- Email: [email protected]
Liver Condition and Resection
678
Letters
REFERENCES 1. Genyk Y, Kato T, Pomposelli JJ, et al. Fibrin sealant patch (TachoSil) vs oxidized regenerated cellulose patch (surgicel original) for the secondary treatment of local bleeding in patients undergoing hepatic resection: a randomized controlled trial. J Am Coll Surg 2016;222:261e268. 2. Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138:1198e1206. 3. Di Carlo I, Toro A. Sealing all of the resection liver surface to maximize the adhesive strength of the carrier-bound fibrin sealant. Arch Surg 2011;146:239.
Disclosure Information: Nothing to disclose.
Liver Condition and Resection In reply to Toro and colleagues Yuri Genyk, MD, FACS Los Angeles, CA We thank Dr Adriana Toro for her comments on our article.1 Dr Toro discussed 3 issues regarding our trial. The first issue concerned the inclusion of patients with hepatic steatosis, fibrosis, and cirrhosis in the trial and a possibility of bias as the result. Overall, liver steatosis was present in 21.9% of patients, fibrosis in 8.5%, and cirrhosis in 9.8%. These variables were similar between the groups, but not specifically mentioned in the article
J Am Coll Surg
as the percentage for each liver condition in both study groups. We did not use Child’s classification for patients with liver cirrhosis due to its potential subjectivity. Instead, we used the Model for End-Stage Liver Disease (MELD) score. Mean MELD score was 7.7 3.9 (MELD score range is 6 to 40). Levels of indocyanine green retention at 15 minutes were not determined in this trial. The second issue brought up was the different extent of liver resection between monosegmentectomy and extensive resection and their comparability, especially in the presence of liver cirrhosis. Similar to the patients with hepatic steatosis, fibrosis, or cirrhosis, patients with different extents of liver resection were equally distributed between 2 study groups, but not specifically mentioned in the article, except that the mean number of resected segments per patient was 3.2. Last, we did not describe the application technique of studied hemostatic products in great detail, but the principles of their application to the cut liver surface at the time of randomization, as described in the study protocol, were presented in the Methods section of the article. REFERENCE 1. Genyk Y, Kato T, Pomposelli JJ, et al. Fibrin sealant patch (TachoSil) vs oxidized regenerated cellulose patch (Surgicel Original) for the secondary treatment of local bleeding in patients undergoing hepatic resection: a randomized controlled trial. J Am Coll Surg 2016;222:261e268.
Disclosure Information: Nothing to disclose.
Letters
REFERENCES 1. Genyk Y, Kato T, Pomposelli JJ, et al. Fibrin sealant patch (TachoSil) vs oxidized regenerated cellulose patch (surgicel original) for the secondary treatment of local bleeding in patients undergoing hepatic resection: a randomized controlled trial. J Am Coll Surg 2016;222:261e268. 2. Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138:1198e1206. 3. Di Carlo I, Toro A. Sealing all of the resection liver surface to maximize the adhesive strength of the carrier-bound fibrin sealant. Arch Surg 2011;146:239.
Disclosure Information: Nothing to disclose.
Liver Condition and Resection In reply to Toro and colleagues Yuri Genyk, MD, FACS Los Angeles, CA We thank Dr Adriana Toro for her comments on our article.1 Dr Toro discussed 3 issues regarding our trial. The first issue concerned the inclusion of patients with hepatic steatosis, fibrosis, and cirrhosis in the trial and a possibility of bias as the result. Overall, liver steatosis was present in 21.9% of patients, fibrosis in 8.5%, and cirrhosis in 9.8%. These variables were similar between the groups, but not specifically mentioned in the article
J Am Coll Surg
as the percentage for each liver condition in both study groups. We did not use Child’s classification for patients with liver cirrhosis due to its potential subjectivity. Instead, we used the Model for End-Stage Liver Disease (MELD) score. Mean MELD score was 7.7 3.9 (MELD score range is 6 to 40). Levels of indocyanine green retention at 15 minutes were not determined in this trial. The second issue brought up was the different extent of liver resection between monosegmentectomy and extensive resection and their comparability, especially in the presence of liver cirrhosis. Similar to the patients with hepatic steatosis, fibrosis, or cirrhosis, patients with different extents of liver resection were equally distributed between 2 study groups, but not specifically mentioned in the article, except that the mean number of resected segments per patient was 3.2. Last, we did not describe the application technique of studied hemostatic products in great detail, but the principles of their application to the cut liver surface at the time of randomization, as described in the study protocol, were presented in the Methods section of the article. REFERENCE 1. Genyk Y, Kato T, Pomposelli JJ, et al. Fibrin sealant patch (TachoSil) vs oxidized regenerated cellulose patch (Surgicel Original) for the secondary treatment of local bleeding in patients undergoing hepatic resection: a randomized controlled trial. J Am Coll Surg 2016;222:261e268.
Disclosure Information: Nothing to disclose.