Is major liver surgery associated with an increased systemic inflammatory response? A prospective comparison of hemihepatectomy and other major abdominal surgery.
OBJECTIVE
Extensive liver resection is associated with a higher morbidity and mortality than other major abdominal surgery. Because the liver is responsible for the clearance of pathogenic particles as well as the clearance and degradation of several inflammatory mediators, the high rate of complications after liver surgery may be due to an enhanced or prolonged inflammatory response. The objective of this prospective study was to investigate whether major liver resection is associated with an enhanced systemic inflammatory response.


METHODS
The course of various inflammatory parameters was studied in 12 patients undergoing a hemihepatectomy and the results were compared with those of 12 patients undergoing other major abdominal surgery.


RESULTS
After hemihepatectomy, the plasma levels of IL-6, IL-8, sPLA2 and elastase were similar to the levels after other major abdominal surgery, though the hepatectomized patients showed higher levels of lactoferrin, possibly due to impaired hepatic clearance. In addition, the hemihepatectomized patients showed signs of impaired liver function, as was indicated by increased plasma bilirubin and ASAT levels, whereas the other patients did not.


CONCLUSIONS
The inflammatory response associated with major liver resection is not significantly different from that after other major abdominal surgery, and therefore does not explain the increased complication rate that is seen after major liver resection. We infer that the most important factor in the development of complications after liver resection may be the hepatic failure itself.
Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
M J
MJ
Wiezer
C
C
Meijer
R
R
Vuylsteke
R H
RH
Pullens
H A
HA
Prins
M A
MA
Cuesta
S
S
Meijer
C E
CE
Hack
P A
PA
van Leeuwen
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007958:Leukocyte Count; D008099:Liver / Q000276:immunology* / Q000378:metabolism / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation; D011183:Postoperative Complications / Q000097:blood / Q000276:immunology*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D013997:Time Factors
D016207:Cytokines