Postsurgical Liver Failure

Abstract

Hepatic resection surgery has been widely performed for the treatment of many liver diseases including tumors, intrahepatic duct calculi, and abscesses. In the majority of patients, this surgery can be performed safely with low morbidity and mortality, but in a subgroup of patients with impaired regenerative capacity or in those undergoing extended resection, the risk of postoperative liver failure, whose pathophysiology still remains poorly understood, is significant. Therefore, the perioperative management of patients undergoing liver surgery can be challenging even nowadays despite technical advances and increased perioperative experience. Postoperative complications include infections, pleural effusion, intraperitoneal hemorrhage, coagulation disorders, bile leakage, and liver failure. These problems are closely related to the presence of a preoperative chronic liver disease, the extent and duration of surgery, and the number of transfusions. Currently there are few treatments available for postoperative liver failure, and the majority of the strategies derive from studies and experience of patients with acute or acute-on-chronic liver failure secondary to toxic or viral injury. This review article focuses on the major perioperative issues of hepatic resection surgery and presents the current knowledge about its management.