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Marino R, Olthof PB, Shi HJ, Tran KTC, Ijzermans JNM, Terkivatan T. Minimally Invasive Liver Surgery: A Snapshot from a Major Dutch HPB and Transplant Center. World J Surg 2022; 46:3090-3099. [PMID: 36161353 PMCID: PMC9636118 DOI: 10.1007/s00268-022-06754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Minimally invasive liver surgery (MILS) has been progressively adopted on a nationwide scale. The aim of this study is to investigate MILS implementation in a high-volume Dutch hepato-pancreato-biliary and transplant center, which is considered a moderate to low-volume center from a European standpoint. METHODS All patients who underwent MILS at Erasmus Medical Center between April 2010 and December 2021 were retrospectively reviewed. Patients' surgical outcomes were compared after stratification according to resections' difficulty and liver cirrhosis. RESULTS A total of 212 cases were included. Major liver resections were performed in 24 patients (11%), while minor resections were performed in 188 patients (89%). Among those, 177 (94%) resections were classified as technically minor and 11 (6%) as technically major. Major morbidity was reported in 14/177 patients (8%) after technically minor resections and in 3/24 patients (13%) after major resections. Anatomically and technically major resections had higher intraoperative blood losses (425 (0-2100) vs. 240 (50-110) vs. 100 (0-2400) mL; p-value < 0.001) and longer hospital stay (6 (3-25) vs. 5 (2-9) vs. 3 (1-44); p-value < 0.001) when compared with the technically minor counterpart. Perioperative outcomes were similar when comparing cirrhotic MILS with the non-cirrhotic cohort. CONCLUSION MILS program implementation can lead to encouraging surgical outcomes even in low- to moderate-volume centers. Although low procedural volume might be predictive of impaired outcomes, long-standing experience in the HPB and liver transplant field could mitigate low-case volume effects on surgical outcomes.
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Affiliation(s)
- Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy ,Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Pim B. Olthof
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Hong J. Shi
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Khe T. C. Tran
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Jan N. M. Ijzermans
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Department of Surgery, Division of HPB & Transplant Surgery, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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Umemura A, Nitta H, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Kobayashi M, Ando T, Sato A, Uesugi N, Sugai T, Sasaki A. Laparoscopic Left Hepatectomy with Middle Hepatic Vein Resection for Hepatocellular Carcinoma with Extrahepatic Portal Vein Obstruction. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928801. [PMID: 33642565 PMCID: PMC7930512 DOI: 10.12659/ajcr.928801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Patient: Female, 70-year-old Final Diagnosis: Hepatocellular carcinoma with extrahepatic portal vein obstruction Symptoms: — Medication:— Clinical Procedure: Preoperative simulation and intraoperative navigation technique Specialty: Surgery
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | | | - Shoji Kanno
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Megumi Kobayashi
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Taro Ando
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Ayaka Sato
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Iwate, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Iwate, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Morioka, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
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Umemura A, Nitta H, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Ando T, Kobayashi M, Sasaki A. Identifying Cystic Vein Perfusion Area Employing Indocyanine Green Fluorescence Imaging during Laparoscopic Extended Cholecystectomy for Clinical T2 Gallbladder Cancer. Case Rep Gastroenterol 2020; 14:110-115. [PMID: 32231511 PMCID: PMC7098343 DOI: 10.1159/000506361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023] Open
Abstract
We present an original surgical technique for identifying the perfusion area of the cystic vein with indocyanine green (ICG) fluorescence imaging and laparoscopic extended cholecystectomy with lymphadenectomy for a 56-year-old woman with diagnosis of clinical T2 gallbladder cancer (GBC). First, we encircled Calot's triangle using the Glissonean approach from the ventral side of the gallbladder plate and then taped the hilar Glissonean pedicles; these were temporally clamped, and ICG was injected into the vein. The perfusion area of the cystic vein was scrutinized, specifically the stained area of the hepatic parenchyma was marked, and extended cholecystectomy was performed along the resection line. Subsequently, we performed lymphadenectomy of the hepatoduodenal ligament to complete the operation. A postoperative histopathological examination revealed moderately differentiated adenocarcinoma with pathological T1bN0M0. Although extended cholecystectomy is currently recommended for clinical T2 GBC, there is no consensus on the definition of the gallbladder bed, and the ideal extent of hepatic resection has, therefore, not yet been determined. In addition, gallbladder bed resection with 2–3 cm of surgical margin is an empirical procedure that lacks scientific verification. Regarding anatomical features, the cystic vein sometimes drains directly into the anterior branch of the portal vein, penetrating the gallbladder plate and Laennec's capsule of the anterior Glissonean pedicle. To address this background, we have developed a technique to identify the perfusion area of the cystic vein to determine the extent of hepatic parenchyma that should be resected during laparoscopic extended cholecystectomy for clinical T2 GBC.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | | | | | | | - Shoji Kanno
