Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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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 2023.4

【mRNAワクチンやゲノム編集で注目が集まる遺伝子治療】遺伝子治療技術を用いた疾患治療消化器がんに対する腫瘍融解ウイルス療法

藤原俊義, 黒田新士, 田澤大

医学のあゆみ 285 ( 5 ) 446 - 452 2023.4

Language：Japanese Publisher：医歯薬出版(株)

がんは1981年以来,わが国の死亡原因の第1位であり,なかでも消化器がんは半数以上を占めており,消化器がん治療の進歩は国民衛生の向上に非常に重要である.遺伝子工学技術が進歩した今,遺伝子改変ウイルスをがん細胞のみを殺傷する治療用医薬品として用いることが可能となってきた.ウイルスはその生活環として本来,ヒトの細胞に感染・増殖し,その細胞をさまざまな機序により破壊する.この細胞傷害性をがん細胞に標的化することで安全性を担保できれば,臨床的にがん治療用ウイルスとしての使用が期待できる.また最近では,ウイルス製剤が宿主の免疫を活性化するという分子機構が明らかとなってきており,複合免疫療法としての開発も進んでいる.本稿では,筆者らが開発しているアデノウイルス製剤を中心に,消化器がんに対するがん治療用ウイルスの可能性を概説する.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00060&link_issn=&doc_id=20230502010024&doc_link_id=issn%3D0039-2359%26volume%3D285%26issue%3D5%26spage%3D446&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D285%26issue%3D5%26spage%3D446&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

厳しい局所進行食道癌に対するロボット支援下手術の経験

白川靖博, 桂佑貴, 清水彰人, 實金悠, 森内俊行, 吉本匡志, 澤田紘幸, 石田道拡, 佐藤太祐, 丁田泰宏, 吉満政義, 中野敢友, 松川啓義, 井谷史嗣, 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 123回 DP - 2 2023.4

外科医療におけるサルコペニア・フレイル対策の最前線胃切除術後の認知行動療法を応用したサルコペニア予防策の効果

菊地覚次, 高田暢夫, 半澤俊哉, 賀島肇, 松三雄騎, 垣内慶彦, 黒田新士, 前田直見, 田辺俊介, 野間和広, 楳田祐三, 藤原俊義

日本外科学会定期学術集会抄録集 123回 SY - 1 2023.4

ロボット支援下肝胆膵高難度手術の導入と教育システムの確立

高木弘誠, 吉田龍一, 藤智和, 安井和也, 八木孝仁, 藤原俊義

日本外科学会定期学術集会抄録集 123回 SF - 3 2023.4

Laparoscopic and Endoscopic Cooperative Surgery for Gastric Submucosal Tumor Near Esophagogastric Junction With Sliding Hiatal Hernia. Reviewed International journal

Hajime Kashima, Satoru Kikuchi, Shinji Kuroda, Toshiyoshi Fujiwara

Cureus 15 ( 4 ) e37902 2023.4

Language：English

The usefulness of laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumors in the cardiac region has been reported in recent years. However, LECS for submucosal tumors at the esophagogastric junction with hiatal sliding esophageal hernia has not been reported, and its validity as a treatment method is unknown. The patient was a 51-year-old man with a growing submucosal tumor in the cardiac region. Surgical resection was indicated because a definitive diagnosis of the tumor was not determined. The lesion was a luminal protrusion tumor, located on the posterior wall of the stomach 20 mm from the esophagogastric junction, and had a maximum diameter of 16.3 mm on endoscopic ultrasound examination. Because of the hiatal hernia, the lesion could not be detected from the gastric side by endoscopy. Local resection was considered to be feasible because the resection line did not extend into the esophageal mucosa and the resection site could be less than half the circumference of the lumen. The submucosal tumor was resected completely and safely by LECS. The tumor was diagnosed as a gastric smooth muscle tumor finally. Nine months after surgery, a follow-up endoscopy showed reflux esophagitis. LECS was a useful technique for submucosal tumors of the cardiac region with hiatal hernia, but fundoplication might be considered for preventing backflow of gastric acid.

DOI： 10.7759/cureus.37902

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Impact of educational video on performance in robotic simulation training (TAKUMI-1): a randomized controlled trial. Reviewed International journal

Kosei Takagi, Nanako Hata, Jiro Kimura, Satoru Kikuchi, Kazuhiro Noma, Kazuya Yasui, Tomokazu Fuji, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara

Journal of robotic surgery 17 ( 4 ) 1547 - 1553 2023.3

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

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Role of the Pfannenstiel Incision in Robotic Hepato-Pancreato-Biliary Surgery. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Takahito Yagi, Toshiyoshi Fujiwara

Journal of clinical medicine 12 ( 5 ) 2023.3

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

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【転移性肝癌を極める】大腸癌肝転移に対する肝切除

楳田祐三, 吉田龍一, 藤智和, 高木弘誠, 安井和也, 重安邦俊, 寺石文則, 八木孝仁, 藤原俊義

消化器外科 46 ( 3 ) 277 - 288 2023.3

Removing the Esophageal Stump During Reconstruction for Esophagojejunostomy in Total Gastrectomy for Gastric Cancer: the Modified Overlap Method. Reviewed International journal

Yoshihiko Kakiuchi, Shinji Kuroda, Satoru Kikuchi, Hajime Kashima, Masahiko Nishizaki, Shunsuke Kagawa, Toshiyoshi Fujiwara

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 27 ( 3 ) 643 - 645 2023.3

Robotic surgery for congenital biliary dilatation using the scope switch technique (with video). Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

Asian journal of surgery 2023.2

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

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Overcoming cancer-associated fibroblast-induced immunosuppression by anti-interleukin-6 receptor antibody. Reviewed International journal

Noriyuki Nishiwaki, Kazuhiro Noma, Toshiaki Ohara, Tomoyoshi Kunitomo, Kento Kawasaki, Masaaki Akai, Teruki Kobayashi, Toru Narusaka, Hajime Kashima, Hiroaki Sato, Satoshi Komoto, Takuya Kato, Naoaki Maeda, Satoru Kikuchi, Shunsuke Tanabe, Hiroshi Tazawa, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Cancer immunology, immunotherapy : CII 2023.2

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

Cancer-associated fibroblasts (CAFs) are a critical component of the tumor microenvironment and play a central role in tumor progression. Previously, we reported that CAFs might induce tumor immunosuppression via interleukin-6 (IL-6) and promote tumor progression by blocking local IL-6 in the tumor microenvironment with neutralizing antibody. Here, we explore whether an anti-IL-6 receptor antibody could be used as systemic therapy to treat cancer, and further investigate the mechanisms by which IL-6 induces tumor immunosuppression. In clinical samples, IL-6 expression was significantly correlated with α-smooth muscle actin expression, and high IL-6 cases showed tumor immunosuppression. Multivariate analysis showed that IL-6 expression was an independent prognostic factor. In vitro, IL-6 contributed to cell proliferation and differentiation into CAFs. Moreover, IL-6 increased hypoxia-inducible factor 1α (HIF1α) expression and induced tumor immunosuppression by enhancing glucose uptake by cancer cells and competing for glucose with immune cells. MR16-1, a rodent analog of anti-IL-6 receptor antibody, overcame CAF-induced immunosuppression and suppressed tumor progression in immunocompetent murine cancer models by regulating HIF1α activation in vivo. The anti-IL-6 receptor antibody could be systemically employed to overcome tumor immunosuppression and improve patient survival with various cancers. Furthermore, the tumor immunosuppression was suggested to be induced by IL-6 via HIF1α activation.

DOI： 10.1007/s00262-023-03378-7

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ADAR1 is a promising risk stratification biomarker of remnant liver recurrence after hepatic metastasectomy for colorectal cancer. Reviewed International journal

Nanako Hata, Kunitoshi Shigeyasu, Yuzo Umeda, Shuya Yano, Sho Takeda, Kazuhiro Yoshida, Tomokazu Fuji, Ryuichi Yoshida, Kazuya Yasui, Hibiki Umeda, Toshiaki Takahashi, Yoshitaka Kondo, Hiroyuki Kishimoto, Yoshiko Mori, Fuminori Teraishi, Hideki Yamamoto, Hiroyuki Michiue, Keiichiro Nakamura, Hiroshi Tazawa, Toshiyoshi Fujiwara

Scientific reports 13 ( 1 ) 2078 - 2078 2023.2

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

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遺伝性出血性末梢血管拡張症(HHT;Hereditary hemorrhagic telangiectasia)による重症心不全患者に対する脳死肝移植の1例

安井和也, 吉田龍一, 楳田祐三, 杭瀬崇, 吉田一博, 藤智和, 藤原俊義, 八木孝仁

肝臓 64 ( 2 ) 103 - 104 2023.2

A Case Report of Non-typical Annular Pancreas Diagnosed during Laparoscopic Gastric Surgery. Reviewed

Toshiaki Takahashi, Yoshihiko Kakiuchi, Satoru Kikuch, Shinji Kuroda, Sho Takeda, Kunitoshi Shigeyasu, Yoshitaka Kondo, Fuminori Teraishi, Shunsuke Kagawa, Toshiyoshi Fujiwara

Acta medica Okayama 77 ( 1 ) 91 - 95 2023.2

Language：English

An annular pancreas is a rare anomaly of the pancreas, defined as pancreatic tissue that totally or partly encircles the duodenum, usually the descending portion. A 76-year-old man who was diagnosed with gastric cancer cT3N0M0 Stage IIB underwent laparoscopic distal gastrectomy with D2 lymph node dissection. Intraoperatively, the dorsal half of the duodenal bulb was seen to be half surrounded by the pancreas, and a non-typical annular pancreas was diagnosed. Because of the risk to the pancreas, it was considered impossible to perform anastomosis by a linear stapler as in the usual laparoscopic procedure. Therefore, we performed laparoscopically assisted distal gastrectomy and Billroth-I reconstruction using a circular stapler, and the surgery was completed without difficulties. His postoperative course was good despite the development of a pancreatic fistula, which was an International Study Group for Pancreas Fistula biochemical leak. Some APs can be diagnosed preoperatively, but the rarer subtypes such as ours are more difficult to visualize on imaging. In gastrectomy, it is both oncologically important and technically challenging to perform lymph node dissection around the pancreas. In this case with an especially proximal pancreas, a circular stapler was considered better suited for gastroduodenal anastomosis and required a broader field than that afforded by laparoscopy. A case of non-typical annular pancreas diagnosed during laparoscopic gastric surgery is described.

DOI： 10.18926/AMO/64368

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Fabry病患者におけるサイトメガロウイルス感染による小腸穿孔の1例

中村峻輔, 菊地覚次, 垣内慶彦, 黒田新士, 野間和広, 楳田祐三, 都地友紘, 藤原俊義

日本消化器外科学会雑誌 56 ( 2 ) 87 - 93 2023.2

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

症例は66歳の男性で,Fabry病による慢性腎不全に対して維持透析中であった.右肺癌に対して肺部分切除を施行後膿胸の増悪のため,ICUで全身管理中に小腸穿孔,汎発性腹膜炎を来し当科紹介となった.原因不明の小腸穿孔として緊急手術を施行した.術中所見では,Treitz靱帯より約200cmの部位での小腸穿孔,腸間膜側から腹腔内への穿破を認め,腹腔内汚染は著明であった.小腸を約20cm切除し,洗浄ドレナージ,回腸人工肛門造設を行った.切除標本では粘膜面に多発潰瘍を認め,その1ヶ所に穿孔を認めた.病理組織学的検査では,サイトメガロウイルス(cytomegalovirus;以下,CMVと略記)免疫染色検査で潰瘍部に一致して陽性細胞が検出され,CMV感染による小腸穿孔と診断した.CMV感染による消化管穿孔はまれであるが,免疫不全患者ではその存在を常に念頭に置く必要があり,早期診断・治療が重要である.(著者抄録)

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Fabry病患者におけるサイトメガロウイルス感染による小腸穿孔の1例

中村峻輔, 菊地覚次, 垣内慶彦, 黒田新士, 野間和広, 楳田祐三, 都地友紘, 藤原俊義

日本消化器外科学会雑誌 56 ( 2 ) 87 - 93 2023.2

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

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01117&link_issn=&doc_id=20230308270006&doc_link_id=10.5833%2Fjjgs.2022.0036&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2022.0036&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

【こだわりの体腔内縫合・吻合術】胃外科腹腔鏡下/ロボット支援下噴門側胃切除後の観音開き法による再建

黒田新士, 菊地覚次, 垣内慶彦, 香川俊輔, 藤原俊義

手術 77 ( 2 ) 189 - 195 2023.2

Oncologic Emergencyに対する二期的腹腔鏡下・ロボット支援下手術の実際閉塞・穿孔を伴う高度進行左側大腸癌に対する二期的低侵襲手術の治療成績

寺石文則, 半澤俊哉, 松三雄騎, 庄司良平, 重安邦俊, 近藤喜太, 香川俊輔, 藤原俊義

日本腹部救急医学会雑誌 43 ( 2 ) 329 - 329 2023.2

Surgical Techniques of Gastrojejunostomy in Robotic Pancreatoduodenectomy: Robot-Sewn versus Stapled Gastrojejunostomy Anastomosis. Reviewed International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Takahito Yagi, Toshiyoshi Fujiwara

Journal of clinical medicine 12 ( 2 ) 2023.1

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 < 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

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Papers - FUJIWARA Toshiyoshi