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PubMedDate not supplied

Modification of T-lymphocyte subsets in peripheral blood, the liver, and the spleen during liver regeneration after partial hepatectomy of mice.

Flow cytometry analysis was performed to investigate the modifications to the T lymphocytes in peripheral blood, the spleen, and two intrahepatic lymphocyte fractions--the intrahepatic lymphocyte fraction 1 (IHL Fr.1), which is easily washed out from the liver by perfusion of collagenase solution, and the intrahepatic lymphocyte fraction 2 (IHL Fr.2), which remains in the liver after the perfusion--occurring in the liver regeneration process after partial hepatectomy of mice. The following findings were obtained: 1) The nontreated murine liver contains Thy 1.2+ cells, alpha beta TCR+ cells, gamma delta TCR+ cells, CD4+ cells, and CD8+ cells. 2) The percentage of each T-cell subset in IHL Fr.1 shows an intermediate value between that in the peripheral blood lymphocytes (PBL) and that in the IHL Fr.2. 3) One day after partial hepatectomy, the Thy 1.2+ cells, alpha beta TCR+ whole cells, and CD4+ cells in IHL Fr.2 all showed a transient, yet significant, decrease, but did not reveal any major change in the other fractions. 4) Both the alpha beta TCR dull+ cells and the CD8+ cells showed practically no change after partial hepatectomy in any of the fractions. This indicates that the alpha beta TCR dull+ cell/alpha beta TCR+ whole cell and the CD8+ cell/CD4+ cell ratios show a significant increase 1 day after partial hepatectomy only in the IHL Fr.2. Double-positive cells, which were scarcely found in the spleen of nontreated mice, appeared in the spleen after partial hepatectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Pharmacokinetics of midazolam in patients with liver damage for hepatectomy].

Pharmacokinetics of midazolam in patients with liver damage for hepatectomy was compared to that in patients without liver injury for gastrectomy. Anesthesia was induced with midazolam 0.15 mg.kg-1 and fentanyl. Serum concentration of midazolam was measured at 30 minutes, 1, 2, 3, 4, 6 and 8 hours after midazolam injection. Serum midazolam levels were not significantly different between the two groups at any time. The elimination half-life of midazolam was about 3 times longer in hepatectomy group (24.2 hours) than in the group without liver injury (8.4 hours). Area under the curve of the serum midazolam concentration was larger in the group with liver damage than in the group without it. But distribution volume and clearance of midazolam were not different between the two groups probably because of more blood transfusion and bleeding in hepatectomy group. The recovery time from anesthesia in hepatectomy group was as long as that in the group without liver injury. The results suggest that in patients with liver damage for hepatectomy, the elimination of midazolam is prolonged but its effect is not.

Aged↗
PubMed1993

[Influence of epinephrine infusion on the metabolism of exogenous lipid emulsions after 70% hepatectomy in the rat].

We investigated the effects of epinephrine on the metabolism of a lipid emulsion administrated to rats after 70% hepatectomy. Sprague-Dawley rats were underwent 70% hepatectomy and then were given lipid total parenteral nutrition (lipid-TPN) for 96 h. To increase catabolism after hepatectomy, epinephrine (Bosmine) infused continuously with the lipid-TPN. With increasing doses of the epinephrine, weight loss and the increased urinary excretion of nitrogen and 3 methyl histidine were observed. This indicated that administration of epinephrine after hepatectomy produced a model of increased surgical stress. As the epinephrine dose increased the linoleic acid content of the hepatic phospholipids increased and the arachidonic acid decreased at 96 h after hepatectomy. Epinephrine apparently inhibited the activity of the delta 5.6 desaturase involved in the biosynthesis of polyunsaturated fatty acids, leading to changes of the cell membrane fatty acid composition that could possibly influence membrane function. Thus, the fatty acid composition of lipid emulsions for TPN should be tailored according to the severity of surgical stress, because the pattern of secretion of stress hormone is dependent on the degree of such stress.

Animals↗
PubMed1993

[Experimental studies on the relation of platelet activating factor (PAF) to high mortality in sublethal endotoxemia after massive hepatectomy and effects of its antagonist].

The effects of platelet activating factor antagonist (PAF-A) for sublethal endotoxemia after 70% or 84% hepatectomy in rats were studied. Endotoxin of 1mg/kg b.w. was intravenously given once on the first, third or fifth day hepatectomy. One week survival rates of 84%-hepatectomized rats with endotoxin injection on the third postoperative day was the lowest at 20%, and the lowest survival rate improved to 80% with PAF-A administration. Pathophysiology of PAF-A treated and nontreated rats with endotoxemia was investigated on the third day after 84% hepatectomy. There was no significant difference in SGOT, SGPT and blood glucose level between the two groups. PAF-A nontreated rats' prothrombin time was prolonged (p < 0.05) and serum fibrinogen level significantly decreased (p < 0.01), compared to treated rats. Platelet count distinctly decreased in both groups. Fibrin was pathologically proved in the glomeruli of the kidney in both groups. However, single cell necrosis of hepatocytes was significantly reduced by PAF-A administration. Rats without PAF-A had bloody ascites in 75% of cases and showed shock and pathologically pulmonary congestion. PAF may be related to DIC, shock, bloody ascites and high mortality rate in sublethal endotoxemia after massive hepatectomy. PAF-A was significantly effective for endotoxemia after hepatectomy.

Animals↗
PubMed1993

Hepatic fibrosis as a predictor of hepatic regenerative activity after partial hepatectomy in the rat.

Liver regeneration is an essential component of the recovery period after partial hepatectomy. Unfortunately, tests that accurately predict regenerative activity in the postoperative period have yet to be described. This study was designed to determine whether the extent of hepatic fibrosis correlates with liver regeneration activity after partial hepatectomy in rats with carbon tetrachloride-induced liver disease. Two groups of adult male Sprague-Dawley rats (12 to 30/group) were treated for 20 to 22 wk with weekly intragastric doses of carbon tetrachloride or vehicle. All rats then underwent 70% hepatectomy while under ether anesthesia. Liver regeneration activity was determined at 24 and 48 hr by [3H]thymidine incorporation into DNA. Hepatic fibrosis was calculated at the time of partial hepatectomy by automated image analysis on Van Gieson-stained liver tissue. Although a significant inverse correlation was found between the extent of hepatic fibrosis and DNA synthesis when all rats were considered (carbon tetrachloride-treated and vehicle-treated) at 24 and 48 hr after partial hepatectomy (r = -0.4943 and -0.7396, respectively; p < 0.05), no such correlation existed when carbon tetrachloride-treated rats were considered independently (r = -0.3231 and -0.0910 at 24 and 48 hr, respectively). In conclusion, we believe that in diseased livers, preoperative quantitation of hepatic fibrosis on automated image analysis does not serve as a useful predictor of liver regeneration activity.

Animals↗
PubMed1993

[Effects of medium chain triglyceride administration on liver regeneration after partial hepatectomy in rats].

The influence of lipid emulsion, especially medium chain triglyceride (MCT), on liver regeneration was investigated after 70% hepatectomy in rats. The rats received one of the following 3 solutions as a fuel source in total parenteral nutrition (TPN) regimen: a glucose solution (Group-G), a mixture of long chain triglyceride (LCT) and glucose (Group-L), or a mixture of MCT and glucose (Group-M). The calorie ratio of fat to glucose in LCT and MCT was 1 to 1. The energy charge (EC) of the regenerating liver decreased at 6 or 12 hours after hepatectomy and returned to the pre-operative level at 24 hours in each group. But EC at 6 hours was significantly higher in group-M than in group-G. Lipoperoxide (LPO) in regenerating liver was significantly lower in group-Mand-L than in group-G at 12 hours after hepatectomy, but it was significantly higher in group-M than in group-G and -L at 48 hours. Labeling index (LI) of bromodeoxyuridine (BrdU) was significantly higher in group-Mand L than in group-G at 24 hours after hepatectomy. These results indicate that MCT may be beneficial energy substrates in acute phase of regenerating liver. Although lipid emulsion has beneficial effect on the liver regeneration after hepatectomy, in recovery phase of liver regeneration, addition of LCT with MCT may be considered more beneficial.

Adenine Nucleotides↗
PubMed1995

[Studies of liver macrophage function in the intraabdominal infection after partial hepatectomy in the rat model].

