Objective
To assess the impact of liver hypertrophy of the future liver remnant volume (FLR) induced by preoperative portal vein embolization (PVE) on the immediate postoperative complications after a standardized major liver resection.

Portal vein embolization before right hepatectomy: prospective clinical trial.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.1840360710

Hepatocellular carcinoma and hepatitis C in the United States.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.510280111

Expression of vascular endothelial growth factor in human hepatocellular carcinoma

Summary Background Data On an healthy liver, PVE of the liver to be resected induceshypertrophy of the remnant liver and increases the safety ofhepatectomy. On injured liver, this effect is still debated. Methods During the study period, 10 patients underwent preoperativePVE and 19 patients did not before resection of three or moreliver segments for HCC in injured liver (cirrhosis or ﬁbrosis).PVE was performed when the estimated rate of remnant func-tional liver parenchyma (ERRFLP) assessed by computed to-mographic scan volumetry was less than 40%. Results In all patients, PVE was feasible. There were no deaths orcomplications. The ERRFLP after PVE was signiﬁcantly in-creased compared with the pre-PVE value. Liver resectionwas performed after PVE in 9 of 10 patients, with surgicaldeath and complication rates of 0% and 45%, respectively.PVE increased the number of resections of three or more seg-ments by 47% (9/19). Overall actuarial survival rates with orwithout previous PVE (89%, 67%, and 44% vs. 80%, 53%,and 53% at 1, 3 and 5 years, respectively) and disease-freeactuarial survival rates (86%, 64%, and 21% vs. 55%, 17%,and 17% at 1, 3, and 5 years respectively) after hepatectomywere comparable.

http://www.polysalov.vipvrach.ru/download/Percutaneous_Portal_Vein_Embolization.pdf

Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver.

Angiotensin-II type 1 receptor interaction is a major regulator for liver fibrosis development in rats.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/jhep.2000.18658

Inhibition of Hepatic Stellate Cell Proliferation and Activation by the Semisynthetic Analogue of Fumagillin TNP-470 in Rats

Although there have been many studies of the risk factors for recurrence after resection of hepatocellular carcinoma (HCC), the subjects were patients with various viral status in the previous studies, and hepatitis C viremia has not been evaluated. We investigated risk factors, including hepatic C viremia and histologic findings of noncancerous hepatic tissue, for recurrence after resection of hepatitis C virus (HCV)-related HCC. A total of 223 patients who underwent liver resection for HCV-related HCC were studied. HCV viremia, laboratory data, degree of HCC malignancy, histologic findings in noncancerous hepatic tissue, preoperative interferon therapy, and operative methods were evaluated for recurrence risk by univariate and multivariate analyses. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin, and the proportion of patients with a high histologic activity score (mild to severe active hepatitis) were significantly higher in patients with HCV viremia than in those without viremia. Serum albumin was significantly lower in patients with HCV viremia. By univariate analysis, older age (> 65 years old), HCV viremia, elevated AST (> 40 IU/L) and ALT (> 45 IU/L), large tumors (> 40 mm), multiple HCCs, moderately or poorly differentiated HCC, portal invasion, mild to severe active hepatitis, and lack of preoperative interferon therapy were risk factors for recurrence. Multivariate analysis showed that older age, HCV viremia, high AST, multiple HCCs, and portal invasion were independent risk factors. For HCV-related HCCs, not only the degree of malignancy of the HCC but also HCV viremia and active hepatitis are risk factors for recurrence.

Risk Factors for Recurrence after Resection of Hepatitis C Virus-related Hepatocellular Carcinoma

The frequency of lymph node (LN) metastasis in patients undergoing surgery for hepatocellular carcinoma (HCC) has rarely been studied. We evaluated the clinicopathologic characteristics and outcomes of six patients with nodal metastases from HCC among a total of 504 patients who underwent hepatic resection for HCC in our department over a 16-year period. The nodal metastases were diagnosed preoperatively in two patients. The average diameter of the resected tumors was 7.8 cm and all were confirmed as poorly differentiated HCC. All of the six patients had intrahepatic metastatic nodules and five also had portal vein invasion. One patient underwent limited resection, and the other five underwent bisegmentectomy. All of the regional LNs were removed in one patient, while only enlarged LNs were removed in the other five. One patient died of postoperative liver failure and the others all died later of intrahepatic or nodal recurrence. Our findings suggest that the prognosis of patients with nodal metastasis from HCC is generally poor, even if hepatic resection with regional LN dissection is performed.

The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma.

Multicentric occurrence is an important characteristic of hepatocellular carcinoma We evaluated clinicopathological criteria for multicentric hepatocellular carcinoma and identified risk factors for such carcinogenesis Subjects were 251 consecutive patients undergoing liver resection for hepatocellular carcinoma One kind of multicentric hepatocellular carcinoma had at least one tumor consisting of well-differentiated hepatocellular carcinoma, together with moderately or poorly differentiated hepatocellular carcinoma located in a separate region The other kind had an area of well-differentiated component around hepatocellular carcinoma with less differentiation in all occurrences The outcome of patients with tumors classified in this way was studied Univariate and multivariate analyses were done to identify risk factors for multicentric hepatocellular carcinoma The cumulative survival rate was significantly higher in patients with multicentric hepatocellular carcinoma than in patients with hepatocellular carcinoma associated with intrahepatic metastasis Analysis by Cox's proportional hazard model showed that multicentricity was not a factor in the outcome The risk of multicentric occurrence increases with progression of chronic liver disease Univariate analysis showed hepatitis C virus marker and hepatitis B core antibody to be risk factors By multivariate analysis, the odds ratio for multicentric occurrence in patients infected with hepatitis C virus and with serum hepatitis B virus core antibody compared with patients without either hepatitis C virus or hepatitis B virus was 1086 This ratio in patients with hepatitis C virus alone was 430 These criteria for multicentric hepatocellular carcinoma seem to be clinically useful Hepatitis C virus infection with or without former infection by hepatitis B virus is a strong risk factor for multicentric hepatocarcinogenesis

/pdf/clinicopathological-criteria-for-multicentricity-of-4g4d7pw8jv.pdf

Takashi Ikebe

Papers

Inhibition of Hepatic Stellate Cell Proliferation and Activation by the Semisynthetic Analogue of Fumagillin TNP-470 in Rats

Risk Factors for Recurrence after Resection of Hepatitis C Virus-related Hepatocellular Carcinoma

The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma.

Clinicopathological criteria for multicentricity of hepatocellular carcinoma and risk factors for such carcinogenesis

Surgical strategy for hepatocellular carcinoma originating in the caudate lobe.