Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Biliary reconstruction remains a technically demanding and complicated procedure in minimally invasive hepatopancreatobiliary surgeries. No optimal hepaticojejunostomy (HJ) technique has been demonstrated to be superior for preventing biliary complications. This study aimed to investigate the feasibility of our unique technique of posterior double-layer interrupted sutures in robotic HJ. METHODS: We performed a retrospective analysis of a prospectively collected database. Forty-two patients who underwent robotic pancreatoduodenectomy using this technique between September 2020 and November 2022 at our center were reviewed. In the posterior double-layer interrupted technique, sutures were placed to bite the bile duct, posterior seromuscular layer of the jejunum, and full thickness of the jejunum. RESULTS: The median operative time was 410 (interquartile range [IQR], 388-478) min, and the median HJ time was 30 (IQR, 28-39) min. The median bile duct diameter was 7 (IQR, 6-10) mm. Of the 42 patients, one patient (2.4%) had grade B bile leakage. During the median follow-up of 12.6 months, one patient (2.4%) with bile leakage developed anastomotic stenosis. Perioperative mortality was not observed. A surgical video showing the posterior double-layer interrupted sutures in the robotic HJ is included. CONCLUSIONS: Posterior double-layer interrupted sutures in robotic HJ provided a simple and feasible method for biliary reconstruction with a low risk of biliary complications.

DOI： 10.1007/s00423-023-03020-1

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIMS: Lymph node metastases (LNM) are associated with lethal prognosis in intrahepatic cholangiocarcinoma (ICC). Lymphadenectomy is crucial for accurate staging and hopes of possible oncological treatment. However, the therapeutic implications and optimal extent of lymphadenectomy remain contentious. METHODS: To clarify the prognostic value and optimal extent of lymphadenectomy, the therapeutic index (TI) for each lymph node was analyzed for 279 cases that had undergone lymphadenectomy in a multi-institutional database. Tumor localization was divided into hilar lesions (n = 130), right peripheral lesions (n = 60), and left peripheral lesions (n = 89). In addition, the lymph node station was classified as Level 1 (LV1: hepatoduodenal ligament node), Level 2 (LV2: postpancreatic or common hepatic artery nodes), or Level 3 (LV3: gastrocardiac, left gastric artery, or celiac artery nodes). RESULTS: Lymph node metastases were confirmed in 109 patients (39%). Five-y survival rates were 45.3% for N0 disease, 27.1% for LV1-LNM, 22.9% for LV2-LNM, and 7.3% for LV3-LNM (P < 0.001). LV3-LNM were the most frequent and earliest recurrence outcome, including multisite recurrence, followed by LV2, LV1, and N0 disease. The 5-year TI (5year-TI) for lymphadenectomy was 7.2 for LV1, 5.5 for LV2, and 1.9 for LV3. Regarding tumor location, hilar lesions showed 5-year TI >5.0 in LV1 and LV2, whereas bilateral peripheral lesions showed 5-year TI > 5.0 in LV1. CONCLUSION: The implications and extent of lymphadenectomy for ICC appear to rely on tumor location. In the peripheral type, the benefit of lymphadenectomy would be limited and dissection beyond LV1 should be avoided, while in the hilar type, lymphadenectomy up to LV2 could be recommended.

DOI： 10.1002/ags3.12642

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received an educational video and robotic simulation training or the control group that received only simulation training. The da Vinci® Skills Simulator was used for the basic course, including nine drills. The primary endpoint was the overall score of nine drills in cycles 1-10. Secondary endpoints included overall, efficiency, and penalty scores in each cycle, as well as the learning curves evaluated by the cumulative sum (CUSUM) analysis. Between September 2021 and May 2022, 20 participants were assigned to the video (n = 10) and control (n = 10) groups. The video group had significantly higher overall scores than the control group (90.8 vs. 72.4, P < 0.001). Significantly higher overall scores and lower penalty scores were confirmed, mainly in cycles 1-5. CUSUM analysis revealed a shorter learning curve in the video group. The present study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.

DOI： 10.1007/s11701-023-01556-4

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Studies remain limited on the role of the Pfannenstiel incision in minimally invasive hepato-pancreato-biliary (HPB) surgery, especially robotic surgery. The role of various extraction sites in robotic HPB surgery should be understood. Herein, we describe the surgical techniques, outcomes, advantages, and disadvantages of the Pfannenstiel incision in robotic pancreatic surgery. Seventy patients underwent robotic pancreatectomy at our institution between September 2020 and October 2022. The Pfannenstiel incision was used for specimen retrieval in 55 patients. Advantages of the Pfannenstiel incision include less pain, cosmetic benefits, and a lower incidence of complications. Moreover, the specimen could be removed using the robotic system docked. However, all complex reconstructions should be performed intra-abdominally during robotic pancreatoduodenectomies. The incidence of mortality and postoperative pancreatic fistula (grade B) was 0% and 9.1%, respectively. During the median follow-up (11.2 months) after surgery, complications at the Pfannenstiel incision site included surgical site infection (n = 1, 1.8%) and incisional hernia (n = 1, 1.8%). The Pfannenstiel incision can be a useful option for specimen retrieval in minimally invasive HPB surgery, according to the surgeon's preferences and the patient's condition.

DOI： 10.3390/jcm12051971

PubMed

researchmap

Language：Japanese   Publisher：(株)へるす出版  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

TECHNIQUE: Minimally invasive congenital biliary dilatation (CBD) surgery is technically demanding. However, few studies have reported surgical approaches of robotic surgery for CBD. This report presents robotic CBD surgery using a scope-switch technique. Our robotic surgery technique for CBD consisted of four steps: step 1, Kocher's maneuver; step 2, dissection of the hepatoduodenal ligament using the scope switch technique; step 3, preparation for the Roux-en-Y loop; and step 4, hepaticojejunostomy. RESULTS: The scope switch technique can provide different surgical approaches for dissecting the bile duct, including anterior approach by the standard position and right approach by the scope switch position. When approaching the ventral and left side of the bile duct, anterior approach with the standard position is suitable. In contrast, the lateral view by the scope switch position is preferable for approaching the bile duct laterally and dorsally. Using this technique, the dilated bile duct can be dissected circumferentially from four directions: anterior, medial, lateral, and posterior. Thereafter, complete resection of the choledochal cyst can be achieved. CONCLUSIONS: The scope switch technique in robotic surgery for CBD can be useful for dissecting around the bile duct with different surgical views, leading to the complete resection of the choledochal cyst.

DOI： 10.1016/j.asjsur.2023.02.021

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Adenosine-to-inosine RNA editing is a process mediated by adenosine deaminases that act on the RNA (ADAR) gene family. It has been discovered recently as an epigenetic modification dysregulated in human cancers. However, the clinical significance of RNA editing in patients with liver metastasis from colorectal cancer (CRC) remains unclear. The current study aimed to systematically and comprehensively investigate the significance of adenosine deaminase acting on RNA 1 (ADAR1) expression status in 83 liver metastatic tissue samples collected from 36 patients with CRC. The ADAR1 expression level was significantly elevated in liver metastatic tissue samples obtained from patients with right-sided, synchronous, or RAS mutant-type CRC. ADAR1-high liver metastasis was significantly correlated with remnant liver recurrence after hepatic metastasectomy. A high ADAR1 expression was a predictive factor of remnant liver recurrence (area under the curve = 0.72). Results showed that the ADAR1 expression level could be a clinically relevant predictive indicator of remnant liver recurrence. Patients with liver metastases who have a high ADAR1 expression requires adjuvant chemotherapy after hepatic metastasectomy.

DOI： 10.1038/s41598-023-29397-z

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Delayed gastric emptying (DGE) is a major complication of pancreatoduodenectomy (PD). Several efforts have been made to decrease the incidence of DGE. However, the optimal anastomotic method for gastro/duodenojejunostomy (GJ) remains debatable. Moreover, few studies have reported the impact of GJ surgical techniques on outcomes following robotic pancreatoduodenectomy (RPD). This study aimed to investigate the surgical outcomes of robot-sewn and stapled GJ anastomoses in RPD. METHODS: Forty patients who underwent RPD at the Okayama University Hospital between September 2020 and October 2022 were included. The outcomes between robot-sewn and stapled anastomoses were compared. RESULTS: The mean [standard deviation (SD)] operative and GJ time were 428 (63.5) and 34.0 (15.0) minutes, respectively. Postoperative outcomes included an overall incidence of DGE of 15.0%, and the mean postoperative hospital stays were 11.6 (5.3) days in length. The stapled group (n = 21) had significantly shorter GJ time than the robot-sewn group (n = 19) (22.7 min versus 46.5 min, p &lt; 0.001). Moreover, stapled GJ cases were significantly associated with a lower incidence of DGE (0% versus 21%, p = 0.01). Although not significant, the stapled group tended to have shorter postoperative hospital stays (9.9 days versus 13.5 days, p = 0.08). CONCLUSIONS: Our findings suggest that stapled GJ anastomosis might decrease anastomotic GJ time and incidence of DGE after RPD. Surgeons should select a suitable method for GJ anastomosis based on their experiences with RPD.

DOI： 10.3390/jcm12020732

PubMed

researchmap

Language：English  

The incidence and mortality rates of pancreatic ductal adenocarcinoma (PDAC) have increased in recent years worldwide [...].

DOI： 10.3390/jcm12020465

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Cancer-associated fibroblasts (CAFs) reportedly enhance the progression of gastrointestinal surgery; however, the role of CAFs in ampullary carcinomas remains poorly examined. This study aimed to investigate the effect of CAFs on the survival of patients with ampullary carcinoma. MATERIALS AND METHODS: A retrospective analysis of 67 patients who underwent pancreatoduodenectomy between January 2000 and December 2021 was performed. CAFs were defined as spindle-shaped cells that expressed α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP). The impact of CAFs on survival, including recurrence-free (RFS) and disease-specific survival (DSS), as well as prognostic factors associated with survival, was analyzed. RESULTS: The high-α-SMA group had significantly worse 5-year RFS (47.6% vs. 82.2%, p = 0.003) and 5-year DSS (67.5% vs. 93.3%, p = 0.01) than the low-α-SMA group. RFS (p = 0.04) and DSS (p = 0.02) in the high-FAP group were significantly worse than those in the low-FAP group. Multivariable analyses found that high α-SMA expression was an independent predictor of RFS [hazard ratio (HR): 3.68; 95% confidence intervals (CI): 1.21-12.4; p = 0.02] and DSS (HR: 8.54; 95% CI: 1.21-170; p = 0.03). CONCLUSIONS: CAFs, particularly α-SMA, can be useful predictors of survival in patients undergoing radical resection for ampullary carcinomas.

DOI： 10.3389/fonc.2023.1072106

PubMed

researchmap

Language：Japanese   Publisher：日本分子腫瘍マーカー研究会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

DOI： 10.3390/jcm11237112

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本小児血液・がん学会  

researchmap

Publishing type：Research paper (scientific journal)   Publisher：AME Publishing Company  

DOI： 10.21037/ls-22-39

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.

DOI： 10.1159/000527249

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Understanding different surgical approaches and anatomical landmarks adjacent to the splenic artery (SpA) is important for safe robotic distal pancreatectomy (RDP). Herein, we propose our standardized RDP techniques, focusing on these issues. PATIENTS AND METHODS: Between April 2021 and April 2022, 19 patients who underwent RDP at our Institution were reviewed. Anatomical patterns of the SpA were classified into three types: Type 1, no pancreatic parenchyma on the root of the SpA; type 2, any pancreatic parenchyma on the root of the SpA; and type 3, dorsal pancreatic artery around the bifurcation of the common hepatic artery and SpA. Next, the surgical strategy for approaching the SPA was determined according to the location of the pancreatic transection line: On the superior mesenteric vein (SMV) or on the left side of the root of the SpA. RESULTS: There were seven cases of type 1, nine cases of type 2, and three cases of type 3. When transecting the pancreas on the SMV, the SpA-first ligation technique was used for type 1 SpA anatomy, and the pancreas-first division technique was applied for types 2 and 3. In patients in whom the pancreas was transected at the left side of the root of the SpA, the SpA-first ligation technique was used. CONCLUSION: Our standardized surgical strategy based on anatomical landmarks and focusing on the approach to the SpA in RDP is demonstrated. Our strategy should help trainees approach the SpA and perform RDP safely.

DOI： 10.21873/anticanres.15947

PubMed

researchmap

Language：Japanese   Publisher：日本分子腫瘍マーカー研究会  

researchmap

Language：Japanese   Publisher：日本分子腫瘍マーカー研究会  

researchmap

Language：Japanese   Publisher：(一社)日本小児外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control. CASE PRESENTATION: A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively. CONCLUSION: When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection.

DOI： 10.1186/s13256-022-03440-5

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Adenomatoid mesothelioma is a rare subtype of malignant mesothelioma that can be confused with adenomatoid tumors, which are classified as benign. The clinical features and optimal management of adenomatoid mesothelioma have not been elucidated in the literature. In this report, we present an extremely rare case of adenomatoid mesothelioma that developed on the peritoneal surface of the diaphragm as well as a literature review of adenomatoid mesothelioma in the abdominal cavity. CASE PRESENTATION: The patient was a 61-year-old Japanese woman who had undergone resection of a malignant peripheral nerve sheath tumor of the hand 18 years prior. She was diagnosed with clinical stage I lung adenocarcinoma on follow-up chest radiography. Simultaneously, a 20-mm enhancing nodule with slow growth on the right diaphragm was detected on contrast-enhanced computed tomography. She presented no specific clinical symptoms. At this point, the lesion was suspected to be a hypervascular tumor of borderline malignancy, such as a solitary fibrous tumor. After a left upper lobectomy for lung adenocarcinoma, she was referred to our department, and laparoscopic tumor resection was performed. Adenomatoid tumors were also considered based on the histopathological and immunohistochemical analyses, but we made the final diagnosis of adenomatoid mesothelioma using the results of the genetic profile. The patient remains alive, with no recurrence noted 6 months after surgery. CONCLUSION: We encountered a valuable case of adenomatoid mesothelioma of peritoneal origin. There are some previously reported cases of adenomatoid mesothelioma and adenomatoid tumors that may need to be recategorized according to the current classification. It is important to accumulate and share new findings to clarify the clinicopathological characteristics and genetic status of adenomatoid mesothelioma.

DOI： 10.1186/s13256-022-03420-9

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Despite advances in perioperative management, recurrence after curative pancreatectomy is a critical issue in the treatment of pancreatic ductal adenocarcinoma (PDAC). The significance of local therapy for recurrent PDAC remains unclear. METHODS: We reviewed the medical records of patients with PDAC who underwent curative resection at our institution between January 2009 and December 2019. We examined the patterns of relapse and assessed the clinical outcomes of patients with recurrence who underwent local therapy, including surgical resection, radiotherapy, and radiofrequency ablation. RESULTS: A total of 246 patients with PDAC who underwent R0 or R1 resection were included in this study. The 3-year overall survival (OS) rate was 39.8%, and the 1-year recurrence-free survival rate was 51.2% for the entire population. Recurrence was observed in 172/246 (69.9%) patients, including multiple site recurrences in 50, liver metastasis in 41, locoregional recurrence in 34, and peritoneal dissemination in 27. Of the 172 patients, treatment was administered in 137 (79.7%), and 16 received local therapy, including surgical resection (n = 13), radiotherapy (n = 5), and RFA (n = 1). PS-matched analysis revealed that patients with recurrence who were treated with chemotherapy combined with local therapy showed better post-recurrence survival rates than those treated with chemotherapy alone (P = 0.016). Detailed clinical courses of these patients are presented in the main manuscript. CONCLUSIONS: Our results suggest that a multimodal approach may improve the clinical outcomes of patients with recurrent PDAC.

DOI： 10.1016/j.pan.2022.05.004

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Emerging evidence indicates that immunogenicity plays an important role in intrahepatic cholangiocarcinoma (ICC). Herein, we systematically evaluated the clinical relevance of immunogenicity in ICC. METHODS: Highly immunogenic ICCs identified in the public dataset and the Cancer Immunome Atlas (TCIA) were assessed to determine the prognostic impact of immunogenicity in ICC and key components after curative resection. We also investigated the clinical relevance of the immune milieu in ICC. RESULTS: Using the Gene Expression Omnibus dataset 89749 and TCIA, we identified CD8+/forkhead box P3 (FoxP3)+ tumour-infiltrating lymphocytes (TILs), T-cell immunoglobulin and mucin domain 3 (TIM-3) and human leukocyte antigen-A (HLA-A) in highly immunogenic ICCs. Immunohistochemical analysis of the in-house cohort showed that intratumoral FoxP3+ TILs correlated with CD8+ TILs (P = 0.045, Fisher's exact test) and that high FoxP3+/CD8+ ratio (FCR) was an important marker for poor survival (P < 0.001, log-rank test). Furthermore, the FCR was higher in tumour-free lymph nodes in ICCs with lymph node metastases than in those without lymph node metastases (P = 0.003, Mann-Whitney U test). CONCLUSIONS: FCR should be considered an important biomarker that represents the immune environment of ICC based on its potentially important role in tumour progression, especially lymph node metastasis.

DOI： 10.1038/s41416-022-01838-y

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Little is known regarding the impact of lymph node dissection on survival benefit after curative resection for pancreatic neuroendocrine tumor (PNET). This study aimed to evaluate the efficacy of lymph node dissection based on tumor location of PNET. PATIENTS AND METHODS: A retrospective study, including 50 patients with surgical resection for PNET between 2004 and 2020, was performed. The efficacy index (EI) was calculated by multiplication of the incidence of lymph node metastasis (LNM) at the station and the 5-year survival rate of patients with LNM at the station. RESULTS: In the pancreatic head tumors, the peri-pancreatic head and superior mesenteric artery lymph node stations had high EI of 13.3 and 25, respectively. In contrast, other stations, including stations 8 and 12, had zero EI. In the pancreatic body and tail tumors, only the splenic artery lymph node station had a survival benefit from lymph node dissection with an EI of 6.7. CONCLUSION: The extent of lymph node dissection for PNET should be decided based on the efficacy of lymph node dissection in accordance with tumor location. Our findings may be helpful in determining the extent of lymph node dissection required.

DOI： 10.21873/anticanres.15760

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Mixed neuroendocrine-non-neuroendocrine neoplasm (MINEN) is a rare disease and there is scarce literature on its diagnosis, treatment, and prognosis. We encountered two unusual cases of MINEN in the biliary tract, one in the ampulla of Vater and the other in the distal bile duct. In this report, we describe the clinical course of these two cases in detail. CASE PRESENTATION: Case 1: A 69-year-old woman presented with a chief complaint of epigastric pain. When endoscopic sphincterotomy and retrograde biliary drainage were performed for gallstone pancreatitis, an ulcerated lesion was found in the ampulla of the Vater. Based on the biopsy results, the lesion was diagnosed as the ampulla of Vater carcinoma and subtotal stomach-preserving pancreatoduodenectomy (SSPPD) was performed. Postoperative histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, consistent with the diagnosis of MINEN. In addition, lymph node metastasis was found on the dorsal side of the pancreas and the metastatic component was adenocarcinoma. Adjuvant chemotherapy with etoposide and cisplatin was administered for 6 months, and presently the patient is alive without recurrence 64 months after surgery. Case 2: A 79-year-old man presented with a chief complaint of anorexia. Cholangiography showed severe stenosis of the distal bile duct. A biopsy was conducted from the stenotic lesion and it revealed the lesion to be adenocarcinoma. A diagnosis of distal bile duct carcinoma was made, and SSPPD was performed. Histopathological examination revealed the coexistence of adenocarcinoma and neuroendocrine carcinoma components, and the tumor was confirmed as MINEN of the distal bile duct. No adjuvant chemotherapy was administered due to the poor performance status. 7 months later, the patient was found to have a liver metastasis. CONCLUSION: We experienced two valuable cases of biliary MINEN. To identify better treatments, it is important to consider the diversity of individual cases and to continue sharing a variety of cases with different presentations.

DOI： 10.1186/s40792-022-01386-w

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本小児外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The optimal extent of lymph node dissection for ampullary carcinoma is controversial. The aim of this study was to investigate the efficacy of lymph node dissection for ampullary carcinoma. PATIENTS AND METHODS: Between 2000 and 2020, a total of 75 patients undergoing radical resection for ampullary carcinoma were included. The efficacy index (EI) was calculated by multiplication of the frequency of lymph node metastasis (LNM) at the station and the 5-year survival rate of patients with metastasis at the station. RESULTS: Out of 75 patients, 14 had LNM. The EI for the peri-pancreatic head (station 13 and 17) and superior mesenteric artery (station 14) lymph node were 4.4 and 3.5, respectively. Whereas the peri-gastric (station 5 and 6), common hepatic artery (station 8), and liver hilum (station 12) lymph node stations had zero EI. Although the number of patients with the station 16 dissected was small (9%), the para-aortic (station 16) lymph nodes had the highest EI of 14.3 despite being distant lymph nodes. CONCLUSION: We identified the distribution of LNM and survival benefit of lymph node dissection for ampullary carcinoma. Our results suggest that the optimal extent of lymph node dissection for ampullary carcinoma could be reconsidered.

DOI： 10.21873/invivo.12789

PubMed

researchmap

Language：Japanese   Publisher：(株)へるす出版  

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract
</title><sec>
<title>Background</title>
To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH).


</sec><sec>
<title>Study design</title>
Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx).


</sec><sec>
<title>Results</title>
Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (<italic>P</italic>=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, <italic>P</italic>=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (<italic>P</italic>=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (<italic>P</italic>=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (<italic>P</italic>=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (<italic>P</italic>=0.060) than the Major Hx group.


</sec><sec>
<title>Conclusions</title>
VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes.


</sec>

DOI： 10.1007/s00423-021-02373-9

researchmap

Other Link： https://link.springer.com/article/10.1007/s00423-021-02373-9/fulltext.html

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J05229&link_issn=&doc_id=20220308270016&doc_link_id=10.34410%2Fjspbm.44.0_42&url=https%3A%2F%2Fdoi.org%2F10.34410%2Fjspbm.44.0_42&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J05229&link_issn=&doc_id=20220308270011&doc_link_id=10.34410%2Fjspbm.44.0_36&url=https%3A%2F%2Fdoi.org%2F10.34410%2Fjspbm.44.0_36&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

The outcomes of pancreatectomy with resection and reconstruction of the involved arteries for locally advanced pancreatic cancer following chemotherapy have improved in recent years. In pancreatic head cancers in which there is contact with the common and proper hepatic arteries, margin-negative resection requires pancreati-coduodenectomy, with the resection of these arteries and the restoration of hepatic arterial flow. Here, we describe a middle colic artery transposition technique in hepatic arterial reconstruction during pancreatoduo-denectomy for an initially unresectable locally advanced pancreatic cancer. This technique was effective and may provide a new option for hepatic artery reconstruction in such cases.

DOI： 10.18926/AMO/62410

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The prognosis of intrahepatic cholangiocarcinoma (ICC) has been poor, because of the high recurrence rate even after curative surgery. This study aimed to evaluate the prognostic impact of surgical resection of recurrent ICC. PATIENTS AND METHODS: A total of 345 cases of ICC who underwent hepatectomy with curative intent in 17 institutions were retrospectively analyzed, focusing on recurrence patterns and treatment modalities for recurrent ICC. RESULTS: Median survival time and overall 5-year recurrence-free survival rate were 17.8 months and 28.5%, respectively. Recurrences (n = 223) were classified as early (recurrence at ≤1 year, n = 131) or late (recurrence at >1 year, n = 92). Median survival time was poorer for early recurrence (16.3 months) than for late recurrence (47.7 months, p<0.0001). Treatment modalities for recurrence comprised surgical resection (n = 28), non-surgical treatment (n = 134), and best supportive care (BSC) (n = 61). Median and overall 1-/5-year survival rates after recurrence were 39.5 months and 84.6%/36.3% for surgical resection, 14.3 months and 62.5%/2.9% for non-surgical treatment, and 3 months and 4.8%/0% for BSC, respectively (p<0.0001). Multivariate analysis identified early recurrence, simultaneous intra- and extrahepatic recurrence, and surgical resection of recurrence as significant prognostic factors. In subgroup analyses, surgical resection may have positive prognostic impacts on intra- and extrahepatic recurrences, and even on early recurrence. However, simultaneous intra- and extrahepatic recurrence may not see any survival benefit from surgical management. CONCLUSION: Surgical resection of recurrent ICC could improve survival after recurrence, especially for patients with intra- or extrahepatic recurrence as resectable oligo-metastases.

DOI： 10.1371/journal.pone.0238392

PubMed

researchmap

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Because of the different forms of circulating miRNAs in plasma, Argonaute2 (Ago2)-miRNAs and extracellular vesicles (EV-miRNAs), we examined the two forms of extracellular miRNAs in vitro and developed a unique methodology to detect circulating Ago2-miRNAs in small volumes of plasma. We demonstrated that Ago2-miR-21 could be released into the extracellular fluid by active export from viable cancer cells and cytolysis in vitro. As miR-21 and miR-200c were abundantly expressed in both metastatic liver sites and primary lesions, we evaluated Ago2-miR-21 as a candidate biomarker of both active export and cytolysis while Ago2-miR-200c as a biomarker of cytolysis in plasma obtained from colorectal cancer (CRC) patients before treatment and in a series of plasma obtained from CRC patients with liver metastasis who received systemic chemotherapy. The measurement of Ago2-miR-21 allowed us to distinguish CRC patients from subjects without CRC. The trend in ΔCt values for Ago2-miR-21 and -200c during chemotherapy could predict tumor response to ongoing treatment. Thus, capturing circulating Ago2-miRNAs from active export can screen patients with tumor burdens, while capturing them from passive release by cytolysis can monitor tumor dynamics during chemotherapy treatment.

DOI： 10.1002/ijc.31960

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. METHODS: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. RESULTS: During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. CONCLUSION: Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.

DOI： 10.1159/000486548

PubMed

researchmap

Authorship：Lead author   Language：Japanese  

J-GLOBAL

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03156&link_issn=&doc_id=20181205100018&doc_link_id=10.3919%2Fjjsa.79.2296&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.79.2296&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：OKAYAMA UNIV MED SCHOOL  

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an extremely rare cause of hyponatremia post-liver transplantation. A 15-year-old Japanese girl with recurrent cholangitis after Kasai surgery for biliary atresia underwent successful living donor liver transplantation. Peritonitis due to gastrointestinal perforation occurred. Hyponatremia gradually developed but improved after hypertonic sodium treatment. One month later, severe hyponatremia rapidly recurred. We considered the hyponatremia's cause as SIADH. We suspected that tacrolimus was the disease's cause, so we used cyclosporine instead, plus hypertonic sodium plus water intake restriction, which improved the hyponatremia. Symptomatic hyponatremia manifested by SIADH is a rare, serious complication post-liver transplantation.

DOI： 10.18926/AMO/54830

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Although limited understanding exists for the presence of specific genetic mutations and aberrantly methylated genes in pancreatobiliary intraductal papillary mucinous neoplasms (IPMNs), the fundamental understanding of the dynamics of methylation expansion across CpG dinucleotides in specific gene promoters during carcinogenesis remains unexplored. Expansion of DNA methylation in some gene promoter regions, such as EFEMP1, one of the fibulin family, with tumor progression has been reported in several malignancies. We hypothesized that DNA hypermethylation in EFEMP1 promoter would expand with the tumor grade of IPMN.
A sample of 65 IPMNs and 30 normal pancreatic tissues was analyzed. IPMNs were divided into the following three subsets according to pathological findings: 31 with low-grade dysplasia (low grade), 11 with high-grade dysplasia (high grade), and 23 with associated invasive carcinoma (invasive Ca). Mutations in the KRAS or GNAS genes were analyzed by Sanger sequencing, and methylation status of two discrete regions within the EFEMP1 promoter, namely region 1 and region 2, was analyzed by bisulfite sequencing and fluorescent high-sensitive assay for bisulfite DNA (Hi-SA). Expression status of EFEMP1 was investigated by immunohistochemistry (IHC).
KRAS mutations were detected in 39, 55, and 70 % of low-grade, high-grade, and invasive Ca, respectively. GNAS mutations were observed in 32, 55, and 22 % of low-grade, high-grade, and invasive Ca, respectively. The methylation of individual regions (region 1 or 2) in the EFEMP1 promoter was observed in 84, 91, and 87 % of low-grade, high-grade, and invasive Ca, respectively. However, simultaneous methylation of both regions (extensive methylation) was exclusively detected in 35 % of invasive Ca (p = 0.001) and five of eight IPMNs (63 %) with extensive methylation, whereas 20 of 57 (35.1 %) tumors of unmethylation or partial methylation of the EFEMP1 promoter region showed weak staining EFEMP1 in extracellular matrix (p = 0.422). In addition, extensive EFEMP1 methylation was particularly present in malignant tumors without GNAS mutations and associated with disease-free survival of patients with IPMNs (p &lt; 0.0001).
Extensive methylation of the EFEMP1 gene promoter can discriminate invasive from benign IPMNs with superior accuracy owing to their stepwise accumulation of tumor progression.

DOI： 10.1007/s00432-016-2164-x

Web of Science

PubMed

researchmap

Language：English   Publisher：Okayama University Medical School  

DOI： 10.18926/AMO/54419

CiNii Article

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2017055395

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Verlag  

Background: The gene expressions of netrin-1 dependence receptors, DCC and UNC5C, are frequently downregulated in many cancers. We hypothesized that downregulation of DCC and UNC5C has an important growth regulatory function in gastric tumorigenesis. Results: In the present study, a series of genetic and epigenetic analyses for DCC and UNC5C were performed in a Japanese cohort of 98 sporadic gastric cancers and corresponding normal gastric mucosa specimens. Loss of heterozygosity (LOH) analyses and microsatellite instability (MSI) analysis was applied to determine chromosomal instability (CIN) and MSI phenotypes, respectively. More than 5 % methylation in the DCC and UNC5C promoters were found in 45 % (44/98) and 32 % (31/98) gastric cancers, respectively, and in 9 % (9/105) and 5 % (5/105) normal gastric mucosa, respectively. Overall, 70 % (58 of 83 informative cases) and 51 % (40 of 79 informative cases) of gastric cancers harbored either LOH or aberrant methylation in the DCC and UNC5C genes, respectively. In total, 77 % (51 of 66 informative cases) of gastric cancers showed cumulative defects in these two dependence receptors and were significantly associated with chromosomal instability. Both DCC and UNC5C were inactivated in 97 % of CIN-positive gastric cancers and in 55 % of CIN-negative gastric cancers. Conclusions: Defect in netrin receptors is a common feature in gastric cancers. DCC alterations are apparent in the early stages, and UNC5C alterations escalate with the progression of the disease, suggesting that the cumulative alterations of netrin-1 receptors was a late event in gastric cancer progression and emphasizing the importance of this growth regulatory pathway in gastric carcinogenesis.

DOI： 10.1186/s13148-015-0096-y

Scopus

PubMed

researchmap

Authorship：Lead author   Language：Japanese   Publisher：日本臨床外科学会  

症例は74歳,男性.68歳より原発性胆汁性肝硬変(primary biliary cirrhosis,以下PBC)の診断で経過観察中であった.定期フォローの腹部造影CTでsegment 7に右肝静脈に接する34mm大の腫瘤を認めた.精査にて肝細胞癌と診断,右肝静脈を含む拡大後区域切除術を施行した.術中PBCの硬変肝に対する肝切離は他の肝硬変症への肝切離と大きく異なる印象は無く,また術後も特異な合併症なく軽快した.切除標本の病理組織検査所見では中分化型を主体とする肝細胞癌を認め,非腫瘍部ではScheuer分類IV期のPBC像を呈していた.PBCに対する肝切除の報告では,PBCに特有の周術期合併症は認められず,PBCに発生した肝細胞癌に対する肝切除術を施行する際には,他の原因の肝硬変の際と同様に,癌の進行度診断と肝予備能評価に基づいて切除術式を決定することが重要と考えられた.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03156&link_issn=&doc_id=20150806090042&doc_link_id=10.3919%2Fjjsa.76.1766&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.76.1766&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background
To improve the outcome of patients suffering from gastric cancer, a better understanding of underlying genetic and epigenetic events in this malignancy is required. Although CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) have been shown to play pivotal roles in gastric cancer pathogenesis, the clinical significance of these events on survival outcomes in patients with gastric cancer remains unknown.
Methods
This study included a patient cohort with pathologically confirmed gastric cancer who had surgical resections. A cohort of 68 gastric cancers was analyzed. CIMP and MSI statuses were determined by analyzing promoter CpG island methylation status of 28 genes/loci, and genomic instability at 10 microsatellite markers, respectively. A Cox's proportional hazards model was performed for multivariate analysis including age, stage, tumor differentiation, KRAS mutation status, and combined CIMP/MLH1methylation status in relation to overall survival (OS).
Results
By multivariate analysis, longer OS was significantly correlated with lower pathologic stage (P = 0.0088), better tumor differentiation (P = 0.0267) and CIMP-high and MLH1 3' methylated status (P = 0.0312). Stratification of CIMP status with regards to MLH1 methylation status further enabled prediction of gastric cancer prognosis.
Conclusions
CIMP and/or MLH1 methylation status may have a potential to be prognostic biomarkers for patients with gastric cancer.

