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- Title
Liver regeneration following experimental major hepatectomy with choledochojejunostomy.
- Authors
Takagi, T.; Yokoyama, Y.; Kokuryo, T.; Yamaguchi, J.; Nagino, M.
- Abstract
Background Surgical treatment for perihilar cholangiocarcinoma frequently involves hepatectomy and extrahepatic bile duct resection with a choledochojejunostomy ( CJ). Cholangitis owing to bilioenteric anastomosis is a common complication. The impact of CJ or regurgitating cholangitis on the liver regeneration process after major hepatectomy is unknown. Methods Rats underwent 70 per cent hepatectomy (Hx group) or hepatectomy with CJ (Hx + CJ group). The intrahepatic inflammatory response, hepatic regeneration rate, and expression of regeneration-associated genes in the liver and blood were compared between these two groups. Results Levels of hepatobiliary markers in the blood were significantly higher 4 and 7 days after operation in the Hx + CJ group than the Hx group. Intrahepatic expression of inflammation-associated genes, such as interleukin 6 and tumour necrosis factor α, was also significantly higher in the Hx + CJ group on days 4 and 7. A progressive periportal inflammatory response was identified in the Hx + CJ group by histological examination. The hepatic regeneration rate was significantly lower in the Hx + CJ group than in the Hx group on day 2 (mean(s.d.) 14·2(6·3) versus 21·4(2·6) per cent; P = 0·013) and day 4 (32·4(5·3) versus 41·3(4·4) per cent; P = 0·004). Gene expression levels of hepatic regeneration-promoting factors such as hepatocyte growth factor were significantly lower in the Hx + CJ group than the Hx group on day 1. Conclusion CJ perturbs early liver regeneration after hepatectomy. An excessive inflammatory response in the liver and suppression of liver regeneration-associated factors may play a role.
- Subjects
REGENERATION (Biology); LIVER regeneration; CHOLANGIOCARCINOMA; HEPATECTOMY; JEJUNOSTOMY; CHOLEDOCHO-duodenal junction; CHOLANGITIS; PATIENTS
- Publication
British Journal of Surgery, 2015, Vol 102, Issue 11, p1410
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1002/bjs.9908