研究者詳細 - 橋本　将志

論文 - 橋本　将志

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Neoadjuvant chemotherapy for locally advanced esophageal cancer comparing cisplatin and 5-fluorouracil versus docetaxel plus cisplatin and 5-fluorouracil: a propensity score matching analysis. 査読

Noriyuki Nishiwaki, Kazuhiro Noma, Tomoyoshi Kunitomo, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Esophagus : official journal of the Japan Esophageal Society 19 ( 4 ) 626 - 638 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The standard treatment for locally advanced esophageal cancer is preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), followed by surgery. Although docetaxel plus cisplatin and 5-fluorouracil (DCF) has been reported to have favorable outcomes, no study has compared its therapeutic efficacy to that of standard treatment. This study aimed to compare the therapeutic effects of CF and DCF in the real world by matching patient background factors using propensity scores. METHODS: We retrospectively reviewed the data of 237 patients with esophageal squamous cell carcinoma who underwent esophagectomy between January 2008 and December 2018. Patients were divided into two groups based on the preoperative chemotherapy regimens of CF (79 patients) or DCF (158 patients), and 49 matched pairs were finally analyzed using propensity score matching. Short- and long-term outcomes were compared between groups. RESULTS: After matching, although no significant differences in survival were observed among the groups, patients receiving DCF showed a significantly high histological response (P < 0.001). Subgroup analyses demonstrated that DCF therapy had better overall survival (P = 0.046) and relapse-free survival (P = 0.010) among pathological T3 and T4 cases. Whereas, adverse effects of chemotherapy were more frequent in the DCF group. CONCLUSIONS: Patients receiving DCF had higher pathological response and better survival than those receiving CF, especially in pathological T3 and T4 cases matched using propensity scores. Thus, the DCF regimen might be an effective treatment for locally advanced esophageal cancer. However, the adverse side effects of chemotherapy remain high and should be handled appropriately.

DOI： 10.1007/s10388-022-00934-5

Initial introduction of robot-assisted, minimally invasive esophagectomy using the microanatomy-based concept in the upper mediastinum. 査読国際誌

Yasuhiro Shirakawa, Kazuhiro Noma, Tomoyoshi Kunitomo, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Toshiyoshi Fujiwara

Surgical endoscopy 35 ( 12 ) 6568 - 6576 2021年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: We have recently standardized upper mediastinal lymph node dissection (UMLND) using a microanatomy-based concept in thoracoscopic esophagectomy in the prone position (TEPP), and introduced robot-assisted minimally invasive esophagectomy (RAMIE) using the same concept as in TEPP while aiming at solo surgery. The purpose of this study was to investigate the outcomes of RAMIE using the microanatomy-based concept in the initial introduction phase. METHODS: We have performed more than 500 TEPP procedures as minimally invasive esophagectomy (MIE). After performing about 400 cases of MIE, we established a microanatomy-based standardization of UMLND. In October 2018, we introduced RAMIE, and have performed 75 procedures in 20 months. Two groups were analyzed: a group after microanatomy-based standardization in TEPP (100 cases after completing 400 cases of TEPP) and a RAMIE group (75 cases). Finally, 51 paired cases were matched using a propensity score. Furthermore, the change in postoperative short-term outcome for RAMIE in the initial introduction phase was analyzed. RESULTS: Although there were no significant differences between the two groups in the number of upper mediastinal lymph nodes dissected, there was a significant decrease (P = 0.036) in intraoperative blood loss volume with RAMIE, representing a definite benefit for patients. The thoracoscopic operative time for RAMIE decreased by almost 100 min following less than 50 cases of experience, reaching the same level as that for recent TEPP, but with only one-tenth the operator experience. There were no significant differences in the total postoperative morbidity rate including the recurrent laryngeal nerve palsy rate. CONCLUSION: RAMIE has been introduced safely and smoothly using the microanatomy-based concept established in TEPP.

DOI： 10.1007/s00464-020-08154-7

Immune Modulation by Telomerase-Specific Oncolytic Adenovirus Synergistically Enhances Antitumor Efficacy with Anti-PD1 Antibody. 査読国際誌

Nobuhiko Kanaya, Shinji Kuroda, Yoshihiko Kakiuchi, Kento Kumon, Tomoko Tsumura, Masashi Hashimoto, Toshiaki Morihiro, Tetsushi Kubota, Katsuyuki Aoyama, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Hiroshi Tazawa, Hiroyuki Mizuguchi, Yasuo Urata, Toshiyoshi Fujiwara

Molecular therapy : the journal of the American Society of Gene Therapy 28 ( 3 ) 794 - 804 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

The clinical benefit of monotherapy involving immune checkpoint inhibitors (ICIs) such as anti-programmed death-1 antibody (PD-1 Ab) is limited to small populations. We previously developed a telomerase-specific oncolytic adenovirus, Telomelysin (OBP-301), the safety of which was confirmed in a phase I clinical study. Here, we examined the potential of OBP-502, an OBP-301 variant, as an agent for inducing immunogenic cell death (ICD) and synergistically enhancing the efficacy of OBP-502 with PD-1 Ab using CT26 murine colon cancer and PAN02 murine pancreatic cancer cell lines. OBP-502 induced the release of ICD molecules such as adenosine triphosphate (ATP) and high-mobility group box protein 1 (HMGB1) from CT26 and PAN02 cells, leading to recruitment of CD8-positive lymphocytes and inhibition of Foxp3-positive lymphocyte infiltration into tumors. Combination therapy involving OBP-502 intratumoral administration and PD-1 Ab systemic administration significantly suppressed the growth of not only OBP-502-treated tumors but also tumors not treated with OBP-502 (so-called abscopal effect) in CT26 and PAN02 bilateral subcutaneous tumor models, in which active recruitment of CD8-positve lymphocytes was observed even in tumors not treated with OBP-502. This combined efficacy was similar to that observed in a CT26 rectal orthotopic tumor model involving liver metastases. In conclusion, telomerase-specific oncolytic adenoviruses are promising candidates for combined therapies with ICIs.

DOI： 10.1016/j.ymthe.2020.01.003

Induction chemoradiotherapy including docetaxel, cisplatin, and 5-fluorouracil for locally advanced esophageal cancer. 査読

Hashimoto M, Shirakawa Y, Maeda N, Tanabe S, Noma K, Sakurama K, Katsui K, Nishizaki M, Fujiwara T

Esophagus : official journal of the Japan Esophageal Society 17 ( 2 ) 127 - 134 2020年1月

Prognosis and prognostic factors of esophageal spindle cell carcinoma treated by esophagectomy: a retrospective single-institution analysis 査読

Masashi Hashimoto, Hidehiko Kitagami, Hiroki Niwa, Tomohiro Kikkawa, Tomoyuki Ohuchi, Toshinao Takenouchi, Masao Hosokawa

Esophagus 16 ( 3 ) 292 - 299 2019年7月

The prognostic effect of recurrent laryngeal nerve palsy after esophagectomy in locally advanced esophageal squamous cell carcinoma: A multi-center retrospective study

Koichi Ogawa, Takeshi Toyozumi, Kazuhiro Noma, Yoshimasa Akashi, Yohei Owada, Masashi Hashimoto, Zennichiro Saze, Masayuki Kano, Yoshihiro Nabeya, Koji Kono, Toshiyoshi Fujiwawa, Kazushi Maruo, Hisahiro Matsubara, Tatsuya Oda

European Journal of Surgical Oncology 2025年9月

Laparoscopic resection for oesophageal duplication cyst: A case report. 査読国際誌

Tomohiro Hamazaki, Kazuhiro Noma, Kento Kawasaki, Masashi Hashimoto, Shunsuke Tanabe, Toshiyoshi Fujiwara

International journal of surgery case reports 126 110572 - 110572 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Oesophageal duplication cyst is a congenital malformation and rare tumour, clinically manifesting as dysphagia, epigastric pain, or respiratory distress. Duplicate cysts associated with abscess formation or mediastinal penetration and malignancies have been reported, necessitating surgical resection. PRESENTATION OF CASE: A 55-year-old woman had chest discomfort for 1 year. Preoperative imaging, including computed tomography (CT), upper gastrointestinal endoscopy, and endoscopic ultrasound, revealed a tumour extending from the anterior wall to the lesser curvature of the near the oesophagogastric junction (OGJ) and a suspected mural nodule within the tumour. Contrast-enhanced CT revealed a cystic nodule on the wall of the lesser curvature of the OGJ, with an unclear boundary between the cystic nodule and the oesophageal wall. Magnetic resonance imaging showed an isointense signal on T1-weighted imaging and hyperintensity on T2-weighted imaging. Laparoscopic lower oesophagectomy and proximal gastrectomy with lymph node dissection were performed to the confirm mucinous cyst. Pathological findings revealed a cystic lesion in the muscularis propria of the OGJ filled with mucinous components and lined with multilayered columnar epithelial cells. The cyst was diagnosed as a duplicate without malignancy. DISCUSSION: Since the border between the cyst and the oesophageal walls was unclear, and the cyst potentially contained a malignant component, instead of cystectomy, lower oesophagectomy and proximal gastrectomy with lymph node dissection were performed with oesophagogastric anastomosis using the double-flap technique, tailored specifically for OGJ cancer. CONCLUSIONS: Oesophageal duplication cysts are rare. Lower oesophagectomy and proximal gastrectomy are selective surgical approaches for cyst duplication at the OGJ.

DOI： 10.1016/j.ijscr.2024.110572

Dendritic cell maturation is induced by p53-armed oncolytic adenovirus via tumor-derived exosomes enhancing systemic antitumor immunity. 査読国際誌

Tomoko Ohtani, Shinji Kuroda, Nobuhiko Kanaya, Yoshihiko Kakiuchi, Kento Kumon, Masashi Hashimoto, Chiaki Yagi, Ryoma Sugimoto, Satoru Kikuchi, Shunsuke Kagawa, Hiroshi Tazawa, Yasuo Urata, Toshiyoshi Fujiwara

Cancer immunology, immunotherapy : CII 74 ( 1 ) 12 - 12 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Dendritic cells (DCs) are crucial in cancer immunity, because they activate cytotoxic T cells by presenting tumor antigens. Recently, oncolytic virus therapy has been recognized as a systemic immune stimulator. We previously developed a telomerase-specific oncolytic adenovirus (OBP-301) and a p53-armed OBP-301 (OBP-702), demonstrating that these viruses strongly activate systemic antitumor immunity. However, their effects on DCs remained unclear. In the present study, the aim was to elucidate the mechanisms of DC activation by OBP-702, focusing particularly on tumor-derived exosomes. Exosomes (Exo53, Exo301, or Exo702) were isolated from conditioned media of human or murine pancreatic cancer cell lines (Panc-1, MiaPaCa-2, and PAN02) after treatment with Ad-p53, OBP-301, or OBP-702. Exo702 derived from Panc-1 and MiaPaCa-2 cells significantly upregulated CD86, CD80, CD83 (markers of DC maturation), and IFN-γ in DCs in vitro. Similarly, Exo702 derived from PAN02 cells upregulated CD86 and IFN-γ in bone marrow-derived DCs in a bilateral PAN02 subcutaneous tumor model. This DC maturation was inhibited by GW4869, an inhibitor of exosome release, and anti-CD63, an antibody targeting the exosome marker. Intratumoral injection of OBP-702 into PAN02 subcutaneous tumors significantly increased the presence of mature DCs and CD8-positive T cells in draining lymph nodes, leading to long-lasting antitumor effects through the durable activation of systemic antitumor immunity. In conclusion, tumor-derived exosomes play a significant role in DC maturation following OBP-702 treatment and are critical for the systemic activation of antitumor immunity, leading to the abscopal effect.

DOI： 10.1007/s00262-024-03849-5

Gastro-tracheal fistula following esophageal cancer surgery through the retrosternal route: a case report. 査読国際誌

Seitaro Nishimura, Kazuhiro Noma, Kento Kawasaki, Masashi Hashimoto, Takuya Kato, Naoaki Maeda, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Surgical case reports 10 ( 1 ) 252 - 252 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Gastro-tracheal fistula is a rare but serious complication after esophageal surgery, often requiring long-term treatment and invasive procedures. Gastro-tracheal fistula usually occurs through the posterior mediastinal route and rarely through the retrosternal route. No previous reports have described gastro-tracheal fistula after retrosternal route reconstruction was cured by conservative treatment. CASE PRESENTATION: A 70-year-old man with lower thoracic esophageal cancer underwent thoracoscopic esophagectomy in the prone position and gastric tube reconstruction through the retrosternal route with neck anastomosis after neoadjuvant chemotherapy. Despite anastomotic leakage on postoperative day 10, his general condition was stable, and he was managed conservatively with antibiotics and gastric tube decompression. On day 29, he presented with high fever and a gastro-tracheal fistula was observed by esophagography. Conservative management was continued because the patient remained stable. On day 48, esophagography showed that the fistula was undetectable. The patient was able to take fluids orally. He progressed well on an oral diet and was transferred to a different hospital. CONCLUSIONS: A gastro-tracheal fistula, although rare, can occur after retrosternal route reconstruction. When a patient is stable, gastro-tracheal fistula after retrosternal route reconstruction may be cured by conservative treatment.

DOI： 10.1186/s40792-024-02052-z

食道癌の集学的治療～高齢化社会とICI時代の先鞭をつける～高齢者食道癌患者に対する免疫チェックポイント阻害薬+化学療法

橋本将志, 野間和広, 松本聖, 河崎健人, 國友知義, 田上幸憲, 前田直見, 菊地覚次, 重安邦俊, 田辺俊介, 近藤喜太, 黒田新士, 寺石文則, 香川俊輔, 藤原俊義

日本癌治療学会学術集会抄録集 62回 OSY8 - 7 2024年10月

【食道胃接合部癌診療のすべて】食道胃接合部癌に対する上縦隔リンパ節郭清招待

橋本将志, 野間和広

消化器外科 47 ( 6 ) 647 - 655 2024年6月

Subtotal esophagectomy and concurrent reconstruction with free jejunal flap for primary esophageal cancer after pancreatoduodenectomy. 査読国際誌

Kazuya Moriwake, Kazuhiro Noma, Kento Kawasaki, Tasuku Matsumoto, Masashi Hashimoto, Takuya Kato, Naoaki Maeda, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Surgical case reports 10 ( 1 ) 128 - 128 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Pancreatoduodenectomy and subtotal esophagectomy are widely considered the most invasive and difficult surgical procedures in gastrointestinal surgery. Subtotal esophagectomy after pancreatoduodenectomy is expected to be extremely difficult due to complicated anatomical changes, and selecting an appropriate intestinal reconstruction method will also be a difficult task. Therefore, perhaps because the method is considered impossible, there have been few reports of subtotal esophagectomy after pancreatoduodenectomy. CASE PRESENTATION: A 73-year-old man with a history of pancreatoduodenectomy was diagnosed with superficial thoracic esophageal squamous cell carcinoma. Definitive chemoradiation therapy was recommended at another hospital; however, he visited our department to undergo surgery. We performed the robot-assisted thoracoscopic subtotal esophagectomy. There were some difficulties with the reconstruction: the gastric tube could not be used, the reconstruction was long, and the organs reconstructed in the previous surgery had to be preserved. However, the concurrent reconstruction was achieved with the help of a free jejunal flap and vascular reconstruction. All reconstructions from the previous surgery, including the remnant stomach, were preserved via regional abdominal lymph node dissection. After reconstruction, intravenous indocyanine green showed that circulation in the reconstructed intestines was preserved. On postoperative day 1, no recurrent nerve paralysis was observed during laryngoscopy. The patient could start oral intake smoothly 2 weeks after surgery and did not exhibit any postoperative complications related to the reconstruction. The patient was transferred to another hospital on postoperative day 21. CONCLUSIONS: Owing to the free jejunal flap interposition method, we safely performed one stage subtotal esophagectomy and concurrent reconstruction, preservation of the remnant stomach, and pancreaticobiliary reconstruction in patients with a history of pancreatoduodenectomy. We believe that this method is acceptable and useful for patients undergoing complicated reconstruction.

DOI： 10.1186/s40792-024-01919-5

【食道癌2024-基礎・臨床の最新動向-】食道癌の治療ワクチン療法・ミサイル療法の今後の展開招待

橋本将志, 野間和広, 前田直見, 田邊俊介, 藤原俊義

日本臨床 82 ( 増刊3 食道癌2024 ) 473 - 477 2024年5月

Surgical repair for a parahiatal hernia with an esophageal hiatal hernia: A case report and literature review 査読

Yosuke Takahashi, Kazuhiro Noma, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Toshiyoshi Fujiwara

International Journal of Surgery Case Reports 117 2024年4月

掲載種別：研究論文（学術雑誌）

Introduction and importance: A parahiatal hernia (PH) is a rare diaphragmatic hernia (DH) adjacent to but separated from the esophageal hiatus. The surgical repair for PH needs primary suture closure or complicated hernioplasty and the addition of an anti-reflux procedure. This report describes a case of PH with a symptomatic esophageal hiatal hernia managed using three-dimensional (3D) laparoscopy. Case presentation: A 65-year-old woman with back pain and breathlessness was referred to our hospital for a DH. Computed tomography showed a diaphragmatic defect on the left side of the esophageal hiatus. Upper gastrointestinal endoscopy and 24-hour esophageal impedance-pH monitoring showed a symptomatic esophageal hiatal hernia. Laparoscopic repair for both hernias was performed using 3D laparoscopy. The DH orifice was located in the left crus of the diaphragm, and it was separated from the esophageal hiatus. These findings showed that this DH was a PH. The PH was repaired with primary suturing, and a hiatoplasty was performed. Toupet fundoplication was performed with a 270° posterior wrap of the gastric fornix. The patient has remained asymptomatic a year after surgery without any complications. Clinical discussion: 3D laparoscopy provides significant advantages in surgeries requiring precise suturing. PH repairs require complex procedures, including mesh repair or suturing. Approximately 44 % of PH cases also necessitate fundoplication. 3D laparoscopy was useful for the present case. Conclusions: A rare PH and a symptomatic type 1 hiatal hernia were repaired with 3D laparoscopy, which is helpful for PH treatment in cases requiring complicated procedures.

DOI： 10.1016/j.ijscr.2024.109565

上部消化管外科におけるロボット手術のトラブルシューティング(ヒヤリハットを含む) ロボット支援食道癌手術におけるトラブルシューティングに対するわれわれの工夫

白川靖博, 桂佑貴, 宇根悠太, 吉本匡志, 真島宏聡, 澤田紘幸, 石田道拡, 吉田龍一, 佐藤大祐, 丁田泰宏, 吉満政義, 中野敢友, 井谷史嗣, 松川啓義, 塩崎滋弘, 橋本将志, 前田直見, 田辺俊介, 野間和広, 藤原俊義

日本外科学会定期学術集会抄録集 124回 WS - 8 2024年4月

Author Correction: Long-term activation of anti-tumor immunity in pancreatic cancer by a p53-expressing telomerase-specific oncolytic adenovirus 査読

Hashimoto Masashi

British Journal of Cancer 2024年2月

Adenocarcinoma arising from widespread heterotopic gastric mucosa in the cervicothoracic esophagus: a case report. 査読国際誌

Shohei Nogi, Kazuhiro Noma, Masashi Hashimoto, Takuya Kato, Naoaki Maeda, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Surgical case reports 9 ( 1 ) 132 - 132 2023年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: In Japan, about 6% of esophageal cancers are adenocarcinomas, although most of them arise from Barrett's epithelium. Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is very rare. Due to its rarity, there is no unified view on its treatment strategy and prognosis. CASE PRESENTATION: A 57-year-old man presented with a protruding lesion in the cervicothoracic esophagus that was detected by an upper gastrointestinal series at a medical checkup. Esophagoscopy revealed a 30 mm Type 1 tumor circumferentially surrounded by widespread HGM. Computed tomography (CT) and fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed no metastasis or invasion of the surrounding organs. We diagnosed the lesion as cT2N0M0 cStageIIB [Union for International Cancer Control (UICC) 8th Ed] cancer and performed subtotal esophagectomy with three-field lymph node dissection. The tumor was determined to be a well-differentiated adenocarcinoma arising from HGM, with deep invasion of the submucosa. The patient underwent no adjuvant therapy and has currently survived without any evidence of recurrence for 15 months. CONCLUSIONS: Although the treatment for adenocarcinoma arising from HGM is basically the same as that for squamous cell carcinoma (SCC) of the esophagus, it is important to determine the treatment strategy based on the characteristics of the adenocarcinoma arising from HGM.

DOI： 10.1186/s40792-023-01707-7

Outcomes of solitary postoperative recurrence of esophageal squamous cell carcinoma diagnosed with FDG-PET/CT and treated with definitive radiation therapy. 査読

Hiroki Ihara, Kotaro Yoshio, Shunsuke Tanabe, Soichi Sugiyama, Masashi Hashimoto, Naoaki Maeda, Shinsuke Akagi, Soshi Takao, Kazuhiro Noma, Takao Hiraki

Esophagus : official journal of the Japan Esophageal Society 20 ( 3 ) 548 - 556 2023年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Surgical resection of esophageal cancer is frequently performed to achieve a complete cure. However, the postoperative recurrence rate is 36.8-42.5%, leading to poor prognosis. Radiation therapy has been used to treat recurrences; solitary recurrence has been proposed as a prognostic factor for radiation therapy, though its significance is unclear. 18F-fluorodeoxyglucose positron emission tomography is a highly accurate diagnostic modality for esophageal cancer. This retrospective study aimed to analyze the outcomes of solitary postoperative recurrences of esophageal squamous cell carcinoma diagnosed with 18F-fluorodeoxyglucose positron emission tomography and treated with definitive radiation therapy. METHODS: We examined 27 patients who underwent definitive radiation therapy for single or multiple postoperative recurrences of esophageal squamous cell carcinoma between May 2015 and April 2021. 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed within 3 months before the commencement of radiation therapy. Kaplan-Meier, univariate, and multivariate analyses were performed to examine the overall survival and identify potential prognostic factors. RESULTS: The 1-, 2-, and 3-year overall survival rates were 85.2%, 62.6%, and 47.3%, respectively, and solitary recurrence was the only significant factor associated with overall survival (P = 0.003). The 1-, 2-, and 3-year overall survival rates in patients with solitary recurrence were 91.7%, 80.2%, and 80.2%, respectively, and in patients with multiple recurrences they were 80.0%, 50.3%, and 25.1%, respectively. Multivariate analysis also showed solitary recurrence as a significant factor for overall survival. CONCLUSIONS: When diagnosed with 18F-fluorodeoxyglucose positron emission tomography/computed tomography, solitary recurrence appears to have a more favorable prognosis than multiple recurrences.

DOI： 10.1007/s10388-023-01000-4

Case of robot-assisted salvage surgery for esophageal cancer with a mediastinal fistula after definitive chemoradiotherapy. 査読

Daisuke Kadowaki, Kazuhiro Noma, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Asian journal of endoscopic surgery 16 ( 3 ) 505 - 509 2023年7月

記述言語：英語

Salvage surgery for esophageal cancer after definitive chemoradiotherapy (dCRT) is effective, but it is associated with a high rate of perioperative complications. The indications for robot-assisted minimally invasive esophagectomy (RAMIE) are expanding. However, there are few reports of salvage RAMIE. A 73-year-old man was referred to our hospital for residual esophageal cancer with a mediastinal fistula after dCRT. The perioperative diagnosis was T3N1M0-Stage III, and the salvage RAMIE was performed. Although the dissection was difficult due to fibrosis caused by dCRT and the esophageal mediastinal fistula, RAMIE was performed safely with no complications. Multiple features of RAMIE contributed to stable surgery. The monopolar dissection is effective for hard scar tissue caused by CRT and inflammation.

DOI： 10.1111/ases.13155

Safe and curative modified two-stage operation for T4 esophageal cancer after definitive chemoradiotherapy: a case report. 査読国際誌

Tasuku Matsumoto, Kazuhiro Noma, Naoaki Maeda, Takuya Kato, Kazuya Moriwake, Kento Kawasaki, Masashi Hashimoto, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Surgical case reports 9 ( 1 ) 119 - 119 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The prognosis of esophageal cancer (EC) with organ invasion is extremely poor. In these cases, definitive chemoradiotherapy (CRT) followed by salvage surgery can be planned; however, the issue of high morbidity and mortality rates persists. Herein, we report the long-term survival of a patient with EC and T4 invasion who underwent a modified two-stage operation after definitive CRT. CASE PRESENTATION: A 60-year-old male presented with type 2 upper thoracic EC with tracheal invasion. First, definitive CRT was performed, which resulted in tumor shrinkage and improvement in the tracheal invasion. However, an esophagotracheal fistula subsequently developed, and the patient was treated with fasting and antibiotics. Although the fistula recovered, severe esophageal stenoses made oral intake impossible. To improve quality of life and cure the EC, a modified two-stage operation was planned. In the first surgery, an esophageal bypass was performed using a gastric tube with cervical and abdominal lymph node dissections. After confirming improved nutritional status and absence of distant metastasis, the second surgery was performed with subtotal esophagectomy, mediastinal lymph node dissection, and tracheobronchial coverage of the fistula. The patient discharged without major complications after radical resection and has been recurrence-free for 5 years since the start of treatment. CONCLUSION: A standard curative strategy could be difficult for EC with T4 invasion due to differences in the invaded organs, presence of complications, and patient condition. Therefore, patient-tailored treatment plans are needed, including a modified two-stage operation.

DOI： 10.1186/s40792-023-01692-x

ロボット手術と多科合同手術で食道癌に挑む

門脇大輔, 野間和広, 橋本将志, 前田直見, 重安邦俊, 菊地覚次, 近藤喜太, 黒田新士, 田辺俊介, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本外科学会定期学術集会抄録集 123回 DP - 5 2023年4月

食道良性疾患に対する手術の限界と挑戦高齢者に対する食道裂孔ヘルニアの腹腔鏡根治術における現状と手技の工夫

藤田脩斗, 野間和広, 橋本将志, 前田直見, 菊地覚次, 重安邦俊, 黒田新士, 近藤喜太, 田辺俊介, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本外科学会定期学術集会抄録集 123回 WS - 6 2023年4月

食道癌術前化学療法時から介入する多職種チーム医療と微量元素に着目した栄養管理

田辺俊介, 野間和広, 橋本将志, 前田直見, 重安邦俊, 菊地覚次, 黒田新士, 近藤喜太, 吉田龍一, 櫻間教文, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本外科学会定期学術集会抄録集 123回 DP - 6 2023年4月

Oncolytic virus-mediated p53 overexpression promotes immunogenic cell death and efficacy of PD-1 blockade in pancreatic cancer. 査読国際誌

Hiroyuki Araki, Hiroshi Tazawa, Nobuhiko Kanaya, Yoshinori Kajiwara, Motohiko Yamada, Masashi Hashimoto, Satoru Kikuchi, Shinji Kuroda, Ryuichi Yoshida, Yuzo Umeda, Yasuo Urata, Shunsuke Kagawa, Toshiyoshi Fujiwara

Molecular therapy oncolytics 27 3 - 13 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Immune checkpoint inhibitors, including anti-programmed cell death 1 (PD-1) antibody, provide improved clinical outcome in certain cancers. However, pancreatic ductal adenocarcinoma (PDAC) is refractory to PD-1 blockade therapy due to poor immune response. Oncolytic virotherapy is a novel approach for inducing immunogenic cell death (ICD). We demonstrated the therapeutic potential of p53-expressing telomerase-specific oncolytic adenovirus OBP-702 to induce ICD and anti-tumor immune responses in human PDAC cells with different p53 status (Capan-2, PK-59, PK-45H, Capan-1, MIA PaCa-2, BxPC-3) and murine PDAC cells (PAN02). OBP-702 significantly enhanced ICD with secretion of extracellular adenosine triphosphate and high-mobility group box protein B1 by inducing p53-mediated apoptosis and autophagy. OBP-702 significantly promoted the tumor infiltration of CD8+ T cells and the anti-tumor efficacy of PD-1 blockade in a subcutaneous PAN02 syngeneic tumor model. Our results suggest that oncolytic adenovirus-mediated p53 overexpression augments ICD and the efficacy of PD-1 blockade therapy against cold PDAC tumors. Further in vivo experiments would be warranted to evaluate the survival benefit of tumor-bearing mice in combination therapy with OBP-702 and PD-1 blockade.

DOI： 10.1016/j.omto.2022.09.003

An oncolytic virus as a promising candidate for the treatment of radioresistant oral squamous cell carcinoma. 査読国際誌

Shunsuke Gohara, Kosuke Shinohara, Ryoji Yoshida, Ryusho Kariya, Hiroshi Tazawa, Masashi Hashimoto, Junki Inoue, Ryuta Kubo, Hikaru Nakashima, Hidetaka Arita, Sho Kawaguchi, Keisuke Yamana, Yuka Nagao, Asuka Iwamoto, Junki Sakata, Yuichiro Matsuoka, Hisashi Takeshita, Masatoshi Hirayama, Kenta Kawahara, Masashi Nagata, Akiyuki Hirosue, Yoshikazu Kuwahara, Manabu Fukumoto, Seiji Okada, Yasuo Urata, Toshiyoshi Fujiwara, Hideki Nakayama

Molecular therapy oncolytics 27 141 - 156 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

We evaluated the usefulness of an oncolytic virus (Suratadenoturev; OBP-301) against radioresistant oral squamous cell carcinoma. We confirmed the expression of human telomerase reverse transcriptase and the coxsackievirus and adenovirus receptor in cell lines. Also, we examined the potential presence in a patient who has received existing therapy that is amenable to treatment with OBP-301. We evaluated: (1) the antitumor effects of OBP-301 alone and in combination with radiotherapy on radioresistant cell lines, (2) the molecular mechanism underlying the radiosensitizing effect and cell death increased by the combination therapy, and (3) the antitumor effect of the combination therapy in vivo using xenograft models (a radioresistant cell line-derived xenograft in mouse and a patient-derived xenograft). Human telomerase reverse transcriptase and the coxsackievirus and adenovirus receptor were expressed in all cell lines. OBP-301 decreased the proliferative activity of these cell lines in a concentration-dependent manner, and significantly enhanced the antitumor effect of irradiation. Phosphorylated STAT3 and its downstream molecules, which correlated with apoptosis and autophagy, showed significant changes in expression after treatment with OBP-301. The combination therapy exerted a significant antitumor effect versus radiotherapy alone in both xenograft models. Combination of OBP-301 with radiotherapy exerts a synergistic effect and may represent a promising treatment for radioresistant oral squamous cell carcinoma.

DOI： 10.1016/j.omto.2022.10.001

低侵襲食道癌手術における専門医制度:食道外科専門医vs技術認定医食道外科医における技術認定制度、認定医とは?技術認定合格に必須なコンセプト

野間和広, 橋本将志, 前田直見, 菊地覚次, 田辺俊介, 近藤喜太, 黒田新士, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 428 - 428 2022年12月

縦隔郭清を伴う食道胃接合部癌に対する岡山大学病院での取り組み

橋本将志, 野間和広, 前田直見, 菊地覚次, 重安邦俊, 近藤喜太, 田辺俊介, 黒田新士, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 789 - 789 2022年12月

食道良性疾患に対する胸腔鏡・腹腔鏡手術:手技の工夫と成績食道裂孔ヘルニアの腹腔鏡下根治手術における手技の工夫とQOL改善への貢献

田辺俊介, 野間和広, 橋本将志, 前田直見, 菊地覚次, 重安邦俊, 黒田新士, 近藤喜太, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 86 - 86 2022年12月

神経モニタリングを用いたより低侵襲なロボット支援下食道手術

野間和広, 橋本将志, 前田直見, 菊地覚次, 田辺俊介, 近藤喜太, 黒田新士, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 1150 - 1150 2022年12月

胸腔鏡下食道癌手術のコンセプトと成績、教育方法

前田直見, 野間和広, 橋本将志, 菊地覚次, 黒田新士, 近藤喜太, 田辺俊介, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 1722 - 1722 2022年12月

OBP-702を用いたウイルス治療による膵癌の長期抗腫瘍免疫賦活効果招待

橋本将志, 黒田新士, 金谷信彦, 垣内慶彦, 菊地覚次, 田澤大, 香川俊輔, 浦田泰生, 藤原俊義

癌と化学療法 49 ( 10 ) 1127 - 1129 2022年10月

記述言語：日本語出版者・発行元：(株)癌と化学療法社

膵癌は予後不良な癌であり,近年話題の癌免疫療法に対しても免疫細胞の浸潤が乏しい腫瘍として知られている。また,近年術前化学療法の有効性が注目されている。我々は,腫瘍特異的に増殖する腫瘍融解アデノウイルス製剤(OBP-301)を開発し,食道癌において放射線療法+OBP-301治療の臨床試験が進行中である。臨床試験のなかで腫瘍浸潤リンパ球やPD-L1の発現増強を認め,免疫学的な治療効果も期待されている。次世代の薬剤としてOBP-301にp53遺伝子を搭載したOBP-702を開発し,膵癌に対して強力な治療効果を発揮することを確認した。今回,膵癌におけるOBP-702の有効性に関し,長期抗腫瘍免疫の指標としてCD8陽性メモリーT細胞に注目して検討した。(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20221021370020&doc_link_id=%2Fab8gtkrc%2F2022%2F004910%2F021%2F1127-1129%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004910%2F021%2F1127-1129%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

[Telomerase-Specific Oncolytic Adenovirus Expressing p53 Gene Stimulating CD8+ Memory T Cells in Pancreatic Cancer]. 招待

Masashi Hashimoto, Shinji Kuroda, Nobuhiko Kanaya, Yoshihiko Kakiuchi, Satoru Kikuchi, Hiroshi Tazawa, Shunsuke Kagawa, Yasuo Urata, Toshiyoshi Fujiwara

Gan to kagaku ryoho. Cancer & chemotherapy 49 ( 10 ) 1127 - 1129 2022年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Pancreatic cancer has poor prognosis despite the various developed multimodal treatment strategies. Currently, neoadjuvant chemotherapy and immunotherapy have attracted substantial attention as effective treatment strategies. However, amplifying immune response with existing treatments is difficult. We developed telomerase-specific oncolytic adenoviruses (OAs), including OBP-301 that is currently tested in a clinical trial of combined anti-PD-1 antibody and p53-armed OBP- 301 variant(OBP-702). OAs have immune-modulation functions and induce CD8+ T cells into tumors by releasing immunogenic cell death markers, such as extracellular adenosine triphosphate. Here, we investigated the effectiveness of OBP- 702 in pancreatic cancer treatments, focusing on the influence on CD8+ memory T cells.

