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BACKGROUND: Most adult cases of intussusception are caused by colorectal cancer, and emergency surgery is performed when symptoms such as abdominal pain and vomiting are present. The patient must customarily undergo both bowel decompression and radical surgery for colorectal cancer at the same time, and laparotomy is generally the procedure of choice. CASE PRESENTATION: An 86-year-old woman presented to our hospital with diarrhea and bloody stools. Preoperative examination revealed the presence of a cancerous tumor in the advanced part of the transverse colon and bowel intussusception. Radical surgery was successfully performed using the laparoscopic single-port technique through a small incision at the umbilical site to treat intussusception caused by cecum cancer. CONCLUSIONS: With only one wound site at the umbilicus, this single-port laparoscopic approach is much less invasive than endoscopic surgery that requires four to five incision wounds to perform the procedure. Furthermore, the patient was discharged without major complications and this surgical technique could be of great benefit if established as a standard procedure in the future.
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BACKGROUND: An increasing number of patients are achieving long-term survival after pancreatoduodenectomy, meaning that risk assessments of endocrine and exocrine pancreatic insufficiency are needed. Herein, we investigated the risk factors for pancreatic insufficiency after pancreatoduodenectomy by incorporating pancreatic morphologic changes and perioperative factors. METHODS: Patients who underwent pancreatoduodenectomy between January 2015 and December 2020 were enrolled in this single-center retrospective study. Clinicopathologic, surgical, and pancreatic morphologic factors were collected, and risk factors for exocrine pancreatic insufficiency and endocrine pancreatic insufficiency were analyzed. Exocrine pancreatic insufficiency was defined as steatorrhea requiring pancreatic enzymes and new onset steatosis, and endocrine pancreatic insufficiency was defined as postoperative new-onset diabetes mellitus. Multivariate analysis was performed. RESULTS: Among the 206 patients enrolled, 14% and 24% developed endocrine pancreatic insufficiency and exocrine pancreatic insufficiency, respectively. Multivariate analysis revealed residual pancreatic stent 1 year postoperatively, lymph node metastasis, and postoperative pancreatic atrophy (P-atrophy) as independent risk factors for exocrine pancreatic insufficiency, whereas preoperative glycated hemoglobin levels, residual pancreatic stent, and postoperative main pancreatic duct dilatation were risk factors for endocrine pancreatic insufficiency. Subgroup analysis of pancreatic ductal adenocarcinoma revealed that exocrine pancreatic insufficiency in patients with pancreatic ductal adenocarcinoma was caused by preoperative decreased pancreatic function (high glycated hemoglobin and a low postoperative pancreatic fistula rate), whereas the high incidence of POPF influenced the development of exocrine pancreatic insufficiency in patients without pancreatic ductal adenocarcinoma. CONCLUSION: Postoperative pancreatic atrophy and main pancreatic duct dilatation are risk factors for exocrine pancreatic insufficiency I and endocrine pancreatic insufficiency, respectively, and residual pancreatic stent affects both types of pancreatic dysfunction. Improving the surgical approach and stent management may help prevent these late complications.
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Insuficiencia Pancreática Exocrina , Neoplasias Pancreáticas , Pancreaticoduodenectomía , Complicaciones Posoperatorias , Humanos , Pancreaticoduodenectomía/efectos adversos , Estudios Retrospectivos , Masculino , Femenino , Insuficiencia Pancreática Exocrina/etiología , Insuficiencia Pancreática Exocrina/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Anciano , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Neoplasias Pancreáticas/cirugía , Adulto , Carcinoma Ductal Pancreático/cirugíaRESUMEN
BACKGROUND: Laparoscopic liver resection (LLR) is rapidly gaining popularity; however, its efficacy for nonalcoholic fatty liver disease (NAFLD)-associated hepatocellular carcinoma (HCC) (NAFLD-HCC) has been not evaluated. The purpose of this study was to compare short- and long-term outcomes between LLR and open liver resection (OLR) among patients with NAFLD-HCC. METHODS: We used a single-institution database to analyze data for patients who underwent LLR or OLR for NAFLD-HCC from January 2007 to December 2022. We performed propensity score-matching analyses to compare overall postoperative complications, major morbidities, duration of surgery, blood loss, transfusion, length of stay, recurrence, and survival between the two groups. RESULTS: Among 210 eligible patients, 46 pairs were created by propensity score matching. Complication rates were 28% for OLR and 11% for LLR (p = 0.036). There were no significant differences in major morbidities (15% vs. 8.7%, p = 0.522) or duration of surgery (199 min vs. 189 min, p = 0.785). LLR was associated with a lower incidence of blood transfusion (22% vs. 4.4%, p = 0.013), less blood loss (415 vs. 54 mL, p < 0.001), and shorter postoperative hospital stay (9 vs. 6 days, p < 0.001). Differences in recurrence-free survival and overall survival between the two groups were not statistically significant (p = 0.222 and 0.301, respectively). CONCLUSIONS: LLR was superior to OLR for NAFLD-HCC in terms of overall postoperative complications, blood loss, blood transfusion, and postoperative length of stay. Moreover, recurrence-free survival and overall survival were comparable between LLR and OLR. Although there is a need for careful LLR candidate selection according to tumor size and location, LLR can be regarded as a preferred treatment for NAFLD-HCC over OLR.
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Carcinoma Hepatocelular , Hepatectomía , Laparoscopía , Tiempo de Internación , Neoplasias Hepáticas , Enfermedad del Hígado Graso no Alcohólico , Complicaciones Posoperatorias , Puntaje de Propensión , Humanos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/mortalidad , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/mortalidad , Masculino , Femenino , Enfermedad del Hígado Graso no Alcohólico/cirugía , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Laparoscopía/métodos , Hepatectomía/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Resultado del Tratamiento , Estudios Retrospectivos , Anciano , Transfusión Sanguínea/estadística & datos numéricos , Tempo Operativo , Pérdida de Sangre Quirúrgica/estadística & datos numéricosRESUMEN
BACKGROUND: We compared the recurrence-free survival (RFS), overall survival (OS), and safety of laparoscopic liver resection (LLR) between non-alcoholic fatty liver disease (NAFLD) and non-NAFLD hepatocellular carcinoma (HCC) patients. METHODS: Patients with HCC (n = 349) were divided into four groups based on the HCC etiology (NAFLD [n = 71], hepatitis B [n = 27], hepatitis C [n = 187], alcohol/autoimmune hepatitis [AIH] [n = 64]). RFS and OS were assessed by multivariate analysis after adjustment for clinicopathological variables. A subgroup analysis was performed based on the presence (n = 248) or absence (n = 101) of cirrhosis. RESULTS: Compared with the NAFLD group, the hazard ratios (95% confidence intervals) for RFS in the hepatitis B, hepatitis C, and alcohol/AIH groups were 0.49 (0.22-1.09), 0.90 (0.54-1.48), and 1.08 (0.60-1.94), respectively. For OS, the values were 0.28 (0.09-0.84), 0.52 (0.28-0.95), and 0.59 (0.27-1.30), respectively. With cirrhosis, NAFLD was associated with worse OS than hepatitis C (P = 0.010). Without cirrhosis, NAFLD had significantly more complications (P = 0.034), but comparable survival than others. DISCUSSION: Patients with NAFLD-HCC have some disadvantages after LLR. In patients with cirrhosis, LLR is safe, but survival is poor. In patients without cirrhosis, the complication risk is high.
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Carcinoma Hepatocelular , Hepatitis B , Hepatitis C , Laparoscopía , Neoplasias Hepáticas , Enfermedad del Hígado Graso no Alcohólico , Humanos , Enfermedad del Hígado Graso no Alcohólico/cirugía , Estudios Retrospectivos , Cirrosis Hepática/cirugía , Hepatitis C/complicaciones , Hepatitis B/complicaciones , Laparoscopía/efectos adversosRESUMEN
BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in patients with Child-Pugh A cirrhosis has been shown to be beneficial. However, less is known regarding the outcomes of such treatment in patients with Child-Pugh B cirrhosis. We conducted a retrospective study to evaluate the outcomes of laparoscopic liver resection for HCC in patients with Child-Pugh B cirrhosis, focusing on surgical risks, recurrence, and survival. METHODS: 357 patients with HCC who underwent laparoscopic liver resection from 2007 to 2021 were identified from our single-institute database. The patients were divided into three groups by their Child-Pugh score: the Child-Pugh A (n = 280), Child-Pugh B7 (n = 42), and Child-Pugh B8/9 groups (n = 35). Multivariable Cox regression models for recurrence-free survival (RFS) and overall survival (OS) were constructed with adjustment for preoperative and postoperative clinicopathological factors. RESULTS: The Child-Pugh B8/9 group had a significantly higher complication rate, but the complication rates were comparable between the Child-Pugh B7 and Child-Pugh A groups (Child-Pugh A vs. B7 vs. B8/9: 8.2% vs. 9.6% vs. 26%, respectively; P = 0.010). Compared with the Child-Pugh A group, the risk-adjusted hazard ratios (95% confidence intervals) in the Child-Pugh B7 and B8/9 groups for RFS were 1.39 (0.77-2.50) and 3.15 (1.87-5.31), respectively, and those for OS were 0.60 (0.21-1.73) and 1.80 (0.86-3.74), respectively. There were no significant differences in major morbidities (Clavien-Dindo grade > II) (P = 0.117) or the proportion of retreatment after HCC recurrence (P = 0.367) among the three groups. CONCLUSION: Among patients with HCC, those with Child-Pugh A and B7 cirrhosis can be good candidates for laparoscopic liver resection in terms of complications and recurrence. Despite poor postoperative outcomes in patients with Child-Pugh B8/9 cirrhosis, laparoscopic liver resection is less likely to interfere with retreatment and can be performed as part of multidisciplinary treatment.
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Carcinoma Hepatocelular , Laparoscopía , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/cirugía , Estudios Retrospectivos , Neoplasias Hepáticas/cirugía , Cirrosis Hepática/complicaciones , Hepatectomía , Resultado del TratamientoRESUMEN
BACKGROUND: The Senhance Digital Laparoscopy System (Asensus Surgical Inc, Morrisville, NC, United States), which was introduced for the first time in Japan by our hospital, is a new surgical assistive robot following the da Vinci Surgical System. We herein report the short-term outcomes of 55 colorectal cancer surgery cases using this system at our hospital to assess the feasibility and safety of our procedures. MATERIALS AND METHODS: We retrospectively reviewed the patient backgrounds and surgical outcomes of 55 patients who underwent Senhance-assisted laparoscopic colorectal cancer surgery. RESULTS: The median age was 71 years. There were 31 males and 24 females, and the median body mass index was 23.1 kg/m2 . Fifteen patients had a history of abdominal surgery. The most common surgical technique was ileocecal resection (18 cases, 32.7%), followed by high anterior resection (11 cases, 20.0%). D2 or D3 dissection was performed in each operation, and D3 dissection was performed in 41 cases (74.5%). The median operative time was 240 minutes, the median blood loss was 5 mL, there were no intraoperative complications, and there were no cases of intraoperative blood transfusion. The median postoperative hospital stay was 7 days, which was comparable to conventional laparoscopic surgery. Postoperative complications of grade 2 or higher in the Clavien-Dindo classification were observed in two cases. CONCLUSION: The short-term results of 55 colorectal cancer surgery cases using the Senhance Digital Laparoscopy System were excellent and the system was introduced and surgery was safely performed.
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Neoplasias Colorrectales , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Anciano , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Laparoscopía/métodos , Masculino , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Although the novel coronavirus disease 2019 did not lead to a serious medical collapse in Japan, its impact on treatment of oesophageal cancer has rarely been investigated. This study aimed to investigate the influence of the pandemic on consultation status and initial treatment in patients with primary oesophageal cancer. METHODS: A retrospective study was conducted among 546 patients with oesophageal cancer who visited our hospital from April 2018 to March 2021. Pre-pandemic and pandemic data were compared with the clinical features, oncological factors and initial treatment as outcome measures. RESULTS: Diagnoses of oesophageal cancer decreased during the early phase of the pandemic from April to June (P = 0.048); however, there was no significant difference between the pre-pandemic and pandemic periods throughout the year. The proportion of patients diagnosed with distant metastases significantly increased during the pandemic (P = 0.026), while the proportion of those who underwent initial radical treatment decreased (P = 0.044). The rate of definitive chemoradiotherapy decreased by 58.6% relative to pre-pandemic levels (P = 0.001). CONCLUSIONS: Patients may have refrained from consultation during the early phase of the coronavirus disease 2019 pandemic. The resultant delay in diagnosis may have led to an increase in the number of patients who were not indicated for radical treatment, as well as a decrease in the number of those who underwent definitive chemoradiotherapy. Our findings highlight the need to maintain the health care system and raise awareness on the importance of consultation.
