2012 Liver resections in the 21st century: we are far from zero mortality

Dokmak, Safi; Ftériche, F.S.; Borscheid, Rene; Cauchy, François; Farges, Olivier; Belghiti, Jacques

doi:10.1111/hpb.12069

Cited by 162 publications

(124 citation statements)

References 45 publications

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“…This is consistent with data from the ALPPS registry, where mortality was 8% in total and 5% in patients suffering from CRLM and being <60 years of age [26]. With these complex oncologic strategies and technically even more complex surgeries, it is unlikely that we will ever reach a 0% mortality rate [48]. In this respect, we have to keep in mind that even palliative chemotherapy has a 90-day mortality of 5.5% according to large series [49].…”

Section: Discussionsupporting

confidence: 83%

Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice The Hamburg Barmbek Experience of 58 Cases

et al. 2017

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Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced only 10 years ago and has gained wide acceptance as a variation of staged procedures in liver surgery. It has been criticized for its high morbidity and mortality, which all centers reported in their initial series. Methods: After a world expert meeting in Hamburg in 2015 where all experts in the field met to discuss this method, caveats were extracted and formulated. We researched our complete prospective ALPPS database to see if the recommendations had any impact on outcome. Results: In total, we performed 58 ALPPS procedures in our center. 33 patients were operated on before, 25 after the meeting. Results in terms of morbidity and mortality were significantly better after the meeting, as were patient selection and strategy. Conclusion: In our own center's experience, the implementation of the meetings' recommendations and the information gathered through this valuable exchange had a dramatic impact on results. Having performed 58 ALPPS procedures in total, we can now conclude that ALPPS has become much safer in our hands since the 2015 meeting and that morbidity and mortality are no longer the issue to be discussed. Future research must focus on oncologic outcomes in these patients.

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Section: Discussionsupporting

confidence: 83%

Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice The Hamburg Barmbek Experience of 58 Cases

et al. 2017

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“…Based on a recent report, the 5-and 10-year overall survival rates may reach 50 and 35%, respectively [2]. Even though the safety of hepatectomy has improved, its mortality and morbidity remain considerable, particularly in the event of MH [4,5]. On the other hand, in the recent years, PSH have increased their clinical relevance once new operations have been introduced for challenging even complex tumor presentation usually demanding the removal of a large amount of liver parenchyma [15,16,22,[29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis

et al. 2017

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Background: The performance of parenchymal-sparing hepatectomy (PSH) versus major hepatectomy (MH) in patients with multiple colorectal liver metastases (CLM) is a matter that is yet debated. We investigated the outcome of patients with multiple CLM undergoing PSH instead of MH. Methods: Databases at 2 institutions were reviewed. A propensity score-matched analysis was applied. Among 554 patients, 110 undergoing PSH and 110 undergoing MH were matched. They were similar in baseline characteristics, comorbidity, and tumor features. Primary outcomes were short- and long-term outcomes. Results: Morbidity was significantly higher in the MH group, while mortality was not significantly different. There were no differences in free-margins width, but a trend of increased survival was seen in the PSH group with a median advantage of 6 months over the MH group. Among the prognostic factors, the T status (hazard ratio [HR] 2.6; p = 0.001), the N status (HR 2.9; p = 0.001), the timing of CLM diagnosis (HR 2.1; p = 0.002), the tumor number (HR 2.0; p = 0.001), the tumor size (HR 2.2; p = 0.015), and the neo-adjuvant chemotherapy (HR 1.7; p = 0.023) were found to be statistically and independently significant for survival. Conclusions: PSH conveys advantage over MH in terms of decreased postoperative morbidity, and a trend of survival benefit. PSH should be considered a suitable alternative to MH whenever it is technically feasible.

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“…Reported risk factors for blood transfusion include preoperative anemia (hemoglobin level < 125 g/L), extrahepatic procedure, caval exposure, major hepatectomy, tumour diameter, thrombopenia, cirrhosis and repeat liver resection. 4,6,7 It has been shown that perioperative allogeneic blood transfusion is a risk factor for complications and death 2,3,8,9 and may reduce disease-free survival after resection of hepatocellular carcinoma 10 and colorectal liver metastases. 11,12 Consequently, a reduction of the allogeneic blood transfusion rate would be welcome.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score–matched case–control analysis

Zacharias

Ahlschwede

Dufour

et al. 2018

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2012 Liver resections in the 21st century: we are far from zero mortality

Abstract: The profile of patients undergoing liver resection has changed and now includes more high-risk patients with diseased parenchyma undergoing major hepatectomy for malignancy. This change in patient profile is responsible for the stability in mortality rates over the years.

Cited by 162 publications

References 45 publications

Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice The Hamburg Barmbek Experience of 58 Cases

Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice The Hamburg Barmbek Experience of 58 Cases

Parenchymal-Sparing Surgery for the Surgical Treatment of Multiple Colorectal Liver Metastases Is a Safer Approach than Major Hepatectomy Not Impairing Patients' Prognosis: A Bi-Institutional Propensity Score-Matched Analysis

Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score–matched case–control analysis

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