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ABSTRACT: PURPOSE: Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy. METHODS: We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis. RESULTS: SSIs developed in 21 patients (33 %). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p < 0.05). The multivariate logistic regression analysis revealed that a pancreatic fistula and the NRI were independent risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI. CONCLUSION: The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.
Surgery Today 09/2012; · 1.22 Impact Factor
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Kazuhisa Kaneda,
Shoji Kubo,
Hiromu Tanaka, Shigekazu Takemura,
Kazuki Ohba,
Takahiro Uenishi,
Shintaro Kodai,
Hiroji Shinkawa,
Yorihisa Urata,
Masayuki Sakae,
Takatsugu Yamamoto,
Shigefumi Suehiro
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ABSTRACT: Background/Aims: We investigated the clinicopathological findings and outcome after surgery for hepatocellular carcinoma in patients without hepatitis B or C virus infection. Methodology: Among 562 patients who underwent curative resection for hepatocellular carcinoma, the sera from 97 patients (B group) were positive for hepatitis B surface antigen alone, sera from 355 patients (C group) were positive for anti-hepatitis C virus antibody alone and sera from 104 patients (NBNC group) were negative for both hepatitis B surface antigen and anti-hepatitis C virus antibody. We compared the clinicopathological findings and postoperative outcomes in the 3 groups. Results: The prevalence of diabetes mellitus, hypertension, hyperlipidemia and alcohol abuse were higher in the NBNC group than in the other groups. The prevalence of obesity was higher in the NBNC group than in the B group. Non-alcoholic steatohepatitis was detected in 16 NBNC patients. The tumor- free survival rate was higher in the NBNC group than in the C group. Conclusions: Obesity, diabetes mellitus, hypertension, hyperlipidemia, alcohol abuse and non-alcoholic steatohepatitis were the possible risk factors for hepatocellular carcinoma in the NBNC group. The patients in the NBNC group are expected to show a better outcome as compared to patients in the C group.
Hepato-gastroenterology 09/2012; 59(118):1889-92. · 0.66 Impact Factor
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Hiroji Shinkawa,
Seikan Hai,
Hiromu Tanaka, Shigekazu Takemura,
Kazuki Ohba,
Takahiro Uenishi,
Shintaro Kodai,
Yorihisa Urata,
Kazuhisa Kaneda,
Masayuki Sakae,
Kenichi Wakasa,
Shoji Kubo
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ABSTRACT: A 65-year-old man presented at our hospital in 2006 because of a liver tumor. He had been treated for chronic hepatitis C
with interferon-α2b for 6months in 1998. A pathological examination showed that the hepatic tissue before interferon (IFN)
therapy was classified as moderately active hepatitis with severe hepatic fibrosis. The IFN therapy induced the disappearance
of the hepatitis C virus (HCV) RNA from his serum and normalized alanine aminotransferase activity. In 2005, a tumor (2cm
in diameter) was detected in the right lobe of the liver by ultrasonography and computed tomography, and the tumor was stained
with contrast medium during abdominal angiography. A right lobectomy was performed under the diagnosis of hepatocellular carcinoma.
The pathological examination revealed that the tumor was an intrahepatic cholangiocarcinoma (ICC). The noncancerous hepatic
tissue was classified as having minimal activity with mild fibrosis. It is important to monitor closely for ICC as well as
hepatocellular carcinoma even patients in whom the HCV RNA has disappeared after IFN therapy, because the outcome of treatment
for small ICC is favorable.
Clinical Journal of Gastroenterology 04/2012; 3(1):45-49.
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Yorihisa Urata,
Shoji Kubo, Shigekazu Takemura,
Takahiro Uenishi,
Shintaro Kodai,
Hiroji Shinkawa,
Masayuki Sakae,
Kazuhisa Kaneda,
Kazunori Ohata,
Akinori Nozawa,
Shigefumi Suehiro
Journal of hepato-biliary-pancreatic sciences. 04/2012;
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Masayuki Sakae,
Shoji Kubo, Shigekazu Takemura,
Chikaharu Sakata,
Takahiro Uenishi,
Shintaro Kodai,
Hiroji Shinkawa,
Yorihisa Urata,
Kazunori Ohata,
Kazuhisa Kaneda,
Takayoshi Nishioka,
Akinori Nozawa,
Shigefumi Suehiro
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ABSTRACT: Aim: Several investigators have shown that interferon (IFN) therapy can suppress the recurrence of hepatocellular carcinoma (HCC) after curative treatment. We investigated the effect of IFN therapy on the first and second HCC recurrence following hepatic resection of hepatitis C virus (HCV)-related HCC. Methods: Subjects included 166 patients who had undergone curative resection for a single HCV-related HCC. We analyzed the outcome after initial hepatic resection and risk factors of a second HCC recurrence following treatment for the first HCC recurrence. Results: Using multivariate analysis, a non-sustained virological response (non-SVR) was significantly associated with a high incidence of first HCC recurrence. The rate of second HCC recurrence tended to be higher in the non-SVR group than in the SVR group. In the patients with recurrence of multiple tumors or who received non-curative treatment for recurrent HCC, the second HCC recurrence rates were significantly higher. Multivariate analysis demonstrated that non-curative treatment for first HCC recurrence was an independent risk factor for a second HCC recurrence. Among the patients who received curative treatment for their first HCC recurrence, the rates of second recurrence were significantly higher in the non-SVR group than in the SVR group. Multivariate analysis also revealed that SVR was independently associated with prevention of a second HCC recurrence. Conclusions: These results suggest that on first HCC recurrence, a curative treatment should be considered in order to prevent a second recurrence if possible. In addition, IFN therapy contributes to improved prognosis after curative treatment, even in patients with recurrent HCC.
Hepatology Research 01/2012; 42(6):564-73. · 2.20 Impact Factor
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Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2012; 109(11):1872-7.
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Yorihisa Urata,
Shoji Kubo, Shigekazu Takemura,
Takahiro Uenishi,
Shintaro Kodai,
Hiroji Shinkawa,
Masayuki Sakae,
Kazuhisa Kaneda,
Kazunori Ohata,
Akinori Nozawa,
Shigefumi Suehiro
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ABSTRACT: BACKGROUND/PURPOSE: We investigated the effects of nucleos(t)ide analogues (NAs) on long-term outcome in patients following curative treatment for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODS: This study involved 70 of the 76 patients who had undergone liver resection for HBV-related HCC in our department; 6 patients were excluded due to non-curative resection or advanced cancer. The 70 patients were divided into three groups, as follows: 13 patients with high serum concentration of HBV DNA (≥4 log(10) copies/mL) and no antiviral therapy (high viral group); 46 patients who received antiviral therapy during the serial follow up (antiviral therapy group) because of high viral concentration (≥4 log(10) copies/mL); and 11 patients with low serum concentration of HBV DNA (<4 log(10) copies/mL) and no antiviral therapy (low viral group). RESULTS: Tumor-free survival rate was significantly higher in the low viral group than in the high viral group (P = 0.0058). Multivariate analysis revealed that a high serum concentration of HBV DNA (≥4 log(10) copies/mL) (risk ratio 6.717, 95% confidence interval 1.435-31.434, P = 0.0156) was an independent risk factor for a short tumor-free survival time. Tumor-free survival rate was significantly higher in the antiviral therapy group than in the high viral group (P = 0.0478). Multivariate analysis revealed that presence of multiple tumors (risk ratio 2.857, 95% confidence interval 1.403-5.816, P = 0.0038) was an independent risk factor for a short tumor-free survival time. The cumulative survival rate was significantly higher in the antiviral therapy group than in the high viral group (P = 0.0025). Multivariate analysis revealed that not undergoing antiviral therapy (risk ratio 0.121, 95% confidence interval 0.024-0.608, P = 0.0104) was an independent risk factor for a short survival time. CONCLUSIONS: A high serum concentration of HBV DNA (≥4 log(10) copies/mL) was a strong risk factor for HCC recurrence after resection of HBV-related HCC. Antiviral therapy with NAs improved the long-term outcome after resection of HBV-related HCC in patients with high serum concentrations of HBV DNA.
Journal of hepato-biliary-pancreatic sciences. 12/2011;
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ABSTRACT: To elucidate the influence of diabetes on tumor recurrence after curative resection for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC).
A total of 100 patients who underwent curative resection for solitary HCV-related HCC were analyzed. Data from 26 patients with diabetes were compared to those of 74 patients without diabetes. The two groups were matched in terms of presence of cirrhosis, Child-Pugh classification, and tumor size (within 10%).
Tumor-free survival rates were 45% and 48% at 3 years and 27% and 27% at 5 years in patients with and without diabetes, respectively. No significant difference was observed in the tumor-free survival rates between patients with and without diabetes. Tumor-free survival rates were 66% and 27% at 3 years in patients with normal postoperative glycated hemoglobin (HbA1c) level (HbA1c, <6.5%) and elevated postoperative HbA1c level (HbA1c, ≥6.5%), respectively. Multivariate analysis showed that poor glycemic control (HbA1c, ≥6.5%) was associated with postoperative tumor recurrence in patients with diabetes [odds ratio (OR) = 3.551, 95% confidence interval (CI) = 1.129-11.172, P = 0.030].
Careful control of plasma glucose should be performed to prevent tumor recurrence after curative resection for HCV-related HCC in patients with diabetes.
Journal of Surgical Oncology 11/2011; 105(6):606-11. · 2.10 Impact Factor
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ABSTRACT: Bisphenol A (BPA) and diethylstilbestrol (DES) have been reported to cause sperm toxicity. To identify an earlier marker of toxicity of environmental substances or food additives, this study determined whether the levels of reactive oxygen species (ROS) in sperms could serve as indices for the prediction of sperm toxicity and quality. Male Wistar rats were given drinking water containing various doses of BPA or DES for 8 weeks. Some rats were treated with 0.45% N-acetyl cysteine (NAC) for 2 days prior to the administration of DES or BPA. Administration of BPA or DES to rats for 1 week dose-dependently increased the production of ROS, even at doses and time points which had no effect on sperm motility. 4-Hydroxy-2-nonenal modified proteins increased in sperms 8 weeks after BPA or DES treatment. NAC reversed oxidative stress and prevented the loss of sperm function in the DES or BPA-treated group. During observation, changes in the sperm motility, sperm count and morphology were not correlated to the increase in ROS levels. These results suggest that ROS levels may be used as an early indicator of sperm count and quality decreases which result from chronic toxicity.
Free radical research 12/2010; 44(12):1398-406. · 2.22 Impact Factor
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ABSTRACT: Long-term administration of nitroglycerin (NTG) causes tolerance secondary to increased vascular formation of reactive oxygen species. Carvedilol, which has potent antioxidant activity in addition to functioning as an adrenergic blocker, prevents nitrate tolerance by a still to be elucidated mechanism. The present study investigated how carvedilol attenuates nitrate tolerance, particularly with reference to cytochrome P450 (CYP), an enzyme involved in the development of tolerance.
Male Wistar rats were subjected to 48-h continuous infusion of NTG alone (0.5 mg/h) or NTG with concomitant carvedilol (20 or 100 microg/h), and then compared with vehicle-treated rats (4 groups; n=6 in each group). Following the continuous administration, nitrate tolerance, assessed by bolus NTG injections, was hemodynamically prevented by coadministration of carvedilol. Levels of CYP1A1/1A2, superoxide production, and phosphorylated vasodilator-stimulated phosphoprotein at serine 239 (P-VASP) were examined in the aortic wall and heart tissue. When NTG alone was continuously administered, vascular superoxide was produced, there was a decrease in the cardiac CYP1A1/1A2 level, and depletion of P-VASP. However, each of these changes induced by continuous NTG administration was significantly attenuated by coadministration of carvedilol and the extent of attenuation was more pronounced at the higher dose (100 microg/h).
Coadministration of carvedilol attenuates nitrate tolerance through maintenance of NO/cGMP pathway activity by preventing free radical generation and CYP depletion.
Circulation Journal 08/2010; 74(8):1711-7. · 3.77 Impact Factor
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ABSTRACT: Accumulating evidence suggests that alcohol, hepatitis C virus infection, steatosis with obesity, and insulin resistance are accompanied by iron overload states. Phlebotomy and oral iron chelators are effective treatments for these conditions and for hemochromatosis. However, the mechanisms by which iron depletion improves clinical factors remain unclear. We examined the effect of iron depletion in a model of type 2 diabetes, Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Age-matched Long-Evans Tokushima Otsuka (LETO) rats were used as controls for all experiments. Iron restriction was performed by eliminating iron in the diet from 15 wk of age or by phlebotomy. Phlebotomy was commenced at 29 wk of age by removing 4 and 3 ml of blood from the tail vein every week in OLETF and LETO rats, respectively. Rats were euthanized at 43 wk of age, and detailed analyses were performed. The plasma ferritin concentration was markedly higher in OLETF rats and decreased in iron-deficient (ID) diet and phlebotomy rats. Hemoglobin A(1c) (Hb A(1c)) was decreased significantly in OLETF rats fed the ID diet and in the phlebotomy group. Increased levels of triglycerides, glucose, free fatty acids, and total cholesterol were found in ID OLETF rats. Plasma, liver, and pancreas lipid peroxidation and hepatic superoxide production decreased in both groups. Pancreatic fibrosis and insulin levels improved in both groups of OLETF rats. Pancreatic levels of peroxisome proliferator-activated receptor-beta/delta (PPARbeta/delta) ligands and hypoxia-inducible factor (HIF)-1alpha were decreased significantly in OLETF rats. These factors were normalized in both rats fed ID and phlebotomy groups of OLETF rats. In conclusion, iron depletion improved diabetic complications by inhibition of oxidative stress and TGFbeta signal pathways and the maintenance of pancreatic PPARbeta/delta and HIF-1alpha pathways.
AJP Endocrinology and Metabolism 03/2010; 298(6):E1140-9. · 4.75 Impact Factor
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ABSTRACT: Hepatic fibrosis is a chronic progressive disorder with a poor prognosis for which no definitive treatment exists. S-allylcysteine (SAC), an ingredient of aged garlic extract, is known to have antioxidant and hepatoprotective effects. The aim of this study was to investigate the antifibrotic effects of SAC in the liver.
Hepatic fibrosis was induced in male Wistar rats by porcine serum (PS) intraperitoneal injection. SAC (0.15% of basal diet) or N-acetylcysteine (NAC, 0.45% of basal diet) was orally administered for 12 weeks. Liver damage was assessed by the levels of plasma alanine aminotransferase (ALT), hepatic lipid peroxides (LPO), and hepatic total thiols 12 weeks after first PS injection. Area of fibrosis was examined by Azan-Mallory staining. Hydroxyproline content of liver were assessed as an index of collagen content. Liver was examined for expression of alpha-smooth muscle actin (alpha-SMA) as a marker of hepatic stellate cell (HSC) activation.
There were no significant differences in levels of plasma ALT, hepatic LPO, or hepatic total thiols among the groups. PS significantly increased area of fibrosis and hydroxyproline content in the liver. SAC and NAC each markedly attenuated the development ofhepatic fibrosis. SAC and NAC markedly suppressed the PS-induced increase in alpha-SMA expressions.
Oral administration of SAC reduced PS-induced hepatic fibrosis in rats via inhibition of HSC activation. SAC could provide a new therapeutic strategy for hepatic fibrosis.
Osaka city medical journal 12/2009; 55(2):61-9.
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ABSTRACT: The majority of hepatocellular carcinomas are associated with chronic infection with hepatitis B or C virus. Recently, however, the proportion of non-B non-C hepatocellular carcinomas has been increasing. It is necessary to determine the optimal surgical approach for non-B non-C hepatocellular carcinoma.
Seventy-seven patients with non-B non-C hepatocellular carcinoma who underwent curative hepatic resection were included in this study. Univariate and multivariate analyses were performed to clarify risk factors for postoperative recurrence of non-B non-C hepatocellular carcinoma.
On univariate analysis, surgical margin <5 mm (P = 0.001) and the presence of multiple tumors (P = 0.002) were significantly associated with lower disease-free survival rate. On multivariate analysis, surgical margin <5 mm and the presence of multiple tumors were independent risk factors for postoperative recurrence.
Curative resection with adequate surgical margins for single non-B non-C hepatocellular carcinoma can achieve a good outcome.
Journal of hepato-biliary-pancreatic sciences. 09/2009; 17(3):291-5.
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Akihiro Tamori,
Takehiro Hayashi,
Mayumi Shinzaki,
Sawako Kobayashi,
Shuji Iwai,
Masaru Enomoto,
Hiroyasu Morikawa,
Hiroki Sakaguchi,
Susumu Shiomi, Shigekazu Takemura,
Shoji Kubo,
Norifumi Kawada
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ABSTRACT: Hepatocellular carcinoma (HCC) develops several years after the eradication of hepatitis C virus (HCV) by interferon therapy. Risk factors for the development of HCC are only partly understood. To elucidate the role of occult hepatitis B virus (HBV) infection in hepatocarcinogenesis in patients with sustained virologic response, the prevalences of HBV-related makers were examined. Study group comprised 16 patients with sustained virologic response (group A) and 50 with HCV (group B). Anti-HBc and anti-HBs in serum were examined by enzyme-linked immunoassay. HBV DNA in liver was examined by nested polymerase chain reaction, using primers specific for genes encoding for HBx, HBsAg, HBcAg, and HBV cccDNA. Sequence of the amplified HBV DNA for 'a' determinant of HBsAg was determined in HCC. Anti-HBc was positive in 10 of 16 in group A and 25 of 50 in group B. HBV DNA in liver was detected in 12 of 16 in group A and 21 of 50 in group B (P = 0.044). In group A, HBV DNA in liver was detected frequently in patients without cirrhosis and in those with a longer period from the time of HCV eradication to the development of HCC. Mutation in 'a' determinant of HBsAg was found in three HCC of group A. Occult HBV infection may be one of the most important risk factors in hepatocarcinogenesis of Japanese patients with sustained virologic response.
Journal of Medical Virology 05/2009; 81(6):1009-14. · 2.82 Impact Factor
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ABSTRACT: Hepatic resection is main approach to treatment of hepatolithiasis, but the long-term follow-up results of hepatic resection for hepatolithiasis are rarely reported.
A retrospective study was conducted of 87 patients with hepatolithiasis who underwent hepatic resection.
The final stone clearance rates were 95%. There was a significant difference in the incidence of recurrent stones between patients with and without remaining biliary strictures. On multivariate analysis, the presence of residual or recurrent stones was an independent risk factor associated with recurrent cholangitis. The 10-year overall survival rate was 80.3%. On multivariate analysis, the development of cholangiocarcinoma was an independent predictor of survival in patients who underwent hepatic resection for hepatolithiasis.
The long-term outcomes after hepatic resection were satisfactory in patients whose intrahepatic stones and strictures were completely removed. Cholangiocarcinoma associated with hepatolithiasis was an independent prognostic factor in patients with hepatolithiasis who underwent hepatic resection.
American journal of surgery 03/2009; 198(2):199-202. · 2.36 Impact Factor
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Hiroji Shinkawa,
Takuya Nakai,
Akihiro Tamori,
Hiromu Tanaka, Shigekazu Takemura,
Kazuki Ohba,
Takahiro Uenishi,
Masao Ogawa,
Satoshi Yamamoto,
Seikan Hai,
Tsuyoshi Ichikawa,
Shintaro Kodai,
Kazuhiro Hirohashi,
Kenichi Wakasa,
Shoji Kubo
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ABSTRACT: A 62-year-old man had been followed up for chronic hepatitis B (HB) since 1973. Hepatocellular carcinoma (HCC) was detected in 1985, at the age of 42 years. Serum HB surface antigen and anti-HB envelope antibody were positive at that time. A right hepatic lobectomy was performed. In 1995, serum HB surface antigen had cleared spontaneously and liver function had normalized. In March 2005, at the age of 62 years, a 1.5-cm diameter hepatic mass was detected in the left lateral segment. At that time, he was seropositive only for anti-HB core antibody. A diagnosis of recurrent HCC was made, and partial hepatectomy was performed. Covalently closed circular HBV DNA was detected in both cancerous and noncancerous tissues by nested polymerase chain reaction (PCR). Cassette-ligation-mediated PCR showed that HBV DNA was integrated into the telomerase reverse transcriptase gene located on chromosome 5p15.
International Journal of Clinical Oncology 01/2009; 13(6):562-6. · 1.41 Impact Factor
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Tsuyoshi Ichikawa,
Takahiro Uenishi, Shigekazu Takemura,
Kazuki Oba,
Masao Ogawa,
Shintaro Kodai,
Hiroji Shinkawa,
Hiromu Tanaka,
Takatsugu Yamamoto,
Shogo Tanaka,
Satoshi Yamamoto,
Seikan Hai,
Taichi Shuto,
Kazuhiro Hirohashi,
Shoji Kubo
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ABSTRACT: A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma.
Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses.
Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10.
Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.
Journal of Hepato-Biliary-Pancreatic Surgery 01/2009; 16(1):42-8. · 1.60 Impact Factor
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ABSTRACT: This study examined effects of S-allyl cysteine (SAC) on carbon tetrachloride (CCl4)-induced interstitial pulmonary fibrosis in Wistar rats. CCl4 (0.5 ml/kg) was intraperitoneally injected into rats twice a week for 8 weeks, and SAC (50, 100, or 200 mg/kg), N-acetyl cysteine (NAC, 200 or 600 mg/kg), or L-cysteine (CYS, 600 mg/kg) were orally administrated to rats everyday for 8 weeks. SAC significantly reduced the increases of transforming growth factor beta, lipid peroxides, AST, and ALT in plasma, induced by CCl4. Although CCl4 is mainly metabolized by hepatic cytochrome P450, CCl4 induced systemic inflammation and some organ fibrosis. SAC dose-dependently and significantly attenuated CCl4-induced systemic inflammation and fibrosis of lung. SAC also inhibited the decrease of thiol levels, the increase of inducible nitric oxide synthase expression, the infiltration of leukocytes, and the generation of reactive oxygen species in lungs. Although NAC and CYS attenuated CCl4-induced pulmonary inflammation and fibrosis, the order of preventive potency was SAC > NAC > CYS according to their applied doses. These results indicate that SAC is more effective than other cysteine compounds in reducing CCl4-induced lung injury, and might be useful in prevention of interstitial pulmonary fibrosis.
BioFactors 12/2008; 26(1):81 - 92. · 4.93 Impact Factor
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Takashi Iwata,
Noritoshi Nishiyama,
Koshi Nagano,
Nobuhiro Izumi,
Shinjiro Mizuguchi,
Ryuhei Morita,
Takuma Tsukioka,
Shoji Hanada,
Kiyotoshi Inoue,
Shoji Kubo, Shigekazu Takemura,
Shigefumi Suehiro
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ABSTRACT: This study was designed to determine the clinical characteristics and verify the results of surgical treatment for non-small cell lung cancer (NSCLC) in patients with hepatocellular carcinoma (HCC), from the results of retrospective analysis of the cases.
We retrospectively reviewed our database of 751 patients who underwent curative surgical intervention for NSCLC from January 1993 to December 2006 and found 11 patients with NSCLC with coexisting or previously treated HCC at a perioperative period of lung cancer surgery. Postoperative complications and long-term outcome were analyzed.
All cases had coexisting liver cirrhosis. The overall morbidity was 27.2% (n = 3). All complications were considered to be the result of liver cirrhosis-related conditions, such as liver failure (n = 2), postoperative bleeding from the thoracic tube (n = 2), and gastrointestinal bleeding (n = 1). There was no operative mortality. The 1-, 3-, and 5-year survival rates of patients with lung cancer were 88.9%, 74.1%, and 74.1%, respectively. The 1-, 3-, and 5-year survival rates for death from hepatic causes were 79.5%, 79.5%, and 39.8%, respectively. Overall survival rates were 70.7%, 58.9%, and 29.5%, respectively. Preoperative indicators of liver function, such as serum values of total bilirubin (P < 0.01), choline esterase (P < 0.05), prothrombin test (P < 0.01), and platelet count (P < 0.05), were significantly correlated with long-term survival, whereas local extensiveness and nodal stage of lung cancer were not.
We conclude that postoperative complications and factors that influence long-term survival are correlated with the severity of impaired liver function, whereas early and mid term death are the result of lung cancer. Standard operation is encouraged for NSCLC when the patient is expected to live more than 3 years with impaired liver function, even if coexisting with HCC.
World Journal of Surgery 11/2008; 32(10):2204-12. · 2.36 Impact Factor
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ABSTRACT: Interferon therapy might reduce recurrence after resection of hepatitis C virus-related hepatocellular carcinoma, especially among sustained virologic or biochemical responders.
Of 209 patients who underwent curative resection for early-stage hepatitis C virus related hepatocellular carcinoma, 70 patients underwent interferon therapy. A sustained virologic or biochemical response was achieved in 40 patients (SVR/BR group). Thirty no responders and 139 patients who had not received interferon therapy were classified as the NR/non-IFN group. Risk factors for postoperative recurrence in each group were analyzed.
The tumor-free survival rates in the SVR/BR group were significantly higher than those in the NR/non-IFN group. By multivariate analysis, the presence of multiple tumors was independently associated with recurrence after resection in both groups, while histologic evidence of cirrhosis was another independent risk factor for postoperative recurrence in the NR/non-IFN group.
Newly multicentric carcinogenesis after resection could be suppressed when active hepatitis is controlled by interferon therapy. Patients with single hepatitis C virus related hepatocellular carcinoma detected after successful interferon therapy are good candidates for surgical resection. Adjuvant interferon therapy might be indicated for patients who undergo curative resection for single hepatocellular carcinoma associated with hepatitis C.
Journal of Surgical Oncology 10/2008; 98(5):358-62. · 2.10 Impact Factor
