Evaluation of irregular hepatectomy for primary liver carcinoma

From 1964 to 1985, 120 patients with primary liver carcinoma were treated by operation in our hospital. Regular hepatectomy was done in 7 patients, palliative irregular hepatectomy in 28 and radical irregular in 85. The operation mortality was 4.2% in irregular hepatectomy group (113 cases) but 14.3% in regular hepatectomy group (7 cases) (P greater than 0.05). The 1, 3 and 5 year survival rates were 68.8%, 48.1% and 20.0% in radical irregular hepatectomy group but 83.3%, 33.3% and 16.7% in regular hepatectomy group. 10 of 28 patients treated by palliative hepatectomy were added with radiation. Majority of these patients died in 1 year after operation but 2 patients survived for more than 2 years and 1 for more than 7 years. The data show that in Asia, the incidence of primary liver carcinoma concurrent with liver cirrhosis is high and irregular hepatectomy is a suitable treatment. There is no difference between irregular and regular hepatectomy groups in the prognosis. But the former could reduce the operative time, mortality and the possibility of bleeding and complications.     

Liver resection for hepatocellular carcinoma: results from 150 consecutive patients

During the past 6 years, 150 consecutive hepatic resections were performed for hepatocellular carcinoma on 129 male and 21 female patients. Their ages ranged from 17 years to 78 years, with an average of 57.0 years. All but two patients had an underlying parenchymal disease of the liver; 131 had liver cirrhosis, 16 chronic hepatitis, and one liver fibrosis. The operations performed were extended right lobectomy in 10cases, right lobectomy in 13, left lobectomy in 5, left lateral segmentectomy in 11, other segmentectomies in 31, and partial wedge resection in 80 instances. The operative and in-hospital mortality rates were 6.0% and 12.0% respectively. In the 122 patients with curative resection, the 1-, 3- and 5-year survival rates were 75.2%, 49.0% and 30.0% respectively. The 1- and 3-year survival rates were 14.3% and 7.1% in the 28 patients with palliative resection. The tumor size and Child's classification generally reflected the survival rate.     

肝部分切除与肝十二指肠韧带骨髂化治疗肝门部胆管癌

Objective To summarize the surgical experience of partial hepatectomy with skeletonization of the hepatoduodenal ligament in the treatment of hilar cholangiocarcinoma.Methods Between Jan.1999 and Dec,2001,67 consecutive patients with hilar cholangiocarcinoma underwent surgical exploration at the Second Military Medical University,Eastern Hepatobiliary Surgery Hospital.The clinical data of these patients were reviewed.Results Of the 67 patients,65(97%) underwent surgical resection.Fourty-nine patients(73%) received curative resection:22 skeletonization resection(SR) and 27 SR combined with partial hepatectomy.In 16 patients(9%) with curative resection the tumor margin was histologically postive and the resection was therefore considered palliative.The tumors were classified according to Bismuth with SR was type Ⅱ(17cases),various types of partial hepatectomy with SR was type Ⅲ and type IV.Right lobectomy with right caudate lobectomy was indicated in type Ⅲ(6cases),left lobectomy with complete caudate lobectomy in type Ⅲb(15cases),right loobectomy with complete caudate lobectomy(3 cases),left lobectomy with complete caudate lobectomy(9 cases) and quadrate lobectomy(2 cases)in type IV.SR and left lobectomy with complete caudate lobectomy was successfully performed in 2 patients(3%) who had undergone palliative biliary resection and cholangiojejunostomy before.Eight patients(12%) had local resecton of the tumor with Roux-en-Y hepaticojejunostomy reconstruction using intrahepatic stents.Two patients(3%) had palliative biliary drainage.Combined portal vein resection was performed in 13 patients(20%) and hepatic artery resection in 27 patients(40%) .Twenty-four atients(36%) had no postoperative complication,23 patients(34%) had minor complications only ,and the remaining 20 patients(30%) had major complications.Of the 20 patients with major complications,14 recovered,the remaining 6 patients died from hepatorenal failure with other organ failures,from myocardial infarction or from intraabdominal or gastrointestianl bleeding 7,12,14,42,57 or 89 days after surgery.The 30-day operative mortality was 4.5%.The mean survival of the patient with curative resecton was 16 months(range 1-32 months);for those undergong palliative resection mean survival was 7 months(range 1-14months).Conlusion Partial hepatectomy with SR for hilar cholangiocarcinoma can be performed with acceptable morbidity and mortality.For curative treatmet of hilar cholangiocarcinoma,caudate lobectomy is always recommended in Bismuth Ⅲ/IV.     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

原发性肝癌自发性破裂出血31例外科治疗分析

目的：探讨原发性肝癌自发性破裂出血的临床表现,治疗方案疗效。方法：对1998年1月到2008年1月我院收治的31例原发性肝癌自发性破裂出血的临床资料进行回顾性分析,并结合文献进行探讨。结果：全组31例中,非手术治疗10例,手术治疗21例,4例行肝动脉结扎加大网膜填塞止血,余17例行肝切除。左肝外叶切除5例,左肝内叶切除2例,左半肝切除2例,肝右叶部分切除8例。非手术组生存时间平均为30±23天,手术组肝动脉结扎加大网膜填塞生存时间平均为1994-86天。肝切除组生存453±124天。1、3．5年生存率为75．4％、40．2％、0％。结论：应尽量完善术前检查,及时诊断,严格掌握治疗方法适用症,迅速控制出血,是抢救肝癌自发性破裂出血病人的关键。肝切除是治疗原发性肝癌破裂出血的最好方法。     

肝癌破裂出血TAE后行肝切除及区域化疗的效果

目的：探讨肝癌破裂出血采用肝动脉栓塞术（TAE）止血后施行肝切除及区域性化疗的效果。方法：对27例肝癌破裂行急诊TAE止血，3～14天内开腹手术。结果：27例中，肝功能属Child A级5例，B级14例，C级8例，TAE止血率达100％。肝癌均获延期切除，其中半肝切除9例，中叶切除2例，局部切除9例，肿瘤切出1例．多发癌结节犬部分切除6例。术中均行腹腔温热化疗及肝动脉、门静脉插管术后灌注化疗。手术死亡率3．7％、1、3、5年生存率和无瘤生存率分别为80．1％和65．4％，68，4％和42．1％，27．3％和18.2％。结论：TAE止血及改善全身状况后手术，有利于提高肝癌切除率及行综合治疗，是提高该病疗效的有效方法。     

原发性肝癌的综合治疗--附607例报告

背景与目的：虽然原发性肝癌(简称肝癌)的早期诊断和早期治疗取得了很大进步,但大多数为合并有肝硬化的中晚期肝癌患者,手术切除并非适合所有肝癌患者,即使能切除,术后复发率也高达60％以上,因而,肝癌的整体治疗效果较差。本研究探讨肝癌的综合治疗方法,以进一步提高肝癌的整体治疗效果。方法：回顾性分析我科以外科为主综合治疗的607例肝癌患者的病例资料,其中,手术切除共423例,行不规则性肝叶切除134例,局部切除95例,肝叶或肝段切除123例,半肝或半肝以上切除共54例,联合脏器切除17例;手术不能切除184例,行肝固有动脉结扎联合肝动脉及门静脉双插管化疗或瘤体内注射无水乙醇或冷冻、射频治疗、微波固化、腹腔化疗等。结果：总的手术切除率69．7％(423／607),手术死亡率1．2％(5／423);全组3、5、10年生存率分别为42．7％(218／511)、37．5％(123／328)和26．5％(26／98);切除组3、5、10年生存率分别为57．2％(203／355)、51．3％(118／230)和35．3％(24／68);不能切除组3、5、10年生存率分别为9．6％(15／156)、5．1％(5／98)和6．7％(2／30)。结论：以外科为主的综合治疗是目前可切除肝癌较好的治疗方法。术后个体化综合治疗可提高肝癌的手术治疗效果。     

Laparoscopic hepatectomy for liver neoplasms in 15 cases

Objective

The aim of our study was to retrospectively analyze 15 patients’ clinical materials with laparoscopic resection of liver neoplasms.

Methods

From December 2007, a total of 15 patients with liver neoplasms were performed with laparoscopic hepatectomy, and their clinical materials, perioperative dates, postoperative complications, postoperative recovery and short-term curative effects were analyzed and summarized respectively.

Results

Laparoscopic hepatectomy (LH) were performed in 15 patients, including 1 case underwent laparoscopic hepatic left lobectomy, 1 case of left lateral hepatectomy, 13 cases of partial liver resection. Fourteen cases of total laparoscopic liver resections for liver neoplasms, 1 case of hand-assisted laparoscopic liver resection of the tumor, there was no conversion to open approach. Of the 15 patients with liver neoplasms, 13 cases of hepatic neoplasms with the maximum diameter was 8 cm × 8 cm × 9 cm, 9 cases of the borderline micro hepatocellular carcinoma (MHCC) with the diameter not more than 2 cm, 3 cases of hepatic benign tumor. The mean operation time was (120 ± 30) min, and the intraoperative average hemorrhage was 100 mL, beginning to eat and get out of bed following 1–2 days of operation. The average postoperative hospitalization was 8 days, WBC, ALT, AST, albumin, bilirubin returned to normal after one week of operation. There were no postoperative complications such as hemorrhage, bile leakage or air embolism etc. Twelve patients with HCC were confirmed by postoperative pathology, 1 case of liver smooth muscle lipoma, 2 case of hepatic hemangioma. By one year of followed-up in 12 cases of HCC, the longest survival was 38 months, and no recurrence or death, 1 year survival rate was 100%.

Conclusion

Among the choice of cases, the advantages of LH for liver neoplasms compared with open surgery were less trauma, faster recovery and less blood loss. it is safe and effective for choosing a reasonable surgical indication, especially for peripheral micro hepatocellular carcinoma.     

Prognostic significance of intrahepatic lymphatic invasion in patients with hepatic resection due to metastases from colorectal carcinoma

BACKGROUND: Intrahepatic spread from liver metastases of colorectal carcinoma has been well described; however, its prognostic value after hepatectomy is controversial. To clearly determine factors predicting survival after hepatectomy in such patients, the authors evaluated 14 clinicopathologic factors of liver metastasis from colorectal carcinoma with special reference to intrahepatic lymphatic invasion. METHODS: The authors retrospectively analyzed data obtained from 67 consecutive patients who underwent hepatectomy for liver metastasis from colorectal carcinoma. Intrahepatic spread was classified into discreet categories that were evaluated separately: invasion to the portal vein, hepatic vein, bile duct, and lymphatic or perineural space. Overall survival and disease free survival periods were examined as functions of clinicopathologic determinants by univariate and multivariate analyses. RESULTS: Intrahepatic spread was found in a total of 28 (43.1%) of the 65 evaluable cases. Portal vein invasion was found in 15 (23.1%) of these cases, hepatic vein invasion in 3 (4.6%), bile duct invasion in 10 (15.4%), and intrahepatic lymphatic invasion in 10 (15.4%). Five year overall and disease free survival rates after hepatectomy were 33.4% and 28.5%, respectively. A short interval (< 12 months) from treatment of primary colorectal carcinoma to liver metastasis and the presence of intrahepatic lymphatic invasion significantly and adversely affected the overall and disease free survival rates. CONCLUSIONS: Intrahepatic lymphatic invasion was shown statistically to be an independent predictor of recurrence and death after hepatectomy in patients with liver metastases from primary colorectal carcinoma.     

复发性肝癌再切除的探讨

探讨肝癌术后复发再切除的临床价值和手术指是征以及再切除方式。方法：我院自１９８８年至１９９８年对原发性肝癌施行切除术２３３例,有２０例术后复发获得 切除共２６例次。其中伴肝硬化１６例,占８０％;肿瘤〈５ｃｍ１９例次,〉５ｃｍ７例次;行肝叶切除３例;肝段切除７例次;局部切除１２例次;肝部分切除３例次;右后叶切除１例。结果无１例死亡,再切除后１－５年生存率为９５％、６５％、３５％、３０％、３０％。有１     

不同肝血流阻断方法对可手术小肝癌预后的影响

目的 比较可手术小肝癌选择性适时半肝血流阻断法与肝十二指肠韧带阻断法（Pringle法）对患者中长期生存的影响。方法 根据肝血流阻断不同方式,将我院腹部外科222例小肝癌手术患者分为无肝门阻断、选择性适时半肝血流阻断与Pringle法3组,对以上患者进行随访,收集生存资料进行分析比较。结果 选择性适时半肝血流阻断组与无肝门阻断和Pringle法组患者之间中位生存时间差异有统计学意义（P值分别为0.02、0.04）。无肝门阻断、选择性适时半肝血流阻断和Pringle法组患者3年生存率分别为81.3%、93.3%和76.0%,三者间差异有统计学意义（P=0.008）;5年生存率分别为70.6%、90.8%和50.7%,三者间差异有统计学意义（P<0.001）。选择性适时半肝血流阻断组3年生存率与5年生存率均优于其他两组。结论 在小肝癌可手术患者中应用选择性适时半肝血流阻断较Pringle法能显著延长患者的生存时间,提高患者生存率。     

Whole liver intraoperative irradiation after partial hepatectomy produces minimal functional and pathologic lesions.

Intraoperative radiation therapy (IORT) was delivered to remnant rat liver after partial hepatectomy to determine the chronic effects of treatment on survival, blood chemistry, liver weight, and histology. Survival at one year was 100%. Remnant liver weight was markedly increased in all animals. Liver function appeared to be unaltered in all groups and at all observation times. Inflammatory cell infiltration occurred immediately after treatment in all animals, showing a slight progression until day 45; by day 180 the values had returned to baseline. Vascular changes were seen early in all groups, then progressively decreased; the vascular score was back to baseline at days 180 and 365. Nuclear alterations were observed in both irradiated and nonirradiated hepatic cells; in all cases these were limited to isolated or focal areas of hepatocytes. There was little fibrosis formation and by day 180 all scores were back to baseline. We conclude that the chronic effects of whole liver IORT after one-third hepatectomy are minimal in the rat and are similar to those observed after surgery alone.     

Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes

Hepatectomy may be the only treatment modality for the cure of colorectal liver metastasis. However, whether to perform nonanatomical resection or anatomical resection remains unclear. Original articles in English on liver metastasis, including reports that dealt with case series of more than 50 curative hepatectomies, were reviewed, and the current status of surgical treatment for colorectal liver metastasis was summarized, with a special emphasis on the relevance, indications, and outcomes of anatomical hepatectomy. Anatomical hepatic resection was performed in 63% of the patients. For patients who were treated by curative hepatectomy, including both anatomical and nonanatomical resection, the morbidity rates, mortality rates, 5-year survival rates, and rates of hepatic recurrence were 23%, 3.3%, 34%, and 41.2%, respectively. In 73 articles that each analyzed more than 50 patients treated with potentially curative hepatectomy, the incidence of anatomical resection exceeded 50% in 56 series, while anatomical resection was performed in fewer than 50% of the patients in 17 series. A comparison between these two groups naturally revealed a remarkable difference in the incidence of anatomical resection (72% versus 34%), but no difference in terms of morbidity; mortality; survival rates at 3, 5, and 10 years; or rate of hepatic recurrence. The profile of liver metastasis related to prognosis was generally advantageous to patients treated with nonanatomical resection, and this may have nullified the survival advantage of anatomical hepatectomy over nonanatomical resection. Anatomical resection provides a higher probability of coresecting microscopic invasions that are predictable but undetectable, and can be recommended as a standard procedure for locally advanced metastatic liver cancer.     

Surgical treatment of hepatic metastases from breast cancer

We have performed a retrospective study to evaluate whether surgical treatment is beneficial in patients with hepatic metastases from breast cancer. Between September 1985 and September 1998, 25 patients with hepatic metastases (14 solitary and 11 multiple), eight of whom had extrahepatic metastases, underwent hepatectomy. All of the detectable liver metastasis were resected in all of the cases. There were no severe postoperative complications. All but one of the patients received adjunctive polychemotherapy after the hepatectomy. After the hepatectomy, recurrent tumors were detected in 18 of the patients, being located in the liver in 12 (67%) of them. Overall, however, hepatectomy ensured that the liver was clinically recurrence-free for a median of 24 months (range 2–132 months). Eleven patients died of recurrent tumors, two died of other causes and the remaining 12 are currently alive. The 2- and 5-year cumulative survival rates after hepatectomy were 71% and 27%, respectively, and the median survival duration was 34.3±3.2 months, much better than the period of 8.5 months for another series of patients treated with standard or non-surgical therapies at our institution. The number and the size of hepatic metastases, the interval between treatment of the primary lesion and hepatectomy, and the existence of extrahepatic metastasis were not adverse prognostic factors. In conclusion, our data, although limited and highly selective, suggest that surgical treatment of hepatic metastases from breast cancer may prolong survival in certain subgroups of patients to a greater extent than standard or non-surgical therapies.     

