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Institution: Liverpool Hospital - NSW, Australia
In hepatic surgery, managing small Future Liver Remnants (FLRs) is pivotal for successful outcomes.
Initially, FLR assessment involves liver function
tests (LFTs), including plasma bilirubin, transaminases, and albumin levels. Dynamic tests like Indocyanine Green (ICG) clearance and ^{99m}Tc-Mebrofenin scintigraphy provide in-depth evaluations of liver functional capacity.
For augmenting FLR, established techniques like Portal Vein Embolization (PVE) and Portal Vein Ligation (PVL) are utilized to stimulate FLR hypertrophy by redirecting blood flow. The adequacy of FLR is contingent on liver function status; typically, a 20% FLR suffices for those with normal liver function, but this increases for patients with prior chemotherapy exposure, obesity, or cirrhosis.
Novel strategies such as Liver Venous Deprivation (LVD) and Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) offer enhanced hypertrophy. LVD combines PVE with hepatic vein embolization, while ALPPS accelerates FLR growth through liver partitioning.
Additionally, Selective Internal Radiotherapy (SIRT), initially used for hepatocellular carcinoma treatment, is now explored for FLR augmentation.
These evolving strategies, personalized based on liver quality and surgical requirements, aim to mitigate postoperative liver failure risks, enhancing patient recovery and long-term health following major liver resections.
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Authors
Dr Marwan Idrees - , Dr Yasser Farooque -
