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A new technique for accelerated liver regeneration: An experimental study in rats
Kasper Jarlhelt Andersen1, Anders Riegels Knudsen1, Betina Norman Jepsen1
1Department of Surgery, Section for Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Aarhus University Hospital, Aarhus, Denmark.
Surgery
|April 15, 2017
Summary
Radiofrequency ablation of the deportalized liver can significantly increase future liver remnant growth, offering an alternative to Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS). This method may be performed percutaneously, potentially improving clinical applicability.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Regenerative medicine
Background:
- Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a critical procedure to enhance future liver remnant (FLR) growth before major liver resection.
- Investigating alternative, potentially less invasive, methods to stimulate FLR hypertrophy is essential for improving surgical outcomes in patients with extensive liver disease.
Purpose of the Study:
- To compare the efficacy of radiofrequency ablation (RFA) techniques with standard ALPPS in promoting FLR regeneration.
- To evaluate alternative strategies for increasing FLR volume, aiming to identify methods comparable to ALPPS.
Main Methods:
- A study involving 152 rats randomized into seven groups: sham, portal vein ligation (PVL), PVL/surgical split (ALPPS), PVL/split with RFA needle, PVL/RFA of deportalized liver, PVL/RFA of FLR, and controls.
- Assessment included body weight, liver parameters, hepatic regeneration rate, cytokine levels, hepatocyte proliferation, and gene expression on postoperative days 2 and 4.
Main Results:
- All intervention groups showed increased hepatic regeneration compared to sham controls (P < .001).
- PVL/RFA of the deportalized liver demonstrated significantly higher regeneration rates on postoperative day 2 compared to PVL alone (P = .039).
- On postoperative day 4, ALPPS, PVL/split with RFA needle, and PVL/RFA of the deportalized liver groups showed significantly greater regeneration than PVL alone (P < .05). Hepatocyte proliferation was significantly higher in multiple RFA and ALPPS groups compared to PVL.
Conclusions:
- Liver regeneration after ALPPS is likely driven by parenchymal damage and growth factor release, upregulating regenerative genes.
- Radiofrequency ablation treatment of the deportalized liver achieved FLR growth comparable to ALPPS.
- RFA of the deportalized liver represents a promising alternative, with the potential for percutaneous application in humans.