Katsutoshi Taniguchi

Laparoscopic resection for gastrointestinal stromal tumors of the stomach.

BACKGROUND We reviewed our experience with primary gastrointestinal tumors (GISTs) after surgical treatment. METHODS Between 1998 and 2003, 56 patients who underwent surgical treatment for primary GIST of the stomach were enrolled in this study. Statistical analyses of the risk factors for recurrence were assessed. RESULTS The proportion of cases undergoing laparoscopic surgery was 25 of 56 (44%) in these retrospective data. The site of recurrence was only the liver in all cases. These recurrent cases were defined as high-risk category. Tumors measuring over 2 cm in size tended to recur earlier, namely within 32 months. A statistical analysis showed a statistically significant correlation between the disease progression and the pathological phenotype. CONCLUSIONS This retrospective study has shown that an initial laparoscopic resection of gastric GISTs is feasible even when the tumor size is relatively small (2-5 cm). The pathological phenotype (especially tumor mitosis) directly correlates to the patients survival even if the resected tumor size was relatively small.

Postoperative evaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer.

Abstract We evaluated postoperative function in 98 patients who underwent surgery for early gastric cancer between 1995 and 1998 to compare the results of pylorus-preserving procedures to those of conventional distal gastrectomy with Billroth I (B-I). The pylorus-preserving procedures included endoscopic mucosal resection (EMR), performed in 12 patients; local resection (Local), performed in 14 patients; segmental resection (Seg), performed in 8 patients; and pylorus-preserving gastrectomy (PPG), performed in 19 patients. B-I was performed in 45 patients. The nutritional status and serum albumin (Alb) levels after PPG, the hemoglobin (Hb) levels after EMR, Local, and PPG, and the present/preoperative body weight ratios after EMR, Local, Seg, and PPG were superior to those after B-I. The time before oral intake was recommenced after EMR and Local, the volume of oral intake tolerated after EMR, Local, Seg, and PPG, and the postoperative hospital stay after EMR were all superior to those after B-I. Moreover, significantly fewer patients suffered reflux symptoms after EMR, Local, and PPG, abdominal fullness after EMR, and early dumping syndrome after EMR, Local, and PPG than after B-I. There was also less evidence of gastritis after EMR, Local, and PPG, and of bile reflux after EMR, Local, and PPG, than after B-I. These findings indicate that pylorus-preserving procedures may result in a better postoperative quality of life for selected patients with early gastric cancer.

Impact of lymph node metastasis on survival in patients with pathological T1 carcinoma of the ampulla of vater

To determine the prognostic factors for patients with pathological T1 (pT1) carcinoma of the ampulla of Vater, 36 consecutive patients with carcinoma of the ampulla of Vater who underwent surgery were retrospectively analyzed in terms of clinicopathological features. The overall 5-year Kaplan-Meier survival in all patients was 50.2%, and the median survival of all patients was 64.0 months. Factors favorably influencing a long-term outcome were the absence of lymph node metastasis (P<0.0001), the absence of ulcer formation of the tumor (P=0.0062), and the absence of tumor invasion into the duodenum (P = 0.0025) and the pancreas (P=0.0098). In a multivariate analysis, lymph node metastasis was the only predictor of survival (P=0.0023). In the pT1 stage patients, 20% of the patients had lymph node metastasis, and their survival was statistically poor compared to the pT1 patients without lymph node metastasis (P=0.017). As for survival after the operation, there was no significant difference between pancreatoduodenectomy and pylorus-preserving pancreatoduodenectomy.

Papilloma of the gallbladder

A case of papilloma of the gallbladder is reported. The gallbladder was associated with cholesterosis but not with stones. The causes of colicky pain in this case are discussed. Papillomas of the gallbladder exhibit no characteristic clinical picture; the symptoms are similar to those of any type of gallbladder disease. Papillomas of the gallbladder may be associated with malignant degeneration. Cholecystectomy is the treatment of choice.

Clinical evaluation of fructose‐1,6‐bisphosphate for in situ cold perfusion in hepatic resection

In situ cold perfusion was employed in two patients with large hepatocellular carcinoma. Fructose-1,6-bisphosphate, a cytoprotective drug, was added to the oxygenated perfusate, resulting in reduction of the liver injury that occurs during liver perfusion and allowing hepatic resection to proceed safely. Recovery after, reperfusion of the energy charge in the hepatic tissue sampled during surgery was good in both patients. During the postoperative course, serum GOT and GPT values in the two patients were normalized 7–13 days postoperatively after a peak on the 1st and 2nd postoperative days, respectively. This finding was similar to the usual course after hepatectomy. Serum total bilirubin gradually decreased from the peak 2.3 mg/dl on the 5th postoperative day in case 1, and from 3.6 mg/dl on the 7th postoperative day in case 2. There were no serious complications in either patient.

Gastric Cancer Developing 40 Years after Simple Gastrojejunostomy

Two patients with gastric cancer developing over 40 years after gastrojejunostomy without gastric resection were operated on. These rare cases were reported and the literature was reviewed. The first case was a 72-year-old male with a chief complaint of heart burn. He had gastrojejunostomy for a perforation of duodenal ulcer 42 years ago. He was diagnosed as gastric cancer by endoscopy. A subtotal gastrectomy was performed. Histological diagnosis was papillary adenocarcinoma. The second case was a 85-year-old female who had gastrojejunostomy for gastric ulcer 40 years ago. She was examined for abdominal fullness and diagnosed as anastomotic cancer. She received subtotal gastrectomy. Histological diagnosis was moderately differentiated adenocarcinoma. The patients recovered. The good prognosis was obtained by radical operation.

Multidisciplinary Treatment of Gastric Endocrine Cell Carcinoma and Large Liver Metastasis

Gastric endocrine cell carcinoma is rare. The multidisciplinary treatment of a 52-year-old man with endocrine cell carcinoma and liver metastasis was reported. A total gastrectomy and left hepatectomy were performed. After the operation he had adjuvant plus maintenance chemotherapy of UFT, 5-FU, ADM, and MMC. MMC, 5-FU, ADM, and CDDP had high chemosensitivity and were used for intra-arterial infusion chemotherapy. Furthermore they were periodically injected into the hepatic artery from a vascular access device. Nine months later he died of liver metastases in spite of aggressive treatments. Endocrine cell carcinoma with liver metastasis is one of the most serious diseases and we need a more advanced treatment.

Evaluation of surgical treatment for advanced gastric cancer based on long term results.

進行胃癌のうち, R2以上のリンパ節郭清を施行しえたA領域癌150例, M領域癌178例およびC領域癌100例を対象に, 組織学的リンパ節転移率を検討し, 手術時のリンパ節郭清の差が遠隔成績に及ぼす影響を, R1と比較して検討した. リンパ節郭清の意義が5年生存率に最もよく反映されるのはA, M領域のstage IIとM領域のstage III症例であることが判明した. C, CMにMCを含めた進行癌に対する胃全摘時の脾摘または膵脾合併切除の是非については, 5生率からは差は得られなかったが, 膵脾合併切除例で10, 11番リンパ節転移率が高率なこと, stage IVの全摘の5年生存例4例全例が膵合併切除例であったことより, 積極的な合併切除によるリンパ節郭清が重要であるといえる.

[A study of hepato-biliary and alimentary scintigrams using a triple tracer method].

In order to evaluate the gastric emptying and postprandial mixing of bile with food, the scintigraphies of hepatobiliary and gastrointestinal tracts by using three different kinds of radioisotopes were performed simultaneously (99mTc-E.HIDA for hepatobiliary scintigraphy, 111In-DTPA containing orange juice and 131I-albumin containing scrambled egg for gastrointestinal scintigraphy). This method was available for observation of gastric emptying of liquid and solid foods and also examination of the mixing effect of bile and food quantitatively.

Congenital Biliary Dilatation – frequently presenting as acute pancreatitis in infants and children and showing highest incidence in Japanese -

Acute pancreatitis has been routinely diagnosed by clinical findings such as abdominal pain, jaundice or elevated serum amylase [ 1 ] . Now, the situation is being significantly improved by the advent of new diagnostic procedures, especially by that of imaging techniques for the biliary tract. Congenital biliary dilatation (CBD), frequently presenting as acute pancreatitis in infants and children, is one of the diseases which receive the benefits of the development. Our statistics revealed that CBD (7 cases) accounted for almost the half of the cases with pancreatitis, excluding those