Does preoperative MELD score affect outcomes following robotic hepatectomy for liver tumors?

Sucandy, Iswanto; Giovannetti, Andres; Spence, Janelle; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1007/s11701-020-01046-x

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…Prior studies have shown that increased preoperative MELD score was associated with increased LOS, but there was no significant increase in postoperative complications, EBL, or increased operative times. 17 It was concluded that elevated MELD scores should not be a limitation on patient eligibility for robotic hepatectomy. 17 Currently, hesitancy exists in offering minimally invasive liver resection to patients with complications secondary to cirrhosis, such as thrombocytopenia, due to concerns of poorer perioperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…17 It was concluded that elevated MELD scores should not be a limitation on patient eligibility for robotic hepatectomy. 17 Currently, hesitancy exists in offering minimally invasive liver resection to patients with complications secondary to cirrhosis, such as thrombocytopenia, due to concerns of poorer perioperative outcomes. Our current study is the first to evaluate the effect of preoperative thrombocytopenia in patients undergoing robotic hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

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Does Preoperative Thrombocytopenia in Patients Undergoing Robotic Hepatectomy for Liver Tumors Predict Poor Outcomes? A Propensity-Score Match Analysis

Crowley

Rayman

Ross

et al. 2022

The American Surgeon

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Introduction Thrombocytopenia is a known surrogate marker for cirrhosis and portal hypertension and has been associated with increased risk of poor perioperative outcomes when studied in “open” operations. This study was undertaken to assess thrombocytopenia as an independent risk factor for undesirable perioperative outcomes after robotic hepatectomy. Methods We retrospectively reviewed 279 patients who underwent robotic hepatectomy at our institution. Patients were stratified into two cohorts based on preoperative platelet counts. Thrombocytopenia was classified as having a platelet count less than 150 /μL. Patients were 2:1 ratio propensity-score matched based on IWATE score and age. Data are presented as median (mean ± SD). Results Thirty-six patients with thrombocytopenia were matched to 72 patients without thrombocytopenia. Patients with thrombocytopenia had higher MELD scores [p = 0.02] and higher Child-Pugh Scores [p <0.001]. Intraoperatively, patients with thrombocytopenia had shorter operative duration [p = 0.03] but similar estimated blood loss (EBL) [p = 0.78]. Postoperatively, there were more fresh frozen plasma transfusions in patients with thrombocytopenia [p = 0.04]. There were no differences in IWATE scores, tumor size, conversions to “open” operations, intraoperative complications, patient length of stay (LOS), Clavien-Dindo score ≥ III complications, perioperative RBC transfusion, in-hospital mortality, or 30-day readmissions. Conclusions In our propensity-score matched study, patients with thrombocytopenia had more severe liver disease; however, there were no differences in their EBL, LOS, or perioperative complications. Preoperative thrombocytopenia, while being an indicator of severity of liver disease potentially promoting perioperative bleeding, does not negatively affect the perioperative course of patients undergoing robotic hepatectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Preoperative Thrombocytopenia in Patients Undergoing Robotic Hepatectomy for Liver Tumors Predict Poor Outcomes? A Propensity-Score Match Analysis

Crowley

Rayman

Ross

et al. 2022

The American Surgeon

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“…Studies by Muhammad et al have shown that creatinine is signi cantly elevated in patients with fatty liver, which is obviously correlated with fatty liver (22). Creatinine is an important indicator of model for end-stage liver disease (MELD) score, which measures liver function and predicts survival in patients with liver disease (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

The prediction model of fatty liver was established by blood biochemical indexes

Liu

2021

Preprint

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Background The main cause of chronic liver disease is fatty liver, which includes alcoholic fatty liver and non-alcoholic fatty liver disease. This study is aimed to establish the prediction model of fatty liver, and provide help for the prevention and treatment of fatty liver, especially NAFLD in the future. Methods Datasets from 2017 to March 2020 NHANES required for the analysis were downloaded from the NHANES web site and R 4.1.1. Software was used for data analysis. A total of 3762 subjects were enrolled in this study, which were divided into model construction group and model validation group in a 2:1 ratio. Results The study selected 6 indicators to build the prediction model, which are as follows: ALT, Platelet count, Creatinine, LDH, HS C-Reactive Protein, Glucose. Then the prediction model was constructed. The area under ROC curve of the model was 0.7471. In the validation population, the area under the ROC curve of the model was 0.7816. Conclusions F score has a good predictive effect on fatty liver, which can be used as an important means for the prevention and treatment of fatty liver, especially NAFLD in the future.

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“…Otherwise, other authors preferred a routine use of pedicle clamping during major hepatectomies or for difficult resections [2,[16][17][18] . [25] 61 66 LS, PS 9/52 -277 0 100 89 9 25/2 Beard et al [26] 115 [30] 75 64 LS 25/50 125 227 0 81 -3 11/-Wang et al [31] 92 54 [32] 97 62 LS, PS 13/84 144* 197* 9.7 85.5 --9.7/-Ceccarelli et al [33] Conversion to open surgery occurred with a median of 5.45% (range 0-14.8). Four authors reported that higher conversions rates (greater than 10%) were related to bleeding, adhesions, technical difficulty, advanced oncological diseases and the requirement of adequate oncologic margins [2,[18][19][20] .…”

Section: Surgery Related Factorsmentioning

confidence: 99%

Robotic liver surgery: literature review and current evidence

Ruzzenente¹,

Alaimo²,

Conci³

et al. 2020

Mini-invasive Surg

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In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy. Among 112 publications found in the literature, the 72 most relevant were selected and the following data were extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including 1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were evaluated to underline the differences in operative outcomes. Eventually, 4 sub-group analyses were conducted on hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients’ recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to laparoscopy, in order to standardize patient selection criteria and techniques.

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Does preoperative MELD score affect outcomes following robotic hepatectomy for liver tumors?

Cited by 5 publications

References 25 publications

Does Preoperative Thrombocytopenia in Patients Undergoing Robotic Hepatectomy for Liver Tumors Predict Poor Outcomes? A Propensity-Score Match Analysis

Does Preoperative Thrombocytopenia in Patients Undergoing Robotic Hepatectomy for Liver Tumors Predict Poor Outcomes? A Propensity-Score Match Analysis

The prediction model of fatty liver was established by blood biochemical indexes

Robotic liver surgery: literature review and current evidence

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