Masaru Izumi

Combined Liver and Inferior Vena Cava Resection for Adrenocortical Carcinoma

PurposeAdrenocortical carcinoma (ACC) is a rare malignancy, usually diagnosed at an advanced stage when it has invaded or adhered to adjacent organs. We report our experience of performing combined liver and inferior vena cava (IVC) resection for ACC.MethodsSix patients with clinical stage III (n = 4) or IV (n = 2) ACC underwent combined resection of the liver and IVC. Two patients underwent extended right hepatectomy, and four underwent segmentectomy. In four patients, the IVC was resected segmentally: it was replaced with expanded polytetrafluoroethylene (ePTFE) in three of these patients, and not reconstructed in one. In two patients, the IVC was partially resected and closed directly.ResultsPerioperative mortality was zero, and morbidity was 33.3%, with temporary liver failure in two patients and renal failure in one patient. Recurrence was found within 8.1 months in three (50%) of the six patients. The mean recurrence-free survival period was 20.1 ± 7.7 months (95% confidence interval [CI]: 5.1–35.4), and the median survival time was 6.1 ± 9.8 months (95% CI: 00–25.3). The 5-year disease-free survival rate was 16.7%.ConclusionsPatients with ACC involving both the liver and IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, and prolonged survival in some patients.

Left Colon Substitution with His’ Angle following Total Gastrectomy

To resolve the disadvantages of jejunal Roux-en-Y reconstruction following total gastrectomy, we attempted the use of left colon substitution with all anastomoses conducted using mechanical stapling devices. A His’ angle was formed to reduce regurgitation esophagitis. About 25 cm of the left colon with the ascending branch of the left colic artery with an adequate blood supply was brought up to the remnant esophagus without tension on the mesentery. The colon graft was interposed between the esophagus and duodenum in an isoperistaltic fashion. Three anastomoses, esophagocolic, duodenocolic and colocolic, were completed with a circular stapling device. An end-to-side esophagocolonostomy was positioned about 3 cm distal from the blind end of the proximal colon stump. The proximal end of the left colon was pexied to the esophagus using 3–4 stitches to make a new His’ angle. Gastrointestinal continuity was restored by a side-to-end colonoduodenostomy and an end-to-end colonocolonostomy. Fifteen gastric cancer patients underwent left colon substitution following total gastrectomy. The circular staple used for esophagocolonostomy and colonoduodenostomy was 25 mm in all patients, and for colonocolonostomy was 29 mm in 9 patients and 33 mm in 6 patients. No problems were encountered in any steps of the procedure, and faulty stapling was avoided. Neither anastomotic leakage nor necrosis of the interposed colon segment was seen, nor was late anastomotic stricture, in any patient. Barium radiograms of the interposed colon segment showed that the capacity and passage of the interposed colon were adequate, and regurgitation did not occur. Diet volume was satisfactory and weight loss minimal.

Sudden Hemorrhage of the Breast Caused by Breast Cancer Without Skin Invasion: Report of a Case

A rare case of sudden hemorrhage caused by breast cancer is herein presented. A 65-year-old woman was admitted to our hospital because of bleeding from her left breast. On physical examination, a continuous hemorrhage accompanied by an open cavity formation was observed in her left breast. She had no history of breast trauma. Her bleeding profile studies and liver function were both normal. In addition, no anticoagulation medication had been administered. The histological findings of the cavity wall indicated invasive ductal carcinoma without skin invasion. After carrying out chemotherapy, a standard radical mastectomy was performed.

Minutes of the 3rd General Assembly of European Digestive Surgery (EDS)

EDS Secretary M.W. Büchler gave a short report on the ongoing increasing membership of EDS. EDS presently has 1,013 members from 52 countries. He especially mentioned the following 3 countries as bringing most of the members: (1) the former Yugoslavia, with 125 members; (2) Switzerland, with 117 members, and (3) Germany, with 78 members. M.W. Büchler underlined that with over 1000 members our society has reached great importance in the field of European digestive surgeons. However, it should continue to be our aim to encourage young doctors with an interest in digestive surgery to join the society. Agenda of the EDS General Assembly

Limited Surgery for Early Cancer in the Middle Part of the Stomach : A Retrospective Study Based on Lymph Node Metastasis

胃中部早期胃癌144例の所属リンパ節への転移状況をretrospectiveに検討し, 縮小手術の可能性と合理的なリンパ節郭清範囲について検討した.リンパ節転移は6例 (4.2%) で, m癌, Sm癌の転移率はおのおの1.1%, 9.8%であった.sm癌で大きさ5.1cm以上, 混合型 (IIa+IIcなど), porにリンパ節転移が多かった.リンパ節転移部位は (1),(3),(4d),(7),(8a) であった.胃中部早期胃癌の縮小手術の適応を胃切除と系統的リンパ節郭清範囲の縮小との観点から想定した.縮小手術は内視鏡的治療の適応外で肉眼型と大きさにかかわらず深達度M癌, 深達度SM癌 (SM1またはSM2) は, 大きさ5.0cm以下の隆起型 (I, IIa) または陥凹型 (IIc, III) が適応となる.porのSM癌は縮小手術の適応とはなりえない.また, 縮小手術としては, 分節胃切除, リンパ節は,(1),(3),(4d),(7),(8a) を郭清するのが合理的と考える.