Lateral Segment Thickness of the Liver Is a Risk Factor for Elevated Liver Enzymes After Laparoscopic Gastrectomy Using the Nathanson Liver Retractor.

INTRODUCTION

Liver transaminase levels may be elevated following gastrectomy using the Nathanson liver retractor, which is widely used in laparoscopic gastrectomy. However, risk factors for developing liver dysfunction associated with this procedure remain unclear.

METHODS

Overall, 258 consecutive patients who underwent laparoscopic gastrectomy for gastric cancer using a Nathanson retractor between 2015 and 2022 were categorized into groups with and without Common Terminology Criteria for Adverse Event grade 3 or higher elevation in transaminases. Factors associated with transaminase elevation after laparoscopic gastrectomy were analyzed.

RESULTS

Grade 3 or higher transaminase elevation was observed in 62 (24.0%) patients. Male sex, preoperative transaminase elevation, fatty liver, high body mass index, thickness of the lateral segment of the liver, D2 lymph node dissection, long operative duration, and high amount of blood loss were significantly associated with elevated transaminase levels in the univariable analysis. In the multivariable analysis, lateral segment thickness of the liver and operative duration were independent risk factors for postoperative elevation in transaminase levels.

CONCLUSION

Lateral segment thickness of the liver and operative duration were independent risk factors for transaminase elevation after laparoscopic gastrectomy using a Nathanson retractor. Although it is an easy and useful liver retractor, alternative methods of liver elevation should be considered in patients at risk of elevated postoperative liver enzyme levels.