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Isao Kurosaki

Publications and source records attributed to Isao Kurosaki.

At least 19 recordsLinked to original sources
PubMed2006

An 11-year-old male patient demonstrating cholangiocarcinoma associated with congenital biliary dilatation.

We herein report an 11-year-old male patient demonstrating advanced cholangiocarcinoma associated with congenital biliary dilatation (CBD). This Japanese boy presented with abdominal pain lasting a few days, and a diagnosis of type IV-A CBD was made based on the findings of imaging studies using ultrasonography, computed tomography, and magnetic resonance imaging. These studies also revealed a wide flat lesion associated with a few small round masses in the dilated choledochus. Intraoperative cholangiography revealed the presence of pancreaticobiliary maljunction of CP type. Malignant cells were found in biopsy specimens from both the flat and polypoid lesions. Because the distal stump of choledochus at anomalous confluent to the pancreatic duct also showed malignant cells, a pyloric preserved pancreaticoduodenectomy with lymph node dissection was thus performed. Lymph node metastasis was found in one of the mesenteric lymph nodes, and vascular invasion was also found in the main tumor lesions of the dilated bile duct. The postoperative course was uneventful, and the patient has been followed with chemotherapy as an outpatient without any evidence of recurrence. To our knowledge, this report is the youngest case of cholangiocarcinoma associated with CBD.

Age of Onset↗
PubMed2006

Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation.

OBJECTIVES: There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT. METHODS: For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used. RESULTS: VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure. CONCLUSION: We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.

Adult↗
PubMed2005

Adjuvant systemic chemotherapy with gemcitabine for stage IV pancreatic cancer: a preliminary report of initial experience.

BACKGROUND: The effects of gemcitabine on postoperative adjuvant chemotherapy were evaluated in patients with stage IV pancreatic cancer. The results were compared with those of our historical control patients treated with surgery alone. PATIENTS AND METHODS: Nineteen patients with stage IV pancreatic cancer who had pancreatic resection with curative intent during the 5 years up to February 2003 were enrolled in this study. Nine cases received postoperative adjuvant chemotherapy with biweekly administration of 1,000 mg/m(2) gemcitabine, while the remaining 10 cases underwent surgery without any adjuvant chemotherapy. RESULTS: The chemotherapy was well tolerated with only mild symptomatic and hematologic toxicities. The disease-specific cumulative survival rates of the chemotherapy and surgery-alone groups were 86 and 70% at 1 year, and 50 and 12% at 2 years, with a median survival of 20 and 14 months, respectively (p = 0.0255). The disease-free interval was improved, and the occurrence of hepatic metastasis was reduced in the chemotherapy group compared with the surgery-alone group. CONCLUSIONS: Adjuvant systemic chemotherapy utilizing gemcitabine was feasible with acceptable adverse effects, and showed some survival benefit in stage IV pancreatic cancer patients. Further investigation into gemcitabine-based combination therapies is warranted.

Aged↗
PubMed2005

Long-term survival after hepatectomy for hepatic recurrence of carcinoma of the papilla of Vater.

We present herein a rare case of a long-term survivor after major hepatectomy performed for a metastatic liver tumor from carcinoma of the papilla of Vater. A 74-year-old man had undergone a pancreaticoduodenectomy for carcinoma of the papilla of Vater with obstructive jaundice, in April 1995. Histologically, an exposed mass-forming type of tumor, measuring 40 x 30 mm, was composed of mucinous and papillary adenocarcinoma, invading into the muscularis propria of the duodenum, without lymph node metastases. The patient did not receive any type of chemotherapy. In September 1999, a solitary hepatic tumor, 3.5 cm in diameter, was detected in segment VIII of the liver by computed tomography. In November 1999, right hepatic lobectomy was carried out. The anterior and posterior portal pedicles were ligated and dissected in the hepatic parenchyma so as not to compromise the hepaticojejunostomy. After the hepatectomy, the patient was treated with low-dose tegafur/uracil/cisplatin therapy for approximately 2 years. He has been doing well, without recurrence, for 5 years after the hepatectomy. Hepatectomy for hepatic metastases from carcinoma of the papilla of Vater is thought to be a useful surgical treatment in selected patients.

Adenocarcinoma, Mucinous↗
PubMed2005

Repeated hepatectomy for recurrent intrahepatic cholangiocarcinoma: report of two cases.

Repeated hepatectomy for remnant liver recurrence of primary intrahepatic cholangiocarcinoma (ICC) is a seldom-encountered surgical technique because of its poor prognosis. Here, we present two long-term survivors of recurrent ICC by repeated hepatectomy. One patient underwent five hepatectomies in 6 years; first, extended left hepatectomy for a primary mass-forming-type ICC and then four partial hepatectomies for independent recurrent tumors all developing in segment V. The other patient underwent re-hepatectomy for a very large recurrent tumor 7 years after the first left hepatectomy for a primary periductal-infiltrating-type ICC; and has survived for approximately 2 years from the second operation under hepatic arterial infusion chemotherapy. The recurrent tumor in the latter case arose in the segment IV remnant corresponding to the cut margin of the liver after the first inappropriate left hepatectomy. The mode of hepatic recurrence seemed closely related to the portal segmentation: in the first case, intrahepatic metastases via portal tributaries; and in the second, the occult residual cancer spreading widely through bile ductules.

Aged↗
PubMed2004

Celiac axis stenosis in pancreaticoduodenectomy.

BACKGROUND/PURPOSE: Celiac axis (CA) stenosis is a fairly common condition in candidates for upper abdominal surgery. In this report, we have documented 5 patients with CA stenosis or occlusion who underwent pancreaticoduodenectomy, and we have discussed the surgical strategy for this condition. METHODS: We reviewed the records of 126 patients who had undergone resection of the pancreatic head during the past 10 years, and a search was made for obstructive lesions of the CA. RESULTS: Among these 126 patients, there were 5 cases (4%) of CA stenosis or occlusion. Three of them were interpreted as typical CA compression syndrome, based on arteriographic or operative findings, and an excision of the median arcuate ligament dramatically improved the blood flow of the celiac branches after division of the main collaterals. The remaining 2 patients, with organized occlusion of the CA, successfully underwent pancreaticoduodenectomy through preservation of the collateral pathway between the superior mesenteric artery and the celiac branch. In one of these 2 patients, the main collateral pathway, which ran across immediately behind the pancreatic head, was skeletonized and preserved. All 5 patients had uneventful postoperative courses. CONCLUSIONS: We conclude that, in pancreaticoduodenectomy for patients with organized CA occlusion, precise assessment of the vascular anatomy and preservation of the main collateral pathway are essential for carrying out a successful operation. Celiac axis (CA) stenosis is a fairly common condition in candidates for upper abdominal surgery. In this report, we have documented 5 patients with CA stenosis or occlusion who underwent pancreaticoduodenectomy, and we have discussed the surgical strategy for this condition.

Adult↗
PubMed2004

[Role of postoperative adjuvant chemotherapy with gemcitabine for pancreatic cancer: feasibility and anti-tumor effect].

BACKGROUND: The feasibility and anti-tumor activity of gemcitabine in postoperative adjuvant chemotherapy were evaluated retrospectively. PATIENTS AND METHODS: Sixteen patients with advanced pancreatic cancer, who had a pancreatic resection with curative intent over the three years up to February 2003, were enrolled in this study. Aggressive surgery with dissection of para-aortic nodes and nerves around the superior mesenteric and celiac artery was carried out. After the operation, all patients have been given biweekly administration of 1,000 mg/m2 gemcitabine for more than 12 courses. RESULTS: The chemotherapy was well tolerated with only mild symptomatic and hematologic toxicities. Grade 3 adverse effects were observed in only 3 patients (19%); nausea and vomiting in 1 patient and leucocytopenia in 2 patients. The disease-specific cumulative survival rates were 81% at 1 year and 47% at 2 years, with a median survival of 20.4 months. The median disease-free interval was 16.8 months in all patients. CONCLUSIONS: Adjuvant systemic chemotherapy utilizing gemcitabine was feasible with acceptable adverse effects. Gemcitabine is a promising agent for the treatment of resectable advanced pancreatic cancer, and a randomized control trial is warranted for gemcitabine-based chemotherapy.

Aged↗
PubMed2002

Remote development of hepatocellular carcinoma in patients with liver cirrhosis type B serologically cured for HBs antigenemia with long-standing normalization of ALT values.

In this report, we examine two patients with chronic hepatitis B virus (HBV) infection that had been diagnosed as precirrhosis or liver cirrhosis more than a decade previously. These patients had been cleared of HBsAg and had developed anti-HBs at a later time, yet hepatocellular carcinoma (HCC) eventually occurred. Both patients had been found negative for HBV DNA, using sensitive methods. Interestingly, a nontumor specimen of the liver obtained at surgical resection showed a marked reduction of fibrosis when compared to the histology observed when the patient was diagnosed as precirrhosis. Our findings suggest that the fibrosis from liver cirrhosis had been absorbed to a large extent during the long-term absence of active viremia and the normalization of alanine aminotransferase (ALT) levels. However, the cancer-prone biological characteristics of liver cirrhosis remained. Thus, patients with liver cirrhosis due to past chronic hepatitis B should be monitored carefully for the development of HCC even if HBV infection has been serologically resolved.

