Nihon Geka Gakkai Zasshi
· 2015 Nov · PMID 26845888
RNAs lacking protein-coding ability are called "noncoding RNAs" (ncRNAs). ncRNAs include microRNA (19-24 nucleotides in length) and long ncRNA (lncRNA). MicroRNA binds to the 3'-untranslated regions of target mRNAs and r...RNAs lacking protein-coding ability are called "noncoding RNAs" (ncRNAs). ncRNAs include microRNA (19-24 nucleotides in length) and long ncRNA (lncRNA). MicroRNA binds to the 3'-untranslated regions of target mRNAs and regulates target genes at a posttranscriptional level. In hepatocellular carcinoma (HCC), the roles of microRNAs in hepatocarcinogenesis and microRNAs that can determine the nature of HCC have been reported. Because microRNA is stable in the bloodstream or formalin-fixed specimens, it can be used as a tumor marker. MicroRNAs as therapeutic targets for HCC are being intensively investigated. A phase I clinical study using miR-34 is currently in progress. On the other hand, the investigation of lncRNAs has only recently begun. Because lncRNAs are also involved in hepatocarcinogenesis and can determine the nature of cancers, many researchers are now working on these RNAs.
Nihon Geka Gakkai Zasshi
· 2015 Nov · PMID 26845887
Recent advances in the field of RNA research have shown that microRNAs (MiRNAs) are among noncoding RNAs that function in posttranscriptional regulation of target gene expression via base-pairing with complementary seque...Recent advances in the field of RNA research have shown that microRNAs (MiRNAs) are among noncoding RNAs that function in posttranscriptional regulation of target gene expression via base-pairing with complementary sequences in mRNAs to induce mRNA degradation and translational inhibition. Together with several causes of colorectal cancer (CRC) initiation and progression which are regulated by both genetic and epigenetic modifications, aberrant expression of oncogenic and tumor suppressor MiRNAs in cancer cells was found to be up- or downregulated by targeted mRNAs specific to tumor promoter or inhibitor genes. In particular, the study of MiRNAs as CRC biomarkers utilizes expression profiling methods from tissue samples along with newly introduced noninvasive samples of feces and body fluids, since MiRNAs are known to be extremely stable under several conditions. Additionally, MiRNAs could be employed to predict chemo- and radiotherapy responses and be manipulated in order to alleviate CRC characteristics. This article introduces progress in the utilization of MiRNAs as noninvasive biomarkers for cancer detection, estimation of recurrence and prognosis, and prediction of chemotherapeutic agent response in CRC. It also discusses the obstacles that have limited the routine use of MiRNA biomarkers in the clinical setting.
Nihon Geka Gakkai Zasshi
· 2015 Nov · PMID 26845886
Although cancer is a genetic disease, epigenetic alterations are involved in its initiation and progression. Previous studies showed that the introduction of endogenous small-sized, noncoding ribonucleotides including mi...Although cancer is a genetic disease, epigenetic alterations are involved in its initiation and progression. Previous studies showed that the introduction of endogenous small-sized, noncoding ribonucleotides including microRNA200c, -302s, and -369 resulted in the induction of cellular reprogramming. MicroRNA200c inhibits the epithelial-mesenchymal transition. MicroRNA302s induces the demethylation of the tumor suppressor gene promoter region, while microRNA369 changes cancer cell metabolism. These three types of microRNA induce cancer cellular reprogramming and modulate malignant phenotypes of human cancer cells. These results suggest that the appropriate delivery of functional small-sized ribonucleotides may be a novel approach to the treatment of human cancer.
In non-cardiac surgery patients receiving antithrombotic therapy (antiplatelet therapy (APT) and anticoagulation therapy (ACT)) for prevention of cardiovascular and/or cerebrovascular complications, perioperative antithr...In non-cardiac surgery patients receiving antithrombotic therapy (antiplatelet therapy (APT) and anticoagulation therapy (ACT)) for prevention of cardiovascular and/or cerebrovascular complications, perioperative antithrombotic management is challenging due to increased risks of both bleeding and thromboembolic complications. The effect of APT and/or ACT on surgical outcomes in patients undergoing general or gastroenterologic surgery is still unknown because of the limited evidence. We conducted a survey of 38 major surgical facilities at Kyoto University Related Hospital Surgical Group of Cancer Research on perioperative management in patients undergoing antithrombotic therapy. In elective surgery, most facilities used heparin substitution during cessation of ACT or APT, while surgery was performed under continuation of APT in 22% of facilities. In emergent surgery, the effect of ACT was reversed before surgery, but surgery was performed without the reversal of APT effect. Laparoscopic surgery was performed in most facilities in spite of the use of ACT or APT. Severe bleeding complications requiring transfusion of fresh frozen plasma or platelet were experienced in over half of facilities. Conclusion : Variation of antithrombotic management has shown to be large between facilities. For safe surgical treatment, creation of the perioperative antithrombotic management guideline on the basis of the evidence from multicenter study is requisite.
Developments in laparoscopic surgery have undoubtedly improved postoperative discomfort and morbidity, decreased hospital stays, enhanced recovery, and improved wound cosmesis. There are, however, several limitations to...Developments in laparoscopic surgery have undoubtedly improved postoperative discomfort and morbidity, decreased hospital stays, enhanced recovery, and improved wound cosmesis. There are, however, several limitations to the use of conventional laparoscopic and thoracoscopic surgical techniques such as two-dimensional visualization of the surgical field with loss of depth perception, counterintuitive movements with rigid, nonarticulated instruments, loss of hand-eye coordination, and poor ergonomics for the operating surgeon. However, thoracoscopic repair of tracheoesophageal fistulas and laparoscopic repair of choledochal cysts and biliary atresia have recently been performed. We anticipate that, as the number of complex pediatric laparoscopic/thoracoscopic procedures performed increases, there will be improvements in the hardware with associated measurable benefits in patient outcomes.
Endoscopic breast surgery (EBS) for breast disease has been developed in Japan since 1995. The purpose of EBS is to accomplish the same local control as with conventional breast surgery through small skin incisions. Over...Endoscopic breast surgery (EBS) for breast disease has been developed in Japan since 1995. The purpose of EBS is to accomplish the same local control as with conventional breast surgery through small skin incisions. Over the nearly 20-year history of EBS, equipment size has been reduced and procedures have been simplified. Recently, oncoplastic breast surgery, breast surgery using the open-window method, and imageguided nonsurgical ablation have been introduced into clinical practice for local breast treatment. Simplified procedures for EBS should be applied with newly introduced local treatments to achieve local control and expand the indications for those local treatments.
Minimally invasive surgery is an attractive choice for patients undergoing major cardiac procedures. This paper focuses on minimally invasive mitral valve repair and robotic surgery using the da Vinci Surgical System. Mi...Minimally invasive surgery is an attractive choice for patients undergoing major cardiac procedures. This paper focuses on minimally invasive mitral valve repair and robotic surgery using the da Vinci Surgical System. Minimally invasive mitral valve repair is usually performed through a right minithoracotomy with direct vision. The techniques used in this procedure are similar to those in open surgery. The outcome of minimally invasive mitral valve repair is also equivalent to that of open surgery, with high levels of patient satisfaction. On the other hand, minimally invasive cardiac surgery using the da Vinci Surgical System has not been approved in Japan except for internal mammary artery harvesting. A Japanese clinical trial of da Vinci surgery for mitral valve repair and atrial septal defect closure has been completed and approval is awaited. Although da Vinci surgery is technically demanding, this less-invasive technique may provide another choice for patients in the near future.
Minimally invasive general thoracic surgery entered a new era with the introduction of thoracoscopic surgery into clinical practice in the early 1990s. Thoracoscopic surgery is already widely accepted in most countries....Minimally invasive general thoracic surgery entered a new era with the introduction of thoracoscopic surgery into clinical practice in the early 1990s. Thoracoscopic surgery is already widely accepted in most countries. However, single-port thoracic surgery, needlescopic thoracic surgery, and robot-assisted thoracic surgery are not yet accepted widely. More advances in the instruments and equipment appear necessary.
Laparoscopic hepatobiliary-pancreatic surgery (L-HPB), excluding cholecystectomy, is a highly specialized field. However, important technological developments and improved endoscopic procedures are being established. Thu...Laparoscopic hepatobiliary-pancreatic surgery (L-HPB), excluding cholecystectomy, is a highly specialized field. However, important technological developments and improved endoscopic procedures are being established. Thus, the number of L-HPB procedures has been increasing. Recent systematic reviews or metaanalyses based on observational data have reported not only the advantage of less invasiveness in early disease stages but also less bleeding, fewer complications, and no oncologic disadvantage, although prospective, randomized trials have not yet been performed. L-HPB is expected to develop further in the future as a new surgical method to improve patients' quality of life. While it is certain that L-HBP surgery will not totally supplant open HBP surgery, the laparoscopic approach in selected patients should be considered as the treatment of choice. However, it must be remembered that the benefits of L-pancreatic duodenectomy as well as liver resection should be balanced against the high degree of difficulty. Robotic-assisted L-HBP is expected to support difficult operative procedures by allowing more precise hand manipulations, although a greater accumulation of clinical cases is needed to evaluate this. The success of L-HBP is affected by individual surgeons' learning curves and the selection of patients with appropriate indications. The basic principle of L-HBP as well as other digestive surgery is to achieve minimal invasion with optimal safety.
Randomized clinical trials (RCTs) comparing laparoscopic surgery (LS) with open surgery (OS) in patients with colon cancer showed no statistical differences in, safety, and long-term outcomes. LS for colon cancer has bec...Randomized clinical trials (RCTs) comparing laparoscopic surgery (LS) with open surgery (OS) in patients with colon cancer showed no statistical differences in, safety, and long-term outcomes. LS for colon cancer has become a standard procedure. LS for rectal cancer has also shown advantages, although RCTs showed no significant differences between groups in the long-term outcome. The magnification of laparoscopy enables surgeons to operate precisely in the narrow pelvis while sparing the autonomic nerves and nerves to the anal sphincter. Good visualization of the pelvis offers better education and will likely be used more frequently for rectal cancer. Invasion of rectal cancer to other organs and massive tumors are, however, technically demanding. The younger generation is more susceptible to Crohn's disease and inflammatory bowel disease (IBD), and high recurrence rates mean more reoperations. Esthetic outcomes and minimal adhesion maximize the advantages of LS in treating Crohn's disease and IBD. Total proctocolectomy LS for IBD and ulcerative colitis is safe and minimally invasive. However, LS may take longer than OS, and emergencies such as toxic megacolon and massive hemorrhage remain contraindications. Ongoing clinical trials should reveal the feasibility of these new LS procedures in robotic and single-port surgery.
In recent years, the number of facilities performing endoscopic surgeries, i.e., thoracoscopic and laparoscopic surgery, of the upper gastrointestinal tract has increased. Endoscopic surgery has many advantages, such as...In recent years, the number of facilities performing endoscopic surgeries, i.e., thoracoscopic and laparoscopic surgery, of the upper gastrointestinal tract has increased. Endoscopic surgery has many advantages, such as magnification effects, good lighting, and a wide field of view in deep, narrow spaces. On the other hand, there are some technical difficulties in performing endoscopic procedures as in conventional open surgeries. Compared with endoscopic surgery, robotic surgery may facilitate more accurate, safer operations. The da Vinci Surgical System is a high-quality robotic system used for endoscopic surgeries, which offers a three-dimensional view, more degrees of freedom of the instruments, a tremor-filtering system, etc. However, in the absence of adequate operator skill and knowledge, the system cannot provide substantial improvements in the surgical technique. Endoscopic and robotic surgery must be used to offer treatment to patients which is at least equivalent to conventional surgery.