scholarly journals Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

2017 ◽  
Vol 313 (4) ◽  
pp. G313-G319 ◽  
Author(s):  
Mohammad Golriz ◽  
Sepehr Abbasi ◽  
Parham Fathi ◽  
Ali Majlesara ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Artery ◽  
Base Excess ◽  
Jugular Vein ◽  
Liver Volume ◽  
Remnant Liver ◽  
Extended Hepatectomy ◽  
Acid Base ◽  
Jugular Veins ◽  
Small For Size

Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco2 values increased after 75% resection in the jugular vein. In contrast, arterial Po2 increased after every resection, whereas the venous Po2 decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco2 in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation. NEW & NOTEWORTHY This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.

Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

2018 ◽  
Vol 56 (01) ◽  
pp. E2-E89
Author(s):  
S Abbasi ◽  
M Golriz ◽  
P Fathi ◽  
A Majlesara ◽  
T Brenner ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Volume ◽  
Remnant Liver ◽  
Acid Base ◽  
Base Equilibrium ◽  
Remnant Liver Volume ◽  
Acid Base Equilibrium

scholarly journals Establishing a Porcine Model of Small for Size Syndrome following Liver Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mohammad Golriz ◽  
Maryam Ashrafi ◽  
Elias Khajeh ◽  
Ali Majlesara ◽  
Christa Flechtenmacher ◽  
...  
Keyword(s):  
Liver Resection ◽  
Porcine Model ◽  
Clinical Laboratory ◽  
Liver Volume ◽  
International Normalized Ratio ◽  
Remnant Liver ◽  
Extended Liver Resection ◽  
Group A ◽  
Group B ◽  
Small For Size

Background. Small for size syndrome (SFSS) is responsible for a high proportion of mortalities and morbidities following extended liver resection. Aim. The aim of this study was to establish a porcine model of SFSS. Methods. Twenty-four Landrace pigs underwent liver resection with a remnant liver volume of 50% (group A, n=8), 25% (group B, n=8), and 15% (group C, n=8). After resection, the animals were followed up for 8 days and clinical, laboratory, and histopathological outcomes were evaluated. Results. The survival rate was significantly lower in group C compared with the other groups (p<0.001). The international normalized ratio, bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase levels increased shortly after surgery in groups B and C, but no change was observed in group A (p<0.05 for all analyses). The histopathological findings in group A were mainly mild mitoses, in group B severe mitoses and hepatocyte ballooning, moderate congestion, and hemorrhage, along with mild necrosis, and in group C extended tissue damage with severe necrosis, hemorrhage, and congestion. Conclusions. Combination of clinical, laboratory, and histopathological evaluations is needed to confirm the diagnosis of SFSS. 75% liver resection in porcine model results in SFSS. 85% liver resection causes irreversible liver failure.

scholarly journals Increasing the remnant liver volume using portal vein embolization

2010 ◽  
Vol 4 (5) ◽  
pp. 817-820
Author(s):  
Thanis Saksirinukul ◽  
Permyot Kosolbhand ◽  
Natthaporn Tanpowpong
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Major Hepatectomy ◽  
Liver Volume ◽  
Measurement Methods ◽  
Remnant Liver ◽  
Extended Hepatectomy ◽  
Volumetric Measurement ◽  
Common Procedure ◽  
Total Liver Volume

Abstract Background: Portal vein embolization (PVE) is a common procedure to induce hypertrophy of the remnant liver (RL) before major hepatectomy. Objective: Evaluate increased RL volume after PVE based on CT volumetric measurement. Methods: Multi-detector computed tomography (MDCT) was used to measure hepatic volumetric measurement, including total liver volume and RL volumes of pre- and post-PVE. Complications were recorded from PVE and from three-month after post-extended hepatectomy liver dysfunction. Result and conclusion: There was a 10% increase in RL volume. Mean days between CT and PVE were 20 days. No major complications from PVE were observed.

scholarly journals Preoperative Chemotherapy on Functional Liver Regeneration for Colorectal Liver Metastases Assessed With 99mTc-GSA SPECT/CT Imaging

2018 ◽  
Vol 102 (9-10) ◽  
pp. 431-439 ◽  
Author(s):  
Toru Beppu ◽  
Hiromitsu Hayashi ◽  
Morikatsu Yoshida ◽  
Hidetoshi Nitta ◽  
Katsunori Imai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Liver Regeneration ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Liver Volume ◽  
Control Group ◽  
Remnant Liver ◽  
Resection Rate

Objective: To investigate the functional liver regeneration after chemotherapy and liver resection for colorectal liver metastases (CRLM). Background/Purpose: Preoperative chemotherapy followed by liver resection for CRLM has been increasing; however, its negative impact on liver regeneration remains unknown. Methods: From January 2009 to December 2013, we enrolled 40 selected patients who underwent major hepatectomy without viral hepatitis and severe liver fibrosis. CRLM patients with preoperative chemotherapy (CT-CRLM group, n = 12) and patients without preoperative chemotherapy (control group, n = 28) were evaluated. Liver volume (LV) and functional liver volume (FLV) was assessed using Tc-99m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, single-photon emission computed tomography (SPECT), CT-fused images. Preoperative, future remnant liver, and post 1-month values were compared. Results: Median course of preoperative chemotherapy was 8 (range: 6–16). Preoperative background factors were almost identical including resection rate and functional resection rate. In the CT-CRLM group and in the control group, the percentage increases in LV were 39.3% ± 29.0% and 23.2% ± 23.5% (P = 0.037), and FLV were 79.4% ± 43.1% and 57.0% ± 33.4% (P = 0.417), respectively; absolute differences in LV were 216.2 ± 155.7 cm3 and 148.7 ± 134.7 cm3 (P = 0.086) and FLV were 19.4% ± 8.5%/m2 and 17.4% ± 7.9%/m2 (P = 0.235), respectively. We found no obvious tendency for negative influence on liver functional regeneration by the preoperative regimens for CRLM. Conclusions: Several courses of preoperative chemotherapy may not affect functional liver regeneration for CRLM patients after major hepatectomy.

Triggered Liver Regeneration: From Experimental Model to Clinical Implications

2015 ◽  
Vol 54 (3-4) ◽  
pp. 148-161 ◽  
Author(s):  
Attila Szijártó ◽  
András Fülöp
Keyword(s):  
Liver Resection ◽  
Surgical Technique ◽  
Liver Regeneration ◽  
Molecular Mechanisms ◽  
Liver Tumors ◽  
Therapeutic Option ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Comprehensive Overview

Background: Major liver resection is the only therapeutic option for patients with malignant liver tumors. However, extended hepatectomy often leads to postoperative liver failure, mainly due to insufficient amounts of the remnant liver. Recently, selective portal vein occlusion (PVO) has been introduced to increase the remnant liver volume. This novel surgical technique initiated a progressive development in liver surgery, resulting in a significant increment in potential candidates for curative liver resection. Summary: The theoretical basis for this great advancement is formed by an understanding of the mechanisms of PVO-induced liver regeneration, mainly obtained from animal studies. The aim of this review is to give a comprehensive overview of the relevant animal models of PVO and to discuss the main characteristics of triggered liver regeneration, including the induced hemodynamic, morphological and functional alterations as well as the underlying molecular mechanisms, which might be of interest in both the laboratory and the clinic. Key Messages: Although basic research revealed the main characteristics of PVO-triggered liver regeneration within the last decades, several important issues regarding the regenerative process remain uncertain. To answer these open questions, additional well-designed animal experiments are needed in the future, which allow further refinement of this surgical technique.

scholarly journals The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Khai Viet Ninh ◽  
Nghia Quang Nguyen ◽  
Son Hong Trinh ◽  
Anh Gia Pham ◽  
Thi-Ngoc-Ha Doan
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Anterior Approach ◽  
Liver Volume ◽  
Operation Time ◽  
Vascular Occlusion ◽  
Remnant Liver ◽  
Term Survival ◽  
Average Hospital ◽  
Hepatic Pedicle

Background. Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). Objectives. In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. Methods. We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in 52.6 ± 33 months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm3) to body   weight   kg > 0.8 % (for right hepatectomy). Perioperative parameters were collected and analyzed. Results. The average operation time was 196.2 ± 62.2 minutes, and blood loss was 261.4 ± 202.9  ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was 11.4 ± 3.7 days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. Conclusion. SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.

Does conversion chemotherapy really improve survival in patients with colorectal liver metastases?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 435-435
Author(s):  
Kozo Kataoka ◽  
Akiyoshi Kanazawa ◽  
Shigeyoshi Iwamoto ◽  
Yasuhiro Miyake ◽  
Takeshi Kato ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Colorectal Liver Metastases ◽  
Liver Volume ◽  
Hepatic Metastases ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Remnant Liver ◽  
Unresectable Colorectal Liver Metastases

435 Background: Recently, liver resection becomes possible by intensive chemotherapy, i.e. conversion chemotherapy, in patients with initially unresectable colorectal liver metastases (CLM). But the criteria for non-resectability varies one team to another, and there are few reports about the clinical benefit of conversion chemotherapy followed by liver resection. Methods: Our criteria for resectability of CLM depends on the size of remnant liver volume (>30%) and expected function after the removal of all metastases, regardress of number and size of CLM. From December 2007 to September 2011, 113 patients were diagnosed as CLM without extra-hepatic metastases and received chemotherapy. 47 patients were initially diagnosed as resectable and received hepatic resection after chemotherapy (resected group). 66 patients were initially diagnosed as unresectable, but 11 patients become resectable after chemotherapy (conversion group) and 55 patients remain unresectable in spite of chemotherapy (unresecetd group). We assessed the survival benefit between these 3 groups, retrospectively. Results: 110 patients received oxaliplatin-based regimen and 3 irrinotecan-based regimen. In coversion group, 8 patients received cetuximab containing regimen and 2 received bevacizumab containing regimen. 46 of 47 patients in resected group received R0 resection and 7 of 11 patients in conversion group. No serious postoperative complications were observed in resected and conversion group, but the incidence of a surgical site infection in conversion group was somewhat higher than in resected group. Median disease-free survival was significantly higher in the resected group than conversion group (16.73 months [95% CI: 7.80~25.47] and 3.83 months [95% CI: 0.35~7.31 months]) (P=0.031). And median overall survival (OS) was also higher in resected group, but not significant. In resected and conversion group, median OS was significantly higher than in unresected group. (52.20 vs 39.37 vs 20.57 months (p <0.001)). Conclusions: The recurrence rate was higher in coversion group, but conversion chemotherapy followed by hepatic resection seems to be promising and feasible strategy in initially unresectable CLM patients.

Liver Function Following Extended Hepatectomy Can Be Accurately Predicted Using Remnant Liver Volume to Body Weight Ratio

2015 ◽  
Vol 39 (5) ◽  
pp. 1193-1201 ◽  
Author(s):  
Stéphanie Truant ◽  
Emmanuel Boleslawski ◽  
Géraldine Sergent ◽  
Emmanuelle Leteurtre ◽  
Alain Duhamel ◽  
...  
Keyword(s):  
Body Weight ◽  
Liver Function ◽  
Liver Volume ◽  
Weight Ratio ◽  
Remnant Liver ◽  
Extended Hepatectomy ◽  
Body Weight Ratio ◽  
Remnant Liver Volume

scholarly journals Two-stage liver resection for intrahepatic cholangiocarcinoma

2020 ◽  
Vol 25 (1) ◽  
pp. 106-112
Author(s):  
A. V. Chzhao ◽  
B. N. Gurmikov ◽  
V. A. Vishnevsky ◽  
A. A. Olifir ◽  
Ya. Ya. Gavrilov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Volume ◽  
Liver Parenchyma ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Alternative Version ◽  
The Right ◽  
Cholangiocellular Cancer

The small remnant liver volume remains an urgent problem in liver resection surgery. The use of the method of twostage liver resection – the Associated Liver Partition and Portal vein ligation for Staged hepatectomy in most cases allows to solve this problem. However, this method is associated with a number of complications and limitations. The presented clinical observation shows the effectiveness of an alternative version of this technology – radiofrequency ablation of the liver parenchyma in the plane of the proposed resection with ligation of the right branch of the portal vein to increase the volume of the estimated liver remnant in intrahepatic cholangiocellular cancer.

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