Eisuke Kawamura

Prognostic factors after hepatectomy for hepatocellular carcinomas. A univariate and multivariate analysis

The current study determines the prognostic factors after hepatectomy for hepatocellular carcinomas. The 295 patients who underwent hepatectomy from 1973 through 1987 were included for a univariate and a Cox multivariate analysis. The favoring conditions were determined as follows. The essential requirements are (1) the absence of tumor thrombi; (2) no intrahepatic metastasis, but even when present, it should be close to the main tumor and removed with a massive resection; and (3) retention rate of indocyanine green dye (ICG) at 15 minutes should be within 14 ± 4.2% (M ± SD) to allow that resection. The desired requirement is that the tumor size should preferably be less than 5 cm; a wider free margin from tumors (⩾ 1 cm) is recommended, but not determining factor. The eligible patients, having no thrombi, no intrahepatic metastasis, a tumor size of 5 cm or less, negative surgical margin (⩾ 1 cm), had achieved a 5‐year survival of 78%. In conclusion, resection therapy is the first option for patients with those requirements.

Contribution of the portal flow on hepatic tissue perfusion increases in reduced hepatic vascular bed

Background: A hepatic artery-portal vein reciprocal response and hepatic hemodynamics have well been investigated under normal condition, but not under pathologic condition with decreased vascular bed. This study was designed to determine the hemodynamic changes in the hepatic blood flow, tissue perfusion and interrelationship between portal venous flow (PVF) and hepatic arterial flow (HAF) after inflow interruption in the various size of hepatic vascular bed. Methods: Anesthetized dogs were used to measure PVF and HAF using a transit time flow meter and hepatic tissue flow (HTF) using a laser Doppler flow meter before and after portal venous (PVO) or hepatic arterial occlusion (HAO) under various range of portal triad occlusion (PTO). Results: The ratio of HAF/TLF (total liver flow) was 38+/-14% under the basal condition. This ratio did not change under the 30% PTO where there was a similar decrease in PVF and HAF, but reduced to 25+/-12% under the 70% PTO where there was more selective reduction in HAF than PVF. Although a reciprocal HAF increase was observed under any conditions after PVO, the TLF and HTF decreases after PVO were largest under the 70% PTO with the highest PVF/TLF ratio. On the other hand, there was no reciprocal PVF increase in any conditions after HAO, and the TLF and HTF decreases after HAO were minimal under the 70% PTO with the lowest HAF/TLF ratio. Conclusions: With decreasing hepatic vascular bed, dependency of the remnant hepatic hemodynamics and tissue perfusion on the portal blood flow increased. These findings suggest that an integrity of portal venous flow becomes crucial in the remnant hepatic tissue perfusion after extensive hepatic resection.

Determinants of long-term survival following hepatectomy for hepatocellular carcinoma, with special reference to patients surviving more than 10 years

To elucidate the determinants of survival and the clinicopathologic features of long-term survivors of resections for HCC, we reviewed 539 patients who had had hepatectomy alone or hepatectomy together with hepatic arterial ligation or ethanol injection for the treatment of hepatocellular carcinoma (HCC) at our department between 1973 and December 1992. Of these patients, 30% (79/264) survived for more than 5 years and 11% (10/87) for more than 10 years. All the long-term survivors had received curative resections. The 5- and 10-year survivors accounted for 58% (79/136) and 29% (10/35) of those with curative resections, respectively. Crucial determinants for long-term survival were the absence of portal invasion and satellite nodules, a diploid pattern of DNA content, and a curative resection. A curative resection for diploid HCCs led to much better survival rates (73%) at 5 years than such a resection for aneuploid HCCs (35%), and than for non-curative resections for aneuploid HCCs (0%). The history and tumor background of the ten patients who survived for more than 10 years were characterized by good reserve liver function, warranting a wider resection, predominance of female sex, single nodular growth, and the absence of poorly differentiated cells, in addition to the favorable conditions described above. Three of the ten patients developed a new lesion; these were successfully treated by re-resection or repeated arterial embolization, since they were confined to the remnant liver and showed single nodular growth without extranodular spread. This analysis indicates that hepatectomy is the option of first choice for HCC patients with the potential for cure and good reserve liver function.

Successful Kasai operation for biliary atresia in a 9 month old

A rare case of a successful Kasai operation for biliary atresia in a 9 month old is described. For infants over 6 months of age, there had been no reports of long-term survival after this procedure.

Indication Criteria of Hepatectomy for Hepatocellular Carcinoma Based on Long-Term Result

The current study reports what patients with hepatocellular carcinoma can get a potential cure and good quality of life from hepatectomy based on the long-term results. 504 hepatectomized patients from 1973 through 1992 were used. The survival rate of curative resections was 24% at 10 years in contrast to 0% at 7 years. Crucial factors determining curability and prognosis were degree of portal invasion (Vp) and intrahepatic metastasis (IM), and nuclear DNA content (diploidy vs. aneuploidy). No Vp and IM were found in 72% of 66 patients who survived more than 5 years, and diploidy HCCs accounted for 89% of them. Single nodular type of HCC less than 5 cm in size and well reserved liver functions allowing a wide resection, in whom are definite indication of hepatectomy.

Intratumor Pressure in Hepatocellular Carcinoma

Intratumor pressure and hepatic tissue pressure were measured intraoperatively in 50 patients with hepatocellular carcinoma. Changes in these pressure were monitored before and after individual occlusion of the proper hepatic artery and the portal vein. Our result indicated that intratumor pressure was regulated predominantly by hepatic arterial blood flow, and increased with tumor capsular formation. In contrast, hepatic tissue pressure was regulated predominantly by portal blood flow, and increased with portal vein pressure.