Learning curve for laparoscopic transabdominal preperitoneal repair: A single-surgeon experience of consecutive 105 procedures.

INTRODUCTION: Based on previously published papers, the learning curve for laparoscopic groin hernia repair is controversial. The purpose of the present study was to evaluate the learning curve for laparoscopic surgery for groin hernia in a local hospital setting. METHOD: We analyzed 100 consecutive cases of laparoscopic transabdominal preperitoneal repair performed by a single surgeon at a single facility from April 2013 to December 2015. The total operative time was divided into three parts: (a) preparing the peritoneal flap, (b) unfolding the mesh, and (c) suturing the peritoneum. A cumulative sum method for the total operative time and duration of the three parts was used to determine the learning curve. RESULTS: The learning curve was overcome after 75 cases based on cumulative sum analysis of the total operative time. The cumulative sum analysis of the times to unfold mesh and to suture the peritoneum indicated that the learning curve was overcome after 22 and 32 cases, respectively. The learning curve for preparing the peritoneal space was correlated with that for the entire procedure. No cases of recurrence were encountered. CONCLUSION: At least 75 cases were needed to overcome the learning curve for laparoscopic transabdominal preperitoneal repair.

Surfactant-driven Amphoteric Doping of Carbon Nanotubes.

Aqueous surfactant dispersion is the most typical starting step to functionalize materials consisting of carbon nanotubes, but the effects of surfactants on the electronic properties are still unclear. Here we report how the functional groups of surfactants affect the electronic properties of carbon nanotube films. Using spectroscopic and thermoelectric characterization, we demonstrate that anionic and non-ionic surfactants contribute to the formation of p-type and n-type carbon nanotubes, respectively. Additionally, p-type doping with oxygen adsorption is found to compete with surfactants' doping. These findings are useful for designing the srarting carbon nanotube materials exhibiting desirable electronic properties.

[A Case of Long-Term Survival after Pancreatoduodenectomy for Gastric Cancer with Pancreatic Invasion].

A 79-year-old woman with symptomatic pyloric stenosis was diagnosed with advanced gastric cancer. CT revealed that the tumor had invaded into the pancreatic head.Since no contraindications were found at laparotomy, we performed pancreatoduodenectomy. The histopathologic diagnosis was pT4b (panc), pN3a (11/35), P0, CY0, H0, M0, pStage ⅢC, R0. The patient received adjuvant chemotherapy with S-1 for 1 year. The patient has survived without recurrence for more than 2 years. The efficacy of pancreatoduodenectomy for advanced gastric cancer is still controversial. Pancreatoduodenetomy may be indicated for selected cases of advanced gastric cancer, if an R0 resection can be achieved.

[The treatment plan for squamous cell anal canal carcinoma].

The current treatment plan for squamous cell anal canal carcinoma using chemoradiotherapy (CRT) is becoming more standardized. We use CRT rather than surgery to select the appropriate treatment. We experienced 4 patients treated with abdominoperineal resection(APR), of which 1 underwent adjuvant CRT. We also experienced 3 patients treated with radiotherapy(RT) and 2 treated with CRT. A patient treated with RT underwent APR because of radiation colitis. RT and CRT are advantageous for quality of life and are expected to be effective for controlling the disease. We hope that the standard treatment plan for anal cancer in Japan will be determined on the basis of histological features.

[A surgical (right lobectomy) case of liver metastasis of colon cancer after chemotherapy using mFOLFIRI and cetuximab].

A man in his early seventies underwent low anterior resection and partial resection of the liver for the rectal cancer and liver metastasis. However, 4 months after the surgery, he was found to have a liver tumor at S5 and S7 by abdominal CT scan. Then, he underwent chemotherapy (mFOLFOX6), but the metastatic tumor was progressive. We selected FOLFIRI + cetuximab regimen for second-line therapy to resect the metastatic tumor. As the metastatic lesion was become smaller after 4-course of the regimen including cetuximab, we decided to perform a radical resection. We conducted a right lobectomy of the liver, and the tumor was completely resected.

[A surgical (pancreatoduodenectomy) case of lymph node metastatic recurrence of colon cancer after chemotherapy].

A woman in her fifties underwent a right hemicolectomy (D3) for cancer of the ascending colon in October 2007, definitively and pathologically diagnosed as papillary adenocarcinoma invading to the subserosa, and no metastasis was detected to lymph node. But 13 months after the surgery, she was found to have a mass near the anastomosis by an abdominal CT scan. Colonoscopy showed an evaluating lesion with ulcer in the anal side of the anastomosis. We tried to resect the metastasis, but it was not resectable because of the invasion to the pancreas. The mFOLFOX regimen was effective. After the chemotherapy (6 courses), we decided to perform a radical resection. We conducted pancreatoduodenectomy in May 2009. She is still alive 12 months after surgery.

[The introduction of the clinical study in the general hospital].

Our hospital fights against a clinical study clearly. However, our hospital did not participate in a clinical study here. When I widened a clinical study in cooperation with the staff, I make a progress report. I started a clinical study only with a doctor first. Therefore it was recognized many problems happened and to promote a clinical study without cooperation of the work of many kinds. I studied with the staff to promote a clinical study and deepened understanding. Thereafter the clinical study was led by a nurse of the chemotherapy room; , in addition, was able to get various cooperation from a skiagrapher. When OGSG0603 began, the nurse and the pharmacist served to become the key than a doctor. I was able to promote a clinical study by cooperation of much staff. In addition, I was able to carry out the system improvement of each section by performing a clinical study.

High lymphatic vessel density correlates with overexpression of VEGF-C in gastric cancer.

Lymph node metastasis is one of the most important prognostic factors in malignant tumors. In this study, we investigated vascular endothelial growth factor (VEGF)-C expression in human gastric cancer using immunohistochemical techniques and determined the number of microvessels in peritumoral tissue. VEGF-C expression was positive in 22 of 79 cases (27.8%), and correlated with the presence of lymphatic invasion and lymph node metastasis. We confirmed by reverse transcription-polymerase chain reaction (RT-PCR) that VEGF-C mRNA expression is observed more commonly in cancer tissues than normal tissues. For 59 gastric tumors, we examined lymphatic vessel density (LVD) using the specific lymphatic vessel endothelial hyaluronan receptor (LYVE) -1 antibody. VEGF-C expression was observed in 10 of 25 cases (40%) that exhibited a high LVD. Furthermore, high LVD exhibited a significant correlation with VEGF-C expression. Our findings suggest that VEGF-C plays a pivotal role for lymphangiogenesis and tumor growth in gastric cancer.

The prognostic significance of overexpression of the decoy receptor for Fas ligand (DcR3) in patients with gastric carcinomas.

BACKGROUND: The FasL-Fas system has an important role in mediating immune-cytotoxic killing of cells such as virus-infected or tumor cells. It was recently reported that there is a soluble decoy receptor (DcR3), which binds to FasL and inhibits FasL-induced apoptosis, and certain tumors may escape FasL-dependent immune-cytotoxic attack by expressing a decoy receptor that blocks FasL. We evaluated whether DcR3 has clinical relevance in actual human gastric cancers. METHODS: : The expression of DcR3 was investigated by Northern blot analysis in a series of 84 primary gastric carcinomas and compared with clinicopathological features and prognosis. The DcR3 expression level was analyzed and quantified densitometrically. The location of DcR3 mRNA in gastric carcinoma tissue was detected by in situ hybridization. RESULTS: The frequency of DcR3 overexpression was 26% (22 of 84 surgical specimens). The DcR3 expression level was significantly associated with lymph node metastasis and pathological stage, but did not correlate with tumor size, metastatic status, or histological type. In situ hybridization demonstrated that DcR3 mRNA was expressed in tumor cells. When the patients were followed up for 63 months, DcR3 overexpression was found to be associated with a significantly shortened duration of overall survival compared with findings in patients having normal DcR3 expression. CONCLUSION: The DcR3 decoy receptor for FasL may be involved in the progression of gastric cancer. Further evaluation of these possible roles of DcR3 and the regulation of DcR3 expression in malignant cells will be critically important for the development of new strategies for controlling the growth of malignant cells that escape host immune surveillance.