Resectability and regeneration of liver in postsinusoidal block.

To study resectability and regeneration of cirrhotic liver, hemodynamic changes following partial hepatectomy were observed in dogs with presinusoidal block caused by ligation of the portal vein or with postsinusoidal block caused by ligation of the hepatic veins after portacaval anastomosis, since cirrhosis of the liver in man is mainly of postsinusoidal block occasionally accompanied by presinusoidal block. With a presinusoidal block, resection of 50 per cent liver was tolerated well, but with postsinusoidal block only less than 30 per cent could be resected. Thus the functional reserve of the liver with postsinusoidal block seems to be much less than that of presinusoidal block. After major hepatic resection the weight of the remnant liver with a dual blood supply increased markedly, while with a postsinusoidal block it increased slightly and with a presinusoidal block there was no change. Histometric studies showed that regeneration was prominent in the remnant liver with a dual blood supply, slight with a postsinusoidal block, and even less with a presinusoidal block. Thus, the liver with a postsinusoidal block possesses more extensive regenerative capacity but shows much lower resectability than with a presinusoidal block. Therefore, the resectability of the liver associated with cirrhosis seems to be more closely related to its functional reserve capacity than to its regenerative capacity.