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Oba A, Inoue Y, Ono Y, Ishizuka N, Arakaki M, Sato T, Mise Y, Ito H, Saiura A, Takahashi Y. Staging laparoscopy for pancreatic cancer using intraoperative ultrasonography and fluorescence imaging: the SLING trial. Br J Surg 2021; 108:115-118. [PMID: 33711121 DOI: 10.1093/bjs/znaa111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/18/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
This prospective trial revealed the additional diagnostic value of staging laparoscopy with contrast-enhanced intraoperative ultrasonography and indocyanine green-fluorescence imaging, detecting radiologically occult liver metastases and other occult metastases effectively for patients with high-risk resectable or borderline resectable pancreatic cancer. The 2-year survival rate of patients without occult metastasis was significantly better than that of patients with occult metastasis. These favourable results for patients without occult metastasis indicate that an enhanced screening strategy and modern multidisciplinary treatment may improve the outcome even of patients affected by high-risk advanced pancreatic cancer.
State-of-the-art staging worth the effort
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Affiliation(s)
- A Oba
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Inoue
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Ono
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - N Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Arakaki
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Sato
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Mise
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Ito
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - A Saiura
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Hepato-Biliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Y Takahashi
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Oba A, Ito H, Ono Y, Sato T, Mise Y, Inoue Y, Takahashi Y, Saiura A. Regional pancreatoduodenectomy versus standard pancreatoduodenectomy with portal vein resection for pancreatic ductal adenocarcinoma with portal vein invasion. BJS Open 2020; 4:438-448. [PMID: 32191395 PMCID: PMC7260410 DOI: 10.1002/bjs5.50268] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/04/2019] [Revised: 12/12/2019] [Accepted: 01/19/2020] [Indexed: 12/11/2022] Open
Abstract
Background Pancreatoduodenectomy (PD) with portal vein resection (PVR) is a standard operation for pancreatic ductal adenocarcinoma (PDAC) with portal vein (PV) invasion, but positive margin rates remain high. It was hypothesized that regional pancreatoduodenectomy (RPD), in which soft tissue around the PV is resected en bloc, could enhance oncological clearance and survival. Methods This retrospective study included consecutive patients who underwent PD with PVR between January 2005 and December 2016 in a single high‐volume centre. In standard PD (SPD) with PVR, the PV was skeletonized and the surrounding soft tissue dissected. In RPD, the retropancreatic segment of the PV was resected en bloc with its surrounding soft tissue. The extent of lymphadenectomy was similar between the procedures. Results A total of 268 patients were included (177 SPD, 91 RPD). Tumours were more often resectable in patients undergoing SPD (60·5 per cent versus 38 per cent in those having RPD; P = 0·014), and consequently they received neoadjuvant therapy less often (7·9 versus 25 per cent respectively; P < 0·001). R0 resection was achieved in 73 patients (80 per cent) in the RPD group, compared with 117 (66·1 per cent) of those in the SPD group (P = 0·016), although perioperative outcomes were comparable between the groups. Median recurrence‐free (RFS) and overall (OS) survival were 17 and 32 months respectively in patients who had RPD, compared with 11 and 21 months in those who had SPD (RFS: P = 0·003; OS: P = 0·004). Conclusion RPD is as safe and feasible as SPD, and may increase the survival of patients with PDAC with PV invasion.
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Affiliation(s)
- A Oba
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - H Ito
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Y Ono
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - T Sato
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Y Mise
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Y Inoue
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Y Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - A Saiura
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Oba A, Ishizawa T, Mise Y, Inoue Y, Ito H, Ono Y, Sato T, Takahashi Y, Saiura A. Possible underestimation of blood loss during laparoscopic hepatectomy. BJS Open 2019; 3:336-343. [PMID: 31183450 PMCID: PMC6551416 DOI: 10.1002/bjs5.50145] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
Background Previous studies have documented potential advantages of laparoscopic hepatectomy in decreasing blood loss compared with open surgery. This study aimed to compare intraoperative blood loss estimated using four different methods in open versus laparoscopic hepatectomy. Methods Patients undergoing liver resection between 2014 and 2017 were evaluated prospectively, differentiating between the laparoscopic and open approach. Groups were compared using univariable and multivariable analyses. Intraoperative blood loss was estimated using three formulas based on the postoperative decreases in haematocrit, haemoglobin or red blood cell volume, and using the conventional method of the sum of suction fluid amounts and gauze weight. In addition, blood loss per hepatic transection area was calculated to compare groups. Results Some 125 patients who underwent hepatectomy were selected, including 56 open hepatectomies and 69 laparoscopic liver resections. Intraoperative blood loss per hepatic transection area estimated by the conventional method was significantly less in the laparoscopic than the open group (3·6 (range 0·2-50·0) versus 6·6 (1·2-82·5) ml/cm2 respectively; P < 0·001). In contrast, there were no significant differences between groups in blood loss estimated based on the decrease in haematocrit (12·9 (0-65·2) versus 8·1 (0-123·7) ml/cm2; P = 0·818), haemoglobin or red blood cell volume. Blood loss estimation using three formulas showed significant linear correlations with the blood loss estimated by the conventional method in the open group (r s = 0·758 to 0·762), but not in the laparoscopic group (r s = -0·019 to 0·031). Conclusion The conventional method of calculating blood loss in laparoscopic hepatectomy can underestimate losses.
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Affiliation(s)
- A Oba
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - T Ishizawa
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Y Mise
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Y Inoue
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - H Ito
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Y Ono
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - T Sato
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - Y Takahashi
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
| | - A Saiura
- Department of Gastroenterological Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research
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Nishioka Y, Hasegawa K, Saiura A, Oba M, Yamamoto J, Nomura Y, Takayama T, Hashiguchi Y, Shibasaki M, Sakamoto H, Yamagata S, Aoyanagi N, Kaneko H, Koyama H, Miyagawa S, Mise Y, Shinozaki E, Yoshida S, Nozawa H, Kokudo N. A multicenter phase II trial to evaluate the efficacy of mFOLFOX6+cetuximab as induction chemotherapy to achieve R0 surgical resection for advanced colorectal liver metastases (NEXTO trial). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hasegawa K, Saiura A, Oba M, Aosasa S, Tanaka N, Takayama T, Hashiguchi Y, Bandai Y, Sakamoto H, Yamagata S, Aoyanagi N, Kaneko H, Koyama H, Miyagawa S, Yamamoto J, Mise Y, Shinozaki E, Yoshida S, Watanabe T, Kokudo N. A multicenter phase II trial to evaluate the efficacy of mFOLFOX6 + cetuximab as induction chemotherapy to achieve R0 surgical resection for advanced colorectal liver metastases (NEXTO trial). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lim C, Vibert E, Azoulay D, Salloum C, Ishizawa T, Yoshioka R, Mise Y, Sakamoto Y, Aoki T, Sugawara Y, Hasegawa K, Kokudo N. Indocyanine green fluorescence imaging in the surgical management of liver cancers: current facts and future implications. J Visc Surg 2014; 151:117-24. [PMID: 24461273 DOI: 10.1016/j.jviscsurg.2013.11.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Imaging detection of liver cancers and identification of the bile ducts during surgery, based on the fluorescence properties of indocyanine green, has recently been developed in liver surgery. The principle of this imaging technique relies on the intravenous administration of indocyanine green before surgery and the illumination of the surface of the liver by an infrared camera that simultaneously induces and collects the fluorescence. Detection by fluorescence is based on the contrast between the (fluorescent) tumoral or peri-tumoral tissues and the healthy (non-fluorescent) liver. Results suggest that indocyanine green fluorescence imaging is capable of identification of new liver cancers and enables the characterization of known hepatic lesions in real time during liver resection. The purpose of this paper is to present the fundamental principles of fluorescence imaging detection, to describe successively the practical and technical aspects of its use and the appearance of hepatic lesions in fluorescence, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver surgery.
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Affiliation(s)
- C Lim
- Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique et Transplantation Hépatique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - E Vibert
- Service de Chirurgie Hépatobiliaire, Pancréatique et Transplantation Hépatique, Hôpital Paul-Brousse, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif, France
| | - D Azoulay
- Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique et Transplantation Hépatique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - C Salloum
- Service de Chirurgie Digestive, Hépatobiliaire, Pancréatique et Transplantation Hépatique, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - T Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - R Yoshioka
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - Y Mise
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - Y Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - T Aoki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - Y Sugawara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - K Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
| | - N Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of medicine, University of Tokyo, Tokyo, Japan
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Mise Y, Hasegawa K, Satou S, Aoki T, Beck Y, Sugawara Y, Makuuchi M, Kokudo N. Venous reconstruction based on virtual liver resection to avoid congestion in the liver remnant. Br J Surg 2011; 98:1742-51. [PMID: 22034181 DOI: 10.1002/bjs.7670] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatic vein (HV) reconstruction may prevent venous congestion following resection of liver tumours that encroach on major HVs. This study aimed to identify criteria for venous reconstruction based on preoperative evaluation of venous congestion. METHODS A volumetric analysis using image-processing software was performed in selected patients with liver tumours suspected on preoperative imaging of major HV invasion. The size of the non-congested liver remnant (NCLR) was calculated by subtracting the congested area from the liver remnant. Venous reconstruction was scheduled in patients who met the following criteria: normal liver function (indocyanine green retention rate at 15 min (ICGR(15) ) of less than 10 per cent) with a NCLR smaller than 40 per cent of total liver volume (TLV), or liver dysfunction (ICGR(15) 10-20 per cent) with a NCLR smaller than 50 per cent of TLV. Surgical outcomes and liver regeneration were investigated. RESULTS A total of 55 patients with suspected HV invasion were enrolled. Sacrifice of one or more HVs was deemed possible in 37 patients. Venous reconstruction was scheduled in 18 patients. At operation, there was seen to be no venous involvement in 11 patients. The HV was sacrificed in 29 patients, and preserved or reconstructed in 24. Volume restoration ratios at 3 months were similar in the sacrifice (88 per cent) and preserve (87 per cent) groups. Operating time was shorter (465 min) and blood loss was lower (580 ml) in the sacrifice than in the preserve group (523 min and 815 ml respectively). CONCLUSION The HV can be sacrificed safely according to the proposed criteria, reducing surgical invasiveness without influencing the postoperative course.
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Affiliation(s)
- Y Mise
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
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