title: Surgical treatment of hepatocellular carcinoma associated with spontaneous portosystemic shunts.
abstract: OBJECTIVE
  To clarify the short and long term prognosis after hepatectomy and shunt ligation in patients with hepatocellular carcinoma (HCC) and spontaneous portosystemic (P-S) shunts.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital, Japan.
  
  
  METHODS
  Fourteen patients with HCC and a P-S shunt.
  
  
  METHODS
  Hepatic resection (radical in 12 and palliative in 2 patients) and ligation of the shunt; 12 also had prophylactic operations for oesophagogastric varices.
  
  
  METHODS
  Morbidity, mortality, hepatic function, and survival.
  
  
  RESULTS
  Serum ammonia concentrations fell after operation and stayed low throughout the postoperative period. Though prothrombin time and serum antithrombin-III concentrations deteriorated for one month after operation, they gradually returned to the preoperative values. Serum albumin did not change throughout the follow up period. Serum bilirubin concentrations were reduced postoperatively in 10 patients. Results of indocyanine green and Bromsulphalein retention tests were similar before and one month after operation. Child's grade improved in four patients within a year. At 1, 3, and 5 years 10, 5, and 3 patients were alive, and 10, 4, and 1 of these were free of disease. No patients ruptured their oesophagogastric varices during the follow up period.
  
  
  CONCLUSIONS
  Simultaneous ligation of spontaneous P-S shunts makes hepatic resection safe and produces unexpectedly good survival in patients with HCC and the severe cirrhosis associated with such shunts.
authors.affiliation: Second Department of Surgery, Shimane Medical University, Izumo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: H
authors.initials: H
authors.lastname: Kohno
authors.forename: A
authors.initials: A
authors.lastname: Yamanoi
authors.forename: H
authors.initials: H
authors.lastname: Kubota
authors.forename: M
authors.initials: M
authors.lastname: Tachibana
authors.forename: N
authors.initials: N
authors.lastname: Nagasue
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D011168:Portal System / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies