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Role of hepatectomy for recurrent or initially unresectable hepatocellular carcinoma

World Journal of Hepatology 2014年第12期6卷 836-843页

作者： yoji kishi Kazuaki Shimada Satoshi Nara Minoru Esaki Tomoo Kosuge Hepatobiliary and Pancreatic Surgery Division National Cancer Center Hospital Tokyo 104-0045 Japan

As a result of donor shortage and high postoperative morbidity and mortality after liver transplantation,hepatectomy is the most widely applicable and reliable option for curative treatment of hepatocellular carcinoma(HCC).Because intrahepatic tumor recurrence is frequent after loco-regional therapy,repeated treatments are advocated provided background liver function is *** treatments including local ablation and transarterial chemoembolization,hepatectomy provides the best long-term outcomes,but studies comparing hepatectomy with other nonsurgical treatments require careful review for selection *** patients with initially unresectable HCC,transarterial chemo-or radio-embolization,and/or systemic chemotherapy can down-stage the tumor and conversion to resectable HCC is achieved in approximately 20%of ***,complete response is rare,and salvage hepatectomy is essential to help prolong patients’*** counter the short recurrence-free survival,excellent overall survival is obtained by combining and repeating different *** is important to recognize hepatectomy as a complement,rather than a contraindication,to other nonsurgical treatments in a mul-tidisciplinary approach for patients with HCC,including recurrent or unresectable tumors.

关键词： Hepatocellular carcinoma Hepatectomy Repeat hepatectomy Conversion therapy Multidisciplinary treatment

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Left hepatic trisectionectomy for perihilar cholangiocarcinoma with a right-sided round ligament:A case report

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World Journal of Gastrointestinal Surgery 2020年第2期12卷 68-76页

作者： Tomoyuki Ishida Satoshi Nara Keiichi Akahoshi Takeshi Takamoto yoji kishi Minoru Esaki Nobuyoshi Hiraoka Kazuaki Shimada Department of Hepatobiliary and Pancreatic Surgery National CancerCenter HospitalTokyo 104-0045Japan Department of Pathology and Clinical Laboratories National Cancer Center HospitalTokyo 104-0045Japan

BACKGROUND A right-sided round ligament(RSRL)is a rare,congenital anomaly of the intrahepatic portal vein,with a reported frequency of 0.2%-1.2%.For patients with perihilar cholangiocarcinoma associated with an RSRL,an accurate understanding of the vascular and biliary anatomy is *** SUMMARY We report a 70-year-old male with perihilar cholangiocarcinoma associated with an *** percutaneous transhepatic embolization of the left and anterior portal branches,we conducted a left trisectionectomy of the liver with extrahepatic bile duct resection and *** postoperative course was uneventful,and R0 resection was *** the liver volume of each section was compared between 7 patients with an RSRL and 20 patients with normal portal vein anatomy,the posterior section in RSRL patients was significantly larger than that in patients with normal portal vein anatomy(median:457 mL vs 306 mL,P=0.031).In patients with perihilar cholangiocarcinoma associated with an RSRL,left trisectionectomy has several surgical advantages:(1)The posterior branch of the portal vein often ramifies independently,and the division of the portal vein is easily conducted;(2)A relatively large amount of remnant liver can be retained;and(3)The anatomy of the posterior branch of the Glissonian pedicle is similar to that in patients with normal *** In patients with an RSRL and perihilar cholangiocarcinoma that does not involve the posterior section,left trisectionectomy may be a favorable choice.

关键词： Right-sided round ligament Left-sided gallbladder Perihilar cholangiocarcinoma Case report

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Liver atrophy after percutaneous transhepatic portal embolization occurs in two histological phases: Hepatocellular atrophy followed by apoptosis

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World Journal of Hepatology 2017年第32期9卷 1227-1238页

作者： Yasuhito Iwao Hidenori Ojima Tatsushi Kobayashi yoji kishi Satoshi Nara Minoru Esaki Kazuaki Shimada Nobuyoshi Hiraoka Minoru Tanabe Yae Kanai Division of Molecular Pathology National Cancer Center Research Institute Hepatobiliary and Pancreatic Surgery Division National Cancer Center Hospital Hepatobiliary and Pancreatic Surgery Tokyo Medical and Dental University Department of Pathology Keio University School of Medicine Diagnostic Radiology Division National Cancer Center Hospital East

AIM To clarify the histological changes associated with liver atrophy after percutaneous transhepatic portalembolization(PTPE) in pigs and humans. METHODS As a preliminary study, we performed pathological examinations of liver specimens from five pigs that had undergone PTPE in a time-dependent model of liver atrophy. In specimens from embolized lobes(EMB) and nonembolized lobes(controls), we measured the portal vein to central vein distance(PV-CV), the area and number of hepatocytes per lobule, and apoptotic activity using the terminal deoxynucleotidyl transferase dU TP nickend labeling assay. Immunohistochemical reactivities were evaluated for light chain 3(LC3) and lysosomal-associated membrane protein 2(LAMP2) as autophagy markers and for glutamine synthetase and cytochrome P450 2 E1(CYP2 E1) as metabolic zonation markers. Samples from ten human livers taken 20-36 d after PTPE were similarly examined. RESULTS PV-CVs and lobule areas did not differ between EMB and controls at day 0, but were lower in EMB than in controls at weeks 2, 4, and 6(P ≤ 0.001). Hepatocyte numbers were not significantly reduced in EMB at day 0 and week 2 but were reduced at weeks 4 and 6(P ≤ 0.05). Apoptotic activity was higher in EMB than in controls at day 0 and week 4. LC3 and LAMP2 staining peaked in EMB at week 2, with no significant difference between EMB and controls at weeks 4 and 6. Glutamine synthetase and CYP2 E1 zonation in EMB at weeks 2, 4, and 6 were narrower than those in controls. Human results were consistent with those of porcine specimens. CONCLUSION The mechanism of liver atrophy after PTPE has two histological phases: Hepatocellular atrophy is likely caused by autophagy in the first 2 wk and apoptosis thereafter.

关键词： Liver atrophy Portal vein embolization Autophagy Apoptosis Zonation Lobule

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