Impact of steatosis on perioperative outcome following hepatic resection

被引:350
作者
Kooby, DA
Fong, Y
Suriawinata, A
Gonen, M
Allen, PJ
Klimstra, DS
DeMatteo, RP
D'Angelica, M
Blumgart, LH
Jarnagin, WR
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10021 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Pathol, New York, NY 10021 USA
关键词
chemotherapy; surgical complications; nonalcoholic steatohepatitis; infection;
D O I
10.1016/j.gassur.2003.09.012
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Fatty liver disease may interfere with liver regeneration and is postulated to result in an adverse outcome for patients subjected to partial hepatectomy. This study examines the impact of steatosis on outcome following hepatic resection for neoplasms.. All patients with fatty livers (n = 325) who under-went hepatectomy between December 1991 and September 2001 were identified from a prospective database. Slides were reviewed and steatosis was quantified as follows: <30% (mild) and greater than or equal to30% (marked). Patient data were gathered and compared with results in 160 control patients with normal livers; subjects were matched for age, comorbidity, and extent of liver resection. There were 223 patients with mild and 102 with marked steatosis. Those with steatosis were more likely to be men (59% marked vs. 55% mild vs. 43% control; P = 0.01) with a higher body mass index (29.7 +/- 5.5 marked vs. 28.2 +/- 5.5 mild vs. 26.0 +/- 5.4 control; P < 0.01), and treated preoperatively with chemotherapy (66% marked vs. 55% mild vs. 38% control; P < 0.01). Total (62%, 48%, and 35%; P < 0.01) and infective (43%, 24%, and 14%; P < 0.01) complications correlated with the degree of steatosis. No difference was observed in complications requiring major medical intervention, hospitalization, or admission to the intensive care unit between groups. On multivariate analysis, steatosis was an independent predictor of complications (P < 0.01, risk ratio = 3.04, 95% confidence interval = 1.7 to 5.54). There was a nonsignificant trend toward higher 60-day mortality in patients with marked steatosis who had lobe or more resections (9.4% marked vs. 5.0% mild vs. 5.0% control; P = 0.30). Marked steatosis is an independent predictor of complications following hepatic resection but does not have a significant impact on 60-day mortality. Steatosis alone should not preclude aggressive hepatic resection for neoplasms when indicated; however, patients with marked steatosis undergoing large resections should still be approached with due caution. (C) 2003 The Society for Surgery of the Alimentary Tract.
引用
收藏
页码:1034 / 1043
页数:10
相关论文
共 48 条
  • [21] Hepatic resection for noncolorectal, nonneuroendocrine metastases: A fifteen-year experience with ninety-six patients
    Harrison, LE
    Brennan, MF
    Newman, E
    Fortner, JG
    Picardo, A
    Blumgart, LH
    Fong, Y
    [J]. SURGERY, 1997, 121 (06) : 625 - 632
  • [22] Effects of fatty infiltration of the graft on the outcome of living-related liver transplantation
    Hayashi, M
    Fujii, K
    Kiuchi, T
    Uryuhara, K
    Kasahara, M
    Takatsuki, M
    Takeichi, T
    Kitade, H
    Sugimoto, T
    Uemoto, S
    Asonuma, K
    Egawa, H
    Fujita, S
    Inomata, Y
    Tanaka, K
    [J]. TRANSPLANTATION PROCEEDINGS, 1999, 31 (1-2) : 403 - 403
  • [23] LIVER HISTOLOGY IN A NORMAL POPULATION - EXAMINATIONS OF 503 CONSECUTIVE FATAL TRAFFIC CASUALTIES
    HILDEN, M
    CHRISTOFFERSEN, P
    JUHL, E
    DALGAARD, JB
    [J]. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1977, 12 (05) : 593 - 597
  • [24] HORNBOLL P, 1982, ACTA PATH MICRO IM A, V90, P199
  • [25] Improvement in Perioperative outcome after hepatic resection - Analysis of 1,803 consecutive cases over the past decade
    Jamagin, WR
    Gonen, M
    Fong, YM
    DeMatteo, RP
    Ben-Porat, L
    Little, S
    Corvera, C
    Weber, S
    Blumgart, LH
    [J]. ANNALS OF SURGERY, 2002, 236 (04) : 397 - 407
  • [26] Jamison RL, 1997, ARCH SURG-CHICAGO, V132, P505
  • [27] Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma
    Jarnagin, WR
    Fong, Y
    DeMatteo, RP
    Gonen, M
    Burke, EC
    Bodniewicz, J
    Youssef, M
    Klimstra, D
    Blumgart, LH
    [J]. ANNALS OF SURGERY, 2001, 234 (04) : 507 - 517
  • [28] Murine leptin deficiency alters Kupffer cell production of cytokines that regulate the innate immune system
    Li, ZP
    Lin, HZ
    Yang, SQ
    Diehl, AM
    [J]. GASTROENTEROLOGY, 2002, 123 (04) : 1304 - 1310
  • [29] Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer
    Little, SA
    Jarnagin, WR
    DeMatteo, RP
    Blumgart, LH
    Fong, YM
    [J]. JOURNAL OF GASTROINTESTINAL SURGERY, 2002, 6 (01) : 88 - 94
  • [30] Leptin regulates proinflammatory immune responses
    Loffreda, S
    Yang, SQ
    Lin, HZ
    Karp, CL
    Brengman, ML
    Wang, DJ
    Klein, AS
    Bulkley, GB
    Bao, C
    Noble, PW
    Lane, MD
    Diehl, AM
    [J]. FASEB JOURNAL, 1998, 12 (01) : 57 - 65