Improving Perioperative Outcome Expands the Role of Hepatectomy in Management of Benign and Malignant Hepatobiliary Diseases

Poon, Ronnie T. P.; Fan, Sheung Tat; Lo, Chung Mau; Liu, Chi Leung; Lam, Chi‐Ming; Yuen, WK; Yeung, Chun; Wong, John

doi:10.1097/01.sla.0000141195.66155.0c

Cited by 630 publications

(544 citation statements)

References 48 publications

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“…The presence of distant metastasis, main portal vein thrombosis, or inferior vena cava thrombosis is a definite contraindication for resection. Hepatic resection for HCC is associated with a hospital mortality rate of less than 5% in major centers; however, the complication rate remains high, around 30-40% in large series [253][254][255]. Serious complications such as liver failure, postoperative bleeding, and bile leak occur in less than 5% of patients after hepatectomy nowadays [253][254][255].…”

Section: Liver Resectionmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Section: Liver Resectionmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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“…[1][2][3][4][5] Despite many technical advances, intraoperative bleeding remains a problem during liver resection with 30-40% of patients receiving perioperative blood transfusions. [6][7][8] Blood transfusion carries several risks, including transfusion-transmitted viruses, transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reactions, bacterial contamination and severe allergic reactions.…”

Section: Introductionmentioning

confidence: 99%

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

Karanicolas

Lin

Tarshis

et al. 2016

HPB

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“…Advances in preoperative assessment, surgical techniques, anesthesiology, and postoperative care have progressively lowered the perioperative risk of liver resections and thereby widened operative indications. [1][2][3] This has markedly increased the number of patients evaluated for liver resections. 4 Besides this, increased life expectancy and improved general health status lead to an increase in the number of elderly patients eligible for liver resection.…”

Section: Introductionmentioning

confidence: 99%

The Survival Paradox of Elderly Patients After Major Liver Resections

IJtsma

Boevé

Hilst

et al. 2008

Journal of Gastrointestinal Surgery

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Objective The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. Patients and Methods From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Results Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. Conclusion This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.

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Improving Perioperative Outcome Expands the Role of Hepatectomy in Management of Benign and Malignant Hepatobiliary Diseases

Abstract: Perioperative outcome has improved despite extending the indication of hepatectomy to more high-risk patients. The role of hepatectomy in the management of hepatobiliary diseases can be expanded. Reduced perioperative transfusion is the main contributory factor for improved outcome.

Cited by 630 publications

References 48 publications

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

The Survival Paradox of Elderly Patients After Major Liver Resections

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