Akhaladze DG*, Rabaev GS, Merkulov NN, Tverdov IV and Grachev NS

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of Health of Russian Federation, Moscow, Russian Federation

*Corresponding Author: Akhaladze DG, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of Health of Russian Federation, Moscow, Russian Federation.

Received: June 10, 2021; Published: July 13, 2021

Abstract

Two-staged liver resections with portal vein embolization or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are proven as an alternative to liver transplantation in adult patients. The widespread application of two-staged hepatectomies is associated with a high incidence of posthepatectomy liver failure (PHLF) after major liver resections. Nevertheless, two-stage resections are also characterized by a large number of complications, including PHLF due to the insufficient regeneration time or on the contrary the disease progression due to increased time between procedure stages. Insufficient values of the future liver remnant volume (FLR-V) or future liver remnant function (FLR-F) are the main limitations for single-stage hepatectomy. Wherein the future liver remnant function assessment has a greater sensitivity among adult patients. The lack of the data about the PHLF in pediatric patients and application of the FLR-V with a minimal borderline 25% as indications for two-stage liver resections, as well as the lower incidence of chronic concomitant diseases, suggest a greater significance of the liver functional capacity in children and the possibility to perform major liver resections in cases when FLR-V is less than allowable but FLR-F is sufficient. This is the first report describes how much FLR-V should be necessary in pediatric patients and confirms the possibility to wider perform one-stage liver resections in pediatric oncology without the risk of PHLF depending on the future liver remnant function assessment.

Keywords: Posthepatectomy Liver Failure; ALPPS; Hepatobiliary Scintigraphy; Future Liver Remnant Function; Future Liver Remnant Volume; Children

References

1. Clavien PA., et al. “Strategies for Safer Liver Surgery and Partial Liver Transplantation”. The New England Journal of Medicine 15 (2007): 1545-1559.
2. Van Den Broek M., et al. “Liver failure after partial hepatic resection: Definition, pathophysiology, risk factors and treatment”. Liver International6 (2008): 767-780.
3. Vauthey JN., et al. “Standardized measurement of the future liver remnant prior to extended liver resection: Methodology and clinical associations”. Surgery5 (2000): 512-519.
4. Kauffmann R and Fong Y. “Post-hepatectomy liver failure”. Hepatobiliary Surgery and Nutrition 5 (2014): 238-246.
5. Olthof PB., et al. “99mTc-mebrofenin hepatobiliary scintigraphy predicts liver failure following major liver resection for perihilar cholangiocarcinoma”. Hpb10 (2017): 850-858.
6. Balzan S., et al. “The “50-50 criteria” on postoperative day 5: An accurate predictor of liver failure and death after hepatectomy”. Annals of Surgery6 (2005): 824-829.
7. Rahbari NN., et al. “Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)”. Surgery5 (2011): 713-724.
8. Chan A., et al. “Little girl who conquered the “ALPPS”. World Journal of Gastroenterology29 (2014): 10208-10211.
9. Ribero D., et al. “Preoperative cholangitis and future liver remnant volume determine the risk of liver failure in patients undergoing resection for hilar cholangiocarcinoma”. Journal of the American College of Surgeons 1 (2016): 87-97.
10. Matsuo K., et al. “Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization”. Surgery5 (2016): 1289-1298.
11. Sandstrom P., et al. “ALPPS Improves Resectability Compared with Conventional Two-stage Hepatectomy in Patients with Advanced Colorectal Liver Metastasis: Results from a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial)”. Annals of Surgery5 (2018): 833-840.
12. Yokoyama Yu., et al. “Mechanism of impaired hepatic regeneration in cholestatic liver”. Journal of Hepato-Biliary-Pancreatic Sciences 14 (2007): 159-166.
13. Chan A., et al. “ALPPS Versus Portal Vein Embolization for Hepatitis-related Hepatocellular Carcinoma”. Annals of Surgery 20 (2019): 1-9.
14. de Graaf W., et al. “Nuclear imaging techniques for the assessment of hepatic function in liver surgery and transplantation”. The Journal of Nuclear Medicine 5 (2010): 742-752.
15. Olthof PB., et al. “Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy: Liver volume overestimates liver function”. Surgery4 (2017): 775-783.
16. Chapelle T., et al. “Future remnant liver function estimated by combining liver volumetry on magnetic resonance imaging with total liver function on 99mTc-mebrofenin hepatobiliary scintigraphy: Can this tool predict post-hepatectomy liver failure?” HPB6 (2016): 494-503.
17. Rassam F., et al. “Quantitative assessment of liver function using hepatobiliary scintigraphy: The effect of microcirculatory alterations after portal vein embolization”. Nuclear Medicine Communications 7 (2019): 720-726.

Citation

Citation: Akhaladze DG. “Prognostic Value of the Future Liver Remnant Function Before Extensive Liver Resection in a Child with an Extremely Low Future Liver Remnant Volume”. Acta Scientific Cancer Biology 5.8 (2021): 27-31.

Copyright

Copyright: © 2021 Akhaladze DG. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.