Cone Unit-Based Anatomical Liver Resection Guided by Preoperative Embolization and ICG Fluorescence: A Novel Surgical Strategy.

Background: The liver cone unit (Tokyo 2020 terminology) of the peripheral portal vein territory represents the smallest anatomical and functional unit of the liver. While this unit enables anatomical, subsegmental resection, particularly in patients with cirrhosis, the tumor-bearing cone unit can be challenging to identify intraoperatively. PATIENTS AND METHODS: A 58-year-old man with hepatitis C-related cirrhosis (Child-Pugh B) was diagnosed with a subcapsular hepatocellular carcinoma (HCC) in segment 8.

Robotic Central Pancreatectomy with Omental Pedicle Flap: Tactics and Tips.

Background: Robotic central pancreatectomy is increasingly used for pre- or low-grade malignant tumors in the pancreatic body balancing preservation of pancreatic function while removing the target lesion. Today, there is no established reconstruction method and high rates of postpancreatectomy fistulas (POPF) remain a significant concern. We developed novel technique involving transgastric pancreaticogastrostomy with an omental pedicle advancement flap to reduce the risk of POPF.

Western and Eastern experience in treating perihilar cholangiocarcinoma: retrospective bi-centre study.

Background: Resection outcomes for perihilar cholangiocarcinoma differ between Western and Eastern centres, but reasons behind these disparities remain unclear. This study aimed to compare current outcomes between a Western and an Eastern expert centre to identify prognostic factors.

Methods: Patients who underwent hepatobiliary resection for perihilar cholangiocarcinoma between 2010 and 2022 at Karolinska University Hospital (Stockholm, Sweden) and Cancer Institute Hospital (Tokyo, Japan) were retrospectively included.

Are More Young, Western Patients Also Developing Hepatocellular Carcinoma?

Background: While the incidence of early-onset cancers is rising, it is unclear whether this is the case for early-onset hepatocellular carcinoma (eHCC). Even the definition of eHCC remains unclear. This study was designed to identify an age cutoff for eHCC and to explore trends in its incidence, clinical presentation, surgical outcomes, and long-term survival compared to typical-onset HCC (tHCC).

Analyzing the high frequency of false-positive carcinoembryonic antigen elevations in postoperative pancreatic ductal adenocarcinoma.

Purpose: The dynamics of postoperative carcinoembryonic antigen (CEA) in pancreatic ductal adenocarcinoma (PDAC) patients have not been well assessed. This study investigated the correlation between postoperative CEA elevations and tumor recurrence.

Methods: Medical records were retrospectively analyzed for 84 patients who received curative resection for PDAC from January 2019 to December 2020.

Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence.

Purpose: Recently, bail-out cholecystectomy (BOC) during laparoscopic cholecystectomy to avoid severe complications, such as vasculobiliary injury, has become widely used and increased in prevalence. However, current predictive factors or scoring systems are insufficient. Therefore, in this study, we aimed to test the validity of existing scoring systems and determine a suitable cutoff value for predicting BOC.

Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines.

Background: Robotic pancreatoduodenectomy (RPD) is a newly introduced procedure, which is still evolving and lacks standardization. An objective assessment is essential to investigate the feasibility of RPD. The current study aimed to assess our initial ten cases of RPD based on IDEAL (Idea, Development, Exploration, Assessment, and Long-term study) guidelines.

Essential updates 2021/2022: Update in surgical strategy for perihilar cholangiocarcinoma.

Resection is the only potential curative treatment for perihilar cholangiocarcinoma (PHC); however, complete resection is often technically challenging due to the anatomical location. Various innovative approaches and procedures were invented to circumvent this limitation but the rates of postoperative morbidity (20%-78%) and mortality (2%-15%) are still high. In patients diagnosed with resectable PHC, deliberate and coordinated preoperative workup and optimization of the patient and future liver remnant are crucial.

Role of Intraoperative Assessment of Proximal Bile Duct Margin Status and Additional Resection of Perihilar Cholangiocarcinoma: Can Local Clearance Trump Tumor Biology? A Retrospective Cohort Study.

Background: The aim of this study was to evaluate the clinical implications of the proximal bile duct margin status in resection of perihilar cholangiocarcinoma (PHCC). Intraoperative frozen section (IFS) analysis to assess the bile duct margin status is commonly used during PHCC resection. However, the impact of additional resection after obtaining a positive margin on the long-term outcome remains unclear.

Segmental resection with partial mesopancreatic and mesojejunal excision (pMME) for duodenal carcinoma of the third or fourth portion.

Introduction: Pancreatoduodenectomy is the standard procedure for duodenal carcinoma of the third or fourth portion. As an alternative option, we developed a novel segmental resection (SR) with partial mesopancreatic and mesojejunal excision (pMME) that enhances radicality. In this report, the surgical technique with video and outcomes are described.

Hepatic vein resection and reconstruction for liver malignancies: expanding indication and enhancing parenchyma-sparing hepatectomy.

The short-term outcomes after hepatic vein reconstruction (HVR) were evaluated in 41 patients. HVR can be performed safely using autologous vein graft. HVR can increase the functional remnant liver volume, facilitating parenchyma-sparing one-step hepatectomy as well as expanding resectability even in patients with all major hepatic veins involved.

A case report of fibrolamellar hepatocellular carcinoma, with particular reference to preoperative diagnosis, value of molecular genetic diagnosis, and cell origin.

Background: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a liver tumor that occurs almost exclusively in young adults without underlying liver disease. In spite of its distinct clinical characteristics and specific imaging findings, preoperative diagnosis is often difficult due to the extremely low incidence of the tumor. Although FL-HCC shows particular morphological features on H&E-stained tissue sections, differential diagnosis from ordinary HCC, especially the scirrhous variant of HCC, and intrahepatic cholangiocarcinoma needs additional immunohistochemical (IHC) analyses and/or molecular genetic testing.

A case of necrotic enteritis during neoadjuvant chemotherapy with gemcitabine and S-1 for resectable pancreatic ductal adenocarcinoma.

Pancreatic cancer is the fourth leading cause of cancer-related death in Japan. Pancreatic cancer is categorized as resectable, borderline resectable, or unresectable based on the degree of adjacent vascular invasion and the presence of distant metastases. Neoadjuvant chemotherapy with gemcitabine and S-1 (NAC-GS) has recently become a standard option for resectable pancreatic cancer in Japanese patients.

Factors Affecting Persistent Splenomegaly After Adult-to-Adult Living Donor Liver Transplantation Using a Left Lobe.

Background: The aim of the present study was to evaluate spleen volume (SV) and the factors influencing it after adult-to-adult living donor liver transplantation (A2LDLT) using a left lobe.

Methods: Pretransplant computed tomography (CT) and post-transplant CT 2 years after A2LDLT were examined by volumetric analysis in 24 patients. We divided the recipients into the following 2 groups according to the post-transplant SV: >500 mL (Group A) and ≤500 mL (Group B).

Laparoscopic resection of an intra-abdominal esophageal duplication cyst: a case report and literature review.

Duplication of the alimentary tract is a rare congenital malformation that occurs most often in the abdominal region, whereas esophageal duplication cyst develops typically in the thoracic region but occasionally in the neck and abdominal regions. Esophageal duplication cyst is usually diagnosed in early childhood because of symptoms related to bleeding, infection, and displacement of tissue surrounding the lesion. We recently encountered a rare adult case of esophageal duplication cyst in the abdominal esophagus.

A case of perforated sigmoid diverticulitis in which gram staining of ascitic fluid was useful for diagnosis.

An 85-year-old woman was admitted to our hospital for steroid therapy for relapsing nephrotic syndrome. During hospitalization, she complained of sudden epigastric pain at night. Although there were signs of peritoneal irritation, CT showed a large amount of ascitic fluid, but no free intraperitoneal gas.