No abstract

Recently, there has been increasing evidence that systemic inflammatory response predicts the survival outcome in cancer patients. C-reactive protein (CRP),

Aim The 2016 guidelines of the Japan Society for Surgical Infection and the Japan Society of Chemotherapy advocate giving prophylactic antibiotics 1 hour before surgery and until 24 hours after surgery in patients undergoing elective hepatic resection. However, the efficacy of short‐term antimicrobial prophylaxis has not been evaluated according to surgical approach. We evaluated the efficacy of giving prophylactic antibiotics in patients undergoing open or laparoscopic hepatic resection. Methods The study comprised 218 and 185 patients undergoing open and pure laparoscopic hepatic resection, respectively. Incidence rates of postoperative infectious complications were compared between patients who received flomoxef sodium as the prophylactic antibiotic before and until 24 hours after surgery (short‐term group) and those who received flomoxef sodium until 72 hours after surgery (long‐term group) among patients undergoing open or laparoscopic hepatic resection. Propensity score matching analysis was carried out to adjust for confounding factors between the short‐ and long‐term groups. Results There was no significant difference in the postoperative infectious complication incidence between the short‐ and long‐term groups among patients undergoing open (18.9% vs 12.2%; P = 0.36) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection after propensity score matching. Incidence rate of surgical site infections was comparable between the short‐ and long‐term groups among patients undergoing open (13.5% vs 10.8%; P = 0.80) or laparoscopic (3.3% vs 1.7%; P > 0.99) hepatic resection. Conclusion Giving short‐term prophylactic antibiotics might be sufficient in preventing postoperative infectious complications in patients undergoing open and laparoscopic hepatic resection.

AimSome patients who achieve a sustained virological response (SVR) to interferon (IFN) treatment for chronic hepatitis C prior to hepatic resection for hepatocellular carcinoma (HCC) experience postoperative recurrence. This study investigated the relationship between obesity and postoperative HCC recurrence in SVR patients.MethodsFifty‐nine patients who had achieved SVR before hepatic resection were evaluated. Patients had a solitary tumor ≤5 cm in diameter or ≤3 lesions each ≤3 cm in size with no macroscopic vascular invasion (Milan criteria). Patient characteristics potentially associated with recurrence risk were investigated.ResultsThree‐, 5‐, and 7‐year recurrence‐free survival after surgery were 65%, 44%, and 41%, respectively. Univariate analysis showed that obesity (P < .01), hypertension (P = .038), and non‐anatomical resection (P = .022) were significantly associated with a lower recurrence‐free survival rate. In a multivariate analysis, obesity (hazard ratio, 2.8; 95% confidence interval [CI] 1.3‐6.1; P < .01) and non‐anatomical resection (hazard ratio, 2.7; 95% CI 1.1‐6.2; P = .025) were independently associated with postoperative recurrence. Three‐, 5‐, and 7‐year overall survival rates after surgery were 100%, 80%, and 64% in obese patients and 100%, 92%, and 82% in non‐obese patients, respectively (P = .014). However, other variables showed no significant difference in the overall survival rate.ConclusionsObesity and non‐anatomical resection were independent risk factors for HCC recurrence after hepatic resection and successful IFN therapy. Obesity is an important clinical problem to consider to improve postoperative outcomes in such patients.

SummaryThe aim of this study was to investigate the relationship between coronary microvascular function and smoking using the 3 parameters fractional flow reserve (FFR), coronary flow reserve (CFR thermo ), and index of microcirculatory resistance (IMR) in patients with coronary artery disease (CAD). A total of 97 CAD patients with 148 intermediate stenotic lesions were divided into two groups: current and former smokers (Smokers: n = 54), and those who had never smoked (Non-smokers: n = 43). Coronary physiology measurements were made following coronary angiography at rest and during hyperemia induced with intravenous adenosine triphosphate. If a patient had several intermediate lesions, the lesion producing the largest IMR value and minimum FFR myo and CFR thermo value was selected. Averaged over all patients, the FFR myo , CFR thermo , and IMR values were 0.86 ± 0.10, 2.66 ± 1.50, and 20.8 ± 10.7, respectively. There was no significant correlation between FFR myo and IMR. There were no significant differences between smokers and non-smokers in FFR myo value ( perfusion is dependent on both epicardial and microvascular resistance. 1) An increased microcirculatory resistance indicates the presence of coronary microvascular dysfunction (CMVD), a term introduced to describe abnormalities in the regulation of microvascular blood flow. CMVD has been found to play an important role in determining ischemic threshold 2) and to be independent of epicardial stenosis severity.3) Smoking is known to be associated with the development of epicardial atherosclerosis and impairment of coronary endothelial function. [4][5][6] However, the effects of smoking on coronary microvascular function are unknown.Recently, a parameter called the index of microcirculatory resistance (IMR) was proposed for evaluating coronary microvascular function. The advantage of this parameter is that it could be calculated from values obtained using a coronary temperature and pressure sensing guidewire. 7) IMR has been found to be a reproducible index and to be independent of epicardial stenosis severity.7-10) The aim of this study was to investigate the relationship between microvascular function and smoking in patients with CAD by comparing 3 coronary physiology parameters, fractional flow reserve (FFR), coronary flow reserve (CFR), and IMR, between patients with and without a smoking history. MethodsStudy population: A total of 97 patients with CAD who had 148 discrete intermediate grade stenotic lesions (40-70% diameter stenosis on visual assessment) and visited the Department of Cardiovascular Medicine, Kashiwa Municipal Hospital (Chiba, Japan) from August 2010 to August 2013 were retrospectively enrolled. To examine the relationship between coronary physiology and smoking, patients were divided into two groups based on smoking status; current and former smokers (smokers), and those who had never smoked (non-smokers). The exclusion criteria were 1) history of coronary artery bypass surgery; 2) history of myocardial infarction (MI); 3) recent MI,...