Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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ADAR1-high tumor-associated macrophages induce drug resistance and are therapeutic targets in colorectal cancer. International journal

Hibiki Umeda, Kunitoshi Shigeyasu, Toshiaki Takahashi, Kazuya Moriwake, Yoshitaka Kondo, Kazuhiro Yoshida, Sho Takeda, Shuya Yano, Yuki Matsumi, Hiroyuki Kishimoto, Tomokazu Fuji, Kazuya Yasui, Hideki Yamamoto, Kosei Takagi, Masashi Kayano, Hiroyuki Michiue, Keiichiro Nakamura, Yoshiko Mori, Fuminori Teraishi, Hiroshi Tazawa, Yuzo Umeda, Shunsuke Kagawa, Ajay Goel, Toshiyoshi Fujiwara

Molecular cancer 24 ( 1 ) 116 - 116 2025.4

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

BACKGROUND: Colorectal cancer (CRC) is considered the third most common type of cancer worldwide. Tumor-associated macrophages (TAMs) have been shown to promote drug resistance. Adenosine-to-inosine RNA-editing, as regulated by adenosine deaminase acting on RNA (ADAR), is a process that induces the posttranscriptional modification of critical oncogenes. The aim of this study is to determine whether the signals from cancer cells would induce RNA-editing in macrophages. METHODS: The effects of RNA-editing on phenotypes in macrophages were analyzed using clinical samples and in vitro and in vivo models. RESULTS: The intensity of the RNA-editing enzyme ADAR1 (Adenosine deaminase acting on RNA 1) in cancer and mononuclear cells indicated a strong positive correlation between the nucleus and cytoplasm. The ADAR1-positive mononuclear cells were positive for CD68 and CD163, a marker for M2 macrophages. Cancer cells transport pro-inflammatory cytokines or ADAR1 protein directly to macrophages via the exosomes, promoting RNA-editing in AZIN1 (Antizyme Inhibitor 1) and GLI1 (Glioma-Associated Oncogene Homolog 1) and resulting in M2 macrophage polarization. GLI1 RNA-editing in the macrophages induced by cancer cells promotes the secretion of SPP1, which is supplied to the cancer cells. This activates the NFκB pathway in cancer cells, promoting oxaliplatin resistance. When the JAK inhibitors were administered, oncogenic RNA-editing in the macrophages was suppressed. This altered the macrophage polarization from M2 to M1 and decreased oxaliplatin resistance in cancer cells. CONCLUSIONS: This study revealed that ADAR1-high TAMs are crucial in regulating drug resistance in CRC and that targeting ADAR1 in TAMs could be a promising treatment approach for overcoming drug resistance in CRC.

DOI： 10.1186/s12943-025-02312-y

Tailoring Neoadjuvant Therapy for Rectal Cancer: A Single-center Study of Local Recurrence Patterns. International journal

Ryohei Shoji, Fuminori Teraishi, Yoshitaka Kondo, Yusuke Yoshida, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Shunsuke Kagawa, Toshiyoshi Fujiwara

Anticancer research 45 ( 3 ) 1261 - 1271 2025.3

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

BACKGROUND/AIM: Postoperative local recurrence remains an important issue in rectal cancer, and the optimal treatment strategy, surgical approach, and prognosis after treatment are yet to be addressed. PATIENTS AND METHODS: We reviewed 21 patients who underwent surgical resection at our department for postoperative pelvic local recurrence of rectal cancer between January 2013 and December 2022, and performed a retrospective analysis of outcomes in terms of preoperative treatment and surgical approach. RESULTS: Of the 21 patients, four (19%) were treated with upfront surgery (Upfront surgery group), 13 (62%) with chemotherapy (Chemotherapy group), and four (19%) with neoadjuvant chemoradiotherapy (NACRT; NACRT group). The surgical approach was open laparotomy (Open group) in 10 (47.6%) patients and minimally invasive surgery (MIS, MIS group) in 11 (52.4%). Seventeen (81.0%) had a negative resection margin (RM). Overall median postoperative survival was 71 months and median relapse-free survival was 6.2 months. The most common form of recurrence was pelvic local re-recurrence in seven patients (33.3%). By preoperative treatment type, the RM securement rate was higher in the Chemotherapy and NACRT groups than in the Upfront surgery group, and the postoperative recurrence rate was lowest in the NACRT group. By surgical approach, intraoperative blood loss and incidence of Clavien-Dindo Grade 3 or higher postoperative adverse events were both significantly lower in the MIS group than in the Open group. CONCLUSION: Surgical intervention for postoperative recurrence of rectal cancer results in good survival, but short relapse-free survival. NACRT can deter local re-recurrence after resection, and MIS may contribute to reducing complications.

