Characterization of Biochemical and Clinical Correlates of Hypocholesterolemia after Hepatectomy

Although hypocholesterolemia in posttraumatic states is considered a generic expression of acute-phase response, a relationship between severity of hypocholesterolemia and bad prognosis has also been found (1)(2)(3)(4)(5)(6). The issue is still poorly understood and is complicated by the circumstance that plasma cholesterol is affected simultaneously by multiple factors whose impacts have never been distinctly characterized. The postoperative state after hepatectomy is an interesting condition in which most of these factors may be simultaneously present. We have assessed in detail the main biochemical and clinical correlates of hypocholesterolemia in a large group of patients undergoing hepatectomy.Hepatectomies were performed in 92 patients (47 women, 45 men). The mean (± SD) age was 57 ± 12 years, body weight was 70 ± 11 kg, the ratio of actual to ideal body weight was 1.13 ± 0.16 (1983 Metropolitan Tables), body surface area was 1.78 ± 0.15 m2, and body mass index (weight/height2) was 25.0 ± 4.0 kg/m2. Thirty-six patients had primary liver malignancy (23 with hepatocarcinoma, 10 with cholangiocarcinoma, 3 with other neoplasms), 35 had secondary hepatic malignancies (23 from colorectal cancer, 12 from other sources), and 21 had benign lesions. Eighteen patients had liver cirrhosis. Fifty-four patients were in ASA class I (7), 7 in class II, 30 in class III, and 1 in class IV. No patient was on cholesterol-lowering medication. Hepatectomies consisted of 43 minor (<3 liver segments) and 49 major resections (3–6 segments). The mean number of resected segments was 3 ± 1. There were 17 associated bowel operations (resections for primary malignancy or Roux-en-Y biliary reconstructions). The duration of the operations was 390 ± 149 min, and the duration of normothermic liver ischemia (used in 61 patients) was 49 ± 28 min. …