1
|
Ochi T, Katsuno H, Kato H, Takagi S, Kikuchi K, Nakamura K, Endo T, Matsuo K, Yasuoka H, Nishimura A, Horiguchi A, Morise Z. Preliminary comparative study of lower extremity pressure measurements under the conditions using former models and new lithotomy stirrups in rectal cancer surgery. World J Surg Oncol 2024; 22:85. [PMID: 38566192 PMCID: PMC10988980 DOI: 10.1186/s12957-024-03352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery. METHODS A total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups. RESULTS The use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle. CONCLUSION These results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.
Collapse
Affiliation(s)
- Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan.
| | - Hiroyuki Kato
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Shinya Takagi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiro Nishimura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, Nagoya, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| |
Collapse
|
2
|
Nakamura K, Higashiguchi T, Chikaishi Y, Matsuo K, Endo T, Morohara K, Kikuchi K, Shibasaki S, Katsuno H, Uyama I, Suda K, Morise Z. Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report. Surg Case Rep 2024; 10:31. [PMID: 38302668 PMCID: PMC10834912 DOI: 10.1186/s40792-024-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.
Collapse
Affiliation(s)
- Kenichi Nakamura
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan.
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Takahiko Higashiguchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Koji Morohara
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
- Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| |
Collapse
|
3
|
Miyama A, Chikaishi Y, Kobayashi D, Matsuo K, Ochi T, Nakamura K, Endo T, Kikuchi K, Katsuno H, Nishijima A, Morise Z. A case of non-ampullary duodenal adenosquamous carcinoma with successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage. Surg Case Rep 2023; 9:161. [PMID: 37698671 PMCID: PMC10497460 DOI: 10.1186/s40792-023-01749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma. CASE PRESENTATION A 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery. CONCLUSIONS This report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.
Collapse
Affiliation(s)
- Arimasa Miyama
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Daigo Kobayashi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Takayuki Ochi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan
| | - Aki Nishijima
- Department of Diagnostic Pathology, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, 444-0827, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, 1 Gotanda Harisakicho, Okazaki, Aichi, 444-0827, Japan.
| |
Collapse
|
4
|
Takagi S, Morise Z, Katsuno H, Kikuchi K, Nakamura K, Endo T, Ochi T, Matsuo K, Yasuoka H, Nishimura A, Nishijima A. Successful treatment with laparoscopic extended posterior sectionectomy for inflammatory pseudotumor in the liver with para-aortic lymphadenitis. Asian J Endosc Surg 2023; 16:621-626. [PMID: 37280744 DOI: 10.1111/ases.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
Inflammatory pseudotumor (IPT) is a rare disease that requires a differential diagnosis from malignancies. We describe a case of hepatic IPT with para-aortic lymphadenopathy, treated with a stepwise strategy of laparoscopic surgery. A 61-year-old woman was referred with a liver lesion. Computed tomography revealed a 13 cm well-defined lesion in segments VII-VI. The patient also had bead-like enlarged lymph nodes from the perihilar to the para-aortic regions. Although percutaneous lymph node biopsy showed no evidence of malignancy, 18 F-fluorodeoxyglucose positron emission tomography revealed accumulation in the lesion and lymph nodes. Lymph nodes were harvested laparoscopically for intraoperative pathological examination. With no evidence of malignancy, laparoscopic liver resection was continuously performed as a diagnostic treatment. The patient was given a pathological diagnosis of IPT and was discharged on the 16th day and is well 2 years after surgery. The minimally invasive laparoscopic approach to diagnostic treatment could be useful with secure advantages.
Collapse
Affiliation(s)
- Shinya Takagi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Takayuki Ochi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Hironobu Yasuoka
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Akihiro Nishimura
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Aki Nishijima
- Department of Diagnostic Pathology, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| |
Collapse
|
5
|
Maeda K, Koide Y, Katsuno H, Tajima Y, Hanai T, Masumori K, Matsuoka H, Shiota M. Long-term results of minimally invasive transanal surgery for rectal tumors in 249 consecutive patients. Surg Today 2023; 53:306-315. [PMID: 35962290 PMCID: PMC9950212 DOI: 10.1007/s00595-022-02570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To delineate the long-term results of minimally invasive transanal surgery (MITAS) for selected rectal tumors. METHODS We analyzed data, retrospectively, on consecutive patients who underwent MITAS between 1995 and 2015, to establish the feasibility, excision quality, and perioperative and oncological outcomes of this procedure. RESULTS MITAS was performed on 243 patients. The final histology included 142 cancers, 47 adenomas, and 52 neuroendocrine tumors (NET G1). A positive margin of 1.6% and 100% en bloc resection were achieved. The mean operative time was 27.4 min. Postoperative morbidity occurred in 7% of patients, with 0% mortality. The median follow-up was 100 months (up to ≥ 5 years or until death in 91.8% of patients). Recurrence developed in 2.9% of the patients. The 10-year overall survival rate was 100% for patients with NET G1 and 80.3% for those with cancer. The 5-year DFS was 100% for patients with Tis cancer, 90.6% for those with T1 cancer, and 87.5% for those with T2 or deeper cancers. MITAS for rectal tumors ≥ 3 cm resulted in perioperative and oncologic outcomes equivalent to those for tumors < 3 cm. CONCLUSION MITAS is feasible for the local excision (LE) of selected rectal tumors, including tumors ≥ 3 cm. It reduces operative time and secures excision quality and long-term oncological outcomes.
Collapse
Affiliation(s)
- Kotaro Maeda
- Department of Surgery, Medical Corporation Kenikukai Shonan Keiiku Hospital, 4360 Endo, Fujisawa, Kanagawa 252-0816 Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, 444-0827 Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Miho Shiota
- Department of Surgery, Kaisei Hospital, Sakaide, 657-0068 Japan
| |
Collapse
|
6
|
Endo T, Katsuno H, Kikuchi K, Ochi T, Matsuo K, Suzuki K, Yasuoka H, Nakano Y, Nakagawa M, Kuroda M, Morise Z. Intravascular papillary endothelial hyperplasia in the cecum: a case report. Surg Case Rep 2022; 8:179. [PMID: 36155876 PMCID: PMC9510079 DOI: 10.1186/s40792-022-01512-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia. Case presentation A 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection. Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient’s postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up. Conclusions IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.
Collapse
|
7
|
Masumori K, Maeda K, Hanai T, Sato H, Koide Y, Matsuoka H, Katsuno H, Endo T, Cheong Y, Uyama I. Usefulness of vacuum-assisted closure after stoma closure with purse string suturing: a retrospective trial. Fujita Med J 2022; 8:67-72. [PMID: 35949515 PMCID: PMC9358675 DOI: 10.20407/fmj.2021-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022]
Abstract
Objectives Surgical site infection (SSI) is a problematic complication after stoma closure. The purse string suture (PSS) technique eliminates this problem, but the area takes longer to heal. The present retrospective study was performed to evaluate the usefulness of a vacuum-assisted closure (VAC) system for the promotion of wound healing after stoma closure. Methods Consecutive patients undergoing stoma closure with the PSS technique were divided into two groups: those treated with and without use of the VAC system. The volume of dead space and the size of the wound were measured after stoma closure in both groups. The same measurements were performed on days 3 and 7 after closure. The time needed for wound closure was also examined in both groups. Outcomes were also evaluated according to age, body mass index, operative time, bleeding volume, wound consistency, patient satisfaction, perioperative inflammatory response, occurrence of SSI, and hospitalization days. Results The VAC group comprised 31 patients, and the non-VAC group comprised 34 patients. The volume of dead space on days 3 and 7 after closure was significantly smaller in the VAC group than in the non-VAC group (P=0.006 and P<0.001, respectively). The number of SSIs was significantly lower in the VAC group than in the non-VAC group (P=0.014). Conclusion The dead space volume on days 3 and 7 after stoma closure with PSS significantly decreased by using the VAC system. The incidence of SSI after stoma closure also significantly decreased by using the VAC system.
Collapse
Affiliation(s)
- Koji Masumori
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Tsunekazu Hanai
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Harunobu Sato
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yoshikazu Koide
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Matsuoka
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hidetoshi Katsuno
- Department of Gastroenterological Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Tomoyoshi Endo
- Department of Gastroenterological Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yeongcheol Cheong
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Ichiro Uyama
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
8
|
Cheong Y, Katsuno H, Matsuoka H, Mizuno M, Endo T, Kamiya T, Tajima Y, Ashida K, Koide Y, Masumori K, Sato H, Hanai T, Maeda K, Uyama I, Hiro J, Suda K. Establishment of the menthol test as a clinical evaluation method for oxaliplatin-induced neuropathy. Fujita Med J 2022; 8:88-95. [PMID: 35949518 PMCID: PMC9358673 DOI: 10.20407/fmj.2021-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/08/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVES To determine whether the tongue menthol test, which measures the cold sensation detection threshold (CDT) of the tongue, used before and after oxaliplatin administration is an objective evaluation method for oxaliplatin-induced peripheral neuropathy (OPN). METHODS The tongue menthol test was administered to patients both before and after undergoing chemotherapy containing oxaliplatin for colorectal cancer. The tongue menthol test was conducted by applying a menthol solution (a selective agonist of transient receptor potential cation channel subfamily M member 8 [TRPM8]) to the tongue and measuring the CDT. RESULTS The mean CDT before the first dose of oxaliplatin was 0.34% (0.005%-1%; n=38), and the mean CDT after the first dose was 0.32% (0.005%-1%; n=38). The CDT appeared to decrease after the first dose, but this difference was not significant. In patients who received five courses of oxaliplatin, changes in CDT values were compared before and after the five courses. In patients with Neurotoxicity Criteria of Debiopharm (DEB-NTC) grade 2 neuropathy, the pre-oxaliplatin administration CDT was compared between before grade exacerbation and when exacerbation occurred, and was found to decline when grade exacerbation occurred. Moreover, when the CDTs before and after administration were compared before grade exacerbation, there was a significant decrease in CDT after administration (P=0.04). CONCLUSIONS By performing a menthol test in oxaliplatin-treated patients, it may be possible to objectively predict the exacerbation of peripheral neuropathy at an early stage.
Collapse
Affiliation(s)
- Yeongcheol Cheong
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hidetoshi Katsuno
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Okazaki, Aichi, Japan
| | - Hiroshi Matsuoka
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | | | - Tomoyoshi Endo
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Okazaki, Aichi, Japan
| | - Tadahiro Kamiya
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yosuke Tajima
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Keigo Ashida
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori ,Tottori, Japan
| | - Yoshikazu Koide
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Koji Masumori
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Harunobu Sato
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tsunekazu Hanai
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Junichiro Hiro
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Koichi Suda
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
9
|
Endo T, Morise Z, Katsuno H, Kikuchi K, Matsuo K, Asano Y, Horiguchi A. Caudal Approach to Laparoscopic Liver Resection—Conceptual Benefits for Repeated Multimodal Treatment for Hepatocellular Carcinoma and Extended Right Posterior Sectionectomy in the Left Lateral Position. Front Oncol 2022; 12:950283. [PMID: 35898874 PMCID: PMC9309811 DOI: 10.3389/fonc.2022.950283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 12/07/2022] Open
Abstract
We had reported the novel concept of “caudal approach in laparoscopic liver resection” in 2013. In the first report, the caudal approach of laparoscopic transection–first posterior sectionectomy without prior mobilization of the liver in the left lateral position was described. Thereafter, 10 complex laparoscopic extended posterior sectionectomies with combined resection of the right hepatic vein or diaphragm were performed using the same approach. In the present study, the short-term outcomes of these cases and 42 cases of laparoscopic sectionectomies or hemi-hepatectomies (excluding left lateral sectionectomy) were compared. There was no statistically significant difference between the groups in terms of patients’ backgrounds, diseases for resection, preoperative liver function, tumor number and size, as well as outcomes, operation time, intraoperative blood loss, morbidity, conversion to laparotomy, and post-operative hospital stay. Even complex laparoscopic extended posterior sectionectomy was safely performed using this procedure. This approach has the technical benefits of acquiring a well-opened transection plane between the resected liver fixed to the retroperitoneum and the residual liver sinking to the left with the force of gravity during parenchymal transection, and less bleeding from the right hepatic vein due to its higher position than the inferior vena cava. Furthermore, it has an oncological benefit similar to that of the anterior approach in open liver resection, even in posterior sectionectomy. The detailed procedure and general conceptual benefits of the caudal approach to laparoscopic liver resection for repeated multimodal treatment for hepatocellular carcinoma are described.
Collapse
Affiliation(s)
- Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
- *Correspondence: Zenichi Morise,
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya, Japan
| |
Collapse
|
10
|
Inaguma G, Tajima Y, Hiro J, Hanai T, Katsuno H, Masumori K, Koide Y, Matsuoka H, Endo T, Kamiya T, Chong Y, Sato H, Maeda K, Uyama I, Suda K. Usefulness of laparoscopic right colectomy with intracorporeal anastomosis and preoperative weight reduction for ascending colon cancer in a severely obese patient. Asian J Endosc Surg 2022; 15:401-404. [PMID: 34935290 DOI: 10.1111/ases.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
Obesity has been considered a risk factor for postoperative complications following colorectal cancer surgery. However, the usefulness of a combination of intracorporeal anastomosis and preoperative weight reduction for severely obese patients with colon cancer remains unclear. A 66-year-old man with a body mass index (BMI) of 43 kg/m2 presented with abdominal pain and iron deficiency anemia. Colonoscopy and computed tomography revealed advanced ascending colon cancer with regional lymph node metastasis and excessive abdominal fat. Preoperative diet-induced weight reduction was performed for severe obesity, which decreased his BMI to 39.7 kg/m2 after 1 month. Thereafter, curative resection was performed using intracorporeal anastomosis for reconstruction to achieve minimal colon and mesentery mobilization and a shorter incision. The patient was discharged from the hospital without complications. Laparoscopic right hemicolectomy combining intracorporeal anastomosis and preoperative weight reduction was extremely useful in the current patient with severe obesity and ascending colon cancer.
Collapse
Affiliation(s)
- Gaku Inaguma
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yosuke Tajima
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Gastrointestinal Surgery, Fujita Health University Okazaki Medical Center, Toyoake, Japan
| | - Koji Masumori
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Gastrointestinal Surgery, Fujita Health University Okazaki Medical Center, Toyoake, Japan
| | - Tadahiro Kamiya
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Yongchol Chong
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Harunobu Sato
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Kotaro Maeda
- Fujita Health University Hospital International Medical Center, Toyoake, Japan
| | - Ichiro Uyama
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Gastrointestinal Surgery, Fujita Health University, Toyoake, Japan
| |
Collapse
|
11
|
Katsuno H, Hanai T, Endo T, Morise Z, Uyama I. The double bipolar method for robotic total mesorectal excision in patients with rectal cancer. Surg Today 2022; 52:978-985. [PMID: 35000035 DOI: 10.1007/s00595-021-02418-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Although meta-analyses and systematic reviews have clarified the benefits of robotic surgery, few studies have focused on robotic rectal surgery (RRS) and the use of Endowrist® instruments. Therefore, we evaluated RRS using the double bipolar method (DBM) and compared its short-term outcomes with those of RRS using the single bipolar method (SBM). This study enrolled 157 consecutive patients and all procedures were performed by the same surgeon and recorded through short video clips. We analyzed the patient demographics and short-term clinical outcomes. Although this observational study has several limitations, the console time for total mesorectal excision using the DBM was significantly shorter than that using the SBM. Although the DBM did not demonstrate a specific learning curve, it was a safe and feasible procedure even for patients with advanced disease. Further studies are needed to evaluate the cost-effectiveness of the DBM.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Okazaki Medical Center, Fujita Health University, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan.
| | - Tsunekazu Hanai
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Okazaki Medical Center, Fujita Health University, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Zenichi Morise
- Department of Surgery, Okazaki Medical Center, Fujita Health University, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Ichiro Uyama
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| |
Collapse
|
12
|
Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Tajima Y, Endo T, Cheong YC. Prevalence and Risk Factors of Anal and Fecal Incontinence in Japanese Medical Personnel. J Anus Rectum Colon 2021; 5:386-394. [PMID: 34746503 PMCID: PMC8553347 DOI: 10.23922/jarc.2021-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to elucidate the actual state of anal incontinence (AI), fecal incontinence (FI), and the associated factors in Japanese medical personnel. Methods A questionnaire was completed by Japanese medical personnel after listening to lectures on AI. AI was defined as involuntary loss of feces or flatus. Results A total of 463 persons (mean age, 35.6 years; range, 20-91; male/female/no answer, 132/324/7) participated in the questionnaire. AI occurred in 34.4% of 450 participants (flatus/liquid stool/solid stool: 30.4%/3.6%/0.4%). AI was significantly more prevalent in females (male/female: 15.5%/42.7%, p < 0.001). AI and FI occurred significantly more prevalent in participants aged ≧40 years (p < 0.024). AI was significantly associated with childbirth, frequency of childbirth (more than three times), vaginal delivery, urinary incontinence, the style of urination/defecation, and a history of gynecologic surgery and systemic diseases (p < 0.05). Female gender and age as well as urinary incontinence and inability to defecate separately in female and previous colorectal disease and/or surgery in male were risk factors of AI by multivariate analysis (p < 0.05). FI was correlated with urinary incontinence. Conclusions AI and FI occurred in 34.4% and 4.0% of Japanese medical personnel, respectively. Gas incontinence was common in every age group. AI was associated with female gender, higher age group, urinary incontinence, the style of urination and defecation in female, and previous colorectal disease and/or surgery in male. FI was associated with urinary incontinence.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
13
|
Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC. Erratum for Questionnaire Survey of Bowel Habit in Japanese Medical Personnel. J Anus Rectum Colon 2021; 5:439. [PMID: 34746510 PMCID: PMC8553356 DOI: 10.23922/jarc.e001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
14
|
Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC. Questionnaire Survey of Bowel Habit in Japanese Medical Personnel. J Anus Rectum Colon 2021; 5:297-305. [PMID: 34395943 PMCID: PMC8321588 DOI: 10.23922/jarc.2021-014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aims to clarify the bowel habit, change of bowel movement throughout the cycle of menstruation, and toilet use in Japanese medical personnel. METHODS A questionnaire survey was completed by Japanese medical personnel after listening to lectures on bowel disorders. Constipation was defined according to Rome III criteria, whereas diarrhea was defined as Bristol stool form scale type 6 and 7. RESULTS In total, 463 persons (mean age, 35.6 years, range 20-91, male/female/no answer: 132/324/7) have completed the questionnaire. Constipation was significantly more often observed in females (male/female: 3%/31%, p > 0.001, Chi-squared test), while diarrhea was noted to be less in females (male/female: 1%/7%). Constipation was observed in 20% of participants in their 20s, and the constipation rate was observed to gradually increase with age. It was observed in 45% of participants in their 70s or older. Bowel movement changed to constipation around menstruation in 18% of females and changed to diarrhea in 43% of females. Constipation often occurred before menstruation and diarrhea during menstruation. Only 2% of participants used a Japanese-style toilet, and 5% of participants claimed that they were unable to pass a stool on a Japanese-style toilet. CONCLUSIONS Constipation was significantly more frequent in females and increased with age among female Japanese medical personnel. Change of bowel movement occurred in 61% of females around menstruation. Five percent of participants were unable to pass stools on a Japanese-style toilet.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
15
|
Matsuyama T, Tachi T, Katsuno H, Sugioka M, Aoyama S, Osawa T, Koyama A, Murayama A, Noguchi Y, Yasuda M, Mizui T, Goto C, Teramachi H. Effects of polypharmacy on the prevalence of adverse drug events resulting in outpatient visits and hospitalization. Pharmazie 2021; 76:279-286. [PMID: 34078523 DOI: 10.1691/ph.2021.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A high proportion of hospitalizations is attributable to the prevalence of adverse drug events. This retrospective study included outpatients and inpatients to determine the prevalence of adverse drug events and if polypharmacy increases it. The prevalence, classification, and causality of adverse drug events were assessed based on medical records, laboratory values, and other data. Multivariate analysis (multiple logistic regression analysis) was performed with the presence or absence of adverse drug events at the time of the visit as the dependent variable and items for which the P-value was <0.25 in the univariate analysis as independent variables. The prevalence of adverse drug events was 13.0%, 10.9%, and 16.0% among all patients, the outpatient group, and the inpatient group, respectively. Multivariate analysis showed that polypharmacy (≥5 drugs) significantly increased the risk of adverse drug events in all patients. The prevalence of adverse drug events significantly increased with each additional drug used. We expect that minimizing the number of medications through moderation of the number of prescription drugs and elimination of polypharmacy will reduce the number of outpatient visits and hospitalizations due to adverse drug events.
