gms | German Medical Science

Introduction: Extended liver resection require to induce liver regeneration in the future liver remnant (FLR).

We hypothesize that

1.

increasing the size of the portally deprived lobe,

2.

performing an additional liver resection

would increase regeneration of the future remant liver.

Material and methods: Three extent of atrophy (20%PVL, 70%PVL and 90%PVL) and its effect on liver regeneratgion of future remnant were compared; Besides, comparision of effect after additional resection of different size were performed.

Results: Concurrent regenerative stimuli either induced by an extended PVL or an additional small to moderate resection induces liver regeneration in the atrophying liver lobe and limits regeneration of FLR in a size dependent way:

1.

Atrophy is high when depriving small (20%) or moderate amount (70%) of liver mass from portal blood supply.

2.

Portal deprivation large amount (90%)of liver mass acts as a regenerative stimulus not only for the FLR, but also for the portally deprived lobe itself.

3.

Small (20%) resection induces low level of proliferation in ligated lobe, but does not impair regeneration of the FLR.

4.

Large (70%) resection induces high level of proliferation in ligated lobe, but does reduce regeneation of FLR.

Conclusion: Size increase and liver regeneration of the future liver remnat after PVL is dependent on the combined action of atrophic and regenerative stimuli. These findings speak against portal hypertension and shear stress as key mechanism initiating liver regeneration, since even a portally-deprived lobe undergoes regeneration albeit following a different kinetic than after liver resection.