maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.

Correction to “Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model [World J Gastroenterol 2018 March 14; 24(10): 1107-1119]”

Correction to:Tong YF,Meng N,Chen MQ,Ying HN,Xu M,Lu B,Hong JJ,Wang YF,Cai XJ.Maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model(World J Gastroenterol 2017;24(10):1107-1119)[1].Erratum:In the“Conclusion of Abstract”,“Core tip”,“Discussion”and“Research perspectives”,the description regarding the relationship between the volumetric and functional proliferation during ALPPS-derived liver regeneration should be revised.Specifically,the sentence that reads“as the ALPPS-derived proliferation in volume lags behind the functional regeneration”should be revised to“as the ALPPS-derived functional regeneration lags behind the proliferation in volume”.

Is Laparoscopic Hepatectomy a Safe, Feasible Procedure in Patients with a Previous Upper Abdominal Surgery？

Background： Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial.The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.Methods： Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study.They were divided into two groups： Those with previous upper abdominal surgery （PS group, n =42） and a control group with no previous upper abdominal surgery （NS group, n =294）.Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.Results： There was no significant difference in median operative duration between the PS group and the NS group （180 min vs.160 min, P =0.869）.Median intraoperative blood loss was same between the PS group and the control group （200 ml vs.200 ml, P =0.907）.The overall complication rate was significantly lower in the NS group than in the PS group （17.0% vs.31.0%, P =0.030）.Mortality and other short-term outcomes did not differ significantly between groups.Conclusions： Our study showed no significant difference between the PS group and NS group in term of short-term outcomes.Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.