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Two hundred and forty-one consecutive liver resections: an experience from India.

ABSTRACT: Although liver resection has become an established procedure in western countries and South-east Asia it is still not performed frequently in most centres in India. In the last 10 years newly created specialized units have been performing more liver resections but no major series have been reported.We analysed the results of 241 hepatic resections in the Gyan Burman Liver Unit, Sir Ganga Ram Hospital to compare our results with those published from established centres and to identify the factors relating to morbidity and mortality. To examine the effect of a greater experience with the procedure we compared the outcome of our operations from 1996-2000 (first period) and those from 2001-2005 (second period).The overall mortality and morbidity rates were 6.6% and 44.8%, respectively, which are comparable with those of most recently published Western series. Life-threatening complications occurred in 12.4% patients. Multivariate analysis showed that the presence of comorbid conditions, intraoperative blood transfusions of >3 units, hepatocellular carcinoma with underlying cirrhosis and gall bladder carcinoma with jaundice were the independent risk factors for morbidity, whereas the presence of comorbid illness and underlying liver cirrhosis were the risk factors for mortality. During the second period there was an increase in the number of operations performed (66 vs 175; first vs second period), but the mortality rates remained essentially unchanged (6.1% vs 6.8%).Hepatic resections can be performed safely in India with results comparable to those achieved in the West. Increasing experience did not reduce overall mortality. Perhaps more careful patient selection and better perioperative management of comorbid illnesses may reduce the morbidity and mortality further.

SUBMITTER: Marwah S

PROVIDER: S-EPMC2020779 | biostudies-other | 2007

REPOSITORIES: biostudies-other

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Project description:AimTo report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically review the related literature.MethodsSince January 2013, patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow hepatic resection were prospectively assessed for the ALPPS procedure. A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central.ResultsUntil July 2014 ALPPS was completed in 9 patients whose mean age was 60 ± 8 years. Indications for surgical resection were metastases from colorectal cancer in 3 cases, perihilar cholangiocarcinoma in 3 cases, intrahepatic cholangiocarcinoma in 2 cases and hepatocellular carcinoma without chronic liver disease in 1 case. The calculated FLR volume was 289 ± 122 mL (21.1 ± 5.5%) before ALPPS-1 and 528 ± 121 mL (32.2 ± 5.7%) before ALLPS-2 (p < 0.001). The increase in FLR between the two procedures was 96 ± 47% (range: 24-160%, p < 0.001). Additional interventions were performed in 4 cases: 3 patients underwent Roux-en-Y hepaticojejunostomy, and one case underwent wedge resection of a residual tumor in the FLR. The average time between the first and second step of the procedure was 10.8 ± 2.9 days. The average hospital stay was 24.1 ± 13.3 days. There was 1 postoperative death due to hepatic failure in the oldest patient of this series who had a perihilar cholangiocarcinoma and concomitant liver fibrosis; 11 complications occurred in 6 patients, 4 of whom had grade III or above disease. After a mean follow-up of 17.1 ± 8.5 months, the overall survival was 89% at 3-6 and 12 months. The recurrence-free survival was 100%, 87.5% and 75% at 3-6-12 months respectively. The literature search yielded 148 articles, of which 22 articles published between 2012 and 2015 were included in this systematic review.ConclusionThe ALPPS technique effectively increased the resectability of otherwise inoperable liver tumors. The postoperative morbidity in our series was high in accordance with the data from the systematic review. Age, liver fibrosis and presence of biliary stenting were predisposing factors for postoperative morbidity and mortality.

