Junichi Mikuni

Therapeutic significance of palliative operations for gastric cancer for survival and quality of life.

Background and Objectives: There have been few reports on the objective assessment of quality of life (QOL) in patients with gastric cancer following palliative operations. The benefit of a palliative operation for survival and QOL of patients with gastric cancer is not clear.

Mitotic Index Is the Best Predictive Factor for Survival of Patients with Resected Hepatocellular Carcinoma

Background: In patients with hepatocellular carcinoma (HCC), tumor recurrence is not infrequent after resection. It is presumed that characteristics of the tumor such as cellular malignancy might influence the prognosis of the patients in association with tumor stage and radicality of the procedure. Methods: Univariate and multivariate analyses were used to retrospectively determine the clinicopathologic factors potentially related to survival in 40 patients who underwent hepatectomy for HCC. Results: In univariate analysis, tumor stage I or II, mitotic index of 4 or less/10 random high-power fields, solitary tumor, and curative resection were significantly correlated with better survival. In multivariate analysis, the mitotic index and surgical curability were independently significant variables influencing survival of patients, and the mitotic index was the best predictive factor. A highly significant correlation was found between the mitotic index and Ki-67 labeling index. Compared to tumors with a mitotic index of 4 or less, those with a mitotic index of 5 or more had a higher association with multiple tumors and advanced tumor stage, which preclude curative resection. Conclusion: Analysis of the mitotic index is quite simple, and the mitotic index could be a useful factor for predicting the long-term survival of patients with HCC following hepatic resection.

Prediction of recurrence and extratumor spread of hepatocellular carcinoma following resection

The prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy depends mostly on tumor recurrence. Portal vein invasion (Vp) and intrahepatic metastasis (IM) might strongly reflect the invasiveness of HCC, but the number of patients in the present series in whom either of these factors were detected was small. In this study, we defined Vp and IM as the extratumor spread, and we focused on the relationship between recurrence in patients after hepatectomy and the extratumor spread and the mitotic activities of cancer cells, in the hope that careful monitoring of recurrence might be possible by simply analyzing histology of the resected specimens.

Palliative operation for cancer of the head of the pancreas: significance of pancreaticoduodenectomy and intraoperative radiation therapy for survival and quality of life.

Abstract. The benefits of a palliative operation and intraoperative radiation therapy (IORT) for survival and quality of life (QOL) of patients with cancer of the head of the pancreas are not clear. Survival and hospital-free survival (HFS), which are considered to be objective indicators of QOL, were studied in 13 patients who underwent palliative pancreaticoduodenectomy (PD) and 32 patients who underwent surgical bypass. Although there was no significant difference in the survival of patients who underwent PD or bypass (median survivals of 9 months and 7 months, respectively), HFS for 3 months or longer was achieved in 84.6% of the patients who underwent PD, which was significantly higher than that of the 53.1% in patients who underwent surgical bypass (p < 0.05). Among TNM stage III patients, a significant difference in survival was observed between surgical bypass associated with IORT and bypass alone (p < 0.05); the median survival time of the IORT group was 10 months, whereas that of the control group was 5 months. In addition, HFS of 3 months or longer was achieved in 83.3% of patients who underwent bypass with IORT but in only 25.0% of the patients who underwent surgery alone (p < 0.01). The addition of IORT to palliative PD neither prolonged survival nor improved HFS. These results show the beneficial effect of palliative PD on QOL, and the efficacy of IORT for survival and QOL was proved in cases with stage III pancreatic cancer who underwent surgical bypass. For patients subjected to palliative PD, however, IORT is not thought to be beneficial for either survival or QOL.

Hepatectomy Using an Ultrasonically Activated Scalpel for Hepatocellular Carcinoma

Background: The first retrospective studies were performed to compare the efficacy of the ultrasonic cavitational aspirator (aspirator group) and the ultrasonically activated scalpel (scalpel group) for hepatic resection in patients with hepatocellular carcinoma. Patients and Methods: The aspirator group consisted of 8 patients (6 with liver cirrhosis and 2 with chronic hepatitis in the nontumorous liver), and the scalpel group of 7 patients (6 with liver cirrhosis and 1 with chronic hepatitis). All patients underwent limited hepatic resection, and the intermittent Pringle maneuver was applied during hepatic transection. Results: There were no significant differences in preoperative hepatic function, type of hepatectomy, tumor size and maximum cross-sectional area of the resected specimen between the 2 groups. The amount of intraoperative blood loss was significantly less in the scalpel group than in the aspirator group (684 versus 1,859 ml, p < 0.05). The operation time was significanly shorter in the scalpel group than in the aspirator group (176 versus 262 min, p < 0.05). There were no significant differences in postoperative liver function and morbidity between the 2 groups. Conclusions: The ultrasonically activated scalpel is effective in reducing blood loss and in shortening the time of operation, and can be employed during limited resection of the liver with cirrhosis or chronic hepatitis.

