Naofumi Nagasue

Hepatic dearterialization for nonresectable primary and secondary tumors of the liver

Seventeen patients with primary or secondary liver tumors were treated by dearterialization of the liver and intraportal infusion of cytotoxic drugs. In 14 cases, ligation of the main (10), right and left (1), right and middle (1), and right (2) hepatic arteries was performed. In three in whom hepatic artery ligation was considered to be contraindicated due to occlusion of the portal vein, temporary occlusion of the hepatic artery was repeated postoperatively. Only one patient died from the cause related to the ligation. Out of 14 patients who survived for more than one month ten showed an apparent regression of tumors radiologically. The mean survival period of the patients excluding those who died from other unrelated causes was 28 weeks. That of the control patients who received only chemotherapy through the hepatic artery was 13 weeks. The results were not always satisfactory, but dearterialization of the liver can be a palliative treatment for nonresectable liver tumors with a forceful combined chemotherapy.

Effect of 5-fluorouracil on liver regeneration and metabolism after partial hepatectomy in the rat

The effects of 5‐fluorouracil (5‐FU) on regenerating liver were studied after two thirds hepatectomy in rats. In Group I, 68% hepatectomy was performed. In Group II, 5‐FU in a dose of 20 mg/kg was administered intravenously immediately after, 24 and 48 hours after the same hepatectomy. In Group III, the same amount of 5‐FU was given after sham‐operation. The mortality rates were 4.5% in Group I, 28.0% in Group II, and 0% in Group III. The treatment with 5‐FU following hepatectomy caused not only suppression but delay of liver cell division. Histologic changes such as cellular degeneration, liver steatosis and dilatation of the sinusoidal space were marked and prolonged in the hepatectomy‐5‐FU group. The metabolic abnormalities in albumin, cholesterol, triglycedides, and phospholipids were further more profound in Group II compared to those in Group I. In Group III, moderate derangements in albumin, triglycerides and phopholipids were observed. The results may indicate that adjuvant chemotherapy with 5‐FU or similar drugs immediately after partial hepatectomy in hepatoma patients should be performed with great care if necessary. Otherwise, it should not be carried out until hepatic regeneration is almost completed.

Serum alpha-fetoprotein in patients following partial hepatectomy

Serum alpha-fetoprotein (AFP) concentrations were estimated postoperatively at weekly intervals with the radioimmunoassay in eight adult patients. Seven patients underwent partial hepatectomies of up to 80% of the liver. Surgical drainage was carried out in one individual who had a huge pyogenic abscess in the right hepatic lobe. Despite evidence of clinical and biochemical recovery associated with normal liver regeneration, none of the sera were positive for AFP during the period 4–12 weeks after operation. This study does not support the hypothesis that the elevation of serum AFP in benign liver diseases reflects the extent of liver regeneration.

Serum alpha-fetoprotein levels after hepatic artery ligation and postoperative chemotherapy: correlation with clinical status in patients with hepatocellular carcinoma.

Eight patients with hepatocellular carcinoma and positive serum alpha‐feto‐protein (AFP) levels were treated by hepatic artery legation and postoperative chemotherapy. Three patterns of clinical response were discerned. First, a marked decrease in AFP levels was found in five patients following the treatment. Three of these patients are alive, all with lowered or normal serum AFP levels at 20, 22, and 60 weeks after operation. Second, two patients displayed only a transient decrease in AFP levels followed by a gradual increase. Third, there was a continuous increase in AFP levels in one patient who showed no clinical improvement. The serum AFP levels in each case appeared to correlate with the prognosis of these patients. Thus, serial measurements of AFP levels may provide an index to assess the clinical result of hepatic artery ligation in patients affected with hepatoma. Cancer 40:615–618, 1977.

Trends in surgical results of hepatic resection for hepatocellular carcinoma: 1,000 consecutive cases over 20 years in a single institution

BACKGROUND Surgical results have been reported to be improved in hepatic resections for hepatocellular carcinoma (HCC) in recent years, but the detailed trends in surgical results for HCC in a single high-volume center are still not clear. METHODS Surgical results in 1,000 hepatic resections for HCC performed at a single medical center from 1989 to 2011 were analyzed. Patients were divided into 3 groups: those performed in the early period (1989 to 1995, n = 181), the middle period (1996 to 2004, n = 391), and the late period (2005 to 2011, n = 428). RESULTS Hospital mortality (3.9%, 1.0%, and .5%; P = .0027) and morbidity (45%, 24%, and 15%; P < .0001) rates were significantly decreased. The overall survival rates were significantly improved (50%, 72%, and 78% at 5 years; P = .0021), but there was no significant difference in the disease-free survival (29%, 34%, and 31% at 5 years; P = .7823). CONCLUSIONS Surgical results of hepatic resections for HCC were significantly improved, with the mortality rate nearly reaching 0%. The 5-year survival rate after hepatic resections for HCC was also improved to 78%, but the consistently high rate of HCC recurrence after hepatic remains a problem.

Serum activities of lysosomal enzymes in patients with liver cell carcinoma.

Serum activities of two lysosomal enzymes, β-glucuronidase and acid phosphatase, were estimated in 66 patients with liver cell carcinoma, 10 with secondary liver cancer, 14 with cirrhosis of the liver, and 9 normal controls. A substantial increase in the enzyme activities was found in patients with liver cell carcinoma but not in those with secondary liver cancer. The degree of the enzyme elevations paralleled the stage of hepatoma. Although the serum activities of both enzymes were also elevated in patients with liver cirrhosis, the elevations were significantly higher in hepatoma than in liver cirrhosis. Possible mechanisms for the elevation of serum lysosomal enzyme activities in hepatoma are discussed, but further studies are necessary to elucidate the biological and clinicopathological significance of estimating serum lysosomal acid hydrolases in patients with primary liver cell carcinoma.

Hemangiosarcoma of liver and spleen treated by hepatic artery ligation, intraportal infusion chemotherapy, and splenectomy.

Hepatic artery ligation is useful as a palliation of irresectable hepatic tumors, but does not always produce a satisfactory result. Hepatic tumor with high vascularity is expected to respond more favorably. In this context, primary liver cell carcinoma and carcinoid tumor or leiomyosarcoma of the liver have been satisfactorily treated by hepatic artery ligation. A case is presented of hemangiosarcoma of the liver and spleen treated effectively by hepatic artery ligation, splenectomy, and postoperative intraportal infusion of 5‐fluorouracil, as indicated by the regression of hepatic tumors on postoperative scanning and arteriograms.

Gallium scanning in the diagnosis of hepatocellular carcinoma: A clinicopathological study of 45 patients

Gallium-67 citrate scintigraphy was carried out in 45 patients with primary hepatocellular carcinoma in conjunction with serum alpha-fetoprotein measurement, 99mTc-colloid liver scan and selective arteriography. 67Ga accumulated in the tumour in 31 patients, and partial uptake was noted in three others. Scanning detected small hepatomas in four patients with cirrhosis in whom 99mTc-colloid scanning was negative. Clinical, laboratory and histopathological comparisons of 67Ga-positive and -negative patients showed no significant differences. 67Ga scanning of the liver was found to be useful in the diagnosis of hepatocellular carcinoma, especially in patients with associated cirrhosis.

Transthoracic cardiectomy with infraesophago-supragastric devascularization for bleeding esophageal varices.

Based on the thoughts that transthoracic approaches give less load to the liver than transabdominal ones, and that effectiveness for bleeding esophageal varices is secured by cardiectomy with complete devascularization of lower esophagus and upper stomach, a new operative procedure for esophageal varices is described which is more safely applicable to the risky patients.Twenty cases with portal hypertension were operated, including eight cirrhotic patients with severe hepatic dysfunction, six cases of emergency bleeding and six reoperated cases. No operative death was encountered, but three cirrhotic patients died during the late follow up period. The remaining 17 patients had uneventful postoperative courses without recurrence of esophageal bleeding during 20 months follow up period. Thus this operation may eliminate the shortcoming of previous operative methods for portal hypertension.

Tumor embolism in the right atrium after hepatic artery ligation for hepatoma.

A case of tumor embolism in the right atrium after hepatic artery ligation for hepatoma was reported. Patient was a 55 year old male complaining of upper abdominal pain. Preoperative angiogram and scintigram revealed multinodular hepatomas in the right and middle lobes of the liver. During the first week after the ligation of the right and middle hepatic arteries, the patient progressed satisfactorily. But his condition gradually deteriorated thereafter and sudden hypotension occurred on the 22nd postoperative day with a fatal sequela. At autopsy, the orifice of the right atrium was impacted by a tumor embolus. The cause of death seemed to be attributable to this embolus liberated from the hepatic veins. Accordingly, we emphasize the necessity of careful angiographic evaluation not only of the hepatic inflow but of the outflow tract in performing hepatic artery ligation as a treatment of nonresectable hepatoma.