A retrospective study on the key factors that influence the liver regeneration after the stage-1 associating liver partition and portal ligation for staged hepatectomy

Objective As seen in literature, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could promote the rapid regeneration of the future liver remnant (FLR). One reason is that occluded portal ligation could significantly increase the portal blood supply of the remaining liver. Another reason is that it might be provoked by dividing liver. Yet, the leading reason remains unclear. By retrospective study, we aim to find out whether it is the hepatic blood inflow that plays key role in this process. Methods From June 2014 to June 2016, thirteen patients received ALPPS at our department, among whom 5 patients accepted complete ALPPS(complete ALPPS group), and 8 patients accepted partial ALPPS. The correlation with the regeneration of the FLR was evaluated. The time interval between stage-1 ALPPS and stage-2 ALPPS and other clinical data were compared between partial ALPPS and complete ALPPS. Results One patient with moderate cirrhosis in the complete ALPPS group had absent hypertrophy of FLR due to recanalization of the ligated right portal vein but his FLR augmented significantly after repeated transcatheter arterial chemoembolization (TACE). After stage-1 ALPPS, the FLR of other twelve patients increased significantly; partial ALPPS promotes the regeneration of FLR much slower than complete ALPPS, and the time interval between stage-1 ALPPS and stage-2 ALPPS was (10.0±1.6) days for complete ALPPS and (31.3±5.2) days for partial ALPPS respectively, indicating statistical significance (P<0.001). Conclusion Recanalization of the portal vein, the intrahepatic portal collaterals after partial ALPPS that divert portal blood from FLR could slow down the augment of FLR; transcatheter arterial embolization (TAE) could increase arterial blood supply to FLR and promote the regeneration of FLR. Less invasive portal vein occlusion and TAE might replace ALPPS to promote the regeneration of the FLR. Hepatic blood supply is probably the key factor that influences the regeneration of the FLR after ALPPS.