Chikaharu Sakata

The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma.

The frequency of lymph node (LN) metastasis in patients undergoing surgery for hepatocellular carcinoma (HCC) has rarely been studied. We evaluated the clinicopathologic characteristics and outcomes of six patients with nodal metastases from HCC among a total of 504 patients who underwent hepatic resection for HCC in our department over a 16-year period. The nodal metastases were diagnosed preoperatively in two patients. The average diameter of the resected tumors was 7.8 cm and all were confirmed as poorly differentiated HCC. All of the six patients had intrahepatic metastatic nodules and five also had portal vein invasion. One patient underwent limited resection, and the other five underwent bisegmentectomy. All of the regional LNs were removed in one patient, while only enlarged LNs were removed in the other five. One patient died of postoperative liver failure and the others all died later of intrahepatic or nodal recurrence. Our findings suggest that the prognosis of patients with nodal metastasis from HCC is generally poor, even if hepatic resection with regional LN dissection is performed.

Case series of 17 patients with cholangiocarcinoma among young adult workers of a printing company in Japan.

An outbreak of cholangiocarcinoma occurred among workers in the offset color proof‐printing department at a printing company in Japan. The aim of this study was to clarify the characteristics of the patients with cholangiocarcinoma.

Adjuvant therapy after curative resection for hepatocellular carcinoma associated with hepatitis virus.

The outcome after curative resection for hepatocellular carcinoma (HCC) is still unsatisfactory because of the high rate of recurrence of HCC, including intrahepatic metastasis originating from the primary carcinoma and multicentric carcinogenesis after surgery. The rate of recurrence, particularly of multicentric carcinogenesis after surgery, is affected by persistent active hepatitis and hepatic fibrosis caused by chronic hepatitis B or C. In patients with hepatitis B virus (HBV)-related HCC, a high viral load is a strong risk factor for HCC recurrence. Nucleos(t)ide analogues improve the outcome after curative resection for HBV-related HCC. Interferon therapy improves the outcome after curative resection for hepatitis C virus (HCV)-related HCC by decreasing recurrence and preserving or improving liver function when treatment is successful. Low-dose intermittent interferon therapy has also been reported to be effective in suppressing HCC recurrence. New antiviral agents including protease or polymerase inhibitors are expected to be effective because these agents can eradicate HCV in most patients who receive such treatment.

Eosinophilic Enteritis Presenting as Acute Intestinal Obstruction: A Case Report and Review of the Literature

A 37-year-old man was admitted to our hospital complaining of severe abdominal pain and vomiting. His abdomen was distended, and there was diffuse tenderness and guarding in all four quadrants. Laboratory examinations revealed leukocytosis without eosinophilia. Abdominal radiograph revealed air-fluid levels in the small intestine. Computed tomography confirmed a dilatation of the small intestine and the presence of ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. A large amount of yellow transudate was present in the abdominal cavity. An area of induration in the ileum was identified about 40 cm from the ileocecal valve. The ileum proximal to the induration was dilated, and the site of obstruction seemed to be the indurated segment. A partial iliectomy was performed. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed. One year later, the patient was free of gastrointestinal symptoms. The relevant literature on eosinophilic gastroenteritis is discussed.

Changes in Laboratory Test Results and Diagnostic Imaging Presentation before the Detection of Occupational Cholangiocarcinoma

Changes in Laboratory Test Results and Diagnostic Imaging Presentation before the Detection of Occupational Cholangiocarcinoma: Shoji KUBO, et al. Department of Hepato‐Biliary‐Pancreatic Surgery, Osaka City University Graduate School of Medicine—

Effect of interferon therapy on first and second recurrence after resection of hepatitis C virus-related hepatocellular carcinoma

Aim:  Several investigators have shown that interferon (IFN) therapy can suppress the recurrence of hepatocellular carcinoma (HCC) after curative treatment. We investigated the effect of IFN therapy on the first and second HCC recurrence following hepatic resection of hepatitis C virus (HCV)‐related HCC.

Efficacy of preoperative portal vein embolization prior to major hepatectomy for patients with impaired liver function: A retrospective study

Hepatocellular carcinoma (HCC) is often associated with chronic liver disease, such as hepatitis or cirrhosis, and this association may limit the use of surgery as a therapy, and if surgery is pursued, may give rise to postoperative hepatic failure. We evaluated the outcome in patients with HCC given preoperative portal vein embolization (PVE) before they underwent major hepatectomy. After PVE, portal pressure increased significantly. Two weeks after PVE, both the volume of the non-embolized lobe and the 15-min indocyamine green retention rate (ICG R15) were significantly increased. The prognostic score, calculated on the basis of age, ICG R15, and the resection rate, was significantly decreased. The operative mortality rate was significantly lower in patients who underwent PVE before surgery than in patients who did not receive PVE. The cumulative survival rate of the PVE patients, even those with cirrhosis of the liver, was significantly higher. Prior PVE appears to allow more extensive major hepatectomy and to lessen the risk of this invasive surgery. However, patients in whom the portal pressure immediately after PVE was more than 30cm H2O and/or whose prognostic score exceeded 50 points developed postoperative hepatic failure. These features should be kept in mind when it is decided whether surgery is indicated. Nevertheless, preoperative PVE appears to be a beneficial procedure for patients undergoing major hepatectomy, particularly those with chronic liver disease.

Selection of Scale of Hepatic Resection for Small Hepatocellular Carcinoma Evaluated on the Basis of Recurrences Examined Retrospectively.

1993年末までの主腫瘍径2cm以下の小肝細胞癌 (肝癌) 切除82例を対象に, 術式と肝機能評価法, 予後との関係を検討した. 施行術式はHr2: 8例, Hr1: 11例, HrS: 20例, Hr0: 43例であり, 広範囲切除例の肝機能は良好であったが, 術式決定には術中の肝肉眼所見が最も重視されていた. 82例中39例が残肝再発したが, Hr2の予後は他の肝切除術式より良好であった. そこでHr2可能条件をICGR1515%以下, CS1, Z1以下と仮定すると, Hr2未満切除74例中12例がHr2可能例であったが, 再発は2例にすぎなかった. 逆にHr2未満施行で再発をきたした37例のうちHr2を行えば切除領域に再発病巣が含まれた症例は7例であったが, Hr2可能例は1例に過ぎなかった. 小肝癌に対する切除術式は再発からみると, 術前の肝機能成績および術中所見を考慮した現行の基準が適切であると考えられた.