Researcher Profile and Settings

Master

Affiliation (Master)

• Faculty of Medicine　Surgery　Surgery

Affiliation (Master)

• Faculty of Medicine　Surgery　Surgery

researchmap

Profile and Settings

Profile and Settings

• Name (Japanese)

  Hirano

• Name (Kana)

  Satoshi

• Name

  200901095619375164

Alternate Names

http://surg2-hokudai.jp/
http://www.med.hokudai.ac.jp/~surg-2w/

Achievement

Research Interests

• 消化器外科学   外科学一般   Surgical Therapeutics   Surgical Diagnostics   Surgical Oncology   

Research Areas

• Life sciences / Digestive surgery / pancreatobiliary surgery
• Life sciences / Digestive surgery
• Life sciences / General surgery, pediatric surgery

Published Papers

• The relationship between perioperative central venous oxygen saturation and postoperative complications in highly invasive gastroenterological surgery.

  Dai Miyazaki, Toshiaki Shichinohe, Yusuke Watanabe, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Yo Kurashima, Yuma Ebihara, Soichi Murakami, Satoshi Hirano

  Annals of gastroenterological surgery 8 (4) 660 - 667 2024/07 

  PURPOSE: Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after these surgeries is high, which affects the postoperative course and mortality. In patients who undergo these types of surgeries, continuous monitoring of the perioperative central venous oxygen saturation (ScvO2) is possible via a central venous catheter. We aimed to investigate the relationship between continuously monitored perioperative ScvO2 values and postoperative complications. METHODS: The medical records of 115 patients who underwent highly invasive gastroenterological surgeries and ScvO2 monitoring from April 2012 to March 2014 were analyzed. Sixty patients met the inclusion criteria, and their ScvO2 levels were continuously monitored perioperatively. The relationship between ScvO2 levels and major postoperative complications, defined as Clavien-Dindo grade ≥ III, was examined using uni- and multivariate analysis. RESULTS: Thirty patients developed major postoperative complications. The adequate cut-off value derived from receiver operating curves of the postoperative average ScvO2 levels for predicting major complications was 75%. Multivariate analysis revealed that low average postoperative ScvO2 levels (p = 0.016) and blood loss ≥ 1000 mL (p = 0.039) were significant predictors of major postoperative complications. CONCLUSIONS: Low perioperative ScvO2 values were associated with an increased risk of major postoperative complications. Continuous ScvO2 monitoring will help prevent postoperative complications.
• Preoperative risk factors for skeletal muscle mass loss in patients with biliary tract cancer

  Ryo Sugiura, Masaki Kuwatani, Kazumichi Kawakubo, Kazuma Kishi, Hiroki Yonemura, Shunichiro Nozawa, Masatsugu Ohara, Takehiro Noji, Satoshi Hirano, Naoya Sakamoto

  Journal of Hepato-Biliary-Pancreatic Sciences 1868-6974 2024/06/06 

  Abstract Background Endoscopic retrograde cholangiography (ERC)‐related procedures, usually performed before biliary tract cancer (BTC) surgery, are associated with increased risk for various complications, which can cause sarcopenia. No study has previously elucidated the relationship between preoperative ERC‐related procedures and sarcopenia/skeletal muscle mass loss. Methods Patients with BTC who underwent radical surgical resection following ERC‐related procedures were included. Skeletal muscle mass was evaluated using the psoas muscle mass index (PMI), which was determined using computed tomography images, and the change in PMI before the initial pre‐ERC and surgery (ΔPMI) was calculated. Risk factors for advanced skeletal muscle mass loss, defined as a large ΔPMI, were evaluated. Results The study cohort included 90 patients with a median age of 72 (interquartile range, 65–75) years. The median PMI pre‐ERC and surgery was 4.40 and 4.15 cm²/m², respectively (p < .01). The median ΔPMI was −6.2% (interquartile range, −10.9% to 0.5%). By multivariate analysis, post‐ERC pancreatitis and cholangitis before surgery were independent predictive factors for large PMI loss (odds ratio, 4.57 and 3.18, respectively; p = .03 and p = .02, respectively). Conclusions Skeletal muscle mass decreases preoperatively in most patients with BTC undergoing ERC. Post‐ERC pancreatitis and cholangitis before surgery were independent risk factors for large skeletal muscle mass loss.
• Clinical practice guidelines for telesurgery 2022

  Masaki Mori, Satoshi Hirano, Kenichi Hakamada, Eiji Oki, Shigeo Urushidani, Ichiro Uyama, Masatoshi Eto, Yuma Ebihara, Kenji Kawashima, Takahiro Kanno, Masaru Kitsuregawa, Yusuke Kinugasa, Junjiro Kobayashi, Hiroshige Nakamura, Hirokazu Noshiro, Masaki Mandai, Hajime Morohashi

  Surgery Today 0941-1291 2024/06/03 

  Abstract Telesurgery is expected to improve medical access in areas with limited resources, facilitate the rapid dissemination of new surgical procedures, and advance surgical education. While previously hindered by communication delays and costs, recent advancements in information technology and the emergence of new surgical robots have created an environment conducive to societal implementation. In Japan, the legal framework established in 2019 allows for remote surgical support under the supervision of an actual surgeon. The Japan Surgical Society led a collaborative effort, involving various stakeholders, to conduct social verification experiments using telesurgery, resulting in the development of a Japanese version of the “Telesurgery Guidelines” in June 2022. These guidelines outline requirements for medical teams, communication environments, robotic systems, and security measures for communication lines, as well as responsibility allocation, cost burden, and the handling of adverse events during telesurgery. In addition, they address telementoring and full telesurgery. The guidelines are expected to be revised as needed, based on the utilization of telesurgery, advancements in surgical robots, and improvements in information technology.
• Aldehyde Dehydrogenese-1 High Cancer Stem-like Cells/Cancer-initiating Cells Escape from Cytotoxic T Lymphocytes due to Lower Expression of Human Leukocyte Antigen Class 1.

  Tomohide Shirosaki, Noriko Kawai, Yuma Ebihara, Aiko Murai, Terufumi Kubo, Rena Morita, Kenji Murata, Takayuki Kanaseki, Tomohide Tsukahara, Toshiaki Shichinohe, Yoshihiko Hirohashi, Satoshi Hirano, Toshihiko Torigoe

  Anticancer research 44 (5) 1877 - 1883 2024/05 

  BACKGROUND/AIM: Human gastric cancer stem-like cells (CSCs)/cancer-initiating cells can be identified as aldehyde dehydrogenase-high (ALDHhigh) cells. Cancer immunotherapy employing immune checkpoint blockade has been approved for advanced gastric cancer cases. However, the effectiveness of cancer immunotherapy against gastric CSCs/CICs remains unclear. This study aimed to investigate the susceptibility of gastric CSCs/CICs to immunotherapy. MATERIALS AND METHODS: Gastric CSCs/CICs were isolated as ALDHhigh cells using the human gastric cancer cell line, MKN-45. ALDHhigh clone cells and ALDHlow clone cells were isolated using the ALDEFLUOR assay. ALDH1A1 expression was assessed via qRT-PCR. Sphere-forming ability was evaluated to confirm the presence of CSCs/CICs. A model neoantigen, AP2S1, was over-expressed in ALDHhigh clone cells and ALDHlow clone cells, and susceptibility to AP2S1-specific TCR-T cells was assessed using IFNγ ELISPOT assay. RESULTS: Three ALDHhigh clone cells were isolated from MKN-45 cells. ALDHhigh clone cells exhibited a stable phenotype in in vitro culture for more than 2 months. The High-36 clone cells demonstrated the highest sphere-forming ability, whereas the Low-8 cells showed the lowest sphere-forming ability. High-36 cells exhibited lower expression of HLA-A24 compared to Low-8 cells. TCR-T cells specific for AP2S1 showed lower reactivity to High-36 cells compared to Low-8 cells. CONCLUSION: High-36 cells and Low-8 cells represent novel gastric CSCs/CICs and non-CSCs/CICs, respectively. ALDHhigh CSCs/CICs evade T cells due to lower expression of HLA class 1.
• 当院において経皮経脾静脈アプローチによるIVRを施行した2例

  高柳 歩, 阿保 大介, 森田 亮, 高橋 文也, 木野田 直也, 加藤 大祐, 藤井 宝顕, 山崎 康之, 中西 喜嗣, 荘 拓也, 中井 正人, 平野 聡, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 39 (Suppl.) 304 - 304 1340-4520 2024/04
• 冷凍倉庫内で受傷した腹部骨盤腔外傷,低体温症,そして凝固破綻 救えなかったか?

  村上 壮一, 和田 剛志, 方波見 謙一, 高岡 憲敬, 林 真理子, 三浦 巧, 海老原 裕磨, 倉島 庸, 七戸 俊明, 平野 聡

  日本外傷学会雑誌 (一社)日本外傷学会 38 (2) 227 - 227 1340-6264 2024/04
• Development of a simulator and training curriculum for liver trauma surgery training for general surgeons

  Hiroyasu Tojima, Soichi Murakami, Saseem Poudel, Yo Kurashima, Toshimichi Asano, Takehiro Noji, Kazufumi Okada, Yoichi M. Ito, Hiroyuki Kaneko, Yoshimitsu Izawa, Hiroshi Homma, Satoshi Hirano

  Global Surgical Education - Journal of the Association for Surgical Education 3 (1) 2024/03/17
• Tele‐robotic distal gastrectomy with lymph node dissection on a cadaver

  Yuma Ebihara, Satoshi Hirano, Yo Kurashima, Hironobu Takano, Kunishige Okamura, Soichi Murakami, Toshiaki Shichinohe, Hajime Morohashi, Eiji Oki, Kenichi Hakamada, Norihiko Ikeda, Masaki Mori

  Asian Journal of Endoscopic Surgery 2024/01
• SSPPD後の胆管空腸吻合部閉塞に対するsharp recanalizationによる内外瘻化

  岡村 実幸, 阿保 大介, 森田 亮, 松井 あや, 木野田 直也, 加藤 大祐, 藤井 宝顕, 山崎 康之, 高柳 歩, 若林 直人, 平野 聡, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 38 (3) 221 - 221 1340-4520 2024/01
• The Short- and Long-Term Surgical Results of Consecutive Hepatopancreaticoduodenectomy for Wide-Spread Biliary Malignancy

  Yasunori Yoshimi, Takehiro Noji, Keisuke Okamura, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Yasuyuki Kawamoto, Kazuaki Harada, Kanako Fuyama, Kazuhumi Okada, Satoshi Hirano

  Annals of Surgical Oncology 1068-9265 2023/10/29
• Insights from managing clinical issues in distal pancreatectomy with en bloc coeliac axis resection: experiences from 626 patients.

  Toru Nakamura, Ken-Ichi Okada, Masayuki Ohtsuka, Ryota Higuchi, Hidenori Takahashi, Kazuyuki Nagai, Michiaki Unno, Yoshiaki Murakami, Atsushi Oba, Moriaki Tomikawa, Atsushi Kato, Akihiko Horiguchi, Masafumi Nakamura, Shintaro Yagi, Sohei Satoi, Itaru Endo, Ryosuke Amano, Ippei Matsumoto, Yoichi M Ito, Takukazu Nagakawa, Satoshi Hirano

  The British journal of surgery 110 (10) 1387 - 1394 2023/09/06 

  BACKGROUND: Distal pancreatectomy with en bloc coeliac axis resection (DP-CAR) for pancreatic body cancer has been reported increasingly. However, its large-scale outcomes remain undocumented. This study aimed to evaluate DP-CAR volume and mortality, preoperative arterial embolization for ischaemic gastropathy, the oncological benefit for resectable tumours close to the bifurcation of the splenic artery and coeliac artery using propensity score matching, and prognostic factors in DP-CAR. METHODS: In a multi-institutional analysis, 626 DP-CARs were analysed retrospectively and compared with 1325 distal pancreatectomies undertaken in the same interval. RESULTS: Ninety-day mortality was observed in 7 of 21 high-volume centres (1 or more DP-CARs per year) and 1 of 41 low-volume centres (OR 20.00, 95 per cent c.i. 2.26 to 177.26). The incidence of ischaemic gastropathy was 19.2 per cent in the embolization group and 7.9 per cent in the no-embolization group (OR 2.77, 1.48 to 5.19). Propensity score matching analysis showed that median overall survival was 33.5 (95 per cent c.i. 27.4 to 42.0) months in the DP-CAR and 37.9 (32.8 to 53.3) months in the DP group. Multivariable analysis identified age at least 67 years (HR 1.40, 95 per cent c.i. 1.12 to 1.75), preoperative tumour size 30 mm or more (HR 1.42, 1.12 to 1.80), and preoperative carbohydrate antigen 19-9 level over 37 units/ml (HR 1.43, 1.11 to 1.83) as adverse prognostic factors. CONCLUSION: DP-CAR can be performed safely in centres for general pancreatic surgery regardless of DP-CAR volume, and preoperative embolization may not be required. This procedure has no oncological advantage for resectable tumour close to the bifurcation of the splenic artery, and should be performed after appropriate patient selection.
• ARF6-AMAP1経路は免疫抑制性ケモカインの発現を誘導し、免疫回避に有利に機能する(ARF6-AMAP1 pathway is linked to induction of immunosuppressive chemokine expression for favor immune evasion)

  橋本 あり, 半田 悠, 畑 宗一郎, 奥崎 大介, 麓 佳月, 蔦保 暁生, 西川 義浩, 児玉 裕三, 平野 聡, 橋本 茂, 佐邊 壽孝

  日本癌学会総会記事 82回 1922 - 1922 0546-0476 2023/09
• ARF6-AMAP1経路は免疫抑制性ケモカインの発現を誘導し、免疫回避に有利に機能する(ARF6-AMAP1 pathway is linked to induction of immunosuppressive chemokine expression for favor immune evasion)

  橋本 あり, 半田 悠, 畑 宗一郎, 奥崎 大介, 麓 佳月, 蔦保 暁生, 西川 義浩, 児玉 裕三, 平野 聡, 橋本 茂, 佐邊 壽孝

  日本癌学会総会記事 82回 1922 - 1922 0546-0476 2023/09
• Randomized phase II trial of chemoradiotherapy with S-1 versus combination chemotherapy with gemcitabine and S-1 as neoadjuvant treatment for resectable pancreatic cancer (JASPAC 04)

  Sugiura T, Toyama H, Fukutomi A, Asakura H, Takeda Y, Yamamoto K, Hirano S, Satoi S, Matsumoto I, Takahashi S, Morinaga S, Yoshida M, Sakuma Y, Iwamoto H, Shimizu Y, Uesaka K

  J Hepatobiliary Pancreat Sci. 2023/09 [Refereed][Not invited]
   

  OBJECTIVE: The aim of the present study was to investigate which treatment, neoadjuvant chemoradiotherapy (NAC-RT) with S-1 or combination neoadjuvant chemotherapy with gemcitabine and S-1 (NAC-GS), is more promising as neoadjuvant treatment (NAT) for resectable pancreatic cancer in terms of effectiveness and safety. METHODS: In the NAC-RT with S-1 group, the patients received a total radiation dose of 50.4 Gy in 28 fractions with oral S-1. In the NAC-GS group, the patients received intravenous gemcitabine at a dose of 1000 mg/m2 with oral S-1 for two cycles. The primary endpoint was the 2-year progression-free survival (PFS) rate. The trial was registered with the UMIN Clinical Trial Registry as UMIN000014894. RESULTS: From April 2014 to April 2017, a total of 103 patients were enrolled. After exclusion of one patient because of ineligibility, 51 patients were included in the NAC-RT with S-1 group, and 51 patients were included in the NAC-GS group in the intention-to-treat analysis. The 2-year PFS rate was 45.0% (90% confidence interval [CI]: 33.3%-56.0%) in the NAC-RT with S-1 group and 54.9% (42.8%-65.5%) in the NAC-GS group (p = .350). The 2-year overall survival rate was 66.7% in the NAC-RT with S-1 group and 72.4% in the NAC-GS group (p = .300). Although leukopenia and neutropenia rates were significantly higher in the NAC-GS group than in the NAC-RT with S-1 group (p = .023 and p < .001), other adverse events of NAT and postoperative complications were comparable between the two groups. CONCLUSION: Both NAC-RT with S-1 and NAC-GS are considered promising treatments for resectable pancreatic cancer.
• ASO Visual Abstract: Predictors of Long-Term Survival in Pancreatic Ductal Adenocarcinoma After Pancreatectomy-TP53 and SMAD4 Mutation Scoring in Combination with CA19-9.

  Masato Ono, Yusuke Ono, Toru Nakamura, Takahiro Tsuchikawa, Tomotaka Kuraya, Shota Kuwabara, Yoshitsugu Nakanishi, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Yuma Ebihara, Yo Kurashima, Takehiro Noji, Soichi Murakami, Toshiaki Shichinohe, Tomoko Mitsuhashi, Yuko Omori, Toru Furukawa, Kenzui Taniue, Mayumi Suzuki, Ayumu Sugitani, Hidenori Karasaki, Yusuke Mizukami, Satoshi Hirano

  Annals of surgical oncology 30 (9) 5766 - 5767 2023/09
• Delphi Method Consensus-Based Identification of Primary Trauma Care Skills Required for General Surgeons in Japan

  Kazuyuki Hirose, Soichi Murakami, Yo Kurashima, Nagato Sato, Saseem Poudel, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yuma Ebihara, Toru Nakamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Kazufumi Okada, Isao Yokota, Naoto Hasegawa, Satoshi Hirano

  Journal of Acute Care Surgery 13 (2) 58 - 65 2288-5862 2023/07/31 

  Purpose: General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons.Methods: An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants.Results: There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1^st round, 85 specialists participated (response rate: 72.6%). In the 2^nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons.Conclusion: A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.
• 献体による手術トレーニングの立ち上げと運営のコツ-本邦の手術を今後も安全かつ世界最高水準で続けるために 北海道大学献体による外傷手術臨床解剖学的研究会C-BESTの発展と質の担保

  村上 壮一, 七戸 俊明, 倉島 庸, 東嶋 宏泰, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 本間 宙, 平野 聡

  医学教育 (一社)日本医学教育学会 54 (Suppl.) 70 - 70 0386-9644 2023/07
• Drosophila Screening Identifies Dual Inhibition of MEK and AURKB as an Effective Therapy for Pancreatic Ductal Adenocarcinoma

  Sho Sekiya, Junki Fukuda, Ryodai Yamamura, Takako Ooshio, Yusuke Satoh, Shinya Kosuge, Reo Sato, Kanako C. Hatanaka, Yutaka Hatanaka, Tomoko Mitsuhashi, Toru Nakamura, Yoshihiro Matsuno, Satoshi Hirano, Masahiro Sonoshita

  Cancer Research OF1 - OF12 0008-5472 2023/06/28 

  Abstract Significant progress has been made in understanding the pathogenesis of pancreatic ductal adenocarcinoma (PDAC) by generating and using murine models. To accelerate drug discovery by identifying novel therapeutic targets on a systemic level, here we generated a Drosophila model mimicking the genetic signature in PDAC (KRAS, TP53, CDKN2A, and SMAD4 alterations), which is associated with the worst prognosis in patients. The ‘4-hit’ flies displayed epithelial transformation and decreased survival. Comprehensive genetic screening of their entire kinome revealed kinases including MEK and AURKB as therapeutic targets. Consistently, a combination of the MEK inhibitor trametinib and the AURKB inhibitor BI-831266 suppressed the growth of human PDAC xenografts in mice. In patients with PDAC, the activity of AURKB was associated with poor prognosis. This fly-based platform provides an efficient whole-body approach that complements current methods for identifying therapeutic targets in PDAC. Significance: Development of a Drosophila model mimicking genetic alterations in human pancreatic ductal adenocarcinoma provides a tool for genetic screening that identifies MEK and AURKB inhibition as a potential treatment strategy.
• 【切除不能胆道癌:定義・診断・治療】局所(解剖学的)因子からみた切除不能の定義 肝門部領域胆管癌

  和田 雅孝, 中西 喜嗣, 野路 武寛, 松井 あや, 田中 公貴, 武内 慎太郎, 浅野 賢道, 中村 透, 平野 聡

  胆と膵 医学図書出版(株) 44 (6) 495 - 499 0388-9408 2023/06 

  肝門部領域胆管癌に対する根治的治療法は外科的切除のみであるため,可能な限り外科的切除の可能性を追求しているのが現状である。肝門部領域胆管癌における手術適応の一般的条件は,明らかな遠隔転移を認めないことはもちろん,局所因子としては各切除断端に癌遺残を認めないR0切除が可能であり,かつ合併切除された脈管の再建が技術的に可能であることの二つである。胆管水平方向では,患者要因によって規定される最大肝切除の胆管分離限界点が基準となり,これを超えて浸潤癌を認める場合には切除不能となる。門脈因子は,腫瘍進展が左右側肝切除時にそれぞれ後区域門脈分岐部,門脈臍部を越えるか否かが合併切除の可否を決める。肝動脈は合併切除再建が問題となる左側肝切除において後区域動脈への進展が再建可能な位置までであれば切除可能である。術前画像診断にはMDCTが多用されるが診断精度は不十分であるため,術中所見を含めて切除可能性を慎重に判断する必要がある。(著者抄録)
• The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan.

  Koya Hida, Satoshi Hirano, Saseem Poudel, Yo Kurashima, Dimitrios Stefanidis, Daisuke Hashimoto, Hirotoshi Akiyama, Susumu Eguchi, Toshihiro Fukui, Masaru Hagiwara, Tomoko Izaki, Shunsuke Kawamoto, Yasuhiro Otomo, Eishi Nagai, Hideki Takami, Yuko Takeda, Masakazu Toi, Hiroki Yamaue, Motofumi Yoshida, Shigetoshi Yoshida, Yasuhiro Kodera, Mitsue Saito

  Surgery today 2023/05/10 

  PURPOSE: Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. METHODS: The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. RESULTS: The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. CONCLUSION: Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.
• 【イラストで見る消化器癌手術アトラス】肝胆膵 腹腔動脈合併切除を伴う尾側膵切除術

  平野 聡, 中村 透, 浅野 賢道

  手術 金原出版(株) 77 (6) 961 - 967 0037-4423 2023/05
• 本邦における外傷センター構想 本邦の外傷診療システムは地域事情に即したHub & Spokesとすべきである

  村上 壮一, 東嶋 宏泰, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外傷学会雑誌 (一社)日本外傷学会 37 (2) 161 - 161 1340-6264 2023/05
• 腹部手術後門脈狭窄/閉塞に対する門脈ステント留置による血液検査データ変化に関する検討

  木野田 直也, 阿保 大介, 木村 輔, 作原 祐介, 藤井 宝顕, 加藤 大祐, 高橋 文也, 森田 亮, 折茂 達也, 柿坂 達彦, 中村 透, 平野 聡, 箕輪 和行, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 38 (Suppl.) 205 - 205 1340-4520 2023/04
• 肝左葉尾状葉切除術後の門脈狭窄、右肝動脈出血に対しstentgraft留置が奏功した一例

  村本 朋之, 阿保 大介, 森田 亮, 高橋 文也, 木野田 直也, 加藤 大祐, 藤井 宝顕, 田中 公貴, 中西 喜嗣, 野路 武寛, 平野 聡, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 38 (Suppl.) 205 - 205 1340-4520 2023/04
• 腹部手術後門脈狭窄/閉塞に対する門脈ステント留置による血液検査データ変化に関する検討

  木野田 直也, 阿保 大介, 木村 輔, 作原 祐介, 藤井 宝顕, 加藤 大祐, 高橋 文也, 森田 亮, 折茂 達也, 柿坂 達彦, 中村 透, 平野 聡, 箕輪 和行, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 38 (Suppl.) 205 - 205 1340-4520 2023/04
• 肝左葉尾状葉切除術後の門脈狭窄、右肝動脈出血に対しstentgraft留置が奏功した一例

  村本 朋之, 阿保 大介, 森田 亮, 高橋 文也, 木野田 直也, 加藤 大祐, 藤井 宝顕, 田中 公貴, 中西 喜嗣, 野路 武寛, 平野 聡, 工藤 與亮

  日本インターベンショナルラジオロジー学会雑誌 (一社)日本インターベンショナルラジオロジー学会 38 (Suppl.) 205 - 205 1340-4520 2023/04
• 肝門部胆管癌に対する拡大手術の定義と手技 肝門部胆管癌に対する三区域切除・動脈合併切除・肝膵同時切除術施行の妥当性の検討

  野路 武寛, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 SY - 6 2023/04
• 切除可能境界および局所進行切除不能膵癌における切除成績の検討

  浅野 賢道, 中村 透, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 SF - 5 2023/04
• 肝門部胆管癌に対する肝切除術後の胆汁漏に対する治癒課程からみたドレナージ治療戦略

  田中 公貴, 野路 武寛, 中西 喜嗣, 松井 あや, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 SF - 6 2023/04
• 膵頭十二指腸領域の内視鏡合併症に対するSurgical Rescueの取り組み

  村上 壮一, 東嶋 宏泰, 岡村 国茂, 和田 雅孝, 武内 慎太郎, 寺村 紘一, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 DP - 4 2023/04
• 膵癌治療中に経験した症候性椎体圧迫骨折の6例

  藤井 正和, 中村 透, 浅野 賢道, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 中西 喜嗣, 野路 武寛, 倉島 庸, 海老原 祐磨, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 DP - 7 2023/04
• 遠位肝外胆管癌のCT所見による術式選択の可能性

  中西 喜嗣, 野路 武寛, 土川 貴裕, 中村 透, 浅野 賢道, 松井 あや, 田中 公貴, 和田 雅孝, 寺村 紘一, 岡村 国茂, 武内 慎太郎, 村上 壮一, 海老原 裕磨, 倉島 庸, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 DP - 5 2023/04
• 膵頭十二指腸切除術後膵空腸吻合部結石の臨床的意義

  松井 あや, 武内 慎太郎, 和田 雅孝, 岡村 国茂, 寺村 紘一, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 DP - 8 2023/04
• 一般外科医のための腹部外傷手術シミュレーターおよびトレーニングプログラム開発

  東嶋 宏泰, 村上 壮一, 倉島 庸, サシーム・パウデル, 野路 武寛, 金古 裕之, 伊澤 祥光, 本間 宙, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 123回 SP - 6 2023/04
• Surgical skills assessment of pancreaticojejunostomy using a simulator may predict patient outcomes: A multicenter prospective observational study.

  Kenichi Mizunuma, Yo Kurashima, Saseem Poudel, Yusuke Watanabe, Takehiro Noji, Toru Nakamura, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgery 2023/03/30 

  BACKGROUND: Pancreatoduodenectomy, an advanced surgical procedure with a high complication rate, requires surgical skill in performing pancreaticojejunostomy, which correlates with operative outcomes. We aimed to analyze the correlation between pancreaticojejunostomy assessment conducted in a simulator environment and the operating room and patient clinical outcomes. METHODS: We recruited 30 surgeons (with different experience levels in pancreatoduodenectomy) from 11 institutes. Three trained blinded raters assessed the videos of the pancreaticojejunostomy procedure performed in the operating room using a simulator according to an objective structured assessment of technical skill and a newly developed pancreaticojejunostomy assessment scale. The correlations between the assessment score of the pancreaticojejunostomy performed in the operating room and using the simulator and between each assessment score and patient outcomes were calculated. The participants were also surveyed regarding various aspects of the simulator as a training tool. RESULTS: There was no correlation between the average score of the pancreaticojejunostomy performed in the operating room and that in the simulator environment (r = 0.047). Pancreaticojejunostomy scores using the simulator were significantly lower in patients with postoperative pancreatic fistula than in those without postoperative pancreatic fistula (P = .05). Multivariate analysis showed that pancreaticojejunostomy assessment scores were independent factors in postoperative pancreatic fistula (P = .09). The participants highly rated the simulator and considered that it had the potential to be used for training. CONCLUSION: There was no correlation between pancreaticojejunostomy surgical performance in the operating room and the simulation environment. Surgical skills evaluated in the simulation setting could predict patient surgical outcomes.
• CCR7 Mediates Cell Invasion and Migration in Extrahepatic Cholangiocarcinoma by Inducing Epithelial-Mesenchymal Transition.

  Mitsunobu Oba, Yoshitsugu Nakanishi, Tomoko Mitsuhashi, Katsunori Sasaki, Kanako C Hatanaka, Masako Sasaki, Ayae Nange, Asami Okumura, Mariko Hayashi, Yusuke Yoshida, Takeo Nitta, Takashi Ueno, Toru Yamada, Masato Ono, Shota Kuwabara, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Kimitaka Tanaka, Kiyoshi Takayama, Yutaka Hatanaka, Satoshi Hirano

  Cancers 15 (6) 2023/03/21 

  The epithelial-mesenchymal transition (EMT) contributes to the metastatic cascade in various tumors. C-C chemokine receptor 7 (CCR7) interacts with its ligand, chemokine (C-C motif) ligand 19 (CCL19), to promote EMT. However, the association between EMT and CCR7 in extrahepatic cholangiocarcinoma (EHCC) remains unknown. This study aimed to elucidate the prognostic impact of CCR7 expression and its association with clinicopathological features and EMT in EHCC. The association between CCR7 expression and clinicopathological features and EMT status was examined via the immunohistochemical staining of tumor sections from 181 patients with perihilar cholangiocarcinoma. This association was then investigated in TFK-1 and EGI-1 EHCC cell lines. High-grade CCR7 expression was significantly associated with a large number of tumor buds, low E-cadherin expression, and poor overall survival. TFK-1 showed CCR7 expression, and Western blotting revealed E-cadherin downregulation and vimentin upregulation in response to CCL19 treatment. The wound healing and Transwell invasion assays revealed that the activation of CCR7 by CCL19 enhanced the migration and invasion of TFK-1 cells, which were abrogated by a CCR7 antagonist. These results suggest that a high CCR7 expression is associated with an adverse postoperative prognosis via EMT induction and that CCR7 may be a potential target for adjuvant therapy in EHCC.
• 肝内胆管癌と胆嚢癌肉腫の衝突癌の1例

  内藤 善, 野路 武寛, 伊野 永隼, 郷 雅, 吉見 泰典, 武内 慎太郎, 岡村 国茂, 和田 雅孝, 寺村 紘一, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 中島 正人, 三橋 智子, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 132回・126回 67 - 67 2023/03
• 進行胆嚢癌に対する肝・膵切除術の妥当性

  野路 武寛, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 原田 一顕, 川本 泰之, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 132回・126回 67 - 67 2023/03
• 【血管再建を伴う高難度肝胆膵外科手術】動脈再建を伴う局所進行膵癌に対する腹腔動脈合併膵全摘術

  中村 透, 浅野 賢道, 篠原 良仁, 松井 あや, 田中 公貴, 中西 喜嗣, 野路 武寛, 土川 貴裕, 平野 聡

  外科 (株)南江堂 85 (2) 196 - 201 0016-593X 2023/02 

  ＜文献概要＞腹腔動脈浸潤を伴う膵癌における外科切除は,R0切除が可能と判断できる場合においてのみ許容される.本稿では,腹腔動脈合併膵全摘術(total pancreatectomy with en bloc celiac axis resection:TP-CAR)を遂行するにあたっての適応症例の選択,手術アプローチの基本,血行再建について概説する.
• ACSの新たな専門領域"Surgical Rescue"について考える Surgical RescueはAcute Care Surgeryの5本目の柱になり得るか?

  村上 壮一, 東嶋 宏泰, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本腹部救急医学会雑誌 (一社)日本腹部救急医学会 43 (2) 343 - 343 1340-2242 2023/02
• ライフル銃による外傷性脾損傷術後に遅発性腸管穿孔を来した1例

  内藤 善, 竹林 徹郎, 桑谷 俊彦, 佐野 海渡, 真名瀬 博人, 和田 雅孝, 寺村 紘一, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 祐磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本腹部救急医学会雑誌 (一社)日本腹部救急医学会 43 (2) 425 - 425 1340-2242 2023/02
• 慢性偽性腸閉塞を伴う全身性強皮症患者に発症した絞約性腸閉塞症の治療経験

  武田 真太郎, 村上 壮一, 東嶋 宏泰, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本腹部救急医学会雑誌 (一社)日本腹部救急医学会 43 (2) 473 - 473 1340-2242 2023/02
• Identification of antibody against wingless‑type MMTV integration site family member 7B as a biliary cancer tumor marker.

  Mizuna Takahashi, Takahiro Tsuchikawa, Takaki Hiwasa, Toru Nakamura, Koji Hontani, Toshihiro Kushibiki, Kazuho Inoko, Hironobu Takano, Yutaka Hatanaka, Kazuyuki Matsushita, Hisahiro Matsubara, Tyuji Hoshino, Masayuki Ohtsuka, Hideaki Shimada, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Oncology reports 49 (2) 2023/02 

  Biliary cancer has a poor prognosis due to a lack of specific biomarkers and difficulty in diagnosis. The present study aimed to identify serum tumor markers for the diagnosis of biliary cancer via serological identification of antigens by recombinant cDNA expression cloning. Wingless‑type MMTV integration site family, member 7 (WNT7B) was identified as a target antigen, suggesting the presence of serum antibodies against this antigen. Deletion mutants were then prepared to evaluate the response to serum antibodies. When serum antibody levels against WNT7B deletion mutants (WNT7B-92‑2, -92‑260, 2-260 and 184-260) were examined using amplified luminescence proximity homogeneous assay‑linked immunosorbent assay, the levels of the antibody against WNT7B with amino acids 184‑260 were higher in patients with biliary cancer than in healthy donors. Therefore, the region covering residues 184‑260 of WNT7B was decomposed to generate seven peptides, and the levels of antibodies against these peptides were measured. Among them, the levels of antibodies against WNT7B234‑253 and WNT7B244‑260 were higher in patients with biliary cancers than in healthy donors (WNT7B234‑253, P=0.0009; WNT7B244‑260, P=0.0005). The levels of the antibody against the former were specifically high in patients with biliary cancer but not in those with esophageal, gastric, colorectal, pancreatic, or breast cancer. Furthermore, analysis by the cutoff value of WNT7B234‑253 defined by ROC showed a high sensitivity of 70% in patients with biliary cancer. Therefore, the serum levels of the antibody against WNT7B234‑253 may be useful as a marker for biliary cancer diagnosis.
• Technical evaluation of robotic tele-cholecystectomy: a randomized single-blind controlled pilot study

  Yuma Ebihara, Satoshi Hirano, Hironobu Takano, Takahiro Kanno, Kenji Kawashima, Hajime Morohashi, Eiji Oki, Kenichi Hakamada, Shigeo Urushidani, Masaki Mori

  Journal of Robotic Surgery 17 (3) 1105 - 1111 2023/01/05
• A Case of Solitary Pancreatic Metastasis from Gallbladder Cancer

  Shinya Kosuge, Takehiro Noji, Masaru Go, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Tomoko Mitsuhashi, Satoshi Hirano

  Japanese Journal of Gastroenterological Surgery 56 (9) 487 - 495 0386-9768 2023 

  A 54-year-old man underwent radical cholecystectomy, extrahepatic bile duct resection, lymph node dissection, and choledochojejunostomy for gallbladder cancer associated with pancreaticobiliary maljunction. The histopathological diagnosis was moderately differentiated adenocarcinoma; pT2, pN0, and pStage II. Two years and 10 months after surgery, abdominal US revealed a hypoechoic mass of 11 mm with an irregular shape and a prolonged contrast effect in the pancreatic body. Histological examination using endoscopic ultrasound fine-needle aspiration revealed that the tumor was adenocarcinoma. Distal pancreatectomy was performed under a diagnosis of pancreatic cancer cT3N0M0 cStage IIA. Histopathological examination revealed two lesions in the pancreatic body, both of which were poorly to moderately differentiated adenocarcinoma. Since the morphology of the lesions on HE staining and immunohistochemistry were consistent with the gallbladder cancer, the final diagnosis was pancreatic metastasis from gallbladder cancer. At 18 months after surgery, the patient is alive without recurrence. Most metastatic pancreatic tumors are metastases from renal cell carcinoma, sarcoma, colorectal cancer, or malignant melanoma, whereas pancreatic metastasis from gallbladder cancer is extremely rare. Thus, we report this case as an example of solitary pancreatic metastasis from gallbladder cancer.
• Impact of Neutrophil Extracellular Traps Identified by Citrullinated Histone H3 Immunohistochemistry for Postoperative Prognosis in Patients with Extrahepatic Cholangiocarcinomas

  Hiroyuki Yamamoto, Yoshitsugu Nakanishi, Tomoko Mitsuhashi, Yutaka Hatanaka, Kanako Hatanaka, Ayae Nange, Yusuke Yoshida, Norito Ino, Masaru Go, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe, Satoshi Hirano

  Annals of Surgical Oncology 1068-9265 2023 

  Background: Neutrophil extracellular traps (NETs) are extracellular chromatin structures composed of cytoplasmic, granular, and nuclear components of neutrophils. Recently, NETs have received much attention for their role in tumor biology; however, their impact on the postoperative prognosis of patients with extrahepatic cholangiocarcinomas (EHCCs) remains unclear. The purpose of this study was to clarify the impact of NETs identified by immunohistochemical citrullinated histone H3 (Cit-H3) staining on postoperative overall survival (OS) in patients with perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC). Methods: This study included 318 patients with EHCC (PHCC, n = 192; DCC, n = 126) who underwent surgical resection with curative intent. Neutrophils and NETs were identified by immunohistochemistry using antibodies against CD15 and Cit-H3, respectively. Based on the distribution of CD15 and Cit-H3 expression in the tumor bed, the patients were classified into four groups: one negative group and three subgroups of the positive group (diffuse, intermediate, and focal subgroups). Results: No significant difference was found in the postoperative OS rate depending on the distribution of CD15 expression in patients with PHCC or DCC. However, the three subgroups with positive Cit-H3 expression had significantly poorer OS than the negative group for both PHCC and DCC. Moreover, positive Cit-H3 was an independent OS factor in the multivariable analyses of PHCC (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.11–2.59, P = 0.0115) and DCC (HR 2.03; 95% CI 1.21–3.42, P = 0.0057). Conclusions: The presence of NETs in the tumor microenvironment may have adverse prognostic effects in patients with EHCCs.
• 膵癌外科治療における術前治療と術後補助化学療法中の血液毒性発現の関連

  武内 慎太郎, 中村 透, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡, 桑原 健, 田中 伸哉

  北海道外科雑誌 北海道外科学会 67 (2) 190 - 191 0288-7509 2022/12
• 直腸癌に対するtaTMEの遠隔手術指導

  寺村 紘一, 海老原 裕磨, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 27 (7) 1951 - 1951 1344-6703 2022/12
• 膵癌腹腔動脈周囲神経叢浸潤の術前CT画像所見と切除病理組織の対比

  郷 雅, 中村 透, 浅野 賢道, 田中 公貴, 松井 あや, 中西 喜嗣, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  北海道外科雑誌 北海道外科学会 67 (2) 192 - 192 0288-7509 2022/12
• 膵癌治療中に経験した症候性椎体圧迫骨折の5例

  藤井 正和, 中村 透, 浅野 賢道, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 中西 善嗣, 野路 武寛, 倉島 庸, 海老原 祐磨, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  北海道外科雑誌 北海道外科学会 67 (2) 194 - 194 0288-7509 2022/12
• Relationship between laparoscopic total gastrectomy-associated postoperative complications and gastric cancer prognosis.

  Yuma Ebihara, Noriaki Kyogoku, Yoshihiro Murakami, Katsuhiko Murakawa, Fumitaka Nakamura, Takayuki Morita, Shunichi Okushiba, Satoshi Hirano

  Updates in surgery 2022/11/11 

  This study aimed to investigate the incidence and prognosis of postoperative complications after laparoscopic total gastrectomy (LTG) for gastric cancer (GC). We retrospectively enrolled 411 patients who underwent curative LTG for GC at seven institutions between January 2004 and December 2018. The patients were divided into two groups, complication group (CG) and non-complication group (non-CG), depending on the presence of serious postoperative complications (Clavien-Dindo grade III [≥ CD IIIa] or higher complications). Short-term outcomes and prognoses were compared between two groups. Serious postoperative complications occurred in 65 (15.8%) patients. No significant difference was observed between the two groups in the median operative time, intraoperative blood loss, number of lymph nodes harvested, or pathological stage; however, the 5-year overall survival (OS; CG 66.4% vs. non-CG 76.8%; p = 0.001), disease-specific survival (DSS; CG 70.1% vs. non-CG 76.2%; p = 0.011), and disease-free survival (CG 70.9% vs. non-CG 80.9%; p = 0.001) were significantly different. The Cox multivariate analysis identified the serious postoperative complications as independent risk factors for 5-year OS (HR 2.143, 95% CI 1.165-3.944, p = 0.014) and DSS (HR 2.467, 95% CI 1.223-4.975, p = 0.011). A significant difference was detected in the median days until postoperative recurrence (CG 223 days vs. non-CG 469 days; p = 0.017) between the two groups. Serious postoperative complications after LTG negatively affected the GC prognosis. Efforts to decrease incidences of serious complications should be made that may help in better prognosis in patients with GC after LTG.
• 胆嚢癌十二指腸浸潤により消化管出血をきたしoncological emergencyとして緊急手術を行った1例

  出口 琢人, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本集中治療医学会雑誌 (一社)日本集中治療医学会 29 (Suppl.1) 677 - 677 1340-7988 2022/11
• 胸・腹腔鏡併用下に横隔膜縫縮術を施行した食道癌術後横隔膜弛緩症の1例

  武藤 潤, 山崎 雅久, 千葉 龍平, 野村 俊介, 高島 雄太, 藤原 晶, 氏家 秀樹, 村上 壮一, 倉島 庸, 海老原 裕磨, 七戸 俊明, 樋田 泰浩, 加賀 基知三, 平野 聡, 加藤 達哉

  気管支学 (NPO)日本呼吸器内視鏡学会 44 (6) 457 - 457 0287-2137 2022/11
• 胸・腹腔鏡併用下に横隔膜縫縮術を施行した食道癌術後横隔膜弛緩症の1例

  武藤 潤, 山崎 雅久, 千葉 龍平, 野村 俊介, 高島 雄太, 藤原 晶, 氏家 秀樹, 村上 壮一, 倉島 庸, 海老原 裕磨, 七戸 俊明, 樋田 泰浩, 加賀 基知三, 平野 聡, 加藤 達哉

  気管支学 (NPO)日本呼吸器内視鏡学会 44 (6) 457 - 457 0287-2137 2022/11
• Prognostic significance of NY-ESO-1 antigen and PIGR expression in esophageal tumors of CHP-NY-ESO-1-vaccinated patients as adjuvant therapy.

  Yasuhiro Nagata, Shinichi Kageyama, Takeshi Ishikawa, Satoshi Kokura, Tetsuya Okayama, Tetsuya Abe, Masahiko Murakami, Koji Otsuka, Tomotake Ariyoshi, Takashi Kojima, Ken Taniguchi, Shinichiro Kobayashi, Hideaki Shimada, Satoshi Yajima, Takashi Suzuki, Satoshi Hirano, Takahiro Tsuchikawa, Toshiaki Shichinohe, Shugo Ueda, Kengo Kanetaka, Akira Yoneda, Hisashi Wada, Yuichiro Doki, Hiroki Yamaue, Masahiro Katsuda, Masaki Ohi, Hiromi Yasuda, Ken Kondo, Masato Kataoka, Yasuhiro Kodera, Masahiko Koike, Taizo Shiraishi, Yoshihiro Miyahara, Naoki Goshima, Eriko Fukuda, Kei Yamaguchi, Eiichi Sato, Hiroaki Ikeda, Tomomi Yamada, Masaharu Osako, Kaoru Hirai, Hiroshi Miyamoto, Takashi Watanabe, Hiroshi Shiku

  Cancer immunology, immunotherapy : CII 71 (11) 2743 - 2755 2022/11 

  The aim of this study was to determine the efficacy and the biomarkers of the CHP-NY-ESO-1 vaccine complexed with full-length NY-ESO-1 protein and a cholesteryl pullulan (CHP) in patients with esophageal squamous cell carcinoma (ESCC) after surgery. We conducted a randomized phase II trial. Fifty-four patients with NY-ESO-1-expressing ESCC who underwent radical surgery following cisplatin/5-fluorouracil-based neoadjuvant chemotherapy were assigned to receive either CHP-NY-ESO-1 vaccination or observation as control. Six doses of CHP-NY-ESO-1 were administered subcutaneously once every two weeks, followed by nine more doses once every four weeks. The endpoints were disease-free survival (DFS) and safety. Exploratory analysis of tumor tissues using gene-expression profiles was also performed to seek the biomarker. As there were no serious adverse events in 27 vaccinated patients, we verified the safety of the vaccine. DFS in 2 years were 56.0% and 58.3% in the vaccine arm and in the control, respectively. Twenty-four of 25 patients showed NY-ESO-1-specific IgG responses after vaccination. Analysis of intra-cohort correlations among vaccinated patients revealed that 5% or greater expression of NY-ESO-1 was a favorable factor. Comprehensive analysis of gene expression profiles revealed that the expression of the gene encoding polymeric immunoglobulin receptor (PIGR) in tumors had a significantly favorable impact on outcomes in the vaccinated cohort. The high PIGR-expressing tumors that had higher NY-ESO-1-specific IgA response tended to have favorable prognosis. These results suggest that PIGR would play a major role in tumor immunity in an antigen-specific manner during NY-ESO-1 vaccinations. The IgA response may be relevant.
• Development of a systematic telesimulation curriculum for laparoscopic inguinal hernia repair

  Kotoe Kiriyama, Saseem Poudel, Yo Kurashima, Yusuke Watanabe, Yoshihiro Murakami, Kyosuke Miyazaki, Yo Kawarada, Satoshi Hirano

  Global Surgical Education - Journal of the Association for Surgical Education 1 (1) 2022/10/20
• Hereditary cancer variants and homologous recombination deficiency in biliary tract cancer.

  Yuki Okawa, Yusuke Iwasaki, Todd A Johnson, Nobutaka Ebata, Chihiro Inai, Mikiko Endo, Kazuhiro Maejima, Shota Sasagawa, Masashi Fujita, Koichi Matsuda, Yoshinori Murakami, Toru Nakamura, Satoshi Hirano, Yukihide Momozawa, Hidewaki Nakagawa

  Journal of hepatology 78 (2) 333 - 342 2022/10/12 

  BACKGROUND & AIMS: The heritability and actionability of molecular therapies for biliary tract cancer are uncertain. Although associations between biliary tract cancer and BRCA germline variants have been reported, homologous recombination deficiency has not been investigated in BTCs. METHODS: We sequenced germline variants in 27 cancer-predisposing genes in 1,292 biliary tract cancer cases and 37,583 controls without a personal and family history of cancer. We compared pathogenic germline variant frequencies between cases and controls and documented the demographic and clinical characteristics of carrier patients. In addition, whole-genome sequencing of 45 biliary tract cancers was performed to evaluate homologous recombination deficiency status. RESULTS: Targeted sequencing identified 5,018 germline variants, which were classified into 317 pathogenic, 3,611 variants of uncertain significance, and 1,090 benign variants. Seventy-one BTC cases (5.5%) had at least one pathogenic variant among 27 cancer-predisposing genes. Pathogenic germline variants enriched in biliary tract cancers were in BRCA1, BRCA2, APC, and MSH6 (P < 0.00185). PALB2 variants were marginally associated with BTC (P = 0.01). APC variants were predominantly found in ampulla of Vater carcinomas. Whole-genome sequencing demonstrated that three biliary tract cancers with pathogenic germline variants in BRCA2 and PALB2 accompanied with loss of heterozygosity displayed HRD. Conversely, pathogenic germline variants without in homologous recombination-related genes showed homologous recombination proficient phenotypes. CONCLUSIONS: This study described the heritability and the actionability of homologous recombination deficiency targeted treatments and provides possibilities for expanding therapeutic strategies and screening for BTCs.
• 術前化学療法を施行した膵癌患者における骨格筋量と術後合併症の関連

  櫻井 悠人, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 83 (10) 1840 - 1840 1345-2843 2022/10
• 食道癌に対する化学放射線療法後の狭窄に対してロボット支援下胸腔鏡下食道切除術を施行した1例

  岡崎 遼, 海老原 裕磨, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 75回 ECPA1 - 1 2022/10
• 胆道癌に対するconversion surgeryの有用性

  野路 武寛, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 55 (Suppl.2) 257 - 257 0386-9768 2022/10
• 肝線維化例は減量・代謝改善手術後のテストステロン上昇が乏しい

  大江 悠希, 亀田 啓, 高瀬 崇宏, 小川 浩司, 海老原 裕磨, 宮 愛香, 野本 博司, 曹 圭龍, 中村 昭伸, 坂本 直哉, 平野 聡, 渥美 達也, 三好 秀明

  日本内分泌学会雑誌 (一社)日本内分泌学会 98 (2) 629 - 629 0029-0661 2022/10
• Optimal Intraluminal Drug-Coated Balloon Versus Drug-Eluting Stent in Patients With Chronic Total Occlusion of the Superficial Femoral Artery: A Retrospective Analysis.

  Naoki Hayakawa, Satoshi Kodera, Keisuke Takanashi, Teruaki Kanagami, Shinya Ichihara, Masataka Arakawa, Satoshi Hirano, Yasunori Inoguchi, Sandeep Shakya, Junji Kanda

  Cardiovascular revascularization medicine : including molecular interventions 43 87 - 96 2022/10 

  BACKGROUND: Paclitaxel-eluting technologies improve the clinical outcome of femoropopliteal (FP) occlusive disease. Several studies reported efficacy of the high-dose (nominal paclitaxel density of 3.5 μg/mm2) drug-coated balloon (DCB) for complex FP lesions. However, previous studies of DCB have shown a high rate of bailout stents, and few studies have compared the high-dose DCB with successful lesion pre-dilation without bailout stent and drug-eluting stent (DES) in chronic total occlusion (CTO) of the superficial femoral artery (SFA). This study aimed to compare the clinical outcome of high-dose DCB with successful lesion preparation and DES in CTO of the SFA. METHODS: This was a single-center, retrospective study. From June 2018 to November 2020, we compared 41 patients (43 lesions) treated with high-dose DCB and 36 patients (37 lesions) treated with DES. The study period was defined as the period after DCB and DES became available simultaneously at our hospital, when all surviving patients had at least 1 year of follow-up. The primary endpoint was 12-month primary patency. The secondary endpoints were 12-month freedom from: (1) clinically driven target lesion revascularization (CD-TLR), and (2) re-occlusion. RESULTS: Baseline clinical data were comparable between the two groups. Reference vessel diameter was smaller in the DCB group. The mean lesion and occlusion lengths were about the same in both groups. The subintimal angioplasty and bailout stent rate was 0% in the DCB group. The Kaplan-Meier estimate for 12-month primary patency was 92.0% in the DCB group and 87.2% in the DES group (p = 0.47). Freedom from CD-TLR also did not differ significantly between the two groups. The 12-month freedom from re-occlusion rate tended to be higher in the DCB group than in the DES group. CONCLUSIONS: High-dose DCB with successful lesion preparation showed 12-month clinical outcomes comparable with DES for CTO of the SFA, even without bailout stents.
• TRIM22 negatively regulates MHC-II expression.

  Ayano Inoue, Masashi Watanabe, Takeshi Kondo, Satoshi Hirano, Shigetsugu Hatakeyama

  Biochimica et biophysica acta. Molecular cell research 1869 (10) 119318 - 119318 2022/10 

  The development of cancer treatment has recently achieved a remarkable breakthrough, and checkpoint blockade immunotherapy has received much attention. To enhance the therapeutic efficacy of checkpoint blockade immunotherapy, recent studies have revealed the importance of activation of CD4+ T cells via an increase in major histocompatibility complex (MHC) class II molecules in cancer cells. Here, we demonstrate that tripartite motif-containing (TRIM) 22, negatively regulates MHC-II expression. Gene knockout of TRIM22 using Cas9-sgRNAs led to an increase of MHC-II proteins, while TRIM22 overexpression remarkably decreased MHC-II proteins. mRNA levels of MHC-II and class II transactivator (CIITA), which plays an essential role in the regulation of MHC-II transcription, were not affected by TRIM22. Furthermore, TRIM22 knockout did not suppress the degradation of MHC-II protein but rather promoted it. These results suggest that TRIM22 decreases MHC-II protein levels through a combination of multiple mechanisms other than transcription or degradation. We showed that inhibition of TRIM22 can increase the amount of MHC-II expression in cancer cells, suggesting a possibility of providing the biological basis for a possible therapeutic target to potentiate checkpoint blockade immunotherapy.
• Tumor-Informed Approach Improved ctDNA Detection Rate in Resected Pancreatic Cancer.

  Kazunori Watanabe, Toru Nakamura, Yasutoshi Kimura, Masayo Motoya, Shigeyuki Kojima, Tomotaka Kuraya, Takeshi Murakami, Tsukasa Kaneko, Yoshihito Shinohara, Yosuke Kitayama, Keito Fukuda, Kanako C Hatanaka, Tomoko Mitsuhashi, Fabio Pittella-Silva, Toshikazu Yamaguchi, Satoshi Hirano, Yusuke Nakamura, Siew-Kee Low

  International journal of molecular sciences 23 (19) 2022/09/29 

  Pancreatic cancer is one of the cancers with very poor prognosis; there is an urgent need to identify novel biomarkers to improve its clinical outcomes. Circulating tumor DNA (ctDNA) from liquid biopsy has arisen as a promising biomarker for cancer detection and surveillance. However, it is known that the ctDNA detection rate in resected pancreatic cancer is low compared with other types of cancer. In this study, we collected paired tumor and plasma samples from 145 pancreatic cancer patients. Plasma samples were collected from 71 patients of treatment-naïve status and from 74 patients after neoadjuvant therapy (NAT). Genomic profiling of tumor DNA and plasma samples was conducted using targeted next-generation sequencing (NGS). Somatic mutations were detected in 85% (123/145) of tumors. ctDNA was detected in 39% (28/71) and 31% (23/74) of treatment-naïve and after-NAT groups, respectively, without referring to the information of tumor profiles. With a tumor-informed approach (TIA), ctDNA detection rate improved to 56% (40/71) and 36% (27/74) in treatment-naïve and after-NAT groups, respectively, with the detection rate significantly improved (p = 0.0165) among the treatment-naïve group compared to the after-NAT group. Cases who had detectable plasma ctDNA concordant to the corresponding tumor showed significantly shorter recurrence-free survival (RFS) (p = 0.0010). We demonstrated that TIA improves ctDNA detection rate in pancreatic cancer, and that ctDNA could be a potential prognostic biomarker for recurrence risk prediction.
• Zandelisib (ME-401) in Japanese patients with relapsed or refractory indolent non-Hodgkin's lymphoma: an open-label, multicenter, dose-escalation phase 1 study.

  Hideki Goto, Koji Izutsu, Daisuke Ennishi, Yuko Mishima, Shinichi Makita, Koji Kato, Miyoko Hanaya, Satoshi Hirano, Kazuya Narushima, Takanori Teshima, Hirokazu Nagai, Kenichi Ishizawa

  International journal of hematology 116 (6) 911 - 921 2022/09/15 

  The selective phosphatidylinositol 3-kinase δ inhibitor zandelisib demonstrated favorable safety and efficacy [objective response rate (ORR) 79%] in patients with B-cell malignancies in a phase 1b study in the US and Switzerland. In this phase 1 dose-escalation study (NCT03985189), 9 Japanese patients with relapsed/refractory indolent non-Hodgkin's lymphoma (R/R iNHL) received zandelisib on a continuous daily schedule (45 or 60 mg) until progressive disease/unacceptable toxicity. No dose-limiting toxicities were observed. The maximum tolerated dose was not reached. At a median follow-up of 17.5 months, Grade ≥ 3 treatment-emergent adverse events that occurred in 2 or more patients were neutrophil count decreased (55.6%; 5/9) and diarrhea (33.3%; 3/9). Immune-related toxicities, including hepatobiliary disorder, aspartate/alanine aminotransferase increased, diarrhea/colitis, organizing pneumonia, stomatitis, and rash, led to zandelisib discontinuation in 4 patients. The investigator-assessed ORR, based on modified Lugano criteria, was 100%, including 2 complete responses (22.2%; in follicular lymphoma patients receiving 60 mg/day). Median duration of response, progression-free survival, and time to response were 7.9, 11.1, and 1.9 months, respectively. Zandelisib demonstrated a manageable safety profile at 60 mg, the recommended phase 2 dose (RP2D) in Japanese patients. The RP2D resulted in favorable pharmacokinetics and anti-tumor efficacy in Japanese patients with R/R iNHL.Trial registration. NCT03985189 (ClinicalTrials.gov).
• Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study.

  Kimitaka Tanaka, Yasutoshi Kimura, Tsuyoshi Hayashi, Yoshiyasu Ambo, Makoto Yoshida, Kazufumi Umemoto, Takeshi Murakami, Toshimichi Asano, Toru Nakamura, Satoshi Hirano

  Cancers 14 (18) 2022/09/11 

  Distal pancreatectomy (DP) with lymphadenectomy is the standard surgery for pancreatic body-tail cancer. However, the optimal lymph node (LN) dissection area for DP remains controversial. Thus, we evaluated the frequency and patterns of LN metastasis based on the tumor site. In this multicenter retrospective study, we examined 235 patients who underwent DP for pancreatic cancer. Tumor sites were classified as confined to the pancreatic body (Pb) or pancreatic tail (Pt). The efficacy index (EI) was calculated by multiplying the frequency of metastasis to each LN station by the five-year survival rate of patients with metastasis to that station. LN metastasis occurred in 132/235 (56.2%) of the patients. Patients with Pb tumors showed no metastasis to the splenic hilum LN. Distal splenic artery LNs and anterosuperior/posterior common hepatic artery LNs did not benefit from dissection for Pb and Pt tumors, respectively. In multivariate analysis, splenic artery LN metastasis was identified as an independent predictor of poor overall survival in patients with pancreatic body-tail cancer. In conclusion, differences in metastatic LN sites were evident in pancreatic body-tail cancers confined to the Pb or Pt. Spleen-preserving pancreatectomy might be feasible for Pb cancer.
• 【胆膵周術期合併症のマネージメント】胆膵手術後の乳び腹水に対するマネージメント

  田中 公貴, 平野 聡, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕

  胆と膵 医学図書出版(株) 43 (9) 891 - 895 0388-9408 2022/09 

  広範囲のリンパ節郭清を伴う胆膵手術には、ときに術後ドレーンから乳び腹水を経験する。肝胆膵領域手術における授後乳び腹水の発生率は約2～3%とされ、まれな合併症とはいえない頻度である。乳び腹水とは、脂質を高濃度に含有する腹水を指し、その診断にはドレーン排液の中性脂肪値が110mg/dLを超えることが基準となる。一方、乳び腹水に対する治療は、脂質制限食といった食事制限やオクトレオチドのような薬物療法、リンパ管造影やリンパ管塞栓術のような経皮的インターベンション、リンパ管静脈吻合術といった複数のオプションがあり、これらの治療方法を侵襲が少ないものから順番に行っていくのが一般的である。乳び腹水の病態に低栄養状態や腹腔内感染を伴った場合には長期の加療を要したり、重篤化したりすることもあるため、適切な診断と早期治療介入が重要と考える。(著者抄録)
• 膵・胆管合流異常症に発生した胆嚢癌の膵転移の1例

  岡崎 遼, 野路 武寛, 小菅 信哉, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本膵・胆管合流異常研究会プロシーディングス 日本膵・胆管合流異常研究会 45 83 - 83 1883-4116 2022/09
• 定期的な腹部超音波検査が発見契機となった膵上皮内癌(PanIN-3)の1例

  長川 達哉, 岡崎 遼, 浅野 賢道, 平野 聡, 伊野 永隼, 三橋 智子

  日本農村医学会雑誌 (一社)日本農村医学会 71 (3) 225 - 225 0468-2513 2022/09
• 高Na血症による意識障害を併発した膿瘍形成性虫垂炎の1例

  内藤 善, 村上 壮一, 和田 雅孝, 吉見 泰典, 武内 慎太郎, 岡村 国茂, 寺村 紘一, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 祐磨, 中村 透, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 12 (Suppl.) 144 - 144 2022/09
• 内科・外科による消化器病共同診療の現況と展望 当科における切除可能境界膵癌に対する術前治療の現状

  原田 一顕, 中村 赳晶, 渡辺 亮介, 山村 貴洋, 川本 泰之, 結城 敏志, 桑谷 将城, 田口 大志, 加藤 徳雄, 浅野 賢道, 中村 透, 平野 聡, 小松 嘉人, 坂本 直哉

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 131回・125回 28 - 28 2022/09
• 日本人肥満2型糖尿病における腹腔鏡下スリーブ状胃切除術が脂肪肝と膵β細胞機能に及ぼす効果 前向きコホート研究

  大江 悠希, 中村 昭伸, 曹 圭龍, 高瀬 崇宏, 小川 浩司, 海老原 裕磨, 吉川 仁人, 西田 睦, 宮 愛香, 野本 博司, 亀田 啓, 荘 拓也, 須田 剛生, 倉島 庸, 阿保 大介, 工藤 與亮, 坂本 直哉, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病合併症 (一社)日本糖尿病合併症学会 36 (Suppl.1) 172 - 172 2022/09
• 肝外傷ダメージコントロール手術用シミュレーターの開発

  東嶋 宏泰, 村上 壮一, 倉島 庸, サシーム・パウデル, 野路 武寛, 金古 裕之, 伊澤 祥光, 本間 宙, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 12 (Suppl.) 109 - 109 2022/09
• Transanal total mesorectal excision after incomplete endoscopic submucosal dissection for early-stage low rectal cancer: A small case series.

  Mamoru Miyasaka, Shuji Kitashiro, Shunichi Okushiba, Tetsuya Sumiyoshi, Hiroko Takeda, Satoshi Hirano

  International journal of surgery case reports 98 107590 - 107590 2022/09 

  Endoscopic submucosal dissection (ESD) for colorectal cancer is challenging but is gradually being performed worldwide. It is less invasive than surgical resection and can be performed on lesions in which malignancy cannot be diagnosed. In low rectal cancers, changes such as scarring after ESD may make it challenging to preserve the anus when additional surgical resection is required. Transanal total mesorectal excision (TaTME) is a novel surgical technique involving transanal endoscopic manipulation. It is useful for lesions in the deep pelvis near the anus. Herein, we report six cases of TaTME after ESD for early-stage low rectal cancer that resulted in incomplete resection. As a representative case, a 77-year-old female was referred to our hospital, and colonoscopy revealed low rectal cancer. ESD was performed, and the pathological diagnosis was an invasion of the submucosal layer and microscopic lymphovascular invasion. We performed an additional laparoscopic low anterior resection with TaTME. Lymph node metastasis was observed, and the final diagnosis was pT1b, pN1a, pStage IIIa, and R0. In other cases, the anus can also be preserved, and the distal margin can be secured. TaTME enabled anal preservation without being affected by the ESD scars. It is considered useful for additional resection after ESD of low rectal cancer.
• Detection of sentinel lymph node with a novel near-infrared fluorescence spectrum system and indocyanine green fluorescence in patients with early breast cancer: First clinical experience.

  Yuma Ebihara, Hiroaki Kato, Yoshiaki Narita, Masaru Abe, Reiko Kubota, Satoshi Hirano

  Photodiagnosis and photodynamic therapy 40 103061 - 103061 2022/08/09 

  BACKGROUND: Sentinel lymph node biopsy (SLNB) for early breast cancer is common, and many studies have reported its usefulness with indocyanine green (ICG). However, in the case of sentinel lymph node (SNs) identification using ICG, it is difficult to accurately identify the fluorescence signal of SNs through the skin because of the weakening of the signal due to the intervening tissue thickness. In this study, we examined whether fluorescence spectroscopy can detect weaker fluorescence signals and accurately identify SNs that have accumulated ICG. METHODS: Six women with early breast cancer and clinically confirmed negative axillae were recruited. The periareolar region was subcutaneously injected with ICG (1 ml, 5 mg/mL). The identification rate of SNs in the skin was studied using the novel fluorescence spectroscopy (Lumifinder™, ADVANTEST, Tokyo, Japan). RESULTS: Lumifinder™ was able to identify 100% of SNs in the skin (6/6 patients). In addition, for SNs identification in deeper axillary areas, pressing the probe tip against the body surface allows clearer fluorescence observation. CONCLUSION: Novel fluorescence spectroscopy (Lumifinder™) may overcome the problem of SLNB using ICG for breast cancer.
• 腹腔鏡下スリーブ状胃切除術は肥満2型糖尿病患者の治療薬剤を減量し得る

  高橋 由華, 曹 圭龍, 大江 悠希, 高瀬 崇宏, 野本 博司, 亀田 啓, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 473 - 473 0021-437X 2022/08
• 肥満合併2型糖尿病患者において、術前骨格筋量が肥満手術の減量効果を予測する

  大江 悠希, 高瀬 崇宏, 野本 博司, 亀田 啓, 曹 圭龍, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 474 - 474 0021-437X 2022/08
• 腹腔鏡下スリーブ状胃切除術は脂質代謝および脂肪肝を改善させる

  安井 彩乃, 高瀬 崇宏, 野本 博司, 亀田 啓, 曹 圭龍, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 474 - 474 0021-437X 2022/08
• 本邦における腹腔鏡下スリーブ状胃切除術後の骨密度変化と関連因子 前向きコホート研究

  大江 悠希, 曹 圭龍, 小川 浩司, 海老原 裕磨, 宮 愛香, 野本 博司, 亀田 啓, 中村 昭伸, 坂本 直哉, 平野 聡, 渥美 達也, 三好 秀明

  日本骨粗鬆症学会雑誌 (一社)日本骨粗鬆症学会 8 (Suppl.1) 158 - 158 2189-8383 2022/08
• Acute Care Surgery概論

  村上 壮一, 平野 聡

  消化器外科 (株)へるす出版 45 (8) 929 - 935 0387-2645 2022/08
• 腹腔鏡下スリーブ状胃切除術は肥満2型糖尿病患者の治療薬剤を減量し得る

  高橋 由華, 曹 圭龍, 大江 悠希, 高瀬 崇宏, 野本 博司, 亀田 啓, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 473 - 473 0021-437X 2022/08
• 肥満合併2型糖尿病患者において、術前骨格筋量が肥満手術の減量効果を予測する

  大江 悠希, 高瀬 崇宏, 野本 博司, 亀田 啓, 曹 圭龍, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 474 - 474 0021-437X 2022/08
• 腹腔鏡下スリーブ状胃切除術は脂質代謝および脂肪肝を改善させる

  安井 彩乃, 高瀬 崇宏, 野本 博司, 亀田 啓, 曹 圭龍, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (8) 474 - 474 0021-437X 2022/08
• A novel system for analyzing indocyanine green (ICG) fluorescence spectra enables deeper lung tumor localization during thoracoscopic surgery.

  Ryohei Chiba, Yuma Ebihara, Haruhiko Shiiya, Hideki Ujiie, Aki Fujiwara-Kuroda, Kichizo Kaga, Liming Li, Satoru Wakasa, Satoshi Hirano, Tatsuya Kato

  Journal of thoracic disease 14 (8) 2943 - 2952 2022/08 

  Background: Palpation of tumors during thoracoscopic surgery remains difficult, and identification of deep-seated tumors may be impossible. This preclinical study investigated the usefulness of a novel indocyanine green (ICG) fluorescence spectroscopy system for tumor localization. Methods: ICG was diluted to 5.0×10-2 mg/mL in fetal bovine serum (FBS) and mixed with silicone resin to prepare pseudo-tumors. Sponges of different densities and a porcine lung were placed on top of the pseudo-tumors, which were examined using a novel fluorescence spectroscopy system and a near-infrared (NIR) camera. Spectra were measured for different sponge and lung thicknesses, and the lung spectra were measured during both inflation and deflation. Results: The fluorescence spectroscopy system was able to identify tumors at depths ≥15 mm, while the NIR system was not. The spectroscopy system also detected tumors at greater depths when the density of the intervening material was lower. Depending on the density and thickness of the intervening material, the system could detect spectra as deep as 40 mm for sponges and 30 mm for lungs. Conclusions: This new fluorescence spectroscopy system can be used to identify lung tumors up to a depth of 30 mm in experiments using pseudo-tumors and a porcine lung, which may aid in tumor identification during thoracoscopic surgery.
• ASO Author Reflections: Constructed Scoring System Using TP53 and SMAD4 Mutations Combined with Carbohydrate Antigen 19-9 in Pancreatic Ductal Adenocarcinoma.

  Masato Ono, Toru Nakamura, Yusuke Mizukami, Satoshi Hirano

  Annals of surgical oncology 29 (8) 5020 - 5021 2022/08
• 胆道癌根治切除後の肝または肺転移に対する外科切除例の検討

  中西 喜嗣, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 宮谷内 健吾, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 O13 - 1 2022/07
• 肝門部領域胆管癌に対するPreoperative Prognostic Score(PPS)の妥当性に関する検討

  青木 佑磨, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 P157 - 3 2022/07
• 切除不能膵癌に対するconversion surgeryの長期成績および再発症例の検討

  浅野 賢道, 中村 透, 野路 武寛, 土川 貴裕, 中西 喜嗣, 田中 公貴, 松井 あや, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 RS16 - 6 2022/07
• 膵頭十二指腸切除術後胆管空腸吻合部狭窄の発生状況と治療戦略

  松井 あや, 宮谷内 健吾, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 O29 - 5 2022/07
• 完全オンライン臨床実習は実現可能か? COVID-19への挑戦する消化器外科バーチャル臨床実習

  村上 壮一, 副島 昌太, 濱邉 英彦, 石川 幸司, 大野 栄三, 倉島 庸, 中村 透, 岡村 圭祐, 東嶋 宏泰, 石堂 敬太, 桐山 琴衣, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 土川 貴裕, 七戸 俊明, 平野 聡

  医学教育 (一社)日本医学教育学会 53 (Suppl.) 147 - 147 0386-9644 2022/07
• 【総論】各臓器サブサブスペシャルティ外科医の育成法 言語化された技能評価と重要局面にポイントを置いた腹腔鏡下胃切除術教育法

  倉島 庸, サシーム・パウデル, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 WS15 - 5 2022/07
• 【上部】上部消化管手術における栄養・リハビリ療法 低栄養と"サージカルサルコペニア"が食道癌手術患者の短期・長期成績に及ぼす影響

  七戸 俊明, 上村 志臣, 倉島 庸, 海老原 裕磨, 村上 壮一, 細川 正夫, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 PD4 - 3 2022/07
• 胆道癌根治切除後の肝または肺転移に対する外科切除例の検討

  中西 喜嗣, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 宮谷内 健吾, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 O13 - 1 2022/07
• 肝門部領域胆管癌に対するPreoperative Prognostic Score(PPS)の妥当性に関する検討

  青木 佑磨, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 P157 - 3 2022/07
• 切除不能膵癌に対するconversion surgeryの長期成績および再発症例の検討

  浅野 賢道, 中村 透, 野路 武寛, 土川 貴裕, 中西 喜嗣, 田中 公貴, 松井 あや, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 RS16 - 6 2022/07
• Preemptive retropancreatic approachを用いたロボット支援腹腔鏡下幽門側胃切除術

  海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 P230 - 7 2022/07
• 胆嚢癌の膵転移と考えられた1例

  小菅 信哉, 野路 武寛, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 S12 - 3 2022/07
• 膵頭十二指腸切除術後胆管空腸吻合部狭窄の発生状況と治療戦略

  松井 あや, 宮谷内 健吾, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 77回 O29 - 5 2022/07
• Carbon dioxide embolism during transanal total mesorectal excision: A hint of prevention from a case report.

  Masakazu Fujii, Kentaro Kato, Chisato Ichimaru, Hiroki Kushiya, Kazufumi Umemoto, Shotaro Furukawa, Naoya Okada, Kiyotaka Imamura, Takumi Yamabuki, Yoshihiro Kinoshita, Minoru Takada, Yoshiyasu Ambo, Fumitaka Nakamura, Satoshi Hirano

  Asian journal of endoscopic surgery 15 (3) 670 - 673 2022/07 

  Transanal total mesorectal excision is a relatively new approach for treating lower rectal cancer. Carbon dioxide embolism is a critical complication of this procedure. We report the case of a 69-year-old man with lower rectal cancer who underwent transanal total mesorectal excision followed by laparoscopic low anterior resection. He had a sudden intraoperative carbon dioxide embolism during the transanal mesorectal excision. During the ventral dissection of the rectum, end-tidal carbon dioxide and blood oxygen saturation suddenly decreased. We stopped the insufflation of carbon dioxide and suspended the procedure. There was no circulatory collapse, and the vital signs gradually recovered; therefore, we resumed the surgery approximately 30 minutes later and completed it without additional complications. Upon reviewing the video, we found a small injured vein that would aspirate carbon dioxide. These findings suggested that careful hemostasis is essential to prevent carbon dioxide embolus during transanal total mesorectal excision.
• Usage of cadavers in surgical training and research in Japan over the past decade.

  Toshiaki Shichinohe, Hiroshi Date, Satoshi Hirano, Eiji Kobayashi, Yoshimitsu Izawa, Yasuhiro Shirakawa, Masako Hiramatsu, Mitsuhito Mase, Hiroshi Taneichi, Hiroyuki Yaginuma, Toyoshi Fujimoto, Toshiyuki Tsurumoto, Masahiko Watanabe, Hiroshi Kurita, Naohito Hato, Tomoyasu Kato, Hiroomi Kanayama, Takane Suzuki, Kumiko Yamaguchi, Yoshimasa Takeda

  Anatomical science international 97 (3) 241 - 250 2022/07 

  The "Guidelines for Cadaver Dissection in Education and Research of Clinical Medicine" drafted by the Japan Surgical Society (JSS) and the Japanese Association of Anatomists in 2012 helped dispel legal concerns over cadaver surgical training (CST) and the usage of donated human bodies for research and development (R&D) in the country. Subsequently, in the fiscal year 2018, the Ministry of Health, Labour and Welfare increased the funding for CST, prompting its wider implementation. This study analyzed data obtained in 2012-2021 through the reporting system of the JSS-CST Promotion Committee to map the usage of cadavers for clinical purposes, specifically education and R&D, in Japan. We found that the number of medical universities using cadavers for CST and R&D programs was just 5 in 2012, and it reached 38 for the decade. Thus, about half of Japan's medical universities implemented such programs over the period. Meanwhile, the total number of programs was 1,173. In the clinical field, the highest number of programs were implemented in orthopedics (27%), followed by surgery (21%), and neurosurgery (12%). Based on the purpose, the most common objective of the programs (approximately 70%) was acquiring advanced surgical techniques. Further, the highest number of programs and participants were recorded in 2019 (295 programs, 6,537 participants). Thus, the guidelines helped expand cadaver usage for clinical purposes in Japan. To further promote the clinical usage of cadavers in medical and dental universities throughout Japan, sharing know-how on operating cadaver laboratories and building understanding among the general public is recommended.
• Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists).

  Toshiaki Shichinohe, Takashi Kondo, Hiroshi Date, Masako Hiramatsu, Satoshi Hirano, Chizuka Ide, Toshihiko Iwanaga, Yoshimitsu Izawa, Akio Kikuta, Eiji Kobayashi, Yoshiro Matsui, Yutaka Nohara, Takanori Shibata, Yasuhiro Shirakawa, Takane Suzuki, Haruo Takahashi, Hiroshi Taneichi, Toshiyuki Tsurumoto, Yasuo Uchiyama, Masahiko Watanabe, Hiroyuki Yaginuma, Kumiko Yamaguchi, Kazunari Yoshida

  Surgery today 52 (7) 989 - 994 2022/07 

  This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.
• Effects of obesity on CC16 and their potential role in overweight/obese asthma.

  Houman Goudarzi, Hirokazu Kimura, Hiroki Kimura, Hironi Makita, Munehiro Matsumoto, Nozomu Takei, Kaoruko Shimizu, Masaru Suzuki, Taku Watanabe, Eiki Kikuchi, Hiroshi Ohira, Ichizo Tsujino, Jun Sakakibara-Konishi, Naofumi Shinagawa, Noriharu Shijubo, Hirokazu Sato, Katsunori Shigehara, Kichizo Kaga, Yasuhiro Hida, Soichi Murakami, Yuma Ebihara, Akinobu Nakamura, Hideaki Miyoshi, Satoshi Hirano, Nobuyuki Hizawa, Tatsuya Atsumi, Shau-Ku Huang, Yoichi M Ito, Masaharu Nishimura, Satoshi Konno

  Respiratory research 23 (1) 174 - 174 2022/06/29 

  INTRODUCTION: Club cell secretory protein-16 (CC16) is a major anti-inflammatory protein expressed in the airway; however, the potential role of CC16 on overweight/obese asthma has not been assessed. In this study, we examined whether obesity reduces airway/circulatory CC16 levels using experimental and epidemiological studies. Then, we explored the mediatory role of CC16 in the relationship of overweight/obesity with clinical asthma measures. METHODS: Circulating CC16 levels were assessed by ELISA in three independent human populations, including two groups of healthy and general populations and asthma patients. The percentage of cells expressing club markers in obese vs. non-obese mice and human airways was determined by immunohistochemistry. A causal mediation analysis was conducted to determine whether circulatory CC16 acted as a mediator between overweight/obesity and clinical asthma measures. RESULTS: BMI was significantly and monotonously associated with reduced circulating CC16 levels in all populations. The percentage of CC16-expressing cells was reduced in the small airways of both mice and humans with obesity. Finally, mediation analysis revealed significant contributions of circulatory CC16 in the association between BMI and clinical asthma measures; 21.8% of its total effect in BMI's association with airway hyperresponsiveness of healthy subjects (p = 0.09), 26.4% with asthma severity (p = 0.030), and 23% with the required dose of inhaled corticosteroid (p = 0.042). In logistic regression analysis, 1-SD decrease in serum CC16 levels of asthma patients was associated with 87% increased odds for high dose ICS requirement (p < 0.001). CONCLUSIONS: We demonstrate that airway/circulating CC16, which is inversely associated with BMI, may mediate development and severity in overweight/obese asthma.
• HOPS-R01 phase II trial evaluating neoadjuvant S-1 therapy for resectable pancreatic adenocarcinoma.

  Toru Nakamura, Tsuyoshi Hayashi, Yasutoshi Kimura, Hiroshi Kawakami, Kuniyuki Takahashi, Hirotoshi Ishiwatari, Takuma Goto, Masayo Motoya, Keisuke Yamakita, Yusuke Sakuhara, Michihiro Ono, Eiichi Tanaka, Makoto Omi, Katsuhiko Murakawa, Tomoya Iida, Tamaki Sakurai, Shin Haba, Takehiro Abiko, Yoichi M Ito, Hiroyuki Maguchi, Satoshi Hirano

  Scientific reports 12 (1) 9966 - 9966 2022/06/15 

  Although neoadjuvant therapy (Nac) is recommended for high-risk resectable pancreatic cancer (R-PDAC), evidence regarding specific regimes is scarce. This report aimed to investigate the efficacy of S-1 Nac for R-PDAC. In a multicenter phase II trial, we investigated the efficacy of Nac S-1 (an oral fluoropyrimidine agent containing tegafur, gimeracil, and oteracil potassium) in R-PDAC patients. The protocol involved two cycles of preoperative S-1 chemotherapy, followed by surgery, and four cycles of postoperative S-1 chemotherapy. Two-year progression-free survival (PFS) rates were the primary endpoint. Overall survival (OS) rates and median survival time (MST) were secondary endpoints. Forty-nine patients were eligible, and 31 patients underwent resection following Nac, as per protocol (31/49; 63.3%). Per-protocol analysis included data from 31 patients, yielding the 2-year PFS rate of 58.1%, and 2-, 3-, and 5-year OS rates of 96.8%, 54.8%, and 44.0%, respectively. MST was 49.2 months. Intention-to-treat analysis involved 49 patients, yielding the 2-year PFS rate of 40.8%, and the 2-, 3-, and 5-year OS rates of 87.8%, 46.9%, and 33.9%, respectively. MST was 35.5 months. S-1 single regimen might be an option for Nac in R-PDAC; however, the high drop-out rate (36.7%) was a limitation of this study.
• 【縫合不全と戦う】肝門部で胆管切除を行う膵頭十二指腸切除術における胆管空腸吻合のテクニック

  松井 あや, 平野 聡

  外科 (株)南江堂 84 (7) 757 - 764 0016-593X 2022/06 

  ＜文献概要＞肝胆膵手術における胆管空腸吻合部縫合不全の発症頻度はそれほど高くない.しかし,ひとたび発症すれば,入院期間の延長はもちろん,再手術やインターベンショナルラジオロジー(IVR)手技を含む複数回の侵襲的処置が必要となることが多く,長期的には吻合部狭窄をきたし,胆管炎から時に生命にかかわる重篤な敗血症にいたることもある.本稿では,特に肝門部胆管-空腸吻合の縫合・結紮手技に焦点をおき,縫合不全を起こさないために注意すべき点について述べた.
• 膵・消化管神経内分泌腫瘍の最前線 膵神経内分泌腫瘍の根治切除術適応および至適リンパ節郭清に関する検討

  土川 貴裕, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 野路 武寛, 中村 透, 七戸 俊明, 平野 聡

  日本内分泌外科学会雑誌 (一社)日本内分泌外科学会 39 (Suppl.1) S128 - S128 2434-6535 2022/06
• 側腹部腹壁瘢痕ヘルニアに対して腹腔鏡下IPOM-Plus法が有用であった1例

  佐藤 大介, 大柏 秀樹, 川原田 陽, 平野 聡

  北海道外科雑誌 北海道外科学会 67 (1) 63 - 67 0288-7509 2022/06 

  腹壁瘢痕ヘルニアは比較的多く遭遇する術後合併症の一つであるが、側腹部瘢痕ヘルニアの治療にはしばしば難渋する。今回、側腹部瘢痕ヘルニアに対して腹腔鏡下IPOM-Plus法による修復が有用であった症例を経験した。症例は70歳代、女性。右腎盂癌術後の右側腹部斜切開創に瘢痕ヘルニアを生じて当科を受診した。外腹斜筋に約7cmの筋膜離開があり、その深層では内腹斜筋・腹横筋に約14cmの筋膜離開を認めた。腹腔鏡下IPOM-Plus法で30cm大の癒着防止メッシュを腹部正中から腰方形筋右側まで展開し、これを留置した。術後合併症の発生やヘルニア再発なく経過中である。メッシュサイズが大きく、取り扱いがやや煩雑であるが、側腹部瘢痕ヘルニアに対する腹腔鏡下IPOM-Plus法は安全に施行可能であり、術後合併症のリスクも軽減できるため有効であると考える。(著者抄録)
• Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma.

  Takehiro Noji, Satoko Uemura, Jimme K Wiggers, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Pim B Olthof, William R Jarnagin, Thomas M van Gulik, Satoshi Hirano

  Hepatobiliary surgery and nutrition 11 (3) 375 - 385 2022/06 

  Background: Surgery for perihilar cholangiocarcinoma (PHCC) remains a challenging procedure with high morbidity and mortality. The Academic Medical Center (Amsterdam UMC) and Memorial Sloan Kettering Cancer Center proposed a postoperative mortality risk score (POMRS) and post-hepatectomy liver failure score (PHLFS) to predict patient outcomes. This study aimed to validate the POMRS and PHLFS for PHCC patients at Hokkaido University. Methods: Medical records of 260 consecutive PHCC patients who had undergone major hepatectomy with extrahepatic bile duct resection without pancreaticoduodenectomy at Hokkaido University between March 2001 and November 2018 were evaluated to validate the PHLFS and POMRS. Results: The observed risks for PHLF were 13.7%, 24.5%, and 39.8% for the low-risk, intermediate-risk, and high-risk groups, respectively, in the study cohort. A receiver-operator characteristic (ROC) analysis revealed that the PHLFS had moderate predictive value, with an analysis under the curve (AUC) value of 0.62. Mortality rates based on the POMRS were 1.7%, 5%, and 5.1% for the low-risk, intermediate-risk, and high-risk groups, respectively. The ROC analysis demonstrated an AUC value of 0.58. Conclusions: This external validation study showed that for PHLFS the threshold for discrimination in an Eastern cohort was reached (AUC >0.6), but it would require optimization of the model before use in clinical practice is acceptable. The POMRS were not applicable in the eastern cohort. Further external validation is recommended.
• Robotic real-time vessel navigation using indocyanine green fluorescence for lymph node dissection along the left gastroepiploic vessels during robotic distal gastrectomy First experience.

  Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of minimal access surgery 2022/05/27 

  Splenic infarction (SI) following gastrectomy is common; severe complications related to SI, such as splenic haemorrhage, abscess formation or rupture, can be fatal. To overcome these problems, we performed real-time vessel navigation using indocyanine green (ICG) fluorescence during robotic distal gastrectomy (RDG). The aim of study is to report the efficacy of robotic real-time vessel navigation for lymph node dissection (LND) along left gastroepiploic vessels (LGEVs). We treated seven patients with gastric cancer who underwent LND along the LGEVs using robotic real-time vessel navigation during RDG at our institution from January 2021 to July 2021. There were no complications (Clavien-Dindo classification II). There were no cases of post-operative SI or spleen-related complications. Robotic real-time vessel navigation using ICG for LND along LGEVs during RDG could help to reduce post-operative spleen-related complications associated with RDG.
• Concomitant Hepatic Artery Resection for Advanced Perihilar Cholangiocarcinoma: A Narrative Review.

  Takehiro Noji, Satoshi Hirano, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa

  Cancers 14 (11) 2022/05/27 

  Perihilar cholangiocarcinoma (PHCC) is one of the most intractable gastrointestinal malignancies. These tumours lie in the core section of the biliary tract. Patients who undergo curative surgery have a 40-50-month median survival time, and a five-year overall survival rate of 35-45%. Therefore, curative intent surgery can lead to long-term survival. PHCC sometimes invades the surrounding tissues, such as the portal vein, hepatic artery, perineural tissues around the hepatic artery, and hepatic parenchyma. Contralateral hepatic artery invasion is classed as T4, which is considered unresectable due to its "locally advanced" nature. Recently, several reports have been published on concomitant hepatic artery resection (HAR) for PHCC. The morbidity and mortality rates in these reports were similar to those non-HAR cases. The five-year survival rate after HAR was 16-38.5%. Alternative procedures for arterial portal shunting and non-vascular reconstruction (HAR) have also been reported. In this paper, we review HAR for PHCC, focusing on its history, diagnosis, procedures, and alternatives. HAR, undertaken by established biliary surgeons in selected patients with PHCC, can be feasible.
• A nationwide certification system to increase the safety of highly advanced hepatobiliary-pancreatic surgery.

  Takehito Otsubo, Shinjiro Kobayashi, Keiji Sano, Takeyuki Misawa, Satoshi Katagiri, Hisashi Nakayama, Shuji Suzuki, Manabu Watanabe, Shunichi Ariizumi, Michiaki Unno, Minoru Tanabe, Hiroaki Nagano, Norihiro Kokudo, Satoshi Hirano, Masafumi Nakamura, Ken Shirabe, Yasuyuki Suzuki, Masahiro Yoshida, Yasutsugu Takada, Toshio Nakagohri, Akihiko Horiguchi, Hideki Ohdan, Susumu Eguchi, Masayuki Ohtsuka, Masayuki Sho, Toshiki Rikiyama, Etsuro Hatano, Akinobu Taketomi, Tsutomu Fujii, Hiroki Yamaue, Masaru Miyazaki, Masakazu Yamamoto, Tadahiro Takada, Itaru Endo

  Journal of hepato-biliary-pancreatic sciences 30 (1) 60 - 71 2022/05/24 

  BACKGROUND: To ensure that highly advanced hepatobiliary-pancreatic surgery (HBPS) is performed safely, the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) board certification system for expert surgeons established a safety committee to monitor surgical safety. METHODS: We investigated postoperative mortality rates based on summary reports of numbers and outcomes of highly advanced HBPS submitted annually by the board-certified training institutions from 2012 to 2019. We also analyzed summary reports on mortality cases submitted by institutions with high 90-day post-HBPS mortality rates and recommended site visits and surveys as necessary. RESULTS: Highly advanced HBPS was performed in 121,518 patients during the 8-year period. Thirty-day mortality rates from 2012 to 2019 were 0.92%, 0.8%, 0.61%, 0.63%, 0.70%, 0.59%, 0.48%, and 0.52%, respectively (p < .001). Ninety-day mortality rates were 2.1%, 1.82%, 1.62%, 1.28%, 1.46%, 1.22%, 1.19%, and 0.98%, respectively (p < .001). Summary reports were submitted by 20 hospitals between 2015 and 2019. Mortality rates before and after the start of report submission and audit were 5.72% and 2.79%, respectively, (odds ratio 0.690, 95% confidence interval 0.487-0.977; p = .037). CONCLUSIONS: Development of a system for designation of board-certified expert surgeons and safety management improved the mortality rate associated with highly advanced HBPS.
• Guidelines for cadaver dissection in education and research of clinical medicine (The Japan Surgical Society and The Japanese Association of Anatomists).

  Toshiaki Shichinohe, Takashi Kondo, Hiroshi Date, Masako Hiramatsu, Satoshi Hirano, Chizuka Ide, Toshihiko Iwanaga, Yoshimitsu Izawa, Akio Kikuta, Eiji Kobayashi, Yoshiro Matsui, Yutaka Nohara, Takanori Shibata, Yasuhiro Shirakawa, Takane Suzuki, Haruo Takahashi, Hiroshi Taneichi, Toshiyuki Tsurumoto, Yasuo Uchiyama, Masahiko Watanabe, Hiroyuki Yaginuma, Kumiko Yamaguchi, Kazunari Yoshida

  Anatomical science international 2022/05/24 

  This article translates the guidelines for cadaver surgical training (CST) published in 2012 by Japan Surgical Society (JSS) and Japanese Association of Anatomists from Japanese to English. These guidelines are based on Japanese laws and enable the usage of donated cadavers for CST and clinical research. The following are the conditions to implement the activities outlined in the guidelines. The aim is to improve medicine and to contribute to social welfare. Activities should only be carried out at medical or dental universities under the centralized control by the department of anatomy under the regulation of Japanese law. Upon the usage of cadavers, registered donors must provide a written informed-consent for their body to be used for CST and other activities of clinical medicine. Commercial use of cadavers and profit-based CST is strongly prohibited. Moreover, all the cadaver-related activities except for the commercial-based ones require the approval of the University's Institutional Review Board (IRB) before implementation. The expert committee organized at each university for the implementation of CST should summarize the implementation of the program and report the details of the training program, operating costs, and conflicts of interest to the CST Promotion Committee of JSS.
• Validation study of a skill assessment tool for education and outcome prediction of laparoscopic distal gastrectomy.

  Yo Kurashima, Hidehiko Kitagami, Koichi Teramura, Saseem Poudel, Yuma Ebihara, Noriyuki Inaki, Fumitaka Nakamura, Kazunari Misawa, Kazunori Shibao, Eishi Nagai, Yoshimasa Akashi, Shuji Takiguchi, Shinichiro Kobayashi, Satoshi Hirano

  Surgical endoscopy 36 (12) 8807 - 8816 2022/05/16 

  BACKGROUND: The Japanese operative-rating scale for laparoscopic distal gastrectomy (JORS-LDG) was developed through cognitive task analysis together with the Delphi method to measure intraoperative performance during laparoscopic distal gastrectomy. This study aimed to investigate the value of this rating scale as an educational tool and a surgical outcome predictor in laparoscopic distal gastrectomy. METHODS: The surgical performance of laparoscopic distal gastrectomy was assessed by the first assistant, through self-evaluation in the operating room and by video raters blind to the case. We evaluated inter-rater reliability, internal consistency, and correlations between the JORS-LDG scores and the evaluation methods, patient characteristics, and surgical outcomes. RESULTS: Fifty-four laparoscopic distal gastrectomy procedures performed by 40 surgeons at 16 institutions were evaluated in the operating room and with video recordings using the proposed rating scale. The video inter-rater reliability was > 0.8. Participating surgeons were divided into the low, intermediate, and high groups based on their total scores. The number of laparoscopic surgeries and laparoscopic gastrectomy procedures performed differed significantly among the groups according to laparoscopic distal gastrectomy skill levels. The low, intermediate, and high groups also differed in terms of median operating times (311, 266, and 229 min, respectively, P < 0.001), intraoperative complication rates (27.8, 11.8, and 0%, respectively, P = 0.01), and postoperative complication rates (22.2, 0, and 0%, respectively, P = 0.002). CONCLUSIONS: The JORS-LDG is a reliable and valid measure for laparoscopic distal gastrectomy training and could be useful in predicting surgical outcomes.
• Tele-assessment of bandwidth limitation for remote robotics surgery.

  Yuma Ebihara, Eiji Oki, Satoshi Hirano, Hironobu Takano, Mitsuhiko Ota, Hajime Morohashi, Kenichi Hakamada, Shigeo Urushidani, Masaki Mori

  Surgery today 52 (11) 1653 - 1659 2022/05/12 

  PURPOSE: We investigated the communication bandwidth (CB) limitation for remote robotics surgery (RRS) using hinotori™ (Medicaroid, Kobe, Japan). METHODS: The operating rooms of the Hokkaido University Hospital and Kyushu University Hospital were connected using the Science Information NETwork (SINET). The minimum required CB for the RRS was verified by decreasing the CB from 500 to 100 Mbps. Ten surgeons were tested on a task (intracorporeal suturing) at different levels of video compression (VC) (VC1: 120 Mbps, VC2: 40 Mbps, VC3: 20 Mbps) with the minimum required CB, and assessed based on the task completion time, Global Evaluative Assessment of Robotic Skills (GEARS), and System and Piper Fatigue Scale-12 (PFS-12). RESULTS: Packet loss was observed at 3-7% and image degradation was observed at 145 Mbps CB. The task performance with VC1 was significantly worse than that with VC2 and VC3 according to the task completion time (VC1 vs VC2, P = 0.032; VC1 vs. VC3, P = 0.032), GEARS (VC1 vs VC2; P = 0.029, VC1 vs VC3; P = 0.031), and PFS-12 (VC1 vs. VC2; P = 0.032, VC1 vs. VC3; P = 0.032) with 145 Mbps. CONCLUSION: Our findings provide evidence that RRS using hinotori™ requires a CB ≥ 150 Mbps. We also found that when there is insufficient CB, RRS can be continued by compressing the image.
• ロボット支援腹腔鏡下噴門側胃切除術における脾動脈幹近位リンパ節郭清手技について

  海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本外科系連合学会誌 日本外科系連合学会 47 (3) 475 - 475 0385-7883 2022/05
• 【肝胆膵癌におけるconversion therapy】膵癌におけるconversion therapy 膵癌conversion 慎重な立場から

  浅野 賢道, 中村 透, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 平野 聡

  肝胆膵 (株)アークメディア 84 (5) 647 - 654 0389-4991 2022/05
• 横行結腸間膜裂孔ヘルニアの1例

  植木 知音, 和田 秀之, 丹羽 弘貴, 水沼 謙一, 高橋 亮, 鈴置 真人, 平野 聡

  日本腹部救急医学会雑誌 (一社)日本腹部救急医学会 42 (4) 541 - 544 1340-2242 2022/05 

  横行結腸間膜裂孔ヘルニアの1例を経験したので報告する。症例は74歳,男性。右上腹部痛を主訴に近医を受診し,絞扼性腸閉塞の疑いで当院へ紹介された。腹部造影CTの軸位断で上腹部の小腸がclosed loopを形成しており,内ヘルニアによる絞扼性腸閉塞と診断し緊急で腹腔鏡手術を施行した。術中,横行結腸間膜の欠損部への空腸の嵌入を認め,横行結腸間膜裂孔ヘルニアと診断した。腸管壊死は認めず,ヘルニア門の縫合閉鎖のみで手術を終了した。術後経過は良好で,第21病日に退院した。本症はまれな疾患であり,術前診断は比較的困難とされるが,後方視的には造影CTの多断面再構成画像(multi-planar reconstruction:以下,MPR)で横行結腸間膜および小腸間膜の血管を同定することで診断が可能であった。MPR像が本症の診断に有用な可能性があると考えられた。(著者抄録)
• Effects of the Robot-Assisted Gait Training Device Plus Physiotherapy in Improving Ambulatory Functions in Patients With Subacute Stroke With Hemiplegia: An Assessor-Blinded, Randomized Controlled Trial.

  Natapatchakrid Thimabut, Pattarapol Yotnuengnit, Jittima Charoenlimprasert, Thipwimon Sillapachai, Satoshi Hirano, Eiichi Saitoh, Krisna Piravej

  Archives of physical medicine and rehabilitation 103 (5) 843 - 850 2022/05 

  OBJECTIVE: To investigate the effects of the robot-assisted gait training (RAGT) device plus physiotherapy vs physiotherapy alone in improving ambulatory functions in patients with subacute stroke with hemiplegia. DESIGN: A prospective, assessor-blinded, randomized controlled trial. SETTING: Patients with subacute stroke with hemiplegia admitted at the Rehabilitation Center. PARTICIPANTS: Twenty-six patients with subacute stroke with hemiplegia (N=26). INTERVENTION: All patients received 30 training sessions (5 d/wk for 6 wk), which included conventional physiotherapy training (60 minutes) and ambulation training (60 minutes). In the ambulation training session, the RAGT device group received robotic training (40 minutes) and ground ambulation training (20 minutes). The control group received only ground ambulation training (60 minutes). The outcomes were assessed at the initial session and at the end of the 15th and 30th sessions. Comparisons within groups and between groups were conducted. MAIN OUTCOME MEASURES: Primary outcome variables were the FIM-walk score and the efficacy of FIM-walk. RESULTS: The RAGT device group showed greater improvements from baseline than control in (1) the FIM-walk score at the end of the 15th session (P=.012), (2) the efficacy of FIM-walk at the end of the 15th session (P=.008), (3) walking distance in the 6-minute walk test at the end of the 15th session (P=.018), (4) the Barthel Index for Activities of Daily Living (ADL) at the end of the 30th session (P<.001), and (5) gait symmetry ratio at the end of the 30th session (P=.044). Other gait parameters showed tendencies of improvement in the RAGT device group, but there were no significant differences. CONCLUSIONS: RAGT devices plus physiotherapy showed early improvements in walking ability and Barthel ADL index compared with the ground level training plus physiotherapy in patients with subacute stroke with hemiplegia.
• Nationwide registry for patients with neuroendocrine neoplasm of pancreas, gastrointestinal tract, lungs, bronchi, or thymus in Japan.

