title: Functional liver reserve parameters predictive for posthepatectomy complications.
abstract: BACKGROUND
  Posthepatectomy complications have markedly decreased with advances in techniques and management; however, surgical risk to patients with injured livers is still not negligible. We evaluated several preoperative parameters of functional liver reserve tests in patients with various liver diseases as predictors of posthepatectomy complications. A comprehensive evaluation of preoperative liver functions is necessary for the prediction of the risk of posthepatectomy complications.
  
  
  METHODS
  Over a 10-y period, we examined 442 patients who underwent hepatectomy for liver and biliary diseases. The patients' background liver diseases included chronic viral liver diseases in 211 patients, obstructive jaundice in 29 patients, and normal liver in 202 patients. Hepatectomy-related postoperative complications (i.e., long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 115 (26%) patients. A multivariate logistic analysis was performed to detect the predictive parameters, and a multivariate linear regression analysis was performed to derive a predictive formula for complications.
  
  
  RESULTS
  A univariate analysis identified 15 significant parameters associated with hepatectomy-related complications, and eight parameters (i.e., presence of chronic hepatic injury, clearance index by technetium-99 m galactosyl human serum albumin liver scintigraphy of ≥ 0.60, total bilirubin level of >1 mg/dL, serum hyaluronic acid level of ≥ 75 ng/mL, major hepatectomy, blood loss of ≥ 950 mL, operating time of ≥ 500 min, and combined resection of another organ or major vessel) were independent predictive factors identified in the multivariate analysis. Clearance index by technetium-99 m galactosyl human serum albumin liver, bilirubin level, hyaluronic acid level, and major hepatectomy were the parameters included in the predictive formula.
  
  
  CONCLUSIONS
  In the present study, we present a comprehensive formula based on the predictive parameters for hepatic complications for prospective assessment to avoid posthepatectomy morbidity.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Electronic address: a-nanasm@nagasaki-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Junichi
authors.initials: J
authors.lastname: Arai
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kudo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006521:Hepatitis, Chronic / Q000453:epidemiology / Q000601:surgery / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000502:physiology* / Q000601:surgery*; D008107:Liver Diseases / Q000453:epidemiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015609:Organotechnetium Compounds; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000418:Albumins; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C036586:technetium Tc 99m neogalactoalbumin
keywords: 99mTc-GSA liver scintigraphy; Liver resection; Posthepatectomy complications; Prognostic functional parameters