Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

Prediction of posthepatectomy liver failure in patients with hepatocellular carcinoma through ultrasound elastography

In this article, we comment on the article by Cheng et al published in recently. Posthepatectomy liver failure (PHLF) remains a leading cause of hepatectomy-related mortality and can be evaluated according to liver reserve function. Liver stiffness (LS) measured by ultrasonic elastography and spleen area demonstrate a strong correlation with hepatic proliferation, fibrosis, and portal vein congestion, thus indirectly reflecting liver reserve function. This article highlights a meticulous study aimed at investigating the potential of two-dimensional shear wave elastography in assessing LS, as well as its integration with spleen area, surgical factors, and laboratory indicators, for predicting the risk of PHLF in hepatocellular carcinoma patients. In this article, we discussed the non-invasive elastography modality by ultrasound and magnetic resonance imaging to assess LS. Based on literature data, we subsequently suggested that several risk factors may contribute to PHLF, including excessive intrahepatic neutrophil accumulation, the formation of neutrophil extracellular traps, end-stage liver disease scores, and albumin-bilirubin scores. Therefore, a more comprehensive study incorporating detailed information requires further investigation.