Posthepatectomy liver failure

Ocak, İlhan; Topaloğlu, Serdar

doi:10.3906/sag-2006-31

Cited by 21 publications

(20 citation statements)

References 50 publications

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“…Continuous elevation of serum bilirubin levels and reduction of prothrombin concentration until POD-5 is a valuable predictor of failure of recovery of hepatic functions and increased mortality after partial liver resection. 28,29 We observed slower normalization of bilirubin and prothrombin levels among elderly patients. This finding was more evident among elderly cirrhotics in contrast to their non-elderly controls.…”

Section: Discussionmentioning

confidence: 74%

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

El‐Badry¹,

Aldardeer²

2021

Int Surg J

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Background: Aging hinders the liver capacity to restitute its volume and function after partial hepatectomy. Concomitant hepatic parenchyma disorders and major resections may increase the susceptibility of elderly patients to worse postoperative outcome.Methods: Prospectively collected medical records of adult patients who underwent elective partial hepatectomy for malignant liver tumors at Sohag University Hospital (June 2014–May 2020) were analyzed. A group of elderly (≥65 years) were compared with a matched control group of non-elderly (<65 years) patients as regards posthepatectomy liver failure (PHLF) and overall complications, including mortality. Markers associated with PHLF and postoperative death were investigated.Results: Forty-eight patients were enrolled, 24 per group. 34 were males (71%). All patients had primary hepatic malignancy or metastatic tumors. Hepatocellular carcinoma (HCC) was the most common indication for liver resection in both groups (32 patients, 66.6%). Elderly patients exhibited significantly higher grades of overall postoperative complications (p<0.05). PHLF was significantly increased in the elderly group, in evident connection with significant persistence of higher bilirubin levels and reduced prothrombin concentration (p<0.05) until 5th postoperative day. Subgroup analysis showed that major resections and cirrhosis correlated with increased morbidity among elderly compared with younger patients. Postoperative mortality occurred in 3 elderly cirrhotic patients, who failed to recover normal platelet count postoperatively.Conclusions: In elderly patients, major liver resection for malignant tumors is associated with worse outcome, particularly in those with coexisting cirrhosis. Predictors include early postoperative thrombocytopenia and persistent hyperbilirubinemia and coagulopathy.

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Section: Discussionmentioning

confidence: 74%

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

El‐Badry¹,

Aldardeer²

2021

Int Surg J

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“…While most studies on risk factors for PHFL have focused on the liver or spleen (11,12), or patient related factors (13).…”

Section: Discussionmentioning

confidence: 99%

Diabetes mellitus and postoperative blood glucose value help predict posthepatectomy liver failure in patients with hepatocellular carcinoma

Luo¹,

Xu²,

Lian³

et al. 2021

J Gastrointest Oncol

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Background: Many complications after hepatectomy can lead to perioperative death, among which posthepatectomy liver failure (PHLF) is the leading one. Existing studies suggest that one of the most important risk factors for PHLF is cirrhosis. Hepatitis B virus (HBV) infection is an important factor in the occurrence of cirrhosis, and the exact relationship between HBV infection and PHLF is not obvious. Diabetes mellitus and postoperative blood glucose are closely associated with liver regeneration, but its exact relationship with PHLF remains unclear.

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“…Благодаря развитию методов диагностики, анестезиологического пособия, совершенствованию хирургической техники становится возможным безопасное выполнение обширных резекций в целях радикального удаления опухоли [3][4][5]. Данная ступень развития хирургии печени привела и к увеличению частоты пострезекционной печеночной недостаточности (ППН)основной причины летальных исходов в послеоперационном периоде [6][7][8][9]. Эволюция методик двухэтапных резекций, а также трансплантации печени позволила снизить частоту ППН, рекомендовать эти методы лечения в качестве альтернативных, однако большое количество противопоказаний и осложнений таких операций требует поиска критериев, позволяющих с высокой точностью определить риск…”

Section: обширная резекция печени у ребенка при экстремально низком объеме будущего остаткаunclassified

“…Одним из таких критериев является определение объема будущего остатка печени (Future Liver Remnant Volume, FLR-V) по данным компьютерной томографии (КТ-волюметрия) или других методов визуализации. Минимальное пороговое значение FLR-V в различных публикациях составляет от 25 до 40% объема здоровой паренхимы печени, при меньших значениях высока вероятность развития ППН [3,5,6,8,10]. Столь широкий диапазон обусловлен различиями в соматическом статусе пациентов, функциональном состоянии паренхимы печени и анамнестических данных (возраст, сопутствующие заболевания, лечение гепатотоксическими препаратами и др.)…”

Section: обширная резекция печени у ребенка при экстремально низком объеме будущего остаткаunclassified

“…Столь широкий диапазон обусловлен различиями в соматическом статусе пациентов, функциональном состоянии паренхимы печени и анамнестических данных (возраст, сопутствующие заболевания, лечение гепатотоксическими препаратами и др.) [6,10,11] и является главным недостатком при оценке риска развития ППН. Вышесказанное приводит к выводу о большей роли определения функционального состояния паренхимы печени, чем ее объема, что подтверждается рядом публикаций [4,10,12].…”

Section: обширная резекция печени у ребенка при экстремально низком объеме будущего остаткаunclassified

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Extensive liver resection in a child with an extremely low future liver remnant volume

Ахаладзе

Rabaev

Меркулов

et al. 2021

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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The incidence of posthepatectomy liver failure in adult patients and a large number of complications of two-stage liver resections require a search for criteria that allow highly accurate assessment of the risk of liver failure. For this purpose, the study of the future liver remnant volume and function have been widely introduced among adult patients, and the future liver remnant function measurement reflects the greater sensitivity. The absence of references to posthepatectomy liver failure, as well as the experience of determining the functional reserve of the future liver remnant in children, let us to suggest the possibility of a wider using one-stage liver resections when the future liver remnant volume is below the generally accepted threshold (25% of the healthy liver parenchyma volume) in the case of the functional reserve sufficient value. This clinical case describes the successful extended right hemihepatectomy and segmentectomy 1 in a 3-year patient with a future liver remnant volume of 16.5% without clinical signs of postresection hepatic failure, which confirms the thesis of the need to assess the functional liver reserve in pediatric oncology to reduce the frequency of two-stage resections and liver transplants. The patient’s parents gave consent to the use of their child’s data, including photographs, for research purposes and in publications.

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Posthepatectomy liver failure

Cited by 21 publications

References 50 publications

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

Diabetes mellitus and postoperative blood glucose value help predict posthepatectomy liver failure in patients with hepatocellular carcinoma

Extensive liver resection in a child with an extremely low future liver remnant volume

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