Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

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

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

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

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.

DOI： 10.18926/AMO/55435

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

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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

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

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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. Reviewed International journal

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

BMC surgery 17 ( 1 ) 64 - 64 2017.5

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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. Reviewed

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

Authorship：Lead author Language：English

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. Reviewed 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

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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. Reviewed 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

Authorship：Lead author Language：English

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

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

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

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

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

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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

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

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

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

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

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

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

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

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

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

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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Papers - Takagi Kosei