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PubMed1985

[Effect of tritoqualine on liver regeneration after partial hepatectomy in rats].

Effect of tritoqualine (TRQ) on liver regeneration after partial hepatectomy in normal rats and chronically injured rats treated with carbon tetrachloride (CCl4) for 12 weeks were investigated by the measurement of serum and liver biochemical parameters concerning the hepatic function. The results are as follows: 1) In normal rats, the liver regeneration rate after partial hepatectomy was increased dose-dependently with the administration of TRQ for 7 days after the operation. TRQ improved BSP retention rate which was decreased after partial hepatectomy. In addition, protein synthetic activity in the liver microsomes prepared from TRQ-administered rats was higher than that prepared from control rats, and the contents of serum total protein, serum albumin and liver protein were also higher in TRQ-administered rats. 2) In the rats treated with CCl4 for 12 weeks, the liver regeneration rate after partial hepatectomy was increased dose-dependently with the administration of TRQ for 6 days. TRQ also improved the contents of serum total protein, serum albumin and liver protein. Though the amount of collagen in the liver chronically injured by CCl4 increased more than twice compared with that in the normal liver, the amount of collagen in the regenerating liver of CCl4-treated rats whose liver regeneration was accelerated by TRQ was not different from that in the normal liver. These results suggest that TRQ has the effect of improving the various hepatic functions through the activation of the protein synthesis in hepatocytes.

Animals↗
PubMedDate not supplied

[Study of renal glucose release in rabbits submitted to total functional hepatectomy and norepinephrine infusion].

AIM: To study the possible endogenous sources of glucose in the absence of the liver (equivalent to the anhepatic period of liver transplantation). MATERIAL AND METHODS: A experimental model of total functional hepatectomy in anesthetized rabbits was developed. The aorta and the right renal vein were catheterised in order to collect blood samples to measure glucose contents. The animals were divided into two groups: group 1, 5 animals underwent only norepinephrine infusion; group 2, 15 animals underwent norepinephrine infusion and submitted to total functional hepatectomy. RESULTS: In group 2, before the hepatectomy, arterial glucose levels were higher than venous ones and after the liver removal, the venous levels became higher than the arterial ones. This pattern showed an inversion in the glycemic curves. In group 1 this pattern was not observed. CONCLUSION: The glycemic curves behavior observed in group 2 its not due to norepinephrine infusion, but represents renal glucose release after total functional hepatectomy.

Adrenergic alpha-Agonists↗
PubMed1987

The significance of activation of reticuloendothelial function on hepatectomy.

The prognosis of patients after massive hepatectomy is poor in certain cases whose hepatic reserve, including reticuloendothelial function, is deteriorated. We administered OK-432 before 70% hepatectomy on rats to activate the reticuloendothelial function and studied its effect on postoperative course. The elevations in plasma endotoxin, GOT and GTP were attenuated, and the deterioration of the complement activity after hepatectomy was greatly improved by OK-432 treatment. The RNA content in the liver was significantly increased by OK-432 administration. These findings suggest that activation of the reticuloendothelial function at the time of massive hepatectomy enhances endotoxin clearance from blood and thereby contributes in lessening the magnitude of hepatic injury, maintaining the serum complement, and improving liver protein synthesis.

Animals↗
PubMed1987

Activation of reticuloendothelial function for prevention of endotoxemia after hepatectomy in cirrhotic patients.

In order to prevent endotoxemia after hepatectomy in cirrhotic patients, we administered OK-432 before and after hepatectomy to activate the reticuloendothelial function and studied its effect on postoperative endotoxemia. In the cirrhotic group without OK-432 administration (7 patients), the value of endotoxin increased significantly after hepatectomy, compared to the cirrhotic group which received OK-432 administration (5 patients) and the non-cirrhotic group (12 patients), and the endotoxin level was still higher than the preoperative value even on the 14th day. On the other hand, the cirrhotic group with OK-432 administration and the non-cirrhotic group showed minimal increases of endotoxin levels at the first day, which returned to the preoperative values at the third day. Base on these findings, it is suggested that activation of the reticuloendothelial function bears substantial significance as one of the therapeutic modalities for prevention of endotoxemia after hepatectomy in cirrhotic patients.

