The purpose of this study was to clarify the risk factors associated with complications following hepatic resections and discuss the appropriate types of perioperative management.A retrospective analysis was made of the complications in 355 patients undergoing hepatic resection between April 1985 and August 1992 at the Second Department of Surgery, Kyushu University Hospital. The patients were placed in two groups according to the occurrence of complications: patients with morbidity and/or mortality (187 patients); patients without either morbidity or mortality (168 patients).The leading complications were the accumulation of fluid in the abdominal and pleural cavities along with septic complications. The only significant factory affecting morbidity and mortality among the preoperative medical conditions was the presence of diabetes while, in addition, the patients with morbidity and/or mortality had higher levels of perioperative transaminase and serum creatinine as compared with those in patients without either morbidity or mortality.The perioperative strategies for reducing morbidity include the strict control of diabetes to reduce septic complications as well as preserve renal function, which can protect against the refractory accumulation of fluid in the peritoneal and pleural cavities.
To compare the nutritional efficacy, especially regarding the systemic immunity of early enteral (EEN) and total parenteral nutrition (TPN) in major hepatic resection.A randomized, prospective controlled study was performed in the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan. Twenty-six patients who underwent a major hepatic resection were divided into 2 groups: EEN (n = 13), and TPN (n = 13). There was no significant difference between the two groups in regard to either clinical backgrounds, nutritional parameters.There was no significant difference in the nutritional parameters after hepatectomy, such as the serum levels of retinol binding protein, transierrin, pre-albumin, and 3-methylhistidine between the two groups. Among the immunologic parameters, NK activity and changes in the lymphocyte number, the PHA response and the NK activity, which was expressed as a percentage of the preoperative values, was significantly higher in the EEN group than in the TPN group (p < 0.05). The incidence of infectious complications in the TPN group was 4 of 13 patients (31%), although the same incidence in the EEN group was only 1 of 13 (8%). In one case of TPN, a bacterial strain of gut origin was isolated from the intra-abdominal abscess, which suggested that bacterial translocation occurred.No significant difference was observed in the nutritional parameters between the EEN and TPN groups. Early enteral feeding maintained immunocompetence, and thus such feeding possibly reduced the rate of infectious complications after major hepatic resection.
