Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Lafaro, Kelly J.; Buettner, Stefan; Maqsood, Hadia; Wagner, Doris; Bagante, Fabio; Spolverato, Gaya; Xu, Li; Kamel, Ihab R.; Pawlik, Timothy M.

doi:10.1007/s11605-015-2872-6

Cited by 101 publications

(107 citation statements)

References 145 publications

(182 reference statements)

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“…Surgery can often involve a major resection with attendant post-operative morbidity. [18, 19] While the impact of post-operative complications on long-term survival has been examined for other gastrointestinal and hepatic malignancies, the effect of complications on prognosis following resection of EHBM has not been reported. [14–17] In addition, the specific prognostic impact of SSI, one of the most common post-operative complications, has not been reported among patients with EHBM.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Peri-operative outcomes following these extensive operations can be associated with considerable morbidity, with post-operative complications as high as 30–40% in many centers. [18, 19] When a complication does occur, the long-term prognosis of the patient can be adversely impacted independent of tumor-specific factors. Specifically, complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Buettner

Ethun

Poultsides

et al. 2017

Journal of Gastrointestinal Surgery

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Background Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extra-hepatic bilary malignancies (EHBM). Methods Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results 728 patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection liver resection was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n=70, 9.6%) or formation of an abscess in the operative bed (n=91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p=0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p=0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p=0.008). Conclusion SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of post-operative SSI was adversely associated with long-term survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Buettner

Ethun

Poultsides

et al. 2017

Journal of Gastrointestinal Surgery

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“…Its pathophysiology is mediated by postoperative portal hyperperfusion (into the liver remnant) which leads to transient portal hypertension, sinusoidal constriction and endothelial injury [1]. Morbidity and mortality is intimately related to failure of remnant liver and/or infection.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options are limited and mostly supportive [1]. Herein, we describe a case of PHLF after extended right hepatectomy for hepatocellular carcinoma in a non-cirrhotic liver, where plasmapheresis was used to salvage the remnant liver.…”

Section: Introductionmentioning

confidence: 99%

Salvage Plasmapheresis for Post-hepatectomy Liver Failure

Inayat

Hussain

Tasleem

et al. 2016

Cureus

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In the latest decades, an important change has been registered in liver surgery related to the progress of surgical techniques, critical care, and postoperative treatment, allowing a sharp decrease in mortality and morbidity. However, management of post-hepatectomy liver failure (PHLF) still remains a challenge and no supportive treatment has been found to be generally effective. The present study is a reappraisal of plasmapheresis as a potential supportive measure in patients with PHLF following major liver resection.

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“…SFSF and posthepatectomy liver failure (PHLF) are often mistaken as the same, and this is shown in the comments made by Athanasiou. This mistake is common because SFSF and PHLF are usually overlapping [8]. However, SFSF is a clinical syndrome after liver resection which can lead to irreversible PHLF but can also be prevented from ending in that.…”

mentioning

confidence: 99%

Response to: Comment on “Establishing a Porcine Model of Small for Size Syndrome following Liver Resection”

Golriz

Khajeh

Ghamarnejad

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

Abstract: Given its resistance to treatment and the high postoperative mortality associated with PHLF, great effort has been put in to both accurately identify patients at high risk and to develop strategies that can help prevent its occurrence.

Cited by 101 publications

References 145 publications

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Salvage Plasmapheresis for Post-hepatectomy Liver Failure

Response to: Comment on “Establishing a Porcine Model of Small for Size Syndrome following Liver Resection”

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