悪性疾患:腹腔鏡下胃全摘術 食道空腸吻合関連合併症回避手技のABC

悪性疾患:腹腔鏡下胃全摘術 食道空腸吻合関連合併症回避手技のABC


周術期の体組成評価:―サルコペニアの観点より―

周術期の体組成評価:―サルコペニアの観点より―

The Japanese Journal of Surgical Metabolism and Nutrition


膵・胆管合流異常と胆道癌(特集 慢性炎症から肝胆膵癌にいたるランドスケープ)

膵・胆管合流異常と胆道癌(特集 慢性炎症から肝胆膵癌にいたるランドスケープ)


【ドクターTの心の声を聞け!留置&抜去の理由がわかる! 術式別術後ドレーンの観察とケア】 肝切除術


Loss of Fbxw7 expression is a predictor of recurrence in colorectal liver metastasis.

Fbxw7 is a tumor suppressor through ubiquitination and degradation of multiple oncoproteins. Loss of Fbxw7 is frequently observed in various human cancers. In this study, we examined the role of Fbxw7 expression in colorectal liver metastasis (CRLM) and its mechanism. Fifty-six patients with CRLM who undergo curative resection were enrolled. Fbxw7 in tumor tissue was determined by immunohistochemistry. Patients were divided into two groups, the Fbxw7 high and low groups. Clinicopathological factors including miR-223 expression were compared between the high (n = 32) and low Fbxw7 groups (n = 24). Fbxw7 expression in tumor tissues was significantly lower than that in normal tissues. The disease-free survival in the low Fbxw7 group was significantly worse than that in the high Fbxw7 group, and 3 years disease-free survival of the low and high Fbxw7 groups were 12.5% and 47.0%, respectively (P = 0.023). On multivariate analysis, loss of Fbxw7 was detected as one of the independent risk factors for recurrence of CRLM (hazard ratio: 2.390, P = 0.017). Likewise, Fbxw7 expression inversely correlated to miR-223 expression (P = 0.017). Loss of Fbxw7 in tumor tissues could be a reliable predictor of recurrence after hepatectomy in patients with CRLM, and miR-223 might be a possible regulator of Fbxw7.

Journal of Hepato-Biliary-Pancreatic Sciences


Treatment strategy of conversion hepatectomy for colorectal liver metastasis

【Conversion Surgery-進行消化器がんのトータル治療戦略】がん種別Conversion Surgeryの戦略 転移性肝癌


【どこをどう切る?どうつなぐ?なぞって覚える!消化器外科術式理解イラストノート】 肝臓・胆道の手術 肝切除術


胆・膵 嚢胞切除 先天性胆道拡張症に対する手術

胆・膵 嚢胞切除 先天性胆道拡張症に対する手術


Evidence and topics of surgical treatment for hepatocellular carcinoma

【肝細胞癌 診断・治療におけるエビデンスとトピックス】 肝細胞癌に対する外科的治療のエビデンスとトピックス

肝細胞癌に対する外科的治療のエビデンスとして，ガイドライン(2013年版)における，手術(外科的治療)に関係するClinical Questionの中で，CQ21 腫瘍条件からみた肝切除の適応は?，CQ22 肝切除後の予後因子は何か?，CQ24 系統的切除は予後に寄与するか?，CQ31 肝細胞癌に対する肝移植の適応基準は何か?，について概説する．また，今後エビデンス構築が期待されるトピックスとして，腹腔鏡下肝切除の治療適応，BCLC Stage Bに対する外科的治療選択，Conversion Hepatectomyに関しても言及する．

The Japanese Journal of Gastro-enterology


【胆膵進行癌に対する外科治療戦略】 閉塞性黄疸に対する最新の術前減黄戦略

【胆膵進行癌に対する外科治療戦略】 閉塞性黄疸に対する最新の術前減黄戦略


【がん治療医のための漢方ハンドブック】 漢方と癌診療

【がん治療医のための漢方ハンドブック】 漢方と癌診療


【先天性胆道拡張症の最前線】 先天性胆道拡張症に胆道癌を合併した20歳以下症例の検討 日本膵・胆管合流異常研究会登録委員会報告


【先天性胆道拡張症の最前線】 先天性胆道拡張症における胆道癌の発癌機序

【先天性胆道拡張症の最前線】 先天性胆道拡張症における胆道癌の発癌機序


【先天性胆道拡張症の最前線】 先天性胆道拡張症の診療ガイドライン

【先天性胆道拡張症の最前線】 先天性胆道拡張症の診療ガイドライン


【小児外科 ディベート対決(日常よくみる疾患)】 鼠径ヘルニアの手術 LPEC

【小児外科 ディベート対決(日常よくみる疾患)】 鼠径ヘルニアの手術 LPEC


Development of new molecular targeted therapy for advanced hepatocellular carcinoma

進行肝細胞癌に対する分子標的薬治療の最新情報 (特集 進行肝細胞癌に対する治療戦略(集学的治療を含めて)) -- (総論および最新の内科的治療)


Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy.

Laparoscopic hepatectomy remains one of the most difficult procedures for young surgeons to perform. We recently developed a new training method and standardization procedure for teaching young surgeons to perform laparoscopic left hepatectomy (Lap-LHx). The aim of this study was to assess the effectiveness of our method. In 2004, we standardized a laparoscopic procedure for Lap-LHx, using a laparoscopy-assisted method as a stepping stone. The laparoscopic training method comprised the following three steps: (1) training in fundamental procedures using a dry box and checking by mentors; (2) detailed preoperative simulation using Vincent three-dimensional software for each patient; and (3) self-assessment including understanding of relevant anatomy and completion grade for each procedure using a check sheet and feedback by both mentors and a professor. Twenty-three Lap-LHx procedures performed during the study period were divided into two groups: those performed by young non-board-certified surgeons (n = 9) and those performed by senior board-certified surgeons (n = 14). The blood loss and operative time were similar in the young surgeon (194 g and 336 min, respectively) and senior surgeon groups (208 g and 322 min, respectively). Our standardized Lap-LHx procedure and stepwise training to perform it enable young surgeons to perform Lap-LHx as confidently and safely as more experienced surgeons.


【最新 肝胆膵高難度外科手術アトラス】 高難度外科手術手技 肝臓 肝下部下大静脈再建を伴う肝切除


【外科領域におけるサルコペニア】 周術期サルコペニア発生の予防法

【外科領域におけるサルコペニア】 周術期サルコペニア発生の予防法


High NEK2 Expression Is a Predictor of Tumor Recurrence in Hepatocellular Carcinoma Patients After Hepatectomy.

Better prognosis of cancer including hepatocellular carcinoma (HCC) remains unsatisfactory due to recurrence and chemoresistance. In this respect it is important to identify molecular targets specific to the disease in order to design effective therapeutic strategies. In the present study, we investigated the prognostic role of Never-in-mitosis-A-related kinase 2 (NEK2) in HCC. Fifty HCC patients who underwent hepatectomy were enrolled in the study. NEK2 gene and protein expression was examined by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry, respectively. Higher expression of NEK2 was detected in HCC tumoral compared to adjacent non-tumor tissues (p<0.001), and protein expression was also relatively high in tumor than corresponding non-tumor tissues. Furthermore, high NEK2 expression was positively correlated with hepatic venous invasion (p=0.047), des-gammacarboxy prothrombin (p=0.003), and alpha-fetoprotein (AFP) (p=0.024). Patients with high NEK2 expression had significantly poor recurrence-free survival (p=0.042) and early recurrence. Overall, these results suggest that NEK2 could be a promising biomarker for HCC recurrence.


Loss of SFRP1 Expression Is Associated with Poor Prognosis in Hepatocellular Carcinoma.

Secreted frizzled-related protein-1 (SFRP1) is a well-known inhibitor of the wingless type (WNT)-β-catenin signaling pathway and its inactivation plays an important role in the development and progression of various types of cancer. However, the clinical significance of SFRP1 expression in patients with hepatocellular carcinoma (HCC) remains unknown. A total of 63 patients with HCC who underwent hepatectomy at our Institution were enrolled in this study. A quantitative real-time polymerase chain reaction (RT-PCR) was performed to determine the SFRP1 mRNA expression level in both the tumorous and non-tumorous tissues of HCC. The patients were divided into low and high gene-expression groups based on the SFRP1 gene expression level in their tumor tissues. We analyzed the differences in clinicopathological characteristics between these two groups of patients. The expression level of SFRP1 was significantly lower in tumor tissue than in non-tumor tissue (p<0.0001). Significant correlations were observed between a high expression of SFRP1 in tumor tissue and older than 65 years (p=0.030), tumor size less than 5 cm (p=0.011); and no vascular invasion (p=0.004). Patients with high SFRP1 expression in tumor tissue had a significantly better overall survival rate (p=0.040). However, the SFRP1 expression level was not defined as an independent risk factor for patient survival based on results of multivariate analysis. SFRP1 may play a role in the development and progression of HCC. Therefore, more studies are required to investigate a potential role of SFRP1 in HCC prognosis.


Epigallocatechin gallate hinders human hepatoma and colon cancer sphere formation.

The long-term survival of patients with hepatocellular carcinoma remains unsatisfactory because of the presence of cancer stem cells (CSCs), which are responsible for tumor recurrence and chemoresistance after hepatectomy. Drugs that selectively target CSCs thus offer great promise for cancer treatment. Although the antitumor effects of epigallocatechin gallate (EGCG) have been reported in some cancer cells, its effects on CSCs remain poorly studied. In this study, we investigated the effects of EGCG on human hepatoma and colon CSCs. HepG2 and HCT-116 cell lines were enriched by sphere formation, and their gene-expression profiles were analyzed by quantitative real-time polymerase chain reaction. EGCG-induced growth inhibition in the parental cells was determined by WST-8 assay, and protein expression was assessed by western blotting. Cell cycle profile and apoptosis analysis was performed using flow cytometer. Sphere-derived cells grown in serum-free, nonadherent cultures showed increased expression of stem cell markers, Nek2, and ATP-binding cassette transporter genes, compared with parental cells grown in conventional culture. EGCG induced growth inhibition in the parental cells in a dose-dependent manner. EGCG also inhibited self-renewal in hepatoma and colon CSCs, attenuated the expression of stem cell markers and ATP-binding cassette transporter genes, which are putative molecules associated with treatment resistance in CSCs, and decreased the transcription of Nek2 and p-Akt, resulting in the inhibition of Akt signaling. EGCG also altered cell cycle profile and apoptosis, which may in part play an important role in EGCG-induced cancer cell death. Overall, these results suggest that EGCG could be a useful chemopreventive agent for targeting hepatocellular carcinoma and colon CSCs, in combination with standard chemotherapies.

Journal of Gastroenterology and Hepatology


肝胆膵手術例の術前栄養管理

肝胆膵手術例の術前栄養管理


【膵・胆管合流異常の診断基準の改訂をめぐって】 膵・胆管合流異常の診断の最前線 胆汁中アミラーゼ値


Esophagus Hiatus Hernia after Laparoscopic Total Gastrectomy

腹腔鏡下胃全摘術1年後に傍食道裂孔ヘルニアを発症した1例

We report on a rare case of esophageal hitus hernia after laparoscopic total gastrectomy (LTG). A 73-year-old man underwent LTG with D2 lymph node dissection and Roux-en-Y (overlap) reconstruction for early gastric cancer. After one year, he was admitted to our hospital with acute abdominal pain. Abdominal CT scan revealed a dilated small intestine prolapsing into the thoracic cavity through the left side of the esophageal hiatus and ischemia of the prolapsed small intestine. He underwent emergency operation based on a diagnosis of strangulation ileus caused by esophageal hiatal hernia. We successfully reduced the prolapsed small intestine back to the abdominal cavity. There was no necrosis in the area. The hernia orifice was occluded by suturing posterior walls of the diaphragm crus and the esophagus was securely fixed by 4 sutures to the diaphragm crus.

