Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

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

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

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

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

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

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

A novel difficulty grading system for laparoscopic living donor nephrectomy. Reviewed 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

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

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

Loss of antibodies to hepatitis E virus in organ transplant patients with hepatitis E. Reviewed 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

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

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

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

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

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

Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3). Reviewed 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

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

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

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

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

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

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

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

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.

DOI： 10.1186/s12893-020-00981-8

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

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

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.

DOI： 10.1016/j.ijsu.2020.11.013

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

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

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

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

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

Surgical endoscopy 34 ( 11 ) 4901 - 4908 2020.11

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

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.

DOI： 10.1007/s00464-019-07276-x

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

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

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.

DOI： 10.1016/j.trre.2020.100571

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

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

Anticancer research 40 ( 10 ) 5343 - 5349 2020.10

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

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

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

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

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

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

Systematic review on immunonutrition in partial pancreatoduodenectomy. Reviewed International journal

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

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

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

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).

DOI： 10.1007/s00423-020-01916-w

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

Kosei Takagi, Stefan Buettner, Jan N M Ijzermans

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

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

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.

DOI： 10.1016/j.ijsu.2020.04.046

Right posterior segment graft for living donor liver transplantation: A systematic review. Reviewed 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

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

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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