A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

European Surgery / Liver resection for non-colorectal metastases

Whereas liver resection for colorectal metastasis has become standard of care, hepatectomy in patients with non-colorectal metastases remains controversial, mainly due to a heterogeneous tumor biology and missing data from prospective trials. This review aims at giving an overview about the indications and limits of liver surgery in patients with an advanced disease of a non-colorectal malignancy. Even though prospective trials are largely missing, results from retrospective studies indicate a survival benefit for liver resection in selected patients. Thus, in metastasized patients, treatment strategies should be developed in a multidisciplinary tumor board including an experienced liver surgeon.(VLID)358403

Annals of Surgical Oncology / Impact of Neoadjuvant Chemotherapy on Clinical Risk Scores and Survival in Patients with Colorectal Liver Metastases

Background Several clinical risk scores for patients with colorectal liver metastases (CLM) were established in cohorts of patients undergoing liver resection (LR) without neoadjuvant chemotherapy (NAC). The purpose of the study was to evaluate the predictive values of four common risk scores in the setting of NAC and the impact of score changes during NAC. Methods Risk scores (Fong, Nordlinger, Nagashima, and Konopke) were retrospectively calculated for 336 patients undergoing LR for CLM, including 109 patients without and 227 patients with NAC. In patients with NAC, the scores were calculated before and after NAC. Results In patients without NAC (n = 109), all risk scores except the Konopke score showed a significant correlation with disease-free survival (DFS). Only the Nagashima score also was predictive for overall survival (OS). In patients with NAC (n = 227), all scores except the Konopke score were predictive for DFS and OS before and after NAC. Score changes in the Fong and the Nagashima score showed a significant correlation with DFS and OS. Conclusions Nagashima score was the most universally applicable score and predicted prognosis in all tested scenarios.(VLID)349712

L'Infirmière française : revue mensuelle d'enseignement technique / directeur Prof Calmette,... ; rédacteurs en chef Dr Cruveilhier,... Dr Lafosse,...

septembre 19231923/09 (A1,N6)-1923/09

What defines ‘cure’ after liver resection for colorectal metastases? Results after 10 years of follow-up

AbstractBackgroundDuring the last two decades, resection of colorectal liver metastases (CLM) in selected patients has become the standard of care, with 5-year survival rates of 25–58%. Although a substantial number of actual 5-year survivors are reported after resection, 5-year survival rates may be inadequate to evaluate surgical outcomes because a significant number of patients experience a recurrence at some point.ObjectivesThis study aimed to analyse longterm results and prognostic factors in liver resection for CLM in patients with complete 10-year follow-up data.MethodsA total of 369 patients who underwent liver resection for CLM between 1985 and 1998 were identified from a bi-institutional database. Postoperative deaths and patients with extrahepatic disease were excluded. Clinicopathological prognostic factors were analysed using univariate and multivariate analyses.ResultsThe sample included 309 consecutive patients with complete 10-year follow-up data. Five- and 10-year overall survival rates were 32% and 23%, respectively. Overall, 93% of recurrences occurred within the first 5 years of follow-up, but 11% of patients who were disease-free at 5 years developed later recurrence. Multivariate analysis demonstrated four independent negative prognostic factors for survival: more than three metastases; a positive surgical margin; tumour size >5cm, and a clinical risk score >2.ConclusionsFive-year survival rates are not adequate to evaluate surgical outcomes of patients with CLM. Approximately one-third of actual 5-year survivors suffer cancer-related death, whereas patients who survive 10 years appear to be cured of disease

Scientific Reports / The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection

Postoperative liver dysfunction remains a major concern following hepatic resection. In order to identify patients who are at risk of developing liver dysfunction, indocyanine green (ICG) clearance has been proposed to predict postoperative liver function. All patients who underwent liver resection at the Medical University Vienna, Austria between 2006 and 2015 with preoperative ICG clearance testing (PDR, R15) were analyzed in this study. Postoperative liver dysfunction was analyzed as defined by the International Study Group of Liver Surgery. Overall, 698 patients (male: 394 (56.4%); female: 304 (43.6%)) with a mean age of 61.3 years (SD: 12.9) were included in this study, including 313 minor liver resections (44.8%) and 385 major liver resections (55.2%). One hundred and seven patients developed postoperative liver dysfunction after liver resection (15.3%). Factors associated with liver dysfunction were: male sex (p=0.043), major liver resection (p5.6%. To the best of our knowledge, this is the largest study analyzing the predictive value of preoperative ICG clearance assessment in patients undergoing liver resection. ICG clearance is useful to identify patients at risk of postoperative liver dysfunction.(VLID)492645

Enrollment and randomization.

<p>Forty-six patients were enrolled for this study. In five patients liver resection was not performed due to tumor progression. The remaining 41 patients were randomized intraoperative and assigned to CUSA resection (n = 21) or stapler hepatectomy (n = 20). One patient from the CUSA group was excluded after randomization, as the patient emerged to be non-resectable.</p

Perioperative alteration of pro- (IL-6, IL-8) and anti-inflammatory cytokines (IL-10).

<p>Systemic IL-6 <b>(A)</b>, IL-8 <b>(C)</b> and IL-10 <b>(E)</b> levels significantly increased perioperatively compared to baseline values. Graphs show mean cytokine concentrations [pg/ml] ± SEM. There was a significant increase in IL-6 during liver resection in the portal vein (PV; p = 0.0001) and hepatic vein (HV; p<0.0001) respectively <b>(B)</b>. Similar to that IL-10 increased significantly in the PV (p = 0.008) but not HV <b>(F)</b>. IL-8 levels measured in the in and out flow remained virtually unchanged (<b>D)</b>. Statistical significance compared to baseline values is abbreviated with * (p = 0.010–0.050), ** (p = 0.001–0.010), *** (p = 0.0001–0.001) or **** (p < 0.0001).</p