Abstract 5272: The correlation between the change of future remnant liver volume and functional capacity in ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), and establishment of ALPPS model in rats
Authors: Kawaguchi Daisuke , Hiroshima Yukihiko , Murakami Takashi , Matsuo Kenichi , Kosugi Chihiro , Syuto Kiyohiko , Yamada Akimitsu , Endo Itaru , Koda Keiji , Tanaka Kuniya 
Published: August 2015

Abstract
Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) has been recently introduced, and has demonstrated that it produces rapid future remnant liver (FRL) volumes compared with conventional staged hepatectomy using portal vein embolization (PVE). The correlation between the change of volume and functional capacity in ALPPS is not clear. Furthermore, exact mechanisms of the spectacular regenerative response in ALPPS have not been elucidated. The aim of this study is to evaluate whether FRL volume increases with its change of functional capacity in ALPPS compared with PVE and to elucidate the mechanism of the regenerative response in ALPPS. A retrospective review of all patients with liver metastases undergoing ALPPS or conventional staged hepatectomies using PVE was performed. ALPPS consisted of 2 steps; parenchymal transection between the FRL and the diseased part of the liver with concomitant selective PVL was performed. After that, the diseased deportalized part of the liver was removed 7 - 10 days later. In contrast, the diseased deportalized part of the liver was removed 4 - 6 weeks after PVE for the conventional staged hepatectomy. The fusion data of multi-detector raw CT and 99mTc-GSA dynamic SPECT using the software, SYNAPSE VINCENT (Fujifilm, Japan) was analyzed. FRL volume was measured by CT volumetry at 1 week after 1st step of ALPPS and 4 weeks after PVE. Seven patients with ALPPS were compared with 6 patients with conventional staged hepatectomies. The increasing rate of FRL volume was higher in ALPPS than in PVE (13.7% and 4.6%, respectively), whereas the increasing rate of the functional capacity of FRL was higher in PVE than in ALPPS (18.5% and 10.7%, respectively). This result suggests that the increasing rate of the functional capacity of FRL might be lower compared with the volume, resulting in an overestimation of the functional capacity of FRL for ALPPS. To elucidate the mechanism of the regenerative response and figure out which day is the best time for the diseased liver resection after 1st step of ALPPS, rats were randomly assigned to three experimental groups: selective PVL and ALPPS, sham operation. The hepatic regeneration rate, histopathology, liver biochemical determinations were assessed at 24, 48 and 72h after surgery. The hepatic regeneration rate of ALPPS was much higher than that of the PVL at 72h after surgery. And we successfully established the ALPPS model using rats and demonstrated the accelerated hepatic regeneration in ALPPS compared with PVL. Our model provides a basis for further studies of ALPPS.
Citation Format: Daisuke Kawaguchi, Yukihiko Hiroshima, Takashi Murakami, Kenichi Matsuo, Chihiro Kosugi, Kiyohiko Syuto, Akimitsu Yamada, Itaru Endo, Keiji Koda, Kuniya Tanaka. The correlation between the change of future remnant liver volume and functional capacity in ALPPS (associating liver partition and portal vein ligation for staged hepatectomy), and establishment of ALPPS model in rats. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5272. doi:10.1158/1538-7445.AM2015-5272