Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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経口摂取不能上部消化管癌に対し外科医は何ができるのか? 食道バイパス術の有用性に関する検討

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

日本外科学会定期学術集会抄録集 122回 PD - 6 2022.4

肝胆膵領域における再生医療研究の最前線ベーラー大学における膵全摘自家膵島移植200例の検討

熊野健二郎, 藤智和, 金平典之, 佐藤博紀, 高木弘誠, 安井和也, 吉田一博, 吉田龍一, 楳田祐三, 八木孝仁, 藤原俊義, Bashoo Naziruddin

日本外科学会定期学術集会抄録集 122回 WS - 7 2022.4

The Gastrohepatic Ligament Approach in Robotic Spleen-Preserving Distal Pancreatectomy with Resection of the Splenic Vessels: The Superior Window Approach in the Warshaw Technique. International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi, Toshiyoshi Fujiwara

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 26 ( 6 ) 1342 - 1344 2022.3

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

BACKGROUND: There have been few studies reporting on the surgical approaches of minimally invasive spleen-preserving distal pancreatectomy (SPDP). Herein, we present two cases who underwent robotic SPDP with resection of the splenic vessels using our novel gastrohepatic ligament approach (the superior window approach in the Warshaw technique). METHODS: Our gastrohepatic ligament approach in robotic SPDP consists of four steps: step 1, the gastrohepatic ligament transection; step 2, dissection around the pancreas; step 3, transection of the pancreas; and step 4, resection of the splenic vessels (the Warshaw technique). RESULTS: Starting with the gastrohepatic ligament transection, the pancreas was directly dissected with neither dissecting the gastrocolic ligament nor retracting the stomach. The mean operative time was 217 min with minimal estimated blood loss. Both of the patients had no postoperative morbidity. CONCLUSIONS: The gastrohepatic ligament approach may be helpful and optional in robotic SPDP with the Warshaw technique.

DOI： 10.1007/s11605-022-05286-0

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Surgical resection of mixed neuroendocrine-non-neuroendocrine neoplasm in the biliary system: a report of two cases. International journal

Ayano Tamaki, Yuma Tani, Hiroki Sato, Ryuichi Yoshida, Kazuya Yasui, Shigeru Horiguchi, Takashi Kuise, Yuzo Umeda, Kazuhiro Yoshida, Tomokazu Fuji, Kenjiro Kumano, Kosei Takagi, Takahito Yagi, Toshiyoshi Fujiwara

Surgical case reports 8 ( 1 ) 38 - 38 2022.3

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

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高齢者胃癌症例(80歳以上)に対する周術期管理:合併症を予防するには高齢胃癌患者に対する周術期多職種介入の効果(The efficacy of the perioperative management for elderly gastric cancer patient by multiple experts)

垣内慶彦, 黒田新士, 菊地覚次, 香川俊輔, 藤原俊義

日本胃癌学会総会記事 94回 195 - 195 2022.3

腹腔鏡下スリーブ状胃切除術導入から4年間での治療成績

香川俊輔, 菊地覚次, 黒田新士, 垣内慶彦, 武田正, 江口潤, 中司敦子, 山口哲志, 和田淳, 藤原俊義

肥満研究 27 ( Suppl. ) 358 - 358 2022.3

Surgical technique of suprapancreatic D2 lymphadenectomy focusing on the posterior hepatic plexus for advanced gastric cancer. International journal

Nobuhiko Kanaya, Shinji Kuroda, Yoshihiko Kakiuchi, Sho Takeda, Satoru Kikuchi, Kazuhiro Noma, Ryuichi Yoshida, Yuzo Umeda, Fuminori Teraishi, Masahiko Nishizaki, Shunsuke Kagawa, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 407 ( 2 ) 871 - 877 2022.3

