Second and third hepatectomies for recurrent hepatocellular carcinoma are justified.

BACKGROUND: Liver resection is the main curative treatment for hepatocellular carcinoma (HCC), but recurrence rates are high. The remnant liver is the most common site of recurrence, but the role of repeat hepatectomy in the treatment of recurrent HCC is controversial. METHODS: Patients who underwent curative hepatectomy for HCC and subsequent repeat hepatectomy for recurrent HCC between 1990 and 2007 were reviewed retrospectively. Clinicopathological characteristics, and early- and long-term outcomes of patients who had a first, second, third and fourth hepatectomy were compared. RESULTS: Some 1177 patients underwent a first hepatectomy for HCC, and 149, 35 and eight patients respectively had a second, third and fourth hepatectomies for recurrence. There were no significant differences in early postoperative outcomes after first and repeat hepatectomies. Five-year disease-free and overall survival rates after first, second and third hepatectomies were 43.6, 31.8 and 33.8 per cent (P = 0.772), and 52.4, 56.4 and 59.4 per cent (P = 0.879), respectively. Patients undergoing second and third hepatectomies for recurrence had better survival rates than those who did not have a repeat hepatectomy, but not those after fourth hepatectomy. CONCLUSION: Second and third hepatectomies seem justified for hepatic recurrence of HCC. The role of fourth hepatectomy needs further investigation.

Liver resection for hepatocellular carcinoma in patients with cirrhosis.

BACKGROUND: Although liver resection is now a safe procedure, its role for hepatocellular carcinoma (HCC) in patients with cirrhosis remains controversial. METHODS: This study compared the results of liver resection for HCC in patients with cirrhosis over two time intervals. One hundred and sixty-one patients had resection during period 1 (1991-1996) and 265 in period 2 (1997-2002). Early and long-term results after liver resection in the two periods were compared, and clinicopathological characteristics that influenced survival were identified. RESULTS: Tumour size was smaller, indocyanine green retention rate was higher, patients were older and a greater proportion of patients were asymptomatic in period 2 than period 1. Operative blood loss, need for blood transfusion, operative mortality rate, postoperative hospital stay and total hospital costs were significantly reduced in period 2. The 5-year disease-free survival rates were 28.2 and 33.9 per cent in periods 1 and 2 respectively (P = 0.042), and 5-year overall survival rates were 45.9 and 61.2 per cent (P < 0.001). Multivariate analysis identified serum alpha-fetoprotein level, need for blood transfusion and Union Internacional Contra la Cancrum tumour node metastasis stage as independent determinants of disease-free and overall survival. CONCLUSION: The results of liver resection for HCC in patients with cirrhosis improved over time. Liver resection remains a good treatment option in selected patients with HCC arising from a cirrhotic liver.

Liver resection for hepatocellular carcinoma in patients with end-stage renal failure.

BACKGROUND AND OBJECTIVES: Surgical resection remains the main option for curing hepatocellular carcinoma (HCC). However, liver resection in patients with end-stage renal disease (ESRD) is risky. The aim of this study is to clarify the role of liver resection for treating HCC in patients with ESRD. METHODS: A retrospective review was carried out on 468 patients who underwent liver resection for HCC between 1989 and 1999. The clinicopathological characteristics and operative results of 12 patients who had ESRD (ESRD group) were compared with those of the other 456 patients who did not have ESRD (non-ESRD group). In the ESRD group, heparin-free hemodialysis using the periodic saline-rinse method was performed during the perioperative period. RESULTS: The ESRD group had lower hemoglobin and a higher serum creatinine levels. Other patient background and tumor pathological characteristics were comparable between the two groups as well. The operative morbidity and mortality between the two groups were also similar. The 5-year disease-free survival rates for ESRD and non-ESRD groups were 35.0 and 34.2% (P = 0.31), respectively, while the 5-year actuarial survival rates were 67.8 and 53.3% (P = 0.54), respectively. CONCLUSION: With improving techniques and knowledge of dialysis, liver resection for HCC is justified in selected patients with ESRD.

Management of acute pancreatitis: results of a 15-year experience in Taiwan.

In the past two decades, there have been great changes regarding the policy for treating acute pancreatitis. The aim of this study was to examine the chronological changes in the management of acute pancreatitis in a tertiary referral center. A retrospective review was carried out of the management approaches for acute pancreatitis in the 15 years since 1984. The patients were divided into groups according to the admission date, representing two periods: period 1, from 1984 through 1992; and period 2, from 1993 through 1999. Decision-making for treating acute pancreatitis was based mainly on Beger's criteria. The background features and treatment outcome were compared between the two periods. The severity of pancreatitis was based on the Atlanta classification system. Octreotide was available from January 1993. No differences could be found between the two periods regarding the patients' background characteristics or severity of pancreatitis. Patients in period 2 had a longer interval between the onset of pancreatitis and surgery, and a lower incidence of pancreatectomy. Although the surgical morbidity, mortality, and reoperation rates were not significantly different between the two periods, more patients with severe acute pancreatitis in period 2 received nonsurgical treatment, and a lower mortality rate was also noted. With improvements in critical care, increasing experience, and better surgical techniques, even patients with severe acute pancreatitis can be treated by nonsurgical means. However, aggressive surgical intervention is necessary for patients who have signs of infected necrosis and whose disease is not controllable by conservative methods.

Comparison of the UICC/AJCC 1992 and 1997 pN categories for gastric cancer patients after surgery.

BACKGROUND/AIMS: UICC/AJCC 1997 classification changes pN category. We evaluated its prognostic impact. METHODOLOGY: A total of 710 patients who underwent a > or = D2 gastrectomy were recruited. Among them, the data of 319 patients who had involved regional lymph nodes and no evidence of distant metastases were used for comparing the 1992 and 1997 pN categories. RESULTS: For 1997 category, 201 patients (64%) were pN1, 75 (23.5%) pN2, and 43 (13.5%) pN3. For 1992 category, 143 patients (44.8%) were pN1, and 147(46.1%) pN2. 29 patients (9.1%) with lymph node metastasis to the hepatoduodenal ligament were distant metastasis. The 1997 pN category was a more powerful prognostic discriminant (relative risk: 2.086) than the 1992 category. Compared to the 1992 stage classification, the 1997 one had a skewed distribution of patients with marked shift of patients of stage IIIA (105-126 patients), IIIB (116-58 patients), and IV (100-122 patients). The survival difference between stage IIIA and IIIB for the 1997 stage classification is narrower than for 1992. CONCLUSIONS: The 1997 pN category allows for estimation of prognosis superior to the 1992 category.

Improving operative safety for cirrhotic liver resection.

BACKGROUND: Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose safe strategies for cirrhotic liver resection. METHODS: Based on the date of operation, 359 cirrhotic liver resections in 329 patients were divided into two intervals: period 1, from September 1989 to December 1994, and period 2, from January 1995 to December 1999. The patient backgrounds, operative procedures and early postoperative results were compared between the two periods. The factors that influenced surgical morbidity were analysed. RESULTS: In period 2, patient age was higher and the amounts of blood loss and blood transfused were lower. Although postoperative morbidity rates were similar, blood transfusion requirement, postoperative hospital stay and mortality rate were significantly reduced in period 2. No death occurred in 154 consecutive cirrhotic liver resections in the last 38 months of the study. Prothrombin activity and operative time were independent factors that influenced postoperative morbidity. CONCLUSION: With improving perioperative assessment and operative techniques, most complications after cirrhotic liver resection can be treated with a low mortality rate. However, more care should be taken if prothrombin activity is low or there is a long operating time.

An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation.

BACKGROUND: The role of surgical resection for hepatocellular carcinoma with tumor thrombi involving the major portal vein is controversial because of a high operative risk and poor prognosis. Previously, a resection was performed only when the tumor thrombi were limited to the first branch of the portal vein without extension to the portal bifurcation. HYPOTHESIS: Concomitant liver and portal vein resection may be beneficial in patients with hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. DESIGN: Retrospective review. SETTING: University hospital, tertiary referral center. PATIENTS: Among 368 patients with hepatocellular carcinoma who underwent a curative resection, portal vein involvement occurred in 112 patients. Fifteen of the 112 patients underwent a concomitant liver and portal vein resection owing to extension of tumor thrombi to the portal bifurcation (group 1). The remaining 97 patients did not need portal vein resection (group 2). INTERVENTION: Surgical indications, procedures, and results of pathological examination of resected specimens were assessed in patients in group 1. The clinicopathological characteristics, operative morbidity and mortality, and operative results were compared between the 2 groups. MAIN OUTCOME MEASURES: Disease-free and actuarial survival rates. RESULTS: Intramural tumor infiltration was found at the site of thrombi adhesion to the portal vein cuff in 11 of 15 patients in group 1. Owing to patient selection bias, patients in group 1 were significantly younger and had better liver function and greater resected liver weight. The operative time, postoperative hospitalization, operative blood loss, amount of blood transfusion, and operative morbidity and mortality did not differ significantly between the 2 groups. The 5-year disease-free survival rates of groups 1 and 2 were 21.6% and 20.4% (P =.19), respectively, while the actuarial survival rates were 26. 4% and 28.5% (P =.33), respectively. CONCLUSION: Liver resection with partial resection of the portal vein is justified in selected patients with hepatocellular carcinoma with tumor thrombi extending to portal bifurcation.

