Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume

Shirabe, Ken; Shimada, Mitsuo; Gion, Tomonobu; Hasegawa, Hiroo; Takenaka, Katsuto; Utsunomiya, Tohru; Sugimachi, Keizō

doi:10.1016/s1072-7515(98)00301-9

Cited by 407 publications

(279 citation statements)

References 11 publications

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“…A linear regression formula to estimate TLV based on BSA was obtained: TLV ‫؍‬ I n the past decade, the role of computed tomography (CT) has extended beyond its use for liver imaging to include three-dimensional volumetric measurement before liver transplantation or major hepatic resection. [1][2][3][4] This has been possible because of a close correlation between the volume obtained by three-dimensional reconstruction of computed tomographic images and actual liver volume. 5 In a recent Japanese study, a formula that enables calculation of total liver volume (TLV) from body surface area (BSA) was generated after study of CT-based three-dimensional volumetric measurement of livers of children and adults.…”

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confidence: 99%

Body surface area and body weight predict total liver volume in Western adults

Vauthey¹

2002

Liver Transplantation

544

436

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Computed tomography (CT) is used increasingly to measure liver volume in patients undergoing evaluation for transplantation or resection. This study is designed to determine a formula predicting total liver volume (TLV) based on body surface area (BSA) or body weight in Western adults. TLV was measured in 292 patients from four Western centers. Liver volumes were calculated from helical computed tomographic scans obtained for conditions unrelated to the hepatobiliary system. BSA was calculated based on height and weight. Each center used a different established method of three-dimensional volume reconstruction. Using regression analysis, measurements were compared, and formulas correlating BSA or body weight to TLV were established. A linear regression formula to estimate TLV based on BSA was obtained: TLV ‫؍‬ I n the past decade, the role of computed tomography (CT) has extended beyond its use for liver imaging to include three-dimensional volumetric measurement before liver transplantation or major hepatic resection. [1][2][3][4] This has been possible because of a close correlation between the volume obtained by three-dimensional reconstruction of computed tomographic images and actual liver volume. 5 In a recent Japanese study, a formula that enables calculation of total liver volume (TLV) from body surface area (BSA) was generated after study of CT-based three-dimensional volumetric measurement of livers of children and adults. This formula has been applied to calculate the graft to TLV ratio for living related donor liver transplantation 4,6 and the future liver remnant (FLR) to TLV ratio before liver resection. 2 However, the formula has not gained general acceptance at Western centers, and its accuracy has been questioned because of Western autopsy measurements that indicate on average a TLV of 323 cm 3 greater than expected based on the Japanese formula. 7 In addition, body weight, rather than BSA, has been used to estimate graft volume before liver transplantation, particularly donorrecipient weight ratio. [8][9][10] However, to our knowledge, the correlation between body weight and TLV has not been evaluated.In addition to the issue of liver size match, the goal of preoperative liver volume estimation is to estimate hepatic metabolic demands of an individual patient. 11 Thus, a method that estimates appropriate volume based on patient characteristics (e.g., patient weight or BSA) in combination with a measure of liver volume (by CT) is desirable. Although caloric needs, total body water, and extracellular water correlate more closely to BSA than body weight in children, differences are minor. 12,13 Therefore, either weight or BSA could provide a standard means to estimate liver function, as well as size, before resection or transplantation.We designed a multicenter study to evaluate the correlation between TLV and BSA or body weight in Western patients with normal livers who underwent CT for conditions unrelated to the hepatobiliary system. The newly derived formula based on BSA then was

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confidence: 99%

Body surface area and body weight predict total liver volume in Western adults

Vauthey¹

2002

Liver Transplantation

544

436

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“…Poor or insufficient liver regeneration may be potentially fatal for these patients. [4][5][6] Therefore, better understanding of the patho-physiological features of liver regeneration could lead to clinical benefits.…”

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p66Shc has a pivotal function in impaired liver regeneration in aged mice by a redox-dependent mechanism

Haga

Morita

Irani

et al. 2010

Laboratory Investigation

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Liver regeneration involves complicated processes and is affected by various patho-physiological conditions. This study was designed to examine the molecular mechanisms underlying the aging-associated impairment of liver regeneration. Male C57BL/6J mice were used as young and aged mice (o10 weeks and 420 months old, respectively). These mice were subjected to 70% partial hepatectomy (PH). Liver regeneration and liver injury/stresses were evaluated chronologically after PH. Post-hepatectomy liver regeneration was markedly impaired in aged mice. Though the extent of hepatocyte proliferation in the regenerating liver was similar in aged and young mice, cell growth was absent in aged mice. Oxidative stress (OS) was observed immediately after hepatectomy, followed by marked apoptosis in aged mice. Signaling molecules regarding cell proliferation (mitogen-activated protein kinase, STAT3, p46/52 Shc ) and anti-oxidation (catalase, superoxide dismutase, Ref-1, glutathione peroxidase) were expressed/activated after hepatectomy in livers of both aged and young mice. Akt was not activated in aged-mouse liver, but its expression was similar to that in young mice. p66 Shc , known as an age-/oxidantassociated protein, was strongly phosphorylated. By knocking down p66 Shc , the impairment of liver regeneration was normalized. OS immediately after hepatectomy induced subsequent liver injury (apoptosis), and deletion of p66 Shc suppressed both OS and hepatocyte apoptosis in the regenerating liver of aged mice. Though we need additional data in other animal models to fully understand the mechanism, p66 Shc may have a pivotal function in the impairment of liver regeneration in aged mice by triggering OS and subsequent apoptosis. This data may provide a clue to understanding the mechanism underlying the association between aging and the impairment of liver regeneration.

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“…Poor or insufficient liver regeneration may be potentially fatal for these patients. [3][4][5] Therefore, better understanding of the physiopathological features of liver regeneration could lead to clinical benefits.…”

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The survival pathways phosphatidylinositol-3 kinase (PI3-K)/phosphoinositide-dependent protein kinase 1 (PDK1)/Akt modulate liver regeneration through hepatocyte size rather than proliferation

et al. 2008

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Liver regeneration comprises a series of complicated processes. The current study was designed to investigate the roles of phosphoinositide-dependent protein kinase 1 (PDK1)-associated pathways in liver regeneration after partial hepatectomy (PH) using liver-specific Pdk1-knockout (L-Pdk1KO) and Pdk1/STAT3 double KO (L-DKO) mice. There was no liver regeneration, and 70% PH was lethal in L-Pdk1KO mice. Liver regeneration was severely impaired equally in L-Pdk1KO and L-DKO mice, even after nonlethal 30% PH. There was no cell growth (measured as increase of cell size) after hepatectomy in L-Pdk1KO mice, although the post-PH mitotic response was the same as in controls. As expected, hepatectomy did not induce hepatic Akt-phosphorylation (Thr308) in L-Pdk1KO mice, and post-PH phosphorylation of Akt, mammalian target of rapamycin (mTOR), p70 ribosomal S6 kinase (p70 S6K ), and S6 were also reduced. To examine the specific role of PDK1-associated signals, a "pif-pocket" mutant of PDK1, which allows PDK1 only to phosphorylate Akt, was used.

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Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume

Cited by 407 publications

References 11 publications

Body surface area and body weight predict total liver volume in Western adults

Body surface area and body weight predict total liver volume in Western adults

p66Shc has a pivotal function in impaired liver regeneration in aged mice by a redox-dependent mechanism

The survival pathways phosphatidylinositol-3 kinase (PI3-K)/phosphoinositide-dependent protein kinase 1 (PDK1)/Akt modulate liver regeneration through hepatocyte size rather than proliferation

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