Abstract
BackgroundThe aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth.MethodsData was abstracted from a retrospectively maintained database on 27 patients undergoing hepatic resection followed by PVE and the ALPPS procedure between October 1, 2007 and December 31, 2016. The increasing rate of liver volume and remnant liver LU15 was defined as the percentage-point difference between the liver volume and remnant liver LU15 before and after the intervention or surgery. And correlation between kinetic growth rate (KGR) of liver and future remnant liver volume or remnant liver LU15 was analyzed.ResultsThe degree of hypertrophy (DH) of volume and LU15 was significantly greater after ALPPS (volume: 40.3% and LU15: 65.0%) than after PVE (volume: 22.7% and LU15: 48.8%) (P < 0.05). KGR of volume and LU15 was significantly greater after ALPPS (volume: 19.0 cm3/day and 2.00%/day) (LU15: 0.61 /day and 1.82%/day) than after PVE (volume: 3.89 cm3/day and 0.42%/day) (LU15: 0.19 /day and 0.63%/day) (P < 0.001). An inverse correlation between KGR and initial remnant liver volume was observed. And a positive correlation between KGR and LU15 was observed.ConclusionFuture remnant liver volume and KGR was greater after the ALPPS procedure than after PVE. Liver hypertrophy is related to the expected remnant liver volume and total liver function. This study suggested that total liver function and initial remnant liver volume might be a new indication of hepatectomy after PVE and ALPPS in the case of insufficient remnant liver volume.
Highlights
The aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth
The degree of hypertrophy of volume and LU15 was significantly greater after ALPPS than after PVE
Future remnant liver volume and kinetic growth rate (KGR) was greater after the ALPPS procedure than after PVE
Summary
The aim was to analyze hepatic hypertrophy after portal vein embolization (PVE) and Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) to determine whether clinical circumstances associated with major hepatic resections correlated with remnant growth. As more extensive hepatic resections are performed, achieving adequate remnant liver function often remains the rate limiting step [1]. Assessment of hepatic functional reserve is one of the most important steps in hepatic resection [2]. To estimate hepatic functional reserve, 99mTc-labelled diethylene triamine penta-acetate–galactosyl human serum albumin (99mTc-GSA), a radiopharmaceutical that binds to the hepatic asialoglycoprotein receptor (ASGP-R), has been developed and used clinically to estimate hepatic function [3]. Because ASGP-R is a natural superficial antigen of viable hepatocytes, the uptake of 99mTc-GSA is independent of biochemical processes and allows direct estimation of the functioning hepatocyte mass [4]. Our previous study has shown that a novel index, remnant liver LU15, has been identified as a surrogate marker for remnant liver function and preoperative remnant liver LU15 values might predict hepatic failure following a liver resection without biliary reconstruction [6]
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