Document Detail


Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study.
MedLine Citation:
PMID:  17522518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the impact of microsteatosis (MiS) and macrosteatosis (MaS) on major hepatectomy.
SUMMARY BACKGROUND DATA: While steatosis of a liver graft is an established risk factor in transplantation, its impact on major hepatectomy remains unclear.
METHODS: Fifty-eight steatotic patients who underwent major hepatectomy were matched 1:1 with patients with normal liver according to age, gender, ASA score, diagnosis, extent of hepatectomy, and need of hepaticojejunostomy. Steatosis was evaluated quantitatively and qualitatively. Primary endpoints were mortality and complications.
RESULTS: Pure MaS and MiS were present in only 10 and 3 patients, respectively, while mixed steatosis was noted in 45 patients. Forty-four patients had mild (10%-30%) and 14 moderate/severe (>30%) steatosis. Steatotic patients had significantly higher serum transaminase and bilirubin levels, and lower prothrombin time. Blood loss (P = 0.04) and transfusions (P = 0.03), and ICU stay (P = 0.001) were increased in steatotic patients. Complications were higher in steatotic patients when considered either overall (50% vs. 25%, P = 0.007) or major (27.5% vs. 6.9%, P = 0.001) complications. Patients with pure MaS had increased mortality (MaS: 20% vs. MiS: 6.6% vs. mixed: 0%; P = 0.36) and major complications (MaS: 66% vs. MiS: 50% vs. mixed: 24%; P = 0.59), but not significantly. Preoperative cholestasis was a highly significant risk factor for mortality in patients with hepatic steatosis.
CONCLUSION: Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery. Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis.
Authors:
Lucas McCormack; Henrik Petrowsky; Wolfram Jochum; Katarzyna Furrer; Pierre-Alain Clavien
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  245     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-24     Completed Date:  2007-07-19     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  923-30     Citation Subset:  AIM; IM    
Affiliation:
Swiss Hepato-Pancreato-Biliary (HPB) Center, Department of Visceral and Transplantation Surgery, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Case-Control Studies
Chi-Square Distribution
Fatty Liver / complications*
Female
Hepatectomy*
Humans
Liver / pathology
Liver Diseases / surgery*
Logistic Models
Male
Middle Aged
Postoperative Complications / epidemiology*
Prospective Studies
Risk Factors
Statistics, Nonparametric
Treatment Outcome
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