title: Influence of hepatic parenchymal histology on outcome following right hepatic trisectionectomy.
abstract: BACKGROUND
  Histological abnormalities in the non-tumour-bearing liver (NTBL) may influence outcome following hepatectomy. Effects will be most pertinent following right trisectionectomy but have yet to be specifically examined in this context. This study aimed to investigate the influence of perioperative factors, including NTBL histology, on outcome following right trisectionectomy.
  
  
  METHODS
  Pathological review of the NTBL of 103 consecutive patients undergoing right trisectionectomy between January 2003 and December 2009 was performed using established criteria for steatosis, non-alcoholic steatohepatitis (NASH), sinusoidal injury (SI), fibrosis and cholestasis. Perioperative and pathological factors were correlated with post-operative outcome (morbidity, major morbidity, hepatic insufficiency and mortality).
  
  
  RESULTS
  Morbidity, hepatic insufficiency and major morbidity occurred in 37.9 %, 14.6 % and 22.3 % of cases, respectively. Ninety-day mortality rate was 5.8 %. NASH (P = 0.007) and perioperative blood transfusion (P = 0.001) were independently associated with hepatic insufficiency following trisectionectomy. NASH (P = 0.028), perioperative transfusion (P = 0.016), diabetes mellitus (P = 0.047) and coronary artery disease (P = 0.036) were independently associated with major morbidity. Steatosis, SI, fibrosis and cholestasis in the NTBL demonstrated no association with any adverse outcome.
  
  
  CONCLUSIONS
  NASH, but not steatosis or SI, is associated with adverse outcome following right trisectionectomy and caution must be exerted when considering major hepatectomy in patients with NASH.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Gwendolen Road, Leicester, UK. cpn3@le.ac.uk
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Neal
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mann
authors.forename: Esme
authors.initials: E
authors.lastname: Pointen
authors.forename: Angus
authors.initials: A
authors.lastname: McGregor
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Metcalfe
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery; D005234:Fatty Liver / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult