Review
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 28, 2013; 19(44): 7983-7991
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.7983
Management of post-hepatectomy complications
Shan Jin, Quan Fu, Gerile Wuyun, Tu Wuyun
Shan Jin, Gerile Wuyun, Tu Wuyun, Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China
Quan Fu, Department of Clinical Laboratory, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China
Author contributions: Jin S, Fu Q, Wuyun G and Wuyun T designed the research and analyzed the data; Jin S performed the research and wrote the paper.
Supported by Inner Mongolia Science Foundation, No. 2009BS1103; and Inner Mongolia Public Health Department Clinical and Health Research Projects, No. 2010042
Correspondence to: Shan Jin, MD, PhD, Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Tongdao South Rd, Hohhot 010050, Inner Mongolia Autonomous Region, China. jinshangood@163.com
Telephone: +86-471-6637645 Fax: +86-471-6637645
Received: August 13, 2013
Revised: September 29, 2013
Accepted: October 17, 2013
Published online: November 28, 2013

Abstract

Hepatic resection had an impressive growth over time. It has been widely performed for the treatment of various liver diseases, such as malignant tumors, benign tumors, calculi in the intrahepatic ducts, hydatid disease, and abscesses. Management of hepatic resection is challenging. Despite technical advances and high experience of liver resection of specialized centers, it is still burdened by relatively high rates of postoperative morbidity and mortality. Especially, complex resections are being increasingly performed in high risk and older patient population. Operation on the liver is especially challenging because of its unique anatomic architecture and because of its vital functions. Common post-hepatectomy complications include venous catheter-related infection, pleural effusion, incisional infection, pulmonary atelectasis or infection, ascites, subphrenic infection, urinary tract infection, intraperitoneal hemorrhage, gastrointestinal tract bleeding, biliary tract hemorrhage, coagulation disorders, bile leakage, and liver failure. These problems are closely related to surgical manipulations, anesthesia, preoperative evaluation and preparation, and postoperative observation and management. The safety profile of hepatectomy probably can be improved if the surgeons and medical staff involved have comprehensive knowledge of the expected complications and expertise in their management. This review article focuses on the major postoperative issues after hepatic resection and presents the current management.

Key Words: Hepatectomy, Postoperative complication, Management

Core tip: Despite technical advances and high experience of liver resection of specialized centers, it is still burdened by relatively high rates of postoperative morbidity and mortality. Common post-hepatectomy complications include fever, hemorrhage, bile leakage, liver failure, pleural effusion, and subphrenic infection. The aim of this study was to summary the causes for post-hepatectomy complications and to discuss the prevention and treatment trick for postoperative complications.



INTRODUCTION

The era of hepatic surgery began with a left lateral hepatic lobectomy performed successfully by Langenbuch in Germany in 1887. Since then, hepatectomy has been widely performed for the treatment of various liver diseases, such as malignant tumors, benign tumors, calculi in the intrahepatic ducts, hydatid disease, and abscesses. Operation on the liver is especially challenging because of its unique anatomic architecture and because of its vital functions. Despite technical advances and high experience of liver resection of specialized centers, it is still burdened by relatively high rates of postoperative morbidity (4.09%-47.7%) and mortality (0.24%-9.7%)[1-16] (Table 1). Common post-hepatectomy complications include fever, hemorrhage, bile leakage, liver failure, pleural effusion, and subphrenic infection, which we will discuss.

Table 1 Summary of studies investigating the post-hepatectomy mortality and morbidity.
Ref.JournalDate ofCountry ofNO. of PatientsDisease’sMortality and morbidity of hepatectomy
publicationstudystudieddiagnosis
Savage et al[1]Ann SurgDecember 1991United States300Liver trauma or liver tumorsThe operative mortality was 19% (1962-1979) or 9.7% (1980-1988), and the overall complication rate was 12.3%
Wu et al[2]Zhonghua Waike ZazhiMay 2002China1762Liver cancerThe total mortality was 0.40%, and the total complication rate was 4.09%
Ishikawa et al[3]HepatogastroenterolNovember-December 2002Japan139HCCThe mortality within 30 postoperative days was 2.2%, and complication morbidity was 40.2%
Descottes et al[4]Surg EndoscJanuary 2003France87Benign liver tumorsThere was no postoperative mortality, and the postoperative complication rate was 5% (laparoscopic liver resection)
Dimick et al[5]Arch SurgJanuary 2003United States569Malignant or benign liver diseaseThe overall in-hospital mortality rate was 4.8%
Benzoni et al[6]Hepatobiliary Pancreat Dis IntNovember 2006Italy287HCC or liver metastasisIn-hospital mortality rate was 4.5%, and the morbidity rate was 47.7%
Benzoni et al[7]HepatogastroenterolJanuary-February 2007Italy134HCCIn-hospital mortality rate was 7.4%, and the morbidity rate was 47.7%
Mullen et al[8]J Am Coll SurgMay 2007United States1059Noncirrhotic patientsThe complication rate was 43%, and the 90-d all-cause mortality rate was 4.7% (1.9% patients died of causes unrelated to the liver)
McKay et al[9]Ann Surg OncolMay 2008Canada1107Liver tumorIn-hospital mortality rate was 6.0%, and an overall complication rate was 46%
Feng et al[10]World J GastroenterolDecember 2008China827Benign hepatic lesionIn-hospital mortality rate was 0.24%, and the postoperative complication rate was 13.54%
Tomuş et al[11]Chirurgia (Bucur)May-June 2009Romania50Benign hepatic lesionThere was no mortality, and the morbidity rate was 18%
Cescon et al[12]Ann SurgJune 2009Italy1500Malignant or benign diseaseOverall mortality was 3%, and the morbidity was 22.5%
Huang et al[13]Chin Med J (Engl)October 2009China2008Malignant or benign liver diseaseThe overall hospital mortality was 0.55%, and the overall postoperative complication rate was 14.44%
Mathur et al[14]J Gastrointest SurgAugust 2010United States3960Liver tumorThe overall mortality rate was 2.5%, and the overall complication rate was 23.3%
Sato et al[15]J GastroenterolOctober 2012Japan5270HCCIn-hospital mortality was 2.6%, and the postoperative complication rate was 14.5%
Dan et al[16]Chirurgia (Bucur)November-December 2012Romania133Benign or malignant tumorsThe overall mortality rate was 2.25%
POSTOPERATIVE FEVER AND INFECTIONS
Venous catheter-related infection

Deep-vein catheterization is routinely performed for hepatic surgery, and venous catheter-related infection is the most common cause of fever after hepatectomy. This source of fever should be considered if the fever cannot be attributed to some other cause. If it cannot, the catheter should be immediately removed and its tip cultured, so that appropriate antibacterial therapy can be instituted promptly[17-21].

Pleural effusion

Reactive pleural effusion may occur after hepatectomy and usually is the result of diaphragmatic injury, obstruction of thoracic venous or lymphatic systems, or surgical manipulation on the hepatic coronary ligament (usually causing a subphrenic fluid collection). The pleural effusion, which most often occurs in the right chest, can cause fever even though it is aseptic. X-ray and ultrasound examinations should be performed promptly in febrile patients in order to determine whether a pleural effusion has developed. If only a small effusion is present it may spontaneously resolve, and if the patient has no significant symptoms or signs, no special treatment will be needed; otherwise, thoracic puncture and drainage of the effusion should be carried out[22-24].

Incisional infection

Incisional infection usually occurs within 1 wk after operation. Swelling and exudation at the incision site, or in the case of severe infection, dehiscence of the wound may be seen. If infection is found, the sutures and necrotic tissue should be removed and adequate drainage established. Antibiotics may be prescribed to help control the infection. If wound dehiscence is present, tension sutures may be placed[25-27]. Albumin may be administered intravenously in order to help relieve intra-abdominal pressure if present[28].

Pulmonary atelectasis or infection

Postoperative atelectasis or pulmonary infection most commonly presents 3-5 d after the operation. Symptoms and signs may include chest tightness, shortness of breath, and cyanosis. Surgical trauma, prolonged bed rest, and limited coughing because of incisional pain are the major factors predisposing to pulmonary atelectasis or infection. The findings of hypoxemia, determined by blood-gas analysis, and abnormalities seen on chest X-ray films, will assist in making the diagnosis. If the pulmonary infection progresses to pneumonia, the patient may have fever, cough, and pulmonary rales; increased bronchovascular shadows and pulmonary consolidation may be seen on chest X-ray films. Analgesic drugs may be given to relieve patient’s pain and to facilitate deep breathing; bronchial lavage may be performed for relief of airway obstruction; and antibiotics may be prescribed after sputum culture and testing bacteria for drug sensitivity[28-30].

Ascites

Ascites is common in hepatectomy patients who have associated liver malfunction or cirrhosis. Ascitic fluid may drain from the incision site or the drainage tube[31]. Accumulation of much ascites may result in imbalance of water and electrolytes. Paracentesis for treatment of the ascites usually is not recommended; administration of diuretics and albumin is preferred. However, if the ascites is suspected of being infected and the source of fever, diagnostic paracentesis under ultrasonic guidance should be performed[32-35].

Subphrenic infection

Subphrenic infection is a severe complication of hepatectomy, usually resulting from incomplete or premature removal of a subphrenic fluid collection or a bile leak. Fever, tenderness in the upper abdomen, and abdominal muscle tension are the major manifestations of subphrenic infection. Septicopyemia or septicemia may develop if infection is severe, which may occur with pleural effusion or pulmonary atelectasis[36]. Thorough drainage of the fluid, in addition to anti-inflammatory therapy, is critical in the treatment. Ultrasonic guidance may be useful in the aspiration of subphrenic fluid collections or in the evacuation of abscesses. Open operation may be needed if the infection is severe[37].

Urinary tract infection

Fever, back pain and bladder irritation are the common symptoms of upper urinary tract infection. In contrast, fever is not common in lower urinary tract infection, which is usually manifested by dysuria and urinary frequency and urgency. Treatment of the urinary infection includes anti-inflammatory medications, oral hydration, and medications to relieve cystospasm and symptoms of bladder irritation.

POSTOPERATIVE HEMORRHAGE
Intraperitoneal hemorrhage

The incidence of intraperitoneal hemorrhage ranges from 4.2% to 10%[6,38-41]. Three common reasons for intraperitoneal hemorrhage are: (1) bleeding from the surfaces of the residual liver, which may be a consequence of arterial branch truncation or congestion of the hepatic vein due to stenosis or ligation; (2) incomplete intraoperative hemostasis, which sometimes is due to inappropriate manipulation of the hepatic vein root or trauma to the diaphragm, and increased intrathoracic pressure and vena cava pressure which may lead to bleeding; and (3) vascular sutures loosened or fallen off, an event which usually is ascribed to elevated pressure in the vena cava from patients’ body movement, such as turning over or coughing severely. Detachment of the ligature on the short hepatic veins may cause a gap in the vena cava wall. Postoperative intraperitoneal hemorrhage usually occurs within 48 h, and from the residual liver’s surface or the diaphragm. Thorough intraoperative hemostasis is critical and must be ascertained before the operation is concluded. When the root of the hepatic vein is manipulated during the operation, hemorrhage from the vein or anterior to the inferior vena cava should be carefully sought by increasing the intrathoracic pressure artificially. Mattress sutures with hepatic needles should be used for the hemostasis, and the traumatized surface can be covered with hemostasis film, gelatin sponge, biological glue, or omentum as means of achieving additional hemostasis[42]. The presence of persistent bloody drainage might indicate that intraperitoneal clots have formed, which may occlude abdominal drains, leading to abdominal distention. Close monitoring of vital signs and transfusion of whole blood, platelets, and plasma are usually recommended as long as the patient’s blood pressure and pulse remain stable. Otherwise, secondary open surgery should be considered[43]. We recommend that open surgery to attain hemostasis be performed if blood loss exceeds 1000 mL/h for more than eight hours. In summary, correct timing for operations on infected liver sections, careful manipulation during operation, and thorough hemostasis and drainage are critical for success in attaining hemostasis.

