Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis
Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis
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DOI：
10.1016/j.ejso.2012.12.020
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发表时间：
2013-04-01
期刊：
影响因子：
3.8
通讯作者：
Coimbra, F. J. F.
中科院分区：
文献类型：
--
作者：
Ribeiro, H. S. C.;Costa, W. L., Jr.;Coimbra, F. J. F.
目的：本研究的目的是确定术后肝功能衰竭的发病率和预后因素提交给肝切除术的结直肠metastasis.Method：CLM谁做了肝切除术，从1998年至2009年的患者纳入回顾性分析。术后肝功能衰竭的定义使用50-50标准或血清胆红素水平高于7 mg/dL的峰值independent.Results：二百零九（209）程序进行了170例。120例手术在6个月内进行了化疗。总发病率为53.1%，90天死亡率为2.3%。所有手术中有10%发生术后肝功能衰竭，这组患者的死亡率为9.5%。多因素分析显示，肝切除范围、术前输血量及术前化疗周期数超过8个是术后肝功能不全的独立预后因素。这种并发症与化疗方案无关。结论：我们得出结论，术后肝功能衰竭的发生率相对较低（10%）CLM切除术后，但对术后死亡率的影响显着。肝切除量、输血需要和术前化疗时间延长是其发生的独立预测因素，这些知识可用于多学科方法预防术后肝功能衰竭。(C)2013爱思唯尔有限公司保留所有权利。
Aim: The aim of this study was to determine the incidence and prognostic factors of postoperative liver failure in patients submitted to liver resection for colorectal metastases.Method: Patients with CLM who underwent hepatectomy from 1998 to 2009 were included in retrospective analysis. Postoperative liver failure was defined using either the 50-50 criteria or the peak of serum bilirubin level above 7 mg/dL independently.Results: Two hundred and nine (209) procedures were performed in 170 patients. 120 surgeries were preceded by chemotherapy within six months. The overall morbidity rate was 53.1% and 90-day mortality was 2.3%. Postoperative liver failure occurred in 10% of all procedures, accounting for a mortality rate of 9.5% among this group of patients. In multivariate analysis, extent of liver resection, need of blood transfusion and more than eight preoperative chemotherapy cycles were independent prognostic factors of postoperative liver insufficiency. This complication was not related with the chemotherapy regimen used.Conclusion: We conclude that postoperative liver failure has a relatively low incidence (10%) after CLM resection, but a remarkable impact on postoperative mortality rate. The amount of liver resected, the need of blood transfusion and extended preoperative chemotherapy are independent predictors of its occurrence and this knowledge can be used to prevent postoperative liver failure in a multidisciplinary approach. (C) 2013 Elsevier Ltd. All rights reserved.