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Table of ContentsA study of therapy for pediatric hepatoblastoma: prevention and treatment of pulmonary metastasis. A multi-centre randomized phase II study of nolatrexed versus doxorubicin in treatment of Chinese patients with advanced hepatocellular carcinoma. ERCP and stent therapy for progressive jaundice in hepatocellular carcinoma: which patients benefit, which patients don't? A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease. Major compared with limited hepatic resection for hepatocellular carcinoma without underlying cirrhosis: a retrospective analysis. Hepatic resection and percutaneous ethanol injection for the treatment of selected patients with more than one hepatocellular carcinoma. [Study on small hepatocellular carcinoma: a review of 20 years experience] [Factors linked to 5-year survival after hepatectomy for hepatocellular carcinoma: univariate and multivariate analyses of 312 patients] Determining the optimal block margin on the planning target volume for extracranial stereotactic radiotherapy. Orthotopic liver transplantation for unresectable hepatoblastoma: a single center's experience. Total vascular exclusion for liver resections: pros and cons. Management of hepatocellular carcinoma: many ways to skin a cat [editorial] Prognosis of small hepatocellular carcinoma after laparoscopic ethanol injection. Surgical treatment of hepatocellular carcinoma in cirrhotic and noncirrhotic patients. Comparative study of survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. *Efficacy of an implanted drug delivery system for advanced hepatocellular carcinoma using 5-fluorouracil, epirubicin and mitomycin C. Ratio of branched chain amino acid to tyrosine after hepatectomy. Should hepatomas be treated with hepatic resection or transplantation? [Vascular clamping in cirrhotic liver surgery] Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a 'cooled-tip needle'. A preliminary clinical experience. Serum hyaluronan as a predictor of hepatic regeneration after hepatectomy in humans. [Prevention of hepatic carcinogenesis by retinoids] Chromosome breakage and cell lethality in human hepatoma cells irradiated with X rays and carbon-ion beams. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management [see comments] 1UI - 99356495AU - Uchiyama M; Iwafuchi M; Naito M; Yagi M; Iinuma Y; Kanada S; Tsukada K TI - A study of therapy for pediatric hepatoblastoma: prevention and treatment of pulmonary metastasis. SO - Eur J Pediatr Surg 1999 Jun;9(3):142-5 AD - Department of Pediatric Surgery, Niigata University School of Medicine, Japan. Our results of treatment for pediatric hepatoblastoma are presented with special emphasis on pulmonary metastasis. The pulmonary metastasis rate of hepatoblastoma was 44% (11/25). In 19 patients with resected hepatoblastomas, the 5-year survival rate without pulmonary metastasis was 90% (9/10); while with pulmonary metastasis it was 22% (2/9). Six patients with unresected hepatoblastomas all died within 4 months regardless of chemotherapy and/or metastasis. To improve survival in patients with hepatoblastoma, preoperative or postoperative chemotherapy was thought to be essential for tumors extending over 2 hepatic segments and having predictable factors for pulmonary metastasis (large size or histological evidence of capsular invasion). A long-term multidisciplinary approach including hepatic lobectomy, current multiagent chemotherapy (including CDDP, THP-ADR), and partial pulmonary resection for localized lung areas with metastases would ultimately be needed. 2UI - 99376760AU - Mok TS; Leung TW; Lee SD; Chao Y; Chan AT; Huang A; Lui MC; Yeo W; Chak K; Johnston A; Johnson P TI - A multi-centre randomized phase II study of nolatrexed versus doxorubicin in treatment of Chinese patients with advanced hepatocellular carcinoma. SO - Cancer Chemother Pharmacol 1999;44(4):307-11 AD - Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China. mok206551@cuhk.eu.hk PURPOSE: A multi-centre randomized phase II study of single agent nolatrexed dihydrochloride versus doxorubicin was undertaken in Chinese patients with advanced hepatocellular carcinoma (HCC) to study and compare the clinical efficacy of the two drugs. METHODS: Fifty-four patients with clinical or histological diagnosis of HCC were randomized in a 2:1 ratio to receive nolatrexed or doxorubicin. Nolatrexed 725 mg/m(2)/day was given by continuous infusion via a central venous device for 5 days and doxorubicin 60 mg/m(2) was given as a rapid intravenous infusion every 3 weeks. RESULTS: No objective responses were observed in either treatment arm. Two patients in the nolatrexed arm and none in the doxorubicin arm had >50% decline in serum alpha-fetoprotein. The median survival for the patients in the nolatrexed and doxorubicin arms was 139 days and 104 days, respectively. Moderate toxicities including leukopenia, thrombocytopenia, mucositis and skin rash were observed in both treatment arms. CONCLUSION: Nolatrexed and doxorubicin are minimally active in the treatment of advanced HCC. Given the small sample size, no difference is observed between the two drugs. 3UI - 99418441AU - Martin JA; Slivka A; Rabinovitz M; Carr BI; Wilson J; Silverman WB TI - ERCP and stent therapy for progressive jaundice in hepatocellular carcinoma: which patients benefit, which patients don't? SO - Dig Dis Sci 1999 Jul;44(7):1298-302 AD - University of Pittsburgh Medical Center, Pennsylvania, USA. Jaundice in hepatocellular carcinoma (HCC) can be due to biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) can be both diagnostic and therapeutic. Biliary stenting can relieve jaundice and allow further chemotherapy, but at additional expense and potential morbidity. We sought to determine whether CT scan or ultrasound (US) could identify which patients with HCC and jaundice would benefit from endoscopic stenting. We retrospectively analyzed 26 patients with HCC and jaundice who underwent ERCP after CT or US. We compared biliary dilation on CT or US with the dominant biliary stricture seen on ERCP, and with response to biliary stenting. Eleven of 26 patients had dominant biliary stricture on ERCP; 11 underwent stenting. Six of 11 (55%) stented patients had a significant decline in bilirubin; three became eligible for further chemotherapy. All six responders to stenting had biliary dilation on prior CT or US. Procedure-related complications occurred in 1/11 (9%) who underwent stent placement. In conclusion, in selected patients, stenting can safely relieve jaundice and allow subsequent chemotherapy. CT or US accurately predicted lesions that responded to stenting. ERCP and stenting provided no benefit in the absence of biliary dilation on CT or US. 4UI - 99416054AU - Midorikawa Y; Kubota K; Takayama T; Toyoda H; Ijichi M; Torzilli G; Mori M; Makuuchi M TI - A comparative study of postoperative complications after hepatectomy in patients with and without chronic liver disease. SO - Surgery 1999 Sep;126(3):484-91 AD - Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. BACKGROUND: Although hepatic resection is the most reliable treatment for hepatocellular carcinoma, impaired liver function because of cirrhosis or chronic hepatitis contributes to relatively high rates of postoperative complications. We have reviewed a series of hepatectomies at our institution and investigated risk factors for complications after hepatectomy in patients with impaired liver compared with patients with normal liver. METHODS: From October 1994 to March 1998, 277 hepatectomies for hepatocellular carcinoma, cholangiocellular carcinoma, metastatic liver tumors, and other hepatic diseases were performed. In an attempt to clarify the safety of hepatectomy for the impaired liver at our institution, we did a comparative study of postoperative complications after hepatectomy in 2 groups: patients with impaired livers (187 hepatectomies) and patients with normal livers (90 hepatectomies). RESULTS: Of the 277 hepatectomies, bile leakage occurred in 25 patients (16 in impaired livers vs 9 in normal livers), abdominal infection in 45 patients (30 vs 15 patients), wound infection in 13 patients (9 vs 4 patients), pleural effusion in 52 patients (35 vs 17 patients), atelectasis in 26 patients (17 vs 9 patients), pneumonia in 4 patients (3 vs 1 patients), ileus in 6 patients (3 vs 3 patients), intra-abdominal hemorrhage in 3 patients (0 vs 3 patients), and hyperbilirubinemia in 5 patients (4 vs 1 patients). Hepatic insufficiency and hospital death were not experienced in this series. The mean postoperative hospital stay was 22.9 days (23.5 vs 23.1 days), and except for intra-abdominal hemorrhage there was no statistically significant difference between the 2 groups. CONCLUSIONS: Hepatectomy for the impaired liver is now as safe a procedure as for the normal liver, provided the overall guidelines outlined in our algorithm are followed. 5UI - 99379326AU - Nagasue N; Yamanoi A; el-Assal ON; Ohmori H; Tachibana M; Kimoto T; Kohno H TI - Major compared with limited hepatic resection for hepatocellular carcinoma without underlying cirrhosis: a retrospective analysis. SO - Eur J Surg 1999 Jul;165(7):638-46 AD - Department of Surgery, Shimane Medical University, Izumo, Japan. OBJECTIVE: To find out if patients with hepatocellular carcinoma (HCC) with no underlying cirrhosis benefit from major hepatic resection. DESIGN: Retrospective study. SETTING: University hospital, Japan. PATIENTS: 58 patients without cirrhosis and with HCC 10 cm in diameter or less. INTERVENTIONS: 25 had major and 33 had limited hepatic resections. MAIN OUTCOME MEASURES: Overall and disease-free survival, and prognostic factors verified by univariate and multivariate analyses. RESULTS: 6 patients developed major complications (10%), two of whom died within 60 days of operation. There were no differences in postoperative morbidity and mortality between the two groups. The overall and disease-free survival were similar as was the incidence and pattern of intrahepatic tumour recurrence. Hepatitis B surface (HBs) antigen (positive), tumour size (smaller than 3 cm), and surgical margin (clear) were favourable indicators of disease-free survival on multivariate analysis. CONCLUSIONS: Major hepatic resection should not necessarily be done for HCC without cirrhosis but it is important to take an adequate surgical margin. Overall and disease-free survival are better in patients who are HBs-antigen positive than those who are negative because most of the latter are positive for hepatitis C virus. 6UI - 99379327AU - Belli G; Iannelli A; Romano G; Marano I TI - Hepatic resection and percutaneous ethanol injection for the treatment of selected patients with more than one hepatocellular carcinoma. SO - Eur J Surg 1999 Jul;165(7):647-51 AD - Department of General Surgery and Organ Transplants, University of Naples, Federico II School of Medicine, Italy. OBJECTIVE: To report our results in a selected series of patients who had two separate hepatocellular carcinomas that were not suitable for treatment by resection alone or percutaneous injection of ethanol alone, whom we treated by a combination of the two. DESIGN: Open study. SETTING: Teaching hospital, Italy. SUBJECTS: 11 patients with Child's grade A or B cirrhosis who had two hepatocellular carcinomas in distant segments of the liver. INTERVENTIONS: Percutaneous injection of ethanol into the smaller of the two nodules before, during, or after resection. MAIN OUTCOME MEASURES: Morbidity, mortality, and recurrence. RESULTS: No patient died and there was one postoperative complication (atelectasis). During a median follow-up period of 24 months (range 8-48) two patients have developed recurrences (at 10 and 18 months). CONCLUSION: Although we have studied only a few patients for a relatively short time this double approach may be an important treatment option for suitable patients with two hepatocellular carcinomas. 7UI - 99382904AU - Tang Z; Yu Y; Zhou X; Yang B; Lin Z; Lu J; Ma Z; Liu K; Ye S; Wu Z TI - [Study on small hepatocellular carcinoma: a review of 20 years experience] SO - Chung Kuo I Hsueh Ko Hsueh Yuan Hsueh Pao 1997 Oct;19(5):395-400 8UI - 99412646AU - Ohgaki K; Shirabe K; Rikimaru T; Hamatsu T; Yamashita Y; Sugimachi K TI - [Factors linked to 5-year survival after hepatectomy for hepatocellular carcinoma: univariate and multivariate analyses of 312 patients] SO - Fukuoka Igaku Zasshi 1999 Jul;90(7):324-8 AD - Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka. The purpose of this study was to clarify the factors linked to 5-year survival after hepatectomy for hepatocellular carcinoma (HCC). Three hundreds and twelve patients who underwent hepatectomy for HCC between 1985 and 1994 were observed for at least 5 years. These patients were divided into 2 groups: 160 patients who died within 5 years after hepatectomy and 152 patients who did not die within 5 years. Statistical analysis by chi 2 test showed that the favorable factors linked to 5-year survival were (a) diabetes mellitus (-), (b) albumin > 3.7 g/dl, (c) hepaplastin test > 61%, (d) indocyanine green retention test at 15 minutes < 16%, (e) curative resection (+), (f) alpha-fetoprotein < or = 32 ng/ml, (g) portal vein invasion (-), (h) intrahepatic metastasis (-), and (i) stage I and II. Statistical analysis by stepwise regression test showed that the favorable factors linked to 5-year survival were (a) intrahepatic metastasis (-), (b) diabetes mellitus, (c) indocyanine green retention test at 15 minutes < 16%, (d) curative resection (+) and (e) alpha-fetoprotein < or = 32 ng/ml. When patients diagnosed with HCC, patients selection for hepatectomy should be done, based on the total estimation, such as tumor invasiveness, liver functions, and diabetes mellitus. 