Yoshito Ogura

Effects of exogenous prostaglandin E1 in hepatectomized patients

The efficacy of prostaglandin E1 (PGE1) in preventing hepatic failure after hepatectomy was investigated prospectively in eight PGE1-treated patients and in seven untreated controls. The patients in the PGE1-treated group received PGE1 (0.03 μg/kg per min) intravenously for 72 h beginning at the initiation of surgery. The cardiac index increased markedly and the systemic vascular resistance decreased markedly during PGE1 treatment, while no significant changes were observed in the control group. The platelet count in the PGE1-treated group decreased slightly, while that in the control group decreased significantly during the first 3 postoperative days. The percent change of alanine aminotranferase in the PGE1-treated group was less than that in the control group. These findings suggest that the administration of exogenous PGE1 following hepatectomy increases hepatic blood flow and suppresses platelet aggregation, and therefore may be cytoprotective to the remnant liver. Thus, PGE1 may be effective in preventing hepatic failure after hepatectomy.

Serum hepatocyte growth factor (HGF) levels predict the outcomes in hepatectomized patients with postoperative hyperbilirubinemia

Abstract The purpose of this report is to evaluate the usefulness of serum hepatocyte growth factor (HGF) levels as a prognostic factor in hepatectomized patients with early postoperative hyperbilirubinemia (HB). The serum HGF levels of 14 patients with early postoperative HB (serum total bilirubin level above 5 mg/dl lasting at least 3 days), were measured perioperatively (prior to and 6 h, 1, 2, 3, 4, 7 and 14 days following surgery) and the relationship between changes in serum HGF levels and postoperative outcome was analyzed. The 14 patients were divided into two groups; 6 patients (Group A) ameliorated by conservative therapies within 7 days after surgery, and 8 patients (Group B) with prolonged HB more than 2 weeks after surgery. Five patients (83%) in Group A showed relatively low maximum serum HGF levels ( 2.0 ng/ml). Six of the 7 patients in Group B developed hepatic failure and died. These results suggest that, in patients with HB or those in whom it is expected to occur soon after hepatectomy, the measurements of serum HGF levels would be beneficial for determining therapy and predicting postoperative outcomes.

Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi-institutional study by the Kyushu Study Group of Liver Surgery

Objectives of the present study were to identify predictors of the recurrence of intrahepatic cholangiocarcinoma (ICC), and to evaluate the survival benefit of adjuvant chemotherapy and surgical treatment for ICC recurrence. A multi‐institutional retrospective study was carried out in 356 patients with ICC who underwent curative surgery at one of 14 institutions belonging to the Kyushu Study Group of Liver Surgery. A total of 214 patients (60%) had recurrence. Predictors of ICC recurrence were as follows: positive for pathological intrahepatic metastasis (im), positive for lymph node metastasis (n), positive for pathological lymphatic infiltration (ly), pathological bile duct invasion (b), and tumor size ≥4.4 cm. Adjuvant chemotherapy was given to 120 patients (34%) and, in the patients with im or tumor size ≥4.4 cm, adjuvant chemotherapy showed a survival benefit. Only 37 patients (17%) underwent surgical treatment for ICC recurrence. The surgical treatment resulted in a good 5‐year survival rate (44%), which is similar to the rate obtained by the first operation for primary ICC. Prognosis of patients with primary im after the second operation was significantly worse (5‐year survival 18%) compared to patients without primary im. Primary im+ should be considered a contraindication for surgical treatment for ICC recurrence.

Two Successfully Treated Cases with Ruptured Duodenal Varices.

十二指腸静脈瘤出血の2例を報告した.症例1は50歳の男性で, 主訴は下血.肝外門脈閉塞症手術の既往歴をもっていた.上部消化管X線造影・内視鏡検査によって十二指腸球部前壁に屈曲蛇行する隆起が認められ, 血管造影にて同部位に蛇行・拡張した血管が認められ, 血行郭清術を行った.症例2は69歳の女性で, 主訴は下血.肝硬変を有していた.内視鏡検査によって十二指腸下行脚に蛇行する隆起と同部位からの出血が認められた.内視鏡的硬化療法を行ったが, 再出血を起こしたため開腹下に血管結紮術を行った.2例とも術後経過は順調で再出血も認められていない.十二指腸静脈瘤は門脈圧亢進症の1病態としてまれにみられる.消化管出血を認めた場合には十二指腸まで十分に検索し, 十二指腸静脈瘤が出血源であることが判明したらなるべく早期に血管結紮術または血行郭清術を行うのが望ましいと考えられた.