Association of Sarcopenia and Body Composition With Postoperative 90-Day Morbidity After Liver Resection for Malignant Tumors—Reply

Abstract Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

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Nutritional Status and Body Composition of Adult Patients with Brain Tumours Awaiting Surgical Resection

Canadian Journal of Dietetic Practice and Research ◽

10.3148/cjdpr-2014-007 ◽

2014 ◽

Vol 75 (03) ◽

pp. 148-151 ◽

Cited By ~ 7

Author(s):

Michele McCall ◽

Ashley Leone ◽

Michael D. Cusimano

Keyword(s):

Weight Loss ◽

Body Composition ◽

Nutritional Status ◽

Brain Tumour ◽

Surgical Resection ◽

Brain Tumours ◽

Malignant Tumors ◽

Bioelectrical Impedance ◽

Assessment Tools ◽

Tumour Resection

Purpose: To measure the prevalence of malnutrition, risk factors for poor dietary intake and body composition in patients with brain tumours admitted to hospital for surgical resection. Methods: In this study, 316 patients admitted for brain tumour resection to the Neurosurgical service at St. Michael's Hospital were screened. Assessment tools included the Subjective Global Assessment (SGA) for nutritional status and Bioelectrical Impedance Analysis (BIA) for body composition. All measurements were performed by one research dietitian. Information regarding medical history, symptomology, and tumour pathology was recorded. Results: One hundred and nine participants were recruited. Malnutrition was present in 17.6% of patients, of whom 94.7% were moderately malnourished (SGA-B) and 5.3% severely malnourished (SGA-C). Key symptoms contributing to malnutrition included weight loss, nausea, vomiting, dysphagia, headaches, and fatigue. Patients with malignant tumors were more likely to have weight loss and lower fat mass. Conclusions: This study demonstrated that patients admitted for brain tumour resection have a low prevalence of malnutrition compared with other cancer populations. Useful parameters for nutritional screening of inpatient admissions include weight loss >5% of usual weight, nausea, vomiting, dysphagia, and headaches.

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Regular versus irregular liver resection for malignant tumors of the liver

World Chinese Journal of Digestology ◽

10.11569/wcjd.v21.i32.3566 ◽

2013 ◽

Vol 21 (32) ◽

pp. 3566

Author(s):

Chang-Hua Kou ◽

Hai-Xin Qian ◽

Zi-Ming Zhao

Keyword(s):

Liver Resection ◽

Malignant Tumors ◽

Tumors Of The Liver

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Video-assisted thoracoscopic transdiaphragmatic liver resection for malignant tumors located in the posterosuperior segments.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e15161 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e15161-e15161

Author(s):

Masao Sunahara ◽

Yosuke Ono ◽

Yusuke Tsunetoshi ◽

Takeyuki Sawano ◽

Hiroyuki Kasajima ◽

...

Keyword(s):

Liver Resection ◽

Malignant Tumors ◽

Posterosuperior Segments ◽

Video Assisted

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Intake of Selective Serotonin Re-uptake Inhibitors Modulates Postoperative Outcome after Liver Resection for Malignant Tumors

HPB ◽

10.1016/j.hpb.2020.11.090 ◽

2021 ◽

Vol 23 ◽

pp. S37-S38

Author(s):

D. Pereyra ◽

J. Santol ◽

G. Ortmayr ◽

C. Köditz ◽

P. Jonas ◽

...

Keyword(s):

Liver Resection ◽

Malignant Tumors ◽

Postoperative Outcome ◽

Selective Serotonin ◽

Uptake Inhibitors

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Combined liver-visceral resection for neoplastic lesions correlates with increased postoperative complications

International Surgery Journal ◽

10.18203/2349-2902.isj20201843 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1335

Author(s):

Ashraf Mohammad El-Badry ◽

Mohamed Mahmoud Ali

Keyword(s):

Liver Resection ◽

Postoperative Complications ◽

Clinical Outcome ◽

Malignant Tumors ◽

University Hospital ◽

Control Group ◽

Resected Liver ◽

Increased Risk ◽

Complication Score ◽

Cirrhotic Patients

Background: Combined liver-visceral resections (CLVRs) may impose increased risk of postoperative complications. The clinical outcome of CLVRs versus sole liver resection (SLR) has not been adequately reported from upper Egypt cancer surgery programs.Methods: Medical records of adult non-cirrhotic patients who electively underwent liver resection from February 2015 to April 2018 at Sohag University Hospital, Egypt, were retrospectively reviewed. Indications for liver resection comprised definitively malignant tumors and those with equivocal radiologic features. The severity of surgical complications, including mortality, was compared among patients who underwent CLVRs versus SLR control group with matching age, gender, number of resected liver segments, method of hepatic inflow occlusion and parenchyma transection techniques.Results: Twenty-six patients were enrolled, including 13 with CLVRs group and their 13 SLR control group. Histopathologic examination of resected specimens confirmed malignancy in 17 patients (10 in CLVR group and 7 in SLR group). Major liver resection (≥3 segments) was carried out in 14 (54%) patients, 7 per each group. The complication score was significantly higher in CLVRs (p<0.05). Similarly, the length of hospital and intensive care unit stays was significantly prolonged in CLVRs group (p<0.05). Overall, 2 patients died (8%), exclusively in the CLVRs. Elderly patients (>65 years) who underwent CLVRs exhibited increased complications compared with their matching controls.Conclusions: CLVR predisposes to increased morbidity rates and mortality. It should be carried out in carefully selected patients to avoid worse clinical outcome.

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