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PubMed1998

Advantage of preoperative portal vein occlusion for hepatectomy that exceeds portal vein occluded lobes.

BACKGROUND: The purpose of our study was to examine the effect of preoperative portal vein (PV) occlusion on hepatic reserve function after extended hepatectomy that is an excision of areas beyond the PV occluded lobes. METHODS: Male Wistar rats were divided into three groups and underwent a two-stage operation: a PVL-hepatectomy group (ligation of the PV [PVL] of the left and median lobes followed by hepatectomy of the right lobes together with the PV occluded lobes), a sham-88% hepatectomy group (sham operation without PVL followed by hepatectomy corresponding to the lobes excised in the PVL-hepatectomy group), and a sham-67% hepatectomy group (sham operation followed by hepatectomy of the left and median lobes to approximate the volume excised in the PVL-hepatectomy group). In all subjects, hepatectomy was carried out 7 days after the PVL or sham operation. On days 0, 1, 2, and 3 after hepatectomy, liver weight, histologic elements, DNA synthesis rates, energy charge, adenine nucleotides, and lipoperoxide levels of the remaining liver were determined. RESULTS: In the sham-88% hepatectomy group, the volume of resected liver was 88.2% +/- 0.5%. In the PVL-hepatectomy group it was 69.1% +/- 0.8%, although anatomically identical lobes were excised. At the time of hepatectomy, DNA synthesis, hepatic concentrations of adenine nucleotides and lipoperoxide, and serum liver function tests showed similar results in all three groups. The survival rate 3 days after hepatectomy was significantly low (53%) in the sham-88% hepatectomy group, whereas it was 100% in the PVL-hepatectomy and sham-67% hepatectomy groups. The gain in liver weight per day was significantly lower in the sham-88% hepatectomy group than in the other two groups. The decline in hepatic energy charge after hepatectomy was less, with less activated DNA synthesis, in the PVL-hepatectomy group compared with the sham-88% hepatectomy and sham-67% hepatectomy groups. Lipoperoxide concentration in the PVL-hepatectomy group was significantly lower than that in the sham-88% hepatectomy and sham-67% hepatectomy groups. CONCLUSIONS: Preoperative PV occlusion not only increases the remaining liver volume but also is advantageous to hepatic reserve after hepatectomy that exceeds PV occluded lobes.

Adenine Nucleotides↗
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

Repeat hepatectomy for recurrent colorectal metastases.

Recurrence rates after hepatic resection in patients with colorectal metastases are reported to range from 47% to 80%. Hepatic recurrence is seen in 35% to 50% of patients. Aggressive surgical resection appears to be a worthwhile treatment in patients with recurrent hepatic metastases to promote longer patient survival because surgical resection remains the only curative therapy available. This is a retrospective review of our experience with 15 patients undergoing repeat hepatic resection culled from 67 patients undergoing initial hepatectomy for metastatic colorectal cancer. Of 67 patients who underwent hepatectomy for colorectal hepatic metastases, 33 developed hepatic recurrence at a median interval of 23 months (range 1-176 months) after the first hepatectomy. The second hepatectomy was performed in 15 patients 5 to 29 months after the first hepatectomy, with no mortality. The mean operating time and blood loss at the second hepatectomy were similar to those at the first hepatectomy. The mean hospital stay at the second hepatectomy was significantly shorter than that at the first hepatectomy. The cumulative survival rate for the 15 patients was 42.4% at 3 years and 21.2% at 5 years, respectively, which compared favorably with the survival rate of the 67 patients who underwent initial hepatectomy. Patients who underwent the second hepatectomy had significantly higher survival rates from the first hepatectomy than the 18 patients with unresectable hepatic recurrence. Repeat hepatectomy can be performed safely and provides long-term survival rates similar to those of first hepatectomies. In appropriately selected patients, repeat hepatectomy for colorectal metastases is a worthwhile treatment.

Adult↗