Updated on 2024/02/01

写真a

 
Takagi Kosei
 
Organization
Okayama University Hospital Special-Appointment Assistant Professor
Position
Special-Appointment Assistant Professor
External link

Degree

  • 博士(医学) ( 岡山大学 )

 

Papers

  • ASO Author Reflections: The Role of Robotic Surgery in Patients with Portal Annular Pancreas. International journal

    Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Yuzo Umeda, Toshiyoshi Fujiwara

    Annals of surgical oncology   2023.12

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    DOI: 10.1245/s10434-023-14778-5

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  • Robotic Pancreatoduodenectomy in Portal Annular Pancreas Using a Hanging Maneuver with Indocyanine Green Fluorescence Imaging. International journal

    Kosei Takagi, Tomokazu Fuji, Motohiko Yamada, Jiro Kimura, Kazuya Yasui, Yuzo Umeda, Toshiyoshi Fujiwara

    Annals of surgical oncology   2023.12

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    BACKGROUND: Sufficient knowledge and surgical management of portal annular pancreas (PAP) are essential for pancreatic surgery. As PAP is a relatively rare pancreatic anomaly, few studies have described surgical techniques for patients with PAP undergoing robotic pancreatoduodenectomy (RPD). PATIENTS AND METHODS: An 82-year-old female patient who underwent RPD presented with distal cholangiocarcinoma and type III PAP (the fusion of the uncinate process with the anteportal main pancreatic duct). After the Kocher maneuver and stomach transection, the pancreas was transected into the neck of the anteportal portion. The retroportal portion was dissected, encircled with hanging tape, and compressed. Blood supply from the mesenteric vessels was confirmed using indocyanine green (ICG) fluorescence imaging. Subsequently, the retroportal portion was stapled. CONCLUSIONS: This study demonstrates a unique surgical technique for type III PAP using the hanging maneuver with ICG fluorescence imaging. Surgeons should decide on the surgical strategy on the basis of the fusion and ductal anatomy of the pancreas.

    DOI: 10.1245/s10434-023-14685-9

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  • Robotic Pancreaticoduodenectomy Using the Right Posterior Superior Mesenteric Artery Approach. International journal

    Kosei Takagi, Yuzo Umeda, Tomokazu Fuji, Kazuya Yasui, Toshiyoshi Fujiwara

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   2023.8

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    DOI: 10.1007/s11605-023-05806-6

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  • Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures. International journal

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

    Langenbeck's archives of surgery   408 ( 1 )   284 - 284   2023.7

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    PURPOSE: Biliary reconstruction remains a technically demanding and complicated procedure in minimally invasive hepatopancreatobiliary surgeries. No optimal hepaticojejunostomy (HJ) technique has been demonstrated to be superior for preventing biliary complications. This study aimed to investigate the feasibility of our unique technique of posterior double-layer interrupted sutures in robotic HJ. METHODS: We performed a retrospective analysis of a prospectively collected database. Forty-two patients who underwent robotic pancreatoduodenectomy using this technique between September 2020 and November 2022 at our center were reviewed. In the posterior double-layer interrupted technique, sutures were placed to bite the bile duct, posterior seromuscular layer of the jejunum, and full thickness of the jejunum. RESULTS: The median operative time was 410 (interquartile range [IQR], 388-478) min, and the median HJ time was 30 (IQR, 28-39) min. The median bile duct diameter was 7 (IQR, 6-10) mm. Of the 42 patients, one patient (2.4%) had grade B bile leakage. During the median follow-up of 12.6 months, one patient (2.4%) with bile leakage developed anastomotic stenosis. Perioperative mortality was not observed. A surgical video showing the posterior double-layer interrupted sutures in the robotic HJ is included. CONCLUSIONS: Posterior double-layer interrupted sutures in robotic HJ provided a simple and feasible method for biliary reconstruction with a low risk of biliary complications.

    DOI: 10.1007/s00423-023-03020-1

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  • 【肝胆膵】膵頭十二指腸切除術後膵液瘻の克服を目指した工夫 膵頭十二指腸切除術のハイリスク膵空腸吻合におけるロボット支援下手術の役割

    藤 智和, 高木 弘誠, 楳田 祐三, 吉田 龍一, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 藤原 俊儀

    日本消化器外科学会総会   78回   WS32 - 7   2023.7

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  • 【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略 血中循環腫瘍DNA内KRAS mutation profileとCA19-9値を組み合わせた膵癌予後の層別化戦略

    安井 和也, 吉田 龍一, 宮本 耕吉, 藤 智和, 高木 弘誠, 寺石 文則, 黒田 新士, 野間 和広, 楳田 祐三, 藤原 俊義

    日本消化器外科学会総会   78回   WS30 - 10   2023.7

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  • 非大腸癌由来の少数肝転移症例の切除適応を見極める

    岡田 尚大, 藤 智和, 楳田 祐三, 吉田 龍一, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 藤原 俊義

    日本消化器外科学会総会   78回   O11 - 6   2023.7

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  • 【肝胆膵】膵頭十二指腸切除術後膵液瘻の克服を目指した工夫 膵頭十二指腸切除術のハイリスク膵空腸吻合におけるロボット支援下手術の役割

    藤 智和, 高木 弘誠, 楳田 祐三, 吉田 龍一, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 藤原 俊儀

    日本消化器外科学会総会   78回   WS32 - 7   2023.7

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  • 非大腸癌由来の少数肝転移症例の切除適応を見極める

    岡田 尚大, 藤 智和, 楳田 祐三, 吉田 龍一, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 藤原 俊義

    日本消化器外科学会総会   78回   O11 - 6   2023.7

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  • 【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略 血中循環腫瘍DNA内KRAS mutation profileとCA19-9値を組み合わせた膵癌予後の層別化戦略

    安井 和也, 吉田 龍一, 宮本 耕吉, 藤 智和, 高木 弘誠, 寺石 文則, 黒田 新士, 野間 和広, 楳田 祐三, 藤原 俊義

    日本消化器外科学会総会   78回   WS30 - 10   2023.7

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  • The Feasibility, Proficiency, and Mastery Learning Curves in 635 Robotic Pancreatoduodenectomies Following A Multicenter Training Program: 'Standing on the Shoulders of Giants'. International journal

    Maurice J W Zwart, Bram van den Broek, Nine de Graaf, J Annelie Suurmeijer, Simone Augustinus, Wouter W Te Riele, Hjalmar C van Santvoort, Jeroen Hagendoorn, Inne H M Borel Rinkes, Jacob L van Dam, Kosei Takagi, T C Khé Tran, Jennifer Schreinemakers, George van der Schelling, Jan H Wijsman, Roeland F de Wilde, Sebastiaan Festen, Freek Daams, Misha D Luyer, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Daan J Lips, M Abu Hilal, Olivier R Busch, Olivier Saint-Marc, Herbert J Zeh 3rd, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, I Quintus Molenaar, Marc G Besselink

    Annals of surgery   278 ( 6 )   e1232-e1241   2023.6

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    OBJECTIVE: To assess the feasibility, proficiency, and mastery learning curves for RPD in 'second generation' RPD centers following a multicenter training program adhering to the IDEAL framework. BACKGROUND: The long learning curves for robotic pancreatoduodenectomy (RPD) reported from 'pioneering' expert centers may discourage centers interested in starting a RPD program. However, the feasibility, proficiency, and mastery learning curves may be shorter in 'second generation' centers who participated in dedicated RPD training programs, although data are lacking. We report on the learning curves for RPD in 'second generation' centers trained in a dedicated nationwide program. METHODS: Post-hoc analysis of all consecutive patients undergoing RPD in seven centers that participated in the LAELAPS-3 training program, each with a minimum annual volume of 50 pancreatoduodenectomies, using the mandatory Dutch Pancreatic Cancer Audit (March 2016-December 2021). Cumulative sum (CUSUM) analysis determined cut-offs for the three learning curves: operative time for the feasibility (1), risk-adjusted major complication (Clavien-Dindo grade ≥III) for the proficiency (2), and textbook outcome for the mastery (3) learning curve. Outcomes before and after the cut-offs were compared for the proficiency and mastery learning curves. A survey was used to assess changes in practice and the most valued 'lessons learned'. RESULTS: Overall, 635 RPD were performed by 17 trained surgeons, with a conversion rate of 6.6% (n=42). The median annual volume of RPD per center was 22.5±6.8. From 2016-2021, the nationwide annual use of RPD increased from 0% to 23% whereas the use of laparoscopic PD decreased from 15% to 0%. The rate of major complications was 36.9% (n=234), surgical site infection (SSI) 6.3% (n=40), postoperative pancreatic fistula (grade B/C) 26.9% (n=171), and 30-day/in-hospital mortality 3.5% (n=22). Cut-offs for the feasibility, proficiency, and mastery learning curves were reached at 15, 62, and 84 RPD. Major morbidity and 30-day/in-hospital mortality did not differ significantly before and after the cut-offs for the proficiency and mastery learning curves. Previous experience in laparoscopic pancreatoduodenectomy shortened the feasibility (-12 RPDs, -44%), proficiency (-32 RPDs, -34%), and mastery phase learning curve (-34 RPDs, -23%), but did not improve clinical outcome. CONCLUSIONS: The feasibility, proficiency, and mastery learning curves for RPD at 15, 62, and 84 procedures in 'second generation' centers after a multicenter training program were considerably shorter as previously reported from 'pioneering' expert centers. The learning curve cut-offs and prior laparoscopic experience did not impact major morbidity and mortality. These findings demonstrate the safety and value of a nationwide training program for RPD in centers with sufficient volume.

    DOI: 10.1097/SLA.0000000000005928

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  • Impact of sarcopenia on clinical outcomes for patients with resected hepatocellular carcinoma: A retrospective comparison of eastern and western cohorts. International journal

    Berend Robert Beumer, Kosei Takagi, Stefan Buettner, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara, Jeroen Laurens Ad van Vugt, Jan Nicolas Maria IJzermans

    International journal of surgery (London, England)   109 ( 8 )   2258 - 2266   2023.5

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    BACKGROUND: Patient fitness is important for guiding treatment. Muscle mass, as a reflection thereof, can be objectively measured. However, the role of east-west differences remains unclear. Therefore, we compared the impact of muscle mass on clinical outcomes after liver resection for HCC in a Dutch (NL) and Japanese (JP) setting and evaluated the predictive performance of different cut-off values for sarcopenia. METHOD: In this multicenter retrospective cohort study patients with hepatocellular carcinoma (HCC) undergoing liver resection were included. The skeletal muscle mass index (SMI) was determined on CT scans obtained within 3 months before surgery. The primary outcome measure was overall survival (OS). Secondary outcome measures were: 90-day mortality, severe complications, length of stay, and recurrence free survival. The predictive performance of several sarcopenia cut-off values was studied using the c-index and area under the curve. Interaction terms were used to study geographic effect modification of muscle mass. RESULTS: Demographics differed between NL and JP. Gender, age, and body mass index were associated with SMI. Significant effect modification between NL and JP was found for BMI. The predictive performance of sarcopenia for both short- and long-term outcomes was higher in JP compared to NL (max c-index: 0.58 vs 0.55, respectively). However, differences between cut-off values were small. For the association between sarcopenia and OS, a strong association was found in JP (Hazard ratio (HR) 2.00 95%CI[1.230 ; 3.08], P=0.002), where this was not found in NL (0.76 [0.42 ; 1.36], P=0.351). The interaction term confirmed that this difference was significant (HR 0.37 95%CI[0.19 ; 0.73], P=0.005). CONCLUSIONS: The impact of sarcopenia on survival differs between the east and west. Clinical trials and treatment guidelines using sarcopenia for risk stratification should be validated in race-dependent populations prior to clinical adoption.

    DOI: 10.1097/JS9.0000000000000458

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  • Clinical implications and optimal extent of lymphadenectomy for intrahepatic cholangiocarcinoma: A multicenter analysis of the therapeutic index.

    Yuzo Umeda, Kosei Takagi, Tatsuo Matsuda, Tomokazu Fuji, Toru Kojima, Daisuke Satoh, Masayoshi Hioki, Yoshikatsu Endo, Masaru Inagaki, Masahiro Oishi, Takahito Yagi, Toshiyoshi Fujiwara

    Annals of gastroenterological surgery   7 ( 3 )   512 - 522   2023.5

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    AIMS: Lymph node metastases (LNM) are associated with lethal prognosis in intrahepatic cholangiocarcinoma (ICC). Lymphadenectomy is crucial for accurate staging and hopes of possible oncological treatment. However, the therapeutic implications and optimal extent of lymphadenectomy remain contentious. METHODS: To clarify the prognostic value and optimal extent of lymphadenectomy, the therapeutic index (TI) for each lymph node was analyzed for 279 cases that had undergone lymphadenectomy in a multi-institutional database. Tumor localization was divided into hilar lesions (n = 130), right peripheral lesions (n = 60), and left peripheral lesions (n = 89). In addition, the lymph node station was classified as Level 1 (LV1: hepatoduodenal ligament node), Level 2 (LV2: postpancreatic or common hepatic artery nodes), or Level 3 (LV3: gastrocardiac, left gastric artery, or celiac artery nodes). RESULTS: Lymph node metastases were confirmed in 109 patients (39%). Five-y survival rates were 45.3% for N0 disease, 27.1% for LV1-LNM, 22.9% for LV2-LNM, and 7.3% for LV3-LNM (P < 0.001). LV3-LNM were the most frequent and earliest recurrence outcome, including multisite recurrence, followed by LV2, LV1, and N0 disease. The 5-year TI (5year-TI) for lymphadenectomy was 7.2 for LV1, 5.5 for LV2, and 1.9 for LV3. Regarding tumor location, hilar lesions showed 5-year TI >5.0 in LV1 and LV2, whereas bilateral peripheral lesions showed 5-year TI > 5.0 in LV1. CONCLUSION: The implications and extent of lymphadenectomy for ICC appear to rely on tumor location. In the peripheral type, the benefit of lymphadenectomy would be limited and dissection beyond LV1 should be avoided, while in the hilar type, lymphadenectomy up to LV2 could be recommended.

    DOI: 10.1002/ags3.12642

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

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    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. 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

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    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

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

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

    Asian journal of surgery   46 ( 10 )   4399 - 4402   2023.2

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    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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  • Video Grading of Pancreatic Anastomoses During Robotic Pancreatoduodenectomy to Assess both Learning Curve and the Risk of Pancreatic Fistula - A Post Hoc Analysis of the LAELAPS-3 Training Program. International journal

    Bram L J van den Broek, Maurice J W Zwart, Bert A Bonsing, Olivier R Busch, Jacob L van Dam, Ignace H J T de Hingh, Melissa E Hogg, Misha D Luyer, J S D Mieog, Luna A Stibbe, Kosei Takagi, T C K Tran, Roeland F de Wilde, Herbert J Zeh 3rd, Amer H Zureikat, Bas Groot Koerkamp, Marc G Besselink

    Annals of surgery   278 ( 5 )   e1048-e1054   2023.1

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    OBJECTIVE: To assess the learning curve of pancreaticojejunostomy during robotic pancreatoduodenectomy(RPD) and to predict the risk of postoperative pancreatic fistula(POPF) by using the objective structured assessment of technical skills(OSATS) score, taking the fistula risk score into account. SUMMARY BACKGROUND DATA: RPD is a challenging procedure that requires extensive training and confirmation of adequate surgical performance. Video grading, modified for RPD, of the pancreatic anastomosis could assess the learning curve of RPD and predict the risk of POPF. METHODS: Post-hoc assessment of patients prospectively included in four Dutch centers in a nationwide LAELAPS-3 training program for RPD. Video grading of the pancreaticojejunostomy was performed by two graders using OSATS (attainable scores 12-60). The main outcomes were the combined OSATS of the two graders and POPF (grade B/C). CUSUM analyzed a turning point in the learning curve for surgical skill. Logistic regression determined the cut-off for OSATS. Patients were categorized for POPF risk (i.e. low, intermediate, high) based on the updated alternative fistula risk scores (uaFRS). RESULTS: Videos from 153 pancreatic anastomoses were included. Median OSATS score was 48 (IQR 41-52) points and with a turning point at 33 procedures. POPF occurred in 39 patients (25.5%). An OSATS score below 49, present in 77 patients (50.3%), was associated with an increased risk of POPF, OR 4.01, P=0.004. The POPF rate was 43.6% with OSATS < 49 versus 15.8% with OSATS ≥49. The uaFRS category "soft pancreatic texture" was the second strongest prognostic factor of POPF (OR 3.37, P=0.040). Median cumulative surgical experience was 17 years (IQR 8-21) at their first anastomosis. CONCLUSIONS: Video grading of the pancreatic anastomosis in RPD using OSATS identified a learning curve and a reduced risk of POPF in case of better surgical performance. Video grading may provide a valid method to surgical training, quality control and improvement.

    DOI: 10.1097/SLA.0000000000005796

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  • Surgical Techniques of Gastrojejunostomy in Robotic Pancreatoduodenectomy: Robot-Sewn versus Stapled Gastrojejunostomy Anastomosis. 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

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    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 &lt; 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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  • Role of Surgery for Pancreatic Ductal Adenocarcinoma in the Era of Multidisciplinary Treatment. International journal

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

    Journal of clinical medicine   12 ( 2 )   2023.1

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    The incidence and mortality rates of pancreatic ductal adenocarcinoma (PDAC) have increased in recent years worldwide [...].

    DOI: 10.3390/jcm12020465

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  • Survival Impact of Postoperative Skeletal Muscle Loss in Gastric Cancer Patients Who Underwent Gastrectomy. International journal

    Kazuya Kuwada, Satoru Kikuchi, Shinji Kuroda, Ryuichi Yoshida, Kosei Takagi, Kazuhiro Noma, Masahiko Nishizaki, Shunsuke Kagawa, Yuzo Umeda, Toshiyoshi Fujiwara

    Anticancer research   43 ( 1 )   223 - 230   2023.1

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    BACKGROUND/AIM: It has recently been recognized that preoperative sarcopenia contributes to postoperative complications and overall survival in gastric cancer (GC). However, few studies have investigated the relationship between postoperative skeletal muscle loss (SML) and survival in GC, despite the inevitability of body weight loss after gastrectomy in most GC patients. Herein, we studied the impact of postoperative SML on GC prognosis. PATIENTS AND METHODS: A total of 370 patients with GC who underwent curative gastrectomy were retrospectively evaluated in this study. Postoperative SML was assessed on computed tomography (CT) images taken before surgery and 1 year after surgery. The impact of postoperative SML on survival was evaluated. RESULTS: Postoperative severe SML was significantly associated with presence of comorbidities, higher tumor stage, higher postoperative complication rate and longer hospital stay. Univariate and multivariate analyses of prognostic factors for overall survival revealed that SML was an independent indicator of poor prognosis, along with age, tumor stage, preoperative sarcopenia, and operation time (hazard ratio, 2.65; 95% confidence interval, 1.68-4.20, p<0.0001). There was a strong association of severe postoperative SML with decreased overall survival in patients with preoperative sarcopenia. CONCLUSION: To improve the prognosis of GC patients after surgery, it is important to prevent postoperative SML as well as preoperative sarcopenia. Perioperative multimodal interventions including nutritional counseling, oral nutritional supplements, and exercise are required to prevent SML after gastrectomy.

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  • Impact of cancer-associated fibroblasts on survival of patients with ampullary carcinoma. International journal

    Kosei Takagi, Kazuhiro Noma, Yasuo Nagai, Satoru Kikuchi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Takehiro Tanaka, Hajime Kashima, Takahito Yagi, Toshiyoshi Fujiwara

    Frontiers in oncology   13   1072106 - 1072106   2023

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    BACKGROUND: Cancer-associated fibroblasts (CAFs) reportedly enhance the progression of gastrointestinal surgery; however, the role of CAFs in ampullary carcinomas remains poorly examined. This study aimed to investigate the effect of CAFs on the survival of patients with ampullary carcinoma. MATERIALS AND METHODS: A retrospective analysis of 67 patients who underwent pancreatoduodenectomy between January 2000 and December 2021 was performed. CAFs were defined as spindle-shaped cells that expressed α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP). The impact of CAFs on survival, including recurrence-free (RFS) and disease-specific survival (DSS), as well as prognostic factors associated with survival, was analyzed. RESULTS: The high-α-SMA group had significantly worse 5-year RFS (47.6% vs. 82.2%, p = 0.003) and 5-year DSS (67.5% vs. 93.3%, p = 0.01) than the low-α-SMA group. RFS (p = 0.04) and DSS (p = 0.02) in the high-FAP group were significantly worse than those in the low-FAP group. Multivariable analyses found that high α-SMA expression was an independent predictor of RFS [hazard ratio (HR): 3.68; 95% confidence intervals (CI): 1.21-12.4; p = 0.02] and DSS (HR: 8.54; 95% CI: 1.21-170; p = 0.03). CONCLUSIONS: CAFs, particularly α-SMA, can be useful predictors of survival in patients undergoing radical resection for ampullary carcinomas.

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  • 切除可能膵癌における血中循環腫瘍DNA内Kras遺伝子変異とCA19-9値による予後層別化の試み

    宮本 耕吉, 吉田 龍一, 重安 邦俊, 安井 和也, 高木 弘誠, 藤 智和, 楳田 祐三, 八木 孝仁, 藤原 俊義

    日本分子腫瘍マーカー研究会誌   38   20 - 21   2022.12

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  • Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy. International journal

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

    Journal of clinical medicine   11 ( 23 )   2022.11

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    The concept of the superior mesenteric artery (SMA)-first approach has been widely accepted in pancreatoduodenectomy. However, few studies have reported surgical approaches to the SMA in robotic pancreatoduodenectomy (RPD). Herein, we present our surgical strategies to dissect around the SMA in RPD. Among the various approaches, our standard protocol for RPD included the right approach to the SMA, which can result in complete tumor resection in most cases. In patients with malignant diseases requiring lymphadenectomy around the SMA, we developed a novel approach by combining the left and right approaches in RPD. Using this approach, circumferential dissection around the SMA can be achieved through both the left and right sides. This approach can also be helpful in patients with obesity or intra-abdominal adhesions. The present study summarizes the advantages and disadvantages of both the approaches during RPD. To perform RPD safely, surgeons should understand the different surgical approaches and select the best approach or a combination of different approaches, depending on demographic, anatomical, and oncological factors.

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  • Robotic liver resection for hepatic cyst using indocyanine green fluorescence imaging. International journal

    Kosei Takagi, Yuzo Umeda, Jiro Kimura, Takahito Yagi

    Asian journal of surgery   46 ( 4 )   1839 - 1841   2022.10

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  • Clinical impact of lipid injectable emulsion in internal medicine inpatients exclusively receiving parenteral nutrition: a propensity score matching analysis from a Japanese medical claims database. International journal

    Kosei Takagi, Kenta Murotani, Satoru Kamoshita, Akiyoshi Kuroda

    BMC medicine   20 ( 1 )   371 - 371   2022.10

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    BACKGROUND: Although guidelines recommend lipid injectable emulsions (ILEs) be used as a part of parenteral nutrition, many patients in Japan receive lipid-free parenteral nutrition. Furthermore, little is known about the effect of ILEs on clinical outcomes in medical inpatients managed with parenteral nutrition. The aim of this study was to investigate the clinical impact of ILEs on internal medicine inpatients receiving parenteral nutrition. METHODS: A propensity score matching (PSM) analysis was performed using a medical claims database covering 451 hospitals in Japan. Participants included the following internal medicine inpatients, ages ≥ 18 years, fasting > 10 days, and receiving exclusively parenteral nutrition, between 2011 and 2020. Participants were divided into 2 groups: those who did and did not receive ILEs. The primary endpoint was in-hospital mortality. The secondary endpoints included intravenous catheter infection, activities of daily living (ADL), hospital length of stay (LOS), and total medical costs. To adjust for energy doses, logistic or multiple regression analyses were performed using energy dose as an additional explanatory variable. RESULTS: After PSM, 19,602 matched pairs were formed out of 61,437 patients. The ILE group had significantly lower incidences than the non-ILE group of in-hospital mortality (20.3% vs. 26.9%; odds ratio [OR], 0.69; 95% confidence interval [CI], 0.66-0.72; p < 0.001), deteriorated ADL (10.8% vs. 12.5%; OR, 0.85; 95% CI, 0.79-0.92; p < 0.001), and shorter LOS (regression coefficient, - 0.8; 95% CI, - 1.6-0.0; p = 0.045). After adjusting for energy dose, these ORs or regression coefficients demonstrated the same tendencies and statistical significance. The mean total medical costs were $21,009 in the ILE group and $21,402 in the non-ILE group (p = 0.08), and the adjusted regression coefficient for the ILE vs. the non-ILE group was - $860 (95% CI, - $1252 to - $47). CONCLUSIONS: ILE use was associated with improved clinical outcomes, including lower in-hospital mortality, in internal medicine inpatients receiving parenteral nutrition.

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  • Current status and future perspectives of minimally invasive and open radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma: a review

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

    Laparoscopic Surgery   6   39 - 39   2022.10

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    DOI: 10.21037/ls-22-39

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  • 膵がんの治療成績は向上したか? 切除可能膵癌に対するNAC-GS療法は予後を改善したか? 非切除例を含む全コホート解析

    安井 和也, 吉田 龍一, 楳田 祐三, 藤 智和, 高木 弘誠, 宮本 耕吉, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本癌治療学会学術集会抄録集   60回   OWS15 - 5   2022.10

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  • Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique. International journal

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

    Digestive surgery   39 ( 4 )   137 - 140   2022.9

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    Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.

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  • 切除可能膵癌における血中循環腫瘍DNA内Kras遺伝子変異とCA19-9値による予後層別化の試み

    宮本 耕吉, 吉田 龍一, 重安 邦俊, 安井 和也, 高木 弘誠, 藤 智和, 楳田 祐三, 八木 孝二, 藤原 俊義

    日本分子腫瘍マーカー研究会プログラム・講演抄録   42回   78 - 79   2022.9

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  • Surgical Strategies to Approaching the Splenic Artery in Robotic Distal Pancreatectomy. International journal

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

    Anticancer research   42 ( 9 )   4471 - 4476   2022.9

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    BACKGROUND/AIM: Understanding different surgical approaches and anatomical landmarks adjacent to the splenic artery (SpA) is important for safe robotic distal pancreatectomy (RDP). Herein, we propose our standardized RDP techniques, focusing on these issues. PATIENTS AND METHODS: Between April 2021 and April 2022, 19 patients who underwent RDP at our Institution were reviewed. Anatomical patterns of the SpA were classified into three types: Type 1, no pancreatic parenchyma on the root of the SpA; type 2, any pancreatic parenchyma on the root of the SpA; and type 3, dorsal pancreatic artery around the bifurcation of the common hepatic artery and SpA. Next, the surgical strategy for approaching the SPA was determined according to the location of the pancreatic transection line: On the superior mesenteric vein (SMV) or on the left side of the root of the SpA. RESULTS: There were seven cases of type 1, nine cases of type 2, and three cases of type 3. When transecting the pancreas on the SMV, the SpA-first ligation technique was used for type 1 SpA anatomy, and the pancreas-first division technique was applied for types 2 and 3. In patients in whom the pancreas was transected at the left side of the root of the SpA, the SpA-first ligation technique was used. CONCLUSION: Our standardized surgical strategy based on anatomical landmarks and focusing on the approach to the SpA in RDP is demonstrated. Our strategy should help trainees approach the SpA and perform RDP safely.

    DOI: 10.21873/anticanres.15947

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  • 切除可能膵癌における血中循環腫瘍DNA内Kras遺伝子変異とCA19-9値による予後層別化の試み

    宮本 耕吉, 吉田 龍一, 重安 邦俊, 安井 和也, 高木 弘誠, 藤 智和, 楳田 祐三, 八木 孝二, 藤原 俊義

    日本分子腫瘍マーカー研究会プログラム・講演抄録   42回   78 - 79   2022.9

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  • Dose-Dependent Effects of Amino Acids on Clinical Outcomes in Adult Medical Inpatients Receiving Only Parenteral Nutrition: A Retrospective Cohort Study Using a Japanese Medical Claims Database. International journal

    Kosei Takagi, Kenta Murotani, Satoru Kamoshita, Akiyoshi Kuroda

    Nutrients   14 ( 17 )   2022.8

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    The majority of inpatients requiring parenteral nutrition (PN) do not receive adequate amino acid, which may negatively impact clinical outcomes. We investigated the influence of amino acid doses on clinical outcomes in medical adult inpatients fasting &gt;10 days and receiving only PN, using Japanese medical claims database. The primary endpoint was in-hospital mortality, and the secondary endpoints included deterioration of activities of daily living (ADL), intravenous catheter infection, hospital readmission, hospital length of stay (LOS), and total medical costs. Patients were divided into four groups according to their mean prescribed daily amino acid doses from Days 4 to 10 of fasting: Adequate (≥0.8 g/kg/day), Moderate (≥0.6-&lt;0.8 g/kg/day), Low (≥0.4-&lt;0.6 g/kg/day), and Very low (&lt;0.4 g/kg/day). Multivariate logistic or multiple regression analyses were performed with adjustments for patient characteristics (total n = 86,702). The Adequate group was used as the reference in all analyses. For the Moderate, Low, and Very low groups, adjusted ORs (95% CI) of in-hospital mortality were 1.20 (1.14-1.26), 1.43 (1.36-1.51), and 1.72 (1.62-1.82), respectively, and for deterioration of ADL were 1.21 (1.11-1.32), 1.34 (1.22-1.47), and 1.22 (1.09-1.37), respectively. Adjusted regression coefficients (95% CI) of hospital LOS were 1.2 (0.4-2.1), 1.5 (0.6-2.4), and 2.9 (1.8-4.1), respectively. Lower prescribed doses of amino acids were associated with worse clinical outcomes including higher in-hospital mortality.

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  • 【肝胆膵】大腸癌肝転移におけるBRとURの定義 BR大腸癌肝転移に対する肝切除アプローチ Vessel-Skeletonized Parenchyma-sparing Hepatectomyの有用性

    楳田 祐三, 藤 智和, 高木 弘誠, 安井 和也, 黒田 新士, 吉田 龍一, 野間 和広, 寺石 文則, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   77回   PD1 - 10   2022.7

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  • Impact of Amino Acids Nutrition Following Gastrectomy in Gastric Cancer Patients. International journal

    Satoru Kikuchi, Nobuo Takata, Shinji Kuroda, Hibiki Umeda, Shunsuke Tanabe, Naoaki Maeda, Kosei Takagi, Kazuhiro Noma, Yuko Hasegawa, Kumiko Nawachi, Shunsuke Kagawa, Yuzo Umeda, Kenichi Shikata, Toshiyoshi Fujiwara

    Anticancer research   42 ( 7 )   3637 - 3643   2022.7

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    BACKGROUND/AIM: Postoperative body weight loss (BWL) and skeletal muscle loss (SML) after gastrectomy are associated with a decline in quality of life and worse longterm prognosis in gastric cancer (GC) patients. This study aimed to evaluate the efficacy of amino acids nutrition on BWL and SML in the early period following gastrectomy. PATIENTS AND METHODS: The parameters of body composition were measured by bioelectrical impedance analysis in the patients undergoing radical gastrectomy for GC and analyzed retrospectively. Patients received either peripheral parenteral nutrition (PPN) of 4.3% glucose fluid with regular diet (control group, n=43) or PPN of 7.5% glucose fluid containing amino acids plus oral nutritional supplement (ONS) rich in protein with regular diet (amino acids group, n=40) following gastrectomy. The percentages of BWL and SML from preoperative values to those at 7 days and 1 month after surgery were compared between the two groups. RESULTS: The %BWL and %SML at 7 days after surgery were significantly lower in the amino acids group than those in the control group (%BWL, -2.4±1.7% vs. -4.2±1.8%; p<0.0001, %SML, -4.1±3.8 vs. -6.5±3.8; p=0.006). Moreover, the %BWL at 1 month after surgery was significantly lower in the amino acids group compared to that in the control group (- 4.6±2.9% vs. -6.1±2.6%; p=0.01); however, the %SML was similar between the two groups. The hematological nutritional parameters were similar between the two groups. CONCLUSION: Amino acids nutrition by PPN and ONS following gastrectomy prevented postoperative BWL and SML in the early period after surgery in GC patients.

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  • Favorable control of hepatocellular carcinoma with peritoneal dissemination by surgical resection using indocyanine green fluorescence imaging: a case report and review of the literature. International journal

    Yuma Tani, Hiroki Sato, Ryuichi Yoshida, Kazuya Yasui, Yuzo Umeda, Kazuhiro Yoshida, Tomokazu Fuji, Kenjiro Kumano, Kosei Takagi, Masaaki Kagoura, Takahito Yagi, Toshiyoshi Fujiwara

    Journal of medical case reports   16 ( 1 )   222 - 222   2022.6

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    BACKGROUND: The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control. CASE PRESENTATION: A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively. CONCLUSION: When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection.

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  • Adenomatoid mesothelioma arising from the diaphragm: a case report and review of the literature. International journal

    Kenta Kawabe, Hiroki Sato, Akiko Kitano, Ryuichi Yoshida, Kazuya Yasui, Yuzo Umeda, Kazuhiro Yoshida, Tomokazu Fuji, Kenjiro Kumano, Kosei Takagi, Masaaki Kagoura, Takahito Yagi, Toshiyoshi Fujiwara

    Journal of medical case reports   16 ( 1 )   228 - 228   2022.5

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    BACKGROUND: Adenomatoid mesothelioma is a rare subtype of malignant mesothelioma that can be confused with adenomatoid tumors, which are classified as benign. The clinical features and optimal management of adenomatoid mesothelioma have not been elucidated in the literature. In this report, we present an extremely rare case of adenomatoid mesothelioma that developed on the peritoneal surface of the diaphragm as well as a literature review of adenomatoid mesothelioma in the abdominal cavity. CASE PRESENTATION: The patient was a 61-year-old Japanese woman who had undergone resection of a malignant peripheral nerve sheath tumor of the hand 18 years prior. She was diagnosed with clinical stage I lung adenocarcinoma on follow-up chest radiography. Simultaneously, a 20-mm enhancing nodule with slow growth on the right diaphragm was detected on contrast-enhanced computed tomography. She presented no specific clinical symptoms. At this point, the lesion was suspected to be a hypervascular tumor of borderline malignancy, such as a solitary fibrous tumor. After a left upper lobectomy for lung adenocarcinoma, she was referred to our department, and laparoscopic tumor resection was performed. Adenomatoid tumors were also considered based on the histopathological and immunohistochemical analyses, but we made the final diagnosis of adenomatoid mesothelioma using the results of the genetic profile. The patient remains alive, with no recurrence noted 6 months after surgery. CONCLUSION: We encountered a valuable case of adenomatoid mesothelioma of peritoneal origin. There are some previously reported cases of adenomatoid mesothelioma and adenomatoid tumors that may need to be recategorized according to the current classification. It is important to accumulate and share new findings to clarify the clinicopathological characteristics and genetic status of adenomatoid mesothelioma.

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  • Optimal surveillance of intraductal papillary mucinous neoplasms of the pancreas focusing on remnant pancreas recurrence after surgical resection. International journal

    Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Kazuyuki Matsumoto, Hironari Kato, Takahito Yagi, Toshiyoshi Fujiwara

    BMC cancer   22 ( 1 )   588 - 588   2022.5

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    BACKGROUND: The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence, including de novo lesions, is essential, optimal surveillance protocols have not been established. AIM AND METHODS: This study aimed to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one patients of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence. RESULTS: The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n = 42), high-grade dysplasia (HAD, n = 19), and invasive carcinoma (IPMC, n = 30). Recurrence was observed in 26 patients (29%), of which recurrence was seen at Rem-Panc in 19 patients (21%) and Ex-Panc in 7 patients (8%). The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs. 35 months, p < 0.001; median OS 25 months vs. 72 months, p < 0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no repeat pancreatectomy (MST 36 months vs. 15.5 months, p = 0.033). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p = 0.002) and positive surgical margin (HR 4.4, p = 0.018) were identified as risk factors for Rem-Panc recurrence. CONCLUSIONS: The risk factors for Rem-Panc and Ex-Panc recurrence differ. Therefore, optimal surveillance on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.

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  • Feasibility of local therapy for recurrent pancreatic cancer. International journal

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

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]   22 ( 6 )   774 - 781   2022.5

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    BACKGROUND: Despite advances in perioperative management, recurrence after curative pancreatectomy is a critical issue in the treatment of pancreatic ductal adenocarcinoma (PDAC). The significance of local therapy for recurrent PDAC remains unclear. METHODS: We reviewed the medical records of patients with PDAC who underwent curative resection at our institution between January 2009 and December 2019. We examined the patterns of relapse and assessed the clinical outcomes of patients with recurrence who underwent local therapy, including surgical resection, radiotherapy, and radiofrequency ablation. RESULTS: A total of 246 patients with PDAC who underwent R0 or R1 resection were included in this study. The 3-year overall survival (OS) rate was 39.8%, and the 1-year recurrence-free survival rate was 51.2% for the entire population. Recurrence was observed in 172/246 (69.9%) patients, including multiple site recurrences in 50, liver metastasis in 41, locoregional recurrence in 34, and peritoneal dissemination in 27. Of the 172 patients, treatment was administered in 137 (79.7%), and 16 received local therapy, including surgical resection (n = 13), radiotherapy (n = 5), and RFA (n = 1). PS-matched analysis revealed that patients with recurrence who were treated with chemotherapy combined with local therapy showed better post-recurrence survival rates than those treated with chemotherapy alone (P = 0.016). Detailed clinical courses of these patients are presented in the main manuscript. CONCLUSIONS: Our results suggest that a multimodal approach may improve the clinical outcomes of patients with recurrent PDAC.

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  • Prognostic Value of the Regional Lymph Node Station in Pancreatic Neuroendocrine Tumor. International journal

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

    Anticancer research   42 ( 5 )   2797 - 2801   2022.5

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    BACKGROUND/AIM: Little is known regarding the impact of lymph node dissection on survival benefit after curative resection for pancreatic neuroendocrine tumor (PNET). This study aimed to evaluate the efficacy of lymph node dissection based on tumor location of PNET. PATIENTS AND METHODS: A retrospective study, including 50 patients with surgical resection for PNET between 2004 and 2020, was performed. The efficacy index (EI) was calculated by multiplication of the incidence of lymph node metastasis (LNM) at the station and the 5-year survival rate of patients with LNM at the station. RESULTS: In the pancreatic head tumors, the peri-pancreatic head and superior mesenteric artery lymph node stations had high EI of 13.3 and 25, respectively. In contrast, other stations, including stations 8 and 12, had zero EI. In the pancreatic body and tail tumors, only the splenic artery lymph node station had a survival benefit from lymph node dissection with an EI of 6.7. CONCLUSION: The extent of lymph node dissection for PNET should be decided based on the efficacy of lymph node dissection in accordance with tumor location. Our findings may be helpful in determining the extent of lymph node dissection required.

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  • Division of the pancreas at the right side of the superior mesenteric vein in robotic distal pancreatectomy: The splenic vessel-first approach. International journal

    Kosei Takagi, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi

    Asian journal of surgery   45 ( 8 )   1591 - 1593   2022.3

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  • 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

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    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

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    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.

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  • 移植I 葛西術後減黄不良患児に対する肝移植時期の検討

    藤 智和, 金平 典行, 佐藤 博紀, 高木 弘誠, 安井 和也, 熊野 健二郎, 吉田 一博, 吉田 龍一, 楳田 祐三, 八木 孝仁

    日本小児外科学会雑誌   58 ( 1 )   124 - 124   2022.2

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  • 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

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    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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  • 【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

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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

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    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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  • Prediction of Early Recurrence After Surgery for Liver Tumor (ERASL): An International Validation of the ERASL Risk Models. International journal

    Berend R Beumer, Kosei Takagi, Bastiaan Vervoort, Stefan Buettner, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara, Ewout W Steyerberg, Jan N M IJzermans

    Annals of surgical oncology   28 ( 13 )   8211 - 8220   2021.12

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    BACKGROUND: This study aimed to assess the performance of the pre- and postoperative early recurrence after surgery for liver tumor (ERASL) models at external validation. Prediction of early hepatocellular carcinoma (HCC) recurrence after resection is important for individualized surgical management. Recently, the preoperative (ERASL-pre) and postoperative (ERASL-post) risk models were proposed based on patients from Hong Kong. These models showed good performance although they have not been validated to date by an independent research group. METHODS: This international cohort study included 279 patients from the Netherlands and 392 patients from Japan. The patients underwent first-time resection and showed a diagnosis of HCC on pathology. Performance was assessed according to discrimination (concordance [C] statistic) and calibration (correspondence between observed and predicted risk) with recalibration in a Weibull model. RESULTS: The discriminatory power of both models was lower in the Netherlands than in Japan (C statistic, 0.57 [95% confidence interval {CI} 0.52-0.62] vs 0.69 [95% CI 0.65-0.73] for the ERASL-pre model and 0.62 [95% CI 0.57-0.67] vs 0.70 [95% CI 0.66-0.74] for the ERASL-post model), whereas their prognostic profiles were similar. The predictions of the ERASL models were systematically too optimistic for both cohorts. Recalibrated ERASL models improved local applicability for both cohorts. CONCLUSIONS: The discrimination of ERASL models was poorer for the Western patients than for the Japanese patients, who showed good performance. Recalibration of the models was performed, which improved the accuracy of predictions. However, in general, a model that explains the East-West difference or one tailored to Western patients still needs to be developed.

    DOI: 10.1245/s10434-021-10235-3

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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

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    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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  • 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

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    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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  • 【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

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  • 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

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  • Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases. International journal

    Yuzo Umeda, Takeshi Nagasaka, Kosei Takagi, Ryuichi Yoshida, Kazuhiro Yoshida, Tomokazu Fuji, Tatsuo Matsuda, Kazuya Yasui, Kenjiro Kumano, Hiroki Sato, Takahito Yagi, Toshiyoshi Fujiwara

    Langenbeck's archives of surgery   407 ( 2 )   685 - 697   2021.11

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    BACKGROUND: To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH). STUDY DESIGN: Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx). RESULTS: Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8-53) in the VESPAH group and 10 (range, 8-41) in the Major Hx group (P=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, P=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (P=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (P=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (P=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (P=0.060) than the Major Hx group. CONCLUSIONS: VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients' lifetimes.

    DOI: 10.1007/s00423-021-02373-9

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  • Performance with robotic surgery versus 3D- and 2D-laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials. International journal

    Maurice J W Zwart, Leia R Jones, Ignacio Fuente, Alberto Balduzzi, Kosei Takagi, Stephanie Novak, Luna A Stibbe, Thijs de Rooij, Jony van Hilst, L Bengt van Rijssen, Susan van Dieren, Aude Vanlander, Peter B van den Boezem, Freek Daams, J Sven D Mieog, Bert A Bonsing, Camiel Rosman, Sebastiaan Festen, Misha D Luyer, Daan J Lips, Arthur J Moser, Olivier R Busch, Mohammad Abu Hilal, Melissa E Hogg, Martijn W J Stommel, Marc G Besselink

    Surgical endoscopy   2021.11

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    BACKGROUND: Robotic surgery may improve surgical performance during minimally invasive pancreatoduodenectomy as compared to 3D- and 2D-laparoscopy but comparative studies are lacking. This study assessed the impact of robotic surgery versus 3D- and 2D-laparoscopy on surgical performance and operative time using a standardized biotissue model for pancreatico- and hepatico-jejunostomy using pooled data from two randomized controlled crossover trials (RCTs). METHODS: Pooled analysis of data from two RCTs with 60 participants (36 surgeons, 24 residents) from 11 countries (December 2017-July 2019) was conducted. Each included participant completed two pancreatico- and two hepatico-jejunostomies in biotissue using 3D-robotic surgery, 3D-laparoscopy, or 2D-laparoscopy. Primary outcomes were the objective structured assessment of technical skills (OSATS: 12-60) rating, scored by observers blinded for 3D/2D and the operative time required to complete both anastomoses. Sensitivity analysis excluded participants with excess experience compared to others. RESULTS: A total of 220 anastomoses were completed (robotic 80, 3D-laparoscopy 70, 2D-laparoscopy 70). Participants in the robotic group had less surgical experience [median 1 (0-2) versus 6 years (4-12), p < 0.001], as compared to the laparoscopic group. Robotic surgery resulted in higher OSATS ratings (50, 43, 39 points, p = .021 and p < .001) and shorter operative time (56.5, 65.0, 81.5 min, p = .055 and p < .001), as compared to 3D- and 2D-laparoscopy, respectively, which remained in the sensitivity analysis. CONCLUSION: In a pooled analysis of two RCTs in a biotissue model, robotic surgery resulted in better surgical performance scores and shorter operative time for biotissue pancreatic and biliary anastomoses, as compared to 3D- and 2D-laparoscopy.

    DOI: 10.1007/s00464-021-08805-3

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  • Robotic spleen-preserving distal pancreatectomy using indocyanine green fluorescence imaging (with video). International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi

    Asian journal of surgery   45 ( 1 )   596 - 597   2021.11

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  • A Rare Complication of Barium Swallow Test. International journal

    Kosei Takagi, Noriyuki Kanehira, Kazuyuki Matsumoto

    Gastroenterology   2021.10

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    DOI: 10.1053/j.gastro.2021.10.019

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  • Splenic and Peritoneal Metastases with Para-aortic and Virchow Lymph Node Metastases: Late Recurrence of Ovarian Cancer 30 Years after Initial Treatment.

    Kosei Takagi, Takahito Yagi, Toshiyoshi Fujiwara

    JMA journal   4 ( 4 )   428 - 431   2021.10

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  • Robotic distal pancreatectomy using a medial approach for bulky mucinous cystic neoplasm of the pancreas (with video). International journal

    Kosei Takagi, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi

    Asian journal of surgery   45 ( 1 )   542 - 543   2021.10

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  • Adult Bochdalek hernia following living donor left hepatectomy repaired by thoracoscopy-assisted surgery: A case report.

    Kosei Takagi, Takashi Kuise, Kazuhiro Yoshida, Ryuichi Yoshida, Yuzo Umeda, Toshiyoshi Fujiwara, Takahito Yagi

    Asian journal of endoscopic surgery   15 ( 1 )   220 - 224   2021.8

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    Bochdalek hernia is a congenital diaphragmatic hernia (DH). Herein, we report a case of adult Bochdalek hernia following living donor hepatectomy repaired by thoracoscopy-assisted surgery. A 36-year-old man underwent living donor left hepatectomy. Four months later, the patient presented with acute epigastric pain. Computed tomography found the left-sided DH in which the stomach was incarcerated into the pleural cavity without ischemic changes. As endoscopic intervention was unsuccessful, the herniated stomach was repositioned by thoracoscopy-assisted surgery. The 3-cm hernia orifice was found to have a smooth edge with no hernia sac, suggesting Bochdalek hernia, and the defect was primarily closed. The patient was followed up for 20 months without hernia recurrence. This is the first presentation of a case of Bochdalek hernia following donor hepatectomy. In cases of early detected DH, primary repair via a transthoracic approach with thoracoscopy-assisted surgery is safe and feasible.

    DOI: 10.1111/ases.12981

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  • Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. International journal

    Emanuele Contarini, Kosei Takagi, Hendrikus J A N Kimenai, Jan N M Ijzermans, Lucrezia Furian, Paolo Rigotti, Robert C Minnee

    Annals of vascular surgery   2021.8

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    OBJECTIVES: Renal artery aneurysm (RAA) is a rare vascular disease. Kidney autotransplantation (KAT) is the treatment option when endovascular approach is not available. However, the evidence on KAT for RAA is mostly limited to small case series or reports. Here, we describe our 2 center experience of KAT for RAA, and provide the results of our systematic literature review to evaluate the outcomes. METHODS: A retrospective 2 center study was conducted in patients undergoing KAT for RAA between 2010 and 2018. Moreover, a systematic review was performed on medical databases to evaluate the outcomes of KAT for RAA. RESULTS: Nine patients were surgically treated at our institutions: eight with laparoscopic nephrectomy (LN), and 1 with open followed heterotopic KAT. All RAAs were ex-vivo reconstructed, and in 3 cases a vein graft was used for reconstruction. There were 2 postoperative major complications including 1 graft loss. In the systematic review, 102 studies with 355 patients were included. In 35 patients (9.9%) a minimal invasive approach was performed. The incidence of postoperative major complications and graft loss was 9.4% and 4.1%. CONCLUSIONS: Our experiences showed that laparoscopic approach for nephrectomy followed heterotopic KAT was feasible with good postoperative outcomes. KAT is an effective treatment for RAA when endovascular approach is not feasible for interpretation of the outcomes, the quality and sample size of the evidence should be taken into consideration.

    DOI: 10.1016/j.avsg.2021.05.039

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  • Robotic Radical Antegrade Modular Pancreatosplenectomy Using the Supracolic Anterior Superior Mesenteric Artery Approach. 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   25 ( 11 )   3015 - 3018   2021.8

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    BACKGROUND: Radical antegrade modular pancreatosplenectomy (RAMPS) is the standardized approach in open pancreatic resection for pancreatic body and tail cancer. However, few studies have described regarding robotic RAMPS for pancreatic cancer. We herein present our techniques of robotic RAMPS using the supracolic anterior superior mesenteric artery (SMA) approach with the ventral view. METHODS: The patient was a 75-year-old female with a diagnosis of pancreatic body cancer. Following neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel, robotic RAMPS was performed. Our techniques of robotic RAMPS include four steps: (1) gastrocolic ligament division, (2) dissection of superior and inferior border of the pancreas, (3) division of the pancreas, and (4) retroperitoneal dissection. RESULTS: The operative time was 251 min with an estimated blood loss of 10 mL. The uneventful postoperative course was observed. The final pathology confirmed R0 surgical resection. CONCLUSIONS: Robotic RAMPS using the supracolic anterior SMA approach is safe and feasible for pancreatic body and tail cancer. Standardization and precise anatomical knowledge are key elements of performing robotic RAMPS.

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  • Usefulness of Middle Colic Artery Transposition Technique for Hepatic Arterial Reconstruction in Conversion Surgery for an Initially Unresectable, Locally Advanced Pancreatic Cancer.

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

    Acta medica Okayama   75 ( 4 )   543 - 548   2021.8

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    The outcomes of pancreatectomy with resection and reconstruction of the involved arteries for locally advanced pancreatic cancer following chemotherapy have improved in recent years. In pancreatic head cancers in which there is contact with the common and proper hepatic arteries, margin-negative resection requires pancreati-coduodenectomy, with the resection of these arteries and the restoration of hepatic arterial flow. Here, we describe a middle colic artery transposition technique in hepatic arterial reconstruction during pancreatoduo-denectomy for an initially unresectable locally advanced pancreatic cancer. This technique was effective and may provide a new option for hepatic artery reconstruction in such cases.

    DOI: 10.18926/AMO/62410

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  • 先天性胆道拡張症術後46年目に発生し根治切除が可能であった肝門部胆管癌の1例

    吉田 龍一, 野田 卓男, 安井 和也, 佐藤 博紀, 楳田 祐三, 吉田 一博, 藤 智和, 熊野 健二郎, 高木 弘誠, 金平 典之, 納所 洋, 谷本 光隆, 八木 孝仁, 藤原 俊義

    日本膵・胆管合流異常研究会プロシーディングス   44   42 - 43   2021.8

  • 膵・胆管合流異常に対する術後中長期的な経過観察の検討

    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

    日本膵・胆管合流異常研究会プロシーディングス   44   36 - 36   2021.8

  • 肝細胞癌治療における肝移植の役割 肝癌肝移植の長期予後に向けて 肝移植適応の選別と再発時治療

    楳田 祐三, 吉田 龍一, 吉田 一博, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 香川 俊輔, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   WS20 - 6   2021.7

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  • 進行膵癌集学的治療における術前血中KRAS遺伝子変異の新規バイオマーカーとしての有用性に関する検討

    吉田 龍一, 安井 和也, 楳田 祐三, 吉田 一博, 高木 弘誠, 佐藤 博紀, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P167 - 3   2021.7

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  • 肝細胞癌治療における肝移植の役割 肝癌肝移植の長期予後に向けて 肝移植適応の選別と再発時治療

    楳田 祐三, 吉田 龍一, 吉田 一博, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 香川 俊輔, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   WS20 - 6   2021.7

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  • 切除後再発時期・生存期間に着目した膵癌治療成績の検討 今後の治療方向性を探る

    安井 和也, 吉田 龍一, 佐藤 博紀, 楳田 祐三, 吉田 一博, 高木 弘誠, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P224 - 4   2021.7

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  • 膵癌術後再発巣に対する局所療法の有用性の検討

    佐藤 博紀, 吉田 龍一, 安井 和也, 楳田 祐三, 吉田 一博, 高木 弘誠, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P224 - 3   2021.7

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  • 高齢者に対する肝臓外科治療 高齢者に対する肝切除術前評価における5-Item Modified Frailty Indexの有用性

    吉田 一博, 楳田 祐三, 吉田 龍一, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 香川 俊輔, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   PD5 - 3   2021.7

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  • Pittsburgh styleによるロボット支援下膵頭十二指腸切除術 術式の定型化と手技の工夫

    高木 弘誠, 楳田 祐三, 吉田 龍一, 吉田 一博, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P147 - 4   2021.7

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  • 高齢者に対する肝臓外科治療 高齢者に対する肝切除術前評価における5-Item Modified Frailty Indexの有用性

    吉田 一博, 楳田 祐三, 吉田 龍一, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 香川 俊輔, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   PD5 - 3   2021.7

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  • 切除可能大腸癌肝転移に対する治療戦略 大腸癌肝転移における術前化学療法の適応選別 RAS/RAF変異による肝外進展リスク

    岡林 弘樹, 楳田 祐三, 吉田 龍一, 吉田 一博, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   RS24 - 1   2021.7

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  • 進行膵癌集学的治療における術前血中KRAS遺伝子変異の新規バイオマーカーとしての有用性に関する検討

    吉田 龍一, 安井 和也, 楳田 祐三, 吉田 一博, 高木 弘誠, 佐藤 博紀, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P167 - 3   2021.7

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  • Pittsburgh styleによるロボット支援下膵頭十二指腸切除術 術式の定型化と手技の工夫

    高木 弘誠, 楳田 祐三, 吉田 龍一, 吉田 一博, 安井 和也, 黒田 新士, 野間 和広, 寺石 文則, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P147 - 4   2021.7

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  • 高度なHCCの治療を目的とする粒子線治療を先行させた肝移植

    八木 孝仁, 吉田 龍一, 安井 和也, 佐藤 博紀, 楳田 祐三, 吉田 一博, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    日本消化器外科学会総会   76回   P143 - 6   2021.7

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  • 切除可能大腸癌肝転移に対する治療戦略 大腸癌肝転移における術前化学療法の適応選別 RAS/RAF変異による肝外進展リスク

    岡林 弘樹, 楳田 祐三, 吉田 龍一, 吉田 一博, 高木 弘誠, 安井 和也, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   RS24 - 1   2021.7

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  • 胆管空腸吻合術後の難治性肝内結石症に対する治療経験

    永井 康雄, 杭瀬 崇, 高木 弘誠, 楳田 祐三, 吉田 龍一, 黒田 新士, 野間 和広, 寺石 文則, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P184 - 5   2021.7

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  • 切除後再発時期・生存期間に着目した膵癌治療成績の検討 今後の治療方向性を探る

    安井 和也, 吉田 龍一, 佐藤 博紀, 楳田 祐三, 吉田 一博, 高木 弘誠, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P224 - 4   2021.7

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  • 膵癌術後再発巣に対する局所療法の有用性の検討

    佐藤 博紀, 吉田 龍一, 安井 和也, 楳田 祐三, 吉田 一博, 高木 弘誠, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P224 - 3   2021.7

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  • 胆管空腸吻合術後の難治性肝内結石症に対する治療経験

    永井 康雄, 杭瀬 崇, 高木 弘誠, 楳田 祐三, 吉田 龍一, 黒田 新士, 野間 和広, 寺石 文則, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   76回   P184 - 5   2021.7

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  • ASO Visual Abstract: Prediction of Early Hepatocellular Carcinoma Recurrence After Resection-An International Validation of the ERASL Risk Models. International journal

    Berend R Beumer, Kosei Takagi, Bastiaan Vervoort, Stefan Buettner, Yuzo Umeda, Takahito Yagi, Toshiyoshi Fujiwara, Ewout W Steyerberg, Jan N M IJzermans

    Annals of surgical oncology   28 ( Suppl 3 )   505 - 506   2021.6

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    DOI: 10.1245/s10434-021-10132-9

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  • Gastroenteropancreatic neuroendocrine tumor of the accessory papilla of the duodenum: a case report. International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Hiroki Sato, Takahito Yagi, Toshiyoshi Fujiwara

    Surgical case reports   7 ( 1 )   156 - 156   2021.6

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    BACKGROUND: Contrary to the increasing incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), GEP-NETs of the accessory papilla of the duodenum are extremely rare. Furthermore, there have been no recommendations regarding the treatment strategy for GEP-NETs of the accessory papilla of the duodenum. We present a case of GEP-NET of the accessory papilla of the duodenum successfully treated with robotic pancreatoduodenectomy. CASE PRESENTATION: A case of a 70-year-old complaining of no symptoms was diagnosed with GEP-NET of the accessory papilla of the duodenum. A 8-mm tumor was located at the submucosal layer with a biopsy demonstrating a neuroendocrine tumor grade 1. The patient underwent robotic pancreatoduodenectomy as curative resection for the tumor. The total operative time was 406 min with an estimated blood loss of 150 mL. The histological examination revealed a well-differentiated neuroendocrine tumor with low Ki-67 index (< 1%). In the posterior areas of the pancreas, the lymph node metastases were detected. The patient was followed up for 6 months with no recurrence postoperatively. CONCLUSIONS: Considering the potential risks of the lymph node metastases, the standard treatment strategy for GEP-NETs of the accessory papilla of the duodenum should be radical resection with pancreatoduodenectomy. Minimally invasive approach can be the alternative to the conventional open surgery.

    DOI: 10.1186/s40792-021-01241-4

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  • Added value of 3D-vision during robotic pancreatoduodenectomy anastomoses in biotissue (LAEBOT 3D2D): a randomized controlled cross-over trial. International journal

    Maurice J W Zwart, Leia R Jones, Alberto Balduzzi, Kosei Takagi, Aude Vanlander, Peter B van den Boezem, Freek Daams, Camiel Rosman, Daan J Lips, Arthur J Moser, Melissa E Hogg, Olivier R C Busch, Martijn W J Stommel, Marc G Besselink

    Surgical endoscopy   35 ( 6 )   2928 - 2935   2021.6

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    BACKGROUND: We tested the added value of 3D-vision on procedure time and surgical performance during robotic pancreatoduodenectomy anastomoses in biotissue. Robotic surgery has the advantage of articulating instruments and 3D-vision. Consensus is lacking on the added value of 3D-vision during laparoscopic surgery. Given the improved dexterity with robotic surgery, the added value of 3D-vision may be even less with robotic surgery. METHODS: In this experimental randomized controlled cross-over trial, 20 surgeons and surgical residents from 5 countries performed robotic pancreaticojejunostomy and hepaticojejunostomy anastomoses in a biotissue organ model using the da Vinci® system and were randomized to start with either 3D- or 2D-vision. Primary endpoint was the time required to complete both anastomoses. Secondary endpoint was the objective structured assessment of technical skill (OSATS; range 12-60) rating; scored by two observers blinded to 3D/2D. RESULTS: Robotic 3D-vision reduced the combined operative time from 78.1 to 57.3 min (24.6% reduction, p < 0.001; 20.8 min reduction, 95% confidence intervals 12.8-28.8 min). This reduction was consistent for both anastomoses and between surgeons and residents, p < 0.001. Robotic 3D-vision improved OSATS performance by 6.1 points (20.8% improvement, p = 0.003) compared to 2D (39.4 to 45.1 points, ± 5.5). CONCLUSION: 3D-vision has a considerable added value during robotic pancreatoduodenectomy anastomoses in biotissue in both time reduction and improved surgical performance as compared to 2D-vision.

    DOI: 10.1007/s00464-020-07732-z

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  • A novel difficulty grading system for laparoscopic living donor nephrectomy. International journal

    Kosei Takagi, Hendrikus J A N Kimenai, Turkan Terkivatan, Khe T C Tran, Jan N M Ijzermans, Robert C Minnee

    Surgical endoscopy   35 ( 6 )   2889 - 2895   2021.6

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    BACKGROUND: Several difficulty grading systems have been developed as a useful tool for selecting patients and training surgeons in laparoscopic procedures. However, there is little information on predicting the difficulty of laparoscopic donor nephrectomy (LDN). The aim of this study was to develop a grading system to predict the difficulty of LDN. METHODS: Data of 1741 living donors, who underwent pure or hand-assisted LDN between 1994 and 2018 were analyzed. Multivariable analyses were performed to identify factors associated with prolonged operative time, defined as a difficulty index with 0 to 8. The difficulty of LDN was classified into three levels based on the difficulty index. RESULTS: Multivariable analyses identified that male (odds ratio [OR] 1.69, 95% CI 1.37-2.09, P < 0.001), BMI > 28 (OR 1.36, 95% CI 1.08-1.72, P = 0.009), pure LDN (OR 1.99, 95% CI 1.53-2.60, P < 0.001), multiple renal arteries (OR 2.38, 95% CI 1.83-3.10, P < 0.001) and multiple renal veins (OR 2.18, 95% CI 1.52-3.16, P < 0.001) were independent risk factors influencing prolonged operative time. The difficulty index based on these factors was calculated and categorized into three levels: low (0-2), intermediate (3-5), and high (6-8) difficulty. Operative time was significantly longer in the high difficulty group (225 min) than in the low (169 min, P < 0.001) and intermediate difficulty group (194 min, P < 0.001). The conversion rate was higher in the high difficulty group (4.4%) than in the low (2.1%, P = 0.04) and the intermediate difficulty group (3.0%, P = 0.27). No significant difference in major complications was found between the groups. CONCLUSION: We developed a novel grading system with simple preoperative donor factors to predict the difficulty of LDN. This grading system may help surgeons in patient selection to advance their experiences and/or teach fellows from simple to difficult LDN.

    DOI: 10.1007/s00464-020-07727-w

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  • Robotic Total Pancreatectomy: A Novel Pancreatic Head-First Approach (with Video). International journal

    Kosei Takagi, Bas Groot Koerkamp

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   25 ( 6 )   1649 - 1650   2021.6

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    BACKGROUND: The development of the Da Vinci robotic platform has drastically altered the paradigm of minimal invasive pancreatic surgery. However, the evidence of robotic total pancreatectomy (RTP) is still limited. Here we report an alternative approach of RTP, starting with pancreatoduodenectomy (the pancreatic head-first approach). METHODS: The patient was a 55-year-old female with a diagnosis of diffuse PNET in the head, body, and tail of the pancreas. The da Vinci Xi robotic system was used for RTP. Our technique of RTP consists of three steps: (1) pancreatoduodenectomy, (2) (en bloc) distal pancreatectomy, and (3) reconstructions. RESULTS: The operative time was 490 min with an estimated blood loss of 100 ml. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. CONCLUSIONS: RTP is a technically challenging procedure; however, the pancreatic head-first approach of RTP has several advantages.

    DOI: 10.1007/s11605-021-04922-5

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  • Loss of antibodies to hepatitis E virus in organ transplant patients with hepatitis E. International journal

    Yukio Oshiro, Hiroshi Harada, Kiyoshi Hasegawa, Naotake Akutsu, Tomoharu Yoshizumi, Naoki Kawagishi, Koji Nanmoku, Naotsugu Ichimaru, Kenichi Okamura, Masahiro Ohira, Yoshihiro Itabashi, Nobuhiro Fujiyama, Kentaro Ide, Hideaki Okajima, Kohei Ogawa, Kosei Takagi, Hidetoshi Eguchi, Masahiro Shinoda, Kiyotaka Nishida, Jiro Shimazaki, Mitsugi Shimoda, Masaharu Takahashi, Hiroaki Okamoto, Shuji Suzuki

    Hepatology research : the official journal of the Japan Society of Hepatology   51 ( 5 )   538 - 547   2021.5

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    AIM: Studies regarding changes in antibodies to hepatitis E virus (HEV) after HEV infection in organ transplant patients are limited. This study aimed to clarify HEV infection trends in organ transplant patients who contracted HEV using data from a previous Japanese nationwide survey. METHODS: This study was undertaken from 2012 to 2019. Among 4518 liver, heart, and kidney transplant patients, anti-HEV immunoglobulin G (IgG) antibodies were positive in 164; data were collected from 106 of these patients, who consented to participate in the study. In total, 32 liver transplant patients, seven heart transplant patients, and 67 kidney transplant patients from 16 institutions in Japan were examined for IgG, IgM, and IgM antibodies to HEV and the presence of HEV RNA in the serum. The χ2 -test was used to determine the relationship between the early and late postinfection groups in patients with anti-HEV IgG positive-to-negative conversion rates. The Mann-Whitney U-test was used to compare clinical factors. RESULTS: Anti-HEV IgG positive-to-negative conversion occurred in 25 (23.6%) of 106 organ transplant patients. Of eight patients with hepatitis E who tested positive for HEV RNA, one (14.0%) had anti-HEV IgG positive-to-negative conversion. Twenty-four (24.5%) of 98 patients negative for HEV RNA had anti-HEV IgG positive-to-negative conversion. CONCLUSIONS: This study revealed, for the first time, the changes in HEV antibodies in organ transplant patients. Loss of anti-HEV IgG could often occur unexpectedly in organ transplant patients with previous HEV infection.

    DOI: 10.1111/hepr.13637

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  • Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: a technical note. International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi, Toshiyoshi Fujiwara, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp

    World journal of surgical oncology   19 ( 1 )   55 - 55   2021.2

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    BACKGROUND: Growing evidence for the advantages of robotic pancreatoduodenectomy (RPD) has been demonstrated internationally. However, there has been no structured training program for RPD in Japan. Herein, we present the surgical training model of RPD and a standardized protocol for surgical technique. METHODS: The surgical training model and surgical technique were standardized in order to implement RPD safely, based on the Dutch training system collaborated with the University of Pittsburgh Medical Center. RESULTS: The surgical training model included various trainings such as basic robotic training, simulation training, biotissue training, and a surgical video review. Furthermore, a standardized protocol on the surgical technique was established to understand the tips, tricks, and pitfalls of RPD. CONCLUSIONS: Safe implementation of RPD can be achieved through the completion of a structured training program and learning surgical technique. A nationwide structured training system should be developed to implement the program safely in Japan.

    DOI: 10.1186/s12957-021-02167-9

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  • Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3). International journal

    Maurice J W Zwart, Carolijn L M Nota, Thijs de Rooij, Jony van Hilst, Wouter W Te Riele, Hjalmar C van Santvoort, Jeroen Hagendoorn, Inne H M Borel Rinkes, Jacob L van Dam, Anouk E J Latenstein, Kosei Takagi, T C Khé Tran, Jennifer Schreinemakers, George van der Schelling, Jan H Wijsman, Sebastiaan Festen, Freek Daams, Misha D Luyer, Ignace H J T de Hingh, J Sven D Mieog, Bert A Bonsing, Daan J Lips, Mohammed Abu Hilal, Olivier R Busch, Olivier Saint-Marc, Herbert J Zeh 3rd, Amer H Zureikat, Melissa E Hogg, I Quintus Molenaar, Marc G Besselink, Bas Groot Koerkamp

    Annals of surgery   2021.2

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    OBJECTIVE: To assess feasibility and safety of a multicenter training program in robotic pancreatoduodenectomy (RPD) adhering to the IDEAL framework for implementation of surgical innovation. BACKGROUND: Good results for RPD have been reported from single center studies. However, data on feasibility and safety of implementation through a multicenter training program in RPD are lacking. METHODS: A multicenter training program in RPD was designed together with the University of Pittsburgh Medical Center, including an online video bank, robot simulation exercises, biotissue drills, and on-site proctoring. Benchmark patients were based on the criteria of Clavien. Outcomes were collected prospectively (March 2016-October 2019). Cumulative sum (CUSUM) analysis of operative time was performed to distinguish the first and second phase of the learning curve. Outcomes were compared between both phases of the learning curve. Trends in nationwide use of robotic and laparoscopic PD were assessed in the Dutch Pancreatic Cancer Audit. RESULTS: Overall, 275 RPD procedures were performed in seven centers by 15 trained surgeons. The recent benchmark criteria for low-risk PD were met by 125 (45.5%) patients. The conversion rate was 6.5% (n = 18) and median blood loss 250 ml (IQR 150-500). The rate of Clavien-Dindo grade ≥III complications was 44.4% (n = 122), postoperative pancreatic fistula (grade B/C) rate 23.6% (n = 65), 90-day complication-related mortality 2.5% (n = 7) and 90-day cancer-related mortality 2.2.% (n = 6). Median postoperative hospital stay was 12 days (IQR 8-20). In the subgroup of patients with pancreatic cancer (n = 80), the major complication rate was 31.3% and POPF rate was 10%. CUSUM analysis for operative time found a learning curve inflection point at 22 RPDs (IQR 10-35) with similar rates of Clavien-Dindo grade ≥III complications in the first and second phase (43.4% vs 43.8%, P = 0.956, respectively). During the study period the nationwide use of laparoscopic PD reduced from 15% to 1%, whereas the use of RPD increased from 0% to 25%. CONCLUSIONS: This multicenter RPD training program in centers with sufficient surgical volume was found to be feasible without a negative impact of the learning curve on clinical outcomes.

    DOI: 10.1097/SLA.0000000000004783

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  • Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors. International journal

    Kosei Takagi, Hendrikus J A N Kimenai, Turkan Terkivatan, Khe T C Tran, Jan N M Ijzermans, Robert C Minnee

    International journal of surgery (London, England)   86   7 - 12   2021.2

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    BACKGROUND: Few studies have investigated the learning curves of minimally invasive donor nephrectomy (MIDN) using the cumulative sum (CUSUM) analysis. In addition, no study has compared the learning curves of the different surgical MIDN techniques in one cohort study using the CUSUM analysis. This study aims to evaluate and compare learning curves for several MIDN using the CUSUM analysis. METHODS: A retrospective review of consecutive donors, who underwent MIDN between 1997 and 2019, was conducted. Three laparoscopic-assisted techniques were applied in our institution and included for analysis: laparoscopic (LDN), hand-assisted retroperitoneoscopic (HARP), and robot-assisted laparoscopic (RADN) donor nephrectomy. The outcomes were compared based on surgeon volume to develop learning curves for the operative time per surgeon. RESULTS: Out of 1895 MIDN, 1365 (72.0%) were LDN, 427 (22.5%) were HARP, and 103 (5.4%) were RADN. The median operative time and median blood loss were 179 (IQR, 139-230) minutes and 100 (IQR, 40-200) mL, respectively. The incidence of major complication was 1.2% with no mortality, and the median hospital stay was three (IQR, 3-4) days. The CUSUM analysis resulted in learning curves, defined by decreased operative time, of 23 cases in LDN, 45 cases in HARP, and 26 cases in RADN. CONCLUSIONS: Our study shows different learning curves in three MIDN techniques with equal post-operative complications. The LDN and RADN learning curves are shorter than that of the hand-assisted donor nephrectomy. Our observations can be helpful for informing the development of teaching requirements for fellows to be trained in MIDN.

    DOI: 10.1016/j.ijsu.2020.12.011

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  • Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report. International journal

    Kazuhiro Yoshida, Yuzo Umeda, Masaya Iwamuro, Kazuyuki Matsumoto, Hironari Kato, Mayu Uka, Yusuke Matsui, Ryuichi Yoshida, Takashi Kuise, Kazuya Yasui, Kosei Takagi, Hiroyuki Araki, Takahito Yagi, Toshiyoshi Fujiwara

    BMC surgery   20 ( 1 )   307 - 307   2020.12

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    BACKGROUND: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. CASE PRESENTATION: A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. CONCLUSION: Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.

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  • Short-term and long-term outcomes in living donors for liver transplantation: Cohort study. International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Nobuyuki Watanabe, Takashi Kuise, Kazuhiro Yoshida, Kazuya Yasui, Tatsuo Matsuda, Toshiyoshi Fujiwara, Takahito Yagi

    International journal of surgery (London, England)   84   147 - 153   2020.12

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    BACKGROUND: Although perioperative outcomes following donor hepatectomy (DH) have been reported, little is known about the long-term outcomes in living donors of liver transplantation. The aim of this study was to investigate the short-term and long-term outcomes following DH. METHODS: A total of 408 living donors who underwent DH between 1996 and 2019 were analyzed in this retrospective study, focusing on short-term outcomes with respect to the operation period (era) and the graft type, as well as long-term outcomes. RESULTS: The overall incidence of postoperative complications was 40.4%. These included minor (30.4%), major (10.0%), and biliary (14.0%) complications. Short-term outcomes after DH slightly improved over time, and outcomes did not differ significantly between the graft types. With regards to long-term outcomes, the incidence of surgery-related complications such as keloids, incisional hernias, and mechanical bowel obstructions was 6.6% over a median follow-up of 7.2 years. In addition, some donors developed comorbidities such as lifestyle diseases and cancers during the follow-up period. CONCLUSIONS: Our study confirmed an improvement of perioperative outcomes in living donors. There was no significant association between the graft type and postoperative outcomes. Donors could develop various morbidities during long-term follow-up. Therefore, a careful perioperative management and long-term follow-up should be provided to living donors.

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  • 切除可能/切除可能境界膵癌における術前後血中KRAS遺伝子変異検出とその意義に関する検討

    吉田 龍一, 安井 和也, 楳田 祐三, 杭瀬 崇, 吉田 一博, 松田 達雄, 高木 弘誠, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   75回   P276 - 4   2020.12

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  • 膵頭十二指腸切除術における周術期栄養療法のエビデンス

    高木 弘誠, 楳田 祐三, 吉田 龍一, 杭瀬 崇, 吉田 一博, 安井 和也, 松田 達雄, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   75回   O17 - 6   2020.12

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  • 局所進行切除不能膵癌における予後規定因子の検討 非切除例を含めたall cohort解析

    安井 和也, 吉田 龍一, 楳田 祐三, 杭瀬 崇, 吉田 一博, 高木 弘誠, 松田 達雄, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   75回   O16 - 2   2020.12

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  • Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy. International journal

    Kosei Takagi, Hendrikus J A N Kimenai, Jan N M IJzermans, Robert C Minnee

    Surgical endoscopy   34 ( 11 )   4901 - 4908   2020.11

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    BACKGROUND: The aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome. METHODS: Out of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function. RESULTS: Out of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30-35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation. CONCLUSION: Our results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30-35.

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  • The effect of donor body mass index on graft function in liver transplantation: A systematic review. International journal

    Kosei Takagi, Roeland F de Wilde, Wojciech G Polak, Jan N M IJzermans

    Transplantation reviews (Orlando, Fla.)   34 ( 4 )   100571 - 100571   2020.10

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    The impact of donor body mass index (BMI) on graft function outcomes in liver transplantation (LT) is still controversial. The aim of this study was to review the current evidence investigating the effect of donor BMI on outcomes in patients undergoing LT. A systematic review was performed to evaluate relevant outcomes such as the availability of data on donor BMI as well as graft and patient survival after LT. Screening of 901 articles resulted in 11 observational studies for data extraction. In adult deceased donor after brain death and living donor LT, donor BMI was not associated with graft and patient survival. However, high donor BMI was associated with a higher chance of macrosteatosis besides a significantly higher incidence of declined livers. In pediatric LT, severe obesity in adult donors with BMI ≥35 was associated with graft loss and mortality, whereas obesity in pediatric donors was not associated with graft loss and mortality. Accordingly, donor BMI is not associated with long-term outcomes in adult patients undergoing LT. However, further research should be conducted to identify the effect of donor BMI on outcomes in LT.

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  • Systematic Review on the Controlling Nutritional Status (CONUT) Score in Patients Undergoing Esophagectomy for Esophageal Cancer. International journal

    Kosei Takagi, Stefan Buettner, Jan N M Ijzermans, Bas P L Wijnhoven

    Anticancer research   40 ( 10 )   5343 - 5349   2020.10

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    BACKGROUND/AIM: The present study aimed to examine the association of the controlling nutritional status (CONUT) score with outcomes in patients undergoing esophagectomy for esophageal cancer (EC). MATERIALS AND METHODS: A systematic literature review was carried out to investigate the impact of the CONUT score in EC. Next, meta-analysis of long-term outcomes was performed. RESULTS: The search found six eligible retrospective studies, and five studies with 952 patients were included in the meta-analysis. Meta-analysis found a significant association of the CONUT score with outcomes including overall survival [hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.75-3.60, p<0.001], cancer-specific survival (HR=2.60, 95%CI=1.53-4.41, p<0.001), and recurrence free survival (HR=2.08, 95%CI=1.39-3.12, p<0.001). CONCLUSION: The CONUT score may be an independent predictor associated with prognosis in patients undergoing esophagectomy for EC. However, further studies are needed to clarify the association of the CONUT score with postoperative outcomes in EC patients.

    DOI: 10.21873/anticanres.14541

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  • 肝癌に対する肝移植の長期成績と再発予防 肝癌肝移植の長期予後に向けて 肝移植適応の選別と再発時治療

    楳田 祐三, 吉田 龍一, 杭瀬 崇, 吉田 一博, 高木 弘誠, 安井 和也, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   81 ( 増刊 )   246 - 246   2020.10

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  • Learning curve of kidney transplantation in a high-volume center: A Cohort study of 1466 consecutive recipients. International journal

    Kosei Takagi, Loubna Outmani, Hendrikus J A N Kimenai, Turkan Terkivatan, Khe T C Tran, Jan N M Ijzermans, Robert C Minnee

    International journal of surgery (London, England)   80   129 - 134   2020.8

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    BACKGROUND: The purpose of this study was to evaluate surgical outcomes of kidney transplantation (KTX) based on surgeon volume and surgeon experience, and to develop the learning curve model for KTX using the cumulative sum (CUSUM) analysis. METHODS: A retrospective review of 1466 consecutive recipients who underwent KTX between 2010 and 2017 was conducted. In total, 51 surgeons, including certified transplant surgeons, transplant fellows and surgical residents were involved in these procedures using a standardized protocol. Outcomes were compared based on surgeon volume (low [1-30] versus high [31≥] volume) and surgeon's type (consultant surgeons, fellows or residents). RESULTS: Operative time (129 versus 135 min, P < 0.001) and warm ischemia time (20.9 versus 24.2 min, P < 0.001) were significantly shorter in the high-volume group, however postoperative outcomes were equal in both groups. The CUSUM analysis revealed that approximately 30 procedures were necessary to improve surgical skills. In addition, no effect of surgeon's type including consultant surgeons, fellows and residents on postoperative outcomes was found. CONCLUSIONS: Surgical training in KTX using a standardize protocol can be accomplished with a steep learning curve without compromising perioperative outcomes under the careful selection of surgeons and procedures.

    DOI: 10.1016/j.ijsu.2020.06.047

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  • Systematic review on immunonutrition in partial pancreatoduodenectomy. International journal

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

    Langenbeck's archives of surgery   405 ( 5 )   585 - 593   2020.8

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    BACKGROUND: The effect of immunonutrition (IM) on postoperative outcomes has been investigated in gastrointestinal cancer surgery; however, strong evidence regarding IM in partial pancreatoduodenectomy (PD) is lacking. This study evaluated the effect of IM on short-term outcomes in patients undergoing PD. METHODS: A systematic literature review of randomized controlled trials was conducted to identify the studies investigating the IM effect on outcomes in PD. Random-effects meta-analyses were conducted to calculate the pooled risk ratio (RR). Studies were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Five studies were included in the meta-analysis. IM was associated with a lower incidence of overall complications (RR 0.74; 95% confidence interval (CI) 0.58, 0.94; P = 0.01; I2 = 0%) and infectious complications (RR 0.60; 95% CI 0.42, 0.84; P = 0.003; I2 = 0%). However, no significant association was noted in the incidence of major complications (RR 0.68; 95% CI 0.41, 1.12; P = 0.13), mortality (RR 0.79; 95% CI 0.16, 3.99; P = 0.78), postoperative pancreatic fistula (RR 0.92, 95% CI 0.59, 1.46; P = 0.74), and delayed gastric emptying (RR 1.09; 95% CI 0.55, 2.15; P = 0.81). CONCLUSIONS: IM administration in PD can prevent the incidence of overall and infectious complications postoperatively (GRADE recommendation: moderate). However, IM has no impact on major complications, mortality, and PD-specific complications (GRADE recommendation: low).

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  • Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: A systematic review and meta-analysis. International journal

    Kosei Takagi, Stefan Buettner, Jan N M Ijzermans

    International journal of surgery (London, England)   78   91 - 96   2020.6

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    BACKGROUND: The clinical evidence of the controlling nutritional status (CONUT) score for outcomes has increased in gastroenterological surgical oncology. The aim of this study was to investigate the impact of the CONUT score on outcomes in patients with colorectal cancer (CRC). METHODS: A literature review was systematically conducted to evaluate the significance of the CONUT score in CRC patients. Meta-analyses of survival were performed to investigate the effects of the CONUT score in CRC patients. RESULTS: Nine studies met the inclusion criteria, and six studies with 2601 patients were included in the present meta-analyses. High CONUT score was associated with poor overall survival (HR 1.97, 95%CI = 1.40-2.77, P < 0.001), cancer-specific survival (HR 3.64, 95%CI = 1.96-6.75, P < 0.001), and recurrence/relapse-free survival (HR 1.68, 95%CI = 1.23-2.29, P = 0.001) after CRC surgery. CONCLUSIONS: The CONUT score is a practical prognostic factor associated with prognosis of CRC. Further studies are needed to clarify the significance of the CONUT score in CRC patients.

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  • Right posterior segment graft for living donor liver transplantation: A systematic review. International journal

    Kosei Takagi, Piotr Domagala, Wojciech G Polak, Jan N M Ijzermans, Markus U Boehnert

    Transplantation reviews (Orlando, Fla.)   34 ( 1 )   100510 - 100510   2020.1

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    The clinical significance of the right posterior segment (RPS) graft in living donor liver transplantation (LDLT) is unknown because of its limited use and technical concerns. This study aimed to review published studies investigating outcomes of RPS grafts. The systematic literature search was conducted to retrieve data from Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Among the 388 articles, six retrospective studies from Asian countries were included. The overall incidences of major and minor complications after RPS graft procurement were 5.6% and 34.6%, respectively and no donor deaths were reported. RPS graft recipients had the following postoperative complications: overall mortality rate, 14.5%; bile leakage, 8.7%, biliary stenosis, 18.8%, hepatic artery thrombosis, 8.7%, and liver re-transplantation, 2.9%. The RPS graft can be considered as an option for a living liver graft respecting donor safety under strict selection criteria and surgical strategy. The precise evaluation and understanding of anatomical variations and volumetric analyses is critical for selecting donors and planning the surgical strategy in the RPS grafts procurement. The RPS grafts procurement requires carefully dissection of the hepatic artery and portal vein, safely confirmation of the bile duct, and precisely parenchymal transection. However, further experience is needed to clarify the significance of the RPS graft in LDLT. The special technical requirements should limit this donor procedure to centers with a high level of experience in LDLT.

    DOI: 10.1016/j.trre.2019.100510

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  • Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands.

    Kosei Takagi, Piotr Domagala, Robert J Porte, Ian Alwayn, Herold J Metselaar, Aad P van den Berg, Bart van Hoek, Jan N M Ijzermans, Wojciech G Polak

    Journal of hepato-biliary-pancreatic sciences   27 ( 1 )   26 - 33   2020.1

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    BACKGROUND: Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. METHODS: A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. RESULTS: Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979-2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. CONCLUSIONS: Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.

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  • A novel modified hanging maneuver in laparoscopic left hemihepatectomy. International journal

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

    International journal of surgery case reports   76   251 - 253   2020

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    INTRODUCTION: The liver hanging maneuver is an essential technique for controlling bleeding in hepatectomy, however it is often difficult in laparoscopic major hepatectomy. The present study describes a novel modified hanging maneuver in laparoscopic left hemihepatectomy. PRESENTATION OF CASE: A 29-year-old female underwent laparoscopic left hemihepatectomy for mucinous cystic neoplasm. After mobilizing the left lobe, the liver parenchyma was dissected along the demarcation line. For the hanging technique, the upper edge of the hanging tape was placed on the lateral side of the left hepatic vein, and fixed with the Falciform ligament. The lower edge of the tape was extracted outside the abdomen. Accordingly the hanging tape can be controlled extraperitoneally during the liver parenchyma dissection. DISCUSSION: This technique includes several advantages including no need of assistance using forceps, easy control of the hanging tape extraperitoneally, outflow control, better exposure of surgical field, and helpful guide of the liver dissection line toward the root of the left hepatic vein. CONCLUSION: Our novel modified hanging maneuver is easy and reproducible to use in laparoscopic left hemihepatectomy. Moreover, this technique can be applied to other laparoscopic hepatectomy.

    DOI: 10.1016/j.ijscr.2020.10.002

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  • Laparoscopic liver resection of segment seven: A case report and review of surgical techniques. International journal

    Kosei Takagi, Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Fuminori Teraishi, Takahito Yagi, Toshiyoshi Fujiwara

    International journal of surgery case reports   73   168 - 171   2020

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    INTRODUCTION: Laparoscopic liver resection of segment seven (LLR-S7) is a technically challenging procedure due to its anatomical location and difficult accessibility. Herein, we present our experience with LLR-S7, and demonstrate a literature review regarding surgical techniques. PRESENTATION OF CASE: A 28-year-old female was diagnosed with rectosigmoid cancer and synchronous liver metastases at the segment three (S3) and S7, which were treated with laparoscopic procedure. After the completely mobilization of the right lobe, the Glissonean pedicle of S7 (G7) was intrahepatically transected. The right hepatic vein was exposed to identify the venous branch of S7 (V7). Finally the liver parenchyma between RHV and dissection line was divided. DISCUSSION: Various laparoscopic approaches for S7 have been reported including the Glissonian approach from the hilum, the intrahepatic Glissonean approach, the caudate lobe first approach, and the lateral approach from intercostal ports. To perform LLR-S7 safely, it is important to understand the advantage of each technique including the trocar placement and approaches to S7 by laparoscopy. CONCLUSION: We present our experience of LLR-S7 for the tumor located at the top of S7, successfully performed with the intrahepatic Glissonean approach. LLR-S7 can be performed safely with advanced laparoscopic techniques and sufficient knowledge on various approaches for S7.

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  • Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. International journal

    Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Jan N M Ijzermans

    BMC gastroenterology   19 ( 1 )   211 - 211   2019.12

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    BACKGROUND: The clinical value of the controlling nutritional status (CONUT) score in hepatocellular carcinoma (HCC) has increased. The aim of this meta-analysis was to systematically review the association between the CONUT score and outcomes in patients undergoing hepatectomy for HCC. METHODS: Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar were systematically searched. Random effects meta-analyses were conducted to examine the prognostic value of the CONUT score in HCC patients. RESULTS: A total of five studies including 4679 patients were found to be eligible and analyzed in the meta-analysis. The CONUT score was significantly associated with overall survival (HR 1.78, 95%CI = 1.20-2.64, P = 0.004, I2 = 79%), recurrence-free survival (HR 1.34, 95%CI = 1.17-1.53, P < 0.001, I2 = 16%) and postoperative major complications (OR 1.85, 95%CI: 1.19-2.87, P = 0.006, I2 = 72%) in HCC patients. Moreover, the CONUT score was associated with the Child-Pugh classification, liver cirrhosis, ICGR15, and tumor differentiation. However, it was not associated with tumor size, tumor number, and microvascular invasion. CONCLUSIONS: The CONUT score is an independent prognostic indicator of the prognosis and is associated with postoperative major complications and hepatic functional reserve in HCC patients.

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  • Current evidence of nutritional therapy in pancreatoduodenectomy: Systematic review of randomized controlled trials.

    Kosei Takagi, Piotr Domagala, Hermien Hartog, Casper van Eijck, Bas Groot Koerkamp

    Annals of gastroenterological surgery   3 ( 6 )   620 - 629   2019.11

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    Aim: Evidence of nutritional therapies in pancreatoduodenectomy (PD) has been shown. However, few studies focus on the association between different nutritional therapies and outcomes. The aim of this review was to summarize the current evidence of nutritional therapies such as enteral nutrition (EN), immunonutrition, and synbiotics on postoperative outcomes after PD. Methods: A systematic literature search of Embase, Medline Ovid, and Cochrane CENTRAL was done to summarize the available evidence, including randomized controlled trials, meta-analyses and reviews, regarding nutritional therapy in PD. Results: A total of 20 randomized controlled trials were included in this review. Safety and tolerability of EN in PD was shown. Giving postoperative EN can shorten length of stay compared to parenteral nutrition; however, the effect of EN on postoperative complications remains controversial. Postoperative EN should be given only on selective indications rather than routinely used, and preoperative EN is indicated only in patients with severe malnutrition. Giving preoperative immunonutrition is considered to reduce the incidence of infectious complications; however, evidence level is moderate and recommendation grade is weak. The beneficial effect of perioperative synbiotics on postoperative infectious complications is limited. Furthermore, the effectiveness of other nutritional supplements remains unclear. Conclusion: Recently, evidence of enhanced recovery after surgery (ERAS) in PD has been increasing. Early oral intake with systematic nutritional support is an important aspect of the ERAS concept. Future well-designed studies should investigate the impact of systematic nutritional therapies on outcomes following PD.

    DOI: 10.1002/ags3.12287

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  • Grafts from selected deceased donors over 80 years old can safely expand the number of liver transplants: A systematic review and meta-analysis. International journal

    Piotr Domagala, Kosei Takagi, Jan N Ijzermans, Wojciech G Polak

    Transplantation reviews (Orlando, Fla.)   33 ( 4 )   209 - 218   2019.10

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    AIM: The aim of this systematic review and meta-analysis was to present the outcome of deceased adult liver transplantation from octogenarian (≥80 years old) donors compared to younger grafts. METHODS: A systematic search was performed on six databases to identify all available original papers that report the outcome of adult recipients who underwent liver transplantation from a deceased octogenarian donor. RESULTS: Overall, 39,034 liver transplantations from 12 studies were reported with 789 (2.02%) cases receiving grafts from octogenarian donors. Eight studies were included in the meta-analysis. There was no difference regarding the one, three, and five-year graft and patient survival between the recipients of livers <80 years old and octogenarian grafts. There were significantly more episodes of biliary complications in the recipients of octogenarian grafts (34/459; 7.4%) in comparison to the recipients of livers <80 years old (372/37074; 1.0%) (OR 0.53; 95% CI = 0.35-0.81; P 0.004; I2 = 0%). The incidence of primary non-function, vascular complications and re-transplantation did not differ between groups. CONCLUSIONS: The short- and medium-term graft and patient survival of octogenarian liver transplantation is not inferior compared to the liver transplantation with younger grafts, however with a higher rate of biliary complications.

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  • Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. International journal

    Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Bas P L Wijnhoven, Jan N M Ijzermans

    BMC surgery   19 ( 1 )   129 - 129   2019.9

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    BACKGROUND: In recent years, the clinical evidence of the controlling nutritional status (CONUT) score has increased in patients with gastrointestinal cancers. The purpose of this systematic review and meta-analysis was to investigate the association between the preoperative CONUT score and outcomes in patients undergoing gastrectomy for gastric cancer (GC). METHODS: A systematic literature search for studies reporting the prognostic impact of the CONUT score in patients with GC was conducted. Meta-analyses of survival, postoperative outcomes, and postoperative clinico-pathological parameters were conducted. RESULTS: Five studies with 2482 patients were found to be eligible and subsequently reviewed and analyzed. The CONUT score was significantly associated with overall survival (HR 1.85, 95%CI 1.38-2.48, P <  0.001), cancer-specific survival (HR 2.56, 95%CI 1.24-5.28, P = 0.01) and recurrence/relapse-free survival (HR 1.43, 95%CI 1.12-1.82, P = 0.004). Moreover, the CONUT score was associated with the incidence of postoperative complications (OR 1.39, P = 0.003) and mortality (OR 6.97, P = 0.04), and clinico-pathological parameters (T factor [OR 1.75, P <  0.001], N factor [OR 1.51, P <  0.001], TNM stage [OR 1.73, P <  0.001], and microvascular invasion [OR 1.50, P = 0.006]), but not with tumor differentiation (OR 0.85, P = 0.13). CONCLUSIONS: The preoperative CONUT score is an independent prognostic indicator of survival and postoperative complications, and is associated with clinico-pathological parameters in patients with GC.

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  • Order of liver graft revascularization in deceased liver transplantation: A systematic review and meta-analysis. International journal

    Piotr Domagala, Kosei Takagi, Robert J Porte, Wojciech G Polak

    Surgery   166 ( 3 )   237 - 246   2019.9

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    BACKGROUND: The ideal order for liver graft revascularization during liver transplantation remains unknown. The majority of liver transplant centers prefer portal venous reperfusion followed by arterial reperfusion to shorten the warm ischemia time. The aim of this study was to review the different revascularization techniques used in clinical liver transplantation to identify any potential clinical benefits. METHODS: A systematic search of 5 databases was performed to identify all available original articles that reported liver transplantation and compared different techniques of reperfusion. The primary outcomes were patient and graft survival. Secondary outcomes were defined by postreperfusion syndrome, primary nonfunction, vascular complications, biliary complications, and retransplantation. RESULTS: A total of 1,160 patients undergoing liver transplantation from 15 studies were included in this review and meta-analysis. There were no differences regarding the 1-year patient and graft survival for the revascularization techniques. The incidence of primary nonfunction, vascular complications, and retransplantation did not differ between the groups. Although there were no differences regarding biliary complications between the different groups, there were more nonanastomotic strictures in patients with initial portal revascularization (9%) compared with those with simultaneous revascularization (2%; risk ratio 1.07; 95% confidence interval, 1.00-1.14; P = .05; I2 = 51%). CONCLUSION: The order of liver graft revascularization does not influence patient and graft survival. Each revascularization technique offers potential benefits that can be used under specific clinical situations.

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  • 膵頭十二指腸切除術患者におけるenhanced recovery after surgeryプロトコールの有効性について 前向きランダム化比較試験(Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial)

    高木 弘誠, 吉田 龍一, 八木 孝仁, 楳田 祐三, 信岡 大輔, 杭瀬 崇, 樋之津 史郎, 松崎 孝, 森松 博史, 江口 潤, 和田 淳, 千田 益生, 藤原 俊義

    学会誌JSPEN   1 ( Suppl. )   15 - 15   2019.9

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  • 乳児劇症肝炎に対して生体肝移植術を施行した1例

    高木 弘誠, 八木 孝仁, 吉田 龍一, 藤 智和, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 楳田 祐三, 篠浦 先, 藤原 俊義

    肝臓   60 ( 6 )   216 - 216   2019.6

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  • Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial. International journal

    Kosei Takagi, Ryuichi Yoshida, Takahito Yagi, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Shiro Hinotsu, Takashi Matsusaki, Hiroshi Morimatsu, Jun Eguchi, Jun Wada, Masuo Senda, Toshiyoshi Fujiwara

    Clinical nutrition (Edinburgh, Scotland)   38 ( 1 )   174 - 181   2019.2

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    BACKGROUND & AIMS: Evidence of the advantages of enhanced recovery after surgery (ERAS) protocols following pancreaticoduodenectomy (PD) is limited. The aim of this study was to examine the efficiency of ERAS protocols in patients following PD. METHODS: Between June 2014 and October 2016, patients undergoing PD were randomly assigned to receive ERAS protocols or standard care. The primary endpoint was the postoperative length of stay. Secondary endpoints included postoperative complications, postoperative quality-of-life (QoR-40J), readmission, and medical cost. RESULTS: Of 80 eligible patients, 74 were analyzed in intention-to-treat principles: 37 in the control group and 37 in the ERAS group. The mean length of stay in the ERAS group was significantly shorter than that in the control group (20.1 ± 5.4 vs 26.9 ± 13.5 days, P < 0.001). The ERAS group had a significantly lower percentage of postoperative complications (32.4% vs 56.8%, P = 0.034) and readmissions (0% vs 8.1%, P = 0.038). Quality-of-life was also significantly better in the ERAS group (184 ± 12.4 vs 177 ± 14.5, P = 0.022). The total medical cost was lower in the ERAS group, but not significantly ($25,445 ± 5065 vs $28,384 ± 9999, P = 0.085). CONCLUSIONS: The optimization of ERAS protocols in patients undergoing PD is safe and accelerates perioperative recovery and quality-of-life, thereby reducing the length of stay. Morbidity was significantly decreased in the ERAS group without compromising surgical outcome. REGISTRATION NUMBER: UMIN000014068.

    DOI: 10.1016/j.clnu.2018.01.002

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  • The Outcome of Complex Hepato-Pancreato-Biliary Surgery for Elderly Patients: A Propensity Score Matching Analysis. International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Takuro Fushimi, Toshiyoshi Fujiwara, Takahito Yagi

    Digestive surgery   36 ( 4 )   323 - 330   2019

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    BACKGROUND/AIMS: Postoperative mortality and morbidity rates after hepato-pancreato-biliary (HPB) surgery remain high, and the number of elderly patients requiring such surgery has been increasing. This study aimed to investigate postoperative outcomes of complex HPB surgery for elderly patients. METHODS: We retrospectively reviewed perioperative data of 721 patients who underwent complex HPB surgery between 2010 and 2015. The patients were divided into 2 groups: elderly (≥75 years) and non-elderly (< 75 years). Surgical outcomes of both groups were compared after propensity score-matching analysis. Subsequently, risk factors for serious postoperative morbidity were identified by multivariate analysis. RESULTS: Before matching, the elderly group (n = 170) had more comorbidities, such as cardiovascular and renal disease, than the non-elderly group (n = 551). Matching yielded elderly (n = 170) and non-elderly groups (n = 170) with similar preoperative backgrounds. The mortality and morbidity rates did not differ significantly between the groups. In multivariate analyses, operative time (OR 1.79; p = 0.005) and blood loss (OR 1.66; p = 0.03) were identified as independent risk factors for serious postoperative morbidity, whereas older age did not have a predictive impact (OR 1.16; p = 0.52). CONCLUSIONS: Although elderly -patients had more comorbidities and higher incidences of postoperative mortality and several complications before matching, their postoperative outcomes were equivalent to those of non-elderly patients after matching.

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  • The Controlling Nutritional Status Score and Postoperative Complication Risk in Gastrointestinal and Hepatopancreatobiliary Surgical Oncology: A Systematic Review and Meta-Analysis. International journal

    Kosei Takagi, Piotr Domagala, Wojciech G Polak, Stefan Buettner, Jan N M Ijzermans

    Annals of nutrition & metabolism   74 ( 4 )   303 - 312   2019

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    The controlling nutritional status (CONUT) score is associated with prognosis in gastrointestinal (GI) cancer patients, but the clinical significance of the CONUT score for postoperative short-term outcome remains controversial. The aim of this study was to investigate the impact of the CONUT score on postoperative outcomes in patients with GI and hepatopancreatobiliary (HPB) cancers. We conducted a systematic literature search of Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Meta-analyses were performed to estimate the pooled risk ratio (RR) for postoperative complications in patients with lower -CONUT score versus higher CONUT score. Furthermore, we explored the most appropriate cutoff value of the CONUT score to predict postoperative complications. Ten retrospective studies (5,138 patients) were included in this meta-analysis. Patients with higher CONUT score had an increased risk of mortality (RR 5.38, 95% CI 2.19-13.2, p < 0.001, I2 = 0%), postoperative major complications (RR 1.56, 95% CI 1.05-2.33, p= 0.03, I2 = 79%), and overall complications (RR 1.38, 95% CI 1.16-1.63, p < 0.001, I2 = 6%). We found that the cutoff of CONUT ≤4 vs. CONUT ≥5 had the highest pooled RR compared with other cutoff values (RR 4.79, 95% CI 0.97-23.5, p= 0.05, I2 = 91%). In conclusion, the present study suggests that the preoperative CONUT score was associated with an increased risk of mortality and complications in GI and HPB surgical oncology. Patients with higher CONUT score as compared with those having a lower score had approximately a fivefold mortality risk and an increased risk up to 55% on major and overall complications after GI and HPB surgery. Our analysis indicates that the appropriate cutoff value of the CONUT score to predict postoperative major complications would be between 4 and 5. The preoperative evaluation of the CONUT score would be helpful for predicting the risk of postoperative outcomes.

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  • Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis? International journal

    Masashi Utsumi, Yuzo Umeda, Takahito Yagi, Takeshi Nagasaka, Susumu Shinoura, Ryuich Yoshida, Daisuke Nobuoka, Takashi Kuise, Tomokazu Fuji, Kosei Takagi, Akinobu Takaki, Toshiyoshi Fujiwara

    Digestive surgery   36 ( 1 )   59 - 66   2019

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    BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. METHODS: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. RESULTS: During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. CONCLUSION: Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.

    DOI: 10.1159/000486548

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  • Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma. International journal

    Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Takuro Fushimi, Toshiyoshi Fujiwara, Takahito Yagi

    Digestive surgery   36 ( 3 )   226 - 232   2019

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    BACKGROUND: Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes. METHODS: We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. -Results: The high CONUT group had a significantly higher -incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08). CONCLUSIONS: Preoperative assessment of the CONUT score is helpful for evaluating patients' nutritional status and mortality risk after liver surgery.

    DOI: 10.1159/000488215

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  • Prognostic Factors for Pediatric Living Donor Liver Transplantation: Impact of Zero-mortality Transplant for Cholestatic Diseases.

    Takahito Yagi, Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara

    Acta medica Okayama   72 ( 6 )   567 - 576   2018.12

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    Living donor liver transplantation (LDLT) is the final therapeutic arm for pediatric end-stage liver diseases. Toward the goal of achieving further improvement in LDLT survival, we investigated factors affecting recipient survival. We evaluated the prognostic factors of 60 pediatric recipients (< 16 years old) who underwent LDLT between 1997 and 2015. In a univariate analysis, non-cholestatic (NCS) disease, graft/recipient body weight ratio, cold and warm ischemic times, and intraoperative blood loss were significant factors impacting survival. In a multivariate analysis, NCS disease was the only significant factor worsening survival (p=0.0021). One-and 5-year survival rates for the cholestatic disease (CS, n=43) and NCS (n=17) groups were 100% vs. 70.6% and 97.4% vs. 58.8% (p=0.004, log-rank). Intergroup comparisons revealed that CS was significantly associated with operation time, cold ischemia, hepatomegaly of the native liver, and portal plasty. These data suggest that a cirrhotic, swollen, artery-dominant liver did not increase graft size-related risks despite the surgical complexity of preceding operations. The NCS group's poorer survival originated from recurrence of the primary disease and liver manifestation of systemic disease untreatable by transplantation. Improving the survival of pediatric recipients requires intensive efforts to prevent primary disease relapse and more rapid diagnoses to exclude contraindications from NCS disease.

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  • A subclinical high tricuspid regurgitation pressure gradient independent of the mean pulmonary artery pressure is a risk factor for the survival after living donor liver transplantation. International journal

    Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Onishi, Hidenori Shiraha, Shinichiro Nakamura, Hiroshi Morimatsu, Hiroshi Ito, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada

    BMC gastroenterology   18 ( 1 )   62 - 62   2018.5

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    BACKGROUND: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver. We investigated the impact of a subclinical high TRPG on the survival of small grafted living donor liver transplantation (LDLT). METHODS: We retrospectively analyzed 84 LDLT candidates. Patients exhibiting a TRPG ≥25 mmHg on echocardiography were categorized as potentially having liver congestion (subclinical high TRPG; n = 34). The mean pulmonary artery pressure (mPAP) measured after general anesthesia with FIO20.6 (mPAP-FIO20.6) was also assessed. Patients exhibiting pO2 < 80 mmHg and an alveolar-arterial oxygen gradient (AaDO2) ≥ 15 mmHg were categorized as potentially having HPS (subclinical HPS; n = 29). The clinical course after LDLT was investigated according to subclinical high TRPG. RESULTS: A subclinical high TRPG (p = 0.012) and older donor age (p = 0.008) were correlated with a poor 40-month survival. Although a higher mPAP-FIO20.6 was expected to correlate with a worse survival, a high mPAP-FIO20.6 with a low TRPG was associated with high frequency complicating subclinical HPS and a good survival, suggesting a reduction in the PH pressure via pulmonary shunt. CONCLUSION: In cirrhosis patients, mPAP-FIO20.6 may not accurately reflect the congestive pressure to the liver, as the pressure might escape via pulmonary shunt. A subclinical high TRPG is an important marker for predicting a worse survival after LDLT, possibly reflecting congestive pressure to the grafted small liver.

    DOI: 10.1186/s12876-018-0793-z

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  • New Left Lobe Transplantation Procedure with Caval Reconstruction Using an Inverted Composite Graft for Chronic Budd-Chiari Syndrome in Living-Donor Liver Transplantation—A Case Report Reviewed

    T. Yagi, K. Takagi, R. Yoshida, Yuzo Umeda, D. Nobuoka, T. Kuise, T. Fujiwara, A. Takaki

    Transplantation Proceedings   50 ( 4 )   1192 - 1195   2018.5

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    When the Budd-Chiari syndrome (BCS) lesion extends to the inferior vena cava (IVC) or the orifices of the hepatic vein, the thickened IVC and/or hepatic vein wall must be removed and IVC reconstruction is required in living-donor liver transplantation (LDLT). In various reports about IVC resection in LDLT for BCS, there are none about left lobe liver transplantation with reconstruction of the retrohepatic IVC (rhIVC). To overcome removal and reconstruction of the rhIVC in LDLT for BCS, we introduced a composite IVC graft that is applicable to both right and left lobe partial liver grafts for LDLT for BCS. Pathogenic IVC was removed together with the native liver between the lower edge of the right atrium and 5 cm above the renal vein junction with the use of venovenous bypass. The e-polytetrafluoroethylene graft was anastomosed to the suprarenal intact IVC. Then the native part was detached at the level of just above the renal junction. The composite graft was inverted and a half rim of the native part of the graft was anastomosed to the posterior wall of the right atrium. Next, the common venous orifice of the left lobe graft was anastomosed to the wall defect which was composed of the anterior wall of the right atrium and the distal end of the native part of the composite graft. In conclusion, our inverted composite graft technique will overcome the weak points of LDLT for BCS, such as incomplete removal of the pathogenic caval wall and reconstruction of the rhIVC.

    DOI: 10.1016/j.transproceed.2017.11.078

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  • 膵頭十二指腸切除術におけるERAS(Enhanced recovery after surgery)の有効性に関するランダム化比較試験

    高木 弘誠, 吉田 龍一, 八木 孝仁, 楳田 祐三, 信岡 大輔, 杭瀬 崇, 樋之津 史郎, 松崎 孝, 森松 博史, 江口 潤, 和田 淳, 千田 益生, 藤原 俊義

    日本静脈経腸栄養学会雑誌   33 ( Suppl. )   227 - 227   2018.1

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  • 胆道閉鎖症に対するABO不適合移植術後に遷延する肝機能異常を認めた一例

    國府島 健, 信岡 大輔, 楳田 祐三, 吉田 龍一, 杭瀬 崇, 熊野 健二郎, 高木 弘誠, 伏見 卓郎, 吉田 真理, 田中 健大, 藤原 俊義, 八木 孝仁

    移植   52 ( 4-5 )   477 - 478   2017.11

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  • 肝移植後C型肝炎再発に対するソホスブビル含有治療の有効性

    大山 淳史, 高木 章乃夫, 安中 哲也, 足立 卓哉, 池田 房雄, 和田 望, 竹内 康人, 大西 秀樹, 中村 進一郎, 白羽 英則, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 吉田 龍一, 楳田 祐三, 吉田 真理, 有森 千聖, 八木 孝仁, 岡田 裕之

    肝臓   58 ( 11 )   599 - 604   2017.11

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    肝移植後C型肝炎に対するDirect Acting Antivirals(DAA)治療効果を検討した。Genotypelは29症例で、ダクラタスビル+アスナプレビル(DCV+ASV)5例、ソホスブビル+レジパスビル(SOF+LDV)25例(含DCV+ASV無効1例)、Genotype2が2症例でSOF+リバビリン治療を行った。DCV+ASVは5例中4例で治療完遂、3例でSustained viral response(SVR)24を達成。SOF+LDVは全例SVR24を達成、移植後2ヵ月以内の肝炎再燃例も含まれているが問題なく治療完遂可能であった。Genotype2はSVR24を達成。SOF中心レジメンで100%のSVR24達成率であり、移植後早期においても問題なくウイルス駆除達成可能であった。C型肝硬変の肝移植適応評価においてC型肝炎のネガティブインパクトはなくなったと言っても過言ではない。(著者抄録)

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  • Living Donor Liver Transplantation for Acute Liver Failure : Comparing Guidelines on the Prediction of Liver Transplantation.

    Kazuhiro Yoshida, Yuzo Umeda, Akinobu Takaki, Takeshi Nagasaka, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Tetsuya Yasunaka, Hiroyuki Okada, Takahito Yagi, Toshiyoshi Fujiwara

    Acta medica Okayama   71 ( 5 )   381 - 390   2017.10

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    Determining the indications for and timing of liver transplantation (LT) for acute liver failure (ALF) is essential. The King's College Hospital (KCH) guidelines and Japanese guidelines are used to predict the need for LT and the outcomes in ALF. These guidelines' accuracy when applied to ALF in different regional and etiological backgrounds may differ. Here we compared the accuracy of new (2010) Japanese guidelines that use a simple scoring system with the 1996 Japanese guidelines and the KCH criteria for living donor liver transplantation (LDLT). We retrospectively analyzed 24 adult ALF patients (18 acute type, 6 sub-acute type) who underwent LDLT in 1998-2009 at our institution. We assessed the accuracies of the 3 guidelines' criteria for ALF. The overall 1-year survival rate was 87.5%. The new and previous Japanese guidelines were superior to the KCH criteria for accurately predicting LT for acute-type ALF (72% vs. 17%). The new Japanese guidelines could identify 13 acute-type ALF patients for LT, based on the timing of encephalopathy onset. Using the previous Japanese guidelines, although the same 13 acute-type ALF patients (72%) had indications for LT, only 4 patients were indicated at the 1st step, and it took an additional 5 days to decide the indication at the 2nd step in the other 9 cases. Our findings showed that the new Japanese guidelines can predict the indications for LT and provide a reliable alternative to the previous Japanese and KCH guidelines.

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  • Preoperative Controlling Nutritional Status (CONUT) Score for Assessment of Prognosis Following Hepatectomy for Hepatocellular Carcinoma. International journal

    Kosei Takagi, Takahito Yagi, Yuzo Umeda, Susumu Shinoura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Hiroyuki Araki, Toshiyoshi Fujiwara

    World journal of surgery   41 ( 9 )   2353 - 2360   2017.9

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    BACKGROUND: Immune-nutritional status has been recently reported as a prognostic factor in hepatocellular carcinoma (HCC). The controlling nutritional status (CONUT) score has been established as a useful tool to evaluate immune-nutritional status. This study aimed to investigate the efficacy of the CONUT score as a prognostic factor in patients undergoing hepatectomy for HCC. METHODS: A total of 295 patients who underwent curative hepatectomy for HCC between January 2007 and December 2014 were retrospectively analyzed. Patients were divided into two groups according to the CONUT score. The impact of the CONUT score on clinicopathological, surgical, and long-term outcomes was evaluated. Subsequently, the impact of prognostic factors, including the CONUT score, associated with outcomes was assessed using multivariate analyses. RESULTS: Of 295 patients, 118 (40%) belonged to the high CONUT group (CONUT score ≥ 3). The high CONUT group had a significantly lower 5-year recurrence-free survival rate than the low CONUT group (27.9 vs. 41.4%, p = 0.011) and a significantly lower 5-year overall survival rate (61.9 vs. 74.9%, p = 0.006). In multivariate analyses of prognostic factors, the CONUT score was an independent predictor of recurrence-free survival (hazard ratio = 1.64, p = 0.006) and overall survival (hazard ratio = 2.50, p = 0.001). CONCLUSIONS: The CONUT score is a valuable preoperative predictor of survival in patients undergoing hepatectomy for HCC.

    DOI: 10.1007/s00268-017-3985-8

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  • 大腸癌肝転移に対する治療戦略 大腸癌多発肝転移におけるRAS/RAF変異の意義 生物学的悪性度から術前化学療法適応を見極める

    楳田 祐三, 八木 孝仁, 永坂 岳司, 吉田 龍一, 信岡 大輔, 母里 淑子, 杭瀬 崇, 高木 弘誠, 河合 毅, 藤原 俊義

    日本消化器外科学会総会   72回   WS04 - 7   2017.7

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  • Primary pancreatic-type acinar cell carcinoma of the jejunum with tumor thrombus extending into the mesenteric venous system: a case report and literature review. International journal

    Kosei Takagi, Takahito Yagi, Takehiro Tanaka, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara

    BMC surgery   17 ( 1 )   75 - 75   2017.6

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    BACKGROUND: Although ectopic pancreatic tissue is common in the upper gastrointestinal tract, the incidence of ectopic pancreatic tissue in the jejunum is low, and malignant transformation in ectopic pancreatic tissue is rare. Furthermore, pancreatic-type acinar cell carcinoma (ACC) developing in the jejunum and ACC accompanied by tumor thrombus are extremely rare. CASE PRESENTATION: A 78-year-old-woman presented with melena. Abdominal computed tomography images and endoscopic examination revealed a submucosal jejunal mass with tumor thrombus extending into a jejunal vein. The patient underwent a curative resection combined with a partial jejunectomy and partial pancreatectomy. Histopathological examination of the resected tissue showed tumor cells with a homogeneous acinar architecture identical to pancreatic-type ACC and tumor thrombus. Postoperatively, she was followed for 10 months and had no recurrence. CONCLUSION: We present an extremely rare case of pancreatic-type ACC in the jejunum with extensive tumor thrombus invading into the mesenteric venous system. This type of cancer has not been reported previously but should be considered in the differential diagnosis of a jejunal mass.

    DOI: 10.1186/s12893-017-0273-3

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  • Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy. International journal

    Kosei Takagi, Ryuichi Yoshida, Takahito Yagi, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara

    BMC surgery   17 ( 1 )   64 - 64   2017.5

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    BACKGROUND: Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). METHODS: We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections. RESULTS: The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P < 0.001). In multivariate analyses, sarcopenia (odds ratio = 3.43; P < 0.001), preoperative biliary drainage (odds ratio = 2.20; P = 0.014), blood loss (odds ratio = 1.92; P = 0.048), and soft pancreatic texture (odds ratio = 3.71; P < 0.001) were independent predictors of postoperative infections. CONCLUSIONS: Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

    DOI: 10.1186/s12893-017-0261-7

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  • Syndrome of Inappropriate Antidiuretic Hormone Secretion Following Liver Transplantation.

    Kosei Takagi, Takahito Yagi, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Nobuyuki Watanabe, Takashi Kuise, Tomokazu Fuji, Hiroyuki Araki, Toshiyoshi Fujiwara

    Acta medica Okayama   71 ( 1 )   85 - 89   2017.2

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    Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an extremely rare cause of hyponatremia post-liver transplantation. A 15-year-old Japanese girl with recurrent cholangitis after Kasai surgery for biliary atresia underwent successful living donor liver transplantation. Peritonitis due to gastrointestinal perforation occurred. Hyponatremia gradually developed but improved after hypertonic sodium treatment. One month later, severe hyponatremia rapidly recurred. We considered the hyponatremia's cause as SIADH. We suspected that tacrolimus was the disease's cause, so we used cyclosporine instead, plus hypertonic sodium plus water intake restriction, which improved the hyponatremia. Symptomatic hyponatremia manifested by SIADH is a rare, serious complication post-liver transplantation.

    DOI: 10.18926/AMO/54830

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  • A novel intestinal rotation method for digestive reconstruction after combined pancreaticoduodenectomy and extended right hemicolectomy: A case report and surgical technique. International journal

    Kosei Takagi, Takahito Yagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kenjiro Kumano, Takeshi Kojima, Takuro Fushimi, Toshiyoshi Fujiwara

    International journal of surgery case reports   39   51 - 55   2017

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    INTRODUCTION: Pancreaticoduodenectomy (PD) combined with extended right hemicolectomy (RH) is a challenging procedure for locally advanced malignancies. However, information concerning the reconstruction method of the digestive system is limited. Here, we present a case and surgical technique of a novel intestinal rotation method for digestive reconstruction after PD combined with RH. PRESENTATION OF CASE: A 62-year-old man with locally advanced pancreatic cancer received conversion surgery combined with PD and RH after preoperative chemotherapy. With respect to the reconstruction of the digestive system, the entire intestinal mesentery was rotated 180° forward counterclockwise around the axis of the superior mesenteric artery, and then the reconstruction, according to Child's method, was performed. The patient recovered without problems in gastroenterological functions after the operation. DISCUSSION: With respect to the reconstruction of the digestive system in patients undergoing combined PD and RH, practitioners should pay close attention to twisting of the intestinal mesentery when bringing up the proximal jejunum for pancreatojejunostomy and hepatojejunostomy and the distal ileum for ileocolic anastomosis. This intestinal rotation method enables a smooth and uneventful reconstruction of the digestive system. CONCLUSION: This is the first detailed description of an intestinal rotation method for digestive reconstruction after combined PD and extended RH. The intestinal rotation method can be an alternative and helpful technical option for digestive reconstruction in patients with combined PD and RH.

    DOI: 10.1016/j.ijscr.2017.07.063

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  • A successful case of deceased donor liver transplantation for a patient with intrahepatic arterioportal fistula. International journal

    Kosei Takagi, Takahito Yagi, Ryuichi Yoshida, Susumu Shinoura, Yuzo Umeda, Daisuke Nobuoka, Nobuyuki Watanabe, Takashi Kuise, Kenta Sui, Akira Hirose, Makiko Tsuboi, Mitsunari Ogasawara, Shinji Iwasaki, Toshiji Saibara, Toshiyoshi Fujiwara

    Hepatology research : the official journal of the Japan Society of Hepatology   46 ( 13 )   1409 - 1415   2016.12

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    Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension that is often difficult to treat with interventional radiology or surgery. Liver transplantation for IAPF is extremely rare. We report a case of bilateral diffuse IAPF with severe portal hypertension requiring deceased donor liver transplantation (DDLT). A 51-year-old woman with no past medical history was admitted to another hospital complaining of abdominal distension and marasmus. A computed tomography scan and digital subtraction angiography indicated a massive pleural effusion, ascites, and a very large IAPF. Several attempts of interventional embolization of the feeding artery failed to ameliorate arterioportal shunt flow. As ruptures of the esophageal varices became more frequent, hepatic encephalopathy worsened. After repeated, uncontrollable attacks of hepatic coma, the patient was referred to our facility for further treatment. Surgical approaches to IAPF other than liver transplantation were challenging because of diffuse collateralization; therefore, we placed the patient on the national waiting list for DDLT. Although her Model for End-Stage Liver Disease score was relatively low, she received a DDLT 2 months after the waiting period. The postoperative course was uneventful, and the patient was discharged 44 days after her transplant. Liver transplantation may be a valid treatment option for uncontrollable IAPF with severe portal hypertension.

    DOI: 10.1111/hepr.12701

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  • 内臓錯位症候群、胆道閉鎖症に伴う最重症型肝肺症候群に対し施行した生体肝移植の1例

    荒木 宏之, 吉田 龍一, 高木 弘誠, 藤 智和, 渡辺 信之, 杭瀬 崇, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁

    移植   51 ( 6 )   513 - 513   2016.12

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  • 生体肝移植術後早期に急速な卵巣癌の進行を認めた一例 当科における肝移植後二次発癌の解析

    藤 智和, 信岡 大輔, 楳田 祐三, 篠浦 先, 吉田 龍一, 杭瀬 崇, 高木 弘誠, 荒木 宏之, 八木 孝仁

    移植   51 ( 6 )   513 - 513   2016.12

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  • 当院における膵頭十二指腸切除術の治療成績

    高木 弘誠, 八木 孝仁, 吉田 龍一, 藤 智和, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 楳田 祐三, 篠浦 先, 藤原 俊義

    日本消化器外科学会雑誌   49 ( Suppl.2 )   351 - 351   2016.11

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  • Sarcopenia and American Society of Anesthesiologists Physical Status in the Assessment of Outcomes of Hepatocellular Carcinoma Patients Undergoing Hepatectomy.

    Kosei Takagi, Takahito Yagi, Ryuichi Yoshida, Susumu Shinoura, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Nobuyuki Watanabe, Toshiyoshi Fujiwara

    Acta medica Okayama   70 ( 5 )   363 - 370   2016.10

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    Sarcopenia following liver surgery has been reported as a predictor of poor prognosis. Here we investigated predictors of outcomes in patients with hepatocellular carcinoma (HCC) and attempted to establish a new comprehensive preoperative assessment protocol. We retrospectively analyzed the cases of 254 patients who underwent curative hepatectomy for HCC with Child-Pugh classification A at our hospital between January 2007 and December 2013. Sarcopenia was evaluated by computed tomography measurement. The influence of sarcopenia on outcomes was evaluated. We used multivariate analyses to assess the impact of prognostic factors associated with outcomes, including sarcopenia. Of the 254 patients, 118 (46.5% ) met the criteria for sarcopenia, and 32 had an American Society of Anesthesiologists (ASA) physical status 3. The sarcopenic group had a significantly lower 5-year overall survival rate than the non-sarcopenic group (58.2% vs. 82.4% , p=0.0002). In multivariate analyses of prognostic factors, sarcopenia was an independent predictor of poor survival (hazard ratio [HR]=2.28, p=0.002) and poor ASA status (HR=3.17, p=0.001). Sarcopenia and poor ASA status are independent preoperative predictors for poor outcomes after hepatectomy. The preoperative identification of sarcopenia and ASA status might enable the development of comprehensive approaches to assess surgical eligibility.

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  • 安全で正確な肝切除 ICG蛍光法によるfusion imagingとSoft凝固付CUSAによる肝静脈露出

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 藤原 俊義

    日本臨床外科学会雑誌   77 ( 増刊 )   513 - 513   2016.10

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  • 胆膵領域手術における病理医との連携強化の取り組み

    信岡 大輔, 八木 孝仁, 田中 顕之, 篠浦 先, 楳田 祐三, 吉田 龍一, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 柳井 広之, 藤原 俊義

    日本臨床外科学会雑誌   77 ( 増刊 )   761 - 761   2016.10

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  • 膵全摘術 その意義と問題点 膵IPMNに対する膵全摘適応について 残膵再発リスク因子解析を用いた検討

    吉田 龍一, 藤 智和, 篠浦 先, 楳田 祐三, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 高木 弘誠, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   77 ( 増刊 )   398 - 398   2016.10

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  • 肝硬変合併肝細胞癌に対する脾摘の肝機能改善効果

    渡辺 信之, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   77 ( 増刊 )   678 - 678   2016.10

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  • 肝切除術後難治性胆汁瘻に対し無水エタノール注入によるbiliary ablationを施行した2例

    信岡 大輔, 木村 裕司, 篠浦 先, 楳田 祐三, 吉田 龍一, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 八木 孝仁, 藤原 俊義

    胆道   30 ( 3 )   628 - 628   2016.8

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  • 白血病治療中の骨髄抑制期に発症した急性虫垂炎の1例

    吉川 公見子, 杭瀬 崇, 木村 裕司, 高木 弘誠, 藤 智和, 須井 健太, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 猪俣 知子, 乗金 精一郎, 田中 健大, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   77 ( 7 )   1861 - 1861   2016.7

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  • 安全で低侵襲な肝葉切除のコツ 生体肝移植における低侵襲性のための外科的技法 コツと落とし穴(Tips and tricks of safe and less-invasive hepatic lobectomy Surgical technique for minimal invasiveness in living donor liver surgery: Knack & Pitfalls)

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 藤原 俊義

    日本消化器外科学会総会   71回   SY14 - 5   2016.7

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  • Surgical Outcome of Patients Undergoing Pancreaticoduodenectomy: Analysis of a 17‒Year Experience at a Single Center.

    Kosei Takagi, Takahito Yagi, Ryuichi Yoshida, Susumu Shinoura, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Nobuyuki Watanabe, Kenta Sui, Tomokazu Fujii, Toshiyoshi Fujiwara

    Acta medica Okayama   70 ( 3 )   197 - 203   2016.6

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    The operative mortality and morbidity of pancreaticoduodenectomy (PD) remain high. We analyzed PD patients' clinical characteristics and surgical outcomes and discuss how PD clinical outcomes could be improved. We retrospectively reviewed the cases of 400 patients who underwent a PD between January 1998 and April 2014 at Okayama University Hospital, a very-high-volume center. We identified and compared the clinical outcomes between two time periods (period 1: 1998-2006 vs. period 2: 2007-2014). The total postoperative mortality and major complication rates were 0.75% and 15.8% , respectively, and the median postoperative length of stay (LOS) was 32 days. Subsequently, patients who underwent a PD during period 2 had a significantly shorter LOS than those who underwent a PD during period 1 (29 days vs. 38.5 days, p<0.001). The incidence of mortality and major complications did not differ between the two periods. In our multivariate analysis, period 1 was an independent factor associated with a long LOS (p<0.001). The improvement of the surgical procedure and perioperative care might be related to the shorter LOS in period 2 and ot the consistently maintained low mortality rate after PD. The development of multimodal strategies to accelerate postoperative recovery may further improve PD's clinical outcomes.

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  • Liver transplantation; Liver transplantation for HCC, when and how? Complicated portal vein reconstruction, technical consideration 肝細胞癌切除後再発に対する肝移植タイミングの見極め(Liver transplantation: Liver transplantation for HCC, when and how? Complicated portal vein reconstruction, technical consideration Prediction of salvage liver transplantation for hepatocellular carcinoma recurrence after hepatic resection)

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 藤 智和, 須井 健太, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   360 - 360   2016.6

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  • 肝細胞癌切除術後長期成績に対する術前Controlling Nutritional Status(CONUT)Scoreの意義

    高木 弘誠, 八木 孝仁, 藤 智和, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 藤原 俊義

    外科と代謝・栄養   50 ( 3 )   144 - 144   2016.6

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  • 非機能性pNETにおける、肝転移症例の検討と外科的治療戦略

    杭瀬 崇, 楳田 裕三, 高木 弘誠, 藤 智和, 須井 健太, 渡辺 信之, 信岡 大輔, 吉田 龍一, 篠浦 先, 八木 孝仁

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   481 - 481   2016.6

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  • 右側肝円索・門脈分枝走行異常を伴った進行胆嚢癌切除の経験

    吉田 龍一, 高木 弘誠, 須井 健太, 藤 智和, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 楳田 佑三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   429 - 429   2016.6

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  • 各科手術におけるエネルギーデバイス使用の現状 高機能電気メス付CUSAによる肝切除

    楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本外科系連合学会誌   41 ( 3 )   402 - 402   2016.5

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  • 白血病治療中の骨髄抑制期に発症した急性虫垂炎の1例

    吉川 公見子, 杭瀬 崇, 木村 裕司, 高木 弘誠, 藤 智和, 須井 健太, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 猪俣 知子, 乗金 精一郎, 田中 健大, 八木 孝仁, 藤原 俊義

    岡山医学会雑誌   128 ( 1 )   78 - 78   2016.4

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  • A Nationwide Survey of Hepatitis E Virus Infection and Chronic Hepatitis E in Liver Transplant Recipients in Japan. International journal

    Yuki Inagaki, Yukio Oshiro, Tomohiro Tanaka, Tomoharu Yoshizumi, Hideaki Okajima, Kohei Ishiyama, Chikashi Nakanishi, Masaaki Hidaka, Hiroshi Wada, Taizo Hibi, Kosei Takagi, Masaki Honda, Kaori Kuramitsu, Hideaki Tanaka, Taiji Tohyama, Toshihiko Ikegami, Satoru Imura, Tsuyoshi Shimamura, Yoshimi Nakayama, Taizen Urahashi, Kazumasa Yamagishi, Hiroshi Ohnishi, Shigeo Nagashima, Masaharu Takahashi, Ken Shirabe, Norihiro Kokudo, Hiroaki Okamoto, Nobuhiro Ohkohchi

    EBioMedicine   2 ( 11 )   1607 - 12   2015.11

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    BACKGROUND: Recently, chronic hepatitis E has been increasingly reported in organ transplant recipients in European countries. In Japan, the prevalence of hepatitis E virus (HEV) infection after transplantation remains unclear, so we conducted a nationwide cross-sectional study to clarify the prevalence of chronic HEV infection in Japanese liver transplant recipients. METHODS: A total of 1893 liver transplant recipients in 17 university hospitals in Japan were examined for the presence of immunoglobulin G (IgG), IgM and IgA classes of anti-HEV antibodies, and HEV RNA in serum. FINDINGS: The prevalence of anti-HEV IgG, IgM and IgA class antibodies was 2.9% (54/1893), 0.05% (1/1893) and 0% (0/1893), respectively. Of 1651 patients tested for HEV RNA, two patients (0.12%) were found to be positive and developed chronic infection after liver transplantation. In both cases, HEV RNA was also detected in one of the blood products transfused at the perioperative period. Analysis of the HEV genomes revealed that the HEV isolates obtained from the recipients and the transfused blood products were identical in both cases, indicating transfusion-transmitted HEV infection. INTERPRETATION: The prevalence of HEV antibodies in liver transplant recipients was 2.9%, which is low compared with the healthy population in Japan and with organ transplant recipients in European countries; however, the present study found, for the first time, two Japanese patients with chronic HEV infection that was acquired via blood transfusion during or after liver transplantation.

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  • 結腸右半切除を伴う拡大膵頭十二指腸切除術後の再建の工夫

    佐藤 博紀, 信岡 大輔, 安井 和也, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本消化器外科学会雑誌   48 ( Suppl.2 )   203 - 203   2015.10

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  • 腹腔鏡下肝切除の適応拡大に向けたcadaver trainingの実際

    信岡 大輔, 八木 孝仁, 近藤 喜太, 佐藤 博紀, 森廣 俊昭, 高木 弘誠, 安井 和也, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 大塚 愛二, 藤原 俊義

    日本消化器外科学会雑誌   48 ( Suppl.2 )   206 - 206   2015.10

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  • 高齢化社会に向けたこれからの胃癌治療戦略 治療すべきか経過観察か サルコペニアが高齢胃癌患者の予後に及ぼす影響

    桑田 和也, 高木 弘誠, 菊地 覚次, 黒田 新士, 吉田 龍一, 西崎 正彦, 香川 俊輔, 藤原 俊義

    日本胃癌学会総会記事   87回   175 - 175   2015.3

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  • Correlation of Computed Tomography Imaging Features and Pathological Features of 41 Patients with Pancreatic Neuroendocrine Tumors Reviewed

    Masashi Utsumi, Yuzo Umeda, Kosei Takagi, Kuise Takashi, Daisuke Nobuoka, Ryuichi Yoshida, Susumu Shinoura, Hiroshi Sadamori, Takahito Yagi, Toshiyoshi Fujiwara

    HEPATO-GASTROENTEROLOGY   62 ( 138 )   441 - 446   2015.3

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    Background:/Aims: Pancreatic neuroendocrine tumors (PNET) are relatively rare. Here, we present clinical and pathological characteristics of PNETs to show a relationship between computed tomography (CT) imaging and the 2010 World Health Organization (WHO) classification. Methodology: We retrospectively reviewed the records of 41 PNET patients who were treated between 2002 and 2012. All tumors were classified as neuroendocrine tumor (NET) grade 1 (121), NET grade 2 (G2), or neuroendocrine carcinoma (NEC) grade 3 (G3) on the basis of the 2010 WHO classification system. Results: Twenty-five tumors were classified as G1, 11 as G2, and five as G3. Mean sizes of the G1, G2 and G3 tumors were 1.84 +/- 0.54, 4.90 +/- 0.84, and 5.62 +/- 1.18 cm, respectively, (P &lt; 0.01). A PNET is typically hypervascular and exhibits contrast enhancement on enhanced CT. Higher percentage of G1 tumors demonstrated typical imaging and showed a significantly greater distinct mass compared with G2 and G3 tumors. Conclusions: Although PNET has many imaging features that appear on CT, G2 and G3 tumors often show atypical imaging features, particularly with large sizes and/or ill-defined features, when compared with G1 tumors. If a PNET has atypical imaging features, possibility of malignancy should be considered.

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  • Risk Factors of Morbidity and Predictors of Long-term Survival after Hepatopancreatoduodenectomy for Biliary Cancer Reviewed

    Masashi Utsumi, Hiroshi Sadamori, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Kosei Takagi, Toshiyoshi Fujiwara, Takahito Yagi

    HEPATO-GASTROENTEROLOGY   61 ( 136 )   2167 - 2172   2014.11

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    Background/Aims: Hepatopancreatoduodenectomy (HPD) is performed to achieve radical resection of malignant biliary tumors. We reviewed clinical outcomes to evaluate the utility of HPD in terms of morbidity and mortality. Methodology: A retrospective analysis was conducted on 17 patients underwent HPD between August 1991 and May 2013; 9 bile duct cancel; 5 advanced gallbladder and 3pancreatic tumor with liver metastasis. Results: The morbidity and mortality rates were 88.3% and 0%, respectively. Univariate analysis showed that a body mass index of &gt;= 22 and preoperative total bilirubin level &gt;= 0.8 mg/dl were significantly associated with severe complications. One, 3- and 5-year survival rate were 73.3%, 60.0% and 30.0%. In 14 patients with biliary carcinoma, univariate analysis showed that a histological grade of G1 was significantly associated with survival. Patients without pancreatic invasion or portal vein invasion tended to survive longer than patients with these types of invasion, although the difference was not significant. Conclusions: HPD can be performed with no mortality and provides a survival benefit for some patients with biliary carcinoma undergoing curative resection. In patients with grade G1 biliary carcinoma without pancreatic or portal vein invasion in particular, this aggressive surgery might offer a chance of long-term survival.

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  • 肝胆膵外科手術の修練方法 遺体を用いた肝胆膵外科手術教育

    信岡 大輔, 八木 孝仁, 近藤 喜太, 森廣 俊昭, 高木 弘誠, 藤 智和, 渡邉 祐介, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 日置 勝義, 藤原 俊義

    日本臨床外科学会雑誌   75 ( 増刊 )   333 - 333   2014.10

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  • Surgical education using a multi-viewpoint and multi-layer three-dimensional atlas of surgical anatomy (with video).

    Daisuke Nobuoka, Tomokazu Fuji, Kazuhiro Yoshida, Kosei Takagi, Takashi Kuise, Masashi Utsumi, Ryuichi Yoshida, Yuzo Umeda, Susumu Shinoura, Yoshimasa Takeda, Aiji Ohtsuka

    Journal of hepato-biliary-pancreatic sciences   21 ( 8 )   556 - 61   2014.8

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    BACKGROUND: Trainee surgeons must have a good understanding of surgical anatomy. Especially in the hepatobiliary-pancreatic field, beginning surgeons often find it difficult to recognize the three-dimensional structure of the target organ and its complex anatomical correlation with surrounding organs. Conventional anatomy textbooks are not written with the aim of teaching these three-dimensional structures and complex correlations. We developed a novel teaching atlas of surgical anatomy using a multi-viewpoint and multi-layer three-dimensional camera system. METHODS: Layer-by-layer dissection of the upper abdominal organs of a cadaver was performed by expert surgeons. A stereoscopic camera system was used to capture a series of anatomical views. The images were remodeled in a multi-viewpoint and multi-layer manner. RESULTS: Images of each dissection layer could be viewed serially from the appropriate angle, which was tilted up to 90° along the anteroposterior axis. The clinical anatomy specific to the surgical procedure could thus be learned using this atlas system. CONCLUSIONS: Rotatable three-dimensional panoramic views of local dissection of the upper abdominal organs of a cadaver were developed for educational purposes. Trainee surgeons could use these anatomical images instead of conventional anatomical atlases to learn how to perform surgical procedures such as pancreaticoduodenectomy and major hepatectomy.

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  • 乳児急性リンパ性白血病臍帯血移植後に発症した肝中心静脈閉塞症に対し生体肝移植、骨髄移植を施行した1例

    吉田 龍一, 高木 弘誠, 藤 智和, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 保田 裕子, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   130 - 130   2014.5

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  • 脳死ドナーの増加は肝移植成績を改善したか 脳死肝移植成績 当院15症例の検討

    篠浦 先, 八木 孝仁, 貞森 裕, 楳田 祐三, 吉田 龍一, 佐藤 太祐, 信岡 大輔, 内海 方嗣, 藤 智和, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   241 - 241   2013.6

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  • 肝腫瘍および生体肝移植ドナーにおける肝切離法の工夫

    貞森 裕, 八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 佐藤 太祐, 信岡 大輔, 内海 方嗣, 藤 智和, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   319 - 319   2013.6

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  • 生体肝移植の手術手技の工夫 低体重児に対するS2移植+in situ reductionをもちいたsub-monosegment liver transplantation

    八木 孝仁, 貞森 裕, 篠浦 先, 楳田 祐三, 吉田 龍一, 佐藤 太祐, 内海 方嗣, 信岡 大輔, 杉原 正大, 藤 智和, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   287 - 287   2013.6

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  • [Two cases of CPT-11 and CDDP chemotherapy for advanced pancreatic cancer].

    Kosei Takagi, Kazuyuki Kawamoto, Tadashi Itoh

    Gan to kagaku ryoho. Cancer & chemotherapy   39 ( 5 )   847 - 9   2012.5

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    We report two cases of advanced pancreatic cancer treated with CPT-11 and CDDP as third-line chemotherapy. CPT-11 was administered as an intravenous injection at a dose of 60 mg/m², and CDDP was administered at a dose of 30 mg/m2 biweekly. The patients showed no adverse events greater than grade 2 toxicity, and these adverse events were tolerated. The patients showed partial response and stable disease. These results suggested that this treatment schedule was safe and effective for progressive pancreatic cancer.

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  • [A case of drug-induced interstitial pneumonitis after chemotherapy with UFT and leucovorin for multiple lung metastases of rectal cancer].

    Kosei Takagi, Kazuyuki Kawamoto, Hiroyoshi Ikeda, Tadashi Itoh

    Gan to kagaku ryoho. Cancer & chemotherapy   38 ( 6 )   1025 - 7   2011.6

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    The patient was a 70-year-old male who had multiple lung metastases of rectal cancer. He was administered UFT(300mg/ day)and LV(75mg/day)after Hartmann operation for rectal cancer. He complained of fever and difficulty breathing after 2 courses of these medicines, and was admitted for UFT-and LV-induced interstitial pneumonitis. Treatment with methylpredni- solone(30mg/day)improved his symptoms and revealed radical findings. He was ready for discharge on the 10th day after treatment. Interstitial pneumonitis-induced UFT and LV is rare, but can lead to severe complications, which should be diagnosed and treated by corticosteroid as soon as possible.

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  • 術前化学療法を施行した膵癌患者における代謝栄養学的指標の意義に関する検討

    佐藤 博紀, 吉田 龍一, 安井 和也, 楳田 祐三, 藤 智和, 高木 弘誠, 黒田 新士, 野間 和広, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   77回   P224 - 3   2022.7

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  • 高度なHCCの治療を目的とする粒子線治療を先行させた肝移植

    八木 孝仁, 吉田 龍一, 安井 和也, 佐藤 博紀, 楳田 祐三, 吉田 一博, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    日本消化器外科学会総会   76回   P143 - 6   2021.7

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  • ロボット支援下膵頭十二指腸切除術の安全な導入と術式の定型化

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

    日本外科学会定期学術集会(Web)   121st   2021

  • 消化器外科における多施設共同研究の意義-地方からのevidence発信を目指して-

    楳田祐三, 黒田新士, 香川俊輔, 吉田龍一, 菊池覚次, 杭瀬崇, 吉田一博, 高木弘誠, 安井和也, 西崎正彦, 八木孝仁, 藤原俊義

    日本外科学会定期学術集会(Web)   121st   2021

  • R/BR膵癌術前化学療法施行症例における術直前CA19-9値の意義に関する検討

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

    日本外科学会定期学術集会(Web)   121st   2021

  • 進行胆嚢癌に対する外科治療-手術成績を踏まえ,その限界を考える-

    吉田一博, 楳田祐三, 吉田龍一, 杭瀬崇, 安井和也, 高木弘誠, 荒木宏之, 谷悠真, 實金悠, 八木孝仁, 藤原俊義

    日本外科学会定期学術集会(Web)   121st   2021

  • Robotic Pancreatoduodenectomy in the West

    高木弘誠, 楳田祐三, 吉田龍一, 八木孝仁, 藤原俊義

    胆と膵   42 ( 3 )   2021

  • CDDP+VP-16療法を根治術後に施行し長期無再発生存している十二指腸乳頭部MANECの1例

    谷悠真, 杭瀬崇, 堀口繁, 實金悠, 荒木宏之, 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

    日本癌治療学会学術集会(Web)   58th   2020

  • 局所進行切除不能膵癌conversion surgeryにおける結腸動脈を用いた肝動脈再建

    吉田龍一, 楳田祐三, 杭瀬崇, 吉田一博, 安井和也, 高木弘誠, 荒木宏之, 八木孝仁, 藤原俊義

    日本膵切研究会プログラム・抄録集   47th   2020

  • The Six National University Consortium in Liver Transplant Professionals Training Program (SNUC-LT Program) in Japan: Experiences as a trainee

    高木弘誠, 杭瀬崇, 楳田祐三, 藤原俊義, 八木孝仁

    移植(Web)   55 ( 4 )   2020

  • Operative Technique in Robotic Pancreatoduodenectomy at Erasmus MC

    高木弘誠, TRAN Khe T.C., GROOT Koerkamp Bas

    日本内視鏡外科学会総会(Web)   32nd   2019

  • 膵癌と胆管癌が発見された2型糖尿病の1例

    水草典子, 平田教至, 中迫幸男, 天田雅文, 土橋優子, 水野郁子, 高木弘誠, 八木孝仁

    糖尿病(Web)   61 ( 5 )   2018

  • 移植後C型肝炎に対するインターフェロンフリーDAA治療の高い効果

    大山 淳史, 高木 章乃夫, 安中 哲也, 足立 卓哉, 和田 望, 池田 房雄, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 高木 弘誠, 八木 孝仁, 岡田 裕之

    移植   52 ( 4-5 )   416 - 416   2017.11

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  • 再発肝癌に対する治療戦略 Salvage transplantationの見極め

    楳田 祐三, 八木 孝仁, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 国府島 健, 熊野 健二郎, 高木 弘誠, 吉田 真里, 高木 章乃夫, 藤原 俊義

    移植   52 ( 4-5 )   414 - 415   2017.11

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  • 抗体関連型拒絶反応の関与が示唆された遅発性拒絶反応の一例

    伏見 卓郎, 楳田 祐三, 杭瀬 崇, 田中 健大, 吉田 龍一, 信岡 大輔, 國府島 健, 熊野 健二郎, 高木 弘誠, 吉田 真理, 藤原 俊義, 八木 孝仁

    移植   52 ( 4-5 )   476 - 477   2017.11

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  • 造血幹細胞移植後肝中心静脈閉塞症の2例 自験例を踏まえた至適治療戦略の考察

    吉田 龍一, 楳田 祐三, 信岡 大輔, 杭瀬 崇, 熊野 健二郎, 國府島 健, 高木 弘誠, 荒木 宏之, 梶岡 裕紀, 八木 孝仁

    移植   52 ( 4-5 )   462 - 462   2017.11

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  • 生体肝移植における非顕微鏡下肝動脈再建 手技的要点とその安全性

    八木 孝仁, 高木 弘誠, 吉田 真理, 梶岡 裕紀, 楳田 祐三, 熊野 健二郎, 杭瀬 崇, 信岡 大輔, 吉田 龍一, 藤原 俊義

    移植   52 ( 4-5 )   409 - 410   2017.11

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  • SURGICAL OUTCOMES OF LIVING DONOR LIVER SURGERY: TECHNICAL KNACK FOR ZERO MORBIDITY

    Takashi Kuise, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Kenjiro Kumano, Takeshi Koujima, Kosei Takagi, Toshiyoshi Fujiwara, Takahito Yagi

    TRANSPLANT INTERNATIONAL   30   128 - 129   2017.9

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  • IS POOR OUTCOME OF LIVING DONOR LIVER TRANSPLANTATION FOR PRIMARY SCLEROSING CHOLANGITIS THE NATURE OF THE DISEASE ITSELF OR INSUFFICIENT IMMUNOSUPPRESSION?

    Takahito Yagi, Daisuke Nobuoka, Yuzo Umeda, Ryuichi Yoshida, Takashi Kuise, Kosei Takagi, Kenjiro Kumano, Toshiyoshi Fujiwara

    TRANSPLANT INTERNATIONAL   30   288 - 289   2017.9

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  • PREDICTION OF SALVAGE LIVER TRANSPLANTATION FOR HCC RECURRENCE: WHEN AND WHICH PATIENT SHOULD WE DECIDE TRANSPLANT?

    Yuzo Umeda, Takahito Yagi, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kenjiro Kumano, Takeshi Koujima, Kosei Takagi, Takeshi Nagasaka, Toshiyoshi Fujiwara

    TRANSPLANT INTERNATIONAL   30   180 - 180   2017.9

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  • ANALYSIS OF PROGNOSTIC FACTORS OF PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION: A SINGLE CENTER EXPERIENCE OF MORTALITY ZERO TRANSPLANTATION FOR CHOLESTATIC DISEASE

    Takahito Yagi, Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kenjiro Kumano, Mari Yoshida, Toshiyoshi Fujiwara

    TRANSPLANT INTERNATIONAL   30   158 - 159   2017.9

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  • 脾摘の功罪からみた生体肝移植における術前脾動脈塞栓術の意義

    楳田 祐三, 八木 孝仁, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 國府島 健, 熊野 健二郎, 高木 弘誠, 伏見 卓郎, 友田 健, 吉田 真里, 加藤 博也, 高木 章乃夫, 藤原 俊義

    移植   52 ( 総会臨時 )   333 - 333   2017.8

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  • PSCに対する肝移植の現状と新たな展開 PSCに対する生体肝移植におけるintensive inductionは後の再燃性Graft lossを防げるか?

    八木 孝仁, 信岡 大輔, 国府島 健, 熊野 健二郎, 高木 弘誠, 吉田 真理, 杭瀬 崇, 吉田 龍一, 楳田 祐三, 藤原 俊義

    移植   52 ( 総会臨時 )   316 - 316   2017.8

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  • 肝移植へのブリッジとしての門脈圧亢進症治療 生体肝移植特有の肝移植周術期門脈圧亢進症対策

    八木 孝仁, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 高木 弘誠, 熊野 健二郎, 國府島 健, 伏見 卓郎, 藤原 俊義

    日本門脈圧亢進症学会雑誌   23 ( 3 )   99 - 99   2017.8

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  • 膵切除における周術期VTE発症予測因子の解析

    荒木 宏之, 吉田 龍一, 楳田 祐三, 信岡 大輔, 杭瀬 崇, 國府島 健, 熊野 健二郎, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   72回   RS3 - 142   2017.7

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  • 膵全摘患者に対するインスリンポンプ療法を用いた新たな血糖管理

    吉田 龍一, 楳田 祐三, 信岡 大輔, 杭瀬 崇, 熊野 健二郎, 國府島 健, 高木 弘誠, 荒木 宏之, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   72回   PL10 - 2   2017.7

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  • 原発性硬化性胆管炎に対する肝移植の治療成績

    信岡 大輔, 八木 孝仁, 楳田 祐三, 吉田 龍一, 杭瀬 崇, 熊野 健二郎, 國府島 健, 高木 弘誠, 荒木 宏之, 藤原 俊義

    日本消化器外科学会総会   72回   PN14 - 4   2017.7

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  • 腎癌の多発膵転移・単発肺転移・下大静脈腫瘍栓に対して膵全摘を含めた一期的切除を施行し良好な術後経過を得た一例

    國府島健, 信岡大輔, 八木孝仁, 楳田祐三, 吉田龍一, 杭瀬崇, 熊野健二郎, 高木弘誠, 伏見卓郎, 谷本竜太, 藤原俊義

    日本膵切研究会プログラム・抄録集   44th   2017

  • 急性肝不全にて発症した造血幹細胞移植後肝中心静脈閉塞症の2例~自験例を踏まえた至適治療戦略の考察~

    吉田龍一, 高木弘誠, 杭瀬崇, 信岡大輔, 楳田佑三, 篠浦先, 八木孝仁

    肝臓   58 ( 6 )   2017

  • 膵頭十二指腸切除術におけるERAS(Enhanced recovery after surgery)の取り組みと理学療法士の役割

    岩井賢司, 高木弘誠, 吉田龍一, 築山尚司, 太田晴之, 福田智美, 堅山佳美, 八木孝仁, 千田益夫

    Japanese Journal of Rehabilitation Medicine   54 ( Supplement )   2017

  • Sarcopenia predicts postoperative infection in patients undergoing hepato-biliary-pancreatic surgery

    Kosei Takagi, Takahito Yagi, Ryuichi Yoshida, Yuzo Umeda, Daisuke Nobuoka, Takashi Kuise, Toshiyoshi Fujiwara

    International Journal of Surgery Open   6   12 - 18   2017

  • 血液型不適合・術前抗ドナー抗体陽性生体肝移植の経験

    渡辺 信之, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 藤原 俊義, 八木 孝仁

    移植   51 ( 6 )   512 - 513   2016.12

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  • 多視点3D映像システムによる次世代の手術解剖教育

    信岡 大輔, 八木 孝仁, 近藤 喜太, 篠浦 先, 楳田 祐三, 吉田 龍一, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 藤原 俊義

    日本消化器外科学会雑誌   49 ( Suppl.2 )   358 - 358   2016.11

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  • 肝 C型肝炎についてup to date 肝移植後のC型肝炎ウイルス治療の進歩 ソホスブビル含有治療の有用性

    高木 章乃夫, 安中 哲也, 足立 卓哉, 池田 房雄, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 高木 弘誠, 八木 孝仁, 岡田 裕之

    移植   51 ( 総会臨時 )   223 - 223   2016.9

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  • 小児胆汁うっ帯性肝疾患に対するMortality zero肝移植

    八木 孝仁, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡邉 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 藤原 俊義

    移植   51 ( 総会臨時 )   250 - 250   2016.9

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  • 全国腸管不全登録患者データベースにおける成人腸管不全の成人発症例とCarry over症例の比較

    渡邉 信之, 八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 藤 智和, 高木 弘誠, 荒木 宏之, 藤原 俊義

    移植   51 ( 総会臨時 )   420 - 420   2016.9

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  • 「全国腸管不全登録患者データベース」における成人腸管不全の成人発症例とCarry over症例の比較

    八木 孝仁, 高木 弘誠, 楳田 祐三, 吉田 龍一, 篠浦 先, 信岡 大輔, 杭瀬 崇, 藤原 俊義, 吉田 真理, 保田 裕子, 上野 豪久, 福澤 正洋

    移植   51 ( 2-3 )   310 - 310   2016.8

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  • IPMN由来浸潤癌の進展様式と再発形態の検討

    藤 智和, 楳田 祐三, 信岡 大輔, 篠浦 先, 吉田 龍一, 杭瀬 崇, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   71回   P3 - 71   2016.7

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  • 当院における膵頭十二指腸切除術周術期におけるERASの取り組み

    高木 弘誠, 吉田 龍一, 須井 健太, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   71回   P1 - 71   2016.7

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  • 生体肝移植ドナー340例の手術成績

    渡辺 信之, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 藤 智和, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   71回   P3 - 51   2016.7

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  • 肝細胞癌切除患者におけるsarcopeniaが長期予後に及ぼす影響に関する検討

    高木 弘誠, 吉田 龍一, 藤 智和, 須井 健太, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   639 - 639   2016.6

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  • 再肝切除における根治性確保と合併症軽減に向けた手術手技と工夫

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 藤 智和, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   403 - 403   2016.6

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  • von Hippel-Lindau病に合併した膵NETの治療戦略

    信岡 大輔, 杭瀬 崇, 篠浦 先, 楳田 祐三, 吉田 龍一, 渡辺 信之, 須井 健太, 藤 智和, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   28回   496 - 496   2016.6

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  • 肝内胆管癌の外科治療 リンパ節郭清結果を踏まえ手術戦略を再考する

    渡辺 信之, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 須井 健太, 藤 智和, 高木 弘誠, 木村 裕司, 八木 孝仁, 藤原 俊儀

    日本外科学会定期学術集会抄録集   116回   OP - 068   2016.4

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  • 複数回使用可能なシリコンレプリカ膵臓モデルを用いた膵管空腸吻合トレーニングキットの開発

    杭瀬 崇, 八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 渡辺 信之, 高木 弘誠, 須井 健太, 木村 祐司, 藤原 俊義

    日本外科学会定期学術集会抄録集   116回   OP - 011   2016.4

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  • 当院成人生体肝移植術後菌血症症例の検討

    篠浦 先, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 八木 孝仁, 藤原 俊義

    日本外科学会定期学術集会抄録集   116回   PS - 097   2016.4

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  • 【脳死肝移植の進展をいかに考えるべきか-脳死肝移植をもっと進展させなければ!-】 現場の声を聞こう 肝移植医療を地域と大学が一体としてまとめ上げた実績とさらなる発展

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 渡辺 信之, 高木 弘誠, 須井 健太, 藤原 俊義, 高木 章乃夫, 吉田 真理, 保田 裕子, 森松 博史

    肝・胆・膵   72 ( 3 )   481 - 487   2016.3

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  • 肝胆膵外科手術における術後感染性合併症の指標としてSarcopeniaは有用な術前指標である

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本静脈経腸栄養学会雑誌   31 ( 1 )   264 - 264   2016.1

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  • 内臓錯位症候群,胆道閉鎖症に伴う最重症型肝肺症候群に対し施行した生体肝移植の1例

    荒木宏之, 吉田龍一, 高木弘誠, 藤智和, 渡辺信之, 杭瀬崇, 信岡大輔, 楳田祐三, 篠浦先, 八木孝仁

    移植(Web)   51 ( 6 )   2016

  • 多視点3D映像システムによる次世代の手術解剖教育

    信岡大輔, 八木孝仁, 近藤喜太, 篠浦先, 楳田祐三, 吉田龍一, 渡辺信之, 杭瀬崇, 藤智和, 高木弘誠, 藤原俊義

    日本消化器外科学会雑誌(Web)   49 ( Supplement2 )   2016

  • 当院における膵頭十二指腸切除術の治療成績

    高木弘誠, 八木孝仁, 吉田龍一, 藤智和, 杭瀬崇, 渡辺信之, 信岡大輔, 楳田祐三, 篠浦先, 藤原俊義

    日本消化器外科学会雑誌(Web)   49 ( Supplement2 )   2016

  • 肝移植後肝癌再発に対する治療成績

    渡辺 信之, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 須井 健太, 高木 弘誠, 木村 裕司, 藤原 俊義, 八木 孝仁

    移植   50 ( 6 )   662 - 663   2015.12

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  • Cadaver trainingによる腹腔鏡下肝切除の修練

    信岡 大輔, 八木 孝仁, 近藤 喜太, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 吉田 龍一, 楳田 祐三, 篠浦 先, 香川 俊輔, 藤原 俊義

    日本内視鏡外科学会雑誌   20 ( 7 )   OS251 - 5   2015.12

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  • 脳死肝腎同時移植の3例

    篠浦 先, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 八木 孝仁

    移植   50 ( 6 )   662 - 662   2015.12

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  • 肝切除術後難治性胆汁瘻に対し無水エタノール注入によるbiliary ablationが有効であった2例

    木村 裕司, 信岡 大輔, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   76 ( 増刊 )   1114 - 1114   2015.10

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    DOI: 10.3919/jjsa.76.1114

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  • 肝腎同時移植の適応と問題点 3例の脳死下肝腎同時移植の経験から

    八木 孝仁, 吉田 龍一, 篠浦 先, 信岡 大輔, 楳田 祐三, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    移植   50 ( 4-5 )   470 - 470   2015.10

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  • 化学療法にて組織学的CRが得られた切除不能肝内胆管原発小細胞癌の1例

    信岡 大輔, 八木 孝仁, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 吉田 龍一, 楳田 祐三, 篠浦 先, 堤 康一郎, 加藤 博也, 柳井 広之, 藤原 俊義

    日本臨床外科学会雑誌   76 ( 増刊 )   1117 - 1117   2015.10

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  • 移植医療におけるHCV治療up-to-date 肝移植後C型肝炎における免疫抑制性T細胞とキメリズムの病態への影響

    高木 章乃夫, 内海 方嗣, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 高木 弘誠, 安中 哲也, 保田 裕子, 八木 孝仁

    移植   50 ( 総会臨時 )   207 - 207   2015.9

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  • 肝移植術前管理と肝移植後の難治性腹水におけるトルバプタンの有効性

    楳田 祐三, 八木 孝仁, 高木 章乃夫, 篠浦 先, 吉田 龍一, 信岡 大輔, 安中 哲也, 渡辺 信之, 杭瀬 崇, 高木 弘誠, 保田 裕子, 藤原 俊義

    移植   50 ( 総会臨時 )   336 - 336   2015.9

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  • 肝臓移植における血管吻合とくに非顕微鏡的肝動脈再建と肝静脈・下大静脈置換の手技

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 渡辺 信之, 高木 弘誠, 須井 健太, 木村 祐司, 藤原 俊義, 吉田 真理, 保田 裕子, 高木 章乃夫

    移植   50 ( 総会臨時 )   197 - 197   2015.9

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  • 移植医療人の役割分担と協調はどうあるべきか 外科医、内科医、コーディネーターの関係

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 渡辺 信之, 高木 弘誠, 須井 健太, 木村 祐司, 藤原 俊義, 吉田 真理, 保田 裕子, 高木 章乃夫

    移植   50 ( 総会臨時 )   219 - 219   2015.9

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  • Intrahepatic arterioportal fistulaに伴う門脈圧亢進症に対して脳死肝移植術を施行した1例

    高木 弘誠, 吉田 龍一, 篠浦 先, 楳田 祐三, 信岡 大輔, 渡辺 信之, 杭瀬 崇, 須井 健太, 木村 裕司, 吉田 真里, 保田 裕子, 八木 孝仁, 藤原 俊義

    移植   50 ( 総会臨時 )   491 - 491   2015.9

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  • 当院における脳死肝腎同時移植3症例の検討

    篠浦 先, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 信岡 大輔, 吉田 龍一, 楳田 祐三, 八木 孝仁

    移植   50 ( 総会臨時 )   491 - 491   2015.9

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  • 生体肝移植におけるリスク因子としての高齢ドナーと背景疾患との関連性

    楳田 祐三, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 吉田 龍一, 篠浦 先, 保田 裕子, 高木 章乃夫, 藤原 俊義, 八木 孝仁

    移植   50 ( 2-3 )   248 - 249   2015.8

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  • 生体肝移植患者におけるItraconazoleの長期内服による真菌感染症予防効果、安全性の検討

    内海 方嗣, 楳田 祐三, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 吉田 龍一, 藤原 俊義, 八木 孝仁

    移植   50 ( 2-3 )   280 - 280   2015.8

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  • 初診時肺転移を伴った切除不能肝芽腫に対し生体肝移植を施行した2例

    吉田 龍一, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁

    移植   50 ( 2-3 )   311 - 311   2015.8

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  • 肝癌に対する生体肝移植intentiontotreat(移植前肝癌治療)は移植成績のリスク因子か?

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    移植   50 ( 2-3 )   234 - 235   2015.8

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  • 再肝移植症例に対する手技的工夫

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 杭瀬 崇, 藤原 俊義

    移植   50 ( 2-3 )   257 - 257   2015.8

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  • 脳死肝腎同時移植2例の経験

    篠浦 先, 信岡 大輔, 吉田 龍一, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 楳田 祐三, 貞森 裕, 藤原 俊義, 八木 孝仁

    移植   50 ( 2-3 )   270 - 270   2015.8

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  • 生体肝移植術後致死的経過を辿ったムコール症の2例

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 藤原 俊義, 八木 孝仁

    移植   50 ( 2-3 )   279 - 279   2015.8

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  • 世界へ発信する移植外科医療 生体肝移植の更なる発展を目指して 技術革新と手術戦略による移植予後の向上

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 杭瀬 崇, 内海 正嗣, 高木 弘誠, 安井 和也, 藤原 俊義

    日本消化器外科学会総会   70回   SY - 6   2015.7

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  • PNETに対する治療 膵神経内分泌腫瘍のDynamic CT画像所見についての検討

    内海 方嗣, 楳田 祐三, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 吉田 龍一, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   70回   RS - 75   2015.7

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  • 切除血行再建により治癒した固有肝動脈瘤の1例

    佐藤 博紀, 信岡 大輔, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   70回   P - 193   2015.7

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  • 肝臓外科領域における手術手技の工夫 再肝切除における根治性確保と合併症軽減に向けた工夫

    安井 和也, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 杭瀬 崇, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   70回   SY - 16   2015.7

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  • 膵臓癌切除患者におけるsarcopeniaが長期予後に及ぼす影響に関する検討

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   70回   P - 153   2015.7

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  • 当院における十二指腸乳頭部腺腫/早期癌に対する治療成績

    吉田 龍一, 加藤 博也, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   677 - 677   2015.6

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  • 胆管拡張を伴わない胆管内乳頭状腫瘍(IPNB)由来肝内胆管癌の1例

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   679 - 679   2015.6

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  • 肝胆膵外科領域における周術期栄養管理 当院における膵頭十二指腸切除術周術期ERASプロトコールの有効性に関する臨床試験の取組み

    吉田 龍一, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    外科と代謝・栄養   49 ( 3 )   117 - 117   2015.6

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  • 迷わない確実な膵吻合術を目指して2 再使用可能なシリコンレプリカ膵臓を用いた膵管空腸吻合を用いた吻合トレーニングモデルの開発

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 佐藤 博紀, 安井 和也, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   420 - 420   2015.6

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  • 肝内胆管癌の治療方針 肝内胆管癌の外科治療 リンパ節郭清結果を踏まえ手術戦略を見直す

    楳田 祐三, 八木 孝仁, 篠浦 先, 吉田 龍一, 信岡 大輔, 佐藤 太祐, 杭瀬 崇, 高木 弘誠, 安井 和也, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   429 - 429   2015.6

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  • 腹腔鏡下肝嚢胞開窓術のポイント

    信岡 大輔, 八木 孝仁, 森廣 俊昭, 佐藤 博紀, 安井 和也, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   507 - 507   2015.6

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  • 難治性手術部位感染に対する局所陰圧閉鎖療法の工夫

    佐藤 博紀, 信岡 大輔, 近藤 喜太, 安井 和也, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   27回   666 - 666   2015.6

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  • 膵癌術後局所再発に対し腹腔動脈合切尾側膵切除にて再膵切除可能であった一例

    吉田 龍一, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    膵臓   30 ( 3 )   478 - 478   2015.5

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  • 肝胆膵 生体肝移植後の制御性T細胞とマイクロキメリズムの相関

    内海 方嗣, 高本 章乃夫, 高木 弘誠, 杭瀬 崇, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 藤原 俊義, 八木 孝仁

    日本外科学会定期学術集会抄録集   115回   OP - 163   2015.4

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  • 肝胆膵 膵切除後の残膵腫瘍に対する再膵切除

    渡邉 佑介, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 正嗣, 杭瀬 崇, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本外科学会定期学術集会抄録集   115回   OP - 159   2015.4

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  • 解剖学教室とのコラボレーションによる肝胆膵外科手術教育

    信岡 大輔, 近藤 喜太, 森廣 俊昭, 高木 弘誠, 藤 智和, 吉田 一博, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 武田 吉正, 大塚 愛二, 八木 孝仁, 藤原 俊義

    岡山医学会雑誌   127 ( 1 )   77 - 77   2015.4

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  • 腹腔鏡下肝嚢胞開窓術のピットフォール

    森廣 俊昭, 信岡 大輔, 佐藤 博紀, 安井 和也, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    岡山医学会雑誌   127 ( 1 )   76 - 76   2015.4

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  • 困難例に対する肝移植手術の工夫と限界 基礎研究・移植再生 移植困難症例に対する手技的工夫 無肝期Veno-venous bypass使用による循環安定化の試み

    八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    日本外科学会定期学術集会抄録集   115回   PD - 6   2015.4

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  • 肝胆膵 膵頭十二指腸切除術の手技習得に向けたcadaver trainingの実際

    信岡 大輔, 八木 孝仁, 近藤 喜太, 森廣 俊昭, 高木 弘誠, 藤 智和, 渡邉 佑介, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 日置 勝義, 藤原 俊義

    日本外科学会定期学術集会抄録集   115回   OP - 055   2015.4

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  • 肝胆膵 当科における膵頭十二指腸切除術におけるERAS(術後回復力強化:Enhanced recovery after surgery)の取り組み

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本外科学会定期学術集会抄録集   115回   OP - 157   2015.4

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  • 肝胆膵 膵癌における外科治療戦略 先行手術の問題点と術前療法の適応選別

    藤 智和, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 杭瀬 崇, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本外科学会定期学術集会抄録集   115回   OP - 267   2015.4

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  • 当院における膵頭十二指腸切除術周術期におけるERAS(術後回復力強化:Enhanced recovery after surgery)プロトコールの取り組み

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 野口 絢子, 坂本 八千代, 八木 孝仁, 藤原 俊義

    日本静脈経腸栄養学会雑誌   30 ( 1 )   410 - 410   2015.1

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  • 安全で確実な腹腔鏡下肝切除を目指して~開腹肝切除からのKnow-how~

    楳田祐三, 篠浦先, 吉田龍一, 信岡大輔, 渡辺信之, 杭瀬崇, 須井健太, 高木弘誠, 木村裕司, 八木孝仁, 藤原俊義

    日本内視鏡外科学会雑誌   20 ( 7 (CD-ROM) )   2015

  • 生体肝移植における後区域グラフトの有用性

    杭瀬 崇, 楳田 祐三, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 渡邉 佑介, 高木 弘誠, 森廣 俊昭, 藤原 俊義, 八木 孝仁

    移植   49 ( 4-5 )   380 - 381   2014.11

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  • 当院脳死肝移植18例の検討

    篠浦 先, 森廣 俊昭, 高木 弘誠, 渡辺 佑介, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 八木 孝仁

    移植   49 ( 4-5 )   378 - 379   2014.11

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  • 小児生体肝移植後ステロイド抵抗性急性拒絶反応に対するサイモグロブリンの使用経験

    高木 弘誠, 吉田 龍一, 保田 裕子, 山下 里美, 森廣 俊昭, 渡邉 佑介, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 藤原 俊義, 八木 孝仁

    移植   49 ( 4-5 )   380 - 380   2014.11

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  • ペプチドゲルを用いた新規局所止血材の開発と腹腔鏡下肝切除における使用法

    信岡 大輔, 八木 孝仁, 田村 周太, 富丸 慶人, 永野 浩昭, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 藤原 俊義

    日本内視鏡外科学会雑誌   19 ( 7 )   870 - 870   2014.10

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  • 腹腔鏡下肝嚢胞開窓術における注意点

    森廣 俊昭, 信岡 大輔, 高木 弘誠, 渡邉 祐介, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   75 ( 増刊 )   481 - 481   2014.10

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  • 岡山大学病院における安全な鏡視下膵切除の段階的導入

    吉田 龍一, 八木 孝仁, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 藤原 俊義

    日本内視鏡外科学会雑誌   19 ( 7 )   487 - 487   2014.10

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  • 肝腎同時移植の2症例

    篠浦 先, 信岡 大輔, 吉田 龍一, 高木 弘誠, 森廣 俊昭, 渡辺 佑介, 杭瀬 崇, 内海 方嗣, 楳田 祐三, 貞森 裕, 藤原 俊義, 八木 孝仁

    日本移植学会総会プログラム抄録集   50回   443 - 443   2014.8

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  • 生体肝移植における人工血管の使用経験

    信岡 大輔, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 山下 里美, 保田 裕子, 藤原 俊義, 八木 孝仁

    日本移植学会総会プログラム抄録集   50回   325 - 325   2014.8

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  • 生体肝移植におけるドナー年齢限界の見極めと個別化治療戦略

    杭瀬 崇, 楳田 祐三, 貞森 裕, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 藤原 俊義, 八木 孝仁

    岡山医学会雑誌   126 ( 2 )   179 - 179   2014.8

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  • Tape re-positioningとEnergy deviceを活用した安全な高難度肝切除技術

    貞森 裕, 八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 杭瀬 崇, 高木 弘誠, 藤原 俊義

    日本消化器外科学会総会   69回   P - 16   2014.7

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  • 当科における進行胆嚢癌症例に対する外科切除成績 拡大手術の意義と限界

    杭瀬 崇, 吉田 龍一, 高木 弘誠, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊儀

    日本消化器外科学会総会   69回   P - 68   2014.7

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  • 術後感染性合併症に繋がる脆弱性を識別する指標としてのSarcopenia 年齢区分を超えたリスク因子を求めて

    高木 弘誠, 吉田 龍一, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   69回   O - 70   2014.7

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  • 肝移植術後における真菌感染症に対する危険因子の解析

    内海 方嗣, 高木 弘誠, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   69回   O - 102   2014.7

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  • 腫瘍縮小にて膵頭十二指腸切除術を回避できた膵Solid-pseudopapillary neoplasmの1例

    信岡 大輔, 八木 孝仁, 篠浦 先, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 貞森 裕, 藤原 俊義

    日本癌治療学会誌   49 ( 3 )   2101 - 2101   2014.6

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  • 多視点3D映像システムによる次世代の手術解剖教育 高難度肝胆膵外科手術の修得を目指した解剖教材の開発(Surgical education using a multi-viewpoint and multi-layer three-dimensional atlas system of surgical anatomy)

    信岡 大輔, 藤 智和, 吉田 一博, 高木 弘誠, 杭瀬 崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 武田 吉正, 大塚 愛二

    日本肝胆膵外科学会・学術集会プログラム・抄録集   26回   333 - 333   2014.6

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  • 膵臓癌切除患者におけるSarcopeniaの存在とその意義に関する検討

    高木 弘誠, 吉田 龍一, 熊野 健二郎, 杭瀬 崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本癌治療学会誌   49 ( 3 )   1086 - 1086   2014.6

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  • 劇症肝炎に対する肝移植

    楳田 祐三, 貞森 裕, 高木 章乃夫, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 保田 裕子, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   165 - 165   2014.5

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  • 生体肝移植におけるドナー年齢限界の見極めと個別化治療戦略

    楳田 祐三, 八木 孝仁, 貞森 裕, 高木 章乃夫, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 保田 裕子, 高木 弘誠, 藤原 俊義

    移植   49 ( 1 )   80 - 81   2014.5

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  • 再肝移植症例に対する肝腎同時移植経験と、本邦の複数臓器分配におけるMELD scoreのもつ問題点

    八木 孝仁, 信岡 大輔, 篠浦 先, 保田 裕子, 高木 章乃夫, 吉田 龍一, 内海 方嗣, 楳田 祐三, 高木 弘誠, 貞森 裕, 藤原 俊義, 佐藤 大輔

    移植   49 ( 1 )   69 - 70   2014.5

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  • 肝移植術後における真菌感染症に対する危険因子の解析

    内海 方嗣, 楳田 祐三, 貞森 裕, 篠浦 先, 吉田 龍一, 信岡 大輔, 高木 弘誠, 保田 裕子, 高木 章乃夫, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   95 - 95   2014.5

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  • 乳児急性リンパ性白血病臍帯血移植後に発症した肝中心静脈閉塞症に対し生体肝移植、骨髄移植を施行した1例

    高木 弘誠, 吉田 龍一, 保田 裕子, 田村 周太, 谷口 文崇, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   165 - 166   2014.5

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  • 生体肝移植後拒絶反応およびC型肝炎再発におけるHigh Mobility Group Box-1の動態解析

    貞森 裕, 八木 孝仁, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 杉原 正大, 内海 方嗣, 高木 弘誠, 藤原 俊義

    移植   49 ( 1 )   119 - 119   2014.5

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  • HMGB 1制御による阻血再灌流障害の軽減効果と肝再生機序への影響解析

    杉原 正大, 貞森 裕, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   124 - 124   2014.5

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  • 肝腎不全に対する脳死肝腎同時移植の一例

    信岡 大輔, 篠浦 先, 保田 裕子, 高木 弘誠, 田村 周太, 谷口 文崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 貞森 裕, 藤原 俊義, 八木 孝仁

    移植   49 ( 1 )   164 - 164   2014.5

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  • 生体肝移植後のsmall-for-size症候群と急性腎損傷に関する危険度分析を基盤にした治療戦略(Treatment strategy on the basis of risk analysis for small-for-size syndrome and acute renal injury after living donor liver transplantation)

    楳田 祐三, 八木 孝仁, 貞森 裕, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 高木 弘誠, 藤原 俊義

    日本外科学会雑誌   115 ( 臨増2 )   79 - 79   2014.3

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  • 膵頭十二指腸切除後の完全膵外瘻に対する非手術的内瘻化

    信岡 大輔, 八木 孝仁, 高木 弘誠, 田村 周太, 谷口 文崇, 内海 方嗣, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 藤原 俊義

    日本外科学会雑誌   115 ( 臨増2 )   322 - 322   2014.3

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  • 生体肝移植患者におけるItraconazoleの真菌感染症予防効果の検討

    内海 方嗣, 貞森 裕, 高木 弘誠, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 八木 孝仁, 藤原 俊義

    日本外科学会雑誌   115 ( 臨増2 )   499 - 499   2014.3

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  • 膵頭十二指腸切除症例における創部SSI危険因子の検討 術前胆道ドレナージの合併症

    谷口 文崇, 八木 仁, 貞森 裕孝, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 田村 周太, 高木 弘誠, 藤原 俊義

    日本外科学会雑誌   115 ( 臨増2 )   629 - 629   2014.3

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  • 進行肝癌の切除限界克服を目指した新展開 IVC合併切除を伴う肝細胞癌手術 人工血管を用いたIVC再建

    田村 周太, 篠浦 先, 高木 弘誠, 谷口 文崇, 内海 方嗣, 信岡 大輔, 吉田 龍一, 楳田 祐三, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   74 ( 増刊 )   436 - 436   2013.10

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    DOI: 10.3919/jjsa.74.436

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  • 再発癌の治療戦略(肝・胆・膵) 再発肝細胞癌に対する再肝切除の有効性とSalvage Transplantationの適応選別

    谷口 文崇, 楳田 祐三, 貞森 裕, 篠浦 先, 吉田 龍一, 信岡 大輔, 内海 方嗣, 田村 周太, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本臨床外科学会雑誌   74 ( 増刊 )   365 - 365   2013.10

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  • アルコール性肝硬変患者に対する肝移植適応基準確立に向けた岡山大学病院での取組み

    吉田 龍一, 高木 弘誠, 内海 方嗣, 信岡 大輔, 楳田 祐三, 篠浦 先, 貞森 裕, 保田 裕子, 高木 章乃夫, 藤原 俊義, 八木 孝仁

    移植   48 ( 総会臨時 )   309 - 309   2013.8

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  • 肝臓の虚血再灌流障害+肝切除モデルにおけるHMGB-1の動態・機能解析と制御

    杉原 正大, 貞森 裕, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 谷口 文崇, 田村 周太, 高木 弘誠, 藤原 俊義, 八木 孝仁

    移植   48 ( 総会臨時 )   386 - 386   2013.8

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  • HCV肝炎に対する肝移植 肝移植後の再発性C型肝炎における調節性T細胞とHCV抗原特異的免疫応答の発生頻度(Frequericy of regulatory T cell and HCV antigen-specific immune response in recurrent hepatitis C after liver transplantation)

    内海 方嗣, 高木 章, 高木 弘誠, 信岡 大輔, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 保田 裕子, 藤原 俊義, 八木 孝仁

    移植   48 ( 総会臨時 )   271 - 271   2013.8

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  • Enhanced Recovery After Surgery(ERAS)を応用した消化器外科手術 肝移植におけるERASプロトコル確立を目指して 周術期栄養療法による早期回復効果を可視化する試み

    吉田 龍一, 高木 弘誠, 内海 方嗣, 信岡 大輔, 佐藤 太祐, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   68回   SY - 2   2013.7

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  • 高齢者膵頭十二指腸切除におけるsarcopeniaの及ぼす影響

    高木 弘誠, 吉田 龍一, 内海 方嗣, 信岡 大輔, 佐藤 太祐, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    日本消化器外科学会総会   68回   P - 48   2013.7

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  • 肝細胞癌に対する系統的切除の意義

    佐藤 太祐, 八木 孝仁, 貞森 裕, 篠浦 先, 楳田 祐三, 吉田 龍一, 信岡 大輔, 内海 方嗣, 藤 智和, 高木 弘誠, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   341 - 341   2013.6

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  • PpPD術後に生じた未破裂動脈瘤に対してステント留置が有効であった一例

    高木 弘誠, 吉田 隆一, 藤 智和, 内海 方嗣, 信岡 大輔, 佐藤 太祐, 楳田 祐三, 篠浦 先, 貞森 裕, 藤原 俊義, 八木 孝仁

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   440 - 440   2013.6

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  • 肝切除後胆道・動脈合併症に対するリカバリーショット 総胆管離開を伴う胆汁漏と肝内外多発動脈瘤の1例

    藤 智和, 楳田 祐三, 貞森 裕, 篠浦 先, 吉田 龍一, 佐藤 太祐, 信岡 大輔, 内海 方嗣, 高木 弘誠, 八木 孝仁, 藤原 俊義

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   449 - 449   2013.6

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  • 膵頭部癌に対する膵頭十二指腸切除・門脈合併切除再建手技

    信岡 大輔, 貞森 裕, 篠浦 先, 楳田 祐三, 吉田 龍一, 佐藤 太祐, 内海 方嗣, 藤 智和, 高木 弘誠, 藤原 俊義, 八木 孝仁

    日本肝胆膵外科学会・学術集会プログラム・抄録集   25回   322 - 322   2013.6

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  • 膵神経内分泌腫瘍切除症例のWHO分類と画像所見、予後に関する検討

    藤田 俊彦, 内海 方嗣, 藤 智和, 高木 弘誠, 信岡 大輔, 佐藤 太祐, 吉田 龍一, 楳田 祐三, 篠浦 先, 貞森 裕, 八木 孝仁, 藤原 俊義

    岡山医学会雑誌   125 ( 1 )   92 - 92   2013.4

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  • 食道癌術後恥骨筋および腰方形筋転移を認めた1例

    高木弘誠, 河本和幸, 伊藤雅

    日本外科系連合学会誌   37 ( 6 )   2012

  • 回盲部潰瘍穿通,食道潰瘍穿通を来した腸管べーチェットの一例

    高木弘誠, 河本和幸, 石川英樹, 本間周作, 河合隆之, 伊藤雅

    日本臨床外科学会雑誌   72   2011

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Research Projects

  • Development of Surgical Training System in Robotic Hepato-Pancreato-Biliary Surgery

    Grant number:21K16447  2021.04 - 2024.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research  Grant-in-Aid for Early-Career Scientists

    高木 弘誠

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    Grant amount:\4550000 ( Direct expense: \3500000 、 Indirect expense:\1050000 )

    本研究では、実際のロボット支援下肝胆膵高難度手術を想定したより実践的なSimulation training、Biotissue training、Video trainingを組み込んだ本邦初の新たな包括的トレーニングプログラムを確立することを目的としており、現在その効果を明らかにしている。①Simulation trainingを通して、ロボット手術の基本となる操作を習得し、その術者およびtrainee のラーニングカーブを評価している。現在、被験者をリクルートし、研究を継続している。②Biotissue trainingではBiotissueを用いた吻合トレーニングを行い、膵臓モデルや胆管モデルを用いて実際の臨床におけるロボット手術に極めて近い吻合トレーニングを行っている。また吻合の評価を行い、術者およびtrainee のラーニングカーブを評価している。引き続き被 者をリクルートし、研究を継続している③Video training:ロボット支援下肝胆膵高難度手術を安全に行うには、術式、手技の定型化が必須であるが、そのビデオ教材やテキストは本邦においてほとんど存在しない。本研究では、申請者が行った実際の症例ビデオを現在集積し、Tips & Pitfallsを含んだ教育的ビデオ教材や手術手技の詳細を記したテキストブックの作成を目指している。

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