ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT）...ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.展开更多
BACKGROUND Benign oesophageal strictures carry a significant level of morbidity,causing burdensome symptoms impacting on quality of life.Post-oesophagectomy anastomotic stricture rates as high as 41%have been reported...BACKGROUND Benign oesophageal strictures carry a significant level of morbidity,causing burdensome symptoms impacting on quality of life.Post-oesophagectomy anastomotic stricture rates as high as 41%have been reported in the literature.These can require endoscopic dilatation,often multiple times to relieve dysphagia.The aim of the present study was to determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.AIM To determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.METHODS We performed a retrospective analysis of a prospectively collected database of Ivor-Lewis oesophagectomy performed from 2004-2018 to determine the stricture rate.The database comprised a single-surgeon series of open,two-stage oesophagectomies with a circular stapled intra-thoracic anastomosis.Tumour location,histology,neoadjuvant chemotherapy,stapler size,T-stage and R-status were analysed to see if they could predict stricture formation.Stricture was defined as dysphagia requiring endoscopic dilatation.Patients with anastomotic leaks were excluded on the basis they would develop an anastomotic stricture.RESULTS One hundred and seventy patients were collected in the database.Nineteen were excluded on the basis of anastomotic leak,perioperative death and early recurrence.One hundred and fifty-four patients(119 males,35 females)with a mean age of 64±10 years were eligible for analysis.A total of 15 patients developed strictures a median of 99 d(interquartile range:84-133)after surgery,giving a Kaplan-Meier estimated stricture rate of 10%at one year.None of the factors considered were found to be significantly associated with strictures.CONCLUSION In this study the stricture rate was 10%,with the majority occurring in the first 100 d after surgery.No significant independent factors were found in the development of strictures.展开更多
Further to refinements in immunosuppression and the significant gains witnessed in outcomes over recent decades, liver transplantation has firmly established itself as the definitive treatment for end stage liver dise...Further to refinements in immunosuppression and the significant gains witnessed in outcomes over recent decades, liver transplantation has firmly established itself as the definitive treatment for end stage liver disease and selected instances of hepatic malignancy. However, there exists a constant divide between organ supply and demand, with the numbers of new entrants to liver transplant waiting lists consistently and significantly outstripping that of transplants performed annually, as exemplified by United Network for Organ Sharing (UNOS) data from the United States (1).展开更多
文摘ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
文摘BACKGROUND Benign oesophageal strictures carry a significant level of morbidity,causing burdensome symptoms impacting on quality of life.Post-oesophagectomy anastomotic stricture rates as high as 41%have been reported in the literature.These can require endoscopic dilatation,often multiple times to relieve dysphagia.The aim of the present study was to determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.AIM To determine a single surgeons stricture rate in a series of 2-stage Ivor-Lewis procedures,and to identify any independent risk factors in their development.METHODS We performed a retrospective analysis of a prospectively collected database of Ivor-Lewis oesophagectomy performed from 2004-2018 to determine the stricture rate.The database comprised a single-surgeon series of open,two-stage oesophagectomies with a circular stapled intra-thoracic anastomosis.Tumour location,histology,neoadjuvant chemotherapy,stapler size,T-stage and R-status were analysed to see if they could predict stricture formation.Stricture was defined as dysphagia requiring endoscopic dilatation.Patients with anastomotic leaks were excluded on the basis they would develop an anastomotic stricture.RESULTS One hundred and seventy patients were collected in the database.Nineteen were excluded on the basis of anastomotic leak,perioperative death and early recurrence.One hundred and fifty-four patients(119 males,35 females)with a mean age of 64±10 years were eligible for analysis.A total of 15 patients developed strictures a median of 99 d(interquartile range:84-133)after surgery,giving a Kaplan-Meier estimated stricture rate of 10%at one year.None of the factors considered were found to be significantly associated with strictures.CONCLUSION In this study the stricture rate was 10%,with the majority occurring in the first 100 d after surgery.No significant independent factors were found in the development of strictures.
文摘Further to refinements in immunosuppression and the significant gains witnessed in outcomes over recent decades, liver transplantation has firmly established itself as the definitive treatment for end stage liver disease and selected instances of hepatic malignancy. However, there exists a constant divide between organ supply and demand, with the numbers of new entrants to liver transplant waiting lists consistently and significantly outstripping that of transplants performed annually, as exemplified by United Network for Organ Sharing (UNOS) data from the United States (1).
