Exploring the Enhanced Liver Regeneration Patterns Following ALPPS Versus Selective Portal Vein Ligation in an...

Area of Science:

• Hepatobiliary Surgery
• Regenerative Medicine
• Surgical Oncology

Background:

• Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and selective portal vein embolization (PVE) are key liver surgery strategies.
• While ALPPS shows more rapid hypertrophy than PVL/PVE, the underlying mechanisms remain unclear.

Purpose of the Study:

• To investigate and characterize the enhanced liver regeneration patterns following ALPPS compared to PVL in a rat model.
• To elucidate the cellular and molecular mechanisms driving accelerated liver regeneration in ALPPS.

Main Methods:

• Utilized a rat model (n=84) undergoing microsurgical selective PVL or ALPPS.
• Assessed liver regeneration parameters, including microcirculation, hepatocyte morphology, injury, and protein kinase activation (pAkt/Akt).

Main Results:

• ALPPS demonstrated significantly more rapid and pronounced right median lobe hypertrophy compared to PVL (regeneration ratio 1.980 vs. 1.669).
• ALPPS induced greater hepatocellular injury, increased microcirculation, and enlarged hepatocyte size (374.48 μm² vs. 300.43 μm²).
• Early pAkt/Akt activation was significantly higher in the ALPPS group post-surgery (9.7-fold vs. 5-fold).

Conclusions:

• Enhanced liver regeneration in ALPPS is linked to specific alterations in liver microcirculation and hepatocyte morphology.
• Activation of pAkt/Akt signaling pathway plays a crucial role in mediating the accelerated regeneration observed in ALPPS.