Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jan 2015
Review[Advantages and pitfalls of minimally invasive surgery for esophagogastric junction tumors].
Several studies of minimally invasive esophagectomy (MIE) for esophagogastric junction (EGJ) tumors have been reported from Western countries with high incidences of lower esophageal cancer. Less invasiveness and a better quality of life after MIE compared with open esophagectomy were found in a randomized controlled trial in Europe. On the other hand, as laparoscopic total gastrectomy for upper gastric cancer has gradually become more common, laparoscopic transhiatal resection and reconstruction to treat EGJ tumors have been reported in Japan. ⋯ Therefore, similar benefits are also expected for EGJ tumors, although there is no current evidence for this. It is difficult to determine which minimally invasive approach is better because the appropriate approach and extent of resection may differ depending on the location and size of each tumor. For the minimally invasive approach to the treatment of EGJ tumors to be accepted as an option, a safe reconstruction method with good long-term quality of life needs to be established.
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Although laparoscopic colon cancer surgery is widely accepted as a feasible alternative to open surgery, there is still limited evidence on the use of the laparoscopic approach for rectal cancer. Although laparoscopic rectal surgery is a technically demanding procedure with a steep learning curve because of adherence to the oncologic principle of total mesorectal excision, the laparoscopic approach has some advantages over open surgery, including not only less invasiveness but also a good surgical view of the deep pelvis through its magnification effect. ⋯ Nationwide surveys show the numbers of laparoscopic rectal cancer surgery cases are increasing in Japan, and about 20% of rectal cancer operations are performed laparoscopically, but concerns about the concurrently increasing anastomotic leakage rate should be noted. The development of laparoscopic instruments specifically to facilitate dissection and transection of the rectum in the deep pelvis is expected to increase the future widespread adoption of this procedure.
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Nihon Geka Gakkai zasshi · Nov 2010
Review[Nutritional support to prevent infectious complications after surgery].
The nutritional condition of patients affects the results of surgical treatment. In patients in poor nutritional condition, postoperative complications, length of hospital stay, and mortality rate were reported to increase. Perioperative nutritional management is an important factor in preventing the incidence of postoperative infectious complications. ⋯ The effects of immunonutrition and synbiotics in surgical patients have been discussed in many recent reports. The advantages and disadvantages of nutritional therapy must be understood to provide the most appropriate regimen. This paper reviews the contribution of nutritional support to the prevention of complications after surgery.
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Nihon Geka Gakkai zasshi · Jul 2008
Review[Current surgical treatment for acquired valvular heart disease].
We discuss the current status of surgical treatment for acquired valvular heart disease. Mitral valve repair for organic and functional mitral regurgitation is the first choice instead of valve replacement. It is important that surgery for functional mitral regurgitation restores the geometry of the left ventricle and mitral valve. ⋯ At present, the surgical procedure for both aortic stenosis and aortic regurgitation is valve replacement in most cases, although aortic valve repair has been attempted for aortic regurgitation in recent years. The early results of aortic valve repair are excellent, but the long-term results have not been clarified. The durability of valve repair in both the mitral and aortic position is a future issue and it may be improved by revising the indications for valve repair and using new surgical techniques.