Hepatic Arterial Infusion Chemotherapy Prior to Standard Systemic Chemotherapy in Patients with Highly Advanced Unresectable Liver Metastases from Colorectal Cancer: A Report of Three Patients

We administered hepatic arterial infusion chemotherapy (HAIC) prior to FOLFOX to three patients with unresectable liver metastases from colorectal cancer. The patients' disease state was found to be highly advanced based on both computed tomography findings and liver function tests. The treatment strategy included an initial administration of HAIC to control liver metastases and improve liver function in order to facilitate the subsequent safe administration of FOLFOX without drug loss. As the HAIC regimen, 1,000mg/m2 of 5-FU was administered weekly by continuous 5-h infusion after performing laboratory investigations through an implanted port-catheter system. After 3 HAIC cycles administered over 3 consecutive weeks, the mean alkaline phosphatase levels decreased from 969.3IU/l to 422IU/l due to shrinkage of the liver metastases. Thereafter, FOLFOX without drug loss could be safely initiated for all patients. Two patients succumbed 488 and 333 days after HAIC was initiated;the third patient is still alive and has been followed-up for 1215 days. The combined use of HAIC and standard systemic chemotherapy could be a feasible and efficacious treatment in highly advanced cases of liver dysfunction

“Hook and Roll Technique” Using an Articulating Hook Cautery to Provide a Critical View during Single-incision Laparoscopic Cholecystectomy

We describe a new simple and easy technique called the "Hook and roll technique" (HRT) that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC). A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing

Immunotherapy by a Slow Delivery System of Interleukin-2 in Mice Model

A sustained release system for interleukin-2 (IL-2), and IL-2 mini-pellet (IL-2 mp), was developed by fusing IL-2 into a needle shaped collagen. Serum concentration of IL-2 after a single subcutaneous injection of the IL-2 mp into C57BL/6 mice remained elevated longer than after an injection of aqueous IL-2. IL-2 in the serum became undetectable by 6h after a subcutaneous injection of 1 x 10(6) unit of IL-2 in phosphate-buffered saline (PBS). In contrast, after a single subcutaneous injection of IL-2 mp containing the same amount of IL-2, the concentration of IL-2 increased to its maximum at 6h after injection, then began to decrease gradually. IL-2 was detected even on the third day after a single subcutaneous injection of one IL-2 mp. Augmentation of NK activity and generation of IL-2 activated killer cells were observed in the spleen from day 1--day 3 after a single subcutaneous injection of IL-2 mp into C57BL/6 mice. This activation was not observed following a single subcutaneous injection of the same amount of IL-2 in PBS. Adoptive immunotherapy by a single subcutaneous injection of IL-2 mp followed by intravenous injections of in vitro cultured IL-2 activated killer cells showed better results in decreasing the number of metastases of Lewis lung carcinoma in C57BL/6 mice than immunotherapy using IL-2 solution.(ABSTRACT TRUNCATED AT 250 WORDS)</p

Small Intestinal Neuroendocrine Tumour Incidentally Diagnosed Along with Large Mesenteric Lymph Node Metastasis: A Case Report

Small intestinal neuroendocrine tumours (NETs) are rare malignancies that occur in the small intestine. The incidence of small intestinal NETs has increased substantially in recent decades. Similar to that of general NETs, the diagnosis rate of small intestinal NETs is increasing continuously. Small intestinal NETs often metastasize to the lymph nodes, even when the lesions are small. Surgical resection of the primary tumour and associated mesenteric lymph nodes is recommended. We present a case of a NET in the ileum that was incidentally diagnosed along with large mesenteric lymph node metastasis. Abdominal computed tomography for examination of urinary frequency revealed an intra-abdominal mass, measuring 80 mm in diameter. The patient was intraoperatively diagnosed with an ileocaecal mesenteric mass, and ileocaecal resection with lymph node dissection was performed. The resected specimen incidentally showed a NET measuring 14 mm in diameter in the ileum, located 90 cm from the ileocaecal valve. The ileocaecal mesenteric mass was histopathologically diagnosed as lymph node metastasis of the NET. This case confirms the importance of making an immediate intraoperative pathological diagnosis and performing a thorough examination of small intestinal lesions when a large mesenteric tumour is suspected

Laparoscopic repair of an abdominal incisional hernia above the pubis

　　Laparoscopic repair of a suprapubic hernia typically carries a high risk of recurrence, because fixation of the mesh in the peripubic area is difficult. We herein report a patient undergoing laparoscopic repair of a suprapubic hernia, along with a description of the surgical techniques employed. 　A 78-year-old woman visited our hospital with a chief complaint of swelling at the median hypogastric incision site after surgery for an ovarian cyst performed at age 25 years. Laparoscopic examination revealed the hernia orifice to be 3.5×3.0 cm in size and that the distance between the caudal margin of the hernia orifice and the pubis was 2.5 cm. Parietex composite mesh was used for fixation through all layers of the abdominal wall with non-absorbable sutures and tack fixation. On the pubic side, after the pubis had been exposed by separating it from the bladder, we performed mesh fixation through all layers of the abdominal wall immediately above the pubis with the sutures placed inside the mesh, combined with tack mesh fixation directly to the pubis. This procedure enabled definite fixation of the mesh. Six days after surgery, she was discharged without complications. To date, two years and five months after surgery, no recurrence has been observed

Rare Contents of an Internal Hernia through a Defect of the Broad Ligament of the Uterus

Herniation through a defect of the uterine broad ligament is a rare internal hernia that is difficult to diagnose definitively. Common hernia contents contain ileal loops. Herein, we report a rare case of internal herniation of both the ileum and fallopian tube through a defect of the broad ligament. A 52-year-old woman presented to our hospital with suprapubic pain and vomiting. She had a history of bowel obstruction following cesarean section. On abdominopelvic computed tomography, we suspected a closed-loop obstruction associated with bowel herniation in the right broad ligament. However, we could not identify an area of poor enhancement adjacent to distended small intestines. Emergency laparoscopic exploration revealed a viable ileal loop and incarcerated organ. Therefore, we switched to laparotomy that revealed the right fallopian tube as the ischemic organ. We reduced the hernia, resected necrotic right fallopian tube, and closed the defect of the broad ligament. The patient had an uneventful postoperative course. Rare hernia contents might complicate preoperative clinical diagnosis. Laparoscopy is useful for establishing a definitive diagnosis and treating broad ligament hernias

Open versus laparoscopic resection of primary tumor for incurable stage IV colorectal cancer: a large multicenter consecutive patients cohort study.

Objective: To investigate the hypothesis that laparoscopic primary tumor resection is safe and effective when compared with the open approach for colorectal cancer patients with incurable metastases. Background: There are only a few reports with small numbers of patients on laparoscopic tumor resection for stage IV colorectal cancer. Methods: Data from consecutive patients who underwent palliative primary tumor resection for stage IV colorectal cancer between January 2006 and December 2007 were collected retrospectively from 41 institutions. Short- and long-term outcomes were compared between patients who underwent laparoscopic or open resection. Results: A total of 904 patients (laparoscopic group: 226, open group: 678) with a median age of 64 years (range: 22-95) were included in the analysis. Conversion was required in 28 patients (12.4%) and the most common reasons for conversion (23/28: 82%) were bulky or invasive tumors. There was no 30-day postoperative mortality in either group. The complication rate (NCI-CTCAE grade 2-4) after laparoscopic surgery (17%) was significantly lower than that after open surgery (24%) (P = 0.02), and the difference was greater (4% vs 12%; P =grade 3) complications. The median length of postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group (14 vs 17 days; P = 0.002). In univariate analysis, overall survival for the laparoscopic group was significantly better than that for open surgery (median survival time: 25.9 vs 22.3 months, P = 0.04), although no difference was apparent in multivariate analysis. Conclusions: Compared with open surgery, laparoscopic primary tumor resection has advantages in the short term and no disadvantages in the long term. It is a reasonable treatment option for certain stage IV colorectal cancer patients with incurable disease