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COVID-19 , Neoplasias Esofágicas , COVID-19/epidemiología , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/terapia , Humanos , Pandemias , Enfermedades Raras , Estudios Retrospectivos , SARS-CoV-2 , Tokio/epidemiologíaRESUMEN
BACKGROUND: Covered stent placement (CSP) is gaining popularity for the management of delayed massive hemorrhage (DMH) after pancreatic or biliary surgery. However, early studies have produced conflicting results regarding the potential advantages of the procedure. We aimed to compare the short- and medium-term outcomes of arterial embolization (AE) and CSP for DMH. METHODS: We analyzed data for patients who underwent AE or CSP as an endovascular treatment (EVT) for DMH from the common hepatic artery (CHA) and its distal arteries between January 2009 and December 2019. We evaluated the major hepatic complications, in-hospital mortality, and 1-year mortality associated with the procedures, according to age, sex, reintervention, arterial variant, interval between surgery and EVT, and portal vein stenosis. RESULTS: All hemorrhages were treated using AE (n = 50) or CSP (n = 20). CSP was associated with no in-hospital mortality (32% vs. 0%, p = 0.003), and lower incidences of major hepatic complications (44% vs. 10%, p = 0.011) and 1-year mortality (54% vs. 25%, p = 0.035) compared with AE, respectively. There was no significant difference in technical success and reintervention rates. Compared with AE, the risk-adjusted odds ratios for CSP (95% confidence intervals) for major hepatic complications and 1-year mortality were 0.06 (0.01-0.39) and 0.19 (0.05-0.71), respectively. CONCLUSIONS: CSP is superior to AE regarding major hepatic complications and in-hospital- and 1-year mortality in patients with DMH from hepatic arteries.
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Embolización Terapéutica , Hemorragia Posoperatoria , Humanos , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Hemorragia Posoperatoria/cirugía , Hemorragia Posoperatoria/terapia , Estudios Retrospectivos , Stents/efectos adversos , Resultado del TratamientoRESUMEN
Lymphoid hyperplasia is a type of tumor-like hyperplasia of lymphoid tissue. There have been few reports on lymphoid hyperplasia of the gallbladder. Here, we report a case of lymphoid hyperplasia with a polyp form of the gallbladder macroscopically mimicking carcinoma. Liver dysfunction was diagnosed in a 75-year-old woman who presented with a gallbladder mass measuring 20 mm during an annual health checkup. Antibody tests for infectious diseases were positive for anti-HBs and anti-HBc antibodies. Accordingly, a laparoscopic cholecystectomy was performed. Macroscopically, the mass was a papillary/sessile tumor (29 × 25 mm) located in the fundus of the gallbladder. Histologically, the tumor was accompanied by an erosion on a portion of the surface layer, while the remaining epithelium showed regenerative changes and mild hyperplasia. No atypia was observed in the constituent epithelium. Hyperplasia of the polarized lymphoid follicles was observed in the interstitium, and tingible body macrophages were scattered in the germinal center. Immuno-histologically, the germinal center showed CD20 positivity, weak CD10 positivity, Bcl-2 negativity, and a high Ki-67 index (MIB-1). These findings suggested that the proliferating lymphoid follicles were reactive rather than neoplastic. Therefore, we diagnosed the patient with lymphoid hyperplasia of the gallbladder and chronic cholecystitis.
