Changes in liver function after hepatic dearterialization in man

Complete devascularization of hepatic lobe with nonresectable hepatoma

Complete dearterialization of the entire liver was carried out in three patients with nonresectable liver cell carcinoma in whom the right or left portal vein had already obstructed due to tumor thrombosis or invasion. Although remittent fever ensued for two to three weeks postoperatively in all patients, hepatic infaction never occurred in the devascularized hepatic lobes. The effect of the treatment on tumorous lesions appeared satisfactory. The results indicated that the tumor-bearing liver can tolerate nearly complete deprivation of hepatic arterial and portal blood in at least one lobe of the liver if it is not simultaneous.

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.