Original CommunicationPosthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)
Section snippets
Literature search
An extensive search of the English literature was carried out within the Medline database. Studies on hepatic resection published within the past 5 years were reviewed to assess whether a standard definition of PHLF has been accepted already among hepatic surgeons. The literature search was carried out among 12 leading surgery journals: Journal of the American College of Surgeons, American Journal of Surgery, The British Journal of Surgery, Annals of Surgery, Journal of Gastrointestinal Surgery
Terminology
The literature review revealed “liver/hepatic failure” and “liver/hepatic insufficiency” as the terms applied most commonly for the description of PHLF. Some authors used “dysfunction” and “failure” to grade the severity of PHLF. To illustrate that the reported liver failure developed as a complication of hepatic resection, some authors used the prefix “postresectional” or “postoperative.” We propose to standardize the terminology of this complication by using the term “posthepatectomy liver
Discussion
The development of PHLF is a major cause of postoperative morbidity and mortality after elective hepatic resection.3, 7, 8, 9, 10 The clinical relevance of PHLF within surgical practice has increased because extended resections are carried out more frequently, even in patients who have received potentially hepatotoxic systemic therapy. With smaller remnant liver volume and impaired functional capacity in some of these patients, there is an increased risk of PHLF.15, 49 Despite the growing
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