Adult↗
PubMedDate not supplied

Preservation of the left gastric vein in delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy.

The definition of delayed gastric emptying (DGE) after pyloric-preserving pancreaticoduodenectomy (PPPD) varies among surgeons. We compared and evaluated three different definitions reported elsewhere. In addition, we investigated the correlation between multiple surgical factors and recovery of gastric motility. First, 55 consecutive patients were reviewed to assess the three different definitions. Second, surgical factors affecting gastric motility were investigated in 46 patients showing no major complications. All 55 patients underwent PPPD, which was reconstructed with antecolic duodenojejunostomy, with aggressive lymph node dissection and with no mortality. The duration of nasogastric intubation was 2 days, and a solid diet started on the 12th postoperative day (median). Re-nasogastric intubation or emesis was observed in 12.7% of patients. Overall, DGE occurrence rate was 5.5%-29.1%, with striking differences depending on the type of definition. Technically, division of the left gastric vein was accompanied with significantly delayed removal of the nasogastric tube (3 versus 2 days, P = 0.0002) and delayed start on a solid diet (14 versus 9 days, P < 0.0001) compared with its preservation. Antecolic duodenojejunostomy after PPPD improved DGE occurrence despite aggressive surgery, and preservation of LGV accelerated restoration of gastric motility in our experiments. However, an understanding of a common definition of DGE is needed when discussing the outcome of the various interventions.

Adolescent↗
PubMedDate not supplied

Postoperative management for donor safety in living related donor liver transplantation.

BACKGROUND/AIMS: Living related donor liver transplantation must hold on in absolute donor safety. Nevertheless, the risks to the donors are increased because of the use of right lobe for size mismatch. Therefore the intensive management for donor operation can hardly be overestimated. In this study, we investigated the utility of prostaglandin E1, methylprednisolone and C-tube in the postoperative management for donor operation based on our understanding of the mechanisms of liver injury after massive hepatectomy. METHODOLOGY: Outcome of the thirteen donors, whose right lobe was removed (right lobe group: 7 cases) or the left lobe only (3 cases) and left lobe plus caudate lobe (3 cases) (left lobe group: 6 cases) from 1999 March to 2000 August, for living related liver transplantation were evaluated. Indication for right lobe living related liver transplantation was basically defined as an estimated left lobe volume/recipient body weight ratio (GVBW ratio) of < 0.8% (range: 0.65-1.4, right lobe group: 1.05 +/- 0.18, left lobe group: 0.89 +/- 0.16). RESULTS: The donors recovered from the operation without the differentiation between right and left lobe group. There were no significant differences in the operative time, the operative hemorrhage, the hospital stays and the postoperative liver function in the two groups. They had no bile leakage and no serious complications. We experienced the left lobe donor who suffered from a cholangitis without any infection and he recovered by the administration of prostaglandin E1 and steroid. They improved bile secretion and bilirubinemia. Eleven recipients (84.6%) were successfully treated. The two causes of death were the sepsis (right lobe) and brain hemorrhage (left lobe). CONCLUSIONS: The current series of right lobe donation was able to show successful results as well as left lobe donation by the postoperative management with steroid, prostaglandin E1 and C-tube drainage based on our understanding of liver injury after massive hepatectomy in the adult-to-adult living donor liver transplantation.

Adult↗
PubMedDate not supplied

Pancreaticogastrostomy: unreliable long-term pancreatic duct patency.

BACKGROUND/AIMS: Long-term patency of pancreaticogastrostomy remains unclear. The purpose of this study is to clarify the long-term patency of pancreaticogastrostomy based on change in the main pancreatic duct diameter. METHODOLOGY: Seventeen of 33 patients who underwent pancreaticogastrostomy in our institution were divided into 2 groups according to the preoperative diameter of main pancreatic duct: the non-dilated group (phi main pancreatic duct < or = 4 mm, 11 patients) and the dilated group (phi main pancreatic duct > or = 5 mm, 6 patients). Clinical and radiological parameters were assessed by a postoperative comparison between the 2 groups. RESULTS: phi main pancreatic duct after operation was dilated in all 11 patients in the non-dilated group, and the difference was significant (p = 0.0003, mean dilatation ratio = 2.6) when compared with phi main pancreatic duct before operation. In contrast, the mean phi main pancreatic duct decreased after operation (mean dilatation ratio = 0.9) in the dilated group. Clinical symptoms (5 patients), impaired endocrine and exocrine pancreatic function (4 and 3 patients, respectively), elevated serum amylase level (6 patients), and pancreatic parenchymal changes on radiological examinations (5 patients) were observed only in the non-dilated group. CONCLUSIONS: Degree of dilatation of main pancreatic duct seems to correspond to likelihood of anastomotic stenosis of pancreaticogastrostomy. Pancreaticogastrostomy has less reliability in terms of the long-term patency in cases having non-dilated main pancreatic duct.

Adult↗
PubMedDate not supplied

The clinical efficacy of adjuvant systemic chemotherapy with gemcitabine in node-positive pancreatic cancer.

BACKGROUND/AIMS: The effects of gemcitabine in postoperative adjuvant chemotherapy were evaluated in patients suffering from locally advanced pancreatic cancer with lymph node metastases. The results were compared with those of our historical control patients treated by surgery alone. METHODOLOGY: Twenty-one patients with node-positive pancreatic cancer who had undergone a pancreatic resection with curative intent over the five years up to February 2003, were enrolled in this study. Nine cases received postoperative adjuvant chemotherapy with biweekly administration of 1000 mg/m2 gemcitabine, while the remaining 12 cases underwent surgery without any adjuvant chemotherapy. RESULTS: The chemotherapy was well tolerated with only mild symptomatic and hematologic toxicities. The overall cumulative survival rates of the chemotherapy and surgery-alone groups were 86% and 75% at one year, and 50% and 0% at two years, with a median survival of 20.3 months and 15.4 months, respectively (p=0.0084). The disease-free interval was also significantly greater in the chemotherapy group compared with the surgery-alone group (p=0.0244). CONCLUSIONS: Adjuvant systemic chemotherapy utilizing gemcitabine was feasible with acceptable adverse effects and improved the survival rate of patients with node-positive pancreatic cancer. Although further investigation is needed to confirm these results, gemcitabine is a promising agent for the treatment of resectable advanced pancreatic cancer.

Aged↗
PubMedDate not supplied

Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy.

Occasionally, a pancreatic leakage results in a poor outcome. Even today, its rate of occurrence ranges from 2 to 13%. The purpose of this study is to describe the omental-wrapping technique and to evaluate its clinical utility for preventing serious complications following pancreatic leakage. The clinical records of 54 patients who underwent this technique were reviewed for their short-term outcome. After completing all reconstruction, an omental flap was spread out behind the pancreaticojejunostomy, allowing complete isolation of the skeletonized major vessels from the pancreatic anastomosis. There was no operative death or intra-abdominal bleeding. Pancreatic leakage occurred in 5 patients, all associated with bacterial infection. However, drains placed in the retroperitoneal space, which was isolated from the pancreatic anastomosis by the flap, were aseptic in all patients. The pancreatic leakage was closed with no additional serious conditions related to the leak. Our studies demonstrate that the omental wrapping technique is one of the useful surgical options for preventing serious conditions following a pancreatic leakage.

Aged↗
PubMedDate not supplied

Acute renal failure during the early postoperative period in adult living-related donor liver transplantation.

BACKGROUND/AIMS: Acute renal failure after liver transplantation can occur in some and is an important postoperative complication. Our goal is to clarify the risk factors of acute renal failure after living-related donor liver transplantation (LDLT). METHODOLOGY: From March 1999 to August 2000, ten consecutive patients were investigated the changes of the systemic hemodynamics and the renal function. They were classified into Group A (Creatinine (Cre) was over 2.0 mg/dL) and B (Cre was below 2.0 mg/dL). Retrospective variables were examined with two groups A and B being compared. RESULTS: In both groups, Cardiac Index (CI) was above standard levels. However, the CI levels in Group B were significantly higher than those in Group A (p=0.031). The early postoperative transaminase levels were significantly higher in Group A than in Group B (p=0.049) and graft liver volume/recipient body weight ratio was significantly smaller in Group A than in Group B (p=0.016). CONCLUSIONS: Our study suggests that small-for-size graft or hypovolemia, resulting in the delay of the recovery of graft liver function, may be an important cause of acute renal failure during the early postoperative period in adult LDLT.

Acute Kidney Injury↗