Partial Hepatectomy for Hepatocellular Carcinoma in 6 Hemodialysis Patients

Akio Harada, Akimasa Nakao, Toshiaki Nonami, Hiroyuki Kobayashi, Hirotaka Maruyama, Masahiro Suenaga*, Hiroshi Takagi

Department of Surgery II, Nagoya University School of Medicine
*Department of Surgery, Nagoya Memorial Hospital

Six cases of partial hepatectomy for hepatocellular carcinoma (HCC) in hemodialysis patients are presented. All patients were male and the mean age was 52 years. Three patients had associated chronic hepatitis and the other 3 had liver cirrhosis, but liver function had not greatly deteriorated. The systemic pressure fluctuated sharply during the operation, especially in two patients with total hepatic vascular occlusion. Catheterization with a Swan-Ganz catheter and microinfusion of catecholamine were very effective for management of the intra- and post-operative circulatory status. Hemodialysis was performed without any problems using anti-coagulants, and all patients were transferred to dialysis centers about a week after the operation. Two patients had severe hemorrhagic gastritis, one with a chronic infectious fistula and the other was on hepatic arterial infusion chemotherapy. All patients survived for more than 1 year after the operation but 4 patients died. Three of the 4 patients who died had associated recurrent HCC. We conclude that partial hepatectomy in a hemodialysis patient may be performed successfully under careful management with due care for minimal operative invasion and prevention of gastrointestinal bleeding.

Key words
hemodialysis patient, hepatocellular carcinoma, partial hepatectomy

Reprint requests
Akio Harada Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
May 11, 1993

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