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Functional assessment of liver regeneration after major hepatectomy

Hepatobiliary Surgery and Nutrition 2022年第4期11卷 530-538页

作者： Fadi Rassam Pim B.Olthof Bart Takkenberg Marc G.Besselink Olivier R.Busch Joris I.Erdmann Rutger-Jan Swijnenburg krijn pvan lienden Ulrich H.Beuers Roelof J.Bennink Thomas Mvan Gulik Department of Surgery Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamThe Netherlands Department of Gastroenterology&Hepatology Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands Departments of Radiology and Nuclear Medicine Cancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands

Background: Liver regeneration is crucial to restore the functional liver mass after liver resection. The aim of this study was to evaluate the early postoperative changes in remnant liver function, volume and liver stiffness after major liver resection and their correlation with postoperative outcomes. Methods: Patients undergoing major liver resection (≥3 segments) between February and November 2018 underwent both functional assessment using technetium-99m mebrofenin hepatobiliary scintigraphy (HBS) and CT-volumetry of the (future) remnant liver on preoperative day 1, the 5th postoperative day, and 4-6 weeks after resection. At the same time points, patients underwent transient elastography (TE) for the assessment of liver stiffness. Severe postoperative complications (Clavien-Dindo ≥ 3A) and mortality were correlated with the functional and volumetric increases of the remnant liver. Liver failure was graded according to the International Study Group of Liver Surgery (ISGLS) criteria. Results: A total of 18 patients were included of whom 10 (56%) had severe complications and one patient (5%) developed liver failure. Function and volume of the remnant liver had increased by the 5th postoperative day from 6.9 (5.4-10.9) to 9.6 (6.7-13.8) %/min/m2, P=0.004 and from 795.5 (538.3-1,037.5) to 1,080.0 (854.0-1,283.3) mL, P<0.001, respectively. After 4-6 weeks, remnant liver volume had further increased [from 1,080.0 (854.0-1,283.3) to 1,222.0 (1,016.0-1,380.5) mL, P=0.035], however, liver function did not show any significant, further increase [from 9.6 (6.7-13.8) to 10.9 (8.8-13.6) %/min/m2, P=0.177]. Liver elasticity of the future remnant liver (FRL) increased [from 10.8 (5.7-18.7) to 17.5 (12.4-22.6) kPa, P=0.018] and gradually recovered after 4-6 weeks to a median of 10.9 (5.7-18.8) kPa (T3 vs. T4, P=0.079). Patients who had severe postoperative complications did not show a significant increase in liver function on the 5th postoperative day (P=0.203), despite increas

关键词： Hepatobiliary scintigraphy(HBS) liver resection liver regeneration posthepatectomy liver failure liver function test

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Effect of hepatic artery embolization on liver hypertrophy response in a rabbit liver VX2tumor model

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Hepatobiliary & Pancreatic Diseases International 2013年第6期12卷 622-629页

作者： krijn P van lienden Lisette T Hoekstra Jessica D van Trigt Joris J Roelofs Otto M van Delden Thomas M van Gulik Department of RadiologyAcademic Medical Center University of Amsterdam Department of Surgery (Surgical Laboratory)Academic Medical Center University of Amsterdam Department of PathologyAcademic Medical Center University of Amsterdam

BACKGROUND:Portal vein embolization not only induces hypertrophy of the non-embolized liver,but also enhances tumor *** latter could be prevented by embolizing the hepatic arteries supplying the tumor-bearing liver *** study aimed to determine the effects of transcatheter arterial embolization(TAE)on tumor volume and liver regeneration in a rabbit VX2 tumor ***:Twenty-three rabbits underwent subcapsular tumor implantation with a VX2 *** weeks after implantation,18 rabbits were used for TAE experiments,5were for sham *** response and liver regeneration response of the embolized cranial and non-embolized caudal liver lobes were assessed by CT volumetry,liver to body weight index,and the amount of proliferating ***:All super-selective arterial tumor embolization procedures were performed *** embolization,the tumor volume increased after an initial steady *** tumor volume after embolization was smaller than that of the sham group,but this difference was not *** necrosis of the tumor,however,was seen after embolization,without damage of the surrounding liver *** was a significant atrophy response of the tumor bearing cranial lobe after super-selective arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized,caudal *** regeneration response was confirmed histologically by a significantly higher number of proliferating hepatocytes on the Ki-67 stained ***:Super-selective,bland arterial coil embolization causes massive necrosis of the tumor,despite increase of volume on CT *** of the tumor bearing liver lobe is seen after arterial embolization of the tumor with a concomitant hypertrophy response of the non-embolized lobe,despite absence of histological damage of the tumor-surrounding liver parenchyma.

关键词： hypertrophy liver regeneration animal model transarterial embolization hepatic artery

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