title: The unreliability of continuous postoperative lactate monitoring after extended hepatectomies: single center experience.
abstract: Postoperative plasma lactate clearance has been established as an important prognostic factor for liver resection morbidity and mortality. The aim of this study was to analyse continuous monitoring of plasma lactate in patients submitted to extended hepatectomy (EH) with special attention to those who received preoperative portal vein branch embolization (PVE) to augment the future remnant liver. In this single center retrospective study, a full revision of 45 medical records was performed from patients who underwent EH at ISMETT from October 1999 to August 2013. Plasma lactates from admission to ICU to day 5 were recorded. Postoperative lactate clearance (ΔLAC) was defined as lactate at postoperative day 5 minus lactate at ICU presentation (hour 0). ΔLAC was analysed in relation to total hospital stay and 90 days' perioperative morbidity and mortality, using Clavien-Dindo classification, and by presence or absence of PVE. Forty-one right and four left EH were performed. 17 patients underwent previous PVE with a mean of 44 ± 28.9 days-to-surgery time and a 24 ± 8.3% degree of hypertrophy. In 39 cases (86.7%), a malignant etiology was the indication for EH, length of surgery was 486 ± 122 min with a median of 300 ml of blood transfusion. In 25 patients, a Clavien grade IIIa or worst complication has been experienced, and in three cases the death occurred during the first 3 months after EH. The median length of hospitalization was 11 days. In patients with preoperative PVE a significative association with an early post-resectional lactate clearance was obtained (p 0.01). Conversely, the univariate analysis measured by t test did not show any significative associations between ΔLAC and a median time of hospital stay longer than 11 days (p 0.08), or the onset of any complications (p 0.67) and of a Clavien's grade of complications ≥IIIa patients (p 0.48). After adjusting for co-variables, results of the multivariate logistic regression analyses confirmed that ΔLAC is not independent or significant predictor for initial poor liver function following EH. In our single center experience, the continuous monitoring of postoperative lactate clearance did not work as an early marker of postoperative liver dysfunction following EH. Although lactate clearance, worked as guide having a clinical utility in the ICU statement for hemodynamic optimization and systemic fluid balance management.
authors.affiliation: Unit of Abdominal Surgery and Organ Transplantation, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Via E. Tricomi 5, 90127, Palermo, Italy.
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tropea
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006753:Hospital Records; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D019344:Lactic Acid / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D019344:Lactic Acid