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Demystifying post-hepatectomy enzyme kinetics for the surgical learner: an analysis of 989 major hepatectomies

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Abstract

Purpose

Few resources exist for surgical learners in interpreting trends in biochemical markers following major hepatic resections.

Methods

Adult patients who underwent major hepatectomy between 2010 and 2020 were included from twelve international centers. Patients were classified as healthy donor, benign disease, non-alcoholic fatty liver disease, prior chemotherapy, or cirrhosis. Median values of total bilirubin and INR were plotted against time and compared across groups using the Kruskal–Wallis test.

Results

Across groups (n = 989), median total bilirubin and INR were observed to peak on postoperative day (POD) 1. While the healthy donor group (n = 156) had the highest median total bilirubin on POD1 (2.4, IQR: 1.7–3.3), they had the fastest rate of recovery such that by POD5, values were lower than those of the NAFLD (n = 26), chemotherapy (n = 92), and cirrhosis (n = 668) groups. Donor patients also had the highest POD1 INR (median 1.5, IQR: 1.4–1.7), while patients with NAFLD had the highest POD5 INR levels (1.2, IQR: 1.1, 1.4). The lowest POD1 total bilirubin and INR levels were observed in the cirrhosis group (1.5, 1.3, respectively). Statistically significant differences in total bilirubin and INR were observed across groups at all timepoints (p < 0.05).

Conclusions

We observed the healthy donor patients to have the highest postoperative enzyme peaks, but most rapid rate of return to normal. This illustration of the postoperative kinetics of biochemical liver function tests may serve as a useful reference for clinical learners monitoring patients in the first week following major hepatectomy.

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Data availability

Available from authors upon reasonable request.

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Acknowledgements

The International Post-Hepatectomy Liver Failure Study Group is comprised of the following members: Yuta Abe (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Thomas Armstrong (Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK); Alessandro Ferrero (Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy); Carlos Corvera (Department of Surgery, Division of Surgical Oncology, University of California San Francisco, San Francisco, CA, USA); Koki Hayashi (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Taisuke Imamura (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Minoru Kitago (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Shoji Kubo (Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan); Masatsugu Ishii (Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan); Federico Mocchegiani (Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy); Zenichi Morise (Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan); Kosuke Ogawa (Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan); Yukiyasu Okamura (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Shimpei Otsuka (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); John Primrose (Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK); Edoardo Rosso (Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France); Fernando Rotellar (HPB and Liver Transplant Unit. Department of General and Digestive Surgery, Clínica Universidad de Navarra, Pamplona, Spain); Nadia Russolillo (Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy); Shareef M Syed (Department of Surgery, Division of Abdominal Transplantation, University of California San Francisco, San Francisco, CA, USA); Minoru Tanabe (Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan); Shogo Tanaka (Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan); Fumihiro Terasaki (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Marco Vivarelli (Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy); Giuseppe Zimmitti (Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.

Funding

P.C.C. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant Number TL1 TR001871. These contents are solely the responsibility of the authors, the funding source had no role in the collection, analysis and interpretation of data; in the writing of the report; or the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. School of Medicine, University of California San Francisco, San Francisco, CA, USA

    Lucia Calthorpe

  2. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Jaeyun Wang, Patricia C. Conroy, Daniel Hoffman, Mohamed Abdelgadir Adam & Adnan Alseidi

  3. Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy

    Andrea Benedetti Cacciaguerra & Mohammad Abu Hilal

  4. Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK

    Andrea Benedetti Cacciaguerra & Mohammad Abu Hilal

  5. Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

    Taizo Hibi

  6. Division of Plastic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Keon Min Park

  7. Department of Human Structure and Repair, Ghent University, Ghent, Belgium

    Nikdokht Rashidian

Authors
  1. Lucia Calthorpe
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  2. Jaeyun Wang
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  3. Andrea Benedetti Cacciaguerra
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  4. Patricia C. Conroy
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  5. Taizo Hibi
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  6. Mohammad Abu Hilal
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  7. Daniel Hoffman
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  8. Keon Min Park
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  9. Nikdokht Rashidian
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  10. Mohamed Abdelgadir Adam
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  11. Adnan Alseidi
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Consortia

International Post-Hepatectomy Liver Failure Study Group

  • Yuta Abe
  • , Thomas Armstrong
  • , Alessandro Ferrero
  • , Carlos Corvera
  • , Koki Hayashi
  • , Taisuke Imamura
  • , Minoru Kitago
  • , Shoji Kubo
  • , Masatsugu Ishii
  • , Federico Mocchegiani
  • , Zenichi Morise
  • , Kosuke Ogawa
  • , Yukiyasu Okamura
  • , Shimpei Otsuka
  • , John Primrose
  • , Edoardo Rosso
  • , Fernando Rotellar
  • , Nadia Russolillo
  • , Shareef M. Syed
  • , Minoru Tanabe
  • , Shogo Tanaka
  • , Fumihiro Terasaki
  • , Marco Vivarelli
  •  & Giuseppe Zimmitti

Contributions

LC, JW, KMP and NR contributed to the conception and design of the study, to the analysis of the results and to the writing of the manuscript. ABC, PCC, TH, DH, MAH contributed to the acquisition of data, and critically revised the manuscript for important intellectual content. MAA and AA contributed to the conception and design of the study, acquisition of data, and critically revised the manuscript for important intellectual content. The International Post-Hepatectomy Liver Failure Study Group is comprised of authors responsible for data collection and cleaning at their respective sites. All authors critically revised the manuscript for important intellectual content and gave final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Adnan Alseidi.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

This study was approved by the Institutional Review Board of the University of California San Francisco (IRB No: 20–31911).

Consent

This study used retrospective de-identified data, as such informed consent was not obtained for the present analysis.

Additional information

The members of International Post-Hepatectomy Liver Failure Study Group are listed in Acknowledgements.

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Calthorpe, L., Wang, J., Benedetti Cacciaguerra, A. et al. Demystifying post-hepatectomy enzyme kinetics for the surgical learner: an analysis of 989 major hepatectomies. Global Surg Educ 1, 8 (2022). https://doi.org/10.1007/s44186-022-00009-0

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  • DOI: https://doi.org/10.1007/s44186-022-00009-0

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