J S Hammond1, I N Guha, I J Beckingham, D N Lobo. 1. Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute of Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
Abstract
BACKGROUND: Postresection liver failure (PLF) is the major cause of death following liver resection. However, there is no unified definition, the pathophysiology is understood poorly and there are few controlled trials to optimize its management. The aim of this review article is to present strategies to predict, prevent and manage PLF. METHODS: The Web of Science, MEDLINE, PubMed, Google Scholar and Cochrane Library databases were searched for studies using the terms 'liver resection', 'partial hepatectomy', 'liver dysfunction' and 'liver failure' for relevant studies from the 15 years preceding May 2011. Key papers published more than 15 years ago were included if more recent data were not available. Papers published in languages other than English were excluded. RESULTS: The incidence of PLF ranges from 0 to 13 per cent. The absence of a unified definition prevents direct comparison between studies. The major risk factors are the extent of resection and the presence of underlying parenchymal disease. Small-for-size syndrome, sepsis and ischaemia-reperfusion injury are key mechanisms in the pathophysiology of PLF. Jaundice is the most sensitive predictor of outcome. An evidence-based approach to the prevention and management of PLF is presented. CONCLUSION: PLF is the major cause of morbidity and mortality after liver resection. There is a need for a unified definition and improved strategies to treat it.
BACKGROUND: Postresection liver failure (PLF) is the major cause of death following liver resection. However, there is no unified definition, the pathophysiology is understood poorly and there are few controlled trials to optimize its management. The aim of this review article is to present strategies to predict, prevent and manage PLF. METHODS: The Web of Science, MEDLINE, PubMed, Google Scholar and Cochrane Library databases were searched for studies using the terms 'liver resection', 'partial hepatectomy', 'liver dysfunction' and 'liver failure' for relevant studies from the 15 years preceding May 2011. Key papers published more than 15 years ago were included if more recent data were not available. Papers published in languages other than English were excluded. RESULTS: The incidence of PLF ranges from 0 to 13 per cent. The absence of a unified definition prevents direct comparison between studies. The major risk factors are the extent of resection and the presence of underlying parenchymal disease. Small-for-size syndrome, sepsis and ischaemia-reperfusion injury are key mechanisms in the pathophysiology of PLF. Jaundice is the most sensitive predictor of outcome. An evidence-based approach to the prevention and management of PLF is presented. CONCLUSION: PLF is the major cause of morbidity and mortality after liver resection. There is a need for a unified definition and improved strategies to treat it.
Authors: Maciej Malinowski; Johan Friso Lock; Daniel Seehofer; Bernhard Gebauer; Antje Schulz; Lina Demirel; Jan Bednarsch; Victoria Stary; Peter Neuhaus; Martin Stockmann Journal: Surg Today Date: 2015-12-31 Impact factor: 2.549
Authors: Linde A D Busweiler; Marc H W A Wijnen; Jim C H Wilde; Egbert Sieders; Sheila E J Terwisscha van Scheltinga; L W Ernest van Heurn; Joseph Ziros; Roel Bakx; Hugo A Heij Journal: Pediatr Surg Int Date: 2016-10-11 Impact factor: 1.827