Abstracts
1997 Digestive Disease Week

Steatohepatitis as a potential risk factor for major hepatic resection.

KE Behrns, GG Tsiotos, NF DeSouza, MK Krishna, J Ludwig, DM Nagorney. Departments of Surgery and Pathology, Mayo Clinic, Rochester, MN.

Fatty infiltration of the liver is a recognized risk factor for primary nonfunction of an hepatic allograft, but whether steatohepatitis is a risk factor for major hepatectomy is unknown. AIM: To determine whether steatohepatitis is associated with higher morbidity and mortality after major hepatectomy, the medical records of 135 patients who underwent resection of>4 hepatic segments were analyzed. METHODS: Histopathology was reviewed for hepatocyte macro- and microvesicular steatosis. Its extent was graded as non (Group 1: 72 patients), mild (<30% hepatocytes-Group 2: 56 patients), and moderate-severe (>30% hepatocytes-Group 3: 7 patients). Morbidity, mortality, and liver tests were abstracted from patient records and correlated with steatohepatitis. RESULTS: Patients in Group 3 had an increased preoperative body mass index (33±3* vs. 26±1 vs. 27±1, p=0.00004) and hyperbilirubinemia (2.2±1.3 vs. 1.2±0.3 vs. 0.6±0.1 mg/dl, p=0.04), and hepatectomy required more time (355±24 vs. 290±9 vs. 287±13 min, p=0.05) and frequent blood transfusions (71% vs. 51% vs. 52%) compared to Groups 1 & 2. Mortality was higher in Group 3 (14%) than Group 1 (3%) and Group 2 (7%). Hepatic failure occurred in 4%, 9%, and 14% in Groups 1, 2, and 3 respectively. Hyperbilirubinemia at discharge was evident in Group 3 (5.6±2.4 mg/dl) versus Groups 1 & 2 (1.4±0.2 & 1.5±0.2 mg/dl) (p=0.00006). The change between the postoperative and preoperative value of alkaline phosphatase was -112±50 vs. 69±39 vs. 57±21 U/L (p=0.02), and of AST 18±9 vs. 48±8 vs. 52±15 U/L, (p=0.04), in Groups 1, 2, 3 respectively. SUMMARY: Moderate or severe steatohepatitis is associated with longer operative time, more frequent blood transfusion, increased hepatic enzymes and higher postoperative morbidity and mortality. CONCLUSION: Moderate to severe hepatosteatosis is a risk factor for major hepatectomy and preoperative identification of steatohepatitis should prompt caution before resection is undertaken.

*mean±sem.