Takaaki Yamane

Surgical Treatment of pT2 Gallbladder Carcinoma: A Reevaluation of the Therapeutic Effect of Hepatectomy and Extrahepatic Bile Duct Resection Based on the Long-term Outcome

BackgroundThe clinical indications for hepatectomy and extrahepatic bile duct resection (EBDR) for pT2 gallbladder carcinoma (GBC) remains controversial. The aim of this study is to elucidate the therapeutic effect of hepatectomy and extrahepatic bile duct resection on the surgical treatment of pT2 GBC.MethodsNinety-four patients with pT2 GBC who underwent a potentially curative resection were retrospectively analyzed regarding their pathological findings, surgical procedures, and survival.ResultsThe most powerful predicting factor for the survival is the nodal status. The 5-year survival rate was 87.1% for the pN0 patients and 55.7% for the pN1 patients. With respect to surgical procedures, the 5-year survival rate was 73.3% for the 51 patients with hepatectomy, and 87.2% for the 43 patients without hepatectomy. In addition, the 5-year survival rate was 66.7% for the 11 patients with EBDR, and 81.1% for the 83 patients without EBDR. When restricting the patients to those with pN1 disease, the 5-year survival rate of the patients who received these procedures did not surpass that of the patients who did not.ConclusionThere is no positive therapeutic effect besides providing surgical margins in hepatectomy and EBDR in the surgical treatment of pT2 GBC whereas lymph node dissection is most effective procedure for improving survival. Provided that the negative surgical margins are secured, a hepatectomy and an EBDR can therefore be withheld in the surgical treatment for the pT2 GBC.

Intrahepatic Ramification of the Portal Vein in the Right and Caudate Lobes of the Liver

We defined the subsegmental divisions and the ramification patterns of the portal vein in the right and caudate lobes using 25 human liver casts. The ramifications of the portal vein and the subdivisions of the liver were classified based on the major portal veins with the largest diameter and those having a diameter of not less than two thirds of the largest vein in each subsegment. The following results were obtained. (1) The portal trunk showed three ramification patterns and the basic pattern was bifurcation (80%). (2) The anterior portal vein first ramified into several anterior-inferior portal veins (P5) and ran toward the superior direction to bifurcate into 2 major portal veins in the anterior-superior subsegment (S8). (3) There were three types of ramification patterns of the portal veins in S8: bifurcation (84%), trifurcation and one-pedicle type. (4) There were also three branching types of the largest vein (P5-max) in P5: ramification from the anterior portal vein, P8-anterior vein supplying the anterior region of S8 and P8-posterior vein supplying the posterior region of S8. (5) The posterior portal vein showed two ramification patterns of the bifurcation (36%) and nonbifurcation type. (6) The major portal veins in the caudate subsegment ramified at various sites such as the portal trunk, left, right and/or other portal veins.

Glucagon in the metabolic and nutritional management after total pancreatectomy —A case report—

The effects of exogenous glucagon on a totally pancreatectomized patient were evaluated in both the acute postoperative and convalescent periods. In the acute postoperative phase, glucagon stabilized the blood glucose level and allowed the administration of an adequate amount of energy, while during the convalescent period, it proved useful in promoting the metabolism of lipids and amino acids and maintaining liver function. Moreover, we developed a glucagon aerosol which enabled frequent administration without causing major discomfort to the patient and raised the blood glucagon to satisfactory level.

Adenofibromyomatous hyperplasia of the extrahepatic bile duct — A report of two cases—

Two patients with adenofibromyomatous hyperplasia located at the distal end of the extrahepatic bile duct are reported herein. The chief symptom in both patients was upper abdominal pain and the lesions found involved the proliferation of submucosal mucous glands and fibrous elements. Further progress in imaging diagnostic techniques would increase the frequency with which such lesions are discovered. But, even now, if mural irregularities and shadow defects are found in the extrahepatic bile duct, particularly in the distal end of the common bile duct, the possibility of a benign lesion such as adenofibromyomatous hyperpasia should be taken into consideration when making a diagnosis.

A Case of Gastric Cancer, Presenting with Extensive Lymphangitis Carcinomatosa in the Gastric Wall, Though Primary Lesion Remained in the Submucosal Layer

原発巣の直接浸潤は粘膜下層 (sm) に留まりながら胃壁内の著明な癌性リンパ管症を呈した胃癌の1例を経験したので報告する. 症例は70歳の女性. 胃内視鏡検査にて噴門部から体中部小彎に陥凹性病変を認め, 生検の結果Group Vであり加療目的にて当院に紹介された. 術前は表層拡大型早期胃癌と診断し胃全摘術を施行した. しかし, 病理組織診断では, 直接浸潤以外に固有筋層 (mp) から漿膜下層 (ss) までリンパ管侵襲による進展が認められ, 癌性リンパ管症を呈していた. 画像所見を再検討すると, X線検査にIIc面より広範囲に胃壁の浮腫状変化と思われる “しめ縄状” の粘膜ひだを認めた. これは, 癌細胞がリンパ管内で腫瘍塞栓を起こし, リンパのうっ滞が起こるために生ずるもので, 胃壁内に進展した癌性リンパ管症に特徴的であると考えられる.