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

PURPOSE: Although D2 lymphadenectomy is currently considered a standard procedure for advanced gastric cancer (GC) worldwide, there is room for discussion about the appropriate range of suprapancreatic D2 lymphadenectomy. Focusing on the posterior hepatic plexus (PHP), which is not well recognized, we developed a surgical technique of suprapancreatic D2 lymphadenectomy, which we have called PHP-D2, and its short-term and long-term efficacies were evaluated in comparison with non-PHP-D2. METHODS: GC patients who underwent distal gastrectomy with D2 lymphadenectomy between July 2006 and May 2013 were enrolled, from which patients who had peritoneal metastasis and/or were peritoneal cytology-positive during surgery were excluded. Their medical records were retrospectively reviewed. RESULTS: Ninety-two patients (non-PHP-D2: 48, PHP-D2: 44) were enrolled. Shorter operation time (330 min vs 275 min, p < 0.0001) and less blood loss (290 mL vs 125 mL, p < 0.0001) were observed in PHP-D2, and no pancreatic fistulas were observed in PHP-D2. More lymph nodes of #11p (1 vs 1.5, p = 0.0328) and #12a lymph nodes (0 vs 1, p = 0.0034) were retrieved in PHP-D2, with no significant differences in #8a and #9 lymph nodes. Lymphatic recurrence was significantly less in PHP-D2 (p = 0.0166), and univariate and multivariate analyses showed that non-PHP-D2 was a significant risk factor for lymphatic recurrence (p = 0.0158), although there were no significant differences between non-PHP-D2 and PHP-D2 in 5-year overall survival and 5-year relapse-free survival. CONCLUSION: PHP-D2 was a safe and feasible procedure that had the potential to reduce lymphatic recurrence, and it can be a standard procedure of D2 lymphadenectomy for advanced GC.

DOI： 10.1007/s00423-022-02437-4

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進行・再発胃癌患者に対するNivolumabの実臨床での治療成績の検討(Clinical outcomes of nivolumab in patients with advanced or recurrent gastric cancer)

香川俊輔, 黒田新士, 菊地覚次, 野間和広, 田辺俊介, 重安邦俊, 前田直見, 垣内慶彦, 武田正, 近藤喜太, 寺石文則, 藤原俊義

日本胃癌学会総会記事 94回 425 - 425 2022.3

腹腔鏡下スリーブ状胃切除術導入から4年間での治療成績

香川俊輔, 菊地覚次, 黒田新士, 垣内慶彦, 武田正, 江口潤, 中司敦子, 山口哲志, 和田淳, 藤原俊義

肥満研究 27 ( Suppl. ) 358 - 358 2022.3

進行・再発胃癌患者に対するNivolumabの実臨床での治療成績の検討(Clinical outcomes of nivolumab in patients with advanced or recurrent gastric cancer)

香川俊輔, 黒田新士, 菊地覚次, 野間和広, 田辺俊介, 重安邦俊, 前田直見, 垣内慶彦, 武田正, 近藤喜太, 寺石文則, 藤原俊義

日本胃癌学会総会記事 94回 425 - 425 2022.3

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer. International journal

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi, Toshiyoshi Fujiwara

Anticancer research 42 ( 2 ) 653 - 660 2022.2

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

BACKGROUND/AIM: The aim of this study was to investigate surgical and oncological outcomes of minimally invasive (MI) and open radical antegrade modular pancreatosplenectomy (RAMPS) for the treatment of left-sided pancreatic cancer. MATERIALS AND METHODS: A systematic literature search and meta-analyses were performed focusing on short-term surgical oncology of MI- and open-RAMPS. RESULTS: A total of seven studies with 423 patients were included in this review. The equivalent short-term and long-term outcomes of the groups were confirmed. The results of meta-analyses found no significant difference in R0 resection rates (OR=1.78, 95%CI=0.76-4.15, p=0.18), although MI-RAMPS was associated with a smaller number of dissected lymph nodes (MD=-3.14, 95%CI=-4.75 - -1.53, p<0.001) and lymph node metastases (OR=0.55, 95%CI=0.31-0.97, p=0.04). CONCLUSION: MI-RAMPS could provide surgically and oncologically feasible outcomes for well-selected left-sided pancreatic cancer as compared to open-RAMPS. However, further high-level evidence should be needed to confirm survival benefits following MI-RAMPS.

DOI： 10.21873/anticanres.15523

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【今知っておきたいゲノム医療と遺伝子治療-基礎から臨床まで】がんに対する腫瘍融解ウイルス療法

藤原俊義, 谷本光隆, 野田卓男, 田澤大

小児内科 54 ( 2 ) 361 - 364 2022.2

Language：Japanese Publisher：(株)東京医学社

＜Key Points＞(1)腫瘍融解ウイルスは低侵襲ながん治療プラットフォームとして注目されている。(2)神経芽腫など多くのヒト悪性腫瘍ではテロメラーゼ活性の上昇が認められる。(3)米国およびわが国で臨床開発が進むテロメラーゼ特異的腫瘍融解ウイルスTelomelysin(OBP-301)は、がん細胞を選択的に破壊して免疫学的活性化も誘導する。(4)p53遺伝子で武装化されたOBP-702は、N-mycを抑制して神経芽腫細胞を破壊する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00648&link_issn=&doc_id=20220309070022&doc_link_id=10.24479%2Fpm.0000000073&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fpm.0000000073&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Effectiveness of early exercise on reducing skeletal muscle loss during preoperative neoadjuvant chemotherapy for esophageal cancer.

Tomohiro Ikeda, Kazuhiro Noma, Naoaki Maeda, Shunsuke Tanabe, Yoko Sakamoto, Yoshimi Katayama, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Masuo Senda

Surgery today 52 ( 8 ) 1143 - 1152 2022.1

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

PURPOSE: To investigate if early exercise can help prevent skeletal muscle loss and improve the clinical outcomes of esophageal cancer patients receiving preoperative neoadjuvant chemotherapy (NAC). METHODS: This was a single-center, retrospective observational cohort study of 110 patients with advanced esophageal cancer. We analyzed the effect of early exercise on the risk of skeletal muscle loss (defined as > 2.98%) during NAC and the subsequent clinical outcomes. Patients in the early exercise group (n = 71) started exercise therapy 8 days earlier than those the late exercise group (n = 39). RESULTS: The median age of the patients was 65.4 years, the mean BMI was 21.1 kg/m2, and 92 (84%) of the 110 patients were men. Skeletal muscle loss occurred in 34% and 67% of the early and late exercise groups, respectively (p < 0.001). There was a lower risk of surgical site infection in the early exercise group (1% vs 16%, p = 0.021). Multivariate analysis revealed that early exercise reduced the risk of skeletal muscle loss (OR = 0.25, 95% CI 0.09-0.65, p = 0.006). CONCLUSIONS: Our results suggest that early exercise reduces the risk of both skeletal muscle loss during NAC and subsequent surgical site infection in patients with esophageal cancer.

DOI： 10.1007/s00595-021-02449-5

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【消化器外科ロボット支援手術の導入と手術教育】ロボット支援下膵切除術の導入と手術教育

高木弘誠, 楳田祐三, 吉田龍一, 藤原俊義, 八木孝仁

手術 76 ( 1 ) 69 - 77 2022.1

《外科学再興特別企画》癌に対する免疫治療New Era がん微小環境内のマクロファージ、好中球を癌の治療標的として解析する

香川俊輔, 吉本匡志, 伊藤雅典, 梶岡裕樹, 坂本修一, 桑田和也, 吉田龍一, 野間和広, 楳田祐三, 菊地覚次, 黒田新士, 矢野修也, 重安邦俊, 寺石文則, 田澤大, 藤原俊義

日本外科学会雑誌 123 ( 1 ) 80 - 82 2022.1

Acute acalculous cholecystitis caused by SARS-CoV-2 infection: A case report and literature review. International journal

Hana Futagami, Hiroki Sato, Ryuichi Yoshida, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 90 106731 - 106731 2022.1

