Search

We report a novel technique of laparoscopic hepatectomy (lap-HT) performed at our hospital and the outcomes.Lap -HT was performed in 90 cases at our hospital, including 38 cases of anatomical resection of the liver.After mobilization of the right lobe with the patient in the half-lateral position, we resected the liver tissue using cavitron ultrasonic surgical aspirator (CUSA) and AquamantysTM Bipolar®.This surgical instrument is useful for laparoscopic anatomical resection of the liver because it is based on vessel sealing technology.In the 90 cases in which lap-HT was performed, the mean duration of surgery and mean blood loss were 332.9 minutes and 381 mL, respectively. The mean duration of hospitalization after surgery was 12.1 days, and postoperative complications were noted in 5 cases(5.6%). Comparison of the clinical factors and short-term performance of the surgery between liver cirrhosis patients who underwent open hepatectomy and lap-HT revealed that blood loss was significantly lower and the hospital stay duration was significantly shorter in patients who underwent lap-HT. Our findings suggest that laparoscopic anatomical resection of the liver can be safely performed using this novel technique and surgical instrument.

The patient was a 55-year-old man who had been diagnosed as having liver metastases (S3, S4, S5, S6, and S7) from sigmoid colon cancer in March 2010. In June 2010, he underwent sigmoid colon cancer resection, followed by local ablation therapy for the liver tumors( S4, S5, and S6) and hepatic segmentectomy( S3 and S7). Subsequently, adjuvant chemotherapy with S-1 and oxaliplatin( SOX) was initiated. After 6 courses, hepatic metastasis from colon cancer recurred. Thus, primary treatment with SOX plus bevacizumab for advanced metastatic colorectal cancer was initiated. However, progressive disease was diagnosed after 10 postoperative courses of chemotherapy, and therefore, chemotherapy with irinotecan and S-1 (IRIS) plus panitumumab was initiated as secondary treatment. Tumor marker levels reduced with this treatment, and diagnostic imaging indicated a partial response. We report herein a case of a patient who was successfully treated with IRIS plus panitumumab. This therapeutic regimen is useful as second-line treatment because it has the advantage of not requiring a pump for administration and treatment can be tailored to an individual patient's condition, for example, according to pathology and the patient's lifestyle needs.

A 76-year-old woman was diagnosed as having hepatocellular carcinoma( HCC), and partial hepatectomy was performed in 2007. Transarterial chemoembolization (TACE) was performed for recurrent HCCs in 2009. Ileocecal resection was performed for peritoneal dissemination of HCC localized in the ileocecal area, and sorafenib therapy was initiated in October 2009. TACE was performed for recurrent HCCs in December 2009 and March 2010. Positron emission tomography( PET) revealed a solitary intrahepatic recurrent HCC and left ovarian metastasis, and partial hepatectomy and left ovariectomy were performed in June 2010. Multiple lung metastases were detected, and systemic chemotherapy with cisplatin was initiated in February 2011. The lung metastatic tumors disappeared after 3 courses of treatment. The patient is disease free at 2 years after treatment. We encountered a case of advanced recurrent HCC is which complete response (CR) was achieved with multimodality therapy using sorafenib and surgical treatment.

Background: Intravenous injection of the indocyanine green (ICG) reagent was performed as a liver function test 1 to 2 weeks prior to surgery. ICG fluorescent imaging was performed using the Photodynamic Eye (PDE) infrared camera (Hamamatsu Photonics k. k., Shizuoka, Japan)., Methods: Intravenous injection of the ICG reagent was performed as a liver function test 1 to 2 weeks before surgery. ICG fluorescent imaging was performed using the PDE infrared camera., Results: ICG fluorescent imaging was useful for liver surgical navigation as follows: three cases of recurrent hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization or thermal ablation therapy; three cases of colorectal metastatic liver tumors after chemotherapy as conversion therapy; two cases of intrahepatic cholangiocellular carcinoma (ICC); and two cases of surface HCC that were not detected by preoperative computed tomography (CT) scan. In the ICC cases, although dilatation of the bile duct could be detected, the tumor margins were ambiguous by ultrasonography(US). ICG fluorescent imaging clearly described the dilatation of the bile duct including the tumor., Conclusions: ICG fluorescent imaging was useful for liver surgical navigation including selection of the mode of hepatic resection.

An 84-year-old woman experienced epigastralgia with increasing serum protein induced by vitamin K absence or antagonists -II(PIVKA-II) levels, and she was referred to our hospital. The serum levels of tumor markers were elevated[ alpha -fetoprotein(AFP) 22,640 ng/mL, PIVKA-II 35,140 mAU/mL], and a mass lesion of 7 cm in diameter in the right lobe of the liver with portal vein tumor thrombus (PVTT) in the major trunk was detected by abdominal computed tomography (CT) scan. She was diagnosed with unresectable hepatocellular carcinoma (HCC) with PVTT, and sorafenib in combination with intermittent cisplatin(CDDP) hepatic arterial infusion chemotherapy(HAIC)was performed. After 3 courses of the therapy, the serum levels of tumor markers were decreased (AFP: 16,283 ng/mL, PIVKA-II: 2,924 mAU/mL), and the size of the tumor had also decreased to 2 cm in diameter. PVTT decreased from Vp4 to Vp3. We judged that it was resectable, and extended right hepatectomy and portal vein embolectomy was performed. Complete tumor necrosis was seen during pathologic inspection of PVTT. Although she presented with refractory pleural effusion and ascites after operation, she recovered and left our hospital on postoperative day 70. No recurrences have occurred during the 6 months after the operation. Sorafenib in combination with intermittent CDDP HAIC is considered to be an effective therapy for advanced HCC with PVTT in the major trunk.

A 55-year-old man who underwent eye enucleation at our hospital's ophthalmology department was pathologically diagnosed with malignant melanoma. Four months later after diagnosis, he underwent positron emission tomography/computed tomography for detecting systemic metastasis. Abnormal accumulation was found in S4 of the liver. He was therefore referred to the gastrointestinal department, where liver metastasis from malignant melanoma was diagnosed by biopsy. He underwent radiofrequency ablation therapy. A recurrence 3 months later was judged difficult to manage medically. He was thus sent to our department. Preoperative magnetic resonance imaging revealed multiple tumors in both liver lobes. Thus far, no treatment strategy has been established for hepatic metastases of malignant melanoma. After receiving a thorough explanation, he agreed to partial hepatectomy. We identified 14 tumors by intraoperative ultrasonography as sites for partial hepatectomy. Postoperative chemotherapy was administered. He died of hepatic failure 9 months after the operation. It is necessary to accumulate further cases on a national scale, because establishment of appropriate therapy for this condition is urgently needed.

In 2006, a 70-year-old man who underwent low anterior resection for rectal cancer (SS, N0, H1, Stage IV)at a nearby hospital was referred to our hospital. He was noted to have multiple liver metastases of approximately 1 cm in diameter in S2, S3, S6, and S7, and was subsequently treated with chemotherapy for 5 courses of mFOLFOX6 regimen. He achieved a complete response radiographically. Thereafter, he underwent lateral segmentectomy of the liver and was noted to have residual tumor cells by histopathological examination of the resected tissue. Seven months after the hepatectomy, recurrence occurred in S6 and S7 and a new lesion in S8 was noted. He then underwent 12 courses of mFOLFOX6. As of June 2012, the patient is alive without recurrence. A prolonged survival may be possible if downstaging is achieved with successful chemotherapy. However, similar to the present case, the detection of residual cancer cells during histopathological examination of the resected tissues has been reported in the literature. Thus, further investigation is needed to determine the optimal treatment of cases achieving a radiographic complete response.

We report here the experience of the treatment with sorafenib for advanced hepatocellular carcinoma (HCC) in our department. Forty patients received the therapy of sorafenib until April 2011. Twenty seven unresectable advanced HCC, 7 lung metastasis, 6 bone metastasis, 3 abdominal lymph node metastasis, and 2 peritoneal dissemination were included. The median duration of sorafenib treatment was 197 days. Grade 3 adverse event occurred in 9 patients (22.5%), and grade 4 adverse event occurred in 1 patient (3%). The response rate and disease control rate were 5% and 55%, respectively (CR 2, PR 0, SD 20, PD 9). The median overall survival was 15.2 months, and median recurrence-free survival was 3.7 months. These results suggested that a prevention of adverse events would lead to a continued treatment with sorafenib, and could expect to have a prolonged survival in patients with advanced HCC.

Unlabelled: We evaluated the effect of sorafenib and intermittent hepatic arterial infusion chemotherapy (HAIC) using cisplatin for unresectable advanced hepatocellular carcinoma (HCC)., Methods: 5 patients (4 male/1 female, median age: 73.0 years) with unresectable advanced HCC including portal vein tumor thrombus were treated with soraenib (400 mg/body, day 1-28) and cisplatin (20 mg/m2 HAIC, day 1, 8, 15). We assess efficacy and safety after 1 course of this therapy., Results: Grade 3 adverse events occurred in 2 patients (1 serum bilirubin and aspartate aminotransferase (AST) elevation, 1 serum bilirubin elevation and hepatic encephalopathy). Grade 2 adverse events occurred in 4 patients (1 hypertension and nertropenia, 1 hypertension and thrombocytopenia, 1 hypertension and serum amylase elevation, and 1 abdominal pain). Grade 3 adverse events were improved by suspending this therapy, and completion of this therapy was achieved in all patients. After one course of this therapy, the clinical response was rated as 1 partial response (PR), 3-stable disease (SD), and 1 progressive disease (PD)., Conclusion: Sorafenib and intermittent HAIC using cisplatin for unresectable advanced HCC was expected to be safe and effective treatment.

S-1, an oral fluoropyrimidine derivative, has been identified as an effective agent for the treatment of breast cancer. We present here a case of interstitial pneumonitis that occurred after S-1 treatment. A n 80-year-old woman was diagnosed with stage III infiltrating ductal carcinoma of the left breast and underwent a modified radical mastectomy in November 2001, followed by six courses of paclitaxel. In October 2008, metastatic disease was detected in her skeletal system. Therefore, S-1 chemotherapy was initiated (100 mg/body). Five days after starting S-1, she developed severe eruptions along with dyspnea. X-rays and CT scan showed diffuse ground glass shadow. Both her symptoms and the radiographic findings resolved dramatically after the start of high-dose corticosteroid therapy. Clinicians should be aware that S-1 has the potential to cause lung injury when it is included in chemotherapy.