The Experts below are selected from a list of 513 Experts worldwide ranked by ideXlab platform
Yuji Kaneoka - One of the best experts on this subject based on the ideXlab platform.
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en bloc resection of the Hepatoduodenal Ligament for advanced biliary malignancy
Journal of Gastrointestinal Surgery, 2015Co-Authors: Yuji Kaneoka, Atsuyuki Maeda, Masatoshi IsogaiAbstract:En bloc resection of the Hepatoduodenal Ligament (HDL) for advanced biliary malignancy by hepato-Ligamento-pancreatoduodenectomy (HLPD) or hepatoLigamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients. Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method. Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57 % of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57 %, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years. En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
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Hepatoduodenal Ligament invasion by gallbladder carcinoma histologic patterns and surgical recommendation
World Journal of Surgery, 2003Co-Authors: Yuji Kaneoka, Akihiro Yamaguchi, Masatoshi Isogai, Tohru Harada, Masahiko SuzukiAbstract:Abstract A consensus for the optimal management of Hepatoduodenal Ligament (HDL) invasion by gallbladder carcinoma has yet to be reached. We retrospectively correlated the patterns of HDL invasion with the surgical outcome. From 1985 to 2000, 59 patients underwent combined resection of the extrahepatic bile duct and gallbladder and contiguous organs if required. Pathologic staging (UICC) was stage II, 4; stage III, 14; stage IVa, 10; and stage IVb, 31. Hepatoduodenal Ligament invasion was subdivided into lymph node involvement (LNI) and bile duct infiltration (BDI). Patterns of HDL invasion were compared with bile duct morphology, resectability, and outcome. Bile duct infiltration (n = 32) caused stenosis of the bile duct in all cases, whereas LNI (n = 40) caused stenosis in only 4 cases. Resection was complete after extended cholecystectomy (n = 22) in 36%; 4b/5 segmentectomy (n = 10) in 90%; major hepatectomy (n = 2) in 50%; and hepatopancreatoduodenectomy (n = 17) in 53% of cases. Surgery was curative in 75% of patients without BDI, and was < 30% with BDI. The most common factor preventing curative resection in BDI was perineural invasion around the HDL. Perineural invasion occurred in over 70% of cases at either the cut end of the bile duct or in the margin of dissection. The 3-year survival rates, excluding patients with R2 resection (residual cancer) and death in hospital, were LNI(−)BDI(−) (n = 8), 65.6%; LNI(+)BDI(−) (n = 17), 35.3%; LNI(−)BDI(+) (n = 7), 14.3%; and LNI(+)BDI(+) (n = 17), 5.9%. There were no 5-year survivors with BDI. In conclusion, perineural invasion in BDI is an important obstacle to complete resection. Hepatopancreatoduodenectomy is a feasible strategy only for LNI(+)BDI(−) disease.
Shinji Togo - One of the best experts on this subject based on the ideXlab platform.
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indications for curative resection of advanced gallbladder cancer with Hepatoduodenal Ligament invasion
Journal of Hepato-biliary-pancreatic Surgery, 2001Co-Authors: Itaru Endo, Hiroshi Shimada, Yoshiro Fujii, Mitsutaka Sugita, Hideki Masunari, Yasuhiko Miura, Kuniya Tanaka, Koichiro Misuta, Hitoshi Sekido, Shinji TogoAbstract:Hepatoduodenal Ligament invasion (HLI) is an inhibiting factor for the curative resection of advanced gallbladder cancer. The aim of this study was to clarify the indications for surgical resection in patients with advanced gallbladder cancer with and without HLI by analyzing outcomes. The subjects were 58 patients with advanced gallbladder cancer who underwent aggressive resection, and 20 nonresected patients diagnosed as haring HLI. The presence of stromal cancerous infiltration at six sites in the Hepatoduodenal Ligament was investigated. The extent of cancer spread was classified into two grades by the number of sites where cancer cells detected: low grade, one or two invasion sites; high grade, three or more sites. Pancreatoduodenectomy, vascular reconstruction, and extensive hepatectomy were frequently performed in the patients with HLI. The cumulative 5-year-survival rate of the HLI patients was 10.9%, significantly worse than that of the resected patients without HLI (46.6%; P < 0.01). Patients with paraaortic lymph node metastasis died within 1 year. The cumulative 5-year-survival rate after curative resection was 38.1%, significantly better than that after noncurative resection (0%; P < 0.05). The survival was significantly worse in patients with high-grade invasion than in these with low-grade invasion (P < 0.05), being equivalent to that in the nonresection patients. Of four factors, operative curability, hepatic lobectomy, HLI grade, and paraaortic lymph node metastasis, the HLI grade and hepatic lobectomy were considered to be significant prognostic factors by Cox's multivariate analysis (backward stepwise method). Aggressive surgical resection for curative purposes should be limited to patients with low-grade HLI and metastasis-negative paraaortic lymph nodes.
Masatoshi Isogai - One of the best experts on this subject based on the ideXlab platform.
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en bloc resection of the Hepatoduodenal Ligament for advanced biliary malignancy
Journal of Gastrointestinal Surgery, 2015Co-Authors: Yuji Kaneoka, Atsuyuki Maeda, Masatoshi IsogaiAbstract:En bloc resection of the Hepatoduodenal Ligament (HDL) for advanced biliary malignancy by hepato-Ligamento-pancreatoduodenectomy (HLPD) or hepatoLigamentectomy (HL) remains challenging, and only short-term outcomes have been reported. We showed our surgical technique of HLPD and HL, and retrospectively investigated surgical outcomes of the patients. Between 2003 and 2014, we performed four HLPD and three HL including major hepatectomy with concomitant caudate lobectomy. Portal vein reconstruction (PVR) was performed with a right external iliac vein graft, and hepatic artery reconstruction (HAR) was accomplished with the heterogeneous artery using the continuous suturing method. Mean operation time and blood loss were 575 ± 111 min and 1539 ± 950 mL, respectively, and patency of the reconstructed vessels was confirmed postoperatively in all cases. Histologically, negative surgical margins (R0) were achieved in 57 % of patients, while the resected vascular invasion was confirmed in all patients. Overall morbidity was high at 57 %, but we have achieved no postoperative mortality. Overall median survival time of the patients was 36 months, and a patient of HL survived over 5 years. En bloc resection of the HDL based on steady vascular reconstruction can improve the surgical outcome of biliary cancer in selected patients.
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Hepatoduodenal Ligament invasion by gallbladder carcinoma histologic patterns and surgical recommendation
World Journal of Surgery, 2003Co-Authors: Yuji Kaneoka, Akihiro Yamaguchi, Masatoshi Isogai, Tohru Harada, Masahiko SuzukiAbstract:Abstract A consensus for the optimal management of Hepatoduodenal Ligament (HDL) invasion by gallbladder carcinoma has yet to be reached. We retrospectively correlated the patterns of HDL invasion with the surgical outcome. From 1985 to 2000, 59 patients underwent combined resection of the extrahepatic bile duct and gallbladder and contiguous organs if required. Pathologic staging (UICC) was stage II, 4; stage III, 14; stage IVa, 10; and stage IVb, 31. Hepatoduodenal Ligament invasion was subdivided into lymph node involvement (LNI) and bile duct infiltration (BDI). Patterns of HDL invasion were compared with bile duct morphology, resectability, and outcome. Bile duct infiltration (n = 32) caused stenosis of the bile duct in all cases, whereas LNI (n = 40) caused stenosis in only 4 cases. Resection was complete after extended cholecystectomy (n = 22) in 36%; 4b/5 segmentectomy (n = 10) in 90%; major hepatectomy (n = 2) in 50%; and hepatopancreatoduodenectomy (n = 17) in 53% of cases. Surgery was curative in 75% of patients without BDI, and was < 30% with BDI. The most common factor preventing curative resection in BDI was perineural invasion around the HDL. Perineural invasion occurred in over 70% of cases at either the cut end of the bile duct or in the margin of dissection. The 3-year survival rates, excluding patients with R2 resection (residual cancer) and death in hospital, were LNI(−)BDI(−) (n = 8), 65.6%; LNI(+)BDI(−) (n = 17), 35.3%; LNI(−)BDI(+) (n = 7), 14.3%; and LNI(+)BDI(+) (n = 17), 5.9%. There were no 5-year survivors with BDI. In conclusion, perineural invasion in BDI is an important obstacle to complete resection. Hepatopancreatoduodenectomy is a feasible strategy only for LNI(+)BDI(−) disease.
Tingbo Liang - One of the best experts on this subject based on the ideXlab platform.
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gallbladder cancer with tumor thrombus in the portal vein a case report
Medicine, 2018Co-Authors: Xiaozhen Zhang, Wei Chen, Xueli Bai, Tingbo LiangAbstract:AbstractRationale:Gallbladder cancer (GBC) is a highly fatal malignancy. Due to its invasiveness and delayed diagnosis, many GBC patients are diagnosed with synchronous liver and Hepatoduodenal Ligament involvement. In our case, we report a gallbladder cancer with portal vein thrombus.Patient concer
Koichiro Misuta - One of the best experts on this subject based on the ideXlab platform.
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indications for curative resection of advanced gallbladder cancer with Hepatoduodenal Ligament invasion
Journal of Hepato-biliary-pancreatic Surgery, 2001Co-Authors: Itaru Endo, Hiroshi Shimada, Yoshiro Fujii, Mitsutaka Sugita, Hideki Masunari, Yasuhiko Miura, Kuniya Tanaka, Koichiro Misuta, Hitoshi Sekido, Shinji TogoAbstract:Hepatoduodenal Ligament invasion (HLI) is an inhibiting factor for the curative resection of advanced gallbladder cancer. The aim of this study was to clarify the indications for surgical resection in patients with advanced gallbladder cancer with and without HLI by analyzing outcomes. The subjects were 58 patients with advanced gallbladder cancer who underwent aggressive resection, and 20 nonresected patients diagnosed as haring HLI. The presence of stromal cancerous infiltration at six sites in the Hepatoduodenal Ligament was investigated. The extent of cancer spread was classified into two grades by the number of sites where cancer cells detected: low grade, one or two invasion sites; high grade, three or more sites. Pancreatoduodenectomy, vascular reconstruction, and extensive hepatectomy were frequently performed in the patients with HLI. The cumulative 5-year-survival rate of the HLI patients was 10.9%, significantly worse than that of the resected patients without HLI (46.6%; P < 0.01). Patients with paraaortic lymph node metastasis died within 1 year. The cumulative 5-year-survival rate after curative resection was 38.1%, significantly better than that after noncurative resection (0%; P < 0.05). The survival was significantly worse in patients with high-grade invasion than in these with low-grade invasion (P < 0.05), being equivalent to that in the nonresection patients. Of four factors, operative curability, hepatic lobectomy, HLI grade, and paraaortic lymph node metastasis, the HLI grade and hepatic lobectomy were considered to be significant prognostic factors by Cox's multivariate analysis (backward stepwise method). Aggressive surgical resection for curative purposes should be limited to patients with low-grade HLI and metastasis-negative paraaortic lymph nodes.
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successful choledochojejunostomy for choledochal stricture with preservation of the collateral parabiliary venous system following iatrogenic portal occlusion
Journal of Hepato-biliary-pancreatic Surgery, 1997Co-Authors: Nobumichi Takeuchi, Hiroshi Shimada, Koichiro Misuta, Akira NakanoAbstract:We surgically treated a patient with biliary stricture and portal vein occlusion, after operation for gastric cancer with lymphadenectomy along the Hepatoduodenal Ligament, that had led to choledochal stone formation and a dilatated parabiliary venous system. A 57-year-old man without hepatic dysfunction exhibited hepatic duct dilatation with choledochal stone on ultrasonography and percutaneous transhepatic cholangiography, respectively. Pharmacoportography revealed occlusion of the portal vein and dilatation of the parabiliary venous system. Of various preoperative imaging studies used, enhanced computed tomography was most useful for delineating the surgical anatomy of the Hepatoduodenal Ligament. Complete preservation of the dilatated vessels, which functioned as the main portal collateral pathway, resulted in a successful choledocho-jejunostomy, with an uneventful postoperative course.