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Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management

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hepatobiliary & pancreatic Diseases International 2020年第4期19卷 334-341页

作者： Yuichi Masuda Kazuki Yoshizawa Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of Medicine3-1-1 AsahiMatsumotoNaganoJapan

Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used ***-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult *** definition of SFSS slightly varies among transplant *** use of a partial liver graft has risks of SFSS *** portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main ***,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this ***,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own *** sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this ***:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and *** these techniques,patient outcome has been improved even when using a"small"*** factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various ***:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill *** the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy t

关键词： Liver transplantation Living donor liver transplantation Small-for-size graft Small-for-size syndrome

Synchronous intraoperative radiofrequency ablation for multiple liver metastasis and resection of giant solid pseudopapillary tumors of the pancreas

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Chinese Medical Journal 2012年第9期125卷 1661-1663页

作者： LI Jia-xin WU Hong HUANG Ji-wei Pankaj Prasoon ZENG Yong Department of hepato-bilio-pancreatic Surgery West China HospitalSichuan UniversityChengduSichuan 610041China

The solid pseudopapillary tumors of the pancreas （SPTP） are rare tumors, which are commonly found in adolescent women. Radical surgical resection of the primary tumor or metastases is the standard treatment for SPTP and could achieve long-term survival. We reported a case of a 20-year-old female with multiple liver metastases of SPTP, and performed surgical resection for primary tumor 14 cm in diameter and 2 major liver metastases （both 5 cm in diameter）, radiofrequency ablation （RFA） for small lesions and one major liver metastase 6 cm in diameter successfully. No evidence of recurrence in situ or in the liver was found by computed tomography （CT） scan 3 months after the operation. RFA is a safe and effective treatment for unresectable multiple liver metastases of SPTP.

关键词： radiofrequency ablation resection solid pseudopapillary tumors of the pancreas liver metastases

Impact of endothelial nitric oxide synthase activation on accelerated liver regeneration in a rat ALPPS model

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World Journal of Gastroenterology 2023年第5期29卷 867-878页

作者： Hitoshi Masuo Akira Shimizu Hiroaki Motoyama Koji Kubota Tsuyoshi Notake Takahiro Yoshizawa Kiyotaka Hosoda Koya Yasukawa Akira Kobayashi Yuji Soejima division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumoto 390-8621Japan

BACKGROUND Although the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)induces more rapid liver regeneration than portal vein embolization,the mechanism remains *** To assess the influence of inflammatory cytokines and endothelial nitric oxide synthase(eNOS)activation on liver regeneration in *** The future liver remnant/body weight(FLR/BW)ratio,hepatocyte proliferation,inflammatory cytokine expression,and activation of the Akt-eNOS pathway were evaluated in rat ALPPS and portal vein ligation(PVL)*** proliferation was assessed based on Ki-67 expression,which was confirmed using *** serum concentrations of inflammatory cytokines were measured using enzyme linked immune-solvent *** Akt-eNOS pathway was assessed using western *** explore the role of inflammatory cytokines and NO,Kupffer cell inhibitor gadolinium chloride(GdCl3),NOS inhibitor N-nitro-arginine methyl ester(L-NAME),and NO enhancer molsidomine were administered *** The ALPPS group showed significant FLR regeneration(FLR/BW:1.60%±0.08%,P<0.05)compared with that observed in the PVL group(1.33%±0.11%)48 h after *** the ALPPS group,serum interleukin-6 expression was suppressed using GdCl3 to the same extent as that in the PVL ***,the FLR/BW ratio and Ki-67 labeling index were significantly higher in the ALPPS group administered GdCl3(1.72%±0.19%,P<0.05;22.25%±1.30%,P<0.05)than in the PVL group(1.33%±0.11%and 12.78%±1.55%,respectively).Phospho-Akt Ser473 and phospho-eNOS Ser1177 levels were enhanced in the ALPPS group compared with those in the PVL *** was no difference between the ALPPS group treated with L-NAME and the PVL group in the FLR/BW ratio and Ki-67 labeling *** the PVL group treated with molsidomine,the FLR/BW ratio and Ki-67 labeling index increased to the same level as in the ALPPS *** Early induction of inflammatory cytokines may n

关键词： Hepatectomy Nitric oxide Liver regeneration Cytokines NG-Nitroarginine methyl ester Molsidomine

pancreaticoduodenectomy: how to handle a replaced right hepatic artery

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hepatobiliary Surgery and Nutrition 2023年第2期12卷 280-283页

作者： Junichi Kaneko Akihiko Ichida Yoshikuni Kawaguchi Kiyoshi Hasegawa hepato-Biliary-pancreatic Surgery division Department of SurgeryGraduate School of MedicineThe University of TokyoTokyoJapan

hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a biliary leak or stenosis at the choledocho-jejunostomy and liver ischemia,resulting in ischemic cholangitis,liver abscess,and sepsis(1).

关键词： pancreaticoduodenectomy(PD) replaced right hepatic artery pancreatic ductal adenocarcinoma(PDAC)

Neoadjuvant therapy for resectable pancreatic cancers

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hepatobiliary Surgery and Nutrition 2022年第4期11卷 583-585页

作者： Yosuke Inoue Hiromichi Ito Yu Takahashi division of hepato-Biliary-pancreatic Surgery Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

pancreatic cancer(PC)is a potentially systemic disease with more diverse biology than generally *** present,surgical resection is the only curative therapy available for patients with PC,and its indications have long been discussed based on anatomical resectability.A recent consensus recommends neoadjuvant therapy(NAT)for anatomically borderline resectable(BR)cancers(1)as well as induction therapy for unresectable locally advanced(UR-LA)or metastatic(UR-M)cancers.

关键词： cancers therapy curative

Management of neuroendocrine liver metastasis:Searching for new prognostic factor and appraising repeat hepatectomy

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hepatobiliary Surgery and Nutrition 2021年第3期10卷 410-412页

作者： Junichi Arita Sho Kiritani Kiyoshi Hasegawa hepato-Biliary and pancreatic Surgery division Department of SurgeryGraduate School of MedicineUniversity of TokyoTokyoJapan

Gastro-enteric and pancreatic neuroendocrine neoplasm(NEN)is categorized as a borderline malignant tumor and was historically called carcinoid,meaning *** tumors usually grow slower than most carcinoma tumors originat... 详细信息

关键词： organs metastasis liver neoplasm

Central pancreatectomy: The Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach

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World Journal of Gastroenterology 2014年第42期20卷 15674-15681页

作者： Calogero Iacono Andrea Ruzzenente Luca Bortolasi Alfredo Guglielmi Department of Surgery Division of General Surgery "A" Unit of Hepato-Biliary-Pancreatic Surgery University of Verona Medical School "GB Rossi" University Hospital

Central pancreatectomy(CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection(SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot(1957) and Letton and Wilson(1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.

关键词： pancreatic history pancreatic surgery Central pancreatectomy Conservative pancreatectomy

Sorafenib-based combined molecule targeting in treatment of hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第42期21卷 12059-12070页

作者： Jian-Jun Gao Zhen-Yan Shi Ju-Feng Xia Yoshinori Inagaki Wei Tang Department of Pharmacology School of Pharmaceutical Sciences Qingdao University hepato-Biliary-pancreatic Surgery division Department of Surgery Graduate School of MedicineThe University of Tokyo

Sorafenib is the only and standard systematic chemotherapy drug for treatment of advanced hepatocellular carcinoma(HCC) at the current stage. Although sorafenib showed survival benefits in large randomized phase Ⅲ studies, its clinical benefits remain modest and most often consist of temporary tumor stabilization, indicating that more effective first-line treatment regimens or second-line salvage therapies are required. The molecular pathogenesis of HCC is very complex, involving hyperactivated signal transduction pathways such as RAS/RAF/MEK/ERK and PI3K/AKT/m TOR and aberrant expression of molecules such as receptor tyrosine kinases and histone deacetylases. Simultaneous or sequential abrogation of these critical pathways or the functions of these key molecules involved in angiogenesis, proliferation, and apoptosis may yield major improvements in the management of HCC. In this review, we summarize the emerging sorafenib-based combined molecule targeting for HCC treatment and analyze the rationales of these combinations.

关键词： Angiogenesis Mammalian target of rapamycin Extrace

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake Hiroaki Yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto division of hepato-Biliary-pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of *** use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative ***,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after *** To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after *** The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively *** were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower *** factors,including demographic data and perioperative D-dimer values,were compared between the two *** operating characteristic curve analysis was performed to determine the D-dimer cutoff *** and multivariate analyses were performed using logistic regression analysis to identify significant *** In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE *** the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after *** Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism