Post-hepatectomy liver failure

Abstract

Hepatectomies are among some of the most complex operative interventions performed. Mortality rates after major hepatectomy are as high as 30%, with post-hepatic liver failure (PHLF) representing the major source of morbidity and mortality. We present a review of PHLF, including the current definition, predictive factors, pre-operative risk assessment, techniques to prevent PHLF, identification and management. Despite great improvements in morbidity and mortality, liver surgery continues to demand excellent clinical judgement in selecting patients for surgery. Appropriate choice of pre-operative techniques to improve the functional liver remnant (FLR), fastidious surgical technique, and excellent post-operative management are essential to optimize patient outcomes.

Keywords: Post-hepatectomy liver failure (PHLF); predictive factors for liver failure; prevention of liver failure.

Figure 1

CT scan image of steatohepatitis, with liver attenuation lower than that of the spleen.

Figure 2

(A) CT scan demonstrating evidence of cirrhosis, with ascites, small liver, and splenomegaly; (B) CT scan demonstrating evidence of cirrhosis, with ascites, small liver, splenic varices, and splenomegaly.

Figure 3

(A) Pre-portal vein embolization of right lobe of liver to induce hypertrophy of left lobe of liver; (B) six weeks post-portal vein embolization of right lobe of liver to induce hypertrophy of left lobe of liver. Line marks middle hepatic vein, dividing right and left hemilivers.