Papers - NANASHIMA Atsushi
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Tanoue, Y., Takeno, S., Kawano, F., Tashiro, K., Hamada, R., Miyazaki, Y. and Nanashima, A.
International Journal of Surgery Case Reports 44 24 - 28 2018.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Authors Introduction: An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. Presentation of case: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. Discussion: Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. Conclusion: Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT.
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Mizutani Y, Hirai T, Nagamachi S, Nanashima A, Yano K, Kondo K, Hiyoshi M, Imamura N, Terada T.
Clinical Nuclear Medicine 43 ( 2 ) 77 - 81 2018.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Nuclear Medicine
© 2017 Wolters Kluwer Health, Inc. All rights reserved. Purpose The International Study Group of Liver Surgery (ISGLS) proposed a definition and grading system for posthepatectomy liver failure (PHLF). We evaluated the usefulness of residual liver function estimation using 99m Tc-galactosyl human serum albumin (99m Tc-GSA) for the prediction of PHLF. Methods Patients with liver tumors (n = 136) and scheduled for hepatectomy underwent 99m Tc-GSA scintigraphy. Based on their imaging data, the maximal GSA removal rate (GSA-Rmax)was calculated using multicompartment analysis. We also calculated GSA-Rmax in the predicted residual liver (GSA-RL) whose volume was determined on computed tomography (CT) scans. We compared the age, sex, 15-minute indocyanine green retention rate; albumin, bilirubin, hyaluronic acid, and type 4 collagen levels; the Child-Pugh classification; residual liver volume; residual liver percentage; GSA-Rmax; and GSA-RL in patients with and without PHLF. Univariate and multivariate logistic analyses were used for statistical assessments. Results Of 136 patients, 17 (12.5%) met the ISGLS criteria for PHLF (ISGLS-PHLF). There was a statistically significant difference in the age, albumin level, Child-Pugh classification, residual liver volume, residual liver percentage, GSA-Rmax, and GSA-RL between patients with and without PHLF. Based on multivariate analysis, GSA-RL and the residual liver volume were significant independent predictors of ISGLS-PHLF (P = 0.004 and P = 0.038, respectively). The odds ratio was 149423 for GSA-RL and 1.003 for the residual liver volume. Conclusions GSA-RL calculated using 99m Tc-GSA scintigraphy was the most useful independent predictor for ISGLS-PHLF.
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Clinical significance of the C-reactive protein-to-albumin ratio for the prognosis of patients with esophageal squamous cell carcinoma. Reviewed
Kunizaki M, Tominaga T, Wakata K, Miyazaki T, Matsumoto K, Sumida Y, Hidaka S, Yamasaki T, Yasutake T, Sawai T, Hamamoto R, Nanashima A, Nagayasu T
Molecular and clinical oncology 8 ( 2 ) 370 - 374 2018.2
Language：English Publishing type：Research paper (scientific journal)
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Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report Reviewed
Kawano, F., Tashiro, K., Nakao, H., Fujii, Y., Ikeda, T., Takeno, S., Nakamura, K. and Nanashima, A.
International Journal of Surgery Case Reports 44 105 - 109 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Authors Introduction: Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment. Presentation of case: An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high—grade fever occurred on postoperative day 12, after which oral intake became difficult. Discussion: Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception. Conclusion: Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary.
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Nanashima A., Tominaga T., Sumida Y., Tobinaga S., Nagayasu T.
International Journal of Surgery Case Reports 46 56 - 61 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Author(s) Introduction: The indocyanine green-photodynamic eye (ICG-PDE) system is useful to detect small hypervascular liver tumors, hepatocellular carcinoma (HCC), on the liver surface. This system may be also applied to improve determining the location of metastasis or tumor thrombus (TT). We herein report three case reports. ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. Case series: The patient in case 1 exhibited advanced HCC with TT in the portal trunk. The TT in the right portal vein was clearly fluorescent by ICG-PDE and the right portal vein was adequately transected to remove TT. The patient in case 2 exhibited a large HCC in the right liver and the right adrenal gland was simultaneously swollen with enhancement. By confirming the fluorescent spot in the right adrenal gland, the metastasized lesion was completely resected. The patient in case 3 previously underwent central bi-segmentectomy, and lymph node metastasis and TT in the vena cava was observed during one-year follow-up. Although it was difficult to detect the definite margin of these lesions by the outline appearance, both lesions could be clearly observed with strong fluorescence and were completely resected. Discussion and conclusion: ICG-PDE is a useful tool for detecting the precise tumor location even in extrahepatic tumor lesions, such as metastases or tumor thrombus, which is useful for deciding which parts to resect.