巨大肝癌手术切除治疗的临床疗效

目的：通过手术切除巨大肝癌36例,总结手术经验,分析手术疗效和肿瘤复发相关因素。方法：肝门血流阻断16例,半肝血流阻断20例（右半肝阻断14例、左半肝阻断6例）。结果①无手术死亡者;②肝癌复发率为69．44％;③1、2、3年生存率分别为83．33％、44．44％、33．33％。结论巨大肝癌若肿瘤边缘清楚而且患者肝功能正常仍应积极手术切除治疗,半乳治疗,半肝阻断法提高了巨大肝癌的切除率和手术安全性,长了中晚期患者的生存时间,术后经化疗泵化对防治肝癌复发有积极作用。     

RESULTS OF HEPATECTOMY FOR 600 CASES WITH PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦ　ＨＥＰＡＴＥＣＴＯＭＹＦＯＲ６００ＣＡＳＥＳＷＩＴＨＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ李国辉；ＬｉＪｉｎｑｉｎｇ李锦清；Ｚｈａｎｇｙａｑｉ张亚奇；Ｙｕａｎｙｕｎｆｅｉ元云飞；ＣｈｅｎＭｉｎｓｈａｎ陈敏山；ＧｕｏＲ...     

Complications related to arterial infusion chemotherapy in patients with hepatic metastasis from colorectal cancer

Complications of hepatic arterial infusion chemotherapy were analyzed in 30 cases with hepatic metastasis from colorectal cancer from July 1993 to February 2000 in our department. Thirty patients were treated with three kinds of arterial infusion course that mainly consisted of 5-FU. Complications resulting in interruption of therapy occurred in 10 patients (33%), and there was no difference in the incidence rate of complications among the three chemotherapy regimens. The complications with our therapy were hepatic arterial occlusion in two patients, catheter tip dislocation in four patients, fistulus between the hepatic artery and common bile duct in two patients, and fistulus between the hepatic artery and duodenal bulb in two patients. Four patients who had severe complications with fistulus all underwent hepatectomy, especially right hepatic lobectomy in two cases. Sixty percent of our patients had complications after hepatectomy, so regular GIF and DSA are necessary to prevent severe complications after hepatectomy.     

肺癌手术中心包内肺血管及心房部分切除的疗效观察

目的:探讨心包内处理肺血管及部分切除心房组织在肺癌手术中的应用及价值.方法:在141例肺癌患者术中打开心包处理肺血管及扩大切除受肿瘤侵犯的部分左心房组织.结果:术后并发症发生率36.88%,术后近期死亡率1.42%,术后1、3、5年生存率为74.47%、41.13%、23.40%.结论:心包内处理肺血管及扩大切除部分左房组织安全性好,术后并发症发生率虽有上升,但术后近、远期死亡率无改变,这一行之有效的手术方式可为部分患者增加手术机会,减少手术探查率和扩大手术范围.     

Treatment of Rupture of a Liver Metastasis from Esophageal Leiomyosarcoma

We describe a case of rupture of a liver metastasis from esophagealleiomyosarcoma which was treated successfully by hepatic arterialembolization, thus facilitating hepatectomy. A 59-yearold womanwho had previously undergone esophagectomy for leiomyosarcomawas admitted in a state of hypovolemic shock. Ultrasonographyrevealed multiple tumors in the left lobe of the liver and massiveintraperitoneal hemorrhage, confirmed by paracentesis, possiblydue to spontaneous rupture. Subsequent hepatic angiography showedextravasation from the tumor, and embolization of the feedingleft hepatic artery was performed. After achieving hemostasis,a left hepatic lobectomy was carried out just beneath the reconstructedstomach tube. The patient made an uneventful recovery and remainswell after one year. Emergency arterial embolization followedby hepatectomy is an appropriate treatment for patients withspontaneous rupture of liver metastases.     

"Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P＜0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P＜0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.