Risk predictors of post-hepatectomy liver failure: unraveling complexities and navigating challenges in clinical application

Studies related to the prediction of post-hepatectomy liver failure(PHLF)have seen a surge in recent literature.A PubMed search using the terms((“pred*”OR“nomogra*”OR“model*”)AND(“mortality”OR“liver failure”OR“PHLF”)AND(“hepatect*”OR“liver resect*”))revealed 29 relevant studies on PHLF prediction between January 2020 and November 2023,with 20 adhering to grade B/C International Study Group of Liver Surgery(ISGLS)definitions(Table 1).These studies are primarily enrolling patients with hepatocellular carcinoma(HCC).This underscores the growing interest in applying such predictive scores in routine clinical practice.However,the extent to which these predictive models can be effectively implemented in clinical settings remains unclear(21,22).Indeed,all studies are retrospective,and only a limited number underwent external validation.It is crucial to recognize that these scores predominantly emerge within surgical cohorts,where patients underwent prior meticulous selection,leading to tailored surgical strategies and the exclusion of specific candidates(21).