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Hinojosa-Gonzalez DE, Salgado-Garza G, Tellez-Garcia E, Escarcega-Bordagaray JA, Bueno-Gutierrez LC, Madrazo-Aguirre K, Muñoz-Hibert MI, Diaz-Garza KG, Ramirez-Mulhern I, Alvarez de la Reguera-Babb R, Flores-Villalba E, Rodarte-Shade M, Gonzalez-Urquijo M. Blood salvage and autotransfusion during orthotopic liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis. Clin Transplant 2024; 38:e15222. [PMID: 38064310 DOI: 10.1111/ctr.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a significant cause of oncologic mortality worldwide. Liver transplantation represents a curative option for patients with significant liver dysfunction and absence of metastases. However, this therapeutic option is associated with significant blood loss and frequently requires various transfusions and intraoperative blood salvage for autotransfusion (IBS-AT) with or without a leukocyte reduction filter. This study aimed to analyze available evidence on long-term oncologic outcomes of patients undergoing liver transplantation for HCC with and without IBS-AT. METHODS Per PRISMA guidelines, a systematic review of keywords "Blood Salvage," "Auto-transfusion," "Hepatocellular carcinoma," and "Liver-transplant" was conducted in PubMed, EMBASE, and SCOPUS. Studies comparing operative and postoperative outcomes were screened and analyzed for review. RESULTS Twelve studies totaling 1704 participants were included for analysis. Length of stay, recurrence rates, and overall survival were not different between IBS-AT group and non IBS-AT group. CONCLUSION IBS-AT use is not associated with increased risk of recurrence in liver transplant for HCC even without leukocyte filtration. Both operative and postoperative outcomes are similar between groups. Comparison of analyzed studies suggest that IBS-AT is safe for use during liver transplant for HCC.
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Affiliation(s)
| | | | | | | | | | | | | | - Karla G Diaz-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | | | | | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
- Tecnologico de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
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2
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Hu L, Li Z, Qiao Y, Wang A. Does perioperative allogeneic blood transfusion worsen the prognosis of patients with hepatocellular carcinoma? A meta-analysis of propensity score-matched studies. Front Oncol 2023; 13:1230882. [PMID: 37854678 PMCID: PMC10581339 DOI: 10.3389/fonc.2023.1230882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background Allogeneic blood transfusion is required in a part of liver resection. The effect of allogeneic blood transfusion on the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. To investigate whether perioperative allogeneic blood transfusion (PBT) affects the long-term prognosis of patients with HCC, we conducted a meta-analysis that included only propensity score-matched (PSM) studies. Methods The Cochrane Library, Embase, PubMed, and Web of Science databases were systematically searched to identify PSM studies that compared the long-term outcomes of allogeneic blood transfusion in resected HCC patients. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated. Results This meta-analysis included 9 PSM studies with 12 datasets involving 2476 patients. Lower OS and RFS in HCC patients receiving allogeneic blood transfusion were observed than those in patients not receiving blood transfusion (OS: hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.10-1.64; p < 0.01; RFS: HR, 1.29; 95% CI, 1.07-1.56; p < 0.01). Subgroup analysis revealed that among patients with BCLC A HCC, those receiving allogeneic blood transfusion had lower OS and RFS (OS: HR, 2.27; 95% CI, 1.61-3.21; RFS: HR, 2.11; 95% CI, 1.30-3.41). OS and RFS were similar in both groups of patients with BCLC B and C HCC. Conclusion The receipt of perioperative allogeneic blood transfusion is associated with a decrease in OS and RFS. These results seem to be reliable for patients in BCLC stage A. But more high-quality research is needed to confirm this conclusion.
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Affiliation(s)
- Lingbo Hu
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China
| | - Zhenyu Li
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China
| | - Yingli Qiao
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China
| | - Aidong Wang
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China
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Imaoka Y, Ohira M, Imaoka K, Bekki T, Nakano R, Kuroda S, Tahara H, Ide K, Kobayashi T, Tanaka Y, Ohdan H. Surgery-related disseminated intravascular coagulation predicts postoperative complications. BMC Surg 2023; 23:86. [PMID: 37041491 PMCID: PMC10091651 DOI: 10.1186/s12893-023-01986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
PURPOSE The rate of postoperative morbidity, including infectious complications, is still high after major hepatobiliary pancreatic (HBP) surgery. Although surgery-related disseminated intravascular coagulation (DIC) occurs in some cases, its significance has not been elucidated in HBP surgery. This study aimed to evaluate the influence of surgery-related DIC on the complication severity after HBP surgery. METHODS We analyzed the records of 100 patients with hepatectomy in two or more segments, hepatectomy with biliary tract reconstruction, and pancreaticoduodenectomy. The baseline characteristics and complications were compared between patients with and without surgery-related DIC on postoperative day 1 (POD1) after HBP surgery between 2010 and 2018. Complication severity was assessed using the Comprehensive Complication Index (CCI). RESULTS The DIC group (surgery-related DIC on POD1) had predictive factors, such as larger bleeding volume and higher liver enzyme levels. The DIC group exhibited significantly elevated rates of surgical site infection, sepsis, prolonged intensive care unit stay, more frequent blood transfusions, and higher CCI. Furthermore, compared with and without adjustment of DIC, odds ratio (OR) of AST level and operation time for the risk of high CCI decreased (OR of AST level: 1.25 to 1.19 and OR of operation time: 1.30 to 1.23) and the significant differences had vanished. CONCLUSIONS Surgery-related DIC on POD1 could be a partial mediator between AST level, operation time and higher CCI. The prevention or proper management of surgery-related DIC on POD1 can be an important target to reduce the severity of postoperative complications.
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Affiliation(s)
- Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
- Division of Regeneration and Medicine,, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Kouki Imaoka
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoaki Bekki
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Ryosuke Nakano
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuka Tanaka
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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4
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Bai Y, Liu T, Cui YH, Li ZZ, Zhou XF, Cheng Y, Wang JH, Guo JR. Autologous blood transfusion promotes autophagy and inhibits hepatocellular carcinoma progression through HIF-1α signalling pathway. J Cell Mol Med 2023; 27:1353-1361. [PMID: 37038623 PMCID: PMC10183710 DOI: 10.1111/jcmm.17736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
To explore the molecular mechanism of autologous blood transfusion promoting autophagy of hepatocellular carcinoma (HCC) cells and inhibiting the HCC progression through HIF-1α signalling pathway. This is a research paper. Rat hepatocellular carcinoma model and HepG2 cell model were built. The rats with HCC were conducted a surgery, and their blood was collected for detection to detect the recurrence and metastasis of the rats. Western blot was used to analysed the expression of HIF-1α, TP53, MDM2, ATG5 and ATG14 protein. The apoptosis rate of HepG2 cells was detected by flow cytometry, and autophagosomes were observed by transmission electron microscopy. HIF-1α expression was measured by immunofluorescence assay. The expressions of HIF-1α, TP53, MDM2, ATG5 and ATG14 protein were highest in model + autoblood group compared with the model group. HIF-1α content of model group was higher, but content of TP53, MDM2, ATG5 and ATG14 in the model group is the second. The highest apoptosis rate was found in HepG2 + autoblood group. The number of autophagosomes in HepG2 + autoblood was obviously larger than that of HepG2 + autoblood + inhibitor. HIF-1α expression of immunofluorescence assay showed that high expression of HIF-1α was clearly observed in HepG2 and HepG2 + autoblood group from confocal observation. However, there was no HIF-1α protein expression in HepG2 + autoblood + inhibitor group. The migration rate in HepG2 group, HepG2 + autoblood group and HepG2 + autoblood + inhibitor group was 85.71 ± 7.38%, 14.36 ± 6.54% and 61.25 ± 5.39%, respectively. Autologous blood transfusion promotes autophagy of HCC cells through HIF-1α signalling pathway, which further inhibits HCC migration and erosion.
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Affiliation(s)
- Yu Bai
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Tong Liu
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Ying-Hui Cui
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Zhen-Zhou Li
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Xiao-Fang Zhou
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Yong Cheng
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Jin-Huo Wang
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
| | - Jian-Rong Guo
- Department of Anesthesiology, Shanghai Gongli Hospital, Naval Military Medical University, Shanghai, China
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Tan LLY, Chew VTW, Syn N, Tan EK, Koh YX, Teo JY, Cheow PC, Jeyaraj PR, Chow PKH, Chan CY, Chung AYF, Ooi LLPJ, Goh BKP. Intraoperative blood transfusion does not impact overall and recurrence-free survival after curative hepatectomy for hepatocellular carcinoma: A propensity-score-matched and inverse probability of treatment-weighted study. J Surg Oncol 2023; 127:598-606. [PMID: 36354172 DOI: 10.1002/jso.27141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Our primary objective was to determine if receiving intraoperative blood transfusion was a significant prognostic factor for overall and recurrence-free survival after curative resection of hepatic cellular carcinoma (HCC). METHODOLOGY Between 2001 and 2018, 1092 patients with histologically proven primary HCC who underwent curative liver resection were retrospectively reviewed. Primary study endpoints were recurrence-free survival (RFS) and overall survival (OS). The main analysis was undertaken using propensity-score matching (PSM) to minimize confounding and selection biases in the comparison of patients with or without transfusion. RESULTS There were 220 patients who received and 666 patients who did not receive intraoperative blood transfusion. The PSM cohort consisted of 163 pairs of patients. After PSM, the only perioperative outcome that appeared to significantly affect whether patients would receive blood transfusion was median blood loss (p = 0.001). In the PSM cohort, whether patients received blood transfusion was neither associated with OS (p = 0.759) nor RFS (p = 0.830). When the volume of blood transfusion was analyzed as a continuous variable, no significant dose-response relationship between blood transfusion volume and HR for OS and RFS was noted. CONCLUSION Intraoperative blood transfusion had no significant impact on the survival outcomes in patients who receive curative resection in primary HCC.
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Affiliation(s)
- Laura L Y Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Ministry of Health Holdings, Singapore, Singapore
| | - Valerie T W Chew
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Ministry of Health Holdings, Singapore, Singapore
| | - Nicholas Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Ministry of Health Holdings, Singapore, Singapore
| | - Ek-Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Prema Raj Jeyaraj
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - London L P J Ooi
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.,Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
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6
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Chin JLJ, Allen JC, Koh YX, Tan EK, Teo JY, Cheow PC, Jeyaraj PR, Chow PKH, Ooi LLPJ, Chung AYF, Chan CY, Goh BKP. Poor utility of current nomograms assessing the risk of intraoperative blood transfusion in patients undergoing liver resection for hepatocellular carcinoma and proposal of a new model. Surgery 2022; 172:1442-1447. [PMID: 36038372 DOI: 10.1016/j.surg.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The Memorial Sloan Kettering Cancer Center nomogram, the predictive scoring system of Yamamoto et al, and the 3-point transfusion risk score of Lemke et al are models used to determine the probability of receiving intraoperative blood transfusion in patients undergoing liver resection. However, the external validity of these models remains unknown. The objective of this study was to evaluate their predictive performance in an external cohort of patients with hepatocellular carcinoma. We also aimed to identify predictors of blood transfusion and develop a new predictive model for blood transfusion. METHODS Post hoc analysis of our prospective database of 1,081 patients undergoing liver resection for hepatocellular carcinoma from 2001 to 2018. The predictive performance of current prediction models was evaluated using C statistics. Demographic and clinical variables as predictors of blood transfusion were assessed. Using logistic regression, an alternative model was created. RESULTS The Lemke transfusion risk score performed better than the Memorial Sloan Kettering Cancer Center nomogram (0.69, 95% confidence interval 0.66-0.73 vs 0.66, 95% liver resection 0.62-0.69) (P < .001). The model from Yamamoto et al performed comparably with no statistically significant differences found through pairwise comparison. In our alternative model, hemoglobin level, albumin level, liver resection type, and tumor size were independent predictors of blood transfusion. The new HATS model obtained a C statistic of 0.74 (95% confidence interval 0.71-0.78), performing significantly better than the previous 3 models (P ≤ 0.001 for all). CONCLUSION The existing Memorial Sloan Kettering Cancer Center, Yamamoto et al, and Lemke et al had nomograms with the suboptimal accuracy of predicting risk of intraoperative blood transfusion in patients undergoing liver resection for hepatocellular carcinoma. The proposed HATS model was more accurate at predicting patients at risk of blood transfusion.
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Affiliation(s)
- Joel L J Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore
| | - John Carson Allen
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore
| | - Ek-Khoon Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore. https://twitter.com/ekkhoontan
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore
| | - Prema Raj Jeyaraj
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore
| | - Pierce K H Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore
| | - London L P J Ooi
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Alexander Y F Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore, Singapore; Liver Transplant Service, Singhealth Duke-National University Liver Transplant Center, Singapore, Singapore.
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Chopinet S, Bobot M, Reydellet L, Bollon E, Gérolami R, Decoster C, Blasco V, Moal V, Grégoire E, Hardwigsen J. Peri-operative risk factors of chronic kidney disease after liver transplantation. J Nephrol 2021; 35:607-617. [PMID: 34426948 DOI: 10.1007/s40620-021-01127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a frequent long-term complication after liver transplantation (LT) and is associated with poor long-term survival. The aim of our study was to identify the risk factors of developing post-transplant CKD at 1 year, during the pre-operative, peri-operative, and post-LT phases. METHODS All consecutive patients who underwent primary LT between July 2013 and February 2018 were analyzed. To assess the impact of peri- and post-operative factors on renal function at 1 year we performed a propensity score matching on gender, age of the recipient, Model for End-Stage Liver Disease (MELD) score, etiology of the hepatic disease, and estimated Glomerular Filtration Rate (eGFR) at baseline. RESULTS Among the 245 patients who underwent LT, 215 had available data at one year (Y1), and 46% of them had CKD. Eighty-three patients in the CKD group and 83 in the normal renal function group were then matched. The median follow-up was 35 months (27-77). Patients with CKD at Y1 had a decreased 5-year survival compared to patients with normal renal function at one year: figures were 62% and 90%, respectively, p = 0.001. The independent predictors of CKD at Y1 were major complications (OR = 2.2, 95% CI [1.2-4.2]), p = 0.015, intensive care unit (ICU) stay > 5 days (OR = 2.2, 95% CI [1.3-5.1]), p = 0.046, ICU serum lactate level at 24 h ≥ 2.5 mmol/L (OR = 3.8 95% CI [1.1-8]), p = 0.034, need for post-LT renal replacement therapy (OR = 6.4 95% CI [1.4-25]), and MELD score ≥ 20 (OR = 2.1 95% CI [1.1-3.9]), p = 0.019. CONCLUSIONS The peri-operative period has a major impact on CKD incidence. Early recognition of patients at high risk of CKD may be critical for implementation of nephroprotective measures.
