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PubMed2001

Laparoscopic hepatectomy for hepatocellular carcinoma.

BACKGROUND: No reports exist on the role of laparoscopic hepatectomy in the short- and long-term outcomes of patients with hepatocellular carcinoma (HCC). We present our results from using laparoscopic hepatectomy for HCC and discuss the importance of this procedure. METHODS: To investigate the role of laparoscopic hepatectomy in the short- and long-term outcomes, 17 patients with HCC who underwent laparoscopic hepatectomy (laparoscopic hepatectomy group) were compared with 38 patients who underwent conventional open hepatectomy (open hepatectomy group) during the same period. RESULTS: No differences in operation time, blood loss, rate of blood transfusion, or incidence of postoperative complications were found between the two groups. The postoperative hospital stay for the laparoscopic hepatectomy group was significantly shorter than for the open hepatectomy group. With long-term prognosis, no difference was found in survival rate and disease-free survival rate between the two groups. No recurrence was found in the stump of the remaining liver after laparoscopic hepatectomy. CONCLUSIONS: Laparoscopic hepatectomy has resulted in a better short-term outcome after surgery than conventional open hepatectomy. The long-term prognosis in the laparoscopic hepatectomy group was similar to that in the open hepatectomy group. Therefore, laparoscopic hepatectomy can be a new alternative for treatment of cirrhotic patients with HCC when patients are strictly selected.

Carcinoma, Hepatocellular↗
PubMed1996

Doxorubicin-induced disturbance of the energy metabolism after hepatectomy.

This study was designed to clarify effects of gamma-glutamylcysteine ethyl ester, a prodrug of glutathione, on doxorubicin-induced changes in liver energy metabolism after hepatectomy. Rats were divided into two major groups dependent on whether hepatectomy had been performed. Rats undergoing hepatectomy were subdivided into three groups: the control group, 70% of the liver was resected; the doxorubicin group, after hepatectomy 2 mg/kg body weight doxorubicin was administered intraperitoneally; and the doxorubicin + gamma-glutamylcysteine group, 30 min before hepatectomy 50 mg/kg body weight of gamma-glutamylcysteine ethyl ester was injected intravenously and other procedures were performed as in the doxorubicin group. In the group not undergoing hepatectomy, 2 mg/kg body weight doxorubicin was administered intraperitoneally after a sham operation. Rats in each group were sacrificed 24, 72, and 120 hr after hepatectomy or sham operation, and the remnant liver was isolated. Liver mitochondrial function, adenine nucleotide concentrations, and glutathione and glutathione peroxidase activities were determined. Doxorubicin did not show any significant effects on parameters measured in rats not undergoing hepatectomy. Liver mitochondrial function was increased significantly 24 hr after hepatectomy, and significant decreases in adenine nucleotide concentrations were observed 24 and 72 hr after hepatectomy. Doxorubicin inhibited the increase in mitochondrial function associated with hepatectomy and delayed recovery of liver adenine nucleotide concentrations. Significant increases in tissue glutathione concentrations were observed 24 and 72 hr after hepatectomy. These significant increases in glutathione concentrations were not observed in rats treated with doxorubicin 72 hr after hepatectomy. Furthermore, doxorubicin decreased glutathione peroxidase activity after hepatectomy. Administration of gamma-glutamylcysteine ethyl ester lessened these doxorubicin-induced changes. These results indicate that changes in the glutathione redox system might be involved in the doxorubicin-induced deterioration of the remnant liver energy metabolism. Clinical application of gamma-glutamylcysteine ethyl ester might be expected.

Adenosine Triphosphate↗
PubMed1996

Inhibition of 5-lipoxygenase promotes the regeneration of the liver after partial hepatectomy in normal and icteric rats.

The role of leukotriene (LT) on liver regeneration after hepatectomy is still unknown. LTB4 stagnates in the liver with obstructive jaundice, because LTB4 is excreted in the bile; therefore, LTB4 may have an effect on liver regeneration after hepatectomy with obstructive jaundice. Release of obstructive jaundice and simultaneous 70% hepatectomy was performed in rats to study the effect of 5-lipoxygenase inhibitor (AA-861) on liver regeneration. Group 1 underwent hepatectomy with administration of 0.1 mL dimethyl sulfoxide (DMSO), group 2 underwent hepatectomy with administration of AA-861 (20 mg/kg/d) dissolved in 0.1 mL DMSO, group 3 underwent hepatectomy with administration of AA-861 (40 mg/kg/d) dissolved in 0.1 mL DMSO, group 4 underwent release of obstructive jaundice and hepatectomy with administration of 0.1 mL DMSO, and group 5 underwent relief of obstructive jaundice and hepatectomy with administration of AA-861 (20 mg/kg/d). DMSO or AA-861 was administered 24 hours before, during, and 24 hours after hepatectomy in each group. Whole blood LTB4 and serum alanine aminotransferase (ALT), total bilirubin, and bromodeoxyuridine labeling index (LI) were measured before and after hepatectomy. The LTB4 level increased during obstructive jaundice and after hepatectomy. LTB4 and serum ALT levels were significantly lower after hepatectomy in the rats that were administered AA-861, and a significantly higher LI was observed at 24 hours after hepatectomy in rats receiving AA-861. Inhibition of 5-lipoxygenase promotes liver regeneration and decreases hepatocyte injury after hepatectomy associated with obstructive jaundice.

Alanine Transaminase↗
PubMed2002

Minimally invasive hepatectomy: modulation of systemic reactions to operation or laparoscopic approach?

BACKGROUND: A new concept of surgical stress has been proposed that consists of both aggressiveness of operation and systemic reactions to an operation. METHODS AND RESULTS: We have investigated a possible modulation of such systemic reactions to operation and have demonstrated the following 3 points: (1) coagulation and fibrinolytic systems are independently activated during hepatectomy and such activation can be modulated by protease inhibitors such as nafamostat mesilate and antithrombin III; (2) elevated thromboxane A2 during hepatectomy is characterized in the prostanoid system, the elevation of thromboxane A2 is inhibited by thromboxane A2 synthetase inhibitor, and postoperative liver injury is reduced; (3) cytokine response induced by hepatectomy is modulated by preoperative administration of methylprednisolone, leading to possible prevention of bacterial translocation. Therefore, modulating systemic reactions to hepatectomy may be important for successful minimally invasive hepatectomy. Another important option for minimally invasive hepatectomy is the use of operative procedures such as laparoscope or thoracoscope. We have investigated the usefulness of a laparoscopic hepatectomy from the standpoints of early and long-term outcome after hepatectomy. Laparoscopic hepatectomy, which is a difficult and dangerous procedure, can be a feasible option and can result in better short-term outcome and a similar long-term outcome after hepatectomy when compared with conventional open hepatectomy. Therefore, the laparoscopic approach is also a viable option for minimally invasive hepatectomy. CONCLUSIONS: Modulation of systemic reactions to the operation itself and laparoscopic hepatectomy may be new strategies for performing minimally invasive hepatectomy.

Blood Coagulation↗
PubMed1997

Repeat hepatectomy for colorectal liver metastases.

