Hyperbilirubinemia after esophagectomy. A possible role of lipid peroxidation.

Postoperative hyperbilirubinemia was investigated in 18 patients who underwent a single-staged esophagectomy and reconstruction. The total serum bilirubin (TSB) concentration increased progressively after surgery without any evidence of sepsis and reached a peak on day 5 from 0.5 +/- 0.1 to 2.4 +/- 0.4 mg/dl (p less than 0.01), and then decreased by day 14. The TSB concentration rose above 2.5 mg/dl on days 5 or 7 in 8 patients (44%). Alkaline phosphatase and SGOT showed a mild increase during the postoperative period. The increase in the serum lipid peroxide (LPO) concentration, which was measured as malondialdehyde, after surgery correlated closely with the change in the TSB concentration. The LPO concentration was significantly elevated only in the patients with postoperative hyperbilirubinemia, and showed a correlation with the TSB concentration (r = 0.81, p less than 0.01). The level of serum alpha-tocopherol decreased after surgery, but did not differ between the patients with or without postoperative hyperbilirubinemia. These results suggest that lipid peroxidation reactions play a role in the development of hyperbilirubinemia after esophagectomy, which may be due to benign intrahepatic cholestasis.