The clinical significance of monitoring alkaline phosphatase level to estimate postoperative liver failure after hepatectomy.
OBJECTIVE
To predict the occurrence of postoperative liver failure after hepatectomy, the clinical significance of monitoring alkaline phosphatase (ALP) has been studied, and the relationship between the change of total bilirubin and the level of ALP or gamma-glutamyl transpeptidase (gamma-GTP) after hepatectomy was evaluated.


METHODS
The 163 patients, who underwent hepatectomy at our institute for the past 12 years, were divided into three groups according to the postoperative events. HF consisted of 5 patients with liver failure, HB showed the postoperative high bilirubinemia (over 5mg/dL) in 13 cases and GP were 145 cases without any postoperative problems.


RESULTS
1. The postoperative highest level of total bilirubin (T-Bil) correlated with the decreasing rate of ALP, prothrombin time (PT), total cholesterol (T-CHO) or gamma-GTP and total blood loss (p<0.01). 2. The level of ALP decreased after hepatectomy significantly and the decreasing rate was serious in HB and HF (p<0.05). 3. The recovering time to preoperative level of ALP was clearly shorter in GP than in HB and HF. 4. The level of ALP and gamma-GTP at the point where the level of T-Bil increased over 5mg/dL, was useful to distinguish between HF and HB. 5. The good correlation between postoperative level of ALP and gamma-GTP was noted. The decreasing levels of ALP and gamma-GTP were found to be critical below 80% and 55% after bisegmentectomy. Furthermore, the recovered levels of ALP and gamma-GTP were important to distinguish between HF and HB.


CONCLUSIONS
Monitoring the ALP level was indicated to be useful to estimate the postoperative course of bilirubin.
Osada
Shinji
S
Second Department of Surgery, Gifu University School of Medicine, Gifu City, Japan. sting@cc.gifu-u.ac.jp
Saji
Shigetoyo
S
D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D006498:Hepatectomy; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000201:enzymology / Q000401:mortality; D007770:L-Lactate Dehydrogenase / Q000097:blood; D017093:Liver Failure / Q000175:diagnosis* / Q000201:enzymology / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000201:enzymology / Q000401:mortality; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate
D002784:Cholesterol; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin