Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy

Abstract

Aim: To highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models (clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration, which would help in designing new therapeutic options for the regenerative drive in difficult setup, such as chronic liver diseases. Associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery.

Methods: A comprehensive literature review of Associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed.

Results: Liver regeneration after Associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling.

Conclusion: Associating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety, efficacy and oncological outcomes. As far as Associating Liver Partition and Portal vein ligation for Stage hepatectomy -induced liver regeneration is concerned, further research on the field should focus on the role of non-parenchymal cells in liver regeneration as well as on the effect of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regeneration in the setup of parenchymal liver disease.

Keywords: Associating liver partition with portal vein ligation for staged hepatectomy; Liver regeneration; Liver transection; Portal vein embolization; Portal vein ligation.

Figure 1

Mechanisms of liver regeneration after liver injury. Green arrow indicates strong induction, orange arrow indicates secondary induction. NPCs: Non-parenchymal cells; IL-6: Interleukin-6; HGF: Hepatic growth factor; TGF-α: Tumor growth factor-alpha; EGF: Epidermal growth factor; VEGF: Vascular-endothelial growth factor; NF-κB: Nuclear factor-κB; STAT-3: Signal transducer and activator of transcription.

Figure 2

Mechanisms of liver regeneration after associating liver partition with portal vein ligation for staged hepatectomy. Green arrow indicates strong induction, orange arrow indicates secondary induction. IL-6: Interleukin-6; TGF-α: Tumor growth factor-alpha; STAT-3: Signal transducer and activator of transcription; CINC-1: Cytokine-induced neutrophil chemoattractant-1; ALPPS: Associating liver partition with portal vein ligation for staged hepatectomy.

Figure 3

Cascade of mechanisms involved in liver regeneration after associating liver partition with portal vein ligation for staged hepatectomy. STAT-3: Signal transducer and activator of transcription; NPCs: Non-parenchymal cells; IL-6: Interleukin-6.