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Review
. 2018 Mar 28;6(1):97-104.
doi: 10.14218/JCTH.2017.00060. Epub 2017 Nov 30.

Update on Liver Failure Following Hepatic Resection: Strategies for Prediction and Avoidance of Post-operative Liver Insufficiency

Amir A Rahnemai-Azar  1 , Jordan M Cloyd  2 , Sharon M Weber  1 , Mary Dillhoff  2 , Carl Schmidt  2 , Emily R Winslow  1 , Timothy M Pawlik  2
Affiliations
Review

Update on Liver Failure Following Hepatic Resection: Strategies for Prediction and Avoidance of Post-operative Liver Insufficiency

Amir A Rahnemai-Azar et al. J Clin Transl Hepatol. .

Abstract

Liver resection is increasingly used for a variety of benign and malignant conditions. Despite advances in preoperative selection, surgical technique and perioperative management, posthepatectomy liver failure (PHLF) is still a leading cause of morbidity and mortality following liver resection. Given the devastating physiological consequences of PHLF and the lack of effective treatment options, identifying risk factors and preventative strategies for PHLF is paramount. In the past, a major limitation to conducting high quality research on risk factors and prevention strategies for PHLF has been the absence of a standardized definition. In this article, we describe relevant definitions for PHLF, discuss risk factors and prediction models, and review advances in liver assessment tools and PHLF prevention strategies.

Keywords: Complication; Hepatectomy; Liver failure; Liver resection; Prevention; Risk models.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1.
Fig. 1.. (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 hemi-livers. Used with permission.
Fig. 2.
Fig. 2.. Visualization of pre- or perioperative interventions and their effect on liver remnant volume.
(A) Malignant liver disease. (B) Embolization/ligation of the right portal branch, (1) resulting in atrophy of the right hemi-liver and compensatory growth of the left hemi-liver, which can be removed when appropriate hypertrophy has been achieved (2). (C) Removal of tumours from the left hemi-liver and occlusion of the right portal branch (1). After 4–6 weeks, the volume of the left hemi-liver is increased and the right hemi-liver can be removed (2). (D) Removal of tumours from the left hemi-liver, in situ splitting of the hemi-livers, and simultaneous ligation of the right portal vein branch (1). After 1 week, augmented hypertrophy of the left hemi-liver permits removal of the right hemi-liver (2). Used with permission.
See this image and copyright information in PMC

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