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Cited by 19Hepatocellular Carcinoma Treatment and PrognosisEnhanced Recovery After SurgeryCancer, Stress, Anesthesia, and Immune Response

Transection Speed and Impact on Perioperative Inflammatory Response – A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection

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Schwarz, Christoph, Klaus, Daniel A., Tudor, Bianca, Fleischmann, Edith, Wekerle, Thomas, Roth, Georg, Bodingbauer, Martin, Kaczirek, Klaus·2015·PLOS ONE
DOI 10.1371/journal.pone.0140314PMC PMC4599945
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Abstract

BACKGROUND: Parenchymal transection represents a crucial step during liver surgery and many different techniques have been described so far. Stapler resection is supposed to be faster than CUSA resection. However, whether speed impacts on the inflammatory response in patients undergoing liver resection (LR) remains unclear. MATERIALS AND METHODS: This is a randomized controlled trial including 40 patients undergoing anatomical LR. Primary endpoint was transection speed (cm2/min). Secondary endpoints included the perioperative change of pro- and anti-inflammatory cytokines, overall surgery duration, length of hospital stay, morbidity and mortality. RESULTS: Mean transection speed was significantly higher in patients undergoing stapler hepatectomy compared to CUSA resection (CUSA: 1 (0.4) cm2/min vs. Stapler: 10.8 (6.1) cm2/min; p<0.0001). Analyzing the impact of surgery duration on inflammatory response revealed a significant correlation between IL-6 levels measured at the end of surgery and the overall length of surgery (p<0.0001, r = 0.6188). Patients undergoing CUSA LR had significantly higher increase of interleukin-6 (IL-6) after parenchymal transection compared to patients with stapler hepatectomy in the portal and hepatic veins, respectively (p = 0.028; p = 0.044). C-reactive protein levels on the first post-operative day were significantly lower in the stapler cohort (p = 0.010). There was a trend towards a reduced overall surgery time in patients with stapler LR, especially in the subgroup of patients undergoing minor hepatectomies (p = 0.020). CONCLUSIONS: Liver resection using staplers is fast, safe and suggests a diminished inflammatory response probably due to a decreased parenchymal transection time. TRIAL REGISTRATION: ClinicalTrials.gov NCT01785212.

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Sorted by citations

Authors
Schwarz, C., Klaus, D. A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., & Kaczirek, K.
Affiliations
Medical University of Vienna (AT)
Corresponding author
Kaczirek, Klaus
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2015-10-09
Volume
10
Issue
10
Pages
e0140314
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0140314
PMC
PMC4599945
OpenAlex
W1896958355
Cited by
19
References
0
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 1
FWCI
0.99
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
  • Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
Keywords
hepatectomy, perioperative inflammatory response, interleukin-6, C-reactive protein, operative time, length of hospital stay, surgical morbidity and mortality
MeSH terms
Aged, Female, Hepatectomy, Humans, Inflammation, Liver, Male, Middle Aged, Treatment Outcome, Perioperative Period, Operative Time

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