Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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腹腔鏡下幽門側胃切除において技術認定医取得は手術成績を改善する

菊地覚次, 香川哲也, 黒田新士, 西崎正彦, 垣内慶彦, 田辺俊介, 寺石文則, 野間和広, 香川俊輔, 楳田祐三, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) MO126 - 2 2021.12

術前診断が困難であった膵炎を伴った胃異所性膵に対して腹腔鏡下胃切除を行った1例

成田周平, 菊地覚次, 垣内慶彦, 黒田新士, 西崎正彦, 田辺俊介, 野間和広, 寺石文則, 香川俊輔, 楳田祐三, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) MO200 - 7 2021.12

Initial introduction of robot-assisted, minimally invasive esophagectomy using the microanatomy-based concept in the upper mediastinum. International journal

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

Surgical endoscopy 35 ( 12 ) 6568 - 6576 2021.12

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

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

DOI： 10.1007/s00464-020-08154-7

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Paraesophageal hernia repair can decrease BNP levels. International journal

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

Surgical endoscopy 35 ( 12 ) 6921 - 6929 2021.12

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

BACKGROUND: Although the main manifestation of giant paraesophageal hernia (PEH) is disordered meal passage due to gastric torsion, the contents of the hernia sometimes squeeze the heart and lungs and induce the symptoms of respiratory or heart failure. Furthermore, the quality of life (QOL) of patients with a heavy cardiac load deteriorates. In this study, changes in a heart failure marker and symptoms of cases with a giant PEH from before to after laparoscopic surgery were examined. METHODS: Levels of brain natriuretic peptide (BNP) as a heart failure marker were measured before and after radical laparoscopic surgery in cases of type III, IV type of giant PEH. Changes of the symptoms due to heart failure were also investigated. RESULTS: A total of 75 hiatal hernia surgeries were performed in 2012-2019. Of them, 50 had a giant PEH, and 20 (40.0%) had heart failure symptoms such as fatigue and exertional dyspnea. In the giant PEH cases, BNP could be measured before and after surgery to evaluate the presence of heart failure in 23 cases; postoperative BNP levels decreased from the preoperative values in 18 of them. Furthermore, in many cases, chest symptoms also improved. CONCLUSIONS: Radical laparoscopic surgery can reduce heart failure due to giant PEH. Therefore, in addition to conventional surgical indication criteria such as vomiting and food loss, increased cardiac load may be added to the new surgical indication criteria.

DOI： 10.1007/s00464-020-08202-2

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Left Hemihepatectomy for Hepatocellular Carcinoma Following Esophagectomy with Retrosternal Gastric Tube Reconstruction for Esophageal Cancer.

Kosei Takagi, Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Kazuhiro Yoshida, Yasuo Nagai, Kazuhiro Noma, Shunsuke Tanabe, Naoaki Maeda, Takahito Yagi, Toshiyoshi Fujiwara

Acta medica Okayama 75 ( 6 ) 755 - 758 2021.12

Language：English

Approximately 4% of patients with esophageal cancer develop a second primary malignancy in the upper gastrointestinal trunk. However, hepatectomy following esophagectomy for esophageal cancer has rarely been reported. We report the case of a 70-year-old man who underwent an esophagectomy for esophageal cancer with retrosternal gastric tube reconstruction. Nine years later, he developed hepatocellular carcinoma with tumor thrombus involving the left portal vein, and was successfully treated with left hemihepatectomy. Special attention should be paid to avoiding incidental injury of the gastric tube as well as the right gastroepiploic artery during the hepatectomy.

DOI： 10.18926/AMO/62818

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Multiple Hepatolithiasis Following Hepaticojejunostomy Successfully Treated with Left Hemihepatectomy and Double Hepaticojejunostomy Reconstruction.

Yasuo Nagai, Kosei Takagi, Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

Acta medica Okayama 75 ( 6 ) 735 - 739 2021.12

Language：English

Surgical intervention for hepatolithiasis following hepaticojejunostomy (HJ) has rarely been reported. Herein, we present a case of post-HJ multiple hepatolithiasis treated with left hemihepatectomy with double HJ reconstruction. A 72-year-old woman who had undergone HJ for iatrogenic bile duct injury developed repeated cholangitis due to complicated hepatolithiasis accompanied by an atrophied left hepatic lobe and HJ stricture. Since endoscopic intervention was unsuccessful, the patient underwent left hemihepatectomy with HJ re-anastomoses of the common hepatic duct and left hepatic duct (double HJ technique). The double HJ technique with hepatectomy can be a useful option for treating complicated hepatolithiasis following HJ.

