Preoperative thrombocytopenia may predict poor surgical outcome after extended hepatectomy

Golriz, Mohammad; Ghamarnejad, Omid; Khajeh, Elias; Sabagh, Mohammadsadegh; Weiss, Karl Heinz; Mehrabi, Arianeb

doi:10.1016/j.hpb.2018.06.2782

Cited by 8 publications

(16 citation statements)

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“…Nevertheless, the rates of laparoscopic and robotic major liver resections have increased, and controlling blood loss during these minimally invasive surgeries is difficult; to address this, several studies have recently been published to introduce different methods of the PM in laparoscopic or robotic surgeries [16][17][18] . In addition, the risk of intraoperative bleeding, perioperative blood infusion, postoperative complications, and mortality after EH are still considerable 5,24,25 .…”

Section: Discussionmentioning

confidence: 99%

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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Despite the ongoing decades-long controversy, pringle maneuver (pM) is still frequently used by hepatobiliary surgeons during hepatectomy. The aim of this study was to investigate the effect of PM on intraoperative blood loss, morbidity, and posthepatectomy hemorrhage (PHH). A series of 209 consecutive patients underwent extended hepatectomy (eH) (≥5 segment resection). The association of pM with perioperative outcomes was evaluated using multivariate analysis with a propensity score method to control for confounding. Fifty patients underwent PM with a median duration of 19 minutes. Multivariate analysis revealed that risk of excessive intraoperative bleeding (≥1500 ml; odds ratio [OR] 0.27, 95%-confidence interval [CI] 0.10-0.70, p = 0.007), major morbidity (OR 0.41, 95%-CI 0.18-0.97, p = 0.041), and PHH (OR 0.22, 95%-CI 0.06-0.79, p = 0.021) were significantly lower in PM group after EH. Furthermore, there was no significant difference in 3-year recurrence-free-survival between groups. pM is associated with lower intraoperative bleeding, pHH, and major morbidity risk after eH. Performing PM does not increase posthepatectomy liver failure and does not affect recurrence rate. Therefore, PM seems to be justified in EH. Extended hepatectomy (EH) is the only curative treatment option for patients with large primary or bilobar metastatic liver malignancies 1. Better patient selection and developments in surgical techniques and instruments have increased the number and safety of EH 2,3. However, the risk of complications such as intraoperative bleeding, especially in patients with large tumors or tumors near to major vessels, is still high. These factors are associated with poorer postoperative outcomes 4,5. Patients with massive intraoperative blood loss have a higher rate of posthepatectomy morbidity and mortality 2 and lower recurrence-free survival due to blood transfusion 6. Therefore, reducing intraoperative bleeding during EH and reducing the amount of blood products transfused are important points in liver surgery. Despite the ongoing controversy regarding the advantages and disadvantages of hepatic inflow control during hepatectomy, the Pringle maneuver (PM) remains the most commonly used and evidence-based method of hepatic inflow control 7. The PM significantly decreases intraoperative blood loss, the amount of blood products transfused, and operation time, especially when performed in combination with low central venous pressure 8-10. Nevertheless, there is no evidence that the PM can reduce posthepatectomy morbidity and mortality 11,12 ; in fact, the PM may result in ischemia-reperfusion injury of the liver, which negatively affects hepatocyte metabolism, thereby increasing the rate of posthepatectomy liver failure (PHLF) 13,14. Despite several studies investigating the role of the PM in liver resection, the effects of the PM on intra-and postoperative outcomes have not been investigated exclusively in EH, which has a higher risk of intraoperative bleeding than minor hepatectomies 15. In addition, applica...

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Section: Discussionmentioning

confidence: 99%

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Al-Saeedi

Ghamarnejad

Khajeh

et al. 2020

Sci Rep

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“…The median PS was 16.0 (IQR 14-18.8) and the mean PS was 17.1 (SD 4.5). The median OS was 17.0 (IQR [13][14][15][16][17][18][19] and the mean OS was 16.2 (SD 4.2). The median mortality rate of the P-POSSUM scoring system amounted to 2.3% (IQR 1.4-4.4) and the mean mortality rate amounted to 4.3% (SD 7.3).…”

Section: Comparison With Labmeld Score and P-possum Scoresmentioning

confidence: 99%

“…2), p-value 0.0132. The median and mean mortality rates of the P-POSSUM system were for Risk Score Group 1 (very low-risk) median mortality rate 1.7% (IQR 1.2-2.8) and mean mortality rate 2.9% (SD 4.5); for Risk Score Group 2A (low-risk) median mortality rate 2.4% (IQR 1.4-4.9) and mean mortality Several risk assessment scores have been proposed for the prediction of outcomes after liver resection previously [15][16][17][18][19][20][21][22][23][24]. The labMELD and P-POSSUM scoring systems are well-established, frequently used and have been developed or validated in large patient cohorts [7,[9][10][11][12][13][14][25][26][27][28].…”

