Background: Postoperative mortality commonly is defined as death occurring within 30 days of surgery or during hospitalization. After resection for liver malignancies, this definition may result in underreporting, because mortality caused by postoperative complications can be delayed as the result of improved critical care. The aim of this study was to estimate statistically the acute postoperative period (APP) after partial hepatectomy and to compare mortality within this phase to standard timestamps.
Methods: From a prospective database, 784 patients undergoing resection for primary and secondary hepatic malignancies between 2003 and 2013 were reviewed. For estimation of APP, a novel statistical method applying tests for a constant postoperative hazard was implemented. Multivariable mortality analysis was performed.
Results: The APP was determined to last for 80 postoperative days (95% confidence interval 40-100 days). Within this period, 55 patients died (7.0%; 80-day mortality). In comparison, 30-day mortality (N = 32, 4.0%) and in-hospital death (N = 39, 5.0%) were relevantly less. No patient died between postoperative days 80 and 90. The causes of mortality within 30 days and from days 30-80 did not greatly differ, especially regarding posthepatectomy liver failure (44% vs 39%, P = .787). Septic complications, however, tended to cause late deaths more frequently (43% vs 25%, P = .255). Comorbidities (Charlson comorbidity index ≥ 3; P = .046), increased preoperative alanine aminotransferase activity (P = .030), and major liver resection (P = .035) were independent risk factors of 80-day mortality.
Conclusion: After liver resection for primary and secondary malignancies, 90-day rather than 30-day or in-hospital mortality should be used to avoid underreporting of deaths.
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http://dx.doi.org/10.1016/j.surg.2015.07.019 | DOI Listing |
Background: Liver malignancies present substantial challenges to surgeons due to the extensive hepatic resections required, frequently resulting in posthepatectomy liver failure. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was designed to increase the resectable liver volume, yet it is associated with significant mortality and morbidity rates. Recently, minimally invasive techniques have been incorporated into ALPPS, with the potential to improve the procedure's safety profile whilst maintaining efficacy.
View Article and Find Full Text PDFPheochromocytoma (PHEO) currently is considered to be malignant due to metastatic potential. One of the most common familial forms of PHEO is multiple endocrine neoplasia syndrome (MEN) type 2. The penetrance of PHEO in MEN2 syndrome is up to 50% of cases.
View Article and Find Full Text PDFFront Med (Lausanne)
January 2025
Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou, China.
Primary hepatic carcinosarcoma (HCS) is an extremely rare malignant tumor with carcinomatous and sarcomatous elements. Few reported cases of HCS exist, especially with sufficient records to describe imaging and pathological features, making the diagnosis, treatment, and prognosis of HCS a significant challenge for physicians. Here, we report a case of HCS with spontaneous rupture as the initial symptom in a 77-year-old elderly male who was admitted with right upper abdominal pain for 8 days.
View Article and Find Full Text PDFPak J Med Sci
January 2025
Dongming Zhu Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, P.R. China.
Objective: To analyze the efficacy of indocyanine green fluorescence (ICG-F)-assisted laparoscopic hepatectomy in patients with hepatocellular carcinoma (HCC).
Methods: This retrospective study included 120 patients with HCC who underwent laparoscopic hepatectomy in The First Affiliated Hospital of Soochow University from February 2020 to November 2022. Among them, 58 patients underwent conventional laparoscopic surgery (laparoscopic group), and 62 patients underwent ICG-F assisted laparoscopic surgery (ICG-F group).
Gastroenterol Rep (Oxf)
January 2025
Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Intrahepatic cholangiocarcinoma (iCCA) is an aggressive liver malignancy that arises from second-order biliary epithelial cells. Its incidence is gradually increasing worldwide. Well-known risk factors have been described, although in many cases, they are not identifiable.
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