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Serum lactate in liver resection with intermittent Pringle maneuver: the “square‐root‐ shape
Author(s) -
Giustiniano Enrico,
Procopio Fabio,
Costa Guido,
Rocchi Laura,
Ruggieri Nadia,
Cantoni Stefania,
Zito Paola C.,
Gollo Yari,
Torzilli Guido,
Raimondi Ferdinando
Publication year - 2017
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.501
Subject(s) - hyperlactatemia , medicine , resection , surgery , nuclear medicine , gastroenterology
Background Serum lactate (sLac) concentration during liver resection with intermittent hepatic hilum clamping (i.e. Pringle maneuver, PM ) was retrospectively investigated. Methods A total of 133 patients who underwent liver resection were enrolled. We analyzed the sL ac peri‐operatively. Correlations were searched between the PM and lactatemia and its variations (i.e. lactate clearance, cL ac) and other factors which it might be related to. Lactatemia in triplicate intraoperatively was recorded, just after the awakening, and 1 and 2 h later. The cL ac between two consecutive measurements [(sLac 1 − sLac 2 )/sLac 1 ] was computed. Results A reliable dependence of sL ac was found from the cumulative PM . More than 76 min of cumulative Pringle Time ( cPT ) exposed patients to a worse cL ac at the end of the resection phase ( P < 0.0001). We found cPT >76 min, global operation time >365 min and bleeding >225 ml to be predictors of hyperlactatemia ( sL ac >4 mmol/L). Normal liver resulted as a risk factor for hyperlactatemia and steatosis was not ( P = 0.030 vs. P = 0.325). Finally, cL ac showed a “square‐root‐ shape, just like the mathematical operation sign. Conclusions Lactatemia during liver resection depends on the duration of PM , bleeding and the duration of the operation. Normal liver may expose the patient to the risk of hyperlactatemia.