title: Liver regeneration after major hepatectomy for biliary cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate serial changes in liver volume after major hepatectomy for biliary cancer and to elucidate clinical factors influencing liver regeneration.
  
  
  METHODS
  Serial changes in liver volume were determined, using computed tomography, in 81 patients with biliary cancer who underwent right hepatic lobectomy or more extensive liver resection with or without portal vein resection and/or pancreatoduodenectomy. Possible factors influencing liver regeneration were evaluated by univariate and multivariate analyses.
  
  
  RESULTS
  The remnant mean(s.d.) liver volume was 41(8) per cent straight after hepatectomy. This increased rapidly to 59(9) per cent within 2 weeks, then increased more slowly, finally reaching a plateau at 74(12) per cent about 1 year after hepatectomy. The regeneration rate within the first 2 weeks was 16(8) cm3/day and was not related to the extent of posthepatectomy liver dysfunction. On multivariate analysis, the extent of liver resection (P < 0.001), body surface area (P = 0.02), combined portal vein resection (P = 0.024) and preoperative portal vein embolization (P = 0.047) were significantly associated with the liver regeneration rate within the first 2 weeks. In addition, body surface area (P < 0.001) and liver function expressed as plasma clearance rate of indocyanine green (P = 0.01) were significant determinants of final liver volume 1 year after hepatectomy.
  
  
  CONCLUSIONS
  The liver regenerates rapidly in the first 2 weeks after major hepatectomy for biliary cancer. This early regeneration is influenced by four clinical factors. Thereafter, liver regeneration progresses slowly and stops when the liver is three-quarters of its original volume, approximately 6 months to 1 year after hepatectomy.
authors.affiliation: First Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. nagino@med.nagoya-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Nagino
authors.forename: M
authors.initials: M
authors.lastname: Ando
authors.forename: J
authors.initials: J
authors.lastname: Kamiya
authors.forename: K
authors.initials: K
authors.lastname: Uesaka
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: Y
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000473:pathology*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods