Sumio Matsumoto

Cimetidine and survival with colorectal cancer

aiming to reduce appetite loss and reflux oesophagitis in colorectal cancer patients receiving 5-fluorouracil after operation, and have been surprised to find that treatment with cimetidine is advantageous in increasing the diseasefree period and survival, as Adams and Morris reported.1 64 colorectal cancer patients (46 colon cancer and 18 rectal cancer patients) were registered and assorted randomly into two groups. All patients received 8 mg/m2 of mitomycin intravenously within 24 h of surgical resection of the tumour. The patients in one group were given cimetidine 800 mg together with 5-fluorouracil 150 mg orally every day for about 1 year starting 2 weeks after the operation, while the patients in the control group received 5-fluorouracil alone. There were no significant differences between the two groups in the distribution of Dukes’ stages or other factors defined by the general rules of the Japanese Research Society for Cancer of the Colon and Rectum. At a mean follow-up of 31 months, the 3-9-year survival in cimetidine-treated colon cancer patients (n=27) was 96-3% and in controls

A safe laparoscopic cholecystectomy depends upon the establishment of a critical view of safety

Bile duct injuries (BDI) during a laparoscopic cholecystectomy (LC) occur more frequently than during an open cholecystectomy. Many expert surgeons learn to perform procedures safely based on their experience. Above all, the critical view of safety (CVS) introduced by Strasberg in 1995 is the standard practice to prevent BDI during an LC. The CVS is achieved by clearing all fat and fibrous tissue in Calot’s triangle, after which the cystic structures can be clearly identified, occluded, and divided. Failure to successfully create this view may be an indication for conversion to an open cholecystectomy. The Japan Society for Endoscopic Surgery (JSES) introduced an accreditation examination in 2004. The critical view is an important factor used to judge a safe dissection. The annual ratios of successful applicants were 63% in 2004, 45% in 2005, 36% in 2006, 39% in 2007, and 44% in 2008. Biennial questionnaire surveys by JSES show that the laparoscopic BDI rates were 0.66% in 1990–2001, 0.79% in 2002, 0.77% in 2003, 0.66% in 2004, 0.77% in 2005, 0.65% in 2006, and 0.58% in 2007. Therefore, 2007 was the first year in which the rate was below 0.6%. A decreasing BDI rate is therefore expected because successful candidates will introduce technical improvements to colleagues in their hospitals and local regions.

Oral adjuvant chemotherapy with carmofur (HCFU) for colorectal cancer : Five-year follow-up. Tokai HCFU Study Group : Third study on colorectal cancer

A joint study was performed by the Tokai HCFU study group, which included seven institutions, to examine the value of oral administration of Carmofur (HCFU), a 5‐fluorouracil (5‐FU) derivative, for postoperative adjuvant chemotherapy in patients with colorectal cancer undergoing curative resection.

A tactile sensor for laparoscopic cholecystectomy

Abstract. During laparoscopic surgery, surgeons observe the three-dimensional abdominal cavity on a two-dimensional TV monitor, which is a limitation. Another limitation is that surgeons are unable to estimate the softness of organs or tissues during laparoscopic surgery as they are only allowed to use instruments which touch objects and direct palpation is not permitted during the procedure. The tactile sensor which we used displays the object softness immediately as a digital score, which can then be superimposed on a TV monitor as a graph. With the tactile sensor, we were able to ascertain the presence of a gallstone in the gallbladder or cholecystic duct during laparoscopic cholecystectomy and also able to discriminate between a stone and an air bubble during intraoperative cholangiography. We were convinced that the tactile sensor would be useful in laparoscopic surgery, which does not permit surgeons to palpate objects with human fingers.

A patient with early gallbladder cancer derived from a Rokitanski-Aschoff sinus

We present herein a case of a 40-year-old male with early gallbladder cancer derived from a Rokitanski-Aschoff sinus (RAS). The patient originally presented at our hospital with epigastric discomfort, following which a diagnosis of adenomyomatosis (ADM) of the gallbladder was made, and a cholecystectomy performed. Histopathological examination of the resected specimen revealed a 7-mm well-differentiated papillo-tubular adenocarcinoma in the RAS epithelium in the body of the gallbladder. The RAS extended to the “pm” layer but the adenocarcinoma was an in situ lesion localized within the RAS epithelium. Considering the difficulties in making an early diagnosis of gallbladder cancer, active surgery should be performed for patients in whom ADM is seen in the gallbladder.

Laparoscopic cholecystectomy performed by a single surgeon using a visual field tracking camera

AbstractBackground: This report describes a visual field tracking camera for laparoscopic surgery that allows the visual field to be changed without moving the laparoscope. We also report on our early experience with this camera for single-surgeon laparoscopic cholecystectomy. Methods: The visual field tracking camera has a tracking mechanism (composed of a zoom lens and a charge-coupled device [CCD] slide mechanism) built into the camera head. The 80° visual field observed with the laparoscope can be expanded using the zoom lens, and the field can be shifted by changing the size of the area being viewed by the CCD. This is accomplished by pushing a switch on the forceps or by verbal command. Cholecystectomy was carried out on 12 patients with gallstones using this camera. The operations were performed by either a single surgeon or two surgeons. Forceps held with a forceps holder were inserted through the right port to lift the fundus of the gallbladder. The single surgeon used the other two ports to resect the gallbladder by the two-handed technique. Results: In all cases, cholecystectomy was completed without any need to move the laparoscope at any point during the operation. Seven operations were performed by a single surgeon. Mainly for education purposes, five other operations were performed by a pair of surgeons. The mean time required for surgery was 76 ± 17 min. This time did not differ from that of laparoscopic cholecystectomy performed during the same period on 22 patients by teams of three surgeons using conventional cameras. Conclusions: Using the visual field tracking camera, laparoscopic cholecystectomy can be performed without any need to touch the laparoscope. This camera allowed laparoscopic cholecystectomy to be performed by a single surgeon.

Endoscopic surgery in Japan: The 12th national survey(2012–2013) by the Japan Society for Endoscopic Surgery

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. With the acceptance of endoscopic surgery as less invasive than open surgery, the number of the endoscopic procedures continues to increase in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has had an important role in the development of endoscopic surgery in Japan. For example, JSES established a technical skills certification system for physicians to train instructors to teach safe endoscopic surgery. Additionally, JSES has performed a national survey every 2 years. In 2013, 178 084 patients underwent endoscopic surgery in all surgical domains, including abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The development and current status of laparoscopic surgery are reported here based on the results of the most recent questionnaire survey conducted by JSES.

New integrated ultrasonic surgical system, ‘Sonosurg’

A new surgical system named ‘SonoSurg’ integrating both the ultrasonic coagulating cutter and the conventional ultrasonic aspirator has been developed for clinical use. It maintains the functions of each independent device. Various types of hand pieces can be easily exchanged at the time of surgery. Moreover, all output switches are installed in the common foot switch. Therefore, the extent of the application of this system has been extremely expanded through these additional ancillary units with different function or varieties of hand pieces that are usable in accordance with the purposes. Experience with this system used in endoscopic or open surgeries at a couple of institutions is evaluated in this paper. We believe that the integration of these two different models will be very useful in various aspects, such as the improvement of surgical safety and to simplify surgical procedures as well as functional improvement of the operating theater.

The Diagnosis of the Anomalous Connection of Pancreaticobiliary Ducts Without Biliary Dilatation—The Usefulness of US/EUS Serial Examination—

The anomalous connection of the pancreaticobiliary duct (ACPBD) without accompanying dilatation of the bile duct (non‐dilated type of ACPBD) has recently been found to be associated with gallbladder cancer at a rather high rate. We analyzed the diagnostic process of 5 patients with non‐dilated type of ACPBD including 3 asymptomatic cases and reviewed the literature. Symptoms and laboratory data were not useful in detecting this type of lesion. All our patients were checked by ultrasonography for gallbladder lesions which are suggested by: wall thickening, multiple polyps, intramural gall stones, cholecystolithiaisis, and debris. ACT revealed only wall thickening of the gallbladder. An EUS revealed a high rate of ACPBD in addition to the ultrasonographic findings of gallbladder lesions obtained by US. An ERCP was effective in clearly demonstrating ACPBD, but was not so useful for the diagnosis of concomitant gallbladder lesions. Therefore, an US is considered to be a useful means for screening this disease, and EUS is useful as a procedure to follow in order to select patients with or without ACPBD, because EUS can be conducted on an outpatient basis and is highly sensitive in detecting ductal anomalies in ACPBD. Therefore, the US/EUS serial examination is thought to be an effective means for diagnosing this disease.

Effect of oral adjuvant therapy with Carmofur (HCFU) for distant metastasis of colorectal cancer.

AbstractBackground. The effectiveness of adjuvant chemotherapy for colorectal cancers after curative resection has been reported recently; this study was performed to clarify the reasons of for this effectiveness, which have been unclear. Methods. Two joint prospective clinical randomized studies were performed. In the first study, of patients operated on between July 1, 1981 and June 30, 1983, at 41 Centers in the Tokai district, 172 patients with colorectal cancer were allocated to two groups. In the control group, mitomycin C (MMC) was given eight times intravenously in the 4 weeks after surgery. The other group, in addition to receiving the same regimen as the controls, received oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU) at 600 mg/day for at least 6 months after the 4-week MMC treatment. In the second study of patients operated at 7 Centers in the Tokai district between October 1, 1987 and September 30, 1990, 173 patients with colorectal cancer were allocated to two groups after surgery, a control group receiving no HCFU, the other group receiving HCFU at 0.8 mg/kg per day orally, for 1 year, beginning 4 weeks after the operation. Results. In the first study, the cumulative 10-year survival rate of the MMC + HCFU group was higher than that of the MMC-alone group (P < 0.05). In the second study, the cumulative 5-year disease-free survival rate of the HCFU group was higher than that of the control group (surgery alone; P < 0.05). In patients with colon cancers, the rate of distant metastases for all evaluable patients was lower in the MMC + HCFU group than in the MMC-alone group in the first study (P < 0.05), and the rate was lower in the HCFU group than in the surgery-alone group in the second study (P < 0.02). Conclusion. The effectiveness of HCFU in reducing the disease-free survival rate appeared to be mainly due to its preventive effect on distant metastases.