Biological Products↗
PubMed1989

MR appearance of the liver after partial hepatectomy.

To define the MR appearance of the liver after partial hepatectomy, we reviewed retrospectively 61 MR examinations performed on 25 patients 10 days to 48 months after surgery. Twenty-seven partial hepatectomies performed in the 25 patients included right lobectomy in 11, trisegmentectomy in two, left lobectomy in five, and wedge resection in nine. By using vascular landmarks, demonstration of the falciform ligament, and the presence of surgical clips, we correctly identified the type of partial hepatectomy in 21 of the 25 patients. The signal intensity of the resection margin was similar to that of the remaining parenchyma in 16 of 18 patients and was poorly defined and had a higher signal intensity (T2-weighted image) in the remaining two. Liver regeneration was observed on serial MR scans 2-16 months after surgery. Findings related to chemotherapy, including periportal changes and inhomogeneous appearance of the liver, were shown in six of eight patients. Tumor recurrence was present in nine patients, either intrahepatic (seven patients) or at the resection margin (two patients), and was consistently identified with MR imaging. The ability of MR imaging to produce images without artifacts from surgical clips is helpful in displaying the MR appearance of the liver after partial hepatectomy. Anatomic landmarks, findings related to chemotherapy, and tumor recurrence were shown well.

Adolescent↗
PubMed1994

Detection of recurrent hepatic metastases after partial hepatectomy: value of CT combined with arterial portography.

OBJECTIVE: We did a retrospective study to evaluate the sensitivity of CT combined with arterial portography in detecting recurrent hepatic metastases after partial hepatectomy. MATERIALS AND METHODS: CT scans combined with arterial portography in 18 patients who had partial hepatectomy and suspected intrahepatic recurrence of metastases were retrospectively reviewed. Eleven of the patients had further surgery, and recurrent hepatic metastases were proved; seven patients were inoperable. The sensitivity of CT with arterial portography for detecting recurrent intrahepatic metastases was determined and correlated with intraoperative findings and findings on follow-up imaging studies in the 11 patients (with a total of 23 hepatic metastases) who had further surgery. RESULTS: Not one of the 18 CT examinations combined with arterial portography was compromised by inhomogeneous perfusion of contrast material in the portal vein. Of the 23 metastases that were found in the 11 patients who had further surgery, 21 (91%) were shown on CT with arterial portography. In two patients, CT with arterial portography showed two subcapsular hypoattenuating pseudolesions that were correctly identified as nontumorous perfusion defects, as confirmed by intraoperative findings and follow-up imaging studies. CONCLUSION: This study shows that postoperative CT with arterial portography is efficacious in the detection of intrahepatic recurrent metastases in patients who have had a partial hepatectomy. Furthermore, prior partial hepatectomy does not compromise the quality of this examination.

Colorectal Neoplasms↗
PubMed1986

Effects of H2-receptor antagonists on the rat liver after partial hepatectomy or carbon tetrachloride-induced hepatic injury.

A total of 512 male rats were used to investigate the effects of H2-receptor antagonists on the liver after two-thirds hepatectomy or after carbon tetrachloride (CCl4)-induced hepatic injury. The serum aminotransferase levels in hepatectomy rats were significantly elevated as compared with those of rats with the sham operation 1 and 2 days after the operation. However, there were no differences in the serum aminotransferase levels and liver regeneration rates among the groups of hepatectomy rats who were treated with saline, cimetidine, or ranitidine. The injections of cimetidine or ranitidine did not induce a significant increase in serum amino-transferase levels or increase the severity of liver cell necrosis in CCl4-treated rats, as compared with the CCl4-treated rats who received saline injection. Thus, our data indicate that H2-receptor antagonists do not inhibit liver regeneration in rats after two-thirds hepatectomy or exert a detrimental effect on the liver cell necrosis in rats after CCl4-induced hepatic injury.

