National Cancer Institute®
Last Modified: February 1, 2002
UI - 11778559
AU - Lin Z; Ren Z; Xia J
TI - [Appraisal of postoperative transcatheter arterial chemoembolization (TACE) for prevention and treatment of hepatocellular carcinoma recurrence]
SO - Zhonghua Zhong Liu Za Zhi 2000 Jul;22(4):315-7
AD - Liver Cancer Institute, Zhongshan Hospital, Shanghai Medical University, Shanghai 200032, China.
OBJECTIVE: To evaluate the effect of postoperative TACE for prevention and treatment of hepatocellular carcinoma (HCC) recurrence after radical after radical resection were followed up with serum AFP, liver US and CT, chest X-ray film, hepatic artery angiography, etc. They were divided into 2 groups. Patients in group A (n = 68) with no residual tumor were given prophylactic TACE treatment, 1-2 times at the second and fifth month after operation. Patients in group B (n = 41) with residual tumor left were treated with regular TACE, once every 2 months. The 2 groups of patients were followed up for 6-45 months after operation. RESULTS: In group A, the real curative resection rate was 62.4%. Tumor recurrence was found in 10 of the 68 patients, with a total recurrence rate of 14.7% within 3 years after radical resection. The 1-, 2-, and 3-year cumulative recurrence rate was 7.4%, 13.2% and 14.7%, respectively. The 1-, 2-, and 3-year survival rate was 100%, 93.4% and 85.7%, respectively, while that in group B was 78.1%, 57.7% and 57.7%, respectively. The differences between the 2 groups of patients were statistically significant. The predictive pathological factors hampering completeness of tumor resection were: tumor size > 5 cm, more than 2 tumor nodules, the presence of satellite nodules, tumor with partial or without encapsulation and tumor thrombus in portal vein. Hepatic artery angiography with LP-CT and maintenance of high serum AFP level were the most sensitive methods for detecting residual tumor after operation. CONCLUSION: Post-operative TACE is very useful for prevention and treatment of HCC recurrence. It helps improve survival of surgically treated HCC patients.
UI - 11815984
AU - Bisogno G; Pilz T; Perilongo G; Ferrari A; Harms D; Ninfo V; Treuner J;
TI - Carli M Undifferentiated sarcoma of the liver in childhood: a curable disease.
SO - Cancer 2002 Jan 1;94(1):252-7
AD - Pediatric Oncology-Hematology Division, University of Padova, Padova, Italy. firstname.lastname@example.org
BACKGROUND: Undifferentiated (embryonal) sarcoma of the liver (UESL) is a rare childhood hepatic tumor, and it is generally considered an aggressive neoplasm with an unfavorable prognosis. METHODS: The Soft Tissue Sarcoma Italian and German Cooperative Groups enrolled 17 children with UESL in studies conducted between 1979 and 1995. They were treated using the same multimodal approach as for patients with sarcomas including conservative surgery at diagnosis, multiagent chemotherapy, and second-look operation in cases of residual disease. Radiotherapy was occasionally used (2 of 17 patients). RESULTS: Twelve patients are alive with follow-up ranging from 2.4 to 20 years. Eight underwent complete tumor resection either at diagnosis or after preoperative chemotherapy, and all are currently alive. After initial chemotherapy tumor reduction was evident in six of nine evaluable cases. Overall three patients died of disease and one of a surgical complication. One child died in second complete remission for a non-disease-related cause. CONCLUSIONS: The current prognosis of UESL no longer should be regarded as poor. Modern multimodal treatment and supportive therapy have improved survival. Copyright 2002 American Cancer Society.
UI - 11443478
AU - Chung MH; Wood TF; Tsioulias GJ; Rose DM; Bilchik AJ
TI - Laparoscopic radiofrequency ablation of unresectable hepatic malignancies. A phase 2 trial.
SO - Surg Endosc 2001 Sep;15(9):1020-6
AD - John Wayne Cancer Institute, Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, California, 90404, USA.
BACKGROUND: Radiofrequency ablation (RFA) of hepatic malignancies has been performed successfully via a percutaneous route or at laparotomy. We analyzed the efficacy and utility of laparoscopic intraoperative ultrasound and RFA in patients with unresectable hepatic malignancies. unresectable hepatic malignancies and no evidence of extrahepatic disease were entered in a phase 2 trial of laparoscopic intraoperative ultrasound and RFA. Real-time ultrasonography was used to guide RFA, and lesions were ablated at a temperature of 100 degrees C for 10 min. Overlapping ablations were performed for larger lesions. RESULTS: Additional tumors were identified in 10 (37%) of the 27 study patients by laparoscopy and laparoscopic intraoperative ultrasound despite extensive preoperative imaging. Radiofrequency ablation of 85 hepatic tumors yielded no mortality and only one case of postoperative bleeding. During a mean follow-up period of 14 months, four tumors (4.7%) locally recurred. Of the 27 patients, 11 (41%) remain free of disease at this writing; (22%) are alive with disease; and 10 (37%) have died with disease. CONCLUSION: Laparoscopic RFA and intraoperative ultrasound constitute a safe and accurate method for ablation of unresectable hepatic tumors.
UI - 11677974
AU - Itamoto T; Katayama K; Fukuda S; Fukuda T; Yano M; Nakahara H; Okamoto
TI - Y; Sugino K; Marubayashi S; Asahara T Percutaneous microwave coagulation therapy for primary or recurrent hepatocellular carcinoma: long-term results.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1401-5
AD - Department of Surgery II, Hiroshima University Faculty of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan. email@example.com
BACKGROUND/AIMS: To clarify the indication of percutaneous microwave coagulation therapy for hepatocellular carcinoma. METHODOLOGY: Thirty-three hepatocellular carcinoma patients who underwent percutaneous microwave coagulation therapy were enrolled in this study, including 18 primary and 15 recurrent hepatocellular carcinoma patients. We examined the local recurrence rates and the long-term results after the treatment. RESULTS: The overall survival rates of the primary group at 1, 2, 3, 4 and 5 years were 94.4%, 77.8%, 77.8%, 77.8% and 48.6%, respectively, whereas those of the recurrent group were 100%, 85.7%, 66.7% and 50.0% at 1, 2, 3 and 4 years, respectively. Local recurrence after percutaneous microwave coagulation therapy was found in about 50% of patients in both groups. Seventeen of the 27 patients (63.0%) with a moderately or poorly differentiated hepatocellular carcinoma tumor had local recurrence, while none of the 6 patients with a well-differentiated hepatocellular carcinoma tumor did (P = 0.005). CONCLUSIONS: Irrespective of primary or recurrent hepatocellular carcinoma, the indication of percutaneous microwave coagulation therapy as an alternative to hepatic resection should be limited to cases of a well-differentiated hepatocellular carcinoma tumor smaller than 2 cm in diameter.
UI - 11677976
AU - Dohmen K; Shirahama M; Shigematsu H; Miyamoto Y; Torii Y; Irie K;
TI - Ishibashi H Transcatheter arterial chemoembolization therapy combined with percutaneous ethanol injection for unresectable large hepatocellular carcinoma: an evaluation of the local therapeutic effect and survival rate.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1409-15
AD - Saga Prefectural Hospital Koseikan, Saga, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: This study was undertaken to evaluate the effectiveness of combination therapy with transcatheter arterial chemoembolization followed by percutaneous ethanol injection in patients with unresectable large hepatocellular carcinoma by comparing the use of this combined regimen with transcatheter arterial chemoembolization alone. METHODOLOGY: Six hundred and thirty-one consecutive patients with hepatocellular carcinoma lesions observed from Jan 1989 to Dec 1999 (11 years) at the Internal Medicine Department, Saga Prefectural Hospital Koseikan were retrospectively enrolled in the study. The series included 120 patients with large unresectable hepatocellular carcinoma lesions, the largest of which were greater than 3 cm in largest dimension. Fifty-two patients underwent a single transcatheter arterial chemoembolization followed by percutaneous ethanol injection, which were compared with 68 patients treated by transcatheter arterial chemoembolization alone. Both groups of patients with hepatocellular carcinoma did not differ regarding the base-line characteristics. The overall survival rates and recurrence ratio of initially treated lesions were compared in both groups. RESULTS: On overall survival rates by the Kaplan-Meier method, three- and five-year survival in the transcatheter arterial chemoembolization and percutaneous ethanol injection group (59.0%, 32.1%) proved to be significantly longer than those in the transcatheter arterial chemoembolization group (27.1%, 17.0%). In addition, during the follow-up local recurrence in the combination group (23.1%) was significantly lower than that in the transcatheter arterial chemoembolization group (50.0%). CONCLUSIONS: The combined treatment with transcatheter arterial chemoembolization and percutaneous ethanol injection proved to be more effective and safer. Furthermore, a lower incidence of local recurrence was observed than transcatheter arterial chemoembolization alone which resulted in an increased survival of the patients associated with unresectable large hepatocellular carcinoma lesions.
