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ABSTRACT: OBJECTIVES: The aim of the study was to accurately examine the functional volume (RI-vol) of the hepatic segments on single photon emission computed tomography/computed tomography (CT) fusion imaging by technetium-99m galactosyl human serum albumin scintigraphy and compare it with the RI-vol and morphological volume obtained on computed tomography (CT-vol). METHODS: In 60 patients with various liver background statuses who had undergone hepatectomy, the RI-vol and CT-vol were examined in each sector using imaging analysis. The values from a control group (n=91) were used as reference data. RESULTS: The mean RI-vol and CT-vol of the right liver were 64±10 and 63±6%, respectively, whereas the values for the left liver were 36±10 and 37±6%, respectively. Compared with the control group, the ratios in each hemiliver were similar. The mean RI-vol and CT-vol for each sector were also similar, and significant positive correlations were identified between the two volumes (P<0.01). In four patients with hepatic tumors involving the main hepatic vessels or the bile duct and in 10 patients who had undergone portal vein embolization, the actual RI-vol in the injured sector was significantly decreased compared with CT-vol (P<0.05). There were marked changes in functional volume in segment 6+7 and segment 2+3 after portal vein embolization (P<0.05). CONCLUSION: Volumetric measurement using single photon emission computed tomography/CT imaging with technetium-99m galactosyl human serum albumin scintigraphy is useful for evaluating the functional volume in separated livers and offers a good reflection of the background liver status.
Nuclear Medicine Communications 05/2013; · 1.40 Impact Factor
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Atsushi Nanashima, Syuuichi Tobinaga,
Takafumi Abo,
Tomohito Morisaki,
Ryouhei Uehara,
Hiroaki Takeshita,
Takashi Nonaka,
Shigekazu Hidaka,
Fuminao Takeshima,
Ken Ohnita,
Hajime Isomoto,
Masaki Kunizaki,
Terumitsu Sawai,
Kazuhiko Nakao,
Takeshi Nagayasu
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ABSTRACT: Background/Aims: Surgical resection is a radical treatment option for gallbladder carcinoma (GBC); however, it is still difficult to cure and patient prognosis is poor. An assessment of the surgical results and chemotherapy options may elucidate effective treatments. Methodology: We retrospectively examined the demographics, surgical records and outcome in 33 patients with GBC undergoing surgical resection. Results: Postoperative cancer recurrence was observed in 36% of patients. Mean cancer-free survival time was 84 months and 3-year cancer-free survival rate was 70% Mean overall survival time was 96 months and 5-year overall survival rate was 52%. The 3-year cancer-free survival and the 5-year overall survival were significantly different between the final tumor stages (p<0.001). Higher CEA and CA19- 9 level were significantly related to poor overall survival (p<0.05). Macroscopically, papillary type tumor showed significantly better overall survival compared to nodular or flat types (p<0.05). Degree of invasion, node metastasis, moderate or poor differentiation, vascular or perineural invasion and invasion of the liver or hepatoduodenal ligament were significantly associated with poor overall survival (p<0.05). A cancerfree margin at the hepatic cut end and dissected periductal structures showed a significantly poor prognosis (p<0.05). The overall survival in final curability A was significantly associated with better curability than B or C (p<0.05). Conclusions: Radically extended surgical resection for GBC is necessary to obtain improved patient survival and new adjuvant chemotherapy would be expected to improve results after surgery.
Hepato-gastroenterology 09/2012; 59(118):1717-21. · 0.66 Impact Factor
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ABSTRACT: Efficacy of fibrin glue to prevent biliary or pancreas fistula at the resected edge of the liver or pancreas is controversial. We examined surgical results of fibrin glue use in patients who underwent hepatectomy or pancreatectomy to assess the efficacy of its use.
Subjects were divided into two groups; the fibrin glue group in hepatectomy (n=228) and in pancreatectomy (n=113), and the non-fibrin glue group in hepatectomy (n=94) and in pancreatectomy (n=24). In case of hepatectomy, the fibrin glue was sprayed on the cut-surface or anastomotic site of hepatico-jejunostomy. In case of pancreatectomy, the fibrin glue was sprayed on the anastomotic site of pancreato-jejunostomy or closed pancreatic stump.
In the hepatectomy group, uncontrolled ascites were more frequent in the fibrin glue group (p<0.05). The use of fibrin glue for both groups has been less frequent in recent years. Prevalence of biliary fistula was not significantly different between groups. Hospital stay in the fibrin glue group was significantly longer than that in the non-fibrin glue group, and was not significantly different between hepatectomy or pancreatectomy groups. There was no significant difference of any complications including pancreatic fistula between groups. Prevalence of pancreatic fistula was not significantly different between the fibrin glue group and the non-fibrin glue group.
Use of fibrin glue did not prevent biliary or pancreatic fistula in patients who underwent hepatectomy and pancreatectomy with or without enteric anastomosis.
Hepato-gastroenterology 07/2012; 59(117):1544-7. · 0.66 Impact Factor
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ABSTRACT: To achieve complete extended right hepatectomy or trisectionectomy for a bismuth type IV hilar bile duct carcinoma, we propose the application of Belghiti's liver hanging maneuver (LHM) using a small nasogastric tube. This small nasogastric tube was placed in the cut plane: the top of the tube was placed between the hepatic veins. The tube was placed along the border between the left lateral sector and Spiegel's caudate lobe and the bottom of the tube was placed at the left side of the umbilical Glissonian pedicle. Hepatic parenchyma was transected using a vascular sealing device. Hepatic transection was always targeted to the tube and, eventually, a cut line of left hepatic ducts remained. We report the case of a 76-year-old female and an 83-year-old female with widely extended hilar bile duct carcinomas showing Bismuth type IV. Applying the modified LHM for extended right hepatectomy, the cut planes were easily and adequately obtained in patients with hilar bile duct carcinoma.
Hepato-gastroenterology 07/2012; 59(117):1583-5. · 0.66 Impact Factor
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ABSTRACT: This case involved a 75-year-old woman with obstructive jaundice who was diagnosed with hilar bile duct carcinoma. After endoscopic
retrograde biliary drainage, the total bilirubin level was normalized. The indocyanine green test retention rate at 15min
(ICGR15) was 26%. The liver uptake ratio (LHL15) by technetium-99m galactosyl human serum albumin (99mTc-GSA) liver scintigraphy was 0.87. Left hepatectomy was scheduled by CT volumetry. However, biliary drainage was insufficient,
and the functional liver volume showed functional deterioration of the left liver. After percutaneous transhepatic biliary
drainage, future remnant liver volume by 99mTc-GSA liver scintigraphy changed to 52% from 42%, and ICGR15 and LHL15 were improved to 16% and 0.914, respectively. Scheduled
left hepatectomy was performed following the results of functional liver volume. The measurement of functional volume by 99mTc-GSA liver scintigraphy provides useful information with respect to segmental liver function for deciding operative indications.
KeywordsBile duct carcinoma-Technetium-99m galactosyl human serum albumin liver scintigraphy-Functional liver volume-Biliary obstruction-Operative indication
Clinical Journal of Gastroenterology 04/2012; 3(3):174-178.
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ABSTRACT: Background/Aims: Recent developments in radiological technology allowed acquisition of images with high spatial resolution that facilitate effective 3-dimensional (3D) reconstruction of fusion images. Present study utilized 3D cholangiography and angiography with multi-detector-row computed tomography (MDCT) to acquire information regarding operative simulations. Methodology: 3D-fusion images were evaluated in 39 patients with hepatobiliary malignancies who underwent surgical resections. Results: An aberrant branch of segment 3 over the umbilical portal vein, a large hepatoma compressed the hilar vessels, an aberrant branch of the caudate lobe vasculature in case of metastatic liver tumor with a right-sided umbilical portal vein and transected biliary leakage were clearly observed by 3D imaging system. Four patients with intrahepatic cholangiocarcinoma underwent multiple biliary stent placements and adequate placement of biliary stents was possible. In 22 patients with extrahepatic biliary carcinomas, visualization of the extent of tumor invasion by 3D-fusion images was equivalent to conventional cholangiography. In 2 patients, adequate placement of multiple stents could be visualized with this system. In 2 patients who underwent hepatectomy, more extended cancer invasion was observed than was visualized by 3D-fusion images. Conclusions: 3D fusion images were very useful for preoperative simulations in order to understand relationships between tumors and adjacent vasculatures.
