Biochemical and morphological responses to post-hepatectomy liver failure in rats.

The upper limit for partial hepatectomy (PH) in rats is 90%, which is associated with an increased risk of post-hepatectomy liver failure (PHLF), correlating with high mortality. Sixty-eight rats were randomized to 90% PH, sham operation, or no surgery. Further block randomization was performed to determine the time of euthanasia, whether 12, 24, or 48 h after surgery. A general distress score (GDS) was calculated to distinguish between rats with reversible (GDS < 10) and irreversible PHLF (GDS ≥ 10). At euthanasia, the liver remnant and blood were collected. Liver-specific biochemistry and regeneration ratio were measured. Hepatocyte proliferation and volume were estimated using stereological methods. All rats subjected to 90% experienced biochemical PHLF. The biochemical and morphological liver responses did not differ between the groups until 48 h after surgery. At 48 h, liver regeneration and function were significantly improved in survivors. The peak mean regeneration ratio was 15% for rats with irreversible PHLF compared to 26% for rats with reversible PHLF. The 90% PH rat model was associated with PHLF and high mortality. Irreversible PHLF was characterized by impaired liver regeneration capacity and an insufficient ability to metabolize ammonia.

Clinical implications of multidisciplinary team pancreatic cyst evaluation.

INTRODUCTION: The detection of incidental pancreatic cysts (PCs) is increasing due to frequent use of imaging. The aim of the present study was to evaluate the clinical consequences of regular multidisciplinary team (MDT) conferences for patients with PCs. METHODS: All patient data were obtained by review of patient medical records. PCs were assessed at the weekly MDT in accordance with the revised Fukuoka guidelines. RESULTS: A total of 455 patients were evaluated within 12 months. A large proportion of the cysts could not be characterised and was handled as branch duct (BD)-intraductal papillary mucinous neoplasia (IPMN). A total of 245 patients were included in a follow-up programme, whereas 175 patients were excluded. Further diagnostic work-up was recommended for 31 patients. A total of 66 patients were reviewed on MDT a second time during the study period, eight of whom received a diagnosis different from that given at the first MDT. A total of 35 patients with mucinous PC or cysts treated as BD-IPMN had either worrisome features (WF) or high-risk stigmata (HRS), four of these patients had a PC ≤ 10 mm. Indication for surgery was WF or HRS and, in the course of 12 months, six patients were recommended surgery taking their PS into account. Two patients had a malignant and two had a premalignant lesion. CONCLUSION: In all, 455 patients were evaluated to find 35 patients with suspected premalignant PCs. This means that almost 8% of the referred patients had suspicious lesions, which indicates a need for a regular MDT conference. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Validation of a surgical model for posthepatectomy liver failure in rats.

BACKGROUND: The upper limit for liver resections in rats is approximately 90%. In the early postoperative phase, mortality increases. The aim of the present study was to validate the rat model of 90% partial hepatectomy (PH) as a model of post-hepatectomy liver failure (PHLF). Further, we wanted to test a quantitative scoring system as a detector of lethal outcomes caused by PHLF in rats. METHODS: Sixty-eight rats were randomized to 90% PH, sham operation, or no surgery. Further, block randomization was performed based on time of euthanization: 12, 24, or 48 h after surgery. A general distress score (GDS) ≥10 during the day or ≥6 at midnight prompted early euthanization and classification as nonsurvivor. Animals euthanized as planned were classified as survivors. During euthanization, blood and liver tissue were collected, and liver-specific biochemistry was evaluated. RESULTS: Based on the biochemical results, all animals subjected to 90% PH experienced PHLF. Seventeen rats were euthanized due to irreversible PHLF. The GDS increased for nonsurvivors within 12-18 h after surgery. The mean time for euthanization was 27 h after surgery. CONCLUSION: Based on the GDS and liver-specific biochemistry, we concluded that the model of 90% PH seems to be a proper model for investigating PHLF in rats. As a high GDS is associated with increased mortality, the GDS appears to be valuable in detecting lethal outcomes caused by PHLF in rats.