How much liver resection is too much?
BACKGROUND
Hepatic failure occurring after liver resection carries a poor prognosis and is a complication dreaded by surgeons. Inadequate reserve in the remaining parenchyma leads to a steady decrease in liver function, inability to regenerate, and progression to liver failure. For this reason, many methods to quantify functional hepatic reserve have been developed.


METHODS
This article reviews the main methods used in the assessment of hepatic reserve in patients undergoing hepatectomy and their use in operative decision making.


RESULTS
A range of methods to categorically quantify the functional reserve of the liver have been developed, ranging from scoring systems (such as the Child-Pugh classification) to tests assessing complex hepatic metabolic pathways to radiological methods to assess functional reserve. However, no one method has or is ever likely to emerge as a single measure with which to dictate safe limits of resectability.


CONCLUSIONS
In the future, the role of residual liver function assessment may be of most benefit in the routine stratification of risk, thus enabling both patient consent to be obtained and surgical procedure to be performed, with full information and facts regarding operative risks. However, there is no one single test that remains conclusively superior.
University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia.
Emma J
EJ
Mullin
Matthew S
MS
Metcalfe
Guy J
GJ
Maddern
D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D017114:Liver Failure, Acute / Q000517:prevention & control*; D008111:Liver Function Tests; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome