Sepsis after liver resection: predisposition, clinical relevance and synergism with liver dysfunction

Liver resection, compared with other abdominal operations, is characterized by greater predisposition to septic complications. This may be explained by several factors, including the major role of the liver in immune defense, anatomical features such as the close relation¬ship of the hepato biliary system with the intestine, underlying liver disease if present and specific preoperative treatments favouring postoperative sepsis. A critical point is that sepsis does not always present with immediately recognizable signs, such as fever or leukocytosis. At times it presents with more subtle signs, for instance hyperbilirubinemia and encephalopathy. After liver resection these may be misinterpreted as simple consequences of transient parenchymal insufficiency, therefore resulting in failure to recognize and promptly treat underlying sepsis. Particular caution is needed in this setting to avoid dismal outcomes. This chapter focuses on these aspects, describing underlying mechanisms and preventive mea¬sures and further characterizing the powerful synergism of sepsis overimposed on postoperative liver dysfunction in determining poor outcome.