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Some patients with refractory esophagogastric varices require surgery, such as gastric devascularization and splenectomy (Hassab's procedure). However, these patients are at risk of perioperative morbidities when undergoing devascularization to develop collateral vessels. We performed a more simplified procedure, splenectomy, and en bloc gastropancreatic fold division (GPFD) with hand-assisted laparoscopic surgery. Four patients with refractory esophagogastric varices and portal hypertension underwent splenectomy and GPFD. We reviewed patients' perioperative laboratory and morphological data, operative variables, and postoperative outcomes. Esophagogastric varices improved in 3 (75%) of the 4 patients. In one patient, esophageal varices (F1RC0) were observed 3 years after surgery, but they required no treatment and only received follow-up. Treatment with splenectomy and GPFD is not only less invasive than Hassab's procedure but also provides effective outcomes for refractory esophagogastric varices.
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BACKGROUND: The role of preoperative neoadjuvant chemotherapy (NAC) in patients with resectable colorectal liver metastases (CRLM) remains undetermined. This study aimed to assess the efficacy of NAC in patients with resectable CRLM, especially in high-risk subgroups for recurrence, with special reference to synchronicity and the CRLM grade in the Japanese classification system. METHODS: A retrospective analysis of a multi-institutional cohort who was diagnosed with resectable CRLM was performed. CRLM was classified into three grades (A, B, and C) according to the combination of H stage (H1: ≤ 4 lesions and ≤ 5 cm, H2: ≥ 5 lesions or > 5 cm, H3: ≥ 5 lesions and > 5 cm), nodal status of the primary tumor (pN0/1: ≤ 3 metastases, pN2: ≥ 4 metastases), and the presence of resectable extrahepatic metastases. RESULTS: Among 222 patients with resectable CRLM, 97 (43.7%) had synchronous CRLM. The surgical failure-free survival (SF-FS) of patients with synchronous CRLM (without NAC) was significantly worse than that of patients with metachronous CRLM (P = 0.0264). The SF-FS of patients with Grade B/C was also significantly worse than that of Grade A (P = 0.0058). Among the 53 patients with synchronous and Grade B/C CRLM, 31 were assigned to NAC, and all of them underwent liver surgery. In this high-risk subgroup, the SF-FS and OS in the NAC group were significantly better than those in the upfront surgery group (P < 0.0001 and P = 0.0004, respectively). CONCLUSIONS: Patients with synchronous and Grade B/C CRLM could be good candidates for indication of NAC.
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Neoplasias Colorretais , Neoplasias Hepáticas , Quimioterapia Adjuvante , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Terapia Neoadjuvante , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: The necessity of surgical treatment of liver metastases of gastric cancer is still controversial. PATIENTS AND METHODS: We conducted a multicenter retrospective cohort study of liver-limited metastasis of gastric cancer treated surgically between 2000 and 2010. In this study, 103 patients were registered, with nine patients excluded from the analysis as they did not meet the eligibility criteria. RESULTS: Of the 94 patients, 69 underwent surgical resection, 11 underwent surgical resection combined with radiofrequency ablation or microwave coagulation therapy for small or deep tumors, and 14 underwent radiofrequency ablation or microwave coagulation therapy only. Synchronous and metachronous metastases were found in 37 and 57 patients, respectively. The 3- and 5-year overall survival rates of all the patients were 51.4 and 42.3 %, respectively. The 3- and 5-year relapse-free survival rates were 29.2 and 27.7 %, respectively. No significant difference in prognosis was observed between the patients who underwent surgical resection and those who underwent ablation therapy. The patients with hepatic solitary lesions and low-grade lymph node metastases of primary gastric cancer had significantly better overall survival and relapse-free survival. CONCLUSIONS: To our knowledge, this study is the largest series and first multicenter cohort study of liver-limited metastasis of gastric cancer. The study indicated that patients with a single liver metastasis with a grade lower than N2 lymph node metastasis of the primary lesion are the best candidates for liver resection.
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Ablação por Cateter/métodos , Gastrectomia/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Metástase Linfática , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de SobrevidaRESUMO
OBJECTIVES: The purpose of this phase II study was to explore the efficacy and safety of an alternating regimen consisting of folinic acid, 5-fluorouracil (5-FU) and oxaliplatin (mFOLFOX6) plus bevacizumab, and folinic acid, 5-FU and irinotecan (FOLFIRI) plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer. METHODS: Fifty-two patients with metastatic colorectal cancer received an alternating regimen consisting of four cycles of mFOLFOX6 plus bevacizumab followed by four cycles of FOLFIRI plus bevacizumab until disease progression. The primary endpoint was progression-free survival. RESULTS: The median age was 60 years (range 37-75 years). Median progression-free survival was 14.2 months (95 % confidence interval [CI] 10.6-16.3) and median overall survival was 28.4 months (95 % CI 22.6-39.1). The overall response rate was 60.0 % (95 % CI 45.2-73.6). Regarding toxicity, the commonest grade 3-4 hematological adverse events were neutropenia (34.6 %) and leukopenia (7.7 %), and the commonest grade 3-4 non-hematological adverse events were anorexia (13.5 %), fatigue (9.6 %), nausea (9.6 %), and vomiting (9.6 %). Bevacizumab-related grade 3-4 adverse events included hypertension (1.9 %) and thrombosis (1.9 %). CONCLUSIONS: An alternating regimen consisting of mFOLFOX6 plus bevacizumab and FOLFIRI plus bevacizumab is an effective and well-tolerated first-line chemotherapy combination for patients with metastatic colorectal cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Adulto , Idoso , Anorexia/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/administração & dosagem , Bevacizumab/efeitos adversos , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Fadiga/induzido quimicamente , Feminino , Fluoruracila/administração & dosagem , Humanos , Hipertensão/induzido quimicamente , Leucovorina/administração & dosagem , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Neutropenia/induzido quimicamente , Compostos Organoplatínicos/administração & dosagem , Taxa de Sobrevida , Trombose/induzido quimicamente , Vômito/induzido quimicamenteRESUMO
BACKGROUND: The Kyushu Study Group of Clinical Cancer (KSCC) conducted phase II trials of KSCC1002 (UMIN000001308) concerning liver resectability after first-line treatment of initially unresectable or not optimally resectable colorectal liver metastases in a prospective, multicenter study. METHODS: Patients with wild-type KRAS received 4-6 cycles of S-1 and oxaliplatin (SOX) plus cetuximab. Liver resectability was evaluated subsequently with the liver resection rate as the primary endpoint. RESULTS: Of the 33 patients enrolled between March 2010 and July 2013, the median number of administration cycles was 4 (range 0-10). The overall response rate was 63.6 % (95 % confidence interval [CI] 45.1-79.6 %). Liver resection was possible in 16 of 33 (48.5 %) patients, and there were 13 R0 cases (39.4 %). We conducted a central review of liver resectability evaluated by five liver surgeons, and the resectability increased from 18.2 to 66.7 % after chemotherapy, based on imaging. The median overall survival for all 33 cases was 31.6 months (95 % CI 14.8-not reached). The median progression-free survival was 9.7 months (95 % CI 6.2-11.8). CONCLUSIONS: SOX plus cetuximab is safe and effective for advanced colorectal cancer with limited liver metastasis, and may lead to high liver resectability.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Cetuximab/administração & dosagem , Neoplasias Colorretais/patologia , Combinação de Medicamentos , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Ácido Oxônico/administração & dosagem , Prognóstico , Taxa de Sobrevida , Tegafur/administração & dosagemRESUMO
We report a case of repeat hepatectomies for hepatic malignant lymphoma and hepatocellular carcinoma (HCC). A 75-year-old man with chronic hepatitis C underwent partial hepatectomy for a 25 mm hepatic tumor in S5. The histological diagnosis was diffuse large B-cell malignant lymphoma and as postoperative (18)F-fluorodeoxyglucose-positron emission tomography showed no hot spots, the mass was presumed to be primary hepatic lymphoma. Thus, adjuvant systemic chemotherapy was given following the hepatectomy. Abdominal ultrasonography, done 12 months after the hepatectomy, showed a hepatic tumor in S6 and repeat partial hepatectomy was performed. This tumor was histologically diagnosed as HCC.