DOI： 10.21873/anticanres.17513

Short-term Safety of Robot-assisted Rectal Surgery in Patients Aged ≥75 Years: A Single-center Retrospective Study. International journal

Fuminori Teraishi, Yusuke Yoshida, Ryohei Shoji, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Shunsuke Kagawa, Toshiyoshi Fujiwara

Anticancer research 45 ( 3 ) 1291 - 1299 2025.3

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

BACKGROUND/AIM: The aging population challenges surgical management of rectal cancer. This study evaluated the short-term safety of robot-assisted rectal surgery (RARS) in patients aged 75 years and older, examining perioperative complications and surgical outcomes in this vulnerable population. PATIENTS AND METHODS: A single-center retrospective cohort study was conducted at Okayama University Hospital from September 2020 to December 2024, including 109 patients undergoing RARS. Patients were divided into older (≥75 years, n=19) and non-older (<75 years, n=90) groups. Surgical procedures utilized the da Vinci Xi system, with comprehensive assessment of perioperative characteristics and complications using the Clavien-Dindo classification. RESULTS: The older group demonstrated significantly higher American Society of Anesthesiologists classification (89.5% ≥2 vs. 58.9% in non-older group, p=0.036). Postoperative complications were more frequent in the older group (8 vs. 18 cases, p=0.04), though severe complications were similar to those in the non-older group. Median postoperative hospital stay was longer in the older group (12 vs. 9 days, p=0.01), but this difference disappeared when excluding stoma cases. Critically, no postoperative mortality was observed within 30 days in either group. CONCLUSION: Robot-assisted rectal surgery appears safe for patients aged 75 years and older. While the older group experienced more complications, these were predominantly manageable. The findings suggest that careful patient selection and experienced surgical teams can successfully employ robotic techniques in older patients while maintaining oncological standards.

DOI： 10.21873/anticanres.17516

Cancer-associated fibroblasts promote pro-tumor functions of neutrophils in pancreatic cancer via IL-8: potential suppression by pirfenidone. International journal

Tomohiko Yagi, Shunsuke Kagawa, Shohei Nogi, Atsuki Taniguchi, Masashi Yoshimoto, Kanto Suemori, Yasuo Nagai, Shuto Fujita, Shinji Kuroda, Satoru Kikuchi, Yoshihiko Kakiuchi, Fuminori Teraishi, Kosei Takagi, Toshiaki Ohara, Hiroshi Tazawa, Toshiyoshi Fujiwara

Cancer immunology, immunotherapy : CII 74 ( 3 ) 96 - 96 2025.2

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

BACKGROUND: The mechanisms by which neutrophils acquire pro-tumor properties remain poorly understood. In pancreatic cancer, cancer-associated fibroblasts (CAFs) may interact with neutrophils, directing them to promote tumor progression. METHODS: To validate the association between CAFs and neutrophils, the localization of neutrophils was examined in clinically resected pancreatic cancer specimens. CAFs were produced by culturing in cancer-conditioned media, and the effects of these CAFs on neutrophils were examined. In vitro migration and invasion assays assess the effect of CAF-activated neutrophils on cancer cells. The factors secreted by the activated neutrophils were also explored. Finally, pirfenidone (PFD) was tested to determine whether it could suppress the pro-tumor functions of activated neutrophils. RESULTS: In pancreatic cancer specimens, neutrophils tended to co-localize with IL-6-positive CAFs. Neutrophils co-cultured with CAFs increased migratory capacity and prolonged life span. CAF-affected neutrophils enhance the migratory and invasive activities of pancreatic cancer cells. IL-8 is the most upregulated cytokine secreted by the neutrophils. PFD suppresses IL-8 secretion from CAF-stimulated neutrophils and mitigates the malignant traits of pancreatic cancer cells. CONCLUSION: CAFs activate neutrophils and enhance the malignant phenotype of pancreatic cancer. The interactions between cancer cells, CAFs, and neutrophils can be disrupted by PFD, highlighting a potential therapeutic approach.

DOI： 10.1007/s00262-025-03946-z

Association between accelerometer-measured light-intensity physical activity and tumor regression for male patients with esophageal cancer receiving neoadjuvant therapy: a retrospective cohort study.

Tomohiro Ikeda, Kazuhiro Noma, Masanori Konuma, Naoaki Maeda, Shunsuke Tanabe, Takayoshi Kawabata, Masashi Kanai, Masanori Hamada, Toshiyoshi Fujiwara, Toshifumi Ozaki

Esophagus : official journal of the Japan Esophageal Society 2025.2

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

BACKGROUND: Physical activity has the potential to promote tumor regression in patients with esophageal cancer receiving neoadjuvant chemotherapy (NAC); however, the benefits of light-intensity physical activity (LIPA) are unclear. This study aimed to investigate the impact of LIPA on tumor regression in male patients with esophageal cancer during NAC and its optimal cutoff value. METHODS: This retrospective single-center observational study included all male patients who underwent NAC or curative esophagectomy. We assessed the physical activity of patients using an accelerometer and calculated the time spent on LIPA. Tumor regression was defined as grade ≥ 1b according to the Japanese classification of esophageal cancer. The impact of LIPA on tumor regression was analyzed using multivariate analysis, and the optimal cutoff value was identified using the receiver operating characteristic curve. RESULTS: Sixty-nine male patients with esophageal cancer who underwent NAC were analyzed. The mean age was 68 years, mean body mass index was 22.4, and 80% of the patients were diagnosed with clinical stage 3 or 4 disease. Every extra 30-min increase in LIPA during the treatment phase was associated with tumor regression (adjusted OR 1.41 [1.02-2.04]). The optimal cutoff value of LIPA was 156.11 min/day, and patients with rich LIPA (≥ 156.11 min/day) were less likely to suffer from anorexia and malnutrition during NAC. CONCLUSION: This study demonstrated that LIPA during NAC has a potential of promoting tumor regression with a cutoff value of 156.5 min/day. Further clinical research is required to determine the prognostic benefits of LIPA in patients receiving NAC.

DOI： 10.1007/s10388-025-01108-9

Short-Term and Long-Term Outcomes of Robotic Gastrectomy for Gastric Cancer: A Single-Center, Single-Arm Prospective Study. International journal

Nobuhiko Kanaya, Shinji Kuroda, Yoshihiko Kakiutchi, Hajime Kashima, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Toshiyoshi Fujiwara

Cureus 17 ( 2 ) e79063 2025.2

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

BACKGROUND: Robotic gastrectomy (RG) has emerged as a promising approach for gastric cancer (GC) treatment, offering advantages such as enhanced dexterity, improved visualization, and increased precision. However, its widespread adoption remains limited due to technical complexity, high costs, limited applications, and insufficient evidence. METHODS: We conducted a single-center, prospective study to evaluate the safety and feasibility of RG, including robotic total gastrectomy (RTG), robotic proximal gastrectomy (RPG), and robotic distal gastrectomy (RDG) with D1+ or D2 lymphadenectomy, in clinical stage I/II GC. The primary endpoint was the incidence of intraoperative and postoperative complications, while the secondary endpoints included surgical outcomes and long-term prognosis. RESULTS: Seven patients were enrolled. No intraoperative complications or conversions to open surgery occurred. The primary endpoint was met, with no major postoperative complications. RTG had a longer operative time and more lymph nodes dissected than RDG and RPG. The median postoperative hospital stay was 10 days. Recurrence was observed in two cases, one of which achieved long-term survival without chemotherapy. CONCLUSION: Our findings demonstrate the safety and feasibility of RG for early and advanced GC. Further multicenter studies with larger cohorts are needed to establish its oncological benefits and cost-effectiveness, facilitating broader clinical adoption.

DOI： 10.7759/cureus.79063

閉塞・穿通を伴う進行左側大腸癌に対する術前化学療法の治療成績

寺石文則, 伊木道子, 吉田有佑, 庄司良平, 松三雄騎, 重安邦俊, 近藤喜太, 香川俊輔, 藤原俊義

日本大腸肛門病学会雑誌 78 ( 2 ) 107 - 107 2025.2

直腸癌術後骨盤内局所再発に対する予後向上を目指した集学的治療の治療成績

庄司良平, 寺石文則, 近藤喜太, 松三雄騎, 重安邦俊, 藤原俊義

日本大腸肛門病学会雑誌 78 ( 2 ) 105 - 105 2025.2

Novel treatment strategy targeting interleukin-6 induced by cancer associated fibroblasts for peritoneal metastasis of gastric cancer. International journal

Ema Mitsui, Satoru Kikuchi, Tomohiro Okura, Hiroshi Tazawa, Yuta Une, Noriyuki Nishiwaki, Shinji Kuroda, Kazuhiro Noma, Shunsuke Kagawa, Toshiaki Ohara, Junko Ohtsuka, Rieko Ohki, Toshiyoshi Fujiwara

Scientific reports 15 ( 1 ) 3267 - 3267 2025.1

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

Cancer-associated fibroblasts (CAFs) are a crucial component in the tumor microenvironment (TME) of peritoneal metastasis (PM), where they contribute to tumor progression and metastasis via secretion of interleukin-6 (IL-6). Here, we investigated the role of IL-6 in PM of gastric cancer (GC) and assessed whether anti-IL-6 receptor antibody (anti-IL-6R Ab) could inhibit PM of GC. We conducted immunohistochemical analysis of IL-6 and α-smooth muscle (α-SMA) expressions in clinical samples of GC and PM, and investigated the interactions between CAFs and GC cells in vitro. Anti-tumor effects of anti-IL-6R Ab on PM of GC were investigated in an orthotopic murine PM model. IL-6 expression was significantly correlated with α-SMA expression in clinical samples of GC, and higher IL-6 expression in the primary tumor was associated with poor prognosis of GC. Higher IL-6 and α-SMA expressions were also observed in PM of GC. In vitro, differentiation of fibroblasts into CAFs and chemoresistance were observed in GC cells cocultured with fibroblasts. Anti-IL-6R Ab inhibited the progression of PM in GC cells cocultured with fibroblasts in the orthotopic mouse model but could not inhibit the progression of PM consisting of GC cells alone. IL-6 expression in the TME was associated with poor prognosis of GC, and CAFs were associated with establishment and progression of PM via IL-6. Anti-IL-6R Ab could inhibit PM of GC by the blockade of IL-6 secreted by CAFs, which suggests its therapeutic potential for PM of GC.

DOI： 10.1038/s41598-025-88033-0

Impact of robotic surgery on postoperative pancreatic fistula for high-risk pancreaticojejunostomy after pancreatoduodenectomy. International journal

Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara

Digestive surgery 1 - 21 2025.1

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

BACKGROUND: The safety and feasibility of robotic pancreatoduodenectomy (RPD) in high-risk patients with postoperative pancreatic fistula (POPF) have rarely been investigated, although the rate of POPF is lower than in open pancreatoduodenectomy (OPD). This study aimed to examine the impact of robotic surgery on POPF in high-risk patients after pancreatoduodenectomy (PD). METHODS: This retrospective analysis included 204 patients who underwent RPD between January 2018 and June 2023. Of the 204 patients, 126 with high-risk POPF were included. The outcomes of RPD and OPD were compared. Multivariate analyses were conducted to identify risk factors associated with the development of clinically relevant POPF (CR-POPF) after surgery. RESULTS: Of the 126 patients, 50 underwent RPD and 76 underwent OPD. The incidence of CR-POPF was significantly lower in the RPD group than in the OPD group (6.0% vs. 38.2%, P < 0.001). Multivariate analyses identified OPD as an independent risk factor associated with CR-POPF (odds ratio [OR]: 7.87, 95% confidence interval [CI]: 2.11-29.4, P = 0.002). CONCLUSIONS: This study demonstrated the impact of robotic surgery on POPF in high-risk patients after PD. These results suggest that RPD may be significantly associated with a decreased incidence of CR-POPF in high-risk anastomoses.

DOI： 10.1159/000543737

Predictive marker for response to trifluridine/tipiracil plus bevacizumab in metastatic colorectal cancer patients. International journal

Toshiaki Takahashi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Sho Takeda, Hibiki Umeda, Kazuya Moriwake, Masashi Kayano, Yuya Sakurai, Shunsuke Nakamura, Masafumi Takahashi, Kaori Nitta, Kazuhiro Yoshida, Yuki Matsumi, Hiroyuki Michiue, Hideki Yamamoto, Hiroyuki Kishimoto, Fuminori Teraishi, Ryohei Shoji, Nobuhiko Kanaya, Hajime Kashima, Yoshihiko Kakiuchi, Shinji Kuroda, Shunsuke Kagawa, Toshiyoshi Fujiwara

BMC cancer 25 ( 1 ) 1 - 1 2025.1

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

OBJECTIVE: Trifluridine/tipiracil (FTD/TPI) is one of the options for late-line treatment of colorectal cancer (CRC). However, the specific patient populations that would particularly benefit from it remain unclear. This study attempted to identify predictive markers of chemotherapy efficacy with trifluridine/tipiracil (FTD/TPI), focusing on the RNA-editing enzyme adenosine deaminase acting on RNA 1 (ADAR1) expression and neutrophil-lymphocyte ratio (NLR). METHODS: To assess the effectiveness of FTD/TPI in CRC patients, we retrospectively analyzed 72 CRC patients at Okayama University Hospital from 2014 to 2022. RESULTS: Adding bevacizumab to FTD/TPI resulted in a more prolonged progression-free survival (PFS), consistent with the SUNLIGHT study findings (p = 0.0028). Among the participants, those with a high NLR had a shorter PFS (p = 0.0395). Moreover, high ADAR1 expression was associated with longer PFS (p = 0.0151). In multivariate analysis, low ADAR1 (HR = 3.43, p = 0.01) and absence of bevacizumab (HR = 4.25, p = 0.01) were identified as factors shortening PFS. The high ADAR1 group demonstrated fewer cases of progressive disease and a higher proportion of stable disease than the low ADAR1 group (p = 0.0288). Low NLR and high ADAR1 were predictive markers of prolonged PFS in the bevacizumab-treated group (p = 0.0036). CONCLUSION: Low NLR and high ADAR1 were predictive markers for a positive response to the FTD/TPI plus bevacizumab regimen associated with prolonged PFS. The FTD/TPI plus bevacizumab regimen should be proactively implemented in the low NLR and high ADAR1 subgroups.

DOI： 10.1186/s12885-024-13370-8

An effective surgical educational system in the era of robotic surgery: "Double-Surgeon Technique" in robotic gastrectomy for minimally invasive surgery. International journal

Yoshihiko Kakiuchi, Shinji Kuroda, Yusuke Yoshida, Nobuhiko Kanaya, Hajime Kashima, Satoru Kikuchi, Shunsuke Kagawa, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 410 ( 1 ) 20 - 20 2024.12

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

PURPOSE: Gastric cancer (GC) remains a major malignancy. Robotic gastrectomy (RG) has gained popularity due to various advantages. Despite those advantages, many hospitals lack the necessary equipment for RG and are still performing laparoscopic gastrectomy (LG) due to its established minimal invasiveness and safety. METHODS: This study assessed the effectiveness of the "Double-Surgeon Technique" (DST) for improving surgical education and proficiency with LG. The DST involves both a console-side surgeon and a patient-side surgeon working actively in RG, enhancing the skill acquisition needed for LG and potentially reducing surgical time. Assessment of this method was performed by surgical time, and cases were divided into three groups: first half (Phase 1: P1) and second half (P2) before the introduction of DST, and after the introduction of DST (P3). RESULTS: Two surgical trainees were trained using the DST. The learning curve in both reached a plateau in P2, but descended again in P3. For one trainee, surgical time for P3 was significantly reduced compared to P1 (p = 0.001) and P2 (p = 0.0027) despite the intervals between laparoscopic distal gastrectomy as the main surgeon in P3 being significantly longer than in P2 (p = 0.0094). Other surgical results in both trainees did not differ significantly. Further, no difference in induction phase results of RG were evident between surgeons and trainees with or without DST experience. CONCLUSION: Surgical education using the DST could be effective in the current context of the need for RG and LG.

DOI： 10.1007/s00423-024-03593-5

Association Between Change in Prognostic Nutritional Index During Neoadjuvant Therapy and Dental Occlusal Support in Patients with Esophageal Cancer Under Neoadjuvant Therapy: A Retrospective Longitudinal Pilot Study. International journal

Reiko Yamanaka-Kohno, Yasuhiro Shirakawa, Mami Inoue-Minakuchi, Aya Yokoi, Kazuhiro Noma, Shunsuke Tanabe, Naoaki Maeda, Toshiyoshi Fujiwara, Manabu Morita, Daisuke Ekuni

Nutrients 16 ( 24 ) 2024.12

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

Background: A high prognostic nutritional index (PNI) is associated with good prognosis in patients with esophageal cancer. However, nutritional status often decreases during neoadjuvant therapy. Functional tooth units (FTUs) provide an index for the status of posterior occlusal support. We have previously reported that low PNI is related to low FTUs. Objectives: The purpose of this study was to retrospectively examine whether the status of occlusal support relates to changes in PNI during neoadjuvant therapy in patients with esophageal cancer. Methods: This study included 34 patients who underwent neoadjuvant therapy before esophagectomy (32 men, 2 women; age, 36-82 years) in 2012 at Okayama University Hospital. Patients were divided into the good occlusal support group (FTUs ≥ 11, n = 18) or poor occlusal support group (FTUs < 11, n = 16), and changes in PNI during neoadjuvant therapy were investigated. Results: PNI decreased significantly after neoadjuvant therapy, particularly in the good occlusal support group, and became more dispersed after neoadjuvant therapy. Decreases in PNI after neoadjuvant therapy showed a significant positive correlation with good occlusal support by multiple regression analysis (p = 0.03). The proportions of patients provided with nutritional intervention (p = 0.02) or early dental intervention (p = 0.04) were lower in the good occlusal support group than in the poor occlusal support group. Conclusions: Even in patients with esophageal cancer with good occlusal support experienced significant declines in PNI during neoadjuvant therapy, potentially due to delayed nutritional and dental interventions. Early multidisciplinary interventions are thus recommended for all patients, regardless of preoperative dental or nutritional status.

DOI： 10.3390/nu16244383

Optimization of workflow processes for sustainable paternal involvement: case study of an academic "daddy surgeon" in Japan.

Nobuhiko Kanaya, Shinji Kuroda, Yoshitaka Kondo, Yuko Takehara, Yoshihiko Kakiuchi, Hitoshi Minagi, Masaki Sakamoto, Shunsuke Kagawa, Hitomi Kataoka, Toshiyoshi Fujiwara

Surgery today 2024.12

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

Work-life balance is often discussed in Japan. Yet surgeons find it challenging to take paternity leave because of their demanding surgical duties and a strong sense of responsibility. One Japanese male surgeon had his first paternity experience as a research fellow in the US. When he returned to Japan, he resumed his surgical training and started a research project to become an academic surgeon. When he and his wife were expecting their second child, they discussed his paternity participation before the delivery and decided on a sustainable paternity participation plan. By coordinating his responsibilities with his co-workers, he limited his attendance at work to daytime hours only for 1 month to manage paternity duties. This adjustment did not affect the number of main and assistant operations conducted that month and effective optimization of workflow processes decreased the extra workload for other team members. His experience suggests that the optimization of workflow processes can enhance personal life, including paternity participation. (150/150).

DOI： 10.1007/s00595-024-02959-y

Hemodynamic Assessment Using SPY Laser Fluorescence Imaging During Pancreatoduodenectomy with Common Hepatic Artery Resection. International journal

Tomokazu Fuji, Kosei Takagi, Kazuya Yasui, Takeyoshi Nishiyama, Motohiko Yamada, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Annals of surgical oncology 2024.12

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

BACKGROUND: Pancreatectomies combined with arterial resection can be indicated for pancreatic cancer. In a pancreatectomy with arterial resection, intraoperative confirmation of blood flow through reconstructed vessels is crucial. This study highlights the usefulness of SPY laser fluorescence imaging during a pancreatoduodenectomy with common hepatic artery resection (PD-CHAR). PATIENT AND METHODS: A 55-year-old man with borderline resectable pancreatic head cancer underwent a PD-CHAR. After confirming tumor resectability, reconstruction of the CHA to the proper hepatic artery was performed. Subsequently, the superior mesenteric vein was reconstructed. RESULTS: SPY laser fluorescence imaging demonstrated arterial blood perfusion to the liver through the reconstructed hepatic artery, followed by perfusion from the portal vein. The operation lasted 493 min, with an estimated blood loss of 400 mL. The postoperative course was uneventful with good arterial blood flow. CONCLUSION: The SPY Portable Handheld Imager could be valuable for visualizing blood flow in reconstructed vessels and assessing tissue perfusion during a pancreatectomy combined with vascular reconstruction.

DOI： 10.1245/s10434-024-16659-x

Robot-Assisted Laparoscopic Resection With the Transanal Approach for Massive Rectal Gastrointestinal Stromal Tumor: A Case Report. International journal

Yusuke Yoshida, Fuminori Teraishi, Ryohei Shoji, Yuki Matsumi, Toshiyoshi Fujiwara

Cureus 16 ( 12 ) e76352 2024.12

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

Rectal gastrointestinal stromal tumors (GISTs) are often asymptomatic and may be detected as giant tumors. This may require highly invasive surgery for radical resection. Here, we describe a 74-year-old man with a locally advanced non-metastatic GIST in the right anterolateral wall of the lower rectum. The tumor was giant (128 × 93 mm), and invasion into adjacent organs (right seminal vesicle and prostate gland) was suspected. Although neoadjuvant chemotherapy (NAC) with imatinib reduced the tumor size, it was still giant, 80 mm in diameter. Therefore, we performed super-low anterior resection using a robot-assisted laparoscopic approach with the transanal approach. The bi-directional approach enabled safe and precise surgery, is expected to increase the rate of anorectal preservation as well as R0 resection, and may prevent a decline in quality of life.

DOI： 10.7759/cureus.76352

Rare internal hernia following pancreatoduodenectomy: A case report. International journal

Teruyuki Tsujii, Kosei Takagi, Yasuo Nagai, Kazuya Yasui, Tomokazu Fuji, Toshiyoshi Fujiwara

