ABSTRACT
BACKGROUND: Prediction of failure of nonoperative management (NOM) in uncomplicated appendicitis (UA) is difficult. This study aimed to establish a new prediction model for NOM failure in UA. METHODS: We included 141 adults with UA who received NOM as initial treatment. NOM failure was defined as conversion to operation during hospitalization. Independent predictors of NOM failure were identified using logistic regression analysis. A prediction model was established based on these independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test were used to assess the discrimination and calibration of the model, respectively, and risk stratification using the model was performed. RESULTS: Among 141 patients, NOM was successful in 120 and unsuccessful in 21. Male sex, maximal diameter of the appendix, and the presence of fecalith were identified as independent predictors of NOM failure for UA. A prediction model with scores ranging from 0 to 3 was established using the three variables (male sex, maximal diameter of the appendix ≥ 15 mm, and the presence of fecalith). The area under the ROC curve for the new prediction model was 0.778, and the model had good calibration (P = 0.476). A score of 2 yielded a sensitivity of 71.4% and a specificity of 90.8%. Patients were stratified into low (0-1), moderate (2), and high (3) risk categories, which had NOM rates of 5.2%, 47.1%, and 77.8%, respectively. CONCLUSIONS: Our prediction model may predict NOM failure in UA with good diagnostic accuracy and help surgeons select appropriate treatments.
Subject(s)
Appendicitis , Appendix , Adult , Appendicitis/drug therapy , Humans , Male , ROC Curve , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). METHODS: Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. RESULTS: Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. CONCLUSION: Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.
Subject(s)
Hepatectomy , Postoperative Complications , Aged , Elective Surgical Procedures , Hepatectomy/adverse effects , Humans , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Gastrointestinal surgery in elderly individuals presents unexpected postoperative complications. However, predicting postoperative complications in elderly patients undergoing gastrointestinal surgeries is challenging because of the lack of a reliable preoperative evaluation system. We aimed to prospectively evaluate three new preoperative assessment methods to predict the postoperative complications in elderly patients undergoing elective gastrointestinal surgery. Moreover, we aimed to identify new risk factors of postoperative complications in this patient group. METHODS: This prospective cohort study enrolled 189 patients (age ≥ 65 years) who underwent elective gastrointestinal surgery at Tokyo Medical University Hachioji Medical Center between April 2017 and March 2019. Assessments performed preoperatively included the biological impedance analysis for evaluating the skeletal muscle mass, the SF-8 questionnaire for evaluating the subjective health-related quality of life, and the blood pressure/pulse wave test for assessing arteriosclerosis. The risk factors for Clavien-Dindo Grade ≥ III postoperative complications were assessed using these new evaluation methods. RESULTS: Clavien-Dindo Grade ≥ III postoperative complications were observed in 28 patients (14.8%). Univariate and multivariate analyses identified male sex, low skeletal muscle mass, and cardio-ankle vascular index ≥ 10 (arteriosclerosis) as significant independent risk factors of developing Grade ≥ III complications. CONCLUSIONS: Male sex, low skeletal muscle mass, and arteriosclerosis were significant risk factors of postoperative complications in elderly patients undergoing elective gastrointestinal surgery. The obtained knowledge could be useful in identifying high-risk patients who require careful perioperative management.
Subject(s)
Digestive System Surgical Procedures , Elective Surgical Procedures , Postoperative Complications , Aged , Digestive System Surgical Procedures/adverse effects , Elective Surgical Procedures/adverse effects , Female , Humans , Male , Postoperative Complications/epidemiology , Prospective Studies , Risk FactorsABSTRACT
BACKGROUND: Morbidity following pancreaticoduodenectomy (PD) has been reported to remain high. This study sought to measure the peak Hounsfield units (HUs) of visceral attenuation in patients undergoing PD and to assess the quality of adipocytes by comparing these measurements with perioperative factors. METHODS: Patients undergoing PD were retrospectively identified (n = 108). Abdominal perimeter, subcutaneous fat area (SFA), visceral fat area (VFA), and peak HU of the VFA were measured. Logistic regression analysis was used to identify independent predictors of postoperative pancreatic fistula (POPF) or complications. Histopathological examination was performed for qualitative diagnosis of the stromal tissue. RESULTS: The overall rate of POPF was 16%, and severe complications occurred in 23% of the cases. A criterion for peak HU of the VFA only independently predicted POPF (p = 0.007) in the multivariate analysis. A criterion for peak HU of the VFA (p = 0.015) was associated with an increased rate of postoperative severe complications in the univariate analysis. The peak HU of the VFA was significantly correlated with abdominal perimeter (p < 0.001) and VFA (p < 0.001). The peak HU of the VFA was significantly correlated with adipocyte diameter (p < 0.001) and the ratio of stromal connective tissue area around the adipocytes (p < 0.001). CONCLUSION: The peak HU of the VFA was an independent factor contributing to severe complications, including POPF after PD. It reflects the amount of stromal connective tissue around the adipocytes.
