Riauka Romualdas, Ignatavicius Povilas, Barauskas Giedrius
Department of Surgery, Lithuanian University of Health Sciences, Kaunas 50161, Lithuania.
World J Gastrointest Surg. 2023 Feb 27;15(2):249-257. doi: 10.4240/wjgs.v15.i2.249.
Post-hepatectomy liver failure (PHLF) is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection. Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.
To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.
This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. PubMed, Cochrane and Lippincott Williams & Wilkins databases were systematically searched up to March 31, 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF, overall postoperative morbidity and liver regeneration. The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.
After final assessment, nine studies (eight retrospective and one prospective cohort study) with 1677 patients were included in the systematic review. All selected studies scored ≥ 6 points according to the Newcastle-Ottawa Scale. Cutoff values of hypophosphatemia varied from < 1 mg/dL to ≤ 2.5 mg/dL in selected studies with ≤ 2.5 mg/dL being the most used defining value. Five studies analyzed PHLF, while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia. Only two of the selected studies analyzed postoperative liver regeneration, with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia. In three studies hypophosphatemia was associated with better postoperative outcomes, while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.
Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection. However, routine measurement of perioperative serum phosphorus levels remains questionable and should be evaluated individually.
肝切除术后肝衰竭（PHLF）是术后死亡的主要原因之一，在肝切除术后患者中早期预测具有挑战性。一些研究表明，术后血清磷可能预测这些患者的预后。
对低磷血症进行系统的文献综述，并评估其作为PHLF和总体发病率的预后因素。
本系统综述按照系统评价和Meta分析的首选报告项目声明进行。该综述的研究方案已在国际前瞻性系统评价注册数据库中注册。截至2022年3月31日，对PubMed、Cochrane和Lippincott Williams & Wilkins数据库进行了系统检索，以查找分析术后低磷血症作为PHLF、总体术后发病率和肝再生预后因素的研究。根据纽卡斯尔-渥太华量表对纳入的队列研究进行质量评估。
经过最终评估，9项研究（8项回顾性研究和1项前瞻性队列研究）共1677例患者被纳入系统综述。所有入选研究根据纽卡斯尔-渥太华量表得分均≥6分。在入选研究中，低磷血症的截断值从<1mg/dL到≤2.5mg/dL不等，其中≤2.5mg/dL是最常用的定义值。5项研究分析了PHLF，其余4项分析了与低磷血症相关的总体并发症作为主要结局。仅2项入选研究分析了术后肝再生，报告显示术后低磷血症患者的术后肝再生情况较好。3项研究中低磷血症与较好的术后结局相关，而6项研究表明低磷血症是患者预后较差的预测因素。
术后血清磷水平的变化可能有助于预测肝切除术后的预后。然而，围手术期血清磷水平的常规测量仍存在疑问，应个体化评估。
