Abstract
BackgroundLiver resection is the mainstay of treatment for most of the liver tumors. Liver has a unique capability to restore the lost volume following resection, however, most of the primary tumors grow in a liver with preexisting parenchymal diseases and secondary tumors often present in multiple liver lobes precluding a safe curative resection. Two-stage hepatectomy and portal vein ligation (PVL) are used to achieve a safer future remnant liver volume (FRLV), however, these procedures take several weeks to achieve adequate FRLV. A recently introduced faster alternative two-stage hepatectomy, also know as associated liver partitioning and portal vein ligation for staged hepatectomy (ALPPS), produces a desirable FRLV in days.MethodsTo have an insight into the mechanism of ALPPS associated liver regeneration, we reproduced a rat model of ALPPS and compared the results with the PVL group.ResultsOur results convincingly showed an advantage of the ALPPS procedure over PVL group in terms of early regeneration, however, in 1-week time the amount of regeneration was comparable. An early regeneration in the ALPPS group coincided with an early entry of hepatocytes into the cell proliferation phase, a significant increase in portal pressure and increase in hepatic enzymes in the ALPPS group compared with the PVL group. According to the protein array evaluation of 29 cytokines/chemokines, cytokine induced neutrophil chemoattractant-1 had the highest expression whereas IL-6 had the highest fold (>6 vs PVL group) expression at the early phase of regeneration in the ALPPS group.ConclusionsThis unique rat model of ALPPS would help to improve our understanding about the liver generation process and also will help in further refinement of the ALPPS procedure for the clinical benefit.Electronic supplementary materialThe online version of this article (doi:10.1186/s13022-015-0020-3) contains supplementary material, which is available to authorized users.
Highlights
Liver resection is the mainstay of treatment for most of the liver tumors
The whole liver weight/body weight ratio was marginally higher in the ALPPS group when compared with the portal vein ligation (PVL) and the Sham groups, there was no statistical differences among the groups
When compared with the PVL group, significant increases in the future remnant liver volume (FRLV)/BW ratio were noticed in the ALPPS group at 24 h (p = 0.024, ANOVA/Turkey HSD) and 96 h (p = 0.001, ANOVA/Turkey HSD) time periods and it was almost similar in both groups at 1 week time period (Fig. 2)
Summary
Liver resection is the mainstay of treatment for most of the liver tumors. Liver has a unique capability to restore the lost volume following resection, most of the primary tumors grow in a liver with preexisting parenchymal diseases and secondary tumors often present in multiple liver lobes precluding a safe curative resection. Schnitzbauer et al [6] has pioneered a new strategy of two-staged approach to achieve faster growth of FRL by combining the portal vein ligation and parenchymal partitioning between the ligated and non-ligated part of the liver which ideally prevents cross collateral flow between the lobes and increases the pace of the growth of the FRL. This procedure was later acronymed as associated liver partitioning and portal vein ligation for staged hepatectomy (ALPPS). We describe for the first time an animal model of ALPPS in rats and evaluated possible mechanism(s) of enhanced liver regeneration
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