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Aim: To elucidate the clinical factors having an impact on liver regeneration rate following preoperative portal vein embolization (PVE) and subsequent extended hepatectomy. The correlation between liver volume and functional recovery after extended hepatectomy was also investigated. Methods: Records of patients who underwent extended hepatectomy with extrahepatic bile duct resection following PVE for perihilar cholangiocarcinoma were reviewed retrospectively with attention to liver regeneration. All patients underwent computed tomography before PVE, after PVE (immediately before surgery), and on postoperative day (POD) 7. The kinetic growth rate (KGR) was calculated as the percent increase in liver volume relative to the future liver remnant volume per day after PVE (KGRPVE) and after POD 7 (KGRPOD7) using the computed tomography images before PVE, after PVE, and on POD 7. Results: In the 289 study patients, the median of KGRPVE was 1.35%/day whereas that of KGRPOD7 was 5.56%/day. The extent of liver resection had the greatest impact on both KGRPVE and KGRPOD7 and the impacts of other factors were less. There was a significant negative correlation between KGRPVE and KGRPOD7 (P = 0.002). No correlations were observed between KGRPVE or KGRPOD7 and serum total bilirubin and prothrombin time – international normalized ratio on POD 7, nor in the incidence of liver failure after surgery. Conclusions: Early phase liver regeneration after extended hepatectomy was largely influenced by the extent of liver resection and showed no correlation with the indices of liver failure. There was a discrepancy between volume and functional recovery in early phase liver regeneration. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the outcome of patients with hepatocellular carcinoma (HCC), Barcelona Clinic Liver Cancer (BCLC) stages 0 and A, and portal hypertension (PHT) who underwent liver resection (LR) or radiofrequency ablation (RFA). Methods: The study population consisted of 121 patients with PHT and HCC of BCLC stage 0 and A who underwent LR ( n = 81) or RFA ( n = 40). To reduce bias in patient selection, the different covariate distributions in two groups were adjusted using inverse probability treatment weighting (IPTW). The prognostic outcomes of LR- and RFA-treated patients were then analyzed. Results: Before IPTW adjustment, the 5-year overall survival (OS) of LR and RFA patients was comparable. Five-year recurrence-free survival (RFS) was significantly better in the LR group than in the RFA group ( P < 0.0001). Multivariate analysis showed that RFA was an independent predictor of worse RFS ( P = 0.0004). The local recurrence rate was higher in the RFA than in the LR group, with recurrences in each group tending to be treated with the same modality as initially. After IPTW adjustment, the OS of patients in the LR and RFA groups did not significantly differ, whereas the RFS of the LR group remained significantly better than that of the RFA group ( P = 0.00014). However, the RFA group had fewer postoperative complication rates and a shortened length of hospital stay. Conclusions: By reducing postoperative complications, LR may be a treatment option for patients with BCLC stage 0 or A HCC and PHT. [ABSTRACT FROM AUTHOR]

Background: The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV. Methods: We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy. Results: Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV ( p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR) >17 % ( p = 0.007) and α-fetoprotein >12.5 ng/ml ( p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR >17 % ( p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV ( p = 0.008) and red color sign ( p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy. Conclusions: These results suggest that HCC patients with EV and ICGR ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately. [ABSTRACT FROM AUTHOR]

Introduction: Previous reports have indicated an association between blood transfusion and prognosis of hepatocellular carcinoma (HCC) after hepatectomy. However, clinicopathological biases were not adjusted in these studies. We aimed to clarify the effect of blood transfusions in patients with HCC and Child-Pugh class A after hepatectomy by using inverse probability of treatment weighting (IPTW) analysis for selection bias control. Materials and methods: We enrolled 479 patients with primary HCC and Child-Pugh class A retrospectively (91 transfused and 388 nontransfused patients) who underwent curative hepatectomy. After adjusting for different covariate distributions for both groups by IPTW, we analyzed the prognostic outcomes. Results: In the unweighted analyses, overall survival (OS) rate of transfused patients was significantly lower than in nontransfused patients ( P < 0.0001). Recurrence-free survival (RFS) rate of transfused patients was significantly lower than that of nontransfused patients ( P = 0.0024). Multivariate analysis showed that blood transfusion was an independent prognostic factor of OS and RFS. The different distributive covariates between the two groups were age, presence of liver cirrhosis, serum level of alpha-fetoprotein, maximum tumor diameter, and amount of intraoperative blood loss. After IPTW by these covariates, OS rate of transfused patients was not significantly lower than those of nontransfused patients, whereas RFS rate of transfused patients remained significantly lower than those of nontransfused patients ( P = 0.038, adjusted HR 1.45; 95 % CI 1.0-2.1). Conclusions: These results suggest that blood transfusion was associated with recurrence of HCC after hepatectomy in patients with HCC and Child-Pugh class A. [ABSTRACT FROM AUTHOR]

Background. Measurement of thymidine phosphorylase (TP) activity in normal liver tissue adjacent to hepatocellular carcinoma (HCC) may predict multicentric recurrence a long time after an operation. The authors investigated this activity in 92 patients with HCC who had a single HCC equal to or less than 5cm. Methods. Fresh samples (tumors with adjacent normal tissues) were collected from 92 patients with HCC who underwent curative hepatic resection. The levels of TP activity in nonfixed, fresh, and frozen HCC specimens with adjacent noncancerous liver tissue were biochemically measured by using an enzyme-linked immunosorbent assay method. Results. Patients who had a high TP level in normal liver tissue had significantly earlier recurrence (median disease-free survival, 819 days; 95% confidence interval [95% CI], 478-1044 days) compared with patients who had a low TP level (median disease-free survival, 1376 days; lower limit of 95% CI, 921 days; P = 0.0171). Multivariate analysis showed that patients who had a low TP level in adjacent liver tissue had a 0.387-fold higher risk of postoperative recurrence compared with patients who had a high TP level (P = 0.0067). Conclusion. TP activity in normal liver tissue adjacent to HCC is related to tumor occurrence and may predict postoperative tumor recurrence. [ABSTRACT FROM AUTHOR]

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy. [ABSTRACT FROM AUTHOR]