Chan KS, Mohan S, Shelat VG. Outcomes of patients with post-hepatectomy hypophosphatemia: A narrative review. World J Hepatol 2022; 14(8): 1550-1561 [PMID: 36157866 DOI: 10.4254/wjh.v14.i8.1550]
Corresponding Author of This Article
Kai Siang Chan, MBBS, Doctor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kchan023@e.ntu.edu.sg
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Aug 27, 2022; 14(8): 1550-1561 Published online Aug 27, 2022. doi: 10.4254/wjh.v14.i8.1550
Outcomes of patients with post-hepatectomy hypophosphatemia: A narrative review
Kai Siang Chan, Swetha Mohan, Vishal G Shelat
Kai Siang Chan, Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Swetha Mohan, Vishal G Shelat, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Author contributions: Chan KS and Mohan S acquired the data, prepared the tables, drafted the article and approved the final version of the manuscript to be published; Chan KS interpreted and analysed the data and prepared the figures; Shelat VG conceptualized and designed the study and made critical revision of the manuscript and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai Siang Chan, MBBS, Doctor, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. kchan023@e.ntu.edu.sg
Received: April 16, 2022 Peer-review started: April 16, 2022 First decision: May 31, 2022 Revised: May 31, 2022 Accepted: August 1, 2022 Article in press: August 1, 2022 Published online: August 27, 2022 Processing time: 131 Days and 19.3 Hours
Abstract
Phosphate is an essential electrolyte for proper mineralisation of bone, buffering of urine, and diverse cellular actions. Hypophosphatemia (HP) is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications, or even death. Post-hepatectomy HP (PHH) has been reported to be 55.5%-100%. Post-hepatectomy, there is rapid uptake of phosphate and increased mitotic counts to aid in regeneration of residual liver. Concurrently, PHH may be due to increased urinary phosphorous from activation of matrix extracellular phosphoglycoprotein in the injured liver, which decreases phosphate influx into hepatocytes to sustain adenosine triphosphate synthesis. A literature review was performed on PubMed till January 2022. We included 8 studies which reported on impact of PHH on post-operative outcomes. In patients with diseased liver, PHH was reported to have either beneficial or deleterious effects on post-hepatectomy liver failure (PHLF), morbidity and/or mortality in various cohorts. In living donor hepatectomy, PHLF was higher in PHH. Benefits of correction of PHH with reduced post-operative complications have been shown. Correction of PHH should be done based on extent of PHH. Existing studies were however heterogenous; further studies should be conducted to assess PHH on post-operative outcomes with standardized phosphate replacement regimes.
Core Tip: Hypophosphatemia (HP) is a clinical spectrum which range from asymptomatic to severe complications such as neuromuscular and pulmonary complications, or even death. Post-hepatectomy HP (PHH) has been reported to be 55.5%-100%. Pathophysiologic mechanisms have been proposed. However, literature on the outcomes of patients following PHH is scarce. This is the first review to summarize existing literature on the pathophysiology of PHH in both healthy and diseased liver, and its impact on post-operative outcomes.
