Abstract

It is important to assess regeneration of volume and function of the future liver remnant (FLR) for optimal timing of resection after liver augmenting techniques. Herein we discuss the mechanisms of liver regeneration and methods to assess volumetric and functional increase of the FLR following PVE or ALPPS. Hepatocytes undergoing cell division after contralateral portal vein occlusion need time to mature to obtain full function within the first week, leading to discrepancies in volumetric and functional increase of FRL. In PVE, increase in function of the FLR exceeds CT-volumetric increase after 3–4 weeks, whereas in the first days after ALPPS stage-1, volumetric increase may overestimate functional increase. CT-volumetric analysis is commonly used to evaluate growth of the FRL. However, nuclear imaging techniques such as 99mTc-GSA or hepatobiliary scintigraphy provide direct functional assessment of specifically the FRL and, therefore, are useful to reliably assess regeneration of the FRL after PVE or ALPPS.
Original languageEnglish
Title of host publicationSafe Major Hepatectomy after Preoperative Liver Regeneration
Subtitle of host publicationPreopearative PVE, Two-Satage Hepatetomy, ALPPS and Hepatic Vein Deprivation
PublisherElsevier
Pages149-165
Number of pages17
ISBN (Electronic)9780323996983
ISBN (Print)9780323996990
DOIs
Publication statusPublished - 1 Jan 2024

Publication series

NameSafe Major Hepatectomy after Preoperative Liver Regeneration: Preopearative PVE, Two-Satage Hepatetomy, ALPPS and Hepatic Vein Deprivation

Keywords

  • ALPPS
  • CT-volumetric analysis
  • Future liver remnant
  • Hepatic venous deprivation
  • Hepatobiliary scintigraphy
  • Liver function
  • Liver regeneration
  • Portal vein embolization

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