9UI - 99415520AU - Cardinale RM; Wu Q; Benedict SH; Kavanagh BD; Bump E; Mohan R TI - Determining the optimal block margin on the planning target volume for extracranial stereotactic radiotherapy. SO - Int J Radiat Oncol Biol Phys 1999 Sep 1;45(2):515-20 AD - Department of Radiation Oncology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond 23298-0058, USA. PURPOSE: To determine the block margin that minimizes normal tissue irradiation outside of the planning target volume (PTV) for body stereotactic radiotherapy (Body-SRT) of lung and liver tumors. METHODS AND MATERIALS: Representative patient cases of lung and liver tumors were chosen for analysis. A PTV was constructed for each case and plans were generated which employed an array of block margins ranging from -2.5 mm to 10 mm at isocenter. Plans were generated for cerrobend blocks and for a multileaf collimator. The prescription isodose coverage was renormalized for each case and dose-volume histograms (DVH) and normal tissue complication probabilities (NTCP) were determined for each plan. RESULTS AND CONCLUSION: For the cases studied, the optimal block margin was in the 0.0 mm range. The ranking of plans was identical for both dose-volume based and biological based criteria. The method of blocking had no significant effect on treatment plans. The use of narrow margins for Body-SRT results in normal tissue sparing and creates significant target dose inhomogeneity which may be beneficial for tumor control. 10UI - 99394484AU - Al-Qabandi W; Jenkinson HC; Buckels JA; Mayer AD; McKiernan P; Morland B; John P; Kelly D TI - Orthotopic liver transplantation for unresectable hepatoblastoma: a single center's experience. SO - J Pediatr Surg 1999 Aug;34(8):1261-4 AD - Department of Oncology, The Birmingham Children's Hospital NHS Trust, England. BACKGROUND/PURPOSE: Complete surgical resection after chemotherapy is the definitive treatment for hepatoblastoma. However, orthotopic liver transplantation (OLT) is now accepted as a treatment modality for patients with unresectable tumours. The aim of this study was to review a single center's experience of OLT for unresectable hepatoblastoma. METHODS: A retrospective review of 8 patients with unresectable hepatoblastoma who were referred for liver transplantation was conducted. RESULTS: The patients assessed had an age range of 5 to 105 months at presentation; median, 24 months, (5 boys; 3 girls). Two patients have familial adenomatous polyposis, and one has right hemihypertrophy. All 8 patients had received standard chemotherapy according to SIOP (International Society of Pediatric Oncology) protocols. Extrahepatic metastases were found in 3 patients at diagnosis, but none had detectable metastases at the time of OLT. Four patients continued chemotherapy while awaiting OLT. Three patients received whole grafts, and 5 received reduced grafts. The median follow-up period was 22 months (range, 2 to 78 months). Five patients are alive and well, although 1 patient had a second OLT for biliary cirrhosis secondary to biliary stricture at 6 years. Three patients died: one 26 days post OLT of sepsis and two of disease recurrence at 22 months and 70 months posttransplant. The actuarial survival rate is 88% and 65% at 1 and 5 years, respectively, whereas the overall survival rate is 62.5%. CONCLUSION: OLT for unresectable hepatoblastoma without extra hepatic metastases is highly successful with a low recurrence rate. 11UI - 99408926AU - Zografos GN; Kakaviatos ND; Skiathitis S; Habib N TI - Total vascular exclusion for liver resections: pros and cons. SO - J Surg Oncol 1999 Sep;72(1):50-5; discussion 55-6 AD - Third Academic Department of Surgery, Athens University, Athens, Greece. gnzografos@yahoo.com Dramatic improvements in morbidity and mortality rates following liver resections have been reported in the past decade. Consequently, the indications for hepatectomy are becoming more liberal. Many techniques of liver resection with or without vascular clamping have been reported with excellent clinical results. Total vascular exclusion (TVE) of the liver during parenchymal transection has been advocated susceptible to increase the resectability of tumors that might not be safely approached by other techniques. Cirrhotic livers are probably more vulnerable to ischemic injury related to TVE than normal livers. The indications and technical and metabolic aspects of the technique are reviewed. Copyright 1999 Wiley-Liss, Inc. 12UI - 99414528AU - Acharya SK TI - Management of hepatocellular carcinoma: many ways to skin a cat [editorial] SO - Trop Gastroenterol 1999 Apr-Jun;20(2):59-60 13UI - 99355791AU - Kawamoto C; Ido K; Isoda N; Nagamine N; Hozumi M; Ono K; Nakazawa Y; Sato Y; Kimura K TI - Prognosis of small hepatocellular carcinoma after laparoscopic ethanol injection. SO - Gastrointest Endosc 1999 Aug;50(2):214-20 AD - Department of Gastroenterology, Jichi Medical School, Tochigi, Japan. BACKGROUND: Most patients with hepatocellular carcinoma have underlying cirrhosis, and this impairment of liver function makes hepatectomy difficult, prompting the use of other modalities such as transcatheter arterial embolization and percutaneous ethanol injection. METHODS: Laparoscopic ethanol injection was performed in 48 previously untreated patients with hepatocellular carcinoma smaller than 2 cm in diameter. Long-term survival was evaluated. RESULTS: In 12 patients, hepatocellular carcinoma was not detected by trans-cutaneous ultrasonography but could be demonstrated by laparoscopic ultrasonography. Laparoscopic ethanol injection did not cause serious complications in any patient. The mean hospital stay after ethanol injection was 8.6 days (4 to 15 days). The cumulative survival rate was 86.7% at 3 years and 60.0% at 5 years. According to the Child-Pugh classification, the cumulative survival rate at 5 years was 87.9% for class A, 65.7% for class B, and 28.6% for class C. CONCLUSIONS: The long-term prognosis for patients with small hepatocellular carcinoma treated solely by laparoscopic ethanol injection is satisfactory but still dependent on underlying liver function. 14UI - 99430455AU - Figueras J; Ramos E; Ibanez L; Rafecas A; Fabregat J; Torras J; Lama C; Ruiz D; Moreno G; Arteche N; Jaurrieta E TI - Surgical treatment of hepatocellular carcinoma in cirrhotic and noncirrhotic patients. SO - Transplant Proc 1999 Sep;31(6):2455-6 AD - Liver Transplant Unit, C.S.U. Bellvitge, University of Barcelona, Spain. 15UI - 99430470AU - Figueras J; Ramos E; Ibanez L; Rafecas A; Fabregat J; Torras J; Lama C; Ruiz D; Moreno G; Arteche N; Jaurrieta E TI - Comparative study of survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma. SO - Transplant Proc 1999 Sep;31(6):2487-8 AD - Liver Transplant Unit, C.S.U. Bellvitge, University of Barcelona, Spain. 16UI - 99415535AU - Torzilli G; Makuuchi M; Inoue K; Takayama T; Sakamoto Y; Sugawara Y; Kubota K; Zucchi A TI - No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. SO - Arch Surg 1999 Sep;134(9):984-92 AD - Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. BACKGROUND: Low resectability rates and significant morbidity and mortality rates often make surgery for hepatocellular carcinomas (HCCs) unfeasible. HYPOTHESIS: Our policy for surgical treatment of cirrhotic and noncirrhotic patients with HCC is adequate and safe. DESIGN: Prospective validation cohort study. SETTING: University hospital. PATIENTS: One hundred seven consecutive patients with HCCs. Associated cirrhosis was present in 64 (59.8%), and only 7 (6.5%) had normal livers. INTERVENTIONS: The presence of ascites, serum bilirubin level, and indocyanine green retention rate at 15 minutes were considered when selecting patients for surgery. Preoperative recovery of liver function was achieved with portal venous branch embolization, liver volumetry, bed rest, and control of serum aminotransferase levels. The surgical techniques mainly involved bloodless dissection using intraoperative ultrasonography and intermittent warm ischemia. The main perioperative care regimen was fresh frozen plasma infusion and strict limitation of blood transfusion. MAIN OUTCOME MEASURES: The 30-day postoperative mortality and morbidity rates. RESULTS: All the patients underwent surgery (37 major resections, 45 segmentectomies, and 25 limited resections), with no 30-day postoperative mortality, overall morbidity of 26.2%, and no major complications. Multiple logistic regression analysis revealed that only the type of operation was associated with a significantly higher morbidity risk (P = .05). CONCLUSION: With high resectability, low morbidity, and no mortality, our policy represents a solution to the drawbacks of surgical resection for treatment of HCCs, especially in patients with associated liver cirrhosis. 17UI - 99410161AU - Seno H; Ito K; Kojima K; Nakajima N; Chiba T TI - Efficacy of an implanted drug delivery system for advanced hepatocellular carcinoma using 5-fluorouracil, epirubicin and mitomycin C. SO - J Gastroenterol Hepatol 1999 Aug;14(8):811-6 AD - Department of Gastroenterology and Hepatology, Shizuoka General Hospital, Japan. seno@kuhp.kyoto-u.ac.jp BACKGROUND: In order to assess the efficacy of repeated hepatic arterial infusion (HAI) therapy for advanced hepatocellular carcinoma, we administered HAI therapy using 5-fluorouracil, epirubicin and mitomycin C, with an implanted drug delivery system. METHODS AND RESULTS: Thirty-seven patients received HAI therapy with a response rate of 21.6%. The 6-month and 1-year survival rates were 67.6 and 29.7%, respectively. Responders to HAI therapy showed significantly longer survival than non-responders, while patients with mild liver dysfunction tended to survive longer than those with severe dysfunction. Neither tumour thrombosis of the main trunk of the portal vein nor extrahepatic metastases were considered to constitute contraindications for HAI therapy. Catheter-related trouble occurred in eight patients and biloma in one patient, but other side effects were transient and tolerable. These patients received HAI therapy as outpatients for an average of 79.6% of the entire course of therapy. CONCLUSIONS: Hepatic arterial infusion therapy proved effective for patients with advanced hepatocellular carcinoma in terms of improving survival and outpatient rates. 18UI - 99411570AU - Niguma T; Yumura M; Yamasita Y; Maeda K; Kimura T; Yamamura M; Kodani J TI - Ratio of branched chain amino acid to tyrosine after hepatectomy. SO - Surg Today 1999;29(8):825-7 AD - Department of Surgery, Tottori Municipal Hospital, Tottori City, Japan. The roles of branched chain amino acids (BCAAs) and the tyrosine (Tyr) profile after liver resection were investigated using an inexpensive enzymatic method that was recently developed to quantify their concentrations. The preoperative BCAAs-to-Tyr ratio (BTR) was significantly correlated with the preoperative indocyanin green clearance ratio. The BTR decreased immediately after surgery in all patients, but it was significantly lower in those who had undergone major hepatectomies. After the infusion of BCAA-enriched amino acid solution, the BTR increased substantially, being significantly higher in patients who had not suffered an elevation in total bilirubin after liver resection. These findings indicate that this new enzymatic method to quantify the concentration of BCAAs and Tyr is useful to control the infusion of amino acids and to study the role of amino acid metabolization during the perioperative period. 19UI - 99438413AU - Yamamoto J; Iwatsuki S; Kosuge T; Dvorchik I; Shimada K; Marsh JW; Yamasaki S; Starzl TE TI - Should hepatomas be treated with hepatic resection or transplantation? SO - Cancer 1999 Oct 1;86(7):1151-8 AD - Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. BACKGROUND: The aim of this collaborative study was to compare the long term results of hepatic resection (Hx) with those of orthotopic liver transplantation (OLTx) in large numbers of cirrhotic patients with hepatocellular carcinoma (HCC) and to delineate the roles of these two surgical treatments. METHODS: The databases of the National Cancer Center Hospital in Japan and the University of Pittsburgh Medical Center in the U. S. were exchanged and 294 cirrhotic patients who underwent curative Hx and 270 cirrhotic patients who underwent curative OLTx were selected for comparison. RESULTS: The mortality rate within 30 days and that within 150 days after Hx were significantly lower than those after OLTx (P = 0.001 and P = 0.00007, respectively). Overall survival was similar between the Hx group and the OLTx group (P = 0.40). When compared in the HCC patients without macroscopic vascular invasion and lymph node metastases, the overall survival rate after OLTx was significantly higher than that after Hx (P = 0.006). However, this difference was not significant between the patients with Child-Pugh Grade A tumors in the Hx group and all patients (majority with Child-Pugh Grade C tumors) in the OLTx group (P = 0.25). Tumor free survival after OLTx was significantly higher than that after Hx (P < 0.0001), particularly in HCCs measuring </=5 cm, unilobarly distributed tumors, and HCCs with either no or only microscopic vascular invasion. In HCCs measuring > 5 cm and those with macroscopic vascular invasion, the tumor free survival rate was similar between the Hx group and the OLTx group. CONCLUSIONS: In the face of organ shortage, HCC developing in a well compensated cirrhotic liver initially may be treated with Hx. However, the authors believe OLTx should be applied selectively to those patients with tumor recurrence and/or progressive hepatic failure. Copyright 1999 American Cancer Society. 20UI - 99444519AU - Bartolotta M; Florio MG; Manganaro T; Miceli J; Saitta FP; Micali B TI - [Vascular clamping in cirrhotic liver surgery] SO - Chir Ital 1999 Mar-Apr;51(2):145-9 AD - Dipartimento di Patologia Umana, Universita degli Studi di Messina. Different vascular clamp methods in liver surgery have led to less complications. The aim of this study was to evaluate the results after hepatic resection involving different vascular clamping methods and liver function outcome. Our study examined 46 patients who underwent surgery for liver lesions, developed on cirrhotic and noncirrhotic livers, applying the technique of selective clamping and pedicular clamping. There was one death (1/17; 5.9%) due to postoperative liver failure which occurred in a cirrhotic liver patient who underwent left hepatectomy with pedicular clamping. Complication rate was higher, but not significant (4/7; 57.1%) in the group with selective clamping compared to those with pedicular clamping (3/10; 30%). Hemorrhagic complications were observed in a higher rate among patients with selective clamping (3/7; 42.9%) compared to those with pedicular clamping (1/10; 10%). Selective clamping seems to find major indications in patients with chronic liver disease undergoing minimal hepatic resections. Intermittent pedicular clamping seems to be more effective in regards to blood loss and postoperative hepatic function. 21UI - 99343901AU - Francica G; Marone G TI - Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a 'cooled-tip needle'. A preliminary clinical experience. SO - Eur J Ultrasound 1999 May;9(2):145-53 AD - Divisione di Gastroenterologia, Ospedale 'Cardinale Ascalesi', ASL Napoli 1, Via Egiziaca a Forcella 44, Napoli, Italy. gfrancica@mbx.idn.it OBJECTIVE: Radiofrequency hyperthermia using the newly-developed 'cooled-tip' needle has recently been proposed as a therapeutic modality for hepatocellular carcinoma (HCC). Herein we report our preliminary results on feasibility and effectiveness of the thermal ablation of mono- or pauci-focal hepatocellular carcinoma with the cooled-tip needle. MATERIALS AND METHODS: We treated 15 cirrhotic patients (mean age 68.8 years; 12 males; 14 HCV-positive; 13 in Child's Class A and 2 in Class B) with 20 hepatocellular carcinoma nodules (mean diameter 28.1 mm; range 10-43 mm; nine lesions with diameter greater than 3 cm). None of the patients had portal thrombosis and/or extrahepatic spread. We used a radiofrequency generator (100 W of power) connected to a 18 g perfusion electrode needle with an exposed tip of 2-3 cm. The circuit was closed through a dispersive electrode positioned under the patient's thighs. A peristaltic pump infused a chilled (2-5 degrees C) saline solution to guarantee the continuous cooling of the needle tip. The needle was placed into target lesions under US guidance. The interventional procedure was carried out in general anesthesia without intubation. Dynamic helical CT was carried out 15-20 days after thermal ablation to assess therapeutic efficacy. RESULTS: In all, 38 areas of coagulation necrosis (at 1000-1200 mA for 10-15 min) were generated in 24 sessions in the 20 hepatocellular carcinoma nodules (mean 1.9 lesions per nodule and 1.2 sessions per nodule). Complete necrosis as assessed at dynamic CT (lack of enhancement during the arteriographic phase) was achieved in 75% of cases in a single session; after a second RF session success rate was 90% (18 out of 20 nodules). A self-limited pleurisy along with a 5-fold increase in transaminases occurred in one patient; a 3-fold elevation of transaminases was encountered in three other patients. During the follow-up (median 15 months) five patients had recurrent hepatocellular carcinoma with a 1-year disease free interval of 64%. Of the three recorded deaths, two were due to intrahepatic tumor diffusion. CONCLUSIONS: In our experience radiofrequency hyperthermia with the cooled-tip needle afforded an effective and safe percutaneous ablative method for HCC in cirrhosis and shortened treatment time. 22UI - 99398368AU - Ogata T; Okuda K; Ueno T; Saito N; Aoyagi S TI - Serum hyaluronan as a predictor of hepatic regeneration after hepatectomy in humans. SO - Eur J Clin Invest 1999 Sep;29(9):780-5 AD - Kurume University School of Medicine, Kurume, Japan. BACKGROUND: The capacity for hepatic regeneration after hepatectomy is important for allowing surgeons to determine the appropriate extent of resection. However, conventional preoperative liver function tests are unsatisfactory for estimating the post-operative regenerative capacity of the remnant liver. The aim of this study was to evaluate the relationship between preoperative serum hyaluronan and hepatic regeneration. METHODS: Preoperative serum hyaluronan levels and the hepatic regeneration rate were estimated in 49 patients using computerized tomographic volumetry. The hepatic fibrotic rate was calculated with non-tumorous tissues stained with Azan-Mallory. Immunolocalization of factor VIII-related antigen (FVIIIAg) was examined as a marker for hepatic sinusoidal capillarization. RESULTS: The serum hyaluronan level was significantly correlated with the hepatic regeneration rate (P < 0. 