Laparoscopic versus open pancreaticoduodenectomy for ampullary cancer: A retrospective study.

INTRODUCTION: Studies comparing laparoscopic pancreaticoduodenectomy (LPD) with open pancreaticoduodenectomy (OPD) for ampullary carcinoma (AC) are limited. This study aimed to compare short- and long-term outcomes between LPD and OPD for AC. METHODS: This study included patients with AC who underwent pancreaticoduodenectomy (PD) with curative intention at Ogaki Municipal Hospital from April 2008 to March 2023. RESULTS: Fifty-five patients underwent LPD (n = 26) or OPD (n = 29). There were no significant differences in the demographics between the two groups. The LPD group had a significantly longer operative time (268 vs. 225 min), less blood loss (125 vs. 450 mL), and shorter postoperative hospital stay (18 vs. 23 days) than the OPD group. There was no significant difference in the morbidity ratio. Fewer lymph nodes were harvested in the LPD group than OPD group (9.5 vs. 16.0), but there were no significant differences in lymph node metastasis or pathological stages. There were no significant differences in overall survival (OS) or recurrence-free survival (RFS). The 3- and 5-year OS rates in the LPD group and the OPD group were 63.0% and 54%, 64.8%, and 61.2%, respectively. The 3- and 5-year RFS rates were 57.4% and 57.4%, 58.1%, and 54.4%, respectively. CONCLUSIONS: LPD for AC had short- and long-term outcomes comparable with those of OPD. LPD could be considered the standard treatments for AC because of less blood loss and a shorter hospital stay.

A new procedure with stomach-lifting techniques to simplify laparoscopy-assisted distal gastrectomy and extraperigastric lymph node dissection for gastric cancer.

Laparoscopy-assisted gastrectomy with extraperigastric lymph node dissection for gastric cancer is a complicated procedure that generally requires advanced laparoscopic surgical skill. We devised a simplified but effective laparoscopic procedure that provides a better visual field to perform safe lymph node dissection more quickly. First, a mini-laparotomy is done and a clear visual field is created by pulling a mini-retractor to the right or left. The laparoscopic procedure is made easier and safer by taping the stomach body, and by using the fringe of an abdominal wall sealing device (Lapdisk) placed behind the stomach, and a scope holder for the snake-retractor. The lymph nodes along the common hepatic vessels, left gastric vessels, and celiac artery (extraperigastric lymph nodes) are then dissected laparoscopically. The suprapyloric and infrapyloric lymph nodes are dissected through the mini-laparotomy incision and gastroduodenostomy is done using an anastomotic device. We performed laparoscopy-assisted distal gastrectomy (LADG) in 70 patients with gastric carcinomas located in the distal stomach (mean body mass index: 24.3). The mean operating time was 170 min and blood loss was minimal. All patients recovered well with minimal pain and good postoperative quality of life. We conclude that our simple and practical procedure for LADG with extraperigastric lymph node dissection can be performed safely and easily.

Is histopathological evidence really essential for making a surgical decision about mucinous carcinoma arising in a perianal fistula? Report of a case.

We report an unusual case of mucinous adenocarcinoma of the anus associated with a chronic anal fistula, treated successfully by abdominoperineal resection (APR). Although multiple biopsies failed to reveal any histological evidence of malignancy, cancer was diagnosed from the mucin obtained for cytology. Subsequent histological examination of the resected specimen revealed clusters of cancer cells floating in a mucous lake, suggesting that it would have been difficult to acquire the cells in a biopsy sample. Conversely, the presence of mucin lakes and globules in specimens drained from the region of perianal sepsis may have been histologically informative for diagnosis. Thus, although biopsy of the lesion is undoubtedly essential for diagnosis, it often fails to provide enough information to make a definite diagnosis of mucinous carcinoma. This case illustrates that clinicians should base their decision on whether to perform surgery on clinical manifestations, imaging findings, and cytology of mucin obtained by drainage when it is difficult to obtain malignant cells by biopsy.

Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: report of a case.

