Naoya Ikeda

Effects of pancrelipase on nonalcoholic fatty liver disease after pancreaticoduodenectomy

Postoperative nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has recently become recognized. However, the pathoetiology of postoperative NAFLD is largely unknown. Furthermore, the optimal treatment has not been established. The aim of this prospective study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse NAFLD.

Epidermal growth factor receptor mutations in malignant pleural and peritoneal mesothelioma

Background Epidermal growth factor receptor (EGFR) gene mutation at the kinase domain and EGFR gene amplification are reported to be predictors of the response to EGFR tyrosine kinase inhibitors in lung cancer cases. In malignant mesothelioma (MM), the role of EGFR is less clear. Methods Thirty-eight MM specimens were submitted to EGFR mutation evaluation, and compared with the results of immunohistochemical staining and fluorescence in situ hybridization (FISH) analysis. DNA was extracted from paraffin blocks and PCR was performed to amplify exon regions 18–21 of the EGFR gene. Direct sequencing of the purified PCR products was performed. Results Five EGFR missense mutations were detected in six of the 38 patients (16%); two of these mutations were novel, two were originally detected in non-small cell lung carcinoma, and one resembled a location previously noted for malignant peritoneal mesothelioma. Conclusion As far as the authors are aware there has been no report of the EGFR mutation of MM in Japanese cases, but in this study EGFR missense mutations were detected in some cases. EGFR mutation results were not related to immunohistochemical and FISH analysis.

A comparison of epidermal growth factor receptor expression in malignant peritoneal and pleural mesothelioma.

An evaluation of epidermal growth factor receptor (EGFR) phenotypic expression in malignant pleural and peritoneal mesothelioma was undertaken, using immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) analysis. Thirty‐eight malignant mesothelioma (MM) specimens were subjected to IHC staining and FISH to evaluate the expression of EGFR protein and gene status. Overall positive IHC reaction was detected in 20/38 (53%) cases, in 11/22 (50%) pleural MM, and in 9/16 (56%) peritoneal MM. Our study confirmed that EGFR membranous expression is a common feature in MM, but not in benign mesothelial lesion. Thirty‐seven cases did not show a gene copy number gain. Only one case showed a copy number gain. The protein overexpression of EGFR was not related to a gene copy number gain.

Potential role of surgical resection for pancreatic cancer in the very elderly

BACKGROUND There is increasing need to evaluate the surgical indication of pancreatic cancer in very elderly patients. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of pancreatic resection in pancreatic cancer patients over the age of 80. METHODS Between 2005 and 2012, 26 octogenarian patients who received pancreatic resection and 20 who received chemotherapy for pancreatic cancer were retrospectively reviewed. Clinicopathological factors, chemotherapy administration status, and survival were compared. Univariate and multivariate analysis of prognostic factors for survival was performed. RESULTS Postoperative major complication rate was 8%, with no mortality. The one-year survival rate and median survival time of the surgery and chemotherapy groups were 50% and 45%, and 12.4 months and 11.7 months, respectively (P = 0.263). Of the 26 resected cases, 6 completed the planned adjuvant chemotherapy treatment course. The median survival time of those 6 completed cases was significantly longer than that of the 20 not completed cases (23.4 versus 10.0 months, P = 0.034). Furthermore, a multivariate analysis of the 26 resected cases showed that distant metastasis (HR 3.206, 95%CI 1.005-10.22, P = 0.049) and completion of the planned adjuvant therapy (HR 4.078, 95%CI 1.162-14.30, P = 0.028) were independent prognostic factors of surgical resection. CONCLUSIONS Surgical resection was safe, but not superior to chemotherapy for pancreatic cancer in octogenarians. In the very elderly, only selected patients may benefit from pancreatic resection.

Do pancrelipase delayed-release capsules have a protective role against nonalcoholic fatty liver disease after pancreatoduodenectomy in patients with pancreatic cancer? A randomized controlled trial.

The aim of this randomized controlled trial (RCT) was to investigate whether pancrelipase protects against nonalcoholic fatty liver disease (NAFLD) development after pancreatoduodenectomy in patients with pancreatic cancer better than conventional pancreatic enzyme supplementation.

Central Pancreatectomy with Double Pancreaticojejunostomy

Received March 26, 2015; Revised May 1, 2015; Accepted From the Departments of Surgery, Nara Medical Universi (Sho, Akahori, Nagai, Kinoshita, Nakajima); Kansai Med Hirakata, Japan (Satoi, Yanagimoto, Yamamoto, Kwon); an ture Western Medical Center, Japan (Ikeda). Correspondence address: Masayuki Sho, MD, PhD, FACS, Surgery, Nara Medical University, 840 Shijo-cho, Kashiha 8522, Japan. email: m-sho@naramed-u.ac.jp

Anastomotic leakage rate following modified double staple technique of anterior resection with vertical division of the rectum for rectal cancer surgery

Introduction: Anastomotic leakage (AL) after double staple technique (DST) for rectal cancer surgery is a major complication. The aim of this study is to assess the usefulness of the modified double-stapling technique with vertical division of the rectum (IO-DST). Patients and methods: Forty-three consecutive cases performed by IO-DST technique from July 2011 to August 2015 were reviewed retrospectively. All cases were performed by IO-DST technique for the anastomosis controlled by one skillful colorectal surgeon who has worked for over 30 years as a surgeon and over 20 years as a colorectal surgeon, experienced in over 1500 cases of colorectal cancer as operator or an assistant. AL was clinically evaluated. Results: 41 cases (95.3%) were performed in open surgery, left colic artery (LCA) was preserved in 35 cases (81.4%), diverting ileostomy was performed in 6 cases (14%) and pelvic lymphadenectomy was performed in 7 cases (16.3%). IO-DST anastomosis was performed in 30 cases (69.8%) with PCEEA 31mm. Leakage was found in one case (2.3%), it was not found for the cases of anterior resection or the cases with preservation of LCA. Conclusion: We conclude IO-DST anastomosis for rectal cancer was safe procedure with low AL rate. Correspondence to: Dr. Masahiro Tsubaki, Department of Surgery, Yuai Memorial Hospital, 770, Higashi-ushigaya, Koga, Ibaraki, Japan, E-mail: tsubamasa1987@gmail.com