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Changes in liver anatomy following right hepatectomy: A CT-scan-based study
e100
Electronic Poster Abstracts
among patients with resectable HCC and to assess the best definition of sarcopenia to predict long-term survival. Methods: All patients who underwent liver resection for HCC, between 2006 and 2012, were included. A univariate and multivariate analysis evaluating prognostic factor of survival was performed. Results: Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available CT scan and represent the study cohort. Fifty-nine patients (54%) were considered sarcopenic according with surface of whole abdominal muscleswhereas 64 patients (58.7%) were considered sarcopenic when surface of psoas have been used. Patients in AbdoSarco group had significantly shorter mean overall survival (38,4 months vs 55,8 months, p = 0.015) and shorter mean disease-free survival (20 months vs 52 months, p < 0.0001) than non- AbdoSarco patients. In multivariate analysis, AbdoSarco was found to be an independent predictor of poor overall survival (HR = 3.19; p = 0.013) and disease-free survival (HR = 2.60;p = 0.001), while PsoasSarco was found to be only an independent predictor of poor disease-free survival (HR = 2.65; p = 0.001). Conclusion: Sarcopenia assessed by the surface of whole abdominal muscles in CT scan imaging was found to be a strong and independent prognostic factor for mortality and recurrence after hepatectomy for CHC.
FP30-11 PREDICTION OF ESOPHAGEAL VARICES IN CIRRHOTIC BY ARFI (ACOUSTIC RADIATION FORCE IMPULSE) ELASTOMETRY F. B. Ferreira1, J. Schmillevitch2, R. G. Silva Junior1, L. A. Szutan3 and F. Ferreira3 1 Internal Medicine, Santa Casa de Sao Paulo School of Medical Sciences, 2Schmillevitch Diagnostic Center, and 3 Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Brazil Background: Viral and alcoholic liver diseases are the most common etiologies for portal hypertension (PH). On this new hemodynamic scenario, esophageal varices (EV) remain important complication with increased morbidity and mortality. However, there isn’t yet a non-invasive method to indicate the presence of VE, forcing the realization of endoscopy whenever cirrhosis is diagnosed. Objective: Find a noninvasive method to predict the presence of EV and endoscopic signs of increased risk of varices bleeding. Method: We studied liver and spleen ARFI-elastometry (Acuson S2000; Siemens Medical Systems, USA) in 21 consecutive viral cirrhotic patients at Santa Casa de Sao Paulo School of Medical Sciences and correlate the mean values with its endoscopic findings. Results: Splenic-ARFI higher than 2.96 (+/ 0.53) m/s is associated with increased risk in presence of EV, and lower than 2.11 (+/ 0.52) m/s is correlated with absence of EV (p = 0.005). Splenic-ARFI lower than 2.32 (+/ 0.59) m/s is predictive of non-endoscopic signs of bleeding,
compared to values up to 3.12 (+ / e 0.51) m/s (p = 0.02). The best point of splenic-ARFI ROC curve for predicting EV is 2.67 m/s (100% specificity, sensitivity of 66.67% and AUC = 0.83). Hepatic-ARFI was not statistical significant to predict EV, only to predict increased risk of bleeding (> 2.60 (+/ 1.07) m/s, p = 0.031). When compared the 2 AUC (splenic-ARFI x hepatic-ARFI) for EV bleeding risk, it wasn’t statistical significant. Conclusion: Splenic-ARFI could predict esophageal varices presence and risk of bleeding, better than hepatic-ARFI in our patients.
FP30-12 CHANGES IN LIVER ANATOMY FOLLOWING RIGHT HEPATECTOMY: A CT-SCAN-BASED STUDY V. Drubay1, G. Millet1, S. Truant1, E. Vibert2, F. -R. Pruvot1 and E. Boleslawski1 1 Chirurgie Digestive et Transplantation, CHRU de Lille, and 2Centre Hépato-Biliaire, Paul Brousse Hospital, France Introduction: Repeat-hepatectomy has become a standard for the surgery of colorectal liver metastases. Yet, little is known about the anatomical changes following the previous hepatectomy. The aim of this study was to describe the changes in liver-anatomy following righthepatectomy. Method: Sequential CT-scans (baseline/Day-30/Day-180) of 32 non-cirrhotic patients undergoing a right-hepatectomy have been reviewed by the same author (V.D.). Measurements of the portal-vein (PV) length and axis, the angle between the left portal-vein (LPV) and the PV, as well as the axis (relative to a frontal plan going through the vena-cava) of the median hepatic-vein (MHV) and of the left hepatic-vein (LHV) were performed. Remnant and total liver-volumes were computed. Quantitative data are expressed as mean (CI95%). Results: Baseline measurements were: PV-length: 57.2mm [52.9;61.5]; PV-axis: posteriorly ( 8 [3.6;12.3]) and cranially (33.1 [29.4;36.7]) directed; LPV-to-PV angle: 48.7 [42.5;54.9]; MHV-axis: 151 [147;155]; LHV-axis: 81.2 [72.3;90.1]; remnantliver to total-liver volume-ratio: 34% [32;37]. At Day-30, significant changes were: PV-elongation: +12.8mm [+9.8;+15.8] (p < 0.0001); posterior ( 23.9 [ 19.0; 28.8], p < 0.0001) and cranial (+12.7 [+9.1;+16.4], p < 0.0001) tilt of PV; narrowing of the LPVto-PV angle: 19.0 [ 13.6; 24.5] (p < 0.0001); lateral (+24.0 [+19.6;+30.3], p < 0.0001) and cranial (+29.4 [+23.7;+35.0], p < 0.0001) tilt of the MHV-axis; remnantliver hypertrophy: +100% [+82;+119] (p < 0.0001). There were no significant changes between Day-30 and Day-180 except a reopening of the LPV-to-PV angle (+6.02 [+3.70;+8.77], p = 0.0001). Conclusion: This is the first study to detail the changes in liver-anatomy following right-hepatectomy. The knowledge of these data may help the surgeon to anticipate intraoperative difficulties during a repeat-hepatectomy.
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
among patients with resectable HCC and to assess the best definition of sarcopenia to predict long-term survival. Methods: All patients who underwent liver resection for HCC, between 2006 and 2012, were included. A univariate and multivariate analysis evaluating prognostic factor of survival was performed. Results: Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available CT scan and represent the study cohort. Fifty-nine patients (54%) were considered sarcopenic according with surface of whole abdominal muscleswhereas 64 patients (58.7%) were considered sarcopenic when surface of psoas have been used. Patients in AbdoSarco group had significantly shorter mean overall survival (38,4 months vs 55,8 months, p = 0.015) and shorter mean disease-free survival (20 months vs 52 months, p < 0.0001) than non- AbdoSarco patients. In multivariate analysis, AbdoSarco was found to be an independent predictor of poor overall survival (HR = 3.19; p = 0.013) and disease-free survival (HR = 2.60;p = 0.001), while PsoasSarco was found to be only an independent predictor of poor disease-free survival (HR = 2.65; p = 0.001). Conclusion: Sarcopenia assessed by the surface of whole abdominal muscles in CT scan imaging was found to be a strong and independent prognostic factor for mortality and recurrence after hepatectomy for CHC.
FP30-11 PREDICTION OF ESOPHAGEAL VARICES IN CIRRHOTIC BY ARFI (ACOUSTIC RADIATION FORCE IMPULSE) ELASTOMETRY F. B. Ferreira1, J. Schmillevitch2, R. G. Silva Junior1, L. A. Szutan3 and F. Ferreira3 1 Internal Medicine, Santa Casa de Sao Paulo School of Medical Sciences, 2Schmillevitch Diagnostic Center, and 3 Surgery, Santa Casa de Sao Paulo School of Medical Sciences, Brazil Background: Viral and alcoholic liver diseases are the most common etiologies for portal hypertension (PH). On this new hemodynamic scenario, esophageal varices (EV) remain important complication with increased morbidity and mortality. However, there isn’t yet a non-invasive method to indicate the presence of VE, forcing the realization of endoscopy whenever cirrhosis is diagnosed. Objective: Find a noninvasive method to predict the presence of EV and endoscopic signs of increased risk of varices bleeding. Method: We studied liver and spleen ARFI-elastometry (Acuson S2000; Siemens Medical Systems, USA) in 21 consecutive viral cirrhotic patients at Santa Casa de Sao Paulo School of Medical Sciences and correlate the mean values with its endoscopic findings. Results: Splenic-ARFI higher than 2.96 (+/ 0.53) m/s is associated with increased risk in presence of EV, and lower than 2.11 (+/ 0.52) m/s is correlated with absence of EV (p = 0.005). Splenic-ARFI lower than 2.32 (+/ 0.59) m/s is predictive of non-endoscopic signs of bleeding,
compared to values up to 3.12 (+ / e 0.51) m/s (p = 0.02). The best point of splenic-ARFI ROC curve for predicting EV is 2.67 m/s (100% specificity, sensitivity of 66.67% and AUC = 0.83). Hepatic-ARFI was not statistical significant to predict EV, only to predict increased risk of bleeding (> 2.60 (+/ 1.07) m/s, p = 0.031). When compared the 2 AUC (splenic-ARFI x hepatic-ARFI) for EV bleeding risk, it wasn’t statistical significant. Conclusion: Splenic-ARFI could predict esophageal varices presence and risk of bleeding, better than hepatic-ARFI in our patients.
FP30-12 CHANGES IN LIVER ANATOMY FOLLOWING RIGHT HEPATECTOMY: A CT-SCAN-BASED STUDY V. Drubay1, G. Millet1, S. Truant1, E. Vibert2, F. -R. Pruvot1 and E. Boleslawski1 1 Chirurgie Digestive et Transplantation, CHRU de Lille, and 2Centre Hépato-Biliaire, Paul Brousse Hospital, France Introduction: Repeat-hepatectomy has become a standard for the surgery of colorectal liver metastases. Yet, little is known about the anatomical changes following the previous hepatectomy. The aim of this study was to describe the changes in liver-anatomy following righthepatectomy. Method: Sequential CT-scans (baseline/Day-30/Day-180) of 32 non-cirrhotic patients undergoing a right-hepatectomy have been reviewed by the same author (V.D.). Measurements of the portal-vein (PV) length and axis, the angle between the left portal-vein (LPV) and the PV, as well as the axis (relative to a frontal plan going through the vena-cava) of the median hepatic-vein (MHV) and of the left hepatic-vein (LHV) were performed. Remnant and total liver-volumes were computed. Quantitative data are expressed as mean (CI95%). Results: Baseline measurements were: PV-length: 57.2mm [52.9;61.5]; PV-axis: posteriorly ( 8 [3.6;12.3]) and cranially (33.1 [29.4;36.7]) directed; LPV-to-PV angle: 48.7 [42.5;54.9]; MHV-axis: 151 [147;155]; LHV-axis: 81.2 [72.3;90.1]; remnantliver to total-liver volume-ratio: 34% [32;37]. At Day-30, significant changes were: PV-elongation: +12.8mm [+9.8;+15.8] (p < 0.0001); posterior ( 23.9 [ 19.0; 28.8], p < 0.0001) and cranial (+12.7 [+9.1;+16.4], p < 0.0001) tilt of PV; narrowing of the LPVto-PV angle: 19.0 [ 13.6; 24.5] (p < 0.0001); lateral (+24.0 [+19.6;+30.3], p < 0.0001) and cranial (+29.4 [+23.7;+35.0], p < 0.0001) tilt of the MHV-axis; remnantliver hypertrophy: +100% [+82;+119] (p < 0.0001). There were no significant changes between Day-30 and Day-180 except a reopening of the LPV-to-PV angle (+6.02 [+3.70;+8.77], p = 0.0001). Conclusion: This is the first study to detail the changes in liver-anatomy following right-hepatectomy. The knowledge of these data may help the surgeon to anticipate intraoperative difficulties during a repeat-hepatectomy.
HPB 2016, 18 (S1), e1ee384