Surgery In Japan Research Articles

Combination of endoscopic mucosal resection and chemoradiotherapy as a nonsurgical treatments for patients with clinical stage I esophageal squamous cell carcinoma

4529 Background: Endoscopic mucosal resection (EMR) has become the standard treatment for mucosal cancer. For the other clinical stage I esophageal squamous cell carcinoma (ESCC), radical surgery is standard and chemoradiotherapy (CRT) is optional but has high locoreginoal failure. If EMR and CRT are combined efficiently, these may improve outcomes with less invasion. A retrospective analysis was conducted to evaluate the efficacy of these combined nonsurgical modalities. Methods: Recruitment criteria were histologically proven SCC, clinically estimated as stage I except for the candidates of the standard EMR, age ≤ 75, PS ≤ 2, no prior therapy, no serious complication and no other active malignancy. Primary EMR was indicated if a tumor was within the focal submucosal (SM) invasion and a width of less than two-thirds of its circumference. EMR was followed by prophylactic CRT (5-FU + cisplatin + RT; 40Gy) for latent node metastasis when SM invasion was present pathologically. The remaining patients (pts) underwent primary CRT (5-FU + cisplatin + RT; 60Gy); salvage EMR was indicated for local residual, recurrent, or metachronous tumors. Results: Between Jan. 1996 and Apr. 2004, 86 pts fulfilled the criteria; median age 60 years (46–75), male/female; 74/12. Forty-one received primary EMR and 45 received primary CRT. Pathological diagnoses of primary EMR revealed eight mucosal cancers of the epithelium and lamina propria, 19 of the musclaris mucosae (MM), and 14 SM cancers. Eleven pts with SM cancers subsequently underwent prophylactic CRT, one with SM cancer underwent surgery, and the remaining 29 pts with mucosal and MM cancers received no additional treatment. Of the 45 CRT pts, 11 (24%) received salvage EMR. Three (3%) (one primary EMR pt and two primary CRT pts) underwent salvage surgery. With a median follow-up of 4.2 years, the 4-year overall survival of all, primary EMR, and primary CRT pts was 76%, 78%, and 72%, respectively; the disease-specific survival was 86%, 91%, and 81%, respectively. Conclusion: The survival of combination treatment with EMR and CRT for clinical stage I ESCC was comparable with that of surgery in Japan. EMR and/or CRT may be highly effective, minimally invasive treatments for stage I ESCC. No significant financial relationships to disclose.

Current status of neuroendoscopic surgery in Japan and discussion on the training system

The objectives of this study was to investigate the current status of neuroendoscopic surgery in Japan and to discuss the issue disclosed by the survey. We delivered questionnaires about neuroendoscopic surgeries to 1,237 of Japan Neurosurgical Society certified training institutions. Of these institutions, 592 (47.9%) returned completed questionnaires, and 316 (53.4%) among them experienced neuroendoscopic surgeries in the past. Two hundred seventy-six institutions had at least one procedure in the year 2003, but 208 (75.5%) had only one to ten procedures per year. Total number of procedures was 2,796, and trans-sphenoidal surgery was performed most frequently (705). Aneurysmal neck clipping (637) was second, and the third place was third ventriculostomy (ETV, 357). ETV was performed at 126 institutions, and 112 (88.9%) of them had only five cases or under per year. Neuroendoscopic surgeries are performed at many institutions, but little experience per institution was reported. We refer to the on-going project of the Japanese Society for Neuroendoscopy on establishing training system of neuroendoscopic surgeries.

Dawn of cardiac surgery in Japan

Dawn of cardiac surgery in Japan

Dawn of cardiac surgery in Japan

Because of World War II, the development of closed heart surgery in Japan was delayed for several years. As far as open heart surgery was concerned, the tireless Japanese investigators in the early 1950s worked extremely hard to quickly catch up with the North Americans and Europeans. Looking back at the dawn of Japan's open heart surgery, we are impressed at how the investigators precisely reported their experiences as cited in this editorial, how many times they repeated their experiments prior to clinical application, and most importantly how cooperatively they worked as a group even in the very competitive environment.

Proposed Pediatric Anesthesia by Specialists in Pediatric Surgery—Results of Questionnaire for Accredited Institutions of Pediatric Surgery in Japan—

日本小児外科学会認定施設 (125施設) を対象に ｢小児麻酔に関するアンケート調査｣ を行った. その結果, 日本の小児外科医からの提言としては, (1)臓器の未熟性や特殊な生理状態を熟知した経験豊富な小児専門の麻酔科医の管理による麻酔, (2)｢麻酔・手術による小児期のトラウマ構築の予防｣ ｢怖くない手術室への入室｣ ｢痛くない術後｣ への配慮と工夫, (3)周術期を通して麻酔科医と小児外科医のバリアのないコミュニケーション, 等に集約された. 小児外科医からの一方的な提言に終わることなく, 少子化時代のなかで小児麻酔にかかわる麻酔科医と小児外科医が相互理解のもとにさらなる協力体制を構築していく礎になることを心から期待するものである.

In-Hospital Outcomes of Primary Percutaneous Coronary Interventions Performed at Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery

Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the ;real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan. In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class>or=3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class>or=3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels>or=2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not. These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan.

非侵襲的レジストレーションを用いた光学式手術ナビゲーションシステムの口腔疾患治療への応用

It is generally recognized that the optic surgical navigation system is a useful tool that provides accurate anatomical information in neurosurgery and orthopedic surgery. However, at present, this system is not used in maxillofacial surgery in Japan. We report a patient with postoperative maxillary cyst treated by cystectomy using an optical navigation system. A 68-year-old female visited our department due to swelling in the right maxillary area. CT scanning showed a cystic lesion extending from the maxillary tuberosity to the nasal cavity. The lesion was surgically resected using an optical navigation system. In this patient, the use of a navigation system allowed objective confirmation of the portion of the lesion close to the nasal cavity and that surrounding the root of the second molar. In the future, the optic navigation system is expected to become a useful tool for safe and accurate surgery by oral surgeons.

The omission of axillary lymph node dissection by Sentinel Node biopsy

Sentinel Node Biopsy, SNB has become very popular not only among medical experts but also among breast cancer patients and is now the hottest maneuver in minimizing breast cancer surgery in Japan. In this sense, this presidential symposium Possibility of omitting ALND by SNBwas presented as the first event at the 14th Annual Meeting of the Japanese Breast Cancer Society. The symposium was consisted of 6 speakers, including one speaker from abroad, Korea. The first presentation was a preliminary report on the possibility of SNB in cases of Primary Systemic Treatment, PST by Dr. Kinoshita of the Central Hospital of the National Cancer Center. He spoke about the results of 104 PST cases who received SNB and radical surgery. The results approached those obtained with usual SNB with backup dissection. The identification rate was 93.3% and the false negative rate was 10%. Based on this result, they started omitting ALND in cases of SNB ca(-) after PST from October, 2005. The second presentation was also a success report of SNB after PST by Dr. S. Y. Lee of the National Cancer Center, Goyand, Korea. Although the identification rate was low at 77.6%, the false negative rate was only 5.0% compared to 7.0% in cases without PST. The third speaker was Dr. the Takei, Saitama Prefecture Cancer Center who spoke about the outcome of 1,704 cases of SNB in mean observation period 36 m (8-82 m). General metastasis of SNB N(-) and ALND(-) cases was 5.0%, whereas SNB N(-) and ALND(+) cases was 6.9%.They considered SNB to be safe and useful. The fourth presentation was by Dr. Motomura, the Osaka Medical Center for Cancer and Cardiovascular Disease. He spoke about their feasibility study of combined dye (ICG) and RI (Tc Tin colloid)method. The detection rate was 93%, and the FNR was 3.5%. After that, observational study started in 2000, ALND was omitted in 432 cases. The results were satisfactory and the physicians concluded that SNB was safe and useful. The fifth presentation was by Dr. Imoto of the East Hospital National Cancer Center. He talked about SNB guidelines from the study group of Sentinel Node Navigation Surgery, SNNS in Japan. They are making a revised version now. It would be available free of charge. The last presentation was by Dr. Sato of the National Defense Medical College, who introduced the largest projects in the world presently under analysis. These have already been performed and we are waiting for their final results now. These projects are NSABP B-32, AOSOGZ0010, Z0011, and EORTC-10981 ARAMOS SNB. Although its true efficacy is still uncertain, has spread all over the world and now the main topic is not an omission of ALND after SNB ca(-) but an omission of ALND after even SNB ca(+). SNB may not only predict axillary status but also predict the need for chemotherapy and endocrine therapy.

