Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy

Abstract

AIMTo highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models (clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration, which would help in designing new therapeutic options for the regenerative drive in difficult setup, such as chronic liver diseases. Associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery.METHODSA comprehensive literature review of Associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed.RESULTSLiver regeneration after Associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling.CONCLUSIONAssociating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety, efficacy and oncological outcomes. As far as Associating Liver Partition and Portal vein ligation for Stage hepatectomy -induced liver regeneration is concerned, further research on the field should focus on the role of non-parenchymal cells in liver regeneration as well as on the effect of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regeneration in the setup of parenchymal liver disease.

The role of platelets on regenerating liver: Thoughts beyond parenchymal proliferation

“…Moreover, LSEC are also involved in modulating vascular tone and portal flow, which can also be a crucial trigger for liver regeneration after partial hepatectomy. 4 As the authors demonstrated a clear interaction between PLT and LSEC, it would be of interest to know whether this interaction had an effect on portal flow, as demonstrated in previous studies. 5 Finally, the authors modulated PLT count by the intravenous injection of platelet-depleting antibodies.VWF was, however, the only PLT-associated factor examined.…”

“…Additional data on PLT function in terms of PLT-mediated molecules could shed additional light on understanding the mechanism of liver regeneration following hepatectomy. 2,4,5 Focusing more on the function of remnant liver and the activity rather than the expression of different cells could help our understanding on the liver regeneration. REFERENCES 1.…”

Liver transplantation for unresectable colorectal liver metastases: A systematic review

“…In addition, peri‐operative (portal vein embolization) and intra‐operative (two‐stage hepatectomy, associating liver partitioning with portal vein ligation for staged hepatectomy (ALPPS), etc.) advances have also been critical in expanding the number of patients with CLM who are candidates for surgery , . Despite these advances, many patients with CLM still present with unresectable disease that is not amenable to surgical resection.…”

Modern Methods for Assessing the Regenerative Potential of the Liver after Partial Hepatectomy (Review)

“…It is known [5][6][7][8][9] that 25% is the minimum volume of hepatic remnant for adequate recovery in patients with morphologically intact liver. In the presence of druginduced damage (chemotherapy) or with background liver diseases (cirrhosis, fibrosis, hepatosis), at least 40% of the initial liver volume is needed to remain.…”