Murase H, Matsuo Y, Nakatani E, Denda Y, Nonoyama K, Kato T, Saito K, Sato T, Morimoto M, Yamakawa Y, Sagawa H, Takiguchi S. Association between preoperative serum zinc levels and postoperative infectious complications after minimally invasive hepatectomy: A retrospective cohort study. World J Hepatol 2026; 18(6): 118905 [DOI: 10.4254/wjh.118905]
Corresponding Author of This Article
Yoichi Matsuo, MD, PhD, Professor, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Japan. nukemat0328@gmail.com
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Murase H, Matsuo Y, Nakatani E, Denda Y, Nonoyama K, Kato T, Saito K, Sato T, Morimoto M, Yamakawa Y, Sagawa H, Takiguchi S. Association between preoperative serum zinc levels and postoperative infectious complications after minimally invasive hepatectomy: A retrospective cohort study. World J Hepatol 2026; 18(6): 118905 [DOI: 10.4254/wjh.118905]
World J Hepatol. Jun 27, 2026; 18(6): 118905 Published online Jun 27, 2026. doi: 10.4254/wjh.118905
Association between preoperative serum zinc levels and postoperative infectious complications after minimally invasive hepatectomy: A retrospective cohort study
Hiromichi Murase, Yuki Denda, Keisuke Nonoyama, Tomokatsu Kato, Kenta Saito, Takafumi Sato, Mamoru Morimoto, Yushi Yamakawa, Hiroyuki Sagawa, Shuji Takiguchi, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Yoichi Matsuo, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, Nagoya 464-8547, Japan
Eiji Nakatani, Department of Biostatics, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Co-corresponding authors: Yoichi Matsuo and Eiji Nakatani.
Author contributions: Murase H conceived and designed the study, collected and curated the data, interpreted the results, and drafted the manuscript; Matsuo Y supervised the project and critically revised the manuscript for important intellectual content; Nakatani E provided biostatistical guidance and reviewed the statistical methods and results; Denda Y, Nonoyama K and Kato T collected the data; Saito K, Sato T, Morimoto M, Yamakawa Y, Sagawa H and Takiguchi S critically reviewed the manuscript for important intellectual content; all authors read and approved the final manuscript; Matsuo Y and Nakatani E have played important and indispensable roles in the manuscript preparation as the co-corresponding authors.
Institutional review board statement: This retrospective study was reviewed and approved by the Institutional Review Board of Nagoya City Univercity (No. 60-24-0099).
Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study, and an opt-out approach was used.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are not publicly available due to ethical and privacy restrictions, but are available from the corresponding author on reasonable request and with approval from the institutional review board.
Corresponding author: Yoichi Matsuo, MD, PhD, Professor, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Japan. nukemat0328@gmail.com
Received: January 14, 2026 Revised: February 13, 2026 Accepted: April 23, 2026 Published online: June 27, 2026 Processing time: 157 Days and 9.7 Hours
Abstract
BACKGROUND
Minimally invasive hepatectomy (MIH) reduces surgical trauma; however, postoperative infectious complications (PICs) still occur in 10%-20% of patients and remain a clinical issue. Zinc (Zn), an essential trace element for innate and adaptive immunity, may influence postoperative infection risk.
AIM
To evaluate the association between preoperative serum Zn concentration and PIC after MIH.
METHODS
This single-center retrospective cohort study included 182 consecutive patients who underwent MIH between April 2020 and April 2025. The primary endpoint was PIC within 30 days, defined as Clavien-Dindo grade ≥ II requiring systemic antibiotic therapy. The preoperative Zn concentration was analyzed categorically (< 60, 60-69, 70-79, ≥ 80 μg/dL) and as a continuous variable. Multivariable logistic regression was performed with adjustment for age, sex, body mass index, liver function indices, comorbidities, surgical approach, operative time, and blood loss.
RESULTS
Median preoperative Zn concentration was 72.0 μg/dL. PIC occurred in 39/182 patients (21.4%), with about 90% being intra-abdominal events. Zn concentration was lower with vs without infection (65.2 μg/dL vs 72.0 μg/dL, respectively; P = 0.015). Each 1-μg/dL increase in Zn was associated with a lower infection risk [odds ratio (OR) = 0.964; 95%CI: 0.938-0.991; P = 0.009]. Zn ≥ 80 μg/dL was independently protective (OR = 0.318; 95%CI: 0.112-0.904; P = 0.032), whereas blood loss and hypoalbuminemia were not independent predictors. Severe infection occurred in 9 patients (4.9%); lower Zn and longer operative time were independent risk factors. Infection rates decreased with increasing Zn strata: 34.4% (< 60 μg/dL), 23.9% (60-69 μg/dL), 22.2% (70-79 μg/dL), and 10.0% (≥ 80 μg/dL).
CONCLUSION
Low preoperative serum Zn was associated with postoperative infection after MIH. Zn measurement may aid risk stratification; prospective studies should validate cutoffs and test whether optimization improves outcomes.
Core Tip: In 182 minimally invasive hepatectomies (MIH), lower preoperative Zinc (Zn) concentration was associated with a higher incidence of postoperative infectious complications. Zn ≥ 80 μg/dL independently protected against infection (adjusted odds ratio = 0.318); infection rates declined stepwise with increasing Zn categories. Because Zn is measurable and modifiable preoperatively, assessment and correction may represent a simple strategy to reduce infections after MIH. Prospective studies are required.
