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ABSTRACT: BACKGROUND: Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into "BILI." We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance. METHODS: We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery. RESULTS: 1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration. CONCLUSIONS: Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.
Journal of hepato-biliary-pancreatic sciences. 02/2013;
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ABSTRACT: Sclerosing mesenteritis is a rare inflammatory and fibrosing disorder of unknown etiology, while IgG4-related disease (IgG4-RD) consists of mass-forming, fibroinflammatory lesions characterized by high serum IgG4 levels and tissue infiltration of many IgG4-positive plasma cells; obliterative phlebitis is common. This report describes a case of sclerosing mesenteritis that was considered a manifestation of IgG4-RD. A 53-year-old man underwent right hemicolectomy because of an ileocecal mass that did not improve with conservative therapy. The ill-defined fibroinflammatory lesion extended in the mesentery with storiform fibrosis, obliterative phlebitis, and infiltration of many IgG4-positive plasma cells. The ratio of IgG4-positive/IgG-positive cells was 64%, and the ratio of forkhead box protein 3 (FOXP3)-positive/CD4-positive cells was elevated (13%). It is likely that at least some cases of sclerosing mesenteritis are a manifestation of IgG4-RD. It is important to investigate this relationship because steroid therapy may benefit such cases.
Pathology International 04/2012; 62(4):281-6. · 1.62 Impact Factor
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Junzo Shimizu,
Keizo Dono,
Kenichi Nagai,
Masakazu Miyake,
Taishi Hata,
Kenshu Kawanishi,
Junya Fujita,
Kimimasa Ikeda,
Kenzo Akagi,
Takashi Iwazawa,
Masashi Kitada,
Takashi Shimano
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ABSTRACT: A 60-year-old man with intrahepatic cholangiocarcinoma (ICC) underwent a left hepatectomy. Following the procedure, S-1 was administered during the period of five months. About two years after the hepatectomy, the patient underwent a hepatic resection again for remunant hepatic recurrences of ICC. Aggressive surgical resection may be the only method to assure a good outcome. An indication of resection for the hepatic recurrence of ICC will be examined in the future.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2469-71.
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Koji Munakata,
Junya Fujita,
Tsuyoshi Hata,
Shiki Fujino,
Tomohiro Kitahara,
Takehiro Yanagawa,
Noriyuki Watanabe,
Kaori Takamoto,
Kenichi Nagai,
Masakazu Miyake,
Taishi Hata,
Kensyu Kawanishi, Junzo Shimizu,
Kimimasa Ikeda,
Kenzo Akagi,
Takashi Iwazawa,
Keizo Dono,
Masashi Kitada,
Taku Yasumoto,
Takashi Shimano
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ABSTRACT: CASE 1: A 61-year-old man having advanced gastric cancer was presented with massive hematemesis. We could not control bleeding by gastrointestinal endoscopic hemostatic therapy, so we performed a transcatheter arterial embolization (TAE). We performed embolization on the left gastric artery. CASE 2: A 58-year-old man having advanced gastric cancer was presented with hematemesis. We could not control bleeding by gastrointestinal endoscopic procedure, so we conducted TAE. We performed embolization on the left gastric artery and right gastric artery. In both cases, hemostasis was achieved by TAE, and effectively controlled the bleeding from advanced gastric cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2354-6.
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Noriyuki Watanabe,
Takashi Iwazawa,
Tomohiro Kitahara,
Takehiro Yanagawa,
Koji Munakata,
Kaori Takamoto,
Kenichi Nagai,
Masakazu Miyake,
Taishi Hata,
Kenshu Kawanishi, Junzo Shimizu,
Kimimasa Ikeda,
Jyunya Fujita,
Kenzou Akagi,
Keizou Dono,
Masashi Kitada,
Nobuyuki Takimoto,
Kinya Abe,
Shiro Adachi,
Takashi Shimano
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ABSTRACT: A 41-year-old man who had non-small cell lung cancer invading his right 3rd, 4th and 5th ribs with hilum lymph node swelling(cT3N1M0, cStage III A), received chemoradiation therapy, cisplatin(CDDP)/docetaxel, and 2 Gy/Fr of irradiation prior to surgery. But the therapy was discontinued due to interstitial pneumonitis on day 24, during 28 Gy of radiation. At that time, a PET-CT scan revealed the accumulation of FDG in the primary tumor, hilar lymph node, and one of the ipsilateral axillar lymph nodes, in which cancer cell presence was proven by aspiration needle cytology. We organized a radical operation even though the node status was classified to cStage IV, because ipsilateral axillary lymph nodes may be regarded as regional nodes for tumors invading the chest wall. Right upper lobectomy and chest wall resection were performed, and the ipsilateral hilar, mediastinal, and axillary lymphnode were dissected. Pathological findings showed no active cancer cell in the primary lesion and hilar lymph nodes(Ef. 3), but obvious metastasis in one of the axillary lymph nodes(pT0N0M1b, pStage IV). The patient received adjuvant chemotherapy(CDDP/vinorelbine), and is alive and tumor-free 10months after the resection.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2011; 38(6):991-4.
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International Journal of Colorectal Disease 05/2011; 27(3):411-3. · 2.38 Impact Factor
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ABSTRACT: We present a rare case of adenosquamous carcinoma of the lung in a patient with complete situs inversus. The patient was a 76-year-old woman with the chief complaint of hemosputum. Chest X-ray and computed tomography (CT) scans of the thorax showed a mirror image of the organs and vessels and revealed a tumor 3.5 cm in diameter, in the left lower lung field. She was referred and admitted to KKR Hokuriku Hospital, Kanazawa, Japan to undergo surgery. Bronchoscopy showed a mirror image of the usual arrangement of the bronchi, and 5 segmental branches in the left lower bronchi. During surgery, care was exercised when intubation with the Univent bronchial tube for one-lung ventilation. On thoracotomy, the gross appearance of the left lung and the arrangement of the pulmonary vessels and the bronchi corresponded to those normally found on the right side. We were successful in performing a left lower lobectomy. Postoperative diagnosis confirmed an adenosquamous carcinoma with localized pleural dissemination as p-t4n1m0, stage IIIa. Preoperative imaging, including CT, bronchoscopy, and angiographic examination of the patient, will be useful for prevention of vascular or bronchial injury during surgery in patients with complete situs inversus undergoing lung resection. Possible vascular or bronchial anomalies should always be taken into consideration while operating on these patients.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 04/2011; 17(2):178-81.
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Takehiro Yanagawa, Junzo Shimizu,
Keizo Dono,
Taku Yasumoto,
Tsuyoshi Hata,
Shiki Fujino,
Tomohiro Kitahara,
Koji Munakata,
Noriyuki Watanabe,
Kaori Takamoto,
Kenichi Nagai,
Masakazu Miyake,
Taishi Hata,
Kensyu Kawanishi,
Kimimasa Ikeda,
Junya Fujita,
Kenzo Akagi,
Takashi Iwasawa,
Masashi Kitada,
Takashi Shimano
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ABSTRACT: A 75-year-old female presented with appetite and weight loss and epigastralgia. CT revealed a primary gallbladder carcinoma Stage IVb with multiple hepatic metastases. Gastrofiberscopy revealed an invasion to duodenal and bleeding from the tumor. For her poor performance status, it seems to be too difficult to undergo a general chemotherapy. So after gastrojejunostomy, transarterial embolization (TAE) was performed. She underwent 2 times TAE. There was a notable reduction in tumor size. But pulmonary metastases were found in bilateral lung. She died after 8 months. TAE may be useful for advanced gallbladder carcinoma with tumor vascularity.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2711-3.
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Taishi Hata,
Siki Fujino,
Takehiro Yanagawa,
Tomohiro Kitahara,
Kouji Munakata,
Noriyuki Watanabe,
Kaori Takamoto,
Masakazu Miyake,
Kenshu Kawanishi, Junzo Shimizu,
Kimimasa Ikeda,
Junya Fujita,
Takashi Iwazawa,
Kenzo Akagi,
Keizou Douno,
Masashi Kitada,
Takashi Shimano
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ABSTRACT: Combined chemotherapy including 5-FU plus radiation treatment resulted in a synergistic effect has been reported. S-1 enhances a radiation response of colon cancer cell line xenografts. Also the effectiveness of S-1 + radiation therapy has been reported. A 66-year-old man underwent a low anterior resection for lower rectal cancer. Adjuvant chemotherapy was not performed due to Stage II rectal cancer. Twenty months after the operation, solitary sacral bone metastasis was found during the postoperative work-up. S-1 (120 mg/day) combined with radiotherapy was performed on days 1-14 and 21-35. Radiation (3 Gy) was administered a total of 45 Gy on days 1-5, 7-12 and 35-40. Moreover, the reduction was judged as complete response after 11 courses of mFOLFOX 6. There has been no sign of recurrence for 44 months. It suggested that local control therapy (S-1 + radiation) plus systemic chemotherapy (mFOLFOX6) was one of the promising effective therapies for single sacral bone metastasis of rectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2343-5.
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Junzo Shimizu,
Keizo Dono,
Shiki Fujino,
Tsuyoshi Hata,
Tomohiro Kitahara,
Takehiro Yanagawa,
Koji Munakata,
Noriyuki Watanabe,
Kaori Takamoto,
Kenichi Nagai,
Masakazu Miyake,
Taishi Hata,
Kenshu Kawanishi,
Kimimasa Ikeda,
Junya Fujita,
Kenzo Akagi,
Takashi Iwazawa,
Masashi Kitada,
Takashi Shimano
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ABSTRACT: We analyzed a treatment outcome and the effect of systemic chemotherapy for patient with unresectable gallbladder carcinoma. Sixteen patients were investigated. Gemcitabine (GEM) was administrated for fifteen patients as the first-line chemotherapy. S-1 was administrated for ten patients as the second-line chemotherapy. The response rate and tumor control rate of the first-line GEM were 14.3% and 78.6%, respectively. The median progression free time of the first-line GEM was 6.0 months. The response rate and tumor control rate of the second-line S-1 were respectively 20.0% and 30.0%. The median progression free time of the second-line S-1 was 1.8 months. The median survival time of all cases was 14.9 months. The outcome of systemic chemotherapy for patients with unresectable gallbladder carcinoma in our hospital was feasible compared with past reports.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2708-10.
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ABSTRACT: Postoperative antimicrobial therapy is generally administered as standard prophylaxis against postoperative infection, despite a lack of sufficient evidence for its usefulness. This study was a phase II study to evaluate the necessity of postoperative antibiotic prophylaxis in patients undergoing a colectomy.
Patients received 1 g cefmetazole or flomoxef immediately after anesthetic induction, every 3 h during surgery, and then later once again on the next day. They were randomly assigned to receive either cefmetazole or flomoxef.
Ninety-one patients were enrolled in the study. A surgical site infection (SSI) occurred in 7.7% (7/91) of patients. All cases were superficial incisional infections. When comparing the two drugs, SSI occurred in 8.3% (4/48) of patients treated with cefmetazole and in 7.0% (3/43) treated with flomoxef, showing no significant difference (P > 0.99).
Antimicrobial prophylaxis was well tolerated when used on the day of a colectomy and once again on the next day.
Surgery Today 10/2010; 40(10):954-7. · 1.22 Impact Factor
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ABSTRACT: Carcinomatous pleuritis, accompanied by pleural dissemination or malignant pleural effusion, is listed as one of the factors limiting adequate surgical treatment. It is relatively easy to peel the parietal pleura of the chest wall and mediastinum during a pleuropneumonectomy, but it is quite difficult to peel the parietal pleura of the diaphragm. A pleuropneumonectomy was conducted with the combined resection of the pericardium and all layers of the diaphragm without opening of the peritoneum through a posterolateral subcostal approach. This approach thus made it possible to perform a complete resection of the diaphragm relatively easily in a reliable manner, and also contributed to a more thorough resection of pleural dissemination without a second thoracotomy.
Surgery Today 09/2010; 40(9):890-3. · 1.22 Impact Factor
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ABSTRACT: A 68-year-old man presented with a chief complaint being a cough. Based on a bronchoscopic biopsy, it was diagnosed at a nearby clinic as an advanced left lung cancer, and he was referred to our hospital. Chest computed tomography (CT) scans demonstrated a giant mass of the left lower lobe, 14 × 12 cm in size, which appeared to have invaded the left atrium (LA). The operation was started with double vena cava cannulation via the right internal jugular vein and the right femoral vein as well as arterial cannulation via the right femoral artery. The patient underwent left pneumonectomy combined with LA resection using cardiopulmonary bypass (CPB), without aortic clamping, through left posterolateral thoracotomy under hypothermia (32 °C). The tumor-invaded LA was resected in a 3.5 × 3.0 cm area, with vascular clamping, and the stump was closed with 3-0 Prolene sutures. The surgical margin was free of tumor cells, and the duration of CPB was 28 minutes. The patient was smoothly weaned from CPB. His postoperative course was uneventful, and he received 2 courses of adjuvant chemotherapy. For a combined resection of the LA, it is safer to use CPB than simple vascular clamping, since the latter involves the risk of dislocation. If CPB is used, the tension of the LA is removed by blood extraction into the bypass, and bradycardia is induced by a reduction of body temperature, probably reducing the risk of clamp dislocation. Even when clamp dislocation or bleeding resulting from injury of the LA wall unfortunately takes place during surgery, these events can be dealt with appropriately during the use of CPB.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 08/2010; 16(4):286-90.
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ABSTRACT: Between 1980 and 2007, five patients were pathologically diagnosed as tracheobronchial adenoid cystic carcinoma (ACC). All five patients were women aged 37-67 years. Four tumors were located in the larger airways, and one tumor was located in the peripheral lung. The following operations were done: bronchoplastic procedures in three (carinal resection with doublebarreled carinoplasty in one, sleeve right pneumonectomy in one, sleeve middle lobectomy in one), left pneumonectomy in one, and left upper lobectomy in one. Three of the five patients have survived for 172, 144, and 10 months after surgery, respectively. The best local treatment for ACC of the major airway is considered to be sleeve resection of the trachea or bronchus in an area where airway reconstruction may not be disturbed and to add postoperative irradiation when there is residual carcinoma at the stump. However, it seems controversial to recommend adjuvant radiotherapy in all patients undergoing resection.
General Thoracic and Cardiovascular Surgery 02/2010; 58(2):82-6.
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ABSTRACT: The case is a man in his 50s who had a curative surgical resection for cholangiocarcinoma in August 2006. The lesion was judged to be T3, N1, H0, P0, M0 and Stage III, and then he received various treatments including thermotherapy, CD3-activated T lymphocyte therapy. Then from June 2007, he was treated for multiple liver metastases by GEM, radiofrequency ablation (RFA), stereotactic radiotherapy, S-1, dendritic cell therapy. But there were multiple liver metastases whose maximum size was 17 mm in diameter and he was introduced to our hospital. In September 2008, ultrasonography and CT fluoroscopy guided RFA was operated on him for the liver tumors with a safety margin. But 2 hours after the ablation, he complained of epigastralgia. CT examination revealed a bile peritonitis caused by perforation of the jejunum which has been anastomosed to the pancreas, and was adjacent to the avascular area caused by RFA in segment 4 of the liver. We treated him by various interventional procedures including percutaneous drainage for bile leakage, pancreatic fistula, abscess in peritoneal cavity, and biloma in segment 3. Fifty days after the ablation, T-tube, with which pancreatic fluid and bile was induced from the cecal portion of the anastomosed jejunum to the anal side slipping through the perforated point, was successfully inserted through right flank, and resulted in complete recovery from a major technical complication of the bile peritonitis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2093-5.
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ABSTRACT: We report a case of local recurrent tumor after a resection of right adrenal metastasis from hepatocellular carcinoma successfully treated with radiofrequency ablation combined with transcatheter arterial chemoembolization. The case is a man in his 80s who had a curative surgical resection and microwave coagulation therapy (MCT) for multiple hepatocellular carcinomas in February 2003. The lesions were judged to be T4, N0, M0 and Stage IV,then, he was treated as an outpatient on a regular schedule. In July 2003, a right adrenal tumor 2 cm in diameter was detected by computed tomography (CT), but the value of the adrenocortical hormones were normal on blood examination, and he was observed at regular intervals. In February 2005, the adrenal lesion enlarged to 5 cm in diameter and the value of PIVKA-II became high on blood examination, so April 2005, a surgical resection was performed, and it was diagnosed as the metastasis from HCC. In July 2008, the recurrent tumor 3 cm in diameter was observed in the right retroperitoneum. It was considered inoperable because of the past operation, and transcatheter arterial chemoembolization of an inferior adrenal artery and a fine branch through a right sub-phrenic artery was performed for the recurrent tumor, and one week after the embolization, radiofrequency ablation was treated by CT fluoroscopy guidance. Ten months after the tumor embolization combined with radiofrequency ablation, there were no local and distant recurrences observed by CT examination. Transcatheter arterial embolization combined with radiofrequency ablation is considered as a feasible and effective method for not only HCC but also for a local recurrent tumor after resection of the adrenal metastasis from hepatocellular carcinoma.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2371-3.
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Junzo Shimizu,
Shoho Hayashi,
Keizo Dono,
Taku Yasumoto,
Masahiro Zenitani,
Kouji Munakata,
Noriyuki Watanabe,
Kaori Takamoto,
Yoshinori Kagawa,
Taishi Hata,
Kensyu Kawanishi,
Kimimasa Ikeda,
Junya Fujita,
Kenzo Akagi,
Masashi Kitada,
Takashi Shimano
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ABSTRACT: Primary liver cancer with lymph node metastasis was recognized as poor prognosis. We herein report a case of post operative lymph node recurrence treated with UFT. A 74-year-old man with a huge mass lesion in the right liver with para Aortic lymph node metastasis admitted our hospital in April 2007. Extended right lobe hepatectomy and lymph node dissection were performed in May. A histological examination of the resected specimen showed a combined hepatocellular-cholangiocarcinoma with three lymph node metastasis. Computed tomography(CT)revealed intra hepatic metastasis (S3) and right adrenal grand metastasis 5 months after surgery. Transarterial embolization (TAE) and right adrenalectomy were performed for each metastasis. CT revealed a lymph node metastasis at the right side of infra vena cava 1 year after surgery. He was treated by oral administration of UFT (200 mg/day). The AFP and PIVKA-II value gradually decreased after administration of UFT. The size of lymph node metastasis became small confirmed by CT. But the AFP and PIVKA-II value increased 1 year and 7 months after surgery. TAE was performed against lymph node metastasis 1 year and 9 months after surgery. This case suggests UFT is useful for suppressing the growth of the lymph node metastasis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2380-2.
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ABSTRACT: A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity. Finally, the abscess was filled with a free greater omentum flap, accompanied by microvascular anastomosis. In this way, the intractable lung abscess was successfully cured. Conventionally, surgical treatment, particularly cavernostomy, has been applied only to limited cases when dealing with a lung abscess. Our experience with the present case suggests that surgical treatment, including cavernostomy as one option, should also be considered when dealing with lung abscesses resisting medical treatment and causing compromised respiratory function. To enable maximum utilization of the greater omental flap, which is available in only a limited amount, it seems useful to prepare and graft a free omental flap making use of microvascular surgery.
General Thoracic and Cardiovascular Surgery 11/2009; 57(11):616-21.
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Masaki Okuyama,
Hiroaki Nagano,
Shogo Kobayashi,
Li He,
Hirofumi Ota, Junzo Shimizu,
Yutaka Takeda,
Shigeru Masrubashi,
Hidetoshi Eguchi,
Masahiro Tanemuea,
Keizo Dono,
Masato Sakon,
Koji Umeshita,
Mitsukazu Gotoh,
Morito Monden
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ABSTRACT: The aim of our study was to investigate the allogeneic influence inside and outside the liver in vitro following donor-specific cell injection (DSI). DA rats (RT1a) were used as donors and WS rats (RT1k) as recipients. WS were sensitized with DA spleen cells, followed 24h later by total hepatectomy. The liver was transplanted into another WS (sensitized liver-grafted; SL-Grafted). The hepatectomized WS underwent liver transplantation from a naive WS (sensitized liver-removed; SL-Removed). Alloantigens accumulated in the liver in SL-Grafted and in the extrahepatic tissue/organ(s) in SL-Removed. DA hearts were transplanted 10days after antigen administration. To analyze the immune responses, we measured Th1/Th2 cytokine profiles, and perforin mRNA in various organs, allogeneic mixed lymphocyte reaction (MLR), and donor-specific immunoglobulin. Th1 cytokine levels in the liver of SL-Grafted and in spleen of SL-Removed were highly and rapidly upregulated but decreased thereafter. IFN-gamma and perforin mRNAs were significantly higher in SL-Grafted and lower in SL-Removed. MLR was significantly higher in SL-Grafted than SL-Removed and controls. There was no significant difference in the donor-specific immunoglobulin level. Our findings suggest that liver and other organs may behave differently to alloantigen, suggesting the importance of an early Th1 reaction in the liver and spleen.
Transplant Immunology 10/2009; 22(3-4):150-6. · 1.46 Impact Factor
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ABSTRACT: Second operations were performed in 1961–1990 on 23 patients with non-small cell bron-chogenic carcinoma, constituting 2.5% of 906 who had undergone pulmonary resection for such tumor and 3.6% of the 641 with apparently curative surgery. The second operation was performed for recurrent tumor in 15 cases and for second primary tumor in eight. Five-year survival after the first operation was 30% in the former group and 88% in the latter (significant difference). Among the total 23 patients, this survival rate was 51%. The study indicates that an aggressive attitude to second surgical intervention is warranted. For early detection of second lesions, follow-up at maximally 6-month intervals should be continued for more than 5 years after the first operation.
07/2009; 26(1):73-78.
