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Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study


McCormack, Lucas; Petrowsky, Henrik; Jochum, Wolfram; Furrer, Katarzyna; Clavien, Pierre-Alain (2007). Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Annals of Surgery, 245(6):923-930.

Abstract

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.

Abstract

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:June 2007
Deposited On:24 Jul 2015 10:58
Last Modified:05 Apr 2016 19:19
Publisher:Lippincott Williams & Wilkins
ISSN:0003-4932
Publisher DOI:https://doi.org/10.1097/01.sla.0000251747.80025.b7
PubMed ID:17522518

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