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  • 1
    Online Resource
    Online Resource
    A nationwide assessment of hepatocellular adenoma resection: Indications and pathological discordance
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Hepatology Communications Vol. 7, No. 1 ( 2022-11-2), p. e2110-e2110
    Details
    In: Hepatology Communications, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 1 ( 2022-11-2), p. e2110-e2110
    Abstract: Hepatocellular adenomas (HCAs) are benign liver tumors associated with bleeding or malignant transformation. Data on the indication for surgery are scarce. We analyzed indications and outcome of patients operated for HCAs  〈  50 mm compared to HCAs ≥ 50 mm. Changes in final postoperative diagnosis were assessed. We performed a retrospective study that included patients who underwent resection for (suspected) HCAs in the Netherlands from 2014 to 2019. Indication for resection was analyzed and stratified for small ( 〈 50 mm) and large (≥50 mm) tumors. Logistic regression analysis was performed on factors influencing change in tumor diagnosis. Out of 222 patients who underwent surgery, 44 (20%) patients had a tumor 〈 50 mm. Median age was 46 (interquartile range [IQR], 33–56) years in patients with small tumors and 37 (IQR, 31–46) years in patients with large tumors ( p  = 0.016). Patients with small tumors were more frequently men (21% vs. 5%, p  = 0.002). Main indications for resection in patients with small tumors were suspicion of (pre)malignancy (55%), (previous) bleeding (14%), and male sex (11%). Patients with large tumors received operations because of tumor size 〉 50 mm (52%), suspicion of (pre)malignancy (28%), and (previous) bleeding (5.1%). No difference was observed in HCA‐subtype distribution between small and large tumors. Ninety‐six (43%) patients had a postoperative change in diagnosis. Independent risk factors for change in diagnosis were tumor size 〈 50 mm (adjusted odds ratio [aOR], 3.4; p   〈  0.01), male sex (aOR, 3.7; p  = 0.03), and lack of hepatobiliary contrast‐enhanced magnetic resonance imaging (CE‐MRI) (aOR, 1.8; p  = 0.04). Resection for small (suspected) HCAs was mainly indicated by suspicion of (pre)malignancy, whereas for large (suspected) HCAs, tumor size was the most prevalent indication. Male sex, tumor size  〈 50 mm, and lack of hepatobiliary CE‐MRI were independent risk factors for postoperative change in tumor diagnosis.
    Type of Medium: Online Resource
    ISSN: 2471-254X
    URL: Article
    DOI: 10.1002/hep4.2110
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2881134-3
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  • 2
    Online Resource
    Online Resource
    Practice variation and outcomes of minimally invasive minor liver resections in patients with colorectal liver metastases: a population-based study
    Springer Science and Business Media LLC ; 2023
    In:  Surgical Endoscopy Vol. 37, No. 8 ( 2023-08), p. 5916-5930
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 37, No. 8 ( 2023-08), p. 5916-5930
    Abstract: In 2017, the Southampton guideline stated that minimally invasive liver resections (MILR) should considered standard practice for minor liver resections. This study aimed to assess recent implementation rates of minor MILR, factors associated with performing MILR, hospital variation, and outcomes in patients with colorectal liver metastases (CRLM). Methods This population-based study included all patients who underwent minor liver resection for CRLM in the Netherlands between 2014 and 2021. Factors associated with MILR and nationwide hospital variation were assessed using multilevel multivariable logistic regression. Propensity-score matching (PSM) was applied to compare outcomes between minor MILR and minor open liver resections. Overall survival (OS) was assessed with Kaplan–Meier analysis on patients operated until 2018. Results Of 4,488 patients included, 1,695 (37.8%) underwent MILR. PSM resulted in 1,338 patients in each group. Implementation of MILR increased to 51.2% in 2021. Factors associated with not performing MILR included treatment with preoperative chemotherapy (aOR 0.61 CI:0.50–0.75, p   〈  0.001), treatment in a tertiary referral hospital (aOR 0.57 CI:0.50–0.67, p   〈  0.001), and larger diameter and number of CRLM. Significant hospital variation was observed in use of MILR (7.5% to 93.0%). After case-mix correction, six hospitals performed fewer, and six hospitals performed more MILRs than expected. In the PSM cohort, MILR was associated with a decrease in blood loss (aOR 0.99 CI:0.99–0.99, p   〈  0.01), cardiac complications (aOR 0.29, CI:0.10–0.70, p  = 0.009), IC admissions (aOR 0.66, CI:0.50–0.89, p  = 0.005), and shorter hospital stay (aOR CI:0.94–0.99, p   〈  0.01). Five-year OS rates for MILR and OLR were 53.7% versus 48.6%, p  = 0.21. Conclusion Although uptake of MILR is increasing in the Netherlands, significant hospital variation remains. MILR benefits short-term outcomes, while overall survival is comparable to open liver surgery. Graphical abstract
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-023-10010-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1463171-4
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