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Invited Critique
March 1, 2008

Prognostic Utility of Postoperative C-reactive Protein for Posthepatectomy Liver Failure—Invited Critique

Arch Surg. 2008;143(3):253. doi:10.1001/archsurg.2007.76

Major hepatic resections are often required for the treatment of primary and secondary hepatic malignancies. A key step in planning a major hepatectomy is predicting the risk of PHLF. It is generally accepted that a postoperative liver remnant volume of 25% or greater is sufficient to minimize the risk of PHLF in a healthy liver.1 However, this method is incapable of determining a subtle decrement in baseline hepatic function. This is a significant limitation in patients with cirrhosis or chemotherapy-induced steatohepatitis. To augment volumetric analysis, functional tests such as indocyanine green excretion are under investigation for their role as a predictor of PHLF.2