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Yano K, Kondo K, Nanashima A, Fujii Y, Imamura N, Hiyoshi M, Hamada T, Tsuchimochi Y, Wada T, Mizutani Y, Hirai T.
Nuclear Medicine Communications 39 ( 1 ) 28 - 34 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Nuclear Medicine Communications
© Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved. Background Prognosis in patients with hepatocellular carcinoma (HCC) is not only influenced by tumor-related factors but also by the background liver functions. The maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-R max) of the remnant liver (rGSA-R max) is a useful candidate for predicting the liver function and clarifying the relationship between the remnant liver functional reserve and tumor-free survival in patients who have undergone hepatectomy. Patients and methods One hundred and sixty-five patients with HCC who underwent curative hepatectomy were divided into three groups of hepatitis B virus (B-HCC; n=42), hepatitis C virus (C-HCC, n=58), and non-B, non-C (NBNC-HCC, n=65). The relationship between rGSA-R max and survival was examined by univariate and multivariate analyses. Results In the C-HCC group, the albumin, or LHL15, level was significantly lower, and alanine aminotransferase, ICGR15, and the prevalence of grade B liver damage were significantly higher than other two groups (P<0.05). GSA-R max or rGSA-R max was not different between the three groups. Lower GSA-R max and rGSA-R max were only significantly associated with lower tumor-free survival in the C-HCC group by the univariate analysis (P<0.05) but not significantly by the multivariate analysis. Conclusion GSA-R max and rGSA-R max reflect the severity of liver dysfunction and furthermore, the lower rGSA-R max is useful as a complementary factor to predict the early HCC recurrence after hepatectomy.
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Nanashima A., Imamura N., Hiyoshi M., Yano K., Hamada T., Chiyotanda T., Nagatomo K., Hamada R., Ito H.
International Journal of Surgery Case Reports 53 85 - 89 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Author(s) Introduction: This case report describes a successful radical operation for a patient with extensive advanced cholangiocarcinoma who had previously undergone intra-abdominal poly-surgery for advanced gall bladder carcinoma. Careful diagnosis to define the adequate division of the right hepatic duct was performed, and the operation was completed without postoperative complications. Case presentation: A 61-year-old woman was admitted to a hospital for obstructive jaundice, and extra-hepatic cholangiocarcinoma was found. Seven years prior, she underwent poly-surgery, which included cholecystectomy, gastrectomy, and colectomy, for advanced gall bladder carcinoma. Although she did not receive adjuvant chemotherapy, she had no tumor relapse. She was recommended chemo-radiation therapy to treat the cholangiocarcinoma; however, she visited our hospital to inquire the possibility of receiving radical operation. Enhanced computed tomography showed extensive cholangiocarcinoma without distant metastases, which was confirmed by endoscopic biopsy. Since the transected bile duct was without cancer-invasion, which was confirmed by a negative biopsy result, we were able to perform radical left hepatectomy and pancreaticoduodenectomy (HPD). The patient was discharged without any complications. Careful preoperative examination allowed for a complex operation to be successfully completed. Discussion: Complex surgery for advanced hepato-biliary-pancreatic malignancies after poly-surgery is difficult and requires expertise and intensive postoperative care. Conclusion: HPB surgeons should adopt an aggressive policy to treat patients who have undergone previous major abdominal surgery.
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Imamura, N., Nanashima, A., Tsuchimochi, Y., Hamada, T., Yano, K., Hiyoshi, M., Fujii, Y. and Nakamura, K.
International Journal of Surgery Case Reports 42 20 - 23 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Authors Introduction This case report aims to inform pancreatic surgeons about our perioperative management of intrahepatic portal vein thrombosis caused by an obstruction of hepaticojejunostomy (HJ) after pancreaticoduodenectomy (PD). Case presentation A 65-year-old woman was diagnosed with pancreas head carcinoma involving the superior mesenteric vein (SMV). Pancreaticoduodenectomy combined with SMV resection was followed by HJ. Twisting or narrowing was not evident during anastomosis. Total bilirubin values progressively increased to 13 mg/dL on day 5. At that time, we suspected anastomotic occlusion and found complete portal thrombosis of the left liver. Therefore, emergency re-anastomosis of the HJ was followed by thrombectomy, which was not completely successful and did not completely recover initial portal flow. Thrombolytic drugs improved obstructive jaundice, eradicated the organized thrombosis and recovered the portal flow by day 30. The post-operative course was uneventful. Discussion A thrombosis immediately formed in the portal vein due to biliary obstruction of an anastomotic site. We speculated that biliary dilation and related inflammation caused a relative increase in arterial flow and decreased portal flow at the localized part of the umbilical portion. Although early surgical thrombectomy was attempted soon after the primary operation, the organized thrombosis persisted. However, thrombolytic therapy eradicated the thrombosis. Conclusion Careful anastomosis of HJ during PD was necessary to avoid postoperative biliary stricture. This type of complication affects intrahepatic blood flow, particularly via the portal vein. Although immediate re-anastomosis or thrombectomy is applied, organized thrombosis cannot always be surgically removed.
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Tsuchimochi Yuki, Imamura Naoya, Hamada Takeomi, Yano Koichi, Hiyoshi Masahide, Ohuchida Jiro, Fujii Yoshiro, Nanashima Atsushi
The Japanese Journal of Gastroenterological Surgery 51 ( 4 ) 257 - 262 2018
Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
<p>A 51-year-old man was followed up due to hereditary hemorrhagic telangiectasia (HHT). We pointed out a polyposis lesion of the duodenum by gastroscopy. A duodenal polyp located on the opposite side of the major duodenal papilla was diagnosed as adenocarcinoma by biopsy. We also pointed out a polypotic lesion of the colon by colonoscopy. As the polypectomy for colonic polyposis was difficult to treat, we performed subtotal stomach-preserving pancreaticoduodenectomy for the duodenal cancer, and partial resection of the cecum and descending colon for the colonic polyposis. Although the hepatic artery was dilated because of HHT, we safely achieved a curative operation. Histological diagnosis revealed a well differentiated adenocarcinoma in juvenile polyposis (JP) of the duodenal lesion. Juvenile polyps were also seen in the colon. To the best of our knowledge, this is the first case undergoing pancreaticoduodenectomy for combined syndrome of juvenile polyposis and hereditary hemorrhagic telangiectasia in Japan.</p>
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Nanashima A., Sumida Y., Tominaga T., Arai J., Tobinaga S., Wakata K., Murakami G., Hidaka S., Sawai T., Nagayasu T.
Acta Medica Nagasakiensia 61 ( 3 ) 97 - 103 2018
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2018, Nagasaki University School of Medicine. All rights reserved. After pancreaticoduodenectomy (PD), pancreatic duct-to-mucosa anastomosis (PDM) has been usually applied which may prevent risk of pancreatic fistula (PF). In cases with a small pancreatic duct, however, PDM is difficult to complete. Procedures involving the invagination (IV) or complete external tube drainage (CED) are supposed to be alternative options for anastomosis. We retrospectively compared clinical results between PDM and IV or CED in 104 patients with a tiny pancreatic duct who underwent PD. The 77 patients undergoing PDM (the control group) and 27 patients undergoing other procedures, including 19 for CED and 8 for IV, were comparatively examined. Fatty pancreas was commonly observed in CED group. Pancreaticojejunostomy was significantly more frequently applied in CED group, and the operating time in the IV group was significantly longer than in control group (p<0.05). The anastomotic time in CED group tended to be shorter than those in control and IV groups (18 versus 29 and 37 min). The incidences of PF were not significantly different among groups (31% in control, 47% in CED and 14% in IV, respectively); however, a grade B or C level of PF was not observed in the IV group. PDM is often difficult to achieve and inadequate suturing may injure the pancreatic parenchyma in cases of very small pancreatic duct. Re-evaluation of the CED or IV procedure as an alternative option was suggested to be warranted.
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Matsumoto J., Suzuki K., Yasuda M., Yamaguchi Y., Hishikawa Y., Imamura N., Nanashima A.
Bioorganic & Medicinal Chemistry 25 ( 24 ) 6536 - 6541 2017.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Bioorganic and Medicinal Chemistry
© 2017 Elsevier Ltd A series of phosphorus porphyrin complexes ([(RO) 2 P(tpp)]Cl, tpp = tetraphenylporphyrinato group, R = −(CH 2 CH 2 O) m (CH 2 ) n H; 1a: m = 2, n = 2; 1b: m = 2, n = 4; 1c: m = 2, n = 6; 1d: m = 3, n = 6) were used for the photodynamic therapy (PDT) of human biliary cancer cell line (NOZ) when exposed to the irradiation of light emitting diodes (LEDs). A Dulbecco's modified Eagle's medium (DMEM) containing NOZ cells (2000 cell well −1 ) and 1 (0–100 nM) was introduced into a 96-well microplate and incubated for 24 h to accumulate 1 into the NOZ cells and to multiply the NOZ cells until the cell number reached 10 4 cells well −1 . After replacing the DMEM medium containing 1 with a fresh DMEM medium without 1, the plates were irradiated for 30 min at 610 nm. After incubation was performed for 24 h in dark conditions, the cell viability of the NOZ cells was determined using the MTT assay. The half maximum inhibitory concentrations 50 (IC 50 ) of 1a–1d were found to be in the range of 33.7–58.7 nM for NOZ. These IC 50 values for the NOZ were one hundredth the IC 50 value (7.57 μM) for mono-L-aspartyl chlorin e6 (laserphyrin®). Thus, it was found that the PDT activity of 1a–1d was much higher than the mono-L-aspartyl chlorin e6. Similarly, IC 50 vales of 1a–1d for HeLa cells were found to be 27.8–52.5 nM. This showed that 1a–1d had high photodynamic activity in cancer cells. At the same time, it was speculated that an LED is a useful light source for deactivating the cancer cells because it can excite the sensitizers with peak width in their absorption spectra using the light of the specified wave length with band width of 10–20 nm; LEDs provide a homogeneous light distribution for the target cells.
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East meets West: East and West pioneers of "anatomical right hepatectomy" - period of dawn to establishment. Invited Reviewed
Nanashima A, Ariizumi SI, Yamamoto M
Journal of hepato-biliary-pancreatic sciences 2017.12
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Hiyoshi, M., Nanashima, A., Wada, T., Tsuchimochi, Y., Hamada, T., Yano, K., Imamura, N. and Fujii, Y.
Clinical Journal of Gastroenterology 10 ( 6 ) 551 - 557 2017.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2017, Japanese Society of Gastroenterology. Pancreatic cancer patients have a poor prognosis because of a low rate of resection that results from distant metastases or local advancement. We report a successful case of unresectable locally advanced pancreatic cancer in a patient who was curatively resected after combination therapy with nab-paclitaxel (nab-PTX) and gemcitabine (GEM). A 61-year-old man was referred for treatment of a 45-mm pancreatic tail tumor involving the celiac axis, common hepatic artery, and splenic artery that appeared as an abnormal soft-density mass on imaging. This patient’s tumor was defined as unresectable due to local advancement, and, therefore, the powerful combined chemotherapy regimen of nab-PTX with GEM was initiated to allow for possible resection later. After three cycles of chemotherapy, a CT scan revealed that the soft-density mass around the celiac axis and common hepatic artery had dramatically disappeared, and the tumor was then determined to be a resectable lesion. Thus, distal pancreatectomy with en bloc celiac axis resection was performed and curability was achieved. There has been no tumor recurrence or distant metastasis at more than 12 months after surgery, and the patient remains alive at 17 months after initial chemotherapy.
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Significance of liver hanging maneuver for anatomical hepatectomy in patients with a large hepatocellular carcinoma compressing intrahepatic vasculatures. Reviewed
Nanashima A, Sumida Y, Tominaga T, Nagayasu T
Annals of hepato-biliary-pancreatic surgery 21 ( 4 ) 188 - 193 2017.11
Language：English Publishing type：Research paper (scientific journal)
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Accompanying role of hepato-biliary-pancreas surgeon in urological surgery Reviewed
Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Fujii Y., Kawano F., Ikeda T., Takeno S., Nakamura E., Nakamura K., Mukai S., Kamimura T., Kamoto T.
International Journal of Surgery Case Reports 41 215 - 218 2017.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s) Introduction The present case reports demonstrated the accompanying surgical support from hepato-biliary-pancreas (HBP) surgeons for urological surgery to secure operative safety because HBP surgeons are well experienced in dissecting techniques for mobilization of the liver or pancreas. We experienced 9 consecutive patients who underwent nephrectomy, adrenectomy or resection of retroperitoneal tumors by urological surgeons. Cardiovascular intervention was also required in cases of long tumor thrombus into the vena cava. Cases All patients had no severe co-existing diseases except the main tumor. Reverse T-shape incision was performed in 7 cases and thoracolaparotomy in two. Dissection and mobilization at the site of severe compression by the urinary tumors were performed in three cases. Partial liver resection was performed for testicular liver metastases in two, and right hepatectomy for right renal cancer was performed in one. Encircling the vena cava and preparation of transection for tumor thrombi were performed in three, and among these, cardiovascular intervention was necessary in two because of extension into the right atrium. During admission, all patient outcomes were uneventful without severe complications. We herein showed the representative two cases of combined surgery. Discussion and conclusion The point of this case report is the coordination between each surgeon and anesthesiologist under precise perioperative planning or management. The role of HBP surgeons is to provide information as a specialist on the operative field for urological or cardiovascular surgery to achieve operative safety.
