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Masato Nagino - One of the best experts on this subject based on the ideXlab platform.
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postoperative infectious complications caused by multidrug resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2020Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Masato NaginoAbstract:Abstract Background Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with Extrahepatic Bile Duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. Methods Medical records of consecutive patients who underwent major hepatectomy with Extrahepatic Bile Duct resection between 2006 and 2017 were retrospectively reviewed. Results Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P Conclusion The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with Extrahepatic Bile Duct resection.
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preoperative biliary colonization infection caused by multidrug resistant mdr pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Tetsuya Yagi, Masato NaginoAbstract:Abstract Background The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with Extrahepatic Bile Duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens. Methods Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance Bile cultures. Results In total, 565 patients underwent surgical resection. Based on the results of Bile cultures, the patients were classified into three groups: group A, patients with negative Bile cultures (n = 113); group B, patients with positive Bile cultures without multidrug-resistant pathogen growth (n = 416); and group C, patients with multidrug-resistant pathogen–positive Bile culture (n = 36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive Bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P Conclusion Major hepatectomy with Extrahepatic Bile Duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens.
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duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Takashi Mizuno, Masahiko Ando, Tetsuya Yagi, Masato NaginoAbstract:Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with Extrahepatic Bile Duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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a clear difference between the outcomes after a major hepatectomy with and without an Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Takehiro Takagi, Tomoki Ebata, Yukihiro Yokoyama, Toshio Kokuryo, Masahiko Ando, Masato NaginoAbstract:The procedure of a simple hepatectomy and a hepatectomy with an Extrahepatic Bile Duct resection and subsequent choledocho-jejunostomy is largely different. However, these two procedures are sometimes included in the same category. There are no studies comparing postoperative course and liver regeneration rate after a major hepatectomy with and without an Extrahepatic Bile Duct resection. We retrospectively reviewed medical records of 245 patients who underwent a right hepatectomy (RH, n = 55) or RH with an Extrahepatic Bile Duct resection (RHEBR, n = 190). Postoperative complications, including incidence of posthepatectomy liver failure (PHLF) and hepatic regeneration rates after surgery, were evaluated. The incidence of PHLF was considerably higher in the RHEBR group than in the RH group (39.5 vs. 16.4 %, p = 0.001). The percentage of newly regenerated liver volume after the hepatectomies on postoperative days 6–8 was significantly lower in the RHEBR group than in the RH group (14.0 % in the RH; 7.9 % in the RHEBR group, p < 0.001). Especially type of surgery (RHEBR) was the only independent risk factor for an impaired liver regeneration rate by univariate and multivariate analyses. Furthermore, estimated hepatic regeneration rate by stepwise linear regression analysis in the RHEBR group was 7.1 % lower (95 % confidence interval 1.8–12.3, p = 0.011) than in the RH group. These results suggest that the procedure of Extrahepatic Bile Duct resection has a possibility of adverse impact on the postoperative outcome after major hepatectomy.
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surgery related muscle loss and its association with postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Hidehiko Otsuji, Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Masato NaginoAbstract:Several studies have reported that preoperative sarcopenia negatively impacts postoperative outcomes. Meanwhile, changes in skeletal muscle mass during the acute phase after surgery and their association with postoperative complications are unknown. The objective of this study was to investigate the relation between changes in skeletal muscle mass and postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection. This study included 254 patients who underwent major hepatectomies with Extrahepatic Bile Duct resections. Total psoas muscle area (TPA) was measured using abdominal computed tomography images obtained before and 1 week after surgery. The percent change in TPA after surgery was calculated. Patients were stratified by sex-specific tertiles according to the extent of muscle mass change by percentage. Surgery-related muscle loss (SML) was defined as the lowest tertile of percent change in TPA. Male patients with a percent change of TPA lower than −5.0 % (n = 54) and female patients with that lower than −2.6 % (n = 31) were included in the lowest tertile and were categorized into a group with SML. The incidence rates of major complications, pancreatic fistula, infectious complications, and mortality were all significantly higher in the group with SML than in the group without SML. By multivariate analyses, SML was identified as an independent factor associated with major complications (odds ratio 3.21; 95 % confidential interval 1.82–5.76, p < 0.001). SML is significantly associated with postoperative morbidity and mortality in patients who underwent major hepatectomies with Extrahepatic Bile Duct resections.
Tomoki Ebata - One of the best experts on this subject based on the ideXlab platform.
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impact of perioperative steroid administration in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgical Oncology, 2021Co-Authors: Shunsuke Onoe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Nobuyuki Watanabe, Shogo Suzuki, Kimitoshi Nishiwaki, Masahiko AndoAbstract:To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of ‘minor’ hepatectomies. The benefit of steroid administration for patients undergoing ‘complex’ hepatectomy, such as major hepatectomy with Extrahepatic Bile Duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy. Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with Extrahepatic Bile Duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure. A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups. Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with Extrahepatic Bile Duct resection.
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postoperative infectious complications caused by multidrug resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2020Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Masato NaginoAbstract:Abstract Background Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with Extrahepatic Bile Duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. Methods Medical records of consecutive patients who underwent major hepatectomy with Extrahepatic Bile Duct resection between 2006 and 2017 were retrospectively reviewed. Results Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P Conclusion The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with Extrahepatic Bile Duct resection.
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preoperative biliary colonization infection caused by multidrug resistant mdr pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Tetsuya Yagi, Masato NaginoAbstract:Abstract Background The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with Extrahepatic Bile Duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens. Methods Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance Bile cultures. Results In total, 565 patients underwent surgical resection. Based on the results of Bile cultures, the patients were classified into three groups: group A, patients with negative Bile cultures (n = 113); group B, patients with positive Bile cultures without multidrug-resistant pathogen growth (n = 416); and group C, patients with multidrug-resistant pathogen–positive Bile culture (n = 36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive Bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P Conclusion Major hepatectomy with Extrahepatic Bile Duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens.
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duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Takashi Mizuno, Masahiko Ando, Tetsuya Yagi, Masato NaginoAbstract:Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with Extrahepatic Bile Duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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a clear difference between the outcomes after a major hepatectomy with and without an Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Takehiro Takagi, Tomoki Ebata, Yukihiro Yokoyama, Toshio Kokuryo, Masahiko Ando, Masato NaginoAbstract:The procedure of a simple hepatectomy and a hepatectomy with an Extrahepatic Bile Duct resection and subsequent choledocho-jejunostomy is largely different. However, these two procedures are sometimes included in the same category. There are no studies comparing postoperative course and liver regeneration rate after a major hepatectomy with and without an Extrahepatic Bile Duct resection. We retrospectively reviewed medical records of 245 patients who underwent a right hepatectomy (RH, n = 55) or RH with an Extrahepatic Bile Duct resection (RHEBR, n = 190). Postoperative complications, including incidence of posthepatectomy liver failure (PHLF) and hepatic regeneration rates after surgery, were evaluated. The incidence of PHLF was considerably higher in the RHEBR group than in the RH group (39.5 vs. 16.4 %, p = 0.001). The percentage of newly regenerated liver volume after the hepatectomies on postoperative days 6–8 was significantly lower in the RHEBR group than in the RH group (14.0 % in the RH; 7.9 % in the RHEBR group, p < 0.001). Especially type of surgery (RHEBR) was the only independent risk factor for an impaired liver regeneration rate by univariate and multivariate analyses. Furthermore, estimated hepatic regeneration rate by stepwise linear regression analysis in the RHEBR group was 7.1 % lower (95 % confidence interval 1.8–12.3, p = 0.011) than in the RH group. These results suggest that the procedure of Extrahepatic Bile Duct resection has a possibility of adverse impact on the postoperative outcome after major hepatectomy.
Gen Sugawara - One of the best experts on this subject based on the ideXlab platform.
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postoperative infectious complications caused by multidrug resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2020Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Masato NaginoAbstract:Abstract Background Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with Extrahepatic Bile Duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. Methods Medical records of consecutive patients who underwent major hepatectomy with Extrahepatic Bile Duct resection between 2006 and 2017 were retrospectively reviewed. Results Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P Conclusion The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with Extrahepatic Bile Duct resection.
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preoperative biliary colonization infection caused by multidrug resistant mdr pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Tetsuya Yagi, Masato NaginoAbstract:Abstract Background The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with Extrahepatic Bile Duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens. Methods Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance Bile cultures. Results In total, 565 patients underwent surgical resection. Based on the results of Bile cultures, the patients were classified into three groups: group A, patients with negative Bile cultures (n = 113); group B, patients with positive Bile cultures without multidrug-resistant pathogen growth (n = 416); and group C, patients with multidrug-resistant pathogen–positive Bile culture (n = 36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive Bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P Conclusion Major hepatectomy with Extrahepatic Bile Duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens.
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duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Takashi Mizuno, Masahiko Ando, Tetsuya Yagi, Masato NaginoAbstract:Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with Extrahepatic Bile Duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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surgery related muscle loss and its association with postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Hidehiko Otsuji, Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Masato NaginoAbstract:Several studies have reported that preoperative sarcopenia negatively impacts postoperative outcomes. Meanwhile, changes in skeletal muscle mass during the acute phase after surgery and their association with postoperative complications are unknown. The objective of this study was to investigate the relation between changes in skeletal muscle mass and postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection. This study included 254 patients who underwent major hepatectomies with Extrahepatic Bile Duct resections. Total psoas muscle area (TPA) was measured using abdominal computed tomography images obtained before and 1 week after surgery. The percent change in TPA after surgery was calculated. Patients were stratified by sex-specific tertiles according to the extent of muscle mass change by percentage. Surgery-related muscle loss (SML) was defined as the lowest tertile of percent change in TPA. Male patients with a percent change of TPA lower than −5.0 % (n = 54) and female patients with that lower than −2.6 % (n = 31) were included in the lowest tertile and were categorized into a group with SML. The incidence rates of major complications, pancreatic fistula, infectious complications, and mortality were all significantly higher in the group with SML than in the group without SML. By multivariate analyses, SML was identified as an independent factor associated with major complications (odds ratio 3.21; 95 % confidential interval 1.82–5.76, p < 0.001). SML is significantly associated with postoperative morbidity and mortality in patients who underwent major hepatectomies with Extrahepatic Bile Duct resections.
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the predictive value of indocyanine green clearance in future liver remnant for posthepatectomy liver failure following hepatectomy with Extrahepatic Bile Duct resection
World Journal of Surgery, 2016Co-Authors: Yukihiro Yokoyama, Gen Sugawara, Tomoki Ebata, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Masato NaginoAbstract:Postoperative liver failure (PHLF) is one of the most common complications following major hepatectomy. The preoperative assessment of future liver remnant (FLR) function is critical to predict the incidence of PHLF. To determine the efficacy of the plasma clearance rate of indocyanine green clearance of FLR (ICGK-F) in predicting PHLF in cases of highly invasive hepatectomy with Extrahepatic Bile Duct resection. Five hundred and eighty-five patients who underwent major hepatectomy with Extrahepatic Bile Duct resection, from 2002 to 2014 in a single institution, were evaluated. Among them, 192 patients (33 %) had PHLF. The predictive value of ICGK-F for PHLF was determined and compared with other risk factors for PHLF. The incidence of PHLF was inversely proportional to the level of ICGK-F. With multivariate logistic regression analysis, ICGK-F, combined pancreatoduodenectomy, the operation time, and blood loss were identified as independent risk factors of PHLF. The risk of PHLF increased according to the decrement of ICGK-F (the odds ratio of ICGK-F for each decrement of 0.01 was 1.22; 95 % confidence interval 1.12–1.33; P < 0.001). Low ICGK-F was also identified as an independent risk factor predicting the postoperative mortality. ICGK-F is useful in predicting the PHLF and mortality in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection. This criterion may be useful for highly invasive hepatectomy, such as that with Extrahepatic Bile Duct resection.
Yukihiro Yokoyama - One of the best experts on this subject based on the ideXlab platform.
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impact of perioperative steroid administration in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgical Oncology, 2021Co-Authors: Shunsuke Onoe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Nobuyuki Watanabe, Shogo Suzuki, Kimitoshi Nishiwaki, Masahiko AndoAbstract:To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of ‘minor’ hepatectomies. The benefit of steroid administration for patients undergoing ‘complex’ hepatectomy, such as major hepatectomy with Extrahepatic Bile Duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy. Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with Extrahepatic Bile Duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure. A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups. Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with Extrahepatic Bile Duct resection.
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postoperative infectious complications caused by multidrug resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2020Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Masato NaginoAbstract:Abstract Background Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with Extrahepatic Bile Duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. Methods Medical records of consecutive patients who underwent major hepatectomy with Extrahepatic Bile Duct resection between 2006 and 2017 were retrospectively reviewed. Results Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P Conclusion The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with Extrahepatic Bile Duct resection.
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preoperative biliary colonization infection caused by multidrug resistant mdr pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Tetsuya Yagi, Masato NaginoAbstract:Abstract Background The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with Extrahepatic Bile Duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens. Methods Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance Bile cultures. Results In total, 565 patients underwent surgical resection. Based on the results of Bile cultures, the patients were classified into three groups: group A, patients with negative Bile cultures (n = 113); group B, patients with positive Bile cultures without multidrug-resistant pathogen growth (n = 416); and group C, patients with multidrug-resistant pathogen–positive Bile culture (n = 36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive Bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P Conclusion Major hepatectomy with Extrahepatic Bile Duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens.
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duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Takashi Mizuno, Masahiko Ando, Tetsuya Yagi, Masato NaginoAbstract:Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with Extrahepatic Bile Duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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a clear difference between the outcomes after a major hepatectomy with and without an Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Takehiro Takagi, Tomoki Ebata, Yukihiro Yokoyama, Toshio Kokuryo, Masahiko Ando, Masato NaginoAbstract:The procedure of a simple hepatectomy and a hepatectomy with an Extrahepatic Bile Duct resection and subsequent choledocho-jejunostomy is largely different. However, these two procedures are sometimes included in the same category. There are no studies comparing postoperative course and liver regeneration rate after a major hepatectomy with and without an Extrahepatic Bile Duct resection. We retrospectively reviewed medical records of 245 patients who underwent a right hepatectomy (RH, n = 55) or RH with an Extrahepatic Bile Duct resection (RHEBR, n = 190). Postoperative complications, including incidence of posthepatectomy liver failure (PHLF) and hepatic regeneration rates after surgery, were evaluated. The incidence of PHLF was considerably higher in the RHEBR group than in the RH group (39.5 vs. 16.4 %, p = 0.001). The percentage of newly regenerated liver volume after the hepatectomies on postoperative days 6–8 was significantly lower in the RHEBR group than in the RH group (14.0 % in the RH; 7.9 % in the RHEBR group, p < 0.001). Especially type of surgery (RHEBR) was the only independent risk factor for an impaired liver regeneration rate by univariate and multivariate analyses. Furthermore, estimated hepatic regeneration rate by stepwise linear regression analysis in the RHEBR group was 7.1 % lower (95 % confidence interval 1.8–12.3, p = 0.011) than in the RH group. These results suggest that the procedure of Extrahepatic Bile Duct resection has a possibility of adverse impact on the postoperative outcome after major hepatectomy.
Takashi Mizuno - One of the best experts on this subject based on the ideXlab platform.
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impact of perioperative steroid administration in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgical Oncology, 2021Co-Authors: Shunsuke Onoe, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Nobuyuki Watanabe, Shogo Suzuki, Kimitoshi Nishiwaki, Masahiko AndoAbstract:To date, five randomized controlled trials have assessed the clinical benefit of perioperative steroid administration in hepatectomy; however, all of these studies involved a substantial number of ‘minor’ hepatectomies. The benefit of steroid administration for patients undergoing ‘complex’ hepatectomy, such as major hepatectomy with Extrahepatic Bile Duct resection, is still unclear. This study aimed to evaluate the clinical benefit of perioperative steroid administration for complex major hepatectomy. Patients with suspected hilar malignancy scheduled to undergo major hepatectomy with Extrahepatic Bile Duct resection were randomized into either the control or steroid groups. The steroid group received hydrocortisone 500 mg immediately before hepatic pedicle clamping, followed by hydrocortisone 300 mg on postoperative day (POD) 1, 200 mg on POD 2, and 100 mg on POD 3. The control group received only physiologic saline. The primary endpoint was the incidence of postoperative liver failure. A total of 94 patients were randomized to either the control (n = 46) or steroid (n = 48) groups. The two groups had similar baseline characteristics; however, there were no significant differences between the groups in the incidence of grade B/C postoperative liver failure (control group, n = 8, 17%; steroid group, n = 4, 8%; p = 0.188) and other complications. Serum bilirubin levels on PODs 2 and 3 were significantly lower in the steroid group than those in the control group; however, these median values were within normal limits in both groups. Perioperative steroid administration did not reduce the risk of postoperative complications, including liver failure following major hepatectomy with Extrahepatic Bile Duct resection.
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postoperative infectious complications caused by multidrug resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2020Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Shunsuke Onoe, Nobuyuki Watanabe, Masato NaginoAbstract:Abstract Background Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with Extrahepatic Bile Duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. Methods Medical records of consecutive patients who underwent major hepatectomy with Extrahepatic Bile Duct resection between 2006 and 2017 were retrospectively reviewed. Results Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P Conclusion The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with Extrahepatic Bile Duct resection.
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preoperative biliary colonization infection caused by multidrug resistant mdr pathogens in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection
Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Tetsuya Yagi, Masato NaginoAbstract:Abstract Background The aim of this study was to review the surgical outcomes of patients who underwent major hepatectomy with Extrahepatic Bile Duct resection after preoperative biliary drainage with a particular focus on the impact of preoperative biliary colonization/infection caused by multidrug-resistant pathogens. Methods Medical records of patients who underwent hepatobiliary resection after preoperative external biliary drainage between 2001 and 2015 were reviewed retrospectively. Prophylactic antibiotics were selected according to the results of drug susceptibility tests of surveillance Bile cultures. Results In total, 565 patients underwent surgical resection. Based on the results of Bile cultures, the patients were classified into three groups: group A, patients with negative Bile cultures (n = 113); group B, patients with positive Bile cultures without multidrug-resistant pathogen growth (n = 416); and group C, patients with multidrug-resistant pathogen–positive Bile culture (n = 36). The incidence of organ/space surgical site infection, bacteremia, median duration of postoperative hospital stay, and the mortality rate did not differ among the three groups. The incidence of incisional surgical site infection and infectious complications caused by multidrug-resistant pathogens was significantly higher in group C than in groups A and B. Fifty-two patients had postoperative infectious complications caused by multidrug-resistant pathogens. Multivariate analysis identified preoperative multidrug-resistant pathogen–positive Bile culture as a significant independent risk factor for postoperative infectious complications caused by multidrug-resistant pathogens (P Conclusion Major hepatectomy with Extrahepatic Bile Duct resection after biliary drainage can be performed with acceptable rates of morbidity and mortality using appropriate antibiotic prophylaxis, even in patients with biliary colonization/infection caused by multidrug-resistant pathogens.
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duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with Extrahepatic Bile Duct resection a randomized controlled trial
Annals of Surgery, 2018Co-Authors: Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Takashi Mizuno, Masahiko Ando, Tetsuya Yagi, Masato NaginoAbstract:Objective:To evaluate the optimal duration of antimicrobial prophylaxis in patients undergoing “complicated”’ major hepatectomy with Extrahepatic Bile Duct resection.Background:To date, 4 randomized controlled trials (RCTs) have assessed the duration of antimicrobial prophylaxis after hepatectomy. H
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surgery related muscle loss and its association with postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection
World Journal of Surgery, 2017Co-Authors: Hidehiko Otsuji, Gen Sugawara, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Takashi Mizuno, Junpei Yamaguchi, Masato NaginoAbstract:Several studies have reported that preoperative sarcopenia negatively impacts postoperative outcomes. Meanwhile, changes in skeletal muscle mass during the acute phase after surgery and their association with postoperative complications are unknown. The objective of this study was to investigate the relation between changes in skeletal muscle mass and postoperative complications after major hepatectomy with Extrahepatic Bile Duct resection. This study included 254 patients who underwent major hepatectomies with Extrahepatic Bile Duct resections. Total psoas muscle area (TPA) was measured using abdominal computed tomography images obtained before and 1 week after surgery. The percent change in TPA after surgery was calculated. Patients were stratified by sex-specific tertiles according to the extent of muscle mass change by percentage. Surgery-related muscle loss (SML) was defined as the lowest tertile of percent change in TPA. Male patients with a percent change of TPA lower than −5.0 % (n = 54) and female patients with that lower than −2.6 % (n = 31) were included in the lowest tertile and were categorized into a group with SML. The incidence rates of major complications, pancreatic fistula, infectious complications, and mortality were all significantly higher in the group with SML than in the group without SML. By multivariate analyses, SML was identified as an independent factor associated with major complications (odds ratio 3.21; 95 % confidential interval 1.82–5.76, p < 0.001). SML is significantly associated with postoperative morbidity and mortality in patients who underwent major hepatectomies with Extrahepatic Bile Duct resections.
