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1. A case of non-ampullary duodenal adenosquamous carcinoma with successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage

Author

Arimasa Miyama, Yuko Chikaishi, Daigo Kobayashi, Kazuhiro Matsuo, Takayuki Ochi, Kenichi Nakamura, Tomoyoshi Endo, Kenji Kikuchi, Hidetoshi Katsuno, Aki Nishijima, and Zenichi Morise

Subjects
Non-ampullary duodenal adenosquamous carcinoma, Emergency pancreaticoduodenectomy, Gastrointestinal hemorrhage, Surgery, RD1-811
Abstract

Abstract Background Although most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma. Case presentation A 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery. Conclusions This report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.

Published
2023
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2. Multicenter Propensity Score-Based Study of Laparoscopic Repeat Liver Resection for Hepatocellular Carcinoma: A Subgroup Analysis of Cases with Tumors Far from Major Vessels

Author

Charles Chung Wei Lin, Francesca Ratti, Takashi Kaizu, Andrea Belli, David A. Geller, Masafumi Yasunaga, Alexis Laurent, Joseph F. Buell, Go Wakabayashi, Ibrahim Dagher, Shogo Tanaka, Hiroshi Sadamori, Katsuhiko Uesaka, Nasser Abdul Halim, Tomoaki Yoh, Naoto Gotohda, Ho-Seong Han, Ki-Hun Kim, Ruben Ciria, Kazuki Hashida, Hwui Dong Cho, Hironori Kaneko, Olivier Soubrane, Hiroyuki Nitta, Masaki Ueno, Gregory C. Wilson, Arimasa Miyama, Atsushi Sugioka, Toshiro Ogura, Yoshiaki Ohmura, Mohammad Alzoubi, Masahiro Shinoda, Yusuke Kumamoto, Giammauro Berardi, Kazuteru Monden, Kyung-Suk Suh, Bjørn Edwin, Minoru Tanabe, Tan To Cheung, Yuta Abe, Kazuyuki Kawamoto, Joel Lewin, Chung Mau Lo, Luca Aldrighetti, Zenichi Morise, Daniel Cherqui, Kuohsin Chen, Ela Ekmekcigil, Mohammed Abu Hilal, David Fuks, Roberto Ivan Troisi, Giulio Belli, Yuichiro Otsuka, Brice Gayet, Yusuke Ome, Yukiyasu Okamura, Fernando Rotellar, Javier Briceno, Nicholas O'Rourke, Akishige Kanazawa, Yasuji Seyama, Yutaka Takeda, Yutaro Kato, Shoji Kubo, Miyama, A., Morise, Z., Aldrighetti, L., Belli, G., Ratti, F., Cheung, T. -T., Lo, C. -M., Tanaka, S., Kubo, S., Okamura, Y., Uesaka, K., Monden, K., Sadamori, H., Hashida, K., Kawamoto, K., Gotohda, N., Chen, K., Kanazawa, A., Takeda, Y., Ohmura, Y., Ueno, M., Ogura, T., Suh, K. -S., Kato, Y., Sugioka, A., Belli, A., Nitta, H., Yasunaga, M., Cherqui, D., Halim, N. A., Laurent, A., Kaneko, H., Otsuka, Y., Kim, K. -H., Cho, H. -D., Lin, C. C. -W., Ome, Y., Seyama, Y., Troisi, R. I., Berardi, G., Rotellar, F., Wilson, G. C., Geller, D. A., Soubrane, O., Yoh, T., Kaizu, T., Kumamoto, Y., Han, H. -S., Ekmekcigil, E., Dagher, I., Fuks, D., Gayet, B., Buell, J. F., Ciria, R., Briceno, J., O'Rourke, N., Lewin, J., Edwin, B., Shinoda, M., Abe, Y., Hilal, M. A., Alzoubi, M., Tanabe, M., Wakabayashi, G., and Troisi, R.

Subjects
long-term outcome, Cancer Research, medicine.medical_specialty, Patient characteristics, Subgroup analysis, morbidity, Article, Resection, 03 medical and health sciences, 0302 clinical medicine, Blood loss, medicine, Stage (cooking), short-term outcome, RC254-282, business.industry, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, hepatocellular carcinoma, laparoscopic liver resection, medicine.disease, Surgery, Oncology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Propensity score matching, 030211 gastroenterology & hepatology, repeat surgery, Liver function, repeat liver resection, business
Abstract

Simple Summary Less morbidity is considered among the advantages of laparoscopic liver resection for HCC patients. However, our previous international, multi-institutional study of laparoscopic repeat liver resection (LRLR) failed to prove it. We hypothesize that these results may be since the study included complex cases performed during the procedure’s developing stage. To examine it, subgroup analysis based on propensity score were performed, defining the proximity of the tumors to major vessels as the complexity. A propensity score matching earned 115 each patient of LRLR and open repeat liver resection (ORLR) without the proximity to major vessels, and the outcomes were compared. With comparable operation time and long-term outcome, less blood loss and less morbidity were shown in LRLR group than ORLR. Even in its worldwide developing stage, LRLR for HCC patients could be beneficial in blood loss and morbidity for the patients with less complexity in surgery. Abstract Less morbidity is considered among the advantages of laparoscopic liver resection (LLR) for HCC patients. However, our previous international, multi-institutional, propensity score-based study of emerging laparoscopic repeat liver resection (LRLR) failed to prove this advantage. We hypothesize that these results may be since the study included complex LRLR cases performed during the procedure’s developing stage. To examine it, subgroup analysis based on propensity score were performed, defining the proximity of the tumors to major vessels as the indicator of complex cases. Among 1582 LRLR cases from 42 international high-volume liver surgery centers, 620 cases without the proximity to major vessels (more than 1 cm far from both first–second branches of Glissonian pedicles and major hepatic veins) were selected for this subgroup analysis. A propensity score matching (PSM) analysis was performed based on their patient characteristics, preoperative liver function, tumor characteristics and surgical procedures. One hundred and fifteen of each patient groups of LRLR and open repeat liver resection (ORLR) were earned, and the outcomes were compared. Backgrounds were well-balanced between LRLR and ORLR groups after matching. With comparable operation time and long-term outcome, less blood loss (283.3±823.0 vs. 603.5±664.9 mL, p = 0.001) and less morbidity (8.7 vs. 18.3 %, p = 0.034) were shown in LRLR group than ORLR. Even in its worldwide developing stage, LRLR for HCC patients could be beneficial in blood loss and morbidity for the patients with less complexity in surgery.

Published
2021

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