Multicenter Propensity Score-Based Study of Laparoscopic Repeat Liver Resection for Hepatocellular Carcinoma: A Subgroup Analysis of Cases with Tumors Far from Major Vessels

Less morbidity is considered among the advantages of laparoscopic liver resection (LLR) for HCC patients. However, our previous international, multi-institutional, propensity score-based study of emerging laparoscopic repeat liver resection (LRLR) failed to prove this advantage. We hypothesize that these results may be since the study included complex LRLR cases performed during the procedure’s developing stage. To examine it, subgroup analysis based on propensity score were performed, defining the proximity of the tumors to major vessels as the indicator of complex cases. Among 1582 LRLR cases from 42 international high-volume liver surgery centers, 620 cases without the proximity to major vessels (more than 1 cm far from both first–second branches of Glissonian pedicles and major hepatic veins) were selected for this subgroup analysis. A propensity score matching (PSM) analysis was performed based on their patient characteristics, preoperative liver function, tumor characteristics and surgical procedures. One hundred and fifteen of each patient groups of LRLR and open repeat liver resection (ORLR) were earned, and the outcomes were compared. Backgrounds were well-balanced between LRLR and ORLR groups after matching. With comparable operation time and long-term outcome, less blood loss (283.3±823.0 vs. 603.5±664.9 mL, p = 0.001) and less morbidity (8.7 vs. 18.3 %, p = 0.034) were shown in LRLR group than ORLR. Even in its worldwide developing stage, LRLR for HCC patients could be beneficial in blood loss and morbidity for the patients with less complexity in surgery.

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Long-Term Outcome of Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Case-Controlled Study with Propensity Score Matching

Surgical Endoscopy ◽

10.1007/s00464-013-3254-3 ◽

2013 ◽

Vol 28 (3) ◽

pp. 950-960 ◽

Cited By ~ 54

Author(s):

Hyeyoung Kim ◽

Kyung-Suk Suh ◽

Kwang-Woong Lee ◽

Nam-Joon Yi ◽

Geun Hong ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

Propensity Score Matching ◽

Controlled Study ◽

Term Outcome ◽

Long Term Outcome ◽

Open Liver Resection

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Repeated Liver Resection for Colorectal Liver Metastases: A Comparison with Primary Liver Resections concerning Perioperative and Long-Term Outcome

Gastroenterology Research and Practice ◽

10.1155/2012/568214 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

Kristoffer Jönsson ◽

Gerd Gröndahl ◽

Martin Salö ◽

Bobby Tingstedt ◽

Roland Andersson

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Postoperative Mortality ◽

Term Outcome ◽

Long Term Outcome ◽

Liver Resections

Introduction. 60% of patients operated for colorectal liver metastases (CRLM) will develop recurrent disease and some may be candidates for a repeated liver resection. The study aimed to evaluate differences in intraoperative blood loss and complications comparing the primary and the repeated liver resection for metastases of colorectal cancer (CRC), as well as to evaluate differences in long-time follow-up.Method. 32 patients underwent 34 repeated liver resections due to recurrence of CRLM an studied retrospectively to identify potential differences between the primary and the repeat resections.Results. There was no 30-day postoperative mortality or postoperative hospital deaths. The median blood loss at repeat resection (1850 mL) was significantly (P=0.014) higher as compared to the primary liver resection (1000 mL). This did not have any effect on the rate of complications, even though increased bleeding in itself was a risk factor for complications. There were no differences in survival at long-term follow-up.Discussion. A repeated liver resection for CRLM was associated with an increased intraoperative bleeding as compared to the first resection. Possible explanations include presence of adhesions, deranged vascular anatomy, more complicated operations and the effects on the liver by chemotherapy following the first liver resection. 30 out of 32 patients had only one reresection of the liver.

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The effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on the patients with placenta percreta

10.21203/rs.3.rs-31115/v1 ◽

2020 ◽

Author(s):

Huidan Zhao ◽

Chen Chen ◽

Ya Tao ◽

Zhuan Liu ◽

Cai Liu ◽

...

