Prognostic Value of the Future Liver Remnant Function Before Extensive Liver Resection in a Child with an Extremely Low Future Liver Remnant Volume
Akhaladze DG*, Rabaev GS, Merkulov NN, Tverdov IV and Grachev NS
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of Health of Russian Federation, Moscow, Russian Federation
*Corresponding Author: Akhaladze DG, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology Ministry of Health of Russian Federation, Moscow, Russian Federation.
June 10, 2021; Published: July 13, 2021
Two-staged liver resections with portal vein embolization or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are proven as an alternative to liver transplantation in adult patients. The widespread application of two-staged hepatectomies is associated with a high incidence of posthepatectomy liver failure (PHLF) after major liver resections. Nevertheless, two-stage resections are also characterized by a large number of complications, including PHLF due to the insufficient regeneration time or on the contrary the disease progression due to increased time between procedure stages. Insufficient values of the future liver remnant volume (FLR-V) or future liver remnant function (FLR-F) are the main limitations for single-stage hepatectomy. Wherein the future liver remnant function assessment has a greater sensitivity among adult patients. The lack of the data about the PHLF in pediatric patients and application of the FLR-V with a minimal borderline 25% as indications for two-stage liver resections, as well as the lower incidence of chronic concomitant diseases, suggest a greater significance of the liver functional capacity in children and the possibility to perform major liver resections in cases when FLR-V is less than allowable but FLR-F is sufficient. This is the first report describes how much FLR-V should be necessary in pediatric patients and confirms the possibility to wider perform one-stage liver resections in pediatric oncology without the risk of PHLF depending on the future liver remnant function assessment.
Keywords: Posthepatectomy Liver Failure; ALPPS; Hepatobiliary Scintigraphy; Future Liver Remnant Function; Future Liver Remnant Volume; Children
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