[Hepatic failure following resection of cholestatic liver]

Hepatectomy for biliary cancer with obstructive jaundice is often followed by postoperative septic complications associated with hyperbilirubinemia, both of which could lead to cholestatic liver failure by affecting each other. Such septic complications seem to develop from contamination of bile, reduction of intestinal integrity, or impairment of host resistance to bacteria, each resulting from biliary obstruction. Hyperbilirubinemia after hepatectomy is demonstrated to develop due to hepatic mitochondrial dysfunction or impaired expression of bile efflux pumps on the canalicular membrane of hepatocytes. Since no therapeutic strategy is established for liver failure following hepatectomy, it is important to take all possible measures before surgery to enhance the functions of the liver, intestine, and host immunity and to prevent postoperative septic complications.