Steatosis worsens ischemia-reperfusion injury post hepatectomy with intermittent inflow occlusion.

PURPOSE: Intermittent Vascular Inflow Occlusion (VIO) is widely used during hepatectomy, but its impact on Liver Ischemia-Reperfusion Injury (LIRI) - especially in steatotic livers - remains debated. This study aims to evaluate the effects of VIO and hepatic steatosis on LIRI severity and postoperative recovery after hepatectomy. METHODS: A retrospective cohort study analyzed 200 patients undergoing hepatectomy. Patients were divided into three groups according to the number of hepatic inflow occlusion episodes: N-VIO (no occlusion, n = 136), F-VIO (few-VIO, 1-2 occlusions, n = 35), and M-VIO (multiple-VIO, ≥ 3 occlusions, n = 29). After 1:1:1 Propensity Score Matching (PSM) based on surgical approach and tumor characteristics, 23 matched triplets were generated among the three groups. Liver function (ALT, AST) was assessed preoperatively and on Postoperative Days-3 (POD3) and 7 (POD7). Steatosis effects were evaluated. RESULTS: At POD3, the three groups exhibited a trending overall difference in ALT levels before PSM (p = 0.009). Following PSM, no significant intergroup differences were observed at either POD3 (p = 0.422) or POD7 (p = 0.156). Collectively, these results suggest that, within the confines of the present study, variations in the number of hepatic inflow occlusions do not translate into significant differences in early postoperative ALT recovery. Steatosis significantly exacerbated IRI, with higher ALT in steatosis patients at POD3 (p = 0.026) and POD7 (p = 0.006). CONCLUSIONS: Appropriate VIO does not exacerbate LIRI. Steatosis heightens LIRI susceptibility. Patients with liver steatosis should pay more attention to controlling the number of VIO during the operation.