Assessment of preoperative exercise capacity in hepatocellular carcinoma patients with chronic liver injury undergoing hepatectomy

BMC Gastroenterology

A Hon Kon⁵  Yutaka Kimura³  Sawako Yoshiuchi⁴  Daiki Habu²  Tatsuma Sakaguchi⁵  Richi Nakatake⁵  Kosuke Matsui⁵  Morihiko Ishizaki⁵  Masaki Kaibori¹ 

[1]Masaki Kaibori, Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan

[2]Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka City University, 545-8585 Osaka, Japan

[3]Health Science Center, Hirakata Hospital, Kansai Medical University, 573-191 Hirakata, Osaka, Japan

[4]Department of Nutrition Management, Hirakata Hospital, Kansai Medical University, 573-191 Hirakata, Osaka, Japan

[5]Department of Surgery, Hirakata Hospital, Kansai Medical University, 573-191 Hirakata, Osaka, Japan

关键词: BCAA/tyrosine ratio;    Exercise capacity;    Hepatectomy;    Chronic liver injury;    Liver cancer;   

Others  :  857772
DOI  :  10.1186/1471-230X-13-119

 received in 2012-08-30, accepted in 2013-07-19,  发布年份 2013

【 摘 要 】

Background

Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.

Methods

Sixty-one HCC patients underwent preoperative cardiopulmonary exercise testing to determine their anaerobic threshold (AT). The AT was defined as the break point between carbon dioxide production and oxygen consumption per unit of time (VO₂). Postoperative events including recurrence of HCC, death, liver failure, and complications of cirrhosis were recorded. Univariate and multivariate analyses were performed to evaluate associations between 35 clinical factors and outcomes, and identify independent prognostic indicators of event-free survival and maintenance of Child-Pugh class.

Results

Multivariate analyses identified preoperative branched-chain amino acid/tyrosine ratio (BTR) <5, alanine aminotransferase level ≥42 IU/l, and AT VO₂ <11.5 ml/min/kg as independent prognostic indicators of event-free survival. AT VO₂ <11.5 ml/min/kg and BTR <5 were identified as independent prognostic indicators of maintenance of Child-Pugh class.

Conclusions

This study identified preoperative exercise capacity as an independent prognostic indicator of event-free survival and maintenance of Child-Pugh class in HCC patients with chronic liver injury undergoing hepatectomy.

