Risk of Major Liver Resection in Patients With Underlying Chronic Liver Disease
| Autor: | Alain Sauvanet, Benoît Malassagne, Olivier Farges, Jean François Fléjou, Silvio Balzan, Jacques Belghiti |
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| Rok vydání: | 1999 |
| Předmět: |
Liver Cirrhosis
medicine.medical_specialty medicine.medical_treatment Aspartate transaminase Disease Chronic liver disease Gastroenterology Postoperative Complications Risk Factors Internal medicine medicine Hepatectomy Humans Risk factor Aged biology medicine.diagnostic_test business.industry Liver Diseases Liver Neoplasms Middle Aged medicine.disease Surgery Liver Hepatocellular carcinoma Chronic Disease biology.protein Complication business Liver function tests Research Article |
| Zdroj: | Annals of Surgery. 229:210-215 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/00000658-199902000-00008 |
| Popis: | OBJECTIVE: To explore the relation of patient age, status of liver parenchyma, presence of markers of active hepatitis, and blood loss to subsequent death and complications in patients undergoing a similar major hepatectomy for the same disease using a standardized technique. SUMMARY BACKGROUND DATA: Major liver resection carries a high risk of postoperative liver failure in patients with chronic liver disease. However, this underlying liver disease may comprise a wide range of pathologic changes that have, in the past, not been well defined. METHODS: The nontumorous liver of 55 patients undergoing a right hepatectomy for hepatocellular carcinoma was classified according to a semiquantitative grading of fibrosis. The authors analyzed the influence of this pathologic feature and of other preoperative variables on the risk of postoperative death and complications. RESULTS: Serum bilirubin and prothrombin time increased on postoperative day 1, and their speed of recovery was influenced by the severity of fibrosis. Incidence of death from liver failure was 32% in patients with grade 4 fibrosis (cirrhosis) and 0% in patients with grade 0 to 3 fibrosis. The preoperative serum aspartate transaminase (ASAT) level ranged from 68 to 207 IU/l in patients with cirrhosis who died, compared with 20 to 62 in patients with cirrhosis who survived. CONCLUSION: A major liver resection such as a right hepatectomy may be safely performed in patients with underlying liver disease, provided no additional risk factors are present. Patients with a preoperative increase in ASAT should undergo a liver biopsy to rule out the presence of grade 4 fibrosis, which should contraindicate this resection. |
| Databáze: | OpenAIRE |
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