Kanzo

Original Article

Comparison of the long-term results between surgical resection and local ablation for Child-Pugh A patients with a single hepatocellular carcinoma of 5 cm or less in size: A single center study

Osamu Yamazaki, Hiroko Oka, Takao Manabe, Kiyohide Kioka, Osamu Kurai, ...

Article type: Original Article
2009 Volume 50 Issue 4 Pages 173-184
Published: 2009
Released on J-STAGE: April 30, 2009

DOIhttps://doi.org/10.2957/kanzo.50.173

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Three hundred and ninety-nine Child-Pugh A patients diagnosed between January 1994 and March 2007 were studied to evaluate the therapeutic impact of surgical resection and local ablation for a single hepatocellular carcinoma, 5 cm or less in diameter on outcomes. The patients classified into any of an anatomical resection (n=110), a limited resection (n=88), thermal ablation (n=97) and PEIT (n=104). The 5-year overall survival rate was 72%, 51%, 68% and 62% in the anatomical resection, limited resection, thermal ablation and PEIT, while the 5-year disease-free survival rate was 41%, 27%, 23% and 11%, respectively. Using Cox's regression model, the following independent favorable factors of overall survival were determined. 1) liver damage A, 2) 2 cm or less in size, 3) well differentiated type, 4) anatomical resection. Liver damage A, well differentiated type and anatomical resection were also confirmed to be independent favorable factors of disease-free survival. In patients with either degree of liver damage A or B, having a solitary tumor, 2 cm or less in size, differences of the overall survival were not significant between surgical resection and local ablation. Also in this group, no significant difference of the locoregional recurrence between an anatomical resection and a limited resection was seen, and thermal ablation had a smaller risk of local tumor progression after initial therapy than PEIT. In patients having a single tumor larger than 2 cm in diameter, prognosis of patients who underwent an atomical resection was the best of all groups, especially in liver damage A patients, the 5-year overall survival and 5-year disease-free survival were 75% and 52%, respectively. The comparative 5-year overall survival for patients who received a limited resection, thermal ablation and PEIT were 46%, 48% and 51%, 5-year disease-free survival were 27%, 0% and 9%, respectively.

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Case Reports

Intraarterial infusion chemotherapy following splenectomy for unresectable hepatocellular carcinoma with hypersplenism: a case report

Nobuyuki Tamaki, Kojiro Taura, Etsuro Hatano, Iwao Ikai, Shinji Uemoto

Article type: Case Report
2009 Volume 50 Issue 4 Pages 185-191
Published: 2009
Released on J-STAGE: April 30, 2009

DOIhttps://doi.org/10.2957/kanzo.50.185

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Hepatic arterial infusion chemotherapy (HAIC) is a promising therapeutic option for unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). However, pancytopenia due to hypersplenism frequently hinders application of HAIC for such patients. Here we describe an HCC patient with thrombocytopenia who benefited from splenectomy to overcome thrombocytopenia. A 56-year-old man suffered from unresectable HCC with PVTT. Because of thrombocytopenia (3.5×10⁴/mm³) due to splenomegaly, the patient underwent partial splenic embolization before HAIC. However, the platelet count was not fully recovered and continuation of HAIC was impeded. Then we performed splenectomy and the platelet count was recovered to a sufficient level (15.4×10⁴/mm³) to complete a full course of the HAIC. The tumor shrinked remarkabley and serum PIVKA II level was decreased from 1190 mAU/ml to 107 mAU/ml. Splenectomy may be one of the useful therapeutic options for unresectable HCC with liver cirrhosis to overcome pancytopenia due to hypersplenism.

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A case of hepatocellular carcinoma relapsed 44 months after living donor liver transplantation, with a 50-month survival thereafter by multimodal treatments

Hiroko Oka, Osamu Yamazaki, Katsuhiko Horii, Takao Manabe, Kiyohide Ki ...

Article type: Case Report
2009 Volume 50 Issue 4 Pages 192-200
Published: 2009
Released on J-STAGE: April 30, 2009

DOIhttps://doi.org/10.2957/kanzo.50.192

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Here we report a case of 34 years old female with chronic hepatitis B, who had undergone extended left lobectomy for a huge hepatocellular carcinoma (HCC) with a diameter of 12 cm when she was 25 years old. The HCC recurred in the following year, and a living donor liver transplantation (LDLT) was performed at 27 years of age. Recurrent tumors were revealed in the graft at 44 months after LDLT. Though percutaneous treatments were done repeatedly, many uncontrollable tumors appeared in succession. Posterior-segmentectomy and partial resection of anterior-segment were performed at 32 years of age. Recurrent tumors appeared one after another despite those intensive therapies, and the patient expired 94 months after LDLT; 50 months after the post-LDLT recurrence. To our knowledge, this is the first case of recurrent HCCs appearing more than 3 years after LDLT and then undergoing a graft segmentectomy.

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Complete response to treatment with hepatic arterial chemoembolization and arterial infusion chemotherapy in a case of hepatocellular carcinoma with multiple lung metastases

Masatora Haruno, Kazufumi Dohmen, Minako Oyama, Keita Fukaura, Norihik ...

Article type: Case Report
2009 Volume 50 Issue 4 Pages 201-207
Published: 2009
Released on J-STAGE: April 30, 2009

DOIhttps://doi.org/10.2957/kanzo.50.201

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A 68-year-old Japanese male admitted at our hospital because of further examination and therapy for liver tumors. Based on the elevated values of serum alpha-fetoprotein (AFP) and PIVKA II and imaging examinations, he was diagnosed to have primary hepatocellular carcinoma (HCC) with multiple lung metastases. After the therapy with 4 sessions of transcatheter arterial chemoembolization (TACE) and arterial infusion chemotherapy (TAI) for primary HCC measuring 8 cm in diameter, lung nodules were disappeared along with a prominent decrease to the normal levels of the values of serum AFP and PIVKA II. The clinical course revealed that a complete response was obtained. Although the precise mechanisms underlying this intriguing phenomenon remain unknown, thus possibilities are raised that natural regression of HCC or the necrotic change of tumor cells on the immunological effect produced by TACE/TAI.

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Two cases of Inose-type hepatic encephalopathy successfully treated with shunt resection

Mitsuaki Morimoto, Ken Shirabe, Kiyoshi Kajiyama, Norifumi Harimoto, K ...

Article type: Case Report
2009 Volume 50 Issue 4 Pages 208-212
Published: 2009
Released on J-STAGE: April 30, 2009

DOIhttps://doi.org/10.2957/kanzo.50.208

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An Inose-type hepatic encephalopathy due to a porto-systemic shunt was successfully treated by resection of the shunt.
Patient 1, 71-year-old man with normal liver, was presented with hepatic encephalopathy after the operation of diffuse peritonitis with strangulated ileus. Computed tomography revealed the presence of a large spleno-renal shunt. We ligated and divided the splenorenal shunt during an open surgery.
Patient 2 was a 79-year-old man with hepatitis C. Computed tomography showed the large shunt from superior mesenteric vein to inferior vena cava. The shunt resection was performed. Portal thrombosis developed after the operation but anti-coagulant therapy was effective.
No evidence of hepatic encephalopathy in this two patients occurred after the operation. For the treatment of porto-systemic shunt resection is available but caution must be exercised for liver cirrhosis, esophageal varix and portal thrombosis.

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