SAFE MAJOR HEPATECTOMY AFTER PREOPERATIVE LIVER REGENERATIO

Safe Major Hepatectomy After Preoperative Liver Regeneration: Preoperative PVE, Two-Stage Hepatectomy, ALPPS and Hepatic Vein Deprivation provides both history and recent topics of major hepatectomy after liver regeneration―as well as the basic background of liver regeneration―allowing liver surgeons, general surgeons, and hepatologists to increase the safety of major hepatectomy in patients suffering from advanced liver disease. This reference provides importance guidance to cutting edge topics, including the molecular mechanism of liver regeneration after preoperative portal vein embolization (PVE), two-stage hepatectomy, associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) and results of hepatic vein occlusion.

The mortality rate after major hepatectomies is high worldwide and there is a need to establish a strategy for safe major hepatectomies, and hepatectomy after preoperative liver regeneration is a key process to prevent posthepatectomy liver failure (PHLF).

• Covers various methods of accelerating regeneration of the hemiliver volume, such as portal vein embolization (PVE), two-stage hepatectomy, associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) and hepatic vein occlusion
• Provides guidance to increase future liver remnant (FLR) volume as the key to avoid posthepatectomy liver failure and succeeding patients’ death after major hepatectomy
• Helps guide the optimal way to program major surgery with decreased risk of liver failure

Professor Yoshihiro Sakamoto has performed more than 900 hepatectomies and has published more than 300 papers on hepato-biliary-pancreatic surgeries. He is well-versed in liver regeneration and portal vein embolization, contributed on papers on major hepatectomies with portal vein embolization (Ann Surg 2006, Hepato-Gastroenterol 2010, Surgery 2013, Ann Surg Oncol 2017), and also developed modified procedure of ALPPS (Ann Surg 2016 & 2018).

Professor Masatoshi Makuuchi has first introduced preoperative portal vein embolization (PVE) for resection of hilar cholangiocarcinoma in 1982. Since then, preoperative PVE has been widely accepted as an ancillary procedure before major hepatectomy, to prevent posthepatectomy liver failure (PHLF). The original paper, “Preoperative PVE to increase the safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report,” published in Surgery 1990, has been cited over 1400 times.