Functional Liver Recovery After Major Hepatectomy: Integrating Hemodynamic Optimization and Oxidative Stress

Area of Science:

• Hepatobiliary Surgery
• Surgical Physiology
• Regenerative Medicine

Background:

• Major liver resections require accurate assessment of the future liver remnant (FLR) to prevent post-hepatectomy liver failure (PHLF).
• Standard volumetric assessment of FLR may not reflect true functional reserve, especially in compromised livers (steatotic, fibrotic, chemotherapy-damaged).

Purpose of the Study:

• To propose an integrative physiological framework for assessing functional liver recovery after major hepatectomy.
• To connect preoperative functional assessments with perioperative hemodynamic, oxidative, and metabolic parameters for enhanced patient management.

Main Methods:

• Conducted a narrative literature review (PubMed, Web of Science, 2000-2025) on major hepatectomy, liver regeneration, and related physiological parameters.
• Focused on clinically relevant studies and consensus guidelines, supplementing with reference list screening.
• Developed a pragmatic framework for perioperative management based on physiological principles where direct clinical evidence was limited.

Main Results:

• The proposed framework integrates three domains: hemodynamic stability (arterial/venous pressures, portal-splanchnic gradients), oxidative stress balance (lipid peroxidation, antioxidant capacity), and functional liver tests (e.g., indocyanine clearance (ICG-PDR), LiMAx test, Factor V).
• This integration allows for real-time monitoring of physiological response and guides individualized perioperative support.
• A functional profile of liver recovery can be defined, moving beyond simple remnant volume assessment.

Conclusions:

• Functional liver recovery is a dynamic process influenced by reperfusion stress, hemodynamic stabilization, and hepatocellular regeneration.
• Integrating functional FLR assessment with perioperative physiological monitoring enables better prediction of regenerative capacity and personalized therapeutic decisions.
• A physiology-guided approach enhances perioperative management for major hepatectomy patients.