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1.
Anticancer Res ; 40(1): 373-377, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892589

RESUMO

AIM: In colorectal cancer surgery, the efficacy of intestinal blood flow evaluation with the indocyanine green (ICG) fluorescence method using the VISERA ELITE2 system was investigated. PATIENTS AND METHODS: Participants in this study comprised 50 patients who underwent elective laparoscopic colorectal cancer surgery at the Department of Surgery, the Jikei Daisan Hospital. With the ICG fluorescence method, whether it was necessary to change the intestinal transection line for anastomosis was evaluated. RESULTS: For three cases of rectal cancer, the oral transection line determined from macroscopic observation was judged to offer insufficient blood flow according to the ICG fluorescence method. The transection line for anastomosis was changed according to fluorescence. None of these cases showed complications. CONCLUSION: The ICG fluorescence method may allow safe anastomosis in colorectal surgery for cancer.


Assuntos
Cirurgia Colorretal , Verde de Indocianina/química , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Cirurgia Colorretal/efeitos adversos , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
2.
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
3.
Asian J Endosc Surg ; 13(1): 39-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30945434

RESUMO

BACKGROUND: To achieve safety of the operation, preoperative simulation became a routine practice for hepatobiliary and pancreatic (HBP) surgery. The use of intraoperative ultrasonography (IOUS) is essential in HBP surgery. There is a limitation in the use of IOUS in laparoscopic surgery (LS), for which a new intraoperative system is expected. We have developed an image-guided navigation system (IG-NS) for open HBP surgery since 2006, and we have applied our system to LS. The aim of this study is to evaluate the results of clinical application of IG-NS in LS. MATERIALS AND METHODS: Eight patients underwent LS using IG-NS; LS consisted of cholecystectomy and hepatectomy in four patients each. After registration, the 3D models were superimposed on the surgical field. We performed LS while observing the navigation image. Moreover, we developed a support system for operations. RESULTS: The average registration error was 8.8 mm for LS. Repeated registration was effective for organ deformation and improved the precision of IG-NS. By using various countermeasures, identification of the tumor's position and the setting of the resection line became easy. CONCLUSION: As IG-NS provided real-time detailed and intuitive information, this intraoperative assist system may be an effective tool in LS.

4.
Dig Surg ; : 1-7, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722357

RESUMO

INTRODUCTION: A preoperative scoring system to predict carcinoma in patients with gallbladder polyps (GBPs). METHODS: Preoperative parameters of patients with GBPs who underwent cholecystectomies were used to construct a scoring system to ascertain the risk of malignancy (reference group). The scoring system developed from this approach was applied to the validation group. RESULTS: In the reference group, 11.5% of patients had carcinomas, in whom the median age was 68 years and the polyp size was 16.9 mm. According to the univariate analysis, the significant factors for carcinoma were age ≥65 years, the presence of gallstones, polyp size ≥13 mm, solitary polyp, and sessile polyp. Age ≥65 years and polyp size ≥13 mm were significant factors according to the multivariate analysis. From these results, we developed a preoperative scoring system to predict carcinoma. The patients were divided into 1 of 2 groups: low-risk and high-risk and their malignancy rates were 4.1 and 61.1% respectively (p < 0.001). In the validation group, the malignancy rate was higher for those in the high-risk group (p = 0.016). CONCLUSIONS: The proposed preoperative scoring system based on simple clinical variables appears to be useful for predicting malignancy in patients with GBPs.

5.
Anticancer Res ; 39(6): 3009-3013, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177142

RESUMO

BACKGROUND/AIM: Indocyanine green (ICG) fluorescence technique is known to help visualize blood vessels. The efficacy of real-time fluorescence vessel navigation (FVN) using ICG for ligation of the inferior mesenteric vein (IMV) and left colic artery (LCA) during laparoscopic left colorectal cancer surgery was investigated. PATIENTS AND METHODS: Participants were 59 patients who underwent laparoscopic left colorectal cancer surgery from February 2017 to November 2018, and were divided into groups: i) with FVN (FVN+, n=21) and ii) without FVN (FVN-, n=38). Groups were compared for the time it took to ligate their IMV and LCA. RESULTS: The results are expressed as median values. The time to ligate the IMV and LCA was significantly shorter for FVN+ (230 seconds; range 126-346) than for FVN- (417.5 seconds; range 137-1327) (p<0.001). CONCLUSION: Real-time FVN using ICG shortened the times for IMV and LCA ligation. This was enabled by clear visualization of the direction of the bloodstream flow inside the vessels. This technique simplifies vessel ligation and safer laparoscopic surgery for left colorectal cancer.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Corantes Fluorescentes/administração & dosagem , Verde de Indocianina/administração & dosagem , Laparoscopia/métodos , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/cirurgia , Imagem Óptica/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Ligadura , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
6.
Anticancer Res ; 39(6): 3227-3230, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177172

RESUMO

BACKGROUND: We advocated the usefulness of pylorus-reconstruction gastrectomy (PRG) to improve quality of life following surgery for gastric cancer. The current study assessed gastric emptying following PRG in comparison with those who underwent conventional Billroth-I (B-I) reconstruction and in healthy controls using a 13C breath test. PATIENTS AND METHODS: The study group consisted of 24 patients who underwent PRG from September 20, 2007 to July 26, 2012 at the Department of Surgery at Daisan Hospital (affiliated with The Jikei University School of Medicine). These patients underwent the 'standard' version of a gastric-emptying study using a 13C breath test at 20.5±11.8 months after surgery. During the study, the half gastric-emptying time (T1/2) and gastric retention at 5 min after ingestion (RR5) were measured. The data of the PRG group were compared to those for 26 patients who underwent conventional B-I reconstruction and with a group consisting of 20 healthy controls. RESULTS: RR5 was 69.6±21.8% in the patients who underwent PRG, 45.3±28.6% in those who underwent B-I reconstruction, and 93.7±5.7% in healthy controls. T1/2 was 17.0±13.0 min in patients who underwent PRG, 5.9±4.0 min in those who underwent B-I reconstruction, and 23.3±4.9 min in healthy controls. Gastric emptying was delayed in patients who underwent PRG compared to those who underwent B-I reconstruction (RR5: p<0.0014, T1/2: p<0.0002), and was comparable to that of healthy controls. CONCLUSION: Gastric emptying improved significantly after PRG compared to B-I reconstruction, and approached that of healthy controls.


Assuntos
Testes Respiratórios , Gastrectomia/métodos , Esvaziamento Gástrico , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Int Cancer Conf J ; 8(3): 101-104, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31218183

RESUMO

It is generally reported that prognosis of patients who have unresectable gastric cancer is from 3 to 5 months with best supportive care. Despite the improvement of survival after the appearance of S-1, the outcome of treatment for advanced gastric cancer is still unfavorable. Here we present a valuable case of advanced gastric cancer with synchronous liver metastasis, which was treated by S-1 + CDDP and S-1 therapy without surgery. A 58-year-old man was referred to our hospital with a diagnosis of advanced gastric cancer with liver metastasis at stage of cT3N0M1. He underwent first-line chemotherapy consisting of S-1 plus cispatin. 3 months later, a follow-up endoscopy revealed complete response (CR) of the gastric lesion. 3 months later, computed tomography (CT) also demonstrated disappearance of liver metastasis. Then he underwent maintenance chemotherapy with S-1 alone for 8 months. To date, there has been no recurrence for 6 years and 6 months since the acquisition of CR.

8.
Asian J Endosc Surg ; 12(2): 222-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30549252

RESUMO

INTRODUCTION: Recently, single-incision laparoscopic cholecystectomy has been accepted as an alternative to conventional laparoscopic cholecystectomy. The aim of this study was to retrospectively evaluate the safety and feasibility of unique gallbladder retraction methods using an ENDOLOOP® (Ethicon, Tokyo, Japan) and Lapaherclosure™ (Hakko Medical, Tokyo, Japan). MATERIALS AND SURGICAL TECHNIQUE: From May 2013 to April 2015, 77 patients underwent single-incision laparoscopic cholecystectomy with this retraction technique. During the same period, conventional laparoscopic cholecystectomy was performed in 85 patients; these patients were the control group. The patients' data, including the operative time, total blood loss, conversion rate to laparotomy, and perioperative complications, were compared. Alexis® Wound Retractor XS (Applied Medical, Tokyo, Japan) was inserted through a 25-30-mm vertical transumbilical incision to prevent bile contamination. Next, a SILS Port (Covidien, Tokyo, Japan) was inserted. A flexible 5-mm laparoscope was inserted through the port with a grasper (SILS Clinch, Covidien) and a normal 5-mm scalpel. The fundus of the gallbladder was tied by the ENDOLOOP. The Lapaherclosure was then directly inserted through a right lower intercostal space to capture and pull the Lapaherclosure out. After the cystic artery and duct were cut, the resected gallbladder was directly extracted from the umbilical incision. DISCUSSION: Several methods and devices have been developed to perform single-incision laparoscopic cholecystectomy, including the suturing method, the Mini Loop Retractor II (Covidien), and the EndoGrab (Virtual Ports, Caesarea, Israel). However, considering medical costs and safety, our retraction method seems to be feasible and comparable to existing methods.


Assuntos
Colecistectomia Laparoscópica/métodos , Vesícula Biliar/cirurgia , Instrumentos Cirúrgicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
In Vivo ; 32(6): 1643-1646, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30348728

RESUMO

AIM: To retrospectively examine efficacy and safety of oral combination of trifluridine and tipiracil hydrochloride (TAS-102) as the second-line therapeutic agent for unresectable colorectal cancer. PATIENT AND METHODS: Treatment outcomes of 17 patients who had received TAS-102 at our Institution from January 2015 to January 2017 were analyzed. The indications for second-line TAS-102 treatment were intolerance to other multi-drug combination (four patients) or patient refusal of the standard second-line therapy (13 patients). RESULTS: Among 17 patients who received TAS-102 as second-line therapy, partial response was observed in two (12%) and stable disease in two (12%). Outcomes of TAS-102 given as second-line therapy were: median overall survival of 5 months, response rate of 12% and disease control of 24%. Overall, no adverse events other than neutropenia were noted. CONCLUSION: Our findings suggest a beneficial role of TAS-102 in second-line therapy for unresectable colorectal carcinoma.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Trifluridina/administração & dosagem , Administração Oral , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirrolidinas , Resultado do Tratamento , Trifluridina/efeitos adversos , Uracila/análogos & derivados
10.
Kyobu Geka ; 71(7): 556-559, 2018 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-30042261

RESUMO

Pulmonary cryptococcosis is difficult to distinguish from lung cancer clinically, and is often diagnosed by surgery. A 72-year-old woman, who underwent distal pancreatectomy and splenectomy for pancreatic carcinoma. Four months after surgery, a tumor shadow was detected in the left lung as a groundglass nodule (GGN)of 12 mm in diameter, which was found to change to 15 mm with increased density by the computed tomography(CT)scan after 2 months. The nodule showed positive accumulation of fluorodeoxyglucose(FDG)by positron emission tomography(PET), and was suspected of malignant tumor. She underwent a partial resection of the left lung under thoracoscopy.


Assuntos
Criptococose/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X
11.
Int J Med Robot ; 14(5): e1921, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29749069

RESUMO

BACKGROUND: We previously developed an image-guided navigation system (IG-NS) using augmented reality technology for hepatobiliary and pancreatic (HBP) surgery. This system superimposed a 3D model onto a stereoscope-captured surgical field (i.e., the scope method). Unfortunately, this method requires an expensive stereoscope, surgeons have to shift their eyesight away from the surgical field, and the method has poor controllability. Therefore, an IG-NS using a tablet PC (i.e., the tablet method) was developed. The aim of the current study is to evaluate the efficiency of this novel method. METHODS: We studied 9 patients, for whom a 3D model was created from computed tomography images. After registration was performed, the 3D model was superimposed onto the surgical field, which was captured by the tablet PC's camera. RESULTS: The IG-NS could be applied with very little time lag. The visibility and controllability of the tablet method were superior to those of the scope method. It was especially useful in surgery for multiple metastatic liver carcinoma due to easy localization of the position of the carcinomas and vessels. CONCLUSIONS: We successfully developed the tablet method and tested it in a clinical setting. This system may contribute to surgical efficacy and improve the educational effects.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Computadores de Mão , Neoplasias Hepáticas/cirurgia , Neoplasias Pancreáticas/cirurgia , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
12.
Asian J Endosc Surg ; 11(4): 378-384, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29573191

RESUMO

INTRODUCTION: The ideal surgical technique for large incisional hernia repair has not yet been identified. The aim of this study was to evaluate surgical outcomes of standard intraperitoneal onlay mesh (sIPOM) versus fascial defect closure with intraperitoneal onlay mesh (IPOM-Plus) for large incisional hernia repair. METHODS: Of 49 patients who underwent laparoscopic incisional hernia repair between November 2005 and December 2016, 26 cases with large incisional hernia (transverse diameter ≥10 cm) were examined to compare surgical outcomes between sIPOM (n = 12) and IPOM-Plus (n = 14). Statistical analysis was performed using the Mann-Whitney U-test and Fisher's exact test. P < 0.05 was considered to be statistically significant. RESULTS: We compared sIPOM with IPOM-Plus for similar hernia types during median follow-up periods of 53 and 21 months, respectively. The operation time was 150 min for sIPOM and 148 min for IPOM-Plus (P = 0.6220). Early postoperative complications including seroma formation were observed in four sIPOM patients (33%) and three IPOM-Plus patients (21%) (P = 0.6652). Significantly more mesh bulged with sIPOM than with IPOM-Plus (50% vs 0%; P = 0.0082). Chronic pain lasting 3 months after the operation was found in two cases of IPOM-Plus (14%), but this was not statistically significant. Postoperative hospital stay was longer for sIPOM patients than for IPOM-Plus patients. Only one recurrence was observed in the sIPOM group (8%), but this was not statistically significant. CONCLUSION: For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging.


Assuntos
Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas , Idoso , Idoso de 80 Anos ou mais , Fáscia , Feminino , Seguimentos , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Peritônio , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
14.
World J Surg ; 42(1): 233-238, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28748420

RESUMO

PURPOSE: The aim of the study was to evaluate risk factors for small bowel obstruction (SBO) in early postoperative period after anterior resection for rectal cancer. METHODS: Patients who underwent anterior resection (AR) [high AR (HAR) or low AR (LAR)] for rectal cancer between January 2009 and April 2016 were enrolled into the study after fulfilling selection criteria. In included patients, risk factors for early postoperative SBO (EPSBO) were analyzed by means of univariate and multivariate analysis. Cases with perioperative major complications other than intestinal obstruction and with simultaneous resection of other organs were excluded. The same analyses were also performed for cases of redo surgery due to EPSBO. EPSBO was defined as clinically and radiologically confirmed SBO that developed after resuming oral intake within 30 days following surgery. The logistic regression method was used for statistical analyses. RESULTS: In enrolled 180 patients, EPSBO occurred in 23 (12.8%). In univariate analysis, male sex [odds ratio (OR) = 2.17, 95% CI = 0.82-6.84, p < 0.0001], previous abdominal surgery (OR = 0.20, 95% CI = 0.03-0.73, p = 0.0117), low tumor (OR = 3.26, 95% CI = 1.28-8.13, p = 0.0140), LAR (OR = 17.25, 95% CI = 3.49-312.55, p < 0.0001), D3 node dissection (OR = 13.61, 95% CI = 2.75-246.69, p = 0.0002), defunctioning ileostomy (DI) formation (OR = 9.88, 95% = 3.80-29.14, p < 0.0001), and prolonged operation time (OR = 1.01, 95% CI = 1.00-1.01, p = 0.0122) were significantly related to EPSBO. Multivariate analysis demonstrated that D3 node dissection (OR = 10.93, 95% CI = 1.94-208.23, p = 0.0038) and DI formation (OR = 5.82, 95% CI = 1.55-25.31, p = 0.0083) were independent risk factors for EPSBO. Four cases (17.4%) with EPSBO required re-operation because conservative therapies failed; all were laparoscopic DI formation cases. In three of those four cases, stenosis of stoma at the level of the posterior sheath of rectus abdominis muscle was the reason of SBO, and in one case it was kinking of the stomal limb. CONCLUSIONS: D3 lymph node dissection and DI formation are independent risk factors for EPSBO in AR.


Assuntos
Obstrução Intestinal/etiologia , Intestino Delgado , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Ileostomia/efeitos adversos , Intestino Delgado/cirurgia , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Reoperação , Fatores de Risco , Estomas Cirúrgicos , Fatores de Tempo
15.
Surg Case Rep ; 3(1): 128, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29260424

RESUMO

BACKGROUND: Subareolar breast abscess (SBA) is a rare infectious disease of the breast in male patients. CASE PRESENTATION: Herein, we report two male patients with SBA. Patient 1 was initially diagnosed with a malignant tumor based on imaging findings; ultrasonography revealed a hypoechoic mass with blood flow. Patient 2 was diagnosed with inflammatory changes to his nipple; ultrasonography findings supported the diagnosis with an irregular hypoechoic mass with blood flow. Both patients received a cytological or histological biopsy preoperatively, which showed an abscess without malignant cells. CONCLUSION: These cases serve as an important reminder to consider complete resection of the tumor including the responsible mammary duct (tumor and duct resection (TDR)) for curative therapy of SBA.

16.
Anticancer Res ; 37(9): 5309-5316, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28870969

RESUMO

AIM: Pancreaticoduodenectomy (PD) is still the only curative treatment for periampullary cancer. Confirming the outcomes of PD in elderly patients is important as the aging population continues to grow. PATIENTS AND METHODS: We analyzed 340 patients with periampullary cancer who underwent PD, dividing them into three groups by age: group A: aged 64 years or younger, n=115; group B: 65-74 years, n=144; and group C: 75 years or older, n=81. RESULTS: Group C had a significantly higher 60-day mortality of 6.3% (p=0.04), the lowest 5-year overall survival rate of 9.9% (p=0.02), and there was no impact of staging of the Union for International Cancer Control classification on overall survival of patients with pancreatic cancer. Independent prognostic factors of group C in the multivariate analysis were pancreatic cancer and reoperation. CONCLUSION: For elderly patients aged 75 years or over, caution should be exercised in selecting PD for patients with pancreatic cancer.


Assuntos
Pancreaticoduodenectomia/métodos , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Pancreáticas/cirurgia , Assistência Perioperatória , Reprodutibilidade dos Testes , Análise de Sobrevida , Resultado do Tratamento
17.
J Hepatobiliary Pancreat Sci ; 24(8): 466-474, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28547910

RESUMO

BACKGROUND: Delayed gastric emptying (DGE), a common postoperative complication of pancreaticoduodenectomy, is not considered a life-threatening complication. In the present study, we analyzed the risk factors for DGE and its impact on long-term prognosis. METHODS: We analyzed 383 patients who underwent pancreaticoduodenectomy between 2003 and 2010, dividing them into two groups according to DGE grade as defined by the International Study Group of Pancreatic Surgery: 243 without DGE (non-DGE group) and 140 with DGE of any grade (DGE group). RESULTS: The 5-year overall survival was 32.7% in the DGE group, and 41% in the non-DGE group (P = 0.02). Cox proportional hazards analyses showed that pancreatic cancer (compared with ampulla of Vater cancer: hazard ratio [HR] 3.4, 95% confidence interval [CI] 1.82-6.34, P < 0.001), bile duct cancer (HR 2.1, 95% CI 1.08-4.06, P = 0.03), the Union for International Cancer Control stage (compared with stages I and II: HR 2.98, 95% CI 1.66-5.35, P < 0.001; compared with stage III: HR 4.71, 95% CI 2.51-8.86, P < 0.001), and DGE grade (grade C; HR 1.6, 95% CI 1.04-2.46, P = 0.03) were independent risk factors for cancer-specific survival. CONCLUSIONS: DGE, especially grade C, negatively affects cancer-specific survival.


Assuntos
Esvaziamento Gástrico , Monitorização Fisiológica/métodos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Idoso , Causas de Morte , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
18.
Anticancer Res ; 37(2): 909-914, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28179351

RESUMO

BACKGROUND: Gemcitabine (GEM) plus cisplatin (CDDP) chemotherapy has been used worldwide as the standard first-line treatment for advanced biliary tract cancer (BTC). A phase II trial has also suggested promising activity of GEM plus S-1 chemotherapy against advanced BTC. The aim of this study was to evaluate the efficacy and safety of GEM plus S-1 chemotherapy in patients with advanced BTC. PATIENTS AND METHODS: The eligibility criteria were as follows: histologically-proven BTC, unresectable or recurrent disease, ECOG performance status (PS) 0-1 regardless of previous treatment. Gemcitabine was administered intravenously at the dose of 1,000 mg/m2 over 30 min on days 1 and 8, and S-1 was administered orally at doses of 60/80/100 mg/day based on the BSA, from day 1 to day 14, every 3 weeks. The primary endpoint was the response rate according to RECIST, ver. 1.1, and the secondary endpoints were the frequency/severity of toxicities, progression-free survival (PFS) and overall survival (OS). RESULTS: A total of 38 patients were enrolled between August 2008 and November 2011. There were 19 men and 19 women, with a median age of 66 years (range=44-81 years). Seven patients had a previous history of first-line or adjuvant chemotherapy after surgery. The PS was 0 and 1 in 30 and 7 patients, respectively. The treatment response was classified as partial response in 6 patients (15.8%) and as stable disease in 18 patients (47.4%). The median PFS and OS were 5.8 and 15.9 months, respectively. The toxicity was generally mild, and the most common grade 3/4 toxicities were leukopenia (31.6%), neutropenia (36.8%), nausea/vomiting (2.6%), and diarrhea (2.6%). There was one treatment-related death due to interstitial pneumonia. CONCLUSION: Our study revealed that gemcitabine plus S-1 chemotherapy was well-tolerated and exhibited favorable antitumor activity in patients with advanced BTC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Biliar/tratamento farmacológico , Administração Intravenosa , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Sistema Biliar/patologia , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Diarreia/induzido quimicamente , Intervalo Livre de Doença , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Neutropenia/induzido quimicamente , Ácido Oxônico/administração & dosagem , Ácido Oxônico/efeitos adversos , Tegafur/administração & dosagem , Tegafur/efeitos adversos , Resultado do Tratamento , Vômito/induzido quimicamente
19.
Surg Case Rep ; 2(1): 144, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27900729

