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M Esmat Gamil,
J Pirenne,
H Van Malenstein,
M Verhaegen,
B Desschans,
D Monbaliu, R Aerts,
W Laleman,
D Cassiman,
C Verslype,
W Van Steenbergen,
J Van Pelt,
F Nevens
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ABSTRACT: Advanced liver disease is characterized by prolonged global coagulation tests such as prothrombin time (PT). Using Model of End-stage Liver Disease (MELD) score-based allocation, many current transplant recipients show advanced end-stage liver disease with an elevated international normalized ratio (INR). The relationship between abnormalities in coagulation tests and the risk of bleeding has been recently challenged among liver disease patients. In this study we reassessed risk factors for bleeding and the clinical implications for patients who underwent orthotopic liver transplantation (OLT).
We studied OLT patients between 2005 and 2011 excluding combined transplantations, retransplantations, or cases due to acute liver failure. We collected prospectively pre-OLT, during OLT, and post-OLT clinical and biochemical data to assess the risk for bleeding using linear regression models.
The strongest predictor of overall survival among 286 patients with a mean follow-up of 32 months was the number of blood transfusions (P = .005). The risk factor for bleeding during surgery investigated by multivariate analysis only showed the INR (P < .001) and the presence of ascites (P = .003) to independently correlate with the amount of blood transfusion. Receiver operation characteristics (ROC) analysis performed to determine the risk for massive blood transfusion (more than 6 units) revealed a cut-off value for INR ≥1.6. Appreciation of the operative field by the surgeon during the intervention as "wet" versus "dry", amounts of blood transfusion and fresh frozen plasma, and stay in the intensive care unit (ICU) and in the hospital were all significantly different (P < .001) for patients with INR <1.6 versus INR ≥1.6.
Bleeding during OLT affects the outcome. The risk is independently influenced by the presence of ascites (probably reflecting the degree portal hypertension) and an INR ≥1.6. To improve survival after OLT therapeutic interventions should be further explored to reduce the need for blood transfusions.
Transplantation Proceedings 11/2012; 44(9):2857-60. · 1.00 Impact Factor
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N Vermeer,
N Meurisse,
D Vlasselaers,
L Desmet,
K Ameloot,
D Cassiman,
B Meyns, R Aerts,
M Verhaegen,
D Monbaliu,
J Pirenne
[show abstract]
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ABSTRACT: The presence of a cardiac assist device in a liver transplantation candidate should not be considered to be an absolute contraindication to transplantation. In this first case report of liver transplantation in a patient with an intraabdominally located left ventricular assist device, we have described the surgical aspects and discussed the timing of the liver transplantation and the removal of the left ventricular assist device.
Transplantation Proceedings 11/2012; 44(9):2885-7. · 1.00 Impact Factor
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N Meurisse,
S Vanden Bussche,
I Jochmans,
J Francois,
B Desschans,
W Laleman,
S Van der Merwe,
W Van Steenbergen,
D Cassiman,
C Verslype, R Aerts,
F Nevens,
J Pirenne,
D Monbaliu
[show abstract]
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ABSTRACT: Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT.
Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze biliary complications, retransplantation rates, and patient/graft survivals.
Median donor age was similar for DCD and DBD-OLT: 51 versus 53 years (P = .244). Median donor warm ischemia time (stop ventilation to cold perfusion in DCD donors) was 24 minutes. Median cold ischemia time was shorter for DCD (6 hours 54 minutes) compared with DBD-OLT (8 hours 36 minutes; P < .0001). Median laboratory model of end-stage liver disease score was 15 for DCD, and 16 for DBD-OLT (P = .59). Median post-OLT Aspartate Aminotransferase (AST) peak was higher after DCD: 1178 versus DBD-OLT 651 IU/L (P = .005). The incidence of nonanastomotic strictures was different: 33.3% for DCD versus 12.5% for DBD-OLT (P = .001). The overall retransplantation rate was 3% after both DCD and DBD-OLT. After DCD-LTx actuarial 1, 3- and 5-year patient survivals were 93, 85 and 85%, and corresponding graft survivals, 90%, 82%, and 82% respectively, and not different compared with DBD-OLT: 88%, 78%, and 72% (P = .348) and 85%, 74%, and 68% (P = .524) respectively.
Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted.
Transplantation Proceedings 11/2012; 44(9):2868-73. · 1.00 Impact Factor
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T Darius,
D Monbaliu,
I Jochmans,
N Meurisse,
B Desschans,
W Coosemans,
M Komuta,
T Roskams,
D Cassiman,
S van der Merwe,
W Van Steenbergen,
C Verslype,
W Laleman, R Aerts,
F Nevens,
J Pirenne
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ABSTRACT: Wider utilization of liver grafts from donors ≥70 years old could substantially expand the organ pool, but their use remains limited by fear of poorer outcomes. We examined the results at our center of liver transplantation (OLT) using livers from donors ≥70 years old.
From February 2003 to August 2010, we performed 450 OLT including 58 (13%) using donors ≥70 whose outcomes were compared with those using donors <70 years old.
Cerebrovascular causes of death predominated among donors ≥70 (85% vs 47% in donors <70; P < .001). In contrast, traumatic causes of death predominated among donors <70 (36% vs 14% in donors ≥70; P = .002). Unlike grafts from donors <70 years old, grafts from older individuals had no additional risk factors (steatosis, high sodium, or hemodynamic instability). Both groups were comparable for cold and warm ischemia times. No difference was noted in posttransplant peak transaminases, incidence of primary nonfunction, hepatic artery thrombosis, biliary strictures, or retransplantation rates between groups. The 1- and 5-year patient survivals were 88% and 82% in recipients of livers <70 versus 90% and 84% in those from ≥70 years old (P = .705). Recipients of older grafts, who were 6 years older than recipients of younger grafts (P < .001), tended to have a lower laboratory Model for End-Stage Liver Disease score (P = .074).
Short and mid-term survival following OLT using donors ≥70 yo can be excellent provided that there is adequate donor and recipient selection. Septuagenarians and octogenarians with cerebrovascular ischemic and bleeding accidents represent a large pool of potential donors whose wider use could substantially reduce mortality on the OLT waiting list.
Transplantation Proceedings 11/2012; 44(9):2861-7. · 1.00 Impact Factor
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ABSTRACT: We present the case of a 30-year-old female suffering from a type five maturity onset diabetes of the young deficiency, resulting in type 1 diabetes and terminal renal insufficiency. She also had chronic and refractory pruritis due to primary sclerosing cholangitis-like fibrosis. She underwent combined en bloc liver and pancreas transplantation and kidney transplantation. The postoperative course was complicated by a gastric outlet obstruction due to compression of the native gastroduodenal junction by the donor aortic tube. This was treated by construction of a roux-en-Y gastrojejunostomy at posttransplant day 24. To our knowledge, compression of the gastroduodenal junction by a donor aortic tube after combined liver and pancreas (or multivisceral) transplantation has not been reported previously.
Transplantation Proceedings 11/2012; 44(9):2888-92. · 1.00 Impact Factor
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ABSTRACT: Severe superimposed infection during open abdomen treatment with development of intra-abdominal sepsis is a challenging complication
associated with high mortality rates. We report our experience with VAC-Instill® therapy (KCI, San Antonio, USA) used for treatment of an infected open abdomen following pancreatic surgery. A literature
search revealed no analogous case reports using VAC-Instill® therapy for treatment of an infected laparostomy. The encouraging result of the case presented seems to indicate that VAC-Instill® therapy could be used as adjunctive treatment in the management of the infected open abdomen when traditional therapy fails
to control the infection.
KeywordsVAC-Instill–Infection–Open abdomen
Techniques in Coloproctology 04/2012; 15(1):75-77. · 1.29 Impact Factor
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P Roelandt,
C George,
F d'Heygere, R Aerts,
D Monbaliu,
W Laleman,
D Cassiman,
C Verslype,
W van Steenbergen,
J Pirenne,
A Wilmer,
F Nevens
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ABSTRACT: We describe the case of a 26-year-old man with acute liver failure secondary to ingestion of khat (Catha edulis) leaves. In fact, this is the first case of acute liver failure due to khat reported outside the United Kingdom. The combination of specific epidemiologic data (young man of East African origin) and clinical features (central nervous system stimulation, withdrawal reactions, toxic autoimmune-like hepatitis) led to the diagnosis. Mechanisms of action and potential side effects of khat are elaborated on.
