Brain surgery in patients with liver cirrhosis

Chen, Ching-Chang; Hsu, Peng‐Wei; Lee, Shih‐Tseng; Chang, Chen-Nen; Wei, Kuo‐Chen; Wu, Chieh‐Tsai; Hsu, Yung-Hsin; Lin, Tzu-Kang; Lee, Sai-Cheung; Huang, Yin-Cheng

doi:10.3171/2012.4.jns111338

Cited by 30 publications

(25 citation statements)

References 28 publications

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“…Child-Pugh classification is the most commonly used criterion to evaluate the status of liver function. The rate of complications, hemorrhage and mortality increase with poor liver function, especially in patients with HCC or liver cirrhosis [15]. Choi et al [6] reported that the Child-Pugh classification was shown to influence the median survival time in patients with brain metastasis from HCC.…”

Section: Discussionmentioning

confidence: 99%

Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor

et al. 2013

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BackgroundThe incidence of brain metastasis from hepatocellular carcinoma (HCC) is expected to increase as a result of prolonged survival due to the recent advances in HCC treatment. However, there is no definite treatment strategy for brain metastasis from HCC mainly due to its rarity and dismal prognosis. To provide helpful recommendations in treatment of brain metastasis from HCC, the authors aimed to identify prognostic factors that influence survival rates with a review of the recently published data.MethodsThirty-three cases of brain metastasis, whose incidence was 0.65%, were selected from a total of 5015 HCC patients and reviewed retrospectively in terms of clinical and radiological features.ResultsMedian overall survival time after diagnosis of brain metastasis was 10.4 weeks (95% confidence interval [CI], 5.1-15.7 weeks) with 1-, 6- and 12-month survival rates, of 79%, 24% and 6%, respectively. Median survival of the patients treated with surgical resection or surgical resection followed by whole-brain radiation therapy (WBRT) (25.3 weeks; range, 15.8-34.8 weeks) was longer than that of the patients treated with gamma knife surgery (GKS), WBRT, or GKS followed by WBRT (10.4 weeks; range, 7.5-13.3 weeks) as well as that of patients treated with only steroids (1 week; range, 0.0-3.3 weeks) (p < 0.001). Child-Pugh’s classification A group had a longer median survival time than Child-Pugh’s classification B or C group (14.4 weeks vs 8.4 weeks, p = 0.038). RPA class I & II group had also a longer median survival time than RPA class III group did (13.4 weeks vs 2.4 weeks, p = 0.001). Surgical resection (hazard ratio [HR] 0.23, 95% CI 0.08-0.66, p = 0.006) and good liver function at the time of brain metastasis (HR 0.25, 95% CI 0.09-0.69, p = 0.007) were found to be the powerful prognostic factors for favorable survival in the multivariate analysis. In addition, presence of intratumoral hemorrhage was a statistically significant prognostic factor for survival.ConclusionAlthough HCC patients with brain metastasis showed a very dismal prognosis, surgical intervention was shown to lead to relative prolongation of the survival time, especially in those with preserved hepatic function.

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Section: Discussionmentioning

confidence: 99%

Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor

et al. 2013

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“…A study by Chen et al also showed that mortality rates tend to be higher in patients with several comorbidities. 4 The analysis of sex differences in 5-year mortality in the patients in this study who had received TBI surgery also indicated that 5-year mortality tends to be higher in males than in females. An earlier sex comparison of TBI also suggested that outcomes and recovery tend to be better in females than in males.…”

Section: Discussionmentioning

confidence: 99%

“…4,20,21 Advanced age reportedly has a strong positive association with a high DCCI score. A study by Chen et al also showed that mortality rates tend to be higher in patients with several comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan

Shi¹,

Hwang

Lee³

et al. 2014

JNS

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Object.The authors sought to analyze trends in hospital resource utilization and mortality rates in a population of patients who had received traumatic brain injury (TBI) surgery.Methods. This nationwide population-based cohort study retrospectively analyzed 18,286 patients who had received surgical treatment for TBI between 1998 and 2010. The multiple linear regression model and Cox proportional hazards model were used for multivariate assessment of outcome predictors.Results. The prevalence rate of surgical treatment for patients with TBI gradually but significantly (p < 0.001) increased by 47.6% from 5.0 per 100,000 persons in 1998 to 7.4 per 100,000 persons in 2010. Age, sex, DeyoCharlson comorbidity index score, hospital volume, and surgeon volume were significantly associated with TBI surgery outcomes (p < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 19.06%, whereas the in-hospital mortality rate decreased 10.9%. The estimated mean time of overall survival after TBI surgery (± SD) was 83.0 ± 4.2 months, and the overall in-hospital and 1-, 3-, and 5-year survival rates were 74.5%, 67.3%, 61.1%, and 57.8%, respectively.Conclusions. These data reveal an increased prevalence of TBI, especially in older patients, and an increased hospital treatment cost but a decreased in-hospital mortality rate. Health care providers and patients should recognize that attributes of the patient and of the hospital may affect hospital resource utilization and the mortality rate. These results are relevant not only to other countries with similar population sizes but also to countries with larger populations. (http://thejns.org/doi/abs/10.3171/2014.8.JNS131526) KeY worDS • traumatic brain injury • trends • predictors • hospital resource utilization • mortality rateAbbreviations used in this paper: BNHI = Bureau of National Health Insurance; DCCI = Deyo-Charlson comorbidity index; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; IQR = interquartile range; LOS = length of stay; TBI = traumatic brain injury.* Drs. K. T. Lee and Lin contributed equally to this study.

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“…Moreover, platelet count below 50×10 3 /dL determines an increased risk of bleeding during surgery. Another predictor of bleeding associated with surgery in cirrhosis patients is severity of liver disease itself: recently, severity of liver disease has been shown to be correlated with the risk of bleeding complications during brain surgery, with mortality reaching 63 % in Child C patients [99].…”

Section: Bleeding Risk Associated With Surgerymentioning

confidence: 99%

Assessment of Bleeding Risk in Patients with Cirrhosis

Zanetto

Senzolo

Ferrarese

et al. 2015

Curr Hepatology Rep

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Cirrhosis is characterized by varying degrees of alterations of the different components of hemostasis, including thrombocytopenia, reduction of procoagulant factors, overactivation of the fibrinolytic system, and a precarious hemostatic equilibrium that can easily tilt towards bleeding. Predicting the risk of spontaneous bleeding from nonvariceal sites, variceal bleeding, and hemorrhagic complications associated with surgery or invasive procedures is a formidable challenge faced by clinicians caring for cirrhosis patients, and standard assays have demonstrated a poor correlation with episodes of bleeding. While new tests evaluating different components of coagulation as well as global assays are increasingly available and used to guide therapeutic approaches, there is still no optimal method to assess bleeding risk, and a combination between severity of liver disease, the presence of ongoing infection or renal insufficiency, as well as the type of bleeding itself seems to still be very important in evaluating the individual patient's risk.

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Brain surgery in patients with liver cirrhosis

Abstract: Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; in addition, grave outcomes were observed in patients with TBI.

Cited by 30 publications

References 28 publications

Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor

Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan

Assessment of Bleeding Risk in Patients with Cirrhosis

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