The activities of superoxide (O2-), tumor necrosis factor (TNF) and interleukin-1 (IL-1) of rat liver macrophage (M phi) were studied in the condition of intraabdominal infection (E group), hepatectomy (H group) and intraabdominal infection following hepatectomy (HE group). In the early stage of E and HE groups, O2- production was significantly increased after infection. In the H and HE groups, O2- production was significantly increased at 48 hours after hepatectomy, probably due to liver regeneration. In every group, the changes of TNF activity showed the similar pattern to those of O2- production. In H and E groups, the elevation of IL-1 activities was significantly increased. However in HE group, the IL-1 level remained low during 72 hours. When the M phi 48 hours following hepatectomy was stimulated by lipopolysaccharide (LPS), activities of TNF and IL-1 were correlated and reversely correlated with the LPS level, respectively. In the excessive stimulation by infection following hepatectomy, IL-1 activity is significantly suppressed with production of O2- and TNF by M phi maintained.

Animals↗
PubMedDate not supplied

Behavior of collagen extracellular liver matrix during regenerative growth after partial hepatectomy or after stimulation by exogenous hepatotrophic factors. Study in rats.

During regeneration after partial hepatectomy, the hepatic parenchyma grows by reproducing its histological elements at different rates. The hepatic cells grow more rapidly and the collagen components of the extracellular matrix more slowly. This report studies the behavior of liver tissue collagen in intact livers, increased in size by stimulation with exogenous hepatotrophic factors, comparing them to regenerated livers after hepatectomy. The series consists of a group of rats (n = 4), seven days after 70% hepatectomy, with an average growth of the residual liver mass of 71.55% and another group (n = 4), seven days after stimulation of the intact livers with an average growth of 121.05%. The exogenous hepatotrophic factors administered intraperitoneally (portal) included glucose, amino acids, insulin, glucagon and triiodothyronine. The hepatic collagen content was compared by studying slides stained with Picrossirius and examined with an optical microscope attached to a computer with an image analyzing program. The hepatic collagen was reduced from 2.07% +/- 0.13 to 1.14 +/- 0.08 (a difference of 44.57%; P < 0.001) after hepatectomy and from 1.98% +/- 0.19 to 1.24% +/- 0.07 (difference of 37.46%; P < 0.01) after exogenous hepatotrophic factors stimulation. It was concluded that the production of collagen in hepatic growth initiating with intact livers stimulated by exogenous hepatotrophic factors, occurs with a time difference similarly to what is observed after 70% hepatectomy.

Animals↗
PubMed1997

Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results.

BACKGROUND: The objective of this study was to evaluate the efficacy of combined pancreaticoduodenectomy and hepatectomy for the treatment of patients with locally advanced gallbladder carcinoma. METHODS: Long term results over 5 years of follow-up were analyzed retrospectively in 17 consecutive patients with gallbladder carcinoma who underwent combined pancreaticoduodenectomy and hepatectomy with radical lymphadenectomy. The indications for pancreaticoduodenectomy were direct invasion of the adjacent organs (stomach, duodenum, or pancreas) and/or the presence of peripancreatic (head only) lymph node metastases. The hepatectomy performed was a nonanatomic resection of the gallbladder bed in 15 patients and an extended right hepatectomy in 2 patients. There was 1 in-hospital death (6%). RESULTS: Overall, 5 patients (29%) survived 5 years after surgery. Of these patients, four had Stage IVB disease with positive peripancreatic lymph nodes. Eight of the 10 patients who underwent a potentially curative resection survived longer than 3 years, whereas none of the 7 patients with residual tumor survived beyond 15 months. The 5-year survival of 50% (median survival: 58.5 months) in those undergoing a potentially curative resection was significantly better than the 5-year survival of 0% (median survival: 8 months) observed in those patients with residual tumor (P = 0.00086). CONCLUSIONS: Combined pancreaticoduodenectomy and hepatectomy is an efficacious treatment for patients with locally advanced gallbladder carcinoma, but only if a potentially curative resection is feasible. The presence of peripancreatic (head only) lymph node disease is not a contraindication for this procedure.

Adenocarcinoma↗
PubMedDate not supplied

Arterial ketone body ratio does not correlate with ischemic changes during major hepatectomy.

BACKGROUND/AIMS: The arterial ketone body ratio (AKBR) has been proposed as an accurate indicator of hepatic mitochondrial redox potential. However, recent studies of the utility of the AKBR as a biochemical marker have been called into question. It is not clear whether the AKBR is closely related to ischemic changes during major hepatectomy. METHODOLOGY: Arterial acetoacetate and beta-hydroxybutyrate concentrations were measured in eleven patients who underwent major hepatectomy. The ratio between them (AKBR) was calculated before and after vascular occlusion during the hepatectomy procedure. RESULTS: The AKBR increased following normothermic arterial or portal venous ischemia as compared to the levels prior to vascular occlusion in 36.4% of the patients who underwent major hepatectomy. An AKBR of less than 0.5 prior to vascular occlusion did not correlate with preoperative hepatocellular function. An AKBR of less than 0.7 throughout surgery was not a consistent risk factor for postoperative complications or liver dysfunction. CONCLUSIONS: The AKBR does not correlate with ischemic changes or postoperative complications after major hepatectomy.

3-Hydroxybutyric Acid↗
PubMed1998

Partial hepatectomy accelerates local tumor growth: potential roles of local cytokine activation.

BACKGROUND: Surgical excision of liver tumors represents the only curative treatment for primary and metastatic liver malignancies. It has been suspected that hepatectomy may stimulate growth of microscopic tumors. To determine whether local or systemic factors after hepatectomy are responsible for enhancement of tumor growth, the effects of hepatectomy on the experimental growth of liver or pulmonary tumors were examined. METHODS: One hour after injection of 10(6) Morris hepatoma cells into either the portal or femoral vein, which produces isolated liver and lung tumors, respectively, animals were randomized to undergo 0%, 30%, or 70% partial hepatectomy (PH). RESULTS: Animals that underwent portal injection of tumor had significantly increased liver tumor burden after PH (sham, 25 +/- 7 vs PH, 94 +/- 17; p < 0.01), whereas animals that underwent femoral injection had no change in lung tumor burden after PH. PH was associated with significantly increased levels of transforming growth factor-alpha, transforming growth factor-beta, and basic fibroblast growth factor in the liver but not in the lung. CONCLUSIONS: Changes in liver cytokine-growth factor activation may contribute to enhanced tumor growth in the liver after hepatectomy.

Animals↗
PubMed1982

Distribution of mRNAS of fibrinogen polypeptides and albumin in free and membrane-bound polyribosomes and induction of alpha-fetoprotein mRNA synthesis during liver regeneration after partial hepatectomy.

To study the effect of regenerative response of the liver following partial hepatectomy on the synthesis of major plasma proteins (secretory proteins), we have determined the sequence contents and the distribution of albumin and fibrinogen polypeptide mRNAs in rat liver at intervals after partial hepatectomy and sham operation. Using a quantitative technique for the isolation of polyribosomes, we demonstrated that the distribution of RNA between free and membrane-bound polyribosomal fraction was unchanged in these experiments. There was no shift in the polyribosomal population to favor free polyribosomes after partial hepatectomy. However, there was a dramatic increase (5-6-fold) of the fibrinogen polypeptide mRNA concentration during the first 24 h after resection. In contrast, the albumin mRNA concentration decreased (2-3-fold). There were no alpha-fetoprotein mRNA sequences detectable in any liver RNA fraction in these experimental animals. In sham-operated rats with intact livers, similar changes of fibrinogen polypeptide and albumin mRNA concentrations as described in regenerating liver after partial hepatectomy, were observed. These results suggest that albumin and fibrinogen synthesis after partial hepatectomy is reciprocally regulated at the mRNA level and represents a nonspecific acute phase response to surgical trauma.

Albumins↗
PubMed2005

Free radical scavenger (edaravone) prevents endotoxin-induced liver injury after partial hepatectomy in rats.

BACKGROUND/AIMS: Infection after major surgery, such as massive hepatectomy, induces liver dysfunction, occasionally leading to multiple organ failure and death. We demonstrated the anti-inflammatory effects and functional mechanisms of 3-methyl-1-phenyl-2-pyrazolin-5-one (edaravone), a newly synthesized free radical scavenger, on an experimental model of endotoxemia after partial hepatectomy in rats. METHODS: Rats were treated with lipopolysaccharide (LPS) 48h after 70% hepatectomy. Edaravone was administered intravenously before LPS-treatment. RESULTS: Edaravone markedly improved the survival rate of LPS-treated rats after hepatectomy and inhibited increases in serum levels of AST and LDH. Histopathological analysis demonstrated that edaravone prevented inflammatory changes in the liver, kidney and spleen. Edaravone inhibited the formation of one of the markers of oxidative damage, malondialdehyde. Increases in inflammatory cytokines and cytokine-induced neutrophil chemoattractant (CINC) in serum and liver tissue were inhibited in the edaravone-treated group. An electrophoretic mobility shift assay revealed that edaravone inhibited the activation of the transcription factor, nuclear factor-kappa B (NF-kappaB). Edaravone also reduced the induction of inducible nitric oxide synthase (iNOS). CONCLUSIONS: Edaravone prevents endotoxin-induced liver injury after partial hepatectomy not only by attenuating oxidative damage, but also by reducing the production of inflammatory cytokines, CINC and iNOS, in part through the inhibition of NF-kappaB activation.

Alanine Transaminase↗
PubMed1983

The effects of partial hepatectomy and of promoters on macromolecular binding of trans-4-acetylaminostilbene metabolites in liver and some extrahepatic tissues of rats.

Trans-4-acetylaminostilbene (trans-AAS) is a complete carcinogen for sebaceous glands and an initiator for liver in rats. Partial hepatectomy alone or in combination with phenobarbital, 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane or diethylstilbestrol produce liver tumors in trans-AAS pretreated rats. The effects of such secondary treatments on the macromolecular binding of [3H]trans-AAS metabolites was studied in several tissues. Partial hepatectomy was performed either 24 h before or after a single trans-AAS dose, and binding to proteins, RNA and DNA was measured 1, 3, and 17 d after the last treatment. Initial DNA-binding in liver was, if at all, somewhat lower than in controls, and then decreased more rapidly independent of the time of partial hepatectomy. In extrahepatic tissues, exposure and initial macromolecular binding was considerably higher, and elimination differentially delayed, if partial hepatectomy preceded dosing. With subsequent partial hepatectomy, initial binding was similar to controls, but elimination of DNA-binding was retarded in lung and glandular stomach. In a similar experiment, promoters were added to the feed 1 d after a single trans-AAS dose and macromolecular binding was determined 2 and 16 d thereafter. DNA-binding was little affected in liver, and in extrahepatic tissues at the first time point. In lung and glandular stomach its elimination was retarded, while in kidney DNA-binding even increased during promoter feeding. It is concluded that the secondary treatments have little impact on the primary lesion in the target tissue liver, but profoundly alter the disposal of trans-AAS metabolites which leads to increased tissue doses in extra-hepatic tissues.

Animals↗
PubMedDate not supplied

Hepatocyte growth factor as well as vascular endothelial growth factor gene induction effectively promotes liver regeneration after hepatectomy in Solt-Farber rats.

BACKGROUND/AIMS: Hepatic oval cells play an important role in liver regeneration when proliferation of mature hepatocytes is inhibited. The aim of this study was to examine the effect of hepatocyte growth factor (HGF), or vascular endothelial growth factor (VEGF) on proliferation of oval cells in the Solt-Farber rat model. METHODOLOGY: One hour after 70% partial hepatectomy, 2-acetyl-aminofluorene-induced damaged rats were infected intravenously with recombinant adenoviral vectors, encoding rat HGF or human VEGF, or Escherichia coli beta-galactosidase as a control. RESULTS: The plasma HGF concentrations in the HGF-transferred rats were elevated compared with the other groups at 4 and 7 days after hepatectomy. Oval cells were confirmed by positive staining of both cytokeratin-19 and alpha-fetoprotein. Oval cells around the portal tracts in the HGF or VEGF-transferred rats increased in number compared with the control rats at 7 and 9 days after hepatectomy. The proliferating cell nuclear antigen labeling indices of oval cells and the hepatic regeneration rate after hepatectomy were significantly augmented by the HGF or VEGF treatment. Moreover, cyclin E expression was elevated in the HGF-treated rats. CONCLUSIONS: In the Solt-Farber rat model, HGF or VEGF gene injection effectively promoted liver regeneration after hepatectomy mainly with increased proliferation of hepatic oval cells.

Adenoviridae↗
PubMed1994

Rapid activation of post-hepatectomy factor/nuclear factor kappa B in hepatocytes, a primary response in the regenerating liver.

