Extended Liver Resection Research Articles

Options for Two-Stage Extensive Liver Resections in the Surgical Treatment 
 of Advanced Liver Echinococcosis

Introduction. The major and effective option for the treatment of liver echinococcosis are surgical operations. To choose a type of surgical intervention in a common form of liver echinococcosis under suspected deficit in the functional reserves of the organ and developing post-resection liver failure remains challenging.The aim of the study is to present and analyze the effectiveness of two-stage extensive resection interventions in patients with advanced liver echinococcosis.Materials and methods. The study included clinical findings of 24 patients with advanced liver echinococcosis (9/37.5% men, 15/62.5% women) who underwent surgical treatment in Surgical Department №2, Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky " (Kemerovo). The use of a two-stage major resection protocol was the criterion for inclusion in the study. Stage I was aimed to achieve vicarious hypertrophy of the contralateral lobe using various techniques to stop blood flow along the right branch of the portal vein. A two-stage protocol for extensive resection intervention was applied due to insufficient functional liver reserves and the small volume of the potential remnant; this resulted in the inability to safely use a single-stage extensive resection due to the predicted developing post-resection liver failure and a likely lethal outcome.Results and discussions. The applied surgical stage approaches for prevention of post-resection liver failure are effective due to the following parameters: CT volumetry (p0.05), residual concentration of indocyanine green at the 15th minute (p0.05), statistical model value (p0, 05). The level of effectiveness of the above technique is comparable with the laparotomic ligation of the right branch of the portal vein; however, the laparoscopic option is less traumatic, which can significantly reduce postoperative hospital stay (p0.05). In addition, there were no specific and nonspecific complications registered in case of the laparoscopic option.Conclusion. Two-stage extensive resection interventions for advanced liver echinococcosis are effective and sufficiently safe when operations are performed in specialized hepatological centers using a comprehensive protocol for preoperative examination. They can be recommended in case of the initial significant deficit in the volume of the potential liver remnant and functional reserves of the organ.

EFFICACY OF ONE-STAGE AND TWO-STAGE EXTENSIVE SURGICAL RESECTIONS IN LIVER ECHINOCOCCOSIS

Surgery is the main effective way to treat liver echinococcosis. The problem of choosing a surgical technique for treating liver echinococcosis under impaired liver functional reserve and development of post- hepatectomy liver failure remains relevant.
 The aim of the study is to analyze the effectiveness of extensive surgical resections while treating patients with liver echinococcosis.
 Materials and Methods. The article presents the results of surgical treatment of 85 patients with liver echinococcosis from 2006 to 2022. All patient underwent extensive liver resection: 61 patients (71.8 %) were operated on according to one-stage extensive surgical resection protocol; 24 patients (28.2 %) were operated on according to two-stage extensive surgical resection protocol. 
 Results. The applied surgical step-by-step methods for prevention of post-resection liver failure were effective in 24 patients (100 %), Group 2. Three deaths (3.5 %) were recorded in the total mass of the trial patients. Progressive post-resection liver failure was the cause of deaths. After the introduction of a new examination protocol into clinical practice, the authors observed no deaths after extensive surgery resections because of the development of post-resection liver failure. Moreover, no relapses were observed after extensive surgery resections.
 Conclusion. Extensive surgical resections in patients with liver echinococcosis are effective and sufficiently safe when performed in specialized hepatological centers using an in-depth preoperative protocol. Two-stage surgical resections can be recommended in case of initial significant deficit in the volume of the future liver remnant and functional organ reserves.

Early and long-term outcomes of liver resections: a single specialized center experience

The purpose of the study was to evaluate the outcomes of a series of liver resections performed in a single regional specialized cancer center. Material and Methods. Eighty-nine patients underwent liver and/ or extrahepatic bile duct resections in the Penza Regional Oncology Hospital over the 8-year study period. Malignancies were observed in 81 patients. Extended liver resections (4 segments or more) were performed in 58 (65.2 %) cases. Results. Postsurgical morbidity and mortality rates were 31.5 % (28 of 89) and 6.7 % (6 of 89), respectively. Six of 10 patients with primary liver carcinomas were alive without evidence of disease progression at a follow-up time ranged from 1.0 to 76.7 months. Adjuvant chemotherapy (ACT) was the only predictor (HR=0.40; 95 % CI 0.16-0.98) of overall survival in patients with metastatic colorectal cancer (mCRC). The median survival time after liver resections for mCRC with or without ACT was 54.5 (95 % CI: 14.5-94.5) vs 21.8 months (95 % CI: 14.2-29.4), respectively. In mCRC patients with ACT, the 5-year overall survival rate was 44.8 ± 12.9 %. Conclusion. Primary hepatobiliary carcinomas and colorectal cancer liver metastases are the most common reasons for liver resections. A series of liver resections in a low-volume hospital is feasible with the achievement of good outcomes.

ALBI and APRI score as prognostic factors for predicting the FABIB complications after liver resection in metastatic colorectal cancer.

e15577 Background: Previous studies and this study demonstrate that liver resection, even with subsequent extrahepatic relapse, may be associated with long-term survival, are very encouraging for future studies of the effectiveness of liver cytoreduction in conditions of minimal extrahepatic disease. These data also contribute to selective cytoreduction in extrahepatic sites. If it is necessary to achieve an oncological result (maximally extended liver resection), sometimes the surgical result suffers in the form of postoperative complications. The most serious complication of liver resection due to colorectal cancer metastases is postoperative liver failure, characterized by high levels of INR and bilirubin by day 5 after surgery. Methods: To classify the most frequent postoperative complications, the FABIB system has been developed, which includes Failure, Ascites, Bile leakage, Infection, Bleeding. We tried to evaluate the possibilities of using the ALBI and APRI indicators as one of the factors that must be taken into account when predicting the development of complications from the FABIB group. ALBI score is used in predicting the development of liver failure in patients with hepatocellular cancer. APRI score is a predictor of fibrosis and cirrhosis in patients suffering from hepatitis. Results: We have analyzed the results of liver resections in 174 patients with metastatic liver damage in colorectal cancer. Among them 57% are women, 43% are men. Metastatic lesion of the right lobe – 38 (21.8%), the left lobe – 78 (44.8%), right and left lobes – 58 (33.4%). Right–sided tumors - 25% - 43 patients, left–sided tumors - 75% - 131 patients. According to the FABIB classification, liver insufficiency was observed in 25 patients (14%), ascites in 4 patients (2.3%), bile leakage in 8 (4.6%), infectious complications in 9 (5%), bleeding in 15 patients (8%). A single-factor analysis of the variance of ALBI and APRI indicators on the day of surgery, the day after surgery and on the 5th day after surgery did not show a statistically significant difference in the groups with all FABIB complications and without FABIB complications. However, statistical analysis separately in each subgroup of complications revealed a statistically significant difference in ALBI and APRI in the groups with and without postoperative liver failure, as well as a statistically significant difference in the groups with and without bleeding. Conclusions: Thus, it can be concluded that ALBI score and APRI score can be used in the early postoperative period to predict the development of postoperative liver failure and hemorrhagic complications not only in patients with hepatocellular cancer or cirrhosis, but also in patients with colorectal cancer with liver metastases. It could be useful in patients who have undergone several lines of chemotherapy before liver resection or with a large tumor lesion of the liver.

Correction of nutritional status in patients with focal liver diseases

Purpose of the research. To study the effect of nutritional support on the results of treatment of patients after liver resection for its focal neoplasms.Materials and methods. Nutritional status at the pre- and inpatient stages was studied based on the examination of 74 patients with focal liver neoplasms. Through a comprehensive clinical and laboratory examination, were identified groups of patients with mild, moderate and severe malnutrition were identified. Comparison groups were formed from them to develop corrective measures aimed at minimizing the phenomena of nutritional deficiency and reducing the frequency ofpurulent- septic complications from wounds.Results. As a result of the study, it was revealed that after undergoing large and extended liver resections, a mild degree of malnutrition was noted in 18 (47.4%) patients in the main group and in 16 (44.4%) patients in the control group (p = 0.796). The average degree of malnutrition was recorded in 7 (18.4%) patients in the main group and in 5 (13.9%) patients in the control group (p = 0.641). Severe malnutrition was observed in 3 (7.9% and 8.3%, respectively) patients in the analyzed groups (p = 0.796). It has been proven that the use of ATP allows accelerating the normalization of nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p <0.001). Nutritional support with the use of enteral nutrition on day 2 after surgery makes it possible to improve PS markers, which, as a result, helps to reduce the number of septic complications by 9% in the main group.Conclusion. The use of ATP allows to normalize the nutritional status in patients who underwent liver resection, compared with patients who did not receive nutritional support, up to 5.5 ± 2.2 days compared to 12.8 ± 3.9 in the second group (p < 0.001). After liver resection in the early postoperative period, nutritional support with enteral nutrition on day 2 after surgery allows improving PS markers, which, as a result, helps to reduce the number of purulent- septic complications by 9% compared to patients who did not receive nutritional support.

Surgical treatment of the perihilar cholangiocarcinoma with portal vein invasion

Background. Perichilar cholangiocarcinoma is a rare type of malignant neoplasm and is 3-7 cases per 100,000 population. Surgical method is the only radical method of treatment, allowing to improve long-term survival results. One of the important and characteristic features of perihilar cholangiocarcinoma is tumor invasion to the area of the portal vein bifurcation, which occurs in 30–45% of cases. Portal vein invasion is the one of the main causes of perihilar cholangiocarcinoma irresectability. However, innovative surgical technologies allow resection of the liver with resection and reconstruction of the portal vein with acceptable mortality.
 The aim. The aim of our study was to asses results of surgical treatment of perihilar cholangiocarcinoma with (Group 1) and without (Group 2) portal vein invasion.
 Materials and methods. From 2003 to January 2023 in the Department of Surgery and Liver Transplantation of the Ukrainian National Institute of Surgery and Transplantation, 208 patients with perihilar cholangiocarcinoma underwent major extended liver resections. We compared 93 (46%) patients who received extended liver resection with portal vein resection (Group 1) with 115 (54%) patients who underwent liver resections without vascular reconstructions (Group 2). The average Ca 19–9 in the group 1 was 288 (8 – 1000) U/ml, in the group 2 –262 (10 – 612) U/ml. The level of total bilirubin in patients of the group 1 was 312 (43 – 621) mcmol/l, in the group 2 – 267 (10 – 612) mcmol/l. In view of this, in the preoperative period, 190 (91,3%) patients underwent decompression of the bile ducts, using percutaneous transhepatic cholangiostomy (PTBD) or retrograde endobiliary stenting. For patients with small remnant liver volume less than 40 %, in 80(38,5%) cases we did preoperative PVE of a resected part of the liver. In 9 cases we made simultaneous PVE and PTBD. When choosing the volume of surgical intervention, we proceeded from the tumor type of Bismuth-Corlette classification, invasion into the portal vessels and the depth of the liver lesion. The portal vein reconstruction was in all cases performed in an “end-to-end”. In all cases we made extended lymphadenectomy.
 Results. All complications were classified according to the Dindo-Clavien classification. Postoperative mortality in the main group was 11.5%. The overall 1, 3, 5-year survival in the group 1 was 96%, 68,3%, 57,4%, respectively. 1, 3, 5-year survival rate in the comparison group 2 was 98,4%, 76,7%, 47,3%, respectively.
 Conclusions. Aggressive tactics of surgical treatment of perihilar cholangiocarcinoma provides maximum radicality, allows to increase resectability in case of tumor invasion of the portal vein with acceptable mortality and long-term survival.

Reversal of liver failure using a bioartificial liver device implanted with clinical-grade human-induced hepatocytes

Liver resection is the first-line treatment for primary liver cancers, providing the potential for a cure. However, concerns about post-hepatectomy liver failure (PHLF), a leading cause of death following extended liver resection, have restricted the population of eligible patients. Here, we engineered a clinical-grade bioartificial liver (BAL) device employing human-induced hepatocytes (hiHeps) manufactured under GMP conditions. In a porcine PHLF model, the hiHep-BAL treatment showed a remarkable survival benefit. On top of the supportive function, hiHep-BAL treatment restored functions, specifically ammonia detoxification, of the remnant liver and facilitated liver regeneration. Notably, an investigator-initiated study in seven patients with extended liver resection demonstrated that hiHep-BAL treatment was well tolerated and associated with improved liver function and liver regeneration, meeting the primary outcome of safety and feasibility. These encouraging results warrant further testing of hiHep-BAL for PHLF, the success of which would broaden the population of patients eligible for liver resection.

Aminodihydrophthalazinedione Sodium Transdermal Therapeutic System Specific Activity on an ExperimentalModel of Extensive Liver Resection

Previously, the authors showed that the application of the aminodihydrophthalazinedione sodium (ADPS) immunomodulator transdermal therapeutic system (TTS) to laboratory animals provides bioavailability analogous to the intramuscular administration of this drug at the same dose. At the same time, its maximum blood concentration is significantly reduced, and the retention time of the drug in the body is increased more than 10-fold, which can contribute to prolonging the drug effect. The aim of the work was to identify a possible positive effect of the transdermal administration of the ADPS immunomodulator on reparative liver regeneration on an experimental model of extensive liver resection (ELR). It has been shown that at a period of 48 h after ELR, the percutaneous administration of the immunomodulator has a pronounced stimulating effect on the mitotic activity of rat liver cells; by 72 h after ELR, an accelerated rate of recovery of hepatic homeostasis in the body was observed in laboratory animals in groups with the application of the ADPS TTS versus the control group.

Platelets mediate acute hepatic microcirculatory injury in a protease-activated-receptor-4-dependent manner after extended liver resection

BackgroundSmall-for-size syndrome (SFSS) is a major complication following extended liver resection. The role of platelets in the early development of SFSS remains to be cleared. We aimed to investigate the impact of platelets and PAR-4, a receptor for platelet activation, on the acute phase microcirculatory injury after liver resection by in vivo microscopy analyzing the changes in leukocyte recruitment, platelet-neutrophil interaction, and microthrombosis-induced perfusion failure. MethodsSixty-percent partial hepatectomy (PH) models using C57BL/6 mice receiving platelet depletion with anti-GPIbα, PAR-4 blockade with tcY-NH2, or vehicle treatment with saline were used. Sham-operated animals served as controls. Epifluorescence microscopic analysis was performed 2 h after PH to quantify the leukocyte recruitment and microcirculatory changes. Sinusoidal neutrophil recruitment, platelet-neutrophil interaction, and microthrombosis were evaluated using two-photon microscopy. ICAM-1 expression and liver liver injury were assessed in tissue/blood samples. ResultsThe increments of leukocyte recruitment in post-sinusoidal venules and sinusoidal perfusion failure, the upregulation of ICAM-1 expression, and the deterioration of liver function 2 h after 60% PH were alleviated in the absence of platelets or by PAR-4 blockade. Intensified platelet-neutrophil interaction and microthrombosis in sinusoids were observed 2 h after 60% PH, which significantly attenuated after PAR-4 blockade. ConclusionPlatelets play a critical role in acute liver injury after extended liver resection within 2 h. The deactivation of platelets via PAR-4 blockade ameliorated liver function deterioration by suppressing early leukocyte recruitment, platelet-neutrophil interaction, and microthrombosis in hepatic sinusoids.

Mixed Hepatocellular Cholangiocarcinoma: A Comparison of Survival between Mixed Tumors, Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma from a Single Center.

Hepatocellular carcinoma (HCC) is the most frequent primary liver malignancy, followed by intrahepatic cholangiocarcinoma (ICC). In addition, there is a mixed form for which only limited data are available. The aim of this study was to compare recurrence and survival of the mixed form within the cohorts of patients with HCC and ICC from a single center. Between January 2008 and December 2020, all patients who underwent surgical exploration for ICC, HCC, or mixed hepatocellular cholangiocarcinoma (mHC-CC) were included in this retrospective analysis. The data were analyzed, focusing on preoperative and operative details, histological outcome, and tumor recurrence, as well as overall and recurrence-free survival. A total of 673 surgical explorations were performed, resulting in 202 resections for ICC, 344 for HCC (225 non-cirrhotic HCC, ncHCC; 119 cirrhotic HCC, cHCC), and 14 for mHC-CC. In addition, six patients underwent orthotopic liver transplant (OLT) in the belief of dealing with HCC. In 107 patients, tumors were irresectable (resection rate of 84%). Except for the cHCC group, major or even extended liver resections were required. Vascular or visceral extensions were performed regularly. Overall survival (OS) was highly variable, with a median OS of 17.6 months for ICC, 26 months for mHC-CC, 31.8 months for cHCC, and 37.2 months for ncHCC. Tumor recurrence was common, with a rate of 45% for mHC-CC, 48.9% for ncHCC, 60.4% for ICC, and 67.2% for cHCC. The median recurrence-free survival was 7.3 months for ICC, 14.4 months for cHCC, 16 months for mHC-CC, and 17 months for ncHCC. The patients who underwent OLT for mHC-CC showed a median OS of 57.5 and RFS of 56.5 months. mHC-CC has a comparable course and outcome to ICC. The cholangiocarcinoma component seems to be the dominant one and, therefore, may be responsible for the prognosis. 'Accidental' liver transplant for mHC-CC within the Milan criteria offers a good long-term outcome. This might be an option in countries with no or minor organ shortage.

Upper Transversal Hepatectomy with Two Hepatic Veins Reconstruction: Combining Parenchymal-Sparing Liver Surgery with Transplantation Techniques for Colorectal Liver Metastases

BackgroundColorectal liver metastases (CRLM) involving two or three main hepatic veins pose a surgical challenge. For these lesions, compelled surgical strategies have usually included major and/or extended liver resections according to the two-stage hepatectomy (TSH) strategy. More recently, a one-stage transversal hepatectomy resecting the posterosuperior liver segment (7,8,4 superior) along with one or more hepatic veins has been described, such as showed herein in a didactical video. MethodsThe patient is a 78-year-old woman with two large CRLMs located into segment 2 and into segment 8. Magnetic resonance imaging and computed tomography showed tumour stability after chemotherapy. The lesion of segment 2 is close to the left hepatic vein while the lesion of segment 8 infiltrates the middle (MHV) and the right hepatic veins (RHV). ResultsUnder intermittent pedicular clamping, resection of the segment 7, 8, 4 superior along with the right and middle hepatic veins is performed. Reconstruction of the veins was performed with 2 cryopreserved autologous saphenous grafts. Postoperative course was uneventful and postoperative CT scan showed patency of the two venous graft reconstructions. ConclusionsSurgery for CRLM has evolved over the last two decades shifting from large anatomical resections to parenchymal-sparing resections. Sparing liver parenchyma allows surgical radicality while reducing the risk of liver failure and allowing repeated liver resection. Associating vascular reconstruction to parenchymal-sparing surgery reduces the risk of venous congestion of the spared liver parenchyma.

Use of hepatocyte transplantation after extensive liver resections in experiment.

he aim of our research is to prove, that the transplanted hepatocytes can survive and compensate for inadequate liver function in experimental animals. Thesis discusses the basic principles of hepatocyte transplantations, the process of their adaptation and effect on the organism as well as possibilities of their further use as apromising treatment method.In the experiment we used hepatocytes isolated and produced from explanted livers of laboratory rats. Hepatocytes form the basis of liver tissue and are responsible for anumber of metabolic processes ocurring in the liver, therefore is the possibility of their use as acell therapy one of the alternative treatment methods for liver failure.Into the laboratory experiment, rats of the Sprague Dawleyspecies were placed, which we divided into five groups of equal numbers. Groups consisted of healthy rats, rats after 2/3 liver resection and rats with liver damage induced by intraperitoneal administration of thioacetamide.Two groups with impaired liver had hepatocytes prepared in advance transplanted into their portal vein.Hepatocyte function was assessed in the blood serum and compared with acontrol group of healthy animals and groups with liver damage without the application of hepatocytes at the same time intervals.Whole experiment lasted 21 days. On the last day of the experiment all the animals were killed by decapitation.Livers of all animals were explanted and sent for histopathological analysis which used classical histological methods. After evaluating the results we observed significant changes of evaluated laboratory levels in blood serum and weight in experimental animals after the transplantation of hepatocytes in comparison with the laboratory results of the control group of healthy animals and groups with liver damage without transplanted hepatocytes. The results of our experiment show that by biochemical and histological analysis we managed to clearly prove the function of transplanted hepatocytes in the model of laboratory rat with impaired liver function (Tab. 5, Fig. 17 , Ref. 17) Keywords: liver, transplantation, hepatocytes, liver tumors, resection of liver, liver failure, experiment.

Serine proteases mediate leukocyte recruitment and hepatic microvascular injury in the acute phase following extended hepatectomy.

Post-hepatectomy liver failure (PHLF) is the main limitation of extended liver resection. The molecular mechanism and the role of leukocytes in the development of PHLF remain to be unveiled. We aimed to address the impact of serine proteases (SPs) on the acute phase after liver resection by intravitally analyzing leukocyte recruitment and changes in hemodynamics and microcirculation of the liver. C57BL/6 mice undergoing 60% partial hepatectomy were treated with aprotinin (broad-spectrum SP inhibitor), tranexamic acid (plasmin inhibitor), or vehicle. Sham-operated animals served as controls. In vivo fluorescence microscopy was used to quantify leukocyte-endothelial interactions immediately after, as well as 120 min after partial hepatectomy in postsinusoidal venules, along with measurement of sinusoidal perfusion rate and postsinusoidal shear rate. Recruitment of leukocytes, neutrophils, T cells, and parameters of liver injury were assessed in tissue/blood samples. Leukocyte recruitment, sinusoidal perfusion failure rate, and shear rate were significantly increased in mice after 60% partial hepatectomy compared to sham-operated animals. The inhibition of SPs or plasmin significantly attenuated leukocyte recruitment and improved the perfusion rate in the remnant liver. ICAM-1 expression and neutrophil recruitment significantly increased after 60% partial hepatectomy and were strongly reduced by plasmin inhibition. Endothelial activation and leukocyte recruitment in the liver in response to the increment of sinusoidal shear rate were hallmarks in the acute phase after liver resection. SPs mediated leukocyte recruitment and contributed to the impairment of sinusoidal perfusion in an ICAM-1-dependent manner in the acute phase after liver resection.

The Effectiveness of Surgical Techniques in Performing Extensive Liver Resections for Echinococcosis

The Effectiveness of Surgical Techniques in Performing Extensive Liver Resections for Echinococcosis

Биоимпедансный анализ селезенки после обширной резекции печени в эксперименте

Введение. Пострезекционная печеночная недостаточность является наиболее серьезным осложнением обширных резекций печени. Одним из направлений поиска диагностических и прогностических критериев тяжести печеночной недостаточности может стать исследование влияния обширной резекции печени на морфофункциональное состояние селезенки. цель исследования - оценка показателей полного электрического сопротивления селезенки в условиях обширной резекции печени. методика. Исследование выполнено на 20 белых крысах Вистар массой 180-230 г. Обширную резекцию печени (ОРП) моделировали путем удаления 70% органа. До операции, непосредственно сразу после ОРП, а также на 3-и и 14-е сут после нее выполняли инвазивную биоимпедансометрию печени и селезенки. Селезенка подвергалась гистологическому исследованию. результаты. Сразу после обширной резекции печени показатели электрического импеданса печени и селезенки статистически значимо уменьшались на частоте 2 кГц по сравнению с исходными значениями. На 3-и сут после оперативного вмешательства электрический импеданс паренхимы печени на частоте измерения 2 кГц достигал максимальных за весь период наблюдения значений, при этом импеданс паренхимы селезенки не увеличивался по сравнению с показателем до проведения обширной резекции печени. На 14-е сут наблюдения электрический импеданс паренхимы печени статистически значимо снижался относительно значений, полученных на 3-сут, и соответствовал показателям до обширной резекции печени. Импеданс селезенки был статистически значимо меньше значений до операции. По данным гистологического исследования на 14-е сут после операции наблюдались признаки малокровия красной пульпы и обеднения белой пульпы. Заключение. В условиях изменения внутриорганного кровотока сразу после проведения обширной резекции печени регистрировалось снижение значений импеданса селезенки. На 14-е сут после операции наблюдалось снижение показателей импеданса селезенки на фоне малокровия красной пульпы и обеднения белой пульпы, по данным гистологического исследования. Background. Post-resection liver failure is considered the most serious complication of extended liver resections. One of possible directions in the search for diagnostic and prognostic criteria of liver failure severity is studying the effect of extended liver resection on morphology and function of the spleen.aim. To evaluate parameters of full electrical resistance of the spleen following extended liver resection.materials and methods. The study was performed on 20 Wistar rats weighing 180-230 g. Extended liver resection was modeled by removing 70% of the organ. Prior to the surgery, immediately after the surgery, and on postoperative days 3 and 14, invasive bioimpedancemetry of the liver and spleen was performed.results. Following extended liver resection, biophysical parameters of the liver and spleen parenchyma were characterized by a significant decrease in the impedance at a frequency of 2 kHz compared to normal background values obtained immediately after the removal of a part of the liver. On the 3rd day after surgery, the liver parenchyma impedance at a measurement frequency of 2 kHz reached a maximum for the entire observation period while the spleen parenchyma impedance did not increase compared to the respective values before extensive liver resection. On the 14th day of follow-up, the liver parenchyma impedance was significantly decreased compared to the values obtained on the 3rd day and corresponded to the preoperative values. The spleen impedance was significantly lower than the preoperative values. Histological study performed on the 14th postoperative day showed signs of depletion of the red and white pulp.conclusions. The decrease in the spleen impedance observed immediately after extended liver resection was associated with intensified parenchymal blood flow. The decrease in the spleen impedance observed on the 14th day was associated with depletion of the red and white pulp as shown by histological examination.

