Associated Radiofrequency Ablation and Portal vein ligation for Staged hepatectomy (ARAPS) compared to Portal Vein Ligation (PVL) induces prolonged and enhanced liver regenerative response.

BACKGROUND: Several techniques have been designed to increase the size of the future liver rem-nant (FLR) prior to liver resection. This experimental study in pigs builds on our previous rat study, in which we demonstrated that portal vein ligation (PVL) combined with radiofrequency ablation (RFA)-termed Associated Radiofrequency Ablation and Portal Vein Ligation for Staged Hepatec-tomy (ARAPS)-induces accelerated future liver remnant (FLR) growth comparable to the ALPPS procedure. METHODS: Eighteen female pigs were randomly assigned to PVL, ARAPS, or as controls. On post operative day (POD) 0, blood samples were collected, and 18F-FDGal PET and ceCT scans were conducted. Intervention pigs underwent either PVL or ARAPS. On POD 7, intervention pigs were re-evaluated with blood samples and 18F-FDGal PET/ceCT scans. Liver biopsies were obtained from the devascularized liver on POD 0 and POD 7, and from the FLR on POD 7 for histological analysis and growth rate kinetics. Control pigs were assessed only on POD 0. RESULT: The median FLR volume increase was comparable between the two groups at POD 7 (p=0.52). Further a shift in the distribution of liver function between the FLR and the deportalized liver was observed at POD 7 without significant difference in 18F-FDGal accumulation (percentage of injected dose in the liver) between groups (p = 0.15). The biochemical liver response did not differ between groups at any time. Additionally, no differences in hepatocyte morphology were found at POD 0. At POD 7, increased hepatocyte hypertrophy (p<0.004) and proliferation (p<0.001) were found in the ARAPS group compared to PVL. The regenerative capacity was most prominent in the FLR compared to the deportalized liver. CONCLUSION: ARAPS may enhance the proliferative response of the FLR compared to PVL alone, while still maintaining liver function comparable to PVL.