Colorectal liver metastasis surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection

Konopke, Ralf; Kersting, Stephan; Bunk, A.; Dietrich, Joachim; Denz, Axel; Gastmeier, J.; Saeger, Hans‐Detlev

doi:10.1007/s00384-009-0669-3

Cited by 29 publications

(20 citation statements)

References 34 publications

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“…Inflow occlusion was independently correlated with morbidity (but not with severe morbidity or LOS). This result is not unprecedented, [29][30][31][32] although the influence of portal triad clamping on outcome is controversial. 23,33 Because the reason for this is not (peak) cytolysis, there is a need to pursue investigations on the influence of inflow occlusion.…”

Section: Interpretation With Reference To Other Studiesmentioning

confidence: 71%

Relevance of Postoperative Peak Transaminase After Elective Hepatectomy

Boleslawski

Vibert²,

Pruvot³

et al. 2014

Annals of Surgery

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Section: Interpretation With Reference To Other Studiesmentioning

confidence: 71%

Relevance of Postoperative Peak Transaminase After Elective Hepatectomy

Boleslawski

Vibert²,

Pruvot³

et al. 2014

Annals of Surgery

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“…Extensive liver resection involves a considerable reduction of hepatic parenchyma that can lead to clinical manifestation of decompensation, including hepatic insufficiency (34,35). The extent of HR correlates with the rate of postoperative complications (36) and it is associated with higher tumour recurrence rate due to heightened activation of regenerative growth factors (37)(38)(39)(40).…”

Section: Technical Considerations Total Laparoscopic Resection Hand-mentioning

confidence: 99%

Laparoscopic Liver Surgery: New Frontiers

2011

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“…Despite robust evidence of the protective benefit of direct IPC in small animal models 5,6 , direct IPC has been shown in small animal models to impair liver regeneration 7,8 . Although this effect has not been shown on donor grafts in human liver transplantation, a multivariate analysis has shown that direct IPC is an independent predictor for post-operative morbidity 9 following hepatic resection surgery in humans.Ten small studies have investigated the effect of direct IPC of donor livers in the setting of deceased donor liver transplantation and a recent meta-analysis has shown that donor IPC of donor grafts lead to a large reduction in recipient mortality and incidence of primary graft non-function although this difference was not statistically significant 10 .Remote Ischaemic Preconditioning (RIPC), again first described in a canine cardiac model 11 , is the process by which preconditioning of one organ or vascular bed provides protection to distant organs or vascular beds during a sustained period of ischaemia. RIPC has been shown by our own group and others to ameliorate hepatic IR injury in small animal models 12,13,14,15 .…”

mentioning

confidence: 91%

mentioning

confidence: 91%

Remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial): a pilot randomized controlled feasibility study

Robertson

Goswami

Wright

et al. 2017

HPB

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Abstract:Ischaemia Reperfusion (IR) injury is a major cause of post-operative morbidity, mortality and graft loss following Orthotopic Liver Trasnplantation (OLT). There is no current accepted treatment for IR injury. The recent drive to implant more marginal grafts, which are more susceptible to IR injury makes this clinical problem a key research goal. Remote Ischaemic Preconditioning (RIPC) has been shown to ameliorate hepatic IR injury in small animal models. Whether recipient RIPC can reduce IR injury in human liver transplant recipients has not previously been investigated. Methods:Forty patients with end stage liver disease undergoing liver transplantation were randomized to RIPC or a sham control group. RIPC was induced through three 5 minute cycles of alternate ischaemia and reperfusion using an orthopaedic tourniquet to the left lower limb under general anaesthesia prior to commencement of the abdominal procedure. The aim of the study was to determine the safety and feasibility of limb RIPC in patients with end stage cirrhosis. Data on clinical outcomes was collected prospectively (minimum 3 month follow up) and the function of the graft was also evaluated. Plasma cytokine levels were measured at baseline, 2 hours post reperfusion and at 24 hours post-operatively. Results:45 of 51 patients approached (88%) were willing to enroll in the study. 5 patients were then excluded and 40 patients were randomized of which 20 underwent RIPC.RIPC was able to be performed in all patients randomized to the RIPC group. There was no evidence of localized complications following RIPC. One patient died in the control group and 1 further graft was lost in the control group due to a non-IR related 3 issue. Median AST levels on the third post-operative day showed a slightly higher trend in the RIPC group than in the control group (221iU vs 149iU, p=1.00) but this was not statistically significant. Conclusions:RIPC is acceptable and can be carried out safely in patients with advanced liver disease. This pilot feasibility study has not demonstrated evidence of a reduction in IR injury or clinical benefit. A longer follow up, a larger study or an altered preconditioning protocol may be required. 4Liver transplantation is the treatment of choice for both acute and chronic end stage liver disease. As outcomes following transplantation have improved, the indications for liver transplantation have been widened and a shortage of suitable organ donors has developed. This has resulted in an increased use of grafts from marginal donors such as the elderly and those with a fatty liver from obesity (extended criteria donors) and especially the use of grafts from donors following cardiac death (DCD). The use of liver DCD grafts in the UK has increased from 6.9% in 2005 1 to 19.1% of grafts implanted in 2013 2 .Ischaemia Reperfusion (IR) injury is the damage that happens to an organ when its blood supply is interrupted and reconstituted. It is a major cause of morbidity and mortality following liver transplantation and is believed to acc...

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Colorectal liver metastasis surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection

Abstract: Factors for complications differ depending on the extent of colorectal liver metastasis resection. Only knowledge and particular consideration of these factors may provide for an optimal postoperative outcome for the individual patient.

Cited by 29 publications

References 34 publications

Relevance of Postoperative Peak Transaminase After Elective Hepatectomy

Relevance of Postoperative Peak Transaminase After Elective Hepatectomy

Laparoscopic Liver Surgery: New Frontiers

Remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial): a pilot randomized controlled feasibility study

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