Observations on liver regeneration after right hepatic lobectomy

Blumgart, Leslie H.; Leach, K. G.; Karran, S. J.

doi:10.1136/gut.12.11.922

Cited by 51 publications

(21 citation statements)

References 10 publications

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“…Moreover, we found that the satisfactory outcome group had a high portal velocity on PODs 1 to 3 (more than twice the preoperative value), which then decreased gradually. This marked change might correspond to the period of rapid regeneration of the remnant liver identified in a previous study [21], which showed that liver regeneration was well advanced in humans within 10 days after right hepatectomy.…”

Section: Discussionmentioning

confidence: 74%

Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy

et al. 1994

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In 17 consecutive patients who underwent major hepatic resection, 9 of whom with combined resection of the gastrointestinal tract or the pancreatic head (or both), postoperative hepatic blood flow was investigated. In this study, the patients were classified into two groups according to their postoperative serum total bilirubin level: Group A comprised 7 patients with the level higher than 7 mg/dl for more than 1 week postoperatively, and group B comprised 10 patients who did not meet this criterion. For 2 weeks after surgery, the portal blood flow velocity, the hepatic artery resistive index (RI) calculated from the changes in Doppler frequency shifts, and the hepatic venous blood flow velocity were measured intermittently using color Doppler ultrasonography. Liver volume was assessed by computed tomography to provide the restoration. Significant differences in portal blood flow velocity and hepatic artery RI were noted between the two groups from the third postoperative day. In group A the portal blood flow velocity decreased below the preoperative value, and the hepatic artery RI increased above 0.75. In contrast, group B showed high portal blood flow velocity and low hepatic artery RI. In both groups the RI correlated significantly with the total bilirubin level (r = 0.74; p < 0.0001), and the growth rate of the remnant liver was proportional to the mean postoperative portal blood flow velocity (r = 0.70; p = 0.016). We concluded that measurement of the portal blood flow velocity and hepatic artery RI can be useful for predicting postoperative liver dysfunction and liver regeneration after major hepatic resection.

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Section: Discussionmentioning

confidence: 74%

Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy

et al. 1994

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“…[48] The observation that the majority of the regeneration process occurs within 10 days of resection in healthy patients was reported in 1971. [49,50] Fig. 5 provides an example of hepatic regeneration in a patient who underwent an extended right hepatic resection.…”

Section: Assessment Of Liver Function and Regenerative Capacitymentioning

confidence: 99%

Surgical Management of Hepatic Malignancy

Kooby

Jarnagin

2004

Cancer Investigation

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Over the past twenty-five years, hepatic resection has evolved from a high risk, resource-intensive procedure with limited application to a safe and commonly performed operation with broad indications. This period has seen dramatic improvements in perioperative outcome, including reductions in mortality, blood loss, transfusion rates, and hospital stay. These improved perioperative results are largely responsible for the emergence of hepatic resection as a viable and effective treatment option for selected patients with 1 degree and 2 degrees hepatobiliary malignancy. Continued advances in imaging technology, along with a heightened awareness of the clinical and tumor-related variables that dictate outcome, have allowed better preoperative assessment of disease extent and improved patient selection. Advances in other areas, such as minimally invasive and ablative techniques, have increased the treatment options and have had some impact on the approach to patients with malignant hepatobiliary disease; however, resection remains the most effective therapy. Although the long term results after resection are better than with other modalities, recurrence rates remain high, and further improvements in survival will require more effective systemic agents. As better adjuvant and neo-adjuvant therapies emerge, the results of resection are likely to improve and the indications for its application perhaps will extend to patients currently considered to have unresectable disease.

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“…Better techniques of resuscitation and surgery have undoubtedly improved the once very serious prognosis in this situation. Blumgart & Vajrabukka (1972) reviewed forty-four cases of closed injury of the abdomen requiring laparotomy. Thirty-five of these were due to motor vehicle accidents; twenty of the forty-four cases had liver injuries, and in eighteen of these there were associated injuries, particularly to the head chest and skeletal system.…”

Section: Liver and Biliary Systemmentioning

confidence: 99%

“…Blumgart, Leach & Karran (1971) have made some interesting observations on their five patients after right hepatic lobectomy, which effects an approximate 50%. resection of liver substance.…”

Section: Liver and Biliary Systemmentioning

confidence: 99%

Annual review of surgery 1972

Ellis

1973

Postgraduate Medical Journal

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Observations on liver regeneration after right hepatic lobectomy

Cited by 51 publications

References 10 publications

Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy

Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy

Surgical Management of Hepatic Malignancy

Annual review of surgery 1972

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