Portal Inflow Modulation by Somatostatin After Major Liver Resection

Rhaiem, Rami; Piardi, Tullio; Chetboun, Mikaël; Pessaux, Patrick; Lestra, Thibaut; Méméo, Riccardo; Kianmanesh, Réza; Sommacale, Danièle

doi:10.1097/sla.0000000000002601

Cited by 26 publications

(25 citation statements)

References 11 publications

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“…In another clinical pilot study, SST was initiated intraoperatively following completion of major or extended major hepatectomy when post-resection portal pressure was >20 mmHg. The somatostatin bolus (250 µg) immediately reduced portal pressure in the majority of cases and was maintained as a continuous 250-µg/h infusion given over the course of five days [47]. In a recent update on this series, portal inflow modulation using SST was administered in 31 patients undergoing major or extended major hepatectomy for oncological indications.…”

Section: Discussionmentioning

confidence: 99%

Somatostatin Therapy Improves Stellate Cell Activation and Early Fibrogenesis in a Preclinical Model of Extended Major Hepatectomy

Hessheimer

Vengohechea

Maza

et al. 2021

Cancers

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Liver resection treats primary and secondary liver tumors, though clinical applicability is limited by the remnant liver mass and quality. Herein, major hepatic resections were performed in pigs to define changes associated with sufficient and insufficient remnants and improve liver-specific outcomes with somatostatin therapy. Three experimental groups were performed: 75% hepatectomy (75H), 90% hepatectomy (90H), and 90% hepatectomy + somatostatin (90H + SST). Animals were followed for 24 h (N = 6) and 5 d (N = 6). After hepatectomy, portal pressure gradient was higher in 90H versus 75H and 90H + SST (8 (3–13) mmHg vs. 4 (2–6) mmHg and 4 (2–6) mmHg, respectively, p < 0.001). After 24 h, changes were observed in 90H associated with stellate cell activation and collapse of sinusoidal lumen. Collagen chain type 1 alpha 1 mRNA expression was higher, extracellular matrix width less, and percentage of collagen-staining areas greater at 24 h in 90H versus 75H and 90H + SST. After 5 d, remnant liver mass was higher in 75H and 90H + SST versus 90H, and Ki-67 immunostaining was higher in 90H + SST versus 75H and 90H. As well, more TUNEL-staining cells were observed in 90H versus 75H and 90H + SST at 5 d. Perioperative somatostatin modified portal pressure, injury, apoptosis, and stellate cell activation, stemming changes related to hepatic fibrogenesis seen in liver remnants not receiving treatment.

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Section: Discussionmentioning

confidence: 99%

Somatostatin Therapy Improves Stellate Cell Activation and Early Fibrogenesis in a Preclinical Model of Extended Major Hepatectomy

Hessheimer

Vengohechea

Maza

et al. 2021

Cancers

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“…38 Even if the prognostic impact of tumor margin is still debated, at the second stage (minor hepatectomy), the risk of a positive margin is limited by the hypertrophy induced by the first stage. [39][40][41][42] And to better control risk of liver insufficiency following major hepatectomy, some options seem interesting in terms of modulation of the portal flow such as pharmacological 43 or mechanical or hemodynamic modulation with vascular ring. 44…”

Section: Discussionmentioning

confidence: 99%

Major hepatectomy decreased tumor growth in an experimental model of bilobar liver metastasis

Schwarz

Nicol

Audigier

et al. 2020

HPB

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Background/Purpose: Two-stage hepatectomy (TSH), is associated with a risk of drop-out due to tumoral progression following portal vein occlusion (PVO). We explored the impact of majorhepatectomy on tumor growth by objective radiological measures comparing to PVO and minor hepatectomy, using a model of bilobar colorectal liver metastasis (CLM).Methods: CLM were induced in 48 BDIX rats by injection of DHDK12-cells. 7 days after cells injection, animals were distributed into 4 groups of equal number (n = 12): portal vein ligation (PVL), sham laparotomy (sham), minor (30%Phx) and major (70%Phx) hepatectomy. MR imaging was used for in vivo analysis of tumor implantation, growth and volumes.Results: At POD10, tumour volumes were homogeneously distributed among the 4 groups. Lower TV were significantly observed after 70%Phx comparing to PVL at POD17 (0.63 ± 0.14cm3 vs 0.9 ± 0.16cm3, p = 0.008) and to the 3 others groups at POD24: 1.78 ± 0.38cm3 vs 3.2 ± 0.62cm3 (PVL, p = 0.019), 2.41 ± 0.74cm3 (Sham, p = 0.024) and 2.32 ± 0.59cm3 (30%PHx, p = 0.019). Conclusion:We confirmed in a reproducible model that contrary to PVO, a major hepatectomy decreases the growth of CLM in the remnant liver. This result leads to questioning the usual TSH and justifies exploring alternative strategies. The "major hepatectomy first-approach" should be an option to be evaluated.

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“… [125] , [126] , [127] Somatostatin use in the intra-and postoperative period was found to have a positive effect on portal inflow during major hepatectomy in a recent but small series. 128 These results must be confirmed and somatostatin's impact on postoperative complications still needs to be determined in further randomised trials. …”

Section: Perioperative Managementmentioning

confidence: 97%

New frontiers in liver resection for hepatocellular carcinoma

et al. 2020

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Liver resection is one of the main curative options for early hepatocellular carcinoma (HCC) in patients with cirrhosis and is the treatment of choice in non-cirrhotic patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. In the last decades, improved surgical techniques and perioperative management, as well as better patient selection, have enabled the indications for liver resection to be expanded. In this review, we aim to describe the main indications for liver resection in the management of HCC, its role compared to percutaneous ablation and liver transplantation in the therapeutic algorithm, as well as the recent advances in liver surgery that could be used to improve the prognosis of patients with HCC.

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Portal Inflow Modulation by Somatostatin After Major Liver Resection

Cited by 26 publications

References 11 publications

Somatostatin Therapy Improves Stellate Cell Activation and Early Fibrogenesis in a Preclinical Model of Extended Major Hepatectomy

Somatostatin Therapy Improves Stellate Cell Activation and Early Fibrogenesis in a Preclinical Model of Extended Major Hepatectomy

Major hepatectomy decreased tumor growth in an experimental model of bilobar liver metastasis

New frontiers in liver resection for hepatocellular carcinoma

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