Questionnaire for Trial Submission

Please return the completed questionnaire as soon as possible to the Section Editor: Susan Galandiuk, MD Department of Surgery School of Medicine University of Louisville Louisville, KY 40292, USA Tel.: +1 502 852 5442 Fax: +1 502 852 8915 or contact: S. Karger AG Attn.: Ms. Yvonne Rebmann Allschwilerstrasse 10 PO Box CH–4009 Basel Tel.: +41 61 306 13 51 Fax: +41 61 306 12 34 E-Mail: y.rebmann@karger.ch ABC K I 99 69 3

Differences in Tumor Growth Measured by Carcinoembryonic Antigen Doubling Time between Synchronous and Metachronous Hepatic Colorectal Metastases

The operative results and carcinoembryonic antigen (CEA) doubling times of patients with synchronous hepatic metastasis (group A) and metachronous hepatic metastasis (group B) from colorectal carcinom

A Case of Hepatic Failure after Right Hepatic Lobectomy for Hepatocellular Carcinoma with Chronic Active Hepatitis.

術前肝機能検査にて肝硬変非併存肝癌と診断され肝右葉切除を施行し術後肝不全に陥った症例について報告する. 症例は59歳の男性でT.Bil0.5mg/dl, GOT48, GPT60IU/l, PT97.5%, ICG-R155.4%と良好な肝機能を呈したため肝右葉切除術を施行した. しかし術後早期より黄疸が出現し, 15回の血漿交換療法にもかかわらず第63病日に肝不全にて死亡した. 切除肝の非癌部は門脈域の細胞浸潤, 門脈域間のbridgingおよびpiecemealnecrosisを伴う慢性活動性肝炎であった. 術前の一般肝機能検査では診断しえず, 肝炎の活動性の評価には数か所にわたる肝生検が必要であると思われた.

Bile Peritonitis following Major Hepatic Resection – Clinical and Experimental Studies

Postoperative mortality and morbidity following hepatic resection are increased when bile peritonitis is present. The records of 51 consecutive patients undergoing hepatic lobectomy were reviewed. Fifteen patients (29%) suffered postoperative bile leaks, and 4 died of hepatic failure with peritonitis secondary to bacterial contamination of undrained bile. To study the effect of bile peritonitis on early hepatic regeneration and energy metabolism, bile peritonitis was produced in rats undergoing a 70% hepatectomy. The peak level of DNA synthesis was lower and delayed and the hepatic energy charge was lower during the 48 h following hepatectomy in rats with peritonitis than in control rats undergoing 70% hepatectomy only. We conclude that bile peritonitis induces hepatic failure following hepatectomy by impeding liver regeneration and energy metabolism, in addition to facilitating bacterial peritonitis.

Glucose overload and hepatic energy metabolism after resection of the cirrhotic liver in rats

SummaryThe effect of glucose hyperalimentation on energy metabolism in the cirrhotic rat liver after 70% hepatectomy was studied. After resection, rats received either 30 kcal/kg per day (group I) or 200 kcal/kg per day (group II) of glucose for 48 h. In both groups, hepatic mitochondrial ATP synthesis was accelerated when palmitic acid was used as substrate and suppressed when pyruvate was used. This suggests that the energy substrate of the remnant liver was principally fatty acis rather than glucose. Hepatic energy charge was within normal limits in group I, but decreased significantly in group II after hepatectomy. An abundance of glucose in the early postoperative period, therefore, caused a hepatic energy derangement by suppressing fatty acids utilization; this suppression was corroborated by the findings of lower immunoreactive glucagon and non-esterified fatty-acid concentrations in group II. To determine optimal glucose administration, the predicted value of glucose disposal rate (GDR) was calculated after an intravenous glucose tolerance test. GDR decreased significantly after hepatectomy and did not increase appreciably even with a large dose of insulin administration. These results suggest that glucose administration should be tailored to the GDR values after resection of the cirrhotic liver.