Language：English

BACKGROUND: Emerging data indicate that gastrointestinal disorders, in addition to pulmonary dysfunction, are also hallmarks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE PRESENTATION: A 42-year-old man with maintenance hemodialysis developed high fever and dyspnea. He was positive for SARS-CoV-2 and was diagnosed with pneumonia. After treatment for SARS-CoV-2, his respiratory condition improved. However, he developed right upper quadrant pain with elevated inflammatory markers (white blood cells, 21,160/μL; c-reactive protein, 163.9 mg/L) on the 13th day. Abdominal computed tomography revealed acute acalculous cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed together with antibiotic therapy, which resulted in improvement of symptoms. Laparoscopic cholecystectomy was performed 36 days after PTGBD. CONCLUSION: We report a rare case of acute acalculous cholecystitis (AAC) following pneumonia caused by SARS-CoV-2 infection. We also conducted a literature search to characterize SARS-CoV-2-related cholecystitis. Infection with SARS-CoV-2 is an important trigger for AAC, and appropriate therapeutic alternatives should be cautiously selected according to individual cases.

DOI： 10.1016/j.ijscr.2021.106731

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大腸癌肝転移におけるRNA編集酵素ADAR1発現は肝転移切除後の残肝再発を予測するバイオマーカーになる

畑七々子, 重安邦俊, 高橋一剛, 梅田響, 武田正, 矢野修也, 楳田祐三, 田澤大, 藤原俊義

日本分子腫瘍マーカー研究会誌 37 23 - 24 2022

Association between Advanced T Stage and Thick Rectus Abdominis Muscle and Outlet Obstruction and High-Output Stoma after Ileostomy in Patients with Rectal Cancer

Yasuhiro Komatsu, Kunitoshi Shigeyasu, Sho Takeda, Yoshiko Mori, Kazutaka Takahashi, Nanako Hata, Kokichi Miyamoto, Hibiki Umeda, Yoshihiko Kakiuchi, Satoru Kikuchi, Shuya Yano, Shinji Kuroda, Yoshitaka Kondo, Hiroyuki Kishimoto, Fuminori Teraishi, Masahiko Nishizaki, Shunsuke Kagawa, Toshiyoshi Fujiwara

International Surgery 106 ( 3 ) 102 - 111 2022

Publishing type：Research paper (scientific journal)

Objective: This study aimed to identify factors associated with outlet obstruction and high-output stoma (HOS) after ileostomy creation. Summary of background data: Ileostomy creation is effective in preventing leakage among patients undergoing low anterior resection for rectal cancer. However, major complications such as outlet obstruction and HOS can occur after surgery. Moreover, these complications cannot be prevented. Methods: This retrospective study included 34 patients with rectal cancer who underwent low anterior resection and ileostomy creation at Okayama University Hospital from January 2015 to December 2018. Then, the risk factors associated with outlet obstruction and HOS were analyzed. Results: Of 34 patients, 7 (21%) experienced outlet obstruction. In a multivariate logistic regression analysis, advanced T stage (P ¼ 0.10), ileostomy with a short horizontal diameter (P ¼ 0.01), and thick rectus abdominis (RA) muscle (P ¼ 0.0005) were considered independent risk factors for outlet obstruction. There was a significant correlation between outlet obstruction and HOS (P ¼ 0.03). Meanwhile, the independent risk factors of HOS were advanced T stage (P ¼ 0.03) and thick RA muscle (P ¼ 0.04). Conclusions: Thick RA muscle and advanced T stage were the common risk factors of outlet obstruction and HOS. Therefore, in high-risk patients, these complications can be prevented by choosing an appropriate ileostomy location according to RA muscle thickness and by preventing tubing into the ileostomy.

DOI： 10.9738/INTSURG-D-21-00012.1

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Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma. International journal

Kosei Takagi, Yasuo Nagai, Yuzo Umeda, Ryuichi Yoshida, Kazuhiro Yoshida, Tomokazu Fuji, Kenjiro Kumano, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

In vivo (Athens, Greece) 36 ( 2 ) 973 - 978 2022

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

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鏡視下での噴門側胃切除、胃全摘後の再建術腹腔鏡下噴門側胃切除後の観音開き法再建

西崎正彦, 黒田新士, 菊地覚次, 垣内慶彦, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) WS19 - 1 2021.12

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Papers - FUJIWARA Toshiyoshi