Major abdominal cancer resections in cirrhotic patients: how frequent is postoperative hepatocellular decompensation?
BACKGROUND
The reported incidence of postoperative liver failure in cirrhotic patients is highly varied with diverse risk factors identified to predict risk, mainly drawn from organ or disease-specific studies. We aimed to assess risk factors for the development of postoperative liver failure in a specific cohort of patients with cirrhosis undergoing abdominal cancer resection.


METHODS
From November 2007 to October 2012, 30 cirrhotic patients who underwent curative resection for abdominal cancer were analyzed. The postoperative trends in liver function were followed and the incidence of postoperative liver failure was demonstrated.


RESULTS
Among the 30 patients, the tumors were located in the stomach (n = 5), pancreas (n = 5), colon/rectum (6), liver (n = 11), gallbladder (n = 1), and retroperitoneum (n = 2). Eighteen (60 %) patients experienced postoperative liver failure of which 7 (23 %) patients required deviation from the clinical course or management. There was one mortality due to grade C liver failure and hepatorenal syndrome. On multivariate analysis, only age (>55 years) was found to be statistically significant to predict postoperative liver failure (p = 0.024).


CONCLUSIONS
Liver dysfunction remains a major problem during the postoperative phase of major gastrointestinal cancer resections. However, less than one fourth of well-selected patients will develop significant postoperative liver failure. This incidence may be further reduced if the selection is restricted to younger patients.
Division of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Centre, Parel, Mumbai, 400 012, India, shailushrikhande@hotmail.com.
Shailesh Vinayak
SV
Shrikhande
Vinay
V
Gaikwad
Dipak
D
Purohit
Mahesh
M
Goel
D000008:Abdominal Neoplasms / Q000150:complications* / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors