title: Histologic features after surgery associating liver partition and portal vein ligation for staged hepatectomy versus those after hepatectomy with portal vein embolization.
abstract: OBJECTIVE
  We compared histologic findings in nonneoplastic portions of liver resected during surgery associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) with those from hepatectomy after portal vein embolization (PVE).
  
  
  BACKGROUND
  Effects of congestion and ischemia in ALPPS on hepatocyte regeneration are incompletely understood, as are those on hepatocyte maturity.
  
  
  METHODS
  Specimens obtained from 8 patients treated with ALPPS and from 14 patients treated with hepatectomy after PVE were examined by light and electron microscopy.
  
  
  RESULTS
  Extrapolated kinetic growth of the future liver remnant (FLR) for ALPPS was 14.4 ± 4.8 mL/d, which was faster than for PVE (3.6 ± 2.2 mL/d; P < .001). Microscopically, the FLR showed greater hepatocyte cell density and smaller hepatocyte size in ALPPS than in PVE (P < .01 for each). Bright-appearing hepatocytes and sinusoidal narrowing were more frequent in ALPPS (50% and 50%) than in PVE (0% and 8.3%; P = .025 for each). In the deportalized ventral aspect of the anterior section, hepatocyte atrophy, hepatocyte degeneration or necrosis, sinusoidal dilation, fibrosis, and congestion were more frequent in ALPPS than in PVE (P = .001, P = .002, P < .001, and P < .001, respectively). Electron microscopy frequently showed vacant-appearing hepatocytic cytoplasm filled with glycogen granules in the FLR in ALPPS. Fewer cytoplasmic organelles and lipofuscin granules were observed in ALPPS than in PVE.
  
  
  CONCLUSIONS
  In the FLR, regenerative hepatocytes in ALPPS were morphologically immature compared with PVE. ALPPS should be performed with caution, considering limited functional increase in the FLR reflecting immaturity of the regenerative hepatocytes.
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Division of Diagnostic Pathology, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Division of Diagnostic Pathology, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. Electronic address: U17-92TS@med.teikyo-u.ac.jp.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D022781:Hepatocytes / Q000473:pathology / Q000502:physiology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000502:physiology / Q000601:surgery; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D016896:Treatment Outcome