Section: Performance Of Labmeld Score and P-possum Scores According Tmentioning

confidence: 99%

Comparison of score-based prediction of 90-day mortality after liver resection

et al. 2020

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Background: Indications for liver surgery are expanding fast and complexity of procedures increases. Preoperative mortality risk assessment by scoring systems is debatable. A previously published externally validated Mortality Risk Score allowed easy applicable and precise prediction of postoperative mortality. Aim of the study was to compare the performance of the Mortality Risk Score with the standard scores MELD and P-POSSUM. Methods: Data of 529 patients undergoing liver resection were analysed. Mortality Risk Score, the labMELD Score and the P-POSSUM Scores (PS, OS, P-POSSUM mortality %) were calculated. The ROC curves of the three scoring systems were computed and the areas under the curve (C-index) were calculated using logistic regression models. Comparisons between the ROC curves were performed using the corresponding Wald tests. Results: Internal validation confirmed that the risk model was predictive for a 90-day mortality rate with a C-index of 0.8421. The labMELD Score had a C-index of 0.7352 and the P-POSSUM system 0.6795 (PS 0.6953, OS 0.5413). The 90-day mortality rate increased with increasing labMELD values (p < 0.0001). Categorized according to the Mortality Risk Score Groups the labMELD Score showed a linear increase while the POSSUM Scores showed variable results. Conclusions: By accurately predicting the risk of postoperative mortality after liver surgery the Mortality Risk Score should be useful at the selection stage. Prediction can be adjusted by use of the well-established labMELD Score. In contrast, the performance of standard P-POSSUM Scores is limited.

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“…Improvements in patient selection criteria, surgical methods and postoperative care have made major liver resections (hemihepatectomy or extended hepatectomy) more feasible and safer 4–8. However, posthepatectomy liver failure (PHLF) or the risk of developing PHLF because of small remnant liver (as small for size syndrome) still needs novel predictive factors9 10 and remains challenging because they can render the patient inoperable or cause postoperative mortality and morbidity 11 12. The current preventive and therapeutic efforts, which focus only on the remnant liver volume (eg, two-staged hepatectomy, portal vein embolisation, or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)), have improved the results, but they are still not effective enough 13–16.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the role of transhepatic flow in postoperative outcomes following major hepatectomy (THEFLOW): study protocol for a single-centre, non-interventional cohort study

et al. 2019

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IntroductionLiver resection is the only curative treatment for primary and secondary hepatic tumours. Improvements in perioperative preparation of patients and new surgical developments have made complex liver resections possible. However, small for size and flow syndrome (SFSF) is still a challenging issue, rendering patients inoperable and causing postoperative morbidity and mortality. Although the role of transhepatic flow in the postoperative outcome has been shown in small partial liver transplantation and experimental studies of SFSF, this has never been studied in the clinical setting following liver resection. The aim of this study is to systematically evaluate transhepatic flow changes following major liver resection and its correlation with postoperative outcomes.Methods and analysisThe TransHEpatic FLOW (THEFLOW) study is a single-centre, non-interventional cohort study, and aims to enrol 50 patients undergoing major hepatectomy (defined as hemihepatectomy or extended hepatectomy based on the Brisbane classification) with or without prior chemotherapy. The portal venous flow, hepatic artery flow and portal venous pressure are measured before and after each resection. All patients are followed-up for 3 months after the operation. During each evaluation, standard clinical data, posthepatectomy liver failure and overall morbidity and mortality will be recorded. THEFLOW study was initiated on 25 March 2018 and is expected to progress for 2 years.Ethics and disseminationThis protocol study received approval from the Ethics Committee of the University of Heidelberg (registration number: S576/2017). The results of this study will be published in a peer-reviewed journal, and will also be presented at medical meetings.Trial registration number NCT03762876.

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Preoperative thrombocytopenia may predict poor surgical outcome after extended hepatectomy

Cited by 8 publications

References 0 publications

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Pringle Maneuver in Extended Liver Resection: A propensity score analysis

Comparison of score-based prediction of 90-day mortality after liver resection

Evaluation of the role of transhepatic flow in postoperative outcomes following major hepatectomy (THEFLOW): study protocol for a single-centre, non-interventional cohort study

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