Major abdominal cancer resections in cirrhotic patients: How frequent is postoperative hepatocellular decompensation?

• Published in: Indian journal of gastroenterology 2014-05, Vol.33 (3), p.258-264
• Main Authors: Shrikhande, Shailesh Vinayak, Gaikwad, Vinay, Purohit, Dipak, Goel, Mahesh
• Format: Article
• Language: English
• Subjects: Abdominal Neoplasms - complications; Abdominal Neoplasms - surgery; Adult; Age Factors; Aged; Cohort Studies; Female; Forecasting; Gastroenterology; Hepatology; Humans; Incidence; India - epidemiology; Liver Cirrhosis - complications; Liver Cirrhosis - etiology; Liver Failure - epidemiology; Liver Failure - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Article; Patient Selection; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Risk Factors
• ISSN: 0254-8860; 0975-0711
• DOI: 10.1007/s12664-013-0426-y

Background The reported incidence of postoperative liver failure in cirrhotic patients is highly varied with diverse risk factors identified to predict risk, mainly drawn from organ or disease-specific studies. We aimed to assess risk factors for the development of postoperative liver failure in a specific cohort of patients with cirrhosis undergoing abdominal cancer resection. Methods From November 2007 to October 2012, 30 cirrhotic patients who underwent curative resection for abdominal cancer were analyzed. The postoperative trends in liver function were followed and the incidence of postoperative liver failure was demonstrated. Results Among the 30 patients, the tumors were located in the stomach ( n  = 5), pancreas ( n  = 5), colon/rectum (6), liver ( n  = 11), gallbladder ( n  = 1), and retroperitoneum ( n  = 2). Eighteen (60 %) patients experienced postoperative liver failure of which 7 (23 %) patients required deviation from the clinical course or management. There was one mortality due to grade C liver failure and hepatorenal syndrome. On multivariate analysis, only age (>55 years) was found to be statistically significant to predict postoperative liver failure ( p  = 0.024). Conclusion Liver dysfunction remains a major problem during the postoperative phase of major gastrointestinal cancer resections. However, less than one fourth of well-selected patients will develop significant postoperative liver failure. This incidence may be further reduced if the selection is restricted to younger patients.