Coagulation disorders

Five common causes of coagulation disorders associated with hepatectomy are: (1) functional failure of the residual liver due to prolonged ischemia, especially in the presence of cirrhosis[44]; (2) massive intraoperative bleeding, or blood transfusion of more than 4000 mL; (3) consumption of coagulation factors and platelets due to severe infection; (4) overdose of heparin after hepatic artery or portal vein catheterization; and (5) cardiopulmonary bypass or extracorporeal circulation[45,46]. Coagulation time, prothrombin time, platelet count, and fibrinogen level should be tested to aid in making the diagnosis of a postoperative coagulation disorder, and the 3P test may be performed if necessary[47]. Expansion of the circulating blood volume and transfusion of fresh blood should be carried routinely once a coagulation disorder is confirmed, and prompt administration of fibrinogen, prothrombin complex, fresh platelets, and plasma cold precipitates also is important[48-50]. Protamine can be administered to neutralize the heparin if it has been overdosed.

Gastrointestinal tract bleeding

The common causes of gastrointestinal tract bleeding after hepatectomy are: (1) stress ulcer, the most common; (2) portal hypertension due to liver cirrhosis; and (3) congestion of gastrointestinal organs because of secondary portal hypertension due to the limited volume of the residual liver. Gastrointestinal tract bleeding usually occurs within two weeks after operation. It may be manifested by the passage of brown or bloody drainage, hematemesis, melena, deterioration of vital signs, and abdominal pain. If the bleeding is mild, nasogastric suctioning and administration of proton pump inhibitors and hemostatic drugs may be adequate treatment. Somatostatin and ulinastatin may be given if the bleeding is massive. Operation should be considered if the blood pressure and pulse are unstable, or if hemorrhage persists after 48 h of aggressive treatment[51-54].

Biliary tract hemorrhage

Iatrogenic bile duct injury is the most common cause of biliary tract hemorrhage after hepatectomy. Surgical maneuvers, including operating in the hepatic portal region, bile duct exploratory surgery, and placement of T-tubes in the biliary ducts could result in biliary tract hemorrhage. Other common causes are mucosal erosion ulcer and coagulation disorders due to biliary tract infection and inflammation. The major manifestations of biliary tract hemorrhage are right upper quadrant gripping pain, upper gastrointestinal bleeding, and obstructive jaundice. Usually, bleeding of this kind can be treated effectively with appropriate hemostasis, antibiotics, and supportive measures. For patients who have massive biliary tract bleeding or whose bleeding site is unclear (after hepatic artery angiography), explorative operation should be carried out[55-59].

BILE LEAKAGE

The incidence of bile leakage ranges from 4.0% to 17%[60-63]. Common causes of postoperative bile leakage are: (1) truncation of the distal bile duct in the residual liver, the most common cause; (2) leakage at the bile duct-intestinal anastomosis, or incomplete suture around the T-tube; and (3) injury of the bile duct from inappropriate surgical technique. A retrospective analysis by Yoshioka et al[64] of 505 hepatectomy cases found that the incidence of bile leakage was 6.7%, with three independent risk factors: (1) multiple hepatectomy (P = 0.002, OR = 3.439; 95%CI: 1.552-7.618); (2) traumatized liver surface ≥ 57.5 cm2 (P = 0.004, OR = 5.296; 95%CI: 1.721-16.302); and (3) intraoperative bleeding ≥ 775 mL (P = 0.01, OR = 2.808; 95%CI: 1.280-6.160)[64]. Another analysis by Sadamori et al[65] of 359 hepatectomy cases found that operative time ≥ 300 min was an independent risk factor for bile leakage after hepatectomy. To help predict if postoperative bile leakage will occur, the residual liver can be covered with wet gauze, which may show the presence of minimal bile seepage. To help avoid postoperative bile leakage, biological glue can be applied to the surface of the residual liver, and a C tube can be placed in the cystic duct for decompression[66,67]. Intraoperatively, bile leakage might be revealed with the use of indocyanine green fluorescein[68-70]. Close postoperative monitoring is mandatory and should include observing for abdominal pain, rebound tenderness, muscle tension, and bile leakage from the drainage tube. Bile leakage also may be evident by the presence of bile in the peritoneal drainage (the concentration of bilirubin in the bile will be higher than in serum). In addition, computed tomography (CT) visualization can be used to determine if the bile duct is occluded and, if so, where the occlusion is located. A drainage tube can remain in the bile duct if there is no sign of peritonitis; the bile leakage may resolve spontaneously within two months. However, if peritonitis develops, open surgery should be performed as soon as possible for thorough cleaning of the abdominal cavity and repair of the damaged common bile duct. Antibiotics may be administered for control of infection, and supportive treatment should be given as usual after a major operation[71,72]. It has been reported that bile leakage occurred in 14 of 96 patients who underwent hepatectomy; nine were treated successfully without operation, but five required a second operation. In general, non-operative treatment was sufficient if the results of ERCP and CT were negative for bile leakage, but operative intervention was needed if conservative therapy failed[73].

LIVER FAILURE

Liver failure is a severe postoperative complication of hepatectomy. It is closely associated with active hepatitis, cirrhosis, limited residual liver tissue, massive intraoperative hemorrhage, the mode and duration of hepatic portal vein occlusion, the kind of anesthesia used, and perioperative medication used. An incidence of liver failure after hepatectomy of about 0.70%-33.83% has been reported[74-77], and the failure was related to inadequate residual liver tissue and functional capacity[78,79]. Comprehensive therapy for liver failure includes postoperative supplementation with albumin, fibrinogen or prothrombin complex; intravenous nutrition; and transfusion of fresh blood. Prognosis is poor if coagulation disorders develop. Presently, the most effective therapy for liver failure is liver transplantation, but it is associated with a high mortality rate in patients with liver cirrhosis and, therefore, it remains a controversial treatment choice in this circumstance[80-86], Generally, prevention of liver failure is felt to be more important than treatment of it. Some common preventive measures are: careful preoperative assessment of the liver’s functional reserve and institution of measures to improve the liver function. Prevention of intraoperative bleeding and the need for blood transfusion also are important in preventing liver failure. In one report, the incidence of postoperative complications increased significantly when the intraoperative blood loss exceeded 1200 mL[11]. Several methods can be used to reduce the chance of intraoperative bleeding: CUSA[87-89], heat solidification technology[90-93], reduction of central venous pressure[94-96], and blocking of hepatic portal blood inflow (with or without control of hepatic blood outflow)[97-101]. For patients with liver cirrhosis, the volume of residual liver and the time of portal occlusion must be strictly assessed. Also, the method used for occluding blood flow to the liver must be appropriately selected. It has been recommended that half hepatic blood flow occlusion should be used for patients with cirrhosis, and hepatic blood inflow occlusion without hemihepatic artery control (hemi-hepatic artery-preserved portal occlusion) used if half occlusion is difficult or inadequate. Hepatic blood inflow occlusion without hemihepatic artery control is simple for operation, with less damage to the liver function; more importantly, the effect of the blood flow blocking is equivalent to the half-hepatic blood flow blocking[102,103]. The procedure for inflow occlusion is the following: the hepatic artery is exposed first, to separate the right and left hepatic arteries from the root of the artery. To restrict blood flow to the right half of the liver, the hepatic portal vein, bile duct, and the right hepatic artery should be tightened together with a catheter; the opposite arrangement is used for restricting blood flow to the left half of the liver, except that the left hepatic artery, instead of the right hepatic artery, is occluded[98]. It is important that the patient receive sufficient oxygen throughout the perioperative period, and that hepatotoxic drugs are avoided.

After hepatectomy, the patient should be closely monitored, with particular attention to abnormalities in levels of consciousness, liver function, the volume and character of drainage fluid, acid-base balance, and serum lactic acid levels. In general, during the first postoperative day, the ideal levels of serum hepatic transaminases, total bilirubin, and prothrombin activity can be expected to remain below 1000 IU/mL, about 2 mg/dL, and about 50%, respectively. Acidosis is very common in liver failure, so the level of serum lactic acid should be carefully monitored. Serum bilirubin level should rapidly decrease; if the level increases abruptly after the second postoperative day the risk of hepatic failure increases. Currently, there is not a unified definition of liver failure after hepatectomy. The international hepatic surgery research team has proposed a definition based on the normal postoperative course of serum bilirubin concentration and international normalized ratio (INR), reflecting the ability of the liver to maintain its synthetic, excretory, and detoxifying functions. Postoperative liver failure is defined as an increased INR and hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5[104]. The severity of post-hepatectomy liver failure is graded based on its effect on clinical management; grade A failure requires no change in the patient’s clinical management; grade B failure requires deviation from the usual management but does not require invasive therapy; grade C requires invasive treatment[104].

CONCLUSION

In conclusion, hepatectomy still has significant associated complications and mortality. These problems are closely related to surgical manipulations, anesthesia, preoperative evaluation and preparation, and postoperative observation and management. The safety profile of hepatectomy probably can be improved if the surgeons and medical staff involved have comprehensive knowledge of the expected complications and expertise in their management.

Footnotes

P- Reviewers: Chiu KW, Chuma M, Zezos P S- Editor: Qi Y L- Editor: Wang TQ E- Editor: Wang CH

