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Volume 47, Issue 1
Displaying 1-12 of 12 articles from this issue
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Notice for Members
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2014 Volume 47 Issue 1 Pages Announce1-Announce3
Published: 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESSDownload PDF (702K)
ORIGINAL ARTICLE
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Yushi Yamakawa, Etsuro Bando, Taiichi Kawamura, Yutaka Tanizawa, Masan ...Article type: ORIGINAL ARTICLE
2014 Volume 47 Issue 1 Pages 1-10
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: Selecting operative procedures for very elderly patients over 85 years of age with gastrointestinal cancer is quite difficult because radicality and tolerability of surgery and the patient’s social background must be considered. In order to establish the optimal treatment method for very elderly patients, we compared the short and long term outcomes in elderly patients (EP; 75 to 84 years old) and very elderly patients (VEP; 85 years old or more) who underwent gastrectomy at our institute. Methods: Subjects were 557 patients 75 years old or more who underwent curative gastrectomy between October 2002 and October 2011 (EP group: 515 patients, VEP group: 42 patients). We investigated several clinicopathologic and social factors and outcomes of these patients. Furthermore, we investigated the cause of death in the VEP group to determine the predictor of death from other causes. Results: Preoperative BMI and serum Alb levels were significantly lower in the VEP group. There were no significant differences in preoperative stage or postoperative complications between the two groups. A significantly higher incidence of limited surgery was noted in the VEP group (P=0.012). Overall survival was longer in the EP group than in the VEP group (P=0.034). However, there was no difference in disease-free-survival between the two groups (P=0.304). In univariate analysis, the significant predictors of death from other causes included BMI<20, lower level of preoperative Alb, solitude, and length of hospital stay of 15 days or more after surgery. Conclusions: Gastrectomy for the VEP group can be performed safely as well as EP group. In order to improve outcome in the VEP group, support with preoperative nutritional management and postoperative time at home is essential.View full abstractDownload PDF (1306K) Full view HTML
CASE REPORT
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Kei Tanaka, Masayuki Ohtsuka, Hiroaki Shimizu, Hiroyuki Yoshidome, Ats ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 11-17
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 61-year-old woman presenting with nausea was found by gastrointestinal endoscopy to have an ulcerative lesion in the second portion of the duodenum. Histological examination of a biopsy specimen revealed poorly differentiated adenocarcinoma. Computed tomography showed a hypovascular mass in the hepatic posterior section. She was recommended to receive chemotherapy following a diagnosis of duodenal cancer with synchronous liver metastasis. After receiving a second and third opinion elsewhere, the patient was finally referred to our hospital 4 months after the symptom onset. Based on a diagnosis of duodenal cancer and a hepatic mass that could not be definitively diagnosed, we conducted pancreaticoduodenectomy and resection of the right posterior hepatic section. Histologically, there was no evidence of viable cancer cells in the resected duodenum or liver, but granulomas with necrosis were observed. In the necrotic area, ghost cells were observed, which resembled cancer cells biopsied from the duodenum preoperatively and were immunohistochemically positive for cytokeratin. These findings suggested that the duodenal cancer and liver metastasis spontaneously disappeared without any treatment. Spontaneous regression of gastrointestinal cancer is rare, and the present report is the first to document a case of spontaneous regression of duodenal cancer.View full abstractDownload PDF (1844K) Full view HTML -
Toshimitsu Irei, Masahiro Tanemura, Masashi Inoue, Yuichi Hiyama, Hiro ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 18-25
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 60-year-old man presented to our emergency room with numbness on the left side of his body. Brain CT revealed bleeding in the right thalamus. Simultaneous abdominal CT revealed a large hepatocellular carcinoma (HCC) originating from segment 1 (S1) of the liver. Furthermore, blood examination showed erythrocytosis and a high serum erythropoietin (Epo) concentration. After conservatively treating the bleeding in the thalamus, we performed Spiegel lobectomy and extracted the hepatic tumor, which had originated from the S1 of the liver. The large resected tumor was diagnosed as HCC based on histological findings. Furthermore, in immunohistochemical staining, Epo was stained in the cytoplasm of the HCC, but no Epo was observed in the normal liver tissue. Normalization of postoperative erythrocytosis and serum Epo levels could be seen. Patients with HCC may display a variety of paraneoplastic syndromes, including erythrocytosis. Currently, there are only 23 reported cases of HCC with erythrocytosis in Japan, including this case. Out of these 23 cases, only 8, including our case, showed positive staining for the Epo molecule in the HCC cytoplasm. Recently, a few reports have suggested that HCC tumor development has a high correlation with the Epo/Epo receptor signal. Here, we report a case of a large HCC where erythrocytosis was proven to be caused by Epo production from the HCC by immunohistochemical staining.View full abstractDownload PDF (2082K) Full view HTML -
