Analysis of 100 consecutive hepatectomies: Risk factors in patients with liver cirrhosis or obstructive jaundice

We analyzed various pre-, intra-, and postoperative variables in 100 consec utive patients treated by hepatectomy for various malignant and benign Live r diseases to identify patients at risk of developing postoperative complic ations. Patients were divided into three groups: those with normal liver (N L, n = 53); those with liver cirrhosis (LC, n = 32); and those with obstruc tive jaundice (OJ, n = 15). The overall postoperative morbidity and mortali ty rates were 14% and 4% (due to liver failure), respectively. In the LC gr oup the combined presence of abnormal levels of serum hyaluronic acid (HA, > 200 ng/ml), indocyanine green retention rate at 15 minutes (ICGR15, > 15% ), and hepatic uptake ratio of Tc-99m-galactosyl human serum albumin (GSA) at 15 minutes (LHL15, < 0.9) preoperatively was found to be a risk factor w ith a 100% morbidity rate. Operative blood loss of more than 1000 ml in LC patients was associated with high morbidity. in the OJ group preoperative p arameters were almost normal after biliary drainage, but the extent of live r resection, blood loss > 2000 ml, and high serum interleukin-6 12 hours af ter hepatectomy correlated with high postoperative morbidity. No morbidity or mortality was reported in the NL group, except in a single patient who r eceived long-term intraarterial chemotherapy preoperatively. Consequently, the extent of hepatectomy should be carefully determined according to the p reoperative risk factors in LC patients; and in OJ patients hepatectomy, wh ich tends to become extensive, should be carefully performed to minimize su rgical stress because preoperative factors do not help predict outcome. Fur thermore, the present Study revealed that a serum RA lever higher than 500 ng/ml on postoperative day 1 or day 7 (or both) was a useful marker for hep atic failure.