Transplantation Proceedings 11/2011; 43(9):3493-5. · 1.00 Impact Factor
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L Mortier,
G Stockmans,
G Maleux,
S Heye, R Aerts,
D Monbaliu,
T Darius,
J Pirenne,
P Meersseman,
C George,
W Van Steenbergen,
D Cassiman,
C Verslype,
F Nevens,
W Laleman
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ABSTRACT: Endotipsitis or primary infection of a TIPS-stent, is an uncommon but possible life- threatening condition by its potential evolution to sepsis and death. Diagnosis should be suspected in patients with a TIPS-stent presenting with stent-dysfunction associated with fever or relapsing episodes of bacteremia/sepsis without any other alternative focus. A certain diagnosis is made by post-factum histopathological and/or microbiological examination of the TIPS-stent which is only possible after liver transplantation or at autopsy, whereas it can be highly suspected in case of repetitive positive blood-cultures without any other focus in a patient with a TIPS-stent. The microorganisms responsible for endotipsitis are most frequently of Gram-negative enteric origin. The regimen and duration of the treatment should be individualized and depends on multiple factors like the antibiotic sensitivity of the organism and the patients condition. In case of a fungal infection, longer treatment is recommended.
Acta gastro-enterologica Belgica 03/2011; 74(1):82-7. · 0.64 Impact Factor
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ABSTRACT: Intratumoral hypoxia has been suggested to drive more aggressive tumor behavior. Our aim was to define whether markers of tumor hypoxia are predictors of outcome in patients with gallbladder carcinoma.
From 1996 to 2006, 34 patients underwent resection for gallbladder carcinoma. The median follow-up was 12.6 months. Immunohistochemical stains for VEGF, HIF1α, GLUT1, GLUT3, CA9 and EGFR were performed on archival tissue. Immunohistochemical results were correlated with clinical and histopathological parameters. Cumulative overall survival (OS) rates were estimated using the Kaplan-Meier method. Multivariable Cox regression models were used to identify predictors of OS.
The median OS was 11.9 (IQR: 3.4-22.0) months. Ubiquitous VEGF staining was observed in all gallbladder carcinomas. High (>50% of tumor cells) EGFR expression was associated with worse OS (p0.03). CA9 expression was less prevalent in poorly differentiated tumors (p0.02). GLUT3, GLUT1 and HIF1α expression were not associated with survival, but did correlate with the presence of lymph node metastasis (p0.02), tumor differentiation (p0.04) and tumor stage (p0.03) respectively. High EGFR expression, TNM stage and preoperative serum CA19.9 were retained as independent predictors of OS in multivariable analysis.
In gallbladder cancer high expression of EGFR is an independent predictor of survival.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2011; 37(1):80-6. · 2.56 Impact Factor
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[show abstract]
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ABSTRACT: Severe superimposed infection during open abdomen treatment with development of intra-abdominal sepsis is a challenging complication associated with high mortality rates. We report our experience with VAC-Instill therapy (KCI, San Antonio, USA) used for treatment of an infected open abdomen following pancreatic surgery. A literature search revealed no analogous case reports using VAC-Instill therapy for treatment of an infected laparostomy. The encouraging result of the case presented seems to indicate that VAC-Instill therapy could be used as adjunctive treatment in the management of the infected open abdomen when traditional therapy fails to control the infection.
Techniques in Coloproctology 01/2011; 15(1):75-7. · 1.29 Impact Factor
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[show abstract]
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ABSTRACT: The aim of this study was to investigate the safety and efficacy of lifelong therapy with intravenous hepatitis B immunoglobulins (i.v. HBIg) to prevent recurrence of hepatitis B after orthotopic liver transplantation (OLT).
This was a single-center retrospective study of the long-term outcome of 56 patients who were transplanted for active hepatitis B-related liver disease. In addition to i.v. HBIg, patients received antiviral therapy for at least 1 year.
1-, 5-, and 10-year survival rates were 95%, 82%, and 80%, respectively. None of the patients died due to hepatitis B virus (HBV)-related complications. In 3 patients (5%), a hepatitis B surface antigen (HBsAg)-negative status was not reached. All of these patients had a very high viral load at the time of OLT. HBsAg and HBV DNA reappeared in 6 patients (11%): In 1 patient, recurrence occurred 9 months after OLT while still under combination treatment with lamivudine, and 2 patients were temporarily treated abroad with intramuscular HBIg. Only 3 patients suffered from HBV recurrence while under monotherapy with i.v. HBIg. No serious side effects to i.v. HBIg were reported during this long-term follow-up.
Lifelong administration of i.v. HBIg is safe, and recurrence of HBV disease occurred only in a minority of the patients during long-term follow-up. Prognosis of HBV-related OLT with this therapy is excellent.
Transplantation Proceedings 12/2010; 42(10):4399-402. · 1.00 Impact Factor
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T Darius,
D Monbaliu, R Aerts,
W Coosemans,
J de Roey,
D Blockmans,
M Hiele,
G Van Assche,
P Ferdinande,
D Dierickx,
N Ectors,
E Lerut,
G De Hertogh,
E Benedetti,
J Pirenne
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ABSTRACT: Exceptionally, gastrointestinal involvement of Churg-Strauss syndrome (CSS) may require extensive bowel resection resulting in a short bowel syndrome. Living related intestinal transplantation (IT) has emerged as an alternative to deceased-donor IT in the management of patients with irreversible short bowel syndrome. Herein, we have presented a 35-year-old patient with isolated intestinal involvement of CSS lesions refractory to steroids and azathioprine requiring multiple abdominal resections resulting in an ultrashort bowel syndrome. A living related IT (from the mother) was performed. She underwent several acute rejection episodes treated with additional immunosuppressive therapy. Despite higher doses of immunosuppression, these repeated acute rejection episodes eventually evolved into a syndrome of chronic allograft rejection. Eventually, owing to her poor general condition and to avoid life-threatening infections, transplantectomy was inevitable. Recent immunologic studies indicate that peripheral mononuclear cells from patients with CSS secrete large amounts of T-helper type 1 and 2 cytokines. It is likely that patients with CSS are at higher risk for acute and chronic rejection after transplantation.
Transplantation Proceedings 12/2010; 42(10):4423-4. · 1.00 Impact Factor
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ABSTRACT: Microwave ablation (MWA) is the most recent development in the field of local ablative therapies. The aim of this study was to evaluate the variability and reproducibility of single-probe MWA vs. radiofrequency ablation (RFA) of liver metastases smaller than 3cm in patients without underlying liver disease.
Sixteen liver metastases were treated using MWA, and matched for size and localisation with 13 metastases treated by RFA. Tumour diameters and postoperative ablation diameters were recorded (D1 transverse; D2 antero-posterior; D3 cranio-caudal; mm) on computed tomography scans.
Median D1, D2, and D3 ablation diameters after MWA vs. RFA were 18.5 (12-64) vs. 34 (16-41)mm (p=0.003), 26 (14-60) vs. 35 (28-40)mm (p=0.046), and 20 (10-73) vs. 32 (20-45)mm (p=0.025), respectively. As compared to RFA, the variability between the lesions after MWA was significantly higher for D2 (p<0.0001) and D3 (p=0.002) but not for D1 (p=0.15). The ablation diameters were less uniform after MWA than after RFA (p<0.001).
Ablation diameters after single-probe MWA of metastatic liver tumours are highly variable and suboptimal. Improvements are needed before MWA can be implemented routinely.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 08/2010; 36(8):725-30. · 2.56 Impact Factor
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J Pirenne,
D Monbaliu, R Aerts,
B Desschans,
Q Liu,
D Cassiman,
W Laleman,
C Verslype,
M Magdy,
W Van Steenbergen,
F Nevens
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ABSTRACT: Biliary strictures (BS), a major complication after orthotopic liver transplantation (OLT), cause morbidity, mortality, graft loss, and increased costs. The virtually unchanged incidence of BS (approximately 10%-25%) suggests that they are not simply "technical" in origin, but probably represent a mucosa ischemic injury inherent in the transplantation procedure. To study risk factors for BS, we analyzed 403 OLTs performed between January 1, 1997 and December 31, 2006, at a single center, excluding cases of regraft or death within 1 month. The average time to the diagnosis of the BS was 253 days (range, 7-1002 days). Upon univariate analysis, the absence of flushing of donor bile ducts, an imported versus a locally procured liver, and rejection were risk factors for BS. In contrast, the following factors were protective: donor cardiac arrest followed by resuscitation (suggesting an ischemic preconditioning effect) as well as addition of epoprostenol to and pressurization of the preservation solution. Patients with higher postoperative peak values of transaminases, bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase were at greater risk for later development of BS. Donor hypotension, donor age, donor intensive care unit (ICU) stay, type of preservation, positive cross-match, cold and warm ischemia times, sequential versus simultaneous portal/arterial reperfusion, as well as cytomegalovirus (CMV) infection were not risk factors for BS. Upon multivariate analysis, only epoprostenol and pressurization offered protection from BS. In conclusion, this study 2 novel points: (1) patients with high(er) transaminase values and cholestasis early postoperatively are at greater risk to develop later BS and require close monitoring and (2) donor maneuvers for better flushing and preserving peribiliary vascular plexus and biliary mucosa (epoprostenol and pressurization of preservation solution) offer protection from BS.
Transplantation Proceedings 10/2009; 41(8):3399-402. · 1.00 Impact Factor
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T Darius,
D Monbaliu, R Aerts,
W Laleman,
T Roskams,
W Van Steenbergen,
D Cassiman,
C Verslype,
G Maleux,
F Nevens,
J Pirenne
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ABSTRACT: A 53-year-old man with alcoholic liver cirrhosis underwent orthotopic liver transplantation (OLT) using a marginal graft. Persistent cholestasis post-OLT was successfully treated using a molecular adsorbent recirculating system (MARS). Afterwards, the patient developed refractory ascites, which was controlled by a transjugular intrahepatic portosystemic shunt (TIPS). TIPS reduction and eventually occlusion was necessary due to the development of encephalopathy. Despite TIPS occlusion, the ascites did not relapse probably because of the onset of other adaptive mechanisms. MARS and TIPS used sequentially were capable of rescuing a liver graft, thereby avoiding the morbidity and mortality associated with early retransplantation and sparing a liver graft from the donor pool.
Transplantation Proceedings 10/2009; 41(8):3427-9. · 1.00 Impact Factor
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ABSTRACT: In the era of cost-conscious healthcare, hospitals are focusing on costs. Analysis of hospital costs per cost category may provide indications for potential cost-saving measures in the management of common bile duct stones (CBDS) with gallbladder in situ.
Between October 2005 and September 2006, 53 consecutive patients suffering from CBDS underwent either a one-stage procedure [laparoscopic common bile duct exploration (LCBDE) with stone clearance and cholecystectomy (LCCE)] or a two-stage procedure [endoscopic retrograde cholangiopancreatography with sphincterotomy and stone clearance (ERCP/ERS) followed by LCCE]. Costs were defined in different cost categories for each activity centre and were linked to the individual patient via the "bill of activities". Only patients (n = 38) with an uneventful post-procedural course and with available cost data were considered for cost analysis. Total length of hospital stay (LOS) was 2 (0-6) days after one-stage and 8 (3-18) days after two-stage procedure (p < 0.0001).
Costs per patient were significantly (p < 0.0001) less after one-stage versus two-stage management, i.e. total hospital costs (euro2,636 versus euro4,608), hospitalisation costs (euro701 versus euro2,190), consumables/pharmacy (euro645 versus euro1,476) and para-medical personnel (euro1,035 versus euro1,860; p = 0.0002). Operation room (OR) costs were comparable for one-stage and two-stage management (euro1,278 versus euro1,232; p = 0.280). Total hospital costs during ERCP were euro2,648 (euro729-4,544), during LCCE without LCBDE were euro2,101 (euro1,033-4,269), and during LCCE with LCBDE were euro2,636 (euro1,176-4,235).
In the management of patients with CBDS and gallbladder in situ a one-stage procedure is associated with significantly less costs as compared with a two-stage procedure. From the economical point of view these patients should preferably be treated via a one-stage procedure as long as safety and efficacy of this approach are provided.
Surgical Endoscopy 06/2009; 24(2):413-6. · 4.01 Impact Factor
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ABSTRACT: Gastrointestinal discomfort is one of the main adverse events in patients treated with mycophenolic acid (MPA). The aim of this prospective study was to evaluate the effect of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) in liver transplant patients with gastrointestinal side effects.
A single center, open-label, single arm, prospective study was undertaken in previous MMF-treated liver transplant patients who stopped MMF due to gastrointestinal side effects. Patients were rechallenged with the same dose of MMF which previously provoked the discomfort. Subsequently, patients with gastrointestinal complaints were switched from MMF (mean dose, 1325 mg [interquartile range (IQR), 750-2000 mg]) to equimolar doses of EC-MPS (mean dose, 858 mg [IQR, 525-1170 mg]).