Takahiro Nishida, Kazuo Chijiiwa, Hideki Hidaka, Hidenobu Ishizaki, Sh ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 26-33
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLAn 84-year-old woman with sigmoid colon cancer underwent sigmoidectomy with lymph node dissection at the age of 72. Final diagnosis was well differentiated adenocarcinoma, pSE, ly2, v1, pN1 (3/19), sH0, sP0, sM0, fStage IIIa. Computed tomography (CT) scan 19 months later detected a liver metastasis in S6, and S6 subsegmentectomy was performed. Although there was no cancer recurrence after hepatectomy for more than 5 years, follow-up was continued through laboratory examinations including CEA. Just over 11 years after sigmoidectomy, the serum CEA level was markedly elevated, and abdominal CT scan showed a 7-cm liver tumor with some calcifications and peripheral bile duct dilatation in the lateral segment. We considered this tumor to be an intrahepatic cholangiocarcinoma with hepatolithiasis, not a metastatic liver tumor. Lateral segmentectomy was performed, and pathological examinations showed well- to moderately-differentiated adenocarcinoma with necrosis and hyalinization. Furthermore, immunohistochemical examinations revealed CK7-/CK20+, as in previous findings, and we diagnosed this as liver metastasis from sigmoid colon cancer. We report a rare case of liver metastasis that developed 19 months and 135 months after curative resection of the primary sigmoid colon cancer.View full abstractDownload PDF (1400K) Full view HTML -
Ryota Kiuchi, Teiichi Sugiura, Yukiyasu Okamura, Takashi Mizuno, Hidey ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 34-41
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 75-year-old man was referred to our hospital with a diagnosis of left hepatic duct carcinoma. The abdominal CT scan revealed thickened bile duct wall of the left and common hepatic ducts and dilated intrahepatic bile ducts of the left liver. Endoscopic retrograde cholangiography showed a filling defect at the hepatic duct confluence. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. Macroscopic examination showed a papillary tumor originating from the left hepatic duct. Histologically, the tumor consisted of a mixture of adenocarcinoma with a squamous cell carcinoma component and spindle-shaped sarcomatous cells with osteogenesis. Immunohistochemically, the sarcomatous element was negative for AE1/AE3 and positive for vimentin, resulting in a diagnosis of in true carcinosarcoma.View full abstractDownload PDF (2212K) Full view HTML -
Hirofumi Terakawa, Isamu Makino, Hirohisa Kitagawa, Hisatoshi Nakagawa ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 42-48
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 55-year-old woman, presented with jaundice, and a medical examination revealed a cystic tumor in the head of pancreas. She had iatrogenic Cushing’s syndrome, because she had taken an antihistamine agent, containing a corticosteroid, for more than 15 years. Contrast enhanced CT showed the multilocular cystic tumor of the head of pancreas. The bile duct, superior mesenteric vein and portal vein were compressed by the tumor, and significant collateral veins were developed in the hepatoduodenal ligament. We diagnosed the tumor as a macrocystic type serous cystic neoplasm. We performed fenestration of the cystic wall and ethanol ablation into the lumen of the residual wall, considering the high surgical risk of the patient. No recurrence of the cystic tumor or obstructive jaundice has been detected 12 months after the operation. Thus, fenestration of the tumor may be an option for treatment of a patient with large and symptomatic macrocystic type serous cystic neoplasm at high surgical risk.View full abstractDownload PDF (1649K) Full view HTML -
A Case of Laparoscopic Distal Pancreatectomy for Metachronous Pancreatic Metastasis from Lung CancerYukinari Tokoro, Tsukasa Takayashiki, Shintaro Maeda, Hideyuki Yoshito ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 49-56
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 49-year-old man underwent right upper lobectomy of the lung with chest wall resection for invasive lung cancer followed by neoadjuvant chemoradiotherapy. One year after primary operation, a solitary pancreas tail tumor without other organ invasion was found by follow-up examination. Endoscopic ultrasonography guided fine-needle aspiration biopsy of the specimen suggested metachronous pancreatic metastasis from lung cancer. We performed laparoscopic distal pancreatectomy for pancreatic tumor because the primary lung cancer responded completely to curative resection and chemoradiotherapy. The pancreatic tumor was diagnosed pathologically as poorly differentiated adenocarcinoma, which was identical to the primary lung cancer. The patient was discharged on postoperative day 10 without complications, and he is alive without recurrence 1 year after the second operation. Pancreatic metastasis generally has a poor outcome, but reports on selected cases state that surgical resection improved patient outcome. In addition, laparoscopic surgery may contribute in the preventing of postoperative respiratory complications as it is a minimally invasive surgical method for pancreatic metastasis.View full abstractDownload PDF (2002K) Full view HTML -
Hiroyuki Negishi, Jo Sakurai, Taro Hamabe, Reina Kyoi, Keiichiro Onoda ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 57-65
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 70-year-old woman with Churg-Strauss syndrome had been treated by prednisolone and cyclophosphamide for a month. She began to complain of abdominal pain. She was given steroid-pulse treatment, because her physician thought that the abdominal pain was due to worsening Churg-Strauss syndrome. A colonoscopic examination was performed. On the day following the examination, she complained of severe abdominal pain which spread to the whole abdomen. An abdominal CT scan showed extra-intestinal free air. Emergency operation was performed with a diagnosis of intestinal perforation. The operation revealed four ulcerations in the ileum, about 120 cm to 210 cm distally from the ligament of Treitz. We performed partial resection of about 100 cm of the ileum, and also performed enterostomy. The pathological study disclosed that the perforation was caused by cytomegalovirus enteritis. In the treatment of intestinal perforation in the immunosuppressive patient, we suspect the presence of cytomegalovirus enteritis therefore early administration of antiviral agent is desirable.View full abstractDownload PDF (1430K) Full view HTML -
Takashi Inoue, Fumikazu Koyama, Tadashi Nakagawa , Shinji Nakamura, Ta ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 66-72
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of resected anal fistula cancer in which abdominal wall reconstruction using the sliding door technique was useful in abdominal wall dehiscence after buttock and perineum reconstruction using a rectus abdominis musculocutaneous flap. A 62-year-old man underwent surgery for anal fistula at the ages of 10 and 13. However, the anal fistula recurred after about 50 years. He was admitted to an outside facility because of swelling and pain around the anus. Anal fistula cancer was diagnosed, and he was referred to our hospital for further treatment. The tumor had directly invaded the buttock skin, right gluteus maximus and fourth sacrum, and he underwent an abdominoperineal resection accompanied with buttock, perineal and sacral resection. For buttock and perineal reconstruction we used a rectus abdominis musculocutaneous flap. However, abdominal wall dehiscence was detected 7 days after surgery, therefore abdominal wall reconstruction was performed using the sliding door technique. There has been no recurrence of abdominal wall dehiscence, infection of the wound or pelvic dead space after the emergency surgery. He is alive with no cancer recurrence or ventral hernia 5 years after surgery.View full abstractDownload PDF (1373K) Full view HTML -
Naohiko Nakamura, Jyun Nakagawa, Takehumi Yazawa, JyuJynicirou Kawamur ...Article type: CASE REPORT
2014 Volume 47 Issue 1 Pages 73-79
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 66-year-old woman underwent hepatopancreatoduodenectomy for advanced gallbladder carcinoma. The postoperative course was complicated by portal vein thrombosis and pancreatic fistula. The portal vein thrombosis was managed conservatively while relaparotomy was done for drainage of the pancreatic fistula. In spite of these measures for the complications, the hepatic insufficiency gradually deteriorated. On postoperative day 48, she had sudden bleeding from the drainage tube placed near the pancreatic stump. Abdominal enhanced computed tomographic angiography revealed marked stenosis of the hepatic artery and a false aneurysm arising at the right hepatic artery stump. Angiography was carried out immediately and a covered stent was implanted at the site of extravasation to exclude the pseudoaneurysm and maintain hepatic arterial blood flow. Consequently hepatic insufficiency was relieved with improved blood flow, by dilation of the stenotic hepatic artery. Hepatic arterial pseudoaneurysm formation can be a fatal complication in hepatobiliary surgery. Transcatheter arterial embolization (TAE) has been applied for this situation, however, TAE is associated with a high risk of liver abscess or liver failure caused by interruption of hepatic arterial flow. Thus, for preserving hepatic arterial flow, the utilization of a covered stent is considered to be a better treatment of choice than TAE. Hepatic artery stenosis caused by lymphadenectomy or other operative procedures is also a serious complication which sometimes may result in liver failure. It seems, in our experience, that endovascular covered stent grafting is an effective option for the treatment of not only pseudoaneurysm, but also liver dysfunction due to hepatic artery stenosis.View full abstractDownload PDF (1141K) Full view HTML
SPECIAL CONTRIBUTION
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Takako Kojima, Edward BarrogaArticle type: SPECIAL CONTRIBUTION
2014 Volume 47 Issue 1 Pages 80-82
Published: January 01, 2014
Released on J-STAGE: January 21, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (522K) Full view HTML
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