摘要:

AbstractThe association between hepatocellular carcinoma (HCC) and cirrhosis provides a formidable means for prospectively studying patients who are at risk of HCC. Early diagnosis of HCC is possible not only due to knowledge of the risk factors for this tumor, but also because HCC has a very long phase of intrahepatic growth and tends to grow as a solitary mass. Early diagnosis is also possible because sensitive and relatively inexpensive diagnostic tools are available. Several prospective studies of Oriental and Western patients with cirrhosis now in progress have led to the identification of many patients with small tumors. However, in the face of this evidence that screening high‐risk patients may increase the yield of sub‐clinical small tumors, no firm conclusion has yet been reached on whether early diagnosis of HCC may also increase the number of operable patients and reduce the mortality rate for this tumor. © 1993 Wiley‐Lis

ISSN:0022-4790    

DOI:10.1002/jso.2930530513

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractAn overview is given of current practice in deciding which patients can undergo a major abdominal operative procedure involving the hepatobiliary system. The criteria developed for individuals with normal and diseased livers are presented, and the unique circumstances of liver transplantation are also addressed. © 1993 Wiley‐Liss, I

ISSN:0022-4790    

DOI:10.1002/jso.2930530514

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractBecause increased prolactin levels and hyperprolactinemia in the presence of encephalopathy in males with cirrhosis (alcohol‐induced cirrhosis in particular) are associated with statistically increased mortality, we have examined pre‐surgical levels of prolactin and other hormones, as well as the presence of encephalopathy, in 12 postmenopausal women with endstage alcohol‐induced cirrhosis in relation to liver transplant survival. Levels of estradiol were significantly lower, while luteinizing hormone (LH) and 17‐hydroxyprogesterone as well as the ratio of estradiol to testosterone were significantly higher prior to transplantation among the women who survived, compared with non‐survivors. A similar pattern was seen for transplant candidates who died before transplantation as compared with still‐living candidates. These findings suggest that pre‐operative levels of sex steroids and pituitary hormones may have prognostic value in alcoholic cirrhotic postmenopausal women undergoing liver transplantation. © 1993 W

ISSN:0022-4790    

DOI:10.1002/jso.2930530515

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractSubclinical hepatocellular carcinoma (SCHCC) is defined as HCC without obvious HCC symptoms and signs. During 1958–1991, 391 patients with SCHCC were analyzed. In the entire series, 1) 67.3% was detected by natural population screening using alpha‐fetoprotein (AFP) serosurvey, while the others were discovered by high‐risk population screening or regular health checkup using AFP and/or ultrasonography (US); 2) AFP>20 μg/L was found in 77.6% of patients; 3) serum hepatitis B surface antigen (HBsAg) was positive in 68.9%; 4) associated liver cirrhosis occurred in 89.1%; 5) the median tumor size was 5 cm, and small HCC (≦ 5 cm) amounted to 61.1%; 6) resection was done in 81.4%, and limited resection was performed in the majority (71.3%); 7) re‐resection for subclinical recurrence was done in 44 patients; and 8) cytoreduction and sequential resection was carried out in 13 patients with unresectable SCHCC. Comparison between SCHCC and clinical HCC (n = 1,251) revealed higher resectability (81.4% vs. 46.8%), lower operative mortality (1.9% vs. 6.0%), and higher 5‐year survival (entire series: 50.7% vs. 20.6%; resection: 60.5% vs. 36.8%). It is concluded that the study of SCHCC has resulted in marked improvement of ultimate outcome of HCC; screening in high‐risk populations using AFP and/or US, limited resection, and re‐resection for subclinical recurrence are some of the key features. © 199

