Biomedical subjects

K Shirabe

Publications and source records attributed to K Shirabe.

At least 55 records · Page 3Linked to original sources

PubMed1998

Perioperative change in albumin messenger RNA levels in patients with hepatocellular carcinoma.

A quantitative assay of albumin messenger RNA (mRNA) in blood samples was designed using the competitive reverse-transcription polymerase chain reaction, and the significance of measuring albumin mRNA levels in the blood of patients with hepatocellular carcinoma (HCC) in hepatic resection was evaluated. Albumin mRNA levels were measured in the following: (1) peripheral blood in 11 patients with HCC and 20 control subjects without liver disease, (2) blood in the portal and hepatic veins in five patients with HCC immediately after laparotomy, and (3) a perioperative series of peripheral blood in eight patients with HCC. Two patients with HCC whose albumin mRNA level in peripheral blood was markedly high were both at stage IVa. On the other hand, 20 control subjects showed negative or <5 x 10(3) transcripts/microgram RNA of albumin mRNA expression. Immediately after laparotomy, the albumin mRNA levels in the tumor-draining hepatic vein were greater than in the portal and non-tumor-draining hepatic veins in four of five patients with HCC. Albumin mRNA levels in peripheral blood showed a marked increase after mobilization and/or resection of the liver and, thereafter, gradually decreased at postoperative day 7 in all eight patients with HCC. A new method to measure the albumin mRNA levels in blood samples was developed, and high albumin mRNA levels in the peripheral blood of patients with advanced-stage HCC suggest the presence of HCC cells in the circulation. Increased levels in the tumor-draining hepatic vein could indicate the spontaneous release of tumor cells or nontumorous hepatocytes or an increased albumin transcription in activated blood mononuclear cells. An increase in the levels in peripheral blood during an operation is intermittent. Therefore, an increased albumin mRNA level in the tumor-draining vein suggests, but does not prove, that the increased albumin mRNA level reflects tumor cells entering the systemic circulation. This alone does not prove that the prognosis is worsened.

Aged↗

PubMed1998

Role of adhesion molecule expression and soluble fractions in hepatic resection.

BACKGROUND: Little has so far been documented about the relationship between liver injury and adhesion molecules. The aim of this study is to clarify the role of adhesion molecules in hepatic resection by studying both the expression of such adhesion molecules and the measurement of their soluble fractions in the blood. STUDY DESIGN: To study adhesion molecule expression in the liver, liver biopsies were obtained before and after hepatectomy in 14 patients. Using frozen sections, immunochemical staining for intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was then performed. To study the soluble fractions of adhesion molecules in the hepatic venous blood, the serum soluble fractions of ICAM-1 and VCAM-1 from another 17 patients were measured using an enzyme-linked immunosorbent assay. The plasma levels of polymorphonuclear leukocyte (PMN) elastase were also measured using an enzyme immunoassay. Both the preoperative and postoperative values of the serum soluble fractions of ICAM-1, VCAM-1, and PMN elastase were then compared. The correlation between their values and the perioperative variables was also investigated. RESULTS: Either ICAM-1 or VCAM-1 was stained on the sinusoidal endothelial cells and Kupffer cells or circulating PMNs in the sinusoid. The positive rate of either ICAM-1 or VCAM-1 staining in livers with more than 40 minutes of total ischemic time (80%) was significantly higher than that in livers with less than 40 minutes of total ischemic time (0%; p < 0.05). The incidence of postoperative complications in the ICAM-1 positive staining group tended to be higher than that in the ICAM-1 negative group. Both soluble fractions of ICAM-1 and VCAM-1 in patients with cirrhotic liver disease were also significantly higher than those in patients with a normal liver. The soluble VCAM-1 level in patients with a chronic active hepatitic liver tended to be higher than that in those with a nonactive hepatitic liver. The preoperative level of soluble ICAM-1 correlated with that ofVCAM- 1, PMN elastase, albumin, aspartate aminotransferease (AST), and the indocyanine green dye retention test at 15 minutes (ICG R15), while the preoperative level of VCAM-1 correlated with albumin, the hepaplastin test, AST, and ICG R15. Both the serum soluble ICAM-1 and VCAM-1 levels after hepatectomy were significantly lower than those before hepatectomy. By contrast, the posthepatectomy level of PMN elastase was significantly higher than its prehepatectomy level. The difference between the postoperative and preoperative values of soluble ICAM-1 correlated with the postoperative AST level, postoperative alanine aminotransferase level, and total ischemic time. CONCLUSIONS: Adhesion molecules were expressed in the liver after hepatic resection, and such expression correlated with a total ischemic time during hepatectomy. In addition, judging from the soluble forms of such molecules, these adhesion molecules play an important role in hepatic resection.

Aged↗

PubMed1998

Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma.

BACKGROUND: The aim of this study was to clarify the risk factors for morbidity as well as to establish an optimum surgical strategy for hepatocellular carcinoma (HCC). METHODS: The risk factors linked to postoperative complications were analysed in 388 patients over a 10-year period, according to the kind of operative procedure. RESULTS: Stepwise regression analysis revealed that the most important factors related to postoperative morbidity were: age, creatinine level and the histological grade of fibrosis for the bisegmentectomy; the presence of diabetes mellitus, blood urea nitrogen level, the indocyanine green dye retention rate at 15 min and blood loss for the segmentectomy; the presence of diabetes mellitus and blood loss for subsegmentectomy; the presence of diabetes mellitus, the aspartate aminotransferase level, and the total operating time for resection less than subsegmentectomy. CONCLUSION: The most important risk factors were not always related to liver function tests, but instead to other coexisting conditions such as diabetes mellitus and operation stress including operating time and blood loss. Therefore, any future treatment strategy of hepatic resection for HCC should make every effort both to evaluate coexisting conditions carefully and to reduce operative stress as far as possible.

Age Factors↗

PubMed1998

Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma.

OBJECTIVE: The aims of this study were to identify prognostic factors in patients who developed recurrent hepatocellular carcinoma (HCC) after repeat hepatectomy and to elucidate the role of multicentric occurrence in the second tumor after a first hepatectomy. SUMMARY BACKGROUND DATA: A repeat hepatectomy for recurrent HCC has been established as the most effective treatment modality, whenever it is possible. However, the prognostic factors for recurrent HCC after repeat hepatectomy have yet to be clarified. METHODS: Forty-one patients who underwent a curative repeat hepatectomy were retrospectively studied. Patient survival and disease-free survival after recurrence were univariately and multivariately analyzed using 38 clinicopathologic variables. The histologic grade of HCC at repeat hepatectomy was also compared with that at first hepatectomy. RESULTS: Patient survival after repeat hepatectomy did not differ substantially from that in 312 patients undergoing primary hepatectomy. However, the disease-free survival after repeat hepatectomy was significantly lower than that in patients with only a primary hepatectomy (p < 0.05). Multivariate analysis revealed only portal vein invasion in the first hepatectomy to be an independent and significantly poor prognostic factor. Regarding multicentric occurrence at repeat hepatectomy, only 6 of 40 patients (15%) whose specimens could be evaluated histologically were determined to be Edmondson and Steiner's Grade 1. CONCLUSIONS: The only prognostic factor identified in patients with recurrent HCC after repeat hepatectomy was portal vein invasion in the first hepatectomy. Most second tumors after the first hepatectomy are considered to be caused by metastatic recurrence, not by multicentric occurrence.

Algorithms↗

PubMed1998

Nm23-H1 expression in intrahepatic or extrahepatic metastases of hepatocellular carcinoma.

AIMS/BACKGROUND: Decreased expression of nm23, a putative metastasis suppressor gene, has been reported to be related to either intrahepatic metastasis or a poor prognosis in hepatocellular carcinoma (HCC). The aim of this study was to elucidate the true role of nm23-H1 expression in both intrahepatic and distant metastases of HCC. METHODS: Thirteen patients with single-nodule HCC, seven patients with HCC having satellite nodules and seven patients with HCCs having extrahepatic metastases were included in this study. The expression of nm23-H1 protein was immunohistochemically examined in both primary and metastatic nodules. RESULTS: Ten of 13 single-nodule HCCs were found to overexpress nm23-H1 protein. All main tumors, having satellite nodules, were found to overexpress nm23-H protein, except for two HCCs, which only partially expressed nm23-H1 protein. Regarding the nm23-H1 expression in intrahepatic metastases, most nodules overexpressed the protein. The expression of nm23-H1 was found to be low in only one intrahepatic metastasis specimen, while its primary tumor was also found to show a low expression of nm23-H1 protein. Microscopic portal vein invasion was found in three of the five patients studied, and all cancer cells in portal invasion overexpressed nm23-H1 protein. Nm23-H1 protein was expressed in all distant metastatic tumors and the staining intensity of most metastatic nodules was similar to that of the primary tumors. CONCLUSIONS: Our study demonstrated that nm23-H1 expression did not always decrease but instead tended to increase at both intrahepatic and extrahepatic metastatic sites. Based on these findings, nm23-H1 expression is not considered to be a reliable indicator of either intrahepatic or distant metastasis in HCC.

Adrenal Gland Neoplasms↗

PubMed1997

Adenosquamous carcinoma of the liver: clinicopathologic characteristics and cytokeratin profile.

BACKGROUND: The clinicopathologic characteristics, biologic behavior, and histogenesis of primary adenosquamous carcinoma (ASC) of the liver have yet to be fully clarified. METHODS: Eight cases of ASC of the liver were analyzed both clinicopathologically and immunohistochemically using antibodies of cytokeratin (CK) 7, CK 8, CK 18, CK 19, and CK 903 (CK 5, CK 10, CK 11, and CK 14). The survival curve of the 6 patients with surgically resected ASC was compared with that of the 32 patients with common cholangiocarcinoma (CC). RESULTS: Most ASCs had invasive pathologic features, including venous invasion, lymphatic permeation, and intrahepatic metastases. There were lymph node metastases from 7 tumors (88%), and most of the metastases were adenocarcinoma. All adenocarcinoma (AC) components were positive for both CK 7 and CK 19. The squamous cell carcinoma (SCC) components were positive for CK 7 in all cases but were positive for CK 19 in only 5 cases (62.5%). The ACs were positive for CK 903 in only 3 cases (37.5%), whereas all SCCs were positive for CK 903. Almost all ACs were positive for both CK 8 and CK 18, whereas the SCCs were positive for CK 8 in only 3 cases (37.5%) and for CK 18 in no cases. All 6 patients with surgically resected ASC died of the disease within 1 year postoperatively. Their survival curve was significantly worse than that of the 32 patients with common CC (P < 0.001). The two patients on whom autopsy was performed also died within 1 year after diagnosis. CONCLUSIONS: ASC tended to have more aggressive biologic behavior and a poorer prognosis than common CC. The authors' immunohistochemical analysis of CK expression indicated that most of the ASCs of the liver that were studied developed from a squamous transformation of the preexisting CC.

Aged↗

PubMed1997

Identification of alternative first exons of NADH-cytochrome b5 reductase gene expressed ubiquitously in human cells.

Two forms of NADH-cytochrome b5 reductase (b5R), soluble and membrane-bound, are known. A hypothesis that the human soluble form b5R is generated through post-translational processing of the membrane-bound form was previously proposed. In this study, the 5'-rapid amplification of cDNA ends for human reticulocyte, liver, brain, and HL-60 cell mRNAs revealed the ubiquitous presence of an alternative type of human b5R mRNA which can probably be translated into the soluble form b5R directly; however, the erythroid-specific transcript of the b5R gene was not found. This type of b5R mRNA initiating from at least two sites contains a non-coding new first exon located between the first two exons of the human b5R gene identified before. In addition, this new first exon shares 62% homology with the first exon and its 3'-flanking intron sequences of rat erythroid-specific b5R mRNA, whereas the 5'-flanking region of the new first exon possesses features of house-keeping gene. These results might be important to understand the regulation mechanism of human b5R biosynthesis and divergent evolution of the gene regulation.

Animals↗

PubMed1997

Lack of promotion of colon carcinogenesis by high-oleic safflower oil.

BACKGROUND: The nonpromoting effect of olive oil on colon carcinogenesis has been attributed to its high oleic acid content, whereas a positive association of monounsaturated fat in beef tallow with colon tumors has been reported. The effect of constituents other than fatty acids could not be neglected in these experiments. In order to minimize the effects of minor constituents in the oils, the authors compared conventional safflower oil with oil from a mutant strain of safflower that is rich in oleic acid. METHODS: ICR mice were treated with 1,2-dimethylhydrazine (DMH, 20 mg/kg body weight every week for 12 weeks) and then were fed either a high-fat diet (23.5% by weight), containing safflower oil (HF-LA) or high-oleic safflower oil (HF-OA), or a low-fat diet (5% by weight), containing safflower oil (LF-LA) or high-oleic safflower oil (LF-OA). The test diets were continued until termination of the experiment at 30 weeks after the first administration of DMH. Fatty acid composition of colon phospholipids was determined by gas-liquid chromatography-mass spectrometry. RESULTS: Tumor multiplicity in animals fed the HF-OA diet was indistinguishable from that in animals fed LF-LA or LF-OA. In contrast, animals fed the HF-LA diet had a significantly higher incidence of colon tumors (mostly adenocarcinomas) than the other groups. Fatty acid profiles of colon phospholipids reflected those of the diet. Animals fed a HF-LA diet showed a marked decrease of nervonic acid (C24:1, n-9) in the colon sphingomyelin. CONCLUSIONS: These data indicate that oleic acid does not enhance DMH-induced colon carcinogenesis in mice, even when they are fed a high-fat diet.

1,2-Dimethylhydrazine↗

PubMed1997

Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index.

OBJECTIVES: To clarify the indications for and the significance of palliative reduction surgery in the multidisciplinary treatment of advanced hepatocellular carcinoma (HCC) and to propose the use of a remnant tumor index (RTI) as a simplified criterion for palliative reduction surgery in cases of advanced HCC. DESIGN: A comparison of survival based on the RTI. SETTING: A large university hospital in Japan. PATIENTS: Twenty-five patients with advanced HCC who underwent palliative reduction surgery were divided into 3 groups as follows: group 1 (n = 9), the remnant tumor after operation existed only in the liver and the RTI was less than 5.0; group 2 (n = 11), the remnant tumor after operation existed only in the liver and the RTI was greater than 5.0; and group 3 (n = 5), extrahepatic metastatic tumor existed after operation. MAIN OUTCOME MEASURES: Pathological findings and survival rate after surgery. RESULTS: There was no significant difference in the degree of macroscopic intrahepatic metastases among the 3 groups; however, both the portal vein invasion and the histological grade tended to be more severe in groups 2 and 3. The respective 1-year and 3-year survival rates for group 1 were 67% and 33%, and those for group 2 were 21% and 0%. There were no survivors in group 3 at 1 year after surgery. Significant differences were found in the survival rates between groups 1 and 2 (P < .05), and between groups 1 and 3 (P < .05). CONCLUSION: Palliative reduction surgery for advanced HCC is only considered effective for patients with both an RTI of less than 5.0 and no extrahepatic metastasis.

Aged↗

PubMed1997

Significance of alpha-fetoprotein levels for detection of early recurrence of hepatocellular carcinoma after hepatic resection.

BACKGROUND: The recurrence of hepatocellular carcinoma (HCC) after surgery is common. The present study was conducted in order to clarify the significance of alpha-fetoprotein (AFP) in the detection of the early recurrence of HCC after surgery. METHODS: Fifty-eight patients who underwent a curative hepatic resection for HCC and whose preoperative AFP levels were >100 ng/ml, were selected for this study. RESULTS: In 26 cases, the postoperative AFP levels within 3 months after surgery did not decrease to <20 ng/ml (high AFP group). In the other 32 cases, the postoperative AFP levels within 3 months after surgery decreased to <20 ng/ml (low AFP group). No significant difference was observed in clinical or pathological backgrounds. The postoperative disease free rate in the low and high AFP groups was 84.2% and 18.4%, at 1 year, 61.2 and 4.6% at 3 years, respectively. The difference was statistically significant (P < 0.01). At the time of recurrence, the AFP levels increased in 25 (96.2%) of the patients who had early recurrence within 1 year after surgery as well as in 11 of 14 (78.5%) who had recurrence >1 year after surgery. The interval from surgery to recurrence significantly correlated with the doubling time of AFP at the time of recurrence in patients with early recurrence (within 1 year after hepatectomy) (r = 0.60, P < 0.01). In cases in which the preoperative AFP level was >100 ng/ml and the postoperative AFP level did not decrease to <20 ng/ml, early recurrence within 1 year after surgery would thus be strongly suspected. CONCLUSION: The measurement of the AFP levels after surgery is therefore considered to be important in the follow-up of hepatectomized patients, especially regarding the detection of early recurrence.

Aged↗

PubMed1997

Commitment of motoneuron progenitors of chick embryo along the anterior-posterior axis.

To identify molecules that might be involved in the early development of motoneurons, we performed RT-PCR for receptor tyrosine kinases (RTKs) and mRNA differential display with embryonic day 5 (E5) chick motoneurons enriched by panning. In situ hybridization revealed that Cek88 RTK among the cloned molecules was specifically expressed on motoneurons at the brachial and lumbar segments of the spinal cord which innervate limb muscles. We found that the expression of Cek8 in limb motoneurons was already intrinsically determined at E2. To analyze how motoneurons acquire regional specification along the anterior-posterior (A-P) axis and in the transverse plane, we observed the expression of Cek8, Islet-1, SC1 and low-affinity NGF receptor on ectopic motoneurons induced by implanting a supernumerary notochord or floor plate. The ectopic motoneurons induced by the graft obtained from either the thoracic or lumbar segments had the same expression profile as the in situ motoneurons at each A-P level. These findings suggest that regional specification of motoneurons is independent of the notochord and the floor plate and that the whole neural tube is committed to differentiate into the motoneuron subtypes along the A-P axis at the operative stages.

Animals↗

PubMed1997

Analysis of prognostic risk factors in hepatic resection for metastatic colorectal carcinoma with special reference to the surgical margin.

BACKGROUND: Liver resection for metastatic colorectal cancer has been established. Nevertheless, it is still controversial whether the surgical margin from the tumour edge to the cut surface of the liver is a significant prognostic factor in hepatic resection for colorectal metastatic liver cancer. METHODS: To clarify the prognostic risk factors in hepatic resection for colorectal metastasis, univariate and multivariate analyses were performed. Between April 1985 and April 1995, 31 patients underwent curative hepatic resection for metastatic colorectal cancer. The clinical and pathological factors were examined retrospectively. RESULTS: Overall 1-, 3- and 5-year survival rates of the patients were 92, 42 and 39 per cent respectively. Pathological study of 16 resected specimens with a solitary liver tumour revealed hepatic vein invasion by cancer cells in two of 16 cases, portal vein invasion in three, microsatellite lesions in two and biliary tract invasion in six cases. In resected specimens with a solitary tumour measuring less than 4 cm in diameter, one of these factors was observed in only two of nine cases, whereas in specimens with a solitary tumour measuring more than 4 cm in diameter, these factors were observed in six of seven patients (P < 0.05). The distance from the tumour edge to the intrahepatic invasion was less than 10 mm. With univariate analysis, tumour size of 4 cm or more in diameter, an interval of 6 months or less between colorectal and hepatic resection, four or more gross tumours, bilobar involvement and a resection margin from the tumour of less than 10 mm were found to be significant factors indicating a poor prognosis. Cox's proportional hazards model identified a tumour of 4 cm or more in diameter and a resection margin from the tumour of less than 10 mm as poor prognostic factors (P < 0.05). CONCLUSION: In treating metastatic colorectal cancer to the liver, the surgical margin should be more than 10 mm because occult intrahepatic invasion was always found to be located within 10 mm from the edge of the tumour.

Adult↗

PubMed1996

Des-gamma-carboxy prothrombin and alpha-fetoprotein positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma.

BACKGROUND: The aim of this study was to elucidate the usefulness of measuring the positive status of both des-gamma-carboxy prothrombin (DCP) and alpha-fetoprotein (AFP) preoperatively as a new prognostic indicator of hepatocellular carcinoma (HCC). METHODS: One hundred forty-seven patients who underwent curative hepatic resection for primary HCC were studied. The definitions of DCP and AFP positivity were: positive DCP > 0.1 AU/ml, and positive AFP > 50 ng/ml. The patients were classified into four groups according to their levels of positivity for DCP and/or AFP: Group 1 (n = 59), negative levels of both DCP and AFP; Group 2 (n = 28), negative DCP and positive AFP levels; Group 3 (n = 31), positive DCP and negative AFP levels; and Group 4 (n = 29), positive levels of both DCP and AFP. RESULTS: Patient survival and disease free survival in Group 4 were the worst among the four groups. By multivariate analysis, using Cox proportional hazards model, both the DCP- and AFP-positive status (in combination) and poorly differentiated histology were independent factors of poor prognosis for patient survival; and DCP- and AFP-positive status (in combination), poorly differentiated histology, positive intrahepatic metastasis, and tumor diameter over 5 cm were independent factors of poor prognosis for disease free survival. CONCLUSIONS: The combination of DCP- and AFP-positive status is a new prognostic indicator for patients with HCC after hepatic resection.

Adult↗

PubMed1996

Postoperative hepatitis status as a significant risk factor for recurrence in cirrhotic patients with small hepatocellular carcinoma.

BACKGROUND: Recurrence of small hepatocellular carcinoma (HCC) is common. Recent studies have suggested that the status of the underlying liver parenchyma is a significant risk factor for recurrence of HCC. METHODS: The postoperative values of transaminase were examined every 6 months after surgery in 57 patients with a surgically resected solitary small HCC measuring up to 3 cm in greatest dimension. Based on the patterns of the transaminase values, the patients were divided into two groups. Group 1 (n = 20) had a high transaminase level; the values of postoperative transaminase were always more than 100 IU/L. Group II (n = 37) had a low transaminase level; the values of postoperative transaminase were sometimes lower than 100 IU/L. RESULTS: The cumulative carcinoma-free survival rates in Groups I and II were 91% and 80%, respectively, at 1 year, 64.5% and 5.5%, respectively, at 3 years, and 48.2% and 0%, respectively, at 5 years after surgery. The disease free survival rates in Group I were significantly lower than those in Group II (P = 0.0007), although no significant differences in histologic risk factors for recurrence or in clinical backgrounds were observed. With regard to the recurrence pattern, solitary recurrence was more frequently observed in Group I (P = 0.02), compared with the patients in Group II. A histologic comparison between the primary and recurrent tumor in patients who underwent re-resection for solitary recurrence demonstrated the possible multicentric occurrence of HCC in 2 of 8 patients (25%) in Group I. CONCLUSIONS: This study suggests that the hepatitis status of the remnant liver plays an important role in the recurrence rates and patterns of small HCC after hepatectomy.

Carcinoma, Hepatocellular↗

PubMed1996

Inhibition of thromboxane A2 activity during warm ischemia of the liver.

To determine the role of thromboxane A2 (TxA2) in ischemic damage of the rat liver, we examined the effects of a TxA2 synthetase inhibitor (OKY 046) and a TxA2 receptor antagonist (ONO 3708). Rats were divided into three groups. In group I, a portion of the liver was subjected to 100 min of warm ischemia and the remaining liver resected. In group II, OKY 046 (30 mg/kg, intravenously) was given 5 min before the same procedure. In group III, ONO 3708 (10 mg/kg, intravenous) was given 5 min before ischemia. We then assessed survival, serum biochemistry, extent of histologic necrosis, and the levels of prostaglandin E2 (PGE2), TxB2, and 6-keto-PGF1-alpha. Pretreatment with OKY 046 and ONO 3708 significantly improved survival, decreased the tissue water content, and lowered the levels of serum transaminases and the extent of histological liver necrosis compared with the control group. OKY 046 markedly suppressed the level of TxB2, but not the levels of PGE2 or 6-keto-PGF1-alpha. ONO 3708 did not change the levels of PGE2, TxB2, or 6-keto-PGE1-alpha. In a liver perfusion model, OKY 046 and ONO 3708 did not suppress the uptake of trypan blue in hepatocytes. Our results demonstrate that either a TxA2 synthetase inhibitor or a TxA2 receptor antagonist can protect the liver from an ischemic insult. The effects of these drugs were due to inhibition of TxA2 synthesis and TxA2 blockade at the receptor, without modulating PGI2 or PGE1. Our results in a perfused rat liver model suggest that these drugs work during reperfusion and prevent postischemic tissue edema.

Animals↗

PubMed1996

Results of 280 liver resections for hepatocellular carcinoma.

OBJECTIVE: To evaluate the recent results of liver resection in patients with hepatocellular carcinoma. DESIGN: Retrospective study. SETTING: A university hospital in Japan. PATIENTS: Two hundred eighty patients who underwent liver resection with complete extirpation of hepatocellular carcinoma from 1985 to 1993. MAIN OUTCOME MEASURES: Morbidity and survival after operation and the pathologic features of hepatocellular carcinoma according to the TNM classification of the International Union Against Cancer. RESULTS: More than 40% of the patients with stages I and II disease underwent a partial resection of the liver, whereas 50% of those with stages III and IVA were operated on with more than a bisegmentectomy. Fifty percent of all patients had no postoperative complications. The morbidities included intra-abdominal abscess (7%), bile leakage (5%), and hepatic failure (4%, of whom half died; mortality rate, 2%). Histopathologically, 32% of the stage I tumors were well differentiated (grade 1), while, in stage III, 56% had portal invasion and 61% had daughter lesions in the liver. The cumulative survival rates of patients with stages I, II, and III disease and all patients at 5 years were 69%, 52%, 32%, and 50%, respectively, while the disease-free survival rates at 5 years were 38%, 34%, 17%, and 29%, respectively. CONCLUSION: The recent results of liver resection for hepatocellular carcinoma are generally satisfactory; however, the recurrence rate is still high.

Aged↗

PubMed1996

Cardiac complications after hepatic resection.

During a period of 94 months between 1985 and 1993, 474 hepatic resections were performed in 451 patients, of whom 23 (5 per cent) had cardiac problems: ischaemic heart disease in 16 (previous myocardial infarction in five and angina pectoris in 11), arrhythmic disorders in three, valvular disease in three (previous mitral valve replacement in two) and hypertrophic cardiomyopathy in one. The cardiac patients had a higher incidence of cardiac complications (24 versus 0 per cent, P < 0.0001) including two myocardial infarctions, and of non-cardiac complications consisting of postoperative liver failure (16 versus 4 per cent, P < 0.01) and bile leak (16 versus 5 per cent, P = 0.02), as well as hospital death (16 versus 3 per cent, P < 0.001). However, long-term survival was similar in the two groups. Patients with preoperative cardiac conditions appear to be at increased risk for early postoperative morbidity and mortality after hepatic resection.

Adolescent↗

PubMed1996

Surgical treatment strategy for patients with stage IV hepatocellular carcinoma.

BACKGROUND: This study was conducted to identify the prognostic indicators for patients with stage IV hepatocellular carcinoma (HCC), as well as to clarify the strategy of surgical treatment for those patients. METHODS: Forty-six patients with stage IV HCC were included in this study. Prognostic factors were univariately and multivariately analyzed. Furthermore, the significance of intraoperative treatment for residual tumors was investigated in patients with an absolute noncurative operation. RESULTS: The poor prognostic factors were as follows: host factors, Child's classification of B and C and immunosuppressive acidic protein level of greater than 400 micrograms/ml; tumor factors, tumor diameter of greater than 5 cm, poorly differentiated histologic features, positive portal vein invasion, and intrahepatic metastases involving more than three segments; others, an absolute noncurative operation and no preoperative treatment. Tumor diameter of more than 5 cm was then suggested to be an independent prognostic indicator. Survival of patients with stage IV-A HCC who underwent a curative operation was similar to that of those with stages III HCC: Furthermore, the survival of patients with Stage IV-A who had an absolute noncurative operation but underwent either intraoperative microwave coagulation or ethanol injection to the residual HCCs was not statistically different from that of those with a curative operation. CONCLUSIONS: Therefore for stage IV-A HCC surgical treatment is considered to be both useful and the first choice of treatment when all the tumors in the liver can be removed or when the residual tumors can be treated during operation by either microwave coagulation or ethanol injection as a result of an incomplete removal of the tumors.

Adult↗