Collapse
Affiliation(s)
- T Matsuyama
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - T Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan; Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan;,
| | - H Katsuno
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - M Sugioka
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - S Aoyama
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - T Osawa
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - A Koyama
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - A Murayama
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Y Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - M Yasuda
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - T Mizui
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - C Goto
- Department of Pharmacy, Gifu Municipal Hospital, Gifu, Japan
| | - H Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan; Laboratory of Community Health Pharmacy, Gifu Pharmaceutical University, Gifu, Japan;,
| |
Collapse
|
16
|
Maeda K, Honda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC. Outcomes of Transvaginal Anterior Levatorplasty with Posterior Colporrhaphy for Symptomatic Rectocele. J Anus Rectum Colon 2021; 5:137-143. [PMID: 33937553 PMCID: PMC8084542 DOI: 10.23922/jarc.2020-062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
Objectives: To clarify the long-term outcomes of transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele with defecographic changes. Methods: Consecutive patients undergoing transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele were prospectively registered and retrospectively reviewed using medical records. Symptoms, fecal incontinence, and defecographic findings were evaluated before and after surgery. Results: Fifty-seven women (mean age, 68 years) were identified, and the median disease duration was 24 months. Symptoms of vaginal mass (n = 32) and difficult defecation (n = 21) disappeared (90.6% and 71.4%, respectively) or improved (6.3% and 28.6%, respectively) after surgery. However, the feeling of residual stool was unchanged in two of eight patients. Seventeen patients who performed digitation on defecation before surgery discontinued digitation after surgery. The proportion of patients who had fecal incontinence preoperatively (40.4%) decreased significantly after surgery (17.5%) during a median follow-up period of 47 months. Defecography revealed a disappearance or improvement of rectocele in all 18 patients examined. The average rectocele size decreased significantly in six improved patients (p = 0.0006, paired t-test). Conclusions: Transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele was a useful option to improve symptoms and anatomical disorders in the long term, but it had limitations in improving defecatory symptoms.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | | | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
17
|
Maeda K, Yamana T, Takao Y, Mimura T, Katsuno H, Seki M, Tsunoda A, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version. J Anus Rectum Colon 2021; 5:52-66. [PMID: 33537501 PMCID: PMC7843140 DOI: 10.23922/jarc.2020-057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
| |
Collapse
|
18
|
Maeda K, Katsuno H, Tsunoda A, Seki M, Takao Y, Mimura T, Yamana T, Yoshioka K. Japanese Practice Guidelines for Fecal Incontinence Part 3 -Surgical Treatment for Fecal Incontinence, Fecal Incontinence in a Special Conditions- English Version. J Anus Rectum Colon 2021; 5:84-99. [PMID: 33537503 PMCID: PMC7843139 DOI: 10.23922/jarc.2020-075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022] Open
Abstract
In Japan, the surgical treatment for fecal incontinence (FI) can be performed using minimally invasive surgery, such as anal sphincteroplasty and sacral neuromodulation (SNM), as well as antegrade continence enema (ACE), graciloplasty, and stoma construction. In addition, currently, several other procedures, including biomaterial injection therapy, artificial bowel sphincter (ABS), and magnetic anal sphincter (MAS), are unavailable in Japan but are performed in Western countries. The evidence level of surgical treatment for FI is generally low, except for novel procedures, such as SNM, which was covered by health insurance in Japan since 2014. Although the surgical treatment algorithm for FI has been chronologically modified, it should be sequentially selected, starting from the most minimally invasive procedure, as FI is a benign condition. Injuries to the neural system or spinal cord often cause disorders of the sensory and motor nerves that innervate the anus, rectum, and pelvic floor, leading to the difficulty in controlling bowel movement or FI and/or constipation. FI and constipation are closely associated; when one improves, the other tends to deteriorate. Patients with severe cognitive impairment may present with active soiling, referred to as "incontinence" episodes that occur as a consequence of abnormal behavior, and may also experience passive soiling.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
| |
Collapse
|
19
|
Maeda K, Mimura T, Yoshioka K, Seki M, Katsuno H, Takao Y, Tsunoda A, Yamana T. Japanese Practice Guidelines for Fecal Incontinence Part 2-Examination and Conservative Treatment for Fecal Incontinence- English Version. J Anus Rectum Colon 2021; 5:67-83. [PMID: 33537502 PMCID: PMC7843146 DOI: 10.23922/jarc.2020-079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Examination for fecal incontinence is performed in order to evaluate the condition of each patient. As there is no single method that perfectly assesses this condition, there are several tests that need to be conducted. These are as follows: anal manometry, recto anal sensitivity test, pudendal nerve terminal motor latency, electromyogram, anal endosonography, pelvic magnetic resonance imaging (MRI) scan, and defecography. In addition, the mental and physical stress most patients experience during all these examinations needs to be taken into consideration. Although some of these examinations mostly apply for patients with constipation, we hereby describe these tests as tools for the assessment of fecal incontinence. Conservative therapies for fecal incontinence include diet, lifestyle, and bowel habit modification, pharmacotherapy, pelvic floor muscle training, biofeedback therapy, anal insert device, trans anal irrigation, and so on. These interventions have been identified to improve the symptoms of fecal incontinence by determining the mechanisms resulting in firmer stool consistency; strengthening the pelvic floor muscles, including the external anal sphincter; normalizing the rectal sensation; or periodic emptying of the colon and rectum. Among these interventions, diet, lifestyle, and bowel habit modifications and pharmacotherapy can be performed with some degree of knowledge and experience. These two therapies, therefore, can be conducted by all physicians, including general practitioners and other physicians not specializing in fecal incontinence. However, patients with fecal incontinence who did not improve following these initial therapies should be referred to specialized institutions. Contrary to the initial therapies, specialized therapies, including pelvic floor muscle training, biofeedback therapy, anal insert device, and trans anal irrigation, should be conducted in specialized institutions as these require patient education and instructions based on expert knowledge and experience. In general, conservative therapies should be performed for fecal incontinence before surgery because its pathophysiologies are mostly attributed to benign conditions. All Japanese healthcare professionals who take care of patients with fecal incontinence are expected to understand the characteristics of each conservative therapy, so that appropriate therapies will be selected and performed. Therefore, in this chapter, the characteristics of each conservative therapy for fecal incontinence are described.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center Fujita Health University Hospital, Toyoake, Japan
| | - Toshiki Mimura
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Mihoko Seki
- Nursing Division, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yoshihiko Takao
- Division of Colorectal Surgery, Department of Surgery, Sanno Hospital, Tokyo, Japan
| | - Akira Tsunoda
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center, Tokyo, Japan
| |
Collapse
|
20
|
Tajima Y, Hanai T, Katsuno H, Masumori K, Koide Y, Ashida K, Matsuoka H, Hiro J, Endo T, Kamiya T, Chong Y, Maeda K, Uyama I. Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis. World J Surg Oncol 2021; 19:14. [PMID: 33441169 PMCID: PMC7807432 DOI: 10.1186/s12957-021-02121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis. Case presentation A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis. Conclusion Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.
Collapse
Affiliation(s)
- Yosuke Tajima
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Tsunekazu Hanai
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hidetoshi Katsuno
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Koji Masumori
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshikazu Koide
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Keigo Ashida
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Matsuoka
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Junichiro Hiro
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tomoyoshi Endo
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tadahiro Kamiya
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yongchol Chong
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
21
|
Maeda K, Katsuno H, Kono T. The Japanese Extracted Herbal Medicine Daikenchuto Increases the Contractile Activity of the Internal Anal Sphincter Muscle in Conscious Dogs. J Anus Rectum Colon 2020; 4:193-200. [PMID: 33134601 PMCID: PMC7595681 DOI: 10.23922/jarc.2020-041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Objectives: This study aimed to elucidate the effect of the extract of daikenchuto (DKT), a Japanese Kampo medicine, on the contractile activity of the internal anal sphincter in conscious dogs. Methods: Force transducers were attached to the serosal surface of the rectum and the internal anal sphincter of male beagle dogs. In addition, the contractile activity of the rectum and the internal anal sphincter was continuously measured until 6 h after DKT administration via telemetry in the conscious state. The DKT dose was 1.5 g/body, and the administration route was intrarectal in the expectation of a direct effect on the rectoanal region. DKT was re-administered to the same animal after drug withdrawal, and the plasma concentrations of hydroxy-α-sanshool (HAS) and hydroxy-β-sanshool (HBS) before and after administration were measured. Results: After DKT administration, the contractile activity of the internal anal sphincter immediately increased, peaked at 10 min, continued for ≥1 h, and had almost disappeared after 4 h. Rectal contraction differed from that of the internal anal sphincter, with no significant contraction observed. HAS and HBS were found in the plasma of animals administered with DKT and persisted up to 2 h after the administration. Conclusions: This is the first report on in vivo telemetry demonstrating that DKT exhibited contractile effects on the dog's internal anal sphincter. The increased anal pressure and improvement of fecal incontinence symptoms observed in previous clinical studies may have been based on this sphincter contraction.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Toru Kono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| |
Collapse
|
22
|
Maeda K, Koide Y, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo TS, Cheong YC. Transvaginal peritoneocele repair with anterior levatorplasty for patients with a rectocele and an enterocele. Surg Today 2020; 51:844-847. [PMID: 33030652 DOI: 10.1007/s00595-020-02161-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Enteroceles and rectoceles are often identified as the cause of a vaginal mass and pelvic discomfort. The combination of a rectocele and an enterocele as pelvic organ prolapses is not infrequent; however, there are few reports on possible simultaneous treatments of these two conditions. We report a new and simple procedure for repairing an enterocele during a transvaginal anterior levatorplasty with posterior colporrhaphy for a rectocele repair. This technique involves making an excision in the peritoneal sac, with high ligation, and attaching the uterine cervix and/or cardinal ligament to the upper most part of the approximation of the levator muscles, to reinforce and lift the deep peritoneal sac. This procedure allows for transvaginal repair of both an enterocele and a rectocele. The enterocele is visualized by applying barium to the posterior vaginal wall during defecography.
Collapse
Affiliation(s)
- Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyo Shi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
23
|
Yokoi K, Nakajima Y, Matsuoka H, Shinkai Y, Ishihara T, Maeda Y, Kato T, Katsuno H, Masumori K, Kawada K, Yoshikawa T, Ito T, Kurahashi H. Impact of DPYD, DPYS, and UPB1 gene variations on severe drug-related toxicity in patients with cancer. Cancer Sci 2020; 111:3359-3366. [PMID: 32619063 PMCID: PMC7469832 DOI: 10.1111/cas.14553] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
Cancer treatment with a fluoropyrimidine (FP) is often accompanied by severe toxicity that may be dependent on the activity of catalytic enzymes encoded by the DPYD, DPYS, and UPB1 genes. Genotype-guided dose individualization of FP therapy has been proposed in western countries, but our knowledge of the relevant genetic variants in East Asian populations is presently limited. To investigate the association between these genetic variations and FP-related high toxicity in a Japanese population, we obtained blood samples from 301 patients who received this chemotherapy and sequenced the coding exons and flanking intron regions of their DPYD, DPYS, and UPB1 genes. In total, 24 single nucleotide variants (15 in DPYD, 7 in DPYS and 2 in UPB1) were identified including 3 novel variants in DPYD and 1 novel variant in DPYS. We did not find a significant association between FP-related high toxicity and each of these individual variants, although a certain trend toward significance was observed for p.Arg181Trp and p.Gln334Arg in DPYS (P = .0813 and .087). When we focused on 7 DPYD rare variants (p.Ser199Asn, p.IIe245Phe, p.Thr305Lys, p.Glu386Ter, p.Ser556Arg, p.Ala571Asp, p.Trp621Cys) which have an allele frequency of less than 0.01% in the Japanese population and are predicted to be loss-of-function mutations by in silico analysis, the group of patients who were heterozygous carriers of at least one these rare variants showed a strong association with FP-related high toxicity (P = .003). Although the availability of screening of these rare loss-of-function variants is still unknown, our data provide useful information that may help to alleviate FP-related toxicity in Japanese patients with cancer.
Collapse
Affiliation(s)
- Katsuyuki Yokoi
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Yoko Nakajima
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Gastrointestinal Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yasuko Shinkai
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital Gifu University, Gifu, Japan
| | - Yasuhiro Maeda
- Center for Joint Research Facilities Support, Fujita Health University, Toyoake, Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| | - Hidetoshi Katsuno
- Department of Gastrointestinal Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Gastrointestinal Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Kawada
- Department of Medical Oncology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tetsuya Ito
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Japan
| |
Collapse
|
24
|
Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC, Uyama I. Outcomes of stapler repair with anastomosis for stoma prolapse. Surg Today 2020; 51:226-231. [PMID: 32656699 DOI: 10.1007/s00595-020-02076-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The published data on the outcomes of an operative repair for stoma prolapse are limited. This study aimed to clarify the long-term outcomes of stapler repair with anastomosis for stoma prolapse. METHODS Twenty-four patients (15 men, median age 64 years, range 33-88 years) undergoing 25 stapler repairs with anastomosis were prospectively registered, and their medical records were retrospectively reviewed. RESULTS The median length of prolapse was 10 cm (range 5-22). Stoma prolapse repair was performed by means of 16 loop colostomies, four end colostomies, three loop ileostomies, and one end ileostomy. A stapler was used 4.6 times on average (range 4-8). The average operative time and bleeding were 40.8 (range 15-75) min and 40 (range 0-214) mL, respectively. No mortality and morbidity were observed after surgery. A recurrence of stoma prolapse was reported in only one of 25 repairs (4%) at the proximal limb of loop ileostomy during a median follow-up period of 1 year (range 1-120 months). However, a new stoma prolapsed in one untreated limb of loop stoma. CONCLUSIONS Stapler repair with anastomosis is a safe and minimally invasive treatment option for stoma prolapse with a low recurrence. However, the effectiveness of reparing stoma prolapse on the proximal limb of loop ileostomy might be limited.
Collapse
Affiliation(s)
- Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center Fujita, Health University Hospital, 1-98, Kutsukake, Toyoake, 470-1192, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
25
|
Maeda K, Koide Y, Katsuno H, Matsuoka H. Malignant potential of multiple rectal carcinoid tumors measuring ≤10 mm. Asian J Surg 2020; 43:1033-1034. [PMID: 32631622 DOI: 10.1016/j.asjsur.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Japan.
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Japan.
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Japan.
| |
Collapse
|
26
|
Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC, Uyama I. Exfoliated cancer cells during intersphincteric resection for very low rectal cancer. Surg Today 2020; 50:1652-1656. [PMID: 32617675 DOI: 10.1007/s00595-020-02064-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the frequency of exfoliated cancer cells and the efficacy of rectal washout during intersphincteric resection (ISR) in patients not receiving chemoradiotherapy (CRT) for very low rectal cancer. METHOD The subjects of this prospective study were 16 consecutive patients who underwent ISR without CRT for very low rectal cancer. Brushing cytology of the posterior anorectal wall was performed twice in each step of the ISR procedure and the samples were sent for blind cytological examination to identify exfoliated cancer cells. RESULTS Exfoliated cancer cells were identified in 9 of 13 patients (69%) preoperatively. The number of cancer cells identified after abdominal total mesorectal dissection decreased significantly from 94% (15/16) to 25% (4/16) after transanal irrigation with 2000 mL saline (p < 0.001). No cancer cells were identified after swabbing the anal wall following transanal dissection with purse-string closure of the distal stump. No suture-line recurrence was found during a median follow-up duration of 6 years. CONCLUSION Exfoliated cancer cells, confirmed in 94% of patients after total mesorectal excision, could be eliminated by performing rectal irrigation after clamping the rectum proximal to the tumor and swabbing the anorectal wall during ISR.
Collapse
Affiliation(s)
- Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
27
|
Katsuno H, Hanai T, Masumori K, Koide Y, Ashida K, Matsuoka H, Tajima Y, Endo T, Mizuno M, Cheong Y, Maeda K, Uyama I. Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature. J Anus Rectum Colon 2020; 4:14-24. [PMID: 32002472 PMCID: PMC6989125 DOI: 10.23922/jarc.2019-037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincter-preserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and long-term oncological outcomes, lateral lymph node dissection, and the cost of the procedure.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Keigo Ashida
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Masahiro Mizuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yeongcheol Cheong
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| |
Collapse
|
28
|
Matsuoka H, Morise Z, Tanaka C, Hayashi T, Ikeda Y, Maeda K, Masumori K, Koide Y, Katsuno H, Tanahashi Y, Nakajima S, Hanai T, Kato Y, Sugioka A, Uyama I. Repeat hepatectomy with systemic chemotherapy might improve survival of recurrent liver metastasis from colorectal cancer-a retrospective observational study. World J Surg Oncol 2019; 17:33. [PMID: 30770753 PMCID: PMC6377761 DOI: 10.1186/s12957-019-1575-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although hepatectomy for metastatic colorectal cancer (mCRC) prolongs survival in up to 40% of people, recurrence rates approach 70%. We used a multidisciplinary approach to treat recurrent liver metastases, including chemotherapy, surgery, and palliative care. On the other hand, development of chemotherapeutic agents is remarkable and improves long-term survival. However, whether chemotherapy and repeat hepatectomy combination therapy improve survival or not is still unclear. The aim of this study was to analyze the outcomes of repeat hepatectomy with systemic chemotherapy for mCRC. METHODS Following Institutional Review Board approval, we reviewed the records of all patients who underwent hepatectomy for mCRC between 1974 and 2015 at Fujita Health University Hospital. We used the Kaplan-Meier method to estimate overall survival from the first and last hepatectomy in multi hepatectomy cases after 2005 and compared outcomes between groups using the log-rank test. RESULTS A total of 426 liver resections were performed for mCRC; of these, 236 cases were performed after 2005 (late group). In 118 (50%) cases, the site of recurrence was the liver, 59 (50%) underwent repeat hepatectomy, and 14 cases had ≥ 2 repeat hepatectomies. Overall survival (OS) before and after 2005 was 42.2 and 64.1 months, respectively, with the late group having better OS compared to the early (1974-2004) group. OS for single hepatectomy cases was 83.2 months, for two hepatectomies was 42.9 months, and for three hepatectomies was 35.3 months. In total, 59 patients did not undergo surgery after recurrence with an OS of 28.7 months. Mortality of the second and third repeat hepatectomy was 1.7% and 15.3%, respectively. CONCLUSION Repeat hepatectomy with systemic chemotherapy for mCRC is feasible and might achieve improved survival in carefully selected patients.
Collapse
Affiliation(s)
- Hiroshi Matsuoka
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Zenichi Morise
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Chihiro Tanaka
- College of Pharmacy, Kinjo Gakuin University, 2-1723 Oomori Moriyama, Nagoya City, Aichi 463-8521 Japan
| | - Takahiro Hayashi
- College of Pharmacy, Kinjo Gakuin University, 2-1723 Oomori Moriyama, Nagoya City, Aichi 463-8521 Japan
| | - Yoshiaki Ikeda
- College of Pharmacy, Kinjo Gakuin University, 2-1723 Oomori Moriyama, Nagoya City, Aichi 463-8521 Japan
| | - Koutarou Maeda
- Fujita Health University Hospital International Medical Center, 1-98 Dengakugakubo Kutsukake-cho, Toyoake city, Aichi 470-1192 Japan
| | - Koji Masumori
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Yoshikazu Koide
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Hidetoshi Katsuno
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Yoshinao Tanahashi
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Sanae Nakajima
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Tsunekazu Hanai
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Yutaro Kato
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Atsushi Sugioka
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| | - Ichiro Uyama
- Department of Surgery Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake City, Aichi 470-1192 Japan
| |
Collapse
|
29
|
Matsuoka H, Nakagawa M, Hanai T, Masumori K, Koide Y, Katsuno H, Endo T, Mizuno M, Chong Y, Maeda K, Tsukamoto T, Uyama I. A case of locally advanced adenosquamous carcinoma of the cecum with long-term survival. Fujita Med J 2019; 5:107-109. [PMID: 35111512 PMCID: PMC8766237 DOI: 10.20407/fmj.2019-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022]
Abstract
A 63-year-old woman was admitted to our hospital with a right lower abdominal mass and general fatigue. Preoperative examination suggested a large ovarian tumor or cecal carcinoma. However, her intraoperative diagnosis was colon cancer; we therefore performed an ileocecal resection with oophorectomy. The tumor was pathologically diagnosed as adenosquamous carcinoma T4bN1M-stage IIIa. We administrated CapeOX adjuvant chemotherapy for 6 months. Adenosquamous carcinoma is extremely rare, at around 0.1% of all colorectal cancers, and usually has a poor prognosis. The patient is still alive without recurrence after 84 post-operative months, even with later developments of metachronous early colorectal cancer and breast cancer. We herein report a rare case of cecal ASC with good prognosis.
Collapse
Affiliation(s)
- Hiroshi Matsuoka
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Mitsuru Nakagawa
- Department of Pathology, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Tsunekazu Hanai
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Koji Masumori
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Yoshikazu Koide
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Hidetoshi Katsuno
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Tomoyoshi Endo
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Masahiro Mizuno
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Yongchol Chong
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Koutarou Maeda
- International Medical Center, Fujita Health University Hospital,
Toyoake, Aichi, Japan
| | - Testuya Tsukamoto
- Department of Pathology, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Ichiro Uyama
- Departments of Surgery, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
30
|
Tahara S, Sakai Y, Katsuno H, Urano M, Kuroda M, Tsukamoto T. Pneumatosis intestinalis and hepatic portal venous gas associated with gas-forming bacterial translocation due to postoperative paralytic ileus: A case report. Medicine (Baltimore) 2019; 98:e14079. [PMID: 30633214 PMCID: PMC6336625 DOI: 10.1097/md.0000000000014079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially lethal conditions in which gas pathologically accumulates in the portal vein and intestinal wall, respectively. Proposed mechanisms include flatus escaping through an injured intestinal mucosa into the submucosa and thence into the portal venous system, or bacterial translocation (BT) of gas-forming enteric microorganisms from the gut into and through the intestinal wall to other organs. However, there has been no clear histopathological evidence to support these hypotheses. PATIENT CONCERNS A 61-year-old man underwent sigmoidectomy for colonic adenocarcinoma. Postoperatively, he developed paralytic ileus and then had a sudden cardiopulmonary arrest. DIAGNOSES PI and HPVG were found at autopsy, presumably caused by the postoperative paralytic ileus and associated with BT of gas-forming organisms. INTERVENTIONS Cardiopulmonary resuscitation was unsuccessful. OUTCOMES Postmortem imaging indicated the presence of massive PI and HPVG. At autopsy, there was marked intestinal emphysema with diffuse ischemic mucosal necrosis and severe pneumatosis in the stomach and intestine and marked gaseous dilation of the intrahepatic portal veins. Postmortem bacterial cultures revealed enteric bacteria in the peripheral blood and liver tissue. LESSONS Postoperative ileus leading to intestinal mucosal damage may be associated with BT of gas-forming enteric bacteria and the rapid onset of PI and HPVG with a lethal outcome.
Collapse
Affiliation(s)
| | | | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | | | | |
Collapse
|
31
|
Ino Y, Tachi T, Ueno A, Otsubo M, Katsuno H, Noguchi Y, Sakai C, Iguchi K, Kawakami C, Fujisaki K, Teramachi H. Clinic-level factors associated with collaboration with community pharmacies in Japan. Pharmazie 2018; 73:545-552. [PMID: 30223940 DOI: 10.1691/ph.2018.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The aim of this study was to clarify the clinic-level factors related to experiences of and attitudes toward collaboration with community pharmacies. We conducted a postal questionnaire survey of all clinics in Gifu, Japan, assessing the experiences and attitudes of representative clinical staff regarding the following activities in collaboration with community pharmacists: regional care meetings/service adjustment meetings, case study conferences, joint workshops/continuing education conferences, community services, information sharing through medical cooperation networks, and accompanying community pharmacists during home care. The factors significantly related to experiences of joint workshops/continuing education conferences included home care visits (odds ratio [OR] 2.39) and a 100 % out-of-hospital prescription ratio (OR 4.80). In contrast, only home care visits were significantly associated with consideration of information sharing through medical cooperation networks and accompanying community pharmacists during home care (OR 2.06 and 11.91, respectively). Finally, the factors significantly associated with considering implementing case study conferences and joint workshops/continuing education conferences included home care visits (OR 4.64 and 2.98, respectively) and a 100% out-of-hospital prescription ratio (OR 4.64 and 6.38). Overall, having more opportunities to communicate with community pharmacists and other healthcare professionals appeared to facilitate clinics' consideration of collaboration with community pharmacies, along with actual experiences.
Collapse
|
32
|
Yamaguchi T, Gotoh Y, Hattori H, Katsuno H, Imaizumi K. Gastrointestinal perforation during treatment with erlotinib plus bevacizumab in two patients with non-small cell lung cancer exhibiting epidermal growth factor receptor mutations: A case report. Oncol Lett 2018; 16:1046-1050. [PMID: 29963181 DOI: 10.3892/ol.2018.8708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/07/2017] [Indexed: 12/14/2022] Open
Abstract
A previous randomized phase II study in patients with non-small cell lung cancer (NSCLC) identified that combination treatment with erlotinib plus bevacizumab prolonged progression-free survival compared with erlotinib alone. However, combination bevacizumab and erlotinib treatment generally increased the risk of severe adverse events, including hemorrhage, thrombosis, fistula formation and gastrointestinal perforation. The present report describes two patients with NSCLC harboring epidermal growth factor receptor (EGFR) mutations, who experienced gastrointestinal perforation associated with erlotinib plus bevacizumab combination therapy. The first patient, a 67-year-old male with stage IIIB lung adenocarcinoma harboring a L858R point mutation in EGFR exon 21, received concurrent chemoradiotherapy. However, seven months later, the patient experienced a relapse and was administered erlotinib plus bevacizumab treatment. A total of two months subsequent to commencing treatment, the patient developed a perforated duodenal ulcer. The second patient, a 66-year-old male with lung adenocarcinoma harboring a deletion in EGFR exon 19 and multiple pulmonary metastases, demonstrated a partial response to erlotinib plus bevacizumab treatment. A total of seven months subsequent to starting treatment, the patient experienced lower abdominal pain, and abdominal computed tomography confirmed a diagnosis of colocutaneous fistula complicating sigmoid diverticulitis. Following repair of the perforation, both patients were restarted on erlotinib treatment alone. Gastrointestinal perforation may be a potentially severe adverse event of erlotinib plus bevacizumab combination therapy, even in the absence of tumor metastasis in the abdomen.
Collapse
Affiliation(s)
- Teppei Yamaguchi
- Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Yusuke Gotoh
- Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan
| |
Collapse
|
33
|
Koide Y, Maeda K, Hanai T, Masumori K, Matuoka H, Katsuno H, Endo T, Shiota M, Mizuno M, Cheong YC. Successful repair of a rectovaginal fistula caused by a tension-free vaginal mesh (TVM): a case report. J Anus Rectum Colon 2018; 2:66-69. [PMID: 31583323 PMCID: PMC6768818 DOI: 10.23922/jarc.2017-041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/21/2017] [Indexed: 12/27/2022]
Abstract
Rectovaginal fistula caused by a tension-free vaginal mesh (TVM) is a rare condition. Moreover, a rectovaginal fistula is a challenging issue to address for surgeons regardless of causes. Due to a low rate of occurrence, treatment modality for a rectovaginal fistula caused by a TVM has previously received little attention. A successful surgery using several key techniques to address a rectovaginal fistula caused by a TVM is herein reported. A 78-year-old woman who underwent a TVM for a rectocele three months ago was referred to our hospital with a two-month history of anal bleeding. Mesh protruding into both the vagina and the rectum was confirmed. The patient was operated on under diagnosis of a rectovaginal fistula caused by TVM. TVM was removed by transvaginal dissection of the rectovaginal septum with division of both anterior and posterior arms of the TVM. Layer-to-layer sutures of rectal and vaginal walls were crossly performed with a drain placed in the rectovaginal septum after saline irrigation followed by a covering sigmoid colostomy. The wound healed without infection after surgery, and a water-soluble contrast enema demonstrated the healing of the rectovaginal fistula two months after surgery. No recurrent fistula was confirmed 15 months after stoma closure.
Collapse
Affiliation(s)
- Yoshikazu Koide
- International Medical Center, Fujita Health University Hospital
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine
| | - Hiroshi Matuoka
- Department of Surgery, Fujita Health University School of Medicine
| | | | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University School of Medicine
| | - Miho Shiota
- Department of Surgery, Fujita Health University School of Medicine
| | - Masahiro Mizuno
- Department of Surgery, Fujita Health University School of Medicine
| | | |
Collapse
|
34
|
Matsuoka H, Maeda K, Hanai T, Sato H, Masumori K, Koide Y, Katsuno H, Endo T, Shiota M, Sugihara K. Surgical management of colorectal cancer for the aging population—A survey by the Japanese Society for Cancer of Colon and Rectum. Asian J Surg 2018; 41:192-196. [DOI: 10.1016/j.asjsur.2016.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023] Open
|
35
|
Kono T, Shimada M, Nishi M, Morine Y, Yoshikawa K, Katsuno H, Maeda K, Koeda K, Morita S, Watanabe M, Kusano M, Sakamoto J, Saji S, Sokuoka H, Ohtake Y, Sato Y, Kanematsu T, Kitajima M. Efficacy of daikenchuto for the intestinal hypomotility after open abdominal surgery: A pooled analysis of three randomized controlled trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
801 Background: Postoperative intestinal hypomotility (IH) is very common after open abdominal (OAS) surgery. Although several advances have been made in medical therapy, very few recognized treatment or prevention methods are currently available. Daikenchuto (DKT), a traditional Japanese prescribed medicine, peripherally stimulates the neurogenic pathway, attempted to reduce postoperative IH in three exploratory randomized controlled trials (RCT). For further analysis of whether DKT accelerates IH recovery after scheduled OAS we conducted a pooled analysis of three RCTs. Methods: A pooled retrospective subset analysis of OAS patients with colon, liver, or gastric cancer in DKT RCTs was performed; RCTs were supported by the Japanese Foundation for Multidisciplinary Treatment of Cancer (JFMC). Among all patients enrolled and randomized in the three RCTs (JFMC project numbers 39-0902, 40-1001, and 42-1002), 740 patients who were eligible were included for the efficacy analysis. The modified intent-to-treat population was 410 patients, who did not have their bowel movement before the first meal; these patients were randomized to receive either 5 g DKT (n = 214) or placebo (n = 196) orally, three times a day for up to 12 days. The primary end point of each trial was the time from the end of the surgery (extubation) to the first bowel movement; this was assessed using survival analysis. Results: Compared with the placebo group, the time from the end of the surgery to the first bowel movement was accelerated in the DKT group (p = 0.004, hazard ratio;1.337 (95% CI 1.096-1.631)), with a difference of median 14.8 h. The tolerability profiles were similar in both the groups. Conclusions: Compared with the placebo, DKT was well tolerated, and it significantly accelerated IH recovery in patients who underwent OAS. Clinical trial information: UMIN000026292.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Koutarou Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | | | - Satoshi Morita
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Hiroki Sokuoka
- Public Interest Incorporated Foundation, Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Yuya Ohtake
- Public Interest Incorporated Foundation, Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | - Yasuto Sato
- Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masaki Kitajima
- International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
36
|
Higashi D, Katsuno H, Kimura H, Takahashi K, Ikeuchi H, Kono T, Nezu R, Hatakeyama K, Kameyama H, Sasaki I, Fukushima K, Watanabe K, Kusunoki M, Araki T, Maeda K, Kameoka S, Itabashi M, Nakao S, Maeda K, Ohge H, Watadani Y, Watanabe T, Sunami E, Hotokezaka M, Sugita A, Funayama Y, Futami K. Current State of and Problems Related to Cancer of the Intestinal Tract Associated with Crohn's Disease in Japan. Anticancer Res 2016; 36:3761-3766. [PMID: 27354651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Cancer of the intestinal tract (small and large intestine) associated with Crohn's disease has a low incidence but can be fatal if it develops. Thus, the key question is how to deal with this type of cancer. The current study surveyed major medical facilities that treat inflammatory bowel disease (IBD) surgically in Japan in order to examine the clinical features of cancer of the intestinal tract associated with Crohn's disease and explore ways to deal with this cancer in the future. PATIENTS AND METHODS Sixteen major medical facilities that treat IBD surgically were surveyed regarding cancer of the intestinal tract associated with Crohn's disease. The medical facilities had treated 3,454 patients with Crohn's disease, 122 of whom had developed intestinal cancer. The medical facilities were surveyed regarding those 122 patients. RESULTS The incidence of intestinal cancer associated with Crohn's disease has increased yearly. Cancer most often developed in the left side of the colon and, particularly, in the rectum and anal canal. Seventy-six percent of cases were diagnosed preoperatively, 4% were diagnosed intraoperatively, while the remaining 20% were diagnosed pathologically after surgery. The most prevalent histological type of cancer was mucinous carcinoma (50%). Forty-two percent of cancers were differentiated, with 4% being poorly differentiated. The surgical procedure performed most often (67%) was abdominoperineal resection. The 5-year survival rate by stage was 88% for Stage I, 68% for Stage II, 71% for Stage IIIa, 25% for Stage IIIb and 0% for Stage IV. Overall, the 5-year survival rate was 52%. CONCLUSION Gastrointestinal (GI) cancer associated with Crohn's disease had an incidence of 3.5%, but also involved a poor prognosis with a 5-year survival rate of 52%. Early detection through surveillance is crucial to improving the prognosis for patients. However, surveillance of the intestinal tract with endoscopy or contrast studies is technically and diagnostically hampered by Crohn's disease and intestinal strictures. A biopsy of the anal canal, a common site of cancer, can readily be performed and constitutes the first step in surveillance.
Collapse
Affiliation(s)
- Daijiro Higashi
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| | | | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease Surgery, Hyogo College of Medicine, Nishonomiya, Japan
| | - Toru Kono
- Advanced Surgery Center Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Riichiro Nezu
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Katsuyoshi Hatakeyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Iwao Sasaki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kouhei Fukushima
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masato Kusunoki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kiyoshi Maeda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shingo Kameoka
- Department of Surgery 2, Tokyo Women's Medical University, Tokyo, Japan
| | - Michio Itabashi
- Department of Surgery 2, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayumi Nakao
- Department of Surgery 2, Tokyo Women's Medical University, Tokyo, Japan
| | - Koutaro Maeda
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Hiroki Ohge
- Department of Surgery, Hiroshima University, Hiroshima, Japan
| | - Yusuke Watadani
- Department of Surgery, Hiroshima University, Hiroshima, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | - Eiji Sunami
- Department of Surgical Oncology and Vascular Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Akira Sugita
- Inflammatory Bowel Disease Center, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yuji Funayama
- Coloproctology Center, Tohoku Rosai Hospital, Sendai, Japan Department of Surgery, Sendai Red Cross Hospital, Sendai, Japan
| | - Kitaro Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino, Japan
| |
Collapse
|
37
|
Kono T, Fichera A, Maeda K, Sakai Y, Ohge H, Krane M, Katsuno H, Fujiya M. Kono-S Anastomosis for Surgical Prophylaxis of Anastomotic Recurrence in Crohn's Disease: an International Multicenter Study. J Gastrointest Surg 2016; 20:783-90. [PMID: 26696531 DOI: 10.1007/s11605-015-3061-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The Kono-S (antimesenteric functional end-to-end handsewn) anastomosis has been used for Crohn's disease in Japan and the USA since 2003 and 2010, respectively. This technique was designed to reduce the risk of anastomotic surgical recurrence. This study reviews the outcomes a decade after the introduction of the Kono-S anastomosis to clinical practice. METHODS This study was conducted at five hospitals (four in Japan and one in the USA). A total of 187 patients in Japan (144 patients, group J) and the USA (43 patients, group US) who underwent Kono-S anastomosis for Crohn's disease between September 2003 and September 2011 were included. RESULTS With a median follow-up of 65 months, two surgical anastomotic recurrences have occurred in group J. Kaplan-Meier analysis showed that 5 and 10 years surgical recurrence-free survival rate was 98.6% in group J. No surgical anastomotic recurrences have been detected in group US with a median follow-up of 32 months. The Kono-S anastomosis was technically feasible and performed in all patients. CONCLUSION The Kono-S anastomosis appears to be safe and effective in reducing the risk of surgical recurrence in Crohn's disease.
Collapse
Affiliation(s)
- Toru Kono
- Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, 3-1, N 33, E 14, Higashi-ku, Sapporo, Hokkaido, 065-0033, Japan.
| | - Alessandro Fichera
- Division of General Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Koutarou Maeda
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Mukta Krane
- Division of General Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| |
Collapse
|
38
|
Katsuno H, Maeda K, Ohya M, Yoshioka K, Tsunoda A, Koda K, Matsuoka H, Ohge H, Morita S, Saji S, Kanematsu T, Kitajima M. Clinical pharmacology of daikenchuto assessed by transit analysis using radiopaque markers in patients with colon cancer undergoing open surgery: a multicenter double-blind randomized placebo-controlled study (JFMC39-0902 additional study). J Gastroenterol 2016; 51:222-9. [PMID: 26162646 DOI: 10.1007/s00535-015-1100-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/21/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND This exploratory trial was conducted to investigate whether daikenchuto accelerates the recovery of gastrointestinal function in patients undergoing open surgery for sigmoid or rectosigmoid cancer. METHODS Eighty-eight patients who underwent colectomy at one of the 11 clinical trial sites in Japan from January 2009 to June 2011 were registered in the study. Patients received either placebo or daikenchuto (15.0 g/day, 5 g three times a day) from postoperative day 2 to postoperative day 8. The study end points included the gastrointestinal tract transit time evaluated with radiopaque markers and the time to first flatus. The safety profile of daikenchuto was also evaluated until postoperative day 8. RESULTS Seventy-one patients (daikenchuto, n = 38; placebo, n = 33) were statistically analyzed. Although the number of radiopaque markers in the anal side of the small intestine at 6 h was significantly greater in the daikenchuto group than in the placebo group (15.19 vs 10.06, p = 0.008), the total transit analysis results and the mean time to first flatus did not differ significantly between the two groups. CONCLUSIONS Daikenchuto has a positive effect on the resolution of delayed gastric emptying, but has a limited effect on the resolution of postoperative paralytic ileus after open surgery in patients with sigmoid or rectosigmoid cancer. Daikenchuto may contribute to early oral intake in the postoperative course.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University School of Medicine, Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Koutarou Maeda
- Department of Surgery, Fujita Health University School of Medicine, Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masatoshi Ohya
- Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University Takii Hospital, Moriguchi, Japan
| | - Akira Tsunoda
- Department of Surgery, Kameda Medical Center, Kamogawa, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | | | - Hiroki Ohge
- Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, Tokyo, Japan
| | | | - Masaki Kitajima
- International University of Health and Welfare, Otawara, Japan
| |
Collapse
|
39
|
Hanai T, Maeda K, Masumori K, Katsuno H, Matsuoka H. Technique of Robotic-assisted Total Proctocolectomy with Lymphadenectomy and Ileal Pouch-Anal Anastomosis for Transverse Colitic Cancer of Ulcerative Colitis, Using the Single Cart Position. Surg Technol Int 2015; 27:86-92. [PMID: 26680383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Robotic surgery offers advantages for operating in a narrow space such as inside the pelvis. We report on the technique of robotic-assisted laparoscopic total proctocolectomy with lymphadenectomy and ileal pouch-anal anastomosis for ulcerative colitis with transverse colitic cancer, using the single cart position. A 46-year-old female patient was diagnosed with colitic cancer of the transverse colon during the surveillance of ulcerative colitis. Six port sites were used. Mobilization of the left-sided colon through to the rectum and mobilization of the transverse colon with lymphadenectomy around the middle colic artery were performed using the robotic surgical system. After rectal mobilization was conducted near the anus, the right side of the colon was mobilized and the ileum resected laparoscopically. Thereafter, a mucosectomy of the proctorectum was carried out through a trans-anal approach, and a hand-sewn J-pouch was performed. Finally, a diverting ileostomy was constructed through the right lower abdomen. The operative time was 460 minutes, including the console time of 361 minutes. The amount of blood loss was 76 g. The patient was discharged on postoperative day nine. Pathological results demonstrated that the depth of the lesion was T3, and the positive lymph node was 1 of 115 retrieved lymph nodes. There were no complications or mortality. Robotic-assisted total proctocolectomy and lymphadenectomy with ileal pouch-anal anastomosis for transverse colitic cancer of ulcerative colitis was performed safely using the single cart position.
Collapse
Affiliation(s)
- Tsunekazu Hanai
- Gastrointestinal Surgery, Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koutarou Maeda
- Gastrointestinal Surgery, Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koji Masumori
- Gastrointestinal Surgery, Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Hidetoshi Katsuno
- Gastrointestinal Surgery, Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroshi Matsuoka
- Gastrointestinal Surgery, Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
40
|
Maeda K, Koide Y, Hanai T, Sato H, Masumori K, Matsuoka H, Katsuno H. The long-term outcome of transvaginal anterior levatorplasty for intractable rectovaginal fistula. Colorectal Dis 2015; 17:1002-6. [PMID: 25891199 DOI: 10.1111/codi.12977] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/16/2015] [Indexed: 02/08/2023]
Abstract
AIM Several procedures have been described for rectovaginal fistula with a wide range of success, but there is little information on the long-term outcome. The aim of the present study was to investigate the long-term outcome after transvaginal anterior levatorplasty (ALP) for intractable rectovaginal fistula. METHOD Data of 16 consecutive patients undergoing transvaginal ALP with fistulectomy and closure of the rectum and vagina between 1998 and 2011 were prospectively recorded and retrospectively investigated to study the long-term outcome. RESULTS Birth injury (n = 7), low anterior resection for rectal cancer (n = 3), pouch surgery for ulcerative colitis (n = 2) and a procedure for prolapse and haemorrhoids (n = 2) were the main causes of the fistula. Nine patients had a covering stoma before surgery. All patients underwent ALP, with a covering stoma in two patients. Infection occurred in one patient and wound rupture after surgery in another patient. These patients underwent reoperation by ALP. All fistulae had healed at a median follow-up of 84 (8-193) months after initial surgery or stoma closure. CONCLUSION Transvaginal ALP is effective for the treatment of mid or low rectovaginal fistula. The results show that a graft is not necessary regardless of whether or not previous surgery has been performed.
Collapse
Affiliation(s)
- K Maeda
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Y Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - T Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - H Sato
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - K Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - H Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - H Katsuno
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
41
|
Katsuno H, Shiomi A, Ito M, Koide Y, Maeda K, Yatsuoka T, Hase K, Komori K, Minami K, Sakamoto K, Saida Y, Saito N. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients. Surg Endosc 2015; 30:2848-56. [PMID: 26487228 DOI: 10.1007/s00464-015-4566-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND This observational study was conducted to compare the rate of symptomatic anastomotic leakage (AL), as defined by precise criteria, between laparoscopic and open surgery in patients with mid-to-low rectal cancer using a relatively novel statistical technique. METHODS A total of 1014 consecutive low anterior resection (LAR) patients were registered, of whom 936 were included in this prospective, multicenter, and cohort study (UMIN-CTR, Number 000004017). Patients with rectal cancer within 10 cm from the anal verge underwent either open or laparoscopic LAR at one of the 40 institutions in Japan from June 2010 to February 2013. The primary endpoint of this study was to compare the rate of symptomatic AL between the two groups before and after propensity score matching (PSM). The secondary endpoint was to analyze the risk factors for symptomatic AL in open and laparoscopic surgery. RESULTS After PSM, the incidence of symptomatic AL in open and laparoscopic surgery was 12.4 and 15.3 %, respectively (p = 0.48). AL requiring relaparotomy occurred after 3.8 % of open surgeries and 6.2 % of laparoscopic surgeries (p = 0.37). Multivariate analysis identified male gender as an independent risk factor for symptomatic AL following laparoscopic surgery (p = 0.001; odds ratio 5.2; 95 % CI 2.0-13.8), and male gender (p = 0.004; odds ratio 2.6; 95 % CI 1.3-5.6), tumor size (p = 0.002; odds ratio 1.2; 95 % CI 0.7-0.9), and number of stapler firing (p = 0.04; odds ratio 4.1; 95 % CI 1.0-15.0) following open surgery. CONCLUSION The rate of symptomatic AL was comparable following laparoscopic and open LAR in this large, multicenter, cohort study after PSM. Male gender was associated with an increased risk of symptomatic AL after laparoscopic LAR.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Departments of Surgery, Fujita Health University School of Medicine, Hidetoshi Katsuno Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Akio Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masaaki Ito
- Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yoshikazu Koide
- Departments of Surgery, Fujita Health University School of Medicine, Hidetoshi Katsuno Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koutarou Maeda
- Departments of Surgery, Fujita Health University School of Medicine, Hidetoshi Katsuno Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | | | - Kazuo Hase
- Departments of Surgery, National Defence Medical College Hospital, Saitama, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Toyoake, Aichi, Japan
| | - Kazuhito Minami
- Division of Colorectal Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | | | - Yoshihisa Saida
- Departments of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Norio Saito
- Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
42
|
Katsuno H, Maeda K, Kaiho T, Kunieda K, Funahashi K, Sakamoto J, Kono T, Hasegawa H, Furukawa Y, Imazu Y, Morita S, Watanabe M. Clinical efficacy of Daikenchuto for gastrointestinal dysfunction following colon surgery: a randomized, double-blind, multicenter, placebo-controlled study (JFMC39-0902). Jpn J Clin Oncol 2015; 45:650-6. [PMID: 25972515 PMCID: PMC4485603 DOI: 10.1093/jjco/hyv056] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022] Open
Abstract
Objective This exploratory trial was performed to determine whether Daikenchuto accelerates recovery of gastrointestinal function in patients undergoing open colectomy for colon cancer. Methods A total of 386 patients undergoing colectomy at 1 of the 51 clinical trial sites in Japan from January 2009 to June 2011 were registered for the study (JFMC39-0902). Patients received either placebo or Daikenchuto (15.0 g/day, t.i.d) between post-operative day 2 and post-operative day 8. Primary end-points included time to first bowel movement, frequency of bowel movement and stool form. The incidence of intestinal obstruction was evaluated post-operatively. The safety profile of Daikenchuto until post-operative day 8 was also evaluated. Results The results for 336 patients (Daikenchuto, n = 174; placebo, n = 162) were available for statistical analysis. The time to first bowel movement did not differ significantly between the two groups. All patients reported having diarrhea or soft stools immediately after surgery, and the time until stool normalization (50th percentile) in the Daikenchuto and placebo groups was 6 days and 7 days, respectively. The placebo group had a significantly greater number of hard stools at post-operative day 8 (P = 0.016), and bowel movement frequency continued to increase until post-operative day 8 as well. In contrast, bowel movement frequency in the Daikenchuto group increased until post-operative day 6, however decreased from post-operative day 7 and was significantly lower at post-operative day 8 compared with the placebo group (P = 0.024). Conclusion The moderate effects of Daikenchuto were observed ∼1 week after the operation. Although Daikenchuto had an effect on gastrointestinal function after open surgery in patients with colon cancer, this study did not show its clinical benefits adequately.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake
| | - Koutarou Maeda
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake
| | - Takashi Kaiho
- Department of Surgery, Kimitsu Chuo Hospital, Kisarazu
| | - Katsuyuki Kunieda
- Department of Surgery, Gifu Prefectural General Medical Center, Gifu
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo
| | | | - Toru Kono
- Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo
| | | | | | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
43
|
Katsuno H, Maeda K, Hanai T, Masumori K, Koide Y, Kono T. Novel antimesenteric functional end-to-end handsewn (Kono-S) anastomoses for Crohn's disease: a report of surgical procedure and short-term outcomes. Dig Surg 2015; 32:39-44. [PMID: 25678306 DOI: 10.1159/000371857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/31/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Anastomotic surgical recurrence after bowel resection is a major problem in patients with Crohn's disease. The aim of this prospective observational study was to evaluate the efficacy of a novel technique for restoring bowel continuity after resection involving either the small or the large intestine. METHODS The first case was instructed by Dr. Kono at Fujita Health University. The involved bowel segment was divided transversely with a linear stapler. The edges of two stapled lines are then connected to create a supporting column, which prevented surgical recurrence from anastomotic distortion due to mesenteric longitudinal ulcers. Thereafter, an antimesenteric longitudinal enterotomy was performed on each side to create a large-sized handsewn end-to-end anastomosis. RESULTS Thirty consecutive patients underwent Kono-S anastomoses from December 2009 to August 2013. Neither anastomotic leakage nor surgical recurrence was observed during a median follow-up period of 35 months. Endoscopic surveillance was performed in 18 cases (69.2%) undergoing ileo-colonic or ileo-rectal anastomosis with an average Rutgeert's score of 0.78 (0-3) at a mean of 14.5 months postoperatively. CONCLUSION The Kono-S anastomosis for Crohn's disease has been a safe and feasible technique. Long-term outcomes are required to confirm its advantage in preventing surgical recurrence at the anastomosis.
Collapse
|
44
|
Abstract
Local excision is increasingly performed for “early stage” rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in Western countries. Local recurrence is considered to originate based on the type of tumor and procedure performed, and in surgical margin-positive cases. This review focuses on the inclusion criteria of “early” rectal cancers for local excision from the Western and Japanese points of view. “Early” rectal cancer is defined as T1 cancer in the rectum. Only the tumor grade and depth of invasion are the “high risk” factors which can be evaluated before treatment. T1 cancers with sm1 or submucosal invasion <1,000 μm are considered to be “low risk” tumors with less than 3.2 % nodal involvement, and are considered to be candidates for local excision as the sole curative surgery. Tumors with a poor tumor grade should be excluded from local excision. Digital examination, endoscopy or proctoscopy with biopsy, a barium enema study and endorectal ultrasonography are useful for identifying “low risk” or excluding “high risk” factors preoperatively for a comprehensive diagnosis. The selection of an initial local treatment modality is also considered to be important according to the analysis of the nodal involvement rate after initial local treatment and after radical surgery.
Collapse
Affiliation(s)
- Kotaro Maeda
- Department of Surgery, Fujita Health University School of Medicine, 1-98 Kutsukake, Toyoake, Aichi, 470-1192, Japan,
| | | | | |
Collapse
|
45
|
Maeda K, Katsuno H, Kono T. [Effectiveness and motion mechanism of Taikencyuto in the perioperative period]. Nihon Geka Gakkai Zasshi 2013; 114:232-5. [PMID: 24167974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Taikencyuto (TJ-100) is a Japanese herbal (Kampo) medicine that contains Zanthouxylum and piperitum, Zingiber officinale, Panax ginseng, and Saccharum granorum. TJ-100 enhances intestinal motility, is thought to promote acetylcholine and motilin release, and is a vanilloid receptor. Furthermore, TJ-100 increases intestinal blood flow and works as an antiinflammatory and anticytokine agent by producing calcitonin gene-related peptide and adrenomedullin. TJ-100 is considered to be useful for promoting intestinal motility and preventing ileus during the perioperative period. Further studies must be performed to confirm its usefulness in perioperative care.
Collapse
Affiliation(s)
- Koutarou Maeda
- Department of Surgery, Fujita Health Univeristy, Sapporo, Japan
| | | | | |
Collapse
|
46
|
Masumori K, Maeda K, Hanai T, Sato H, Koide Y, Matsuoka H, Katsuno H, Shiota M. Short-term outcomes of local correction of stoma prolapse with a stapler device. Tech Coloproctol 2013; 17:437-40. [DOI: 10.1007/s10151-012-0959-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 11/27/2012] [Indexed: 11/24/2022]
|
47
|
Katsuno H, Maeda K, Hanai T, Sato H, Masumori K, Koide Y, Matsuoka H, Shiota M, Endo T, Matsuoka S, Hatta K, Mizuno M, Tohyama K. Current Status and Future Perspectives of Robotic Surgery for Colorectal Cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.3862/jcoloproctology.66.982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
48
|
Hanai T, Uyama I, Sato H, Masumori K, Katsuno H, Ito M, Maeda K. Laparoscopic assisted synchronous gastrectomy and colectomy with lymphadenectomy for double cancer in our experience. ACTA ACUST UNITED AC 2012; 59:2177-81. [PMID: 22246213 DOI: 10.5754/hge11841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Laparoscopic gastrointestinal surgery with lymphadenectomy is rarely performed for multiple gastrointestinal cancers. We report four patients undergoing laparoscopic surgery for synchronous cancer of the stomach and colon. Resection of each organ with lymphadenectomy was performed by each specialist and the region of the lymphadenectomy was determined according to the lesion of cancer and its depth. The selection of gastric anastomosis, whether intracorporeal or extracorporeal, depended on the resecting areas of the large bowel to allow a small incision. All four cases were male with the median age of 69 (range 59-77) years. The median number of trocars used were 6 (range 5-8) and median length of incision was 4.5 cm (range 4-4.5 cm). The median operative time and blood loss were 495.5 minutes (range 390-605) and 88 g (range 36-245), respectively. In all four cases, laparoscopic surgery with a lymphadenectomy on each region was successfully accomplished according to the respective progression stage. Anastomosis was completed with a small incision by using techniques and devices to provide a variation of anastomosis methods and incision positions. Laparoscopic surgery with lymphadenectomy was also undertaken for a patient with gastric remnant cancer and colorectal cancer. The median length of the postoperative hospital stay was 14.5 days (range 12-29). No complications were observed after the surgery. There was no case of recurrence during a median follow-up of 84.3 months (range 54.9-111.5). Laparoscopic surgery was feasible for patients with double cancer of the stomach and colon.
Collapse
Affiliation(s)
- Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan.
| | | | | | | | | | | | | |
Collapse
|
49
|
Katsuno H, Maeda K, Hanai T. [Robotic surgery for colon cancer]. Gan To Kagaku Ryoho 2011; 38:1790-1792. [PMID: 22164896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- H Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | | | | |
Collapse
|
50
|
Katsuno H, Maeda K, Hanai T, Sato H, Masumori K, Koide Y, Matsuoka H, Noro T, Takakuwa Y, Hanaoka R. Trans-sacral resection of a solitary fibrous tumor in the pelvis: report of a case. Surg Today 2011; 41:1548-51. [PMID: 21969160 DOI: 10.1007/s00595-010-4535-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/22/2010] [Indexed: 12/27/2022]
Abstract
Solitary fibrous tumors (SFTs) develop most commonly in the pleura, although they have occasionally been reported to arise in the pelvic cavity. We report a case of an SFT presenting as a painless nodule in the pelvis of a 56-year-old woman. Histologically, the tumor was composed of spindle-shaped cells arranged without pattern, with short and narrow fascicles and interspersed bundles of thick collagen, and numerous blood vessels with a focally hemangiopericytoma-like appearance. Immunohistochemically, the tumor cells strongly expressed vimentin, CD34, and bcl-2. The tumor was excised via a trans-sacral approach, without preoperative transcatheter embolization, and the patient remains well more than 2 years after her operation. To our knowledge, this is the first case of an SFT in the pelvis, which was excised completely via a trans-sacral approach.
Collapse
Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|