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Affiliation(s)
- Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France. .,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France. .,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Mickaël Bobot
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,C2VN, INSERM 1263 INRAE 1260 Aix-Marseille Université, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Laurent Reydellet
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Bollon
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - René Gérolami
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Claire Decoster
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valéry Blasco
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valérie Moal
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
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Kostalas M, Frampton AE, Low N, Lahiri R, Ban EJ, Kumar R, Riga AT, Worthington TR, Karanjia ND. Left hepatic trisectionectomy for hepatobiliary malignancies: Its' role and outcomes. A retrospective cohort study. Ann Med Surg (Lond) 2020; 51:11-16. [PMID: 31993198 PMCID: PMC6976864 DOI: 10.1016/j.amsu.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 11/21/2022] Open
Abstract
Background Left hepatic trisectionectomy (LHT) is a complex hepatic resection; its’ role and outcomes in hepatobiliary malignancies remains unclear. Materials and methods All patients undergoing LHT at the tertiary HPB referral unit at RSCH, Guildford, UK from September 1996 to October 2015 were included. Data were collected from a prospectively maintained database. Results Twenty-eight patients underwent LHT. The M:F ratio was 1.8:1. Median age was 60 years (range 43–76 years). Diagnoses included colorectal liver metastases (CRLM; n = 20); cholangiocarcinoma (CCA; n = 4); and other (neuroendocrine tumour metastases (NET; n = 3) and breast metastases (n = 1)). Median duration of surgery was 270 min (range 210–585 min). Median blood loss was 750 ml (300–2400 ml) with a perioperative transfusion rate of 21% (n = 6/28). The rate of all post-operative complications was 21% for all patients, and given the extensive resection performed four patients (14%) developed varying degrees of hepatic insufficiency. One patient with cholangiocarcinoma developed severe hepatic insufficiency, which was fatal within 90 days of surgery. 1 and 3-year survivals were 92% and 68% respectively. Conclusion This study supports LHT in patients with significant tumour burden. Despite extensive resection, our favourable morbidity and mortality rates show this is a safe and beneficial procedure for patients with all hepatobiliary malignancies. Given the nature of resection the incidence of post-operative hepatic insufficiency is higher than less extensive hepatic resections. LHT is an extended resection reported to have higher incidences of morbidity and mortality compared with less extensive hepatic resections. This procedure is useful for the surgical management of patients with hepatic lesions that were previously considered unresectable. We report favourable outcomes following LHT at our institution compared with less extensive hepatic resections. An initial post-operative lactate of >1.5 mmol/L was associated with an increased risk of developing post-operative complications (p = 0.035).
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Affiliation(s)
- Marcos Kostalas
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom.,Faculty of Health and Medical Sciences, The Leggett Building, University of Surrey, Daphne Jackson Road, Guildford, Surrey, GU2 7WG, United Kingdom
| | - Adam E Frampton
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom.,Faculty of Health and Medical Sciences, The Leggett Building, University of Surrey, Daphne Jackson Road, Guildford, Surrey, GU2 7WG, United Kingdom
| | - Nadeen Low
- General Surgical Unit, Wexham Park Hospital, Slough, SL2 4HL, United Kingdom
| | - Rajiv Lahiri
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom
| | - Ee Jun Ban
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom.,General Surgical Unit, The Alfred Hospital, Melbourne, Victoria, 3004, Australia
| | - Rajesh Kumar
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom
| | - Angela T Riga
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom
| | - Tim R Worthington
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom
| | - Nariman D Karanjia
- HPB Surgical Unit, Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, United Kingdom
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9
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Kron P, Kimura N, Farid S, Lodge JPA. Current role of trisectionectomy for hepatopancreatobiliary malignancies. Ann Gastroenterol Surg 2019; 3:606-619. [PMID: 31788649 PMCID: PMC6875946 DOI: 10.1002/ags3.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Trisectionectomy is a treatment option in extensive liver malignancy, including colorectal liver metastases (CRLM). However, the reported experience of this procedure is limited. Therefore, we present our experience with right hepatic trisectionectomy (RHT) for CRLM as an example and discuss the changing role of trisectionectomy in the context of modern treatment alternatives based on a literature review. METHODS Between January 1993 and December 2014 all patients undergoing RHT at a single center in the UK for CRLM were included. Patient and tumor characteristics were reviewed and a multivariate analysis was done. Based on a literature review the role of trisectionectomy in the treatment of HPB malignancies was discussed. RESULTS A total of 211 patients undergoing RHT were included. Overall perioperative morbidity was 40.3%. Overall 90-day mortality was 7.6% but reduced to 2.8% over time. Multivariate analysis identified additional organ resection (P = .040) and blood transfusion (P = .028) as independent risk factors for morbidity. Multiple tumors, total hepatic vascular exclusion, and R1 resection were independent risk factors for significantly decreased disease-free and disease-specific survival. Further surgery for recurrence after RHT significantly prolonged survival compared with palliative chemotherapy only. CONCLUSION With the further development of surgical and multimodal treatment strategies in CRLM the indications for trisectionectomy are decreasing. Having being formerly associated with high rates of perioperative morbidity and mortality, this single-center experience clearly shows that these concomitant risks decrease with experience, liberal use of portal vein embolization and improved patient selection. Trisectionectomy remains relevant in selected patients.
