title: Liver resection and metabolic disorders: an undescribed mechanism leading to postoperative mortality.
abstract: OBJECTIVE
  To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.
  
  
  METHODS
  The link between Metabolic Syndrome and non-alcoholic fatty liver disease is currently demonstrated. Various metabolic disorders and the Metabolic Syndrome (the association of ≥ 3 metabolic disorders) have been recently described as a risk factor of perioperative mortality in major liver resection. Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed.
  
  
  RESULTS
  From January 2001 to May 2010 in a tertiary centre, ten patients presenting with ≥ 2 metabolic disorders without any other known cause of liver disorders died during perioperative course of major liver resection. The same four-consecutive-steps sequence of events occurred, including jaundice. The analysis of this series suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure (mimicking septic collapse) as the mechanism leading to exitus. The acute portal hypertension is mainly related to the surgical procedure. The chronic portal hypertension is indeterminate. Patients with ≥ 2 metabolic disorders should be considered as potentially presenting with portal hypertension possibly evolving towards hepatorenal syndrome; thus, they should be considered as having a high perioperative risk and should be carefully evaluated before undergoing major liver resection.
  
  
  CONCLUSIONS
  As fibrosis was not present or marginal in liver specimens, the real cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies.
authors.affiliation: Alban Zarzavadjian Le Bian, Renato Costi, Claude Smadja, Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-XI, 91400 Orsay, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Zarzavadjian Le Bian
authors.affiliation: Alban Zarzavadjian Le Bian, Renato Costi, Claude Smadja, Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-XI, 91400 Orsay, France.
authors.forename: Renato
authors.initials: R
authors.lastname: Costi
authors.affiliation: Alban Zarzavadjian Le Bian, Renato Costi, Claude Smadja, Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-XI, 91400 Orsay, France.
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Sbai-Idrissi
authors.affiliation: Alban Zarzavadjian Le Bian, Renato Costi, Claude Smadja, Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-XI, 91400 Orsay, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Smadja
mesh_terms: D000368:Aged; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality*; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008659:Metabolic Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hepatorenal syndrome; Liver resection; Major hepatectomy; Metabolic syndrome; Postoperative mortality