RESUMEN
BACKGROUND: Robotic three-dimensional magnified visual effects and field of view stabilization have enabled precise surgical operations. Intracorporeal anastomosis in right-sided colorectal cancer surgery is expected to shorten operation times, avoid paralytic ileus, and shorten wound lengths; however, there are few reports of intracorporeal anvil fixation for intestinal anastomosis in left-sided colorectal cancer surgery. Herein, we introduce a simple, novel procedure for using robotic purse-string suture (RPSS) in intracorporeal anastomosis with the double-stapling technique in rectal and sigmoid cancer surgery and report short-term outcomes. METHODS: From September 2022 to April 2024, 105 consecutive patients underwent robotic surgery with double-stapling technique anastomosis for rectal or sigmoid colon cancer at our institution. Their data were retrospectively analyzed. Intracorporeal anastomosis with the double-stapling technique using RPSS was performed in 26 patients (the RPSS group), while the double-stapling technique anastomosis with extracorporeal anvil fixation was performed in 79 patients (the EC group). A 1:1 propensity score-matched analysis was performed (matching criteria: sex, age, body mass index (BMI), tumor location and tumor size) using a caliper 0.3. In the RPSS group, after tumor-specific or total mesorectal excision, specimens were extracted from the umbilical wound with simultaneous anvil placement in the body cavity. The oral colonic stump was robotically excised and robotically circumferentially stitched with 3-0 Prolene in all layers. After anvil insertion into the stump, the bowel wall of the colon was completely sewn onto the central rod of the anvil. Reconstructions were anastomosed using the double-stapling technique. RESULTS: The matched cohort contained 23 patients in each group. The RPSS group had significantly less bleeding than the EC group (p = 0.038). Super-low anterior resection (SLAR) in the RPSS group had shorter total operative times than those in the EC group (p = 0.045). The RPSS group experienced no perioperative complications greater than Clavien-Dindo grade III or any anastomosis-related complications. CONCLUSIONS: The RPSS technique can be performed safely without any anastomosis-related complications and reduces the total operative times in SLAR and blood loss through total robotic surgery. This may be a useful modality for robotic colorectal surgery.
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Anastomosis Quirúrgica , Puntaje de Propensión , Procedimientos Quirúrgicos Robotizados , Técnicas de Sutura , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Anastomosis Quirúrgica/métodos , Femenino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Técnicas de Sutura/instrumentación , Grapado Quirúrgico/métodos , Neoplasias del Recto/cirugía , Neoplasias del Colon Sigmoide/cirugía , Colon Sigmoide/cirugíaRESUMEN
INTRODUCTION: Previous studies have not evaluated the surgical difficulty of minimally invasive distal pancreatectomy for pancreatic cancer in elderly patients. Therefore, we aimed to investigate the effect of elderly age on the perioperative outcomes of minimally invasive distal pancreatectomy, focusing on surgical difficulty. METHODS: This single-center retrospective study included patients who underwent minimally invasive distal pancreatectomy for pancreatic cancer at Kansai Rosai Hospital between September 2012 and December 2023. Perioperative outcomes were investigated between the elderly (>75 years) and non-elderly (≤75 years) groups. RESULTS: Fifty-six patients were included: 26 and 30 in the elderly and non-elderly groups, respectively. The median operative time was significantly shorter in the elderly group than in the non-elderly group (324 vs. 414 min, p = .022), but other surgical outcomes were not significantly different including oncological factors. The median difficulty score was similar between the elderly and non-elderly groups (6 vs. 7, respectively; p = .699). The incidences of postoperative complications and pancreatic fistulas were not significantly different in the elderly and non-elderly groups (23% vs. 43%, p = .159, and 19% vs. 36%, p = .236, respectively), even though analyzed in subgroups with low-to-intermediate or high difficulty score. CONCLUSIONS: The safety and feasibility of minimally invasive distal pancreatectomy for pancreatic cancer were not significantly different between elderly and non-elderly patients, even when surgical difficulty was considered. This surgical procedure can be safe and feasible for elderly patients.
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Estudios de Factibilidad , Pancreatectomía , Neoplasias Pancreáticas , Humanos , Pancreatectomía/métodos , Estudios Retrospectivos , Neoplasias Pancreáticas/cirugía , Anciano , Femenino , Masculino , Persona de Mediana Edad , Anciano de 80 o más Años , Factores de Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Laparoscopía/métodosRESUMEN
A 91-year-old man had a history of cholecystectomy and choledochostomy for cholecystolithiasis and choledocholithiasis. Eleven years earlier, intrahepatic stones were found in the posterior bile duct, and he did not wish to undergo treatment. Over time, worsening of the intrahepatic stones and dilation of the intrahepatic bile duct were observed. At 91 years old, enhanced abdominal CT revealed wall thickening of the hilar bile duct, and MRCP showed stenosis of the hilar bile duct. Endoscopic retrograde cholangiography showed no contrast in the right intrahepatic bile duct and marked dilation of the left intrahepatic bile duct. Brush cytology confirmed adenocarcinoma, leading to a diagnosis of hilar cholangiocarcinoma. He underwent open right and caudal lobectomy with biliary reconstruction. Histopathological examination revealed a hilar cholangiocarcinoma, T3N1M0, Stage â ¢c, mainly located at the confluence of the right and left hepatic ducts. This case suggests a potential association between hepatolithiasis and hilar cholangiocarcinoma, emphasizing the importance of regular imaging examinations for timely surgical resection. Early intervention, including liver resection, is recommended for the management of hepatolithiasis.
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Neoplasias de los Conductos Biliares , Colangiocarcinoma , Humanos , Masculino , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Anciano de 80 o más Años , Colangiocarcinoma/cirugía , Factores de Tiempo , Litiasis/cirugía , Conductos Biliares Intrahepáticos/cirugía , Conductos Biliares Intrahepáticos/patología , Hepatectomía , Estudios de Seguimiento , Hepatopatías/cirugía , Tumor de Klatskin/cirugía , Tumor de Klatskin/patologíaRESUMEN
A 73-year-old man underwent upper gastrointestinal endoscopy during a medical check-up that revealed a Type 2 lesion in the anterior wall of the gastric body. The biopsy confirmed tub2. A contrast-enhanced CT scan revealed focal wall thickening and lymphadenopathy in the gastric body. The patient was diagnosed with gastric cancer(M, ante, Type 2, T4aN1M0, Stage â ¢A). Laparotomy total gastrectomy D2 dissection and Roux-en-Y reconstruction were performed. Pathological results were tub1, int, INF b, ly0, v1, pT4aN0M0, pStage â ¡B. S-1(100 mg/day)was started as adjuvant chemotherapy but discontinued after 3 courses due to anorexia(Grade 2). Multiple pulmonary metastases(both lungs, 5)were confirmed by CT examination 9 months after the operation. A diagnosis of gastric cancer recurrence was made, and CapeOX plus nivolumab was started as first-line therapy. After 2 courses, lung metastases tended to shrink. The lesion developed a complete response(CR)after 3 months. After that, CapeOX plus nivolumab was continued, but peripheral neuropathy(Grade 2)was observed in the 15th course. With continued capecitabine monotherapy and nivolumab(impaired liver function [Grade 3]for irAE), despite the maintenance of CR, hepatic function increased repeatedly(Grade 3)and led to the discontinuation of chemotherapy upon patient's request. Currently, CR has been maintained for 5 years and 6 months after recurrence.
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Neoplasias Pulmonares , Neoplasias Gástricas , Masculino , Humanos , Anciano , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Nivolumab , Recurrencia Local de Neoplasia , Quimioterapia Adyuvante , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Respuesta Patológica CompletaRESUMEN
We report a case in which a patient with advanced gastric cancer with liver metastasis and bulky N showed marked tumor shrinkage with chemotherapy, and underwent conversion surgery. A 77-year-old male. Patient was referred to our department because of advanced gastric cancer. Upper gastrointestinal endoscopy revealed type 2 advanced cancer in the posterior wall of the gastric antrum. Abdominal CT showed thickening of the gastric wall in the same region and bulky lymph node enlargement and para-aortic lymphadenopathy behind the stomach. Staging laparoscopy showed the primary tumor and bulky lymph nodes forming a single mass, invading the pancreas, jejunum, and mesentery, and a solitary mass in the hepatic S3. Biopsy pathology revealed adenocarcinoma. We diagnosed the advanced gastric cancer cT4b(pancreas, jejunum), N2M1 (LYM, HEP), P0CY0, Stage â £B. After 2 courses of systemic chemotherapy FOLFOX/nivolumab, total gastrectomy, D2 node dissection, splenectomy pancreas tail resection, cholecystectomy, hepatic resection, partial transverse colon resection, partial jejunum resection, Roux-en-Y reconstruction. R0 resection was performed. The operative time was 620 minutes and blood loss was 1,025 mL. Pathologically, the patient was diagnosed with hepatoid adenocarcinoma, ypT4bN1M1(LYM, HEP), ypStage â £. The pathological efficacy evaluation was Grade 1a in the primary tumor. The patient has been recurrence-free for 9 months since the initial diagnosis.
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Adenocarcinoma , Laparoscopía , Neoplasias Gástricas , Masculino , Humanos , Anciano , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Metástasis Linfática , Adenocarcinoma/cirugía , Adenosina TrifosfatoRESUMEN
INTRODUCTION: Cholangiolocellular carcinoma (CoCC) resembles cholangiocellular carcinoma (CCC) and presents a variety of imaging findings; thus, preoperative diagnosis is often difficult. METHODS: We retrospectively studied patients who were diagnosed with CoCC at the Kansai Rosai Hospital from 2006 to 2021 and treated by laparoscopic liver resection (LLR) or open liver resection (OLR). RESULT: Among 918 liver resections, 15 patients were diagnosed with CoCC: 11 underwent LLR and 4 OLR. For LLR and OLR, respectively, patient age was 69.9 ± 6.8 and 72.8 ± 10.6, sex was M/F: 10/1 and 2/2, Child-Pugh was A/B/C: 10/1/0 and 4/0/0, liver damage was A/B/C: 8/3/0 and 4/0/0, preoperative diagnosis was CoCC/CCC/HCC: 1/2/8 and 2/2/0, pathological stage of Union for International Cancer Control (UICC) was IA/IB/II/IIIA/IIIB/IV: 8/0/2/1/0/0 and 0/0/3/0/1/0 (p = .0312), and extent of liver resection was Hr0/HrS/Hr1/Hr2/: 3/0/5/3 and 1/1/0/2. In LLR and OLR, respectively, operation time was 417.5 ± 191.0 and 407.5 ± 187.9 min, blood loss was 123.3 ± 217.4 and 1385.0 ± 1038.7 mL, and postoperative hospital stay was 12.2 ± 13.7 and 15.0 ± 6.6 days. For stages I and II/III, respectively, the 5-year disease-free survival rates were 100.0% and 34.3%, and the 5-year overall survival rates were 100.0% and 55.6%. For stage II/III LLR and OLR, respectively, the 3-year disease-free survival rates were 33.3% and 37.5% (p = .8418), and the 5-year overall survival rates were 66.7% and 50.0% (p = .8084). CONCLUSION: Although further studies are still needed to confirm, minimally invasive liver resection without lymph node dissection is one of a safe and effective approach to the management of CoCC.
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Neoplasias de los Conductos Biliares , Carcinoma Hepatocelular , Colangiocarcinoma , Laparoscopía , Levamisol/análogos & derivados , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Estudios Retrospectivos , Hepatectomía/métodos , Laparoscopía/métodos , Colangiocarcinoma/cirugía , Tiempo de Internación , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos , Complicaciones Posoperatorias/cirugíaRESUMEN
A persistent descending mesocolon is defined as a congenital fixation anomaly caused by the defective membrane fusion of the descending colon and the lateral abdominal wall. Anatomically, in persistent descending mesocolon, the left colonic artery is often shortened, and joins the marginal artery soon after its bifurcation from the inferior mesenteric artery, while the colonic mesentery often adheres firmly to the mesentery of the small intestine. As a result of these characteristics, anatomical knowledge of the persistent descending mesocolon and preservation of bowel blood flow are important during surgery for left-sided colorectal cancer to avoid adverse events. Moreover, indocyanine green based blood flow assessment is useful for the detailed evaluation of bowel ischemia at the anastomotic site. Here we report the usefulness of blood flow evaluation using indocyanine green fluorescence in laparoscopic or robot-assisted surgery for three patients with colorectal cancer and persistent descending mesocolons.
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Neoplasias del Colon , Neoplasias Colorrectales , Laparoscopía , Mesocolon , Procedimientos Quirúrgicos Robotizados , Humanos , Mesocolon/cirugía , Mesocolon/anomalías , Verde de Indocianina , Fluorescencia , Laparoscopía/efectos adversos , Neoplasias Colorrectales/cirugía , Colectomía , Neoplasias del Colon/cirugíaRESUMEN
Malignant tumor occurring in the inguinal region are relatively infrequent, and metastatic tumor is extremely rare. We report a case of inguinal hernial sac metastasis of cecal cancer resected with TAPP approach. The case is a 80's man. One year and 6 months after cecal cancer surgery, contrast-enhanced computer tomography(CT)examination revealed a solitary tumor in the right inguinal canal. We diagnosed inguinal hernia sac metastasis of cecal cancer and performed surgery. The mass in the hernia sac was resected with the TAPP approach. Histopathological findings were consistent with peritoneal metastasis directly to the inguinal hernia sac. The patient has been alive without 2 years after metastasectomy. It is necessary to treat patients with a history of malignant disease with keeping the possibility of inguinal hernia sac metastasis in mind.
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Neoplasias del Ciego , Hernia Inguinal , Masculino , Humanos , Hernia Inguinal/cirugía , Hernia Inguinal/diagnóstico , Hernia Inguinal/patología , Peritoneo/patología , Peritoneo/cirugía , Neoplasias del Ciego/cirugía , Herniorrafia , Ciego/cirugíaRESUMEN
An umbilical metastasis from an internal malignancy is called Sister Mary Joseph's nodule(SMJN)and has a poor prognosis. Herein, we report a case of umbilical metastasis of cervical cancer. A woman in her eighties underwent radiation therapy for cervical cancer(cT3bN0M0, cStage â ¢B). Primary tumor shrank after treatment, suggesting that radiation therapy induced complete response. Two years and 9 months after treatment, the patient presented with umbilical pain. A CT scan showed an umbilical mass near the umbilical hernia. PET-CT demonstrated high accumulation of FDG at the mass, which led to suspicion of umbilical metastasis(SMJN). Although she underwent radical surgery, she died from cancer 8 months after surgery.
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Nódulo de la Hermana María José , Neoplasias del Cuello Uterino , Humanos , Femenino , Nódulo de la Hermana María José/secundario , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Ombligo/patología , Tomografía Computarizada por Rayos XRESUMEN
A 66-year-old woman was referred to the gastroenterology division of our hospital due to elevation of serum CEA level. Contrast-enhanced CT showed a hypovascular tumor at the body of pancreas. She was diagnosed with pancreatic cancer by EUS-FNA. By laparotomy, we found white nodules on mesentery and abdominal wall, which were diagnosed as peritoneal metastasis. After systemic chemotherapy with 9 courses of gemcitabine(GEM)plus nab-paclitaxel(PTX)and 30 courses of mFOLFIRINOX, the tumor had shrunk and serum CA19-9 level were remarkably decreased. Distal pancreatectomy was performed as conversion surgery. Pathological analysis revealed no remnant cancer cells in the primary tumor or the lymph nodes, confirming a pCR. S-1 was started as adjuvant chemotherapy, and she remains alive without recurrence 8 months after surgery.
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Neoplasias Pancreáticas , Neoplasias Peritoneales , Femenino , Humanos , Anciano , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/secundario , Gemcitabina , Pancreatectomía , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias PancreáticasRESUMEN
INTRODUCTION: There are few reports of surgery which preserve the function of pancreas for benign or low malignant tumors. While we have introduced laparoscopic pancreaticoduodenectomy (LPD), we have also performed laparoscopic pancreas-sparing duodenectomy (LPSD). In the present study, we investigated surgical techniques and results of LPSD. MATERIALS AND METHODS: Between October 2019 and January 2022, 3 patients were underwent LPSD. The procedure was performed after obtaining approval from the Ethics Review Committee of our hospital. RESULTS: Three patients conducted LPSD were all males with a median age of 74 years, and diagnoses were adenomas of duodenum in 2 cases and gastrointestinal stromal tumor of duodenum in 1 case. The median blood loss was small amount. The median operative time was 430 minutes, and the median postoperative hospital stay was 13 days. One of the cases was performed with conversion to HALS. In LPSD, an intraoperative ultrasonography and an intraoperative radiographic contrast study were performed to confirm that the ampulla of Vater was preserved. There were no postoperative complications. CONCLUSION: We experienced cases performed LPSD in our hospital. We need further research for feasibility and safety of the procedure.
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Laparoscopía , Neoplasias Pancreáticas , Masculino , Humanos , Anciano , Páncreas/cirugía , Pancreaticoduodenectomía , Duodeno/cirugía , Pancreatectomía , Estudios Retrospectivos , Neoplasias Pancreáticas/cirugíaRESUMEN
A 41-year-old male, with a history of neurofibromatosis type 1(NF1)was referred for further evaluation of positive fecal occult blood test. Abdominal contrast-enhanced CT incidentally showed a mass lesion with early darkening in the small intestine. It was suspected to be a small intestinal arteriovenous malformation, and surgery was performed. The tumor in the small intestine was resected under laparoscopic assistance. The histopathological diagnosis was gastrointestinal stromal tumors associated with NF1, which are usually located in the small intestine and relatively favorable prognosis.
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Tumores del Estroma Gastrointestinal , Neoplasias Intestinales , Laparoscopía , Neurofibromatosis 1 , Masculino , Humanos , Adulto , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/cirugía , Neurofibromatosis 1/patología , Tumores del Estroma Gastrointestinal/diagnóstico , Neoplasias Intestinales/patología , Intestino Delgado/cirugía , Intestino Delgado/patologíaRESUMEN
INTRODUCTION: Laparoscopic pancreaticoduodenectomy(LPD)has been covered by insurance since 2016 in Japan. Advance LPD and robotic pancreaticoduodenectomy(RPD)has been also covered by insurance since 2020 in Japan. The aim of this study was to analyze the perioperative results and outcomes of RPD and LPD for the elderly patients and to compare to the non-elderly patients. PATIENTS AND METHOD: Between July 2020 and April 2023, 67 patients underwent RPD and between May 2012 and February 2021, 63 patients underwent LPD at Kansai Rosai Hospital. Sixty-seven RPD and 62 LPD patients without extended resection were divided into 2 groups those who were over 75 years old(R/LPD E)(n=55)and under 74 years old(R/LPD non-E)(n=74). Control patients who received open pancreaticoduodenectomy(OPD)without extended resection between April 2010 and April 2023 were also divided into 2 groups those who were over 75 years old(OPD E)(n =60)and under 74 years old(OPD non-E)(n=78). The patient age was 79.0 and 60.5 years, the male to female ratio was 35/20 and 45/29, disease ratio(invasive ductal carcinoma or not)was 7/48 and 9/65 in R/LPD E and R/LPD non-E groups, respectively. The patient age was 79.0 and 79.5 years, the male to female ratio was 35/20 and 31/29, disease ratio (invasive ductal carcinoma or not)was 7/48 and 30/30(p<0.0001)in R/LPD E and OPD E groups, respectively. This study was approved by the Human Ethics Review Committee of Kansai Rosai Hospital(Certificate Number: 2001019). RESULTS: The average operation time was 644.6 and 675.2 minutes, an estimated blood loss was 220.8 and 134.4 g, postoperative pancreatic fistula(ISGPS 2016, [-]/BL/Grade B/C)was 24/18/13/0 and 28/25/21/0, delayed gastric emptying(ISGPS 2007, [-]/Grade A/B/C)was 48/0/4/3 and 61/2/6/5 and postoperative hospital stay was 27.9 and 25.9 and in R/LPD E and R/LPD non-E groups, respectively. No significant differences were noted between the groups, However, postoperative complication over â ¢a Clavien-Dindo classification was 8(15.7%)and 3(4.4%)cases(p=0.0319)in R/LPD E and R/ LPD non-E groups. The average operation time was 644.6 and 492.1 minutes(p<0.0001), an estimated blood loss was 220.8 and 534.8 g(p=0.0004), postoperative pancreatic fistula(ISGPS 2016, [-]/BL/Grade B/C)was 24/18/13/0 and 27/8/24/1(p=0.0442), postoperative hospital stay was 27.9 and 42.0(p=0.0490)in R/LPD E and OPD E groups, respectively. CONCLUSION: The R/LPD was undergone in safety, even for the over 75 years old patients.
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Carcinoma Ductal , Laparoscopía , Neoplasias Pancreáticas , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Pancreaticoduodenectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/complicaciones , Fístula Pancreática/etiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Retrospectivos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tiempo de Internación , Carcinoma Ductal/complicacionesRESUMEN
Para-aortic lymphadenectomy in gastric cancer surgery is a highly difficult surgical technique. In our hospital, we introduced robotic surgery in anticipation of the minimal invasiveness and advanced operability. We use a tunneling approach that progresses from the Treitz ligament to the peri-aorta. The transverse mesocolon is expanded with a tissue grasping clip, and the retroperitoneum is incised from the side of the Treitz ligament to approach the abdominal aorta and inferior vena cava. The No.16b1 and No.16a2 latero lymph nodes can be dissected with a good visual field. When it is judged that the visual field development of the No.16a2 inter-lymph nodes is poor, Kocher's operation is added. Since 2016, 18 patients have undergone para-aortic lymphadenectomy, 3 of whom underwent robotic surgery in our hospital. R0 resection was performed in all the cases, and 22.5 lymph nodes were dissected as No.16 lymph nodes(20.0 in all the cases included laparotomy). Although only a small number of patients were examined, robot-assisted para-aortic lymphadenectomy was considered safe.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Procedimientos Quirúrgicos Robotizados/métodos , Laparoscopía/métodosRESUMEN
Tumor mutation burden(TMB)-High is known to potentially elicit a favorable response to immune checkpoint inhibitors. In this report, we present a case of recurrent hilar cholangiocarcinoma with TMB-High, in which we performed comprehensive treatment including immune checkpoint inhibitor pembrolizumab. The patient was a 58-year-old male diagnosed with hilar cholangiocarcinoma who underwent extended right hepatectomy, caudate lobe resection, bile duct excision, and bile duct reconstruction. Postoperatively, peritoneal seeding recurrence and liver metastasis were observed, indicating TMB-High. Therefore, pembrolizumab therapy was administered. The tumor marker CA19-9 significantly decreased, and the peritoneal seeding and liver metastatic lesions disappeared on imaging. In this case, we experienced the use of pembrolizumab monotherapy for TMB-High recurrent bile duct cancer with early postoperative peritoneal seeding recurrence. Further accumulation of cases is needed, but pembrolizumab monotherapy holds promise as a treatment option for TMB-High bile duct cancer at the hepatic hilum.
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Anticuerpos Monoclonales Humanizados , Neoplasias de los Conductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Masculino , Humanos , Persona de Mediana Edad , Tumor de Klatskin/cirugía , Conductos Biliares Intrahepáticos/patología , Recurrencia Local de Neoplasia/cirugía , Colangiocarcinoma/tratamiento farmacológico , Colangiocarcinoma/cirugía , Colangiocarcinoma/patología , Hepatectomía/métodos , Neoplasias de los Conductos Biliares/tratamiento farmacológico , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/patologíaRESUMEN
BACKGROUND: In recent years, the number of colorectal cancer in Europe and the U. S. has been decreasing, but there are increasing reports on the trend of early-onset colorectal cancer(EOCRC), which is a rare population with no established knowledge on its characteristics. SUBJECTS AND METHODS: Of 3,501 colorectal cancer cases treated at our hospital between April 2011 and December 2021, those aged 39 years and younger were included. RESULTS: There were 32 EOCRC cases, 11 males/21 females. The histological type was tub in 31 cases and por in 1 case. Postoperative adjuvant chemotherapy was administered in 14 patients, and 12 completed the scheduled course. Twenty nine patients underwent R0 resection, of which 6 patients had recurrence and 5 patients died of primary disease. In summary, although EOCRC patients were in good general condition and had a high completion rate of adjuvant chemotherapy, the relapse rate was high, suggesting the need for aggressive adjuvant chemotherapy and careful postoperative surveillance.
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Neoplasias Colorrectales , Masculino , Femenino , Humanos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/epidemiología , Recurrencia Local de Neoplasia/tratamiento farmacológico , Quimioterapia Adyuvante , Hospitales , Europa (Continente)RESUMEN
INTRODUCTION: Laparoscopic liver resection(LLR)has been reported as a safe, minimally invasive, and effective approach to the management of liver tumor. The aim of this study was to analyze the perioperative results and outcomes of LLR for the elderly hepatocellular carcinoma(HCC)patients and to compare to the non-elderly HCC patients. PATIENTS AND METHOD: Between May 2010 and November 2021, 725 patients(HCC 407, CRC Mets 171, others 147)patients underwent LLR at Kansai Rosai Hospital. 407 patients who underwent LLR for HCC were divided into 2 groups those who were over 80 years old(n=67)and under 79 years old(n=340). The patient age was 82.7 and 68.8 years, while the male to female ratio was 41/26 and 238/102 in the elderly and non-elderly groups, respectively. According to the liver cancer study group of Japan, the pathological Stage 0/â /â ¡/â ¢/â £ was 23/34/8/2 and 117/146/57/20 patients(p=0.1086)in the elderly and non- elderly groups, respectively. This study was approved by the Human Ethics Review Committee of Kansai Rosai Hospital(Certificate Number: 2101006). RESULTS: The elderly group had an average operation time of 316.1 minutes, an estimated blood loss of 277.3 g, and a hospital stay of 14.3 days. The non-elderly group had an average operation time of 347.2 minutes, an estimated blood loss of 233.7 g, and a hospital stay of 12.9 days. No significant differences were noted between the elderly patients and the non-elderly patients with respect to the rate of procedure, operation time, intraoperative blood loss, hospital stay, morbidity, and postoperative laboratory data. CONCLUSION: The LLR was undergone in safety, even for the over 80 years old patients. The results of LLR for HCC over 80 years old were comparable both in short-term results with under 79 years old group. It was considered that the minimally invasiveness of LLR allows comparable surgical treatment for the elderly with non-eldery.
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Carcinoma Hepatocelular , Laparoscopía , Neoplasias Hepáticas , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Anciano , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Estudios Retrospectivos , Complicaciones Posoperatorias , Hepatectomía/métodos , Laparoscopía/métodos , Tiempo de InternaciónRESUMEN
The laparoscopic surgery is less invasive and better cosmetic. The laparoscopic liver resection(LLR)has been accepted for the insurance in April 2010, and increasingly performed in many hospitals, and also expected in metastasis of colorectal cancer. We retrospectively examined the results of LLR for liver metastasis of colorectal cancer. From June 2010 to July 2021, 174 cases of LLR for liver metastasis of colorectal cancer were performed in our hospital. The operation time was 384.5 minutes, the blood loss was small amount, and the postoperative hospital stay was 8 days. The complications were post-bleeding in 1 case, bile leakage in 7 cases, SSI in 16 cases, and no surgery-related deaths were observed. The 3-year disease-free survival rate was 22.8%, and the 5-year overall survival rate was 53.3%. In the comparison between single LLR and multiple LLR, the operation time and the blood loss increased, but there was no significant difference in the length of postoperative hospital stay. In initial LLR and repeat LLR, there were no significant differences in the operation time, blood loss, and postoperative hospital stay. In the primary lesion and simultaneous LLR and heterochronous LLR, the operation time and blood loss were not significantly different, but postoperative intra-abdominal abscess and SSI were more happened, and the postoperative hospital stay was significantly extended. LLR for liver metastasis of colorectal cancer can be safely performed at multiple sites or multiple times, and good treatment results have been obtained, so it was considered to be an effective treatment method.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Colorrectales , Laparoscopía , Neoplasias Hepáticas , Humanos , Estudios Retrospectivos , Neoplasias Hepáticas/secundario , Hepatectomía/métodos , Laparoscopía/métodos , Complicaciones Posoperatorias , Tiempo de Internación , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Carcinoma Hepatocelular/cirugíaRESUMEN
A 78-year-old man was diagnosed with a liver tumor on follow-up CT after thoracic aortic aneurysm surgery. Esophagogastroduodenoscopy revealed a type 2 tumor in the gastric antrum, a biopsy showed poorly differentiated adenocarcinoma, and CT revealed multiple liver metastases, resulting in a diagnosis of clinical Stage â £B(cT4aN0M1[HEP]). S-1/oxaliplatin (SOX)chemotherapy was started. However, after 9 courses of chemotherapy, the primary tumor continued to increase in size. Ramucirumab/paclitaxel(RAM/PTX)was started; after 3 courses, CT revealed shrinkage of the primary tumor and disappearance of multiple liver metastases. PET-CT showed no abnormal FDG accumulation in the stomach, surrounding lymph nodes, and liver. Therefore, the patient was considered to have a PR in efficacy, and a decision to perform conversion surgery was made based on the assumption that curative resection was possible. The patient underwent laparoscopic distal gastrectomy D2 lymph node dissection and Billroth â reconstruction. The pathological result was M, Ant, type 2, por, ypT2N0M0, ypStage â B, while the histological effect of the chemotherapy was Grade 0. The patient was treated with paclitaxel as adjuvant chemotherapy, which was discontinued 1 year after surgery owing to no recurrence. No recurrence has been noted during 2 years of follow-up.
Asunto(s)
Neoplasias Hepáticas , Neoplasias Gástricas , Masculino , Humanos , Anciano , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Paclitaxel , Gastrectomía , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/secundario , RamucirumabRESUMEN
INTRODUCTION: Laparoscopic pancreaticoduodenectomy(LPD)has been covered by insurance since 2016 in Japan. Advance LPD and robotic pancreaticoduodenectomy(RPD)has been also covered by insurance since 2020 in Japan. We report our technique and the short-term outcome of RPD performed in our institution. SURGICAL PROCEDURES: As a first step, the resection phase was performed laparoscopically. Pancreato-jejunostomy and choledocho-jejunostomy were performed robotically (hybrid-RPD). As a second step, Kocher maneuver and jejunal transection were performed laparoscopically. Other procedures were performed robotically(modified-RPD). As a final step, all procedures were performed robotically(pure-RPD). SURGICAL TECHNIQUES: RPD is performed in reverse Trendelenburg supine position. An extended Kocher maneuver is performed. The common bile duct is then identified and transected after proximal aspect is secured with a surgical bulldog clamp. IPDA is divided by using an energy device after clip placement. The pancreatic neck is then divided with the use of scissors. Pancreato-jejunostomy was performed by modified Blumgart and pancreatic duct to jejunal mucosa method. Choledocho- jejunostomy was performed with continuous and interrupted suturing. PATIENTS AND METHOD: Between 2020 and 2022, 45 patients underwent RPD at our institution. Cases were divided into hybrid-RPD(n=20), modified-RPD(n=9) and pure-RPD(n=16). RESULTS: No significant differences were noted between hybrid-RPD, modified-RPD and pure-RPD groups with respect to patient age(73.6, 68.7, 70.6 years old), gender(male/female 15/5, 6/3, 8/8), respectively. The operation time was longer(667, 770, 746 minutes)and the resection time was longer(286, 399, 380 minutes)in modified- RPD and pure-RPD than hybrid-RPD group. In the pure-RPD group, the resection time was decreasing(y=-12.0×+ 481.5)as a learning curve. No significant differences were noted between hybrid-RPD, modified-RPD and pure-RPD groups with respect to reconstruction time(388, 371, 367 minutes)and the estimated blood(261, 199, 293 mL), respectively. All postoperative pancreatic fistula was under Grade B. CONCLUSION: Although further studies are still needed to confirm the benefit of RPD, RPD is safe, minimally invasive, and effective approach to the management of pancreatic tumor.