ldquo Small for flow rdquo liver failure after extended hepatectomy a call for update

Emond et al first described in a new syndrome occurring in small grafts in transplantation field named small for Size Syndrome After surgery patients with a small grafts were affected by unpredictable elevation of bilirubin not linked with surgical procedures coagulopathy prolonged cholestasis portal hypertension and if severe ascites The continuing liver dysfunction predisposes to further complications including sepsis and gastrointestinal bleedings leading to a clear liver failure In the meantime in liver resection field the same syndrome was noticed after major hepatectomy gt segments resected and it was named Post Hepatectomy Liver Failure With improvement of knowledge nowadays we know that SFSS and PHLF are two side of the same coin Different strategies more in transplantation context have been described to prevent and to treat the syndrome but lack of data regarding the resection context is still a matter In fact where in transplant pathophysiological studies and randomized clinical trial have been published to evaluate the etiology and the efficacy of procedures proposed in resection field we are just translate transplantation experience without a whole consensus between physician on how to predict to diagnose and to treat this post hepatectomy liver failure Diagnostic criteria treatments and pathophysiology are still unclear with different opinion between physicians and also disaccording if small for size and post hepatectomy liver failures are really the same Our opinion a part we think it rsquo s time to start to analyze in deep this syndrome that account for more than of death after major liver resections