Association between preoperative serum zinc levels and postoperative infectious complications after minimally invasive hepatectomy: A retrospective cohort study

doi:10.4254/wjh.118905

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. Jun 27, 2026; 18(6): 118905
Published online Jun 27, 2026. doi: 10.4254/wjh.118905

Table 1 Baseline characteristics of the total cohort and subgroups with and without infection, n (%)/mean ± SD/median (interquartile range)

Variable	Category	Total (n = 182)	Infection
Variable	Category	Total (n = 182)	+ (n = 39)	- (n = 143)
Age (years)		67.84 ± 11.72	69.85 ± 10.68	67.29 ± 11.97
Sex	Male	102 (56.0)	26 (66.7)	76 (53.1)
Sex	Female	80 (44.0)	13 (33.3)	67 (46.9)
ASA-PS	0	2 (1.1)	0	2
	1	10 (5.5)	1	9
	2	157 (86.3)	35	122
	3	13 (7.1)	3	10
Chronic kidney disease	Presence	24 (13.2)	3 (7.7)	21 (14.7)
Diabetes mellitus	Presence	48 (26.4)	13 (33.3)	35 (24.5
Habitual smoking	Yes	54 (29.7)	14 (35.9	40 (28.0)
Habitual alcohol	Yes	55 (30.2)	10 (25.6)	45 (31.5)
Malignant status	Malignant	170 (93.4)	38 (97.4)	132 (92.3)
	Metastatic liver tumors	87 (47.8)	21 (53.8)	66 (46.2)
	HCC	63 (34.6)	13 (33.3)	50 (35.0)
	CCC	15 (8.2)	3 (7.7)	12 (8.4)
	Others	5 (2.7)	1 (2.6)	4 (2.8)
	Benign	12 (6.6)	1 (2.6)	11 (7.7)
Child-Pugh	A	178 (97.8)	38 (97.4)	140 (97.9)
Child-Pugh	B	4 (2.2)	1 (2.6)	3 (2.1)
ICG R15		10.0 (8.00-15.00)	10.0 (8.0-15.0)	10.0 (8.0-13.0)
Body mass index (kg/m²)		22.62 (20.37-24.86)	23.44 (20.24-24.53)	22.52 (20.48-25.02)
Albumin (g/dL)		4.05 (3.80-4.30)	4.00 (3.70-4.30)	4.10 (3.80-4.30)
Albumin (g/dL)	< 3.5	18 (9.9)	7 (17.9)	11 (7.7)
Albumin (g/dL)	≥ 3.5	164 (90.1)	32 (82.1)	132 (92.3)
PNI		47.00 (44.12-50.50)	48.0 (44.75-50.50)	47.0 (44.00-50.50)
PNI	< 45	53 (29.1)	10 (25.6)	43 (30.1)
PNI	≥ 45	129 (70.9)	29 (74.4)	100 (69.9)
Zn (μg/dL)		72.00 (63.00-80.10)	65.2 (57.05-76.25)	72.00 (63.00-80.10)
Zn (μg/dL)	< 80	132 (72.5)	34 (87.2)	98 (68.5)
Zn (μg/dL)	≥ 80	50 (27.5)	5 (12.8)	45 (31.5)
CONUT score		2.00 (1.00-2.00)	1.00 (0.00-6.00)	2.00 (0.00-6.00)
CONUT score	0-1	90 (49.5)	22 (56.4)	68 (47.6)
CONUT score	≥ 2	92 (50.5)	17 (43.6)	75 (52.4)
MIH approach	Laparoscopic	87 (47.8)	16 (41.0)	71 (49.7)
MIH approach	Robotic	95 (52.2)	23 (59.0)	72 (50.3)
Operative procedure	Anatomical resection	115 (63.2)	27 (69.2)	88 (61.5)
Operative procedure	Partial resection	67 (36.8)	12 (30.8)	55 (38.5)
Iwate criteria		6.00 (5.00-8.00)	7.00 (2.00-11.00)	6.00 (1.00-11.00)
Operative time (hour)		6.45 (4.50-7.97)	6.85 (5.50-8.52)	6.13 (4.28, 7.88)
Estimated blood loss (mL)		120.5 (61.3-284.5)	178.0 (83.0-445.5)	106.0 (55.00-261.5)

ASA-PS: American Society of Anesthesiologists-Physical Status classification; HCC: Hepatocellular carcinoma; CCC: Cholangiocellular carcinoma; ICG R15: Indocyanine green retention rate at 15 minutes; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; MIH: Minimally invasive hepatectomy.

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Table 2 Results of univariable and multivariable logistic regression analyses for postoperative infection

Variable (reference)	Category or unit	Univariable logistic model		Multivariable logistic model
Variable (reference)	Category or unit	OR (95%CI)	P value	OR (95%CI)	P value
Age (year)	1	1.02 (0.99-1.06)	0.228
Sex (female)	Male	1.76 (0.84-3.70)	0.148
ASA-PS (0-1)	2-3	3.17 (0.396-25.3)	0.277
Chronic kidney disease	Presence	0.48 (0.14-1.72)	0.300
Diabetes mellitus	Presence	1.54 (0.72-3.32)	0.306
Habitual smoking	Yes	1.44 (0.68-3.05)	0.332
Habitual alcohol consumption	Yes	0.75 (0.34-1.67)	0.558
Malignant status (benign)	Malignant	3.19 (0.40-25.50)	0.467
Child-Pugh (B)	A	1.23 (0.12-12.1)	> 0.999
ICG R15 (point)	1	0.99 (0.94-1.04)	0.574
Body mass index (kg/m²)	1	1.03 (0.95-1.12)	0.572
Albumin (g/dL)	1	0.47 (0.18-1.21)	0.115
Albumin (≥ 3.5 g/dL)	< 3.5	2.62 (0.94-7.30)	0.071	2.28 (0.79-6.57)	0.126
PNI (point)	1	1.00 (0.92-1.07)	0.898
PNI (≥ 45 points)	< 45	0.80 (0.36-1.79)	0.693
Zn (μg/dL)	1	0.96 (0.94-0.99)	0.015	0.96 (0.94-0.99)	0.009
Zn (≥ 80 μg/dL)	< 80	0.32 (0.12-0.87)	0.025	0.32 (0.11-0.90)	0.032
CONUT score (point)	1	0.96 (0.74-1.25)	0.455
CONUT score (≥ 2 points)	0-1	0.70 (0.34-1.43)	0.369
MIH approach (robot)	Lap	1.42 (0.69-2.90)	0.370
Operative procedure (partial)	Anatomical	0.71 (0.33-1.52)	0.455
Iwate criteria (point)	1	1.05 (0.91-1.21)	0.497
Operative time (hour)	1	1.17 (1.00-1.37)	0.043	1.12 (0.93-1.34)	0.228
Estimated blood loss (mL)	100	1.09 (1.00-1.19)	0.039	1.08 (0.98-1.20)	0.140

For binary variables, odds ratios were calculated using the category shown in parentheses as the reference category. For continuous variables, odds ratios represent the change in odds associated with each unit increase specified in the category/unit column. ASA-PS: American Society of Anesthesiologists Physical Status classification; ICG R15: Indocyanine green retention rate at 15 minutes; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; MIH: Minimally invasive hepatectomy; Lap: Laparoscopic.

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Table 3 Results of univariable and multivariable logistic regression analyses comparing Clavien–Dindo grade IIIa–negative and grade IIIa–positive groups

Variable	Category or unit	Univariable logistic model		Multivariable logistic model
Variable	Category or unit	OR (95%CI)	P value	OR (95%CI)	P value
Age (year)	1	1.05 (0.97-1.14)	0.190
Sex (female)	Male	0.98 (0.25-3.77)	0.976
ASA-PS (0-1)	2-3	1.85 (0.21-16.13)	0.581
Chronic kidney disease	Presence	0.82 (0.10-6.82)	0.850
Diabetes mellitus	Presence	0.79 (0.16-3.93)	0.772
Habitual smoking	Yes	1.97 (0.51-7.63)	0.328
Habitual alcohol consumption	Yes	1.16 (0.28-4.83)	0.835
Malignant status (benign)	Malignant	1.48 (0.17-194.84)¹	0.780¹
Child-Pugh (B)	A	0.141(0.013-1.52)	0.106
ICG R15 (point)	1	0.96 (0.84-1.10)	0.559
Body mass index (kg/m²)	1	0.77 (0.61-0.97)	0.029	0.79 (0.61-1.02)	0.066
Albumin (g/dL)	1	0.15 (0.02-0.91)	0.039	0.54 (0.07-4.19)	0.558
Albumin (≥ 3.5 g/dL)	< 3.5	3.15 (0.58-17.00)	0.183
PNI (point)	1	0.98 (0.85-1.13)	0.752
PNI (≥ 45 points)	< 45	0.68 (0.14-3.40)	0.642
Zn (μg/dL)	1	0.93 (0.88-0.98)	0.007	0.94 (0.88-1.00)	0.046
Zn (≥ 80 μg/dL)	< 80	7.77 (0.95-1008.52)¹	0.057¹
CONUT score (point)	1	0.62 (0.33-1.17)	0.139
CONUT score (≥ 2 points)	0-1	0.26 (0.05-1.30)	0.102
MIH approach (robot)	Lap	3.38 (0.68-16.70)	0.136
Operative procedure (partial)	Anatomical	0.48 (0.10-2.35)	0.362
Iwate criteria (point)	1	1.33 (0.98-1.81)	0.070
Operative time (minute)	1	1.55 (1.13-2.13)	0.006	1.58 (1.09-2.30)	0.016
Estimated blood loss (mL)	100	1.06 (0.92-1.21)	0.429

