Volume and flow modulation strategies to mitigate post-hepatectomy liver failure

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver regeneration

Background:

• Post hepatectomy liver failure (PHLF) is a significant cause of mortality after major liver resections, with rates between 40-60%.
• Strategies to enhance future liver remnant (FLR) volume and function are crucial for patient survival.

Purpose of the Study:

• To review current strategies for volume and flow modulation aimed at reducing PHLF.
• To explore techniques that promote FLR hypertrophy and improve its function.

Main Methods:

• A comprehensive electronic literature search was conducted across MEDLINE, EMBASE, and PubMed databases (2000-2022).
• Keywords included "Post hepatectomy liver failure", "flow modulation", "small for size flow syndrome", "portal vein embolization", "dual vein embolization", "ALPPS", and "staged hepatectomy".

Main Results:

• Volume and flow modulation techniques, such as portal vein embolization, dual vein embolization, Associating Liver Partition and Portal Ligation for Staged hepatectomy (ALPPS), and staged hepatectomy, promote significant FLR hypertrophy and growth.
• Interventions like portal flow diversion, splenic artery ligation, splenectomy, and pharmacological agents (somatostatin, terlipressin) aim to mitigate small-for-size (SFS) syndrome by optimizing portal and hepatic artery flow.

Conclusions:

• Various volume and flow modulation strategies can be applied individually or in combination to manage patients at risk of PHLF.
• These strategies are essential for maximizing FLR volume and function, thereby reducing the incidence of post hepatectomy liver failure.