Abstract
Background
Associating liver partition and portal vein ligation for staged hepatectomy induces
rapid and effective hypertrophy of the future liver remnant to prevent postoperative
liver failure. The aim of this study was to determine cofactors, including sarcopenia,
influencing the kinetic growth rate, and subsequently future liver remnant, in terms
of safety, complications, and posthepatectomy liver failure.
Method
Patients undergoing associating liver partition and portal vein ligation for staged
hepatectomy between 2010 and 2020 were included in this study. Kinetic growth rate
was defined as the quotient of the degree of hypertrophy and the time interval between
the 2 steps. The sarcopenia muscle index was defined as the skeletal muscle area of
both psoas major muscles normalized to the patient’s height.
Results
During the study period, 90 patients underwent associating liver partition and portal
vein ligation for staged hepatectomy. The association between kinetic growth rate
and posthepatectomy liver failure indicates a significant nonlinear effect (P = .02). The incidence of posthepatectomy liver failure significantly increased at
a kinetic growth rate below 7% per week (31%) compared to patients with a kinetic
growth rate >7%/wk (7%, P = .02). In patients with a low kinetic growth rate (<7%/wk), the sarcopenia muscle
index was significantly lower compared to patients with a high kinetic growth rate
(>7%/wk). Furthermore, a low sarcopenia muscle index and a high body mass index turned
out to be independent risk factors for a low kinetic growth rate.
Conclusion
After the first step of the associating liver partition and portal vein ligation for
staged hepatectomy procedure, a low kinetic growth rate (<7%/wk) increases the risk
of posthepatectomy liver failure. The presence of a low sarcopenia muscle index and
a high body mass index are profoundly correlated with clinically substantial impaired
liver regeneration, which can result in increased liver dysfunction after associating
liver partition and portal vein ligation for staged hepatectomy.
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References
- Partial ALPPS versus complete ALPPS for staged hepatectomy.BMC Gastroenterol. 2019; 19: 170
- Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings.Ann Surg. 2012; 255: 405-414
- Operative results and oncologic outcomes of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus two-stage hepatectomy (TSH) in patients with unresectable colorectal liver metastases: a systematic review and meta-analysis.World J Surg. 2018; 42: 806-815
- Complex liver resections for intrahepatic cholangiocarcinoma.J Clin Med. 2021; 10: 1672
- Dealing with an insufficient future liver remnant: portal vein embolization and two-stage hepatectomy.J Surg Oncol. 2019; 119: 594-603
- The future liver remnant: definition, evaluation, and management.Am Surg. 2021; 87: 276-286
- A nomogram to predict hypertrophy of liver segments 2 and 3 after right portal vein embolization.J Gastrointest Surg. 2016; 20: 1317-1323
- Prediction of the remnant liver hypertrophy ratio after preoperative portal vein embolization.Eur Surg Res. 2013; 51: 129-137
- Influence of chemotherapy on liver regeneration induced by portal vein embolization or first hepatectomy of a staged procedure for colorectal liver metastases.J Gastrointest Surg. 2010; 14: 359-368
- Overall body composition and sarcopenia are associated with poor liver hypertrophy following portal vein embolization.J Gastrointest Surg. 2021; 25: 405-410
- Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization-the effect of collaterals on embolized liver volume.Br J Radiol. 2016; 89: 20160306
- Liver regeneration after major liver hepatectomy: impact of body mass index.Surgery. 2016; 160: 81-91
- Liver kinetic growth rate predicts postoperative liver failure after ALPPS.HPB (Oxford). 2016; 18: 800-805
- Correlation between sarcopenia and growth rate of the future liver remnant after portal vein embolization in patients with colorectal liver metastases.Cardiovasc Interven Radiol. 2020; 43: 875-881
- A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people.J Nutr Health Aging. 2014; 18: 277-283
- Sarcopenia.Lancet. 2019; 393: 2636-2646
- al. Sarcopenia with limited mobility: an international consensus.J Am Med Dir Assoc. 2011; 12: 403-409
- al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): screening, diagnosis and management.J Nutr Health Aging. 2018; 22: 1148-1161
- Sarcopenia: definition, epidemiology, and pathophysiology.J Bone Metab. 2013; 20: 1
- Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis.HPB (Oxford). 2011; 13: 439-446
- Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma.Ann Surg. 2015; 261: 1173-1183
- Sarcopenia negatively affects preoperative total functional liver volume in patients undergoing liver resection.HPB (Oxford). 2013; 15: 165-169
- A multicenter study to define sarcopenia in patients with end-stage liver disease.Liver Transpl. 2017; 23: 625-633
- Sarcopenia is a negative prognostic factor after curative resection of colorectal cancer.Ann Surg Oncol. 2015; 22: 2663-2668
- Cellular and molecular mechanisms of sarcopenia: the S100B perspective.J Cachexia Sarcopenia Muscle. 2018; 9: 1255-1268
- Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.Lancet Oncol. 2008; 9: 629-635
- L3 skeletal muscle index (L3SMI) is a surrogate marker of sarcopenia and frailty in non-small cell lung cancer patients.Cancer Manag Res. 2019; 11: 2579-2588
- Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS).Surgery. 2011; 149: 713-724
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- The Comprehensive Complication Index.Ann Surg. 2013; 258: 1-7
- Body surface area and body weight predict total liver volume in Western adults.Liver Transpl. 2002; 8: 233-240
- Simplified calculation of body-surface area.N Engl J Med. 1987; 317: 1098
- Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations.Surgery. 2000; 127: 512-519
- Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant.J Am Coll Surg. 2013; 216: 201-209
- Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population.Eur J Clin Nutr. 2018; 72: 288-296
- Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome.Br J Surg. 2007; 94: 1386-1394
- Current Knowledge about the effect of nutritional status, supplemented nutrition diet, and gut microbiota on hepatic ischemia-reperfusion and regeneration in liver surgery.Nutrients. 2020; 12: 284
- Liver regeneration: mechanisms and models to clinical application.Nature Rev Gastroenterol Hepatol. 2016; 13: 473-485
- Effects of exercise and aging on skeletal muscle.Cold Spring Harb Perspect Med. 2018; 8: a029785
- Randomized clinical trial of prehabilitation before planned liver resection.Br J Surg. 2016; 103: 504-512
- The effects of physical prehabilitation: Improved liver regeneration and mitochondrial function after ALPPS operation in a rodent model.J Hepatobiliary Pancreat Sci. 2021; 28: 692-702
- The technique of 3D reconstruction combining with biochemistry to build an equivalent formula of indocyanine green (ICG) clearance test to assess the liver reserve function.BMC Surg. 2020; 20: 283
- Biliary leak in the postsurgical abdomen: a primer to HIDA scan interpretation.Semin Nucl Med. 2017; 47: 618-629
- Dosing of antimycotic treatment in sepsis-induced liver dysfunction by functional liver testing with LiMAx®.Case Rep Crit Care. 2019; 2019: 5362514
Article info
Publication history
Published online: May 21, 2022
Accepted:
April 12,
2022
Footnotes
Tim Reese and Clemens Galavics contributed equally.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
