Malnutrition associated with postoperative complications in patients undergone hepatectomy for hepatocellular carcinoma

Abstract

Background: The factors affecting hypertrophy of the future liver remnant (FLR) after portal vein embolization (PVE) remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after PVE and to develop a scoring system predicting insufficient liver hypertrophy. Methods: A total of 152 patients who underwent PVE of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before PVE. Results: After PVE, the FLR volume significantly increased from 364 (151e801) ml, 33.3% (17.9%e 53.8%) to 451 (242e866) ml, 41.9% (26.1%e65.1%). The median hypertrophy rate was 23.9% (À5.1%e 95.5%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 4 factors; an initial FLR volume !35% (2 points), alkaline phosphatase !450 IU/dL (1 point), cholinesterase <220 mg/dL (1 point), and the indocyanine green disappearance rate <0.16 (1 point). The constructed scoring system showed the proportion of patients with insufficient liver hypertrophy (<25%) to be 1/22 (4.5%) in the low-score group (0 point), 33/75 (44.0%) in the medium-score group (1e2 points), and 46/ 55 (83.6%) in the high-score group (3e5 points). The hypertrophy rate of FLR was significantly different among the 3 groups (low-score group, 40.1% [2.1e 73.2%]; medium-score group, 26.5% [À5.1e81.4%]; high-score group, 20.1% [1.1e49.8%]) (P < 0.001). Conclusion: The constructed scoring system was able to stratify patients before PVE according to the possibility of developing insufficient liver hypertrophy. P 5.

Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study

“…9,37 Huang et al found that malnourished patients based on the patient-generated subjective global assessment undergoing hepatectomy were found to be associated with more occurrences of major postoperative complications (CD grade C 3a). 38 Although postoperative infections contributed to the majority of postoperative complications (56.6%) in our study, we did not find a significant association between high MUST score and postoperative infections in our study. This is in contrast to other studies that found an association between preoperative malnutrition and increased postoperative infections.…”