Hepatic resection

The rate of resectability is only 15-20% for proximal bile duct carcinomas but up to 70% for distal lesions. In addition, there is little benefit to preoperative decompression of the biliary tree in patients having obstructive jaundice (65,66). However, this procedure is frequently practiced. For proximal cancers, local excision is often possible. In particular, hepatic resection is indicated for upper bile duct cancers with quadrate lobe invasion or unilateral intrahepatic ductal or vascular involvement, and distal and midductal lesions may require pancreatoduodenectomy. Also, biliary-enteric continuity... 

G. Steele Jr., R. Bleday, R.J. Mayer, A. Lindblad, N. Petrelli, D. Weaver, A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver Gastrointestinal Tumor Study Group Protocol (6584), J. Clin. Oncol. 9(7) (1991) 1105-1112. 

As the basis for decisions about the first dosing in humans, the preclinical safety program needs to mimic the intended clinical regimen. Although these studies are commonly conducted in normal healthy animals, they may also require development and use of an animal model that mimics the health status or condition if it is deemed to possibly sensitize the subject to treatment. For example, we have conducted studies evaluating the safety of recombinant human Factor XIII in an animal model of extracorporeal blood circulation [6] and the safety of recombinant human thrombin in an animal model of hepatic resection [7]. 

Hemming, A.W., Scudamore, Ch.H., Shackieton, Ch.R., Pudek, M., Erb, S.R. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhosis patients. Amer. J. Surg. 1992 163 515-518... 

Preoperative diagnosis prior to hepatic resection or shunt operation... 

Nagasue, N. Successful treatment of Caroli s disease by hepatic resection. Report of six patients. Ann. Surg. 1984 200 718 - 723... 

Eckhauser, F.E., Knol, J.A., Raper, S.E., Thompson, N.W. Enucleation combined with hepatic vascular exclusion is a safe and effective alternative to hepatic resection for liver cell adenoma. Amer. Surg. 1994 60 466-472... 

J. Hepatic resection of giant cavernous hemangioma of the liver. J. Clin. Gastroenterol. 1999 29 257-260... 

Hanazaki, K., Kajikawa, S., Shimozawa, N., Mihara, M., SUmada, K., Hiraguri, M., Koide, N., Adachi, W., Amano, J. Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. Amer. J. Surg. 2000 191 381-388... 

Nagasue, N., Ono, T., Yamanoi, A., Kohno, H., El-Assal, O.N., Taniura, H., Uchida, M. Prognostic factors and survival after hepatic resection for hepatoceilular carcinoma without cirrhosis. Brit. J. Surg. 2001 88 515-522... 

Poon, R.T.P., Fan, S.T., Wong, J. Selection criteria for hepatic resection in patients with large hepatocellular carcinoma larger than 10 cm in diameter. J. Amer. Coll. Surg. 2002 194 592-602... 

Shimada, M., Takenaka, K., Fujiwara, Y., Gion, T., Kajiyama, K., Maeda, T., Shirabe, K., Sugimachi, K. Des-y-carboxy prothrombin and a-fetoprotein positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma. Cancer 1996 78 2094-2100... 

Redaelli, C.A., Dufour, J.F., Wagner, M., Schilling, M., Hiisler, J., Krahenbiihl, L., Biichler, M.W., Reichen, J. Preoperative galactose elimination capacity predicts complications and survival after hepatic resection. Ann. Surg. 2002 235 77-85... 

Mimoz O, Incagnoli P, Josse C, GiUon MC, Kuhlman L, Mirand A, SoiUeux H, Fletcher D. Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection. Anaesthesia 2001 56(6) 520-5. 

Keywords hepatic resection, protein synthesis, aminoacyl-tRNA-synthetases, silatranes, germatranes... 

Shimada M, Matsumata T, Taketomi A, et al. The role of mterleukin-6, interleukin-16, tumor necrosis factor-a and endotoxin in hepatic resection. Hepato-gastroenterology 1995 42 691-7. 

Because approximately two-thirds of patients who undergo resection of hepatic metastases will have disease recurrence, adjuvant systemic and hepatic arterial infusion chemotherapy have been studied in an attempt to improve long-term outcomes. A randomized trial that compared 6 months of hepatic floxuridine and dexamethasone plus TV fluorouracil with leucovorin to TV fluorouracil with leucov-orin alone following resection of hepatic metastases in 156 patients showed improved 2-year DPS (86% vs. 72%) and hepatic recurrence-free survival at 2 years (90% vs. 60%) with the combined therapy. Many practitioners offer adjuvant chemotherapy to select patients following potentially curative hepatic resection, but further studies, especially those involving more active agents, are needed to determine an optimal treatment regimen. ... 

Pack and Molander (PI) performed hepatic lobectomy in 23 patients suffering from tumors and allied diseases. Following surgery, serum alkaline phosphatase increased in the majority of patients, although prompt decreases occurred in several patients with extremely high preoperative levels. By the third week after surgery, 20 out of 33 patients had serum alkaline phosphatase values within reference limits. Decreases in serum alkaline phosphatase after hepatic resection were also observed by Almersjo et al. (A9). None of the 12 patients studied by Almersjo et al. (A9) showed a postoperative rise in serum alkaline phosphatase. Williams et al. (W23) reported massive falls in serum alkaline phosphatase values after liver transplantation. ... 

Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239 818-825 discussion 825-817... 

Primary or secondary liver cancer is a major cause of cancer-related mortality worldwide and local tumor growth within the liver determines survival in a great number of patients [1]. Although surgical resection is considered to be the only curative treatment for hepatocellular carcinoma (HCC) or metastases confined to the liver, only a small number of patients are candidates for this type of treatment. In most cases, hepatic resection is not a therapeutic option owing to the size, number, or location of the lesions. Therefore, a number of palliative local treat-... 

With the exception of gastric cancer, surgical results for gastrointestinal primaries remain disappointing. Although pancreatic adenocarcinoma frequently metastasizes to the liver, hepatic resection for this disease has never been shown to result in a survival benefit [39]. 

Takada T, Yasuda H, Amano H et al (1997) Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma does it improve survival Hepatogastroenterology 44 567-573... 

Miyazaki M, Itho H, Nakagawa K et al (1997) Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol 92 490-493... 

Amhiru S, Miyazaki M, Ito H et al (2001) Benefits and limits of hepatic resection for gastric metastasis. Am J Surg 181 279-283... 

Schwartz SI (1995) Hepatic resection for noncolorectal nonneuroendocrine metastases. World J Surg 19 72-75... 

Harrison LE, Brennan MF, Newmann E et al (1997) Hepatic resection for noncolorectal, nonneuroendocrine metastases a fifteen-year experience with ninety-six patients. Surgery 121 625-632... 

Another possible area of investigation includes the prophylactic radioemboiization of remnant liver tissue in patients undergoing hepatic resection for HCC or colorectal metastases. Although initially attractive, this approach may hinder and limit the ability for future Y to the prophylactically radio-embolized lobe. Furthermore, the blood supply to small metastases is derived from the portal vein, not the hepatic artery, bringing into question whether prophylactic treatment would yield any radiation effect to microscopic metastases [59]. Therefore, if such a study is undertaken, since imaging of micro-metastases is not possible, improved survival or decreased time to disease recurrence would represent possible endpoints. It is clear that further research is needed to address possible treatment options for advanced stage HCC. Any studies in this patient population require careful consideration of the risk of therapy induced liver failure vs. the benefit of lesion stabilization. 

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