The liver represents one of the few organs in the intact animal that has the capacity to regenerate following injury or partial hepatectomy. One of the earliest responses that has been detected in the remnant liver is the activation of post-hepatectomy factor(s) (PHF), a kappa B site DNA binding activity. We reasoned that understanding the molecular nature of PHF might provide insight into what triggers liver regeneration. We found that PHF is rapidly activated and turned over in the regenerating liver, demonstrating peak activity at 30 min post-hepatectomy and virtual disappearance by 1 h. As determined by supershift, cross-linking, and cross-linking/immunoprecipitation analyses, PHF contains intact p50/p65nuclear factor kappa B (NF-kappa B) subunits. To explore the basis for activation of PHF/NF-kappa B in the regenerating liver, we determined the level of individual Rel family subunits in the nuclei of normal and regenerating liver cells. We found evidence for nuclear translocation of p65/RelA, but other Rel family proteins including p50/NF-kappa B1 and p52/NF-kappa B2 are present at a low level in the nuclei of cells at a constitutive level pre- and post-hepatectomy and appear not to form DNA binding homodimers. The level of I kappa B-alpha falls slightly then increases at 3 h post-hepatectomy in concert with the induction of its mRNA. As demonstrated by the induction of I kappa B-alpha mRNA in hepatocytes in situ and identification of PHF/NF-kappa B in cultured hepatocytes, PHF/NF-kappa B is localized primarily in hepatocytes in the regenerating liver. This represents one of the few examples of NF-kappa B activation in the intact animal in a non-hematopoietic cell type. The activation of PHF/NF-kappa B suggests a mechanism by which hepatocytes regulate their mitogenic program during liver regeneration.

Animals↗
PubMed1995

Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer.

OBJECTIVE: Evaluation of extended right hepatectomy (ERH) after biliary drainage in patients with hilar bile duct cancer. DESIGN: Case series. SETTING: University hospital. PATIENTS: Extended right hepatectomy was performed in 25 patients, and 12 underwent other surgical procedures. INTERVENTIONS: Among the 25 patients, 16 had obstructive jaundice. After biliary drainage, 11 had no biliary stasis in both lobes and five had undrained biliary trees in the right lobe. MAIN OUTCOME MEASURES: Long-term disease-free survival, presence or absence of undrained biliary trees in each lobe, rate of decrease in serum total bilirubin levels, and future remnant liver (left lobe) volume. RESULTS: Patients who underwent ERH had significantly longer disease-free survival than patients who underwent other procedures. There were no hospital deaths and no significant differences in morbidity between patients with and without prior jaundice. Patients with an undrained biliary tree in the right lobe had a larger future remnant liver volume, a slower rate of decrease in serum total bilirubin levels after biliary drainage, and a more rapid return of the postoperative serum total bilirubin level to the normal range than patients without biliary stasis in both lobes. CONCLUSIONS: Extended right hepatectomy can be performed safely even in patients showing a very slow decrease in the serum total bilirubin level after biliary drainage, caused by the presence of an undrained biliary tree in the right lobe with no biliary stasis in the left lobe, which induces compensatory hypertrophy of the left lobe. Extended right hepatectomy is a suitable surgical choice for achieving long-term survival in patients with hilar bile duct cancer.

Adult↗
PubMed1998

Results of 136 curative hepatectomies with a safety margin of less than 10 mm for colorectal metastases.

BACKGROUND AND OBJECTIVES: It is now established that liver resection is beneficial for metastases from colorectal cancer. Nevertheless, a surgical margin estimated at less than 10 mm at preoperative imaging is considered an absolute contraindication to surgery by some, and a relative contraindication by others. The true impact of the width of the margin on the prognosis is unclear. METHODS: From 1984 to 1996, 196 patients underwent curative hepatectomy for liver metastases and were studied prospectively. Surgery was to be curative (or a complete R0 resection) and mortality was to be avoided. Of these 196 patients, 136 had surgical margins of less than 10 mm. Sixty-eight percent had multiple liver metastases and 15% had extrahepatic metastatic lesions. Clinical and pathological factors were studied specifically and a multivariate analysis was carried out. RESULTS: Overall 5-year survival rate of these 136 patients (taking into account postoperative mortality which attained 1.5%) was 27.8% and the disease-free survival was 22.9%. The surgical margin was 0 mm in 30 cases. The sole prognostic factor was the discovery of unsuspected (resectable) extrahepatic lesions at laparotomy (P < 0.001) ; the width of the free margin had no significant effect. However, in the multivariate analysis of prognostic factors for the entire series (269 hepatectomies), three powerful parameters were identified : (1) the curative nature of resection (P = 0.0007), (2) less than 20% of liver involvement (P = 0.002), and (3) a free margin exceeding 9 mm (P = 0.02). A correlation was found between narrow margins and extensive disease (high number of metastases, bilateral sites, and extended hepatectomy). There was also a greater likelihood of microscopic satellite lesions within 10 mm around the metastases. CONCLUSIONS: The prognostic impact of the width of the surgical margin should not be overestimated. Hepatectomy for liver metastases can procure long-term survival, even in patients with supposedly poor prognostic factors. Resection is justified as long as it is complete and the risks are minimal.

Aged↗