Association of different central venous pressure levels with outcome of living-donor liver transplantation in children under 12 years

Background Pediatric liver transplantation is an important modality for treating biliary atresia.The overall survival(OS)rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago,but it is still unsatisfactory.The anesthesia strategy of maintaining low central venous pressure(CVP)has shown a positive effect on prognosis in adult liver transplantation.However,this relationship remains unclear in pediatric liver transplantation.Thus,this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of recipients.Methods This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure:low CVP(LCVP)(≤10 cmH2O,n=470)and high CVP(HCVP)(>10 cmH2O,n=242).The primary outcome measured in the study was the overall survival rate.The secondary outcomes included the duration of mechanical ventilation in the intensive care unit(ICU),length of stay in the ICU,and postoperative stay in the hospital.Patient demographic and perioperative data were collected and compared between the two groups.Kaplan-Meier curves were constructed to determine the associations of different CVP levels with the survival rate.Results In the study,712 patients,including 470 in the LCVP group and 242 in the HCVP group,were enrolled.After propensity score matching,212 pairs remained in the group.The LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses(P=0.018),and the HCVP group had a hazard ratio of 2.445(95%confidence interval,1.163–5.140).Conclusion This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay.

Long-term survival of esophageal squamous cell carcinoma after surgical treatment in a large-scale retrospective study from a single cancer center

Purpose To analyze the long-term overall survival(OS)and influencing factors of patients with esophageal squamous cell cancer(ESCC)under surgical treatment.Method We collected patients with ESCC who received surgical treatment in Sichuan Cancer Hospital&institute from January 2010 to December 2017,and selected 2,766 patients with thoracic esophageal carcinoma with relatively complete follow-up results as the objects of this study.We analyzed the characteristics,postoperative complications and long-term OS results of those patients.Results Of the 2766 patients,81.6%were male,midthoracic esophageal cancer accounted for 53.5%.McKeown was used in 72.0%of patients and Ivor-Lewis was used in 26.4%of patients.About 47.8%of patients received minimally invasive esophagectomy(MIE).The overall complication rate was 25.8%.The 1-year,3-year and 5-year OS rates were 86.2%,57.5%and 46.8%,respectively.McKeown had a better long-term OS rate than Ivor-Lewis(49.5%vs 41.2%,P<0.001),and MIE is superior to open surgery(51.8%vs 42.5%,P<0.001).Conclusion McKeown has advantages over Ivor-Lewis.MIE results in better long-term survival outcomes for patients.But more prospective randomized controlled trials with large samples are needed.