Takashi Kaiho

Effective hepatic artery chemoembolization for advanced hepatocellular carcinoma with extensive tumour thrombus through the hepatic vein

Background and Aims : Advanced hepatocellular carcinoma (HCC) with extensive tumour growth through the hepatic vein still has an extremely poor prognosis, even after cancer chemotherapy and/or transarterial embolization. Although aggressive surgical treatments using extracorporeal circulation and liver transplantation have been performed by some authors, the reported results were still unsatisfactory. In this study, we report the favourable result of hepatic artery chemoembolization and subsequent surgical resection in three patients with advanced HCC with extensive tumour thrombus through the hepatic vein.

Inhibition of Hepatic Regeneration after 70% Partial Hepatectomy by Simultaneous Resection of the Bowel in Rats

This study was aimed to evaluate bow simultaneous resection of the bowel influences hepatic regeneration after partial hepatectomy (HTX). Two hundred and sixty-four rats underwent 70% partial HTX, ileocecal resection (ICR), transverse colon resection (TR), colon amputation and simulatenous resection of the liver and the bowel (HTX+ICR, HTX+TR). Hepatic DNA synthesis was remarkably suppressed by simultaneous resection compared with the 70% HTX group (p < 0.01). In simultaneous resection groups, delayed enhanced hepatic protein synthesis (HPS) was observed after the operation as compared with the 70% HTX group, which showed an early postoperative peak of HPS. Postoperative anastomosis leakage occurred more frequently and survival rates were significantly lower in simultaneous resection groups. Higher plasma endotoxin levels of the portal and the peripheral veins were found in simultaneous resection groups as compared with other groups (p < 0.01-0.001). This study suggested that simultaneous resection of the bowel with partial HTX might inhibit hepatic regeneration and result in the increased risk of anastomosis leakage and high surgical mortality rate by increased plasma endotoxin levels and delayed enhanced HPS.

Effect of Daikenchuto, a Traditional Japanese Herbal Medicine, after Total Gastrectomy for Gastric Cancer: A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase II Trial

BACKGROUND Daikenchuto (DKT) has widely been used to improve abdominal symptoms by being expected to accelerate bowel motility. The purpose of this study is to examine the efficacy and safety of DKT for prevention of ileus and associated gastrointestinal symptoms after total gastrectomy. STUDY DESIGN Two hundred and forty-five gastric cancer patients who underwent total gastrectomy were enrolled. Patients received either DKT (15.0 g/d) or matching placebo from postoperative days 1 to 12. Primary end points were time to first flatus, time to first bowel movement (BM), and frequency of BM. Secondary end points included quality of life, C-reactive protein level, symptoms indicative of a severe gastrointestinal disorder, and incidence of postoperative ileus. RESULTS A total of 195 patients (DKT, n = 96; placebo, n = 99) were included in the per-protocol set analysis. There were no significant differences between the groups in terms of patient background characteristics. Median time to first BM was shorter in the DKT group than in the placebo group (94.7 hours vs 113.9 hours; p = 0.051). In patients with high medication adherence, median time to first BM was significantly shorter in the DKT group than in the placebo group (93.8 hours vs 115.1 hours; p = 0.014). Significantly fewer patients in the DKT group had ≥2 symptoms of gastrointestinal dysfunction than those in the placebo group on postoperative day 12 (p = 0.026). CONCLUSIONS Administration of DKT during the immediate postoperative period after total gastrectomy appears to promote early recovery of postoperative bowel function.

Sustained virologic response achieved after curative treatment of hepatitis C virus-related hepatocellular carcinoma as an independent prognostic factor.

Whether an antiviral interferon (IFN)‐based therapy (IBT) after curative treatment of hepatocellular carcinoma (HCC) improves the prognosis in patients with hepatitis C virus (HCV)‐related HCC remains to be elucidated.

Increased Serum Interleukin-6 Level and Reduction of Hepatic Acute-Phase Response after Major Hepatectomy

It has been proposed that a major hepatectomy impairs the liver-related host defense mechanism. The changes in the levels of serum inflammatory cytokines and plasma acute-phase proteins synthesized in the liver were measured after partial hepatectomy. Peak levels of serum interleukin-6 were significantly higher after extended lobectomy than after lobectomy or segmentectomy (p < 0.01). Serum interleukin-1 beta and tumor necrosis factor alpha levels showed no significant changes. Plasma levels of acute-phase proteins were significantly lower after lobectomy or extended lobectomy (p < 0.05). A reduced hepatic acute-phase response probably renders patients liable to infection after major hepatectomy.

Clinical efficacy of Daikenchuto for gastrointestinal dysfunction following colon surgery: a randomized, double-blind, multicenter, placebo-controlled study (JFMC39-0902)

Objective This exploratory trial was performed to determine whether Daikenchuto accelerates recovery of gastrointestinal function in patients undergoing open colectomy for colon cancer. Methods A total of 386 patients undergoing colectomy at 1 of the 51 clinical trial sites in Japan from January 2009 to June 2011 were registered for the study (JFMC39-0902). Patients received either placebo or Daikenchuto (15.0 g/day, t.i.d) between post-operative day 2 and post-operative day 8. Primary end-points included time to first bowel movement, frequency of bowel movement and stool form. The incidence of intestinal obstruction was evaluated post-operatively. The safety profile of Daikenchuto until post-operative day 8 was also evaluated. Results The results for 336 patients (Daikenchuto, n = 174; placebo, n = 162) were available for statistical analysis. The time to first bowel movement did not differ significantly between the two groups. All patients reported having diarrhea or soft stools immediately after surgery, and the time until stool normalization (50th percentile) in the Daikenchuto and placebo groups was 6 days and 7 days, respectively. The placebo group had a significantly greater number of hard stools at post-operative day 8 (P = 0.016), and bowel movement frequency continued to increase until post-operative day 8 as well. In contrast, bowel movement frequency in the Daikenchuto group increased until post-operative day 6, however decreased from post-operative day 7 and was significantly lower at post-operative day 8 compared with the placebo group (P = 0.024). Conclusion The moderate effects of Daikenchuto were observed ∼1 week after the operation. Although Daikenchuto had an effect on gastrointestinal function after open surgery in patients with colon cancer, this study did not show its clinical benefits adequately.

Reduced Hepatic Functional Reserve in Cirrhosis and Obstructive Jaundice with Special Reference to Histological Morphometric Analysis and Galactose Elimination Capacity

To evaluate liver dysfunction in patients with obstructive jaundice (OJ), morphological and functional hepatic mass was analyzed in comparison with cirrhosis (LC). Total hepatic parenchymal ratio (THPR) was estimated by morphometric analysis and hepatic functional mass by galactose tolerance test (GaTT) in 30 patients who underwent hepatectomy. The value of GaTT in patients with LC was remarkably depressed compared to those with normal liver function (p < 0.001). It was also depressed in OJ (p < 0.05 vs. normal liver), but less than in LC (p < 0.05). However, THPR decreased only in LC (p < 0.05 vs. either normal liver or OJ). A significant correlation between the value of GaTT and THPR was revealed in patients with LC, but not in OJ. These results suggested that liver dysfunction in OJ was independent of the decreased number of hepatocytes, differing from LC.

Enhancement of cytotoxicity of doxorubicin by verapamil in the hepatic artery infusion for liver tumors in rats

Background. The calcium channel blocker has been demonstrated to be effective in the accumulation and retention of chemotherapeutic agents in tumor cells.

Primary isolated extramedullary plasmacytoma of the colon.

Dear Editor, Plasmacytoma is an immunoproliferative monoclonal disease of the B-cell line that originates from malignant transformed plasma cells. Plasmacytoma, or plasmoma, was originally mentioned by Unna in 1891 and first described by Schridde in 1905. It is a tumor composed almost exclusively of plasma cells that are arranged in clusters or sheets with a scant, delicate, supportive, connective tissue stroma. Four different types of plasma cell tumors were described by Dolin as follows: (1) myelomatosis or multiple myeloma (MM); (2) solitary myeloma of bone; (3) plasma cell leukemia; and (4) extramedullary plasmacytoma (EMP). EMPs account for only 3–5% of all plasma cell diseases. Although they occur in the upper air passage, nasal cavity, and paranasal sinuses in 75% of cases, a small percentage is found in the gastrointestinal tract, especially in the stomach and small intestine. A solitary tumor or primary localization in the colon is extremely rare. Here, we report a rare case of a primary isolated extramedullary plasmacytoma of the ascending colon and its clinical course after surgery and also present a review of the literature. A 64-year-old man was brought to our hospital by ambulance with a 1-month history of the aggravated pain in the right lower abdomen. Physical examination revealed a palpable mass of 10 cm in diameter at the right upper quadrant and tenderness in the same location, but there was no sign of peritonitis. None of the lymph nodes were palpable from the body surface. An abdominal X-ray showed ileus and he was taken to the hospital for examination and treatment. Laboratory data on admission revealed that white blood cell count was 9600/μl, hemoglobin was 12.6 g/ml, lactate dehydrogenase was 425 IU/L, and C-reactive protein was 9.12 mg/dl. Serum carcinoembryonic antigen and CA19-9 were within their normal limits. Total protein was 7.1 g/dl and albumin was 2.7 g/dl, but serum protein electrophoresis was not performed. A barium enema and colonoscopy demonstrated a severe stricture due to an irregular circular tumor with ulceration of the ascending colon where the fiberscope was unable to pass through. The histological diagnosis of a biopsy specimen was group III, ulcer with degenerative atypical cells. An abdominal computed tomography (CT) scan revealed a tumor of 9 cm in diameter in the ascending colon which seemed infiltrating into the posterior portion of the right lobe of the liver. In addition, the spread of inflammation was seen in the right retroperitoneal space next to the tumor. Under a diagnosis of ascending colon carcinoma or lymphoma, a semi-emergency operation was performed because the colon was nearly obstructed. At laparotomy, there was a small amount of slightly bloody ascites, and the cytological diagnosis of these ascites was class II. No dissemination was observed. A large mass involving the ascending colon and infiltrating into the liver was found, and right hemicolectomy, lymph node dissection, excision of Gerota’s fascia, and partial resection of the posterior portion of the liver were performed. MacroscopiInt J Colorectal Dis (2008) 23:719–720 DOI 10.1007/s00384-008-0439-7

Portal vein infusion of cancer chemotherapeutic agent emulsified with Lipiodol in regenerating liver after partial hepatectomy in rats

Portal vein infusion of aclarubicin (ACR) emulsified with Lipiodol (LP) in regenerating liver after 70% partial hepatectomy in rats was evaluated for its safety and usefulness. DNA synthesis in regenerating liver was transiently suppressed by LP, ACR or LP+ACR, but no obvious inhibition was seen in aminopyrineN-demethylase activity and liver weights. LP significantly enhanced hepatic tissue levels of ACR and its active metabolites by long-term retention in the sinusoidal space. This study demonstrates that in rats LP has a powerful effect on the long-term retention of anticancer agents in the sinusoidal space after infusion into the portal vein, without aggravating hepatic damage by anticancer agents.