Background: s/Aims: Patients with hepatocellular carcinoma (HCC) and histologically confirmed F4 cirrhosis often have limited hepatic reserve, making major hepatectomy difficult. Although laparoscopic liver resection is increasingly performed, its perioperative safety in this setting remains unclear. This study compared laparoscopic and open partial hepatectomy in these patients using propensity score matching (PSM). Methods: Among 298 patients who underwent hepatectomy for HCC between 2006 and 2023, 112 with histologically confirmed F4 cirrhosis who underwent partial hepatectomy were included (laparoscopic, n = 60; open, n = 52). PSM was performed using previous liver resection, difficulty score, tumor size, tumor number, and platelet count, yielding 32 matched pairs. Outcomes included operative time, blood loss, transfusion requirements, complications, hospital stay, posthepatectomy liver failure (PHLF), R0 resection rate, and 30-day mortality. Results: After matching, intraoperative blood loss was significantly lower in the laparoscopic group than in the open group (50 mL vs. 295 mL, p < 0.001). Operative time, transfusion rate, complication rate, R0 resection rate, and 30-day mortality were comparable between groups. Hospital stay was significantly shorter in the laparoscopic group (13 vs. 22 days, p < 0.001). Grade A PHLF occurred in one patient in the open group, with no significant between-group difference. Conclusions In patients with HCC and histologically confirmed F4 cirrhosis, laparoscopic partial hepatectomy was associated with less blood loss and shorter hospital stay than open surgery, without increasing perioperative morbidity. It may be a safe option in carefully selected patients undergoing limited liver resection.

BACKGROUND: To develop human space exploration, it is necessary to study the effects of an isolated and confined environment, as well as a microgravity environment, on cerebral circulation. However, no studies on cerebral circulation in an isolated and confined environment have been reported. Therefore, we investigated the effects of a 14-day period of confinement in an isolated environment on dynamic cerebral autoregulation. METHODS: We participated in an isolation and confinement experiment conducted by the Japan Aerospace Exploration Agency in 2016. Eight healthy males were isolated and confined in a facility for 14 days. Data were collected on the days immediately before and after confinement. Arterial blood pressure waveforms were obtained using a finger blood pressure monitor, and cerebral blood flow velocity waveforms in the middle cerebral artery were obtained using transcranial Doppler ultrasonography for 6 min during quiet rest in a supine position. Dynamic cerebral autoregulation was evaluated by transfer function analysis between spontaneous variability of beat-to-beat mean arterial blood pressure and mean cerebral blood flow velocity. RESULTS: Transfer function gain in the low- and high-frequency ranges increased significantly (0.54 ± 0.07 to 0.69 ± 0.09 cm/s/mmHg and 0.80 ± 0.05 to 0.92 ± 0.09 cm/s/mmHg, respectively) after the confinement. CONCLUSION: The increases observed in transfer function gain may be interpreted as indicating less suppressive capability against transmission from arterial blood pressure oscillation to cerebral blood flow velocity fluctuation. These results suggest that confinement in an isolated environment for 14 days may impair dynamic cerebral autoregulation. TRIAL REGISTRATION UMIN000020703 , Registered 2016/01/22.
Adult ; Cerebrovascular Circulation ; physiology ; Confined Spaces ; Homeostasis ; physiology ; Humans ; Male ; Middle Aged ; Space Flight ; Young Adult