Prediction, prevention and management of postresection liver failure

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Postresection liver failure (PLF) is a significant cause of mortality following liver resection.
• Current understanding of PLF pathophysiology is limited, and a unified definition is lacking.
• Optimizing PLF management requires further research and evidence-based strategies.

Purpose of the Study:

• To review and present strategies for predicting, preventing, and managing postresection liver failure (PLF).
• To highlight the need for a unified definition and improved management approaches for PLF.
• To consolidate current knowledge on PLF risk factors, mechanisms, and outcomes.

Main Methods:

• Comprehensive literature search of major databases (Web of Science, MEDLINE, PubMed, Google Scholar, Cochrane Library) up to May 2011.
• Inclusion of studies on liver resection, partial hepatectomy, liver dysfunction, and liver failure.
• Inclusion of key historical papers if recent data were unavailable, excluding non-English papers.

Main Results:

• The incidence of PLF varies from 0% to 13%, with comparisons hindered by the lack of a unified definition.
• Key risk factors include the extent of liver resection and pre-existing parenchymal liver disease.
• Mechanisms include small-for-size syndrome, sepsis, and ischemia-reperfusion injury; jaundice is a sensitive outcome predictor.

Conclusions:

• Postresection liver failure (PLF) remains a primary cause of morbidity and mortality after liver resection.
• A unified definition for PLF is essential for consistent research and clinical practice.
• Improved strategies for the prevention and management of PLF are critically needed.