Impact of Perioperative Phosphorus and Glucose Levels on Liver Regeneration and Long-term Outcomes after Major Liver Resection.
The impact of phosphorus as well as glycemic alterations on liver regeneration has not been directly examined. We sought to determine the impact of phosphorus and glucose on liver regeneration after major hepatectomy.



Early and late liver regeneration index was defined as the relative increase of liver volume (RLV) within 2[(RLV2m-RLVp)/RLVp] and 7 months[(RLV7m-RLVp)/RLVp] following surgery. The association of perioperative metabolic factors, liver regeneration, and outcomes was assessed.



On postoperative day 2, 50 (52.6 %) patients had a low phosphorus level (≤2.4 mg/dl), while 45 (47.4 %) had a normal/high phosphorus level (>2.4 mg/dl). Despite comparable clinicopathologic characteristics (all P > 0.05) and RLV/TLV at surgery (P = 0.84), regeneration index within 2 months was lower in the normal/high phosphorus group (P = 0.01) with these patients having increased risk for postoperative liver failure (P = 0.01). The inhibition of liver regeneration persisted at 7 months (P = 0.007) and was associated with a worse survival (P = 0.02). Preoperative hypoglycemia was associated only with a lower early regeneration index (P = 0.02).



Normal/high phosphorus was associated with inhibition of early and late liver regeneration, as well as with an increased risk of liver failure and worse long-term outcomes. Immediate preoperative hypoglycemia was associated with a lower early volumetric gain. Metabolic factors may represent early indicators of liver failure that could identify patients at increased risk for worse outcomes.
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Georgios Antonios
GA
Margonis
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Neda
N
Amini
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Stefan
S
Buettner
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mounes Aliyari
MA
Ghasebeh
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sepideh
S
Besharati
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Yuhree
Y
Kim
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Faiz
F
Gani
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Fatemeh
F
Sobhani
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
Mario
M
Samaha
Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ihab R
IR
Kamel
Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D017093:Liver Failure / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000502:physiology; D010758:Phosphorus / Q000097:blood*; D011184:Postoperative Period
D001786:Blood Glucose; D010758:Phosphorus
Glucose; Hepatectomy; Liver regeneration; Phosphorus