DOI： 10.18926/AMO/62814

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Concordance of acquired mutations between metastatic lesions and liquid biopsy in metastatic colorectal cancer. International journal

Fumitaka Taniguchi, Akihiro Nyuya, Toshiaki Toshima, Kazuya Yasui, Yoshiko Mori, Makoto Okawaki, Hiroyuki Kishimoto, Yuzo Umeda, Toshiyoshi Fujiwara, Hiroaki Tanioka, Yoshiyuki Yamaguchi, Ajay Goel, Takeshi Nagasaka

Future science OA 7 ( 10 ) FSO757 2021.12

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

Aim: To evaluate whether PCR-reverse sequence-specific oligonucleotide can examine the concordance between liquid biopsy and metastatic lesions with acquired resistance. Materials & methods: We examined acquired mutations in chemoresistant lesions and blood obtained from four patients with RAS wild-type metastatic colorectal cancer who underwent treatment with anti-epidermal growth factor receptor antibodies. Results: In one patient, metastatic lesions harbored diverse acquired mutations in KRAS in all seven metastases; the two acquired mutations were detectable in blood collected after the patient acquired resistance. None of the other patients exhibited liquid biopsy mutations, except one, with a BRAF mutation confirmed in primary tumor and peritoneal dissemination. Conclusion: Liquid biopsy based on PCR-reverse sequence-specific oligonucleotide is a successful procedure for capturing acquired mutations with precise information on the RAS mutational spectrum.

DOI： 10.2144/fsoa-2021-0059

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【conversion surgeryのすべて切除不能を切除可能に!】切除不能大腸癌肝転移に対するconversion surgery

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

消化器外科 44 ( 13 ) 1897 - 1913 2021.12

術中ドプラ超音波腹腔鏡により腹腔動脈の乱流と流速を評価した正中弓状靱帯圧迫症候群の1例

吉田有佑, 矢野修也, 菊地覚次, 高木弘誠, 高橋利明, 垣内慶彦, 武田正, 重安邦俊, 近藤喜太, 黒田新士, 野間和広, 寺石文則, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) MO073 - 7 2021.12

大腸癌術前Frail評価と腹腔鏡手術高Frail大腸癌患者に対する周術期管理チーム介入により腹腔鏡手術の安全性は向上したか

寺石文則, 成田周平, 武田正, 高橋利明, 吉田有佑, 重安邦俊, 矢野修也, 近藤喜太, 黒田新士, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) WS24 - 7 2021.12

術前CAPOX+RTを施行した局所進行直腸癌に対する鏡視下手術成績の検討

武田正, 寺石文則, 高橋利明, 成田周平, 吉田有佑, 垣内慶彦, 重安邦俊, 菊地覚次, 矢野修也, 近藤喜太, 黒田新士, 野間和広, 楳田祐三, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) MO206 - 3 2021.12

輪状膵を伴う進行胃癌において術式変更にて術中対応した腹腔鏡補助下幽門側胃切除を施行した1例

高橋利明, 垣内慶彦, 菊地覚次, 黒田新士, 武田正, 矢野修也, 重安邦俊, 近藤喜太, 寺石文則, 西崎正彦, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) MO123 - 9 2021.12

横行結腸・脾彎曲・下行結腸癌に対する郭清手技と治療成績脾彎曲結腸脾彎曲進行癌D3は下腸間膜静脈を軸にする腸間膜化を行うと郭清範囲が明確になる

矢野修也, 重安邦俊, 近藤喜太, 寺石文則, 黒田新士, 菊地覚次, 吉田有佑, 垣内慶彦, 武田正, 野間和広, 楳田祐三, 西崎正彦, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) PD17 - 3 2021.12

食道胃接合部癌に対する鏡視下手術と再建術:胃外科vs食道外科の立場より食道食道浸潤が2cmを超える食道胃接合部進行癌に対する胸腔鏡下操作を先行した手術手技

白川靖博, 久保田哲史, 石田道拡, 丁田泰宏, 松川啓義, 井谷史嗣, 岡島正純, 塩崎滋弘, 橋本将志, 前田直見, 田辺俊介, 野間和広, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) SY1 - 5 2021.12

定型的鏡視下食道癌根治術:術後合併症回避のための適切な剥離層を目指して左反回神経麻痺軽減のための適切な剥離層の確保

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

日本内視鏡外科学会雑誌 26 ( 7 ) PD6 - 3 2021.12

右胸腔アプローチ困難例に対する縦隔鏡下食道切除術の治療成績

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

日本内視鏡外科学会雑誌 26 ( 7 ) MO251 - 6 2021.12

胸腔鏡手術の利点を活かした食道癌サルベージ手術の治療成績

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

日本内視鏡外科学会雑誌 26 ( 7 ) MO249 - 3 2021.12

ロボット支援食道切除術の工夫と周術期治療成績ロボット支援下手術による立体的微細解剖の理解を基礎とした安全で合理的な食道上縦隔郭清術

野間和広, 橋本将志, 最所公平, 前田直見, 田辺俊介, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) WS21 - 5 2021.12

食道裂孔ヘルニアに対する腹腔鏡下手術食道裂孔ヘルニアの腹腔鏡下根治手術による心負荷軽減への貢献

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

日本内視鏡外科学会雑誌 26 ( 7 ) WS27 - 6 2021.12

地域基幹病院における高難度鏡視下手術の安全な実践と後進への教育について地域基幹病院での高難度鏡視下手術に対するCadaver Surgical Trainingの意義

近藤喜太, 前田直見, 矢野修也, 菊地覚次, 田辺俊介, 黒田新士, 野間和広, 吉田龍一, 楳田祐三, 寺石文則, 西崎正彦, 香川俊輔, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) CSY11 - 6 2021.12

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Papers - FUJIWARA Toshiyoshi