Showing papers in "Surgery Today in 2012"
TL;DR: A 56-year-old male who received a transplant of autologous myoblast sheets manufactured in temperature-responsive culture dishes improved markedly, leaving him without any arrhythmia and able to discontinue using a left ventricular assist system and avoid cardiac transplantation.
Abstract: Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by progressive heart failure, and is a leading cause of mortality and morbidity. Recently, cellular therapy for end-stage heart failure has been emerging. We herein report a 56-year-old male who received a transplant of autologous myoblast sheets manufactured in temperature-responsive culture dishes. His clinical condition improved markedly, leaving him without any arrhythmia and able to discontinue using a left ventricular assist system and avoid cardiac transplantation. These findings suggest that cellular therapy using myoblast sheets is a promising new strategy for treating patients with end-stage DCM. This method might be an effective alternative to heart transplantation in the near future.
292 citations
TL;DR: The aim of the current study was to clarify the significance of Onodera’s prognostic nutritional index (OPNI), which can simply account for the immunological and nutritional conditions, in patients with colorectal carcinoma.
Abstract: Preoperative assessments regarding a patient’s immunological and nutritional condition are required to predict the outcomes of patients with malignant tumors. The aim of the current study was to clarify the significance of Onodera’s prognostic nutritional index (OPNI), which can simply account for the immunological and nutritional conditions, in patients with colorectal carcinoma. The correlations of the preoperative OPNI value with clinicopathological features were examined in 219 patients with colorectal carcinoma who had been surgically treated. Not only the tumor stage (P = 0.028) and venous invasion (P = 0.002), but also an OPNI of less than 40 (P = 0.002) were found to be independently correlated with a worse prognosis of patients with colorectal carcinoma. The preoperative OPNI can be used as a simple prognostic indicator in colorectal carcinoma.
181 citations
TL;DR: New therapeutic approaches are identified, involving the targeting of TAMs with adjuvant therapy after hepatic resection for HCC, and the possibility of new therapies targeting TAMs is discussed.
Abstract: Recent studies have shown that the tumor microenvironment plays an important role in cancer progression Tumor-associated macrophages (TAMs), in particular, have been found to be associated with tumor progression Macrophages have multiple biological roles, including antigen presentation, target cell cytotoxicity, removal of foreign bodies, tissue remodeling, regulation of inflammation, induction of immunity, thrombosis, and endocytosis Recent immunological studies have identified two distinct states of polarized macrophage activation: the classically activated (M1) and the alternatively activated (M2) macrophage phenotypes Bacterial moieties such as lipopolysaccharides and the Th1 cytokine interferon-γ polarize macrophages toward the M1 phenotype The M2 polarization was discovered as a response to the Th2 cytokine interleukin-4 In general, M2 macrophages exert immunoregulatory activity, participate in polarized Th2 responses, and aid tumor progression TAMs have recently been found to play an important role in hepatocellular carcinoma (HCC) progression Based on the properties of TAMs, obtained from pathological examination of resected specimens, we have identified new therapeutic approaches, involving the targeting of TAMs with adjuvant therapy after hepatic resection for HCC This review discusses the roles of TAM in HCC progression and the possibility of new therapies targeting TAMs
138 citations
TL;DR: The diagnosis of granulomatous mastitis should be made carefully to avoid a misdiagnosis and Steroid therapy should be considered based on the idea that this is an autoimmune disease.
Abstract: Granulomatous mastitis (GM) is a rare benign inflammatory breast disease. The clinical presentation of granulomatous mastitis usually mimics malignancy or infection. The aim of this study was to review the clinical and diagnostic features of GM and discuss the medical and surgical treatment of our series of eight GM patients. Between 2008 and 2010, eight patients were diagnosed with GM and underwent surgery. Patients were evaluated clinically and radiologically. The diagnosis of GM was confirmed in all cases by core needle or excisional biopsies. Serological tests were performed for rheumatoid factor (RF), antinuclear antibody (ANA), and anti-double-stranded DNA (anti-dsDNA). The mean patient age was 37 years. Common presenting symptoms were a hard mass, pain, inflamed hyperemic skin, and sinus formation. Serological tests for RF were positive in 6 patients, and ANA and anti-dsDNA antibodies were detected in 2 patients. All patients underwent antibiotic therapy before surgery, and were treated with wide surgical excision with negative margins. Methylprednisolone (16 mg/day for 3 months) therapy was used in 3 patients (all RF and 2 ANA/anti-dsDNA positive) following a wide excisional biopsy after a postoperative recurrence mimicking skin lesions was seen. These patients responded well to steroid therapy. The diagnosis of GM should be made carefully to avoid a misdiagnosis. Steroid therapy should be considered based on the idea that this is an autoimmune disease.
88 citations
TL;DR: The mechanism of action of protein-bound polysaccharide K (PSK; KRESTIN®) involves the following actions: (1) recovery from immunosuppression induced by humoral factors such as transforming growth factor (TGF)-β or as a result of surgery and chemotherapy; (2) activation of antitumor immune responses including maturation of dendritic cells, correction of Th1/Th2 imbalance, and promotion of interleukin-15 production by monocytes; and (3) enhancement of the antitumour effect of chemotherapy by induction
Abstract: The mechanism of action of protein-bound polysaccharide K (PSK; KRESTIN®) involves the following actions: (1) recovery from immunosuppression induced by humoral factors such as transforming growth factor (TGF)-β or as a result of surgery and chemotherapy; (2) activation of antitumor immune responses including maturation of dendritic cells, correction of Th1/Th2 imbalance, and promotion of interleukin-15 production by monocytes; and (3) enhancement of the antitumor effect of chemotherapy by induction of apoptosis and inhibition of metastasis through direct actions on tumor cells. The clinical effectiveness of PSK has been demonstrated for various cancers. In patients with gastric or colorectal cancer, combined use of PSK with postoperative adjuvant chemotherapy prolongs survival, and this effect has been confirmed in multiple meta-analyses. For small-cell lung carcinoma, PSK in conjunction with chemotherapy prolongs the remission period. In addition, PSK has been shown to be effective against various other cancers, reduce the adverse effects of chemotherapy, and improve quality of life. Future studies should examine the effects of PSK under different host immune conditions and tumor properties, elucidate the mechanism of action exhibited in each situation, and identify biomarkers.
67 citations
TL;DR: The Japanese Society for the Study of postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy as discussed by the authors, which dealt with the reconstruction after a distal gastrecture, pylorus-preserving gastrectoma (PPG), total gastrectomies, and proximal gastrectoms.
Abstract: The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy conducted a nationwide questionnaire survey to clarify the current status of reconstruction after gastrectomy. One hundred and forty-five institutions (66%) responded to the survey. The questionnaire dealt with the reconstruction after a distal gastrectomy, pylorus-preserving gastrectomy (PPG), total gastrectomy, and proximal gastrectomy. The most common method of reconstruction after distal gastrectomy was Billroth I in 112 institutions (74%), and Roux-en-Y (RY) in 30 (21%). Seventy-seven institutions (53%) responded to the PPG questions. The lengths of the antral cuff were widely distributed among the institutions. Segmental gastrectomy was performed by 23 institutions for limited cases. The most common method of reconstruction after total gastrectomy was RY in 138 institutions (95%). Reconstruction with a pouch after total gastrectomy was done in 26 institutions (18%). The most common reconstructions after proximal gastrectomy were esophagogastrostomy in 69 institutions (48%), jejunal interposition in 41 (28%), double tract in 19 (13%) and pouch reconstruction in 6 (7%). Although most Japanese surgeons are concerned about the revised methods of reconstruction and quality of life after gastrectomy, surgeons have not yet reached a full consensus on these issues.
60 citations
TL;DR: CHO appears to be safe, and may attenuate postoperative insulin resistance as compared to placebo, however, the quality of most of the published trials has been poor, and the evidence levels for most outcomes were low, so rigorous and larger RCTs are needed in the future.
Abstract: Background and objective
It is unclear whether the preoperative administration of oral carbohydrates (CHO) is safe and effective, and therefore we herein evaluated the efficacy and adverse events associated with CHO for elective surgery.
60 citations
TL;DR: The findings reinforce the importance of careful follow-up for both loco-regional and hematogenous recurrence after esophagectomy, particularly during the first 2 years, and of treating patients with recurrence treated by chemotherapy alone or multimodal therapy.
Abstract: The results and outcomes of surgical resection for esophageal carcinoma have improved remarkably in recent years; however, recurrence still frequently develops, even after complete resection. The purpose of this study is to clarify the characteristics of recurrence in this patient population. Among 208 patients, who underwent R0 resection for esophageal carcinoma, recurrence developed in 61. Clinical data were available for 56 of these patients, who were the subjects of this study. We evaluated the time, patterns, and treatment of recurrence in these patients. Recurrence developed within 1 and 2 years after esophagectomy in 71 and 84% of the patients, respectively, and was classified as loco-regional (54%), hematogenous (36%), or mixed type (10%). The prognosis of patients with loco-regional recurrence tended to be better than that of those with distant metastasis, although the difference was not significant (P = 0.088). Patients with recurrence treated by chemotherapy alone or multimodal therapy, such as radiation or surgery combined with systemic chemotherapy, survived significantly longer than those with untreatable recurrence (P = 0.016). These findings reinforce the importance of careful follow-up for both loco-regional and hematogenous recurrence after esophagectomy, particularly during the first 2 years.
59 citations
TL;DR: The numerical values revealed by this study reinforce the medical-economic importance of instigating preventive measures against SSI, as SSI clearly prolonged the hospital stay and increased medical costs.
Abstract: To clarify the impact of surgical site infection (SSI) after colorectal surgery on the length of hospital stay and medical expenditure in Japan. This was a multi-center, retrospective-matched case–control study. The total number of patients enrolled was 334 (167 case/control pairs). The average hospital stay after surgery was prolonged by 17.8 days (95% CI 11.9–23.5) and the average medical cost after surgery was increased by $5,938 (95% CI 3,610–8,367) in the SSI group versus the non-SSI group. Hospital charges comprised the largest among all cost categories and accounted for 53% of the additional cost. The hospital stay and medical costs both increased proportionately to the depth of the SSI, from 4.4 days and $608 for superficial incisional SSI, to 39.2 days and $14,448 for organ/space SSI. SSI caused by MRSA prolonged the hospital stay by 19.3 days and incurred an additional cost of $7,015. SSI clearly prolonged the hospital stay and increased medical costs. The numerical values revealed by this study reinforce the medical-economic importance of instigating preventive measures against SSI.
57 citations
TL;DR: A pulmonary wedge resection for peripheral NSCLC should result in a negative malignant margin, which might be obtained from a sufficient tumor margin ratio of M/T ≥ 1, although the long-term clinical implications remain unclear.
Abstract: A pulmonary wedge resection is useful for the treatment of peripheral non-small cell lung cancer (NSCLC). The margin/tumor size ratio (M/T) is a predictor of positive margin cytology findings in these procedures, although the long-term clinical implications remain unclear. This relationship was investigated in this study. Thirty-seven cases with a high surgical risk without additional pulmonary resection were selected from those accrued in a multicenter prospective study of optimal margin distance for pulmonary excision of peripheral NSCLC and followed for more than 5 years (range 5.3–14 years). Both the M/T and margin cytology findings were indicators of cancer recurrence and survival. All seven cases of surgical margin recurrence had a cytology-positive surgical margin. The 5-year survival rate was 54.2% (n = 24) for M/T < 1 and 84.6% for M/T ≥ 1 (n = 13, P = 0.05), while it was 38.5% for positive margin (n = 13) and 79.2% for negative margin (n = 24) cases (P = 0.001). In addition, the margin cytology findings were an independent prognostic factor. A pulmonary wedge resection for peripheral NSCLC should result in a negative malignant margin, which might be obtained from a sufficient tumor margin ratio of M/T ≥ 1.
51 citations
TL;DR: Early referral to tertiary centers with an alliance among hepatobiliary surgeons, interventional radiologists, and endoscopists is necessary to assure optimal results in benign biliary strictures.
Abstract: As laparoscopic cholecystectomy and liver transplantation (LT) have become more common, so has biliary stricture. Fortunately, endoscopic treatment has almost simultaneously been developed. This article reviews the recent reports concerning the management of benign biliary strictures (BBS). The literature regarding the diagnosis and treatment of BBS is reviewed after an electronic search of PubMed from 1982 to 2009 was performed. Despite the existence of diagnostic tools including tumor markers, brush cytology, intraductal ultrasonography and other imaging modalities, differentiating BBS from malignant stricture remains challenging, as does differentiating IgG4-related sclerosing cholangitis from other benign strictures. Endoscopic treatment with balloon dilation of the stricture and serial insertions of stents is the preferred initial treatment for BBS. However, the outcomes of endoscopic treatments for primary sclerosing cholangitis or chronic pancreatitis are poorer than those for post-surgical biliary stricture. When endoscopic treatments fail to repair complicated biliary strictures such as Bismuth types III, IV, and V, surgical repair is recommended. Among the non-anastomotic BBS, intrahepatic bilateral type strictures after LT may require repeat transplantation. Early referral to tertiary centers with an alliance among hepatobiliary surgeons, interventional radiologists, and endoscopists is necessary to assure optimal results.
TL;DR: Reading published studies using a microarray-based analysis to identify gene expression profiles associated with the response of rectal cancer to radiation or CRT finds that the microarray analysis could still have potential to improve the management of locally advancedrectal cancer.
Abstract: Preoperative radiotherapy or chemoradiotherapy (CRT) has become a standard treatment for patients with locally advanced rectal cancer. However, there is a wide spectrum of responses to preoperative CRT, ranging from none to complete. There has been intense interest in the identification of molecular biomarkers to predict the response to preoperative CRT, in order to spare potentially non-responsive patients from unnecessary treatment. However, no specific molecular biomarkers have yet been definitively proven to be predictive of the response to CRT. Instead of focusing on specific factors, microarray-based gene expression profiling technology enables the simultaneous analysis of large numbers of genes, and might therefore have immense potential for predicting the response to preoperative CRT. We herein review published studies using a microarray-based analysis to identify gene expression profiles associated with the response of rectal cancer to radiation or CRT. Although some studies have reported gene expression signatures capable of high predictive accuracy, the compositions of these signatures have differed considerably, with little gene overlap. However, considering the promising data regarding gene profiling in breast cancer, the microarray analysis could still have potential to improve the management of locally advanced rectal cancer. Increasing the number of patients analyzed for more accurate prediction and the extensive validation of predictive classifiers in prospective clinical trials are necessary before such profiling can be incorporated into future clinical practice.
TL;DR: Postoperative DKT administration significantly suppressed the CRP level and shortened the time until first flatus and significantly suppressed postoperative inflammation following surgery for colorectal cancer.
Abstract: The inflammatory response after surgery is associated with various postoperative complications. The aim of the present prospective study was to evaluate the effects of Daikenchuto (DKT) (a Japanese herbal medicine) on the inflammatory response in patients following laparoscopic colorectal resection. Thirty patients who underwent laparoscopic colectomy for colorectal carcinoma were divided into two groups: a DKT intake group (D group, n = 15) and a control group (C group, n = 15). The D group took 7.5 g/day of DKT from the day after surgery until the 7th postoperative day. The body temperature, heart rate, WBC count, lymphocyte count, C-reactive protein (CRP) level, β-d-glucan level and Candida index were compared between the two groups. The patients’ mean age in the D group was significantly younger than that in the C group. D3 lymph node dissection was performed more often in the D group. The time until first flatus was significantly shorter in the D group (1.8 ± 0.5 days) than in the C group (2.7 ± 0.5 days). The CRP level was significantly lower in the D group (4.6 ± 0.6 mg/dl) than in the C group (8.3 ± 1.1 mg/dl) on the 3rd postoperative day. Postoperative DKT administration significantly suppressed the CRP level and shortened the time until first flatus. DKT administration also significantly suppressed postoperative inflammation following surgery for colorectal cancer.
TL;DR: Appendiceal diverticulitis is more likely to perforate over the progression of the clinical course, which would mandate appendectomy when appendiceal DiverticULitis is detected by US, even if the patient has no severe abdominal pain.
Abstract: Purpose
Previous authors have suggested that a diverticulum of the vermiform appendix has a higher risk of perforation than acute appendicitis. Therefore, this study compared appendiceal diverticulitis with acute appendicitis to explain the characteristics of appendiceal diverticulitis.
TL;DR: Meticulous preoperative evaluation based on volumetric analysis, together with sophisticated surgical techniques, achieved zero mortality and minimized intraoperative blood loss, which was classified as one of the most significant predictors of postoperative complications after major hepatic resection.
Abstract: We reviewed a series of patients who underwent hepatic resection at our institution, to investigate the risk factors for postoperative complications after hepatic resection of liver tumors and for procurement of living donor liver transplantation (LDLT) grafts. Between April 2004 and August 2007, we performed 304 hepatic resections for liver tumors or to procure grafts for LDLT. Preoperative volumetric analysis was done using 3-dimensional computed tomography (3D-CT) prior to major hepatic resection. We compared the clinicopathological factors between patients with and without postoperative complications. There was no operative mortality. According to the 3D-CT volumetry, the mean error ratio between the actual and the estimated remnant liver volume was 13.4%. Postoperative complications developed in 96 (31.6%) patients. According to logistic regression analysis, histological liver cirrhosis and intraoperative blood loss >850 mL were significant risk factors of postoperative complications after hepatic resection. Meticulous preoperative evaluation based on volumetric analysis, together with sophisticated surgical techniques, achieved zero mortality and minimized intraoperative blood loss, which was classified as one of the most significant predictors of postoperative complications after major hepatic resection.
TL;DR: The results indicate that the length of remaining small bowel is closely related to SBS in patients who have undergone surgery for CD, and at least 200 cm of small bowel should be preserved when total colectomy and ostomy creation are performed for CD.
Abstract: Patients with Crohn’s disease (CD) often need home parenteral nutrition for short bowel syndrome (SBS), as a result of frequent surgery and extended bowel resections. We conducted this study to evaluate the influence of the patient’s condition on the occurrence of SBS in CD. The subjects of this study were 721 patients, who underwent bowel resections for CD at Hyogo College of Medicine between September 1974 and September 2010. The collective total of bowel resection operations was 1286. The possible risk factors for SBS were analyzed by univariate and multivariate logistic regression analyses to determine their predictive significance. SBS was diagnosed in 24 patients. A stepwise logistic regression model revealed that penetrating type (odds ratio 14.9, p = 0.02), remaining small intestine <200 cm (odds ratio 141.4, p < 0.01), ostomy creation (odds ratio 7.5, p = 0.03), and post-total colectomy (odds ratio 17.6, p < 0.01) were independent risk factors for SBS. These results indicate that the length of remaining small bowel is closely related to SBS in patients who have undergone surgery for CD. At least 200 cm of small bowel should be preserved to prevent SBS when total colectomy and ostomy creation are performed for CD.
TL;DR: The VIO system was safe for hepatic resection and its use was associated with a significant decrease in intraoperative blood loss even in cirrhotic patients.
Abstract: This study aimed to evaluate a novel surgical device combination [VIO system containing a bipolar clamp (BiClamp) and the monopolar soft-coagulation (SOFT COAG)] in hepatic resection for patients with hepatocellular carcinoma (HCC). This study performed 124 hepatic resections for HCC and divided them into 2 groups: 60 patients (Conventional group) underwent liver parenchymal transection using Cavitron Ultrasonic Surgical Aspirator (CUSA) system and saline-coupled bipolar electrocautery for hemostasis; the BiClamp was used with the CUSA system for liver parenchymal transection and SOFT COAG was used with saline-coupled bipolar electrocautery for hemostasis in 64 patients (VIO group). The median blood loss in the VIO group was 345 mL, which was less than that in the Conventional group (median 548 mL, P = 0.0423). A multivariate logistic regression analysis showed that no use of the VIO system (P = 0.0172) was an independent predictor of intraoperative blood loss, respectively. In patients with liver cirrhosis, the VIO group included a significantly lower proportion of patients with liver cirrhosis that experienced more than 500 mL of intraoperative blood loss in comparison to those in the Conventional group (P = 0.0262). The VIO system was safe for hepatic resection and its use was associated with a significant decrease in intraoperative blood loss even in cirrhotic patients.
TL;DR: Esophagectomy with mediastsinal and abdominal lymph node dissection is considered to be an appropriate approach for surgical resection of squamous cell carcinomas, whereas transhiatally extended gastrectomy with lower mediastinal and abdomen lymph nodeDissection is recommended for the treatment of adenocarcinomas.
Abstract: Purpose
Both squamous cell carcinomas and adenocarcinomas can develop in the esophagogastric junction. To clarify the appropriate lymph node dissection range, lymph node metastases from cancers in the esophagogastric junction were investigated.
TL;DR: Curative surgery might improve the prognosis of patients with peripheral-type intrahepatic cholangiocarcinoma, but routine LN dissection is not recommended, particularly for patients without LN metastasis.
Abstract: To investigate the prognostic factors of peripheral-type intrahepatic cholangiocarcinoma (PP-IHCC) and evaluate the surgical outcomes according to surgical strategy alterations. Twenty-two patients were divided into two groups according to the surgical strategy: an extended surgery group (Ex group: n = 10), composed of those who underwent hepatic lobectomy combined with lymph node (LN) dissection and bile duct resection; and a customized surgery group (Cx group: n = 12), composed of those who underwent hepatectomy and bile duct resection according to tumor spread. LN dissection was not performed in patients without LN metastasis. Multivariate analysis revealed that R2 resection, LN metastasis, and intrahepatic metastasis were independent prognostic factors. LN dissection was significantly infrequent in the Cx group. Survival after curative resection was similar in the two groups (3-year survival: 42.9 vs. 57.1%). Liver metastasis was the most frequent primary recurrence, occurring in more than 80% of patients from both groups. Curative surgery might improve the prognosis of patients with PP-IHCC, but routine LN dissection is not recommended, particularly for patients without LN metastasis. Surgery alone, including LN dissection, cannot control this type of tumor, and additional treatment should be given.
TL;DR: Chylous ascites after colorectal cancer surgery occurred at an incidence of 1.0%, but was significantly more frequent after surgery for tumors fed by the superior mesenteric artery and after D3 lymph node dissection.
Abstract: Purpose
To evaluate the diagnosis, epidemiology, risk factors, and treatment of chylous ascites after colorectal cancer surgery.
TL;DR: The current status of prognostic and predictive biomarkers for stage II colon cancer is reviewed and an update on the most recent developments is provided.
Abstract: The use of adjuvant chemotherapy for stage II colon cancer remains controversial. The accurate assessment of the risk factors associated with recurrence in patients with stage II disease is the key to identifying the patients that are most likely to benefit from adjuvant chemotherapy. Recent guidelines advocate that adjuvant chemotherapy for high-risk stage II colon cancer should take into account factors such as the T stage, number of lymph nodes examined, tumor differentiation, and tumor perforation. In addition to these clinicopathological factors, there has also been intense interest in the identification of new prognostic or predictive biomarkers that can improve outcomes through better patient classification and selection for adjuvant chemotherapy. Recent advances in the field of molecular genetics have led to the identification of specific biomarkers involved in colorectal cancer progression, whereas gene expression microarray technology has led to the identification of molecular profiles able to predict recurrence or benefit from adjuvant chemotherapy. However, none of these has yet been validated in large prospective clinical trials. In this article, we review the current status of prognostic and predictive biomarkers for stage II colon cancer and provide an update on the most recent developments.
TL;DR: Strangulated inguinal hernias cannot be considered a contraindication to the use of a prosthetic mesh even in cases requiring small-intestinal resection, despite being significantly older than the patients who underwent mesh repair.
Abstract: Purpose
No consensus has been reached on the use of prostheses in a potentially infected operating field. In this study, we evaluated the validity of a mesh prosthesis for the repair of incarcerated groin hernias with intestinal resection.
TL;DR: An elevated GLUT1 expression may be a useful predictor of distant recurrence and poor prognosis in rectal cancer patients after preoperative CRT and in the in vitro studies, it was observed that 3-BrPA significantly suppressed the proliferation of colon cancer cells with highGLUT1 gene expression, compared with those with low expression.
Abstract: Most cancer cells exhibit increased glycolysis. The elevated glucose transporter 1 (GLUT1) expression has been reported to be associated with resistance to therapeutic agents and a poor prognosis. We wondered whether GLUT1 expression was associated with the clinical outcome in rectal cancer after preoperative chemoradiotherapy (CRT), and whether glycolysis inhibition could represent a novel anticancer treatment. We obtained total RNA from residual cancer cells using microdissection from a total of 52 rectal cancer specimens from patients who underwent preoperative CRT. We performed transcriptional analyzes, and studied the association of the GLUT1 gene expression levels with the clinical outcomes. In addition, we examined each proliferative response of three selected colorectal cancer cell lines to a glycolysis inhibitor, 3-bromopyruvic acid (3-BrPA), with regard to their expression of the GLUT1 gene. An elevated GLUT1 gene expression was associated with a high postoperative stage, the presence of lymph node metastasis, and distant recurrence. Moreover, elevated GLUT1 gene expression independently predicted both the recurrence-free and overall survival. In the in vitro studies, we observed that 3-BrPA significantly suppressed the proliferation of colon cancer cells with high GLUT1 gene expression, compared with those with low expression. An elevated GLUT1 expression may be a useful predictor of distant recurrence and poor prognosis in rectal cancer patients after preoperative CRT.
TL;DR: This case indicates that SPN of the pancreas has a latent ability to recur, regardless of its benign pathological features, and peritoneal spread may be promoted by trauma, and a close postoperative follow-up is thus mandatory in all patients with SPN even after a radical resection.
Abstract: A solid pseudopapillary neoplasm (SPN) of the pancreas is generally regarded as a neoplasm of low malignant potential and there is rarely recurrence of the disease. A 12-year-old female underwent a pylorus preserving pancreaticoduodenectomy for a ruptured pancreatic SPN following a blunt abdominal trauma. The tumor showed no pathological features suggesting malignant potential. Follow-up imaging studies depicted small nodules adjacent to the superior mesenteric vein 7 years after surgery. A laparotomy was performed, and exploration revealed 3 nodules adjacent to the superior mesenteric vein and 4 small nodules in the mesointestine. All of these lesions were extirpated, and were histologically confirmed to be nodal and peritoneal recurrence of SPN. This case indicates that SPN of the pancreas has a latent ability to recur, regardless of its benign pathological features, and peritoneal spread may be promoted by trauma. A close postoperative follow-up is thus mandatory in all patients with SPN even after a radical resection.
TL;DR: Surgical management should be considered as palliative treatment in patients with a bowel obstruction or peritonitis caused by primary lung cancer, according to the results of a series of cases of small bowel metastases from lung cancer.
Abstract: Purpose
To investigate the treatment and outcomes in a series of seven cases of small bowel metastases from lung cancer.
TL;DR: Endoscopic ultrasound-guided FNAB is recommended for definite preoperative diagnosis of histopathologically unknown SMTs to determine the indications for surgery, and the laparoscopic approach with the assistance of endoscopy is useful for improving the curability, with minimal invasiveness for the partial resection of GISTs.
Abstract: Gastrointestinal stromal tumors (GISTs) should be surgically resected, even those smaller than 5 cm in size, which is the threshold of clinical malignancy for submucosal tumors (SMTs) in the gastrointestinal tract. This study reviewed the use of laparoscopic surgery for gastric partial resection of GISTs or SMTs that were suspected to be GISTs. Eighteen patients underwent laparoscopic partial resection of the stomach for GISTs or SMTs. The tumor location was confirmed by intraluminal endoscopy. One-half of the circumference around the tumor was dissected, and the tumor was turned toward the abdominal cavity. The nonresected part of the tumor and the edge of the incision line was lifted up using forceps, and the incision line was closed using laparoscopic stapling devices. Two cases were diagnosed as GIST by endoscopic biopsy. Six patients underwent endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) examinations, which diagnosed five GISTs. There were 18 tumors smaller than 5 cm, including 10 GISTs, 4 leiomyomas, 3 schwannomas, and one heterotopic pancreas. Endoscopic ultrasound-guided FNAB is recommended for definite preoperative diagnosis of histopathologically unknown SMTs to determine the indications for surgery. The laparoscopic approach with the assistance of endoscopy is useful for improving the curability, with minimal invasiveness for the partial resection of GISTs.
TL;DR: MIVAT is a feasible, practical, and safe alternative with better cosmetic benefits, and it can be performed with an ease of manipulation that is similar to that of conventional neck surgery.
Abstract: Minimally invasive video-assisted thyroidectomy (MIVAT) is now emerging as a novel and less invasive procedure for thyroid diseases. This study conducted a systematic review of the available data to evaluate the safety and efficacy of this new technique over conventional procedure. A systematic literature search was performed on Medline, Embase, and The Cochrane Library. Randomized controlled trials comparing the MIVAT with open thyroidectomy were selected and meta-analyzed. Nine RCTs involving 730 patients were included and all were restricted to patients with a thyroid nodule no larger than 4 cm and surgery did not involve lymph node dissection. Both procedures were of similar efficacy in nodule resection. Open surgery had a 1.6 times higher rate of postoperative complications than the novel technique, with no significant difference (P = 0.08), especially in transient recurrent nerve palsy (OR = 0.93, P = 0.87). Although longer operative time was required for MIVAT (MD = 15.0 min, P < 0.00001), patients experienced less postoperative pain, especially in the early postoperative period (MD = −11.52, P = 0.0003). There was also a shorter incision length (MD = −2.36 cm, P < 0.00001), better cosmetic results and greater patient satisfaction in the novel technique group (WD = 2.59; P < 0.00001). MIVAT is a feasible, practical, and safe alternative with better cosmetic benefits, and it can be performed with an ease of manipulation that is similar to that of conventional neck surgery.
TL;DR: The surgical outcomes were acceptable in relation to other published results and the prognosis was favorable, and esophageal reconstruction using the ileum and right colon is useful for patients with esophagal cancer for whom the stomach is not available.
Abstract: To evaluate the outcomes of colon interposition based on our surgical experience. We reviewed data from 40 patients who underwent esophagectomy with colon interposition using the terminal ileum and right colon, to treat esophageal cancer, between January 1990 and December 2009. Transthoracic esophagectomy, transhiatal esophagectomy, and pharyngolaryngoesophagectomy were performed in 31 (77.5%), 8 (20.0%), and 1 (2.5%) patients, respectively. The routes of the colon interposition were posterior mediastinal in 30 (75.0%) patients, retrosternal in 5 (12.5%), and subcutaneous in 5 (12.5%). The median operative time was 450 min (range 320–760 min) and the median blood loss was 755 ml (range 180–3,000 ml). Overall postoperative morbidity involved 18 (45.0%) patients and included esophagoileostomy leakage in 7 (17.5%; minor, n = 4; major, n = 3) and necrosis of the colon conduit in 2 (5%) patients. The 30- and 90-day mortality rates were 0 and 2.5%, respectively. The 1-, 3-, and 5-year survival rates were 80, 66, and 66%, respectively. Our surgical outcomes were acceptable in relation to other published results and the prognosis was favorable. Thus, esophageal reconstruction using the ileum and right colon is useful for patients with esophageal cancer for whom the stomach is not available. We currently perform colon interposition with microvascular anastomoses for grafts via the subcutaneous route to increase the safety of this operation.
TL;DR: Findings support that LS is safe and effective for advanced carcinoma of the colon, and the LS group in this study had a significantly better long-term outcome than the OS group.
Abstract: There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3 years. The subjects of this prospective non-randomized multicentric study were 290 consecutive patients, who underwent open surgery (OS group; n = 164) or laparoscopic surgery (LS group; n = 126) between 1994 and 2005, at one of the four surgical centers. The same surgical techniques were used for the laparoscopic and open approaches to right and left colectomy. The distribution of TNM substages (III A, III B, IIIC) as well as the grading of carcinomas (G1, G2, G3) were similar in each arm of the study. The median follow-up periods were 76.9 and 58.0 months after OS and LS, respectively. There were 10 (6.1 %) versus 9 (7.1 %) deaths unrelated to cancer, 15 (9.1 %) versus 5 (4 %) cases of local recurrence, 7 (4.2 %) versus 5 (4 %) cases of peritoneal carcinosis, and 37 (22.5 %) versus 14 (11.1 %) cases of metastases in the OS and LS groups, respectively. There was also one case of port-site recurrence after LS (0.8 %). The OS group had a significantly higher probability of local recurrence and metastases (p < 0.001) with a significant higher probability of cancer-related death (p = 0.001) than the LS group. These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better long-term outcome than the OS group, further investigations are needed to draw a definitive conclusion.
TL;DR: Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.
Abstract: To achieve early recovery and early discharge from the hospital by applying an enhanced recovery after surgery (ERAS) protocol, which is mainly used with colonic surgery, for the perioperative management of open AAA surgery. One hundred twenty-seven open AAA surgery cases successfully carried out between 2003 and 2011 were included in this study. The ERAS protocol was used for the cases from April 2008 onward, and we performed a comparison of the conventionally treated cases with ERAS cases regarding the start of postoperative oral consumption, the postoperative hospital stay, and hospitalization medical costs. The time to restarting oral consumption and the postoperative hospital stay were significantly shorter for the ERAS group (n = 52) compared to the conventionally managed group (n = 75); with values of 59 ± 15 and 93 ± 25 h (p = 0.021), 9 ± 3 and 16 ± 5 days (p = 0.001), respectively. The medical costs for the ERAS group were 92 % of the costs of the conventionally managed group. Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.