Liver regeneration after liver resection: clinical aspects and correlation with infective complications

Abstract

Aim: To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.

Methods: A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010. Regeneration was evaluated by multidetector computed tomography at a mean follow-up of 43.85 d. The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation, and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data. Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.

Results: Ten of the 27 patients (37%) underwent chemotherapy prior to surgery, with a statistically significant prevalence of patients with metastasis (P = 0.007). Eight patients (30%) underwent embolization, 3 with primary tumors, and 5 with secondary tumors. Twenty patients (74%) experienced complications, with 12 (60%) experiencing Clavien-Dindo Grade 3a to 5 complications. Regeneration ≥ 100% occurred in 10 (37%) patients. The predictors were smaller future remnant liver volume (-0.002; P < 0.001), and a greater spleen volume/future remnant liver volume ratio (0.499; P = 0.01). Patients with a resection of ≥ 5 Couinaud segments experienced greater early regeneration (P = 0.04). Nine patients experienced surgical site infections, and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected (P = 0.016). There were no significant differences between patients with primary or secondary tumors, and either onset or infections or severity of surgical complications.

Conclusion: Regardless of the onset of infective complications, future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.

Keywords: Liver regeneration; Liver resection; Liver tumor.

Figure 1

Distribution of liver regeneration over time in all patients. A physiologic association between follow-up time and greater percentage of liver regeneration is showed.

Figure 2

Box plot of liver regeneration comparing patients with primary and patients with secondary tumors. The distribution could indicate that the type of malignancy might not influence the early liver regeneration in resected patients.

Figure 3

Scatterplot with line fit. A: Percentage of liver regeneration in relation to future remnant liver volume (FRLV); B: Percentage of liver regeneration in relation spleen volume (SV)/FRLV; C: Percentage of liver regeneration in relation to follow-up time.