Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance

Table 1 Patient characteristics n (%)

Variables	Stomach cancer (n = 215)			Colon cancer (n = 121)
	LAG (n = 91)	OG (n = 124)	P	LAC (n = 43)	OC (n = 78)	P
Gender (M:F)	70:21	94:30	NS	22:21	43:35	NS
Age (yr, mean ± SD)	57.1 ± 13.2	59.7 ± 11.9	NS	58.9 ± 10.3	62.0 ± 13.5	NS
BMI (kg/m2, mean ± SD)	23.8 ± 3.2	23.5 ± 3.4	NS	24.2 ± 3.6	24.7 ± 2.9	NS
Underlying liver disease			NS			NS
No	81 (89.0)	103 (83.1)		30 (69.8)	66 (84.6)
Yes	10 (11.0)	21 (16.9)		13 (30.2)	12 (15.4)
Fatty liver	6	9		11	8
Hepatitis	4	12		2	4
TNM stage			< 0.001			0.004
I	84 (92.3)	53 (42.7)		18 (41.9)	15 (19.2)
II	4 (4.4)	22 (17.7)		8 (18.6)	35 (44.9)
III	3 (3.3)	30 (24.3)		17 (39.5)	28 (35.9)
IV	0	19 (15.3)		0	0
Operation time (min, mean ± SD)	230.1 ± 77.6	165.2 ± 52.1	< 0.001	252.5 ± 77.2	184.1 ± 62.4	< 0.001
Combined operation			0.004			NS
No	80 (87.9)	89 (71.8)		42 (97.7)	74 (94.9)
Yes	11 (12.1)	35 (28.2)		1 (2.3)	4 (5.1)
Anesthetic agent			NS			NS
Sevoflurane	21 (23.1)	45 (36.3)		15 (34.9)	18 (23.1)
Desflurane	70 (76.9)	79 (63.7)		28 (65.1)	60 (76.9)
Postoperative morbidity	8 (8.8)	16 (12.9)	NS	1 (2.3)	5 (6.4)	NS
Postoperative mortality	1	1		1	0
Hospital stay (d, mean ± SD)	10.7 ± 16.0	14.9 ± 12.6	NS	12.7 ± 3.8	17.9 ± 12.3	0.007

LAG: Laparoscopy-assisted gastrectomy; OG: Open gastrectomy; LAC: Laparoscopy-assisted colectomy; OC: Open colectomy; BMI: Body mass index; NS: Not significant.

Table 2 Preoperative and postoperative liver enzymes (mean ± SD)

Variables	Stomach cancer (n = 215)			Colon cancer (n = 121)
	LAG (n = 91)	OG (n = 124)	P1	LAC (n = 43)	OC (n = 78)	P2
AST (IU/L)
Preoperative	22.1 ± 7.6	21.8 ± 7.3	NS	20.8 ± 8.7	19.9 ± 6.3	NS
POD1	73.8 ± 67.2a	57.6 ± 45.9a	0.047	23.2 ± 11.8	22.2 ± 11.5	NS
POD3	41.1 ± 43.5a	38.4 ± 24.3a	NS	22.9 ± 9.5	22.4 ± 8.4	NS
POD5	28.9 ± 24.1a	29.5 ± 18.1a	NS	25.3 ± 10.8	22.3 ± 10.8	NS
POD7	24.0 ± 11.6	22.2 ± 11.3	NS	28.9 ± 26.2	24.7 ± 13.4	NS
ALT (IU/L)
Preoperative	23.9 ± 13.5	23.8 ± 15.8	NS	24.1 ± 3.7	17.0 ± 2.6	0.045
POD1	89.1 ± 103.7a	63.3 ± 65.9a	0.039	18.4 ± 8.1	17.4 ± 15.0	NS
POD3	62.2 ± 97.3a	51.5 ± 57.6a	NS	16.6 ± 6.5	15.9 ± 9.6	NS
POD5	43.2 ± 49.1a	39.4 ± 40.6a	NS	20.6 ± 13.9	16.4 ± 8.5	NS
POD7	33.7 ± 25.4	26.9 ± 17.9	0.033	32.1 ± 43.8	21.0 ± 25.4	NS
Total bilirubin (mg/dL)
Preoperative	0.6 ± 0.2	0.5 ± 0.3	NS	0.5 ± 0.2	0.5 ± 0.3	NS
POD1	0.8 ± 0.3	0.7 ± 0.3	NS	0.7 ± 0.4	0.6 ± 0.3	NS
POD3	0.8 ± 0.4	0.7 ± 0.5	NS	0.4 ± 0.2	0.4 ± 0.2	NS
POD5	0.7 ± 0.3	0.6 ± 0.3	NS	0.5 ± 0.2	0.4 ± 0.2	NS
POD7	0.7 ± 0.3	0.5 ± 0.2	NS	0.5 ± 0.2	0.4 ± 0.2	NS
ALP (IU/L)
Preoperative	65.6 ± 17.6	65.8 ± 22.1	NS	69.1 ± 20.3	64.4 ± 22.2	NS
POD1	46.7 ± 11.9	47.8 ± 14.6	NS	49.9 ± 15.5	44.6 ± 13.3	NS
POD3	44.2 ± 10.5	45.8 ± 14.5	NS	44.1 ± 11.7	41.9 ± 10.2	NS
POD5	50.6 ± 23.5	48.6 ± 15.6	NS	47.5 ± 18.7	43.2 ± 11.3	NS
POD7	57.9 ± 38.3	54.7 ± 22.6	NS	51.1 ± 24.1	47.2 ± 13.1	NS

¹P values represent the statistical difference between the laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) groups; ²P values represent the statistical difference between the laparoscopy-assisted colectomy (LAC) and open colectomy (OC) groups;

^aP < 0.05 vs preoperative liver enzymes using the paired t-test. POD: Postoperative day; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; NS: Not significant.

Table 3 Comparison of alanine transaminase levels on the first postoperative day in patients who underwent a gastrectomy n (%)

Variables	Normal group (n = 80)	Elevated group (n = 135)	P value
Gender (M:F)	59:21	105:30	0.502
Age (yr, mean ± SD)	58.6 ± 13.4	58.6 ± 12.0	0.981
BMI (kg/m2, mean ± SD)	22.3 ± 3.3	24.4 ± 3.0	< 0.001
Underlying liver disease			0.153
No	70 (87.5)	114 (84.4)
Yes	10 (12.5)	21 (15.6)
Fatty liver	2 (2.5)	13 (9.7)
Hepatitis	8 (10.0)	8 (5.9)
Operation time (min, mean ± SD)	168.9 ± 61.4	206.7 ± 73.6	< 0.001
Types of operation			0.094
Open	52 (65.0)	72 (53.3)
Laparoscopy-assisted	28 (35.0)	63 (46.7)
Combined operation			0.093
No	58 (72.5)	111 (82.2)
Yes	22 (27.5)	24 (17.8)
Anesthetic agent			0.979
Sevoflurane	24 (30.0)	40 (29.6)
Desflurane	56 (70.0)	95 (70.4)
Intraoperative transfusion			0.894
No	71 (88.8)	119 (88.1)
Yes	9 (11.3)	16 (11.9)
Aberrant left hepatic artery			0.052
Absence or preservation	79 (98.8)	127 (94.1)
Artery ligation	1 (1.3)	8 (5.9)
Intraoperative hepatic injury			0.048
No	79 (98.8)	125 (92.6)
Yes	1 (1.3)	10 (7.4)
Mean ALT at POD1 (± SD)	28.2 ± 8.1	101.4 ± 97.1	< 0.001

BMI: Body mass index; POD: Postoperative day; ALT: Alanine aminotransferase.