術前DCF療法を行った食道癌切除後の再発パターンと再発リスク因子

橋本将志, 野間和広, 前田直見, 菊地覚次, 重安邦俊, 田辺俊介, 近藤喜太, 黒田新士, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 83 ( 増刊 ) S223 - S223 2022年10月

食道胃接合部がんの集学的治療のこれから食道胃接合部癌に対する集学的治療の後方視的解析と食道浸潤長から導かれる至適術式

野間和広, 橋本将志, 前田直見, 菊地覚次, 田辺俊介, 近藤喜太, 黒田新士, 吉田龍一, 櫻間教文, 寺石文則, 楳田祐三, 香川俊輔, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS16 - 2 2022年10月

呼吸筋サルコペニア・フレイル評価とリハビリは食道癌術後呼吸器合併症を減少させる

前田直見, 野間和広, 橋本将志, 菊地覚次, 黒田新士, 近藤喜太, 田辺俊介, 櫻間教文, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OF - 2 2022年10月

食道癌術後オリゴ転移に対する集学的治療

橋本将志, 野間和広, 前田直見, 田辺俊介, 菊地覚次, 近藤喜太, 黒田新士, 櫻間教文, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OF - 2 2022年10月

食道癌手術における周術期チーム医療について呼吸筋機能評価と重点的呼吸筋リハビリは食道癌術後呼吸器合併症を低減する

前田直見, 野間和広, 橋本将志, 菊地覚次, 黒田新士, 近藤喜太, 田辺俊介, 櫻間教文, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 83 ( 増刊 ) S116 - S116 2022年10月

食道がん集学的治療におけるチーム医療の実践とこれから食道癌周術期管理における多職種チーム医療の早期介入の有用性と今後の展望

田辺俊介, 野間和広, 橋本将志, 前田直見, 菊地覚次, 黒田新士, 近藤喜太, 櫻間教文, 吉田龍一, 寺石文明, 楳田祐三, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS8 - 2 2022年10月

食道癌に対するロボット支援下手術の治療成績進行食道癌におけるロボット支援下食道手術の有用性

野間和広, 橋本将志, 前田直見, 菊地覚次, 田辺俊介, 近藤喜太, 黒田新士, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 83 ( 増刊 ) S118 - S118 2022年10月

根治性とQOL維持の両立を目指した食道胃接合部癌に対する至適術式の検討

田辺俊介, 野間和広, 橋本将志, 前田直見, 菊地覚次, 重安邦俊, 黒田新士, 近藤喜太, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 83 ( 増刊 ) S209 - S209 2022年10月

Verrucous carcinoma of the esophagus with complete response after chemoradiotherapy. 査読国際誌

Masashi Hashimoto, Yasuhiro Shirakawa, Shunsuke Tanabe, Takehiro Tanaka, Naoaki Maeda, Kazufumi Sakurama, Kazuhiro Noma, Toshiyoshi Fujiwara

Surgical case reports 8 ( 1 ) 128 - 128 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Verrucous carcinoma of the esophagus (VCE) is a rare tumor that is difficult to diagnose. In most cases, biopsies show nonspecific inflammatory and hyperkeratotic changes and do not show malignant findings. Most VCEs are slowly growing, locally advanced tumors with few metastases. Treatments for VCE are the same as for normal esophageal cancer, involving combined chemotherapy, surgical resection, and radiation therapy. However, it has been reported that VCE has a poor response to radiation or chemoradiotherapy (CRT). A case of VCE with complete response (CR) after CRT is presented. CASE PRESENTATION: A 70-year-old man was found to have white, irregular esophageal mucosa 4 years earlier. He had been followed up as an outpatient as having candidal esophagitis. However, his tumor grew gradually, and biopsy was performed by endoscopic mucosal resection (EMR). He was finally diagnosed with VCE. He had no metastases to distant organs, but some lymph node metastases were suspected. The tumor invaded his left bronchus. The esophagostomy and gastrostomy were constructed as emergent procedures. The patient then underwent definitive CRT. 4 weeks after the end of CRT, two-stage esophagectomy was performed. First, he underwent esophagectomy with thoracic lymph node dissection. A latissimus dorsi flap was patched to the bronchus after primary suture of the hole. 6 weeks later, reconstruction of the gastric tube was performed through the antethoracic route. The pathological findings showed CR to CRT, with no proliferative cancer cells in the specimen. The patient has had no recurrence for three and half years after the resection. CONCLUSIONS: We presented a locally advanced VCE that achieved CR to CRT. In cases that have some difficulty for local resection, CRT might be an appropriate treatment for VCE.

DOI： 10.1186/s40792-022-01486-7

Extracellular vesicle-mediated distant signaling; Systemic adenovirotherapy via immune activation and cytotoxicity

Hashimoto Masashi

Cancer Science 2022年

Immunity-activating telomerase-specific oncolytic adenoviruses produce synergistic effects with anti-PD1 antibody

Hashimoto Masashi

Cancer Science 2022年

Local oncolytic adenovirotherapy produces an abscopal effect via tumor-derived extracellular vesicles 査読国際誌

Yoshihiko Kakiuchi, Shinji Kuroda, Nobuhiko Kanaya, Kento Kumon, Tomoko Tsumura, Masashi Hashimoto, Chiaki Yagi, Ryoma Sugimoto, Yuki Hamada, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Hiroshi Tazawa, Yasuo Urata, Toshiyoshi Fujiwara

Molecular Therapy 29 ( 10 ) 2920 - 2930 2021年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Elsevier {BV}

Extracellular vesicles (EVs) play important roles in various intercellular communication processes. The abscopal effect is an interesting phenomenon in cancer treatment, in which immune activation is generally considered a main factor. We previously developed a telomerase-specific oncolytic adenovirus, Telomelysin (OBP-301), and occasionally observed therapeutic effects on distal tumors after local treatment in immunodeficient mice. In this study, we hypothesized that EVs may be involved in the abscopal effect of OBP-301. EVs isolated from the supernatant of HCT116 human colon carcinoma cells treated with OBP-301 were confirmed to contain OBP-301, and they showed cytotoxic activity (apoptosis and autophagy) similar to OBP-301. In bilateral subcutaneous HCT116 and CT26 tumor models, intratumoral administration of OBP-301 produced potent antitumor effects on tumors that were not directly treated with OBP-301, involving direct mediation by tumor-derived EVs containing OBP-301. This indicates that immune activation is not the main factor in this abscopal effect. Moreover, tumor-derived EVs exhibited high tumor tropism in orthotopic HCT116 rectal tumors, in which adenovirus E1A and adenovirus type 5 proteins were observed in metastatic liver tumors after localized rectal tumor treatment. In conclusion, local treatment with OBP-301 has the potential to produce abscopal effects via tumor-derived EVs.

