[Show abstract][Hide abstract] ABSTRACT: Denver Shunt® (DS) is used for palliating symptoms of intractable ascites in patients with cirrhosis or malignant ascites. We have 3 cases successfully treated with DS after pancreaticoduodenectomy (PD) for pancreatic cancer. Ascites was serous in 2 patients and chylous in 1 patient. Cytological evaluation of the ascites before DS placement was negative in all patients. DS was safely placed and was effective to quickly improve their symptoms of abdominal distention and fatigue. Two patients survived for about 1 year and 1 patient died 46 days after placement. Disseminated intravascular coagulation (DIC) and sepsis was observed in one patient. DS is an option for intractable ascites after PD in selected patients to improve the symptoms. Careful follow up is needed to avoid severe complications.
[Show abstract][Hide abstract] ABSTRACT: A 78-year-old man presented with a chiefcomplaint ofdysphagia. He was diagnosed with an esophageal squamous cell carcinoma and referred to our hospital. A type 3 tumor was identified in the lower thoracic esophagus on endoscopy. A CT scan revealed lymph node metastases at the No. 3 station. The clinical stage ofthe tumor was T3N1M0, Stage III. The patient was treated with neoadjuvant chemotherapy consisting of2 courses of5 -FU and nedaplatin. He had a partial response and underwent a radical esophagectomy. Histopathological examination revealed a complete response ofthe primary lesion and viable cancer cells in only one lymph node at the No. 3 station. No adjuvant chemotherapy was administered. Three months after the operation, recurrences in the upper abdominal multiple para-aortic lymph nodes were detected. Although he was treated with chemotherapy, he died 7 months after the operation. Even after a complete response of the primary lesion was achieved using neoadjuvant chemotherapy, esophageal cancer with lymph node metastasis has the potential for an early recurrence. Therefore, we should consider adjuvant therapy in such cases.
No preview · Article · Oct 2015 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: We evaluated the efficacy of intraperitoneal chemotherapy with cisplatin(CDDP)for peritoneal recurrent gastric cancer following surgical intervention. Twelve patients were enrolled. The combination systemic chemotherapy was S-1 or S-1 plus paclitaxel(S-1+PTX). PTX was administered intravenously at 80mg/m / 2 on day S-1 and 15. S-1 was administered at 80 mg/ m 2/ day for 7 consecutive days, followed by 7 days of rest, and the cycle was repeated. CDDP was administered intraperito- neally at 40mg/body on day 8. This treatment was repeated every 4 weeks until disease progression was diagnosed. The survival time(ST)and time to treatment failure(TTF)were estimated. The surgical interventions were gastrectomy in 3 patients, colostomy in 8 patients, and enterostomy in 1 patient. Overall, the median TTF and ST were 294 days and 455 days, respectively. When stratified by surgical method and combination chemotherapy, the median TTF and ST were not statistically significant. However, when stratified by performance status(PS), the median TTF was 352 days for patients with PS 0 and 218 days for those with PS 1, 2(p=0.0029), whereas the median ST was 553 days for patients with PS 0 and 331 days for those with PS 1, 2(p=0.0198). In conclusion, the data suggest that intraperitoneal CDDP chemotherapy with systemic chemotherapy is effective for the treatment of extensive peritoneal recurrent gastric cancer, especially in patients with good PS.
No preview · Article · Nov 2014 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: We report a case of gastrointestinal stromal tumor(GIST)locally resected after long-term chemotherapy with imatinib mesylate. A 78-year-old woman was diagnosed with GIST in the lower rectum on screening colonoscopy for anemia. The tumor was 7 cm in diameter, and the anal sphincter was considered to be difficult to preserve due to the extent of the tumor. The patient refused surgery, so she was administered imatinib mesylate chemotherapy. The medication was continued for 5 years without any major adverse events, and the status of the tumor was stable. Five years later, she underwent transanal local resection for anal prolapse and incarceration of the tumor. Pathological findings revealed a 7 cm sized high-risk GIST. The long-term stable status of the tumor was maintained, and the anal function was preserved by the local resection.
No preview · Article · Nov 2014 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: We report a case of a 68-year-old woman, who underwent extended right hepatectomy with extrahepatic bile duct resection for intrahepatic cholangiocarcinoma (ICC). Histopathological examination showed a mass-forming type of ICC and no lymph node metastasis. Adjuvant chemotherapy with gemcitabine and cisplatin was performed for 6 months after operation, and S-1 was administered intermittently from 11 months after operation, because the serum CA19-9 level was elevated without imaging evidence of recurrence. She presented with nausea and vomiting 32 months after operation. Upper gastrointestinal endoscopy showed pyloric stenosis. Enhanced CT showed a circumferential submucosal thickening of the pyloric wall. Distal gastrectomy was performed, and we considered a diagnosis of gastric cancer or metastatic gastric cancer from ICC. Histological findings of the gastric lesion were compatible with metastasis of ICC. Immunohistochemical staining of CK19 and CA19-9 were positive in both the primary and metastatic lesions. To the best of our knowledge, this is the first case of metachronous gastric metastasis from ICC.
No preview · Article · Jan 2014 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We report a case of retroperitoneal enteric duplication cyst (REDC) in an adult. A 46-year-old-woman was referred to our hospital. Enhanced CT showed a retroperitoneal cystic mass 4.6 cm in diameter. Endoscopic ultrasound (EUS) showed a cystic mass with a thick and multi-layered wall. It grew to 5.7 cm in diameter after 18 months later. Then tumor extirpation under laparotomy was performed. The cystic mass, located adjacent to the pancreatic head, did not communicate with any gastrointestinal tract and mesentery. Its wall had thick muscular layers lined with inner layers mimicking gastrointestinal mucosa. On histological examination, the diagnosis was an enteric duplication cyst. REDC that has neither communication nor common mesentery with gastrointestinal tracts is extremely rare. We should consider REDC when a retroperitoneal cystic mass with thick and layered wall is found by ultrasound (US).
No preview · Article · Jan 2014 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: We monitored serum p53 antibody (s-p53-Ab) titers in a 76-year-old man with esophageal adenocarcinoma, clinical stage III (T2N2M0), for over 4 years, including during the perioperative period and throughout follow-up after surgery. Screening tests for CA19-9 (205 IU/ml) and s-p53-Abs (381 U/ml) were positive before treatment. After neoadjuvant chemotherapy with 5-FU and cisplatin, CA19-9 decreased to the normal range, but the s-p53-Ab titer remained positive (224 U/ml). Pathological findings of surgically resected specimens showed stage T1b disease and no lymph node metastases. After surgery, s-p53-Ab titers consistently decreased, with no disease recurrence. Although the s-p53-Ab titer remained positive even after 4 years, it decreased to 8.66, 3.59, 2.38, and 1.92 U/ml, 1, 2, 3, and 4 years after surgery, respectively. Thus, monitoring perioperative changes in s-p53-Ab titers proved useful for detecting the presence of residual cancer cells in a patient with superficial esophageal adenocarcinoma.
[Show abstract][Hide abstract] ABSTRACT: Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic pancreatic resection, laparoscopic pancreaticoduodenectomy still presents major technical difficulties, such as when performing pancreatic-enteric anastomosis.
Laparoscopic dunking pancreaticojejunostomy using mattress sutures was performed in 15 consecutive patients with a soft pancreas and a nondilated pancreatic duct between October 2011 and December 2012.
According to the International Study Group on Pancreatic Fistula criteria, 3 patients developed PF (grade A), whereas the remaining 12 patients did not.
Dunking pancreaticojejunostomy using mattress sutures is considered to be a feasible and safe method for performing pure laparoscopic pancreaticoduodenectomy.
No preview · Article · Aug 2013 · Surgical Endoscopy
[Show abstract][Hide abstract] ABSTRACT: Purpose: There is no consensus regarding indications for additional surgery in postgastrectomy patients with gastric cancer with resection margin involvement. In this study, we examined cases with resection margin involvement at our hospital in order to determine the most appropriate treatment strategy. Methods: Fifty-nine cases with resection margin involvement after surgery for gastric cancer between January 2000 and September 2010 were analyzed clinicopathologically. Results: Positive resection margins were seen in 3.3% of cases, and the highest rate was seen in Stage IV disease. Additional surgery was performed in 3 out of 5 cases with early gastric cancer, and residual cancer was observed in 2 cases. Seventeen Stage II·III cases included significantly elevated numbers of large tumors, lymph node metastasis, invasion depth of serosa, and undifferentiated adenocarcinoma. Additional surgery was performed in 2 cases and chemotherapy was performed in 15 cases. The rate of distant recurrence within 2 postoperative years was 25% in Stage II, 42% in Stage IIIA, and 67% in Stage IIIB. Additional surgery was not performed in 37 cases of Stage IV advanced gastric cancer. Conclusion: Stage I patients may be considered as candidates for additional surgery. On the other hand, additional surgery is not recommended for Stage IV patients. Many cases of Stage II·III have high risk of distant recurrence. Indication for additional surgery is limited, and chemotherapy was performed in many cases. For Stage II·III patients, assessment for the need of additional surgery should be based on histopathological findings.
No preview · Article · Jan 2013 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Laparoscopic hemihepatectomy has not yet become widely accepted because of the technical difficulties in controlling each Glissonean pedicle laparoscopically.
Materials and surgical technique:
The subjects in the present study included 12 patients who underwent laparoscopic left hemihepatectomy between August 2007 and June 2011. Arantius' ligament was divided. Retracting the caudal stump of the ligament revealed a space between the left Glissonean pedicle and the liver parenchyma. The left Glissonean pedicle could be easily encircled by using an Endo Retract Maxi. No Glissonean injuries, including bleeding or biliary leakage, occurred in any of the 12 patients.
Therefore, the Arantius' ligament approach for the left extrahepatic Glissonean pedicle appears to be feasible and safe for successfully performing pure laparoscopic left hemihepatectomy.
No preview · Article · Nov 2012 · Asian Journal of Endoscopic Surgery
[Show abstract][Hide abstract] ABSTRACT: Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic major liver resection remains a highly specialized field because there are major technical difficulties, such as hilar dissection and pedicle control. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver. In contrast, the trunks of the secondary branches and more peripheral branches run inside the liver. The right, left, anterior, or posterior Glissonean pedicle can thus be tied and divided en bloc extrahepatically during open anatomical liver resection. Each Glissonean pedicle can be easily and safely encircled and divided en bloc extrahepatically during laparoscopic anatomical liver resection using an Endo Retract Maxi or Endo Mini-Retract. This report describes a novel technique by which the extrahepatic Glissonean approach appears to be both feasible and safe for the performance of laparoscopic major liver resection.
No preview · Article · Sep 2012 · Journal of Hepato-Biliary-Pancreatic Sciences
[Show abstract][Hide abstract] ABSTRACT: Pancreas-sparing duodenectomy (PSD) is a practical surgical procedure for patients with duodenal adenoma, which is difficult to resect endoscopically. We describe how we performed a totally laparoscopic PSD to resect a duodenal adenoma in a 64-year-old woman, who had been referred for treatment of a 50-mm villous polypoid mass in the second portion of the duodenum. We performed end-to-side anastomosis between the common duct of the bile and pancreatic ducts and the jejunal limb intracorporeally following the duodenal resection. A biliary leak developed, but resolved spontaneously and the patient was discharged on postoperative day (POD) 32. The surgical margin was free of neoplastic change. Although there is limited experience and appropriate indications must await future studies, this case demonstrates that laparoscopic PSD is feasible, safe, and effective for selected patients.
[Show abstract][Hide abstract] ABSTRACT: A 67-year-old woman had a 5 cm hepatic tumor of the lateral hepatic segment, associated with a peripheral lesion effect, based on abdominal contrast-enhanced CT, which was conducted when a diagnosis of dermatomyositis was made. The patient was negative for HBV as well as HCV, and the levels of AFP and PIVKA-2 were within the normal range. PET scan did not reveal extrahepatic primary lesions. Laparoscopic partial hepatectomy was performed for diagnosis and treatment. HE staining revealed the proliferation of small tumor cells with a high nucleoplasmic ratio and nuclear grade. As she was positive for CD56 and synaptophysin based on immunostaining, a diagnosis of small cell carcinoma of the liver was made. Two courses of CDDP and VP-16 were given postoperatively. However, she had recurrence of intra-abdominal lymph nodes 10 months postoperatively, and recurrence in the right adrenal gland 12 months postoperatively. She has survived for 16 months postoperatively without treatment. Small cell carcinoma of the liver is an extremely rare disease, and there is no consensus on the prognosis of and treatment methods for the disease.
No preview · Article · Jan 2012 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Recent technological developments and improved endoscopic procedures have greatly enlarged the applications of laparoscopic pancreatic resection.
A 77-year-old female with invasive ductal cancer of the pancreatic body touching the common hepatic and splenic arteries underwent a pure laparoscopic distal pancreatectomy with en bloc celiac axis resection (DP-CAR). The celiac axis, the celiac plexus and ganglions, the left gastric artery, the Gerota fascia, the left adrenal gland, and the retroperitoneal fat tissues above the left renal vein were removed en bloc.
The procedure took 245 minutes and there was minimal blood loss. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day. The surgical margins were histologically clear (R0 resection).
Pure laparoscopic DP-CAR is minimally invasive, safe and feasible, and can achieve R0 resection in selected patients with pancreatic invasive ductal adenocarcinoma.
No preview · Article · Nov 2011 · Journal of Laparoendoscopic & Advanced Surgical Techniques
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic pancreatic resection of pancreatic cancer is still not universally accepted as an alternative approach to open surgery because of technical difficulties and a lack of consensus regarding the adequacy of this approach for malignancy. Ten patients with pancreatic cancer underwent laparoscopic pancreatic resection, including pancreaticoduodenectomy and distal pancreatectomy in our institution. Eight of the 10 patients recovered without any complications and were discharged on the 10-29th postoperative day. The remaining 2 patients developed pancreatic fistula and were discharged on the 46 and 60th postoperative day, respectively. All lesions were well clear of surgical margins in 6 patients (R0). In the remaining 4 patients, microscopic neoplastic change was found at the surgical margin (R1). Those 4 patients developed tumor recurrence, including liver metastases or peritoneal dissemination, and 3 of the 4 died of the primary disease. Although experience is limited, laparoscopic pancreatic resection of pancreatic cancer can be feasible, safe, and effective in carefully selected patients. However, the benefit of this procedure has yet to be confirmed. Not only adequate experience in pancreatic surgery but also expertise in laparoscopy is mandatory, and careful selection of patients is essential for successful application of this procedure.
No preview · Article · May 2011 · Nippon Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic anatomical liver resection still presents major technical difficulties, such as pedicle control.
Subjects comprised 27 patients who underwent laparoscopic anatomical liver resection using an extrahepatic Glissonean pedicle transaction between August 2005 and February 2010.
A total of 61 Glissonean pedicles could be encircled en bloc extrahepatically, as planned. No serious complications, including major bleeding or injury of the portal triad, were encountered during procedures.
Extrahepatic Glissonean access seems to be feasible and safe for laparoscopic anatomical resection of the liver.
No preview · Article · Apr 2011 · Surgical Endoscopy
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old man was referred with lower rectal cancer showing anal canal invasion and liver metastasis. He underwent an abdominoperineal resection and a partial hepatectomy. Adjuvant therapy with tegafur-uracil and leucovorin was administered postoperatively. Lung metastasis was detected 2 years later and was resected. Right mandibular metastasis was diagnosed 2 months after the resection of the lung metastasis. A partial mandibular resection was performed after chemoradiotherapy, followed by reconstruction with a titanium frame and oral cavity reconstruction with a greater pectoral musculocutaneous flap. The pathological diagnosis was metastatic rectal cancer, and the therapeutic effect chemoradiotherapy was Grade 2. He is presently alive without any evidence of cancer, and has maintained a good quality of life 3 years after the mandibular resection and more than 5 years after his first operation. Mandibular metastasis from rectal cancer is very rare and the prognosis is poor according to the literature, so this case is considered to be very unusual.
[Show abstract][Hide abstract] ABSTRACT: The neutrophil-lymphocyte ratio (NLR) reflects inflammatory status. An elevated NLR has been reported to be a prognostic indicator in some malignant tumors. The aim of this study was to evaluate the clinical significance of the preoperative NLR in patients with primary gastric cancer.
A total of 709 men and 319 women, with a mean age of 64.4 years, who underwent gastrectomy were included. The numbers of patients in each pathological stage were as follows: stage I, 584; stage II, 132; stage III, 153; and stage IV, 159. The mean NLR was 2.62 +/- 1.68. A total of 127 patients (12.4%) with an NLR of 4.0 or more were classified as high NLR individuals in this study. The prognostic significance of a high NLR, together with various clinicopathological factors, was evaluated by multivariate analysis.
The 5-year survival of patients with a high NLR was significantly worse than that of patients with a low NLR (57% vs 82%, P < 0.001). Univariate and multivariate analyses of clinicopathological factors affecting survival revealed that high NLR, depth of tumor, positive lymph nodes, distant metastasis, peritoneal metastasis, poorly differentiated type, and high platelet count were significant risk factors for reduced survival. On multivariate analysis, after adjusting for tumor stage, a high NLR was an independent risk factor for reduced survival (P = 0.003; adjusted hazard ratio, 1.845; 95% confidence interval, 1.236-2.747).
A high preoperative NLR may be a convenient biomarker to identify patients with a poor prognosis after resection for primary gastric cancer.