Surgical treatment for recurrent hepatocellular carcinoma with tumor thrombi in right atrium: using cardiopulmonary bypass and deep hypothermic circulatory arrest.

Tumor in the right atrium creates a life-threatening condition and should be removed immediately. A cirrhotic patient who had recurrent hepatocellular carcinoma (HCC) over remnant liver with tumor thrombi extending to inferior vena cava (IVC) and right atrium presented with impending congestive heart failure. The recurrent tumor and its thrombi were successfully resected en-bloc using cardiopulmonary bypass and hypothermic circulatory arrest. Although the patient's disease-free and actual survival time were only 6 months and 14 months, respectively, he was rescued from heart failure. This aggressive surgical strategy creates further possibility to treat such advanced HCC cases. Further investigations regarding adjuvant therapies in these circumstances, however, are necessary.

Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly.

Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged >/= 65 years (1987-1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those > 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41. 3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged >74 years had a higher mortality rate than those aged 65 to 74 years (10. 1% vs. 3.5%; p = 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long-term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.

Hepatitis viral status in patients undergoing liver resection for hepatocellular carcinoma.

BACKGROUND: Hepatitis B and C viruses are the main causative agents of hepatocellular carcinoma (HCC). The influence of hepatitis viral status on liver resection for HCC remains undetermined. METHODS: Patients who underwent curative resection for HCC were divided into four groups: group 1, seronegative for hepatitis B surface antigen (HBsAg) and antihepatitis C antibody (HCVAb); group 2, seropositive for HBsAg only; group 3, seropositive for HCVAb only; and group 4, seropositive for HBsAg and HCVAb. The clinicopathological characteristics and surgical results of the four groups were compared. Resection of HCC was determined according to liver functional reserve and tumour extent. RESULTS: There were 40, 131, 70 and 20 patients in groups 1, 2, 3 and 4 respectively. Due to patient selection bias, there were significant differences in some background features, resectional extent and pathological characteristics among the four groups. Postoperative morbidity and mortality, as well as the Union Internacional Contra la Cancrum tumour node metastasis stages, did not differ. Patients in group 1 had a higher disease-free survival rate than those in group 2 (P = 0. 02). The actuarial survival rates of patients in groups 2 and 4 were lower than those of groups 1 and 3. CONCLUSION: With careful patient selection, the hepatitis viral status does not influence the surgical risks of hepatectomy for HCC. After liver resection for HCC, the long-term survival rate of patients seronegative for HBsAg is greater than that of patients seropositive for HBsAg.

Development of a new prognostic system and validation of APACHE II for surgical ICU mortality: a multicenter study in Taiwan.

BACKGROUND: To develop and to validate a new prognostic prediction system for patients admitted to the surgical intensive care unit (ICU), and to compare its performance with the Acute Physiology and Chronic Health Evaluation (APACHE) II system. METHODS: The database was derived from three surgical ICUs in three hospitals. For each patient, demographic data, diagnosis, APACHE II score and hospital survival data were collected. The accuracy in outcome prediction of the APACHE II was assessed by means of receiver operating characteristic (ROC) analysis. The new prognostic system was developed by using a multiple logistic regression in the developmental data set and validated with the validation data set. RESULTS: A total of 1,248 patients were included from three ICUs. The area under the ROC curve was 0.74 for the APACHE II score. The new prognostic system includes 18 variables. Goodness-of-fit tests indicated that the model performed well in the developmental and validation samples (p = 0.235 in the developmental data set and p = 0.297 in the validation set). The area under the ROC curve was 0.84 in the developmental sample and 0.77 in the validation sample for the new prognostic score. The area under the ROC curve was 0.71 in the validation sample for the APACHE II score. CONCLUSIONS: Although APACHE II correlates with mortality for surgical ICU patients in Taiwan, its accuracy is not as good as in the original study. Mortality prediction performance improved with the use of the new, local scoring system.

Factors affecting morbidity, mortality and survival after pancreaticoduodenectomy for carcinoma of the ampulla of Vater.

BACKGROUND/AIMS: The aim of this paper is to reevaluate the factors responsible for hospital morbidity, mortality and post-operative survival following pancreaticoduodenectomy for ampullary cancer. METHODOLOGY: Peri-operative data on 132 patients undergoing pancreaticoduodenectomy for ampullary cancer were correlated with post-operative morbidity, mortality and long-term survival. RESULTS: Three factors were found to correlate well with post-operative morbidity; however, only intraabdominal or wound sepsis was an independently significant variable. Four parameters correlated well with hospital mortality, while multivariate analysis revealed age > 75 y/o, positive blood culture and albumin < or = 3.0 g% to be independently significant in predicting post-operative mortality. Univariate analysis identified seven significant factors: 1) age < or = 75 y/o, 2) hematocrit > 30%, 3) blood urea nitrogen < 20 mg%, 4) earlier TNM staging, 5) smaller tumor size, 6) negative nodal status and 7) well-differentiated tumors, which were associated with longer survival. However, multivariate analysis disclosed nodal status and hematocrit to be the two most significant independent variables. CONCLUSIONS: Although radical resection for ampullary cancer can be performed with a low mortality in recent years, the justification for performing this major operation in a patient over 75 years of age should be reevaluated for prohibitively high mortality (10x) and shorter survival (median 6.0 months). Pre-operative nutritional support and careful surgical technique to prevent post-operative sepsis are mandatory to reduce operative morbidity and mortality. Correction of anemia and adequate lymph node dissection will clarify the patient's survival benefit following this operation.

Peri-anhepatic phase oxygen kinetics in porcine liver transplantation.

BACKGROUND: We applied a liver transplantation animal model to examine the relationship between oxygen delivery and consumption. The presence of pathologic flow-dependent oxygen consumption was investigated during and after the anhepatic phase. The effect of venous-to-venous bypass on oxygen kinetics was evaluated. METHODS: Twelve pigs were randomly divided into two groups. The non-bypass group consisted of six pigs that were subjected to clamping of the hepatic artery, portal vein, and the superior and inferior vena cava to produce an anhepatic phase. The bypass group consisted of six pigs that underwent vascular clamping and liver transplantation with venous bypass. Hemodynamics, oxygen delivery index (DO2) and oxygen consumption index (VO2) were recorded during the peri-anhepatic phase. Best-fit regression lines were calculated for DO2 vs VO2. RESULTS: In the pigs without venous bypass, the blood pressure, cardiac index and VO2 dropped significantly after vascular clamping and lactic acidosis developed. In pigs with venous bypass, vascular clamping induced a significant decline of cardiac output and DO2 but VO2 was maintained by a compensatory increase in oxygen extraction ratio. DO2 and VO2 after the release of vascular clamping increased significantly higher than that before vascular clamping. The O2 supply-dependent regression line was drawn from the points below critical oxygen delivery with a slope of 0.232 (95% CI = 0.110-0.354, r2 = 0.50, p = 0.010). The pathologic supply-dependent line was drawn from the points with supranormal DO2 and VO2 with a slope of 0.185 (95% CI = 0.050-0.333, r2 = 0.510, p = 0.029). The slope of the supply-independent line was 0.0089 (95% CI = -0.030-0.050, r2 < 0.009, p = 0.12). CONCLUSIONS: Oxygen delivery dropped below the critical level and flow-dependent oxygen consumption developed during the anhepatic phase without venous bypass. Venous-to-venous bypass is necessary to maintain a critical DO2 and stable hemodynamics during porcine liver transplantation. Pathologic flow-dependent oxygen consumption developed after the anhepatic phase.

Evaluation of a simplified staging system for prognosis of hepatocellular carcinoma.

The current TNM (tumor, nodes, metastases) staging system for human hepatocellular carcinoma (HCC) has been challenged since a new T staging system was proposed to correlate the staging group with patient outcome after curative liver resection. The new T staging system proposed T1 as no vascular invasion, small size (< or = 5 cm), and solitary tumor. T2 was defined as the presence of one of the following factors: size greater than 5 cm, vascular invasion, or multiple tumors; T3 as the presence of two of the above three factors; and T4, the presence of all three factors. A total of 323 patients undergoing curative partial hepatectomy for HCC were studied. Kaplan-Meier survival analysis was used to evaluate the postoperative outcome. The new T staging showed good correlation between the staging group and patient outcome. The 1-year disease-free survival (DFS) rate and overall survival (OS) rate were 80.0% and 87.8% for stage 1 (n = 115), 67.6% and 81.6% for stage 2 (n = 136), 40.0% and 58.0% for stage 3 (n = 58), and 21.4% and 42.8% for stage 4 (n = 14), respectively. The 3-year DFS rate and OS rate were 61.0% and 64.5% for stage 1, 37.8% and 50.7% for stage 2, 21.4% and 29.8% for stage 3, and 21.4% and 34.3% for stage 4, respectively. When analyzed using the current International Union Against Cancer (UICC) pathologic (p) TNM staging system, the 1-year and 3-year DFS rates were 86.2% and 64.0% for stage 1 (n = 30), 73.9% and 50.0% for stage 2 (n = 182), and 46.8% and 22.3% for stage 3 (n = 111), respectively. Our results showed that, while both staging systems allow clear stratification of patients into prognostic groups, the modified TNM system is not superior to the UICCpTNM system in predicting survival of HCC patients after curative partial hepatectomy. A larger scale, multicenter study may be needed to test the revised TNM system.

Is hepatic resection absolutely contraindicated for hepatocellular carcinoma in Child-Pugh class C cirrhotic patients?

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma (HCC) in Child-Pugh class C cirrhotic patients is considered to be high risk and even contraindicated. This study examined our results of hepatectomy for HCC in such cirrhotic patients. METHODOLOGY: A retrospective review of the clinicopathological features, as well as early and late resection results of Child-Pugh class A (n = 181) and class C patients (n = 13) were compared. The extent of hepatectomy was based on the pre-operative liver function test and indocyanine-green (ICG) clearance rate. RESULTS: The tumor size in class C patients was smaller than that in class A patients. There were no significant differences with regard to operative blood loss, amount of blood transfusion, operative morbidity or mortality. The surgical margins of class C patients were narrower (p = 0.003). The tumors of class C patients had higher incidences of well-formed capsules and absence of satellite nodules. The 5-year disease-free and actuarial survival rates of class A and C patients were 35.4% and 40.7% (p = 0.28), and 48% and 50% (p = 0.13), respectively. CONCLUSIONS: Not all HCCs in Child-Pugh class C cirrhotic patients are contraindicated for liver resection. In the absence of uncontrollable ascites, marked jaundice and encephalopathy, surgical resection is still justified in some selected cases, in spite of a narrow surgical margin.

Concomitant splenectomy for hypersplenic thrombocytopenia in hepatic resection for hepatocellular carcinoma.

BACKGROUND/AIMS: Resection of hepatocellular carcinoma (HCC) in patients with liver cirrhosis and hypersplenic thrombocytopenia (HSTC) is risky. Controversy exists concerning the role of concomitant splenectomy for HSTC in cirrhotic patients undergoing hepatectomy for HCC. METHODOLOGY: During the past 10 years, 294 patients have undergone hepatic resection for HCC in our department. Among them, 11 cirrhotic patients with severe HSTC (platelet count < or = 80000/mm3) underwent splenectomy simultaneously. The clinical outcomes were retrospectively reviewed. RESULTS: The resected spleen weighed 479 +/- 242 g. The post-operative mortality and morbidity were 9.1% and 27.3%, respectively. In all patients, the platelet count was elevated to above 100000/mm3, and serum total bilirubin was significantly lowered within 1 week of operation. The overall 5-year actuarial and disease-free survival rates were 66.7%. None of the patients developed severe infectious complications during the follow-up period. CONCLUSIONS: Concomitant splenectomy for severe HSTC in cirrhotic patients undergoing hepatectomy for HCC is justified as the benefits of concomitant splenectomy by far surpass the adverse effects.

Comparison of liver resection for hepatocellular carcinoma in hepatitis B and hepatitis C-related cirrhotic patients.

BACKGROUND/AIMS: The differences of liver resection for hepatocellular carcinoma (HCC) between hepatitis B and C-related cirrhotic liver remain unknown. This study compares the surgical results of HCC in hepatitis B and hepatitis C-related cirrhotic patients in an area endemic of hepatitis B. METHODOLOGY: A retrospective comparison of the clinicopathological features and early and long-term results of 110 cirrhotic patients with seropositive hepatitis B surface antigen only (group B) and 55 patients with seropositive anti-hepatitis C antibody only (group C) was carried out. RESULTS: Group C patients were older, had a lower serum alpha-fetoprotein level, greater indocyanine retention rate, and higher incidence of multicentric tumors. Tumor size was larger and there was a higher incidence of combined satellite nodules in group B patients. There were no significant differences in operative morbidity and mortality between the two groups. Group B patients had a slightly shorter disease-free interval (p = 0.07) but a better actuarial survival rate (p = 0.05) than group C patients. CONCLUSIONS: The hepatitis status did not affect the operative risks in cirrhotic livers. However, after resection of HCC, poorer liver functional reserve in hepatitis C-related cirrhotic patients caused poorer actuarial survival rate when compared with hepatitis B-related cirrhotic patients.

Mesohepatectomy for centrally located hepatocellular carcinoma: an appraisal of a rare procedure.

BACKGROUND: For centrally located hepatocellular carcinoma (HCC), extended major hepatectomy is usually recommended, but the risk of postoperative liver failure is high when liver function is not sound. Mesohepatectomy (en bloc resection of Goldsmith and Woodburne's left medial and right anterior segments or Couinaud's segments IV, V, and VIII) is a rare procedure, so its role in treating HCC is unclear. STUDY DESIGN: We retrospectively reviewed 364 patients who underwent a curative resection for HCC. Among them, 15 patients were treated by mesohepatectomy. Their nontumorous liver revealed cirrhosis in 11 and chronic hepatitis in 4. The mean tumor diameter was 12.8 cm. In 10 of the 15 patients, HCC also invaded adjacent organs. The operative results of another 25 patients with different disease extent who underwent extended major hepatectomy were compared. RESULTS: The hepatic inflow occlusion time for mesohepatectomy was longer than for extended hepatectomy (p = 0.01). The mean operative blood loss, amount of blood transfusion, operating time, and postoperative hospital stay in the mesohepatectomy group were 2,450 mL, 1,100 mL, 7.9 hours, and 14.9 days, respectively. In the extended-hepatectomy group, the values were 1,863mL, 768mL, 5.8 hours, and 16.8 days, respectively (all p>0.05 compared with mesohepatectomy). No patient died after mesohepatectomy, but after extended hepatectomy there was one death from liver failure. The Union Internationale contre le cancer (UICC) TNM stages of patients who underwent mesohepatectomy were as follows: stage II in 1, stage III in 4, and stage IVA in 10. All patients who underwent extended hepatectomy presented with stage IVA disease. The 6-year disease-free and actuarial survival rates after mesohepatectomy were 21% and 30%, respectively. The 6-year disease-free survival rate after extended hepatectomy was 9% (p = 0.11 compared with mesohepatectomy). CONCLUSION: Although mesohepatectomy is time-consuming, it is justified for selected patients with centrally located large HCC in a diseased liver.

Liver resection for hepatocellular carcinoma in octogenarians.

BACKGROUND: Liver resection is risky in patients aged > or = 80 years. Because of short life expectancies and improved nonoperative modalities, the role of liver resection in octogenarians with hepatocellular carcinoma (HCC) is unclear. METHODS: A retrospective review of the operative results of 260 patients with HCC between 1991 and 1997 was performed. According to the age at the time of operation, these patients were divided into 2 groups. Group 1 comprised 21 patients aged > or = 80 years, and group 2 comprised the other 239 younger patients. The backgrounds, pathologic features of the tumor, and operative results of the patients were compared. RESULTS: Octogenarians had a higher incidence of associated medical diseases, a higher incidence of negative serum hepatitis B surface antigen, a lower alpha-fetoprotein level, and a higher indocyanine green retention rate. Although octogenarians had a longer postoperative hospital stay, there were no significant differences between the 2 groups regarding operative morbidity and mortality. The 5-year disease-free and actuarial survival rates for octogenarians and younger patients were 50.6% and 35.3% (P = .15) and 40.9% and 59.3% (P = .46), respectively. CONCLUSION: Under meticulous preoperative assessments and postoperative care, liver resection for HCC is justified in selected octogenarians, with short- and long-term results comparable to those of younger patients.

Serum hepatocyte growth factor level associate with gastric cancer progression.

We have measured serum HGF levels from 80 gastric cancer patients and 51 normal subjects by enzyme-linked immunosorbent assay. The results showed that the mean value of serum HGF level in gastric cancer patients was significantly higher than in normal subjects (0.30 +/- 0.02 vs 0.22 +/- 0.05 ng/ml; p = 0.005). The increase was stage related. Patients with serum HGF < or = 0.30 ng/ml survived longer than those with serum HGF > 0.30 ng/ml (p = 0.02). These data suggest that HGF involve in progression of gastric cancer.