¹Odds ratios for binary variables with zero cell counts were calculated using Firth’s penalized likelihood logistic regression.

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Table 4 Preoperative serum zinc level-specific infection rates, n (%)

Serum zinc level (μg/dL)	Number of patients	Number of infected patients
< 60	32	11 (34.4)
60 to < 70	46	11 (23.9)
70 to < 80	54	12 (22.2)
≥ 80	50	5 (10.0)

P for trend was assessed using the Cochran-Armitage trend test (two-sided), P = 0.0098.

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Table 5 Comparison of baseline characteristics according to preoperative serum zinc level, n (%)/median (interquartile range)

Variable	Category	Preoperative serum zinc level		P value
Variable	Category	< 80 μg/dL (n = 132)	≥ 80 μg/dL (n = 50)	P value
Age (years)		69.61 (10.96)	63.16 (12.46)	0.001
Sex	Male	73 (55.3)	29 (58.0)	0.867
Sex	Female	59 (44.7)	21 (42.0)
ASA-PS	0	1 (0.8)	1 (2.0)	0.212
	1	6 (4.5)	4 (8.0)
	2	113 (85.6)	44 (88.0)
	3	12 (9.1)	1 (2.0)
Chronic kidney disease	Presence	19 (14.4)	5 (10.0)	0.624
Diabetes mellitus	Presence	35 (26.5)	13 (26.0)	> 0.999
Habitual smoking	Yes	40 (30.3)	14 (28.0)	0.857
Habitual alcohol	Yes	40 (30.3)	15 (30.0)	> 0.999
Malignant status	Malignant	128(96.9)	42 (84.0)	0.004
Malignant status	Benign	4 (3.1)	8 (16.0)
Child-Pugh	A	129 (97.7)	49 (98.0)	> 0.999
Child-Pugh	B	3 (2.3)	1 (2.0)
ICG R15		11.0 (8.0-15.0)	10.0 (7.3-12.8)	0.094
Body mass index (kg/m²)		23.1 (4.2)	23.1 (3.9)	0.964
Albumin (g/dL)		3.99 (0.37)	4.20 (0.36)	0.001
Albumin (g/dL)	< 3.5	17 (12.9)	1 (2.0)	0.027
Albumin (g/dL)	≥ 3.5	115 (87.1)	49 (98.0)
PNI		46.80 (4.55)	48.87 (4.63)	0.007
PNI	< 45	42 (31.8)	11 (22.0)	0.207
PNI	≥ 45	90 (68.2)	39 (78.0)
CONUT score		2.0 (0.0-6.0)	1.0 (0.0-5.0)	0.428
CONUT score	0-1	63 (47.7)	27 (54.0)	0.508
CONUT score	≥ 2	69 (52.3)	23 (46.0)
MIH approach	Lap	62 (47.0)	25 (50.0)	0.742
MIH approach	Robot	70 (53.0)	25 (50.0)
Operative procedure	Anatomical	83 (62.9)	32 (64.0)	1.000
Operative procedure	Partial	49 (37.1)	18 (36.0)
Iwate criteria		6.0 (1.0-11.0)	6.5 (2.0-11.0)	0.683
Operative time (minute)		6.48 (4.55-7.90)	6.16 (4.17-8.36)	0.928
Estimated blood loss (mL)		128 (2.0-2520)	94 (3.0-1544)	0.304

ASA-PS: American Society of Anesthesiologists Physical Status classification; ICG R15: Indocyanine green retention rate at 15 minutes; PNI: Prognostic nutritional index; CONUT: Controlling nutritional status; MIH: Minimally invasive hepatectomy.

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Citation: 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
URL: https://www.wjgnet.com/1948-5182/full/v18/i6/118905.htm
DOI: https://dx.doi.org/10.4254/wjh.118905

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]

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