Alanine Transaminase↗
PubMed1993

Persistence of the circadian variation and altered response to hepatectomy of hepatic ornithine decarboxylase activity with malignant tumor burden.

We measured the effect of MC-26 mouse colon cancers (of different sizes) on the circadian rhythm of hepatic ornithine decarboxylase (ODC) activity and hepatic ODC activity during the 24 hr after 60% hepatectomy. Tumor-free control mice showed a normal circadian rhythm of ODC activity with the highest levels at 1100 hr and the lowest levels at 2300 hr. The amplitude of the rhythm was diminished significantly in mice with a large tumor burden (3% of their body weight), and hepatic ODC activity was significantly less than in the tumor-free mice at every point during the 24 hr of the study. In mice with "early" tumors (0.3% of body weight), basal activity of ODC was normal and there was no reactive increase in activity following hepatectomy. In contrast, mice with "late" (3% of body weight) tumors had significantly lower basal ODC activities and the increase in ODC activity following hepatectomy was prolonged and exaggerated. We concluded that tumor burden is associated with abnormal ODC activity and that these differences are exaggerated after hepatectomy. Furthermore, although average ODC concentrations in tumor-bearing mice fell precipitously, the circadian rhythm in hepatic ODC persisted. This finding indicates early recognition by the host of tumor presence, which has a profound negative regulatory effect on hepatic ODC. Apparently, this effect does not impinge on circadian control mechanisms, indicating that these signals act independently.

Animals↗
PubMed1993

Comparative effect of proteins, peptides, and amino acid mixtures on recovery from 70% hepatectomy in rats.

The effects of proteins, peptides, and amino acid mixtures on the recovery from 70% hepatectomy were compared in rats. In Experiment 1, the most suitable time for the comparison was studied. Rats weighing 250 g after 70% hepatectomy were fed 20% casein diet. On day 0,1,2,3,4,6,8,11,15 post-operation, 3-5 rats were killed for the observation of recovery. The recovery time, evaluated by daily food intake, body weight gain, liver weight and compositions, and hematologic values was about 10 days. For the comparison of different nitrogen sources, we estimated that the 6th day after the operation when the animals did not fully recover was suitable. In Experiment 2, rats of each group after hepatectomy were fed one of 14 experimental diets containing protein (3 types), peptides (8 types), or amino acid mixture (3 types) for 5 days and killed on the 6th day after the operation. Daily food intake, body weight gain, liver weight and compositions, and hematologic values were measured and pathological examination was also done. The effect of different nitrogen sources were similar on the recovery after 70% hepatectomy with only a few minor exceptions in rats.

Amino Acids↗
PubMed2002

Ultrasonic aspiration hepatectomy for 136 patients with hepatocellular carcinoma.

AIM: To study the operative injury, post-operative complications, the hospitalization time, the post-operative survival rate of ultrasonic aspiration hepatectomy with a domestic new type of ultrasonic surgical device in comparison with that of conventional techniques of hepatectomy. METHODS: A total 136 patients with hepatocellular carcinoma (HCC, including 12 patients in 1991 and 124 consecutive patients from July 1995 to December 2000) underwent ultrasonic aspiration in liver resection (group T) and 179 HCC patients received conventional hepatectomy during the corresponding period (group C). The results of the two groups were compared statistically. RESULTS: There was no significant difference in the mean operation time between group T (152+/-11 min) and C (144+/-11 min). No operation or hospital death occurred in both groups. In group T, the mean volumes of bleeding (463+/-15 ml) and blood transfusion (381+/-12 ml) were markedly less than those in group C (557+/-20 ml, and 507+/-18 ml, respectively, P<0.05). The mean hospitalization time of group T (8.9+/-0.6 d) was markedly shorter than that of group C (11.7d+/-0.6 d) (P<0.05). The incidence of complications in group T was markedly lower than in group C, post-operative jaundice occurred in 4/136 and 31/179, respectively (P<0.05), liver failure in 0/136 and 2/179, cholorrhea in 0/136 and 6/179, hydrothorax in 21/136 and 39/179 (P<0.05), ascices in 9/136 and 54/179, respectively (P<0.05 ). There was no significant difference in the 1-year survival rate between the two groups (P>0.05), while the 3-year survival rate of group T (64.2 % ) increased markedly as compared with that of group C (55.7 %) (P<0.01). CONCLUSION: The ultrasonic aspiration hepatectomy with a domestic new type of ultrasonic surgical device could evidently reduce the operative injury and post-operative complications, shorten the hospitalization time and prolong the survivals of HCC patients.

Adolescent↗
PubMedDate not supplied

Portal serum human hepatocyte growth factor levels after partial hepatectomy.

BACKGROUND/AIMS: We investigated whether or not hepatocyte growth factor increases in portal serum via an endocrine mode after partial hepatectomy in humans. METHODOLOGY: Portal blood was sampled through a catheter inserted through the umbilical vein to the portal trunk during surgery in 17 patients. Serum human hepatocyte growth factor levels were determined by enzyme-linked immunosorbent assay. RESULTS: Human hepatocyte growth factor levels were higher in portal than in peripheral serum throughout the study. Portal and peripheral serum human hepatocyte growth factor levels without complications increased rapidly and reached a maximum level 1 day after partial hepatectomy. The maximal level of portal and peripheral serum human hepatocyte growth factor was 1.20 and 1.00 ng/ml, respectively. In the case of hepatic failure after partial hepatectomy, portal and peripheral serum human hepatocyte growth factor levels markedly increased and reached 9.31 ng/ml and 6.78 ng/ml 2 days before death, respectively. CONCLUSIONS: These results suggest that hepatocyte growth factor increases in portal serum via an endocrine mode after partial hepatectomy in humans. Furthermore, measurement of the portal and peripheral serum human hepatocyte growth factor levels may be useful for the clinical evaluation of patients with post-operative hepatic failure.

Aged↗
PubMedDate not supplied

[Effect of partial hepatectomy on the invertor mechanism of regulation of the Na+,K+-ATPase activity in hepatocytes of rats of various ages].

Age peculiarities of partial hepatectomy effect on the hepatocytes plasma membrane Na+, K(+)-ATPase activity and its insulin-induced stimulation has been studied. It has been shown that partial hepatectomy does not change basal Na+, K(+)-ATPase activity in adult rats. In old partial hepatectomised rats Na+, K(+)-ATPase activity is slightly higher than in control old rats, although this increase is not statistically significant. At the same time, partial hepatectomy acts differently on the insulin-induced Na+, K(+)-ATPase activation in adult and old rats. Insulin activates Na+, K(+)-ATPase at the same extent both in control and partial hepatectomized adult animals. In old hepatectomized rats, but not in old control animals, insulin stimulates Na+, K(+)-ATPase activity as well as. Thus hepatectomy "rejuvenates" old hepatocytes and results in recovery of invertor mechanism of Na+, K(+)-ATPase activation.

Aging↗
PubMed1999

[Factors linked to 5-year survival after hepatectomy for hepatocellular carcinoma: univariate and multivariate analyses of 312 patients].

The purpose of this study was to clarify the factors linked to 5-year survival after hepatectomy for hepatocellular carcinoma (HCC). Three hundreds and twelve patients who underwent hepatectomy for HCC between 1985 and 1994 were observed for at least 5 years. These patients were divided into 2 groups: 160 patients who died within 5 years after hepatectomy and 152 patients who did not die within 5 years. Statistical analysis by chi 2 test showed that the favorable factors linked to 5-year survival were (a) diabetes mellitus (-), (b) albumin > 3.7 g/dl, (c) hepaplastin test > 61%, (d) indocyanine green retention test at 15 minutes < 16%, (e) curative resection (+), (f) alpha-fetoprotein < or = 32 ng/ml, (g) portal vein invasion (-), (h) intrahepatic metastasis (-), and (i) stage I and II. Statistical analysis by stepwise regression test showed that the favorable factors linked to 5-year survival were (a) intrahepatic metastasis (-), (b) diabetes mellitus, (c) indocyanine green retention test at 15 minutes < 16%, (d) curative resection (+) and (e) alpha-fetoprotein < or = 32 ng/ml. When patients diagnosed with HCC, patients selection for hepatectomy should be done, based on the total estimation, such as tumor invasiveness, liver functions, and diabetes mellitus.

Analysis of Variance↗
PubMed1999

[Long-term oncological results of hepatectomy performed after selective portal embolization].

BACKGROUND: Preoperative selective portal vein embolization (PSPVE), usually of the right portal branch, allows some patients to undergo an hepatectomy which was initially impossible as it would have left an insufficient amount of liver parenchyma. PSPVE induces relative atrophy of the embolized part of the liver, inducing compensatory hypertrophy of the nonembolized part (future remaining liver). Its technical aspects, its tolerance, its immediate results and indications are currently well-known, but long-term results of PSPVE followed by hepatectomy are unknown. The objective of this retrospective study was to assess the long-term survival of this unusual therapeutic approach. PATIENTS AND METHODS: Forty-one patients with initially unresectable (for volumetric reasons) malignant lesions of the liver, underwent PSPVE followed by hepatectomy between September 1987 and September 1998. In two-thirds of cases, the primary tumor was a colorectal adenocarcinoma. The mean number of resected lesions was 4.6 per patient, the mean size of the free margin was 4.3 mm, and 26.8% of the patients presented a (resectable) extrahepatic tumor. RESULTS: Overall 5-year survival (including the two postoperative deaths) was 31.3%, and 5-year survival without recurrence was 24%. For the 27 patients with colorectal metastases (the only homogenous subgroup of the series), overall 5-year survival was 28.6%. Although this result was lower than those obtained with classical hepatectomy (34.4%), it can be considered to be satisfactory, due to the number and size of the lesions. CONCLUSION: In conclusion, it is justified to use PSPVE to make initially unresectable very large liver tumors resectable, in view of the good survival results.

Adenocarcinoma↗
PubMedDate not supplied

Postoperative complications of repeat hepatectomy for liver metastasis from colorectal carcinoma.

BACKGROUND/AIMS: When a repeat hepatectomy is possible, it is the most effective treatment modality for recurrent colorectal liver metastasis. The aim of this study was to evaluate the surgical risks of repeat hepatectomy for liver metastasis from colorectal carcinoma. METHODOLOGY: Between 1986 and 1996, 60 patients with hepatic metastasis from colorectal carcinoma underwent surgery in the Department of Surgery I, Oita Medical University. Ten of them underwent a repeat hepatectomy. The cases of these 10 patients were studied retrospectively; in particular, postoperative complications and intraoperative blood loss were compared between the initial and second operation. RESULTS: During the second surgery, recurrence was detected adjacent to the hepatic stump in 9 of the 10 patients. During the initial surgery, 6 underwent non-anatomic resections, and 4 had anatomic resection, including 1 extended lobectomy, 1 lobectomy, and 2 segmentectomies. For the second surgery, 3 had anatomic resections, including 2 lobectomies, and 1 segmentectomy, and 7 underwent non-anatomic resections. There were no mortalities during the initial or second operation. There was no morbidity following the initial surgeries and 7 postoperative complications (intraabdominal abscess, 4 cases; biloma, 3 cases) following the second surgeries. Mean blood loss during the second operation (1044 mL) was significantly greater than during the initial operation (561 mL). CONCLUSIONS: The present results show that repeat hepatectomy for recurrent liver metastasis from colorectal carcinoma resulted in significantly greater intraoperative blood loss and postoperative complications than those of the initial surgeries. The blood loss and complications in the second operation, the one for the recurrence, were directly associated with the fact that the recurrence was so close to the hepatic stump. Since the resection line in the second surgery was adjacent to the hepatic hilus, resection of the lesion caused much more injury to the main bile duct and main portal vein than that caused by the.

Aged↗
PubMedDate not supplied

Hepatectomy for hepatocellular carcinoma in a renal transplant patient--report of a case and literature review.

A 45-year-old woman underwent hepatectomy for hepatocellular carcinoma developing after 2 renal transplants. She had a solitary hepatocellular carcinoma and central bisegmentectomy of the liver was performed. Administration of immunosuppressants was continued to maintain renal function in the perioperative period. Although our patient suffered from severe pneumonia postoperatively, she recovered without a decline in renal function. She has been alive for 1 year and 3 months after hepatectomy with hepatocellular carcinoma recurrence in the remnant liver. Any patient undergoing hepatectomy for hepatocellular carcinoma after renal transplantation should be managed as an immunocompromised host. Previously reported cases of hepatectomy for hepatocellular carcinoma in renal transplant recipients were reviewed.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

Retrospective study on the effects of lipiodolization before a potentially curative hepatectomy for colorectal liver metastases: long-term results of a pilot study.

BACKGROUND/AIMS: Lipiodolization, a selective regional cancer chemotherapeutic modality using lipiodol plus anticancer drugs, can prolong the survival time of patients with unresectable liver cancer. A preliminary study was conducted with adjuvant lipiodolization before a potentially curative hepatectomy for patients with metachronous colorectal liver metastases. The ultimate aim of this study was to improve the long-term survival after hepatectomy. METHODOLOGY: Twenty-one consecutive patients with colorectal hepatic metastases were included in this study. Seven patients underwent preoperative lipiodolization, while the remaining 14 patients did not receive any preoperative adjuvant therapy. The clinicopathological features and prognoses of these patients were investigated. The median follow-up period after a curative hepatectomy was 56 months. RESULTS: The clinicopathological factors did not differ markedly between the 2 groups. However, the cumulative survival rate of the 7 patients receiving preoperative lipiodolization was significantly (P < 0.05) better than that in those not receiving any preoperative treatment. CONCLUSIONS: Based on the above encouraging findings, we therefore propose that a prospective randomized trial should be carried out to confirm the beneficial effects of our adjuvant chemotherapeutic modality on patient survival following a curative hepatectomy for the patients with colorectal liver metastases.

Aged↗
PubMedDate not supplied

Hypersplenism induced by hepatectomy.

BACKGROUND/AIMS: We encountered a case of posthepatectomy splenic enlargement and hypersplenism followed by disseminated intravascular coagulopathy with airway hemorrhage causing death. METHODOLOGY: We, therefore, retrospectively investigated postoperative splenic enlargement, hypersplenism and disseminated intravascular coagulopathy by computed tomography and laboratory data in 57 hepatectomized patients with a malignant or benign disease in the postoperative period. RESULTS: Of 32 patients with hepatocellular carcinoma or biliary tract carcinoma (group A), 12 with metastatic hepatic lesions (group B), and 13 with benign liver disease (group C); remarkable (20%) splenic enlargement was noted in 8 patients in group A, 2 in group B, and 2 in group C. Seven of the 12 patients were associated with liver cirrhosis, 5 with preoperative splenomegaly, and 8 had undergone major hepatectomy. Postoperative hypersplenism developed in 5 patients in group A, and one patient in group C. All of them were associated with liver cirrhosis or chronic hepatitis and preoperative splenomegaly, and five had undergone hepatic lobectomy or more extensive resections. All except for the disseminated intravascular coagulopathy case recovered. Statistically, splenic enlargement was significantly related to the extent of hepatectomy; lobectomy versus segmentectomy = 28.3 +/- 28.5% (n = 14) versus 12.4 +/- 13.8% (n = 20), (unpaired Student's t test, P = 0.037). Platelet counts of the patients with liver cirrhosis or chronic hepatitis is lower than those without the diseases, both pre- and postoperatively (14.0 +/- 6.0 x 10(4)/mm3 vs. 21.5 +/- 6.2 x 10(4)/mm3, P = 0.0001). CONCLUSIONS: Postoperative hypersplenism was noted only in the patients with liver cirrhosis or chronic hepatitis and preoperative splenomegaly, and developed more frequently after larger hepatectomies than after smaller hepatectomies; 5 (45%) of 11 versus 1 (7%) of 14, chi 2 test, P = 0.026).

Aged↗