Outcomes of patients with post-hepatectomy hypophosphatemia: A narrative review

Table 1 Summary of study characteristics of all included studies in the literature review

No	Ref.	Definition of HP	PHH, n (%)	NP, n (%)	Type of liver resection (%)	Histopathology (%)	Post-operative phosphate replacement regime	Phosphate replacement, n (%)
1	Buell et al[14], 1998	< 2.5 mg/dL	21/35 (60)	14/35 (40)	Major hepatectomy (NR); Cryosurgery (NR)	CRLM: 8 (23) HCC: 4 (11) Others: 23 (66)	For phosphate < 3.0 mg/dL: sodium phosphate or potassium phosphate HP: mean of 15 mmol/d on POD1, to 25 mmol/d on POD3 NP: mean of 5 mmol/d	NR
2	George et al[11], 1992	NR	44/44 (100)	0	Right hepatectomy and extended right hepatectomy	NR	NR	NR
3	Giovannini et al[12], 2002	Normal: > 2.5 mg/dL; Mild-moderate: 1.6-2.5 mg/dL; Severe: < 1.5 mg/dL	38/59 (64.4)	21/59 (35.6)	Major hepatectomy (58); Minor hepatectomy (42)	CRLM: 10 (17) ICC: 7 (12) HCC: 16 (27) GBC: 2 (3) Others: 24 (41)	If > POD3 and oral feeding cannot be resumed: parenteral phosphate (fructose 1-6 diphosphate or potassium phosphate) at 20-50 mmol/d	NR
4	Hallet et al[10], 2016	≤ 0.65 mmol/L	223/402 (55.5)	179/402 (44.5)	Major hepatectomy (52) Minor (48) Hepatectomy	CRLM: 260 (65) ICC: 53 (13) HCC: 27 (7)Others: 62 (15)	Based on serum phosphate: Intravenous potassium phosphate or sodium phosphate	NR
5	Serrano et al[38], 2019	Normal: > 2.5 mg/dL; Mild: 1.6-2.5 mg/dL; Moderate: 1.0-1.5 mg/dL; Severe: < 1.0 mg/dL	161		Living donor hepatectomy	NA	Elemental phosphate based on phosphate levels: < 1.1 mg/dL: 25 mmol 1.1-1.9 mg/dL: 20 mmol 2.0-2.3 mg/dL: 15 mmol 2.4-2.7 mg/ dL: 10 mmol	NR
6	Squires et al[13], 2014	Normal: > 2.5 mg/dL; Mild: 1.6-2.5 mg/dL; Moderate: 1.0-1.5 mg/dL; Severe: < 1.0 mg/dL	488/719 (67.9)	231/719 (32.1)	Extended left hepatectomy (6) Extended right hepatectomy (20) Left hemihepatectomy (23) Right hemihepatectomy (39) Central hepatectomy (2) Non-anatomical (10)	CRML: 229 (32) HCC: 69 (9) ICC: 88 (12) Metastatic NET: 34 (5) Other: 299 (42)	Discretion of surgeon Median replacement: 55 mmol (range 10-170 mmol)	469 (69)
7	Tan et al[39], 2003	Normal: > 2.5 mg/dL; Moderate: 1.5-2.5 mg/dL; Severe: 1.0-1.5 mg/dL; Profound: < 1.0 mg/dL	89/95 (93.7)	6/95 (6.3)	Right-lobe living donor hepatectomy: Right hepatectomy (94); Left lateral segmentectomy (5); Left lobectomy (11)	NA	Based on phosphate deficit: intravenous or oral phosphate	NR
8	Yuan et al[40], 2010	Normal: > 2.5 mg/dL; Mild: 1.5-2.5 mg/dL; Moderate: 1.0-1.5 mg/dL; Severe: < 1.0 mg/dL	Overall: 100/102 (98) Mild: 56/102 Moderate: 25/102 Severe: 19/102	2/102 (2)	Living donor hemi-hepatectomy	NA	Severe HP: Intravenous phosphate	7/19 (36.8)

All categorical variables are expressed as n (%). CRLM: Colorectal liver metastasis; GBC: Gallbladder carcinoma; HCC: Hepatocellular carcinoma; ICC: Intrahepatic cholangiocarcinoma; ILI: Initial liver insufficiency; INR: International normalized ratio; LOS: Length of stay; NA: NET: Neuroendocrine tumor; Not applicable; NP: Normophosphatemia; NR: Not reported; PHH: Post-hepatectomy hypophosphatemia; PHLF: Post-hepatectomy liver failure.