Liver hypertrophy: Underlying mechanisms and promoting procedures before major hepatectomy

Roy, Bertrand Le; Dupré, Aurélien; Gallon, A.; Chabrot, P.; Gagnière, Johan; Buc, Emmanuel

doi:10.1016/j.jviscsurg.2018.03.005

Cited by 28 publications

(12 citation statements)

References 55 publications

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“…Liver regeneration is a complex process, and the exact pathophysiological situation following PVE remains unclear. It is known that various cytokines, growth factors, vasoregulators, hormones and proteins initiate hepatocyte proliferation [ 4 , 59 ]. It could be considered that the FLR volume will increase more if the embolized area is more extensive.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Soykan

Aarts

López-Yurda

et al. 2021

Cardiovasc Intervent Radiol

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This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy(pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50).The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).

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Section: Discussionmentioning

confidence: 99%

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Soykan

Aarts

López-Yurda

et al. 2021

Cardiovasc Intervent Radiol

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show abstract

“…Forty percent to 50% of oxygen is provided by HA, and the portal vein provides 50%-60%. While the portal vein blood's oxygen saturation is 50%-60%, the HA oxygen saturation is over 90%[ 3 , 58 ]. In case of interruption of HA flow, the deficiency is compensated by portal vein flow.…”

Section: Discussionmentioning

confidence: 99%

“…In a patient with impaired hemodynamics, the portal vein's oxygen parameters deteriorate further, and the liver's oxygenation is disrupted. The presence of hypovolemia, dehydration, anemia, lung problems, pain, excessive sedation, limitation of movement, or heart problems will further increase the risks associated with artery ligation[ 44 , 58 ]. Struggle with shock and providing oxygenation are the first protective and therapeutic procedures.…”

Section: Discussionmentioning

confidence: 99%

Dealing with hepatic artery traumas: A clinical literature review

Dılek¹,

Atay²

2021

WJCC

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BACKGROUND The hepatic artery (HA) is one of the most threatened vascular structures during hepatopancreatobiliary (HPB) surgeries and interventional procedures. It can be affected by many clinical pictures, especially tumors, due to its anatomical position and neighborhood. AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature. METHODS In this article, 100 years of MEDLINE (PubMed) literature and articles including cases and series of HA injuries were reviewed, and the types of injury occurrence, treatment, and related complications and their management were compiled. RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies, among the most common operations. HA anatomy shows anomalies in approximately 15%-25% of the cases, further increasing this risk. The incidence of HA injury is not precisely known. Approaches that have evolved in recent years in managing patients with HA injury (laceration, transection, ligation, resection) with severe morbidity and mortality risk are reviewed in light of the current literature. CONCLUSION In conclusion, complications and deaths due to HA injury are less common today. The risk of complications increases in patients with hemodynamic instability, jaundice, cholangitis, and sepsis. Revealing the variations in the preoperative radiological evaluation will reduce the risks. In cases where HA injury is detected, arterial flow continuity should be tried to maintain with primary anastomosis, arterial transpositions, or grafts. In cases where bile duct injury develops, patients should be directed to HPB surgery centers, considering the possibility of accompanying HA injury. Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

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“…Hepatic vein embolization induces liver hypertrophy through an increase in portal pressure by regurgitation into the portal vein through the sinusoids [27]. In contrast, the pathophysiology of hypertrophy in ALPPS is still not fully understood, yet similar mechanisms must be present [28].…”

Section: Discussionmentioning

confidence: 99%

Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

Dondorf

Deeb

Bauschke

et al. 2021

Langenbecks Arch Surg

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Purpose Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy. Methods In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses. Results Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown. Conclusion This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.

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Liver hypertrophy: Underlying mechanisms and promoting procedures before major hepatectomy

Cited by 28 publications

References 55 publications

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

Dealing with hepatic artery traumas: A clinical literature review

Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

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