Right Lobectomy Research Articles

Liver resection volume-dependent pancreatic strain following living donor hepatectomy

The liver and pancreas work together to recover homeostasis after hepatectomy. This study aimed to investigate the effect of liver resection volume on the pancreas. We collected clinical data from 336 living liver donors. They were categorized into left lateral sectionectomy (LLS), left lobectomy, and right lobectomy (RL) groups. Serum pancreatic enzymes were compared among the groups. Serum amylase values peaked on postoperative day (POD) 1. Though they quickly returned to preoperative levels on POD 3, 46% of cases showed abnormal values on POD 7 in the RL group. Serum lipase levels were highest at POD 7. Lipase values increased 5.7-fold on POD 7 in the RL group and 82% of cases showed abnormal values. The RL group’s lipase was twice that of the LLS group. A negative correlation existed between the remnant liver volume and amylase (r = − 0.326)/lipase (r = − 0.367) on POD 7. Furthermore, a significant correlation was observed between POD 7 serum bilirubin and amylase (r = 0.379)/lipase (r = 0.381) levels, indicating cooccurrence with liver and pancreatic strain. Pancreatic strain due to hepatectomy occurs in a resection/remnant liver volume-dependent manner. It would be beneficial to closely monitor pancreatic function in patients undergoing a major hepatectomy.

Elective lung resection increases spatial QRS-T angle and QTc interval.

Lung resection changes intra-thoracic anatomy, which may affect electrocardiographic results. While postoperative cardiac arrhythmias have been recognized after lung resection, no study has documented changes in vectorcardiographic variables in patients undergoing this surgery. The purpose of this study was to analyse changes in spatial QRS-T angle (spQRS-T) and corrected QT interval (QTc) after lung resection. Adult patients undergoing elective lung resection under general anaesthesia were studied. The patients were allocated into four groups: those undergoing (1) left lobectomy (LL); (2) left pneumonectomy (LP); (3) right lobectomy (RL); and (4) right pneumonectomy (RP). The spQRS-T angle and QTc interval were measured one day before surgery (baseline) and 24, 48 and 72 h after surgery. Seventy-one adult patients (47 men and 24 women) aged 47-80 (65 ± 7) years were studied. In the study group as a whole, lung resection was associated with significant increases in spQRS-T (p < 0.001) and QTc (p < 0.05 at 24 and 48 h and p < 0.01 at 72 h). The greatest changes were noted in patients undergoing LP. Postoperative atrial fibrillation (AF) was noted in 6.4% of patients studied, in whom the widest spQRS-T angle and the most prolonged QTc intervals were also noted. Lung resection widens the spQRS-T angle and prolongs the QTc interval, especially in patients undergoing LP. While postoperative AF was a relatively rare complication after lung resection in this study, it was associated with the widest spQRS-T angles and most prolonged QTc intervals.

Defining risk factors and outcomes in 537 patients with simultaneous liver and pancreas resection.

Background: As HPB surgery has become safer, a larger number of combined liver/pancreas (L/P) resections are being performed. Method: All elective operations with both a hepatectomy (partial lobectomy(PL), left lobectomy(LL), right lobectomy(RL), or trisectionectomy(TS)) and simultaneous pancreatectomy (pancreatoduodenectomy(PD), distal(DP), or total pancreatectomy(TP)) were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Project database. Operations were categorized based on combined magnitude of resection as basic (PL/LL & DP), major (RL/TS & DP or PL/LL & PD/TP), and extreme (RL/TS & PD/TP). Risk factors and outcomes were assessed with standard statistical methods. Results: 537 patients underwent combined L/P operations with 241 basic(B), 275 major(M) and 21 extreme(E). The number of operations has increased from 103 (2005-2009) to 434 (2010-2014). Increasing magnitude of resection was associated with longer median operative time (B: 283/ M: 372/ E: 484 minutes), median length of stay (B: 7/ M: 9/ E: 12 days), severe complication (SC) rates (B: 21.2%/ M: 37.8%/ E: 52.4%, p<0.001) and 30-day mortality rates (B: 1.2%/ M 6.2%/ E 18.2%, p=0.008). After controlling for cancer types, multivariate analysis demonstrated that E/M vs. B was predictive of SC (OR 2.74, p=0.029). Conclusion: Simultaneous L/P resection is an increasingly frequent procedure associated with significant morbidity and mortality when complex liver and complex pancreas resection are combined.

Defining risk factors and outcomes in 537 patients with simultaneous liver and pancreas resection

Background: As HPB surgery has become safer, a larger number of combined liver/pancreas (L/P) resections are being performed. Methods: All elective operations with both a hepatectomy (partial lobectomy(PL), left lobectomy(LL), right lobectomy(RL), or trisectionectomy(TS)) and simultaneous pancreatectomy (pancreatoduodenectomy(PD), distal(DP), or total pancreatectomy(TP)) were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Project database. Operations were categorized based on combined magnitude of resection as basic (PL/LL & DP), major (RL/TS & DP or PL/LL & PD/TP), and extreme (RL/TS & PD/TP). Risk factors and outcomes were assessed with standard statistical methods. Results: 537 patients underwent combined L/P operations with 241 basic(B), 275 major(M) and 21 extreme(E). The number of operations has increased from 103 (2005–2009) to 434 (2010–2014). Increasing magnitude of resection was associated with longer median operative time (B: 283/ M: 372/ E: 484 minutes), median length of stay (B: 7/ M: 9/ E: 12 days), severe complication (SC) rates (B: 21.2%/ M: 37.8%/ E: 52.4%, p < 0.001) and 30-day mortality rates (B: 1.2%/ M 6.2%/ E 18.2%, p = 0.008). After controlling for cancer types, multivariate analysis demonstrated that E/M vs. B was predictive of SC (OR 2.74, p = 0.029). Conclusion: Simultaneous L/P resection is an increasingly frequent procedure associated with significant morbidity and mortality when complex liver and complex pancreas resection are combined.

Impact of Platelets and Serotonin on Liver Regeneration After Living Donor Hepatectomy

BackgroundSeveral animal models have revealed that platelet-derived serotonin initiates liver regeneration after hepatectomy. However, there are few reports regarding the effects of serotonin in the clinical setting. The aim of this study was to explore the impact of serotonin and platelets in the early phase after healthy living donor hepatectomy. Study DesignStored samples from 34 living donors who received left lobectomy with caudate lobectomy (LL+C) or right lobectomy (RL) were available in the study. Serum serotonin levels and platelet counts associated with liver regeneration such as whole liver volume and hepatic graft weight (GW) were retrospectively collected from the database and analyzed. ResultsThe remnant liver volume rate of RL grafts was smaller than that of LL+C grafts (45.4% vs 64.7%; P < .001). The regeneration rate at 7 days after surgery did not differ between the 2 groups (123% vs 122%). The serotonin levels and platelet counts decreased after surgery until postoperative day 3, then increased thereafter. The platelet counts and serotonin levels of LL+C donors were significantly higher than those of RL donors. ConclusionsOur findings suggest that platelets and serotonin play a pivotal role in initiating liver regeneration in the remnant liver.

Remnant liver regeneration and spleen volume changes after living liver donation: influence of the middle hepatic vein

Graft harvest with or without the middle hepatic vein (MHV) affects venous return and function of the remaining liver. The aims of this study are to compare the remnant liver volume and spleen changes in the donors of different types of graft harvest and to evaluate the influence of resection with or without the MHV on the remnant liver volume regeneration, spleen volume change and serum total bilirubin. A total of 165 donors were grouped according to the type of graft harvest: 88 donors underwent left lateral segmentectomy (LLS), 10 donors underwent extend LLS or left lobectomy (LL), and 67 donors underwent right lobectomy (RL). Groups LLS and LL were later combined as group LH (left hepatectomy, n = 98). There were 68 men and 97 women. The mean age was 32.9 +/- 8.1 yr. The total liver volume (LV) and spleen volume (S1) before graft harvest, graft weight (GW), regenerated liver volume (LV(6m)) and spleen volume (S2) six months post-donation were calculated. There were no significant differences in the regenerated liver volume six months postoperation (LV(6m)) and recovery ratio (LV(6m)/LV x 100%) among the different groups, albeit significant smaller LV(6m) in both groups compared with the initial liver volume was noted. Postoperative spleen volume (S2), average spleen ratio (S2/S1) and spleen change ratio were significantly larger and higher in group RL than in group LH. A significant increase in spleen volume was noted in both groups six months after graft harvest. A significantly higher TB in group RL (4.1 +/- 1.7 mg/dL, range: 1.4-8.5 mg/dL) was noted compared with that of group LH (1.6 +/- 1.0 mg/dL, range: 0.7-6.2 mg/dL). There was a significant increase in the regenerated remnant liver and splenic volumes six months postoperation in all types of hepatectomy following living donor hepatectomy, and there was no difference in the mean TB levels among donors whether the MHV was included or not in the graft.