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Zusammenfassung

     Wir berichten über den perioperativen Verlauf eines 47-jährigen Patienten, der sich aufgrund eines bilobär metastasierten kolorektalen Karzinoms einer zweizeitigen Leberresektion unterziehen musste und 8 Tage später verstarb. Abstract We report the perioperative course of a 47-year-old patient who underwent a two-stage liver resection for bilobar metastatic colorectal carcinoma. The respiratory asymptomatic patient was tested positive for SARS-CoV-2 by PCR detection one day before the second surgical procedure. Postoperatively, the patient suffered cardiovascular arrest on postoperative day 8 and died despite immediately initiated resuscitative measures. With an initial clinical suspicion of vascular liver failure, postmortem pathologic examination revealed the underlying cause of death to be COVID-19-related myocarditis with acute right heart failure. Individual multidisciplinary risk assessment should be considered very critically when deviating from the „7-week rule“ because the benefit is difficult to objectify, even in oncologic patients. Kernaussagen Positiv auf SARS-CoV-2 getestete, aber klinisch asymptomatische Patientinnen und Patienten besitzen ein relevantes Risiko für schwere COVID-19-bedingte Komplikationen. Perioperativ kann bei SARS-CoV-2-positiven Patienten ein erhöhtes Mortalitätsrisiko bestehen. Die Entscheidung zur Abweichung von der „7-Wochen Regel“ sollte interdisziplinär, unter Abwägung und Kenntnis aller Befunde, sehr kritisch erfolgen. Schlüsselwörter SARS-CoV-2 - Myokarditis - In-situ-Split-Leberresektion - perioperative Mortalität Keywords myocarditis - Covid - “in situ split” liver resection - perioperative mortality 06 December 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Zhu N, Zhang D, Wang W. et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733 DOI: 10.1056/NEJMoa2001017. (PMID: 31978945) CrossrefPubMedGoogle Scholar 2 Gleich S, Graw M, Viehover S. et al. COVID-19-assoziierte Sterbefälle. Rechtsmedizin (Berl) 2021; 31: 408-417 DOI: 10.1007/s00194-021-00455-y. CrossrefPubMedGoogle Scholar 3 Atri D, Siddiqi HK, Lang JP. et al. COVID-19 for the Cardiologist: Basic Virology, Epidemiology, Cardiac Manifestations, and Potential Therapeutic Strategies. JACC Basic Transl Sci 2020; 5: 518-536 DOI: 10.1016/j.jacbts.2020.04.002. (PMID: 32292848) CrossrefPubMedGoogle Scholar 4 Abou Hassan OK, Sheng CC, Wang TKM. et al. SARS-CoV-2 Myocarditis: Insights Into Incidence, Prognosis, and Therapeutic Implications. Curr Cardiol Rep 2021; 23: 129 DOI: 10.1007/s11886-021-01551-x. CrossrefPubMedGoogle Scholar 5 Basso C, Leone O, Rizzo S. et al. Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. Eur Heart J 2020; 41: 3827-3835 DOI: 10.1093/eurheartj/ehaa664. (PMID: 32968776) CrossrefPubMedGoogle Scholar 6 Okor I, Bob-Manuel T, Price J. et al. COVID-19 Myocarditis: An Emerging Clinical Conundrum. Curr Probl Cardiol 2022; 47: 101268 DOI: 10.1016/j.cpcardiol.2022.101268. (PMID: 35644500) CrossrefPubMedGoogle Scholar 7 Rodriguez Guerra MA, Lappot R, Urena AP. et al. COVID-Induced Fulminant Myocarditis. Cureus 2022; 14: e23894 DOI: 10.7759/cureus.23894. CrossrefPubMedGoogle Scholar 8 Schnitzbauer AA, Lang SA, Goessmann H. et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255: 405-414 DOI: 10.1097/SLA.0b013e31824856f5. CrossrefPubMedGoogle Scholar 9 Coco D, Leanza S. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastases: review of the literature. Clin Exp Hepatol 2021; 7: 125-133 DOI: 10.5114/ceh.2021.106521. (PMID: 34295978) CrossrefPubMedGoogle Scholar 10 Werlein C, Ackermann M, Stark H. et al. Inflammation and vascular remodeling in COVID-19 hearts. Angiogenesis 2023; 26: 233-248 DOI: 10.1007/s10456-022-09860-7. (PMID: 36371548) CrossrefPubMedGoogle Scholar 11 Saner FH, Heuer M, Meyer M. et al. When the heart kills the liver: acute liver failure in congestive heart failure. Eur J Med Res 2009; 14: 541-546 DOI: 10.1186/2047-783x-14-12-541. (PMID: 20149988) CrossrefPubMedGoogle Scholar 12 Oldhafer KJ, Donati M, Jenner RM. et al. ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg 2014; 38: 1504-1509 DOI: 10.1007/s00268-013-2401-2. CrossrefPubMedGoogle Scholar 13 Donlon NE, Davern M, Hayes C. et al. The immune response to major gastrointestinal cancer surgery and potential implications for adjuvant immunotherapy. Crit Rev Oncol Hematol 2022; 175: 103729 DOI: 10.1016/j.critrevonc.2022.103729. (PMID: 35662586) CrossrefPubMedGoogle Scholar 14 Bakouny Z, Labaki C, Grover P. et al. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9: 128-134 DOI: 10.1001/jamaoncol.2022.5357. CrossrefPubMedGoogle Scholar 15 Lobo D, Devys JM. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia 2022; 77: 110 DOI: 10.1111/anae.15540. (PMID: 34251685) CrossrefPubMedGoogle Scholar 16 Becke-Jakob KG, Vescia F, Meyer H. et al. Aktualisierung der Empfehlungen: Zeitpunkt elektiver Eingriffe nach SARS-CoV-2-Infektion und Impfung. Dtsch Arztebl Ausg A 2022; 119: A964-965 PubMedGoogle Scholar 17 El-Boghdadly K, Cook TM, Goodacre T. et al. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England. Anaesthesia 2022; 77: 580-587 DOI: 10.1111/anae.15699. (PMID: 35194788) CrossrefPubMedGoogle Scholar 18 Lang SA, Loss M, Schlitt HJ. [„In-situ split“ (ISS) liver resection: new aspects of technique and indication]. Zentralbl Chir 2014; 139: 212-219 DOI: 10.1055/s-0032-1328742. (PMID: 24022245) Article in Thieme ConnectPubMedGoogle Scholar

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