LIVER-REGENERATION IN CHILDREN AFTER MAJOR HEPATECTOMY FOR MALIGNANCY- EVALUATION USING A COMPUTER-AIDED TECHNIQUE OF VOLUME MEASUREMENT

Purpose: The time course of hepatic volume regeneration and return of excretory and synthetic function was studied in eight children undergo ing lobar or extended lobar liver resections for hepatoblastoma (n = 5 ), hepatoma (n = 1), and recurrent nephroblastoma (n = 2). Five patien ts received preoperative and all were administered postoperative chemo therapy. Whole-liver irradiation was administered to one patient. One additional patient who underwent an extended hepatic resection for ben ign disease and did not receive chemotherapy was included for comparis on. Methods: A previously validated technique of computer-aided volume measurement was used to measure liver volumes from serial CT scans ob tained after hepatic surgery. Normal liver volume as a function of age was determined from the literature and the time course of regeneratio n was compared to normal liver growth. Postoperative serum albumin, to tal bilirubin, serum glutamic oxaloacetic transaminase, and alkaline p hosphatase levels were recorded and correlated with volume regeneratio n. Results: In six patients hepatic regeneration had progressed to nor mal volume by 90 days after resection (normal volume for age was achie ved by 50 days in three patients). There was an initial rapid rate of regeneration (>10 cc/day) which declined to a normal rate of less than 0.5 cc/day at 90 days after surgery. Two children with failure to thr ive displayed the same pattern of rapid regeneration, attaining a volu me appropriate for weight but less than that expected for age. The sha pe of the liver volume regeneration curve was similar in one additiona l patient undergoing an extended left lobectomy for benign disease. A brief rise in bilirubin occurred during the first week and a transient fall in serum albumin was followed by resumption of normal synthetic capacity within 6 weeks in all but two patients. Conclusions: Liver re generation in children is a rapid process occurring despite the admini stration of cytotoxic agents and hepatic irradiation. (C) 1996 Academi c Press, lnc.