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1.
Yanming Zhou Xiaofeng Zhang Zuobing Zhang Xiaobin Liu Lupeng Wu Yumin Li Bin Li 《World journal of surgery》2013,37(12):2899-2910
Background
With the increase in average life expectancy in recent decades, the proportion of elderly patients requiring liver surgery is rising. The aim of the meta-analysis reported here was to evaluate the safety and efficacy of hepatectomy in elderly patients.Methods
An extensive electronic search was performed for relevant articles that compare the outcomes of hepatectomy in patients ≥70 years of age with those in younger patients prior to October 2012. Analysis of pooled data was performed with RevMan 5.0.Results
Twenty-eight observational studies involving 15,480 patients were included in the analysis. Compared with the younger patients, elderly patients experienced more complications (31.8 vs 28.7 %; P = 0.002), mainly as a result of increased cardiac complications (7.5 vs 1.9 %; P < 0.001) and delirium (11.7 vs 4.5 %; P < 0.001). Postoperative major surgical complications (12.6 vs 11.3 %; P = 0.55) and mortality (3.6 vs 3.3 %; P = 0.68) were comparable between elderly and younger patients. For patients with malignancies, both the 5-year disease-free survival (26.5 vs 26.3 %; P = 0.60) and overall survival (39.5 vs 40.7 %; P = 0.29) did not differ significantly between the two groups.Conclusions
Postoperative major surgical complications, mortality, and long-term results in elderly patients seem to be comparable with those in younger patients, suggesting that age alone should not be considered a contraindication for hepatectomy. 相似文献2.
3.
Lianyue Yang Jiangfeng Xu Dipeng Ou Wei Wu Zhijun Zeng 《World journal of surgery》2013,37(9):2189-2196
Background
The surgical resection of huge hepatocellular carcinoma (HCC) is still controversial. This study was designed to introduce our experience of liver resection for huge HCC and evaluate the safety and outcomes of hepatectomy for huge HCC.Methods
A total of 258 hepatic resections for the patients with huge HCC were analysed retrospectively from December 2002 to December 2011. The operative outcomes were compared with 293 patients with HCC >5.0 cm but <10.0 cm in diameter. Prognostic factors for long-term survival were evaluated by univariate and multivariate analyses.Results
The 1-, 3-, 5-year overall survival rates after liver resection were 84, 62, and 33 %. Overall survival and disease-free survival in huge HCC group and HCC >5.0 cm but <10.0 cm group were similar (P = 0.751, P = 0.493). Solitary huge HCC group has significantly a more longer overall and disease-free survival time than nodular huge HCC (P = 0.026, P = 0.022). Univariate and multivariate analysis revealed that the types of tumour, vascular invasion, and UICC stage were independent prognostic factors for overall survival (P = 0.047, P = 0.037, P = 0.033).Conclusions
Hepatic resection can be performed safely for huge HCC with a low mortality and favorable survival outcomes. Solitary huge HCC has the better surgical outcomes than nodular huge HCC. 相似文献4.
5.
Sawada T Kubota K Kita J Kato M Shiraki T Park K Shimoda M 《World journal of surgery》2011,35(2):377-385
Background
The treatment strategy for hepatocellular carcinomas (HCCs) ≤2 cm (HCC2−) is still controversial. In this study, we retrospectively analyzed clinicopathological data for HCC2− and HCCs >2 cm (HCC2+) to establish the treatment strategy for HCC2−. 相似文献6.
BACKGROUND: The clamp-crushing technique has been proved to be the most cost-efficient approach for hepatectomy. If the advantageous characteristics, such as lower blood loss and morbidity, could be utilized, this method could be ideal. METHODS: The records of 380 patients who underwent hepatectomy using the clamp-crushing technique with intermittent inflow occlusion between 2002 and 2006 were retrospectively reviewed. One hundred fifty patients underwent major hepatectomy, and 230 underwent minor hepatectomy. RESULTS: Thirteen (3.4%) patients received red cell transfusion, and 21 (5.5%) patients received fresh frozen plasma. According to Clavien's classification system, grade I complications occurred in 42 (11.1%), grade II in 32 (8.4%), grade III in 14 (3.7%), grade IV in 1 (0.3%), and grade V in 2 (0.5%) patients. Female sex, preoperative albumin-to-globulin ratio, and type of resection were independent factors predictive of blood loss. CONCLUSIONS: The present patient series, who underwent traditional Péan clamp-crushing technique under intermittent Pringle maneuver, had a low risk of complications. This procedure is an acceptable technique for hepatic parenchymal transection. 相似文献
7.
Liang-He Yu Nan Li Jie Shi Wei-Xing Guo Meng-Chao Wu Shu-Qun Cheng 《Annals of surgical oncology》2014,21(3):1010-1015
The Hepatitis B virus (HBV) is an important etiological factor for hepatocarcinogenesis, because HBV DNA load and HBV reactivation are major risks that influence the long-term survival of hepatocellular carcinoma (HCC) patients who underwent hepatectomy and, thus, may cause postoperative liver function deterioration, tumor recurrence, and reduce patient’s overall survival. However, anti-HBV therapy can suppress HBV replication, improve the remnant liver function, render patients better able to tolerate HCC treatments, and may even improve their prognosis. In this paper, an anti-HBV therapy that benefits the prognosis of HBV-related HCC following hepatectomy is reviewed. 相似文献
8.
Michael E. Lidsky Paul J. Speicher Ryan S. Turley Andrew S. Barbas Bryan M. Clary 《Journal of gastrointestinal surgery》2014,18(4):709-718
Introduction
Coronary artery disease (CAD) is often considered a contraindication to hepatectomy despite a lack of data to support this practice. The purpose of this study is to evaluate the impact of CAD on postoperative outcomes in patients undergoing hepatectomy.Material and Methods
A total of 1,206 consecutive patients undergoing hepatectomy from August 1995 to June 2009 were included. Propensity matching was performed to identify differences in morbidity and mortality between patients with and without CAD. Subgroup analyses were performed to stratify patients based on the severity of CAD and the interval between coronary intervention and hepatectomy.Results
Of all patients, 138 (11.4 %) had a diagnosis of CAD and were more likely to have a malignant diagnosis and other comorbid conditions including renal insufficiency, COPD, and diabetes. Matched patients with CAD had no significant differences in complication rates, with 2.2 and 5.8 % of CAD patients experiencing a postoperative myocardial infarction or arrhythmia, respectively. Propensity matching failed to identify differences in mortality or morbidity. Subgroup analysis revealed similar rates of mortality and complications regardless of the severity of CAD or the time interval between coronary intervention and hepatectomy.Conclusion
Despite the increased prevalence of major medical comorbidities, selected patients with CAD can safely undergo hepatectomy with acceptable rates of postoperative morbidity and mortality. 相似文献9.
Kentaroh Yamamoto MD Hiroshi Imamura MD Yutaka Matsuyama PhD Kiyoshi Hasegawa MD Yoshifumi Beck MD Yasuhiko Sugawara MD Masatoshi Makuuchi MD Norihiro Kokudo MD 《Annals of surgical oncology》2009,16(10):2795-2804
Background
Alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are well-known tumor markers of hepatocellular carcinoma (HCC). The aims of this study are to calculate the sensitivity/specificity of AFP and DCP measurement for the diagnosis of HCC, measure response rates of the markers following curative-intent resections, determine the correlations between the marker levels and clinicopathological prognostic variables, and determine the correlations between the marker levels before hepatectomy and those at diagnosis of recurrence. 相似文献10.
Kuo-Hsin Chen Kuo-Shyang Jeng Shih-Horng Huang Shu-Hsun Chu 《Journal of gastrointestinal surgery》2013,17(3):522-526
Background
Caudate hepatectomy remains a surgical challenge in spite of recent advances in laparoscopic technique. Hepatic tumor in the caudate lobe is usually deeply located in the center of the liver and close to the vena cava and hepatic hilum. Thus, lesion in this region was considered as a contraindication of laparoscopic hepatectomy. Only sporadic reports could be found in the literature. The aim of this study is to review the safety and feasibility of laparoscopic hepatectomy for lesions in the caudate lobe.Methods
Nine consecutive patients with caudate hepatic tumor received laparoscopic caudate hepatectomy in our institute from February 2006 to July 2010. One patient with hepatic adenoma was excluded from the analysis. Demographic data, intraoperative parameters, and postoperative outcomes of the remaining eight patients were assessed.Results
All procedure for these eight patients with caudate hepatic tumors (size 0.9–4.5 cm) were completed with totally laparoscopic technique except one in which additional left hepatectomy was also done. The average operative time was 254 min (range 210–345 min) and estimated blood loss was 202 ml (range 10–1,000 ml), and average length of postoperative hospital stay was 6.9 days (range 4–11 days). There was no perioperative complications and patient mortality in this series.Conclusions
Our experience demonstrated that laparoscopic hepatectomy is a safe and feasible procedure for caudate hepatic tumors in selected patients. 相似文献11.
Mueller L Hillert C Möller L Krupski-Berdien G Rogiers X Broering DC 《Annals of surgical oncology》2008,15(7):1908-1917
Background This study investigates oncological risks and benefits of portal occlusion (PO) in major resection for colorectal liver metastases
(CLM).
Methods Between 1995 and 2004, 107 patients were scheduled for major hepatectomy for CLM. Of these, 53 patients were selected for
PO due to insufficient future liver remnant (FLR), and 54 patients had straightforward hepatectomy. Associations of clinicopathologic
factors with resectability, and outcome after PO were analyzed.
Results 21 of 53 patients (39.6%) after PO were unresectable. These patients had a significant smaller volume of the FLR than the
32 resected patients after PO (P = .029). In total, 17 patients (80.9%) did not undergo resection due to cancer progression. Among these, 11 patients (52.4%)
exhibited either a progression of known metastases located in the occluded lobes, or new metastases in the nonoccluded portion
of the liver. In another 4 individuals (19%), the decision against resection resulted from insufficient hypertrophy of the
FLR. Following major hepatectomy, the 5-year survival was 43.66%. Although there was a significantly higher rate of extended
hepatectomies versus formal hepatectomies (P < .001), more bilobar distributed metastases versus unilobar manifestations (P = .015), and a smaller resection margin (P = .01) in patients who had PO, no adverse effect on mortality, morbidity, recurrence and survival was observed.
Conclusion Unresectability after PO is a major problem that warrants multidisciplinary improvements, and randomization to resection with
or without PO remains ethically problematic. However, following adequate patient selection, PO may provide a significant survival
benefit for patients with prior unresectable CLM.
L. Mueller and C. Hillert contributed equally to this work. 相似文献
12.
Safi Dokmak MD Yacine Ben Safta MD Fadhel Samir Ftériche MD Béatrice Aussilhou MD Jacques Belghiti MD 《Annals of surgical oncology》2014,21(12):3800-3801
A 54-year-old woman with multiple telangiectatic hepatocellular adenoma without degeneration (>5 cm) underwent laparoscopic right hepatectomy with the hanging maneuver. The patient was installed in the supine position with the legs spread apart. Five trocars were used for the intervention. The liver hanging maneuver was performed up-to-down with a nasogastric tube and no prior mobilization of the right liver. Surgery lasted 270 min with 100 ml of blood loss and 15 min of hepatic pedicle clamping. The patient was discharged on postoperative day 7. This anterior approach avoids difficult mobilization of the right liver, guides the anatomical transaction plane, limits bleeding, and increases the number of patients who can benefit from the laparoscopic approach. 相似文献
13.
Chih-Cheng Lu Chong-Chi Chiu Jhi-Joung Wang Yu-Hsien Chiu Hon-Yi Shi 《Journal of gastrointestinal surgery》2014,18(6):1138-1145
Objective
The objective of this study was to explore volume–outcome associations after major hepatectomy for hepatocellular carcinoma (HCC).Methods
This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan–Meier method, and differences were compared by log-rank test.Results
The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P?<?0.001).Conclusions
The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume–outcome analysis may also be confirmed. 相似文献14.
Ching-Wei D. Tzeng MD Thomas A. Aloia MD Jean-Nicolas Vauthey MD George J. Chang MD Lee M. Ellis MD Barry W. Feig MD Steven A. Curley MD John M. Skibber MD Eddie K. Abdalla MD Y. Nancy You MD Miguel A. Rodriguez-Bigas MD 《Annals of surgical oncology》2013,20(2):482-490
Background
Proctectomy after hepatectomy, or the reverse approach, is an alternative to traditional sequencing for advanced liver metastases with asymptomatic colorectal primary tumors. We sought to evaluate the surgical morbidity of proctectomy for colorectal cancer after previous liver surgery.Methods
A single-institution colorectal database was queried for patients treated with proctectomy after previous hepatectomy from 2003 to 2011. Reverse-approach patients (n = 31) were matched 1:2 with a cohort of standard proctectomy patients (n = 62) using operation, age, gender, and surgeon. Perioperative factors were analyzed by univariate/multivariate models for associations with complications graded by Dindo–Clavien criteria.Results
Thirty-one patients with adenocarcinoma ≤20 cm from the anal verge underwent proctectomy after hepatectomy. Median time from hepatectomy to proctectomy was 5.1 months. Median tumor distance was 8.5 cm. Before proctectomy, patients underwent 28 (90 %) major hepatectomies and 7 (22 %) portal vein embolizations. There were no perioperative deaths. Reverse-approach patients did not differ from control patients in operation, demographics, body mass index (BMI), comorbidities, tumor distance, operative time, estimated blood loss, length of stay, or complication rates (p > 0.05). Grade 2 or higher complications developed in 42 % of reverse-approach and 27 % of standard proctectomies (p = 0.17). Grade 3 or higher complications developed in 10 % and 8 %, respectively (p = 1.00). Independent predictors of complications of grade 2 or higher were BMI ≥30 kg/m2 (p = 0.007), operative time ≥300 min (p = 0.012), intraoperative transfusion (p = 0.044), concurrent procedures (p = 0.024), and age ≥50 years (p = 0.030).Conclusions
Risk factors for morbidity of staged proctectomy are similar to those for standard proctectomy. In selected patients, the reverse-approach proctectomy is safe with acceptable morbidity. 相似文献15.
Wakai T Shirai Y Sakata J Valera VA Korita PV Akazawa K Ajioka Y Hatakeyama K 《Annals of surgical oncology》2008,15(9):2472-2481
Background This study sought to clarify the distribution of intrahepatic micrometastases and elucidate an adequate hepatectomy margin
for colorectal carcinoma liver metastases.
Methods Intrahepatic micrometastases in resected specimens from 90 patients who underwent hepatectomy for colorectal carcinoma liver
metastases were examined retrospectively. Intrahepatic micrometastases were defined as microscopic lesions spatially separated
from the gross tumor. Distances from these lesions to the hepatic tumor borders were measured histologically, and the density
of intrahepatic micrometastases (number of lesions/mm2) calculated relative to the advancing tumor border in a zone <1 cm from the border (close) or ≥1 cm away (distant). Median
follow-up time was 127 months.
Results A total of 294 intrahepatic micrometastases were detected in 52 (58%) patients; 95% of these occurred in the close zone. The
density of intrahepatic micrometastases was significantly higher in the close zone (mean 74.8 × 10−4 lesions/mm2) than in the distant zone (mean 7.4 × 10−4 lesions/mm2; P < 0.001). Hepatectomy margin status was positive by 0 cm in 10 patients or negative by <1 cm in 51, and by ≥1 cm in 29 patients.
The median survival times were 18, 33, and 89 months in patients with hepatectomy margins 0 cm, <1 cm, and ≥1 cm, respectively.
Hepatectomy margin status independently influenced survival (P < 0.001) and disease-free survival (P < 0.001).
Conclusion The currently recommended ≥1 cm hepatectomy margin should remain the goal for resections of colorectal carcinoma liver metastases,
based on the distribution of intrahepatic micrometastases and survival risk. 相似文献
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17.
Watanabe Genki Mise Yoshihiro Ito Hiromichi Inoue Yosuke Ishizawa Takeaki Takahashi Yu Saiura Akio 《World journal of surgery》2020,44(1):268-276
World Journal of Surgery - It is unclear how early liver recurrence negatively affects survival in patients undergoing surgery for colorectal liver metastases (CLM) and whether to perform... 相似文献
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Background
The purpose of this study was to introduce an advanced technique for the best living donor right hepatectomy (LDRH) using the hanging maneuver by Glisson’s approach under an upper midline incision. 相似文献20.
Mee Joo Kang Jin-Young Jang Wooil Kwon Jae Woo Park Ye Rim Chang Sun-Whe Kim 《Journal of gastrointestinal surgery》2013,17(9):1592-1599