Service médicochirurgical des maladies de l’appareil digestif et de la transplantation hépatique, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
Hepatic resection in cirrhotic patients is correlated with an increased risk of liver failure and mortality. Major hepatectomies should not be undertaken in patients with chronic liver disease without specific preoperative assessment and preparation. Currently, no reliable test or biological value is available to predict precisely the risk of liver failure after surgery. In most Western countries, preoperative hepatic function assessment is based on the Child-Pugh score, with particular attention being given to portal hypertension. In Asian countries, indocyanine green clearance test (ICG) is used to refine the selection of patients. Preoperative portal vein embolization (PVE) can be used to induce hypertrophy of the future remnant liver, and thus reduce the risks of postoperative liver failure due to insufficient residual liver volume. Trans-arterial chemo-embolization (TACE), when combined to PVE, could improve the degree of hypertrophy and overall survival. Meticulous preoperative assessment of liver function, rigorous selection of patients and application of the specific procedures of preoperative preparation can together reduce morbidity and mortality due to hepatic resection in cirrhotic patients.