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Non Hepatic Surgery in Cirrhotic Patients: 10 Year Experience - Vision Beyond Nihilism
( Saurabh Galodha ),( Waliullah Siddiqui ),( Jacob Mathew ),( John Mathew ),( Manipadam ),( Abhishek Yadav ),( Mahesh S,H Ramesh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Non hepatic surgery in cirrhotic patients has been viewed with a feeling of nihilism with reported in hospital mortality rates of 8-25%. In this study we look for risk factors associated with increased morbidity and mortality and present a positive perspective for these patients. Methods: A retrospective analysis of patients with cirrhosis undergoing nonhepatic surgery during the period from January 2007 to December 2016 was done. Child Turcot Pugh (CTP) and MELD scores, intraoperative parameters, perioperative morbidity (Clavien Dindo classification) and mortality and hospital stay was recorded. Results: 193 patients with cirrhosis underwent non-hepatic surgery. 88 patients (45%) had biliary pathology. Other groups were gastroduodenal (n=20,10%), pancreatic (n=13,6.7%), colorectal (n=15,7.5%) and hernia (n=13,6.7%). 38 patients (19.6%) underwent surgery for malignancy. Emergency surgery was done in 6 patients. 133 patients had CTP grade A while 49 patients grade B and 11 patients had grade C. Mean MELD score was 8.5 ± 5.2. Overall mean operating time was 3.1 ± 1.1 hours with mean blood loss of 105 ± 40 ml while in those undergoing major surgery (Frey’s procedure, pancreaticoduodenectomy, colorectal resections, gastrectomy) operating time was 4.5 ± 2.6 hours and blood loss was 335 ± 130 ml. Median blood transfusion requirement was 2 (1-5) PRBC in these patients. Major morbidity (Clavien Dindo > 3) was seen in 11 patients (5.6%) with majority having CTP grade C (n=6,55%). Perioperative mortality occurred in 2 patients (1%). Patients undergoing surgery in emergency had more morbidity (n=2,33%) and mortality (n=1,16%). Conclusions: In cirrhotic patients undergoing non-hepatic surgery factors associated with poor outcomes are emergency surgery, higher CTP grade and MELD score. We need to shun nihilistic attitude in these patients as better preoperative optimization and meticulous surgery lead to very good outcomes.
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Ramesh Babu Telugu,Anne Jennifer Prabhu,Nobin Babu Kalappurayil,John Mathai,Birla Roy Gnanamuthu,Marie Therese Manipadam 대한병리학회 2017 Journal of Pathology and Translational Medicine Vol.51 No.3
Background: Inflammatory myofibroblastic tumor is a histopathologically distinctive neoplasm of children and young adults. According to World Health Organization (WHO) classification, inflammatory myofibroblastic tumor is an intermediate-grade tumor, with potential for recurrence and rare metastasis. There are no definite histopathologic, molecular, or cytogenetic features to predict malignant transformation, recurrence, or metastasis. Methods: A 5-year retrospective study of histopathologically diagnosed inflammatory myofibroblastic tumors of various anatomic sites was conducted to correlate anaplastic lymphoma kinase-1 (ALK-1) expression with histological atypia, multicentric origin of tumor, recurrence, and metastasis. Clinical details of all the cases were noted from the clinical work station. Immunohistochemical stains for ALK-1 and other antibodies were performed. Statistical analysis was done using Fisher exact test. Results: A total of 18 cases of inflammatory myofibroblastic tumors were found during the study period, of which 14 were classical. The female-male ratio was 1:1 and the mean age was 23.8 years. Histologically atypical (four cases) and multifocal tumors (three cases, multicentric in origin) were noted. Recurrence was noted in 30% of ALK-1 positive and 37.5% of ALK-1 negative cases, whereas metastasis to the lung, liver, and pelvic bone was noted in the ALK-1 positive group only. Conclusions: Overall, ALK-1 protein was expressed in 55.6% of inflammatory myofibroblastic tumors. There was no statistically significant correlation between ALK-1 expression, tumor type, recurrence and metastasis. However, ALK-1 immunohistochemistry is a useful diagnostic aid in the appropriate clinical and histomorphologic context.
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