Outflow modulation to target liver regeneration: Something old, something new

Abstract Background Stimulation of hepatic hypertrophy is a useful aid to accomplish hepatic resections when the future liver remnant (FLR) is small. Although inflow occlusion, especially through portal flow, has been extensively studied, the role of outflow modulation has not yet been described. Me...

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Bibliographic Details
Published in:	European journal of surgical oncology Vol. 40; no. 2; pp. 140 - 143
Main Authors:	Balzan, S.M.P, Gava, V.G, Magalhaes, M.A, Dotto, M.L
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-02-2014
Subjects:	Adenocarcinoma - secondary Adenocarcinoma - surgery Colorectal Neoplasms - pathology Female Hematology, Oncology and Palliative Medicine Hepatectomy Hepatectomy - methods Hepatic Veins - surgery Humans Hypertrophy - diagnostic imaging Liver - blood supply Liver - diagnostic imaging Liver - surgery Liver hypertrophy Liver Neoplasms - secondary Liver Neoplasms - surgery Liver Regeneration Middle Aged Outflow modulation Portal Vein - surgery Surgery Tomography, X-Ray Computed Liver hypertrophy Outflow modulation Hepatectomy
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Summary:	Abstract Background Stimulation of hepatic hypertrophy is a useful aid to accomplish hepatic resections when the future liver remnant (FLR) is small. Although inflow occlusion, especially through portal flow, has been extensively studied, the role of outflow modulation has not yet been described. Methods Description of outflow modulation to tailor hypertrophy of future liver remnant in the context of bilobar metastatic disease. A patient with small FLR (segments I and IV) was managed with a two-stage procedure. The first stage consisted of a right hepatectomy and modulation of the left hepatic vein outflow through reduction of its diameter, with macroscopic congestion of segments II–III. The second stage consisted of a left lateral sectionectomy six weeks later. Postoperative courses were uneventful without any sign of liver failure. Results Following the first stage procedure computed tomography revealed distinct hypertrophy rates between sections. The non-congested area had an increase of 156% in the volume of segment IV (from 137 to 351 cm3 ) and 100% in the volume of segment I (from 20 to 40 cm3 ). The congested area, segments II–III, increased only 24% (from 205 to 253 cm3 ). Conclusion Modulation of liver outflow allows maintenance of function in the segments to be resected while avoiding their hypertrophy. This process prevents liver failure and optimizes regeneration of hepatic territories to be preserved.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0748-7983 1532-2157
DOI:	10.1016/j.ejso.2013.08.012