“Given the relative rarity of PCLD, current data on the outcomes of surgical debulking for advanced PCLD are scarce, particularly within the realm of laparoscopic hepatic
resection techniques. We therefore sought to evaluate the characteristics of patients undergoing operative debulking for advanced PCLD and analyze the perioperative and long-
term postoperative outcomes of hepatic resection for PCLD.”
“Adult polycystic liver disease (PCLD) is an autosomal dominant condition commonly associated with autosomal dominant polycystic kidney disease (ADPKD). However
in the last decade, it has been recognized that there is a distinct form of autosomal dominant PCLD that arises without concomitant ADPKD. Early knowledge of the pathogenesis was gained from the study of hepatic cysts in patients with ADPKD.”
“Colorectal cancer (CRC) represents a major worldwide health care burden, as the
second most common cancer diagnosed in women and third most common in men,
and accounting for 10% of all annually diagnosed cancers and cancer-related deaths
worldwide.
As result of improvements in detection through screening, better referral
pathways, centralisation of services, effective primary surgery, development of
systemic chemotherapy, biological agents, and understanding of tumour biology,
survival rates following diagnosis have improved.
Nevertheless, at least 25%-50% of patients with CRC develop colorectal liver
metastases (CRLM) during the course of their illness.”
“Advances in surgical techniques and perioperative management over the last 2–3 decades have enabled the safe performance of hepatic resections. In the 1980s, when the perioperative mortality was reported to be as high as around 10%, drain placement was
considered to be necessary so as to provide information about intraabdominal adverse events promptly and for prophylactic drainage. However, as the necessity of drain placement in other surgical fields has been ruled out and as the incidence of life-threatening adverse
events after hepatic resection decreased, several randomized controlled trials (RCTs) were performed; the conclusions of these trials were that drain placement was not necessary. However, some of them lacked a primary endpoint and calculation of sample size; in
the other studies, the primary endpoint was the incidence of wound-related complication, most of which could be resolved using antibiotics or bed-side opening of the wound, corresponding to Clavien-Dindo (C-D) grade 11 2 or even 1.”
“Historically, prophylactic intraoperative peritoneal drain placement has been advocated after hepatectomy in order to identify and drain bile leaks and decrease the risk of potential perihepatic fluid collections and abscess formation postoperatively. Several small randomized trials have suggested, however, that routine abdominal drainage after elective liver resection may not be necessary.”
“The use of drains in surgery has been practiced for many years. Prophylactic drainage of the abdominal cavity is employed to prevent the formation of collections and abscesses and for early detection of complications. For years, there has been debate as to whether the use of prophylactic drains has more advantages than disadvantages. For many procedures such as routine colon resection, cholecystectomy, and appendectomy, the use of prophylactic drains has been abandoned as studies have shown that drains do not lower the rate of postoperative complications. However, there is still debate of whether to leave a drain routinely after major liver resection.”
One discussion this week involved etiologies of postpancreatectomy hemorrhage.
Reference: Yekebas EF, et al. Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Annals of Surgery. 2007 Aug;246(2):269-280. doi:10.1097/01.sla.0000262953.77735.db
Summary: With the purpose of creating algorithms for managing postpancreatectomy hemorrhage (PPH), Yekebas et al (2007) restrospectively analyzed more than 1669 pancreatic resections conducted between 1992 and 2006. They concluded that the prognosis of postpancreatectomy hemorrhage (PPH) is primarily dependent on the presence of “preceding pancreatic fistula” (p.269).
Surgical Focus 