DOI： 10.1016/j.ymthe.2021.05.015

A case of esophageal cancer with an aberrant right subclavian artery treated with mediastinoscopic esophagectomy 査読

Masashi Hashimoto, Yasuhiro Shirakawa, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Kazuhiro Noma, Toshiyoshi Fujiwara

Asian Journal of Endoscopic Surgery 14 ( 2 ) 293 - 296 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Wiley

An aberrant right subclavian artery (ARSA) is one of the famous anatomical abnormalities with a prevalence of 0.16-4.4%. In esophagectomy, anatomical abnormalities of the ARSA could cause complications with some surgical procedures. An 85-year old man was referred to our department for esophageal adenocarcinoma that was at a slightly high position for esophagectomy with the abdominal approach. However, he had a significant past medical history. This risk factor made it difficult to perform thoracoscopic esophagectomy. He underwent mediastinoscopic esophagectomy (ME) with the left cervical and laparoscopic approach. The ARSA presented no difficulties with the ME surgical technique including the dissection of the left recurrent laryngeal nerve lymph node. Although this patient had a respiratory dysfunction and some difficulties in a prone position, ME enabled a safe esophagectomy with lymph node dissection.

DOI： 10.1111/ases.12859

Extracellular vesicles derived from tumor treated with oncolytic adenovirus potentially activate dendritic cells

Hashimoto Masashi

Cancer Science 2021年

Telomerase-specific oncolytic adenovirus amplifies immunogenic effects with anti-PD1 antibody

Hashimoto Masashi

Cancer Science 2021年

Innovative exosome-based therapeutics; Local oncolytic adenovirotherapy inducing the abscopal effect via exosome

Hashimoto Masashi

Cancer Science 2021年

Laparoscopic treatment for celiac artery stenosis caused by median arcuate ligament compression with Adachi V type vascular anomaly: a case report

Hashimoto Masashi

Surgical Case Reports 2021年

術前化学療法を行った後の術後病理で診断された癌肉腫成分を含む食道癌の2例査読

橋本将志, 北上英彦, 丹羽弘貴, 吉川智宏, 大内知之, 武内利直, 細川正夫

日本消化器外科学会雑誌 52 ( 6 ) 281 - 290 2019年6月

担当区分：筆頭著者記述言語：日本語出版者・発行元：(一社)日本消化器外科学会

症例1は73歳の男性で,cT4N2M0,Stage IVaの扁平上皮癌の診断で化学療法の後に手術を行った.病理で肉腫様成分と腺扁平上皮癌成分を認め,pT3N2M0,Stage IIIで治療効果はGrade 1aであった.術後経過観察中に多発転移を認め,術後4ヵ月で原病死した.症例2は68歳の男性で,cT2N3M0,Stage IIIの扁平上皮癌の診断で化学療法の後に手術を行った.病理で肉腫様成分と扁平上皮癌成分を認め,pT1bN0M0,Stage Iで治療効果はGrade 1aであった.術後4年無再発生存中である.今回,病理学的治療効果はともにGrade 1aで臨床的治療効果もSDであった.食道癌肉腫は正確な診断が難しく,術前化学療法のエビデンスがない.内視鏡で食道癌肉腫の特徴に当てはまるものは,組織診断を正確につけるよう診断努力を要し,術前化学療法の有効性は今後症例を集積し,検討する必要がある.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01117&link_issn=&doc_id=20190708310002&doc_link_id=10.5833%2Fjjgs.2018.0023&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2018.0023&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

【食道癌(第2版)-基礎・臨床研究の進歩-】食道癌の治療外科治療胸部食道癌に対する手術胸腔鏡下食道切除術腹臥位-臓器鞘をランドマークとした胸腔鏡下食道切除術

大幸宏幸, 小熊潤也, 藤田武郎, 金森淳, 藤原尚志, 岡田尚也, 佐藤琢爾, 石山廣志朗, 佐藤中, 栗田大資, 平野祐樹, 岡本宏史, 佐藤和磨, 橋本将志

日本臨床 76 ( 増刊8 食道癌 ) 278 - 282 2018年10月

手術手技腹腔鏡下胃全摘術におけるOverlap吻合を用いたRoux-en-Y再建の定型化と工夫

北上英彦, 丹羽弘貴, 橋本将志, 坂下啓太, 吉川智宏, 細川正夫

手術 = Operation 72 ( 1 ) 83 - 88 2018年1月

胃癌肝転移との鑑別に苦慮した肝reactive lymphoid hyperplasiaの1例査読

橋本将志, 松本祐介, 浜野郁美, 遠藤芳克, 甲斐恭平, 佐藤四三, 堀田真智子

日本臨床外科学会雑誌 78 ( 5 ) 1060 - 1067 2017年5月

記述言語：日本語出版者・発行元：日本臨床外科学会

症例は41歳，女性．心窩部痛を主訴に近医を受診し，上部消化管内視鏡検査を行ったところ胃角部に胃癌を指摘された．精査の結果，肝に5-15mm大の肝腫瘤を複数指摘された．肝腫瘤は腹部CTや造影MRIで周囲の造影効果が淡く，また超音波でも典型的な転移性肝癌の所見とは判断できなかった．サイズが小さいという点を考えても，画像だけで胃癌肝転移の確定診断に至らないと判断し針生検行った．生検の結果ではリンパ球の集簇という結果となり，肝reactive lymphoid hyperplasia（以下，肝RLH）を強く疑い，原発巣切除と診断的肝部分切除を行った．切除後の病理所見で胃癌と肝RLHと診断された．現在術後1年無再発生存中である．肝RLHは診断が難しく，特に悪性疾患との併存の場合は画像所見だけで転移性肝癌と鑑別することは難しい．今回，生検をきっかけにして胃癌に併存する肝RLHを診断，切除できた症例を経験したので報告する．

