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PubMed1992

Effects of partial hepatectomy on the growth characteristics and hypoxic fractions of xenografted DLD-2 human colon cancers.

A recent publication by Leith et al. (Cancer Res. 51, 4111-4113, 1991) showed that administration of epidermal growth factor (EGF) (0.25 mg/kg; q.i.d. x 7) to mice bearing xenografted A431 human epidermoid cancers produced increased tumor growth and a reduction of the percentage of hypoxic cells within neoplasms. In contrast, sialoadenectomy, which removes the majority of circulating EGF in the mouse, resulted in slower tumor growth and increased hypoxic percentages. To investigate such homeostatic mechanisms further, we investigated the growth characteristics and hypoxic fractions of xenografted DLD-2 human colon tumors when tumor-bearing mice received partial hepatectomy (about 65%), unilateral nephrectomy, or nonspecific surgical trauma (laparotomy). Surgical procedures were performed when tumor volumes were about 375 mm3, and hypoxic percentages within tumors were measured by clonogenic excision assay procedures 72 h later. We found that partial hepatectomy increased the growth rates of the transplanted DLD-2 cancers by about a factor of 2.4. This increased growth rate was accompanied by an increase in the mitotic index from about 1.5 to 3.0%. Also, hypoxic fractions were decreased from 0.561 in control tumors to 0.235 in tumors from mice receiving partial hepatectomies. Unilateral nephrectomy and nonspecific surgery manipulations did not alter tumor growth rates, mitotic indices, or hypoxic percentages. These results indicate that partial hepatectomy produces significant alterations in tumor physiology. Results are consistent with a growth factor-mediated mechanism.

Animals↗
PubMed2004

[Role and significance of extrahepatic control of hepatic vein and inferior vena cava in difficult hepatectomies for patients with liver tumors].

OBJECTIVE: To explore the role of extrahepatic control on blood flow of hepatic vein and inferior vena cava in hepatectomy, and observe its effect on minimizing hemorrhage. METHODS: From 2001 to April 2003, 33 patients who had liver tumors involving segment IV, VII, VIII or half liver underwent major hepatectomies that required exposure of the inferior vena cava and main trunks of hepatic veins, during which the major hepatic veins and inferior vena cava were isolated and taped to control blood flow when necessary. RESULTS: In 33 attempts, 32 were successful and all tumors were resected successfully. The placement of occlusion tape was unsuccessful in 1 case. 7 cases did not need blood transfusion during operation. The amount of blood transfusion for other cases were form 0 to 1 600 ml. there was no operative mortality. CONCLUSIONS: Appropriate control of main truck of hepatic vein and inferior vena cava is effective in reducing blood loss during hepatectomies. It is also very helpful for performing difficult hepatectomies.

Adult↗
PubMedDate not supplied

Selective suppression of initial cytokine response facilitates liver regeneration after extensive hepatectomy in rats.

BACKGROUND/AIMS: After extensive hepatectomy, the cytokine network plays an important role in injury to the remnant liver and subsequent impairment of liver regeneration. Tumor necrosis factor alpha (TNF alpha) and interleukin 1beta (IL-1beta) are thought to be the initial cytokines associated with liver injury as well as with regeneration. We investigated the effect of the suppression of these cytokines on liver function and on liver regeneration after subtotal hepatectomy in rats. METHODOLOGY: Following 90% hepatectomy, rats were divided into two groups. Animals in the FR group received intraperitoneal FR167653, a selective inhibitor of TNF alpha and IL 1beta, while those in the Control group received vehicle only. Liver chemistry and serum levels of TNF alpha and IL-6 were measured serially. Liver specimens were obtained 48 hr after surgery and regenerative activity assessed by proliferating cell nuclear antigen (PCNA) expression and remnant liver weight. RESULTS: The survival rate was significantly better in the FR group (76.4+/-11.7 hrs) than in the Control group (26.8+/-4.3 hrs, p=0.0014). Liver enzyme and blood sugar levels after surgery were higher in the FR group compared to the Control group (p=0.03 or less). Changes in serum levels of both TNF alpha and IL-6 were suppressed in FR group rats after surgery. Microscopically, hepatocellular damage and steatosis was less prominent in FR group livers. PCNA labeling index and residual liver weights were higher in the FR group (p<0.001). CONCLUSIONS: Following extensive hepatectomy in rats, suppression of early cytokine induction improved liver function and facilitated liver regeneration. Suppression of selective cytokine responses could allow extended liver resection and reduced risk of liver failure.

Animals↗
PubMed2004

Etiological factors for subphrenic infection after hepatectomy for patients with hepatic malignancy.

BACKGROUND: This study was to clarify the high risk factors for subphrenic infection (SI) after liver resection for patients with hepatic malignancy. METHODS: Three hundred and sixty-eight patients who had undergone hepatectomy from January 1985 through June 2002 were randomly divided into 2 groups according to resection of liver parenchyma, hepatic cirrhosis, primary liver cancer, intraoperative blood loss, and subphrenic drainage. The chi-square was used for statistical analysis. RESULTS: Thirteen patients (3.53%) of the 368 patients had SI. The high-risk factors for SI after hepatectomy were related to resection of liver parenchyma and hepatic cirrhosis; but the course or stage of primary liver cancer was not related to the incidence of SI. Intraoperative blood loss of over 1500 ml was found to be a significant risk factor for postoperative SI. Adequate drainage of the subdiaphragm and the raw surface of the liver after operation was essential to decreasing SI after liver resection. CONCLUSION: Inadequate subphrenic drainage may largely contribute to SI in patients with hepatic malignancy undergoing hepatectomy apart from other factors. Comprehensive measures should be taken to prevent the infection after hepatectomy.

Adult↗
PubMedDate not supplied

The clinical significance of monitoring alkaline phosphatase level to estimate postoperative liver failure after hepatectomy.

BACKGROUND/AIMS: To predict the occurrence of postoperative liver failure after hepatectomy, the clinical significance of monitoring alkaline phosphatase (ALP) has been studied, and the relationship between the change of total bilirubin and the level of ALP or gamma-glutamyl transpeptidase (gamma-GTP) after hepatectomy was evaluated. METHODOLOGY: The 163 patients, who underwent hepatectomy at our institute for the past 12 years, were divided into three groups according to the postoperative events. HF consisted of 5 patients with liver failure, HB showed the postoperative high bilirubinemia (over 5mg/dL) in 13 cases and GP were 145 cases without any postoperative problems. RESULTS: 1. The postoperative highest level of total bilirubin (T-Bil) correlated with the decreasing rate of ALP, prothrombin time (PT), total cholesterol (T-CHO) or gamma-GTP and total blood loss (p<0.01). 2. The level of ALP decreased after hepatectomy significantly and the decreasing rate was serious in HB and HF (p<0.05). 3. The recovering time to preoperative level of ALP was clearly shorter in GP than in HB and HF. 4. The level of ALP and gamma-GTP at the point where the level of T-Bil increased over 5mg/dL, was useful to distinguish between HF and HB. 5. The good correlation between postoperative level of ALP and gamma-GTP was noted. The decreasing levels of ALP and gamma-GTP were found to be critical below 80% and 55% after bisegmentectomy. Furthermore, the recovered levels of ALP and gamma-GTP were important to distinguish between HF and HB. CONCLUSIONS: Monitoring the ALP level was indicated to be useful to estimate the postoperative course of bilirubin.

Alanine Transaminase↗
PubMedDate not supplied

Simultaneous transfer of vascular endothelial growth factor and hepatocyte growth factor genes effectively promotes liver regeneration after hepatectomy in cirrhotic rats.

