Multiple factors affect the regeneration of liver

SUMMARY OBJECTIVE To study factors affecting the liver regeneration after hepatectomy METHODS With 3D reconstitution technology, liver regeneration ability of 117 patients was analysed, and relative factors were studied. RESULTS There was no statistically difference between the volume of simulated liver resection and the actual liver resection. All livers had different degrees of regeneration after surgery. Age, gender and blood indicators had no impact on liver regeneration, while surgery time, intraoperative blood loss, blood flow blocking time and different ways of liver resection had a significant impact on liver regeneration; In addition, the patients' own pathological status, including, hepatitis and liver fibrosis all had a significant impact on liver regeneration. CONCLUSION 3D reconstitution model is a good model to calculate liver volume. Age, gender, blood indicators and biochemistry indicators have no impact on liver regeneration, but surgery indicators and patients' own pathological status have influence on liver regeneration.

RESUMO OBJETIVO Estudar os fatores que afetam a regeneração hepática após hepatectomia. MÉTODOS A capacidade de regeneração hepática de 117 pacientes foi analisada com a tecnologia de reconstituição 3D e foram estudados os fatores relacionados. RESULTADOS Não houve diferença estatística significante entre o volume de ressecção hepática simulada e a ressecção atual. Todos os fígados apresentaram diferentes graus de regeneração após cirurgia. Idade, gênero e indicadores sanguíneos não tiveram impacto na regeneração hepática, enquanto que tempo de cirurgia, perda sanguínea intraoperatória, tempo de bloqueio do fluxo sanguíneo e diferentes formas de ressecção mostraram impacto significante na regeneração do órgão. Além disso, condições patológicas dos pacientes, incluindo hepatite e fibrose hepática, tiveram impacto significante na regeneração hepática. CONCLUSÃO O modelo de reconstituição 3D é um bom modelo para calcular o volume do fígado. Idade, gênero, indicadores sanguíneos e bioquímicos não tiveram impacto na regeneração hepática, mas indicadores operatórios e condição patológica dos pacientes mostraram influência na regeneração do órgão.

Resultados a corto y largo plazo de la resección hepática por hepatocarcinoma: análisis de 232 resecciones consecutivas / Short and long-term results of liver resection for hepatocarcinoma in peru: a peruvian single center experience on 232 cases

ANTECEDENTES: Para evaluar la morbilidad, mortalidad post operatoria sobrevida yrecurrencia luego de las resecciones hepáticas por carcinoma hepatocelular (HCC) se realizóun análisis en 232 pacientes consecutivos con HCC resecados entre enero de 1990 y Diciembredel 2006 en el departamento de abdomen del Instituto de Enfermedades Neoplasicas (INEN).METODOS:La sobrevida global y libre de enfermedad fue calculada por el metodo deKaplan-Meier, los factores pronósticos fueron evaluados utilizando análisis univariadoy multivariado (Cox).RESULTADOS.- La media de edad fue 36 años, 44.2 tuvieron infección por virus de lahepatitis, solo el 16.3 por ciento tuvo cirrosis. La media de AFP fue de 5,467 ng/ml. la medianadel tamaño del HCC fue 15 cms.La mayoría de pacientes tuvo una resección hepática mayor (74.2 por ciento tuvo 4 o mássegmentos resecados).La morbilidad y mortalidad post operatoria fue de 13.7 ciento y 5.3 por ciento respectivamente. Despuésde una media de seguimiento de 40 meses el 53.3% de los pacientes presentó recurrencia.La sobrevida global a 1, 3 y 5 años fue de 66.5 por ciento , 38.7 por ciento y 26.7 por ciento respectivamente. Lasobrevida libre de enfermedad a 1, 3 y 5 años fue de 53.7 por ciento , 27.6 por ciento y 19.9 por ciento .En análisis multivariado, la presencia de múltiples nódulos (p<0.000), la cirrosis (p<0.001)y la invasión vascular macroscopica (p<0.001) fueron factores independientes asociadosa una pobre sobrevida.CONCLUSION: La resección quirúrgica es el tratamiento de elección para elhepatocarcinoma y puede realizarse en el Departamento de Abdomen del INEN con bajamorbi-mortalidad y adecuada sobrevida.

BACKGROUND: To evaluate the short and long term outcome of liver resections for hepatocellular carcinoma a retrospective analysis was performed on 232 consecutive patients with hepatocellular carcinoma resected between January 1990 and December 2006 at the Department of Abdomen of the Instituto de Enfermedades Neoplasicas of Lima Peru. METHODS: Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan- Meier method, Prognostic factors were evaluated using univariate and multivariate analysis RESULTS: The median age was 36 years. 44.2% were associated with hepatitis B, only16.3% had cirrhosis. The median size of the tumors was 15 cm. The median value of AFP was 5,467 ng/ml. The majority of patients underwent a major hepatectomy (74.2 % hadfour or more segments resected)Overall morbidity and mortality were 13.7% and 5.3% respectively. After a median followup of 40 months, tumour recurrence appeared in 53.3% of the patients. The 1, 3, and 5 year overall survival rates were 66.5%, 38.7% and 26.7%respectively. The 1, 3, and 5year disease-free survival rates were 53.7%, 27.6%, and 19.9%. On multivariate analysis, presence of multiple nodules (p<0.000), cirrhosis (p=0.001), and macroscopic vascularinvasion (p=0.001) were found to be independent prognostic factors related to a worse long-term survival.CONCLUSIONS: Surgical resection is the optimal therapy for large HCC and can be safely performed with a reasonable long-term survival.