The Impact Of Liver Steatosis On The Perioperative Complications After Hepatic Resection

Baekgroud:At present,liver resection remains the most important curative treatment of most patients with the live malignant tumor.With the developments in surgical techniques and postoperative care,the hepatic resections become much safer than before.As a result,the mortality rate for liver resection is less than 5%in most high-volume medical centers.Recently,the incidence of metabolic disease such as obesity,diabetes, hyperlipema is increasing,so fatty liver or hepatic steatosis becomes a common parenchymal liver disease.Hepatic steatosis is characterized by an accumulation of lipid in liver and the content,consisting mainly of triglycerides,exceeds 5%of the actual wet weight of liver.It's also related to a spectrum of etiologic features such as obesity,diabetes, excessive use of alcohol and variety of drugs and toxins.Some studies have reported that the accumulation of lipid in hepatocyte may reduce hepatic microcirculation flow, induce the energy homeostasis,ischemia/reperfusion injury and impaired liver regeneration.These mechanisms are associated with the increase of postoperative morbidity and mortality.The adverse effects of liver steatosis in liver surgery have been acknowledged in liver transplantation,researches reported impaired outcome of steatotic grafts due to increasing risk of primary non-functon or dysfunction and decreasing the survival after liver transplantation.It's estimated that about 20%of the patients planning for liver resection with some degree of steatosis,and they are accompanied with profiled postoperative morbidity and mortality.Therefore,we should realize the exact impact of liver steatosis on the safety of hepatic resection and postoperative outcome of patients.Until now,there's only a few studies investigating the impact of hepatic steatosis, there's even a blankness about this area in our country,and the conclusion remains controversy.Therefore our study firstly investigate the impact of liver steatosis on the perioperative complications after hepatic resection. Objective:Discover the impact of liver steatosis on the per~operative complications after hepatic resection.Methods:270 patients carried out hepatic resection in our hospital for the first time during 2002～2007 were randomly choosed.We retrospectively analyzed the clinical course of these patients and compared the results of patients with steatosis to matched patients without steatosis to discover the impact of liver steatosis on perioperative outcome of hepatic resection.Results:We find there were 35 patients with mild steatosis,25 patients with marked steatosis in 270 patients who underwent hepatic resection.The age of patients with steatosis was older than the control(marked 55.8±11.3 vs mild 57±10.0 vs control 50.8±11.0,P＜0.05),and the incidence of obesity was obviously higher(marked 68% vs mild 51.4%vs control 21.4%,P＜0.01).Patients with marked steatosis had a higher prevalence of diabetes than the control.The patients with steatosis was with a higher BMI than the control(marked 26.4±3.7 vs mild 24.8±2.9 vs control 22.9±2.8,P＜0.01). During this study,we also found the prealbumin decreasing extent of these with steatosis is higher than the control(marked 0.11±0.04 vs mild 0.13±0.05 vs control 0.09±0.04,P＜0.05).There was no difference about the prevalence of total complications within groups,but the marked have a higher prevalence of complications needed clinically medical therapy than the control(40%vs 21.0%, P＜0.05).However,we failed to find the difference of the prevalence about major postoperative complications,liver dysfunction and mortality between these groups. On multivariate analysis,the study discovers that the steatosis is a risk factor for postoperative complications needed medical therapy(P=0.045＜0.05).Conclusions:Marked steatosis is associated with increased postoperative complication needed medical therapy,but not with the increased prevalence of liver dysfunction and mortality.Steatosis is an independent risk factor for postoperative complications needed medical therapy. The novelty of this study:To our knowledge,this is the first time to investigate the impact of liver steatosis on the perioperative complications after hepatic resection.