Risk factors for major morbidity after liver resection for hepatocellular carcinoma

Shinmoto, Hiroshi; Yagi, T.; Shinoura, Susumu; Umeda, Yuzo; Yoshida, Ryuichi; Satoh, Daisuke; Nobuoka, Daisuke; Utsumi, Masashi; Fujiwara, Toshiyoshi

doi:10.1002/bjs.8957

Cited by 91 publications

(72 citation statements)

References 30 publications

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“…Consistent with the findings of the present study, several reports have indicated that postoperative bile leakage and repeat resection are independent risk factors for postoperative organ/space SSI [2,17]. Indeed, bile leakage has been considered the main cause of morbidity after hepatectomy because bile juice in the dead space predisposes to infection [23].…”

Section: Discussionsupporting

confidence: 80%

“…Categorical variables are presented as number (%) and were analyzed using the χ 2 Fisher exact test as appropriate. A multivariate analysis was performed by logistic regression and the backward elimination procedure, using p values <0.10 as the cutoff value for elimination.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature review [2,5,6,8,[15][16][17][18][19] (Table 5), we found that studies conducted in Asian countries showed low rates of incisional SSI compared with those conducted in Europe or America. By contrast, the incidences of organ/space SSIs were similar between these regions.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

“…However, postoperative morbidity remains relatively common. After hepatectomy, bile leakage, ascites, and surgical site infection (SSI) are the main causes of major postoperative morbidity [2][3][4]. The incidence of SSIs after hepatectomy has been reported to be 3.1-14% [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata

Hasegawa²,

Kobayashi³

et al. 2017

Dig Surg

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Aims: To clarify the clinical impact, risk factors, and preventive methods for surgical site infection (SSI) after hepatectomy for hepatocellular carcinoma (HCC). Methods: We included 879 consecutive patients who underwent hepatectomy for HCC between 2002 and 2011. Univariate and multivariate analyses were conducted to identify the risk factors for incisional and organ/space SSIs. ORs and 95% CIs are reported. Results: The incidences of incisional and organ/space SSIs were 24 (2.7%) and 73 (8.3%), respectively. High body mass index, multiple resections, and organ/space SSI were associated with incisional SSIs, while repeat hepatectomy (OR 2.14, 95% CI 1.27-3.60), ascites (OR 2.97, 95% CI 1.55-5.48), and bile leakage (OR 4.77, 95% CI 2.77-8.11) were independent risk factors for organ/space SSI. Among the cases with bile leakage, lower rates of organ/space SSIs tended to be observed in patients with cystic duct tubes than in patients without such tubes (13.2 vs. 26.5%, p = 0.157). Retrograde drain infections increased when drain placement was prolonged for more than 4 postoperative days. Conclusion: Bile leakage was associated with the greatest risk of organ/space SSI after hepatectomy for HCC. Cystic duct tubes might be useful for preventing bile leakage and subsequent organ/space SSI after procedures that extensively expose Glissonean pedicles.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Systematic Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata

Hasegawa²,

Kobayashi³

et al. 2017

Dig Surg

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“…Re‐hepatectomy is thought to be useful for improving long‐term survival in recurrent HCC and L‐Mets;104, 105, 106 however, such procedures can be technically challenging because of conditions created by the first surgery 107. As mentioned earlier, when performed as the first surgery, LLR is associated with minor, or no, adhesion in the abdominal cavity, except at resection margins in the liver.…”

Section: Indications and Oncological Outcomesmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

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Relationship between postoperative biliary complications and biliary anatomical aspects in performing right anterior‐ or central bisectionectomy: Single‐center retrospective observational study

Ueno,

Hayami,

Miyamoto

et al. 2024

Annals of Gastroent Surgery

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AimCentral liver resections are considered to be high‐risk procedures due to postoperative biliary complications. However, anatomical aspect‐related causes are underreported. Focusing upon right anterior sectionectomy (H58) and central bisectionectomy (H458), we assessed risk factors for postoperative biliary complications.MethodsWe retrospectively reviewed patients who underwent H58 or H458 in our hospital between April 2008 and June 2023 (n = 58). We conducted univariate and multivariate analysis of risk factors of postoperative biliary complications among perioperative factors and anatomical factors including the branching type of the right posterior hepatic duct (RPHD) and the length of the right hepatic duct (RHD).ResultsTwenty‐six patients (44.8%) had postoperative biliary complications. Potent risk factors in univariate analysis were the tumor proximity to the right anterior Glissonean branch and longer RHD (both P < 0.01). In multivariate analysis, longer RHD was the only independent risk factor and its hazard (95% confidence interval [CI] was 1.19 (1.05–1.35). Receiver operating characteristics curve (ROC) analysis and the area under the ROC showed that 10 mm was the optimal cutoff value with high discriminatory power (0.72). Considering intraoperative procedures of the right anterior segment Glissonean branch dissection, mass ligation at the second‐order branch had marginal risk, especially in patients with RHD >10 mm; its hazard (95% CI) was 5.83 (0.95–35.7).ConclusionAnatomical factors of RPHD and RHD influenced postoperative biliary complications in this cohort. The supraportal with RHD type was most common anatomy but considered to be hazardous if the RHD was >10 mm.

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Risk factors for major morbidity after liver resection for hepatocellular carcinoma

Abstract: Repeat hepatectomy and prolonged surgery were identified as risk factors for bile leakage after liver resection for HCC. Bile leakage and repeat hepatectomy increased the risk of organ/space SSI.

Cited by 91 publications

References 30 publications

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Evolution and revolution of laparoscopic liver resection in Japan

Relationship between postoperative biliary complications and biliary anatomical aspects in performing right anterior‐ or central bisectionectomy: Single‐center retrospective observational study

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