Ikuo Oikawa

Lack of Survival Benefit of Extended Lymph Node Dissection for Ductal Adenocarcinoma of the Head of the Pancreas: Retrospective Multi-institutional Analysis in Japan

Abstract. It has not been established that extended lymph node resection is necessary for ductal adenocarcinoma of the head of the pancreas. According to the general rules for the study of pancreatic cancer, a multiinstitutional, retrospective clinical study was undertaken to investigate the efficiency of extended lymph node dissection for this malignancy. Altogether 501 patients underwent resection of the pancreas between 1991 and 1994 at 77 medical facilities; the surgical procedures, staging, lymph node dissection, curability, and survival rate were analyzed retrospectively. Eighteen of the patients died within 30 postoperative days, leaving 483 patients to be studied. The resection was curative microscopically in 94 patients, resulting in a 3-year survival of 29%. Macroscopically curative resection resulted in a 3-year survival of 14%; noncurative resection produced a 3-year survival of 6%. Although extended lymph node dissection was performed on 38 patients in stage I, 42 patients in stage II, 206 patients in stage III, and 1 patient in stage IV, there was no improvement in survival when the results were compared to those seen after standard or palliative lymph node dissection. The extent of lymph node dissection has not affected the prognosis for ductal adenocarcinoma of the head of the pancreas at any stage of the course of the disease. Excessive lymph node dissection in advanced cases does not necessarily lead to a favorable prognosis. The patients who undergo a radical operation with an adequate lymph node dissection have longer survivals.

Neuroendocrine Carcinoma of the Extrahepatic Biliary Tract with Positive Immunostaining for Gastrin-Releasing Peptide: Report of a Case

We report herein the first documented case of gastrin-releasing peptide-positive neuroendocrine (NE) carcinoma of the extrahepatic biliary tract. An invasive tumor measuring 2.5 x 1.5 cm was located in the confluence portion of the cystic duct in a 70-year-old Japanese man. Histologically, the tumor was found to be composed of small polygonal cells which formed a solid and trabecular structure, and the frequencies of both mitoses and small necrotic areas were dominant. The tumor cells were immunoreactive to the NE markers chromogranin-A and neuron-specific enolase, as well as to carcinoembryonic antigen and gastrin-releasing peptide. Although a few cases of gastrin-releasing peptide-positive small-cell lung carcinoma have been documented, there have been no reports of gastrin-releasing peptide-positive NE carcinoma occurring in the gastrointestinal tract. We consider our case not merely to be of pathological interest, but also to have clinical and therapeutic implications.

HEMOBILIA CAUSED BY A GIANT BENIGN HEMANGIOMA OF THE LIVER : REPORT OF A CASE

We report herein the extremely unusual case of a 39-year-old woman in whom a giant cavernous hemangioma caused hemobilia. Cavernous hemangioma is the most common benign neoplasm of the liver and rarely causes any clinical symptoms or signs, while hemobilia usually occurs secondary to accidental operative or iatrogenic trauma, vascular disease, inflammatory disorders, gallstones, or tumors of the liver. Although invasive or malignant hepatic tumors often result in a communication between the biliary tract and the blood vessels, only one case of hemobilia caused by a benign cavernous hemangioma has ever been reported, but with no details about the patient. Our patient presented to a local hospital with severe melena as the initial main symptom, where ligation of the right hepatic artery was performed. This failed to relieve her symptoms, and she was subsequently referred to our department where a right hepatectomy was performed. Histopathological examination revealed no malignancy combined with the tumor; however, the hemangioma was exposed to the bile duct in segment VIII, which was presumably the cause of the hemobilia. This patient remains in good health almost 6 years after her operation. To the best of our knowledge this is the first case report of hemobilia caused by a cavernous hemangioma, and is accompanied by a detailed analysis.

Monitoring perioperative hepatic venous oxygen saturation (ShvO2) in hepatectomy—Changes of ShvO2 in hemorrhagic shock

Hepatic venous oxygen saturation (ShvO2) is an indicator of the hepatic oxygen supply-to-demand ratio, which can be used to estimate adequate hepatic blood flow if hepatic oxygen is constant. We monitored ShvO2 intraoperatively and postoperatively in a patient who underwent right hepatic lobectomy. Decreases in ShvO2 were noted during surgical maneuvers which included manipulation of the hepatic hilum and mobilization of the liver. The ShvO2 recovered immediately after termination of these procedures. After the operation the patient developed hypovolemic shock due to postoperative bleeding; blood pressure dropped from 120 to 90 mmHg and the ShvO2 fell from 70% to 30%. Dopamine (5μg/kg per min) was administered to maintain the blood pressure. Temporary cessation of the dopamine infusion caused a decrease in ShvO2 (from 85% to 75%) without a major change in blood pressure. Dopamine increases hepatic blood flow, and accordingly, this decrease in ShvO2 must have been caused by cessation of the dopamine infusion. This finding suggests that ShvO2 can be used to determine optimal dopamine dosage for maintaining hepatic blood flow. From these observations, ShvO2 accurately reflects changes in hepatic blood flow and ShvO2 monitoring was helpful in avoiding hepatic ischemia during the periperative period in a patient undergoing a hepatectomy. Unexpected changes in hepatic blood flow can be immediately identified by monitoring ShvO2, enabling more rapid intervention.

An experimental study on the effects of selected drugs on pancreatic regeneration after partial pancreatectomy

This study was undertaken to determine the effect of the single and combined administration of caerulein, hydrocortisone, and FOY-305 (camostat) on the regeneration of the remnant pancreas after a 90% pancreatectomy in rats. After undergoing either a sham operation or a 90% pancreatectomy, the rats were administered the three drugs either singly or in combination. After the rats were killed, the pancreas was weighed and examined for tissue amylase activity, tissue protein content and total DNA content. The results were as follows: In the sham operation group, the caerulein among three drugs produced a significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. In the 90% pancreatectomy group, of the three drugs administered, hydrocortisone produced the most significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. These data suggest that the trophic effect of caerulein is significant in mature pancreatic cells while that of hydrocortisone is an immature one and that an additive effect of the three drugs was observed.