(Press-News.org) CHICAGO (March 12, 2015): A surgical approach in which a surgeon removes less than a lobe of the liver in a patient undergoing an operation for liver cancer is associated with lower mortality and complication rates, according to new study results published online as an "article in press" in the Journal of the American College of Surgeons (JACS). The article will appear in print in the April issue of the Journal.
Historically, the most common surgical method of treatment for liver cancer was a major hepatectomy in which a lobe (hemi-liver) is removed in order to remove the tumor. The five-year survival rate of selected patients who undergo a complete resection is as high as 50 percent, yet many people aren't operated on because of the high complication rate, blood loss, and liver dysfunction associated with a major hepatectomy.
However, over the last 20 years liver operations have become safer and more effective due to advances in surgical and anesthetic techniques and operating room devices; improvements in perioperative patient care; and a much wider availability of surgeons who are trained in liver surgery techniques.
When a patient has a single tumor, or tumors confined to one side of the liver, a surgical approach called hepatic parenchymal preservation is far better for the patient than the traditional approach of removing large sections of the liver. This preservation procedure involves removing less than a lobe of the liver without compromising principles of cancer surgery. It places less physical stress on the body, and gives patients a quicker recovery time and the option to have another operation if the cancer recurs.
"The majority of patients with metastatic colorectal cancer are never sent to a liver surgeon because of the impression that a liver operation is too dangerous and patient outcomes are poor," according to T. Peter Kingham, MD, FACS, lead study author and a surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. "But we've shown that it's possible to do safe liver resection, so patients should be considered for hepatic parenchymal preservation."
The aim of this retrospective study was to investigate the correlation between surgical methods, mortality, and complication rates over the last 19 years. Dr. Kingham and colleagues at MSK analyzed hospital records of all patients who underwent liver resection for a malignant diagnosis from 1993 to 2012 at their cancer center.
There were 3,875 patients who underwent 4,152 resections for cancer entered into the MSK database. The most common diagnosis was metastatic colorectal cancer. The researchers divided the patients into three equal groups according to time period: early (1993 to 1999), middle (2000 to 2006), and late (2007 to 2012).
They then looked at what percentage of cases in each era were major versus minor hepatectomies (major resection was defined as removal of three or more segments of the liver), and compared outcomes in terms of surgical morbidity and mortality rates between the three time periods.
Over the study period, the 90-day mortality rate decreased from 5 percent to 1.6 percent. Overall complications dropped from 53 percent to 20 percent. The percentage of major hepatectomies decreased from 66 percent to 36 percent. The transfusion rate decreased from 51 percent to 21 percent, and liver dysfunction for all cases decreased from 3 percent to 1 percent.
One interesting finding was that the mortality risk for major hepatectomies remained the same in all three time periods, suggesting that the improved outcomes were related specifically to the increased use of parenchymal sparing resections. "This change in approach to resection appears to be largely responsible for the decrease in overall mortality, given that the mortality rate associated with major liver resections remained constant over the entire study period," Dr. Kingham said.
In addition, the researchers found that abdominal infections were the most common complication of liver surgical procedures. The study authors conclude that encouraging parenchymal preservation and preventing abdominal infections are critical for continued improvement of liver procedure outcomes.
"The biggest takeaway from our study is that parenchymal preservation should be applied to all patients undergoing liver operations for malignancies because the data show that the mortality rate and complication rate, the blood loss, the requirement for blood transfusions, time in the hospital, all of these things which we are all trying to improve on, are all less," Dr. Kingham said. "That is an important message because parenchymal preservation is not always done. While it may be technically easier to remove more liver in some cases, it is worth considering a technically more challenging approach to remove less liver. In the end, there is a real difference in a patient's mortality risk: the more segments of liver that you take out, the higher the risk to the patient." he said.
"We hope our study findings interest more physicians who advise patients with liver cancers to send their patient to be evaluated by a liver surgeon, particularly high-risk patients who previously may not have been considered for a liver operation at all," Dr. Kingham concluded.
INFORMATION:
Other study participants include Camilo Correa-Gallego, MD; Michael I D'Angelica, MD, FACS; Mithat Gonen, PhD; Ronald P DeMatteo, MD, FACS; Yuman Fong, MD, FACS; Peter J Allen, MD, FACS; Leslie H. Blumgart, MD, FACS; and William R Jarnagin, MD, FACS.
"FACS"designates that a surgeon is a Fellow of the American College of Surgeons.
Support for this study was provided by NIH/NCI Cancer Center Support Grant P30 CA008748.
Citation: Hepatic Parenchymal Preservation Surgery: Decreasing Morbidity and Mortality Rates in 4,152 Resections for Malignancy, Journal of the American College of Surgeons. DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2014.12.026.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org.
