Experience with 150 Liver Resections

Iwatsuki, Shunzaburo; Shaw, Byers W.; Starzl, Thomas E.

doi:10.1097/00000658-198303000-00001

Cited by 257 publications

(72 citation statements)

References 16 publications

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“…Localized hepatic metastasis from colorectal carcinoma can be treated by surgical resection, although multiple hepatic metastases cannot be removed by surgical treatment. 7 In the present study, we demonstrate that transduction of the tPA gene to murine colon cancer using a retroviral vector was an effective inhibitor of hepatic metastasis.…”

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confidence: 50%

Inhibitory effect on the establishment of hepatic metastasis by transduction of the tissue plasminogen activator gene to murine colon cancer

Hayashi¹,

Yokoyama²,

Namii³

et al. 1999

Cancer Gene Ther

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Hepatic metastasis is a major factor in limiting the prognosis of patients with colon carcinoma. Recent investigations indicate a correlation between plasminogen activator profiles and hepatic metastasis. We examined the effectiveness of tissue plasminogen activator (tPA) gene therapy using a hepatic metastasis model of murine colon carcinoma. Murine colon carcinoma Colon 26 cells transduced with an MFGtPA retroviral vector (Colon 26/tPA) or an MFGLacZ retroviral vector (Colon 26/LacZ) were injected into the liver via the superior mesenteric vein of BALB/c mice, whose survival rates were checked daily. The mean survival rate of mice with hepatic metastasis induced by Colon 26/LacZ was 23.1 days, whereas that of mice with Colon 26/tPA was Ͼ100 days. The in vitro proliferation of Colon 26/tPA was comparable with that of Colon 26/LacZ, and antitumor immunity to wild-type Colon 26 cells was not induced after an intrahepatic injection of Colon 26/tPA. We suggest that transduction of the tPA gene to murine colon cancer is useful against the establishment of hepatic metastasis.Key words: gene therapy; hepatic metastasis; colon cancer; tissue plasminogen activator.T issue-type plasminogen activator (tPA) is a major activator of the extrinsic fibrolytic system, which plays an important role in thrombolysis.1 Remarkable changes in plasminogen activator profiles in several types of cancer, such as colon and breast carcinomas, have been reported. [2][3][4] These studies indicate that colorectal carcinomas have an increase both in the urokinase-type plasminogen activator (uPA) antigen (Ag) level and in uPA activity compared with normal mucosa, whereas both the tPA Ag level and tPA activity are decreased in colorectal carcinomas compared with normal mucosa. Furthermore, recent studies have demonstrated that the decreased tPA Ag level and tPA activity correlate well with both the recurrence and hepatic metastasis of colorectal carcinomas. 5,6The effective treatment of hepatic metastasis is extremely important for the prognosis of patients with advanced colorectal carcinomas who have undergone the surgical resection of the primary tumor. Localized hepatic metastasis from colorectal carcinoma can be treated by surgical resection, although multiple hepatic metastases cannot be removed by surgical treatment. 7In the present study, we demonstrate that transduction of the tPA gene to murine colon cancer using a retroviral vector was an effective inhibitor of hepatic metastasis. MATERIALS AND METHODS Cell lines and animalsMurine colon carcinoma cell line Colon 26 cells were used in the experiment. Female BALB/c mice (8 weeks old; Clea, Tokyo, Japan) were purchased for the induction of hepatic metastasis using the Colon 26 cells. Retroviral vector and virus-producing cellsRetroviral vectors (MFGtPA and MFGLacZ) were constructed by ligating tPA and LacZ cDNA to an MFG retroviral vector. These cDNAs were inserted between the NcoI and BamHI sites in such a way that the initiation codons of the inserted sequence were placed precisely at ...

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confidence: 50%

Inhibitory effect on the establishment of hepatic metastasis by transduction of the tissue plasminogen activator gene to murine colon cancer

Hayashi¹,

Yokoyama²,

Namii³

et al. 1999

Cancer Gene Ther

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confidence: 99%

“…6,8,10,11 Although the survival rate for the first year has been very high, late tumor recurrence has plagued these efforts. Yet, liver transplantation has resulted in the long-term success on more than the isolated occasion, as has been reported previously.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the large size of the tumor, its prognosis after partial hepatic resection or after liver transplantation is significantly better than that of other types of hepatoma. 5,6,8,10,15 Aggressive surgical treatment is warranted for fibrolamellar hepatocellular carcinoma.The results after liver transplantation for primary hepatic malignancy have not been quite as good. 6,8,10,11 Although the survival rate for the first year has been very high, late tumor recurrence has plagued these efforts.…”

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confidence: 99%

“…Yet, liver transplantation has resulted in the long-term success on more than the isolated occasion, as has been reported previously. 6,8,10,11 The most favorable lesions for transplantation, just as with resection, are the fibrolamellar hepatoma and the epithelioid hemangioendothelioma. 7,8,10,11 Apparent cures have been achieved in about half of these malignancies after liver transplantation.…”

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Experience with Resection of Primary Hepatic Malignancy

Iwatsuki

Starzl

1989

Surgical Clinics of North America

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Although hepatocellular carcinoma is one of the most common malignancies worldwide, primary hepatic malignancy (including hepatocellular carcinoma) is a relatively uncommon neoplasm in the United States and other Western countries. Nevertheless, the authors had treated 106 patients with primary hepatic malignancy by various kinds of hepatic resection by the end of 1987. The experience is summarized here with emphasis on operative mortality, some aspects of surgical technique, and long-term follow-up. Portions of our experience have been reported earlier. 5,6,[12][13][14][15][16] Case MaterialsDuring the 23-year period from October 1964 to December 1987, 411 patients underwent hepatic resection at the University of Colorado Health Sciences Center (1964Center ( to 1980 and the University Health Center of Pittsburgh (1981Pittsburgh ( to 1987. The number of hepatic resections increased sharply through the years (Table 1), 78 patients being treated in 1987 alone. The indications for hepatic resection in the total series were primary hepatic malignancy in 106 patients, secondary hepatic malignancy in 123 patients (including 90 patients with metastases from colorectal cancer), and histologically benign hepatic lesions in 182 patients. Histologic diagnoses of the 106 patients with primary hepatic malignancy are listed in Table 2. The liver was grossly cirrhotic in 16 of these 106 patients. The ages of the 106 patients ranged from 5 to 86 years old, with a mean of 55. Fifty-six were male, and 50 were female. Resection Techniques and ClassificationOur operative techniques have been described in detail elsewhere with emphasis on right trisegmentectomy and left trisegmentectomy. 13,14,16 The extent of hepatic resection was classified into the following six categories ( Fig. 1): right and left trisegmentectomy, right and left lobectomy, left lateral segmentectomy, and nonanatomic local resection. In brief, right trisegmentectomy is the complete removal of the right lobe plus the medial segment of the left lobe, where the caudate lobe is also completely removed or its left posterolateral portion is spared, depending on the location of the hepatic lesion. Extended right lobectomy, which removes only a portion of quadrate lobe and of the right side of the caudate lobe with the right lobe, was classified as right lobectomy in this report. Left trisegmentectomy is the complete removal of the left lobe plus the anterior segment of the right lobe, where the caudate lobe alongside the retrohepatic vena cava is removed or spared as dictated by the location of the hepatic lesion. Extended left hepatic lobectomy, which removes only a Nonanatomic local excision in our classification is not equivalent to "wedge resection." This type of hepatic resection was applied mostly for benign hepatic lesions, but when it was utilized for malignant lesions, the anatomic resection could not be done because of associated cirrhosis or the presence of severe cardiopulmonary disease. The tissue mass excised by nonanatomic local resection is ...

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Screening for Hepatocellular Carcinoma in High-Risk Individuals

Regan

1989

Arch Intern Med

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Experience with 150 Liver Resections

Cited by 257 publications

References 16 publications

Inhibitory effect on the establishment of hepatic metastasis by transduction of the tissue plasminogen activator gene to murine colon cancer

Inhibitory effect on the establishment of hepatic metastasis by transduction of the tissue plasminogen activator gene to murine colon cancer

Experience with Resection of Primary Hepatic Malignancy

Screening for Hepatocellular Carcinoma in High-Risk Individuals

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