Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat

Ypsilantis, Petros; Lambropoulou, María; Αναγνωστόπουλος, Κωνσταντίνος; Kiroplastis, Konstantinos; Tepelopoulos, Georgios; Bangeas, Petros; Ypsilantou, Ifigenia; Pitiakoudis, Michail

doi:10.1016/j.surg.2021.11.002

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…Clinical and experimental studies shown that LLR reduces the secretion of proinflammatory factors, such as IL-6, C-reactive protein, TNF alpha, or NFkB and preserves better postoperative immunity. 35 , 39 , 40 These two factors appear to play an important role in tumor development and metastasis as well as in the production of tumor angiogenesis and secretion of tumor-promoting mitogens, which could lead to cancer recurrence and negatively impact survival. 41…”

Section: Discussionmentioning

confidence: 99%

Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

et al. 2023

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Background Recent studies have associated laparoscopic surgery with better overall survival (OS) in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The potential benefits of laparoscopic liver resection (LLR) over open liver resection (OLR) have not been demonstrated in patients with intrahepatic cholangiocarcinoma (iCC). Methods A systematic review of the PubMed, EMBASE, and Web of Science databases was performed to search studies comparing OS and perioperative outcome for patients with resectable iCC. Propensity-score matched (PSM) studies published from database inception to May 1, 2022 were eligible. A frequentist, patient-level, one-stage meta-analysis was performed to analyze the differences in OS between LLR and OLR. Second, intraoperative, postoperative, and oncological outcomes were compared between the two approaches by using a random-effects DerSimonian-Laird model. Results Six PSM studies involving data from 1.042 patients (530 OLR vs. 512 LLR) were included. LLR in patients with resectable iCC was found to significantly decrease the hazard of death (stratified hazard ratio [HR]: 0.795 [95% confidence interval [CI]: 0.638–0.992]) compared with OLR. Moreover, LLR appears to be significantly associated with a decrease in intraoperative bleeding (− 161.47 ml [95% CI − 237.26 to − 85.69 ml]) and transfusion (OR = 0.41 [95% CI 0.26–0.69]), as well as with a shorter hospital stay (− 3.16 days [95% CI − 4.98 to − 1.34]) and a lower rate of major (Clavien-Dindo ≥III) complications (OR = 0.60 [95% CI 0.39–0.93]). Conclusions This large meta-analysis of PSM studies shows that LLR in patients with resectable iCC is associated with improved perioperative outcomes and, being conservative, yields similar OS outcomes compared with OLR.

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Section: Discussionmentioning

confidence: 99%

Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

et al. 2023

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“…To the best of our knowledge, there are no experimental or clinical data comparing the magnitude of the hepatectomy-induced gut barrier impairment between the LT context and other conditions. However, preclinical studies have shown that gut barrier disruption is attenuated when a laparoscopic approach was employed rather than an open surgery for major liver resection [ 37 ]. Therefore, it is possible that a pure laparoscopic living donor liver transplantation, when performed in appropriate candidates by an experienced transplantation team, might lead to improved patient outcomes through attenuation of gut barrier injury [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

The role of gut barrier dysfunction in postoperative complications in liver transplantation: pathophysiological and therapeutic considerations

Assimakopoulos,

Bhagani,

Aggeletopoulou

et al. 2024

Infection

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Purpose Gut barrier dysfunction is a pivotal pathophysiological alteration in cirrhosis and end-stage liver disease, which is further aggravated during and after the operational procedures for liver transplantation (LT). In this review, we analyze the multifactorial disruption of all major levels of defense of the gut barrier (biological, mechanical, and immunological) and correlate with clinical implications. Methods A narrative review of the literature was performed using PubMed, PubMed Central and Google from inception until November 29th, 2023. Results Systemic translocation of indigenous bacteria through this dysfunctional barrier contributes to the early post-LT infectious complications, while endotoxin translocation, through activation of the systemic inflammatory response, is implicated in non-infectious complications including renal dysfunction and graft rejection. Bacterial infections are the main cause of early in-hospital mortality of LT patients and unraveling the pathophysiology of gut barrier failure is of outmost importance. Conclusion A pathophysiology-based approach to prophylactic or therapeutic interventions may lead to enhancement of gut barrier function eliminating its detrimental consequences and leading to better outcomes for LT patients.

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“…Laparotomy can improve the complete resection rate of tumour lesions, but it is greatly traumatic and causes a strong stress response and serious damage to the immune function of the body. In addition, after laparotomy, the tumour can escape, recur and metastasize ( 6 ). Accordingly, for patients with LC, laparotomy is a double-edged sword that causes great trauma to the body while removing the lesion.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and factors of postoperative recurrence

et al. 2023

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ObjectiveFor exploring the clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and analysing related factors of postoperative recurrence.MethodsTotally 212 patients with hepatocellular carcinoma admitted to our hospital between April 2017 and December 2020 were enrolled, and all of them were followed up after the operation. According to the treatment modes, the patients were assigned to a laparotomy group (n=106) and a laparoscopic group (n=106). Perioperative indicators, haematological examination results, complications and recurrence were compared between the two groups. The recurrence time of hepatocellular carcinoma after the operation was confirmed by imaging examination with definite mass, and logistic multivariate analysis was used for analyzing the risk factors associated with postoperative recurrenceResultsPatients in both groups were comparable in terms of general baseline data. The laparoscopic group experienced longer operation time and shorter incision length, less intraoperative blood loss, early time to have the first off-bed activity and time to eat liquid and shorter hospital stay than the laparotomy group (all P<0.05). Seven days after the operation, the laparoscopic group showed notably lower levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8), and C-reactive protein (CRP) than the laparotomy group (all P<0.05), and also showed notably higher levels of immunoglobulin A (IgA), IgG and IgM than the laparotomy group (all P<0.05). Additionally, the laparotomy group showed a higher total incidence rate of complications than the laparoscopic group (19.81% vs. 9.43%, P<0.05). During the one-year follow-up, the laparotomy group was not greatly different from the laparoscopic group in recurrence rate (22.64% (24/106) vs. 16.98% (18/106), P>0.05). Multivariate analysis showed that average tumour diameter and microvascular invasion were risk factors for postoperative recurrence (P<0.05).ConclusionLaparoscopic radical hepatectomy for hepatocellular carcinoma can reduce the influence on liver function and immune function, with less damage to tissues, and can ameliorate postoperative inflammatory reaction, and promote postoperative recovery of patients as soon as possible. There are many factors influencing the postoperative recurrence of hepatocellular carcinoma, and average tumour diameter and microvascular invasion are the risk factors.

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Gut-Barrier Disruption After Laparoscopic Versus Open Major Liver Resection in the Rat

Cited by 4 publications

References 32 publications

Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

The role of gut barrier dysfunction in postoperative complications in liver transplantation: pathophysiological and therapeutic considerations

Clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and factors of postoperative recurrence

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