Hepato-gastroenterology 01/2012; 59(118):1748-57. · 0.66 Impact Factor
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Atsushi Nanashima,
Takafumi Abo, Syuuichi Tobinaga,
Takashi Nonaka,
Hidetoshi Fukuoka,
Shigekazu Hidaka,
Hiroaki Takeshita,
Terumitsu Sawai,
Toru Yasutake,
Takeshi Nagayasu,
Takashi Kudo
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ABSTRACT: Indocyanine green retention rate at 15 min (ICGR15) is a useful marker of liver function in deciding on the extent of hepatectomy. To determine ICGR15 regardless of liver condition, we sought to establish a formula for converted ICGR15 based on conventional blood tests and technetium-99 m galactosyl human serum albumin ((99m)Tc-GSA) scintigraphy.
We measured liver function parameters, including ICGR15, in 307 patients, including 265 liver cancer patients without biliary obstruction (no obstruction group) and 42 with biliary obstruction (obstruction group).
In the no obstruction group, multiple regression analysis identified blood pool clearance ratio (HH15), liver uptake ratio (LHL15) calculated by heart and liver activity between 3 and 15 min after injection of (99m)Tc-GSA, and serum hyaluronic acid as significant correlates (P < 0.05). The calculated converted ICGR15 was then equal to 0.02∗HA + 0.276∗(HH15∗100)-0.501∗(LHL15∗100) + 41.41. The mean difference between actual and converted ICGR15 was significantly lower in the obstruction than in the no obstruction group (P = 0.031). A significantly larger proportion of patients of the obstruction group had lower converted ICGR15 than those of the no obstruction group (P = 0.045).
The converted ICGR15 is useful for evaluating hepatic function in patients with biliary obstruction who plan to undergo major hepatectomy.
Journal of Surgical Research 05/2011; 169(2):e119-25. · 2.25 Impact Factor
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ABSTRACT: A resection of the caudate lobe often needs to be combined with a hemi-hepatectomy for hilar cholangiocarcinoma or a liver tumor in segment 1. To achieve complete resection of the whole caudate lobe, the cut line between the right edge of the paracaval portion and the right lateral sector should be precisely controlled. The liver-hanging maneuver (LHM) is a useful anterior approach that does not require mobilization of the remnant liver. However, the precise set-up of the cut line of the right edge has not been optimized in previous reports. We herein introduce a new modification of LHM that we named the "dorsally fixed liver-hanging maneuver" (DF-LHM) based on the results in five patients who underwent left hepatectomy combined with a total resection of segment 1. This technique provided adequate cut planes along the right edge of the caudate lobe, shortening the transection time and reducing intraoperative blood loss. The DF-LHM may represent a new key technique for this type of hepatectomy, and further applications for other anatomical resections can be modeled on the strategy.
Surgery Today 03/2011; 41(3):453-8. · 1.22 Impact Factor
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Atsushi Nanashima, Syuuichi Tobinaga,
Takafumi Abo,
Masaki Kunizaki,
Hiroaki Takeshita,
Shigekazu Hidaka,
Naota Taura,
Tatsuki Ichikawa,
Terumitsu Sawai,
Kazuhiko Nakao,
Takeshi Nagayasu
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ABSTRACT: To improve diagnostic accuracy of intraoperative ultrasonography (IOUS), we investigated the usefulness of new contrast medium of microbubble agent, Sonazoid as a preliminary study.
We examined IOUS in 50 patients with liver tumors who underwent hepatectomy. Sonazoid was administrated intravenously and Kupffer-phase images of the tumor were observed before hepatectomy. Sonazoid was reinjected to observe the tumor vasculature.
The tumors included hepatocellular carcinoma (HCC) in 25 patients, intrahepatic cholangiocarcinoma in 3, colorectal liver metastasis in 14, gastrointestinal stromal tumor in 1, and benign hematoma in 1. Liver tumors were clearly detected as perfusion defect in most cases. Small lesions (<1 cm), extra-capsular tumor growth, and portal vein tumor thrombus were also clearly detected on the Sonazoid-IOUS. Small occult tumors were detected in five cases. Differential diagnosis with suspicious non-tumorous lesions and benign mass was possible based on vascular findings at the early phase. In comparison with hepatectomy for HCC under conventional IOUS, the proportion of patients with positive surgical margin (0%) tended to be lower than that of the control group (P = 0.073).
