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Same soup different taste-how to best manage the future liver remnant-a surgical perspective

Hepatobiliary Surgery and Nutrition 2021年第5期10卷 734-736页

作者： John R.Bergquist patrick starlinger Brendan C.Visser Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryStanford UniversityStanfordCAUSA Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryMayo ClinicRochesterMNUSA

A small but measurable percentage of major hepatic resection patients will experience major morbidity or mortality due post-hepatectomy liver failure after major liver ***-operative optimization,in particular pre-operative induction of liver growth to increase the future liver remnant(FLR)volume,has become frequently used in patients considered to be high ***,this process of hepatic augmentation remains incompletely understood,particularly in *** advances in techniques for FLR management have resulted in dramatic expansion of the liver surgeon’s armamentarium.

关键词： operative hepatic mortality

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The 3-60 criteria challenge established predictors of postoperative mortality and enable timely therapeutic intervention after liver resection

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Hepatobiliary Surgery and Nutrition 2019年第2期8卷 111-124页

作者： Georg P.Gyoeri David Pereyra Eva Braunwarth Markus Ammann Philipp Jonas Florian Offensperger Florian Klinglmueller Ruth Baumgartner Sandra Holzer Michael Gnant Friedrich Laengle Stefan Staettner Thomas Gruenberger patrick starlinger Department of Surgery General HospitalMedical University of ViennaViennaAustria Department of Surgery Medical University of InnsbruckInnsbruckAustria Department of Surgery State Hospital Wiener NeustadtWiener NeustadtAustria Department of Surgery Kaiser Franz Josef HospitalViennaAustria Core Unit for Medical Statistics and Informatics Medical University of ViennaViennaAustria

Background:To date,definitions of liver dysfunction(LD)after hepatic resection rely on late postoperative time ***,the used parameters are markedly influenced by perioperative ***,we aimed to establish a very early postoperative score to predict postoperative ***:Liver related parameters were evaluated after liver resection in a retrospective evaluation cohort of 228 colorectal cancer patients with liver metastasis(mCRC)and subsequent validation in a prospective set of 482 consecutive patients from 4 independent institutions undergoing hepatic resection was ***:C-reactive protein(CRP,AUC=0.739,P<0.001)and antithrombinⅢ-activity(ATⅢ,AUC=0.844,P<0.001)on the first postoperative day(POD)were found to be elevated in patients with ***-off values for CRP at 3 mg/dL and for ATⅢat 60%significantly identified high-risk patients for postoperative LD and mortality(P<0.001)and thus defined the 3-60 criteria on *** 3-60 criteria showed superior sensitivity and specificity compared to established criteria for LD[3-60 criteria:total positive patients:26 patients(70%mortality detected),odds ratio(OR):48.8;International Study Group for Liver Surgery:total positive patients:43(70%mortality detected),OR:23.3;Peak7:total positive patients:9(30%mortality detected),OR:27.8;50-50:total positive patients:9(30%mortality detected),OR:27.8].These results could be validated in a multi-center analysis and ultimately the 3-60 criteria remained an independent predictor of postoperative mortality upon multivariable ***:The 3-60 criteria on POD1 predict postoperative LD and mortality early after liver resection with a comparable or better accuracy than established criteria,allowing for immediate identification of high-risk patients.

关键词： Liver surgery liver dysfunction(LD) mortality C-reactive protein(CRP) AntithrombinⅢ-activity(ATⅢ)

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