Numerical Aberrations of Chromosomes 8, 11, 12, 17, X, and Y on Esophageal Squamous Cell Carcinomas by Fluorescence in situ Hybridization

Numerical aberrations of chromosomes 8, 11, 12, 17, X, and Y were investigated on fifteen cases of esophageal squamous cell carcinoma using fluorescence in situ hybridization (: FISH) with chromosome specific DNA probes. There were various aberrations in autosomal chromosomes. Trisomy 12 and trisomy 17 were the most common numerical aberrations (found in six cases, respectively), followed by trisomy 11 and monosomy 17 (in five cases, respectively), trisomy 8 (in four cases), tetrasomy 8 and monosomy 11 (in three cases, respectively). In regard to sex chromosomes, all cases except for one showed extra copy number of X chromosome, two signals were found in male and three signals were encountered in female. Loss of Y was found in six cases and gain of Y was shown in two cases. Quantification of nuclear DNA content by flow cytometry was performed using the same materials. Three of fifteen (20 %) revealed DNA diploidy on DNA histogram, but several numerical aberrations were found in all DNA diploid cases by FISH. Comparing the results with clinicopathologic parameters, there is a good correlation between the number of chromosome 8 and lymph node metastasis (p = 0.0089). Numerical chromosome aberrations of esophageal cancer can be detected easily in preoperative status using endoscopic biopsy specimens. FISH analysis correlates with the extent of disease and may be helpful to determine methods of surgical procedure for the patients with esophageal squamous cell carcinoma

Resection of Segments 4, 5 and 8 for a Cystic Liver Tumor Using the Double Liver Hanging Maneuver

To achieve complete anatomic central hepatectomy for a large tumor compressing surrounding vessels, transection by an anterior approach is preferred but a skillful technique is necessary. We propose the modified technique of Belghiti's liver hanging maneuver (LHM). The case was a 77-year-old female with a 6-cm liver cystic tumor in the central liver compressing hilar vessels and the right hepatic vein. At the hepatic hilum, the spaces between Glisson's pedicle and hepatic parenchyma were dissected, which were (1) the space between the right anterior and posterior Glisson pedicles and (2) the space adjacent to the umbilical Glisson pedicle. Two tubes were repositioned in each space and ‘double LHM’ was possible at the two resected planes of segments 4, 5 and 8. Cut planes were easily and adequately obtained and the compressed vessels were secured. Double LHM is a useful surgical technique for hepatectomy for a large tumor located in the central liver

Colorectal cancer with high-frequency microsatellite instability expresses high-level thymidine phosphorylase but not dihydropyrimidine dehydrogenase

Recent clinical studies have reported that microsatellite instability (MSI) colorectal cancers show a high sensitivity to 5-FU, but these reports are contradictory to findings from in vitro analyses. In this study, we analyzed the relationship between MSI phenotypes and the expression of 5-FU metabolic enzymes in human colorectal cancer specimens. MSI phenotypes in 174 sporadic colorectal carcinomas were determined and grouped into the following three categories based on the Bethesda guidelines: high-frequency MSI (MSI-H), low-frequency MSI (MSI-L), and stable microsatellite (MSS). The expressions of dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) in tumor specimens were measured by enzymelinked immunosorbent assays. The ratio of TP to DPD expression (TP/DPD ratio) was calculated for each tumor. These three factors were compared with regard to MSI phenotypes by non-parametric and logistic regression analyses using cut-off values at their medians. MSI-L tumors were excluded from statistical analyses. Thirteen tumors were classified as MSI-H, 8 tumors as MSI-L, and 153 tumors as MSS. DPD expression did not differ between MSI-H tumors and MSS tumors. TP expression and the TP/DPD ratio were significantly higher in MSI-H tumors than in MSS tumors [TP, 160.1± 104.0 vs 97.3 ± 53.7 (Units/mg protein) (P=0.009); TP/DPD ratio, 3.04 ± 1.62 vs 2.07 ± 1.08, (P=0.016)]. These differences were also significant in multivariate analysis. In conclusion, these data suggest that 5-FU catabolic activity in cancer tissue does not differ between MSI-Hand MSS tumors. However, 5-FU anabolic activity in cancer tissue is higher in MSI-H than in MSS colorectal carcinomas

Portal Vein Anastomosis with Parachute Method in Hepatectomy and Pancreatectomy

In advanced cancers of hepatobiliary and pancreatic lesions, major vascular resection and reconstruction are necessary to accomplish curative resection. Stenosis of vascular anastomosis is a concern in case of portal or superior mesenteric venous anastomosis with different vascular calibers. We attempted to apply parachute anastomosis in such a situation, which has often been used in the field of cardiovascular surgery. We applied this procedure in 4 cases of two hepatectomies in intrahepatic cholangiocarcinomas and two pancreatectomies in pancreatic carcinomas, in which combined vascular resection was necessary. After anastomosis, the orifice of anastomotic veins was well matched and did not show stenosis or poor blood flow on ultrasonographic examination. Parachute anastomosis in the portal or superior mesenteric vein is a useful procedure to prevent vascular stenosis, particularly in case of anastomosis with different calibers

Three-dimensional cholangiography applying C-arm computed tomography in bile duct carcinoma: A new radiological technique

A C-arm equipped with a flat detector CT (C-arm CT) has been developed, which provides images with high spatial resolution that could facilitate effective 3D information during interventional procedures. The cone beam reconstructive method was applied for reconstruction of images. Time of reconstruction of 3D images was approximately one minute after the scan. The axial thin-slice images, the real-time volume rendering, maximum intensity projection, shaded surface display and multi-planner reconstruction images could be obtained from any direction in a single scan. We experienced 7 cases and present two informative cases with biliary obstruction caused by tumor that underwent C-arm CT. The First case shows gallbladder carcinoma invading the hilum. The C-arm CT provided precise images of the stenotic bile ducts that could be viewed in any direction. Multiple expandable metallic stent could be accurately placed in 3 stenotic bile ducts. The second case shows a hilar bile duct carcinoma. By using various pressure infusion of the contrast medium, severely stenotic hepatic duct was confirmed before surgery. C-arm CT provided useful information regarding the precise 3D status of the bile duct and the extent of tumor invasion

A Case of Intraductal Papillary Neoplasm of the Bile Duct with Stromal Invasion

Intraductal papillary neoplasm of the bile duct (IPNB) represents biliary papillary tumors mainly growing and is considered to be of relatively low-grade malignancy. Here we report a case of IPNB in whom the poorly differentiated component deeply infiltrated the bile duct wall. A 77-year-old male had an invasive carcinoma of the bile duct 3 cm in size. He underwent right hemihepatectomy with combined resection of the extrahepatic bile duct. Papillary growing tumor was observed in the common bile duct and the right posterior Glisson's pedicle was invaded. Histologic finding showed papillary adenocarcinoma in the surface layer superficially extending to the epithelium of the surrounding bile duct. In the subserosal layer, the tumor represented poorly differentiated adenocarcinoma. The tumor was diagnosed as invasive bile duct carcinoma arising from IPNB

Comparison of Outcome of Hepatectomy with Thoraco-abdominal or Abdominal Approach

Background/Aims: Thoraco-abdominal approach is a suitable choice for hepatectomy to secure good view for mobilization. The aim of this study was to assess efficacy of thoraco-abdominal approach (TAA) for hepatectomy. Methodology: There were compared clinicopathological data, surgical results and postoperative complications of 425 consecutive patients who underwent hepatectomy via abdominal (AA) (n=147) or TAA (n=278). Results: Blood loss and operating time were significantly higher in TAA than AA group (970 vs. 830ml and 408 vs. 372 min.)(p<0.05). Prevalence of pleural effusion was significantly higher in TAA than AA group (24 vs. 9%) (p<0.01). However, proportions of patients who developed hepatic complications such as biloma (14 vs. 23%), and wound infection (8 vs.25%) were significantly less in TAA than AA group (p<0.05). Hospital stay after hepatectomy and mortality were similar between both groups. Presence of chronic viral hepatitis, lower platelet count, higher level of serum hyaluronic acid, larger blood loss and TAA correlated significantly with thoracic complications (p<0.05). Multivariate analysis showed that increased blood loss (p=0.011), but not TAA, was a significant determinant of thoracic complications (p=0.08). Conclusions: TAA can be considered a relatively safe approach for hepatectomy with minimal abdominal complications nevertheless of frequent pleural effusion

Omental Pedicle Graft to Protect Compromised Double-Stapled Anastomosis in Anterior Resection for Rectal Cancer

PURPOSE: The purpose of this study was to investigate the effects of omental pedicle graft (OPG) wrapping to limit leakage from compromised double-stapled anastomoses after anterior resection for rectal cancer. PATIENTS AND METHODS: Between 1994 and 1997, a prospective study was conducted on 80 consecutive patients who had undergone double-stapled anastomoses after anterior resection for rectal cancer. Decisions to perform OPG were made intraoperatively because of compromised doublestapled anastomoses. RESULTS: Twenty-one patients (26%) received OPG to protect anastomosis, the remainder of patients had no OPG. Ten of the 21 patients underwent OPG for stapler-related operative complications, 5 for rectal carcinoma with stenosis, 3 for obstructive colitis or diverticulitis in the sigmoid colon, and 6 for very low anterior resection with coloanal anastomosis after total mesorectal excision. Three of 21 patients had more than one indication for OPG. The two types of patients were comparable with respect to patient characteristics and operative procedures, although tumor diameter in the OPG patients was significantly larger than in the non-OPG patients. Anastomotic leakage was noted in 1 non-OPG patient (2%) but in none of the OPG patient. There were no statistically significant differences between the two types of patients with regard to postoperative course and anastomotic or other postoperative complications. CONCLUSION: We conclude that OPG wrapping provides an effective protection for a compromised anastomosis of anterior resection in selected patients with rectal cance

Robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach

Robotic surgery is increasingly being applied for rectal cancer and its feasibility and safety have been reported. However, problems associated with advanced robotic surgery such as pelvic exenteration include lengthy operation time and difficulty in controlling unexpected bleeding. A 47-year-old woman had undergone laparoscopic left hemicolectomy for descending colon cancer three years previously (pT3N0M0 pStageII). And had undergone bilateral oophorectomy for ovarian metastases one year previously. Follow-up CT detected a peritoneal metastasis in the pelvic space. After seven courses of systemic chemotherapy, she received robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach. The postoperative course was uneventful. There is no evidence of recurrent disease 8 months after surgery. In conclusion, robotic anal preserving posterior pelvic exenteration combined with the transanal-vaginal approach is a safe and feasible minimally invasive approach for the treatment of advanced rectal malignancies

Vascular transection using endovascular stapling in hepatic resection

In anatomical resection of the liver, transection of the hepatic vein or Glisson\u27s pedicle is necessary. We examined the surgical records and outcome of 25 patients who underwent hepatectomy. An endovascular stapler with 36 and 60 mm staples was used for transection of the hepatic vein or Glisson\u27s pedicle, and hepatic parenchyma including vessels. Surgery included also left lateral sectorectomy in 6 patients, right lateral sectorectomy in one, right hepatectomy in 12, left hepatectomy in two and trisegraenteetomy in 4. Endovascular stapling was used for transection of hepatic veins (n=25) in all patients and Glisson\u27s pedicle (n=8). No failure of firing occurred during cutting. Injury of an aberrant bile duct occurred in one patient, but none suffered bleeding or bile leakage from the transected parts. Vascular transection using vascular stapler could be performed safely and rapidly during anatomical hepatic resection