Skip to main content

Extended surgery for malignant liver tumors

  • Chapter
Primary Liver Cancer in Japan

Abstract

Even though recent advances in imaging technology has allowed detection of small liver tumors, only 20% of patients with liver tumors benefit from surgical resection. The reason for this low incidence of resectability in our country is mainly due to decreased liver functional reserve caused by coexisting chronic liver diseases such as cirrhosis or chronic hepatitis [1], Therefore, even when the tumor is small, and is located in the center of one lobe, wide resection may not be advisable. In the last five years, we have reformed the operative procedures and postoperative management according to the redox theory, which involves measurement of the arterial ketone body ratio (AKBR), improving in operative mortality and morbidity [2–7]. In this paper, some of the operative procedures will be presented such as liver resection under hepatic vascular exclusion (HVE) using veno-venous bypass, and hepatic resection using a technique for living related liver transplantation which we have performed in 14 cases in the last 10 months.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. The Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan, clinicopathologic features and results of surgical treatment. Ann Surg 211: 277–287

    Google Scholar 

  2. Ozawa K (1990) Hepatic function and liver resection. J Gastroenterol Hepatol 5: 296–309

    Article  PubMed  CAS  Google Scholar 

  3. Yamaoka Y, Ozawa K, Shimahara Y, Nakatani T, Mori K, Kobayashi N, Kumada K (1988) A simple and direct approach to the portal triad structures for a left lobectomy or a left lateral segmentectomy. Surg Gynecol Obstet 166: 78–80

    PubMed  CAS  Google Scholar 

  4. Kumada K, Ozawa K, Okamoto R, Takayasu T, Yamaguchi M, Yamamoto Y, Higashiyama H, Morikawa S, Sasaki Y, Shimahara Y, Yamaoka Y, Takeuchi E (1990) Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi. Surgery 108: 821–827

    PubMed  CAS  Google Scholar 

  5. Mori K, Ozawa K, Yamamoto Y, Maki A, Shimahara Y, Kobayashi N, Yamaoka Y, Kumada K (1990) Response of hepatic mitochondrial redox state to oral glucose load—redox tolerance test as a new predictor of surgical risk in hepatectomy. Ann Surg 211: 438–446

    Article  PubMed  CAS  Google Scholar 

  6. Kiuchi T, Shimahara Y, Wakashiro S, Tokunaga Y, Ozaki N, Takayasu T, Mori K, Kobayashi N, Yamaoka Y, Ozawa K (1990) Reduced arterial ketone body ratio during laparotomy: An evaluation of operative stress through the changes in hepatic mitochondrial redox potential. J Lab Clin Med 115: 433–440

    PubMed  CAS  Google Scholar 

  7. Shimahara Y, Kiuchi T, Yamamoto Y, Yamaguchi T, Takada Y, Yamauchi A, Higashiyama H, Kobayashi N, Mori K, Yamaoka Y, Kumada K, Ozawa K (1990) Hepatic mitochondrial redox potential and nutritional support in liver insufficiency. In: Tanaka T and Okada A (eds) Nutritional support in organ failure. Elsevier, Amsterdam, pp 295–307

    Google Scholar 

  8. Delva E, Camus Y, Nordlinger B, Hannoun L, Parc R, Deriaz H, Lienhart A, Huge C (1989) Vascular occlusion for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases. Am J Surg 209: 211–218

    CAS  Google Scholar 

  9. Bismuth H, Castaing D, Garden J (1989) Major hepatic resection under total vascular exclusion. Ann Surg 210: 13–19

    Article  PubMed  CAS  Google Scholar 

  10. Fortner GF, Shiu MH, Howland WS, Gaston JP, Kunlin A, Kawano N, Hattori T, Beattie EJ (1971) A new concept for hepatic lobectomy: Experimental studies and clinical application. Arch Surg 102: 312–315

    Article  PubMed  CAS  Google Scholar 

  11. Huget C, Nordlinger B, Bloch P, Conard J (1978) Tolerance of the human liver to prolonged normothermic ischemia: A biological study of 20 patients submitted to extensive hepatectomy. Arch Surg 113: 1448–1451

    Article  Google Scholar 

  12. Howland WS, Schweizer OS, Fortner J, Shiu MH, Ragasa JP, Wightman AE, Gould P (1975) Intraoperative physiologic monitoring and management during hepatic lobectomy using the liver isolationperfusion technique. Am J Surg 129: 608–615

    Article  PubMed  CAS  Google Scholar 

  13. Delva E, Barberousse JP, Nordlinger B, Olliver JM, Vacher B, Guilmet C, Huget C (1984) Hemodynamic and biochemical monitoring during major liver resection with use of hepatic vascular exclusion. Surgery 95: 309–318

    PubMed  CAS  Google Scholar 

  14. Yamaoka Y, Shimahara Y, Nakatani T, Mori K, Kobayashi N, Maki A, Nitta N, Yamamoto S, Ozawa K (1988) Clinical role of blood ketone body ratio as an indicator evaluating hepatic tolerance for portal triad cross-clamping in cirrhotic liver resection. Surg Res Comm 3: 87–93

    Google Scholar 

  15. Nitta N, Yamamoto S, Yamaoka Y, Ozawa K (1988) Arterial blood ketone body ratio as an indicator of the no-return point in hepatic inflow occlusion without venous shunt in dogs. Life Sci 42: 1973–1979

    Article  PubMed  CAS  Google Scholar 

  16. Shaw BW, Martin D, Marquez JM, Kang YG, Bugbee AC, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TS (1984) Venous bypass in clinical liver transplantation. Ann Surg 200: 524–532

    Article  PubMed  Google Scholar 

  17. Yamaoka Y, Ozawa K, Kumada K, Shimahara Y, Tanaka K, Mori K, Takayasu T, Okamoto R, Kobayashi N, Konishi Y, Egawa H (to be published) (1991) Total vascular exclusion for hepatic resection in cirrhotic patients: Application of venovenous bypass. Arch Surg

    Google Scholar 

  18. Taki Y, Gubernatis G, Yamaoka Y, Oellerich M, Yamamoto Y, Ringe B, Okamoto R, Bunzendahl H, Beneking M, Burdelski M, Bornscheuer A, Ozawa K, Pichlmayr R (1990) Significance of arterial ketone body ratio measurement in human liver transplantation. Transplantation 49: 535–539

    Article  PubMed  CAS  Google Scholar 

  19. Asonuma K, Takaya S, Selby R, Okamoto R, Yamamoto Y, Yokoyama T, Todo S, Ozawa K, Starzl TE (1991) The clinical significance of the arterial ketone body ratio as an early indicator of graft viability in human liver transplantation. Transplantation 51: 164–171

    Article  PubMed  CAS  Google Scholar 

  20. Yamaoka Y, Ozawa K, Tanaka A, Mori K, Morimoto T, Shimahara Y, Zaima M, Tanaka K, Kumada K (to be published) (1991) New devices for harvesting the hepatic graft from the living donor. Transplantation 52: 157–160

    Article  PubMed  CAS  Google Scholar 

  21. Pichlmayr R, Grosse H, Hauss J, Gubernatis G, Lamesch P, Bretschneider HJ (1990) Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver. Br J Surg 77: 21–26

    Article  PubMed  CAS  Google Scholar 

  22. Kishi K, Shikata T, Hirohashi S, Hasegawa H, Yamazaki S, Makuuchi M (1983) Hepatocellular carcinoma: A clinical and pathologic analysis of 57 hepatectomy cases. Cancer 51: 542–548

    Article  PubMed  CAS  Google Scholar 

  23. Nagasue N, Yukaya H, Ogawa Y, Sasaki Y, Chang YC, Niimi K (1986) Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery 99: 694–702

    PubMed  CAS  Google Scholar 

  24. Yamanaka N, Okamoto E, Toyosaka A (1990) Prognostic factors after hepatectomy for hepatocellular carcinomas. Cancer 65: 1104–1110

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1992 Springer-Verlag Tokyo

About this chapter

Cite this chapter

Yamaoka, Y. et al. (1992). Extended surgery for malignant liver tumors. In: Tobe, T., et al. Primary Liver Cancer in Japan. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68177-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-4-431-68177-9_21

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68179-3

  • Online ISBN: 978-4-431-68177-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics