Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH)

Matteo Serenari^#^{1

2}, Francesca Ratti^#^{3

4}, Mohammed Abu Hilal⁵, Francesco Ardito⁶, Giammauro Berardi⁷, Ugo Boggi⁸, Alberta Cappelli⁹, Matteo Cescon^{10

11}, Umberto Cillo¹², Alessandro Cucchetti^{11

13}, Luciano De Carlis¹⁴, Francesco De Cobelli^{4

15}, Fabrizio Di Benedetto¹⁶, Giorgio Ercolani^{11

13}, Giuseppe Maria Ettorre⁷, Massimo Fedi¹⁷, Alessandro Ferrero¹⁸, Felice Giuliante⁶, Gian Luca Grazi¹⁹, Enrico Gringeri¹², Salvatore Gruttadauria^{20

21}, Francesco Izzo²², Marcello Maestri²³, Paolo Magistri¹⁶, Marco Massani²⁴, Vincenzo Mazzaferro^{25

26}, Riccardo Memeo²⁷, Federico Mocchegiani²⁸, Cristina Mosconi⁹, Damiano Patrono²⁹, Matteo Ravaioli^{10

11}, Fabrizio Romano³⁰, Gianluca Rompianesi³¹, Nadia Russolillo¹⁸, Andrea Ruzzenente³², Carlo Sposito^{25

26}, Roberto Troisi³¹, Giovanni Vennarecci³³, Luca Viganò^{34

35}, Marco Vivarelli²⁷, Giacomo Zanus^{36

37}, Pedro M Baptista^{38

39

40

41}, Karl Oldhafer⁴², Erik Schadde^{43

44

45}, Luca Aldrighetti^#^{3

4}, Elio Jovine^#^{11

46}

Affiliations

¹ Hepato-Biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy. matteo.serenari@gmail.com.
² Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. matteo.serenari@gmail.com.
³ Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Vita-Salute San Raffaele University, Milan, Italy.
⁵ Department of HPB Surgery, University Hospital Southampton, Southampton, UK.
⁶ Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy.
⁸ Department of Surgery, University Hospital of Pisa, Pisa, Italy.
⁹ Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
¹⁰ Hepato-Biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
¹¹ Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
¹² General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.
¹³ General and Oncology Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy.
¹⁴ Department of General Surgery and Transplantation, School of Medicine, Niguarda Hospital-University of Milano-Bicocca, Milan, Italy.
¹⁵ Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁶ Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
¹⁷ Hepatobiliary Surgery Unit, USL Toscana Centro-San Jacopo Hospital, Pistoia, Italy.
¹⁸ Department of Surgery, Mauriziano Hospital, Turin, Italy.
¹⁹ HepatobiliaryPancreatic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
²⁰ Department Abdominal Center, UPMC (University of Pittsburgh Medical Center), 90127, Palermo, Italy.
²¹ Department of Surgery and Medical and Surgical Specialties, University of Catania, 95124, Catania, Italy.
²² Division of Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
²³ Division of General Surgery 1, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
²⁴ Regional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy.
²⁵ Department of Surgery, Division of HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Milan, Italy.
²⁶ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
²⁷ Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva Delle Fonti, Bari, Italy.
²⁸ HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy.
²⁹ General Surgery 2U-Liver Transplant Unit, Department of Surgical Sciences, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Università Di Torino, Turin, Italy.
³⁰ School of Medicine and Surgery, Hepatobiliary Surgery, University of Milan Bicocca, IRCCS San Gerardo, Monza, Italy.
³¹ Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy.
³² Division of General and Hepatobiliary Surgery, G.B, University of Verona, Rossi University Hospital, Verona, Italy.
³³ Department of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.
³⁴ Department of Minimally Invasive General & Oncologic Surgery, Hepatobiliary Unit, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
³⁵ Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.
³⁶ Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Padua, Italy.
³⁷ Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Treviso, Italy.
³⁸ Laboratory of Organ Bioengineering and Regenerative Medicine, Health Research Institute of Aragon (IIS Aragon), Saragossa, Spain.
³⁹ Biomedical Engineering Department, Carlos III of Madrid University, Madrid, Spain.
⁴⁰ ARAID Foundation, Saragossa, Spain.
⁴¹ Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
⁴² Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
⁴³ Department of Surgery, Rush University Chicago, Chicago, IL, USA.
⁴⁴ Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland.
⁴⁵ VISCERA Lucerne, Hirslanden St. Anna, Lucerne, Switzerland.
⁴⁶ Department of General Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.

^# Contributed equally.

PMID: 40859042
DOI: 10.1007/s13304-025-02364-1

Free article

Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH)

Matteo Serenari et al. Updates Surg. 2025.

Free article

. 2025 Aug 26.

doi: 10.1007/s13304-025-02364-1. Online ahead of print.

Authors

Affiliations

¹ Hepato-Biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy. matteo.serenari@gmail.com.
² Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. matteo.serenari@gmail.com.
³ Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Vita-Salute San Raffaele University, Milan, Italy.
⁵ Department of HPB Surgery, University Hospital Southampton, Southampton, UK.
⁶ Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy.
⁸ Department of Surgery, University Hospital of Pisa, Pisa, Italy.
⁹ Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
¹⁰ Hepato-Biliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
¹¹ Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
¹² General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.
¹³ General and Oncology Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy.
¹⁴ Department of General Surgery and Transplantation, School of Medicine, Niguarda Hospital-University of Milano-Bicocca, Milan, Italy.
¹⁵ Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁶ Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
¹⁷ Hepatobiliary Surgery Unit, USL Toscana Centro-San Jacopo Hospital, Pistoia, Italy.
¹⁸ Department of Surgery, Mauriziano Hospital, Turin, Italy.
¹⁹ HepatobiliaryPancreatic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
²⁰ Department Abdominal Center, UPMC (University of Pittsburgh Medical Center), 90127, Palermo, Italy.
²¹ Department of Surgery and Medical and Surgical Specialties, University of Catania, 95124, Catania, Italy.
²² Division of Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
²³ Division of General Surgery 1, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy.
²⁴ Regional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy.
²⁵ Department of Surgery, Division of HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Milan, Italy.
²⁶ Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
²⁷ Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva Delle Fonti, Bari, Italy.
²⁸ HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy.
²⁹ General Surgery 2U-Liver Transplant Unit, Department of Surgical Sciences, Azienda Ospedaliero Universitaria Città Della Salute E Della Scienza Di Torino, Università Di Torino, Turin, Italy.
³⁰ School of Medicine and Surgery, Hepatobiliary Surgery, University of Milan Bicocca, IRCCS San Gerardo, Monza, Italy.
³¹ Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy.
³² Division of General and Hepatobiliary Surgery, G.B, University of Verona, Rossi University Hospital, Verona, Italy.
³³ Department of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy.
³⁴ Department of Minimally Invasive General & Oncologic Surgery, Hepatobiliary Unit, Humanitas Gavazzeni University Hospital, Bergamo, Italy.
³⁵ Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy.
³⁶ Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Padua, Italy.
³⁷ Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Treviso, Italy.
³⁸ Laboratory of Organ Bioengineering and Regenerative Medicine, Health Research Institute of Aragon (IIS Aragon), Saragossa, Spain.
³⁹ Biomedical Engineering Department, Carlos III of Madrid University, Madrid, Spain.
⁴⁰ ARAID Foundation, Saragossa, Spain.
⁴¹ Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
⁴² Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany.
⁴³ Department of Surgery, Rush University Chicago, Chicago, IL, USA.
⁴⁴ Chirurgisches Zentrum Zürich (CZZ), Klinik Hirslanden Zurich, Zurich, Switzerland.
⁴⁵ VISCERA Lucerne, Hirslanden St. Anna, Lucerne, Switzerland.
⁴⁶ Department of General Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.

^# Contributed equally.

PMID: 40859042
DOI: 10.1007/s13304-025-02364-1

Abstract

In candidates for hepatectomy, different techniques to induce liver hypertrophy and modulate the future liver remnant are available. However, their use in specific clinical scenarios is highly heterogeneous and there is no consensus about minimal safety standards needed to incorporate these strategies into routine clinical practice. The aim of this position paper was to summarize newly available evidence in the field and compare medical practice among different hepatobiliary surgical units to evaluate the transformative potential of liver hypertrophy techniques in surgical oncology. This paper sets the stage for a future structured consensus on the application of liver hypertrophy techniques before hepatectomy.

Keywords: Liver function; Liver hypertrophy; Liver volume; Portal vein embolization.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The local ethics committee waived the requirement for formal ethical evaluation. Informed consent: Not available.

References

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1. Memeo R, Conticchio M, Deshayes E et al (2021) Optimization of the future remnant liver: review of the current strategies in Europe. Hepatobiliary Surg Nutr. https://doi.org/10.21037/hbsn-20-394 - DOI - PubMed - PMC
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Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH)

Affiliations

Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH)

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Conflict of interest statement

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