Preoperative Hepatic Reserve Research Articles

Laparoscopic versus open mesohepatectomy for centrally located hepatocellular carcinoma

Centrally located liver tumors that involve Couinaud’s segment I, IV, V and VIII are surrounded by the inferior vena cava (IVC), the hepatic vein [the middle hepatic vein (MHV) or the right hepatic vein], and the first branch of the Glisson’s pedicle, which need difficult surgical techniques. Extended hemihepatectomy (EH) is a standard procedure to achieve curative resection for centrally located liver tumors when the preoperative hepatic reserve is sufficient.

Dynamics of Portal and Peripheral Endothelin-1 in Hepatic Resection and Its Implication

Background. The liver and portal circulation contribute to production and clearance of endothelin-1 (ET-1). This study was undertaken to investigate what variables relate to the dynamics of ET-1 in hepatic resection and its clinical implication.Patients and Methods. On 20 patients with (n = 8) or without (n = 12) chronic liver disease who underwent hepatic resection, peripheral arterial and portal venous ET-1 were serially measured to determine a correlation with pre-, intra-, and postoperative variables.Results. The preoperative factors with which the portal ET-1 showed a positive correlation were the indocyanine green retention rate at 15 min (ICG R15) and portal venous pressure. The ET-1 clearance, as calculated from the difference between the portal and the peripheral ET-1 concentrations, was also correlated with the ICG R15. The peripheral ET-1 elevated significantly in the patients with increasing intraoperative blood loss or hepatic inflow occlusion. An increase in the portal ET-1 was correlated with an elevation of portal venous pressure after hepatectomy. Postoperative increase in serum bilirubin was closely correlated with the peripheral ET-1 at closure.Conclusion. The peripheral and portal ET-1 are correlated with not only preoperative hepatic reserve and portal venous pressure but also invasiveness of hepatectomy and postoperative course.