Prevalence and safety of robotic surgery for gastrointestinal malignant tumors in Japan

[Aim] The National Health Insurance system has reimbursed robotic gastrointestinal surgery since April 2018 in Japan. Additionally, strict facility and surgeon standards were established by the government and the academic society. This study aimed to evaluate the prevalence and safety of robotic surgery using a Japanese nationwide web-based database. [Methods] Patients who underwent the following robotic surgeries for malignant tumors in 2018 were included: esophagectomy (RE), total gastrectomy (RTG), distal gastrectomy (RDG), proximal gastrectomy (RPG), low anterior resection (RLAR), and rectal resections other than RLAR (RRR). The number of cases and surgical mortality rates each month were calculated to evaluate the prevalence and safety of robotic procedures. [Results] A total of 3281 patients underwent robotic gastrointestinal surgery. The monthly number of robotic surgeries nearly doubled in April 2018 when they were initially reimbursed by the National Health Insurance system. Operative mortality rates were 0.9%, 0.4%, 0.2%, and 2.8% for RE (n = 330), RTG (n = 239), RDG (n = 1167), and RPG (n = 109), respectively. No mortality was observed in RLAR (n = 1062) or RRR (n = 374). [Conclusion] Robotic surgery for gastrointestinal malignant tumors was safely introduced into daily clinical practice along with rigorous surgeon and facility standards in Japan

A case of locally advanced adenosquamous carcinoma of the cecum with long-term survival

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

イガン ニ タイスル da Vinci シュジュツ ノ ケイケン

The da Vinci Surgical System is a telerobotic system consisting of４components, including the Insite vision system with a true３‐dimensional endoscope providing a high-resolution binocular view of the surgical field, and the Endo Wrist instrument system, which is capable of７degrees of freedom and２degrees of axial rotation to replicate human wrist-like movements. Distal gastrectomy and D１＋lymphnode dissection was performed in a７３-year-old man with cT１bN０N０StageIA gastric cancer. Preoperative abdominal CT findings were showed that celiac artery branching patterns was Adachi VI type２６groups. The operating time was４３３minutes, and the blood loss was２８４g. The da Vinci Surgical System has useful advantages over conventional Laproscopic Assisted gastrectomy（LAG）surgery concerning the precise lymphnodes dissection. With further innovations in the future, the da Vinci Surgical System has the potential to facilitate technically difficult surgery employing conventional LAG techniques

Propensity-score-matching-based analysis of laparoscopic gastrectomy with neoadjuvant chemotherapy for gastric carcinoma

OBJECTIVES: Neoadjuvant chemotherapy (NAC) is widely accepted as a potential treatment for advanced gastric cancer (AGC). Laparoscopic gastrectomy (LG) has recently been performed for advanced gastric cancer and could lead to improved adherence to multimodal treatment. In the present study, we compared the feasibility and outcomes of LG in patients with or without NAC in our institution. METHODS: We assessed patients who underwent LG with (n=185) or without (n=1204) NAC between 1997 and 2013. We used propensity score matching to evaluate perioperative short-term outcomes and long-term outcome. RESULTS: We used propensity score matching by patient background and treatment-rerated factors to establish two groups of 157 patients with or without NAC. There were no significant differences in perioperative short-term outcomes or long-term outcome between the groups. CONCLUSIONS: LG for selected patients with NAC is feasible and safe but has no long-term survival benefit

Robotic liver resection for hepatocellular carcinoma: a focus on anatomic resection

Aim: Robotic liver resection (RLR) is a new platform for minimally invasive hepatobiliary surgery. Minimally invasive surgery can confer benefits to patients with hepatocellular carcinoma (HCC), which is mostly associated with underlying chronic liver disease. Despite the inherent functional merits of robotics for surgical techniques, the clinical advantages of hepatectomy are not well defined. Therefore, we reviewed the short-term and long-term surgical results of 57 HCC cases in 46 patients who underwent RLR at our institution.Methods: We evaluated the feasibility and safety of robotic anatomic liver resection for HCC by comparing the results of the anatomic resection (AR) group (n = 23) and non-anatomic resection (NAR) group (n = 34).Results: Overall (n = 57), the liver-specific console time was 487 min, blood loss was 194 g, and there was one open conversion (2%). Postoperative data showed acceptable hepatic functional recovery, with a major complication rate of 11% and no 90-day mortality. Compared to NAR, AR was associated with longer operative and console times, more blood loss, and worse postoperative liver function, thus reflecting the greater extent and complexity of hepatectomies for more advanced-stage tumors than NAR. Nonetheless, major complication rate, mortality rate, length of hospital stay, and R0 resection rate were comparable between groups. Long-term results were comparable to those of previously reported hepatectomies for HCC and were similar between groups.Conclusion: RLR including AR may be a safe and feasible form of hepatectomy for select patients with HCC

Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux