Evaluation of the “50-50 criteria” of post-hepatectomy liver failure as mortality predictor after resection of liver tumors

Abstract

Liver resection represents the only curative treatment option for a variety of primary and secondary liver tumors. Post-hepatectmy liver failure (PHLF) remains as serious challenge after major liver resection and may be associated with grave outcome. Recognition of key factors that precisely predict poor outcome could help identification of high risk patients who would benefit from specific protective strategies or particular interventions. A major cause of PHLF is the development of small for size syndrome (SFSS) after liver resection which signifies that the remnant liver is too small to perform normal liver functions. In the setting of normal liver parenchyma, SFSS relates to excessive resection of the liver parenchyma. However, in the cirrhotic, fatty and cholestatic liver PHLF develop after major liver resection due to the impaired quality of liver parenchyma. Experimental studies have demonstrated that several factors are involved in the evolution of PHLF. For instance, reduced platelet count was associated with slow restoration of bilirubin levels and prothrombin time after ABSTRACT