Pub Date : 2021-04-01DOI: 10.9738/intsurg-d-18-00018.1
S. Komatsu, M. Kido, Motofumi Tanaka, H. Kinoshita, D. Tsugawa, M. Awazu, H. Gon, H. Toyama, K. Ueno, T. Ajiki, Y. Fujino, M. Tominaga, T. Fukumoto
The prognostic impact of intrahepatic recurrence pattern and/or operative procedure (anatomical resection [AR] and nonanatomical resection [NAR]) for hepatocellular carcinoma (HCC) in patients with postoperatively proven portal vein tumor thrombus on histology has not yet been clearly examined. A total of 52 HCC patients who had no visible macroscopic vascular invasion preoperatively and histologically proven portal vein tumor thrombus distal to second-order portal branches after surgery were analyzed. The overall survival and disease-free survival rates were analyzed using the Kaplan-Meier method. The risk factors for intrahepatic recurrence and distant metastasis were analyzed using the log-rank test. There was no significant difference in the overall survival rates at 5 years, based on the operative procedure. The disease-free survival rates at 3 years were 59.2% (AR group) and 30.1% (NAR group), respectively, and were statistically significant. Intrahepatic recurrence in the same remnant segment was seen in 5 patients undergoing NAR. These cases developed multiple bilobar recurrences simultaneously, including the same segment, and recurrence only in the same remnant segment was not seen in any case, irrespective of solitary or multiple recurrence. Intrahepatic recurrence in the same remnant segment does not influence the disease-free survival rate in patients after NAR. Although AR would be an ideal procedure, the current study suggests NAR can achieve identical outcomes for patients who cannot be considered for AR.
{"title":"Impact on Prognosis Following Nonanatomical Resection of Hepatocellular Carcinoma Postoperatively Proven as Micro Portal Vein Tumor Thrombus on Histology","authors":"S. Komatsu, M. Kido, Motofumi Tanaka, H. Kinoshita, D. Tsugawa, M. Awazu, H. Gon, H. Toyama, K. Ueno, T. Ajiki, Y. Fujino, M. Tominaga, T. Fukumoto","doi":"10.9738/intsurg-d-18-00018.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-18-00018.1","url":null,"abstract":"\u0000 \u0000 The prognostic impact of intrahepatic recurrence pattern and/or operative procedure (anatomical resection [AR] and nonanatomical resection [NAR]) for hepatocellular carcinoma (HCC) in patients with postoperatively proven portal vein tumor thrombus on histology has not yet been clearly examined.\u0000 \u0000 \u0000 \u0000 A total of 52 HCC patients who had no visible macroscopic vascular invasion preoperatively and histologically proven portal vein tumor thrombus distal to second-order portal branches after surgery were analyzed.\u0000 \u0000 \u0000 \u0000 The overall survival and disease-free survival rates were analyzed using the Kaplan-Meier method. The risk factors for intrahepatic recurrence and distant metastasis were analyzed using the log-rank test.\u0000 \u0000 \u0000 \u0000 There was no significant difference in the overall survival rates at 5 years, based on the operative procedure. The disease-free survival rates at 3 years were 59.2% (AR group) and 30.1% (NAR group), respectively, and were statistically significant. Intrahepatic recurrence in the same remnant segment was seen in 5 patients undergoing NAR. These cases developed multiple bilobar recurrences simultaneously, including the same segment, and recurrence only in the same remnant segment was not seen in any case, irrespective of solitary or multiple recurrence.\u0000 \u0000 \u0000 \u0000 Intrahepatic recurrence in the same remnant segment does not influence the disease-free survival rate in patients after NAR. Although AR would be an ideal procedure, the current study suggests NAR can achieve identical outcomes for patients who cannot be considered for AR.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49475486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.9738/intsurg-d-21-00020.1
B. Park, Sung Hwan Cho, H. Jung, G. Son, H. S. Kim
Despite the advances in surgical techniques, Hartmann's reversal is often considered a difficult procedure, and the stoma cannot be restored in up to 40% of the cases. We report a patient with a challenging case of severe dense adhesions and a short rectal stump who recovered successfully after undergoing Hartmann's reversal through rectal mucosectomy and transanal hand-sewn anastomosis. A 39-year-old man had multiple bowel injuries, including rectum, bladder, and ureter laceration, due to a stab wound. He underwent Hartmann's procedure with a short rectal stump. One year and 9 months later, Hartmann's reversal was performed. In the operative field, severe dense adhesions were observed in the pelvic cavity. Therefore, complications, including fistula, were likely to occur. Thus, we minimized the dissection around the rectal stump and avoided stapled anastomosis. Proctotomy was performed behind the rectal stump, and the proximal colon was inserted into the rectum. Rectal mucosectomy was performed for the rectum above the expected anastomosis site. Colorectal hand-sewn anastomosis was performed on the rectum, 3 cm from the anal verge. The patient recovered well after the surgery, and has remained healthy, without any discomfort, except for frequent defecation. Rectal mucosectomy and transanal hand-sewn anastomosis were performed in a complex case of Hartmann's reversal, resulting in the patient's successful recovery without complications. This study recommends the preceding surgical technique for similar cases.
{"title":"Hartmann's Reversal Through Transanal Hand-Sewn Anastomosis With Rectal Mucosectomy for a Challenging Case: Case Report","authors":"B. Park, Sung Hwan Cho, H. Jung, G. Son, H. S. Kim","doi":"10.9738/intsurg-d-21-00020.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00020.1","url":null,"abstract":"\u0000 \u0000 Despite the advances in surgical techniques, Hartmann's reversal is often considered a difficult procedure, and the stoma cannot be restored in up to 40% of the cases. We report a patient with a challenging case of severe dense adhesions and a short rectal stump who recovered successfully after undergoing Hartmann's reversal through rectal mucosectomy and transanal hand-sewn anastomosis.\u0000 \u0000 \u0000 \u0000 A 39-year-old man had multiple bowel injuries, including rectum, bladder, and ureter laceration, due to a stab wound. He underwent Hartmann's procedure with a short rectal stump. One year and 9 months later, Hartmann's reversal was performed. In the operative field, severe dense adhesions were observed in the pelvic cavity. Therefore, complications, including fistula, were likely to occur. Thus, we minimized the dissection around the rectal stump and avoided stapled anastomosis. Proctotomy was performed behind the rectal stump, and the proximal colon was inserted into the rectum. Rectal mucosectomy was performed for the rectum above the expected anastomosis site. Colorectal hand-sewn anastomosis was performed on the rectum, 3 cm from the anal verge. The patient recovered well after the surgery, and has remained healthy, without any discomfort, except for frequent defecation.\u0000 \u0000 \u0000 \u0000 Rectal mucosectomy and transanal hand-sewn anastomosis were performed in a complex case of Hartmann's reversal, resulting in the patient's successful recovery without complications. This study recommends the preceding surgical technique for similar cases.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44992972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-30DOI: 10.9738/INTSURG-D-20-00041.1
A. Nanashima, N. Imamura, M. Hiyoshi, K. Yano, T. Hamada, T. Nishida, Daichi Sakurahara, R. Sakamoto, Yukako Uchise, T. Wada, Kenzo Nagatomo
Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p<0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.
{"title":"Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy","authors":"A. Nanashima, N. Imamura, M. Hiyoshi, K. Yano, T. Hamada, T. Nishida, Daichi Sakurahara, R. Sakamoto, Yukako Uchise, T. Wada, Kenzo Nagatomo","doi":"10.9738/INTSURG-D-20-00041.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00041.1","url":null,"abstract":"Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p<0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45733023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-08DOI: 10.9738/INTSURG-D-21-00006.1
Masashi Okawa, J. Kadono, Iwao Kitazono, S. Motoi, K. Gejima, M. Nakajo, Y. Kumagae, M. Higashi, Y. Imoto
Introduction Only 12 cases of gallbladder (GB) cancer associated with leptomeningeal carcinomatosis (LMC) have been reported so far. Herein, we report the first known case of LMC originating from GB cancer after curative resection and discuss the risk factors of LMC associated with GB cancer. Case Presentation An 85-year-old Japanese woman presented with vomiting and impaired awareness 2 years after curative extended cholecystectomy for GB cancer . Computed tomography showed hydronephrosis of the right kidney and ureteral thickening. Magnetic resonance imaging revealed areas of hyperintense reflecting lesions along the cerebral sulci, suggesting meningitis. A spinal tap showed an elevated cerebrospinal fluid pressure of > 270 mmH 2 O, and cytological examination of the spinal fluid revealed the presence of adenocarcinoma cells. The patient was diagnosed with retroperitoneal metastasis and LMC originating from GB cancer. The patient was given palliative care and died 4 weeks after the onset of symptoms. Conclusion The findings of this study show that LMC could occur even after curative resection of GB cancer and should be considered when patients present with neurological symptoms. Retroperitoneal metastases and poorly differentiated tumors are possible risk factors of LMC originating from GB cancer.
{"title":"Leptomeningeal carcinomatosis from gallbladder cancer after curative resection: A case report and review of literature","authors":"Masashi Okawa, J. Kadono, Iwao Kitazono, S. Motoi, K. Gejima, M. Nakajo, Y. Kumagae, M. Higashi, Y. Imoto","doi":"10.9738/INTSURG-D-21-00006.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-21-00006.1","url":null,"abstract":"Introduction Only 12 cases of gallbladder (GB) cancer associated with leptomeningeal carcinomatosis (LMC) have been reported so far. Herein, we report the first known case of LMC originating from GB cancer after curative resection and discuss the risk factors of LMC associated with GB cancer. Case Presentation An 85-year-old Japanese woman presented with vomiting and impaired awareness 2 years after curative extended cholecystectomy for GB cancer . Computed tomography showed hydronephrosis of the right kidney and ureteral thickening. Magnetic resonance imaging revealed areas of hyperintense reflecting lesions along the cerebral sulci, suggesting meningitis. A spinal tap showed an elevated cerebrospinal fluid pressure of > 270 mmH 2 O, and cytological examination of the spinal fluid revealed the presence of adenocarcinoma cells. The patient was diagnosed with retroperitoneal metastasis and LMC originating from GB cancer. The patient was given palliative care and died 4 weeks after the onset of symptoms. Conclusion The findings of this study show that LMC could occur even after curative resection of GB cancer and should be considered when patients present with neurological symptoms. Retroperitoneal metastases and poorly differentiated tumors are possible risk factors of LMC originating from GB cancer.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47927064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-04DOI: 10.9738/INTSURG-D-20-00036.1
Tohru Takahashi, N. Inaki, H. Saito, Yusuke Sakimura, Kengo Hayashi, T. Tsuji, D. Yamamoto, Hirotaka Kitamura, S. Kadoya, H. Bando
Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p < 0.001), and shorter period to the first flatus passage (2 vs. 3 days; p < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and fewer metastatic lymph nodes than the open group leading to an earlier distribution of the pathological stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.
{"title":"Laparoscopic completion total gastrectomy as a standardized procedure for gastric stump cancer: a case control study","authors":"Tohru Takahashi, N. Inaki, H. Saito, Yusuke Sakimura, Kengo Hayashi, T. Tsuji, D. Yamamoto, Hirotaka Kitamura, S. Kadoya, H. Bando","doi":"10.9738/INTSURG-D-20-00036.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00036.1","url":null,"abstract":"Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p < 0.001), and shorter period to the first flatus passage (2 vs. 3 days; p < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and fewer metastatic lymph nodes than the open group leading to an earlier distribution of the pathological stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44773465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-25DOI: 10.9738/INTSURG-D-20-00017.1
Yu-Jen Chen, Ta-Wei Pu, Gang-Hua Lin, Nung-Sheng Lin, Jung-Cheng Kang, C. Hsiao, Chao-Yang Chen, Je-Ming Hu, Tzu-Chiao Lin
Introduction: Enterocutaneous fistulas (ECFs) can be caused by abscess formation at the site of anastomotic leakage (AL) after surgery. Rectocutaneous fistula following low anterior resection (LAR) is rare, and medical management of ECFs is usually the initial treatment. We report a case of rectocutaneous fistula after laparoscopic LAR, which was successfully treated, for the first time, with a transanal endoscopic operation (TEO). Case Presentation: A 58-year-old man presented with a history of hypertension, benign prostatic hyperplasia, peptic ulcer, and recent diagnosis of rectal cancer. The patient underwent laparoscopic LAR with coloanal anastomosis complicated with AL. He then underwent transanal repair of the anastomosis site and laparoscopy with ileostomy. Six months later, he complained of a painful mass lesion over the right buttock that relieved after passing purulent fluid and feces. Colonoscopy and imaging revealed a fistula for which he received antibiotics and wound incision and drainage. He also underwent TEO repair of the rectal fistula, recovered well, and was discharged from hospital. On follow-up 7 months later, there was no recurrence or sign of localized infection. Conclusion: TEO repair may be an effective method for managing rectocutaneous fistula after LAR complicated with AL instead of a major operation.
{"title":"Transanal endoscopic operation for rectocutaneous fistula after low anterior resection: a case report","authors":"Yu-Jen Chen, Ta-Wei Pu, Gang-Hua Lin, Nung-Sheng Lin, Jung-Cheng Kang, C. Hsiao, Chao-Yang Chen, Je-Ming Hu, Tzu-Chiao Lin","doi":"10.9738/INTSURG-D-20-00017.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00017.1","url":null,"abstract":"Introduction: Enterocutaneous fistulas (ECFs) can be caused by abscess formation at the site of anastomotic leakage (AL) after surgery. Rectocutaneous fistula following low anterior resection (LAR) is rare, and medical management of ECFs is usually the initial treatment. We report a case of rectocutaneous fistula after laparoscopic LAR, which was successfully treated, for the first time, with a transanal endoscopic operation (TEO). Case Presentation: A 58-year-old man presented with a history of hypertension, benign prostatic hyperplasia, peptic ulcer, and recent diagnosis of rectal cancer. The patient underwent laparoscopic LAR with coloanal anastomosis complicated with AL. He then underwent transanal repair of the anastomosis site and laparoscopy with ileostomy. Six months later, he complained of a painful mass lesion over the right buttock that relieved after passing purulent fluid and feces. Colonoscopy and imaging revealed a fistula for which he received antibiotics and wound incision and drainage. He also underwent TEO repair of the rectal fistula, recovered well, and was discharged from hospital. On follow-up 7 months later, there was no recurrence or sign of localized infection. Conclusion: TEO repair may be an effective method for managing rectocutaneous fistula after LAR complicated with AL instead of a major operation.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43838933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-25DOI: 10.9738/INTSURG-D-20-00028.1
T. Kusano, Takeshi Aoki, T. Koizumi, Kazuhiro Matsuda, Kosuke Yamada, Koji Nogaki, Y. Tashiro, Y. Wada, Tomoki Hakozaki, H. Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, K. Mitamura, Akira Fujimori, Reiko Koike, Y. Enami, M. Murakami
Hepatectomy for liver cirrhosis patients requires skillful surgical technique and careful attention caused by the fibrotic parenchyma, elevated portal pressure, and impaired coagulation. This report evaluated short- and long-term outcomes for liver cirrhosis patients receiving pre-coagulation therapy on the parenchymal transection plane, as compared to non-coagulation cases. 73 patients diagnosed with cirrhosis via post-operative pathological findings were selected upon reviewing 887 hepatectomy patient files. They were divided into a pre-coagulation group (n=20) and a non-coagulation group (n=53). There were no significant differences in patient and tumor factors between two groups. Pre-coagulation group had significantly less blood loss compared with non-coagulation group [282 vs 563g (p < 0.05)], shorter operative time [214 vs 276min (p = 0.06)], and shorter postoperative hospital stays [14.5 vs 22.5 days (p = 0.12)]. The median recurrence free survival rates time in the pre-coagulation group (733 days) was significantly longer than that in the non-coagulation group (400 days) (p < 0.05). Overall survival rates showed rates showed no difference among the two groups (p = 0.62). Pre-coagulation therapy may be one of the a preferred treatment application for hepatectomy patients with severe liver fibrosis.
肝硬化患者的肝切除术需要熟练的手术技术和对纤维化实质、门静脉压力升高和凝血障碍引起的仔细关注。本报告评估了在实质横断平面上接受凝血前治疗的肝硬化患者与非凝血病例相比的短期和长期结果。在回顾887例肝切除术患者档案后，选择了73例经术后病理结果诊断为肝硬化的患者。他们被分为预凝固组（n=20）和非凝固组（n=53）。两组患者和肿瘤因素无显著差异。凝血前组与非凝血组相比失血量显著减少[282 vs 563g（p＜0.05）]、手术时间缩短[214 vs 276min（p＝0.06）]，术后住院时间更短[14.5 vs 22.5天（p=0.12）]。预凝组中位无复发生存率时间（733天）明显长于非凝组（400天）（p<0.05）。总生存率显示两组之间无差异（p=0.62）肝切除术治疗严重肝纤维化的应用。
{"title":"Liver transection with pre-coagulation therapy in liver cirrhosis ~ Effective usage of an energy device at hepatectomy ~","authors":"T. Kusano, Takeshi Aoki, T. Koizumi, Kazuhiro Matsuda, Kosuke Yamada, Koji Nogaki, Y. Tashiro, Y. Wada, Tomoki Hakozaki, H. Shibata, Kodai Tomioka, Takahito Hirai, Tatsuya Yamazaki, Kazuhiko Saito, K. Mitamura, Akira Fujimori, Reiko Koike, Y. Enami, M. Murakami","doi":"10.9738/INTSURG-D-20-00028.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00028.1","url":null,"abstract":"Hepatectomy for liver cirrhosis patients requires skillful surgical technique and careful attention caused by the fibrotic parenchyma, elevated portal pressure, and impaired coagulation. This report evaluated short- and long-term outcomes for liver cirrhosis patients receiving pre-coagulation therapy on the parenchymal transection plane, as compared to non-coagulation cases. 73 patients diagnosed with cirrhosis via post-operative pathological findings were selected upon reviewing 887 hepatectomy patient files. They were divided into a pre-coagulation group (n=20) and a non-coagulation group (n=53). There were no significant differences in patient and tumor factors between two groups. Pre-coagulation group had significantly less blood loss compared with non-coagulation group [282 vs 563g (p < 0.05)], shorter operative time [214 vs 276min (p = 0.06)], and shorter postoperative hospital stays [14.5 vs 22.5 days (p = 0.12)]. The median recurrence free survival rates time in the pre-coagulation group (733 days) was significantly longer than that in the non-coagulation group (400 days) (p < 0.05). Overall survival rates showed rates showed no difference among the two groups (p = 0.62). Pre-coagulation therapy may be one of the a preferred treatment application for hepatectomy patients with severe liver fibrosis.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41443101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-25DOI: 10.9738/INTSURG-D-20-00040.1
T. Yoshimoto, K. Yoshikawa, M. Shimada, Jun Higashijima, T. Tokunaga, M. Nishi, C. Takasu, H. Kashihara, Shohei Eto
Introduction: The right gastroepiploic artery (RGEA) is used in coronary artery bypass grafting (CABG). However, the treatment of gastric cancer after CABG using the RGEA is complex, as stopping coronary blood flow from the RGEA may cause lethal myocardial ischemia. Adequate treatment must strike a balance between the curability and safety. Case presentation: The patient was a 79-year-old man with advanced gastric cancer who had previously undergone CABG with the RGEA. It was impossible to perform curative gastrectomy with preservation of the RGEA. Thus, percutaneous coronary intervention was performed to revascularize the native right coronary artery. The patient then started chemotherapy using oxaliplatin and S-1. After four courses of chemotherapy, the patient underwent robotic distal gastrectomy with D2 lymphadenectomy, including regional lymph node dissection around the RGEA. The RGEA was cut after a clamp test confirmed that there was no ST change. Conclusion: In patients who develop gastric cancer after CABG using the RGEA, percutaneous coronary intervention of the native coronary artery is useful when resection of the RGEA is required to dissect the no. 6 lymph node. Robotic gastrectomy is a surgical option in such cases.
{"title":"Robotic distal gastrectomy for advanced gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery","authors":"T. Yoshimoto, K. Yoshikawa, M. Shimada, Jun Higashijima, T. Tokunaga, M. Nishi, C. Takasu, H. Kashihara, Shohei Eto","doi":"10.9738/INTSURG-D-20-00040.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00040.1","url":null,"abstract":"Introduction: The right gastroepiploic artery (RGEA) is used in coronary artery bypass grafting (CABG). However, the treatment of gastric cancer after CABG using the RGEA is complex, as stopping coronary blood flow from the RGEA may cause lethal myocardial ischemia. Adequate treatment must strike a balance between the curability and safety. Case presentation: The patient was a 79-year-old man with advanced gastric cancer who had previously undergone CABG with the RGEA. It was impossible to perform curative gastrectomy with preservation of the RGEA. Thus, percutaneous coronary intervention was performed to revascularize the native right coronary artery. The patient then started chemotherapy using oxaliplatin and S-1. After four courses of chemotherapy, the patient underwent robotic distal gastrectomy with D2 lymphadenectomy, including regional lymph node dissection around the RGEA. The RGEA was cut after a clamp test confirmed that there was no ST change. Conclusion: In patients who develop gastric cancer after CABG using the RGEA, percutaneous coronary intervention of the native coronary artery is useful when resection of the RGEA is required to dissect the no. 6 lymph node. Robotic gastrectomy is a surgical option in such cases.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42545940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-25DOI: 10.9738/INTSURG-D-20-00020.1
Shuji Suzuki, M. Shimoda, J. Shimazaki, Y. Oshiro, Kiyotaka Nishida, N. Orimoto, Masahiro Shiihara, Wataru Izumo, Masakazu Yamamoto
Objective Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiological findings as risk factors for POPF after PD. Summary of Background Data We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women’s Medical University. Methods In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into two groups as follows: group A (no fistula/ biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiological parameters were collected and analyzed as predictors of POPF for univariate and multivariate analyses. Results There were 213 male and 137 female patients. The mean age was 65.4 years (range: 21-87years). Univariate analysis showed that sex (p=0.047), amylase (p=0.032), prognostic nutritional index (PNI) (p=0.001), C-reactive protein/Albumin ratio (p=0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (p=0.045) and PNI (p=0.012) were independent risk factors for POPF. Conclusions Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.
{"title":"Assessment of preoperative clinicophysiological findings as risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy","authors":"Shuji Suzuki, M. Shimoda, J. Shimazaki, Y. Oshiro, Kiyotaka Nishida, N. Orimoto, Masahiro Shiihara, Wataru Izumo, Masakazu Yamamoto","doi":"10.9738/INTSURG-D-20-00020.1","DOIUrl":"https://doi.org/10.9738/INTSURG-D-20-00020.1","url":null,"abstract":"Objective Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiological findings as risk factors for POPF after PD. Summary of Background Data We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women’s Medical University. Methods In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into two groups as follows: group A (no fistula/ biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiological parameters were collected and analyzed as predictors of POPF for univariate and multivariate analyses. Results There were 213 male and 137 female patients. The mean age was 65.4 years (range: 21-87years). Univariate analysis showed that sex (p=0.047), amylase (p=0.032), prognostic nutritional index (PNI) (p=0.001), C-reactive protein/Albumin ratio (p=0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (p=0.045) and PNI (p=0.012) were independent risk factors for POPF. Conclusions Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-18-00027.1
Emad M. Al-Osail, M. Bshait, Hassan Alyami, Eman Zakarnah, Mohammed A. Alaklabi, M. Y. Taha
Patients with symptomatic cholelithiasis may undergo cholecystectomy, as an emergency or elective, in the outpatient clinic after discharge from the emergency department (ED). Increasing waiting times for elective cholecystectomy may lead to multiple ED visits for pain management or admission for emergency cholecystectomy. The aim of our study was to determine the relationship between waiting time for elective cholecystectomy and emergency admission. This retrospective, observational study was designed and conducted at a single institution. The medical records of 239 patients with gallstone diseases who underwent emergency or elective cholecystectomy between January 2013 to November 2017 were obtained from the clinic. Approximately 76% (182/239) of the study participants underwent elective cholecystectomy and ∼24% (57/239) visited the ED during their waiting period, of which 42% (24/57) proceeded with emergency cholecystectomy during the waiting time for elective cholecystectomy and the remaining 58% (33/57) were managed in the ED and eventually underwent elective cholecystectomy. A waiting period of 60 days or more increased the risk of emergency cholecystectomy 5.21 times compared to a waiting period of less than 60 days. A waiting period of 31 to 180 days and above increased the chances of emergency cholecystectomy 4.13 (risk ratio) times and 25.5 (risk ratio) times, respectively, compared to a waiting period of 30 days or less. Waiting time for elective cholecystectomy should be less than 30 days to reduce the risk of emergency cholecystectomy and multiple ED visits.
{"title":"The Relationship Between Waiting Time for Elective Cholecystectomy and Emergency Admission in KFMMC: Single Centre Experience","authors":"Emad M. Al-Osail, M. Bshait, Hassan Alyami, Eman Zakarnah, Mohammed A. Alaklabi, M. Y. Taha","doi":"10.9738/intsurg-d-18-00027.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-18-00027.1","url":null,"abstract":"\u0000 \u0000 Patients with symptomatic cholelithiasis may undergo cholecystectomy, as an emergency or elective, in the outpatient clinic after discharge from the emergency department (ED). Increasing waiting times for elective cholecystectomy may lead to multiple ED visits for pain management or admission for emergency cholecystectomy. The aim of our study was to determine the relationship between waiting time for elective cholecystectomy and emergency admission.\u0000 \u0000 \u0000 \u0000 This retrospective, observational study was designed and conducted at a single institution. The medical records of 239 patients with gallstone diseases who underwent emergency or elective cholecystectomy between January 2013 to November 2017 were obtained from the clinic.\u0000 \u0000 \u0000 \u0000 Approximately 76% (182/239) of the study participants underwent elective cholecystectomy and ∼24% (57/239) visited the ED during their waiting period, of which 42% (24/57) proceeded with emergency cholecystectomy during the waiting time for elective cholecystectomy and the remaining 58% (33/57) were managed in the ED and eventually underwent elective cholecystectomy. A waiting period of 60 days or more increased the risk of emergency cholecystectomy 5.21 times compared to a waiting period of less than 60 days. A waiting period of 31 to 180 days and above increased the chances of emergency cholecystectomy 4.13 (risk ratio) times and 25.5 (risk ratio) times, respectively, compared to a waiting period of 30 days or less.\u0000 \u0000 \u0000 \u0000 Waiting time for elective cholecystectomy should be less than 30 days to reduce the risk of emergency cholecystectomy and multiple ED visits.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49609431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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