Risk factors for postoperative liver dysfunction in robot-assisted gastrectomy for gastric cancer

Liver dysfunction after robotic gastrectomy for gastric cancer is common. Liver elevation or cutting of the accessory left hepatic artery (ALHA) can cause liver dysfunction, which may be emphasized by the prolonged operation time in robotic gastrectomy.

To identify the risk factors for liver dysfunction, we examined 160 patients who underwent robot-assisted gastrectomy between August 2019 and April 2024. Liver dysfunction was defined as an elevated AST level (≥100 IU/L) on postoperative day 1. The risk factors were explored using univariate and multivariate logistic regression analyses.

Liver dysfunction was observed in 25.6 % (41/160). Significant independent risk factors were cutting of ALHA, liver elevation by Nathanson retractor, body mass index (BMI) ≥23.65, and blood loss ≥179.5 ml. Among them, cutting of the ALHA had the highest odds ratio (19.5), followed by the liver elevation method (10.07), blood loss (7.06), and BMI (3.99). Notably, the anatomical type of ALHA was significantly associated with liver dysfunction: Type C, no branches from the proper hepatic artery, had the highest incidence of liver dysfunction (4/4, 100 %); followed by Type B, only medial artery branches from the proper hepatic artery (4/5, 80 %); and Type A, medial and lateral arteries diverged from the proper hepatic artery (2/9, 22.2 %). Although no patient with liver dysfunction required special medication, all patients with Type C showed liver atrophy on follow-up computed tomography one year after surgery.

Surgeons must pay attention to the type of ALHA and gentle elevation of the liver in robot-assisted gastrectomy, especially when the BMI is high or blood loss is predicted.