Side Effects of Surgical Hepatobiliary Cancer Therapy

Hepatectomy represents a potentially curative option for primary and secondary liver tumors. Recent advances in perioperative management led to a sensible decrease in surgery-related morbidity and mortality. Besides, amelioration of surgical strategy planning and improvement of instruments and technical skills make it possible to push the limit of resectability for even more complex cases. However, postoperative complications still affect a consistent proportion of patients undergoing liver resection with postoperative liver failure (PHLF) representing the most challenging scenario to deal with. Despite preoperative algorithms and better estimation of function and volume of future liver remnant, PHLF still affects, with different severities, up to 40% of patients. In addition, no specific treatment, apart from supportive therapy, has been recognized. Although accounting for an inferior percentage of hepatic-related mortality, other postsurgical complications can manifest as well ranging from the liver-specific ones such as bile leakage to the more common postoperative hemorrhage, pulmonary infections, or venous thromboembolism. These conditions should be promptly recognized and treated not only for the immediate surgical outcome but also for the history of the patient’s disease. Indeed, postoperative morbidity has been recognized as a risk factor for tumor recurrence resulting in a general decrease of overall survival. Only through carefully planning the resection strategy and meticulous postoperative care, the so-called textbook outcomes, can be guaranteed making it possible for the patients to really benefit from surgical treatment.