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. 2025 Dec;77(8):2155-2171.
doi: 10.1007/s13304-025-02364-1. Epub 2025 Aug 26.

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 Hilal  5 , Francesco Ardito  6 , Giammauro Berardi  7 , Ugo Boggi  8 , Alberta Cappelli  9 , Matteo Cescon  10   11 , Umberto Cillo  12 , Alessandro Cucchetti  11   13 , Luciano De Carlis  14 , Francesco De Cobelli  4   15 , Fabrizio Di Benedetto  16 , Giorgio Ercolani  11   13 , Giuseppe Maria Ettorre  7 , Massimo Fedi  17 , Alessandro Ferrero  18 , Felice Giuliante  6 , Gian Luca Grazi  19 , Enrico Gringeri  12 , Salvatore Gruttadauria  20   21 , Francesco Izzo  22 , Marcello Maestri  23 , Paolo Magistri  16 , Marco Massani  24 , Vincenzo Mazzaferro  25   26 , Riccardo Memeo  27 , Federico Mocchegiani  28 , Cristina Mosconi  9 , Damiano Patrono  29 , Matteo Ravaioli  10   11 , Fabrizio Romano  30 , Gianluca Rompianesi  31 , Nadia Russolillo  18 , Andrea Ruzzenente  32 , Carlo Sposito  25   26 , Roberto Troisi  31 , Giovanni Vennarecci  33 , Luca Viganò  34   35 , Marco Vivarelli  27 , Giacomo Zanus  36   37 , Pedro M Baptista  38   39   40   41 , Karl Oldhafer  42 , Erik Schadde  43   44   45 , Luca Aldrighetti #  3   4 , Elio Jovine #  11   46
Affiliations

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 Dec.

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.

Figures

Fig. 1
Fig. 1
Decision-making algorithm for surgical planning based on future liver remnant (FLR) volume and function. The table presents clinical recommendations according to the combined assessment of FLR volume and function. When both parameters are adequate, upfront surgery can be performed without the need for portal vein occlusion (PVO). When either or both parameters are inadequate, further clinical data (patient history, comorbidities, laboratory findings, cholestasis, age, and middle hepatic vein [MHV] resection) should be considered before proceeding. In cases of insufficient volume and function, PVO is recommended, followed by surgery once adequate values are achieved
Fig. 2
Fig. 2
Recommended future liver remnant (FLR) volume thresholds according to underlying liver parenchyma condition. FLR cut-off values are stratified for normal liver, chemotherapy-associated liver injury (CALI), cholestatic liver disease, and cirrhosis
Fig. 3
Fig. 3
Summary of surgical strategies to enhance future liver remnant according to different indications. ALPPS = Associating Liver Partition and Portal vein Ligation for Staged hepatectomy; DVE = double vein embolization; LVD = liver venous deprivation; PVE = portal vein embolization; TSH = two-stage hepatectomy
See this image and copyright information in PMC

References

    1. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724. 10.1016/j.surg.2010.10.001 - DOI - PubMed
    1. Müller PC, Linecker M, Kirimker EO et al (2021) Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: state of the art of parenchyma augmentation–assisted liver surgery. Langenbecks Arch Surg. 10.1007/s00423-021-02148-2 - DOI - PMC - PubMed
    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. 10.21037/hbsn-20-394 - DOI - PMC - PubMed
    1. Ratti F, Serenari M, Aldrighetti L et al (2023) Cornerstones and divergencies in the implementation and use of liver hypertrophy techniques in Italy: results from a nationwide survey for National Registry set up. HPB. 10.1016/j.hpb.2023.07.304 - DOI
    1. Honjo I, Suzuki T, Ozawa K et al (1975) Ligation of a branch of the portal vein for carcinoma of the liver. Am J Surg. 10.1016/0002-9610(75)90389-X - DOI - PubMed

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