Dr Lucas McCormack and colleagues assessed the impact of microsteatosis and macrosteatosis on major hepatectomy.
The team noted that while steatosis of a liver graft is an established risk factor in transplantation, its impact on major hepatectomy remains unclear.
The research team matched 58 steatotic patients who underwent major hepatectomy with 58 patients with a normal liver.
|Blood loss and transfusions were increased in steatotic patients|
|Annals of Surgery|
The patients were matched according to age, gender, American Society of Anesthesiologists score, diagnosis, extent of hepatectomy, and need of hepaticojejunostomy.
Steatosis was evaluated quantitatively and qualitatively.
Primary endpoints were mortality and complications.
The researchers found that pure macrosteatosis and microsteatosis were present in only 10 and 3 patients, respectively.
However, mixed steatosis was noted in 45 patients.
The team observed that 44 patients had mild, and 14 had moderate/severe steatosis.
Steatotic patients had significantly higher serum transaminase and bilirubin levels, and lower prothrombin time.
Blood loss and transfusions, and intensive care unit stay were increased in steatotic patients.
The team noted that complications were higher in steatotic patients when considering either overall or major complications.
Patients with pure macrosteatosis had increased mortality, and major complications, although this was not significant.
The researchers found that preoperative cholestasis was a highly significant risk factor for mortality in patients with hepatic steatosis.
Dr McCormack's team concluded, "Steatosis per se is a risk factor for postoperative complications after major hepatectomy and should be considered in the planning of surgery."
"Caution must be taken to perform major hepatectomy in steatotic patients with preexisting cholestasis."