  Toshihiko Masui, Tetsuhide Ito, Izumi Komoto, Shinsuke Kojima, Yosuke Kasai, Minoru Tanabe, Kazuo Hara, Satoshi Hirano, Takuji Okusaka, Yasushi Ichikawa, Yusuke Kinugasa, Norihiro Kokudo, Atsushi Kudo, Akihiro Sakurai, Kenichi Sugihara, Hiroshi Date, Ken Haruma, Susumu Hijioka, Koichi Hirata, Hiroo Yamano, Motohiro Sakamine, Takashi Kikuchi, Masanori Fukushima, Masayuki Imamura, Shinji Uemoto

  International journal of clinical oncology 27 (5) 840 - 849 2022/05 

  BACKGROUND: Neuroendocrine neoplasm (NEN) is a comparatively rare tumor that has been considered indolent. Due to these characteristics, detailed epidemiological data have not been analyzed in Japan. To elucidate the present status of NEN diagnosis and treatment in Japan, we started a registry cohort study in January 2015. METHODS: Patients pathologically diagnosed with NENs of the pancreas, gastrointestinal tract, lungs, bronchi, or thymus after January 2012 were enrolled in this registry after the date of ethics review committee approval in each hospital or institute. Follow-up was continued for enrolled patients. RESULTS: During 5 years of enrollment between January 2015 and December 2019, a total of 1526 participants from 63 departments were enrolled in this registry (mean, 305.2 participants/year), covering approximately 5.8% of the annual incidence of NENs in Japan. For pancreatic NEN, 41.9% of patients had metastasis and the dominant metastatic site was the liver, at twice the rate of lymph node metastasis in the current registry. In contrast, the frequency of lymph node metastasis from gastrointestinal (GI)-NEN was similar to that of the liver. The distribution of WHO 2019-based grades varied according to the primary site. Low-to-intermediate grade (G1-G2) was dominant for duodenal, jejunal/ileal, rectal, and pancreatic NENs, whereas high grade (G3 or NEC) was dominant for esophageal, stomach, and colon NENs. For PanNENs, G3 and NEC accounted only for 1.6% and 2.9%, respectively. CONCLUSIONS: These cohort data provide crucial information for clinical research to clarify the characteristics of NENs in Japan.
• Predictors of Long-Term Survival in Pancreatic Ductal Adenocarcinoma after Pancreatectomy: TP53 and SMAD4 Mutation Scoring in Combination with CA19-9

  Masato Ono, Yusuke Ono, Toru Nakamura, Takahiro Tsuchikawa, Tomotaka Kuraya, Shota Kuwabara, Yoshitsugu Nakanishi, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Yuma Ebihara, Yo Kurashima, Takehiro Noji, Soichi Murakami, Toshiaki Shichinohe, Tomoko Mitsuhashi, Yuko Omori, Toru Furukawa, Kenzui Taniue, Mayumi Suzuki, Ayumu Sugitani, Hidenori Karasaki, Yusuke Mizukami, Satoshi Hirano

  Annals of Surgical Oncology 29 (8) 5007 - 5019 1068-9265 2022/04/10
• 日本人肥満2型糖尿病における腹腔鏡下スリーブ状胃切除術が脂肪肝に及ぼす効果 前向きコホート研究

  大江 悠希, 高瀬 崇宏, 曹 圭龍, 小川 浩司, 海老原 裕磨, 吉川 仁人, 西田 睦, 宮 愛香, 野本 博司, 亀田 啓, 荘 拓也, 須田 剛生, 中村 昭伸, 倉島 庸, 阿保 大介, 工藤 與亮, 坂本 直哉, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (Suppl.1) S - 139 0021-437X 2022/04
• 日本人肥満症合併2型糖尿病患者への減量・代謝改善手術により代謝疾患は改善し治療薬を減量し得る

  大藤 悠理, 曹 圭龍, 海老原 裕磨, 大江 悠希, 高瀬 崇宏, 宮 愛香, 野本 博司, 亀田 啓, 中村 昭伸, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 65 (Suppl.1) S - 288 0021-437X 2022/04
• 腹腔鏡下胃全摘術の食道空腸吻合法におけるOverlap法とFunctional法の手術成績についての多施設共同研究

  海老原 裕磨, 倉島 庸, 渡邊 祐介, 村上 壮一, 七戸 俊明, 村上 慶洋, 村川 力彦, 中村 文隆, 森田 高行, 奥芝 俊一, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 5 2022/04
• 膵癌術後早期再発の危険因子 術前治療の有無に着目した膵癌術後早期再発症例の検討

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 PD - 1 2022/04
• 肝門部胆管癌術後の臨床的肝不全の病態と危険因子の解析

  野路 武寛, 岡村 圭祐, 田中 公貴, Matsui Aya, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 7 2022/04
• 肝門部領域胆管癌に対する門脈塞栓術後に行った根治切除における術後肝不全症例の検討

  櫻井 悠人, 野路 武寛, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 8 2022/04
• 膵頭十二指腸切除術後胆管炎におけるPneumobiliaの臨床的意義

  松井 あや, 岡崎 遼, 小菅 信哉, 出口 琢人, 櫻井 悠人, 石堂 敬太, 宮谷内 健吾, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 池田 篤, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 3 2022/04
• 肝胆膵疾患に対する胆道再建術後の晩期胆管炎の臨床的特徴とTG18による評価

  田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 6 2022/04
• 肝外胆管癌における術前胆管炎と臨床病理学的因子および予後に関する検討

  山本 寛之, 中西 喜嗣, 田中 公貴, 松井 あや, 浅野 賢道, 海老原 裕磨, 倉島 庸, 野路 武寛, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 7 2022/04
• 地域の一般外科医は、Acute Care Surgeonたり得るのか?

  村上 壮一, 廣瀬 和幸, 東嶋 宏泰, 出口 琢人, 宮谷内 健吾, 池田 篤, 松井 あや, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 2 2022/04
• 肝門部浸潤を伴う腫瘤形成型肝内胆管癌と肝門部胆管癌の予後の比較検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 宮谷内 健吾, 村上 壮一, 海老原 裕磨, 倉島 庸, 池田 篤, 渡邊 祐介, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 SF - 6 2022/04
• 膵頭部癌診断目的のEUS-FNAによる十二指腸下行脚穿孔の1例

  石倉 慶太郎, 村上 壮一, 松井 あや, 出口 琢人, 櫻井 悠人, 小菅 信哉, 岡崎 遼, 東嶋 宏泰, 石堂 敬太, 宮谷内 健吾, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 RS - 4 2022/04
• 大動脈気管支瘻腸管瘻に対する治療 大動脈食道瘻に対する治療戦略 内視鏡手術を行う食道外科医の立場から

  七戸 俊明, 海老原 裕磨, 村上 壮一, 倉島 庸, 若狭 哲, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 122回 WS - 1 2022/04
• Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network.

  Hajime Morohashi, Kenichi Hakamada, Takahiro Kanno, Kenji Kawashima, Harue Akasaka, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori

  Surgery today 52 (4) 705 - 714 2022/04 

  PURPOSE: In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines. METHODS: A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time. RESULTS: The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed. CONCLUSIONS: The social implementation of telesurgery using the currently available commercial communication network is feasible.
• Clinical Features of Pancreatic Neuroendocrine Microadenoma: A Single-Center Experience and Literature Review.

  Yuki Okawa, Takahiro Tsuchikawa, Kanako C Hatanaka, Aya Matsui, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Tomoko Mitsuhashi, Keisuke Okamura, Yutaka Hatanaka, Satoshi Hirano

  Pancreas 51 (4) 338 - 344 2022/04/01 

  OBJECTIVES: Pancreatic neuroendocrine microadenoma (NEMA) is a nonfunctioning neuroendocrine tumor of less than 5 mm. Most studies of NEMA were based on autopsies, and few reports have revealed the clinical frequency of NEMA. We investigated the clinicopathological features of NEMA. METHODS: The pathological results of the pancreatic resection specimens of patients, older than 18 years, who underwent pancreatic resection at Hokkaido University Hospital between April 2008 and December 2020 were retrospectively reviewed. The NEMAs were re-examined in detail and examined by immunohistochemical staining. RESULTS: Among 850 patients enrolled in this study, 24 NEMAs were identified in 12 patients (1.4%). Of the 12 patients, 2 patients had multiple endocrine neoplasia type 1, and the others had no hereditary disease, including 2 patients with multiple NEMAs. A difference in the number of NEMA was observed between patients with multiple endocrine neoplasia type 1 and sporadic NEMA. Intratumoral Ki-67 heterogeneity was correlated with the Ki-67 index. One grade 2 NEMA (Ki-67 index, 4.6%) was detected, but ATRX and DAXX labeling showed intact nuclear protein expression. CONCLUSIONS: Multiple sporadic NEMAs and grade 2 NEMAs were observed, suggesting that NEMA may have malignant potential. Thus, NEMAs should be carefully monitored for lymph node metastasis and postoperative recurrence.
• An AnteOwl WR intravascular ultrasound-guided parallel wiring technique for chronic total occlusion of below-the-knee arteries.

  Naoki Hayakawa, Satoshi Kodera, Satoshi Hirano, Masataka Arakawa, Yasunori Inoguchi, Junji Kanda

  CVIR endovascular 5 (1) 18 - 18 2022/03/26 

  BACKGROUND: Although endovascular therapy is used to treat chronic limb-threatening ischemia, long chronic total occlusion (CTO) is still challenging to treat. Especially in patients with poor run-off below-the-knee (BTK) arteries, it is difficult to perform a retrograde approach, and even guidewire passage may be difficult. CASE PRESENTATION: We treated two cases of chronic limb-threatening ischemia using our novel extreme antegrade guidewire crossing technique by AnteOwl WR intravascular ultrasound (IVUS)-guided parallel wiring to a BTK artery (EXCAVATOR technique). Case 1 was a 70-year-old man with ulceration of the right toe. The AnteOwl WR IVUS was intentionally advanced into the subintimal space of the posterior tibial artery, and the totally intraplaque route was advanced by IVUS-guided parallel wiring that was successfully passed from the lateral plantar aspect to the true lumen of the digital artery. Case 2 was a 76-year-old woman with rest pain and cyanosis of the right lower limb. Angiography showed total occlusion from the superficial femoral artery to BTK arteries. AnteOwl WR IVUS-guided parallel wiring was repeatedly performed until the distal true lumen of the peroneal artery was reached, and revascularization was successfully achieved via the antegrade approach alone. CONCLUSIONS: With its excellent crossable performance, good image quality, and high navigational ability within the CTO, the AnteOwl WR can be used to pass parallel wiring into the distal true lumen for BTK CTO.
• Preoperative embolization strategy for the combined resection of replaced right hepatic artery in pancreaticoduodenectomy: a small case series.

  Shintaro Takeuchi, Yoshiyasu Ambo, Yoshihisa Kodama, Minoru Takada, Kentaro Kato, Fumitaka Nakamura, Satoshi Hirano

  Surgical case reports 8 (1) 49 - 49 2022/03/22 

  BACKGROUND: Replaced right hepatic artery (rRHA) is a common vascular variation, and combined resection of this vessel is sometimes needed for the curative resection of pancreatic head malignancy. Safe surgical management has not been established, and there is a small number of reported cases. Here, we reported five cases, wherein preoperative embolization of rRHA was performed for combined resection. CASE PRESENTATION: All patients had pancreatic head malignancies that were in contact with rRHA. We performed a preoperative embolization of the rRHA before the scheduled pancreaticoduodenectomy for the combined resection. Arterial embolization was safely accomplished, and the communicating arcade from the left hepatic artery via the hilar plate was clearly revealed in all cases. Four patients underwent the operative procedure, except for one patient who had liver metastasis at laparotomy. No patient suffered from a severe abnormal liver function during the management; however, one patient had multiple liver infarctions during the postoperative course. CONCLUSIONS: Preoperative embolization for the combined resection of rRHA in pancreaticoduodenectomy can be a management option for the precise evaluation of hemodynamics after sacrificing rRHA. In our cases, arterial flow to the right liver lobe was supplied by the left hepatic artery via the bypass route, including the communicating arcade of the hilar plate.
• 化学療法が奏功し、組織学的に完全奏効が得られた局所進行膵臓癌の1例

  横山 大輔, 石部 絵梨奈, 中村 赳晶, 江上 太基, 小林 智絵, 加藤 貴司, 浅野 賢道, 中村 透, 平野 聡, 郷 雅, 三橋 智子

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 130回・124回 75 - 75 2022/03
• Preemptive retropancreatic approachによるロボット支援腹腔鏡下幽門側胃切除術(Short-term outcomes of robotic distal gastrectomy with the "preemptive retropancreatic approach")

  海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本胃癌学会総会記事 94回 257 - 257 2022/03
• 膵空腸吻合における技能の評価ツールおよびシミュレーションモデルの開発

  水沼 謙一, 倉島 庸, サシーム・パウデル, 渡邊 祐介, 田中 公貴, 中西 善嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 83 (3) 599 - 599 1345-2843 2022/03
• 肝門部領域胆管癌に対する術前99mTc-GSAシンチを用いた肝不全死予測

  野路 武寛, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 130回・124回 57 - 57 2022/03
• Individual patient data meta-analysis of adjuvant gemcitabine-based chemotherapy for biliary tract cancer: combined analysis of the BCAT and PRODIGE-12 studies.

  Julien Edeline, Satoshi Hirano, Aurélie Bertaut, Masaru Konishi, Meher Benabdelghani, Katsuhiko Uesaka, Jérôme Watelet, Masayuki Ohtsuka, Pascal Hammel, Yuji Kaneoka, Jean-Paul Joly, Masakazu Yamamoto, Laure Monard, Yoshiyasu Ambo, Christophe Louvet, Masahiko Ando, David Malka, Masato Nagino, Jean-Marc Phelip, Tomoki Ebata

  European journal of cancer (Oxford, England : 1990) 164 80 - 87 2022/03 

  BACKGROUND: Although gemcitabine-based chemotherapy is the standard of care for advanced biliary tract cancers (BTCs), adjuvant phase III studies (BCAT in Japan, PRODIGE 12 in France) failed to show benefit, possibly owing to fewer patients (n = 225 and n = 194) compared with the adjuvant capecitabine BILCAP trial (n = 447). We performed a combined analysis of both gemcitabine-based chemotherapy adjuvant studies. METHODS: We performed individual patient data meta-analysis of all patients included in BCAT and PRODIGE 12. BCAT study randomised patients with extrahepatic cholangiocarcinoma to single-agent gemcitabine or observation. PRODIGE 12 randomised patients with all BTC subtypes to gemcitabine-oxaliplatin combination or observation. Combined analysis was performed using Kaplan-Meier curves and a Cox regression model stratified on the trial. RESULTS: Two hundred and twelve versus 207 patients were randomised in the gemcitabine-based chemotherapy versus observation arms. Baseline characteristics were balanced between arms. The median follow-up was 5.5 years. After 258 relapse-free survival (RFS) events, there was no difference in RFS (log-rank p = 0.45; hazard ratio [HR] = 0.91 [95% confidence interval [CI] 0.71-1.16]; p = 0.46). RFS rates at five years were 40.8% (95%CI: 33.9%-47.5%) for gemcitabine-based chemotherapy versus 36.6% (95%CI: 29.8%-43.4%) for observation. After 201 deaths, there was no difference in overall survival (OS) (log-rank p = 0.83; HR = 1.03 [95%CI: 0.78-1.35]; p = 0.85). OS rates at five years were 50.5% (95%CI: 43.1%-57.4%) for gemcitabine-based chemotherapy versus 49.3% (95%CI: 41.6%-56.5%) for observation. CONCLUSION: With 419 patients included, this analysis did not show significant improvement in RFS and no trend in improvement in OS. Gemcitabine-based chemotherapy should not be used as an adjuvant treatment for BTC.
• Functional outcomes in acute care settings vary by disease categories but show a consistent pattern of disability.

  Koji Mizutani, Yohei Otaka, Masaki Kato, Miwako Hayakawa, Megumi Ozeki, Hirofumi Maeda, Satoshi Hirano, Masahiko Mukaino, Seiko Shibata, Hitoshi Kagaya, Hiroaki Sakurai, Eiichi Saitoh

  Annals of physical and rehabilitation medicine 101648 - 101648 2022/02/24
• Outcomes of lung metastasis from pancreatic cancer: A nationwide multicenter analysis.

  Yuki Homma, Itaru Endo, Ryusei Matsuyama, Masayuki Sho, Shugo Mizuno, Yasuji Seyama, Satoshi Hirano, Takashi Aono, Chie Kitami, Yoshifumi Morita, Yutaka Takeda, Kazuhiro Yoshida, Masaji Tani, Takashi Kaiho, Yuzo Yamamoto, Hideki Aoki, Masao Ogawa, Takefumi Niguma, Yuko Mataki, Hiroshi Kawasaki, Hideo Baba, Hiroshi Yokomizo, Toshiki Rikiyama, Hiroki Yamaue, Masakazu Yamamoto

  Journal of hepato-biliary-pancreatic sciences 29 (5) 552 - 561 2022/02/18 

  BACKGROUND: Although distant metastasis from pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis, some single center studies reported that lung metastasis has a favorable prognosis. The aim of this study is to evaluate the prognostic value of site-specific metastasis after pancreatectomy for PDAC, with a focus on lung metastasis. METHODS: Data from 117 cases of lung metastasis after pancreatectomy were collected retrospectively from 23 institutions in Japan. To compare the sites of metastasis we also collected the data of 134 patients with liver only metastasis, 67 patients with peritoneal only metastasis and 121 patients with locoregional recurrence alone. RESULTS: In patients with lung only metastasis, the median time from recurrence to death (RTD) was 23.1 months, which was better in comparison to other sites of recurrence. In lung metastasis group, the patients who underwent pulmonary resection had better long-term outcomes in comparison to those who did not. (RTD: 29.2 vs 15.2, P < .001). In the multivariate analysis, solitary metastasis (HR 5.03; 95% CI 1.195-21.144, P = .022) and postoperative chemotherapy (HR 14.089; 95% CI 1.729-114.77, P = .023) were identified as significant prognostic factors after lung resection. CONCLUSIONS: Surgical resection is a favorable option for selected patients with a solitary lung metastasis and for whom adjuvant chemotherapy can be administrated.
• Efficacy of active hexose correlated compound on survival of patients with resectable/borderline resectable pancreatic cancer: a study protocol for a double-blind randomized phase II study.

  Daisuke Hashimoto, Sohei Satoi, Hideki Ishikawa, Yasuhiro Kodera, Keiko Kamei, Satoshi Hirano, Tsutomu Fujii, Kenichiro Uemura, Akihiko Tsuchida, Suguru Yamada, Tomohisa Yamamoto, Kiichi Hirota, Mitsugu Sekimoto

  Trials 23 (1) 135 - 135 2022/02/12 

  BACKGROUND: The prognosis of pancreatic ductal adenocarcinoma remains very poor. One possible reason for the short survival of patients with this disease is malnutrition, which can be present at the initial diagnosis, and continue after pancreatectomy. Then, it is important to improve nutritional status and to decrease adverse events during neoadjuvant and adjuvant chemotherapy. Active hexose correlated compound (AHCC) is a standardized extract of cultured Lentinula edodes mycelia, and is considered a potent biological response modifier in the treatment of cancer. To evaluate the survival impact of AHCC on the patients with pancreatic ductal adenocarcinoma, we plan to perform this trial. METHODS: This is a prospective multicenter phase II trial in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma to investigate the efficacy of AHCC regarding survival. Patients will begin taking AHCC or placebo on the first day of neoadjuvant therapy. AHCC or placebo will be continued until 2 years after surgery. The primary endpoint will be 2-year disease-free survival. The secondary endpoints are the completion rate, dose intensity, and adverse event profile of preoperative chemotherapy; response rate to preoperative chemotherapy; rate of decrease in tumor marker (carbohydrate antigen 19-9, carcinoembryonic antigen) concentrations during preoperative chemotherapy; entry rate, completion rate, dose intensity, and adverse event profile of adjuvant chemotherapy; safety of the protocol therapy (adverse effect of AHCC); 2-year overall survival rate; and nutrition score before and after preoperative chemotherapy, and before and after adjuvant chemotherapy. We will enroll 230 patients, and the study involves eight leading Japanese institutions that are all high-volume centers in pancreatic surgery. DISCUSSION: AHCC is expected to function as a supportive food in patients with pancreatic ductal adenocarcinoma, to reduce the proportion of severe adverse events related to neoadjuvant chemotherapy, and to increase the completion proportion of multimodal treatments, resulting in improved survival. TRIAL REGISTRATION: The trial protocol has been registered in the protocol registration system at the Japan Registry of Clinical Trials (Trial ID: jRCTs051200029 ). At the time of the submission of this paper (October 2020), the protocol version is 2.0. The completion date is estimated to be November 2024.
• SWATH-Based Comprehensive Determination of the Localization of Apical and Basolateral Membrane Proteins Using Mouse Liver as a Model Tissue

  Satoshi Hirano, Ryohei Goto, Yasuo Uchida

  Biomedicines 10 (2) 383 - 383 2022/02/05 

  The purpose of this study was to develop a method to comprehensively determine the localization of apical and basolateral membrane proteins, using a combination of apical/basolateral membrane separation and accurate SWATH (Sequential Window Acquisition of all THeoretical fragment ion spectra) proteomics. The SWATH analysis of basolateral and apical plasma membrane fractions in mouse liver quantified the protein expression of 1373 proteins. The basolateral/apical ratios of the protein expression levels were compared with the reported immunohistochemical localization for 41 model proteins (23 basolateral, 11 apical and 7 both membrane-localized proteins). Three groups were perfectly distinguished. Border lines to distinguish the apical-, both- and basolateral localizations were determined to be 0.766 and 1.42 based on probability density. The method that was established was then applied to the comprehensive determination of the proteins in mouse liver. The findings indicated that 154 and 125 proteins were localized in the apical and basolateral membranes, respectively. The levels of receptors, CD antigens and integrins, enzymes and Ras-related molecules were much higher in apical membranes than in basolateral membranes. In contrast, the levels of adhesion molecules, scaffold proteins and transporters in basolateral membranes were much higher than in apical membranes.
• Randomized phase III trial of intravenous and intraperitoneal paclitaxel with S-1 versus gemcitabine plus nab-paclitaxel for pancreatic ductal adenocarcinoma with peritoneal metastasis (SP study).

  Tomohisa Yamamoto, Tsutomu Fujii, Satoshi Hirano, Fuyuhiko Motoi, Goro Honda, Kenichiro Uemura, Joji Kitayama, Michiaki Unno, Yasuhiro Kodera, Hiroki Yamaue, Toshio Shimokawa, Daisuke Hashimoto, So Yamaki, Hideyuki Yoshitomi, Fumihiko Miura, Hideki Ueno, Mitsugu Sekimoto, Sohei Satoi

  Trials 23 (1) 119 - 119 2022/02/05 

  The prognosis of pancreatic ductal carcinoma (PDAC) with peritoneal metastasis remains dismal. Systemic chemotherapy alone may not be effective, and the combination of intraperitoneal chemotherapy with systemic chemotherapy is expected to prolong the overall survival in patients with peritoneal metastasis. We have designed a randomized phase III trial to confirm the superiority of intravenous (i.v.) and intraperitoneal (i.p.) paclitaxel (PTX) with S-1 relative to gemcitabine plus nab-PTX (GnP), which is the current standard therapy for patients with metastatic PDAC. A total of 180 patients will be accrued from 30 institutions within 3 years. Patients will be randomly assigned in a 1:1 ratio to receive either i.v. and i.p. PTX with S-1 or GnP (target of 90 patients per group). The primary endpoint is overall survival; secondary endpoints are progression-free survival, response rate, proportion with negative peritoneal washing cytology during chemotherapy, proportion requiring conversion surgery, and adverse event profiles. Japan Registry of Clinical Trials jRCTs051180199 ( https://jrct.niph.go.jp/ ).
• Bacteremia after hepatectomy and biliary reconstruction for biliary cancer: the characteristics of bacteremia according to occurrence time and associated complications.

  Junki Fukuda, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Satoshi Hirano

  Surgery today 52 (9) 1373 - 1381 2022/02/02 

  PURPOSE: Bacteremia occurring after extensive hepatic resection and biliary reconstruction (Hx + Bx) for biliary cancer is a critical infectious complication. This study evaluated postoperative bacteremia and examined the potential usefulness of surveillance cultures. METHODS: We retrospectively reviewed 179 patients who underwent Hx + Bx for biliary cancer from January 2008 to December 2018 in our department. RESULTS: Bacteremia occurred in 41 (23.0%) patients. Patients with bacteremia had a longer operation time and more frequent intraoperative transfusion and more frequently developed organ/space surgical site infection (SSI) than those without bacteremia. The most frequently isolated bacterial species from blood cultures were Enterococcus faecium (29.3%), Enterobacter cloacae (24.4%), and Enterococcus faecalis (22.0%). The SIRS duration of bacteremia associated with organ/space SSI was significantly longer than that of other infectious complications (median 96 h vs. 48 h; p = 0.043). Bacteremia associated with organ/space SSI occurred most often by postoperative day (POD) 30. The concordance rate of bacterial species between blood and surveillance cultures within POD 30 was 67-82%. CONCLUSIONS: Bacteremia associated with organ/space SSI required treatment for a long time and typically occurred by POD 30. Postoperative surveillance cultures obtained during this period may be useful for selecting initial antibiotic therapy because of their high concordance rate with blood cultures.
• 【胆道癌治療の最前線】切除不能胆道癌に対する薬物療法とconversion surgery

  野路 武寛, 平野 聡, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕

  外科 (株)南江堂 84 (2) 163 - 171 0016-593X 2022/02 

  ＜文献概要＞切除不能胆道癌に対する化学療法は,gemcitabineをベースにした多剤併用化学療法(gemcitabine+cisplatin,gemcitabine+S-1,gemcitabine+cisplatin+S-1)が標準治療とされている.さらに,近年は遺伝子パネル診断結果に基づいて有効な分子標的治療薬を探索する個別化治療も試みられている.診断時非切除とした胆道癌に対し,抗腫瘍療法後に根治切除を行うconversion surgery(CS)は,症例数が稀少であるためエビデンスはいまだ確立されていないが,長期生存例も報告されるようになってきた.
• Outcomes of laparoscopic total gastrectomy in elderly patients: a propensity score matching analysis.

  Yuma Ebihara, Yo Kurashima, Yusuke Watanabe, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Yoshihiro Murakami, Katsuhiko Murakawa, Fumitaka Nakamura, Takayuki Morita, Shunichi Okushiba, Toshiaki Shichinohe, Satoshi Hirano

  Langenbeck's archives of surgery 407 (4) 1461 - 1469 2022/01/26 

  PURPOSE: This study evaluated the short-term outcomes and prognosis after laparoscopic total gastrectomy (LTG) in elderly patients aged ≥ 80 years in a multicenter retrospective cohort study using propensity score matching. METHODS: We retrospectively enrolled 440 patients who underwent curative LTG for gastric cancer at six institutions between January 2004 and December 2018. Patients were categorized into an elderly patient group (EG; age ≥ 80 years) and non-elderly patient group (non-EG; age < 80 years). Patients were matched using the following propensity score covariates: sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Short-term outcomes and prognoses were compared. RESULTS: We identified 37 propensity score-matched pairs. The median operative time was significantly shorter, and postoperative stay was longer in the EG. In terms of postoperative outcomes, the rates of all complications were comparable. The median follow-up period of the EG and non-EG was 11.5 (1-106.4) months and 35.7 (1-110.0) months, respectively; there were significant differences in 5-year overall survival between the two groups (EG, 58.5% vs. non-EG, 91.5%; P = 0.031). However, there were no significant differences in 5-year disease-specific survival (EG, 62.1% vs. non-EG, 91.5%; P = 0.068) or 5-year disease-free survival (EG, 52.9% vs. non-EG, 60.8%; P = 0.132). CONCLUSIONS: LTG seems to be safe and feasible in elderly patients. LTG had a limited effect on morbidity, disease recurrence, and survival in elderly patients. Therefore, age should not prevent elderly patients from benefitting from LTG.
• REHABILITATION OUTCOMES IN PATIENTS WITH LOWER LIMB AMPUTATION RECEIVING HAEMODIALYSIS: A RETROSPECTIVE COHORT STUDY.

  Yoshitaka Wada, Yohei Otaka, Yuki Senju, Hiroshi Hosokawa, Takamichi Tohyama, Hirofumi Maeda, Masahiko Mukaino, Seiko Shibata, Satoshi Hirano

  Journal of rehabilitation medicine. Clinical communications 5 2525 - 2525 2022 [Refereed]
   

  OBJECTIVE: To compare the functional outcomes of patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis. DESIGN: A retrospective cohort study. PATIENTS: Patients with lower limb amputation who were admitted to a convalescent rehabilitation ward between January 2018 and December 2021. METHODS: The primary outcome was the effectiveness of the Functional Independence Measure (FIM) during hospitalisation in the ward. Secondary outcomes included the total and subtotal (motor/cognitive) FIM scores at discharge, gain in the total and subtotal (motor/cognitive) FIM scores, K-level at discharge, length of hospital stay in the ward, rehabilitation time, and discharge destination. Outcomes were compared between the non-haemodialysis and haemodialysis groups. RESULTS: A total of 28 patients (mean [standard deviation] age, 67.0 [11.9] years; men, 20) were enrolled in this study. Among them, 11 patients underwent haemodialysis. The FIM effectiveness was significantly higher in the non-haemodialysis group than in the haemodialysis group (median [interquartile range], 0.78 [0.72 - 0.81] vs 0.65 [0.28 - 0.75], p = 0.038). The amount of rehabilitation and all secondary outcomes were not significantly different between the groups (p > 0.05). CONCLUSION: Patients with lower limb amputation who were receiving haemodialysis had poorer FIM effectiveness than those not receiving haemodialysis.
• A novel gait analysis system for detecting abnormal hemiparetic gait patterns during robot-assisted gait training: A criterion validity study among healthy adults.

  Daisuke Imoto, Satoshi Hirano, Masahiko Mukaino, Eiichi Saitoh, Yohei Otaka

  Frontiers in neurorobotics 16 1047376 - 1047376 2022 [Refereed]
   

  INTRODUCTION: Robot-assisted gait training has been reported to improve gait in individuals with hemiparetic stroke. Ideally, the gait training program should be customized based on individuals' gait characteristics and longitudinal changes. However, a gait robot that uses gait characteristics to provide individually tailored gait training has not been proposed. The new gait training robot, "Welwalk WW-2000," permits modification of various parameters, such as time and load of mechanical assistance for a patient's paralyzed leg. The robot is equipped with sensors and a markerless motion capture system to detect abnormal hemiparetic gait patterns during robot-assisted gait training. Thus, it can provide individually tailored gait training. This study aimed to investigate the criterion validity of the gait analysis system in the Welwalk WW-2000 in healthy adults. MATERIALS AND METHODS: Twelve healthy participants simulated nine abnormal gait patterns that were often manifested in individuals with hemiparetic stroke while wearing the robot. Each participant was instructed to perform a total of 36 gait trials, with four levels of severity for each abnormal gait pattern. Fifteen strides for each gait trial were recorded using the markerless motion capture system in the Welwalk WW-2000 and a marker-based three-dimensional (3D) motion analysis system. The abnormal gait pattern index was then calculated for each stride from both systems. The correlation of the index values between the two methods was evaluated using Spearman's rank correlation coefficients for each gait pattern in each participant. RESULTS: Using the participants' index values for each abnormal gait pattern obtained using the two motion analysis methods, the median Spearman's rank correlation coefficients ranged from 0.68 to 0.93, which corresponded to moderate to very high correlation. CONCLUSION: The gait analysis system in the Welwalk WW-2000 for real-time detection of abnormal gait patterns during robot-assisted gait training was suggested to be a valid method for assessing gait characteristics in individuals with hemiparetic stroke. CLINICAL TRIAL REGISTRATION: [https://jrct.niph.go.jp], identifier [jRCT 042190109].
• A novel laparoscopic near-infrared fluorescence spectrum system with indocyanine green fluorescence overcomes limitations of near-infrared fluorescence image-guided surgery.

  Yuma Ebihara, Liming Li, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of minimal access surgery 18 (1) 125 - 128 2022 

  BACKGROUND: Near-infrared (NIR) fluorescence image-guided surgery (FIGS) introduces a revolutionary new approach to address this basic challenge in minimally invasive surgery. However, current FIGS systems have some limitations - the infrared rays cannot detect and visualise thick tissues with low concentrations of the fluorescent agent. We established a novel laparoscopic fluorescence spectrum (LFS) system using indocyanine green (ICG) fluorescence to overcome these limitations. MATERIALS AND METHODS: Bovine serum albumin (BSA) was conjugated to ICG, and the mixtures were serially diluted at 5 × 10-8-5 × 10-1 mg/mL. We used the LFS system and a NIR camera system (NLS; SHINKO OPTICAL CO., LTD Tokyo, Japan) to determine the optical dilution for the fluorescence detection. BSA was conjugated to ICG (5.0 × 10-2 mg/mL) and used to coat the clips. We attempted to identify the fluorescence-coated clip from the serosal side of the cadaveric porcine stomach tissues using the LFS system and the NIR camera system. We measured the depth of the cadaveric porcine stomach wall at the thickest part that could be confirmed. RESULTS: We could not visualise fluorescence concentrations <2.5 × 10-3 mg/mL using the NIR camera system. The spectrum was detected at a concentration <2.5 × 10-3 mg/mL. We were able to identify the spectrum of ICG (829 nm) to a 13-mm depth of cadaveric porcine stomach wall by using the LFS system but could not identify the same with the NIR camera system regardless of wall thickness. CONCLUSIONS: The novel LFS system with NIR fluorescence imaging in this ex vivo and cadaveric porcine model was confirmed useful at deeper depths and lower concentrations. Based on these findings, we anticipate that the LFS system can be integrated and routinely used in minimally invasive surgery.
• Robotic real-time vessel navigation using indocyanine green fluorescence for lymph node dissection along the left gastroepiploic vessels during robotic distal gastrectomy - First experience.

  Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of minimal access surgery 18 (4) 619 - 621 2022 

  Splenic infarction (SI) following gastrectomy is common; severe complications related to SI, such as splenic haemorrhage, abscess formation or rupture, can be fatal. To overcome these problems, we performed real-time vessel navigation using indocyanine green (ICG) fluorescence during robotic distal gastrectomy (RDG). The aim of study is to report the efficacy of robotic real-time vessel navigation for lymph node dissection (LND) along left gastroepiploic vessels (LGEVs). We treated seven patients with gastric cancer who underwent LND along the LGEVs using robotic real-time vessel navigation during RDG at our institution from January 2021 to July 2021. There were no complications (Clavien-Dindo classification II). There were no cases of post-operative SI or spleen-related complications. Robotic real-time vessel navigation using ICG for LND along LGEVs during RDG could help to reduce post-operative spleen-related complications associated with RDG.
• Effective treatment of iatrogenic femoral pseudoaneurysms by combined endovascular balloon inflation and percutaneous thrombin injection.

  Naoki Hayakawa, Satoshi Kodera, Ayako Miyauchi, Satoshi Hirano, Shuichi Sahashi, Noriyuki Ishibashi, Yuhei Kasai, Masataka Arakawa, Sandeep Shakya, Junji Kanda

  Cardiovascular intervention and therapeutics 37 (1) 158 - 166 2022/01 

  The increasing number of percutaneous endovascular procedures in highly anticoagulated patients has increased the possibility of iatrogenic femoral artery pseudoaneurysm (IFAP). Ultrasound (US)-guided percutaneous thrombin injection is one of the feasible treatments; however, there are concerns about complications such as peripheral embolization. This study was performed to examine the efficacy and safety of treatment of IFAPs using a combination of percutaneous thrombin injection and intravascular balloon inflation. In this retrospective, single-center study, we analyzed 11 patients who developed and were treated for IFAPs from January 2017 through April 2020. The patients were treated with endovascular therapy (EVT) with percutaneous thrombin injection. The technique utilized fluoroscopic guidance to place a balloon at the neck of the IFAP, and the balloon was then inflated to prevent the inflow of blood to the aneurysm. We then performed US-guided thrombin injection. The mean age was 72.36 ± 10.43 years; mean body mass index (BMI) was 25.25 ± 3.18. All patients had hypertension, 72.7% were undergoing hemodialysis, and 54.5% used oral anticoagulant drugs. The mean aneurysm size was 24.34 ± 13.54 mm. The approach was transfemoral in ten patients and transradial in one patient. All procedures were successful, and there were no complications. The mean thrombin dose was 677.3 ± 410.7 IU; the total hemostatic time was 45.4 ± 24.9 min. In conclusion, the combination of percutaneous thrombin injection and endovascular balloon inflation was feasible and safe for the treatment of IFAPs. This technique may contribute to the treatment of IFAPs.
• Stroke Patients with Nearly Independent Transfer Ability are at High Risk of Falling.

  Yoshitaka Kato, Shin Kitamura, Masaki Katoh, Asuka Hirano, Yuki Senjyu, Mao Ogawa, Hirofumi Maeda, Masahiko Mukaino, Satoshi Hirano, Hiroaki Sakurai, Seiko Shibata, Yohei Otaka

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 31 (1) 106169 - 106169 2022/01 

  OBJECTIVES: To examine the relationship between patients' transfer ability and fall risk in stroke patients during hospitalization. MATERIALS AND METHODS: We retrospectively enrolled 237 stroke patients who were transferred to a convalescent rehabilitation ward from acute wards in the same hospital. Using incident reports, we investigated their fall rates and activity status at the falls according to their transfer abilities, which were assessed with Functional Independence Measure (FIM) transfer scores. The bi-weekly time trend of fall rates in all patients and in three subgroups based on FIM transfer scores of 1-3, 4-5, and 6-7, and activity status at the falls, were investigated. In addition, changes of patients' transfer ability on admission, at the first fall, and at discharge were investigated among falling patients. RESULTS: The fall rate was the greatest in patients with a FIM transfer score of 4 (14.3 times/1000 person-days). The majority of falls for patients with a FIM transfer score of 1 occurred at the activity status of "on the bed" and "sitting", while three quarters of patients with a FIM score of 7 had falls during "standing" and "walking". No longitudinal trend in fall rates was found overall; however, the fall rate trends differed depending on the FIM transfer score. The majority of the patients who fell required full assistance for transfers upon admission but required no assistance at discharge. CONCLUSIONS: Fall risk differed among patients with various transfer abilities; the greatest risk was in those who needed minimal assistance for transfers.
• [Hyperammonemic encephalopathy after treatment with modified FOLFOX6 regimen for recurrent gastric cancer:a case report].

  Shota Kuwabara, Katsuhiko Murakawa, Kentaro Kumagai, Yuta Takeuchi, Hideyuki Wada, Masaomi Ichinokawa, Joe Matsumoto, Koichi Ono, Satoshi Hirano

  Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 (1) 72 - 78 2022 

  A 64-year-old female received modified FOLFOX6 therapy with continuous administration of a high concentration of 5-fluorouracil (5-FU) for recurrence of peritoneal dissemination after total gastrectomy. Twenty-nine hours after the administration, there was the sudden onset of altered consciousness and hepatic dysfunction accompanied by hyperammonemia. The consciousness and hepatic function improved the following day after treatment with branched-chain amino acid formulation, lactulose, fresh frozen plasma, and continuous hemodiafiltration. Thus, the diagnosis was 5-FU-induced hyperammonemia. Improvement of dehydration and renal dysfunction would be important for avoiding the risk of developing the side effects. Because recurrent gastric cancer is often a progressive condition, post-treatment might be promptly transferred to the other posterior regimen without 5-FU as required.
• Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study.

  Soichiro Koyama, Shigeo Tanabe, Takeshi Gotoh, Yuta Taguchi, Masaki Katoh, Eiichi Saitoh, Yohei Otaka, Satoshi Hirano

  Frontiers in neurorobotics 16 775724 - 775724 2022 

  Wearable robotic exoskeletons (WREs) have been developed from orthoses as assistive devices for gait reconstruction in patients with spinal cord injury. They can solve some problems encountered with orthoses, such as difficulty in independent walking and standing up and high energy consumption during walking. The Wearable Power-Assist Locomotor (WPAL), a WRE, was developed based on a knee-ankle-foot orthosis with a single medial hip joint. The WPAL has been updated seven times during the period from the beginning of its development, in 2005, to 2020. The latest version, launched as a commercialized model in 2016, is available for medical facilities. In this retrospective study, which included updated results from previous reports, all data were extracted from development research records from July 2007 to December 2020. The records were as follows: patient characteristics [the number of participants, injury level, and the American Spinal Injury Association Impairment Scale (AIS) score], the total number of WPAL trials when aggregating the cases with all the versions or only the latest version of the WPAL, and maximum walking performance (functional ambulation category [FAC], distance, and time of continuous walking). Thirty-one patients participated in the development research. The levels of spinal cord injury were cervical (C5-C8), upper thoracic (T3-T6), lower thoracic (T7-T12), and lumbar (L1) in 10, 5, 15, and 1 of the patients, respectively. The numbers of patients with AIS scores of A, B, C, and D were 20, 7, 4, and 0, respectively. The total number of WPAL trials was 1,785, of which 1,009 were used the latest version of the WPAL. Twenty of the patients achieved an FAC score of 4 after an average of 9 (median 8, range 2-22) WPAL trials. The continuous walking distance and time improved with the WPAL were compared to the orthosis. We confirmed that the WPAL improves walking independence in people with a wide range of spinal cord injuries, such as cervical spinal cord injuries. Further refinement of the WPAL will enable its long-term use at home.
• Impact of the suboptimal communication network environment on telerobotic surgery performance and surgeon fatigue.

  Harue Akasaka, Kenichi Hakamada, Hajime Morohashi, Takahiro Kanno, Kenji Kawashima, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori

  PloS one 17 (6) e0270039  2022 

  BACKGROUND: Remote surgery social implementation necessitates achieving low latency and highly reliable video/operation signal transmission over economical commercial networks. However, with commercial lines, communication bandwidth often fluctuates with network congestion and interference from narrowband lines acting as bottlenecks. Therefore, verifying the effects on surgical performance and surgeon fatigue when communication lines dip below required bandwidths are important. OBJECTIVES: To clarify the communication bandwidth environment effects on image transmission and operability when bandwidth is lower than surgical robot requirements, and to determine surgeon fatigue levels in suboptimal environments. METHODS: Employing a newly developed surgical robot, a commercial IP-VPN line connected two hospitals 150 km apart. Thirteen surgical residents remotely performed a defined suturing procedure at 1-Gbps to 3-Mbps bandwidths. Communication delay, packet loss, time-to-task completion, forceps-movement distance, video degradation, and robot operability were evaluated before and after bandwidth changes. The Piper Fatigue Score-12 (PFS-12) was used to measure fatigue associated with surgeon performance. RESULTS: Roundtrip communication time for both 1-Gbps and 3-Mbps lines averaged 4 ms. Video transmission delay from camera to monitor was comparable, at 92 ms. Surgical robot signal transmission rate averaged 5.2 Mbps, so changing to 1-Gbps-3-Mbps lines resulted in significant packet loss. Surgeons perceived significant roughness, image distortion, diplopia, and degradation of 3D images (p = 0.009), but not changes in delay time or maneuverability. All surgeons could complete tasks, but objective measurement of task-completion time and forceps-travel distance were significantly prolonged (p = 0.013, p = 0,041). Additionally, PFS-12 showed post-procedure fatigue increase at both 1-Gbps and 3-Mbps. Fatigue increase was significant at 3-Mbps (p = 0.041). CONCLUSIONS: In remote surgery environments with less than the optimal bandwidth, even when delay time and operability are equivalent, reduced surgical performance occurs from video degradation from packet loss. This may cause increased surgeon fatigue.
• Development of a simple mechanical measurement method to measure spasticity based on an analysis of a clinical maneuver and its concurrent validity with the modified Ashworth scale.

  Hiroki Tanikawa, Masahiko Mukaino, Shota Itoh, Hikaru Kondoh, Kenta Fujimura, Toshio Teranishi, Kei Ohtsuka, Satoshi Hirano, Hitoshi Kagaya, Eiichi Saitoh, Yohei Otaka

  Frontiers in bioengineering and biotechnology 10 911249 - 911249 2022 

  Background: Despite recent developments in the methodology for measuring spasticity, the discriminative capacity of clinically diagnosed spasticity has not been well established. This study aimed to develop a simple device for measuring velocity-dependent spasticity with improved discriminative capacity based on an analysis of clinical maneuver and to examine its reliability and validity. Methods: This study consisted of three experiments. First, to determine the appropriate motion of a mechanical device for the measurement of velocity-dependent spasticity, the movement pattern and the angular velocity used by clinicians to evaluate velocity-dependent spasticity were investigated. Analysis of the procedures performed by six physical therapists to evaluate spasticity were conducted using an electrogoniometer. Second, a device for measuring the resistance force against ankle dorsiflexion was developed based on the results of the first experiment. Additionally, preliminary testing of validity, as compared to that of the Modified Ashworth Scale (MAS), was conducted on 17 healthy participants and 10 patients who had stroke with spasticity. Third, the reliability of the measurement and the concurrent validity of mechanical measurement in the best ankle velocity setting were further tested in a larger sample comprising 24 healthy participants and 32 patients with stroke. Results: The average angular velocity used by physical therapists to assess spasticity was 268 ± 77°/s. A device that enabled the measurement of resistance force at velocities of 300°/s, 150°/s, 100°/s, and 5°/s was developed. In the measurement, an angular velocity of 300°/s was found to best distinguish patients with spasticity (MAS of 1+ and 2) from healthy individuals. A measurement of 300°/s in the larger sample differentiated the control group from the MAS 1, 1+, and 2 subgroups (p < 0.01), as well as the MAS 1 and 2 subgroups (p < 0.05). No fixed or proportional bias was observed in repeated measurements. Conclusion: A simple mechanical measurement methodology was developed based on the analysis of the clinical maneuver for measuring spasticity and was shown to be valid in differentiating the existence and extent of spasticity. This study suggest possible requirements to improve the quality of the mechanical measurement of spasticity.
• Maximum acceptable communication delay for the realization of telesurgery.

  Akitoshi Nankaku, Masanori Tokunaga, Hiroki Yonezawa, Takahiro Kanno, Kenji Kawashima, Kenichi Hakamada, Satoshi Hirano, Eiji Oki, Masaki Mori, Yusuke Kinugasa

  PloS one 17 (10) e0274328  2022 

  AIM: To determine acceptable limits of communication delays in telesurgery, we investigated the impact of communication delays under a dynamic environment using a surgical assist robot. Previous studies have evaluated acceptable delays under static environments. Effects of delays may be enhanced in dynamic environments, but studies have not yet focused on this point. METHODS: Thirty-four subjects with different surgical experience (Group1: no surgical experience; Group2: only laparoscopic surgical experience; Group3: robotic surgery experience) performed 4 tasks under different delays (0, 70, 100, 150, 200, or 300 ms) using a surgical assist robot. Task accomplishment time and total movement distance of forceps were recorded and compared under different communication delays of 0-300 ms. In addition, surgical performance was compared between Group1or Group2 without delay and Group3 with communication delays. RESULTS: Significant differences in task accomplishment time were found between delays of 0 and 70 ms, but not between delays of 70 and 100 ms. Thereafter, the greater the communication delay, the longer the task accomplishment time. Similar results were obtained in total movement distance of forceps. Comparisons between Group3 with delay and Group1 or Group2 without delay demonstrated that surgical performance in Group3 with delay was superior or equal to that of Group1 or Group2 without delay as long as the delay was 100 ms or less. CONCLUSIONS: Communication delays in telesurgery may be acceptable if 100 ms or less. Experienced surgeons with more than 100 ms of delay could outperform less-experienced surgeons without delay.
• Rehabilitation of a Patient with COVID-19 Who Underwent Right Transfemoral Amputation Due to Acute Limb Ischemia: A Case Report.

  Yoshitaka Wada, Satoshi Hirano, Ayaka Kumagai, Kaori Takeuchi, Ryosuke Inagaki, Hiroshi Hosokawa, Hirofumi Maeda, Seiko Shibata, Yohei Otaka

  Progress in rehabilitation medicine 7 20220052 - 20220052 2022 

  Background: Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic complications. Nonetheless, there is a paucity of clinical knowledge regarding rehabilitation of patients with COVID-19 after lower-limb amputation. Case: A 74-year-old woman with COVID-19 was admitted to a university hospital. During hospitalization, she underwent right transfemoral amputation due to acute limb ischemia. Three months after admission, the patient was transferred to a convalescent rehabilitation ward in the same hospital. A femoral prosthesis was prescribed 2 weeks after her transfer to the rehabilitation ward. It featured ischial-ramal containment with a soft liner and belt suspension, 668-g multiple linkage-type safety knee joint (Imasen Engineering; M0781 SwanS), and a solid-ankle cushioned-heel foot. The total rehabilitation time during the patient's stay in the acute-care and rehabilitation wards was 65.5 h (0.99 h/day, 66 days) and 275.0 h (3.02 h/day, 91 days), respectively. In the rehabilitation ward, the patient underwent 54.4 h (19.8%) of muscle strength training, 48.1 h (17.5%) of comprehensive assessments, and 47.1 h (17.1%) of gait training. The patient was discharged home 6 months after admission, with a total Functional Independence Measure score of 120. The patient could walk slowly [44.2 s (0.23 m/s) in the 10 m-walk test] with a femoral prosthesis and a quad cane but exhibited limited endurance (75.0 m in the 6-min walk test). Discussion: Following appropriate rehabilitation, a patient was able to walk independently after lower-limb amputation despite the complication of COVID-19, although her walking ability was limited.
• 地域基幹病院における高難度鏡視下手術の安全な実践と後進への教育について 科学的プロセスに基づいた内視鏡外科手術技能評価による教育・アウトカム予測の意義

  倉島 庸, サシーム・パウデル, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 26 (7) CSY11 - 1 1344-6703 2021/12
• 【Conversion surgeryアップデート】がん種別の最新動向 肝内胆管癌に対するconversion surgery

  野路 武寛, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭佑, 平野 聡

  臨床外科 (株)医学書院 76 (13) 1498 - 1504 0386-9857 2021/12 

  ＜文献概要＞ポイント ◆肝内胆管癌の非切除適応は,患者因子・局所進展度などにより決定されるが,リンパ節転移・局所進展度に対する画像診断所見の正診率は低い.◆胆道癌および肝内胆管癌に対するconversion surgery術後の長期成績は良好である可能性が報告されているが,エビデンスは確立されていない.◆肝内胆管癌に対するconversion surgeryの安全性は確立しておらず,適応は慎重であるべきである.
• 胸腔鏡手術の教育と技術評価 食道外科手術におけるCadaver Surgical Training

  七戸 俊明, 岡村 圭祐, 土川 貴裕, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 野路 武寛, 浅野 賢道, 中西 喜嗣, 田中 公貴, 渡邊 祐介, 松井 あや, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 26 (7) PD12 - 6 1344-6703 2021/12
• エネルギーデバイスで発生するサージカルスモークの新知見

  近藤 彰宏, 渡邊 祐介, 石田 稔, 岡野 圭一, 鈴木 康之, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 26 (7) SP11 - 2 1344-6703 2021/12
• Targeted amplicon sequencing for primary tumors and matched lymph node metastases in patients with extrahepatic cholangiocarcinoma.

  Toru Yamada, Yoshitsugu Nakanishi, Hideyuki Hayashi, Shigeki Tanishima, Ryo Mori, Kyoko Fujii, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Yusuke Watanabe, Yo Kurashima, Yuma Ebihara, Soichi Murakami, Toshiaki Shichinohe, Tomoko Mitsuhashi, Satoshi Hirano

  HPB : the official journal of the International Hepato Pancreato Biliary Association 24 (7) 1035 - 1043 2021/11/25 

  BACKGROUND: Lymph node metastasis (LNM) is one of the most adverse prognostic factors in extrahepatic cholangiocarcinoma (EHCC) cases. As next-generation sequencing technology has become more widely available, the genomic profile of biliary tract carcinoma has been clarified. However, whether LNMs have additional genomic alterations in patients with EHCC has not been investigated. Here, we aimed to compare the genomic alterations between primary tumors and matched LNMs in patients with EHCC. METHODS: Sixteen patients with node-positive EHCCs were included. Genomic DNA was extracted from tissue samples of primary tumors and matched LNMs. Targeted amplicon sequencing of 160 cancer-related genes was performed. RESULTS: Among the 32 tumor samples from 16 patients, 91 genomic mutations were identified. Genomic mutations were noted in 31 genes, including TP53, MAP3K1, SMAD4, APC, and ARID1A. TP53 mutations were most frequently observed (12/32; 37.5%). Genomic mutation profiles were highly concordant between primary tumors and matched LNMs (13/16; 81.3%), and an additional genomic mutation of CDK12 was observed in only one patient. CONCLUSION: Genomic mutations were highly concordant between primary tumors and matched LNMs, suggesting that genotyping of archived primary tumor samples may help predict genomic mutations of metastatic tumors in patients with EHCC.
• Correction to: Clinical and oncological benefits of left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma.

  Yoshitsugu Nakanishi, Satoshi Hirano, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Yusuke Watanabe, Toshiaki Shichinohe

  Surgery today 52 (5) 853 - 853 2021/11/18
• Laparoscopic approach as a safe and effective option for incarcerated femoral hernias.

  Ryo Okazaki, Saseem Poudel, Yuma Hane, Takahiro Saito, Jun Muto, Yasuhito Syoji, Ryunosuke Hase, Naoto Senmaru, Satoshi Hirano

  Asian journal of endoscopic surgery 15 (2) 328 - 334 2021/11/08 

  INTRODUCTION: The laparoscopic approach for elective femoral herniorrhaphy is well established. However, femoral hernias often present as incarcerations and require emergency repair surgery, mainly using the open approach. This study aimed to retrospectively analyze the efficacy of the laparoscopic approach for incarcerated femoral hernias. METHODS: Data of patients who underwent emergency surgery for incarcerated femoral hernia between April 2016 and August 2021 were retrospectively analyzed. Laparoscopy was performed whenever possible; however, conversion to an open approach remained a fallback option for when laparoscopic repair was not possible. In laparoscopic repair, incarcerated femoral hernias reduced using traction, water pressure, and preperitoneal methods. Data of patients who underwent open repair and laparoscopy were then compared. RESULTS: During the observation period, 20 patients underwent emergency surgery for incarcerated femoral hernia. Eleven patients subsequently underwent repair using a laparoscopic approach, and eight underwent repair using an open approach. Only one patient underwent intestinal resection without hernia repair due to perforated bowel. Operative time for laparoscopic repair was longer. Mesh repair was performed in 18 patients. Four patients each in the laparoscopic repair and open group required intestinal resection. CONCLUSION: Incarcerated femoral hernias can be safely repaired using the laparoscopic approach.
• 再発胆道癌に対する積極的外科切除の成績

  野路 武寛, 松井 あや, 田中 公貴, 中西 喜嗣, 渡邉 祐介, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 川本 泰之, 桑谷 将城, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 54 (Suppl.2) 155 - 155 0386-9768 2021/11
• 心停止に至った胃蜂窩織炎の1救命例

  東嶋 宏泰, 村上 壮一, 池田 篤, 渡邊 祐介, 倉島 庸, 海老原 裕磨, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 11 (1) 112 - 112 2021/11
• 【Challenge to Change】外科医と救急医の連携 当院における外科医と救急医の良好な連携について

  村上 壮一, 廣瀬 和幸, 東嶋 宏泰, 出口 琢人, 渡邊 祐介, 倉島 庸, 海老原 裕磨, 七戸 俊明, 早川 峰司, 平野 聡

  日本救急医学会雑誌 (一社)日本救急医学会 32 (12) 1234 - 1234 0915-924X 2021/11
• ACSにおける鏡視下手術の意義 ACSにおける鏡視下手術の適応と課題

  七戸 俊明, 村上 壮一, 海老原 裕磨, 倉島 庸, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 中西 喜嗣, 松井 あや, 田中 公貴, 渡邊 祐介, 池田 篤, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 11 (1) 88 - 88 2021/11
• 初療室開腹を行った腹部刺創の1例

  新堂 大我, 村上 壮一, 富田 明子, 早川 峰司, 松井 あや, 出口 琢人, 東嶋 宏泰, 池田 篤, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 11 (1) 124 - 124 2021/11
• 重症膵炎・十二指腸穿孔で発症したPetersenヘルニアによる輸入脚症候群の1例

  武田 真太郎, 村上 壮一, 松井 あや, 出口 琢人, 東嶋 宏泰, 石堂 敬太, 宮谷内 健吾, 池田 篤, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 11 (1) 124 - 124 2021/11
• 再発胆道癌に対する積極的外科切除の成績

  野路 武寛, 松井 あや, 田中 公貴, 中西 喜嗣, 渡邉 祐介, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 川本 泰之, 桑谷 将城, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 54 (Suppl.2) 155 - 155 0386-9768 2021/11
• Effect of tongue-hold swallow on posterior pharyngeal wall using dynamic area detector computed tomography.

  Keiko Aihara, Yoko Inamoto, Daisuke Kanamori, Marlís González-Fernández, Seiko Shibata, Hitoshi Kagaya, Satoshi Hirano, Hiroko Kobayashi, Naoko Fujii, Eiichi Saitoh

  Journal of oral rehabilitation 48 (11) 1235 - 1242 2021/11 

  PURPOSE: The purpose of this study was to elucidate the effects of the tongue-hold swallow (THS) on the pharyngeal wall by quantifying posterior pharyngeal wall (PPW) anterior bulge during the THS. In addition, the effect of tongue protrusion length on the extent of pharyngeal wall anterior bulge was analysed. METHODS: Thirteen healthy subjects (6 males and 7 females, 23-43 years) underwent 320-row area detector CT during saliva swallow (SS) and THS at two tongue protrusion lengths (THS1 protrude the tongue as much as 1/3 of premeasured maximum tongue protrusion length (MTP-L) and THS2 protrude the tongue as much as 2/3 of MTP-L). To acquire images of the pharynx at rest, single-phase volume scanning was performed three times during usual breathing with no tongue protrusion (rest), protrusion of the tongue at 1/3 of MTP-L (rTHS1) and protrusion of the tongue at 2/3 of MTP-L (rTHS2). Length from cervical spine to PPW (PPW-AP) and the volume of pharyngeal cavity was measured and was compared between rest, rTHS1 and rTHS2 and between SS, THS1 and THS2. Correlation between MTP-L and PPW-AP was calculated in three conditions, SS, THS1 and THS2. RESULTS: PPW-AP at rest, rTHS1 and rTHS2 was 2.9 ± 0.6 mm, 3.0 ± 0.5 mm and 3.0 ± 0.5 mm, respectively, showing no significant differences across swallows. PPW-AP at the maximum pharyngeal constriction was 8.1 ± 2.0 mm, 9.1 ± 2.4 mm and 8.7 ± 2.0 mm in SS, THS1 and THS2, respectively. Compared to SS, PPW-AP in THS1 was significantly larger (p = 0.04) and PPW-AP in THS2 was not significantly different (p = 0.09). Pharyngeal volume at rest, rTHS1 and rTHS2 was 16.4 ± 5.2 mm3 , 18.4 ± 4.5 mm3 and 21.3 ± 6.2 mm3 , respectively. It was significantly larger during rTHS2 compared with rest or rTHS1 (rTHS2-rest p = 0.007, rTHS2-rTHS1 p = 0.007). Pharyngeal volume was completely obliterated (zero volume) at maximum pharyngeal contraction in all except one subject. There was no correlation between MTP-L and PPW-AP in any of the three conditions (SS, THS1 and THS2). DISCUSSION: This study demonstrated that the expanded pharyngeal cavity due to the tongue protrusion was completely obliterated by the increase in anterior motion of pharyngeal wall during THS. It also became clear that the degree of tongue protrusion did not linearly correlate with the movement of PPW during THS. There was no relationship between PPW motion and the MTP-L, suggesting that the effect of tongue protrusion is better determined in each subject by analysing the motion of PPW using imaging tools.
• Clinical and oncological benefits of left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma.

  Yoshitsugu Nakanishi, Satoshi Hirano, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Yusuke Watanabe, Toshiaki Shichinohe

  Surgery today 52 (5) 844 - 852 2021/11/01 

  PURPOSE: This retrospective study aimed to clarify whether the postoperative prognosis differs between right and left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma. METHODS: Preoperative images of 195 patients with perihilar cholangiocarcinoma were reexamined. Patients with Bismuth type I/II perihilar cholangiocarcinoma without a difference in extraductal tumor invasion between the right and left sides of the hepatic portal region were classified into those undergoing left (L group) or right (R group) hepatectomy. RESULTS: Twenty-three patients (11.8%) were classified into the L group and 33 (16.9%) into the R group. All eight patients with pTis/1 belonged to the L group. The L group had significantly less liver failure than the R group (p = 0.001). One patient (4.3%) in the L group and four patients (12.1%) in the R group died from postoperative complications. Among 48 patients with pT2, the L group tended to have better overall survival (median, 12.2 vs. 5.6 years; p = 0.072), but not recurrence-free survival (median, 9.1 vs. 3.6 years; p = 0.477), in comparison to the R group. CONCLUSIONS: Postoperative survival after left hepatectomy for Bismuth type I/II perihilar cholangiocarcinoma is expected to be as long as that after right hepatectomy.
• Perihilar Cholangiocarcinoma - Novel Benchmark Values for Surgical and Oncological Outcomes From 24 Expert Centers.

  Matteo Mueller, Eva Breuer, Takashi Mizuno, Fabian Bartsch, Francesca Ratti, Christian Benzing, Noémie Ammar-Khodja, Teiichi Sugiura, Tsukasa Takayashiki, Amelia Hessheimer, Hyung Sun Kim, Andrea Ruzzenente, Keun Soo Ahn, Tiffany Wong, Jan Bednarsch, Mizelle D'Silva, Bas Groot Koerkamp, Heithem Jeddou, Victor López-López, Charles de Ponthaud, Jennifer A Yonkus, Warsan Ismail, Lynn E Nooijen, Camila Hidalgo-Salinas, Elissaios Kontis, Kim C Wagner, Ganesh Gunasekaran, Ryota Higuchi, Ana Gleisner, Chaya Shwaartz, Gonzalo Sapisochin, Richard D Schulick, Masakazu Yamamoto, Takehiro Noji, Satoshi Hirano, Myron Schwartz, Karl J Oldhafer, Andreas Prachalias, Giuseppe K Fusai, Joris I Erdmann, Pål-Dag Line, Rory L Smoot, Olivier Soubrane, Ricardo Robles-Campos, Karim Boudjema, Wojciech G Polak, Ho-Seong Han, Ulf P Neumann, Chung-Mau Lo, Koo Jeong Kang, Alfredo Guglielmi, Joon Seong Park, Constantino Fondevila, Masayuki Ohtsuka, Katsuhiko Uesaka, René Adam, Johann Pratschke, Luca Aldrighetti, Michelle L De Oliveira, Gregory J Gores, Hauke Lang, Masato Nagino, Pierre-Alain Clavien

  Annals of surgery 274 (5) 780 - 788 2021/11/01 

  OBJECTIVE: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons. BACKGROUND: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking. METHODS: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014-2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers. RESULTS: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes. CONCLUSION: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.
• Aberrant expression of MYD88 via RNA-controlling CNOT4 and EXOSC3 in colonic mucosa impacts generation of colonic cancer.

  Masumi Tsuda, Misa Noguchi, Tsuyoshi Kurai, Yuji Ichihashi, Koki Ise, Lei Wang, Yusuke Ishida, Mishie Tanino, Satoshi Hirano, Masahiro Asaka, Shinya Tanaka

  Cancer science 112 (12) 5100 - 5113 2021/10/08 

  In 2020, the worldwide incidence and mortality of colorectal cancer (CRC) were third and second, respectively. Since the five-year survival rate is low when CRC is diagnosed at an advanced stage, a reliable method to predict CRC susceptibility is important for preventing the onset and development and improving the prognosis of CRC. Therefore, we focused on the normal colonic mucosa to investigate alterations in gene expression that may induce subsequent genetic alterations that induce malignant transformation. Comprehensive gene expression profiling in the normal mucosa adjacent to colon cancer (CC) compared to tissue from noncolon cancer (NCC) patients was performed. PCR arrays and qRT-PCR revealed that the expression of five genes involved in the immune response, including MYD88, was increased in the normal mucosa of CC patients. The expression levels of MYD88 were strikingly increased in precancerous normal mucosa specimens, which harbored no somatic mutations, as shown by immunohistochemistry (IHC). Microarray analysis identified two novel RNA-controlling molecules, EXOSC3 and CNOT4, that were significantly upregulated in the normal mucosa of CC patients and were clearly visualized in the nuclei. Forced expression of EXOSC3 and CNOT4 in human colonic epithelial cells increased the expression of IFNGR1, MYD88, NFκBIA, and STAT3 and activated ERK1/2 and JNK in 293T cells. Taken together, these results suggest that in the inflamed mucosa, EXOSC3- and CNOT4-mediated RNA stabilization, including that of MYD88, may trigger the development of cancer and can serve as a potential predictive marker and innovative treatment to control cancer development.
• 切除不能膵癌に対するConversion surgeryのタイミング 切除不能膵癌に対する集学的治療におけるconversion surgeryの功罪

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S253 - S253 1345-2843 2021/10
• 医学生に対する臨床輸液・栄養教育

  村上 壮一, 七戸 俊明, 武田 宏司, 池田 陽子, 熊谷 聡美, 平野 聡

  学会誌JSPEN (一社)日本臨床栄養代謝学会 3 (Suppl.1) 843 - 843 2021/10
• 胆管内腫瘍栓を形成した肝門部胆管癌の1例

  倉谷 友崇, 松井 あや, 野路 武寛, 田中 公貴, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭佑, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (10) 1940 - 1940 1345-2843 2021/10
• 外科修練医は何を求めてるのか? 日本外科学会専門医取得に関する全国アンケート調査から

  橋本 大輔, 里井 壯平, 関本 貢嗣, サシーム・パウデル, 倉島 庸, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S62 - S62 1345-2843 2021/10
• 切除不能膵癌に対するConversion surgeryのタイミング 切除不能膵癌に対する集学的治療におけるconversion surgeryの功罪

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S253 - S253 1345-2843 2021/10
• Acute Care Surgeryにおける開胸開腹手術vs内視鏡下手術 当教室における特発性食道破裂に対する左胸腔・腹腔同時アプローチ(Minimally-invasive Abdominal and Left Thoracic Approach;MALTA)を用いた鏡視下手術について

  海老原 裕磨, 村上 壮一, 倉島 庸, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S432 - S432 1345-2843 2021/10
• 胃原発絨毛癌と巨大転移性肝腫瘍に対して幽門側胃切除と肝区域切除を二期的に施行した一例

  依田 卓也, 鈴木 善法, 宮坂 衛, 櫛引 敏寛, 才川 大介, 山村 喜之, 川原田 陽, 北城 秀司, 奥芝 俊一, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S1272 - S1272 1345-2843 2021/10
• 商用回線を用いた遠隔手術の実証研究

  諸橋 一, 袴田 健一, 赤坂 治枝, 海老原 裕磨, 沖 英次, 平野 聡, 森 正樹

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S12 - S12 1345-2843 2021/10
• 日本製ロボット手術支援システムを用いた遠隔操作の初期検討

  沖 英次, 海老原 裕磨, 諸橋 一, 南角 哲俊, 安藤 幸滋, 徳永 正則, 絹笠 祐介, 袴田 健一, 平野 聡, 森 正樹

  日本臨床外科学会雑誌 日本臨床外科学会 82 (増刊) S13 - S13 1345-2843 2021/10
• Long-term survival after repetitive lymphadenectomy for nodal recurrence of pancreatic neuroendocrine neoplasms: a report of two cases.

  Yuma Hane, Takahiro Tsuchikawa, Satoshi Takeuchi, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Yuma Ebihara, Soichi Murakami, Toru Nakamura, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Journal of surgical case reports 2021 (10) rjab446  2021/10 

  Pancreatic neuroendocrine neoplasms (PNENs) are rare, but their incidence has increased in recent years. Curative surgery is recommended in several global guidelines for resectable PNENs. Lymph node recurrence after R0 resection for PNENs is infrequent, and global guidelines recommend surgical resection for recurrence, if resectable. However, data on the prognosis after surgical resection for nodal recurrence of PNENs are limited. We herein report two cases in which long-term survival was achieved after repetitive lymphadenectomy for nodal recurrence of PNENs. In both cases, the pathological findings for primary PNEN showed well-differentiated neuroendocrine neoplasms and R0 resection was successfully performed. The Ki-67 index increased with each resection in both cases. Both patients showed long-term survival (10 and 14 years, respectively). Repetitive lymphadenectomy for nodal recurrence of PNENs may improve patient prognosis.
• Effects of preoperative psoas muscle index and body mass index on postoperative outcomes after video-assisted esophagectomy for esophageal cancer.

  Shion Uemura, Toshiaki Shichinohe, Yo Kurashima, Yuma Ebihara, Soichi Murakami, Satoshi Hirano

  Asian journal of endoscopic surgery 14 (4) 739 - 747 2021/10 

  INTRODUCTION: Preoperative psoas muscle index (PMI) and body mass index (BMI) are relevant to postoperative outcomes. We investigated the associations of PMI, BMI, and preoperative nutritional and muscular score with postoperative outcomes in patients with esophageal cancer who underwent video-assisted surgery. METHODS: We examined 150 patients (124 men, 26 women) who underwent video-assisted esophagectomy from February 2002 to March 2016. We used the Clavien-Dindo (CD) classification to analyze postoperative complications. Because skeletal muscle volume differs significantly between male and female patients, all analyses were performed separately. In male patients, we used the following cut-off values to categorize patients into three groups: PMI = 600 mm2 /m2 , BMI = 18.5 kg/m2 , and preoperative nutritional and muscular (PNM) scores 0 to 2. RESULTS: Two patients were converted to open thoracotomy. Among male patients, PMI and PNM scores were significant risk factors for complications. Among male patients, in the high PMI group, the number of CD ≥ IIIa complications was significantly lower. In the PNM score 0 group (both PMI and BMI values exceeded the cut-off values), the number of complications was significantly lower. In both genders, PMI and BMI were not significantly associated with survival. CONCLUSIONS: PMI and PNM scores can be useful for predicting postoperative outcomes in male patients with esophageal cancer having undergone video-assisted surgery.
• JNETS clinical practice guidelines for gastroenteropancreatic neuroendocrine neoplasms: diagnosis, treatment, and follow-up: a synopsis.

  Tetsuhide Ito, Toshihiko Masui, Izumi Komoto, Ryuichiro Doi, Robert Y Osamura, Akihiro Sakurai, Masafumi Ikeda, Koji Takano, Hisato Igarashi, Akira Shimatsu, Kazuhiko Nakamura, Yuji Nakamoto, Susumu Hijioka, Koji Morita, Yuichi Ishikawa, Nobuyuki Ohike, Atsuko Kasajima, Ryoji Kushima, Motohiro Kojima, Hironobu Sasano, Satoshi Hirano, Nobumasa Mizuno, Taku Aoki, Takeshi Aoki, Takao Ohtsuka, Tomoyuki Okumura, Yasutoshi Kimura, Atsushi Kudo, Tsuyoshi Konishi, Ippei Matsumoto, Noritoshi Kobayashi, Nao Fujimori, Yoshitaka Honma, Chigusa Morizane, Shinya Uchino, Kiyomi Horiuchi, Masanori Yamasaki, Jun Matsubayashi, Yuichi Sato, Masau Sekiguchi, Shinichi Abe, Takuji Okusaka, Mitsuhiro Kida, Wataru Kimura, Masao Tanaka, Yoshiyuki Majima, Robert T Jensen, Koichi Hirata, Masayuki Imamura, Shinji Uemoto

  Journal of gastroenterology 56 (11) 1033 - 1044 2021/09/29 

  Neuroendocrine neoplasms (NENs) are rare neoplasms that occur in various organs and present with diverse clinical manifestations. Pathological classification is important in the diagnosis of NENs. Treatment strategies must be selected according to the status of differentiation and malignancy by accurately determining whether the neoplasm is functioning or nonfunctioning, degree of disease progression, and presence of metastasis. The newly revised Clinical Practice Guidelines for Gastroenteropancreatic Neuroendocrine Neoplasms (GEP-NENs) comprises 5 chapters-diagnosis, pathology, surgical treatment, medical and multidisciplinary treatment, and multiple endocrine neoplasia type 1 (MEN1)/von Hippel-Lindau (VHL) disease-and includes 51 clinical questions and 19 columns. These guidelines aim to provide direction and practical clinical content for the management of GEP-NEN preferentially based on clinically useful reports. These revised guidelines also refer to the new concept of "neuroendocrine tumor" (NET) grade 3, which is based on the 2017 and 2019 WHO criteria; this includes health insurance coverage of somatostatin receptor scintigraphy for NEN, everolimus for lung and gastrointestinal NET, and lanreotide for GEP-NET. The guidelines also newly refer to the diagnosis, treatment, and surveillance of NEN associated with VHL disease and MEN1. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the first edition was published.
• Laparoscopic approach for surgical treatment of pleuroperitoneal communication interfering with peritoneal dialysis: a case report.

  Satoko Yorinaga, Takehiro Maki, Noriko Kawai, Hiroyuki Kaneko, Kenjiro Misu, Hitoshi Inomata, Makoto Omi, Satoshi Hirano

  Surgical case reports 7 (1) 217 - 217 2021/09/28 

  BACKGROUND: Pleuroperitoneal communication is a rare disorder that interferes with peritoneal dialysis. Although favorable results of thoracoscopic fistula closure have been reported, there are some cases in which the fistulas cannot be identified by thoracoscopy and the patients are forced to switch to hemodialysis. CASE PRESENTATION: We present two cases of pleuroperitoneal communication in which diaphragmatic fistulas could not be identified thoracoscopically, but could be identified laparoscopically. Patient 1 had difficulty continuing peritoneal dialysis 9 months after its introduction due to right pleural effusion. Although we could not detect the fistula thoracoscopically, we could laparoscopically identify the fistula in the center of the tendon of the right diaphragm and closed the site from the thoracic side. Patient 2 developed dyspnea due to right pleural effusion 6 months after the introduction of peritoneal dialysis. We could not find the fistulas with a thoracoscopic approach, but could identify multiple diaphragmatic fistulas with a laparoscopic approach and close the sites from the thoracic side. CONCLUSION: In the surgical treatment of pleuroperitoneal communication, diaphragmatic fistulas can be identified laparoscopically even when thoracoscopic observation fails to find any fistulas.
• The assessment of risk factors for postoperative delirium using cubic spline curves in gastroenterological surgery.

  Yuki Okawa, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yuma Ebihara, Yo Kurashima, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgery today 51 (12) 1969 - 1977 2021/09/25 

  PURPOSE: Delirium is associated with longer hospital stays and increased medical costs and mortality. This study explored the risk factors for postoperative delirium in gastroenterological surgery and investigated the association between qualitative changes in risk factors and the incidence of postoperative delirium. METHODS: A total of 418 patients > 18 years old who underwent gastroenterological surgery at our department between April 2018 and September 2019 were included. Risk factors were identified by comparing patients with and without postoperative delirium. Continuous variables were evaluated graphically using cubic spline curves. A logistic regression analysis was performed to assess independent risk factors. RESULTS: The incidence of postoperative delirium was 6.9%. The cubic spline curve showed that the incidence of postoperative delirium began to increase at 50 years old and increased sharply at 70 years old. A multiple logistic regression analysis of patients > 50 years old identified 5 risk factors: age ≥ 70 years, preoperative serum albumin ≤ 3.8 g/dL, psychosis, sedative-hypnotics, and intensive-care unit admission. CONCLUSION: The risk of postoperative delirium increases progressively at 50 years old and sharply at 70 years old. Advanced age, preoperative hypoalbuminemia, psychosis, sedative-hypnotics, and intensive-care unit admission are risk factors for postoperative delirium in patients > 50 years old undergoing gastroenterological surgery.
• A Multicenter Retrospective Study Comparing Surgical Outcomes Between the Overlap Method and Functional Method for Esophagojejunostomy in Laparoscopic Total Gastrectomy: Analysis Using Propensity Score Matching.

  Yuma Ebihara, Yo Kurashima, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Yoshihiro Murakami, Katsuhiko Murakawa, Fumitaka Nakamura, Takayuki Morita, Shunichi Okushiba, Toshiaki Shichinohe, Satoshi Hirano

  Surgical laparoscopy, endoscopy & percutaneous techniques 32 (1) 89 - 95 2021/09/21 

  BACKGROUND: This study aimed to compare the postoperative outcomes after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using the overlap method or the functional method in a multicenter retrospective study with propensity score matching. METHODS: We retrospectively enrolled all patients who underwent curative LTG for gastric cancer at 6 institutions between January 2004 and December 2018. Patients were categorized into the overlap group (OG) or functional group (FG) based on the type of anastomosis used in EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. The surgical results and postoperative outcomes were compared. RESULTS: We identified 69 propensity score-matched pairs among 440 patients who underwent LTG. There was no significant between-group difference in the median operative time, intraoperative blood, or number of lymph nodes resected. In terms of postoperative outcomes, the rates of all complications [Clavien-Dindo (CD) classification ≥II; OG 13.0 vs. FG 24.6%, respectively; P=0.082], complications more severe than CD grade III (OG 8.7 vs. FG 18.8%, respectively; P=0.084), and the occurrence of EJS leakage and stenosis more severe than CD grade III (OG 7.3% vs. FG 2.9%, P=0.245; OG 1.5 vs. FG 8.7%, P=0.115, respectively) were comparable. The median follow-up period was 830 days (range, 18 to 3376 d), and there were no differences in overall survival between the 2 groups. CONCLUSIONS: There was no difference in surgical outcomes and overall survival based on the type of anastomosis used for EJS after LTG. Therefore, selection of anastomosis in EJS should be based on each surgeon's preference and experience.
• Short-term outcomes of robotic distal gastrectomy with the "preemptive retropancreatic approach": a propensity score matching analysis.

  Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of robotic surgery 16 (4) 825 - 831 2021/09/12 

  We report the usefulness of the preemptive retropancreatic approach (PRA) in robotic distal gastrectomy (RDG) using multi-jointed forceps. Therefore, this study aimed to compare the short-term outcomes of RDG with PRA and conventional laparoscopic distal gastrectomy using the propensity score matching method. A total of 126 patients [RDG = 55; laparoscopic distal gastrectomy (LDG) = 71] were retrospectively enrolled. Patients were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, the extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Surgical results and postoperative outcomes were compared. We identified 28 propensity score-matched pairs. The median operative time and blood loss were comparable (P = 0.272 and P = 0.933, respectively). Regarding postoperative outcomes, the incidence of postoperative complications [Clavien-Dindo classification II (CD ≥ II)] was lower in the RDG group than in the LDG group (P = 0.020). No significant differences in the peak C-reactive protein value and length of hospital stay were observed between the two groups (P = 0.391 and P = 0.057, respectively). In addition, no patients had postoperative pancreas-related complications (≥ CD II) in the RDG group. RDG using PRA seems to be a safe and feasible procedure for gastric cancer because of short-term outcomes and reduction of postoperative complications (especially postoperative pancreas-related complications) as compared to conventional LDG.
• デジタルデータで再構築できない画像情報をイラストで再構築することのメリット

  大川 裕貴, 岡村 圭祐, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本メディカルイラストレーション学会雑誌 日本メディカルイラストレーション学会 3 (1) 98 - 98 2433-6181 2021/09
• 切除不能膵癌に対する集学的治療におけるconversion surgeryの功罪

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 129回・123回 27 - 27 2021/09
• 胆膵内視鏡手技関連の十二指腸穿孔に対する手術治療の検討

  岡崎 遼, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 129回・123回 46 - 46 2021/09
• Transhepatic Direct Approach to the "Limit of the Division of the Hepatic Ducts" Leads to a High R0 Resection Rate in Perihilar Cholangiocarcinoma.

  Takehiro Noji, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Satoshi Hirano

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 25 (9) 2358 - 2367 2021/09 

  BACKGROUND: Previous studies have shown that curative resection (R0 resection) was among the most crucial factors for the long-term survival of patients with PHCC. To achieve R0 resection, we performed the transhepatic direct approach and resection on the limits of division of the hepatic ducts. Although a recent report showed that the resection margin (RM) status impacted PHCC patients' survival, it is still unclear whether RM is an important clinical factor. OBJECTIVE: To describe a technique of transhepatic direct approach and resection on the limit of division of hepatic ducts, investigate its short-term surgical outcome, and validate whether the radial margin (RM) would have a clinical impact on long-term survival of perihilar cholangiocarcinoma (PHCC) patients. METHODS: Consecutive PHCC patients (n = 211) who had undergone major hepatectomy with extrahepatic bile duct resection, without pancreaticoduodenectomy, in our department were retrospectively evaluated. RESULTS: R0 resection rate was 92% and 86% for invasive cancer-free and both invasive cancer-free and high-grade dysplasia-free resection, respectively. Overall 5-year survival rate was 46.9%. Univariate analysis showed that preoperative serum carcinoembryonic antigen level (> 7.0 mg/dl), pathological lymph node metastasis, and portal vein invasion were independent risk factors, but R status on both resection margin and bile duct margin was not an independent risk factor for survival. CONCLUSION: The transhepatic direct approach to the limits of division of the bile ducts leads to the highest R0 resection rate in the horizontal margin of PHCC. Further examination will be needed to determine the adjuvant therapy for PHCC to improve patient survival.
• Robot-assisted thoracoscopic esophagectomy for gastrointestinal stromal tumor of the esophagus: A case report.

  Hiroyuki Yamamoto, Yuma Ebihara, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  International journal of surgery case reports 86 106335 - 106335 2021/09 

  INTRODUCTION: A gastrointestinal stromal tumor (GIST) often arises in the stomach and small intestine, while esophageal GIST is rare. The first-choice treatment is surgical resection, but there is no standard technique. Herein, we describe our experience in the treatment of esophageal GIST and discuss the usefulness of robotic esophagectomy. PRESENTATION OF CASE: The patient was a 60-year-old woman, who was diagnosed with a 30 mm GIST in the middle thoracic esophagus. We underwent robot-assisted thoracoscopic esophagectomy in the prone position. The duration of the thoracoscopic part was 69 min and the total operation time was 319 min. Total blood loss was 135 ml. The patient's postoperative course was uneventful after surgery and the patient was discharged home in good condition on the 18th postoperative day. DISCUSSION: The prognosis of esophageal GIST was less favorable compared with gastric GIST, and due to the anatomical peculiarities of the esophagus, which surgical procedure should be performed is still under debate. Robotic surgery has several technological advantages as it provides a three-dimensional view, ten times magnification, tremor control, and ambidexterity. Therefore, Robotic-assisted minimally invasive esophagectomy (RAMIE) allows achieving for safe R0 resection of esophageal GIST. CONCLUSION: RAMIE may be useful for esophageal GIST because it facilitates safe and minimally invasive surgery in a limited space of the thoracic cavity.
• 診断・治療に難渋した症例～round table discussion 反復する急性膵炎と膵周囲液体貯留を認めたpancreatic fistulaの1例

  平田 甫, 桑谷 将城, 永井 孝輔, 瀧新 悠之介, 古川 龍太郎, 坂本 直哉, 浅野 賢道, 平野 聡, 三橋 智子

  膵臓 (一社)日本膵臓学会 36 (3) A257 - A257 0913-0071 2021/08
• 膵神経内分泌腫瘍の集学的治療 当院における膵神経内分泌腫瘍に対する集学的治療の成績

  土川 貴裕, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭佑, 平野 聡

  膵臓 (一社)日本膵臓学会 36 (3) A156 - A156 0913-0071 2021/08
• ERCP関連乳頭部穿孔例に対する手術治療の工夫

  田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  胆道 (一社)日本胆道学会 35 (3) 429 - 429 0914-0077 2021/08
• 肝門部胆管癌におけるinvasive tumor thicknessによる予後の層別化

  中西 喜嗣, 大場 光信, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 平野 聡

  胆道 (一社)日本胆道学会 35 (3) 478 - 478 0914-0077 2021/08
• 膵神経内分泌腫瘍の集学的治療 当院における膵神経内分泌腫瘍に対する集学的治療の成績

  土川 貴裕, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭佑, 平野 聡

  膵臓 (一社)日本膵臓学会 36 (3) A156 - A156 0913-0071 2021/08
• Can general surgeons perform laparoscopic surgery independently within 10 years of training? A nationwide survey on laparoscopic surgery training in Japan.

  Yo Kurashima, Satoshi Hirano, Shigeki Yamaguchi

  Surgery today 51 (8) 1328 - 1334 2021/08 

  PURPOSE: There is no standard program for laparoscopic surgery training in Japan, and competency in these procedures does not require the acquisition of board certification. The purpose of this survey was to investigate the current status of laparoscopic surgery training in Japan. METHODS: A questionnaire survey was mailed to 2296 members of the Japan Society for Endoscopic Surgery who were between postgraduate year 3 and 10. The questionnaire inquired about laparoscopic surgical training conditions, operation case numbers, and autonomy in eight laparoscopic procedures. RESULTS: The total response rate was 28.1%. The number of cases required to perform procedures independently was demonstrated. Most participants felt confident in performing laparoscopic appendectomy and cholecystectomy; however, they felt less confident about performing laparoscopic colectomy and gastrectomy. CONCLUSIONS: The information from this survey may be useful for surgical educators, surgical societies, and the board certification council for rebuilding the surgical training system in Japan.
• Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery.

  Fateme Rajabiyazdi, Roshni Alam, Aditya Pal, Joel Montanez, Susan Law, Nicolò Pecorelli, Yusuke Watanabe, Luciana D Chiavegato, Massimo Falconi, Satoshi Hirano, Nancy E Mayo, Lawrence Lee, Liane S Feldman, Julio F Fiore Jr

  JAMA surgery 156 (8) 758 - 765 2021/08/01 

  Importance: Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care. Objective: To elucidate the meaning of recovery from the perspective of patients undergoing abdominal surgery. Design, Setting, and Participants: This international qualitative study involved semistructured interviews with patients recovering from abdominal surgery from October 2016 to November 2018 in tertiary hospitals in 4 countries (Canada, Italy, Brazil, and Japan). A purposive maximal variation sampling method was used to ensure the recruitment of patients with varying demographic, clinical, and surgical characteristics. Data on race were not collected. Each interview lasted between 1 and 2 hours. Interviews were recorded and then transcribed verbatim. Transcripts were then analyzed using an inductive thematic analysis approach. Data analysis was conducted from July 2019 to September 2019. Main Outcomes and Measures: The qualitative analysis revealed themes reflecting the meaning of recovery from the perspective of patients undergoing abdominal surgery. Results: Thirty patients recovering from abdominal surgery were interviewed (15 [50%] female; mean [SD] age, 57 [18] years; 10 [33%] underwent major surgery; 16 [53%] underwent laparoscopic surgery). The interviews revealed that for patients undergoing abdominal surgery, the meaning of recovery embodied 5 overarching themes: (1) returning to habits and routines, (2) resolution of symptoms, (3) overcoming mental strains, (4) regaining independence, and (5) enjoying life. Themes associating the meaning of recovery to traditional parameters, such as earlier hospital discharge or absence of complications, were not identified in the interviews. Conclusions and Relevance: This qualitative study suggests that the meaning of recovery from the perspective of patients undergoing abdominal surgery goes beyond traditional clinical parameters. The elements of recovery identified in this study should be taken into account in patient-surgeon discussions about recovery and when developing patient-centered strategies to improve postoperative outcomes.
• Actionability evaluation of biliary tract cancer by genome transcriptome analysis and Asian cancer knowledgebase.

  Yuki Okawa, Nobutaka Ebata, Nayoung K D Kim, Masashi Fujita, Kazuhiro Maejima, Shota Sasagawa, Toru Nakamura, Woong-Yang Park, Satoshi Hirano, Hidewaki Nakagawa

  Oncotarget 12 (15) 1540 - 1552 2021/07/20 

  INTRODUCTION: Treatment options for biliary tract cancer (BTC) are very limited. It is necessary to investigate actionable genes and candidate drugs using a sophisticated knowledgebase (KB) and characterize BTCs immunologically for evaluating the actionability of molecular and immune therapies. MATERIALS AND METHODS: The genomic and transcriptome data of 219 patients with BTC who underwent surgery were analyzed. Actionable mutations and candidate drugs were annotated using the largest available KB of the Asian population (CancerSCAN®). Predictive biomarkers of immune checkpoint inhibitors were analyzed using DNA and RNA sequencing data. RESULTS: Twenty-two actionable genes and 43 candidate drugs were annotated in 74 patients (33.8%). The most frequent actionable genes were PTEN (7.3%), CDKN2A (6.8%), KRAS (6.4%). BRCA2, CDKN2A, and FGFR2 mutations were most frequently identified in case of intrahepatic cholangiocarcinoma. PTEN and CDKN2A mutations were associated with significantly shorter overall survival. PD-L1 and PD-1 expression was significantly higher in case of extrahepatic cholangiocarcinoma and T-cell-high expression. In total, 49.7% of cases were evaluated as having actionability for molecular therapy or immune checkpoint inhibitors. CONCLUSIONS: Identifying actionable genes and candidate drugs using the KB contribute to the development of therapeutic drugs and personalized treatment for BTC.
• Clinical outcome of drug-coated balloon versus scaffold device in patients with superficial femoral artery chronic total occlusion.

  Naoki Hayakawa, Satoshi Kodera, Masataka Arakawa, Satoshi Hirano, Sandeep Shakya, Junji Kanda

  Heart and vessels 37 (2) 282 - 290 2021/07/19 

  The demand for endovascular therapy is increasing in an aging society, but the problem of restenosis in the chronic phase has not been resolved in femoropopliteal occlusive disease. Few studies have compared drug-coated balloon (DCB) and scaffold devices in chronic total occlusion (CTO) of the superficial femoral artery (SFA). This study aimed to compare DCBs with scaffold in patients with CTO of the SFA. This was a single-center, retrospective study. From June 2018 to December 2019, we compared 31 patients and 33 limbs treated with DCBs and 44 patients and 45 limbs treated with a stent or stent-graft (scaffold) for SFA CTO. The primary endpoint was 12-month primary patency. The secondary endpoints were 12-month freedom from clinically driven target lesion revascularization (CD-TLR) and 12-month freedom from re-occlusion. The DCBs were performed using an intravascular ultrasound (IVUS)-guided approach or a non-loop wire technique. Baseline characteristics were similar between the groups. An intraluminal approach was performed to use all DCBs. The bailout stent rate was 0% in the DCB group. Kaplan-Meier analysis showed that rates of 12-month primary patency tended to be higher in the DCB than in the scaffold group (92.7 vs. 76.6%, p = 0.073) and that freedom from CD-TLR also did not differ significantly between the two groups (96.8 vs. 86.3%, p = 0.17). Kaplan-Meier analysis also showed that the 12-month freedom from re-occlusion rate was significantly less in the Scaffold than in the DCB group (96.8 vs. 79.3%, p = 0.045). Therefore, we concluded that in treatment for CTO of the SFA, a DCB with intraluminal angioplasty without bailout stenting was less re-occlusion compared with scaffold.
• Laparoscopic distal pancreatectomy for pancreatic arteriovenous malformation complicated with portal hypertension

  Takehiro Abiko, Yuma Ebihara, Motoya Takeuchi, Hiroki Sakamoto, Minoru Takahashi, Hisato Homma, Satoshi Hirano

  Journal of Minimal Access Surgery 17 (3) 373 - 375 1998-3921 2021/07/01 

  Pancreatic arteriovenous malformation (PAVM) is defined as a vascular anomaly with an abnormal anastomosis of the arterial and portal networks within the pancreas. Treatment modalities of PAVM include transarterial embolisation (TAE), irradiation and operation. Most patients treated with TAE alone will experience recurrence, so surgery is the best radical treatment. A female patient was admitted to our institution for the treatment of haematemesis. Examination revealed varices in the oesophagus and stomach, collateral circulation development caused by portal hypertension and PAVM of the pancreas. Surgical treatment was intended to reduce left portal hypertension. In this case, collateral circulation were considered dangerous points for unexpected bleeding. TAE was performed on the splenic artery before surgery to reduce blood flow in the areas with collateral circulation. En bloc resection of retroperitoneal tissue using the surgical procedure of radical antegrade modular pancreatosplenectomy was effective to minimise blood loss.
• GSAシンチによる肝門部胆管癌手術後肝不全死亡の予測

  野路 武寛, 井上 綾乃, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭佑, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P017 - 5 2021/07
• 肝外胆管癌術後再発後予後因子の検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P055 - 2 2021/07
• ERCP後十二指腸穿孔に対してドレナージ療法を施行した1例

  東嶋 宏泰, 中西 嘉嗣, 松井 あや, 田中 公貴, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P231 - 4 2021/07
• UR膵癌に対するConversion surgeryの適応 切除不能膵癌に対するconversion surgeryの長期成績および主要動脈に着目した切除範囲適正化の検討

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 PD6 - 2 2021/07
• 特集 消化器ステント術のすべて II. 臓器別各論 4. 胆･膵 2)術前胆道ドレナージにおけるステント留置-適応と臨床成績

  桒谷 将城, 永井 孝輔, 平田 甫, 瀧新 悠之介, 古川 龍太郎, 川久保 和道, 坂本 直哉, 平野 聡

  外科 南江堂 83 (8) 917 - 927 0016-593X 2021/07/01
• GSAシンチによる肝門部胆管癌手術後肝不全死亡の予測

  野路 武寛, 井上 綾乃, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭佑, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P017 - 5 2021/07
• 肝外胆管癌術後再発後予後因子の検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P055 - 2 2021/07
• ERCP後十二指腸穿孔に対してドレナージ療法を施行した1例

  東嶋 宏泰, 中西 嘉嗣, 松井 あや, 田中 公貴, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 P231 - 4 2021/07
• UR膵癌に対するConversion surgeryの適応 切除不能膵癌に対するconversion surgeryの長期成績および主要動脈に着目した切除範囲適正化の検討

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴

  日本消化器外科学会総会 (一社)日本消化器外科学会 76回 PD6 - 2 2021/07
• Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia.

  Akira Endo, Fumitaka Saida, Yuzuru Mochida, Shiei Kim, Yasuhiro Otomo, Daisuke Nemoto, Hisahiro Matsubara, Shigeru Yamagishi, Yoshinori Murao, Kazuki Mashiko, Satoshi Hirano, Kentaro Yoshikawa, Toshiki Sera, Mototaka Inaba, Hiroyuki Koami, Makoto Kobayashi, Kiyoshi Murata, Tomohisa Shoko, Noriaki Takiguchi

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 25 (7) 1837 - 1846 2021/07 

  BACKGROUND: There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. METHODS: We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. In-hospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)-free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intra-operative, and hospital-related confounders. RESULTS: A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78-4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. CONCLUSIONS: The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required.
• [Chemo-Resistant Breast Carcinoma with Cartilaginous Differentiation Manifestation after Neoadjuvant Chemotherapy-A Case Report].

  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Yasunari Takakuwa, Mayumi Sasaki, Kenichi Watanabe, Satoshi Hirano

  Gan to kagaku ryoho. Cancer & chemotherapy 48 (7) 951 - 953 0385-0684 2021/07 

  A 49-year-old woman was admitted to our hospital because of a tumor in her right breast. The tumor was localized to the C area and was approximately 3 cm in size. A right axillary lymphadenopathy was also found. Histopathological examination and needle biopsy of the breast tumor revealed invasive lobular carcinoma, and she was diagnosed with Stage ⅡB triple-negative breast cancer(cT2N1M0). Paclitaxel plus bevacizumab chemotherapy followed by ddAC chemotherapy was administered as neoadjuvant chemotherapy, but the tumor remained stable. Thus, she underwent mastectomy and lymph node dissection. Pathological findings of the resected specimen showed invasive carcinoma with cartilaginous differentiation. She was then treated with capecitabine 15 days after the surgery; however, multiple lung metastases were found on CT after 6 courses. Therefore, she was transferred to another hospital and received other chemotherapies, but died after 5 months.
• 99mTc-GSA Scintigraphy Could Predict Post-Hepatectomy Liver Failure-Related Death in Biliary Surgery.

  Takehiro Noji, Ayano Inoue, Yoshitsugu Nakanishi, Takahiro Tsuchikawa, Keisuke Okamura, Kenji Hirata, Satoshi Hirano

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 25 (12) 3236 - 3238 2021/06/25
• Postoperative Outcomes of Closed Versus Nonclosed Mesentery Laparoscopic Colectomy: A Retrospective Single-center Study.

  Takeo Nitta, Yuma Ebihara, Satoshi Hirano

  Surgical laparoscopy, endoscopy & percutaneous techniques 31 (6) 703 - 706 2021/06/23 

  PURPOSE: This study aimed to clarify the clinical significance of closing the mesenteric defect in laparoscopic colectomy. MATERIALS AND METHODS: We retrospectively evaluated 369 patients who underwent left-sided or right-sided resection via laparoscopic colectomy at our institute. Patients were stratified by open versus closed handling of the mesenteric defect. The perioperative clinical factors, surgical maneuvers, and postoperative complications were statistically analyzed. RESULTS: No significant intergroup differences were found in the perioperative clinical factors or surgical maneuvers except for number of days to the first soft diet (P=0.0214) and postoperative complications (P=0.0379). Among the postoperative complications, only ileus occurred more frequently in the closed group than in the open group (P=0.0227). CONCLUSIONS: This study revealed that closure of the mesenteric defect following laparoscopic colectomy might be associated with an increased incidence of postoperative ileus.
• 【上部消化管手術におけるトラブルシューティング-困難症例・偶発症への対策】頸部食道癌術後の永久気管孔の合併症予防とトラブルシューティング

  七戸 俊明, 村上 壮一, 倉島 庸, 海老原 裕磨, 平野 聡, 本間 明宏

  手術 金原出版(株) 75 (7) 1147 - 1152 0037-4423 2021/06
• A case of pseudomyxoma peritonei successfully treated with trifluridine/tipiracil (TAS-102) and bevacizumab after palliative debulking surgery.

  Satoshi Hirano, Yoshimasa Gohda, Hideki Miyazaki, Nami Hayama, Shinichiro Shimizu, Toru Igari, Hideaki Yano

  Chinese clinical oncology 10 (3) 29 - 29 2021/06 

  Pseudomyxoma peritonei is a rare disease with a reported prevalence of about 1-3 per million people annually. Cytoreductive surgery and perioperative hyperthermic intraperitoneal chemotherapy are considered as treatment options improving disease control or long-term survival. However, for patients with incomplete cytoreduction or debulking surgery, outcomes are significantly poorer compared with patients who have obtained complete or optimal cytoreduction. In cases of high-grade pseudomyxoma peritonei that are considered inoperable and/or unresectable, combination chemotherapy regimen with a neo-angiogenesis inhibitor such as bevacizumab is recommended. In this report, a 62-year-old Japanese man presented with abdominal distention. Examination of ascites demonstrated a jelly-like consistency and peritoneal pseudomyxoma was suspected. To relieve progressive symptoms, palliative debulking surgery with total colectomy was performed. Postoperative pathology confirmed high-grade appendiceal mucinous neoplasm with high-grade pseudomyxoma peritonei. In our case, combination chemotherapy with trifluridine/tipiracil (TAS-102) and bevacizumab was initiated after palliative debulking surgery. As a result, carcinoembryonic antigen level was kept stable and the volume of ascites remained almost the same as at the beginning of treatment for more than 2 years. In conclusion, combination chemotherapy comprising TAS-102 and bevacizumab in patients with palliative debulking could be a useful option for patients with high-grade mucinous appendiceal neoplasm and high-grade pseudomyxoma peritonei.
• Predicting the Outcomes of Postoperative Pancreatic Fistula After Pancreatoduodenectomy Using Prophylactic Drain Contrast Imaging.

  Hiroki Kushiya, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Takehiro Noji, Yoshitsugu Nakanishi, Kimitaka Tanaka, Toshiaki Shichinohe, Satoshi Hirano

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 25 (6) 1445 - 1450 2021/06 

  BACKGROUND: Postoperative pancreatic fistula is a main cause of fatal complications post-pancreatoduodenectomy. However, no universally accepted drainage management exists for clinically relevant postoperative pancreatic fistulas. We retrospectively evaluated cases in which drain contrast imaging was used to determine its utility in identifying clinically relevant postoperative pancreatic fistulas post-pancreatoduodenectomy. METHODS: Between January 2014 and December 2018, 209 consecutive patients who underwent pancreatoduodenectomy in our institute were retrospectively analyzed. Drain monitoring with contrast imaging was performed in 47 of the cases. We classified drain contrast type into three categories and evaluated postoperative outcome in each group: (1) fistulous tract group-only the fistula was contrasted; (2) fluid collection group - fluid collection connected to the drain fistula; and (3) pancreatico-anastomotic fistula group-fistula connected to the digestive tract. RESULTS: The durations of postoperative hospital stay and drainage were significantly shorter in the fistulous tract group than in the fluid collection group (31 vs. 46 days, p = 0.0026; and 12 vs. 38 days, p < 0.0001, respectively). The cost and number of drain exchanges were significantly lower in the fistulous tract group than in the fluid collection group ($163.6 vs. 467.5, p < 0.0001; and 1 vs. 5.5, p < 0.0001, respectively). Notably, no patient had grade C postoperative pancreatic fistula. CONCLUSION: Classification of prophylactic drain contrast type can aid in predicting outcomes of clinically relevant postoperative pancreatic fistulas and optimizing drainage management.
• Initial Results of Laparoscopic Proximal Gastrectomy With Double-tract Reconstruction Using Oblique Jejunogastrostomy Method on the Long-term Outcome of Postoperative Nutritional Status: A Propensity Score-matched Study.

  Kotaro Kimura, Yuma Ebihara, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgical laparoscopy, endoscopy & percutaneous techniques 31 (5) 603 - 607 2021/05/27 

  BACKGROUND: The aim of this study was to evaluate the long-term nutritional state of patients with gastric cancer who underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) using oblique jejunogastrostomy method (OJG). METHODS: Medical records of 38 patients who underwent LPG-DTR using OJG (21 patients) or laparoscopic total gastrectomy with Roux-en-Y reconstruction (LTG-RY) (17 patients) between October 2011 and March 2018 were retrospectively reviewed. In these patients, clinicopathologic variables were analyzed using propensity score matching for age, sex, body mass index, American Society of Anesthesiologists physical state, clinical stage, and lymph node dissection. Operative outcomes and postoperative nutritional status were compared between the 2 groups. RESULTS: A total of 16 patients were matched to analyze the LPG-DTR and LTG-RY groups. The serum hemoglobin, total protein, and albumin levels at 12 months postoperatively (P=0.008, 0.034, and 0.049) and serum hemoglobin level at 24 months (P=0.025) in the LPG-DTR group was significantly superior to those in the LTG-RY group. CONCLUSIONS: The postoperative nutritional status as long-term outcomes of patients who underwent LPG-DTR using OJG was significantly superior to those who underwent LTG-RY. The results hereby presented suggest that LPG-DTR using OJG for gastric cancer produces better postoperative nutritional status.
• A novel laparoscopic near-infrared fluorescence spectrum system with indocyanine green fluorescence overcomes limitations of near-infrared fluorescence image-guided surgery.

  Yuma Ebihara, Liming Li, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of minimal access surgery 2021/05/24 

  Background: Near-infrared (NIR) fluorescence image-guided surgery (FIGS) introduces a revolutionary new approach to address this basic challenge in minimally invasive surgery. However, current FIGS systems have some limitations - the infrared rays cannot detect and visualise thick tissues with low concentrations of the fluorescent agent. We established a novel laparoscopic fluorescence spectrum (LFS) system using indocyanine green (ICG) fluorescence to overcome these limitations. Materials and Methods: Bovine serum albumin (BSA) was conjugated to ICG, and the mixtures were serially diluted at 5 × 10-8-5 × 10-1 mg/mL. We used the LFS system and a NIR camera system (NLS; SHINKO OPTICAL CO., LTD Tokyo, Japan) to determine the optical dilution for the fluorescence detection. BSA was conjugated to ICG (5.0 × 10-2 mg/mL) and used to coat the clips. We attempted to identify the fluorescence-coated clip from the serosal side of the cadaveric porcine stomach tissues using the LFS system and the NIR camera system. We measured the depth of the cadaveric porcine stomach wall at the thickest part that could be confirmed. Results: We could not visualise fluorescence concentrations <2.5 × 10-3 mg/mL using the NIR camera system. The spectrum was detected at a concentration <2.5 × 10-3 mg/mL. We were able to identify the spectrum of ICG (829 nm) to a 13-mm depth of cadaveric porcine stomach wall by using the LFS system but could not identify the same with the NIR camera system regardless of wall thickness. Conclusions: The novel LFS system with NIR fluorescence imaging in this ex vivo and cadaveric porcine model was confirmed useful at deeper depths and lower concentrations. Based on these findings, we anticipate that the LFS system can be integrated and routinely used in minimally invasive surgery.
• Inhibition of mutant KRAS-driven overexpression of ARF6 and MYC by an eIF4A inhibitor drug improves the effects of anti-PD-1 immunotherapy for pancreatic cancer.

  Ari Hashimoto, Haruka Handa, Soichiro Hata, Akio Tsutaho, Takao Yoshida, Satoshi Hirano, Shigeru Hashimoto, Hisataka Sabe

  Cell communication and signaling : CCS 19 (1) 54 - 54 2021/05/17 

  Many clinical trials are being conducted to clarify effective combinations of various drugs for immune checkpoint blockade (ICB) therapy. However, although extensive studies from multiple aspects have been conducted regarding treatments for pancreatic ductal adenocarcinoma (PDAC), there are still no effective ICB-based therapies or biomarkers for this cancer type. A series of our studies have identified that the small GTPase ARF6 and its downstream effector AMAP1 (also called ASAP1/DDEF1) are often overexpressed in different cancers, including PDAC, and closely correlate with poor patient survival. Mechanistically, the ARF6-AMAP1 pathway drives cancer cell invasion and immune evasion, via upregulating β1-integrins and PD-L1, and downregulating E-cadherin, upon ARF6 activation by external ligands. Moreover, the ARF6-AMAP1 pathway enhances the fibrosis caused by PDAC, which is another barrier for ICB therapies. KRAS mutations are prevalent in PDACs. We have shown previously that oncogenic KRAS mutations are the major cause of the aberrant overexpression of ARF6 and AMAP1, in which KRAS signaling enhances eukaryotic initiation factor 4A (eIF4A)-dependent ARF6 mRNA translation and eIF4E-dependent AMAP1 mRNA translation. MYC overexpression is also a key pathway in driving cancer malignancy. MYC mRNA is also known to be under the control of eIF4A, and the eIF4A inhibitor silvestrol suppresses MYC and ARF6 expression. Using a KPC mouse model of human PDAC (LSL-Kras(G12D/+); LSL-Trp53(R172H/+)); Pdx-1-Cre), we here demonstrate that inhibition of the ARF6-AMAP1 pathway by shRNAs in cancer cells results in therapeutic synergy with an anti-PD-1 antibody in vivo; and furthermore, that silvestrol improves the efficacy of anti-PD-1 therapy, whereas silvestrol on its own promotes tumor growth in vivo. ARF6 and MYC are both essential for normal cell functions. We demonstrate that silvestrol substantially mitigates the overexpression of ARF6 and MYC in KRAS-mutated cells, whereas the suppression is moderate in KRAS-intact cells. We propose that targeting eIF4A, as well as mutant KRAS, provides novel methods to improve the efficacy of anti-PD-1 and associated ICB therapies against PDACs, in which ARF6 and AMAP1 overexpression, as well as KRAS mutations of cancer cells are biomarkers to identify patients with drug-susceptible disease. The same may be applicable to other cancers with KRAS mutations. Video abstract.
• Laparoscopic real-time vessel navigation using indocyanine green fluorescence during laparoscopy-assisted gastric tube reconstruction: First experience.

  Yuma Ebihara, Toshiaki Shichinohe, Yo Kurashima, Soichi Murakami, Satoshi Hirano

  Journal of minimal access surgery 2021/05/06 

  A considerable percentage of morbidity and mortality after oesophagectomy is due to leakage of oesophagogastrostomy, which is mainly caused by ischaemia of the gastric tube. Therefore, we performed laparoscopic real-time vessel navigation (LRTVN) using indocyanine green fluorescence (ICG) during laparoscopy-assisted gastric tube reconstruction (LAGR) to evaluate gastric tube blood flow and avoid vascular injury. This study included five oesophageal cancer patients who underwent video-assisted thoracoscopic oesophagectomy and LAGR. We confirmed the presence of the left gastroepiploic artery (LGEA) in all cases, and no findings such as post-operative gastric tube ischaemia were observed. In all cases, no vascular injury was observed, and the vascularization of LGEA was confirmed. This report is the first to consider the usefulness of LRTVN using ICG during LAGR. LRTVN using ICG during LAGR was considered to be useful for evaluating gastric tube blood flow and avoiding vascular injury around the splenic hiatus.
• 糖代謝障害を伴った高度肥満症患者における腹腔鏡下スリーブ状胃切除術による糖・脂質代謝および肝臓への好影響

  安井 彩乃, 曹 圭龍, 大江 悠希, 野本 博司, 亀田 啓, 中村 昭伸, 海老原 裕磨, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 64 (Suppl.1) I - 4 0021-437X 2021/05
• 耐糖能異常合併肥満症患者における腹腔鏡下スリーブ状胃切除後の骨密度低下

  上垣 里紗, 大江 悠希, 亀田 啓, 高瀬 崇宏, 野本 博司, 曹 圭龍, 中村 昭伸, 平野 聡, 渥美 達也, 三好 秀明

  糖尿病 (一社)日本糖尿病学会 64 (Suppl.1) P - 6 0021-437X 2021/05
• 腫瘍の一部が胆管内腫瘍栓様発育を呈した浸潤型肝門部胆管癌

  野路 武寛, 松井 あや, 桑谷 将城, 大場 光信, 三橋 智子, 平野 聡

  胆道 (一社)日本胆道学会 35 (2) 230 - 236 0914-0077 2021/05
• An Effective Method for Percutaneous Removal of Venoarterial Extracorporeal Membrane Oxygenation by a Combination of Balloon Dilatation in Endovascular Therapy and the Perclose Proglide™ Closure Device.

  Naoki Hayakawa, Kazuki Tobita, Satoshi Kodera, Noriyuki Ishibashi, Yuhei Kasai, Masataka Arakawa, Satoshi Hirano, Sandeep Shakya, Kotaro Miyaji, Syunichi Kushida, Junji Kanda, Shigeru Saito

  Annals of vascular surgery 73 532 - 537 2021/05 

  BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be undertaken surgically, but there are various problems with this method. METHODS AND CASE REPORT: We removed the arterial cannula of VA-ECMO percutaneously by combining intravascular balloon dilatation and the Perclose ProGlide™ (PP) closure device in a short amount of time and the extent of bleeding was extremely small. Simultaneously, the venous cannula was removed by suturing and manual compression. We report a series of cases of percutaneous removal of VA-ECMO using intravascular balloon dilatation and PP. CONCLUSIONS: By using this method, VA-ECMO removal was possible in a very short amount of time with minimal invasiveness.
• 【消化器癌;診断と治療のすべて】消化器癌の診断・病期分類・治療・成績 胆嚢癌 疫学と病期分類

  松井 あや, 平野 聡

  消化器外科 (株)へるす出版 44 (6) 937 - 942 0387-2645 2021/05
• 腫瘍の一部が胆管内腫瘍栓様発育を呈した浸潤型肝門部胆管癌

  野路 武寛, 松井 あや, 桑谷 将城, 大場 光信, 三橋 智子, 平野 聡

  胆道 日本胆道学会 35 (2) 230 - 236 0914-0077 2021/05
• A drainage strategy for postoperative pancreatic fistula after left-sided pancreatectomy based on the wall status of collected fluid.

  Masaki Kuwatani, Masafumi Imamura, Tsuyoshi Hayashi, Makoto Yoshida, Yasutoshi Kimura, Toshimichi Asano, Toru Nakamura, Masayo Motoya, Makoto Yoshida, Takehiro Noji, Keisuke Okamura, Kuniyuki Takahashi, Akio Katanuma, Satoshi Hirano

  Langenbeck's archives of surgery 406 (3) 743 - 751 2021/05 

  PURPOSE: Postoperative pancreatic fistula (POPF) after pancreatectomy is one of the severe postoperative adverse events. We aimed to clarify the outcomes of a strategy for POPF after left-sided pancreatectomy with one-step endoscopic ultrasonography-guided drainage (EUSD) and percutaneous drainage (PCD) based on the wall status of collected fluid. METHODS: From January 2012 to September 2017, 90 of 336 patients developed grade B/C POPF and were retrospectively analyzed. Primary outcome measures were the technical and clinical success and resolution rates. Secondary outcome measures were time from surgery to intervention, and time from intervention to discharge/resolution or stent/tube removal and adverse events. RESULTS: Seventeen patients underwent EUSD and 73 patients underwent PCD for POPF. The technical success rates were 100% in both the EUSD and PCD groups. The clinical success and resolution rates in the EUSD group were 100%, while those in the PCD group were 98.6%. The time from surgery to intervention was significantly longer in the EUSD group than in the PCD group (20 vs. 11 days, p < 0.001). The time from intervention to discharge/resolution was significantly shorter in the EUSD group than in the PCD group (11 vs. 22 days, p < 0.001/10 vs. 20 days, p < 0.001). The time from intervention to stent/tube removal was significantly shorter in the PCD group than in the EUSD group (20.5 vs. 873 days, p < 0.001). Adverse event rates were similar in the two groups (11.8% vs. 5.5%). CONCLUSION: A drainage strategy for POPF based on the wall status of collected fluid is appropriate.
• Biglycan, tumor endothelial cell secreting proteoglycan, as possible biomarker for lung cancer.

  Hirofumi Morimoto, Yasuhiro Hida, Nako Maishi, Hiroshi Nishihara, Yutaka Hatanaka, Cong Li, Yoshihiro Matsuno, Toru Nakamura, Satoshi Hirano, Kyoko Hida

  Thoracic cancer 12 (9) 1347 - 1357 2021/05 

  OBJECTIVES: In lung cancer, surgery remains the most curative treatment and limited resection is beneficial for patients with low cardiopulmonary function and low malignancy tumors. However, there are no biomarkers of low malignancy to select candidates for limited resection without compromising the outcome of treatments. Recently we identified biglycan (BGN) as a tumor endothelial cell (TEC) marker that is associated with tumor progression in various cancers. In this study, we analyzed the association between BGN expression in TECs in lung cancer and cancer progression in patients. MATERIALS AND METHODS: First, we performed immunohistochemistry of BGN with resected lung tumor tissues of 155 patients who had undergone thoracic surgery and analyzed the correlation between BGN-positive vessel density in primary lung tumors and clinicopathological factors. Second, we measured the BGN levels in preoperative serum of other 46 patients with lung cancer by ELISA, and analyzed the correlation between BGN expression in tumor tissues and blood BGN levels. RESULTS: High BGN expression in the TECs was significantly associated with T factor, and was a significant negative predictor. BGN levels in preoperative serum of 46 patients with lung cancer was significantly correlated with BGN expression in the TECs. Preoperative serum BGN level was significantly lower in healthy volunteers and less invasive adenocarcinoma than in invasive adenocarcinoma and other lung carcinomas. These results suggest that low BGN level in preoperative serum in patients with lung cancer might indicate low malignancy. CONCLUSIONS: BGN can be a potential biomarker for lung cancer.
• Particle Size Distributions in Surgical Smoke Generated by Advanced Energy Devices: A Meaningful Perspective From an Experimental Study in the Time of COVID-19.

  Akihiro Kondo, Yusuke Watanabe, Minoru Ishida, Yasuyuki Suzuki, Satoshi Hirano

  Annals of surgery 273 (5) e168-e170  2021/05/01
• A case report of necrotizing soft tissue infection of the chest wall: Effective management with serial debridement.

  Masakazu Fujii, Kiyotaka Imamura, Kentaro Kato, Minoru Takada, Yoshiyasu Ambo, Fumitaka Nakamura, Satoshi Hirano

  International journal of surgery case reports 82 105908 - 105908 2021/05 

  INTRODUCTION: Necrotizing soft tissue infection (NSTI) of the chest wall is a rare, rapidly spreading, highly lethal surgical disease. Radical debridement interferes with the important anatomical function of the chest wall. We report a case of chest wall NSTI that was successfully managed with early diagnosis and serial debridement. PRESENTATION OF CASE: A 43-year-old, previously healthy woman presented with severe malaise and worsening right axillary pain. She was severely lethargic and had a painful, large, pale lesion with surrounding erythema of the right chest and trunk. Computed tomography revealed NSTI, with diffuse soft tissue inflammation extending from the axilla to the lower abdomen. There was no obvious entry portal. Prompt surgical drainage was established. Group A streptococcus infection was diagnosed. During her 3-month postoperative course, she underwent four more surgeries, including two debridements. This treatment proved successful and avoided the need for complicated muscle flap reconstruction. She was discharged on postoperative day 109. DISCUSSION: Group A streptococcus can cause NSTI even in immunocompetent patients without an entry portal. Radical debridement is recommended for infection control. Preserving anatomical chest wall function, however, is also important. Serial debridement with close follow-up solved the problem in this patient. CONCLUSIONS: Serial debridement with close follow-up enabled to avoid large tissue deficits and complicated reconstruction in the case of NSTI of the chest wall.
• Robotic Distal Gastrectomy With a Novel "Preemptive Retropancreatic Approach" During Dissection of Suprapancreatic Lymph Nodes for Gastric Cancer.

  Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Surgical laparoscopy, endoscopy & percutaneous techniques 31 (4) 457 - 461 2021/04/23 

  INTRODUCTION: Abrogating contact with the pancreas in suprapancreatic lymph nodes dissection for gastric cancer can prevent pancreatic fistula because of postoperative pancreatic damage. Our novel "Preemptive retropancreatic approach" is a useful technique that minimizes pancreatic compression during robotic distal gastrectomy (RDG) with multijointed forceps. Here, we report the usefulness of RDG for gastric cancer surgery using our novel "Preemptive retropancreatic approach". MATERIALS: "Preemptive retropancreatic approach": initial dissection of the bilateral retropancreatic space, the adherence between the retroperitoneum surface and the pancreas (fusion fascia) is released, providing a good operative field and hindering contact with the pancreas in suprapancreatic lymph nodes dissection during RDG. We herein reported consecutive 30 patients with gastric cancer who underwent RDG at Hokkaido University from September 2014 to March 2020. RESULTS: All operations were performed by a single surgeon (Y.E.). The median operating time was 281 minutes (132 to 415). The median intraoperative bleeding was 0 ml of blood (0 to 255). There were 2 incidences of postoperative complications (≥Clavien-Dindo classification II), and there were no cases of postoperative pancreas-related complications. The median length of hospital stay after the surgery was 10 days (6 to 33). CONCLUSION: As RDG for gastric cancer is still in its early introductory phase, its superiority has yet to be definitively established. However, we believe that "Preemptive retropancreatic approach" may reduce postoperative pancreatic-related complications in suprapancreatic lymph nodes dissection.
• Altered microvascular reactivity assessed by near-infrared spectroscopy after hepato-pancreato-biliary surgery.

  Kazuyuki Mizunoya, Yasunori Yagi, Yuji Morimoto, Satoshi Hirano

  Journal of clinical monitoring and computing 36 (3) 703 - 712 2021/04/07 

  Little is known about microcirculatory dysfunction following abdominal surgeries. This study aimed to evaluate changes in microvascular reactivity (MVR) before and after major abdominal surgery, assessed by near-infrared spectroscopy in conjunction with a vascular occlusion test. This prospective observational study included 50 adult patients who underwent hepato-pancreato-biliary surgery lasting ≥ 8 h. MVR was assessed by tissue oxygen saturation (StO2) changes in the plantar region of the foot during 3 min of vascular occlusion and subsequent release under general anesthesia before and after surgery. The primary outcome was alteration in the recovery slope of StO2 (RecStO2) and recovery time (tM) between the preoperative and postoperative values. Postoperative short-term outcome was represented by the Post-operative Morbidity Survey (POMS) score on the morning of postoperative day 2. After surgery, RecStO2 was reduced (0.74% [0.58-1.06]/s vs. 0.89% [0.62-1.41]/s, P = 0.001), and tM was longer (57.0 [42.9-71.0] s vs. 41.3 [35.5-56.5] s, P < 0.001), compared to the preoperative values. Macrohemodynamic variables such as cardiac index, arterial pressure, and stroke volume during postoperative measurement did not differ with or without relative MVR decline. In addition, the POMS score was not associated with postoperative alterations in microcirculatory responsiveness. MVR in the plantar region of the foot was reduced after major hepato-pancreato-biliary surgery regardless of macrocirculatory adequacy. Impaired MVR was not associated with short-term outcomes as long as macrocirculatory indices were well maintained. The impact of relative microcirculatory changes, especially combined with inadequate macrocirculation, on postoperative complications remains to be elucidated.Clinical Trial Registrations UMIN-CTR trial ID: 000033461.
• Development, validation, and comparison of a nomogram based on radiologic findings for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: An international multicenter study.

  Hyeong Seok Kim, Wookyeong Song, Wonho Choo, Sungyoung Lee, Youngmin Han, Claudio Bassi, Roberto Salvia, Giovanni Marchegiani, Christopher L Wolfgang, Jin He, Alex B Blair, Michael D Kluger, Gloria H Su, Song Cheol Kim, Ki-Byung Song, Masakazu Yamamoto, Takashi Hatori, Ching-Yao Yang, Hiroki Yamaue, Seiko Hirono, Sohei Satoi, Tsutomu Fujii, Satoshi Hirano, Wenhui Lou, Yasushi Hashimoto, Yasuhiro Shimizu, Marco Del Chiaro, Roberto Valente, Matthias Lohr, Dong Wook Choi, Seong Ho Choi, Jin Seok Heo, Fuyuhiko Motoi, Ippei Matsumoto, Woo Jung Lee, Chang Moo Kang, Yi-Ming Shyr, Shin-E Wang, Ho-Seong Han, Yoo-Seok Yoon, Marc G Besselink, Nadine C M van Huijgevoort, Masayuki Sho, Hiroaki Nagano, Sang Geol Kim, Goro Honda, Yinmo Yang, Hee Chul Yu, Jae Do Yang, Jun Chul Chung, Yuichi Nagakawa, Hyung Il Seo, Seungyeoun Lee, Hongbeom Kim, Wooil Kwon, Taesung Park, Jin-Young Jang

  Journal of hepato-biliary-pancreatic sciences 30 (1) 133 - 143 2021/04/02 

  BACKGROUND: Although we previously proposed a nomogram to predict malignancy in intraductal papillary mucinous neoplasms (IPMN) and validated it in an external cohort, its application is challenging without data on tumor markers. Moreover, existing nomograms have not been compared. This study aimed to develop a nomogram based on radiologic findings and to compare its performance with previously proposed American and Korean/Japanese nomograms. METHODS: We recruited 3708 patients who underwent surgical resection at 31 tertiary institutions in eight countries, and patients with main pancreatic duct >10 mm were excluded. To construct the nomogram, 2606 patients were randomly allocated 1:1 into training and internal validation sets, and area under the receiver operating characteristics curve (AUC) was calculated using 10-fold cross validation by exhaustive search. This nomogram was then validated and compared to the American and Korean/Japanese nomograms using 1102 patients. RESULTS: Among the 2606 patients, 90 had main-duct type, 900 had branch-duct type, and 1616 had mixed-type IPMN. Pathologic results revealed 1628 low-grade dysplasia, 476 high-grade dysplasia, and 502 invasive carcinoma. Location, cyst size, duct dilatation, and mural nodule were selected to construct the nomogram. AUC of this nomogram was higher than the American nomogram (0.691 vs 0.664, P = .014) and comparable with the Korean/Japanese nomogram (0.659 vs 0.653, P = .255). CONCLUSIONS: A novel nomogram based on radiologic findings of IPMN is competitive for predicting risk of malignancy. This nomogram would be clinically helpful in circumstances where tumor markers are not available. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.
• 臨床医学の発展に貢献するCSTの将来像 実施例の紹介『献体による外傷手術臨床解剖学的研究会』献体外傷手術研究グループによる全国開催と、COVID-19流行下での感染防止対策について

  本間 宙, 織田 順, 伊藤 正裕, 村上 壮一, 七戸 俊明, 平野 聡, 川副 友, 久志本 成樹, 佐藤 格夫, 真弓 俊彦, 献体外傷手術研究グループ

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 CST - 4 2021/04
• 【専門医必携 新外科手術書-新しい手術手技のエッセンス】食道 食道胃接合部癌に対する胸腔鏡併用下部食道胃切除術

  海老原 裕磨, 七戸 俊明, 倉島 庸, 村上 壮一, 平野 聡

  外科 (株)南江堂 83 (5) 412 - 416 0016-593X 2021/04
• 神経内分泌腫瘍治療の展開 膵・直腸原発神経内分泌腫瘍肝転移の腫瘍学的相違点に関する検討

  土川 貴裕, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭佑, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 NES - 3 2021/04
• 肝門部胆管癌 安全性に配慮したR0手術への取り組みと工夫 肝門部領域胆管癌手術における予防的門脈合併切除再建の功罪

  岡村 圭祐, 中西 喜嗣, 野路 武寛, 田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 SY - 3 2021/04
• Acute Care Surgeonを目指す君へ-外科と救急のキャリア展開- 一般外科医からAcute Care Surgeonを目指す医師を増やすためには何が必要か 一般外科医の持つ外傷診療技能に関するアンケート調査結果から

  村上 壮一, 廣瀬 和幸, 東嶋 宏泰, 楢崎 肇, 松井 あや, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 2 2021/04
• 膵癌に対するリンパ節郭清 境界と神経叢郭清の今 膵体尾部癌における腫瘍位置からみた好発リンパ節転移部位の検討よる新たなリンパ節郭清範囲の提案

  田中 公貴, 中村 透, 浅野 賢道, 松井 あや, 中西 喜嗣, 野路 武寛, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 5 2021/04
• 切除境界域膵癌に対する至適術前療法 Borderline resectable膵癌の術前治療期間は切除例の選択と予後に影響するか?

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 村上 壮一, 倉島 庸, 海老原 裕磨, 野路 武寛, 中西 喜嗣, 田中 公貴, 渡邊 祐介, 松井 あや, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 5 2021/04
• 局所進行膵癌に対する腹腔動脈合併膵全摘術(TP-CAR)の実際

  篠原 良仁, 中村 透, 倉島 庸, 浅野 賢道, 松井 あや, 田中 公貴, 海老原 裕磨, 村上 壮一, 野路 武寛, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 SF - 4 2021/04
• Bismuth I、II型肝門部領域胆管癌に対する左右肝切除間の短期および長期成績の検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 田中 公貴, 松井 あや, 村上 壮一, 倉島 庸, 海老原 佑磨, 楢崎 肇, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PS - 3 2021/04
• 膵管内乳頭粘液性腫瘍に対する縮小手術の意義

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 海老原 裕磨, 野路 武寛, 中西 喜嗣, 田中 公貴, 松井 あや, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PS - 5 2021/04
• 神経内分泌腫瘍治療の展開 膵・直腸原発神経内分泌腫瘍肝転移の腫瘍学的相違点に関する検討

  土川 貴裕, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭佑, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 NES - 3 2021/04
• 肝門部胆管癌 安全性に配慮したR0手術への取り組みと工夫 肝門部領域胆管癌手術における予防的門脈合併切除再建の功罪

  岡村 圭祐, 中西 喜嗣, 野路 武寛, 田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 SY - 3 2021/04
• 膵癌に対するリンパ節郭清 境界と神経叢郭清の今 膵体尾部癌における腫瘍位置からみた好発リンパ節転移部位の検討よる新たなリンパ節郭清範囲の提案

  田中 公貴, 中村 透, 浅野 賢道, 松井 あや, 中西 喜嗣, 野路 武寛, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 5 2021/04
• 局所進行膵癌に対する腹腔動脈合併膵全摘術(TP-CAR)の実際

  篠原 良仁, 中村 透, 倉島 庸, 浅野 賢道, 松井 あや, 田中 公貴, 海老原 裕磨, 村上 壮一, 野路 武寛, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 SF - 4 2021/04
• Bismuth I、II型肝門部領域胆管癌に対する左右肝切除間の短期および長期成績の検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 田中 公貴, 松井 あや, 村上 壮一, 倉島 庸, 海老原 佑磨, 楢崎 肇, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PS - 3 2021/04
• 膵管内乳頭粘液性腫瘍に対する縮小手術の意義

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 海老原 裕磨, 野路 武寛, 中西 喜嗣, 田中 公貴, 松井 あや, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PS - 5 2021/04
• Acute Care Surgeonを目指す君へ-外科と救急のキャリア展開- 一般外科医からAcute Care Surgeonを目指す医師を増やすためには何が必要か 一般外科医の持つ外傷診療技能に関するアンケート調査結果から

  村上 壮一, 廣瀬 和幸, 東嶋 宏泰, 楢崎 肇, 松井 あや, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 2 2021/04
• 切除境界域膵癌に対する至適術前療法 Borderline resectable膵癌の術前治療期間は切除例の選択と予後に影響するか?

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 村上 壮一, 倉島 庸, 海老原 裕磨, 野路 武寛, 中西 喜嗣, 田中 公貴, 渡邊 祐介, 松井 あや, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 121回 PD - 5 2021/04
• Clinical practice guidelines for the management of biliary tract cancers 2019: the 3rd English edition

  Masato Nagino, Satoshi Hirano, Hideyuki Yoshitomi, Taku Aoki, Katsuhiko Uesaka, Michiaki Unno, Tomoki Ebata, Masaru Konishi, Keiji Sano, Kazuaki Shimada, Hiroaki Shimizu, Ryota Higuchi, Toshifumi Wakai, Hiroyuki Isayama, Takuji Okusaka, Toshio Tsuyuguchi, Yoshiki Hirooka, Junji Furuse, Hiroyuki Maguchi, Kojiro Suzuki, Hideya Yamazaki, Hiroshi Kijima, Akio Yanagisawa, Masahiro Yoshida, Yukihiro Yokoyama, Takashi Mizuno, Itaru Endo

  Chinese Journal of Digestive Surgery 20 (4) 359 - 375 1673-9752 2021/04 

  The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.
• ASO Author Reflections: Can Invasive Tumor Thickness Stratify the Postoperative Prognosis of Perihilar Cholangiocarcinoma?

  Yoshitsugu Nakanishi, Mitsunobu Oba, Satoshi Hirano

  Annals of surgical oncology 28 (4) 2010 - 2011 2021/04
• Stratification of Postoperative Prognosis by Invasive Tumor Thickness in Perihilar Cholangiocarcinoma.

  Mitsunobu Oba, Yoshitsugu Nakanishi, Toraji Amano, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Kimitaka Tanaka, Satoshi Hirano

  Annals of surgical oncology 28 (4) 2001 - 2009 2021/04 

  BACKGROUND: The pathological tumor classification of distal cholangiocarcinoma in the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 8th edition is based on invasive depth, whereas that of perihilar cholangiocarcinoma (PHCC) continues to be layer-based. We aimed to clarify whether invasive depth measurement based on invasive tumor thickness (ITT) could help determine postoperative prognosis in patients with PHCC. METHODS: We enrolled 184 patients with PHCC who underwent hepatectomy plus extrahepatic bile duct resection or hepatopancreatoduodenectomy with curative intent. ITT was measured using simple definitions according to the sectioning direction or gross tumor pattern. RESULTS: The median ITT was 5.8 mm (range 0.7-15.5). Using the recursive partitioning technique, ITT was classified into grades A (ITT < 2 mm, n = 9), B (2 mm ≤ ITT < 5 mm, n = 68), C (5 mm ≤ ITT < 11 mm, n = 81), and D (11 mm < ITT, n = 26). The median survival times (MSTs) in patients with grade B, C, or D were 90.8, 44.6, and 21.1 months, respectively (patients with grade A did not reach the MST). There were significant differences in postoperative prognosis between ITT grades (A vs. B, p = 0.027; B vs. C, p < 0.001; C vs. D, p = 0.004). Through multivariate analysis, regional node metastasis, invasive carcinoma at the resected margin, and ITT grade were determined as independent prognostic factors. CONCLUSION: ITT could be measured using simple methods and may be used to stratify postoperative prognosis in patients with PHCC.
• Mortality, morbidity, and failure to rescue in hepatopancreatoduodenectomy: An analysis of patients registered in the National Clinical Database in Japan.

