Publication: Evaluación del impacto del “Precondicionamiento regenerativo” en el perfil molecular y energético del síndrome de “Small-For-Flow” en un modelo porcino
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2021-07-06
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Universidad Complutense de Madrid
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Abstract
Actualmente, los límites de resección en la cirugía hepática están establecidos por la posibilidad de desarrollar insuficiencia hepática posthepatectomía. Esto impide en ocasiones, intervenir a pacientes para los que la cirugía hepática es el único tratamiento potencialmente curativo, como es el caso de numerosos pacientes con metástasis hepáticas de cáncer colorrectal. Y es por eso, que conseguir un volumen hepático remanente suficiente para mantener la función hepática, es en nuestros días, uno de los temas más relevantes en el ámbito de la cirugía hepatobiliar. Por otro lado, a día de hoy, se llevan a cabo de rutina, distintas estrategias para aumentar el volumen del futuro remanente como la embolización portal o la hepatectomía en dos tiempos. Nuestro grupo evalúa una estrategia diferente, el “Precondicionamiento regenerativo”, que se basa en aplicar un estímulo regenerativo antes de la resección hepática. Se trata de una técnica de estimulación de la regeneración hepatocitaria, que consiste en realizar una ligadura o embolización portal del área de parénquima hepático que va a ser resecado, seguida de una hepatectomía precoz, entre 1 y 4 días después. A diferencia de la técnica clásica, que espera unas 4 semanas, no buscamos un aumento del volumen del remanente hepático sino un aumento de su tolerancia a la resección...
Nowadays, the limits of resection in liver surgery are established by the possibility of developing the posthepatectomy liver failure. This prevents, on numerous occasions, to operate patients for whom liver surgery is the only potentially curative treatment, as in some cases of colorectal cancer liver metastases. And that is why, reaching an adequate remaining liver volume for keeping a good liver function, is today one of the most relevant issues in the field of hepatobiliary surgery.On the other hand, currently, different strategies to increase the volume of the remaining liver are routinely carried out, such as portal embolization or two-stage hepatectomy. Our investigation group evaluated a different strategy, the "Regenerative preconditioning", based on a regenerative stimulus applied before liver resection. It is a hepatocyte regeneration stimulation technique, which consists of performing a portal vein ligation or embolization at the liver parenchyma that is going to be resected, followed by an early hepatectomy, between 1 and 4 days later. Unlike the classical technique, that is postponed around 4 weeks, we do not seek an increase in the volume of the liver remnant but an increase in its tolerance to resection. Previous studies on this technique have shown satisfactory results in animal models...
Nowadays, the limits of resection in liver surgery are established by the possibility of developing the posthepatectomy liver failure. This prevents, on numerous occasions, to operate patients for whom liver surgery is the only potentially curative treatment, as in some cases of colorectal cancer liver metastases. And that is why, reaching an adequate remaining liver volume for keeping a good liver function, is today one of the most relevant issues in the field of hepatobiliary surgery.On the other hand, currently, different strategies to increase the volume of the remaining liver are routinely carried out, such as portal embolization or two-stage hepatectomy. Our investigation group evaluated a different strategy, the "Regenerative preconditioning", based on a regenerative stimulus applied before liver resection. It is a hepatocyte regeneration stimulation technique, which consists of performing a portal vein ligation or embolization at the liver parenchyma that is going to be resected, followed by an early hepatectomy, between 1 and 4 days later. Unlike the classical technique, that is postponed around 4 weeks, we do not seek an increase in the volume of the liver remnant but an increase in its tolerance to resection. Previous studies on this technique have shown satisfactory results in animal models...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 04/11/2020