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Carcinoma , Enfermedades de la Vesícula Biliar , Neoplasias de la Vesícula Biliar , Anciano , Carcinoma/patología , Diagnóstico Diferencial , Femenino , Vesícula Biliar , Enfermedades de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/patología , Humanos , Hiperplasia/patologíaRESUMEN
PURPOSE: Bleeding from unresectable gastric cancer is a localized condition that adversely affects quality of life. Radiotherapy can be used to treat gastric cancer bleeding when surgery, endoscopic treatment, and intravascular embolization are ineffective. This study evaluated the utility of radiotherapy for unresectable hemorrhagic gastric cancer. METHODS: We retrospectively analyzed data from 33 patients with gastric cancer bleeding who underwent palliative radiotherapy in our hospital between April 2013 and May 2020. In this study, successful hemostasis was defined as > 1 month after starting radiotherapy with the patient alive and showing no need for blood transfusion, no drop in hemoglobin, and no evidence of melena or hematemesis. RESULTS: Patients comprised 26 men (79%) and 7 women (21%), with a median age of 71 years (range, 41-78 years). Hemostasis was achieved in 24 patients (73%). Thirty-two patients (94%) have been discharged home or transferred to the hospice. Patients with successful hemostasis from radiotherapy showed significantly longer overall survival than patients with unsuccessful hemostasis (p = 0.0026). No toxicities of grade 2 or more were encountered. CONCLUSIONS: This retrospective study found that palliative radiotherapy for gastric cancer bleeding was useful and safe and can improve remaining quality of life in patients with poor prognosis.
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Neoplasias Gástricas , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Hemorragia Gastrointestinal/radioterapia , Hemorragia Gastrointestinal/terapia , Hemostasis , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/radioterapia , Resultado del TratamientoRESUMEN
The Senhance® robotic system (TransEnterix, Morrisville, NC, USA), previously called the TELELAP Alf-X system, is a novel robotic system with a telesurgical concept. We herein describe our initial experience of Senhance® assisted laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) with detailed figures and videos. Case 1: A left renal tumor was incidentally detected in a 52-year-old female on ultrasonography. Case 2: A right renal tumor was detected in a 67-year-old male with epigastric pain on computed tomography. They were referred for further examination and diagnosed with RCC (clinical T1bN0M0 and clinical T2aN0M0, respectively). Senhance® assisted LRN was completed without conversion to conventional LRN or open surgery in both cases. The pneumoperitoneum time, console time and estimated blood loss in case 1 and case 2 were 173 min, 143 min and 3 mL, and 154 min, 122 min and 50 mL, respectively. The postoperative course was uneventful. Senhance® assisted LRN for RCC was safely and precisely performed. Furthermore, the operator was comfortable during the surgery. Although further surgical experience and long-term follow-up are required to assess surgical and oncological outcomes, Senhance® assisted LRN for RCC may be a promising procedure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13691-021-00487-x.
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BACKGROUND: Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. METHODS: We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. RESULTS: A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). CONCLUSION: cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.
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Neoplasias Abdominales/secundario , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/cirugía , Neoplasias del Mediastino/secundario , Neoplasias Abdominales/mortalidad , Anciano , Neoplasias Esofágicas/mortalidad , Femenino , Humanos , Masculino , Neoplasias del Mediastino/mortalidad , Metástasis de la Neoplasia , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: There are various reconstruction methods for Laparoscopic proximal gastrectomy (LPG), such as esophagogastrostomy (EG), double-tract reconstruction, and jejunal interposition. We have performed EG using a circular stapler (OrVil) from 2013 and using a linear stapler from 2017. The aim of this retrospective study was to clarify which stapler is better for EG for LPG. METHODS: The data of 84 patients who underwent EG for LPG between January 2013 and September 2019 were analyzed. EG with fundoplication was done using a circular stapler (OrVil) in 45 patients (CS group) and a linear stapler in 39 patients (LS group). The patients' medical records were reviewed. Clinical symptoms were obtained by interview at each outpatient consultation. All patients underwent postoperative 1-year follow-up endoscopy. To minimize bias between the two groups, propensity scores were calculated using a logistic regression model. After propensity-score matching, 60 patients (30 in the CS group and 30 in the LS group) were studied. RESULTS: Patient characteristics, operative outcomes were similar in two groups. Anastomotic leakage occurred in one patient (3.3%) in both groups. Anastomotic stenosis occurred in five patients (16.7%) in the CS group and two patients (6.7%) in the LS group. The rate of patients with severe reflux esophagitis (grade C or D) was significantly lower in the LS group (3.4%) than in the CS group (26.7%) (p = 0.026). CONCLUSIONS: EG with a linear stapler could reduce the risk of severe reflux esophagitis, and it could be a safe and feasible anastomosis for patients after LPG.
