Changes of Liver Volume and Functions after Hepatic Resection according to the Fibrosis (Stage of Chronic Hepatitis) of Liver Parenchyma

Lee, Jae Gil; Kim, Kyung Sik; Choi, Jin Sub; Lee, Woo Jung; Kim, Byong Ro; Park, Young Nyun

Abstract

PURPOSE
The aim of this study was to assess the regeneration rate and functional recovery of the liver due to the stage of parenchymal fibrosis following a hepatectomy. METHODS: We reviewed 41 patients that had undergone a hepatectomy for living liver donation and 35 for an HCC. The HCC patients were classified into three groups according to their histopathological status. The liver volume was serially estimated using CT scans before the operation, and on postoperative days (POD) 7 and 30. The liver function tests for AST, ALT and bilirubin were serially checked before the operation, immediately postoperative, and on POD 1, 3, 5, 7 and 30. RESULTS: There were 61 and 15 males and females, respectively, with a mean age of 40 years. Patients were divided into four subgroups: parenchymal fibrosis, none (normal), periportal, septal and cirrhotic fibrosis. Within all the patients 55, 13 and 8 right lobectomy (RL), left lobectomy (LL) and left lateral segmentectomy (LLS), respectively, were performed. In the RL cases, the regeneration rate (RR) was significantly higher than those in the cases of LL and LLS. The RR of the fibrotic livers was significantly lower than that of normal livers, and became lower as the degree fibrosis increased. The RR at POD #7 was lowest in cirrhotic livers. The levels of Serum AST and ALT rapidly increased on the immediate postoperative day, and increased maximally on POD #1, but thereafter decreased gradually, and recovered to normal on POD #30. The serum bilirubin level reached a maximal value on POD #2, and returned to normal on POD #7. CONCLUSION: The regenerative activity in chronic hepatitis patients is poor, especially in cases of severe fibrosis - cirrhosis. Therefore, in cases of major resection in HCC patients with chronic hepatitis, it is advisable to decide the extent of resection after confirmation of the stage of fibrosis.