Faculty Profiles - Takagi Kosei

Papers - Takagi Kosei

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Impact of robotic surgery on postoperative pancreatic fistula for high-risk pancreaticojejunostomy after pancreatoduodenectomy. International journal

Tomokazu Fuji, Kosei Takagi, Yuzo Umeda, Kazuya Yasui, Motohiko Yamada, Yasuo Nagai, Toshiyoshi Fujiwara

Digestive surgery 1 - 21 2025.1

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

BACKGROUND: The safety and feasibility of robotic pancreatoduodenectomy (RPD) in high-risk patients with postoperative pancreatic fistula (POPF) have rarely been investigated, although the rate of POPF is lower than in open pancreatoduodenectomy (OPD). This study aimed to examine the impact of robotic surgery on POPF in high-risk patients after pancreatoduodenectomy (PD). METHODS: This retrospective analysis included 204 patients who underwent RPD between January 2018 and June 2023. Of the 204 patients, 126 with high-risk POPF were included. The outcomes of RPD and OPD were compared. Multivariate analyses were conducted to identify risk factors associated with the development of clinically relevant POPF (CR-POPF) after surgery. RESULTS: Of the 126 patients, 50 underwent RPD and 76 underwent OPD. The incidence of CR-POPF was significantly lower in the RPD group than in the OPD group (6.0% vs. 38.2%, P < 0.001). Multivariate analyses identified OPD as an independent risk factor associated with CR-POPF (odds ratio [OR]: 7.87, 95% confidence interval [CI]: 2.11-29.4, P = 0.002). CONCLUSIONS: This study demonstrated the impact of robotic surgery on POPF in high-risk patients after PD. These results suggest that RPD may be significantly associated with a decreased incidence of CR-POPF in high-risk anastomoses.

DOI： 10.1159/000543737

Hemodynamic Assessment Using SPY Laser Fluorescence Imaging During Pancreatoduodenectomy with Common Hepatic Artery Resection. Reviewed International journal

Tomokazu Fuji, Kosei Takagi, Kazuya Yasui, Takeyoshi Nishiyama, Motohiko Yamada, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Annals of surgical oncology 2024.12

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

BACKGROUND: Pancreatectomies combined with arterial resection can be indicated for pancreatic cancer. In a pancreatectomy with arterial resection, intraoperative confirmation of blood flow through reconstructed vessels is crucial. This study highlights the usefulness of SPY laser fluorescence imaging during a pancreatoduodenectomy with common hepatic artery resection (PD-CHAR). PATIENT AND METHODS: A 55-year-old man with borderline resectable pancreatic head cancer underwent a PD-CHAR. After confirming tumor resectability, reconstruction of the CHA to the proper hepatic artery was performed. Subsequently, the superior mesenteric vein was reconstructed. RESULTS: SPY laser fluorescence imaging demonstrated arterial blood perfusion to the liver through the reconstructed hepatic artery, followed by perfusion from the portal vein. The operation lasted 493 min, with an estimated blood loss of 400 mL. The postoperative course was uneventful with good arterial blood flow. CONCLUSION: The SPY Portable Handheld Imager could be valuable for visualizing blood flow in reconstructed vessels and assessing tissue perfusion during a pancreatectomy combined with vascular reconstruction.

DOI： 10.1245/s10434-024-16659-x

Rare internal hernia following pancreatoduodenectomy: A case report. Reviewed International journal

Teruyuki Tsujii, Kosei Takagi, Yasuo Nagai, Kazuya Yasui, Tomokazu Fuji, Toshiyoshi Fujiwara

International journal of surgery case reports 126 110673 - 110673 2024.11

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

INTRODUCTION: Pancreatoduodenectomy (PD) is a complex procedure with a high morbidity rate. Internal hernia following PD is a rare but potentially life-threatening complication. Herein, we describe a rare case of internal hernia after PD. PRESENTATION OF CASE: A 76-year-old man who underwent subtotal stomach-preserving PD 7 years ago presented with vomiting and abdominal pain. Abdominal computed tomography revealed an internal hernia. Because conservative treatment failed, surgical intervention was performed. Intraoperative findings revealed efferent loop herniation in the space between the afferent loop near the Braun anastomosis and transverse mesocolon. The hernia was repositioned and the mesenteric defect was closed. DISCUSSION: This is an extremely rare case of an internal hernia that developed 7 years after PD. As conservative management provides a little chance for improvement, precise diagnosis and prompt re-intervention are essential for the management of internal hernia. In this case, the hernial orifice developed in the space between the afferent and efferent loops and the transverse mesocolon. Internal hernia could be a differential diagnosis in patients with ileus after PD. CONCLUSION: This study provided a detailed description of an extremely rare case of internal hernia following PD. Therefore, internal hernias should be considered in patients undergoing PD.

DOI： 10.1016/j.ijscr.2024.110673

The required experience of open pancreaticoduodenectomy before becoming a specialist in hepatobiliary and pancreatic surgeons: a multicenter, cohort study of 334 open pancreaticoduodenectomies. Reviewed International journal

Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Masayoshi Hioki, Ryuichi Yoshida, Yoshikatsu Endo, Kazuya Yasui, Daisuke Nobuoka, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara

BMC surgery 24 ( 1 ) 366 - 366 2024.11

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

BACKGROUND: Open pancreaticoduodenectomy (OPD) is an essential surgical procedure for expert hepato-biliary-pancreatic (HBP) surgeons. However, there is no standard for how many surgeries must be performed by a surgeon in training before they are considered to have enough experience to ensure surgical safety. METHODS: Cumulative Sum (CUSUM) analysis was performed using the surgical data of OPDs performed during the training period of board-certified expert surgeons of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. RESULTS: Fourteen HBP surgeons participated in this study and performed 334 OPDs during their training period. The median (interquartile range) values for operative time, blood loss, and length of hospital stay were 455 (397-519) minutes, 450 (234--716) ml, and 28 (21-38) days, respectively. CUSUM analysis showed inflection points at 20 surgeries performed for operative time. After 20 procedures, operative time was significantly shorter (461 min vs. 425 min, p = 0.021) and blood loss was significantly lower (470 ml vs. 340 ml, p = 0.038). No significant differences between within 20 and after 21 procedures were found in the complication rate (53% vs. 48%, p = 0.424) and rate of in-hospital deaths (1.5% vs.1.4%. p = 0.945). Up to 20 surgeries, PDAC and another malignant tumor had longer operative time than benign/low malignant diseases (486 min vs. 472 min vs. 429 min, p < 0.001), and higher blood loss (500 ml vs. 502 ml vs. 355 ml, p < 0.001). Mortality rate was higher at PDAC cases (5% vs. 0% vs. 0%, p = 0.01). After the 21 procedures, these outcomes were improved and no differences in by primary disease were observed. Multivariable analysis showed that within 20 surgeries were independent risk factors of longer operative time (HR2.6, p = 0.013) and higher blood loss (HR2.0, p = 0.049). CONCLUSIONS: To stabilize the surgical outcome of OPD for malignant disease, at least 20 surgeries should be performed at a certified institution during surgeon training. TRIAL REGISTRATION: Clinical trial number: Not applicable.

DOI： 10.1186/s12893-024-02677-9

Risk model for predicting failure to rescue after hepatectomy: Cohort study of 1371 consecutive patients. Reviewed International journal

Jiro Kimura, Kosei Takagi, Yuzo Umeda, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Hepatology research : the official journal of the Japan Society of Hepatology 2024.11

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

AIM: Although hepatectomy is a complex surgical procedure, its incidence among older patients has increased due to global aging. However, few studies have focused on the association between age and failure to rescue (FTR) posthepatectomy. This study aimed to investigate the association between age and FTR and develop a risk model for FTR following hepatectomy. METHODS: We analyzed a total of 1371 consecutive patients who underwent primary hepatectomy between July 2003 and September 2022. The patients were divided into three groups according to their age: young-old (<65 years), pre-old (65-74 years), and old group (≥75 years). Additionally, the associations among age, FTR, and risk factors for FTR were investigated. Subsequently, a risk model was developed to predict the FTR. RESULTS: Of the 1371 patients, 373 (27.2%) experienced major complications, and FTR occurred in 15 patients. The older group showed a higher FTR rate (8.4%) than the young-old (1.3%) and pre-old (4.3%) groups (p = 0.03). Multivariate analyses indicated that older age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15; p = 0.045) and American Society of Anesthesiologists Physical Status score ≥3 (OR 4.35; 95% CI 1.24-15.2; p = 0.02) were independent predictive factors for FTR. The risk model exhibited an accuracy with an area under the curve of 0.80 (95% CI 0.69-0.92). Calibration plots of the model revealed a concordance index of 0.73. CONCLUSIONS: This study identified an association between age, FTR, and risk factors for FTR posthepatectomy. Together, our risk model is a clinically relevant, internally validated, and useful tool for predicting FTR posthepatectomy.

DOI： 10.1111/hepr.14134

膵癌の更なる早期発見、早期診断に向けて Ct-DNA内KRAS mutation profileとCA19-9値による膵癌予後予測診断と治療戦略

安井和也, 吉田龍一, 宮本耕吉, 重安邦俊, 高木弘誠, 藤智和, 黒田新士, 藤原俊義

日本癌治療学会学術集会抄録集 62回 OSY9 - 4 2024.10

Robot-Assisted Pancreaticoduodenectomy Using the Anterior Superior Mesenteric Artery-First Approach for Pancreatic Cancer. Reviewed International journal

Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Annals of surgical oncology 2024.9

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

BACKGROUND: The superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) is common surgical technique in pancreaticoduodenectomy. To date, few studies have reported SMA-first approach in robot-assisted pancreaticoduodenectomy (RPD). Herein, we present the anterior SMA-first approach for PC during RPD. PATIENT AND METHOD: A 75-year-old man with resectable PC underwent RPD after neoadjuvant chemotherapy. As pancreatic head tumor contacted with the superior mesenteric vein (SMV), the anterior SMA approach was applied. After the mesenteric Kocher maneuver, the jejunum was divided and the left side of the SMA was dissected. Subsequently, the anterior plane of the SMA was dissected. Following the division of branches from the mesenteric vessels, the SMA was taped, and the circumferential dissection around the SMA was performed to detach the pancreatic neck from the SMA completely. Finally, the dissection between the SMV and the tumor was performed under vascular control to remove the specimen. CONCLUSIONS: The anterior SMA-first approach can be optional in patients with PC undergoing RPD. This unique approach allows for the circumferential dissection around the SMA during RPD.

DOI： 10.1245/s10434-024-16305-6

The Liver Transection Area Is a Novel Predictor for Surgical Difficulty in Laparoscopic Liver Resection. International journal

Motohiko Yamada, Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Journal of clinical medicine 13 ( 19 ) 2024.9

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

Background: A difficulty scoring system was developed to estimate the surgical outcomes of laparoscopic liver surgery (LLS); however, the effect of the liver transection area (LTA) on LLS outcomes have not been previously examined. Therefore, this study investigated the predictive significance of the LTA for LLS. Methods: This retrospective study included 106 patients who underwent LLS in our hospital between January 2012 and December 2023. The association of the LTA with the surgical difficulty level and operative time was investigated. Multivariate analyses were performed to identify factors predicting surgical difficulty in LLS. Results: The median LTA and operative time were 62.5 (IQR, 36.0-91.8) cm2 and 250 (IQR, 195-310) minutes, respectively. The LTA was significantly associated with surgical difficulty as evaluated using the IWATE Criteria. Moreover, the LTA significantly correlated with operative time (r2 = 0.19, p < 0.001). The multivariable analyses found that the LTA (≥59 cm2) (odds ratio [OR], 6.07; 95% confidence interval [CI], 2.38-16.6; p < 0.001) and the type of LLS (≥segmentectomy) (OR, 3.79; 95% CI, 1.35-11.4; p = 0.01) were significant factors associated with surgical difficulty. Conclusions: The LTA is a useful parameter that reflects the difficulty of LLS.

DOI： 10.3390/jcm13195686

Central pancreatectomy of the remnant pancreas without reconstruction after pancreatoduodenectomy. Reviewed International journal

Kinji Hirono, Kosei Takagi, Motohiko Yamada, Jiro Kimura, Tomokazu Fuji, Kazuya Yasui, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Surgical case reports 10 ( 1 ) 214 - 214 2024.9

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

BACKGROUND: There are several reports on the safety and feasibility of pancreatoduodenectomy (PD) without reconstruction of the small remnant pancreas. However, a few studies have explored central pancreatectomy (CP) for non-reconstructed small remnant pancreases after PD. This study presents a case of CP without pancreatic reconstruction after PD. CASE PRESENTATION: A 58-year-old man with cerebral palsy underwent PD for distal cholangiocarcinoma. Three years postoperatively, a 12-mm tumor was detected in the remnant pancreatic body and diagnosed as a pancreatic neuroendocrine neoplasm. Surgical resection was performed, because the tumor was enlarged and chemotherapy resistant. The afferent loop with pancreatojejunostomy anastomosis was dissected, and CP, including pancreatojejunostomy anastomosis, was performed. Given the remnant pancreas was hard and atrophic, the pancreatic tail was transected using a stapler without reconstructing the small remnant pancreas. The patient experienced no postoperative complications including postoperative pancreatic fistula, and the endocrine function of the pancreas was preserved. CONCLUSIONS: We present a case of remnant pancreatic CP that did not require reconstruction after PD. Preservation of the small remnant pancreas without reconstruction during CP may be feasible to maintain endocrine function in select patients after PD.

DOI： 10.1186/s40792-024-02018-1

切除不能大腸癌肝転移に対する肝移植における至適適応の検討

藤智和, 高木弘誠, 安井和也, 西山岳芳, 山田元彦, 永井康雄, 金平典之, 藤原俊儀

移植 59 ( 総会臨時 ) 269 - 269 2024.9

The state of robotic vs. open pancreatoduodenectomy. Reviewed International journal

Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara

Gland surgery 13 ( 8 ) 1344 - 1348 2024.8

Usefulness of robotic-arm hopping technique in robotic left hemihepatectomy. Reviewed International journal

Kosei Takagi, Kazuya Yasui, Tomokazu Fuji

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 28 ( 7 ) 1214 - 1217 2024.7

浸潤性膵管癌に対する膵切除断端の検討

永井康雄, 安井和也, 山田元彦, 木村次郎, 高木弘誠, 藤智和, 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 79回 1865 - 1865 2024.7

切除可能膵癌に対する術前化学療法は高齢者に本当に必要か?

安井和也, 永井康雄, 木村次郎, 山田元彦, 高木弘誠, 藤智和, 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 79回 1161 - 1161 2024.7

肝胆膵高難度腹腔鏡・ロボット支援下膵頭十二指腸切除術の現状と今後の展望 Two-surgeon techniqueを用いたロボット支援下膵頭十二指腸切除術

藤智和, 高木弘誠, 楳田祐三, 安井和也, 山田元彦, 永井康雄, 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 79回 466 - 466 2024.7

Robotic isolated caudate lobe liver resection using the caudal approach for giant hepatic hemangioma (with video). Reviewed International journal

Ryutaro Kondo, Kosei Takagi, Yuzo Umeda, Toshiyoshi Fujiwara

Asian journal of surgery 2024.5

Robotic pancreatoduodenectomy after right hemicolectomy: A case report. Reviewed International journal

Kosei Takagi, Tomokazu Fuji, Motohiko Yamada, Yuzo Umeda

Asian journal of surgery 47 ( 5 ) 2324 - 2325 2024.5

Left posterior superior mesenteric artery approach using a hanging maneuver in robotic pancreaticoduodenectomy. Reviewed International journal

Kosei Takagi, Motohiko Yamada, Yuzo Umeda

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 28 ( 5 ) 786 - 788 2024.5

【微小環境から読み解く胆膵癌】胆道癌制御性T細胞による肝内胆管癌の免疫微小環境の制御

吉田一博, 楳田祐三, 重安邦俊, 藤智和, 安井和也, 高木弘誠, 藤原俊義

肝胆膵 88 ( 5 ) 619 - 624 2024.5

Innovative mesenteric Kocher maneuver during robotic pancreatoduodenectomy. Reviewed International journal

Kosei Takagi, Motohiko Yamada, Yuzo Umeda

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 28 ( 4 ) 596 - 597 2024.4

ロボット支援下膵頭十二指腸切除術は術後膵液瘻High risk症例のPOPFを減少させる

藤智和, 高木弘誠, 楳田祐三, 安井和也, 木村次郎, 永井康夫, 藤原俊義

日本外科学会定期学術集会抄録集 124回 SF - 6 2024.4

Double-surgeon techniqueによるロボット支援下膵切除術

高木弘誠, 楳田祐三, 藤智和, 安井和也, 山田元彦, 木村次郎, 藤原俊義

日本外科学会定期学術集会抄録集 124回 SF - 2 2024.4

【消化器良性疾患に対する外科治療update】肝胆膵巨大肝嚢胞に対する外科治療update

藤智和, 楳田祐三, 高木弘誠, 安井和也, 木村次郎, 山田元彦, 永井康雄, 藤原俊義

外科 86 ( 4 ) 347 - 354 2024.4

Language：Japanese Publisher：(株)南江堂

＜文献概要＞単純性肝嚢胞のほとんどは治療を要しないが,巨大な嚢胞では周囲臓器の圧排による症状を認めることがあり治療介入が行われる.腹腔鏡下嚢胞開窓術は侵襲も少なく短期成績が良好で第一選択として広く行われている.開窓部の閉鎖による再発を防ぐためには十分な嚢胞壁切開が必要であり,インドシアニングリーン蛍光法を用いた術中ナビゲーションが胆道損傷回避に有用である.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00393&link_issn=&doc_id=20240416110010&doc_link_id=10.15106%2Fj_geka86_347&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka86_347&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Role of robotic surgery as an element of Enhanced Recovery After Surgery protocol in patients undergoing pancreatoduodenectomy. Reviewed International journal

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

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 28 ( 3 ) 220 - 225 2024.3

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

BACKGROUND: Although the current trend in pancreatoduodenectomy (PD) has shifted from open surgery to minimally invasive surgery (MIS), evidence on the role of MIS as an element of Enhanced Recovery After Surgery (ERAS) in PD is limited. This study aimed to investigate the effect of robotic surgery using the ERAS protocol on the outcomes of patients undergoing PD. METHODS: This retrospective study included 252 patients who underwent open PD (OPD) or robotic PD (RPD) managed using the ERAS protocol between January 2017 and March 2023. Outcomes stratified by the surgical approach were compared. Multivariable analyses were performed to evaluate the effect of ERAS items, including robotic surgery, on outcomes after PD. RESULTS: Of 252 patients, 202 (80.2%) underwent OPD, and 50 (19.2%) underwent RPD. Multivariable analyses demonstrated that perioperative management center support (odds ratio [OR], 2.85; 95% CI, 1.14-7.72; P = .025), robotic surgery (OR, 6.40; 95% CI, 1.94-26.1; P = .002), early solid intake (OR, 2.84; 95% CI, 1.46-5.63; P = .002), and early drain removal (OR, 3.77; 95% CI, 2.04-7.06; P < .001) were significant ERAS items related to early discharge after PD. CONCLUSION: Our study demonstrated that employing the ERAS protocol for OPD and RPD is feasible and safe. Moreover, our results suggested the role of robotic surgery as an element of the ERAS protocol for PD. A combination of ERAS protocols and MIS may be safe and feasible for accelerating postoperative recovery after PD.

DOI： 10.1016/j.gassur.2023.12.017

Perioperative and Postoperative Continuous Nutritional Counseling Improves Quality of Life of Gastric Cancer Patient Undergoing Gastrectomy. Reviewed International journal

Shunya Hanzawa, Satoru Kikuchi, Shinji Kuroda, Ryohei Shoji, Hajime Kashima, Yuki Matsumi, Ayako Takahashi, Yoshihiko Kakiuchi, Kosei Takagi, Shunsuke Tanabe, Kazuhiro Noma, Shunsuke Kagawa, Kenichi Shikata, Toshiyoshi Fujiwara

Nutrition and cancer 76 ( 6 ) 476 - 485 2024

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

Post-gastrectomy syndrome (PGS) and body weight loss (BWL) decrease quality of life (QOL) and survival of the patient undergoing gastrectomy. We have introduced perioperative and post-discharge continuous nutritional counseling (CNC) to prevent BWL and improve QOL after gastrectomy. In the present study, we evaluated the effect of CNC on QOL using the Post-gastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Eighty-three patients with gastric cancer (GC) who underwent curative gastrectomy between March 2018 and July 2019 were retrospectively analyzed. Patients received either pre-discharge nutritional counseling alone (control group, n = 45) or CNC (CNC group, n = 38) after gastrectomy. QOL at 12 months after gastrectomy was compared between the two groups. In QOL assessment, change in body weight (-7.98% vs. -12.77%, p = 0.0057), ingested amount of food per meal (7.00 vs. 6.07, p = 0.042) and ability for working (1.89 vs. 2.36, p = 0.049) were significantly better in CNC group than control group. Multiple regression analysis showed that CNC was a significantly beneficial factor for abdominal pain subscale (p = 0.028), diarrhea subscale (p = 0.047), ingested amount of food per meal (p = 0.012), Ability for working (p = 0.031) and dissatisfaction at the meal (p = 0.047). Perioperative and postoperative CNC could improve QOL in the patient undergoing gastrectomy in addition to preventing postoperative BWL.

DOI： 10.1080/01635581.2024.2340782

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

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

Annals of surgical oncology 2023.12

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

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

Annals of surgical oncology 2023.12

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

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

Fontan手術後の肝腺腫に対してロボット支援下肝切除術を施行した2例

山田元彦, 高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村裕司, 木村次郎, 萱野真史, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 1281 - 1281 2023.12

鼠径ヘルニア術後、膀胱上窩ヘルニアに対して腹腔鏡下根治術を施行した1例

萱野真史, 高木弘誠, 山田元彦, 近藤喜太, 木村次郎, 木村裕司, 安井和也, 藤智和, 楳田祐三, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 1932 - 1932 2023.12

Double-surgeon techniqueによるロボット支援下肝切除術

高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村裕司, 山田元彦, 木村次郎, 萱野真史, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 2336 - 2336 2023.12

鼠径ヘルニア術後、膀胱上窩ヘルニアに対して腹腔鏡下根治術を施行した1例

萱野真史, 高木弘誠, 山田元彦, 近藤喜太, 木村次郎, 木村裕司, 安井和也, 藤智和, 楳田祐三, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 1932 - 1932 2023.12

Fontan手術後の肝腺腫に対してロボット支援下肝切除術を施行した2例

山田元彦, 高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村裕司, 木村次郎, 萱野真史, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 1281 - 1281 2023.12

【胆道癌・膵臓癌の集学的治療におけるsupportive careの有用性について】胆道癌集学的治療における栄養指標の有用性

楳田祐三, 日置勝義, 吉田一博, 松田達雄, 児島亨, 佐藤太祐, 遠藤芳克, 藤智和, 高木弘誠, 安井和也, 木村真士, 石堂展宏, 大石正博, 稲垣優, 藤原俊義

胆と膵 44 ( 12 ) 1631 - 1637 2023.12

Language：Japanese Publisher：医学図書出版(株)

癌患者は,蛋白質の同化障害や異化亢進を特徴とする栄養不良に陥りやすく,筋肉量も減少しやすい。こうした担癌状態に伴う栄養不良,筋肉量低下・筋肉の質の低下といった二次性サルコペニアは,胆道癌において予後不良因子となることが報告されている。また手術後の感染性合併症の危険因子ともなるため,とくに胆道再建を伴う肝切除や膵頭十二指腸切除を要する胆道癌では注意を要する。胆道癌のさらなる治療予後向上には,腫瘍進行度のみならず,栄養状態を正確に評価し,リハビリ栄養療法を積極的に介入していくことが必要である。今回,肝内胆管癌切除例における栄養指標についての解析結果を踏まえ,胆道癌集学的治療における栄養評価と術前リハビリ栄養療法介入の意義について概説する。(著者抄録)

ロボット支援下vs.腹腔鏡下膵体尾部切除術 100例の経験から

安井和也, 高木弘誠, 楳田祐三, 藤智和, 吉田龍一, 木村裕司, 山田元彦, 木村次郎, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 1941 - 1941 2023.12

Double-surgeon techniqueによるロボット支援下肝切除術

高木弘誠, 楳田祐三, 藤智和, 安井和也, 木村裕司, 山田元彦, 木村次郎, 萱野真史, 藤原俊義

日本内視鏡外科学会雑誌 28 ( 7 ) 2336 - 2336 2023.12

短期間で急速に進行し、根治外科切除を行うも遠隔転移再発を来した十二指腸癌の一例

渋谷香苗, 河野吉泰, 神尾知宏, 平田翔一郎, 倉岡紗樹子, 稲生祥子, 里見拓也, 松枝克典, 濱田健太, 岩室雅也, 川野誠司, 河原祥朗, 高木弘誠, 楳田祐三, 田中健大, 大塚基之

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 120回・131回 75 - 75 2023.11

左内頸静脈自家グラフト再建を施行した肝外門脈瘤の切除例

大倉友博, 楳田祐三, 藤智和, 吉田龍一, 高木弘誠, 安井和也, 木村次郎, 畑七々子, 三島顕人, 八木孝仁, 藤原俊義

日本臨床外科学会雑誌 84 ( 11 ) 1827 - 1827 2023.11

膵・胆管合流異常に対する術後晩期合併症の検討

木村次郎, 藤智和, 廣野欣司, 佐藤真歩, 萱野真史, 山田元彦, 木村裕司, 高木弘誠, 安井和也, 楳田祐三, 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 46 43 - 43 2023.9

肝静脈狭窄によるOut-flow Block、十二指腸憩室穿孔による度重なる腹腔内出血と大量腹水に苦悩した生体肝移植の1例

安井和也, 佐藤真歩, 谷口厚樹, 木村次郎, 木村裕司, 高木弘誠, 藤智和, 楳田祐三, 藤原俊義

移植 58 ( 総会臨時 ) 265 - 265 2023.9

Robotic Pancreaticoduodenectomy Using the Right Posterior Superior Mesenteric Artery Approach. Reviewed 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

Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures. Reviewed 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

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

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

【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

【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

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

【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

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

【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

膵癌診療における検体固定の工夫と外科医と病理医間での相互フィードバックの実際

安井和也, 木村次郎, 高木弘誠, 藤智和, 楳田祐三, 藤原俊義

膵臓 38 ( 3 ) A461 - A461 2023.7

低侵襲時代の膵臓手術ロボット支援下膵切除術の定型化と普及にむけて

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

膵臓 38 ( 3 ) A179 - A179 2023.7

【必携ロボット支援下消化器外科手術-基本手技とトラブルシューティング】肝胆膵領域ロボット支援下先天性胆道拡張症手術

高木弘誠, 楳田祐三, 藤智和, 安井和也, 藤原俊義, 八木孝仁

手術 77 ( 8 ) 1231 - 1238 2023.7

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

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

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

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

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

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

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

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

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

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

ロボット支援下肝胆膵高難度手術の導入と教育システムの確立

高木弘誠, 吉田龍一, 藤智和, 安井和也, 八木孝仁, 藤原俊義

日本外科学会定期学術集会抄録集 123回 SF - 3 2023.4

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

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

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

Role of the Pfannenstiel Incision in Robotic Hepato-Pancreato-Biliary Surgery. Reviewed 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

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

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

【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

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

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

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

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. Reviewed 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

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

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

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

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

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 < 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

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

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

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

【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)

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

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

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

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

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. Reviewed International journal

Kosei Takagi, Kenta Murotani, Satoru Kamoshita, Akiyoshi Kuroda

Nutrients 14 ( 17 ) 2022.8

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

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 >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-<0.8 g/kg/day), Low (≥0.4-<0.6 g/kg/day), and Very low (<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.

DOI： 10.3390/nu14173541

【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

Impact of Amino Acids Nutrition Following Gastrectomy in Gastric Cancer Patients. Reviewed 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

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

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.

DOI： 10.21873/anticanres.15852

【総論】各臓器サブサブスペシャルティ外科医の育成法肝胆膵外科高度技能専門医の効率的な育成に向けて膵頭十二指腸切除のラーニングカーブ解析

藤智和, 楳田祐三, 高木弘誠, 安井和也, 熊野健二郎, 吉田龍一, 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 WS15 - 1 2022.7

ベーラー大学における膵全摘自家膵島移植200例の検討

熊野健二郎, 藤智和, 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, バシュー・ナジルディン

日本消化器外科学会総会 77回 P130 - 7 2022.7

80歳以上の高齢者に対する術前GS療法の忍容性はあるか?dose intensityの視点から

安井和也, 吉田龍一, 楳田祐三, 藤智和, 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 77回 RS5 - 3 2022.7

膵癌における術前血中KRAS遺伝子変異情報を用いた予後予測

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

日本消化器外科学会総会 77回 O3 - 4 2022.7

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

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

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.

DOI： 10.1186/s13256-022-03440-5

Adenomatoid mesothelioma arising from the diaphragm: a case report and review of the literature. Reviewed 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

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

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.

DOI： 10.1186/s13256-022-03420-9

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

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

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.

DOI： 10.1186/s12885-022-09650-w

Feasibility of local therapy for recurrent pancreatic cancer. Reviewed 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

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

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.

DOI： 10.1016/j.pan.2022.05.004

Prognostic Value of the Regional Lymph Node Station in Pancreatic Neuroendocrine Tumor. Reviewed 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

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

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.

DOI： 10.21873/anticanres.15760

肝胆膵領域における再生医療研究の最前線ベーラー大学における膵全摘自家膵島移植200例の検討

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, Bashoo Naziruddin

日本外科学会定期学術集会抄録集 122回 WS - 7 2022.4

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

Kosei Takagi, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi

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

The Gastrohepatic Ligament Approach in Robotic Spleen-Preserving Distal Pancreatectomy with Resection of the Splenic Vessels: The Superior Window Approach in the Warshaw Technique. Reviewed 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

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

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

Surgical resection of mixed neuroendocrine-non-neuroendocrine neoplasm in the biliary system: a report of two cases. Reviewed 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

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

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.

DOI： 10.1186/s40792-022-01386-w

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

A Systematic Review of Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy for Pancreatic Cancer. Reviewed International journal

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

Anticancer research 42 ( 2 ) 653 - 660 2022.2

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

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

【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

Prognostic Value of the Regional Lymph Node Station in Pancreatoduodenectomy for Ampullary Carcinoma. Reviewed 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

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

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

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

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

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

Multiple Hepatolithiasis Following Hepaticojejunostomy Successfully Treated with Left Hemihepatectomy and Double Hepaticojejunostomy Reconstruction. Reviewed

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

Language：English

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

Left Hemihepatectomy for Hepatocellular Carcinoma Following Esophagectomy with Retrosternal Gastric Tube Reconstruction for Esophageal Cancer. Reviewed

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

Authorship：Lead author Language：English

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

【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

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

ロボット肝胆膵手術のコツとピットフォールロボット支援下膵切除術のコツとピットフォール

高木弘誠, 楳田祐三, 吉田龍一, 吉田一博, 藤智和, 熊野健二郎, 安井和也, 佐藤博紀, 八木孝仁, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) PD1 - 5 2021.12

腹腔鏡下右葉系系統的肝切除の定型化腹腔鏡下肝後区域切除の定型化

楳田祐三, 藤智和, 高木弘誠, 吉田一博, 安井和也, 野間和広, 黒田新士, 吉田龍一, 八木孝仁, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) PD2 - 3 2021.12

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

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

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

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

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

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

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

Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Takahito Yagi

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

A Rare Complication of Barium Swallow Test. Reviewed International journal

Kosei Takagi, Noriyuki Kanehira, Kazuyuki Matsumoto

Gastroenterology 2021.10

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

Kosei Takagi, Takahito Yagi, Toshiyoshi Fujiwara

JMA journal 4 ( 4 ) 428 - 431 2021.10

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

Kosei Takagi, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi

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

生体肝移植ドナー肝切除成熟段階となった開腹手技

楳田祐三, 高木弘誠, 藤智和, 吉田一博, 安井和也, 熊野健二郎, 佐藤博紀, 吉田龍一, 八木孝仁, 藤原俊義

日本臨床外科学会雑誌 82 ( 増刊 ) S586 - S586 2021.10

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

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

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

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

Kidney Autotransplantation for Renal Artery Aneurysm: Case Series and a Systematic Review. Reviewed 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

Language：English

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

Robotic Radical Antegrade Modular Pancreatosplenectomy Using the Supracolic Anterior Superior Mesenteric Artery Approach. Reviewed 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

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

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.

DOI： 10.1007/s11605-021-05112-z

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gastroenteropancreatic neuroendocrine tumor of the accessory papilla of the duodenum: a case report. Reviewed 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

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

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

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

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

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

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

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.

DOI： 10.1002/jhbp.701

A novel modified hanging maneuver in laparoscopic left hemihepatectomy. Reviewed 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

Authorship：Lead author Language：English

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

Laparoscopic liver resection of segment seven: A case report and review of surgical techniques. Reviewed 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

Authorship：Lead author Language：English

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.

DOI： 10.1016/j.ijscr.2020.06.107

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

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

BMC gastroenterology 19 ( 1 ) 211 - 211 2019.12

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

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.

DOI： 10.1186/s12876-019-1126-6

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

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

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

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

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

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

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

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

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

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.

DOI： 10.1016/j.trre.2019.06.004

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

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

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.

DOI： 10.1186/s12893-019-0593-6

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

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

Surgery 166 ( 3 ) 237 - 246 2019.9

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

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.

DOI： 10.1016/j.surg.2019.03.024

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

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

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

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

Preoperative Controlling Nutritional Status Score Predicts Mortality after Hepatectomy for Hepatocellular Carcinoma. Reviewed 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

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

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

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

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

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.

DOI： 10.1159/000489826

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

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

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

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

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.

DOI： 10.1159/000500233

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

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

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

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

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

Acta medica Okayama 72 ( 6 ) 567 - 576 2018.12

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

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.

DOI： 10.18926/AMO/56374

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. Reviewed 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

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

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

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

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier USA

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

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

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

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

Language：Japanese Publisher：(一社)日本肝臓学会

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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00263&link_issn=&doc_id=20171128110001&doc_link_id=10.2957%2Fkanzo.58.599&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.58.599&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

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

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

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

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

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

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.

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.

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

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

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

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

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

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

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

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

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.

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

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

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

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

Language：English Publishing type：Research paper (scientific journal) Publisher：H G E UPDATE MEDICAL PUBLISHING S A

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 < 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.

DOI： 10.5754/hge14388

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

Language：English Publishing type：Research paper (scientific journal) Publisher：H G E UPDATE MEDICAL PUBLISHING S A

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 >= 22 and preoperative total bilirubin level >= 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.

DOI： 10.5754/hge14701

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

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

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

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

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.

DOI： 10.1002/jhbp.108

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

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

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

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

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

Kosei Takagi, Kazuyuki Kawamoto, Tadashi Itoh

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

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

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.

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

Kosei Takagi, Kazuyuki Kawamoto, Hiroyoshi Ikeda, Tadashi Itoh

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

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

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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