Practical Contribution of Virtual Hepatectomy for Colorectal Liver Metastases: a Propensity-Matched Analysis of Clinical Outcome

Background

Recent improvements in imaging technologies have enabled surgeons to perform precise planning using virtual hepatectomy (VH). However, the practical and clinical benefits of VH remain unclear. This study sought to assess how three-dimensional analysis using a VH contributed to preoperative planning and postoperative outcome in patients undergoing liver surgery for the treatment of colorectal liver metastases (CRLM).

Methods

From 2007 to 2017, a total of 473 CRLM patients who received curative hepatectomy were retrospectively assessed. A 1:1 matched propensity analysis was performed between patients who did not receive a VH (without 3D group: n?=?188) and received a VH (3D(+) group: n?=?285).

Result

The rate of VH increased over the study period (P?<?0.001). After propensity score matching (n?=?150 for each group), no significant differences were observed in the intraoperative and postoperative outcome, including liver transection time, blood loss, or morbidity between the groups. More patients received a small anatomical resection (plus limited resections) in the 3D(+) group (25 vs 11%, [P?=?0.03]). A submillimeter margin was less frequent in the 3D(+) group. No significant differences in the 5-year overall survival and disease-free survival rates were seen between the without 3D group and the 3D(+) group (38.0 vs. 45.9% [P?=?0.99], 11.1 vs. 21.7%, respectively [P?=?0.109]).

Conclusion

Although VH did not significantly influenced on the long-term outcome after hepatectomy, a more parenchymal-sparing operative procedure (anatomical resections, plus limited resections) was selected and the risk of a submillimeter surgical margin was reduced after introduction of VH.

     

Two cases of preceded aortic valve replacement for severe aortic stenosis before the cancer operations

We report two cases of aortic valve replacement (AVR) for severe aortic stenosis (AS) before the cancer operations. Severe AS poses a great risk for noncardiac surgery. In the ACC/AHA 2007 Guideline on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, if the AS is symptomatic, elective noncardiac surgery should generally be postponed or canceled. Such patients require AVR before elective noncardiac surgery. On the other hand, in patients with severe AS who refuse cardiac surgery, noncardiac surgery can be performed with a mortality risk of approximately 10%. In our cases, severe AS was found in the preoperative examination. We informed them about necessary AVR before noncardiac surgery, and patients consented to our suggestion. AVR was performed around 7 days after this consent, and cancer operation was performed around 30 days after the AVR. However, there are no clear guidelines for this interval between AVR and cancer operation. In our cases the patients underwent the cardiac surgery and noncardiac surgery in a short period without serious complication in the perioperative management. It is very important to discuss among surgeon, cardiovascular surgeon, cardiologist and anesthesiologist. Especially anesthesiologist should take an important role in organizing these departments for such patients.     

Antihistamine effects of an ethanol extract from the white petals of Impatiens balsamina L

Using blood pressure (BP) monitoring in ddY Mice administered exogenous histamine, we tried to characterize the antianaphylactic mechanisms of a 35% ethanol extract (IB) from the petals of Impatiens balsamina L. Histamine was suggested to act as an initiator of anaphylactic hypotension in mice. IB could incompletely inhibit the first stage of hypotension caused by histamine. The antianaphylactic effect of IB was demonstrated to be different from that of diphenhydramine (DPH) a typical H₁ blocker.     

Preventive effects of Impatiens balsamina on the hen egg-white lysozyme (HEL)-induced decrease in blood flow

Monitoring the blood flow of unanesthesized mice was found to be a reliable and effective method for studying their anaphylactic responses, in addition to the known method of monitoring blood pressure. Hen egg-white lysozyme (HEL)-specific anaphylaxis in mice was estimated by monitoring the decrease in blood flow with a Doppler blood flow meter. This method is convenient for searching for both anaphylaxis and anti-anaphylactic substances from natural products. Using this system, we estimated the anti-anaphylactic effects of the 35% ethanol extract (IB) of petals of Impatiens balsamina L., as well as those of anti-allergic agents currently used. Kaempferol 3-rutinoside and lawsone from IB significantly inhibited the decrease of blood flow. We also found that platelet-activating factor (PAF) and serotonin participate in decreasing the blood flow, but histamine does not.     

Aneurysmal change of the ductus arteriosus after prostaglandin E1 administration for pulmonary atresia: Demonstration with magnetic resonance imaging

Summary We report a case of pulmonary atresia in which the ductus arteriosus underwent aneurysmal dilatation after infusion of prostaglandin E₁ incorporated in lipid microspheres. To our knowledge this is the first case in which this rare morphological change has been demonstrated with the noninvasive method of magnetic resonance imaging.     

Selection of multi-modality treatment of hepatocellular carcinoma

Multi-modalities of the treatment of hepatocellular carcinoma were utilized in clinical, however, we should consider not only tumor factors but also background of the patients and hepatic function reserve as well as multicentric carcinogenesis by hepatitis viruses. Most important message for clinician is how to select the suitable treatment for the patient based on survival rate and recurrence rate in each modalities. In this chapter, the author summarized the result of each treatment and indicated a selection of each treatment of hepatocellular carcinoma.     

Primary biliary cirrhosis in Japan: national survey by the Subcommittee on Autoimmune hepatitis

A total of 280 cases of primary biliary cirrhosis were reported from 86 institutes in Japan, of whom 208 were middle aged women. Four clinical stages (asymptomatic, pruritus, icteric and terminal stage) were set up for analysing clinical and histopathological features based on the natural course of the disease. The clinical and histopathological findings were similar to the study reported from the United States and European countries. Out of 270 cases examined, 245 (90.7%), had mitochondrial antibodies. Concerning the prognosis 37 of 120 asymptomatic patients developed symptoms and the average symptom-free period in these patients was 28.7 months. Fifty-eight cases were fatal and causes of death were hepatic failure in 27, gastrointestinal bleeding in 20 and others in 11 cases. Patients were subdivided into three groups to elucidate the survival rate in patients with different symptoms. Asymptomatic patients showed almost the same survival rate as the patients with pruritus alone, showing about 50% survival 8 years after the diagnosis, in contrast to jaundiced cases with only 13.6% surviving 8 years after the onset of this symptom.