Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications (original) (raw)
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Liver resective surgery: a multivariate analysis of postoperative outcome and complication
Langenbeck's Archives of Surgery, 2007
Introduction Notwithstanding technical advances and high experience of liver resection of specialized centers, the rate of complications after surgical resection could be high. In this study, we analyzed causes and foreseeable risk factors linked to postoperative morbidity on the ground of data derived from a single center surgical population. Materials and methods From September 1989 to March 2005, 134 consecutive patients had liver resection for Hcc and 153 consecutive patients with liver metastasis (derived from either colorectal cancer or noncolorectal cancer) at our department. We performed 22 major hepatectomy, 20 left hepatectomy, 14 trisegmentectomy, 77 bisegmentectomy and/or left lobectomy, 74 segmentectomy, and 80 wedge resection. Results In-hospital mortality rate was 4.5%, about 7% in Hcc cases and 2.6% in liver metastasis. Morbidity rate was 47.7%, caused by the rising of ascites (10%), temporary impairment liver function (19%), biliary fistula (6%), hepatic abscess (25%), hemoperitoneum (10%), and pleural effusion (30%) sometimes combined each other. Some variables, associated with the technical aspects of surgical procedure, are responsible of the rising of complication as: Pringle maneuver length of more than 20 minutes (p=0.001); the type of liver resection procedure [major hepatectomy (p=0.02), left hepatectomy (p=0.04), trisegmentectomy (p=0.04), bisegmentectomy and/or left lobectomy (p=0.04)]; and the request of an amount of blood transfusion of more than 600 cc (p=0.04). Also, both liver dysfunction, in particular Child A vs B and C (p=0.01), and histopathological grading (p=0.01) are associated with a high rate of postsurgical complication in Hcc cases. Conclusion We make the following recommendations: every liver resection should be planned after intraoperative ultrasonography, anatomical surgical procedure should be preferred instead of wedge resection, and modern devices should be used, like Argon Beam and Ligasure® dissector, to reduce the incidence of both intraoperative and postoperative bleeding and biliary leakage.
Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients
PubMed, 2013
Introduction: Hepatic resection had an impressive growth over time, both by broadening the range of its indications and the occurrence of changes and technical tricks in order to reduce postoperative mortality and morbidity. Material and methods: This study is a retrospective study presenting an analysis of 133 patients hospitalized in the Department of Hepatic Surgery in City Hospital Timisoara, between January 2000 and November 2011, in which a surgical intervention was performed, either for a primary hepatic tumor (benign or malignant) or a secondary liver tumor. All cases were analyzed in terms of etiopathogenesis, preoperative and intraoperative investigations, indication and type of hepatectomy performed, the surgical technique used and postoperative evolution. Results: The study group comprises 133 patients. From the whole group, 100 patients (75.19%) were diagnosed with primitive liver tumors, in 70 patients (70% of primary tumors) HCC occurring on a cirrhotic liver. Liver disease was secondary in 33 patients (24.81%), colorectal tumors being most commonly involved (19 patients). Of all liver resections, 21 (15.79%) were major hepatectomies. The remaining were minor hepatectomies, including a trisegmentectomy (V, VI, VII), 51 bisegmentectomies and 60 liver resections limited to one segment. Vascular clamping was used in 89 cases (66.92%), pedicular clamping in 65 patients (73.03%) and selective extraglissonian clamping in 24 patients (26.97%) respectively. Of the 33 patients with liver metastases, 12 (36.36%) received synchronous resections. The most common complication in our study group was postoperative liver failure, found in 45 patients (33.83%), being irreversible in one case (2.22%), followed by the death of the patient. In 34 patients (75.55%), hepatic failure was seen in cirrhotic patients and the other cases were patients with major hepatec-tomies. Hepatic failure occurred in 35 patients (77.78%) with vascular clamping, four of them after selective clamping. 31 of the patients (68.89%) with postoperative liver failure were transfused, 25 patients (55.55%) receiving more than 2 units of blood. Of all patients, 3 (2.25%) died postoperatively. Conclusions: Respecting the principles of liver surgery, hepatic resection can be performed, even in cirrhotic patients, with acceptable morbidity and minimal mortality. The most common complication after hepatic resection, in our study group, was postoperative liver failure, which was mostly reversible.
