Experimental study to establish new therapeutic method for liver cancer with hepatic cirrhosis-gradual interruption of hepatic blood flow

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For the surgical treatment of unresectable hepatic tumor, we devised a new method whereby portal branch ligation with gradual occlusion of hepatic arterial branch by ameroid constrictor.We investigated the possibility of clinical application of this new therapeutic method using forty-four mongrel dogs. Experimental group was designed as follows. Group A ; sham operation (n=6). Group B ; 70 percent hepatectomy (n=10). Group C ; 70 percent of the liver was deprived of portal blood flow by portal branch ligation (n=15). Group D ; portal branch ligation with gradual occlusion of hepatic arterial branch which supplying about 70 percent of the liver (n=13). In A, B and C group, one dog died of infection and hepatic necrosis, respectively. In group D, one dog died on eighth post operative day (but we could not find the evidence of hepatic necrosis). During eight weeks, we observed the changes of hepatic function test including ICG Rmax. Hepatic tissue blood flow (Laser Doppler Verocimetry) an … More d viability of isolated hepatocytes (MTT assay) was measured at the time of operation and sacrifice (eight weeks after initial operation).Marked increase of serum GOT and GPT level was observed in group D (maximum, >10,000 U/I), although the changes in ICG Rmax were almost the same as group C, and the surgical stress was less than hepatectomy group. In group C and D, the viability of hepatocytes of non occluded lobes were significantly higher than occluded ones (P<0.001). In group d, the viability of non occluded lobes was significantly higher than preoperative value (p<0.01). In group D the occuluded lobes showed atrophy and focal necrosis, and non occluded lobes showed regeneration and hypertrophy. Comparing with group C and B, hypertrophy and regeneration seemed greater in group D (even in occluded lobes, hypertrophy of hepatocytes was noted). These findings indicate the possibility of clinical application not only as anti cancer therapy, but also as preoperative treatment that increases remnant hepatic reserve function. Less