UI - 11677980
AU - Ueno H; Okada S; Okusaka T; Ikeda M; Tanaka N; Sakamoto M; Yoshimori M
TI - Prognosis of hepatocellular carcinoma with no tumor stain treated by percutaneous ethanol injection.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1430-4
AD - Department of Internal Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. email@example.com
BACKGROUND/AIMS: Some hepatocellular carcinoma nodules do not show tumor stain by hepatic angiography or enhanced computed tomography. The aim of this study was to clarify the prognosis of hepatocellular carcinoma with no tumor stain treated by percutaneous ethanol injection. METHODOLOGY: Twenty patients who had hepatocellular carcinoma with no tumor stain percutaneous ethanol injection. Recurrence-free survival, predictive factors for recurrence and recurrent patterns were examined. Overall survival was also examined. RESULTS: Ten of the 20 patients showed intrahepatic recurrences in other parts of the treated lesions, although no local recurrence was observed. Median recurrence-free survival time, 1-, 3- and 5-year recurrence-free survival rates were 2.8 years, 66%, 43% and 22%, respectively. A serum alpha-fetoprotein level of 20 ng/mL or less was the only factor that was significantly associated with prolonged recurrence-free survival. Of the 12 recurrent nodules in 10 patients, 9 occurred in different segments of the treated lesion and 8 were histopathologically confirmed to be well-differentiated hepatocellular carcinoma. Overall survival rates 1, 3, and 5 years after percutaneous ethanol injection were 100%, 82%, and 75%, respectively. CONCLUSIONS: Percutaneous ethanol injection may be useful for the treatment of hepatocellular carcinoma with no tumor stain.
UI - 11792985
AU - Chardot C; Saint Martin C; Gilles A; Brichard B; Janssen M; Sokal E;
TI - Clapuyt P; Lerut J; Reding R; Otte JB Living-related liver transplantation and vena cava reconstruction after total hepatectomy including the vena cava for hepatoblastoma.
SO - Transplantation 2002 Jan 15;73(1):90-2
AD - Centre Hospitalier Universitaire de Bicetre, 78 rue du General Leclerc, F-94275 Le Kremlin Bicetre, France. firstname.lastname@example.org
BACKGROUND: In most cases of total hepatectomy (TH) required for hepatoblastoma (HB), the retrohepatic inferior vena cava (IVC) has to be removed with the native liver for complete tumor excision. Because the liver graft procured by living donation has no IVC, a reconstruction of the recipient IVC is needed. We report our experience with living-related liver transplantation (LRLT) and IVC replacement in such underwent TH, including IVC and LRLT with IVC replacement for otherwise irresectable HB after chemotherapy (SIOPEL 2 and 3 protocols). IVC reconstruction used an allogenic iliac vein procured from a cadaveric donor (bank graft) in two cases and an internal jugular vein procured from the donor parent in two cases. Median age and weight at surgery were 17 months (range 10-60) and 9.6 kg (range 8.3-17.9). RESULTS: In the living donors, there were two complications of the procurement: one intra-abdominal biliary collection and one subcutaneous abscess. In all four children, complete excision of the tumor could be achieved without any intra-operative complication. One patient died 5 months after LRLT due to lung metastases. Three patients were alive and well with no evidence of tumor recurrence 13-24 months after surgery. Reconstructed IVC was patent in two patients, and asymptomatic thrombosis occurred 2 years after operation in one patient. CONCLUSION: Total hepatectomy including the retrohepatic IVC is not a technical obstacle to LRLT. Therefore, scheduled surgery, at the best time after chemotherapy, can be considered in all patients with otherwise irresectable HBs.
UI - 11592607
AU - Bruix J; Sherman M; Llovet JM; Beaugrand M; Lencioni R; Burroughs AK;
TI - Christensen E; Pagliaro L; Colombo M; Rodes J; EASL Panel of Experts on HCC Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver.
SO - J Hepatol 2001 Sep;35(3):421-30
AD - Liver Unit, Digestive Disease Institute, Hospital Clinic, IDIBAPS, Barcelona, Catalonia, Spain. email@example.com
UI - 11775842
AU - Cao X; He N; Sun J; Wang S; Ji X; Wang J; Zhang C; Yang J; Lu T; Li J;
TI - Zhang G Interventional treatment of huge hepatic cavernous hemangioma.
SO - Chin Med J (Engl) 2000 Oct;113(10):927-9
AD - Department of Radiology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
OBJECTIVE: To study the methods of interventional treatment of huge hepatic cavernous hemangioma (HCH). METHOD: A total of 14 patients with HCH were treated with lipiodol-ultrafluid (10-15 ml), bleomycin A (PYM 16-32 mg), and gelatin-sponge particles. RESULTS: DSA hepatic arteriography showed multiple vascular lakes in the early arterial phase, so-called "to hang the fruits on the branches", which persisted for a long time. CT scan showed a significant reduction in tumor size in 8 of the 14 patients after the treatment. CONCLUSION: Embolization with lipiodol-ultrafluid, PYM and gelatin sponge particles is one of the best methods for the treatment of HCH.
UI - 11813186
AU - Chan KL; Fan ST; Tam PK; Chiang AK; Chan GC; Ha SY
TI - Management of spontaneously ruptured hepatoblastoma in infancy.
SO - Med Pediatr Oncol 2002 Feb;38(2):137-8
AD - Center of Study of Liver Disease, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, SAR, China. firstname.lastname@example.org
UI - 9383352
AU - Jaeck D; Bronowicki JP; Boudejma K; Bachellier P; Chone L; Nisand G;
TI - Bazin C; Pflumio F; Uhl G; Wenger JJ; Boissel P; Bigard MA; Gaucher P; Vetter D; Wolf P; Doffoel M Comparison of resection, liver transplantation and transcatheter oily chemoembolisation in the treatment of hepatocellular carcinoma.
SO - Wiad Lek 1997;50 Suppl 1 Pt 1():413-5
AD - Centre de Chirurgie Viscerale et de Transplantation, Hopitaux Universitaires de Strasbourg.
UI - 11778243
AU - Fan J; Wu Z; Zhou J
TI - [Comparison of several therapeutic methods for hepatocellular carcinoma with tumor thrombi in portal vein]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):247-9
AD - Zhongshan Hospital & Liver Cancer Institute, Shanghai Medical University, Shanghai 200032, China.
OBJECTIVE: To compare the therapeutic effect and significance of different treatment methods for hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT). METHODS: One hundred and forty-seven HCC patients with tumor thrombi in the main portal vein or the first branch of portal vein were divided into four groups. A, conservative treatment group (n = 18); B, hepatic artery ligation (HAL) and/or hepatic artery infusion (HAI) group (n = 18), periodically received postoperative chemoembolizations; C, excision of HCC with removal of PVTT group (n = 79); D, transcatheter hepatic arterial chemoembolization or portal vein infusion (PVI) or HAI after operation group (n = 32). RESULTS: The median survival period was 2, 5, 12, and 16 months in group A, B, C, D, respectively. Their 1-, 3- and 5-year survival rates was 5.6%, 0 and 0 in group A; 22.2%, 5.6% and 0 in group B; 53.9%, 26.9% and 16.6% in group C; 82.8%, 48.8% and 41.3% in group D, respectively. The survival rates differed significantly between the 4 groups (P < 0.05). CONCLUSION: Resection of cancer with removal of tumor thrombi for HCC with PVTT significantly improves the curative effect and quality of life. Local hepatic chemotherapy or chemoembolization after tumor resection with removal of tumor thrombi may further prolong survival period.
UI - 11778245
AU - Wang C; Shao Y; Lan Z
TI - [Surgical treatment of patients with stage IV a liver carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2000 May;22(3):252-4
AD - Tumor Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
OBJECTIVE: To study the result of surgical treatment of patients with stage IV a primary liver carcinoma (PLC). METHODS: Twenty-seven patients with stage IV a PLC treated in 1989-1998 were retrospectively studied. The patients could be divided into 2 groups: (1) The resected group(19 cases) and (2) cytoreductive group(8 cases). Intra-operative B-ultrasound was used to prevent missing of any tumor nodules. Unresectable residual nodules were treated by ethanol injection. Multidisciplinary treatment was given in the perioperative period. RESULTS: The overall 1-, 2- and 3-year survival rate of the 27 patients was 71.4%, 55.6% and 7.7% respectively. The 1-, 2- and 3-year survival rate of the resected and cytoreductive group of patients was 73.3%, 58.3%, 10.0% and 66.7%, 50.0%, 0% (P > 0.05) respectively. Complications occurred in 22.0% of the treated patients. There was no operative and hospitalization mortality. CONCLUSIONS: Surgical resection or cytoreductive operation with adjuvant therapy is effective as the first choice of treatment for stage IV a PLC.
UI - 10915728
AU - Ikeda K; Arase Y; Saitoh S; Kobayashi M; Suzuki Y; Suzuki F; Tsubota A;
TI - Chayama K; Murashima N; Kumada H Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor-A prospective randomized study of hepatitis C virus-related liver cancer.
SO - Hepatology 2000 Aug;32(2):228-32
AD - Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan, and Okinaka Memorial Institute for Medical Research, Tokyo, Japan. email@example.com
Because hepatocellular carcinoma often recurs after surgical resection or ethanol injection therapy, we conducted a prospective randomized controlled trial of interferon (IFN) in patients with chronic liver disease caused by hepatitis C virus (HCV). Twenty eligible patients with cirrhosis were randomized into two groups: 10 patients treated with 6 million units of natural IFN-beta twice a week for 36 months and 10 patients without IFN therapy. One patient within the treatment group discontinued interferon therapy after 19 months of treatment because of a mild degree of retinopathy. None of the patients in either group lost HCV-RNA until the end of the observation. Although 7 (70.0%) of 10 patients in the nontreatment group showed tumor recurrence, only 1 (10.0%) of 10 patients with IFN therapy developed tumor recurrence during a median observation period of 25.0 months. Cumulative recurrence rates of the treated and untreated groups were 0% and 62.5% at the end of the first year, and 0% and 100% at the second year, respectively (log-rank test, P =.0004). In conclusion, intermittent administration of IFN suppressed tumor recurrence after treatment with surgery or ethanol injection in patients with HCV-related chronic liver disease.
UI - 11780473
AU - Ho S; Lau WY; Leung WT
TI - Comments on "Hepatic radioembolization with yttrium-90 glass microspheres for treatment of primary liver cancer" by Cao et al, Chin Med J 1999; 112: 430-432.
SO - Chin Med J (Engl) 2001 Apr;114(4):433-4
UI - 11817790
AU - Puliyel JM; Taneja V; Jindal K; Thomas N
TI - Hepatitis B leading to hepatocellular carcinoma: calculating the risk.
SO - Indian J Gastroenterol 2001 Nov-Dec;20(6):251-2
UI - 11768566
AU - Kuyvenhoven JPh; Lamers CB; van Hoek B
TI - Practical management of hepatocellular carcinoma.
SO - Scand J Gastroenterol Suppl 2001;(234):82-7
AD - Dept. of Gastroenterology and Hepatology, Leiden University Medical Centre, The Netherlands. firstname.lastname@example.org
Primary hepatocellular carcinoma (HCC) is one of the ten commonest tumours in the world and occurs mainly in patients with cirrhosis. To date, in Western countries, curative treatment options include partial liver resection or liver transplantation in selected patients with small tumours. Unfortunately, most patients are detected with non-resectable or non-transplantable HCC due to disease extension, hepatic dysfunction or comorbid factors. These patients may benefit from local ablative therapy, such as percutaneous ethanol injection or radiofrequency ablation, with curative intent in patients with small tumours. In advanced HCC chemoembolization has a high response rate, but there is no clear evidence of a survival benefit. In this review we discuss practical considerations in the treatment of HCC and propose an algorithm for the selection of different treatment modalities.
UI - 11812959
AU - Ho WL; Wu CC; Yeh DC; Chen JT; Huang CC; Lin YL; Liu TJ; P'eng FK
TI - Roles of the glucocorticoid receptor in resectable hepatocellular carcinoma.
SO - Surgery 2002 Jan;131(1):19-25
AD - Department of Surgery and Pathology, Taichung Veterans General Hospital, Chung-Shan Medical College, Taichung, Taiwan.
