Partial hepatic resection

At present, partial hepatic resection remains the method against which all interventional radiological methods of treatment have to be compared. It is important that prospective randomised trials comparing surgery with cryotherapy and radiofrequency treatment are carried out in order to determine the precise role of these modalities in patients with hepatic metastases. 

Tc-DTPA Arterial perfusion accounts for 20%-40% of the circulation in portal hypertension, cirrhosis causes arterial perfusion to increase to over 60%. In portal vein thrombosis, only an arterial curve is visible. Liver metastasis usually displays relatively high arterial perfusion. In (rare) occlusions of the hepatic artery, only a portal venous curve is visible. When a bolus injection of 400 MBq "Tc-diethylenetriamine pentaacetic acid (DTPA) is applied, scintigraphy is able to reveal a bi-phasic time-activity curve. The initial increase of activity is produced by the arterial influence and the second peak by the portal venous inflow. Both curves can be evaluated quantitatively. (36) Perfusion scintigraphy may be useful in the case of liver trauma, TIPS, hyper-vascularized hepatic tumours and partial liver resection as well as after liver transplantation. 

The aim of the study was to compare the effects of LITT and hepatic resection on the immune response to residual intrahepatic tumor tissue and the growth of untreated liver metastases. Adenocarcinoma cells were implanted into hoth lohes of 60 Wistar Alhino Glaxo (WAG) rats. The left lohe tumor was treated either by LITT or partial hepatectomy. The control right lobe tumor was subjected to further investigation at regular intervals after treatment. The expression of several immunity factors was significantly enhanced at the invasion front of untreated control tumors after LITT compared to hepatic resection, which can then lead to reduced tumor growth (ISBERT et al. 2004). 

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