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Cirrhosis, surgical mortality

Marta Hernández Conde, Elba Llop Herrera, Juan de la Revilla Negro, Fernando Pons Renedo, Natalia Fernández Puga, José Luis Martínez Porras, María Trapero Marugan, Valentín Cuervas-Mons, Víctor Sánchez Turrión, José Luis Calleja Panero
INTRODUCTION: The prevalence of portal vein thrombosis (PVT) in patients that have undergone liver transplantation (LT) is 9.7% (SD 4.5). The aim of our study was to determine the prevalence, assess the factors that are associated with PVT and clarify their association with prognosis in patients with liver cirrhosis (LC) and LT. AIMS AND METHODS: From 2005 to 2014, laboratory, radiological and surgical data were collected from patients with LC in our center who had undergone LT for the first time...
October 19, 2016: Revista Española de Enfermedades Digestivas
David J Pinato, Rohini Sharma, Elias Allara, Clarence Yen, Tadaaki Arizumi, Keiichi Kubota, Dominik Bettinger, Jeong Won Jang, Carlo Smirne, Young Woon Kim, Masatoshi Kudo, Jessica Howell, Ramya Ramaswami, Michela E Burlone, Vito Guerra, Robert Thimme, Mitsuru Ishizuka, Justin Stebbing, Mario Pirisi, Brian I Carr
BACKGROUND & AIMS: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in HCC, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate-stage HCC, where OS is highly heterogeneous. METHODS: We evaluated the prognostic accuracy of the ALBI grade in estimating overall survival (OS) in a large, multi-center study including 2426 patients, including a large proportion of intermediate-stage patients treated with chemoembolization (n=1461) accrued from Europe, the United States and Asia...
September 24, 2016: Journal of Hepatology
Michael Kwok, Andrew Maurice, Carl Lisec, Jason Brown
INTRODUCTION: Campylobacter is the leading cause of bacterial diarrhoeal illness worldwide. Toxic megacolon is a rare but potentially devastating complication. PRESENTATION OF CASE: A 55year old female with liver cirrhosis, alcoholism and hepatitis C, presented with severe colitis and stool specimen positive for Campylobacter. She developed septic shock, multi-organ dysfunction syndrome and toxic megacolon unresponsive to medical therapy, and underwent a subtotal colectomy with end ileostomy...
2016: International Journal of Surgery Case Reports
Liang Gui, Ye Liu, Jun Qin, Lei Zheng, Yi-Jun Huang, Yue He, Wen-Sheng Deng, Bin-Bin Qian, Meng Luo
OBJECTIVE: To evaluate the safety and benefits of laparoscopic common bile duct exploration (LCBDE) compared with open approach (OCBDE) in cirrhotic patients. MATERIALS AND METHODS: Between January 2009 and December 2012, a total of 113 cirrhotic patients with choledocholithiasis underwent common bile duct (CBD) explorations in our department. There were two groups of patients: A:LCBDE (n = 61) and B:OCBDE (n = 52). Patients' demographic characteristics, surgical data, postoperative outcomes, and long-term results were retrospectively collected and analyzed...
August 10, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Mai-Britt Tolstrup, Sara Kehlet Watt, Ismail Gögenur
PURPOSE: Emergency abdominal surgery results in a high rate of post-operative complications and death. There are limited data describing the emergency surgical population in details. We aimed to give a detailed analyses of complications and mortality in a consecutive group of patients undergoing acute abdominal surgery over a 4-year period. METHODS: This observational study was conducted between 2009 and 2013 at Copenhagen University Hospital Herlev, Denmark. All patients scheduled for emergency laparotomy or laparoscopy were included...
August 9, 2016: Langenbeck's Archives of Surgery
Stuart Cleland, Carlos Corredor, Jia Jia Ye, Coimbatore Srinivas, Stuart A McCluskey
From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials...
June 24, 2016: World Journal of Transplantation
Assaf Moore, Michal Cohen-Naftaly, Ofer Benjaminov, Marius Braun, Assaf Issachar, Eitan Mor, Anna Tovar, Michal Sarfaty, Noa Gordon, Salomon M Stemmer
BACKGROUND & AIMS: Hepatocellular Carcinoma (HCC) is the sixth most common malignancy and the third most common cause of cancer mortality worldwide. We aimed to assess the effect of novel treatment options on the survival of HCC patients. METHODS: This retrospective study included all HCC patients diagnosed between 2000 and 2013 referred to the Davidoff center and treated by a multidisciplinary team. RESULTS: The analysis included 321 patients (median age, 64 years; 74...
2016: Journal of Cancer
G K Glantzounis, E Tokidis, S-P Basourakos, E E Ntzani, G D Lianos, G Pentheroudakis
BACKGROUND: Primary liver and biliary cancers are very aggressive tumors. Surgical treatment is the main option for cure or long term survival. The main purpose of this systematic review is to underline the indications for portal vein embolization (PVE), in patients with inadequate future liver remnant (FLR) and to analyze other parameters such as resection rate, morbidity, mortality, survival after PVE and hepatectomy for primary hepatobiliary tumors. Also the role of trans-arterial chemoembolization (TACE) before PVE, is investigated...
June 1, 2016: European Journal of Surgical Oncology
Stefan Wolter, Anna Duprée, Christina Coelius, Alexander El Gammal, Johannes Kluwe, Nina Sauer, Oliver Mann
OBJECTIVES: The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients and evaluate the influence on perioperative complications. BACKGROUND: Patients undergoing bariatric surgery have a high incidence of non-alcoholic steatohepatitis (NASH). Upcoming data indicates that liver disease has a significant effect on perioperative complications. However, the influence of NAFLD/NASH on perioperative outcome in bariatric patients is still controversial...
June 7, 2016: Obesity Surgery
Davide Citterio, Antonio Facciorusso, Carlo Sposito, Roberta Rota, Sherrie Bhoori, Vincenzo Mazzaferro
IMPORTANCE: Liver resection is the treatment of choice for hepatocellular carcinoma (HCC) in well-compensated liver cirrhosis. Postoperative liver decompensation (LD) is the most representative and least predictable cause of morbidity and mortality. OBJECTIVES: To determine the hierarchy and interaction of factors associated with the risk for LD and to define applicable risk classes among surgical candidates. DESIGN, SETTING, AND PARTICIPANTS: This retrospective review collected data from 543 patients with chronic liver disease who underwent hepatic resection for HCC from January 1, 2000, through December 31, 2013, in a tertiary comprehensive cancer center...
September 1, 2016: JAMA Surgery
Jared M Newman, Nicholas K Schiltz, Christopher D Mudd, Caleb R Szubski, Alison K Klika, Wael K Barsoum
BACKGROUND: Cirrhosis is a major cause of morbidity and mortality and is an important risk factor for complications in surgical patients. The purpose of this study was to investigate the association of cirrhosis with postoperative complications, length of stay (LOS), and costs among patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA). METHODS: Using the Nationwide Inpatient Sample between 2000 and 2011, we identified patients who had a primary TKA or primary THA...
April 27, 2016: Journal of Arthroplasty
Haddon Jacob Pantel, Kristian D Stensland, Jason Nelson, Todd D Francone, Patricia L Roberts, Peter W Marcello, Thomas Read, Rocco Ricciardi
We sought to determine the accuracy of the Model for End-Stage Liver Disease and the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator in patients with ascites who underwent colorectal surgery. The National Surgical Quality Improvement Program database was queried for patients with ascites who underwent a major colorectal operation. Predicted 90-day mortality rate based on the Model for End-Stage Liver Disease and 30-day mortality based on the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator were compared with observed 30-day mortality...
August 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Giovanni Vennarecci, Gian Luca Grazi, Isabella Sperduti, Elisa Busi Rizzi, Emanuele Felli, Mario Antonini, Giampiero D'Offizi, Giuseppe Maria Ettorre
INTRODUCTION: To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. METHODS: ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. RESULTS: Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL)...
April 22, 2016: International Journal of Surgery
Masaya Sato, Ryosuke Tateishi, Hideo Yasunaga, Hiromasa Horiguchi, Hiroki Matsui, Haruhiko Yoshida, Kiyohide Fushimi, Kazuhiko Koike
BACKGROUND: The majority of previous studies that evaluated risk factors for in-hospital mortality of cirrhotic patients following surgical procedures were limited by a small sample size. METHODS: Using a Japanese nationwide administrative database, we enrolled 2197 cirrhotic patients who underwent elective (n = 1973) or emergency (n = 224) surgery. We analyzed the risk factors for postoperative mortality and established a scoring system for predicting postoperative mortality in cirrhotic patients using a split-sample method...
April 7, 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
H Riediger, C M Krueger, F Makowiec, U Adam
INTRODUCTION: In line with the current demographic development, elderly patients make up an increasing proportion of surgical patients. It is still unclear under which conditions pancreatic surgery can be performed with low mortality in these patients. PATIENTS AND METHODS: From 2009 to 2014, 250 consecutive pancreatoduodenectomies (PDs) were performed in a non-university hospital. Perioperative data were documented prospectively. Based on median patient age (< 70 years vs...
June 2016: Zentralblatt Für Chirurgie
Christina Hackl, Hans J Schlitt, Philipp Renner, Sven A Lang
The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome...
March 7, 2016: World Journal of Gastroenterology: WJG
Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Antoni J Betbese, Joan A Roncal, Casimiro Javierre
Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes...
March 7, 2016: World Journal of Gastroenterology: WJG
Jung Yeon Lee, Young Hoon Kim, Young Hoon Roh, Kyung Bin Roh, Kwan Woo Kim, Sung Hwa Kang, Yang Hyun Baek, Sung Wook Lee, Sang Young Han, Hee Jin Kwon, Jin Han Cho
PURPOSE: This retrospective study was an investigation of overall survival (OS), disease-free survival (DFS) and prognostic factors affecting OS and DFS in cirrhotic patients who received intraoperative radiofrequency ablation (IORFA). METHODS: Between April 2009 and November 2013, 112 patients (94 men, 84%; 18 women, 16%) underwent IORFA for 185 cases of hepatocellular carcinomas (HCC). Repeat IORFA was done in 9 patients during the same period (total of 121 treatments)...
March 2016: Annals of Surgical Treatment and Research
David J Worhunsky, Monica M Dua, Thuy B Tran, Bernard Siu, George A Poultsides, Jeffrey A Norton, Brendan C Visser
BACKGROUND: Minimally invasive liver surgery is a growing field, and a small number of recent reports have suggested that laparoscopic liver resection (LLR) is feasible even in patients with cirrhosis. However, parenchymal transection of the cirrhotic liver is challenging due to fibrosis and portal hypertension. There is a paucity of data regarding the technical modifications necessary to safely transect the diseased parenchyma. METHODS: Patients undergoing LLR by a single surgeon between 2008 and 2015 were reviewed...
October 2016: Surgical Endoscopy
Madeleine Oliver, Christopher Chiodo Ortiz, Jorge Ortiz
Caring for liver transplant patients suffering from chronic hepatitis C virus (HCV) infection is a challenging task for transplant surgeons and primary physicians alike. HCV is the leading cause of liver transplantation in the USA and comes with a myriad of complications that increase morbidity and mortality. This review focuses on patient follow-up, spanning from before the liver transplant occurs to the patient's long-term health. Pretransplant, both donor and recipient variables, must be carefully chosen to ensure optimal surgical success...
2016: Hepatic Medicine: Evidence and Research
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