BACKGROUND: The glucocorticoid receptor (GR) was discovered in the cytosol of hepatocellular carcinoma (HCC) cells more than 10 years ago. However, the influence of the GR on the prognosis of HCC after liver resection remains unclear. METHODS: Ninety-two consecutive patients with HCC who survived liver resection and who did not receive any preoperative neoadjuvant therapy were enrolled in this study. The GR level in cytosol of cancerous tissue was determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term prognosis of patients with GR-positive tumors (GR-positive group) were compared with those of patients with GR-negative tumors (GR-negative group). RESULTS: GR was found in 63 patients (68.5%) with a mean +/- SEM concentration of 26.97 +/- 4.05 fmol/g protein. There were no significant differences in patient clinicopathologic characteristics between GR-positive and GR-negative groups. The 5-year disease-free and actuarial survival rates for GR-positive and GR-negative groups were 21.6% and 44.4% (P =.002) and 57.2% and 83.3% (P =.0003), respectively. After multivariate analysis was performed, GR positivity was found to be an independent prognostic factor of disease-free and actuarial survival after liver resection for HCC. CONCLUSIONS: The GR can be found in the cytosol of most HCCs and is an independent prognostic factor of HCC after liver resection. Patients with GR-positive HCC have lower survival rates than those with GR-negative HCC.
UI - 11812960
AU - Wakabayashi H; Ishimura K; Okano K; Karasawa Y; Goda F; Maeba T; Maeta H
TI - Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma.
SO - Surgery 2002 Jan;131(1):26-33
AD - First Department of Surgery, Kagawa Medical University, Japan.
BACKGROUND: Clinical parameters influencing the effect of preoperative portal vein embolization (PVE) in hypertrophying the nonembolized lobe of patients with either normal or abnormal liver parenchyma and its effect upon portal pressure were examined to identify the patient population for whom this approach is most suited. METHODS: The study population included 43 patients undergoing major hepatectomy after PVE. Patients were divided into 2 groups according to their liver parenchyma: 17 patients with normal liver parenchyma (N group) and 26 patients with damaged liver parenchyma due to viral hepatitis (D group). We calculated the correlation between volumetric increases in the nonembolized (left) lobe after PVE (hypertrophic ratio = post-PVE left lobe volume/pre-PVE left lobe volume) using computed tomography volumetry before and 2 weeks after PVE. Clinical parameters also were examined to identify those parameters modifying the hypertrophic ratio in each group, and changes in portal pressure by PVE and the subsequent hepatectomy were recorded. Finally, by comparing patients with or without postoperative liver failure after hepatectomy, the influence of the hypertrophic ratio and portal pressure on the outcome of subsequent hepatectomy was examined. RESULTS: The hypertrophic ratio was 1.34 +/- 0.23 in the N group, and 1.25 +/- 0.21 in the D group. This difference was not significant. Multiple regression analysis revealed that the parenchymal volumetric rate of the right lobe (PVR) in the D group and both PVR and prothrombin time in the N group were independent parameters predicting the hypertrophic ratio. The portal pressure increased immediately after PVE and was similar in both groups to levels after hepatectomy. Six patients in the D group experienced postoperative liver dysfunction. In 5 of these 6 patients, the hypertrophic ratio was below 1.2, and the portal pressure was higher than that in patients without liver dysfunction. CONCLUSIONS: PVE induces hypertrophy of the nonembolized lobe of both abnormal and normal liver parenchyma, and the effect was predictable. Postoperative liver failure appeared to be more severe in patients having a lower hypertrophic ratio and higher portal pressure in abnormal liver parenchyma, however. PVE also may have diagnostic use in predicting portal pressure after hepatectomy, which may be associated with surgical outcome.
UI - 11446923
AU - Figueras J; Busquets J; Ramos E; Torras J; Ibanez L; Llado L; Rafecas A;
TI - Fabregat J; Serano T; Dalmau A; Valls C; Jaurrieta E [Clinical study of 437 consecutive hepatectomies]
SO - Med Clin (Barc) 2001 Jun 16;117(2):41-4
AD - Jefe Clinico de Cirugia General y Digestiva, Hospital Prineps d'Espanya, Barcelona, Spain.
BACKGROUND: The aim of this prospective study was to analyze the risk of liver resection in unselected patients. PATIENTS AND METHOD: From 1990 to 2000, 437 consecutive hepatectomies were performed in our center. Most frequent indications were liver metastases (n = 288), hepatocellular carcinoma (n = 62), Klatskin tumor (n = 17), gallblader carcinoma (n = 139) and other malignant tumors (n = 6). The indication was a benign tumor in 51 patients. In 357 cases the liver parenchyma was normal, 51 patients had an underlying cirrhosis and 17 patients had an obstructive jaundice. RESULTS: Overall mortality was 3.6% (15 cases). Mortality in benign tumors was lacking. The prevalence of postoperative complications was 43.9%, which was mainly influenced by malignancy (46.9% vs 21.6%, p = 0.001) and type of tumor (Klastkin tumor, p # 0.001). Major liver resection (p < 0.001), blood transfusion (p < 0.001), age over 60 years (p = 0.001) and the type of hepatectomy (p < 0.001) also increased significantly the morbidity.The prevalence of biliary fistula was 11.2%, which was mainly related to the type of hepatectomy (major hepatectomy; p = 0.002) and a biliary-enteric anastomosis (p < 0.001). The prevalence of hepatic insufficiency was 3.6%, and chief risk factors for its development were underlying liver disease and major liver resection (p = 0.017). CONCLUSIONS: Mortality after hepatectomy in experienced centers is low. Morbidity is mainly related to the amount of parenchyma resected, type of hepatectomy, underlying liver disease and associated procedures. Liver resection should be performed preferentially in centers with high volume by specialized surgeons.
UI - 11783027
AU - Chen M; Li J; Zhang Y
TI - [Transarterial chemoembolization with high dose iodized oil for the treatment of large hepatocellular carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Mar;23(2):165-7
AD - Cancer Center, Sun Yet-sen University of Medical Sciences, Guangzhou 510060, China.
OBJECTIVE: To report the method and result of high dose iodized oil chemoembolization for the treatment of large hepatocellular carcinoma. METHODS: From 1993 to 1998, 163 patients with unresectable hepatocellular carcinoma were treated by transarterial chemoembolization (TACE) with more than 20 ml lipiodol. RESULTS: TACE with high dose lipiodol was well tolerated by the treated patients. In patients whose liver function was of Child A stage, or in patients whose residual indocyanine green level 15 min after injection was less than 20%, the frequency of post-treatment hepatic insufficiency was not significantly different from that of patients treated with routine dose of lipiodol. On CT scan at 4 wk after TACE, more lipiodol was located in the liver. The 1-, 2-,3-year survival rate of patients in Child A stage was 79.8%, 50.3%, and 38.5%, respectively, as compared to 57.5%, 24.8% and 8.37%, respectively in patients treated with routine dose of lipiodol (P = 0.0136). CONCLUSION: High dose lipiodol TACE for the treatment of large hepatocellular carcinoma is practically acceptable with better therapeutic effect but its use should be limited to those patients with compensated liver function.
UI - 11788696
AU - Loewe C; Cejna M; Schoder M; Thurnher MM; Lammer J; Thurnher SA
TI - Arterial embolization of unresectable hepatocellular carcinoma with use of cyanoacrylate and lipiodol.
SO - J Vasc Interv Radiol 2002 Jan;13(1):61-9
AD - Department of Radiology, Section of Interventional Radiology, University of Vienna, Waehringer Guertel 18 - 20, A-1090 Vienna, Austria. email@example.com
PURPOSE: To assess the potential of transarterial permanent embolization with use of a mixture of cyanoacrylate and lipiodol for treatment of unresectable primary hepatocellular carcinoma (HCC). MATERIALS AND METHODS: In a retrospective study, 36 patients with histologically proven HCC were treated with transarterial embolization (TAE) of the hepatic arteries. None of these patients were candidates for surgical resection and some had advanced disease with multinodular disease or bulky tumor, thrombosis of a segmental branch of the portal vein, and/or extrahepatic spread. To induce permanent and more peripheral embolization, cyanoacrylate, an adhesive polymerizing on contact with blood, was used in TAE. From 1990 to 1998, a total of 76 embolization procedures were performed. Cumulative survival rates were calculated. RESULTS: Most of the patients presented with a self-limited postembolization syndrome. Severe procedure-related complications were found after four treatment sessions (5.2%). The 30-day perioperative mortality rate was 2.7%. The mean follow-up period was 20.3 months (range, 1-68 mo), with a median survival of 26 months. The median survival was also estimated for different Okuda stages of disease: stage II (n = 26) versus stage III (n = 5) disease (32 vs 9 months; P <.05); patients with (n = 9) or without (n = 27) extrahepatic metastasis (10 vs 26 months; P <.05); and patients with (n = 10) or without (n = 26) thrombosis of a segmental branch of the portal vein (7 versus 34 months [P <.005]). CONCLUSION: TAE with use of cyanoacrylate and lipiodol for unresectable HCC is a feasible treatment modality. This retrospective report indicates beneficial effects on survival even in patients with advanced disease.
UI - 11766086
AU - Kimoto T; Yamanoi A; Uchida M; Makino Y; Ono T; Kohno H; Nagasue N
TI - Repeated hepatic dearterialization for unresectable carcinomas of the liver: report of a 10-year experience.