Keyword(s):

Blood Loss ◽

Abdominal Aorta ◽

Operation Time ◽

Balloon Occlusion ◽

Placenta Percreta ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

The Mean

Abstract Background Patients with placenta accreta spectrum (PAS) disorders often experience overwhelming hemorrhage during cesarean. Placenta percreta is the most serious subtype. In this paper, we propose a new procedure in order to control intraoperative bleeding. We aimed to evaluate the effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on patients with placenta percreta. Methods In a retrospective study, data from patients with placenta percreta who delivered by cesarean section between January 1, 2017 and December 31, 2019 were analyzed. Short-term and long-term outcomes were followed up by outpatient clinic and by phone. The quantity of estimated blood loss (EBL), operation time, urine tube time, hospital stay and short-term and long-term complications including fever, thrombosis, hematoma, breast feeding and menstruation problems, lower limb complaints, intrauterine adhesion and so on, were analyzed. Results For all cases, the mean EBL in the surgery was 1399 ± 948 mL, the mean operation time was 107 ± 35minutes, and the mean perioperative hospital stay was 9.6 ± 5.0 days. All the patients had a preserved uterus. Menstrual quantity decreased in 12 patients. Menstrual period prolonged in 11 cases. Uncomfortable abdomen symptoms happened in 9 cases after the surgery. Four cases got thrombosis and 3 got hematoma. Lower extremity discomfort was found in 6 patients. Conclusion Combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet, Partial Anterior Myometrial Resection and Reconstruction is highly effective in reducing the intraoperative blood loss and hysterectomy in placenta percreta. But we should pay great attention to short-term and long-term complications, especially to the complications associated with aorta balloon occlusion.

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Ứng dụng dao siêu âm Sonastar trong phẫu thuật cắt gan

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2020.65.19 ◽

2020 ◽

Author(s):

Hien Pham Nhu

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Operative Time ◽

Resection Margin ◽

Operation Time ◽

Bile Leakage ◽

Hepatic Veins ◽

Early Results ◽

Solitary Liver ◽

The Mean

Background: Researching specification and evaluating early results after hepatectomy that it’s used with Sonastar ultrasonic tool. Materials and methods: We prospectively examined data of 19 patients who underwent hepatectomy at Hue Central Hospitalfrom 7/2019to 7/2020. Results: The mean ages was 60,7 ± 10,5 range (19 – 90) and males/females was 6:1.. Patients with solitary liver tumor accounted for 79%; while tumors that have satellite cores accounted for 21% of all cases. 68,4% of all patients have tumor that is more than 5cm in size. Blocking hepatic blood flow by clamping of hepatoduodenal ligament accounts for 57,9%, while right and left hepatic vein clamp accounted for 68,4% and 36,8% respectively. In 78,9% of the cases, surgicel was used to cover the liver resection margin, while the in the remainder 21,5% of the cases, BioGlue was used. Large liver resection (2 and more lobes resected) accounted for 73,7% of all cases. Mean liver resection time was 50 ( 45-110) minutes, mean operation time was 125 (90-280) minutes, mean blood loss amount was 250 (150-650)ml. On average, post-operative time was 8 days (7-23). Post-operative complications was observed in 15,9% of cases, and there was 5,3% deceased. Conclusion: Application of Sonastar ultrasonic tool in hepatectomy reduces blood loss, help better manage hepatic veins, thus reducing complications such as bile leakage. It also helps surgeons manage the liver resection margin, minimalizing recurrences cancer

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1029 LONG-TERM OUTCOME OF CIRRHOTIC PATIENTS WITH SINGLE HCC ≤ 5CM. DOES LIVER RESECTION HAVE THE SAME RESULTS AS LIVER TRANSPLANTATION?

