Takehito Ohtsubo

Multicentric hepatocellular carcinomas tend to grow in more damaged segments of the liver

Abstract: In 115 patients (68 with liver cirrhosis and 47 without) who underwent curative resection of hepatocellular carcinoma (HCC) caused by hepatitis C virus (HCV)-related chronic liver diseases, we separated the liver into three segments (right, middle, and left) according to the three secondary branches of the Glissonean pedicle. We examined the weight of each resected segment. We also examined the histological findings of the segments in the same liver in 24 other patients with HCV-related chronic liver diseases. The average weight of the segments did not vary significantly in patients without liver cirrhosis. However, the average weight of the segments was significantly different in patients with liver cirrhosis (P = 0.0414) and the weight of the middle segment was lower than that of the other segments. In another group, of 246 patients with curative resection of HCC, of the 90 patients with single nodular HCCs, 45 nodules (50%) were located in the middle segment (P = 0.0004); in the 156 pa-tients with synchronous multicentric HCCs (total, 401 nodules), 220 nodules (54.9%) were located in the middle segment. In 74 of the 156 patients with synchronous multicentric HCCs (47.4%), the HCCs were located in the same segment. The grade, stage of hepatitis, and number of sites of irregular regeneration were significantly different in each segment (P < 0.05), and the middle segment had more advanced hepatitis than the other segments. The rate of occurrence of HCC in the middle segment was higher than that in the other segments. The difference among the segments of the liver in regard to the degree of damage done by hepatitis may be related to the differences in HCC occurrence among the liver segments.

Surgical management of patients with hepatocellular carcinoma who undergo hepatectomy: Emphasis on early discharge after operation

During the past decade, considerable efforts have been expended to promote early recovery in patients undergoing hepatic resection. This paper reviews the outcome of surgical therapy in a series of 259 consecutive patients with hepatocellular carcinoma who were managed according to a recently developed protocol that emphasized early resumption of daily activities. Although the hospital mortality and morbidity rates were 4.63% and 46.2%, respectively, about one-half of the patients returned home within 12 postoperative days. The major reasons for prolonged duration of hospital care were intra-abdominal infection and persistent fluid retention in the abdominal and thoracic cavities. The preoperative presence of cardiac, pulmonary, and renal diseases had no effect on mortality or morbidity; however, the presence of diabetic condition was significantly correlated with the occurrence of intra-abdominal infection. Appropriate management of diabetes and efforts to reduce bile leakage are expected to contribute further to improvements in outcome in patients with hepatocellular carcinoma who undergo hepatectomy.

Diagnosis of Abscesses at the Resection Margin after Hepatectomy. Evaluation of Computed Tomography Appearance of Perihepatic Fluid Collection.

肝切除術後の断端膿瘍の早期診断を目的として, 術後のcomputed tomography (CT) をもちいた診断について検討した. 過去7年間の肝切除例637例中, 術後在院中にCTを施行しえた159例を対象とし, 切離断端部の感染群75例, 非感染群84例のCT所見の比較検討を行った. 切離断端部の液貯留 (fluid collection) は感染群の66例, 非感染群の63例に認めた. 感染群に有意に認められたCT所見は, 1. 不均一で高いCT値を示すfluid collection, 2. Fluid collection内部のガス像, 3. Fluid collection断端部辺縁の不整像, 4. Fluid collection断端部のenhancement効果, 5. 胸水合併であった. これらの所見は感染群のなかでも発熱などの症状を有する群に, より顕著に認められる傾向にあった. また, CT所見上, 断端部のドレーンの留置状況を把握することより, ドレーンの再留置, 追加留置など, 断端膿瘍の治療に役立たせることができた.