Liver hypertrophy: Underlying mechanisms and promoting procedures before major hepatectomy - 11/10/18
, A. Dupré b, A. Gallon c, d, P. Chabrot c, d, J. Gagnière a, E. Buc a, d| pages | 9 |
| Iconographies | 4 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Hepatic metabolism requires continuous exchanges between hepatocytes and endothelial cells: an asynchronism during the regeneration phase may impair liver function. |
• | Hepatic volume does not reflect perfectly liver function. |
• | Liver hypertrophy is correlated to portal blood flow and hypoxemia. |
• | Procedures promoting liver hypertrophy include: portal vein embolization/ligation, hepatic vein embolization, associated portal embolization and arterial ligation, and associating liver partition and portal vein ligation. |
• | Inhibitory factors include biliary obstruction, diabetes mellitus, malnutrition, ethanol, male gender, age and viral infection. |
• | The feasibility of hepatectomy following a procedure promoting liver hypertrophy ranges from 70% to 95% in most of studies, suggesting that development of new procedures combined with precise identification and specific treatments of factors inhibiting liver regeneration are still mandatory. |
Summary |
Various procedures can promote hypertrophy of the future liver remnant (FLR) before major hepatectomy to prevent postoperative liver failure. The pathophysiological situation following portal vein embolization (PVE), hepatic artery ligation/embolization or hepatectomy remains unclear. On one hand, the main mechanisms of hepatic regeneration appear to be driven by hepatic hypoxia (involving the hepatic arterial buffer response), an increased portal blood flow inducing shear stress and the involvement of several mediators (inflammatory cytokines, vasoregulators, growth factors, eicosanoids and several hormones). On the other hand, several factors are associated with impaired liver regeneration, such as biliary obstruction, malnutrition, diabetes mellitus, male gender, age, ethanol and viral infection. All these mechanisms may explain the varying degrees of hypertrophy observed following a surgical or radiological procedure promoting hypertrophy the FLR. Radiological procedures include left and right portal vein embolization (extended or not to segment 4), sequential PVE and hepatic vein embolization (HVE), and more recently combined PVE and HVE. Surgical procedures include associated liver partition and portal vein ligation for staged hepatectomy, and more recently the combined portal embolization and arterial ligation procedure. This review aimed to clarify the pathophysiology of liver regeneration; it also describes radiological or surgical procedures employed to improve liver regeneration in terms of volumetric changes, the feasibility of the second step and the benefits and drawbacks of each procedure.
Le texte complet de cet article est disponible en PDF.Keywords : Liver hypertrophy, Hepatectomy, Radiological technique, Surgical technique, Embolization
Plan
Vol 155 - N° 5
P. 393-401 - octobre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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