Nobutaka Tanaka

A multiple regression equation for prediction of posthepatectomy liver failure.

This article reports a multiple regression equation for prediction of posthepatectomy liver failure. In phase I, using the correlations between 17 preoperative parameters (Xi) and the postoperative course scored (Y) of the past 36 hepatectomized patients, we proposed the following multiple regression equation: Y = -110 + 0.942 X resection rate (%) + 1.36 X ICG retention rate (%) + 1.17 X patients age + 5.94 X ICG maximal removal rate (mg/kg/min). With the equation, the calculated Y value (prediction score) of these patients revealed that prediction scores of the eight nonsurvivors with liver failure were more than 50 points while those of the 28 survivors were 50 points or less. In phase II, the relationships between early prognosis and a precalculated prediction score were prospectively found the same as that seen in phase I. These findings indicate that our formula is a useful prognostic index for prediction of posthepatectomy liver failure.

Results of surgical treatments of primary hepatocellular carcinoma: Some aspects to improve long-term survival

AbstractFrom 1973 through 1982 we have treated 226 patients with primary hepatocellular carcinoma, including 103 by hepatectomy and 93 by hepatic artery ligation. Most were associated with cirrhosis or related liver diseases and one-third with esophageal varices. As in other Japanese and Asian series, our long-term overall results for the 90 patients who survived hepatectomy were poor in comparison with Western series dealing with non-cirrhotic patients. However, the actuarial survival rate at 3 years was 90% in patients with carcinomas smaller than 3 cm in diameter (n = 18). The 5-year survival rate was 70.8% in the 25 patients whose carcinoma had a curative resection, and 100% at 3 years in the 16 patients in whom a tumor smaller than 5 cm had been resected. Eighty-four patients survived hepatic artery ligation; in 50 of them the area of ischemia was thought to include all the neoplastic lesions within the liver. The survival rate of these 50 patients was superior to that of the patients who had undergone noncurative hepatic resection.nWe conclude that early detection and curative resection is the best way to improve the long-term results in cirrhotic patients with hepatocellular carcinoma and that hepatic artery ligation is better than incomplete (noncurative) resection.RésuméDe 1973 à 1982 les auteurs ont opéré 226 malades qui présentaient un cancer hépatocellulaire, 103 par hépatectomie et 93 par ligature de lartère hépatique. La majorité des patients présentaient une cirrhose ou des lésions hépatiques, un tiers étaient porteurs de varices oesophagiennes. Comme dans les autres séries japonaises ou asiatiques, les résultats à long terme chez les 90 malades qui avaient subi une hépatectomie furent décevants par comparaison avec les séries occidentales concernant les sujets indemnes de cirrhose. Cependant la survie actuarielle à 3 ans fut de 90% chez les opérés qui présentaient un cancer dun diamètre inférieur à 3 cm (n=18). Le taux de survie à 5 ans fut de 70,8% chez 25 malades qui avaient subi une résection à but curatif, et le taux de survie à 3 ans fut de 100% chez 16 opérés qui avaient subi une résection pour une tumeur dun diamètre inférieur à 5 cm. Quatrevingt-quatre malades ont survécu à la ligature de lartère hépatique; chez 50 dentre eux la zone ischémique provoquée par la ligature intéressait la totalité de la région hépatique occupée par les lésions néoplasiques. Le taux de survie de ces 50 malades fut toujours supérieur à celui de ceux qui navaient pu être lobjet dune résection hépatique.De cette étude, on peut retenir les conclusions suivantes: le diagnostic précoce et la résection à but curatif du cancer hépatocellulaire chez les cirrhotiques représentent des conditions favorables à lobtention de résultats à long terme satisfaisants; les résultats de la ligature de lartère hépatique sont supérieurs à ceux de la résection incomplète (résection à but non curatif).ResumenHemos tratado 226 pacientes con carcinoma hepatocelular primario entre 1973 y 1982, incluyendo 103 con hepatectomía y 93 con ligadura de la arteria hepática. La mayoría apareció asociada con cirrosis o enfermedades hepáticas relacionadas y un tercio con varices esofágicas. Al igual que en otras series japonesas y asiáticas, nuestros resultados globales a largo término para los 90 pacientes que sobrevivieron la hepatectomía fueron pobres en comparación con las series occidentales que incluyen pacientes no cirróticos. Sin embargo, la tasa de supervivencia actuarial a 3 años fue del 90% en pacientes con carcinomas menores de 3 cm de diámetro (n= 18). La tasa de supervivencia en 5 años fue de 70,8% en los 25 pacientes cuyos carcinomas fueron sometidos a resección curativa, y del 100% en 3 años en los 16 pacientes en quienes se resecó un tumor de menos de 5 cm de diámetro. Ochenta y cuatro pacientes sobrevivieron la ligadura de la arteria hepática; en 50 de éstos se consideró que el área de isquemia incluía las lesiones neoplásicas contenidas en el hígado. La tasa de supervivencia de estos 50 pacientes fue superior a la de los pacientes que fueron sometidos a resección hepática no curativa.Nuestra conclusión es que la detección precoz y la resección curativa son la mejor manera de superar los resultados a largo plazo en pacientes cirróticos con carcinoma hepatocelular y que la ligadura de la arteria hepática es superior a la resección incompleta (no curativa).

Current Status of Hepatic Resection in the Treatment of Hepatocellular Carcinoma

Most patients suffering from hepatocellular carcinoma (HCC) in Japan have associated liver cirrhosis or a related liver disease. In the past, massive hepatic resection in these patients applied to cure the HCC frequently resulted in a fatal liver failure postoperatively. Preoperative assessment to determine a safe limit for resection is the most urgent problem for liver surgeons in Japan [1].

Consistency of human liver

Liver consistency was measured biomechanically on the left lobe during laparotomy (n = 52) and on the resected specimen (n = 24) using a specially devised technique. Its relationship with histological findings and hepatic functions was also investigated. Instrumentation included a venipuncture needle with a closed tip and a round latex microballoon attached at a side hole. The needle was connected to a pressure transducer and infusion pump with a polyethylene tube. After the needle was introduced into the liver tissue, liver consistency was measured as delta P/delta V (cm H2O/ml) from the slope of pressure rise on a Pressure (P)-Volume (V) curve obtained at constant saline infusion. Liver consistency increased proportionally with the degree of hepatic fibrosis: 589 +/- 191 (cm H2O/ml) for nonfibrosis (n = 25), 869 +/- 139 for periportal fibrosis (n = 14), 1030 +/- 116 for incomplete cirrhosis (n = 15), and 1250 +/- 206 for fully developed cirrhosis (n = 22). Correspondingly, liver consistency correlated closely with morphometrically estimated hepatic fiber content (r = 0.82, P less than 0.01). With the exception of albumin, liver function tests including prothrombin time, gamma-globulin fraction, zinc turbidity, and indocyanine green retention rate showed significant correlations with liver consistency (0.41 less than magnitude of r less than 0.68, P less than 0.001). However, correlation was much less than that between liver consistency and hepatic fiber content. The present study demonstrates that liver consistency measured by this technique can be a predictive index of hepatic fiber gradings.