Kenji Fukuhara

Recurrence of hepatocellular carcinoma in the liver remnant after hepatic resection

We analyzed the results of 19 patients who had intrahepatic recurrence of hepatocellular carcinoma (HCC) among 47 patients who were discharged from the hospital after having a hepatic resection in order to evaluate the factors affecting recurrence and survival. Recurrence-free survival rates were 80%, 44%, and 28% at 1, 3, and 5 years, respectively. Of the 19 patients with recurrence, 14 had multiple lesions, and 16 of the recurrences were detected within 3 years of surgery. None of the following factors correlated with recurrence: hepatic function; tumor size; presence of tumor capsule; capsular invasion; vascular invasion and intrahepatic metastasis; extent of hepatic resection; and resection with tumor-free margins. Patients having multiple recurrent HCCs, however, had larger-sized tumors at the time of resection than those with a solitary recurrence. The survival rates after recurrence were significantly better in patients with a solitary recurrence, and these patients were treated with transcatheter arterial embolization (TAE) therapy. Early detection as well as TAE for recurrent HCCs is necessary to improve long-term survival.

THE DEGREE OF HEPATIC REGENERATION AFTER PARTIAL HEPATECTOMY IN RATS WITH PERITONITIS AND THE ROLE OF LIPID PEROXIDATION

Bile accumulation in the peritoneal cavity after partial hepatectomy reduces hepatic regeneration. In 70% of hepatectomized rats with bile peritonitis, hepatic DNA synthesis showed a delayed initiation and diminished peak level. Because intraperitoneal bile significantly accelerated lipid peroxidation and decreased energy metabolism in the liver remnant, all hepatectomized rats with bile peritonitis died within 7 days. Subcutaneous administration of exogenous combined antioxidants SOD and catalase dramatically reduced lipid peroxidation and improved the survival rate. Although the slightly elevated serum endotoxin level in rats with peritonitis may play a role in the inhibition of hepatic regeneration, the result suggest that intraperitoneal accumulation of bile components may also directly accelerate lipid peroxidation in the liver remnant, inhibiting the hepatic regeneration.

Kupffer cell-mediated inhibition of liver regeneration after combined hepatectomy and pancreatectomy.

Recently, simultaneous hepatectomy and pancreatoduodenectomy has been performed for the treatment of some biliary tract cancers in Japan. Postoperative hepatic failure is a common and potentially fatal complication. The aim of this study was to examine the reduction in the rate of liver regeneration after 70% hepatectomy (Hx) alone or in combination with 70% pancreatectomy (HPx). Male Sprague-Dawley rats underwent hepatectomy or simultaneous hepatectomy and pancreatectomy. The ratio of liver weight to body weight, the labeling index of hepatocytes in vivo, and DNA synthesis of the hepatocytes and/or Kupffer cells in primary culture were analyzed. The ratio of liver weight to body weight and the labeling index in HPx rat were found to be significantly lower than those values in Hx rats. There were no significant differences in plasma alanine aminotransferase levels between the two groups. The inhibitory effect on DNA synthesis was observed with coculture of hepatocytes and Kupffer cells when the portal plasma obtained 1 hour after operation was added. We further observed that the conditioned medium of Kupffer cells stimulated by the addition of the portal plasma that was obtained 1 hour after HPx inhibited DNA synthesis of hepatocytes. This effect was abolished after incubation at 56° C for 30 minutes. These results strongly suggest the existence of a growth inhibitory factor in portal plasma after HPx. This heat-labile growth inhibitory factor was released from Kupffer cells and would appear to act on hepatocytes in a paracrine manner.

Evaluation of prognostic factors of primary hepatocellular carcinoma after hepatectomy: 10 years' experience

In order to elucidate both short- and long-term prognostic factors, 54 patients with hepatocellular carcinoma who underwent hepatic resection in the past 10 years were studied. In the analysis of fact

Factors Affecting Long-Term Survival and Recurrence of Hepatocellular Carcinoma (HCC) After Hepatic Resection

In order to elucidate prognostic factors affecting long-term survival and intrahepatic tumor recurrence, 56 patients with HCC who underwent hepatic resection in the past 10 years were studied. The actual survival rate of the patients excluding 9 hospital deaths was 65% at 3 years, and 43% at 5 years. Prothrombin time and size of tumor were the decisive factors that affected long-term prognosis. Nineteen patients had intrahepatic recurrence of HCC among 47 patients who were discharged from the hospital. Of the 19 patients with recurrence, 14 had multiple lesions, and 16 of the recurrences were detected within 3 years of surgery. Patients having multiple recurrent HCCs had larger sized tumors at the time of resection than those with a solitary recurrence. The survival rates after recurrence were significantly better in patients with a solitary recurrence, and those treated with transcatheter arterial embolization therapy (TAE). Hepatic resection for patients with functionally well-preserved livers, bearing small tumors correlates with long-term survival. Early detection as well as TAE for recurrent HCCs is necessary to improve long-term survival.

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.