Sumihiko Koizumi

Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy in patients undergoing pancreatoduodenectomy to promote earlier discharge from hospital

Internal stenting of the hepaticojejunostomy and pancreaticojejunostomy was performed in 11 consecutive patients undergoing pancreatoduodenectomy between July 1992, and July 1994, to promote earlier discharge from hospital. Although minor leakage of the pancreaticojejunostomy occurred in 4 patients, this resolved within a short period and all 11 patients were able to be discharged by the 29th postoperative day in good health and without any intubation. Follow-up abdominal X-ray and computed tomography (CT) scans proved that all 22 of the stenting tubes had spontaneously fallen out by the 176th postoperative day. No complication related to the stenting tubes occurred in any of our patients.

Pancreatoduodenectomy for locally advanced or recurrent colon cancer: Report of two cases

A 66-year-old man, who had ascending colon cancer which invaded the duodenum, pancreas, and superior mesenteric vein, underwent a curative resection including an extended right hemicolectomy, pylorus-preserving pancreatoduodenectomy, and a partial resection of the superior mesenteric vein. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas, thus causing duodenocolic fistula. Tumor infiltration to the superior mesenteric vein was not histologically proven. Two out of 40 lymph nodes were also involved. The patient is still alive and disease-free 37 months after the operation. A 72-year-old man, with a history of surgery two previous times for ascending colon cancer and its recurrence, underwent a third operation including a resection of the former ileocolic anastomosis en bloc by means of a pylorus-preserving pancreatoduodenectomy with a curative intent. The pathological examination revealed adenocarcinoma of the colon, which directly invaded the duodenum and pancreas. Seven out of 31 lymph nodes were also involved. The patient died of recurrence 24 months after the third operation. These two cases demonstrated the usefulness of a resection of the colon en bloc by means of a pancreatoduodenectomy in patients with either locally advanced colon cancer or locally advanced recurrent colon cancer.

Pulmonary artery reconstruction using a great saphenous vein autograft in the treatment of bronchogenic cancer

Sleeve resection of the pulmonary artery, followed by reconstruction with or without bronchoplasty, for bronchogenic carcinoma located at a major lobar orifice has been reported as an alternative to pneumonectomy in patients with poor respiratory functional reserve. We describe herein what is, to our knowledge, the first, report of a successful pulmonary arterial reconstruction using a saphenous vein autograft. This operation was performed in a 63-year-old man with poor pulmonary functional reserve who was diagnosed as having a large bronchogenic cancer in the left lower lobe of the lung, located close to the pulmonary hilum. First, a left lower lobectomy was performed with segmental resection of the pulmonary artery, from the basal artery to the lingular artery, after which pulmonary arterial continuity was reconstructed using a saphenous vein autograft. The patient had an uneventful recovery and remains well without any sign of recurrence 4 months after his operation.

Application of three-dimensional spiral computed tomographic angiography prior to hepatectomy for hepatocellular carcinoma.

A newly developed method of spiral computed tomography (CT) angiography was employed for 19 consecutive hepatocellular carcinoma (HCC) patients who underwent hepatectomy. Fine images of the intrahepatic vascular structure, portal venous branches and hepatic veins, and HCC nodules were obtained in 16 patients. A more accurate and easier understanding of the relationship between the intrahepatic vascular structure and the HCC nodules was provided by this spiral CT angiography compared with any other imaging modality.