency.
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Affiliation(s)
- Haoyu Zhao
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Baifeng Li
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiaohang Li
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiangning Lv
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Tingwei Guo
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zongbo Dai
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Chengshuo Zhang
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Jialin Zhang
- Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China
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Ratti F, Marino R, Aldrighetti L. Comment on "The Goal of Intraoperative Blood Loss in Major Hepatectomy Resection for Perihilar Cholangiocarcinoma Saving Patients From a Heavy Complication Burden". ANNALS OF SURGERY OPEN 2024; 5:e371. [PMID: 38883941 PMCID: PMC11175901 DOI: 10.1097/as9.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 06/18/2024] Open
Affiliation(s)
- Francesca Ratti
- From the IRCCS Ospedale San Raffaele, Hepatobiliary Surgery Division, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca Marino
- From the IRCCS Ospedale San Raffaele, Hepatobiliary Surgery Division, Milan, Italy
| | - Luca Aldrighetti
- From the IRCCS Ospedale San Raffaele, Hepatobiliary Surgery Division, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Wang D, Xiong F, Wu G, Wang Q, Chen J, Liu W, Wang B, Chen Y. The value of total caudate lobe resection for hilar cholangiocarcinoma: a systematic review. Int J Surg 2024; 110:385-394. [PMID: 37738006 PMCID: PMC10793735 DOI: 10.1097/js9.0000000000000795] [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: 05/26/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Hilar cholangiocarcinoma (HCCA) is widely considered to have a poor prognosis. In particular, combined caudate lobe resection (CLR) as a strategy for radical resection in HCCA is important for improving the R0 resection rate. However, the criteria for R0 resection, necessity of CLR, optimal extent of hepatic resection, and surgical approach are still controversial. This review aimed to summarize the findings and discuss the controversies surrounding CLR. Numerous clinical studies have shown that combined CLR treatment for HCCA improves the R0 resection rate and postoperative survival time. Whether surgery for Bismuth type I or II is combined with CLR depends on the pathological type. Considering the anatomical factors, total rather than partial CLR is recommended to achieve a higher R0 resection rate. In the resection of HCCA, a proximal ductal margin greater than or equal to 10 mm should be achieved to obtain a survival benefit. Although there is no obvious boundary between the right side (especially the paracaval portion) and the right posterior lobe of the liver, Peng's resection line can serve as a reference marker for right-sided resection. Laparoscopic resection of the caudate lobe may be safer, more convenient, accurate, and minimally invasive than open surgery, but it needs to be completed by experienced laparoscopic doctors.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongjun Chen
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
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Kawakatsu S, Mizuno T, Yamaguchi J, Watanabe N, Onoe S, Sunagawa M, Baba T, Igami T, Yokoyama Y, Imaizumi T, Ebata T. The Goal of Intraoperative Blood Loss in Major Hepatobiliary Resection for Perihilar Cholangiocarcinoma: Saving Patients From a Heavy Complication Burden. Ann Surg 2023; 278:e1035-e1040. [PMID: 37051914 DOI: 10.1097/sla.0000000000005869] [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: 04/14/2023]
Abstract
OBJECTIVE To determine the goal of intraoperative blood loss in hepatectomy for perihilar cholangiocarcinoma. BACKGROUND Although massive bleeding can negatively affect the postoperative course, the target value of intraoperative bleeding to reduce its adverse impact is unknown. METHODS Patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2010 and 2019 were included. Intraoperative blood loss was adjusted for body weight [adjusted blood loss (aBL)], and the overall postoperative complications were evaluated by the comprehensive complication index (CCI). The impact of aBL on CCI was assessed by the restricted cubic spline regression. RESULTS A total of 425 patients were included. The median aBL was 17.8 (interquartile range, 11.8-26.3) mL/kg, and the CCI was 40.6 (33.7-49.5). Sixty-three (14.8%) patients had an aBL<10 mL/kg, nearly half (45.4%) of the patients were in the range of 10 ≤aBL<20 mL/kg, and 37 (8.7%) patients had an aBL >40 mL/kg. The spline regression analysis showed a nonlinear incremental association between aBL and CCI; CCI remained flat with an aBL under 10 mL/kg; increased significantly with an aBL ranging from 10 to 20 mL/kg; grew gradually with an aBL over 20 mL/kg. These inflection points of ~10 and 20 mL/kg were almost consistent with the cutoff values identified by the recursive partitioning technique. After adjusting for other risk factors for the postoperative course, the spline regression identified a similar model. CONCLUSIONS aBL had a nonlinear aggravating effect on CCI after hepatectomy for perihilar cholangiocarcinoma. The primary goal of aBL should be <10 mL/kg to minimize CCI.
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Affiliation(s)
- Shoji Kawakatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Sunagawa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Baba
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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7
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Fukuda J, Tanaka K, Matsui A, Nakanishi Y, Asano T, Noji T, Nakamura T, Tsuchikawa T, Okamura K, Hirano S. Bacteremia after hepatectomy and biliary reconstruction for biliary cancer: the characteristics of bacteremia according to occurrence time and associated complications. Surg Today 2022; 52:1373-1381. [PMID: 35107650 DOI: 10.1007/s00595-022-02462-2] [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: 10/05/2021] [Accepted: 12/27/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE Bacteremia occurring after extensive hepatic resection and biliary reconstruction (Hx + Bx) for biliary cancer is a critical infectious complication. This study evaluated postoperative bacteremia and examined the potential usefulness of surveillance cultures. METHODS We retrospectively reviewed 179 patients who underwent Hx + Bx for biliary cancer from January 2008 to December 2018 in our department. RESULTS Bacteremia occurred in 41 (23.0%) patients. Patients with bacteremia had a longer operation time and more frequent intraoperative transfusion and more frequently developed organ/space surgical site infection (SSI) than those without bacteremia. The most frequently isolated bacterial species from blood cultures were Enterococcus faecium (29.3%), Enterobacter cloacae (24.4%), and Enterococcus faecalis (22.0%). The SIRS duration of bacteremia associated with organ/space SSI was significantly longer than that of other infectious complications (median 96 h vs. 48 h; p = 0.043). Bacteremia associated with organ/space SSI occurred most often by postoperative day (POD) 30. The concordance rate of bacterial species between blood and surveillance cultures within POD 30 was 67-82%. CONCLUSIONS Bacteremia associated with organ/space SSI required treatment for a long time and typically occurred by POD 30. Postoperative surveillance cultures obtained during this period may be useful for selecting initial antibiotic therapy because of their high concordance rate with blood cultures.
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Affiliation(s)
- Junki Fukuda
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Aya Matsui
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Guilabert P, Asmis L, Cortina V, Barret JP, Colomina MJ. Factor XIII and surgical bleeding. A narrative review. Minerva Anestesiol 2022; 88:156-165. [PMID: 35072429 DOI: 10.23736/s0375-9393.22.15772-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
FXIII is the final factor in the coagulation cascade. It converts soluble fibrin monomers into a stable fibrin clot, prevents premature degradation of fibrin, participates in wound healing, and helps prevent the loss of the endothelial barrier function. FXIII deficiency is believed to be rare, and this may explain why clinicians do not routinely take it into consideration. Congenital FXIII deficiency is a rare disease with a reported prevalence of 1 per million. However, the prevalence of acquired FXIII deficiency is much higher. Acquired forms have been described in patients with decreased hepatic or bone marrow synthesis, hyperconsumption and increased degradation by autoantibodies. This review offers guidance on how to suspect and diagnose FXIII deficiency in both the preoperative consultation and different surgical settings. We also analyze current scientific evidence in order to clarify when and why this clinical situation should be suspected, and how it may be treated.
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Affiliation(s)
- Patricia Guilabert
- Anesthesia and Critical Care Department, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain -
| | - Lars Asmis
- Centre for Perioperative Thrombosis and Hemostasis, University of Zurich, Zurich, Switzerland
| | - Vicente Cortina
- Hemostasis Laboratory, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Joan P Barret
- Plastic Surgery Department and Burn Centre, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria J Colomina
- Anesthesia and Critical Care Department, University Bellvitge Hospital, University of Barcelona, Barcelona, Spain
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Endo I, Hirahara N, Miyata H, Yamamoto H, Matsuyama R, Kumamoto T, Homma Y, Mori M, Seto Y, Wakabayashi G, Kitagawa Y, Miura F, Kokudo N, Kosuge T, Nagino M, Horiguchi A, Hirano S, Yamaue H, Yamamoto M, Miyazaki M. Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: An analysis of patients registered in the National Clinical Database in Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:305-316. [DOI: 10.1002/jhbp.918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/11/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Itaru Endo
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | | | - Hiroaki Miyata
- Department of Healthcare Quality Assessment University of Tokyo Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment University of Tokyo Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery Yokohama City University Yokohama Japan
| | - Takafumi Kumamoto
- Department of Gastroenterological Surgery Yokohama City University Yokohama Japan
| | - Yuki Homma
- Department of Gastroenterological Surgery Yokohama City University Yokohama Japan
| | - Masaki Mori
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Fumihiko Miura
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | - Norihiro Kokudo
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | - Tomoo Kosuge
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | - Masato Nagino
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | | | - Satoshi Hirano
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | - Hiroki Yamaue
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
| | | | - Masaru Miyazaki
- Japanese Society of Hepato‐Biliary‐Pancreatic Surgery Tokyo Japan
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10
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Lee SH, Choi GH, Han DH, Kim KS, Choi JS, Rho SY. Chronological analysis of surgical and oncological outcomes after the treatment of perihilar cholangiocarcinoma. Ann Hepatobiliary Pancreat Surg 2021; 25:62-70. [PMID: 33649256 PMCID: PMC7952679 DOI: 10.14701/ahbps.2021.25.1.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Backgrounds/Aims Despite advances in surgical techniques and perioperative supportive care, radical resection of hilar cholangiocarcinoma is the only modality that can achieve long-term survival. We chronologically investigated surgical and oncological outcomes of hilar cholangiocarcinoma and analyzed the factors affecting overall survival. Methods We retrospectively enrolled 165 patients with hilar cholangiocarcinoma who underwent liver resection with a curative intent. The patients were divided into groups based on the period when the surgery was performed: period I (2005-2011) and period II (2012-2018). The clinicopathological characteristics, perioperative outcomes, and survival outcomes were analyzed. Results The patients’ age, serum CA19-9 levels, and serum bilirubin levels at diagnosis were significantly higher in the period I group. There were no differences in pathological characteristics such as tumor stage, histopathologic status, and resection status. However, perioperative outcomes, such as estimated blood loss (1528.8 vs. 1034.1 mL, p=0.020) and postoperative severe complication rate (51.3% vs. 26.4%, p=0.022), were significantly lower in the period II group. Regression analysis demonstrated that period I (hazard ratio [HR]=1.591; 95% confidence interval [CI]=1.049-2.414; p=0.029), preoperative serum bilirubin at diagnosis (HR=1.585; 95% CI=1.058-2.374; p=0.026), and tumor stage (III, IV) (HR=1.671; 95% CI: 1.133-2.464; p=0.010) were significantly associated with poor prognosis. The 5-year survival rate was better in the period II patients than in the period I patients (35.1% vs. 21.0%, p=0.0071). Conclusions The surgical and oncological outcomes were better in period II. Preoperative serum bilirubin and advanced tumor stage were associated with poor prognosis in patients with hilar cholangiocarcinoma.
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Affiliation(s)
- Sung Ho Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dai Hoon Han
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seoung Yoon Rho
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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11
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Kamada Y, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Sato A, Tani R, Aoyama R, Sasaki Y, Zaima M. Surgical treatment of gallbladder cancer: An eight-year experience in a single center. World J Hepatol 2020; 12:641-660. [PMID: 33033570 PMCID: PMC7522563 DOI: 10.4254/wjh.v12.i9.641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [e.g., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology. AIM To present our data together with a discussion of the therapeutic strategies for GBC. METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment. RESULTS Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins (e.g., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively. CONCLUSION Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan.
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Asahi Sato
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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12
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Kim D, Choi JW, Han S, Gwak MS, Kim GS, Jeon SY, Ryu S, Hahm TS, Ko JS. Ischemic Preconditioning Protects Against Hepatic Ischemia-Reperfusion Injury Under Propofol Anesthesia in Rats. Transplant Proc 2020; 52:2964-2969. [PMID: 32586662 DOI: 10.1016/j.transproceed.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/19/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Propofol is widely used in general anesthesia, and it has been reported to protect various organs against ischemia-reperfusion injury (IRI), including liver. To evaluate the hepatoprotective effects of ischemic preconditioning (IP) under propofol anesthesia, we investigated the possible underlying mechanisms in rats. METHODS Male Sprague-Dawley rats were randomly assigned to 3 groups: sham group (n = 5), non-IP group (n = 9; 45 minutes of hepatic ischemia followed by 2 hours of reperfusion), and IP group (n = 9; IP applied as 10 minutes of hepatic ischemia followed by 15 minutes of reperfusion before 45 minutes of ischemia). Anesthesia was maintained with intravenous (IV) infusion of propofol (800 μg/kg/min). Liver enzymes, histopathological changes, and cytokine expression were examined. RESULTS The IP group showed significantly lower liver enzyme levels (aspartate aminotransferase, P = .045; alanine aminotransferase, P = .006) and reduced the histologic grades of hepatic injury 2 hours after reperfusion (P = .004) compared to the non-IP group. Lactate dehydrogenase activity (P < .001) and interleukin-6 mRNA levels were significantly higher in the non-IP group than in the sham and IP groups (P = .002, both groups). CONCLUSIONS Our results demonstrate that IP under propofol anesthesia significantly attenuated hepatic IRI. The principal mechanism of the protective effects appeared to involve reduced expression of the IL-6 pro-inflammatory cytokine and subsequent reduction of the degree of necrosis.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Yeon Jeon
- Department of Laboratory Animal Research, Samsung Biomedical Research Institute, Seoul, Korea
| | - Sun Ryu
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Soo Hahm
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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13
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Chen X, Sun S, Yan X, Fu X, Fan Y, Chen D, Qiu Y, Mao L. Predictive Factors and Microbial Spectrum for Infectious Complications after Hepatectomy with Cholangiojejunostomy in Perihilar Cholangiocarcinoma. Surg Infect (Larchmt) 2019; 21:275-283. [PMID: 31710266 DOI: 10.1089/sur.2019.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Despite advances in surgical techniques and peri-operative management, post-operative infectious complications still are common after perihilar cholangiocarcinoma (PHCC). This study investigated the predictive factors and microbial spectrum for infections after hepatectomy with cholangiojejunostomy performed to treat PHCC. Methods: A total of 70 consecutive patients, who underwent hepatectomy with cholangiojejunostomy by the same surgeons at a tertiary referral medical center between September 2010 and January 2019, were enrolled. Clinical data were reviewed for multivariable analysis to find independent risk factors for infectious complications. Microorganisms isolated from bile and infection sites were counted to explore the microbial spectrum. Results: A total of 43 patients (61.4%) suffered post-operative infections (33 with surgical site infection [SSI], four with bacteremia, three with pneumonia, 10 with cholangitis, and two with fungus infectious stomatitis), and 28 of them (65.1%) had a positive bile culture. Four independent risk factors were identified: male sex (odds ratio [OR] 12.737; 95% confidence interval [CI] 2.298-70.611; p = 0.004), red blood cell (RBC) count <3.8 × 1012/L (OR 5.085; 95% CI 1.279-20.211; p = 0.021), total cholesterol (TC) <2.90 mmol/L (OR 5.715; 95% CI 1.534-21.299; p = 0.009), and serum Na+ >145 mmol/L (OR 10.387; 95% CI 1.559-69.201; p = 0.016) on post-operative day (POD) 1. A total of 217 and 196 microorganisms were cultured from 311 and 627 specimens, respectively, collected from pre-/intra-operative bile and possible infection sites. Staphylococcus, Enterococcus, Acinetobacter, Streptococcus, and Escherichia were the most common findings of bile culture. The first five organisms most frequently isolated from infection sites were Enterococcus, Staphylococcus, Klebsiella, Acinetobacter, and Candida. A total of 18 patients (64.3%) had at least one species isolated from infection sites that had appeared in a previous bile culture. Conclusions: Male sex, erythrocytopenia, hypocholesterolemia, and hypernatremia on POD 1 are independent risk factors for infectious complications. For patients without positive bile cultures, third-generation cephalosporins could be considered as the prophylactic antibiotic. It is important to monitor the pathogens throughout the hospital stay.
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Affiliation(s)
- Xiaoyuan Chen
- Drum Tower Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Shiquan Sun
- Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Xiaopeng Yan
- Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Xu Fu
- Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Yinyin Fan
- Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Dayu Chen
- Department of Pharmacy, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Yudong Qiu
- Drum Tower Clinical Medical School, Nanjing Medical University, Nanjing, Jiangsu, P.R. China.,Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
| | - Liang Mao
- Department of Hepatobiliary and Pancreatic Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu, P.R. China
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Ito T, Sugiura T, Okamura Y, Yamamoto Y, Ashida R, Uesaka K. The impact of posthepatectomy liver failure on long-term survival after hepatectomy for colorectal liver metastasis. HPB (Oxford) 2019; 21:1185-1193. [PMID: 30777694 DOI: 10.1016/j.hpb.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postoperative complications affect both the short-term and long-term outcomes. The aim of this study was to identify specific prognostic factors among complications after hepatectomy for colorectal liver metastasis (CRLM). METHODS Between 2002 and 2014, 427 patients underwent initial hepatectomy for CRLM. The clinicopathological parameters including postoperative complications were evaluated to identify the prognostic factors for the overall (OS) and relapse-free survival (RFS). RESULTS One hundred and forty-nine patients (34%) developed postoperative complications, including surgical site infection (n = 49, 11.4%), bile leakage (n = 41, 9.6%), posthepatectomy liver failure (PHLF) (n = 26, 6.0%), and pulmonary complication (n = 20, 4.6%). The independent predictors of RFS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, bilateral CRLMs, ≥5 CRLMs, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year RFS rates in patients with and without PHLF were 8% and 32%, respectively (P < 0.001). The independent prognostic factors for OS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, positive surgical margins, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year OS rates in patients with and without PHLF were 31% and 63%, respectively (P = 0.004). CONCLUSIONS Among the complications, only PHLF was associated with decreased long-term survival after hepatectomy for CRLM as well as tumor-specific prognostic factors.
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Affiliation(s)
- Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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15
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Long B, Xiao ZN, Shang LH, Pan BY, Chai J. Impact of perioperative transfusion in patients undergoing resection of colorectal cancer liver metastases: A population-based study. World J Clin Cases 2019; 7:1093-1102. [PMID: 31183340 PMCID: PMC6547314 DOI: 10.12998/wjcc.v7.i10.1093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/24/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Perioperative allogeneic blood transfusion is associated with poorer outcomes.
AIM To identify the factors that were associated with perioperative transfusion and to examine the impact of perioperative transfusion in patients undergoing resection of colorectal cancer (CRC) liver metastases.
METHODS The United States National Inpatient Sample (NIS) database was searched for patients with CRC who received surgery for liver metastasis. Linear and logistic regression analyses were performed.
RESULTS A total of 2018 patients were included, and 480 had a perioperative transfusion. Emergency admission (adjusted odds ratio [aOR] = 1.42; 95%CI: 1.07-1.87), hepatic lobectomy (aOR = 1.76; 95%CI: 1.42-2.19), and chronic anemia (aOR = 2.62; 95%CI: 2.04-3.35) were associated with increased chances of receiving a transfusion, but receiving surgery at a teaching hospital (aOR = 0.75; 95%CI: 0.58-0.98) was associated with a decreased chance of receiving a transfusion. Receiving a perioperative transfusion was significantly associated with increased in-hospital mortality (aOR = 3.38; 95%CI: 1.57-7.25), and increased overall postoperative complications (aOR = 1.67; 95%CI: 1.31-2.13), as well as longer length of hospital stay
CONCLUSION Patients with an emergency admission, hepatic lobectomy, chronic anemia, and who have surgery at a non-teaching hospital are more likely to receive a perioperative transfusion. Patients with CRC undergoing surgery for hepatic metastases who receive a perioperative transfusion are at a higher risk of in-hospital mortality, postoperative complications, and longer length of hospital stay.
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Affiliation(s)
- Bo Long
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhen-Nan Xiao
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Li-Hua Shang
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Bo-Yan Pan
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
- Department of Anesthesiology, Shenyang Women’s and Children’s Hospital, Shenyang 110011, Liaoning Province, China
| | - Jun Chai
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
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16
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Onoe S, Yokoyama Y, Ebata T, Igami T, Mizuno T, Yamaguchi J, Watanabe N, Nagino M. Comparison between autologous and homologous blood transfusions in liver resection for biliary tract cancer: a propensity score matching analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:550-559. [PMID: 30428161 DOI: 10.1002/jhbp.592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND It remains unclear whether preoperative blood donation is truly beneficial in liver surgery. The aim of this study was to compare surgical outcomes between patients receiving autologous and homologous transfusions during liver resection for biliary tract cancer (BTC). METHODS Patients who underwent hepatectomy for BTC were retrospectively reviewed (2006-2017). Patients who deposited autologous blood and underwent resection without homologous blood transfusion intraoperatively (Autologous group) were compared with non-depositing patients who required homologous transfusion during hepatectomy (Homologous group). Propensity score matching analyses were performed to adjust the data for the baseline characteristics of both groups. RESULTS During the study period, 359 patients were included in the Autologous group, and 105 patients were in the Homologous group. The postoperative maximum total bilirubin (T-Bil) levels and the incidence of postoperative liver failure were significantly higher in the Homologous group than in the Autologous group. After propensity score matching, postoperative maximum T-Bil levels were significantly higher in the Homologous group, whereas the incidence of postoperative liver failure was comparable between the two groups; between-group differences were not observed for the remaining major complications, hospital stays and mortality. CONCLUSION Although autologous blood transfusion may minimize postoperative hyperbilirubinemia, it may not decrease the risk for mortality or morbidities following hepatectomy for BTC.
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Affiliation(s)
- Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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17
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Loftus TJ, Lopez AN, Jenkins TK, Downey EM, Sikora JR, Pelletier JPR, Zendejas IR, Sarosi GA, Thomas RM. Packed red blood cell donor age affects overall survival in transfused patients undergoing hepatectomy for non-hepatocellular malignancy. Am J Surg 2018; 217:71-77. [PMID: 30172359 DOI: 10.1016/j.amjsurg.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/19/2018] [Accepted: 08/23/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients undergoing hepatectomy often require packed red blood cell (PRBC) transfusion, which has been associated with worse oncologic outcomes. However, limited data exist regarding the impact of PRBC donor factors. We hypothesized that PRBC donor age impacts survival after hepatectomy for non-hepatocellular malignancies. METHODS Patients who underwent hepatectomy for non-hepatocellular malignancy from 2005 to 2014 were retrospectively evaluated. Impact of clinicopathologic and PRBC factors on oncologic outcomes were assessed. RESULTS Of 149 identified patients, 76 received a perioperative PRBC transfusion (median 2 units). Transfusion was associated with increased median length of stay (8 vs. 6 days; p < 0.01) and median operative blood loss (700 vs. 350 mL; p < 0.01) versus non-transfused, respectively. In transfused patients, receipt of PRBC from older donors compared to younger resulted in decreased RFS (0.94 vs. 2.63 years, respectively; p = 0.02) and OS (1.94 vs. 3.44 years, respectively; p = 0.6). The PRBC donor age was an independent predictor of decreased recurrence free survival on multivariate analysis (HR 2.5, p = 0.04). CONCLUSIONS In patients undergoing hepatectomy for non-hepatocellular malignancies and receiving perioperative transfusion, PRBC donor age may impact survival and warrants further investigation.
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Affiliation(s)
- Tyler J Loftus
- University of Florida College of Medicine, Department of Surgery, Gainesville, FL, USA
| | | | | | | | - James R Sikora
- University of Florida, Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
| | - J Peter R Pelletier
- University of Florida, Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
| | | | - George A Sarosi
- University of Florida College of Medicine, Department of Surgery, Gainesville, FL, USA; North Florida/South Georgia Veterans Health System, Department of Surgery, Gainesville, FL, USA
| | - Ryan M Thomas
- University of Florida College of Medicine, Department of Surgery, Gainesville, FL, USA; North Florida/South Georgia Veterans Health System, Department of Surgery, Gainesville, FL, USA.
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18
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Akashi K, Ebata T, Mizuno T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, Nagino M. Surgery for perihilar cholangiocarcinoma from a viewpoint of age: Is it beneficial to octogenarians in an aging society? Surgery 2018; 164:1023-1029. [PMID: 30082134 DOI: 10.1016/j.surg.2018.05.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Whether operative treatment provides benefits for elderly patients with perihilar cholangiocarcinoma is unknown. The aim of this study was to review resection of perihilar cholangiocarcinoma according to age and to clarify its value for octogenarians. METHODS Between April 1977 and December 2015, we reviewed consecutive patients who underwent resection for perihilar cholangiocarcinoma with a special focus on patient age. RESULTS During the study interval, 831 patients underwent resection for perihilar cholangiocarcinoma. The median age of the resected patients increased by 11 years over approximately 40 years. Before 2001, no octogenarians underwent operative intervention; however, the proportion of operations for octogenarians increased to 9% after 2010. Further analyses were performed on 643 resected patients between 2001 and 2015. The resectability rate was not different between the octogenarians and the other age groups (71% vs 72.4%). The Charlson Comorbidity Index and preoperative laboratory data were similar between the 2 groups. A less advanced tumor was a predominant feature in the octogenarians compared to the other age groups. Consequently, the procedure used in the octogenarians were less extensive, but the proportion of R0 resection was greater in the octogenarians than in the other age groups (95.% vs 78.3%, P = .008). The ratio of patients who died of other diseases was also greater among octogenarians (29% vs 6.0%, P < .001). Overall survival was similar between the 2 groups (41% vs 38.9% at 5 years). CONCLUSION Resection of perihilar cholangiocarcinoma can be performed with low mortality irrespective of age with careful patient selection and offers long-term survival even in octogenarians.
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Affiliation(s)
- Kumiko Akashi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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19
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Validation of a Nomogram to Predict the Risk of Perioperative Blood Transfusion for Liver Resection. World J Surg 2017; 40:2481-9. [PMID: 27169566 DOI: 10.1007/s00268-016-3544-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nomograms may be important clinical tools to estimate the preoperative risk of transfusion and allow for preemptive arrangements for alternatives to allogeneic blood transfusions. METHODS A multicentric international cohort of 1345 patients who underwent hepatectomy for benign or malign liver diseases was used to validate a nomogram developed by the Memorial Sloan-Kettering Cancer Center. RESULTS A total of 449 (33.3 %) patients received a blood transfusion after hepatectomy. Several variables were associated with the need of transfusion on univariate analysis: age, BMI, hemoglobin, PT-INR, bilirubin, AST, ALT, GGT, albumin, primary liver cancer, and number of segments resected. The MSKCC nomogram, including the number of segments resected, diagnosis (primary vs. non-primary), extrahepatic organ resection, as well as platelet and hemoglobin levels, had a good predictive ability (AUC = 0.69). The frequency of patients transfused ranged from 19 % for patients who were at "low risk" (<20 % risk to be transfused) up to 68 % for patients at "high risk" (>70 % risk to be transfused). The nomogram was tested in a multivariable model including other factors associated with risk of transfusion. The final model included age (OR 1.02, 95 % CI 1.01-1.03, p < 0.001), PT-INR (OR 1.54, 95 % CI 1.01-2.36, p = 0.048), and bilirubin (OR 1.86, 95 % CI 1.09-3.18, p = 0.021). The prediction ability for the integrated prediction model was AUC = 0.73. CONCLUSION The MSKCC nomogram was an effective clinical tool able to predict the perioperative risk of transfusion in our independent external validation. The inclusion of patient age, as well as factors associated with liver functional status (bilirubin and PT-INR), improved the predictive ability of the MSKCC nomogram.
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20
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Watanabe N, Yokoyama Y, Ebata T, Sugawara G, Igami T, Mizuno T, Yamaguchi J, Nagino M. Clinical influence of preoperative factor XIII activity in patients undergoing pancreatoduodenectomy. HPB (Oxford) 2017; 19:972-977. [PMID: 28728890 DOI: 10.1016/j.hpb.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/10/2017] [Accepted: 07/02/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The influence of decreased factor XIII (FXIII) activity on perioperative bleeding has been reported in some surgical procedures. The purposes of this study were to investigate the perioperative dynamics of FXIII in patients undergoing pancreatoduodenectomy and to clarify the effects of low preoperative FXIII activity on intraoperative bleeding and postoperative complications. METHODS Total of 43 patients who underwent a pancreatoduodenectomy were enrolled. The perioperative FXIII activities were measured, and their associations with intraoperative bleeding and postoperative outcomes were analyzed. RESULTS Fifteen patients (35%) had low FXIII activities (<70%, lower than the institutional normal range). The patients with preoperative FXIII activities <70% experienced significantly greater blood loss (median, 1309 mL) during surgery compared to those with FXIII levels of ≥70% (median, 710 mL) (p = 0.001). The postoperative morbidity rates, including pancreatic fistula, were comparable between the patients with FXIII activities <70% and those with FXIII activities ≥70%. The FXIII levels substantially decreased on postoperative day 1 and remained at low levels until postoperative day 7. CONCLUSION Unexpectedly high proportions of patients undergoing pancreatoduodenectomy had low preoperative FXIII activities. Preoperative FXIII deficiency may increase intraoperative bleeding but had no influence on the postoperative outcomes.
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Affiliation(s)
- Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Miyazaki M, Shimizu H, Yoshitomi H, Kato A, Furukawa K, Takayashiki T, Kuboki S, Takano S, Ohtsuka M. Clinical implication of surgical resection for recurrent biliary tract cancer: Does it work or not? Ann Gastroenterol Surg 2017; 1:164-170. [PMID: 29863155 PMCID: PMC5881345 DOI: 10.1002/ags3.12036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/20/2017] [Indexed: 12/23/2022] Open
Abstract
Although recent advances in imaging diagnosis, surgical techniques, and perioperative management can result in increased resectability and improved surgical outcomes, most resected patients still develop cancer recurrence. If patients develop cancer recurrence, their prognosis is very ominous. However, there have been some recent reports to show promising outcomes by aggressive surgical strategy in selected patients who developed cancer recurrence. Because there are various surgical procedures being selected at initial surgery in patients with biliary tract cancers, recurrent patterns after resection are very variable in each patient. However, surgical procedures might usually be very complicated and difficult if re‐surgical resection is considered in patients with recurrent biliary tract cancer, Therefore, surgical re‐resection could bring about high surgical morbidity and mortality rates in most previously reported series. Although re‐surgical resection might offer a chance of favorable outcome in selected patients with biliary tract cancers, these aggressive surgical approaches should be carried out in strictly selected patients by expert surgeons at high‐volume centers.
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Affiliation(s)
- Masaru Miyazaki
- Department of General Surgery Chiba University Chiba Japan.,Department of Gastroenterological Surgery Mita Hospital International University of Health & Welfare Tokyo Japan
| | | | | | - Atsushi Kato
- Department of Gastroenterological Surgery Mita Hospital International University of Health & Welfare Tokyo Japan
| | | | | | - Satoshi Kuboki
- Department of General Surgery Chiba University Chiba Japan
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22
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Hsieh CE, Chou CT, Lin CC, Lin KH, Lin PY, Lin HC, Ko CJ, Chang YY, Wang SH, Chen YL. Hemodynamic Changes Are Predictive of Coagulopathic Hemorrhage After Living Donor Liver Transplant. EXP CLIN TRANSPLANT 2017; 15:664-668. [PMID: 28585915 DOI: 10.6002/ect.2016.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. MATERIALS AND METHODS We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. RESULTS Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group. CONCLUSIONS Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant.
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Affiliation(s)
- Chia-En Hsieh
- From the Liver Transplantation of Nurse Practitioner, Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan
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23
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Karavokyros I, Orfanos S, Angelou A, Meropouli A, Schizas D, Griniatsos J, Pikoulis E. Incidence and Risk Factors for Organ/Space Infection after Radiofrequency-Assisted Hepatectomy or Ablation of Liver Tumors in a Single Center: More than Meets the Eye. Front Surg 2017; 4:17. [PMID: 28439517 PMCID: PMC5384425 DOI: 10.3389/fsurg.2017.00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Surgical site infections (SSIs) and especially organ/space infection (O/SI) after resection or ablation of liver tumors are associated with increased morbidity and mortality. A secondary blood stream infection (BSI) is considered an O/SI but the exact prevalence is unknown. We aimed to investigate the incidence of O/SI and BSIs in a cohort of consecutive patients after liver resection or ablation, to seek for a possible connection between them and to search for potential risk factors. Materials and methods We reviewed all patients who underwent hepatic resection or intraoperative liver ablation between January 2012 and December 2016 in our department. We focused on age, gender, Child–Pugh score, preoperative biliary drainage, indication for surgery, type of resection, resection or ablation of tumor, need for bilioenteric reconstruction, additional procedure to hepatectomy, blood transfusion, operative time, postoperative admission to ICU, and antibiotic chemoprophylaxis. All positive cultures from intra-abdominal fluids and blood were recorded. O/SI and BSIs were diagnosed by the criteria set by Centers for Disease Control. All variables were compared between the group with O/SI and the group without infection. BSIs were associated with these infections also. Results Eighty-one consecutive patients with a mean age of 64 years were enrolled. Fifteen patients presented a positive culture postoperatively: intra-abdominal fluid in eight, blood cultures in six, and both blood and intra-abdominal fluid in one patient. The directly estimated incidence of O/SI amounted to 11.1%. Four blood cultures were secondary to O/SI, and the remaining two secondary to central line catheter. O/SI was diagnosed indirectly, through the BSI in an additional 4.9% of the patients, raising the incidence of SSI to 16%. Among the factors studied, only admission to the ICU was found to be statistically significant as a risk factor for the development of O/SI (p = 0.026). Conclusion O/SI should be actively seeked for after liver surgery including blood cultures. Patients with affected physical status, comorbidities are in greater risk of developing O/SI.
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Affiliation(s)
- Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Orfanos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anastasios Angelou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Antonia Meropouli
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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24
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Lemke M, Law CHL, Li J, Dixon E, Tun Abraham M, Hernandez Alejandro R, Bennett S, Martel G, Karanicolas PJ. Three-point transfusion risk score in hepatectomy. Br J Surg 2017; 104:434-442. [PMID: 28079259 DOI: 10.1002/bjs.10416] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/27/2016] [Accepted: 09/30/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Perioperative red blood cell transfusions are required in up to 23 per cent of patients undergoing hepatectomy. Previous research has developed three transfusion risk scores to assess risk of perioperative red blood cell transfusion. Here, the performance of these transfusion risk scores was evaluated in a multicentre cohort of patients who underwent hepatectomy and compared with that of a simplified transfusion risk score. METHODS A database of patients undergoing hepatectomy at four specialized centres between 2008 and 2012 was developed. External validity was assessed by discrimination and calibration. Discrimination was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Calibration was evaluated by the degree of agreement between predicted and actual red blood cell transfusion probabilities. A simplified transfusion risk score using variables common to the three models was created, and discrimination and calibration were evaluated. RESULTS There were 1287 patients included in this study, with 341 (26·5 per cent) receiving a red blood cell transfusion. Discriminative ability was similar between the three transfusion risk scores, with AUCs of 0·66-0·68 and good calibration. A new three-point risk score was developed based on factors present in all models: haemoglobin 12·5 g/dl or less, primary liver malignancy and major resection (at least 4 segments). Discriminative ability and calibration of the three-point model were similar to those of the three existing models, with an AUC of 0·66. CONCLUSION The three-point transfusion risk score simplifies assessment of perioperative transfusion risk in hepatectomy without sacrificing predictive ability.
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Affiliation(s)
- M Lemke
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - C H L Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - J Li
- Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - E Dixon
- Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - M Tun Abraham
- Hepatobiliary Surgery, Division of General Surgery, London Health Sciences Centre, University of Western Ontario, London, Canada
| | - R Hernandez Alejandro
- Hepatobiliary Surgery, Division of General Surgery, London Health Sciences Centre, University of Western Ontario, London, Canada
| | - S Bennett
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - G Martel
- Liver and Pancreas Unit, Department of Surgery, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - P J Karanicolas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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25
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Perioperative blood transfusion and the clinical outcomes of patients undergoing cholangiocarcinoma surgery: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28:1233-40. [PMID: 27560845 DOI: 10.1097/meg.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several studies have reported different results on the association between perioperative blood transfusion (PBT) and clinical outcomes for patients undergoing cholangiocarcinoma surgery. So far, no systematic review and meta-analysis have focused on this inconsistent issue. Therefore, we carried out a systematic review and meta-analysis to evaluate the association between PBT and the clinical outcomes of cholangiocarcinoma surgery patients. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched from their inception to 6 April 2016 to evaluate the relationship between PBT and clinical outcomes for patients undergoing cholangiocarcinoma surgery. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the Cochrane Collaboration's RevMan 5.3 software. A total of 10 studies (1719 patients) were included in the meta-analysis. Pooled analysis showed that PBT was associated with worse 5-year survival rate (HR=1.67, 95% CI=1.41-1.98, P<0.0001) and median overall survival (OS) (HR=1.45, 95% CI=1.14-1.83, P=0.002) in the patients who underwent cholangiocarcinoma surgery. Subgroup analysis showed that intraoperative blood transfusion was also associated with worse 5-year survival rate (HR=1.95, 95% CI=1.49-2.57, P<0.00001). Intraoperative blood transfusion is associated with poor OS for patients undergoing cholangiocarcinoma surgery because it will increase the risk of death. Postoperative blood transfusion may not be associated with OS. In addition, the relationship between PBT and the postoperative complication rate of cholangiocarcinoma surgery is still unclear.
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26
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Cheng J, Zhao P, Liu J, Liu X, Wu X. Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma. Medicine (Baltimore) 2016; 95:e5486. [PMID: 27902606 PMCID: PMC5134803 DOI: 10.1097/md.0000000000005486] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) has been identified as a biochemical marker for histological fibrogenesis and fibrosis in cirrhosis and prognosis of hepatocellular carcinoma (HCC). Whether preoperative APRI can predict postoperative short-term outcomes has not been studied. The purpose of this study was to investigate the ability of preoperative APRI to predict short-term outcomes following liver resection for HCC. APRI was evaluated in 360 patients undergoing liver resection for HCC. The receiver operating characteristic curve analysis was conducted to determine the cutoff value of the APRI in predicting postoperative morbidity. Univariate and multivariate analysis was performed to identify the risk factors for postoperative outcomes. The correlation of the preoperative APRI value with clinicopathological parameters was also examined. We found that the optimal cutoff value of the APRI was set at 9.5 for postoperative complications. APRI was an independent risk factor for overall complications by univariate and multivariate analyses. HCC patients with elevated APRI (>9.5) had a worse liver function and significantly higher postoperative complication rate. In conclusion, preoperative APRI is a useful biochemical marker to predict postoperative outcomes in HCC patients.
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Affiliation(s)
- JiWen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University
| | - Pu Zhao
- Department of Neonatology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi Province
| | - JiangBo Liu
- Department of General Surgery, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, Henan Province
| | - Xi Liu
- Department of Pathology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - XuanLin Wu
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University
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27
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Voskanyan SE, Naidyonov EV, Artemyev AI, Zabezhinsky DA, Rudakov VS, Zhurbin AS, Bashkov AN, Grigorieva OO. [Comparative results of use liver protecting drugs for prophylaxis of the liver failure after extensive resections of the liver]. Khirurgiia (Mosk) 2016:71-75. [PMID: 27723699 DOI: 10.17116/hirurgia2016971-75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After 100 extensive resections of a liver for excision of metastasises of a colorectal cancer, the different drugs protecting a liver were used for prophylaxis of a liver failure. MATERIAL AND METHODS Patients were distributed on 2 equivalent groups. Patients of the first group received Ademetionin in a dosage 400 mg 2 times a day within 7 days. Patients of the second group received Remaxol in a dosage 400 ml within 7 days once a day. RESULTS Frequency of cases of an acute liver failure in the first group of patients was 38%, in the second group of patients - 20% (p<0.05). Patients of the second group had milder course of an acute liver failure (by criteria of ISGLS, 2011) in comparison with patients of the first group. Postoperative bed - days in the first group of patients lasted 13 (11-15) days, in the second group of patients - 11 (10-13) days (p<0.05). There was no postoperative lethality.
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Affiliation(s)
- S E Voskanyan
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - E V Naidyonov
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - A I Artemyev
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - D A Zabezhinsky
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - V S Rudakov
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - A S Zhurbin
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - A N Bashkov
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
| | - O O Grigorieva
- State Research Center of the Russian Federation - Burnazyan Federal Medical Biophysical Center, FMBA of Russia, Moscow, Russia
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28
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Okhotnikov OI, Yakovleva MV, Pakhomov VI. [Percutaneous cholangiostomy for portal cholangiocarcinoma]. Khirurgiia (Mosk) 2016:21-27. [PMID: 27723691 DOI: 10.17116/hirurgia2016921-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM to analyze the efficacy of interventional methods in treatment of Klatskin tumor patients. MATERIAL AND METHODS Treatment of 133 patients with Klatskin tumor for the period 2000-2015 was analyzed. Bismuth I type was revealed in 28 (21.1%) cases, type II - in 45 (33.8%) cases, type III - in 51 (38.3%) cases, type IV - in 9 (6.8%) cases. All patients underwent sonofluoroscopy-assisted percutaneous transhepatic cholangiostomy using self-fixing Pig tail 8Fr drains at the first stage followed by externointernal drainage or antegrade biliary stenting. We deployed 1-6 drains simultaneously or step by step depending on severity of biliary occlusion. RESULTS Technical success was achieved in all patients. Major postoperative complication such as drain dislocation followed by advanced biliary peritonitis was observed in 1 (0.8%) case. Minor complications occurred in 22 (16.5%) patients. In-hospital mortality was 7.5% (10 patients). The cause of death was severe liver-renal failure. Liver abscesses occurred in 13 patients after transpapillary externointernal drainage on background of temporary occlusion of biliary drain. This required interventional surgery. CONCLUSION Obstructive jaundice management should be performed using interventional techniques simultaneously or step by step if unresectable tumor or inoperable patient are present. Herewith it is advisable to restore bile flow in maximal volume of liver parenchyma. Use of uncovered self-expanding biliary stents for palliative treatment of Klatskin tumor may be realized in «hybrid» variant to control stent patency as well as for neoadjuvant therapy of tumor.
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Affiliation(s)
- O I Okhotnikov
- Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital; Department of Radiological Diagnosis and Therapy and Department of Surgical Diseases, Faculty of Postgraduate Education, Kursk State Medical University, Russia
| | - M V Yakovleva
- Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital; Department of Radiological Diagnosis and Therapy and Department of Surgical Diseases, Faculty of Postgraduate Education, Kursk State Medical University, Russia
| | - V I Pakhomov
- Department of Endovascular Diagnosis and Treatment #2, Kursk Regional Clinical Hospital
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29
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Xu W, Xu H, Yang H, Liao W, Ge P, Ren J, Sang X, Lu X, Zhong S, Mao Y. Continuous Pringle maneuver does not affect outcomes of patients with hepatocellular carcinoma after curative resection. Asia Pac J Clin Oncol 2016; 13:e321-e330. [PMID: 27519165 DOI: 10.1111/ajco.12585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022]
Abstract
AIM To investigate whether the use of continuous Pringle maneuver (PM) adversely impacts the outcome of patients with hepatocellular carcinoma (HCC). METHODS From January 1989 to January 2011, 586 HCC patients who underwent curative resection in Peking Union Medical College Hospital were identified from the database. Continuous PM was performed in 290 patients (PM group), including 163 patients with a hepatic inflow occlusion time of <15 min (PM-1 group) and 127 with 15-30 min (PM-2 group). An additional 296 patients underwent partial hepatectomy without inflow occlusion (occlusion-free, OF group). RESULTS The PM group showed less estimated blood loss during hepatectomy than the OF group (P = 0.005) and the two groups experienced similar incidence of perioperative complications. There were no significant differences in either overall survival or disease-free survival (DFS) between the PM and OF groups (P = 0.117 and 0.291, respectively), and between the PM-1 and PM-2 groups (P = 0.344 and 0.103, respectively). Hepatic inflow occlusion and occlusion time were not independent risk factors for OS or DFS. CONCLUSIONS Continuous PM effectively reduces intraoperative bleeding and does not adversely impact the outcomes of HCC patients. It remains a valuable tool in hepatic resection, even difficult, complicated resections requiring prolonged clamping times.
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Affiliation(s)
- Wei Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huayu Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Liao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penglei Ge
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinjun Ren
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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30
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Russolillo N, Langella S, Perotti S, Lo Tesoriere R, Forchino F, Ferrero A. Preoperative assessment of chemotherapeutic associated liver injury based on indocyanine green retention test. Int J Surg 2016; 31:80-5. [DOI: 10.1016/j.ijsu.2016.05.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/27/2016] [Accepted: 05/28/2016] [Indexed: 01/22/2023]
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31
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Dong J, Xu XH, Ke MY, Xiang JX, Liu WY, Liu XM, Wang B, Zhang XF, Lv Y. The FIB-4 score predicts postoperative short-term outcomes of hepatocellular carcinoma fulfilling the milan criteria. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:722-727. [PMID: 26927299 DOI: 10.1016/j.ejso.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/20/2016] [Accepted: 02/03/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The fibrosis score 4 (FIB-4) score is a useful tool to determine the degree of hepatic fibrosis. Liver fibrosis and cirrhosis are well-known predictors of postoperative complications after hepatectomy. This study examined the impact of FIB-4 on postoperative short-term outcomes of patients with hepatocellular carcinoma (HCC). METHODS Three hundred and fifty patients undergoing hepatectomy for HCC between 2008 and 2013 were enrolled. The receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the FIB-4. Univariate and multivariate analysis was performed to identify the risk factors. The correlation of the preoperative FIB-4 value with clinicopathological parameters was examined. RESULTS Postoperative complications were observed in 202 (57.7%) patients. The optimal cutoff value of the FIB-4 was set at 2.88 and 3.85 for postoperative complications and intraoperative blood loss respectively. It was also an independent prognostic factor for postoperative complications (hazard ratio [HR], 1.202; 95% CI, 1.076-1.344; P = 0.001) and intraoperative blood loss (HR, 1.196; 95% CI, 1.091-1.343; P < 0.001) by multivariate analysis. The FIB-4 was significantly correlated with age, liver function, coagulation function, blood loss, intraoperative blood transfusion (all P < 0.05). CONCLUSION Preoperative FIB-4 is a useful index to predict postoperative outcomes in patients with HCC. The FIB-4 should be assessed routinely for hepatocellular carcinoma patients.
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Affiliation(s)
- J Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - X-h Xu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - M-y Ke
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - J-x Xiang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - W-y Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - X-m Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - B Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - X-f Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Y Lv
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China; Research Institute of Advanced Surgical Techniques and Engineering, Xi'an Jiaotong University, Xi'an, China.
