Liver Regeneration in Children after Major Hepatectomy for Malignancy—Evaluation Using a Computer-Aided Technique of Volume Measurement

Abstract

Purpose: The time course of hepatic volume regeneration and return of excretory and synthetic function was studied in eight children undergoing lobar or extended lobar liver resections for hepatoblastoma (n= 5), hepatoma (n= 1), and recurrent nephroblastoma (n= 2). Five patients received preoperative and all were administered postoperative chemotherapy. Whole-liver irradiation was administered to one patient. One additional patient who underwent an extended hepatic resection for benign disease and did not receive chemotherapy was included for comparison. Methods: A previously validated technique of computer-aided volume measurement was used to measure liver volumes from serial CT scans obtained after hepatic surgery. Normal liver volume as a function of age was determined from the literature and the time course of regeneration was compared to normal liver growth. Postoperative serum albumin, total bilirubin, serum glutamic oxaloacetic transaminase, and alkaline phosphatase levels were recorded and correlated with volume regeneration. Results: In six patients hepatic regeneration had progressed to normal volume by 90 days after resection (normal volume for age was achieved by 50 days in three patients). There was an initial rapid rate of regeneration (>10 cc/day) which declined to a normal rate of less than 0.5 cc/day at 90 days after surgery. Two children with failure to thrive displayed the same pattern of rapid regeneration, attaining a volume appropriate for weight but less than that expected for age. The shape of the liver volume regeneration curve was similar in one additional patient undergoing an extended left lobectomy for benign disease. A brief rise in bilirubin occurred during the first week and a transient fall in serum albumin was followed by resumption of normal synthetic capacity within 6 weeks in all but two patients. Conclusions: Liver regeneration in children is a rapid process occurring despite the administration of cytotoxic agents and hepatic irradiation.