Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2016; 22(33): 7613-7624
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7613
Mechanistic insights of rapid liver regeneration after associating liver partition and portal vein ligation for stage hepatectomy
Demetrios Moris, Spyridon Vernadakis, Alexandros Papalampros, Michail Vailas, Nikolaos Dimitrokallis, Athanasios Petrou, Dimitrios Dimitroulis
Demetrios Moris, Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Spyridon Vernadakis, Alexandros Papalampros, Michail Vailas, Nikolaos Dimitrokallis, Athanasios Petrou, Dimitrios Dimitroulis, Laikon General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; Moris D, Vernadakis S, Papalampros A and Dimitroulis D designed the study; Moris D, Petrou A and Dimitroulis D performed the article search and retrieval; Moris D, Vernadakis S and Dimitrokallis N analyzed the data; Moris D wrote the paper; and Vailas M and Dimitrokallis N revised the manuscript; and Dimitroulis D supervised the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
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: Demetrios Moris, MD, PhD, Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Ave., NE60, Cleveland, OH 44195, United States. dimmoris@yahoo.com
Telephone: +1-216-4442574 Fax: +1-216-4454658
Received: April 23, 2016
Revised: June 9, 2016
Accepted: July 6, 2016
Published online: September 7, 2016
Abstract
AIM

To highlight the potential mechanisms of regeneration in the Associating Liver Partition and Portal vein ligation for Stage hepatectomy models (clinical and experimental) that could unlock the myth behind the extraordinary capability of the liver for regeneration, which would help in designing new therapeutic options for the regenerative drive in difficult setup, such as chronic liver diseases. Associating Liver Partition and Portal vein ligation for Stage hepatectomy has been recently advocated to induce rapid future liver remnant hypertrophy that significantly shortens the time for the second stage hepatectomy. The introduction of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in the surgical armamentarium of therapeutic tools for liver surgeons represented a real breakthrough in the history of liver surgery.

METHODS

A comprehensive literature review of Associating Liver Partition and Portal vein ligation for Stage hepatectomy and its utility in liver regeneration is performed.

RESULTS

Liver regeneration after Associating Liver Partition and Portal vein ligation for Stage hepatectomy is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling.

CONCLUSION

Associating Liver Partition and Portal vein ligation for Stage hepatectomy represents a real breakthrough in the history of liver surgery because it offers rapid liver regeneration potential that facilitate resection of liver tumors that were previously though unresectable. The jury is still out though in terms of safety, efficacy and oncological outcomes. As far as Associating Liver Partition and Portal vein ligation for Stage hepatectomy -induced liver regeneration is concerned, further research on the field should focus on the role of non-parenchymal cells in liver regeneration as well as on the effect of Associating Liver Partition and Portal vein ligation for Stage hepatectomy in liver regeneration in the setup of parenchymal liver disease.

Keywords: Liver regeneration, Associating liver partition with portal vein ligation for staged hepatectomy, Portal vein embolization, Portal vein ligation, Liver transection

Core tip: It seems that liver regeneration after associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) is a combination of portal flow changes and parenchymal transection that generate a systematic response inducing hepatocyte proliferation and remodeling. Further research on the field should focus on the role of non-parenchymal cells as well as on the effect of ALPPS in liver regeneration in the setup of parenchymal liver disease.