Project description:A species discovery and description pipeline to accelerate and improve taxonomy is outlined, relying on concise expert descriptions, combined with DNA sequencing, digital imaging, and automated wiki species page creation from the journal. One hundred and one new species of Trigonopterus Fauvel, 1862 are described to demonstrate the feasibility of this approach: Trigonopterus aeneipennis sp. n., Trigonopterus aeneus sp. n., Trigonopterus agathis sp. n., Trigonopterus agilis sp. n., Trigonopterus amplipennis sp. n., Trigonopterus ancoruncus sp. n., Trigonopterus angulatus sp. n., Trigonopterus angustus sp. n., Trigonopterus apicalis sp. n., Trigonopterus armatus sp. n., Trigonopterus ascendens sp. n., Trigonopterus augur sp. n., Trigonopterus balimensis sp. n., Trigonopterus basalis sp. n., Trigonopterus conformis sp. n., Trigonopterus constrictus sp. n., Trigonopterus costatus sp. n., Trigonopterus costicollis sp. n., Trigonopterus crassicornis sp. n., Trigonopterus cuneipennis sp. n., Trigonopterus cyclopensis sp. n., Trigonopterus dentirostris sp. n., Trigonopterus discoidalis sp. n., Trigonopterus dromedarius sp. n., Trigonopterus durus sp. n., Trigonopterus echinus sp. n., Trigonopterus edaphus sp. n., Trigonopterus eremitus sp. n., Trigonopterus euops sp. n., Trigonopterus ferrugineus sp. n., Trigonopterus fusiformis sp. n., Trigonopterus glaber sp. n., Trigonopterus gonatoceros sp. n., Trigonopterus granum sp. n., Trigonopterus helios sp. n., Trigonopterus hitoloorum sp. n., Trigonopterus imitatus sp. n., Trigonopterus inflatus sp. n., Trigonopterus insularis sp. n., Trigonopterus irregularis sp. n., Trigonopterus ixodiformis sp. n., Trigonopterus kanawiorum sp. n., Trigonopterus katayoi sp. n., Trigonopterus koveorum sp. n., Trigonopterus kurulu sp. n., Trigonopterus lekiorum sp. n., Trigonopterus lineatus sp. n., Trigonopterus lineellus sp. n., Trigonopterus maculatus sp. n., Trigonopterus mimicus sp. n., Trigonopterus monticola sp. n., Trigonopterus montivagus sp. n., Trigonopterus moreaorum sp. n., Trigonopterus myops sp. n., Trigonopterus nangiorum sp. n., Trigonopterus nothofagorum sp. n., Trigonopterus ovatus sp. n., Trigonopterus oviformis sp. n., Trigonopterus parumsquamosus sp. n., Trigonopterus parvulus sp. n., Trigonopterus phoenix sp. n., Trigonopterus plicicollis sp. n., Trigonopterus politoides sp. n., Trigonopterus pseudogranum sp. n., Trigonopterus pseudonasutus sp. n., Trigonopterus ptolycoides sp. n., Trigonopterus punctulatus sp. n., Trigonopterus ragaorum sp. n., Trigonopterus rhinoceros sp. n., Trigonopterus rhomboidalis sp. n., Trigonopterus rubiginosus sp. n., Trigonopterus rubripennis sp. n., Trigonopterus rufibasis sp. n., Trigonopterus scabrosus sp. n., Trigonopterus scissops sp. n., Trigonopterus scharfi sp. n., Trigonopterus signicollis sp. n., Trigonopterus simulans sp. n., Trigonopterus soiorum sp. n., T sordidus sp. n., Trigonopterus squamirostris sp. n., Trigonopterus striatus sp. n., Trigonopterus strigatus sp. n., Trigonopterus strombosceroides sp. n., Trigonopterus subglabratus sp. n., Trigonopterus sulcatus sp. n., Trigonopterus taenzleri sp. n., Trigonopterus talpa sp. n., Trigonopterus taurekaorum sp. n., Trigonopterus tialeorum sp. n., Trigonopterus tibialis sp. n., Trigonopterus tridentatus sp. n., Trigonopterus uniformis sp. n., Trigonopterus variabilis sp. n., Trigonopterus velaris sp. n., Trigonopterus verrucosus sp. n., Trigonopterus violaceus sp. n., Trigonopterus viridescens sp. n., Trigonopterus wamenaensis sp. n., Trigonopterus wariorum sp. n., Trigonopterus zygops sp. n.. All new species are authored by the taxonomist-in-charge, Alexander Riedel.

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Two hundred and forty-one consecutive liver resections: an experience from India.

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