Podwyssozki and Ponfick (1887) did the fundamental work on experimental hepatectomy. Since then many workers have performed this operation. Keen (1889) did left hapatectomy, Wendel (1911) did a right hepatectomy and Mann performed partial hepatectomy after Eck fistula formation.
Ravinovici reported the regeneration of cirrhotic liver after causing cirrhosis through CC4 inhalation. Lamson and Raymond succeeded in producing cirrhotic livers after administration of CCI4. Ashburn also induced cirrhosis with subcutaneous injection of CC4 in guinea pigs. Edward and Dalton also induced liver carcinoma by means of CC14 administration.
Hou reported the relationship between Clonorchis sinensis infestation and hepatoma. Inoue reported on the liver pathology after formation of liver cirrhosis. The author induced liver cirrhosis by feeding the metacercariae of Clonorchis sinensis to rabbits and then studied the hepatic pathology which was produced.
If the cirrhosis continues for a long period of time, Overton and Kaden believe that hepatoma is more likely to occur, since they reported that 50-60% of hepatoma are accompanied by liver cirrhosis. One would expect that in such cases of hepatoma, hepatectomy would be done as soon as possible, but a review of the literature fails to show any report of resection in the presence of cirrhosis. One finds little mention of the association of the two conditions, or, the indications for surgical treatment. Mac Donald counsels against resection of the liver tumor in the presence of cirrhosis, but gave no reference to suggest that this had ever been done. Blakemore states that patients he has treated for hepatoma and associated cirrhosis with portal hypertension were unsuitable candidates for surgery due to their poor liver function.
As above mentioned, it is very important in the development in the surgical treatment of hepatoma, to know whether or not the cirrhotic liver can withstand operation. From this standpoint, the author has concentrated his study on the limitations of hepatectomy.
The method of the experiment was as follows: A preliminary experiment was carried out first to determine the stage of hepatic cirrhosis produced. Then, the main experimental study was done and cirrhosis was produced by the following two methods: (1) CC14 inhalation and subcutaneous injection, and (2) feeding the metacercariae of Clonorchis sinensis. A total of 234 rabbits was divided into 4 groups, after the rabbits had attained about 2500 gm. in body weight. That is, the normal group (60 rabbits), CCL4 inhalation group (58 rabbits), CC14 injection group (58 rabbits) and Clonorchis sinensis infestation group (58 rabbits). When liver cirrhosis was definitely determined, hepatectomy was performed on the animals. Before and after hepatectomy, liver function tests were done and the following conclusions were obstained.
1) Liver cirrhosis induced by CCl4 was required a longer time : to induce cirrhosis and was severe. Clonorchis sinensis group was next in severity and its degree was lighter than that in the first group. Cirrhotic stage was reached in 6-.8 : weeks by clonorchis, and in 9-14 weeks by CC14.
21 The limitation of ´hepatectomy in the two groups was in cirrhosis due to CCl4 40% of the liver could be resected by hepatectomy; and, in cirrhosis due to Clonorchis, 60% of the liver could be resected.
3) Liver function was decreased in the cirrhotic liver. The Clonorchis sinensis group showed more favorable function than the CC14 group and the deaths in both groups were among those with poor liver function, as compared to those in the survival cases. The liver function tests which showed the most significant changes were the Albumin and Cephalin-cholesterol Flocculation tests.
Good operative risk: more than 2.8gm. % of Albumin; less than 2+C-C-F in 24 hours, and 3+in 48 hours.
Poor operative risk: less than 2.6gm. % of Albumin; more than 2+C-C-F in 24 hours, and 3+in 48 hours.
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