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1.
Artigo em Inglês | MEDLINE | ID: mdl-34664121

RESUMO

PURPOSE: In surgery for strangulated bowel obstruction, intestinal blood flow (IBF) is usually evaluated by observing bowel colour, peristalsis, intestinal temperature and arterial pulsations in the mesentery. We investigated whether indocyanine green (ICG) fluorescence angiography (ICG-FA) is an effective alternative to palpation. METHODS: Thirty-eight patients who underwent emergency surgery for strangulated bowel obstruction from January 2017 to April 2021 were divided into two groups: (i) the ICG + group, in which ICG was used during laparoscopic surgery (n = 16), and (ii) the ICG - group, in which palpation without ICG was used during open surgery (n = 22). Starting in July 2019, ICG and laparoscopic surgery were applied in all cases except emergency cases when the fluorescence laparoscope was not ready. Surgical outcomes and patient characteristics were compared. RESULTS: Patient characteristics, the operative duration and postoperative hospitalization duration did not significantly differ between the groups. Bowel resection was performed in 4 cases (25%) among ICG + patients and 11 cases (50%) among ICG - patients. The ratios of pathological findings (ischaemia:mucosal necrosis:transmural necrosis) were 0:2:2 and 1:6:4 in the two groups, respectively. Blood loss was measured with gauze and suction tubes and was 1 (0-5) mL in the ICG + group and 12.5 (0-73) mL in the ICG - group (p = 0.002). Postoperative complications occurred in 1 case (6.3%) in the ICG + group and 9 cases (40.9%) in the ICG - group (p = 0.025). CONCLUSION: Although there were few intestinal resections in the ICG + group, the rate of pathological necrosis tended to be high, and no complications due to ineligibility were noted in the intestinal preservation group. During laparoscopic surgery, ICG-FA is useful as a substitute for palpation and has the potential to improve surgical outcomes. CLINICAL TRIAL REGISTRATION: Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2019-40.

2.
Asian J Surg ; 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34518078

RESUMO

INTRODUCTION: Intestinal blood flow evaluation during strangulated bowel obstruction is often based on the subjective assessment of the operator. Therefore, we aimed to comprehensively determine the presence or absence of intestinal blood flow based on normal light and indocyanine green (ICG) fluorescence imaging. Moreover, we ascertained whether the chosen surgical plan was appropriate, based on the patients' postoperative course and pathological findings. METHODS: All 14 patients diagnosed with strangulated bowel obstruction at our hospital who underwent laparoscopic surgery between July 2019 and January 2021 were enrolled. Surgical plans were chosen based on normal light imaging combined with near-infrared imaging after intravenous ICG injection. Intestinal resection was performed via a small laparotomy if resection was considered necessary. In the intestinal resection group, the presence of intestinal necrosis was examined based on the pathological findings of the resected specimens. In the intestinal preservation group, postoperative complications, such as delayed intestinal perforation and intestinal stricture, were examined. RESULTS: Intestinal resection was performed in 4 cases. The pathological findings of the resected specimens showed necrosis of the small intestine in all cases. No intra-abdominal complication occurred any of the cases, and the median postoperative hospital stay was 9.9 days. CONCLUSIONS: The selection of a surgical plan in conjunction with ICG fluorescence findings was valid in all 14 cases. ICG fluorescence imaging is useful in laparoscopic surgery for strangulated bowel obstruction and may be a novel method for evaluating intestinal blood flow during surgery.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34378079

RESUMO

BACKGROUND: Lateral lymph node metastasis in lower rectal cancer is considered a local disease in Japan, and guidelines suggest lateral lymph node dissection (LLND). However, laparoscopic procedures are relatively difficult. The ureter and hypogastric fascia must be dissected from the vesicohypogastric fascia to preserve the autonomic nerve and ureter. Additionally, lymph node dissection around the internal iliac artery is complex because many patterns of branching from the internal iliac artery exist. We investigated the utility of fluorescence ureter and vessel navigation using a near-infrared ray fluorescent ureteral catheter (NIRFUC) and indocyanine green (ICG). METHODS: Fourteen patients who underwent laparoscopic LLND using fluorescence navigation were included. Eleven patients had rectal cancer, 1 had anal cancer, and 2 exhibited recurrence of rectal cancer. Eleven patients underwent NIRFUC insertion before surgery. Fluorescence vessel navigation (FVN) was performed with intraoperative ICG injections in 14 patients, with a total of 18 sides. The outcome measures were ureter navigation visibility, detection of the branch form from the internal iliac artery with FVN, differences between the fluorescence findings and anatomy of the internal iliac artery determined after LLND, and the surgical outcome. RESULTS: In all 11 patients, the ureters were clearly identified as fluorescent before dissection around the ureter. FVN revealed the internal iliac, umbilical, and superior vesical arteries in all patients. The branch from the internal iliac artery according to the Adachi classification was revealed on 16 sides (89%). The time from intravenous ICG injection to fluorescence of the internal iliac artery was 38 (17-57) s. The time from intravenous injection to when the vessels were observed as fluorescent was 113 (65-661) s. No ureteral or vessel injuries occurred. CONCLUSIONS: Fluorescence navigation of vessels and the ureter is feasible in laparoscopic LLND and has the potential to increase safety. CLINICAL TRIAL REGISTRATION: Examination of fluorescence navigation for laparoscopic colorectal cancer surgery Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf.

4.
Surg Endosc ; 35(8): 4882-4889, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33978850

RESUMO

BACKGROUND: Ureteral injury is the most common urological complication of pelvic surgery, with a reported incidence during colon resection of 0.3-1.5%. Ureteral stenting is commonly performed preoperatively to prevent ureteral injury. Because tactile sensation is not reliable during laparoscopic surgery, the effect of the ureteral stent is considered limited. Recently, fluorescence imaging has been used in laparoscopic surgery. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) is a new catheter with built-in NIR fluorescent resin. This pilot study was performed to evaluate the utility of fluorescence ureteral navigation using the NIRFUC during laparoscopic colorectal surgery. METHODS: We evaluated the intraoperative utility of the NIRFUC and the short-term outcomes in 20 patients treated with colorectal surgery at Kawaguchi Municipal Medical Center between February and July 2020. In all, 18 patients with malignant tumors and 2 patients with benign disease, i.e., a sigmoid colovesical fistula, were included. Ten patients developed preoperative intestinal obstruction. One patient experienced preoperative perforation. Nine patients developed preoperative peritumoral abscesses. Laparoscopic surgery was performed with the VISERA ELITE2 system. RESULTS: In all cases, the ureters were very clearly identified as fluorescent without the need for dissection. In all cases, only a moment was required to identify the ureter by fluorescence observation. In all cases, R0 resection was performed. The mean surgical duration was 334 min (161-1014), the mean blood loss was 10 ml (1-500), and the mean postoperative hospital stay was 11 days (8-47). There were no cases of ureteral injury. CONCLUSION: The NIRFUC was very clearly identified as fluorescent in a moment during surgery without dissection around the ureter. Fluorescence ureteral navigation using the NIRFUC may make colorectal surgery easier and facilitate completion of complex minimally invasive surgery, especially during surgery in patients with invasion of the surrounding tissue or a history of pelvic surgery or radiation.


Assuntos
Cirurgia Colorretal , Laparoscopia , Ureter , Colectomia , Humanos , Projetos Piloto , Ureter/cirurgia , Cateteres Urinários
5.
J Gastrointest Surg ; 25(11): 2835-2841, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33772400

RESUMO

BACKGROUND: The superiority of outcomes associated with anatomical resection (AR) versus those associated with non-anatomical resection (NAR) remains controversial in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance of AR on therapeutic outcomes of patients with small HCCs (≤ 5 cm), using propensity score-matched (PSM) analysis. METHODS: A total of 195 patients who had undergone elective hepatic resection for small HCCs (≤ 5 cm) were included in this study. We conducted PSM analysis for baseline characteristics (age, sex, hepatitis virus status, retention rate of indocyanine green at 15 min, and Child-Pugh grade), preoperative serum α-fetoprotein, and tumor characteristics (tumor size, tumor number, portal vein invasion, and surgical margin status) to eliminate potential selection bias. The prognostic significance of AR on the disease-free and overall survival was analyzed in patients selected by PSM analysis. RESULTS: Applying PSM analysis, the patients were divided into PSM-AR (N = 66) and PSM-NAR (N = 66) groups. Disease-free survival was significantly better in the PSM-AR group than that of the PSM-NAR group (P = 0.018), while there was no significant difference in the overall survival between the PSM-AR and PSM-NAR groups (P = 0.292). The univariate HRs of the PSM-AR group were 0.55 (95% CI, 0.33-0.90) for disease-free survival and 0.61 (95% CI, 0.24-1.53) for overall survival, respectively. Remnant liver recurrence was significantly lower in the AR group (P = 0.014). CONCLUSIONS: AR may improve the disease-free survival in HCC patients with tumors of ≤5 cm diameter.

6.
Asian J Endosc Surg ; 14(3): 565-569, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33029854

RESUMO

In surgery for incarcerated hernia, intestinal blood flow is an important factor in intraoperative decision-making given that irreversible ischemia can result in intestinal necrosis. Here, we report a case of incarcerated obturator hernia in which the bowel was successfully preserved by evaluating intestinal blood flow with the indocyanine green fluorescence imaging method. A woman in her 80s was diagnosed with incarcerated right obturator hernia, and a laparoscopic operation was performed. The small bowel tissue that had been incarcerated exhibited dark red discoloration. Fluorescence examination of the bowel wall indicated that the ischemic changes were reversible, and accordingly, the bowel was not resected. The postoperative course was uneventful. The indocyanine green fluorescence imaging method is a useful new source of evidence that will improve intraoperative decision-making regarding bowel ischemia.


Assuntos
Hérnia do Obturador , Herniorrafia , Obstrução Intestinal , Intestino Delgado/irrigação sanguínea , Isquemia/diagnóstico por imagem , Idoso de 80 Anos ou mais , Feminino , Corantes Fluorescentes , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/cirurgia , Humanos , Verde de Indocianina , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Laparoscopia , Imagem Óptica
7.
Surg Oncol ; 35: 434-440, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039849

RESUMO

BACKGROUND: Recently, the indocyanine green (ICG) fluorescence navigation method has attracted much attention as a means of intraoperative navigation, especially during laparoscopic surgery. The newly developed near-infrared (NIR) fluorescent resin also emits NIR fluorescence, as does ICG. Presently, new devices made with this resin are being developed. The purpose of this study was to present our fluorescence navigation techniques for left-sided colon and rectal cancer. METHOD: Fifty-nine patients with left-sided colon and rectal cancer underwent laparoscopic surgery with fluorescence navigation between July 2019 and April 2020. The surgeries included 54 intestinal blood flow (IBF) evaluations using ICG, 16 preoperative fluorescence clip marking (FCM) procedures, 7 fluorescence ureteral navigation procedures, 4 fluorescence vessel navigation (FVN) procedures during lateral lymph node dissection, and 3 fluorescence-guided trans-anal tube insertion procedures. Laparoscopic surgery and fluorescence observation were performed using a VISERA ELITE 2. In FCM, the Zeoclip FS device was used. In ureteral navigation and trans-anal tube insertion, the Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) was used. RESULTS: No complications related to the fluorescence navigation techniques, including those involving ICG, the Zeoclip FS and the NIRFUC, occurred. In 5 cases, the surgical plan was changed according to the IBF evaluation with ICG, and no anastomotic leakage occurred in those cases. These fluorescence navigation techniques provide previously unavailable visual information regarding the IBF, vessel and ureter routes and accurate endoscopic clip and drainage tube locations in the intestinal tract. CONCLUSIONS: Technology to visualize blood flow dynamics and structures using fluorescence can be considered innovative, especially when applied in laparoscopic surgery, which relies on vision. The popularity of fluorescence navigation has also appeared to increase the safety of colorectal surgery. CLINICAL TRIAL REGISTRATION: Examination of fluorescence navigation for laparoscopic colorectal cancer surgery. Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf.


Assuntos
Canal Anal/patologia , Neoplasias do Colo/patologia , Fluorescência , Laparoscopia/métodos , Neoplasias Retais/patologia , Cirurgia Assistida por Computador/métodos , Ureter/patologia , Idoso , Idoso de 80 Anos ou mais , Canal Anal/irrigação sanguínea , Canal Anal/cirurgia , Fístula Anastomótica , Neoplasias do Colo/irrigação sanguínea , Neoplasias do Colo/cirurgia , Feminino , Corantes Fluorescentes , Seguimentos , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/irrigação sanguínea , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Ureter/irrigação sanguínea , Ureter/cirurgia
8.
Anticancer Res ; 40(11): 6517-6523, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109592

RESUMO

BACKGROUND/AIM: Precise tumor localization during gastrointestinal surgery improves curability and function preservation. We investigated the efficacy of preoperative endoscopic fluorescent clip marking using a Zeoclip FS with built-in near-infrared fluorescent resins in delineating gastrointestinal cancer for surgery. PATIENTS AND METHODS: We evaluated the intraoperative visibility of the Zeoclip FS using a VISERA ELITE 2 and the short-term outcomes of 37 cancer patients (colorectal, n=23; gastric, n=14) who underwent preoperative fluorescent clip marking. RESULTS: The study included 23 male and 14 female subjects with a mean age of 73 years (range=39-87 years). Thirty-three patients (89.1%) exhibited clear fluorescent clip marking and easily determined transection lines. Fluorescence was not observed in 1 sigmoid colon cancer patient (2.7%), who required a colonic stent for preoperative obstruction. Three patients (8.1%) required additional procedures for fluorescence visualization. CONCLUSION: Endoscopic fluorescent clip marking can delineate tumors well for determining the extent of resection.


Assuntos
Neoplasias Colorretais/cirurgia , Endoscopia Gastrointestinal , Neoplasias Gastrointestinais/cirurgia , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/fisiopatologia , Feminino , Corantes Fluorescentes/química , Gastrectomia/métodos , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos
9.
Mol Clin Oncol ; 12(2): 134-137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32002181

RESUMO

Postoperative pancreatic fistula (POPF) is a common complication following pancreatic resection. It leads to increased medical costs, and longer hospital stays. However, the risk factors of POPF are still unclear, and therefore, this urgent clinical issue should be resolved. The geriatric nutritional risk index (GNRI) is tool to assess the nutritional status using body weight, and serum albumin value, particularly in elderly patients. On the other hand, POPF is associated with body mass index (BMI). Thus, the present study aimed to investigate whether GNRI can predict the risk of POPF in patients after distal pancreatectomy (DP). We conducted a retrospective cohort study involving 37 patients who were treated at the Department of Digestive Surgery, Kawaguchi Municipal Medical Center between January 2007 and June 2018. All patients were subjected to nutritional screening using GNRI, and were followed up after DP for postoperative complications including POPF. In addition, risk factors of POPF, and patient's height, BMI, and preoperative laboratory values were analyzed. POPF was observed in 7 of the 37 (19%) patients. Those with a POPF had significantly lower GNRI values than those without POPF (P<0.001). Receiver operating characteristic curve analysis was performed to determine a cut-off value of GNRI, which indicated an increased risk of POPF. This value was determined as 96 (sensitivity: 71.4%, specificity: 86.7%, likelihood ratio: 5.36). Univariate analysis confirmed that a GNRI of <96 was significantly associated with POPF (P=0.005), and a multivariate logistic regression analysis revealed that a GNRI of <96 was significant independent predictor of POPF (P=0.005), suggesting its utility for assessing the risk of POPF following DP.

10.
Anticancer Res ; 40(1): 293-298, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892579

RESUMO

BACKGROUND/AIM: The prognosis of pancreatic cancer remains poor with a high incidence of recurrence even after curative resection. The aim of this study was to investigate prognostic factors in patients with recurrent pancreatic cancer using the multicenter database. PATIENTS AND METHODS: The subjects were 196 patients with recurrent pancreatic cancer who underwent resection between 2008 and 2015. We retrospectively investigated the relation between clinicopathological characteristics of the patients and overall survival from recurrence using univariate and multivariate analyses. RESULTS: In univariate analysis, the positive lymphatic invasion (p=0.0240), time to recurrence from resection <1 year (p<0.0001), sites of recurrence except for local or lymph node (p=0.0273), liver recurrence (p=0.0389) and peritoneal recurrence (p<0.0001) were significantly associated with poor overall survival from recurrence. In multivariate analysis, time to recurrence from resection <1 year (p<0.0001) and peritoneal recurrence (p<0.0001) were independently associated with poor overall survival from recurrence. CONCLUSION: Time to recurrence from resection <1 year and peritoneal recurrence were significant independent predictors of poor overall survival from recurrence in patients with recurrent pancreatic cancer.


Assuntos
Recidiva Local de Neoplasia/patologia , Neoplasias Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Peritoneais/patologia , Prognóstico
11.
Gan To Kagaku Ryoho ; 46(9): 1441-1443, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31530786

RESUMO

During a follow-upstudy after the treatment of T cell lymphoma, a 21-year-old man reported an intra-abdominal mass in his right lower abdomen, which was then confirmed using abdominal CT. Therefore, recurrence was suspected due to his medical history. To perform a biopsy, laparoscopic surgery was scheduled, which located the tumor in the mesentery of the terminal ileum, involving the cecum. For this, laparoscopic ileocecal resection was performed. After 7 days, the patient was discharged without complications. Histopathologically, the mass was diagnosed as a desmoid tumor via immunostaining. It is relatively rare that an intra-abdominal desmoid tumor occurs without risk factors in a young man. We herein report a case of an intra-abdominal desmoid tumor, which was successfully treated using laparoscopic surgery.


Assuntos
Fibromatose Abdominal , Fibromatose Agressiva , Humanos , Laparotomia , Masculino , Mesentério , Recidiva Local de Neoplasia , Adulto Jovem
12.
Gan To Kagaku Ryoho ; 46(8): 1323-1325, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501380

RESUMO

A 63-year-old woman was admitted to our hospital owing to advanced rectal carcinoma. The patient underwent laparoscopic lowanterior resectionwith D3 lymph node dissection and partial resection of the uterus. The histopathological diagnosis was fT4bN2M0, fStage Ⅲb. Thus, capecitabine plus oxaliplatin(CapeOX)therapy as adjuvant chemotherapy was scheduled for 6 months. However, after the 4th course of chemotherapy, contrast-enhanced CT revealed multiple metastases of the rectal carcinoma including metastases in the liver, peritoneum, retroperitoneum, and subcutaneous tissue of the left lower back. The patient received palliative treatment and died 8 months after surgery. Only a fewcases of subcutaneous metastasis of rectal carcinoma have been reported. Therefore, we herein report this case with a review of the literature.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Retais , Capecitabina , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Oxaliplatina , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Tela Subcutânea
13.
Gan To Kagaku Ryoho ; 46(6): 1069-1071, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31273178

RESUMO

A 67-year-old woman with anemia was referred to us for further study. A colonoscopy exhibited multiple tumors(tub1)in the transverse and sigmoid colon(two regions)and rectum. Contrast-enhanced CT revealed no apparent distant and lymph node metastases. Thus, subtotal colectomy with D3 lymph node dissection was performed. Pathologically, the tumor was diagnosed as pStage Ⅱand pStage 0. After surgery, the patient had no recurrence for 8 months. We herein report a rare case of four synchronous colorectal carcinomas that were successfully treated.


Assuntos
Neoplasias do Colo , Idoso , Colectomia , Colonoscopia , Feminino , Humanos , Recidiva Local de Neoplasia
14.
Gan To Kagaku Ryoho ; 46(5): 937-939, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31189820

RESUMO

A 19-year-old woman with general fatigue who initially consulted a local hospital was referred to us for further examination of jaundice. Contrast-enhanced CT revealed apparent dilatation of the bile duct. Gastrointestinal endoscopy exhibited a tumor of the papilla of Vater(adenocarcinoma, tub2). Thus, pylorus-preserving pancreatoduodenectomy with D2 lymph node dissection was performed. Pathologically, she was diagnosed with a T3bN1M0, pStage ⅡB tumor. After surgery, the patient underwent adjuvant chemotherapy containing S-1 for 6 months. We herein report a juvenile case of ampullary region carcinoma that was successfully treated.


Assuntos
Adenocarcinoma , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Feminino , Humanos , Excisão de Linfonodo , Pancreaticoduodenectomia , Adulto Jovem
15.
Case Rep Gastroenterol ; 13(1): 219-224, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31123450

RESUMO

Cavernous hemangioma arising from the gallbladder is extremely rare. Here, we report a cavernous hemangioma of the gallbladder masquerading as a carcinoma. A 75-year-old man was referred to our institution for a follow-up study after gastrectomy. Abdominal computed tomography revealed that the gallbladder was filled with a low-density mass with calcification of the wall. The patient underwent extended cholecystectomy. Histologically, the tumor consisted of vascular endothelial cellular elements and hematomas. The postoperative course was uneventful without complications. Presently, only 7 cases of cavernous hemangioma of the gallbladder have been previously reported. This case serves as an important reminder to consider benign tumors including cavernous hemangioma when investigating all possible causes of a gallbladder tumor.

16.
Gan To Kagaku Ryoho ; 46(1): 71-74, 2019 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-30765646

RESUMO

A 70-year-old man with epigastralgia who initially visited a local hospital was referred to us for further examination. Gastrointestinal endoscopy exhibited a type 3 tumor of the stomach from the body to the antrum(adenocarcinoma, por1). Contrast-enhanced CT revealed thickness in the wall of the gastric body with bulky lymph nodes and ascites. Staging laparoscopy showed that the patient was diagnosed with sStage Ⅳ gastric cancer with positive peritoneal cytology. Therefore, SOX therapy was administered. Subsequently, total gastrectomy with D2 lymph node dissection was performed, since the primary tumor and lymph nodes were significantly reduced. Histopathologically, the residual lesion was only observed in the mucosal layer without lymph node metastases. We herein report a case of Stage Ⅳ gastric cancer, which was successfully treated by conversion surgery after SOX therapy.


Assuntos
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/cirurgia , Idoso , Gastrectomia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Neoplasias Gástricas/cirurgia
17.
Mol Clin Oncol ; 10(2): 235-238, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30680200

RESUMO

Primary adenosquamous cell carcinoma (ASCC) arising from the ileum is an exceptionally rare malignant neoplasm exhibiting mixed glandular and squamous differentiation. The clinicopathological characteristics of ASCC have not been clearly determined due to its rarity. We herein report a case of a 74-year-old man with a successfully treated ASCC of the ileum. The patient visited a medical clinic due to abdominal pain. Abdominal computed tomography imaging revealed an intestinal tumor in the ileum. Prior to undergoing capsule endoscopy, the patient complained of severe abdominal pain due to intestinal obstruction from the patency capsule and the tumor. Thus, the patient was referred to our hospital for emergency surgery. Upon relieving the obstruction by partial resection of the ileum, an impacted patency capsule with a tumor with ulceration was identified. On histological examination, the tumor consisted of malignant glandular and squamous cell elements. The postoperative course was uneventful, without complications. The patient subsequently received adjuvant chemotherapy with oxaliplatin and capecitabine for 6 months. The patient has no evidence of recurrence 20 months after surgery. To the best of our knowledge, only 8 cases of ASCC have been reported in the English literature to date. This case serves as an important reminder to consider small intestinal carcinoma, including ASCC, in the differential diagnosis of intestinal obstruction.

18.
Mol Clin Oncol ; 9(3): 274-278, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30155249

RESUMO

Surgical site infections (SSIs) are a well-known potential complication of surgery. They are assocaited with preoperative malnutrition and lead to increased medical costs and longer hospital stays. Therefore, surgeons should appropriately identify patients who are at a high risk. The geriatric nutritional risk index (GNRI) is a tool, increasingly utilized to assess the degree of malnutrition, particularly in elderly patients. Therefore, the present study attempted to validate whether GNRI could predict the risk of SSI in patients following pancreaticoduodenectomy (PD). A cohort study was retrospectively conducted on 106 patients in the Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Japan from January 2007 to December 2017. All patients were subjected to nutritional screening using GNRI and followed up for the occurrence of postoperative complications, including SSI post PD. Additionally, risk factors for developing SSI, and the patient's height, body mass index and preoperative laboratory values were documented. Patients were divided into SSI (n=15) and non-SSI (n=91) groups with a determined incidence of 14.2% (15/106) for SSI. The results revealed that the SSI group had GNRI values that were significantly reduced compared with the non-SSI group (P<0.001). Receiver operating characteristic curve analysis was performed to determine the cut-off value of GNRI that conferred an increased risk of SSI; it was determined as 94 (sensitivity 80.0%, specificity 83.5%). Univariate analysis confirmed that a GNRI <94 was significantly associated with SSI (P<0.001), whereas multivariate logistic regression analysis revealed that a GNRI <94 was independently associated with SSI following PD (relative risk=1.73, 95% confidence interval=1.23-2.43; P<0.001). Therefore, a GNRI <94 is a potential predictive marker for SSI risk following PD.

19.
Int J Surg Case Rep ; 47: 14-18, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29704737

RESUMO

INTRODUCTION: Optimal surgery for a midline incisional hernia extending to the subcostal region remains unclear. We report successful hybrid laparoscopic and percutaneous repair for such a complex incisional hernia. PRESENTATION OF CASE: An 85-year-old woman developed a symptomatic incisional hernia after open cholecystectomy. Computed tomography revealed a 14 × 10 cm fascial defect. Four trocars were placed under general anesthesia. Percutaneous defect closure was performed using multiple non-absorbable monofilament threads, i.e., a "square stitch." Each thread was inserted into the abdominal cavity from the right side of the defect and pulled out to the left side. The right side of the thread was subcutaneously introduced anterior to the hernia sac. The threads were sequentially tied in a cranial to caudal direction. A multifilament polyester mesh with resorbable collagen barrier was selected and fixed using absorbable tacks with additional full-thickness sutures. The cranial-most limit of mesh fixation was at the level of the subcostal margin, and the remaining part was draped over the liver surface. The postoperative course was uneventful, with no seroma, mesh bulge, or hernia recurrence at 1, 3, 6, and 12 months of follow-up. DISCUSSION: The advantages of our technique are the minimal effect on the scar in the midline during defect closure, the minimal damage to the ribs and obtaining more overlap during mesh fixation. The disadvantage is the postoperative pain. CONCLUSION: Our proposed hybrid surgical approach may be considered as the treatment of choice for a large midline incisional hernia extending to the bilateral costal region.

20.
Anticancer Res ; 37(6): 3215-3219, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28551667

RESUMO

BACKGROUND/AIM: Preoperative biliary drainage (PBD) is often performed for jaundiced patients. However, the optimal duration of PBD remains unknown. The aim of this study was to investigate whether duration of PBD influenced the prognosis of patients after pancreaticoduodenectomy (PD) for pancreatic head cancer. PATIENTS AND METHODS: Twenty-five patients who underwent PD for pancreatic head cancer with obstructive jaundice between 2007 and 2013 were included. Tumor and host factors were analyzed to evaluate their potential prognostic effects and patients' characteristics between the two groups according to the duration of PBD were analyzed. RESULTS: In multivariate analysis, overall survival, duration of PBD ≥21 days and tumor-node-metastasis (TNM) stage III or IV were significant predictors. Duration of PBD ≥21 days was positively correlated with higher level of serum C-reactive protein (CRP), modified Glasgow prognostic score (mGPS) and neoadjuvant therapy. CONCLUSION: Duration of PBD is an independent prognostic factor after PD for pancreatic head cancer with obstructive jaundice.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Drenagem/métodos , Icterícia Obstrutiva/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/mortalidade , Distribuição de Qui-Quadrado , Drenagem/efeitos adversos , Drenagem/mortalidade , Feminino , Humanos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/mortalidade , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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