Very low mammographic breast density worsens the prognosis of breast cancer, according to a recent study from the University of Eastern Finland. Disease free survivals as well as overall life expectancies were significantly shorter in women with very low-density breasts in comparison to women with high density breast tissue. The lower the breast tissue density, the less fibroglandular tissue there is compared to fat tissue.
In the future, these findings may prove significant for the assessment of breast cancer prognosis and treatment planning.
The study involved 270 ...
WASHINGTON, DC, March 12, 2015 -- Actresses need to be pickier than men about with whom they work if they want to survive in the movie industry, suggests a new study.
"My research indicates that women in the film industry suffer a lack of access to future career opportunities when they tend to work with people who have collaborated frequently in the past," said Mark Lutter, lead author of the study and head of the "Transnational Diffusion of Innovation" Research Group at the Max Planck Institute for the Study of Societies (MPIfG) in Germany.
Titled, "Do Women Suffer ...
WASHINGTON, D.C., March 12, 2015 - The American Educational Research Association has published a special edition of its peer-reviewed journal Educational Researcher (ER) devoted to examining value-added measures (VAM).
Since 2009, President Barack Obama's Race to the Top initiative has brought on a wave of value-added-based accountability measures, with value-added now embedded in policy in more than 30 states. AERA's journals have examined the validity and reliability of value-added measures over the past six years. This special issue of ER considers the key questions, ...
Materials resulting from chemical bonding of glucosamine, a type of sugar, with fullerenes, kind of nanoparticles known as buckyballs, might help to reduce cell damage and inflammation occurring after stroke. A team from the Max Planck Institute in Germany has tested this on mice, opening the door to potential new drugs for the cerebrovascular accident.
The majority of stroke occurs when the blood vessels that reach the brain are blocked by clots or fatty deposits which decrease the flow of blood towards its cells. It is then that an ischemic attack occurs, a pathology ...
Harvesting fire-killed trees is an effective way to reduce woody fuels for up to four decades following wildfire in dry coniferous forests, a U.S. Forest Service study has found.
The retrospective analysis, among the first to measure the long-term effects of post-fire logging on forest fuels, is published in the journal Forest Ecology and Management.
"Large wildfires can leave behind thousands of acres of fire-killed trees that eventually become fuel for future fires. In the past, post-fire logging has been conducted primarily to recover economic value from those fire-killed ...
Loneliness may be a fundamental part of the human condition, but scientists have only recently begun exploring its causes, consequences, and potential interventions. A special section in Perspectives on Psychological Science, a journal of the Association for Psychological Science, aims to bring these strands of inquiry together, presenting a series of articles that review the current state of scientific research on loneliness.
The section, edited by psychological scientist David Sbarra of the University of Arizona, investigates loneliness across multiple levels, from ...
CHESTNUT HILL, MA (March 12, 2015) Targeting deadly, drug-resistant bacteria poses a serious challenge to researchers looking for antibiotics that can kill pathogens without causing collateral damage in human cells. A team of Boston College chemists details a new approach using a "warhead" molecule to attack bacteria -- and spare healthy human cells -- by targeting a pair of lipids found on the surface of deadly germs, according to a report today in the journal Nature Communications.
The new strategy required the researchers to develop a novel type of "warhead molecule" ...
Study links oddly shaped hippocampus to poor long-term memory in former marijuana users
The longer teens used cannabis, the more abnormal the hippocampus as adults
Former users perform 18 percent worse on long-term memory test
Cannabis affects short and long-term memory
CHICAGO --- Teens who were heavy marijuana users - smoking it daily for about three years -- had an abnormally shaped hippocampus and performed poorly on long-term memory tasks, reports a new Northwestern Medicine study.
The hippocampus is important to long-term memory (also known as ...
A team of scientists from the John Innes Centre (JIC), the National Institute of Agricultural Botany (NIAB) and The Sainsbury Laboratory (TSL) have successfully transferred a receptor that recognises bacteria from the model plant Arabidopsis thaliana - a dicot, to wheat - a monocot. They showed that the receptor can trigger a defensive response and confers increased resistance to bacterial disease. The research findings demonstrate that the signalling pathways or circuitry downstream of the receptor are conserved between evolutionary distant monocots and dicots.
Drs Henk-jan ...
Researchers from ZSL and the Shaanxi Normal University, Xi'an, surveyed 43 farms in China and worked with the Shaanxi Province Fisheries Office to investigate the Chinese giant salamander farming industry. They found that, although only a decade old, the industry houses millions of animals and is a major contributor to the Chinese rural economy. The farming industry however, poses a number of threats to the Chinese giant salamander, but also has potential to benefit the species.
Wild salamanders are illegally poached to supplement farmed populations which often do not ...
