Background
Posthepatectomy liver failure is a feared complication after hepatic resection and
a major cause of perioperative mortality. There is currently no standardized definition
of posthepatectomy liver failure that allows valid comparison of results from different
studies and institutions. The aim of the current article was to propose a definition
and grading of severity of posthepatectomy liver failure.
Methods
A literature search on posthepatectomy liver failure after hepatic resection was conducted.
Based on the normal course of biochemical liver function tests after hepatic resection,
a simple and easily applicable definition of posthepatectomy liver failure was developed
by the International Study Group of Liver Surgery. Furthermore, a grading of severity
is proposed based on the impact on patients' clinical management.
Results
No uniform definition of posthepatectomy liver failure has been established in the
literature addressing hepatic surgery. Considering the normal postoperative course
of serum bilirubin concentration and International Normalized Ratio, we propose defining
posthepatectomy liver failure as the impaired ability of the liver to maintain its
synthetic, excretory, and detoxifying functions, which are characterized by an increased
international normalized ratio and concomitant hyperbilirubinemia (according to the
normal limits of the local laboratory) on or after postoperative day 5. The severity
of posthepatectomy liver failure should be graded based on its impact on clinical
management. Grade A posthepatectomy liver failure requires no change of the patient's
clinical management. The clinical management of patients with grade B posthepatectomy
liver failure deviates from the regular course but does not require invasive therapy.
The need for invasive treatment defines grade C posthepatectomy liver failure.
Conclusion
The current definition of posthepatectomy liver failure is simple and easily applicable
in clinical routine. This definition can be used in future studies to allow objective
and accurate comparisons of operative interventions in the field of hepatic surgery.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit?.J Clin Oncol. 2005; 23: 8490-8499
- Partial hepatectomy for metastases from noncolorectal, nonneuroendocrine carcinoma.Ann Surg. 2005; 241: 269-276
- Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database.Ann Surg. 2004; 240: 698-708
- Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic resection.Br J Surg. 2008; 95: 424-432
- How much liver resection is too much?.Am J Surg. 2005; 190: 87-97
- Preoperative portal vein embolization for major liver resection: a meta-analysis.Ann Surg. 2008; 247: 49-57
- Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal.Ann Surg. 1999; 229: 210-215
- Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection.J Am Coll Surg. 2000; 191: 38-46
- Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade.Ann Surg. 2002; 236: 397-406
- Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases.Br J Surg. 2003; 90: 1131-1136
- Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis.Liver Transpl. 2006; 12: 966-971
- Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry.J Nucl Med. 2007; 48: 685-692
- Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases.Ann Surg. 2006; 243: 1-7
- Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study.Ann Surg. 2007; 245: 923-930
- Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy.J Am Coll Surg. 2007; 204: 854-862
- Short- and long-term outcomes after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis.Ann Surg Oncol. 2008; 15: 1670-1676
- Liver failure following partial hepatectomy.HPB (Oxford). 2006; 8: 165-174
- Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment.Liver Int. 2008; 28: 767-780
- Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies.Am J Surg. 2009; 197: 752-758
- Chemotherapy with bevacizumab does not affect liver regeneration after portal vein embolization in the treatment of colorectal liver metastases.Ann Surg Oncol. 2008; 15: 2765-2772
- Prognostic utility of postoperative C-reactive protein for posthepatectomy liver failure.Arch Surg. 2008; 143: 247-253
- Use of vascular clamping in hepatic surgery: lessons learned from 1260 liver resections.Arch Surg. 2008; 143: 380-387
- Addition of bevacizumab to irinotecan- and oxaliplatin-based preoperative chemotherapy regimens does not increase morbidity after resection of colorectal liver metastases.J Am Coll Surg. 2008; 206: 96-106
- Role for extending hepatic resection using an aggressive approach to liver surgery.J Am Coll Surg. 2008; 206: 870-875
- Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy.Ann Surg. 2008; 247: 118-124
- Assessment of transcutaneous bilirubinometry in hospitalized adults.J Am Coll Surg. 2008; 206: 1129-1136
- Bile leak after hepatectomy: predictive factors of spontaneous healing.Am J Surg. 2008; 196: 195-200
- Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy.Ann Surg. 2008; 247: 603-611
- Hepatic resection after rescue cetuximab treatment for colorectal liver metastases previously refractory to conventional systemic therapy.J Clin Oncol. 2007; 25: 4593-4602
- Steatosis predicts postoperative morbidity following hepatic resection for colorectal metastasis.Br J Surg. 2007; 94: 1395-1402
- Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome.Br J Surg. 2007; 94: 1386-1394
- Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study.World J Surg. 2007; 31: 1643-1651
- Preoperative chemotherapy for colorectal liver metastases: impact on hepatic histology and postoperative outcome.J Gastrointest Surg. 2007; 11: 860-868
- A study into the risk of exacerbation of chronic hepatitis B after liver resection for hepatocellular carcinoma.J Gastrointest Surg. 2007; 11: 612-618
- Application of fibrin glue sealant after hepatectomy does not seem justified: results of a randomized study in 300 patients.Ann Surg. 2007; 245: 536-542
- Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection.Br J Surg. 2007; 94: 297-303
- Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients.Surgery. 2007; 142: 685-694
- Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver.J Am Coll Surg. 2007; 204: 22-33
- Intrahepatic cholangiojejunostomy following hepatobiliary resection.Br J Surg. 2007; 94: 70-77
- Outcomes after major hepatectomy in elderly patients.J Am Coll Surg. 2006; 203: 677-683
- Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease.J Am Coll Surg. 2006; 203: 670-676
- Portal triad clamping (TC) or hepatic vascular exclusion (VE) for major liver resection after prolonged neoadjuvant chemotherapy? A case-matched study in 60 patients.Surgery. 2006; 140: 396-403
- One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality.Ann Surg. 2006; 244: 240-247
- Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma.Br J Surg. 2006; 93: 1091-1098
- Randomized clinical trial of liver resection with and without hepatic pedicle clamping.Br J Surg. 2006; 93: 685-689
- Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis.Langenbecks Arch Surg. 2006; 391: 209-215
- Ischemic preconditioning for major liver resection under vascular exclusion of the liver preserving the caval flow: a randomized prospective study.J Am Coll Surg. 2006; 202: 203-211
- Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma.Br J Surg. 2006; 93: 339-346
- The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy.Ann Surg. 2005; 242 (discussion): 824-828
- The impact of advanced age on hepatic resection of colorectal liver metastases.J Am Coll Surg. 2005; 201: 511-516
- Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial.Ann Surg. 2005; 241: 582-590
- In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection.Ann Surg. 2005; 241: 277-285
- Alpha-gluthathione S-transferase as an early marker of hepatic ischemia/reperfusion injury after liver resection.World J Surg. 2005; 29: 528-534
- Circulating heat-shock protein 70 is associated with postoperative infection and organ dysfunction after liver resection.Am J Surg. 2004; 187: 777-784
- In-contiguity and non-anatomical extension of right hepatic trisectionectomy for liver metastases.Br J Surg. 2005; 92: 340-347
- Is extended hepatectomy for hepatobiliary malignancy justified?.Ann Surg. 2004; 239: 722-730
- Deterioration of hepatic functional reserve in patients with hepatocellular carcinoma after resection: incidence, risk factors, and association with intrahepatic tumor recurrence.World J Surg. 2004; 28: 258-262
- Combined resection of the liver and inferior vena cava for hepatic malignancy.Ann Surg. 2004; 239: 712-719
- Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor.Liver Transpl. 2004; 10: 71-76
- Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma.Ann Surg. 2004; 239: 186-193
- Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy.J Gastrointest Surg. 2003; 7: 1082-1088
- Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis.Arch Surg. 2003; 138: 1207-1213
- One thousand fifty-six hepatectomies without mortality in 8 years.Arch Surg. 2003; 138: 1198-1206
- Preoperative portal vein embolization for extended hepatectomy.Ann Surg. 2003; 237: 686-691
- The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection.Gut. 2005; 54: 289-296
Reissfelder C, Rahbari NN, Koch M, Kofler B, Sutedja N, Elbers H, et al. Postoperative course and clinical significance of biochemical blood tests following hepatic resection. Br J Surg; In press.
Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. In press.
- Postoperative liver insufficiency: prevention and management.World J Surg. 1983; 7: 505-510
- Surgery and portal hypertension.in: Child C.G.I. The liver and portal hypertension. Saunders, Philadelphia (Pa)1964: 50-58
- Transection of the oesophagus for bleeding oesophageal varices.Br J Surg. 1973; 60: 646-649
- A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.Hepatology. 2000; 31: 864-871
- A model to predict survival in patients with end-stage liver disease.Hepatology. 2001; 33: 464-470
- Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13
- Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).Surgery. 2007; 142: 761-768
- Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.Surgery. 2007; 142: 20-25
- Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.Surgery. 2010; 147: 339-351
- Natural history' of hepatectomy.Br J Surg. 1992; 79: 39-42
- Predictive indices of morbidity and mortality after liver resection.Ann Surg. 2006; 243: 373-379
- The new liver allocation system: moving toward evidence-based transplantation policy.Liver Transpl. 2002; 8: 851-858
Article info
Publication history
Published online: January 18, 2011
Accepted:
October 18,
2010
Identification
Copyright
© 2011 Published by Elsevier Inc. All rights reserved.