Subject(s)
Intra-Abdominal Fat/diagnostic imaging , Pancreatic Fistula/etiology , Pancreaticoduodenectomy/adverse effects , Postoperative Complications/etiology , Tomography, X-Ray Computed , Abdomen/diagnostic imaging , Adipocytes/pathology , Adult , Aged , Aged, 80 and over , Connective Tissue/diagnostic imaging , Female , Humans , Male , Middle Aged , Pancreaticoduodenectomy/methods , Predictive Value of Tests , Retrospective Studies , Severity of Illness Index , Subcutaneous Fat/diagnostic imagingABSTRACT
BACKGROUND: Idiopathic portal hypertension (IPH) generally has a good prognosis and rarely results in liver transplantation. Furthermore, there are few reports of living donor liver transplantation (LDLT) for IPH with extrahepatic portal vein stenosis. CASE PRESENTATION: We report the case of a 51-year-old female patient diagnosed with IPH more than 20 years ago. She suffered severe jaundice, massive ascites, and encephalopathy at the time of her visit to our hospital. The patient's extrahepatic portal vein showed a scar-like stenosis, and the portal flow was completely hepatofugal. Collateral circulation such as the splenorenal shunt was well developed, and multiple splenic artery aneurysms up to 2 cm were observed in the splenic hilum. Her Model for End-Stage Liver Disease score increased to over 40 because of renal dysfunction, requiring temporary dialysis. We performed LDLT using her husband's right lobe graft and splenectomy. The extrahepatic stenotic portal vein was completely resected, and the superficial femoral vein (SFV) graft collected from the recipient's right leg was used for portal reconstruction as an interposition graft. Although the clinical course after LDLT had many complications, the patient was discharged on postoperative day 113 and has been fine for 2 years after LDLT. Histopathologically, the explanted liver had obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal cirrhosis. CONCLUSION: This case showed that severe IPH is occasionally associated with extrahepatic portal vein stenosis and can be treated with LDLT with portal vein reconstruction using an interposition graft. It was also suggested that the SFV is a useful choice for the interposition graft.
Subject(s)
Aneurysm/surgery , Hypertension, Portal/surgery , Liver Cirrhosis/surgery , Liver Transplantation , Living Donors , Pancytopenia/surgery , Portal Vein/surgery , Splenic Artery/surgery , Splenomegaly/surgery , Aneurysm/complications , Constriction, Pathologic/complications , Constriction, Pathologic/surgery , Female , Humans , Hypertension, Portal/complications , Liver Cirrhosis/complications , Middle Aged , Pancytopenia/complications , Portal Vein/pathology , Plastic Surgery Procedures/methods , Splenectomy , Splenomegaly/complications , Vascular Surgical Procedures/methods , Idiopathic Noncirrhotic Portal HypertensionABSTRACT
The patient was a 56-year-oldwoman. She presentedto a nearby doctor with a chief complaint of dysphagia andwas diagnosed with esophageal cancer by upper gastrointestinal endoscopy, resulting in a referral to our hospital. Upper gastrointestinal endoscopy revealeda semicircular type 1 lesion 29 to 32 cm from the incisors, andshe was diagnosedwith squamous cell carcinoma by biopsy. Computedtomography (CT)andpositron emission tomography(PET)scans revealedthe enlargement and accumulation of lymph nodes along the lesser curvature of the stomach; thus, she was diagnosed with metastasis. In addition, multiple accumulations were found in the 7th cervical vertebrae as well as in the 1st, 3rd, 4th, and 8th thoracic vertebrae, leading to the diagnosis of bone metastasis. She was finally diagnosed with middle intrathoracic esophageal cancer T2N1M1, Stage â £; thus, we performedchemorad iotherapy(CRT)with 5-FU andCDDP (FP). The main lesion was markedly reduced in upper gastrointestinal endoscopy after CRT, and no apparent malignancy was found in endoscopic biopsy, so the diagnosis was endoscopic complete response. The CT scan also showed marked reductions in both the main lesion and the lymph nodes. As for the bone metastasis, some areas of bone consolidation remained, but they were diagnosed as partial responses since they were shrunk. Since then, FP has been continuously administeredon a regular basis andit has been about 2 years without any appearance of new lesions or re-exacerbation.
Subject(s)
Carcinoma, Squamous Cell , Chemoradiotherapy , Esophageal Neoplasms , Antineoplastic Combined Chemotherapy Protocols , Carcinoma, Squamous Cell/therapy , Esophageal Neoplasms/therapy , Female , Humans , Middle Aged , Positron-Emission TomographyABSTRACT
A 56-year-old man with advanced gastric tumor in the pyloric antrum had multiple lymph node metastases(lymph nodes #5, 6, 8, and 13), as revealed by abdominal computed tomography(CT).The patient was diagnosed with coexisting clinical Stage III A gastric cancer(cT2[SS], cN2, cM0)with concomitant malignant lymphoma.Distal gastrectomy, D2 lymph node dissection, and resection of lymph node #13 were performed.Histopathological findings indicated that both the primary tumor and lymph node metastases were neuroendocrine carcinomas.Adjuvant chemotherapy with S-1 was administered; however, follow-up CT after 6 months revealed local recurrence around the celiac artery.Therefore , the chemotherapy regimen was changed to irinotecan and cisplatin.A clinical complete response was obtained after 6 chemotherapy courses and maintained for up to 45 months.The patient is alive at 60 months after the operation.
Subject(s)
Carcinoma, Neuroendocrine/diagnosis , Stomach Neoplasms/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Camptothecin/administration & dosage , Camptothecin/analogs & derivatives , Carcinoma, Neuroendocrine/drug therapy , Carcinoma, Neuroendocrine/surgery , Cisplatin/administration & dosage , Humans , Irinotecan , Lymph Node Excision , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Middle Aged , Recurrence , Stomach Neoplasms/drug therapy , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Time FactorsABSTRACT
INTRODUCTION: Surgical outcomes for locally advanced pancreatic cancer with severe vascular invasion are generally poor. The aim of this study was to evaluate whether neoadjuvant chemoradiation therapy (NACRT) could improve the survival of patients with locally advanced pancreatic cancer without distant metastasis. METHODS: Between 2010 and 2014, a total of 20 consecutive patients with locally advanced pancreatic cancer without distant metastasis were treated with NACRT. These patients included borderline resectable (BR) and unresectable (UR) pancreatic cancer patients according to the NCCN guidelines. All patients were treated with 2 courses of low-dose gemcitabine plus S-1 combination (GS) chemotherapy and 50.4 Gy of radiation therapy. Restaging was performed 4-6 weeks after completion of NACRT, and curative resection was performed if local control was achieved and distant metastasis was absent. RESULTS: Of the 20 patients, 7 (35.0%) underwent curative resection after NACRT. R0 resections were achieved in 6 patients (85.6%), and R1 resection was achieved in only 1 patient. Curative operation could not be performed in 13 patients (65.0%), because 3 patients refused surgery, 3 patients were diagnosed with dissemination on probe laparotomy or laparoscopy, and 7 patients had progressive disease with liver metastasis or dissemination on CT or MRI. Patients with a curative operation had a median disease-free survival (DFS) of 16.3 months and a median overall survival (OS) of 25.2 months. All of the patients without curative operation were treated with full-dose GS chemotherapy after NACRT. These patients had a median OS of 11.3 months. CONCLUSION: Our strategy for treating BR or UR pancreatic cancer patients seems to be effective and there might be survival benefits if curative operations can be performed after NACRT.
Subject(s)
Chemoradiotherapy , Neoadjuvant Therapy , Pancreatic Neoplasms/therapy , Aged , Female , Humans , Male , Neoplasm Staging , Pancreatectomy , Pancreatic Neoplasms/pathology , Prognosis , Treatment OutcomeABSTRACT
The efficacy of the hanging maneuver for the retropancreatic nerve plexus (RNP) to enhance the confirmation of the margin status and to facilitate en-bloc resection for pancreatoduodenectomy is studied. The exit of the hanging maneuver of the RNP is the left part of the superior mesenteric artery, and the entry is the cranial part of the celiac axis. The entry of the hanging maneuver was connected to the dissection line on the right side of the celiac axis. Thereafter, the tape of the hanging maneuver was pulled to the right side, and the RNP was deployed widely. Finally, the RNP was easily dissected using a sealing device other than inferior pancreaticoduodenal artery. With the correct implementation of the hanging maneuver, we believe that it would be possible to obtain reliable R0 resection as well as a reduction in blood loss and operation time.
Subject(s)
Head and Neck Neoplasms , Pancreatic Neoplasms , Humans , Pancreaticoduodenectomy , Pancreas/surgery , Pancreatic Neoplasms/surgery , Mesenteric Artery, Superior/surgery , Head and Neck Neoplasms/surgeryABSTRACT
There is no gold standard indicator that is currently used to predict posthepatectomy liver failure (PHLF). A novel indicator of liver function, the LU15 index of 99mTc-galactosyl serum albumin (GSA) scintigraphy, refers to the liver uptake ratio over a 15-min interval. We aimed to evaluate the usefulness of the future liver remnant (FLR)-LU15 in predicting PHLF. The clinical data of 102 patients (70 males and 32 females; median age, 70 years) who underwent liver resection between January 2011 and August 2019 were analyzed. The FLR-LU15 was calculated by a fusion of simulated 3-dimensional images and 99mTc-GSA scintigraphy. PHLF was determined according to the definition of the International Study Group of Liver Surgery. The FLR-LU15 was an independent risk factor for PHLF ≥ Grade B according to multivariate analysis, and its value correlated with the PHLF grade. The area under the receiver operating characteristic curve of the FLR-LU15 for PHLF ≥ Grade B was 0.816 (95% confidence interval, 0.704-0.929), which was better than that of other indicators. When the cut-off value of FLR-LU15 was set at 16.7, the sensitivity was 86.7%, specificity was 74.7%, and odds ratio was 19.2 (95% confidence interval, 4.0-90.9), all of which were superior to other indicators. If the cut-off value was 13, the positive predictive value was 57.1%. The FLR-LU15 is a useful predictor of PHLF and may be more reliable than other predictors.
Subject(s)
Hepatectomy/adverse effects , Liver Failure/diagnostic imaging , Liver/diagnostic imaging , Postoperative Complications/diagnostic imaging , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/surgery , Female , Humans , Liver Failure/etiology , Liver Neoplasms/surgery , Male , Middle Aged , Postoperative Complications/etiology , Prognosis , Radionuclide Imaging , Retrospective Studies , Young AdultABSTRACT
BACKGROUND/AIM: Surgery is an important pancreatic ductal adenocarcinoma (PDAC) treatment; existing markers are inadequate prognostic indexes. We herein evaluated the utility of the FA score (fibrinogen/albumin ratio) for predicting PDAC postoperative outcomes. PATIENTS AND METHODS: We analysed the data of 67 PDAC patients who underwent surgical resection. The relationship between postoperative outcomes and the FA score was investigated. Performance of the FA score was compared to that of other variables and prognostic indexes. RESULTS: No patient with FA ≥130 survived >3 years, whereas all patients who survived longer had FA <130. The FA score was superior to all other indexes for predicting postoperative outcomes. Patients with FA ≥130 vs. <130 had significantly shorter overall and recurrence-free survival. CONCLUSION: The FA score is useful for predicting PDAC postoperative outcomes. Preoperatively, it may detect patients likely to have poor postoperative prognoses who may benefit from adjuvant or neoadjuvant therapy, thus improving outcomes.
Subject(s)
Adenocarcinoma/blood , Adenocarcinoma/surgery , Carcinoma, Pancreatic Ductal/blood , Carcinoma, Pancreatic Ductal/surgery , Fibrinogen/metabolism , Serum Albumin/metabolism , Adenocarcinoma/mortality , Aged , Aged, 80 and over , Carcinoma, Pancreatic Ductal/mortality , Female , Humans , Male , Middle Aged , Postoperative Period , Prognosis , Retrospective Studies , Survival AnalysisABSTRACT
For pancreatic cancer, the probability of distant metastasis can help choose the best course of treatment. The aim of this study is to establish the efficacy of hydroxyproline as a biomarker for distant metastasis for pancreatic cancer and to clarify the mechanism of EGLN/HIF1A axis that controls the invasion and metastasis. Metabolites (hydroxyproline) and genes (EGLN2 and EGLN3) were identified by metabolome analysis of the serum with pancreatic cancers with and without distant metastasis. The mechanism of EGLN/HIF1A axis including angiogenesis was examined in pancreatic cancer cells. Hydroxyproline associated with these mechanisms was evaluated to suggest the association with overall survival in pancreatic cancer. Decreased expression of EGLN2 and EGLN3 in pancreatic cancer, via the HIF1A and TGF ß1 pathway, was associated with the induction of angiogenic factors, increased vascular invasion, and poor overall patient survival. Hydroxyproline concentrations were regulated via the HIF1A pathway by EGLN2 and EGLN3, and that increased concentrations of hydroxyproline promote the invasion and metastasis of pancreatic cancer cells. These results suggested that the expression of hydroxyproline through the HIF1A pathway induced by EGLN2 and EGLN3 could be a surrogate marker for treatment and might predict distant metastasis in pancreatic cancer.
ABSTRACT
BACKGROUND: Laparoscopic hepatectomy has rapidly evolved and has become a viable alternative to open hepatectomy. However, the dissection of liver parenchyma via the laparoscopic caudal approach (parenchymal transection from the caudal to cranial direction under a laparoscopic caudal view) has several limitations. To avoid these limitations in anatomical hepatectomy along the hepatic vein with the caudal approach, it is important to recognize the "tenting sign of the hepatic vein," which helps to identify the running of the main trunk of the hepatic vein. TECHNICAL PRESENTATION: In the bifurcation of the hepatic vein, there is a possibility of splitting of the hepatic vein branch or disorientation between the main trunk and branch. Therefore, it is vital that when the branch is pulled, the main trunk of the hepatic vein appears to be toward the direction of the branch. As a result, the main trunk appears in the direction from the original route to the pseudo route. In the caudal approach, this phenomenon is called "tenting sign of the hepatic vein." Therefore, liver dissection should be performed in the contralateral and cranial sides of the main trunk, with the "tenting sign of the hepatic vein" in mind. This report describes specific cases of the "tenting sign of the hepatic vein." CONCLUSION: The "tenting sign of the hepatic vein" from the caudal approach is essential knowledge for safe and reliable anatomical laparoscopic hepatectomy and can lead to expansion of indications in the future.
Subject(s)
Laparoscopy , Liver Neoplasms , Hepatectomy , Hepatic Veins/diagnostic imaging , Hepatic Veins/surgery , Humans , Liver/diagnostic imaging , Liver/surgery , Liver Neoplasms/surgery , Operative TimeABSTRACT
BACKGROUND: The combination of major hepatectomy and pancreatoduodenectomy (PD), that is, a hepatopancreatoduodenectomy (HPD), is the only curative treatment for bile duct cancer with extensive horizontal tumor spread invading both the hepatic hilum and the intrapancreatic bile duct. However, this aggressive procedure remains controversial with regard to the balance between the survival benefit and high risk of mortality and morbidity, especially the risk for postoperative hepatic failure and postoperative pancreatic fistula. Here, we describe the efficacy of a novel modified technique of HPD with delayed division of the pancreatic parenchyma for hilar cholangiocarcinoma, and focus on the surgical technique and the short-term outcomes, with a representative case. TECHNICAL PRESENTATION: This new surgical technique involves dissection of the pancreatic parenchyma and relevant mesoduodenum at the final step after dissecting the required parts on the inferior side and superior side of the tumor, enabling excision of the resected specimen. This technique described herein can prevent saponification of the resected surface of the pancreas by dissecting the pancreatic parenchyma toward the latter half of the surgical procedure as much as possible. The results suggest that there may also be a relationship between this technique and the prevention of postoperative pancreatic fistula. CONCLUSION: This new surgical technique of HPD may be able to prevent postoperative pancreatic fistula by performing intraoperative dissection of the pancreatic parenchyma as late as possible, which in turn, may improve the safety of HPD.
Subject(s)
Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Hepatectomy/methods , Klatskin Tumor/surgery , Pancreaticoduodenectomy/methods , Aged , Humans , Male , Postoperative Complications/prevention & controlABSTRACT
BACKGROUND: Pancreatic vascular malformation causes epigastric pain, pancreatitis, portal vein hypertension, bleeding, and rupture. It is a rare disease, with most pancreatic vascular malformations being arteriovenous malformations (AVMs) and the other types of malformations being rare. We report a case of capillary lymphatic malformation (CLM) in the pancreatic uncinate process. CASE PRESENTATION: A 74-year-old woman, who presented with complaints of repeated upper abdominal pain, was admitted to our institution. Contrast-enhanced dynamic computed tomography (CT) scan revealed that the tumor in the pancreatic uncinate process had a poor contrast effect in the arterial phase and a small contrast effect in the equilibrium phase, which are suggestive of a benign disease-like vascular malformation. However, we suspected that it could possibly be a malignant tumor because the tumor size tended to increase over time; thus, we decided to perform a surgery. We resected the tumor through a partial resection of the pancreas. Macroscopically, the cut surface of the tumor had a spongioid appearance. Histopathological examination findings showed a mixed shape of small capillaries and lymphatic ducts. The patient was diagnosed with CLM according to the International Society for the Study of Vascular Anomalies (ISSVA) classification, based on the histological appearance and immunostaining findings. The postoperative course of the patient was uneventful. CONCLUSIONS: We reported a case of pancreatic vascular malformation, specifically a CLM, which was completely resected through a partial pancreatectomy.
ABSTRACT
Nutritional support after pylorus-preserving pancreaticoduodenectomy (PpPD) is still controversial. This study aimed to evaluate the efficacy of enteral nutrition (EN) via the double elementary diet (W-ED) tube after PpPD. One hundred two patients who received EN by the W-ED tube were compared with 52 patients who received total parental nutrition (TPN) previously. Clinicopathological and postoperative features were analyzed among the two groups. Patients with EN by the W-ED tube after PpPD had a lower incidence of postoperative pancreatic fistula than those with TPN. The total protein and albumin levels on discharge in the EN group were significantly higher than those in the TPN group. In the case without complication, decreasing rate of the third lumbar vertebra skeletal muscle area was significantly lower in the EN group. In the cases of soft pancreas, drainage volume by the W-ED tube until four postoperative day was significantly larger in the case without postoperative pancreatic fistula. The W-ED tube offers the advantages of reducing gastrointestinal pressure and enabling reduction of complications after PpPD surgery.
Subject(s)
Enteral Nutrition/instrumentation , Pancreaticoduodenectomy , Postoperative Care/instrumentation , Postoperative Complications/prevention & control , Adult , Aged , Aged, 80 and over , Enteral Nutrition/methods , Female , Humans , Incidence , Male , Malnutrition/epidemiology , Malnutrition/etiology , Malnutrition/prevention & control , Middle Aged , Pancreatic Fistula/epidemiology , Pancreatic Fistula/etiology , Pancreatic Fistula/prevention & control , Postoperative Care/methods , Postoperative Complications/epidemiology , Pylorus/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. METHODS: Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. RESULTS: A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. CONCLUSIONS: Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
Subject(s)
Surgical Stapling/adverse effects , Surgical Wound Infection/etiology , Suture Techniques/adverse effects , Sutures/adverse effects , Aged , Biliary Tract Surgical Procedures/adverse effects , Body Mass Index , Female , Hepatectomy/adverse effects , Humans , Male , Negative-Pressure Wound Therapy/adverse effects , Pancreaticoduodenectomy/adverse effects , Propensity Score , Retrospective StudiesABSTRACT
INTRODUCTION: Surgical resection is the only curative treatment for perihilar cholangiocarcinoma. However, Hepatopancreatoduodenectomy (HPD) procedure remains controversial in regard to the balance between the survival benefit and high risk of mortality and morbidity. PRESENTATION OF CASE: A 72-year-old man who was revealed the dilation of intrahepatic hepatic duct by computed tomography after laparoscopic total gastrectomy was referred to our hospital. The patient had undergone laparoscopic total gastrectomy with Roux-en-Y esophageal-jejunostomy reconstruction 1year previously. By several examinations, we consequently diagnosed this case as a perihilar cholangiocarcinoma and performed HPD. Histological examination revealed a well differentiated adenocarcinoma without lymph-node metastasis and a negative margin of liver parenchyma and pancreas. He was recovered from a grade B pancreatic fistula by conservative therapy and discharged post-operatively on day 64 in good health. The patient received postoperative systemic chemotherapy with gemcitabine for 6 months. 16 months after surgery, the patient has had no recurrence. DISCUSSION: HPD for biliary and cancers after total gastrectomy is a challenging procedure with high morbidity and mortality rates. However, this procedure can provide the chance for long-term survival if curative resection is feasible. CONCLUSION: This case was the first report of hepatopancreatoduodenectomy following laparoscopic total gastrectomy.
ABSTRACT
At advanced stages of hepatocellular carcinoma (HCC), the multikinase inhibitor sorafenib is the only effective treatment. Surrogate markers that predict the biological and clinical efficacy of sorafenib may help tailor treatment on an individual patient basis. In the present study, the clinical significance of the expression of HOXB9, a transcriptional factor, in HCC was assessed. Increased HOXB9 expression in HCC was found to be positively correlated with the expression of angiogenic factors, increased vascular invasion and was found to be associated with poor overall patient survival. Sorafenib treatment effectively suppressed the expression of angiogenic factors and activation of the Raf/MEK/ERK pathway in HOXB9-expressing HCC cell lines. Consistent with these findings, HCC patients, whose cancer expressed high levels of HOXB9, exhibited increased overall survival upon sorafenib treatment. Collectively, these results suggest that HOXB9 expression in HCC could be a surrogate marker for a beneficial response to sorafenib treatment.
Subject(s)
Carcinoma, Hepatocellular/pathology , Homeodomain Proteins/genetics , Liver Neoplasms/pathology , Niacinamide/analogs & derivatives , Phenylurea Compounds/pharmacology , Up-Regulation , Angiogenesis Inducing Agents/metabolism , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/genetics , Cell Line, Tumor , Disease-Free Survival , Female , Gene Expression Regulation, Neoplastic , Hep G2 Cells , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/genetics , Male , Neoplasm Invasiveness , Niacinamide/pharmacology , Sorafenib , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: A novel index, total liver LU15, has been identified as a surrogate marker for liver function. We evaluated the ability of preoperative remnant liver LU15 values to predict postoperative hepatic failure. METHODS: Preoperative risk factors for postoperative hepatic failure and remnant liver LU15 were evaluated in 123 patients undergoing liver resection for several diseases from September 1st, 2007 to December 1st, 2016. We calculated the remnant liver LU15 value from the total liver LU15 value and the functional remnant liver ratio. Risk factors for postoperative hepatic failure was determined by univariate and multivariate analysis. RESULTS: Hepatic failure grade B/C developed postoperatively in six patients of seven patients within Makuuchi criteria / without criteria for remnant liver LU15. Operative time (p = 0.0242) and criteria for remnant liver LU15 (p = 0.0001) were prognostic factors for hepatic failure according to the univariate analysis. And criteria for remnant liver LU15 (p = 0.0009) was only prognostic factor by multivariate analysis. CONCLUSION: Based on the findings form this pilot study, it appears that patients with a remnant liver LU15 value of 13 or less may have a high risk of postoperative hepatic failure.