Pathophysiological mechanisms of ALPPS: experimental model

Ruifeng Wang; Zhen Quan; Tongsen Zheng; Kai Wang; Yang Liu; Zhaoguo Han; Xiance Wang; Shiling Ma; Lianxin Liu; Wan Yee Lau; Xilin Sun

doi:10.1093/bjs/znac007

Pathophysiological mechanisms of ALPPS: experimental model

Br J Surg. 2022 May 16;109(6):510-519. doi: 10.1093/bjs/znac007.

Authors

Ruifeng Wang^{1

2

3}, Zhen Quan^{1

2}, Tongsen Zheng⁴, Kai Wang^{1

2}, Yang Liu^{1

2}, Zhaoguo Han^{1

2

5}, Xiance Wang^{1

2}, Shiling Ma^{1

2}, Lianxin Liu^{6

7}, Wan Yee Lau⁸, Xilin Sun^{1

2}

Affiliations

¹ NHC and CAMS Key Laboratory of Molecular Probe and Targeted Theranostics, Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, Heilongjiang, China.
² Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang 150028, China.
³ Department of Gastroenterology, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
⁴ Department of Gastrointestinal Medical Oncology, The Affiliated Tumour Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
⁵ Biomedical Research Imaging Center, Department of Radiology, and UNC Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
⁶ Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin, Heilongjiang Province 150001, China.
⁷ Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
⁸ Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR 999077, China.

PMID: 35576390
DOI: 10.1093/bjs/znac007

Abstract

Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two-stage strategy that may increase hepatic tumour resectability and reduce postoperative liver failure rate by inducing rapid hypertrophy of the future liver remnant (FLR). Pathophysiological mechanisms after the first stage of ALPPS are poorly understood.

Methods: An ALPPS model was established in rabbits with liver VX2 tumour. The pathophysiological mechanisms after the first stage of ALPPS in the FLR and tumour were assessed by multiplexed positron emission tomography (PET) tracers, dynamic contrast-enhanced MRI (DCE-MRI) and histopathology.

Results: Tumour volume in the ALPPS model differed from post-stage 1 ALPPS at day 14 compared to control animals. 18F-FDG uptake of tumour increased from day 7 onwards in the ALPPS model. Valid volumetric function measured by 18F-methylcholine PET showed good values in accurately monitoring dynamics and time window for functional liver regeneration (days 3 to 7). DCE-MRI revealed changes in the vascular hyperpermeability function, with a peak on day 7 for tumour and FLR.

Conclusion: Molecular and functional imaging are promising non-invasive methods to investigate the pathophysiological mechanisms of ALPPS with potential for clinical application.

MeSH terms

Animals
Hepatectomy* / methods
Humans
Ligation / methods
Liver / blood supply
Liver / diagnostic imaging
Liver / surgery
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / pathology
Liver Neoplasms* / surgery
Liver Regeneration / physiology
Models, Theoretical
Portal Vein / diagnostic imaging
Portal Vein / surgery
Rabbits