Journal of Hepatology ◽

10.1016/s0168-8278(12)61041-1 ◽

2012 ◽

Vol 56 ◽

pp. S402-S403

Author(s):

G. Sapisochin ◽

C. Dopazo ◽

I. Bilbao ◽

L. Castells ◽

J.L. Lazaro ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Resection ◽

Term Outcome ◽

Long Term Outcome ◽

Cirrhotic Patients

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Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis

Gastric Cancer ◽

10.1007/s10120-018-0889-8 ◽

2018 ◽

Vol 22 (3) ◽

pp. 558-566 ◽

Cited By ~ 5

Author(s):

Kojiro Tanoue ◽

Shusei Fukunaga ◽

Yasuaki Nagami ◽

Taishi Sakai ◽

Hirotsugu Maruyama ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Propensity Score ◽

Endoscopic Submucosal Dissection ◽

Propensity Score Analysis ◽

Term Outcome ◽

Long Term Outcome ◽

Submucosal Dissection ◽

Score Analysis

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Short-term and long-term outcomes of robotic, laparoscopic and open radical gastrectomy in gastric cancer: A single-center retrospective study

10.21203/rs.2.15339/v1 ◽

2019 ◽

Author(s):

Weifan Zhang ◽

Xinhui Zhao ◽

Zhao Liu ◽

Hui Dang ◽

Lei Meng ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Learning Curve ◽

Operation Time ◽

Open Gastrectomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: Few studies on the comparison among robotic, laparoscopic, and open gastrectomy had been reported in gastric cancer . The goal of this study was to evaluate the advantages of robotic-assisted gastrectomy (RAG) by comparing with laparoscopic-assisted gastrectomy(LAG) and open gastrectomy (OG). Methods: 147 gastric cancer patients who underwent gastrectomy were enrolled and retrospectively analyzed between January 2017 and July 2019. Short-term outcomes such as operation time, intraoperative estimated blood loss(EBL),number of retrieved lymph nodes, postoperative recovery, learning curve, and long-term outcome such as overall survival(OS) was compared among RAG, LAG and OG groups. Results: RAG group included 47 patients, 44 in the LAG, and 61 in the OG. Basic information such as gender, age, BMI, ASA degree were similar among three groups, and there were no statistically significances in pathological TNM staging, tumor resection extent, resection margin, methods of reconstruction( P ＞0.05). The cumulative sum(CUSUM) method showed that learning curve of RAG reached stability after 17 cases . For short-term outcomes, the RAG group had the shortest EBL( P =0.033), the shortest time to first flatus( P ＜0.001), shortest time to first intake liquid diet ( P =0.004),shortest postoperative hospital stay ( P =0.023)and the largest number of retrieved lymph nodes( P =0.044),the longest operation time( P ＜0.001), the most expensive treatment cost( P ＜0.001),however, there were no significant differences in postoperative drainage, postoperative white blood cell(WBC)count and early complications among three group( P ＞0.05). In addition to long-term outcome, similar OS was observed in three groups. Conclusion: Compared with LAG and OG, RAG has certain advantages in short-term outcomes and is a safe and reliable surgical method. But still need further prospective, multi-center research to confirm this.

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Reducing Morbidity in Urgent Gastroenterologic Surgery; Propensity Score Analysis Using Triclosan-Coated Polydioxanone Sutures

International Surgery ◽

10.9738/intsurg-d-17-00047.1 ◽

2017 ◽

Vol 102 (1-2) ◽

pp. 58-63

Author(s):

Shinsuke Takeno ◽

Kanefumi Yamashita ◽

Tomoaki Noritomi ◽

Seichiro Hoshino ◽

Yasushi Yamauchi ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Hospital Stay ◽

Propensity Score Matching ◽

Propensity Score Analysis ◽

Univariate Analysis ◽

Operation Time ◽

Surgical Site Infections ◽

Propensity Score Matching Analysis ◽

Abdominal Closure

Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P = 0.043); wound classification (P = 0.0005); peritonitis (P = 0.019); prolonged operation time (P = 0.0001); increased blood loss (P = 0.019); transfusion (P = 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P = 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P = 0.20), but it tended to be associated with a shorter hospital stay (P = 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.

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