Impact of Complications After Surgery for Colorectal Liver Metastasis on Patient Survival
Journal of Surgical Research, 2010
Background. In some patients with colorectal liver metastases it is not clear whether liver resection or isolated liver perfusion is the best treatment option. For instance, the risk of complications after surgery may be so substantial and affect subsequent survival. Aim of the present study is to compare complication occurrence and its effect on survival after liver resection and perfusion.
Impact of complications on long-term survival after resection of colorectal liver metastases
British Journal of Surgery, 2013
Background Postoperative complications may have an adverse effect not only on short-term but also long-term outcome among patients having surgery for cancer. A retrospective series of patients who had surgery for colorectal liver metastases (CLM) was used to assess this association. Methods Patients who had surgery with curative intent for CLM from 2000 to 2009 were included. The impact of postoperative complications, patient characteristics, disease stage and treatment on long-term survival was analysed using multivariable Cox regression models. Results A total of 251 patients were included. The median age was 58 (interquartile range 51–68) years and there were 87 women (34·7 per cent). A minor or major postoperative complication developed in 41 and 14 patients respectively, and five patients (2·0 per cent) died after surgery. The 5-year recurrence-free (RFS) and overall survival rates were 19·5 and 41·9 per cent respectively. Multivariable analysis revealed that postoperative comp...
Journal of Gastrointestinal Surgery, 2009
Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases. One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction, and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an objective surgical complication classification. The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%. The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative complications was 3.2 years, compared to 4.4 years in those patients without complications (p < 0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients with a margin (p = 0.019). Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following liver resection for colorectal metastases.
BMC Surgery
Background For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. Methods All patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression. Results 564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 day...
Journal of Gastrointestinal Surgery, 2007
Background Hepatic resection is the treatment of choice in patients with colorectal liver metastases. Perioperative morbidity is associated with decreased long-term survival in several cancers. The aim of this study was to assess the impact of perioperative morbidity and other prognostic factors on the outcome of patients undergoing liver resection for colorectal metastases. Methods One hundred ninety seven patients undergoing liver resection with curative intent were investigated. The influence of prognostic factors, such as complications, tumor stage, margins, age, sex, number of lesions, transfusion, portal inflow obstruction, and era and type of resection, was assessed using univariate and multivariate analysis. Complications were graded using an objective surgical complication classification. Results The 5-year survival rate was 38%, with a median follow up of 4.5 years. The disease-free survival rate at 5 years was 23%. The perioperative morbidity and mortality rates were 30 and 2.5%, respectively. The median survival of patients with perioperative complications was 3.2 years, compared to 4.4 years in those patients without complications (p<0.01). For patients with positive resection margins, the median survival was 2.1 years, compared 4.4 years in patients with a margin (p=0.019). Conclusion Perioperative morbidity and a positive resection margin had a negative impact on long-term survival in patients following liver resection for colorectal metastases.
Liver resection: 10-year experience from a single Institution
Arquivos de Gastroenterologia, 2004
BACKGROUND: Liver resection constitutes the main treatment of most liver primary neoplasms and selected cases of metastatic tumors. However, this procedure is associated with significant morbidity and mortality rates. AIM: To analyze our experience with liver resections over a period of 10 years to determine the morbidity, mortality and risk factors of hepatectomy. PATIENTS AND METHODS: Retrospective review of medical records of patients who underwent liver resection from January 1994 to March 2003. RESULTS: Eighty-three (41 women and 42 men) patients underwent liver resection during the study period, with a mean age of 52.7 years (range 13-82 years). Metastatic colorectal carcinoma and hepatocellular carcinoma were the main indications for hepatic resection, with 36 and 19 patients, respectively. Extended and major resections were performed in 20.4% and 40.9% of the patients, respectively. Blood transfusion was needed in 38.5% of the operations. Overall morbidity was 44.5%. Life-th...