Clinical trial with surgery and intraperitoneal hyperthermic perfusion for peritoneal recurrence of gastrointestinal cancer
Shigeru FujimotoRam Dhoj ShresthaM KokubunKokuriki KobayashiS KiuchiMakoto TakahashiChiyuki KonnoMasayasu OhtaS KoikeYukio KitsukawaMasahiko MizutaniKatsuji Okui
53
Citation
17
Reference
10
Related Paper
Citation Trend
Abstract:
To treat six patients with peritoneal recurrence after radical operation for gastrointestinal cancer, an intraperitoneal hyperthermic perfusion (IPHP), combined with surgical resection of recurrent tumors, intestinal by-pass anastomosis, or both, was carried out. Immediately after complete resection of the intraperitoneal recurrent tumors, a 2- to 3-hour IPHP was performed under hypothermic general anesthesia at about 32°C, using a perfusate containing 10 μg/ml or 20 μg/ml of mitomycin C (MMC) warmed at the inflow temperature of 46.6°C to 46.9°C. The apparatus used for IPHP was designed for intraperitoneal perfusion as a closed circuit. Although five of the six patients had a malignant peritoneal effusion at the time of admission, the effusion disappeared soon after IPHP, and no cancer cell was present in the lavage from Douglas' pouch. The other patient had a recurrent tumor at the anastomotic region after low anterior resection for rectal cancer and complete resection of the recurrent tumor, combined with IPHP, was carried out. One patient with a recurrent gastric cancer died of hepatic metastasis and cancerous pleuritis 5 months after this treatment, and the other five are in good health 12.8 ± 5.1 months after IPHP. On the other hand, five patients with intra-abdominal recurrent gastric cancer, who received only surgical treatment within the same period of time, died 3.0 ± 2.1 months after the surgery. Postoperatively, in the six patients with IPHP, transitory hepatic dysfunction, hypoproteinemia, and thrombocytopenia occurred. These results show that IPHP using MMC combined with surgery is a safe, reliable treatment for patients with peritoneal recurrence of gastrointestinal cancer.The microvascular sleeve anastomosis, where one vessel is inserted into the other, was compared with the conventional end to end anastomosis. In an experimental study in rat femoral arteries 42 anastomoses of each kind were examined. Operating time, patency rates, flow rates and strength of the anastomoses were recorded at various postoperative time intervals. It is concluded that the sleeve anastomosis is quicker to perform and that the two types of anastomoses in biomechanical respects are similar. Flow rates are slightly decreased immediately postoperatively in the sleeve anastomosis but this is of a temporary nature.
Surgical anastomosis
Cite
Citations (33)
Objective The effects of seromuscular layer anastomosis, extramucosal anastomosis,single-layer anastomosis and double-layer anastomosis of gastrointestinal tract on anastomotic healing were compared. MethodsChinese rabbits were divided into four groups: group A (double-layer anastomosis, n=10), group B (single-layer inverted anastomosis, n=10), group C (extramucosal anastomosis, n=10) and group D (seromuscular layer anastomosis, n=10). Five anastomoses were performed in each animal: one side-to-side gastroduodenal anastomosis, two end-to-end ileal and colonic anastomoses respectively. Half of each group was sacrificed on postoperative day 3 and 7 respectively to determine in situ anastomostic bursting pressures (ABP) and hydroxyproline (HP) content, and to receive histopathologic examination. Inflammatory index and mucosal healing index of anastomosis were calculated. Results There were no significant differences in case of ABP among the groups on day 3, and with the same result among group A, B and C on day 7 in gastroduodenal, ileoileal and colocolonic anastomoses. On day 7, the ABP of gastroduodenal anastomosis was dramatically higher in group D than group A and B (P0.05), the ABP of ileoileal anastomosis in group D was significantly increased compared with group A (P0.01), and the ABP of colocolonic anastomosis in group D was also higher than group A, B and C (P0.05). There was no statistical difference in HP content among the 4 groups in gastroduodenal and ileal anastomoses on day 3 (P0.05), and in ileal and colonic anastomoses on day 7 (P0.05). HP content was higher in group A than group B on day 3 in colonic anastomoses (P0.05), and it was also found to be higher in group D than group A on day 7 in gastroduodenal anastomosis (P0.025). Inflammatory reaction was not different among the 4 groups in gastroduodenal and ileoileal anastomoses on day 3, and the inflammatory indices of gastroduodenal and colocolonic anastomoses in all groups were similar on day 7. The inflammatory index of colocolonic anastomosis was signicantly increased in group A than group C on day 3 (P0.05), and that of ileoileal anastomosis in group A was higher than group D on day 7 (P0.05). The mucosal healing indices of anastomoses were not significantly different among the 4 groups on day 7. Conclusion Seromuscular layer anastomosis of gastrointestinal tract is as safe as other hand-sewn anastomoses, but it is more convenient and simpler than others.
Roux-en-Y anastomosis
Surgical anastomosis
Cite
Citations (0)
Abstract Most patients with ovarian cancer present with widely metastatic disease. Although epithelial ovarian cancer was widely believed to metastasize via direct surface spread, the distribution of metastasis from the primary tumor is not completely random. Ovarian cancer has a clear predilection for metastasis to the omentum, but the underlying mechanisms involved in ovarian cancer spread are not well understood. We have used parabiosis model systems that demonstrate preferential hematogenous metastasis of ovarian cancer to the omentum. Our studies revealed that the ErbB3-neuregulin 1 (NRG1) axis is a dominant pathway responsible for hematogenous omental metastasis. Elevated levels of ErbB3 in ovarian cancer cells and NRG1 in the omentum allowed for tumor cell localization and growth in the omentum. Depletion of ErbB3 in ovarian cancer impaired omental metastasis. Our results highlight hematogenous metastasis as an important mode of ovarian cancer metastasis. These findings have implications for designing alternative strategies aimed at preventing and treating ovarian cancer metastasis. Citation Format: Anil K. Sood. Hematogenous metastasis of ovarian cancer: Rethinking mode of spread. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Metastasis; 2015 Nov 30-Dec 3; Austin, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(7 Suppl):Abstract nr IA23.
Debulking
Cite
Citations (0)
The restoration of bowel continuity using multiple classic anastomoses is mostly impossible in unstable critically ill extremely low birth weight neonates. The parameters of healing of approximative anastomoses in which integrity and continuity of bowel is achieved with limited number of stitches were evaluated in an experimental study.Small bowel anastomoses were performed in twenty-two adult male rats. An approximative ileo-ileal anastomosis was performed with five seromuscular-interrupted sutures only; in the control group the anastomosis was performed with the conventional technique of interrupted sutures. The mechanical and biochemical parameters were compared.All anastomoses in both groups healed well without obstruction. The mean operating time needed for an approximative anastomosis was shorter (16 +/- 7.1 min versus 23.6 +/- 6.2 min, p = 0.016). The strength of the approximative anastomoses on the 1st day after surgery was 55 +/- 15 torr; the strength of the conventional anastomoses was 55 +/- 42 torr. The strength of the approximative anastomoses after 7 days was 249 +/- 39 torr; the strength of the conventional anastomoses was 218 +/- 23 torr (p = 0.118). The activity of the collagenolytic enzymes matrix metalloproteinase-2 and matrix metalloproteinase-9 in the anastomotic area was significantly increased compared with the activity in samples of non-operated bowel. There was no significant difference in collagenolytic activity between both types of anastomoses.The approximative anastomosis is a time-saving alternative to conventional anastomoses with a comparable course of anastomotic healing, anastomotic strength, and changes in collagen metabolism.
Cite
Citations (7)
In 10 pigs a nonsutured, glued colonic anastomosis was constructed with a modified stapling device without staples and compared with an EEA-stapled anastomosis and a one-layer-sutured anastomosis concerning radiologic appearance, breaking strength, circulation, and collagen concentration.141Ce-labeled microspheres were used for measurements of the anastomotic blood flow before the animals were sacrificed on the 4th postoperative day. The breaking strength was recorded and an anastomotic index calculated. No leakage was found. The anastomotic width did not differ between the groups, but the interindividual variation was more prominent in the sutured group. The handsewn and stapled anastomoses were stronger than the glued anastomosis (P=0.0009 and 0.0054, respectively). There was an increase in the anastomotic circulation in all of the anastomoses, but no differences were seen between groups. The collagen concentration was independent of the technique used.
Colorectal Surgery
Surgical anastomosis
Cite
Citations (26)
Anastomosis of the gastrointestinal tract has been made more secure by the use of the EEA (U. S. Surgical Corp.) stapler. The development of anastomotic strictures after stapling anastomosis is one of the major postoperative complications of this method. This study was done to compare the incidence of anastomotic stricture between stapling anastomosis and layer-to-layer handsewn anastomosis. Twelve dogs were divided into two groups. In each group, two colonic anastomoses were performed. Intestinal contents were not allowed to pass through one of the anastomotic sites created in an isolated segment of the colon, but were allowed to pass through the other site in the remaining colon. By the 28th postoperative day, anastomoses made with the EEA stapler, which had been excluded from contact with feces, had developed significantly more strictures when compared with the other anastomoses (p less than 0.05). The anastomotic strictures were membranous in nature when examined macroscopically and histologically.
Surgical anastomosis
Cite
Citations (17)
New blood vessels develop as a gastrointestinal anastomosis heals. The morphologic aspects of this neovascularization were studied in 22 dogs, each of which underwent one sutured and one stapled small bowel anastomosis. At intervals ranging from three to 24 days after surgery, the dogs were killed, and the bowel was injected with Batson's compound or india ink. The pattern of vascular growth across the anastomotic site was studied. Both stapled and sutured anastomoses caused an increase in submucosal capillary density at day three compared with control specimens taken from bowel remote from the anastomotic site. This increase was maintained consistently through day 24 in sutured anastomoses but had decreased by day five in stapled anastomoses. Growth of submucosal vessel across the anastomotic site could be demonstrated by day three in sutured and day four in stapled anastomoses. The more vigorous inflammatory response associated with sutured anastomoses may be responsible for more rapid and prominent neovascularization.
Surgical anastomosis
Cite
Citations (2)
Strength of microvascular anastomoses: Comparison between the unilink anastomotic system and sutures
Abstract The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty‐five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded. All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.
Surgical anastomosis
Arteriovenous Anastomosis
Statistical Analysis
Cite
Citations (48)
Objective To investigate the methods and efficacy of anastomosis between vessels with different diameterby using microvascular anastomotic device.Methods From February 2013 to June 2013,5 patients underwent five free-flap transfered with the use of the microvascular anastomotic device in 12 vessels anastomosis,which included 6 anastomosis with different luminal diameter between donor and recipient vessels.We performed vasoplasity via lateral incision or on the Y-shape branch of small-diameter vessels to enlarge the diameter of anastomotic stoma,then microvascular anastomosis device matched the larger-diameter vessel were used in the anastomosis.Conventional therapy of microvascular anastomosis was performed postoperatively.Results Six anastomoses (4 venous,2 arterial) were performed with the microvascular anastomotic device in anastomotic stoma with different luminal diameter between donor and recipient vessels,with diameter (0.8-1.5)mm in one side and 2.0-3.5 mm in the other side,which had ratio from 1.0 ∶ 1.5-1.0∶ 3.0.The end of small-diameter vessel could be everted over the pins of larger microvascular anastomosis device successfully via vasoplasity.The 2.0-3.5 mm microvascular anastomotic device implant was used in these cases.These anastomoses were successfully completed with microvascular anastomotic device without vessel shedding,blood leak intraoperatively and without vascular crisis postoperatively.The time taken to complete an end-to-end anastomosis with microvascular anastomotic device varied from 3-5 min.The followed-up time ranged from 1-3 months,and flap survival in the 5 patients was 100％.Conclusion It is a simple,fast and effective method to perform microvascular anastomosis using microvascular anastomotic device in anastomotic stoma with different luminal diameter through vasoplasity.
Key words:
Microvascular anastomotic device; Blood vessels; Vasoplasity; Free flap
Stoma (medicine)
Surgical anastomosis
Roux-en-Y anastomosis
Cite
Citations (0)
Surgical anastomosis
Cite
Citations (71)