Sung Su Yun

The risk factors of early recurrence after hepatectomy in hepatocellular carcinoma

Purpose Early recurrence after hepatectomy is a well-known poor prognostic factor in patients with hepatocellular carcinoma. This study was undertaken to identify the risk factors of early recurrence in patients with hepatocellular carcinoma after hepatectomy. Methods One hundred and sixty-seven patients that underwent hepatectomy for hepatocellular carcinoma from January 2005 to December 2010 were enrolled. The numbers of patients with or without early recurrence group were 40 and 127, respectively. Clinico-pathologic factors were retrospectively analyzed. Results Potential risk factors were classified as host, tumor, or surgical factors. Of the host factors examined, lobular hepatitis activity was found to be a significant risk factor of early recurrence, and of the tumor factors, infiltrative type of gross appearance, level of preoperative AFP and worst Edmondson-Steiner grade were significant. Conclusion The present study shows that an infiltrative gross appearance, a high preoperative AFP level, high lobular hepatitis activity, and a poor Edmondson-Steiner grade are independent risk factors of early recurrence. Accordingly, patients with these risk factors should be followed closely after hepatectomy.

Laparoscopic liver resection for malignant liver tumors, why not more?

Purpose The precise role of laparoscopic liver resection in liver malignancies remains controversial despite an increasing number of publications that have used the laparoscopic resection of benign liver tumors. This study was performed to assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. Methods This study is a retrospective review of the profiles, pathology, surgery and outcome performed on 61 patients who had undergone laparoscopic liver resection for liver malignancies between January 2004 and March 2011. Results Among the 61 patients, 34 patients had hepatocellular carcinoma (HCC), 24 patients had liver metastasis. The mean tumor size was 2.8 ± 2.0 cm (mean ± standard deviation). Tumors located at Couinaud segment number 2 to 8. The resection included 36 anatomical resections, 25 wedge resections. The mean surgical time was 209.7 ± 108.9 minutes. There was one operation that resulted in death. Postoperative complications occurred in 9 patients (14%). There were 2 conversions to laparotomy (3%). The mean postoperative hospital stay was 9.0 ± 4.4 days. Blood transfusion was needed in 11 patients (18%). The mean surgical margin was 1.3 ± 1.2 cm. The mean follow-up period was 18.1 ± 11.1 months. The three-year overall survival rate was 87% for patients with HCC and 95% for patients having liver metastases from colorectal cancer. Conclusion Even though laparoscopic liver resection requires a learning curve, it produced acceptable outcomes even in patients who had a malignant liver tumor. This study provides evidence to support further investigation and the establishment of laparoscopic liver resection for malignant liver tumors.

Bioelectrical Impedance May Predict Cell Viability During Ischemia and Reperfusion in Rat Liver

Ischemia and reperfusion (I/R) injury is a major cause of hepatic failure after liver surgery, but no method could monitor or predict it real-time during surgery. We measured bioelectrical impedance (BEI) and cell viability to assess the usefulness of BEI during I/R in rat liver. A 70% partial liver ischemia model was used. BEI was measured at various frequencies. Adenosine triphosphate (ATP) content, and palmitic acid oxidation rate were measured, and histological changes were observed in order to quantify liver cell viability. BEI changed significantly during ischemia at low frequency. In the ischemia group, BEI increased gradually during 60 min of ischemia and had a tendency to plateau thereafter. The ATP content decreased below 20% of the baseline level. In the I/R group, BEI recovered to near baseline level. After 24 hr of reperfusion, the ATP contents decreased to below 50% in 30, 60 and 120 min of ischemia and the palmitic acid metabolic rates decreased to 91%, 78%, and 74%, respectively, compared with normal liver. BEI may be a good tool for monitoring I/R during liver surgery. The liver is relatively tolerant to ischemia, however after reperfusion, liver cells may be damaged depending upon the duration of ischemia.

Pathological complete remission of advanced hepatocellular carcinoma with main portal vein tumor thrombosis by hepatic arterial infusion chemotherapy.

Cures for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) are rare and difficult. We report a case of pathologically confirmed complete remission of HCC induced by hepatic arterial infusion chemotherapy (HAIC). A 45-year-old male patient had a massive HCC in the right lobe of the liver and tumor thrombus in the right and main portal veins. He achieved a partial response after two cycles of HAIC with 5-fluorouracil (750 mg/m(2)) and cisplatin (25 mg/m(2)). After the completion of six cycles he received a curative partial hepatectomy, and histopathology revealed complete necrosis without any viable tumor cell. He was in good health at a 4-month follow-up. These results suggest that this regimen is a promising therapeutic modality for the treatment of advanced HCC with PVTT.

Single center experience of laparoscopic hepatectomy: the comparison of perioperative outcomes between early and late period

Backgrounds/Aims The aim of this study is to clarify the safety and feasibility of laparoscopic hepatectomy, through comparing the early and late periods of perioperative outcomes. Methods We retrospectively analyzed 138 patients who underwent laparoscopic hepatectomy from January 2003 to June 2011, at Yeungnam University Hospital. We divided the total patients to early period (from January 2003 to February 2007, n=49) and late period (from March 2007 to June 2011, n=89) groups and compared the perioperative outcomes including the mean operation time, intra-operative blood loss, postoperative hospital stay, intensive care unit (ICU) stay, and duration of liver function test (LFT) normalization. Results The mean operation time was 308 minutes (range: 140-510) in the early group and 193 minutes (range: 40-350) in the late period group (p<0.001). The mean intraoperative blood loss was 171 ml (range: 50-1,200) in the early and 44 ml (range: 0-400) in the late group (p=0.005). The postoperative hospital stay was 9.7 days (range: 4-31) in the early and 6.8 days (range: 2-9) in the late period (p<0.001). The ICU stay hour was 21.6 hours (range: 0-120) in the early and 2.8 hour (range: 0-24) in the late period (p<0.001). The duration of LFT normalization was 5.7 days (range: 0-39) in the early and 2.1 days (range: 0-20) in the late period (p=0.003). The perioperative outcomes in the late period were better than the early period, which showed a statistically significant difference. Conclusions Laparoscopic hepatectomy is feasible and can be safely performed in selected patients but requires a long experience in open liver resection and mastery of laparoscopic surgical skills.

Measurement of Bioelectrical Impedance during Ischemia in the Rat Liver

During liver resection and liver transplant, liver is damaged by ischemia-reperfusion injury. Until now, there is no approved method to measure or predict the extent of liver injury during the operation. This is the preliminary study to make the real time monitoring system by quantification of bioimpedance and ischemia-reperfusion injury in liver. Sprague-Dawley rats were subjected to different periods of 70% partial hepatic ischemia (30, 60, 90 and 120minutes ischemia) and reperfusion. We measured changes of liver bioelectrical impedance (120 Hz-100 KHz) every five minutes.