EXPERIENCE WITH HEPATECTOMY AFTER THE ACTIVATION OF DECREASED HEPATIC FUNCTIONAL RESERVE IN PATIENTS WITH HEPATOCELLULAR CARCINOMA

Abstract

The trimethadione (TMO) tolerance test, an estimation based on serum dimethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) was used to quantitatively confirm the functional hepatic parenchyma after hepatectomy. Hepatic functional reserve was confirmed to be improved when measured by TMO tolerance test after transarterial embolization(TAE)for ruptured case of hepatocellular carcinoma. The patient well tolerated hepatectomy. Accordingly, activation of hepatic functional reserve with TAE was tried on 3 patients who were diagnosed inoperable because of decreased hepatic functional reserve. In these patients, DMO/TMO ratios also increased after TAE and were considered operable. Hepatectomies were carried out and all 3 patients well tolerated the surgery. Histological examination of resected hepatic specimens revealed the regenerative nests at the sites where TAE did not affected. TMO tolerance test was able to evaluate the improvement in hepatic functional reserve, based on the hepatic parenchyma lregeneration. Thus, this test can be applied to evaluate the hepatic functional reserve in cases with decreased hepatic functional reserve.