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PubMedDate not supplied

Liver regeneration and restoration of liver function after partial hepatectomy: the relation of fibrosis of the liver parenchyma.

BACKGROUND/AIMS: Patients who survive partial hepatectomy sometimes have unsatisfactory liver regeneration and restoration of liver function. Although the extent of resection should be adjusted to attain favorable liver regeneration and restoration of liver function, a guiding principle for this has not been established. METHODOLOGY: Seventy patients with hepatic tumors associated with liver disorders of various severity who underwent hepatectomy were studied. We calculated the removal rate of the liver and the regeneration rate of the remnant liver using computed tomography. The liver function was investigated using ICG R-15 (retention rate of indocyanine green). Liver disorder was classified into 4 groups, according to the severity of fibrosis. RESULTS: The regeneration rates of the remnant liver indicated a significant decline in patients with severe fibrosis. In the no fibrosis and mild fibrosis groups, an increased removal rate was associated with increased regeneration rate, and post-operative ICG R-15 improved with time. However, in the moderate fibrosis and severe fibrosis groups, an increased removal rate was not associated with increased regeneration rate, and post-operative ICG R-15 showed no change or became worse with time. CONCLUSIONS: Severe fibrosis of the liver parenchyma is associated with poorer regeneration of the remnant liver leading to poor restoration of post-operative liver function. The severity of fibrosis is useful as a predictive factor for liver regeneration and restoration of liver function after partial hepatectomy.

Adult↗

PubMed1997

[Prevention of acute hepatic failure after "90%" hepatectomy by portal branch ligation in rats].

In this study, ligation of portal branches feeding 90% liver mass was performed in rats. After the ligation, 10% liver mass with portal blood perfusion underwent a progressive hypertrophy. It gained weight against the control by about 5-fold at the 14th day. The measurement of incorporation rate of H3-thymidine showed that the DNA synthesis increased rapidly in the liver tissue keeping portal blood supply. It reached a peak at 24 hours and retumed to normal at 7 days after the ligation. The ligated liver lobes under-went an atrophy gradually. With the pretreatment of such portal branch ligation 2 weeks before, 80% rats survived from the resection of ligated liver lobes which composed of 90% preceding liver mass. In the control group of sham portal branch ligation, all rats died within a short period of time after 90% hepatectomy. This study demonstrated that a secondary extended hepatectomy following the ligation of portal branches feeding 90% liver mass could prevent acute hepatic failure induced by primary 90% hepatectomy in rats.

Animals↗

PubMedDate not supplied

Intraportal insulin therapy after partial hepatectomy for hepatoma patients with insulinopenia.

BACKGROUND/AIMS: This prospective study was carried out in order to assess the role of intraportal insulin infusion after partial hepatectomy in hepatoma patients with insulinopenia. METHODOLOGY: Of the 38 patients who underwent hepatic resection for hepatocellular carcinoma from August 1994 to August 1995, 21 patients took an oral glucose tolerance test with insulin measurement preoperatively. Five patients were treated postoperatively with intraportal insulin infusion, as follows: A 16-gauge catheter was inserted into a reopened umbilical vein and fixed in place by a few absorbable stitches. Regular insulin was administered just after the operation at the rate of 2 units/hour for 2-3 weeks. Blood glucose levels were maintained between 150 and 200 mg/dL. Arterial ketone body ratio was used in monitoring the function of the liver during the perioperative periods. RESULTS: Ten patients (47.6%) were found to be insulinopenic. In the insulin therapy group (n = 5), the arterial ketone body ratio of 3 patients recovered within a few hours after the operation, and that of the remaining 2 patients recovered on the 1st postoperative day. But in the control group (n = 5), none of the 5 cases had an arterial ketone body ratio of more than 0.7 on the day of operation. The arterial ketone body ratio returned to normal on the 1st postoperative day in 2 cases, on the 2nd postoperative day in 1 case, and on the 5th day in 1 case. The arterial ketone body ratio recovery time was shorter in the intraportal insulin therapy group than in the control group (P = 0.042). CONCLUSIONS: Intraportal insulin infusion after hepatectomy via the reopened umbilical vein may be a very simple and safe means of promoting recovery of remnant liver function after hepatectomy in hepatoma patients with insulinopenia.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

The effect of microvesicular fatty change on liver regeneration after partial hepatectomy.

BACKGROUND/AIMS: Hepatic resection for primary and secondary liver tumors and transplantation of segments of liver into patients with severe liver disease has become a common practice. However, the information on the regenerative potential of liver with various underlying diseases, particularly, the common disorder fatty change, is sparse. METHODOLOGY: In the present study we have evaluated the regenerative potential of liver in mice lacking fatty acyl-CoA oxidase (AOX-/-) after partial hepatectomy. Liver regeneration was assessed by measuring mitotic activity and 5-bromo-2'-deoxyuridine (BrdU) labeling using immunohistochemistry. RESULTS: BrdU labeling index in AOX-/- mice was 99 +/- 32, 156 +/- 28, 54 +/- 13, and 120 +/- 33 per 1000 cells at 48, 60, 72 and 84 hours, respectively after partial hepatectomy. Comparable BrdU labeling index was observed in AOX+/+ mice. Similarly, mitotic index in both groups was comparable. CONCLUSIONS: These results suggest that DNA synthesis after partial hepatectomy in genetically altered mice with microvesicular fatty change is unaffected.

Adipose Tissue↗

PubMedDate not supplied

Early enteral nutrition after hepatectomy to prevent postoperative infection.

BACKGROUND/AIMS: Enteral nutrition helps to prevent septic complications in patients with critical illness, but there are few reports on its use after hepatectomy. To evaluate its benefits, we studied the indications for it. METHODOLOGY: In a retrospective study we reviewed 67 hepatectomized patients, 19 with enteral nutrition after hepatectomy (EN group) and 48 without (TPN group). In the TPN group, the risk factors of postoperative infections were analyzed with discriminant analysis. Then we prospectively selected high-risk patients before surgery and started enteral nutrition soon after surgery. The incidences of postoperative infections were examined in the EN and TPN groups of high-risk patients. RESULTS: In high-risk patients selected using a new discriminant formula, the infection rate was decreased from 73.1% in the TPN group to 53.3% in the EN group (NS). However, in cases in which enteral nutrition was initiated within 4 days after surgery, the infection rate dropped to 30%, a significant decrease (P < 0.03). In this prospective study, the infection rate of high-risk patients was markedly decreased and the overall infection rate was decreased significantly, to 21.4% from 47.4% in the retrospective study (P < 0.02). CONCLUSIONS: We conclude that early enteral nutrition after hepatectomy is helpful for preventing septic complications, especially in patients at high risk of infection as evaluated with our new formula.

Enteral Nutrition↗

PubMed2000

The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma.

BACKGROUND: Although surgical resection has produced better results than other therapies for local control of hepatocellular carcinoma (HCC), the long term results have not been satisfactory because of a low disease-free survival rate. The effects of preoperative transcatheter arterial chemoembolization (TACE) on improving disease-free survival of HCC after hepatectomy has remained controversial. METHODS: The current study was retrospective survey of 1725 patients who had hepatectomy for HCC between January 1990 and December 1995 and had follow-up data for 1457 cases. The follow-up rate was 84.5%. The significant prognostic factors were analyzed using a Cox proportional hazards survival model, and the disease-free survival was calculated by Kaplan-Meier estimation. Among 1457 cases, 120 patients underwent preoperative TACE and were divided into a one time TACE group, over two times TACE group, an effective group, and ineffective group. RESULTS: Multivariate analyses revealed significant prognostic factors as follows: preoperative TACE number, preoperative TACE effect, preoperative lesion number, intraoperative tumor thrombus, tumor size, tumor gross type, daughter nodules, vascular invasion, and postoperative alpha-fetoprotein value. Kaplan-Meier estimation showed that the 5-year disease-free survival rates of the over two times group, the one time group, and no TACE group were 51.0%, 35.5%, and 21.4%, respectively, and that the mean disease-free survival times of the three groups were 66.4, 22.5 and 12.5 months, respectively. The effective group had a 5-year disease-free survival rate of 56.8%, with a mean time of 90.1 months. CONCLUSIONS: Effective preoperative TACE may be one of the best methods, which can be clinically performed at present, for resectable HCCs including small HCCs for improving disease-free survival after hepatectomy. According to tumor size, range, location, hepatic function, and TACE effect, TACE can be performed 2-4 times preoperatively within 6 months.

Adolescent↗

PubMedDate not supplied

Hepatectomy of cavernous hemangioma with constitutional indocyanine green excretory defect.

The constitutional ICG excretory defect with marked ICG retention in spite of other normal hepatic functions has not been so rare in Japan. However, there is no previous report of hepatectomy in a patient with this disease. We describe a successful case of hepatectomy for cavernous hemangioma with this disease and use of technetium-99m diethylenetriaminepentaacetic acidgalactosyl-human serum albumin (99mTC-GSA) liver scintigraphy as the preoperative assessment of the liver functional reserve. In our case, ICGR15 was more than 55%, however, a modified receptor index obtained from 99mTC-GSA liver scintigraphy was normal. Left lateral segmentectomy of the liver was performed without any perioperative complications. Hepatectomy of patients with the constitutional ICG excretory defect is possible if modified receptor index value obtained from 99mTC-GSA scintigraphy is within the normal range.

Coloring Agents↗

PubMedDate not supplied

Liver regeneration after hepatectomy.

Following hepatectomy, liver "knows" when to start and when to stop growing, and thereby accurately regulates its mass. Partial hepatectomy triggers hepatocyte proliferation whereas excessive liver mass (transplant) is regulated by apoptosis. Liver regeneration mainly involves the activation of adult hepatocytes and possibly of liver precursor ("stem") cells. The multistep process of liver regeneration comprises at least 2 critical phases: the transition of the quiescent hepatocyte into the cell cycle (priming) and the progression beyond the restriction point in the G1 phase of the cycle. The priming phase is characterized by the expression of immediate early genes. Activation of protooncogenes in the immediate early gene response involves both transcriptional and post-transcriptional mechanisms. Activation of four transcription factors, NF kappa B, STAT3, AP-1, and C/EBP beta, causes secondary activation of multiple genes and plays an important role in the initiation of hepatic regeneration. The passage of primed hepatocytes through the cell cycle is characterized by the expression of cell cycle genes and requires growth factors. An equilibrium between stimulator and inhibitor genes of the cell cycle expressed after hepatectomy, may explain why the liver regeneration is a tightly regulated growth process. Based on the knowledge of the regulation of liver regeneration, several practical considerations and potential therapeutic strategies can be applied in humans with hepatic dysfunction due to liver resection.

Animals↗

PubMed2001

[Patient-controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy].

Postoperative delirium occurs frequently following major surgery, especially after hepatectomy. We hypothesized that better methods of postoperative pain control would decrease postoperative delirium. To clarify the magnitude of postoperative pain and incidence of postoperative delirium in hepatectomy patients, subjects received patient-controlled epidural analgesia (PCEA) using bupivacaine and fentanyl (Group P), or continuous epidural mepivacaine (Group E) following intraoperative epidural administration of morphine. The magnitude of postoperative pain was estimated by use of an analgesic adjuvant and delirium was classified as mild (insomnia, disturbance of sleepwake cycle), moderate (disorientation, hallucination), or severe (restlessness, confusion, agitation), based on the medical records. Analgesic adjuvant usage was less in Group P than in Group E, while the incidences of moderate and severe delirium were significantly less frequent in Group P than in Group E (35.7% versus 75.0%, and 14.3% versus 50.0% respectively). Moreover, less amount of antipsychotic drugs was given in Group P than in Group E. These results suggest that the better pain relief and patient satisfaction provided by PCEA contributed to a decrease in the incidence of delirium, because of continuous opioid administration and patient-control analgesia. We concluded that PCEA with bupivacaine and fentanyl can limit postoperative delirium following hepatectomy.

Aged↗

PubMed2001

[Effect of partial hepatectomy on the glycogen level in hepatocytes in the portal and central lobule zones in cirrhotically-changed rat liver].

Using cytophotometric method, the content of glycogen was studied in hepatocytes of the portal and central zones of a liver lobule in norm, in cirrhosis, and 1, 3, and 6 months after a partial hepatectomy of the normal and cirrhotic rat liver. As we showed earlier, glycogen content in cirrhotic liver hepatocytes rose 2-3-fold, along with obvious impairment of glycogen metabolic heterogeneity in these. In cirrhotic liver glycogen dominates in the central zone, whereas in norm more glycogen is observed in the portal one. The objective of this study was to find out to what degree a partial hepatectomy of cirrhotic liver may promote recovery of the metabolic glycogen heterogeneity in hepatocytes. Glycogen was determined in hepatocytes, using a quantitative variant of PAS-reaction on sections of the material obtained from serial supravital punctate liver biopsies. Glycogen amount in hepatocytes of different liver lobule zones was determined by an image analyzer technique that allows to bring together the cytophotometric analysis of the substance with its localization in a particular liver lobule. Results of these studies have shown that a partial hepatectomy of cirrhotic liver promotes restoration of the hepatocyte metabolic heterogeneity in the liver lobule.

Animals↗

PubMedDate not supplied

Clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer.

BACKGROUND/AIMS: Surgical resection of hepatic colorectal metastasis may produce long-term survival and cure; however, a significant proportion of patients will have intrahepatic and/or extrahepatic recurrence with a poor prognosis. The aim of this study was to define clinical predictors of recurrence site after hepatectomy in terms of stratifying patients for adequate adjuvant trials to improve the prognosis. METHODOLOGY: Clinical, pathologic, and outcome data for 70 consecutive patients undergoing hepatectomy for colorectal metastasis isolated to the liver were reviewed retrospectively, and all data were analyzed by the logistic multivariate regression model. RESULTS: Recurrence in the remnant liver was seen in 60% of patients, and recurrence in the lung was found in 34% of patients. Number of liver tumors was the only significant and independent predictor of recurrence in the remnant liver (P = 0.048). All patients with three or more tumors experienced recurrence. Location of liver tumors lying adjacent to the hepatic vein, which was confirmed by preoperative imaging techniques, was the only significant and independent predictor of recurrence in the lung (P = 0.020). CONCLUSIONS: Number and location of liver tumors would be the significant and independent clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer. This might be useful for justification and selection of effective adjuvant trials after surgery.

Colorectal Neoplasms↗

PubMedDate not supplied

Monocyte CD14 changes and endotoxemia after major hepatectomy.

BACKGROUND/AIMS: This study was designed to ascertain whether decreases in membrane CD14 (mCD14), the endotoxin receptor on the surface of the monocyte cell membrane, reflect the presence of endotoxemia, and whether endogenous endotoxemia is present after hepatectomy. METHODOLOGY: First, in cases with a definitive clinical diagnosis of endotoxemia, we determined the serum endotoxin level by the ES (Endospesy) method, from the percentage of cells positive for membrane CD14, from the CD14 fluorescence intensity (MFI-CD14), and from the quantification of soluble CD14 (sCD14); and calculated the diagnostic accuracy obtained with each. Next, in 13 cases of extended hepatectomy (in excess of lobectomy) the mCD14-positive rates were determined around the time of the operation, and compared with the clinical courses of infection foci, if any, and other findings. RESULTS: The diagnostic accuracy of endotoxemia obtained by ES, mCD14, MFI-CD14 and sCD14 were 77.3%, 95.5%, 86.7% and 66.7%, respectively, so that the highest was given by the positive mCD14 cell rate. Although no infectious complication was detected in any of the 9 patients in whom the mCD14-positive rates changed within the normal range, of the 4 patients in whom the mCD14-positive rates fell, 2 had cholangitis due to gram-negative bacilli, one who was infected by central vein catheterization, was thought to have exogenous endotoxemia; and the fourth, in whom no clear focus of infection was detected, ran a temperature of 38 degrees C (over 100 degrees F) of unknown origin for 16 days. In this last patient, gram-negative bacilli were detected in both the saliva and the gastric juice, and so endogenous endotoxemia was suspected. CONCLUSIONS: These results show that decrease in the mCD14-positive rate is more accurately diagnostic of endotoxemia than the endotoxin value obtained by the ES method, and was considered to be a definitive diagnosis of endotoxemia. In addition, from the reduction of the mCD14-positive rate after extended hepatectomy, it was considered that endogenous endotoxemia occurred in one case out of 13 (8%).

Endotoxemia↗

PubMed2000

Hepatectomy for huge primary liver cancer: report of 171 patients.

OBJECTIVE: To discuss the safety and feasibility of hepatectomy for huge primary liver cancer (PLC). METHODS: The effect of resection of huge PLC was examined retrospectively. Some problems about resection of huge PLC were discussed. RESULTS: In 171 patients with huge PLC undergoing hepatectomy, 2 (1.2%) died in one month after operation. The 1-, 2-, 3-, 5- and 10-year survival rates of the patients were 66.1%, 42.1%, 32.7%, 12.2% and 2.3%, respectively. The effect of prolonging survival time was significant. CONCLUSION: Hepatectomy for huge PLC is safe, feasible, and effective.

Adolescent↗

PubMedDate not supplied

Hepatectomy for metastases from non-colorectal and non-neuroendocrine tumor.

BACKGROUND: The role of hepatectomy for metastases from non-colorectal (NCR) and non-neuroendocrine (NNE) tumors has not been defined. We analyzed several factors of the primary tumor and liver metastases to clarify the prognostic determinants. PATIENTS AND METHODS: From 1990 to 1995, 33 patients underwent hepatectomy for metastases from NCR and NNE tumors. The primary tumors were gastric cancer in 9, biliary cancer in 7, pancreatic cancer in 6, breast cancer in 4 and miscellaneous tumor in 7 patients. RESULTS: The overall 5-year survival after hepatectomy was 12.1%. Morbidity and mortality rates were 21.2% and 9.1%, respectively. The liver metastases from breast cancer, unilateral liver metastases and curative resection of liver metastases were prognostic factors in univariate analysis. CONCLUSION: Resection of liver metastases from NCR and NNE tumors may offer prolonged survival for selected patients.

Adult↗

PubMedDate not supplied

Laparoscopic hepatectomy for benign liver tumors.

We describe our initial experience with videolaparoscopic hepatectomies. From November 1997 to May 1999, 6 female patients whose ages ranged from 36 to 71 years with hepatic benign tumors were submitted to laparoscopic hepatectomy. Three patients had hepatic adenomas, 1 non-parasitic cyst, 1 focal nodular hyperplasia and 1 hemangioma. The laparoscopy was performed under general anesthesia with a pneumoperitoneum of carbonic gas. The following were used: 0 degree and 30 degrees optics, 5, 10 e 12-mm trochars, a ring forceps, dissecting forceps, simple grasping forceps, curved scissors, mono- and bipolar cautery, endoscopic clip and vascular stapler. No ultrasonic scalpel or argonium coagulation were used. The surgical specimens were removed through a Pfannenstiel incision around 4-5 cm long, for a better anatomopathological evaluation. The surgical time ranged from 3 hours to 4 hours and 30 minutes. One patient had a prolonged ileus during the immediate postoperative period. Only a single patient had an abdominal drain. The time of hospitalization ranged from 2 to 7 days. No complications were observed in relation to the pneumoperitoneum. No deaths occurred in this series. In this way, laparoscopic hepatectomy may be an alternative approach in carefully selected patients.

Adenoma↗

PubMed2002

[The effect of postoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma].

OBJECTIVE: To evaluate postoperative transcatheter hepatic arterial chemoembolization (TACE) for improving the disease-free survival of HCC patients after hepatectomy. METHODS: 1 725 HCC patients were followed up after hepatectomy retrospectively. Of 1 457 patients who were followed-up completely, 209 had postoperative TACE. The 1 457 patients were divided into ten groups according to tumor thrombus, small HCC, capsular invasion, vascular invasion and cirrhosis. The disease-free survival was analyzed between subgroups of weather postoperative TACE was performed in every group. Software SAS 6.12 and EGRET package were used. Kaplan-Meier estimation was used to calculate the disease-free survival rates. RESULTS: There were no difference of the disease-free survival between the subgroups in no capsular invasion and in no hepatic cirrhosis groups. CONCLUSION: Postoperative TACE is helpful in improving the disease-free survival of HCC patients after hepatectomy except those with integrated tumor envelope or no hepatocirrhosis. It is important to prolong the long-term results of operation.

Adolescent↗

PubMedDate not supplied

Transparenchymal retraction maneuver: a simple technique in laparoscopic hepatectomy.

The performance of laparoscopic hepatectomy still presents technical problems. One of the main difficulties is the impossibility of directly grasping the liver during resection. To overcome this problem, we have begun using transparenchymal suture traction in laparoscopic hepatectomy. From January 2000 through August 2001, eight laparoscopic hepatectomies were performed using suture traction during parenchymal resection. The advantages of this technique include no leakage of pneumoperitoneum, no increased trocar hole, ability to repeat application to the liver from various directions, and better exposure of the transected line.

Hepatectomy↗

PubMedDate not supplied

Mesenteric lymph nodes status influencing survival and recurrence pattern after hepatectomy for colorectal liver metastases.

BACKGROUND/AIMS: We retrospectively reviewed our results with curative hepatic resection of metastases from colorectal carcinoma, and analyzed several factors of the primary tumor and liver metastases. METHODOLOGY: From 1988 to 1995, 90 patients underwent curative resection of colorectal liver metastases. The total mortality rate was 1.1%. Overall 5-year survival rate after hepatectomy was 37.9%. RESULTS: Mesenteric lymph node metastases from the primary tumor and the prehepatectomy serum carcinoembryonic antigen level were significant. In multivariate analysis, positive mesenteric lymph node was an independent prognostic factor. In the recurrent patterns, mesenteric lymph node metastases were associated with extrahepatic recurrence after hepatectomy. CONCLUSIONS: The prehepatectomy carcinoembryonic antigen level and mesenteric lymph node metastases of the primary tumor were the most important predictive factors for long survival after hepatectomy. Patients with these risk factors should be closely followed up with regard not only to the remnant liver but also extrahepatic organs.

Adult↗