腹腔鏡下胃全摘術1年後に傍食道裂孔ヘルニアを発症した1例を経験したので報告する．症例は73歳男性で，1年前に当院で早期胃癌に対して腹腔鏡下胃全摘術，Roux-en-Y再建を施行した．2012年5月，突然の腹痛を主訴に来院した．腹部は板状硬でBlumberg signを認めた．胸腹部造影CTにて食道裂孔より左胸腔内へ拡張した腸管の脱出像と胸水貯留を認めた．食道裂孔ヘルニアによる絞扼性イレウスと診断し，緊急手術を施行した．食道裂孔を介して挙上空腸が左胸腔内へ進入しており，傍食道裂孔ヘルニアと診断した．食道裂孔を切開しヘルニア門を開大し，腹腔側から空腸を引き戻し，裂孔部を縫合閉鎖し空腸を固定し手術を終了した．術後14日目に軽快，退院した．術後1年の現在まで再発の徴候はない．

The Japanese Journal of Gastroenterological Surgery


嵌頓にて発症し術後縦隔膿瘍を来したcentral tendon defectの1例

Journal of the Japanese Society of Pediatric Surgeons


【食道癌・胃癌におけるロボット支援手術の有用性】 地方での胃癌に対するロボット支援手術導入の現状と問題点


【肝胆膵・術後病態を學ぶ】 膵胆管合流異常・先天性胆道閉鎖症術後 膵胆管合流異常術後発癌の特徴


【膵・胆管合流異常の最前線】 全国集計からみた膵・胆管合流異常

【膵・胆管合流異常の最前線】 全国集計からみた膵・胆管合流異常


【漢方を上手に使う―エビデンスに基づいた外科診療】 周術期管理・合併症と漢方 高アンモニア血症 大建中湯 効果のメカニズム


Kampo for the treatment of adverse effects caused by anticancer drugs. Oxaliplatin-induced neurotoxicity : Goshajinkigan

オキサリプラチンによるしびれ : 牛車腎気丸 (特集 漢方を上手に使う : エビデンスに基づいた外科診療) -- (癌化学療法の副作用と漢方)


Visualization and hypervascularization of the haemorrhoidal plexus in vivo using power Doppler imaging transanal ultrasonography and three-dimensional power Doppler angiography.

The purpose of this study was to demonstrate the distribution of haemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids. One-hundred and three patients with haemorrhoids were studied. Using power Doppler imaging (PDI) transanal ultrasound and three-dimensional power Doppler angiography (3D-PDA), the course of the arteries supplying the haemorrhoids was identified. Measurement of the PDI area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line. The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1% of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from Grade 1 to Grade 4 (P < 0.0001). The PDI areas in Grades 1, 2, 3 and 4 were 0.04 ± 0.03, 0.18 ± 0.07, 0.38 ± 0.18 and 0.96 ± 0.32 cm(2) (P < 0.05). The distribution of haemorrhoidal arteries varies widely in both number and position. Using PDI transanal ultrasonography and 3D-PDA it was possible to visualize the haemorrhoid plexus and the course of the haemorrhoidal artery in vivo.


【各種デバイスを応用した私の手術―使用法と工夫】各種デバイスを応用した肝・胆手術


Evaluation of ICG fluorescence method for confirmation of blood folw in intraoperative pre-anastomosis for laparoscopic anterior resection.

腹腔鏡下直腸切除術におけるICG蛍光法を用いた腸管血流評価

Journal of Japan Society of Computer Aided Surgery

日本コンピュータ外科学会誌


A challenge to ECFMG certification : An experience and difficulties of Japanese examinee

若手小児外科医のECFMG certificate取得への挑戦∼米国小児外科臨床留学を目指して∼

Recently, many Japanese pediatric surgeons undertake clinical training abroad, especially in the United States of America (USA) which is one of the most attractive country for advanced clinical training. Since the Japanese government introduced a 2-year mandatory residency program in 2004, it has become more and more important for busy Japanese residents to spent time efficiently in order to achieve ECFMG (Educational Commission For Foreign Medical Graduates) certification. ECFMG certification requires residents to pass both Step 1 and 2 of the United States Medical License Examination (USMLE). It is especially difficult to pass step2 CS (Clinical Skills) for many Japanese who are unfamiliar with the English language. For example, one of authors started to study for the USMLE in the 6th grade of the Japanese Medical School (MS4), passed step1 and step2 CK (Clinical Knowledge) during the 2-year mandatory intensive rotating residency program, and passed Step2 CS on the 3rd attempt during the general surgery residency program. This shows that a Japanese examinee can pass the ECFMG certificate even during a busy rotating residency program.


A case of rectal metastasis from gastric cancer

症例報告 胃癌術後に直腸転移を来した1例

We report a case of rectal metastasis from gastric cancer. The patient was a 69-year-old man with diarrhea as his major symptoms, who underwent a distal gastrostomy for gastric cancer 2 years previously. We suspected primary or metastatic rectal cancer from colonoscopic examination and barium enema. A lower anterior resection was performed. Postoperative historical examination identified poorly differentiated adenocarcinoma and signet cell carcinoma identical to the gastric cancer. Finally the lesion was diagnosed as metastatic rectal cancer from gastric cancer that showed same pattern in PAS stain. There were only 40 cases in reports in the literature from 2002 to 2012, to our knowledge. We report a rare case.


【膵・胆管合流異常アップデート】膵・胆管合流異常の全国集計 成人の特徴

【膵・胆管合流異常アップデート】膵・胆管合流異常の全国集計 成人の特徴


【プロが見せる手術シリーズ(2):難易度の高い消化管手術】胃食道分離術

【プロが見せる手術シリーズ(2):難易度の高い消化管手術】胃食道分離術


抗リン脂質抗体症候群の臨床的特徴に関する検討

抗リン脂質抗体症候群の臨床的特徴に関する検討


【いつ何が大事かがわかる 消化器外科術後の看護ポイント】 腹腔鏡下胆嚢摘出術後の看護・観察ポイント 0∼12時間，12∼24時間，24∼72時間


【大腸癌肝転移up to date】大腸癌肝転移化学療法後の肝障害

【大腸癌肝転移up to date】大腸癌肝転移化学療法後の肝障害


Fairly rare spontaneous disappearance of a hepatic artery aneurysm following living donor liver transplantation.


【膵・胆管合流異常アップデート】膵・胆管合流異常と胆道癌

【膵・胆管合流異常アップデート】膵・胆管合流異常と胆道癌


【最新 肝胆膵脾手術アトラス】肝臓 右下肝静脈存在下での肝切除術

【最新 肝胆膵脾手術アトラス】肝臓 右下肝静脈存在下での肝切除術


肥満症に対する外科療法 腹腔鏡下スリーブ状胃切除術の1施行例

肥満症に対する外科療法 腹腔鏡下スリーブ状胃切除術の1施行例


【エキスパートが教える内視鏡外科手術・ポイントとなる解剖の理解】 肝・胆・膵・脾の鏡視下手術 肝癌に対する鏡視下手術 腹腔鏡下肝部分切除術


【膵・胆管合流異常診療ガイドラインを巡る残された問題点】 非拡張型膵・胆管合流異常の胆管癌発生頻度を巡る問題点


Atypically large well-differentiated hepatocellular carcinoma with extensive fatty metamorphosis: report of a case.

A large well-differentiated hepatocellular carcinoma (HCC) with fatty change is rare, and to date only a few cases have been reported. Herein, we present a 68-year-old man who developed a well-differentiated HCC with extensive fatty metamorphosis. The patient was referred to our institute because of a rapidly growing tumor in the left lobe of the liver. Ultrasonography showed a hyperechoic lesion with a peripheral hypoechoic area. Dynamic contrast-enhanced computed tomography (CT) scan in all three phases revealed the tumor which showed diffuse low attenuation with internal irregular enhancement. He underwent left lateral segmentectomy at the liver. Histological diagnosis confirmed well-differentiated HCC and the surrounding non-cancerous area was diagnosed as non-alcoholic steatohepatitis. The patient is still alive without recurrence after 17 months of follow-up.

The Journal of Medical Investigation : JMI


Hepatic epithelioid angiomyolipoma with arterioportal venous shunting mimicking hepatocellular carcinoma : report of a case.

A patient with hepatic epithelioid angiomyolipoma (Epi-AML) with arterioportal venous shunting, who was successfully treated by a laparoscopic left lateral sectionectomy, is presented herein. AML is an uncommon benign neoplasm of the liver. Tumors composed predominantly of epithelioid cells have been subcategorized into Epi-AML, and the treatment strategy for Epi-AML is currently undetermined. There are no reports describing Epi-AML with arterioportal venous shunting to date. An arterioportal venous shunting of the liver tumor was suggested to be one of the malignant signs of the liver tumor. It would be important to differentiate Epi-AML with arterioportal venous shunting from hepatocellular carcinoma and hypervascular metastatic tumors. Minimally invasive resection, such as laparoscopic hepatectomy, for patients having Epi-AML with arterioportal venous shunting may be recommended.


Personalized medicine for laparoscopic gastrectomy used to treat gastric cancer.


膵・胆管合流異常診療ガイドライン(日本膵・胆管合流異常研究会・日本胆道学会編)

膵・胆管合流異常診療ガイドライン(日本膵・胆管合流異常研究会・日本胆道学会編)


Efficacy of PET-CT for predicting the malignant potential of gastrointestinal stromal tumors.

Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the intestinal tract. The risk category is usually determined by tumor size and mitotic count, but accurate preoperative diagnosis of GIST is very difficult. The purpose of this study is to evaluate the efficacy of positron emission tomography (PET)-CT for predicting the malignant potential of gastrointestinal stromal tumors. Ten patients with GIST who underwent a preoperative PET-CT examination were divided into two groups by risk category, and various factors were compared between the two groups. The relationships between the maximum standardized uptake value (SUVmax) and GIST parameters were examined. Patients were classified into two groups by their risk category: (low/intermediate-risk or high-risk). The SUVmax was significantly higher in the high-risk group (11.0 ± 3.04) than in the low/intermediate-risk group (2.1 ± 1.5). The Ki67 labeling index was also significantly higher in the high-risk group (8.63 ± 6.2) than in the low/intermediate-risk group (1.75 ± 0.52). There was a significant correlation between the Ki67 labeling index and the SUVmax (p = 0.028) and between the mitotic index and the SUVmax (p = 0.029). PET-CT can predict malignant potential. Cases with a SUVmax of over 5 may have malignant potential.


Short-term results of laparoscopic surgery after preoperative chemoradiation for clinically staged T3 and T4 rectal cancer.

The feasibility of laparoscopic surgery for clinically staged T3 and T4 rectal cancer has not been clearly defined specifically in cases following preoperative chemoradiation therapy (CRT). Our aim was to investigate the feasibility of laparoscopic surgery after preoperative CRT for clinically staged T3 and T4 rectal cancer. Between May 2003 and June 2009, 57 patients (T3: n = 50, T4: n = 7) who underwent preoperative CRT for rectal cancer were identified. Forty-three patients with laparoscopic surgery (Lap group) were compared with 14 patients who underwent open surgery (Open group). Perioperative data including postoperative morbidity were assessed between the two groups. All patients underwent complete laparoscopic operations, and none was converted to laparotomy. Operating time was longer in the Open group (331 vs 375 min, P < 0.01). Blood loss was lower in the Lap group (160 vs 316 mL, P < 0.01). Lymph node harvest and morbidity rate were similar in both groups. The distal tumor margin was negative in all patients. No patients had perioperative mortality associated with surgery after CRT. Laparoscopic surgery after preoperative CRT is a feasible and a safe option for T3 and T4 rectal cancer compared to conventional open surgery.


Japanese clinical practice guidelines for pancreaticobiliary maljunction.

.Working Committee of Clinical Practice Guidelines for Pancreaticobiliary Maljunction; Japanese Study Group on Pancreaticobiliary Maljunction.

There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.


単孔式腹腔鏡下に修復し得たSpiegelヘルニアの1例

単孔式腹腔鏡下に修復し得たSpiegelヘルニアの1例

Journal of Japan Society for Endoscopic Surgery


Robot-assisted distal gastrectomy using the da Vinci Surgical System

胃癌に対するda Vinci手術の経験

The da Vinci Surgical System is a telerobotic system consisting of4components, including theInsite vision system with a true3‐dimensional endoscope providing a high-resolution binocular view ofthe surgical field, and the Endo Wrist instrument system, which is capable of7degrees of freedomand2degrees of axial rotation to replicate human wrist-like movements. Distal gastrectomy andD1+lymphnode dissection was performed in a73-year-old man with cT1bN0N0StageIA gastriccancer. Preoperative abdominal CT findings were showed that celiac artery branching patternswas Adachi VI type26groups. The operating time was433minutes, and the blood loss was284g.The da Vinci Surgical System has useful advantages over conventional Laproscopic Assisted gastrectomy(LAG)surgery concerning the precise lymphnodes dissection. With further innovationsin the future, the da Vinci Surgical System has the potential to facilitate technically difficult surgeryemploying conventional LAG techniques.


腹腔鏡下に切除した大腸平滑筋肉腫の1例

腹腔鏡下に切除した大腸平滑筋肉腫の1例


劇症肝不全に対する肝移植

劇症肝不全に対する肝移植


特集. 術後感染症を防ぐーDPC時代に向けてー 術後感染症を防ぐためのわれわれの工夫 肝臓手術


Living-donor liver transplantation: present status and future perspective

About 15 years have passed since the first liver transplant from a living donor (living donor liver transplantation: LDLT), and the status of the procedure has since been established as a standard cure for end-stage liver disease in Japan where liver transplantation (LTx) from deceased donors has not yet been accepted. However, the following problems are surfacing with the increase in the number of LDLTs between adults: graft size mismatching, an ABO blood-type incompatible transplantation, the expansion of LDLT indication to hepatocellular carcinoma (HCC), the relapse of hepatitis C after LDLT, marginal donors, and the freedom from immunosuppressive treatment. In this article we outline the present conditions of these problems and the future view of the LDLT.


特集 肝移植の最新の進歩と問題点 選択，適応基準とIC取得，実践時期の設定 HCV肝硬変(外科から)


特集 肝移植の最新の進歩と問題点 選択，適応基準とIC取得，実践時期の設定 肝細胞癌に対する肝移植


HCV肝硬変(外科から)

HCV肝硬変(外科から)


特集. 肝切除術:成功の秘訣 肝予備能検査:最新の知見

特集. 肝切除術:成功の秘訣 肝予備能検査:最新の知見


生体肝移植における過小グラフトに対する高圧酸素療法の有用性

生体肝移植における過小グラフトに対する高圧酸素療法の有用性

日本臨床高気圧酸素・潜水医学会雑誌

日本臨床高気圧酸素・潜水医学会雑誌


剥離と切離 実質臓器(肝胆膵)

剥離と切離 実質臓器(肝胆膵)


Present condition of liver transplantation and future problem. 3. Measure for rejection and infection.

肝移植の現況と今後の課題 拒絶反応・感染症に対する対応


ウイルス肝炎と肝移植 九州大学病院において

ウイルス肝炎と肝移植 九州大学病院において


肝癌患者の移植適応の厳格化により5年生存率は向上したが，科学的根拠に基づいた肝癌の生物学的悪性度を基準に反映させる必要がある


特集:肝臓外科∼課題とその対応∼ --- 肝移植ーグラフトサイズと肝機能·移植成績


今日の問題 ハイブリッド型人工肝臓の現状と将来展望

今日の問題 ハイブリッド型人工肝臓の現状と将来展望


特集 肝切除・部分肝移植後の肝再生と肝不全 部分肝移植後の肝再生と肝不全—基礎と臨床— --- 8. 肝移植後肝不全の病態と対策


今日の問題 生体肝移植の現状と将来展望

今日の問題 生体肝移植の現状と将来展望


ウイルス性肝炎(下)—基礎・臨床研究の進歩— --- Hbs抗原消失の機序とその後の問題点

Nihon Rinsho. Japanese Journal of Clinical Medicine


ドミノ肝移植の現況と将来展望

ドミノ肝移植の現況と将来展望


肝炎から肝がんまで 肝がんの治療 肝移植

肝炎から肝がんまで 肝がんの治療 肝移植

The Japanese journal of clinical and experimental medicine


生体肝移植とその短期及び長期成績 脂肪肝グラフト

生体肝移植とその短期及び長期成績 脂肪肝グラフト


特集:肝細胞癌とどう戦うべきか 再発治療とその予防 再発肝細胞癌に対する治療

特集:肝細胞癌とどう戦うべきか 再発治療とその予防 再発肝細胞癌に対する治療


特集:鏡視下手術の適応と限界 肝癌に対する鏡視下肝切除と鏡視下ラジオ波腫瘍焼灼術


肝内胆管癌および混合型肝癌におけるc-kit蛋白発現

肝内胆管癌および混合型肝癌におけるc-kit蛋白発現


特集:癌転移—基礎と臨床アップデート— --- VII. リンパ節郭清の評価 肝内胆管癌切除におけるリンパ節郭清


肝切除におけるクリテイカルパスの有用性と抗菌役flomoxef (FMOX)の効果


特集:ここまで進んだ内視鏡外科 肝癌治療:腹腔鏡下手術の意義

特集:ここまで進んだ内視鏡外科 肝癌治療:腹腔鏡下手術の意義


長期経過例における合併症

長期経過例における合併症


肝細胞癌に対する生体肝移植 術前術後化学療法

肝細胞癌に対する生体肝移植 術前術後化学療法


特集:肝細胞癌の治療方針:最近の進歩 肝細胞癌に対する生体肝移植

特集:肝細胞癌の治療方針:最近の進歩 肝細胞癌に対する生体肝移植


Temporary auxiliary liver transplantation from living donor to an adult recipient with familial amyloid polyneuropathy


特集:鏡視下手術の成績と評価 V. 肝臓 --- 1.肝切除—原発性肝癌に対する成績を中心に


臨床外科学と基礎医学:人工肝臓の現状と問題点

臨床外科学と基礎医学:人工肝臓の現状と問題点


Minimally invasive hepatectomy: modulation of systemic reactions to operation or laparoscopic approach?

A new concept of surgical stress has been proposed that consists of both aggressiveness of operation and systemic reactions to an operation. We have investigated a possible modulation of such systemic reactions to operation and have demonstrated the following 3 points: (1) coagulation and fibrinolytic systems are independently activated during hepatectomy and such activation can be modulated by protease inhibitors such as nafamostat mesilate and antithrombin III; (2) elevated thromboxane A2 during hepatectomy is characterized in the prostanoid system, the elevation of thromboxane A2 is inhibited by thromboxane A2 synthetase inhibitor, and postoperative liver injury is reduced; (3) cytokine response induced by hepatectomy is modulated by preoperative administration of methylprednisolone, leading to possible prevention of bacterial translocation. Therefore, modulating systemic reactions to hepatectomy may be important for successful minimally invasive hepatectomy. Another important option for minimally invasive hepatectomy is the use of operative procedures such as laparoscope or thoracoscope. We have investigated the usefulness of a laparoscopic hepatectomy from the standpoints of early and long-term outcome after hepatectomy. Laparoscopic hepatectomy, which is a difficult and dangerous procedure, can be a feasible option and can result in better short-term outcome and a similar long-term outcome after hepatectomy when compared with conventional open hepatectomy. Therefore, the laparoscopic approach is also a viable option for minimally invasive hepatectomy. Modulation of systemic reactions to the operation itself and laparoscopic hepatectomy may be new strategies for performing minimally invasive hepatectomy.


高度門脈侵襲肝癌に対する治療

高度門脈侵襲肝癌に対する治療


da Vinciを用いた幽門側胃切除術

da Vinciを用いた幽門側胃切除術


特集:わが国における肝移植の現況と展望 ウイルス性肝硬変，肝細胞癌に対する肝移植


da Vinciを用いたロボット手術

da Vinciを用いたロボット手術


劇症肝不全に対する生体肝移植

劇症肝不全に対する生体肝移植


ウイルス性肝硬変，肝癌症例への移植

ウイルス性肝硬変，肝癌症例への移植


腹腔内実質臓器に対する腹腔鏡下手術ーとくに腹腔鏡下肝切除の現状と将来展望

腹腔内実質臓器に対する腹腔鏡下手術ーとくに腹腔鏡下肝切除の現状と将来展望

Journal of Clinical and Experimental Medicine


肝切除の最新の周術期管理

肝切除の最新の周術期管理


肝移植手術のコツと術後管理 急性拒絶反応

肝移植手術のコツと術後管理 急性拒絶反応


Current status and future of surgical robotic systems

In this review, we are commenting the current status and the future of surgical robotic systems. AESOP is a voice-controlled laparoscope manipulator that enables the "Solo-surgery". ZEUS is a master-slave manipulator that is characterized by its simplicity and lightness. da Vinci is another master-slave manipulator that has more range of freedom, therefore a surgeon can perform the operation with fewer difficulties. The technological development of high-quality and real-time 3D simulation, minimization of scopes and power saving techniques made these surgical robots realized. Although many pending matters such as lack of safety guideline or lack of accuracy of sensor/monitor have been raised in current surgical robotics, the development of the technologies may promise to resolve such matters in the future.


ハイブリッド型人工肝臓の臨床応用の現状と問題点

ハイブリッド型人工肝臓の臨床応用の現状と問題点


Reply to "Re: a new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism (14:2,127-130)"


腹腔鏡下リアルタイム三次元エコーによる肝臓手術のナビゲーション

腹腔鏡下リアルタイム三次元エコーによる肝臓手術のナビゲーション

第11回コンピュータ支援画像診断学会，第10回日本コンピュータ外科学会大会合同論文集


内視鏡下手術支援装置da VinciTMを使用した胃静脈瘤に対する胃上部血行遮断術


縦隔外科領域への内視鏡下手術支援装置(da VinciTM)の応用

縦隔外科領域への内視鏡下手術支援装置(da VinciTM)の応用


内視鏡下手術支援装置da VinciTMを用いた食道癌に対する食道切除再建術

内視鏡下手術支援装置da VinciTMを用いた食道癌に対する食道切除再建術


生体肝移植における3D-CT肝静脈画像構成の有用性

生体肝移植における3D-CT肝静脈画像構成の有用性


腹腔鏡下手術支援多自由度長鉗子の屈曲制御に関する研究

腹腔鏡下手術支援多自由度長鉗子の屈曲制御に関する研究


肝癌の診断と治療—最新の研究動向— --- V. 肝癌の診断 画像診断法

肝癌の診断と治療—最新の研究動向— --- V. 肝癌の診断 画像診断法


臨床用ハイブリッド型人工肝臓の開発

臨床用ハイブリッド型人工肝臓の開発

日本バイオレオロジー学会誌(B&B)

日本バイオレオロジー学会誌(B&B)


内視鏡下手術と癌治療—肝癌—

内視鏡下手術と癌治療—肝癌—


PUF/スフェロイド人工肝の倫理委員会申請と問題点

PUF/スフェロイド人工肝の倫理委員会申請と問題点


外科手術におけるロボット技術への期待と課題

外科手術におけるロボット技術への期待と課題


ハイブリッド型人工肝臓の開発

ハイブリッド型人工肝臓の開発


Correspondence re: M. Kondo et al., Increased Expression of COX-2 in Nontumor Liver Tissue Is Associated with Shorter Disease-free Survival in Patients with Hepatocellular Carcinoma


Hybrid Artificial Liver Using a Polyurethane Foam Packed-Bed Culture System

New Aspects of High Technology in Medicine


Laparoscopic hepatectomy: new approach for hepatocellular carcinoma

This article presents the rationale for the laparoscopic approach to liver surgery, showing the technique of fully endoscopic and endoscopic-assisted formal and wedge hepatic resections. The early results are comparable to those of conventional surgery, with the benefits derived from minimal access surgery. Laparoscopic liver resections are technically feasible, with an acceptable morbidity and mortality rate, but extensive experience in conventional liver surgery, advanced laparoscopic surgery, and the availability of all requested technologies are indispensable prerequisites.

Journal of Hepato-Biliary-Pancreatic Surgery


九州大医学における生体肝移植の現状

九州大医学における生体肝移植の現状


超音波外科吸引装置(CUSA)

超音波外科吸引装置(CUSA)


New Generation in Hepato-Biliary Surgery

New Aspects of High Technology in Medicine Bruch HP. Kockerling F, Bouchard R, Schug-Pab (Eds.)


内視鏡下手術の再評価ー通常手術とした手術成績ー --- 肝癌 ∼肝細胞癌に対する腹腔鏡(補助)下手術∼


ロボティックサージャリーの進歩 ∼外科におけるロボテイクス∼

ロボティックサージャリーの進歩 ∼外科におけるロボテイクス∼


臨床応用可能な人工肝臓の開発

臨床応用可能な人工肝臓の開発


外科における遠隔手術の役割

外科における遠隔手術の役割


Stage IV-A 進行肝癌の病態と外科治療

Stage IV-A 進行肝癌の病態と外科治療


マルチメディア時代における外科学の展開

マルチメディア時代における外科学の展開


肝切除により惹起される生体反応と肝癌 --- -生体反応のdormancyは戦略として成り立つか?-

第99回日本外科学会記念誌

第99回日本外科学会記念誌


腹腔鏡下肝部分，肝外側区域切除術

腹腔鏡下肝部分，肝外側区域切除術


肝癌領域における新しい腫瘍マーカー

肝癌領域における新しい腫瘍マーカー


遺伝子の発現を解析:ディファレンシャル・ディスプレイ

遺伝子の発現を解析:ディファレンシャル・ディスプレイ


高度進行肝癌に対する外科治療の適応と限界

高度進行肝癌に対する外科治療の適応と限界


肝癌の遺伝子診断:定量的RT-PCR法による末梢血中肝細胞癌の検出

肝癌の遺伝子診断:定量的RT-PCR法による末梢血中肝細胞癌の検出


Characteristics and treatment of recurrent hepatocellular carcinoma


肝切除により惹起される生体反応と組織障害について;とくにサイトカインを中心として


最新の胸腹腔鏡下手術-適応と問題点-肝癌外科手術

最新の胸腹腔鏡下手術-適応と問題点-肝癌外科手術


肝細胞癌に対する手術適応

肝細胞癌に対する手術適応

The Japanese journal of clinical and experimental medicine


一次線溶が大量出血に深く関与している-肝切除手術後の凝固・線溶系の亢進-

一次線溶が大量出血に深く関与している-肝切除手術後の凝固・線溶系の亢進-


免疫不全症例における外科手術の問題点とストラテジー

免疫不全症例における外科手術の問題点とストラテジー


外科領域感染症に対するempiric therapyの実際

外科領域感染症に対するempiric therapyの実際


消化器外科領域におけるソマトスタチンと(オクトレオチド)