腹腔鏡下幽門側胃切除により改善した非肝硬変性門脈大循環シャントによる肝性脳症の1例査読

浜野郁美, 佐藤四三, 松本祐介, 橋本将志, 森川達也, 下島礼子, 遠藤芳克, 信久徹治, 渡邉貴紀, 甲斐恭平

日本消化器外科学会雑誌 50 ( 8 ) 639 - 645 2017年

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本消化器外科学会

<p> 症例は59歳の男性で，上部消化管内視鏡検査で胃角部に早期胃癌を指摘され手術目的に紹介となった．術前の血液検査で肝機能障害は認めなかったが，血清アンモニア値が軽度上昇しており，造影CTでは左胃静脈から左腎静脈へのシャント血管を認めた．肝疾患既往はなく，アルコールは機会飲酒程度だった．胃癌に対して腹腔鏡補助下幽門側胃切除術を施行し，膵上縁郭清時にシャント血管である左胃静脈を離断した．術後血清アンモニア値は正常化し，術前には個人の性格と思われた易怒的な態度や粗暴な印象が改善した．肝性脳症の臨床症状は多彩で診断が困難な場合があり，また肝疾患のない高アンモニア血症の原因に門脈体循環シャントが存在することがある．このように非常にまれな血管走行を呈する症例であっても，術前のCT-angiographyを用いたシミュレーションにより安全に腹腔鏡下手術を行うことが可能であっ‍た．</p>

DOI： 10.5833/jjgs.2016.0136

単孔式腹腔鏡下手術が診断・治療に有用であった成人重複腸管穿孔の1例査読

西脇紀之, 吉田有佑, 梶原義典, 橋本将志, 浜野郁美, 松本祐介

日本臨床外科学会雑誌 77 ( 2 ) 358 - 362 2016年

記述言語：日本語出版者・発行元：日本臨床外科学会

症例は39歳，男性．右下腹部痛を主訴に受診．右下腹部を中心とする圧痛と，炎症反応の上昇を認めた．腹部造影CTでは右下腹部に周囲の脂肪濃度上昇を伴う腫瘤像を認め，虫垂穿孔による急性腹膜炎の診断にて単孔式腹腔鏡下手術を施行した．虫垂には炎症所見を認めず，腹腔内には多量の汚染腹水を認めた．回腸末端より90cm口側の回腸腸間膜側に炎症を伴う腫瘤を認め，回腸への付着部で穿孔していた．腫瘤を含む回腸部分切除術を施行．病理組織検査では重複腸管穿孔の診断であった．穿孔性腹膜炎にて発症した成人重複腸管症は稀であり，診断・治療に腹腔鏡が有用であった．

Mesodiverticular vascular bandによる絞扼性イレウスの1例

橋本将志, 林同輔, 小畠千晶, 宮本学, 佐藤浩明, 窪田康浩, 松村年久, 野中泰幸, 宮島孝直, 黒瀬通弘, 徳田直彦, 三宅孝佳

津山中央病院医学雑誌 29 ( 1 ) 73 - 77 2015年9月

記述言語：日本語出版者・発行元：(一財)津山慈風会津山中央病院

症例は11歳男子。腹痛と嘔吐を主訴に救急外来を受診した。腹部造影CT検査にてイレウス像の出現と腹膜刺激症状を認めたため、内ヘルニアによる絞扼性イレウスの診断で同日緊急開腹手術となった。手術所見では回腸末端より約80cmの部位に腸間膜付着部対側にメッケル憩室を認めた。腸間膜からメッケル憩室先端に伸びる索状物により腹腔内異常孔を形成しており、小腸が陥入し絞扼していた。腸管は切除せず、索状物を結紮切離した。メッケル憩室を楔状切除した。術後経過は良好で、術後12日目に軽快退院した。切除標本で憩室は固有筋層を有する真性憩室で、異所性組織も認めた。また先端から腸間膜に伸びる索状物は動静脈・神経の遺残と考えられる組織を認め、Mesodiverticular vascular bandに矛盾しない所見であった。メッケル憩室に起因する絞扼性イレウスの中でも比較的稀なMesodiverticular vascular bandによる症例を経験し、病理学的にも証明出来たため、若干の文献的考察も加えて報告する。(著者抄録)

当院でピンチオフによる中心静脈ポートカテーテル断裂を起こした3例

橋本将志, 林同輔, 剱持礼子, 梶岡裕紀, 鳴坂徹, 宮本学, 佐藤浩明, 山本堪介, 木村圭佑, 窪田康浩, 松村年久, 木村幸男, 野中泰幸, 宮島孝直, 黒瀬通弘, 徳田直彦

津山中央病院医学雑誌 27 ( 1 ) 119 - 124 2013年9月

記述言語：日本語出版者・発行元：(一財)津山慈風会津山中央病院

皮下埋込み式中心静脈埋込みポート(以下CVポート)化学療法や中心静脈栄養療法が必要な場合にしばしば挿入され、利便性が高い一方で、合併症も報告されている。今回はその中でもピンチオフ症候群(以下ピンチオフ)が原因と考えられるカテーテル離断が起きた症例を3例経験したので報告する。発見の契機はいずれも点滴の滴下不良で、留置部の疼痛や点滴後の胸壁腫脹を伴っている症例もあった。それぞれ挿入後5年、1年、2年での発症であり、全例鎖骨下静脈からの挿入であった。1例は術前のCTにてカテーテルの逸脱が発覚していたが、2例はCVポートの抜去時に発覚した。また2例は無症候性であったが、1例は肺梗塞をきたしており、CTにて異常陰影を指摘されている。全例循環器科医師によりカテーテル、ワイヤーを使用した経皮的アプローチで2例は大腿静脈から、他の1例は内頸静脈から抜去できた。ピンチオフによるカテーテル離断は稀ではあるが重篤な合併症を引き起こしうるため、CVポート留置はピンチオフを回避する手技の選択が必要であり、留置後もピンチオフを念頭においた経過観察が必要である。(著者抄録)

血行再建を行った末梢側腎動脈瘤の1例

松本三明, 久保陽司, 鳴坂徹, 橋本将志

日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 74 ( 4 ) 896 - 899 2013年4月

記述言語：日本語出版者・発行元：日本臨床外科学会

症例は48歳，男性．左季肋部不快感を訴え来院した．CT検査にて，左腎動脈末梢側分岐部に2.8 cmの動脈瘤を認めたため，手術を行った．正中開腹でアプローチし左腎を可能な限り正中側へ脱転し，腎動脈腹側枝2本と，背側枝1本をそれぞれ大伏在静脈（SVG）2本で再建した．腎保護は氷片による表面冷却と腎保護液（4℃乳酸リンゲル液500mLにヘパリン2ml，メチルプレドニゾロン125mg混注）250mlを最初は動脈瘤から，瘤切開後は30分毎に100mLずつそれぞれ分枝から，そして再建後はSVGから注入し，腎静脈から排出した．腎冷阻血時間は230分であった．推算糸球体濾過量（eGFR）は一時的に低下したが，徐々に改善し6カ月後には術前と同じ値に回復した．末梢側に発生する腎動脈瘤は再建が複雑で困難なことが多く様々な方法が報告されており，術前の詳細な検討が重要である．

DOI： 10.3919/jjsa.74.896

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