title: Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study.
abstract: OBJECTIVE
  To assess the impact of microsteatosis (MiS) and macrosteatosis (MaS) on major hepatectomy.
  
  
  BACKGROUND
  While steatosis of a liver graft is an established risk factor in transplantation, its impact on major hepatectomy remains unclear.
  
  
  METHODS
  Fifty-eight steatotic patients who underwent major hepatectomy were matched 1:1 with patients with normal liver according to age, gender, ASA score, diagnosis, extent of hepatectomy, and need of hepaticojejunostomy. Steatosis was evaluated quantitatively and qualitatively. Primary endpoints were mortality and complications.
  
  
  RESULTS
  Pure MaS and MiS were present in only 10 and 3 patients, respectively, while mixed steatosis was noted in 45 patients. Forty-four patients had mild (10%-30%) and 14 moderate/severe (>30%) steatosis. Steatotic patients had significantly higher serum transaminase and bilirubin levels, and lower prothrombin time. Blood loss (P = 0.04) and transfusions (P = 0.03), and ICU stay (P = 0.001) were increased in steatotic patients. Complications were higher in steatotic patients when considered either overall (50% vs. 25%, P = 0.007) or major (27.5% vs. 6.9%, P = 0.001) complications. Patients with pure MaS had increased mortality (MaS: 20% vs. MiS: 6.6% vs. mixed: 0%; P = 0.36) and major complications (MaS: 66% vs. MiS: 50% vs. mixed: 24%; P = 0.59), but not significantly. Preoperative cholestasis was a highly significant risk factor for mortality in patients with hepatic steatosis.
  
  
  CONCLUSIONS
  Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery. Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis.
authors.affiliation: Swiss Hepato-Pancreato-Biliary (HPB) Center, Department of Visceral and Transplantation Surgery, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
authors.forename: Lucas
authors.initials: L
authors.lastname: McCormack
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Furrer
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome