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Postoperative biochemical liver function after major hepatic resection in children
Paul Needham1, Dowmitra Dasgupta, John Davies
1Department of Surgery, St James's University Hospital, Leeds LS9 7TF, UK.
Insights
Pediatric liver function tests (LFTs) normalize faster after major liver resection than in adults. Preoperative chemotherapy does not significantly impact LFT recovery profiles in children undergoing liver surgery.
Area of Science:
- Pediatric Surgery
- Hepatology
- Biochemistry
Background:
- Limited data exists on biochemical liver function test (LFT) profiles post-partial hepatectomy in children.
- Understanding these profiles is crucial for managing pediatric liver resections.
Purpose of the Study:
- Establish normal LFT profiles after major liver resection in non-cirrhotic children.
- Analyze the impact of preoperative chemotherapy on LFT recovery.
Main Methods:
- Retrospective analysis of clinical and biochemical data from children undergoing major liver resection for hepatic tumors.
- Comparison of LFTs based on resection extent (≥4 segments vs. lesser) and presence of preoperative chemotherapy.
Main Results:
- Peak LFT derangements occurred on postoperative days 1-2.
- Bilirubin and albumin normalized by day 5; INR and alkaline phosphatase by day 7; ALT by 1-2 weeks.
- More extensive resections correlated with higher peak ALT and INR; preoperative chemotherapy showed no significant effect on recovery.
Conclusions:
- Postoperative LFTs in children resolve more rapidly than in adults following partial hepatectomy.
- Preoperative chemotherapy does not substantially alter post-resection LFT profiles in pediatric patients.
Background/Purpose:
There are no detailed reports of the profile of biochemical liver function tests (LFTs) after partial hepatectomy in children. The study aims to establish normal profiles of standard LFTs after major liver resection in noncirrhotic children; the effects of preoperative chemotherapy were also analyzed.
Methods:
Clinical and biochemical data were collected from a consecutive series of children who had undergone a primary major liver resection for a hepatic tumor. Chemotherapy details were recorded. Children who had more than 4 liver segments resected were compared with those undergoing lesser resections. Those with and without preoperative chemotherapy were also compared.
Results:
A total of 22 children underwent major liver resection at a median age of 24 months (range, 2 weeks to 16 years). Fifteen received preoperative chemotherapy. Peak derangements in all standard LFTs occurred on day 1 to day 2 postoperatively. Normal plasma levels of bilirubin and albumin were present by day 5, international normalized ratio and alkaline phosphatase by day 7, and alanine aminotransferase by 1 to 2 weeks. Peak alanine aminotransferase and international normalized ratio values tended to be higher in children having more extensive liver resections. Preoperative chemotherapy given up to 3 weeks before surgery had no major effect on LFT recovery profiles. Hypophosphatemia was maximal on day 2.
Conclusions:
Postoperative LFTs showed a more rapid resolution than typically seen after partial hepatectomy in adults. Preoperative chemotherapy had no major effects on postresection LFT profiles.
