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At least 19 recordsLinked to original sources
PubMed1998

A thoracoabdominal hepatectomy and a transdiaphragmatic hepatectomy for patients with cirrhosis and hepatocellular carcinoma.

OBJECTIVE: To evaluate the results of a thoracoabdominal hepatectomy and a transdiaphragmatic hepatectomy for hepatocellular carcinoma in patients with impaired liver function. DESIGN: Retrospective study. SETTING: A university hospital in Japan. PATIENTS: Twenty-seven patients who from 1991 to 1996 underwent a thoracoabdominal hepatectomy for hepatocellular carcinoma located mainly in the superior portion of the liver and 20 patients who underwent a transdiaphragmatic hepatectomy for hepatocellular carcinoma located near the diaphragm. MAIN OUTCOME MEASURES: Morbidity, survival, and disease-free survival after each operation. Comparisons were then made with 183 patients who had undergone an ordinary transabdominal hepatectomy during the same period. RESULTS: In the thoracoabdominal hepatectomy group, 17 patients underwent a partial resection, 4 patients underwent a subsegmentectomy, and another 6 patients underwent either a segmentectomy or a procedure that was greater in size than a segmentectomy, whereas all of the patients in the transdiaphragmatic group underwent a partial resection. The morbidities in the thoracoabdominal group included pleural effusion in 6 patients (22%); intra-abdominal infection in 5 patients (19%); and hepatic failure in 3 patients (11%), of whom 1 died (mortality rate, 4%). In the transdiaphragmatic group, only 2 patients (10%) had non-life-threatening complications. The cumulative survival rates and the disease-free survival rates of the patients at 3 years were 51% and 24% in the thoracoabdominal hepatectomy group and 62% and 30% in the transdiaphragmatic hepatectomy group; no significant differences were observed when these findings were compared with those of patients who had undergone a transabdominal hepatectomy. CONCLUSION: The outcomes of the patients undergoing thoracoabdominal hepatectomy and those undergoing a transdiaphragmatic hepatectomy were generally satisfactory in spite of the fact that these procedures were performed on patients with cirrhosis and impaired liver function.

Aged↗
PubMed1999

[Management after hepatectomy of colorectal cancer metastases to the liver--intrahepatic arterial infusion chemotherapy and repeated hepatectomy].

Before Dec. 1993, we resected 17 patients with hepatic metastases from colorectal cancer. Hepatic recurrences developed in 82% patients who had been given mitomycin C or doxorubicin by hepatic-artery. The one-, 3- and 5-year survival rate after surgery was, 88%, 18% and 12%, respectively. Therefore, some new types of adjuvant therapy were needed to improve survival after surgery. This is a retrospective study to determine whether preventive intrahepatic artery infusion chemotherapy (HAI) and repeated hepatectomy are of benefit for patients with hepatic metastases from colorectal cancer who underwent hepatectomy. Thirty-five patients with hepatic metastases from colorectal cancer underwent hepatectomy and were administered 1,500 mg of 5-FU 10 times via the hepatic artery for 5 hrs every 1-2 weeks to prevent hepatic recurrence after Jan. 1994. Nine patients underwent repeated hepatectomy, then HAL following the operation. Non-resectable recurrence were treated by HAI. The amounts of the infused 5-FU dose were 8.5-46.5 g (mean 23 g) and 17-31 times HAI (mean 22 times). Survival rates were 81, 67, 67% and 24%, respectively, after 1, 2, 3 and 4 years. Hepatic disease-free interval rates were 49.3% and 32.5%, respectively, after 1 and 2 years. Preventive HAI could not control hepatic recurrence but prognosis after hepatectomy was improved by these modalities compared with treatment before Dec. 1993. Survival rates of 9 patients who underwent repeated hepatectomy were 89, 89% and 37%, respectively, after 1, 3 and 4 years. The prognosis of patients with hepatic metastases from colorectal cancer was improved by HAI and repeated hepatectomy, but further studies should be undertaken to improve preventive HAI.

Adult↗
PubMedDate not supplied

An approach for difficult hepatectomy--retrograde hepatectomy in 29 patients with liver malignant tumor.

BACKGROUND/AIMS: Resection remained the best treatment for malignant liver tumor. However, it is difficult to resect a tumor which is huge and tightly invaded or adhered to the surrounding organs by classical procedures because of poor exposure. The purpose of the present study was to verify that retrograde hepatectomy was an acceptable approach. METHODOLOGY: Retrograde hepatectomy means that the operative procedure is reversed as compared with classical methods. Transection of the liver parenchymal was performed first, isolating adhesions between the resected liver and diaphragm or partial phrenectomy followed, and then after cutting corresponding ligaments, the liver tumor was removed. If the adjacent organs were invaded or adhered too tightly to be separated, they were removed with the resected liver. This approach was adopted in 29 patients with liver malignancy (group A) for difficult hepatectomy from June 1994 to June 1997. In the same period, classical hepatectomy was performed in 13 patients used as a control group (group B). The differences between these two groups were analyzed. RESULTS: When group A was compared with group B, the operative mortality was 0% versus 7.7% (p > 0.05), the operative time was shorter, being 175.9 +/- 49.7 min (range: 150-250 min) versus 251.9 +/- 66.9 min (range: 180-360 min) (p < 0.05), the estimated intra-operative blood loss being 1430.0 +/- 807.6 ml (600-4200 ml) versus 2907.7 +/- 1497.9 ml (800-7000 ml) (p < 0.05), and the incidence of post-operative complications was lower (p < 0.05). CONCLUSIONS: Retrograde hepatectomy is an alternative method to classical hepatectomy and suitable for resection of localized huge liver tumor when the exposure is inadequate by classical approach, particularly when the tumor adheres or invades closely to the diaphragm and/or the surrounding structures.

Adult↗
PubMed1992

[Preoperative percutaneous transhepatic portal vein embolization to extend the indications for hepatectomy and to increase the safety of extended hepatectomy for hepatocellular carcinoma].

The usefulness of preoperative percutaneous transhepatic portal vein embolization (PTPE) in extending the indications for hepatectomy and increasing the safety of extended hepatectomy for hepatocellular carcinoma was studied in 21 patients who underwent right hepatic lobectomy with PTPE of the right first portal branch (group E), in 15 such patients but without PTPE (group N), and in seven such patients who underwent PTPE at this location but could not undergo surgery (group U). The mean volume of the left lobe increased but the results of a 15-minute indocyanine green retention test were worsened 2 weeks after PTPE and again 4 weeks after hepatectomy, but these changes after hepatectomy were almost the same in groups E and N. The worsening of liver function and coagulation test results was less in group E than in group N. The mean prognosis score was better in group E two weeks after PTPE than before, but not in group U. The four patients in group E with high portal vein pressure (> or = 30 cmH2O) or a high prognosis score (> or = 50 points) after PTPE developed hepatic failure after surgery. Preoperative PTPE was useful in extending the indications for hepatectomy and increasing the safety of extended hepatectomy. Evaluation of the clinical course after PTPE was also useful when decisions about the operative method to be used were being made.

Aged↗
PubMed1995

[Risk in major hepatectomy. A consecutive series of 113 extensive hepatectomies].

Up to now, liver resections have been the initial treatment of almost all cancers and benign tumors limited to a liver lobe. This retrospective review assesses the results of a consecutive series of 113 major elective hepatic resections during a ten-year period. Major hepatectomy was defined by the resection of at least 3 Couinaud segments. Mean age was 52 years (20 to 79 years). There were 62 women and 51 men. 35 resections were performed for colorectal metastases, 22 for a benign tumor, 20 for non-colorectal metastases, 11 for hydatid disease, 10 for hepatocarcinoma, 7 for cholangiocarcinoma and 8 for other indications. The resections performed were 86 right hepatectomies with 18 extended right hepatectomies, 24 left hepatectomies with 4 extended left hepatectomies and 3 trisegmentectomies. Total vascular exclusion was used in 22 patients (19%). Mortality rate was zero. Significant morbidity was encountered in 24 patients (21%). These results suggest that the mortality rate may be independent of the extent of liver resection, provided that hepatic function is normal and preoperative selection adequate. With improving surgical management and techniques, and the use of intra-operative sonography, extensive liver surgery can now be performed with a very low mortality rate.

Adult↗
PubMed1990

[Clinical investigation of hepatectomies for hepatocellular carcinoma--significance of extended hepatectomy for advanced hepatocellular carcinoma].

Although the diagnostic methods for hepatocellular carcinoma (HCC) are now being improved, there are still many cases detected at advanced stage. We, based on the Redox theory and using a technique of vascular surgery and liver transplantation, made it possible to perform the extended hepatectomy more actively even in the advanced cases which were previously considered to be in-operable. We report these extended hepatectomies in this paper. From January 1985 to August 1989, we performed 263 hepatectomies for HCC. Out of these 263 cases, we examined 208 cases which had an interval more than three months from the time of the operation and had exact follow-up data at the end of August 1989. There are 57 extended hepatectomies and they consist of 4 groups as follows. 1) Multiple group (14 cases): the operation for the cases with multiple daughter nodules in both lobes besides the main tumor. 2) Thrombus group (30 cases): the operation for the cases with portal tumor thrombus in the first branch or the main trunk of portal vein. 3) IVC group (4 cases): the operation adding resection and reconstruction of IVC because tumor was hardly fixed to the wall of IVC. 4) Recurrence group (9 cases): the operation for hepatic recurrence. Six cases of the Multiple group survived more than one year and one case is still alive more than two years after surgery. The 6-months, 1-year and 2-year cumulative survival rates of the Multiple group are 50.5%, 38.3%, and 8.5% respectively and these results are better than other reports. Forty-three hepatic recurrences were observed in 138 cases whose tumor was completely resected macroscopically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[Plasma concentration of lidocaine in patients undergoing hepatectomy with continuous epidural anesthesia--influence of extent of hepatectomy and prostaglandin E1 infusion].

We investigated changes in plasma concentration of lidocaine during continuous epidural anesthesia in 21 patients undergoing hepatectomy. According to the extent of hepatectomy, patients were assigned into one of the three groups: partial resection group, lobectomy group, and extended lobectomy group. Lidocaine 2.0 mg.kg-1 with 1: 200,000 epinephrine was epidurally administered in a bolus followed by continuous infusion of lidocaine at the rate of 1.5mg.kg-1.h-1. Plasma lidocaine concentration in the extended lobectomy group showed a significantly higher value than those of other two groups (P < 0.05). Plasma lidocaine was detected in the extended lobectomy group at 12 hs after the surgery, but not in the other two groups. Furthermore we investigated the effects of prostaglandin E1 infusion in 7 patients undergoing extended lobectomy. Plasma lidocaine concentration was not increased in this group. In conclusion, we recommend caution regarding the dose of lidocaine administered for epidural anesthesia during hepatectomy; PGE1 infusion appears to be safe in patients undergoing extended hepatectomy.

Adult↗
PubMed1975

Albumin synthesis and catabolism following partial hepatectomy in the rat. The effects of amino acids and adrenocortical steroids on albumin synthesis after partial hepatectomy.

Plasma albumin levels were measured in partially hepatectomized, sham operated and control rats. The levels fell in both the partially hepatectomized and sham operated groups; while the latter group returned to normal within a few days, the low plasma albumin in the partially hepatectomized animals was sustained. Albumin synthesis rates in the isolated perfused rat liver were measured in the three groups of animals at varying intervals after partial hepatectomy. There was a significant depression of albumin synthesis rate in terms of both liver and whole animal weights when compared to the sham operated and control animals. This depression was almost completely reversed by the addition of arginine, asparagine, isoleucine, leucine, lysine, methionine, phenylalanine, proline, threonine, tryptophan and valine added together to 10 times their normal plasma concentrations. The addition of hydrocortisone had no effect on the albumin synthesis rate after partial hepatectomy. Studies in vivo in the three groups of animals (partially hepatectomized, sham operated and control animals) revealed a fall in the albumin catabolic rate after partial hepatectomy coinciding with the fall in the albumin synthesis rate. An hypothesis whereby the amino acids may have their stimulatory effect is proposed.

Albumins↗
PubMed1990

[Portal hemodynamic changes from partial hepatectomy--quantitative analysis of portal flow before, during and after hepatectomy, using an Doppler ultrasound system].

We investigated portal hemodynamic changes in 86 patients with hepatic tumors who underwent partial hepatectomy. Portal blood flow was measured using a sector type Doppler ultrasound system before, during and after operation. In the intraoperative studies, the portal flow in patients who underwent massive liver resection decreased significantly. On the other hand, the portal flow in patients with minor liver resection tended to increase, but not significantly. Overall, portal flow per unit of cardiac out put decreased significantly; it also decreased significantly in patients who underwent massive or major liver resection, in patients with liver cirrhosis, and in patients whose post operative clinical course was satisfactory. In the post-operative studies (10-12 days after surgery), the portal blood flow decreased significantly in patients who manifested a severe post-operative clinical course; it showed no significant change in other patients. It is thus essential to monitor the portal hemodynamics of partial-hepatectomy patients. This is most readily realized using Doppler ultrasound.

Hepatectomy↗
PubMed1996

Functional contribution of preoperative portal vein occlusion to hepatectomy. With special reference to hepatic energy charge and DNA synthesis after hepatectomy in rats.

OBJECTIVE: To examine possible functional contributions of preoperative portal branch ligation before hepatectomy (PBL-Hx). DESIGN: Rats were randomly divided into 3 groups. In the PBL-Hx group, the portal branch supplying the left lateral and median lobes of the liver was ligated and the corresponding lobes (48% of the whole liver) were excised 2 days later. In the sham groups (one 68% Hx; the other 47% [hereafter, sham-67% Hx, and sham-47% Hx]), originally ligated lobes and left lateral and caudate lobes, similar to the excised liver volume in the PBL-Hx group, respectively, were excised 2 days after sham operation without PBL. MAIN OUTCOME MEASURES: Hepatic adenine nucleotides and energy charge, which are essential for vital function of hepatocytes, and liver regeneration were assessed by the DNA synthesis rate and weight before Hx and on days 1, 2, 3, and 7 after Hx. RESULTS: The remaining liver weight was restored similarly in the PBL-Hx and sham-47% Hx groups and more rapidly than in the sham-68% Hx group. Further enhancement of DNA synthesis did not occur after Hx in the PBL-Hx group, and hepatic energy charge did not decrease. In contrast, hepatic DNA synthesis was significantly activated depending on the excised liver volume in both the sham-Hx groups and was accompanied by corresponding decreases in hepatic energy charge. CONCLUSION: Preoperative PBL has a functional advantage because the recovery of the remaining liver volume is not impaired and hepatic energy charge is preserved with no further enhancement of DNA synthesis after Hx.

Adenine Nucleotides↗
PubMed1989

Course of liver regeneration after partial hepatectomy in rats treated with dialysates obtained 17 hours after partial hepatectomy.

Various theories have been put forward to explain the regenerative capacity of liver tissue induce by partial hepatectomy (PH). One of them presumes the existence of humoral factors stimulating proliferation of the liver tissue. We evaluated the course of liver regeneration after 65-70% PH as influenced by dialysates (DIA) of the organs of a rat killed 17 h after PH. In addition to kidney DIA, we were particularly interested in the effect of liver and spleen DIA. The experiments were carried out on rats weighting 310-370 g. Kidney, liver or spleen dialysate was administered subcutaneously and the rats were killed 12 or 24 h later by exsanguination from the abdominal aorta. In further rats, PH was performed 24 h after administering DIA and the rat were killed 18, 24, 30, 48 and 72 h after the operation. The initiation of liver regeneration was stimulated by all the given DIA, but especially by liver DIA. The faster onset of liver regeneration 18 h after PH in rats given spleen DIA is interesting. DIA did not greatly affect the hepatocytes of intact liver, but accelerated the initiation of liver regeneration after PH by synchronizing the cell cycle of proliferating hepatocytes. DIA obtained 17 h after PH contained substances which primarily stimulated liver DNA synthesis. From the changes in inhibition of the migration of spleen macrophages in the medium containing liver antigens, and from the circulating immunocomplex values, we conclude that DIA activation of the immune system, a well as the hepatic stimulator substance contained in the DIA, participates in acceleration of the liver regeneration process.

Animals↗
PubMed1989

Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure.

The mortality rate from hepatic failure after extensive resection should be negligible in the presence of normal results from preoperative liver function tests in patients without pre-existing hepatitis and cirrhosis. Despite conventionally acceptable results from preoperative hepatic function tests in 56 patients undergoing extensive hepatic resection for tumours (47 metastatic, six hepatomas and three adenomas), however, five patients died of hepatic failure. Among the many preoperative and intraoperative risk factors studied, the important factors in the group with hepatic failure were very high levels of serum alkaline phosphatase (p less than 0.05) in the presence of normal levels of bilirubin and large tumor, preoperative administration of chemotherapy, the presence of hepatomas rather than metastatic carcinoma (p = 0.083) and intraoperative blood loss of greater than 5,000 milliliters (p = 0.03). The patients receiving preoperative chemotherapy or those with hepatoma showed a minimal rise of alkaline phosphatase (p less than 0.03) and a minimal regeneration of liver on computed tomographic (CT) scan after hepatic resection. In the group with hepatic failure, a consistent postoperative pattern of increasing bilirubin with normal or subnormal alkaline phosphatase levels corresponded with lack of regeneration of liver on repeated CT scans. Conversely, the pattern of decreasing bilirubin with reciprocal increase in alkaline phosphatase corresponded with hepatic regeneration on CT scan in the group of survivors. Thus, we observe that alkaline phosphatase is a good indicator of hepatic regeneration in the absence of jaundice in patients after hepatectomy. To avoid postoperative hepatic failure, we recommend more discriminant tests than conventional hepatic function tests in patients with large tumors associated with high alkaline phosphatase levels, preoperative chemotherapy and hepatoma even without pre-existing cirrhosis or hepatitis.

Adult↗