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How to expand the safe limits in hepatic resections?
José Manuel Asencio1, José Luis García Sabrido, Luis Olmedilla
1General Surgery III Department and Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, c/ Doctor Esquerdo 46, Madrid, 28007, Spain. jmasencio@gmail.com.
Journal of Hepato-Biliary-Pancreatic Sciences
|February 18, 2014
Summary
Future remnant liver volume is key for safe liver surgery after extended hepatectomy. Strategies like increasing remnant size and monitoring blood flow may expand surgical options and improve patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Regeneration
Background:
- Remnant liver size limits curative liver surgery for tumors and metastasis.
- Current guidelines for extended hepatectomies depend on future remnant liver volume percentages (20-40%) to prevent small-for-size syndrome.
- Small-for-size syndrome presents as liver dysfunction, ascites, coagulopathy, and cholestasis.
Purpose of the Study:
- To review current understanding of liver dysfunction after extended hepatectomies.
- To explore strategies for expanding indications and improving safety in liver surgery.
- To address the limitations imposed by remnant liver size.
Main Methods:
- Review of observations from liver transplantation using small grafts.
- Analysis of increased surgical experience and understanding of liver dysfunction mechanisms.
- Exploration of novel strategies for liver regeneration and blood flow modulation.
Main Results:
- Improved understanding of small-for-size syndrome mechanisms.
- Identification of strategies to enhance remnant liver function and size.
- Potential for increased safety and expanded indications for liver surgery.
Conclusions:
- Increasing future remnant liver volume is crucial.
- The 'small-for-flow' concept and perioperative monitoring are promising.
- Regeneration preconditioning may further enhance outcomes in liver surgery.
