PREVENTION AND MANAGEMENT OF POSTOPERATIVE LIVER FAILURE AFTER EXTENSIVE LIVER RESECTIONS

Acute post-hepatectomy liver failure (PHLF) is one of the most serious complications that accounts for up to 75% mortality after extensive liver resections. Despite the improved perioperative care, the increasing complexity and extensiveness of surgical interventions, the incidence of postresectional liver failure still results in 1-9%. The major risk factors are the amount of resection and the presence of underlying parenchymal disease. The small for size syndrome, sepsis and ischaemia-reperfusion injury are key mechanisms in the PHLF pathophysiology. Preventive measures aim to enhance future remnant liver size and function. Numerous noninvasive techniques to assess liver function and predict remnant liver volume are being developed, however, the parameters determining how much liver may be resected are still not indentified. Treatment of PHLF is primarily symptomatic. Were performed a literature search in Scopus, Web of Science, PubMed, The Cochrane Library, EMBASE, Global Health, RSCI databases. The review presents the current state and new developments in prevention and management of PHLF. The up-to-date views on the treatment of this pathology are discussed. Efficiency of extracorporeal methods and liver transplantation is considered.

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