0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Article |

Sex Dimorphism in the Outcome of Preoperative Right Portal Vein Embolization FREE

Yukihiro Yokoyama, MD; Masato Nagino, MD; Koji Oda, MD; Hideki Nishio, MD; Tomoki Ebata, MD; Tetsuya Abe, MD; Tsuyoshi Igami, MD; Yuji Nimura, MD
[+] Author Affiliations

Author Affiliations: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.


Arch Surg. 2008;143(3):254-259. doi:10.1001/archsurg.2007.58.
Text Size: A A A
Published online

Hypothesis  Although studies indicate that patient sex modulates the process of hepatic regeneration, it remains unknown whether sex has a role in the outcome of preoperative right portal vein embolization (PVE). We analyzed the effects of patient sex on the outcome of right PVE followed by major hepatectomy.

Design  Retrospective study.

Setting  Academic research.

Patients  Eighty-eight patients (42 men and 46 women) who underwent preoperative right PVE for bile duct carcinoma were analyzed retrospectively.

Main Outcome Measures  The percentage liver volume change, the plasma indocyanine green clearance rate, and the rate of postoperative hepatic failure were compared between men and women.

Results  The mean (SD) volume of the nonembolized lobe after PVE in women (323 [61] mL/m2) was statistically significantly greater than that in men (287 [61] mL/m2) (P =.008). The mean (SD) ratio of the nonembolized lobe to the total liver volume was also statistically significantly greater in women (45.8% [5.8%]) than in men (42.0% [5.9%]) (P =.003). The mean (SD) indocyanine green clearance rate of the future liver remnant was 0.075 [0.014] in women and 0.056 [0.011] in men (P =.001). The incidence of postoperative hepatic failure was higher in men (12 of 42 [28.6%]) than in women (8 of 46 [17.4%]) (P =.16).

Conclusion  These results indicate that sex dimorphism can be present in the outcome of preoperative right PVE.

Figures in this Article

Animal models have demonstrated that normal physiology and pathophysiology of the liver are different for males and females of the same species.18 Investigations have shown sex-dimorphic responses in various hepatic stress models, including ischemia-reperfusion,1 liver cirrhosis,2 alcoholic liver disease,3 and hemorrhagic shock and resuscitation.4,5 Female sex also has been shown to be associated with the pathogenesis of hepatic disorders in humans, such as adenoma,6 hepatoma,7 and focal nodular hyperplasia.8 The results of these studies indicate that there are different pathways in the hepatic pathophysiology between males and females.

Preoperative portal vein embolization (PVE) has been performed widely before extended hepatectomy for hepatoma,9 metastatic colorectal cancer,10 and bile duct carcinoma.11 After PVE, the nonembolized lobe enlarges because of hepatocyte hypertrophy and replication,12 which increases the safety of major hepatectomy. Post-PVE patients fared better than non-PVE patients for postoperative peak bilirubin concentrations, occurrence of liver failure, and prolonged hospital stay.13,14

Several pathologic conditions are known to affect the capacity of hepatic regeneration after PVE or partial hepatectomy. These include diabetes mellitus,15,16 malnutrition,17 aging,18 infection,19 chronic alcohol consumption,20 and biliary obstruction.21 Patient sex is another important factor that may have an effect on the process of hepatic regeneration. A clinical study by Imamura et al16 showed that male sex was a negative factor relative to the hepatic regeneration rate following PVE. This seems to be consistent with a study by Shan et al22 reporting that female sex is associated with better hepatic regeneration, although the model they used was a hepatectomy model and not a PVE model. However, no clinical study (to our knowledge) has, to date, specifically analyzed sex dimorphism in the outcome of hepatic regeneration after PVE. Therefore, the objective of this study was to determine whether there is a difference between male and female patients in the outcome of right PVE followed by major hepatectomy.

A previous PVE study13 included multiple types of disease such as hepatocellular carcinoma, colorectal liver metastasis, and bile duct carcinoma. Patients having hepatocellular carcinoma frequently exhibit cirrhosis, which may impair hepatic regeneration. The surgical procedure for colorectal liver metastasis is variable depending on the status of tumor spread. In contrast to these studies, we herein included only bile duct carcinomas that required right-sided hepatectomy. Liver function and the surgery performed were similar among all patients included in this study. The outcomes evaluated were clinical characteristics, volumetric computed tomography (CT) findings, the plasma indocyanine green (ICG) clearance rate, and the rate of postoperative hepatic failure.

Preoperative right PVE and subsequent right hepatectomy were performed in 109 patients (55 men and 54 women) from May 1, 1991, to December 31, 2004, at Nagoya University Hospital, Nagoya, Japan. Of these, 21 patients (13 men and 8 women) were excluded from the study because of delayed postembolization CT longer than 21 days (11 cases), recanalization of the embolized portal vein after PVE (6 cases), or the absence of precise measurement data (4 cases). Therefore, 88 patients (42 men and 46 women) were included in the study.

Portal vein embolization was performed using an ipsilateral approach as previously described.11,23 Briefly, a catheter sheath was inserted into the anterior branch of the right portal vein under ultrasonographic guidance, and a 6F catheter was advanced into the target portal vein. Fibrin glue (Beriplast P; Hoechst Japan, Tokyo, Japan; or Bolheal; Fujisawa Pharmaceutical, Tokyo), mixed with iodized oil (Lipiodol; Kodama Pharmaceutical, Tokyo) or 100% ethanol, and microcoils were used as embolic material.

Serial transverse CT and ICG clearance tests were performed for each patient before and after PVE. The median interval between PVE and CT was 14 days (range, 7-21 days). The volumes of the embolized and nonembolized lobes were calculated using computer analysis for CT images. Borders between embolized and nonembolized lobes were determined before surgery by manual delineation in which the hepatic vessels were used as guides. To adjust for differences in liver volume between men and women, the volumes of the embolized and nonembolized livers were divided by the body surface area (BSA).24 The ratios of the embolized and nonembolized liver volumes to the total liver volume were calculated before and after PVE. Maximum serum total bilirubin concentrations within 3 weeks after hepatectomy were recorded, and a value of greater than 10 mg/dL (to convert bilirubin concentration to micromoles per liter, multiply by 17.104) was considered postoperative hepatic failure.

Comparisons of data among male vs female patients were made using the Mann-Whitney test for continuous variables and Fisher exact test for categorical data. Data before and after PVE were compared using paired t tests. P < .05 was considered statistically significant.

The demographics and clinical features of 88 patients stratified by sex are summarized in Table 1. The mean age was not statistically significantly different between male and female patients. Height, body weight, and BSA were statistically significantly greater in male patients than in female patients. At our institution, PVEs were performed mostly for biliary ductal malignant neoplasms, and no hepatocellular carcinoma or colorectal metastasis cases were included in this study. There were more cases of bile duct carcinoma among men and more cases of gallbladder cancer among women. More than 90% of all patients had undergone percutaneous transhepatic biliary drainage before surgery to relieve obstructive jaundice or to treat cholangitis. Portal vein embolization was performed after these symptoms had subsided. No patient had liver cirrhosis. The proportion of patients with cholangitis and diabetes mellitus, which are known to decrease liver proliferation capacity, was not statistically significantly different between men and women. The mean (SD) interval between PVE and CT was not statistically significantly different between men (13.4 [2.4] days; range, 8-20 days) and women (13.7 [3.2] days; range, 7-21 days) (P =.58).

Table Graphic Jump LocationTable 1. Demographics and Clinical Features of 88 Patients Stratified by Sex

Because the liver volume is proportional to the BSA,25 the liver volumes before and after PVE were normalized to the BSA and are given in Table 2. The average volume of the embolized lobe, nonembolized lobe (ie, left lateral and left medial lobes), and total liver were not different between male and female patients before PVE. The mean volume of the nonembolized lobe after PVE in female patients was statistically significantly greater than that in male patients (P =.008). Similarly, the proportion of the nonembolized lobe, expressed as a percentage of the total liver volume, was not statistically significantly different in male and female patients before PVE. However, it was statistically significantly higher in female patients compared with male patients after PVE (P =.007). Furthermore, the mean (SD) extent of increase in the nonembolized lobe volume was statistically significantly greater in female patients (10.8% [4.1%]) compared with male patients (8.9 [3.8%]) (P =.02).

Table Graphic Jump LocationTable 2. Liver Volumes Before and After Portal Vein Embolization (PVE)a

We normally measure the plasma ICG clearance rate before and after PVE to evaluate the function of the future liver remnant. The ICG clearance rate before PVE was statistically significantly higher in female patients than in male patients (P =.02) (Table 3). The ICG clearance rate did not decline after PVE in male or female patients. These results indicate that our PVE procedure did not alter hepatic function in either sex. Furthermore, the ICG clearance rate of the future liver remnant, which was calculated using a formula [ICG clearance rate × (% volume of the future liver remnant/100)], was statistically significantly higher in female patients compared with male patients before and after PVE (Figure). In our department, patients with an ICG clearance rate of the future liver remnant of less than 0.05 are considered high risk for major hepatectomy,26 as a previous study27 showed that postoperative mortality rates were statistically significantly higher among patients with rates of less than 0.05 than in patients with rates of 0.05 or higher. No female patient, whereas 8 male patients (19%), had an ICG clearance rate of the future liver remnant of less than 0.05 after PVE (Figure). These results suggest that major hepatectomy may have been performed with greater functional reserve in female patients compared with male patients.

Table Graphic Jump LocationTable 3. Plasma Indocyanine Green Clearance Rate (ICGK) and the Future Liver Remnant (FLR) ICGK
Place holder to copy figure label and caption
Figure.

Future liver remnant indocyanine green clearance rate (FLR ICGK) stratified by patient sex. *P < .05 vs pre–portal vein embolization (PVE) by paired t test. †P < .05 vs male patients by paired ttest.

Graphic Jump Location

After PVE, the patients underwent right hepatectomy with caudate lobectomy, or extended right hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The extent of liver resection following PVE was statistically significantly different in male vs female patients (Table 4). Extended right hepatectomy was performed more often in female patients (23 patients [50%]) than in male patients (10 patients [24%]), as gallbladder cancer was more prevalent in women than in men. Therefore, our results demonstrate that more extended surgery was performed in female patients than in male patients. The number of procedures of combined pancreatoduodenectomy or portal vein resection with reconstruction was similar between male and female patients. Nevertheless, the incidence of postoperative hepatic failure, as determined by a serum total bilirubin concentration of greater than 10 mg/dL within 3 weeks after hepatectomy, was greater in male patients (12 of 42 [29%]) than in female patients (8 of 46 [17%]), although the results were not statistically significantly different (P =.16).

Preoperative PVE is widely used before major hepatectomy to induce hypertrophy of the future liver remnant and to reduce the risks of major hepatectomy. The safety and usefulness of PVE have been reported in retrospective11,16,23 and prospective13 studies. Studies13,28 have analyzed the factors that affect the outcome of PVE. Portal vein embolization has been shown to be more beneficial in patients having chronic liver disease compared with patients having normal liver function in a prospective clinical trial.13 Another study28 demonstrated that the portal pressure and the serum hyaluronate concentration, an indicator of sinusoidal endothelial function, were useful predictors of the outcome of PVE. However, few studies, such as Imamura et al,16 have examined the effects of patient sex on the outcome of PVE. The hepatic pathophysiology is different between men and women, especially during hepatic stresses. Moreover, the regeneration capacity of the liver has been shown to be associated with the status of sex hormone and receptor expression.29,30 In view of this, we sought to determine if patient sex has a role in the outcome of preoperative PVE. Only cases of biliary tract malignancy were included because they usually are not accompanied by liver fibrosis and hepatitis, which might affect the regeneration capacity.31,32 To further characterize the comparison, only cases with right PVE were selected and reviewed, as the ratio of the embolized lobe to the total liver volume and the performed surgical procedure are different between right lobe and left lobe embolizations.

The size of the liver, as measured by CT, has been shown to correlate well with the BSA,25,33 and the livers of men are generally larger than those of women. Therefore, each datum of liver volume was divided by the BSA to facilitate comparison. Although no difference was observed before PVE, our data showed a statistically significantly greater volume of nonembolized lobe in female patients compared with male patients following PVE when the volume was adjusted by the BSA. The extent of increase in the nonembolized lobe volume by PVE was also statistically significantly higher in female patients. However, these results do not directly imply that the female liver is more potent in regeneration capacity than the male liver. The results may simply be due to the statistically significant difference in BSA between men and women. Other methods to standardize the different liver volumes between men and women should be evaluated in future studies.

The ICG clearance rate was statistically significantly higher in female patients even before PVE. After PVE, the ICG clearance rate did not deteriorate in male or female patients, and the statistically significant difference between men and women remained. To our knowledge, there is no clinical study that has specifically measured and compared the ICG clearance rates between male and female patients using this method. These observations also need further evaluation by a prospective randomized study.

The ICG clearance rate of the future liver remnant was statistically significantly higher in female patients. In a previous study27 analyzing 240 consecutive cases of PVE for biliary cancer, mortality rates were statistically significantly higher in patients whose ICG clearance rate of the future liver remnant after PVE was less than 0.05 compared with those whose index was 0.05 or higher. In the present study, the mortality rates between men (4 of 42 [10%]) and women (3 of 46 [7%]) are not statistically significantly different. The incidence of postoperative hepatic failure also was not statistically significantly different, although it was higher among male patients (12 of 42 [29%]) than among female patients (8 of 46 [17%]). Together, these data indicate that preoperative right PVE for bile duct carcinoma seems to be associated with better outcomes in female patients than in male patients. Relative to the outcome of PVE, Imamura et al16 studied 84 patients subjected to preoperative PVE and determined by multiple regression analysis that male sex was associated with reduced hypertrophy in the nonembolized lobe. However, their study did not specifically evaluate the effect of patient sex. To our knowledge, the present study is the first to specifically analyze the effect of patient sex on the outcome of preoperative right PVE.

Previous studies29,30,34,35 also proposed that patient sex, through differences in the sex hormone milieu, may modulate hepatic regeneration. It is also well known that women in the proestrus stage of the estrus cycle tolerate the deleterious effects of trauma, hemorrhage, and ischemia-reperfusion on cardiovascular and immunological functions far better than men.4,5,3639 Studies34,35 have also shown that estrogen receptor expression in the rat liver increased after 70% partial hepatectomy; serum estrogen concentrations also were elevated following major hepatectomy, whereas testosterone levels decreased in animals30 and in humans29 under those conditions. These results indicate that female sex hormones promote, whereas male hormones suppress, hepatocyte proliferation. However, the mean age of the patients included in the present study was 63 years or older; therefore, they may not have had high-circulating sex hormone levels. However, the sex steroid levels were not measured, and it remains unknown if high estrogen levels were responsible for the observed results. In addition, the interval between the time of PVE and subsequent volumetric CT was variable (range, 7-21 days), although the mean time was not different between men and women. The precise reason why a sex-dimorphic outcome following PVE occurs is unclear. Nevertheless, it seem that women, even in the postmenopausal stage, have better hepatic regeneration capacity than men of comparable age. A well-controlled prospective randomized study is required to elucidate whether patient sex or the level of sex hormones modulates the rate of hepatic regeneration after PVE. Sex differences in the surgical outcome of major hepatectomy after PVE should also be analyzed by a prospective study to validate the results observed herein.

In summary, this study demonstrated a sex-dimorphic outcome following right PVE before major hepatectomy. Greater volume and function of the future liver remnant after PVE were obtained in female patients compared with male patients, suggesting that female patients may fare better in the outcome of preoperative right PVE in biliary malignancies.

Correspondence: Yukihiro Yokoyama, MD, Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan (yyoko@med.nagoya-u.ac.jp).

Accepted for Publication: May 6, 2007.

Author Contributions:Study concept and design: Yokoyama. Acquisition of data: Yokoyama, Nagino, Oda, Nishio, Ebata, Abe, Igami, and Nimura. Analysis and interpretation of data: Yokoyama, Nagino, Oda, Nishio, Ebata, Abe, Igami, and Nimura. Drafting of the manuscript: Yokoyama, Nagino, Oda, Nishio, Ebata, Abe, Igami, and Nimura. Critical revision of the manuscript for important intellectual content: Yokoyama, Nagino, Oda, Nishio, Ebata, Abe, Igami, and Nimura. Study supervision: Yokoyama, Nagino, Oda, Nishio, Ebata, Abe, Igami, and Nimura.

Financial Disclosure: None reported.

Harada  HPavlick  KPHines  IN  et al.  Selected contribution: effects of gender on reduced-size liver ischemia and reperfusion injury. J Appl Physiol 2001;91 (6) 2816- 2822
PubMed
Xu  JWGong  JChang  XM  et al.  Estrogen reduces CCL4-induced liver fibrosis in rats. World J Gastroenterol 2002;8 (5) 883- 887
PubMed
Iimuro  YFrankenberg  MVArteel  GEBradford  BUWall  CAThurman  RG Female rats exhibit greater susceptibility to early alcohol-induced liver injury than males. Am J Physiol 1997;272 (5, pt 1) G1186- G1194
PubMed
Mizushima  YWang  PJarrar  DCioffi  WGBland  KIChaudry  IH Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg 2000;232 (5) 673- 679
PubMed Link to Article
Jarrar  DWang  PCioffi  WGBland  KIChaudry  IH The female reproductive cycle is an important variable in the response to trauma-hemorrhage. Am J Physiol Heart Circ Physiol 2000;279 (3) H1015- H1021
PubMed
Baum  JKBookstein  JJHoltz  FKlein  EW Possible association between benign hepatomas and oral contraceptives. Lancet 1973;2 (7835) 926- 929
PubMed Link to Article
Christopherson  WMMays  ETBarrows  GH Liver tumors in women on contraceptive steroids. Obstet Gynecol 1975;46 (2) 221- 223
PubMed
Knowles  DMWolff  M Focal nodular hyperplasia of the liver: a clinicopathologic study and review of the literature. Hum Pathol 1976;7 (5) 533- 545
PubMed Link to Article
Makuuchi  MThai  BLTakayasu  K  et al.  Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107 (5) 521- 527
PubMed
Kawasaki  SMakuuchi  MKakazu  T  et al.  Resection for multiple metastatic liver tumors after portal embolization. Surgery 1994;115 (6) 674- 677
PubMed
Nagino  MNimura  YKamiya  J  et al.  Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 1995;117 (6) 677- 681
PubMed Link to Article
Komori  KNagino  MNimura  Y Hepatocyte morphology and kinetics after portal vein embolization. Br J Surg 2006;93 (6) 745- 751
PubMed Link to Article
Farges  OBelghiti  JKianmanesh  R  et al.  Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003;237 (2) 208- 217
PubMed
Hemming  AWReed  AIHoward  RJ  et al.  Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003;237 (5) 686- 693
PubMed
Matsumoto  TYamaguchi  MKuzume  MMatsumiya  AKumada  K Insulin gene transfer with adenovirus vector via the spleen safely and effectively improves posthepatectomized conditions in diabetic rats. J Surg Res 2003;110 (1) 228- 234
PubMed Link to Article
Imamura  HShimada  RKubota  M  et al.  Preoperative portal vein embolization: an audit of 84 patients. Hepatology 1999;29 (4) 1099- 1105
PubMed Link to Article
Skullman  SIhse  ILarsson  J Influence of malnutrition on regeneration and composition of the liver in rats. Acta Chir Scand 1990;156 (10) 717- 722
PubMed
Iakova  PAwad  SSTimchenko  NA Aging reduces proliferative capacities of liver by switching pathways of C/EBPα growth arrest. Cell 2003;113 (4) 495- 506
PubMed Link to Article
Marshall  ARushbrook  SDavies  SE  et al.  Relation between hepatocyte G1 arrest, impaired hepatic regeneration, and fibrosis in chronic hepatitis C virus infection. Gastroenterology 2005;128 (1) 33- 42
PubMed Link to Article
Chen  JIshac  EJDent  PKunos  GGao  B Effects of ethanol on mitogen-activated protein kinase and stress-activated protein kinase cascades in normal and regenerating liver. Biochem J 1998;334 (pt 3) 669- 676
PubMed
Tracy  TF  JrBailey  PVGoerke  MESotelo-Avila  CWeber  TR Cholestasis without cirrhosis alters regulatory liver gene expression and inhibits hepatic regeneration. Surgery 1991;110 (2) 176- 183
PubMed
Shan  YSHsieh  YHSy  EDChiu  NTLin  PW The influence of spleen size on liver regeneration after major hepatectomy in normal and early cirrhotic liver. Liver Int 2005;25 (1) 96- 100
PubMed Link to Article
Nagino  MNimura  YKamiya  JKondo  SKanai  M Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology 1996;200 (2) 559- 563
PubMed
DuBois  DDE A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916;17863- 871
Link to Article
Vauthey  JNAbdalla  EKDoherty  DA  et al.  Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002;8 (3) 233- 240
PubMed Link to Article
Kobayashi  SNagino  MYuasa  N  et al.  Benefit of percutaneous transhepatic portal vein embolization for extended hepatectomy [in Japanese]. Nippon Geka Gakkai Zasshi 2004;105 (6) 354- 358
PubMed
Nagino  MKamiya  JNishio  HEbata  TArai  TNimura  Y Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006;243 (3) 364- 372
PubMed Link to Article
Wakabayashi  HYachida  SMaeba  TMaeta  H Evaluation of liver function for the application of preoperative portal vein embolization on major hepatic resection. Hepatogastroenterology 2002;49 (46) 1048- 1052
PubMed
Francavilla  AGavaler  JSMakowka  L  et al.  Estradiol and testosterone levels in patients undergoing partial hepatectomy: a possible signal for hepatic regeneration? Dig Dis Sci 1989;34 (6) 818- 822
PubMed Link to Article
Francavilla  AEagon  PKDiLeo  A  et al.  Sex hormone–related functions in regenerating male rat liver. Gastroenterology 1986;91 (5) 1263- 1270
PubMed
Yamano  THirai  RHato  SUemura  TShimizu  N Delayed liver regeneration with negative regulation of hepatocyte growth factor and positive regulation of transforming growth factor–β1 mRNA after portal branch ligation in biliary obstructed rats. Surgery 2002;131 (2) 163- 171
PubMed Link to Article
Kanta  JChlumská  A Regenerative ability of hepatocytes is inhibited in early stages of liver fibrosis. Physiol Res 1991;40 (4) 453- 458
PubMed
Urata  KKawasaki  SMatsunami  H  et al.  Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995;21 (5) 1317- 1321
PubMed Link to Article
Francavilla  ADiLeo  AEagon  PK  et al.  Regenerating rat liver: correlations between estrogen receptor localization and deoxyribonucleic acid synthesis. Gastroenterology 1984;86 (3) 552- 557
PubMed
Eagon  PKPorter  LEFrancavilla  ADiLeo  AVan Thiel  DH Estrogen and androgen receptors in liver: their role in liver disease and regeneration. Semin Liver Dis 1985;5 (1) 59- 69
PubMed Link to Article
Angele  MKSchwacha  MGAyala  AChaudry  IH Effect of gender and sex hormones on immune responses following shock. Shock 2000;14 (2) 81- 90
PubMed Link to Article
George  RLMcGwin  G  JrWindham  ST  et al.  Age-related gender differential in outcome after blunt or penetrating trauma. Shock 2003;19 (1) 28- 32
PubMed Link to Article
Kuebler  JFToth  BRue  LW  IIIWang  PBland  KIChaudry  IH Differential fluid regulation during and after soft tissue trauma and hemorrhagic shock in males and proestrus females. Shock 2003;20 (2) 144- 148
PubMed Link to Article
Kher  AWang  MTsai  BM  et al.  Sex differences in the myocardial inflammatory response to acute injury. Shock 2005;23 (1) 1- 10
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure.

Future liver remnant indocyanine green clearance rate (FLR ICGK) stratified by patient sex. *P < .05 vs pre–portal vein embolization (PVE) by paired t test. †P < .05 vs male patients by paired ttest.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 2. Liver Volumes Before and After Portal Vein Embolization (PVE)a
Table Graphic Jump LocationTable 3. Plasma Indocyanine Green Clearance Rate (ICGK) and the Future Liver Remnant (FLR) ICGK
Table Graphic Jump LocationTable 1. Demographics and Clinical Features of 88 Patients Stratified by Sex

References

Harada  HPavlick  KPHines  IN  et al.  Selected contribution: effects of gender on reduced-size liver ischemia and reperfusion injury. J Appl Physiol 2001;91 (6) 2816- 2822
PubMed
Xu  JWGong  JChang  XM  et al.  Estrogen reduces CCL4-induced liver fibrosis in rats. World J Gastroenterol 2002;8 (5) 883- 887
PubMed
Iimuro  YFrankenberg  MVArteel  GEBradford  BUWall  CAThurman  RG Female rats exhibit greater susceptibility to early alcohol-induced liver injury than males. Am J Physiol 1997;272 (5, pt 1) G1186- G1194
PubMed
Mizushima  YWang  PJarrar  DCioffi  WGBland  KIChaudry  IH Estradiol administration after trauma-hemorrhage improves cardiovascular and hepatocellular functions in male animals. Ann Surg 2000;232 (5) 673- 679
PubMed Link to Article
Jarrar  DWang  PCioffi  WGBland  KIChaudry  IH The female reproductive cycle is an important variable in the response to trauma-hemorrhage. Am J Physiol Heart Circ Physiol 2000;279 (3) H1015- H1021
PubMed
Baum  JKBookstein  JJHoltz  FKlein  EW Possible association between benign hepatomas and oral contraceptives. Lancet 1973;2 (7835) 926- 929
PubMed Link to Article
Christopherson  WMMays  ETBarrows  GH Liver tumors in women on contraceptive steroids. Obstet Gynecol 1975;46 (2) 221- 223
PubMed
Knowles  DMWolff  M Focal nodular hyperplasia of the liver: a clinicopathologic study and review of the literature. Hum Pathol 1976;7 (5) 533- 545
PubMed Link to Article
Makuuchi  MThai  BLTakayasu  K  et al.  Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107 (5) 521- 527
PubMed
Kawasaki  SMakuuchi  MKakazu  T  et al.  Resection for multiple metastatic liver tumors after portal embolization. Surgery 1994;115 (6) 674- 677
PubMed
Nagino  MNimura  YKamiya  J  et al.  Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 1995;117 (6) 677- 681
PubMed Link to Article
Komori  KNagino  MNimura  Y Hepatocyte morphology and kinetics after portal vein embolization. Br J Surg 2006;93 (6) 745- 751
PubMed Link to Article
Farges  OBelghiti  JKianmanesh  R  et al.  Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003;237 (2) 208- 217
PubMed
Hemming  AWReed  AIHoward  RJ  et al.  Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003;237 (5) 686- 693
PubMed
Matsumoto  TYamaguchi  MKuzume  MMatsumiya  AKumada  K Insulin gene transfer with adenovirus vector via the spleen safely and effectively improves posthepatectomized conditions in diabetic rats. J Surg Res 2003;110 (1) 228- 234
PubMed Link to Article
Imamura  HShimada  RKubota  M  et al.  Preoperative portal vein embolization: an audit of 84 patients. Hepatology 1999;29 (4) 1099- 1105
PubMed Link to Article
Skullman  SIhse  ILarsson  J Influence of malnutrition on regeneration and composition of the liver in rats. Acta Chir Scand 1990;156 (10) 717- 722
PubMed
Iakova  PAwad  SSTimchenko  NA Aging reduces proliferative capacities of liver by switching pathways of C/EBPα growth arrest. Cell 2003;113 (4) 495- 506
PubMed Link to Article
Marshall  ARushbrook  SDavies  SE  et al.  Relation between hepatocyte G1 arrest, impaired hepatic regeneration, and fibrosis in chronic hepatitis C virus infection. Gastroenterology 2005;128 (1) 33- 42
PubMed Link to Article
Chen  JIshac  EJDent  PKunos  GGao  B Effects of ethanol on mitogen-activated protein kinase and stress-activated protein kinase cascades in normal and regenerating liver. Biochem J 1998;334 (pt 3) 669- 676
PubMed
Tracy  TF  JrBailey  PVGoerke  MESotelo-Avila  CWeber  TR Cholestasis without cirrhosis alters regulatory liver gene expression and inhibits hepatic regeneration. Surgery 1991;110 (2) 176- 183
PubMed
Shan  YSHsieh  YHSy  EDChiu  NTLin  PW The influence of spleen size on liver regeneration after major hepatectomy in normal and early cirrhotic liver. Liver Int 2005;25 (1) 96- 100
PubMed Link to Article
Nagino  MNimura  YKamiya  JKondo  SKanai  M Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology 1996;200 (2) 559- 563
PubMed
DuBois  DDE A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916;17863- 871
Link to Article
Vauthey  JNAbdalla  EKDoherty  DA  et al.  Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002;8 (3) 233- 240
PubMed Link to Article
Kobayashi  SNagino  MYuasa  N  et al.  Benefit of percutaneous transhepatic portal vein embolization for extended hepatectomy [in Japanese]. Nippon Geka Gakkai Zasshi 2004;105 (6) 354- 358
PubMed
Nagino  MKamiya  JNishio  HEbata  TArai  TNimura  Y Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006;243 (3) 364- 372
PubMed Link to Article
Wakabayashi  HYachida  SMaeba  TMaeta  H Evaluation of liver function for the application of preoperative portal vein embolization on major hepatic resection. Hepatogastroenterology 2002;49 (46) 1048- 1052
PubMed
Francavilla  AGavaler  JSMakowka  L  et al.  Estradiol and testosterone levels in patients undergoing partial hepatectomy: a possible signal for hepatic regeneration? Dig Dis Sci 1989;34 (6) 818- 822
PubMed Link to Article
Francavilla  AEagon  PKDiLeo  A  et al.  Sex hormone–related functions in regenerating male rat liver. Gastroenterology 1986;91 (5) 1263- 1270
PubMed
Yamano  THirai  RHato  SUemura  TShimizu  N Delayed liver regeneration with negative regulation of hepatocyte growth factor and positive regulation of transforming growth factor–β1 mRNA after portal branch ligation in biliary obstructed rats. Surgery 2002;131 (2) 163- 171
PubMed Link to Article
Kanta  JChlumská  A Regenerative ability of hepatocytes is inhibited in early stages of liver fibrosis. Physiol Res 1991;40 (4) 453- 458
PubMed
Urata  KKawasaki  SMatsunami  H  et al.  Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995;21 (5) 1317- 1321
PubMed Link to Article
Francavilla  ADiLeo  AEagon  PK  et al.  Regenerating rat liver: correlations between estrogen receptor localization and deoxyribonucleic acid synthesis. Gastroenterology 1984;86 (3) 552- 557
PubMed
Eagon  PKPorter  LEFrancavilla  ADiLeo  AVan Thiel  DH Estrogen and androgen receptors in liver: their role in liver disease and regeneration. Semin Liver Dis 1985;5 (1) 59- 69
PubMed Link to Article
Angele  MKSchwacha  MGAyala  AChaudry  IH Effect of gender and sex hormones on immune responses following shock. Shock 2000;14 (2) 81- 90
PubMed Link to Article
George  RLMcGwin  G  JrWindham  ST  et al.  Age-related gender differential in outcome after blunt or penetrating trauma. Shock 2003;19 (1) 28- 32
PubMed Link to Article
Kuebler  JFToth  BRue  LW  IIIWang  PBland  KIChaudry  IH Differential fluid regulation during and after soft tissue trauma and hemorrhagic shock in males and proestrus females. Shock 2003;20 (2) 144- 148
PubMed Link to Article
Kher  AWang  MTsai  BM  et al.  Sex differences in the myocardial inflammatory response to acute injury. Shock 2005;23 (1) 1- 10
PubMed Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections