Jian Zheng1, Ilya G Glezerman2, Eran Sadot3, Anjuli McNeil1, Cristina Zarama4, Mithat Gönen5, John Creasy1, Linda M Pak1, Vinod P Balachandran1, Michael I D'Angelica1, Peter J Allen1, Ronald P DeMatteo1, T Peter Kingham1, William R Jarnagin1, Edgar A Jaimes6. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY. 3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgery, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY. 6. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Weill Cornell Medical College, New York, NY. Electronic address: jaimese@mskcc.org.
Abstract
BACKGROUND: Postoperative hypophosphatemia is common and is associated with a lower risk of liver failure after hepatectomy, but higher morbidity after pancreatectomy. Whether different physiologic mechanisms underlie the hypophosphatemia associated with these very different clinical outcomes is unclear. This study aims to evaluate the underlying mechanism in postoperative hypophosphatemia. STUDY DESIGN: We prospectively enrolled 120 patients who underwent major hepatectomy (n = 30), minor hepatectomy (n = 30), pancreatectomy (n = 30), and laparotomy without resection (control group, n = 30). Preoperative and postoperative serum and urinary phosphorus, calcium, and creatinine, as well as phosphaturic factors, including serum nicotinamide phosphoribosyltransferase (NAMPT), fibroblast growth factor-23, and parathyroid hormone were measured. In addition, we evaluated urinary levels of nicotinamide catabolites, N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide. RESULTS: We found that significant hypophosphatemia occurred from postoperative day (POD) 1 to POD 2 in all 4 groups and was preceded by hyperphosphaturia from preoperative day to POD 1. Phosphate level alterations were associated with a significant increase in NAMPT levels from preoperative day to POD 2 in all 3 resected groups, but not in the control group. The fibroblast growth factor-23 levels were significantly decreased postoperatively in all 4 groups, and parathyroid hormone levels did not change in any of the 4 groups. Urine levels of N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide decreased significantly in all 4 groups postoperatively. CONCLUSIONS: This study demonstrates that the mechanism of hypophosphatemia is the same for both liver and pancreas resections. Postoperative hypophosphatemia is associated with increased NAMPT. The mechanism that upregulates NAMPT and its role on disparate clinical outcomes in postoperative patients warrant additional investigation.
BACKGROUND:Postoperative hypophosphatemia is common and is associated with a lower risk of liver failure after hepatectomy, but higher morbidity after pancreatectomy. Whether different physiologic mechanisms underlie the hypophosphatemia associated with these very different clinical outcomes is unclear. This study aims to evaluate the underlying mechanism in postoperative hypophosphatemia. STUDY DESIGN: We prospectively enrolled 120 patients who underwent major hepatectomy (n = 30), minor hepatectomy (n = 30), pancreatectomy (n = 30), and laparotomy without resection (control group, n = 30). Preoperative and postoperative serum and urinary phosphorus, calcium, and creatinine, as well as phosphaturic factors, including serum nicotinamide phosphoribosyltransferase (NAMPT), fibroblast growth factor-23, and parathyroid hormone were measured. In addition, we evaluated urinary levels of nicotinamide catabolites, N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide. RESULTS: We found that significant hypophosphatemia occurred from postoperative day (POD) 1 to POD 2 in all 4 groups and was preceded by hyperphosphaturia from preoperative day to POD 1. Phosphate level alterations were associated with a significant increase in NAMPT levels from preoperative day to POD 2 in all 3 resected groups, but not in the control group. The fibroblast growth factor-23 levels were significantly decreased postoperatively in all 4 groups, and parathyroid hormone levels did not change in any of the 4 groups. Urine levels of N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide decreased significantly in all 4 groups postoperatively. CONCLUSIONS: This study demonstrates that the mechanism of hypophosphatemia is the same for both liver and pancreas resections. Postoperative hypophosphatemia is associated with increased NAMPT. The mechanism that upregulates NAMPT and its role on disparate clinical outcomes in postoperative patients warrant additional investigation.
Authors: Sven-Jean Tan; Edward R Smith; Michael M X Cai; Stephen G Holt; Tim D Hewitson; Nigel D Toussaint Journal: Int Urol Nephrol Date: 2015-11-14 Impact factor: 2.370
Authors: Sarmistha Mukherjee; Karthikeyani Chellappa; Andrea Moffitt; Joan Ndungu; Ryan W Dellinger; James G Davis; Beamon Agarwal; Joseph A Baur Journal: Hepatology Date: 2016-12-24 Impact factor: 17.425
Authors: Ian R Corbin; Richard Buist; Vyacheslav Volotovskyy; Jim Peeling; Manna Zhang; Gerald Y Minuk Journal: Hepatology Date: 2002-08 Impact factor: 17.425
Authors: S M Hong; C W Park; S W Kim; Y J Nam; J H Yu; J H Shin; C H Yun; S-H Im; K-T Kim; Y C Sung; K Y Choi Journal: Oncogene Date: 2015-11-16 Impact factor: 9.867
Authors: Malcolm H Squires; Gregory C Dann; Neha L Lad; Sarah B Fisher; Benjamin M Martin; David A Kooby; Juan M Sarmiento; Maria C Russell; Kenneth Cardona; Charles A Staley; Shishir K Maithel Journal: HPB (Oxford) Date: 2014-05-15 Impact factor: 3.647
Authors: Geoffrey A Block; Anthony J Bleyer; Arnold L Silva; Daniel E Weiner; Robert I Lynn; Yang Yang; David P Rosenbaum; Glenn M Chertow Journal: Kidney360 Date: 2021-08-27
Authors: Christoph Zechner; Beverley Adams-Huet; Blake Gregory; Javier A Neyra; Jody A Rule; Xilong Li; Jorge Rakela; Orson W Moe; William M Lee Journal: Transl Res Date: 2021-07-21 Impact factor: 7.012