Elsevier

Surgery

Volume 155, Issue 2, February 2014, Pages 263-270
Surgery

Original Communication
Preoperative total cholesterol predicts postoperative outcomes after partial hepatectomy in patients with chronic hepatitis B- or C-related hepatocellular carcinoma

https://doi.org/10.1016/j.surg.2013.08.017Get rights and content

Background

Total cholesterol (TC) can reflect the degree of liver damage in patients with chronic hepatitis B or C; its role in evaluating liver functional reserve and predicting postoperative complications remains unknown.

Methods

The prospectively collected data of 996 consecutive patients with chronic hepatitis B or C undergoing partial hepatectomy for hepatocellular carcinoma in a tertiary institution were retrospectively reviewed. The relationship between preoperative TC and postoperative liver insufficiency, morbidity and mortality were analyzed.

Results

TC showed significant correlation with postoperative complications on receiver operating characteristic curves, with area under the curve of 0.81 (P < .001), 0.79 (P < .001), and 0.85 (P < .001) for postoperative liver insufficiency, morbidity, and mortality, respectively. Using the calculated cutoff at 2.80 mmol/L, Patients with low TC had worse preoperative liver functional reserve and suffered from more postoperative complications when compared with patients with normal TC (≥2.8 mmol/L). Multivariate analysis revealed that low preoperative TC was more powerful in predicting poor postoperative outcomes than Child-Pugh's classification, indocyanine green (ICG) retention test, and Mayo End-Stage Liver Disease (MELD) score. It was an independent risk factor for postoperative morbidity (odds ratio [OR], 4.87; P < .001) and mortality (OR, 14.60; P < .001).

Conclusion

Among patients with chronic virus B or C hepatitis receiving partial hepatectomy, a low TC (<2.8 mmol/L) predicted poor postoperative outcomes. It was better than Child-Pugh's classification, ICG, and MELD score in the prediction of postoperative complications, and was useful in the preoperative evaluation of liver functional reserve.

Section snippets

Study population

From January 2003 to December 2009, 1,015 consecutive liver resections were carried out for HCC at the Hepatic Surgery Center of Tongji Hospital. The demographic and perioperative data and the types of operations were collected prospectively and entered into a computer database. Nineteen patients with obstructive jaundice were excluded from the study, because obstructive jaundice caused hypercholesterolemia, the TC level could not reflect liver damage. This resulted in a total of 996 patients

Demographics

A total of 996 patients were included in the study (Table I). There were 873 men and 123 women, and the average age was 48 years (range, 12–85). Nine hundred seventy-nine patients (98%) had HBV infection and 21 (2%) had HCV infection; 4 among them (0.4%) had combined HCV and HBV infection. Eight hundred and forty-nine patients had liver cirrhosis (85%); 216 of them had serious liver cirrhosis. The mean preoperative TC level was 3.52 ± 1.00 mmol/L, the mean ICGR-15 rate was 6.6 ± 4.1%, and the

Discussion

Compared with Western series,1, 25 there are more patients with HBV- or HCV-related cirrhosis (85.2%) in this study. Cirrhotic liver tolerates tissue loss poorly, and has impaired function and a decreased ability to regenerate.26 To ensure favorable perioperative outcomes in patients with chronic liver diseases undergoing partial hepatectomy, careful patient selection is important.9, 27, 28 Methods have been developed to assess preoperative hepatic functional reserve, such as the ICG retention

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    Supported by grants from the state key project on infectious diseases of China (Grant No. 2008ZX10002-025).

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