Citations 3
Secondary analysis of data from the HeLiX trial regarding the association between estimated blood loss and post-hepatectomy outcomes: towards the definition of a minimal clinically significant difference
Hallet, Julie , Ribeiro, Tiago C. , Perri, Giampaolo , Ghorbani, Poya , Sparrelid, Ernesto , Marchegiani, Giovanni , Karanicolas, Paul J. , Team, the HPB CONCEPT, Lin, Yulia , McCluskey, Stuart A. , Tarshis, Jordan , Dixon, Elijah , Porter, Geoff , Chaudhury, Prosanto , Nanji, Sulaiman , Ruo, Leyo , Skaro, Anton , Eeson, Gareth, Moulton, Carol-Anne, Bal, Chad G, Coburn, Natalie G. , Serrano, Pablo E, Jayaraman, Shiva , Law, Calvin, Tandan, Ved, Nagorney, David M. , Quan, Douglas , Smoot, Rory L., Gallinger, Steven, Metrakos, Peter, Reichman, Trevor , Jalink, Diederick, Bennett, Sean, Sutherland, Francis, Solano, Edward, Molinari, Michele , Tang, Ephraim , Warner, Susanne G, Bathe, Oliver F. , Barkun, Jeffrey , Kendrick, Michael L. , Truty, Mark J. , Roke, Rachel , Xu, Grace , Fong, Zhi V, Perri, Giampaolo , Marchegiani, Giovanni , Karanicolas, Paul Jack , Ribeiro, Tiago, Fong, Zhi Ven , Team, the HPB CONCEPT, Thorpe, Kevin E. , Wei, Alice C. , Tsang, Melanie E. , Cleary, Sean P. , Bal, Chad G, Serrano, Pablo E , Sapisochín, Gonzalo , Warner, Susanne G. , Lafrenière‐Roula, Myriam , Guyatt, Gordon
British Journal of Surgery | November 11, 2025 | Volume: 112 | Issue: 11 | Pages: No page available
Tranexamic Acid in Patients Undergoing Liver Resection
Karanicolas, Paul J. , Lin, Yulia , McCluskey, Stuart A. , Tarshis, Jordan , Dixon, Elijah , Porter, Geoff , Chaudhury, Prosanto , Nanji, Sulaiman , Ruo, Leyo , Tsang, Melanie E. , Skaro, Anton , Eeson, Gareth, Moulton, Carol-Anne, Ball, Chad G. , Hallet, Julie, Coburn, Natalie, Jayaraman, Shiva, Law, Calvin, Tandan, Ved, Nagorney, David, Quan, Douglas , Smoot, Rory L. , Gallinger, Steven, Metrakos, Peter , Reichman, Trevor , Jalink, Diederick, Bennett, Sean, Sutherland, Francis, Solano, Edward, Molinari, Michele , Tang, Ephraim , Bathe, Oliver F. , Barkun, Jeffrey , Kendrick, Michael L., Truty, Mark J. , Roke, Rachel , Xu, Grace , Lafrenière‐Roula, Myriam , Team, HPB CONCEPT, Truty, Mark, Smoot, Rory L , Thorpe, Kevin E. , Wei, Alice C. , Cleary, Sean P. , Serrano, Pablo E , Sapisochín, Gonzalo , Warner, Susanne G. , Kendrick, Michael L. , Guyatt, Gordon , Team, HPB CONCEPT
JAMA | August 19, 2024 | Volume: 332 | Issue: 13 | Pages: 1080
ImportanceTranexamic acid reduces bleeding and blood transfusion in many types of surgery, but its effect in patients undergoing liver resection for a cancer-related indication remains unclear.ObjectiveTo determine whether tranexamic acid reduces red blood cell transfusion within 7 days of liver resection.Design, Setting, and ParticipantsMulticenter randomized clinical trial of tranexamic acid vs placebo conducted from December 1, 2014, to November 8, 2022, at 10 hepatopancreaticobiliary sites in Canada and 1 site in the United States, with 90-day follow-up. Participants, clinicians, and data collectors were blinded to allocation. A volunteer sample of 1384 patients undergoing liver resection for a cancer-related indication met eligibility criteria and consented to randomization.InterventionsTranexamic acid (1-g bolus followed by 1-g infusion over 8 hours; n = 619) or matching placebo (n = 626) beginning at induction of anesthesia.Main Outcomes and MeasuresThe primary outcome was receipt of red blood cell transfusion within 7 days of surgery.ResultsThe primary analysis included 1245 participants (mean age, 63.2 years; 39.8% female; 56.1% with a diagnosis of colorectal liver metastases). Perioperative characteristics were similar between groups. Red blood cell transfusion occurred in 16.3% of participants (n = 101) in the tranexamic acid group and 14.5% (n = 91) in the placebo group (odds ratio, 1.15 [95% CI, 0.84-1.56]; P = .38; absolute difference, 2% [95% CI, −2% to 6%]). Measured intraoperative blood loss (tranexamic acid, 817.3 mL; placebo, 836.7 mL; P = .75) and total estimated blood loss over 7 days (tranexamic acid, 1504.0 mL; placebo, 1551.2 mL; P = .38) were similar between groups. Participants receiving tranexamic acid experienced significantly more complications compared with placebo (odds ratio, 1.28 [95% CI, 1.02-1.60]; P = .03), with no significant difference in venous thromboembolism (odds ratio, 1.68 [95% CI, 0.95-3.07]; P = .08).Conclusions and RelevanceAmong patients undergoing liver resection for a cancer-related indication, tranexamic acid did not reduce bleeding or blood transfusion but increased perioperative complications.Trial RegistrationClinicalTrials.gov Identifier: NCT02261415
Liver transplantation for “very early” intrahepatic cholangiocarcinoma: International retrospective study supporting a prospective assessment
Facciuto, Marcelo , Rubbia‐Brandt, Laura , Martí, Josep , Mehta, Neil , Yao, Francis Y. , Vibert, Éric , Cherqui, Daniel , Grant, David , Hernandez‐Alejandro, Roberto, Dale, Cheryl, Pinna, Antonio Daniele , Hwang, Shin , Lee, S.G., Busuttil, Ronald W. , Rizvi, Sumera, Montenovo, Martin I. , Reyes, Jorgé , Cesaretti, Manuela , Reichman, Trevor , Seal, John, Kim, P.T.W., Klintmalm, Göran B. , Sposito, Carlo , Mazzaferro, Vincenzo , Dutkowski, Philipp , Clavien, Pierre‐Alain , Toso, Christian , Majno, Pietro, Kneteman, Norman M. , Bruix, Jordi , Sapisochín, Gonzalo , Cucchetti, Alessandro , Agopian, Vatche G. , Heimbach, Julie K. , Soubrane, Olivier , Kim, P T W, Saunders, C., Mazzaferro, Vincenzo , Bruix, Jordi , Sposito, Carlo , Toso, Christian
Hepatology | August 3, 2016 | Volume: 64 | Issue: 4 | Pages: 1178-1188
The presence of an intrahepatic cholangiocarcinoma (iCCA) in a cirrhotic liver is a contraindication for liver transplantation in most centers worldwide. Recent investigations have shown that “very early” iCCA (single tumors ≤2 cm) may have acceptable results after liver transplantation. This study further evaluates this finding in a larger international multicenter cohort. The study group was composed of those patients who were transplanted for hepatocellular carcinoma or decompensated cirrhosis and found to have an iCCA at explant pathology. Patients were divided into those with “very early” iCCA and those with “advanced” disease (single tumor >2 cm or multifocal disease). Between January 2000 and December 2013, 81 patients were found to have an iCCA at explant; 33 had separate nodules of iCCA and hepatocellular carcinoma, and 48 had only iCCA (study group). Within the study group, 15/48 (31%) constituted the “very early” iCCA group and 33/48 (69%) the “advanced” group. There were no significant differences between groups in preoperative characteristics. At explant, the median size of the largest tumor was larger in the “advanced” group (3.1 [2.5‐4.4] versus 1.6 [1.5‐1.8]). After a median follow‐up of 35 (13.5‐76.4) months, the 1‐year, 3‐year, and 5‐year cumulative risks of recurrence were, respectively, 7%, 18%, and 18% in the very early iCCA group versus 30%, 47%, and 61% in the advanced iCCA group, P = 0.01. The 1‐year, 3‐year, and 5‐year actuarial survival rates were, respectively, 93%, 84%, and 65% in the very early iCCA group versus 79%, 50%, and 45% in the advanced iCCA group, P = 0.02. Conclusion: Patients with cirrhosis and very early iCCA may become candidates for liver transplantation; a prospective multicenter clinical trial is needed to further confirm these results. (H epatology 2016;64:1178‐1188)