Kurihara T, Kawano D, Okamoto T
… +7 more, Fujishita T, Suzuki Y, Kitahara H, Shimamatsu S, Kouno M, Morodomi Y, Maehara Y
Fukuoka Igaku Zasshi
· 2014 Jan · PMID 24800531
A 71-year-old male with a history of asbestosis was referred to our department for the treatment of a bilateral pneumothorax. His pulmonary function was severely impaired because of asbestosis and emphysema. Chest comput...A 71-year-old male with a history of asbestosis was referred to our department for the treatment of a bilateral pneumothorax. His pulmonary function was severely impaired because of asbestosis and emphysema. Chest computed tomography showed severe emphysema with bilateral multiple bullae. Although chest drainage tubes were placed in the bilateral thorax, the left lung did not completely expand due to a persistent air leak. We performed VATS while retaining the patient's spontaneous respiration under general sedation with regional epidural anesthesia, since one-lung, positive pressure ventilation was considered to be difficult to achieve. After the airway was secured by a laryngeal-mask, the bullae were then thoracoscopically resected. The pneumothorax improved after surgery.
Takeuchi N, Masumoto K, Nojiri J
… +8 more, Akiho S, Hotokezaka S, Sasaki K, Kawaguchi K, Tsukamoto N, Momii K, Fujita N, Mae T
Fukuoka Igaku Zasshi
· 2014 Jan · PMID 24800530
A 73-year-old female was hit by a car, and transferred to our hospital. On examination, her consciousness was alert, but her vital signs were unstable. There are three 10-cm open wounds on her right buttock. X-rays showe...A 73-year-old female was hit by a car, and transferred to our hospital. On examination, her consciousness was alert, but her vital signs were unstable. There are three 10-cm open wounds on her right buttock. X-rays showed an unstable pelvic ring fracture, a right femoral shaft, a right proximal tibia and a right tibial plafond fractures. One hour after the injury, transarterial embolization (TAE) followed by external fixation (EF), and retroperitoneal pelvic packing (RPP) was performed. Two days and five days after the injury, thorough debridement of the open wounds was performed. The skin defect on the right buttock and the lower abdomen had enlarged to 40 x 35 cm, therefore, negative pressure wound therapy was applied. On the same day, right femur was fixed using a retrograde intramedullary nailing. 12 days after the injury, the proximal tibial fracture was fixed using a plate, and the tibial plafond fracture was fixed using screws and external fixators. 28 days after the injury, the split-thickness skin graft was performed on the right buttock and the lower abdomen. Seven months after the injury, the open wounds were completely healed without infection. She was able to walk smoothly with a T-cane. For the management of open pelvic ring fractures, it is essential to perform TAE, EF and RPP as soon as possible. Providing aggressive management, including thorough debridement, is mandatory to prevent severe infection and sepsis. We achieved a good clinical outcome by using a combination of TAE, EF, RPP and staged surgery, including thorough debridement.
Guntani A, Fukunaga R, Kuma S
… +7 more, Okazaki J, Nishihara Y, Aibe H, Okadome J, Morisaki K, Matsumoto T, Maehara Y
Fukuoka Igaku Zasshi
· 2014 Jan · PMID 24800529
This report presents the case of an abdominal aortic aneurysm (AAA), in which the aortic neck was severely angulated. Furthermore, there was moderate stenosis and a severe angle with calcification of the suprarenal aorta...This report presents the case of an abdominal aortic aneurysm (AAA), in which the aortic neck was severely angulated. Furthermore, there was moderate stenosis and a severe angle with calcification of the suprarenal aorta. EVAR was performed with a commercial Zenith stent-graft, with a slight modification, because an open aneurysm repair was risky in general condition. No complications occurred during the follow-up period.
Izumi D, Watanabe M, Nagai Y
… +7 more, Harada K, Imamura Y, Iwagami S, Miyamoto Y, Iwatsuki M, Baba Y, Baba H
Fukuoka Igaku Zasshi
· 2014 Jan · PMID 24800528
We herein report a case of mediastinitis with left pyothorax due to anastomotic leakage after totally laparoscopic proximal gastrectomy (TLPG) successfully managed by T-tube placement and intercostal muscle flap reinforc...We herein report a case of mediastinitis with left pyothorax due to anastomotic leakage after totally laparoscopic proximal gastrectomy (TLPG) successfully managed by T-tube placement and intercostal muscle flap reinforcement. A 51-year-old man, who had undergone a TLPG at a referring hospital, was referred for fever, elevated inflammation markers, and pleural effusion on postoperative day 3. A computed tomography (CT) scan revealed mediastinitis with left pyothorax caused by anastomotic leakage. An emergency operation was performed through a left thoracotomy. After an irrigation of the thoracic cavity and a decortication of the pleura, we found a perforation in the left side of the anastomosis. We decided to insert a T-tube through the perforation and performed intercostal muscle flap reinforcement. He got acute respiratory distress syndrome but recovered after treatment in Intensive Care Unit for 24 days. Oral intake was started on day 45 and he was discharged on day 71. A T-tube drainage and wrapping with the intercostal muscle flap is a useful choice of treatment for intrathoracic anastomotic leakage with severe inflammation.
Spermatogenesis occurs throughout the adult lifetime of males and is supported by a robust stem cell system. Spermatogonial stem cells (SSCs) are the stem cells of postnatal male germ cells, and not only self-renew but a...Spermatogenesis occurs throughout the adult lifetime of males and is supported by a robust stem cell system. Spermatogonial stem cells (SSCs) are the stem cells of postnatal male germ cells, and not only self-renew but also produce differentiated progeny continuously. Recent report revealed that differentiating spermatogonia could revert into an undifferentiated state, although it was believed that SSCs were homogeneous and that differentiating spermatogonia was not reversible. Although several molecules, which regulate SSC, have been identified so far, molecular mechanisms underlying the maintenance of SSCs as well as the reversible developmental lineage of SSCs remain to be elucidated. In this review, we describe a brief overview of spermatogenesis and summarize the molecular regulation of SSC compartment.
Yonemura Y, Umeda K, Kumashiro R
… +10 more, Mashino K, Ogawa T, Adachi E, Saeki H, Uchiyama H, Kawanaka H, Ikeda T, Tashiro H, Sakata H, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693692
Incarcerated diaphragmatic hernia after laparoscopic right hepatectomy is very rare. An 81-year-old man underwent laparoscopic right hepatectomy for giant hepatic hemangioma. Twenty months after the surgery, he began to...Incarcerated diaphragmatic hernia after laparoscopic right hepatectomy is very rare. An 81-year-old man underwent laparoscopic right hepatectomy for giant hepatic hemangioma. Twenty months after the surgery, he began to complain of nausea and abdominal pain and was brought to our hospital. Chest X-ray showed an abdominal gas shadow above the right diaphragm and computed tomography showed herniation of the colon into the right thoracic cavity. We diagnosed ileus due to incarcerated diaphragmatic hernia and performed emergency operation under laparoscopic surgery. After successfully reducing the prolapsed colon back to the abdominal cavity, the diaphragmatic hernia orifice was repaired. Incarcerated diaphragmatic hernia sometimes causes the fatal state. Clinicians must therefore consider such findings a late complication of laparoscopic hepatectomy.
Hiroshige S, Kubo N, Orita H
… +8 more, Saeki H, Kawanaka H, Tomikawa M, Uchiyama H, Ikeda T, Yano T, Mutou Y, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693691
The occurrence of traumatic abdominal wall hernia secondary to blunt trauma is uncommon, and laparoscopic repair of such hernias is very rare. A 53-year-old man, who had sustained injuries to his right thigh and right ab...The occurrence of traumatic abdominal wall hernia secondary to blunt trauma is uncommon, and laparoscopic repair of such hernias is very rare. A 53-year-old man, who had sustained injuries to his right thigh and right abdomen 8 months previously, visited a hospital because of a bulge in the right lateral abdomen. An abdominal computed tomography scan revealed a rupture in the lateral abdominal muscle and herniation of the cecum into the subcutaneous space. Accordingly, delayed traumatic abdominal wall hernia was diagnosed, which was successfully repaired laparoscopically. Thus, a laparoscopic tension-free mesh repair was safely and effectively performed for delayed traumatic abdominal wall hernia.
Kabashima A, Kitagawa D, Nakamura T
… +11 more, Kondou N, Shoji F, Hasegawa H, Teramoto S, Funahashi S, Ikeda Y, Saeki H, Oki E, Morita M, Ikeda T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693690
A 65-year-old man was admitted to our hospital with nausea, vomiting and appetite loss. First upper endoscopic examination and X-ray examination showed a peptic ulcer and a pyloric stenosis. Fiberscope could not go throu...A 65-year-old man was admitted to our hospital with nausea, vomiting and appetite loss. First upper endoscopic examination and X-ray examination showed a peptic ulcer and a pyloric stenosis. Fiberscope could not go through the pyloric ring. Computed tomography examination and biopsy showed no evidence of malignancy. Though we considered surgical resection of the stenosis at first, he could eat a staple food with therapy of proton pump inhibitor. So we followed up with upper endoscopic examinations. Second, third and forth upper endoscopic examinations showed no evidence of malignancy. Fifth upper endoscopic examination showed an ulcer scar on the pyloric ring and a 0-IIc carcinoma in the antral greater curvature. Distal gastrectomy with D2 lymph node dissection and B-II reconstruction. Pathologically, a mucosal carcinoma with no lymph node metastasis and U1-III peptic ulcer were diagnosed.
Otsu H, Oki E, Kawano H
… +12 more, Ando K, Ito S, Sugimachi K, Saeki H, Uchiyama H, Soejima Y, Kawanaka H, Morita M, Sakaguchi Y, Kusumoto T, Ikeda T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693689
A case was a 77 years old male. Exertional breathlessness was a chief complaint, and anemia was pointed out. A duodenum GIST was detected by gastroscopy. The CT scan showed infiltration in an inferior vena cava, the righ...A case was a 77 years old male. Exertional breathlessness was a chief complaint, and anemia was pointed out. A duodenum GIST was detected by gastroscopy. The CT scan showed infiltration in an inferior vena cava, the right kidney, and an ascending colon, so we judged that radical cure resection was difficult. We started Imatinib medication. Six months after the medication start, because the border with surroundings also became clear, we became a plan of the operation. The tumor existed in the descending limb of duodenum and the distance with papilla Vater was maintained, so the complete excision by duodenal portion resection was possible for it. Although meaning of primary systemic therapy for GIST was not established, it was shown that medicating Imatinib to the high-level partial advance GIST before an operation may become an effective cure which avoids an extended operation and makes complete resection of a tumor possible.
Ishii A, Sugiyama M, Ohta M
… +14 more, Sumida Y, Kimura Y, Tsutsumi N, Yamashita Y, Saeki H, Uchiyama H, Kawanaka H, Morita M, Sakaguchi Y, Ikeda T, Kusumoto T, Harada N, Ikejiri K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693688
Obstructive colorectal cancer accounts for 3.1-15.8% of total colorectal cancer cases, therefore it is not a rare condition. Formerly, it has been often treated with emergent operation such as colostomy or trans-anal tub...Obstructive colorectal cancer accounts for 3.1-15.8% of total colorectal cancer cases, therefore it is not a rare condition. Formerly, it has been often treated with emergent operation such as colostomy or trans-anal tube decompression. Since 2012, revision of the medical payment system, it has become possible to be treated with elective operation when using endoscopic metal stent placement that enable to decompress enlarged intestine by transanal approach. This procedure provides safe elective surgery with sufficient preoperative inspection and conventional bowel preparation. We report two cases of acute large bowel obstruction due to colon cancer treated with endoscopic stent placement as a "bridge to surgery".
Yamaguchi S, Tsutsumi N, Kusumoto E
… +10 more, Endo K, Ikejiri K, Yamashita Y, Uchiyama H, Saeki H, Oki E, Kawanaka H, Morita M, Ikeda T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693687
Superior lumbar hernia, also known as Grynfeltt-Lesshaft hernia, is an uncommon abdominal wall defect. We report a case of superior lumbar hernia, which was successfully treated with a lightweight partially absorbable me...Superior lumbar hernia, also known as Grynfeltt-Lesshaft hernia, is an uncommon abdominal wall defect. We report a case of superior lumbar hernia, which was successfully treated with a lightweight partially absorbable mesh. A 73-year-old man visited our department with complaints of lumbar pain and a feeling of pressure associated with a right lumbar mass. A CT scan of the abdomen demonstrated a defect in the aponeurosis of the transversus abdominis muscle and a protrusion of the small intestine through the defect. The diagnosis of a right superior lumbar hernia was made. The lumbar hernia was surgically treated with a lightweight large-pore polypropylene mesh containing an absorbable component consisting of poliglecaprone (ULTRAPRO Plug). The patient had no evidence of recurrence after 4 years of follow-up without any sense of discomfort. This is the first case report of a lumbar hernia treated with a lightweight partially absorbable mesh. This partially absorbable mesh can be considered to be suitable for the treatment of a lumbar hernia.
