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Chern MC, Lin CW, Lin ZH, Tsai TJ. Mid- to long-term outcome of laparoscopic ultrasound-guided radiofrequency ablation for malignant hepatic tumors. J Gastrointest Surg 2024; 28:103-107. [PMID: 38445930 DOI: 10.1016/j.gassur.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/28/2023] [Accepted: 10/28/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study aimed to evaluate the long-term outcomes of fully laparoscopic ultrasound-guided radiofrequency ablation (LURFA) in malignant hepatic tumors that are difficult to curatively treat with the percutaneous approach or laparoscopic liver resection (LLR). METHODS Between 2011 and 2021, 62 patients with malignant hepatic tumors (37 hepatocellular carcinomas [HCCs] and 25 metastatic colorectal cancers [mCRCs]), who were not feasible to be curatively treated by percutaneous radiofrequency ablation or LLR, were enrolled and treated only by LURFA. Patients who underwent concurrent surgical resection were excluded. The cumulative incidence rates of local recurrence (LR) and survival were analyzed. RESULTS All 93 tumors with a median diameter of 22.0 mm (IQR, 8.0-50.0) and a median number of 1.5 tumors (IQR, 1.0-6.0) in 62 patients were successfully treated. According to the IWATE criteria for LLR, 33 of 62 patients (53.2%) had tumors in difficult locations (segments I, VII, VIII, and IVa). Over a median follow-up period of 92.4 months (IQR, 60.0-128.0), the 1-, 2-, 3-, 5-, 8-, and 10-year cumulative incidence rates of LR were 6.9%, 13.8%, 17.2%, 17.2%, 20.9%, and 20.9%, respectively. In patients with HCC, 1-, 3-, 5-, and 8-year survival rates were 97.2%, 80.6%, 55.6%, and 40.1%, respectively. In patients with mCRC, 1-, 3-, 5-, and 8-year survival rates were 100.0%, 36.4%, 27.3%, and 16.4%, respectively. Adverse events of grade 3 occurred in only 3 of 62 patients (4.8%). CONCLUSION Full LURFA is a safe and effective treatment for malignant hepatic tumors, even in difficult percutaneous ablation or LLR areas.
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Affiliation(s)
- Ming-Chih Chern
- Department of Radiology, Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Chung-Wei Lin
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Zoe H Lin
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Tzu-Jung Tsai
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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2
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Takaichi S, Tomimaru Y, Kobayashi S, Takeda Y, Nakahira S, Tsujie M, Yukawa M, Shimizu J, Murakami M, Miyamoto A, Asaoka T, Sakai K, Morimoto O, Tori M, Yamamoto T, Fukuchi N, Nagano H, Doki Y, Eguchi H. Drainage after laparoscopic liver surgery in the CSGO-HBP-004 study: propensity score-matched analysis. Br J Surg 2021; 108:e57-e58. [PMID: 33711105 DOI: 10.1093/bjs/znaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- S Takaichi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Tomimaru
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - S Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - S Nakahira
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan.,Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - M Tsujie
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan.,Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - M Yukawa
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - J Shimizu
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.,Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - M Murakami
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.,Department of Surgery, Itami City Hospital, Itami, Japan
| | - A Miyamoto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - T Asaoka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - K Sakai
- Department of Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - O Morimoto
- Department of Surgery, Ikeda City Hospital, Ikeda, Japan
| | - M Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - T Yamamoto
- Department of Surgery, Sakai City Medical Center, Sakai, Japan.,Tamesan Clinic, Toyonaka, Japan
| | - N Fukuchi
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - H Nagano
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Y Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - H Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Hasegawa Y, Kitago M, Abe Y, Kitagawa Y. Does laparoscopic resection for colorectal cancer liver metastasis have a long-term oncologic advantage? Hepatobiliary Surg Nutr 2021; 10:246-248. [PMID: 33898568 DOI: 10.21037/hbsn-20-807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yasushi Hasegawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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4
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Hasegawa Y, Nitta H, Takahara T, Katagiri H, Kanno S, Umemura A, Akiyama Y, Iwaya T, Otsuka K, Sasaki A. Surgical outcomes of 118 complex laparoscopic liver resections: a single- center experience. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:942-949. [PMID: 33058554 DOI: 10.1002/jhbp.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUND Indications for laparoscopic liver resection (LLR) are continuously expanding. The Japanese Society of Hepato-Biliary-Pancreatic Surgery defines highly difficult hepatectomy as a procedure involving one or more sections (except for left lateral sectionectomy) or anatomical segmentectomy. This study aimed to assess the outcomes of complex LLR procedures and compare their technical difficulties, about which only a little is known to date. METHODS We performed a retrospective review of the operative outcomes of 118 consecutive patients who underwent pure laparoscopic complex hepatectomy. The surgical outcomes, including operative times, blood loss amounts, and postoperative morbidity rates, were compared among complex LLR procedures. RESULTS The overall median operative time was 280 minutes, and the median intraoperative blood loss was 86 mL. Two patients required conversion to open laparotomy (1.7%). The postoperative major morbidity rate was 11.0% Posterosuperior segmentectomy, right hemihepatectomy, and anterior sectionectomy required the longest operative times. Anterior and posterior sectionectomy resulted in the highest blood loss, and right hemihepatectomy and anterior sectionectomy resulted in the most complications. CONCLUSIONS The surgical difficulties associated with complex LLR procedures vary. It is critical to recognize the specific risks and cautionary points to ensure patient safety and provide proper systemic training to surgeons.
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Affiliation(s)
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | | | | | - Shoji Kanno
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Koki Otsuka
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Yahaba, Japan
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5
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Minimally Invasive Liver Resection for Early-Stage Hepatocellular Carcinoma: Inconsistent Outcomes from Matched or Weighted Cohorts. J Gastrointest Surg 2020; 24:560-568. [PMID: 31012046 DOI: 10.1007/s11605-019-04221-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the current study was to re-evaluate the role of minimally invasive liver resection (MILR) among patients with early-stage (stage I or II) hepatocellular carcinoma (HCC) undergoing partial hepatectomy. METHODS A retrospective analysis of the National Cancer Database (NCDB) was conducted to identify patients with early-stage HCC who underwent partial hepatectomy in the USA from 2010 to 2013. Overall survival (OS) was compared in three cohorts: crude; stabilized inverse probability of treatment propensity score weighting (IPTW); and propensity score matching (PSM). RESULTS Among 4027 patients included in the study, only 11.7%, (n = 473) underwent MILR. In the stabilized IPTW cohort, patients who underwent MILR versus open resection were more likely to have tumors greater than 3 cm (63.9%, n = 285 vs. 51.4%, n = 228, p < 0.001) and poorly/undifferentiated tumors (21.5%, n = 96 vs. 12.9%, n = 57, p < 0.001). Within the crude cohort, a 5-year OS was superior among patients in the open surgical group (67.8%) compared with patients who underwent MILR (56.6%) (p < 0.001). After classic PSM analysis, the 5-year OS of patients undergoing MILR and open surgery were noted to be comparable (57.3% vs 63.8%, p = 0.17; HR 1.16, 95% CI 0.92-1.45). In contrast, after applying IPTW, the 5-year OS of patients who underwent MILR (55.5%) was worse compared with patients who had an open resection (67.5%) (HR 1.46, 95% CI 1.15-1.84; p < 0.001). CONCLUSIONS Long-term outcomes of patients undergoing MILR were comparable with patients who had open surgery when assessed by standard PSM. The use of IPTW resulted in more unbalanced groups leading to residual confounding and bias.
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Ledoux G, Amroun K, Rhaiem R, Cagniet A, Aghaei A, Bouche O, Hoeffel C, Sommacale D, Piardi T, Kianmanesh R. Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor. Surg Endosc 2020; 35:845-853. [PMID: 32076859 DOI: 10.1007/s00464-020-07456-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection. METHODS Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a. RESULTS Mortality was nil and morbidity rate 15.4% including Dindo-Clavien > II grade 3%. The median follow-up was 24 months [0.77-75]. Per lesion LR rate after TA was 18% (n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA. CONCLUSIONS Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.
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Affiliation(s)
- Geoffrey Ledoux
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Koceila Amroun
- University of Reims Champagne Ardenne, Reims, France.,Department of Surgery, Jean Godinot Cancer Institute, Reims, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France. .,Reims Medical Faculty, Reims, France. .,University of Reims Champagne Ardenne, Reims, France.
| | - Audrey Cagniet
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Arman Aghaei
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Olivier Bouche
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Deprtement of Oncology, Robert Debré University- Hospital, Reims, France
| | - Christine Hoeffel
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Departement of Radiology, Robert Debré University- Hospital, Reims, France
| | - Daniele Sommacale
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
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7
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Tomimaru Y, Noguchi K, Morita S, Imamura H, Iwazawa T, Dono K. Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy? World J Surg 2018; 42:3685-3691. [PMID: 29728731 DOI: 10.1007/s00268-018-4655-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Less intraoperative blood loss is frequently reported as an advantage of laparoscopic hepatectomy (LH) over open hepatectomy (OH). However, the small work space during laparoscopic surgery could lead to insufficient blood suction from the abdominal cavity, with possible underestimation of intraoperative blood loss. This study compared estimated blood loss (E-BL) with intraoperatively counted blood loss (IC-BL) in patients undergoing LH. METHODS This study included 110 consecutive patients undergoing partial hepatectomy for solitary liver tumors (59 had OH and 51 had LH). IC-BL and E-BL were determined, and the difference between them was calculated based on the surgical approach. Factors affecting the difference were investigated. IC-BL was quantified from the suction fluid volume and weight of surgical gauzes used for blood and fluid collection. E-BL was calculated with the total blood volume and change in hematocrit. RESULTS Although there were no significant differences between IC-BL and E-BL in the OH group (292 ± 198 vs. 259 ± 167 mL, p = 0.1239), E-BL was significantly greater than IC-BL in the LH group (273 ± 166 vs. 128 ± 177 mL, p < 0.0001). Percentage of patients with E-BL > IC-BL in the LH group was significantly greater than in the OH group (86.3 vs. 42.4%, p < 0.0001). The surgical approach (OH/LH) was the only significant independent factor determining E-BL > IC-BL status. CONCLUSIONS E-BL was significantly greater than IC-BL only in patients undergoing LH, and the surgical approach (OH/LH) was the only factor affecting E-BL > IC-BL status. These results suggest that intraoperative blood loss may be underestimated during LH.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Kozo Noguchi
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Shunji Morita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
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8
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Matsukuma S, Sakamoto K, Tokuhisa Y, Tokumitsu Y, Matsui H, Kanekiyo S, Tomochika S, Iida M, Suzuki N, Takeda S, Ueno T, Wada H, Kobayashi S, Saeki I, Eguchi H, Sakon M, Sakaida I, Nagano H. Outcomes following liver resection for multinodular Barcelona Clinic Liver Cancer-B hepatocellular carcinoma. Oncol Lett 2018; 16:6383-6392. [PMID: 30344760 PMCID: PMC6176380 DOI: 10.3892/ol.2018.9420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022] Open
Abstract
Management of multinodular hepatocellular carcinoma (HCC) in the intermediate Barcelona Clinic Liver Cancer (BCLC)-B stage is controversial. The aim of the present study as to identify the subgroup of patients with BCLC-B HCC who could benefit from liver resection. The present study retrospectively analyzed the outcomes of 65 patients (training cohort) who underwent liver resection for multinodular BCLC-B HCC. Cox's regression analysis was conducted to identify the independent prognostic factors for overall survival and to develop the prognostic score. As some authors have reported that maximum tumor size (cm) plus tumor number (N+S) is a prognostic factor in patients with BCLC-B HCC who undergo chemoembolization, the usefulness of this factor in patients who underwent liver resection was also evaluated. Subsequently, the validity of the prognostic score was assessed in an independent validation cohort (n=132). Multivariate analysis revealed that positivity for hepatitis C virus antibody (HCV-ab), platelet count ≤1010/l, N+S >8, and des-γ-carboxy prothrombin (DCP) >400 mAU/ml were independent prognostic factors for overall survival. The prognostic score differentiated two groups (≤2, ≥3) with distinct outcomes (median survival time 68.3 months vs. 29.1 months; P<0.0001). This result was confirmed in an external validation cohort. Therefore, surgery can promote long-term survival in patients with multinodular HCC although the indications for surgery are limited. HCV-Ab status, preoperative platelet count, DCP level and N+S may be useful for patient selection.
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Affiliation(s)
- Satoshi Matsukuma
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Kazuhiko Sakamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yoshihiro Tokuhisa
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shinsuke Kanekiyo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shinobu Tomochika
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Tomio Ueno
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan
| | - Hiroshi Wada
- Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Issei Saeki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Masato Sakon
- Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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