Recent trends in postoperative mortality after liver resection- A systemic review and metanalysis of studies published in last 5 years and metaregression of various factors affecting 90 days mortality

AbstractAimThe aim of this systemic review and meta-analysis was to analyse 90 days mortality after liver resection, and also study various factors associated with mortality via univariate and multivariate metaregression.MethodsPubMed, Cochrane library, Embase, google scholar, web of science with keywords like ‘liver resection”; “mortality”;” hepatectomy”. Weighted percentage 90 days mortalities were analysed. univariate metaregression was done by DerSimonian-Liard methods. Major hepatectomy, open surgery, cirrhotic livers, blood loss, hepatectomy for hepatocellular carcinoma, hepatectomy for colorectal liver metastasis were taken as moderators in metaregression analysis. We decided to enter all co-variants in multivariate model to look for mixed effects. Heterogeneity was assessed using the Higgins I2 test, with values of 25%, 50% and 75% indicating low, moderate and high degrees of heterogeneity. Cohort studies were assessed for bias using the Newcastle-Ottawa Scale to assess for the risk of bias. Publication bias was assessed using funnel plot. Funnel plot asymmetry was evaluated by Egger’s test.ResultsTotal 29931 patients’ data who underwent liver resections for various etiologies were pooled from 41 studied included1257 patients died within 90 days post operatively. Weighted 90 days mortality was 3.6% (95% C.I 2.8% −4.4%). However, heterogeneity of the analysis was high with I2 94.625%.(p<0.001). We analysed various covariates like major hepatectomy, Age of the patient, blood loss, open surgery, liver resections done for hepatocellular carcinoma or colorectal liver metastasis and cirrhotic liver to check for their association with heterogeneity in the analysis and hence 90 days mortality. On univariate metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p<0.001), blood loss (p=0.002) was associated with heterogeneity in the analysis and 90 days mortality. On multivariate metaregression Major hepatectomy(p=0.003) and Open surgery (p=0.012) was independently associated with higher 90 days mortality, and liver resection for colorectal liver metastasis was independently associated with lesser 90 days mortality (z= −4.11,p<0.01). Residual heterogeneity after all factor multivariate metaregression model was none (I2=0,Tau2=0, H2=1) and nonsignificant (p=0.49).ConclusionMajor hepatectomy, open hepatectomy, and cirrhotic background is associated with higher mortality rates and colorectal liver metastasis is associated with lower peri operative mortality rates.

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Postoperative morbidity after liver resection- A Systemic review, meta-analysis, and metaregression of factors affecting them.

10.1101/2021.04.06.21254984 ◽

2021 ◽

Author(s):

BHAVIN VASAVADA ◽

HARDIK PATEL

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Postoperative Morbidity ◽

Major Hepatectomy ◽

Meta Analysis ◽

Colorectal Metastasis ◽

Systemic Review ◽

Operative Morbidity ◽

Funnel Plot ◽

Open Hepatectomy

Aim of the study: This systemic review and meta-analysis aimed to analyze post-operative morbidity after liver resection, and also study various factors associated with mortality via metaregression analysis. Material and Methods: PubMed, Cochrane Library, Embase, google scholar, web of science with keywords like liver resection; mortality; hepatectomy. Weighted percentage post-operative morbidities were analyzed. Meta-analysis and meta-regression were done by the DerSimonian-Liard random effect model. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asymmetry was evaluated by Eggers test. Morbidity was defined as any postoperative morbidity mentioned. Results: A total of 46 studies was included in the final analysis. Total 45771 patients underwent liver resections. 16111 patients experienced complications during the postoperative period. Weighted post-operative morbidity was 30.2% ( 95 % C.I. 24.8-35.7%). Heterogeneity was high with I2 99.46% and p-value <0.01. On univariate analysis, major liver resections were significantly associated with heterogeneity. (p=0.024). However, residual heterogeneity was still high with I2 98.62%, p<0.001. So, multifactor metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p=0.001), cirrhotic liver (p=0.002), age (p<0.001), blood loss (p<0.001), and colorectal metastasis (p<0.001) independently associated with postoperative morbidity. Residual heterogeneity was moderate I2= 39.9% and nonsignificant p=0.189. Conclusion: Liver resection is associated with high postoperative morbidity and various factors like major hepatectomy, Open hepatectomy, cirrhotic liver, blood loss, and colorectal metastasis were associated with morbidity and responsible for heterogeneity across the studies.

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Postoperative morbidity after liver resection- A Systematic review, meta-analysis, and metaregression of factors affecting them.

10.21203/rs.3.rs-644838/v1 ◽

2021 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Systematic Review ◽

Liver Resection ◽

Blood Loss ◽

Postoperative Morbidity ◽

Major Hepatectomy ◽

Meta Analysis ◽

Colorectal Metastasis ◽

Operative Morbidity ◽

Funnel Plot ◽

Open Hepatectomy

Abstract Aim of the study: This systematic review and meta-analysis aimed to analyse post-operative morbidity after liver resection, and also study various factors associated with mortality via metaregression analysis.Material and Methods: PubMed, Cochrane Library, Embase, google scholar, web of science with keywords like ‘liver resection”; ”mortality”;” hepatectomy”. Weighted percentage post-operative morbidities were analysed. Meta-analysis and meta-regression were done by the DerSimonian-Liard random effect model. Heterogeneity was assessed using the Higgins I2 test. Publication bias was assessed using a funnel plot. Funnel plot asymmetry was evaluated by Egger’s test. Morbidity was defined as any postoperative morbidity mentioned.Results: A total of 46 studies was included in the final analysis. Total 45771 patients underwent liver resections. 16111 patients experienced complications during the postoperative period. Weighted post-operative morbidity was 30.2% ( 95 % C.I. 24.8-35.7%). Heterogeneity was high with I2 99.46% and p-value <0.01. On univariate analysis, major liver resections were significantly associated with heterogeneity. (p=0.024). However, residual heterogeneity was still high with I2 98.62%, p<0.001. So, multifactor metaregression analysis major hepatectomy (p<0.001), Open hepatectomy (p=0.001), cirrhotic liver (p=0.002), age (p<0.001), blood loss (p<0.001), and colorectal metastasis (p<0.001) independently associated with postoperative morbidity. Residual heterogeneity was moderate I2= 39.9% and nonsignificant p=0.189.Conclusion: Liver resection is associated with high postoperative morbidity and various factors like major hepatectomy, Open hepatectomy, cirrhotic liver, blood loss, and colorectal metastasis were associated with morbidity and responsible for heterogeneity across the studies.

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O-L01 Learning curve for laparoscopic liver resection: does it affect survival in colorectal liver metastasis?

British Journal of Surgery ◽

10.1093/bjs/znab429.024 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Hiba Shanti ◽

Rakesh Raman ◽

Saurav Chakravartty ◽

Ajay P. Belgaumkar ◽

Ameet G. Patel

Keyword(s):

Liver Resection ◽

Liver Metastasis ◽

Blood Loss ◽

Learning Curve ◽

Colorectal Liver Metastasis ◽

Laparoscopic Liver Resection ◽

R0 Resection ◽

Recurrence Free Survival ◽

Term Survival ◽

Free Survival

Abstract Background After Gagner introduced laparoscopic liver resection (LLR) in 1992, it was not until 2004 that the first series with more than ten laparoscopic major liver resections was reported. Furthermore, a multicentre study by Allard et al., in 2015 revealed that laparoscopy was only used in 176 (6.7%) patients out of a total of 2620 patients treated for colorectal liver metastasis (CRLM). This lag time in the establishment of LLR was attributed to the steep learning curve (LC) due to technical complexity and caution about oncological safety. The aim of this study is to assess if the learning curve of LLR has affected survival of patients with CRLM. Methods All consecutive LLR performed by a single surgeon between 2000–2019 were retrospectively analysed. RA-CUSUM for conversion rate and the log regression analysis of the blood loss were used to identify two phases in the learning curve. LC was then applied to CRLM patients and the two subgroups were compared for oncological and survival outcomes. The analysis was repeated with propensity score-matched (PSM) groups Results A total of 286 patients were included in the learning curve analysis. Combining the results from the RA-CUSUM and the blood loss log curve identified two distinct phases in the learning curve. The early phase (EP, n = 68) represented the initial learning experience, and the late phase (LP, n = 218) represented increased competence and the introduction of more challenging cases. The LC was applied to 192 patients with colorectal liver metastasis (EPc n = 45, LPc n = 147). R0 resection was achieved in 93%; 100% in EPc and 90% in LPc (P = .02). The cohort median overall survival (OS) and was 60 months. The median recurrence-free survival (RFS) was 16 months. The 5- year OS and RFS were 51% and 33%, respectively. The overall and recurrence-free survival rates were not compromised by the learning curve; OS (HR: 0.78, 95% CI 0.51-1.2, p = .26), RFS (HR: 0.94, 95 % CI 0.64-1.37, p=.76). Results were replicated after PSM. Conclusions In our experience, the development of a laparoscopic liver resection program can be achieved without adverse effect on the long-term survival in CRLM.

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Can Radiofrequency Ablation Replace Liver Resection for Solitary Colorectal Liver Metastasis? A Systemic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.561669 ◽

2020 ◽

Vol 10 ◽

Author(s):

Wu Hao ◽

Jiang Binbin ◽

Yang Wei ◽

Yan Kun

Keyword(s):

Radiofrequency Ablation ◽

Liver Resection ◽

Liver Metastasis ◽

Colorectal Liver Metastasis ◽

Meta Analysis ◽

Systemic Review

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Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

Surgeries ◽

10.3390/surgeries2040035 ◽

2021 ◽

Vol 2 (4) ◽

pp. 357-370

Author(s):

Nabeel Merali ◽

Hajra Ashraf ◽

Tarak Chouari ◽

Badriya Al Araimi ◽

Rajiv Lahiri ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastasis ◽

Blood Loss ◽

Colorectal Liver Metastasis ◽

Liver Surgery ◽

Operative Time ◽

Tumour Size ◽

P Value ◽

Estimated Blood Loss ◽

Average Operative Time

Introduction: Colorectal cancer (CRC) is the third most common cancer in the world. The liver is the most common site of metastasis with 15 to 25% of patients presenting with synchronous colorectal liver metastasis (CRLM). This study is aimed at evaluating the long- and short-term outcomes of laparoscopic and robotic CRLM surgery, and directly comparing their respective effectiveness. Methodology: A literature search was performed and all studies that reported on operative characteristics, oncological outcomes for CRLM, morbidity or mortality and cost-effectiveness on robotic or laparoscopic surgery were included. The study design was in keeping with the PRISMA guidelines. Results: From the initial 606 manuscripts identified, 19 studies were included in the final qualitative analysis. A total of 1340 patients with 1194 LLR (Laparoscopic Liver Resection) and 146 RLR (Robotic Liver Resection) cases were analysed. Within the LLR group, the average tumour size excised was 32.1 mm compared to the RLR group of 33.8 mm. The average operative time in the LLR was 193 min, CI of 95% (147.4 min to 238.6 min) compared to RLR 257 min, CI of 95% (201.5 min to 313.8 min) with a p-value < 0.0001. Estimated blood loss was lower in the RLR group (210 mL) compared with the LLR group (246 mL). Conclusion: Despite the higher operative cost, RLRs do not result in statistically better treatment outcomes, with the exception of lower estimated blood loss and excision of larger CRLMs. Operative time and total complication rate are significantly more favourable with LLRs. Our study has shown that robotic liver surgery is safe and feasible in well-selected patients.

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Two-stage laparoscopic liver resection for bilateral colorectal liver metastasis

Surgical Endoscopy ◽

10.1007/s00464-009-0859-7 ◽

2010 ◽

Vol 24 (8) ◽

pp. 2044-2047 ◽

Cited By ~ 17

Author(s):

M. A. Machado ◽

F. F. Makdissi ◽

R. C. Surjan ◽

G. T. Kappaz ◽

N. Yamaguchi

Keyword(s):

Liver Resection ◽

Liver Metastasis ◽

Colorectal Liver Metastasis ◽

Laparoscopic Liver Resection ◽

Two Stage

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Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors

The American Surgeon ◽

10.1177/0003134820949995 ◽

2020 ◽

pp. 000313482094999

Author(s):

Daisuke Imai ◽

Takashi Maeda ◽

Huanlin Wang ◽

Tomonari Shimagaki ◽

Kensaku Sanefuji ◽

...

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Serum Creatinine ◽

Tumor Size ◽

Major Hepatectomy ◽

Anesthetic Technique ◽

Intraoperative Blood Loss ◽

Liver Malignancies ◽

Data Set ◽

Surgical Devices

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy.

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