The Effect Of Octreotide On Surgical Complications Of Hepatectomy On Hepatitis B-Related Liver Cancer

ObjectivePatients with hepatitis B-related liver cancer usually had cirrhosis and portal hypertension with different levels of severity. Since cirrhosis and portal hypertension led to the decrease of blood flow, which further negatively affected the blood circulation in liver, resulting in adverse liver reservation function and the decline of surgical tolerance, these patients had higher risk of hepatic dysfunction, ascites, pleural effusion, disturbance of water and electrolyte metabolism, and coagulation disorders after hepatectomy comparing with the others. Relevant reports indicated that approximately30%of patients with portal hypertension ended up with serious complications, therefore, comprehensive pre-operative management was necessary. The prevention of surgical complications, effective reduces of surgical risks and improvements of the surgery outcome were the primary tasks in current study. The aim was to evaluate the effect of early clinical application of Octreotide on surgical complications of hepatectomy on hepatitis B-related liver cancer through retrospectively investigation.Methods66patients undergoing hepatectomy on hepatitis B-related liver cancer, hospitalizing at the Department of Hepatic Surgery Center in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between December2011and December2012were retrospectively analyzed. Patients were divided into two groups based on the therapy of using Octreotide after hepatectomy, with control group (n=35) and study group (n=31) respectively. The control group did not apply somatostatin drugs, while the study group received treatment of0.6mg/24h (25μg/h) Octreotide infusion lasting for72hours after2hours from the operation. Other treatments were the same between these two groups. Postoperative laboratory tests, abdominal drainage, incidence rate and severity grading of complications were compared between these two groups. Differences were analyzed, and their clinical significance had been investigated.ResultsThe physical condition and intraoperative indexes were similar between these two groups. Though the preoperative serum total cholesterol, total bilirubin, and blood urea nitrogen of patients were statistically significant P<0.05, values were in the normal range. No statistical difference has been showed in other preoperative laboratory examination.None a case of perioperative death, rebreeding, or grade IV and higher level of complications out of66patients has occurred. The1st,2nd,3rd,4th day abdominal drainage, total abdominal drainage, and the ascites incidence rate in the study group were significantly less than those in the control group, P value<0.05.No significant differences between the two groups in grade Ⅰ, Ⅱ, Ⅲ or higher grade of complications, pleural effusion, thoracentesis, pulmonary infection, abdominal infection, wound infection, bile leakage, hyperbilirubinemia, the length of drainage tube, duration of postoperative hospital stay, and total hospital stay, P value>0.05.Aspartate aminotransferase, total cholesterol, and blood urea nitrogen in the7th day after surgery revealed significantly difference, P value<0.05. The level of aspartate aminotransferase was higher than the normal range, while the total cholesterol level was lower, and the blood urea nitrogen was within the normal range.Univariate analysis indicated that the volume of abdominal drainage (whether higher than500ml) correlated with ICG-R15, operation duration, extent of surgical resection and the postoperative apply of Octreotide. Also, the volume of abdominal drainage (whether higher than1000ml) correlated with Child-Pugh score, ICG-R15, extent of surgical resection, portal vein tumor thrombus, and preoperative prealbumin. Postoperative ascites correlated with preoperative total serum bilirubin and the application of Octreotide. Grade I complication significantly correlated with preoperative serum prealbumin, total bilirubin, and the severity of cirrhosis. P value<0.05.Multivariate analysis suggested that in the case of total volume of abdominal drainage (whether higher than1000ml), ICG-R15(OR=1.361, P=0.029) and portal vein tumor thrombus (OR=18.298, P=0.039) were risk factors. In postoperative ascites, the application of Octreotide was the protective factor. P value<0.05, both had statistical significance.ConclusionEarly, short-term, and continuous use of Octreotide after hepatectomy on hepatitis B-related liver cancer effectively decreased the incidence rate of postoperative ascites, evidently reduced the volume of abdominal drainage. However, the incidence rate of surgical complications, such as pleural effusion, bile leakage, remained the same. Neither did the severity of complications change. Moreover, Octreotide did not delay liver and renal function recovery. It was an effective perioperative clinical medicine in reducing the volume of abdominal drainage and the incidence of ascites after hepatectomy.