Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function

Abstract

We compared liver volume and function kinetics after partial hepatectomy according to extent of resection and severity of coexisting liver disease in 57 adults with uneventful postoperative courses. Liver volume and massiveness of resection, or resection rate, were estimated on computed tomography. Patients were categorized into three groups on the basis of reaction rate: small (< 30%), medium (30%-50%) and large (> 50%). The regenerative patterns of normal livers in the medium and large groups consisted of three phases: a rapid increase during the first month, some decrease in the second month and a final, slower increase. This contrasted with the pattern of injured livers with chronic hepatitis or cirrhosis, which generally showed a phase of less rapid, gradual increase. The regeneration rate (volume gain, cm3/day) during the first month was found to be proportional to resection rate in the presence or absence of liver disease. Normal livers regenerated at least twice as rapidly as injured livers in patients with comparable resection rates. Normal livers reached plateau levels within 1 to 2 mo regardless of the massiveness of resection, whereas regeneration took 3 to 5 mo in injured livers. Liver function (albumin, bilirubin) recovered concomitantly with liver volume in the medium group, whereas in the large group they generally returned to their initial values behind volume restoration, particularly in cirrhotic patients. In conclusion, human liver regeneration is strongly influenced by the massiveness of the resection and presence of coexisting liver disease. However, we found that some cirrhotic livers can regenerate, albeit more slowly and less completely, as long as the extent of hepatectomy remains within safe functional limits.

Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy

“…Although it is well established that partial hepatectomy induces hypertrophy of the liver,[19-28] we found that partial hepatectomy of the FLR prior to PVE did not accelerate but rather impaired hypertrophy induced by PVE. This finding can be explained by 3 separate findings previously reported in the literature.…”

“…First, the effect of liver regeneration after hepatectomy is to revert the volume to the preoperative status, not to surpass the original volume. [19, 21, 23, 24] Second, complete regeneration of the resected liver generally takes 6 months [23, 28] to 1 year [25, 26] after surgery. Finally, a positive correlation has been found between resection volume and hypertrophy of the liver after hepatectomy, and a small resection does not trigger liver hypertrophy.…”

Remnant Growth Rate after Portal Vein Embolization Is a Good Early Predictor of Post-Hepatectomy Liver Failure

“…27, 28 Other possible factors include chronic liver disease, 22, 29 diabetes, 30, 31 and chemotherapy, 32, 33 although these have not been consistently shown to be significant. 34–36 More recent studies have not found chemotherapy to be associated with poor growth. 11, 27, 37–39 …”

Liver Planning Software Accurately Predicts Postoperative Liver Volume and Measures Early Regeneration

“…For nearly 30 years, CT volumetry has been used to study liver regeneration after major hepatic resection for liver donation and resection of malignant tumors (30-32). The rate of hepatic regeneration in normal livers is thought to start with a rapid increase in the first two weeks after surgery, followed by a decrease (possibly due to reduction in edema), and a slow and steady increase (32, 33), and is influenced by liver function (30, 33, 34) and obesity (35). Whether the extent of resection correlates with regeneration rate is debatable (27, 33).…”