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Lopez-Lopez V, Martínez-Caceres C, Gomez-Valles P, Cruz J, Caballero-Illanes A, Brusadin R, López-Conesa A, Pérez M, Miura K, de la Peña-Moral J, Robles-Campos R. Impact of rapid hypertrophy of tourniquet associating liver partition and portal vein ligation in the tumor progression pathways compared to two stage hepatectomy in patients with colorectal liver metastases. HPB (Oxford) 2023; 25:1235-1246. [PMID: 37407399 DOI: 10.1016/j.hpb.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/22/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND It is not known if the inflammatory phenomena related to highly accelerated regeneration activate any signaling pathways that are associated with a major stimulus to colorectal liver metastases (CRLM) disease in tourniquet associating liver partition and portal vein ligation for staged hepatectomy (T-ALPPS) compared to two stage hepatectomy (TSH). METHODS Between January 2012 and April 2018, we prospectively performed biopsies from future liver remnant and deportalized lobe in CRLM patients undergoing T-ALPPS in both stages. Immunohistopathological analysis was performed on the above tissue samples and compared to biopsy samples from patients who underwent TSH for CRLM at our center between September 2000 and August 2011. RESULTS A total of 42 patients (20 TSH and 22 T-ALPPS) were included. There were no differences in the rates of recurrence, overall survival or any of the factors analyzed relating to tumor progression between stages 1 and 2. Regarding the anti-tumor effect, there was a significant reduction in the number of T-CD8 infiltrates in the second stage of TSH (12.5 vs. 5.5, p = 0.02). CONCLUSION The results suggest that liver regeneration with T-ALPPS does not induce higher tumor progression or significant immunological changes in the tumor environment when compared to classical TSH.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Carlos Martínez-Caceres
- Investigation Support Platforms, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Paula Gomez-Valles
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Juan Cruz
- Group of Applied Mathematics in Science and Engineering, Faculty of Computer Science, University of Murcia, C. Campus Universitario, Edificio 32, 30100, Murcia, Spain
| | - Albert Caballero-Illanes
- Department of Pathology, Virgen de La Arrixaca University Hospital, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Roberto Brusadin
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - Asuncion López-Conesa
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain
| | - María Pérez
- University of Lleida, Catalonia, Plaça de Víctor Siurana, 1, 25003, Lleida, Spain
| | - Kohei Miura
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan
| | - Jesús de la Peña-Moral
- Group of Applied Mathematics in Science and Engineering, Faculty of Computer Science, University of Murcia, C. Campus Universitario, Edificio 32, 30100, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120, El Palmar, Murcia, Spain.
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Lopez-Lopez V, Martínez-Caceres C, Ferreras D, Peña-Moral JDL, Cruz JDL, Royo-Villanova M, Rodríguez JM, Fernández-Hernández JA, Zambudio AR, Pons JA, Martínez-Barba E, Sánchez-Bueno F, Campos RR, Ramírez P. Biomarkers of Early Liver Graft Damage in Circulatory Death and Brain Death Donors: A Propensity Score Matching Analysis. Transplant Proc 2021; 53:2659-2662. [PMID: 34602295 DOI: 10.1016/j.transproceed.2021.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Donation after circulatory death (DCD) is related to a warm ischemia time and more complications compared with traditional donors (donation after brain death [DBD]). METHODS This study included biopsy samples retrospectively collected from November 2014 to December 2018 to compare histologic and biological markers of DCD and DBD liver grafts. The analysis includes marker of early apoptosis (p21), senescence (telomerase reverse transcriptase [TERT]), cell damage (caspase-3 active), endothelial damage (vascular endothelial growth factor), stem cell (CD90), hypoxia (HIF1A), inflammatory activation (COX-2), and cross-organ allograft rejection (CD44). A propensity score matching (PSM) was used to match patients receiving DCD livers to those receiving DBD livers. We analyzed the immunohistochemical initial liver damage-related warm ischemia time. RESULTS Positive staining expression of liver damage biomarkers (COX-2, CD44, TERT, HIF1A, and CD90) was found, but no significant differences were found between DCD and DBD and with ischemic cholangiopathy. After PSM, there was a significant relationship between CD90 and male donors (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.07-0.91), TERT with donor sodium (OR, 1.11; 95% CI, 1.02-1.2), HIF1A with steatosis (OR, 0.33; 95% CI, 0.13-0.83), and CD44 with donor vasoactive drugs (OR, 0.36; 95% CI, 0.13-1) and glutamic oxaloacetic transaminase 1 week increase (OR, 1.01; 95% CI, 1-1.03). CONCLUSIONS DCD immunohistochemical initial liver damage was found to behave similarly to DBD. The increase in complications and cholangiopathy associated with warm ischemia could be related to a different later phenomenon.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain.
| | | | - David Ferreras
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | | | - Juan De La Cruz
- Group of Applied Mathematics in Science and Engineering, Faculty of Computer Science, University of Murcia, Murcia, Spain
| | - Mario Royo-Villanova
- Intensive Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jose Manuel Rodríguez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Juan Angel Fernández-Hernández
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Antonio Ríos Zambudio
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Jose Antonio Pons
- Department of Hepatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Francisco Sánchez-Bueno
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Ricardo Robles Campos
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Pablo Ramírez
- Department of Surgery, Virgen de la Arrixaca University Hospital, Biomedical Research Institute of Murcia-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
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