Does Chemotherapy-Induced Liver Injury Impair Postoperative Outcomes After Laparoscopic Liver Resection for Colorectal Metastases?

peer reviewed[en] BACKGROUND: Chemotherapy-associated liver injuries (CALI) have been associated with poor postoperative outcome after open liver resection. To date, no data concerning any correlation of CALI and laparoscopic liver resection (LLR) are available. In the present study, we evaluated the impact of CALI on short-term outcomes in patients undergoing LLR. MATERIALS AND METHODS: All patients who underwent in our department LLR for colorectal liver metastases (CRLM) from 2000 to 2016 were retrospectively reviewed. Patients were divided in 4 groups according to their pathological histology. In group 1 patients had normal liver parenchyma. Group 2 included patients with steatosis and steatohepatitis. Patients with sinusoidal obstruction syndrome (SOS) and nodular regenerative hyperplasia (NRH) were allocated to group 3, whereas the remaining with fibrosis and cirrhosis, were assigned to group 4. RESULTS: A total of 490 LLR for CRLM were included in the study. Perioperative details and morbidity did not differ significantly between the four groups. Subgroup analysis showed that NRH was associated with higher amount of blood loss (p = 0.043), overall (p = 0.021) and liver-specific morbidity (p = 0.039). CONCLUSION: NRH is a severe form of CALI that may worsen the short-term outcomes of patients undergoing LLR for CRLM. However, the remaining forms of CALI do not have a significant impact on perioperative outcomes after LLR

Mieux communiquer avec les patients non hospitalisés

International audienceDay-case surgery is based on a patient-centered organization of health care. It requires a continuum of care from home to ambulatory surgical unit. Communication and information between all participants must be planned at all stages of patient’ care management. The contact with patients is improved by the used of new communication’ tools especially on the days before and after surgery. This manuscript reports on the care pathway from the first consultation to the return home and describes each step and key-points of communications between health care providers and patients.La chirurgie ambulatoire est basée sur un concept d'organisation centrée sur le patient (1). Elle s'inscrit dans une continuité entre la ville et l'unité de chirurgie ambulatoire. Un plan de communication entre tous les acteurs de cette prise en charge doit être mis en place que ce soit avant, pendant ou après l'acte opératoire. Le groupe de travail HAS/ANAP a défini le parcours patient en 6 étapes (2) (3). A chacune de ces étapes il faudra avoir une communication claire avec le patient, son accompagnant ainsi qu'avec tous les acteurs de soins qu'ils soient médicaux ou paramédicaux, en ville ou à l'hôpital. En tant qu'acteur de ses soins le patient devra être informé de toutes les étapes de son séjour pour qu'il participe à sa prise en charge péri-opératoire. Les 6 étapes de cette prise en charge sont : – Eligibilité du patient – Organisation de la prise en charge du patient éligible – Actions à mener la veille ou l'avant-veille de l'intervention prévue (J-1 ou J-2) – Prise en charge du patient le jour de l'intervention (J0) – Suivi immédiat après la sortie (J+1) – Suivi du patient à distance de la sortie. A chacune de ces étapes il faudra connaitre, anticiper et maitriser les risques auxquels le patient sera exposé. 1) Eligibilité du patient Pour que le patient soit éligible à une prise en charge ambulatoire il faut qu'il réponde à des critères médicaux et chirurgicaux d'une part, psycho-sociaux et environnementaux d'autre part. Qui mieux que le médecin traitant peut apprécier avec la famille du patient certains critères d'éligibilité. Pour cela il faut que le chirurgien correspondant du médecin traitant informe celui-ci avec précision du geste qui sera effectué et de sa prise en charge en ambulatoire. 2) Organisation de la prise en charge du patient éligibl

Ropivacaine Wound Infiltration for Pain Management After Breast Cancer Mastectomy: A Population Pharmacokinetic Analysis

International audienc

Cognitive status of patients judged fit for discharge from the post-anaesthesia care unit after general anaesthesia: a randomized comparison between desflurane and propofol

International audienceBackground: The Aldrete's score is used to determine when a patient can safely leave the Post-Anaesthesia Care Unit (PACU) and be transferred to the surgical ward. The Aldrete score is based on the evaluation of vital signs and consciousness. Cognitive functions according to the anaesthetic strategy at the time the patient is judged fit for discharge from the PACU (Aldrete's score ≥ 9) have not been previously studied. The aim of this trial was to assess the cognitive status of inpatients emerging either from desflurane or propofol anaesthesia, at the time of PACU discharge (Aldrete score ≥ 9). Methods: Sixty adult patients scheduled for hip or knee arthroplasty under general anaesthesia were randomly allocated to receive either desflurane or propofol anaesthesia. Patients were evaluated the day before surgery using Digit Symbol Substitution Test (DSST), Stroop Color Test and Verbal Learning Test. After surgery, the Aldrete score was checked every 5 min until reaching a score ≥ 9. At this time, the same battery of cognitive tests was applied. Each test was evaluated separately. Cognitive status was reported using a combined Z score pooling together the results of all 3 cognitive tests. Results: Among the 3 tests, only DSST was significantly reduced at Aldrete Score ≥ 9 in the Desflurane group. Combined Z-scores at Aldrete Score ≥ 9 were (in medians [interquartils]): − 0.2 [− 1.2;+ 0.6] and − 0.4 [− 1.1;+ 0.4] for desflurane and propofol groups respectively (P = 0.62). Cognitive dysfunction at Aldrete score ≥ 9 was observed in 3 patients in the Propofol group and in 2 patients in the Desflurane group) (P = 0.93).ConclusionNo difference was observed in cognitive status at Aldrete score ≥ 9 between desflurane and propofol anaesthesia. Although approximately 10% of patients still had cognitive dysfunctions, an Aldrete score ≥ 9 was associated with satisfactory cognitive function recovery in the majority of the patients after lower limb arthroplasty surgery under general anaesthesia