Perioperative management of liver surgery—review on pathophysiology of liver disease and liver failure

Gasteiger, Lukas; Eschertzhuber, Stephan; Tiefenthaler, Werner

doi:10.1007/s10353-018-0522-4

Cited by 10 publications

(7 citation statements)

References 48 publications

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“…Development of new chemotherapeutics and biologicals markedly increased treatment options since. Likewise, hepatic, pulmonary and peritoneal-surface surgery, as well as perioperative management, have undergone a striking development accompanied by reduced postoperative mortality and morbidity [21,22]. Consequently, our department alongside many others underwent a complete redefinition of our understanding of resectability [23].…”

Section: Discussionmentioning

confidence: 99%

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Primavesi

Stättner

Jäger

et al. 2019

Cancers

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Background: Secondary resection rates in first-line chemotherapy trials for metastatic colorectal cancer (mCRC) remain below 15%, representing a clear contrast to reports by specialised surgical centres, where progressive liver, peritoneal-surface, and pulmonary surgery increased access to curative-intent treatment. We present a long-term evaluation of oncosurgical management in a single-centre, analysing the aggregate effect of gradual implementation of surgical subspecialties and systemic treatments on mCRC patients’ resection rates and prognosis. Methods: Patients with newly diagnosed mCRC from 2003 to 2014 were retrospectively categorised into palliative treatment (PAT) and curative intent surgery (CIS) and three time periods were analysed for treatment changes and factors associated with survival. Results: Four hundred-twenty patients were treated (PAT:250/CIS:170). Over time periods, the number of presenting patients remained consistent, whereas curative resection rates increased from 29% to 55%, facilitated by an increment of patients undergoing hepatectomy (21 to 35%), pulmonary surgery (6 to 17%), and peritonectomy/intraoperative chemotherapy (0 to 8%). Also, recently, significantly more multi-line systemic treatments were applied. The median survival markedly improved from 21.9 months (2003–2006; 95% confidence interval (CI) 17.3–26.5) to 36.5 months (2011–2014; 95% CI 26.6–46.4; p = 0.018). PAT was a significant factor of poor survival and diagnosis of mCRC in the latest time period was independently associated with a distinctly lower risk for palliative treatment (odds ratio 0.15). Conclusions: In modern eras of medical oncology, achieving appropriate resection rates through utilization of state-of-the-art oncological surgery by dedicated experts represents a cornerstone for long-term survival in mCRC.

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Section: Discussionmentioning

confidence: 99%

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Primavesi

Stättner

Jäger

et al. 2019

Cancers

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“…It is well known that malignancy promotes a hypercoagulable or prothrombotic state, thus contributing to thrombosis. 15 Hepatic carcinoma (hepatocellular/HCC, cholangiocellular/CCA or metastatic) remains the leading cause of liver resection, 18 and there is increasing evidence of up-regulation of coagulation after liver resection for malignancy. 11 One of the major limitations of routine coagulation tests (PT-INR or aPTT) is that they cannot adequately reflect the alterations of blood coagulation equilibrium, particularly those associated with the levels of the natural coagulation inhibitors.…”

Section: Introductionmentioning

confidence: 99%

“…It is well known that malignancy promotes a hyper-coagulable or prothrombotic state, thus contributing to thrombosis. 15 Hepatic carcinoma (hepatocellular/HCC, cholangiocellular/CCA or metastatic) remains the leading cause of liver resection, 18 and there is increasing evidence of up-regulation of coagulation after liver resection for malignancy. 11…”

Section: Introductionmentioning

confidence: 99%

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

et al. 2022

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Hepatectomy induced coagulation disturbances have been well studied over the past decade. Cumulative evidence supports the superiority of global coagulation analysis compared to conventional coagulation tests (i.e. PT or aPTT) for clinical decision making. Cancer, however, represents an acquired prothrombotic state and liver resection for cancer deserves a more thorough investigation. This prospective observational study was conducted to assess the perioperative coagulation status of patients undergoing major hepatectomies for primary or metastatic hepatic malignancy. Patients were followed up to the 10th postoperative day by serial measurements of conventional coagulation tests, plasma levels of coagulation factors and thrombin generation assay parameters. An abnormal coagulation profile was detected at presentation and included elevated FVIII levels, decreased levels of antithrombin and lag time prolongation in thrombin generation. Serial hematological data demonstrated increased vWF, FVIII, D-dimer, fibrinogen and decreased levels of natural anticoagulant proteins in the early postoperative period predisposing to a hypercoagulable state. The ratio of the anticoagulant protein C to the procoagulant FVIII was low at baseline and further declined postoperatively, indicating a prothrombotic state. Though no bleeding complications were reported, one patient experienced pulmonary embolism while under thromboprophylaxis. Overall, patients with hepatic carcinoma presenting for elective major hepatectomy may have baseline malignancy associated coagulation disturbances, aggravating the hypercoagulable state documented in the early postoperative period.

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“…In their final two years of life, 10% of patients with severe liver disease need a surgical procedure other than a liver transplant. Surgery may also be performed on people with undiagnosed CLD, with cirrhosis only being identified intraoperatively based on a macroscopic evaluation [5] any surgical procedure in undetected cirrhotic patients could have disastrous consequences.…”

Section: Introductionmentioning

confidence: 99%

Risk of Surgery in Patients with Liver Cirrhosis

Elabd

Mohammed

Alrahman

et al. 2022

Afro-Egyptian Journal of Infectious and Endemic Diseases

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Background and aim: Chronic liver disease patients often undergo surgery for indications other than liver transplantation and may face increased perioperative risk due to surgical and anesthesia-related complications. The current study's objectives were to assess the risk of surgery in cirrhotic patients and to identify various variables that influence postoperative outcomes. Methods: 231 participants underwent non-hepatic surgery under general anesthesia categorized into 117 cirrhotic patients and 114 non-cirrhotic (controls). All participants were subjected to complete clinical and laboratory evaluations (pre-operative, and postoperative) with an assessment of postoperative outcomes. For cirrhotic patients, the severity of liver disease was assessed by Child-Pugh and MELD scores. Results: In cirrhotic patients, hepatic causes are considerably the cause of not having surgery, additionally, the majority of patients who underwent surgery had Child-Pugh scores of A or B (42.7 % and 44.5%,respectively), whereas only 12.8% had Child-Pugh C. Hepatic complications including HE, decompensation, and SBP were more frequent in patients with CTP grades B and C than those with grade A. Postoperative mortality significantly associated with higher white blood cells (WBCs), serum creatinine, and MELD score (p=0.001, 0.049, and 0.002,respectively), and lower serum albumin (p=0.028). AUC for WBCs, serum creatinine, MELD score, and serum albumin was 0.958, 0.759, 0.963, and 0.765 respectively at cut-off >11.5, >1.2, ≤2.3, and >15 respectively. Conclusion: Operative complications (hepatic and non-hepatic)are more frequent in patients with CTP grades B and C than those with grade A. Postoperative mortality significantly associated with higher WBCs, serum creatinine, and MELD score, and lower serum albumin.

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Perioperative management of liver surgery—review on pathophysiology of liver disease and liver failure

Cited by 10 publications

References 48 publications

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

Risk of Surgery in Patients with Liver Cirrhosis

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