Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

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Role of Surgery for Pancreatic Ductal Adenocarcinoma in the Era of Multidisciplinary Treatment. Reviewed International journal

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

Journal of clinical medicine 12 ( 2 ) 2023.1

Survival Impact of Postoperative Skeletal Muscle Loss in Gastric Cancer Patients Who Underwent Gastrectomy. Reviewed 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

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

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.

DOI： 10.21873/anticanres.16153

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Impact of cancer-associated fibroblasts on survival of patients with ampullary carcinoma. Reviewed 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

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

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.

DOI： 10.3389/fonc.2023.1072106

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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

ロボット支援膵頭十二指腸切除術:手技の工夫と成績当院におけるロボット支援下膵頭十二指腸切除術

高木弘誠, 楳田祐三, 吉田龍一, 藤智和, 安井和也, 木村次郎, 畑七々子, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 2595 - 2595 2022.12

小網アプローチによるロボット支援下脾温存膵体尾部切除

高木弘誠, 楳田祐三, 吉田龍一, 藤智和, 安井和也, 木村次郎, 畑七々子, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 1708 - 1708 2022.12

膵癌に対する低侵襲手術のエビデンス膵体尾部癌に対するSupracolic Anterior SMAアプローチを用いたロボット支援下RAMPSの定型化と短期成績

吉田龍一, 高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村次郎, 畑七々子, 藤原俊義

日本内視鏡外科学会雑誌 27 ( 7 ) 1282 - 1282 2022.12

Surgical Strategies to Dissect around the Superior Mesenteric Artery in Robotic Pancreatoduodenectomy. Reviewed 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

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

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.

DOI： 10.3390/jcm11237112

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【ロボット支援下手術の現況と展望】ロボット支援下手術の現況と展望<膵臓>

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

日本外科学会雑誌 123 ( 6 ) 538 - 545 2022.11

Language：Japanese Publisher：(一社)日本外科学会

ロボット支援下膵切除術は,欧米先進諸国において近年急速に普及し,その手術成績についても一定のエビデンスが得られてきている.一方,本邦では2020年の保険収載以降,大学病院や基幹病院を中心として徐々に普及しつつあるが,標準手術としての定着にはもう少し時間を要するのが現状である.高難度手術である膵頭十二指腸切除術や膵体尾部切除術に対するロボット支援下手術の安全な導入と普及には,術式の定型化とトレーニングシステムの確立が急務である.さらに,安全な手術の実践には,ロボット支援下手術の特性を理解し,外科医個人のみならずチームとして成熟していくことが重要である.今回,ロボット支援下膵切除術の欧米におけるコンセンサスを検討するとともに,当施設におけるロボット支援下膵切除術の定型化に向けた手術概要とトレーニングシステム,チームとしての取り組みを報告する.(著者抄録)

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

Kosei Takagi, Yuzo Umeda, Jiro Kimura, Takahito Yagi

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

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. Reviewed International journal

Kosei Takagi, Kenta Murotani, Satoru Kamoshita, Akiyoshi Kuroda

BMC medicine 20 ( 1 ) 371 - 371 2022.10

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

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.

DOI： 10.1186/s12916-022-02568-x

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

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

Laparoscopic Surgery 6 39 - 39 2022.10

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

リキッドバイオプシーが変えるがん医療膵癌術前・術後血中循環腫瘍DNA内KRAS遺伝子変異の臨床的意義に関する検討

吉田龍一, 安井和也, 楳田祐三, 藤智和, 高木弘誠, 宮本耕吉, 黒田新士, 野間和宏, 八木孝仁, 藤原俊義

日本癌治療学会学術集会抄録集 60回 WS3 - 2 2022.10

肝胆膵がんに対する高難度腹腔鏡・ロボット支援手術の定型化と工夫当院におけるロボット支援下膵切除術の初期治療成績

高木弘誠, 楳田祐三, 吉田龍一, 藤智和, 安井和也, 木村次郎, 畑七々子, 八木孝仁, 藤原俊義

日本癌治療学会学術集会抄録集 60回 OWS29 - 8 2022.10

移植患者の外科感染症対策肝移植後の日和見感染症への対策と課題

安井和也, 吉田龍一, 畑七々子, 木村次郎, 高木弘誠, 藤智和, 楳田祐三, 八木孝仁, 藤原俊義

日本外科感染症学会雑誌 19 ( 1 ) 200 - 200 2022.10

切除可能膵癌に対する術前治療の現状と課題血中循環腫瘍DNA内Kras遺伝子変異情報とCA19-9値による切除可能膵癌層別化の試み

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

日本臨床外科学会雑誌 83 ( 増刊 ) S95 - S95 2022.10

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

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

Digestive surgery 39 ( 4 ) 137 - 140 2022.9

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

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.

DOI： 10.1159/000527249

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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

Surgical Strategies to Approaching the Splenic Artery in Robotic Distal Pancreatectomy. Reviewed 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

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

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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Papers - Takagi Kosei