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Ogihara K., Isomoto H., Kurumi H., Kanda T., Hashisako M., Tabata K., Ishii H., Ohnita K., Yamaguchi N., Akazawa Y., Matsushima K., Takeshima F., Kunizaki M., Hidaka S., Nanashima A., Fukuoka J., Nagayasu T., Nakao K.
Photodiagnosis and Photodynamic Therapy 19 15 - 21 2017.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Photodiagnosis and Photodynamic Therapy
© 2017 Elsevier B.V.Background 5-Aminolevulinic acid is a precursor of photosensitizing protoporphyrin IX and has been applied for photodynamic diagnosis of brain and bladder tumors with few side effects. Although most upper gastrointestinal tumors can be detected during photodynamic diagnosis, some tumors containing signet-ring cells cannot be visualized. Here, we aimed to assess whether proteins involved in the absorbance, activation, and turnover of protoporphyrin IX altered the fluorescence signal in gastric cancer. Methods Aminolevulinic acid-mediated photodynamic diagnosis was performed in 23 lesions from 20 patients using an endoscope equipped with a blue laser light that caused red fluorescence emission of photosensitizing protoporphyrin IX. Red fluorescence signal and intensity was assessed during photodynamic diagnosis procedures. Lesions were resected by endoscopic and/or laparoscopic surgery, and specimens were immunostained and assessed for the expression of ATP-binding cassette sub-family G member 2, oligopeptide transporter-1, and coproporphyrinogen oxidase. Results Photodynamic diagnosis was negative in four cases (17.4%). Three cases of photodynamic diagnosis-negative lesions were signet-ring cell carcinomas, and only one case was differentiated adenocarcinoma (intestinal type). Twenty intestinal type, photodynamic diagnosis-positive lesions showed high expression of coproporphyrinogen oxidase, whereas signet-ring cell carcinomas were all negative. Oligopeptide transporter-1 immunoreactivity was significantly higher in tumors of intestinal type. ATP-binding cassette sub-family G member 2 expression tended to be higher in luminal surface tumors than in intestinal type tumors. Conclusion Aminolevulinic acid-mediated photodynamic diagnosis provided good detection of upper gastrointestinal tumors of intestinal type but not diffuse type tumors, such as signet-ring cell carcinomas, possibly owing to coproporphyrinogen oxidase expression.
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Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy. Reviewed
Fujii, Y., Nanashima, A., Hiyoshi, M., Imamura, N., Yano, K. and Hamada, T.
Annals of gastroenterological surgery 1 ( 3 ) 226 - 231 2017.9
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Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin is correlated with liver functional parameters, but did not predict postoperative morbidity. Reviewed
Yano, K., Nanashima, A., Fujii, Y., Hiyoshi, M., Imamura, N., Hamada, T., Tsuchimochi, Y., Wada, T., Mizutani, Y. and Hirai, T.
Nuclear medicine communications 2017.8
Language：English Publishing type：Research paper (scientific journal)
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Hamada, T., Nanashima, A., Yano, K., Sumida, Y., Hiyoshi, M., Imamura, N., Tobinaga, S., Tsuchimochi, Y., Takeno, S., Fujii, Y. and Nagayasu, T.
International Journal of Surgery 45 149 - 155 2017.7
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery
© 2017 IJS Publishing Group Ltd Background The VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. Methods Between September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. Results In limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). Conclusions Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.
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Kamimura T., Kida K., Takeda M., Sato S., Fujii M., Inoue M., Tsukino H., Mukai S., Nanashima A., Nakamura K., Kamoto T.
Research and Reports in Urology 9 107 - 112 2017.6
Language：English Publishing type：Research paper (scientific journal) Publisher：Research and Reports in Urology
© 2017 Kamimura et al. Clear cell renal cell carcinoma (ccRCC) shows extreme hypervascularity, which may cause significant bleeding during surgery. For this reason, control of arterial blood supply is an important factor in the choice of operative procedure and in avoiding perioperative complications. This case series reports the successful dissection of renal artery in the preliminary stage of laparoscopic procedure in three ccRCC patients with inferior vena cava (IVC) extension. Patient 1 had right renal cell carcinoma (RCC) with level I tumor thrombus through two renal veins, and the renal artery was successfully dissected by retroperitonealscopic approach. Patient 2 had right invasive, immobilized RCC with significant infiltration to IVC and liver. Ligation of renal artery was performed by transperitoneal laparoscopic procedure. Patient 3 had left RCC with level III tumor thrombus and lung metastasis. Ligation of left renal artery and mobilization of peritoneal organs and kidney were performed by transperitoneal laparoscopic surgery. These cases suggest that combined laparoscopic-open surgery for RCC with IVC extension may facilitate early control of arterial blood supply.
DOI： 10.2147/RRU.S134817