OBJECTIVE: The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival. SUMMARY BACKGROUND DATA: Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in an increasing number of patients. However, higher operative bleeding and increased morbidity have been reported after repeat hepatectomies, and the long-term benefit of these procedures needs to be evaluated. STUDY POPULATION: Sixty-four patients from a group of 243 patients resected for colorectal liver metastases were submitted to 83 repeat hepatectomies (64 second, 15 third, and 4 fourth hepatectomies). Combined extrahepatic surgery was performed in 21 (25%) of these 83 repeat hepatectomies. RESULTS: There was no intraoperative or postoperative mortality. Operative bleeding was not significantly increased in repeat hepatectomies as compared to first resections. Morbidity and duration of hospital stay were comparable to first hepatectomies. Overall and disease-free survival after a second hepatectomy were 60% and 42%, respectively, at 3 years and 41% and 26%, respectively, at 5 years. Factors of prognostic value on univariate analysis included the curative nature of first and second hepatectomies (p = 0.04 and p = 0.002, respectively), an interval between the two procedures of more than 1 year (p = 0.003), the number of recurrent tumors (p = 0.002), serum carcinoembryonic antigen levels (p = 0.03), and the presence of extrahepatic disease (p = 0.03). Only the curative nature of the second hepatectomy and an interval of more than 1 year between the two procedures were independently related to survival on multivariate analysis. CONCLUSIONS: Repeat hepatectomies can provide long-term survival rates similar to those of first hepatectomies, with no mortality and comparable morbidity. Combined extrahepatic surgery can be required to achieve tumor eradication. Repeat hepatectomies appear worthwhile when potentially curative.

Adult↗
PubMed1994

Repeat hepatectomy for recurrent hepatocellular carcinoma.

BACKGROUND: The significance of repeat hepatectomy for recurrent hepatocellular carcinoma remains controversial. Therefore the aim of this study was to reevaluate both the survival and the surgical risks of repeat hepatectomy. METHODS: The significance of repeat hepatectomy including the survival and the surgical risks for recurrent hepatocellular carcinoma were investigated with 21 patients who underwent a curative repeat hepatectomy during the period between May 1975 and July 1993. For a comparison of survival, 253 patients who underwent a curative primary hepatectomy during the period between April 1985 and July 1993 were used. Moreover, the preoperative liver function tests were also compared between the first and second hepatectomies. RESULTS: Regarding the preoperative liver function tests, the indocyanine green dye excretion rate at 15 minutes in the second hepatectomy (18.7% +/- 8.7%) was significantly higher than that in the first hepatectomy (14.7% +/- 5.9%). With regard to the surgical risks, there was no difference in the clinical parameters for blood loss, operation time, and the incidence of postoperative complications between the first and second hepatectomies. The postoperative hospital stay for the second hepatectomies was relatively shorter than that for the first hepatectomies. In addition, the patient's survival and disease-free survival after a curative repeat hepatectomy were almost identical to that after a curative primary hepatectomy. CONCLUSIONS: A curative repeat hepatectomy is thus considered to be the most effective therapeutic modality for recurrent hepatocellular carcinoma.

Adult↗
PubMed2005

Repeat hepatectomy for recurrent colorectal metastases.

PURPOSE: To determine the risks and benefits of repeat hepatectomy for hepatic metastases from colorectal cancer. METHODS: During a recent 10-year-period, 106 patients underwent hepatectomy for hepatic metastases from colorectal cancer, in our hospital. Recurrence developed in the liver in 57 of these patients, 27 of whom underwent repeat hepatectomy. We reviewed the outcomes of these 27 patients. RESULTS: There were three complications after the first hepatectomy and six complications after the second hepatectomy, but there was no perioperative mortality after the first or second hepatectomy. The median survival from the date of second hepatectomy was 41 months with an actuarial 5-year survival rate of 48.7%. Patients who underwent repeat hepatectomy had significantly higher survival rates from the time of first hepatectomy than those who did not. Univariate analysis showed that among the prognostic factors of repeat hepatectomy, only a disease-free interval (DFI) between the first and second hepatectomy of more than 1 year was significantly predictive of a better outcome (P = 0.047). CONCLUSION: Repeat hepatectomy for recurrent colorectal metastases can be performed safely with acceptable mortality and morbidity rates, and can help to extend survival, if the DFI between the first and second hepatectomy is longer than 1 year.

Adult↗
PubMed1997

Progressive necrosis after hepatectomy and the pathophysiology of liver failure after massive resection.

BACKGROUND: Mortality after hepatectomy in rats increases markedly beyond the classic 2/3 resection from which complete recovery is the rule. Because an extremely small hepatocyte population can theoretically sustain life, we hypothesize that lethal liver failure after subtotal resection could be due to progressive injury occurring in the remnant liver. The obligatory increase in portal blood through the small remnant may be central to the pathogenesis because of sinusoidal injury and Kupffer's cell activation. To test this hypothesis an experimental study in rats was undertaken to characterize liver cell injury after lethal (85%) and nonlethal (70%) hepatectomy. METHODS: One hundred thirty Wistar rats were divided into three groups: control group (Sham laparotomy, n = 30), 70[5] hepatectomy group (n = 50), and 85% hepatectomy group (n = 50). Five rats in each group were killed for blood and liver collections from 15 minutes to day 14 after hepatectomy. Survival, histologic characteristics, serum activities of aspartate (AST) and alanine (ALT) aminotransferases and arginase were determined; serum level of tumor necrosis factor-alpha (TNF-alpha) and plasma level of prostaglandin E2 (PGE2) were measured by enzyme-linked immunosorbent assay. RESULTS: Whatever the extent of resection, hepatic injury, as demonstrated by increased serum levels of arginase, ALT, and AST, was observed. The kinetics of arginase release after hepatectomy mimicked quite well those of AST and ALT, representing a reliable marker of hepatocyte injury. A significantly higher, more prolonged blood release of enzymes was observed after 85% hepatectomy than after 70% hepatectomy. Because of a very short half-life the rise in arginase several hours after hepatectomy seems to indicate ongoing liver damage distinct from the surgical injury. Significant elevations of TNF-alpha were detected that were much more severe after 85% hepatectomy. PGE2 levels that increased significantly after 70% resection remained depressed after 8% hepatectomy. Light microscopy demonstrated extensive patchy necrosis after 85% hepatectomy. CONCLUSIONS: A pattern of progressive necrosis of the remnant liver was identified with Kupffer's cell dysfunction. We hypothesize that failure of down-regulation of TNF-alpha production by PGE2 could contribute to the pathophysiology of liver injury in the remnant after massive hepatectomy. These events may be initiated in part by the dramatic increase of portal flow through a too small remaining liver, and a pathologic mechanism may be amenable to pharmacologic manipulation.

Alanine Transaminase↗
PubMed2001

Impact of repeat hepatectomy on recurrent colorectal liver metastases.

BACKGROUND: Hepatic recurrence is seen in approximately 40% of patients undergoing hepatectomy for colorectal metastases. This study was designed to assess the risks and clinical benefits of repeat hepatectomy for those patients. METHODS: Twenty-six patients underwent repeat hepatectomy for hepatic recurrence, and their clinical data were retrospectively reviewed for operative morbidity and mortality, performance level, and survival. RESULTS: There was no operative mortality after repeat hepatectomy. Operative bleeding was significantly increased in the second hepatectomy; but operating time, duration of hospital stay, and performance status after the second hepatectomy were comparable with those of the initial hepatectomy. The median survival time from the second hepatectomy was 31 months, and the 3- and 5-year survival rates were 62% and 32%, respectively. A short disease-free interval (6 months or less) between the initial hepatectomy and diagnosis of hepatic recurrence in the remnant liver was significantly associated with poor survival after the second hepatectomy. CONCLUSIONS: Repeat resection contributed to clinical benefits for selected patients with hepatic recurrence after the initial hepatectomy for colorectal liver metastases. However, appearance of hepatic recurrence within 6 months or less after the initial hepatectomy is a poor prognostic factor for repeat hepatectomy.

Adult↗
PubMed2003

Prognostic factors for poor survival after repeat hepatectomy in patients with colorectal liver metastases.

BACKGROUND: The recurrence rate for colorectal liver metastases after repeat hepatic resection is high, and selection criteria for repeat hepatectomy are still controversial. METHODS: Clinical data of patients undergoing repeat hepatectomy for metastatic colon cancer were reviewed retrospectively and compared with those of initial hepatectomy and other treatments to determine criteria for repeat hepatectomy and to confirm its efficacy. RESULTS: For 22 patients who underwent repeat hepatectomy, no mortality and an 18% morbidity rate were observed. The 3-year survival rate after repeat hepatectomy was 49%. The only poor prognostic factor after repeat hepatectomy was a serum carcinoembryonic antigen level greater than 50 ng/mL before initial hepatectomy. The prognosis for patients who underwent repeat hepatectomy and had shown high carcinoembryonic antigen levels before initial hepatectomy was approximately equal to that for the patients who received systemic chemotherapy or hepatic arterial infusion for unresectable tumors in the remnant liver. CONCLUSION: Repeat hepatectomy for colorectal liver metastases can be performed safely and appears to be as effective as initial hepatectomy. However, for patients with a carcinoembryonic antigen level greater than 50 ng/mL before the initial hepatectomy, repeat hepatic resection alone may not be as effective, and a new strategy is needed.

Adult↗
PubMed1998

Early gene expression associated with regeneration is intact after massive hepatectomy in rats.

BACKGROUND: Liver regeneration occurs promptly after partial hepatectomy, although the factors regulating this response have not been fully clarified. Molecular events in the regenerative response have been widely characterized after 70% hepatectomy which represents a model of "normal" liver regeneration in rats. More extensive resection results in hepatic failure which has been attributed to a critical loss of hepatic mass. It is not known whether the pattern of genes expressed early in regeneration remains intact after lethal hepatectomy. We hypothesize that the increased expression of selected early response genes remains intact after massive hepatectomy. The aim of this study was to compare the expression of selected genes after 70 and 85% hepatectomy. MATERIALS AND METHODS: One hundred ten Wistar rats were divided into three groups: control group (sham laparotomy) (n = 30), 70% hepatectomy group (n = 40), and 85% hepatectomy group (n = 40). Animals were sacrificed at intervals. Livers were excised and divided into four equal specimens, snap frozen, and stored at -70 degrees C. RNA was extracted by standard methods and preparations were probed for protooncogenes, c-myc, c-fos, and for hepatocyte growth factor, and its receptor, c-met. After overnight exposure of autoradiographs, quantification was accomplished by densitometry of RNA slot blots. RESULTS: After 70% hepatectomy, peaks of maximal expression for both c-myc and c-met were observed after 1 and 12 h. For c-fos, peak of maximal expression was observed at 6 h. For HGF, peak was observed between 12 h and Day 2. After 85% hepatectomy, rats demonstrated similar patterns including peak expression of c-myc at 1 h, but altered peak at 12 h. For c-met, the same pattern was observed between 1 and 12 h. For HGF, two peaks were noted: a first peak at 1 h, and a peak similar to the peak observed after 70% hepatectomy at 12 h. CONCLUSIONS: These results suggest that early molecular events which are part of the regenerative response are largely intact after 85% lethal hepatectomy. We propose that liver dysfunction and the failure of regeneration observed after 85% hepatectomy is not due to alteration of early signaling. Further study will be required to define failure of the regeneration program in this model.

Animals↗
PubMed2001

Induction of E-selectin after partial hepatectomy promotes metastases to liver in mice.

BACKGROUND: The liver is the most frequent site of tumor metastasis. It has been suggested that partial hepatectomy promotes liver metastasis of malignant disease and that expression of E-selectin, a cell adhesion molecule, plays roles in tumor metastasis. However, no reports are available concerning the expression of E-selectin after hepatectomy. METHODS: In the present study, we used BALB/c mice subjected to 30% partial hepatectomy after injection of 1 x 10(4) colon 26 cells to determine the effects of partial hepatectomy on tumor metastasis to liver. E-Selectin expression within the liver after partial hepatectomy was evaluated using reverse transcription polymerase chain reaction and Western blotting. In addition, we injected polyclonal antibody to E-selectin into mice in which partial hepatectomy had augmented liver metastasis. RESULTS: Mice subjected to partial hepatectomy had significantly increased numbers of liver metastases (sham operation, 1.5 +/- 2.0, vs partial hepatectomy, 35.5 +/- 19.3; P < 0.001). Expression of E-selectin mRNA within the liver was markedly increased 4 h after partial hepatectomy, but subsequently decreased at 24 h. E-Selectin protein was detected 8 h after hepatectomy, but subsequently decreased at 24 h as measured by Western blotting. Mice subjected to intraperitoneal injection of neutralizing antibody after operation had significantly decreased numbers of liver metastases (phosphate-buffered saline, 20.6 +/- 9.2, P < 0.05, and normal IgG, 18.0 +/- 8.0, P < 0.05, compared with polyclonal antibody to E-selectin, 5.6 +/- 4.8). CONCLUSION: Induction of E-selectin by partial hepatectomy promotes hematogenous liver metastasis. Our findings can be applied to surgical treatment of liver tumor to reduce the recurrence of liver metastasis after hepatectomy by inhibiting E-selectin-mediated adhesion using reagents to E-selectin.

Animals↗
PubMed1999

Preoperative internal biliary drainage is superior to external biliary drainage in liver regeneration and function after hepatectomy in obstructive jaundiced rats.

OBJECTIVE: To examine the differences in regeneration rates and functions of the liver at the time of and after hepatectomy in obstructive jaundiced rats with preoperative external and internal biliary drainage. SUMMARY BACKGROUND DATA: The significance of biliary drainage before surgery is controversial in patients with obstructive jaundice. METHODS: After biliary obstruction for 7 days, rats were randomly divided into three groups: obstructive jaundice and hepatectomy (OJ-Hx), external biliary drainage and hepatectomy (ED-Hx), and internal biliary drainage and hepatectomy (ID-Hx). The OJ-Hx group underwent hepatectomy without biliary drainage; the other two groups underwent hepatectomy after biliary drainage for 7 days. At the time of hepatectomy, all rats were provided with internal biliary drainage. On days 0, 1, 2, 3, and 7 after hepatectomy, the DNA synthesis rate and the concentrations of adenine nucleotides and malondialdehyde in the liver were determined as markers of the hepatic regeneration rate, energy status, and lipoperoxide concentration, respectively. Portal endotoxin concentrations were measured and serum hyaluronic acid concentrations were determined as an indicator of hepatic endothelial function. RESULTS: The relative liver weight was significantly higher in the ID-Hx group than in the OJ-Hx group on days 1, 3, and 7 after hepatectomy and than in the ED-Hx group on days 1 and 2. The rate of hepatic DNA synthesis was significantly higher in the ID-Hx group than in the OJ-Hx and ED-Hx groups on day 1. The rate was similar in the ED-Hx and ID-Hx groups on day 2 but was significantly higher than in the OJ-Hx group. The hepatic malondialdehyde concentration was significantly higher on day 1 in the ED-Hx group than in the other two groups. It was lowest in the ID-Hx group throughout the study. Both biliary drainage procedures lowered the portal endotoxin concentration and serum hyaluronic acid concentration at the time of hepatectomy. The serum hyaluronic acid concentration was lowest in the ID Hx group. Hepatic adenine triphosphate concentrations and energy charge levels were similar among the three groups. CONCLUSION: Although both external and internal biliary drainage before hepatectomy improved serum liver function tests, portal endotoxin concentration, and serum hyaluronic acid concentration at the time of surgery, preoperative internal biliary drainage was superior to external drainage, as evidenced by the better liver regeneration and function after hepatectomy.

Animals↗
PubMedDate not supplied

Two-stage hepatectomy for multiple bilobular liver metastases from colorectal cancer.

BACKGROUND/AIMS: To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of two-stage hepatectomy in patients with multiple bilobular liver metastases from colorectal carcinoma. METHODOLOGY: Some patients with multiple liver metastases are not candidates for a complete resection by a single hepatectomy, even when downstaged by chemotherapy, after portal embolization. In two-stage hepatectomy, the highest possible number of tumors is resected in a first, noncurative intervention, and the remaining tumors are resected after a period of liver regeneration. Two-stage hepatectomy was performed in 11 patients. RESULTS: Two-stage hepatectomy was feasible in all of the 11 patients. In 3 of them, the first stage was a major resection (more extensive than a lobectomy). This first hepatectomy was uneventful in all patients. The second hepatectomy was also uneventful in nine patients, but in one of the other two, a perihepatic fluid infection occurred, and in the other, postoperative liver failure developed due to a right subphrenic abscess. However, all patients were discharged. The percentage of the expected resection volume at one time, calculated from CT volumetry, was 75.5+/-1.2% and the prognostic score as surgical risk was 56.6+/-4.5. In two-stage hepatectomy cases, the percentage of the resected volume and the prognostic score in the first hepatectomy were 25.4+/-6.4% and 6.7+/-7.3, and in the second, 45.7+/-4.5% and 28.5+/-5.8. During the follow-up procedures, a residual hepatic recurrence was observed in 6 patients, and pulmonary recurrence in 9. The 1- and 3-year survival rates after the first hepatectomy were 90% and 45%, with median survivals of 18 months from the first hepatectomy. CONCLUSIONS: Two-stage hepatectomy is a surgical modality intended for patients with initial unresectable metastases. However, following such surgery, protective treatment against residual liver recurrence and lung metastasis will be a most important issue.

Aged↗
PubMed2005

Laparoscopic hepatectomy: indications and outcomes.

We outline the indications, evaluate the degree of invasiveness, and analyze the outcomes of laparoscopic hepatectomy, mainly in the treatment of hepatocellular carcinoma (HCC). The important considerations in determining indications for laparoscopic hepatectomy include tumor size, type, and location. Nodular tumors smaller than 4 cm or pedunculated tumors smaller than 6 cm are suitable candidates. Concerning location, tumors in the lower segment or the left lateral segment are suitable. Regarding operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral segmentectomy is a feasible, less invasive procedure. Operative time in our recent laparoscopic hepatectomy patients has decreased, with less bleeding. Furthermore, laparoscopic hepatectomy is less invasive than conventional hepatectomy on evaluation by the Estimation of Physiolic Ability and Surgical Stress (E-PASS) scoring system. Patients recovered more quickly after laparoscopic hepatectomy, which allowed shorter hospitalization. Both the 5-year survival rate for HCC and the survival rate without recurrence were nearly identical to those of open conventional hepatectomy, although further analysis will be necessary to reach definitive conclusions. In conclusion, laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy in properly selected patients and is beneficial for patient quality of life, because it is a minimally invasive procedure when indications are strictly followed.

Blood Loss, Surgical↗
PubMed2006

Hepatic sinusoidal endothelial cells promote hepatocyte proliferation early after partial hepatectomy in rats.

BACKGROUND: We undertook this study in rats to investigate the role of hepatic sinusoidal endothelial cells (SECs) in hepatocyte proliferation early after partial hepatectomy and the regulatory mechanisms involved. METHODS: The animal model of 70% hepatectomy was made. Hepatic SECs and hepatocytes were isolated and cultured according to the method of Braet et al. with some modifications. Levels of nitric oxide (NO), interleukin-6 (IL-6), and hepatic growth factor (HGF) in the supernatants of hepatic SEC cultures were measured, and the expression of HGF mRNA by hepatic SECs was analyzed. The relationship between the supernatants of hepatic SEC cultures and hepatocyte proliferation was probed. (3)H-thymidine incorporation and the proliferating cell nuclear antigen (PCNA) labeling index of hepatocytes were used as signs of hepatocyte proliferation. RESULTS: Levels of NO, IL-6, and HGF in the supernatants of hepatic SECs cultures were increased markedly 6 and 24 h after hepatectomy and then were decreased gradually. The expression of HGF mRNA by cultured SECs was increased markedly 6 and 24 h after hepatectomy, with a peak 6 h after hepatectomy. The PCNA labeling index and (3)H-thymidine incorporation of hepatocytes started to increase 6 h after hepatectomy, with a peak at 24 h. Hepatic SECs were isolated from rats 24 h after partial hepatectomy and cultured for 24 h, and the culture supernatants were obtained. The supernatants not only significantly enhanced the PCNA labeling index and (3)H-thymidine incorporation of proliferating hepatocytes isolated from rats after partial hepatectomy but also obviously increased the DNA synthesis of quiescent hepatocytes from the control rats. The extent of hepatocyte proliferation was closely related to the amount of the SEC culture supernatants added in both rats after partial hepatectomy and control rats. CONCLUSIONS: These results suggest that cytokines (such as IL-6, HGF and NO) secreted by SECs play important roles in liver regeneration early after partial hepatectomy. We speculate that activated hepatic SECs secrete some substances that induce or trigger liver regeneration after partial hepatectomy.

Animals↗
PubMed2006

A rat model of a repeat 70% major hepatectomy.

BACKGROUND: This study investigated the effects of a repeat 70% major hepatectomy in a rat model. MATERIALS AND METHODS: The left lateral and median lobes of the livers of 80 seven-week-old male Wistar rats were excised during primary hepatectomy, removing a total of 70% of the liver. In 40 of the rats, the regenerated right lateral lobe, comprising 70% of the remnant liver, was excised during secondary hepatectomy 7 days after the initial procedure. The survival rate, posthepatectomized regeneration ratio, and laboratory blood data were compared between the groups that had undergone initial only and repeat hepatectomies. RESULTS: All of the rats survived for at least 7 days after each procedure. The remaining liver returned to up to about 90% of its original wet weight by 5 days in both groups. The serum glutamic-pyruvic transaminase levels peaked 12 h after hepatectomy, remained at a similar level at 36 h, and had normalized by 2 days. Serum total bilirubin levels were similar in both groups. The total cell numbers after 5 days were significantly higher in the initial hepatectomy group than in the repeat hepatectomy group. CONCLUSIONS: We established a rat model in which an initial 70% major hepatectomy was followed by a repeat 70% major hepatectomy of the regenerated liver. The time taken to restore the integrity of the liver was longer in the rats that underwent repeat hepatectomy. We believe that this model will be useful for investigating the regenerative ability of the liver after a second major hepatectomy.

Alanine Transaminase↗
PubMed2006

Role of node dissection for lymphatic remetastasis in repeat hepatectomy for colorectal liver metastasis.

BACKGROUND: Although the prognosis after hepatectomy for colorectal liver metastasis with hilar node remetastasis is poor, the role of node dissection for lymphatic remetastasis at repeat hepatectomy for hepatic recurrence is unknown. METHODS: Fifty patients who underwent node dissection plus hepatectomy were retrospectively reviewed and divided into three groups: group I, 38 patients with a negative node; group II, 6 with a positive node at initial hepatectomy, and group III, 6 with a positive node at repeat hepatectomy. RESULTS: The 5-year survival rate after initial hepatectomy in group I was 46%. All patients in group II died within 2 years after surgery. In group III, the median survival time was 42 months after repeat hepatectomy, and 4 patients survived for more than 5 years after initial hepatectomy. Disease-free time was more than 1 year after initial hepatectomy in all long-term survivors. In addition, node metastasis was limited around the hepatic pedicle and postpancreatic area in 3 of 4 long-term survivors. CONCLUSIONS: Node dissection for lymphatic remetastasis may contribute to longer survival only when node metastasis is limited around the hepatic pedicle and postpancreatic area at repeat hepatectomy performed more than 1 year after the initial hepatectomy.

Adult↗