Motomura T, Takahashi I, Noguchi S
… +14 more, Ochi T, Kajiwara Y, Mano Y, Nakanishi R, Fujinaka Y, Nishida K, Yamashita Y, Saeki H, Kawanaka H, Morita M, Ikeda T, Soejima Y, Nishizaki T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693686
Intestinal malrotation is a congenital abnormality and is rarely seen in the adulthood. Most adult cases would be classified to the non-rotation type with Ladd's band and Ladd procedure is the treatment of choice. A 66 y...Intestinal malrotation is a congenital abnormality and is rarely seen in the adulthood. Most adult cases would be classified to the non-rotation type with Ladd's band and Ladd procedure is the treatment of choice. A 66 year-old woman admitted to our hospital due to duodenum obstruction. Several tests revealed that she had intestinal malrotation previously undiagnosed. Operative findings showed the fusion of duodenum with jejunum by the incomplete Treitz ligament. There was no Ladd's band and the right colon was unfixed. Dissection of the fusion completely released her symptom and she discharged without any complication. This is the first report of untypically intestinal malrotation in the adulthood without Ladd's band.
Maeda T, Hashimoto K, Ishida T
… +7 more, Yamashita Y, Saeki H, Kawanaka H, Uchiyama H, Ikeda T, Tsujitani S, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693685
A 68-year-old man underwent a partial resection of the liver and lymph node dissection for a tumor, 3.0 cm in diameter, in S4 of the liver under the diagnosis of cholangiocellular carcinoma (CCC). The histological diagno...A 68-year-old man underwent a partial resection of the liver and lymph node dissection for a tumor, 3.0 cm in diameter, in S4 of the liver under the diagnosis of cholangiocellular carcinoma (CCC). The histological diagnosis was cholangiolocellular carcinoma (CoCC) and lymphatic permeation and venous invasion were recognized. Seven months after surgery, CT demonstrated two recurrent nodules in S7 and S8 of the liver, then a partial resection of the liver was performed. The gross and pathological findings were the same as the previously resected tumor. Four months after the second operation, CT demonstrated dilated intrahepatic bile ducts and lymph node swelling of the hepatic hilum. The patient died of disease thirteen months after the first operation. On the basis of the clinical and pathological features of this case, we consider that CoCC clinically resembles CCC and prognosis may be unfavorable, although it has characteristic pathological findings. It is still controversial whether CoCC should be accepted as a separate entity. The significance of repeat hepatectomy for recurrence and adjuvant chemotherapy should be clarified to improve the prognosis of CoCC.
Ueo H, Takano Y, Matsumura T
… +11 more, Kurashige J, Shinden Y, Eguchi H, Sudo T, Sugimachi K, Saeki H, Oki E, Morita M, Ikeda T, Maehara Y, Mimori K
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693684
INTRODUCTION: Currently, Endoscopic mucosal resection (EMR) and laparoscopic surgery with colorectal cancer (CRC) and has been expanding rapidly. In handling of colon cancer, adaptation of EMR is determined by the depth...INTRODUCTION: Currently, Endoscopic mucosal resection (EMR) and laparoscopic surgery with colorectal cancer (CRC) and has been expanding rapidly. In handling of colon cancer, adaptation of EMR is determined by the depth of tumor invasion. It is important to identify genes to predict lymph node metastasis in early CRC tumors precisely in a reproducible fashion to determine the adaptation of EMR treatment. We performed the comprehensive analysis of gene expression and genomic copy number simultaneously in CRC primary tumors to identify the bona-fide indicator of lymph node metastasis. MATERIALS AND METHODS: We collected cancer cells specifically by Laser Microdissection (LMD) on 157 cases of primary colorectal cancer, and performed oligo microarrays for gene expression (GE) and aCGH for copy number aberration. As for candidate genes to be associated with lymph node metastasis, we examined reprodicibility by quantitative RT-PCR using cDNA created from the RNA extracted from 172 cases of CRC. RESULTS: As for the association of lymph node metastasis, we found that 240 genes and 54 genes by aCGH and by oligo GE microarray, respectively. According to database of those two arrays, 501 genes were significantly correlated (correlation coefficient > 0.7) with each other, and we found that 11 out of 501 genes were identified as lymph node metastasis related genes with copy number alteration. Of these 11 genes, we focused on PCM1, MTUS1, ASAH1 on 8p22. Then, we confirmed that the decreased expression and genomic deletion of MTUS1 were observed in lymph node positive cases (p = 0.0195) in another subset of 172 cases of CRC. CONCLUSIONS: To measure the expression of MTUS1 of the tumor by PCR, we can predict the presence of lymph node metastasis. We expected that the loss of MTUS1 should be an important marker in determining the adaptation of endoscopic resection.
Yoshinaga K, Saeki H, Oki E
… +12 more, Morita M, Ikeda T, Sugimachi K, Yamashita Y, Ikegami T, Uchiyama H, Yoshizumi T, Soejima Y, Kawanaka H, Mimori K, Watanabe M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693683
AIM/BACKGROUND: We previously reported that PSK-induced lymphocyte blastogenesis reaction (PSK-stimulation index; PSK-SI) may be a prognostic marker for immunochemotherapy using PSK in gastrointestinal cancer patients. I...AIM/BACKGROUND: We previously reported that PSK-induced lymphocyte blastogenesis reaction (PSK-stimulation index; PSK-SI) may be a prognostic marker for immunochemotherapy using PSK in gastrointestinal cancer patients. In this study we evaluated the usefulness of PSK-SI as a prognostic marker for PSK therapy at higher and lower serum immunosuppressive acidic protein (IAP) levels. PATIENTS AND METHODS: 98 gastric and 135 colorectal cancer patients were analyzed. PSK-SI and serum IAP levels were measured preoperatively. After operation, patients received UFT and PSK for two years. RESULTS: There were no differences between patients with higher and those with lower PSK-SI with respect to the clinicopathological factors. In patients with higher serum IAP levels (> or = 500 microg/ml), recurrence-free survival (RFS) and overall survival (OS) were apparently more favorable in the higher PSK-SI group (gastric cancer; > or = 1.75, colorectal cancer; > or = 2.1) than in lower PSK-SI group, although the differences were not significant. CONCLUSION: Serum IAP levels and PSK-SI may be useful markers for prediction of response to immunochemotherapy using PSK, although further studies are necessary.
Harada N, Shirabe K, Yoshizumi T
… +12 more, Ikegami T, Uchiyama H, Soejima Y, Yamashita Y, Saeki H, Oki E, Kawanaka H, Morita M, Ikeda T, Matsuura H, Okadome K, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693682
INTRODUCTION: Surgery remains the treatment of choice for patients with resectable biliary tract cancer, enhancing the chance of cure and increasing long-term survival. Early recurrence, however, is frequent in patients...INTRODUCTION: Surgery remains the treatment of choice for patients with resectable biliary tract cancer, enhancing the chance of cure and increasing long-term survival. Early recurrence, however, is frequent in patients who have undergone curative resection. To date, no randomized controlled trials have assessed adjuvant chemotherapy in patients with biliary tract cancer. The aim of this study was to evaluate the outcomes of surgical management followed by adjuvant chemotherapy in patients with biliary tract cancer. MATERIALS AND METHODS: This study enrolled 100 patients with Union for International Cancer Control (UICC) stages I-IV biliary tract cancer who underwent surgical resection, including 16 who received sequential adjuvant chemotherapy with gemcitabine or S-1. Overall survival (OS), disease-free survival (DFS), and prognostic factors were analyzed. RESULTS: The median duration of follow-up was 12.6 months. Forty-one patients had lymph node metastasis and 81 underwent RO resection. The 1-, 3-, and 5-year OS rates were 80.9%, 48.6%, and 38.3%, respectively, and the 1-, 3-, and 5-year DFS rates were 59.8%, 39.9%, and 24.9%, respectively. Five-year OS rates were similar in patients who did (40.4%) and did not (32.4%) receive adjuvant chemotherapy. The morbidity and mortality rates were 59% and 3%, respectively. Multivariate analysis showed that only lymph node metastasis (p = 0.042) was independently associated with long-term survival. CONCLUSIONS: The presence of lymph node metastasis significantly affected long-term survival, whereas adjuvant chemotherapy did not affect outcomes in our patients with resectable biliary tract cancer.
Nagata S, Shirabe K, Sugimachi K
… +13 more, Ikegami T, Yoshizumi T, Uchiyama H, Yamashita Y, Saeki H, Kawanaka H, Mimori K, Watanabe M, Gion T, Soejima Y, Ikeda T, Tsujitani S, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693681
INTRODUCTION: Previous studies have demonstrated that oxidative stress by mediating the excessive production of reactive oxygen species is involved in tissue damage and organ failure during and after surgery. The impact...INTRODUCTION: Previous studies have demonstrated that oxidative stress by mediating the excessive production of reactive oxygen species is involved in tissue damage and organ failure during and after surgery. The impact of the preoperative immunonutrition including antioxidants on the postoperative course of patients undergoing hepatic surgery was investigated in this pilot study. PATIENTS AND METHODS: Twenty-three living donor liver transplantation (LDLT) donors were randomly assigned to either an experimental (AO) group, received a commercial supplement enriched with antioxidant nutrients for each of the 5 days immediately prior to surgery while maintaining normal food intake, or a control (CT) group, administered no supplement. Antioxidative capacity was measured by spectrophotometry of patient serum using a free-radical analytical system. RESULTS: The antioxidative capacity of 90.9% patients in the AO group increased after immunonutrition. Compared to the CT group, the AO group was found to have higher antioxidant capacity and transferrin levels; lower WBC, lymphocyte, and neutrophil counts; and briefer duration of postoperative fever during the postsurgical period. No significant differences were found between the 2 groups regarding the nutritional parameters; liver functioning parameters; immunological parameters; intraoperative factors; postoperative outcomes. CONCLUSION: Preoperative immunonutrition including antioxidants might play a beneficial role in improving postsurgical immunological response but the modest biological advantage was not associated with any significant clinical outcome.
Kasagi Y, Saeki H, Ando K
… +10 more, Hiyoshi Y, Ito S, Sugimachi K, Yamashita Y, Oki E, Uchiyama H, Kawanaka H, Morita M, Ikeda T, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693680
PURPOSE: The purpose of this study was to clarify the outcomes of preoperative CDDP/5-FU chemotherapy (FP therapy) followed by surgery for patients with clinical Stage II/III thoracic esophageal cancer. METHODS: Seventee...PURPOSE: The purpose of this study was to clarify the outcomes of preoperative CDDP/5-FU chemotherapy (FP therapy) followed by surgery for patients with clinical Stage II/III thoracic esophageal cancer. METHODS: Seventeen patients with clinical Stage II/III thoracic esophageal cancer who underwent FP therapy followed by esophagectomy were investigated with regard to the perioperative clinical results and postoperative outcomes. RESULTS: Grade 3 or 4 adverse effects associated with FP therapy were recognized in 2 of the 17 (11.8%) cases, and 16 patients completed 2 cycles of FP therapy (94.1%). Complications after surgery occurred in 7 cases (41.2%). There were 7 patients with postoperative recurrences (41.2%), 6 of whom had clinical Stage III disease. Similarly, 4 out of the 5 patients who died of cancer had clinical Stage III disease. All recurrences and cancer-related deaths were recognized in histological effectiveness of Grade 0/1 cases. CONCLUSIONS: Preoperative FP therapy was found to be safe for patients with clinical Stage II/III thoracic esophageal cancer. However, the treatment seemed to be less beneficial for Stage III patients than for Stage II patients, thus suggesting that a more powerful preoperative treatment may be necessary for clinical Stage III patients.
Ikeda T, Akahoshi T, Kawanaka H
… +14 more, Uchiyama H, Yamashita Y, Morita M, Oki E, Saeki H, Sugimachi K, Ikegami T, Yoshizumi T, Soejima Y, Shirabe K, Mimori K, Watanabe M, Hashizume M, Maehara Y
Fukuoka Igaku Zasshi
· 2013 Dec · PMID 24693679
BACKGROUND: Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. PURPOSES: The objective of this study was to evaluate the role of elect...BACKGROUND: Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. PURPOSES: The objective of this study was to evaluate the role of electrosurgical and stapling devices as an alternative to traditional methods of stump closure in an animal model of distal pancreatectomy. METHODS: Four devices were used for transection of the pancreatic body : a bi-polar thermofusion system attached to an automatic irrigation function (BI, n = 3), a bi-polar tissue sealer (BS, n = 3), an ultrasonic scissor (US, n = 3), and an endoscopic stapling device (ES, n = 3). For each group, burst pressure was tested using an electronic manometer, with a focus on the location (s) of the first disruption (s). Histological examination was performed for the dissected surfaces. The transection line, including staples, was embedded in a polyester resin, and histological examination was performed for these polished sections of the resin. RESULTS: Pressure was significantly higher for BI (P < 0.01) than that for the other devices. In contrast, thermal denaturation of the pancreas parenchyma was observed at a depth of approximately 1 mm from the dissected portion for BS, while it extended beyond 15 mm for BI. The staple line was the first disruption point for all of ES cases. CONCLUSIONS: The pellicle of the pancreas is likely to be deficient after a surgical operation. If the pellicle is preserved, the strength of the pellicle may be insufficient for complete closure with high stapling mechanical pressure or the protein coagulation of usually used electrosurgical devices.