We report a pancreatobiliary fistula caused by an intraductal papillary-mucinous pancreatic neoplasm (IPMN), manifesting as obstructive jaundice. Computed tomography showed dilatation of the bile duct and main pancreatic duct, with multiple cystic masses in the head of the pancreas. Endoscopic retrograde pancreatocholangiography showed a patulous papilla with mucin secretion. Contrast enhancement outlined amorphous material obstructing the lower part of the common hepatic duct. Pancreatogram and magnetic resonance cholangiopancreatography showed diffuse dilatation of the main pancreatic duct and side branches without communication with the adjacent organs or duct. We performed pancreaticoduodenectomy for IPMN of the pancreatic head and a tumor-like lesion in the lower common bile duct (CBD). Macroscopically, impacted thick mucus protruded into the CBD from the pancreas via a pancreatobiliary fistula. Histologic examination revealed a pancreatobiliary fistula caused by intraductal papillary-mucinous carcinoma of the pancreas with mucin hypersecretion, an adenoma without interstitial infiltration, and isolated implantation of an IPMN in the bile duct mucosa around the fistula.

Necrotizing fasciitis secondary to carcinoma of the gallbladder with perforation.

We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.

Release of band cells from the bone marrow is impaired by preoperative chemoradiation in patients with esophageal carcinoma: increased risk of postoperative pneumonia.

PURPOSE: To examine the difference in hematological data and postsurgical course after esophagectomy between patients receiving preoperative chemoradiation and patients without preoperative treatment. METHODS: Twenty-two patients with squamous cell carcinoma of the esophagus who underwent esophagectomy during the past 2 years were retrospectively analyzed in the study. Six patients had preoperative chemoradiation (CRT group) and 16 patients had no preoperative treatment (non-CRT group). The hematological data, postoperative course, and surgical complications were compared between the two groups. RESULTS: Patients in the CRT group were given cisplatin and 5-FU (143 and 6,000 mg on average, respectively) plus an average of 35 Gy of radiation. Although the neutrophil count did not show a significant difference between the two groups, the band cell count was lower in the CRT group compared with the non-CRT group on postoperative day 1 (P<0.05). Postoperative pneumonia was detected in three patients (50%) from the CRT group versus none of the non-CRT group. CONCLUSION: Preoperative CRT may be a risk factor for postoperative pneumonia in patients with esophageal carcinoma who undergo esophagectomy. The normal bone marrow response of releasing band cells from the postmitotic marrow pool after surgery could be disturbed by CRT, which might contribute to an increase in later pulmonary complications.

Left trisegmentectomy and combined resection of the inferior vena cava, without reconstruction, for giant cystadenocarcinoma of the liver.

A 54-year-old woman with giant liver cystadenocarcinoma underwent left trisegmentectomy with combined resection of the inferior vena cava (IVC) and the right hepatic vein. As a result, only the right inferior hepatic vein was preserved as a drainage vein. Because the perivertebral plexus and the azygos vein were both well developed, neither veno-venous bypass nor IVC reconstruction was performed. The developed collateral veins acted as the venous drainage pathway to maintain a stable systemic circulation. On the seventh postoperative day, portal vein flow dramatically decreased and the patient tended to liver failure. Prostaglandin E(1) (PGE(1)) was administrated via the superior mesenteric artery. The portal flow then gradually increased and liver failure was avoided. Six months after the operation, she was re-admitted due to obstructive jaundice and presented with complete stenosis of the common bile duct (CBD). The jaundice persisted and liver dysfunction progressed. The patient died seven months after the operation. The confluence of the right inferior vein and the IVC could have been deformed, causing outflow blockade. The intrinsic shunt was not good enough to act as the drainage pathway, and IVC reconstruction may have been needed.

Advanced gastric endocrine cell carcinoma with distant lymph node metastasis: a case report and clinicopathological characteristics of the disease.

Gastric pure endocrine cell carcinoma (ECC) is extremely rare. ECC occasionally shows multidirectional differentiation; that is, adenocarcinomatous and/or squamous proliferation. Because gastric ECC has aggressive biological behavior and shows frequent metastasis to liver and lymph nodes even in the early stage, the prognosis of patients having this disease is extremely poor. We treated a 75-year-old woman with advanced gastric pure ECC with total gastrectomy and lymph node dissection, and reviewed all the previously reported cases of this disease. We compared the clinicopathological findings of ECC with those of gastric carcinoma (GC) and found that ECC had significantly more frequent invasion to lymphatic and vascular lumens ( P < 0.01) and more frequent metastasis to lymph nodes ( P < 0.01) and liver ( P < 0.05) compared to GC. Gastric ECC smaller than 5 cm in the greatest dimension showed a higher percentage of advanced lesions (>T2) than GC ( P < 0.05), which could result in the difficulty of finding early ECC. The findings of the analyses we made in this report may account for the poor prognosis of this disease.