The present clinical study was undertaken to evaluate the effects of partial splenic embolization (PSE) on hypersplenism with severe functional disturbances of the coagulation-fibrinolysis system associated with liver cirrhosis. This was an attempt to achieve radical hepatectomy for hepatocellular carcinoma. [1] Effects of PSE on hypersplenism associated with liver cirrhosis: Functional disturbances of coagulation-fibrinolysis system in 16 patients with liver cirrhosis improved after PSE, but it had disappeared within one month ater PSE in patients with a splenic infarction area of less than 70%, while it had been maintained even after one year in patients with an infarction area of more than 70% with shrinkage of splenic volume. However, 2 out of 5 patients with an infarction area of more than 90% developed splenic cyst. [2] Results of hepatectomy for hepatocellular carcinoma: Among 9 patients with potential DIC risk according to our criteria, 4 (44.4%) developed DIC and died of liver failure within 6 months after hepatectomy without PSE, whereas all 9 patients undergoing hepatectomy after PSE, including 6 cases with potential DIC risk, had an uneventful postoperative course with well maintained function of the coagulation-fibrinolysis system and lessened splenic volume one year after hepatectomy. And they showed appreciable hepatic regeneration.

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The mode of tumor spread and factors influencing survival were analyzed in 93 patients with resection for pancreatoduodenal carcinoma, including 71 pancreaticoduodenectomies and 22 total pancreatectomies. 1) Resectability: 53.3% in 92 surgical patients with carcinoma of the pancreatic head, 92.9% in 28 patients with carcinoma of the papilla of Vater, 86.7% in 15 patients with carcinoma of the lower bile duct, and 100% in 5 patients with carcinoma of the duoenum. 2) Prognosis: The cumulative 5-year survival rate was 52.0% in carcinoma of the papilla of Vater, 38.0% in carcinoma of the lower bile duct, 25.0% in carcinoma of the duodenum, and 6.8% in carcinoma of the pancreatic head. 3) Mode of tumor spread: The incidence of lymph node involvement was 80.0% in carcinoma of the duodenum, 73.5% in carcinoma of the pancreatic head, 34.6% in carcinoma of the papilla of Vater, and 30.8% in carcinoma of the lower bile duct. The incidence of venous and perineural invasions was more than 60% in carcinoma of the pancreatic head and the duodenum, but it was less than 50% in carcinoma of the papilla of Vater and the lower bile duct. 4) Factors influencing survival: Venous and perineural invasions were highly associated with poor prognosis in pancreatoduodenal carcinoma. Other important factors were pancreatic capsular and portal vein invasions in carcinoma of the pancreatic head, pancreatic parenchymal invasion in carcinoma of the papilla of Vater, and duodenal invasion in carcinoma of the lower bile duct. All patients with survival of more than 3 years had well differentiated tubular adenocarcinoma.

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