scholarly journals Colorectal Surgery in Cirrhotic Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Jacqueline Paolino ◽  
Randolph M. Steinhagen
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Portal Hypertension ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Perioperative Management ◽  
Meld Score ◽  
Morbidity And Mortality ◽  
Stomal Complications ◽  
Cirrhotic Patients

Patients with cirrhosis have a greater risk of morbidity and mortality following colorectal surgery. Therefore, preoperative medical optimization and risk assessment using criteria such as the MELD score are vital in preventing complications. Some risk factors include age, urgency of surgery, and ASA score. Postoperative morbidity and mortality are related to portal hypertension, ascites, infection, and anastomotic and stomal complications. This review highlights the assessment of risk and perioperative management of cirrhotic patients undergoing colorectal surgery.

Morbidity and mortality after colorectal cancer surgery in patients with cirrhosis: A critical review of the literature.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 608-608
Author(s):  
Tarek Boussaha ◽  
Jean François Cadranel ◽  
Allaoua Smail ◽  
Hortensia Lison ◽  
Armand Garioud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Cirrhotic Patients ◽  
Independent Risk Factors

608 Background: Cirrhotic patients with localized colorectal cancer are potential candidates for tumor resection. The aim of this review was to evaluate the morbi-mortality after colorectal surgery. Methods: Comprehensive search was conducted using PUBMED, EMBASE, and the COCHRANE Library. Prospective and retrospective studies were selected. The study population included cirrhotic patients who underwent colorectal resection for non-metastatic colorectal cancer and patients with benign and other malignant disease. The postoperative morbi-mortality and independent risk factors were analysed. Results: Eight studies were identified. Among these, four studies compared the risk of colorectal surgery in patients with and without liver cirrhosis. The number of patients varied from 41 to 6,120. The severity of cirrhosis in most of the studies was classified with the Child-Pugh score. Class B and C were observed in 20% to 60% of the patients. Sepsis represented the main postoperative complication and occurred in 48% to 77% of patients. Mortality varied according to the Child-Pugh score, ranging from 11% to 41%, and was significantly higher for patients with cirrhosis in Child-Pugh Class C. Urgent surgical procedure had a negative impact on prognosis. The average length of hospital stay ranged from 9 to 18 days. Cirrhosis was associated with a 2-3 time and a 4-10 time increased risk of postoperative mortality in the absence and presence of portal hypertension, respectively compared with non-cirrhotic patients. The independent risk factors for postoperative morbidity and mortality were encephalopathy, ascites, low haemoglobin, prolonged prothrombin time, elevated bilirubin, hypoalbuminemia, postoperative infection, total colectomy, elective or non-elective surgery, the presence of co-morbidities and MELD score ≥ 15. Conclusions: Colorectal cancer surgery is associated with an increased risk of postoperative morbidity and mortality in cirrhosis patients. Studies evaluating exclusively the operative risk for colorectal cancer surgery in this patient’s population are rare. Prospective controlled trials to optimize the perioperative management of those patients are needed.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

scholarly journals Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer

2021 ◽  
Author(s):  
O.R. Paredes-Torres ◽  
L. García-Ruiz ◽  
J. Luna-Abanto ◽  
K. Meza-García ◽  
I. Chávez- Passiuri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality ◽  
Radical Gastrectomy ◽  
Factors Associated

Laparoscopic Colorectal Surgery Modifies Risk Factors for Postoperative Morbidity

2004 ◽  
Vol 47 (10) ◽  
pp. 1686-1693 ◽  
Author(s):  
Andrea Vignali ◽  
Marco Braga ◽  
Walter Zuliani ◽  
Matteo Frasson ◽  
Giovanni Radaelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Postoperative Morbidity ◽  
Laparoscopic Colorectal Surgery

scholarly journals Preoperative leukocytosis and the resection severity index are independent risk factors for survival in patients with intrahepatic cholangiocarcinoma

2020 ◽  
Vol 405 (7) ◽  
pp. 977-988
Author(s):  
Oliver Beetz ◽  
Clara A. Weigle ◽  
Sebastian Cammann ◽  
Florian W. R. Vondran ◽  
Kai Timrott ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Postoperative Complications ◽  
Intrahepatic Cholangiocarcinoma ◽  
Postoperative Morbidity ◽  
Severity Index ◽  
The Body ◽  
Morbidity And Mortality ◽  
Independent Risk Factors ◽  
Risk Factors For Survival

Abstract Purpose The incidence of intrahepatic cholangiocarcinoma is increasing worldwide. Despite advances in surgical and non-surgical treatment, reported outcomes are still poor and surgical resection remains to be the only chance for long-term survival of affected patients. The identification and validation of prognostic factors and scores, such as the recently introduced resection severity index, for postoperative morbidity and mortality are essential to facilitate optimal therapeutic regimens. Methods This is a retrospective analysis of 269 patients undergoing resection of histologically confirmed intrahepatic cholangiocarcinoma between February 1996 and September 2018 at a tertiary referral center for hepatobiliary surgery. Regression analyses were performed to evaluate potential prognostic factors, including the resection severity index. Results Median postoperative follow-up time was 22.93 (0.10–234.39) months. Severe postoperative complications (≥ Clavien-Dindo grade III) were observed in 94 (34.9%) patients. The body mass index (p = 0.035), the resection severity index (ASAT in U/l divided by Quick in % multiplied by the extent of liver resection graded in points; p = 0.006), additional hilar bile duct resection (p = 0.005), and number of packed red blood cells transfused during operation (p = 0.036) were independent risk factors for the onset of severe postoperative complications. Median Kaplan-Meier survival after resection was 27.63 months. Preoperative leukocytosis (p = 0.003), the resection severity index (p = 0.005), multivisceral resection (p = 0.001), and T stage ≥ 3 (p = 0.013) were identified as independent risk factors for survival. Conclusion Preoperative leukocytosis and the resection severity index are useful variables for preoperative risk stratification since they were identified as significant predictors for postoperative morbidity and mortality, respectively.

