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PubMedDate not supplied

Selection criteria for reduction hepatectomy in multiple advanced hepatocellular carcinoma.

BACKGROUND: Few studies have compared the prognostic impact of reduction hepatectomy (RH) for advanced hepatocellular carcinoma (HCC) with that of non-surgical treatment or curative hepatectomy. PATIENTS AND METHODS: The treatment outcome of 30 RH patients was compared to that of two control groups: control group A, including 71 patients who underwent curative hepatectomy; control group B, including 106 patients who did not receive definitive local therapy or best supportive care. RESULTS: In patients with tumor extension in >50% of the liver, 1-year survival rates for patients according to treatment (RH, control A and B) were 50%, 90% and 11% and 3-year survival rates were 42%, 60% and 0%, respectively. There was no significant difference between RH and control A, but there was a significant difference between RH and control B. CONCLUSION: RH could be recommended to patients with multiple advanced HCC extending to >50% of the whole liver.

Adult↗

PubMed1991

Hepatocyte growth factor (hepatopoietin A) rapidly increases in plasma before DNA synthesis and liver regeneration stimulated by partial hepatectomy and carbon tetrachloride administration.

An enzyme-linked immunosorbent assay was used to measure the level of hepatocyte growth factor in rat plasma at various times after two-thirds partial hepatectomy or CCl4 administration. An initial 17-fold rise and 13-fold rise in the level of hepatocyte growth factor was observed 2 hr after partial hepatectomy and CCl4 treatment, respectively, well before the onset of DNA synthesis in the liver. The peaks of DNA synthesis in remnant livers and livers exposed to CCl4 occurred at 24 hr and 48 hr, respectively, as determined by 5-bromo-2'-deoxyuridine labeling and [3H]thymidine uptake by the liver. A later peak level (17-fold above control) of hepatocyte growth factor at 24 hr after CCl4 treatment coincided with strong immunostaining of damaged or necrotic hepatocytes around central veins with an antibody to hepatocyte growth factor. This suggests a later intrahepatic origin of the signals for liver regeneration after hepatotoxic injury subsequent to the early extrahepatic production of hepatocyte growth factor at 2 hr after CCl4 administration. The absence of staining in the liver remnants in partially hepatectomized rats implies that the increase in hepatocyte growth factor seen in the plasma is caused by production at extrahepatic site(s). Possible sources include the pancreas, brain, thyroid and salivary glands, and Brunner's glands of the duodenum. Norepinephrine also increases in plasma as early as 2 hr after hepatectomy. In vitro, [3H]thymidine incorporation into hepatocyte DNA in the presence of hepatocyte growth factor is greater if 10(-5) mol/L norepinephrine is also present in the media.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

[Effect of LAK cells on liver regeneration after partial hepatectomy].

Lymphokine activated killer (LAK) cells can destroy not only tumor cells but also syngeneic regenerating liver cells. This study was started to determine the effect of passive transfer of LAK cells on liver regeneration after partial hepatectomy. C3H mice were received 70% hepatectomy and LAK cells were injected intravenously at a dose of 5 X 10(7) cells/body. After 36 hours, 3H-thymidine uptake into the residual liver was measured. LAK cells transferred group showed 31% suppression compared with control group. In vitro, 24 hours addition of LAK cells to the primary culture of regenerating liver cells caused 97% suppression of 3H-thymidine uptake at effector to target ratio, 50/1. Then we examined the effects of IL-2 administration on liver regeneration. Though IL-2 showed no effect on cultured liver cells, intraperitoneal administration of IL-2 after hepatectomy at a dose of 1 X 10(4)u/body 5 times every 8 hours brought 38% suppression of 3H-thymidine uptake of the residual liver. Cyclosporine A, which can suppress the IL-2 production of lymphocytes, promoted liver regeneration 45% over the control at a dose of 10 mg/kg. These results suggest that LAK cells could regulate liver regeneration.

Animals↗

PubMed1991

[Experimental study on metabolism of branched chain amino acids after partial hepatectomy].

Metabolism of branched chain amino acids (BCAA) after partial hepatectomy was investigated. Total amino acids of the plasma in the rats undergone 70% partial hepatectomy increased significantly as compared with those of control animals. This increase was due to an increase of sum of all amino acids other than BCAA, whereas total amount of BCAA was unaffected. Both BCAA aminotransferase (BCAA-AT) and branched chain ketoacid dehydrogenase (BCKA-DH), the rate limiting enzymes in BCAA metabolism, increased in mitochondria of the liver and BCAA-AT increased in skeletal muscle homogenate. These increases of both enzymes might reduce the concentration of BCAA relatively. Mitochondrial respiration such as state 3 respiration, respiratory control index (RCI) and ATP synthesis in mitochondria of regenerating liver increased remarkably, when not only succinate but also alpha-ketoisocaproic acid was used as a substrate. ATP synthesis, however, was much higher and mitochondrial respiration was more coupled when alpha-ketoisocaproic acid was used as a substrate. These results suggest that BCAA metabolism was activated after partial hepatectomy and BCAA might serve as an appropriate substrate for regenerating liver.

Amino Acids, Branched-Chain↗

PubMed1990

Liver regeneration after partial hepatectomy: effects of glucose and branched-chain amino acid.

The phenomenon of liver regeneration has been observed within several days after partial hepatectomy, though there is still much controversy as to its initiation, regulation, and the control factors behind it. Male Wistar rats weighing around 200 g were used as subjects in this study. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed. High glucose, low glucose, or high or low branched-chain amino acid (BCAA) solutions were given intravenously 2 days prior to the partial hepatectomy. The rats were sacrificed at 6, 24, 48, and 72 hours after the operation. Remnant liver weight, Deoxyribonucleic acid (DNA) content, DNA synthesis rate, and mitotic index were chosen as markers for comparing the effects of the glucose and branched-chain amino acid solutions on liver regeneration. The results were as follows: (1) following removal of two-thirds of a rat's liver, DNA synthesis increased abruptly, peaking at 24 hours, the mitotic index reached a maximum at 48 hours, and the remaining lobes had doubled in size by 48 hours and had attained around 90% of the normal liver weight at 72 hours; (2) judging by the results of the remnant liver weight, DNA content, and DNA synthesis rate, the low glucose infusion rates showed the worst regenerative condition; and (3) the only effect of BCAA on liver regeneration observed was that low BCAA infusion rates resulted in a lower DNA content in the remnant liver.

Amino Acids, Branched-Chain↗

PubMed1977

Experimental liver failure. A comparison between hepatectomy and hepatic devascularization in the pig.

Difficulties in the treatment of acute hepatic failure due to insufficient knowledge of the pathogenesis and the impredectability of the course has made an experimental model desirable. A number of such models have been proposed, among these hepatectomy and total hepatic devascularization. In the present study hepatectomy and total hepatic devascularization have been compared, as it has been doubted if hepatectomy, not including necrotic liver tissue, is a valid model of human hepatic failure. No significant difference was found in the survival time which was 16 h 2 min +/- 57 min in the anhepatic and 18 h 33 min +/- 1 h 5 min in the devascularized preparation. The blood pressure of the anhepatic preparation decreased gradually, in contrast that of the devascularized preparation remained stable during most of the experimental period with a terminal steep decrease. Except for an increase in serum alanin-aminotransferases and free hemoglobin, seen in the devascularized, but not in the anhepatic preparation, no differences between the two models were seen. It is concluded that the presence of necrotic tissue is of minor importance, but for technical reasons the devascularized preparation is the most suitable model for experimental hepatic failure.

Alanine Transaminase↗

PubMed1990

Effects of partial and sham hepatectomy on ornithine decarboxylase and thymidine kinase activities and mRNA contents.

Ornithine decarboxylase and thymidine kinase are enzymes that increase in activity in regenerating liver. We found that both activities and mRNA levels for these enzymes increase significantly after 70% partial hepatectomy in the rat. After sham hepatectomy (laparotomy) there were significant decreases in activity; however, mRNA content was unaltered. Similar decreases in enzyme activity, without changes in mRNA content, were found with pair-feeding, and additional decreases in activity after starvation. In contrast to previous reports of no change in ornithine decarboxylase and thymidine kinase after sham hepatectomy, the present results indicate that decreases occur. This may be mediated by the decrease in food intake after surgery. Dietary factors may be important in the physiologic regulation of these enzymes in the liver.

Animals↗

PubMed1989

Effect of the parenteral administration of energy substrates in different postoperation phases on the initiation and development of liver regeneration in rats subjected to partial hepatectomy.

DNA specific activity in the liver, the total DNA content of the liver and the mitotic index of the hepatocytes were studied after the infusion of glucose or lipid emulsions in female laboratory rats with a mean pre-operation weight of 250 +/- 30 g after partial (65-70%) hepatectomy (PH). The infusions were administered in the early prereplication phase (the 1st to 6th hour after the operation), in the late prereplication phase (the 7th to 12th hour after the operation), or continuously from the 1st to the 12th, or the 1st to the 24th, hour after partial hepatectomy. The effect of these parenterally administered energy substrates on the initiation of liver regeneration was evaluated 18 and 24 hours after partial hepatectomy. The results indicate that the infusion of glucose, in any interval after the operation, inhibited the initial phases of liver DNA synthesis (18 h after PH), but not its further development (24 h after PH). Neither the mitotic index of the hepatocytes, nor the total DNA content of the liver differed from the control groups in the case of rats given a glucose infusion. In the experimental groups given lipid emulsions, inhibition of liver DNA synthesis was recorded 18 h after PH only when the infusions were given from the 1st to the 12th or the 1st to the 18th hour after PH. The total DNA content of the liver 18 h after PH was raised in all the experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1989

Surgical treatment of adrenal metastasis following hepatectomy for hepatocellular carcinoma.

In three patients who underwent hepatectomy for solitary hepatocellular carcinoma (HCC), adrenal metastases, on the right sides of two patients and the left side of the third were subsequently detected by ultrasonography (US) and/or computed tomography (CT), and successfully resected after an average interval of 16 months from hepatectomy. There were no metastatic lesions in the lung, lymph node or bone. Two patients, however, who were found to have metastasis in the right adrenal also had multiple small recurrent foci in the residual liver. The latter were controlled by arterial embolization therapy and the patients are alive at 12 and three months post-adrenalectomy. In the other patient, with left adrenal metastasis, the serum alphafetoprotein level of 3,000 ng/ml returned to normal and he is doing well three and a half years after adrenalectomy. Since there is no effective therapy for metastatic adrenal HCC after hepatectomy, surgery would appear to be indicated, should no other distant metastasis be recognized clinically.

Adrenal Gland Neoplasms↗

PubMed1989

[Measurement of portal blood flow in man by a continuous local thermodilution method. III. Effects of dopamine on systemic and portal hemodynamics after hepatectomy].

We gave dopamine (3 micrograms/kg/min, 30 min) intravenously on the third day after hepatectomy to 19 patients, and studied the effects of the drug on systemic and portal hemodynamics. In another 42 patients, administration of dopamine at the same rate was started soon after hepatectomy and continued for about 2 weeks; the clinical results were evaluated. After hepatectomy, the systemic hemodynamics were hyperdynamic and the portal hemodynamics were hypodynamic. After 30 min of dopamine administration, the oxygen pressure in portal blood increased, and because portal blood flow also increased, the oxygen delivery to the liver increased. The mechanism involved an increased proportion of portal venous flow to cardiac output, and a decrease in the splanchnic resistance, not portal venous resistance. Probably, specific dopamine receptors played important role in the increase in the superior mesenteric arterial blood flow. Among 42 patients given small dosage of dopamine, the clinical symptoms of five of seven who had developed liver failure improved. None of the other 35 patients given dopamine preventively developed liver failure. Dopamine in small doses is useful for the management of liver failure after liver resection.

Adult↗

PubMed1989

[The role of splenectomy in patients with hepatocellular carcinoma and hypersplenism as an aid to hepatectomy].

To evaluate the clinical value of splenectomy for hepatic resection, a total of 20 patients with hepatocellular carcinoma and hypersplenism were examined focusing on a change of total serum bilirubin values after surgery. Both hepatectomy and splenectomy were simultaneously performed in 12 patients, and in 8 patients as a staged operation. Postoperatively, a significant depression of bilirubin values was observed in a group with the preoperative values between 1.0mg/dl and 2.0mg/ml. Three factors (bilirubin, albumin and prothrombin time) in clinical stage were improved just after splenectomy with a statistical significance (p less than 0.05) in a group received staged operation. In 7 out of 8 patients, clinical stages were getting better as one or two stages prior to the hepatectomies. Therefore, we recommend the addition of splenectomy to hepatectomy in the patients whose hyperbilirubinemia are assumed to be correlated with coexisting hypersplenism.

Adult↗

PubMed1989

[Improving early and late results of hepatectomy for HCC].

The present study reports how we indicate safe and beneficial hepatectomy for hepatocellular carcinomas from the experiences of the consecutive 335 patients treated during 1973 and Dec. 1988. The first question was to appreciate the preoperative prediction of a safe limit of hepatectomy. We established a multiple regression formula consisting of several factors such as CT estimated resection rate, ICG retention rate and patient's age at the end of 1980. Since the beginning of 1981, we have been employing the formula as a major indicator guiding treatment option, leading to a significant drop of postoperative, liver failure. The influencing prognostic factors have been determined to be vascular invasion, intrahepatic metastasis, extent of resection regulated by hepatic reserve and tumor size in the decreasing order. From the viewpoint of the biological aspect, the tumors with DNA diploid pattern showed significantly better prognosis than those with non-diploid ones. The current surgical techniques of hepatectomies with en-bloc ligation of Glisson's vessels or with vascular exclusion supported by veno-venous bypass have greatly encouraged the recent surgical results achieving 56% of 4-year survival rate (1985-1988).

Carcinoma, Hepatocellular↗

PubMed1989

[Is the ultrasonic dissector an advance? Apropos of 70 hepatectomies].

The aim of this retrospective study was to determinate whether the ultrasonic dissector (U.S.D.) is a major advance over existing methods in hepatic surgery. Between 1983 and 1989, we performed 70 hepatectomies "réglées". Twenty seven patients were operated because of benign lesions and 43 patients because of malignant tumours. Transparenchymal approach using "Kellyclasy" or digitoclasy with control of the hilar vessels was carried out 39 times. U.S.D. was used 31 times. No mortality was observed during operating time or post-operative period. The postoperative morbidity was not attributable to the use of the U.S.D. On the whole, U.S.D. has modified neither the amounts of blood loss nor the duration of hilar clamping. However the use of U.S.D. presents 3 advantages: it allows sometimes to perform hepatectomy without pedicular clamping, it makes easy the transparenchymal approach of the large vascular and biliary structures, and it is useful in hydatic cyst surgery. Although the U.S.D. is not indispensable to carry out hepatectomy, it improves intraparenchymal control of vessels and biliary ducts, making therefore hepatic resection easier.

Constriction↗

PubMed1989

[Synchronous hepatectomy and exeresis of primary tumor of the colorectum].

Personal experience of 6 hepatectomies at the some time as primary colorectal tumour excision is reported. Like most Italian and foreign Authors, the paper stresses the negligible mortality and morbidity after this double surgery. Moreover, in these particular patients, it was never necessary to postpone hepatectomy. Finally, emphasis is placed on the importance of intraoperative echography for the identification of micrometastasis in one or two lobes, for the correct staging of the primary tumour and for oncologically appropriate hepatectomy.

Adenocarcinoma↗

PubMed1988

[A new technic of hepatectomy using peroperative echography and intraparenchymatous guide needles. The geometer technic].

A new technique of hepatectomy is described, using intra operative ultrasound and dental cleaner needle. The needle is inserted in the liver under ultrasonographic guidance, in order to mark the vessel which feed the tumor. Then the trans-section of the liver begins near the needle and the contact of its hip allows an elective ligation of the vessel. Thus the hepatectomy is performed safely along the ischaemic line of the subsegment bearing the tumor. The needle have been also used to mark the adjacent segmental portal vein and the hepatic vein which have to be secured during the operation. We have done 12 hepatectomies in cirrhotic patients with this technic without any complication.

Aged↗

PubMed1987

[Sensitivity of rat hepatocytes to phenobarbital after a single dose of N-nitrosodiethylamine in the embryonal and postnatal period or after partial hepatectomy].

For the hepatocarcinogenesis initiation one-fold N-nitrosodiethylamine (NDENA) action upon the livers of embryos and of the 4-weeks rats, before or after partial hepatectomy was used. Phenobarbital and repeated partial hepatectomies were used as the promotive factors. The promotion effect was evaluated by the quantity and size of hyperplastic liver nodules, where gamma-glutamyltranspeptidase activity was revealed. It was determined, that NDENA-affected rat liver cells in the embryonic period or at the age of 4 weeks after single partial hepatectomy proved to be more sensitive to the action of promoters.

Animals↗

PubMed1985

Effect of branched chain amino acids on liver regeneration after partial hepatectomy.

The authors investigated the effect of the enrichment of commercial amino acid solutions with branched chain amino acids on the development of liver regeneration. Partial (65-70%) hepatectomy was performed on male Wistar rats (140-160 g body weight). Starting with the day of the operation, amino acid solutions normally used in clinical practice and the same solutions enriched with branched chain amino acids were administered by stomach tube; 24, 48 and 96 h after the operation the animals were decapitated. The onset of DNA synthesis was found to be more rapid in animals given the enriched solutions. Once regeneration had started, the stimulant effect of an increased supply of branched chain amino acid on liver regeneration was smaller. Nevertheless, even in the later phase after partial hepatectomy branched chain amino acids had a stronger stimulant effect on liver regeneration after partial hepatectomy than an energy supply in the form of sorbitol.

Amino Acids, Branched-Chain↗

PubMed1986

Effect of the activation of macrophages on the course of regeneration of rat liver following partial hepatectomy.

Stimulation of the Kupffer cells with E. coli endotoxin (the purified lipopolysaccharide) or with prodigiosan (a polysaccharide from Serratia marcescens) 24 h before partial hepatectomy (resection of 65-70% of the liver) stimulated and intensified the onset of liver regenerative activity (evaluated from changes in liver DNA synthesis, the H5 labelling index and the mitotic activity of the hepatocytes). Liver DNA synthesis increased together with the dose of endotoxin (i.v., from 25 to 1000 micrograms/kg body weight). If E. coli endotoxin was injected during or 3 h after partial hepatectomy, partial inhibition of liver DNA synthesis was observed. In mice stimulated with zymosan (a polysaccharide isolated from yeast), administered 5 days before performing partial hepatectomy, proliferation of the hepatocytes (evaluated from changes in the 3H labelling index and in the mitotic activity of the hepatocytes) was evaluated. The results confirm that proliferation is correlated to the state of reactivity of the Kupffer cells.

Animals↗