Search

Aims: Surgical treatment for early-stage hepatocellular carcinoma (HCC) is toward transplantation. However, liver resection remains the major surgical treatment for HCC in Asia. This study is to examine the results of liver resection when liver transplantation became an option of treatment for early-stage HCC., Methods: In this retrospective cohort study, 1639 patients with resectable HCC were reviewed and divided into two groups. In the 1st period (2002-2005), all 679 patients received liver resection. In the 2nd period (2006-2010), 916 patients had liver resection and 44 patients jointed liver transplantation program. The results of treatment in these two periods were analyzed., Results: The characteristics of tumors were the most important factors of tumor recurrence after liver resection. Liver function reserve, characteristics of tumors, and surgeons' endeavor were all independent factors for overall survival after liver resection. When the patients with oligo-nodular tumors or portal hypertension with low platelet count had liver transplantation rather than liver resection in the 2nd period, the survival rates in the 2nd period were improved. When the patients in the 1st period with low platelet count (≤105 × 10(3)/uL) were subtracted, the 5-year survival rate of the patients with one-segmentectomy for small-sized HCC in the 1st period was similar to those in the 2nd period and transplant patients., Conclusions: The outcomes of liver resection were improved while liver transplantation was performed for the patients with suspicious portal hypertension. Platelet count, 105 × 10(3)/uL, could be a watershed for early stage HCC patients to undergo liver resection or liver transplantation., (Copyright © 2015. Published by Elsevier Ltd.)

Objective: Liver ischemic reperfusion injury is harmful to transplant recipients, and is associated with postoperative morbidity and mortality. Our study was designed to investigate the oxidative stress and pro-inflammatory mediators in liver transplant recipients., Methods: We prospectively analyzed 14 recipients who underwent liver transplantation by measuring their blood levels of malondialdehyde (MDA) and cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6, at nine time points perioperatively. We also evaluated the correlations between oxidative stress (MDA levels) and the characteristics of the recipient or the donated graft., Results: These parameters significantly increased from 1 minute before reperfusion, and the values peaked within 3 to 30 minutes after reperfusion. On the time point at 5 minutes after reperfusion, the MDA levels which were the highest in the recipients correlated with the values of preoperative direct/and total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), model for end-stage liver disease (MELD) score, international normalized ratio (INR), and surgical blood loss., Conclusion: The levels of MDA, TNF-α, IL-1β, and IL-6 greatly increased with the ischemic reperfusion insult. Recipients with higher values of preoperative direct/and total bilirubin, AST, ALT, MELD score, INR, and surgical blood loss tended to have higher levels of MDA and may suffer more injury from this insult., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aims: Overweight/obesity is currently a common health issue that may cause many diseases, even malignancies. The influence of steatosis on long-term results of surgical treatment for hepatocellular carcinoma (HCC) is not well known. The aim of this study is to analyze the results of hepatectomy for HCC patients with steatosis., Methods: The study included 1048 patients who underwent hepatectomy for HCC from 1999 to 2005. The patients were divided into two groups; group A patients without steatosis (n = 693) and group B patients with steatosis (n = 355). The clinicopathological data and long-term survival were analyzed., Results: Mean tumor size in group B patients was smaller than that in group A patients (4.61 ± 3.40 vs. 5.91 ± 4.36 cm, p < 0.01). Group B patients showed lower tumor differentiation grade, lower vascular invasion rate and better 5-year overall survival compared to group A patients (61.2% vs. 50.1%, p = 0.001). By multivariate analysis, steatosis was found to be associated with well-differentiated, small-sized, and less α-fetoprotein productive tumors. When focusing on the tumors >5 cm in diameter, group B patients had better survival rate than group A patients (p = 0.041). Vascular invasion and steatosis were independent prognostic factors for the overall survival., Conclusion: HCC in steatotic liver was less aggressive than that in non-steatotic liver. HCC patients with steatosis have better surgical outcomes than those without steatosis. Vascular invasion and steatosis were independent prognostic factors for the overall survival if tumors were >5 cm in diameter., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: The aim was to compare short-term results of right hepatectomy using the anterior approach (AA) and liver hanging manoeuvre with the conventional approach (CA) for large hepatocellular carcinoma (HCC)., Methods: This was a retrospective review of 71 consecutive patients with HCC at least 5 cm in diameter who underwent curative right hepatectomy using either the AA with the liver hanging manoeuvre (33) or the CA (38) between January 2004 and December 2008. Clinical data, operative results and survival outcomes were analysed., Results: The groups had similar clinical, laboratory and pathological parameters. The AA group had larger tumours than the CA group (P = 0.039), but comparable grade and stage distribution. The operative results were similar except for an increased blood transfusion requirement with the conventional procedure (P = 0.001). The AA group had a lower recurrence rate (P = 0.003) and better disease-free survival (DFS) (P = 0.001) than the CA group, but overall survival rates were not significantly different (P = 0.091). Presence of tumour encapsulation, absence of tumour microvascular invasion and AA were predictive of DFS, whereas tumour stage was the only independent predictor of overall survival., Conclusion: The AA right hepatectomy with liver hanging manoeuvre for large HCC is associated with reduced blood transfusion requirement and lower recurrence rates in the short term., (Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Hepatic lymphangioma is an extremely rare benign neoplasm that is usually associated with lymphangiomas of other viscera. We report a patient with huge, solitary hepatic lymphangioma involving only the liver. The clinical features and computed tomography findings of this case are described.

Background: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. Ruptured HCC is an uncommon and potentially fatal complication of the condition. Information on the impact of ruptured HCC on hepatic resection is, however, limited., Methods: The clinical features of 60 patients with ruptured HCC who underwent hepatic resection from 1986 to 1998 were reviewed. Clinical features and factors influencing the outcome of 475 patients with non-ruptured HCC were used for comparison., Results: Of 535 surgically resected HCCs, 60 (11.2 per cent) were ruptured. Univariate analysis showed that sudden onset of abdominal pain, physical signs of haemodynamic unstability, reduced haemoglobin level and a raised aspartate aminotransferase level were more frequently found in patients with ruptured HCC than in those with non-ruptured tumours. Multivariate stepwise logistic regression analysis revealed sudden-onset abdominal pain to be the only independently significant factor in patients in the ruptured HCC group. The 1-, 3- and 5-year survival rates of patients with non-ruptured HCC were 72.1, 47.3 and 33.9 per cent, and those of patients with ruptured HCC were 54.2, 35.0 and 21.2 per cent respectively. Similar overall survival rates were found in patients with ruptured and non-ruptured HCC, although patients in the non-ruptured HCC group had a significantly better disease-free survival rate (P = 0.023)., Conclusion: The presence of sudden-onset abdominal pain is the only independent indicator of ruptured HCC. Hepatic resection, when feasible, is the treatment of choice and can result in an overall survival rate comparable to that of patients with non-ruptured HCC.

Aims: We examined the clinical features and outcome of 80 patients with hepatocellular carcinoma (HCC) who had undergone hepatic resection; 32 patients were under 30 years old (younger-HCC), and 48 patients were over 70 years (elderly-HCC)., Methods: Clinical features of 32 cases of younger-HCC (less than 30 years old) and 48 elderly-HCC (over 70 years old) were reviewed between 1986 and 1999. The clinical features, pathological findings and outcome of the younger and elderly HCC patients were summarized for comparison., Results: Of 573 HCC patients who underwent hepatic resection, 32 were younger than 30 years old and 48 older than 70 years. Less hepatitis B infection, higher hepatitis C infection, more liver cirrhosis development, and a higher ICG 15min retention ratio than the younger group. The younger group tended to have a larger tumor size, more major hepatectomy, more operative blood loss during operation, more perioperative blood transfusion, and more recurrence when compared with the elderly-HCC group. The elderly-HCC group had a significantly better disease-free survival rate than the younger-HCC group. The younger-HCC group had a similar overall survival rate to the elderly-HCC group., Conclusions: These results seem to indicate a possible difference in the HCC carcinogenesis between younger and elderly patients. The overall survival of the younger HCC patients who undergone hepatic resection was as favorable as that of the elderly.

Background: The preferred means of treatment for hepatocellular carcinoma is surgical resection. However, the tumour recurrence rate is high. Accurate estimation of the risk of tumour recurrence after hepatectomy may facilitate the administration of adjuvant therapy after hepatectomy to patients with a high likelihood of tumour recurrence., Methods: The clinical and pathological profiles of 176 patients undergoing hepatectomy for hepatocellular carcinoma from March 1992 to August 1998 were reviewed. The Kaplan--Meier method and log rank test were used to analyse univariate prognostic factors. The Cox proportional hazard model was used for multivariate analysis. Disease-free and overall cumulative survival rates were estimated with respect to the number of prognostic factors., Results: Independent factors associated with a lower disease-free survival included the presence of venous infiltration, presence of daughter tumours, absence of tumour encapsulation and tumour size exceeding 5 cm. Factors decreasing the overall survival rate included the presence of venous infiltration, absence of tumour encapsulation and surgical resection margin less than 1 cm. The 1-year disease-free survival rate decreased from 77.5(s.e. 5.6) to 14.0(8.5) per cent when the number of risk factors present increased from zero to three. The 5-year survival rate decreased from 60.2(11.7) per cent to zero when the number of risk factors increased from zero to three., Conclusion: The deterioration of disease-free or overall survival of patients with hepatocellular carcinoma after hepatectomy correlates with increasing number of risk factors. The number of risk factors can be employed to accurately estimate disease-free and overall survival.

Aberrant genome-wide hypomethylation has been thought to be related to tumorigenesis. However, its mechanism and implications in hepatocellular carcinogenesis remain to be elucidated. Samples of hepatoma (hepatocellular carcinoma, HCC) and paired non-HCC liver tissues were obtained from 17 HCC patients. Normal liver tissues obtained from three individuals were used as controls. Compared with the paired non-HCC liver tissues, genome-wide 5-methylcytosine content in HCC was reduced in all of the tested HCC samples (P < 0.001). Conversely, genome-wide 5-methylcytosine content did not significantly differ among normal, noncirrhotic, and cirrhotic liver tissues. Moreover, the degree of reduced DNA methylation was related to late histopathological HCC grade (P = 0.005) and large tumor size (P = 0.079). Compared with the paired non-HCC liver tissues, expression of DNA methyltransferases DNMT-1, DNMT-3A, and DNMT-3B and the DNA methyltransferase-like gene, DNMT-2, was up-regulated in 53, 41, 59, and 47% of the HCC samples, respectively. Surprisingly, small amounts of LINE-1 retrotransposon transcripts were detected in HCC and non-HCC as well as normal liver tissues, and the expression levels were not significantly different in HCC compared with the paired non-HCC or normal liver tissues. Of interest, the 3' ends of these LINE-1 transcripts were truncated. Our findings suggest that genome-wide hypomethylation in HCC is a continuing process that persists throughout the lifetime of the tumor cells rather than a historical event occurring in precancer stages or in cell origins for HCC. Up-regulation of DNA methyltransferases might simply be a result of increased cell proliferation in cancer. In addition, our results did not support the hypothesis of activation of transposable elements in HCC via genome-wide hypomethylation.

Background: The purpose of this study is to investigate the clinicopathologic factors that influence a survival longer than 5 years with no recurrence in patients after resection for hepatocellular carcinoma (HCC)., Methods: Between January 1992 and December 1994, 64 patients with complete viral markers study underwent curative hepatic resection for HCC. Four patients who died of surgical morbidity (hospital mortality, 6.3%) were excluded from this study. Among the 60 patients who survived, 10 patients (16.7%) survived over 5 years without recurrence. The clinicopathologic features and surgical procedures of the patients with long-term survival (> or = 5 years) without recurrence (n = 10) were compared with those of less than 5 years survival or with tumor recurrence (n = 50). The median follow-up was 64.8 months, ranging from 61.1 to 76.7 months., Results: Six of the 10 patients were men with an age ranging from 35 to 75 years (mean, 57.6 +/- 9.7). Using univariate analysis, long-term survival without recurrence was significantly associated with a lower amount of perioperative blood transfusion (less than 7 units, p = 0.036) and an existence of tumor capsule (p = 0.031). But in multivariate analysis, only the presence of tumor capsule was statistically significant., Conclusions: Long-term survival without recurrence was related to a lower amount of perioperative blood transfusion, and an existence of tumor capsule in univariate analysis. But in multivariate analysis, only the existence of tumor capsule plays a significant role.

Inflammatory pseudotumor (IPT) is a rare lesion of the liver that can be clinically indistinguishable from a malignant tumor. A 51-year-old woman was hospitalized for upper abdominal pain and a weight loss of 5 Kg in 2 months. Radiological examination showed a large heterogenous hypervascular mass in the left lobe of her liver, strongly in favor of hepatocellular carcinoma. However, an ultrasound-guided liver biopsy revealed the typical characteristics of IPT, which consist of plump spindle cells with dense inflammatory cell infiltration. A left lobectomy was performed. No microorganisms were found on stained sections. The markedly elevated eosinophil count reverted to normal postoperatively and she remained well on follow-up examination 8 months after discharge. This case exemplifies the difficulty in radiological diagnosis of hepatic IPT and underscores the importance of its histological differentiation from malignancy before laparotomy.

To evaluate the surgical results of patients with hepatitis B-, hepatitis C- and dual hepatitis B- and C-related hepatocellular carcinoma (HCC), we reviewed the clinical records 252 patients (196 men and 56 women) with complete profiles of hepatitis B and hepatitis C infection who had hepatectomies to treat HCC from March, 1992, to August, 1998. The patients were divided into four groups, 30 patients (11.9%) without either hepatitis B surface antigen or anti-hepatitis C antibody (N-HCC group), 133 patients (52.8%) with hepatitis B infection only (B-HCC group), 66 patients (26.2%) with hepatitis C infection only (C-HCC group), and 23 patients (9.1%) with dual hepatitis B and C infection (BC-HCC group). Compared with the patients in the other groups, the patients in the C-HCC group were older and had more severe cirrhotic change of the liver. The surgical complication rates and hospital mortalities in the C-HCC and BC-HCC groups were 30.3% and 12.1% and 30.4% and 17.4%, respectively, which were higher than those in the N-HCC (13.3%, 3.3%) and B-HCC (15.8%, 3.8%) groups. The mean disease-free survivals for the N-HCC, B-HCC, C-HCC, and BC-HCC groups were 31.4, 25.4, 38.9 and 13.8 months, respectively, with the difference between the four groups being significant (P < 0.05). However, the mean overall survival times, 38.3 months for the N-HCC group, 37.2 months for the B-HCC group, 52.1 months for the C-HCC group, and 32.7 months for the BC-HCC group, were not significantly different (P = 0.146). In conclusion, surgical treatments for HCC related to hepatitis C or dual hepatitis B and C infection were associated with a higher surgical complication rate and hospital mortality. Hepatocellular carcinoma related to dual hepatitis B and C infection recurred earlier after hepatectomy, but the overall survival of the four groups was not significantly different.

Background: The purpose of our study was to report on the surgical outcomes of patients with hepatocellular carcinoma (HCC) with dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and to assess the differences in the surgical results between those patients and the patients with hepatitis B- or hepatitis C-related HCC., Methods: The operative outcomes of 13 patients with hepatitis B surface antigen (HBsAg)-positive and hepatitis C antibody (HCV Ab)-positive (the BC-HCC group) results, 57 patients with HBsAg-positive and HCV Ab-negative (the B-HCC group) results, and 34 patients with HBsAg-negative and HCV Ab-positive (the C-HCC group) results, who had undergone hepatic resection from 1991 to 1995, were compared., Results: The operative mortality rate within 1 month after operation for patients with BC-HCC was 7.7%. No statistically significant difference was found compared with the patients with B-HCC and C-HCC (5.3% and 5.9%, respectively). The postoperative course of patients with BC-HCC was complicated by liver failure, postoperative ascites, and wound infection in one patient each. Also, no statistically significant difference was found among the groups (23.1%, 22.8%, and 20.5% for patients with BC-HCC, B-HCC, and C-HCC, respectively). The overall 1-, 3-, and 5-year survival rates of patients with BC-HCC in this series were 75%, 50%, and 40%, respectively. The postoperative recurrence rate was 66.7%. No statistically significant differences were found between the various groups of the virus-related HCC on the overall survival rate and disease-free survival rate., Conclusions: Hepatic resection for HCC in patients with dual HBV and HCV infections was associated with slightly higher operative morbidity and mortality rates, but there were no statistical differences compared with hepatitis B- or C-related HCC regarding the survival and recurrence rates.

Most small hepatocellular carcinomas are asymptomatic. While small hepatocellular carcinomas do have symptoms, these symptoms are usually related to the underlying liver disease, not to the tumor itself. We encountered a 63-year-old male patient with a small hepatocellular carcinoma, 2.5 cm in diameter, presenting with fever, abdominal pain and sensation of abdominal fullness. These were unusual clinical manifestations related to the small hepatocellular carcinoma itself and challenged the diagnosis.

A 26-year-old pregnant woman was diagnosed as having hepatocellular carcinoma at 16 weeks of gestation when extremely high levels of alpha-fetoprotein were found on a routine screening examination. The pregnancy was terminated, and a right hepatectomy was performed. Although such cases are rare, this one suggests that early measurement of maternal serum alpha-fetoprotein in a pregnant woman with hepatitis B surface antigenemia may allow the timely detection of a hepatocellular carcinoma.

The relative role of hepatitis C virus and hepatitis B virus in hepatitis B surface antigen-negative hepatocellular carcinoma was evaluated by polymerase chain reaction in 31 patients from Taiwan. Twenty-one were positive for antibody to hepatitis C virus (group 1) and 10 were negative (group 2). Of the group 1 patients, hepatitis C viral RNA was detected in the serum by polymerase chain reaction in 16 and in the liver tissue in 17, whereas hepatitis B viral DNA was found in the liver tissue in only 4, and none were found in the serum. In group 2 patients, hepatitis C viral RNA was detected in the serum of 1 and in the liver tissue of another. In contrast, hepatitis B viral DNA was found in the serum of 4 patients and in the liver tissues of 5. It was concluded that hepatitis C virus plays an important role in hepatocarcinogenesis in hepatitis B surface antigen-negative patients in Taiwan, especially in those who had antibody to hepatitis C virus; in those without antibody to hepatitis C virus, hepatitis B virus might still be associated with the development of hepatocellular carcinoma in a significant proportion of such patients.