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31.
Itaru Endo Mitsutaka Sugita Hideki Masunari Kenichi Yoshida Kazuhisa Takeda Hitoshi Sekido Shinji Togo Hiroshi Shimada 《Journal of gastrointestinal surgery》2008,12(5):962-965
High hepatic duct resection sometimes is unavoidable in achieving curative resection of hilar cholangiocarcinoma, as tumor
cells can extend further than expected along the bile ducts from the macroscopically evident cancer. In patients undergoing
left hemihepatectomy with caudate lobectomy whose bile duct must be severed at the subsegmental bile duct levels, the orifices
of the posterior bile ducts would lie behind the right portal vein. Conventional hepaticojejunostomy would be risky in such
cases because an anastomosis performed in the usual manner would be subjected to strain. Instead, between 2002 and 2004, three
patients underwent retroportal hepaticojejunostomy using a jejunal limb mobilized and positioned behind the hepatoduodenal
ligament. Primary tumors were classified as type IV in the Bismuth–Corlette classification. Tension-free hepaticojejunal anastomosis
was performed successfully in all three patients; insufficiency of the hepaticojejunostomy did not develop. Neither early
nor late complications directly related to this method occurred. Retroportal hepaticojejunostomy, thus, permits more peripheral
resection of the hepatic duct while providing a sufficient operative field for safe, tension-free anastomosis. This technique
is very useful for patients undergoing left hemihepatectomy requiring high hilar resection of the bile duct. 相似文献
32.
Hiroshi Shimada Kuniya Tanaka Kenichi Matsuo Shinji Togo 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2006,391(2):130-142
Background Recent advances have extended indications for hepatectomy to include multiple bilobar colorectal liver metastases (CLM). Staging
systems based on the biological malignancy of primary and metastatic tumors provide appropriate indications for hepatectomy
in CLM. However, suitability for resection in patients with complex and extensive hepatic metastases is controversial.
Methods A medline search was performed to identify papers reporting the resection for CLM. Techniques, indication, and results were
reviewed.
Results If the anticipated remnant liver volume is small (25–40% of total), suggesting a high risk of postoperative liver failure,
portal vein embolization (PVE) is recommended prior to hepatectomy. However, curative resections are not always possible.
Specifically in synchronous multiple bilobar CLM, two-stage hepatectomy, comprising bilateral hepatectomy and primary resection
with or without PVE, can prevent growth of ipsilateral metastatic nodules in the remnant liver and reduce surgical risk. Several
local ablation techniques can complement surgery if hepatic resection alone increases the risk of postoperative liver failure
or is not curative. Chemotherapy combined with targeted treatment can suppress recurrence and extend indications for hepatectomy
by reducing the size and number of primary irresectable tumors.
Conclusion PVE or staged procedure combining with local ablation or neoadjuvant, downstaging or adjuvant therapies extends indications
for hepatectomy to include multiple bilobar CLM. The 5-year survival rate for multiple bilobar CLM treated with alternating
hepatectomy and chemotherapy is comparable to the values reported for single and hemilateral CLM. 相似文献
33.
Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion 总被引:1,自引:0,他引:1
Endo I Shimada H Fujii Y Sugita M Masunari H Miura Y Tanaka K Misuta K Sekido H Togo S 《Journal of Hepato-Biliary-Pancreatic Surgery》2001,8(6):505-510
Abstract.
Purpose: Hepatoduodenal ligament invasion (HLI) is an inhibiting factor for the curative resection of advanced gallbladder cancer.
The aim of this study was to clarify the indications for surgical resection in patients with advanced gallbladder cancer with
and without HLI by analyzing outcomes.
Methods: The subjects were 58 patients with advanced gallbladder cancer who underwent aggressive resection, and 20 nonresected patients
diagnosed as haring HLI. The presence of stromal cancerous infiltration at six sites in the hepatoduodenal ligament was investigated.
The extent of cancer spread was classified into two grades by the number of sites where cancer cells detected: low grade,
one or two invasion sites; high grade, three or more sites.
Results: Pancreatoduodenectomy, vascular reconstruction, and extensive hepatectomy were frequently performed in the patients with
HLI. The cumulative 5-year-survival rate of the HLI patients was 10.9%, significantly worse than that of the resected patients
without HLI (46.6%; P < 0.01). Patients with paraaortic lymph node metastasis died within 1 year. The cumulative 5-year-survival rate after curative
resection was 38.1%, significantly better than that after noncurative resection (0%; P < 0.05). The survival was significantly worse in patients with high-grade invasion than in these with low-grade invasion
(P < 0.05), being equivalent to that in the nonresection patients. Of four factors, operative curability, hepatic lobectomy,
HLI grade, and paraaortic lymph node metastasis, the HLI grade and hepatic lobectomy were considered to be significant prognostic
factors by Cox's multivariate analysis (backward stepwise method).
Conclusions: Aggressive surgical resection for curative purposes should be limited to patients with low-grade HLI and metastasis-negative
paraaortic lymph nodes.
Received: January 9, 2001 / Accepted: May 11, 2001 相似文献
34.
Fujii Y Ueda M Yoshida K Matsuo K Takeda K Morioka D Tanaka K Endo I Togo S Shimada H 《Nihon Geka Gakkai zasshi》2006,107(4):177-181
Standardization of surgical procedure for pancreatic cancer has been recognized to be necessary and important these days. Recent studies appear to exhibit efficacy of the adjuvant chemoradiation therapy before or after pancreatic surgery. In this study, we examined the standard surgery as part of the multidisciplinary treatment for pancreatic cancer. Invasive ductal carcinoma of the pancreas was resected in 121 patients in our institution from 1992 through 2005. We stopped performing an extended lymphadenectomy with pancreatectomy in 2003, but the survival rates were not significantly different between the cases before and after 2003. We usually resect half of the nerve plexus around the superior mesenteric artery (SMA) as a standard procedure. When we achieved the microscopically curative resection (R0) even if the plexus around SMA or the portal vein was invaded, there were a few long survivors for more than five years. The R0 resection is the most important factor for prolonged survival. Pancreatectomy including removal of regional lymph nodes (D2) and half of the nerve plexus around SMA and combined resection of the infiltrated portal vein is thought to be a standard surgery from the viewpoint of decrease in morbidity and maintenance of curability. 相似文献
35.
the role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy 总被引:3,自引:0,他引:3
Koichiro?MisutaEmail author Hiroshi?Shimada Yasuhiko?Miura Osamu?Kunihiro Toru?Kubota Itaru?Endo Hitoshi?Sekido Shinji?Togo 《Journal of gastrointestinal surgery》2005,9(2):245-253
Division of the splenic vein was performed in 29 patients who underwent pancreatoduodenectomy to achieve lymph node dissection
and neural resection around the superior mesenteric artery. The basic protocol for the splenic vein reconstruction to reduce
congestion of the spleen and stomach is as follows. When the inferior mesenteric vein (IMV) drained into the splenic vein,
the confluence was preserved without reconstruction of the splenic vein. When the IMV drained into the superior mesenteric
vein (SMV) or the splenomesenteric angle, the division of the IMV and spleno-IMV anastomosis were performed. In postoperative
venography, nine patients showed downward flow (from the splenic vein to the IMV) and three patients showed upward flow (from
the IMV to the splenic vein). Postoperative computed tomography scans showed venous dilatation and splenomegaly in the upward
flow group; there were no patients in the downward flow group. In selected patients, splenic vein reconstruction is necessary
to reduce congestion of the spleen and stomach. When the flow is downward, spleno-IMV flow should be preserved. When the flow
is upward, spleno-SMV anastomosis is necessary instead of spleno-IMV anastomosis. 相似文献
36.
Atsuo Yamada Hirotsugu Watabe Shuntaro Obi Takafumi Sugimoto Shintaro Kondo Miki Ohta Goichi Togo Keiji Ogura Yutaka Yamaji Makoto Okamoto Haruhiko Yoshida Takao Kawabe Kazuhiko Koike Masao Omata 《Digestive endoscopy》2011,23(2):124-129
Background: Patients with hepatocellular carcinoma (HCC) sometimes suffer from obscure gastrointestinal bleeding. Portal hypertension (PH), common in cirrhosis, induces esophagogastric varices. Because of the location, PH also may influence mucosal abnormalities in the small intestine. The objective of this study is to estimate the prevalence of small intestinal mucosal abnormalities in HCC patients using capsule endoscopy (CE). Patients and Methods: We prospectively conducted CE in HCC patients, and analyzed the findings in relation to hepatic function, the number and size of HCC tumor and findings obtained by conventional endoscopy. Results: Thirty‐six patients (aged 66.7 ± 7.5 years, 29 men) underwent CE. Abnormal findings in the small bowel were found in 16 patients (44%), angioectasias in eight patients (22%), erosions in five (14%), varices in four (11%), polyps in four (11%), and submucosal tumor in one (3%). The patients with angioectasia had a larger spleen index than the no abnormal lesions group (85.4 ± 15.8 vs 59.0 ± 24.4, P = 0.02). The former group had been more frequently treated for esophageal varices endoscopically (62% vs 15%, P = 0.02). Large HCC nodules seemed more common in the patients with angioectasia than subjects without abnormal lesions (38% vs 5%, P = 0.06). Small intestinal varices also seemed to have a positive association with large HCC. During the follow up after CE, one patient with small intestinal polyps suffered from obscure gastrointestinal bleeding. Conclusions: CE revealed that HCC patients frequently have small intestinal mucosal lesions. In particular, small intestinal angioectasia, which may cause obscure gastrointestinal bleeding, seems to be associated with portal hypertension. 相似文献
37.
38.
Takami M Idei T Nakayama Y Ohta H Fukai H Matsumoto H Togo Y Sakamoto H Yamamoto T Satoh K 《Gan to kagaku ryoho. Cancer & chemotherapy》2002,29(2):305-308
Carcinosarcoma of the ovary is a very rare and highly malignant neoplasm that accounts for less than 1% of ovarian neoplasms. Survival of patients with advanced stage cancer is poor and the best treatment is not clear. We report the case of a 60-year-old woman who had Stage IV advanced heterogeneous ovarian carcinosarcoma with lung and liver metastases. The lesions were considered surgically incurable, so she was placed on neoadjuvant chemotherapy of combination CPT-11 (60 mg/m2, day 1, 15) and CDDP (60 mg/m2, day 1). Tumor markers of CA125 and LDH decreased remarkably to the normal level after 3 and 4 courses of chemotherapy, respectively. After 7 courses of chemotherapy, the ovarian tumor was obviously reduced, and the lung and liver metastases had disappeared. The patient was then able to undergo surgery. The current case suggests that combination CPT-11 and CDDP is effective against advanced ovarian carcinosarcoma. 相似文献
39.
40.
Belogubova EV Togo AV Kondrat'eva TV Lemekhov VG Barchuk AS Romanenko SM Khanson KP Imianitov EN 《Voprosy onkologii》2000,46(5):549-554
The published studies of onco-associated genetic polymorphisms are characterized by insufficient interlaboratory reproducibility. The inconsistency of the results can be partially attributed to some characteristics of patients and control groups, which are used for the comparison of allele frequencies. For instance, many investigations involve so-called "healthy donors" as a standard. However, the efficiency of such a comparison can be questioned; indeed, as an individual life-time risk of malignancy reaches as high as 40-50%, a significant part of "healthy donors" would soon or later become the oncological patients. Here we tested the advantage of using "true" oncologically tolerant individuals as an additional control, e.g. tumor-free people, who succeeded to achieve an elderly age without signs of any neoplastic disease. GSTM1 gene polymorphism was used as a "positive control" for this novel design of molecular epidemiological study, as the GSTM1-null genotype displays slight but reproducible association with lung cancer risk. In the present investigation, GSTM1-deficiency was detected in 45% elderly tumor-free individuals, 55% healthy middle-aged donors, and 59% lung cancer patients. The minimal frequency (43%) of GSTM1(-) genotype was detected in elderly tumor-free smokers, and the maximal one (100%) was found in never-smoking lung cancer patients. Thus, the comparison of lung cancer patients to the "true" oncologically tolerant cohort (elderly tumor-free individuals, especially smokers) revealed more demonstrative deviations for the unfavorable genotype, than the traditional comparative analysis between oncological patients and healthy donors. 相似文献