Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection

Xourafas, Dimitrios; Pawlik, Timothy M.; Cloyd, Jordan M.

doi:10.1007/s11605-018-4016-2

Cited by 23 publications

(15 citation statements)

References 39 publications

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“…Surgical stress-related dysbiosis leads to bacterial translocation resulting in a limited detoxification function of the liver being the central hub of the gut–liver axis, increased susceptibility to infections, and worse outcome. After liver surgery, about 30% of the patients develop a bacterial infection, and if bacteremia occurs, the risk of liver failure increases to over 50% and mortality to over 40% [ 1 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…LR, which is especially performed for tumors, is associated with both mortality and morbidity of 3.5% and 10–15%, respectively [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. About 30% of patients develop a bacterial infection and about 10% intra-abdominal sepsis, mostly caused by enterogenic bacteria after LR.…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of bacterial infections increases to up to 45% after extensive LR. With bacteremia, the risk of liver failure increases to >50% with a mortality of >40% [ 1 , 14 , 15 ]. Postoperative infections are the main reason for both morbidity and mortality, which are also associated with high treatment costs [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

2020

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The gut-liver axis is of upmost importance for the development of infections after surgery. Further bacterial translocation due to surgery-related dysbiosis is associated with limited detoxification function of the liver compromising outcome of surgical therapy. After liver surgery, about 30% of patients develop a bacterial infection, with the risk of bacteremia or even sepsis-associated liver failure and mortality in >40%. The potential benefit of pro-/synbiotics given before surgery is still under debate. Thus, a systematic literature search on trials comparing patients with or without supplementation and outcome after liver resection or transplantation was performed. Our search strategy revealed 12 relevant studies on perioperative administration of pro-/synbiotics in liver surgery. The pro-/synbiotic combinations and concentrations as well as administration timeframes differed between studies. Five studies were performed in liver transplantation and 7 in liver resection. All studies but one reported lower infection rates (pooled RR: 0.46, 95% CI: 0.31–0.67) with pro-/synbiotics. Liver function was assessed after LT/LR in 3 and 5 studies, respectively. Pro-/synbiotics improved function in 1/3 and 2/5 studies, respectively. Concluding, perioperative pro-/synbiotics clearly reduce infection after liver surgery. However, standard protocols with both well-defined probiotic strain preparations and administration timeframes are pending.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

2020

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“…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]. Post-operative morbidity necessitating prolonged hospital stay after hepatic resection is also high at 10%-15% [18].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the significant benefits of the procedure, the overall mortality rate associated with the procedure remains high, at about 3.5% [18]. Post-operative morbidity necessitating prolonged hospital stay after hepatic resection is also high at 10%-15% [18]. Moreover, infectious complications represent an independent risk factor of postoperative morbidity and mortality and are observed in 12% to 23% of patients experiencing hepatic resection, including respiratory infections, intra-abdominal infection, and wound infections [19,20].…”

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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Management of Hepatocellular Carcinoma

et al. 2023

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ImportanceHepatocellular carcinoma (HCC) is the sixth most common malignancy and fourth leading cause of cancer-related death worldwide. Recent advances in systemic and locoregional therapies have led to changes in many guidelines regarding systemic therapy, as well as the possibility to downstage patients to undergo resection. This review examines the advances in surgical and medical therapies relative to multidisciplinary treatment strategies for HCC.ObservationsHCC is a major health problem worldwide. The obesity epidemic has made nonalcoholic fatty liver disease a major risk factor for the development of HCC. Multiple societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, the Asian Pacific Association for the Study of the Liver, and the National Comprehensive Cancer Network, provide guidelines for screening at-risk patients, as well as define staging systems to guide optimal treatment strategies. The Barcelona Clinic Liver Cancer staging system is widely accepted and has recently undergone updates with the introduction of new systemic therapies and stage migration.Conclusions and RelevanceThe treatment of patients with HCC should involve a multidisciplinary approach with collaboration among surgeons, medical oncologists, radiation oncologists, and interventional radiologists to provide optimal care. Treatment paradigms must consider both tumor and patient-related factors such as extent of liver disease, which is a main driver of morbidity and mortality. The advent of more effective systemic and locoregional therapies has prolonged survival among patients with advanced disease and allowed some patients to undergo surgical intervention who would otherwise have disease considered unresectable.

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Early Morbidity and Mortality after Minimally Invasive Liver Resection for Hepatocellular Carcinoma: a Propensity-Score Matched Comparison with Open Resection

Cited by 23 publications

References 39 publications

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut–Liver Axis—A Systematic Review and Meta-Analysis

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

Management of Hepatocellular Carcinoma

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