Impact of Intraoperative Gravity-Dependent Atelectasis Following Laparoscopic Liver Resection Performed in the Lateral Position

Abstract Purpose Laparoscopic liver resection (LLR) is currently an accepted approach for liver surgery in select patients. The correlation between the intraoperative position and the presence of gravity-dependent atelectasis (GDA) has been well discussed. However, LLR is performed in the left half lateral position, and the relationship between this position and the presence of GDA remains unclear. We evaluated the extent to which the intraoperative left half lateral position affects the presence of GDA. Furthermore, univariate and multivariate analyses were performed to identify potential risk factors for LLR postoperative complications with a special emphasis on the presence of GDA by comparing various patient-, liver- and surgery-related factors in a retrospective cohort. Methods We retrospectively evaluated 129 patients who underwent LLR in the left half lateral position at the Saitama Cancer Center in Saitama, Japan between March 2011 and July 2020. The frequency and duration of GDA were investigated. We divided the cohort into with GDA and without GDA groups based on a cutoff value (≥ 5 days, n = 61 and < 5 days, n = 68, respectively). Using multivariate analysis, the duration of GDA and several risk factors for LLR postoperative complications were independently assessed. Results Postoperative GDA was observed in 61 patients (47%) and lasted for 1 to 8 days in these patients. The mean duration of GDA was 4.3 days. Multivariate logistic regression analysis revealed a GDA duration of 5 days or more (odds ratio [OR], 2.03; p = 0.001) and an operating time > 388 minutes (OR, 5.31; p < 0.001) to be independent risk factors for LLR postoperative complications. Conclusions The incidence and duration of postoperative GDA are considered useful predictors of postoperative complications, and these predictors should be assessed to improve the short-term outcomes of patients undergoing LLR.

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Multivariate analysis of preoperative risk factors for prolonged operating time in laparoscopic liver resection

HPB ◽

10.1016/j.hpb.2019.10.1275 ◽

2019 ◽

Vol 21 ◽

pp. S973-S974

Author(s):

A. Sultana ◽

R.P. Sutcliffe ◽

K.J. Roberts ◽

P. Muiesan ◽

P. Nightingale ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Operating Time ◽

Preoperative Risk ◽

Preoperative Risk Factors

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Multivariate analysis of risk factors for postoperative complications after laparoscopic liver resection

Surgical Endoscopy ◽

10.1007/s00464-014-3965-0 ◽

2014 ◽

Vol 29 (9) ◽

pp. 2538-2544 ◽

Cited By ~ 20

Author(s):

Hadrien Tranchart ◽

Martin Gaillard ◽

Mircea Chirica ◽

Stefano Ferretti ◽

Gabriel Perlemuter ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Postoperative Complications ◽

Laparoscopic Liver Resection

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Multivariate analysis of preoperative risk factors for prolonged operating time in laparoscopic liver resection

HPB ◽

10.1016/j.hpb.2019.10.321 ◽

2019 ◽

Vol 21 ◽

pp. S621

Author(s):

A. Sultana ◽

R.P. Sutcliffe ◽

K.J. Roberts ◽

P. Muiesan ◽

P. Nightingale ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Operating Time ◽

Preoperative Risk ◽

Preoperative Risk Factors

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Laparoscopic liver resection or Radiofrequency ablation using the left-lateral position in Segment 7

HPB ◽

10.1016/j.hpb.2019.10.2048 ◽

2019 ◽

Vol 21 ◽

pp. S385-S386

Author(s):

Zhang Li ◽

Xiu Dianrong ◽

Jiang Bin ◽

Yuan Chunhui ◽

Ma Chaolai ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Lateral Position ◽

Left Lateral Position

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Risk factors of open conversion in laparoscopic liver resection – a single center study

HPB ◽

10.1016/j.hpb.2016.02.600 ◽

2016 ◽

Vol 18 ◽

pp. e240

Author(s):

W. Cho ◽

C.H. Kwon ◽

J.W. Joh ◽

S.J. Kim ◽

G.S. Choi ◽

...

Keyword(s):

Risk Factors ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Single Center ◽

Open Conversion ◽

Single Center Study ◽

Center Study

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Single Port Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Preliminary Report

International Journal of Hepatology ◽

10.4061/2011/579203 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 16

Author(s):

Stephen Kin Yong Chang ◽

Maria Mayasari ◽

Iyer Shridhar Ganpathi ◽

Victor Lee Tswen Wen ◽

Krishnakumar Madhavan

Keyword(s):

Hepatocellular Carcinoma ◽

Laparoscopic Surgery ◽

Liver Resection ◽

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Liver Resection ◽

Preliminary Report ◽

Single Port ◽

Operating Time ◽

Length Of Hospital Stay

Single port laparoscopic surgery is an emerging technique, now commonly used in cholecystectomy. The experience of using this technique in liver resection for hepatocellular carcinoma is described in a series of 3 cases with single port laparoscopic liver resection performed during 2010. All patients were male aged 61 to 70 years, with several comorbidities. There were no complications in this early series. The length of hospital stay was 3–5 days. The blood loss was 200–450 mL, with operating time between 142 and 171 minutes. We conclude that this technique is feasible and safe to perform in experienced centers.

