Faculty Profiles - YASUI Kazuya

Papers - YASUI Kazuya

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ADAR1-high tumor-associated macrophages induce drug resistance and are therapeutic targets in colorectal cancer. International journal

Hibiki Umeda, Kunitoshi Shigeyasu, Toshiaki Takahashi, Kazuya Moriwake, Yoshitaka Kondo, Kazuhiro Yoshida, Sho Takeda, Shuya Yano, Yuki Matsumi, Hiroyuki Kishimoto, Tomokazu Fuji, Kazuya Yasui, Hideki Yamamoto, Kosei Takagi, Masashi Kayano, Hiroyuki Michiue, Keiichiro Nakamura, Yoshiko Mori, Fuminori Teraishi, Hiroshi Tazawa, Yuzo Umeda, Shunsuke Kagawa, Ajay Goel, Toshiyoshi Fujiwara

Molecular cancer 24 ( 1 ) 116 - 116 2025.4

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

BACKGROUND: Colorectal cancer (CRC) is considered the third most common type of cancer worldwide. Tumor-associated macrophages (TAMs) have been shown to promote drug resistance. Adenosine-to-inosine RNA-editing, as regulated by adenosine deaminase acting on RNA (ADAR), is a process that induces the posttranscriptional modification of critical oncogenes. The aim of this study is to determine whether the signals from cancer cells would induce RNA-editing in macrophages. METHODS: The effects of RNA-editing on phenotypes in macrophages were analyzed using clinical samples and in vitro and in vivo models. RESULTS: The intensity of the RNA-editing enzyme ADAR1 (Adenosine deaminase acting on RNA 1) in cancer and mononuclear cells indicated a strong positive correlation between the nucleus and cytoplasm. The ADAR1-positive mononuclear cells were positive for CD68 and CD163, a marker for M2 macrophages. Cancer cells transport pro-inflammatory cytokines or ADAR1 protein directly to macrophages via the exosomes, promoting RNA-editing in AZIN1 (Antizyme Inhibitor 1) and GLI1 (Glioma-Associated Oncogene Homolog 1) and resulting in M2 macrophage polarization. GLI1 RNA-editing in the macrophages induced by cancer cells promotes the secretion of SPP1, which is supplied to the cancer cells. This activates the NFκB pathway in cancer cells, promoting oxaliplatin resistance. When the JAK inhibitors were administered, oncogenic RNA-editing in the macrophages was suppressed. This altered the macrophage polarization from M2 to M1 and decreased oxaliplatin resistance in cancer cells. CONCLUSIONS: This study revealed that ADAR1-high TAMs are crucial in regulating drug resistance in CRC and that targeting ADAR1 in TAMs could be a promising treatment approach for overcoming drug resistance in CRC.

DOI： 10.1186/s12943-025-02312-y

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. International journal

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

Annals of surgical oncology 2024.12

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. 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

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. 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. 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

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

RNA編集酵素ADAR1に基づく大腸癌肝転移の残肝再発リスク層別化の検討

高橋利明, 重安邦俊, 中村峻輔, 高橋政史, 萱野真史, 新田薫, 森分和也, 安井和也, 松三雄騎, 藤智和, 近藤喜太, 寺石文則, 田澤大, 藤原俊義

日本癌治療学会学術集会抄録集 62回 P80 - 2 2024.10

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

RNA編集酵素ADAR1に基づく大腸癌肝転移の残肝再発リスク層別化の検討

高橋利明, 重安邦俊, 中村峻輔, 高橋政史, 萱野真史, 新田薫, 森分和也, 安井和也, 松三雄騎, 藤智和, 近藤喜太, 寺石文則, 田澤大, 藤原俊義

日本癌治療学会学術集会抄録集 62回 P80 - 2 2024.10

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

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

Annals of surgical oncology 2024.9

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

肝移植後の抗体関連拒絶反応に対する免疫グロブリン静注(intravenous immunoglobulin;IVIg)療法の有効性と安全性 Reviewed

伊藤孝司, 清水誠一, 澤田雄, 眞田幸弘, 安井和也, 大平真裕, 長谷川康, 中沼伸一, 蔵満薫, 曽山明彦, 嶋村剛, 小寺由人, 種村彰洋, 小川晃平, 吉住朋晴, 嶋田圭太, 中川健, 江川裕人

移植 59 ( 1 ) 15 - 26 2024.7

BRAF-mutant microsatellite-stable rectal cancer with acquired KRAS mutation leading to drug resistance in liver metastasis. Reviewed International journal

Kunitoshi Shigeyasu, Hideki Yamamoto, Toshiaki Takahashi, Kazuya Moriwake, Masashi Kayano, Sho Takeda, Yuki Matsumi, Yuzo Umeda, Yoshitaka Kondo, Fuminori Teraishi, Kazuya Yasui, Tomokazu Fuji, Shunsuke Kagawa, Toshiyoshi Fujiwara

International cancer conference journal 13 ( 3 ) 189 - 192 2024.7

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

BRAF-mutant microsatellite-stable colorectal cancer (CRC), metastasized to distant sites, is associated with a poor prognosis. However, the BEACON CRC regimen, comprising a BRAF inhibitor, MEK inhibitor, and anti-EGFR antibody, offered a prolonged prognosis. Nonetheless, resistance to this regimen may occur, as observed in our reported case of CRC, where a KRAS mutation was identified in addition to the BRAF V600E mutation. Here, we present a case of 74-year-old woman with rectal cancer (pT4bN1bM0 Stage IIIc) harboring the BRAF V600E mutation. After resection of the primary tumor and during adjuvant chemotherapy using CAPOX (capecitabine and oxaliplatin), liver and lung metastases became apparent, and a companion diagnosis test revealed the presence of a BRAF V600E mutation. The new lesions were deemed resistant to the CAPOX regimen, and we decided to introduce encorafenib and cetuximab. After resection of liver metastases, encorafenib and cetuximab were reintroduced, but a new lesion appeared in hepatic S7, indicating resistance to the encorafenib and cetuximab regimen. The resistant liver metastasis was subsequently resected. To elucidate the resistance mechanism, we conducted a comprehensive analysis using the FoundationOne CDx cancer gene panel test, revealing the presence of a KRAS Q61H mutation alongside the BRAF V600E mutation. Subsequent liquid biopsy after liver recurrence confirmed the persistence of the KRAS Q61H mutation. Our results highlight the significance of cancer genome profiling tests (CGP tests) and liquid biopsies in guiding treatment strategies for BRAF-mutant colorectal cancer. Therefore, CGP testing offers valuable information for treatment, even if it does not lead to new drug administrations.

DOI： 10.1007/s13691-024-00678-2

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

【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

【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

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

外科と救急のダブルボード取得を目指した外科救急連携コース

黒田新士, 安井和也, 岡崎幹生, 小谷恭弘, 枝園忠彦, 小林純子, 中尾篤典, 笠原真悟, 豊岡伸一, 藤原俊義

日本外科学会定期学術集会抄録集 124回 SP - 6 2024.4

Long-term activation of anti-tumor immunity in pancreatic cancer by a p53-expressing telomerase-specific oncolytic adenovirus. Reviewed International journal

Masashi Hashimoto, Shinji Kuroda, Nobuhiko Kanaya, Daisuke Kadowaki, Yusuke Yoshida, Masaki Sakamoto, Yuki Hamada, Ryoma Sugimoto, Chiaki Yagi, Tomoko Ohtani, Kento Kumon, Yoshihiko Kakiuchi, Kazuya Yasui, Satoru Kikuchi, Ryuichi Yoshida, Hiroshi Tazawa, Shunsuke Kagawa, Takahito Yagi, Yasuo Urata, Toshiyoshi Fujiwara

British journal of cancer 130 ( 7 ) 1187 - 1195 2024.4

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

BACKGROUND: Pancreatic cancer is an aggressive, immunologically "cold" tumor. Oncolytic virotherapy is a promising treatment to overcome this problem. We developed a telomerase-specific oncolytic adenovirus armed with p53 gene (OBP-702). METHODS: We investigated the efficacy of OBP-702 for pancreatic cancer, focusing on its long-term effects via long-lived memory CD8 + T cells including tissue-resident memory T cells (TRMs) and effector memory T cells (TEMs) differentiated from effector memory precursor cells (TEMps). RESULTS: First, in vitro, OBP-702 significantly induced adenosine triphosphate (ATP), which is important for memory T cell establishment. Next, in vivo, OBP-702 local treatment to murine pancreatic PAN02 tumors increased TEMps via ATP induction from tumors and IL-15Rα induction from macrophages, leading to TRM and TEM induction. Activation of these memory T cells by OBP-702 was also maintained in combination with gemcitabine+nab-paclitaxel (GN) in a PAN02 bilateral tumor model, and GN + OBP-702 showed significant anti-tumor effects and increased TRMs in OBP-702-uninjected tumors. Finally, in a neoadjuvant model, in which PAN02 cells were re-inoculated after resection of treated-PAN02 tumors, GN + OBP-702 provided long-term anti-tumor effects even after tumor resection. CONCLUSION: OBP-702 can be a long-term immunostimulant with sustained anti-tumor effects on immunologically cold pancreatic cancer.

DOI： 10.1038/s41416-024-02583-0

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

Circulating cell-free DNA methylation patterns as non-invasive biomarkers to monitor colorectal cancer treatment efficacy without referencing primary site mutation profiles. Reviewed International journal

Kazuya Yasui, Toshiaki Toshima, Ryo Inada, Yuzo Umeda, Shuya Yano, Hiroaki Tanioka, Akihiro Nyuya, Toshiyoshi Fujiwara, Takeshi Yamada, Yoshio Naomoto, Ajay Goel, Takeshi Nagasaka

Molecular cancer 23 ( 1 ) 1 - 1 2024.1

Language：English

This study investigates methylation patterns in circulating cell-free DNA (ccfDNA) for their potential role in colorectal cancer (CRC) detection and the monitoring of treatment response. Through methylation microarrays and quantitative PCR assays, we analyzed 440 samples from The Cancer Genome Atlas (TCGA) and an additional 949 CRC samples. We detected partial or extensive methylation in over 85% of cases within three biomarkers: EFEMP1, SFRP2, and UNC5C. A methylation score for at least one of the six candidate regions within these genes' promoters was present in over 95% of CRC cases, suggesting a viable detection method. In evaluating ccfDNA from 97 CRC patients and 62 control subjects, a difference in methylation and recovery signatures was observed. The combined score, integrating both methylation and recovery metrics, showed high diagnostic accuracy, evidenced by an area under the ROC curve of 0.90 (95% CI = 0.86 to 0.94). While correlating with tumor burden, this score gave early insight into disease progression in a small patient cohort. Our results suggest that DNA methylation in ccfDNA could serve as a sensitive biomarker for CRC, offering a less invasive and potentially more cost-effective approach to augment existing cancer detection and monitoring modalities, possibly supporting comprehensive genetic mutation profiling.

DOI： 10.1186/s12943-023-01910-y

Clinical T1a Renal Cell Carcinoma with Solitary Diaphragmatic Metastasis in a Patient with von Hippel-Lindau Disease. Reviewed International journal

Tadataka Hirai, Mayu Uka, Toshihiro Iguchi, Kazuya Yasui, Takahiro Kawabata, Noriyuki Umakoshi, Koji Tomita, Yusuke Matsui, Yasuyuki Kobayashi, Motoo Araki, Takao Hiraki

Journal of kidney cancer and VHL 11 ( 3 ) 23 - 26 2024

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

We report the case of a 38-year-old man with two von Hippel-Lindau disease-associated T1a renal cell carcinomas (RCCs) (<2 cm in diameter) which developed into a 2.5-cm solitary diaphragmatic metastatic tumor. After diagnosis using percutaneous biopsy, the diaphragmatic metastasis and two RCCs were treated by laparoscopic resection and percutaneous cryoablation, respectively. One year after treatment, the patient survived without local recurrence or distant metastasis. This report describes a rare case of RCC metastasis in VHL disease and its treatment.

DOI： 10.15586/jkcvhl.v11i3.342

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 31 ( 3 ) 1943 - 1943 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 31 ( 3 ) 1933 - 1936 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

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

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

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)

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

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

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

ゲノム医療の最前線循環遊離DNAメチル化パターンは原発腫瘍変異プロファイルなしに大腸癌検出とモニタリングを可能とする

永坂岳司, 戸嶋俊明, 稲田凉, 安井和也, 楳田祐三, 岡脇誠, 入谷光洋, 矢野修也, 谷岡洋亮, 山田岳史, 猶本良夫

日本大腸肛門病学会雑誌 76 ( 9 ) A67 - A67 2023.9

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

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 27 ( 12 ) 3069 - 3070 2023.8

肝移植後患者に発症したメトロニダゾール誘発性脳症の1例 Reviewed

實金悠, 安井和也, 楳田祐三, 八木孝仁, 藤原俊義

日本臨床外科学会雑誌 84 ( 8 ) 1301 - 1307 2023.8

Language：Japanese Publisher：日本臨床外科学会

患者は57歳,男性.Budd-Chiari症候群による非代償性肝硬変に対して46歳時に生体肝移植術後.慢性期に門脈狭窄に起因する門脈圧亢進症に伴う腸炎や肝性脳症を繰り返していたが,肝不全兆候はなく外来フォロー中であった.今回,間質性肺炎急性増悪に対しステロイド加療中にClostridium difficile腸炎を併発,メトロニダゾール内服にて軽快したが,腸炎症状は遷延していたためメトロニダゾール1g/日の内服を継続していた.約2ヵ月後に内服服薬管理困難,構音障害,手指振戦が出現し,症状発現から1週間後に意識障害の増悪を認め受診.頭部MRIで両側対称性に小脳歯状核の高信号域を確認,メトロニダゾール誘発性脳症と診断した.速やかにメトロニダゾールを中止したことで,徐々に意識レベルは改善した.メトロニダゾール誘発性脳症の発症は稀であり,肝移植・肝障害に関連した報告例は少なく,過去の文献的考察を加えて報告する.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J03156&link_issn=&doc_id=20230907150026&doc_link_id=10.3919%2Fjjsa.84.1301&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.84.1301&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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

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

【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

【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

【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

膵頭部癌術前CT画像診断精度の実際病理診断からの振り返り

谷口厚樹, 安井和也, 藤原俊義

日本消化器外科学会総会 78回 S20 - 2 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

外科専攻医の産育休後復帰支援とダイバーシティ推進のための全体教育への取り組み

竹原裕子, 溝尾妙子, 小林純子, 安井和也, 菊池覚次, 黒田新士, 楳田祐三, 吉田龍一, 小谷恭弘, 杉本誠一郎, 岡崎幹生, 枝國忠彦, 豊岡伸一, 笠原真悟

日本外科学会定期学術集会抄録集 123回 SF - 4 2023.4

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

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

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

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

ADAR1 is a promising risk stratification biomarker of remnant liver recurrence after hepatic metastasectomy for colorectal cancer. Reviewed International journal

Nanako Hata, Kunitoshi Shigeyasu, Yuzo Umeda, Shuya Yano, Sho Takeda, Kazuhiro Yoshida, Tomokazu Fuji, Ryuichi Yoshida, Kazuya Yasui, Hibiki Umeda, Toshiaki Takahashi, Yoshitaka Kondo, Hiroyuki Kishimoto, Yoshiko Mori, Fuminori Teraishi, Hideki Yamamoto, Hiroyuki Michiue, Keiichiro Nakamura, Hiroshi Tazawa, Toshiyoshi Fujiwara

Scientific reports 13 ( 1 ) 2078 - 2078 2023.2

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

Adenosine-to-inosine RNA editing is a process mediated by adenosine deaminases that act on the RNA (ADAR) gene family. It has been discovered recently as an epigenetic modification dysregulated in human cancers. However, the clinical significance of RNA editing in patients with liver metastasis from colorectal cancer (CRC) remains unclear. The current study aimed to systematically and comprehensively investigate the significance of adenosine deaminase acting on RNA 1 (ADAR1) expression status in 83 liver metastatic tissue samples collected from 36 patients with CRC. The ADAR1 expression level was significantly elevated in liver metastatic tissue samples obtained from patients with right-sided, synchronous, or RAS mutant-type CRC. ADAR1-high liver metastasis was significantly correlated with remnant liver recurrence after hepatic metastasectomy. A high ADAR1 expression was a predictive factor of remnant liver recurrence (area under the curve = 0.72). Results showed that the ADAR1 expression level could be a clinically relevant predictive indicator of remnant liver recurrence. Patients with liver metastases who have a high ADAR1 expression requires adjuvant chemotherapy after hepatic metastasectomy.

DOI： 10.1038/s41598-023-29397-z

遺伝性出血性末梢血管拡張症(HHT;Hereditary hemorrhagic telangiectasia)による重症心不全患者に対する脳死肝移植の1例

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

肝臓 64 ( 2 ) 103 - 104 2023.2

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

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

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

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

早期栄養介入とNSTによる多職種連携により良好な転帰を得た多発褥瘡患者の1例

開原裕子, 深川真里, 片山祥子, 長谷川祐子, 高橋絢子, 大木晴美, 山重達也, 川西英明, 三浦太郎, 金聖暎, 山田太平, 安井和也, 菊地覚次, 田辺俊介, 四方賢一

学会誌JSPEN 4 ( Suppl.2 ) 160 - 161 2022.12

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

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

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

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

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

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)

Neonatal hemochromatosis with εγδβ-thalassemia: a case report and analysis of serum iron regulators. Reviewed International journal

Mitsuru Tsuge, Aya Kodera, Hiromi Sumitomo, Tooru Araki, Ryuichi Yoshida, Kazuya Yasui, Hiroki Sato, Yosuke Washio, Kana Washio, Kenji Shigehara, Masato Yashiro, Takahito Yagi, Hirokazu Tsukahara

BMC pediatrics 22 ( 1 ) 622 - 622 2022.10

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

BACKGROUND: Neonatal hemochromatosis causes acute liver failure during the neonatal period, mostly due to gestational alloimmune liver disease (GALD). Thalassemia causes hemolytic anemia and ineffective erythropoiesis due to mutations in the globin gene. Although neonatal hemochromatosis and thalassemia have completely different causes, the coexistence of these diseases can synergistically exacerbate iron overload. We report that a newborn with εγδβ-thalassemia developed neonatal hemochromatosis, which did not respond to iron chelators and rapidly worsened, requiring living-donor liver transplantation. CASE PRESENTATION: A 1-day-old Japanese boy with hemolytic anemia and targeted red blood cells was diagnosed with εγδβ-thalassemia by genetic testing, and required frequent red blood cell transfusions. At 2 months after birth, exacerbation of jaundice, grayish-white stool, and high serum ferritin levels were observed, and liver biopsy showed iron deposition in hepatocytes and Kupffer cells. Magnetic resonance imaging scans showed findings suggestive of iron deposits in the liver, spleen, pancreas, and bone marrow. The total amount of red blood cell transfusions administered did not meet the criteria for post-transfusion iron overload. Administration of an iron-chelating agent was initiated, but iron overload rapidly progressed to liver failure without improvement in jaundice and liver damage. He underwent living-donor liver transplantation from his mother, after which iron overload disappeared, and no recurrence of iron overload was observed. Immunohistochemical staining for C5b-9 in the liver was positive. Serum hepcidin levels were low and serum growth differentiation factor-15 levels were high prior to living-donor liver transplantation. CONCLUSIONS: We reported that an infant with εγδβ-thalassemia developed NH due to GALD, and that coexistence of ineffective erythropoiesis in addition to erythrocyte transfusions may have exacerbated iron overload. Low serum hepcidin levels, in this case, might have been caused by decreased hepcidin production arising from fetal liver damage due to neonatal hemochromatosis and increased hepcidin-inhibiting hematopoietic mediators due to the ineffective hematopoiesis observed in thalassemia.

DOI： 10.1186/s12887-022-03706-3

Genomically stable gastric cancer characterized by hypomethylation in Wnt signal cascade. Reviewed International journal

Hiroaki Tanioka, Yoshiko Mori, Takehiro Tanaka, Kazuya Yasui, Keisuke Kimura, Yuzo Umeda, Toshiyoshi Fujiwara, Akihiro Nyuya, Shuya Yano, Takeshi Nagasaka, Takeshi Nagasaka

Oncology 101 ( 2 ) 105 - 116 2022.10

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

Introduction Gastric cancer is divided into four subtypes by their molecular features linked with genetic alterations, e.g., Epstein-Barr virus (EBV), microsatellite instability-high (MSI-high), chromosomal instability (CIN), and genomically stable (GS), called as TCGA classification. In this study, we tried to clarify the epigenetic features of the four GC subtypes according to aberrant methylation status in 23 loci. Methods A total of 98 gastric cancers and their normal gastric mucosa samples were included in this study. We divided gastric cancers into TCGA subtypes which were determined in line with MSI-high, EBV, CIN, to GS by their molecular features. The 13 loci of polymorphic microsatellite sequences were used to determine loss of heterogeneity (LOH) for the detection of CIN. The MSI status was determined by three mononucleotide repeat markers. Infection of EBV was determined by recovering EBV BNRF1 sequence from genomic DNA collected from gastric cancers. Methylation status of 23 loci was investigated by the combined bisulfite restriction analysis (COBRA). Status of other findings, e.g., KRAS mutations, HER2 expression status and infection of helicobacter pylori were confirmed. Results Gastric cancers were divided into MSI (13%), EBV (7%), CIN (53%), and GS (27%). By histological classification, poorly differentiated adenocarcinoma (por) was more in tumors categorized in MSI-high, and GS and signet-ring cell carcinoma (sig) was more in GS. Among the 23 loci investigated their methylation status, 18 loci were significantly hypermethylated in caner tissues. A unsupervised clustering divided gastric cancers into two clusters, and revealed that most GS tumors clustered together in a cluster that exhibited lower methylation levels, distinct from the other subtypes. The inter-variable clustering revealed that a cluster contained the three loci (SFRP2-region 1/2 and APC) belonging to the Wnt signal cascade (Wnt-associated loci). The mean methylation score of Wnt-associated loci was the lowest in GS tumors (MSI-high: 2.7 [95% confidence interval (CI), 2.3-2.9]; EBV:2.1[1.2-3.1]; CIN: 2.4 [2.2-2.7]; GS: 1.3 [0.8-0.7]). In contrast, the mean methylation score of the other 15 loci was significantly higher in MSI-high, while that in GS was as same as that in EBV or CIN (MSI- high: 10.4 [8.3-12.4]; EBV:5.7 [1.7-9.7]; CIN: 4.4 [3.6-5.1]; GS: 3.4 [2.2-4.6]). Additionally, the lower methylation score of Wnt-associated loci was observed only in sig tumors. Conclusions GS subtype tumors have the potential to possess distinct signatures in DNA hypomethylation profiles in Wnt signaling pathway, especially in signet-ring cell carcinoma.

DOI： 10.1159/000527098

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

Wnt signaling cascadeにおける低メチル化を特徴とするGenomically stable胃癌

谷岡洋亮, 安井和也, 母里淑子, 田中健大, 木村圭介, 入谷光洋, 岡脇誠, 矢野修也, 山口佳之, 永坂岳司

日本癌治療学会学術集会抄録集 60回 P75 - 1 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

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

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

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

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

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

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

男女を問わず外科医が輝き続けるためにステレオタイプ・スレットという問題とニュースレターの果たす役割

竹原裕子, 溝尾妙子, 小林純子, 坂本美咲, 新田薫, 工藤由里絵, 安井和也, 菊池覚次, 黒田新士, 吉田龍一, 岡崎幹生, 枝園忠彦, 山根正修, 小谷恭弘, 豊岡伸一, 笠原真悟, 土井原博義, 藤原俊義

日本外科学会雑誌 123 ( 5 ) 501 - 502 2022.9

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

男女を問わず外科医が輝き続けるためにステレオタイプ・スレットという問題とニュースレターの果たす役割

竹原裕子, 溝尾妙子, 小林純子, 坂本美咲, 新田薫, 工藤由里絵, 安井和也, 菊池覚次, 黒田新士, 吉田龍一, 岡崎幹生, 枝園忠彦, 山根正修, 小谷恭弘, 豊岡伸一, 笠原真悟, 土井原博義, 藤原俊義

日本外科学会雑誌 123 ( 5 ) 501 - 502 2022.9

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

RNA editing facilitates the enhanced production of neoantigens during the simultaneous administration of oxaliplatin and radiotherapy in colorectal cancer. Reviewed International journal

Yasuhiro Komatsu, Kunitoshi Shigeyasu, Shuya Yano, Sho Takeda, Kazutaka Takahashi, Nanako Hata, Hibiki Umeda, Kazuhiro Yoshida, Yoshiko Mori, Kazuya Yasui, Ryuichi Yoshida, Yoshitaka Kondo, Hiroyuki Kishimoto, Fuminori Teraishi, Yuzo Umeda, Shunsuke Kagawa, Hiroyuki Michiue, Hiroshi Tazawa, Ajay Goel, Toshiyoshi Fujiwara

Scientific reports 12 ( 1 ) 13540 - 13540 2022.8

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

Most cases of colorectal cancers (CRCs) are microsatellite stable (MSS), which frequently demonstrate lower response rates to immune checkpoint inhibitors (ICIs). RNA editing produces neoantigens by altering amino acid sequences. In this study, RNA editing was induced artificially by chemoradiation therapy (CRT) to generate neoantigens in MSS CRCs. Altogether, 543 CRC specimens were systematically analyzed, and the expression pattern of ADAR1 was investigated. In vitro and in vivo experiments were also performed. The RNA editing enzyme ADAR1 was upregulated in microsatellite instability-high CRCs, leading to their high affinity for ICIs. Although ADAR1 expression was low in MSS CRC, CRT including oxaliplatin (OX) treatment upregulated RNA editing levels by inducing ADAR1. Immunohistochemistry analyses showed the upregulation of ADAR1 in patients with CRC treated with CAPOX (capecitabine + OX) radiation therapy relative to ADAR1 expression in patients with CRC treated only by surgery (p < 0.001). Compared with other regimens, CRT with OX effectively induced RNA editing in MSS CRC cell lines (HT29 and Caco2, p < 0.001) via the induction of type 1 interferon-triggered ADAR1 expression. CRT with OX promoted the RNA editing of cyclin I, a neoantigen candidate. Neoantigens can be artificially induced by RNA editing via an OX-CRT regimen. CRT can promote proteomic diversity via RNA editing.

DOI： 10.1038/s41598-022-17773-0

【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

術前化学療法を施行した膵癌患者における代謝栄養学的指標の意義に関する検討

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

日本消化器外科学会総会 77回 P224 - 3 2022.7

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

【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

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

Regulatory T cells induce a suppressive immune milieu and promote lymph node metastasis in intrahepatic cholangiocarcinoma. Reviewed International journal

Daisuke Konishi, Yuzo Umeda, Kazuhiro Yoshida, Kunitoshi Shigeyasu, Shuya Yano, Tomohiro Toji, Sho Takeda, Ryuichi Yoshida, Kazuya Yasui, Tomokazu Fuji, Kazuyuki Matsumoto, Hiroyuki Kishimoto, Hiroyuki Michiue, Fuminori Teraishi, Hironari Kato, Hiroshi Tazawa, Hiroyuki Yanai, Takahito Yagi, Ajay Goel, Toshiyoshi Fujiwara

British journal of cancer 127 ( 4 ) 757 - 765 2022.5

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

BACKGROUND: Emerging evidence indicates that immunogenicity plays an important role in intrahepatic cholangiocarcinoma (ICC). Herein, we systematically evaluated the clinical relevance of immunogenicity in ICC. METHODS: Highly immunogenic ICCs identified in the public dataset and the Cancer Immunome Atlas (TCIA) were assessed to determine the prognostic impact of immunogenicity in ICC and key components after curative resection. We also investigated the clinical relevance of the immune milieu in ICC. RESULTS: Using the Gene Expression Omnibus dataset 89749 and TCIA, we identified CD8+/forkhead box P3 (FoxP3)+ tumour-infiltrating lymphocytes (TILs), T-cell immunoglobulin and mucin domain 3 (TIM-3) and human leukocyte antigen-A (HLA-A) in highly immunogenic ICCs. Immunohistochemical analysis of the in-house cohort showed that intratumoral FoxP3+ TILs correlated with CD8+ TILs (P = 0.045, Fisher's exact test) and that high FoxP3+/CD8+ ratio (FCR) was an important marker for poor survival (P < 0.001, log-rank test). Furthermore, the FCR was higher in tumour-free lymph nodes in ICCs with lymph node metastases than in those without lymph node metastases (P = 0.003, Mann-Whitney U test). CONCLUSIONS: FCR should be considered an important biomarker that represents the immune environment of ICC based on its potentially important role in tumour progression, especially lymph node metastasis.

DOI： 10.1038/s41416-022-01838-y

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

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

ステレオタイプ・スレットという問題とニュースレターの果たす役割

竹原裕子, 溝尾妙子, 小林純子, 坂本美咲, 新田薫, 工藤由里絵, 安井和也, 菊池覚次, 黒田新士, 吉田龍一, 岡崎幹生, 杉本誠一郎, 枝園忠彦, 小谷恭弘, 豊岡伸一, 笠原真悟, 藤原俊義, 土井原博義

日本外科学会定期学術集会抄録集 122回 SP - 6 2022.4

ステレオタイプ・スレットという問題とニュースレターの果たす役割

竹原裕子, 溝尾妙子, 小林純子, 坂本美咲, 新田薫, 工藤由里絵, 安井和也, 菊池覚次, 黒田新士, 吉田龍一, 岡崎幹生, 杉本誠一郎, 枝園忠彦, 小谷恭弘, 豊岡伸一, 笠原真悟, 藤原俊義, 土井原博義

日本外科学会定期学術集会抄録集 122回 SP - 6 2022.4

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

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

Acute acalculous cholecystitis caused by SARS-CoV-2 infection: A case report and literature review. Reviewed International journal

Hana Futagami, Hiroki Sato, Ryuichi Yoshida, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara

International journal of surgery case reports 90 106731 - 106731 2022.1

Language：English

BACKGROUND: Emerging data indicate that gastrointestinal disorders, in addition to pulmonary dysfunction, are also hallmarks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE PRESENTATION: A 42-year-old man with maintenance hemodialysis developed high fever and dyspnea. He was positive for SARS-CoV-2 and was diagnosed with pneumonia. After treatment for SARS-CoV-2, his respiratory condition improved. However, he developed right upper quadrant pain with elevated inflammatory markers (white blood cells, 21,160/μL; c-reactive protein, 163.9 mg/L) on the 13th day. Abdominal computed tomography revealed acute acalculous cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed together with antibiotic therapy, which resulted in improvement of symptoms. Laparoscopic cholecystectomy was performed 36 days after PTGBD. CONCLUSION: We report a rare case of acute acalculous cholecystitis (AAC) following pneumonia caused by SARS-CoV-2 infection. We also conducted a literature search to characterize SARS-CoV-2-related cholecystitis. Infection with SARS-CoV-2 is an important trigger for AAC, and appropriate therapeutic alternatives should be cautiously selected according to individual cases.

DOI： 10.1016/j.ijscr.2021.106731

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

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

Concordance of acquired mutations between metastatic lesions and liquid biopsy in metastatic colorectal cancer. Reviewed International journal

Fumitaka Taniguchi, Akihiro Nyuya, Toshiaki Toshima, Kazuya Yasui, Yoshiko Mori, Makoto Okawaki, Hiroyuki Kishimoto, Yuzo Umeda, Toshiyoshi Fujiwara, Hiroaki Tanioka, Yoshiyuki Yamaguchi, Ajay Goel, Takeshi Nagasaka

Future science OA 7 ( 10 ) FSO757 2021.12

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

Aim: To evaluate whether PCR-reverse sequence-specific oligonucleotide can examine the concordance between liquid biopsy and metastatic lesions with acquired resistance. Materials & methods: We examined acquired mutations in chemoresistant lesions and blood obtained from four patients with RAS wild-type metastatic colorectal cancer who underwent treatment with anti-epidermal growth factor receptor antibodies. Results: In one patient, metastatic lesions harbored diverse acquired mutations in KRAS in all seven metastases; the two acquired mutations were detectable in blood collected after the patient acquired resistance. None of the other patients exhibited liquid biopsy mutations, except one, with a BRAF mutation confirmed in primary tumor and peritoneal dissemination. Conclusion: Liquid biopsy based on PCR-reverse sequence-specific oligonucleotide is a successful procedure for capturing acquired mutations with precise information on the RAS mutational spectrum.

DOI： 10.2144/fsoa-2021-0059

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

【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

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

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

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

情熱・努力を継続できる外科教育外科マネージメントセンターによる情熱のある外科医教育・育成システム

菊地覚次, 吉田龍一, 黒田新士, 野間和広, 安井和也, 笠原真悟, 豊岡伸一, 土井原博義, 藤原俊義

日本外科学会雑誌 122 ( 6 ) 680 - 682 2021.11

Pectoralis major and serratus anterior muscle flap for diaphragmatic reconstruction. Reviewed International journal

Toshiyuki Watanabe, Hiroshi Matsumoto, Ryuichi Yoshida, Kazuya Yasui, Takahito Yagi, Yoshihiro Kimata

The Annals of thoracic surgery 114 ( 1 ) e51-e54 2021.10

Language：English

The reconstruction of diaphragmatic defects after chondrosarcoma resection is challenging. In diaphragmatic reconstruction with chest wall defects, strong chest wall reconstruction and diaphragmatic flexibility are important to avoid interference with respiration. The artificial material, Gore-Tex, is used as the first choice, but it has infection-, exposure-, and durability-related drawbacks. As an alternative method using artificial material, we present our new alternative technique for diaphragmatic reconstruction using a reversed-combined pectoralis major and serratus anterior muscle flap.

DOI： 10.1016/j.athoracsur.2021.08.067

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

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

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

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

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

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

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

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

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

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

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

Clinical and epigenetic features of colorectal cancer patients with somatic POLE proofreading mutations. Reviewed International journal

Takashi Kawai, Akihiro Nyuya, Yoshiko Mori, Takehiro Tanaka, Hiroaki Tanioka, Kazuya Yasui, Toshiaki Toshima, Fumitaka Taniguchi, Kunitoshi Shigeyasu, Yuzo Umeda, Toshiyoshi Fujiwara, Makoto Okawaki, Yoshiyuki Yamaguchi, Ajay Goel, Takeshi Nagasaka

Clinical epigenetics 13 ( 1 ) 117 - 117 2021.5

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

BACKGROUND: Mutations in the POLE gene result in an ultra-hypermutated phenotype in colorectal cancer (CRC); however, the molecular characterisation of epigenetic alterations remains unclear. We examined the genetic and epigenetic profiles of POLE-mutant CRC to elucidate the clinicopathological features of the associated genetic and epigenetic alterations. RESULTS: Tumour tissues (1,013) obtained from a cohort of patients with CRC were analysed to determine associations between the proofreading domain mutations of POLE with various clinicopathological variables, microsatellite instability (MSI) status, BRAF and KRAS mutations, and the methylation status of key regions of MLH1, MGMT, and SFRP2 promoters by calculating the methylation scores (range 0-6). Only four cases (0.4%) exhibited pathogenic POLE hotspot mutations (two p.P286R [c.857C > G], one p.V411L [c.1231G > C], and p.S459F [c.1376C > T] each), which were mutually exclusive to BRAF and KRAS mutations and MSI. CRC patients were divided into four subgroups: patients with POLE mutations (POLE, 0.4%, n = 4), patients with both MSI and extensive methylation in MLH1 (MSI-M, 2.9%, n = 29), patients with MSI but no extensive methylation in MLH1 (MSI-U, 3.6%, n = 36), and patients without MSI (non-MSI, 93.2%, n = 944). The POLE group was younger at diagnosis (median 52 years, P < 0.0001), with frequent right-sided tumour localisation (frequency of tumours located in the right colon was 100%, 93.1%, 36.1%, and 29.9% in POLE, MSI-M, MSI-U, and non-MSI, respectively; P < 0.0001), and was diagnosed at an earlier stage (frequency of stages I-II was 100%, 72.4%, 77.8%, and 46.6% in POLE, MSI-M, MSI-U, and non-MSI, respectively, P < 0.0001). The mean methylation score in POLE was not different from that in MSI-U and non-MSI, but the methylation signature was distinct from that of the other subgroups. Additionally, although the examined number of POLE-mutant tumours was small, the number of CD8-positive cells increased in tumours with partial methylation in the MLH1 gene. CONCLUSIONS: CRC patients with POLE proofreading mutations are rare. Such mutations are observed in younger individuals, and tumours are primarily located in the right colon. Diagnosis occurs at an earlier stage, and distinct epigenetic alterations may be associated with CD8 cell infiltration.

DOI： 10.1186/s13148-021-01104-7

外科における多施設臨床試験の意義と方向性消化器外科における多施設共同研究の意義地方からのevidence発信を目指して

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

日本外科学会定期学術集会抄録集 121回 NES - 4 2021.4

外科マネージメントセンターによる情熱のある外科医教育・育成システム

菊地覚次, 吉田龍一, 黒田新士, 野間和広, 安井和也, 笠原真悟, 豊岡伸一, 土井原博義, 藤原俊義

日本外科学会定期学術集会抄録集 121回 SP - 6 2021.4

外科系新専門医制度のあるべきグランドデザイン地域枠医師に対する外科専門研修のあり方充実した地域医療の実現を目指して Reviewed

黒田新士, 吉田龍一, 池田宏国, 岡崎幹生, 大澤晋, 小谷恭弘, 山根正修, 杉本誠一郎, 菊地覚次, 安井和也, 野田卓男, 笠原真悟, 豊岡伸一, 土井原博義, 藤原俊義

日本外科学会雑誌 122 ( 1 ) 83 - 85 2021.1

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

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

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

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

Heterogeneity of Epigenetic and Epithelial Mesenchymal Transition Marks in Hepatocellular Carcinoma with Keratin 19 Proficiency. Reviewed International journal

Naosuke Yokomichi, Naoshi Nishida, Yuzo Umeda, Fumitaka Taniguchi, Kazuya Yasui, Toshiaki Toshima, Yoshiko Mori, Akihiro Nyuya, Takehiro Tanaka, Takeshi Yamada, Takahito Yagi, Toshiyoshi Fujiwara, Yoshiyuki Yamaguchi, Ajay Goel, Masatoshi Kudo, Takeshi Nagasaka

Liver cancer 8 ( 4 ) 239 - 254 2019.7

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

Objective: Keratin 19 (K19) expression is a potential predictor of poor prognosis in patients with hepatocellular carcinoma (HCC). To clarify the feature of K19-proficient HCC, we traced epigenetic footprints in cultured cells and clinical materials. Patients and Methods: In vitro, KRT19 promoter methylation was analyzed and 5-aza-2'-deoxycytidine with trichostatin A (TSA) treatment was performed. Among 564 surgically resected HCCs, the clinicopathological relevance of K19-proficent HCCs was performed in comparison with hepatocytic (HepPar-1 and arginase-1), epithelial-mesenchymal transition (E-cadherin and vimentin), biliary differentiation-associated (K7 and NOTCH-1) markers, and epigenetic markers (KRT19 promoter/long interspersed nucleotide element-1 [LINE-1] methylation status). Results: KRT19 promoter methylation was clearly associated with K19 deficiency and 5-aza-2'-deoxycytidine with TSA treatment-stimulated K19 re-expression, implicating DNA methylation as a potential epigenetic process for K19 expression. After excluding HCCs with recurrence, TNM stage as IIIB or greater, preoperative therapy, transplantation, and combined hepatocellular cholangiocarcinoma, we assessed 125 of 564 HCC cases. In this cohort, K19 expression was found in 29 HCCs (23.2%) and corresponded with poor survival following surgery (p = 0.025) and extrahepatic recurrence-free survival (p = 0.017). Compared with K19-deficient HCCs, lower KRT19 promoter methylation level was observed in K19-proficient HCCs (p < 0.0001). Conversely, HCC with genome-wide LINE-1 hypermethylation was frequently observed in K19-proficient HCCs (p = 0.0079). Additionally, K19 proficiency was associated with K7 proficiency (p = 0.043), and reduced E-cadherin and HepPar-1 expression (p = 0.043 and p < 0.0001, respectively). Conclusions: K19-proficient HCC exhibited poor prognosis owing to extrahepatic recurrence, with molecular signatures differing from those in conventional cancer stem cells, providing novel insights of the heterogeneity underlying tumor development.

DOI： 10.1159/000490806

Detection of circulating microRNAs with Ago2 complexes to monitor the tumor dynamics of colorectal cancer patients during chemotherapy. Reviewed International journal

Tomokazu Fuji, Yuzo Umeda, Akihiro Nyuya, Fumitaka Taniguchi, Takashi Kawai, Kazuya Yasui, Toshiaki Toshima, Kazuhiro Yoshida, Toshiyoshi Fujiwara, Ajay Goel, Takeshi Nagasaka

International journal of cancer 144 ( 9 ) 2169 - 2180 2019.5

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

Because of the different forms of circulating miRNAs in plasma, Argonaute2 (Ago2)-miRNAs and extracellular vesicles (EV-miRNAs), we examined the two forms of extracellular miRNAs in vitro and developed a unique methodology to detect circulating Ago2-miRNAs in small volumes of plasma. We demonstrated that Ago2-miR-21 could be released into the extracellular fluid by active export from viable cancer cells and cytolysis in vitro. As miR-21 and miR-200c were abundantly expressed in both metastatic liver sites and primary lesions, we evaluated Ago2-miR-21 as a candidate biomarker of both active export and cytolysis while Ago2-miR-200c as a biomarker of cytolysis in plasma obtained from colorectal cancer (CRC) patients before treatment and in a series of plasma obtained from CRC patients with liver metastasis who received systemic chemotherapy. The measurement of Ago2-miR-21 allowed us to distinguish CRC patients from subjects without CRC. The trend in ΔCt values for Ago2-miR-21 and -200c during chemotherapy could predict tumor response to ongoing treatment. Thus, capturing circulating Ago2-miRNAs from active export can screen patients with tumor burdens, while capturing them from passive release by cytolysis can monitor tumor dynamics during chemotherapy treatment.

DOI： 10.1002/ijc.31960

膵腫瘍におけるゲノム解析-病態解明と臨床的意義包括的アプローチによる浸潤性膵管癌の非侵襲的診断技術の構築

吉田一博, 楳田祐三, 吉田龍一, 信岡大輔, 杭瀬崇, 藤智和, 安井和也, Goel Ajay, 八木孝仁, 藤原俊義

膵臓 33 ( 3 ) 360 - 360 2018.5

von Hippel-Lindau病に合併した膵NETの治療戦略

信岡大輔, 杭瀬崇, 楳田祐三, 吉田龍一, 吉田一博, 安井和也, 小西大輔, 岡林弘樹, 八木孝仁, 藤原俊義

膵臓 33 ( 3 ) 659 - 659 2018.5

Clinical outcomes of women with ovarian metastases of colorectal cancer treated with oophorectomy with respect to their somatic mutation profiles. Reviewed International journal

Yoshiko Mori, Akihiro Nyuya, Kazuya Yasui, Toshiaki Toshima, Takashi Kawai, Fumitaka Taniguchi, Keisuke Kimura, Ryo Inada, Masahiko Nishizaki, Junko Haraga, Keiichiro Nakamura, Yuzo Umeda, Hiroyuki Kishimoto, Toshiyoshi Fujiwara, Yosuke Katata, Yoshiyuki Yamaguchi, Takeshi Nagasaka

Oncotarget 9 ( 23 ) 16477 - 16488 2018.3

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

We clarified the clinical prevalence of ovarian metastases from colorectal cancers (CRCs) in 296 female patients with CRC and evaluated clinical outcomes with relation to their mutational profiles, such as BRAF/KRAS mutation and microsatellite instability (MSI) status. The female CRCs were categorised into three subsets: CRCs with ovarian metastases [6.4% (n = 19), 5-year overall survival (OS) = 24.7%], CRCs with extra-ovarian metastases only [32.4% (n = 96), 5-year OS = 34.5%] and CRCs without any recurrence or metastasis [61.2% (n = 181), 5-year OS = 91.3%]. All patients with ovarian metastases underwent oophorectomy; of these, 9 who received preoperative chemotherapy had measurable metastases to extra-ovarian sites and the ovaries. Although 5 of 9 (56%) achieved partial response or complete response at extra-ovarian sites, no patient archived objective response at ovarian sites. Regarding the mutation profiles, in CRCs with extra-ovarian metastases only, the median survival time (MST) after initial treatments to progression to stage IV or recurrence was 13 [95% confidence interval (CI): 7-16 months] in BRAF-mutant and 34 months (95% CI: 22-58 months) in BRAF wild-type (P = 0.0033). Although ovarian metastases demonstrated poor response to systemic chemotherapy in CRCs with ovarian metastases, the MST after initial treatments to progression to stage IV or recurrence was 22 (95% CI: 21-25 months) in BRAF-mutant and 38 months (95% CI: 24-42 months) in BRAF wild-type (P = 0.0398). The outcomes of patients with ovarian metastases could be improved by oophorectomy regardless of their mutation profiles.

DOI： 10.18632/oncotarget.24735

Ovarian metastasectomy in colorectal cancer may improve the clinical outcomes of patients with metastatic colorectal cancer regardless of BRAF or KRAS mutational profiles

Mori Yoshiko, Nagasaka Takeshi, Tanioka Hiroaki, Nyuya Akihiro, Kawai Takashi, Toshima Toshiaki, Yasui Kazuya, Shigeyasu Kunitoshi, Kishimoto Hiroyuki, Umeda Yuzo, Fujiwara Toshiyoshi

ANNALS OF ONCOLOGY 28 2017.6

Stage IV大腸癌に対するPrecision Medicineの構築

河合毅, 永坂岳司, 母里淑子, 楳田祐三, 稲田涼, 谷口文崇, 安井和也, 戸嶋俊明, 岸本浩行, 藤原俊義

日本外科学会定期学術集会抄録集 117回 SF - 1 2017.4

上縦隔リンパ節転移を切除した肝外胆管癌の1例

石川亘, 片岡正文, 仁熊健文, 三村太亮, 安井和也, 児島亨

日本臨床外科学会雑誌 77 ( 11 ) 2760 - 2763 2016.11

Language：Japanese Publisher：日本臨床外科学会

症例は76歳,男性.2007年7月に肝外胆管癌の診断で肝拡大左葉切除,肝尾状葉切除,胆管切除,門脈合併切除を施行し,病理診断は胆管細胞癌,T3N0M0,StageIIIであった.術後補助化学療法としてgemcitabineを投与した.13ヵ月後に胸骨後部下部前縦隔リンパ節転移に対し摘出術を施行した.術後TS-1 100mgを投与し経過観察中,上縦隔に12×16mm大の腫大したリンパ節を認めた.徐々に増大傾向を示し,PET-CTでFDGの異常集積(SUVmax=4.57)を認め,その他の部位に転移の所見を認めなかったため,初回手術より23ヵ月後,上縦隔リンパ節転移に対して胸腔鏡補助下縦隔リンパ節郭清を施行した.術後TS-1の投与を継続したが,17ヵ月後に腹膜播種,肝転移再発をきたし初回手術より46ヵ月,2回目のリンパ節転移切除より23ヵ月目に死亡した.予後が極めて不良である胆管細胞癌縦隔リンパ節転移に対し二度の外科的切除を施行し,比較的長期の予後が得られた症例を経験した.肝外胆管癌の遠隔転移病変に対する標準的な治療法は,現段階では確立されていないため,本症例のように再発性孤立性リンパ節転移症例に対して他病変がみられない場合は,外科的切除が一つの有効な治療になりうると考えられる.(著者抄録)

胆道胆道がんの手術療法肝内胆管癌に対する外科治療リンパ節郭清の意義

楳田祐三, 八木孝仁, 永坂岳司, 篠浦先, 吉田龍一, 信岡大輔, 渡辺信之, 藤智和, 安井和也, 藤原俊義

日本癌治療学会学術集会抄録集 54回 WS40 - 1 2016.10

転移性大腸癌における治療標的となりうるマイクロRNAの同定

河合毅, 永坂岳司, 藤智和, 戸嶋俊明, 安井和也, 母里淑子, 藤原俊義

日本癌学会総会記事 75回 P - 1273 2016.10

IDH1/2およびKRAS遺伝子の変異ステータスによる肝内胆管癌の層別化

安井和也, 永坂岳司, 楳田祐三, 藤智和, 戸嶋俊明, 河合毅, 母里淑子, 八木孝仁, 藤原俊義

日本癌学会総会記事 75回 P - 1306 2016.10

circulating cell free DNAのメチル化解析による大腸癌化学療法の治療効果判定の診断

戸嶋俊明, 永坂岳司, 木村圭佑, 安井和也, 河合毅, 母里淑子, 藤原俊義

日本癌学会総会記事 75回 P - 1071 2016.10

膵癌切除症例における免疫チェックポイント分子の発現解析膵癌切除例とTCGA dataを対象とした免疫チェックポイント機構の解析

藤智和, 楳田祐三, 永坂岳司, 母里淑子, 谷口文崇, 安井和也, 河合毅, 八木孝仁, 藤原俊義

日本外科学会定期学術集会抄録集 116回 OP - 1 2016.4

術前内照射および化学療法が著効し、根治切除し得た巨大異所性褐色細胞腫の1例

安井和也, 楳田祐三, 熊野健二郎, 田端雅弘, 大塚文男, 八木孝仁, 藤原俊義

岡山医学会雑誌 127 ( 3 ) 213 - 218 2015.12

Language：Japanese Publisher：岡山医学会

症例は46歳男性で、健診で便潜血陽性を指摘され、上下部内視鏡検査で大腸ポリープが散在するのみで腫瘍性病変は指摘できず、腹部CTで大動脈右側に14cm大の後腹膜腫瘍を認めた。血圧166/96mmHg、脈拍68回/分・整で、腫瘤は触れず、血液生化学検査・甲状腺機能に異常なかった。腫瘍マーカーはCEA 4.6ng/ml、CA19-9 9.2U/ml、AFP 7.8ng/ml、PIVKA-II 31AU/mlでいずれも正常範囲であった。血液中ノルアドレナリンは12.4ng/mlと上昇し、ドーパミン値も24.0ng/mlと高値、血液中アドレナリン値は0.04ng/mlと正常であった。腹部造影CTで右横隔膜下から右腎下極にかけ比較的境界明瞭な14×12×7cmの腫瘤が存在し、造影早期より強く濃染され、腫瘍内部は壊死像を呈した。下大静脈を右側に圧排し、膵臓を腹側に圧排していた。門脈は狭小化し、側副血行路が発達していた。131I-MIGBシンチグラフィーでCTで指摘された腫瘤に一致し集積が亢進していた。遠隔転移を疑う他部位への集積はみられなかった。異所性褐色細胞腫と診断し、根治切除について検討したが、肝臓や十二指腸、膵頭部上腸間膜動脈周囲、さらに右腎動脈などの合併切除を要する可能性があるため、根治切除は不可能と判断し、腫瘍の縮小による根治切除の可能性について検討し、131I-MIGB内照射療法を施行した。CTで軽度縮小効果は得られたが血中アドレナリン値上昇傾向であったため内照射療法を終了し化学療法(CVD療法)を行った。腫瘍の縮小に伴い血中カテコールアミン値も減少した。根治切除を目的に手術を施行した。右斜胸腹部切開で開腹し、腫瘍は肝十二指腸間膜や十二指腸下行脚を圧排して存在していた。術後経過は良好で術後23日目に退院し、術後10ヵ月、降圧薬を使用せず血圧は正常範囲で推移し、血液中ノルアドレナリン値も正常値に改善し再発なく経過している。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00175&link_issn=&doc_id=20151221140005&doc_link_id=10.4044%2Fjoma.127.213&url=https%3A%2F%2Fdoi.org%2F10.4044%2Fjoma.127.213&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

血中のcirculating cell-freeDNAのメチル化検出による大腸癌の同定

戸嶋俊明, 永坂岳司, 河合毅, 藤智和, 谷口文崇, 木村圭佑, 安井和也, 母里淑子, 藤原俊義

日本癌学会総会記事 74回 P - 2007 2015.10

膵嚢胞性疾患の治療方針遺伝子変異解析によるIPMN悪性度診断の新展開

安井和也, 楳田祐三, 永坂岳司, 吉田一博, 藤智和, 篠浦先, 吉田龍一, 信岡大輔, 杭瀬崇, 八木孝仁, 藤原俊義

日本肝胆膵外科学会・学術集会プログラム・抄録集 27回 387 - 387 2015.6

さまざまなアプローチで救命しえた十二指腸遠位部憩室出血の1例 Reviewed

安井和也, 高嶌寛年

日本腹部救急医学会雑誌 35 ( 3 ) 315 - 319 2015.3

Language：Japanese Publisher：(一社)日本腹部救急医学会

症例は85歳,女性。吐下血を主訴に上部消化管内視鏡検査を施行したが,十二指腸第2部まで明らかな出血源を認めなかった。次第に出血性ショックとなり腹部造影CTを施行した。十二指腸第4部に造影剤漏出を認め,経カテーテル的動脈塞栓術を選択し止血を得た。数時間後腹部膨満が増強しCTで再出血および穿孔を疑われ緊急手術を施行した。十二指腸第4部の憩室には出血部位が存在せず,口側の第3部憩室から出血を認めたため憩室縫縮術を施行した。第4部憩室は狭窄を危惧し無処置とした。術後12日目に急激な貧血の進行を認めたため上部消化管内視鏡検査を施行した。第4部の憩室内露出血管が存在し,内視鏡的クリッピングで止血を得ることができた。その後再出血なく経過した。十二指腸遠位部の憩室出血に対し,さまざまな止血アプローチを行い治療した。循環動態や憩室の存在部位に応じて,手術や動脈塞栓術も念頭に置いて治療する必要があると考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J02824&link_issn=&doc_id=20150420590024&doc_link_id=10.11231%2Fjaem.35.315&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.35.315&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Genetic and epigenetic alterations of netrin-1 receptors in gastric cancer with chromosomal instability. Reviewed International journal

Keisuke Toda, Takeshi Nagasaka, Yuzo Umeda, Takehiro Tanaka, Takashi Kawai, Tomokazu Fuji, Fumitaka Taniguchi, Kazuya Yasui, Nobuhito Kubota, Yuko Takehara, Hiroshi Tazawa, Shunsuke Kagawa, Dong-Sheng Sun, Naoshi Nishida, Ajay Goel, Toshiyoshi Fujiwara

