title: Liver regeneration after liver resection: clinical aspects and correlation with infective complications.
abstract: OBJECTIVE
  To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.
  
  
  METHODS
  A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010. Regeneration was evaluated by multidetector computed tomography at a mean follow-up of 43.85 d. The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation, and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data. Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.
  
  
  RESULTS
  Ten of the 27 patients (37%) underwent chemotherapy prior to surgery, with a statistically significant prevalence of patients with metastasis (P = 0.007). Eight patients (30%) underwent embolization, 3 with primary tumors, and 5 with secondary tumors. Twenty patients (74%) experienced complications, with 12 (60%) experiencing Clavien-Dindo Grade 3a to 5 complications. Regeneration ≥ 100% occurred in 10 (37%) patients. The predictors were smaller future remnant liver volume (-0.002; P < 0.001), and a greater spleen volume/future remnant liver volume ratio (0.499; P = 0.01). Patients with a resection of ≥ 5 Couinaud segments experienced greater early regeneration (P = 0.04). Nine patients experienced surgical site infections, and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected (P = 0.016). There were no significant differences between patients with primary or secondary tumors, and either onset or infections or severity of surgical complications.
  
  
  CONCLUSIONS
  Regardless of the onset of infective complications, future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Vishal
authors.initials: V
authors.lastname: Parikh
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mularoni
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Grossi
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.affiliation: Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007558:Italy; D016014:Linear Models; D008099:Liver / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Liver regeneration; Liver resection; Liver tumor