ISSN:0022-4790    

DOI:10.1002/jso.2930530516

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractLiver resections were performed in 168 patients with hepatocellular carcinoma (HCC) over the past 10 years; 116 were cirrhotics. Operative mortality was 7.7% (8.6% in the cirrhotic group and 5.8% in non‐cirrhotics). In the years 1987–1992 the operative mortality decreased from 15.6% to 4.9% (P<.05). A statistical analysis of survival was made with the data of 155 patients with a follow‐up of more than 1 month after curative resection: 56 (36.1%) died, while 99 (63.8%) are currently alive, with a follow‐up varying from 2 to 76 months. The actuarial survival rate is 56.7% after 3 years and 36.3% after 5 years (59% and 35.2% for cirrhotics; 52.2% and 37.7% for non‐cirrhotics, respectively). Satisfactory results can be obtained after liver resections in HCC, even in the presence of cirrhosis. Further efforts are needed in the early diagnosis of HCC, to prevent the formation of satellite nodules and the intrahepatic tumoral spread, which represent the major cause of exclusion from surgical therapy. © 1993 Wiley

ISSN:0022-4790    

DOI:10.1002/jso.2930530517

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:0022-4790    

DOI:10.1002/jso.2930530518

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractA retrospective study was performed in order to identify factors significantly associated with operative mortality and post‐operative complications in 114 patients with liver cirrhosis who underwent resection surgery for single hepatocarcinoma nodules (diameter ≦ 7 cm) from 1980 to 1992. Vascular thrombosis, extrahepatic spread of the tumor, ascites, advanced cirrhosis, severe cardio‐pulmonary disease, and renal failure were exclusion criteria. Forty‐one pre‐operative (demographic, clinical, laboratory, and histopathological features) and two peri‐operative variables (amount of blood transfused and duration of operation) were cross tabulated using X2test with operative mortality and post‐operative complications, which were taken as end‐point variables. Stepwise logistic regression analysis was then employed in order to define factors independently associated with end‐point variables. Only partial thromboplastin time abnormality was significantly (P= 0.003) and independently associated with operative mortality. The length of the operation and the period during which surgery was carried out (1980–1986 and 1987–1992) were significantly (P<0.001) and independently associated with the occurrence of at least one post‐operative complication. The results suggest that the use of more restrictive selection criteria do not make it possible to lower operative mortality, although the coagulative status should be better assessed. Minimizing surgical stress and optimizing post‐operative medical care are crucial for preventing post‐operative complicati

ISSN:0022-4790    

DOI:10.1002/jso.2930530519

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:0022-4790    

DOI:10.1002/jso.2930530520

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractAmong 283 orthotopic liver transplantations made during the last 6 years at our institution, 22 (7.77%) were done on 19 patients with unresectable hepatic malignant tumors [hepatocellular carcinoma (17), angiosarcoma (1), and cholangiocarcinoma (1)]. None of them showed extrahepatic invasion, and only one had lymph node involvement.Cyclosporin A, corticosteroids, and azathioprine were administered for 3 months after the procedure, and maintenance therapy involved the first two drugs. Acute rejection rate and hospital stay were not significantly different compared with non–tumoral grafted patients. Three patients were retransplanted, one with uncontrolled acute rejection and two with chronic rejection. Intraoperative mortality was zero. Eight patients (42.1%) were alive at a mean follow‐up of 31 months (range, 6–74). Four 22.2%) died with tumor recurrence, three of sepsis, two of respiratory insufficiency, one of hepatitis recurrence with cirrhosis, and one of primary lung neoplasia.If adequately selected, primary liver tumor patients may benefit from liver transplantation. Future research with adjuvant therapies will improve the results. © 1993 Wiley‐L

ISSN:0022-4790    

DOI:10.1002/jso.2930530521

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractExperience with liver transplantation over a period of 11 years at the University of Pittsburgh is presented. The application of liver transplantation to cases of hepatocellular carcinoma has changed considerably over this 11‐year period with the sequential introduction of adjuvant and, more recently, neoadjuvant chemotherapy.Results with the combination of chemotherapy plus surgery appear to be better than results with either agent alone. Moreover, the early results with neoadjuvant therapy appear to be better than those achieved with adjuvant therapy.As a result of this experience, conceptual changes in the approach to the problem of hepatic cancer and the role of both chemotherapy and liver transplantation in its management have changed at the University of Pittsburgh. These changes are identified and discussed. © 1993 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930530522

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY