Is faster always better? A comparative study between associating liver partition and portal vein ligation for staged hepatectomy vs classic portal vein ligation for two-stage hepatectomy in rats

SCHELOTTO, PABLO BARROS; MOULIN, LUIS; MEIER, DOMINIK; HECTOR, ALMAU; ANA, CABANNE; VALERIA, DESCALZI; PABLO, STRINGA; GABRIEL E. GONDOLESI

Journal of Liver: Disease & Transplantation

SciTechnol

Lugar: Los Angeles; Año: 2016 vol. 05 p. 2 - 6

AbstractBackground: The associating liver partition and portal vein ligationfor staged hepatectomy (ALPPS) has been proposed to avoidliver failure after major liver resection. We thought to define themechanism by which ALPPS enlarges liver remnant and if it isreally more effective than classic two-stage hepatectomy.Objectives: To compare if ALPPS is superior to portal vein ligation(PVL) to increase liver volume.Methods: Sprague-Dawley rats were divided in sham, ALPPS andPVL groups. Animal weight, volumetric assessment of the livermiddle lobe, mitotic index, binucleate cells index, Ki-67 index andhistological evaluation were done to assess liver regeneration.Results: No differences were found in liver volume after bothprocedures. (48, 65 ± 15 %, 43, 97 ± 13, 4 % and 155 ± 40 %; on3, 7, 14 POD, for ALPPS and PVL) The liver volume/ animal weightratios were similar in both groups. Ki67, binucleate cells and mitoticindex were significantly higher in PVL and ALPPS compared withsham group, only on 3 postoperative day, (p=0.01), but were notdifferent at the end of follow up (14 days). The histological liverdamage score was slightly higher in ALPPS.Conclusion: Both procedures are useful to achieve increasesin future remnant liver volume. There is no difference in the finalvolume reached; observing that the increase achieved by ALPPSis faster.