Twelve patients received a rechallenge and 10 patients experienced complaints again. These patients (4 males, all Caucasian) of ages 14 to 68 years (mean, 54.5 years) were included in the study. There was a decrease in Visual Analogue Scale (VAS) of upper and lower gastrointestinal discomfort/pain between baseline to month 3 from mean 3.9 to 1.75 and from mean 7.6 to 0.2. The number of stools decreased from a mean of 2.25 (IQR, 1.4-2.9) to 0.5 (IQR, 0.3-0.625)/d and mean maximal stool frequency from 3 (IQR, 2-3.5) to 0.9 (IQR, 0.5-1.25)/d. No patients developed rejection. There was no graft loss. No significant changes occurred in hematological or biochemical parameters.
Our results suggested that converting patients with gastrointestinal complaints from MMF to equimolar doses of EC-MMF reduced gastrointestinal-related symptom burden and frequency of stools.
Transplantation Proceedings 04/2009; 41(2):610-3. · 1.00 Impact Factor
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ABSTRACT: Despite curative surgery for pancreatic ductal adenocarcinoma (PDAC), most patients develop cancer recurrence and die from metastatic disease. Understanding of the patterns of failure after surgery can lead to new insights for novel therapeutic modalities. The aim of the present study is to describe the patterns of recurrence after curative resection of PDAC.
A retrospective analysis was performed of 145 consecutive resections for PDAC between 1998 and 2005 (M/F 75/70; median (range) age 67 years (32-85 y)). The location of the first and consecutive recurrences, and the time interval to cancer recurrence after surgical resection was studied. The magnitude of tumour-free margin was less than a millimetre in 48 patients, whereas a positive surgical margin was observed in 27 patients. The median duration of follow-up was 18.5 (range 0.3-116.8) months.
Cancer recurrence was observed in 110 patients. The first location of recurrence was locoregional in 19, extra-pancreatic in 66, and combined locoregional and extra-pancreatic in 25 patients. Extra-pancreatic recurrence developed in the liver in 57, peritoneal in 35, pulmonary in 15, and retroperitoneal in 5 patients. The median (95% CI) overall (OS) and disease-free (DFS) survival was 18.7 (15.7-23.5) and 9.8 (7.5-12.4) months, respectively. The type of cancer recurrence did not significantly influence OS, while the resection margin status had a prognostic effect.
The vast majority of patients who undergo potentially curative surgery for PDAC develop cancer recurrence located in the abdominal cavity. Surgical resection margins with tumour involvement and tumour-free margins of less then 1mm are negative prognostic factors. Further research on better local surgical control, peri-operative locoregional treatment, and more effective adjuvant systemic therapy is necessary to improve long-term survival of patients with curable PDAC.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 02/2009; 35(6):600-4. · 2.56 Impact Factor
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Gut 10/2008; 57(9):1261, 1287. · 10.11 Impact Factor
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ABSTRACT: Concerns have been raised regarding outcome after laparoscopic resection of hepatic neoplasms. This prospective study compared morbidity and adequacy of surgical margins in laparoscopic (LLR) versus open liver resection (OLR).
Outcome in 359 consecutive patients [male/female ratio 187/172; median age 60 years (range 18-84 years)] who underwent partial hepatectomy was analysed. Cirrhosis was present in 32 patients and preoperative chemotherapy was administered in 141 patients. Comparative analyses were performed using propensity scores for all and for matched patients (n=76 per group).
Complications occurred in 68/250 (27.2%) patients after OLR and in 6/109 (5.5%) after LLR [odds ratio (OR) 0.16; 95% confidence interval (CI) 0.07-0.37; p<0.0001]. Median intraoperative blood loss was 500 ml (range 10-7,000 ml) in OLR and 100 ml (range 5-4,000 ml) in LLR (p<0.0001). Postoperative hospital stay was 8 days (range 0-155 days) after OLR and 6 days (range 0-41 days) after LLR (p<0.0001). In patients treated for liver malignancy, the surgical resection margin was positive on histopathological examination in 5/237 after OLR and in 1/77 after LLR. The magnitude of the resection margin was 7.5 mm (range 0-45 mm) in OLR and 10.0 mm (range 0-30 mm) in LLR (p=0.087).
LLR for hepatic neoplasms seems to be noninferior to OLR regarding adequacy of surgical margins, and superior to OLR regarding short-term postoperative outcome.
Surgical Endoscopy 07/2008; 22(10):2208-13. · 4.01 Impact Factor
