Pierre-Alain Clavien

Swiss Epilepsy Centre in Zurich, Zürich, Zurich, Switzerland

Are you Pierre-Alain Clavien?

Claim your profile

Publications (348)2440.33 Total impact


  • No preview · Article · Feb 2016 · Journal of Hepatology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To establish a "consensus" terminology of many variants of the ALPPS procedure. Backround: The rapid development and dissemination of ALPPS with the availability of many variants has led to numerous neologisms, also leading to confusion and difficulties in comparing various experiences. The first expert meeting in February 2015 in Hamburg concluded that the development of a common terminology of procedures, summarized under the acronym ALPPS, is needed. Methods: The current literature on ALPPS and the International ALPPS registry, including more than 600 cases, were reviewed to identify all the acronyms related to ALPPS. A logical nomenclature system was proposed by founding members of the registry and subsequently submitted to each center registered in the ALPPS registry (n = 209) to reach a consensus. Results: The many identified ALPPS terms were classified according to their application (e.g. surgical access such as laparoscopy, transection variants etc.). These variants were subsequently placed in form of prepositions before ALPPS following a defined order: strategy, stage of the procedure, access, portal vein embolization, if used, types of transection and hepatectomy. The principles for the terminology and specific application were eventually commented and approved by each center registered in the registry. Conclusions: The proposed "consensus" terminology should enable to better compare the many variants of ALPPS, and was also designed to implement future developments due to the readily applicable principles.
    No preview · Article · Jan 2016 · Annals of surgery
  • Source
    Dataset: vogel

    Full-text · Dataset · Jan 2016
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Morbidity and mortality rates after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are important quality parameters to compare peritoneal surface malignancy centers. A major problem to assess postoperative outcomes among centers is the inconsistent reporting due to two coexisting systems, the diagnose-based common terminology criteria for adverse events (CTCAE) classification and the therapy-oriented Clavien-Dindo classification. We therefore assessed and compared both reporting systems. Patients and methods: Complications after CRS/HIPEC were recorded in 147 consecutive patients and independently graded by an expert board using both systems. In a next step, a group of residents, experienced surgeons, and medical oncologists evaluated a set of twelve real complications, either with the Clavien-Dindo or CTCAE classification. Results: The postoperative complication rate after CRS/HIPEC was 37 % (54/147), 6.8 % (10/147) were reoperated, and three (2 %) patients died. The most frequent complications were intestinal fistula or abscess, pulmonary complications, and ileus. Grading of complications with the CTCAE classification resulted in a significantly higher major morbidity rate compared to the Clavien-Dindo classification (25 vs. 8 %, p = 0.001). Evaluating a set of complications, residents, surgeons, and oncologists correctly assessed significantly more complications with the Clavien-Dindo compared to the CTCEA classification (p < 0.001). In addition, all participants evaluated the Clavien-Dindo classification as more simple. Residents (p < 0.001) and surgeons (p < 0.01) required less time with the Clavien-Dindo classification; there was no difference for oncologist. Conclusion: In conclusion, our data indicate that there is a different interpretation of severity grades of complications after CRS/HIPEC between the two classifications. There is a need for a common language in the field of CRS/HIPEC, which should be defined by a new consensus to compare surgical outcomes.
    Full-text · Article · Dec 2015 · World Journal of Surgery
  • Source
    Philip F Stahel · Pierre-Alain Clavien
    [Show abstract] [Hide abstract]
    ABSTRACT: Contributing reviewers The Editors of Patient Safety in Surgery would like to thank all our reviewers who have contributed to the journal in Volume 8 (2014).
    Preview · Article · Dec 2015 · Patient Safety in Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of the study was to compare the short-term donor outcomes of laparoscopic left lateral sectionectomy (LLLS) for adult to child living donor liver transplantation (A-C LDLT) and laparoscopic donor nephrectomy (LDN). Background: Although laparoscopy has become the standard approach in kidney donors, its use remains limited and controversial in LLS for A-C LDLT due to the lack of conclusive assessment of procedure-related morbidity. Methods: From 2001 to 2014, 124 healthy donors undergoing laparoscopic LLLS for A-C LDLT at 5 tertiary referral centers in Europe, North America, and Asia, and 300 healthy donors undergoing LDN at 2 tertiary centers in Europe were retrospectively analyzed. The outcomes of LLLS were compared with those of LDN including the use of the comprehensive complication index (CCI). Results: Although liver donors experienced significantly less overall (16.9% vs 31.7%, P = 0.002) and grade 1 to 2 (12.1% vs 24.7%, P = 0.004) complications than kidney donors, the rates of major complication (≥ grade 3) were similar between the 2 groups. In both groups, donors experiencing postoperative complications had similar CCI (19.3 vs 21.9 for liver and kidney donors, respectively, P = 0.29). After propensity score analysis allowing for matching donors on age, sex, and body mass index, the postoperative outcomes remained comparable between the 2 groups. Conclusion: Laparoscopic LLS for A-C LDLT yields at least similar short-term donor outcomes as LDN. These results provide the first validation for a laparoscopic donor hepatectomy and suggest that the laparoscopic approach should be considered a new standard practice for retrieval of left lateral section liver grafts as it is for kidney donation.
    No preview · Article · Nov 2015 · Annals of Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients. Background: Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce. Methods: We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients. For music interventions, we pooled controlled studies measuring health outcomes (eg, pain, anxiety, blood pressure, and heart rate) in a meta-analysis. For other art forms (ambient and architectural features and interior design), we did a narrative review, also including nonsurgical patients, and looked for examples covering 3 countries. Results: Our search identified 1101 hits with 48 studies focusing on art in surgical patients: 47 studies on musical intervention and 1 on sunlight. The meta-analysis of these studies disclosed significant effects for music on pain after surgery, anxiety, systolic blood pressure, and heart rate, when compared with control groups without music. Effects of music were larger with self-selected music, and lower in surgical interventions performed under general anesthesia. Interior design features such as nature images and more spacious rooms, and architectural features providing more sunlight had positive effects on anxiety and postoperative pain. Conclusions: Self-selected music for surgical patients is an effective and low-cost intervention to enhance well being and possibly faster recovery. Although potentially very important, the impact of environmental features and spacious architecture with wide access to sunlight remains poorly explored in surgery. Further experimental research is needed to better assess the magnitude of the impact and cost effectiveness.
    No preview · Article · Nov 2015 · Annals of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate cosmesis, body image, pain, and quality of life (QoL) after single-port laparoscopic cholecystectomy (SPLC) versus conventional 4-port laparoscopic cholecystectomy (4PLC). Background: The impact of SPLC on improving cosmesis, body image, pain, and QoL has not been evaluated in double-blinded randomized controlled trials (RCT). This approach therefore remains controversial. Methods: Between October 2011 and February 2014, 110 patients from 2 centers were randomly assigned to SPLC (n = 55) or 4PLC (n = 55). Primary endpoints were a validated cosmesis (3–24 points) and body image (5–20 points) score after 3 and 12 months. Secondary endpoints included operative duration, postoperative pain, complications, QoL, and length of hospital stay. Patients, physicians, and nurses were blinded until the seventh postoperative day. Results: Demographics were equally distributed between both groups (mean age: 46 years, SD: 14, 62 females, 34 males). The SPLC-group showed superior mean cosmesis and body image compared with the 4PLC-group at 12-weeks (21 vs 16, P < 0.001 and 5 vs 6, P = 0.013, respectively) and at 1-year (24 vs 16, P < 0.001 and 5 vs 6, P < 0.017, respectively). Operation duration was longer in the SPLC-group (mean 101 vs 90 minutes, p = 0.031). Although postoperative pain was less in the SPLC-group (mean VAS 1 vs 2, p = 0.005), there were no differences in complications, and length of hospital-stay. Conclusions: This is the first multicenter double-blinded RCT reporting superior short- and long-term cosmetic and body image, postoperative pain, and QoL in SPLC compared with 4PLC. Although cost-effectiveness is still a subject of ongoing debate, SPLC should be offered to patients undergoing surgery for benign gallbladder disease.
    Full-text · Article · Nov 2015 · Annals of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aim of this study was to identify predictors of 90-day mortality after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS), available after stage-1, either to omit or delay stage-2. Background data: ALPPS is a two-stage hepatectomy for patients with extensive liver tumors with predicted small liver remnants, which has been criticized for its high mortality rate. Risk factors for mortality are unknown. Methods: Patients in the International Registry undergoing ALPPS from April 2011 to July 2014 were analyzed. Primary outcome was 90-day mortality. Liver function after stage-1 was assessed using the criteria of the International Study Group for Liver Surgery (ISGLS) after stage-1 among others. A multivariable model was used to identify independent predictors of 90-day mortality. Results: Three hundred twenty patients registered by 55 centers worldwide were evaluated. Overall 90-day mortality was 8.8% (28/320). The predominant cause for 90-day mortality was postoperative liver failure in 75% of patients. Fourteen percent of patients developed liver failure according to ISGLS criteria already after stage-1 ALPPS. Those and patients with a model of end-stage liver disease (MELD) score more than 10 before stage-2 were at significantly higher risk for 90-day mortality after stage-2 with an odds ratio (OR) 3.9 [confidence interval (CI) 1.4–10.9, P = 0.01] and OR 4.9 (CI 1.9–12.7, P = 0.006), respectively. Other factors, such as size of future liver remnant (FLR) before stage-2 and time between stages, were not predictive. Conclusions: This analysis of the largest cohort of ALPPS patients so far identifies those patients in whom stage-2 ALPPS surgery should be delayed or even denied. These findings may help to make ALPPS safer.
    Full-text · Article · Nov 2015 · Annals of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Exposure of donor liver grafts to prolonged periods of warm ischemia before procurement causes injuries including intrahepatic cholangiopathy, which may lead to graft loss. Due to unavoidable prolonged ischemic time before procurement in donation after cardiac death (DCD) donation in 1 participating center, each liver graft of this center was pretreated with the new machine perfusion "Hypothermic Oxygenated PErfusion" (HOPE) in an attempt to improve graft quality before implantation. Methods: HOPE-treated DCD livers (n = 25) were matched and compared with normally preserved (static cold preservation) DCD liver grafts (n = 50) from 2 well-established European programs. Criteria for matching included duration of warm ischemia and key confounders summarized in the balance of risk score. In a second step, perfused and unperfused DCD livers were compared with liver grafts from standard brain dead donors (n = 50), also matched to the balance of risk score, serving as baseline controls. Results: HOPE treatment of DCD livers significantly decreased graft injury compared with matched cold-stored DCD livers regarding peak alanine-aminotransferase (1239 vs 2065 U/L, P = 0.02), intrahepatic cholangiopathy (0% vs 22%, P = 0.015), biliary complications (20% vs 46%, P = 0.042), and 1-year graft survival (90% vs 69%, P = 0.035). No graft failure due to intrahepatic cholangiopathy or nonfunction occurred in HOPE-treated livers, whereas 18% of unperfused DCD livers needed retransplantation. In addition, HOPE-perfused DCD livers achieved similar results as control donation after brain death livers in all investigated endpoints. Conclusions: HOPE seems to offer important benefits in preserving higher-risk DCD liver grafts.
    Full-text · Article · Nov 2015 · Annals of Surgery
  • Chapter: Platelets
    Mickaël Lesurtel · Pierre-Alain Clavien
    [Show abstract] [Hide abstract]
    ABSTRACT: Besides their well-known role in primary hemostasis, there is increasing evidence that platelets are also involved in many pathways of the physiopathology of the liver. In cold hepatic ischemia/reperfusion injury, platelets act in concert with leukocytes and Kupffer cells and induce endothelial cell apoptosis. After partial hepatectomy, platelets promote liver regeneration mainly through platelet-derived serotonin release. While acute or chronic liver diseases are characterized by thrombocytopenia and functional platelet defects, platelets could be involved in chronic liver diseases such as fibrosis, viral hepatitis, nonalcoholic steatohepatitis, and cholestatic liver disease. A better understanding of the role of platelets and serotonin in liver physiopathology may open new strategies to treat patients suffering from chronic liver disease.
    No preview · Chapter · Aug 2015
  • Salome Dell-Kuster · Pierre-Alain Clavien · Heiner C Bucher · Rachel Rosenthal

