Improved hepatocyte function of future liver remnant of cirrhotic rats after portal vein ligation: A bonus other than volume shifting

Surgery ◽  
2009 ◽  
Vol 145 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Kun-Ju Lin ◽  
Chien-Hung Liao ◽  
Ing-Tsung Hsiao ◽  
Tzu-Chen Yen ◽  
Tse-Ching Chen ◽  
...  
Keyword(s):  
Portal Vein ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant

scholarly journals Folinic Acid Potentiates the Liver Regeneration Process after Selective Portal Vein Ligation in Rats

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 371
Author(s):  
Jorge Gutiérrez Sáenz de Santa María ◽  
Borja Herrero de la Parte ◽  
Gaizka Gutiérrez-Sánchez ◽  
Inmaculada Ruiz Montesinos ◽  
Sira Iturrizaga Correcher ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Liver Regeneration ◽  
Folinic Acid ◽  
Hepatic Metastases ◽  
Future Liver Remnant ◽  
Control Group ◽  
Portal Vein Ligation ◽  
Nuclear Area ◽  
Liver Remnant

Liver resection remains the gold standard for hepatic metastases. The future liver remnant (FLR) and its functional status are two key points to consider before performing major liver resections, since patients with less than 25% FLR or a Child–Pugh B or C grade are not eligible for this procedure. Folinic acid (FA) is an essential agent in cell replication processes. Herein, we analyze the effect of FA as an enhancer of liver regeneration after selective portal vein ligation (PVL). Sixty-four male WAG/RijHsd rats were randomly distributed into eight groups: a control group and seven subjected to 50% PVL, by ligation of left portal branch. The treated animals received FA (2.5 m/kg), while the rest were given saline. After 36 h, 3 days or 7 days, liver tissue and blood samples were obtained. FA slightly but significantly increased FLR percentage (FLR%) on the 7th day (91.88 ± 0.61%) compared to control or saline-treated groups (86.72 ± 2.5 vs. 87 ± 3.33%; p < 0.01). The hepatocyte nuclear area was also increased both at 36 h and 7days with FA (61.55 ± 16.09 µm2, and 49.91 ± 15.38 µm2; p < 0.001). Finally, FA also improved liver function. In conclusion, FA has boosted liver regeneration assessed by FLR%, nuclear area size and restoration of liver function after PVL.

Portal vein ligation with alcohol injection – our first experiences

2019 ◽  
Vol 98 (9) ◽  
pp. 379-384
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Absolute Alcohol ◽  
Alcohol Injection ◽  
Liver Remnant ◽  
Second Stage ◽  
Right Hemihepatectomy

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

scholarly journals Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections

2020 ◽  
pp. 1-8
Author(s):  
Yuzo Yamamoto
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Volume Ratio ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Portal Vein Ligation ◽  
Liver Remnant

<b><i>Background:</i></b> Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. <b><i>Summary:</i></b> FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, <sup>99m</sup>Tc-labeled galactosyl human serum albumin (<sup>99m</sup>Tc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either <sup>99m</sup>Tc-GSA or <sup>99m</sup>Tc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. <b><i>Key Messages:</i></b> Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.

scholarly journals Additional partial hepatectomy at the time of portal vein ligation accelerates the regeneration of the future liver remnant

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chuanfeng Hua ◽  
Weiwei Wei ◽  
Tianjiao Zhang ◽  
Fengming Xu ◽  
Olaf Dirsch ◽  
...  
Keyword(s):  
Portal Vein ◽  
Mrna Expression ◽  
Future Liver Remnant ◽  
Hepatocyte Proliferation ◽  
Nuclear Antigen ◽  
Proliferation Index ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
The Future ◽  
Additional Resection

AbstractPortal vein ligation (PVL) has been adopted to induce hypertrophy of the future liver remnant (FLR) in patients with primarily irresectable liver tumor. However, regeneration of the FLR is not always sufficient to allow curative resection of the portally-deprived tumor-bearing liver lobe. We hypothesize that simultaneous hepatectomy (PHx) and PVL augments regeneration of the FLR and that the effect is related to the extent of the additional resection. Seventy-two Lewis rats were enrolled into 3 groups: 20%PVL + 70%PHx; 70%PVL + 20%PHx; 90%PVL. Animals were observed for 1, 2, 3 and 7 days postoperatively (n = 6/time point). Liver enzymes, caudate liver/body-weight-ratio, BrdU-proliferation-index (PI), proliferating-cell-nuclear-antigen (PCNA)-mRNA-expression level and autophagy-related-proteins were evaluated. Compared with 90% PVL, additional PHx induced significantly more hypertrophy during the observation time, which was confirmed by significantly higher PI and higher level of PCNA-mRNA expression. Similarly, the additional PHx induced more autophagy in the FLR compared with PVL alone. However, both effects were not clearly related to the extent of additional resection. Additional resection augmented liver regeneration and autophagy substantially compared with PVL alone. Therefore, we concluded that autophagy might play a critical role in regulating hepatocyte proliferation and the size of the FLR after simultaneous PVL + PHx.

scholarly journals Advances in the conventional clinical treatment for hepatoblastoma and therapeutic innovation

2021 ◽  
Vol 4 (3) ◽  
pp. e000220
Author(s):  
Zhixue Chen ◽  
Rui Dong
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Portal Vein ◽  
Molecular Mechanisms ◽  
Liver Tumors ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
New Treatments

BackgroundHepatoblastoma (HB) is a rare malignancy usually occurring in children under 3 years old. With advancements in surgical techniques and molecular biology, new treatments have been developed.Data resourcesThe recent literatures on new treatments, molecular mechanisms and clinical trials for HB were searched and reviewed.ResultsSurgical resection remains the main option for treatment of HB. Although complete resection is recommended, a resection with microscopical positive margins (R1) may have similar 5-year overall survival and 5-year event-free survival (EFS) rates after cisplatin chemotherapy and the control of metastasis, as only once described so far. Indocyanine green-guided surgery can help achieve precise resection. Additionally, associating liver partition and portal vein ligation for staged hepatectomy can rapidly increase future liver remnant volume compared with portal vein ligation or embolization. Cisplatin-containing chemotherapies slightly differ among the guidelines from the International Childhood Liver Tumors Strategy Group (SIOPEL), Children’s Oncology Group (COG) and Chinese Anti-Cancer Association Pediatric Committee (CCCG), and the 3-year EFS rate of patients in SIOPEL and CCCG studies was recently shown to be higher than that in COG studies. Liver transplantation is an option for patients with unresectable HB, and successful cases of autologous liver transplantation have been reported. In addition, effective inhibitors of important targets, such as the mTOR (mammalian target of rapamycin) inhibitor rapamycin, β-catenin inhibitor celecoxib and EpCAM (epithelial cell adhesion molecule) inhibitor catumaxomab, have been demonstrated to reduce the activity of HB cells and to control metastasis in experimental research and clinical trials.ConclusionThese advances in surgical and medical treatment provide better outcomes for children with HB, and identifying novel targets may lead to the development of future targeted therapies and immunotherapies.

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