Factors affecting the morbidity of elective liver resection

Stimpson, Ross; Pellegrini, Carlos A.; Way, Lawrence W.

doi:10.1016/0002-9610(87)90812-9

Cited by 93 publications

(45 citation statements)

References 16 publications

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“…Access to the diaphragm and right thoracic space using an oblique or J-shaped incision is easy (36). On the other hand, as previously reported, thoracotomy might carry a risk of postoperative complications (37), and the present study showed a higher incidence of hepatectomy-associated complications and increased blood loss. Thoracotomy itself is not a major risk factor for postoperative outcomes according to our previous study (36), but simultaneous resection of lung or diaphragm with hepatectomy might lead to such complications.…”

Section: Casesupporting

confidence: 70%

Safety of Hepatectomy Accompanying Combined Resection of Other Organs

Nanashima¹,

Abo²,

Takeshita³

et al. 2011

HGE

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Section: Casesupporting

confidence: 70%

Safety of Hepatectomy Accompanying Combined Resection of Other Organs

Nanashima¹,

Abo²,

Takeshita³

et al. 2011

HGE

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“…Nevertheless, extensive liver resection is still associated with a high incidence of infectious complications. [1][2][3][4] Elimination of pathogenic microorganisms by the host immune system occurs mainly through phagocytosis by polymorphonuclear leukocytes (PMNs). By virtue of this capacity, PMNs constitute the initial cellular barrier against infection.…”

mentioning

confidence: 99%

Impaired leukocyte phagocytosis in patients undergoing hemihepatectomy for liver metastases

Wiezer¹,

Meijer²,

Wallast-Groenewoud³

et al. 1999

Liver Transpl

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Patients undergoing partial hepatectomy have an increased susceptibility to infection. To investigate whether this increased risk is related to impaired leukocyte function, we studied polymorphonuclear leukocyte (PMN) phagocytosis in patients undergoing a hemihepatectomy because of liver metastasis (LM, n ‫؍‬ 11) and in patients undergoing major abdominal surgery because of abdominal malignancy (AM, n ‫؍‬ 8). Eight healthy volunteers (HVs) served as controls. Leukocyte suspensions were incubated with fluorescein isothiocyanate-labeled Staphylococcus aureus, and phagocytosis was measured by flow cytometry. Preoperative PMN phagocytosis, in the presence of autologous plasma, was significantly less in patients with LM compared with patients with AM or HVs. This impaired phagocytosis was potentially restored in the presence of normal plasma.The decreased phagocytic capacity of PMNs from patients with LM was not related to levels of known plasma opsonins or phenotypic changes of PMNs. Rather, it was related to a deficiency of unidentified plasma factors. After surgery, the phagocytic capacity of PMNs of patients with AM decreased by approximately 30%, which correlated with decreasing levels of immunoglobulin G and C3. In conclusion, patients with LM had a decreased PMN phagocytic capacity before surgery. This impairment in phagocytosis disappeared 1 week after surgery. We propose that the presence of LM leads to a deficiency of factor(s) in the blood that impairs PMN phagocytic capacity.Copyright 1999 by the American Association for the Study of Liver Diseases P artial hepatectomy is the first choice of treatment for patients with liver metastasis (LM) of colorectal cancer. During the last decade, major advances in anesthetic and surgical techniques, as well as improvement in postoperative care, have significantly reduced mortality and morbidity after liver resection. Nevertheless, extensive liver resection is still associated with a high incidence of infectious complications. [1][2][3][4] Elimination of pathogenic microorganisms by the host immune system occurs mainly through phagocytosis by polymorphonuclear leukocytes (PMNs). By virtue of this capacity, PMNs constitute the initial cellular barrier against infection. Therefore, infections occurring in the immediate postoperative period after partial hepatectomy may be related to a decreased phagocytic capacity of these cells. To investigate this idea, we evaluated the ex vivo phagocytosis of bacteria by PMNs from patients before and after a hemihepatectomy for metastatic colorectal carcinoma. As controls, patients undergoing abdominal surgery because of malignancy, as well as healthy volunteers (HVs), were studied. Materials and Methods PatientsEleven patients undergoing (extended) hemihepatectomy (resection of Ն three liver segments) for LM of colorectal carcinoma (9 men and 2 women; mean age, 60.8 Ϯ 2.5 years) and 8 patients undergoing resection of colorectal cancer, without liver metastases (AM; 6 men and 2 women; mean age, 61.8 Ϯ 3.7 years) were included. Eight...

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“…Careful preoperative assessments and vigilant post-op monitoring are essential in managing these patients. [16].…”

Section: Patient Populationmentioning

confidence: 99%

“…Techniques of occluding hepatic inflow (Pringle maneuver) and outflow are being investigated as means of reducing blood loss in healthy livers [16]. However, the ability of cirrhotic liver to tolerate blood flow occlusion has not yet been fully elucidated and may limit its use in this situation [35].…”

Section: Possible Interventionsmentioning

confidence: 99%

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Review: Research Toward Safer Resectionof the Cirrhotic Liver

Moser

Kneteman

2000

HPB Surgery

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Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

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Factors affecting the morbidity of elective liver resection

Cited by 93 publications

References 16 publications

Safety of Hepatectomy Accompanying Combined Resection of Other Organs

Safety of Hepatectomy Accompanying Combined Resection of Other Organs

Impaired leukocyte phagocytosis in patients undergoing hemihepatectomy for liver metastases

Review: Research Toward Safer Resectionof the Cirrhotic Liver

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