BACKGROUND/AIMS: Liver regeneration in a cirrhotic liver is unsatisfactory. In the course of liver regeneration, non-parenchymal cells such as sinusoidal endothelial cells as well as hepatocytes increase in number while the liver structure and physiological functions are maintained. The aim of this study was to examine whether sufficient liver regeneration could be obtained by the simultaneous, preoperative injection of recombinant adenoviral vectors encoding human vascular endothelial growth factor (VEGF), a potent mitogen for sinusoidal endothelial cells, (pAxCAVEGF) and rat hepatocyte growth factor (HGF), a potent mitogen for hepatocytes, (pAxCAHGF) in 70% hepatectomized cirrhotic rats. METHODOLOGY: Forty-eight hours before 70% hepatectomy, dimethylnitrosamine-induced cirrhotic rats were infused intravenously with pAxCAVEGF or with pAxCAVEGF and pAxCAHGF, or with a control virus encoding Escherichia coli beta-galactosidase (pAxCALacZ). RESULTS: Strong VEGF mRNA expressions were shown in the livers of VEGF and VEGF/HGF-treated animals. The plasma HGF concentrations in the VEGF/HGF-treated rats were elevated compared with the other groups. Proliferating cell nuclear antigen immunostaining showed increased labeling indices of hepatocytes in the VEGF/HGF-treated rats at 24 and 48 h after hepatectomy. PCNA labeling indices of SECs were increased in the VEGF and VEGF/HGF-treated rats compared with the control animals at 24 and 48 h after hepatectomy. Moreover, the hepatic regeneration rate after hepatectomy was significantly augmented by the VEGF and VEGF/HGF treatment. CONCLUSIONS: Simultaneous preoperative injection of recombinant adenoviral vectors encoding VEGF and HGF effectively stimulates liver regeneration in cirrhotic rats.

Animals↗
PubMedDate not supplied

Evaluation of functional liver reserve in patients with obstructive jaundice undergoing hepatectomy.

BACKGROUND/AIMS: In hepatectomy in patients with obstructive jaundice, correct evaluation of the functional liver reserve is sometimes difficult. This study examined whether the preoperative level of total bilirubin in the bile from a predicted remnant liver can be used as a predictor for safe hepatectomy in such patients. METHODOLOGY: Twenty consecutive patients with jaundice who underwent major hepatectomy and in whom all bile from the predicted remnant liver could be collected were included in this study. The level of total bilirubin in the bile was calculated by multiplying bile volume and density obtained by percutaneous transhepatic biliary drainage. Patients were divided into two groups, with (group 1) and without postoperative death due to liver failure (group 2). RESULTS: The level of total bilirubin in the bile from the predicted remnant liver was lower in group 1 than in group 2. Patients did not die of postoperative liver failure if the level of total bilirubin in the bile was maintained, even if the bile volume or density were low. CONCLUSIONS: The preoperative level of total bilirubin in the bile from the predicted remnant liver can be used as a predictor for safe hepatectomy in patients with obstructive jaundice.

Adult↗
PubMedDate not supplied

Recurrence of primary hepatocellular carcinoma after hepatectomy--differences related to underlying hepatitis virus species.

BACKGROUND/AIMS: Studies on post-hepatectomy prognoses by infecting viral species have only been rarely reported. METHODOLOGY: The patients who had undergone hepatectomy for primary hepatocellular carcinoma (HCC) over the past 10 years at our hospital were divided into three groups based on their underlying causal diseases: hepatitis B (B type), hepatitis C (C type), and non-viral hepatitis including alcoholic hepatitis, and their backgrounds and long-term results after hepatectomy were comparatively investigated. RESULTS: As for tumor factors, the tumor diameter was 3.7+/-2.1 cm in C type patients, which was significantly smaller than the 5.2+/-3.3 cm diameter in B type patients (p=0.01) and 7.9+/-5.6 cm in non-viral patients (p=0.001). However, the frequencies of intrahepatic metastasis, portal vein infiltration, capsule formation and capsule infiltration did not differ significantly among the three groups. Although there was no significant difference observed among the three groups for the recurrence-free survival time, HCC had recurred at as early a stage as within 1 postoperative year in 50% of non-viral patients. CONCLUSIONS: The size of a tumor upon hepatectomy and the presence or absence of intrahepatic metastasis were found to be significant factors contributing to the postoperative recurrence of HCC. It is possible that the recurrence-free postoperative survival time may be prolonged by earlier detection of HCC, particularly for the B type and the non-viral type in which the tumor size was already large at the time of surgery.

