Title : The mechanism of associating liver partition and portal vein ligation: A systematic review
Abstract:
Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was widely used in clinic. The mechanism of ALPPS need to be fully illustrated.
Methods: The present systematic review aimed to examine existing data on the mechanism of ALPPS. Electronic databases, including PubMed, Web of Science and Embase, were systemically searched to retrieve articles on ALPPS. Meanwhile, additional articles were identified manually. The mechanisms of ALPPS, including the animal model, histological changes, surgical method, signaling pathway influence of abnormal liver and oncological results, were analyzed.
Results: After screening, we included 66 articles. including 53 studies on animals and 13 studies on humans. The rat model of ALPPS was mostly used, and the proliferation of hepatocytes was thought to be immature. However, the origin of hepatocytes is still not clear. The JNK1-IHH axis is a mechanism unique to ALPPS surgery, while mitochondrial function, the hypoxia pathway and inflammatory factors also play an important role in liver regeneration. NAFLD and cirrhosis were thought to be negatively associated with liver growth of ALPPS, but the exact mechanism was still not clear. The role of ALPPS in inducing the growth of tumors was contradictory.
Conclusions: This review concluded that the JNK1-IHH axis was a mechanism unique to ALPPS surgery, and the origin of hepatocytes in ALPPS, the influence of abnormal liver for ALPPS and oncological results were still not clear. Future studies should focus on these directions and try to explore drugs to enhance liver regeneration of ALPPS without stimulating the growth of tumors.
Audience Take-Away:
- JNK1-IHH axis was a mechanism unique to ALPPS surgery, and the origin of hepatocytes in ALPPS.
- Future studies should focus on these directions and try to explore drugs to enhance liver regeneration of ALPPS without stimulating the growth of tumors.
