Faculty Profiles - TANABE Shunsuke

Papers - TANABE Shunsuke

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Risk factor of mediastinal lymph node metastasis of Siewert type I and II esophagogastric junction carcinomas. Reviewed International journal

Noriyuki Nishiwaki, Kazuhiro Noma, Tatsuo Matsuda, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Langenbeck's archives of surgery 405 ( 8 ) 1101 - 1109 2020.12

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

BACKGROUND: Incidence of esophagogastric junction (EGJ) carcinoma has been increasing worldwide. Several studies revealed that the distance from the EGJ to the proximal edge of the primary tumor (esophageal invasion: EI) may be a significant indicator of metastasis in the mediastinal lymph nodes in patients with Siewert type II carcinomas. However, few studies have been conducted in patients with carcinomas located at Siewert type II sequentially to upper carcinomas (Siewert type I) for mediastinal metastasis regardless of histological types. METHODS: This was a single-center retrospective cohort study. EGJ carcinomas located at Siewert type I and II regions including both squamous cell carcinoma (SCC) and adenocarcinoma were analyzed in terms of lymph node metastasis patterns. RESULTS: We included 121 patients in this study. Thirty-three (27.3%) patients had SCC. In multivariate analysis, the distance of EI (> 20 mm) was an independent risk factor (OR 11.80, p = 0.005) for lower mediastinal lymph node metastasis. In terms of above the middle mediastinal metastasis, the distance of EI (> 30 m), histological type (SCC), and tumor size (> 40 mm) were risk factors in univariate analysis. Furthermore, EI was significant (OR 13.50, p = 0.026) in multivariate analysis. CONCLUSIONS: The distance of EI was the independent risk factor for mediastinal lymph node metastasis, especially > 20 mm related with a higher risk for mediastinal lymph node metastasis. Furthermore, EGJ carcinoma patients who have EI > 30 mm, large SCC carcinoma, and multiple lymph node metastasis might be considered the middle-upper mediastinal lymph node dissection by transthoracic approach.

DOI： 10.1007/s00423-020-02017-4

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再手術症例から学ぶ形成外科的手技を用いた合併症回避のための術式の工夫

松本洋, 太田智之, 川本幸司, 木股敬裕, 白川靖博, 野間和広, 田邊俊介, 前田直見, 藤原俊義

日本食道学会学術集会プログラム・抄録集 74回 327 - 327 2020.12

消化器外科におけるロボット支援下手術ロボット支援下低侵襲食道切除術の現状と展望(Robotic surgery in the field of gastroenterological surgery Current status and perspective of robot-assisted minimally invasive esophagectomy for cancer)

Shirakawa Yasuhiro, Noma Kazuhiro, Kawasaki Kento, Nishie Naoki, Yamada Motohiko, Maeda Naoaki, Tanabe Shunsuke, Kuroda Shinji, Umeda Yuzo, Fujiwara Toshiyoshi

日本消化器外科学会総会 75回 VSY9 - 3 2020.12

食道癌の治療戦略食道胃接合部癌に対する術前化学療法治療効果予測因子の解析

野間和広, 赤井正明, 前田直見, 菊地覚次, 田邊俊介, 黒田新士, 楳田祐三, 西崎正彦, 香川俊輔, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 58回 WS24 - 5 2020.10

女性に発症した食道扁平上皮癌の臨床病理学的特徴に関する検討

松枝真由, 川野誠司, 岡上昇太郎, 里見拓也, 岡本雄貴, 大林由佳, 濱田健太, 馬場雄己, 榮浩行, 安倍真, 神崎洋光, 岩室雅也, 河原祥朗, 田邊俊介, 白川靖博, 藤原俊義, 田中健大, 岡田裕之

日本消化器病学会雑誌 117 ( 臨増大会 ) A693 - A693 2020.10

High incidence of tracheobronchial diverticulum in esophageal cancer patients: a retrospective survey alerting pitfall during thoracoscopic esophagectomy. Reviewed

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

General thoracic and cardiovascular surgery 68 ( 9 ) 1018 - 1023 2020.9

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

OBJECTIVES: Although tracheobronchial diverticulum (DV) rarely cause problems, attention should be paid during esophagectomy, which requires careful dissection around the trachea and bronchi. Here, we retrospectively review cases of tracheobronchial DVs among esophageal cancer patients and report two cases of bronchial DV injury during thoracoscopic esophagectomy that were successfully repaired. METHODS: The thin-section CT images of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2013 to December 2015 were retrospectively reviewed. The localization, number, and size (largest axial diameter) of all detected DVs were recorded. RESULTS: A total of 180 patients were enrolled in this study. The incidence of tracheal DV was 5.0%, and that of bronchial DV was 40.0%. The median diameter of the tracheal diverticula was 2.45 [interquartile range (IQR) 2.00-8.17] mm and that of the bronchial diverticula was 1.90 (IQR 1.51-2.46) mm. All tracheal diverticula presented at the right tracheal wall 4.5-6.0 cm below the vocal cords; bronchial diverticula presented at the subcarinal lesions. We experienced two cases with bronchial diverticulum injuries during thoracoscopic esophagectomy, which were repaired by primary closure and confirmed that there was no air leak. No postoperative complications associated with bronchial injury occurred in either patient. CONCLUSION: Since tracheobronchial DVs are not as rare as previously thought, careful evaluation of thin-slice CT scans is necessary before thoracoscopic esophagectomy. If a tracheobronchial DV is injured during surgery, it is important to carefully repair it and confirm that there is no air leak to avoid complications.

DOI： 10.1007/s11748-020-01421-3

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[Esophageal Reconstruction with Vascular Anastomosis and Perioperative Management].

Shunsuke Tanabe, Yasuhiro Shirakawa

Kyobu geka. The Japanese journal of thoracic surgery 73 ( 10 ) 887 - 891 2020.9

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

Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility. When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis.

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有茎広背筋弁移植による胸部食道癌術後気管瘻の予防

太田智之, 松本洋, 前田直見, 田邊俊介, 野間和広, 白川靖博, 藤原俊義, 木股敬裕

頭頸部癌 46 ( 2 ) 180 - 180 2020.7

Skeletal muscle loss in the postoperative acute phase after esophageal cancer surgery as a new prognostic factor. Reviewed International journal

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

World journal of surgical oncology 18 ( 1 ) 143 - 143 2020.6

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

BACKGROUND: The postoperative survival rate of patients with esophageal squamous cell carcinoma (ESCC) remains poor compared with other gastrointestinal cancers. We hypothesized that skeletal muscle loss in the postoperative acute phase might be a new predictor for long-term prognosis after highly invasive surgery such as ESCC surgery. METHODS: The following items were retrospectively investigated. First, whether skeletal muscle loss occurred in the postoperative acute phase of ESCC was verified. Second, the preoperative and intraoperative factors involved in skeletal muscle loss in the postoperative acute phase of ESCC were investigated. Then, whether skeletal muscle loss in the postoperative acute phase affected long-term prognosis was examined. The medical records of consecutive patients who underwent radical esophagectomy for ESCC between January 2010 and February 2015 were retrospectively reviewed; 72 cases were eligible for this study. The total psoas major muscle mass index (TPI) at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT) before surgery and 3 days after surgery. The long-term prognosis was estimated by the Kaplan-Meier method and the multivariate logistic regression model. RESULTS: There was already a significant reduction of TPI in the acute phase up to POD 3 after ESCC surgery in comparison with the preoperative baseline TPI (P < 0.001). The TPI reduction rate was significantly milder in cases with less blood loss during surgery and in cases that underwent thoracoscopic esophagectomy than in cases that underwent open esophagectomy. The 3-year overall survival rate was significantly different between the TPI reduction rate severe group and the TPI reduction rate mild group. CONCLUSION: Skeletal muscle loss occurred even in the postoperative acute phase. Furthermore, it is very significant that skeletal muscle loss in the postoperative acute phase of ESCC surgery is involved in the long-term prognosis.

DOI： 10.1186/s12957-020-01908-6

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Surgical site infection caused by Aeromonas hydrophila presenting as necrotizing soft tissue infection after esophagectomy. Reviewed International journal

Osamu Yamasaki, Eizo Takahashi, Kazuyo Noda, Nobuhiko Kanaya, Shunsuke Tanabe, Yasuhiro Shirakawa, Shin Morizane

The Journal of dermatology 47 ( 6 ) 673 - 676 2020.6

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

Several virulence factors of Aeromonas such as hemolysin, proteases and lipases have been characterized. The relationship between these virulence factors and disease remains unclear. A 71-year-old man underwent thoracoscopic esophagectomy, lymph node dissection and Roux-en-Y reconstruction for esophageal cancer. On postoperative day 1, redness around the wound on the thoracic abdominal wall gradually enlarged and necrosis became apparent with septic shock. Necrotizing soft tissue infection was suspected and emergency surgical debridement was performed. Blood and wound cultures were positive for Aeromonas hydrophila. The strain was found to have hemolytic activity, proteolytic activity and extremely high elastolytic activity. In addition, the strain actively produced elastolytic metalloprotease, which may contribute to extensive tissue necrosis.

DOI： 10.1111/1346-8138.15323

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Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study. Reviewed

Yukiko Hikasa, Satoshi Suzuki, Yuko Mihara, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of anesthesia 34 ( 3 ) 404 - 412 2020.6

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

PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

DOI： 10.1007/s00540-020-02766-y

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Induction chemoradiotherapy including docetaxel, cisplatin, and 5-fluorouracil for locally advanced esophageal cancer. Reviewed

Masashi Hashimoto, Yasuhiro Shirakawa, Naoaki Maeda, Shunsuke Tanabe, Kazuhiro Noma, Kazufumi Sakurama, Kuniaki Katsui, Masahiko Nishizaki, Toshiyoshi Fujiwara

Esophagus : official journal of the Japan Esophageal Society 17 ( 2 ) 127 - 134 2020.4

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

BACKGROUND: Locally advanced esophageal cancer (EC) invading surrounding organs (T4b) is difficult to treat. In general, definitive chemoradiotherapy (d-CRT) has been chosen as treatment for such cases. However, the outcome has not been good. Recently, the effectiveness of d-CRT with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) has been reported. Furthermore, surgery after d-CRT has a better prognosis than d-CRT alone in some reports, although it has a high risk of surgical complications. This study investigated the effectiveness and safety of induction DCF-RT. METHODS: The subjects were EC patients who underwent induction DCF-RT in Okayama University Hospital between January 2011 and December 2017. Their background characteristics, treatment details, histopathological factors, adverse events during CRT, postoperative complications, and overall survival (OS) were assessed. RESULTS: A total of 16 cases were performed induction DCF-RT. In 10 cases, death occurred, with 9 cancer-related deaths, and 1 death due to other disease. For all cases, OS was 37.5% at 3 years. 12 cases underwent esophagectomy after DCF-RT. Their OS was 50% at 3 years. 13 patients (81.3%) had Grade 3 febrile neutropenia. In 7 cases (62.5%), fasting for the treatment of diarrhea was needed. Three patients (25%) developed anastomotic leakage. Some recurrent laryngeal nerve paralysis was observed in 6 cases (50%). CONCLUSION: Although the rates of adverse events and surgical complications were slightly higher than in past reports, they were acceptable. It is useful to perform induction DCF-RT for T4b EC.

DOI： 10.1007/s10388-019-00709-5

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Flap Reconstruction for Esophageal Perforation Following Anterior Cervical Plate Fixation. Reviewed

Mio Morita, Hiroshi Matsumoto, Yasuhiro Shirakawa, Kazuhiro Noma, Shunsuke Tanabe, Yoshihiro Kimata

Acta medica Okayama 73 ( 1 ) 77 - 80 2019.2

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

Anterior cervical plate fixation is a common surgical treatment for cervical spine trauma, disc herniation, or cervical spondylosis. Esophageal perforation following anterior cervical plate fixation is a rare but serious complication. Management of esophageal perforation is controversial; however, we suggest treating most cases surgically because this condition is slow to heal and often fatal. We managed 2 cases of esophageal perforation following anterior cervical plate fixation by flap reconstruction with the pectoralis major muscle in one case and a jejunal free flap in the other. Here, we report our experience and review the surgical indications.

DOI： 10.18926/AMO/56462

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近位胃切除術後のEGJCに対するDFTを使用した弁形成食道胃吻合術(Valvutoplastic esophagogastrostomy using DFT for EGJC after proximal gastrectomy)

Nishizaki Masahiko, Kuroda Shinji, Noma Kazuhiro, Kikuchi Satoru, Kuwada Kazuya, Tanabe Shunsuke, Kagawa Shunsuke, Shirakawa Yasuhiro, Fujiwara Toshiyoshi

日本胃癌学会総会記事 91回 273 - 273 2019.2

Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Reviewed

Shinji Kuroda, Yasuhiro Choda, Shinya Otsuka, Satoshi Ueyama, Norimitsu Tanaka, Atsushi Muraoka, Shinji Hato, Toshikazu Kimura, Kohji Tanakaya, Satoru Kikuchi, Shunsuke Tanabe, Kazuhiro Noma, Masahiko Nishizaki, Shunsuke Kagawa, Yasuhiro Shirakawa, Yasuaki Kamikawa, Toshiyoshi Fujiwara

Annals of gastroenterological surgery 3 ( 1 ) 96 - 103 2019.1

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

Aim: As a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double-flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single-center studies with a limited number of cases. Methods: We conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1-year after surgery, and secondary endpoint was incidence of anastomosis-related complications. Results: Of 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1-year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra-thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44-10.9, P = 0.0109). Total incidence of anastomosis-related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis-related complications (OR: 3.93, 95% CI: 1.93-7.80, P = 0.0003). Conclusion: Double-flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well-prepared for.

DOI： 10.1002/ags3.12216

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[Forefront of perioperative team medicine for esophageal cancer surgery].

Yasuhiro Shirakawa, Shunsuke Tanabe, Toshiyoshi Fujiwara

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 116 ( 2 ) 138 - 144 2019

上部胃癌に対する再建法を考える腹腔鏡下噴門側胃切除術における観音開き法再建の中長期成績

西崎正彦, 黒田新士, 菊地覚次, 桑田和也, 津村朋子, 田邊俊介, 野間和広, 香川俊輔, 白川靖博, 藤原俊義

日本内視鏡外科学会雑誌 23 ( 7 ) WS12 - 7 2018.12

Clinical characteristics and management of gastric tube cancer after esophagectomy. Reviewed

Yasuhiro Shirakawa, Kazuhiro Noma, Naoaki Maeda, Takayuki Ninomiya, Shunsuke Tanabe, Satoru Kikuchi, Shinji Kuroda, Masahiko Nishizaki, Shunsuke Kagawa, Yoshiro Kawahara, Hiroyuki Okada, Toshiyoshi Fujiwara

Esophagus : official journal of the Japan Esophageal Society 15 ( 3 ) 180 - 189 2018.7

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

BACKGROUND: Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery. METHODS: Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively. RESULTS: Most cases were males. The median interval from TEC surgery to GTC occurrence was 57 (6.5-107.5) months. Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC. CONCLUSION: GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.

DOI： 10.1007/s10388-018-0611-2

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尾山貴徳, 野田卓男, 谷守通, 納所洋, 谷本光隆, 田邊俊介, 白川靖博

小児外科 50 ( 5 ) 520 - 524 2018.5

Language：Japanese Publisher：(株)東京医学社

4歳7ヵ月女児。食道通過障害を主訴とした。出生時に食道閉鎖症と診断され、気管食道瘻切除術、食道端々吻合、胃瘻造設術が施行されていた。生後9ヵ月頃に食道吻合部狭窄を指摘されていたが、成長により改善すると考えられ無処置であった。食事ごとに食物が詰まるため、4歳7ヵ月時に当科紹介となった。上部消化管像にて、食道中部に狭窄を認めたため、食道バルーン拡張術を施行したが、バルーンが破裂し、極めて硬い狭窄と考えられた。胸部CTにて狭窄部に比較的厚い組織を認め、RIC法にて切除可能な瘢痕組織と判断した。まず狭窄部を十字に切開し、切開した間の瘢痕組織を、スコープを回転し進めながら徐々に切除した。術後は、直後に縦隔気腫を認めたが、翌日に軽快し、術後7日目には、穿孔部は閉鎖していた。軽度の狭窄が残存していた箇所は、バルーンにて12mmまで拡張可能となった。流動食と経鼻胃管による経管栄養を併用しつつ、術後23日目に退院した。退院後は瘢痕化が完了するまでに週に1回、バルーン拡張術を行い、手押しの加圧のみで容易に拡張可能となった。食事は術後7ヵ月にはパン、ご飯、糸こんにゃくなどを摂取可能となり、狭窄は解除され瘢痕組織切除部は食道粘膜に覆われていた。術後11ヵ月には、唐揚げを通常の大きさで摂取可能となり、狭窄は認めず口側の拡張も改善した。術後約6年経過したが再狭窄は認めなかった。

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Closed LECSにおける内視鏡・腹腔鏡手技のこつ

西崎正彦, 菊地覚次, 神崎洋光, 黒田新士, 桑田和也, 田邊俊介, 野間和弘, 白川靖博, 岡田裕之, 藤原俊義

Gastroenterological Endoscopy 60 ( Suppl.1 ) 690 - 690 2018.4

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