Nihon Geka Gakkai zasshi最新文献

Surgical treatment offering both cure and good cosmetic outcomes is important in patients with breast cancer. Mastectomy followed by breast reconstruction is performed with a combination of autologous tissue or implant and can be immediate or delayed in one stage or two stages, respectively. Breast surgeons and plastic surgeons should understand the characteristic indications for surgery and select the appropriate procedure for each patient. Oncoplastic breast surgery (OBS) at the time of breast-conserving surgery is classified into two main methods, volume replacement and volume displacement. It is necessary for clinicians to understand both the advantages and disadvantages of oncoplastic procedures. The problem of some OBS methods remaining ineligible for coverage by national health insurance in Japan remains unresolved, but OBS will become more important as a novel method offering a balance between cancer curability and excellent cosmetic results in the near future.

Dr. William Stewart Halsted first advocated performing total mastectomy with pectoral muscle resection and axillary lymph node dissection as the standard surgery for breast cancer. The effectiveness of the sentinel lymph node biopsy was confirmed 100 years later. When a sentinel lymph node biopsy shows no cancer cells in the lymph node, the standard method is to omit axillary dissection. In recent years, there have been some reports of the validity of omitting axillary dissection when sentinel lymph node biopsy is positive for metastasis. When micrometastasis is present in sentinel lymph nodes, it is reasonable to omit axillary dissection. However, when macrometastasis is present, it is necessary to determine whether axillary dissection should be omitted by referring to the inclusion criteria of the Z0011 study. Complications of axillary lymph node dissection may include upper arm edema, glenohumeral joint excursion obstacles, and neuropathy. Early rehabilitation regimens can maintain glenohumeral joint excursion. Good sanitation including the nails, the use of moisturizers, and early administration of antiinflammatory agents for injuries can prevent lymphedema. If lymphedema develops, the wearing of an elastic bandage or sleeve, manual lymph drainage, and kinesiology exercises with a qualified instructor are effective.

Laparoscopic wedge resections are performed for the local resection of gastric submucosal tumors. Recently, laparoscopic and endoscopic cooperative surgery (LECS) has been performed for submucosal tumor resection, independent of tumor location and size. The LECS procedure can be performed safely with adequate incision lines. Nonexposed endoscopic wall-inversion (NEWS) and the combination of laparascopic and endoscopic approaches to neoplasia with the nonexposure technique (CLEAN-NET) were reported as new procedures in laparoscopy and endoscopy without perforation of the stomach to avoid tumor seeding. In the classic LECS procedure, both mucosal and submucosal layers around the tumor are dissected circumferentially using endoscopic submucosal dissection. Subsequently, the seromuscular layer is dissected laparoscopically. The submucosal tumor is then exteriorized to the abdominal cavity and dissected with a standard endoscopic stapling device. In the NEWS procedure, the seromuscular layer is dissected circumferentially and sutured under laparoscopy, and the mucosubmucosal layer is incised circumferentially under endoscopy. These LECS procedures are applicable for submucosal tumor resection such as gastrointestinal stromal tumors and could be applicable for gastric cancer surgery. Cooperation between surgeons and endoscopists is required to perform and develop LECS procedures.