Kohei Ishioka

Safety and feasibility for single-incision laparoscopic cholecystectomy in local community hospital: a retrospective comparison with conventional 4-port laparoscopic cholecystectomy.

Background: The aim of this study was to evaluate the safety and feasibility for single-incision laparoscopic cholecystectomy (SILC) by retrospective comparison with conventional laparoscopic cholecystectomy (CLC) in a local community hospital. Methods: SILC was introduced and performed in 57 patients for benign gallbladder diseases. Their clinical data were compared with those of 62 patients treated with CLC. They included patient demographic data and operative outcomes. Results: SILC was attempted in 57 patients and 52 cases (91.2%) were successfully completed. There were no statistical differences between the 2 groups in terms of operative time, blood loss, and postoperative complications. The length of hospital stay in the SILC group was significantly shorter compared with CLC (P<0.0001). Conclusions: SILC has been successfully introduced in a local community hospital. The safety and feasibility was also confirmed. The SILC procedure may become 1 standard option for the treatment of benign gallbladder diseases.

Long-term observation and treatment of a widespread intraductal papillary neoplasm of the bile duct extending from the intrapancreatic bile duct to the bilateral intrahepatic bile duct: A case report

Highlights • There have been few studies of the long-term outcomes of surgically resected intraductal papillary neoplasm of the bile duct (IPNB).• Mucus might be produced even after the R0 resection of IPNB, and frequent cholangitis or jaundice might be occurred.• The biliary tract of the remnant liver after curative resection should be managed carefully for a long time after surgical resection.

Anal gland adenocarcinoma in situ with pagetoid spread: a case report

BackgroundAnal gland carcinoma with perianal Paget’s disease is rare, and anal gland carcinoma in situ is extremely rare. No cases of anal gland carcinoma in situ with pagetoid spread have been previously reported.Case presentationPhysical examination in a 75-year-old woman revealed an erythematous, inflamed, perianal skin lesion. Neither colposcopy, cystoscopy, colonoscopy, computed tomography, nor magnetic resonance imaging showed evidence of malignant genitourinary or gastrointestinal lesions. Histopathological examination of a biopsy specimen showed many Paget’s cells in the perianal skin lesion and no malignant cells in the rectal or vaginal mucosa. Therefore, primary extramammary Paget’s disease of the anogenital region was suspected, and we performed anus-preserving wide local excision. However, immunohistochemistry revealed a diagnosis of secondary extramammary Paget’s disease due to adenocarcinoma arising from the anal gland. We therefore proceeded with a radical operation. Histopathological examination showed no residual cancer cells. The final diagnosis was anal gland adenocarcinoma in situ with pagetoid spread in the perianal skin.ConclusionsThis is the first case report of anal gland adenocarcinoma in situ with pagetoid spread. We recommend immunohistochemical analysis of biopsy and locally resected specimens to obtain an accurate diagnosis and determine the appropriate treatment when there is no visible tumor.

Significance of bacterial culturing of prophylactic drainage fluid in the early postoperative period after liver resection for predicting the development of surgical site infections

PurposesThe relationship between the results of bacterial drainage fluid cultures in the early postoperative period after liver resection and the development of surgical site infections (SSIs) is unclear. We evaluated the diagnostic value of bacterial cultures of drainage fluid obtained on postoperative day (POD) 1 after liver resection.MethodsThe cases of all consecutive patients who underwent elective liver resection from January 2014 to December 2016 were analyzed. The association between a positive culture result and the development of SSIs was analyzed.ResultsA total of 195 consecutive patients were studied. Positive drainage fluid cultures were obtained in 6 patients (3.1%). A multivariate analysis revealed that a positive drainage fluid culture was an independent risk factor for SSIs (odds ratio: 8.04, P = 0.035), and combined resection of the gastrointestinal tract was a risk factor for a positive drainage fluid culture (P = 0.006). Among the patients who did not undergo procedures involving the gastrointestinal tract, there was no association between drainage fluid culture positivity and SSIs.ConclusionsThe detection of positive culture results for drainage fluid collected on POD 1 after liver resection was associated with SSIs. However, among patients who did not undergo procedures involving the gastrointestinal tract, it was not a predictor of SSIs.

Does anatomic resection improve the postoperative outcomes of solitary hepatocellular carcinomas located on the liver surface

Background It is unclear whether anatomic resection achieves better outcomes than nonanatomic resection in patients with hepatocellular carcinoma. This study aimed to compare the outcomes of anatomic resection and nonanatomic resection for hepatocellular carcinoma located on the liver surface via one‐to‐one propensity score‐matching analysis. Methods Data from all consecutive patients who underwent liver resection for primary solitary hepatocellular carcinoma at Nara Medical University Hospital, Japan, January 2007– December 2015 were retrieved. Superficial hepatocellular carcinomas were defined as hepatocellular carcinoma that extended to a depth of < 3 cm from the liver surface and measured < 5 cm in diameter. The prognoses of the patients with superficial hepatocellular carcinoma who underwent anatomic resection and nonanatomic resection were compared. Results In this study 23 patients with superficial hepatocellular carcinoma underwent anatomic resection and 70 patients who underwent nonanatomic resection. The recurrence‐free survival rate of the patients who underwent anatomic resection was better than that of the patients who underwent nonanatomic resection (P = .006), while no such difference was observed for nonsuperficial hepatocellular carcinoma. After the propensity score‐matching procedure, the resected liver volume and operation time were the only background or clinical characteristics to exhibit significant differences between the anatomic resection (n = 20) and nonanatomic resection groups (n = 20). The recurrence‐free survivial rate of the patients who underwent anatomic resection was significantly than that of the patients that underwent nonanatomic resections (P = .030), but overall survival did not differ significantly between the groups (P = .182). Conclusion Anatomic resection decreases the risk of tumor recurrence and improves recurrence‐free survival compared with nonanatomic resection in patients with superficial hepatocellular carcinoma.