Abstract
Fatty liver disease (FLD), which includes hepatic steatosis or steatohepatitis with or without associated fibrosis, and hepatic sinusoidal injury (SI) are emerging challenges at the forefront of hepatobiliary surgery. Because of the high prevalence of metabolic syndrome elements (hypertension, diabetes mellitus, obesity, and dyslipidemia) many patients considered for hepatic resection for benign or malignant indications will have nonalcoholic fatty liver disease (NAFLD). In parallel with the metabolic syndrome epidemic, NAFLD is the most common chronic liver disease in the Western hemisphere. It is estimated that by 2050, NAFLD will be both the most common cause of hepatocellular carcinoma and indication for liver transplantation in the United States. Because of potential survival benefits from perioperative chemotherapy for initially resectable and “conversion” chemotherapy for initially unresectable colorectal cancer liver metastases, FLD and SI in the background liver will be more commonly encountered during hepatic resection. Understanding the effects of background liver injury on postoperative outcomes is crucial to efforts aimed at improving the safety of liver resection.
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