Yoshiharu Miyamoto

Impact of single-port cholecystectomy on postoperative pain.

This study compared postoperative pain following four‐port laparoscopic cholecystectomy (LC) and single‐port cholecystectomy (SPC).

Proteomics-based identification of autoantibody against heat shock protein 70 as a diagnostic marker in esophageal squamous cell carcinoma

Detection of novel tumor-related antigens and autoantibodies in cancer patients is expected to facilitate the diagnosis of early-stage malignant tumor and establish effective new immunotherapies. The purpose of this study was to identify novel tumor antigens in an esophageal squamous cell carcinoma (ESCC) cell line (TE-2) and related autoantibodies in sera from patients with ESCC using a proteomics-based approach. TE-2 proteins were separated by two-dimensional polyacrylamide gel electrophoresis, followed by Western blot analysis in which sera from patients with ESCC, healthy controls and patients with other cancers were tested for primary antibodies. Positive spots were excised from silver-stained gels and analyzed by matrix-assisted laser disorption/ionization time-of-flight mass spectrometry (MALDI-TOF/TOF-MS). Sera from patients with ESCC yielded multiple spots, one of which was identified as heat shock protein 70 (Hsp70) by MALDI-TOF/TOF-MS. Concentrations of serum Hsp70 autoantibody were significantly higher for patients with ESCC (mean, 0.412+/-0.096 mg/ml) than for patients with gastric (0.236+/-0.112 mg/ml, P<0.001) or colon cancer (0.231+/-0.120 mg/ml, P<0.001) or healthy individuals (0.207+/-0.055 mg/ml, P<0.001) by enzyme-linked immunosorbent assay. We have identified an autoantibody against Hsp70 in ESCC patients. The proteomic approach implemented herein offers a powerful tool for identifying novel serum markers that may display clinical utility against cancer.

Effectiveness of a Surgical Glove Port for Single Port Surgery

BackgroundA new surgical concept, such as single port surgery (SPS), usually raises many questions regarding safety, usefulness, appropriateness, applicability, and cost. Because many new port devices have been developed, choosing the type of port device for SPS is the most important factor. We herein briefly report our newly developed SPS port made using a standard surgical glove.MethodsSPS starts with a 1.5-cm skin incision on the umbilicus. Subsequently, a wound retractor of XS size is installed at the umbilical wound. Then, a non-powdered surgical glove (5.5 inches) is put on the wound retractor through which three 5-mm slim trocars are inserted via the finger tips. A semi-flexible laparoscopic camera is inserted via the middle finger port. From June to December 2009, 23 cases of SPS (20 cholecystectomies, 1 choledocholithotomy, 1 appendectomy, and 1 gastropexy) were performed in our institute using this technique.ResultsAll cases were successfully performed without any intra- or postoperative complications. No conversion to other procedures was needed. The median operative time for cholecystectomy was 110 (range, 55–170)xa0min.ConclusionsThis surgical-glove port is easy to install and is made from conventional, commonly used surgical equipment, making it unnecessary to purchase any expensive new devices. This surgical-glove port technique is a promising method to introduce SPS, because developing or purchasing new devices is unnecessary. Our experience demonstrates the efficacy, appropriateness, and cost-effectiveness of this simple port technique.

Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis

BackgroundHepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors.MethodsEighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis.ResultsThe overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly.ConclusionsOptimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above.

Resection Margin with Anatomic or Nonanatomic Hepatectomy for Liver Metastasis from Colorectal Cancer

BackgroundWhen hepatectomy is used as a primary treatment for liver metastasis from colorectal cancer (CRCLM), the balance between surgical curability and functional preservation of the remnant liver is of great importance.MethodsA total of 108 patients who underwent initial hepatectomy for CRCLM were retrospectively analyzed with respect to tumor extent, operative method, and prognosis, including recurrence.ResultsThe 1-, 2-, 3-, and 5-year overall survival rates (OS) for all patients were 90.5%, 77.8%, 63.2%, and 51.6%, respectively. Multivariate analysis indicated serum carbohydrate antigen 19-9 (CA 19-9) level after hepatectomy (<36 or ≥36xa0mAU/mL) and presence of recurrence as independent prognostic factors of OS (Pu2009=u20090.0458 and 0.0249, respectively), and tumor depth of colorectal cancer (<se (a2) vs. ≥se (a2)) and serum CA 19-9 level after hepatectomy as the significant factors affecting disease-free survival (DFS) (Pu2009=u20090.0025 and 0.00138, respectively). Neither resection margin nor type of hepatectomy (anatomic or nonanatomic) for CRCLM was a significant prognostic factor for OS or DFS or CRCLM recurrence, including intrahepatic recurrence.ConclusionsIn CRCLM, we believe that nonanatomic hepatectomy with narrow margin is indicated, and optimal treatment would include functional preservation of as much of the remnant liver as possible.

A novel method using the VIO soft-coagulation system for liver resection

BACKGROUNDnThe VIO soft-coagulation system (SCS) is a new device for tissue coagulation. The current study evaluated the efficacy of the SCS when used for liver resection.nnnMETHODSnThe 252 patients were divided into 2 groups; in 155 patients (conventional group), liver transection was performed using an ultrasonic dissector and saline-coupled bipolar electrocautery for hemostasis. In 97 patients (SCS group), the SCS was used instead of bipolar electrocautery.nnnRESULTSnThe median blood loss and surgical time were less in the SCS group than in the conventional group (350 vs 640 mL, P = .0028; 280 vs 398 min, P < .0001). No significant differences were found in postoperative complications between the SCS group (32.0%) and the conventional group (40.6%). The risk factors for bleeding were nonuse of the SCS (P = .0039), macroscopic vascular invasion of the hepatic tumors (P = .0088), and collagen type IV value in the sera >200 (P = .0250) on multivariate analysis. In a subgroup analysis, in the collagen type IV value >200 subgroup, the tumor diameter >5 cm subgroup, and the inflow nonocclusion subgroup, use of the SCS decreased surgical bleeding (P = .0120, P = .0126, and P = .0032, respectively) and surgical time (P = .0001, P < .0001, and P = .0036, respectively) compared with the conventional group. Furthermore, even in the major hepatectomy group, the SCS use decreased surgical time (P < .0001).nnnCONCLUSIONnThe SCS is an effective and safe device for decreasing surgical time and surgical bleeding without increasing the rate of bile leakage and causing other complications.

Outcomes and predictors of microvascular invasion of solitary hepatocellular carcinoma

Microvascular invasion (MVI) is an important risk factor for early recurrence of hepatocellular carcinoma (HCC), but preoperative prediction of MVI is difficult.

Surgical Outcomes and Clinical Characteristics of Elderly Patients Undergoing Curative Hepatectomy for Hepatocellular Carcinoma

BackgroundThe aim of this study was to investigate the clinical characteristics and outcomes of elderly patients (≥70xa0years old) undergoing curative hepatectomy for hepatocellular carcinoma (HCC).MethodsClinicopathological data and treatment outcomes in 100 elderly patients (≥70xa0years old) and 120 control patients (≤70xa0years old) with HCC who underwent curative hepatectomy between 2000 and 2011 were retrospectively collected and compared.ResultsThe overall survival rate was similar between the two groups, but the disease-free survival rate was worse in the elderly group when compared with the control group. Prognostic factors for overall and disease-free survival were the same when comparing the two groups. The elderly group had higher rate of females (pu2009=u20090.0230), higher hepatitis C virus infection rate (pu2009=u20090.0090), higher postoperative pulmonary complication rate (pu2009=u20090.0484), lower rate of response to interferon (IFN) therapy (pu2009=u20090.0203) and shorter surgical time (pu2009=u20090.0337) when compared with the control group. The overall recurrence rate was higher in the elderly group than in the control group (pu2009=u20090.0346), but the rate of recurrence within 2xa0years after the operation was similar when comparing the two groups.ConclusionThe survival of elderly patients with HCC was similar to that of younger patients. However, the disease-free survival was worse in elderly patients than in younger patients. Aggressive antiviral therapy (e.g. IFN therapy) may be necessary to improve the disease-free survival, even in elderly patients. Additionally, clinicians should be aware of the risk of pulmonary complications in elderly patients after hepatectomy.

Evaluation of postoperative antibiotic prophylaxis after liver resection: a randomized controlled trial.

BACKGROUNDnAntibiotic prophylaxis is frequently administered after liver resection to prevent postoperative infections. However, very few studies have examined the usefulness of antibiotic prophylaxis after liver resection. A randomized controlled trial was conducted to evaluate the postoperative antibiotic prophylaxis in patients after liver resection.nnnMETHODSnA total of 241 patients scheduled to undergo liver resection were randomly assigned to the non-postoperative antibiotic group (n = 95) or the antibiotic group (n = 95). The antibiotic group was given flomoxef sodium every 12 hours for 3 days after the operation. The end point was signs of infection, surgical site infection, or infectious complications.nnnRESULTSnThere were no significant differences between the 2 groups in signs of infection (21.3% vs 25.5%, P = .606), the incidence of systemic inflammatory response syndrome (11.7% vs 17.0%, Pxa0= .406), infectious complications (7.5% vs 17.0%, P = .073), surgical site infection (10.6% vs 13.8%, P = .657), and remote site infection (2.1% vs 8.5%, P = .100).nnnCONCLUSIONSnPostoperative antibiotic prophylaxis cannot prevent postoperative infections after liver resection, and it is thought that antibiotic prophylaxis is unnecessary and costly.

Reconsideration of the Indications for Adjuvant Chemotherapy for Liver Metastases from Colorectal Cancer After Initial Hepatectomy

AbstractBackgroundnThe effectiveness of perioperative adjuvant chemotherapy for colorectal cancer liver metastasis (CRLM) remains a matter of debate. Despite the lack of clear evidence supporting its effectiveness after curative hepatectomy, adjuvant chemotherapy has been widely used clinically. The purpose of this study was to clarify the indications for adjuvant chemotherapy in order to develop an appropriate treatment strategy for CRLM.MethodsThe clinicopathological factors of 110 patients who underwent initial hepatectomy for CRLM between April 2000 and March 2010 were retrospectively analyzed. The prognostic factors of CRLM were identified and then CRLM was stratified according to the number of prognostic factors into the high-score group (H-group: score 2 or 3) and the low-score group (L-group: score 0 or 1), and the effectiveness of adjuvant chemotherapy was analyzed in each group.ResultsMultivariate analysis identified pT4 (pxa0=xa00.0047), lymph node metastasis in colorectal cancer (CRC) (pxa0=xa00.0165), and H2-classification (pxa0=xa00.0051) as factors related to a poor prognosis. The overall 5-year survival rate was markedly higher in the L-group (68xa0%) than in the H-group (26xa0%, pxa0<xa00.0001). Moreover, in the L-group, patients who did not receive adjuvant chemotherapy had the same prognosis as those who received adjuvant chemotherapy. As for recurrence, tumor relapse more often was treated by resection in the L-group than in the H-group (pxa0=xa00.0339).ConclusionsAdjuvant chemotherapy did not improve overall survival and disease-free survival in patients with no more than two factors of the H2-classification, invasion depth pT4, and lymph node metastasis in CRC.