Koichi Hoshikawa

Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure.

Objective:To assess the feasibility, safety, and short-term outcomes of laparoscopy-assisted major liver resections. Summary of Background Data:The number of reports of laparoscopic major hepatectomies has gradually increased, and living donor hepatectomies for liver transplant have also recently been performed. However, because of the high degree of proficiency required, major hepatectomies have not been widespread. We developed an original procedure in which the liver is mobilized laparoscopically and resected by a hanging technique through a small incision. Methods:Between November 2002 and December 2008, 43 patients underwent laparoscopy-assisted major liver resections (LAMLRs) in our institution for hepatocellular carcinoma, metastatic liver cancer, and benign diseases. Results:LAMLRs were completed for 42 patients (97.7%). The median age was 62 years (range: 24–83 years). Preoperative diagnoses were hepatocellular carcinoma (n = 15), metastatic liver cancer (n = 19), and benign disease (n = 8). The types of liver resection consisted of the following: right trisectionectomy (n = 2), right hepatectomy (n = 14), left hepatectomy (n = 16), trisegmentectomy 4, 5, 8 (n = 2), right anterior sectionectomy (n = 4), and extended right posterior sectionectomy (n = 4). The median operating time was 317 minutes (range: 192–542 minutes) and median blood loss was 631 mL (range: 68–2785 mL). There were neither perioperative deaths nor reoperations. Five patients (11.9%) experienced postoperative complications, 2 patients (4.8%) showed bile leakage, and 3 patients (7.1%) developed wound infections. The median postoperative hospital stay was 13.5 days (range: 6–154 days). Conclusions:LAMLR with the hanging technique can be completed safely. The procedure can be performed by open liver surgeons; and thus may be widely performed in the future.

Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node-positive disease and among them 23.1% had positive para-aortic nodes. Of six node-positive 5-year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5-year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas-preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.

Significance of Measuring S100A12 and sRAGE in the Serum of Sepsis Patients with Postoperative Acute Lung Injury

Background: There is a report that S100A12 is useful as an early marker of acute lung injury (ALI). The purpose of this study was to determine whether S100A12 or sRAGE is useful as a marker during the development of ALI in postoperative sepsis patients. Methods: The subjects were patients who underwent emergency surgery because of sepsis secondary to perforation of the lower gastrointestinal tract. We conducted a retrospective study comparing 2 groups of patients: a group of 9 patients who developed postoperative ALI, the ALI(+) group, and a group of 8 patients who did not develop postoperative ALI, the ALI(–) group. Their blood S100A12, sRAGE, IFN-γ, WBC count, and CRP values were measured immediately after surgery and on postoperative day 1 (D1). Results: The changes in S100A12 showed significantly higher values immediately postoperatively in the ALI(+) group (p < 0.05). The sRAGE values immediately postoperatively were similar, but on D1, they were significantly higher in the ALI(–) group (p < 0.05). Conclusions: S100A12 increases in the early stage of development of ALI. sRAGE production increases in patients who do not develop ALI.

Mono-(2-ethylhexyl) phthalate Targets Glycogen Debranching Enzyme and Affects Glycogen Metabolism in Rat Testis

Phthalate esters are commonly used plasticizers; however, some are suspected to cause reproductive toxicity. Administration of high doses of di-(2-ethylhexyl) phthalate (DEHP) induces germ cell death in male rodents. Mono-(2-ethylhexyl) phthalate (MEHP), a hydrolyzed metabolite of DEHP, appears to be responsible for this testicular toxicity; however, the underlying mechanism of this chemicals action remains unknown. Here, using a one-step affinity purification procedure, we identified glycogen debranching enzyme (GDE) as a phthalate-binding protein. GDE has oligo-1,4-1,4-glucanotransferase and amylo-1,6-glucosidase activities, which are responsible for the complete degradation of glycogen to glucose. Our findings demonstrate that MEHP inhibits the activity of oligo-1,4-1,4-glucanotransferase, but not of amylo-1,6-glucosidase. Among various phthalate esters tested, MEHP specifically binds to and inhibits GDE. We also show that DEHP administration affects glycogen metabolism in rat testis. Thus, inhibition of GDE by MEHP may play a role in germ cell apoptosis in the testis.

G-Csf and Leukocytosis in Anaplastic Thyroid Carcinoma Associationbetween Granulocyte Colonies Stimulating Factor(G-Csf) Production andLeukocytosis in Anaplastic Thyroid Carcinoma

Background: Leukocytosis is an independent prognostic factor for anaplastic thyroid carcinoma (ATC). In the present study, the potential causes of leukocytosis in ATC were analyzed. Methods: This study involved 22 patients with histologic or cytologic evidence of ATC, as well as papillary thyroid carcinoma (PTC), between June 2000 and October 2009. Samples were obtained from ATC patients before treatment. The xMAP serum assay for 17 cytokines [IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, and IL-17, TNF-α, IFN-γ, GM-CSF, G-CSF, MIP-1β, and MCP-1] and IHC from surgical specimens were performed. Results: WBC was ≥ 10000/mm3 in 9 (41%) and G-CSF was ≥ 100 pg/ml in 4 (18%) ATC cases. The G-CSF level showed a positive correlation with the WBC count in ATC cases (r=0.78). Both G-CSF and G-CSFR protein expressions were seen on immunohistochemical staining in 50% (5/10) and 70% (7/10) of ATC cases, respectively. Serum IL-6, IL-7, IL-8, IL-12, IL-17, MCP-1, TNF-α, and G-CSF concentrations were significantly higher in ATC than in PTC. WBC and G-CSF (r=0.61) had a positive correlation (>0.6). Patients with leukocytosis (n=9) had a poorer survival rate than those with WBC<10000/mm3 (p=0.0002). Similarly, patients with G-CSF ≥ 100 pg/ml had a poorer survival rate than those with G-CSF <100 pg/ml (p=0.0107). Conclusion: Leukocytosis and a high G-CSF level before treatment are linked to poor prognosis in ATC patients.