Masanori Aramaki

Optimal management of the branch duct type intraductal papillary mucinous neoplasms of the pancreas.

Goals To determine the optimal management of the intraductal papillary mucinous neoplasms (IPMNs) according to the morphologic type based on distinguishing between benign and malignant diseases. Backgrounds IPMNs are increasingly recognized clinicopathologic entity. Extended pancreatic resection with radical lymph node dissection has been recommended for treatment. Study A retrospective clinicopathologic study was carried out of the 57 cases with IPMNs who were treated between 1985 and 2001. Forty-three patients with IPMNs underwent resection, and 14 patients with small IPMNs were observed without resection. Results Among the 43 resected IPMNs, 25 were benign and 18 were malignant. Malignant tumors were significantly greater in diameter than benign tumors (52.9 vs. 30.2 mm, P < 0.05). All main duct type tumors with mural nodules were malignant. All branch duct type tumors less than 30 mm in diameter and without mural nodules were benign. Twelve branch duct type IPMNs size less than 30 mm were not resected and have not progressed. Conclusion These results suggest that the branch duct type IPMNs less than 30 mm and without mural nodules is benign and might be treatable with limited resection or careful observation.

Prognostic significance of intrahepatic lymphatic invasion in patients with hepatic resection due to metastases from colorectal carcinoma

Intrahepatic spread from liver metastases of colorectal carcinoma has been well described; however, its prognostic value after hepatectomy is controversial. To clearly determine factors predicting survival after hepatectomy in such patients, the authors evaluated 14 clinicopathologic factors of liver metastasis from colorectal carcinoma with special reference to intrahepatic lymphatic invasion.

Microwave coagulation therapy accelerates growth of cancer in rat liver

BACKGROUND/AIMS Although microwave coagulation therapy (MCT) has been performed for liver cancer, there has been no report examining the influence of this therapy on the growth of possible remnant cancer. METHODS A solid cube of AH-130 cells (ascites hepatoma cell line) was implanted into the left lateral lobe of the rat liver. Five days later, MCT was applied to the middle liver lobe of these rats. Tumor growth and cytokine levels in plasma and the liver were compared between rats that underwent MCT and rats that did not. RESULTS The mean tumor weight in the MCT group (222.6+/-51.5 mg, mean+/-SD) was significantly greater than that in the control group (126.7+/-19.7 mg, P<0.01) at postoperative day (POD) 5. Immunohistochemistry for anti-proliferating cell nuclear antigen showed the labeling index in the MCT group (90.4%) to be higher than that in the control group (76.7%, P<0.01). Liver basic fibroblast growth factor and transforming growth factor-beta 1 levels in the MCT group on POD 3 were significantly higher than levels in the control group. CONCLUSIONS The present study suggests the clinically important finding that MCT accelerates the growth of small residual tumors in the liver.

Immunohistochemical expression of cytokeratins in intrahepatic cholangiocarcinoma and metastatic adenocarcinoma of the liver.

This study was designed to identify a difference in immunostaining that might help to distinguish between primary and metastatic liver neoplasms.

Clinicopathologic study of mixed hepatocellular and cholangiocellular carcinoma: modes of spreading and choice of surgical treatment by reference to macroscopic type.

Clinicopathologic features and the choice of surgical treatment for mixed hepatocellular and cholangiocellular carcinoma (MHC) remain controversial.

Proximal Gastrectomy and Gastric Tube Reconstruction for Early Cancer of the Gastric Cardia

Background: Advances in diagnostics and techniques have increased the number of detections of early cancer of the gastric cardia. The aim of this report is to describe a new technique of proximal gastrectomy and gastric tube reconstruction using an autosuture stapler. Methods: At operation, the upper part of the stomach was fully mobilized, and the abdominal esophagus was transected. The stomach was cut between the points of the distal three fourths of the lesser curvature and a half of the greater curvature, and a gastric tube measuring 20 cm in length and 4 cm in width was made. A circular stapler was inserted through a stapled line, and direct anastomosis between the esophagus and gastric tube was completed. Results: When compared with the patients who underwent proximal gastrectomy and jejunal interposition, those who underwent gastric tube reconstruction showed a significantly shorter operation time. All 3 patients who underwent proximal gastrectomy and gastric tube reconstruction recovered uneventfully and took foods satisfactorily. Good passage through the gastric tube was recognized on roentgenography, and reflux esophagitis or stomal ulcer was not found on fiberscopy. Conclusions: We believe the procedure is technically simple and safe, and provides good postoperative results in patients with early cancer of the gastric cardia.

Antitumor and antivascular effects of AC-7700, a combretastatin A-4 derivative, against rat liver cancer

AbstractBackground. Unlike the many chemotherapeutic agents that do not effectively stop blood flow or induce necrosis in hepatocellular carcinoma, AC-7700 has been shown to inhibit tubulin polymerization and selectively stop tumor blood flow. The aim of this study was to elucidate the antivascular and antitumor effects of AC-7700 on rat hepatoma. Methods. AH-130 cells, a rat hepatoma cell line, were solidified and implanted into the liver of Donryu rats. Vascularity of the liver tumor was directly identified by in-vivo fluorescence microscopy from 0 to 60 min after the injection of 10 mg/kg AC-7700. To observe the antivascular effect of AC-7700, the vascular density of the tumor was measured and assessed as the ratio of preinjection to postinjection values. The antitumor effects were evaluated with histopathologic findings and analysis of animal survival. Results. In-vivo microscopic observation showed that tumor perfusion diminished within 30 min after AC-7700 administration. Vascular density in the AC-7700 group was significantly less than that in the control group at 60 min (AC-7700, 26.3 ± 16.4%; control, 88.5 ± 9.2%; P < 0.001). After AC-7700 injection, marked necrosis of tumor cells was observed histologically, and tumor area was decreased significantly (AC-7700, 11.5 ± 15.4 mm2; control, 43.5 ± 18.3 mm2; P < 0.05). The survival rate (50%) of the AC-7700 group animals was better than that of the control group (0%; P < 0.01). Conclusion. Markedly decreased tumor perfusion was induced by AC-7700 within 30 min, and this decrease may have contributed to the tumor necrosis and favorable outcome in the treatment group. AC-7700 appears to be a promising agent for the treatment of hepatocellular carcinoma.

Long-term survival after perforation of advanced gastric cancer: Case report and review of the literature.

Abstract:Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia.

Liver Resections Performed Under Prolonged Portal Triad Occlusion in Patients with Active Chronic Liver Diseases

We analyzed the results of hepatic resections performed during the past 5 years on 27 patients with active chronic liver diseases. The patients included 5 with chronic active hepatitis and 22 with active liver cirrhosis, all of whom had a serum alaninine aminotransferase (ALT) level of more than 100 U/I on admission. Fourteen patients underwent hepatectomy by the conventional method (group 1), and 13 were treated by liver resection with portal triad occlusion (PTO) ranging from 32 to 75 min (group 2). The mean blood loss was significantly lower in group 2 than in group 1, being 630 versus 1,491 ml (P<0.05). No serious complications developed in any of the group 2 patients, whereas liver failure occurred in three of the group 1 patients, two of whom died. The serum bilirubin levels were stabilized in group 2 from 14 days after surgery, whereas the values in group 1 remained elevated. These results indicate that prolonged hepatic inflow occlusion can be used during surgery in selected patients with active chronic liver diseases.

GASTRIC NEOPLASIA DEVELOPED AFTER PROXIMAL GASTRECTOMY : REPORT OF THREE CASES

The incidence of proximal gastric cancer is increasing and proximal gastrectomy is widely accepted as a standard operation for early staged proximal gastric cancer. Recently, we encountered three aged patients with distal gastric cancer or adenoma after proximal gastrectomy: one with mucosal adenocarcinoma and two with adenoma. These patients showed that carcinoma or adenoma could develop in the distal gastric remnant after proximal gastrectomy. Although gastric remnant cancer has been defined as a cancer that arises in the proximal gastric remnant after distal gastrectomy, it hereafter includes a cancer that arises in the distal gastric remnant after proximal gastrectomy. Endoscopic examination of the distal gastric remnant is important in asymptomatic patients who underwent proximal gastrectomy.