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Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Hepatite C Crônica/complicações , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/cirurgia , Linfoma Difuso de Grandes Células B/etiologia , Linfoma Difuso de Grandes Células B/cirurgia , Neoplasias Primárias Múltiplas/etiologia , Neoplasias Primárias Múltiplas/cirurgia , Idoso , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Diagnóstico por Imagem , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Reoperação , Resultado do TratamentoRESUMO
AIM: A sustained virological response (SVR) to interferon (IFN) therapy for chronic hepatitis C decreases but does not eliminate the risk of hepatocellular carcinoma (HCC). The significance of hepatectomy for HCC in patients with SVR has not been clarified. The short- and long-term outcomes of hepatectomy for HCC in patients with SVR were studied. METHODS: From 2006-2011, 69 patients with chronic hepatitis C underwent hepatic resection for primary HCC in our hospital. Of these, 12 patients (17.4%) had SVR to IFN therapy at the time of hepatectomy. The clinicopathological factors and long-term outcomes of these patients were retrospectively reviewed and were compared with those of patients without SVR. RESULTS: The mean time from achievement of SVR to diagnosis of HCC was 62 months (range, 7-174). The histological inflammation of liver parenchyma had improved after IFN therapy in SVR cases. The preoperative serum alanine transaminase, albumin and prothrombin time were significantly preserved in patients with SVR. Intraoperative blood loss and blood transfusion rate were lower, and recurrence-free survival rate was significantly higher, in patients with SVR. CONCLUSION: In patients undergoing hepatectomy for HCC, those with SVR had better perioperative safety and a more favorable long-term prognosis than those without SVR.
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BACKGROUND/AIMS: To identify the risk factors for postoperative biliary complications after hepatic resection for hepatocellular carcinoma. METHODOLOGY: The subjects were 123 patients who underwent hepatic resection for hepatocellular carcinoma between January 2006 and December 2010. Perioperative factors related to postoperative bile leakage were studied. RESULTS: Postoperative bile leakage occurred in eight (6.5%) of the patients. Univariate analysis showed that liver fibrosis or cirrhosis (p=0.007), long operation time (>5 hours) (p=0.002), major hepatic resection (p=0.024) and hepatectomy including Couinaud's segment 4 (p=0.0078) or segment 5 (p=0.023) were associated with an incidence of bile leakage. From multivariate analysis, operation time (relative risk=6.10, p=0.026) or resection of segment 4 (relative risk=6.86, p=0.017) were found to be independent risk factors for bile leakage. CONCLUSIONS: Prolonged operation time and hepatectomy including segment 4 led to a high risk for postoperative bile leakage in this series of patients.
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Fístula Anastomótica/etiologia , Doenças Biliares/etiologia , Carcinoma Hepatocelular/cirurgia , Hepatectomia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
A 74-year-old noncirrhotic woman presented with abdominal distension and pain in the right hypochondrium. Contrast-enhanced computed tomography (CT) demonstrated multiple large simple liver cysts occupying the right lobe of the liver, the largest of which was 19 cm in diameter. Gastric varices were enhanced in the fundus of the stomach. The patient underwent surgery to deroof the hepatic cysts with ablation using argon beam coagulation. Esophagogastroduodenoscopy (EGD) showed that the portal hypertensive gastropathy was ameliorated after the operation; however, the fundal varices were only slightly decreased. After the operation, we observed that the hepatic vein waveform gradually changed from a gently curved pattern to a normal triphasic pattern. We treated the fundal varices with balloon-occluded retrograde transvenous obliteration 3 months after the initial operation. We describe our successful treatment of this rare case and discuss the utility of hepatic vein waveform analysis in the study of portal hypertension.
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Cistos/complicações , Cistos/cirurgia , Varizes Esofágicas e Gástricas/etiologia , Varizes Esofágicas e Gástricas/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Idoso , Coagulação com Plasma de Argônio/métodos , Oclusão com Balão/métodos , Cistos/diagnóstico , Cistos/diagnóstico por imagem , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/diagnóstico , Feminino , Fundo Gástrico , Humanos , Hepatopatias/diagnóstico , Hepatopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Venous thromboembolism is a relatively rare but serious complication of abdominal surgery. This study evaluated the incidence and risk factors for the development of deep venous thrombosis (DVT) after abdominal oncologic surgery using color Doppler ultrasonography (DUS). METHODS: This study enrolled 132 consecutive patients who underwent elective abdominal surgery for malignant tumors. Patients were investigated for DVT using DUS on postoperative day 7 ± 2. Correlations between the incidence of DVT and clinicopathologic parameters and the postoperative course were evaluated. RESULTS: DVT was found in 15 patients (11.4%) using DUS. Clinically evident venous thromboembolism, including pulmonary embolism, was not found in these patients. The incidence of DVT was significantly higher in females (P=0.002), patients with a lower body mass index (P=0.008), and patients with a higher preoperative D-dimer level (P<0.0001). CONCLUSIONS: DUS is noninvasive and is useful for postoperative DVT screening. Thromboprophylaxis is essential in high-risk patients who have undergone abdominal oncologic surgery.
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Neoplasias Abdominais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ultrassonografia Doppler/métodos , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologiaRESUMO
PURPOSES: Delayed gastric emptying (DGE) after hepatectomy affects the quality of life of patients, although the causes and related conditions have not been investigated. This study evaluated the relationship between hepatectomy and DGE by the objective assessment of gastric emptying (GE). METHODS: Nineteen patients who underwent major hepatectomy were prospectively enrolled in the study. Their GE was studied using the (13)C-acetic acid breath test before and after hepatectomy. The results of the GE analysis were correlated with the postoperative course after hepatectomy. RESULTS: Clinically evident DGE, which was defined as the inability to take in an appropriate amount of solid food orally by postoperative day 14, was not found in these patients, but the gastric half-emptying times before and after hepatectomy were 20.2 ± 9.7 and 28.6 ± 12.2 min, respectively (P = 0.01). The GE time was significantly delayed in patients aged ≥ 41 years, or who underwent right hemihepatectomy. CONCLUSIONS: Gastric emptying was significantly inhibited in patients who underwent major hepatectomy, and aging and a right-sided hemihepatectomy may be related to the development of DGE.
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Ácido Acético , Testes Respiratórios/métodos , Esvaziamento Gástrico , Hepatectomia/efeitos adversos , Adulto , Idoso , Radioisótopos de Carbono , Estudos de Coortes , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/etiologia , Feminino , Hepatectomia/métodos , Humanos , Laparotomia/efeitos adversos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: We evaluated the invasiveness of videothoracoscopy-assisted mini-posterolateral thoracotomy (VAmPLT) for non-small cell lung cancer (NSCLC). METHODS: This study prospectively analyzed 50 NSCLC patients who underwent VAmPLT lobectomy. We measured maximal negative inspiratory pressure (PImax), maximal positive expiratory pressure (PEmax), quadriceps strength (QS), 6-min walk test (6mWT), and postoperative pain during the perioperative period. We then compared the results of the 6mWT and the postoperative pain of the VAmPLT lobectomy patients with those of a control group of 50 NSCLC patients who underwent standard posterolateral thoracotomy (PLT) techniques just prior to implementation of the VAmPLT lobectomy. RESULTS: The PImax and PEmax at the baseline, then on postoperative days (PODs) 1, 7, and 14 were 125% ± 5% and 120% ± 4%, 69% ± 4% and 62% ± 4%, 115% ± 5% and 100% ± 4%, and 123% ± 4%, and 110% ± 4%, respectively. The QS at the baseline, then on PODs 7 and 14 was 138% ± 5%, 129% ± 6%, and 133% ± 5%, respectively. Improvement from the baseline was seen in PImax by POD 7, and in PEmax and QS by POD 14. The 6mWT results and the level of postoperative pain after VAmPLT lobectomy were superior to those after PLT. CONCLUSIONS: The advantages of VAmPLT lobectomy over PLT include less postoperative pain and earlier recovery of physical function.
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Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Período Pós-Operatório , Estudos Prospectivos , Estatística como Assunto , Cirurgia Torácica Vídeoassistida/instrumentação , Toracotomia/instrumentação , Fatores de TempoRESUMO
A 67-year-old woman with bloody stools underwent esophagogastroduodenoscopy and colonoscopy, which revealed the presence of a submucosal tumor in the stomach and an adenocarcinoma in the ascending colon. Preoperative screening disclosed an additional 10-cm tumor in the abdomen between the gastric and colonic lesions. Single-balloon enteroscopy was therefore performed. A nonstenotic, circumferential, bleeding ulcerative lesion was found in the jejunum, and the biopsy revealed malignant lymphoma (ML). A partial resection of the small intestine, ascending colectomy, and wedge resection of the stomach were performed, then systemic chemotherapy for ML was started 2 weeks after surgery. Triple gastrointestinal malignant tumors with different histologies are extremely rare, and have not been previously reported. Single-balloon enteroscopy in this case led to a definite diagnosis by biopsy, thus allowing the patient to receive chemotherapy as soon as possible after surgery.
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Adenocarcinoma/diagnóstico , Enteroscopia de Duplo Balão/instrumentação , Neoplasias Gastrointestinais/diagnóstico , Melanoma/diagnóstico , Cuidados Pré-Operatórios , Neoplasias Cutâneas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Colectomia , Colonoscopia , Endoscopia do Sistema Digestório , Feminino , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Intestino Delgado/cirurgia , Melanoma/patologia , Melanoma/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
PURPOSE: This multicenter phase II study was designed to determine the efficacy and tolerability of oxaliplatin in combination with levofolinate and infusion 5-fluorouracil (FOLFOX4) as first-line therapy for Japanese patients with unresectable metastatic colorectal cancer. METHODS: Sixty consecutive patients with histologically confirmed advanced or metastatic colorectal cancer were enrolled in the study. Treatment was repeated every 2 weeks until disease progression or unacceptable toxicity occurred. RESULTS: Two patients were ineligible. Toxicity was evaluated in 60 patients, who had received a part or all of the protocol therapy. A partial response was observed in 20 patients. The overall response rate was 34.5% (95% CI, 22.5%-48.1%) and the tumor control rate (partial response + stable disease) was 82.8%. The median progression-free survival was 6.9 months (95% CI, 5.1-9.8 months), and the median overall survival was 31.5 months (95% CI, 18.1-40.1 months). There were no toxicity-related deaths. Grade 3 or 4 neutropenia occurred in 48.3% of patients and often caused a delay in the subsequent treatment course. Mild to moderate cumulative peripheral sensory neuropathy affected 71.7% of patients. CONCLUSION: The results showed good tolerability and efficacy for first-line FOLFOX4 in the treatment of patients with advanced colorectal cancer, indicating the promise of this regimen as first-line therapy for advanced colorectal cancer in the Japanese population.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Relação Dose-Resposta a Droga , Feminino , Fluoruracila/uso terapêutico , Humanos , Japão , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Compostos Organoplatínicos/uso terapêutico , Estudos ProspectivosRESUMO
Primary hepatic neuroendocrine carcinoma is an extremely rare liver tumor. We herein report a case of primary hepatic neuroendocrine carcinoma coexisting with a hemangioma in a 66-year-old man. Ultrasonography, computed tomography, and magnetic resonance imaging showed a tumor (1.5 cm in diameter) coexisting with a hemangioma in the lateral segment of the liver. Liver biopsy showed malignant cells, and several examinations revealed no alternative primary source. We performed a lateral segmentectomy. Microscopically, the tumor cells had round to oval nuclei and eosinophilic cytoplasm, proliferated in thick trabeculae or solid nests, and formed a focal rosette pattern. Mitotic cells were frequently observed. Immunohistochemically, the tumor cells were positive for the endocrine markers chromogranin A, neuron-specific enolase, and neural cell adhesion molecule, but negative for alpha-fetoprotein and hepatocyte-specific antigen. The patient is still alive after 3 months, without recurrence.
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Carcinoma Neuroendócrino/patologia , Hemangioma/patologia , Neoplasias Hepáticas/patologia , Segunda Neoplasia Primária/patologia , Carcinoma Neuroendócrino/diagnóstico por imagem , Diagnóstico Diferencial , Hemangioma/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico por imagem , Radiografia , Resultado do TratamentoRESUMO
Hepatic resection is the most curative treatment for the patient with hepatocellular carcinoma (HCC) which occurs in the non-cirrhotic liver. It is not common, but extracorporeal hepatic resection (EHR) is sometimes considered as the treatment of otherwise unresectable tumors due to the location, size, and vascular invasion of the tumor. In the EHR, the liver is completely removed and perfused with the preservation solution. Bloodless transection of hepatic parenchyma is done, and reimplanted in the patient. Preoperative assessment of the vascular anatomy and liver volume, advanced surgical technique of hepatic resection and transplantation, and experienced postoperative care are essential to the accomplishment of EHR. In this issue, we give an outline of the indication, procedures, and the problems of EHR.
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Hepatectomia/métodos , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Transplante AutólogoRESUMO
PURPOSE: Patient-controlled epidural analgesia (PCEA) was developed for use after surgery for thoracic esophageal cancer to relieve wound pain, introduce early rehabilitation, and provide an uneventful postoperative recovery. METHODS: This retrospective study investigated 22 patients who underwent esophageal surgery to determine the efficacy of postoperative management with PCEA. In the PCEA group (n = 12), patients had two epidural catheters inserted to cover both the thoracic and abdominal incision with a patient-controlled bolus capability. RESULTS: Postoperative mechanical ventilation was administered in all cases in the control group (n = 10). On the other hand, this was only necessary in two patients in the PCEA group. The amount of time the patients stayed in the intensive care unit and the hospital was significantly shorter in the PCEA group than in the control group (P < 0.001 and P < 0.01, respectively). Respiratory complications occurred in four patients in the control group, and none in the PCEA group. The mean number of supplemental analgesics administered for breakthrough pain until the 7th postoperative day was 5.5 in the control group, and 1.3 in the PCEA group (P < 0.001). CONCLUSIONS: Early rehabilitation is facilitated with intensive PCEA, while it also improves postoperative management and reduces hospitalization after esophageal surgery.
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Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/reabilitação , Idoso , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Estudos de Casos e Controles , Feminino , Fentanila/administração & dosagem , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Morfina/administração & dosagem , Medição da Dor , Pentazocina/administração & dosagem , Complicações Pós-Operatórias , Respiração Artificial , Estudos RetrospectivosRESUMO
Skin metastasis from gastric cancer is rare. We report a case of gluteal skin metastasis from gastric cancer. A 74-year-old woman underwent curative gastrectomy for advanced gastric cancer. Thirty-six months after surgery, follow-up abdominal computed tomography showed a subcutaneous gluteal tumor, and surgical extirpation was performed. Histopathologic examination of the resected tumor revealed poorly differentiated adenocarcinoma, coinciding with the histopathologic diagnosis of the resected gastric cancer. Further systemic evaluation revealed a lung metastasis and left supraclavicular lymph node metastasis. The patient was treated with chemotherapeutic reagents. However, she died of the disease 9 months after the diagnosis of skin metastasis. We reviewed the cases of 50 Japanese patients with skin metastasis from gastric cancer and analyzed the clinicopathologic features.
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Adenocarcinoma/patologia , Neoplasias Cutâneas/secundário , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Nádegas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
BACKGROUND/AIMS: Major surgery in patients on maintenance hemodialysis is associated with an increased incidence of postoperative complications. We conducted the retrospective study to identify risk factors for morbidity and mortality after abdominal surgery in hemodialysis patients. METHODOLOGY: Subjects were 28 consecutive patients on maintenance hemodialysis who underwent abdominal surgery for gastrointestinal disease. They were classified into two groups according to the presence (n = 11) or absence (n = 17) of postoperative complications. Clinical, laboratory, and operative data were obtained from medical records and compared between the two groups. RESULTS: Overall morbidity and mortality rates were 39% (11/28) and 14% (4/28), respectively. The most frequent morbidity was wound complication (6/28). There were statistically significant differences between the patients with and without postoperative complications in the blood urea nitrogen concentration (41.6 vs. 27.5 mg/dL, P < 0.05), total protein level (5.8 vs. 6.9 g/dL, P < 0.01), and hematocrit level (25.7 us. 31.1%, P < 0.05). There were four hospital deaths. All four patients underwent emergency surgery for perforation of the gastrointestinal tract. CONCLUSIONS: A poor surgical outcome after abdominal surgery in patients on maintenance hemodialysis was associated with a high concentration of blood urea nitrogen, hypoproteinemia, severe anemia, and emergency surgery. These factors should be considered in the perioperative management of chronic hemodialysis patients undergoing abdominal surgery.