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A 73-year-old male was initially treated with sorafenib for advanced stage HCC. However, the disease progressed 2 months after starting sorafenib. Progressive disease (PD) was confirmed by radiological examination, which revealed mediastinal and abdominal lymph node metastasis, pulmonary metastasis, and intrahepatic recurrence. The patient was enrolled in the REACH-2 (NCT02435433) trial and randomized to receive ramucirumab (8 mg/kg div. every 2 weeks). The patient had a Child–Pugh score of 6A and his AFP level was found to be 1,256.8 ng/mL at initiation. Radiological examination revealed PD, 5 months after starting ramucirumab. Ramucirumab treatment was continued after the confirmation of radiological PD, not but clinical progression, as allowed by the study protocol. His AFP level increased after continuous ramucirumab treatment, however, it suddenly decreased from 7,653 ng/mL to within normal limits 10 months after initiation of ramucirumab treatment. Radiological evaluation revealed a significant decrease in the size of the tumors, which constituted a partial response (PR). We reported a rare case of advanced HCC with PR to a continuous ramucirumab treatment after radiological PD.

Background Little evidence exists regarding postrecurrence survival after microwave ablation for recurrent hepatocellular carcinoma (HCC) after curative hepatectomy; we aimed to evaluate the feasibility of surgical microwave ablation. Methods In this retrospective review, we enrolled patients who underwent curative hepatectomy for primary HCC in our department and had intrahepatic recurrence. We analyzed overall survival according to treatment modality to clarify the prognostic factors for survival. Results Of 257 patients, 119 had intrahepatic recurrence. Three patients underwent repeat hepatectomy; 75 patients underwent surgical microwave ablation, and 34 patients underwent transcatheter arterial chemoembolization or hepatic arterial infusion chemotherapy. The median postrecurrence survival time and 5-year postrecurrence survival after surgical microwave ablation were 37.4 months and 55.4%, respectively. The major complication rate (Clavien–Dindo classification IIIa or above) after surgical microwave ablation was 5.3% with no mortality. Multivariate analysis showed that microvascular invasion at primary tumors, and recurrent tumors within 3 cm and 3 nodules were independent prognostic factors for overall survival after surgical microwave ablation for recurrent HCC. Conclusion Our results suggested that surgical microwave ablation is safe and feasible for recurrent intrahepatic HCC after curative hepatectomy. Close follow-up and further curative treatment could be important for improving postrecurrence survival.

Few clinical studies concerning the efficacy of microwave ablation for intermediate stage hepatocellular carcinoma have been published. Our purpose was to examine perioperative and long-term outcomes after operative microwave ablation for intermediate stage hepatocellular carcinoma.This retrospective study included 246 patients who had undergone operative microwave ablation for intermediate stage hepatocellular carcinoma in our institute between January 2001 and December 2017. We analyzed overall and recurrence-free survival and used the Cox proportional hazard model to evaluate potential prognostic factors.The overall median follow-up time was 51 months. The 1-, 3-, 5-, and 10-year overall survival rates were 98%, 74%, 51%, and 28%, respectively, whereas the 1-, 3-, 5-, and 10-year recurrence-free survival rates were 80%, 32%, 18%, and 10%, respectively. The major complication rate (Clavien-Dindo classification IIIa or above) after operative microwave ablation was 7%, with no procedure-related mortality. Multivariate analysis identified beyond up-to-7 criteria (the sum of the largest tumor's diameter in cm and the total number of tumors), Child-Pugh grade B, and serum alpha-fetoprotein concentration ≥ 100 ng/mL as independent risk factors for overall survival after operative microwave ablation. The overall survival of patients within up-to-7 and Child-Pugh grade A was better than that of the remaining patients, 5-year overall survivals being 67% and 37%, respectively (P 0.001).Operative microwave ablation is safe and effective in patients with intermediate stage hepatocellular carcinoma. In particular, patients within up-to-7 and Child-Pugh grade A can be expected to have better long-term outcomes after operative microwave ablation.

BACKGROUND There are few published data regarding long-term outcome survival after microwave ablation (MWA) for hepatocellular carcinoma (HCC) within 3 cm and 3 nodules. The aim of this study was to examine long-term outcomes after operative MWA for HCC within 3 cm and 3 nodules. METHODS This cohort of this retrospective study comprised 559 patients who underwent operative MWA for HCC within 3 cm and 3 nodules in our institute between 1996 and 2017. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis. RESULTS Median follow-up time was 69 months for the entire cohort. OS rates were 1-year: 98%, 3-year: 87%, 5-year: 73%, and 10-year:39%; RFS rates were 1-year: 91%, 3-year: 60%, 5-year: 42%, and 10-year: 21%. Multivariate analysis revealed that hepatitis C virus (HCV)-positive status, ALBI grade 2 or 3, maximum tumor diameter ≥ 20 mm, and multiple nodules were independent risk factors for both OS and RFS. A prognostic staging model using one point for each risk factor provided a well-categorized predictive model. The 5-year OS rates were 93%, 81%, and 57% for scores of 0, 1 or 2, and 3 or 4, respectively (P

Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment.One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors.MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24-56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of 55 mAU/mL (OR, 5.50; 95% CI, 2.09-15.4; P 0.001), tumor size of 2.8 cm (OR, 6.10; 95% CI, 2.07-20.0; P 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84-16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score.Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.

Background It remains to be clarified whether combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma (HCC) is feasible. This aim of this study was to examine the perioperative and oncological outcomes after combined hepatectomy and microwave ablation for multifocal HCC. Methods This retrospective study included 81 patients who underwent combined hepatectomy and microwave ablation for multifocal HCC in our institute between June 1998 and December 2017. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis. Results Median follow-up time was 45.6 months for the entire cohort. OS rates were 1-year: 96%, 3-year: 72%, and 5-year: 54%; RFS rates were 1-year: 77%, 3-year: 37%, and 5-year: 22%. The major complication rate (Clavien–Dindo classification IIIa or above) after surgery was 10%, with one patient of in-hospital mortality. Multivariate analysis revealed that des-γ-carboxy prothrombin level >200 mAU/mL and >5 tumors were independent risk factors for OS, and des-γ-carboxy prothrombin level >200 mAU/mL, > 5 tumors, and maximum tumor size >5 cm were independent risk factors for RFS. Conclusions Our results indicate that combined hepatectomy and microwave ablation is safe and feasible for selected patients with multifocal HCC.

Some patients experience very late recurrence of HCC more than 5 years after initial therapy. We aimed to clarify the predictive factors for very late recurrence of HCC in such cases. Among 807 HCC patients undergoing surgical resection or ablative therapy with curative intent, the patients who survived for 5 years without any recurrence were reviewed. The prognosis and possible predictive factors for late recurrence were analyzed retrospectively. A total of 184 patients survived for more than 5 years without recurrence. Among them, 61 patients experienced recurrence, at a median of 6 years after initial therapy. In univariate analysis, the pre-treatment aspartate aminotransferase, alanine aminotransferase, Child-Pugh class, and ALBI grade were not related to recurrence, but those at 5 years after treatment were significantly related to recurrence. By multivariate analysis, an ALBI grade of 2–3 at 5 years was an independent risk factor for recurrence (P

The prognostic implications of the expression patterns of three tumor markers, alpha-fetoprotein (AFP), the Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) and des-γ-carboxy prothrombin (DCP), have been evaluated in patients with hepatocellular carcinoma (HCC). From January 1994 to December 2014, 1182 consecutive patients underwent hepatic resection and surgical microwave ablation for HCC at our institution. This study analyzed 475 patients within the Milan criteria and Child–Pugh class A. Cumulative overall survival (OS) and disease-free survival (DFS) rates were analyzed relative to the number of positive tumor markers. OS and DFS at 5 years postoperatively were 85.3 and 44.2% in triple-negative patients, 79.4 and 48.0% in single-positive patients, 56.2 and 32.9% in double-positive patients, and 61.7 and 35.7% in triple-positive patients with statistical significance. OS in triple-negative or single-positive patients was 85.3%, and that in all double- or triple-positive patients was 58.0% (P

Background Little evidence exists regarding the perioperative and oncologic benefits of microwave ablation for hepatocellular carcinoma. The aim of this study was to compare the efficacy of hepatic resection and operative microwave ablation (microwave coagulo-necrotic therapy) for single hepatocellular carcinoma ≤5 cm. Methods Between 1994 and 2015, a total of 551 patients with a single hepatocellular carcinoma ≤5 cm were treated in our institution (hepatic resection: n = 128; microwave coagulo-necrotic therapy: n = 423). We compared overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy. Propensity score matching analysis identified 94 matched pairs of patients to compare outcomes. Results After propensity score matching, baseline variables, including liver function and tumor size, were well-balanced between the 2 groups. The 5- and 10-year overall survival rates were 76% and 47% for hepatic resection and 77% and 48% for microwave coagulo-necrotic therapy, respectively (P = .865). The 5- and 10-year recurrence-free survival rates were 55% and 41% for hepatic resection and 47% and 32% for microwave coagulo-necrotic therapy, respectively (P = .377). In the subgroup analysis, the hepatic resection group had better recurrence-free survival than the microwave coagulo-necrotic therapy group in patients with tumor size >3 cm, with 5-year recurrence-free survival rates of 56.5% and 32.4% in the hepatic resection and microwave coagulo-necrotic therapy group, respectively (P = .029). Conclusion Our propensity score matching study confirmed no statistically significant differences in both overall survival and recurrence-free survival between hepatic resection and microwave coagulo-necrotic therapy for single hepatocellular carcinoma ≤5 cm; however, hepatic resection is recommended for hepatocellular carcinoma with tumor size >3 cm when patients have good liver function.

Background Because the recurrence rate of hepatocellular carcinoma (HCC) is high, even after curative treatments such as hepatic resection and microwave ablation, chemopreventive agents that can effectively suppress HCC recurrence are required. Cyclooxygenase-2 (Cox-2) was recently found to be overexpressed in HCC. Therefore, Cox-2 inhibitors may offer a chemopreventive therapy for HCC. This randomised controlled trial (RCT) investigated the potential for meloxicam, a clinically used Cox-2 inhibitor, to prevent HCC recurrence after initial curative treatment. Methods A total of 232 consecutive patients underwent hepatic resection and/or microwave ablation as initial therapy for HCC at our institute between July 2008 and April 2011. Eight patients were excluded because of poor renal function, history of non-steroidal anti-inflammatory drug-related ulceration, or multiple cancers. The remaining 224 patients were randomised to a control group (n = 113) or a meloxicam group (n = 111). To patients in the meloxicam group, meloxicam was administered at 15 mg daily (5 mg three times a day) as long as possible. The overall survival (OS) and disease-free survival (DFS) rates were determined. Results The 1-, 3-, and 5-year OS rates of the meloxicam group were 95.4, 82.4, and 70.1 %, respectively. Those of the control group were 98.2, 85.1, and 71.5 %, respectively (p = 0.9549). The corresponding DFS rates of the meloxicam group were 89.2, 53.9, and 44.0 % and those of control group were 86.5, 57.0, and 43.4 %, respectively (p = 0.6722). In the OS and DFS of subsets including patients with hepatitis B or C virus infection, we could not find significant differences between the meloxicam and control groups. However, in the subgroup of analysis of patients without viral hepatitis (NBNC-HCC), significant differences were observed in the DFS between the meloxicam group (1-year DFS, 92.3 %; 3-year DFS, 75.8 %; 5-year DFS, 70.4 %) and control group (1-year DFS, 83.3 %; 3-year DFS, 48.1 %; 5-year DFS, not obtained) (p = 0.0211). Conclusion Administration of the Cox-2 inhibitor meloxicam may have a possibility to suppress HCC recurrence after initial curative treatments in patients with NBNC-HCC.

The effects of achieving sustained virological response (SVR) on recurrence and survival after curative treatment in patients with hepatitis virus C (HCV)-related hepatocellular carcinoma (HCC) is unclear. This study examined the influence of SVR achievement by interferon therapy before HCC occurrence on recurrence and survival. This retrospective study included 518 patients who underwent surgical microwave ablation for initial HCV-related HCC between January 2001 and December 2015. Thirty-four patients had achieved SVR (SVR group) and 484 patients had not (control group). Clinical characteristics and long-term outcomes were compared between the two groups. Overall survival rates at 5 and 10 years after curative ablation were 95.8 and 80.4% in the SVR group, and 50.7 and 23.4% in the control, respectively (p

Sorafenib is an effective treatment for unresectable hepatocellular carcinoma (HCC) characterized by disease stabilization. However, the response rates are very low (

Carcinosarcoma is a rare neoplasm with epithelial and mesenchymal components. We herein report the case of a 68-year-old male with a carcinosarcoma of the gallbladder. Preoperative examinations revealed the gallbladder cancer infiltrating the liver with a multinodular mass with a portal vein tumor thrombus through the right anterior branch of the portal vein. Extended right hepatectomy with portal thrombectomy was performed. Histologically, the tumor comprised a distinct adenocarcinoma and pleomorphic mononuclear cell components. The adenocarcinoma mainly lined the gallbladder lumen, forming irregular papillary glands. The pleomorphic mononuclear cells formed the majority of the tumor. Immunohistochemical analysis revealed that the pleomorphic mononuclear component was strongly positive for vimentin and slightly positive for cytokeratin. These findings suggested that the mononuclear cells formed a degenerated neoplasm of adenocarcinoma cells. The pathological diagnosis was carcinosarcoma of the gallbladder. After curative surgery, adjuvant chemotherapy with gemcitabine chloride was conducted for 3 years. The patient was alive for 5 years without recurrence after resection. The present case showed the longest reported survival among patients with advanced stage carcinosarcoma.

OBJECTIVE: The aim of this study was to validate the FibroScan system compared with liver histology and serum markers for the diagnosis of hepatic fibrosis. We also tried to determine the cut-off levels and assess the feasibility of using FibroScan values to predict the fibrosis stage. METHODS: In 44 patients with HCV infection, liver stiffness was evaluated by FibroScan, serum fibrosis markers and a liver biopsy. Associations between these indices were also analyzed. RESULTS: FibroScan values showed a good correlation with serum levels of type IV collagen, hyaluronic acid and procollagen-III-peptide, and with the platelet count. Compared with liver histology, the FibroScan values increased proportionally with the progression of the histological fibrosis stage. Advanced fibrosis (F3 or F4) could be efficiently predicted by a FibroScan cut-off value of 15 kPa. The FibroScan sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 73.9%, 77.8%, 100%, and 86.4%, respectively. CONCLUSION: FibroScan values gave a good correlation with various markers of fibrosis and increased proportionally with the progression of the hepatic fibrosis stage. A FibroScan value of 15 kPa was found to be a significant separation limit for differentiating advanced fibrosis stages (F3 and F4) from the milder stages (F0‐F2). FibroScan values are clinically useful for predicting the fibrosis stages and helpful in managing interferon therapy in patients with chronic hepatitis C.

Between July 1994 and December 2005, 1,324 patients underwent hepatic surgery in our institute. Of these patients, 508 patients who received their initial therapy for HCC were analyzed this time. MCN (microwave coagulo-necrotic therapy) was performed in 369 patients, hepatic resection (Hr) was in 98, and Hr + MCN was in 38. The remaining 3 patients were treated with laparotomic ethanol injection.The 1-, 3-, 5-, and 10-year cumulative survival rates for patients treated with MCN (mean tumor size, 28.8mm ; mean number of lesion, 2.63 ; Liver Damage, A in 39.1%, B in 56.8%, and C in 4.1%) were 97.3%, 80.2%, 62.3%, and 35.1%, respectively. Five-year survival rate was 62.3% in MCN and 60.8% in Hr group (p = 0.6047). The 1-, 3-, and 5-year local recurrence rates with MCN were 1.8%, 4.3%, and 5.4%. and those with Hr were 1.1%, 4,1%, and 4.1% (p = 0.8990).The 1-, 3-, and 5-year cumulative survival rates for 109 patients, who had 4 or more tumors, were 95.0%, 69.0%, and 43.3%.The 3-, 5-, and 10-year cumulative survival rates for the liver damage-A-patients treated with MCN were 87.6%, 68.9%, and 31.6%. Those for the liver damage-B-patients with MCN were 77.2%, 59.5%, and 37.6%.Based on the above, it was suggested that MCN has the good ability of loco-regional control of HCC and it is less invasive to the patients, especially with multiple tumors and/or with severe liver function. Therefore, we recommend MCN as a first choice for the treatment of HCC.

Yoshiyuki Wada, Yuko Takami, Masaki Tateishi, Tomoki Ryu, Kazuhiro Mikagi, Hideki Saitsu Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan Background: Sorafenib therapy improves survival in unresectable hepatocellular carcinoma (HCC) patients without an objective response. The present study investigated whether the initial imaging response might be a prognostic indicator after administration of sorafenib therapy in HCC patients.Patients and methods: This retrospective study reviewed unresectable HCC patients undergoing sorafenib therapy. Patients evaluated without complete response, partial response (PR), or progressive disease (PD) at the initial imaging response evaluation by modified Response Evaluation Criteria in Solid Tumors were divided into three groups according to more detailed categorization of the shrinkage/progression ratio in initial imaging response. A comparison of progression-free and overall survival among these groups was performed.Results: Of the 43 non-PR non-PD patients with target lesions, ten (23.3%) exhibited mild response (MR; -30% to -5%), 14 (32.6%) exhibited no change (NC; -5% to +5%), and 19 (44.2%) exhibited mild-PD (MPD; +5% to +20%). There was no statistical difference in progression-free or overall survival between MR and NC patients. The median progression-free survivals in NC+MR and mild-PD patients were 15.0 and 5.3 months, respectively (P

Background Whether radiologically detected progressive disease (PD) is an accurate metric for discontinuing sorafenib treatment in patients with hepatocellular carcinoma (HCC) is unclear. We investigated the efficacy of sorafenib treatment after radiologic confirmation of PD in patients with advanced HCC. Methods We retrospectively analyzed HCC patients treated with sorafenib at Kyushu Medical Center. Six of the 92 patients with radiologically confirmed PD were excluded because they were classified as Child-Pugh C or had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥3; 86 patients were ultimately enrolled. Results Among the 86 patients, 47 continued sorafenib treatment after radiologic confirmation of PD (the continuous group), whereas 39 did not (the discontinuous group). The median survival time (MST) in the continuous group after confirmation was 12.9 months compared with 4.5 months in the discontinuous group (p

This paper presents a case of hemangioma of the small intestine, which is relatively rare, in a 63-year-old woman complaining of anemia. She had been treated for anemia since 1993 when no other abnormalities were revealed on examinations of the stomach and large intestine. In 1996, anemia took a turn for the worse again and an oral fluoroscopy of the small intestine revealed abnormality in the ileum. So the patient was referred to the hospital. After admission, a sounding to the small intestine disclosed a nodular protrusion in the ileum. CT scan visualized a segmented tumor with calcification having marginal irregularity in the small intestine. With a diagnosis of small bowel tumor, the patient was operatec on. At operation, a soft tumor, with the size of about 3cm, about 170cm oral to the terminal ileum was palpated, and distended vessels on serosa were confirmed. Macroscopically, hemangioma was suspected and a partial excision of the ileum was carried out. Histopathological diagnosis was hemangioma of the small intestine. In the treatment of patients with anemia without any abnormalities in the esophagus, stomach, duodenum and large intestine, we must conduct close examination of the small intestine by entertaining the possibility of the disease.

To clarify whether pre-operative transcatheter arterial embolization (TAE) improves survival after hepatectomy, a prospective randomized comparative study was done. Of a total of 115 registered patients having solitary hepatocellular carcinoma (HCC) 2 to 5 cm in diameter, 18 (15.7%) were excluded after randomization. As a result, 97 patients were chosen as subjects and divided into two groups: hepatectomy with (group A: n=50) and without (group B: n=47) pre-operative TAE. The period of observation of the patients who survived the surgery was between 4.0 and 6.6 years. The randomization appeared to have provided well-balanced groups of patients and the clinico-pathological characteristics of the two groups were quite similar. The necrotic part of the cancerous lesions, as confirmed by operative specimens, amounted to 74.8+/-33.4% (mean +/-SD) in group A and 6.8+/-7.2% in group B (P

Hilar bile duct resection, by which only the bile duct is resected, was carried out in 31 patients with bile duct carcinoma at the hepatic hilus. However, curative resection was possible in only 4 patients (12.9%). The postoperative 1-, 3-, and 5-year survival rates were 58.1%, 19.4%, and 7.7%, respectively. These results indicate that treatment of this hilar bile duct carcinoma by hilar bile duct resection is of limited value. We believe that this operative procedure should be used only for papillary or nodular carcinoma at the hepatic confluence at relatively early stages of Bismuth's type I or II.

This report is based on an analysis of the recurrent patterns and post-treatment clinical outcome of 78 patients following hepatectomy for hepatocellular carcinoma (HCC). Patients with a single recurrent tumor (group A;n=41) often had multicentric carcinogenesis (41.7%) and were treated locally; i.e., by re-resection or by percutaneous ethanol injection therapy (PEIT). Many of them (42.9%) followed the “curative pattern,” with good prognosis (70.3% 5-year survival rate). Although 6 of the patients with two or three recurrent tumors (group B;n=19) had multicentric carcinogenesis that could be treated locally, 13 of the 19 followed the “non-curative pattern,” with a poor prognosis after recurrence (14.8% 3-year survival rate after recurrence). The primary tumors of the patients with multiple or infiltrating type (group C;n=18) were advanced and these patients had metastatic recurrence, thereby following the “early death pattern” (58.8%) with a poor prognosis (30% 5-year survival rate). For group C patients, hepatectomy was regarded as part of a multidisciplinary treatment regimen that included aggressive postoperative chemotherapy as a necessary component.

Pulmonary metastasis is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC). The outcome of pulmonary metastasectomy of HCC has not yet been thoroughly investigated. The outcomes of surgical treatment of pulmonary metastases from HCC were reviewed in order to analyze the postoperative survival and the relevant prognostic factors.This study retrospectively reviewed 20 patients who underwent pulmonary metastasectomy from an HCC between 1990 and 2007 at two institutions. The surgical outcome was evaluated by both the overall survival and cancer-specific survival after pulmonary resection. The association between various clinico-pathological factors and the survival outcome was analyzed.The overall survival rate after the initial pulmonary metastasectomy was 46.9% at 5 years, and the cancer-specific 5-year survival rate was 63.2%. One patient died of surgery-related events 19 days after the pulmonary resection. The preoperative AFP (alpha-fetoprotein) level was found to be a significant prognostic factor for both overall and cancer-specific survival for patients undergoing pulmonary metastasectomy. Both the overall and cancer-specific survival rates were significantly worse for the patients with AFP ≥ 500 ng/ml in comparison to those with AFP 500 ng/ml (p 0.05). No other factors were associated with the survival after pulmonary metastasectomy.The serum level of AFP might be a valuable predictor for the outcome of pulmonary metastasectomy required for metastasis of HCC.

Excepting operation-related deaths, including deaths within 30 days after operation and hospital deaths, and absolute non-curative resection cases, 171 resected cases of Hepatocellular carcinoma (HCC) were classified into 3 groups in terms of Kobayashi's risk score, namely, group A (score 7.5 or above; 29 cases), group B (7.4-6.0; 94) and group C (5.9 or below; 48). Results were: 1) The number of cases with a score of 6.0 or above was 123 out of 171 cases (71.9%). 2) In comparison with the other 2 groups, both postoperative survival rate and non-recurrent rate were significantly poor in group A (p

The growth rates of recurrent hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLTX) were estimated by calculating the tumor doubling time (TDT) in 20 patients. The mean TDT, calculated by multiple measurement of tumor size, was 44.3 +/- 11.3 days (mean +/- standard error) in 12 patients with pulmonary metastasis (range, 10 to 161 days) and 37.6 +/- 8.9 days (range, 7 to 65 days) in 5 patients with liver allograft recurrence. The TDT as estimated by serum alpha-fetoprotein (AFP) levels in 6 patients was 37.3 +/- 10.0 days (range, 12 to 84 days). The mean TDT obtained from 5 control subjects with HCC who were treated with liver resection (without immunosuppression) was 273.8 +/- 79.1 days (range, 82 to 560 days). The disease-free period and survival time after OLTX both correlated well with the TDT (r = 0.546 and r = 0.701, respectively). The patients with fibrolamellar HCC had a greater TDT and a longer survival time than those with nonfibrolamellar HCC. Despite a wide range of TDT in patients who received transplants, their recurrent HCC tumors grew significantly faster than those of patients with the same disease who did not receive transplants. The factors involved in this accelerated growth rate may include the use of immunosuppressive drugs and the consequent suppression of host immunity against the growth of micrometastasis.

肝細胞癌に対し, 従来の肝流入血遮断法に併用して, パルーンカテーテルによる選択的肝静脈遮断を行って肝中央2区域切除を施行した. カテーテルは術中経肝的に超音波ガイド下に経皮経肝的門脈造影の際のカテーテル挿入手技に準じて, 右および中肝静脈それぞれに挿入した. 切除線右側の右肝静脈に沿った切除の際は, 肝門部でのグリソン氏輪右枝遮断に併用してバルーンによる右肝静脈根部の遮断を, 切除線左側の中および左肝静脈近傍に沿った切除の際は, Pringle法による流入血全遮断に併用して中肝静脈根部の遮断を行うことにより, 良好な無血術野が得られた. 肝授動も肝鎌状間膜の切離のみで切除しえた. 術中出血量は1,100mlで, 術後の肝機能推移も良好であり, 本法は系統的切除あるいは腫瘍が主幹肝静脈に接して存在する場合などで, 肝切除の際, 肝静脈からの出血が予想される例には有用な方法と思われた.

The rarity of the occurrence of metastatic malignancy in injured liver has been noted by many observers. However, since the clinicopathological features of primary carcinoma and the etiology of liver disease of these patients vary greatly, this phenomenon may not be universal.We evaluated the relationship between either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the incidence of colorectal liver metastasis in 438 patients undergoing surgical treatment for advanced colorectal carcinoma.The liver function of the patients in the infection group (n = 37) was significantly worse than that of those in the noninfection group (n = 401). The incidences of tumor recurrence in the lung or peritoneum were comparable between the two groups. However, the percentage of patients with liver metastases in the infection group (3 of 37, 8.1%) was significantly lower (P0.05) than that of those in the noninfection group (85 of 401, 21.2%). The patients in the infection group tended to survive longer than the patients in the noninfection group.We herein report an initial finding that colorectal carcinoma rarely metastasizes to livers infected with HBV or HCV.

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.

Cholangiocellular carcinoma (CCC), the malignant tumor arising from epithelial cells of the intrahepatic bile duct, has been classified as a primary liver cancer, although CCC has occurred less frequently than hepatocellular carcinoma (HCC) in Japan [1]. Most CCCs are advanced because a system for early diagnosis has not been established [2], and even though CCC is resectable, the prognosis is generally unfavorable [3–5]. We therefore studied clinically the 36 patients with CCC encountered at our hospital, and reported the current status of surgical treatment in Japan.

Background/Aim: We describe a novel use of the cholangioscope to help in the intraoperative localization of small colonic malignancies on the right side of the colon. Methods: A small incision was made at the base of the appendix and a cholangioscope was inserted into the ascending colon through the incised hole of the appendix. Results: The site of the lesion was precisely determined by palpating the distal end of the cholangioscope while observing the area right under it. Conclusion: Our procedure therefore appears to be worthy of consideration in patients with small colonic lesions on the right side of the colon in whom preoperative endoscopic marking techniques might otherwise be required.

外科的に切除された最大径3cm以下の肝細胞癌59例について(術死例は除く)再発が確認された23例と非再発例36例とを病理形態学的に検討した.肉眼分類は「原発性肝癌取扱い規約,第2版」の単結節型,単結節周囲増殖型,多結節癒合型,多結節型,塊状型の5型によった.単結節型が最も多く,次いで単結節周囲増殖型が多く塊状型は1例もみられなかった.再発率は肉眼型別では単結節型が他型に比べて低い傾向が認められたが有意差は認められなかった.しかし脈管侵襲は単結節型では他の3型に比べて有意(p

外科的切除された肝細胞癌89例を腫瘍径により4群にわけ,肝癌の進展について肉眼および組織学的検討を行なった.切除例では浸潤性発育を示す肝癌は少なく膨張性発育を示すものが83.2%と圧倒的に多い.肉眼的な被膜は,主結節では75.6%,肝内転移巣(径1cm以下)では5.3%に認められ,腫瘍径による検討から被膜は径1～2cmの段階で形成される可能性が高い,肝癌の進展に伴い,膨張型に浸潤性増殖が加わった混合型の占める割合が増加し,隔壁形成,娘結節も増加する.肝硬変非合併例は約40%を占めるが,その被膜形成率は63%である.組織学的に,肝癌切除例における基本的増殖様式は置換型であり,被膜は置換型増殖の進展とともに形成される.門脈腫瘍塞栓は57.3%で,肝癌の進展に伴い高率となる.

肝切除に際して, 切除すべき脈管と残さなければならない脈管を十分に認識しつつ切除をすすめることは少なからず困難である.われわれは7×3mmの円錐型金属片を考案し, これに糸をつけ肝切除時ポイントとなる部位に, 超音波映像下に穿刺留置しておき, 金属片に向って糸に沿い肝切除をすすめるようになり, さらに安全かつ正確な肝切除が可能となった.肝細胞癌3例, 胆嚢癌1例, 肝門部胆管癌2例の計6例に使用したが極めて有用であった.なお, 金属片は超音波ではcomet signを伴なったstrong echoとしてとらえられ, 十分鑑別が可能であった.

Villous adenoma of the large intestine has been regarded as a relatively rare disease in Japan. It has attracted attention as a tumor that has peculiar macroscopic morphology, a high rate of canceration, and is accompanied by electrolyte abnormalities or dehydration. We have experienced three cases of villous adenoma of the large intestine, which are presented here with 72 cases reported in Japan, together with a discussion of the literature. 1) The male to female ratio was 29:43, with a greater frequency in females. 2) The average age was 62.2 years. 3) The chief complaints of melena, musous descharge and diarrhea were found in 83.3% of the cases. 4) The site of occurrence was the rectum in 60 cases (83.3%) and sigmoid colon in four (5.6%). 5) Malignant changes were seen in 60.3% of cases, and if the diameter of the tumor was more than 5cm, malignant changes were seen in 72.7%. 6) In 32 out of 49 cases of villous adenoma of the rectum (65.3%) operations were performed in accordance with rectal cancer. Among them, infiltrative cancer was found in only 13 cases (26.5%). The operative method must be carefully selected for amputation of the rectum without using the natural anus.