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PubMedDate not supplied

The effect of beta-blocker on intractable ascites in cirrhotic patients undergoing hepatectomy for hepatocellular carcinoma.

BACKGROUND/AIMS: Intractable ascites is one of the serious complications after hepatectomy. Only little is known about their effect on postoperative ascites in patients with liver cirrhosis although beta-blockers have been used for cirrhotic complications including ascites. METHODOLOGY: Here, we report five cases of intractable ascites after hepatectomy, which were treated by propranolol (1 mg/kg/body). RESULTS: In three patients, plasma renin activity and aldosterone concentrations were markedly increased before propranolol administration, but fell to normal levels thereafter. Ascites subsided in all subjects except one, who developed cardiac dysfunction. CONCLUSIONS: Beta-blockers might be a promising drug for intractable ascites in cirrhotic patients undergoing hepatectomy.

Aged↗

PubMedDate not supplied

The effect of trimetazidine on liver regeneration after partial hepatectomy under hepatic blood inflow occlusion.

BACKGROUND/AIMS: It has been shown that hepatic blood inflow occlusion impairs liver regeneration. Our aim in this study was to investigate the effect of trimetazidine, known as an anti-ischemic and anti-oxidant agent, on liver regeneration after hepatic blood inflow occlusion. METHODOLOGY: Sprague-Dawley rats were randomized into three groups. Rats in group 1 underwent 65% hepatectomy. Rats in group 2 and 3 were subjected to 15 minutes of hepatic blood inflow occlusion during 65% hepatectomy. Rats were treated with saline (in group 1 and 2) or trimetazidine (in group 3) 30 minutes before operation. Serum level of aspartate transaminase, wet to dry liver weight ratio, and liver injury score in light microscopy were studied for the evaluation of liver injury. Liver regeneration was evaluated by PCNA-labeling index (the percentage of hepatocytes staining for proliferating cell nuclear antigen), mitotic index (the percentage of mitotic hepatocytes), and liver regeneration rate (the percentage of initial liver weight). RESULTS: Rats in group 2 and 3 had significantly higher serum aspartate transaminase level, wet to dry liver weight ratio and injury score than those in group 1 on day 1 posthepatectomy. Except for serum aspartate transaminase level on day 4, these parameters were significantly higher in group 2 than in group 1 and 3 on day 1 and 4. PCNA-labeling index and mitotic index were significantly less in group 2 and 3 than in group 1 on day 1. In contrast to liver regeneration rate, both indices in group 2 were significantly less than those in group 3 on day 1. There were no differences in regeneration parameters between the groups on day 4. Survival rate was significantly higher in group 3 than in group 2. CONCLUSIONS: Fifteen minutes of hepatic blood inflow occlusion caused an injury in the remnant liver, impaired liver regeneration, and decreased survival rate after partial hepatectomy. However, pretreatment with trimetazidine reduced liver injury, and improved liver regeneration and survival rate. For situations where hepatic blood inflow occlusion is planned in major liver resection, trimetazidine pretreatment would be useful strategy to improve postoperative outcome.

Animals↗

PubMedDate not supplied

Hyperamylasemia after hepatectomy in chronic liver disease patients.

BACKGROUND/AIMS: Postoperative hyperamylasemia after hepatectomy occurs frequently, but the mechanism is not clear. METHODOLOGY: We studied the postoperative evaluation of 11 patients with hyperamylasemia after hepatectomy (Hyper-Amy group), compared with 35 patients without hyperamylasemia (Norm-Amy group), in terms of preoperative features, intraoperative findings or procedures, postoperative management and complications, parameters for pancreatitis, and comparisons in serum amylase and lipase levels between patients with chronic liver disease and those with normal livers. RESULTS: In preoperative features, viral infection and chronic liver disease presented much more in the Hyper-Amy group than in the Norm-Amy group, and indocyanine green 15-minute retention rate was higher in the Hyper-Amy group than in the Norm-Amy group. There were no significant differences in the intraoperative findings or procedures, or postoperative management and complications between the two groups. In parameters for pancreatitis, the serum amylase and lipase levels were higher in the Hyper-Amy group than in the Norm-Amy group on days 3, 7 and 14. In comparison, between patients with chronic liver disease and normal livers, the serum amylase levels were higher in patients with chronic liver disease than in patients with normal livers on days 7 and 14. CONCLUSIONS: We should pay attention to the incidence of hyperamylasemia after hepatectomy in patients with chronic liver disease, so we can give rapid treatment for pancreatitis.

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PubMedDate not supplied

The role of preoperative phenylalanine breath test in hepatectomy.

BACKGROUND/AIMS: The phenylalanine breath test may serve as a liver function test, although its clinical usefulness has never been clarified. This study aimed to evaluate the role of preoperative phenylalanine breath test in patients undergoing hepatectomy. METHODOLOGY: Twenty-seven patients undergoing hepatectomy were studied. The PBT30 (phenylalanine excretion ratio at 30 min) was measured after oral administration of 100 mg of L-[1-(13)C]-phenylalanine. Postoperative mortality and morbidity were compared with the value of PBT30, ICGR15 (plasma retention rate of indocyanine green at 15 min), Child-Pugh score, and other blood chemical tests together with operative factors. Independent factors contributing to postoperative mortality and morbidity were evaluated by multiple logistic regression analysis. RESULTS: Postoperative mortality and morbidity rates were 0 and 25.9%, respectively. PBT30 and ICGR15 values were significantly different between the groups with and without postoperative complication, and these two parameters independently contributed to prediction of postoperative complication. CONCLUSIONS: PBT30 is a clinically useful predictor for postoperative complication in patients undergoing hepatectomy.

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PubMed1992

[Therapeutic value of hepatectomy and transcatheter arterial embolization (TAE) for hepatocellular carcinoma].

Therapeutic value of hepatectomy and TAE was evaluated retrospectively in 150 hepatectomized and 117 non-hepatectomized patients of hepatocellular carcinoma (HCC). Operative death was seen in 5 patients. Cumulative 5 years survival rate and disease free cumulative 5 years survival rate of the 145 hepatectomized patients were 35.4 per cent and 23.6 per cent respectively. These survival rates were significantly affected by tumor size, intrahepatic metastasis (IM) and vascular invasion (Vp). But the influences of tumor margin (TW) and curative resection (relative curative or relative non-curative) were slight. Ninety-two patients (69:dead, 23:alive) had tumor recurrences. TAE was performed in 56 out of 92 patients effectively and 2 years survival rate was 31.5 per cent. Overall cumulative 5 years survival rate of non-hepatectomized patients was 6.6 per cent, but this group showed a more reduced hepatic reserve and more advanced tumor stage. Six patients treated by TAE survived more than 4 years. Hepatectomy is a first option for the treatment of HCC since complete cure may be estimated. However, because of operative risk and higher recurrence rate, use of current multidisciplinary treatment including TAE is necessary for the prognostic improvement of HCC with or without hepatectomy.

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PubMed1992

Rat liver regeneration after partial hepatectomy: effects of insulin, glucagon and epidermal growth factor.

This study evaluated the role of insulin, glucagon and the epidermal growth factor (EGF) on liver regeneration after partial hepatectomy. Male Wistar rats, weighing approximately 200 g, were used. A partial hepatectomy, with resection of the medial and left lateral lobes (67.31%), was performed on the control group and seven hormone-treated groups: insulin, glucagon, EGF, insulin plus glucagon, insulin plus EGF, glucagon plus EGF, and a combination of the three hormones. The hormones were administered subcutaneously two days prior to the partial hepatectomy. The groups administered insulin were allowed to drink 20% glucose in water. Another group of rats received simulated operations, i.e., only a laparotomy was performed. The rats were killed at six, 24, 48 and 72 hours after the operation. Remnant liver weight, deoxyribonucleic acid (DNA) content, rate of DNA synthesis, mitotic index, blood glucose and serum insulin levels were measured. The results showed that: 1) the effects of single hormone administration on posthepatectomy liver regeneration were not obvious; 2) combined administration of insulin and glucagon increased the weight of the remnant liver, the DNA content, and the rate of DNA synthesis; 3) the combined administration of insulin, glucagon, and EGF increased the regeneration based on the remnant liver weight and mitotic index; and 4) there was no concordance between the change in blood glucose levels and the effect of hormones during liver regeneration.

Animals↗

PubMed1992

[The effect of carnitine on the early phase of liver regeneration after partial hepatectomy in rats with experimental diabetes].

The effect of intraperitoneally administered carnitine (10 or 100 mg/kg) on the early stage of liver regeneration after two-third hepatectomy was studied in rats with experimentally induced alloxan diabetes (60 mg/kg IV). The level of regeneration was assessed mainly on the basis of DNA synthesis in the liver. Untreated diabetic rats exhibited significantly lower values of DNA synthesis determined 24 hours after hepatectomy. Administration of carnitine resulted in a significant increase in DNA synthesis over the given time interval. The stimulatory effect of carnitine in diabetic rats was confirmed also by the recorded values of serum lipids, particularly by the decreased concentration of triacylglycerols and the increased concentration of HDL-cholesterol, as determined in carnitine treated diabetic rats 24 hours following partial hepatectomy. (Tab. 2, Fig. 3, Ref. 34.)

Animals↗

PubMed1992

Serum amino acid levels and hepatic protein synthesis during liver regeneration after partial hepatectomy in rats.

The time courses of changes in serum concentrations of free amino acids and in hepatic protein synthesis during liver regeneration after partial hepatectomy were studied in rats. Hepatic protein synthesis was significantly higher 3, 5 and 7 days after partial hepatectomy than it was in sham-operated control rats, but there was no such difference 14 days after surgery. Serum total amino acid level was significantly higher in partially-hepatectomized rats than in control rats 3 days after surgery, and thereafter decreased slowly. By 7 days after surgery there was no significant difference between the two groups. Serum concentrations of threonine, serine, proline, histidine, tyrosine, methionine, ornithine and citrulline were significantly higher than in the control group 3 days after partial hepatectomy, and the concentrations of proline, histidine, tyrosine, methionine and ornithine were still high 5 days after surgery. In contrast, concentrations of branched-chain amino acids did not change.

Amino Acids↗

PubMedDate not supplied

Evaluation of postoperative nutritional state after hepatectomy for hepatocellular carcinoma.

BACKGROUND/AIMS: In spite of many technical advances in liver surgery, optimal nutritional support after hepatectomy has not been established. METHODOLOGY: We clarified the actual nutritional state in 16 patients with total parenteral nutrition (TPN group), and 16 patients without total parenteral nutrition (PPN group), after hepatectomy for hepatocellular carcinoma without biliary tract reconstruction, in terms of preoperative clinical data, intraoperative indexes, postoperative management and complications, liver function data, nutritional state, and changes in metabolic parameters. RESULTS: There were no significant differences in any occurrences of postoperative complications, liver function data, or nutritional parameters between the two groups. On the other hand, the TPN group needed more doses of insulin than the PPN group. The beginning of each water and food intake was earlier in the PPN group than in the TPN group. The blood glucose level was higher in the TPN group than in the PPN group. The serum sodium and chloride levels were lower, but the serum potassium level was higher, in the TPN group compared to the PPN group. Thus, problems such as hyperglycemia and serum electrolyte abnormalities were more conspicuous in the TPN group than in the PPN group. CONCLUSIONS: In the actual clinical care after hepatectomy for hepatocellular carcinoma without biliary tract reconstruction, in which oral feeding is started early, total parenteral nutrition is considered unnecessary.

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PubMed2003

Pre-ligation of afflicted hepatic inflow and outflow blood vessels of lesioned liver lobe during hepatectomy.

OBJECTIVE: To compare the merits of hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned liver lobe with those of Pringle's maneuver. METHODS: A total of 68 patients were divided into two groups A and B. In the group A (n=38), Pringle's maneuver was employed, whereas in the group B (n=30), hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver was used. Peri-operative blood loss, postoperative bleeding and drainage, time of liver function recovery as well as incidence of postoperative complications were compared between the 2 groups. RESULTS: The mean perioperative blood loss, the mean amount of postoperative bleeding and drainage, the time of liver function recovery as well as incidence of postoperative complications were significantly higher in the group A than in the group B (P<0.01). CONCLUSION: Hepatectomy after pre-ligation of the hepatic inflow and outflow blood vessels of the lesioned side of the liver is superior to Pringle's maneuver.

Adult↗

PubMed2002

Hepatectomy in the treatment of very big primary liver cancer: report of 86 cases.

OBJECTIVE: To study the indications for resection of very big primary liver cancer and the operative results. METHODS: From January 1985 to June 1996, 86 patients with very big primary liver cancer (>/= 15 cm in diameter) underwent hepatectomy in our hospital. The volume of bleeding and blood transfusion was recorded during the operation. After the operation, the draining quantity from their abdominal cavities, and the days of transfusion and hospitalization were recorded. The occurrence of complications and survival time of the patient were followed up. RESULTS: The postoperative mortality was 3.48% and the occurrence rate of complications was 31.40%, which was significantly correlated with preoperative lower level of serum albumin or the elevated gamma-globulin level and the amount of resected liver tissue. But their liver function before operation was fairly good, the 1-, 3-and 5-year survival rates after hepatectomy were 58.2%, 35.7% and 17.64%. CONCLUSIONS: patients with very big primary liver cancer, should be subjected to hepatectomy if their liver function before operation are normal and the margins are distinct between the tumor and liver tissues. After the operation, other treatments are suitable for good effects.

Adult↗

PubMed2002

Hepatectomy for patients with huge primary liver cancer in Hubei Province of China.

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 in resection of huge PLC were discussed. RESULTS: Of 375 patients with huge PLC undergoing hepatectomy, 11 (2.9%) died in one month after operation. The 1-, 2-, 3-, 5-and 10-year survival rates of the patients were 63.3%, 45.6%, 34.7%, 16.5% and 1.8%, respectively. The effect of prolonging survival time was significant. CONCLUSION: Hepatectomy for huge PLC is safe, feasible, and effective.

Adult↗

PubMed2003

[The role and significance of retrohepatic tunnel and the liver hanging tape passed through the tunnel in difficult hepatectomies].

OBJECTIVE: To explore the role and significance of liver hanging tape passed through the retrohepatic tunnel developed by dissecting the tissue plane between anterior surface of the inferior vena cava (IVC) and caudate lobe, in order to be substitute for control of in- and out-flow blood vessels in difficult hepatectomies. METHODS: Retrohepatic tunnel was developed by dissecting the anterior surface of the retrohepatic portion of the IVC, 7 difficult hepatectomies were performed with the use of liver hanging tape and hemostatic plate. RESULTS: Liver hanging tape was placed successfully in 7 cases. VIII segmentectomy, right hemihepatectomy, left hemihepatectomy and right trilobectomy plus complete caudate lobectomy were performed, there was no complication related to this maneuver. CONCLUSION: It is feasible for placing liver hanging tape through the retrohepatic tunnel. In addition, it has extensive indications and minimal influence on hemodynamic response. It is a better way for the difficult hepatectomy and for harvesting the liver graft in living related liver transplantation.

Adolescent↗

PubMed2004

[Partial hepatectomy with skeletonization of the hepatoduodenal ligament for hilar cholangiocarcinoma].

OBJECTIVE: To sum up author's experience and to define the role of partial hepatectomy with skeletonization resection in the treatment of hilar cholangiocarcinoma. METHODS: Between January 1999 and December 2001, 67 patients underwent exploration in our hospital. The clinical records of these patients were reviewed. RESULTS: Sixty-five (97%) patients underwent surgical resection. Forty-nine patients (73%) had curative resection [22 skeletonization resection (SR), and the other 27 undergone SR combined with partial hepatectomy]. According to the Bismuth-Corlett classification, tumors were classified into four types. SR was performed in type I (5 cases) and type II (17 cases). Right lobectomy with right caudate lobectomy was performed in type IIIa (6 cases), left lobectomy with left caudate lobectomy in type IIIb (15 cases). Right lobectomy with whole caudate lobectomy (3 cases), left lobectomy with whole caudate lobectomy (9 cases), and quadrate lobectomy (2 cases) were undertaken in type IV. We successfully did SR and left lobectomy with whole caudate lobectomy in 2 patients (3%) who had suffered palliative biliary cancer resection and cholangiojejunostomy before. Eight patients (12%) had local resection of the tumor with Roux-en-Y hepaticojejunostomy reconstruction and intrahepatic bile ducts support. Two patients (3%) had palliative biliary drainage. Combined portal vein resection was performed in 13 (20%) patients and hepatic artery resection in 27 (40.3%). Twenty-four (35.8%) patients had no postoperative complications, and 20 (30.2%) patients developed major complications. Of the 20 patients with major complications 14 recovered; the remaining 6 patients died of liver-renal failure with other organ failure or of heart attack, intraabdominal bleeding, and gastrointestinal bleeding in 7, 12, 14, 42, 57, or 89 days after surgery. Thirty days operative mortality was 4.5%. The median survival of patients with curative resection was 16 months (ranging from 1 to 41 months), while the median survival with palliative operation was 7 months (ranging from 1 to 16 months). CONCLUSIONS: Partial hepatectomy with skeletonization resection for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality. For curative treatment of hilar cholangiocarcinoma, Caudate lobectomy is always recommended in Bismuth type III/IV.

Adult↗

PubMedDate not supplied

Prevention of bile leak after major hepatectomy.

BACKGROUND/AIMS: Bile leak remains a serious complication after major hepatectomy. The usefulness of external biliary drainage to prevent intraperitoneal bile leak was studied. METHODOLOGY: Thirty-nine patients who underwent major hepatectomy from April 1997 through June 2000 were studied. The bile leak test was performed to identify and close leaks following the resection. Patients who still had leakage underwent retrograde transhepatic biliary drainage (RTBD) via a tube inserted through a choledochostomy. Patient's backgrounds, incidence of bile leak, and time until resolution of bile leak were compared between patients who did and did not have an RTBD tube placed. RESULTS: Nineteen patients had an RTBD tube (48.7%). Bile leak developed in 4 patients with the tube (21.1%), and in 4 patients without the tube (20.0%) (not significant). However, the time until resolution of bile leak was 13.3 days for patients with the tube and 51.3 days for patients without the tube (p<0.05). Two patients developed local peritonitis when the tube was removed. CONCLUSIONS: Though some patients had bile leakage even with the RTBD tube, use of the RTBD tube decreased the length of time leakage that occurred. RTBD tube drainage should be done routinely with major hepatectomy.

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PubMed2004

[Hand-assisted laparoscopic partial hepatectomy in the treatment of primary liver cancer].

OBJECTIVE: To explore the techniques of hand-assisted laparoscopic partial hepatectomy and its clinical value in the treatment of primary liver cancer. METHODS: Six patients with primary liver cancers in the segments II, III, V, VI and on the edge of the liver received laparoscopic partial hepatectomy assisted by special instruments such as hand-assisted devices, harmonic scalpel, and Endo-GIA. RESULTS: All of the 6 operations were completed successfully, in which resections of both II and III segments, VI segment, and non-regular segment were performed. The operative time was 54 to 130 min and postoperative hospital stay 6-9 days, with intraoperative blood loss of 150-700 ml. No conversion to laparotomy was needed, nor did any complications occur. Postoperative follow-up lasted for 6 to 15 months, during which relapse occurred in 2 cases 3 months and 4 months after the operations respectively, while no recurrence has been found in the other 4 patients. CONCLUSION: Hand-assisted laparoscopic partial hepatectomy is safe and feasible for primary liver cancer in clinically selected patients.

Adult↗

PubMed2004

[Mechanism of liver failure after hepatectomy].

Liver failure after hepatectomy is caused by many factors such as excessive hepatectomy, ischemic-reperfusion injury, postoperative infection, etc. However, apoptosis of hepatocytes is the most important event in the molecular mechanism of liver failure. Liver failure after excessive hepatectomy is characterized by increased apoptosis of hepatocytes and diminished liver regeneration. The former is induced by hypercytokinemia and hyperendotoxemia, and the latter is caused by cell cycle arrest. In ischemic-reperfusion injury of the liver, the apoptosis of hepatocytes is caused by activation of the MMPT and calpain system that are induced by the intracellular accumulation of Ca. The possible mechanism of liver failure in cases with persistent infection is the inhibition of liver regeneration and the induction of apoptosis of hepatocytes due to transforming growth factor-beta 1. The knowledge of these mechanisms will lead to prompt and appropriate treatments for individual patients.

Animals↗

PubMedDate not supplied

Low mortality major hepatectomy.

BACKGROUND/AIMS: A retrospective series of major hepatectomy using a simple strategy. METHODOLOGY: From 1995 to 2002, 104 major hepatectomies were performed, including 16 extended and 35 right/left lobectomies, 11 bisegmentectomies, and 42 left lateral segmentectomies. Seventy-two patients had malignant tumors. Chronic hepatitis was present in 9 and mild to severe cirrhosis in 16 of 47 hepatocellular carcinomas. Intrahepatic duct stone constituted 28 of 32 patients with benign disease. Hilar ligation without pedicle clamp for lobectomy and Pringle's maneuver for segmentectomy were initially our standard procedures. Since 1997, Chang's needle was applied on 34 patients to block hepatic inflow and outflow by entire thickness, interlocking mattress sutures. RESULTS: Three patients (2.9%) died postoperatively. Of the two cholangiocarcinoma patients, one underwent extended right lobectomy and died of multiple organ failure and the other underwent left lateral segmentectomy and died of AMI unrelated to the surgery. One hepatocellular carcinoma patient underwent left lateral segmentectomy and died of hepatic failure. Significant complications (11.5%) included three bile leaks (2.9%), six abscesses (5.8%), one hepatic failure (1%), one ileus (1%), and one ventral hernia (1%). One major bile leak necessitated a reconstructive surgery. CONCLUSIONS: Our strategies for hepatic resection are simple, however we are able to achieve a low mortality major hepatectomy.

Carcinoma, Hepatocellular↗