Insulinogenic Index in Hepatectomy for Hepatocellular Carcinoma

Abstract

Insulin, a typical hepatotrophic factor acting as a co-mitogen in hepatic regeneration, is essential for the maintenance of ketone body ratio(KBR) above critical level. Insulinopenia, in this context, is considered to be a possible risk factor of hepatic resection. Insulinogenic index represents the ratio of the kcumulative enhancement of insulin to the glucose level after oral ingestion of 75gm of glucose. Insulinopenic patients were defined by Ozawa as those with the insulinogenic index below 0.6. (Objectives) The study was onducted to investigate whether or not insulinogenic index correlates with the currently utilized clinical parameters of hepatic functional reserve and the possible impct of insulinopenia on the postoperative course of the patients who had hepatic resection for hepatocellular careinoma. (Materials and methods) The clinical parameters of hepatic functional reserve and the surgical outcome were studied in relation to insulinogenic index in 64 patients who had liver resection for hepatocellular carcinoma during the period of 7 years from 1986 through 1993. AKBR was measured in 31 patients concomitantly. The insulinogenic index was calculated by a modification of Seltazer's methods for oral glucose tolerance test. (Results) Among 64 patients 54 patients(84.4%) had co-existing liver cirrhosis. The op0erative procedures perrormed included 20 bisegmentectomies, 29 monosegmentectomies, and 15 subsegmentectomies. Postoperative complications developed in 16 patients(25.0%) with no operative mortality. Insulinopenia was seen in 35 patients(54.7% There was no significant correlation between insulinogenic index and the presence of liver eirrhosis(p=0.7133), Child class(p=0.08511), or ICG Rmax(p=0.7324). Postoperative complications developed more frequently in the insulinopenic group, though not significant statistically(p=0.468). there was, however, a significant delay in recovery of postoperative AKBR above 0.7 in the insulinopenic group(p-0.0458). In contrast to the patients with insulinogenic index above 0.6, whose postoperative AKBS's regained the normal value within the first 12 hours in all cases, only 12(70.6%) of 17 insulinopenic patients showed AKBR recovery at the same time period. (Conclusion) Insulinogenic index has little correlation with the presence of liver cirrhosis, Child class, ICG Rmax or postoperative complication rate. The idex, however, has a significant impact on the recovery of AKBR after liver resection suggesting its role as an independent risk factor or hepatic resection.