How to Avoid Postoperative Liver Failure: A Novel Method

Postoperative liver failure (PLF) is the most feared and severe complication after extensive liver resections. We present an innovative surgical technique that has been employed for the treatment of three patients (two with multiple colorectal liver metastases and one with hilar cholangiocarcinoma) whose livers were previously considered locally unresectable because of an insufficient future liver remnant (FLR). In-situ liver transection with right portal vein ligation was implemented. Six days after surgery a volumetric computed tomography (CT)-scan showed 40-80% hypertrophy of the FLR. The patients then underwent a completion surgery with right hepatectomy or right trisectionectomy. None of the patients developed PLF during a mean hospital stay of 16 days. After a mean follow-up of two months, the three of them are free of disease. This technique induced rapid growth of the FLR, greater than that reported with portal vein occlusion alone. It represents a promising advance in oncological liver surgery that readdresses the current management of patients with primarily unresectable liver disease. Such a revolutionary strategy allows a two-stage surgical approach during a single hospital stay and without PLF. However, further research is needed to determine the long-term outcomes of this technique and to explain the occurrence of such enhanced liver regeneration.