References
1.  Savage AP, Malt RA. Elective and emergency hepatic resection. Determinants of operative mortality and morbidity. Ann Surg. 1991;214:689-695.  [PubMed]  [DOI]
2.  Wu M, Zhang Z. Prevention and treatment of complications after hepatectomy. Zhonghua Wai Ke Zazhi. 2002;40:332-335.  [PubMed]  [DOI]
3.  Ishikawa M, Yogita S, Miyake H, Fukuda Y, Harada M, Wada D, Tashiro S. Clarification of risk factors for hepatectomy in patients with hepatocellular carcinoma. Hepatogastroenterology. 2002;49:1625-1631.  [PubMed]  [DOI]
4.  Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E. Laparoscopic liver resection of benign liver tumors. Surg Endosc. 2003;17:23-30.  [PubMed]  [DOI]
5.  Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA. Postoperative complication rates after hepatic resection in Maryland hospitals. Arch Surg. 2003;138:41-46.  [PubMed]  [DOI]
6.  Benzoni E, Lorenzin D, Baccarani U, Adani GL, Favero A, Cojutti A, Bresadola F, Uzzau A. Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications. Hepatobiliary Pancreat Dis Int. 2006;5:526-533.  [PubMed]  [DOI]
7.  Benzoni E, Molaro R, Cedolini C, Favero A, Cojutti A, Lorenzin D, Intini S, Adani GL, Baccarani U, Bresadola F. Liver resection for HCC: analysis of causes and risk factors linked to postoperative complications. Hepatogastroenterology. 2007;54:186-189.  [PubMed]  [DOI]
8.  Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, Abdalla EK, Curley SA, Capussotti L, Clary BM. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854-862; discussion 862-864.  [PubMed]  [DOI]
9.  McKay A, You I, Bigam D, Lafreniere R, Sutherland F, Ghali W, Dixon E. Impact of surgeon training on outcomes after resective hepatic surgery. Ann Surg Oncol. 2008;15:1348-1355.  [PubMed]  [DOI]
10.  Feng ZQ, Huang ZQ, Xu LN, Liu R, Zhang AQ, Huang XQ, Zhang WZ, Dong JH. Liver resection for benign hepatic lesions: a retrospective analysis of 827 consecutive cases. World J Gastroenterol. 2008;14:7247-7251.  [PubMed]  [DOI]
11.  Tomuş C, Iancu C, Bălă O, Graur F, Furcea L, Zaharie F, Mocan L, Vlad L. Liver resection for benign hepatic lesion: mortality, morbidity and risk factors for postoperative complications. Chirurgia (Bucur). 2009;104:275-280.  [PubMed]  [DOI]
12.  Cescon M, Vetrone G, Grazi GL, Ramacciato G, Ercolani G, Ravaioli M, Del Gaudio M, Pinna AD. Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg. 2009;249:995-1002.  [PubMed]  [DOI]
13.  Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Cai SW, Zhang AQ, Feng YQ, Zhou NX, Dong JH. Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J (Engl). 2009;122:2268-2277.  [PubMed]  [DOI]
14.  Mathur AK, Ghaferi AA, Osborne NH, Pawlik TM, Campbell DA, Englesbe MJ, Welling TH. Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg. 2010;14:1285-1291.  [PubMed]  [DOI]
15.  Sato M, Tateishi R, Yasunaga H, Horiguchi H, Yoshida H, Matsuda S, Koike K. Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients. J Gastroenterol. 2012;47:1125-1133.  [PubMed]  [DOI]
16.  Dan RG, Creţu OM, Mazilu O, Sima LV, Iliescu D, Blidişel A, Tirziu R, Istodor A, Huţ EF. Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients. Chirurgia (Bucur). 2012;107:737-741.  [PubMed]  [DOI]
17.  Haga Y, Miyanari N, Takahashi T, Koike S, Kobayashi R, Mizusawa H, Nakamichi C, Goto M. Risk factors for catheter-related bloodstream infections in adult hospitalized patients - multicenter cohort study. Scand J Infect Dis. 2013;45:773-779.  [PubMed]  [DOI]
18.  O’Connor A, Hanly AM, Francis E, Keane N, McNamara DA. Catheter associated blood stream infections in patients receiving parenteral nutrition: a prospective study of 850 patients. J Clin Med Res. 2013;5:18-21.  [PubMed]  [DOI]
19.  Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40:2479-2485.  [PubMed]  [DOI]
20.  Ahn SJ, Kim HC, Chung JW, An SB, Yin YH, Jae HJ, Park JH. Ultrasound and fluoroscopy-guided placement of central venous ports via internal jugular vein: retrospective analysis of 1254 port implantations at a single center. Korean J Radiol. 2012;13:314-323.  [PubMed]  [DOI]
21.  Newman N, Issa A, Greenberg D, Kapelushnik J, Cohen Z, Leibovitz E. Central venous catheter-associated bloodstream infections. Pediatr Blood Cancer. 2012;59:410-414.  [PubMed]  [DOI]
22.  Vladov N, Lukanova Ts, Takorov I, Mutafchiyski V, Vasilevski I, Sergeev S, Odisseeva E. Single centre experience with surgical treatment of hilar cholangiocarcinoma. Chirurgia (Bucur). 2013;108:299-303.  [PubMed]  [DOI]
23.  Nobili C, Marzano E, Oussoultzoglou E, Rosso E, Addeo P, Bachellier P, Jaeck D, Pessaux P. Multivariate analysis of risk factors for pulmonary complications after hepatic resection. Ann Surg. 2012;255:540-550.  [PubMed]  [DOI]
24.  Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg. 2011;35:2073-2082.  [PubMed]  [DOI]
25.  Tsujita E, Yamashita Y, Takeishi K, Matsuyama A, Tsutsui S, Matsuda H, Taketomi A, Shirabe K, Ishida T, Maehara Y. Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg. 2012;36:1651-1656.  [PubMed]  [DOI]
26.  Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, Nobuoka D, Utsumi M, Yoshida K, Fujiwara T. Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases. J Hepatobiliary Pancreat Sci. 2013;20:186-196.  [PubMed]  [DOI]
27.  Harimoto N, Shirabe K, Abe T, Yukaya T, Tsujita E, Gion T, Kajiyama K, Nagaie T. Prospective randomized controlled trial investigating the type of sutures used during hepatectomy. World J Gastroenterol. 2011;17:2338-2342.  [PubMed]  [DOI]
28.  Shiba H, Ishii Y, Ishida Y, Wakiyama S, Sakamoto T, Ito R, Gocho T, Uwagawa T, Hirohara S, Kita Y. Assessment of blood-products use as predictor of pulmonary complications and surgical-site infection after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2009;16:69-74.  [PubMed]  [DOI]
29.  Hirokawa F, Hayashi M, Miyamoto Y, Asakuma M, Shimizu T, Komeda K, Inoue Y, Takeshita A, Shibayama Y, Uchiyama K. Surgical outcomes and clinical characteristics of elderly patients undergoing curative hepatectomy for hepatocellular carcinoma. J Gastrointest Surg. 2013;17:1929-1937.  [PubMed]  [DOI]
30.  Garwood RA, Sawyer RG, Thompson L, Adams RB. Infectious complications after hepatic resection. Am Surg. 2004;70:787-792.  [PubMed]  [DOI]
31.  Li GQ, Zhang F, Lu H, Lu L, Li XC, Wang XH, Sun BC. Drainage by urostomy bag after blockage of abdominal drain in patients with cirrhosis undergoing hepatectomy. Hepatobiliary Pancreat Dis Int. 2013;12:99-102.  [PubMed]  [DOI]
32.  Di Carlo I, Toro A. Correct indication for surgery can prevent postoperative ascites in cirrhotic patients affected by hepatocellular carcinoma. World J Surg. 2012;36:1719-1720; author reply 1719-1720.  [PubMed]  [DOI]
33.  Chan KM, Lee CF, Wu TJ, Chou HS, Yu MC, Lee WC, Chen MF. Adverse outcomes in patients with postoperative ascites after liver resection for hepatocellular carcinoma. World J Surg. 2012;36:392-400.  [PubMed]  [DOI]
34.  Chen LP, Li C, Wang C, Wen TF, Yan LN, Li B. Risk factors of ascites after hepatectomy for patients with hepatocellular carcinoma and hepatitis B virus-associated cirrhosis. Hepatogastroenterology. 2012;59:292-295.  [PubMed]  [DOI]
35.  Wei M, Qian HG, Qiu H, Wu JH, Li YJ, Zhou GQ, Zhang J, Hao CY. A scoring system to predict ascites after hepatectomy for hepatocellular carcinoma. Zhonghua Wai Ke Zazhi. 2010;48:1534-1538.  [PubMed]  [DOI]
36.  Xing X, Li H, Liu WG, Xia SS, Chen XP. Etiological factors for subphrenic infection after hepatectomy for patients with hepatic malignancy. Hepatobiliary Pancreat Dis Int. 2004;3:402-405.  [PubMed]  [DOI]
37.  Xing X, Wu ZD. The retrospective study on high risk factors of subphrenic infection after hepatectomy. J Tongji Med Univ. 1995;15:158-161.  [PubMed]  [DOI]
38.  Benzoni E, Cojutti A, Lorenzin D, Adani GL, Baccarani U, Favero A, Zompicchiati A, Bresadola F, Uzzau A. Liver resective surgery: a multivariate analysis of postoperative outcome and complication. Langenbecks Arch Surg. 2007;392:45-54.  [PubMed]  [DOI]
39.  Benzoni E, Lorenzin D, Favero A, Adani G, Baccarani U, Molaro R, Zompicchiatti A, Saccomano E, Avellini C, Bresadola F. Liver resection for hepatocellular carcinoma: a multivariate analysis of factors associated with improved prognosis. The role of clinical, pathological and surgical related factors. Tumori. 2007;93:264-268.  [PubMed]  [DOI]
40.  Nyckowski P, Krawczyk M, Zieniewicz K, Najnigier B, Fraczek M, Kacka A, Karwowski A. Analysis of morbidity risk in patients after liver resection. Wiad Lek. 1997;50 Suppl 1 Pt 2:277-280.  [PubMed]  [DOI]
41.  Shimada M, Matsumata T, Akazawa K, Kamakura T, Itasaka H, Sugimachi K, Nose Y. Estimation of risk of major complications after hepatic resection. Am J Surg. 1994;167:399-403.  [PubMed]  [DOI]
42.  Frilling A, Stavrou GA, Mischinger HJ, de Hemptinne B, Rokkjaer M, Klempnauer J, Thörne A, Gloor B, Beckebaum S, Ghaffar MF. Effectiveness of a new carrier-bound fibrin sealant versus argon beamer as haemostatic agent during liver resection: a randomised prospective trial. Langenbecks Arch Surg. 2005;390:114-120.  [PubMed]  [DOI]
43.  Yang T, Li L, Zhong Q, Lau WY, Zhang H, Huang X, Yu WF, Shen F, Li JW, Wu MC. Risk factors of hospital mortality after re-laparotomy for post-hepatectomy hemorrhage. World J Surg. 2013;37:2394-2401.  [PubMed]  [DOI]
44.  Yuan FS, Ng SY, Ho KY, Lee SY, Chung AY, Poopalalingam R. Abnormal coagulation profile after hepatic resection: the effect of chronic hepatic disease and implications for epidural analgesia. J Clin Anesth. 2012;24:398-403.  [PubMed]  [DOI]
45.  Lau AW, Chen CC, Wu RS, Poon KS. Hypothermia as a cause of coagulopathy during hepatectomy. Acta Anaesthesiol Taiwan. 2010;48:103-106.  [PubMed]  [DOI]
46.  Silva MA, Muralidharan V, Mirza DF. The management of coagulopathy and blood loss in liver surgery. Semin Hematol. 2004;41:132-139.  [PubMed]  [DOI]
47.  Siniscalchi A, Begliomini B, De Pietri L, Braglia V, Gazzi M, Masetti M, Di Benedetto F, Pinna AD, Miller CM, Pasetto A. Increased prothrombin time and platelet counts in living donor right hepatectomy: implications for epidural anesthesia. Liver Transpl. 2004;10:1144-1149.  [PubMed]  [DOI]
48.  Sabate A, Dalmau A, Koo M, Aparicio I, Costa M, Contreras L. Coagulopathy management in liver transplantation. Transplant Proc. 2012;44:1523-1525.  [PubMed]  [DOI]
49.  Karakoc D, Hamaloglu E, Ozdemir A, Dogrul A, Ozenc A. The effect of hepatectomy on coagulation: an evaluation by thromboelastography. Eur J Gastroenterol Hepatol. 2010;22:43-48.  [PubMed]  [DOI]
50.  Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc. 2006;38:812-814.  [PubMed]  [DOI]
51.  Yoshida H, Onda M, Tajiri T, Itoh S, Uchida E, Arima Y, Mamada Y, Taniai N, Yamashita K, Kumazaki T. Colonic varices ruptured via drainage catheter after extended right hepatectomy. Hepatogastroenterology. 2000;47:718-719.  [PubMed]  [DOI]
52.  Herszényi L, Mihály E, Tulassay Z. Somatostatin and gastrointestinal tract. Clinical experiences. Orv Hetil. 2013;154:1535-1540.  [PubMed]  [DOI]
53.  Branicki FJ, Coleman SY, Pritchett CJ, Cheung WL, Tuen H, Fok PJ, Fan ST, Lai EC, Lau PW, Mok FP. Emergency surgical treatment for nonvariceal bleeding of the upper part of the gastrointestinal tract. Surg Gynecol Obstet. 1991;172:113-120.  [PubMed]  [DOI]
54.  Krause U. Management of upper gastrointestinal bleeding. 8. Surgical treatment of massive hemorrhage from the upper part of the gastrointestinal tract. Lakartidningen. 1972;69:4960-4964.  [PubMed]  [DOI]
55.  Peng Z, Yan S, Zhou X, Xu Z. Hepatic artery angiography and embolization for hemobilia after hepatobiliary surgery. Chin Med J (Engl). 2001;114:803-806.  [PubMed]  [DOI]
56.  Bo JG, Yang XP. Precise orientation and hepatectomy in the management of biliary tract hemorrhage. Zhonghua Yi Xue Zazhi. 2009;89:1408-1410.  [PubMed]  [DOI]
57.  Miura F, Asano T, Amano H, Yoshida M, Toyota N, Wada K, Kato K, Yamazaki E, Kadowaki S, Shibuya M. Management of postoperative arterial hemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology. J Hepatobiliary Pancreat Surg. 2009;16:56-63.  [PubMed]  [DOI]
58.  Xu ZB, Zhou XY, Peng ZY, Xu SL, Ruan LX. Evaluation of selective hepatic angiography and embolization in patients with massive hemobilia. Hepatobiliary Pancreat Dis Int. 2005;4:254-258.  [PubMed]  [DOI]
59.  Bloechle C, Izbicki JR, Rashed MY, el-Sefi T, Hosch SB, Knoefel WT, Rogiers X, Broelsch CE. Hemobilia: presentation, diagnosis, and management. Am J Gastroenterol. 1994;89:1537-1540.  [PubMed]  [DOI]
60.  Lee CC, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Hsia CY, Wu CW. Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma. Hepatogastroenterology. 2005;52:1168-1171.  [PubMed]  [DOI]
61.  Sadamori H, Yagi T, Matsuda H, Shinoura S, Umeda Y, Yoshida R, Satoh D, Utsumi T, Ohnishi T. Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases. J Hepatobiliary Pancreat Sci. 2010;17:709-718.  [PubMed]  [DOI]
62.  Bhattacharjya S, Puleston J, Davidson BR, Dooley JS. Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection. Gastrointest Endosc. 2003;57:526-530.  [PubMed]  [DOI]
63.  Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, Sugimachi K. Bile leakage after hepatic resection. Ann Surg. 2001;233:45-50.  [PubMed]  [DOI]
64.  Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Yamamoto J. Predictive factors for bile leakage after hepatectomy: analysis of 505 consecutive patients. World J Surg. 2011;35:1898-1903.  [PubMed]  [DOI]
65.  Sadamori H, Yagi T, Matsuda H, Shinoura S, Umeda Y, Fujiwara T. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases. Dig Surg. 2012;29:149-156.  [PubMed]  [DOI]
66.  Hotta T, Kobayashi Y, Taniguchi K, Johata K, Sahara M, Naka T, Maeda T, Tanimura H. Postoperative evaluation of C-tube drainage after hepatectomy. Hepatogastroenterology. 2003;50:485-490.  [PubMed]  [DOI]
67.  Fujimura M, Hirano M, Sato I, Kinoshita T, Yamamoto I, Nishimura K, Takahara H, Yamamoto A. The C tube in biliary surgery--its development and clinical application. Nihon Geka Hokan. 2000;68:85-122.  [PubMed]  [DOI]
68.  Kawaguchi Y, Ishizawa T, Masuda K, Sato S, Kaneko J, Aoki T, Beck Y, Sugawara Y, Hasegawa K, Kokudo N. Hepatobiliary surgery guided by a novel fluorescent imaging technique for visualizing hepatic arteries, bile ducts, and liver cancers on color images. J Am Coll Surg. 2011;212:e33-e39.  [PubMed]  [DOI]
69.  Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150:91-98.  [PubMed]  [DOI]
70.  Sakaguchi T, Suzuki A, Unno N, Morita Y, Oishi K, Fukumoto K, Inaba K, Suzuki M, Tanaka H, Sagara D. Bile leak test by indocyanine green fluorescence images after hepatectomy. Am J Surg. 2010;200:e19-e23.  [PubMed]  [DOI]
71.  Li SQ, Liang LJ, Peng BG, Lu MD, Lai JM, Li DM. Bile leakage after hepatectomy for hepatolithiasis: risk factors and management. Surgery. 2007;141:340-345.  [PubMed]  [DOI]
72.  Sugiyama M, Izumisato Y, Abe N, Yamaguchi Y, Yamato T, Masaki T, Mori T, Atomi Y. Endoscopic biliary stenting for treatment of bile leakage after hepatic resection. Hepatogastroenterology. 2001;48:1579-1581.  [PubMed]  [DOI]
73.  Resnick L, Herbst JS, Raab-Traub N. Oral hairy leukoplakia. J Am Acad Dermatol. 1990;22:1278-1282.  [PubMed]  [DOI]
74.  Ribeiro HS, Costa WL, Diniz AL, Godoy AL, Herman P, Coudry RA, Begnami MD, Mello CA, Silva MJ, Zurstrassen CE. Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis. Eur J Surg Oncol. 2013;39:380-385.  [PubMed]  [DOI]
75.  Filicori F, Keutgen XM, Zanello M, Ercolani G, Di Saverio S, Sacchetti F, Pinna AD, Grazi GL. Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy. Hepatobiliary Pancreat Dis Int. 2012;11:507-512.  [PubMed]  [DOI]
76.  Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Kakisaka T, Tsuruga Y, Todo S, Taketomi A. Analysis of the risk factors for early death due to disease recurrence or progression within 1 year after hepatectomy in patients with hepatocellular carcinoma. World J Surg Oncol. 2012;10:107.  [PubMed]  [DOI]