scholarly journals Short- and long-term outcomes for primary anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis: a multivariate logistic regression analysis of risk factors

2020 ◽  
Author(s):  
Ivan Facile ◽  
Raffaele Galli ◽  
Pavlo Dinter ◽  
Robert Rosenberg ◽  
Markus Von Flüe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Postoperative Morbidity ◽  
Primary Anastomosis ◽  
Multivariate Logistic Regression Analysis ◽  
Morbidity And Mortality ◽  
Perforated Diverticulitis ◽  
Multivariate Logistic Regression

Abstract Purpose The management of perforated diverticulitis with generalized peritonitis is still controversial and no preferred standardized therapeutic approach has been determined. We compared surgical outcomes between Hartmann’s procedure (HP) and primary anastomosis (PA) in patients with Hinchey III and IV perforated diverticulitis. Methods Multicenter retrospective analysis of 131 consecutive patients with Hinchey III and IV diverticulitis operated either with HP or PA from 2015 to 2018. Postoperative morbidity was compared after adjustment for known risk factors in a multivariate logistic regression. Results Sixty-six patients underwent HP, while PA was carried out in 65 patients, 35.8% of those were defunctioned. HP was more performed in older patients (74.6 vs. 61.2 years, p < .001), with Hinchey IV diverticulitis (37% vs. 7%, p < .001) and in patients with worse prognostic scores (P-POSSUM Physiology Score, p < .001, Charlson Comorbidity Index p < .001). Major morbidity and mortality were higher in HP compared to PA (30.3% vs. 9.2%, p = .002 and 10.6% vs. 0%, p = .007, respectively) with lower stoma reversal rate (43.9% vs. 86.9%, p < .001). In a multivariate logistic regression, PA was independently associated with lower postoperative morbidity and mortality (OR 0.24, 95% CI 0.06–0.96, p = .044). Conclusions In comparison to PA, HP is associated with a higher morbidity, higher mortality, and a lower stoma reversal rate. Although a higher prevalence of risk factors in HP patients may explain these outcomes, a significant increase in morbidity and mortality persisted in a multivariate logistic regression analysis that was stratified for the identified risk factors.

scholarly journals Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease—A Retrospective Analysis of 76 Cases in a Tertiary Center

Biology ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 349
Author(s):  
Maximilian Wetterkamp ◽  
Cornelius J. van Beekum ◽  
Maria A. Willis ◽  
Tim R. Glowka ◽  
Steffen Manekeller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Wound Healing ◽  
Portal Hypertension ◽  
Postoperative Complications ◽  
Small Bowel ◽  
Morbidity And Mortality ◽  
Bowel Surgery ◽  
Additional Surgery ◽  
Small Bowel Surgery

(1) Purpose: As it is known, patients with liver cirrhosis (LC) undergoing colon surgery or hernia surgery have high perioperative morbidity and mortality. However, data about patients with LC undergoing small bowel surgery is lacking. This study aimed to analyze the morbidity and mortality of patients with LC after small bowel surgery in order to determine predictive risk factors for a poor outcome. (2) Methods: A retrospective analysis was performed of all patients undergoing small bowel surgery between January 2002 and July 2018 and identified 76 patients with LC. Postoperative complications were analyzed using the classification of Dindo/Clavien (D/C) and further subdivided (hemorrhage, pulmonary complication, wound healing disturbances, renal failure). A total of 38 possible predictive factors underwent univariate and multivariate analyses for different postoperative complications and in-hospital mortality. (3) Results: Postoperative complications [D/C grade ≥ II] occurred in 90.8% of patients and severe complications (D/C grade ≥ IIIB) in 53.9% of patients. Nine patients (11.8%) died during the postoperative course. Predictive factors for overall complications were “additional surgery” (OR 5.3) and “bowel anastomosis” (OR 5.6). For postoperative mortality, we identified the model of end-stage liver disease (MELD) score (OR 1.3) and portal hypertension (OR 5.8) as predictors. The most common complication was hemorrhage, followed by pulmonary complications, hydropic decompensation, renal failure, and wound healing disturbances. The most common risk factors for those complications were portal hypertension (PH), poor liver function, emergency or additional surgery, ascites, and high ASA score. (4) Conclusions: LC has a devastating influence on patients’ outcomes after small bowel resection. PH, poor liver function, high ASA score, and additional or emergency surgery as well as ascites were significant risk factors for worse outcomes. Therefore, PH should be treated before surgery whenever possible. Expansion of the operation should be avoided whenever possible and in case of at least moderate preoperative ascites, the creation of an anastomotic ostomy should be evaluated to prevent leakages.

scholarly journals The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection

2020 ◽  
Vol 220 (3) ◽  
pp. 682-686
Author(s):  
Victor M. Zaydfudim ◽  
Florence E. Turrentine ◽  
Mark E. Smolkin ◽  
Todd B. Bauer ◽  
Reid B. Adams ◽  
...  
Keyword(s):  
Liver Resection ◽  
Postoperative Morbidity ◽  
Meld Score ◽  
Morbidity And Mortality ◽  
The Impact
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