Tatsuma Sakaguchi

Influence of Rictor and Raptor Expression of mTOR Signaling on Long-Term Outcomes of Patients with Hepatocellular Carcinoma

BackgroundAberrant signaling mediated by the mammalian target of rapamycin (mTOR) occurs at high frequency in hepatocellular carcinoma (HCC), indicating that mTOR is a candidate for targeted therapy. mTOR forms two complexes called mTORC1 (mTOR complexed with raptor) and mTORC2 (mTOR complexed with rictor). There are minor studies of the expression kinetics of mTORC1 and mTORC2 in HCC.MethodsWe studied 62 patients with HCC who underwent curative resection. We used univariate and multivariate analyses to identify factors that potentially influence disease and overall survival after hepatectomy. The mRNA and protein levels of mTOR, rictor and raptor in cancer and non-cancer tissues were analyzed using quantitative RT-PCR, immunohistochemistry and Western blotting.Results/ConclusionHigh ratio of the levels of rictor and raptor mRNAs in tumors was identified as independent prognostic indicators for disease-free survival. Low and high levels of preoperative serum albumin and mTOR mRNA in the tumor, respectively, were identified as independent indicators of overall survival. HCC is likely to recur early after hepatic resection in patients with high levels of mTOR and rictor mRNAs and high rictor/raptor ratios in cancer tissues. We conclude that analysis of mTOR expression in cancer tissues represents an essential strategy to predict HCC recurrence after curative treatment.

Novel Liver Visualization and Surgical Simulation System

BackgroundSuccessful liver surgery requires an understanding of the patient’s particular liver characteristics, including shape and vessel distribution. In clinical medicine, there is a high demand for surgical assistance systems to assess individual patients. Our aims in this study were to segment the liver based on computed tomography volume data and to develop surgical plans for individual patients.MethodsThe hepatic vessels were semi-automatically extracted from the segmented liver images, and the 3D shape of the liver and extracted vessel distribution were visualized using a surgical simulation system.ResultsThe 3D visualization of the liver allowed easy recognition of vessel and tumor location and selection of these structures with the 3D pointing device. The surgeon’s prior knowledge and clinical experience were integrated into the visualization system to create a practical virtual surgery, leading to improved functionality and accuracy of information recognition in the surgical simulation system.ConclusionsThe 3D visualization demonstrated details of individual liver structure, resulting in better understanding and practical surgical simulation.

Low-grade mucinous neoplasia in a cecal diverticulum: A case report

Highlights • There are no previous reports of mucocele disease in a colonic diverticulum worldwide.• Laparoscopic ileocecal resection was chosen because of its minimal invasiveness and the patient had no evidence of recurrence 12 months postoperatively.• The possibility of a mucocele in a colonic diverticulum should be considered in patients with a colonic SMT.

Loss of skeletal muscle mass in patients with chronic liver disease is related to decrease in bone mineral density and exercise tolerance: Low muscle mass in patients with chronic hepatitis

This study aimed to identify the relationship between loss of skeletal muscle mass and clinical factors such as osteoporosis in patients with chronic liver disease.

Laparoscopic surgery for colon cancer with intestinal malrotation in adults: Two case reports and review of literatures in Japan

Highlights • We reviewed 49 cases of colon cancer with intestinal malrotation.• The laparoscopic approach was chosen because of its minimal invasiveness.• 3D-CT angiography should be used to reveal the anatomic vascular anomalies.

Objective and Quantitative Assessment of Postoperative Pain in Digestive Surgery

Background: Pain is associated with subjective factors, making it difficult to assess. The PainVision™ system has been developed to quantitatively assess pain and compare postoperative pain intensity. We investigated the utility of PainVision in assessing postoperative pain in digestive surgery patients.

Duodenogastric regurgitation in hepaticoduodenostomy after excision of congenital biliary dilatation (choledochal cyst)

PURPOSE We examined the clinical significance of duodenogastric regurgitation (DGR) as a late complication in the long-term follow-up after hepaticoduodenostomy (HD) as a reconstruction surgery for congenital biliary dilatation (CBD). METHODS Seventeen patients with CBD were retrospectively analyzed for late complications (mean follow-up, 16.8 years). All patients had undergone total resection of the extrahepatic bile duct followed by HD. DGR was identified using endoscopic examination, intraluminal bile monitoring, and liver scanning. RESULTS DGR was found in all 17 patients by endoscopic examination and intraluminal bile monitoring. Fourteen of the 17 (82.4%) patients with DGR had experienced abdominal symptoms since a mean of 6.9 years postoperatively. Liver scanning also revealed apparent DGR in all 14 symptomatic patients. We converted 7 of the 14 patients to hepaticojejunostomy reconstruction at a mean of 13.0 years after the initial excisional surgery. Their symptoms were completely relieved postoperatively. CONCLUSIONS DGR is an important complication after HD. Examination of patients for the development of DGR is an essential part of long-term follow-up in patients with CBD who have undergone HD as a reconstruction surgery. Conversion surgery is recommended in patients with DGR accompanied by long-term abdominal symptoms. LEVELS OF EVIDENCE Level IV.

Laparoscopic management for spontaneous jejunal perforation caused by nonspecific ulcer: A case report

Highlights • Reported case of perforated jejunal nonspecific ulcer is limited.• Emergency laparoscopic surgery had diagnostic and therapeutic advantages.• Surgeons should be aware of it as one of the causes of small bowel perforation.

Phase I Study of Sorafenib in Combination with Intermittent Hepatic Arterial Infusion Chemotherapy for Unresectable Hepatocellular Carcinoma

ABSTRACT Objectives: We conducted a phase I study of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for unresectable hepatocellular carcinoma. Methods: Sorafenib was administered continuously, whereas cisplatin was administered once every 3 weeks. We estimated the safety and efficacy. Results: Fifteen patients were enrolled into this study. The dose-limiting toxicities occurred at sorafenib 800 mg and cisplatin 20 mg/m2. The recommended dose was at sorafenib 400 mg and cisplatin 30 mg/m2. The disease control rate was 73.3%. Conclusions: This treatment is feasible for unresectable hepatocellular carcinoma. Further evaluation of the regimen in a randomized controlled trial is warranted.