HPB P68 Multimetric MRI detects improved quality of the future liver remnant post-dual vein embolization – a novel finding

Abstract Background Optimisation of the future liver remnant (FLR) is crucial to the safety of extended liver resections. This study aimed to assess volume and quality of the FLR pre- and post-dual vein embolisation (DVE) by MRI, in patients with insufficient FLR, needing major hepatectomy. Methods Of 81 patients recruited in a clinical trial (Precision1:NCT04597710), seven consecutive patients with colorectal liver metastases underwent multiparametric MRI (Hepatica®) pre- and post-DVE (right hepatic and portal vein). One patient had DVE after a first-stage hepatectomy. FLR volume, fibro-inflammation map (corrected T1) and fat (proton density fat fraction, PDFF) was determined. Results All 7 patients underwent uncomplicated DVE, with significant increase in median(range) %FLR volume at liver surgery [45.7(27.0–57.8)% versus 32.4 (19.5–37.7)%, p=0.016], 46 days (range 28–77) post-DVE. Median(range) FLR cT1 scores reduced post-DVE [747.33 (684–884)ms, versus 771.25(726–945)ms, p=0.047; healthy range<794ms], as did median(range) PDFF scores [3.4 (2–13.25)% versus 6 (1.5–22.5)%, p=0.078; healthy range <5.6%]. No patient developed post-hepatectomy liver failure (PHLF). Conclusions This novel, non-invasive and readily accessible MRI technique shows that volume and quality of the FLR improves after DVE. This is a significant step in improving surgical decision making in patients with borderline FLR, preventing PHLF and improving outcomes.

Assessment of the liver microcirculation by laserdoppler flowmetry after extended liver resection in the experiment

Purpose. To assess microcirculation and mechanisms of its regulation in the liver after its extended resection.Materials and methods. 10 Wistar rats of both sexes weighing 180–270 g which had median laparotomy under general anesthesia were taken in the trial. Microcirculation in the liver of rats was assessed with LAKK-02 Laser-Doppler flowmeter (Russia). A light guide for determining microcirculation was placed on the visceral surface of the right liver lobe; parameters of Laser-Doppler flowmetry (LDF-gram) were registered for 7 min. Then, ligatures were sequentially applied to the left lateral and median lobes of the liver followed by their cutting off; then, about 70 % of the organ were removed. After removal of both liver lobes, LDF-gram was recorded again for 7 minutes with a sensor placed on the visceral surface of the right liver lobe. Basic microcirculation parameters were registered before and after extended liver resection.Results. After the extended liver resection, average arithmetic parameters of microcirculation in the liver parenchyma decreased by 11.71 % (p < 0.05), which indicates the decrease in the microvasculature perfusion. At the same time, indicators of standard deviation of the microcirculation index and the coefficient of variation did not change statistically significantly. The median maximum amplitude of neurogenic oscillations after the resection increased by 2.3 points (p < 0.05). The amplitude of myogenic oscillations also increased after resection (p < 0.05); however, the degree of increase was less than that of the neurogenic rhythms. It was found that in 70 % of animals the maximum amplitude of endothelial oscillations increased in the liver microcirculation after the extended resection; however, in general, differences between the average endothelial oscillations before and after the resection were not statistically significant.Conclusion. In the experimental liver resection, the most informative and reliable LDF criteria on ischemia development in the liver stump were average arithmetic microcirculation indices as well as the amplitude of neurogenic and myogenic oscillations. The authors emphasize that the degree of changes in these indices may be a sign of ischemia severity in the liver stump after its resection and may have a prognostic value, although the results obtained require further research.

Biophysical parameters of the greater omentum after experimental extended liver resection

Bioimpedance parameters of the large omentum after performing extensive liver resection in an experiment were evaluated. The study was performed on 20 Wistar rats that underwent median laparotomy under anesthesia, followed by liver resection with the removal of 70% of the organ. Invasive bioimpedance measurement of the liver and large omentum was performed before and immediately after extensive liver resection on days 3 and 14 after surgery using an original device for measuring the electrical impedance of biological tissues BIM-II at frequencies of 2 and 20 kHz with the calculation of the average impedance values at each frequency and measurement zone. Liver tissue was subjected to histological examination. The minimum values of the impedance of the large omentum were recorded on day 3 after extensive liver resection. By day 14, in both zones of the large omentum, the electrical impedance increased relative to day 3 of the postoperative period and did not differ significantly from the indicators before extensive liver resection. Immediately after extensive liver resection, the bioimpedance index in all animals decreased significantly at a frequency of 2 kHz. On day 3 after surgery, the electrical impedance of the liver parenchyma at a frequency of 2 kHz increased significantly. On day 14, the electrical impedance of the liver parenchyma did not differ from the indicators before extensive resection at frequencies of 2 and 20 kHz. A strong significant correlation was found between the electrical impedance of the large omentum and liver parenchyma. At a frequency of 2 kHz, the correlation coefficient of the liver parenchyma and the proximal part of the large omentum was 0.82 and that of the distal part was 0.87 (p 0.05). A strong correlation was detected at a frequency of 20 kHz, with r = 0.93 and 0.74, respectively, in both parts of the gland. Thus, the electrical impedance of the liver parenchyma by day 3 of the experiment increased compared with values before extensive liver resection, whereas the large omentum decreased. We believe that studying the dynamics of the electrical impedance of the large omentum after extensive liver resection is promising in the development of diagnostic criteria for the severity of liver failure.

Central Hepatectomy for Hepatocellular Carcinoma in a Non-Cirrhotic Liver: Case Report and Literature Review

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver. HCC usually develops in cirrhotic liver but cases arising in a healthy liver are rare and its etiology remains uncertain. The treatment of choice of hepatocellular carcinoma is surgical resection. Centrally located liver tumors were traditionally treated by extensive liver resection. With recent improvements in surgical techniques, centrally hepatectomy became an alternative approach for parenchymal preservation. We report here, the case of a 68-year-old male patient with an incidental finding of a 9 cm hepatic mass in segment IV of a non-cirrhotic liver found to be a hepatocellular carcinoma successfully treated by central hepatectomy. Although technically challenging, improvements in the understanding of liver structure, based on functional segmental anatomy, together with advances in imaging technology have contributed to the development of segment-oriented liver surgery making central hepatectomy an acceptable procedure for centrally located malignancies and allowing parenchyma preservation.

Selective gene expression profiling contributes to a better understanding of the molecular pathways underlying the histological changes observed after RHMVL

BackgroundIn previous studies, five vasoactive drugs were investigated for their effect on the recovery process after extended liver resection without observing relevant improvements. We hypothesized that an analysis of gene expression could help to identify potentially druggable pathways and could support the selection of promising drug candidates.MethodsLiver samples obtained from rats after combined 70% partial hepatectomy and right median hepatic vein ligation (n = 6/group) sacrificed at 0 h, 24 h, 48 h, and 7days were selected for this study. Liver samples were collected from differentially perfused regions of the median lobe (obstruction-zone, border-zone, normal-zone). Gene expression profiling of marker genes regulating hepatic hemodynamics, vascular remodeling, and liver regeneration was performed with microfluidic chips. We used 3 technical replicates from each sample. Raw data were normalized using LEMming and differentially expressed genes were identified using LIMMA.ResultsThe strongest differences were found in obstruction-zone at 24 h and 48 h postoperatively compared to all other groups. mRNA expression of marker genes from hepatic hemodynamics pathways (iNOS,Ptgs2,Edn1) was most upregulated.ConclusionThese upregulated genes suggest a strong vasoconstrictive effect promoting arterial hypoperfusion in the obstruction-zone. Reducing iNOS expression using selective iNOS inhibitors seems to be a promising approach to promote vasodilation and liver regeneration.