Yukiharu Hiyoshi

Technical Improvement of Total Pharyngo-Laryngo-Esophagectomy for Esophageal Cancer and Head and Neck Cancer

AbstractPurposeTotal pharyngo-laryngo-esophagectomy (PLE) is highly invasive, and the subsequent reconstruction is difficult. The purpose of this study was to clarify the techniques that can decrease the surgical stress and allow for safe reconstruction after this operation.nMethodsThe surgical method and clinical outcomes of total PLE were reviewed in 12 patients with either cervicothoracic esophageal cancer or double cancer of the esophagus and pharynx. Microscopic venous anastomosis was principally performed, and arterial anastomosis was added, if needed.ResultsA narrow gastric tube was used in ten patients, including two patients who underwent free jejunal interposition, while the colon was used as the main reconstructed organ in two other patients. Staged operations were performed in three high-risk patients. All six patients treated after 2010 were able to undergo thoracoscopic and/or laparoscopic surgery. No critical postoperative complications developed, although minor anastomotic leakage developed in two patients who were successfully treated conservatively.ConclusionWhen performing PLE, it is important to decrease the surgical stress and ensure a reliable reconstruction by adopting techniques that are appropriate for each case, such as thoracoscopic and laparoscopic surgery, staged operations, microvascular anastomosis, and muscular flaps.

Clinical Significance of Surgical Resection for the Recurrence of Esophageal Cancer After Radical Esophagectomy

AbstractBackgroundThis study aimed to clarify the clinical significance of surgical resection for recurrent lesions after esophagectomy for esophageal cancer.MethodsnRecurrence was detected in 113 of 365 consecutive patients who underwent surgical resection for esophageal cancer, and some treatment was performed for recurrence in 100 of the 113 patients. The treatments were classified into two groups: chemotherapy and/or radiation with surgery (surgery group, nxa0=xa014) and chemotherapy and/or radiation without surgery (no surgery group, nxa0=xa086). The outcomes were retrospectively analyzed.ResultsnOf the 14 patients in the surgery group, 3 underwent repeated resection. Thus, a total of 22 resections were performed for these patients. The resected organs were the lymph nodes in nine patients, the lungs in six patients, local recurrence in two patients, subcutaneous recurrence in two patients, the liver in one patient, the brain in one patient, and the parotid gland in one patient. Among the 22 recurrent cases, 20 involved solitary lesions or multiple lesions located in a small resectable region. When the two groups were compared, the surgery group showed a more favorable prognosis in terms of both survival after esophagectomy (median survival time, 103.3 vs 23.1xa0months; pxa0=xa00.0060) and survival after initial recurrence (92.1 vs 12.2xa0months; pxa0=xa00.0057).ConclusionsMultimodal treatment provides a significant benefit for patients with recurrence after esophagectomy for esophageal cancer. Surgical intervention should be aggressively included in the treatment strategy when the recurrent lesion is solitary or localized.

IgG4-related disease of the ileocecal region mimicking malignancy: A case report

Highlights • The colonic IgG4-RD is rare.• We report the case of a74-year-old female with IgG4-RD of the ileocecal region.• The patient was diagnosed asmalignant lymphoma and underwent right-hemi colectomy.• Postoperative pathologicalexamination revealed IgG4-RD of the ileocecal region.• Surgical resection for IgG4-RDis necessary for cases with concerns of malignancy.

Surgical strategies for esophageal cancer associated with head and neck cancer

Esophageal cancer is frequently associated with squamous cell carcinoma in the head and neck. Both cigarette smoking and alcohol consumption are risk factors for multiple cancers of the head and neck, as well as the esophagus. Routine screening and close follow-up for second cancers are important in patients with esophageal cancer or head and neck cancer. For this purpose, endoscopy with Lugol’s staining, as well as narrow-band imaging combined with magnifying endoscopy, is a powerful tool for the early detection of esophageal cancer. Multimodal therapy is essential for patients with double cancers. When considering surgical treatment, the curability of both cancers must be carefully evaluated. If both tumors are potentially curable, each lesion should be treated individually. In patients with metachronous double cancers, the prior treatment of the first primary carcinoma often affects the treatment of the second cancer. Close cooperation among medical staff members is essential for complicated surgeries for double cancers. Techniques that are appropriate for each case must be adopted, such as careful dissection, staged operations, muscular flaps and microvascular anastomosis.

Surgical Resection of Hypopharynx and Cervical Esophageal Cancer with a History of Esophagectomy for Thoracic Esophageal Cancer

AbstractBackgroundCancer of the hypopharynx and cervical esophagus (PhCe cancer) frequently develops synchronously or metachronously with esophageal cancer. The surgical approach is usually difficult, especially in metachronous PhCe cancer after esophagectomy. The purpose of this study was to clarify the treatment outcomes of patients with metachronous PhCe cancer with a history of esophagectomy.nMethodsThe subjects evaluated in this study were 14 patients with metachronous PhCe cancer who underwent pharyngo-laryngo-esophagectomy after subtotal esophagectomy and gastric tube pull-up for primary esophageal cancer.ResultsDefinitive chemoradiotherapy (CRT; radiation dose >50xa0Gy) was performed for primary laryngeal (nxa0=xa01), pharyngeal (nxa0=xa02), esophageal (nxa0=xa01), and recurrent esophageal cancer (nxa0=xa02). For seven patients with metachronous PhCe cancer, induction CRT (radiation dose <40xa0Gy) was performed. In all 14 patients, pharyngo-laryngo-esophagectomy was followed by free jejunal graft interposition with reconstruction of the jejunal vessels. Although postoperative complications developed in four patients, no perioperative death or necrosis of the reconstructed free jejunum occurred. The 2- and 5-year overall survival rates were 84 and 50xa0%, respectively.ConclusionsPharyngo-laryngo-esophagectomy with free jejunal transfer is considered to be safe for metachronous PhCe cancer, even in patients with a history of CRT and esophagectomy.

