Hepatic artery ligation for metastastic leiomyosarcoma of the liver

Ten-year survival after synchronous resection of liver metastasis from intestinal leiomyosarcoma

This paper reports on a case of intestinal leiomyosarcoma with metastases to the liver, peritoneum, and omentum, which has been successfully treated with four operations. The initial operation was performed for a primary intestinal leiomyosarcoma and intraperitoneal seeding. Three months later "shelling out" of a liver metastasis was carried out. The patient has subsequently been operated upon twice for abdominal recurrence at six years and nine months, and nine years and six months, respectively. The patient is free from symptoms and is working now, ten years after resection of metastasic leiomyosarcoma of the liver. A review of the literatures has revealed that our patient is the first ten-year survivor after resection of hepatic metastasis of leiomyosarcoma. An aggressive surgery is acceptable in selected patients who have spreading leiomyosarcoma of the bowel.

Experimental studies on the treatment of nonresectable liver cancer

In cases of metastatic cancer of the liver in rats, the effect of ligation of the hepatic artery (HAL) or portal vein (PVL) with or without intraportal chemotherapy with Mitomycin C (MMC) was studied in Experiment I. HAL or PVL alone and chemotherapy alone induced only a slight anti-cancer effect. The most striking effect was found in the group treated with HAL plus MMC. PVL plus MMC produced intermediate results. To evaluate which route, via the hepatic artery or portal vein, is more effective for the adjuvant chemotherapy after HAL, Experiment II was conducted on the rats with a minute and/or a rather advanced metastatic cancer of the liver. Chemotherapy with MMC by either route alone and HAL alone did not substantially prolong the survival time, irrespective of the tumor size. HAL plus chemotherapy via both routes produced a statistically longer survival time compared with the control, however, better results were obtained by intraarterial chemotherapy. When compared with the two groups treated by the same procedures but at the different times, the earlier treatments produced better results. In the light of the present studies, it can be concluded that if cytocidal drugs with dose independent effects are given in a single bolus, HAL in connection with intra-arterial chemotherapy is a beneficial modality for the treatment of nonresectable liver cancer.

Cytotoxic perfusion for colorectal liver metastases

A clinical trial to assess the value of different perfusion techniques in the management of colorectal liver metastases is presented. The perfusion with 5-fluorouracil was commenced at the time of resection of the primary tumour when palpable liver metastases were found. In terms of survival, no benefit was found with hepatic artery ligation and perfusion and with portal vein perfusion alone compared with the control group. However, the combination of the two improved the survival rate and a possible explanation for this is discussed.

Hepatic dearterialization for nonrespectable primary and secondary tumors of the liver

Seventeen patients with primary or secondary liver tumors were treated by dearterialization of the liver and intraportal infusion of cytotoxic drugs. In 14 cases, ligation of the main (10), right and left (1), right and middle (1), and right (2) hepatic arteries was performed. In three in whom hepatic artery ligation was considered to be contraindicated due to occlusion of the portal vein, temporary occlusion of the hepatic artery was repeated postoperatively. Only one patient died from the cause related to the ligation. Out of 14 patients who survived for more than one month ten showed an apparent regression of tumors radiologically. The mean survival period of the patients excluding those who died from other unrelated causes was 28 weeks. That of the control patients who received only chemotherapy through the hepatic artery was 13 weeks. The results were not always satisfactory, but dearterialization of the liver can be a palliative treatment for nonresectable liver tumors with a forceful combined chemotherapy.

Hemangiosarcoma of liver and spleen treated by hepatic artery ligation, intraportal infusion chemotherapy, and splenectomy

Hepatic artery ligation is useful as a palliation of irressectable hepatic tumors, but does not always produce a satisfactory result. Hepatic tumor with high vascularity is expected to respond more favorably. In this context, primary liver cell carcinoma and carcinoid tumor or leiomyosarcoma of the liver have been satistfactorily treated by hepatic artery ligation. A case is presented of hemangiosarcoma of theliver and spleen treated effectively by hepatic artery ligation, splenectomy, and postoperative intraportal infusion of 5-fluorouracil, as indicated by the regression of hepatic tumors on postoperative scanning and arteriograpms.

Effect of glucocorticoids on release of lysosomal enzymes in liver ischemia and hemorrhagic shock in pigs

The effect of glucocorticoids on the release of lysosomal enzymes was studied in liver ischemia created by dearterialization and in hemorrhagic shock in pigs. In shock the treatment with glucocoticoids suppressed the release of beta-glucosidase and beta-galactosidase into the circulation. The release of S-GOT was also suppressed in the treated group. However, a contrary effect was observed in liver ischemia indicating that glucocorticoids might even be harmful to the dearterialized hypoxic liver. Provided the plasma increase of acid hydrolases can be interpreted as quantitative signs of cell damage, the findings indicate that glucocorticoids may be of benefit in shock but not after hepatic dearterialization.