DOI： 10.1371/journal.pone.0130409

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：岡山医学会  

61歳女。右季肋部痛を主訴とし、精査を行い胆嚢十二指腸瘻を伴う胆嚢胆管結石症と診断した。既往歴に発作性夜間血色素尿症(PNH)があることから、手術に際し感染の制御、溶血や血栓症の予防などの対策を計画した。術前に内視鏡的経鼻胆道ドレナージ(ENBD)を留置し、PNHによる溶血発作に備えて術前術後ステロイドカバーを行った。これらの周術期管理を行うことで、PNHに関連する重篤な合併症の発症は軽減され、開腹下の胆嚢摘出術、瘻孔閉鎖術を安全に施行することできた。術後はヘパリンによる抗凝固療法を行い、経過良好で第5病日にENBDを抜去し、合併症なく術後12日目に軽快退院した。

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00175&link_issn=&doc_id=20150423220005&doc_link_id=10.4044%2Fjoma.127.35&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.127.35&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Background Trainee surgeons must have a good understanding of surgical anatomy. Especially in the hepatobiliary-pancreatic field, beginning surgeons often find it difficult to recognize the three-dimensional structure of the target organ and its complex anatomical correlation with surrounding organs. Conventional anatomy textbooks are not written with the aim of teaching these three-dimensional structures and complex correlations. We developed a novel teaching atlas of surgical anatomy using a multi-viewpoint and multi-layer three-dimensional camera system.
Methods Layer-by-layer dissection of the upper abdominal organs of a cadaver was performed by expert surgeons. A stereoscopic camera system was used to capture a series of anatomical views. The images were remodeled in a multi-viewpoint and multi-layer manner.
Results Images of each dissection layer could be viewed serially from the appropriate angle, which was tilted up to 90 along the anteroposterior axis. The clinical anatomy specific to the surgical procedure could thus be learned using this atlas system.
Conclusions Rotatable three-dimensional panoramic views of local dissection of the upper abdominal organs of a cadaver were developed for educational purposes. Trainee surgeons could use these anatomical images instead of conventional anatomical atlases to learn how to perform surgical procedures such as pancreaticoduodenectomy and major hepatectomy.

DOI： 10.1002/jhbp.108

Web of Science

PubMed

researchmap

Language：Japanese   Publisher：(株)南江堂  

血液透析患者に発症した出血性胆嚢炎を2例経験した。症例1は67歳女で、食後突然発症した上腹部痛を主訴に救急外来を受診した。慢性腎不全に伴う腎機能異常に加え、CRPの異常高値を認めた。胆嚢出血を疑わせる画像所見から急性出血性胆嚢炎と診断し、開腹下に胆嚢摘出術を施行した。術後経過は良好で、術後13日目に軽快し退院した。症例2は40歳女で、全身性エリテマトーデスで通院治療中であった。突然発症した右季肋部痛を主訴に救急搬送された。慢性腎不全による腎機能異常に加え、CRPとALTの軽度上昇を認めた。胆嚢出血を疑わせる所見により、出血性胆嚢炎と診断し、開腹下で胆嚢摘出術を施行した。術後経過は良好で、術後8日目に軽快退院した。

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00393&link_issn=&doc_id=20140226030022&doc_link_id=issn%3D0016-593X%26volume%3D76%26issue%3D3%26spage%3D336&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D76%26issue%3D3%26spage%3D336&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Establishment of a preferential liver allocation rule for simultaneous liver and kidney transplantation (SLK) and revisions of laws regarding organ transplants from deceased donors have paved the way for SLK in Japan. Very few cases of SLK have been attempted in Japan, and no such recipients have survived for longer than 40 days. The present report describes a case of a 50-year-old woman who had undergone living donor liver transplantation at the age of 38 years for management of post-partum liver failure. After the first transplant surgery, she developed hepatic vein stenosis and severe hypersplenism requiring splenectomy. She was then initiated on hemodialysis (HD) due to the deterioration of renal function after insertion of a hepatic vein stent. She was listed as a candidate for SLK in 2011 because she required frequent plasma exchange for hepatic coma. When her Model for End-stage Liver Disease score reached 46, the new liver was donated 46 days after registration. The reduced trisegment liver and the kidney grafts were simultaneously transplanted under veno-venous bypass and intraoperative HD. The hepatic artery was reconstructed prior to portal reconstruction in order to shorten anhepatic time. Although she developed subcapsular bleeding caused by hepatic contusion on the next day, subsequent hemostasis was obtained by transcatheter embolization. Thereafter, her recovery was uneventful, except for mild rejection and renal tubular acidosis of the kidney graft. This case highlights the need to establish Japanese criteria for SLK.

