Risk Factors for Immediate Postoperative Fatal Recurrence of Hepatocellular Carcinoma

PURPOSE: Tumor recurrence after partial hepatectomy for hepatocellular carcinoma is a major cause of death from this disease. Among those recurrences, when it occurs immediate during the postoperative period, it may due to the overt expression of pre-existing micrometastases or circulating disseminated cancer cells. Therefore; we evaluate herein the risk factors for the immediate postoperative period fatal recurrence to help establish effective preventive countermeasures against these fatal recurrences. METHODS: From 1994 to 2004, the 269 patients in this study all had greater than 6 months of follow-up after curative resection for HCC at our medical center. Those patients who had a fatal recurrence that included diffuse intra-hepatic recurrence or multiple systemic recurrence within 6 months after hepatectomy, and all of the patients who didn't have a fatal recurrence within 6 month after resection of HCC were compared. The clinicopathological factors associated with immediate postoperative recurrence were then analyzed. RESULTS: The overall postoperative mortality was 1%. There were 30 patients in the immediate postoperative group (the subjective group) among the total 269 patients. Among the subjective group patients, 20 patients had diffuse intra-hepatic recurrence and remained 10 patients had multiple systemic recurrence. The mean disease free survival period of the subjective group was 3.9+/-1.7 months and the mean survival period after recurrence was 6.7+/-6.1 months. On multivariate analysis, a serum alpha-fetoprotein level greater than 1, 000 ng/ml (p=0.019; odds ratio: 2.98), a tumor size greater than 6.5 cm (p=0.03; odd ratio: 2.98), and the presence of microvascular invasion (p=0.01; odd ratio: 4.89) were associated with the risk factors for immediate postoperative fatal recurrence. CONCLUSION: These findings can be important indicators to establish countermeasures against immediate postoperative period fatal recurrence, and the high risk patients would also be good candidates for clinical trials with adjuvant anti-cancer treatments such as early postoperative TACE, immunotherapy, anti-angiogenic treatment and so on.

A Rare Metastatic Liver Cancer: Hemangiopericytoma

Hemangiopericytoma is a rare tumor, and especially when it arises in the peritoneal cavity. We present here the case of a 60-year-old woman with an isolated recurrent hemangiopericytoma in the liver. The patient presented to us for evaluation of palpable RUQ mass 7 years after she had undergone her first resection of a malignant hemangiopericytoma arising from the greater omentum. She has been lost to follow up 6 months after the first surgery. Various imaging studies showed a single large liver tumor that was hypervascular, well-capsulated and had central necrosis. She was negative for HBs-Ag and Anti-HCV. Under an impression of the recurrent malignant hemangiopericytoma, a right trisegmentectomy was performed for complete resection of the tumor. The pathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Even though the incidence of hemangiopericytomas is low, malignant hemangiopericytomas have displayed frequent recurrences after long disease- free periods. A recurrent hemangiopericytoma is not easily detected early during follow-up until it is symptomatic because this tumor has no specific tumor marker and it has diverse sites of recurrence. We think that Positron Emission Tomogram (PET) can be a useful tool for detection of recurrent hemangiopericytoma. We describe herein the clinically relevant information about hemangiopericytomas, and we particulary focus on the features of this tumor after the surgical resection.

Energy Expenditure in Young Adults and Newborns by Indirect Calorimetry

PURPOSE: Providing an adequate amount of energy is important in patients with depleted nutrition. Indirect calorimetry is a portable tool that can measure the resting energy expenditure, the respiratory quotient, and the ratio of substrate utilization. Another way of getting the energy expenditure is through the use of equations, and that has been a more common way to get the basal energy expenditure. However, there has been a controversy that the energy expenditures calculated from equations are not the same as the values measured by indirect calorimetry. METHODS: Our study was to clarify this difference in two different groups with different physical conditions and growth. One was a normal-adult group (n=18), and their energy expenditure was calculated using the Harris-Benedict equations. The other was a normal-newborn group (n=7), and their energy expenditure was calculated using the Schofield equations. Calculated values were compared with the resting energy expenditure from indirect calorimetry (Deltatrac Metabolic Monitor, Datex Inc. Finland). RESULTS: In the adults, the basal energy expenditure was 1703.3+/-100.2 kcal/d according to the Harris-Benedict equations, and the resting energy expenditure was 1701+/-289.6 kcal/d according to indirect calorimetry (p>0.1). VO2 was 245.7+/-42.8 ml/min, VCO2 was 210+33.4 ml/min, and RQ was 0.86+/-0.05. In the neonates, the basal energy expenditure was 184.1+/-15.1 kcal/d according to the Schofield equations, and the resting basal energy expenditure was 154.3+/-32.1 kcal/d (p<0.05). VO2 was 21.9+/-4.3 ml/min, VCO2 was 18.7+/-4.0 ml/min, and RQ was 0.85+/-0.02. The ratios of substrate utilization were 192.1+/-58.8 g/d (48.03+/-16.8%) for carbohydrates, 69.7 +/-35.6 g/d (37.8+/-17.2%) for fats, and 55.8+/-14.9 g/d (14.3+/-3.9%) for proteins in the adults. In the neonates, the ratios were 18.6+/-5.6 g/d (50.3+/-7.0%) for carbohydrates, 18.6+/-1.1 g/d (47.7+/-6.2%) for fats, and 1+/-0 g/d (3.0+/-0.73%) for proteins. CONCLUSION: The difference between the basal energy expenditure obtained from equations and the resting energy expenditure obtained from indirect calorimetry could be identified only in the neonate group, but not in the adult group. It is speculated that resting energy expenditure was more reliable than the basal energy expenditure in neonates. Indirect calorimetry canbe a useful tool to correct the errors in the values obtained from equations, and other parameters, such as the respiratory quotient and the ratio of substrate utilization, should be evaluated in nutritional support.