Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 hepatectomy patients registered in the National Clinical Database of Japan

Yokoo, Hideki; Matsubara, Hiroaki; Konno, Hiroyuki; Taketomi, Akinobu; Kakisaka, Tatsuhiko; Hirahara, Norimichi; Wakabayashi, Go; Gotoh, Mitsukazu; Mori, Masaki

doi:10.1097/md.0000000000005466

Cited by 52 publications

(61 citation statements)

References 35 publications

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“…The characteristic complications of this surgery, such as pulmonary embolism and arrhythmia, require special attention as they can be life-threatening. Although a recent report 23 observed cardiac events in only 0⋅9 per cent of patients after hepatectomy, these events, including pulmonary embolism and arrhythmia, occurred in seven of the 37 patients in the study. Furthermore, cardiac events occurred, all in patients who had not required VVB or CPB, contrary to expectations; however, considering the procedures used, it is not hard to imagine that the risk of cardiac events is extremely high, whether or not extracorporeal circulation was used.…”

Section: Discussioncontrasting

confidence: 55%

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

et al. 2020

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Background Hepatocellular carcinoma (HCC) with tumour thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA) is a rare advanced disease state with a poor prognosis. The aim of this study was to examine survival after surgical resection. Methods Patients with HCC and TT of either the IVC or RA, who underwent liver resection between February 1997 and July 2017, were included. Their short‐ and long‐term outcomes and surgical details were analysed retrospectively. Results Thirty‐seven patients were included; 16 patients had TT in the IVC below the diaphragm, eight had TT in the IVC above the diaphragm, and 13 had TT entering the RA. Twelve patients had advanced portal vein TT (portal vein invasion (Vp) greater than Vp3 and Vp4), ten had bilobar disease, and 12 had extrahepatic disease. There were no in‐hospital deaths, although two patients died within 90 days. Median survival did not differ between patients who had resection with curative intent (18·7 months) and those with residual tumour in the lung only (20·7 months), but survival was poor for patients with residual tumour in the liver (8·3 months). Conclusion Liver resection with thrombectomy for advanced HCC with TT in the IVC or RA is safe and feasible, leading to moderate survival.

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Section: Discussioncontrasting

confidence: 55%

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

et al. 2020

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“…There are fewer large‐scale reviews focusing on the influences of obesity on liver surgery than on gastrointestinal surgery. The main diseases studied are hepatocellular carcinoma and liver metastasis of colorectal cancer, but there are reviews actually targeting all hepatic disorders . Table shows a summary of past studies on the effects of obesity on outcomes of liver surgery.…”

Section: Liver Surgerymentioning

confidence: 99%

“…Our group conducted a large‐scale review to examine the impacts of obesity on hepatic resection and found that obesity (BMI > 30) prolonged operative time by approximately 50 min as compared to surgery on non‐obese patients undergoing hepatectomy of more than one segment apart from the lateral segment (n = 14 903) . In addition, Yokoo et al, studying a similar surgical group, reported BMI > 30 to potentially be a risk factor for blood transfusion and BMI > 35 to be a risk factor for unplanned intubation (n = 14 970). In a similar report, Langella et al noted that resection time, blood loss, and rate of pulmonary complications tended to rise if BMI > 30, and that obesity may negatively influence all three of these factors.…”

Section: Liver Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

145

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In recent years, both the actual number of overweight/obese individuals and their proportion of the population have steadily been rising worldwide and obesity‐related diseases have become major health concerns. In addition, as obesity is associated with an increased incidence of gastroenterological cancer, the number of obese patients has also been increasing in the field of gastroenterological surgery. While the influence of obesity on gastroenterological surgery has been widely studied, very few reports have focused on individual organs or surgical procedures, using a cross‐sectional study design. In the present review, we aimed to summarize the impacts of obesity on surgeries for the esophagus, stomach, colorectum, liver and pancreas. In general, obesity prolongs operative time. As to short‐term postoperative outcomes, obesity might be a risk for certain complications, depending on the procedure carried out. In contrast, it is possible that obesity doesn't adversely impact long‐term surgical outcomes. The influences of obesity on surgery are made even more complex by various categories of operative outcomes, surgical procedures, and differences in obesity among races. Therefore, it is important to appropriately evaluate perioperative risk factors, including obesity.

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“…Better or worse outcomes can be detected by the monitoring report. Furthermore, we are proceeding with papers on complications related to each of the eight operative methods for the evaluation of medical standards using data from 2011 and 2012 . To assure collection of high‐quality data, the Japanese Society of Gastroenterological Surgery (JSGS) have started data verification activities for a gastroenterological session in NCD in 2016.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

Kakeji

Takahashi

Udagawa

et al. 2017

Annals of Gastroent Surgery

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The National Clinical Database (NCD) of Japan started its registration in 2011 and over 9 000 000 cases from more than 5000 facilities were registered over a 6‐year period. This is the report of NCD based upon gastrointestinal surgery information in excess of 3 200 000 cases from 2011 to 2016 adding data of complications. About 70% of all gastrointestinal surgeries were carried out at certified institutions, and the percentage of surgeries done at certified institutions was particularly high for the esophagus (92.4% in 2016), liver (88.4%), pancreas (89.8%), and spleen (86.8%). The percentage of anesthesiologist participation was more than 90% for almost all organs, except 85.7% for the rectum and anus. Approximately, more than two‐thirds of the surgeries were carried out with the participation of a board‐certified surgeon. Although patients have been getting older, mortalities have not been increasing. There were differences in the incidence of complications according to organ site and procedure. Remarkably, mortality rates of low anterior resection were very low, and those of hepatectomy and acute diffuse peritonitis surgery have been gradually decreasing. Although the complication rates were gradually increasing for esophagectomy or pancreaticoduodenectomy, the mortality rates for these procedures were decreasing. Nationwide, this database is expected to ensure the quality of the board‐certification system and surgical outcomes in gastroenterological surgery.

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Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 hepatectomy patients registered in the National Clinical Database of Japan

Abstract: Supplemental Digital Content is available in the text

Cited by 52 publications

References 35 publications

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

Liver resection with thrombectomy for patients with hepatocellular carcinoma and tumour thrombus in the inferior vena cava or right atrium

Obesity as a surgical risk factor

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

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