Influence of risk factors for metabolic syndrome and non-alcoholic fatty liver disease on the progression and prognosis of hepatocellular carcinoma.

BACKGROUND/AIMS: We investigated a relationship between the risk factors for metabolic syndrome, such as obesity, diabetes mellitus, hypertension, and hyperlipidemia, and the pathogenesis and outcome of hepatocellular carcinoma (HCC). METHODOLOGY: One hundred twenty four patients who underwent curative resections for HCC were classified into 3 groups: those patients who were positive for hepatitis B surface antigen (group B), those positive for antibody to hepatitis C virus (group C), and those negative for both of them (non-B non-C) (group NBNC). The preoperative laboratory data, risk factors for metabolic syndrome, history of alcohol abuse, and outcome after surgery were investigated. The presence of non-alcoholic steatohepatitis (NASH) was also evaluated. RESULTS: The incidence of diabetes mellitus, hyperlipidemia, and alcohol abuse, and the serum level of triglyceride were significantly higher in group NBNC than in groups B or C. The risk factors for metabolic syndrome tended to lower the survival rates in group B and C, but not in group NBNC. Three of the 37 non-B non-C patients were associated with NASH. CONCLUSIONS: It is suggested that the pathogenesis of non-B non-C HCC may be more closely associated with the risk factors for metabolic syndrome than that of hepatitis virus related HCC.

Resection of a cancer developing in the remnant pancreas after a pancreaticoduodenectomy for pancreas head cancer.

We report a rare case of a curative resection performed on a carcinoma developing in the remnant pancreas at 3 years 7 months after a pancreaticoduodenectomy for pancreatic cancer. A 63-year-old man underwent a pancreaticoduodenectomy for pancreatic cancer on November 1999. Because the celiac trunk was occluded by atherosclerosis, an aortohepatic bypass with a saphenous vein graft was performed simultaneously. In May 2003, tumor marker levels increased, and a tumor was detected in the remnant pancreas on computed tomography. There were no findings such as invasion into the surrounding tissue or distant metastasis, and therefore we removed the remnant pancreas in July 2003. Histopathologically, the tumor consisted of a well-differentiated tubular adenocarcinoma and was limited to the pancreas. Moreover, the anastomotic site of the pancreaticojejunostomy was negative for cancer, and some foci of papillary hyperplasia and goblet cell metaplasia of the pancreatic ductal epithelium, which was thought to be the precursor of the pancreatic cancer, were seen. These findings suggested that the tumor was a second primary cancer developing in the remnant pancreas. This case provided suggestive evidence for the development of pancreatic cancer, and the surgical procedure for a pancreaticoduodenectomy with occlusion of the celiac trunk is discussed.