77.  Ren Z, Xu Y, Zhu S. Indocyanine green retention test avoiding liver failure after hepatectomy for hepatolithiasis. Hepatogastroenterology. 2012;59:782-784.  [PubMed]  [DOI]
78.  van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malagó M, Jalan R, Saner FH. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28:767-780.  [PubMed]  [DOI]
79.  Hammond JS, Guha IN, Beckingham IJ, Lobo DN. Prediction, prevention and management of postresection liver failure. Br J Surg. 2011;98:1188-1200.  [PubMed]  [DOI]
80.  Fábrega E, Mieses MÁ, Terán A, Moraleja I, Casafont F, Crespo J, Pons-Romero F. Etiologies and outcomes of acute liver failure in a spanish community. Int J Hepatol. 2013;2013:928960.  [PubMed]  [DOI]
81.  Lin KH, Liu JW, Chen CL, Wang SH, Lin CC, Liu YW, Yong CC, Lin TL, Li WF, Hu TH. Impacts of pretransplant infections on clinical outcomes of patients with acute-on-chronic liver failure who received living-donor liver transplantation. PLoS One. 2013;8:e72893.  [PubMed]  [DOI]
82.  Mejzlík V, Husová L, Kuman M, Stěpánková S, Ondrášek J, Němec P. Liver transplant outcomes in Brno. Vnitr Lek. 2013;59:663-667.  [PubMed]  [DOI]
83.  Fink DL, Bloch E. Liver transplantation for acute liver failure due to efavirenz hepatotoxicity: the importance of routine monitoring. Int J STD AIDS. 2013;24:831-833.  [PubMed]  [DOI]
84.  Oh SH, Kim KM, Kim DY, Kim Y, Song SM, Lee YJ, Park SJ, Yoon CH, Ko GY, Sung KB. Improved Outcomes in Liver Transplantation in Children with Acute Liver Failure. J Pediatr Gastroenterol Nutr. 2013;Epub ahead of print.  [PubMed]  [DOI]
85.  Patrono D, Brunati A, Romagnoli R, Salizzoni M. Liver transplantation after severe hepatic trauma: a sustainable practice. A single-center experience and review of the literature. Clin Transplant. 2013;27:E528-E537.  [PubMed]  [DOI]
86.  Ezzat TM, Dhar DK, Newsome PN, Malagó M, Olde Damink SW. Use of hepatocyte and stem cells for treatment of post-resectional liver failure: are we there yet? Liver Int. 2011;31:773-784.  [PubMed]  [DOI]
87.  Farid H, O’Connell T. Hepatic resections: changing mortality and morbidity. Am Surg. 1994;60:748-752.  [PubMed]  [DOI]
88.  Qian NS, Liao YH, Cai SW, Raut V, Dong JH. Comprehensive application of modern technologies in precise liver resection. Hepatobiliary Pancreat Dis Int. 2013;12:244-250.  [PubMed]  [DOI]
89.  Takatsuki M, Eguchi S, Yamanouchi K, Tokai H, Hidaka M, Soyama A, Miyazaki K, Hamasaki K, Tajima Y, Kanematsu T. Two-surgeon technique using saline-linked electric cautery and ultrasonic surgical aspirator in living donor hepatectomy: its safety and efficacy. Am J Surg. 2009;197:e25-e27.  [PubMed]  [DOI]
90.  Percivale A, Griseri G, Gastaldo A, Benasso M, Pellicci R. Microwave assisted liver resection: clinical feasibility study and preliminary results. Minerva Chir. 2012;67:415-420.  [PubMed]  [DOI]
91.  Imura S, Shimada M, Utsunomiya T, Morine Y, Ikemoto T, Mori H, Hanaoka J, Iwahashi S, Saito Y, Miyake H. Ultrasound-guided microwave coagulation assists anatomical hepatic resection. Surg Today. 2012;42:35-40.  [PubMed]  [DOI]
92.  Christian DJ, Khithani A, Jeyarajah DR. Making liver transection even safer: a novel use of microwave technology. Am Surg. 2011;77:417-421.  [PubMed]  [DOI]
93.  Strasberg SM, Drebin JA, Linehan D. Use of a bipolar vessel-sealing device for parenchymal transection during liver surgery. J Gastrointest Surg. 2002;6:569-574.  [PubMed]  [DOI]
94.  Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg. 2004;187:398-402.  [PubMed]  [DOI]
95.  Wang WD, Liang LJ, Huang XQ, Yin XY. Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol. 2006;12:935-939.  [PubMed]  [DOI]
96.  Jawan B, Cheng YF, Tseng CC, Chen YS, Wang CC, Huang TL, Eng HL, Liu PP, Chiu KW, Wang SH. Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy. World J Gastroenterol. 2005;11:4233-4236.  [PubMed]  [DOI]
97.  Pringle JH. V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg. 1908;48:541-549.  [PubMed]  [DOI]
98.  Jin S, Dai CL. Hepatic blood inflow occlusion without hemihepatic artery control in treatment of hepatocellular carcinoma. World J Gastroenterol. 2010;16:5895-5900.  [PubMed]  [DOI]
99.  Liu DL, Jeppsson B, Hakansson CH, Odselius R. Multiple-system organ damage resulting from prolonged hepatic inflow interruption. Arch Surg. 1996;131:442-447.  [PubMed]  [DOI]
100.  Castaing D, Garden OJ, Bismuth H. Segmental liver resection using ultrasound-guided selective portal venous occlusion. Ann Surg. 1989;210:20-23.  [PubMed]  [DOI]
101.  Huguet C, Nordlinger B, Bloch P, Conard J. Tolerance of the human liver to prolonged normothermic ischemia. A biological study of 20 patients submitted to extensive hepatectomy. Arch Surg. 1978;113:1448-1451.  [PubMed]  [DOI]
102.  Jin S, Dai CL. Attenuation of reperfusion-induced hepatocyte apoptosis is associated with reversed bcl-2/bax ratio in hemi-hepatic artery-preserved portal occlusion. J Surg Res. 2012;174:298-304.  [PubMed]  [DOI]
103.  Jin S, Dai C, Yang Y, Zhang R, Sileng A. Effect of hepatic blood inflow occlusion without hemihepatic artery control on apoptosis of liver cells in rats. Hepatogastroenterology. 2010;57:35-40.  [PubMed]  [DOI]
104.  Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713-724.  [PubMed]  [DOI]