Hitoshi Idani

Intra-tumoral injection of doxorubicin (adriamycin) encapsulated in liposome inhibits tumor growth, prolongs survival time and is not associated with local or systemic side effects.

Encapsulation of doxorubicin (Adriamycin) in liposome (LipADM) augments the anti‐tumor effects of the drug and reduces side effects such as cardiotoxicity. However, it does not always enhance anti‐tumor effects because of entrapment by the reticuloendothelial system. In this study, we investigated the anti‐tumor effect of LipADM injected directly into the tumor to augment tumor targeting. LipADM (7.5 mg/kg body weight), the same concentration as free ADM (FADM), was injected percutaneously or i.v. into 7‐day‐old established Meth‐A tumors in mice. Mock liposome was injected percutaneously into tumors of control mice. Mean relative tumor weights of the 5 groups on day 15 were as follows: intra‐tumoral injection of LipADM, 2.92 ± 1.09; intra‐tumoral injection of FADM, 6.99 ± 2.92; i.v. injection of LipADM, 11.07 ± 7.95; i.v. injection of FADM, 11.80 ± 6.55; control, 23.94 ± 9.03. Mean survival times were as follows: intra‐tumoral injection of LipADM, 46.2 ± 11.0 days; FADM, 34.6 ± 9.6 days; mock control, 30.2 ± 4.8 days. Histological examination showed no tissue damage at the site of s.c. injection of LipADM. ADM concentrations in tumor tissues after intra‐tumoral injection were persistently high in the LipADM‐treated group. Our results indicate that direct injection of LipADM into the tumor is therapeutically useful by producing persistently high concentrations of ADM in the target tissue, with few local and systemic side effects. Int. J. Cancer 88:645–651, 2000.

Acute intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication.

A rare case of paraesophageal hernia with complete intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication is described. An 85-year-old woman who had undergone laparoscopic Nissen fundoplication for gastroesophageal reflux disease presented 14 months later with nausea and vomiting. Esophagogastroendoscopy showed obstruction of the esophagogastric junction and gastric mucosal necrosis. Emergency laparotomy showed the stomach to be entirely strangulated into the thorax, with areas of necrosis. Gastrotomy was followed by resection of the necrotic anterior wall of the stomach, closure of the hiatus, and suturing of the stomach to the diaphragm. Appropriate closure of crura and anchoring suture between the stomach and diaphragm are helpful to prevent recurrent hernia after laparoscopic Nissen fundoplication.

Effect of aspirin continuation on blood loss and postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

No consensus exists whether to continue or withdraw aspirin therapy perioperatively in patients undergoing major laparoscopic abdominal surgery. To investigate whether preoperative continuation of aspirin therapy increases blood loss and associated morbidity during laparoscopic cholecystectomy and colorectal cancer resection, we compared duration of surgical procedures, amount of intraoperative blood loss, rate of blood transfusion, length of postoperative stay, rate of conversion to open surgery, and reoperation within 48 hours between patients with and without aspirin therapy preoperatively. Twenty-nine of 270 patients who underwent laparoscopic cholecystectomy and 23 of 218 patients who underwent laparoscopic colorectal cancer resection, respectively, were on aspirin therapy. We found no significant difference in the investigated outcome between groups with the exception of longer surgical duration of laparoscopic cholecystectomy in aspirin-treated patients. Although underpowered, above findings may suggest that aspirin continuation is unlikely to increase blood loss or postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

Laparoscopic low anterior resection using a triple stapling technique.

Laparoscopic low anterior resections using a triple stapling technique in five patients with rectal cancers (four Dukes A and one Dukes C) were performed. The location of the tumors was between 5 and 18 cm from the anal verge. For easy maneuverability, a 33-mm suprapubic port was used. In this technique, the Endo TA (the first stapler) is applied at the distal margin of the rectum to occlude the bowel. The bowel is irrigated with povidone-iodine solution and transected by an endolinear (the second) stapler. Anastomosis is completed by firing the circular (the third) stapler. The operative time was 177 +/- 28.0 minutes, estimated blood loss was 41.7 +/- 28.6 g, and flatus appeared 1.8 +/- 0.8 days after surgery. Follow-up studies have showed no local recurrence or distant metastasis. This procedure is safe and useful for performing laparoscopic low anterior resection.

Gastroenterological surgery: esophagus.

1-1 Which stages of thoracic esophageal cancer are indicated for thoracoscopic surgery? In many facilities, thoracoscopic surgery is indicated for cStages I, II, and III, except cT4, according to the TNM Classification of Malignant Tumours, seventh edition, or cStages I–IVa, except cT4, according to the Japanese Classification of Esophageal Cancer, 10th edition, edited by the Japan Esophageal Society.

Proper training in laparoscopic hernia repair is necessary to minimize the rising recurrence rate in Japan

The Japan Society for Endoscopic Surgery reported that the recurrence rate for inguinal hernia repair in Japan was less than 1% in 2010. However, its 2012 survey found that the recurrence rate had increased to 4% for the transabdominal preperitoneal procedure and 5% for the totally extraperitoneal procedure. We held 14 hernia repair training courses from 2011 to 2016 with help from Covidien. This study aimed to determine the effect of this training on the recurrence rate.

ENDOLUMINAL GASTROPLICATION FOR GASTROESOPHAGEAL REFLUX APPEARING AFTER GASTRIC SURGERY

Endoluminal gastroplication (ELGP) is a new endoscopic treatment for gastroesophageal reflux disease (GERD). However, its efficacy has been reported only for primary GERD but not for postoperative GERD. Here we report the first two cases of GERD that appeared after gastric surgery and were successfully treated by ELGP. Both patients developed GERD after gastric surgery. Esophagogastrofiberscopy showed esophagitis and small hiatal hernia. The symptoms failed to disappear after medical therapy and ELGP was performed. ELGP involved the use of the BARD (EndoCinchTM) endoscopic suturing system, where two to three plications were placed at the esophagogastric junction. Procedure time, start of soft diet and hospital stay were 55 min, the first postoperative day (POD), 5 days and 60 min, 1 POD and 5 days, for patients 1 and 2, respectively. No adverse events were noted apart from mild and transient epigastric pain. The GERD‐related symptoms markedly improved after ELGP. Improvements were also noted in acid exposure time and bile reflux time after the procedure. ELGP is safe and effective for GERD that develops after surgery although this needs to be confirmed in long‐term follow‐up studies. ELGP is potentially suitable for GERD after Billroth‐I distal gastrectomy with lymph node dissection for gastric cancer.