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Abstract:
The precise assessment of both tumor factor and the liver function is of a crucial value the surgical treatment with the greatest guarantee of hepatocellular carcinoma (HCC), as the balance between the operative procedure and the remnant liver function is the most important concern in patients with chronic liver disease. The mortality rate in liver resection has decreased significantly worldwide, according to various surgical criteria for liver resection. Among countries where HCC is prevalent Japan is a leading country in doing liver resection. The Japanese evidence-based guidelines for the surgical treatment for HCC were generated in 2005, and the third revised version is now available. A strict evaluation policy for surgical indications and management based on such evidence helps to minimize the mortality rate in these patients. Herein, we report a series of unique approaches to the perioperative management of liver resection based on the available evidence with the goal of achieving 'no mortality' in liver resection for HCC.Keywords:
Chronic liver disease
Liver function
Surgical resection
There has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.
Indocyanine Green
Liver function
Steatosis
Occult
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Subclinical infection
Cardiothoracic surgery
Vascular surgery
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We studied the functional reserve and ability to regenerate of non-embolized liver made hypertrophic by portal vein embolization (PVE) to evaluate the usefulness of two-stage hepatectomy with preoperative PVE. Rats underwent one of four treatments: 1, 70% hepatectomy; 2, 70% hepatectomy 7 days after PVE; 3, 30% hepatectomy; and 4, sham operation. Liver weight, the bromodeoxyuridine labeling index (LI), and the mitotic index (MI) were calculated after surgery. The lipid peroxide level of the liver, serum hepatic enzyme activities, total bilirubin concentration, prothrombin time, and antithrombin-3 activity were also assayed after surgery in each group. Non-embolized lobes made hypertrophic by PVE regenerated further after resection of the embolized portion of the liver. The increases in liver weight, LI, and MI in group 2 were significantly lower than in group 1, but tended to be higher than in group 3. In group 2, lipid peroxidation in the liver and postoperative disorders of liver function and the coagulation system were significantly less than in group 1, and were similar to those in group 3. Preoperative PVE increases not only the weight but also the function of the residual liver, which makes extended hepatectomy safer.
Liver function
Portal vein embolization
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Liver Regeneration
Liver function
Prothrombin time
Liver cell
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Objective: To investigate the clinical application of the half-hepatic blood occlusion for hepatectomy to decrease bleeding during the operation,relieve liver functional impairment and decrease operation risk.Methods: Sixteen cases of half-hepatic blood flow occlusion intra-operation underwent operations of hepatectomy and the stones were removed by cholangiotomy.The postoperative complications,the residual stone in intrahepatic cholelithes,the reoperation rate and the index of liver function were evaluated.Results: After operation,all cases obtained quick recovery of the liver function,and no death and complications occurred.Conclusion: The hemi-hepatic blood flow occlusion for hepatectomy was a feasible,reasonable and effective procedure due to its good control of blood loss,retention of blood circulation in the healthy side of the liver,and lessening of intraoperation and postoperation liver dysfunction.
Liver function
Hepatic function
Vascular occlusion
Hepatic dysfunction
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Percutaneous transhepatic portal vein embolization (PTPE) increases the safety of subsequent major hepatectomy. The aim of this study was to determine the effect of PTPE on long-term prognosis after hepatectomy in patients with hepatocellular carcinoma (HCC).Seventy-one patients with HCC underwent right hepatectomy between 1984 and 1998. Preoperative PTPE was performed in 33 patients (group 1) and was not used in 38 patients (group 2). Outcome after operation was compared between the groups. The patients were further divided according to the median tumour diameter (cut-off 6 cm) and indocyanine green retention rate at 15 min (ICGR15) (cut-off 13 per cent).The cumulative survival rate was significantly higher in group 1 than in group 2 in patients with an ICGR15 of at least 13 per cent. Tumour-free survival rates were similar in both groups. Of patients with tumour recurrence after right hepatectomy, those in group 1 were more frequently subjected to further treatment.Preoperative PTPE improves the prognosis after right hepatectomy for HCC in patients with impaired hepatic function, although it does not prevent tumour recurrence.
Portal vein embolization
Hepatic function
Liver function
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Liver function
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Impaired liver function attenuates liver regeneration and hypertrophy after portal vein embolization
To clarify the clinical factors associated with liver regeneration after major hepatectomy and the hypertrophic rate after portal vein embolization (PVE).A total of 63 patients who underwent major hepatectomy and 13 patients who underwent PVE in a tertiary care hospital between January 2012 and August 2015 were included in the analysis. We calculated the remnant liver volume following hepatectomy using contrast-enhanced computed tomography (CT) performed before and approximately 3-6 mo after hepatectomy. Furthermore, we calculated the liver volume using CT performed 2-4 wk after PVE. Preoperative patient characteristics and laboratory data were analyzed to identify factors affecting postoperative liver regeneration or hypertrophy rate following PVE.The remnant liver volume/total liver volume ratio negatively correlated with the liver regeneration rate after hepatectomy (ρ = -0.850, P < 0.001). The regeneration rate was significantly lower in patients with an indocyanine green retention rate at 15 min (ICG-R15) of ≥ 20% in the right hepatectomy group but not in the left hepatectomy group. The hypertrophic rate after PVE positively correlated with the regeneration rate after hepatectomy (ρ = 0.648, P = 0.017). In addition, the hypertrophic rate after PVE was significantly lower in patients with an ICG-R15 ≥ 20% and a serum total bilirubin ≥ 1.5 mg/dL.The regeneration rate after major hepatectomy correlated with hypertrophic rate after PVE. Both of them were attenuated in the presence of impaired liver function.
Liver Regeneration
Liver function
Indocyanine Green
Portal vein embolization
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Abstract: Background: The assessment of liver function during human liver regeneration is necessary to prevent unexpected liver failure and to prepare for further treatment. We selected patients prospectively and measured serum lipid and lipoprotein levels to identify which lipids and lipoproteins could represent recovery of liver function in human liver regeneration. Methods: Thirty selected patients who underwent hepatectomy were divided into three groups depending on the serum hyaluronate (HA) level and the type of liver resection. Results: We found three patterns of lipid and lipoprotein alterations after hepatectomy. Among the lipids and lipoproteins examined, the serum β‐lipoprotein and low‐density lipoprotein (LDL) levels were significantly different among the groups at 7 days after hepatectomy. The alteration of the apolipoprotein (Apo) B level was similar to that of LDL. The LDL level was correlated with both β‐lipoprotein and Apo B before hepatectomy ( r =0.653 and 0.894, respectively) and at 7 days after hepatectomy ( r =0.841 and 0.943, respectively). Conclusion: Serum HA before hepatectomy can reflect postoperative liver function depending on the type of liver resection. Recovery of the β‐lipoprotein and LDL levels can reflect the recovery of liver function in human liver regeneration within the early period in association with the Apo B level.
Liver Regeneration
Liver function
Low-density lipoprotein
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Objective To study the impact of various donor hepatectomy techniques on clinical rehabilitation and postoperative liver regeneration on living donor liver transplant (LDLT) donors.Methods The data of 13 consecutive LDLT carried out from May 2006 to May 2011,including the surgical techniques,postoperative liver function,and liver regeneration in the donors were retrospectively studied.Results The donor operations included 8 right hepatectomies without the middle hepatic vein,2 right hepatectomies with the middle hepatic vein and 3 left hepatectomies.Hepatic function and blood coagulation function returned to normal within two weeks of hepatectomy in all the donors.There was no severe complication and no death.There was a significant positive correlation between the donor liver volume as measured preoperatively on CT and the resected liver weight as measured intraoperatively (r=0.838,P＜0.01).The volume of the remnant liver increased soon after transplantation.The liver regenerated significantly faster in right than in lefft liver donors.The remnant liver of the right liver donors with middle hepatic vein preservation grew faster than the right liver donors without middle hepatic vein preservation.However,there was no significant difference in the recovery of the liver function between the three groups.Conclusions Donor hepatectomy is safe.The postoperative liver regeneration is affected by multiple factors including the remnant liver volume and blood supply of the remnant liver.
Key words:
Living donor liver transplantation; Donor; Hepatectomy; Liver regeneration
Liver Regeneration
Liver function
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