Kazunari Mori

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.

Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function

BACKGROUND/PURPOSE This study aimed to construct a formula for assessing liver function in order to prevent post-hepatectomy liver failure. METHODS A formula was constructed by analyzing data from 28 patients with hepatocellular carcinoma (HCC) with liver cirrhosis operated on between 1981 and 1984. Next, we evaluated the validity of this formula in 207 hepatectomy patients operated on from 1985 to 1999. For 145 hepatectomy patients operated on from 2000 to 2006, this formula was calculated before surgery in order to assess their risk of hepatectomy. RESULTS The formula for liver functional evaluation, constructed from preoperative hepatic function parameters, was: liver failure score = 164.8 - 0.58 x Alb - 1.07 x HPT + 0.062 x GOT - 685 x K. ICG - 3.57 x OGTT. LI + 0.074 x RW, where Alb is albumin (g/dl); HPT, hepaplastin test (%); GOT, glutamate oxaloacetate transaminase (U/l); K. ICG, K value of indocyanine green clearance test; OGTT. LI, 60-min/120-min glucose level in 75-g oral glucose tolerance test. linearity index of OGTT; and RW, weight of resected liver (g). We decided that a score below 25 would be safe for hepatectomy. CONCLUSIONS The mortality rate decreased from 3.9% in 1985--1999 to 1.3% in 2000--2006. This finding allows us to conclude that the formula is valid for assessing the risk of post-hepatectomy liver failure.

Adenocarcinoma Arising From Heterotopic Pancreas in the Duodenum

We present a rare case of adenocarcinoma arising from a heterotopic pancreas in the duodenum, and review the associated literature. A 62-year-old woman was admitted to our hospital, complaining of vomiting and epigastralgia. Imaging studies revealed advanced gastric cancer with a gastric outlet obstruction. Whipples operation and resection of the regional lymph node were performed because of a direct invasion to the pancreas. Histopathologic examination of the resected specimen demonstrated the malignant transformation of a hetrotopic pancreas in the duodenum. At the 12-month follow-up, there was no recurrence of symptoms. The prognosis of adenocarcinoma arising from a heterotopic pancreas is not known. Further accumulation of cases and investigation of this entity are necessary.

Beneficial effects of fructose-1,6-diphosphate infusion on liver regeneration after ischemie liver injury

SummaryThe effect of fructose-1,6-diphosphate (FDP) on cellular viability after partial hepatectomy in partial ischemie liver was investigated in rats. The administration of FDP did not increase blood flow in the hepatic tissue; however, it significantly suppressed the elevation of serum liver functions for 24 hours after partial hepatectomy. Levels of DNA synthesis, protein synthesis, and labeling index were significantly higher in the groups administered divided doses of FDP before and after partial hepatic ischemia than in the control group (P< 0.01). Thus, these findings indicate that FDP has cytoprotective and hepatotrophic effects on liver with ischemie injury and that divided dose administration of FDP is more effective than bolus doses in decreasing damage following ischemie and reperfusion injury.

A rare case of xanthogranuloma of the stomach masquerading as an advanced stage tumor

BackgroundXanthogranuloma of the stomach is an extremely rare disease, and this lesion has only been found to coexist with early gastric cancer in 2 cases in the literature.Case presentationWe report a case of xanthogranuloma of the stomach combined with early gastric cancer that mimicked an advanced stage tumor. A 65-year-old female was referred to our hospital because of epigastralgia. During a physical examination, a defined abdominal mass was palpable in the region of the left hypochondrium. Imaging studies revealed an advanced gastric cancer, which was suspected of having infiltrated the abdominal wall. Total gastrectomy and resection of the regional lymph node and abdominal wall were performed. Histopathologic examination of the resected specimen demonstrated xanthogranuloma combined with early gastric cancer.ConclusionXanthogranuloma presenting as a form of SMT (submucosal tumor) of the stomach is an extremely rare disease, and diagnosing it preoperatively is difficult. Further accumulation and investigation of this entity is necessary.

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.

Peecutpneous microwave coagulation thrapy by the the new synchronous use of microwave and dissociating electric current method

The synchronous use of microwave irradiation (50-60 Watt) and dissociating electric current (20mA) was newly applied to the percutaneous microwave coagulation therapy. The color evaluation in the albumen of eggs revealed that the rnicrobubbles generated by synchronous dissociating electric current prevented the coagulated albumen from gluing on the needle-electrode. The fine needle-electrode which was 250mm in length and 1.6mm in diameter produced by Heiwa Electronic Co.Ltd. was used for the microwave coagulation of the tumors through the Tru-Cut biopsy needle under ultrasound guidance. This method was newly applied to 2 clinical cases. The case 1 was the 74 female, metastatic liver cancer patient, who had the history of colectomy and left lobectomy of the liver. The target was the solitary 2.5cm sized lesion located in the Couinauds segment 6. The enhanced CT scan after the microwave coagulation therapy revealed that the lesion became 3 cm sized low density area which implied the lesion was successfully coagulated. The case 2 was the 63 male, recurrent hepatocellular carcinoma patient, who had the history of partial resection of the liver and transcatheter arterial embolization. The targets were multiple but they were less than 2cm in diameter. After the treatment, the tumor stains were disappeared on the dynamic CT scan. The outcome of these cases were 14 months and 12 months survival after the treatment, respectively. It is demonstrated that the liver tumor less than 3cm in diameter may become therapeutic indication of the percutaneous microwave coagulation therapy by the synchronous use of microwave irradiation and dissociating electric current. 国立大阪南病院 外科 〒586大 阪府河内長野市木戸町677-2 Department of Surgery, Osaka-Minami National Hospital Address: 677-2, Kido-cho, Kawachinagano, Osaka, 586, Japan J. Microwave Surg. VOL.12 1994 13 マイ クロ波 と解離電流の同時通電法による経皮的マ イクロ波凝固療法

Adverse Relationship Between Blood Transfusion and Survival After Hepatectomy for Hepatocellular Carcinoma Using Microtaze

To evaluate the prognostic influence of blood transfusion in hepatocellular carcinoma patient,the survival rate of 122 hepatectomized cases using Microwave Tissue Coagulator during the years 1981 to 1990 were studied. Fifty-two patients(43%) had not been transfused and Kaplan-Meier estimate revealed the significant worsened prognosis in the transfused group (p<0.05 for generalized Wilcoxon comparison of survival curve). This result couldn’t be attributed to the differences in the backgrounds, i.e. maximum diameter of the tumor(∅),intrahepatic metastasis (IM),capsular formation (Fc),capsular invasion (Fc-inf),and K value of indocianine green test (KICG) between the transfused and non-transfused. Thus,the hypothesis that blood transfusions had an adverse effect on survival was supported by personal retrospective study.