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Medical information

Gastroenterological surgery

The Second Department of Surgery is responsible mainly for gastroenterological surgery, including endocrine surgery, pediatric surgery, endoscopic surgery and general surgery.
In the field of gastroenterological surgery, we treat esophageal and gastric cancers, which have high rates of occurrence in Wakayama Prefecture, and diseases of the gastrointestinal canal, from the small intestine to the large intestine, rectum and anus, as well as conditions of the liver, bladder, biliary tract, pancreas and spleen.
Initially, we focus on rational surgery to nodes in locations predisposed to lymph node metastasis in esophageal and gastric cancers (the clean removal of lymph nodes to which there is the possibility of cancer metastasis). Additionally, we aim only to remove the minimum amount of stomach required in line with the progression of the cancer in order to ensure post-surgery QOL (quality of life). Furthermore, we are proactive about implementing endoscopic therapy in regard to cancers that can be cured without surgery.

Number of surgeries carried out per year(2005~2016)

  '14 '15 '16 ---   ---  ---   ---  --- ---
Gastric 160 162 170  ---   ---  ---  ---  ---  ---
Esophageal
50
  51   57  ---   ---  ---  ---  ---  ---
  ’05 ’06 ’07 ’08  ’09 ’10 '11 '12 '13
Gastric 149 193  178  200 178  170  167 140  153
Esophageal
34
27
33
40
40
45
41
52
32

We have increased the size of the group of doctors working on the large intestine within the Second Department of Surgery, in response to the increasing number of cases of colorectal cancer. Depending on the extent of the cancer’s progression, we are able to implement a wide range of treatments including endoscopic demucosation (dissection method), transanal resection, laparoscopic surgery, standard surgery, extended surgery, and surgical methods to preserve the anus as far as possible (super lower anterior resection during internal anal sphincter muscle resection), etc. We have created evidence-based guidelines for additional therapies and multidisciplinary therapies post-surgery, and apply fixed criteria depending on the level of progression, to ensure that we provide consistent levels of care depending on the extent of progression. As a result, our treatment results are excellent. Patients with refractory inflammatory bowel conditions such as Crone’s disease and ulcerative colitis, etc. are also able to receive appropriate treatment from specialist doctors.

Number of surgeries carried out on colorectal cancers per year(2005~2016)

  '15 ’16 --- ---  ---  --- ---  --- --- ---
All 210   234  ---  ---   ---   ---  ---   ---  ---  ---
Colon 123
147
 ---  ---
---
  ---
---
  ---  ---  ---
Rectum
87
87
---
---
 ---
---
 ---
---
---
 ---
Anal
0
0
---
---
---
 ---
---
  ---
---
---
  ’05 ’06 ’07 ’08 ’09 ’10 ’11 '12 '13 '14
All 164 146 199 180 164 164 172 175 221 203
Colon
82
84
121
115
89
103
113
110
151
131
Rectum
80
62
78
63
75
61
59
64
70
72
Anal
2
0
0
2
0
0
0
1
0
0

Treating gallstones with laparoscopic cholecystectomy allows the procedure to be carried out with little pain, and means that patients can leave hospital within a few days. Cases of hepaticolithiasis, in which stones form in the intrahepatic biliary tract, are common in Wakayama Prefecture, and we have been working on the development of therapies. Recent development of a new treatment method using lasers on biliary tract stones has improved our treatment results for hepaticolithiasis. (No. of surgeries carried out per year: 120 to 150 gallstone cases)

Chronic hepatitis induced by the hepatitis B or C virus is a cause of hepatic cancer. We are in the process of planning new treatment methods based on interferon, to implement alongside drug therapies, which prevent post-resection recurrence in the remaining liver. 
Furthermore, in order to resect the liver safely, we implement a range of measures including portal occlusion, allowing safe resections with thorough accompanying blood vessel resection even in cases of highly advanced liver cancer.
The combined implementation of liver and blood vessel resection in cases of bladder and biliary tract cancers has facilitated long survival rates for patients.

Number of surgeries carried out on hepatic cancers per year (2005~2016)

'14 '15  ’16   ---  ---  ---  ---   ---   ---
Total
71
88
98
---
 ---
 ---
---
---
---
      HCC
39
44
60
---
---
 ---
---
---
 ---
IHCCC
8
12
8
 ---
---
 ---
---
---
---
Hilar Carcinoma
1
4
5
 ---
---
 ---
---
---
---
Meta
22
26
23
---
---
 ---
---
---
---

Others

1
2
2
---
---
 ---
---
---
---

Laparoscopic

Surgery

27
30
49
---
---
 ---
---
---
---

Ratio(%)

38.0
34.1
50.0
---
---
 ---
---
---
---

 

’05 ’06 ’07 ’08 ’09 ’10 ’11 '12 '13
Total
60
82
62
65
73
68
65
82
90
      HCC
28
41
30
33
39
44
39
41
52
IHCCC
4
10
3
10
8
6
9
8
9
Hilar Carcinoma
6
4
4
2
6
1
3
5
3
Meta
22
23
20
17
15
15
12
27
21

Others

0
4
5
3
5
2
2
1
5

Laparoscopic

Surgery

0
0
0
6
9
7
8
19
31

Ratio(%)

9.2
12.3
10.3
12.3
23.2
34.4

Pancreatic and biliary tract cancers are on the increase. Pancreatic cancer, in particular, is the fifth most common cause of death from cancer in Japan, and tends to be found in an advanced state, making it one of the more complex cancers to treat. The Second Department of Surgery sees a large number of patients with pancreatic cancer not only from Wakayama Prefecture but also from Osaka Prefecture, and is a main center for pancreatic cancer in the southern Kinki region. Pancreatic cancer occurring in the pancreas head, and cancers occurring in the extrahepatic biliary tract require an extremely complex abdominal procedure known as “pancreaticoduodenectomy”. In particular, since this procedure involves joining the pancreas and the intestine, it can be accompanied by various complications. At the Second Department of Surgery we use a method that involves joining the mucous membranes of the pancreas and the small intestine. This method has been acknowledged around the world, and been reported on by institutions around the world due to its low leakage of pancreatic fluid. Furthermore, in regard to the stomach, we implement pylorus-preserving pancreaticoduodenectomy procedures wherever possible, which allow the preservation of the entire stomach (where previously, the normal practice was to remove around half of the stomach). We analyze both surgical methods and post-surgical management methods in detail in order to ensure the best possible progress post-surgery, and believe that our vocation as a university hospital is to continue to clarify each of the areas that are as yet unknown, in order to facilitate as swift a recovery as possible for patients undergoing similar surgeries in the future.

In order to improve our results in the treatment of pancreatic cancer, we initially implement rational lymph node dissection – neither too much nor too little – along with a combined portal vein resection in cases where the cancer has spread to the portal vein. In our experience, there has been no relationship between portal vein resection and the frequency of complications. With the aim of preventing post-surgical recurrence of cancer in the liver (liver metastasis), we have demonstrated good success rates in hepatic arterial infusion of anti-cancer drugs via the hepatic artery, as well as whole-body chemotherapy. At present, we are engaged in post-surgical chemotherapy using Gemzar.

Most tumors occurring in the pancreas are a form of pancreatic cancer known as infiltrating pancreatic cancer, but we implement a large number of operations in regard to conditions such as intraductal papillary mucinous neoplasm and mass-forming pancreatitis, which are difficult to distinguish from pancreatic cancer. Furthermore, we aim to minimize surgery so as to preserve pancreatic function wherever possible in clearly benign cases, and those on the borderline between benignity and malignancy. In the future, we are committed to the development of new treatment methods that can be used not only in Wakayama Prefecture but also in the treatment of pancreatic cancers throughout Japan, and to becoming a leading medical institution for pancreatic resection surgery.
Number of surgeries carried out on pancreatic cancers per year
(2005~2016)

'11 '12 '13 '14 ’15 ’16
Pancrreatic Resection
85
100
79
92
108
83
 Pancreatic head resection
48
62
56
64
64
60
 pancreatic tail resection
37
38
23
28
44
23

Cases of resection in regard to

infiltrating pancreatic cancers

(including IPMN)

69
71
56
54
77
52
Lower biliary tract cancer cases
(including papillary edge cancers)
8
20
12
24
15
17
’05 ’06 ’07 ’08 ’09 ’10
Pancrreatic Resection
44
60
102
78
98
86
 Pancreatic head resection
32
39
68
57
73
52
 pancreatic tail resection
12
21
34
21
25
34

Cases of resection in regard to

infiltrating pancreatic cancers

(including IPMN)

22
20
52
46
51
35
Lower biliary tract cancer cases
(including papillary edge cancers)
4
8
12
16
19
12

pediatric surgery

In the field of pediatric surgery we are the only hospital in Wakayama Prefecture approved by the Japanese Society of Pediatric Surgeons, with one training physician and two specialists. We are engaged in the treatment of all pediatric surgical conditions other than cardiac conditions, orthopedic surgery and neurosurgery. Furthermore, as a member of a Perinatal Medical Center, we are involved in the treatment mothers and children from the fetal stage, alongside our obstetrics and neonatal departments. We collaborate with the pediatric department in the treatment of pediatric malignant neoplasm, with the aim of a complete cure, along with the prevention of developmental and growth disorders and late stage complications. We proactively implement laparoscopic surgery, and perform laparoscopic percutaneous extraperitoneal closure (LPEC) in regard to cases of pediatric inguinal hernia in both boys and girls, which reduces the burden placed on the surrounding organs and also allows evaluation of hernia on the opposite side.

Number of pediatric surgeries carried per year (2004-2014) 

’04 ’05 ’06 ’07 ’08 ’09 ’10 '11 '12 '13 '14
Hernia
36
21
43
39
22
51
23
24
37
40  45
Pediatric surgery
21
34
27
33
69
60
80
81
68
96 103

Endocrine surgery

In the field of endocrine surgery, we are engaged in the treatment of thyroid conditions such as thyroid cancer and hyperthyroidism, and adrenal neoplasm.
(Number of surgeries per year: 10 to 15 cases of endocrine surgery)

Endoscopic surgery

In addition to our main work in surgically treating gastroenterological conditions, we have made significant progress in endoscopic and laparoscopic surgical treatments over the past few years. At the Second Department of Surgery, we developed laparoscopic surgical methods for gastroenterological conditions ahead of other hospitals. This allows surgery to be carried out using only a small incision, which reduces pain and is therefore patient-friendly. The reduced amount of pain means that recovery is swift, and in the case of laparoscopic gallbladder bladder extirpation, for example, it is possible for the patient to leave hospital within 2 to 3 days post-surgery. Laparoscopic surgery is increasingly being used not only to treat bladder conditions, but also in surgery to the esophagus, stomach and large intestine.

Endoscopic treatment (ESD:Endoscopic Submucosal Dissection) of gastroenterological neoplasms

(laparoscopic treatments: 1,514 cases)

 

 

No.

patients

Tumor
size

(mm)

Rate of

complete

resection

(%)

Operating
time
(min)

Hospital

stay after

resection
(days)

Esophagus

(atypical

epithelium/

cancer)

194
28.6
(〜70 mm)
92.7
74.8
3.63

Stomach

(adenoma/

cancer)

853
35.3
(〜140 mm)
92.2
73.3
1.93

Large

intestine

(adenoma/

cancer)

435
29.1
(〜145 mm)
91.6
77.1
1.75

Duodenum

(adenoma/

cancer)

  32

15.6

(~35mm)

93.8
39.1
5.13

General surgery

At the Second Department of Surgery we also implement surgical procedures relating to body surface conditions, such as inguinal hernia operations, etc.