Relevance of totally laparoscopic gastrectomy for patients with advanced gastric cancer.

PURPOSEnAlthough the use of laparoscopic gastrectomy for gastric cancer has been widespread, it has remained controversial whether it can be applied for the patients with advanced gastric cancer. The aim of this study was to clarify the safety and usefulness of totally laparoscopic gastrectomy for patients with advanced gastric cancer.nnnPATIENTS AND METHODSnTotally laparoscopic gastrectomy was applied for a total of 38 patients with pStage IB-III advanced gastric cancer at our institute. The surgical and long-term results were analyzed in those patients.nnnRESULTSnTwenty-seven patents underwent distal gastrectomy and 11 patients underwent total gastrectomy. The mean number of dissected lymph nodes was 41 (range, 16-87). The mean length of the operation and amount of blood loss was 324 min and 123 ml, respectively. Two cases of postoperative bleeding were noted, while neither anastomosis-related complications nor in-hospital death was observed. The follow-up period after surgery was 8-72 months. Postoperative recurrence was observed in 6 patients (peritoneal dissemination: 3 patients, pleural dissemination: 1 patient, liver metastasis: 1 patient, ovarian metastasis: 1 patient). The overall survival rates at 1, 3 and 5 years were 94.7%, 76.3% and 76.3%, respectively.nnnCONCLUSIONnTotally laparoscopic gastrectomy is safe and can lead to satisfactory long-term outcomes in cases of advanced gastric cancer. Prospective controlled studies are warranted to confirm our findings.

The Use of a Circular Side Stapling Technique in Laparoscopic Low Anterior Resection for Rectal Cancer: Experience of 30 Serial Cases

The double-stapling technique using a circular stapler (CS) to create an end-to-end anastomosis is currently used widely in laparoscopic-assisted rectal surgery. However, a high rate of anastomotic failure has been reported. We report new side-to-side anastomosis creation using a CS, the so-called circular side stapling technique (CST). After excising the rectum at the oral and anal sides of the tumor with a linear stapler, a side-to-side colorectal anastomosis was made on the anterior wall of the rectosigmoid colon and the anterior or posterior wall of the rectum with a CS. Between 2012 and 2013, we recorded 30 serial cases of rectal-sigmoid or rectal cancer that were treated with laparoscopic-assisted surgeries using this method. In the 30 cases, the mean age was 68 ± 12 years, operating time was 288 ± 80 minutes, and blood loss was 66 ± 67 mL. None of the patients suffered from anastomosis leakage or postoperative anastomotic bleeding, and none complained of their stool habits. Three months after the last surgery in this cohort, no anastomosis strictures were reported. Based on these results, we propose an alternative method of side-to-side anastomosis for low anterior resection by using a CS to prevent staple overlap. Our experience indicates that the CST is easy and safe. Therefore, this method is a useful alternative to the current method used in laparoscopic surgery.

Simultaneous operation for cancer‐related sigmoid colon perforation and abdominal aortic aneurysm of 76 mm in diameter

A 92‐year‐old woman was emergently admitted to our hospital for peritonitis caused by sigmoid colon cancer perforation, with a coexistent abdominal aortic aneurysm of 76u2009mm in diameter.

Pharyngo-laryngo-esophagectomy and reconstruction with a gastric tube for corrosive pharyngoesophagitis

AbstractnWe herein present the case of a 44-year-old male who was successfully treated with pharyngo-laryngo-esophagectomy for severe corrosive esophagitis associated with pharyngitis. He accidentally ingested an unidentified liquid and subsequently developed esophagitis and progressive pharyngolaryngitis. Since he also developed dyspnea, he initially underwent a tracheotomy at an emergency hospital. Afterward, dysphagia due to hypopharingoesophageal stricture gradually developed, and the patient was referred to our hospital. Therefore, under laparotomy, a feeding tube was inserted into the jejunostomy, and the gastroendoscope inserted via the anterior gastric wall revealed that the gastric mucosa along the greater curvature was intact. Based on this information, it was concluded that the patient could undergo reconstruction with a gastric tube following pharyngo-laryngo-esophagectomy, and this was successfully accomplished 3xa0months later.n

Clinicopathological Characteristics of Esophageal Squamous Cell Carcinoma in Patients Younger Than 50 years

PurposeThis study clarifies age differences in clinicopathologic characteristics and risk factor exposure of patients who have undergone esophagectomy for esophageal cancer (EC).MethodsClinical results of esophagectomy were compared between 22 patients younger than 50xa0years of age (Group I) and 327 patients older than 50xa0years of age (Group II) with esophageal squamous cell carcinoma.ResultsThe two groups did not significantly differ in clinicopathological characteristics, including prognosis. Postoperative pulmonary complication incidence rates were 4.2xa0% (Group I) and 14.4xa0% (Group II). In Group I, the incidence of multiple ECs was 36.4xa0%, and association with head and neck cancer was 31.8xa0%, which were significantly higher than in Group II (13.4xa0%, pxa0=xa00.021; and 9.2xa0%, pxa0=xa00.015, respectively). Furthermore, the patients in Group I with multiple cancers were almost all heavy smokers and/or users of alcohol.ConclusionsThese results suggest that multiple upper aerodigestive tract cancers are associated with heavy exposure to risk factors in patients younger than 50xa0years of age.