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(>Grade III, 22% vs. 48%, p30 min) were included in a double-blinded RCT at a single tertiary care center (2006-2009). Based
on the power calculation, 51 patients received intravenous PTX treatment starting 12hr before until
72hr after surgery, while 50 control patients received a saline infusion. Primary endpoint was liver regeneration
as assessed by 3D-volumetry based on MR tomography 8 days postoperatively compared
with preoperative images. Transaminases, cytokines and postoperative complications were recorded.
Results: Although overall liver regeneration was similar in both groups, PTX showed a beneficial effect
on liver regeneration in patients with a low remnant liver volume (remnant-liver-volume/ total-bodyweight
ratio RLV/TBW-ratio 30%)
failed to identify beneficial effects of PTX although the transaminases levels were decreased.
Conclusion: This is the first randomized controlled trial showing beneficial effects of PTX primarily regarding
liver regeneration in patients with low remnant liver volume and secondarily concerning I-/Rinjury
at the 2nd postoperative day. No effect on postoperative complications could be demonstrated
by PTX, might be due to the sample size which was not calculated on patient’s outcome. Therefore,
routine use of PXT cannot yet be recommended for liver resection and transplantation.
12.4
Novel and simple preoperative score predicting outcome following liver resection
S. Breitenstein, M.-L. De Oliveira, D. Raptis, K. Slankamenac, P. Kambakamba, J. Nerl, P.-A. Clavien
(Zurich)
Objective: To develop and validate a simple score to predict serious complications following liver resection
using readily available pre-operative risk factors. Background: Liver surgery is associated with
a substantial rate of complications. Early identification of patients at risk of serious complications is
important to adjust therapeutic strategies, to improve quality, and evaluate cost.
Methods: Complications were prospectively assessed in 615 consecutive non-cirrhotic patients undergoing
liver resection (2002-2008) at one institution. In randomly selected 60% of the population,
multivariate logistic regression analysis was used to develop a score to predict severe complications
defined as complications grade III, IV and V (according to Clavien/Dindo classification). The new score
was validated by calibration within the remaining 40% of the patients.
Results: Serious complications occurred in 159 of the 615 patients (26%) after liver resection, 90
(15%) grade III, 48 (8%) grade lV, and 21 (3%) grade V. Four preoperative parameters were identified
as independent predictors such as transaminases levels (AST), ASA, extend of liver resection and additional
hepatico-jejunostomy. The prediction score was developed involving 369 patients (60%) based
on the 4 predictors and ranged from 0 to 10 points. The risk to develop serious postoperative complications
was 16% in the “low risk” group (0-2 points), 37% in the “intermediate risk” group (3-5 points)
and 60% in the “high risk” group (6-10 points). The predicted mean absolute risk for serious complications
was 27% in the validation population (n=246), while the observed risk was 24%. Predicted and
observed risks were similar throughout the different risk categories (p=0.8). The score was significantly
associated with hospital and ICU stay. Costs of the procedure doubled in the high risk group.
Conclusion: This novel and simple score accurately predicts postoperative outcome and cost in patients
undergoing liver resection. The use of this score allows early identification of patients at risk of
complications and may impact not only on decision-making for surgical intervention but also on quality
assessment and reimbursement.
12.5
Portal vein resection at pancreaticoduodenectomy for pancreatic adenocarcinoma: are the outcomes
worse?
V. Banz 1,2 , D. Croagh 2 , C. Coldham 2 , J. Buckels 2 , J. Isaac 2 , D. Mayer 2 , P. Muiesan 2 , S. Bramhall 2 ,
D. Mirza 2 ( 1 Berne, 2 Birmingham/UK)
14 swiss knife 2010; 7: special edition
Objective: Despite improvements in patient selection, imaging and perioperative care for patients with
adenocarcinoma of the pancreas, 5-year survival rates remain low. Surgery and more recently adjuvant
chemotherapy provides the only potential cure. Selected patients with partial encasement of the
portal vein (PV) undergo simultaneous vein resection at pancreaticoduodenectomy (PD). This study
analyses outcomes for PD with or without PV resection in patients with pancreatic ductal adenocarcinoma
(PDA).
Methods: A retrospective analysis of prospectively collected data on patients requiring PD for histologically
proven adenocarcinoma between 1/1997 and 9/2009 identified 326 patients with PDA, 51
(15.6%) of whom required PD with PV resection. Patients with cholangiocarcinoma, duodenal and
ampullary carcinoma were excluded. Patients were analysed in two groups: PD+PV resection vs. PD
alone. Multivariate analysis was used to identify predictive variables (age, gender, hospital and ITU
stay, pylorus preserving or not, blood product use, postoperative complications, tumour grade, stage
and size, resection margin and site, lymphnode status, histological involvement of resected PV) influencing
survival. The Kaplan-Meier method was used to estimate patient survival after surgery.
Results: Mean age for patients with PV resection was 66.4 (range 46-80) years, 47% were male. Both
groups had similar patient demographics, perioperative and tumour characteristics. Postoperative
morbidity rates were similar for patients with and without PV resection (27.5 vs. 28.4%, p=0.287). 30day
mortality was significantly higher in patients with PV resection (13.7%, n=7) vs. PD alone (5.1%,
n=14), p=0.021. Overall survival however was similar in both groups (median survival PD alone 14.8
months vs. 14.5 months PD+PV, p=0.411). Multivariate analysis identified age (p=0.048), tumour
grading (p=0.046) and stay on the intensive care unit (p