Mortality Of Hepatic Resection Research Articles

Perioperative management of cirrhosis.

Patients with cirrhosis present a clinical challenge in the normal course of their illness. Management becomes particularly challenging in the event of surgery. The stress of surgery and effects of anesthesia can affect the outcome and require identification of risk factors before any surgery is contemplated. Patients with decompensated liver disease have a higher risk of postoperative complications such as acute liver failure, sepsis, hemorrhage, and renal dysfunction.1 Surgical risk factors should be addressed prior to surgery in these patients. Traditionally, this has been performed by means of the Child-Pugh-Turcotte (CPT) score and Model for End-stage Liver Disease (MELD) score. The CPT score takes into consideration three biochemical elements (prothrombin time, albumin and bilirubin) and two clinical parameters (ascites and encephalopathy). Patients are deemed class A, B, or C according to the score. A higher score is suggestive of higher risk for perioperative complications. A patient with class A score is estimated to have 10% mortality after abdominal surgery, but this risk increases to 30% in class B and nearly 70-80% in class C.2 MELD score was originally developed for transjugular intrahepatic portosystemic shunt (TIPS), but has evolved for use in orthotopic liver transplantation. This score takes into account serum bilirubin, creatinine, and INR (International Normalized Ratio) and is arrived at by a validated calculation (3.8 x bilirubin + 11.2 x INR + 9.6 creatinine, values in mg). A MELD score of less than 8 predicts a good outcome for TIPS, whereas a score of > 18 portends a poor outcome.1 MELD has also been used to predict the mortality of hepatic resection for hepatocellular carcinoma; a MELD score of less than 5 was associated with 0% postoperative liver failure.3 Scores of 9-10 were associated with 3.6% postoperative failure, and a score of > 10 was associated with 37% incidence of postoperative liver failure.3 MELD score has been validated as an independent predictor to calculate postoperative mortality and it compares fairly well with Child-Pugh score.4

Colorectal carcinoma with potentially resectable metastases: Factors associated with the failure of curative schedule

The management of patients with colorectal cancer (CRC) and synchronous liver metastases (SLM) depends on the primitive tumor, resectability of the metastatic disseminations and the patient's comorbid condition(s). Considering all patients with potentially resectable primary CRC and SLM, curative resection (R0) will be possible in some patients, although in others surgery will never be performed. The purpose of our study was to identify factors of failure of the curative schedule in these patients. We reviewed the data of patients with CRC and SLM between January 2002 and March 2007. Two groups were defined: group R0 when complete metastatic and primary tumor resection was finally achieved after one and more surgical stages and group R2 when curative resection was not possible at the end of the schedule. Clinical, pathologic and outcome data were retrospectively analyzed as well as preoperative management of SLM (chemotherapy, radiofrequency, portal vein embolization). Forty-five patients were included. Curative resection (group R0) was performed in 31 patients (69%) with 48% undergoing major hepatic resection. Mortality of hepatic resection was 0% although it was 9% for primitive tumor. Portal vein embolization was performed preoperatively in eight patients and radiofrequency ablation in 13. Median follow-up was 21 months. Overall survival was 86% at one year and 39% at three years. Survival in group 1 was 97 and 57% at one and three years respectively. Disease-free survival was 87 and 40% at one and three years. Tumor recurrence was noted in 61% of resected patients. At multivariate analysis, number of hepatic metastases superior than three and complicated initial presentation of primitive tumor were found to be significant and predictors of failure of hepatic resection. Aggressive management with curative resection of SLM may enable long-term survival. More than three SLM and complicated initial presentation of primitive tumor are factors predictive of failure of the curative schedule.

Liver resection using a saline-linked radiofrequency dissecting sealer for transection of the liver

s s w ( 7 a s t l t c c c c s L l w u g t n recent years, mortality of hepatic resection has been arkedly reduced with improvement in surgical techiques and perioperative care. As a result, hepatic reection is used increasingly in treatment of various beign and malignant hepatobiliary diseases. Major leeding during hepatic transaction remains a potential azard in hepatic resection and is associated with inreased postoperative morbidity and mortality. Perioprative transfusion for major blood loss is associated with dverse prognosis in patients who undergo hepatic resecion for liver malignancies. Most blood loss in hepatic resection occurs during ransection of the liver. Various techniques of hepatic ransection have been developed, but bleeding still reains a problem in many patients. In addition to the onventional technique of clamp crushing, other techiques, such as cavitron ultrasonic dissector (CUSA), icrowave coagulation, and harmonic scalpel, are being sed in different centers. More recently, Weber and olleagues described use of radiofrequency (RF) ablaion to create thermal coagulative necrosis along the ransection plane, followed by cutting of the liver using scalpel. This method used an RF needle originally deigned for ablation of liver tumors rather than for liver ransection. In this article, we describe a new technique f hepatic transection using a saline-linked RF device pecifically designed for tissue thermocoagulation and issection. Preliminary results in 10 patients with heatic resection using this technique are presented.

Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma

Hepatic resection is the only curative therapy currently available for colorectal cancer metastases to the liver. However, concern over high morbidity and mortality of the procedure has limited referral of patients for resection. The authors report on 58 patients undergoing hepatic resection for colorectal metastases at the National Cancer Institute between the years 1976 and 1985. Thirty-two patients underwent a major hepatic resection, and 26 patients underwent one or more wedge resections. Mean anesthesia time was 448 minutes, mean estimated blood loss was 3663 ml, and mean hospital stay was 17.5 days. Operative mortality was 3 percent, and morbidity was 62 percent. Using a grading scale for complications, 24 percent of patients had inconsequential complications, 16 percent had moderate complications, and 19 percent had severe complications. Complications were clearly related to extent of procedure. Factors that correlated best with morbidity were high blood loss and trisegmentectomy. The authors conclude that while hepatic resection can carry a high morbidity, much of this morbidity is minor and operative mortality is low. Recent improvements in anesthesia, improved resection technique, and a better understanding of hepatic anatomy have made possible correspondingly lower morbidity and mortality rates. Careful selection of patients can make hepatic resection a safe procedure.