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Hori T, Yasukawa D. Technical aspects in pancreaticoduodenectomy and therapeutic strategies for pancreatic cancer: History, current status, and future perspectives. Hepatobiliary Pancreat Dis Int 2022; 21:600-602. [PMID: 34497034 DOI: 10.1016/j.hbpd.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan.
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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Miyake T, Mori H, Yasukawa D, Hexun Z, Maehira H, Ueki T, Kojima M, Kaida S, Iida H, Shimizu T, Ohno M, Andoh A, Tani M. The Comparison of Fecal Microbiota in Left-Side and Right-Side Human Colorectal Cancer. Eur Surg Res 2021; 62:248-254. [PMID: 34198297 DOI: 10.1159/000516922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Microbiomes play a vital role in the development and progression of cancer. The clinical status, including prognosis, genetic mutations, and sensitivity to chemotherapy, differs depending on the location of colorectal cancer (CRC); however, the association between gut microbiota and the location of CRC is not entirely understood. This study was conducted to evaluate the differences in the gut microbiota in patients with CRC according to the location of the tumor. METHODS Fifty-six patients who underwent surgery for CRC between August 2018 and November 2019 were included in the study. Three patients who had received neoadjuvant therapy or antibiotic treatment within 1 month before surgery were excluded. The metagenomes of microbiota in preoperative feces were assessed using the V3-V4 region of 16s rRNA amplicon sequences. RESULTS The beta diversity of the Bray-Curtis distance was significantly higher in left-sided than in right-sided CRC. Fusobacterium predominated in left-sided CRC according to the linear discriminant analysis effect size method. Blautia, Eryspelotrichales, Holdemanella, Faecalibacterium, Subdoligranulum, and Dorea constituted the dominant intestinal flora in right-sided CRC. Pathway analysis revealed that L-lysine fermentation and cob(II)yrinate a,c-diamide biosynthesis I were predominant in left-sided CRC. DISCUSSION This study demonstrated that fecal microbiota in left-sided CRC constitutionally and functionally differ from those in right-side CRC. These results will help to elucidate the biological differences according to tumor location and develop treatments for human CRC.
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Affiliation(s)
- Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Zhang Hexun
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tomoyuki Ueki
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Tomoharu Shimizu
- Division of Medical Safety Section, Shiga University of Medical Science, Otsu, Japan
| | - Masashi Ohno
- Department of Intestinal Medicine, University of Medical Science, Otsu, Japan
| | - Akira Andoh
- Department of Intestinal Medicine, University of Medical Science, Otsu, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
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Maehira H, Iida H, Maekawa T, Yasukawa D, Mori H, Takebayashi K, Kaida S, Miyake T, Matsubara A, Tani M. Estimated functional remnant pancreatic volume predicts nonalcoholic fatty liver disease after pancreaticoduodenectomy: use of computed tomography attenuation value of the pancreas. HPB (Oxford) 2021; 23:802-811. [PMID: 33046368 DOI: 10.1016/j.hpb.2020.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a late complication of pancreaticoduodenectomy (PD). However, this complication is difficult to predict preoperatively. This study aimed to assess the association between NAFLD and preoperative computed tomography (CT) findings. METHODS Medical records of 112 patients who had undergone PD and had CT scans preoperatively and 6 months postoperatively were retrospectively reviewed. We evaluated several CT findings, including the CT attenuation value of the remnant pancreas, remnant pancreatic volume (RPV), and the estimated functional remnant pancreatic volume (eFRPV) on preoperative CT. The variables, including the CT findings and histopathological findings, were compared between the patients with and without NAFLD after PD. RESULTS The NAFLD group included 21 patients (18.8%). The CT attenuation value of the remnant pancreas was correlated with the pancreatic acinar cell density (r = 0.537), and was lower in the NAFLD group than in the non-NAFLD group (p = 0.007). The eFRPV was lower in the NAFLD group than in the non-NAFLD group (p = 0.002). An eFRPV ≤47 mL·HU was an independent predictive factor for NAFLD (p = 0.007; odds ratio: 6.73; 95% confidence interval: 1.70-26.70). CONCLUSION The eFRPV can be used to preoperatively predict NAFLD after PD.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | | | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akiko Matsubara
- Division of Diagnostic Pathology, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Tokuda A, Miyake T, Yasukawa D, Ikuta D, Mukaisho KI, Murata S, Shimizu T, Tani M. Cancer-derived Exosomes Activate Immune Surveillance and Suppress Peritoneal Metastasis of Murine Colonic Cancer. Anticancer Res 2021; 41:1327-1339. [PMID: 33788724 DOI: 10.21873/anticanres.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Colonic cancer is associated with a low incidence of peritoneal metastasis compared with gastric cancer; however, the reason for this remains unclear. In this study, a model of peritoneal dissemination using the CT26 murine colon cancer cell line was used to analyze the physiological roles of cancer-derived exosomes. MATERIALS AND METHODS Exosomes were collected from the supernatant of CT26 cell culture by ultracentrifugation. The number of peritoneal disseminations in two mouse models of colonic cancer pre-administered exosomes or phosphate-buffered saline were compared. RESULTS Cancer-derived exosomes suppressed peritoneal dissemination compared to phosphate-buffered saline. After administration of exosomes, the number of intraperitoneal macrophages and the expression of inducible nitric oxide synthase increased. Furthermore, cancer-derived exosomes increased activated natural killer cells and interferon-γ expression. CONCLUSION Tumor-derived exosomes from colonic cancer may suppress peritoneal metastasis via an immunological mechanism.
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Affiliation(s)
- Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan;
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Daiji Ikuta
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Department of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Maehira H, Iida H, Mori H, Yasukawa D, Maekawa T, Muramoto K, Takebayashi K, Kaida S, Miyake T, Tani M. Superior perianastomotic fluid collection in the early postoperative period affects pseudoaneurysm occurrence after pancreaticoduodenectomy. Langenbecks Arch Surg 2021; 406:1461-1468. [PMID: 33389107 DOI: 10.1007/s00423-020-02072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Pseudoaneurysm (PA) after pancreaticoduodenectomy (PD) is a harmful complication due to postoperative pancreatic fistula. However, the preventive method for PA is unclear. This study aimed to assess the risk factors for PA after PD and to evaluate the clinical features of patients with PA. METHODS Medical records of 54 patients who underwent PD and developed clinically relevant postoperative pancreatic fistula (POPF) were retrospectively reviewed. We evaluated postoperative computed tomography (CT) findings, including the perianastomotic fluid collection (PFC) location on postoperative day 4. Perioperative findings and postoperative CT findings were compared between patients with and without PA after PD. RESULTS The PA group included nine patients (17%). The median postoperative day of diagnosis of PA was 17 (range, 7-33). The PA locations were the gastroduodenal artery stump (n = 3), dorsal pancreatic artery (DPA) stump from the common hepatic artery (n = 4), DPA stump from the replaced right hepatic artery (n = 1), and inferior pancreaticoduodenal artery stump (n = 1). The prevalence of falciform ligament wrap to the hepatic artery was lower (33% vs. 78%, p = 0.014) and superior PFC prevalence was higher (100% vs. 58%, p = 0.019) in the PA group than in the non-PA group. Superior PFC reached the dorsal part of the caudate lobe of the liver in all patients with PA. Furthermore, all PAs occurred at the arteries that could not be wrapped by the falciform ligament. CONCLUSION Prevention of superior PFC and falciform ligament wrapping may reduce PA occurrence after PD with clinically relevant POPF.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Keiji Muramoto
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Maehira H, Iida H, Matsunaga T, Yasukawa D, Mori H, Miyake T, Tani M. The location of perianastomotic fluid collection predicts postoperative complications after pancreaticoduodenectomy. Langenbecks Arch Surg 2020; 405:325-336. [PMID: 32323009 DOI: 10.1007/s00423-020-01880-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/03/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Perianastomotic fluid collection (PFC) is one of the postoperative complications of pancreaticoduodenectomy (PD). However, no studies have investigated the clinical significance of PFC location and volume during the early postoperative period. This study aimed to assess the association between PFC during the early postoperative period and postoperative complications. METHODS Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The location-superior, inferior, ventral, dorsal, or splenic hilum-and PFC index, which is the estimated volume of fluid collection, were determined using CT. The associations between postoperative complication and the presence of PFC, and PFC index according to the location, were assessed. RESULTS The PFC group included 102 patients (69%). Postoperative pancreatic fistula (POPF) and organ/space surgical site infection (SSI) were more frequent in the PFC group (42% vs 9%, p < 0.001 and 29% vs 11%, p = 0.020, respectively). Additionally, the PFC index was larger in patients who developed POPF, organ/space SSI, or pseudoaneurysm (81 cm3 vs 19 cm3, p < 0.001; 75 cm3 vs 30 cm3, p = 0.001; and 185 cm3 vs 31 cm3, p < 0.001, respectively). Furthermore, superior and ventral PFCs were associated with pseudoaneurysm (11% vs 0%, p = 0.006 and 14% vs 1%, p = 0.002, respectively), whereas inferior and dorsal PFCs were associated with deep incisional SSI (9% vs 0%, p = 0.027 and 8% vs 1%, p = 0.034, respectively). CONCLUSION The PFC location during the early postoperative period is associated with postoperative complications. Our findings may help determine the optimal location of prophylactic drains.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Takashi Matsunaga
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Iida H, Sasaki M, Maehira H, Mori H, Yasukawa D, Takebayashi K, Kurihara M, Bamba S, Tani M. The effect of preoperative synbiotic treatment to prevent surgical-site infection in hepatic resection. J Clin Biochem Nutr 2020; 66:67-73. [PMID: 32001959 PMCID: PMC6983438 DOI: 10.3164/jcbn.19-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/05/2019] [Indexed: 11/22/2022] Open
Abstract
We aimed to clarify the influence of preoperative synbiotic therapy on surgical-site infections (SSIs) after hepatic resection. Between January 2011 and December 2017, 284 patients who underwent hepatic resection without biliary tract reconstruction and resection of other organs were included. We prospectively administered Clostridium butyricum and partially hydrolyzed guar gum before hepatic resection between April 2016 and December 2017 (synbiotic group). One-hundred-fifteen patients of the synbiotic group and 169 patients (conventional group) treated between January 2011 and the end of March 2016 were compared using propensity score matching. The frequency of laparoscopic resection was significantly larger in the synbiotic group (conventional group; 28% vs synbiotic group; 55%, p<0.001) and the amount of intraoperative bleeding was significantly smaller in the synbiotic group (median; conventional group, 700 ml vs synbiotic group, 200 ml; p<0.001). The postoperative SSI was significantly lower in the synbiotic group of six patients (5.2%) than in the conventional group of 30 patients (17.8%) (p = 0.002). Sixty patients in each group remained after propensity score matching. There was no significant difference in the incidence of SSI between the groups (conventional group, 15% vs synbiotic group, 6.7%; p = 0.239). In conclusion, preoperative synbiotic treatment did not reduce SSIs after hepatic resection.
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Affiliation(s)
- Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Mika Kurihara
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Shigeki Bamba
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
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Maehira H, Miyake T, Iida H, Tokuda A, Mori H, Yasukawa D, Mukaisho KI, Shimizu T, Tani M. Vimentin Expression in Tumor Microenvironment Predicts Survival in Pancreatic Ductal Adenocarcinoma: Heterogeneity in Fibroblast Population. Ann Surg Oncol 2019; 26:4791-4804. [PMID: 31583548 DOI: 10.1245/s10434-019-07891-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The tumor microenvironment, including cancer-associated fibroblasts (CAFs), plays various clinical roles in cancer growth. CAFs are a heterogeneous population and express a variety of mesenchymal markers. However, the clinical roles for CAFs expressing different markers in pancreatic ductal adenocarcinoma (PDAC) remain unknown. METHODS We reviewed 67 resected PDAC patients who had not received preoperative therapy. Each primary tumor was analyzed for vimentin and α-smooth muscle actin (α-SMA) expression by immunohistochemical and dual immunofluorescence staining. RESULTS There was no correlation between the percentage of cells expressing vimentin and α-SMA in the tumor stroma (Pearson's correlation coefficient: r = 0.171). Higher vimentin expression (p = 0.018) was associated with significantly shorter overall survival in PDAC patients. Using dual immunofluorescence staining, vimentin-positive CAFs were divided into two subpopulations: co-expression of α-SMA, and no co-expression of α-SMA. In PDAC, the level of co-expression had no effect on survival using univariate analysis (median survival time, 33.3 months for low co-expression vs. 18.2 months for high co-expression; log-rank, p = 0.143). However, multivariate analysis clarified that CAFs expressing vimentin alone was an independent predictor of poor survival (p = 0.014; hazard ratio, 2.305; 95% confidence interval, 1.181-4.497). CONCLUSIONS Vimentin-positive CAFs without co-expression of α-SMA were associated with poor survival in PDAC, and CAFs possessed molecular and functional heterogeneity in this disease.
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Affiliation(s)
- Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Department of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu-shi, Shiga, Japan
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Hori T, Ogawa K, Yamamoto H, Harada H, Matsumura K, Yamamoto M, Yamada M, Yazawa T, Kuriyama K, Tani M, Yasukawa D, Kamada Y, Aisu Y, Tani R, Aoyama R, Nakayama S, Sasaki Y, Nishimoto K, Zaima M. Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports. World J Clin Cases 2019; 7:2526-2535. [PMID: 31559288 PMCID: PMC6745316 DOI: 10.12998/wjcc.v7.i17.2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/10/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess. This refractory complication can be fatal; therefore, intensive treatment is important. Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis, and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL. We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.
CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and pancreatic leakage was observed postoperatively. Intractable pancreatic fistula led to intraperitoneal abscess, and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8. The abscess resolved after 7 d of CLL. The second patient underwent distal pancreatectomy. Pancreatic leakage was observed, and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump. CLL was instituted from POD 9, and the abscess resolved after 4 d of CLL. The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma. Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula; however, intraperitoneal abscess was detected on POD 59. We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult. CLL was instituted from POD 63, and the abscess resolved after 1 wk of CLL.
CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary Pancreatic and Breast Surgery, Ehime University, Toon 791-0295, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kazuyoshi Matsumura
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | | | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Katsutoshi Kuriyama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Shinnosuke Nakayama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Koki Nishimoto
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
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Kitano T, Aisu Y, Yasukawa D, Hori T. Aggressive Graphic/Surgical R0 Resection and Jejunal Interposition with Preservation of Mesojejunal Autonomic Nerves in Patients with Stage IV Esophagogastric Junction Adenocarcinoma: A Report of 3 Cases. Am J Case Rep 2019; 20:465-473. [PMID: 30952831 PMCID: PMC6463956 DOI: 10.12659/ajcr.913960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Three patients with stage IV esophagogastric junction cancer (EGJC) underwent extended resection to achieve a graphic/surgical R0 status (no visible remnant of viable tumor in imaging/surgical findings) and adjuvant chemotherapy from the early postoperative period. We also introduced use of our digestive reconstruction technique in these patients. CASE REPORT We used jejunal interposition for digestive reconstruction, which involved end-to-end jejunojejunostomy with a biofragmentable anastomosis ring. The mesojejunal autonomic nerves of the lifted jejunum were preserved. The first adenocarcinoma involved the perilesional lymph nodes (LNs). Graphic/surgical R0 resection was completed by para-aortic LN dissection. The diagnosis (Japanese Classification of Gastric Carcinoma) was stage IV [pM1(LYM)]. Adjuvant chemotherapy began on postoperative day (POD) 11. The second adenocarcinoma was accompanied by a solitary lung metastasis. Intraoperative cytology of ascitic fluid was positive, and cisplatin was intraperitoneally administered. Adjuvant chemotherapy began on POD 10. The solitary lung metastasis was then resected, and graphic/surgical R0 resection was achieved. The diagnosis was stage IV [pM1(PUL) and CY1]. The third adenocarcinoma was accompanied by multiple liver metastases and metastatic regional LNs. The diagnosis was stage IV [H1]. Systemic chemotherapy was repeated. Only a solitary liver metastasis remained and was treated by radiofrequency ablation. Conversion surgery was conducted, achieving graphic/surgical R0 resection. Systemic chemotherapy was continued from POD 10. CONCLUSIONS For patients with stage IV EGJC, extended resection to achieve a graphic/surgical R0 status is still controversial, and systemic chemotherapy is important. The results of the present study suggest that our physiological reconstruction technique does not affect the efficacy of other therapies, such as adjuvant chemotherapy.
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Aisu Y, Hori T, Kato S, Ando Y, Yasukawa D, Kimura Y, Takamatsu Y, Kitano T, Kadokawa Y. Brachial plexus paralysis after thoracoscopic esophagectomy for esophageal cancer in the prone position: A thought-provoking case report of an unexpected complication. Int J Surg Case Rep 2019; 55:11-14. [PMID: 30654315 PMCID: PMC6348979 DOI: 10.1016/j.ijscr.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
This is the first case of brachial plexus injury during thoracoscopic esophagectomy in the prone position. This paralysis is due to excessive abduction and external rotation associated with the intraoperative position. To avoid intraoperative brachial plexus injury in the prone position, thoughtful orientation of the head and right arm in a less loaded position is important.
Introduction During prone esophagectomy, placement of a port in the third intercostal space for upper mediastinal dissection requires adequate axillary expansion. To facilitate this, the right arm is elevated cranially and simultaneously turned outward. Brachial plexus paralysis associated with esophagectomy in the prone position has not been documented. Presentation of case A 58-year-old man diagnosed with middle intrathoracic esophageal cancer was referred to our department. Thoracoscopic esophagectomy in the prone position was performed following neoadjuvant chemotherapy. After surgery, he complained of difficulty moving his right arm. Physical examination revealed perceptual dysfunction and movement disorder in the territory of cervical spinal nerve 6. Magnetic resonance imaging indicated the injury in the right posterior cord of the brachial plexus at the costoclavicular space. Therefore, we diagnosed the patient with right brachial plexus injury caused by the intraoperative position. The postoperative course was uneventful other than the brachial plexus paralysis, and he was discharged on postoperative day 23. He underwent continuous rehabilitation as an outpatient, and the right brachial plexus paralysis had completely disappeared by 2 months after surgery. Discussion This is the first case of brachial plexus injury during thoracoscopic esophagectomy in the prone position. In prone esophagectomy, managing the patient’s position, especially the head and arm positions, is so important to avoid brachial plexus injury due to intraoperative positioning. Conclusion The clinicians should consider managing the patient’s position with anatomical familiarity to avoid brachial plexus injury due to intraoperative positioning.
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Affiliation(s)
- Yuki Aisu
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Tomohide Hori
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa Prefecture, 761-0793, Japan.
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
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Yasukawa D, Kadokawa Y, Kato S, Aisu Y, Hori T. Safety and feasibility of laparoscopic gastrectomy accompanied by D1+ lymph node dissection for early gastric cancer in elderly patients. Asian J Endosc Surg 2019; 12:51-57. [PMID: 29577648 DOI: 10.1111/ases.12480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/25/2018] [Accepted: 02/18/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The age of patients with gastric cancer has increased worldwide. The aim of this study was to investigate the safety and feasibility of laparoscopic gastrectomy (LG) for early gastric cancer in elderly patients. METHODS We retrospectively investigated 221 consecutive patients who underwent LG for early gastric cancer during a 5-year period (January 2010 to December 2014). We divided the patients into two groups: elderly patients (≥75 years old) and younger patients (<75 years old). We compared these two groups with respect to clinical characteristics, histopathological findings, intraoperative factors, and postoperative outcomes. RESULTS The preoperative characteristics were similar in both groups. Except for the number of harvested lymph nodes (42.0 vs 34.9; P = 0.0016), the short-term operative outcomes, including postoperative complications and histopathological findings, were comparable between the two groups. Although significantly fewer lymph nodes were harvested in the elderly group, the overall survival and relapse-free survival rates did not significantly differ between the groups. Postoperative complications, such as acute cholecystitis and internal hernia, occurred during the long-term postoperative period after LG, and these unexpected complications were more frequently observed in elderly patients. All elderly patients required additional emergent surgeries for delayed complications. CONCLUSION The outcomes of LG for early gastric cancer in elderly patients seem to be reasonable. Aggressive lymph node dissection may be omissible in elderly patients with acceptable results. LG can be a safe and feasible procedure in elderly patients. However, the higher rate of delayed but urgent complications during the long-term postoperative period must be considered.
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Affiliation(s)
- Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
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15
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Yasukawa D, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Hori T. Internal Hernia Associated with Colostomy After Laparoscopic Surgery for Rectal Malignancy: A Report of 3 Thought-Provoking Cases. Am J Case Rep 2018; 19:1488-1494. [PMID: 30546005 PMCID: PMC6302771 DOI: 10.12659/ajcr.912676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Case series Patients: Male, 70 • Male, 75 • Male, 85 Final Diagnosis: Internal hernia Symptoms: Abdominal and/or epigastric pain Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan.,Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
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16
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Aisu Y, Yasukawa D, Kimura Y, Hori T. Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits. World J Gastrointest Oncol 2018; 10:381-397. [PMID: 30487950 PMCID: PMC6247108 DOI: 10.4251/wjgo.v10.i11.381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.
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Affiliation(s)
- Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri 632-8552, Nara, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yusuke Kimura
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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Kitano T, Yasukawa D, Aisu Y, Hori T. Overlap Anastomosis for Digestive Reconstruction during Laparoscopic Distal Gastrectomy with Intensive Regional Lymph Node Dissection: Physiological Impact of Preserving the Mesenteric Autonomic Nerves in the Lifted Jejunal Limb. Surg Res Pract 2018; 2018:4938341. [PMID: 30345344 PMCID: PMC6174744 DOI: 10.1155/2018/4938341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022] Open
Abstract
Laparoscopic gastrectomy is a treatment for gastric cancer, and isoperistaltic side-to-side reconstruction is called "overlap anastomosis." The physiological advantages of preserving the autonomic nerves in the jejunal limb for digestive reconstruction are well known. Here, we focused on overlap anastomosis with autonomic nerve-preserved mesojejunum of the lifted jejunal limb for laparoscopic distal gastrectomy with intentional lymph node dissection. Our surgical techniques and technical pitfalls were described in detail. The jejunum was partially sacrificed to preserve the autonomic nerves in the lifted jejunal limb. The length of the staple line was 35 - 40 mm. The endostapler entry was carefully closed to avoid even subtle stenosis. Twelve patients were retrospectively evaluated with a follow-up of 5.0 ± 0.6 years. Histological findings according to the Japanese classification were stage IA or IB. Dietary intake and postoperative ambulation occurred at 3.3 ± 1.0 and 1.3 ± 0.5 days after surgery, respectively. Postoperative complications according to Clavien-Dindo classification were one each of grade I and grade II. Postoperative hospital stay was 6.7 ± 1.6 days. Five patients were medication-free at final follow-up, with no recurrence in any patient. Overlap anastomosis with autonomic nerve-preserved jejunal limb was safe and feasible for laparoscopic distal gastrectomy with lymph node dissection.
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Affiliation(s)
- Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, Tenri, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Japan
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Takamatsu Y, Yasukawa D, Aisu Y, Hori T. Successful Laparoscopic Cholecystectomy in Moderate to Severe Acute Cholecystitis: Visual Explanation with Video File. Am J Case Rep 2018; 19:962-968. [PMID: 30111767 PMCID: PMC6106691 DOI: 10.12659/ajcr.909586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/02/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Experience alone is insufficient to ensure successful laparoscopic cholecystectomy (LC), although LC has become widespread worldwide. Iatrogenic biliary injuries occur beyond the learning curve. CASE REPORT Biliary injury during laparoscopic cholecystectomy results from anatomical misidentification. The use of a critical view of safety has been established, to identify the cystic artery and the cystic duct, as the cystic duct can be hidden by inflammation (infundibular cystic duct). Seven patients who underwent emergency laparoscopic cholecystectomy due to acute cholecystitis are presented who underwent a critical view of safety protocol during surgery. Five men and two women (mean age, 63.0±13.0 years) included five cases of acute severe cholecystitis and two cases of acute moderate cholecystitis. The mean operative time to complete the critical view of safety exposure was 54.0±17.4 minutes. No cases underwent conversion to open surgery. The mean postoperative duration to ambulation and normal diet was 0.7±0.5 days and 1.0±0.6 days, respectively. The mean time to postoperative patient discharge was 3.9±0.9 days. In all seven cases, the postoperative course was uneventful. The protocol for this surgical procedure is presented, with schematic figures and videos. CONCLUSIONS A case series of seven patients who presented with moderate-to-severe acute cholecystitis and who underwent laparoscopic cholecystectomy, showed good postoperative outcome without surgical complications, using a using a critical view of safety protocol.
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Kimura Y, Hori T, Machimoto T, Ito T, Hata T, Kadokawa Y, Kato S, Yasukawa D, Aisu Y, Takamatsu Y, Kitano T, Yoshimura T. Portal vein aneurysm associated with arterioportal fistula after hepatic anterior segmentectomy: Thought-provoking complication after hepatectomy. Surg Case Rep 2018; 4:57. [PMID: 29904893 PMCID: PMC6002328 DOI: 10.1186/s40792-018-0465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Few cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication. Case presentation A 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle. The patient was discharged on postoperative day 14. Three months later, dynamic magnetic resonance imaging showed an arterioportal fistula and portal vein aneurysm. Surprisingly, the patient did not have subtle symptoms. Although a perfect angiographic evaluation could not be ensured, we performed angiography with subsequent interventional radiology to avoid sudden rupture. Arteriography was immediately performed to create a portogram via the APF from the stump of the anterior hepatic artery, and portography clearly revealed hepatofugal portal vein flow. Portography also showed that the stump of the anterior portal vein had developed a 40-mm-diameter portal vein aneurysm. Selective embolization of the anterior hepatic artery was accomplished in the whole length of the stump of the anterior hepatic artery, and abnormal blood flow through the APF was drastically reduced. The portal vein aneurysm disappeared, and portal flow was normalized. Dynamic computed tomography after embolization clearly demonstrated perfect interruption of the APF. The patient maintained good health thereafter. Conclusions Post-hepatectomy APFs are very rare, and some appear to be cryptogenic. Our thought-provoking case may help to provide a possible explanation of the causes of post-hepatectomy APF.
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan.
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture, 632-8552, Japan
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Kimura Y, Machimoto T, Yasukawa D, Aisu Y, Hori T. Acute appendicitis caused by metastatic adenocarcinoma from the lung: a case report. Surg Case Rep 2018; 4:59. [PMID: 29904902 PMCID: PMC6003897 DOI: 10.1186/s40792-018-0467-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Appendiceal metastasis from lung cancer is rare. However, it often causes acute appendicitis that requires emergency surgery. We herein report a thought-provoking case of appendiceal metastasis from lung cancer. Case presentation A 71-year-old man was diagnosed with advanced lung cancer with multiple metastases and underwent chemotherapy. One month later, he developed acute appendicitis, and laparoscopic appendectomy was promptly performed. A swollen appendix and pus collection were observed during surgery. Histological analysis revealed an invasive adenocarcinoma in the appendix that infiltrated the mucosal, submucosal, and muscular layers. Positive immunostaining of thyroid transcription factor 1 indicated appendiceal metastasis of pulmonary adenocarcinoma, not a primary appendiceal malignancy. The postoperative course was uneventful, and the patient’s pulmonary internist resumed continuous chemotherapy after surgery. Conclusions Although appendiceal metastasis from pulmonary adenocarcinoma is rare, it often results in acute appendicitis. Optimal therapy including emergency surgery should be performed without hesitation so that chemotherapy can be resumed as soon as possible.
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
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Aisu Y, Kato S, Kadokawa Y, Yasukawa D, Kimura Y, Takamatsu Y, Kitano T, Hori T. Feasibility of Extended Dissection of Lateral Pelvic Lymph Nodes During Laparoscopic Total Mesorectal Excision in Patients with Locally Advanced Lower Rectal Cancer: A Single-Center Pilot Study After Neoadjuvant Chemotherapy. Med Sci Monit 2018; 24:3966-3977. [PMID: 29890514 PMCID: PMC6026381 DOI: 10.12659/msm.909163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The feasibility of additional dissection of the lateral pelvic lymph nodes (LPLNs) in patients undergoing total mesorectal excision (TME) combined with neoadjuvant chemotherapy (NAC) for locally advanced rectal cancer (LARC) is controversial. The use of laparoscopic surgery is also debated. In the present study, we evaluated the utility of laparoscopic dissection of LPLNs during TME for patients with LARC and metastatic LPLNs after NAC, based on our experience with 19 cases. MATERIAL AND METHODS Twenty-five patients with LARC with swollen LPLNs who underwent laparoscopic TME and LPLN dissection were enrolled in this pilot study. The patients were divided into 2 groups: those patients with NAC (n=19) and without NAC (n=6). Our NAC regimen involved 4 to 6 courses of FOLFOX plus panitumumab, cetuximab, or bevacizumab. RESULTS The operative duration was significantly longer in the NAC group than in the non-NAC group (648 vs. 558 minutes, respectively; P=0.022). The rate of major complications, defined as grade ≥3 according to the Clavien-Dindo classification, was similar between the 2 groups (15.8% vs. 33.3%, respectively; P=0.4016). No conversion to conventional laparotomy occurred in either group. In the NAC group, a histopathological complete response was obtained in 2 patients (10.5%), and a nearly complete response (Tis N0 M0) was observed in one patient (5.3%). Although the operation time was prolonged in the NAC group, the other perioperative factors showed no differences between the 2 groups. CONCLUSIONS Laparoscopic LPLN dissection is feasible in patients with LARC and clinically swollen LPLNs, even after NAC.
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Yasukawa D, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Hori T. Which Therapeutic Option Is Optimal for Surgery-Related Perineal Hernia After Abdominoperineal Excision in Patients with Advanced Rectal Cancer? A Report of 3 Thought-Provoking Cases. Am J Case Rep 2018; 19:663-668. [PMID: 29880788 PMCID: PMC6024713 DOI: 10.12659/ajcr.909393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Case series Patient: Male, 72 • Male, 71 • Male, 76 Final Diagnosis: Postoperative perineal hernia Symptoms: Perineal discomfort Medication: — Clinical Procedure: Hernia repair Specialty: Surgery
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Affiliation(s)
- Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
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Kimura Y, Yasukawa D, Aisu Y, Hori T. Imanaga's First Method for Reconstruction with Preservation of Mesojejunal Autonomic Nerves During Pylorus-Preserving Pancreatoduodenectomy. Am J Case Rep 2018; 19:608-613. [PMID: 29805155 PMCID: PMC6004051 DOI: 10.12659/ajcr.908817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Case series Patient: — Final Diagnosis: Pancreatic diseases Symptoms: Postoperative physiologic function Medication: — Clinical Procedure: Imanaga’s first method Specialty: Surgery
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, Tenri, Nara, Japan
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Hori T, Yasukawa D, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Surgical options for full-thickness rectal prolapse: current status and institutional choice. Ann Gastroenterol 2018; 31:188-197. [PMID: 29507465 PMCID: PMC5825948 DOI: 10.20524/aog.2017.0220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/08/2017] [Indexed: 12/14/2022] Open
Abstract
Full-thickness rectal prolapse (FTRP) is generally believed to result from a sliding hernia through a pelvic fascial defect, or from rectal intussusception. The currently accepted cause is a pelvic floor disorder. Surgery is the only definitive treatment, although the ideal therapeutic option for FTRP has not been determined. Auffret reported the first FTRP surgery using a perineal approach in 1882, and rectopexy using conventional laparotomy was first described by Sudeck in 1922. Laparoscopy was first used by Bermann in 1992, and laparoscopic surgery is now used worldwide; robotic surgery was first described by Munz in 2004. Postoperative morbidity, mortality, and recurrence rates with FTRP surgery are an active research area and in this article we review previously documented surgeries and discuss the best approach for FTRP. We also introduce our institution's laparoscopic surgical technique for FTRP (laparoscopic rectopexy with posterior wrap and peritoneal closure). Therapeutic decisions must be individualized to each patient, while the surgeon's experience must also be considered.
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Affiliation(s)
- Tomohide Hori
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuichi Takamatsu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
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Aisu Y, Kadokawa Y, Kato S, Yasukawa D, Kimura Y, Hori T. Robot-assisted distal gastrectomy with lymph node dissection for gastric cancer in a patient with situs inversus partialis: a case report with video file. Surg Case Rep 2018; 4:16. [PMID: 29441475 PMCID: PMC5811421 DOI: 10.1186/s40792-018-0422-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/30/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Situs inversus is a rare congenital condition that is currently classified into two types: complete situs inversus (situs inversus totalis, SIT) and partial situs inversus (situs inversus partialis, SIP). In SIP patients, some organs are inverted and others are in their expected position, and individual patient variation in organ position increases surgical difficulty. Several surgeons have performed laparoscopic or robotic surgeries in situs inversus patients, but almost all were SIT patients. We report the first case, to our knowledge, of an SIP patient with gastric cancer who was successfully treated by robot-assisted distal gastrectomy (RADG) with lymph node dissection. CASE PRESENTATION A 64-year-old woman diagnosed with early gastric cancer on the posterior midbody of the stomach was referred to our hospital for treatment. Computed tomography showed levocardia and inverted abdominal organs without enlarged lymph nodes or distant metastases. Polysplenia syndrome, intestinal malrotation, and left-sided gallbladder were also detected. RADG with D1+ lymph node dissection and Billroth I reconstruction (delta-shaped anastomosis) were performed using robotics. Hepatopathy caused by a liver retractor and pancreatic fistula were identified during the postoperative course, and the latter was classified as grade II based on Clavien-Dindo classification. The patient was discharged 18 days after the operation. CONCLUSIONS Preoperative three-dimensional imaging is beneficial, and anatomical organ identification should be routinely performed, especially in SIP patients. We consider RADG a therapeutic option in SIP patients.
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Affiliation(s)
- Yuki Aisu
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
| | - Tomohide Hori
- Department of Gastrointestinal Surgery, Tenri Yorozu Sōdanjo Hospital, 200 Mishima-cho, Tenri City, Nara Prefecture 632-8552 Japan
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Takamatsu Y, Hori T, Machimoto T, Hata T, Kadokawa Y, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Kitano T, Yoshimura T. Intentional Modulation of Portal Venous Pressure by Splenectomy Saves the Patient with Liver Failure and Portal Hypertension After Major Hepatectomy: Is Delayed Splenectomy an Acceptable Therapeutic Option for Secondary Portal Hypertension? Am J Case Rep 2018; 19:137-144. [PMID: 29410393 PMCID: PMC5810619 DOI: 10.12659/ajcr.907178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Major or aggressively-extended hepatectomy (MAEH) may cause secondary portal hypertension (PH), and postoperative liver failure (POLF) and is often fatal. Challenges to prevent secondary PH and subsequent POLF, such as shunt creation and splenic arterial ligation, have been reported. However, these procedures have been performed simultaneously only during the initial MAEH. CASE REPORT A 58-year-old female with chronic hepatitis C developed a solitary hepatic cellular carcinoma with portal tumor thrombosis. Blood examination and imaging revealed a decreased platelet count and splenomegaly. Her liver viability was preserved, and collaterals did not develop, and her tumor thrombosis forced us to perform a right hepatectomy from an oncological standpoint. The estimated volume of her liver remnant was 51.8%. A large volume of ascites and pleural effusion were observed on post-operative day (POD) 3, and ascetic infection occurred on POD 14. Hepatic encephalopathy was observed on POD 16. According to the post-operative development of collaterals due to secondary PH, submucosal bleeding in the stomach occurred on POD 37. Though it is unclear whether delayed portal venous pressure (PVP) modulation after MAEH is effective, a therapeutic strategy for recovery from POLF may involve PVP modulation to resolve intractable PH. We performed a splenectomy on POD 41 to reduce PVP. The initial PVP value was 32 mm Hg, and splenectomy decreased PVP to 23 mm Hg. Thereafter, she had a complete recovery from POLF. CONCLUSIONS Our thought-provoking case is the first successfully-treated case of secondary PH and POLF after MAEH, achieved by delayed splenectomy for PVP modulation.
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Affiliation(s)
- Yuichi Takamatsu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Toshiyuki Hata
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Yoshio Kadokawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Tatsuo Ito
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Shigeru Kato
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
| | - Tsunehiro Yoshimura
- Department of Digestive Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara, Japan
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Hori T, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Sasaki M, Takamatsu Y, Kitano T, Hisamori S, Yoshimura T. Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy. World J Gastroenterol 2017; 23:5849-5859. [PMID: 28932077 PMCID: PMC5583570 DOI: 10.3748/wjg.v23.i32.5849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
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Affiliation(s)
- Tomohide Hori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Maho Sasaki
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeo Hisamori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
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Sasaki M, Hori T, Furuyama H, Machimoto T, Hata T, Kadokawa Y, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Postoperative Biliary Leak Treated with Chemical Bile Duct Ablation Using Absolute Ethanol: A Report of Two Cases. Am J Case Rep 2017; 18:871-877. [PMID: 28784937 PMCID: PMC5560470 DOI: 10.12659/ajcr.905093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Case series Patient: Female, 72 • Male, 78 Final Diagnosis: Postoperative biliary leakage Symptoms: Refractory and intractable symptoms Medication: — Clinical Procedure: Chemical ablation Specialty: Surgery
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Affiliation(s)
- Maho Sasaki
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tomohide Hori
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Hiroaki Furuyama
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Nara, Japan
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Yasukawa D, Hori T, Machimoto T, Hata T, Kadokawa Y, Ito T, Kato S, Aisu Y, Kimura Y, Takamatsu Y, Kitano T, Yoshimura T. Outcome of a Modified Laparoscopic Suture Rectopexy for Rectal Prolapse with the Use of a Single or Double Suture: A Case Series of 15 Patients. Am J Case Rep 2017; 18:599-604. [PMID: 28555067 PMCID: PMC5459315 DOI: 10.12659/ajcr.905118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/20/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Surgery is considered to be a mainstay of therapy for full-thickness rectal prolapse (FTRP). Surgical procedures for FTRP have been described, but optimal treatment is still controversial. The aim of this report is to evaluate the safety and feasibility of a simplified laparoscopic suture rectopexy (LSR) in a case series of 15 patients who presented with FTRP and who had postoperative follow-up for six months. CASE REPORT Fifteen patients who underwent a modified LSR at our surgical unit from September 2010 were retrospectively evaluated. The mean age of the patients was 72.5±10.9 years. All 15 patients underwent general anesthesia, with rectal mobilization performed according to the plane of the total mesorectal excision. By lifting the mobilized and dissected rectum cranially to the promontorium, the optimal point for subsequent suture fixation of the rectum was marked. The seromuscular layer of the anterior right wall was then sutured to the presacral fascia using only one or two interrupted nonabsorbable polypropylene sutures. The mean operative time was 176.2±35.2 minutes, with minimal blood loss. No moderate or severe postoperative complications were observed, and there was no postoperative mortality. One patient (6.7%) developed recurrence of rectal prolapse one month following surgery. CONCLUSIONS The advantages of this LSR procedure for the management of patients with FTRP are its simplicity, safety, efficacy, and practicality and the potential for its use in patients who can tolerate general anesthesia.
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Yasukawa D, Hori T, Kadokawa Y, Kato S, Machimoto T, Hata T, Aisu Y, Sasaki M, Kimura Y, Takamatsu Y, Ito T, Yoshimura T. Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan. Ann Gastroenterol 2017; 30:564-570. [PMID: 28845113 PMCID: PMC5566778 DOI: 10.20524/aog.2017.0157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022] Open
Abstract
Background The number of laparoscopic gastrectomies performed in Japan is increasing with the development of laparoscopic and surgical instruments. However, laparoscopic total gastrectomy is developing relatively slowly because of technical difficulties, particularly in esophagojejunostomy. Methods We retrospectively reviewed 83 patients with early gastric cancer in the upper portion of the stomach who underwent laparoscopic total gastrectomy between April 2007 and March 2016. We classified the patients into three periods, mainly on the basis of the esophagojejunostomy procedures performed: first period, various conventional procedures based on the physicians’ choice (n=14); second period, transoral method (n=51); and third period, fully intracorporeal technique (n=18). We evaluated the clinical impact of a stepwise introduction of unfamiliar new methods during laparoscopic total gastrectomy. Results Between the first and second periods, there were significant differences in the blood loss volume, number of harvested lymph nodes, frequency of conversion to open surgery, and postoperative hospital stay. The number of harvested lymph nodes was significantly higher in the third than in the second period, with no detriment to other intraoperative or postoperative factors. Conclusion The use of a unified surgical method for esophagojejunostomy seems to be the key to a successful and advantageous laparoscopic total gastrectomy. Stepwise introduction of a well-established technique of esophagojejunostomy during laparoscopic total gastrectomy will benefit patients, as shown, for example, by the higher number of dissected lymph nodes in the present study. However, a protracted learning curve is required.
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Affiliation(s)
- Daiki Yasukawa
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Maho Sasaki
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
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31
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Hori T, Oike F, Furuyama H, Machimoto T, Kadokawa Y, Hata T, Kato S, Yasukawa D, Aisu Y, Sasaki M, Kimura Y, Takamatsu Y, Naito M, Nakauchi M, Tanaka T, Gunji D, Nakamura K, Sato K, Mizuno M, Iida T, Yagi S, Uemoto S, Yoshimura T. Protocol for laparoscopic cholecystectomy: Is it rocket science? World J Gastroenterol 2016; 22:10287-10303. [PMID: 28058010 PMCID: PMC5175242 DOI: 10.3748/wjg.v22.i47.10287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/16/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety (CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon’s assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations. Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC: (1) consideration that a high level of experience alone is not enough; (2) recognition of the plateau involving the common hepatic duct and hepatic hilum; (3) blunt dissection until CVS exposure; (4) Calot’s triangle clearance in the overhead view; (5) Calot’s triangle clearance in the view from underneath; (6) dissection of the posterior right side of Calot’s triangle; (7) removal of the gallbladder body; and (8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.
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Aisu Y, Furuyama H, Hori T, Machimoto T, Hata T, Kadokawa Y, Kato S, Ando Y, Uchida Y, Yasukawa D, Kimura Y, Sasaki M, Takamatsu Y, Yoshimura T. Solitary Metastasis to a Distant Lymph Node in the Descending Mesocolon After Primary Resection for Hepatocellular Carcinoma: Is Surgical Resection Valid? Am J Case Rep 2016; 17:909-915. [PMID: 27904130 PMCID: PMC5135475 DOI: 10.12659/ajcr.900813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patient: Female, 65 Final Diagnosis: Mesocolic lymph node metastasis of Hetpatocellular carcinoma Symptoms: None Medication: — Clinical Procedure: Partial resection of descending colon including metastatic lymph node Specialty: Surgery
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Affiliation(s)
- Yuki Aisu
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Hiroaki Furuyama
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yasuhisa Ando
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yuichiro Uchida
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Maho Sasaki
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Yuichiro Takamatsu
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
| | - Tunehiro Yoshimura
- Department of Gastrointestinal and General Surgery, Tenri Hospital, Tenri, Japan
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