Keigo Yada

Laparoscopic resection of hepatoblastoma: Report of a case

Despite the increasing number of recent reports on laparoscopic resection of malignant liver tumors in adults, there have been few reports involving children. In this paper we discuss the laparoscopic resection of a hepatoblastoma in a 1‐year‐old boy. The CT scan revealed an exophytic hepatic tumor on S5 measuring 6 × 5 × 4 cm after preoperative chemotherapy. The operation time was 225 min with an estimated blood loss of about 38 mL; intraoperative transfusion was not required. Radiofrequency‐assisted precoagulation was performed. The patient had an uncomplicated recovery and started postoperative chemotherapy on postoperative day 12. Our literature search revealed only five reported cases of laparoscopic resection of hepatoblastoma in which there was no postoperative complication or recurrence. Laparoscopic resection of a hepatoblastoma in a selected subgroup of patients can be safe and feasible.

Treatment strategy for successful hepatic resection of icteric liver

BACKGROUND The treatment strategy for jaundiced patients with hilar cholangiocarcinoma (HC) is not well established. In this study, we evaluate the feasibility of our perioperative protocol for jaundiced patients with HC. METHODS Twenty patients with HC who underwent hepatic resection at our institute were enrolled, and patients were divided into icteric(n=6) and normal(n=14) group. As a perioperative protocol, Oral administration of Inchinkoto(ICKT), steroid and nafamostat mesilate were introduced. The evaluation of functional future remnant liver(FRL) by asiaroscintigraphy, and postoperative outcomes were retrospectively compared. RESULTS Indocyanine green dye retention rate at 15 minutes was higher, and LHL15 values was lower in icteric group. However, in the functional evaluation of FRL, which was the sum of GSA uptake of the future FRL, there was no significant difference of LHL15 values of the remnant liver functional reserve between the two groups. As results, according to the difference of liver function, serum AST level was not different between two groups. The number of patients with postoperative morbidity in the two groups was comparable. CONCLUSIONS Even in HC patients with icteric liver, accurate assessment of liver functional reserve and effective perioperative treatment may attribute to successful hepatectomy and favorable post-operative outcomes. J. Med. Invest. 65:37-42, February, 2018.

Carcinogenesis of Biliary Tract in Pancreaticobiliary Maljunction

Pancreaticobiliary maljunction (PBM) is a high-risk factor for biliary tract cancer. Because of the excessive length of the common channel in PBM, sphincter action does not directly affect the pancreaticobiliary junction, which allows pancreatic juice to reflux into the biliary tract. The refluxed pancreatic juice injures the epithelium of the biliary tract and promotes the development of the cancer. Indeed, a nationwide survey in Japan revealed that biliary cancers were detected in 21.6 and 42.4% of PBM patients with and without biliary dilatation, respectively. The mechanism of carcinogenesis in PBM is considered to be the “hyperplasia-dysplasia-carcinoma sequence” which differs from the usual biliary carcinogenesis (the “adenoma-carcinoma sequence” or “de novo carcinogenesis”) in the population without PBM. Hyperplastic changes of the biliary epithelium were observed even in children with PBM, and the Ki-67 labeling index was higher. Several gene mutations were reported to be related in biliary carcinogenesis of PBM.