Metabolic disorders, non-alcoholic fatty liver disease and major liver resection: an underestimated perioperative risk.
BACKGROUND
Despite increasing evidence of an association of metabolic syndrome and liver degeneration, little is known about the results of major hepatic resection in patients with metabolic disorders. Following the observation of some unexplained perioperative deaths following uncomplicated right hepatectomy in patients presenting metabolic disorders, we analyzed the perioperative mortality in such population.


METHODS
A retrospective analysis of immediate outcome was performed of patients undergoing right hepatectomy and affected by two or more metabolic disorders (diabetes mellitus, hypertension, dyslipidemia, obesity/overweight) without any other known cause of liver disease from January 2001 to May 2010.


RESULTS
Among 151 patients undergoing right hepatectomy, 30 patients presented two or more metabolic disorders. Perioperative mortality in this group reached 30 % (nine patients). In patients presenting MS (≥3 disorders), mortality reached 54 %. Univariate analysis identified four criteria associated with poor prognosis: MS, perioperative bleeding ≥1,000 mL, middle hepatic vein resection and primary hepatic malignancy. At multivariate analysis, middle hepatic vein resection and underlying primary hepatic malignancy resulted as being related to mortality.


CONCLUSIONS
Patients presenting with multiple metabolic disorders should be carefully evaluated before major liver resection, especially when the procedure is planned for hepatocellular carcinoma and when a middle hepatic vein resection is required.
Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique, Hôpitaux de Paris, Université Paris XI, France. spleen2008@live.fr
Alban
A
Zarzavadjian Le Bian
Renato
R
Costi
Vassilis
V
Constantinides
Claude
C
Smadja
D000368:Aged; D000369:Aged, 80 and over; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors