Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 888-896
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.888
Should temporary extracorporeal continuous portal diversion replace meso/porta-caval shunts in “small-for-size” syndrome in porcine hepatectomy?
Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan
Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
Author contributions: Tan JW designed the research; Wang DD, Xu Y and Zhu ZM performed the research; Tan XL, Tu YL and Han MM analyzed the data; and Wang DD wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing-Wang Tan, MD, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, 51 FuCheng Road, Haidian District, Beijing 100048, China. jingwangtan@126.com
Telephone: +86-10-66848633 Fax: +86-10-66848634
Received: April 4, 2014
Peer-review started: April 6, 2014
First decision: June 10, 2014
Revised: July 3, 2014
Accepted: September 5, 2014
Article in press: September 5, 2014
Published online: January 21, 2015
Abstract

AIM: To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion (ECPD) to relieve portal hyperperfusion in “small-for-size” syndrome following massive hepatectomy in pigs.

METHODS: Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into the control group (n = 7) and diversion group (n = 7). In the diversion group, portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump. After filtration, the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein. With the conversion pump, portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 mL/min. Portal hemodynamics, injury, and regeneration in the liver remnant were compared between the two groups.

RESULTS: Compared to the control group, porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure (PVP); the portal vein flow (PVF), hepatic artery flow (HAF), and PVP in the two groups were not significantly different at baseline; however, the PVF (431.8 ± 36.6 vs 238.8 ± 29.3, P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6, P < 0.01) and PVP (13.8 ± 2.6 vs 8.7 ± 1.4, P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3, P < 0.05) in the control group were significantly higher than those in the diversion group, respectively. The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy, and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes, increased the regeneration index of the liver remnant, and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.

CONCLUSION: ECPD, which can dynamically modulate portal inflow, can reduce injury to the liver remnant and facilitate liver regeneration, and therefore should replace permanent meso/porta-caval shunts in “small-for-size” syndrome.

Keywords: Small-for-size syndrome, Extracorporeal continuous porta-caval diversion, Massive hepatectomy, Regeneration

Core tip: Meso/porta-caval shunts have usually been adopted to relieve portal hyperperfusion in “small-for-size” syndrome (SFSS) or postoperative liver failure; however, these methods cannot dynamically adjust portal inflow to affect “functional competition”. In this study, extracorporeal continuous porta-caval diversion was temporarily adopted to relieve hyperperfusion, dynamically adjust the effect of portal inflow towards functional competition, and preserve optimal portal inflow. This also reduces injury to the sinusoidal endothelium, decreases endotoxin/bacterial translocation, and facilitates liver regeneration in SFSS after massive hepatectomy, and therefore could replace permanent meso/porta-caval shunts, which have no benefit or harm towards liver regeneration in late stages.