[Show abstract][Hide abstract] ABSTRACT: Background/aims:
We investigated the clinicopathological findings and outcome after surgery for hepatocellular carcinoma in patients without hepatitis B or C virus infection.
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.
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.
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.
No preview · Article · Sep 2012 · Hepato-gastroenterology
[Show abstract][Hide abstract] 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.
No preview · Article · Feb 2010 · Clinical Journal of Gastroenterology
[Show abstract][Hide abstract] 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.
No preview · Article · Sep 2009 · Journal of Hepato-Biliary-Pancreatic Sciences
[Show abstract][Hide abstract] ABSTRACT: Background: Management of abdominal drainage after liver resection has not been well established. Methods: We compared clinicopathological findings between patients with the long-term abdominal drainage (5 days or more, long-term group, 32 patients) and those with the short-term abodaminal drainage (4 days or less, short-term group, 72 patients) to study the risk factors for the long-term (5 days or more) abdominal drainage. We also studied the management of abdominal drainage in postoperative bleeding, biliary leakage, intraab-dominal infection, wound infection, refractory pleural effusion, and refractory ascites in 104 patients who underwent liver resection. Results: The drains were removed on postoperative day 4.1 ± 1.3 if the drainage fluid did not contain bile. The risk factors for the long-term abdominal drainage included lager tumor, segmen-tectomy and bisegmentectomy, a long operation time, massive blood loss, and a large amount of drainage fluid (200ml/day at the 4th postoperative day) by univariate analysis and a long operation time, massive blood loss, and a large amount of drainage fluid were independent risk factors by multivariate analysis. Postoperative bleeding did not occur. Biliary leakage developed in one patient in whom an RTBD catheter was placed because of stenosis of the bile duct after central bisegmentectomy. In another patient, biliary leakage developed 16 days after surgery, with intraabdominal infection caused by Staphylococcus aureus infection through the catheter after treatment for biliary leakage. The drainage catheter was replaced in 2 patients in whom refractory pleural effusion or ascites developed. Wound infection developed in one patient. Infection of the drainage site occurred in one patient in whom the catheter was removed 7 days after surgery. There were no differences in the incidence of such postoperative complications between the short-term and long-term groups. Conclusions: Removal of abdominal drainage catheters within 4 days after liver resection is reasonable if the drainage fluid does not contain bile.
[Show abstract][Hide abstract] 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.
No preview · Article · Jan 2009 · International Journal of Clinical Oncology
[Show abstract][Hide abstract] ABSTRACT: In living donor liver transplantation for Budd-Chiari syndrome, it is necessary to eliminate interference with outflow from the liver without the replacement of the involved retrohepatic segment of the inferior vena cava. A 34-year-old female patient underwent living donor liver transplantation for Budd-Chiari syndrome. During surgery, the fibrous tissue surrounding the recipient inferior vena cava was dissected after removal of the recipient liver. The diaphragm was dissected and mobilized from the inferior vena cava on the cranial side to expose the intact inferior vena cava in the posterior mediastinum. The left and middle hepatic veins in the graft liver were anastomosed to a horizontal anastomotic orifice prepared in the anterior wall of the intact inferior vena cava in the posterior mediastinum. Anticoagulant therapy was begun after liver transplantation. Dynamic computed tomography after living donor liver transplantation demonstrated patent hepatic veins. The patient has been doing well, without any episode of thrombosis or occlusion of the graft hepatic veins at 1 year and 6 months after liver transplantation.
No preview · Article · Jan 2009 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Although a second hepatic resection (SHR) for recurrent hepatocellular carcinoma (HCC) is widely accepted, the indications for SHR have not been established. The risk factors for HCC recurrence after SHR were evaluated to investigate the indications for SHR.
Subjects included 51 patients who underwent a second hepatic resection for recurrence of HCV-related HCC. Sixteen patients received interferon therapy before or after the first operation. Six patients attained a sustained viral response (SVR) that was defined as return of the alanine aminotransferase (ALT) activity to within the reference range and no detectable serum HCV RNA for at least 1 year after interferon therapy. A biochemical response (BR), defined as a normalized ALT activity for at least 1 year after interferon therapy with or without the transient disappearance of serum HCV RNA, was attained in three patients. The other seven patients were defined as the nonresponse (NR) group.
By univariate analysis, NR and lack of interferon therapy, high indocyanine green retention rate at 15 min (ICGR15), high aspartate aminotransferase activity, high ALT activity, large tumor, and multiple tumors were risk factors for HCC recurrence after SHR. By multivariate analysis, NR and lack of interferon therapy, high ICGR15, large tumor, and multiple tumors were independent risk factors.
Patients in whom active hepatitis has been controlled by interferon therapy are the best candidates for SHR. Interferon therapy should be recommended in patients undergoing resection of an HCV-related HCC because SHR can prolong life in SVR and BR patients.
No preview · Article · May 2008 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: The liver hanging maneuver is widely used in right lobectomy to resect huge tumors and harvest living donors. The convenience of tape assistance in other types of hepatectomy is not well known.
Tape-guiding technique (TGT) was applied in 30 hepatectomies of different type between April 2003 and April 2006. The indications were liver carcinoma in 22 and living-donor in 8. Hepatectomies included right lobectomy, 14; left lobectomy with caudate lobectomy, 8; left lobectomy without caudate lobectomy, 2; lateral segmentectomy, 3; central bisegmentectomy, posterior segmentectomy, and superior dorsal partial resection, 1 each. A tape was placed in front of the inferior vena cava for right hepatectomy and left hepatectomy with caudate lobectomy. In other hepatectomies, the tape was positioned to be the target of parenchymal dissection.
TGT was successfully performed in all 30 cases. Tape facilitated dissection by helping the surgeon maintain orientation, and traction on the tape flattened the parenchyma, making it easier to identify and manage vessels and ducts. With an assistant holding the tape, the surgeon's left hand was free, and ligation and suturing was easier and more secure.
The TGT is a convenient technique that is applicable to different types of liver resection.
No preview · Article · Jan 2008 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: We investigated the clinical and virologic findings in hepatitis B surface antigen (HBsAg)-negative and anti-hepatitis C virus antibody (anti-HCV)-negative patients with hepatocellular carcinoma (HCC) to investigate the role of previous or occult hepatitis B virus (HBV) infections in the development of HCC.
We examined sera and HCC samples from 40 HBsAg-negative and anti-HCV-negative patients. Sera were tested for some viral markers, and genomic DNA was extracted from the HCC samples. HBx RNA was also extracted from the HCC and amplified by a polymerase chain reaction with reverse transcription (RT-PCR).
Hepatocellular carcinomas from five patients with anti-HBc (group 1, 25 patients) and nine patients without anti-HBc (group 2, 15 patients) were examined for HBx RNA. HBx RNA was detected in four of the five HCC samples from group 1 and in four of the nine HCC samples from group 2.
These findings suggested that previous or occult hepatitis B virus infection is common in HBsAg-negative and anti-HCV-negative patients with HCC.
[Show abstract][Hide abstract] ABSTRACT: We investigated the role of hepatitis B virus infection in development of hepatocellular carcinoma in hepatitis C virus-infected patients without hepatic fibrosis. Of 253 patients, 8 lacked hepatic fibrosis (group 1); group 2 included the remaining 245 patients. Clinicopathologic findings were compared between the groups. Hepatitis B x gene was sought in cancers and adjoining noncancerous liver. Group 1 showed better liver function parameters and milder active hepatitis than group 2. The proportion of patients with anti-hepatitis B virus antibody tended to be higher in group 1 than in group 2. The proportion of patients with hepatitis B x RNA in cancers was significantly higher in group 1 than in group 2. All group 1 patients had previous or occult hepatitis B virus infection. Previous or occult hepatitis B virus infection may be critical in development of hepatocellular carcinomas in hepatitis C virus-infected patients without hepatic fibrosis.
No preview · Article · Dec 2001 · Digestive Diseases and Sciences
[Show abstract][Hide abstract] ABSTRACT: Treatment for dissemination of hepatocellular carcinoma to the pleura and diaphragm following percutaneous needle biopsy has not been established.
The case of a 57-year-old man who underwent percutaneous needle biopsy for liver tumor is presented.
Ten months after resection of the tumor (moderately differentiated hepatocellular carcinoma), masses in the right pleural cavity and on the diaphragm were detected by computed tomography. Resections of the masses with surrounding tissue and the diaphragm and wedge resection of the right lung were performed. A wide range of the pleura and the diaphragm was coagulated with an argon beam coagulator. The patient is in good health without recurrence 4 years after the operation.
Aggressive surgical treatment should be considered for patients with dissemination of hepatocellular carcinoma by needle biopsy when the lesions are limited.
No preview · Article · Feb 2001 · Digestive Surgery