- Email: [email protected]
Bile leakage after liver resection reduces overall survival
Electronic Poster Abstracts Conclusion: Preliminary results of this study describe histopathological changes following weight reduction surgery and suggest that hepatic steatosis, fibrosis and NAFLD activity score are reduced 3 months after surgery. (Registration number: NCT01619215). Disclosure: The clinical trial is financially supported by NPST.
EP01C-052 BILE LEAKAGE AFTER LIVER RESECTION REDUCES OVERALL SURVIVAL J. Joneberg1,2, A. Jansson1,2, E. Jonas2,3, B. Isaksson1,2 and C. Strömberg1,2 1 Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 2 Centre for Digestive Diseases, Karolinska University Hospital, and 3Department of Clinical Sciences, Danderyd Hospital, Sweden Background: Bile leakage (BL) has been linked with poorer overall one-year survival following liver resection for colo-rectal cancer metastases. Post-operative complications including sepsis reduce overall survival after hepatic resection. As clinically more severe BL corresponding to ISGLS classes B and C precipitate inflammatory reactions, we hypothesise that BL hampers overall survival after liver resection for any disease. Methods: Medical charts of all consecutive patients undergoing hepatic resection for any diagnosis in our unit between 2010 and 2013 were retrospectively analysed. BLs were classified according to the ISGLS criteria. The national population registry was consulted for survival status. Follow-up terminated on June 30, 2015, or when patients were lost to emigration. Results: 493 patients were included. There were 145 BLs. There were no significant differences with respect to patient age, sex, BMI or co-morbidity between the BL and no-BL groups. Cox regression adjusting for extent of resection, preoperative chemotherapy and indication for surgery identifies BL, especially class B and C, as an independent risk factor for poorer over-all survival (fig. 1). Conclusion: BL after liver resection for any diagnosis is a risk factor for mortality. This further stresses the need to prevent BL.
Figure 1 Bile leakage and survival
HPB 2016, 18 (S1), e1ee384
e243
EP01C-053 LIVER RESECTION IN THE ELDERLY PATIENT WITHIN MCN NORTHEAST NETHERLANDS C. Buis1, J. Klaasse2, G. Patijn3, E. Manusama4, V. Nieuwenhuijs3, C. Hoff4, J. Sprakel2, J. Erdmann1, P. Velthuis5, R. Porte1, M. Boer de1 and MCN HPB North East Netherlands 1 University Medical Centre Groningen, 2Surgery, Medisch Spectrum Twente, 3Surgery, Isala Kliniek, 4Surgery, Medisch Centrum Leeuwarden, and 5IKNL, Netherlands Introduction: This study evaluated the outcome of liver surgery in patients over 75 years in the Managed Clinical Network (MCN) HPB Surgery Northeast Netherlands, a new national multicentre cooperation. Patients and methods: Within the MCN, 4 hospitals (3 tertiary and 1 quaternary referral center) work closely together to assure optimal quality and service for all HPB pathology in the region. We analyzed the results from a prospective database since the start of our cooperation in 2012 until 2014. Results: 620 patients underwent a liver resection. 81 (13%) were over 75 years, this cohort was separately investigated. The majority of the elderly patients (61, 75%) underwent resection for colorectal liver metastasis. Remaining resections were performed for primary malignancy (14) or benign lesions of the liver. For the elderly group resected for CRLM 24% scored ASA3+. A major resection was performed in one-third of the patients. In 40 patients (66%) one or two lesions were resected. Neoadjuvant chemotherapy was administered in 56%. Postoperative biliary fistula rate was 4%, median length of stay was 7 days. R0 resections were performed in 89% of patients. Recurrent disease was seen in 37% of the patients (median follow up 19.3 months Survival in the entire elderly group was 100% at 90 days. Conclusion: Liver resection in the elderly within the MCN is performed with a excellent survival rate and acceptable morbidity rate. We are encouraged to investigate our selection process further and more in-depth the quality of life of the elderly after surgery.
EP01C-054 HEPATIC RESECTION OF NONCOLORECTAL NON-ENDOCRINE LIVER METASTASES R. Gandy, P. Bergamin and K. S. Haghighi HPB & Transplant Surgery, University of New South Wales, Australia Background: Hepatic resection is standard treatment for liver metastases from colorectal and neuroendocrine cancers as well as primary biliary and hepatic carcinomas. The role of hepatic resection in patients with non-colorectal non-endocrine liver metastases (NCNELM) is less defined. Overall survival in this group of patients is poor with few patients surviving beyond 2 years, even with modern chemotherapy. Methodology: A prospective database of all liver resections performed by a single surgeon (KH) from January 2007 to December 2014 was maintained. Patient demographics, surgical and pathological data was collected
EP01C-052 BILE LEAKAGE AFTER LIVER RESECTION REDUCES OVERALL SURVIVAL J. Joneberg1,2, A. Jansson1,2, E. Jonas2,3, B. Isaksson1,2 and C. Strömberg1,2 1 Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 2 Centre for Digestive Diseases, Karolinska University Hospital, and 3Department of Clinical Sciences, Danderyd Hospital, Sweden Background: Bile leakage (BL) has been linked with poorer overall one-year survival following liver resection for colo-rectal cancer metastases. Post-operative complications including sepsis reduce overall survival after hepatic resection. As clinically more severe BL corresponding to ISGLS classes B and C precipitate inflammatory reactions, we hypothesise that BL hampers overall survival after liver resection for any disease. Methods: Medical charts of all consecutive patients undergoing hepatic resection for any diagnosis in our unit between 2010 and 2013 were retrospectively analysed. BLs were classified according to the ISGLS criteria. The national population registry was consulted for survival status. Follow-up terminated on June 30, 2015, or when patients were lost to emigration. Results: 493 patients were included. There were 145 BLs. There were no significant differences with respect to patient age, sex, BMI or co-morbidity between the BL and no-BL groups. Cox regression adjusting for extent of resection, preoperative chemotherapy and indication for surgery identifies BL, especially class B and C, as an independent risk factor for poorer over-all survival (fig. 1). Conclusion: BL after liver resection for any diagnosis is a risk factor for mortality. This further stresses the need to prevent BL.
Figure 1 Bile leakage and survival
HPB 2016, 18 (S1), e1ee384
e243
EP01C-053 LIVER RESECTION IN THE ELDERLY PATIENT WITHIN MCN NORTHEAST NETHERLANDS C. Buis1, J. Klaasse2, G. Patijn3, E. Manusama4, V. Nieuwenhuijs3, C. Hoff4, J. Sprakel2, J. Erdmann1, P. Velthuis5, R. Porte1, M. Boer de1 and MCN HPB North East Netherlands 1 University Medical Centre Groningen, 2Surgery, Medisch Spectrum Twente, 3Surgery, Isala Kliniek, 4Surgery, Medisch Centrum Leeuwarden, and 5IKNL, Netherlands Introduction: This study evaluated the outcome of liver surgery in patients over 75 years in the Managed Clinical Network (MCN) HPB Surgery Northeast Netherlands, a new national multicentre cooperation. Patients and methods: Within the MCN, 4 hospitals (3 tertiary and 1 quaternary referral center) work closely together to assure optimal quality and service for all HPB pathology in the region. We analyzed the results from a prospective database since the start of our cooperation in 2012 until 2014. Results: 620 patients underwent a liver resection. 81 (13%) were over 75 years, this cohort was separately investigated. The majority of the elderly patients (61, 75%) underwent resection for colorectal liver metastasis. Remaining resections were performed for primary malignancy (14) or benign lesions of the liver. For the elderly group resected for CRLM 24% scored ASA3+. A major resection was performed in one-third of the patients. In 40 patients (66%) one or two lesions were resected. Neoadjuvant chemotherapy was administered in 56%. Postoperative biliary fistula rate was 4%, median length of stay was 7 days. R0 resections were performed in 89% of patients. Recurrent disease was seen in 37% of the patients (median follow up 19.3 months Survival in the entire elderly group was 100% at 90 days. Conclusion: Liver resection in the elderly within the MCN is performed with a excellent survival rate and acceptable morbidity rate. We are encouraged to investigate our selection process further and more in-depth the quality of life of the elderly after surgery.
EP01C-054 HEPATIC RESECTION OF NONCOLORECTAL NON-ENDOCRINE LIVER METASTASES R. Gandy, P. Bergamin and K. S. Haghighi HPB & Transplant Surgery, University of New South Wales, Australia Background: Hepatic resection is standard treatment for liver metastases from colorectal and neuroendocrine cancers as well as primary biliary and hepatic carcinomas. The role of hepatic resection in patients with non-colorectal non-endocrine liver metastases (NCNELM) is less defined. Overall survival in this group of patients is poor with few patients surviving beyond 2 years, even with modern chemotherapy. Methodology: A prospective database of all liver resections performed by a single surgeon (KH) from January 2007 to December 2014 was maintained. Patient demographics, surgical and pathological data was collected