Preoperative Physical Activity Level Measurement by Accelerometer for Predicting Post-Hepatectomy Complications : A Prospective Observational Study

Introduction: Recently, accelerometers have received much attention around the world. This study examined whether the preoperative physical activity level measured by an accelerometer could be a useful predictor of post-hepatectomy complications. Methods: Between December 2016 and December 2020, the physical activity levels of 185 patients were measured using an accelerometer 3 days before hepatectomy and from postoperative day 1 to 7. The patients without postoperative complications (n = 153) and those with postoperative complications (n = 32) were compared using either the χ2 test or Fisher's exact test for nominal variables; continuous variables were analyzed using either Student's t test or Mann-Whitney U test. Differences were considered statistically significant when the p value was <0.05. Risk factors for postoperative complications following hepatectomy were also investigated. Results: The number of patients with an anatomical resection was significantly higher in patients with postoperative complications (p = 0.001). Furthermore, laparoscopic hepatectomy was performed in 65.4% of patients without postoperative complications and in 25.0% of those with postoperative complications; the difference was statistically significant (p < 0.001). The average preoperative physical activity level was 150.6 kcal/day in patients without postoperative complications and 84.5 kcal/day in those with postoperative complications (p = 0.001). Multivariate analysis identified blood loss, operative time, and preoperative physical activity level as independent risk factors for postoperative complications. Discussion/conclusion: Patients with lower preoperative physical activity levels are at a high risk of developing postoperative complications after hepatectomy. Hence, preoperative physical activity level measurement may be useful in predicting post-hepatectomy complications.journal articl

Preoperative Predictive Nomogram Based on Alanine Aminotransferase, Prothrombin Time Activity, and Remnant Liver Proportion (APART Score) to Predict Post-Hepatectomy Liver Failure after Major Hepatectomy

Introduction: Post-hepatectomy liver failure (PHLF) is a serious complication associated with major hepatectomies. An accurate prediction of PHLF is necessary to determine the feasibility of major hepatectomy. This study aimed to assess the association between PHLF and preoperative laboratory and computed tomography (CT) findings. Methods: Medical records of 65 patients who underwent major hepatectomy and preoperative CT were retrospectively reviewed. We evaluated future remnant liver volume evaluation models and remnant liver hemodynamics, which were assessed by arterial enhancement fraction (AEF) by using preoperative CT. Variables, including CT findings, were compared between patients with and without PHLF after major hepatectomy, and the preoperative PHLF-predicting nomogram was constructed using multivariate logistic regression. Results: The PHLF group included 21 patients (32.3%). The AEF was not significantly different between the two groups. In the future remnant liver volume evaluation models, future remnant liver proportion (fRLP) had the highest concordance index (C-index) in the receiver operating characteristic curve analysis (C-index, 0.755). Multivariate analysis of preoperative evaluable factors revealed that alanine aminotransferase levels (p = 0.034), prothrombin time activity (p = 0.021), and fRLP (p = 0.012) were independent predictive factors of PHLF. A nomogram (APART score) was constructed using these three factors, with a receiver operating curve showing a C-index of 0.894. According to the APART score, scores of 51-60 indicated moderate risk (40.0%), and scores over 60 indicated a high risk of PHLF (83.3%) (p < 0.001). Discussion: The APART score may help predict PHLF in patients indicated for major hepatectomies.journal articl

ニュウガン ジュツゼン カガク リョウホウ FECリョウホウ チュウ ニ モウマク ジョウミャク ヘイソクショウ ニ ヨル ヘンソクセイ ノ オウハン フシュ オ ハッショウシタ 1レイ

症例は60歳女性。検診で右乳癌が疑われ、精査により浸潤性乳管癌の診断となった。術前化学療法としてDTX療法(docetaxel)4サイクル終了後にFEC療法(5-FU+epirubicin+cyclophosphamide)を開始した。FEC療法2サイクル目投与中に、左眼の視力低下が出現し、翌日に左眼底に出血を伴う網膜静脈分枝閉塞症および嚢胞状黄斑浮腫を確認した。FEC療法を中止し、非ステロイド性抗炎症点眼薬(NSAIDS点眼薬)投与、抗血管内皮増殖因子抗体薬(抗VEGF抗体薬)の硝子体内注射による治療を開始した。その後も3か月毎に抗VEGF抗体薬投与を行ったところ、徐々に黄斑浮腫は改善、視力は治療開始 1 年後に回復した。これまでにタキサン系の抗癌剤で黄斑浮腫が出現した報告はあるが、FEC療法の副作用で黄斑浮腫が出現したとの報告はなく、本症例は希少な症例と考えられた。また、抗癌剤治療の際には眼副作用の予防、発症の早期検知、早期治療を心掛ける必要がある。The case is a 60-year-old woman. Right breast cancer was suspected during a medical checkup, and a close examination revealed a diagnosis of invasive ductal carcinoma of the breast. After 4 cycles of DTX (docetaxel) as neoadjuvant chemotherapy, FEC (5-FU + epirubicin + cyclophosphamide) was started. During the second cycle of FEC therapy, vision loss in the left eye appeared, and the next day, branch retinal vein occlusion with hemorrhage and cystoid macular edema were observed in the left fundus. FEC therapy was discontinued, and treatment with non-steroidal anti-inflammatory eye drops (NSAIDS eye drops) and intravitreal injection of anti-vascular endothelial growth factor antibody drug (anti-VEGF antibody drug) was started. After administration of anti-VEGF antibody drug every 3 months, macular edema gradually improved and visual acuity was restored one year after the start of treatment. Although there have been reports of macular edema caused by taxane-type anticancer drugs, there have been no reports of macular edema as a side effect of FEC therapy, and this case was considered to be a rare one. In addition, it is necessary to keep in mind the prevention of ocular side effects, early detection of their onset, and early treatment when anticancer drug therapy is used.departmental bulletin pape

Effect of early administration of tolvaptan on pleural effusion post-hepatectomy

Purpose: This study evaluated the efficacy of tolvaptan administration at the early stage after hepatectomy to control pleural effusion and improve the postoperative course. Methods: Patients were administered tolvaptan (7.5 mg) and spironolactone (25 mg) from postoperative day 1 to postoperative day 5 (tolvaptan group, n = 68) for 13 months. Early administration of tolvaptan was not provided in the control group (n = 68); however, diuretics were appropriately administered according to the patient's condition. The amount of pleural effusion on computed tomography on postoperative day 5 was compared between the two groups. Results: The amount of pleural effusion and increase in body weight on postoperative day 5 showed significant differences in both groups (p < 0.001 and p = 0.019, respectively). However, the rate of pleural aspiration and the duration of postoperative hospitalization were comparable between the groups. The amount of intraoperative blood loss and lack of early administration of tolvaptan were identified as independent risk factors contributing to pleural effusion on multivariate analysis. Conclusion: Early administration of tolvaptan to patients after hepatectomy was found to be capable of controlling postoperative pleural effusion and increase in body weight, but it did not reduce the rate of pleural aspiration or the hospitalization period.journal articl

Postoperative computed tomography findings predict re-drainage cases after early drain removal in pancreaticoduodenectomy

Purpose: This study aimed to investigate the risk factors for re-drainage in patients with early drain removal after pancreaticoduodenectomy (PD). Methods: This study retrospectively analyzed 114 patients who underwent PD and prophylactic drain removal on postoperative day (POD) 4 between January 2012 and March 2021. We analyzed the risk factors for re-drainage according to various factors. Peri-pancreaticojejunostomic fluid collection (PFC) index and pancreatic cross-sectional area (CSA) were evaluated using computed tomography on POD 4. The PFC index was calculated by multiplying the length, width, and height at the maximum aspect. Results: Among the 114 patients, 15 (13%) underwent re-drainage due to postoperative pancreatic fistula. Multivariate analysis identified a PFC index ≥ 8.16 cm3 on POD 4 (odds ratio [OR], 20.40, 95%CI 2.38-174.00; p = 0.006) and pancreatic CSA on POD 4 ≥ 3.65 cm2 (OR, 16.40, 95%CI 1.57-171.00; p = 0.020) as independent risk factors for re-drainage. Conclusion: A careful decision might be necessary for early drain removal in patients with a PFC index ≥ 8.16 cm3 and pancreatic CSA ≥ 3.65 cm2.journal articl