Liver regeneration after major hepatectomy for biliary cancer

Citation
M. Nagino et al., Liver regeneration after major hepatectomy for biliary cancer, BR J SURG, 88(8), 2001, pp. 1084-1091
Citations number
44
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
BRITISH JOURNAL OF SURGERY
ISSN journal
0007-1323 → ACNP
Volume
88
Issue
8
Year of publication
2001
Pages
1084 - 1091
Database
ISI
SICI code
0007-1323(200108)88:8<1084:LRAMHF>2.0.ZU;2-Q
Abstract
Background: The aim of this study was to evaluate serial changes in liver v olume after major hepatectomy for biliary cancer and to elucidate clinical factors influencing liver regeneration. Methods: Serial changes in liver volume were determined, using computed tom ography, in 81 patients with biliary cancer who underwent right hepatic lob ectomy or more extensive liver resection with or without portal vein resect ion and/or pancreatoduodenectomy. Possible factors influencing liver regene ration were evaluated by univariate and multivariate analyses. Results: The remnant mean(s.d.) liver volume was 41(8) per cent straight af ter hepatectomy. This increased rapidly to 59(9) per cent within 2 weeks, t hen increased more slowly, finally reaching a plateau at 74(12) per cent ab out 1 year after hepatectomy. The regeneration rate within the first 2 week s was 16(8) cm(3)/day and was not related to the extent of posthepatectomy liver dysfunction. On multivariate analysis, the extent of liver resection (P < 0.001), body surface area (P = 0.02), combined portal vein resection ( P = 0.024) and preoperative portal vein embolization (P = 0.047) were signi ficantly associated with the liver regeneration rate within the first 2 wee ks. In addition, body surface area (P < 0.001) and liver function expressed as plasma clearance rate of indocyanine green (P = 0.01) were significant determinants of final liver volume 1 year after hepatectomy. Conclusion: The liver regenerates rapidly in the first 2 weeks after major hepatectomy for biliary cancer. This early regeneration is influenced by fo ur clinical factors. Thereafter, liver regeneration progresses slowly and s tops when the liver is three-quarters of its original volume, approximately 6 months to 1 year after hepatectomy.