Surgical risk in patients with cirrhosis

Nicoll, Amanda

doi:10.1111/j.1440-1746.2012.07205.x

Cited by 76 publications

(56 citation statements)

References 37 publications

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“…From the clinical perception, cirrhotic patients would seem to be poor candidates for invasive procedures such as ESD because of concerns about increased procedure-related complications [11, 15]. However, several studies have reported the feasibility of gastric ESD for patients with liver cirrhosis, reporting post-procedural bleeding rates of 4.3–16.7 % and perforation rates of 0–1.5 % [16–20].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis

Tsou

Liu

Fu³

et al. 2016

Dig Dis Sci

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BackgroundEsophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients.AimTo report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients.MethodsForty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs).ResultsPlatelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm2, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD.ConclusionEsophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis

Tsou

Liu

Fu³

et al. 2016

Dig Dis Sci

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“…Preoperatively, it is important to evaluate patients for liver disease since it has been associated with increased postoperative complications and mortality [52]. With the patient's history of hepatitis C, the next step was to assess the severity of liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity after Sevoflurane Exposure in a Patient with Chronic Hepatitis C

Shah¹

2015

Glob J Medical Clin Case Rep

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Sevoflurane is considered a safe inhaled anesthetic of choice in patients with liver disease. Compared to other halogenated inhaled anesthetics, Sevoflurane is reported to lessen the severity of decreased hepatic blood flow and undergoes a different mechanism of hepatic metabolism. In patients with preexisting liver disease, there is potential for low-flow Sevoflurane to induce acute liver damage through other mechanisms. Limited data exists to guide clinical decision-making when quantifying the severity of cirrhosis in patients with hepatitis C and its relationship to anesthesia choice. Previous studies have found that exposure to general anesthesia during abdominal surgery may increase the risk of hepatorenal failure. This study has raised a concern that anesthetics may interfere with various hepatic functions secondary to viral infection. The generation of abnormal liver enzymes and hypercoagulation has provided further exploration for such toxicity.laboratory were ordered according to best practice guidelines. Given this patient history of Hepatitis C, Complete metabolic panel and coagulation panel were ordered (Table 1). On admission, the patient had decreased platelet count (98 x 109/L) and hematocrit (35.7%). Liver aminotransferases and alkaline phosphatase were elevated as well as slightly elevated PT/INR (Table 1). Serum electrolytes and kidney function tests were within normal ranges. Preoperative sedation with Midazolam 2mg was administered. The operation happened as planned. Initially it took about 30 minutes of lysis of adhesions due to his prior hernia. Attention was focused on the hernia repair, therefore no effort was made to lyse adhesions that did not interfere with the procedure, or to explore the rest of the abdomen. However, a portion of the liver, which was readily visible, revealed a hard and nodular appearance, consistent with cirrhosis. During the separation of components, the cutaneous flaps were not excessive, and the external oblique release provided enough length to achieve

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“…Preoperatively, it is important to evaluate patients for liver disease since it has been associated with increased postoperative complications and mortality [28]. With the patient's history of hepatitis C, the next step was to assess the severity of liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%