Analysis Of Key Factors Associated With Liver Regeneration After Hepatectomy

Objective: Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)provides a curative opportunity for patients with giant hepatocellular carcinoma.The regenerative volume of remnant liver after portal vein ligation is an important factor for the successful implementation of ALPPS,but liver hyperplasia in some patients after associating liver partition and portal vein ligation is not satisfactory.This study analyzes the key factors associated with liver regeneration after hepatectomy,aiming to promote the successful implementation of ALPPS in patients with giant hepatocellular carcinoma.Methods: The clinicopathologic records of 45 patients with large hepatocellular carcinoma who underwent hemihepatectomy from January 2012 to July 2016 in Tongji Hospital were studied retrospectively.All patients performed contrast-enhanced computed tomography(CT)before and approximately 3-5 months after hemihepatectomy,then 3D images of liver were reconstructed by uploading CT imaging data to IQQA-liver system.Total liver volume,remnant liver volume,future liver remnant volume were calculated.We analyzed the factors associating with liver regeneration in left hemihepatectomy group and right hemihepatectomy group separately.We divided patients who underwent right hemihepatectomy into two groups according to the Laennec fibrosis scoring system.The liver regeneration was analyzed between the group of fibrosis and the group of cirrhosis.Then we made a further analysis of the factors associating with obvious liver regeneration in the right hemihepatectomy group,which was divided by the median of regeneration rate.Results: The remnant liver volume/total liver volume ratio was negatively correlated with the liver regeneration rate after hemihepatectomy(r=-0.573,p=0.001).Cirrhosis,albumin,hepatitis B virus DNA level and portal vein diameter were factors associated with liver regeneration in the right hemihepatectomy group.The average regeneration rate in the group of fibrosis was 82.59%;37.23% in the group of cirrhosis.Patients in the group of fibrosis had significantly higher regeneration rate than those in the group of cirrhosis(p=0.037).The average regeneration rate in the group of albumin<35g/L was 29.29%;79.41% in the group of albumin?35g/L.Patients in the group of albumin?35g/L had significantly higher regeneration rate than those in the group of albumin<35g/L(p=0.014).The average regeneration rate in the group of hepatitis B virus DNA level<104IU/ml was 89.14%%;38.59% in the group of hepatitis B virus DNA level?104IU/ml.Patients in the group of hepatitis B virus DNA level<104IU/ml had significantly higher regeneration rate than those in the group of hepatitis B virus DNA level?104IU/ml(p=0.037).The average regeneration rate in the group of portal vein diameter<1.3cm was 85.22%;31.98% in the group of portal vein diameter?1.3cm.Patients in the group of portal vein diameter<1.3cm had significantly higher regeneration rate than those in the group of portal vein diameter?1.3cm(p=0.013).In the right hemihepatectomy group,the hepatic regeneration was obvious in patients with no cirrhosis and albumin?35g/L.In the left hemihepatectomy group,all these factors had no statistic influence on liver regeneration.Conclusion: The remnant liver volume/total liver volume ratio and cirrhosis were key factors associated with liver regeneration.In addition,albumin,hepatitis B virus DNA level and portal vein diameter can also influence hepatic regeneration.All these factors ought to be taken in consideration before operation,in order to achieve the purpose of radical resection of giant hepatocellular carcinoma by ALPPS.