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1.
J Gastrointest Surg ; 25(11): 2835-2841, 2021 11.
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.

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.
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
4.
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
5.
Asian J Endosc Surg ; 10(2): 162-165, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28008724

RESUMO

INTRODUCTION: Accidental gallbladder perforation frequently occurs during laparoscopic cholecystectomy and may increase the risk of infection. However, the necessity of antimicrobial prophylaxis for these patients is unclear. The aim of this study was to examine the clinical outcomes and necessity of antimicrobial prophylaxis after laparoscopic cholecystectomy with gallbladder perforation. METHODS: One hundred patients who underwent laparoscopic cholecystectomy were divided into two groups: patients with gallbladder perforation (Group A, n = 37) and patients without perforation (Group B, n = 63). We compared the white blood cell count and C-reactive protein level the day after the operation, the complication rates of systemic inflammatory response syndrome and surgical-site infection, and postoperative hospital stay between the two groups. All patients received antimicrobial prophylaxis only once before the operation. RESULTS: There were significant differences in every variable with the exception of postoperative hospital stay. Group A had a higher risk of infection, but the postoperative clinical course of Group A was not inferior to that of Group B. CONCLUSION: The clinical outcomes of patients with accidental gallbladder perforation were acceptable, and the use of antimicrobial prophylaxis once before the operation was sufficient.


Assuntos
Antibacterianos/uso terapêutico , Colecistectomia Laparoscópica/efeitos adversos , Doenças da Vesícula Biliar/cirurgia , Vesícula Biliar/lesões , Infecção da Ferida Cirúrgica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Adulto , Idoso , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Anticancer Res ; 36(12): 6619-6623, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27919992

RESUMO

BACKGROUND/AIM: It has been reported that pancreatic duct stenting for pancreaticojejunostomy in pancreaticoduodenectomy prevents postoperative pancreatic fistula. However, some reports describe severe complications associated with pancreatic duct stenting; it is controversial whether pancreatic duct stent should be used for pancreaticojejunal anastomosis in pancreaticoduodenectomy. The aim of this study was to compare the incidence of pancreatic fistula between non-stented, externally stented, and internally stented pancreaticojejunostomy in pancreaticoduodenectomy for patients with soft pancreas. PATIENTS AND METHODS: Ninety-eight patients undergoing pancreaticoduodenectomy with soft pancreas were divided into three groups: a non-stented group (n=14), an externally-stented group (n=56), and an internally-stented group (n=28), then clinical outcomes were compared. RESULTS: The frequency of clinically relevant postoperative pancreatic fistula (grade B or C) was 14% in the non-stented group, 36% in the externally-stented group, and 39% in the internally-stented group, respectively (p=0.19). The morbidity and mortality rates were also comparable between the three groups (p=0.17 and p=0.88, respectively). CONCLUSION: Since pancreatic duct stenting in pancreaticojejunal anastomosis for patients with soft pancreas did not reduce pancreatic fistula after pancreaticoduodenectomy, non-stented pancreaticojejunostomy for soft pancreas seems safe.


Assuntos
Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
7.
Hepatogastroenterology ; 61(134): 1762-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25436376

RESUMO

BACKGROUND/AIMS: It has been reported that age and hospital volume are risk factors after pancreaticoduodenectomy (PD), however the mortality rate after PD at middle volume center is decreasing by surgical advances and recently PD in the elderly patients is safely performed. The aim of this study is to evaluate the safety and feasibility of PD in the patients over 80 years of age at middle-volume center. METHODOLOGY: 60 patients who underwent PD between 2004 and 2012 were divided into two groups (≥80 and <80years). The clinical outcomes of the two groups were retrospectively analyzed. RESULTS: There were no statistical differences in terms of preoperative parameters, co-morbidity, perioperative data, morbidity, mortality and postoperative hospital stay. We achieved zero mortality in patients over 80 years of age and 40% of them are alive without recurrence. CONCLUSIONS: Clinical outcomes after PD in the elderly patients at middle-volume center are acceptable. Age and hospital volume are not necessarily risk factors after PD.


Assuntos
Hospitais Municipais , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
J Med Case Rep ; 7: 209, 2013 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-23945081

RESUMO

INTRODUCTION: Intra-abdominal hemorrhage following pancreatic fistula is a fatal complication after pancreatico-duodenectomy. Intra-abdominal hemorrhage has reportedly decreased with the use of fibrin glue or polyglycolic acid felt and wrapping of the skeletonized vessels by omentum or falciform ligament. However, there are no extremely effective methods for the prevention of hemorrhage. Here, we report our novel and simple method for the prevention of intra-abdominal hemorrhage due to pancreatic fistula. METHODS: The anastomotic site of the pancreato-jejunostomy in pancreatico-duodenectomy is displaced from the superior to inferior side of the transverse mesocolon through a small window created on the left side of the middle colic artery of the transverse mesocolon. This procedure is expected to prevent exposure of the skeletonized vessels to activated pancreatic juice from a pancreatic fistula after lymph node dissection, decreasing the incidence of hemorrhage. Two drains are placed on the superior and inferior sides of the transverse mesocolon. We performed this procedure in seven patients and compared the amylase level in the drainage fluid from the superior and inferior sides. RESULTS: There was no difference in the fluid amylase level from the drains between the superior and inferior sides, because a pancreatic fistula was not present in all our patients. Therefore, we could not evaluate the efficacy of this method in the current study. CONCLUSIONS: Our procedure is theoretically expected to prevent intra-abdominal hemorrhage and will be an option in pancreatico-duodenectomy, especially for patients with a soft pancreas. However, it is necessary to evaluate the performance and results of this procedure in many more patients.

9.
World J Surg Oncol ; 11: 3, 2013 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-23302293

RESUMO

BACKGROUND: Although adjuvant gemcitabine (GEM) chemotherapy for pancreatic cancer is standard, the quality of life (QOL) in those patients is still impaired by the standard regimen of GEM. Therefore, we studied whether mild dose-intensity adjuvant chemotherapy with bi-weekly GEM administration could provide a survival benefit with acceptable QOL to the patients with pancreatic cancer. METHODS: After a phase I trial, an adjuvant bi-weekly 1,000 mg/m2 of GEM chemotherapy was performed in 58 patients with pancreatic cancer for at least 12 courses (Group A). In contrast, 36 patients who declined the adjuvant bi-weekly GEM chemotherapy underwent traditional adjuvant 5FU-based chemotherapy (Group B). Careful periodical follow-ups for side effects of GEM and disease recurrence, and assessment of patients' QOL using the EORTC QOL questionnaire (QLQ-C30) and pancreatic cancer-specific supplemental module (QLQ-PAN26) were performed. Retrospectively, the degree of side effects, patients' QOL, compliance rate, disease-free survival (DFS), and overall survival (OS) in Group A were compared with those in Group B. RESULTS: No severe side effects (higher than Grade 2 according to the common toxicity criteria of ECOG) were observed, except for patients in Group B, who were switched to the standard GEM chemotherapy. Patients' QOL was better in Group A than B (fatigue: 48.9 ± 32.1 versus 68.1 ± 36.3, nausea and vomiting: 26.8 ± 20.4 versus 53.7 ± 32.6, diarrhea: 21.0 ± 22.6 versus 53.9 ± 38.5, difficulty gaining weight: 49.5 ± 34.4 versus 67.7 ± 40.5, P < 0.05). Compliance rates in Groups A and B were 93% and 47%. There was a significant difference in the median DFS between both groups (Group A : B =12.5 : 6.6 months, P < 0.001). The median OS of Group A was prolonged markedly compared with Group B (20.2 versus 11.9 months, P < 0.005). For OS between both groups, univariate analysis revealed no statistical difference in 69-year-old or under females, and T1-2 factors, moreover, multivariate analysis indicated three factors, such as bi-weekly adjuvant GEM chemotherapy, T2 or less, and R0. CONCLUSIONS: Adjuvant chemotherapy with bi-weekly GEM offered not only the advantage of survival benefits but the excellent compliance with acceptable QOL for postoperative pancreatic cancer patients.


Assuntos
Adenocarcinoma/tratamento farmacológico , Antimetabólitos Antineoplásicos/uso terapêutico , Desoxicitidina/análogos & derivados , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Qualidade de Vida , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desoxicitidina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
10.
Am Surg ; 78(1): 86-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22273321

RESUMO

The aim of this retrospective study was to examine whether various laboratory parameters could predict viability of strangulation in patients with bowel obstruction. Forty patients diagnosed with bowel strangulation were included. We performed operations for all patients within 72 hours of the start of symptoms. Blood samples were obtained from all patients immediately before operation. Arterial blood was examined for pH and lactate levels using a blood gas analyzer. We also evaluated white blood cell count and serum levels of creatine phosphokinase, lactic dehydrogenase, amylase, and C-reactive protein. At surgery, 18 patients had viable strangulation and did not undergo resection, whereas 22 had nonviable strangulation and underwent resection of the necrotic bowel. None of the patients died. Bowel strangulation was caused most commonly by adhesions. In terms of diagnostic efficiency, lactate level was the only laboratory parameter significantly associated with viability (P < 0.01, Mann-Whitney test). Other laboratory data did not show statistically significant associations. These results suggest that arterial blood lactate level (2.0 mmol/L or greater) is a useful predictor of nonviable bowel strangulation.


Assuntos
Obstrução Intestinal/sangue , Obstrução Intestinal/cirurgia , Lactatos/sangue , Idoso , Amilases/sangue , Biomarcadores/sangue , Gasometria , Proteína C-Reativa/metabolismo , Creatina Quinase/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , L-Lactato Desidrogenase/sangue , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Estatísticas não Paramétricas
11.
Hepatogastroenterology ; 58(109): 1368-71, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21937409

RESUMO

BACKGROUND/AIMS: The purpose of this study was to identify basic risk factors for postoperative pancreatic fistula (POPF) after pancreaticojejunostomy. METHODOLOGY: Seventy-one patients underwent pancreaticojejunostomy with duct-to-mucosa anastomosis (DMA). Between POPF group (n=8) and non- POPF group (n=63), the following clinical parameters were compared; pancreatic texture evaluated pathologically with score, diameter of the pancreatic duct, total number of sutures, interval between sutures and the size of suture (5-0 vs. 6-0) for DMA. RESULTS: The mean diameter of the pancreatic duct (POPF/non-POPF) was 3.0±1.4/4.2±2.0mm, total number of sutures for DMA was 6.8±1.6/7.0±2.8, whereas mean interval between sutures was 1.4±0.5/2.1±1.1mm, which failed to achieve significant difference. All cases except one that produced POPF had soft pancreas (p=0.0022). However, for the soft pancreas, the score of pancreatic texture did not achieve significant difference between POPF and non-POPF. 5-0 sutures had less chance of POPF (p=0.0035). As a result of multivariate analysis, suture size and pancreatic texture correlated with POPF. CONCLUSIONS: The suture size and pancreatic texture were risk factors for POPF. Since these factors are related to surgical techniques, gentle handling during pancreaticojejunostomy seems important.


Assuntos
Fístula Pancreática/etiologia , Pancreaticojejunostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/epidemiologia , Fatores de Risco , Suturas
12.
Surg Today ; 41(1): 97-100, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21191698

RESUMO

PURPOSE: Gastrojejunostomy is often performed as palliative surgery for unresectable pancreatobiliary cancer. Modified Devine exclusion (MDE) is a technical variation of gastrojejunostomy, which partially separates the mid-portion of the stomach. We conducted this study to assess whether MDE is necessary for gastrojejunostomy in patients with unresectable pancreatobiliary cancer. METHODS: We compared the postoperative results of MDE (n = 26) with those of conventional gastrojejunostomy (CGJ; n = 20) performed palliatively for unresectable pancreatobiliary cancers. RESULTS: The morbidity rates were 38% after MDE and 50% after CGJ, with 23% and 40% of patients suffering delayed gastric emptying, respectively. Two of the CGJ group patients could never eat again. Modified Devine exclusion slowed the progression of anemia in all of the patients with duodenal bleeding. CONCLUSION: Modified Devine exclusion may be effective for patients with unresectable pancreatobiliary cancer.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Derivação Gástrica/métodos , Cuidados Paliativos , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/patologia , Estudos de Coortes , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Seleção de Pacientes , Estudos Retrospectivos , Resultado do Tratamento
13.
Gan To Kagaku Ryoho ; 37(2): 327-9, 2010 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-20154496

RESUMO

The patient was a 73-year-old woman. Her chief complaints were abdominal pain and lower abdominal distension. After some examinations, we diagnosed pelvic tumor, bladder cancer (adenocarcinoma) and sigmoid colon cancer. We performed a first operation, but the pelvic tumor was firmly fixed anterior to the sacrum and right common pelvic artery. We judged it unresectable and performed tumor biopsy and ileostomy. The pathological findings were very similar to sigmoid colon cancer, so we diagnosed that the pelvic tumor was sigmoid colon cancer with extramural progression. Later, the patient was treated with three courses of FOLFOX4 and three courses of bevacizumab+FOLFOX4. After this chemotherapy, the pelvic tumor was reduced significantly, we considered resection possible and performed pelvic exenteration. She has had no recurrence for 6 months after second operation. This treatment appeared to be effective for unresectable primary colon cancer.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Progressão da Doença , Exenteração Pélvica , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias do Colo Sigmoide/cirurgia , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab , Biópsia , Terapia Combinada , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/uso terapêutico , Humanos , Leucovorina/administração & dosagem , Leucovorina/uso terapêutico , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/uso terapêutico , Indução de Remissão , Neoplasias do Colo Sigmoide/imunologia , Neoplasias do Colo Sigmoide/patologia , Tomografia Computadorizada por Raios X
14.
J Gastrointest Surg ; 12(11): 1995-2000, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18636300

RESUMO

PURPOSE: Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. METHODS: Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). RESULTS: The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. CONCLUSION: Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.


Assuntos
Antibioticoprofilaxia , Colectomia/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Cavidade Abdominal/microbiologia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Estudos de Coortes , Colectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/microbiologia , Neoplasias Retais/patologia , Medição de Risco , Sensibilidade e Especificidade , Neoplasias do Colo Sigmoide/microbiologia , Neoplasias do Colo Sigmoide/patologia , Irrigação Terapêutica/métodos , Resultado do Tratamento
15.
Am J Surg ; 195(1): 115-8, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18070733

RESUMO

BACKGROUND: The use of stapling devices for distal pancreatectomy remains controversial, due to concerns about the development of postoperative pancreatic fistula (POPF) and hemorrhage. METHODS: We report herein the usefulness of the Endo SGIA stapler (Tyco Healthcare, Norwalk, CT) for distal pancreatectomy by placing 2 triple-staggered rows, ie, 6 rows of staples in the pancreatic stump. The pancreas was divided together with both the splenic artery and vein with Endo SGIA in 7 consecutive hand-assisted laparoscopic distal pancreatectomies. RESULTS: No patients developed clinically significant POPF or postoperative hemorrhage. None of the patients had complications that may have influenced the length of hospital stay. CONCLUSION: The 6-row Endo SGIA stapler allows quick and effective prevention of POPF after distal pancreatectomy.


Assuntos
Pancreatectomia/instrumentação , Grampeadores Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grampeamento Cirúrgico
16.
Hepatogastroenterology ; 54(76): 1302-4, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17629094

RESUMO

A 61-year-old male had undergone distal gastrectomy followed by right hepatectomy for alpha-fetoprotein-producing gastric cancer and liver metastasis. Subsequently, multiple lung metastases were detected by follow-up chest examinations. Despite treatment with TS-1/Irinotecan (CPT-11)/Cisplatin (CDDP) combination therapy, the metastases increased gradually in size and number. Combination therapy with TS-1/Paclitaxel (TXL)/CDDP was effective, as confirmed by marked reduction in tumor size on chest computed tomography. TS-1/TXL/CDDP chemotherapy was administered repeatedly for relapse of lung metastases. The relapse was controlled twice with this chemotherapy regimen, and the patient remains alive at 52 months after gastrectomy without pulmonary symptoms such as hemosputum. Although patients with postoperative lung metastases from AFP-producing gastric cancer have a dismal prognosis, our clinical experience suggests that TS-1/TXL/CDDP combination therapy may be a useful regimen for such conditions.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Neoplasias Gástricas/patologia , alfa-Fetoproteínas/metabolismo , Cisplatino/administração & dosagem , Combinação de Medicamentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ácido Oxônico/administração & dosagem , Paclitaxel/administração & dosagem , Tegafur/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , alfa-Fetoproteínas/análise
17.
Surg Endosc ; 21(8): 1446-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17593462

RESUMO

BACKGROUND: Although the clinical benefits of hand-assisted laparoscopic surgery have been shown in several procedures including colorectal resection, splenectomy and gastrectomy, efficacy and invasiveness in pancreatic surgery have not been well investigated. We assessed the clinical benefits and invasiveness of hand-assisted laparoscopic distal pancreatectomy (HALS-DP) in relation to the occurrence of post-operative systemic inflammatory response syndrome (SIRS). METHODS: Subjects comprised 8 patients underwent HALS-DP (with splenectomy, n = 7; without splenectomy, n = 1) for benign or low malignant pancreatic lesions between March 2004 and December 2005. Indications for HALS-DP consisted of mucinous cystadenoma (n = 4), endocrine tumors (n = 2), serous cystadenoma (n = 1) and pancreatic pseudocyst (n = 1). Controls comprised 9 patients who underwent conventional open distal pancreatectomy (Open-DP) for benign or low malignant lesions of the pancreas in the same period. RESULTS: No significant differences were identified between HALS-DP and Open-DP in operation time. However, intra-operative blood loss, CRP on post-operative day (POD) 1 [5.5 mg/dl (1.8-8.1) vs. 9.7 mg/dl (5.9-12.1); p = .006] and POD 3 [8.5 mg/dl (1.7-11.1) vs. 17.7 mg/dl (10.7-21.5); p = .003], occurrence of post-operative SIRS (13% vs. 67%; p < .05, one-sided), duration of SIRS [0 day (0-1) vs. 1 day (0-4); p = .02] and post-operative hospital stay were significantly lower in HALS-DP than in Open-DP. Furthermore, no pancreatic fistula was seen with HALS-DP, as compared to 2 (22%) with Open-DP. CONCLUSION: HALS-DP is safer and less invasive than Open-DP for benign or low malignant pancreatic tumors.


Assuntos
Laparoscopia/efeitos adversos , Pancreatectomia/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia
18.
Surg Endosc ; 21(11): 2034-8, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17404792

RESUMO

BACKGROUND: Although percutaneous endoscopic gastrostomy (PEG) has become popular for patients with swallowing disorders as a nutrition support or a decompressant of gastrointestine, perioperative complications associated with PEG have not decreased, especially peristomal infections. To reduce peristomal infections, we designed a new method of gastrostomy by extracorporeal approach under endoscopic observation, named as extra-corporeal PEG (E-PEG). METHODS: Experimental studies for E-PEG were performed repeatedly using pigs under general anesthesia to confirm the safety of its procedure for human use. After approval of institutional ethics review board in our university, thirty patients with prior consent participated in this study. The operation time, the incidence rate of complications and the hospital stay were compared between E-PEG and ordinary pull-method PEG groups. RESULTS: Two patients (6.7%) in E-PEG group had postoperative complications, i.e., aspiration pneumonia and surgical site infection. The operation time of E-PEG group was 5-16 (mean +/- SD: 10.3 +/- 2.96) min as compared to 14-37 (mean +/- SD: 26.9 +/- 8.39) min with pull-method PEG. The postoperative hospital day of E-PEG was within two days except for the two complicated cases. Significance differences of operation time, complication rate and postoperative hospital stay between those groups observed statistically. CONCLUSIONS: These results indicate that E-PEG was safe, tolerable and speedy when compared ordinary pull-method PEG.


Assuntos
Transtornos de Deglutição/cirurgia , Endoscopia Gastrointestinal/métodos , Gastrostomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscópios Gastrointestinais , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Gastrostomia/instrumentação , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
19.
J Hepatobiliary Pancreat Surg ; 13(4): 317-22, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16858543

RESUMO

BACKGROUND/PURPOSE: We provide an initial report of the indications and procedure for three-port laparoscopic partial hepatectomy. METHODS: Three-port laparoscopic partial hepatectomy was performed in nine patients (age, 49 to 73 years) at our department. Eight patients (seven men and one woman) had hepatocellular carcinoma (HCC); six of these patients had liver cirrhosis (LC) and two had chronic hepatitis (CH). The ninth patient, a woman had a single metastatic liver tumor from colon cancer. The tumors were located in regons S(2), S(3), S(4), S(5), S(6), and S(8). Preoperative liver function assessment revealed Child-Pugh classification A or B. All the tumors were located superficially, and their diameter averaged approximately 3 cm. Hepatectomy was performed laparoscopically, using an ultrasonically activated device (USAD) with or without microwave coagulation therapy (MCT). RESULTS: The operative time was 50 to 168 min, and the intraoperative blood loss ranged from 32 to 158 g. The postoperative hospital stay was 5 to 17 days. No recurrences, including local relapse, were observed. CONCLUSIONS: Three-port laparoscopic partial hepatectomy is safe and feasible for patients with Child-Pugh liver function classification A or B if the tumor is located superficially and is less than 3 cm in diameter.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade
20.
Breast Cancer ; 12(3): 231-3, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16110295

RESUMO

We report a rare case of a huge cavernous hemangioma arising in a male breast. A 60-year-old man first noticed 1 x 2 cm elastic hard nodule just below his right nipple ten years previously. It enlarged 5 x 5 cm over six years. When he came to our clinic, it was size of child head (510 mm in circumference),was an elastic hard with a rather smooth surface, and firmly fixed to the chest wall. Magnetic resonance imaging (MRI) and multidetectocomputed tomography (MDCT)showed a large mass infiltrating into the chest wall. Fine needle aspiration cytology (FNA) and core needle biopsy (CNB) failed to obtain proper material except for old bloody fluid or necrotic connective tissue, precluding a correct diagnosis preoperatively. Mastectomy with partial resection of the chest wall was subsequently performed. Histologically, it was found to be a cavernous hemangioma without cellular atypia. In such a case, complete excision is recommended to exclude the possibility of an underlying malignant lesion.


Assuntos
Neoplasias da Mama Masculina/diagnóstico , Hemangioma Cavernoso/diagnóstico , Biópsia por Agulha , Neoplasias da Mama Masculina/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Mastectomia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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