Kouki Wakata

Usefulness of evaluating hepatic elasticity using artificial acoustic radiation force ultrasonography before hepatectomy

To evaluate hepatic fibrosis and tumor diagnosis preoperatively, we investigated the elasticity calculated by the new parameter of ultrasonography, acoustic radiation force impulse (ARFI).

Predictive parameters of intraoperative blood loss in patients who underwent pancreatectomy.

BACKGROUND/AIMS Despite recent advances in surgical techniques, blood loss is an important factor associated with postoperative outcomes in pancreatectomy. It is useful to identify risk factors of increased blood loss. METHODOLOGY The clinical records of 161 patients who underwent an elective pancreatectomy for peripancreatic diseases between 1994 and March 2011 were retrospectively examined. Univariate and multivariate analysis of clinicopathological and surgical parameters influencing intraoperative blood loss were performed. We determined the cut-off value of the amount of blood loss based on the analyzed results. RESULTS The mean and median blood loss was 1346±901 and 1070 mL, respectively. Red cell blood transfusion was performed in 72 patients (45%). Based on ROC analysis, the predictive value of blood loss in patients who received red cell blood transfusion was 880 mL (p <0.001); however, blood loss was not significantly associated with postoperative complications (p = 0.40). The cut-off level of estimated amount of blood loss in the present study was set at 880 mL. Male patients, fatty pancreas, higher serum alkaline phosphatase level, longer operating time, performance of pancreaticoduodenectomy (PD) and combined resections of adjacent major vessels were associated with significantly more increased blood loss (p <0.05). Based on multivariate analysis, longer operation time over 480 minutes and performance of PD were significantly associated with increased blood loss (p <0.05). CONCLUSIONS Attempting to reduce operating time in cases of PD is necessary to reduce intraoperative blood loss.

Clinical significance of the C‑reactive protein‑to‑albumin ratio for the prognosis of patients with esophageal squamous cell carcinoma

The aim of the present study was to investigate the prognostic value of the C-reactive protein-to-albumin ratio (CAR) and compare it with other inflammation-based prognostic scores (Glasgow prognostic score, modified Glasgow prognostic score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index and prognostic index) in patients with esophageal squamous cell cancer (ESCC). A database of 116 patients with primary ESCC who underwent treatment at the Division of Surgical Oncology at Nagasaki University Hospital between January 2007 and August 2014 was retrospectively reviewed and the correlations between CAR and overall survival (OS) were investigated. Kaplan-Meier and Cox regression analyses were used to assess independent prognostic factors. The area under the curve (AUC) was used to compare the prognostic value of different scores. According to the receiver operator characteristics analysis, the recommended cut-off value for CAR was 0.042, with an AUC of 0.678 (sensitivity 31.1%, specificity 66.7%). Thus, patients were dichotomized into low (<0.042) and high (≥0.042) CAR groups. On multivariate analysis, CAR was found to be significantly associated with OS in patients with ESCC [hazard ratio (HR)=2.350; 95% confidence interval (CI): 1.189-4.650; P=0.014], as was tumor-node-metastasis stage (HR=3.059; 95% CI: 1.422-6.582; P=0.004). In addition, CAR had a higher AUC value (0.678) compared with several other systemic inflammation-based prognostic scores (P<0.001). This study suggested that CAR is a novel and promising inflammation-based prognostic score in patients with ESCC. Due to its simplicity, affordability and availability, CAR may be important for improving clinical decision-making and may contribute to more rational study design and analyses.

A case of multiple synchronous quadruple cancers of the stomach, sigmoid colon, rectum, and pancreas

Highlights • The increased screening results in more pick up multiple primary tumors and that they are being reported more.• Diagnosis and treatment of multiple primary tumors is usually difficult.• A cancer board can be useful for this process.

Liver resection for metastases of tracheal adenoid cystic carcinoma: Report of two cases

Highlights • The optimal treatment for metastases of tracheal adenoid cystic carcinoma (ACC) is remains unclear.• Liver metastasis from tracheal ACC has rarely been reported.• We surgically managed two cases of liver metastases from tracheal ACC.

Single-incision laparoscopic ileocecal resection using an organ retractor ☆

Highlights • SILS is one of the approaches to scarless surgery.• SILS technique is not easy because of the restricted movement and requires a long learning curve.• An organ retractor is effective for SILS not only to maintain a good operative view, but also to shorten the learning curve.

A case of single-incision laparoscopic surgery for a bleeding Meckel’s diverticulum diagnosed pre-operatively by double-balloon endoscopy

Highlights • Meckel’s diverticulum is a relatively rare disease.• Laparoscopic surgery has been reported effective for Meckel’s diverticulum.• Single-port laparoscopic diverticulectomy resulted in a good outcome.

Unusually high levels of serum p53 antibody in recurrent gastric cancer

Serum tumor markers in patients with cancer assist with establishing diagnosis, estimating prognosis, monitoring treatment, and detecting tumor recurrence. Changes in the p53 tumor suppressor gene are the most common genetic abnormalities in many different human malignancies. Several studies have demonstrated that serum p53 antibodies (S-p53Ab) comprise an early marker of malignant disease, a marker for treatment effects and a prognostic factor for patients with several types of tumors. We recently reported that S-p53Ab is useful for patients with gastric cancer. We describe a rare situation in which unusually high serum p53 antibodies helped to detect recurrent gastric cancer in the small intestine after gastrectomy. Further studies are required to gain a more precise understanding of the clinical impact of S-p53Ab titer monitoring in gastric cancer.