Postoperative hepatic insufficiency still occurs in 12% of patients.

Despite achieving the desired future liver remnant volume through portal vein embolization, 12% of patients still experienced postoperative hepatic insufficiency following major hepatectomy. Key risk factors identified include older age, performance status, preoperative biliary drainage, and specific diagnoses such as cholangiocarcinoma or gallbladder cancer. Notably, postoperative hepatic insufficiency significantly increased mortality rates from 3.5% to 45% and prolonged hospital stays from 7 to 16 days, highlighting the importance of considering additional predictors beyond volumetrics.