Risk Factors for Liver Failure and Mortality After Hepatectomy Associated With Portal Vein Resection

Bachellier, Philippe; Rosso, Edoardo; Pessaux, Patrick; Oussoultzoglou, Elíe; Nobili, Cinzia; Panaro, Fabrizio; Jaeck, Daniel

doi:10.1097/sla.0b013e3181f193ba

Cited by 41 publications

(21 citation statements)

References 40 publications

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“…Nagino and coworkers, in a single-center experience of 574 patients with curative-intent surgery for PHC with and without a PVR, reported a postoperative liver failure rate of 53.5% using the ISGLS definition (11). Nevertheless, male gender and right trisectionectomies were significantly associated with an increased risk of postoperative liver failure in patients with combined PVR hepatectomies in a study (50). In the present series, male gender and right trisectionectomies rates were significantly higher in the PVR group (Table 1).…”

Section: Discussionsupporting

confidence: 58%

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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Introducere: Siguranţa rezecţiei de venă portă în chirurgia colangiocarcinoamelor perihilare a fost deja dovedită în Asia, America şi Europa de Vest. Totuşi, nu există nici un fel de date referitoare la acest subiect, care să provină din Europa de Est. Scopul studiului este de a evalua comparativ rezultatele postoperatorii imediate şi pe termen lung după rezecţia cholangiocarcinoamelor perihilare, cu şi fără rezecţie de venă portă. Pacienţi şi metode: Datele a 21 de pacienţi rezecaţi pentru colangiocarcinoame perihilare ce au asociat rezecţia venei porte au fost comparate cu datele a 102 pacienţi fără rezecţie de venă portă. Pentru analiza comparativă a datelor din cele două grupuri s-au folosit teste statistice specifice. Rezultate: Rezecţia venei porte a fost realizată la 17% dintre pacienţi. În grupul pacienţilor cu rezecţie asociată de venă portă au fost realizate semnificativ mai multe trisecţionectomii drepte (p = 0.031) şi rezecţii de lob caudat (p = 0.049). Ca urmare, atât timpul operator (p = 0.015) cât şi pierderea de sânge intraoperator (p = 0.002) au fost semnificativ mai mari în acest grup de pacienţi cu rezecţie de venă portă. Nu s-au constatat diferenţe semnificative între cele două grupuri de pacienţi în ceea ce priveşte rata complicaţiilor severe postoperatorii, mortalitatea postoperatorie şi chimioterapia adjuvantă. Totuşi, în grupul pacienţilor cu rezecţie de venă portă, rata insuficenţei hepatice postoperatorii cu impact clinic

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Section: Discussionsupporting

confidence: 58%

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Dumitraşcu¹,

Stroescu²,

Brasoveanu³

et al. 2017

chr

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“…In case of vascular invasion of 2 out of 3 hepatic veins, an alternative to TVE has been reported by our group using the remnant liver as a portocaval shunt [66] . The need for vascular reconstruction, however, inevitably leads to increased postoperative complications rates with mortality rates as high as 20% in case of extended procedures or an underlying steatotic liver [67] .…”

Section: Technical Considerationsmentioning

confidence: 99%

Surgical Results after Downstaging of Initially Marginal or Non-Resectable Liver Metastases

Cauchy

Faivre²,

Belghiti³

2012

Dig Dis

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Surgery remains the best curative treatment for resectable patients with colorectal liver metastases. In patients initially considered unresectable, both refinements in surgical technique using portal vein occlusion or two-step resections and increased efficiency of chemotherapy regimen with the adjunction of antiangiogenics now allow secondary resection. Recent evidence suggests almost identical long-term survival in case of secondary downstaged lesions advocating an aggressive approach. However, these data lie on disparate and nonconsensual criteria for unresectability, which often do not gather technical and oncologic components together. Furthermore, both impaired general status and damaged underlying parenchyma as a consequence of prolonged chemotherapy to achieve resectability as well as the technical challenge required to perform adequate carcinologic resection could increase the operative risk in such patients. In our experience, a subgroup of slow chemo-responding initially unresectable patients who required preoperative liver volume modulation after ≥12 cycles of chemotherapy to achieve sufficient response experienced dramatically high operative risk which jeopardized postoperative chemotherapy and subsequently put these patients at increased risk of recurrence. Whether all patients preoperatively amenable to surgery using intensive chemotherapy and complex surgical strategy actually benefit from such an aggressive approach is a matter of ongoing debate, which needs a reappraisal.

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“…Insufficient volume of the remnant liver is correlated with perioperative morbidity and mortality [1] . Prognosis of postoperative liver failure due to insufficient liver remnant is poor [1,2] . Orthotopic liver transplantation (OLT) is an accepted therapy for end-stage liver disease and currently provides long-term survival and good quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…However, postoperative liver failure still occurs despite these developments. Extended hepatectomy has the advantage of high curability but increases morbidity and mortality [1] . Insufficient volume of the remnant liver is correlated with perioperative morbidity and mortality [1] .…”

Section: Introductionmentioning

confidence: 99%

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Oxidative stress and extracellular matrices after hepatectomy and liver transplantation in rats

Hori¹,

Üemoto²,

Chen³

et al. 2014

WJH

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AIM:To investigate oxidative stress (OS)-mediated damage and the behavior of extracellular matrices in various rat models because shear stress with portal hypertension and cold ischemia/warm reperfusion injury trigger the liver regeneration cascade after surgery. These injuries also cause fatal liver damage. METHODS:Rats were divided into four groups according to the surgery performed: control; hepatectomy with 40% liver remnant (60% hepatectomy); orthotopic liver transplantation (OLT) with whole liver graft (100% OLT); and split OLT (SOLT) with 40% graft (40% SOLT). Survival was evaluated. Blood and liver samples were collected at 6 h after surgery. Biochemical and histopathological examinations were performed. OSinduced damage, 4-hydroxynonenal, ataxia-telangiectasia mutated kinase, histone H2AX, phosphatidylinositol 3-kinase (PI3K) and Akt were evaluated by western blotting. Behavior of extracellular matrices, matrix metalloproteinase (MMP)-9, MMP-2, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 were also evaluated by western blotting and zymography. RESULTS:Although 100% OLT survived, 60% hepatectomy and 40% SOLT showed poor survival. Histopathological, immunohistological, biochemical and protein assays revealed that 60% hepatectomy, 100% OLT and 40% SOLT showed liver damage. PI3K and Akt were decreased in 60% hepatectomy and 40% SOLT. For protein expression, 40% SOLT showed differences in MMP-9, MMP-2 and TIMP-2. TIMP-1 showed differences in 60% hepatectomy and 40% SOLT. For protein activity, MMP-9 demonstrated significant differences in 60% hepatectomy, 100% OLT and 40% SOLT. CONCLUSION: Under conditions with an insufficient liver remnant, prevention of OS-induced damage viathe Akt/PI3K pathway may be key to improve the postoperative course. MMP-9 may be also a therapeutic target after surgery. Hori T et al . Hepatic damage after liver surgeryCore tip: Although shear stress with portal hypertension and cold ischemia/warm reperfusion injury trigger the liver regeneration cascade after surgery, these injuries also cause fatal liver damage. Postoperative liver damage is still a critical matter in the field of liver surgery. Oxidative stress and extracellular matrices are important for liver regeneration after surgery and these may be important keys to overcome current problems in the field of liver surgery. Here, we investigated oxidative stress-mediated damage and the behavior of extracellular matrices in various rat models with liver surgery.Hori T, Uemoto S, Chen F, Gardner LB, Baine AMT, Hata T, Kogure T, Nguyen JH. ��idative stress and e�tracellular ma��idative stress and e�tracellular matrices after hepatectomy and liver transplantation in rats. World

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Risk Factors for Liver Failure and Mortality After Hepatectomy Associated With Portal Vein Resection

Cited by 41 publications

References 40 publications

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes

Surgical Results after Downstaging of Initially Marginal or Non-Resectable Liver Metastases

Oxidative stress and extracellular matrices after hepatectomy and liver transplantation in rats

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