The clinical implications of hypophosphatemia following major hepatic resection or cryosurgery.

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Abstract
MAJOR HEPATIC resection and cryosurgery have been used for the management of primary and metastatic tumors of the liver to provide prolonged survival and potential cure.1 Recent advances in anesthetic and intraoperative management have reduced operative mortality to 0.6% to 2.7%.2,3 Despite the refinement of surgical technique and advances in anesthetic management, major hepatic procedures are not without considerable morbidity, which ranges from 24% to 37%.3,4 The postoperative period is affected by large fluid shifts and stimulation of hepatic enzyme systems. Postresectional hypophosphatemia has been reported by a few authors in case reports and a single reported series.3,4 Phosphate is an essential anion with a main role in the formation of high-energy bonds. Phosphate is also necessary for the normal function of red blood cells, platelets, oxygen release from oxyhemoglobin, adenosine 5‘-triphosphate synthesis, and the central nervous system. The clinical consequences of severe hypophosphatemia are well recognized and include impaired diaphragmatic contractility, ventricular irritability, myocardial depression, and insulin depression. George and Shiu3 noted a significant correlation between severe hypophosphatemia (phospate level 1.0 mg/dL]) on major postoperative morbidity.