Clinical experience of somatostatin for the treatment of severe posthepatectomy liver failure

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Posthepatectomy liver failure (PHLF) is a major cause of morbidity and mortality after major liver resection. Postoperative excessive portal pressure could cause shear stress to the small remnant liver leading to a PHLF. This study aimed to report the clinical experience of somatostatin for portal modulation in patients with severe PHLF. This retrospective study enrolled 15 patients who received somatostatin for the treatment of PHLF between 2016 and 2019. When the patients fulfilled the 50-50 criteria (serum bilirubin > 2.9 mg/dL and prothrombin time < 50%) on or before postoperative day 5, somatostatin (3.5 μg/kg/h) was administered by continuous infusion. The discontinuation criteria were as follows: serum bilirubin < 2 mg/dL and prothrombin time ≥ 50%. Prospectively collected clinical characteristics, laboratory tests, postoperative morbidity and mortality were evaluated. The study cohort consisted of 8 patients with hepatocellular carcinoma, 6 with cholangiocarcinoma, and 1 with colon cancer liver metastasis. Seven patients (46.7%) had underlying liver cirrhosis, and 14 (93.3%) underwent major hepatectomy. The median start time of somatostatin was postoperative day 1 (range, 1-19), and the median duration of administration was 9 days (2-29 days). There was no obvious side effects or hypersensitivity related to the somatostatin. The median hospital stay was 37 days (21-249 days). The 30-day and 90-day mortality were both 6.7% (1 of 15 patients). Administration of somatostatin in the early postoperative period is considered to be effective for the treatment of PHLF. Further prospective comparative clinical trials are needed to validate this finding.