A possible treatment of hepatic tumors: ligation of the hepatic artery and perfusion with desoxigenated saline
Lanari, A.; Barcat, J.A.
Medicina 40(6 Part 1): 627-634
1980
ISSN/ISBN: 0025-7680 PMID: 22167693 Document Number: 159317
Hepatic artery ligation has been performed as a treatment for primary and metastatic tumors of the liver since they receive their blood supply from the hepatic artery. The results showed a slight and transient improvement because large tumors underwent extensive necrosis or diminished their growth rate. However, small metastatic growths that obtain oxygen by diffusion remain histologically viable, It would therefore be convenient to have a method that could produce an elective and controlled anoxia of the hepatic tissue. In this work we started on the hypothesis that if one could impede the reflux of portal blood through the hepatic sinusoids, and the reflux coming from collaterals of the hepatic artery, a controlled anoxia could be produced. On this premise desoxigenated saline was infused through the distal end of the ligated hepatic artery of mongrel dogs weighing 15-20 kg anesthetized with Embutal. With a flux of 500 ml/h maintained during 2 h slight lesions were produced similar to those resulting from hepatic artery ligation. With a flux of 1000 ml/h - pressure at the level of hepatic artery around 50 mm Hg during 1 h - centrilobular necrosis (area 3 of Rappaport) of moderate magnitude and irregular distribution was obtained. With a flux of 1000 ml/h during 2 h, extensive lesions in the same areas were produced and some of the dogs died a few days later. The lesions produced were those of ischemic massive necrosis or confluent submassive necrosis. Serum transaminases and alkaline phosphatase markedly increased during the first 20 days. Lesions were reversible since dogs' livers studied 20 days after ligation and infusion did not show significant lesions. We believe that this method could be attempted, with the necessary precautions, in cases of primary and metastatic tumors of the liver because the anoxia, and thus the extension of liver necrosis, can be controlled at will.