Toshio Isono

Hepatic resection for colorectal metastases: analysis of prognostic factors.

PURPOSE: Hepatic resection affords the best hope of survival for patients with colorectal carcinoma metastatic to the liver. However, recurrences are observed in about 60 percent of patients after curative hepatic resection. The purpose of this study was to examine the prognostic factors of patients undergoing curative hepatic resection for colorectal metastases. METHODS: Between April 1984 and September 1997, 168 patients underwent curative hepatic resection for colorectal metastases. The clinicopathologic factors studied for prognostic value were gender, age, primary site, nodal status of primary tumor, time of metastases, preoperative serum level of carcinoembryonic antigen, hepatic tumor size and distribution, number of metastases, type of hepatic resection, resection margin, presence of micrometastases in resected specimen and microscopic fibrous pseudocapsule between the hepatic tumor and surrounding hepatic parenchyma, nodal status of hepatoduodenal ligament, adjuvant regional chemotherapy, and perioperative transfusion. RESULTS: The overall survival was 42 percent at three years and 26 percent at five years, including a 3.5 percent 60-day surgical mortality rate. Thirty-one percent of patients had micrometastases located at a median distance of 3 mm from the metastatic tumor edge. Presence of microscopic fibrous pseudocapsule was observed in 28 percent of patients. Univariate and multivariate analyses showed that significant prognostic factors for survival were nodal status of primary tumor, number of metastases, resection margin, microscopic fibrous pseudocapsule, and adjuvant regional chemotherapy. CONCLUSIONS: We conclude that 1) hepatic resection is effective in select patients with colorectal metastases; 2) adequate resection margin and adjuvant regional chemotherapy can improve outcome; and 3) microscopic fibrous pseudocapsule may offer additional postoperative information as an independent prognostic factor.

An exerimental study of the liver lysosomal membrane fragility during a period of partial liver ischemia and following blood reperfusion.

部分肝阻血時の肝細胞障害の病態を明らかにする目的でラットに部分肝阻血を施行し, ライソゾーム酵素の変動の面より検討した.その結果, 阻血葉では阻血開始とともにライソゾーム酵素のfree活性およびfragility indexは漸増し, 阻血解除後より強い上昇を示した.カテプシンDでは, 阻血前のfree活性: 0.27±0.04 (units/mg protein), fragility index: 28.5±2.5 (%) に比べ, 阻血解除2時間後のfree活性: 0.52±0.05 (p<0.001), fragility index: 41.2±3.7 (p<0.01) と著増した.また血清中ライソゾーム酵素は阻血解除後より上昇し始め, カテプシンDでは阻血前2.20±0.28より阻血解除2時間後4.33±0.39と著明な上昇を認めた (p<0.01).以上の結果より, 部分肝阻血により阻血肝細胞内のライソゾーム膜が障害され, ライソゾーム酵素の血中への遊出が起こったと考えられ, ライソゾーム酵素が肝阻血時の肝細胞障害に強く関与することが示唆された.

Influences of hepatic arterial embolization and anticancer drug infusion on hepatectomized rats.

肝切除後に施行される肝動脈塞栓術および制癌剤肝動脈注入療法の再生肝に及ぼす影響をラットを用い基礎的に検討した.(1) 肝切除後, アミノピリン呼気テストで見た肝のマイクロゾーム機能総量の回復には4週を要した.(2) 肝切除後の肝動脈塞栓および注入により血清トランスアミナーゼ値は切除4週目施行群は, 2週目施行群に比べ, 上昇程度が軽度で回復も速やかであった.またアミノピリン呼気テスト値の回復も4週目施行群が速やかであった.(3) 生存率においても4週目施行群に比べ, 2週目施行群は有意に低値を示した.以上より, 肝切除後の肝動脈塞栓および注入は肝の機能総量の回復する時期に施行すれば安全であると思われた.