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Surgical Science 2023年第1期14卷 10-16页

作者： Leh Bi Kalou Ismaèl N’Dri Ahou Bernadette Ekra Amos Serge Kouakou Blaise Amos Bamba Inza Kouakou Kouamé Bernardin Anzoua Kouakou Ibrahim Traore Mamadou Lebeau Roger Diané Bamourou department of General and digestive surgery CHU of Bouaké Bouake Ivory Coast

Hydatid cyst of the liver (KHF) is a parasitic condition caused by the development of the larval form of the dog tapenia Echinococcus granulosus. In sub-Saharan Africa, few writings are interested in this pathology, which remains common and constitutes a public health problem in highly endemic countries [1] [2]. We report the observation of a 61-year-old hypertensive patient owner of a dog admitted for abdominal pain without abdominal mass. In whom ultrasound and computed tomography have made it possible to make the diagnosis of hydatid cyst of the liver (KHF). The patient underwent surgery. We performed an associated conservative treatment post-operative albendazole. The post-operative follow-up was simple. In our patient the evolution was good after a setback of more than 2 months. Through this observation and a review of the literature, we insist on the contribution of imaging in diagnosis and treatment, which is essentially surgical.

关键词： Liver Hydatid Cyst Diagnosis Treatment

Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy

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World Journal of Gastrointestinal Oncology 2017年第6期9卷 257-262页

作者： Yoshinori Fujiwara Shuichi Fukuda Masanori Tsujie Hajime Ishikawa Kotaro Kitani Keisuke Inoue Masao Yukawa Masatoshi Inoue Department of Digestive Surgery Nara HospitalKindai University School of Medicine Department of Digestive Surgery Kawasaki Medical School

AIM To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting(IPTW) method using propensity score.METHODS We enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old(Group A), and 333 patients were aged < 79 years old(Group B). We compared the surgical outcomes and survival of the two groups after IPTW.RESULTS Postoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B(P < 0.05). Overall survival(OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage Ⅰ?disease, OS was significantly lower in Group A(P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection wereindependent prognostic values for OS.CONCLUSION When the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.

关键词：胃的癌症死亡病态老 Lymphadenectomy 倾向分数匹配预后幸存

Impaired immune reaction and increased lactate and C-reactive protein for early prediction of severe morbidity and pancreatic fistula after pancreatoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 58-67页

作者： Mario Rodriguez-Lopez Francisco J.Tejero-Pintor Martin Bailon-Cuadrado Asterio Barrera-Rebollo Baltasar Perez-Saborido David Pacheco-Sanchez General and digestive surgery department Rio-Hortega University Hospital

Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.

关键词： Pancreatoduodenectomy Morbidity Pancreatic fistula Biomarker Prediction Score

Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

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World Journal of Gastroenterology 2018年第18期24卷 1978-1988页

作者： Alba Manuel-Vázquez Raquel Latorre-Fragua Carmen Ramiro-Pérez Aylhin López-Marcano Roberto De la Plaza-Llamas José Manuel Ramia department of General and digestive surgery University Hospital of Guadalajara

The major symptoms of advanced hepatopancreaticbiliary cancer are biliary obstruction, pain and gastric outlet obstruction(GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decisionmaking must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation ofthe patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

关键词： Duodenal obstruction Gastrojejunostomy Gastroenterosmy Gastric outlet obstruction Gastric bypass Laparoscopy Laparoscopic surgery Sytematic review

Severe morbidity after pancreatectomy is accurately pre dicte d by preoperative pancreatic resection score(PREPARE): A prospective validation analysis from a medium-volume center

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Hepatobiliary & Pancreatic Diseases International 2018年第6期17卷 559-565页

作者： Mario Rodriguez-Lopez Francisco J. Tejero-Pintor Baltasar Perez-Saborido Asterio Barrera-Rebollo Martin Bailon-Cuadrado David Pacheco-Sanchez General and digestive surgery department Rio-Hortega University Hospital

Background: Major morbidity in pancreatic surgery remains high. Different scores for predicting complications have been described. Preoperative pancreatic resection(PREPARE) score is based on objective preoperative variables and offers good predictive accuracy for Clavien ≥ III complications. This study aimed to validate this score and analyze other preoperative variables in a prospective study performed in a medium-volume center. Methods: A total of 50 pancreatic resections were included. Preoperative variables were registered and PREPARE was calculated. The main outcome was severe morbidity(Clavien ≥ III) up to 30 days after discharge. The secondary outcomes were length of stay(LOS) and readmission. Statistical validation was performed to compare severe morbidity rate among the scores categories. Association with other preoperative variables(not included in PREPARE) was also tested. Results: Of the 50 pancreatic resections, the severe morbidity was 34.0%, with median LOS of 11 days. Readmission rate was 25.5%. Severe morbidity rates according to PREPARE categories were 18.5% in lowrisk group, 41.7% in intermediate-risk group, and 63.6% in high-risk group, respectively( P = 0.023). The accuracy was 72%(Hosmer–Lemeshow, P = 0.86). ROC curve was obtained both for PREPARE score expressed as incremental values and categorized as the three risk groups, showing an area under curve(AUC) of 0.736(95% CI: 0.586–0.887; P = 0.007) and 0.712(95% CI: 0.555–0.869; P = 0.015), respectively. PREPARE was significant in multivariate analysis. Median LOS was statistically higher as PREPARE category increases(9, 11 and 15 days in low-, intermediate-and high-risk groups, respectively; P = 0.009). Readmission was not associated with any variables. Conclusions: PREPARE behaves as an independent risk factor for severe morbidity after pancreatic surgery. Score validation shows good accuracy prediction. Increasing PREPARE category is also associated with longer LOS.

关键词： Pancreatic surgery Morbidity Complications Preoperative pancreatic resection score Validation

Liquid biopsy in patients with hepatocellular carcinoma: Circulating tumor cells and cell-free nucleic acids

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World Journal of Gastroenterology 2017年第31期23卷 5650-5668页

作者： wataru okajima shuhei komatsu daisuke ichikawa mahito miyamae takuma ohashi taisuke imamura jun kiuchi keiji nishibeppu tomohiro arita hirotaka konishi atsushi shiozaki ryo morimura hisashi ikoma kazuma okamoto eigo otsuji division of digestive surgery department of surgery kyoto prefectural university of medicine

Hepatocellular carcinoma(HCC), with its high incidence and mortality rate, is one of the most common malignant tumors. Despite recent development of a diagnostic and treatment method, the prognosis of HCC remains poor. Therefore, to provide optimal treatment for each patient with HCC, more precise and effective biomarkers are urgently needed which could facilitate a more detailed individualized decision-making during HCC treatment, including the following; risk assessment, early cancer detection, prediction of treatment or prognostic outcome. In the blood of cancer patients, accumulating evidence about circulating tumor cells and cell-free nucleic acids has suggested their potent clinical utilities as novel biomarker. This concept, so-called "liquid biopsy" is widely known as an alternative approach to cancer tissue biopsy. This method might facilitate a more sensitive diagnosis and better decision-making by obtaining genetic and epigenetic aberrations that are closely associated with cancer initiation and progression. In this article, we review recent developments based on the available literature on both circulating tumor cells and cell-free nucleic acids in cancer patients, especially focusing on Hepatocellular carcinoma.

关键词： Hepatocellular 癌 Biomarker 液体活体检视传播肿瘤房间没有房间的 nucleic 酸

Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett's esophagus

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World Journal of Gastroenterology 2015年第29期21卷 8974-8980页

作者： Atsushi Shiozaki Hitoshi Fujiwara Hirotaka Konishi Osamu Kinoshita Toshiyuki Kosuga Ryo Morimura Yasutoshi Murayama Shuhei Komatsu Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Kazuma Okamoto Chouhei Sakakura Eigo Otsuji Division of digestive surgery Department of Surgery Kyoto Prefectural University of Medicine

Barrett's esophagus(BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE(LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach(LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of thearch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 m L of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.

关键词： Laparoscopic transhiatal approach Barrett'sesophageal carcinoma Hiatal hernia

Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device

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World Journal of Gastroenterology 2017年第35期23卷 6534-6539页

作者： Tetsu Yamamoto Yoshitsugu Tajima Ryoji Hyakudomi Takanori Hirayama Takahito Taniura Kazunari Ishitobi Noriyuki Hirahara department of digestive and General surgery Shimane University Faculty of Medicine

A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum(i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient's post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.

关键词： Colonic intussusception Adult Mobile cecum Cecopexy Barbed wound suture device

Neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake?

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World Journal of Gastroenterology 2018年第2期24卷 274-289页

作者： Rossella Reddavid Silvia Sofia Paolo Chiaro Fabio Colli Renza Trapani Laura Esposito Mario Solej Maurizio Degiuli Surgical Oncology and digestive surgery Department of Oncology University of Turin San Luigi University Hospital department of Surgical Sciences Digestive and Oncological Surgery University of Turin Molinette Hospital

AIM To investigate the neoadjuvant chemotherapy(NAC) effect on the survival of patients with proper stomach cancer submitted to D2 gastrectomy.METHODS We proceeded to a review of the literature with Pub Med, Embase, ASCO and ESMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials(RCTs) comparing NAC followed by surgery(NAC + S) with surgery alone(SA) for gastric cancer(GC). The primary outcome was the overall survival rate. Secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association(JGCA) performed in both arms, disease-specific(DSS) and disease-free survival(DFS) rates, clinical and pathological response rates and resectability rates after perioperative treatment. RESULTS We identified a total of 16 randomized controlled trials comparing NAC + S(n = 1089) with SA(n = 973) published in the period from January 1993-March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node(LN) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the NAC arm. Inthe third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without NAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the "Study Treatment" protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of NAC was evident only for esophagogastric junction(EGJ) cancers. In the second study, there was no overall survival benefit of NAC. In the last trial, which documented a survival benefit for the NAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper stomach cancer. Additionally, several patients d

关键词： gastric cancer neoadjuvant chemotherapy perioperative chemotherapy D2 lymphadenectomy randomized control trial

Repeat hepatectomy for recurrent colorectal liver metastases:A comparative analysis of short-and long-term results

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 162-167页

作者： Paulo Figueiredo Costa Fabricio Ferreira Coelho Vagner Birk Jeismann Jaime Arthur Pirola Kruger Gilton Marques Fonseca Ivan Cecconello Paulo Herman digestive surgery Brazilian College of digestive surgery(Colégio Brasileiro de Cirurgia Digestiva-CBCD) São PauloBrazil digestive surgery Division Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil Instituto do Câncer do Estado de São Paulo(ICESP) São PauloBrazil

Background: Liver recurrence after resection of colorectal liver metastases(CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefts for patients with early recurrence have not been clarifed. The aim of this study was to compare the short-and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 20 0 0 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4(3-6) vs. 3(2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies(34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions resected(2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival( P = 0.626) and disease-free survival( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival( P = 0.771) or disease-free survival( P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short-and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.

关键词： Colorectal cancer Metastasis Hepatectomy Postoperative complications Survival analysis