RESUMEN
BACKGROUND AND OBJECTIVES: Postoperative complications (POCs) after hepatic resection for colorectal liver metastases (CRLM) adversely affect long-term survival. The aim of this study was to analyze the effect of POC etiology and severity on overall survival (OS) and disease-free survival (DFS). METHODS: A retrospective study of 254 consecutive hepatectomies for CRLM was performed. Univariate and multivariate analyses were performed to determine the effects of demographic, tumor-related and perioperative variables on OS and DFS. A 1:1 propensity score matching (PSM) was then used to compare patients with different POC etiology: infective (Inf-POC), noninfective (Non-inf POC), and no-complications (No-POC). RESULTS: Inf-POC, Non-inf POC, and No-POC patients represented 18.8%, 19.2%, and 62% of the sample, respectively. In univariate and multivariate analyses infectious POC were independent risk factors for decreased OS and DFS. After PSM, Inf-POC group presented decreased OS and DFS when compared with Non-inf POC (5-year OS 31.8% vs 51.6%; P = .05 and 5-year DFS 13.6% vs 31.9%; P = .04) and with No-POC (5-year OS 29.4% vs 58.7%; P = .03 and 5-year DFS 11.8% vs 39.7%; P = .03). There were no differences between Non-inf POC and No-POC patients. POC severity calculated using the Comprehensive Complications Index did not influence OS and DFS before and after PSM. CONCLUSION: The negative oncological impact of POCs after CRLM resection is determined by infective etiology not by severity.
Asunto(s)
Neoplasias Colorrectales/cirugía , Hepatectomía/efectos adversos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Anciano , Estudios de Cohortes , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Hepatectomía/mortalidad , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/patología , Puntaje de Propensión , Estudios Retrospectivos , España/epidemiología , Tasa de SupervivenciaRESUMEN
La rotura hepática espontánea asociada a síndrome de HELLP (hemólisis, elevación de enzimas hepáticas y plaquetopenia) es extremadamente rara y se acompaña de una elevada tasa de complicaciones y mortalidad maternofetal. Es necesario un tratamiento urgente basado en la finalización del embarazo, reposición de hemoderivados y hemostasia hepática.Presentamos el caso de una paciente con síndrome HELLP y rotura hepática espontánea tratada mediante cesárea urgente y packing hepático (AU)
Spontaneous hepatic rupture associated with HELLP syndrome (hemolysis, elevated liver enzyme levels and low platelet count) is a very rare phenomenon that is frequently associated with a substantial rate of complications and mortality. In these cases, urgent management based on prompt delivery, blood transfusion and hepatic hemostasis is required.We report the case of a patient with spontaneous hepatic rupture caused by HELLP syndrome, which was treated with urgent cesarean section and hepatic packing (AU)