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Impact of Perioperative Phosphorus and Glucose Levels on Liver Regeneration and Long-term Outcomes after Major Liver Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

The impact of phosphorus as well as glycemic alterations on liver regeneration has not been directly examined. We sought to determine the impact of phosphorus and glucose on liver regeneration after major hepatectomy.

Methods

Early and late liver regeneration index was defined as the relative increase of liver volume (RLV) within 2[(RLV2m-RLVp)/RLVp] and 7 months[(RLV7m-RLVp)/RLVp] following surgery. The association of perioperative metabolic factors, liver regeneration, and outcomes was assessed.

Results

On postoperative day 2, 50 (52.6 %) patients had a low phosphorus level (≤2.4 mg/dl), while 45 (47.4 %) had a normal/high phosphorus level (>2.4 mg/dl). Despite comparable clinicopathologic characteristics (all P > 0.05) and RLV/TLV at surgery (P = 0.84), regeneration index within 2 months was lower in the normal/high phosphorus group (P = 0.01) with these patients having increased risk for postoperative liver failure (P = 0.01). The inhibition of liver regeneration persisted at 7 months (P = 0.007) and was associated with a worse survival (P = 0.02). Preoperative hypoglycemia was associated only with a lower early regeneration index (P = 0.02).

Conclusions

Normal/high phosphorus was associated with inhibition of early and late liver regeneration, as well as with an increased risk of liver failure and worse long-term outcomes. Immediate preoperative hypoglycemia was associated with a lower early volumetric gain. Metabolic factors may represent early indicators of liver failure that could identify patients at increased risk for worse outcomes.

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    Authors and Affiliations

    1. Division of Surgical Oncology John L. Cameron Professor of Alimentary Surgery Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

      Georgios Antonios Margonis, Neda Amini, Stefan Buettner, Yuhree Kim, Faiz Gani, Mario Samaha & Timothy M. Pawlik

    2. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

      Mounes Aliyari Ghasebeh, Sepideh Besharati, Fatemeh Sobhani & Ihab R. Kamel

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    1. Georgios Antonios Margonis
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    Georgios Antonios Margonis and Neda Amini contributed equally to this work.

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    Margonis, G.A., Amini, N., Buettner, S. et al. Impact of Perioperative Phosphorus and Glucose Levels on Liver Regeneration and Long-term Outcomes after Major Liver Resection. J Gastrointest Surg 20, 1305–1316 (2016). https://doi.org/10.1007/s11605-016-3147-6

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