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[Treatment of severe post-resection liver failure. Analysis of the specialized center]
R B Alikhanov1, M G Efanov1, V V Subbotin1
1Loginov Moscow clinical research center of the Moscow Department of health, Moscow, Russia.
Insights
Severe posthepatectomy liver failure is a complex challenge even in specialized centers. Comprehensive management strategies are crucial for improving outcomes and reducing mortality in these high-risk patients.
Area of Science:
- Hepatobiliary Surgery
- Surgical Complications
- Liver Failure Management
Background:
- Posthepatectomy liver failure (PHLF) is a significant complication following extensive liver resections.
- Severe PHLF (Grade C ISGLS) presents a critical challenge in patient management.
- Large liver resections, including hemihepatectomies, are increasingly performed, often for malignant diseases.
Purpose of the Study:
- To analyze the management and treatment outcomes of patients experiencing severe posthepatectomy liver failure (Grade C ISGLS).
- To evaluate the effectiveness of a specialized hepatosurgical department in managing complex PHLF cases.
Main Methods:
- Retrospective analysis of 175 liver resections performed between January and December 2019.
- Focus on 80 patients undergoing major-volume liver resections and 125 cases for malignant liver and bile duct diseases.
- Detailed review of management strategies and outcomes for patients with severe PHLF.
Main Results:
- Severe PHLF (Grade C ISGLS) occurred in 3.4% of patients (6 out of 175).
- All patients with severe PHLF required interventions for surgical complications, including drainage and fistula repair.
- Intensive care support was extensive, with 100% requiring inotropic support, 66.6% needing mechanical ventilation, and 83.3% undergoing extracorporeal detoxification.
Conclusions:
- Posthepatectomy liver failure remains a complex problem, even within specialized hepatosurgical centers.
- A comprehensive, multidisciplinary approach to managing severe PHLF is essential for improving patient outcomes.
- Effective management strategies can lead to noticeable improvements and reduced mortality in patients with severe liver failure post-resection.
Abstract:
Posthepatectomy liver failure is one of the most serious complications of large liver resections.
Objective:
The analyzes the management and results of treatment of patients with severe posthepatectomy liver failure (Grade C ISGLS) in a specialized hepatosurgical department.
Material And Methods:
In the period from January to December 2019, 175 liver resections were performed in the Department of liver and pancreatic surgery at the A.S. Loginov Moscow Clinical Scientific Center. Major-volume liver resections (hemihepatectomies and resections of more than three liver segments) were performed in 80 (45%) patients. In 125 (71%) cases liver resctions were performed for malignant liver and bile duct diseases. Laparoscopic liver resections were performed in 77 (44%) patients.
Results:
Postresection liver failure developed in 18 (10.2%) patients. Severe (class C according to ISGLS) developed in 6 (3.4%) patients. In the postoperative period (90-day mortality), 4 patients (2.3%) died, while in two patients, mortality was not associated with liver failure. Hyperbilirubinemia was observed for more than 5 days in 2 (33.3%), coagulopathy in 4 (66.6%), ascites in 5 (83.3%), encephalopathy in 5 (83.3%), hypoglycemia in 3 (50%), and uncontrolled sepsis in 2 (33.3%) patients, respectively. Correction of surgical complications was required in 100% of cases, which consisted in drainage of abscesses and abdominal bylomas, and the the bilio-digestive anastomosis fistulas. Inotropic support was required in all 6 (100%) patients, invasive ventilation in 4(66.6%), and extracorporeal detoxification in 5 (83.3%).
Conclusions:
Posthepatectomy liver failure is a complex problem even in a specialized center. A comprehensive approach to treatment allows to achieve noticeable results and reduce mortality.
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