Influence of the water jet system vs cavitron ultrasonic surgical aspirator for liver resection on the remnant liver

BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.

Neoadjuvant Chemotherapy for Clinical Stage II and III Thoracic Esophageal Squamous Cell Carcinoma with Curative Esophagectomy

Esophageal squamous cell carcinoma (ESCC) is a gastrointestinal carcinoma with a poor prognosis. To improve the survival of patients with this disease, neoadjuvant chemotherapy (NAC) has been introduced. However, the survival benefits of NAC or the correlation between NAC and postoperative complications have not been well considered. In the present study, we retrospectively investigated the clinicopathological effectiveness of NAC in patients with clinical stage II and III thoracic ESCC. This retrospective study enrolled 63 patients with clinical stage II and III thoracic ESCC, who underwent resection of the thoracic esophagus and three-field lymph node dissection between January 2007 and December 2013. NAC with cisplatin plus 5-fluorouracil (5-FU) was introduced in 38 patients. NAC did not correlate with the occurrence of postoperative complications. The 5-year disease-free survival (DFS) rate of the 38 patients with NAC (41.6%) was similar to that for the 25 patients who did not receive NAC (38.1%;P = 0.784). However, we found that the DFS of 17 patients with histopathological Grade 2 and 3 tumors who received NAC (5-year DFS rate: 58.1%) was significantly higher than that of 21 patients with low histopathological grade tumors who received NAC (5-year DFS rate: 28.6%), or than that of the 25 patients who did not receive NAC (38.1%). Moreover, we found that the effectiveness of NAC assessed macroscopically did not correlate with the effectiveness of NAC assessed microscopically. These findings may indicate that preoperative estimation of NAC effectiveness is important in avoiding unnecessary adverse drug effects caused by NAC, and in prolonging the survival of patients with thoracic ESCC.