Current evidence on posthepatectomy liver failure: comprehensive review

Abstract

Introduction Despite important advances in many areas of hepatobiliary surgical practice during the past decades, posthepatectomy liver failure (PHLF) still represents an important clinical challenge for the hepatobiliary surgeon. The aim of this review is to present the current body of evidence regarding different aspects of PHLF. Methods A literature review was conducted to identify relevant articles for each topic of PHLF covered in this review. The literature search was performed using Medical Subject Heading terms on PubMed for articles on PHLF in English until May 2022. Results Uniform reporting on PHLF is lacking due to the use of various definitions in the literature. There is no consensus on optimal preoperative assessment before major hepatectomy to avoid PHLF, although many try to estimate future liver remnant function. Once PHLF occurs, there is still no effective treatment, except liver transplantation, where the reported experience is limited. Discussion Strict adherence to one definition is advised when reporting data on PHLF. The use of the International Study Group of Liver Surgery criteria of PHLF is recommended. There is still no widespread established method for future liver remnant function assessment. Liver transplantation is currently the only effective way to treat severe, intractable PHLF, but for many indications, this treatment is not available in most countries.

Impact of the Prolonged Intermittent Pringle Maneuver on Post‐Hepatectomy Liver Failure: Comparison of Open and Laparoscopic Approaches

“…Importantly, multivariate analysis revealed that CPT ≥ 120 min was an independent risk factor for PHLF in the open group, but not in the laparoscopic group. In the open group, remnant liver volume was the most relevant risk factor for liver failure, as previously reported [19, 25]. In this study, in the laparoscopic group, blood loss was an independent risk factor for PHLF in patients undergoing laparoscopic hepatectomy.…”

“…We identified risk factors for PHLF from previous studies and the results of this study. Thereafter, we selected covariates: age and sex as patient-associated factors, liver cirrhosis as liver-associated factors, and remnant liver volume and blood loss as surgery-associated factors [19]. Propensity scores were calculated for each patient using logistic regression analysis involving the five abovementioned factors.…”

Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score

“…In recent years, immunotherapy and molecular targeting have gradually become hotspots of clinical and scientific research, R0 is still the main modality for the treatment of HCC and occupies an indispensable position. However, residual liver tissue regeneration is impaired after R0, and excessive apoptosis of liver cells will lead to the imbalance between liver regeneration and injury, resulting in ALF after hepatectomy[ 11 ].…”

Critical Roles of the Sphingolipid Metabolic Pathway in Liver Regeneration, Hepatocellular Carcinoma Progression and Therapy

“…Liver regeneration is a complex process that involves the proliferation of hepatocytes and the specific functions of numerous hormones, growth factors, and cytokines [ 60 , 61 ]. Post-hepatectomy liver failure (PHLF) continues to be a significant clinical challenge despite advances in hepatobiliary surgery over recent decades, and understanding the mechanism of liver regeneration after hepatectomy is essential to improving clinical outcomes [ 62 , 63 ]. Zabielski et al reported that the activity of acidic sphingomyelinase increased gradually from the 4th to 24th hour after partial hepatectomy in rats, accompanied by a significant increase in ceramide content and reduction in S1P content [ 33 ].…”