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PubMed1994

Interleukin-6 as a marker of hepatic metabolism following hepatectomy.

This study evaluated the clinical significance of interleukin-6 levels after hepatectomy. Thirty-one patients who underwent hepatectomies were examined. Perioperative data involving serum laboratory tests, serum concentrations of interleukin-6, and liver energy status as indicated by arterial ketone body ratio (AKBR) were analyzed. In each patient, the maximum concentration of interleukin-6 in the postoperative course (IL-6-M) was observed by the 2nd postoperative day. IL-6-M correlated significantly with the maximum concentration of total bilirubin and with the postoperative decrease in AKBR. IL-6-M also correlated with the duration of surgery and blood loss, but no relationship with aminotransferase was found. We conclude that after hepatectomy IL-6-M may be a marker for the metabolic status of the liver as well as operative stress, and is useful because it can be evaluated in the early postoperative period.

Aged↗

PubMed1994

The effect of hepatectomy and plasma cholinesterase inhibition on cocaine metabolism and cardiovascular responses in pigs.

To determine the effects of total hepatectomy and inhibition of plasma cholinesterase activity on cocaine metabolism, we measured plasma concentrations of cocaine and its three major metabolites, benzoylecgonine, ecgonine methyl ester, and norcocaine, by high-performance liquid chromatography in three groups of male pigs. Pigs were anesthetized with sodium thiopental and lungs were ventilated with nitrous oxide in oxygen. A right carotid arterial cannula and an internal jugular venous catheter were then inserted for the administration of cocaine and for blood sampling. A Swan-Ganz catheter was inserted through the right internal jugular vein. Group 1 pigs underwent sham operation; group 2 and 3 pigs underwent hepatectomy and portocaval shunt. In addition, group 3 pigs were treated with tetraisopropyl pyrophosphoramide, a specific plasma cholinesterase inhibitor. After this preparation, pigs were given 4 mg/kg cocaine intravenously over 2 minutes. After cocaine injection, 4 ml blood was collected into heparinized test tubes containing 2.5% sodium fluoride for determination of cocaine and its metabolites at 2, 5, 10, 15, 30, 45, 60, 90, 120, 180, 240, and 300 minutes. We also measured hemodynamic responses after cocaine administration, including heart rate and rhythm, cardiac output, and arterial blood pressure. Data were analyzed by analysis of variance. Blood levels of cocaine and its metabolites were significantly different among the three groups (p < 0.05 by analysis of variance). Our results show that total hepatectomy was associated with a marked slowing of cocaine metabolism, absence of norcocaine, and increased benzoylecgonine levels when compared with the baseline values in the control pigs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Surgical management of large hepatocellular carcinomas: criteria for curative hepatectomy.

This study was designed to determine the criteria for curative resection in hepatectomy for large hepatocellular carcinoma. The extent of resection was closely related to recurrence rate, and complete removal of the involved segments was found to be essential for curative hepatectomy. Patients with satellite nodules had a high incidence of recurrence; in fact, carcinoma recurred in all patients, with satellite nodules scattered through more than one segment, despite whole tumor removal. However, curative resection could be achieved in patients with portal involvement confined to the second portal branches, when the tumor, including tumor thrombi, was removed en bloc. On the basis of these results, we define complete en bloc removal of the involved segments, including portal involvements, as curative resection, even though curative hepatectomy is not attainable in patients with satellite nodules in more than one segment and/or tumor thrombi in the first branches or truncus of the portal vein.

Carcinoma, Hepatocellular↗

PubMed1994

Autologous blood transfusion for hepatectomy in patients with cirrhosis and hepatocellular carcinoma: use of recombinant human erythropoietin.

BACKGROUND: We evaluated the benefit of autologous blood transfusion and the effect of recombinant human erythropoietin (rh-EPO) on preoperative autologous blood donation for hepatectomy in patients with cirrhosis. METHODS: Forty-two patients with cirrhosis and hepatocellular carcinoma underwent hepatectomy, 21 of whom (group A) donated autologous blood before operation. Eleven of these patients (group A1) were administered rh-EPO before operation, and ten patients (group A2) were untreated. Twenty-one patients (group B) did not donate autologous blood. RESULTS: The frequency of homologous blood transfusion was 24% in group A and 62% in group B (p < 0.05). Preoperative erythropoiesis increased markedly in group A1, and postoperative erythropoietin production was not suppressed in this group. Postoperative hematocrits recovered significantly more rapidly in patients transfused with only autologous blood. Postoperative serum total bilirubin concentrations were significantly higher in patients with transfused homologous blood. CONCLUSIONS: Autologous blood transfusion yields clinically superior results for hepatectomy in patients with cirrhosis when compared with homologous transfusion. Preoperative rh-EPO administration minimizes presurgical decreases in hematocrit caused by autologous blood donation.

Adult↗

PubMed1993

Transforming growth factor-alpha expression during liver regeneration after partial hepatectomy and toxic injury, and potential interactions between transforming growth factor-alpha and hepatocyte growth factor.

Transforming growth factor-alpha and hepatocyte growth factor are important stimulators of hepatocyte proliferation. In this series of experiments we sought to measure the expression of transforming growth factor-alpha mRNA by hepatocytes in response to toxic liver injury produced by carbon tetrachloride or galactosamine and to perform a more detailed analysis of transforming growth factor-alpha expression after partial hepatectomy. We also explored the interactions of transforming growth factor-alpha and hepatocyte growth factor in their effects on hepatocytes in vitro and tested the ability of these factors to stimulate endogenous transforming growth factor-alpha production by hepatocytes. In previous work we have used oligonucleotide probes to measure transforming growth factor-alpha mRNA expression after partial hepatectomy. In this study we used a rat transforming growth factor-alpha cDNA probe and found that the level of liver transforming growth factor-alpha mRNA increases 4 hr after partial hepatectomy, shows peak expression at 18 hr and returns to the normal level by 36 to 48 hr. Measurement of the corresponding peptide in the liver by means of radioimmunoassay shows that the level of transforming growth factor-alpha rises by 12 hr, peaks at 24 hr and remains significantly increased at 48 hr compared with the levels in sham-operated rats. Carbon tetrachloride and galactosamine are known to produce different patterns of acute liver injury, with maximal hepatocyte DNA synthesis at 48 hr and 5 days, respectively. After carbon tetrachloride administration the profiles of the transforming growth factor-alpha and hepatocyte growth factor mRNA expression are similar, each showing two peaks: the first at 12 hr and the second at 48 hr. In contrast, after galactosamine-induced liver injury the expression patterns of transforming growth factor-alpha and hepatocyte growth factor mRNAs differ: hepatocyte growth factor shows a major peak at 24 hr, with a smaller increase at 5 days, whereas transforming growth factor-alpha begins to increase after 2 days, with a single peak occurring at 5 days. In primary hepatocyte cultures, transforming growth factor-alpha and hepatocyte growth factor appear to have complementary effects. The maximal hepatocyte nuclear labeling index induced by hepatocyte growth factor was 42%; the addition of transforming growth factor-alpha increased this to 74%. Exogenous transforming growth factor-alpha, but not hepatocyte growth factor, stimulates the production of the transforming growth factor-alpha peptide by hepatocytes.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1993

Serum levels of transforming growth factor-alpha in patients after partial hepatectomy as determined with an enzyme-linked immunosorbent assay.

A sandwich enzyme-linked immunosorbent assay for measuring serum transforming growth factor-alpha levels was developed with monoclonal IgM and polyclonal IgG antihuman transforming growth factor-alpha antibodies and a system to amplify the activity of the conjugated enzyme. The assay detected serum transforming growth factor-alpha levels as low as 5 pg/ml. Serum transforming growth factor-alpha levels were below the detection limit of the assay in 19% of healthy adults, with a mean (+/- S.D.) detectable level of 22.0 +/- 16.7 pg/ml. In 13 patients who underwent partial hepatectomy, serum transforming growth factor-alpha levels were determined serially after surgery. The levels were increased within 28 days of surgery in all the patients, with a mean maximal level of 118.2 +/- 90.8 pg/ml. The maximal level achieved in each case correlated significantly with the resected volume of the liver and the increased volume of the remaining liver 28 days after hepatectomy (r = 0.59, p < 0.05, and r = 0.71, p < 0.005, respectively). In contrast, serum transforming growth factor-alpha levels showed no increase after laparotomy for nonhepatic surgery. Serum transforming growth factor-alpha levels may vary depending on the regenerative stimulus and reflect the degree to which liver regeneration will occur in patients after partial hepatectomy.

Enzyme-Linked Immunosorbent Assay↗

PubMed1993

The significance of post-hepatectomy changes in polymorphonuclear elastase and endotoxin levels.

We studied the association between polymorphonuclear elastase and endotoxin levels and complications following hepatectomy. The blood concentrations of polymorphonuclear elastase, endotoxin, fibrinogen and C-reactive protein were examined with the aim of clarifying their involvement in postoperative complications in twenty-five patients who underwent hepatectomy. Polymorphonuclear elastase increased significantly (p < 0.01) on the second postoperative day compared with preoperative levels, and decreased on the seventh postoperative day. The difference in the polymorphonuclear elastase level with and without liver cirrhosis was significant (p < 0.05) on the second postoperative day. Endotoxin changed in a manner similar to polymorphonuclear elastase, but no positive correlation was found between endotoxin and polymorphonuclear elastase. Neither parameter showed any significant positive correlation with the volume of hepatic resection. We were unable to find any relationship between the degree of elevation of endotoxin and complication after hepatectomy; further study will be needed.

Endotoxins↗

PubMed1993

Donor hepatectomy for living related partial liver transplantation.

BACKGROUND: An essential prerequisite for living related partial liver transplantation is to perform donor hepatectomy with minimal risk while preserving graft viability. This article describes a safe method of donor hepatectomy that was used for five patients who underwent living related liver transplantation. METHODS: Liver parenchymal transection was performed by the selective vascular occlusion technique in four patients, and interruption of the blood supply to the left medial segment was carried out along the right side of the umbilical portion before parenchymal division in the other patient. RESULTS: These procedures resulted in insignificant intraoperative blood loss, for which no banked blood or blood derivatives were transfused. The postoperative course for each of the five donors was uneventful, and excellent graft viability was verified by the fact that the five recipients showed a good immediate postoperative course without marked increases in the serum activities of liver enzymes. CONCLUSIONS: We believe that the operative risk of living related donor hepatectomy is minimal if it is performed by experienced liver surgeons with the present procedures.

Adult↗

PubMed1995

In vivo amino acid fluxes in regenerating liver after two-thirds hepatectomy in the rat.

BACKGROUND/AIMS: Recent reports in the literature suggest that liver cell swelling following amino acid influx exerts anabolic and anti-catabolic effects. We have tested the possibility that rapid liver growth after partial hepatectomy is promoted by an increased amino acid-influx and that this is associated with an increased hepatic water content and a decreased rate of proteolysis. METHODS: Two-thirds hepatectomy was performed in rats. Plasma liver flow and amino acid fluxes were measured after 24 or 48 h. RESULTS: Plasma liver flow was increased 24 and 48 h after partial hepatectomy or sham-operation in pair-fed animals. At these time points, in both groups there was a specific two- to threefold increased net hepatic uptake of the amino acids alanine and glycine, both being transported by the sodium-coupled amino acid transport system A/ASC. No changes in uptake of system N transported amino acids were observed. Both in partially hepatectomized and sham-operated pair-fed animals, the hepatic uptake of alanine and glycine was accompanied by a minor increase in tissue water (from 68 to 70%). Proteolysis, measured by leucine efflux, was only reduced in regenerating livers. CONCLUSIONS: We conclude that cell swelling is not an important factor in the stimulation of net protein synthesis during liver regeneration.

Amino Acids↗

PubMed1995

[Utility of acetated Ringer solution as intraoperative fluids during hepatectomy].

We used acetated Ringer (AR) and lactated Ringer (LR) solutions as an intraoperative fluid during hepatectomy and evaluated their effects on intraoperative and postoperative hemodynamics, metabolism, blood gas and renal as well as liver functions. Twenty patients scheduled for hepatectomy were divided into two groups according to the type of infused solution, AR or LR. The infusion rate was 15 +/- 2 ml.kg-1.min-1 with the first 500 ml and thereafter reduced to 10 +/- 2 ml.kg-1.min-1. Intraoperative serum lactate levels increased significantly in both groups. However, the level of lactate in the LR group (48.6 +/- 16.4 mg.dl-1) was significantly higher than in the AR group (29.1 +/- 14.3 mg.dl-1) at the end of the operation. D-lactate level was significantly higher in the LR group than in the AR group during the operation. Although acetate level increased significantly during the operation in the AR group, it decreased to the normal range at the end of the operation. There were no significant differences in the other parameters between the two groups. These results suggest that AR may be more useful in hepatectomy than LR as an intraoperative fluid.

Adult↗

PubMed1996

The effect of hypothermic perfusion with oxygenated perfluorochemical during in situ extended hepatectomy of canine liver.

BACKGROUND: An oxygen supply is necessary to maintain the energy metabolism of hepatic cells even at low temperatures in total hepatic vascular exclusion (THVE). Little has been written regarding the effect of an oxygenated perfusate for hypothermic perfusion in THVE, required for extended hepatectomy. STUDY DESIGN: Adult mongrel dogs (n=15) were used. Total hepatic vascular exclusion with active venovenous bypass was maintained for 60 minutes and 75 percent of the liver was resected. The LR group (n=7) was perfused using a 4 degrees C Ringer's lactate solution, and the FC43 group (n=8) with 4 degrees C oxygenated perfluorochemical. Blood samples from the hepatic vein were collected in order to measure alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), purine nucleoside phosphorylase (PNP), and NH(3). RESULTS: At every sampling point after hepatectomy, the serum AST levels of hepatic venous blood were significantly lower (p<0.05) in the FC43 group than in the LR group. Serum ALT, LDH, and PNP levels were significantly lower (p<0.05) in the FC43 group than in the LR group immediately after reperfusion. Plasma NH(3) levels were significantly lower (p<0.05) in the FC43 group than in the LR group, 30 minutes and two hours after reperfusion. CONCLUSIONS: Hypothermic perfusion using oxygenated perfluorochemical prevents hepatic cell damage during in situ extended hepatectomy.

Animals↗

PubMedDate not supplied

A refined method of trans-thoracoabdominal hepatectomy for cirrhotic patients with hepatocellular carcinoma.

A hepatectomy in cirrhotic patients with hepatocellular carcinoma, located in either the posterior or superior part of the right lobe, inevitably requires a forced mobilization of the right lobe. Such a forced procedure causes a decreased hepatic blood flow resulting in postoperative morbidity and mortality, as well as an increased risk of the intrahepatic dissemination of cancer cells during the operation. We have thus refined the method of trans-thoracoabdominal hepatectomy to minimize those demerits of conventional transabdominal hepatectomies. The main characteristics of our refinements are as follows; (1) an optimal incision for the best short-cut to the hepatocellular carcinoma is determined by a three-dimensional imaging of either helical computed tomography and/or magnetic resonance imaging before operation; (2) a complete view of the operative field is obtained by the pertinent use of rotating the operation table, on which the patient is placed in a left semi-lateral position; (3) this method is suitable for resecting a tumor located in the posterior segment such as a posterior segmentectomy. This refined method is considered to decrease the postoperative morbidity including post-operative hepatic dysfunction and is also useful for cirrhotic patients with hepatocellular carcinoma.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Factors influencing survival after hepatectomy for peripheral cholangiocarcinoma.

BACKGROUND/AIMS: Radical resection for patients with peripheral cholangiocarcinoma is rare. Prognostic factors related to survival with peripheral cholangiocarcinoma after hepatectomy have not yet been reported. MATERIALS AND METHODS: Of 41 hepatectomized patients with peripheral cholangiocarcinoma, a computer analysis of 14 clinicopathological factors on patients survival was performed with univariate and multivariate analysis. RESULTS: Median and mean survival times for patients with peripheral cholangiocarcinoma after hepatectomy were 12.0 and 22.8 months. The 1-, 2-, 3-, 4- and 5-year survival rates were 53.7%, 39.0%, 36.6%, 26.8%, and 26.8% respectively. Univariate analysis of overall survival involving all patients identified 7 factors that were associated with a significantly outcome: mucobilia (p = 0.043), capsular invasion (p = 0.007), tumor spreading type (p = 0.0003), section margin (p = 0.001), histologic type (p = 0.008), macroscopic and microscopic vascular involvement (p = 0.031), and lymphatic invasion (p = 0.004). With multivariate analysis using the COX stepwise proportional hazards model, only mucobilia, tumor spreading type and section margin were significantly related to prognosis. CONCLUSIONS: Intrahepatic bile duct carcinoma patients with mucobilia, intraductal papillomatosis and a tumor-free margin after hepatectomy had a better prognosis.

Bile Duct Neoplasms↗

PubMed1996

[Bacterial translocation induces remnant liver injury after subtotal (90%) hepatectomy in rats--the effect of decontamination of gram-negative rods in digestive tract by oral polymyxin B treatment].

To clarify the relationship of bacterial translocation (BT) to remnant liver injury after subtotal (90%) hepatectomy, we compared orally polymyxin B treated rats (PL-B (+)), of which gram-negative rods (GNR) in digestive tract decreased, with control rats (PL-B (-)). The increase in intestinal permeability assessed by lactulose/mannitol ratio in urine, the increase in GNR positive in tissue culture including mesenteric lymphnode, liver, spleen, portal blood, and kidney, and the elevation of serum endotoxin levels showed BT after subtotal hepatectomy in PL-B (-) group. Liver injury was also observed by increased serum GPT levels and massive coagulative necrosis of hepatocytes with bleeding in the remnant liver. In PL-B (+) group rats, BT and liver injury decreased and hepatocyte DNA synthesis increased, while intestinal permeability was the same as PL-B (-) group. It is suggested that BT is the cause of remnant liver injury after subtotal hepatectomy, and oral PL-B treatment is effective in preventing liver injury.

Administration, Oral↗

PubMedDate not supplied

The effect of spleen volume on liver regeneration after hepatectomy--a clinical study of liver and spleen volumes by computed tomography.

BACKGROUND/AIMS: The relationship between liver regeneration and spleen volume after partial hepatectomy was studied with computed tomography (CT) in 13 patients with chronic liver disease (chronic active hepatitis: 2, pre-liver cirrhosis: 3, liver cirrhosis: 8). MATERIALS AND METHODS: Liver and spleen volumes were measured by abdominal CT before hepatectomy and 1 and 2 years after operation, and the percent volumes of the liver and spleen of abdominal capacity were compared. RESULTS: While the residual liver volume increased in all patients after 1 year, it continued to increase in 7 patients (percent recovery: 102 +/- 4.8%) but had decreased in 5 patients (90.0 +/- 4.8%) after 2 years. The mean spleen volume 2 years after hepatectomy was 2.8 +/- 0.9% in the former, and 6.0 +/- 1.2% in the latter. The percent increase in liver volume was inversely related to the spleen volume (r = -0.707). In a case of transcatheter splenic arterial embolization, the liver volume continued to be increase despite splenomegaly. CONCLUSION: Splenic volume is suggested to be related to the process of recovery of the liver.

Carcinoma, Hepatocellular↗

PubMed1997

[A new two-part therapy for multiple bilobar liver metastases of colorectal cancer--treatment of one lobe with partial hepatectomy and the other with arterial chemotherapy].

We studied a new two-part therapy for patients of multiple (more than five) bilobar liver metastases from colorectal cancer, in which one lobe is treated with partial hepatectomy and the other with arterial chemotherapy. The patient was a 72-year-old woman who had undergone sigmoidectomy and partial hepatectomy on March 9, 1995, for advanced sigmoid cancer with liver metastasis. In December 1995, new foci were detected in the remaining liver. Intraoperative echography during reoperation revealed 6 foci in the right lobe, 2 in the left lobe and 1 in the caudate lobe. During reoperation, we performed partial hepatectomy at the left lobe metastases and microwave coagulation in the caudate lobe. A catheter was inserted into the right hepatic artery, and the right hepatic artery was ligated with the catheter. From 2 weeks after operation, CDDP (20 mg) and 5-FU (1,500 mg) were given weekly by infusion from the arterial root. As a result, the serum CEA level fell to 3.6 ng/ml on June 26, 1996, and 1.9 mg/ml on August 14, 1996. A right lobectomy would have been performed if no metastasis appeared in the remainder of the left lobe over a one-year period. However, no foci were detected on a CT scan on March 26, 1997. This new two-part therapy warrants detailed investigation for bilobar bilateral liver metastases of colorectal cancer.

Aged↗

PubMedDate not supplied

Laparoscopic partial hepatectomy.

This article describes the surgical techniques and indications of laparoscopic partial hepatectomy, which is not as widely available as laparoscopic cholecystectomy. Three patients with hepatocellular carcinoma and associated severe liver cirrhosis were candidates for this technique from July 1993 to August 1994. The tumor size was 4 cm or less and all the tumors were located in segment 5 or 8 which had grown nodularly and protruded from the liver surface. A microwave tissue coagulator was used for parenchymal dissection under ultrasonographic guidance in a gas-less method with or without low-pressure pneumoperitoteum of 4 mmHg. The principle of dissection consists of tissue coagulation and fragmentation with dissecting forceps. Three hepatectomies were performed uneventfully without blood transfusion and the patients rapidly returned to their preoperative conditions. The laparoscopic partial hepatectomy can be an option of treatment in selected cases where the tumor can be removed by minor, superficial resection.

Carcinoma, Hepatocellular↗

PubMed1998

Liver cell proliferation after partial hepatectomy in rats with liver metastases.

OBJECTIVE: To validate proliferating cell nuclear antigen (PCNA) expression and flow cytometry as proliferation markers in regenerating rat liver containing metastases. STUDY DESIGN: Rats containing colorectal liver metastases were killed at various days after 70% partial hepatectomy or a sham operation. [3H]thymidine and 5-bromo-2'deoxyuridine (BrdU) incorporation, PCNA expression and flow cytometry were used to evaluate liver cell proliferation. RESULTS: The assessment of proliferating liver cells by PCNA expression and BrdU incorporation was more reliable than autoradiography. PCNA expression correlated well with BrdU incorporation (r = .68, P = .003) and autoradiography (r = .57, P = .02) in regenerating liver. BrdU incorporation and PCNA expression were higher in hepatectomized rats as compared to sham-operation rats at days 1-4 after hepatectomy. Flow cytometry of propidium-stained nuclei from livers of hepatectomized rats showed a higher proportion of S-phase nuclei as compared to S-phase nuclei in control rats. The correlation coefficients of the number of S-phase nuclei, BrdU-positive nuclei and PCNA-positive nuclei were .39 (P < .02) and .56 (P < .0005), respectively. CONCLUSION: Flow cytometry and PCNA expression are simple and reliable methods of studying proliferation in metastases containing rat liver after partial hepatectomy.

Animals↗