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Risk Factors of Anastomotic Leakage After Esophagectomy With Intrathoracic Anastomosis

Frontiers in Surgery ◽

10.3389/fsurg.2021.743266 ◽

2021 ◽

Vol 8 ◽

Author(s):

Huan Li ◽

Shimin Zhuang ◽

Honghong Yan ◽

Wenxiao Wei ◽

Quanguan Su

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Hospital Stay ◽

Anastomotic Leakage ◽

Old Age ◽

Multivariate Logistic Regression Analysis ◽

Rank Correlation ◽

Length Of Hospital Stay ◽

Cancer Center ◽

Intrathoracic Anastomosis

Purpose: Anastomotic leakage is one of the most common complications of esophagectomy, it serves as one of the main causes of postoperative death of esophageal cancer. It is of clinical significance to try to discover the risk factors that cause anastomotic leakage.Methods: This retrospective study was conducted on 1,257 consecutive esophageal cancer patients who underwent esophagectomy with intrathoracic anastomosis from January 2010 to December 2015 at a high volume cancer center. Multivariate Logistic Regression analysis, Spearman rank correlation analysis, Mann-Whitney U test and Kruskal-Wallis test were performed to identify the risk factors to the occurrence of anastomotic leakage and the length of hospital stay.Results: Intrathoracic anastomotic leakage occurred in 98 patients (7.8%). Older patients were more likely to develop anastomotic leakage. Patients with diabetes had a higher leakage rate. Intrathoracic anastomotic leakage, old age as well as comorbidities were associated with longer hospital stay.Conclusion: Our study suggested that old age and diabetes were risk factors to intrathoracic anastomotic leakage. In-hospital stay would be lengthened by intrathoracic anastomotic leakage, old age and comorbidities.

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Incidence and risk factors for hypoglycemia in patients with hepatocellular carcinoma

10.21203/rs.3.rs-905429/v1 ◽

2021 ◽

Author(s):

XiaoJing Zheng ◽

Hong-Hong Yan ◽

Bin Gan ◽

Xiao-Ting Qiu ◽

Jie Qiu ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Logistic Regression ◽

Hba1c Level ◽

Glycated Hemoglobin ◽

Multivariate Logistic Regression Analysis ◽

Cancer Center ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Factors Associated

Abstract AimTo evaluate the incidence and risk factors for hypoglycemia in patients with hepatocellular carcinoma (HCC).MethodsWe collected and analyzed the clinical data of patients with HCC in our cancer center between April 2020 and June 2021. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with hypoglycemia.ResultsThe incidence rate of hypoglycemia in patients with HCC was 28.9% (67/232). Multivariate logistic regression analysis showed a significant association between hypoglycemia and Child-Pugh grade C (odds ratio [OR]=7.3, 95% confidence interval [CI] 2.28–23.31, p=0.001), alpha-fetoprotein (AFP) level (OR=1.000035, 95% CI 1.000007–1.000063, p=0.015), and glycated hemoglobin (HbA1c) level (OR=0.46, 95% CI 0.29–0.73, p=0.001).ConclusionChild-Pugh stage and HbA1c and AFP levels were associated with hypoglycemia in patients with HCC. Our study suggests that these three factors should be comprehensively considered when estimating the risk of hypoglycemia in these patients, and the diagnosis, treatment, and nursing plan should be adjusted in time to reduce the incidence of hypoglycemia.

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Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

10.21203/rs.3.rs-1008430/v1 ◽

2021 ◽

Author(s):

Xining Zhao ◽

Jie Liu ◽

Ying Wang ◽

Yuying Yang ◽

Yan Pan ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Postoperative Complications ◽

Geriatric Patients ◽

Cox Regression ◽

Significant Risk ◽

Related Factors ◽

Factors Associated ◽

Delayed Discharge ◽

Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

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Patterns, timing, and predictors of recurrence after laparoscopic liver resection for hepatocellular carcinoma: results from a high-volume HPB center

Surgical Endoscopy ◽

10.1007/s00464-021-08390-5 ◽

2021 ◽

Author(s):

Haili Zhang ◽

Fei Liu ◽

Ningyuan Wen ◽

Bo Li ◽

Yonggang Wei

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Survival Rates ◽

Surgical Margin ◽

Trocar Site ◽

Liver Recurrence ◽

Risk Factors For Recurrence ◽

Recurrence Patterns

Abstract Background Although long-term outcomes may be comparable between laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC), there has been little discussion regarding the patterns of recurrence after LLR. Methods Patients with HCC who underwent hepatectomy between April 2015 and November 2018 were included in this study. The recurrence patterns were analyzed in detail. The recurrence outcomes following laparoscopic versus OLR for HCC were compared after 1:2 propensity score matching. Potential risk factors for recurrence were also assessed with Cox proportional risk models. Results Among 425 patients after LLR, 144 (33.8%) experienced recurrence at the last follow-up, with a median recurrence-free survival (RFS) of 10.0 months (range 1–58 months). The most frequent recurrence site was the liver (n = 99, 68.8%), followed by the surgical margin (n = 15, 10.4%) and distant metastases (n = 12, 8.3%). Liver recurrence with distant metastasis (n = 10, 6.9%) tended to occur early (median 8.0 months), while peritoneal recurrence (n = 8, 5.6%) occurred later (median 14.0 months). A total of 120 (83.3%) patients had recurrence within 2 years after LLR. No trocar site recurrence was observed in this study. The recurrence patterns, timing, and treatment did not show significant differences between the LLR and OLR. The independent risk factors for recurrence included ALBI grade, postoperative α-fetoprotein > 8 ng/ml, tumor size > 5 cm, surgical margin ≤ 1 cm, and multiple tumors. Patients with recurrence had 1- and 5-year overall survival rates of 81.1% and 60.7%, respectively, compared with rates of 95.8% and 92.9% for patients without recurrence (P < 0.000). Conclusion This study suggested that intrahepatic recurrence was still the most common recurrence pattern for HCC after LLR and that LLR did not increase the risk of trocar hole recurrence or implantation. Most cases of recurrence occurred within 2 years after LLR, suggesting that surveillance should be targeted to early recurrence.

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