Two-Stage Portal Vein Ligation Facilitates Liver Regeneration in Rats

Abstract

Background/Aims: Recent reports have demonstrated that some patients are unable to undergo scheduled liver resection after preoperative portal vein embolization due to insufficient hypertrophy of the future remnant liver. The present study examined whether two-stage portal vein ligation (PVL) increases hypertrophy of the future remnant liver compared to conventional PVL in rats. Methods: Rats were divided into 3 groups: group A, ligation of left primary branch; group B, ligation of right and left primary branches; group C, ligation of the left primary branch, followed by 2-stage PVL 7 days postoperatively. To evaluate liver regeneration, the proliferating cell nuclear antigen labeling index (LI), mitotic index (MI) in the caudate lobe and weight ratio of caudate lobe to body weight were measured. Results: The weight ratio of caudate lobe to body weight was significantly higher in group C than in groups A or B 14 days postoperatively. In groups A and B, LI and MI in the caudate lobe peaked 2 days postoperatively, then decreased to preoperative levels by 7–8 days postoperatively, but remained significantly elevated until 10–14 days postoperatively in group C. Conclusion: Two-stage PVL increases hypertrophy of the future remnant liver compared to conventional PVL in rats.

Assessment of remnant liver function and volume after selective ligation of portal vein and hepatic artery in a rat model

“…In this study, undertaken with vascular ligation, average rates of regeneration of 302% and of 399% were obtained in groups III and IV, respectivelly (Table 2), with hypertrophied liver increasing in group III and group IV, reaching 78% and 50% of the overall liver weight, respectively (R1 rate in Figure 3), in seven days. Literature data confirm such findings, as presented by Sugimoto et al 16 . Liu and Zhu 9 performed portal vein embolization and have shown regeneration rates of 20% and 46%, within 2 and 8 weeks respectively, in remnant liver volume.…”

Additional partial hepatectomy at the time of portal vein ligation accelerates the regeneration of the future liver remnant

“…Two-stage PVL, 70%PVL followed by the second 20%PVL seven days later, was established by Sugimoto et al This new strategy was proven to induce more hypertrophy in the FLR compared to the conventional one-stage PVL 30 . Ren et al performed simultaneous bile duct and portal vein ligation in a rat model.…”

Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function

“…Several combined procedures were introduced to better understand regulation of liver regeneration. Sequential procedures include repeated hepatectomy and 2-stage PVL to elucidate the proliferative capacity of the regenerating liver (Saito et al, 2006;Sugimoto et al, 2009). The impact of obstructive jaundice on liver regeneration was studied by first performing bile duct ligation 1 week prior to liver resection (Li 2014).…”