Search

The neural plexus and lymph nodes around the superior mesenteric artery (LN#14), are the most frequent sites involved by pancreatic head cancer. However the influence of metastases to LN#14 on patients’ prognosis has rarely been evaluated. The patients who underwent pancreatectomy for pancreatic head cancer between January 2010 and December 2018 were selected. The patients with nodal metastases were classified into an LN#14 + or LN#14−group according to LN#14 metastasis. Clinical and pathological characteristics and prognosis were compared between the two groups. In total, 99 patients underwent pancreatectomy. Ninety-four patients were positive for lymph node metastases and 14 and 80 were classified as LN#14 + and LN#14 − , respectively. Postoperative median overall survival (OS) of the LN#14 + and LN#14 − groups was 10.2 and 31.1 months, respectively (P

A modified Fong clinical score (m-Fong CS) that includes the RAS mutation status has recently been proposed and offered an improved survival stratification of patients who undergo surgery and systemic chemotherapy for colorectal liver metastases (CLM). The aim of this study is to assess whether a CS that includes RAS status is influenced by whether patients receive perioperative chemotherapy. We created a new CS using multivariate analysis of data of patients who underwent hepatectomy for CLM for the first time between 2010 and 2016 at a single hospital (n = 341, 79% received perioperative chemotherapy). The resulting CS and m-Fong CS were then validated in the patient cohort at three other hospitals (n = 309). Furthermore, the applicability of the two CS in the total cohort (n = 650) was tested according to whether the patients received perioperative chemotherapy. The new CS comprised mutant RAS status, ≥4 CLMs, and a CA19-9 level ≥100 U/mL (1 point per factor). Both the new CS and m-Fong CS failed to stratify the survival of the 309 patients in the validation cohort, including those who did not receive perioperative chemotherapy (29%). Both of the CS accurately stratified the survival of patients who underwent perioperative chemotherapy but not of those who underwent surgery alone. A CS that includes the RAS mutation status can stratify the survival of patients who undergo hepatectomy combined with perioperative chemotherapy, but it has limited value for patients who undergo surgery alone.

A modified Fong clinical score (m-Fong CS) that includes the RAS mutation status has recently been proposed and offered an improved survival stratification of patients who undergo surgery and systemic chemotherapy for colorectal liver metastases (CLM). The aim of this study is to assess whether a CS that includes RAS status is influenced by whether patients receive perioperative chemotherapy.We created a new CS using multivariate analysis of data of patients who underwent hepatectomy for CLM for the first time between 2010 and 2016 at a single hospital (n = 341, 79% received perioperative chemotherapy). The resulting CS and m-Fong CS were then validated in the patient cohort at three other hospitals (n = 309). Furthermore, the applicability of the two CS in the total cohort (n = 650) was tested according to whether the patients received perioperative chemotherapy.The new CS comprised mutant RAS status, ≥4 CLMs, and a CA19-9 level ≥100 U/mL (1 point per factor). Both the new CS and m-Fong CS failed to stratify the survival of the 309 patients in the validation cohort, including those who did not receive perioperative chemotherapy (29%). Both of the CS accurately stratified the survival of patients who underwent perioperative chemotherapy but not of those who underwent surgery alone.A CS that includes the RAS mutation status can stratify the survival of patients who undergo hepatectomy combined with perioperative chemotherapy, but it has limited value for patients who undergo surgery alone.

The efficacy of repeat hepatectomy for recurrent hepatocellular carcinoma and colorectal liver metastases is widely accepted. However, the benefits of such treatment for intrahepatic recurrence of gastric cancer liver metastasis remain unknown. This study sought to clarify the survival benefit for patients undergoing repeat hepatectomy for gastric cancer liver metastasis. A total of 73 patients underwent hepatectomy for gastric cancer liver metastasis from January 1993 to January 2011. Macroscopically curative surgery was performed in 64 patients. Among them, repeat hepatectomy was performed in 14 of the 37 patients with intrahepatic recurrence. Among these 14 patients, clinicopathologic factors were evaluated by univariate and multivariate analysis to identify the factors affecting survival. The overall 1-, 3-, and 5-year survival rates after a second hepatectomy were 71, 47, and 47 %, respectively. The median survival was 31 months. Operative morbidity and mortality rates of repeat hepatectomy were 29 and 0 %, respectively. Multivariate analysis identified the duration of the disease-free interval as the only independent significant factor predicting better survival. In selected patients, repeat hepatectomy for recurrent gastric cancer liver metastasis may offer the same chance of cure as the primary hepatectomy. Disease-free intervals exceeding 12 months predict good patient survival after repeat hepatectomy.

The clinical implications of peritoneal lavage cytology (CY) status in patients with potentially resectable pancreatic cancer have not been established. We retrospectively reviewed clinical data from 254 consecutive patients who underwent macroscopically curative resection for pancreatic cancer from February 2003 to December 2010 in our institution. Correlations between CY status and survival and clinicopathological findings were investigated. Of the 254 patients, 20 were CY+ (7.9 %). There were no significant differences between CY+ and CY− patients in background data (age, sex, the level of preoperative tumor marker, and adjuvant chemotherapy). Patients with positive serosal invasion were more likely to be CY+ than those with negative serosal invasion (P

Bile leakage is the most common complication after hepatectomy and its incidence is not declining. The aim of the present study was to identify predictive factors for bile leakage. Clinical data from 505 consecutive patients who underwent hepatectomy without extrahepatic bile duct resection in our department between January 2006 and December 2009 were reviewed retrospectively. The incidence of bile leakage was found to be 6.7%. Multivariate analysis identified three independent factors that were significantly correlated with the occurrence of bile leakage: (1) repeat hepatectomy (P = 0.002; odds ratio [OR] 3.439; 95% confidence interval [CI] 1.552–7.618), (2) a cut surface area ≥57.5 cm2 (P = 0.004; OR 5.296; 95% CI 1.721–16.302), and (3) intraoperative blood loss ≥775 ml (P = 0.01; OR 2.808; 95% CI 1.280–6.160). More meticulous management is needed to prevent bile leakage in high-risk patients.

Conventional open procedures have been supplanted in part by less invasive approaches, such as laparoscopic surgery developed for treating gastrointestinal malignancies. However, it is unclear whether laparoscopy-assisted gastric tube reconstruction (LAGT) can attenuate the postoperative systemic inflammatory response after esophagectomy for esophageal cancer.We investigated the postoperative clinical course of the systemic inflammatory response syndrome (SIRS) in patients who underwent an esophagectomy for esophageal cancer by LAGT (LAGT group) and gastric tube reconstruction by conventional open surgery (Open group).Compared with the Open group, the LAGT group had a significantly shorter operative time (539.6 min vs. 639.8 min), shorter duration of postoperative mechanical ventilation (1.1 days vs. 2.8 days), and shorter length of stay in the intensive care unit (2.1 days vs. 4.4 days). The LAGT group also had a significantly shorter SIRS duration (1.4 days vs. 2.7 days), a significantly lower incidence of SIRS, and a smaller number of positive SIRS criteria. Throughout the investigation period, the postoperative white blood cell count was lower in the LAGT group than in the Open group. Additionally, in the LAGT group, the heart rate was lower on each postoperative day (POD), and the respiratory rate was significantly lower on postoperative days (PODs) 1 and 4. There was no difference in postoperative oxygenation, morbidity, and mortality between the groups. The C-reactive protein level on PODs 3 and 4 was significantly lower in the LAGT group than in the Open group.Laparoscopy-assisted gastric tube reconstruction significantly attenuates postoperative SIRS, and it is therefore a potentially less invasive surgical procedure.

The prognosis of solitary liver metastasis involving the caudate lobe is unclear. This study analyzed the outcomes after resection of the caudate lobe for solitary colorectal liver metastasis. We reviewed the records of 114 cases in which potentially curative hepatectomy were performed for solitary colorectal liver metastasis. Solitary liver metastasis involving the caudate lobe was seen in 14 cases (Caudate group). The outcomes were compared with those of the remaining 100 cases with metastasis in a site other than the caudate lobe (Other group). No hospital deaths occurred. The 5-year survival rate for all cases was 61%. Recurrence-free and cumulative survivals were similar in the two groups, as were the intraoperative blood loss, duration of operation, and postoperative hospital stay. The distance of the surgical margin was significantly shorter in the Caudate group than in the Other group (0.6 mm vs. 6.6 mm; p = 0.001). A concomitant resection of the inferior vena cava was performed in four patients in the Caudate group but in no patients in the Other group (p < 0.001). Despite a minimal surgical margin, the resection of solitary colorectal liver metastasis offers favorable short- and long-term outcomes comparable to those for colorectal liver metastasis at other sites.

Although venous invasion is reportedly a clinically useful prognostic marker for colorectal cancer, suitable grading criteria have not been established. This prospective observational study aimed to investigate the prognostic value of the number and size of venous invasions in patients with pT3 colorectal cancer. We recruited 139 consecutive patients with pT3 colorectal carcinomas resected between October 2001 and August 2003. We used slides of whole-tissue sections stained with Elastica van Gieson. Venous invasion was classified according to the number of veins with carcinoma infiltration per slide with most venous invasions (V-number classification): V(n)-low 0–3 and V(n)-high ≥4. Additionally, the findings were classified according to the maximal size of veins containing carcinoma infiltration (V-size classification): V(s)-low

Preoperative chemotherapy has become more common in the management of multiple resectable colorectal liver metastases; however, the benefit is unclear. This study examined clinical outcomes following liver resection for multiple colorectal liver metastases with the surgery up-front approach.Data collected prospectively over a 16-year period for 736 patients who underwent hepatic resection at two different centers were reviewed. Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n = 493); group B, between four and seven tumors (n = 141); and group C, eight or more tumors (n = 102).The 5-year overall and recurrence-free survival rates were 51 and 21 %, respectively, for the entire patient cohort, 56 and 29 % in group A, 41 and 12 % in group B, and 33 and 1.7 % in group C. Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size5 cm, and tumor exposure during liver resection.In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules). A further prospective study is necessary to clarify the optimal setting of preoperative chemotherapy.

Adequate preoperative evaluation for gastric cancer staging is essential to develop an individualized treatment strategy involving surgery with reduced lymphadenectomy and laparoscopic gastrectomy. A total of 509 gastric cancer patients with clinical Stage IA or IB disease were divided into two groups: 304 patients were admitted in 2000 or earlier (Group A), and 205 patients were admitted in 2001, when multidetector computed tomography (MD-CT) was available, or later (Group B). We evaluated the accuracy of the preoperative diagnoses of tumor depth, lymph node involvement, and tumor stage. With respect to tumor depth, 94.5 and 52.8% of patients were staged correctly in cT1 and cT2 patients, respectively. Among both cT1 and cT2 patients, the underestimated rates were lower in Group B than in Group A. For nodal metastasis, 83.2 and 30.0% of patients were staged correctly in cN0 and cN1 patients, respectively. Among the cN0 patients, 82.1 and 84.7% of Group A and Group B patients, respectively, were staged correctly. Among the cN1 patients, none of the patients in Group B was underestimated, while 9.7% of Group A patients were underestimated. There was a significant increase in the percentage of correctly staged patients and a decrease in the percentage of underestimated patients in Group B in comparison to Group A in both cStage IA and cStage IB patients. Remarkable advances have been observed in the accuracy of preoperative staging in the early stage of gastric cancer. However, it is necessary to continue to develop accurate preoperative and intraoperative diagnostic systems.

The mortality associated with distal pancreatectomy (DP) has declined to

Celiac axis stenosis is found at an incidence of 2%-24% in the general population. During pancreatoduodenectomy in patients with celiac axis stenosis, division of the gastroduodenal artery from the common hepatic artery may cause acute ischemia of the upper abdominal organs, such as the liver, stomach, or spleen. Under these circumstances, the clinical indications of arterial reconstruction remain controversial. Between 1994 and 2003, seven patients with celiac axis stenosis (n = 4) or occlusion (n = 3) underwent pancreatoduodenectomy at our hospital. Arterial reconstruction, including division of the median arcuate ligament, was conducted in two patients; the replaced right hepatic artery was preserved in one patient, and no vascular refinement was undertaken in the remaining four of the seven patients. In two of the four patients without arterial reconstruction or preservation, the serum levels of liver enzymes were markedly elevated (> 800 IU/l) on postoperative day 1, and these patients subsequently developed liver abscesses. Two patients who underwent arterial reconstruction and three patients who showed no decrease in intrahepatic arterial flow under Doppler ultrasonography after clamping of the gastroduodenal artery developed no ischemic complications. Although our experience is limited, when intraoperative Doppler ultrasonography indicates a decrease in the hepatic arterial signals, we believe that reconstruction of the hepatic artery will be necessary to minimize ischemic complications in the liver in patients with celiac axis stenosis.

Liver metastasis of breast cancer is considered a generalized disease, and surgical treatment is rarely discussed. Thirty-four patients who underwent 35 hepatectomies for liver metastases of breast cancer between 1985 and 2003 were analyzed. The median interval between the breast surgery and relapse in the liver was 1.9 years (0-20 years). The liver was the first site of recurrence in 25 patients. Fifteen clinicopathologic factors were evaluated using univariate and multivariate analyses to predict survival after hepatic resection. No patients died because of the surgery. The median survival was 36 months (1 month to 20 years). The overall and disease-free 5-year survival rates after hepatectomy for breast metastases were 21% and 16%, respectively. Four patients survived more than 5 years. The presence of extrahepatic recurrence prior to hepatectomy was the only significant prognostic factor according to the analyses, and the 5-year survival rate of patients without extrahepatic disease was 31%. No patient who had hilar lymph node metastasis survived more than 5 years. In the absence of extrahepatic recurrence, surgical resection of liver metastasis from breast cancer can offer an acceptable prognosis and should not be avoided in selected patients.

Blood loss during liver transection and ischemia-reperfusion injury associated with hepatic inflow occlusion are significant drawbacks during liver surgery. Sixteen patients underwent liver resection using the Monopolar Floating Ball (FB) plus LigaSure (LS) diathermy without occlusion of the hepatoduodenal ligament (group FB-LS). The liver parenchyma was precoagulated using the FB, and the uncovered tiny vessels were sealed using LS. Surgical outcomes were retrospectively compared with 16 well matched patients who underwent liver resection using the conventional clamp crushing method with Pringle’s maneuver (group CC). The amount of blood loss during liver transection was significantly less in group FB-LS than in group CC [200 ml (0–990 ml) vs. 480 ml (120–1800 ml);p = 0.006]. The median time it took to complete the liver transection was significantly longer in group FB-LS than in group CC [144 minutes (43–335 minutes) vs. 58 minutes (18–94 minutes); p < 0.0001]. Hepatic inflow occlusion was temporally used in five patients in group FB-LS to achieve hemostasis in hepatic venous tributaries for 6,10, 19, 26, and 61 minutes, respectively. Using these two electronic devices allows liver resection to be safely performed, with the advantage of minimal blood loss and a reduced inflow occlusion period compared to the conventional method. The major disadvantage may be a slower transection speed. A prospective randomized trial is needed to clarify the clinical benefits of liver resections performed using this novel technique.

Les facteurs qui contribuent aux effets de l'embolisation de la veine porte avant resection hepatique pour cancer hepatocellulaire ne sont pas clairs. Soixante-six patients ayant un cancer hepatocellulaire sont entres dans l'etude. On a enregistre les modifications de la fonction hepatique, de la pression dans la veine porte et le volume hepatique apres embolisation. Par analyse de regression lineaire multiple on a identifie les facteurs independants des effets de l'embolisation porte. Le rapport entre le volume du foie restant acceptable compare au volume du foie non embolise a ete calcule a partir des tests de fonction hepatique. La mortalite apres embolisation porte ou apres resection hepatique a ete nulle. On n'a note aucun changement significatif dans le taux de bilirubine totale ou du temps de prothrombine apres l'embolisation porte. Chez les patients qui ont eu une embolisation arterielle avant l'embolisation de la veine porte, on a remarque une augmentation significative des transaminases. Le seul facteur predictif des effets d'atrophie apres embolisation porte a ete l'embolisation arterielle anterieure. Le rapport entre le volume du foie non-embolise et le volume du foie restant etait inferieur a l'unite chez 18 des 40 patients, et il a augmente pour depasser l'unite apres embolisation porte dans tous les cas. L'embolisation porte a induit, respectivement, l'atrophie et l'hypertrophie du foie embolise ou non-embolise de facon suffisante, meme quand la fonction hepatique etait perturbee ou quand le foie etait cirrhotique. Les effets d'atrophie ont ete plus importants surtout lorsque l'embolisation arterielle a ete realisee avant l'embolisation porte.

We have devised a new technique for isolated caudate lobe resection in which we access the caudate lobe by separating the liver parenchyma along the interlobar plane. The safety and radicality of the procedure were evaluated in five patients: four with hepatocellular carcinoma (HCC) and one with metastatic rectal cancer. All of the tumors were located mainly in the paracaval portion of the caudate lobe. The patients with HCC (three of four) underwent an anatomic caudate lobe resection by identification of the right margin of the caudate lobe. Two patients required red blood cell transfusion, and one showed bile leakage after surgery. All of the patients are alive without recurrence more than 4 years after surgery, except one with rectal carcinoma who developed lung metastases. The anterior transhepatic approach is a safe and potentially curative surgical option for a tumor in the paracaval portion of the caudate lobe.