Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence

Codony, Clara; López‐Ben, Santiago; Albiol, Maite; Falgueras, Laia; Castro, Ernesto; Codina-Barreras, Antoni; Casellas, Margarida; Gil, J.; Codina‐Cazador, A.; Figueras, Joan

doi:10.1007/s12094-016-1495-z

Cited by 6 publications

(3 citation statements)

References 41 publications

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“…This is possibly due to its reflection of heavy tumor burden. Another reason might be that extreme liver surgery carries a high rate of morbidity and mortality [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of microvascular invasion in early-intermediate stage hepatocelluar carcinoma: a propensity score matching analysis

Shen

Wen

et al. 2018

BMC Cancer

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BackgroundMicrovascular invasion (MVI) is well established as a negative prognostic factor for hepatocelluar carcinoma (HCC). However, its prognostic value in different subgroups of Barcelona Clinical Liver Cancer (BCLC) stages remains to be elucidated.MethodsFour hundred fifty-eight MVI-negative and 204 MVI-positive patients who underwent hepatectomy were retrospectively analyzed. After propensity score matching (PSM) analysis, 187 pairs of matched patients were generated. Long-term survival was compared by the Kaplan–Meier method.ResultsPatients with MVI commonly had more advanced tumors. All the patients with MVI had significantly worse survival rate compared to the patients without MVI before and after PSM(p < 0.001). In the subgroup analysis, BCLC stage A HCC patients without MVI had better prognosis than those with MVI before and after PSM (p < 0.001 and p = 0.024). For BCLC stage B HCCs, long-term survival was significantly better for patients without MVI before PSM(p = 0.001). However, the overall survival (OS) rate was comparable between both groups after PSM (p = 0.682), although MVI-positive group had a higher rate of recurrence (p = 0.011).. Surgery type, satellite lesions, tumor size, and serum ALT level were statistically significant factors associated with survival in MVI-positive group. Tumor number, tumor size and neutrophil to lymphocyte ratio (NLR) were predictors of survival in MVI-negative group.ConclusionsIts prognostic value in different subgroups of BCLC stages differed. MVI is an independent predictor of prognosis in patients with BCLC stage A. For BCLC stage B HCCs, MVI-positive group had poor prognosis through more advanced HCCs.

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“…This is possibly due to its reflection of heavy tumor burden. Another reason might be that extreme liver surgery carries a high rate of morbidity and mortality [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of microvascular invasion in early-intermediate stage hepatocelluar carcinoma: a propensity score matching analysis

Shen

Wen

et al. 2018

BMC Cancer

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“…Patient comorbidities are known to be a risk factor for postoperative mortality in any surgical procedure, particularly in patients developing sepsis or posthepatectomy liver failure (11)(12)(13)(14). However, comorbidities (taken individually or globally) are not yet recognized as a significant risk factor in the ALPPS literature (5,9).…”

Section: Introductionmentioning

confidence: 99%

Development and internal validation of the Comprehensive ALPPS Preoperative Risk Assessment (CAPRA) score: is the patient suitable for Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS)?

Capobianco¹,

Oldhafer²,

Fard-Aghaie³

et al. 2022

Hepatobiliary Surg Nutr

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Background: Preoperative patient selection in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is not always reliable with currently available scores, particularly in patients with primary liver tumor. This study aims to (I) to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and (II) to create a score predicting 90-day mortality preoperatively.Methods: Thirteen high-volume centers participated in this retrospective multicentric study. A risk analysis based on patient characteristics, underlying disease and procedure type was performed to identify risk factors and model the CAPRA score. A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index (CCI), the age-adjusted CCI (aCCI), the ALPPS risk score before Stage 1 (ALPPS-RS1) and Stage 2 (ALPPS-RS2). The model was internally validated applying bootstrapping.Results: A total of 451 patients were included. Mortality was 14.4%. The CAPRA score is calculated based on the following formula: (0.1*age) − (2*BSA) +1 (in the presence of primary liver tumor) +1 (in the presence of severe cardiovascular disease) +2 (in the presence of moderate or severe diabetes) +2 (in the presence of renal disease) +2 (if classic ALPPS is planned). The predictive ability was 0.837 for the CAPRA score, 0.443 for CCI, 0.519 for aCCI, 0.693 for ALPPS-RS1 and 0.807 for ALPPS-RS2. After 1,000 cycles of bootstrapping the C statistic was 0.793. The accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of 4.70.Conclusions: Comorbidities play an important role in ALPPS and should be carefully considered when planning the procedure. By assessing the patient's preoperative condition in relation to ALPPS, the CAPRA score has a very good ability to predict postoperative mortality.

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“…La literatura médica, en la que cabe destacar una serie de 77 casos 10 y la española más extensa, que incluye 12 11 , se centra fundamentalmente en la técnica quirúrgica, el manejo anestésico y el resultado a medio plazo. Las referencias sobre el periodo postquirúrgico inmediato son prácticamente inexistentes.…”

Section: Introductionunclassified

Extreme liver surgery: taking a proactive attitude to improve immediate postsurgical outcomes

Salat¹,

Pérez-Moltó²,

Herraiz³

et al. 2020

rmt

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RESUMEN Objetivo: Describir las primeras intervenciones mediante cirugía hepática extrema en nuestro hospital, así como las reflexiones surgieron entorno a ellas. Material y métodos: Se recogieron datos los sobre los pacientes, intervención e ingreso en la Unidad de Cuidados Intensivos de los 4 pacientes que fueron intervenidos entre noviembre de 2017 y enero de 2019. Resultados: La tasa de complicaciones/acontecimientos adversos en esta serie fue relativamente baja y prácticamente en todos los casos se resolvieron antes del alta de la unidad de cuidados posquirúrgicos. Ninguno de los pacientes con hígado macroscópicamente normal presentó signos clínicos/analíticos de disfunción hepática. Conclusiones: La cirugía hepática extrema parece una opción terapéutica factib le para pacientes que previamente se habrían considerado candidatos únicamente a tratamientos paliativos, aunque todavía es preciso definir claramente los límites de la evolución normal en los primeros días tras la intervención y su perfil de acontecimientos adversos tardíos y mortalidad. Palabras clave Neoplasias hepáticas, complicaciones posoperatorias, estudio observacional (DeCS) SUMMARY Objective: To describe the first extreme liver surgery cases in our hospital, as well as the reflections that arose around them. Material and methods: Data about the patients, operation and admission to the Intensive Care Unit of the 4 patients who were operated on between November 2017 and January 2019 were collected. Results: The rate of complications/adverse events in this series was relatively low and in almost all cases resolved before discharge from the post-surgical care unit. None of the patients with macroscopically normal liver presented clinical/analytical signs of liver dysfunction. Conclusions: Extreme liver surgery seems a feasible therapeutic option for patients who would have previously been considered candidates for palliative treatments only, although it is still necessary to clearly define the limits of normal evolution in the first days after the operation, and its profile of late adverse events and mortality.

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Extreme liver surgery as treatment of liver tumors involving the hepatocaval confluence

Cited by 6 publications

References 41 publications

The prognostic value of microvascular invasion in early-intermediate stage hepatocelluar carcinoma: a propensity score matching analysis

The prognostic value of microvascular invasion in early-intermediate stage hepatocelluar carcinoma: a propensity score matching analysis

Development and internal validation of the Comprehensive ALPPS Preoperative Risk Assessment (CAPRA) score: is the patient suitable for Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS)?

Extreme liver surgery: taking a proactive attitude to improve immediate postsurgical outcomes

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