SO - Surg Today 2001;31(11):984-90
AD - Second Department of Surgery, Shimane Meidcal University, Izumo, Japan.
The effectiveness of repeated hepatic dearterialization (RHD) therapy was evaluated in 26 patients with unresectable primary and secondary liver tumors. RHD was performed in 12 patients with hepatocellular carcinoma (HCC), 7 with hepatic metastases from colorectal carcinoma, and 7 with hepatic metastases from gastric carcinoma. It was repeatedly carried out by occluding the hepatic artery for 1 h twice daily. All patients concurrently received an intra-arterial infusion of anticancer drugs. More than 50% remission of the hepatic tumors, defined as a partial response (PR), was demonstrated in 8 patients (31%). A higher PR was seen in hepatic tumors from metastatic gastric cancer (5 out of 7 patients; 71%). Most patients who suffered severe complications had HCC with liver cirrhosis. These preliminary results suggest that RHD with intra-arterial chemotherapy is an acceptable palliative treatment for patients with unresectable liver metastasis from gastric cancer; however, the majority of patients with HCC are not responsive to such treatment, primarily because most have underlying cirrhosis predisposing to the development of postoperative complications at an unacceptably high rate.
UI - 11797653
AU - Tungjitkusolmun S; Staelin ST; Haemmerich D; Tsai JZ; Webster JG; Lee FT
TI - Jr; Mahvi DM; Vorperian VR Three-Dimensional finite-element analyses for radio-frequency hepatic tumor ablation.
SO - IEEE Trans Biomed Eng 2002 Jan;49(1):3-9
AD - Department of Electronics Engineering, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand.
Radio-frequency (RF) hepatic ablation, offers an alternative method for the treatment of hepatic malignancies. We employed finite-element method (FEM) analysis to determine tissue temperature distribution during RF hepatic ablation. We constructed three-dimensional (3-D) thermal-electrical FEM models consisting of a four-tine RF probe, hepatic tissue, and a large blood vessel (10-mm diameter) located at different locations. We simulated our FEM analyses under temperature-controlled (90 degrees C) 8-min ablation. We also present a preliminary result from a simplified two-dimensional (2-D) FEM model that includes a bifurcated blood vessel. Lesion shapes created by the four-tine RF probe were mushroom-like, and were limited by the blood vessel. When the distance of the blood vessel was 5 mm from the nearest distal electrode 1) in the 3-D model, the maximum tissue temperature (hot spot) appeared next to electrodes A. The location of the hot spot was adjacent to another electrode 2) on the opposite side when the blood vessel was 1 mm from electrode A. The temperature distribution in the 2-D model was highly nonuniform due to the presence of the bifurcated blood vessel. Underdosed areas might be present next to the blood vessel from which the tumor can regenerate.
UI - 11783120
AU - Ren Z; Lin Z; Ye S
TI - [Transcatheter arterial chemoembolization for postoperative residual tumor of hepatocellular carcinoma]
SO - Zhonghua Zhong Liu Za Zhi 2001 Jul;23(4):332-4
AD - Liver Cancer Institute, Zhongshan Hospital, Fudan Univesity, Shanghai 200032, China.
OBJECTIVE: To understand and analyze the survival and prognostic factors of postoperative residual tumor of hepatocellular carcinoma treated by transcatheter arterial chemoembolization. METHODS: Transcatheter arterial chemoembolization was performed in 74 patients who were identified as having residual lesions by ultrasonography, hepatic arterial angiography or enhanced computed tomography about two months after resection of hepatocellular carcinoma. Kaplan-Meier method was used for survival and Cox regression model for prognostic factors. RESULTS: The 1-, 2- and 3-year survival rates were 78.0%, 57.6%, 37.0%, with a median survival of 33 months. Univariate analysis indicated that a primary tumor over > 5 cm in diameter, vascular involvement by the primary tumor and TNM extent of the residual lesion were important factors indicating a bad prognosis, where as the combination of other treatment methods such as percutaneous ethanol injection (PEI), and/or radiotherapy indicated a better prognosis. However, multivariate analysis showed that vascular involvement by the primary tumor and the other combined local treatments were independent factors of prognosis. CONCLUSION: Transcatheter arterial chemoembolization is effective in treating the postoperative residual tumor of hepatocellular carcinoma. Further improvement is observed if combined with other local therapies such as percutaneous ethanol injection or radiotherapy.
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