Evaluation of Postoperative Intravenous Hyperalimentation for Patients with Hepatocellular Carcinoma Treated by Minimal Surgery

Takatsugu Yamamoto, Kazuhiro Hirohashi, Taichi Shuto, Masao Ogawa, Katsu Sakabe, Shogo Tanaka, Takahiro Uenishi, Tadashi Tsukamoto, Hiromu Tanaka and Shoji Kubo

Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine

Aim: To identify which patients undergoing hepatic surgery for hepatocellular carcinoma (HCC) require postoperative intravenous hyperalimentation (IVH). Materials & Methods: Eighty patients with HCC who underwent limited resection (segmentectomy according to Couinaud's classification or less) or laparotomic microwave coagulation between 2001 and 2003 were classified based on whether they received postoperative IVH (IVH group; 62 cases: 48 men and 14 women; 7 treated by laparotomic microwave coagulation and 55 treated by partial resection) (non-IVH group; 18 cases; 12 men and 6 women; 6 treated by laparotomic microwave coagulation, and 12 treated by partial resection). Gender, age, body weight, liver function, weight of the surgical specimen, intravenously infused calories per day, postoperative complications, day of oral ingestion restarted, and day of discharge were compared. Results: In the non-IVH group, mean age was 64. 1 years old, weight, 57.3 kg; weight of surgical specimen, 17.1 g; 15 patients were Child-Pugh's class A and 3 class B; intravenously infused calories, 469.3 Kcal; days until oral ingestion restarted, 2.3 days; and length of stay, 19.9 days. One patient in the non-IVH group developed a minor bile leak, but there was no hospital death. The mean number of daily intravenously infused calories before oral ingestion in the non-IVH group was lower (p<0.01) than in the IVH group (p<0.01), and oral ingestion was restarted significantly earlier in the IVH group (p<0.01). Otherwise the two groups were similer. Conclusion: Postoperative management using hypoalimentary nutrition via a peripheral vein is suitable for patients who have undergone partial resection for HCC and have mild liver dysfunction. The treatment permits early oral ingestion, produces only mild liver disorders, and yields lower surgical stress.

Key words
hepatectomy, hepatocellular carcinoma, postoperative nutrition, intravenous hyperalimentation

Reprint requests
Takatsugu Yamamoto Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
October 29, 2003

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