International journal of surgery case reports 126 110673 - 110673 2024.11

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

INTRODUCTION: Pancreatoduodenectomy (PD) is a complex procedure with a high morbidity rate. Internal hernia following PD is a rare but potentially life-threatening complication. Herein, we describe a rare case of internal hernia after PD. PRESENTATION OF CASE: A 76-year-old man who underwent subtotal stomach-preserving PD 7 years ago presented with vomiting and abdominal pain. Abdominal computed tomography revealed an internal hernia. Because conservative treatment failed, surgical intervention was performed. Intraoperative findings revealed efferent loop herniation in the space between the afferent loop near the Braun anastomosis and transverse mesocolon. The hernia was repositioned and the mesenteric defect was closed. DISCUSSION: This is an extremely rare case of an internal hernia that developed 7 years after PD. As conservative management provides a little chance for improvement, precise diagnosis and prompt re-intervention are essential for the management of internal hernia. In this case, the hernial orifice developed in the space between the afferent and efferent loops and the transverse mesocolon. Internal hernia could be a differential diagnosis in patients with ileus after PD. CONCLUSION: This study provided a detailed description of an extremely rare case of internal hernia following PD. Therefore, internal hernias should be considered in patients undergoing PD.

DOI： 10.1016/j.ijscr.2024.110673

Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer. International journal

Fuminori Teraishi, Yusuke Yoshida, Ryohei Shoji, Nobuhiko Kanaya, Yuki Matsumi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Shunsuke Kagawa, Rie Tamura, Yoshikazu Matsuoka, Hiroshi Morimatsu, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 409 ( 1 ) 356 - 356 2024.11

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

PURPOSE: Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older. METHODS: This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined. RESULTS: The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m2. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15). CONCLUSION: The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.

DOI： 10.1007/s00423-024-03548-w

The required experience of open pancreaticoduodenectomy before becoming a specialist in hepatobiliary and pancreatic surgeons: a multicenter, cohort study of 334 open pancreaticoduodenectomies. International journal

Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Masayoshi Hioki, Ryuichi Yoshida, Yoshikatsu Endo, Kazuya Yasui, Daisuke Nobuoka, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

BMC surgery 24 ( 1 ) 366 - 366 2024.11

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

BACKGROUND: Open pancreaticoduodenectomy (OPD) is an essential surgical procedure for expert hepato-biliary-pancreatic (HBP) surgeons. However, there is no standard for how many surgeries must be performed by a surgeon in training before they are considered to have enough experience to ensure surgical safety. METHODS: Cumulative Sum (CUSUM) analysis was performed using the surgical data of OPDs performed during the training period of board-certified expert surgeons of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. RESULTS: Fourteen HBP surgeons participated in this study and performed 334 OPDs during their training period. The median (interquartile range) values for operative time, blood loss, and length of hospital stay were 455 (397-519) minutes, 450 (234--716) ml, and 28 (21-38) days, respectively. CUSUM analysis showed inflection points at 20 surgeries performed for operative time. After 20 procedures, operative time was significantly shorter (461 min vs. 425 min, p = 0.021) and blood loss was significantly lower (470 ml vs. 340 ml, p = 0.038). No significant differences between within 20 and after 21 procedures were found in the complication rate (53% vs. 48%, p = 0.424) and rate of in-hospital deaths (1.5% vs.1.4%. p = 0.945). Up to 20 surgeries, PDAC and another malignant tumor had longer operative time than benign/low malignant diseases (486 min vs. 472 min vs. 429 min, p < 0.001), and higher blood loss (500 ml vs. 502 ml vs. 355 ml, p < 0.001). Mortality rate was higher at PDAC cases (5% vs. 0% vs. 0%, p = 0.01). After the 21 procedures, these outcomes were improved and no differences in by primary disease were observed. Multivariable analysis showed that within 20 surgeries were independent risk factors of longer operative time (HR2.6, p = 0.013) and higher blood loss (HR2.0, p = 0.049). CONCLUSIONS: To stabilize the surgical outcome of OPD for malignant disease, at least 20 surgeries should be performed at a certified institution during surgeon training. TRIAL REGISTRATION: Clinical trial number: Not applicable.

DOI： 10.1186/s12893-024-02677-9

Laparoscopic resection for oesophageal duplication cyst: A case report. International journal

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

International journal of surgery case reports 126 110572 - 110572 2024.11

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

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

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