Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of...

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Regeneration

Background:

• Extensive liver resection aims for negligible mortality with normal preoperative liver function tests.
• However, some patients without pre-existing liver disease die of hepatic failure post-resection.
• Conventional tests may not identify all at-risk patients.

Purpose of the Study:

• To identify risk factors for postoperative hepatic failure after extensive liver resection.
• To evaluate the utility of alkaline phosphatase in predicting liver regeneration.
• To recommend improved methods for assessing patient risk.

Main Methods:

• Retrospective analysis of 56 patients undergoing extensive liver resection for tumors.
• Evaluation of preoperative and intraoperative factors, including liver function tests, tumor type, chemotherapy, and blood loss.
• Postoperative monitoring of liver function tests and liver regeneration using computed tomographic (CT) scans.

Main Results:

• Five patients died of hepatic failure despite normal preoperative liver function tests.
• Risk factors for failure included high serum alkaline phosphatase with normal bilirubin, large tumors, preoperative chemotherapy, hepatoma, and significant intraoperative blood loss (>5000 ml).
• Alkaline phosphatase levels and CT scans indicated impaired liver regeneration in non-survivors, while survivors showed reciprocal changes in bilirubin and alkaline phosphatase.

Conclusions:

• Conventional liver function tests are insufficient to predict hepatic failure after extensive liver resection.
• High alkaline phosphatase, preoperative chemotherapy, and hepatoma are associated with increased risk.
• Alkaline phosphatase is a valuable indicator of liver regeneration in the absence of jaundice post-hepatectomy.