As a first step, percutaneous transhepatic cholangiodrainage (PTCD) to the left liver was performed to recover left liver function, which declined because of bile congestion on postoperative day 22 (Table 1).
The left liver function rate had changed from 26.2 % on admission to 26.3 % after PTCD and 54.5 % after PVE, while the left liver volume rate was 33.8, 33.3, and 49.6%%, respectively.
Right liver function rate decreased to 45.5 %, and left liver function rate increased to 54.5%% (Fig. 4c, c').
The function shifted from the right to the left liver, and thus, function of the left liver improved rapidly: the total liver volume was 2078 ml, right liver volume was 1048 ml (50.4 %), and left liver volume was 1030 ml (49.6 %).
To improve left liver function, portal vein embolization (PVE) of the right liver was performed as a next step on postoperative day 37.
Via a transverse subcostal laparotomy, blood vessels to the median and left liver lobes were occluded with a surgical clamp for 60 mins.
From the left liver lobes, two sections were taken and fixed in 10% formalin.
In the liver, particles were homogeneously distributed inside small-sized vessels, both in large and small portal spaces and in subcapsular arteries throughout the entire left liver lobe.
Eight studies used partial vascular occlusion to the median and left liver lobes to induce hepatic ischemia to 70% of the liver (Tables 1– 3).
Five partial hepatic resections of the left liver metastases including left S1 tumor and the right portal vein ligation were performed during the first stage.
The remaining left liver lobe and left kidney were minced and snap frozen in liquid nitrogen within several minutes after euthanasia for RNA isolation.
