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World J Hepatol. Oct 27, 2014; 6(10): 745-751
Published online Oct 27, 2014. doi: 10.4254/wjh.v6.i10.745
Comprehensive review of post-liver resection surgical complications and a new universal classification and grading system
Masayuki Ishii, Toru Mizuguchi, Kohei Harada, Shigenori Ota, Makoto Meguro, Tomomi Ueki, Toshihiko Nishidate, Kenji Okita, Koichi Hirata
Masayuki Ishii, Toru Mizuguchi, Kohei Harada, Shigenori Ota, Makoto Meguro, Tomomi Ueki, Toshihiko Nishidate, Kenji Okita, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido 060-8543, Japan
Author contributions: Ishii M and Mizuguchi T contributed equally to this study; Ishii M, Mizuguchi T, Harada K and Hirata K designed the review; Ota S and Meguro M collected and reviewed the literature; Ueki T, Nishidate T and Okita K collected and managed the clinical data.
Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology (No. 26461921) to T. Mizuguchi, (No. 26461920) to M, Meguro and (No. 25861207) to S. Ota
Correspondence to: Toru Mizuguchi, MD, PhD, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, S1, W16, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan. tmizu@sapmed.ac.jp
Telephone: +81-11-6112111 Fax: +81-11-6131678
Received: July 14, 2014
Revised: September 1, 2014
Accepted: September 16, 2014
Published online: October 27, 2014
Abstract

Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consensus regarding the definitions and classification of post-liver resection complications. The Clavien-Dindo (CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for post-hepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.

Keywords: Complication, Liver failure, Bile leakage, Renal failure, Ascites, Coagulation disorder, Surgical site infection

Core tip: The large degree of variation in the post-liver resection morbidity rates reported by previous studies might be due to a lack of consensus regarding the definitions and classification of post-liver resection complications. The Clavien-Dindo classification of postoperative complications is widely accepted internationally. However, it is difficult to apply to some major post-liver resection complications. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.