Clinical epigenetics 7 ( 1 ) 73 - 73 2015

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

BACKGROUND: The gene expressions of netrin-1 dependence receptors, DCC and UNC5C, are frequently downregulated in many cancers. We hypothesized that downregulation of DCC and UNC5C has an important growth regulatory function in gastric tumorigenesis. RESULTS: In the present study, a series of genetic and epigenetic analyses for DCC and UNC5C were performed in a Japanese cohort of 98 sporadic gastric cancers and corresponding normal gastric mucosa specimens. Loss of heterozygosity (LOH) analyses and microsatellite instability (MSI) analysis was applied to determine chromosomal instability (CIN) and MSI phenotypes, respectively. More than 5 % methylation in the DCC and UNC5C promoters were found in 45 % (44/98) and 32 % (31/98) gastric cancers, respectively, and in 9 % (9/105) and 5 % (5/105) normal gastric mucosa, respectively. Overall, 70 % (58 of 83 informative cases) and 51 % (40 of 79 informative cases) of gastric cancers harbored either LOH or aberrant methylation in the DCC and UNC5C genes, respectively. In total, 77 % (51 of 66 informative cases) of gastric cancers showed cumulative defects in these two dependence receptors and were significantly associated with chromosomal instability. Both DCC and UNC5C were inactivated in 97 % of CIN-positive gastric cancers and in 55 % of CIN-negative gastric cancers. CONCLUSIONS: Defect in netrin receptors is a common feature in gastric cancers. DCC alterations are apparent in the early stages, and UNC5C alterations escalate with the progression of the disease, suggesting that the cumulative alterations of netrin-1 receptors was a late event in gastric cancer progression and emphasizing the importance of this growth regulatory pathway in gastric carcinogenesis.

DOI： 10.1186/s13148-015-0096-y

魚骨と考えられる気管支異物による肺放線菌症の1例 Reviewed

安井和也, 松浦求樹, 高嶌寛年

日本臨床外科学会雑誌 75 ( 10 ) 2722 - 2726 2014.10

Language：Japanese Publisher：日本臨床外科学会

症例は74歳,男性.健診で肝臓の異常を指摘され施行したCTで右肺下葉S10に石灰化を伴う結節影を認めた.気管支鏡など精査を希望されなかったため,定期的にCTで経過を観察していたが変化は認めなかった.初診から2年後のCTで陰影の増大傾向を認めた.悪性疾患の可能性が否定できないため気管支鏡を施行したが確定診断は得られなかった.診断加療目的に胸腔鏡補助下右S7+10区域切除を施行した.結節中心部に魚骨と思われる異物と少量の膿が存在しており,培養結果でActinomycesが検出された.病理結果で気管支拡張と内部に菌塊を認め気管支異物による肺放線菌症と診断した.異物誤嚥の既往は明らかでなかった.誤嚥歴は明らかでなくても限局性の陰影や気管支壁内病変,内部の高吸収域の陰影などは気管支異物を鑑別することが重要であり,異物に伴った肺放線菌症の合併にも留意することが必要であると考えられた.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J03156&link_issn=&doc_id=20141107150010&doc_link_id=10.3919%2Fjjsa.75.2722&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.75.2722&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

進行胃癌に対して抗癌剤治療を導入した透析患者の1例 Reviewed

柳川泉一郎, 安井和也, 西谷正史, 高嶌寛年

広島医学 67 ( 10 ) 699 - 702 2014.10

Language：Japanese Publisher：広島医学会

75歳男。食思不振を主訴とした。腹膜透析および血液透析を併用中であり、血液検査では腎機能障害のほか高CEA血症を認めた。上部消化管内視鏡検査では胃噴門小彎側に3型腫瘍を認め、一部は下部食道に突出していた。CTでは肺に多発転移を認めた。腫瘍による通過障害を認めたため、胃全摘術・リンパ節郭清D1、胆嚢摘出術、腹膜透析チューブ抜去術、腸瘻造設術を施行し、術後は抗癌剤(CPT-11/CDDP)治療を開始した。薬剤投与はCPT-11を50mg/CDDPを50mgとし、10%増減の微調整を適宜行い5コース目までGrade3以上の有害事象を認めなかった。6コース目に好中球減少を認めたがG-CSF製剤で対処可能であり、8コース目まで継続した。再び食欲不振と好中球減少を認めたため、抗癌剤を中止したが、その後急激にCEA値が上昇し、抗癌剤導入後8ヵ月で死亡した。

大腸癌腹膜播種症例の予後に関する検討

丸山昌伸, 赤在義浩, 新田泰樹, 河本洋伸, 安井和也, 安原功, 須井健太, 児島亨, 木村臣一, 仁熊健文, 西山宣孝, 筒井信正, 三村哲重, 木村秀幸, 大原利憲

日本大腸肛門病学会雑誌 66 ( 2 ) 141 - 141 2013.2

当科における膵空腸吻合術手技と組織補強剤使用の効果について

児島亨, 仁熊健文, 丸山昌伸, 須井健太, 安原功, 安井和也, 三村哲重

日本肝胆膵外科学会・学術集会プログラム・抄録集 24回 287 - 287 2012.5

肝Mucinous cystic neoplasm(MCN)の1例

安井和也, 安原功, 須井健太, 児島亨, 丸山昌伸, 仁熊健文, 三村哲重

日本肝胆膵外科学会・学術集会プログラム・抄録集 24回 414 - 414 2012.5

乳癌同時性大腸転移切除後長期生存の1例

安井和也, 西山宜孝, 木村秀幸, 宮木功次

日本臨床外科学会雑誌 72 ( 増刊 ) 736 - 736 2011.10

先天性胆道拡張症に合併した胆管癌に対して肝左三区域切除幽門輪温存膵頭十二指腸切除術を施行した一例

井筒将斗, 仁熊健文, 安井和也, 石川亘, 児島亨, 三村哲重

岡山医学会雑誌 123 ( 2 ) 168 - 168 2011.8

縦隔気腫,後腹膜気腫,皮下気腫をきたしたS状結腸捻転穿孔の1例

丸山昌伸, 岡田剛, 安井和也, 三村哲重

日本臨床外科学会雑誌 71 ( 11 ) 2896 - 2901 2010.11

Language：Japanese Publisher：日本臨床外科学会

症例は80歳,男性.腹痛を主訴に受診した.腹部は著明に膨隆していた.腹部X線写真では,S状結腸の著明な拡張と多量の腸管ガス像を認め,胸部X線写真では縦隔にも気腫を認めた.胸腹部CT検査で,S状結腸の捻転と後腹膜気腫,縦隔気腫,皮下気腫が明らかになった.S状結腸捻転症による結腸穿孔の診断で緊急手術を施行した.捻転したS状結腸は虚血壊死をきたし腸間膜側で穿孔していた.S状結腸を切除し,人工肛門を造設した.術後46日に軽快退院した.本邦で縦隔気腫をともなう大腸穿孔は9例の報告があるのみである.広範な気腫を形成したS状結腸捻転穿孔症例を経験したので若干の文献的考察を加えて報告する.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J03156&link_issn=&doc_id=20101209210025&doc_link_id=10.3919%2Fjjsa.71.2896&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.71.2896&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

胃癌術後にリンパ節再発が疑われた後腹膜デスモイド腫瘍の1例

稲葉基高, 高畑隆臣, 木村臣一, 安井和也, 前田直見

日本消化器外科学会雑誌 43 ( Suppl.2 ) 236 - 236 2010.10

膵の縮小手術脾温存膵全摘十二指腸切除の適応

三村哲重, 仁熊健文, 児島亨, 石川亘, 安井和也

日本臨床外科学会雑誌 71 ( 増刊 ) 464 - 464 2010.10

腹腔動脈に浸潤した浸潤性膵管癌に対し術前化学療法が奏効し根治切除しえた1例

安井和也, 仁熊健文, 石川亘, 三村哲重

日本消化器外科学会総会 65回 173 - 173 2010.7

胆管内腫瘍栓を繰り返し、切除を行った肝細胞癌の一例

安井和也, 仁熊健文, 石川亘, 保田紘一郎, 三村哲重

岡山医学会雑誌 122 ( 1 ) 87 - 87 2010.4

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