Methods of postoperative hepatic hypertrophy. ALPPS vs. portal embolization.

Resumen Uno de los puntos principales a la hora de abordar el tratamiento de lesiones hepáticas es el volumen del remanente hepático que vamos a mantener en el paciente. Diversas técnicas han sido aplicadas para intentar hipertrofiar el remanente hepático de cara a una mejor recuperación es quirúrgica y a evitar una insuficiencia hepática que condicione la morbimortalidad del paciente. Analizaremos las mejores técnicas actuales que se utilizan para este fin.

Portal vein ligation alters coding and noncoding gene expression in rat livers

Portal vein occlusion increases the resectability of initially unresectable liver cancer by inducing hypertrophy in non-occluded liver lobes. However, the mechanisms of how portal vein occlusion induces hepatic hypertrophy remain unclear. A cDNA microarray was used to identify the gene expression signatures of ligated (LLLs) and nonligated liver lobes (NLLLs) at different time points after portal vein ligation (PVL). The results of a bioinformatics analysis revealed that LLLs and NLLLs displayed different gene expression profiles. Moreover, the expression levels of both coding and noncoding RNA were different between LLLs and NLLLs at different time points after PVL. A series test of cluster analysis revealed that the No. 22 and No. 5 expression patterns, which showed altered expression at 24 h and maintained this altered expression over the following 14 days, had the lowest P values and the highest number of differentially expressed genes in both the LLLs and NLLLs. The results of a GO analysis showed the activation of hypoxia pathways in LLLs and the activation of cell proliferation and cell-cycle pathways in NLLLs, suggesting the involvement of these pathways in PVL-induced hepatic hypertrophy and regeneration. These results provide insight into the molecular mechanisms underlying hepatic hypertrophy and regeneration induced by portal vein occlusion, and they identify potential targeting pathways that can promote the clinical application of PVL in liver cancer therapy.