title: Prediction, prevention and management of postresection liver failure.
abstract: BACKGROUND
  Postresection liver failure (PLF) is the major cause of death following liver resection. However, there is no unified definition, the pathophysiology is understood poorly and there are few controlled trials to optimize its management. The aim of this review article is to present strategies to predict, prevent and manage PLF.
  
  
  METHODS
  The Web of Science, MEDLINE, PubMed, Google Scholar and Cochrane Library databases were searched for studies using the terms 'liver resection', 'partial hepatectomy', 'liver dysfunction' and 'liver failure' for relevant studies from the 15 years preceding May 2011. Key papers published more than 15 years ago were included if more recent data were not available. Papers published in languages other than English were excluded.
  
  
  RESULTS
  The incidence of PLF ranges from 0 to 13 per cent. The absence of a unified definition prevents direct comparison between studies. The major risk factors are the extent of resection and the presence of underlying parenchymal disease. Small-for-size syndrome, sepsis and ischaemia-reperfusion injury are key mechanisms in the pathophysiology of PLF. Jaundice is the most sensitive predictor of outcome. An evidence-based approach to the prevention and management of PLF is presented.
  
  
  CONCLUSIONS
  PLF is the major cause of morbidity and mortality after liver resection. There is a need for a unified definition and improved strategies to treat it.
authors: Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute of Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
authors: J S
authors: JS
authors: Hammond
authors: I N
authors: IN
authors: Guha
authors: I J
authors: IJ
authors: Beckingham
authors: D N
authors: DN
authors: Lobo
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D016063:Blood Loss, Surgical; D005234:Fatty Liver / Q000209:etiology; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D008111:Liver Function Tests; D008115:Liver Regeneration / Q000502:physiology; D016031:Liver Transplantation / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents