Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance.
OBJECTIVE
To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer.


METHODS
We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, and alkaline phosphatase were measured on the preoperative day and postoperative day 1 (POD1), POD3, POD5, and POD7.


RESULTS
No changes in liver function were observed after the operation in patients with colon cancer (n = 121). However, in gastric cancer patients (n = 215), AST and ALT levels increased until POD5 compared to those in colon cancer patients and these findings were observed both in the LAG and OG without a significant difference except at POD1. The mean hepatic enzyme levels at POD1 in the LAG group were significantly higher than those in the OG group (P = 0.047 for AST and P = 0.039 for ALT). The factors associated with elevated ALT on POD1 in patients with gastric cancer were body mass index (P < 0.001), operation time (P < 0.001), intraoperative hepatic injury (P = 0.048), and ligation of an aberrant left hepatic artery (P = 0.052) but not type of operation (OG vs LAG, P = 0.094).


CONCLUSIONS
We conclude that the liver function alteration after LAG may have been caused by direct liver manipulation or aberrant hepatic artery ligation rather than the CO₂ pneumoperitoneum.
Department of Surgery, Soonchunhyang University College of Medicine, Bucheon-si, 420-767 Gyeonggi-do, South Korea.
Gui-Ae
GA
Jeong
Gyu-Seok
GS
Cho
Eung-Jin
EJ
Shin
Moon-Soo
MS
Lee
Hyung-Chul
HC
Kim
Ok-Pyung
OP
Song
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008099:Liver / Q000378:metabolism* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*
Am J Surg. 2003 Jul;186(1):40-4
12842747
Dig Surg. 1998;15(3):256-9
9845595
World J Gastroenterol. 2003 Feb;9(2):364-7
12532468
Br J Anaesth. 2001 Nov;87(5):774-7
11878531
Dig Surg. 2004;21(2):95-105
15010588
Surg Endosc. 2008 Feb;22(2):365-71
17661139
Ann Surg. 1994 Apr;219(4):362-4
8161261
Surg Endosc. 2005 Nov;19(11):1451-5
16206003
J Gastrointest Surg. 2008 Aug;12(8):1418-21
18516716
World J Surg. 2007 May;31(5):1115-20
17426897
Toxicology. 2008 Mar 20;245(3):194-205
18291570
Regul Toxicol Pharmacol. 1998 Apr;27(2):119-30
9671567
Surg Endosc. 1998 Jul;12(7):968-72
9632872