Retrospective Study
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World J Gastroenterol. Oct 21, 2014; 20(39): 14455-14462
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14455
Liver resection and metabolic disorders: An undescribed mechanism leading to postoperative mortality
Alban Zarzavadjian Le Bian, Renato Costi, Mohamed Said Sbai-Idrissi, Claude Smadja
Alban Zarzavadjian Le Bian, Renato Costi, Claude Smadja, Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-XI, 91400 Orsay, France
Alban Zarzavadjian Le Bian, Laboratoire d’Ethique Médicale et de Médecine Légale, Université Paris Descartes-V, 75006 Paris, France
Alban Zarzavadjian Le Bian, Mohamed Said Sbai-Idrissi, Service de Chirurgie Digestive, Hôpital Simone Veil, 95600 Eaubonne, France
Renato Costi, Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, 43100 Parma, Italy
Author contributions: Zarzavadjian Le Bian A, Costi R and Smadja C designed the study; Zarzavadjian Le Bian A, Costi R collected the data and wrote the paper; Zarzavadjian Le Bian A, Sbai-Idrissi MS and Smadja C gave an important intellectual contribution; Smadja C supervised it.
Correspondence to: Alban Zarzavadjian Le Bian, MD, MPh, Laboratoire d’Ethique Médicale et de Médecine Légale, Université Paris Descartes-V, 45 rue des Saints Pères, 75006 Paris, France. spleen2008@live.fr
Telephone: +33-6-85109112
Received: January 12, 2014
Revised: March 18, 2014
Accepted: June 14, 2014
Published online: October 21, 2014
Processing time: 280 Days and 22.5 Hours
Abstract

AIM: To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.

METHODS: The link between Metabolic Syndrome and non-alcoholic fatty liver disease is currently demonstrated. Various metabolic disorders and the Metabolic Syndrome (the association of ≥ 3 metabolic disorders) have been recently described as a risk factor of perioperative mortality in major liver resection. Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed.

RESULTS: From January 2001 to May 2010 in a tertiary centre, ten patients presenting with ≥ 2 metabolic disorders without any other known cause of liver disorders died during perioperative course of major liver resection. The same four-consecutive-steps sequence of events occurred, including jaundice. The analysis of this series suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure (mimicking septic collapse) as the mechanism leading to exitus. The acute portal hypertension is mainly related to the surgical procedure. The chronic portal hypertension is indeterminate. Patients with ≥ 2 metabolic disorders should be considered as potentially presenting with portal hypertension possibly evolving towards hepatorenal syndrome; thus, they should be considered as having a high perioperative risk and should be carefully evaluated before undergoing major liver resection.

CONCLUSION: As fibrosis was not present or marginal in liver specimens, the real cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies.

Keywords: Metabolic syndrome; Major hepatectomy; Liver resection; Postoperative mortality; Hepatorenal syndrome

Core tip: Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed. The same four-consecutive-steps sequence of events occurred, including jaundice/ascites, renal failure, hemodynamic collapse with inotrope use and death. The analysis suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure as the mechanism leading to exitus. As fibrosis was marginal in liver specimens, cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies.