Extended Hepatic Resection: A 6-Year Retrospective Study of Risk Factors for Perioperative Mortality

Melendez, Jose; Ferri, Enrico; Zwillman, Michael; Fischer, Mary; DeMatteo, Ronald P.; Leung, Denis H. Y.; Jarnagin, William R.; Fong, Yuman; Blumgart, Leslie H.

doi:10.1016/s1072-7515(00)00745-6

Cited by 156 publications

(106 citation statements)

References 16 publications

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“…One of the contraindications to hepatic resection is a small future liver remnant. The small residual liver volume can lead to cholestasis, fluid retention, impaired liver synthetic function and liver failure (Melendez et al, 2001;Schindl et al, 2005). PVE increases the anticipated future liver volume and allows surgery in patients who would otherwise be contraindicated for resection.…”

Section: Discussionmentioning

confidence: 99%

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

et al. 2009

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Portal vein embolisation (PVE) is used to increase the remnant liver volume before major liver resection for colorectal metastases. The resection rate after PVE is 60 -70%, mainly limited by disease progression. The effect of PVE on tumour growth rate has not been investigated. The objective of this study was to compare the growth characteristics of resected colorectal liver metastases in patients undergoing pre-operative PVE with those of matched controls who had not undergone PVE. There were 22 patients who had undergone preoperative PVE and 20 matched controls. Tumour growth rate was calculated by the change in tumour volume (CT/MRI volumetric assessment) from diagnosis to resection. Resected histological specimens were examined by two histopathologists independently for cell differentiation, percentage tumour cell necrosis and mitotic rate. Immunochemical staining with Ki67 was carried out using the MIB-1 monoclonal antibody and quantified using a Glasgow cell-counting graticule. The groups were comparable in demographics, stage of primary disease, volume of liver metastases at presentation and chemotherapy received. The tumour growth rate calculated from imaging was more rapid in the PVE group compared with that in controls (control: 0.05 ± 0.25 ml day À1 , PVE: 0.36 ± 0.68 ml day À1 , P ¼ 0.06). Histology showed no difference in the degree of differentiation, extent of necrosis or apoptosis between the two groups. However, mitotic rate was higher post PVE, as was the proliferation index Ki67 (P ¼ 0.04). This study has confirmed that tumour growth rate increased following PVE and that this is related to increased tumour cell division.

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Section: Discussionmentioning

confidence: 99%

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

et al. 2009

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“…A retrospective study carried out on 97 patients with a gastric tumor measuring 10 cm or more in diameter showed age was not the influencing factor of frequency of complications [5] . Furthermore, analysis of extended hepatectomy (more than four liver segments) demonstrated age was not a contributor to in-hospital mortality [8] . The improvement in perioperative management was a vital reason for reducing the morbidity and mortality [9] .…”

Section: Discussionmentioning

confidence: 98%

Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

Yu²,

Xu³

2004

WJG

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AIM:To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy. METHODS:Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years. RESULTS:The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172). CONCLUSION:It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.Wu YL, Yu JX, Xu B. Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients. World

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“…High bilirubin level has been clearly shown to be a risk factor of increased morbidity and mortality in patients undergoing surgical operations for malignancies or benign diseases [22][23][24][25]. Extended hepatectomy in case of bile obstruction and jaundice may be associated with an increased postoperative morbidity and mortality [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

Caruso¹

2016

J surg

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Extended Hepatic Resection: A 6-Year Retrospective Study of Risk Factors for Perioperative Mortality

Cited by 156 publications

References 16 publications

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

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