    No preview · Article · Aug 2015 · World Journal of Surgery
  • Ksenija Slankamenac · Milo A Puhan · Pierre-Alain Clavien

    No preview · Article · Jun 2015 · Annals of surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic cancer is the seventh most common cancer in Switzerland associated with a dismal prognosis. Its natural course is fatal with a 3-year survival rate below 3%. Advances in diagnostic tools, tumor staging and multimodal treatment strategies resulted in an improved 5-year survival rate of over 20%. Patients presenting with pancreatic cancer significantly benefit from a multi-disciplinary treatment strategy in an experienced hepato-pancreato-biliary center. Following a comprehensive tumor staging, surgical resection associated with adjuvant chemotherapy is still the only curative therapy option. The role of neoadjuvant chemotherapy is currently investigated in clinical trials. Patients presenting with advanced pancreatic cancer not eligible for curative treatment might benefit from inclusion into innovative clinical trials with novel treatment concepts.
    No preview · Article · Apr 2015 · Praxis
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.
    Full-text · Article · Apr 2015 · Annals of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During times of organ scarcity and extended use of liver grafts, protective strategies in transplantation are gaining importance. We demonstrated in the past that volatile anesthetics such as sevoflurane attenuate ischemia-reperfusion injury during liver resection. In this randomized study, we examined if volatile anesthetics have an effect on acute graft injury and clinical outcomes after liver transplantation. Cadaveric liver transplant recipients were enrolled from January 2009 to September 2012 at 3 University Centers (Zurich/Sao Paulo/Ghent). Recipients were randomly assigned to propofol (control group) or sevoflurane anesthesia. Postoperative peak of aspartate transaminase was defined as primary endpoint, secondary endpoints were early allograft dysfunction, in-hospital complications, intensive care unit, and hospital stay. Ninety-eight recipients were randomized to propofol (n = 48) or sevoflurane (n = 50). Median peak aspartate transaminase after transplantation was 925 (interquartile range, 512-3274) in the propofol and 1097 (interquartile range, 540-2633) in the sevoflurane group. In the propofol arm, 11 patients (23%) experienced early allograft dysfunction, 7 (14%) in the sevoflurane one (odds ratio, 0.64 (0.20 to 2.02, P = 0.45). There were 4 mortalities (8.3%) in the propofol and 2 (4.0%) in the sevoflurane group. Overall and major complication rates were not different. An effect on clinical outcomes was observed favoring the sevoflurane group (less severe complications), but without significance. This first multicenter trial comparing propofol with sevoflurane anesthesia in liver transplantation shows no difference in biochemical markers of acute organ injury and clinical outcomes between the 2 regimens. Sevoflurane has no significant added beneficial effect on ischemia-reperfusion injury compared to propofol.
    Full-text · Article · Mar 2015 · Transplantation
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We read with interest the letter by Rohatgi et al. concerning our study comparing ALPPS with PVE/PVL in a population with mixed liver tumors [1]. Our study does not focus only on colorectal liver metastases, as is suggested in the letter’s title. We studied a mixed population with different tumor etiologies. The authors main concern is the increased morbidity and mortality associated with ALPPS. They also take issues with a lack of adjustment for confounders in comparing the groups. The authors do not agree with our conclusion that rapid tumor removal in ALPPS may be advantageous, citing the argument frequently raised by the opponents of this new procedure, that failure to reach the second stage in staged procedures for cancer is just an unavoidable unmasking of the natural history of the disease [2]. Ultimately, they disagree that there is an advantage to ALPPS at all.We acknowledge—as we do in our paper—that ALPPS is associated with a higher complication rate than conventional appro ...
