Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 17; no. 6; pp. 871 - 878
• Main Authors: Nanashima, Atsushi, Tobinaga, Syuuichi, Abo, Takafumi, Nonaka, Takashi, Takeshita, Hiroaki, Hidaka, Shigekazu, Sawai, Terumitsu, Nagayasu, Takeshi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.11.2010; Wiley Subscription Services, Inc
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Ascites - epidemiology; Ascites - etiology; Ascites - prevention & control; Female; Follow-Up Studies; Gastroenterology; Hepatectomy - adverse effects; Hepatology; Humans; Incidence; Japan - epidemiology; Liver cirrhosis; Liver Diseases - surgery; Liver Failure - epidemiology; Liver Failure - etiology; Liver Failure - prevention & control; liver function; Liver Function Tests; Liver Neoplasms - surgery; liver resection; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Original Article; posthepatectomy complications; Postoperative Complications; Preoperative Care - methods; Prognosis; prognostic parameters; Retrospective Studies; Surgical Oncology; Japan; Liver function; Posthepatectomy complications; Liver resection; Prognostic parameters
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-010-0281-5

Background/purpose To prevent or reduce hepatic complications after hepatectomy, it is important to employ preoperative predictive parameters and to determine the indications for hepatectomy. In the present study, we evaluated risk parameters in patients who underwent hepatectomy between 1994 and 2003, and selected three parameters to modify the surgical indications. Using these indications before surgery in patients who underwent hepatectomy between 2004 and 2008, we compared the prevalences of postoperative complications in the the two groups of patients. Methods We examined 250 consecutive patients who underwent hepatectomy for liver disease [149 in 1994–2003 (termed the early period) and 101 in 2004 to 2008 (termed the later period)]. Results In the early period, uncontrolled ascites was observed in 55 patients and hepatic failure was observed in 15 of the 149 patients. Multivariate analysis identified volume of the resected liver (≥50%), intraoperative blood loss (≥1500 ml), prothrombin activity (<70%), hyaluronic acid level (≥200 ng/ml), and LHL15 (hepatic uptake ratio of technetium-99m galactosyl human serum albumin ( 99m Tc-GSA) (<0.85) as risk factors; the latter three parameters were evaluated as predictors of outcome. From 2004, we used these three parameters, in addition to the indocyanine green retention rate at 15 min (ICGR15), as criteria for indications for hepatectomy. Despite the lower prevalence of normal liver in the later period, comparisons showed decreases in the rates of uncontrolled ascites (23 vs. 37%, P  = 0.03), hepatic failure (4 vs. 10%, P  = 0.12), and hepatic complications (25 vs. 44%, P  = 0.003) in patients in the later period compared with these rates in the previous period. Conclusions The use of prothrombin activity, and levels of hyaluronic acid and LHL15, as parameters of functional liver reserve in the selection of candidates for surgery reduced the incidence of hepatic complications after hepatectomy.