Active inflammatory change of the liver as a cause of postoperative hepatic failure.

Histopathology of cirrhosis was compared to the hepatic functional reserve and to the prognosis. One hundred and thirteen patients including 51 surgically treated for hepatocellular carcinoma (HCC) and 62 subjected to wedge biopsy of the liver during surgery for esophageal varices were studied. The type of cirrhosis associated with hepatocellular carcinoma was classified into 4 groups according to the degree of inflammation and the piecemeal necrosis. Of the 16 without cirrhosis, 13 (81 per cent) are living. Nine had an inactive cirrhosis and 5 (56 per cent) are living. Ten had a slightly active cirrhosis and 4 (40 per cent) are living. Sixteen had a fairly active cirrhosis and 7 (44 per cent) are alive. Immediate postoperative death due to acute hepatic failure occurred in 6, 4 of whom had a fairly active cirrhosis. In patients with active alcoholic hepatitis with numerous Mallory bodies and ballooning degeneration of liver cells, the prognosis was the poorest, if the liver was resected, even though the functional reserve seemed to be adequate. To prevent acute hepatic failure, liver histology during the surgery is predictive and wedge biopsy of the liver is recommended.