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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 3/2013

01-03-2013 | Review Article

New Paradigms in Post-hepatectomy Liver Failure

Authors: Nicolas Golse, Petru O. Bucur, René Adam, Denis Castaing, Antonio Sa Cunha, Eric Vibert

Published in: Journal of Gastrointestinal Surgery | Issue 3/2013

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Abstract

Introduction

Liver failure after hepatectomy remains the most feared postoperative complication. Many risk factors are already known, related to patient’s comorbidities, underlying liver disease, received treatments and type of resection. Preoperative assessment of functional liver reserve must be a priority for the surgeon.

Methods

Physiopathology of post-hepatectomy liver failure is not comparable to fulminant liver failure. Liver regeneration is an early phenomenon whose cellular mechanisms are beginning to be elucidated and allowing most of the time to quickly recover a functional organ. In some cases, microscopic and macroscopic disorganization appears. The hepatocyte hyperproliferation and the asynchronism between hepatocytes and non-hepatocyte cells mitosis probably play a major role in this pathogenesis.

Results

Many peri- or intra-operative techniques try to prevent the occurrence of this potentially lethal complication, but a better understanding of involved mechanisms might help to completely avoid it, or even to extend the possibilities of resection.

Conclusion

Future prevention and management may include pharmacological slowing of proliferation, drug or physical modulation of portal flow to reduce shear–stress, stem cells or immortalized hepatocytes injection, and liver bioreactors. Everything must be done to avoid the need for transplantation, which remains today the most efficient treatment of liver failure.
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Metadata
Title
New Paradigms in Post-hepatectomy Liver Failure
Authors
Nicolas Golse
Petru O. Bucur
René Adam
Denis Castaing
Antonio Sa Cunha
Eric Vibert
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 3/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-012-2048-6

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