Plasma cholesterol level after hepatopancreatobiliary surgery provides information on the postoperative clinical course

Abstract

Hypocholesterolemia is commonly considered an index of malnutrition. Conversely, major surgical procedures such as liver resection or pancreaticoduodenectomy and the possibly related adverse events such as sepsis, major bleeding, or other complications may cause a reduction in plasma cholesterol to values even lower than 30 mg/dl. Therefore, in this case, the severity of hypocholesterolemia often becomes an index of severity of illness with relevant prognostic value [1][2][3]. In spite of the fact that cholesterol may be influenced by various other factors, the evolution of hypocholesterolemia (the trend toward worsening or resolution, or the protracted persistence of severe hypocholesterolemia) provides useful information on the clinical evolution of the patient.It is worth outlining the mechanisms which are involved in the development of hypocholesterolemia and some practical cues for its interpretation. Plasma cholesterol behaves like albumin, whose levels tend to decrease in conditions of stress, such as after surgical trauma and with the occurrence of complications (sepsis, liver insufficiency, and hemorrhage). The mechanisms involved in decreasing cholesterol may include the effect of inflammatory mediators, the insufficient hepatic synthesis of cholesterol, and hemodilution, the latter being related to blood loss and fluid reinfusion [4]. The final effect is cumulative, and the severity of hypocholesterolemia reflects the importance of the adverse factors which determine the severity of illness. In our experience, after liver resection, the reduction in cholesterol, with respect to the preoperative value, is cumulatively related to the magnitude of the operation, the possible presence of sepsis and liver insufficiency, and the decrease in hematocrit; in this case, a persistently severe fall in cholesterol correlates with poor prognosis [3, 5] (Fig. 1). The tendency for a greater fall in cholesterol after major abdominal surgery such as after pancreaticoduodenectomy, compared to what is observed after other operations, may at least partly be explained by the magnitude of the operation.The assessment of postoperative cholesterol should also take into account its relative value as a fraction (postoperative/preoperative ratio) or as a percentage of the preoperative level. In any case, the protracted persistence of cholesterol below 60-50 mg/dl (&1.5-1.3 mmol/l) is often associated with severe sepsis, at times occult sepsis which, if not recognized and rapidly treated, may become lethal [3,5]. On the contrary, a transient decrease in cholesterol is less important as long as the levels subsequently steadily increase with the resolution of the underlying problem. Therefore, although plasma cholesterol cannot be used as a precise diagnostic tool, the changes along time may provide useful prognostic information.Cholestasis, if simultaneously present, exerts an opposite influence on the behavior of plasma cholesterol. In fact, cholestasis increases cholesterol, and levels even greater than 400 mg/dl may be observed ...

Prognostic Value for Perioperative Serum Total Cholesterol Level on Postoperative Long-Term Prognosis of Pancreatic Cancer: A Retrospective Clinical Study

“…After retrospectively analyzing 70 patients with hilar cholangiocarcinoma, Chen et al found that hypocholesterolemia on the first postoperative day was an independent risk factor for postoperative infectious complications [ 36 ]. Nuzzo et al reported that postoperative serum TC level under 1.3–1.5 mmol/L often indicates the occurrence of postoperative sepsis after hepatopancreatobiliary surgery, and persistent hypocholesterolemia hints at more severe disease condition and worse prognosis [ 37 ]. Serum TC level decreased in the early postoperative period and increased after 7 days according to our findings.…”