Portal Inflow Modulation by Somatostatin During Major Liver Resection With a High Risk of Postoperative Liver Failure

Abstract Objective A retrospective analysis of the influences of platelet (PLT) counts on liver failure and liver regeneration in patients with primary hepatocellular carcinoma (HCC) provides a treatment strategy for clinical prevention and treatment of postoperative liver failure and residual liver regeneration. Method The clinical data of 111 patients with a background of hepatitis B virus infection and who underwent (expanded) half liver resection at the First Affiliated Hospital of Guangxi Medical University from June 2012 to June 2017 were collected and statistically analyzed. Results　On the basis of the International Study Group of Liver Surgery liver failure-grading standards and Dino–Clavien postoperative complication criteria, the incidence of grade B and above liver failure was 55%, and complication II level and above was 47.5% in the PLT decline group after semihepatectomy. The incidence rates in the normal group were 26.8% and 23.9%. A statistically significant difference was determined in the two groups (P1=0.003, P2 = 0.011). The average volumes of liver hyperplasia (residual liver volume (RLV)80.4 days − RLV) in the PLT decline and normal groups were 132.09 ± 61.89 cm3 and 190.89 ± 91.98c cm3, respectively; the average rates of hyperplasia ((RLV80.4days−RLV)/RLV) were 16.59%± 7.36% and 24.78% ± 10.82%. The difference between the two groups was statistically significant (PProliferation = 0.001, PProliferation rate = 0.001). Univariable and multivariable logistic regression analyses of postoperative liver failure grade and proliferation rate in patients who underwent semihepatectomy suggested that the decrease in postoperative PLT count (PLT < 125 × 109/L) might be an independent risk factor of severe posthepatectomy liver failure (PHLF) (PHLF-B or above) and residual liver regeneration rate for patients with primary HCC after half liver resection. No death occurred. Conclusions A correlation existed between PLT count and postoperative PHLF or liver regeneration. Monitoring PLT counts after liver resection may help us predict the suffering from PHLF-B or above and severe postoperative complications.

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The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection—a single-center experience

Langenbeck s Archives of Surgery ◽

10.1007/s00423-009-0518-4 ◽

2009 ◽

Vol 394 (6) ◽

pp. 1047-1056 ◽

Cited By ~ 27

Author(s):

J. F. Lock ◽

T. Reinhold ◽

M. Malinowski ◽

J. Pratschke ◽

P. Neuhaus ◽

...

Keyword(s):

Liver Resection ◽

Liver Function ◽

Liver Failure ◽

Economic Impact ◽

Postoperative Liver Failure ◽

Single Center ◽

Single Center Experience ◽

Extended Liver Resection

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Preoperative prediction and prevention of intraoperative acute liver failure after major liver resection for metastatic colorectal cancer

Colorectal Oncology ◽

10.17650/2220-3478-2016-6-2-35-39 ◽

2016 ◽

Vol 6 (2) ◽

pp. 35-39

Author(s):

A. D. Kaprin ◽

D. V. Sidorov ◽

N. A. Rubtsova ◽

A. V. Leont’ev ◽

M. V. Lozhkin ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Failure ◽

Acute Liver Failure ◽

Metastatic Colorectal Cancer ◽

Major Liver Resection ◽

Preoperative Prediction ◽

Prediction And Prevention

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Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Annals of Surgical Oncology ◽

10.1245/s10434-020-08258-3 ◽

2020 ◽

Vol 27 (7) ◽

pp. 2311-2318 ◽

Cited By ~ 2

Author(s):

Pim B. Olthof ◽

◽

Luca Aldrighetti ◽

Ruslan Alikhanov ◽

Matteo Cescon ◽

...

Keyword(s):

Liver Resection ◽

Portal Vein ◽

Liver Failure ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

International Study ◽

Perihilar Cholangiocarcinoma ◽

Major Liver Resection ◽

Biliary Leakage ◽

Liver Remnant

Abstract Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

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