[Surgery in patients with liver cirrhosis]. / Chirurgie bei Patienten mit Leberzirrhose.

BACKGROUND AND OBJECTIVE: Patients with liver cirrhosis who are in need of surgery show a high in-hospital mortality. This study examined the risk of postoperative morbidity and in-hospital mortality after operations on patients with liver cirrhosis. MATERIAL AND METHODS: In the time period from January 2010 to December 2017 a total of 321 patients with liver cirrhosis underwent general surgery in this department. Liver-specific scoring systems, such as the Child-Pugh score (CPS) and MELD score were retrospectively assessed and correlated with in-hospital mortality and perioperative morbidity using the Dindo-Clavien classification. RESULTS: Of the 321 patients (68% male) 21.2% underwent emergency surgery. These patients showed a mortality of 60%, which is significantly higher than in elective surgery (12%, p < 0.0001). Complex interventions showed a 41% mortality, minor interventions still 20.5% (p = 0.0001). The postoperative complication rate and mortality were significantly different sorted by CPS with 11.8%/6.3% in the CPS A category and 84%/73% in the CPS C category, respectively (p = 0.001). Statistically in-hospital mortality was increased by 20% for every point increase in the MELD score (odds ratio, OR 1.23, p = 0.0001). The presence of hepatic decompensation had the worst prognosis. CONCLUSION: Surgical interventions in patients with liver cirrhosis are associated with a high complication rate and in-hospital mortality. The CPS and MELD scores can be used for objective risk assessment, while clinical examination for signs of hepatic decompensation is also important. Laboratory values, such as sodium and creatinine can assist the assessment.

Polo-like kinase 3 is associated with improved overall survival in cholangiocarcinoma.

BACKGROUND & AIMS: Cholangiocarcinomas (CCA) paradoxically express the death ligand TRAIL and thus, are dependent on effective survival signals to circumvent apoptosis. Hedgehog signalling exerts major survival signals in CCA by regulating serine/threonine kinase polo-like kinase (PLK)2. We here aimed to examine the role of PLK1/2/3 expression for CCA tumour biology. METHODS: We employed CCA samples from 73 patients and human HUCCT-1/Mz-CHA1/KMCH-1 CCA cells. Immunohistochemistry for PLK1/2/3 was performed using tissue microarrays from representative tumour areas. RESULTS: PLK1/2/3-immunoreactive cancer cells were present in most of the CCA samples. However, only PLK1 and especially PLK3 were expressed in higher amounts within CCA cells as compared to normal liver. Given that fibroblast growth factor (FGF) can induce PLK3 expression and also is present in CCA, we examined the effect of FGF on PLK3 in vitro. Indeed, rhFGF rapidly increased PLK3 mRNA expression all three CCA cell lines giving an explanation for the abundant PLK3 presence in the tissue samples. Clinicopathologically, PLK3 expression was associated with decreased tumour cell migration and lymph/blood vessel infiltration whereas higher levels of PLK1 were correlated with larger tumour sizes. Moreover, strong PLK3 expression was associated with prolonged overall survival. CONCLUSIONS: The results suggest that PLK3 predominantly is expressed in CCA cells and that high PLK3 expression correlates with prolonged overall survival. These observations might have implications for prognosis prediction of human CCA as well as the potential therapeutic use of polo-like kinase inhibitors (i.e., PLK1/2 specifity).

Major liver resections in the elderly-is an aggressive approach justified?

BACKGROUND AND AIMS: As the mean life expectancy rises, the incidence of patients 75 years of age and older who present with colorectal liver metastases continues to increase. The purpose of our study was to evaluate the outcome of major hepatic resections in the elderly population. PATIENT AND METHODS: From April 1998 to December 2006, 572 consecutive patients with colorectal liver metastases were treated at our Institution. Of these, 59 were 75 years or older. There was an intent to proceed with major liver resections in all cases. Data were analyzed according to diagnosis, comorbidities, extent of liver resection, postoperative complications, overall survival, and disease-free survival. RESULTS: Surgical treatment included right hepatectomies (n = 8), left hepatectomies (n = 4), and sectionectomies (more than three segments; n = 33). Fourteen (n = 14) patients received an explorative laparotomy alone. Morbidity and hospital mortality were 10% and 3%, respectively. Overall survival of 1, 3, and 5 years was 90%, 64%, and 33%, respectively. The corresponding disease-free survival was 74%, 42%, and 32%. Resection margin (R class) was the only predictor of survival by both uni- and multivariate analyses. CONCLUSION: Hepatic resections can be performed safely in selected patients 75 years of age or older.