Experience with 225 hepatic resections for hepatocellular carcinoma over a 4-year period

Article Abstract:

The only cure for hepatocellular cancer is resection (removal of a portion) of the liver, and compared with other stomach and bowel cancers, this cancer has a poor outcome. This poor prognosis is due to intrahepatic metastases (spread of the cancer within the liver) as well as a high incidence of associated liver cirrhosis (a degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules infiltrated with fat). The cancer is considered inoperable if there is invasion of the blood vessels into and out of the liver. Liver cirrhosis interferes with major liver resection. There is considerable variation in the functional reserves of cirrhotic livers. A report is presented of the outcomes of 225 patients with hepatocellular carcinoma of the liver who were treated with liver resection. There were 171 men and 54 women who underwent surgery; their average age was 60. Sixty-seven percent of the patients were found to have an underlying liver cirrhosis; 27 percent of patients had chronic hepatitis. Patients were grouped from A to E, depending on the type of surgery to be performed. The percent of patients by group were: Group A (removal of tumorous and additional segment), 5 percent; Group B (removal of tumor with a wide margin), 37 percent; Group C (removal of tumor with a narrow margin), 26 percent; Group D (incomplete tumor removal), 6 percent; Group E (aggressive surgery for advanced cancer), 26 percent. There were four deaths in groups A through D within 30 days of operation (mortality of 2.4 percent); in group E there were 12 deaths (20.7 percent). The three-year survival rates were: Group A, 100 percent; Group B, 74 percent; Group C, 21 percent; Group D, 0 percent; Group E, 35 percent. The authors believe that an aggressive surgical approach should play a more important role in the treatment of patients with hepatocellular cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Japan, Liver cancer

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Vitamin K concentrations in the plasma and liver of surgical patients

Article Abstract:

Vitamin K is required for normal clotting of the blood, and it occurs naturally in two forms, phylloquinone (PK) and menaquinones (MK). PK is consumed in the diet, while MK is made by the bacteria in the intestines. Hospitalized adult patients who were unable to consume an adequate diet or were treated with antibiotics (which can kill intestinal bacteria) have been reported to be deficient in vitamin K, but actual vitamin K levels were not studied. In this study, levels of vitamin K were measured in 22 patients after surgery; in the three days immediately preceding surgery, 11 were on a low-PK diet and 11 were on a normal diet. Following surgery, all patients fasted for three days, and received intravenous electrolytes (such as sodium and potassium), water-soluble vitamins (not vitamin K), and an antibiotic. Blood-clotting function, used to test for deficiencies of vitamin K, was normal in both groups of patients. PK levels dropped rapidly in patients on the low-PK diet and were significantly lower than in patients on a normal diet. MK levels in both groups dropped significantly following surgery, but were not significantly different between the groups. In the liver, PK levels accounted for 10 percent of total vitamin K compounds, while the rest consisted of different types of MK. There were no differences between dietary groups in the levels of vitamin K in the liver. The results suggest that fasting may be responsible for the low plasma levels of PK, and that when PK levels are low, bacteria-derived MK may be important in maintaining blood clotting ability. Further study is needed to determine the relative importance of MK and PK to clotting, the ways in which the body handles them, and the influence of antibiotics on these functions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects

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Vitamin K status of free-living subjects consuming olestra

Article Abstract:

Olestra is a fat substitute that does not contain any calories. It is not digestible because it cannot be broken down by enzymes in the stomach or intestines and therefore cannot be absorbed into the blood. Substances that are not digestible can interfere with the absorption of fat-soluble vitamins such as vitamin K. Serious problems can arise if essential vitamins and minerals are prevented from being absorbed into the blood. For example, vitamin K is essential for blood clotting. Without vitamin K, blood in an open wound will not clot and bleeding will not stop. Vitamin K is found in foods such as liver, fish meal, alfalfa and vegetable oils. To determine if olestra impairs the absorption of vitamin K, 99 volunteers consumed 20 grams of olestra per day, baked in cookies, for a period of six weeks. For comparison, 103 volunteers were given cookies containing lard instead of olestra. Vitamin K status was determined by measuring the length of time required for a sample of blood to clot. Blood clotting times were determined before and after the six-week test period. There was no difference between clotting times before and after olestra was consumed, and there was no difference in clotting times between those eating the olestra cookies and those eating the cookies without olestra. It is concluded that 20 grams of olestra per day for six weeks does not reduce the amount of vitamin K present in the blood. (Consumer Summary produced by Reliance Medical Information, Inc.)

Blood clotting, Blood coagulation, Fat substitutes, Olestra (Fat substitute)

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