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Esofagitis Péptica , Laparoscopía , Neoplasias Gástricas , Anastomosis Quirúrgica , Esofagitis Péptica/etiología , Esofagitis Péptica/prevención & control , Gastrectomía , Humanos , Estudios Retrospectivos , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND: The effectiveness of prophylactic lateral lymph node dissection (LLND) in treating patients with lower rectal cancer remains controversial and has not been clearly established. Therefore, we aimed to retrospectively analyze the survival impact of prophylactic LLND in patients with lower rectal cancer. METHODS: Data of 301 patients with lower rectal cancer (tumor's lower edge on the anal side of the peritoneal reflexion) with clinical T3 disease and negative preoperative lateral lymph node metastasis, who underwent radical resection (R0) at our hospital between April 2007 and March 2017, were included in this study. Patients who received preoperative chemotherapy or radiotherapy were excluded. The relapse-free survival (RFS) and overall survival (OS) rates were compared between the dissection (prophylactic LLND, n = 37) and non-dissection (no prophylactic LLND, n = 264) groups. RESULTS: Significantly fewer men and younger patients were noted in the dissection group than in the non-dissection group. Post-surgery 3- and 5-year RFS rates were 69.6% and 66.8% in the dissection group and 75.1% and 72.5% in the non-dissection group, respectively (5-year post-surgery RFS, p = 0.58). In the dissection and non-dissection groups, the 5-year OS rates were 86.5% and 79.7%, respectively (p = 0.29), and the 5-year cancer-specific survival rates were 88.9% and 86.0%, respectively (p = 0.29), with no significant differences. Lateral lymph node recurrence was observed in one (2.7%) and 10 patients (3.8%) in the dissection and non-dissection groups, respectively, and there was no significant difference between the groups. CONCLUSIONS: In this study, the effectiveness of prophylactic LLND was limited in patients with > T3 lower rectal cancer with no evidence of preoperative lymph node metastasis. Prophylactic LLND may not be necessary if there is no preoperative lymph node metastasis, even if the invasion depth is T3 or higher.
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Recurrencia Local de Neoplasia , Neoplasias del Recto , Disección , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Masculino , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: We have introduced the Senhance Digital Laparoscopy System and actively use for colorectal cancer surgery. Recently, we also try to perform surgery by reduce port as less invasive method. For the first time, we report a case of single-incision plus one-port transverse colectomy using Senhance system. CASE PRESENTATION: The case was a 57-year-old woman, diagnosed with transverse colon cancer referred to our department. The preoperative diagnosis was cT1bN0M0, Stage I. We performed single-incision plus one-port transverse colon resection using Senhance system without any problems. The operative time was 203 min and the blood loss was 35 ml. CONCLUSION: We report the first case of single-incision plus one-port transverse colectomy using Senhance system. We trust this approach will find increasing use, enabling a safer means of minimally invasive robotic surgery.
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Various innovative robotic systems have been developed to improve surgery precision. The Senhance Surgical System (SSS) is a digital laparoscopic system offering eye tracking and haptic feedback. Several reports have described application of the SSS to general surgeries, including cholecystectomy and colectomy. However, use of the SSS for gastric tumor has not been reported. We experienced a case of laparoscopic local gastrectomy (LLG) for gastrointestinal stromal tumor (GIST) with the SSS. A 74-year-old man diagnosed with GIST underwent LLG with the SSS. Operation, docking, and console times were 117, 11, and 59 minutes, respectively. No perioperative complications were encountered. This study is the first to report LLG for GIST with the SSS. LLG with the SSS was safe and feasible. The SSS can use reusable forceps and contribute to reducing medical costs. The development of instruments is also progressing, and various kinds of surgery are likely to be indicated.
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Tumores del Estroma Gastrointestinal , Laparoscopía , Neoplasias Gástricas , Anciano , Gastrectomía , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
The progress and popularization of microvascular surgical techniques may improve the outcomes of esophageal reconstruction using non-gastric tube (GT) grafts. A pedicled jejunum (PJ) with microvascular anastomoses is frequently selected as a reconstructed conduit for esophageal reconstruction when the GT is unavailable, and the internal thoracic (IT) vein is frequently selected as a recipient blood vessel for microvascular anastomosis. However, the IT vein may be inadequate for microvascular anastomosis because of its absence or underdevelopment. Since it is difficult to preoperatively predict such rare cases, it becomes necessary to urgently and rapidly prepare an alternative blood vessel. Herein, we present surgical procedures for superdrainage using the cephalic vein (CeV). Due the superficial nature of the CeV, it is both easy to identify and collect sufficient length. Thus, the CeV is very useful as an urgent substitute blood vessel when the IT vein is unavailable for microvascular anastomosis in esophageal reconstruction.
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Anastomosis Quirúrgica , Vena Axilar , Drenaje , Anastomosis Quirúrgica/métodos , Vena Axilar/cirugía , Venas Braquiocefálicas , Drenaje/métodos , Esófago/cirugía , Humanos , Yeyuno/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: In esophageal cancer, long-term outcomes of minimally invasive surgery using endoscopic surgery are currently being verified. However, most trials have compared thoracic procedures; few studies have focused on the abdominal procedures, which are important for lymph node dissection in radical esophageal cancer surgery. Hand-assisted laparoscopic surgery (HALS) is a simple and minimally invasive procedure. Although HALS superiority in short-term outcomes has been reported, its oncological safety in esophageal cancer remains unclear. Therefore, we retrospectively evaluated oncological safety of HALS compared with that of conventional open laparotomy (OL) in radical surgery for thoracic and abdominal esophageal cancer. METHODS: We retrospectively analyzed the postoperative survival in 142 patients who underwent radical esophageal cancer surgery at our hospital between May 2012 and May 2017, with and without propensity score matching (PSM) between groups. RESULTS: Before PSM, OL (n = 65) and HALS (n = 77) groups differed significantly in overall survival (OS) (3-year OS rate: 74.2% and 87.3%, respectively; log-rank p = 0.040). Additionally, clinical abdominal lymph node metastasis (cALNM) independently predicted OS (p = 0.031). After PSM, the OL and HALS groups did not differ significantly in OS (3-year OS rate: 80.5% and 89.8%, respectively; log-rank p = 0.716). There was no statistically significant difference in abdominal-specific recurrence-free survival between the OL and HALS group before and after PSM. CONCLUSION: HALS may be a well-accepted procedure for radical esophagectomy in esophageal cancer, with oncological safety, including local control specific to the abdomen, comparable to that of the conventional OL.
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Neoplasias Esofágicas , Laparoscópía Mano-Asistida , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Laparoscópía Mano-Asistida/efectos adversos , Humanos , Escisión del Ganglio Linfático/métodos , Puntaje de Propensión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We report the case of a 68-year-old male with EGJ cancer, who was treated with palliative radiotherapy for persistent bleeding, and for whom, pCR was ultimately obtained by chemotherapy. Chemotherapy was planned to treat the EGJ cancer with intramural metastasis of the esophagus, but anemia due to persistent bleeding from the tumor was noted. Even with frequent blood transfusions, the anemia was difficult to control. Palliative radiotherapy was performed at 30 Gy/10 Fr for hemostasis, followed by chemotherapy. After approximately 9 months of chemotherapy, reduction of the primary tumor, a metastatic lymph node, and disappearance of the intramural metastasis of the esophagus were noted, and conversion surgery was performed. In the final histopathological examination, pCR was obtained. Radiotherapy for persistent bleeding from advanced gastric cancer is a minimally invasive treatment, and therefore could be an effective treatment to enable chemother- apy without any loss of compliance.
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Neoplasias Gástricas , Anciano , Terapia Combinada , Unión Esofagogástrica , Hemorragia , Humanos , Masculino , Neoplasias Gástricas/terapia , Resultado del TratamientoRESUMEN
We report the case of a patient with esophageal cancer accompanied by esophago-bronchial fistula and pneumonia, who experienced improved quality of life following multimodal therapy that included esophageal bypass surgery. A 56-year-old man was diagnosed with advanced esophageal cancer with an esophago-bronchial fistula on computed tomography scan. He underwent esophageal bypass surgery followed by definitive chemoradiotherapy. He started eating 12 days after the surgery and was discharged home after the completion of chemoradiotherapy. On follow-up, the primary lesion was found to be significantly decreased in size and the esophago-bronchial fistula was closed. Although the patient ultimately died owing to distant metastases, he enjoyed a prolonged period of survival following surgery. Multimodal therapy including esophageal bypass surgery is an useful strategy for treating patients with critical conditions such as esophago-bronchial fistula induced by esophageal cancer.