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Dumitrascu T, Brasoveanu V, Stroescu C, Ionescu M, Popescu I. Major hepatectomies for perihilar cholangiocarcinoma: Predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions. Asian J Surg 2016; 39:81-89. [PMID: 26103932 DOI: 10.1016/j.asjsur.2015.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/24/2015] [Accepted: 04/01/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIM Major hepatectomies are widely used in curative-intent surgery for perihilar cholangiocarcinoma, but morbidity rates are high. The aim of the study is to explore potential predictors for clinically relevant complications after major hepatectomies for perihilar cholangiocarcinoma. METHODS Seventy patients were included. Univariate and multivariate analyses were performed for risk factors of morbidities using the International Study Group of Liver Surgery definitions. RESULTS Severe morbidity rate was 36.5%. Clinically relevant posthepatectomy liver failure, bile leak, and hemorrhage rates were 24%, 22%, and 8.5%, respectively. A neutrophil-to-lymphocyte ratio > 3.3 is an independent prognostic factor for severe complications (hazard ratio = 1.258; 95% confidence interval 1.008-1.570; p = 0.042) while the number of blood units > 3 is an independent prognostic factor for clinically relevant liver failure (hazard ratio = 1.254; 95% confidence interval 1.082-1.452; p = 0.003). Biliary drainage and portal vein resection were not statistically correlated with any postoperative complication (p ≥ 0.101). Significantly higher bilirubinemia levels were observed in patients with postoperative hemorrhage (p = 0.023). CONCLUSION Clinically relevant morbidity rates after major hepatectomies for perihilar cholangiocarcinoma are high. Liver failure represents the main complication and is correlated with the number of transfused blood units. A patient with increased bilirubinemia appears to have a high risk for postoperative hemorrhage. Biliary drainage and portal vein resection does not appear to have a detrimental effect on morbidities. Neutrophil-to-lymphocyte ratio is a novel independent predictor for severe morbidity after major hepatectomies for perihilar cholangiocarcinoma and may contribute to better and informed decision-making.
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Affiliation(s)
- Traian Dumitrascu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania
| | - Vladislav Brasoveanu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania
| | - Cezar Stroescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania
| | - Mihnea Ionescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania
| | - Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania.
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Bennett S, Baker L, Shorr R, Martel G, Fergusson D. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review protocol. Syst Rev 2016; 5:38. [PMID: 26926289 PMCID: PMC4770706 DOI: 10.1186/s13643-016-0217-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Liver resection is commonly performed for malignant and benign disease and is associated with frequent use of intraoperative and postoperative blood transfusions. Blood transfusions are potentially life-saving, but they have many adverse effects; some well understood, and others less so. Some of the poorly understood side effects include increased risk of postoperative complications and possibly worse oncologic outcomes. The objective of this systematic review is to provide estimates of transfusion prevalence and the effects of perioperative blood transfusion on postoperative mortality and morbidity and long-term cancer outcomes in patients undergoing liver resection. METHODS/DESIGN The Cochrane, Medline, and EMBASE databases will be searched for any randomized controlled trial or observational cohort study comparing liver resection patients that received intraoperative or postoperative allogeneic red blood cell transfusions to those who did not. Outcomes include postoperative mortality, postoperative morbidity (infectious, liver failure, renal failure, cardiovascular/cerebrovascular events, and thromboembolic events), and long-term disease-free and overall survival. Only studies with adult, human patients (>18 years old) undergoing liver resection, in which the primary intervention of interest is blood transfusion will be included. Data will be extracted by two reviewers in duplicate and synthesized into a narrative review. Risk of bias will be assessed. When clinically and methodologically appropriate, meta-analysis will be performed. DISCUSSION Our review will synthesize the literature pertaining to the potential beneficial and detrimental effects of red blood cell transfusion in patients undergoing liver resection. It will be an important step in the development of guidelines for the appropriate use of blood transfusions in patients undergoing liver resection. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015026132.
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Affiliation(s)
- Sean Bennett
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
| | - Laura Baker
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
| | - Risa Shorr
- The Ottawa Hospital, Ottawa, ON, Canada.
| | - Guillaume Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
| | - Dean Fergusson
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
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Abdel Wahab M, El Hanafy E, El Nakeeb A, Hamdy E, Atif E, Sultan AM. Postoperative Outcome after Major Liver Resection in Jaundiced Patients with Proximal Bile Duct Cancer without Preoperative Biliary Drainage. Dig Surg 2015; 32:426-32. [PMID: 26372774 DOI: 10.1159/000438796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/16/2015] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS The need for routine use of preoperative biliary drainage (PBD) before major liver resection in jaundiced patients has recently been questioned. Our aim was to present our experience of patients with proximal bile duct cancer who undergo major liver resection without PBD and compare these results with patients without biliary obstruction who underwent major liver resection. METHODS Eighty six consecutive jaundiced patients underwent major liver resection without PBD. The postoperative outcome was compared to the control group, which was the same size and matched. DESIGN A case-comparison study. RESULTS Fifty nine jaundiced patients (69%) and 22 non-jaundiced patients (25%) received blood transfusion (p = 0.04). Fifty-three patients (62%) in the jaundiced group and 17 (19%) in the non-jaundiced patients experienced postoperative complications (p = 0.003). A statistically significant difference could not be detected for mortality (6 vs. 2%) and transient liver failure (10 vs. 3%). Those patients who underwent extended right hemihepatectomy (with future liver remnant <50%) express high morbidity (55 vs. 24%; p = 0.04) and mortality (23 vs. 8%; p = 0.001) compared to the non-jaundiced patients. CONCLUSIONS Major liver resection without PBD leaving a liver remnant of more than 50% is safe in jaundiced patients. However, transfusion requirement and morbidity are higher in jaundiced patients than in non-jaundiced patients.
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Surgery for Recurrent Biliary Tract Cancer: A Single-center Experience With 74 Consecutive Resections. Ann Surg 2015; 262:121-9. [PMID: 25405563 DOI: 10.1097/sla.0000000000000827] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review our experiences with surgery for recurrent biliary tract cancer (BTC). BACKGROUND Few studies have reported on surgical procedures for recurrent BTC; therefore, it is unclear whether this surgery has survival benefit. METHODS Between 1991 and 2010, 606 patients had recurrences after resection of BTC (gallbladder cancer, n = 135; cholangiocarcinoma, n = 471); 74 patients underwent resection for recurrence, whereas the remaining 532 did not. The medical records were retrospectively reviewed. RESULTS Compared with the 532 patients without surgery for recurrence, the 74 patients with surgery had less advanced cancer, and their time to recurrence was significantly longer (1.4 vs 0.8 years; P < 0.001). A total of 89 surgical procedures for recurrence were performed in the 74 patients (1 time in 63 and ≥2 times in 11). Survival after recurrence was significantly better in the 74 patients with surgery than in the 532 without (32% vs 3% at 3 years; P < 0.001). Survival after surgery for recurrence was (1) similar between gallbladder cancer and cholangiocarcinoma; (2) significantly better in patients with initial disease-free interval of 2 or more years; (3) significantly worse in patients with chest or abdominal wall recurrences; and (4) significantly better in patients with pN0 disease in their primary cancer. Nodal status of the primary tumor and the site of initial recurrence were identified as independent prognostic factors after surgery for recurrence. CONCLUSIONS Surgical resection for recurrent BTC can be performed safely and offers a better chance of long-term survival in selected patients.
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Janny S, Eurin M, Dokmak S, Toussaint A, Farges O, Paugam-Burtz C. Assessment of the external validity of a predictive score for blood transfusion in liver surgery. HPB (Oxford) 2015; 17:357-61. [PMID: 25516363 PMCID: PMC4368401 DOI: 10.1111/hpb.12376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative bleeding is a predictor of morbidity following liver resection. The transfusion-related score (TRS), which is derived from five variables (cirrhosis, preoperative haemoglobin level, tumour size, vena cava exposure and associated extraliver surgical procedure), has been proposed to predict the likelihood of transfusion in liver resection. OBJECTIVE The purpose of this observational study was to evaluate the external validity of the TRS. METHODS In a retrospective, monocentre, observational cohort study of patients undergoing elective liver resection surgery, data for transfused and non-transfused patients were compared by univariate analysis. The TRS was calculated for each patient. The frequency of transfusion was calculated for each score level. The accuracy of the TRS was evaluated using the area under the receiver operator characteristic curve (AUC). RESULTS A total of 205 patients submitted to liver resection were included. Of these, 48 (23.4%) patients received a blood transfusion. There was no significant difference between transfused and non-transfused patients in age, American Society of Anesthesiologists (ASA) score or cirrhosis. The AUC for the TRS was 0.68 (95% confidence interval 0.59-0.77). Among TRS items, only vena cava exposure and associated surgical procedures were significantly associated with risk for transfusion. CONCLUSIONS In the present population, the TRS appeared to serve as a weak predictor of perioperative transfusion. This study confirms that the external validity of the transfusion predictive score should be subject to further investigation before it can be implemented in clinical use.
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Affiliation(s)
- Sylvie Janny
- Department of Anesthesiology and Perioperative Care, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France,Correspondence, Sylvie Janny, Department of Anaesthesiology and Critical Care Medicine, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France. Tel: +33 1 40 87 59 11. Fax: +33 1 47 37 07 03, E-mail:
| | - Mathilde Eurin
- Department of Anesthesiology and Perioperative Care, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France,University of Paris 7 Denis DiderotParis, France
| | - Safi Dokmak
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hepatology and Pathology, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France
| | - Amélie Toussaint
- Department of Anesthesiology and Perioperative Care, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France
| | - Olivier Farges
- University of Paris 7 Denis DiderotParis, France,Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hepatology and Pathology, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France
| | - Catherine Paugam-Burtz
- Department of Anesthesiology and Perioperative Care, Assistance Publique–Hôpitaux de Paris, University Hospitals of Paris Nord Val de Seine, Beaujon HospitalClichy, France,University of Paris 7 Denis DiderotParis, France
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Hanyong S, Wanyee L, Siyuan F, Hui L, Yuan Y, Chuan L, Weiping Z, Mengchao W. A prospective randomized controlled trial: Comparison of two different methods of hepatectomy. Eur J Surg Oncol 2015; 41:243-8. [PMID: 25468459 DOI: 10.1016/j.ejso.2014.10.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 01/17/2023] Open
Affiliation(s)
- Sun Hanyong
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China
| | - Lau Wanyee
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Fu Siyuan
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China
| | - Liu Hui
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China
| | - Yang Yuan
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China
| | - Lin Chuan
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
| | - Zhou Weiping
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China; National Innovation Alliance for Hepatitis & Liver Cancer, Shanghai, PR China.
| | - Wu Mengchao
- Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China
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Kimura N, Toyoki Y, Ishido K, Kudo D, Yakoshi Y, Tsutsumi S, Miura T, Wakiya T, Hakamada K. Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma. J Gastrointest Surg 2015; 19:866-79. [PMID: 25605416 PMCID: PMC4412428 DOI: 10.1007/s11605-014-2741-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival. METHODS Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed. RESULTS Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (P<0.05). In multivariate analysis, only perioperative blood transfusion was independently associated with recurrence (hazard ratio (HR)=2.839 (95 % confidence interval (CI), 1.370-5.884), P=0.005), while perioperative blood transfusion (HR=3.383 (95 % CI, 1.499-7.637), P=0.003) and R1 resection (HR=3.125 (95 % CI, 1.025-9.530), P=0.045) were independent risk factors for poor survival. CONCLUSIONS Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.
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Affiliation(s)
- Norihisa Kimura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Yoshikazu Toyoki
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Keinosuke Ishido
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Daisuke Kudo
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Yuta Yakoshi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Shinji Tsutsumi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Taiichi Wakiya
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province 036-8562 Japan
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Ruptured intrahepatic biliary intraductal papillary mucinous neoplasm in a Jehovah's Witness patient. Int Surg 2014; 99:590-4. [PMID: 25216426 DOI: 10.9738/intsurg-d-13-00134.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 2014; 101:1439-47. [PMID: 25123379 DOI: 10.1002/bjs.9600] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/12/2014] [Accepted: 06/03/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Few larger studies have estimated the incidence of incisional hernia (IH) after abdominal surgery. METHODS Patients who had abdominal surgery between November 2009 and February 2011 were included in the study. The incidence rate and risk factors for IH were monitored for at least 180 days. RESULTS A total of 4305 consecutive patients were registered. Of these, 378 were excluded because of failure to complete follow-up and 3927 patients were analysed. IH was diagnosed in 318 patients. The estimated incidence rates for IH were 5·2 per cent at 12 months and 10·3 per cent at 24 months. In multivariable analysis, wound classification III and IV (hazard ratio (HR) 2·26, 95 per cent confidence interval 1·52 to 3·35), body mass index of 25 kg/m(2) or higher (HR 1·76, 1·35 to 2·30), midline incision (HR 1·74, 1·28 to 2·38), incisional surgical-site infection (I-SSI) (HR 1·68, 1·24 to 2·28), preoperative chemotherapy (HR 1·61, 1·08 to 2·37), blood transfusion (HR 1·46, 1·04 to 2·05), increasing age by 10-year interval (HR 1·30, 1·16 to 1·45), female sex (HR 1·26, 1·01 to 1·59) and thickness of subcutaneous tissue for every 1-cm increase (HR 1·18, 1·03 to 1·35) were identified as independent risk factors. Compared with superficial I-SSI, deep I-SSI was more strongly associated with the development of IH. CONCLUSION Although there are several risk factors for IH, reducing I-SSI is an important step in the prevention of IH. REGISTRATION NUMBER UMIN000004723 (University Hospital Medical Information Network, http://www.umin.ac.jp/ctr/index.htm).
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Affiliation(s)
- K Itatsu
- Divisions of Surgical Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Divisions of Surgical Infection, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Popescu I, Dumitrascu T. Curative-intent surgery for hilar cholangiocarcinoma: prognostic factors for clinical decision making. Langenbecks Arch Surg 2014; 399:693-705. [PMID: 24841192 DOI: 10.1007/s00423-014-1210-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The surgical approach for hilar cholangiocarcinoma (HC) has largely evolved, and increased resectability rates are reported. Large series of patients with resections for HC were published in the last years, and potential predictors for survival were explored. However, the usefulness of these predictors in clinical decision making is controversial. PURPOSE The aim of the present review is to explore the main prognostic factors after curative-intent surgery for HC, as emerged from the current literature. Furthermore, the impact of these predictors on clinical decision making is assessed. CONCLUSION An aggressive surgical approach has improved the survival rates in patients with HC and implies bile duct resection associated with liver resection and loco-regional lymph node dissection. The AJCC staging system remains the main tool to assess the prognosis after resection of HC. Margin-negative resections and absence of lymph node metastases are the main prognostic factor after curative-intent surgery for HC. Response to chemotherapy is also a prognostic factor. Markers of systemic inflammatory response might predict prognosis of patients with HC, but their usefulness in clinical decision making remains unclear.
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Affiliation(s)
- Irinel Popescu
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street no 258, 022328, Bucharest, Romania,
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Ebata T, Ito T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, Nagino M. Surgical technique of hepatectomy combined with simultaneous resection of hepatic artery and portal vein for perihilar cholangiocarcinoma (with video). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:E57-61. [PMID: 24912472 DOI: 10.1002/jhbp.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Perihilar cholangiocarcinomas often involve the bifurcation of the portal vein and the hepatic artery at initial presentation. Previously, vascular invasion was a major obstacle for R0 resection; therefore, such tumors were regarded as locally advanced, unresectable disease. Recently, in leading centers, these tumors have been resected using a specific technique, vascular resection and reconstruction. Vascular resection is classified into three types: portal vein resection alone, hepatic artery resection alone, and simultaneous resection of both the portal vein and hepatic artery. Of these, portal vein resection is widely performed, whereas hepatic artery resection remains controversial. Therefore, hepatectomy combined with simultaneous resection of the portal vein and hepatic artery represents one of the most complicated and challenging procedures in hepatobiliary surgery. The survival benefit of this extended procedure remains unproven, and there is only a single study reporting an unexpectedly favorable outcome in 50 patients. Considering the dismal survival in patients with unresectable disease, hepatic artery resection and/or portal vein resection may be a promising option of choice. However, the technique is highly demanding and has not been standardized. Therefore, this extended surgery may be allowed only in selected hepatobiliary centers.
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Affiliation(s)
- Tomoki Ebata
- Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Stavrou GA, Donati M, Faiss S, Jenner RM, Niehaus KJ, Oldhafer KJ. [Perihilar cholangiocarcinoma (Klatskin tumor)]. Chirurg 2014; 85:155-167. [PMID: 24464335 DOI: 10.1007/s00104-012-2390-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Perihilar cholangiocarcinoma or Klatskin tumors are a rare entity arising from the extrahepatic bile duct bifurcation. Considering the close anatomical relationship of the bile duct bifurcation with the portal vein bifurcation and hepatic arteries, surgical treatment is demanding. With an incidence of only 2-4 cases/100,000 population/year patients should be referred to a specialized center. The tumors are usually poorly differentiated adenocarcinomas growing diffusely along the duct and also the perineural sheath. Only radical surgery offers a curative option and currently surgical strategy usually consists of en bloc resection of the bile duct, extended liver resection and portal vein resection. Proximal and lateral safety margin R0 resections are technically very demanding procedures because of the local anatomy.
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Affiliation(s)
- G A Stavrou
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Medizinische Fakultät der Semmelweis Universität, Asklepios Campus Hamburg, Rübenkamp 220, 22291, Hamburg, Deutschland
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Müller SA, Mehrabi A, Rahbari NN, Warschkow R, Elbers H, Leowardi C, Fonouni H, Tarantino I, Schemmer P, Schmied BM, Büchler MW. Allogeneic blood transfusion does not affect outcome after curative resection for advanced cholangiocarcinoma. Ann Surg Oncol 2014; 21:155-164. [PMID: 23982253 DOI: 10.1245/s10434-013-3226-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Indexed: 01/12/2025]
Abstract
PURPOSE To assess the impact of perioperative blood transfusion on overall and disease-free survival in patients undergoing curative resection for cholangiocarcinoma. METHODS In a single-center study, 128 patients undergoing curative resection for cholangiocarcinoma between 2001 and 2010 were assessed. The median follow-up period was 19 months. Transfused and nontransfused patients were compared by Cox regression and propensity score analyses. RESULTS Overall, 38 patients (29.7 %) received blood transfusions. The patient characteristics were highly biased with respect to receiving transfusions (propensity score 0.69 ± 0.22 vs. 0.11 ± 0.16, p < 0.001). In the unadjusted analysis, blood transfusion was associated with a 105 % increased risk of mortality [hazard ratio (HR) 2.05, 95 % CI 1.19-3.51, p = 0.010]. In the multivariate (HR 1.14, 95 % CI 0.52-2.48, p = 0.745) and the propensity score-adjusted Cox regression (HR 1.02, 95 % CI 0.39-2.62, p = 0.974), blood transfusion had no influence on overall survival. Similarly, in the propensity score-adjusted Cox regression (HR 0.62, 95 % CI 0.24-1.58, p = 0.295), no relevant effect of blood transfusion on disease-free survival was observed. CONCLUSIONS To our knowledge, this is the first propensity score-based analysis providing compelling evidence that the worse oncological outcome after curative resection for advanced cholangiocarcinoma in patients receiving perioperative blood transfusions is caused by the clinical circumstances requiring the transfusions, not by the blood transfusions themselves.
