Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma.
OBJECTIVE
Hepatic resection is still associated with a higher morbidity than other major abdominal surgery. The aim of this study was to define risk factors for postoperative morbidity, and to evaluate the plasma cytokine pattern to detect early postoperative infection in patients with hepatocellular carcinoma.


METHODS
One hundred and thirty-nine hepatic resections for hepatocellular carcinoma over a 10-year period from 1987 to 1997 were performed. Preoperative and intraoperative predictors of morbid outcomes were analyzed using multiple regression in a stepwise, logistic model. The postoperative concentrations of interleukin-6, interleukin-8, granulocytecolony stimulating factor, endotoxin and hepatocyte growth factor were measured in 32 patients following hepatic resection.


RESULTS
Mortality rate within 30 postoperative days was 2.2%, with morbidity occurring in 40.2%. Significant pre- and intraoperative predictors for morbidity were ICGR15 and the presence of liver cirrhosis. Changes of interleukin-6, interleukin-8, granulocytecolony stimulating factor and endotoxin levels were not consistent with the occurrence of postoperative complications. However, the postoperative peak hepatocyte growth factor levels were positively correlated with morbidity.


CONCLUSIONS
ICGR15 and presence of liver cirrhosis had a marked effect on the incidence of postoperative complications after hepatectomy for hepatocellular carcinoma. An increase of serum hepatocyte growth factor level could be used to detect complications in the early postoperative period, but the inflammatory cytokine response after hepatectomy did not relate to an increased complication rate.
Ishikawa
M
M
First Department of Surgery, University of Tokushima, School of Medicine, Tokushima, Japan. masashi@kochi.hosp.go.jp
Yogita
S
S
Miyake
H
H
Fukuda
Y
Y
Harada
M
M
Wada
D
D
Tashiro
S
S
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery*; D016009:Chi-Square Distribution; D004396:Coloring Agents / Q000493:pharmacokinetics; D016207:Cytokines / Q000097:blood; D005260:Female; D006498:Hepatectomy; D017228:Hepatocyte Growth Factor / Q000097:blood; D006801:Humans; D015994:Incidence; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008103:Liver Cirrhosis / Q000150:complications; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
D004396:Coloring Agents; D016207:Cytokines; D017228:Hepatocyte Growth Factor; D007208:Indocyanine Green