Is metabolic syndrome a risk factor in hepatectomy? A meta-analysis with subgroup analysis for histologically confirmed hepatic manifestations.
MAFLD
Metabolic syndrome
NAFLD
NASH
liver surgery
meta-analysis
post-hepatectomy liver failure
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
28 01 2022
28 01 2022
Historique:
received:
20
09
2021
accepted:
06
01
2022
entrez:
1
2
2022
pubmed:
2
2
2022
medline:
24
3
2022
Statut:
epublish
Résumé
Metabolic syndrome (MetS) is a risk factor in surgery. MetS can progress to metabolic (dysfunction)-associated fatty liver disease (MAFLD), a vast-growing etiology of primary liver tumors which are major indications for liver surgery. The aim of this meta-analysis was to investigate the impact of MetS on complications and long-term outcomes after hepatectomy. The protocol for this meta-analysis was registered at PROSPERO prior to data extraction. MEDLINE, Web of Science, and Cochrane Library were searched for publications on liver resections and MetS. Comparative studies were included. Outcomes encompassed postoperative complications, mortality, and long-term oncologic status. Data were pooled as odds ratio (OR) with a random-effects model. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS), and the certainty of the evidence was evaluated with GRADE. Subgroup analyses for patients with histopathologically confirmed non-alcoholic fatty liver disease (NAFLD) versus controls were performed. The meta-analyses included fifteen comparative studies. Patients with MetS suffered significantly more overall complications (OR 1.55; 95% CI [1.05; 2.29]; p=0.03), major complications (OR 1.97 95% CI [1.13; 3.43]; p=0.02; I Patients with MetS that undergo liver surgery suffer more complications, such as postoperative hemorrhage and infection but not liver-specific complications-PHLF and biliary leakage. Histologically confirmed NAFLD is associated with significantly higher PHLF rates, yet, survivals of these patients are similar to patients without the MetS. Further studies should focus on identifying the tipping point for increased risk in patients with MetS-associated liver disease, as well as reliable markers of MAFLD stages and early markers of PHLF. PROSPERO Nr: CRD42021253768.
Sections du résumé
BACKGROUND
Metabolic syndrome (MetS) is a risk factor in surgery. MetS can progress to metabolic (dysfunction)-associated fatty liver disease (MAFLD), a vast-growing etiology of primary liver tumors which are major indications for liver surgery. The aim of this meta-analysis was to investigate the impact of MetS on complications and long-term outcomes after hepatectomy.
METHODS
The protocol for this meta-analysis was registered at PROSPERO prior to data extraction. MEDLINE, Web of Science, and Cochrane Library were searched for publications on liver resections and MetS. Comparative studies were included. Outcomes encompassed postoperative complications, mortality, and long-term oncologic status. Data were pooled as odds ratio (OR) with a random-effects model. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS), and the certainty of the evidence was evaluated with GRADE. Subgroup analyses for patients with histopathologically confirmed non-alcoholic fatty liver disease (NAFLD) versus controls were performed.
RESULTS
The meta-analyses included fifteen comparative studies. Patients with MetS suffered significantly more overall complications (OR 1.55; 95% CI [1.05; 2.29]; p=0.03), major complications (OR 1.97 95% CI [1.13; 3.43]; p=0.02; I
CONCLUSION
Patients with MetS that undergo liver surgery suffer more complications, such as postoperative hemorrhage and infection but not liver-specific complications-PHLF and biliary leakage. Histologically confirmed NAFLD is associated with significantly higher PHLF rates, yet, survivals of these patients are similar to patients without the MetS. Further studies should focus on identifying the tipping point for increased risk in patients with MetS-associated liver disease, as well as reliable markers of MAFLD stages and early markers of PHLF.
TRIAL REGISTRATION
PROSPERO Nr: CRD42021253768.
Identifiants
pubmed: 35101037
doi: 10.1186/s12916-022-02239-x
pii: 10.1186/s12916-022-02239-x
pmc: PMC8802506
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
47Informations de copyright
© 2022. The Author(s).
Références
Curr Hypertens Rep. 2018 Feb 26;20(2):12
pubmed: 29480368
Eur J Surg Oncol. 2022 Jan;48(1):103-112
pubmed: 34325939
J Hepatobiliary Pancreat Sci. 2014 Jun;21(6):399-404
pubmed: 24532454
Surgery. 2012 Aug;152(2):218-26
pubmed: 22828143
J Am Coll Surg. 2019 Nov;229(5):467-478.e1
pubmed: 31398386
Dig Liver Dis. 2018 Jul;50(7):640-646
pubmed: 29636240
J Gastrointest Surg. 2020 Feb;24(2):320-329
pubmed: 30617773
Ann Surg. 2012 Mar;255(3):405-14
pubmed: 22330038
Hepatology. 2012 Jun;55(6):2005-23
pubmed: 22488764
Int J Surg. 2021 Apr;88:105906
pubmed: 33789826
J Gastrointest Surg. 2018 Apr;22(4):615-623
pubmed: 29139083
Anaesthesia. 2016 Jun;71(6):657-68
pubmed: 27030945
J Surg Oncol. 2020 Jun 5;:
pubmed: 32502302
J Hepatol. 2018 Feb;68(2):305-315
pubmed: 29154965
Surgery. 2021 May;169(5):1054-1060
pubmed: 33358472
World J Surg. 2019 Aug;43(8):2048-2060
pubmed: 30949764
Aliment Pharmacol Ther. 2017 Nov;46(9):856-863
pubmed: 28857208
Dig Dis Sci. 2015 Oct;60(10):3142-8
pubmed: 26250831
Diabetes Care. 2012 Nov;35(11):2402-11
pubmed: 23093685
Gastroenterology. 2020 May;158(7):1999-2014.e1
pubmed: 32044314
Langenbecks Arch Surg. 2021 Sep;406(6):1723-1731
pubmed: 34129108
J Gastrointest Surg. 2012 Dec;16(12):2247-55
pubmed: 23054903
Liver Cancer. 2016 Apr;5(2):107-20
pubmed: 27386429
CA Cancer J Clin. 2021 May;71(3):209-249
pubmed: 33538338
HPB (Oxford). 2021 Jul;23(7):1113-1122
pubmed: 33309568
Ann Surg Oncol. 2021 Nov;28(12):7698-7706
pubmed: 33939045
Nature. 2021 Apr;592(7854):450-456
pubmed: 33762733
Hepatology. 2011 Aug;54(2):463-71
pubmed: 21538440
J Gastrointest Surg. 2021 May;25(5):1193-1202
pubmed: 32378092
Sci Rep. 2021 Jul 2;11(1):13739
pubmed: 34215781
World J Surg. 2015 Feb;39(2):471-7
pubmed: 25331727
J Clin Epidemiol. 2020 May;121:62-70
pubmed: 31982539
Dis Colon Rectum. 2019 Jul;62(7):849-858
pubmed: 31188186
J Gastrointest Surg. 2011 Aug;15(8):1450-8
pubmed: 21512848
Ann Surg Oncol. 2013 Apr;20(4):1185-93
pubmed: 23115006
Ann Intern Med. 2013 Feb 19;158(4):280-6
pubmed: 23420236
Hepatobiliary Surg Nutr. 2014 Oct;3(5):238-46
pubmed: 25392835
HPB (Oxford). 2021 Jul 6;:
pubmed: 34330644
Hepatology. 2012 Nov;56(5):1751-9
pubmed: 22707395
Semin Liver Dis. 2012 Feb;32(1):3-13
pubmed: 22418883