INTRODUCTION: Post-hepatectomy liver failure (PHLF) is a significant complication which consumes considerable resource, principally due to the need for intensive care involvement during an extensive and prolonged post-operative recovery. The incidence of PHLF varies from 0.7% to 34% and remains the primary cause of mortality following liver resection. The associated mortality rate varies from 0 to 5% and it remains a contributory factor in 18-75% of fatal cases. METHODS: This is a narrative review of the current literature focusing on the epidemiology, definition, risk factors, pathophysiology, prediction, prevention and management of PHLF. RESULTS: In patients with an increased risk of developing PHLF etiological factors are related to the patients’ co-morbidity and/or the surgical procedure. Patient risk factors include cirrhosis, steatosis, chemotherapy associated steatohepatitis (CASH), sinusoidal injury, cholestasis and cholangitis. Surgical risk factors include the extent of liver resection, the regenerative capacity of the future liver remnant (FLR), sepsis, ischemia reperfusion injury and ‘small for size syndrome’ (SFSS). Pre-operative work up including clinical scoring criteria, volumetric analysis and measurement of hepatocyte uptake and elimination are reviewed. DISCUSSION: PHLF remains a challenging clinical condition which is difficult to treat, and prevention and early recognition remains vitally important. The lack of a single accepted definition hinders the study of PHLF due to the difficulty of cross-comparison. Improved pre-operative planning and the early recognition and treatment of PHLF will improve patient care, morbidity and ultimately the mortality from this complex postoperative complication.
