Kimihiko Kusashio

Hepatic resection for colorectal metastases: analysis of prognostic factors.

PURPOSE: Hepatic resection affords the best hope of survival for patients with colorectal carcinoma metastatic to the liver. However, recurrences are observed in about 60 percent of patients after curative hepatic resection. The purpose of this study was to examine the prognostic factors of patients undergoing curative hepatic resection for colorectal metastases. METHODS: Between April 1984 and September 1997, 168 patients underwent curative hepatic resection for colorectal metastases. The clinicopathologic factors studied for prognostic value were gender, age, primary site, nodal status of primary tumor, time of metastases, preoperative serum level of carcinoembryonic antigen, hepatic tumor size and distribution, number of metastases, type of hepatic resection, resection margin, presence of micrometastases in resected specimen and microscopic fibrous pseudocapsule between the hepatic tumor and surrounding hepatic parenchyma, nodal status of hepatoduodenal ligament, adjuvant regional chemotherapy, and perioperative transfusion. RESULTS: The overall survival was 42 percent at three years and 26 percent at five years, including a 3.5 percent 60-day surgical mortality rate. Thirty-one percent of patients had micrometastases located at a median distance of 3 mm from the metastatic tumor edge. Presence of microscopic fibrous pseudocapsule was observed in 28 percent of patients. Univariate and multivariate analyses showed that significant prognostic factors for survival were nodal status of primary tumor, number of metastases, resection margin, microscopic fibrous pseudocapsule, and adjuvant regional chemotherapy. CONCLUSIONS: We conclude that 1) hepatic resection is effective in select patients with colorectal metastases; 2) adequate resection margin and adjuvant regional chemotherapy can improve outcome; and 3) microscopic fibrous pseudocapsule may offer additional postoperative information as an independent prognostic factor.

Aggressive surgical resection for hepatic metastases involving the inferior vena cava

BACKGROUND The implications of aggressive surgical approaches for hepatic metastases involving the inferior vena cava (IVC) have not been clarified yet. The aim of this study is to assess the preliminary results of aggressive surgical resection for hepatic metastases involving the IVC. METHODS Sixteen patients with hepatic metastases involving the IVC underwent surgical resections with the repair and reconstruction of the IVC: patch repair in 2 and ringed Goretex in 1, primary closure in 13 patients. Hepatic metastases were from colorectal cancer in 14, stomach cancer in 1, and uterine cancer in 1 patient. RESULTS Vascular control utilized for resecting the IVC were total hepatic vascular exclusion in 8, hypothermic isolated hepatic perfusion in 3, and side clamp in 5 patients. The combined IVC resection with hepatectomy in 16 patients brought about 25% and 6% surgical morbidity and mortality rates, respectively. Survival rates following surgical resections were 64%, 33%, 33%, 22%, 22% for 14 patients of colorectal metastases involving the IVC as compared with 82%, 58%, 41%, 37%, 27% at 1, 2, 3, 4, 5 years, respectively, for 154 patients of colorectal metastases not involving the IVC. CONCLUSION Hepatic metastases involving the IVC could be safely resected without an increase in surgical risk. Aggressive surgical approaches might bring about a favorable outcome in select patients with colorectal hepatic metastases involving the IVC.

Angiopoietin-2 levels in the hepatic vein as a useful predictor of tumor invasiveness and prognosis in human hepatocellular carcinoma

Background and Aim:  Hepatocellular carcinoma (HCC) is characteristically a hypervascular tumor and its progression is known to be closely related to angiogenesis. In this study, we investigated angiopoietin‐2 (Ang‐2) and vascular endothelial growth factor (VEGF) levels in the hepatic vein draining from HCC, as well as in the peripheral vein, to evaluate their relation to clinicopathological features and prognosis.

Changes in hepatic venous oxygen saturation related to the extent of regeneration after partial hepatectomy in rats

BACKGROUND Changes in hepatic oxygen metabolism in relation to the extent of liver regeneration are expected after partial hepatectomy. There are few reports, however, about hepatic oxygen metabolism during liver regeneration. In this study, we evaluated changes in hepatic oxygen metabolism related to the regeneration rate, and the relationship between hepatic venous oxygen saturation (Shvo2) and liver regeneration after partial hepatectomy. METHODS The work was done using 50% hepatectomized rats with continuous infusion of octreotide for inhibition of liver regeneration or with saline as control. The hepatic hemodynamics, oxygen metabolism, and Shvo2 levels as well as the regenerating liver status were evaluated for 3 days after hepatectomy. RESULTS Administration of octreotide resulted in a significant reduction of the regenerating liver weight on days 1 and 3 after hepatectomy compared with the control group. Significantly decreased DNA synthesis and proliferating cell nuclear antigen labeling index were also found on day 1. Meanwhile, hepatic oxygen consumption (HVO2) and oxygen extraction ratio were significantly decreased in the octreotide-treated group on day 1. In contrast, the Shvo2 levels in the octreotide-treated group were significantly higher than those in the control group, and were inversely correlated with the HVO2. CONCLUSION The remnant liver demands an increased amount of oxygen in relation to the extent of regeneration, and changes in the Shvo2 are inversely correlated with the HVo2. Therefore, monitoring the Shvo2 could be useful for estimating liver regeneration after partial hepatectomy.