    Full-text · Article · Mar 2015 · World Journal of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Standardized reporting of intraoperative adverse events is important to enhance transparency. To the best of our knowledge, there is no validated definition and classification of intraoperative complications. We conducted a two-round Delphi study to develop a definition and classification of intraoperative complications. Experts were contacted by email and sent a link to the online questionnaire. In a pilot study, two independent raters applied the definition and classification in a sample of 60 surgical interventions of low, intermediate, and high complexity and evaluated practicability. Interrater agreement of the classification was determined (raw categorical agreement, weighted kappa, and intraclass correlation). In the Delphi study, 40 of 52 experts (77 % return rate) from 14 countries took part in each round. The Delphi study resulted in a comprehensive definition of intraoperative complications as any deviation from the ideal intraoperative course occurring between skin incision and skin closure. The classification foresees four grades depending on the need for treatment (no need, grade I; need for treatment, grade II) and the severity of the complication (life-threatening/permanent disability, grade III; death, grade IV). The pilot study showed good practicability (6 on a 7-point scale) and a high raw agreement of 87 %, a weighted kappa of 0.83 [95 % confidence interval (CI) 0.73-0.94] and an intraclass correlation coefficient of 0.83 (95 % CI 0.73-0.90). While the Delphi process enabled to develop definitions and classification of intraoperative complications by severity, further research including a multicentre international full-scale validation needs to be conducted with the ultimate goal to contribute to standardized reporting in surgical practice and research.
    Preview · Article · Feb 2015 · World Journal of Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Standardized reporting of intraoperative adverse events is important to enhance transparency. To the best of our knowledge, there is no validated definition and classification of intraoperative complications. METHODS: We conducted a two-round Delphi study to develop a definition and classification of intraoperative complications. Experts were contacted by email and sent a link to the online questionnaire. In a pilot study, two independent raters applied the definition and classification in a sample of 60 surgical interventions of low, intermediate, and high complexity and evaluated practicability. Interrater agreement of the classification was determined (raw categorical agreement, weighted kappa, and intraclass correlation). RESULTS: In the Delphi study, 40 of 52 experts (77 % return rate) from 14 countries took part in each round. The Delphi study resulted in a comprehensive definition of intraoperative complications as any deviation from the ideal intraoperative course occurring between skin incision and skin closure. The classification foresees four grades depending on the need for treatment (no need, grade I; need for treatment, grade II) and the severity of the complication (life-threatening/permanent disability, grade III; death, grade IV). The pilot study showed good practicability (6 on a 7-point scale) and a high raw agreement of 87 %, a weighted kappa of 0.83 [95 % confidence interval (CI) 0.73-0.94] and an intraclass correlation coefficient of 0.83 (95 % CI 0.73-0.90). CONCLUSIONS: While the Delphi process enabled to develop definitions and classification of intraoperative complications by severity, further research including a multicentre international full-scale validation needs to be conducted with the ultimate goal to contribute to standardized reporting in surgical practice and research.
    Full-text · Article · Feb 2015 · World Journal of Surgery

  • No preview · Article · Jan 2015 · Annals of Surgery

Publication Stats

20k Citations
2,440.33 Total Impact Points

Institutions

  • 2015
    • Swiss Epilepsy Centre in Zurich
      Zürich, Zurich, Switzerland
  • 2001-2015
    • University of Zurich
      • • Center for Microscopy and Image Analysis - ZMB
      • • Center for Integrative Human Physiology
      Zürich, Zurich, Switzerland
  • 2014
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 2002-2014
    • University Hospital Zürich
      Zürich, Zurich, Switzerland
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
    • Duke University
      • Department of Surgery
      Durham, North Carolina, United States
  • 2010
    • The University of Edinburgh
      Edinburgh, Scotland, United Kingdom
  • 2009
    • University of Oxford
      • Centre for Statistics in Medicine
      Oxford, England, United Kingdom
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2007
    • University of Manitoba
      Winnipeg, Manitoba, Canada
  • 2006
    • Kantonsspital Winterthur
      Winterthur, Zurich, Switzerland
  • 2002-2004
    • Duke University Medical Center
      • • Department of Surgery
      • • Department of Anesthesiology
      Durham, North Carolina, United States