RESUMO

A 53-year-old male visited his primary physician for epigastric and back pain. Abdominal-enhanced computed tomography (CT) revealed a simple cyst of the pancreatic tail attached to the stomach. A distal main pancreatic duct (MPD) was clearly dilated, but no pancreatic tumor was identified around the stenosis of MPD by CT scan and magnetic resonance cholangiopancreatography (MRCP). Endoscopic retrograde pancreatography (ERP) revealed stenosis and distal dilation of the MPD located between the body and tail of the pancreas. Endoscopic ultrasound (EUS) revealed a low density mass of 7 mm in size with distal dilation of the MPD. With the suspicion of a small pancreatic cancer, the patient underwent distal pancreatectomy and splenectomy with lymph node dissection (D2). On histopathological evaluation, a small pancreatic adenocarcinoma of 6 mm in size was detected around the stenosis of MPD. Final pathological diagnosis was moderately differentiated invasive ductal adenocarcinoma of the pancreas with no lymph node metastasis (Japan Pancreatic Society (JPS) classification 7th edition; Pbt, TS1 (6 mm), tub2, intermediate type, INF ß, ly1, v1, ne1, mpd(-), pT1b, pN0, pM0, stage IA,PCM(-), DCM(-) and the Union International Control Cancer (UICC) classification of malignant tumors 6th edition; pT1, pN0, pM0, stage IA, R0). We herein reported a patient who underwent radical resection for T1 pancreatic adenocarcinoma of 6 mm in diameter which caused acute pancreatitis and a pseudocyst due to obstruction of the MPD.

20.
Surg Endosc ; 30(12): 5628-5634, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27129541

RESUMO

BACKGROUND: The ideal mesh and mesh fixation technique for laparoscopic Sugarbaker (SB) parastomal hernia repair have not yet been identified. METHODS: Sixteen patients with parastomal hernia who underwent laparoscopic modified SB repair (LSB) between June 2012 and October 2015 were retrospectively analyzed. LSB was performed using a developed standardized 2-point anchoring and zigzag tacking of Parietex™ Parastomal Mesh (PCO-PM) technique. RESULTS: Out of 16 cases, 14 were primary and 2 recurrent hernias; 13 were para-end colostomy and 3 were para-ileal conduit (PIC) hernias. The median longitudinal and transverse diameters of the hernia orifice were 5 cm (2.5-7 cm) and 4.2 cm (2-6 cm), respectively. Five cases had a concomitant midline incisional hernia, which was simultaneously repaired. In all cases, the mesh was placed without deflection. The median operation time was 193 (75-386) min. Perioperative complications occurred in two cases (13 %) with PIC, one intra-operatively and the other postoperatively. The intra-operative complication was enterotomy close to the ureteroenteric anastomosis of the ileal conduit; it was repaired through a mini-laparotomy. LSB was accomplished without any subsequent postoperative complications. The postoperative complication was ureteral obstruction that required creation of nephrostomy. Mini-laparotomy was necessary in those two cases (13 %) because of intra-operative enterotomy and severe intra-abdominal adhesions. The median postoperative length of stay was 9 (5-14) days. No recurrence was observed with a median follow-up of 14.5 (2-41) months. CONCLUSIONS: Our LSB using standardized mesh fixation technique is safe and feasible, and the PCO-PM seems to be the most optimal prosthesis.


Assuntos
Hérnia Ventral/cirurgia , Laparoscopia/métodos , Telas Cirúrgicas , Idoso , Idoso de 80 Anos ou mais , Colostomia/efeitos adversos , Feminino , Hérnia Ventral/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Derivação Urinária/efeitos adversos
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