From the Guidelines
Partial hepatectomy carries significant risks, including bleeding, infection, liver failure, bile leakage, and blood clots, with a mortality rate of around 5% as reported in the most recent guidelines 1. The main risks associated with partial hepatectomy include:
- Bleeding during or after surgery, which can be substantial given the liver's rich blood supply
- Infection at the surgical site or within the abdominal cavity, despite sterile techniques
- Liver failure, a serious potential complication, especially if the remaining liver tissue is insufficient to maintain normal function or is compromised by underlying disease
- Bile leakage, which can develop from the cut surface of the liver, potentially requiring additional procedures to address
- Blood clots, which may form in the legs (deep vein thrombosis) or travel to the lungs (pulmonary embolism) Patients may also experience respiratory complications, such as pneumonia or pleural effusion, and the procedure carries standard anesthesia risks, including adverse reactions. Long-term complications can include incisional hernias at the surgical site. Recovery typically takes 4-8 weeks, with activity restrictions gradually lifting as healing progresses. The risk profile varies based on the extent of liver removal, the patient's overall health, presence of underlying liver disease, and surgical approach used. Careful preoperative assessment, including liver function tests and volumetric imaging, helps surgeons evaluate whether a patient can safely tolerate the planned extent of liver resection, as emphasized in recent studies 1. To minimize the risk of thromboembolic events, low molecular weight heparin or unfragmented heparin should be started postoperatively, unless contraindicated, and intermittent pneumatic compression devices should be used, as recommended by the ERAS society 1.
From the Research
Risks of Partial Hepatectomy
The risks associated with partial hepatectomy include:
- Postoperative hemorrhage 2
- Venous thromboembolism 2
- Bile leak 2
- Post-hepatectomy liver failure (PHLF) 3, 2, 4, 5
Factors Contributing to Risks
Several factors contribute to the risks associated with partial hepatectomy, including:
- Presence of comorbid conditions 3
- Pre-existent liver disease 3
- Small remnant liver volume (RLV) 3
- High liver resection percentage 5
- High albumin-bilirubin (ALBI) score 5
Prevention and Management
Prevention and management of complications after partial hepatectomy involve:
- Identifying risk factors during pre-operative assessment 3
- Evaluating liver volume, anatomy, and function 3
- Applying preventive measures to increase RLV and protect remnant liver function 3
- Supporting end-organ and liver function 3
- Using dynamic functional tests, such as indocyanine green test (ICG), magnetic resonance imaging (MRI), and hepatobiliary scintigraphy (HBS) to assess liver function 4