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Affiliation(s)
- Philipp Kron
- Department of HPB and Transplant SurgerySt. James's University HospitalLeedsUK
| | - Norihisa Kimura
- Department of HPB and Transplant SurgerySt. James's University HospitalLeedsUK
| | - Shahid Farid
- Department of HPB and Transplant SurgerySt. James's University HospitalLeedsUK
| | - J. Peter A. Lodge
- Department of HPB and Transplant SurgerySt. James's University HospitalLeedsUK
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10
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Kantor O, Talamonti MS, Wang CH, Roggin KK, Bentrem DJ, Winchester DJ, Prinz RA, Baker MS. The extent of vascular resection is associated with perioperative outcome in patients undergoing pancreaticoduodenectomy. HPB (Oxford) 2018; 20:140-146. [PMID: 29191690 DOI: 10.1016/j.hpb.2017.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 07/24/2017] [Accepted: 08/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have examined the relation between extent of vascular resection and morbidity following pancreaticoduodenectomy (PD) with vein resection (PDVR). METHODS Patients undergoing PD for malignancy were identified using the American College of Surgeons National Surgical Quality Improvement Project from 2006 to 2013. Current procedural terminology codes were used to characterize PDVR. RESULTS 9235 patients underwent PD, 977 (10.6%) had PDVR - 640 with direct and 224 with graft repair. PDVR had longer operative times (456 ± 136 vs 374 ± 128 min, p < 0.05) and higher intraoperative transfusions (1.8 ± 3.4 vs 4.3 ± 4.9 units, p < 0.05) than PD alone. On adjusted multivariable regression, PDVR with either direct or graft repairs was associated with higher rates of overall morbidity (OR [odds ratio] 1.50 for direct, 1.74 for graft, p < 0.05), bleeding (OR 2.18 for direct, 3.26 for graft, p < 0.05), and DVT (OR 2.12 for direct, 2.62 for graft, p < 0.05) compared to PD alone. Graft repair was further associated with increased risk of reoperation (OR 1.59), septic shock (OR 2.77) and 30-day mortality (OR 2.72), all p < 0.05. DISCUSSION The risk of significant morbidity and mortality for PDVR is associated with the extent of vascular resection, with graft repairs having increased morbidity and mortality rates.
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Affiliation(s)
- Olga Kantor
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Mark S Talamonti
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Chi-Hsiung Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - David J Winchester
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Richard A Prinz
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Marshall S Baker
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
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11
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Validation of a Nomogram to Predict the Risk of Perioperative Blood Transfusion for Liver Resection. World J Surg 2017; 40:2481-9. [PMID: 27169566 DOI: 10.1007/s00268-016-3544-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nomograms may be important clinical tools to estimate the preoperative risk of transfusion and allow for preemptive arrangements for alternatives to allogeneic blood transfusions. METHODS A multicentric international cohort of 1345 patients who underwent hepatectomy for benign or malign liver diseases was used to validate a nomogram developed by the Memorial Sloan-Kettering Cancer Center. RESULTS A total of 449 (33.3 %) patients received a blood transfusion after hepatectomy. Several variables were associated with the need of transfusion on univariate analysis: age, BMI, hemoglobin, PT-INR, bilirubin, AST, ALT, GGT, albumin, primary liver cancer, and number of segments resected. The MSKCC nomogram, including the number of segments resected, diagnosis (primary vs. non-primary), extrahepatic organ resection, as well as platelet and hemoglobin levels, had a good predictive ability (AUC = 0.69). The frequency of patients transfused ranged from 19 % for patients who were at "low risk" (<20 % risk to be transfused) up to 68 % for patients at "high risk" (>70 % risk to be transfused). The nomogram was tested in a multivariable model including other factors associated with risk of transfusion. The final model included age (OR 1.02, 95 % CI 1.01-1.03, p < 0.001), PT-INR (OR 1.54, 95 % CI 1.01-2.36, p = 0.048), and bilirubin (OR 1.86, 95 % CI 1.09-3.18, p = 0.021). The prediction ability for the integrated prediction model was AUC = 0.73. CONCLUSION The MSKCC nomogram was an effective clinical tool able to predict the perioperative risk of transfusion in our independent external validation. The inclusion of patient age, as well as factors associated with liver functional status (bilirubin and PT-INR), improved the predictive ability of the MSKCC nomogram.
