Hepatectomy for hepatocellular carcinoma without hospital mortality

Objective: To report the result of hepatectomy for hepatocellular carcinoma (HCC) in Queen Mary Hospital, Hong Kong. Design: A review of data that were collected prospectively. Subjects: 150 consecutive select patients with resectable HCC operated between December 1995 and August 1998 at Queen Mary Hospital, Hong Kong. Main outcome measure: Hospital mortality rate. Results: There was no hospital mortality in the 150 select patients undergoing hepatectomy for HCC. Blood transfusion was not required in 96 (64%) patients. Cirrhosis was present in 70 (47%) patients and chronic hepatitis was present in 56 (37%) patients. Conclusion: Hepatectomy for HCC can be accomplished without hospital mortality with current techniques.published_or_final_versio

Liver transplantation in Hong Kong

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Liver transplantation in Hong Kong.

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Liver transplantation: who live? who die?

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Perioperative Nutritional Support: Author's reply

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Molecular Adsorbents Recirculating System (MARS): evidence and management pitfalls

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Selection of patients of hepatocellular carcinoma beyond the Milan criteria for liver transplantation

The Milan criteria have been proven to be reliable and easily applicable in selection of patients with small unresectable hepatocellular carcinomas for liver transplantation. It has been repeatedly shown that patients who met these criteria had a 5-year survival of over 70% after transplantation. Such a result is remarkably good for an otherwise incurable malignancy. The main disadvantage of this set of criteria is that it is rather restrictive. Following it religiously denies transplantation to many patients who have tumor stage slightly more advanced. There have been many attempts to extend the criteria to include tumors with larger sizes (as in the UCSF criteria) or with a larger number (as in the Kyoto criteria). Alpha-fetoprotein and PIVKA-II, two biological markers in more aggressive tumors, have also been employed in the selection of patients, and biopsies have been used by the University of Toronto to determine tumor aggressiveness before deciding on transplantation. Patients with tumors beyond the Milan criteria yet not of a high grade have been accepted for transplantation and their survival is comparable to that of transplant recipients who were within the Milan criteria. Preoperative dual-tracer ((11)C-acetate and FDG) positron emission tomography has been used to determine tumor grade, and transarterial chemoembolization has been used to downstage tumors, rendering them meeting the Milan criteria. Patients with downstaged tumors have excellent survival after transplantation. Partial response to chemical treatment is a reflection of less aggressive tumor behavior. Careful selection of patients beyond the Milan criteria with the aid of serum tumor marker assay, positron emission tomography or tumor biopsy allows transplanting more patients without compromising survival. The use of liver grafts either from the deceased or from living donors could thus be justified.published_or_final_versio

Mechanism of metastasis by membrane type 1-matrix metalloproteinase in hepatocellular carcinoma

Aim: To investigate the precise role of membrane type 1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis. Methods: Human HCC cells Hep3B with overexpression of MT1-MMP were established by stable transfection, and compared with control cells carrying the empty vector. Cells were examined in vivo for their differences in the metastatic ability of athymic nude mice, and analyzed in vitro for their differences in invasion ability by invasion chamber coated with Matrigel,adhesion towards collagen I and migration through culture chamber. Cell proliferation and apoptosis in adherent and suspension status were evaluated by MTT and flow cytometry analysis. Results: We found that overexpression of MT1-MMP could increase intrahepatic metastasis in nude mice with orthotopic implantation of HCC cells (incidence of 100% [MT1-MMP transfectants] vs 40% [vector control transfectants], P<0.05). MT1-MMP could also enhance cell invasion through Matrigel (107.7 vs39.3 cells/field, P<0.001), adhesion towards matrix (0.30 vs 0.12 absorbance unit at 540 nm, P<0.001), cell migration (89.3 vs 39.0 cells/field, P<0.001), and cell proliferation (24.3 vs 40.5 h/doubling, P<0.001). We also observed that MT1-MMP supported cell survival (71.4% vs 23.9%, P<0.001) with reduced apoptosis (43.7% vs 51.0%, P<0.05) in an attachment-free environment. Conclusion: MT1-MMP overexpression could enhance metastasis. In addition to its active role in matrix degradation during tumor invasion, MT1-MMP enhances tumor cell survival upon challenge of detachment, which is important during metastasis when cells enter the circulation. © 2005 The WJG Press and Elsevier Inc. All rights reserved.published_or_final_versio

Peri-operative care of patients with hepatocellular carcinoma undergoing hepatectomy

Peri-operative care of patients with hepatocellular carcinoma is critical for the survival of cirrhotic patients undergoing major hepatectomy. Peri-operative nutritional support in the form of branched-chain amino-acid-enriched solution, medium chain triglyceride, inorganic phosphate and multivitamins may be beneficial in sustaining liver function after hepatectomy. Intra-operatively, anaesthetic agents which are potentially harmful to the liver should be avoided, and haemodynamic monitoring to ensure adequate volume replacement should be made to maintain hepatic blood flow. The surgeon has to prevent unnecessary liver injury and excessive bleeding, and to exercise the technique meticulously avoiding bile leakage, haematoma and excessive rotation of the liver which may result in twisting of inflow and outflow vascular pedicles. Postoperatively, prolonged monitoring of haemodynamics is essential; the use of mechanical ventilation enables adequate administration of intravenous analgesics without respiratory depression and provides appropriate oxygenation of the liver and prevents pleural effusion. In the immediate postoperative period, continuation of parenteral nutrition would be beneficial to maintain a higher level of short half-life carrier proteins, decrease the requirement of diuretics to control ascites, induce less weight loss and reduce septic morbidity. Early resumption of enteral feeding may positively affect hepatic function and regeneration, and should be instituted as soon as the bowel function returns.published_or_final_versio

Infectious complications of liver transplantation

Sixteen (50%) of the 32 patients who received liver transplantations from October 1991 to March 1993 at Queen Mary Hospital, Hong Kong, developed viral, bacterial, or fungal infections. The viral infections were largely a result of immunosuppression while accidental bowel perforation, bile leak at the anastomosis, and delayed onset of stricture of the bile duct anastomosis were responsible for the intra-abdominal bacterial or fungal infections. Although the incidence of infectious complications was high, all patients were managed effectively and only one patient with lymphoproliferative disorder died. Infectious complications can lead to a prolonged hospital stay and a substantially increased hospital cost. The adoption of new immunosuppressive regimes that can better prevent acute graft rejection and adherence to meticulous surgical technique will help to reduce the infectious complications of liver transplantation in the future.published_or_final_versio