Aspects of Liver Surgery : From perioperative analgesia to oncological outcomes
(2026) In Lund University, Faculty of Medicine Doctoral Dissertation Series- Abstract
- Background: Despite advances in surgical technique and perioperative care, liver surgery remains associated with high morbidity, varying oncological outcomes and postoperative pain. This thesis evaluates aspects of the surgical technique and perioperative pain management, and their influence on the postoperative recovery, morbidity and overall survival.
Methods: The thesis includes four studies. Paper I‒III were nationwide register-based retrospective cohort studies. Paper I evaluated the association of the surgical resection margin and overall survival (OS), in a cohort resected for colorectal liver metastases (CRLM) where perioperative chemotherapy was utilized. Paper II examined the implementation of minimally invasive liver surgery... (More) - Background: Despite advances in surgical technique and perioperative care, liver surgery remains associated with high morbidity, varying oncological outcomes and postoperative pain. This thesis evaluates aspects of the surgical technique and perioperative pain management, and their influence on the postoperative recovery, morbidity and overall survival.
Methods: The thesis includes four studies. Paper I‒III were nationwide register-based retrospective cohort studies. Paper I evaluated the association of the surgical resection margin and overall survival (OS), in a cohort resected for colorectal liver metastases (CRLM) where perioperative chemotherapy was utilized. Paper II examined the implementation of minimally invasive liver surgery (MILS) in Sweden and its impact on short- and long-term outcomes for CRLM. Paper III compared the outcomes following robotic-assisted (RALS) and laparoscopic liver surgery (LLS) for hepatocellular carcinoma (HCC). Paper
IV was a prospective randomized double-blind, placebo-controlled trial evaluating perioperative intravenous lidocaine and its effects on postoperative opioid consumption, pain and recovery.
Results: A resection margin <1 mm was an independent risk factor associated with poor OS, also after adjustment for tumour burden, tumour biology and neoadjuvant chemotherapy. The use of MILS increased over time in Sweden, and was associated with favourable short-term outcomes, including reduced blood loss, major complications, and postoperative mortality, while maintaining long-term survival comparable to open surgery. For HCC, RALS and LLS were associated with similar perioperative and oncological outcomes, but reduced blood loss compared with open surgery. Perioperative intravenous lidocaine did not reduce opioid requirements, but reduced early postoperative pain, and the
administered dose was well tolerated without safety concerns.
Conclusions: Resection margin remains an important risk factor for poor survival after CRLM resection despite chemotherapy, and surgeons should strive for a margin of ≥1 mm. MILS was safely adopted in Sweden and provided short-term benefits while maintaining oncological outcomes for CRLM. In HCC surgery, RALS and LLS had comparable outcomes, but less blood loss compared with open surgery. Perioperative lidocaine did not reduce opioid use after minor liver surgery, but resulted in early postoperative analgesic benefits. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/c876ff2d-f8a7-4fe6-9f54-2d54c5706c09
- author
- Östrand, Emil LU
- supervisor
- opponent
-
- Professor Yaqub, Sheraz, Faculty of Medicine, University of Oslo
- organization
- publishing date
- 2026
- type
- Thesis
- publication status
- published
- subject
- keywords
- Liver Neoplasms, Colorectal liver metastases, minimally invasive surgery, Lidocaine, hepatocellular carcinoma, Hepatectomy, Postoperative Pain, Surgical Margins, Survival Analyses
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2026:35
- pages
- 79 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Föreläsningssal 3, Centralblocket, Entrégatan 7, Skånes Universitetssjukhus i Lund
- defense date
- 2026-06-08 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-833-7
- language
- English
- LU publication?
- yes
- id
- c876ff2d-f8a7-4fe6-9f54-2d54c5706c09
- date added to LUP
- 2026-05-05 12:10:24
- date last changed
- 2026-08-11 09:54:44
@phdthesis{c876ff2d-f8a7-4fe6-9f54-2d54c5706c09,
abstract = {{Background: Despite advances in surgical technique and perioperative care, liver surgery remains associated with high morbidity, varying oncological outcomes and postoperative pain. This thesis evaluates aspects of the surgical technique and perioperative pain management, and their influence on the postoperative recovery, morbidity and overall survival.<br/>Methods: The thesis includes four studies. Paper I‒III were nationwide register-based retrospective cohort studies. Paper I evaluated the association of the surgical resection margin and overall survival (OS), in a cohort resected for colorectal liver metastases (CRLM) where perioperative chemotherapy was utilized. Paper II examined the implementation of minimally invasive liver surgery (MILS) in Sweden and its impact on short- and long-term outcomes for CRLM. Paper III compared the outcomes following robotic-assisted (RALS) and laparoscopic liver surgery (LLS) for hepatocellular carcinoma (HCC). Paper<br/>IV was a prospective randomized double-blind, placebo-controlled trial evaluating perioperative intravenous lidocaine and its effects on postoperative opioid consumption, pain and recovery.<br/>Results: A resection margin <1 mm was an independent risk factor associated with poor OS, also after adjustment for tumour burden, tumour biology and neoadjuvant chemotherapy. The use of MILS increased over time in Sweden, and was associated with favourable short-term outcomes, including reduced blood loss, major complications, and postoperative mortality, while maintaining long-term survival comparable to open surgery. For HCC, RALS and LLS were associated with similar perioperative and oncological outcomes, but reduced blood loss compared with open surgery. Perioperative intravenous lidocaine did not reduce opioid requirements, but reduced early postoperative pain, and the<br/>administered dose was well tolerated without safety concerns.<br/>Conclusions: Resection margin remains an important risk factor for poor survival after CRLM resection despite chemotherapy, and surgeons should strive for a margin of ≥1 mm. MILS was safely adopted in Sweden and provided short-term benefits while maintaining oncological outcomes for CRLM. In HCC surgery, RALS and LLS had comparable outcomes, but less blood loss compared with open surgery. Perioperative lidocaine did not reduce opioid use after minor liver surgery, but resulted in early postoperative analgesic benefits.}},
author = {{Östrand, Emil}},
isbn = {{978-91-8021-833-7}},
issn = {{1652-8220}},
keywords = {{Liver Neoplasms; Colorectal liver metastases; minimally invasive surgery; Lidocaine; hepatocellular carcinoma; Hepatectomy; Postoperative Pain; Surgical Margins; Survival Analyses}},
language = {{eng}},
number = {{2026:35}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Aspects of Liver Surgery : From perioperative analgesia to oncological outcomes}},
url = {{https://lup.lub.lu.se/search/files/249270595/Disputation_final_strand_e-spik.pdf}},
year = {{2026}},
}