November 20, 2010

Organ fat linked to liver surgery problems

By Lynne Peeples
NEW YORK Thu Nov 18, 2010 5:01pm EST

NEW YORK (Reuters Health) - The amount of fat packed between a patient's organs may help predict problems following major liver surgery, suggests a new study.

The fat sitting below the skin, however, appears to be less important.

Any major operation comes with a range of possible complications, and how long patients stay at the hospital varies accordingly, said Dr. Yuman Fong of Memorial Sloan-Kettering Cancer Center in New York City, who led the study.

"Knowing the potential outcome allows patients and families of patients to weigh the risk and benefit of the procedure, and to plan for care after discharge," he told Reuters Health by e-mail.

Liver surgery outcomes depend on a host of factors, including surgeon experience, patient age and blood levels of bilirubin -- the brownish yellow substance found in bile. And the extra pounds weighing down the health of many Americans complicate medical choices even more.

To determine just how much added risk might come with extra weight, and whether or not the location of that fat matters, Fong and his team studied nearly 350 patients undergoing major liver surgery between 1996 and 2001, primarily as part of cancer treatment.

Within 30 days of the surgery, two out of three patients suffered complications and nine died, report the researchers in the Archives of Surgery. The average patient stayed about 11 days in the hospital.

The more fat a patient had around his or her organs -- determined by a CT scan -- the greater the risk of complications, fatal or not, and the longer the hospital stay.

Body mass index, a measure of weight in relation to height, and outer belly fat were not linked to such problems, however.

Based on other data collected by his team, Fong said his findings may be relevant to other kinds of surgery, too, such as removal of tumors in the pancreas or stomach.

According to the researchers, gauging the amount of organ fat doesn't require much extra work, because most patients being considered for abdominal surgery will have a CT scan done anyway.

"Any surgeon in less than a second can glean the information," said Fong.

So the measurement would usually be available without adding extra cost, Dr. Robert Rege of the University of Texas Southwestern Medical Center, in Dallas, told Reuters Health in an e-mail.

"It is not clear if it would be medically or economically reasonable to order a CT scan simply to make the measurement for risk assessment alone," added Rege, who also wrote a commentary in the journal.

To be practical in any surgical setting, Rege suggested that more data are needed to determine how different amounts of organ fat affect outcomes.

"It would be optimal if there were interventions (during surgery) that could decrease the risk in those patients who were determined to have high risk by the measurement," he said.

SOURCE: Archives of Surgery, online November 15, 2010.


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