Jun Ishii

Bacterial Translocation in Small Intestinal Ischemia-Reperfusion Injury and Efficacy of Anti-CINC Antibody Treatment

The involvement of bacterial translocation in small intestinal ischemia-reperfusion injuries and the efficacy of using anti-CINC antibodies for treatment were investigated. A model for ischemia-reperfusion injury of the small intestine was constructed by clamping the supramesenteric artery (for 90 min) in rats. Anti-CINC antibodies and saline were given just before the induction of ischemia in the treatment group and the control group, respectively. Six hours after reperfusion, bacteria were detected in the mesenteric lymph nodes, but the ‘bacteria-positive’ rate was significantly lower in the treatment group than in the control group. Bacterial cultures and endotoxins in the blood were negative in both groups up to 24 h later. The plasma cytokine levels showed similar variations, although the increases were significantly lower after reperfusion in the treatment group. In addition, the degrees of neutrophil infiltration and mucosal injury were attenuated in the small intestine, and the structure of the liver was maintained. Furthermore, the 1-week survival was improved. These results suggest that bacterial translocation occurred predominantly via the lymphatic system and that anti-CINC antibody treatment exerted a protective effect against small intestinal ischemia-reperfusion injury.

Efficacy of laparoscopic surgery for recurrent hepatocellular carcinoma.

BACKGROUND/AIMS Although laparoscopic hepatectomy is increasingly performed for hepatocellular carcinoma, few studies have investigated the efficacy of laparoscopic surgery, including hepatectomy for the treatment of recurrent hepatocellular carcinoma. We report the results of our study on the efficacy of laparoscopic surgery. METHODOLOGY Forty-three of 123 hepatocellular carcinoma patients underwent laparoscopic surgery in 2002-2009; 16 were treated for recurrent hepatocellular carcinoma. The characteristics and postoperative outcomes of these 16 patients were retrospectively investigated. RESULTS Seven patients underwent laparoscopic hepatectomy, 1 underwent laparoscopic radiofrequency ablation, 7 underwent resection of an extrahepatic metastatic tumor and 1 patient received diagnostic assessment. Twelve of the 15 surgical patients had a repeat recurrence after surgery. Survival at 2 years was significantly higher in patients with intrahepatic vs. extrahepatic recurrence (100% vs. 42.9%). In addition, overall survival (51.2 vs. 23.0 months) was significantly longer in patients with intrahepatic recurrence, although disease-free survival (19.2 vs. 10.6 months) was not so. CONCLUSIONS Laparoscopic surgery for recurrent hepatocellular carcinoma enabled precise tumor localization, more accurate diagnosis, and more careful selection of therapy based on hepatic functional reserve and recurrence type. Laparoscopic surgery appears to be an effective, minimally invasive option for the diagnosis and treatment of recurrent hepatocellular carcinoma.

Efficacy of laparoscopic liver resection in colorectal liver metastases and the influence of preoperative chemotherapy

BackgroundSince 1993, we have performed minimally invasive laparoscopic liver resection (LLR) to treat malignant liver cancer, including colorectal liver metastases (CLM). However, further studies are needed to accumulate sufficient evidence on the oncological outcome of LLR for CLM.MethodsTo elucidate the efficacy of LLR for CLM, this study comparatively analyzed the invasiveness and short-term prognosis of LLR (n = 43 cases) and open liver resection (OR) (n = 62 cases) performed for CLM after 2006 and also investigated the safety of LLR following chemotherapy.ResultsCompared with the OR group, the LLR group had significantly less blood loss (P < 0.001) and a shorter hospital stay (P < 0.001). The E-PASS scoring system was used to compare surgical invasiveness, and although the preoperative risk score did not differ between the groups, the surgical stress score and comprehensive risk score were significantly lower in the LLR group (P < 0.001). Concerning the survival rate and disease-free survival rate, there were no significant differences between procedures. However, more clinical cases and longer follow-up periods are needed to reach a definitive conclusion.Preoperative hemanalysis, intraoperative bleeding, complications, and postoperative length of stay did not differ significantly between LLR patients with preoperative chemotherapy and those with surgery alone, indicating no adverse effects of chemotherapy.ConclusionsLLR can be an effective minimally invasive surgery in CLM patients receiving both perioperative chemotherapy and surgery. Because LLR is comparable with OR with regard to short-term oncological outcome, LLR may be a valuable option for CLM.

Effectiveness of laparoscopic subtotal cholecystectomy: perioperative and long-term postoperative results.

BACKGROUND/AIMS We analyzed perioperative and long-term postoperative data to determine the effectiveness of laparoscopic subtotal cholecystectomy (LSC). METHODOLOGY 89 LSCs done at our center were classified into 3 groups according to the operative procedure required to treat severe cholecystitis. Perioperative and long-term postoperative results were then compared with standard laparoscopic cholecystectomy (s-LC). RESULTS Operative time was longer and postoperative CRP level was higher for LSC. Significantly more bleeding and longer operative times were seen only in the LSC-II subgroup, and average postoperative hospital stay was longer only in the LSC-III subgroup. As for long-term (1.5 to 8 years) postoperative results, 3 of 26 LSC-III cases had a relapse of cholecystolithiasis in remnant gallbladder tissue 2 years or later after initial surgery. CONCLUSIONS There were no serious intraoperative complications such as the bile duct injury, and a smaller proportion of procedures were intraoperatively converted to open laparotomy. It is considered that LSC is a safe, useful surgical procedure to the patients in whom the neck of the gallbladder is anatomically unclear due to cholecystitis or fibrosis although patients undergoing LSC-III should be monitored for cholecystolithiasis in remnant gallbladder tissue. LSC is often the procedure of choice for patients.

Indications and technique for laparoscopic liver resection in patients with hepatocellular carcinoma and liver cirrhosis

Liver resection is the preferable initial treatment option for solitary or limited multifocal HCCs with no extrahepatic spread.[2-6] The mortality and morbidity of liver resection have significantly decreased in the last two decades because of improvements in patient evaluation, surgical technique, and perioperative care. Resection is the ideal treatment, as it allows for complete removal and pathological confirmation of lesions. However, it is more invasive than other locoregional therapies such as transarterial chemoembolization, tumor ablative therapy, and radiation therapy.[7-10]

A Case of Laparoscopic Splenectomy for Blunt Splenic Rupture after Abdominal Trauma.

IIId型外傷性脾破裂に対して腹腔鏡下に保存的治療の可否を判断し, その後腹腔鏡下に脾臓摘出術を施行した症例を経験した. 症例は14歳の男児. サッカーの試合中に腹部を打撲し, 当院に救急搬送された. 腹部CT, 超音波検査から脾損傷の程度はIIIc型と診断した. 循環動態は安定していたが, その後の画像診断で進行性の腹腔内出血と貧血を認めたため腹腔鏡を施行した. 腹腔内は消化管を含め他臓器の損傷はなく, 約1,200mlの血液が貯留していた. 脾損傷の程度はIIId型で脾温存は不可能と判断し, そのまま腹腔鏡下に脾臓摘出術を施行した. 術後経過は順調で, 第14病日に退院した. 腹腔鏡による脾損傷診断は, 保存的加療が可能であるかどうかを正確かつ迅速に判断し, その後摘脾術に移行することも可能である. 腹腔鏡下のアプローチは, これからの外傷性脾破裂に対する診断・治療戦略の選択肢になりうると考えられた.