DOI： 10.1111/hepr.12122

Web of Science

PubMed

researchmap

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Acute renal injury (ARI) is a serious complication after liver transplantation. This study investigated the usefulness of the RIFLE criteria in living donor liver transplantation (LDLT) and the prognostic impact of ARI after LDLT. We analyzed 200 consecutive adult LDLT patients, categorized as risk (R), injury (I), or failure (F), according to the RIFLE criteria. ARI occurred in 60.5% of patients: R-class, 23.5%
I-class, 21%
and F-class, 16%. Four patients in Group-A (normal renal function and R-class) and 26 patients in Group-B (severe ARI: I- and F-class) required renal replacement therapy (P &lt
0.001). Mild ARI did not affect postoperative prognosis regarding hospital mortality rate in Group A (3.2%), which was superior to that in Group B (15.8%
P = 0.0015). Fourteen patients in Group B developed chronic kidney disease (KDIGO stage 3/4). The 1-, 5- and 10-year survival rates were 96.7%, 90.6%, and 88.1% for Group A and 71.1%, 65.9%, and 59.3% for Group B, respectively (P &lt
0.0001). Multivariate analysis revealed risk factors for severe ARI as MELD ≥20 [odds ratio (OR) 2.9], small-for-size graft (GW/RBW &lt
0.7%
OR 3.1), blood loss/body weight &gt
55 ml/kg (OR 3.7), overexposure to calcineurin inhibitor (OR 2.5), and preoperative diabetes mellitus (OR 3.2). The RIFLE criteria offer a useful predictive tool after LDLT. Severe ARI, defined beyond class-I, could have negative prognostic impact in the acute and late postoperative phases. Perioperative treatment strategies should be designed and balanced based on the risk factors for the further improvement of transplant prognosis. © 2013 Steunstichting ESOT. Published by John Wiley &amp
Sons Ltd.

DOI： 10.1111/tri.12138

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Authorship：Lead author   Language：Japanese   Publisher：(株)医学書院  

再発乳癌の経過中に生じた癌性心膜液貯留に対し,シスプラチン(CDDP)の心膜腔投与を行い良好にコントロールし得た3症例を経験した.症例は42歳,58歳,59歳の再発乳癌患者で,外来通院中に心不全症状を認め心膜液貯留を指摘された.癌性心膜液貯留による心タンポナーデの診断で,全例エコーガイド下に心膜腔ドレナージを施行したところ,症状は速やかに改善した.再貯留防止目的にCDDPの心膜腔投与を行い,その後の経過において全例で心膜液の再貯留を認めなかった.3例とも他病巣への転移により心膜腔投与後4〜18ヵ月目に死亡した.乳癌の癌性心膜液再貯留予防に対して,CDDP心膜腔投与が安全かつ有効である可能性が示唆された.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01539&link_issn=&doc_id=20101001210030&doc_link_id=10.11477%2Fmf.1407103233&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407103233&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Authorship：Lead author   Language：Japanese   Publisher：広島市立広島市民病院  

膵漿液性嚢胞腫瘍(serous cyst neoplasm of pancreas以下SCN)は比較的まれな良性の膵嚢胞性疾患であり、近年その報告数が増加している。2002年7月から2009年1月までに当科で経験した膵漿液性嚢胞腫瘍は6例で、平均年齢68.1歳、男性1例、女性5例であった。腫瘍の局在は膵頭部2例、膵体部3例、膵尾部1例で、平均腫瘍径は72mm、全例microcystic typeであった。手術を行った理由については術前にSCNと診断された2例では径10cmを超える大きな腫瘍であったためであり、他の4例は悪性疾患を疑ったため手術が行われた。術式は亜全胃温存膵頭十二指腸切除術2例、尾側膵切除術3例、膵中央切除術1例であった。全例病理学的に悪性所見はなく無再発生存中である。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本移植学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publisher：(一社)日本癌学会  

researchmap

Language：Japanese   Publisher：(一社)日本移植学会  

researchmap

Language：Japanese   Publisher：(一社)日本移植学会  

researchmap

Language：Japanese   Publisher：日本胆道学会  

researchmap

Language：English   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：日本外科代謝栄養学会  

researchmap

Language：English   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：岡山医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本遺伝性腫瘍学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：岡山医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：English   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本移植学会  

researchmap

Language：Japanese   Publisher：(公社)日本小児科学会  

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：西日本泌尿器科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

researchmap

Language：Japanese   Publisher：(NPO)日本小児外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本小児外科学会  

researchmap

Language：Japanese   Publisher：岡山医学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本消化器外科学会  

CiNii Article

CiNii Books

researchmap

Language：Japanese   Publisher：特定非営利活動法人 日本呼吸器内視鏡学会  

DOI： 10.18907/jjsre.32.2_206_3

CiNii Article

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Event date： 2016.12

Language：Japanese  

researchmap

Event date： 2016.7

Language：Japanese  

researchmap

Event date： 2016.4

Language：Japanese  

researchmap

Event date： 2015.10

Language：English  

researchmap

Event date： 2015.4

Language：Japanese  

researchmap

Event date： 2014.7

Language：Japanese  

researchmap

Event date： 2013.7

Language：Japanese  

researchmap

Event date： 2013.6

Language：Japanese  

researchmap

Event date： 2013.3

Language：Japanese  

researchmap

Event date： 2012.10

Language：Japanese  

researchmap

Event date： 2012.9

Language：Japanese  

researchmap

Event date： 2010.5

Language：Japanese  

researchmap

Event date： 2009.10

Language：Japanese  

researchmap

Event date： 2009.6

Language：Japanese  

researchmap

Event date： 2009.6

Language：Japanese  

researchmap

Event date： 2008.8

Language：Japanese  

researchmap

Event date： 2007.7

Language：Japanese  

researchmap