How much remnant is enough in liver resection?

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Liver resection is a primary treatment for liver malignancies, but major hepatectomy carries a risk of post-hepatectomy liver failure (PHLF).
• PHLF leads to increased postoperative complications, mortality, and prolonged hospital stays.

Purpose of the Study:

• To review risk factors for PHLF after liver resection.
• To define safe liver resection limits in patients with normal and injured livers (cirrhosis, cholestasis, steatosis, post-chemotherapy liver injury).

Main Methods:

• A comprehensive literature search was conducted using PubMed and related databases.
• Articles focused on hepatic failure following hepatectomy in both normal and injured liver conditions were analyzed.

Main Results:

• Despite surgical advancements, precise limits for safe liver resection remain undefined.
• Preoperative, intraoperative, and postoperative factors influence the likelihood of PHLF.
• Literature data allows estimation of safe resection limits for normal and injured livers.

Conclusions:

• Preoperative evaluation of remnant liver volume and function is essential before major hepatectomy.
• Critical residual liver volume prediction for PHLF is influenced by pre-existing liver disease and overall liver function.
• Safe resection limits are 20-30% future remnant liver in normal livers; injured livers require additional functional assessment.