Masakatsu Kinuta

The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer

Background. The technique of laparoscopy-assisted distal gastrectomy (LADG) was developed for early gastric cancer, but its feasibility and the associated clinical outcome remain unclear.Methods. We reviewed 24 patients who underwent LADG (LADG group) and 35 patients who underwent traditional open distal gastrectomy (ODG group) for early gastric cancer in our hospital, and compared the clinical data of the two groups.Results. The clinical and pathological backgrounds of the patients in the two groups were similar. The duration of surgery was not significantly different between the two groups, but the blood loss in the LADG group was significantly less than that in the ODG group. The number of removed lymph nodes was not significantly different between the two groups. The times to the first passing of flatus, first walking, and the restarting of oral intake; the length of hospital stay; and the duration of epidural analgesia were significantly shorter in the LADG group. The morbidity rate in the LADG group was lower than that in the ODG group.Conclusions. LADG is a safe and minimally invasive surgical technique, after which we can expect a faster recovery.

Mast cell infiltration around gastric cancer cells correlates with tumor angiogenesis and metastasis

Background. Increased numbers of mast cells are found in various solid tumors. To investigate the role of mast cells in the vicinity of gastric cancer cells, we used special staining and an immunohistochemical technique. Methods. Specimens were surgically obtained from 102 patients with gastric cancer. Mast cells around the tumor edge of gastric cancer nests were counted by staining with 0.05% toluidine blue solution. Blood vessels in these areas were also counted, by immunohistochemical staining of endothelial cells for factor VIII. Results. The average number of mast cells and blood vessels in gastric cancer specimens was significantly higher than that in normal gastric tissue. Specimens from patients with advanced disease with metastases to lymph nodes had more mast cells than specimens from patients with early-stage disease. Mast cells in specimens from patients with metastatic lymph nodes were significantly increased in comparison with numbers in specimens from those without nodal metastases. Mast cell numbers in the specimens of patients with lymphatic or blood vessel invasion were significantly higher than numbers in specimens from patients without such invasion. Mast cells were localized near the new vessels around gastric cancer cells. Mast cell numbers increased as the number of blood vessels increased (correlation coefficient, 0.783). Postoperative survival curves revealed that patients with increased numbers of mast cells had a poor prognosis. Conclusions. All these results suggest that mast cell accumulation at the tumor site may lead to increased rates of tumor vascularization and, consequently, increased rates of tumor growth and metastasis.

The usefulness, indications, and complications of laparoscopy-assisted colectomy in comparison with those of open colectomy for colorectal carcinoma

The technique of laparoscopy-assisted colectomy (LAC) was developed for benign and malignant diseases of the colon and rectum; however, its feasibility and the associated clinical outcome remain unclear. We reviewed 45 patients who underwent LAC (LAC group) and 62 patients who underwent traditional open surgery (Open group) for colorectal carcinoma in our hospital, and compared the clinical data between the two groups in an effort to determine whether LAC is really minimally invasive and if it enhances the quality of life. So that the backgrounds of the patients in both groups were almost the same, we only compared data of patients with colorectal carcinoma of stages 0, I, and II. The duration of surgery in the Open group was significantly shorter for all procedures except sigmoid resection, but the blood loss was not significantly different between any of the procedures except for right colectomy. The time to the first passing of flatus and restarting oral intake, length of hospital stay, and duration of epidural analgesia were significantly shorter in the LAC group. The morbidity and mortality rates in the LAC group were almost the same as those in the Open group at 29.5% and 3.3% versus 22.6% and 1.6%, respectively. However, five major complications of LAC for advanced colorectal carcinomas might be prevented by performing an open procedure. In conclusion, LAC is a safe and minimally invasive surgical technique following which we can expect a faster recovery; however, patients with advanced colorectal carcinomas must be carefully selected for this operation.

Solitary splenic metastasis from ovarian cancer successfully treated by hand-assisted laparoscopic splenectomy: report of a case.

Abstract.Solitary splenic metastasis is an extremely rare phenomenon for which splenectomy is generally indicated because a good prognosis can be achieved if chemotherapy is given postoperatively. We report herein a case of solitary splenic metastasis from ovarian cancer, which was completely removed by hand-assisted laparoscopic surgery.

Efficacy of Absorbable Clips Compared with Metal Clips for Cystic Duct Ligation in Laparoscopic Cholecystectomy

Abstract.Purpose: This study was conducted to examine the usefulness and safety of absorbable clips in laparoscopic cholecystectomy (LC). Methods: We retrospectively compared the clinical data of 328 patients who underwent LC using absorbable clips for cystic duct ligation and 444 patients who underwent LC using metal clips for cystic duct ligation. Results: The mean operative time in the absorbable clip group was significantly shorter than that in the metal clip group. The mean intraoperative blood loss and hospital stay were not significantly different between the two groups. The rate of conversion to open laparotomy in the absorbable clip group was significantly higher than that in the metal clip group, at 6.7% vs 2.3%, respectively. The most common reason for conversion was difficult adhesions and inflammation around the gallbladder. The morbidity of the metal clip group was significantly higher than that of the absorbable clip group, at 8.4% vs 4.0%, respectively. The incidence of major postoperative complications requiring laparotomy did not differ between the two groups. There were no deaths in the absorbable clip group, but 1 of the 444 patients (0.23%) in the metal clip group died from disseminated intravascular coagulation on postoperative day 3. Conclusion: The results of this study suggest that absorbable clips are as safe and effective as standard metal clips for vessel and duct ligation in LC.

An oral anticancer drug, TS-1, enabled a patient with advanced gastric cancer with Virchow's metastasis to receive curative resection.

Abstract.We encountered a patient with advanced gastric cancer, with Virchows lymph node metastasis, who subsequently underwent curative resection after neoadjuvant chemotherapy with the newly developed oral anticancer drug, TS-1. The patient was a 67-year-old woman who had a type 2 tumor in the middle third of the stomach, and Virchows lymph node metastasis, which was diagnosed by fine-needle aspiration cytology; she also had swollen paraaortic lymph nodes. Curative resection was considered impossible, and TS-1 (100 mg/day) was administered for 28 days in one course, mainly in the outpatient clinic. Although grade 2 stomatitis interrupted the therapy on day 21 of the second course and on day 7 of the third course, the type 2 tumor showed marked remission (partial response; PR) and the metastasis in the Virchows and paraaortic lymph nodes had completely disappeared after the third course (complete response; CR). Eleven weeks after the completion of the TS-1 treatment, total gastric resection with D3 lymph node dissection was performed. Histopathological examination revealed tumor involvement only in the mucosal and submucosal layers of the stomach and the no. 4d lymph node. Most of the tumor was replaced with fibrosis with granulomatous change in the muscularis propria of the stomach and in the no. 3, no. 6, and no. 7 lymph nodes. This may be the first report of a patient with advanced gastric cancer with Virchows lymph node metastasis who successfully received curative resection following neoadjuvant chemotherapy with a single oral anticancer drug.

Primary squamous cell carcinoma of the stomach.

Primary squamous cell carcinoma (SCC) of the stomach is extremely rare; only 32 cases are found in the Japanese literature. The pathogenesis of this neoplasm remains obscure and controversial. Furthermore, the optimal treatment, including adjuvant chemotherapy, remains unclear. We report herein a case of SCC of the stomach in a 70-year-old male with amazing effectiveness of neoadjuvant chemotherapy, low-dose FP chemotherapy. To our knowledge, no case of this disease has ever been reported that was given neoadjuvant chemotherapy and histologically showed its effectiveness. Our case demonstrated a striking effectiveness of chemotherapy in the neoplasm both radiologically and histologically.

Follow-up study of combination treatment (TAE and PEIT) for unresectable hepatocellular carcinoma.

The subjects were 35 patients with unresectable hepatocellular carcinoma. The patients were divided into a transcatheter arterial embolization group (TAE group, 18 cases) and a combination therapy group receiving both TAE and percutaneous ethanol injection therapy (TAE+PEIT group, 17 cases). The 50% survival period was 21.1 months for the TAE group and 37.8 months for the TAE+PEIT group (P<0.05). The longest survival period in the TAE group was 89 months. In the TAE+PEIT group, one patient has survived for 59 months. The actuarial 1-, 2-, and 3-year survival rates for the TAE group were 82%, 45%, and 22%, respectively. For the TAE+PEIT group the rates were 83%, 64%, and 64%, respectively. The TAE+PEIT group showed a significantly higher survival rate in the 895-to 1.074-day period as compared with the TAE groupP<0.05). Overall, the survival rate tended to be higher in the TAE-PEIT group (P<0.1). The therapeutic responses of tumors were measured by the maximal reduction rate within 6 months of TAE and PEIT. In the TAE group, a PR was seen in only four cases. In the TAE+PEIT group, CRs and PRs were achieved significantly more frequently than in the TAE group. When the patients were divided into a responder group (CR, PR, and MR) and a nonresponder group (NC and PD), survival was significantly longer in the responder group. The findings of the present study suggest that the combination therapy was useful for improving the survival of patients with unresectable hepatocellular carcinoma.

Use of non-powder surgical glove for extraction of gallbladder in laparoscopic cholecystectomy

Background:  The present study was conducted to evaluate the usefulness and safety of the non‐powder surgical glove for extraction of the gallbladder in laparoscopic cholecystectomy.

Laparoscopic cholecystectomy for asymptomatic cholelithiasis

Background:  Laparoscopic clolecystectomy is now the most appropriate treatment for most patients with symptomatic cholelithiasis (S‐Chole). However, the management of patients with asymptomatic cholelithiasis (A‐Chole) remains controversial. Our research is aimed at determining whether laparoscopic cholecystectomy for patients with A‐Chole is safer, more effective and more convenient than laparoscopic cholecystectomy for patients with S‐Chole.