Sonazoid-IOUS is a promising useful tool to detect the precise tumor margin and small tumors, hence allowing curative hepatectomy or intraoperative ablation.
Journal of Surgical Oncology 02/2011; 103(2):152-7. · 2.10 Impact Factor
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Atsushi Nanashima, Syuuichi Tobinaga,
Masato Araki,
Masaki Kunizaki,
Kuniko Abe,
Hideyuki Hayashi,
Kenichi Harada,
Yasuni Nakanuma,
Tohru Nakagoe,
Hiroaki Takeshita,
Terumitsu Sawai,
Takeshi Nagayasu
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ABSTRACT: Morphologically, liver metastases from colorectal carcinoma usually form as nodular tumor masses, whereas intraductal papillary growth in the bile duct is rare. A 65-year-old man underwent right hemicolectomy for advanced colon carcinoma, and histology of the primary carcinoma confirmed moderately differentiated adenocarcinoma with subserosal invasion, no vascular infiltration, and no lymph node metastasis. A liver tumor was found in the right paramedian Glisson pedicle and intraductal growth of cholangiocarcinoma was seen on imaging. We performed right hepatectomy and macroscopically, the resected specimen contained a growth in the bile duct lumen similar to cholangiocarcinoma. Histological examination revealed intraductal papillary proliferation of well-differentiated adenocarcinoma without vascular infiltration or lymph node metastasis in the hepatic hilum. Immunohistochemical staining revealed that the tumor cells were negative for cytokeratin-7 and positive for cytokeratin-20. Based on these findings, liver metastasis from colon carcinoma was diagnosed. Liver metastasis from colorectal carcinoma rarely arises as intraductal papillary growth in the bile duct, but the possibility of liver metastases with unusual morphology must be borne in mind for patients with a history of carcinoma in the digestive tract.
Surgery Today 02/2011; 41(2):276-80. · 1.22 Impact Factor
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Atsushi Nanashima, Syuuichi Tobinaga,
Takafumi Abo,
Yorihisa Sumida,
Masato Araki,
Hideyuki Hayashi,
Ichiro Sakamoto,
Takashi Kudo,
Hiroaki Takeshita,
Shigekazu Hidaka,
Terumitsu Sawai,
Kazuhiko Hatano,
Takeshi Nagayasu
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ABSTRACT: To identify predictors of changes in functional hepatic volumes after portal vein embolization (PVE) before hepatectomy, we examined the relationship between hepatic functional parameters and changes in functional volume of the embolized and non-embolized liver based on a previous volumetric analysis.
Subjects were 24 patients who underwent PVE, which was performed through the trans-ileocolic vein (n = 4) or by percutaneous transhepatic puncture (n = 20). The RI liver volume parameter was measured by liver scintigraphy with technetium-(99m) galactosyl human serum albumin ((99m)Tc-GSA). Computed tomography (CT) volume parameter was also measured.
Significant atrophy of the embolized liver and hypertrophy of the non-embolized liver (change of 72 ± 108 cm(3) and 111 ± 91 cm(3), respectively) (change of 7.8%) was observed after PVE. The change in these RI volume parameters (change of 173 ± 175 cm(3) and 145 ± 137 cm(3) , respectively) (16.5%) was significantly greater than CT volume parameters (P < 0.01). CT vol and RI vol in the embolized and non-embolized liver were well correlated (r = 0.75 and 0.69, respectively). However, the correlation between CT and RI volume parameters in the embolized and non-embolized liver after PVE was very weak (r = 0.17 and 0.03, respectively). Only alkaline phosphatase level correlated negatively with atrophic CT volume parameter of the embolized liver (r = -0.455, P < 0.05). When compared with CT volume parameter, more parameters were significantly correlated with changes of RI volume parameter in the embolized liver: pre-PVE pressure; ICGR15; and serum levels of hyaluronate, total bilirubin, albumin, and alkaline phosphatase. Only platelet count was significantly correlated with hypertrophy of the non-embolized liver.
RI volume parameter might more accurately reflect functional changes in the embolized liver and non-embolized liver than CT volume parameter. Correlated parameters might allow us to predict the functional effect of PVE.
Journal of Surgical Research 12/2010; 164(2):e235-42. · 2.25 Impact Factor
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ABSTRACT: To prevent or reduce hepatic complications after hepatectomy, it is important to employ preoperative predictive parameters and to determine the indications for hepatectomy. In the present study, we evaluated risk parameters in patients who underwent hepatectomy between 1994 and 2003, and selected three parameters to modify the surgical indications. Using these indications before surgery in patients who underwent hepatectomy between 2004 and 2008, we compared the prevalences of postoperative complications in the the two groups of patients.
We examined 250 consecutive patients who underwent hepatectomy for liver disease [149 in 1994-2003 (termed the early period) and 101 in 2004 to 2008 (termed the later period)].
In the early period, uncontrolled ascites was observed in 55 patients and hepatic failure was observed in 15 of the 149 patients. Multivariate analysis identified volume of the resected liver (> or =50%), intraoperative blood loss (> or =1500 ml), prothrombin activity (<70%), hyaluronic acid level (> or =200 ng/ml), and LHL15 (hepatic uptake ratio of technetium-99m galactosyl human serum albumin ((99m)Tc-GSA) (<0.85) as risk factors; the latter three parameters were evaluated as predictors of outcome. From 2004, we used these three parameters, in addition to the indocyanine green retention rate at 15 min (ICGR15), as criteria for indications for hepatectomy. Despite the lower prevalence of normal liver in the later period, comparisons showed decreases in the rates of uncontrolled ascites (23 vs. 37%, P = 0.03), hepatic failure (4 vs. 10%, P = 0.12), and hepatic complications (25 vs. 44%, P = 0.003) in patients in the later period compared with these rates in the previous period.
The use of prothrombin activity, and levels of hyaluronic acid and LHL15, as parameters of functional liver reserve in the selection of candidates for surgery reduced the incidence of hepatic complications after hepatectomy.
Journal of hepato-biliary-pancreatic sciences. 11/2010; 17(6):871-8.
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ABSTRACT: Minimization of blood loss during resection of the hepatic parenchyma in hepatectomy remains a major problem. The usefulness of the LigaSure sealing system has been reported.
To evaluate the efficacy of combination procedure of LigaSure and forceps clamping for control blood loss and transection time in hepatectomy.
Here, we report our experience with the combination technique of LigaSure Precise, a clamp forceps type, and crush clamping method for hepatic transection in 33 patients who underwent hepatectomy.
The combination technique allows fast and bloodless transection even along the major intrahepatic vessels. Blood loss and transection time were significantly reduced in the group of LigaSure use (P < 0.05). Efficient hemostasis could be achieved also in patients with extensive liver injury such as cirrhosis. The rates of postoperative intraabdominal abscess formation in the combination technique of LigaSure and crush clamping were lower compared with the conventional crush clamping method (P < 0.05).
The combined use of LigaSure Precise and crush clamping technique is safe and allows rapid completion of hepatic resection.
Journal of Surgical Oncology 08/2010; 102(2):179-83. · 2.10 Impact Factor
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ABSTRACT: Vascular infiltration (VI) is an important prognostic factor for hepatocellular carcinoma (HCC) and predictive parameters are necessary to preoperatively decide treatment strategies in patients with HCC.
Relationships between presence and degree of VI in the portal and hepatic veins and bile duct, and post-hepatectomy survival were examined in 271 HCC patients who underwent hepatectomy.
VI was observed in 81 patients (30%). Disease-free and overall survival rates was significantly lower in patients with VI than in patients without VI, and became poorer according to the degree of infiltration (P < 0.01). Multiple, increased size, non-meeting of Milan criteria, irregular macroscopic findings and increased PIVKA-II levels were associated with degree of VI in portal vein (P < 0.01). Increased size and increased PIVKA-II level were associated with degree of VI in hepatic vein (P < 0.05). Non-meeting of Milan criteria was associated with degree of infiltration in bile duct (P = 0.034). Survival was significantly better following anatomical resection than with non-anatomical resection and, furthermore, survival was better with surgical margins >5 mm than with shorter margins in patients who underwent non-anatomical resection.
Adequate extent of operative procedures, but not limited resection with short margins, is useful when predictive parameters associated with VI are observed.
Journal of Surgical Oncology 03/2010; 101(7):557-63. · 2.10 Impact Factor
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Atsushi Nanashima,
Ichiro Sakamoto,
Tomayoshi Hayashi, Syuuichi Tobinaga,
Masato Araki,
Masaki Kunizaki,
Takashi Nonaka,
Hiroaki Takeshita,
Shigekazu Hidaka,
Terumitsu Sawai,
Toru Yasutake,
Takeshi Nagayasu
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ABSTRACT: It is difficult to diagnose lymph node metastasis in biliary and pancreas carcinomas before surgery.
The aim of this study was to assess the utility of the combination of multi-detector computed tomographic (MDCT) findings and serum carbohydrate antigen (CA)19-9 level in the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.
The subjects were 139 patients with biliary and pancreas carcinomas who underwent surgical resection. We calculated the positive predictive values (PPV), sensitivities, specificities, positive likelihood ratios (PLR) and accuracies of diagnosis by MDCT alone, serum CA19-9 level alone, and their combination.
The PPV and sensitivity were higher for node metastasis in hepatoduodenal ligament than in common hepatic artery (CHA) or para-aortic region (PAR). Specificity, accuracy and PLR were highest for CHA in biliary carcinoma. With pancreatic carcinoma, PLR was slightly higher in PAR compared to other regions. The sensitivity of CA19-9 for node metastasis was higher than that of MDCT, while the PPV, specificity, accuracy and PLR were low for both biliary and pancreas carcinoma. The combination of positive CT findings and high CA19-9 level had the highest positive rate for node metastasis for both types of carcinomas. Nodes around the supra-mesenteric vein could not be fully observed on CT.
The combination of high-resolution MDCT and CA19-9 is useful for the diagnosis of lymph node metastasis in biliary and pancreas carcinomas.
Digestive Diseases and Sciences 03/2010; 55(12):3617-26. · 2.12 Impact Factor
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ABSTRACT: First-line treatment for <or=3 hepatocellular carcinomas (HCCs) <or=3 cm in size remains controversial. The superiority of survival benefit needs to be clarified between these modalities for such lesions.
We examined post-treatment survival of 144 consecutive HCC patients who underwent hepatectomy and of 56 consecutive HCC patients who underwent thermal ablation therapy limited to the HCC (<or=3 cm, <or=3 lesions).
Pretreatment liver function was significantly worse and prevalence of Child-Pugh classification B/C was significantly higher in the ablation group compared to the hepatectomy group. Prevalence of tumor recurrence after treatment did not differ significantly between groups, irrespective of solitary or multiple HCC. In solitary HCC, overall survival rates in both groups did not differ significantly. Even in Child-Pugh B patients, survival was not significantly different between hepatectomy and ablation. In HCC with 2-3 lesions <or=3 cm, overall survival was significantly longer with hepatectomy than with ablation and mean survival periods in the hepatectomy and ablation groups were 4.5 and 1.2 years, respectively.
In cases of multiple small HCCs, hepatic resection is recommended over local ablation therapy as the first-line treatment in cases where liver function has been preserved.
Journal of Surgical Oncology 02/2010; 101(6):481-5. · 2.10 Impact Factor
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Atsushi Nanashima,
Kenichirou Shibata,
Toshiyuki Nakayama, Syuuichi Tobinaga,
Masato Araki,
Masaki Kunizaki,
Hiroaki Takeshita,
Shigekazu Hidaka,
Terumitsu Sawai,
Takeshi Nagayasu,
Toru Yasutake
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ABSTRACT: Microvessel count (MVC) has been correlated with patient prognosis in hepatocellular carcinoma. We investigated whether MVC assessed by staining with CD34 antibody was associated with disease-free and overall survival in patients with metastatic liver cancer (MLC).
We examined relationships between MVC and clinicopathologic factors or postoperative outcomes in 139 MLC patients who underwent hepatectomy between 1990 and 2006. CD34 expression was analyzed by the immunohistochemical method.
MVC was associated with fibrous pseudocapsular formation on histological examination. By means of the modern Japanese classification of liver metastasis, poorer survival was associated with higher score, poorly differentiated adenocarcinoma, higher preoperative carcinoembryonic antigen (CEA) level, fibrous pseudocapsular formation, and smaller surgical margin. Shorter disease-free survival was associated with higher score when the Japanese classification of liver metastasis was used, multiple or bilobar tumor, regional lymph node metastasis in primary colon carcinoma, preoperative CEA level, fibrous pseudocapsular formation, and smaller surgical margin (<5 mm). Higher MVC (>or=406/mm(2)) was associated with decreased disease-free and overall survival by univariate analysis (P = .034 and P = .021, respectively), and higher MVC represented an independently poor prognostic factor in overall survival by Cox multivariate analysis (risk ratio, 2.71; P = .023) in addition to histological differentiation.
Tumor MVC seems to be a useful prognostic marker of MLC patient survival.
Annals of Surgical Oncology 07/2009; 16(8):2130-7. · 4.17 Impact Factor
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ABSTRACT: Longitudinal tumor extension from the main tumor involves intramural or superficial spread along the bile duct, which influences surgical curability. Identifying the range of superficial extension is difficult by preoperative imaging. To clarify specific characteristics of bile duct carcinoma (BDC) with superficial extension of epithelium in the bile duct, we examined clinicopathologic features and patient outcomes in BDC patients with or without superficial extension who underwent surgical resection.
Between 1994 and 2008, we retrospectively examined clinicopathologic findings and outcomes for 42 BDC patients who underwent surgical resection and divided them into two groups: (1) superficial extension (SE) group (n = 10); and (2) non-SE group (n = 32).
In terms of macroscopic growth of the main tumor, the papillary type was more common in the SE group than in the non-SE group, whereas the nodular type was dominant in the non-SE group. The prevalence of cancer-positive findings at the cut end of the bile duct was higher in the SE group. Portal vein invasion was not observed in the SE group, and the prevalence of regional lymph node metastasis was significantly greater in the non-SE group than in the SE group. No patients died of cancer in the SE group, who tended to show better survival than the non-SE group.
The present results suggest that a good prognosis may be achieved in BDC patients with SE when complete resection is accomplished.
World Journal of Surgery 05/2009; 33(6):1255-8. · 2.36 Impact Factor
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ABSTRACT: We describe a modification of Belghiti's liver hanging manoeuvre (LHM) using two small tubes placed in the cut planes, the first between the left lateral and medial sections, and the second along the right hepatic vein, to achieve complete anatomic central hepatectomy for a large tumour compressing surrounding vessels. Using this technique, a large central hepatocellular carcinoma compressing hilar vessels and the right hepatic vein was easily and safely resected in a 57-year-old man.
HPB 01/2009; 11(6):529-31. · 1.60 Impact Factor
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ABSTRACT: There is no appropriate grading system for prediction of survival of patients with metastatic liver cancer (MLC) from colorectal carcinoma. We propose the modified grading system for MLC from the present Japanese system.
We compared predictive accuracies of survival of 121 Japanese MLC patients of five systems, including clinical risk score (CRS) proposed by Memorial-Sloan-Kettering-Cancer-Center, original H-number (OHN) by Japanese Society for Cancer of the Colon and Rectum, revised H-number (RHN) and Grade by the same society (GJSCCR), and our modified Grade (MGJSCCR) based on OHN and presence of primary lymph node metastasis.
Univariate analysis showed that discrimination of both disease-free and overall survival rates was significant for CRS, OHN and MGJSCCR (P < 0.05) but not for RHN and GJSCCR. Multivariate analysis showed CRS and MGJSCCR as the best systems for predicting disease-free and overall survival according to disease stage, for which Akaike information criteria (AIC) value was the lowest (423.7 and 313.9, hazard ratio 1.73 and 1.47, respectively for CRS, 423.9 and 313.5, hazard ratio 1.75 and 1.69, respectively for MGJSCCR; P < 0.05).
The simpler system of MGJSCCR is a better predictive grading system of prognosis of MLC patients who had undergone hepatic resection.
Journal of Surgical Oncology 07/2008; 98(5):363-70. · 2.10 Impact Factor