消化器外科領域におけるソマトスタチンと(オクトレオチド)


肝臓移植再開をとりまく諸問題

肝臓移植再開をとりまく諸問題


肝移植の問題点と展望:とくに体外肝切除術の経験

肝移植の問題点と展望:とくに体外肝切除術の経験


臓器移植ネットワークシステム-その問題点-

臓器移植ネットワークシステム-その問題点-


イヌ肝臓移植における迅速肝冷却摘出法の試み

イヌ肝臓移植における迅速肝冷却摘出法の試み


The value of systematic lymph node dissection for intrahepatic cholangiocarcinoma from the viewpoint of liver lymphatics.

Lymph node (LN) metastasis from intrahepatic cholangiocarcinoma (IHCC) might be one of the most important indicators of aggressive surgical resection, yet the value of LN dissection is still controversial. To address this clinical problem, we need to better understand the multidirectional lymphatic outflow from the liver. Although most hepatic lymph flows into the hilar LNs along portal triads, there are also several lymphatic outflows directly communicating with distant areas or the general lymphatic system. Moreover, it has been revealed that LN metastasis spreads to more distal LNs through the hepatoduodenal ligament or other multidirectional lymphatic pathways connected to the general lymphatic system. Therefore, systematic LN dissection might merely be LN sampling in IHCC with LN metastasis. A multidisciplinary strategy focusing on adjuvant treatment after surgery is immediately necessary in these cases. In IHCC without LN metastasis, the accuracy of preoperative imaging assessment of LN metastasis is unsatisfactory and useless for detecting metastatic LNs in clinical settings. Therefore, prophylactic systematic LN dissection for IHCC without preoperative LN swelling is recommended for accurate LN status assessment and reduction of local recurrences. However, this procedure might not offer any clinical benefit according to the results of retrospective comparative studies. In this review, we summarize previous reports regarding lymphatic outflow of the liver and discuss LN dissection for IHCC.


Role of adhesion molecule expression and theie soluble fractions in hepatic resection

Little has so far been documented about the relationship between liver injury and adhesion molecules. The aim of this study is to clarify the role of adhesion molecules in hepatic resection by studying both the expression of such adhesion molecules and the measurement of their soluble fractions in the blood. To study adhesion molecule expression in the liver, liver biopsies were obtained before and after hepatectomy in 14 patients. Using frozen sections, immunochemical staining for intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) was then performed. To study the soluble fractions of adhesion molecules in the hepatic venous blood, the serum soluble fractions of ICAM-1 and VCAM-1 from another 17 patients were measured using an enzyme-linked immunosorbent assay. The plasma levels of polymorphonuclear leukocyte (PMN) elastase were also measured using an enzyme immunoassay. Both the preoperative and postoperative values of the serum soluble fractions of ICAM-1, VCAM-1, and PMN elastase were then compared. The correlation between their values and the perioperative variables was also investigated. Either ICAM-1 or VCAM-1 was stained on the sinusoidal endothelial cells and Kupffer cells or circulating PMNs in the sinusoid. The positive rate of either ICAM-1 or VCAM-1 staining in livers with more than 40 minutes of total ischemic time (80%) was significantly higher than that in livers with less than 40 minutes of total ischemic time (0%; p < 0.05). The incidence of postoperative complications in the ICAM-1 positive staining group tended to be higher than that in the ICAM-1 negative group. Both soluble fractions of ICAM-1 and VCAM-1 in patients with cirrhotic liver disease were also significantly higher than those in patients with a normal liver. The soluble VCAM-1 level in patients with a chronic active hepatitic liver tended to be higher than that in those with a nonactive hepatitic liver. The preoperative level of soluble ICAM-1 correlated with that ofVCAM- 1, PMN elastase, albumin, aspartate aminotransferease (AST), and the indocyanine green dye retention test at 15 minutes (ICG R15), while the preoperative level of VCAM-1 correlated with albumin, the hepaplastin test, AST, and ICG R15. Both the serum soluble ICAM-1 and VCAM-1 levels after hepatectomy were significantly lower than those before hepatectomy. By contrast, the posthepatectomy level of PMN elastase was significantly higher than its prehepatectomy level. The difference between the postoperative and preoperative values of soluble ICAM-1 correlated with the postoperative AST level, postoperative alanine aminotransferase level, and total ischemic time. Adhesion molecules were expressed in the liver after hepatic resection, and such expression correlated with a total ischemic time during hepatectomy. In addition, judging from the soluble forms of such molecules, these adhesion molecules play an important role in hepatic resection.

Journal of the American College of Surgeons


Living donor liver transplantation using a left hepatic graft from a donor with a history of gastric cancer operation.


Characteristics of liver graft in living-donor adult liver transplantation: comparison between right-and left-lobe graft

Few studies have investigated the results of research focused on living-donor adult liver transplantation. Different characteristics between right- and left-lobe grafts have not yet been clarified in living-donor adult liver transplantation. Left-lobe graft remains an important option, even in adult recipients. A single liver transplantation center with a long history of hepatic resection. Forty-five donors received left-lobe (n = 39) and right-lobe (n = 6) grafts. The clinicopathological data for the donor, graft, and recipient were compared. All left-lobe grafts were extended grafts that included the middle hepatic vein, and 24 of the 39 left-lobe grafts included the left caudate lobe. No right-lobe graft included a middle hepatic vein. The postoperative aspartate aminotransferase and total bilirubin values of the donor in the right-lobe graft group were higher, and the postoperative hospital stay was longer than in the left-lobe graft group. Graft weight in the left-lobe graft group was lighter than in the right-lobe graft group (median weight, 450 vs 675 g). The median graft weight divided by the standard liver volume in the left-lobe graft group was 41% (range, 21%-66%), compared with 52% (range, 47%-75%) in the right-lobe graft group. We found no difference in terms of the incidence of postoperative complications between groups. No difference in induced complications of small-for-size grafts such as intractable ascites and persistent hyperbilirubinemia was evident between groups. The survival rate for grafts at 18 months was 75.0% in the right-lobe graft group compared with 85.6% in the left-lobe group. In the right-lobe graft group, we found a few cases in which a marked poor-perfusion area in the anterior segment caused liver dysfunction. Left-lobe grafts are a feasible option for living-donor adult liver transplantation, and in the case of right-lobe grafts, hepatic venous drainage is one of the most critical problems.


