Pylorus-preserving pancreaticoduodenectomy versus conventional pancreaticoduodenectomy for pancreatic adenocarcinoma.

Purpose: A few randomized controlled trials have questioned the justification of pylorus-preserving pancreaticoduodenectomy (PpPD) for pancreatic cancer and periampullary cancer. However, the characteristics of pancreatic cancer are remarkably different from those of other periampullary cancers, so the outcomes of PD and PpPD for pancreatic cancer are being re-evaluated.

Methods: We studied retrospectively, 55 patients who underwent PpPD at Wakayama Medical University Hospital between 1999 and 2005, when PpPD was available, for pancreatic head adenocarcinoma.

Xanthogranulomatous cholecystitis: the use of preoperative CT findings to differentiate it from gallbladder carcinoma.

Background And Aim: A retrospective analysis was performed on 32 patients with histologically confirmed xanthogranulomatous cholecystitis (XGC) and 21 patients with gallbladder carcinoma who underwent surgical treatment between 1998 and 2007.

Methods: All patients underwent preoperative CT scanning. The CT features analyzed were: the presence of intramural hypoattenuated nodules or bands, mucosal line, the patterns of wall thickening and enhancement, and the presence of stones in the gallbladder.

Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function.

Background/purpose: This study aimed to construct a formula for assessing liver function in order to prevent post-hepatectomy liver failure.

Methods: A formula was constructed by analyzing data from 28 patients with hepatocellular carcinoma (HCC) with liver cirrhosis operated on between 1981 and 1984. Next, we evaluated the validity of this formula in 207 hepatectomy patients operated on from 1985 to 1999.

A collision tumor composed of cancers of the bile duct and ampulla of Vater--immunohistochemical analysis of a rare entity of double cancer.

Collision cancer of the bile duct and the papilla of Vater is an extremely rare entity. This is the first report of a case of bile duct collision cancer. A 75-year-old man presented with jaundice.

Nonhepatocytic malignant mixed tumor of the liver in adults: report of a long surviving case.

A primary nonhepatocytic malignant mixed tumor in the liver contains both epithelial and mesenchymal components, and the incidence in adults is extremely rare. A 45-year-old female was admitted because of abdominal fullness. Abdominal imaging studies revealed a huge cystic tumor with a mural nodule in the right lobe.

Laparoscopic splenectomy is a safe and effective procedure for patients with splenomegaly due to portal hypertension.

Background/purpose: This study was conducted retrospectively to examine whether laparoscopic splenectomy is an effective procedure for patients with splenomegaly due to portal hypertension in comparison to patients with a normal-sized spleen.

Methods: From September 1994 to May 2005, we performed laparoscopic splenectomy in 50 patients at Wakayama Medical University Hospital, Japan. Of these, 17 patients with splenomegaly due to portal hypertension and 17 patients with idiopathic thrombocytopenic purpura (ITP) with normal-size spleen were enrolled in this study, in which we compared the surgical outcome between patients with splenomegaly due to portal hypertension and those without splenomegaly (ITP group).

Successful interventional dilatation of a complicated stricture of the anastomotic colon: report of a case.

Colonic anastomotic strictures are usually secondary to ischemia, leakage, inflammation, or hemorrhage at the anastomotic line. Several techniques for stricture dilation including endoscopic and radiologic dilation have been reported to avoid surgery. However, if colonic strictures are more than 1 cm long and the diameter is <5 mm, surgery is usually necessary.

Liver metastasis as an initial recurrence has no impact on the survival of patients with resectable pancreatic adenocarcinoma.

Background: Prognosis of the patients with pancreatic adenocarcinoma is still poor due to a recurrence, and liver metastasis is a distant metastasis that is foreboded the short survival period.

Methods: Between 1999 and 2005, 68 patients for pancreatic adenocarcinoma underwent a pancreaticoduodenectomy (n = 17), a pylorus-preserving pancreaticoduodenectomy (n = 27), distal pancreatectomy (n = 22), or total pancreatectomy (n = 2) with an extensive lymph node dissection.

Results: A tumor recurrence occurred to 55 patients (13 of the liver, 21 of the local recurrence, 16 of peritoneal dissemination, three of the lymph node, and two of lung).

Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure.

Background And Aims: Bleeding from the hepatic vein is closely related to central venous pressure (CVP). To evaluate the effect of low central venous pressure during a hepatectomy, the infrahepatic inferior vena cava (IVC) was half clamped.

Patients And Methods: Between 2006 and 2007, 20 patients undergoing major hepatectomy with the IVC half clamping (half-clamping group) were compared with 58 patients undergoing hepatectomy without IVC half clamping between 2003 and 2005 (control group).

Clinical significance of drainage tube insertion in laparoscopic cholecystectomy: a prospective randomized controlled trial.

Background/purpose: We aimed to investigate the appropriateness of inserting an intraperitoneal drainage tube after laparoscopic cholecystectomy (LC), based on postoperative pain and clinical courses, in a randomized comparative study.

Methods: One hundred and twenty patients who were to have LC were enrolled in this prospective randomized study. An 8-mm Penrose drain was retained below the liver bed for 42 h in each of 60 patients (group A), and no drain was retained in the remaining 60 patients (group B).

Prognostic factors for long-term survival in patients with locally invasive pancreatic cancer.

Background/purpose: We aimed to investigate predictors of survival in patients with resectable locally invasive pancreatic cancer.

Methods: The patient cohort consisted of 55 patients with locally invasive pancreatic cancer (International Union Against Cancer [UICC] stage III in 36 patients and stage IV in 19) who had undergone resection. The patients were informed about the advantages and the adverse effects of postoperative chemotherapy, and prospectively selected either observation alone or postoperative chemotherapy.

CLIP method (preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery) reduces intraoperative bleeding during pancreaticoduodenectomy.

Background: No previous reports have prospectively discussed an operative approach to reducing intraoperative bleeding during pancreaticoduodenectomy (PD). We have established the preoperative CT image-assessed ligation of inferior pancreaticoduodenal artery (IPDA) method (CLIP), which uses a preoperative three-dimensional computed tomographic (3D-CT) image to precisely detect the IPDA root intraoperatively and ligates the IPDA before the pancreas head is isolated. The aim of this study was to clarify whether the new operative approach reduces intraoperative bleeding compared with classical PD.

Pathogenesis of hepatolithiasis based on the analysis of components of intrahepatic stones.

Background/aims: It has been thought that intrahepatic stones are brown pigment stones (bilirubin carbonate stones) but we analyzed a chemical compound to reveal that intrahepatic stones have unique components, and studied their pathogenesis.

Methodology: A total of 45 gallbladder stones (15 cholesterol stones, 15 black pigment stones, and 15 brown pigment stones) and 15 intrahepatic stones were analyzed about amounts of fatty acids, bile acids and trace elements in the gallstones. Thus we established the characteristic components of the intrahepatic stones and studied their pathogenesis.

Prevention of postoperative infections by administration of antimicrobial agents immediately before surgery for patients with gastrointestinal cancers.

Background/aims: This study was conducted to judge the effect of intravenous administration of antimicrobial agents immediately before surgery for patients with gastrointestinal cancers to prevent postoperative surgical site infections (SSIs) and remote site infections.

Methodology: A total of 3437 patients with gastrointestinal cancers underwent standby operations in Wakayama Medical University Hospital between 1987 and 2002. Of these, 1483 were treated between 1987 and 1995, and intravenous antimicrobial agents were used only postoperatively for 2 to 5 days (no AMP group).

The role and mechanism of fatty acids in gallstones.

Background: Cholelithiasis is a common entity in China, but its etiology and pathogenesis have not been fully elucidated. Pigment stones of the intrahepatic and extrahepatic bile duct still form a high proportion in China, while they are rare in Europeans. To date, reports on fatty acids in stones remain few.

Repeat reduction surgery after an initial hepatectomy for patients with colorectal cancer.

A hepatectomy is the only treatment offering long-term survival in patients with colorectal liver metastases. However, 70-80% of the patients with a complete resection develop recurrent disease after an initial hepatectomy. Sixty-one patients who underwent metastases from colorectal carcinoma with a curative hepatectomy were entered into this study.

Reducing residual and recurrent stones by hepatectomy for hepatolithiasis.

The long-term outcomes of 97 consecutive patients with hepatolithiasis, who underwent treatment from January 1971 to June 2006, were analyzed. The short-term outcomes included the rate of residual stones and complications after treatment, whereas the long-term results included the stone recurrence rate. In 22 of the 97 (22.

Adenoviral vector expressing hepatocyte growth factor promotes liver regeneration by preoperative injection: the advantages of performing selective injection to the remnant lobe.

Background: In a cirrhotic liver, the regenerative ability is impaired and liver failure may occur after a hepatectomy. Hepatocyte growth factor (HGF) stimulates liver regeneration and adenoviral vector expressing hepatocyte growth factor (AdHGF) allows hepatocyte growth factor (HGF) to be persistently expressed. The aim of this study is to evaluate the benefits of the selective and preoperative injection of AdHGF to the remnant lobes to regenerate the liver.

Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma.

Background: A fistula between the duodenum and the main portal vein near a peptic ulcer is extremely rare, and only two cases of duodenal ulcers have been reported in the past.

Case Presentation: We report a 68-year-old man with a diagnosis of anemia who had a history of extended right hepatectomy for hilar cholangiocarcinoma 20 months previously. The first endoscopic examination revealed a giant peptic ulcer with active bleeding at the posterior wall of the duodenal bulbs, and hemostasis was performed.

Potential predictors of survival after surgery for colorectal cancer patients with synchronous unresectable liver metastases.

Liver resection has been recognized as the best treatment for patients with colorectal liver metastases, but as a curative resection for multiple and bilobar colorectal liver metastases (MBCLM) it is definitely less effective. We clarify predictors of survival for unresectable MBCLM. Potential predictors of overall survival, and the correlation between tumor marker and survival were evaluated for patients with synchronous unresectable MBCLM, including 6 rectal and 17 colon cancers.

Effect of normothermic perfusion using fructose-1,6-bisphosphate for maintenance of liver function during in situ extended hepatectomy by the total hepatic vascular exclusion technique.

Background: Recently, hepatic surgery has made remarkable progress, and it is important to use appropriate liver perfusion. We evaluated the effect of normothermic liver perfusion with the addition of fructose-1, 6-bisphosphate (FBP) and oxygenation to maintain liver parenchymal, non-parenchymal, and Kupffer cell function.

Materials And Methods: The rats were divided into five groups according to the perfusate and continuous perfusion was performed: Control group = 4 degrees C lactate Ringer with 10% glucose (LRG) solution; normothermic group = 25 degrees C LRG solution; normothermic oxygenated group = 25 degrees C oxygenated LRG solution; normothermic FBP group = 25 degrees C LRG solution with addition of 10 mmol/L FBP; normothermic oxygenated FBP group = 25 degrees C oxygenated LRG solution with addition of 10 mmol/L FBP.

Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients.

Objective: The aim of this study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications.

Background Data: The significance of prophylactic drains after pancreatic head resection is still controversial. No report discusses the association of the period of drain insertion and postoperative complications.

Impact of lymph node metastasis on survival in patients with pathological T1 carcinoma of the ampulla of Vater.

To determine the prognostic factors for patients with pathological T1 (pT1) carcinoma of the ampulla of Vater, 36 consecutive patients with carcinoma of the ampulla of Vater who underwent surgery were retrospectively analyzed in terms of clinicopathological features. The overall 5-year Kaplan-Meier survival in all patients was 50.2%, and the median survival of all patients was 64.

Combination gene therapy of HGF and truncated type II TGF-beta receptor for rat liver cirrhosis after partial hepatectomy.

Background: In a cirrhotic liver, the regenerative ability and specific functions are impaired; a hepatic resection increases the possibility of postoperative liver failure. Hepatocyte growth factor (HGF) stimulates liver regeneration, accelerates restoration of hepatic function, and improves fibrosis. A truncated type II transforming growth factor-beta receptor (TbetaTR), which specifically inhibits TGF-beta signaling as a dominant-negative receptor, appears to prevent the progression of liver fibrosis.

Does postoperative chemotherapy have a survival benefit for patients with pancreatic cancer?

In our study, we investigated whether postoperative chemotherapy improved survival in patients with invasive ductal carcinoma of the pancreas. Between 1987 and 2004, 111 patients underwent pancreatic resection against invasive ductal carcinoma of the pancreas in Wakayama Medical University Hospital. Median survival time (MST) was 19.