title: Transection Speed and Impact on Perioperative Inflammatory Response - A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection.
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.
  
  
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01785212.
authors.affiliation: Dept. of Surgery, Div. of General Surgery, Medical University of Vienna, Vienna, Austria; Section of Transplantation Immunology, Dept. of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarz
authors.affiliation: Dept. of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Klaus
authors.affiliation: Dept. of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Bianca
authors.initials: B
authors.lastname: Tudor
authors.affiliation: Dept. of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Edith
authors.initials: E
authors.lastname: Fleischmann
authors.affiliation: Section of Transplantation Immunology, Dept. of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wekerle
authors.affiliation: Dept. of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Roth
authors.affiliation: Dept. of Surgery, Div. of General Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Bodingbauer
authors.affiliation: Dept. of Surgery, Div. of General Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaczirek
mesh_terms: D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059035:Perioperative Period; D016896:Treatment Outcome