[New method of hepatic regeneration]

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Regeneration

Background:

• Postoperative liver failure (PLF) is a critical complication following extensive liver resections.
• Managing initially unresectable liver metastases from colorectal cancer poses significant surgical challenges.
• Assessing and ensuring adequate future liver remnant (FLR) is crucial for patient outcomes.

Observation:

• A novel surgical approach involving in situ liver split and right portal vein ligation was employed in a patient with unresectable liver metastases.
• Following neoadjuvant chemotherapy, a simultaneous left hemicolectomy and liver metastasis resection were performed.
• The patient presented with an insufficient FLR necessitating further intervention.

Findings:

• Volumetric CT scan on postoperative day 6 revealed a >40% increase in FLR volume.
• The in situ liver split and portal vein ligation technique demonstrated rapid FLR hypertrophy, surpassing outcomes seen with traditional portal vein ligation.
• The patient successfully underwent completion right hepatectomy and was discharged on postoperative day 11.

Implications:

• This innovative technique may enable staged surgical procedures for patients with initially unresectable liver disease within a single hospital admission.
• The rapid FLR regeneration observed suggests a potential to reduce the incidence of PLF in complex liver surgeries.
• Further studies are warranted to validate this technique's efficacy and widespread applicability in treating advanced liver metastases.