Liver Regeneration After Open and Laparoscopic Left Partial Hepatectomy Considering the Fungal Translocation to the Remnant Liver

Konstantinos S Mammas, MD, MSc, PhD¹, Nikolaos Kavantzas, MD, PhD², Georgia Kostopanagiotou, MD, PhD¹, Ismene Dontas, DVM, PhD³, Vasileios Smyrniotis, MD, PhD³, George Arsenis, MD, PhD³, Eustratios Patsouris, MD, PhD². ¹National and Kapodistrian University of Athens-Surgical Laboratory Professor K.TOUNTAS, ²National and Kapodistrian University of Athens- Medical School, Department of Pathology, ³National and Kapodistrian University of Athens

INTRODUCTION: In liver resection It has been shown that the degree of bacterial translocation increases by operative trauma. The liver regeneration after Open (OLPH) and Laparoscopic Left (LLPH) Partial Hepatectomy (PHx) of a porcine experimental model is compared by measuring the known molecules implicated in the regenerating process and the candida species translocation to the remnant liver.

METHODS AND PROCEDURES: Two pairs of double-series of twenty-nine liver tissues taken from twenty nine porcine livers, after OLPH or LLPH (PD0) and on the 7th postoperative day (PD7), were randomly allocated into two groups: the OLPH (n1=19×2) and the LLPH  (n2=10×2). The liver tissue sections in each group, had been prepared and stained with PCNA, Gaspase-III and anti-Ubiquitin respectively. Then a PCNA based proliferative index (LCPI), a Gaspase-III based Apoptotic Index (LCAI), and an Ubiquitin based intracellular stress index (LISI) were prospectively estimated by microscopic visualization. Additionally an anti-VEGF stain based angiogenesis index (LCANGI) based on a sample of twenty eight tissue sections (n1=8×2, n2=6×2) and a PAS-stain based Candida species remnant liver lobule colonization index (CRLLCI) of another sample of twenty eight tissue sections (n1=7×2, n2=7×2) were estimated by microscopic visualization retrospectively. The LCPI, LCAI, LISI, LCANGI and CRLLCI indexes were compared between OLPH and LLPH on PD0 and on PD7 time-points.

RESULTS: Statistical comparisons of LISI resulted in a statistically significant difference, favoring the OLPH on PD0 (p<.1). LCPI was statistically significantly higher after OLPH than LLPH on PD7 (p=.002). LCANGIOLPH was statistically significantly higher than LCANGILLPH, on PD7 (p=.028). No difference was found in the apoptotic level between OLPH and LLPH on PD0 (.926) and on PD7 (p>.313). The CRLLCI was significantly higher in the OLPH in comparison with the LLPH group, on PD0 (p=0.158) and on PD7 (p=.006). 

CONCLUSIONS: In the porcine model: 1.In the context of liver regeneration after PHx, the increased intra-cellular stress in the remnant liver after OLPH seems to trigger a comperatively increased liver cell proliferation in comparison to  LLPH on PD7. 2. Candida species translocation to the remnant liver found significantly increased after OLPH than after LLPH on both PD0 and PD7 time-points.