001). Patients with serum hyaluronan levels below 200 ng mL-1 exhibited a significant correlation between the hepatic regeneration rate and the hepatic fibrotic rate. However, patients with serum hyaluronan levels above 200 ng mL-1 did not demonstrate a distinct correlation. The hepatic regeneration rate of patients with FVIIIAg in the liver and serum hyaluronan levels above 200 ng mL-1 were very low compared with those without FVIIIAg (P < 0.001). Multiple regression analysis revealed that serum hyaluronan was a significant predictor of post-operative hepatic regeneration among several clinical variables (r = 0.857, R2 = 0.735). CONCLUSION: It has been suggested that hepatic regeneration is closely related to both hepatic fibrosis and hepatic sinusoidal capillarization. The serum hyaluronan level is regarded as a useful predictor for hepatic regeneration after hepatectomy. 23UI - 99404270AU - Moriwaki H; Okuno M TI - [Prevention of hepatic carcinogenesis by retinoids] SO - Nippon Naika Gakkai Zasshi 1999 Aug 10;88(8):1548-53 24UI - 99423917AU - Ofuchi T; Suzuki M; Kase Y; Ando K; Isono K; Ochiai T TI - Chromosome breakage and cell lethality in human hepatoma cells irradiated with X rays and carbon-ion beams. SO - J Radiat Res (Tokyo) 1999 Jun;40(2):125-33 AD - Space and Particle Radiation Science Research Group, National Institute of Radiological Sciences, Chiba, Japan. Prediction of radiosensitivity would be valuable for heavy-ion radiotherapy. Premature chromosome condensation (PCC) technique has been a potential predictive assay in photon radiotherapy, but has not been investigated for hepatomas receiving heavy ions. Two human hepatoma cell lines, i.e., HLE and HLF, were irradiated with either 290 MeV/u carbon ions or 200 kVp X rays. Cell lethality was assayed by colony formation and compared with the unrejoined fraction of chromatin breaks as measured by PCC technique. Carbon ions at linear energy transfer (LET) of 76 keV/micron produced cell death more effectively than those of 13 keV/micron and X rays. For the cell killing, the relative biological effectiveness (RBE) of 13 and 76 keV/micron carbon ions compared with X rays was 1.10-1.24 and 2.57-2.59, respectively. Mean number of chromosomes in HLE and HLF cells was similar to each other, i.e., 60.48 and 60.28. RBEs for chromatin breaks of 13 and 76 keV/micron carbon ions were 1.30-1.31 and 2.64-2.79, respectively. A strong correlation between unrejoined chromatin breaks and cell killing for human hepatoma cells was observed irrespective of radiation quality. We conclude that PCC provides a potential predictor for the radiosensitivity of individual hepatoma that are treated with photon as well as heavy ion irradiation. 25UI - 99411810AU - Poon RT; Fan ST; Lo CM; Liu CL; Ngan H; Ng IO; Wong J TI - Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management [see comments] SO - Am J Gastroenterol 1999 Sep;94(9):2460-6 AD - Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, China. OBJECTIVE: This study evaluated the results of surgical and nonsurgical treatments of hepatocellular carcinoma (HCC) in the elderly to determine the optimal management strategy. METHODS: Clinicopathological data and treatment results of 222 elderly (> or = 70 yr) and 1116 younger patients with HCC managed between 1989 and 1997 were prospectively collected and compared between the two groups. RESULTS: The resection rate in the elderly (14%) was lower than in younger patients (27%) (p < 0.001). Among patients who underwent resection, there were no significant differences in morbidity rate (48% vs 40%, p = 0.354), hospital mortality rate (10% vs 6%, p = 0.431), or long-term survival (median, 38 vs 42 months, p = 0.940). Comparing the periods 1989-1992 and 1993-1997, hospital mortality rate in the elderly was reduced from 25% to 4% (p = 0.079). Sixty-seven elderly and 317 younger patients underwent transarterial oily chemoembolization (TOCE), with similar morbidity rate (24% vs 26%, p = 0.775), mortality rate (7% vs 5%, p = 0.365), and long-term survival (median, 12 vs 9 months, p = 0.277). The results of other nonsurgical treatments were also similar between the two groups. CONCLUSIONS: Hepatic resection for HCC is safe in selected elderly patients, and the improved results in recent years indicate that more elderly patients could benefit from surgical management. TOCE is well tolerated in elderly patients and is the treatment of choice for unresectable HCC. The overall management strategy of HCC in the elderly should not be different from that in younger patients. The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted
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