Shinichi Sugiyama

Liver Hanging Maneuver Decreases Blood Loss and Operative Time in a Right-Side Hepatectomy

BACKGROUND/AIMS To clarify the clinical benefits of the maneuver in right-side hepatectomy. METHODOLOGY Eighty-one patients with liver tumor (54 hepatocellular carcinoma, 17 metastatic liver tumor and 10 other tumors) treated with a right-side hepatectomy were prospectively analyzed. The patients were divided into the following three groups: a conventional approach (group A, n=21); liver dissection under the hanging maneuver after liver mobilization (group B, n=19) and liver dissection under the hanging maneuver prior to liver mobilization (group C, n=41). RESULTS The liver hanging maneuver was safely performed in all the patients in groups B and C. Tumor size had a significantly positive correlation with the amount of intraoperative blood loss (R=0.52, p<0.05) in group A only. The patients in groups B and C had a significantly lower intraoperative use of blood loss (both p<0.01), operation time (p<0.05 and p<0.01) and the frequency of blood product (both p<0.05), in comparison to group A, respectively. The postoperative morbidity and the mortality rates were similar in the three groups. CONCLUSIONS Liver hanging maneuver is a safe procedure, which can decrease intraoperative blood loss and administration of blood product in right-side hepatectomy.

Preoperative portal vein embolization (PVE) for patients with hepatocellular carcinoma can improve resectability and may improve disease-free survival

The aim of this study is to identify the efficacy of portal vein embolization (PVE) before right hepatectomy in patients with hepatocellular carcinoma (HCC) with regard to hepatic function, surgical stress, and survival benefit.

Intraductal neoplasm of the intrahepatic bile duct: Clinicopathological study of 24 cases

AIM To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB). METHODS Clinicopathological features of 24 cases of INihB, which were previously diagnosed as biliary papillomatosis or intraductal growth of intrahepatic biliary neoplasm, were reviewed. Mucin immunohistochemistry was performed for mucin (MUC)1, MUC2, MUC5AC and MUC6. Ki-67, P53 and β-catenin immunoreactivity were also examined. We categorized each tumor as adenoma (low grade), borderline (intermediate grade), and malignant (carcinoma in situ, high grade including tumors with microinvasion). RESULTS Among 24 cases of INihB, we identified 24 tumors. Twenty of 24 tumors (83%) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB). In contrast, the remaining four tumors (17%) showed both tubular and papillary structures. In three of the four tumors (75%), macroscopic mucin secretion was limited but microscopic intracellular mucin was evident. Histologically, 16 tumors (67%) were malignant, three (12%) were borderline, and five (21%) were adenoma. Microinvasion was found in four cases (17%). Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P = 0.0095). Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2 ± 15.5 vs 7.5 ± 6.3, P < 0.01). In the 16 malignant cases, expression of MUC5AC showed borderline significant association with high Ki-67 LI (P = 0.0622). Nuclear expression of β-catenin was observed in two (8%) of the 24 tumors, and these two tumors also showed MUC1 expression. P53 was negative in all tumors. CONCLUSION Some cases of INihB have a tubular structure, and are subcategorized as IPNB with tubular structure. MUC1 expression in INihB correlates positively with degree of malignancy.

Primary neuroendocrine tumor in the liver treated by hepatectomy: report of a case.

A 49-year-old woman was admitted to our hospital under suspicion of an enlarging hepatic tumor, which had been previously diagnosed to be a cavernous hemangioma. Computed tomography revealed three enhanced tumors, one measuring 15 cm in diameter within the right lobe of the liver and two intrahepatic metastases in Couinaud’s hepatic segments 3 and 5. We diagnosed the patient to have primary liver cancer, and suspected a combined liver tumor preoperatively. We performed a right trisectionectomy with radiofrequency ablation of the intrahepatic metastasis in S3. According to the immunohistochemical findings of the resected specimen and the findings of postoperative imaging studies, the tumor was diagnosed to be a primary neuroendocrine tumor in the liver. The patient is presently alive without recurrence at 33 months after the operation.

Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma

BACKGROUND/AIMS Numerous prognostic factors for HCC have been reported. Few literatures have reported clinical significance of amount of intraoperative blood loss (ABL) for the outcome after surgery for HCC. The aim of this study is to analyze the significance of ABL for outcome after surgery for HCC. METHODOLOGY A total of 301 patients who underwent liver resection for HCC between January 1998 and June 2007 were included. Clinical and surgical characteristics were collected and prognostic factors were identified using univariate and multivariate analysis. RESULTS Impaired liver function (liver damage B), large tumor (>36mm), multiple tumors, existence of macroscopic vessel invasion, large ABL (=700mL) and replacement of red blood cells were identified as independent prognostic factors for overall survival (OS). For disease free survival (DFS), old age (>66), male gender, impaired liver function, large tumor, multiple tumors, existence of macroscopic vessel invasion and large ABL were extracted. Limited to the patients without blood transfusion, large ABL is associated with poor OS and DFS. CONCLUSIONS Large ABL could result in poor OS and DFS after liver resection of HCC in patients without blood transfusion. Surgeons have to make the best effort to reduce ABL.

Simultaneous total laparoscopic curative resection for synchronous gastric, cecal and rectal cancer: Report of a case

Highlights • Simultaneous total laparoscopic curative resection for synchronous GC, cecal and rectal cancer.• Our ingenious technical attempts can lead to the successful completion of simultaneous total laparoscopic curative resection.• Simultaneous laparoscopic surgery for synchronous GI cancers is a minimally invasive, feasible treatment option.

Images of the Month: Acute Pancreatitis in Gastric Aberrant Pancreas.

The American Journal of GastroenteroloGy Volume 110 | july 2015 www.nature.com/ajg A 37-year-old woman with a gastric aberrant pancreas on the greater curvature of the middle gastric body presented to our hospital with epigastric pain. Her serum pancreatic amylase levels were slightly elevated (176 IU/l). (Left) Upper gastrointestinal endoscopy detected a submucosal tumor (arrows) with edema of the gastric wall. (Right) Abdominal contrast-enhanced computed tomography revealed an enlarged and enhanced gastric aberrant pancreas with duct structures and edema of the gastric wall around it. The primary pancreas appeared normal.

Repeated recurrence of a gastric gastrointestinal stromal tumor on the chest wall after initial curative resection: Report of a case☆

Highlights • Extra-abdominal recurrence or metastasis of a GIST is very rare.• Furthermore, most GISTs recur during the first 5 years of follow-up and few recur after the first 10 years of follow-up.• We herein report a case of repeated recurrence of gastric GIST involving the chest wall of a patient 11 years after curative resection.