Clinicopathological and intraoperative parameters associated with postoperative hepatic complications.
OBJECTIVE
To predict the risk of liver dysfunction associated complications after hepatectomy, we evaluated perioperative parameters in patients after hepatectomy.


METHODS
We examined 185 consecutive patients who underwent hepatectomy for liver tumors. Background liver was normal liver in 73 patients, chronic viral hepatitis in 49, cirrhosis in 46 and icteric liver in 17. Postoperative complications associated liver dysfunction (long-term ascites, intraabdominal infection and hepatic failure) occurred in 70 (38%) patients.


RESULTS
Univariate analysis identified 9 significant parameters associated with postoperative complications (resected volume > or = 50%, intraoperative bleeding volume > or = 1500 mL, liver activity at 15 min by technetium-99m galactosyl human serum albumin scintigraphy of < 0.85, alanine aminotransferase > or = 80 IU/L, total cholesterol < 150 mg/dL, prothrombin activity [PT] < 80%, Liver Damage grade B, histopathological activity index [HAI] of > or = 8 and hyaluronic acid [HA] of > or = 150 ng/mL). Multivariate logistic regression analysis identified resected volume, intraoperative bleeding, PT and HA levels as four significant independent predictors of post-hepatectomy complication with odds ratios of 7.0, 4.4, 7.5, and 5.4, respectively.


CONCLUSIONS
Preoperative assessment and correction of abnormal PT and HA, careful evaluation of resected volume and attempt to reduce intraoperative bleeding are important to avoid postoperative hepatic complications.
Nanashima
Atsushi
A
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. a-nanasm@net.nagasaki-u.ac.jp
Sumida
Yorihisa
Y
Abo
Takafumi
T
Tanaka
Kenji
K
Takeshita
Hiroaki
H
Hidaka
Shigekazu
S
Yano
Hiroshi
H
Sawai
Terumitsu
T
Obatake
Masayuki
M
Yasutake
Toru
T
Nagayasu
Takeshi
T
D000368:Aged; D002784:Cholesterol / Q000097:blood; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011516:Prothrombin / Q000032:analysis
D011516:Prothrombin; D006820:Hyaluronic Acid; D002784:Cholesterol