Takafumi Sekino

Improvement of the survival rate after rat massive hepatectomy due to the reduction of apoptosis by caspase inhibitor

Background and Aim:  Acute liver failure after massive hepatectomy is caused by both necrosis and apoptosis in the remnant liver. We investigate the protective effect of the caspase inhibitor on apoptosis after massive hepatectomy in rats.

Two-stage portal vein ligation facilitates liver regeneration in rats.

Background/Aims: Recent reports have demonstrated that some patients are unable to undergo scheduled liver resection after preoperative portal vein embolization due to insufficient hypertrophy of the future remnant liver. The present study examined whether two-stage portal vein ligation (PVL) increases hypertrophy of the future remnant liver compared to conventional PVL in rats. Methods: Rats were divided into 3 groups: group A, ligation of left primary branch; group B, ligation of right and left primary branches; group C, ligation of the left primary branch, followed by 2-stage PVL 7 days postoperatively. To evaluate liver regeneration, the proliferating cell nuclear antigen labeling index (LI), mitotic index (MI) in the caudate lobe and weight ratio of caudate lobe to body weight were measured. Results: The weight ratio of caudate lobe to body weight was significantly higher in group C than in groups A or B 14 days postoperatively. In groups A and B, LI and MI in the caudate lobe peaked 2 days postoperatively, then decreased to preoperative levels by 7–8 days postoperatively, but remained significantly elevated until 10–14 days postoperatively in group C. Conclusion: Two-stage PVL increases hypertrophy of the future remnant liver compared to conventional PVL in rats.

Reduction of fibrosis in a rat model of non-alcoholic steatohepatitis cirrhosis by human HGF gene transfection using electroporation.

Background and Aim:  To study the histological changes caused by transfection of the hepatocyte growth factor (HGF) gene using electroporation (EP) in a non‐alcoholic steatohepatitis (NASH) cirrhotic liver model.

Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

BACKGROUND Malignant gastric outlet obstruction (GOO) often develops in patients with advanced pancreatic cancer (APC). It is not clear whether endoscopic duodenal stenting (DS) or surgical gastrojejunostomy (GJJ) is preferable as palliative treatment. AIMS To compare the efficacy and safety of GJJ and DS for GOO with APC. METHODS Consecutive 99 patients who underwent DS or GJJ for GOO with APC were evaluated. We compared the technical and clinical success rates, the incidence of adverse event (AE), the time to start chemotherapy and discharge and survival durations between DS and GJJ. Prognostic factors for overall survival (OS) were investigated on the multivariate analysis. RESULTS GOO was managed with GJJ in 35 and DS in 64. The technical and clinical success rates were comparable. DS was associated with shorter time to start oral intake and earlier chemotherapy start and discharge. No difference was seen in the early and late AE rates. Multivariate analyses of prognostic factors for OS showed that performance status ≧2, administration of chemotherapy, and presence of obstructive jaundice to be significant factors. There were no significant differences in survival durations between the groups, regardless of the PS. CONCLUSIONS There were no significant differences in the technical and clinical success and AE rates and survival duration between DS and GJJ in management of GOO by APC. DS may be a preferable option over GJJ given that it will lead to an earlier return to oral intake, a shortened length of hospital stay, and finally an earlier referral for chemotherapy.

Preoperative Granulocyte-Colony Stimulating Factor (G-CSF) Treatment Improves Congested Liver Regeneration

BACKGROUND Hepatic venous congestion after liver surgery can cause liver failure. We evaluated the effectiveness of granulocyte-colony stimulating factor (G-CSF) for regeneration of remnant liver with venous congestion. MATERIALS AND METHODS Rats were divided into three groups. Group A underwent 60% hepatectomy. Group B underwent 60% hepatectomy with partial venous congestion in remnant liver. Group C underwent the same procedures as group B with G-CSF given preoperatively for 5 d. To evaluate liver regeneration in each group at 1, 2, 3, 5, and 7 d postoperatively, the proliferating cell nuclear antigen (PCNA) labeling index (LI), mitotic index (MI) in the congested area of remnant liver, and regeneration rate of remnant liver weight were measured. CD34 antibody-positive hematopoietic stem cell (HSC) colonies were identified using immunopathological staining. RESULTS Compared with group B, in group C, LI, and MI in congested remnant liver increased earlier, peak LI value in the congested area appeared 24h earlier, and full recovery of remnant liver weight occurred 2 d earlier. On postoperative day 3, remnant liver weight was significantly greater in group C than group B. On microscopy, CD34-positive cells were seen in preoperative group C livers. CONCLUSION Preoperative G-CSF improves regeneration of livers with venous congestion.

Radical resection of a giant retroperitoneal calcifying fibrous tumor combined with right hepatectomy and reconstruction of the inferior vena cava and bilateral renal veins

BackgroundWe report a case of a giant retroperitoneal calcifying fibrous tumor (CFT) treated by radical tumor resection combined with right hepatectomy and reconstruction of the inferior vena cava (IVC) and bilateral renal veins. Only three case reports of CFT arising in the retroperitoneum have been reported until today.Case presentationIn a 19-year-old female patient, computed tomography (CT) images showed a well-demarcated expansile lesion around the IVC accompanied by focal calcification, whereas the IVC that was circumferentially surrounded by the lesion was dilated due to the desmoplastic reaction. On magnetic resonance imaging (MRI), the lesion demonstrated heterogeneous hypointensity on T2-weighted images. Delayed enhancement was observed on dynamic contrast-enhanced CT and MRI. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT images showed increased FDG uptake [maximum standardized uptake values (SUVmax), early image 7.28; delayed image 7.40]. On operative examination, because the tumor adhered to the liver parenchyma, the right Glisson capsule, and the origin of bilateral renal veins, radical tumor resection combined with right hepatectomy and reconstruction of the IVC and bilateral renal veins was performed.ConclusionsRadical tumor resection was successfully and appropriately performed for a young patient with a giant retroperitoneal CFT with a view to achieving complete venous reconstruction and safe surgical margins for a potentially malignant tumor.