Izumi Yamaguchi

Standardized less invasive living donor hemihepatectomy using the hybrid method through a short upper midline incision.

BACKGROUND Recently, applications of less invasive liver surgery in living donor hepatectomy (LDH) have been reported. The objective of this study was to evaluate the safety and efficacy of a hybrid method with a midline incision for LDH. METHODS Hemihepatectomy using the hybrid method was performed in the fifteen most recent among 150 living donors who underwent surgery between 1997 and August 2011. Six donors underwent right hemihepatectomy and 9 underwent left hemihepatectomy. An 8-cm subxiphoid midline incision was created for hand assistance during liver mobilization and graft extraction. After sufficient mobilization of the liver, the hand-assist/extraction incision was extended to 12 cm for the right hemihepatectomy and 10 cm for a left hemihepatectomy. Encircling the hepatic veins and hilar dissection were performed under direct vision. Parenchymal transection was performed with the liver hanging maneuver. Bile duct division was performed after visualizing the planned transection point by encircling the bile duct using a radiopaque marker filament under real-time C-arm cholangiography. RESULTS All procedures were completed without any extra subcostal incision. All grafts were safely extracted through the 10-12-cm upper midline incision without mechanical injury. No donors required an allogeneic transfusion; all of them have returned to their preoperative activity levels. CONCLUSION LDH by the hybrid method with a short upper midline incision is a safe procedure.

Self-assessment of postoperative scars in living liver donors.

The application of less invasive techniques for liver surgery in patients undergoing living donor hepatectomy (LDH) has been reported. The objective of this study was to evaluate physical status according to type of incision in donors.

A novel animal model of long-term sustainable anal sphincter dysfunction

BACKGROUND Although intersphincteric resection can avoid the need for permanent colostomy in patients with lower rectal cancer, it sometimes causes anal sphincter dysfunction, thus resulting in a lifelong, debilitating disorder due to incontinence of solid and liquid stool. The development of regenerative medicine could improve this condition by regenerating impaired anal muscle. In order to prove this hypothesis, preliminary experiments in animals will be indispensable; however, an adequate animal model is currently lacking. The purpose of this study was to establish a novel animal model with long-term sustainable anal sphincter dysfunction. MATERIALS AND METHODS Twenty male Sprague-Dawley rats were allocated into sham operation (n = 10) and anal sphincter resection (ASR) (n = 10) groups. The ASR group underwent removal of the left half of both the internal and external anal sphincters. Both groups were evaluated for anal function by measuring their resting pressure before surgery and on postoperative day (POD) 1, 7, 14, and 28. RESULTS The rats in the sham operation group recovered their anal pressure up to baseline on POD 7. The rats in the ASR group showed a significant decrease in anal pressure on POD 1 (P < 0.0001) compared with the baseline, and kept this low pressure until POD 28 (P < 0.0001). The defect of the anal sphincter muscle was confirmed histologically in the ASR group on POD 28. CONCLUSIONS The present novel model exhibits continuous anal sphincter dysfunction for at least 1 mo and may contribute to further studies evaluating the efficacy of therapies such as regenerative medicine.

Evaluation of immune function under conversion from Prograf to Advagraf in living donor liver transplantation.

BACKGROUND Although some reports have shown the safety and efficacy of conversion from Prograf to Advagraf in liver transplantation, there have been no reports showing the change of immune function after conversion. The aim of this study is not only to analyze the safety and efficacy of conversion from Prograf to Advagraf, but also to evaluate the immune function using the ImmuKnow assay. MATERIAL AND METHODS Of the 168 living donor liver transplantation (LDLT) patients, 21 recipients whose liver function was stable after discharge in outpatient clinic and who agreed to conversion from Prograf to Advagraf were enrolled in this study. Liver, renal, and immune functions were retrospectively reviewed. RESULTS There were no significant differences in liver and renal function after conversion from Prograf to Advagraf. The intracellular adenosine triphosphate levels before and after conversion were 263±157 and 256±133 ng/ml, respectively, and there was also no significant difference in immune function. None of the recipients showed adverse effects, rejection, or severe infection during the study. It should be further noted that none of the recipients had to increase the dose of Advagraf, while five of 21 recipients (24%) were able to reduce the dose of Advagraf during this study. CONCLUSIONS Conversion from Prograf to Advagraf in LDLT can be performed safely and effectively without affecting liver, renal, and immune function.

Efficiency of herbal medicine Dai-kenchu-to on portal blood flow in rat models

Introduction To clarify the influence of Dai-Kenchu-To (DKT) on portal blood flow (PBF), PBF was continuously measured with Doppler ultrasound. Methods Normal liver rats were divided into a DKT 90 mg/kg, DKT 270 mg/kg administered group, and control, while cirrhotic liver rats were divided into a DKT-LC 90 mg/kg administered group and Control-LC. The PBF was measured after the administration of either DKT or water for 60 min by laser Doppler flowmetry system. Results The PBF in the DKT 90 increased approximately 10 min after DKT was administrated, and elevated levels were maintained for approximately 10 min. A comparison of the increase in PBF by the calculating the area under the curve (AUC) revealed that flow was significantly higher in the DKT 90 compared to either the control or the DKT 270 (p < 0.05). The cirrhotic liver group showed stable PBF in both the DKT-LC and Control-LC. The AUC, revealed no significant difference between the DKT-LC and Control-LC. Discussion DKT induced an increase in PBF in normal livers; however, its effects were insufficient to increase PBF in the cirrhotic livers. No increase in the portal blood flow in the cirrhotic liver rats was probably the result of the cirrhotic liver, which had fibrotic change, and, therefore, may not have had sufficient compliance to accept the increasing blood flow volume from the intestinal tract. Conclusion We suggested DKT has the potential to protect the liver by increasing PBF when the liver has either normal or mild to moderate dysfunction.

Post-operative complications requiring hospitalization more than one yr after living donor liver transplantation

The long‐term outcomes after living donor liver transplantation (LDLT) have not been clearly established. This retrospective study assessed long‐term outcomes after LDLT through reviewing complications requiring hospitalization more than one yr after engraftment.

In vivo construction of liver tissue by implantation of a hepatic non‐parenchymal/adipose‐derived stem cell sheet

Subcutaneous hepatocyte sheet implantation is an attractive therapeutic option for various liver diseases. However, this technique is limited by the availability of hepatocytes. Thus, the use of hepatic non‐parenchymal cells (NPCs) containing small hepatocytes, which have the ability to proliferate more rapidly than mature hepatocytes, for transplantation has been suggested. The aim of our study was to construct liver tissue subcutaneously in rats by implanting NPC sheets co‐cultivated with adipose‐derived stem cells (ADSCs), which produce certain angiogenic factors. We crafted NPC‐ADSC sheets on temperature‐responsive culture dishes. NPCs formed functioning bile canaliculi and stored glycogen. In addition, their ability to produce albumin was not inferior to that of hepatocytes. Albumin production increased over time when co‐cultivated with ADSCs. We then implanted the co‐cultivated cell sheets subcutaneously. The co‐cultivated sheets retained glycogen, formed bile canaliculi, showed signs of vascularization and survived subcutaneously without pre‐vascularization. These results suggest that NPCs can be a viable option in cell therapy for liver diseases. This technique using co‐cultivated cell sheets may be useful in the field of regenerative medicine. Copyright

Improvement of Anal Function by Adipose-Derived Stem Cell Sheets

Aim: One of the most troublesome complications of anal preserving surgery is anal sphincter dysfunction. The aim of this study was to evaluate functional recovery after implantation of adipose-derived stem cell (ADSC) sheets, novel biotechnology, for an anal sphincter resection animal model. Methods: Eighteen female Sprague-Dawley rats underwent removal of the nearest half of the internal and external anal sphincter muscle. Nine rats received transplantation with ADSC sheets to the resected area while the remaining rats received no transplantation. The rats were evaluated for the anal function by measuring their resting pressure before surgery and on postoperative days 1, 7, 14, 28, and 56. In addition, the rats were examined for the presence of smooth muscle and also to determine its origin. Results: The improvement of the anal pressure was significantly greater in the ADSC sheet transplantation group compared with the control group. Histologically, at the vicinity of the remaining smooth muscle, reproduction of smooth muscle was detected. Using in fluorescence in situ hybridization, the cells were shown to be from the recipient. Conclusion: Regenerative therapy using ADSC sheet has the potential to recover anal sphincter dysfunction due to anorectal surgery.

Extent of intraluminal exfoliated malignant cells during surgery for colon cancer: Differences in cell abundance ratio between laparoscopic and open surgery: Exfoliated malignant cells during LC

Laparoscopic colectomy with intracorporeal anastomosis is a minimally invasive surgical procedure for patients with colon cancer. However, there are often concerns about the presence of intraluminal exfoliated malignant cells in the intracorporeal anastomosis. This study investigated the relationship between colon cancer surgery and the incidence of intraluminal exfoliated malignant cells and several factors.

P3-061Reevaluation of chemotherapy for patients with advanced or recurrent colorectal cancer by RAS status and primary site

Results: 14 patients received oxaliplatin containing chemotherapy reintroduction. Median age was 70 years old(range:46-76 years old).10 patients were male, PS over 1 were 4 patients.10 patients were left side colon cancer, 4 patients were right side colon cancer. 6 patients were RAS mutant. All patients were refractory to fluoropyrimidines, bevacizumab and inotecan. In RAS wild patients, 7 patients(88%) were refractory to anti EGFR rntibodies.TAS-102 and regorafenib was administrated only one patient. 5 patients were refractory to first administration of oxaliplatin, 9 patients discontinued by other reason. Median oxaliplatin free time was 11.9 months(range:3.0-36.9 months).Median progression free survival was 5.2months(95% CI: 1.2-7months), and median overall survival was 13.8months (95% CI: 6.6-16.2 months).In patients who had measurable lesion, response rate was 7% and disease control rate was 50%.