Noboru Yahara

Laparoscopic distal pancreatectomy with preservation of the spleen.

We describe a case of chronic pancreatitis treated by laparoscopic distal pancreatectomy with conservation of the spleen involving the resection of the splenic vessels. A proximal ligation of the splenic artery and vein was performed, followed by transection of the body of the pancreas. Retroperitoneum was dissected to the left by mobilizing the stump of the transected pancreas. The entire distal pancreas was freed posteriorly. The distal splenic artery and vein were ligated and divided individually adjacent to the tail of the pancreas at the hilum of the spleen. The points of this operation were to ligate the splenic artery and vein at both sides of the resected pancreas and to save the spleen with the blood supply continuing through the short gastric vessels and the splenocolic ligament. This operation with splenic preservation is more suitable for a patient who is a candidate for laparoscopic distal pancreatectomy, which will minimize the operation time, preserve the useful immunologic role of the spleen, and obtain the intact resected specimen. Furthermore, this procedure is useful in chronic pancreatitis patients because it avoids the difficult dissection of the posterior pancreas off of the splenic vessels.

Comparison of interleukin-6, interleukin-8, and granulocyte colony–stimulating factor production by the peritoneum in laparoscopic and open surgery

AbstractsBackground: Human mesothelial cells secrete a variety of cytokines. The levels of postoperative serum inflammatory cytokines are thought to reflect the magnitude of surgical stress. Methods: Pieces of peritoneum were obtained immediately upon and 1 h after entry into the abdominal cavity in nine patients undergoing laparoscopic surgery and 11 patients undergoing open surgery. The samples were cultured and interleukin (IL)-6, IL-8, and granylocyte colony–stimulating factor (G-CSF) levels in the supernatants were measured by enzyme-linked immunosorbent assay (ELISA). Expression of IL-6, IL-8, and G-CSF mRNAs was examined by RT-PCR. Results: At 1 h after laparotomy, the amounts of IL-6 and G-CSF produced by the peritoneum were significantly greater than those obtained immediately after the procedure, but this difference was not observed with laparoscopic surgery. Reverse transcription–polymerase chain reaction (RT-PCR), which showed an increase in the expression of cytokine mRNAs at 1 h after laparotomy, was compatible with these results. Conclusion: The lower levels of cytokine production by the peritoneum suggest that laparoscopic surgery is associated with lower degree of surgical stress.

Interleukin-6 production in lung tissue after transthoracic esophagectomy

BACKGROUND The mechanisms of the reported high increase in interleukin-6 (IL-6) levels after esophagectomy are unclear. We investigated the influence of an intrathoracic procedure, esophagectomy, on IL-6 production in lung tissue. STUDY DESIGN Fourteen paired lung tissue samples were obtained from patients before and after they underwent transthoracic esophagectomy for esophageal cancer. IL-6 levels in the lung were measured with enzyme-linked immunosorbent assay, and IL-6 mRNA expression was determined with real-time quantitative reverse transcription-polymerase chain reaction. Immunohistochemical staining was used to localize IL-6, and circulating levels were also measured. RESULTS IL-6 protein and mRNA were significantly increased in lung tissue after this intrathoracic procedure (p < 0.05). Peak levels of plasma IL-6 after surgery were correlated with IL-6 levels in lung tissues obtained after the procedure (p < 0.05). Immunohistochemical staining revealed IL-6 production from alveolar and bronchial epithelial cells but not from alveolar macrophages. CONCLUSIONS Transthoracic esophagectomy causes an increase in IL-6 production from airway epithelial cells, secondary to increased expression of IL-6 mRNA. Local response of lung tissue may be one source of increased serum IL-6 after this procedure.

Long-Term Survival of Patient with Epstein-Barr Virus-Positive Gastric Cancer Treated with Chemotherapy: Case Report

Gastric cancer (GC) is one of the major health problems throughout the world. It is known that early detection and early therapy for GC lead to a favorable outcome. However, inoperable GC is still hard to treat, and further progress in chemotherapy is needed [1]. Recently, the association Epstein-Barr virus (EBV) has been detected in almost 10 % of all cases of GC and 40 % of cancers of the remnant stomach. EBV-positive GC is mainly the poorly differentiated and tumor-infiltrating lymphocyte-rich type (lympho-epithelioma or gastric carcinoma with lymphoid stroma). The monoclonality of the EBV from individual GC lesions indicates the possible causal role of EBVin gastric carcinogenesis. The treatment outcome of advanced EBV-positive GC is reported to be better than that of EBV-negative GC [2–10]. However, accumulated data show some discrepancies between possible favorable chemotherapy outcomes in clinical EBV-positive GC and chemoresistance in EBV-positive GC lines [11–13]. Here, we report the long-term survival of a patient with EBV-positive GC who was treated with chemotherapy.