Tetsuya Kaneko

The Doppler waveform of hepatic veins in healthy humans is a triphasic waveform (two negative waves and one positive). Recent studies emphasize the role of Doppler ultrasonography in the evaluation of liver cirrhosis. The analysis of the Doppler waveform of hepatic veins might be a useful and non-invasive method to assess hepatic functional reserve and the amount of the liver to be excised. In 30 patients scheduled for hepatectomy, we performed quantitative analysis of the Doppler waveform of hepatic veins and correlated the Pulsatility Index (PI) and Resistance Index (RI) with ICG clearance values and histologic findings of resected liver specimens in order to ascertain the clinical utility of this method. The mean (+/-SE) values of PI and RI were 1.31 +/- 0.10 and 0.82 +/- 0.03, respectively, and both values are diminished according to the severity of cirrhosis and very closely correlated with fibrosis of the liver-reflected hepatic consistency (PI: r = -0.611, p = 0.0010; RI: r = -0.647, p = 0.0005). They were also correlated with ICG clearance values to some extent, but several discrepant cases were observed. In four of the discrepant cases (ICGR15 < or = 10%, but PI and RI <mean values), less invasive resections were performed than preoperatively proposed. These results suggested the usefulness of the analysis of the Doppler waveform of hepatic veins as an easy, non-invasive and reliable method for determining hepatic functional reserve and the amount of the liver to be excised.

The Makuuchi criterion was proposed to select for the appropriate hepatectomy in an impaired liver. However, there are no comparative analyses concerning this criterion. Our purpose is to evaluate the efficacy of it. We conducted our study on 471 patients with hepatocellular carcinoma, resected from January 1986 to April 2004. We defined surgery consistent with Makuuchi criterion as group 1, and other as group 2. We performed comparative analysis of surgical results. Group 1 showed lower intraoperative blood loss (1602 +/- 119 mL vs. 2448 +/- 244mL: P = 0.002), mortality (4.4% vs. 12.5%: P = 0.009), and postoperative serum total bilirubin (3.4 +/- 0.2 mg/dL vs. 6.2 +/- 0.8 mg/ dL: P < 0.0001) than group 2. Five-year survival rates were not significantly different between group 1 (43%) and 2 (35%): P = 0.18. Blood loss in operative deaths was greater than in survivors, both in group 1 (6155 +/- 1725 mL vs. 1391 +/- 83 mL: P < 0.0001) and in group 2 (4381 +/- 946 mL vs. 2172 +/- 231mL: P = 0.002). Blood loss in patients with postoperative liver failure was also greater than in others, both in group 1 (2692 +/- 292 mL vs. 1146 +/- 106 mL: P < 0.0002) and in group 2 (2968 +/- 335 mL vs. 1538 +/- 265 mL: P = 0.004). Our study showed Makuuchi criterion is helpful for a safe hepatectomy for hepatocellular carcinoma. If inconsistent with it, 2172 mL and 1538 mL blood loss are considered permissible upper limits to avoid operative death and liver failure, respectively.

Background: Microbubble of Levovist accumulates in liver parenchyma, and the phenomenon has been reported as late liver‐specific parenchymal. The aim of the present study was to compare the parenchymal enhancement effect of Levovist with the degree of liver dysfunction.Patients and methods: Sixty consecutive patients who consented to be treated were enrolled in this study. Pulse‐inversion ultrasonography (US) in the liver parenchymal phase of enhancement with Levovist was performed in a preoperative examination. The mechanical index of pulse‐inversion US was set at 1.3. The gray‐scale intensity of the non‐tumor area of the liver parenchyma at the level of the focal zone was measured. The hepatic fibrosis index was measured in each liver by morphometric analysis. The correlation between the gray‐scale intensity of the non‐tumor area of the liver parenchyma and the hepatic fibrosis index was assessed.Results: There was a significant inverse correlation between the gray scale of the liver parenchyma and the hepatic fibrosis index (r=−0.809, PPConclusions: The signal intensity of a microbubble disruption of the liver parenchyma in the late phase of enhancement with Levovist was considered to reflect the degree of hepatic fibrosis.

Radiofrequency ablation has become a new therapeutic method for treating malignant liver tumors. We reviewed our experience to identify the factors involved in successful radiofrequency ablation therapy. Patients who underwent this therapy between 1999 July and 2002 July were reviewed for the characteristics of their tumors, clinical data and operative techniques used. Sixty-one patients (hepatocellular carcinoma 50 and metastatic tumors 11) were ablated. Forty-six cases (75.4%) were ablated effectively. Survival of patients with hepatocellular carcinoma was superior to those with metastases. The effective factor was the number of nodules while the survival factors were the number of nodules and the maximum tumor diameter. Recurrence factors in patients with hepatocellular carcinoma ablated effectively were poor hepatic function due to cirrhosis and higher protein induced by vitamin K absence or antagonist-II (PIVKA-II). The survival of patients with hepatocellular carcinoma was significantly better than those with metastases. We recommend radiofrequency ablation therapy for cases having a single hepatic tumor less than 3.5 cm in diameter (4 cm for hepatocellular carcinoma requiring much care). In patients with hepatocellular carcinoma, hepatic function with cirrhosis and PIVKA-II showed a significant correlation with recurrence.