Metabolic Disorders, Non-Alcoholic Fatty Liver Disease and Major Liver Resection: An Underestimated Perioperative Risk

Background Despite increasing evidence of an association of Metabolic Syndrome (MS) and liver degeneration (Non-Alcoholic Fatty Liver Disease), little is known about the results of major hepatic resection in patients with multiple metabolic disorders. Aims To quantify and analyze the perioperative mortality in patients presenting isolated metabolic disorders. Methods A retrospective analysis of immediate outcome was performed of patients undergoing right hepatectomy and concomitantly affected by two or more metabolic disorders (including diabetes mellitus, arterial hypertension, dyslipidemia and obesity/overweight) without any other known cause of liver disease from January 2001 to May 2010. Results Among the 151 patients undergoing right hepatectomy, 30 patients presented the association of two or more metabolic disorders. Perioperative mortality in this group reached 30% (nine patients). In patients presenting MS (3 or more disorders), the mortality reached 54%. Univariate analysis identified four criteria associated with poor prognosis: MS, perioperative bleeding ≥ 1000mL, middle hepatic vein resection and underlying primary hepatic malignancy. At multivariate analysis, middle hepatic vein resection and underlying primary hepatic malignancy resulted as being independently related to mortality. Conclusions Patients presenting with multiple metabolic disorders should be carefully evaluated before major liver resection, especially when the procedure is planned for hepatocellular carcinoma and when a middle hepatic vein resection is required