Review: Research Toward Safer Resectionof the Cirrhotic Liver

Abstract

Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

Parenteral Solution of Nutritional Hepatotrophic Factors Improves Regeneration in Thioacetamide-induced Cirrhotic Livers after Partial Hepatectomy

“…Regeneration of the remaining liver tissue may be particularly useful in cirrhotic patients undergoing hepatic resection (Moser, Kneteman, and Minuk 2000).…”

“…Rats in the PH þ NHF group demonstrated an increase of 8.4% and 5.6% in the liver weight and liver weight relative to body weight, respectively. Minimal liver function appears to be adequate to sustain life (Moser, Kneteman, and Minuk 2000), and NHF was shown to promote a more rapid recovery and an increase in the hepatic mass. Moreover, the NHF-treated rat livers had a larger VP of parenchyma with a reduction in the extent of fibrotic area.…”

“…However, in cases of liver trauma, liver infection, or liver neoplasms, liver resection may be necessary in patients with cirrhosis (Merli et al 2002;Redai, Emond, and Brentjens 2004). Surgical resection is considered the treatment option of choice for patients with hepatocarcinoma (HCC) as well as for those with concomitant cirrhosis (Moser, Kneteman, and Minuk 2000;Poon and Fan The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.…”

Efficiency and safety of radiofrequency-assisted hepatectomy for hepatocellular carcinoma with cirrhosis: A single-center retrospective cohort study

“…Liver resection is the most common treatment for HCC [8] . However, due to poor hepatic reserve, regeneration dysfunction, portal hypertension, and other conditions that patients with concomitant cirrhosis may have, liver resection may involve considerable intraoperative blood loss and the incidence of postoperative complications, thereby affecting the prognosis [9,10] . For this reason, the two main goals regarding liver cirrhosis are the prevention of intraoperative bleeding and the prevention of postoperative complications.…”

Efeito da hepatectomia parcial associada à administração de fatores nutricionais hepatotróficos sobre a morfologia, função e expressão de genes pró-fibróticos na cirrose hepática em ratos Wistar induzida por tiocetamida

“…Porém, é conhecido que o fígado cirrótico diminui a síntese de DNA (Hashimoto et al,1998) e a atividade mitótica dos hepatócitos (Kanta e Chlumská, 1991) e, portanto, a sua capacidade de regeneração após uma ressecção hepática (Moser et al, 2000;Redai et al, 2004;Suaréz-Cuenca et al, 2008), além de regenerar cirroticamente (Andiran et al, 2000), embora as alterações histopatológicas diminuem quando este processo regenerativo é estimulado pelo procedimento cirúrgico, em uma verdadeira reengenharia estrutural (Parra, 1982;Hashimoto et al, 2005). No entanto, a remoção do tecido hepático pode resultar em insuficiência hepática aguda (Hashimoto e Watanabe, 1999).…”