Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula.

An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. Selective bile duct cannulation was unsuccessful because of periampullary diverticula (PAD). A pancreatic spontaneous dislodgement stent (PSDS) (5F diameter, 3 cm, straight type) was inserted to prevent post-ERCP pancreatitis.

Predictors of poor prognosis by recurrence patterns after curative hepatectomy for hepatocellular carcinoma in Child-Pugh classification A.

Background/aims: The prevention of recurrence is important for improving long-term outcome for HCC. To identify candidates for postoperative adjuvant therapy after curative hepatectomy for HCC in Child-Pugh classification A (Child A).

Methodology: Of 157 patients who underwent initial hepatectomy for Child A HCC, 93 had recurrence and were divided into 2 groups: group A, ≤2 tumors, each <3 cm in size at the time of intrahepatic recurrence; group B, ≥3 tumors or tumor ≥3 cm in size at the time of intrahepatic recurrence and/or extrahepatic recurrence.

A new strategy with a grading system for liver metastases from colorectal cancer.

Background/aims: The optimal indications, including timing, for resection of liver metastases from colorectal cancer (CRCLM) remain controversial. The Japanese Society of Cancer of the Colon and Rectum has proposed "H-classification" based on the maximum size and number of CRCLM, and has advocated the "CRCLM-grade system", which involves adding the presence of primary lymph node metastasis status to H-classification. We evaluated clinicopathological factors in order to elucidate the optimal indications for and timing of hepatectomy.

Surgical treatment of extrahepatic recurrence of hepatocellular carcinoma.

Purpose: The purpose of this study was to clarify the clinicopathological features of extrahepatic hepatocellular carcinoma (HCC) recurrence after hepatectomy in order to schedule optimal treatment strategies for better long-term outcomes.

Methods: A cohort of 206 patients who had undergone curative hepatectomy for HCC was analysed; 133 patients had developed relapse. Among them, 101 patients had intrahepatic recurrence only (IHR), and 32 patients had extrahepatic recurrence (EHR).

Short- and long-term outcomes of laparoscopic versus open hepatectomy for small malignant liver tumors: a single-center experience.

Background: Laparoscopic hepatectomy (Lap-Hx) has been increasingly performed for patients with liver tumors as surgical techniques and devices have progressed. However, the long-term outcomes of Lap-Hx for malignant liver tumors are not oncologically guaranteed. This study compared the short- and long-term outcomes between Lap-Hx and open hepatectomy (Open-Hx) for malignant liver tumors by matched-pair analysis.

Reconsideration of the indications for adjuvant chemotherapy for liver metastases from colorectal cancer after initial hepatectomy.

Background: The effectiveness of perioperative adjuvant chemotherapy for colorectal cancer liver metastasis (CRLM) remains a matter of debate. Despite the lack of clear evidence supporting its effectiveness after curative hepatectomy, adjuvant chemotherapy has been widely used clinically. The purpose of this study was to clarify the indications for adjuvant chemotherapy in order to develop an appropriate treatment strategy for CRLM.

Surgical outcomes and clinical characteristics of elderly patients undergoing curative hepatectomy for hepatocellular carcinoma.

Background: The aim of this study was to investigate the clinical characteristics and outcomes of elderly patients (≥ 70 years old) undergoing curative hepatectomy for hepatocellular carcinoma (HCC).

Methods: Clinicopathological data and treatment outcomes in 100 elderly patients (≥ 70 years old) and 120 control patients (≤ 70 years old) with HCC who underwent curative hepatectomy between 2000 and 2011 were retrospectively collected and compared.

Results: The overall survival rate was similar between the two groups, but the disease-free survival rate was worse in the elderly group when compared with the control group.

Outcomes and predictors of microvascular invasion of solitary hepatocellular carcinoma.

Aim: Microvascular invasion (MVI) is an important risk factor for early recurrence of hepatocellular carcinoma (HCC), but preoperative prediction of MVI is difficult.

Methods: A retrospective review was undertaken on 167 patients with primary solitary HCC who underwent initial hepatectomy. Independent predictors of MVI were identified, and factors affecting disease-free survival in patients with MVI were clarified.

Clinical usefulness of endo intestinal clips during Pringle's maneuver in laparoscopic liver resection: a technical report.

Background: Control of bleeding is important in parenchymal transection during laparoscopic liver resection. We suggest a new technique using Endo intestinal clips for the intestinal tract to achieve easy, safe hepatoduodenal ligament clamping during laparoscopic liver resection.

Methods: In this study, 10 consecutive patients underwent pure laparoscopic liver resection.

Evaluation of postoperative antibiotic prophylaxis after liver resection: a randomized controlled trial.

Background: Antibiotic prophylaxis is frequently administered after liver resection to prevent postoperative infections. However, very few studies have examined the usefulness of antibiotic prophylaxis after liver resection. A randomized controlled trial was conducted to evaluate the postoperative antibiotic prophylaxis in patients after liver resection.

Multiple metastatic leiomyosarcoma of the pancreas: a first case report and review of the literature.

A 60-year-old woman was referred to our hospital with swelling of the right leg. After surgery, leiomyosarcoma of the right leg was diagnosed. Computed tomography showed two hypovascular masses in the pancreatic body and tail that were heterogeneously enhanced compared with the pancreatic parenchyma.

A case of gastric cancer after living donor liver transplantation.

Background: As newer immunosuppressive regimens have steadily reduced in the incidence of acute rejection and have extended the life expectancy of allograft recipients, posttransplant de novo malignancies have become an important cause of death in cadaveric donor transplantation. Also, according with the recent accumulation of living donor liver transplantation (LDLT), the number of posttransplant recipients with de novo malignancy will be anticipated to increase.

Case Report: A 60 year-old man underwent LDLT for hepatitis C virus-related cirrhosis with hepatocellular carcinoma.

Resection margin with anatomic or nonanatomic hepatectomy for liver metastasis from colorectal cancer.

Background: When hepatectomy is used as a primary treatment for liver metastasis from colorectal cancer (CRCLM), the balance between surgical curability and functional preservation of the remnant liver is of great importance.

Methods: A total of 108 patients who underwent initial hepatectomy for CRCLM were retrospectively analyzed with respect to tumor extent, operative method, and prognosis, including recurrence.

Results: The 1-, 2-, 3-, and 5-year overall survival rates (OS) for all patients were 90.

Clinicopathological risk factors for recurrence within one year after initial hepatectomy for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) shows a high rate of recurrence after hepatectomy; predictive factors for early recurrence would help determine optimal therapeutic and management strategies. Among 163 patients with HCC undergoing hepatectomy with curative intent, 46 patients developed recurrence within 1 year. Clinicopathological data were retrospectively analyzed to identify predictive parameters for early recurrence.

Re-evaluation of the necessity of prophylactic drainage after liver resection.

Abdominal drainage after liver resection is considered unnecessary: however, there still exist a number of cases where drain is effective to prevent serious infectious complications. We re-evaluated the necessity of drain placement after liver resection from the retrospective analysis of postoperative complications with special reference to the need for drain insertion of 140 patients undergoing hepatectomy without intraoperative abdominal drainage from 2007 through 2010. Three patients required drain reinsertion in the early postoperative period (before postoperative Day 7); all had undergone extended right hepatectomy for hepatocellular carcinoma with portal vein thrombus followed by postoperative liver failure.

Prognostic clinicopathological factors after curative resection of small bowel adenocarcinoma.

Purpose: Small bowel adenocarcinoma is a relatively uncommon neoplasm that accounts for approximately 0.3% to 2.4% of digestive cancers.

Appropriate treatment strategy for intrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma.

Introduction: The aim of this study is to evaluate the appropriate treatment for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma (HCC).

Methods: Of 151 patients who underwent initial hepatectomy for HCC, 82 had intrahepatic recurrence and were divided into two groups: group A, ≤2 tumors, each 3 cm in size; and group B, beyond the group A. Survival and treatment in each group were analyzed retrospectively to determine the best therapeutic modality for intrahepatic recurrence.

Small skin incision left-side hepatectomy.

Although pure laparoscopic liver resection is thought to be a useful method in terms of cosmetic outcome and less invasiveness, this procedure has not yet become widespread, presumably due to its high technical demands and proficiency requirements. In order to achieve surgical safety and minimum invasiveness simultaneously, we recently implemented a small skin incision left hepatectomy technique, which is feasible in most centers not currently performing the pure laparoscopic technique. To summarize, a small skin incision of 8-10 cm is taken on the right subcostal region, and Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) is attached to appropriately expand the wound.

Clinical risk factors for postoperative bile leakage after liver resection.

In liver surgery, postoperative bile leakage occurs with a steady incidence and hampers the clinical course of patients, even giving rise to mortality. Clinical parameters of 20 patients complicated with postoperative bile leakage were retrospectively compared with those of 394 patients without this complication after liver resection. On multivariate analysis, significant independent risks for postoperative bile leakage included the following: (1) high-risk operative procedure that exposes the major Glisson's sheath on the cut surface, including caudate lobectomy, central bisegmentectomy, and right anterior sectionectomy, (2) repeated hepatectomy, and (3) the presence of intraoperative bile leakage.

Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis.

Background: Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors.

Methods: Eighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.

Optimal timing for removal of abdominal drainage after liver resection for hepatocellular carcinoma.

The aim of this study was to retrospectively assess the optimal timing for removal of abdominal drainage after liver resection for hepatocellular carcinoma (HCC). A total of 148 patients were divided into 2 groups. In Group I, drains were removed according to the judgment of the surgeon.

Effectiveness of a surgical glove port for single port surgery.

Background: A new surgical concept, such as single port surgery (SPS), usually raises many questions regarding safety, usefulness, appropriateness, applicability, and cost. Because many new port devices have been developed, choosing the type of port device for SPS is the most important factor. We herein briefly report our newly developed SPS port made using a standard surgical glove.