Adult↗
PubMed2005

Prevention and management of pleural effusion following hepatectomy in primary liver cancer.

BACKGROUND: Postoperative pleural effusion occurs frequently after hepatectomy. The risk factors, prevention and management of postoperative pleural effusion in patients with primary liver cancer (PLC) who have undergone hepatectomy and the value of the argon beam coagulator (ABC) for the prevention of pleural effusion are studied. METHODS: A total of 523 patients with PLC at our institution who had had right hepatectomy from July 2000 to June 2004 were studied retrospectively. Comparative analysis was made to identify the factors contributing to postoperative pleural effusion and the efficacy of various managements. RESULTS: Of the 523 patients whose livers were dissociated using argon beam cutting and/or coagulation, 20(3.8%) developed pleural effusions; whereas in the other 467 patients underwent hepatectomy with suture ligation of the diaphragmatic secondary wound surface during the same period, 49(10.5%) had pleural effusion (P < 0.01). The factors contributing to postoperative pleural effusion included subphrenic collection, postoperative hepatic insufficiency with ascites, duration of hepatic occlusion and underlying cirrhosis. CONCLUSIONS: Dissociation of the liver by argon beam cutting and/or coagulation can save suture ligation of the diaphragmatic secondary wound surface and may also prevent postoperative pleural effusion. Pleural drainage using an indwelling central-venous-catheter (CVC) in the pleural cavity is safe and efficacious.

Adult↗
PubMedDate not supplied

Endocutter no-knife and extraparenchymal control of the main hepatic veins for major hepatectomy.

BACKGROUND/AIMS: Extraparenchymal control of the main hepatic veins (ECHV) and use of vascular staplers are now considered as effective methods to prevent intraoperative hemorrhage and duration of hepatic transection. The aim of the present preliminary study was to investigate whether extraparenchymal control of the hepatic veins combined with inflow occlusion and a new articulating linear stapler without a knife (Endocutter no-knife) were effective for major hepatectomy. METHODOLOGY: Twenty patients with hepatic malignant disease underwent major hepatectomies in which 4 or more Couinaud's segments were removed. Extraparenchymal control of the hepatic veins and Endocutter no-knife were used in 7 (Recent group) of the 20 patients after June 2003. Hemihepatic devascularization before hepatic transection, and intermittent hepatic inflow occlusion were also performed in these 7 patients. In the other 13 (Previous group) patients before June 2003, major hepatectomy was performed under only intermittent hepatic inflow occlusion. Intraoperative blood loss volume, transfusion of packed red blood cells, and duration of hepatic transection were compared between the Recent group and Previous group. RESULTS: Estimated blood loss and number of intraoperative blood transfusion were significantly smaller in the Recent group than in the Previous group. Duration of hepatic transection was also significantly shorter in the Recent group than in the Previous group. CONCLUSIONS: The present preliminary study showed that extraparenchymal control of the hepatic veins and Endocutter no-knife are useful for major hepatectomy.

Aged↗
PubMed1991

[The relation of lectin receptor's activity of hepatocellular carcinoma (HCC) with the recurrence after curative hepatectomy].

Recurrence is an important factor affecting the survival rate of patients with hepatocellular carcinoma (HCC) after curative hepatectomy. Twelve types of lectin receptors in 33 cases of HCC tissues were determined by avidin-biotin-peroxidase complex (ABC) method. The relationship between lectin receptors, HCC grading and recurrence time after curative hepatectomy was investigated. The results showed that tumor-free period of patients after the resection of HCC was not closely related to the size of resected tumors, their pathological gradings as well as most lectin receptors. However, tumors that recurred longer than two years after curative hepatectomy had Bandeiraea simplifolia agglutinin I (BSAI) receptors obviously fewer than those recurring within two years. It is suggested that BSAI receptors in tumor tissues might be a useful index in the prognosis of HCC patients after hepatectomy.

Adolescent↗
PubMed1991

[The hemodynamics during hemodilution and its influence on the liver functions after hepatectomy for hepatocellular carcinoma with liver cirrhosis].

The hemodynamics during hemodilution occurred after hepatectomy for hepatocellular carcinoma with liver cirrhosis and its influences on the liver functions were studied. The hematocrit value gradually decreased about 10% until the 4th postoperative day owing to hemodilution after hepatectomy. While anemia progressed, cardiac index inversely increased. Under such a condition, oxygen consumption was maintained so that acidosis did not develop. Arterial blood ketone body ratio was also kept within a normal range except for a case whose hematocrit value decreased to 17.1%. Although the escaped hepatic enzymes such as GOT and GPT increased in the serum after hepatectomy, hemodilution was not responsible for their increase. While total bilirubin increased in the severe hemodiluted group, the increase was not due to hemodilution but caused by blood transfusion. The protein synthesis of the liver measured by rapid turnover protein levels in plasma was depressed after surgery, and this depression prolonged to the 14th postoperative day in the group whose hematocrit value decreased below 20%. These results suggest that it is better to keep hemodynamics without blood transfusion unless the hematocrit value decrease below 20%, and also better to maintain the hematocrit above 20% for liver regeneration after hepatectomy.

Adult↗
PubMed2006

[Role of anatomic hepatectomy performed under vascular exclusion in management of hepatolithiasis].

OBJECTIVE: To evaluate the effect of anatomic hepatectomy performed under vascular exclusion in management of hepatolithiasis. METHODS: From May 2002 to March 2005, fifty-three patients with unilateral hepatolithiasis underwent anatomic hepatectomy with exposure and control of inferior vena cava and main trunk of hepatic veins. The hepatic lobes involved by hepatolithiasis were left lateral lobe (S(2), S(3)) in 12 patients, left lobe (S(2), S(3), S(4)) in 26 patients, right posterior lobe (S(6), S(7)) in 8 patients and right lobe (S(5), S(6), S(7), S(8)) in 7 patients. Atrophy of involved hepatic lobes was found in 38 patients. Fourteen patients had experienced more than one operation on biliary tract. Nine patients showed the symptoms of acute cholangitis preoperatively and 4 patients complicated with liver abscess. RESULTS: Vascular exclusion was successfully performed on all patients to control the blood inflow and outflow of liver. The anatomically resected hepatic lobes were left lateral lobe (S(2), S(3)) in 12 patients, left lobe (S(2), S(3), S(4)) in 26 patients, right posterior lobe (S(6), S(7)) in 8 patients and right lobe (S(5), S(6), S(7), S(8)) in 7 patients. Except hepatectomy, the additional procedures performed on the patients were choledocholithotomy in 39 cases, choledocho-jejunostomy in 5 cases. The majority of complications were bile leakage in 3 cases, subphrenic infection in 2 cases, hydrothorax in 5 cases and wound infection in 5 cases. CONCLUSIONS: Anatomic hepatectomy under vascular exclusion is effective treatment to eradicate intrahepatic stone foci in case of unilateral hepatolithiasis, and help to reduce intraoperative blood loss and decrease postoperative complications.

Adult↗
PubMed2006

[Combined total hepatectomy, orthotopic liver transplantation and pancreatoduodenectomy for unresectable hilar bile duct carcinoma].

OBJECTIVE: To explore the feasibility and outcome of combined hepatectomy, orthotopic liver transplantation and Whipple's pancreatoduodenectomy for radical excision of cholangiocarcinoma. METHODS: A 35-year-old female patient with unresectable cholangiocarcinoma underwent curative radical operation, which includes hepatectomy, orthotopic liver transplantation and pancreaticoduodenectomy of hilar bile duct carcinoma; immunosuppression followed an induction protocol with FK506 and steroids. Lamivudine and HBIg were used to prevent hepatitis B virus from infection again. RESULTS: Pathologic examination revealed low differentiated cholangiocarcinoma and immunohistochemistry stains demonstrated positive expression of cytokeratin 9 and 17, carcinoembryonic antigen and the hepatocyte protein was negative. Neither the margins of resection nor the periductal lymph nodes were involved. The liver showed evidence of cholestasis and metastasis nod. The patient was hospitalized 32 days and came back to the previous work. He has been followed up for more than 14 months up to now and is currently alive without any evidence of recurrent cancer. CONCLUSIONS: For some selected unresectable Klatskin's tumors, combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation was justified. The radical methods maybe provide long-time survival and curative effect. Nevertheless, because of possible tumor recurrence and ethical controversy, the combined hepatectomy, pancreatoduodenectomy and orthotopic liver transplantation procedure has to be applied only with caution and indications.

Adult↗
PubMed2006

Ultrasonographic findings at the resected area after hepatectomy.

BACKGROUND: Since hepatectomy has been widely performed, different operative manner, operating areas, and material in the residual cavity may be found ultrasonographically near the resected area after the operation. In this study, we investigated the changes of focal ultrasonography at the resected area post hepatectomy and recognized the characteristic ultrasonographic images. METHODS: 176 patients whose ultrasonographic findings were studied in the residual area during the early and later periods after hepatectomy were retrospectively analyzed in terms of operative manner, operative area, and material in the residual cavity. RESULTS: There were absence of partial hepatic lobe or hepatic segment, focal anechoic area with thin wall or mixed mass at the resected area, and conformation of irregular high-echoic conglomeration at the resected area, cystic non-anechoic area, and mixed mass with irregularly thickened wall at the resected area, inconsistent internal echoes, and color Doppler twinking artifacts around the material and the residual cavity after curettage and aspiration. CONCLUSIONS: Focal ultrasonographic findings at the resected area after hepatectomy vary with different operative procedures, operative area, resection size, absence or existence of material, and kinds of material in the residual cavity.

Adult↗
PubMed1990

[Changes of lysosomal enzymes in pancreatic juice following hepatectomy in rats].

To explore the changes in the exocrine pancreas and the possible stimulation by gut hormones of secretion of lysosomal enzyme into the pancreatic juice, we measured the caerulein-stimulated amylase output, the cathepsin B output into the pancreatic juice and the pancreatic tissue amylase and cathepsin B contents, as well as the distribution of cathepsin B in acinar cells in both the regenerating (4 days) and recovery (8 days) stages after about 70% hepatectomy in rats. The amylase output increased significantly after hepatectomy. Cathepsin B was secreted into the pancreatic juice after stimulation by caerulein in both the control and hepatectomized groups. Four days after hepatectomy, the cathepsin B output was significantly greater than that of the control group, and redistribution of cathepsin B in acinar cells was noted. These changes in cathepsin B disappeared in the recovery stage (8 days) after hepatectomy. In addition, the pancreatic amylase content was significantly higher than in the control group, but the pancreatic cathepsin B content did not change significantly. These results suggest that caerulein stimulated the secretion of lysosomal enzyme into the pancreatic juice in the same way as digestive enzymes and that lysosomal enzymes in the pancreatic juice play an important physiological role. Furthermore, these results indicate the increased synthesis and secretion of amylase in and from acinar cells as well as the fragility of acinar cells.

Amylases↗
PubMed2006

[The value of TissueLink hemostatic sealer in hepatectomy for hepatocellular carcinoma].

BACKGROUND & OBJECTIVE: Managing the liver stumps reliably is an important guarantee for the accomplishment of hepatectomy. This study was to explore the value of TissueLink hemostatic sealer in hepatectomy for hepatocellular carcinoma (HCC), and evaluate its effects in extending incisal edge and reducing recurrence rate. METHODS: TissueLink hemostatic sealer was used on the liver stumps during hepatectomy for 20 patients (study group); whereas, conventional suturing of the vessels and bile ducts was performed in 28 patients (control group). Peri-operative serum alanine aminotransferase (ALT), total bilirubin, hospitalization period and complication occurrence were observed and compared. RESULTS: The amount of operative bleeding and the amount of post-operative abdominal cavity drainage were significantly lower in study group than in control group [(412.50+/-122.34) ml vs. (530.36+/-151.13) ml, P=0.006; (285.50+/-43.59) ml vs. (347.86+/-67.62) ml, P=0.001]. Three and 7 days after operation, serum ALT levels were significantly lower in study group than in control group [(152.36+/-93.32) U/ml vs. (246.19+/-159.85) U/ml, P=0.015; (56.63+/-21.59) U/ml vs. (96.46+/-47.97) U/ml, P=0.009]; serum total bilirubin levels were significantly lower in study group than in control group [(25.93+/-9.63) micromol/L vs. (40.12+/-16.54) micromol/L, P=0.004; (17.25+/-7.22) micromol/L vs. (39.63+/-19.06) micromol/L, P=0.001]. Hospitalization period was significantly shorter in study group than in control group [(10.5+/-1.5) days vs. (12.9+/-2.8) days, P=0.002]. The occurrence rate of complications was lower in study group than in control group. On CT image after operation, an annular zone of necrosis in the liver was found in most patients of study group. CONCLUSIONS: TissueLink hemostatic sealer is a safe device to manage the liver stumps in hepatectomy. It has less damage on liver function after operation, and can shorten hospitalization period and reduce the occurrence of post-operative complications.

Adult↗
PubMedDate not supplied

Analysis of the changes pattern of serum apolipoprotein A-1 after hepatectomy.

BACKGROUND/AIMS: Previously, we reported that apolipoprotein A-1 (apoA) is a good indicator of hepatic protein synthesis after hepatectomy. In this study, we analyzed whether the recovery patterns of apoA after hepatectomy were different with the operation procedure or the coexistence of liver disease. METHODOLOGY: From 1997-2003, we measured the serum levels of albumin, apoA, prealbumin (prealb), and retinol binding protein (RBP) in 100 patients who underwent hepatectomy. All patients tolerated hepatectomy without severe complications such as liver failure. The type of operation was partial resection in 62 cases, segmentectomy (Hr1) in 9 cases, and bisegmentectomy (Hr2) in 29 cases. Coexistent liver conditions were normal liver (NL) in 43 cases, chronic hepatitis (CH) in 29 cases, and liver cirrhosis (LC) in 28 cases. RESULTS: Postoperative changes of apoA showed the same patterns and no significant difference between operative procedures. Although apoA on preoperation had almost the same value in NL, CH, and LC cases, apoA at POD 14 was the lowest in LC (70.4+ 24.8 mg/dL) compared with NL (79.4+/-23.4 mg/dL) and CH (81.4-19.7 mg/dL). Thirty-five cases showed low recovery of apoA (1.09), and their apoA level was under 70 mg/dL at POD 14. Thirty cases showed a high recovery rate of apoA (1.27), and their apoA at POD 14 was over 90 mg/dL. The percentages of low recovery cases were 28.6% in NL, 31.0% in CH, and 41.9% in LC. For low recovery, there was no significant difference with coexistent liver disease. CONCLUSIONS: The recovery pattern of apoA differed by individual. ApoA synthesis potential depends on individual protein synthesis ability, and not on the operative procedure or coexistent liver disease.

Adult↗