Abstract
Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been reported to be a novel surgical technique that provides fast and effective growth of liver remnant. Despite occasional reports on animal studies, the mechanisms of rapid liver regeneration in ALPPS remains unclear. In the present study, we intend to develop a reproducible rat model to mimick ALPPS and to explore the underlying mechanisms. Rats assigned to the portal vein ligation (PVL), left lateral lobe (LLL) resection, transection and sham groups served as controls. Results indicated that the regeneration rate in the remnant liver after ALPPS was two times relative to PVL, whereas rats with transection alone showed minimal volume increase. The expression levels of Ki-67 and PCNA were about ten-fold higher after ALPPS compared with the transection and LLL resection groups, and four-fold higher compared with the PVL group. The levels of TNF-α, IL-6 and HGF in the regenerating liver remnant were about three-fold higher after ALPPS than the controls. There was a more significant activation of NF-κB p65, STAT3 and Yap after ALPPS, suggesting synergistic activation of the pathways by PVL and transection, which might play an important role in liver regeneration after ALPPS.
Highlights
Hepatic resection is still one of the most effective treatments for liver tumors[1]
The low mortality suggests that ALPPS in rats does not commonly induce liver failure, despite 90% portal vein ligation (PVL) combined with liver transection
Activation of Cdk[2] kinase requires binding of cyclin E and is essential for cells to enter S phase. Because both cyclin E and Cdk[2] are induced after ALPPS, we examined whether the cyclin E/Cdk[2] complex accumulated in ALPPS animal livers
Summary
Hepatic resection is still one of the most effective treatments for liver tumors[1]. the extent of hepatic resection is limited by the minimum volume of the future liver remnant (FLR), which is required to provide sufficient postoperative liver function[2]. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a new surgical strategy It represents a modification of a two-stage hepatectomy in which complete parenchymal transection is associated with ligation of contralateral portal vein[7,8]. It produces a significant increase of the FLR in a much shorter time compared with PVL or PVE. Schlegel et al developed a reproducible mouse model mimicking ALPPS and explored the underlying mechanisms Their results suggested that ALPPS in rats induces an unprecedented degree of liver regeneration, comparable with www.nature.com/scientificreports/.
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