A pooled analysis of combined liver and inferior vena cava resection for hepatic malignancy

Zhou, Yanming; Wu, Lupeng; Xu, Dong; Wan, Tao; Si, Xiaoying

doi:10.1016/j.hpb.2017.05.008

Cited by 20 publications

(31 citation statements)

References 40 publications

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“…However, perioperative mortality, which in the past has frequently been considered as a reason not to perform surgery, was only 4.1%, which is an acceptable mortality for this type of advanced liver surgery. Moreover, the risk found in our study is comparable to the risk that has been reported by others [13].…”

Section: Discussionsupporting

confidence: 91%

“…In addition, it is unclear, if the occurrence of graft thrombosis influences survival. In other studies, it has been shown that graft patency in hepatic malignancies is 100% in the first 22 months [13]. In addition, in our dataset, the number of non-patent grafts in the follow-up period was low.…”

Section: Discussionmentioning

confidence: 43%

“…Owing to the limited number of medical centers performing combined resections and the feared high risk of this interventions, most studies only include small numbers of patients and conclusions about the superiority of a combined surgical approach for long-term survival and morbidity are ethically challenging. In a meta-analysis by Zhou et al [13], 258 patients were included. They evaluated the safety and efficacy of combined liver and ICV resections for oncological indications.…”

Section: Discussionmentioning

confidence: 99%

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Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients

Schipper

Zimmermann

Kroh

et al. 2020

JCM

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Background and Methods: Tumors infiltrating the inferior caval vein (ICV) have been considered irresectable in the past due to high perioperative risks. Consequently, the only treatment option for these patients was best supportive care, which resulted in reduced survival. Advancements in surgical techniques have since evolved, such that combined resections of the ICV and the hepatic malignancy are being performed. The aim of this study was the evaluation of the long-term outcomes (e.g., survival) and short-term risks of this procedure. In this single-center, retrospective cohort study (n = 24), we evaluated surgical and oncological outcome for patients undergoing hepatic surgery for oncological indications in combination with resections of the ICV. In addition, we investigated which factors are associated with survival. Results: First, we showed that perioperative mortality is as low as 4.1%. Second, we showed that perioperative co-morbidities are acceptable for this type of advanced hepatobiliary surgery. Third, the reconstruction of the ICV by means of a patch was superior in terms of survival compared to other types of reconstructions. This finding was independent of the type or the aggressiveness of tumor or the resections status. Discussion: In our cohort, many patients had undergone (multiple) preceding visceral surgical interventions or underwent multi-visceral surgery. Despite the medical complexity, survival was encouraging in this cohort, offering novel treatment modalities with a low risk of severe morbidities.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

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Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients

Schipper

Zimmermann

Kroh

et al. 2020

JCM

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“…Ezt követheti a cava és a hepatica rekonstrukciója. A módszert ante situ reszekciónak hívják, s egyértelműen előnyös a mortalitás és a szövődmények tekintetében [15].…”

Section: Megbeszélésunclassified

A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

et al. 2019

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Introduction: Despite all new promising agents of oncotherapy, it is still liver resection that gives potential curative solution for primary and secondary liver tumors. The size of tumorous liver section for resection means no question any more but major vessel infiltration of tumor proposes challenge in liver surgery. Patients and method: Retrospective analysis was carried out covering 33 patients who underwent liver resection in St. Janos Hospital Surgery Department between 1st May 2017 and 1st May 2019. Demographic, surgical, histological data and postoperative course were taken into consideration and comparison with two of our patients who needed vena cava excision simultaneously with liver resection. Results: Patients with liver resection only (LR) had a mean operation time of 91.7 minutes, while operation time for patients with cava resection (CR) was 250 minutes. The average amount of blood transfusion was 1.2 units (200 ml) in group LR and 5 units in group CR. Among LR patients, resection was rated R0 in 23 and R1 in 8 cases, R2 resection could be performed in 2 cases, in group CR in both cases R1 resection was registered. 5 patients with colorectal liver metastasis were operated after previous chemotherapy. Two patients underwent laparoscopic liver resection and two had synchronous colorectal and liver resection, one of these was treated via laparoscopic approach. Conclusion: Liver resections in case of large vessel (vena cava, hepatic vein) infiltrating by liver tumors are indicated the most challenging procedures of liver surgery. The relating literature refers to oncological liver resections with vena cava excision and reconstruction to be safe and applicable. Orv Hetil. 2019; 160(33): 1304–1310.

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“…In patients who can tolerate the procedure, hepatectomy i mprove s t he chanc e s of achieving complete remission of both primary and secondary cancers [3][4][5]. Hepatectomy for hepatic malignancies has become increasingly common in recent years, and in experienced hands, the procedure has been reported to significantly improve the outcomes [6][7][8][9][10][11][12][13][14][15][16][17]. Despite the significant benefits of the procedure, the overall mortality rate associated with the procedure remains high, at about 3.5% [18].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Probiotics and Prebiotics in Prevention of Infectious Complications Following Hepatic Resections: Systematic Review and Meta-Analysis

et al. 2019

JGLD

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Background & Aims: Infections occurring after hepatic resection cause significant morbidity, mortality, and prolonged hospitalization. Probiotics and prebiotics are considered to offer protection against post-operative infections. We aimed to determine the effect of probiotics and prebiotics on the post-operative infection rate after hepatic resection by conducting a systematic review and a meta-analysis. Method: We searched various databases, namely, the PubMed, Medline, Embase, and Cochrane Controlled Trials Registry (CENTRAL), for randomized controlled trials evaluating the effect of probiotics and/or prebiotics on the infection rate following hepatic resection. Extracted data were pooled and subsequently used in a meta-analysis with a random-effects model. Review was reported following the PRISMA guidelines. Results: A total of 4 studies comprising 205 patients were included for our meta-analysis. The infection rates in the probiotic group and placebo group were 11.7% and 30.3%, respectively (p<0.001). The pooled risk ratio (RR) was 0.41 (95% confidence interval [CI]: 0.128–0.730). Subgroup analysis indicated that the wound infection rate in the probiotic group (5.3%) was significantly lower than that in the placebo group (RR: 0.387, 95% CI: 0.155–0.970, p=0.043). Furthermore, probiotics/prebiotics decreased the duration of hospital stay (-0.57 days; 95% CI: -0.861 to -0.274; p<0.001) and antibiotic use (mean difference: -3.89 days, 95% CI: -4.17 to -3.60; p<0.001). There was no significant statistical heterogeneity. Conclusion: Our findings show that administration of probiotics and/or prebiotics prior to operation day decreases the infection rate post-liver resection and could shorten the duration of hospitalization and antibiotics use.

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A pooled analysis of combined liver and inferior vena cava resection for hepatic malignancy

Abstract: Combined resection of the liver and IVC for hepatic malignancies is safe and applicable, and offers acceptable survival outcomes.

Cited by 20 publications

References 40 publications

Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients

Combined Liver and Inferior Vena Cava Resection for Malignancies Is Safe and Feasible in a Group of High-Risk Patients

A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

Efficacy of Probiotics and Prebiotics in Prevention of Infectious Complications Following Hepatic Resections: Systematic Review and Meta-Analysis

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