Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2023; 15(2): 249-257
Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.249
Hypophosphatemia as a prognostic tool for post-hepatectomy liver failure: A systematic review
Romualdas Riauka, Povilas Ignatavicius, Giedrius Barauskas
Romualdas Riauka, Povilas Ignatavicius, Giedrius Barauskas, Department of Surgery, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania
Author contributions: Riauka R, Ignatavicius P and Barauskas G contributed to study design and conception, data collection, analysis and interpretation and writing the draft of the manuscript; and all authors read and approved the published version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Povilas Ignatavicius, MD, PhD, Academic Research, Doctor, Lecturer, Surgeon, Department of Surgery, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas 50161, Lithuania. povilas.ignatavicius@lsmuni.lt
Received: July 19, 2022
Peer-review started: July 19, 2022
First decision: August 19, 2022
Revised: September 1, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: February 27, 2023
Processing time: 222 Days and 18.1 Hours
Abstract
BACKGROUND

Post-hepatectomy liver failure (PHLF) is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection. Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.

AIM

To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.

METHODS

This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. PubMed, Cochrane and Lippincott Williams & Wilkins databases were systematically searched up to March 31, 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF, overall postoperative morbidity and liver regeneration. The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.

RESULTS

After final assessment, nine studies (eight retrospective and one prospective cohort study) with 1677 patients were included in the systematic review. All selected studies scored ≥ 6 points according to the Newcastle-Ottawa Scale. Cutoff values of hypophosphatemia varied from < 1 mg/dL to ≤ 2.5 mg/dL in selected studies with ≤ 2.5 mg/dL being the most used defining value. Five studies analyzed PHLF, while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia. Only two of the selected studies analyzed postoperative liver regeneration, with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia. In three studies hypophosphatemia was associated with better postoperative outcomes, while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.

CONCLUSION

Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection. However, routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.

Keywords: Hypophosphatemia; Post-hepatectomy liver failure; Liver regeneration; Serum phosphorus; Literature review

Core Tip: A systematic literature review on hypophosphatemia and its value as a prognostic factor for post-hepatectomy liver failure and overall morbidity after liver surgery was performed. In three of nine included studies hypophosphatemia was associated with better postoperative outcomes, while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes. Data show that postoperative hypophosphatemia and changes of postoperative serum phosphorus might be used as a predictor after liver surgery. However, to be implemented in clinical practice as routine measurement more studies and data are needed.