COMPARISON OF LIVER-FUNCTION TESTS AFTER HEPATIC LOBECTOMY AND HEPATIC WEDGE RESECTION

Prior studies have suggested that changes in liver function tests may vary with the postoperative time interval and may be related to the ex tent of hepatic resection. This study describes characteristic profile s in parenchymal liver enzymes and other serum liver function tests ov er a 4-week course comparing anatomic to nonanatomic hepatic resection s. The records of 48 patients undergoing successful major hepatic rese ction during a 3-year period were retrospectively reviewed. Of these 4 8 patients, 28 underwent formal anatomic resection (hepatic lobectomy) , and 20 underwent nonanatomic resections (wedge resection). Routine p ostoperative management in lobectomy patients included drawing liver f unction tests and enzymes daily for the First week, then at approximat ely 2 and 4 weeks postoperatively. These tests included: prothrombin t ime (PT), partial thromboplastin time, total serum bilirubin, total pr otein (TP), aspartate transaminase, lactate dehydrogenase (LDH), alkal ine phosphatase, albumin (A), and glucose. Patients undergoing wedge r esections had these values checked less frequently, approximately 3 to 5 days, 2 weeks, and 4 weeks postoperatively. Profiles of these value s were plotted over the 4-week postoperative time course for each grou p of patients. Patients undergoing hepatic lobectomy showed a characte ristic laboratory value profile. PT elevated within 48 hours to a mean high of 16.0 seconds, then returned to normal by postoperative day 4. Partial thromboplastin time levels remained normal throughout the ent ire perioperative course. Total bilirubin rose slightly, to a mean hig h of 2.6 mg/100 cc, then returned to normal by postoperative day (POD) 14. Parenchymal liver enzymes aspartate transaminase and LDH rose abr uptly to very high levels, then returned abruptly to normal (by POD 5) . TP and A both fell to approximately 50 per cent of normal, gradually rising to normal by POD 14. Glucose rose to a mean high of 199 mg/100 cc within the first 5 days, then returned to normal by POD 7. Alkalin e phosphatase remained normal initially, then showed a progressive ris e to a high of 288 mg/100 cc on POD 14. Patients undergoing wedge rese ctions did not show the same changes in total serum bilirubin, but sho wed similar trends in all other tests, although the magnitude of these changes was smaller. TP and A levels fell acutely after resection, th en began a slow rise toward normal by POD 21. TP and A profiles were s imilar for both lobectomy patients and those undergoing wedge resectio n. The only tests that may have altered clinical management were the P T and total bilirubin. Patients undergoing major hepatic resection hav e characteristic postoperative profiles of liver enzymes and liver fun ction tests. These laboratory profiles differ with the extent of hepat ic resection. The profiles reflect changes in volume status, parenchym al liver destruction, transient hepatic insufficiency, and postoperati ve hepatic regeneration. However, except possibly for PT and bilirubin , the routine use of these tests is not recommended, given that the re sults do not alter clinical management.