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1.
Anticancer Res ; 41(9): 4411-4416, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475062

RESUMO

BACKGROUND/AIM: Detection of hepatocellular carcinoma using intraoperative ultrasonography (IOUS) is indispensable for successful laparoscopic hepatectomy (LH). This study was performed to evaluate patients with intraoperatively unidentified tumours undergoing LH. PATIENTS AND METHODS: Seven patients who underwent LH for hepatocellular carcinoma and whose tumours were not detected using IOUS were included in this study. Clinical features, preoperative imaging, intraoperative imaging, surgical procedures, and pathological findings were evaluated. RESULTS: Using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, all the tumours were enhanced in the arterial phase and rapidly washed out, becoming hypointense to the remainder of the liver. All tumours except one were <2 cm in size. Severe liver fibrosis was observed in all cases. Tumours that were invisible on preoperative ultrasonography also could not be detected using IOUS or indocyanine green fluorescence imaging. Five patients underwent hepatectomy based on anatomical landmarks and achieved curative resection, whereas curative resection failed in two patients. CONCLUSION: When tumours cannot be identified by IOUS, LH based on anatomical landmarks should be preferred. Importantly, invisible tumours on preoperative ultrasonography may not be identified intraoperatively during LH.


Assuntos
Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Gadolínio DTPA/administração & dosagem , Hepatectomia , Humanos , Verde de Indocianina/administração & dosagem , Laparoscopia , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imagem por Ressonância Magnética Intervencionista , Masculino , Pessoa de Meia-Idade , Carga Tumoral , Ultrassonografia de Intervenção
2.
Ann Surg Oncol ; 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34490525

RESUMO

BACKGROUND: Nutritional status assessment is essential in cancer patients because a poor nutritional status has been associated with poor outcomes; however, the impact of rapid turnover proteins (RTPs), such as prealbumin, transferrin, and retinol-binding protein, on the outcomes of hepatocellular carcinoma (HCC) has not been well-investigated. We therefore examined the prognostic significance of RTPs in patients with HCC after curative resection. METHODS: This study included 150 patients who underwent elective hepatic resection for HCC between January 2011 and December 2018. The prealbumin, transferrin, and retinol-binding protein levels were classified into two groups (high vs. low); the RTP score (0-3) was calculated as the sum of each RTP measurement (high = 0; low = 1). We retrospectively investigated the relationship between the RTP score and disease-free and overall survival. RESULTS: Multivariate analysis showed that a high RTP score (P = 0.022), presence of sarcopenia (P = 0.001), and stage III or higher (P = 0.005) were independent predictors of disease-free survival, while a high RTP score (P < 0.001), presence of sarcopenia (P = 0.017), and stage III or higher (P = 0.012) were independent predictors of overall survival. In patients with high RTP scores, positive hepatitis B and C viral infection, high indocyanine green (ICG) at 15 min (ICGR15), Child-Pugh grade B, poorly differentiated carcinoma, and postoperative ascites were more common than in patients with low RTP scores. CONCLUSION: The preoperative RTP score may be a prognostic factor in patients with hepatocellular carcinoma after hepatic resection, suggesting an important role of RTP in the assessment of nutritional status in cancer patients.

5.
Ann Surg Oncol ; 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34240295

RESUMO

BACKGROUND: Under laparoscopy-specific caudal and lateral view, Aranitius' ligament could be the landmark for the root of the venous trunks in the left hepatic lobe.1-3 We performed laparoscopic hepatic extended medial segmentectomy including the middle hepatic vein (MHV) using the Arantius' approach. METHODS: An 86-year-old man was referred to our hospital for hepatocellular carcinoma, 4.5 cm in size, located in the medial hepatic segment (Video 1). After pneumoperitoneum and placement of four working ports, the Arantius' ligament was exposed, isolated, and divided. The liver parenchyma underneath the Arantius' ligament was opened to widely expose the root of the MHV, umbilical fissure vein (UFV), and left hepatic vein (LHV). After dividing the Glissonean branches for segment 4 (G4), the parenchymal tissue between MHV and LHV was divided. The trunk of the MHV was fully exposed and was divided using the endo-stapling device. Parenchymal resection was further proceeded along the dorsal side of the MHV, and the planned hepatectomy was completed. RESULTS: The operation time was 337 min, and the estimated blood loss was 400 g. His postoperative course was uneventful, and he was discharged on postoperative day 10. CONCLUSIONS: The significance of Arantius' ligament approach is short-cut exposure of the MHV as the anatomical landmark during the initial process of the surgery under laparoscopy-specific caudal and lateral view, and is a reasonable technique in extended medial segmentectomy including the MHV.

6.
Ann Surg Oncol ; 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34235601

RESUMO

BACKGROUND: Simultaneous dual hepatic vein embolization (DHVE) has been proposed for safe right-side massive hepatectomy, (Kobayashi et al. in Surgery 167:917-923, 2020, Heil J, Schadde E. in Langenbecks Arch Surg 2020, Narita et al. in Ann Surg 256:e7-8, 2012) and has demonstrated comparable results to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) (Chan et al. in Transl Gastroenterol Hepatol 5:37, 2020) in terms of liver hypertrophy. In this video, we describe our DHVE techniques to perform a safe right trisectionectomy. METHODS: A 40-year-old man with unresectable intrahepatic cholangiocarcinoma with multiple intrahepatic metastases and vena cava invasion received 20 cycles of gemcitabine plus cisplatin, resulting in remarkable shrinkage of the tumor. Conversion surgery was planned to achieve no evidence of disease status. The future liver remnant (FLR) after right trisectionectomy was 363 ml (29.6% of the whole liver) and simultaneous DHVE was performed. The right portal vein embolization was performed via a transhepatic approach, while the right and middle hepatic veins were accessed via a transjugular approach and self-expandable mesh devices were deployed. Remarkable atrophy of the right lobe and hypertrophy of the left lobe was observed 2 weeks after the procedure. Volumetry showed the FLR increased to 485 ml (40.2% of the whole liver). Three weeks after DHVE, right trisectionectomy with combined resection of the vena cava was performed. RESULTS: The operation time was 311 min, and the blood loss was 420 ml. Pathological examination revealed complete resection of liver tumors, and the volumetry on postoperative day 7 revealed an increased remnant liver volume of 874 ml. He was discharged on postoperative day 10 without any complications. CONCLUSION: Simultaneous DHVE could be an effective procedure to increase FLR with safety for massive hepatectomy.

12.
Asian J Endosc Surg ; 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34145963

RESUMO

INTRODUCTION: In March 2019, the supply of cefazolin sodium (CEZ) became difficult owing to contamination of the drug substance. We investigated the efficacy and safety of the oral administration of cephalexin (CEX) in preventing infectious complications following elective laparoscopic cholecystectomy (LC). METHODS: From July 2018 to June 2019, 1 g of CEZ was administered intravenously within 30 min prior to LC (IV group). From July 2019 to June 2020, 0.5 g of CEX was administrated orally within 2 h prior to LC (oral group). We compared clinicopathologic variables and perioperative results between these two groups. RESULTS: During the period, 60 patients underwent elective LC; 35 from the oral group and 25 from the IV group. There was no significant difference in the surgical site infection (P = 0.37), distant infection (P = 0.23), and postoperative medical costs (P = 0.11) between both groups. Postoperative nausea and vomiting were significantly higher in the oral group (P = 0.04), whereas the C-reactive protein value on the first day after the operation was significantly lower in the oral group (P < 0.01). CONCLUSION: During the period of limited CEZ supply, oral administration of CEX may be an alternative antibiotic prophylaxis in LC.

13.
Langenbecks Arch Surg ; 406(1): 99-107, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32936328

RESUMO

PURPOSE: The controlling nutritional status (CONUT) score has been reported to predict outcomes in patients with hepatocellular carcinoma (HCC). However, the prognostic significance of the CONUT score in patients with non-B non-C (NBNC) HCC remains to be established. METHODS: The study comprised 246 patients who had undergone elective hepatic resection for HCC between April 2003 and October 2017. We retrospectively investigated the relation between preoperative CONUT score as well as clinicopathological characteristics and disease-free survival (DFS) as well as overall survival (OS). RESULTS: In univariate analyses, CONUT score was associated with DFS and OS in patients with NBNC-HCC (p ≤ 0.01), while there was no significant association of CONUT score with DFS and OS in patients with HBV- and HCV-related HCC (p ≥ 0.1). Of the 111 patients with NBNC-HCC, 97 (87.4%) had CONUT score ≤ 3 (low CONUT score) and the other 14 (12.6%) had CONUT score ≥ 4 (high CONUT score). In the patients with NBNC-HCC, multivariate analysis identified age ≥ 65 years (p = 0.03), multiple tumors (p < 0.01), and high CONUT score (p = 0.03) as the independent and significant predictors of DFS, while multiple tumors (p = 0.01), microvascular invasion (p < 0.01), and high CONUT score (p = 0.01) were the independent and significant predictors of OS. CONCLUSIONS: The CONUT score seems to be a reliable and independent predictor of both DFS and OS after hepatic resection for NBNC-HCC.

14.
Pancreatology ; 21(1): 299-305, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33214083

RESUMO

INTRODUCTION: A soft remnant texture of the pancreas is commonly accepted as a risk factor for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). However, its assessment is subjective. The aim of this study was to evaluate the significance of intraoperative amylase level of the pancreatic juice as a risk factor of POPF after PD. METHOD: This study included 75 patients who underwent PD between November 2014 and April 2020 at Jikei University Hospital. We investigated the relationship between pancreatic texture, intraoperative amylase level of pancreatic juice, results of the pathological evaluations, and the incidence of POPF. RESULTS: Twenty-three patients (31%) developed POPF. The significant predictors of POPF were non-ductal adenocarcinoma (p < 0.01), soft pancreatic remnant (p < 0.01), high intraoperative blood loss (p < 0.01), high intraoperative amylase level of pancreatic juice (p < 0.01), and low pancreatic fibrosis (p < 0.01). Multivariate analysis revealed that the significant independent predictors of POPF were high intraoperative blood loss (p < 0.01) and high intraoperative amylase level of pancreatic juice (p = 0.02). Receiver operating characteristic (ROC) analysis showed that the cut-off value for the intraoperative amylase level of pancreatic juice was 2.17 × 105 IU/L (area under the curve = 0.726, sensitivity = 95.7%, and specificity = 50.0%) CONCLUSIONS: The intraoperative amylase level of pancreatic juice is a reliable objective predictor for POPF after PD.

15.
Int Cancer Conf J ; 9(2): 55-58, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32257754

RESUMO

A 48-year-old male was referred to our hospital for evaluation of motor speech disorders and difficulty in the movement of both the hands. The clinical diagnosis was Trousseau's syndrome due to advanced gallbladder cancer (cT3aN1M0). The patient received anticoagulation therapy and systemic chemotherapy (gemcitabine and cisplatin). Motor speech disorders and difficulty in movement of both hands were recovered. After 2 courses of chemotherapy, the primary tumor developed a massive hepatic invasion and the peripheral blood eosinophils increased gradually. The patient was admitted to our hospital for abdominal distension, fever, right upper quadrant pain, systemic edema, loss of appetite, and general malaise. The peripheral blood eosinophil count was markedly elevated to 45,900/µl (90.3%). The serum level of GM-CSF was high and there was no evidence of leukemia, allergic status and other diseases. The patient was diagnosed as paraneoplastic eosinophilia with advanced gallbladder cancer, which was suspected to produce GM-CSF. The patient received palliative support and died of disseminated intravascular coagulation 15 days after admission. We herein reported a fatal case of gallbladder cancer suspected of producing GM-CSF.

16.
Surg Case Rep ; 5(1): 103, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31236705

RESUMO

BACKGROUND: Metastatic biliary tract cancer (BTC) has poor prognosis. Recently, patients with metastatic BTC who respond well to systemic chemotherapy can be treated by radical resection or "conversion surgery." CASE PRESENTATION: A 67-year-old male patient was diagnosed with intrahepatic cholangiocarcinoma with para-aortic metastases [cT2N1M1, stage IVB]. He was enrolled in our phase II study for unresectable BTC consisting of cisplatin (25 mg/m2 i.v. for 30 min) followed by gemcitabine (1000 mg/m2 i.v. for 30 min) on days 1 and 8 and oral S-1 on alternate days. After 8 courses of this regimen, marked regression of para-aortic lymph metastases was achieved, and we performed extended left hepatic lobectomy with the caudate lobe, concomitant portal vein resection, and lymph node dissection including the para-aortic region. The patient made a satisfactory recovery and was discharged on postoperative day 25. Histopathological examination revealed more than 50% of the tumor area replaced with fibrosis, and curative resection was achieved (ypT2N1M1, stage IVB, Evans criteria IIb). The patient received adjuvant chemotherapy using S-1 for 12 months and remains well with no evidence of tumor recurrence as of 48 months after surgery. CONCLUSIONS: We herein report a successfully treated case of advanced BTC with para-aortic lymph node metastases by conversion surgery after combination chemotherapy using gemcitabine, cisplatin, and S-1.

17.
Clin J Gastroenterol ; 12(6): 552-555, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30955165

RESUMO

Everolimus is an mTOR (the mammalian target of rapamycin) inhibitor, which is used for the treatment of advanced renal cell carcinoma. Life-threatening hemorrhages are extremely rare adverse effect of everolimus. We herein report a successfully treated case of severe everolimus-related gastrointestinal hemorrhage by emergency surgical resection for patient with advanced renal cell carcinoma. A 72-year-old male was diagnosed with renal cell carcinoma, for which everolimus was administered after unsuccessful treatment with sunitinib and sorafenib. The patient suddenly developed hematemesis 4 weeks after administration. Upper gastrointestinal endoscopy showed gastric antral vascular ectasia. Once the hemorrhage was successfully cauterized by argon plasma coagulation, everolimus was discontinued. However, the patient after re-administration of everolimus developed hematemesis again and exhibited hemorrhage shock. Since therapeutic endoscopy could not achieve hemostasis, the patient underwent emergency distal gastrectomy with Billroth I reconstruction. The patient's vital signs and hemoglobin level stabilized after the surgery. Thereafter, the patient made a satisfactory recovery, and was discharged on postoperative day 10.


Assuntos
Antineoplásicos/efeitos adversos , Everolimo/efeitos adversos , Hematemese/induzido quimicamente , Gastropatias/induzido quimicamente , Idoso , Coagulação com Plasma de Argônio , Carcinoma de Células Renais/tratamento farmacológico , Cauterização/métodos , Substituição de Medicamentos , Hematemese/prevenção & controle , Humanos , Neoplasias Renais/tratamento farmacológico , Masculino , Gastropatias/prevenção & controle
18.
Mol Biol Cell ; 30(9): 1085-1097, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30811271

RESUMO

Syntaxin 11 (stx11) is a soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) that is selectively expressed in immune cells; however, its precise role in macrophages is unclear. We showed that stx11 knockdown reduces the phagocytosis of Escherichia coli in interferon-γ-activated macrophages. stx11 knockdown decreased Toll-like receptor 4 (TLR4) localization on the plasma membrane without affecting total expression. Plasma membrane-localized TLR4 was primarily endocytosed within 1 h by lipopolysaccharide (LPS) stimulation and gradually relocalized 4 h after removal of LPS. This relocalization was significantly impaired by stx11 knockdown. The lack of TLR4 transport to the plasma membrane is presumably related to TLR4 degradation in acidic endosomal organelles. Additionally, an immunoprecipitation experiment suggested that stx11 interacts with SNAP-23, a plasma membrane-localized SNARE protein, whose depletion also inhibits TLR4 replenishment in LPS-stimulated cells. Using an intramolecular Förster resonance energy transfer (FRET) probe for SNAP-23, we showed that the high FRET efficiency caused by LPS stimulation is reduced by stx11 knockdown. These findings suggest that stx11 regulates the stimulus-dependent transport of TLR4 to the plasma membrane by cooperating with SNAP-23 in macrophages. Our results clarify the regulatory mechanisms underlying intracellular transport of TLR4 and have implications for microbial pathogenesis and immune responses.


Assuntos
Proteínas Qa-SNARE/metabolismo , Proteínas Qb-SNARE/metabolismo , Proteínas Qc-SNARE/metabolismo , Receptor 4 Toll-Like/metabolismo , Animais , Linhagem Celular , Membrana Celular/metabolismo , Endocitose/fisiologia , Endossomos/metabolismo , Técnicas de Silenciamento de Genes , Macrófagos/metabolismo , Fusão de Membrana , Camundongos , Camundongos Endogâmicos BALB C , Fagocitose/fisiologia , Ligação Proteica , Transporte Proteico , Proteínas Qa-SNARE/genética , Receptor 4 Toll-Like/genética
19.
Surg Case Rep ; 3(1): 95, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28853036

RESUMO

BACKGROUND: Gastric cancer with multiple liver metastases have poor prognosis. Recently, stage IV gastric cancer patients who respond well to systemic chemotherapy can be treated by gastrectomy. We herein report a case of advanced gastric cancer with liver metastases who was successfully downstaged by systemic chemotherapy and underwent conversion surgery. CASE PRESENTATION: A 60-year-old male patient was diagnosed with gastric cancer with multiple liver metastases [cT3N3M1, stage IV]. After 18 courses of S-1 plus cisplatin combination chemotherapy (S-1 administered orally (80 mg/m2/day) twice a day for 21 consecutive days and cisplatin (60 mg/m2) infused on day 8), marked regression of liver metastasis was achieved, and we performed open total gastrectomy with D2 lymph node dissection. The patient was discharged from the hospital 10 days after the operation. Histopathological examination revealed no malignant cells in the lymph nodes [ypT1bN0M0, stage IA]. S-1 as the adjuvant chemotherapy was administered for 12 months, and the patient is alive without a recurrence for 33 months after surgery. CONCLUSIONS: Conversion surgery may improve the poor prognosis of gastric cancer.

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