Liver regeneration, portal occlusion, chemotherapy, liver tumors

Aim of the study: After portal vein ligation for regeneration of potential remnant,7–8 weeks are needed to achieve appropriate liver volume. Conventionally no chemotherapy is given during this period. Effect of systemic and selective right hepatic artery locoregional chemotherapy on liver regeneration was studied.

Methods: Out of 578 patients operated for liver tumour between 2001–2006 ,42 were unsuitable for primary extended resection because of inadequate size of potential liver remnant. Colorectal metastasis: 27 pts, HCC: 13, metastasis of gastric cc: 2. Right portal branch ligation were performed to promote regeneration of left lateral segment.3 patients were lost after the first intervention. In a prospective study after ligation of right portal branch (PVL) in 15 pts arterial port was inserted through gastroduodenal artery into the right hepatic artery. (Group A). In 24 pts only PVL was performed. 14 of them underwent systemic chemotherapy according DeGramont (group B), in 10 pts no chemotherapy was applied. (Group C) Group A patients were treated like pts in group B, but Adriamycin was admininistered locoregionally into the right hepatic artery.

Results: All patients but one underwent second liver resection without mortality. This patient (GroupA) with HCC missed readmission, but one year later no tumour was found in the previously infiltrated right lobe. Chemotherapy did not influence regeneration of left lobe. Group B=28.4±6.6% v.s. Group C=26.6±9.5%. Surprisingly regeneration was significantly better in Group A=34.5±6.7%.

No significant change of volume of tumorous right lobe in groups B and C could be observed. Contrary to this, in group A both right lobe and tumour volume diminished significantly.

Conclusions: Chemotherapy does not interfere with liver regeneration after portal vein ligation. Hepatic artery chemoperfusion might be recommended as additional therapy before second stage liver resection.