[Show abstract][Hide abstract] ABSTRACT: The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer.
The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software.
Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4 % [95 % confidence interval (CI) 1-6 %], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95 % CI 0.16-0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95 % CI 0.07-0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95 % confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger's test; anastomotic leakage: p = 0.056, re-operation: p = 0.681).
Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.
Full-text · Article · Jun 2015 · Surgical Endoscopy
[Show abstract][Hide abstract] ABSTRACT: The effects of laparoscopic colorectal surgery (LAC) on the long-term outcomes of elderly patients remain unclear. This study aimed to assess the short- and long-term outcomes of LAC in elderly colorectal cancer patients and to quantify the effects of LAC on the patient death patterns.
The clinicopathological data of elderly colorectal cancer patients aged ≥80 years old who were treated between 2006 and 2014 were extracted. The relationships between the clinicopathological factors and overall survival (OS) were assessed using the Cox proportional hazards model and Kaplan-Meier analyses. The risk factors for the types of death were estimated using a competing risk analysis.
A total of 107 patients were included. Fifty-two patients underwent LAC, whereas 55 underwent open surgery (OC). There were no significant differences in the American Society of Anesthesiologists grade or comorbidity rate between the groups. The postoperative complication rate was significantly lower with LAC than OC (p < 0.001). After adjustment for covariates, laparoscopic surgery was not a significant risk factor for any of the types of death.
LAC is an effective and safe technique for elderly patients with colorectal cancer. Furthermore, there was no significant association between the surgical procedure and the pattern of death.
[Show abstract][Hide abstract] ABSTRACT: Background
Acute colorectal obstruction requires immediate surgical treatment. Although one-stage surgery with transanal drainage tubes (TDT) is reportedly safe and feasible, the long-term outcome of this procedure remains unclear.
To assess the outcome of one-stage surgery using TDT in the acute left colon or rectal obstructions due to colorectal carcinomas.
Clinicopathological data were recorded from patients with colorectal cancer with acute obstructions between 2006 and 2013.
A total of 43 patients were enrolled including 29 males and 14 females. Among 39 patients, TDT was successful in 33 (84 %) and was incomplete in 6. Thus, 33 patients received one-stage surgery with TDT decompression, and 9 patients, including 6 with incomplete decompression, received one-stage surgery with no decompression. No significant differences in clinicopathological factors were observed between decompression and non-decompression groups. Adjusted analyses revealed that decompression using TDT was significantly associated with OS (hazard ratio 0.24; 95 % confidence interval, 0.08–0.72; p = 0.01). Furthermore, OS in the TDT decompression group was significantly longer than that in the non-decompression group (p = 0.01).
One-stage surgery with decompression using TDT may be effective to avoid stomas and to improve overall survival in patients with obstructing colorectal cancers.
Full-text · Article · May 2014 · Journal of Gastrointestinal Surgery
[Show abstract][Hide abstract] ABSTRACT: To report the first case of a subserosal uterus-like mass.
A community-based hospital.
A 44-year-old nulliparous woman who complained of a left inguinal mass had a medical history that was notable for two features. One was left oophorectomy for a sliding hernia at 10 months of age; the other was endometriosis at the oophorectomy site at 26 years of age.
Pathologic examination demonstrated that this subserosal mass mimicked a miniature uterus with a leiomyomatous lesion.
As of September 2010, 23 cases of uterus-like mass had been reported. Three pathologic theories of uterus-like mass have been proposed:  congenital anomaly theory,  metaplasia theory, and  heterotopia. The pathogenesis of this rare entity is currently under debate. Most uterus-like masses have been connected to the genital organs (75.0%) and associated with endometriosis (50.0%). In the present case, the uterus-like mass developed at the surgical scar site of oophorectomy for a sliding hernia and a tumorectomy for endometriosis. We review the literature and discuss the theories regarding the histogenesis of uterus-like mass.
No preview · Article · Dec 2010 · Fertility and sterility
[Show abstract][Hide abstract] ABSTRACT: A 25-year-old woman admitted for severe upper abdominal pain was found in ultrasonography to have a low echoic area in the lateral hepatic segment and free fluid was confirmed in the Morrison pouch, Douglas pouch and left subphrenic space. These findings and her shock status on presentation suggested intraabdominal hemorrhage due to hapatic tumor rupture. Enhanced computed tomography (CT) revealed extravasation from the liver tumor in segment 3. She underwent therapeutic arterial embolization (TAE) achieving successful hemostasis. Serum AFP and protein induced vitamin K absence (PIVKA) II were very high, yielding a definitive diagnosis of hapatocellular carcinoma. After initial recovery, she was considered suitable for curative hepatic resection and underwent left lateral segmentectomy. Peritoneal dissemination was not confirmed in laparotomy. Histological examination of the resected specimen showed moderately differentiated hepatocellular carcinoma. She has been regularly followed up and has shown no sign of tumor recurrence in the 21 months since surgery.
[Show abstract][Hide abstract] ABSTRACT: Primary small cell carcinoma of the breast is a very rare disease, and only a few case reports have described small cell carcinoma of the breast that responds to chemotherapy. Here, we report a case of primary small cell carcinoma of the breast that was treated with surgery and chemotherapy for postoperative local recurrence in the chest wall and metastasis to the liver. The metastatic lesions showed a partial response (PR) to carboplatin and irinotecan, but did not respond to subsequent Taxotere and doxifluridine (5'-DFUR) treatment. We then treated the metastatic lesions with CBDCA and etoposide (VP-16), and were able to stop disease progression. Small cell carcinoma of the breast is as aggressive as its pulmonary counterpart. Therefore, the best therapy for primary small cell carcinoma of the breast may be surgery followed by adjuvant therapy similar to that recommended for small cell lung carcinoma.
[Show abstract][Hide abstract] ABSTRACT: Hypercoagulation has been reported to be associated with tumor progression and a poor prognosis in various carcinomas. In this study, we examined fibrinogen levels in pretreated patients with esophageal squamous cell carcinoma (ESCC) and assessed its correlation with clinicopathological factors and prognosis in patients with ESCC.
Pretreatment fibrinogen levels were examined prior to surgery or other treatments (e.g. endoscopic mucosal resection and chemoradiotherapy [CRT]) in 105 patients with primary ESCC. We investigated the association of fibrinogen levels with clinicopathological background factors and the survival of ESCC patients.
The plasma fibrinogen concentration (PFC) ranged from 209.4 to 781.6 mg/dL. Pretreatment PFC correlated significantly with the depth of invasion (T factor). There also existed a significant correlation between higher fibrinogen levels and lymph node metastasis (N factor) and distant organ metastasis. Patients with a higher fibrinogen level experienced a significantly worse overall survival (P = 0.006). Fibrinogen levels strongly correlated with platelet counts, white blood cell counts and tumor length. Pretreatment PFC were observed to have a significant correlation with CRT responsiveness in ESCC patients in stages II and III (P = 0.005).
This study revealed that higher levels of fibrinogen correlated with tumor progression, metastasis and poor responsiveness to CRT in ESCC patients.
No preview · Article · Jan 2008 · Journal of Gastroenterology and Hepatology
[Show abstract][Hide abstract] ABSTRACT: We hypothesized that preoperative and/or postoperative enteral immune-enhanced formulas that are supplemented with arginine, omega-3 fatty acids, and RNA may reduce postoperative complications in patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma (ESCC).
Forty patients who underwent esophagectomy were divided into three groups: group A (n = 20) received a control enteral diet (Erental) through the jejunostomy after surgery. group B (n = 6) received an enteral diet supplemented with immune-enhancing substrates (Impact) containing arginine, omega-3 fatty acids, and RNA after surgery. group C (n = 14) received the impact before and after surgery.
Lymphocyte counts in group C on postoperative day (POD) 7 were somewhat higher than that in group A (p = 0.07) and significantly higher than in group B (p = 0.03). Furthermore the incidence of incisional wound infection in group C was significantly lower than that in group A (p = 0.03). Moreover, the duration of postoperative systemic inflammatory response syndrome (SIRS) was significantly shorter in group C than in group A (p < 0.05).
This study reveals that the perioperative immune-enhanced formula may be superior to postoperative control enteral formulas in terms of reducing surgical wound infection and postoperative SIRS, which may result in serious postoperative complications for patients who have undergone esophagectomy.
No preview · Article · Nov 2007 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of septic shock and acute respiratory distress syndrome (ARDS) associated with non-perforating appendicitis. A Japanese man in his 30s diagnosed with acute nonperforating appendicitis, treated conservatively with antibiotics upon admission, suffered severe septic shock the next day, necessitating emergency appendectomy. The appendix was gangrenous but not perforated macroscopically. After surgery, the patient suffered severe ARDS. He was treated with mechanical ventilation and endotoxin absorption therapy using polymyxin B-immobilized fiber direct hemoperfusion (PMX-DHP), enabling him to recover from sepsis and ARDS. Nonperforating appendicitis with severe sepsis are very rare, and only 7 cases, including our, have been reported in Japanese literature. It may thus be important to recognize the existence of nonperforating appendicitis with severe sepsis or ARDS.
No preview · Article · Nov 2007 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We report a very rare case of primary gastric small cell carcinoma (GSCC) that was accompanied with gastric tubular adenocarcinoma. A male in his 60s had an elevated tumor with a central ulceration in the middle stomach. The patient underwent a distal gastrectomy with lymph node dissection. The pathological examination showed two separated lesions of the stomach, which contained the components of primary GSCC and primary gastric tubular adenocarcinoma. Immunohistochemical (IHC) examination demonstrated that the tumor cells in the small cell carcinoma stained positive for synaptophysin, chromogranin A, and neural cell adhesion molecule (NCAM). GSCC cells and adenocarcinoma cells independently metastasized to each regional lymph node. Further studies on the biological behavior of individual tumors may allow the development of new treatment strategies for GSCC.
No preview · Article · Feb 2005 · International Journal of Gastrointestinal Cancer
[Show abstract][Hide abstract] ABSTRACT: Magnetic resonance imaging (MRI) has the potential to become a useful adjunct in breast imaging. Contrast-enhanced breast MRI has demonstrated a high sensitivity in the detection of benign and malignant breast disease. Our study aimed to correlate the dynamic contrast-enhanced MRI appearance of benign phyllodes tumor of the breast with histopathologic findings. We retrospectively reviewed the MRI findings in eight patients with benign phyllodes tumor of the breast to describe the image characteristics of this disease. The architectural features and enhancement patterns of this tumor were assessed and compared with other breast diseases. MRIs demonstrated some characteristics for large benign phyllodes tumors (more than 3 cm in size). On T(2)-weighted images, they were imaged as spotted tumors in high to iso signal intensity with cystic components or septations inside. In the time-signal intensity curve for the eight patients in our study who underwent dynamic MRI, we demonstrated two patterns of their curve: rapidly and gradually enhanced. In conclusion, MRI findings in benign phyllodes tumor include dynamic curves of gradually and rapidly enhancing types, and a low and inhomogeneous signal intensity on T(2)-weighted images compared with fibroadenoma. These findings appear to be useful for diagnosis.
No preview · Article · May 2004 · The Breast Journal
[Show abstract][Hide abstract] ABSTRACT: We have experienced a very rare case of ruptured pancreaticoduodenal artery aneurysm with acute gangrenous cholecystitis. A 67-year-old male complaining of epigastralgia was admitted to our hospital. Ultrasound sonography demonstrated acute cholecystitis and cholecystolithiasis. Computed tomography scan showed the findings of acute cholecystitis and retroperitoneal mass. Emergency laparotomy revealed an acute gangrenous cholecystitis and a retroperitoneal hematoma around the second portion of the duodenum. Cholecystectomy was performed, however, the bleeding vessel was not identified. The patient bled again from the abdomen on the 6th postoperative day. A postoperative angiography indicated an inferior pancreaticoduodenal artery aneurysm. A resection of the aneurysm was performed following the angiography. Pancreaticoduodenal artery aneurysms are uncommon and ruptured pancreaticoduodenal artery aneurysms result in fatal hemorrhage and high mortality. We reviewed the previously reported cases and discussed the suitable and expeditious diagnosis and management of the pancreaticoduodenal artery aneurysms.
No preview · Article · Mar 2004 · Hepato-gastroenterology