Chronic Liver Diseases in Liver Surgery and Anesthesia

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (20 June 2023) | Viewed by 10129

Special Issue Editors

1. Department of Anesthesiology and Intensive Care I, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
2. Department of Anesthesiology and Intensive Care I, Faculty of Medicine, University of Medicine and Pharmacy, Carol Davila, 020021 Bucharest, Romania
Interests: anesthesia in liver surgery; anesthesia in liver transplant (including living related); intensive care of patients with chronic liver disease
1. Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania
2. Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
Interests: anesthesia in major abdominal surgery; perioperative neurocognition; epigenetics in hepatic diseases; epigenetic modulation of the brain

Special Issue Information

Dear Colleagues,

We are inviting you to contribute to a Special Issue on the interesting topic of chronic liver diseases and liver surgery, including the management of vulnerable patients undergoing liver transplants and other types of surgery.

Due to increased life expectancy, the prevalence of chronic liver pathology is becoming increasingly significant, causing a growing socio-economic burden on various medical systems. Nevertheless, the complexity of the liver function and different etiology of various chronic liver diseases requires a prompt clinical intervention for successful patient management.

This Special Issue aims to highlight new diagnostic and therapeutic concepts in chronic infectious and non-infectious liver diseases, their modern monitoring, the management of various complications of liver cirrhosis, and the importance of a multidisciplinary approach (non-surgical, interventional radiology, and surgery) in malignant neoplasia of the liver. Furthermore, high-quality research on novel prognostic biomarkers and prediction scoring systems in chronic liver disease is warmly welcomed. All studies that focus on liver surgery, including liver transplant experiences, are welcome.

We are delighted to invite you to submit your papers to this Special Issue and look forward to reviewing them. 

Dr. Gabriela Droc
Dr. Sebastian Isac
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • liver cirrhosis
  • liver surgery
  • liver transplant
  • anesthesia for liver surgery
  • liver neoplasia
  • chronic infections of the liver

Published Papers (6 papers)

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Editorial

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2 pages, 212 KiB  
Editorial
Perioperative Care in Patients with Chronic Liver Disease: What Can We Do More?
by Gabriela Droc and Sebastian Isac
Medicina 2023, 59(2), 384; https://doi.org/10.3390/medicina59020384 - 16 Feb 2023
Viewed by 864
Abstract
Chronic liver diseases represent a prevalent pathology that exerts considerable pressure on healthcare providers and various healthcare systems worldwide [...] Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)

Research

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10 pages, 4432 KiB  
Article
Safety and Feasibility of Transarterial Bleomycin–Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas
by Arkadiusz Kacała, Mateusz Dorochowicz, Dariusz Patrzałek, Dariusz Janczak and Maciej Guziński
Medicina 2023, 59(8), 1358; https://doi.org/10.3390/medicina59081358 - 25 Jul 2023
Cited by 3 | Viewed by 2382
Abstract
Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin–lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic [...] Read more.
Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin–lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7–20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin–lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition. Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)
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13 pages, 867 KiB  
Article
Safety and Efficacy of Simultaneous Resection of Gastric Carcinoma and Synchronous Liver Metastasis—A Western Center Experience
by Corina-Elena Minciuna, Stefan Tudor, Alexandru Micu, Andrei Diaconescu, Sorin Tiberiu Alexandrescu and Catalin Vasilescu
Medicina 2022, 58(12), 1802; https://doi.org/10.3390/medicina58121802 - 07 Dec 2022
Cited by 3 | Viewed by 1121
Abstract
Background and objectives: Gastric cancer (GC) is often diagnosed in the metastatic stage. Palliative systemic therapy is still considered the gold standard, even for patients with resectable oligometastatic disease. The aim of the current study is to assess the potential benefit of [...] Read more.
Background and objectives: Gastric cancer (GC) is often diagnosed in the metastatic stage. Palliative systemic therapy is still considered the gold standard, even for patients with resectable oligometastatic disease. The aim of the current study is to assess the potential benefit of up-front gastric and liver resection in patients with synchronous resectable liver-only metastases from GC (LMGC) in a Western population. Materials and Methods: All patients with GC and synchronous LMGC who underwent gastric resection with or without simultaneous resection of LMs between January 1997 and December 2016 were selected from the institutional records. Those with T4b primary tumors or with unresectable or more than three LMs were excluded from the analysis. All patients who underwent emergency surgery for hemorrhagic shock or gastric perforation were also excluded. Results: Out of 28 patients fulfilling the inclusion criteria, 16 underwent simultaneous gastric and liver resection (SR group), while 12 underwent palliative gastric resection (GR group). The median overall survival (OS) of the entire cohort was of 18.81 months, with 1-, 3- and 5-year OS rates of 71.4%, 17.9% and 14.3%, respectively. The 1-, 3- and 5-year OS rates in SR group (75%, 31.3% and 25%, respectively) were significantly higher than those achieved in GR group (66.7%, 0% and 0%, respectively; p = 0.004). Multivariate analysis of the entire cohort revealed that the only independent prognostic factor associated with better OS was liver resection (HR = 3.954, 95% CI: 1.542–10.139; p = 0.004). Conclusions: In a Western cohort, simultaneous resection of GC and LMGC significantly improved OS compared to patients who underwent palliative gastric resection. Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)
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Review