Variant WISPs as targets for gastrointestinal carcinomas.


MENTALITIES OF SURGEONS AND WORK STYLE REFORM : HOW CAN WE PROMOTE GENDER EQUALITY IN SURGERY?

外科医の意識と働き方改革 : 外科における男女共同参画はどうあるべきか?


Des-r-carboxy prothrombin and α-fetoprotein positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma


進行肝癌に対するGFP療法を基本とした集学的治療

進行肝癌に対するGFP療法を基本とした集学的治療


Idiopathic phlebosclerosis: an atypical presentation of ischemic colitis treated by laparoscopic colectomy.


Effects of preoperative steroid administration on surgical stress in hepatic resection

Preoperative administration of methylprednisolone sodium succinate can control surgical stress in patients undergoing hepatic resection. A prospective randomized trial. A university hospital department of surgery. Thirty-three patients who underwent hepatic resection were classified into 2 groups: a control group (n = 16) and a steroid group (n = 17) in which patients were intravenously administered 500 mg of methylprednisolone 2 hours before surgery. Perioperative levels of interleukin (IL)-6 and IL-10 (serum and peritoneal), immunosuppressive acidic protein, Candida antigen, and other laboratory and clinical variables were measured. Postoperative levels of serum and peritoneal IL-6 and levels of C-reactive protein were significantly lower in the steroid group than in controls. Furthermore, serum and peritoneal IL-10 levels were significantly higher in the steroid group. The total bilirubin value on postoperative day 1 was significantly lower in the steroid group than in controls. Postoperative immunosuppressive acidic protein levels were also significantly lower in the steroid group, as was the positive rate of serum Candida antigen. No differences were found in the incidence of postoperative complications. Preoperative steroid administration significantly elevated anti-inflammatory cytokine IL-10 levels, suppressed the levels of inflammatory cytokines IL-6 and C-reactive protein, and prevented postoperative elevation of total bilirubin values. Furthermore, postoperative elevation of immunosuppressive acidic protein levels and the positive rate of Candida antigen were suppressed, indicating that the immune response was maintained by preoperative steroid administration.


Highlights of topic "Intrahepatic cholangiocarcinoma: recent advancements in pathogenesis, diagnosis and treatment".

Journal of Hepato-Biliary-Pancreatic Sciences


A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism : Performing a hepatectomy after a laparoscopic splenectomy

Hepatectomy for cirrhotic patients with hypersplenism is a high-risk operative procedure. We report herein a new strategy for high-risk patients with hepatocellular carcinoma (HCC). Six cirrhotic patients with HCC and hypersplenism received a partial hepatectomy after first undergoing a laparoscopic splenectomy. We then compared the variables for these patients before splenectomy and before hepatectomy. The platelet count and the white blood cell count were found to be significantly elevated before hepatectomy. The ammonia value decreased significantly before hepatectomy. The albumin value tended to be elevated before hepatectomy. Furthermore, the Child's classification of all patients improved significantly before hepatectomy. However, other variables-such as the indocyanine green dye excretion test at 15 min and the bilirubin value-did not change after splenectomy. For hepatectomy patients who first underwent a laparoscopic splenectomy, operation time ranged from 265 to 440 min (average time, 361 min), and blood loss ranged from 500 to 2,200 ml (median volume, 1,300 ml). Four of six patients did not require any blood transfusion; furthermore, no patient needed a platelet-rich plasma transfusion. All but one patient, who suffered postoperatively from an intractable duodenal ulcer, had an uneventful postoperative course. Partial hepatectomy after an initial laparoscopic splenectomy is a new and effective choice of treatment for cirrhotic patients with HCC and hypersplenism.


The role of telomerase activety in hepatocellular carcinoma

The aim of this study was to clarify the role of telomerase activity in hepatocellular carcinoma (HCC). Specimens from both HCC and noncancerous liver were obtained from 39 patients with HCC using a 14-gauge biopsy needle immediately after laparotomy. Telomerase activity was determined using a telomeric repeat amplification protocol assay. The 3+ of telomerase activity in HCC was defined as a high telomerase group, and 2+ or less of HCC telomerase activity was defined as a low telomerase group. In noncancerous liver, 2+ or more of telomerase activity was defined as an increased telomerase group, and 1+ or less of telomerase activity was defined as a nonincreased telomerase group. The correlation between telomerase activity in HCC or noncancerous liver and clinicopathological factors, including prognosis, was investigated. Telomerase activities in HCCs were 0 in one patient, 1+ in two, 2+ in seven, and 3+ in 29 patients. The disease-free survival rate in the high telomerase group was significantly worse than that in the low telomerase group. The des-gamma-carboxy prothrombin level in a high telomerase group (median, 330 mAU/ml) was significantly higher than that in the low telomerase group (median, 150 mAU/ml). A multivariate analysis revealed that higher TNM stage, high telomerase activity in HCC, female gender, and high alpha-fetoprotein value were independent significant factors related to be early recurrence. The incidence of multicentric HCC occurrence in the increased telomerase group (53.3%) tended to be higher than that in the nonincreased telomerase group (27.3%). A high telomerase activity in HCC correlated with the potential of HCC to be more malignant, which was expressed as both a high level of des-gamma-carboxy prothrombin and an earlier recurrence after hepatectomy than that of HCC with a low telomerase activity.

The American Journal of Gastroenterology


免疫チェックポイント時代における漢方とがん免疫

免疫チェックポイント時代における漢方とがん免疫


Recent advances in estimating hepatic functional reserve in patients with chronic liver damage.

Preoperative estimation of liver functional reserve is important in liver surgery to prevent postoperative liver failure. Although the hepatic functional reserve of patients with chronic liver disease is generally evaluated by measuring indocyanine green dye retention at 15 min, no standard method of estimating regional liver function has been established to date. Several recently introduced imaging modalities, such as hepatobiliary scintigraphy and magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, may be used to evaluate liver function. Here, we review recent advances in estimating hepatic functional reserve, mainly by radiological modalities, in patients with chronic liver damage.