Factors influencing the selection of a hospital for colon cancer surgery in Japan: analysis of the effects of surgery volume, hospital functions, and geographic conditions.

To identify factors influencing the hospital choice of patients who undergo colon cancer surgery. We conducted a multivariate analysis using micro data from the Patient Survey and the Survey of Medical Institutions conducted by the Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labour and Welfare of Japan, to identify patient and hospital characteristics which influence a patient's decision whether to undergo surgery at a hospital where many colon surgeries have been performed ("high-volume hospital"). Hospitalizations to high-volume hospitals were linked to factors such as referral from nonmedical facilities and the fact that the medical institution was a teaching hospital. Hospitalizations to high-volume hospitals decreased by about 8% for every 1-km increase in distance to the nearest high-volume hospital. Geographic factors and hospital function had an impact on admission to high-volume hospitals that are expected to contribute to functionalization of medical institutions and improvement of medical standards. This suggests that geographic conditions should be considered in planning regional coordination systems for specialized medical care.

Thoracic and cardiovascular surgery in Japan during 2004

Thoracic and cardiovascular surgery in Japan during 2004

Thoracic and cardiovascular surgery in Japan during 2004

Thoracic and cardiovascular surgery in Japan during 2004

Cataract surgery in Japan and Asia

Cataract surgery in Japan and Asia

Refractive surgery in Japan and Asia

Refractive surgery in Japan and Asia

The Dawn of Surgery in Japan, with Special Reference to the German Society for Surgery

During Japan's period of isolation, Philipp Franz von Siebold came to Nagasaki as a doctor with a Dutch trading company in 1823. He used many kinds of apparatus to examine patients and taught practices such as paracentesis and tumor resection. After the Meiji Restoration, the Japanese government elected to establish a medical educational system based on the German system, and to invite two prominent German doctors to teach in 1869. In 1881, Julius Karl Scriba came to Japan as a teacher. He worked at the University of Tokyo for 25 years. He was the clinical coordinator and trained many surgeons who later became leaders in modern Japanese surgery. In 1898, Sankichi Sato and Tsugishige Kondo founded the Japan Surgical Society. The foundation of the Japan Surgical Society and the government's centralization of the University of Tokyo were major milestones, because from then on, graduates of the university led the way in surgery in Japan. The University of Tokyo has since contributed enormously not only to the development of surgery but to the foundation of surgery-related fields.

Questionnaire on Perioperative Antibiotic Therapy in 2003: Postoperative Prophylaxis

We distributed a questionnaire to institutions accredited by the Japan Surgical Society asking about the use of antibiotics in digestive tract surgery in Japan in 2003, and compared the results with those of a similar questionnaire distributed in 1993. The period of antibiotic administration for esophageal resection was at least 6 days in 64.9% of the 1993 questionnaire responses, but less than 4 days in 60.4% of the present questionnaire responses. For distal gastrectomy, antibiotics were given for 5 days postoperatively at 53.0% of the responding institutions in the 1993 survey, but for only 3 days, at 72.4%, in the present survey. An oral antibiotic was given as part of antibacterial colon preparation before colon resection at 70% or more of the institutions in the 1993 survey, while no antibiotic colon preparation was given at 80% of the institutions in the present survey. The period of antibiotic administration for laparoscopic cholecystectomy was at least 4 days in 72% of the institutions in the 1993 survey, but this decreased remarkably to fewer than 2 days at 80.8% of the institutions in the current survey. There were no differences in the selection of antibiotics between the two surveys. The period of antibiotic administration has decreased remarkably in the last decade.

Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe?

Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe?

Thoracic and cardiovascular surgery in Japan during 2003

The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery to reveal the statistics of the number of procedures according to the operative category throughout the country since 1986. Here we have summarized the results from our annual survey of thoracic surgery performed during 2003. The incidence of hospital mortality was added to this survey to determine the nationwide status that could be useful not only for surgeons to compare their work with that of others, but also for the association to gain a better understanding of present problems as well as future prospects. Thirty-day mortality (sometimes termed operative mortality) is death within 30 days of operation regardless of the patient's geographic location. Thirty-day mortality includes death within 30 days of operation even though the patient is discharged from the hospital within 30 days of operation. Hospital mortality is death within any time interval after operation if the patient is not discharged from the hospital. Hospital-to-hospital transfer is not considered discharge; transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation (the definitions of terms are based on the published guidelines of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery (Edmunds LH, et al. Ann Thorac Surg 1996; 62: 932-5)). Thoracic surgery was classified into three categories as cardiovascular, general thoracic and esophageal surgery, and the pertinent data were examined and analyzed in each group. Access to the computerized data is offered to all members of this association. We honor and value your continued kind support.

Determination of the standard value of circulating blood volume during anesthesia using pulse dye-densitometry: a multicenter study in Japan

The standard value for circulating blood volume (BV) during anesthesia was determined by a multicenter study in Japan. The significance of BV on the reduction of blood pressure after the induction of anesthesia was also examined. The study included 184 patients from eight university hospitals. After the induction of anesthesia, pulse dye-densitometry was performed according to a uniform protocol. Factors contributing to reduced blood pressure after induction of anesthesia were examined by multiple logistic regression analysis. The mean and standard deviation of BV was 80.0 +/- 13.9 ml x kg(-1); for females and 84.2 +/- 15.3 ml x kg(-1) for males (P > 0.05). There was no age difference in terms of BV. After adjusting for the effects of height, weight, and age, the factors predisposing to a reduction in blood pressure of >20 mmHg after induction of anesthesia were found to be age (P < 0.01) and BV (ml x kg(-1)) (P < 0.001). We determined the BV of anesthetized patients before surgery in Japan using pulse dye-densitometry. It is suggested that age is not a factor regarding BV, and that blood pressure tends to be reduced in hypovolemic patients after induction of anesthesia.

Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe?

In Japan, an ever-present problem in the preoperative evaluation of patients with ischemic heart disease is that although such evaluations are based on Western data, these data serve as the basis for determining perioperative risk in Japanese patients. To remedy this problem, the Cardiac Ischemia and Anesthesia Research Committee was formed in 1997 and has conducted studies of perioperative complications in noncardiac surgery in Japan. In two retrospective studies in 1997, the proportions of patients with ischemic heart disease were 3.9% and 3.1%, approximately one tenth the rates reported in Europe and the United States. The incidences of perioperative cardiac complications in patients with ischemic heart disease were 16.4% and 13.2%, not widely divergent from rates reported in Europe and the United States. To investigate the baseline characteristics involved in perioperative complications, we conducted a prospective study of 237 patients classified as having intermediate risk for perioperative cardiac complications according to the American College of Cardiology/American Heart Association Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery. We found that the prominent factor in intraoperative cardiac complications was the presence of hypertension (odds ratio = 2.911). Factors contributing to postoperative cardiac complications included those reflecting coronary lesion severity and cardiac dysfunction (history of heart failure; odds ratio = 6.884, coronary risk index grade; odds ratio = 2.884, and a history of intervention; odds ratio = 4.774).

Coronary artery surgery in Japan

Coronary artery surgery in Japan