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Affiliation(s)
- Sascha A Müller
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany,
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Sano T, Shimizu Y, Senda Y, Kinoshita T, Nimura Y. Assessing resectability in cholangiocarcinoma. Hepat Oncol 2013; 1:39-51. [PMID: 30190940 DOI: 10.2217/hep.13.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Assessment of surgical resectability in cholangiocarcinoma is more complicated than other gastrointestinal malignancies and remains unestablished. According to the primary origin and tumor extent, the applied surgical procedure varies from extrahepatic bile duct resection to right or left trisectionectomy concomitant with pancreatoduodenectomy. Portal vein resection and reconstruction during hepatectomy has been feasible. Thanks to the availability of new microscopic surgical techniques, hepatic arterial resection and reconstruction have also come to be applied for locally advanced cholangiocarcinoma cases. These vascular surgical techniques can expand surgical indications for advanced cholangiocarcinoma. On the other hand, determination of the tumor extent or staging still remains difficult and imprecise. The endoscopic approach has come to play significant roles both for preoperative biliary drainage and tumor staging. Estimation of the functional reserve of future remnant liver in cholestatic patients still remains unresolved. Hepatobiliary surgeons should carefully estimate the safety of the surgical procedure in each individual patient requiring extensive hepatobiliary resection. Early establishment of the measurement methods of the functional capacity of future remnant liver is an important and urgent issue for assessing safer surgical resectablity of cholangiocarcinoma.
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Affiliation(s)
- Tsuyoshi Sano
- Hepato-Biliary & Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yasuhiro Shimizu
- Hepato-Biliary & Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yoshiki Senda
- Hepato-Biliary & Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Taira Kinoshita
- Hepato-Biliary & Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yuji Nimura
- Hepato-Biliary & Pancreatic Surgery Division, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
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Furusawa N, Kobayashi A, Yokoyama T, Shimizu A, Motoyama H, Miyagawa SI. Surgical Treatment of 144 Cases of Hilar Cholangiocarcinoma Without Liver-Related Mortality. World J Surg 2013; 38:1164-76. [DOI: 10.1007/s00268-013-2394-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yokoyama Y, Ebata T, Igami T, Sugawara G, Ando M, Nagino M. Predictive power of prothrombin time and serum total bilirubin for postoperative mortality after major hepatectomy with extrahepatic bile duct resection. Surgery 2013; 155:504-11. [PMID: 24287146 DOI: 10.1016/j.surg.2013.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/27/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND In 2011, the International Study Group of Liver Surgery defined posthepatectomy liver failure using the prothrombin time-international normalized ratio (PT-INR) and total serum bilirubin concentration (T-Bil). Data analyzing the clinical impact of PT-INR and T-Bil on postoperative mortality, however, remain limited, especially for major hepatectomy with extrahepatic bile duct resection (HEBR). METHODS Prospectively collected data from 545 patients who underwent HEBR in a single institution from 2002 to 2011 were analyzed. Receiver operating characteristics (ROC) analyses of PT-INR and T-Bil on postoperative days (POD) 1, 3, and 5 were used to determine optimal cu-off values for predicting postoperative mortality. RESULTS Most of the treated diseases were biliary tract cancers, including perihilar cholangiocarcinoma (n = 418), gallbladder carcinoma (n = 52), and intrahepatic cholangiocarcinoma (n = 27). The mean values for PT-INR and T-Bil on POD 1, 3, and 5 were significantly greater in the patients who died owing to postoperative complications than in the patients who survived. On POD 5, the area under the ROC curve for predicting postoperative mortality and the optimal cutoff value for PT-INR were 0.876 and 1.68, respectively, whereas those of T-Bil were 0.889 and 4.0 mg/dL, respectively. A combination of PT-INR and T-Bil showed strong predictive power (ie, >40% of the patients with values beyond the cutoff value for both PT-INR and T-Bil on POD 5 died). CONCLUSION We recommend monitoring both PT-INR and T-Bil to predict accurately which patients are at a high risk after HEBR.
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Affiliation(s)
- Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 2013; 258:129-40. [PMID: 23059502 DOI: 10.1097/sla.0b013e3182708b57] [Citation(s) in RCA: 489] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review our 34-year experience with 574 consecutive resections for perihilar cholangiocarcinoma and to evaluate the progress made in surgical treatment of this disease. BACKGROUND Few studies have reported improved surgical outcomes for perihilar cholangiocarcinoma; therefore, it is still unclear whether surgical treatment of this intractable disease has progressed. METHODS Between April 1977 and December 2010, a total of 754 consecutive patients with perihilar cholangiocarcinoma were treated, of whom 574 (76.1%) underwent resection. The medical records of these resected patients were retrospectively reviewed. RESULTS The incidence of major hepatectomies has increased, and limited resections, including central hepatectomies and bile duct resections, were rarely performed. Combined vascular resection was being used more often. Operative time has become shorter, and intraoperative blood loss has also decreased significantly. Because of refinements in surgical techniques and perioperative management, morbidity decreased significantly but was still high, with a rate of 43.1% in the last 5 years. Mortality rate has also decreased significantly (P < 0.001) from 11.1% (8/72) before 1990 to 1.4% (3/218) in the last 5 years. The ratio of advanced disease defined as pStage IVA and IVB has increased significantly from 49.4% before 2000 to 61.4% after 2001. The disease-specific survival for the 574 study patients (including all deaths) was 44.3% at year 3, 32.5% at year 5, and 19.9% at year 10. The survival was significantly better in the later period of 2001 to 2010 than in the earlier period of 1977 to 2000 (38.1% vs 23.1% at year 5, P < 0.001). For pM0, R0, and pN0 patients (n = 243), the survival in the later period was good with 67.1% at year 5, which was significantly better than that of the earlier period (P < 0.001). For pM0, R0, and pN1 patients (n = 142), however, the survival in the later period was similar to that of the earlier period (22.1% vs 14.6% at year 5, P = 0.647). Multivariate analysis revealed that lymph node metastasis was the strongest prognostic indicator. CONCLUSIONS Surgical treatment of perihilar cholangiocarcinoma has been evolving steadily, with expanded surgical indication, decreased mortality, and increased survival. Survival for R0 and pN0 patients was satisfactory, whereas survival for pN1 patients was still poor, suggesting that establishment of effective adjuvant chemotherapy is needed.
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Zhimin G, Noor H, Jian-Bo Z, Lin W, Jha RK. Advances in diagnosis and treatment of hilar cholangiocarcinoma -- a review. Med Sci Monit 2013; 19:648-56. [PMID: 23921971 PMCID: PMC3739601 DOI: 10.12659/msm.889379] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hilar cholangiocarcinoma (HC) is a rare tumor that causes devastating disease. In the late stages, this carcinoma primarily invades the portal vein and metastasizes to the hepatic lobes; it is associated with a poor prognosis. HC is diagnosed by its clinical manifestation and results of imaging techniques such as ultrasound, computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiography, and percutaneous transhepatic cholangiography. Preoperative hepatic bile drainage can improve symptoms associated with insufficient liver and kidney function, coagulopathy, and jaundice. Surgical margin-negative (R0) resection, including major liver resection, is the most effective and potentially curative treatment for HC. If the tumor is not resected, then liver transplantation with adjuvant management can improve survival. We conducted a systematic review of developments in imaging studies and major surgical hepatectomy for HC with positive outcomes regarding quality of life.
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Affiliation(s)
- Geng Zhimin
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, P.R. China
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Ni JS, Lau WY, Yang Y, Pan ZY, Wang ZG, Liu H, Wu MC, Zhou WP. A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis. J Gastrointest Surg 2013; 17:1414-21. [PMID: 23715650 DOI: 10.1007/s11605-013-2236-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/13/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The duration of hepatic vascular inflow occlusion and the amount of intraoperative blood loss have significant negative impacts on postoperative morbidity, mortality and long-term survival outcomes of patients who receive partial hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. AIM This study aimed to compare the perioperative outcomes of partial hepatectomy for HCC superimposed on hepatitis B-related cirrhosis using two different occlusion techniques. METHODS A randomized controlled trial was carried out to evaluate the impact of two different vascular inflow occlusion techniques. The postoperative short-term results were compared. RESULTS During the study period, 252 patients received partial hepatectomy for HCC with cirrhosis. Of these patients, 120 were randomized equally into two groups: the Pringle manoeuvre group (n = 60) and the hemi-hepatic vascular inflow occlusion group (n = 60). The number of patients who had poor liver function on postoperative day 5 with ISLGS grade B or worse was 24 and 13, respectively (P = 0.030). The postoperative complication rate was significantly higher in the Pringle manoeuvre group (40 versus 22 %, P = 0.030). However, the Pringle manoeuvre group had significantly shorter operating time (116 versus 136 min, P = 0.012) although there was no significant difference in intraoperative blood loss between the two groups [200 ml (range 10-5,000 ml) versus 300 ml (range 100-1,000 ml); P = 0.511]. There was no perioperative mortality. CONCLUSIONS The results indicated that for patients with HCC with cirrhosis, hemi-hepatic vascular inflow occlusion was a better inflow occlusion method than Pringle manoeuvre.
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Affiliation(s)
- Jun-sheng Ni
- The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China.
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