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Background: Resection combined with radiofrequency ablation (RFA) is a novel approach in patients who are otherwise unresectable. The objective of this study was to investigate the safety and efficacy of hepatic resection combined with RFA. Methods: Patients with multifocal hepatic malignancies were treated with surgical resection combined with RFA. All patients were followed prospectively to assess complications, treatment response, and recurrence. Results: Seven hundred thirty seven tumors in 172 patients were treated (124 with colorectal metastases; 48 with noncolorectal metastases). RFA was used to treat 350 tumors. Combined modality treatment was well tolerated with low operative times and minimal blood loss. The postoperative complication rate was 19.8% with a mortality rate of 2.3%. At a median follow-up of 21.3 months, tumors had recurred in 98 patients (56.9%). Failure at the RFA site was uncommon (2.3%). A combined total number of tumors treated with resection and RFA >10 was associated with a faster time to recurrence (P = .02). The median actuarial survival time was 45.5 months. Patients with noncolorectal metastases and those with less operative blood loss had an improved survival (P = .03 and P = .04, respectively), whereas radiofrequency ablating a lesion >3 cm adversely impacted survival (HR = 1.85, P = .04). Conclusions: Resection combined with RFA provides a surgical option to a group of patients with liver metastases who traditionally are unresectable, and may increase long-term survival.

Combined resection of solitary synchronous brain metastases and non-small-cell lung cancer has been shown to be successful. Thus, we proposed combining the surgery of solitary, extracranial metastases, and resectable lung cancer.Between March 1987 and December 1994, surgery was performed on nine patients with non-small-cell lung cancer with synchronous, solitary, extracranial, or distant metastasis: adrenal (n = 5), cutaneous (n = 2), axillary lymph node (n = 1) and kidney (n = 1). Criteria for operating on these patients included: primary tumor that was locally resectable in a radical manner, non-small-cell histology, no preoperative evidence of N2 disease, complete resection of histologically proven metastasis, and absence of other metastases found with computed tomography or bone scan.Resection of the primary tumor and solitary metastases was achieved in all patients. Primary tumor was always resected by lobectomy. No mortality or major morbidity was reported. Five-year survival rate was 55.6%. Five patients who had adrenal (n = 3), or skin (n = 1), or axillary (n = 1) metastases, survived more than 5 years. All N2 patients (n = 2) died.The presence of solitary, distant metastasis should not be considered, per se, a factor for denying surgery for locally resectable, non-small-cell lung cancer. Unexpected, prolonged survival was demonstrated in our limited series.

Hydatid disease can result in cystic liver disease. If a conservative treatment fails, these cysts require resection. Involvement of the inferior vena cava requiring resection for hydatid disease is unusual. We present a case of hydatid disease with complete caval obstruction and resultant portal hypertension that required combined liver resection and inferior vena cava replacement.

Mediastinal Hodgkin's disease has rarely been reported in the literature in Japan; however, it is not uncommon in Europe and North America. A 32-year-old woman with isolated mediastinal Hodgkin's disease mimicking thymoma is herein described. A preoperative diagnosis of thymoma led to a combined resection of the mediastinal tumor together with the entire thymus, left innominate vein, and left phrenic nerve. The resected tumor was histologically diagnosed to be Hodgkin's disease of the nodular sclerosis type. Adjuvant 40 Gy irradiation of the mediastinum and neck was added postoperatively. The patient is doing well at present with no signs of recurrence 8 months after the operation.

Twenty-six patients who underwent pyloruspreserving pancreaticoduodenectomy (PPPD) for ductal cancer of the head of the pancreas between 1983 and 1993 were reviewed. Gastrointestinal continuity was restored by the methods of Imanaga (n=21) and Traverso (n=5). Combined resection of the portal vein and/or superior mesenteric vein was performed in 13 patients. Surgical complications occurred in 5 patients, but there were no postoperative deaths. Delayed gastric emptying was observed in 42% of patients. The median survival time for all 26 patients was 13 months. Three patients survived for more than 3 years, and one of them is currently alive without recurrence at 10 years. Differences in survival rates were not apparent between patients who underwent PPPD with and without portal vein resection. Survival rate after PPPD was compared with that after pancreaticoduodenectomy (PD) performed between 1974 and 1992; the difference was not significant. Patients who underwent noncurative PPPD had a significantly better survival rate than those who underwent noncurative PD (P

6 Monate bis 2 Jahre nach Resektion wegen komplizierter Ulcuskrankheit mit Wiederherstellung nach B II-Roux wurden 43 Patienten klinisch, endoskopisch und radiologisch nachuntersucht. Nur bei einem Patienten wurden geringe Mengen von Gallensaure im Restmagen gefunden. Die Untersuchung des Saureverhaltens lies zwei Gruppen unterscheiden: eine Gruppe von 6 Patienten mit einem pH zwischen 1,2 und 2,2, hiervon hatten 3 Patienten Ulcusrezidive. Bei 37 Patienten mit einem pH uber 5,5 fand sich nur 1 Patient mit multiplen Ulcera, er litt an einem HPT. Die klinischen Ergebnisse waren mit 86% Visick I und II gut. Die Analyse der Ergebnisse zeigt, das bei fehlendem Reflux und erhaltener vagaler Stimulation auch bei hoher stufenformiger Resektion mit Ulcusrezidiven zu rechnen ist. Beim Saureulcus (Typ Johnson II und III), ulcus duodeni und beim Anastomosenulcus wird daher die zusatzliche Vagotomie empfohlen.