The Clavien-Dindo Classification of Surgical Complications

Clavien, Pierre Alain; Barkun, Jeffrey; Oliveira, Michelle; Vauthey, Jean Nicolas; Dindo, Daniel; Schulick, Richard D.; Santibañés, Eduardo de; Pekolj, Juan; Slankamenac, Ksenija; Bassi, Claudio; Graf, Rolf; Vonlanthen, René; Padbury, Robert; Cameron, John L.; Makuuchi, Masatoshi

doi:10.1097/sla.0b013e3181b13ca2

Cited by 8,646 publications

(5,534 citation statements)

References 121 publications

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“…Postoperative complications occurred in 13 patients, and complications classified as Clavien‐Dindo grade28 III or higher appeared in 5 patients (Table 3). Two patients died: 1 due to severe abdominal hemorrhage in POD4 and 1 due to acute cerebral hemorrhage on POD7.…”

Section: Resultsmentioning

confidence: 99%

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

Yang

Qiu

Huang

et al. 2018

American Journal of Transplantation

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Ex vivo liver resection combined with autotransplantation is a recently introduced approach to cure end‐stage hepatic alveolar echinococcosis (HAE), which is considered unresectable by conventional radical resection due to echinococcal dissemination into the crucial intrahepatic conduits and adjacent structures. This article aims discuss the manipulation details and propose reasonable indications for this promising technique. All patients successfully underwent liver autotransplantation with no intraoperative mortality. The median weight of the autografts was 636 g (360‐1300 g), the median operation time was 12.5 hours (9.4‐19.5 hours), and the median anhepatic phase was 309 minutes (180‐ 460 minutes). Intraoperative blood loss averaged 1800 mL (1200‐6000 mL). Postoperative complications occurred in 13 patients during hospitalization; 5 patients experienced postoperative complications classified as Clavien‐Dindo grade III or higher, and 2 patients died of intraabdominal bleeding and acute cerebral hemorrhage, respectively. Twenty‐nine patients were followed for a median of 14.0 months (3‐42 months), and no HAE recurrence was detected. The technique requires neither an organ donor nor any postoperative immunosuppressant, and the success of the treatment relies on meticulous preoperative assessments and precise surgical manipulation.

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Section: Resultsmentioning

confidence: 99%

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

Yang

Qiu

Huang

et al. 2018

American Journal of Transplantation

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“…Any death that occurred in the hospital after surgery was recorded as a mortality. Complications were evaluated with the Clavien's classification,20 and complications with a score of Grade II or more were defined as positive. OS and disease‐free survival (DFS) curves were generated by the Kaplan‐Meier method and compared by the log‐rank test.…”

Section: Methodsmentioning

confidence: 99%

Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi‐institutional study by the Kyushu Study Group of Liver Surgery

Yamashita

Shirabe²,

Beppu³

et al. 2017

Annals of Gastroent Surgery

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Objectives of the present study were to identify predictors of the recurrence of intrahepatic cholangiocarcinoma (ICC), and to evaluate the survival benefit of adjuvant chemotherapy and surgical treatment for ICC recurrence. A multi‐institutional retrospective study was carried out in 356 patients with ICC who underwent curative surgery at one of 14 institutions belonging to the Kyushu Study Group of Liver Surgery. A total of 214 patients (60%) had recurrence. Predictors of ICC recurrence were as follows: positive for pathological intrahepatic metastasis (im), positive for lymph node metastasis (n), positive for pathological lymphatic infiltration (ly), pathological bile duct invasion (b), and tumor size ≥4.4 cm. Adjuvant chemotherapy was given to 120 patients (34%) and, in the patients with im or tumor size ≥4.4 cm, adjuvant chemotherapy showed a survival benefit. Only 37 patients (17%) underwent surgical treatment for ICC recurrence. The surgical treatment resulted in a good 5‐year survival rate (44%), which is similar to the rate obtained by the first operation for primary ICC. Prognosis of patients with primary im after the second operation was significantly worse (5‐year survival 18%) compared to patients without primary im. Primary im+ should be considered a contraindication for surgical treatment for ICC recurrence.

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“…Surgical and non‐surgical complications were diagnosed clinically, radiographically or endoscopically, and evaluated according to the Clavien–Dindo classification19 20. Reoperation details and duration of hospital stay after palliative intervention until hospital discharge were recorded.…”

Section: Methodsmentioning

confidence: 99%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

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BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

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The Clavien-Dindo Classification of Surgical Complications

Cited by 8,646 publications

References 121 publications

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi‐institutional study by the Kyushu Study Group of Liver Surgery

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

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