Is major liver surgery associated with an increased systemic inflammatory response? A prospective comparison of hemihepatectomy and other major abdominal surgery

Aims/Background: Extensive liver resection is associated with a higher morb idity and mortality than other major abdominal surgery Because the liver is responsible for the clearance of pathogenic particles as well as the clear ance and degradation of several inflammatory mediators, the high rate of co mplications after liver surgery may be due to an enhanced or prolonged infl ammatory response. The objective of this prospective study was to investiga te whether major liver resection is associated with an enhanced systemic in flammatory response. The Methods: The course of various inflammatory parame ters was studied in 12 patients undergoing a hemihepatectomy and the result s were compared with those of 12 patients undergoing other major abdominal surgery. Results: After hemihepatectomy, the plasma levels of IL-6, IL-8, s PLA(2) and elastase were similar to the levels after other major abdominal surgery, though the hepatectomized patients showed higher levels of lactofe rrin, possibly due to impaired hepatic clearance. In addition, the hemihepa tectomized patients showed signs of impaired liver function, as was indicat ed by increased plasma bilirubin and ASAT levels, whereas the other patient s did not. Conclusions: The inflammatory response associated with major liv er resection is not significantly different from that after other major abd ominal surgery, and therefore does not explain the increased complication r ate that is seen after major liver resection. We infer that the most import ant factor in the development of complications after liver resection may be the hepatic failure itself.