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ABSTRACT: To assess the outcome and effectiveness of liver surgery for huge hepatocellular carcinoma (HCC) in the caudate lobe.
This study retrospectively examined 18 patients who underwent surgical treatment for huge HCC in the caudate lobe. An isolated caudate lobectomy and an extended caudate lobectomy were each performed in nine patients (50%). The intraoperative and postoperative complications and treatments for recurrence were recorded. The survival curve was estimated using the Kaplan-Meier method.
The postoperative mortality and morbidity were nil and 33.3%, respectively. Fourteen patients (77%) had tumor recurrence as of the last follow-up. The recurrence was treated in all patients. Eleven patients underwent transcatheter arterial chemoembolization, a median of three times per patient (range, 1-7); one of those patients also received percutaneous ethanol injection therapy and radiotherapy of recurrent nodules. One patient was treated with systemic chemotherapy. One patient underwent liver transplantation, and one underwent a repeated liver resection. The overall survival rates at 1, 3, and 5 years were 83%, 47%, and 31%, respectively.
Long-term survival can be achieved using an aggressive surgical approach in selected patients with huge HCC in the caudate lobe.
Surgery Today 04/2011; 41(4):520-5. · 1.22 Impact Factor
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ABSTRACT: To evaluate the short- and long-term outcomes of liver resection for caudate lobe hepatocellular carcinoma (HCC).
We retrospectively analyzed 114 consecutive patients with HCC, originating from the caudate lobe, who underwent resection between January 2001 and January 2007. Univariate and multivariate analyses were performed on several clinicopathologic variables to determine the factors affecting long-term outcome and intrahepatic recurrence.
Overall mortality and morbidity were 0% and 18%, respectively. After a median follow-up of 31 mo (interquartile range, 11-66 mo), tumor recurrence had occurred in 76 patients (66.7%). The 1-, 3-, and 5-year disease-free survival rates were 65.7%, 38.1%, and 18.4%, respectively. The 1-, 3-, and 5-year overall survival rates were 76.1%, 54.7%, and 31.8%, respectively. Univariate analysis showed that subsegmental location of the tumor (45.7% vs 16.2%, P = 0.01), liver cirrhosis (12.3% vs 47.9%, P = 0.03), surgical margin (18.5% vs 54.6%, P = 0.04), vascular invasion (37.9% vs 23.2%, P = 0.04) and extended caudate resection (42.1% vs 15.4%, P = 0.04) were related to poorer long-term survival. Multivariate analysis showed that only subsegmental location of the tumor, liver cirrhosis and surgical margin were significant independent prognostic factors.
Hepatectomy was an effective treatment for HCC in the caudate lobe. The subsegmental location of the tumor, liver cirrhosis and surgical margin affected long-term survival.
World Journal of Gastroenterology 03/2010; 16(9):1123-8. · 2.47 Impact Factor
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ABSTRACT: To investigate the influence of the amount of portal blood stasis removal on endotoxemia and liver function after liver transplantation.
Forty-seven patients who received liver transplantation from February 2006 to November 2007 were divided into 2 groups according to the amount of portal blood stasis removal during operation: group A (n = 26) 50 ml and group B (n = 21) 200 ml of portal blood stasis removal respectively. The levels of plasma endotoxin, D-lactate, tumor necrosis factor-alpha, interleukin-6, liver function and blood coagulation were examined and analyzed.
Under the condition of no significant difference in sex, age, primary liver diseases and Child-pugh's classification, cold ischemic time, total operation and anhepatic time, operation methods, volume of blood loss and transfusion, and all preoperative observations. Most of observations showed the restoration of the patients in group B was better than that in group A. The plasma levels of endotoxin, D-lactate, tumor necrosis factor-alpha, interleukin-6, alanine aminotransferase, aspartate aminotransferase, prothrombin time and activated partial thromboplastin time in group B were significantly lower than those in group A (P < 0.05). The level of plasma prealbumin in group B was significantly higher than that in group A (P < 0.05).
The removal of 200 ml portal blood stasis leads to a better results than that of 50 ml, and it can help alleviate endotoxemia and facilitate the restoration of the liver function after liver transplantation.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2008; 46(15):1136-8.
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ABSTRACT: To investigate the effect and mechanism of portal blood stasis on lung and renal injury induced by hepatic ischemia reperfusion.
A rabbit hepatic ischemia reperfusion injury model was established by hepatic portal occlusion and in situ hypothermic irrigation for 30 min. Twenty-four New Zealand white rabbits were employed and randomly divided into 3 groups equally by different dosage of portal blood stasis removal: group A5 (5 ml blood removal), group A10 (10 ml blood removal),and group B (no blood removal). Eight rabbits were served as controls with no hepatic portal occlusion and hypothermic irrigation. After reperfusion 4 h serum endotoxin content, tumor necrosis factor-alpha (TNF-alpha), urea nitrogen (BUN), and creatinine (Cr) were examined respectively, meantime lung and kidney tissues were sampled to determine the content of malondialdehyde (MDA), superoxide dismutase (SOD), the pathology, and wet to dry weight ratio, broncho-alveolar lavage fluid protein content in lung tissues.
Removing portal blood stasis ameliorated lung and renal injury as shown by decreasing the level of serum endotoxin, TNF-alpha, BUN, Cr, wet to dry weight ratio, broncho-alveolar lavage fluid protein content, MDA, SOD. TNF-alpha, Cr, broncho-alveolar lavage fluid protein content in lung tissues and MDA in kidney tissue in group A5 were significantly reduced compared with those in group B (P < 0.05), while in lung tissue in group A10 were also markedly reduced (P < 0.05). The activation of SOD in group A5 were significantly increased (P < 0.05).
Removal of portal blood stasis before the resume of splanchnic circulation may ameliorate the lung and renal injury induced by hepatic ischemia reperfusion. The possible mechanism may be that portal blood stasis removal reduces endotoxin absorption, and further decreases production of serum TNF-alpha.
Zhonghua wai ke za zhi [Chinese journal of surgery] 04/2008; 46(8):602-5.