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | - Taro Ando
- Department of Surgery, Iwate Medical University, Yahaba, Japan
| | | | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Yahaba, Japan
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Cheung TT, Han HS, She WH, Chen KH, Chow PK, Yoong BK, Lee KF, Kubo S, Tang CN, Wakabayashi G. The Asia Pacific Consensus Statement on Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Report from the 7th Asia-Pacific Primary Liver Cancer Expert Meeting Held in Hong Kong. Liver Cancer 2018; 7:28-39. [PMID: 29662831 PMCID: PMC5892359 DOI: 10.1159/000481834] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Laparoscopic liver resection has been gaining momentum, and it has become an accepted practice after the two international consensus conferences where experts worked up guidelines to standardize this approach and improve its safety. However, most laparoscopic hepatectomies were performed in patients with liver metastases. The concurrent presence of liver cirrhosis with hepatocellular carcinoma (HCC) poses a great challenge to clinicians trying to establish a routine use of laparoscopic liver resection for HCC. SUMMARY The first Asia Pacific consensus meeting on laparoscopic liver resection for HCC was held in July 2016 in Hong Kong. A group of expert liver surgeons with experience in both open and laparoscopic hepatectomy for HCC convened to formulate recommendations on the role and perspective of laparoscopic liver resection for primary liver cancer. The recommendations consolidate the most recent evidence pertaining to laparoscopic hepatectomy together with the latest thinking of practicing clinicians involved in laparoscopic hepatectomy, and give detailed guidance on how to deploy the treatment effectively for patients in need. KEY MESSAGE The panel of experts gathered evidence and produced recommendations providing guidance on the safe practice of laparoscopic hepatectomy for patients with HCC and cirrhosis. The inherent advantage of the laparoscopic approach may result in less blood loss if the procedure is performed in experienced centers. The laparoscopic approach to minor hepatectomy, particularly left lateral sectionectomy, is a preferred practice for HCC at experienced centers. Laparoscopic major liver resection for HCC remains a technically challenging operation, and it should be carried out in centers of excellence. There is emerging evidence that laparoscopic liver resection produces a better oncological outcome for HCC when compared with radiofrequency ablation, particularly when the lesions are peripherally located. Augmented features in laparoscopic liver resection, including indocyanine green fluorescence, 3D laparoscopy, and robot, will become important tools of surgical treatment in the near future. A combination of all of these features will enhance the experience of the surgeons, which may translate into better surgical outcomes. This is the first consensus workforce on laparoscopic liver resection for HCC, which is a unique condition that occurs in the Asia Pacific region.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong (SAR), China,*Dr. Tan To Cheung, 102 Pok Fu Lam Road, Hong Kong, SAR (China), E-Mail
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National College of Medicine, Seoul, South Korea
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong (SAR), China
| | - Kuo-Hsin Chen
- Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, China
| | | | - Boon Koon Yoong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Kit Fai Lee
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), China
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Chung Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong (SAR), China
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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Cipriani F, Fantini C, Ratti F, Lauro R, Tranchart H, Halls M, Scuderi V, Barkhatov L, Edwin B, Troisi RI, Dagher I, Reggiani P, Belli G, Aldrighetti L, Abu Hilal M. Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients? Surg Endosc 2017; 32:617-626. [PMID: 28717870 DOI: 10.1007/s00464-017-5711-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients. METHODS The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child-Pugh A and 25 Child-Pugh B patients. RESULTS There was no difference in blood loss (250 vs. 250 mL, p 0.465) and morbidity (28.6 vs. 26.4%, p 0.473) between cirrhotics and non-cirrhotics, and liver-specific complications were similar (12.8 vs. 12%, p 0.924). The sub-analysis revealed similar perioperative outcomes in either Child-Pugh A or B patients. Noteworthy, ascitis (11 vs. 12%, p 0.562) and liver failure (3 vs. 4%, p 0.595) were not different. ASA score (OR 1.76, p 0.034) and conversion (OR 2.99, p 0.019) were risk factors for major morbidity. Despite lower recurrence-free survival in cirrhotics (43 vs. 55 months, p 0.034), overall survival was similar to non-cirrhotic patients (84 vs. 76.5, p 0.598). CONCLUSION LLR for HCC appear equally safe in cirrhotic and non-cirrhotic patients, and the advantages can be witnessed in those with advanced cirrhosis. Severe comorbidities and conversion should be considered risk factors for complications-rather than the severity of cirrhosis and portal hypertension-when liver resection is performed laparoscopically. Such results may be of great interest to liver surgeons and hepatologists when deciding on the management of HCC within cirrhosis.
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Affiliation(s)
- Federica Cipriani
- University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.,Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Corrado Fantini
- General and Hepato-Pancreato-Biliary Surgery, Loreto Nuovo Hospital, Naples, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Roberto Lauro
- Hepatobiliary and Liver Transplant Unit, IRCCS Foundation Policlinico Major Hospital, Milan, Italy
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Clamart, France
| | - Mark Halls
- University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK
| | - Vincenzo Scuderi
- Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Leonid Barkhatov
- Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bjorn Edwin
- Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Roberto I Troisi
- Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Clamart, France
| | - Paolo Reggiani
- Hepatobiliary and Liver Transplant Unit, IRCCS Foundation Policlinico Major Hospital, Milan, Italy
| | - Giulio Belli
- General and Hepato-Pancreato-Biliary Surgery, Loreto Nuovo Hospital, Naples, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Mohammad Abu Hilal
- University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
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Levi Sandri GB, de Werra E, Mascianà G, Colasanti M, Santoro R, D'Andrea V, Ettorre GM. Laparoscopic and robotic approach for hepatocellular carcinoma-state of the art. Hepatobiliary Surg Nutr 2016; 5:478-484. [PMID: 28124002 DOI: 10.21037/hbsn.2016.05.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor worldwide and the most common primary liver cancer, in over 80% of cases HCC grown on a cirrhotic liver. Laparoscopic liver resection (LLR) is now worldwide accepted considering the excellent results shown. Minimally invasive surgical approach for HCC is increasing continuously and in specialized centers seems to become the first-line approach for those patients. The aim of this review presents and discusses state of the art in the laparoscopic and robotic surgical treatment of HCC. An electronic search was performed to identify all studies dealing with HCC resected with laparoscopy or robotic approach. Indications for laparoscopic resection, robotic assisted and totally robotic resection of HCC will be doubtless increased in future years. LLR and robotic approach for HCC is safe and feasible.
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Affiliation(s)
- Giovanni Battista Levi Sandri
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy;; Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Marco Colasanti
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Roberto Santoro
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy
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Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Takeda D, Makabe K, Sasaki A. Laparoscopic liver resection for hepatocellular carcinoma with cirrhosis in a single institution. Hepatobiliary Surg Nutr 2016; 4:398-405. [PMID: 26734624 DOI: 10.3978/j.issn.2304-3881.2015.12.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In a statement by the second International Consensus Conference for Laparoscopic Liver Resection (LLR), minor LLR was confirmed to be a standard surgical practice, as it has become adopted by an increasing proportion of surgeons. However, it is unclear whether this applies to the more complex group of patients suffering from cirrhosis. Therefore, the aim of this retrospective study was to compare the feasibility and safety of LLR for hepatocellular carcinoma (HCC) between non-liver cirrhosis (NLC) patients and liver cirrhosis (LC) patients at a single high-volume laparoscopy center. METHODS From the beginning of 2000 to the end of 2013, open liver resection (OLR) was performed in 99 HCC patients, and LLR was in 118. The HCC patients who underwent LLR were divided into NLC-LLR (n=60) and LC-LLR (n=58) groups, and we compare the short-term outcomes between them. RESULTS There was no significant difference in the incidence of blood loss and transfusion requirements between the NLC-LLR group and the LC-LLR group, although wedge resection was mainly performed in the LC-LLR group. There was no significant difference in the complication rate between the two groups, and the remarkable finding was that there was a significantly lower incidence of postoperative ascites in the LC-LLR group than in the NLC-LLR group. CONCLUSIONS According to our experience, it appears that LLR for selected HCC patients with cirrhosis is a feasible and promising procedure that is associated with less blood loss and fewer postoperative complications, especially the incidence of postoperative ascites. Further investigations are clearly warranted.
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Affiliation(s)
- Takeshi Takahara
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Go Wakabayashi
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Hiroyuki Nitta
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Yasushi Hasegawa
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Hirokatsu Katagiri
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Daiki Takeda
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Kenji Makabe
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Akira Sasaki
- 1 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan ; 2 Department of Surgery, Ageo Central General Hospital, Saitama, Japan
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