Impact of Severe Infections on the Outcome of Major Liver Surgery: a Pathophysiologic and Clinical Analysis

Although major progress has been achieved, particularly in the field of patient selection and postoperative intensive care, morbidity and mortality rates after major liver surgery are still significant. In fact, the mortality rate in major series reaches 30% of patients undergoing complex liver procedures, mostly related to postoperative septic events. Among these, although extra-abdominal infectious localizations are also frequently reported, intra-abdominal sepsis and abscess formation are probably the most frequent infective clinical presentations. The literature reports that the magnitude of the resection and duration of surgery are associated with a significantly higher postoperative morbidity and mortality rate. Severe postoperative infectious events cause a high proportion of this morbidity and in the presence of a septic evolution of the clinical picture the mortality rises dramatically. Such a tight association between severe infections and mortality after major hepatic surgery gives account to the fundamental role played by the liver in the metabolic homeostasis of the patient and also to the central hepatic function in the immune response to microorganisms of gastroenteric origin. After major liver surgery these central hepatic functions may by significantly impaired, thus leading to higher susceptibility to infections, in particular in the elderly. On these bases the improvement in prophylaxis protocols, in the early diagnosis and in the treatment of these postoperative infectious events can help optimize clinical results after major hepatic surgery.