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12
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Farid SG, White A, Khan N, Toogood GJ, Prasad KR, Lodge JPA. Clinical outcomes of left hepatic trisectionectomy for hepatobiliary malignancy. Br J Surg 2015; 103:249-56. [DOI: 10.1002/bjs.10059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/18/2015] [Accepted: 10/21/2015] [Indexed: 12/20/2022]
Abstract
Abstract
Background
Left hepatic trisectionectomy (LHT) is a challenging major anatomical hepatectomy with a high complication rate and a worldwide experience that remains limited. The aim of this study was to describe changes in surgical practice over time, to analyse the outcomes of patients undergoing LHT for hepatobiliary malignancy, and to identify factors associated with morbidity and mortality.
Methods
A cohort study was undertaken of patients who underwent LHT at a single tertiary hepatobiliary referral centre between January 1993 and March 2013. Univariable and multivariable analysis was used to identify factors associated with short- and long-term outcomes following LHT.
Result
Some 113 patients underwent LHT for colorectal liver metastasis (57), hilar cholangiocarcinoma (22), intrahepatic cholangiocarcinoma (12) and hepatocellular carcinoma (11); 11 patients had various other indications. Overall morbidity and 90-day mortality rates were 46·0 and 9·7 per cent respectively. Overall 1- and 3-year survival rates were 71·3 and 44·4 per cent respectively. Total hepatic vascular exclusion and intraoperative blood transfusion were independent predictors of postoperative morbidity, whereas blood transfusion was the only factor predictive of in-hospital mortality. Time period analysis revealed a decreasing trend in blood transfusion, duration of hospital stay, and postoperative morbidity and mortality in the last 5 years.
Conclusion
Morbidity, mortality and long-term survival after LHT support its use in selected patients with a significant tumour burden.
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Affiliation(s)
- S G Farid
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
| | - A White
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
| | - N Khan
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
| | - G J Toogood
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
| | - K R Prasad
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
| | - J P A Lodge
- Hepatobiliary Unit, St James's University Hospital Beckett Street, Leeds LS9 7TF, UK
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13
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Nonsteroidal anti-inflammatory drugs are associated with reduced risk of early hepatocellular carcinoma recurrence after curative liver resection: a nationwide cohort study. Ann Surg 2015; 261:521-6. [PMID: 24950265 DOI: 10.1097/sla.0000000000000746] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing the risk of various de novo cancers has been reported; however, its role in reducing hepatocellular carcinoma (HCC) recurrence after liver resection still remains unknown. METHODS We have conducted a nationwide cohort study by recruiting all patients with a newly diagnosed HCC who had received curative liver resection as their initial treatment. The use of NSAIDs and the risk of early HCC recurrence have been examined by multivariate and stratified analyses. To avoid immortal time bias, the use of NSAIDs has been treated as a time-dependent variable in Cox proportional hazard ratio models. RESULTS Between January 1997 and December 2010, a total of 15,574 HCC patients who had received liver resection were enrolled in this study. The 1-, 3-, and 5-year overall survival rates were 90.4%, 73.2%, and 59.8%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 80.5%, 59.4%, and 50.2%, respectively. NSAID use (hazard ratio, 0.81; 95% confidence interval, 0.73-0.90) and minor liver resection (hazard ratio, 0.83; 95% confidence interval, 0.78-0.89) were independently associated with a reduced risk of early HCC recurrence after liver resection. In the stratified analyses, NSAID usage was universally associated with reduced risks in most subgroups, particularly for those aged younger than 65 years, male, with underlying diabetes mellitus and receiving major liver resection. CONCLUSIONS The use of NSAIDs can be associated with a reduced risk of early HCC recurrence within 2 years after curative liver resection, regardless of patients' age, extent of liver resection, viral hepatitis status, underlying diabetes, and liver cirrhosis.
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14
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Abstract
Soft tissue sarcoma is a rare disease. We began a prospective database for in-patients treated on the surgical service at Memorial Sloan-Kettering in 1982. We now celebrate 30 years of this database which has been reviewed and cataloged constantly on a weekly basis. We approach 10,000 treated patients. The study of this heterogeneous group of diverse pathology rising in the soft tissue has been fascinating. We have learned about demographics, prevalence, incidence, and have recognized the value of such databases in describing not just outcome but biology. Site is an important determinant of outcome and illustrates the complexities of including all sites in any staging system. For example, local recurrence in the extremity, while associated with a decrease in survival, is clearly not causative. Conversely, retroperitoneal sarcoma, particularly liposarcoma, is a common locally recurring disease with local progression often the cause of disease-specific mortality. Genetic predispositions have been defined. Radiation therapy and lymphedema, both alone and in combination, predispose to the development of sarcoma. These observations have important relevance as we increasingly utilize radiation therapy to minimize local recurrence in early stage breast cancer and ductal carcinoma in situ. It is clear that outcome is histology specific and wide variations in outcome, depending on the underlying histological types and subtypes, are evident. We have established very clearly that limb preservation as opposed to amputation is equally efficacious and does not diminish survival. Radiation therapy can limit local recurrence but must be balanced against side effects. Unfortunately, the majority of chemotherapeutic regimens have had minimal benefit.
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Affiliation(s)
- Murray F Brennan
- Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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15
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Perioperative red blood cell transfusion for patients undergoing elective non-cardiac surgery: an audit at a Chinese tertiary hospital. Transfus Apher Sci 2014; 51:99-103. [PMID: 25189106 DOI: 10.1016/j.transci.2014.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/25/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
Perioperative blood transfusion still takes a large proportion in inappropriate blood transfusion. As the data are limited in China, we reported a perioperative red blood cell (RBC) transfusion practices in a tertiary hospital in Guangzhou, China. In 2008-2009, patients who underwent elective surgeries receiving RBC transfusions were recorded and the rate of overtransfusion was analyzed. Overtransfusion was defined as discharge hemoglobin (Hb) exceeding 10 g/dL. The median amount of RBC transfused perioperatively was four units in all 2572 patients. The overall rate of overtransfusion was 48.6% and the Department of Neurosurgery had the highest overtransfusion rate. These results are of great use for the future management of blood resource.
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16
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Habib AS, Moul JW, Polascik TJ, Robertson CN, Roche AM, White WD, Hill SE, Nosnick I, Gan TJ. Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial. Curr Med Res Opin 2014; 30:937-43. [PMID: 24351100 DOI: 10.1185/03007995.2013.877436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. RESEARCH DESIGN AND METHODS Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5 mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. RESULTS Ninety-two patients completed the study. Estimated blood loss (mean ± SD) was significantly lower with low central venous pressure (706 ± 362 ml) compared to acute normovolemic hemodilution (1103 ± 635 ml) and conventional (1051 ± 714 ml) groups (p = 0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p = 0.0028) and prostate size (p = 0.0323), accounting for surgeon (p = 0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p = 0.0037), the treatment effect depended on prostate size (p = 0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. KEY LIMITATIONS Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. CONCLUSIONS Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.
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Affiliation(s)
- Ashraf S Habib
- Department of Anaesthesiology, Duke University Medical Center , Durham, NC , USA
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17
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Yeh CC, Lin JT, Jeng LB, Charalampos I, Chen TT, Lee TY, Wu MS, Kuo KN, Liu YY, Wu CY. Hepatic resection for hepatocellular carcinoma patients on hemodialysis for uremia: a nationwide cohort study. World J Surg 2014; 37:2402-9. [PMID: 23811792 DOI: 10.1007/s00268-013-2137-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The association between uremia and survival outcomes of patients undergoing hepatic resection for hepatocellular carcinoma (HCC) has not been well investigated, particularly for perioperative complications. This nationwide cohort study aimed to compare survival outcomes as well as perioperative mortality and complications between uremia-HCC patients and non-uremia-HCC patients who underwent hepatic resection. METHODS Using Taiwan's National Health Institute Research Database, 149 uremia-HCC patients who underwent hepatic resection between 1996 and 2008 were enrolled. The control group comprised 596 HCC patients who also received hepatic resection during the same time period. The two groups were matched for age, gender, viral hepatitis status, and underlying liver cirrhosis. Disease-free survival, overall survival, and perioperative complications were compared between the two groups. RESULTS For the uremia-HCC cohort, the 1-, 5-, and 10-year overall and disease-free survival rates were 86, 52, and 38 %, as well as 77, 27, and 18 %, respectively. The survival outcomes were comparable between uremia-HCC cohort and the HCC cohort, regardless of extent of hepatic resection. As for perioperative complications, the uremia-HCC cohort had a higher risk of postoperative infections requiring invasive interventions as well as an increased risk of life-threatening heart-associated complications, compared to the HCC cohort. CONCLUSIONS Uremia did not influence survival outcomes between the uremia-HCC and the HCC cohorts, irrespective of extent of hepatic resection. This study urges a better perioperative care strategy to avoid potential cardiac and infectious complications in uremia-HCC patients.
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Affiliation(s)
- Chun-Chieh Yeh
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
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Akbulut S, Kayaalp C, Yilmaz M, Ince V, Ozgor D, Karabulut K, Eris C, Toprak HI, Aydin C, Yilmaz S. Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients. World J Gastroenterol 2013; 19:1625-1631. [PMID: 23538988 PMCID: PMC3602480 DOI: 10.3748/wjg.v19.i10.1625] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 01/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the therapeutic efficacy and safety of continuous autotransfusion system (CATS) during liver transplantation of hepatocellular carcinoma patients.
METHODS: Eighty-three hepatocellular carcinoma (HCC) patients who underwent liver transplantation with intraoperative CATS (n = 24, CATS group) and without (n = 59, non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively. Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein (AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals. Inter-group differences in recurrence and correlations between demographic, clinical, and pathological data were assessed by ANOVA and χ2 tests. Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.
RESULTS: Of the 83 liver transplanted HCC patients, 89.2% were male and the overall mean age was 51.3 ± 8.9 years (range: 18-69 years). The CATS and non-CATS groups showed no statistically significant differences in age, sex ratio, body mass index, underlying disease, donor type, graft-to-recipient weight ratio, Child-Pugh and Model for End-Stage Liver Disease scores, number of tumors, tumor size, AFP level, Milan and University of California San Francisco selection criteria, tumor differentiation, macrovascular invasion, median hospital stay, recurrence rate, recurrence site, or mortality rate. The mean follow-up time of the non-CATS group was 17.9 ± 12.8 mo, during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients. The mean follow-up time for the CATS group was 25.8 ± 15.1 mo, during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients. There was no significant difference between the CATS and non-CATS groups in recurrence rate or site. Additionally, no significant differences existed between the groups in overall or disease-free survival.
CONCLUSION: CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Analysis of Variance
- Blood Transfusion, Autologous/adverse effects
- Blood Transfusion, Autologous/instrumentation
- Blood Transfusion, Autologous/mortality
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/secondary
- Carcinoma, Hepatocellular/surgery
- Chi-Square Distribution
- Equipment Design
- Female
- Humans
- Kaplan-Meier Estimate
- Liver Neoplasms/blood
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Transplantation/adverse effects
- Liver Transplantation/mortality
- Male
- Middle Aged
- Multidetector Computed Tomography
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Operative Blood Salvage/adverse effects
- Operative Blood Salvage/instrumentation
- Operative Blood Salvage/mortality
- Predictive Value of Tests
- Retrospective Studies
- Risk Factors
- Time Factors
- Treatment Outcome
- Turkey
- Young Adult
- alpha-Fetoproteins/metabolism
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Complex Hepatectomy under Total Vascular Exclusion of the Liver: Impact of Ischemic Preconditioning on Clinical Outcomes. World J Surg 2013; 37:838-46. [DOI: 10.1007/s00268-012-1865-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Kim SH, Lee JG, Kwon SY, Lim JH, Kim WO, Kim KS. Is close monitoring in the intensive care unit necessary after elective liver resection? JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:155-61. [PMID: 22977762 PMCID: PMC3433552 DOI: 10.4174/jkss.2012.83.3.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/14/2012] [Accepted: 07/14/2012] [Indexed: 02/06/2023]
Abstract
Purpose Many surgical patients are admitted to the intensive care unit (ICU), resulting in an increased demand, and possible waste, of resources. Patients who undergo liver resection are also transferred postoperatively to the ICU. However, this may not be necessary in all cases. This study was designed to assess the necessity of ICU admission. Methods The medical records of 313 patients who underwent liver resections, as performed by a single surgeon from March 2000 to December 2010 were retrospectively reviewed. Results Among 313 patients, 168 patients (53.7%) were treated in the ICU. 148 patients (88.1%) received only observation during the ICU care. The ICU re-admission and intensive medical treatment significantly correlated with major liver resection (odds ratio [OR], 6.481; P = 0.011), and intraoperative transfusions (OR, 7.108; P = 0.016). Patients who underwent major liver resection and intraoperative transfusion were significantly associated with need for mechanical ventilator care, longer postoperative stays in the ICU and the hospital, and hospital mortality. Conclusion Most patients admitted to the ICU after major liver resection just received close monitoring. Even though patients underwent major liver resection, patients without receipt of intraoperative transfusion could be sent to the general ward. Duration of ICU/hospital stay, ventilator care and mortality significantly correlated with major liver resection and intraoperative transfusion. Major liver resection and receipt of intraoperative transfusions should be considered indicators for ICU admission.
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Affiliation(s)
- Sung Hoon Kim
- Department of Surgery, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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