Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers.

OBJECTIVE: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. BACKGROUND: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. METHODS: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a 5-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant comorbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. RESULTS: Of 8044 patients, 2908 (36%) qualified as benchmark (low-risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI ® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1, 4-8 or H4-8) disclosed a higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow-up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. CONCLUSION: These new benchmark cutoffs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation, or novel chemotherapy regimens.

The prognostic significance of serum aspartate transaminase and gamma-glutamyl transferase in liver deceased donors.

The impact of aspartate transaminases (AST) and gamma-glutamyl transferase (GGT) in serum of deceased donors on outcomes after liver transplantation (LT) is unclear. This study aimed to explore the relationship between donor highest AST value or first donor GGT value and graft survival. All consecutive patients who underwent a primary LT in a single center with available donor AST (N = 1253) and GGT value (N = 1152) were included. There was no significant association between donor AST and 90-day graft survival. We found a moderate association between GGT and 90-day graft survival. We found a significant interaction with a donor history of alcohol abuse (HAA). The risk of graft loss was associated with AST and GGT in donors with an HAA but remains unchanged in donors without HAA. There was no difference in graft survival according to donor AST or GGT with a cutoff ≥95th percentile (475 UI/l for AST and 170 UI/l for GGT). However, graft survival was significantly decreased when donors combined GGT ≥ 170 UI/l and HAA (61% at one year). Hepatic grafts from donors with high AST or high GGT but without alcohol history and no additional risk factors can be transplanted in low-risk recipient.

[Self-reported morbidity by riverbank dwellers from Porto Rico, PR, Brasil]. / Morbidade referida por moradores ribeirinhos de Porto Rico, PR, Brasil.

PURPOSE: To investigate the self-reported morbidity rate of riverbank dwellers from Porto Rico, PR, Brazil. METHODS: The case study compared the self-reported morbidity of two groups of residents. The sample consisted of 63 individuals of the three affordable housing complexes of that municipality. Information was collected through home surveys, during the months of June 2005 and January 2006. RESULTS: Most interviewed subjects had a positive perception of their health. The main health problems recalled were associated with arterial hypertension, nervous system conditions, depression, heart and respiratory problems and assorted infections. Alcohol was mentioned more often by group B and tobacco by group A. CONCLUSION: Health education, with emphasis on adopting healthy life habits helps in facing adverse health situations and promotes health.

[The absenteeism-disease of a nursing team in an intensive care unit]. / Absenteísmo-doença da equipe de enfermagem em unidade de terapia intensiva.

This study aimed at investigating the absenteeism disease in an Adult-ICU. The descriptive-exploratory study was carried out with 56 nurses who worked in the ICU in 2006. The frequency (fi)rate and the wasted-time percentage for the absenteeism disease were calculated. Most of the nurses are female (76.79%), between 30 and 39 years old (42.86%), and with a statutory bond (66.07%). The average of the missed workdays was higher in medium nursing workers (2.93), female (3.19), with a short-period bond (4.37), and from the night shift (6.22). The fi average of the team was 0.27 and the Wtp was 1.76%. The absenteeism disease was considered high and thus more studies are necessary in order to find its causes.