【 授权许可】

   
2013 Kaibori et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Older P, Smith R: Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth Intensive Care 1988, 16:389-395.
• [2]Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT, Study of Perioperative Ischemia Reserch Group: Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Ann Intern Med 1996, 125:433-441.
• [3]Dunselman PH, Kuntze CE, Van Bruggen A, et al.: Value of New York Herat Association classification, radionuclide ventriculography, and cardiopulmonary exercise tests for selection of patients for congestive heart failure studies. Am Heart J 1988, 116:1475-1482.
• [4]Mangano DT, London MJ, Tubau JF, Study of Perioperative Ischemia Reserch Group, et al.: Dipyridamole thallium-201scintigraphy as a preoperative screening test: a reexamination of its predictive potential. Circulation 1991, 84:493-502.
• [5]Reilly DF, McNeely MJ, Doerner D, et al.: Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 1999, 159:2185-2192.
• [6]Girish M, Trayner E Jr, Dammann O, Pinto-Plata V, Celli B: Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest 2001, 120:1147-1151.
• [7]Older P, Hall A, Hader R: Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest 1999, 116:355-362.
• [8]Older P, Smith R, Courtney P, Hone R: Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest 1993, 104:701-704.
• [9]Bosch X, Ribes J, Borras J: Epidemiology of primary liver cancer. Semin Liver Dis 1999, 19:271-285.
• [10]Ziegler TR: Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. JPEN J Parenter Enteral Nutr 1996, 20:91-92.
• [11]Ishikawa Y, Yoshida H, Mamada Y, et al.: Prospective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery. Hepatogastroenterology 2010, 57(99–100):583-590.
• [12]Beaver WL, Wasserman K, Whipp BJ: Bicarbonate buffering of lactic acid generated during exercise. J Appl Phsiol 1986, 60:472-478.
• [13]Whipp BJ, Wasserman K: Oxygen uptake kinetics for various intensities of constant-load work. J Appl Physiol 1972, 33:351-356.
• [14]Wasserman K, Hansen JE, Sue DY: Principles of exercise testing and interpretation. In Measurement of the physiological response to exercise. Edited by Wasserman K, Hansen JE, Sue DY, Whipp BJ. Philadelphia, PA: Lea and Febiger; 1987:27-46.
• [15]Snowden CP, Prentis JM, Anderson HL, et al.: Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 2010, 251:535-541.
• [16]Coin A, Sergi G, Minicuci N, et al.: Fat-free mass and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20-80 year-old Italian population. Clin Nutr 2008, 27:87-94.
• [17]Lehnert ME, Clarke DD, Gibbons JG, et al.: Estimation ofbody water compartments in cirrhosis by multiplefrequency bioelectrical-impedance analysis. Nutrition 2001, 17:31-34.
• [18]Strasberg SM, Belghiti J, Clavien PA, et al.: The Brisbane 2000 terminology of liver anatomy and resection: terminology committee of the International Hepato-Pancreato-Biliary Association. HPB 2000, 2:333-339.
• [19]Couinaud C (Ed): “Le Foie: Etudes Anatomiques et Chirurgicales”. Paris: Masson; 1957.
• [20]Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004, 240:205-213.
• [21]Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T: Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg 2001, 121:1064-1068.
• [22]Win T, Jackson A, Sharples L, et al.: Cardiopulmonary exercise tests and lung cancer surgical outcome. Chest 2005, 127:1159-1165.
• [23]Nagamatsu Y, Terazaki Y, Muta F, Yamana H, Shirouzu K, Ishitake T: Expired gas analysis during exercise testing pre-pneumonectomy. Surg Today 2005, 35:1021-1025.
• [24]Smith TP, Kinasewitz GT, Tucker WY, Spillers WP, George RB: Exercise capacity as a predictor of post-thoracotomy morbidity. Am Rev Respir Dis 1984, 129:730-734.
• [25]Bechard D, Wetstein L: Assessment of exercise oxygen consumption as preoperative criterion for lung resection. Ann Thorac Surg 1987, 44:344-349.
• [26]Bolliger CT, Soler M, Stulz P, et al.: Evaluation of high-risk lung resection candidates, pulmonary haemodynamics versus exercise testing: a series of five patients. Respiration 1994, 61:181-186.
• [27]Weisman IM: Cardiopulmonary exercise testing in the preoperative assessment for lung resection surgery. Semin Thorac Cardiovasc Surg 2001, 13:116-125.
• [28]Avramoglu RK, Basciano H, Adeli K: Lipid and lipoprotein dysregulation in insulin resitant states. Clin Chim Acta 2006, 368:1-19.
• [29]Furukawa S, Fujita T, Shimabukuro M, et al.: Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest 2004, 114:1752-1761.
• [30]Valgimigli M, Valgimigli L, Trere D, et al.: Oxidative stress EPR measurement in human liver by radical-probe technique: correlation with etiology, histology and cell proliferation. Free Radic Res 2002, 36:939-948.
• [31]Powell EE, Jonsson JR, Clouston AD: Steatosis: co-factor in other liver diseases. Hepatology 2005, 42:5-13.
• [32]Hickman IJ, Jonsson JR, Prins JB, et al.: Modest weight loss and physical activity in overweight patients with chronoc liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut 2004, 53:413-419.
• [33]Moriwaki H, Miwa Y, Tajika M, Kato M, Fukushima H, Shiraki M: Branched-chain amino acids as a protein- and energy-source in liver cirrhosis. Biochem Biophys Res Commun 2004, 313:405-409.
• [34]Fisher JE, Rosen HM, Ebeid AM, James JH, Keane JM, Soeters PB: The effect of normalization of plasma amino acids on hepatic encephalopathy in man. Surgery 1976, 80:77-91.
• [35]Azuma Y, Maekawa M, Kuwabara Y, Nakajima T, Taniguchi K, Kanno T: Determination of branched-chain amino acids and tyrosine in serum of patients with various hepatic diseases, and its clinical usefulness. Clin Chem 1989, 35:1399-1403.
• [36]Shimizu H, Taniguchi K, Sugiyama M, Kanno T: Rapid enzymatic analysis of plasma for tyrosine. Clin Chem 1990, 36:32-35.
• [37]Mizuguchi T, Kawamoto M, Meguro M, Nakamura Y, Harada K, Kukita K, Hirata K: Prognostic impact of preoperative the branched-chain amino acid to the tyrosine ratio in hepatocellular carcinoma patients after initial hepatectomy. J Gastrointest Surg 2011, 15:1433-1439.