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

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.

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

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.

scholarly journals 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

2021 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Liver Resection ◽  
Liver Metastasis ◽  
Blood Loss ◽  
Colorectal Liver Metastasis ◽  
Open Surgery ◽  
Major Hepatectomy ◽  
Mortality Rates ◽  
Systemic Review ◽  
Funnel Plot ◽  
Open Hepatectomy

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.

720 Pringle Versus Selective Hepatic Vascular Exclusion in Major Hepatectomy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Mobarak ◽  
M Stott ◽  
M Tarazi ◽  
R Varley ◽  
M Davé ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Major Hepatectomy ◽  
Meta Analysis ◽  
Operating Time ◽  
Morbidity And Mortality ◽  
Vascular Exclusion ◽  
Hepatic Vascular Exclusion ◽  
Pringle Manoeuvre

Abstract Aim Mortality and morbidity following hepatic resection is significantly affected by major intra-operative blood loss. Multiple techniques have been developed in an attempt to minimise blood loss by occluding hepatic inflow and outflow. This systematic review and meta-analysis evaluates whether selective hepatic vascular exclusion compared to a Pringle manoeuvre in hepatic resection reduces rates of morbidity and mortality. Method A systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, CENTRAL, SCOPUS and bibliographic reference lists for comparative studies meeting the predetermined inclusion criteria. Intra- and post-operative outcome measures were investigated. Pooled odds ratios or mean differences with 95% confidence intervals were calculated using either fixed- or random-effects models. Results Five studies were identified including two randomized controlled trials and three observational studies reporting a total of 2,198 patients. Data synthesis showed significantly decreased rates of mortality, overall complications, patients requiring blood transfusion, air embolism, warm ischaemia time, liver failure and multi-organ failure when performing SHVE compared to a Pringle manoeuvre. Rates of hepatic vein rupture and post-operative haemorrhage remained the same. Performing SHVE resulted in a significantly longer operation time. Conclusions Performing SHVE in major hepatectomy may result in reduced rates of morbidity and mortality when compared to a Pringle manoeuvre, although may prolong operating time. The results of this meta-analysis are based on a few high-quality studies where tumours were adjacent to major vessels. Further RCTs are required to validate these results and determine the best technique for hepatic vascular control in this patient cohort.

scholarly journals Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients

2018 ◽  
Vol 36 (2) ◽  
pp. 111-123 ◽  
Author(s):  
Tim van Tuil ◽  
Ali A. Dhaif ◽  
Wouter W. te Riele ◽  
Bert van Ramshorst ◽  
Hjalmar C. van Santvoort
Keyword(s):  
Systematic Review ◽  
Liver Resection ◽  
Elderly Patients ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Colorectal Metastases ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Short And Long Term

Background: This systematic review and meta-analysis evaluated the short- and long-term outcomes of liver resection for colorectal liver metastases (CRLM) in elderly patients. Methods: A PubMed, EMBASE, and Cochrane Library search was performed from January 1995 to April 2017, for studies comparing both short- and long-term outcomes in younger and elderly patients undergoing liver resection for CRLM. Results: Eleven studies comparing patients aged <70 years with patients aged >70 years and 4 studies comparing patients aged <75 years with patients aged >75 years were included. Postoperative morbidity was similar in patients aged >70 years (27 vs. 30%; p = 0.35) but higher in patients aged >75 years (21 vs. 32%; p = 0.001). Postoperative mortality was higher in both patients aged >70 years (2 vs. 4%; p = 0.01) and in patients aged >75 years (1 vs. 6%; p = 0.02). Mean 5-year overall survival was lower in patients aged >70 years (40 vs. 32%; p < 0.001) but equal in patients aged >75 years (42 vs. 32%; p = 0.06). Conclusion: Although postoperative morbidity and mortality were increased with higher age, liver resection for CRLM seems justified in selected elderly patients.

scholarly journals Robotic Versus Conventional Laparoscopic Liver Resections: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 145749692092563 ◽  
Author(s):  
S. K. Kamarajah ◽  
J. Bundred ◽  
D. Manas ◽  
L. R. Jiao ◽  
M. A. Hilal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Robotic Surgery ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Meta Analysis ◽  
Conventional Laparoscopic Surgery ◽  
Robotic Liver Resection ◽  
Conventional Laparoscopic

Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

scholarly journals Acute kidney injury after liver resection: A systematic review, meta-analysis, and metaregression of factors affecting it.

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
HARDIK PATEL
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Liver Resection ◽  
Major Hepatectomy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Final Analysis ◽  
P Value ◽  
Factors Affecting ◽  
Male Sex

Aim: This systematic review and meta-analysis aimed to study the incidence of acute kidney injury after liver resection and to analyze various factors affecting it by metaregression analysis. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020) and MOOSE guidelines. The meta-analysis was done using Review Manager 5.4 and the JASP Team (2020). JASP (Version 0.14.1)(University of Amsterdam). Weighted percentage incidence with 95% confidence intervals were used. Univariate metaregression was done by DerSimonian-Laird methods. Factors with a p-value less than 0.05 in the univariate metaregression model were entered in the multivariate metaregression model. Heterogeneity was assessed using the Higgins I2 test. The random-effects model was used in meta-analysis. Results: Total 14 studies including 15510 patients were included in the final analysis. 1247 patients developed Acute Kidney Injury. Weighted Acute kidney injury percentage after liver resection was 15% with a 95% confidence interval of 11%-19%. On univariate metaregression analysis major hepatectomy (p=0.001), Underlying cirrhosis of liver (p=0.031), AKIN definition used (0.017), male sex (p<0.001), open surgery (p=0.032), underlying diabetes (0.026). On multivariate metaregression analysis major hepatectomy (p=0.003), underlying cirrhosis (p<0.001), male sex (p<0.001), AKIN classification used for defining acute kidney injury (p < 0.001, independently predicted heterogeneity and hence acute kidney injury. Conclusion: Liver resection is associated with a high incidence of acute kidney injury. Major hepatectomy, male sex, underlying cirrhosis were independently predicting acute kidney injury.

scholarly journals Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zhipeng Zhu ◽  
Lulu Li ◽  
Jiuhua Xu ◽  
Weipeng Ye ◽  
Junjie Zeng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Positive Trend ◽  
Open Approach ◽  
Intraoperative Blood Loss

Abstract Background Additional studies comparing laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for advanced gastric cancer (AGC) have been published, and it is necessary to update the systematic review of this subject. Objective We conducted the meta-analysis to find some proof for the use of LG in AGC and evaluate whether LG is an alternative treatment for AGC. Method Randomized controlled trials (RCT) and high-quality retrospective studies (NRCT) compared LG and OG for AGC, which were published in English between January 2010 and May 2019, were search in PubMed, Embase, and Web of Knowledge by three authors independently and thoroughly. Some primary endpoints were compared between the two groups, including intraoperative time, intraoperative blood loss, harvested lymph nodes, first flatus, first oral intake, first out of bed, post-operative hospital stay, postoperative morbidity and mortality, rate of disease recurrence, and 5-year over survival (5-y OS). Besides, considering for this 10-year dramatical surgical material development between 2010 and 2019, we furtherly make the same analysis based on recent studies published between 2016 and 2019. Result Thirty-six studies were enrolled in this systematic review and meta-analysis, including 5714 cases in LAG and 6094 cases in OG. LG showed longer intraoperative time, less intraoperative blood loss, and quicker recovery after operations. The number of harvested lymph nodes, hospital mortality, and tumor recurrence were similar. Postoperative morbidity and 5-y OS favored LG. Furthermore, the systemic analysis of recent studies published between 2016 and 2019 revealed similar result. Conclusion A positive trend was indicated towards LG. LG can be performed as an alternative to OG for AGC.

scholarly journals A Cochrane systematic review and network meta-analysis comparing treatment strategies aiming to decrease blood loss during liver resection

2015 ◽  
Vol 23 ◽  
pp. 128-136 ◽  
Author(s):  
Constantinos Simillis ◽  
Tianjing Li ◽  
Jessica Vaughan ◽  
Lorne A. Becker ◽  
Brian R. Davidson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Resection ◽  
Blood Loss ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Cochrane Systematic Review ◽  
Decrease Blood Loss
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