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Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control
Lucas McCormack1, Henrik Petrowsky, Wolfram Jochum
1Swiss Hepato-Pancreato-Biliary (HPB) Center, Department of Visceral and Transplantation Surgery, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
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.
Insights
Liver steatosis increases major hepatectomy complications and mortality risk. Surgeons should carefully plan procedures for steatotic patients, especially those with pre-existing cholestasis.
Area of Science:
- Hepatobiliary surgery
- Gastroenterology
- Surgical oncology
Background:
- Liver graft steatosis is a known risk factor in transplantation.
- The impact of hepatic steatosis on major hepatectomy outcomes is not well-established.
Purpose of the Study:
- To evaluate the influence of microsteatosis (MiS) and macrosteatosis (MaS) on outcomes following major hepatectomy.
- To compare outcomes between steatotic and non-steatotic patients undergoing major hepatectomy.
Main Methods:
- A retrospective matched-cohort study involving 58 steatotic patients and 58 controls undergoing major hepatectomy.
- Quantitative and qualitative assessment of liver steatosis.
- Primary endpoints included mortality and postoperative complications.
Main Results:
- Steatotic patients exhibited significantly higher rates of overall (50% vs. 25%) and major complications (27.5% vs. 6.9%).
- Increased blood loss, transfusion requirements, and ICU stay were observed in steatotic patients.
- While not statistically significant, pure macrosteatosis was associated with higher mortality and major complications compared to microsteatosis or mixed steatosis.
Conclusions:
- Hepatic steatosis is an independent risk factor for postoperative complications after major hepatectomy.
- Surgical planning for major hepatectomy must account for the presence and degree of liver steatosis.
- Particular caution is advised for steatotic patients with preoperative cholestasis due to increased mortality risk.