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12 pages, 1757 KiB  
Review
Addressing the Challenges in the Diagnosis and Management of Pediatric Wilson’s Disease—Case Report and Literature Review
by Irene Maria Ungureanu, Mara Ioana Iesanu, Catalin Boboc, Vlad Cosoreanu, Lorena Vatra, Anna Kadar, Evelina Nicoleta Ignat and Felicia Galos
Medicina 2023, 59(4), 786; https://doi.org/10.3390/medicina59040786 - 18 Apr 2023
Viewed by 1507
Abstract
Wilson’s disease (WD) is an autosomal recessive disorder, in which the metabolism of copper is affected by metal accumulation in several organs that causes gradual organ degeneration. Since Wilson’s initial description of WD over a century ago, there have been significant improvements in [...] Read more.
Wilson’s disease (WD) is an autosomal recessive disorder, in which the metabolism of copper is affected by metal accumulation in several organs that causes gradual organ degeneration. Since Wilson’s initial description of WD over a century ago, there have been significant improvements in understanding and managing the condition. Nevertheless, the ongoing gap between the onset of symptoms and diagnosis highlights the difficulties in identifying this copper overload disorder early. Despite being a treatable condition, detecting WD early remains a challenge for healthcare professionals at all levels of care, likely due to its rarity. The key challenge is, therefore, to educate physicians on how to identify atypical or infrequent symptoms of WD, prompting them to consider the diagnosis more carefully. The purpose of our review is to draw attention to the difficulties associated with diagnosing pediatric WD, starting from our personal experience of a complex case and then examining relevant literature. In summary, the diagnosis of WD in children is intricate and requires a heightened level of suspicion to identify this infrequent condition. A thorough evaluation by a multidisciplinary team of physicians, along with genetic testing, histopathologic examination, and specialized imaging studies, may be necessary to confirm the diagnosis and guide treatment. Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)
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18 pages, 1732 KiB  
Review
The Management of Postoperative Cognitive Dysfunction in Cirrhotic Patients: An Overview of the Literature
by Daiana-Georgiana Ingustu, Bogdan Pavel, Silvia-Ioana Paltineanu, Diana-Irene Mihai, Mihail Cotorogea-Simion, Cristina Martac, Madalina-Marieta Florescu, Cristian Cobilinschi, Sebastian Isac and Gabriela Droc
Medicina 2023, 59(3), 465; https://doi.org/10.3390/medicina59030465 - 26 Feb 2023
Cited by 2 | Viewed by 2173
Abstract
Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving [...] Read more.
Background and objectives: Postoperative cognitive dysfunction (POCD) represents a decreased cognitive performance in patients undergoing general anesthesia for major surgery. Since liver cirrhosis is associated with high mortality and morbidity rates, cirrhotic patients also assemble many risk factors for POCD. Therefore, preserving cognition after major surgery is a priority, especially in this group of patients. The purpose of this review is to summarize the current knowledge regarding the effectiveness of perioperative therapeutic strategies in terms of cognitive dysfunction reduction. Data Collection: Using medical search engines such as PubMed, Google Scholar, and Cochrane library, we analyzed articles on topics such as: POCD, perioperative management in patients with cirrhosis, hepatic encephalopathy, general anesthesia in patients with liver cirrhosis, depth of anesthesia, virtual reality in perioperative settings. We included 115 relevant original articles, reviews and meta-analyses, and other article types such as case reports, guidelines, editorials, and medical books. Results: According to the reviewed literature, the predictive capacity of the common clinical tools used to quantify cognitive dysfunction in cirrhotic settings is reduced in perioperative settings; however, novel neuropsychological tools could manage to better identify the subclinical forms of perioperative cognitive impairments in cirrhotic patients. Moreover, patients with preoperative hepatic encephalopathy could benefit from specific preventive strategies aimed to reduce the risk of further neurocognitive deterioration. Intraoperatively, the adequate monitoring of the anesthesia depth, appropriate anesthetics use, and an opioid-sparing technique have shown favorable results in terms of POCD. Early recovery after surgery (ERAS) protocols should be implemented in the postoperative setting. Other pharmacological strategies provided conflicting results in reducing POCD in cirrhotic patients. Conclusions: The perioperative management of the cognitive function of cirrhotic patients is challenging for anesthesia providers, with specific and targeted therapies for POCD still sparse. Therefore, the implementation of preventive strategies appears to remain the optimal attitude. Further research is needed for a better understanding of POCD, especially in cirrhotic patients. Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)
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Other

12 pages, 4897 KiB  
Case Report
A “Mix and Match” in Hemochromatosis—A Case Report and Literature Focus on the Liver
by Claudia Oana Cobilinschi, Ioana Săulescu, Simona Caraiola, Andra Florina Nițu, Radu Lucian Dumitru, Ioana Husar-Sburlan, Andra Rodica Bălănescu and Daniela Opriș-Belinski
Medicina 2023, 59(9), 1586; https://doi.org/10.3390/medicina59091586 - 01 Sep 2023
Cited by 1 | Viewed by 1219
Abstract
Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant [...] Read more.
Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant delay in disease recognition. The key organ that is affected by iron overload is the liver, suffering from fibrosis, cirrhosis or hepatocellular carcinoma, complications that can be prevented via early diagnosis and treatment. This review aims to draw attention to the pitfalls in diagnosing hemochromatosis. We present a case with multiorgan complaints, abnormal iron markers and a consistent genetic result. We then examine the relevant literature and discuss hemochromatosis subtypes and liver involvement, including transplant outcome and treatment options. In summary, hemochromatosis remains difficult to diagnose due to its symptom heterogeneity and rarity; thus, further education for practitioners of all disciplines is useful in facilitating its early recognition and management. Full article
(This article belongs to the Special Issue Chronic Liver Diseases in Liver Surgery and Anesthesia)
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