Analysis of 100 Consecutive Hepatectomies: Risk Factors in Patients with Liver Cirrhosis or Obstructive Jaundice

Abstract

We analyzed various pre-, intra-, and postoperative variables in 100 consecutive patients treated by hepatectomy for various malignant and benign liver diseases to identify patients at risk of developing postoperative complications. Patients were divided into three groups: those with normal liver (NL, n = 53); those with liver cirrhosis (LC, n = 32); and those with obstructive jaundice (OJ, n = 15). The overall postoperative morbidity and mortality rates were 14% and 4% (due to liver failure), respectively. In the LC group the combined presence of abnormal levels of serum hyaluronic acid (HA, > 200 ng/ml), indocyanine green retention rate at 15 minutes (ICGR15, > 15%), and hepatic uptake ratio of (99m)Tc-galactosyl human serum albumin (GSA) at 15 minutes (LHL15, < 0.9) preoperatively was found to be a risk factor with a 100% morbidity rate. Operative blood loss of more than 1000 ml in LC patients was associated with high morbidity. In the OJ group preoperative parameters were almost normal after biliary drainage, but the extent of liver resection, blood loss > 2000 ml, and high serum interleukin-6 12 hours after hepatectomy correlated with high postoperative morbidity. No morbidity or mortality was reported in the NL group, except in a single patient who received long-term intraarterial chemotherapy preoperatively. Consequently, the extent of hepatectomy should be carefully determined according to the preoperative risk factors in LC patients; and in OJ patients hepatectomy, which tends to become extensive, should be carefully performed to minimize surgical stress because preoperative factors do not help predict outcome. Furthermore, the present study revealed that a serum HA level higher than 500 ng/ml on postoperative day 1 or day 7 (or both) was a useful marker for hepatic failure.

Functional liver reserve parameters predictive for posthepatectomy complications

“…The presence of chronic liver injury, increased levels of bilirubin and serum HA predicted uncontrolled ascites; the combined resection of major vessels and longer operative time predicted intra-abdominal infection; and increased levels of HH15 and serum HA predicted hepatic failure. This comprehensive predictive model should be useful even in posthepatectomy patients with chronic viral hepatitis and bile duct carcinomas [47].…”

Risk Assessment of Posthepatectomy Liver Failure Using Hepatobiliary Scintigraphy and CT Volumetry

“…Although overall mortality rates have improved in the last decade, postoperative morbidity rates still can be substantial. A large resection and underlying parenchymal disease such as cirrhosis or obstructive jaundice correlate with increased morbidity and mortality rates (1)(2)(3)(4)(5)(6). When too much healthy liver parenchyma is resected, the risk of liver failure increases.…”

Mortalidade após ressecção hepática: determinação de um fator de risco pós-operatório precoce e eficaz

“…Porém, publicações objetivando a identificação precoce no período pós-operatório de pacientes que apresentarão evolução desfavorável são escassos 3,11 .…”

“…Porém, publicações objetivando a identificação precoce no período pós-operatório de pacientes que apresentarão evolução desfavorável são escassos 3,11 .Desde as primeiras séries de ressecções hepáticas até a década de 60, não eram raros índices de mortalidade ultrapassando 30% 9 . A seguir, houve redução da mortalidade para cerca de 10% até os anos 80 27 .…”