Background: Although hepatic resection is one of the most effective treatments for hepatocellular carcinoma (HCC), the longterm results of hepatic resection of this malignancy are far from ...satisfactory. The potential benefits of hepatectomy for patients with HCC have not been fully delineated. This study aimed to identify surgical outcomes of 386 consecutive patients with HCC undergoing hepatic resection.
Study Design: The retrospective study looked at records of 293 men and 93 women. The mean age was 63.2 years. Preoperative transarterial chemoembolizaton and portal vein embolization were performed in 138 patients (35.8%) and 8 patients (2.1%), respectively. Sixty-two patients (16.1%) had major hepatectomy and the other 324 (83.9%) had minor hepatectomy. Thirty-seven of 386 patients (9.6%) had a noncurative operation.
Results: The 30-day (operative) mortality rate was 4.1%, and there were 11 additional late deaths (2.9%). Two hundred fourteen of 327 patients (65.4%) had recurrence after curative resection. Unfavorable factors for survival and recurrence were resection between 1983 and 1990, Child class B or C, cirrhosis, a high value of indocyanine green retention-15, a large amount of intraoperative blood loss, stage IV disease, positive surgical margin, vascular invasion, and postoperative complications. Preoperative transarterial chemoembolization increased the recurrence rate and showed no contribution to prognosis. Currently, 106 patients (27.5%) are alive: 7 (1.8%) after more than 10 years and 43 (11.1%) after more than 5 years. Mean and median overall survivals after operation were 38 months and 29 months, respectively. The 5-year and 10-year overall or disease-free survival rates after hepatic resection were 34.4% and 10.5% or 23.3% and 7.8%, respectively.
Conclusions: The longterm survival rate after operation remains unsatisfactory mainly because of the high recurrence rate. Preoperative transarterial chemoembolization should be avoided because of a high risk of postoperative recurrence. Treatment strategies for recurrent HCC may play an important role in achieving better prognosis after operation, especially in patients with more than Child class B, cirrhosis, high values of indocyanine green retention-15, massive intraoperative blood loss, stage IV disease, positive surgical margin, vascular invasion, and postoperative complica- tions.
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GEOZS, IJS, NUK, OILJ, SBCE, SBJE, UL, UM, UPUK
The purpose of this investigation was to evaluate the effect of magnesium sulfate (magnesium) alone or along with urinary trypsin inhibitor (UTI) in a mouse model in the prevention of preterm ...delivery.
On day 17 of pregnancy, female C3H/HeN mice impregnated by male B6D2F1 mice were given two intraperitoneal injections of lipopolysaccharide (LPS; 50 microg/kg) at a 3-hour interval, which treatment induced a 100% incidence of preterm delivery within 25 hours of the second dose. Magnesium (4, 5, 6, 7, or 8 mg/hr, s.c.), UTI (25 x 10(4) units/kg, i.p.), magnesium (5 mg/hr, s.c.) plus UTI (25 x 10(4) units/kg, i.p.), saline solution (0.3 ml/hr, s.c.), or saline solution (0.1 ml/hr, s.c. and 2.5 ml/kg, i.p.) was administered to pregnant animals on day 18 of gestation. UTI was intraperitoneally given 5 times at 2-hour intervals from 8:00 am to 4:00 pm, and magnesium was infused subcutaneously and constantly from 8:00 am to 6:00 pm. In addition, the preventive effect of magnesium on LPS-induced contraction of uterine muscle strips and that of magnesium, UTI, or magnesium plus UTI on LPS-induced calcium influx in uterine smooth muscle cells were examined using muscle tissue isolated from pregnant mice on day 17 of gestation.
The incidence of preterm delivery decreased significantly in a dose-dependent fashion with magnesium treatment, and there was a significant and synergistic decrease after combined treatment with magnesium plus UTI. The in vitro uterine contraction and calcium influx induced by LPS were significantly suppressed by magnesium. The latter was significantly suppressed by UTI and additively reduced by magnesium plus UTI.
Combination therapy with magnesium plus UTI may possibly be helpful for preventing preterm delivery in humans without the severe side effects induced by hypermagnesemia.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To examine the mechanism of reduced tolerance to glucose in obstructive jaundice, insulin and glucagon metabolism was examined using mongrel dogs. Perfused pancreas isolated from obstructive jaundice ...dogs was used for this purpose, and the following results were obtained. Insulin release from the pancreas was decreased but glucagon was not changed by stimulation with cholecystokinin octapeptide. Extraction of insulin and glucagon in the liver was examined using the dogs which had cholestatic and non-cholestatic lobes in each individual. Insulin levels of the hepatic blood were significantly lower than those of the portal blood. In comparison of the insulin levels between the hepatic blood from cholestatic and non-cholestatic lobes, the value of the cholestatic hepatic blood was significantly higher than that of the non-cholestatic hepatic blood. Concerning on glucagon, however, there were no significant differences between the two blood samples. Therefore, the reduced tolerance to glucose in obstructive jaundice could not be attributed to the enhanced extraction of insulin in the liver but to the decrease of insulin production in the pancreas.
Although the incidence of hepatocellular carcinoma (HCC) with hepatitis C virus (HCV) infection is higher than in patients with hepatitis B virus (HBV)-related HCC in Japan, the long-term prognosis ...and prognostic factors of HCV-related HCC after hepatic resection are poorly understood.
The surgical outcome of HCV-related HCC in 172 consecutive patients who underwent hepatic resection between 1989 and 1997 was retrospectively clarified. Postresection prognostic factors were evaluated by univariate and multivariate analysis using Cox's proportional hazards model.
The overall incidence of postoperative complications was 23.2%, and 11 patients among that group had hospital deaths (6.4%) including 9 (5.2%) operative deaths. The mean and median overall survivals including hospital death after surgery were 41 months and 33 months, respectively. The 3-, 5-, and 7-yr overall survival rates after hepatic resection were 63%, 52%, and 47%, respectively. The 3-, 5-, and 7-yr disease-free survival rates after hepatic resection were 33%, 20%, and 15%, respectively. Multivariate analysis revealed that serum alpha-fetoprotein (AFP) of > or = 1000 ng/ml and the presence of vascular invasion were independent unfavorable prognostic factors affecting overall survival and that AFP of > or = 1000 ng/ml was an independently significant factor of poor disease-free survival.
We found the postresection survival of patients with HCV-related HCC should be stratified by the high value of AFP and the presence of vascular invasion. AFP may be the most powerful predictor of the long-term prognosis and recurrence in such patients.
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