  Itaru Endo, Norimichi Hirahara, Hiroaki Miyata, Hiroyuki Yamamoto, Ryusei Matsuyama, Takafumi Kumamoto, Yuki Homma, Masaki Mori, Yasuyuki Seto, Go Wakabayashi, Yuko Kitagawa, Fumihiko Miura, Norihiro Kokudo, Tomoo Kosuge, Masato Nagino, Akihiko Horiguchi, Satoshi Hirano, Hiroki Yamaue, Masakazu Yamamoto, Masaru Miyazaki

  Journal of hepato-biliary-pancreatic sciences 28 (4) 305 - 316 2021/04 

  BACKGROUND: The high operative mortality rate after hepatopancreatoduodenectomy (HPD) is still a major issue. The present study explored why operative mortality differs significantly due to hospital volume. METHOD: Surgical case data were extracted from the National Clinical Database (NCD) in Japan from 2011 to 2014. Surgical procedures were categorized as major (≥2 sections) and minor (<2 sections) hepatectomy. Hospitals were categorized according to the certification system by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) based on the number of major hepato-biliary-pancreatic surgeries performed per year. The FTR rate was defined as death in a patient with at least one postoperative complication. RESULTS: A total of 422 patients who underwent HPD were analyzed. The operative mortality rates in board-certified A training institutions, board-certified B training institutions, and non-certified institution were 7.2%, 11.6%, and 21.4%, respectively. Multiple logistic regression showed that certified A institutions, major hepatectomy, and blood transfusion were the predictors of operative mortality. Failure to rescue rates were lowest in certified A institutions (9.3%, 17.0%, and 33.3% in certified A, certified B, and non-certified, respectively). CONCLUSIONS: To reduce operative mortality after HPD, further centralization of this procedure is desirable. Future studies should clarify specific ways to improve the failure-to-rescue rates in certified institutions.
• Conversion surgery in patients with pancreatic cancer and peritoneal metastasis.

  Suguru Yamada, Tsutomu Fujii, Tomohisa Yamamoto, Hideki Takami, Isaku Yoshioka, So Yamaki, Fuminori Sonohara, Kazuto Shibuya, Fuyuhiko Motoi, Satoshi Hirano, Yoshiak Murakami, Hitoshi Inoue, Masamichi Hayashi, Daisuke Hashimoto, Kenta Murotani, Joji Kitayama, Hideki Ishikawa, Yasuhiro Kodera, Mitsugu Sekimoto, Sohei Satoi

  Journal of gastrointestinal oncology 12 (Suppl 1) S110-S117  2021/04 

  Background: Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal malignancies globally. We have previously explored the clinical efficacy of intraperitoneal (IP) paclitaxel therapy for patients with PDAC and peritoneal metastasis, which demonstrated favourable response and disease control rates. However, the real implications of conversion surgery after IP therapy remain unclear. Methods: We conducted two multicenter clinical trials of IP therapy with paclitaxel in patients with PDAC and peritoneal metastasis. We focused on patients who underwent conversion surgery and investigated the long-term outcomes, particularly, initial recurrence patterns and long-term survival. Results: Seventy-nine patients with PDAC and peritoneal metastasis were treated, and 33 (41.8%) patients received SP (intravenous IP paclitaxel with S-1) and 46 (58.3%) were administered GAP (intravenous gemcitabine + nab-paclitaxel combined with IP paclitaxel) combination therapy. Of the 79 patients, 16 (20.3%) underwent conversion surgery. The median time to surgery was 9.0 (range, 4.1-13.0) months after the initiation of chemotherapy. Finally, 13 (81.3%) patients underwent R0 resection. Evans grade was IIA in nine patients, IIB in four patients, III in two patients, and IV in one patient. The median overall survival time in patients who underwent conversion surgery was 32.5 (range, 13.5-66.9) months. Twelve (75.0%) patients were found to have experienced recurrence after conversion surgery. Especially, peritoneal recurrence was observed in 50% of patients as the initial recurrence pattern. The median recurrence-free survival time was 9.2 (range, 5.1-32.8) months, and three patients have survived without recurrence to date. Conclusions: Our IP therapy displays promising clinical efficacy with acceptable tolerability in patients with PDAC and peritoneal metastasis. Although we could observe some super-responders in the cohort, further improvements in IP therapy are warranted.
• Laparoscopic ultrasound guided wedge resection of the stomach: a novel procedure for gastric submucosal tumor.

  Hideyuki Wada, Katsuhiko Murakawa, Koichi Ono, Satoshi Hirano

  Updates in surgery 74 (1) 367 - 372 2021/03/12 

  It is essential for the surgery of gastric submucosal tumors to resect the tumor with a negative margin and minimize the incision of the normal stomach wall. We developed a novel procedure for patients with gastric submucosal tumors using a laparoscopic ultrasound probe as a guide to determine the resection line. Since 2014, we have performed the laparoscopic ultrasound-guided wedge resection of the stomach in seven patients. The tumor was localized, and the property of the tumor was clearly identified using a laparoscopic ultrasound probe. As a result, the ideal incision line was determined without intraoperative endoscopy. The stomach wall was perforated along the marking on the planned incision line and the whole layer is subsequently incised along with the tumor. The surgical margins were negative, and there were no obvious injuries of the pseudocapsule, microscopically, in any case. It is possible that the laparoscopic ultrasound-guided wedge resection of the stomach contributes to a simplification of the surgery of gastric submucosal tumors resulting in reduced medical cost while maintaining curability and functional preservation.
• Direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography ("BAMBOO SPEAR").

  Naoki Hayakawa, Satoshi Kodera, Masataka Arakawa, Satoshi Hirano, Sandeep Shakya, Junji Kanda

  CVIR endovascular 4 (1) 27 - 27 2021/03/04 

  BACKGROUND: Surgical endarterectomy for common femoral artery (CFA) disease is still considered the gold standard for treatment. Development of various techniques and devices has improved the clinical results of endovascular therapy (EVT) for CFA. However, severe conditions remain, especially for occlusive lesions owing to calcified plaque. We developed a useful technique for passing a lesion by directly penetrating the calcified plaque of the CFA using a bare metal needle and then passing through a balloon or dilating it. We named this technique "direct bare metal needle puncture and balloon angioplasty in calcified plaques of the common femoral artery guided by angiography" or "BAMBOO SPEAR." MAIN TEXT: This report describes our technique for crossing a lesion by directly penetrating the calcified plaque of the CFA using a needle. We report a case of a 73-year-old male with hemodialysis who presented with cyanosis and ischemic rest pain of both lower limbs. Control angiography showed total occlusion of the left CFA with a calcified plaque. We advanced a 21-G metal needle that was slightly curved into the blood vessel from where the lumen of the distal CFA was located. The needle was advanced into the center of the calcified plaque, while observing from multiple directions with a fluoroscopic guide. We succeeded in advancing the needle into the lumen of the distal external iliac artery. After guidewire crossing, intravascular ultrasound (IVUS) showed that guidewire was able to completely pass through the center of the calcified plaque. We could dilate the lesion by scoring balloon and drug-coated balloon. The final angiography showed sufficient results. We named this technique "direct BAre Metal needle puncture and BallOOn angioplaSty in calcified PlaquEs of the common femoral ARtery guided by angiography" (BAMBOO SPEAR). CONCLUSIONS: The BAMBOO SPEAR technique may be considered a useful option in EVT for occlusive CFA with calcified plaques.
• Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report.

  Tomoko Mizota, Masato Suzuoki, Saya Kaku, Kenichi Mizunuma, Kazuto Ohtaka, Ryo Takahashi, Kazuteru Komuro, Nozomu Iwashiro, Masanori Ohara, Noriko Kimura, Satoshi Hirano

  Surgical case reports 7 (1) 63 - 63 2021/03/04 

  BACKGROUND: Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. CASE PRESENTATION: A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. CONCLUSIONS: SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.
• 【肝胆膵外科における再切除と再手術-最新の治療戦略】膵頭十二指腸切除術後の膵液瘻に対する対処と再手術の位置付け

  櫛谷 洋樹, 村上 壮一, 浅野 賢道, 平野 聡

  手術 金原出版(株) 75 (3) 333 - 338 0037-4423 2021/03
• コロナ禍における世界の外科教育の現状と展望

  倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP2 - 1 1344-6703 2021/03
• コロナ禍における腹腔鏡下手術遠隔シミュレーショントレーニングシステムの開発

  桐山 琴衣, 倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP2 - 4 1344-6703 2021/03
• コロナ禍における腹腔鏡下手術遠隔シミュレーショントレーニングシステムの開発

  桐山 琴衣, 倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP4 - 3 1344-6703 2021/03
• 胆嚢癌に対する腹腔鏡下手術の適応と手術成績 胆嚢癌に対する腹腔鏡下手術の可能性と限界

  平野 聡, 岡村 圭祐, 野路 武寛, 中西 善嗣, 田中 公貴

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) WS19 - 1 1344-6703 2021/03
• 十二指腸癌に対する術前壁深達度診断から見た術式選択と予後の検討

  北山 陽介, 田中 公貴, 中西 善嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 51 - 51 2021/03
• 胆嚢癌手術症例の非切除因子と予後不良因子の検討

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 53 - 53 2021/03
• 食道癌根治術後に幽門輪温存膵頭十二指腸切除を施行した1例

  郷 雅, 岡村 圭祐, 中西 善嗣, 野路 武寛, 田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 73 - 73 2021/03
• 胆嚢癌に対する腹腔鏡下手術の適応と手術成績 胆嚢癌に対する腹腔鏡下手術の可能性と限界

  平野 聡, 岡村 圭祐, 野路 武寛, 中西 善嗣, 田中 公貴

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) WS19 - 1 1344-6703 2021/03
• 十二指腸腫瘍-あなたの治療選択は? 十二指腸腫瘍内視鏡治療による穿孔とその治療

  村上 壮一, 倉島 庸, 岡村 圭祐, 渡邊 祐介, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 37 - 37 2021/03
• ロボット支援下に胸腔鏡下食道切除術を施行した食道GISTの1例

  山本 寛之, 海老原 裕磨, 渡邊 祐介, 倉島 庸, 村上 壮一, 七戸 俊明, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 48 - 48 2021/03
• 当教室におけるロボット支援腹腔鏡下胃切除術の定型化と短期成績

  篠原 良仁, 海老原 裕磨, 倉島 庸, 松井 あや, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 51 - 51 2021/03
• 肝門部胆管癌切除に対し"胆管分離限界点での胆管切離"を行った症例のR0切除率

  野路 武寛, 田中 公貴, 松井 あや, 渡邊 祐介, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 52 - 52 2021/03
• 肝門部胆管癌におけるinvasive tumor thicknessによる予後層別化

  中西 喜嗣, 大場 光信, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴, 村上 壮一, 倉島 庸, 渡邊 祐介, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 128回・122回 52 - 52 2021/03
• コロナ禍における世界の外科教育の現状と展望

  倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP2 - 1 1344-6703 2021/03
• コロナ禍における腹腔鏡下手術遠隔シミュレーショントレーニングシステムの開発

  桐山 琴衣, 倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP2 - 4 1344-6703 2021/03
• コロナ禍における腹腔鏡下手術遠隔シミュレーショントレーニングシステムの開発

  桐山 琴衣, 倉島 庸, サシーム・パウデル, 渡邊 祐介, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (7) BSP4 - 3 1344-6703 2021/03
• A novel laparoscopic near-infrared fluorescence spectrum system for photodynamic diagnosis of peritoneal dissemination in pancreatic cancer.

  Takahiro Saito, Yuma Ebihara, Liming Li, Tomoya Shirosaki, Hiroaki Iijima, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Photodiagnosis and photodynamic therapy 33 102157 - 102157 2021/03 

  BACKGROUND: Diagnosing peritoneal dissemination is essential for selecting the appropriate therapeutic strategy for patients with pancreatic cancer. Intraoperative laparoscopic diagnosis enables the selection of less invasive surgical strategies. Photodynamic diagnosis using 5-aminolevulinic acid may improve gastrointestinal cancer diagnostic accuracy, although weak fluorescence is not easily detected. Here we aimed to improve this sensitivity using laparoscopic spectrophotometry. METHODS: Photodynamic diagnosis was performed using serial dilutions of protoporphyrin IX, and its detectability using laparoscopic spectrophotometry was compared with that using naked-eye observation. Five-aminolevulinic acid-photodynamic diagnosis was performed for pancreatic cancer cell lines, and a murine peritoneal disseminated nodule model was established. We compared laparoscopic spectrophotometry and naked-eye observation results using white and fluorescent lights and compared them to routine histopathological examination results. Photodynamic diagnoses were made in 2017 and 2018 in eight patients with pancreatic cancer. RESULTS: Weaker fluorescence of the diluted protoporphyrin IX samples was better detected with spectrophotometry than with naked-eye observation. Moreover, a spectrograph of protoporphyrin IX in multiple cell lines was detected by spectrophotometry. In the murine model, the detection rates were 62 %, 78 %, and 90 % for naked-eye observation with white light, fluorescent light, and spectrophotometry, respectively. Comparisons of fluorescent light-negative peritonea with and without pathological metastases showed significantly higher spectrophotometric intensities in the former (P < 0.010). In clinical studies, three fluorescent light-negative spectrophotometry-positive pathologically metastatic lesions were observed. CONCLUSIONS: Laparoscopic spectrophotometry in the murine model and extraperitoneally photodynamic diagnoses using spectrophotometry in clinical practice are sensitive photodynamic diagnostic techniques.
• [A Case of Gastric Cancer Which Caused Severe Anemia(Hemoglobin 1.8 g/dL)].

  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Atsuhiko Kawakami, Satoshi Hirano

  Gan to kagaku ryoho. Cancer & chemotherapy 48 (3) 363 - 365 0385-0684 2021/03 

  A 61-year-old woman, who consulted another doctor with chief complaints of epigastric pain, nausea, anorexia, palpitation, and shortness of breath since a month was referred to our hospital for diagnosis and treatment. She was diagnosed with advanced gastric cancer. She was also found to have severe anemia(hemoglobin 1.8 g/dL)and malnutrition. With adequate precautions to prevent development of heart failure and refeeding syndrome, the patient was treated for anemia with blood transfusion and intravenous iron injection; and for malnutrition with intravenous hyperalimentation and enteral nutrition. The patient underwent distal gastrectomy 17 days after admission. Histological examination revealed a type 3 moderately differentiated tubular adenocarcinoma>solid type of poorly differentiated adenocarcinoma>mucinous adenocarcinoma corresponding to pT4a, pN3a, pStage ⅢB, respectively. The postoperative course was good and adjuvant chemotherapy was started 22 days after surgery. However, the patient died approximately 15 months after surgery due to metastases of gastric cancer to the lymph nodes.
• Molecular Classification and Tumor Microenvironment Characterization of Gallbladder Cancer by Comprehensive Genomic and Transcriptomic Analysis.

  Nobutaka Ebata, Masashi Fujita, Shota Sasagawa, Kazuhiro Maejima, Yuki Okawa, Yutaka Hatanaka, Tomoko Mitsuhashi, Ayako Oosawa-Tatsuguchi, Hiroko Tanaka, Satoru Miyano, Toru Nakamura, Satoshi Hirano, Hidewaki Nakagawa

  Cancers 13 (4) 2021/02/10 

  Gallbladder cancer (GBC), a rare but lethal disease, is often diagnosed at advanced stages. So far, molecular characterization of GBC is insufficient, and a comprehensive molecular portrait is warranted to uncover new targets and classify GBC. We performed a transcriptome analysis of both coding and non-coding RNAs from 36 GBC fresh-frozen samples. The results were integrated with those of comprehensive mutation profiling based on whole-genome or exome sequencing. The clustering analysis of RNA-seq data facilitated the classification of GBCs into two subclasses, characterized by high or low expression levels of TME (tumor microenvironment) genes. A correlation was observed between gene expression and pathological immunostaining. TME-rich tumors showed significantly poor prognosis and higher recurrence rate than TME-poor tumors. TME-rich tumors showed overexpression of genes involved in epithelial-to-mesenchymal transition (EMT) and inflammation or immune suppression, which was validated by immunostaining. One non-coding RNA, miR125B1, exhibited elevated expression in stroma-rich tumors, and miR125B1 knockout in GBC cell lines decreased its invasion ability and altered the EMT pathway. Mutation profiles revealed TP53 (47%) as the most commonly mutated gene, followed by ELF3 (13%) and ARID1A (11%). Mutations of ARID1A, ERBB3, and the genes related to the TGF-β signaling pathway were enriched in TME-rich tumors. This comprehensive analysis demonstrated that TME, EMT, and TGF-β pathway alterations are the main drivers of GBC and provides a new classification of GBCs that may be useful for therapeutic decision-making.
• Clinical Impact of Organ-Preserving Surgery for Pancreatic Neuroendocrine Neoplasms: A Single-Center Experience.

  Takahiro Tsuchikawa, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Pancreas 50 (2) 196 - 200 2021/02/01 

  OBJECTIVES: Organ-preserving surgery (OPS) has been accepted for pancreatic neuroendocrine neoplasms, particularly for the management of small tumors. This study aimed to analyze the surgical outcome following this treatment at our institute, focusing on the perioperative factors and postoperative locoregional recurrence. METHODS: We analyzed 71 consecutive patients with no synchronous liver metastasis. These patients were classified into 1 of 2 groups: the standard operation group (SOG, 41 patients) with prophylactic regional lymph node dissection and the organ-preserving surgery group (OPG, 30 patients). We performed OPS based on size criteria (tumor size <1.5 cm in nonfunctional pancreatic neuroendocrine neoplasms and <2 cm in insulinoma with no evident bulky lymph node swelling on preoperative imaging). RESULTS: The median follow-up periods were 37 months. The OPG included enucleation, partial resection, proximal parenchymal pancreatectomy, central pancreatectomy, spleen-preserving distal pancreatectomy, and Warshaw operation. The SOG included pancreatoduodenectomy and distal pancreatectomy, showing no statistically significant differences between the 2 groups in terms of operation time, hospitalization duration, and postoperative complications. Ten patients showed lymph node metastasis (25%) only in the SOG. There were no locoregional recurrent cases in the OPG. CONCLUSIONS: In selected patients, OPS may be effective based on the appropriate tumor size criteria.
• Laparoscopic real-time vessel navigation using indocyanine green fluorescence during the laparoscopic-Warshaw technique: First clinical experience.

  Yuma Ebihara, Takehiro Noji, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Journal of minimal access surgery 17 (2) 226 - 229 2021 

  BACKGROUND: Laparoscopic-Warshaw technique (lap-WT) may be selected as a function-preserving operation for malignant border lesions in the tail region of the pancreas. However, previous reports showed that there are complications such as infection and abscess formation due to lack of blood flow to the spleen after surgery. To overcome the problems, we have performed real-time vessel navigation by using indocyanine green (ICG) fluorescence during lap-WT. MATERIALS AND METHODS: We report our experience of three patients with pancreatic tumour who underwent real-time vessel navigation during lap-WT at Hokkaido University from May 2017 to September 2018. RESULTS: The median operating time was 339 min (174-420). The median intraoperative bleeding was 150 ml (0-480). There were no incidences of complications. There were no cases with post-operative spleen ischaemia or abscess formation and varices formation. CONCLUSION: We believe that laparoscopic real-time vessel navigation using indocyanine green fluorescence during lap-WT could contribute in reducing the post-operative spleen-related complications.
• Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition.

  Masato Nagino, Satoshi Hirano, Hideyuki Yoshitomi, Taku Aoki, Katsuhiko Uesaka, Michiaki Unno, Tomoki Ebata, Masaru Konishi, Keiji Sano, Kazuaki Shimada, Hiroaki Shimizu, Ryota Higuchi, Toshifumi Wakai, Hiroyuki Isayama, Takuji Okusaka, Toshio Tsuyuguchi, Yoshiki Hirooka, Junji Furuse, Hiroyuki Maguchi, Kojiro Suzuki, Hideya Yamazaki, Hiroshi Kijima, Akio Yanagisawa, Masahiro Yoshida, Yukihiro Yokoyama, Takashi Mizuno, Itaru Endo

  Journal of hepato-biliary-pancreatic sciences 28 (1) 26 - 54 2021/01 

  BACKGROUND: The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. METHODS: In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as Grade 1 (strong) or Grade 2 (weak) according to the concepts of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: The 31 CQs covered the six topics: (a) prophylactic treatment, (b) diagnosis, (c) biliary drainage, (d) surgical treatment, (e) chemotherapy, and (f) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. CONCLUSIONS: This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.
• Robot-assisted Gait Training Using Welwalk in Hemiparetic Stroke Patients: An Effectiveness Study with Matched Control.

  Takuma Ii, Satoshi Hirano, Shigeo Tanabe, Eiichi Saitoh, Junya Yamada, Masahiko Mukaino, Makoto Watanabe, Shigeru Sonoda, Yohei Otaka

  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 29 (12) 105377 - 105377 2020/12 [Refereed]
   

  OBJECTIVE: Although studies on the efficacy of the rehabilitation robot are increasing, there are few reports using the robot for gait training in the actual clinical setting. This study aimed to investigate the effectiveness of gait training using Welwalk in hemiparetic stroke patients in a real clinical setting. MATERIALS AND METHODS: This prospective study included 36 hemiparetic stroke patients who underwent gait training using Welwalk. We examined the walking ability improvement efficiency using Functional Independence Measure (FIM)-walk as the primary outcome, which was compared with that of 36 patients (matched control group) who underwent conventional rehabilitation. Other outcomes were the actual gait training period using Welwalk, raw FIM-walk score, lower extremity motor functions score in Stroke Impairment Assessment Set at discharge, and duration from stroke onset until discharge. RESULTS: The improvement efficiency of the FIM-walk was significantly higher in the Welwalk group than in the matched control group (control 0.48 ± 0.31, Welwalk 0.80 ± 0.38, p-value < 0.001). The mean gait training period using Welwalk was 5 weeks. No significant differences were found in other outcomes between the Welwalk group and the matched control group. CONCLUSION: This study demonstrated the effectiveness of gait training using Welwalk on the improvement efficiency of the FIM-walk in hemiparetic stroke patients in an actual clinical setting.
• ロボット支援腹腔鏡下幽門側胃切除術の短期成績における検討

  海老原 裕磨, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 RSV5 - 5 2020/12
• Cadaver surgical trainingによる食道内視鏡外科手術の定型化

  七戸 俊明, 海老原 裕磨, 倉島 庸, 村上 壮一, 楢崎 肇, 土川 貴裕, 岡村 圭祐, 中村 透, 野路 武寛, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P007 - 5 2020/12
• 食道GISTに対してロボット支援胸腔鏡下食道切除術を施行した1例

  山本 寛之, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 野路 武寛, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P014 - 4 2020/12
• 胃後壁斜め吻合によるダブルトラクト再建を用いた腹腔鏡下噴門側胃切除術の術後栄養状態に関する中長期成績

  木村 弘太郎, 海老原 裕磨, 楢崎 肇, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P052 - 4 2020/12
• 消化器外科医のための外傷診療手技・手術トレーニングコース開発

  村上 壮一, 廣瀬 和幸, 倉島 庸, 七戸 俊明, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 海老原 裕磨, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P333 - 7 2020/12
• 新規技術の開発とカダバートレーニングの実際 カダバートレーニングの胸腔鏡下食道切除術の手技向上に対する有用性の検討

  大川 裕貴, 七戸 俊明, 倉島 庸, 海老原 裕磨, 村上 壮一, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 74回 75 - 75 2020/12
• 食道胃接合部癌に対するMALTAを用いた腹腔鏡下胃切除+下部食道切除術の手術成績

  海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 74回 319 - 319 2020/12
• 食道亜全摘後縫合不全に対する電動式低圧吸引機を用いた管腔内持続減圧法の検討

  金子 司, 七戸 俊明, 上村 志臣, 楢崎 肇, 宮坂 大介, 海老原 裕磨, 倉島 庸, 村上 壮一, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 74回 339 - 339 2020/12
• 【膵頭十二指腸切除の完全ガイド-定型術式から困難症例への対処法まで】困難症例に対する手技・対処法 肝門部に達する金属ステント留置が行われた症例に対するPD

  松井 あや, 平野 聡, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐

  臨床外科 (株)医学書院 75 (13) 1452 - 1456 0386-9857 2020/12 

  ＜文献概要＞ポイント ◆金属ステントが留置された症例の胆管切離時には,切除側胆管の閉鎖が困難な場合があり,胆汁の漏出をきたさないように工夫が必要である.◆金属ステント留置部より肝臓側での胆管切離が理想であるが,膵癌に対する膵頭十二指腸切除ではステント留置部での切離も許容されると考える.◆胆管から右肝動脈の剥離を行う場合は,動脈周囲神経鞘を切開し,血管外膜を露出する層で剥離を行うと操作が容易で安全である.
• [膵]進行膵癌に対するConversion surgery 切除不能膵癌に対するconversion surgeryの切除成績と主要動脈の取り扱い

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 PD6 - 5 2020/12
• [胆]進行胆嚢癌に対する治療方針 胆嚢癌の傍大動脈リンパ節検索の意義と手術例の予後不良因子

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 PD5 - 3 2020/12
• 治療前予後スコアを用いたResectable膵癌における術前補助療法の患者選択

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 倉島 庸, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 O17 - 1 2020/12
• 胆道癌に対する肝切除を伴う根治切除術後の菌血症およびその起因菌に関する検討

  福田 純己, 田中 公貴, 中西 喜嗣, 野路 武寛, 岡村 圭祐, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P257 - 4 2020/12
• 肝門部胆管癌切除において高いR0切除率を得るための"胆管分離限界点での胆管切離"

  野路 武寛, 岡村 圭祐, 松井 あや, 田中 公貴, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P266 - 5 2020/12
• 膵頭十二指腸切除術後のドレーンマネージメント 排液アミラーゼ値とドレーン造影所見による管理

  田中 公貴, 山本 寛之, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P307 - 2 2020/12
• 消化器手術患者の術後せん妄に関するリスク因子の検討

  大川 裕貴, 田中 公貴, 海老原 裕磨, 野路 武寛, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 75回 P324 - 1 2020/12
• 超音波凝固切開装置のBest Practice!

  渡邊 祐介, 倉島 庸, 平野 聡

  日本外科系連合学会誌 日本外科系連合学会 45 (5) 490 - 490 0385-7883 2020/12
• Fundamental Use of Surgical Energy(FUSE) 目から鱗!電気メスの基礎原理と正しい使い方

  渡邊 祐介, 倉島 庸, 七戸 俊明, 平野 聡

  日本皮膚悪性腫瘍学会学術大会プログラム・抄録集 (一社)日本皮膚悪性腫瘍学会 36回 61 - 61 2020/12
• 内視鏡手術手技のトレーニングと伝承 消化器外科領域のカダバートレーニングの実践と今後の課題

  七戸 俊明, 村上 壮一, 倉島 庸, 海老原 裕磨, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本外科系連合学会誌 日本外科系連合学会 45 (5) 550 - 550 0385-7883 2020/12
• Is there disparity between regions and facilities in surgical resident training in Japan? Insights from a national survey.

  Daisuke Hashimoto, Saseem Poudel, Satoshi Hirano, Yo Kurashima, Hirotoshi Akiyama, Susumu Eguchi, Toshihiro Fukui, Masaru Hagiwara, Koya Hida, Tomoko Izaki, Hirotaka Iwase, Shunsuke Kawamoto, Yasuhiro Otomo, Eishi Nagai, Mitsue Saito, Hideki Takami, Yuko Takeda, Masakazu Toi, Hiroki Yamaue, Motofumi Yoshida, Shigetoshi Yoshida, Takao Ohki, Yasuhiro Kodera

  Surgery today 50 (12) 1585 - 1593 2020/12 

  PURPOSE: This study sought to assess the disparity between regions and facilities in surgical resident training in Japan via a national level needs-assessment. METHODS: A survey was sent to all 909 graduating residents of 2016. Residents trained in the six prefectures with a population of 7 million or more were included in the large prefecture (LP) group. Residents trained in the other 41 prefectures were included in the small prefecture (SP) group. Each group was further divided into a university hospital (UH) group and a non-university hospital (NUH) group. RESULTS: The response rate was 56.3% (n = 512). Excluding nine residents who did not report their prefectures and facilities, surveys from 503 residents were analyzed. The UH group received significantly more years of training. In the SP and UH groups, there were significantly fewer residents who had performed 150 procedures or more under general anesthesia in comparison to the LP and NUH groups, respectively. Self-assessed competencies for several procedures were significantly lower in the SP and UH groups. CONCLUSION: Disparity in surgical resident training was found between regions and facilities in Japan. The surgical residency curriculum in Japan could be improved to address this problem.
• Risk prediction for malignant intraductal papillary mucinous neoplasm of the pancreas: logistic regression versus machine learning.

  Jae Seung Kang, Chanhee Lee, Wookyeong Song, Wonho Choo, Seungyeoun Lee, Sungyoung Lee, Youngmin Han, Claudio Bassi, Roberto Salvia, Giovanni Marchegiani, Cristopher L Wolfgang, Jin He, Alex B Blair, Michael D Kluger, Gloria H Su, Song Cheol Kim, Ki-Byung Song, Masakazu Yamamoto, Ryota Higuchi, Takashi Hatori, Ching-Yao Yang, Hiroki Yamaue, Seiko Hirono, Sohei Satoi, Tsutomu Fujii, Satoshi Hirano, Wenhui Lou, Yasushi Hashimoto, Yasuhiro Shimizu, Marco Del Chiaro, Roberto Valente, Matthias Lohr, Dong Wook Choi, Seong Ho Choi, Jin Seok Heo, Fuyuhiko Motoi, Ippei Matsumoto, Woo Jung Lee, Chang Moo Kang, Yi-Ming Shyr, Shin-E Wang, Ho-Seong Han, Yoo-Seok Yoon, Marc G Besselink, Nadine C M van Huijgevoort, Masayuki Sho, Hiroaki Nagano, Sang Geol Kim, Goro Honda, Yinmo Yang, Hee Chul Yu, Jae Do Yang, Jun Chul Chung, Yuichi Nagakawa, Hyung Il Seo, Yoo Jin Choi, Yoonhyeong Byun, Hongbeom Kim, Wooil Kwon, Taesung Park, Jin-Young Jang

  Scientific reports 10 (1) 20140 - 20140 2020/11/18 

  Most models for predicting malignant pancreatic intraductal papillary mucinous neoplasms were developed based on logistic regression (LR) analysis. Our study aimed to develop risk prediction models using machine learning (ML) and LR techniques and compare their performances. This was a multinational, multi-institutional, retrospective study. Clinical variables including age, sex, main duct diameter, cyst size, mural nodule, and tumour location were factors considered for model development (MD). After the division into a MD set and a test set (2:1), the best ML and LR models were developed by training with the MD set using a tenfold cross validation. The test area under the receiver operating curves (AUCs) of the two models were calculated using an independent test set. A total of 3,708 patients were included. The stacked ensemble algorithm in the ML model and variable combinations containing all variables in the LR model were the most chosen during 200 repetitions. After 200 repetitions, the mean AUCs of the ML and LR models were comparable (0.725 vs. 0.725). The performances of the ML and LR models were comparable. The LR model was more practical than ML counterpart, because of its convenience in clinical use and simple interpretability.
• 消化器悪性疾患に対するconversion surgery

  浅野 賢道, 中村 透, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 53 (Suppl.2) 123 - 123 0386-9768 2020/11
• 胆道 悪性

  野路 武寛, 岡村 圭祐, 楢崎 肇, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 53 (Suppl.2) 300 - 300 0386-9768 2020/11
• 電気メスのBest Practice 適正使用とサージカルスモークに潜む感染リスク

  渡邊 祐介, 平野 聡

  日本産科婦人科内視鏡学会雑誌 (一社)日本産科婦人科内視鏡学会 36 (Suppl.I) [JMSB3 - 1] 1884-9938 2020/11
• 膵管胆管合流異常症に限局性肝内胆管狭窄を生じた症例に対する手術経験

  野路 武寛, 渡邊 佑介, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本膵・胆管合流異常研究会プロシーディングス 日本膵・胆管合流異常研究会 43 72 - 72 1883-4116 2020/11
• Development of an abnormal gait analysis system in gait exercise assist robot 'Welwalk' for hemiplegic stroke patients

  Issei Nakashima, Daisuke Imoto, Satoshi Hirano, Masahiko Mukaino, Masayuki Imaida, Eiichi Saitoh, Yohei Otaka

  Proceedings of the IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics 2020-November 1030 - 1035 2155-1774 2020/11 

  © 2020 IEEE. Welwalk WW-1000 is a gait exercise robotic assist system that allows subjects to walk on treadmill by attaching a knee-ankle-foot robot to a paralyzed limb. Abnormal gait patterns during exercise using Welwalk WW-1000 are evaluated by gait observation or marker-based motion analysis systems. However, gait observation is a subjective and ordinal measure, and marker-based motion analysis systems are challenging to implement due to the complexity of preparing equipment and attaching markers to subjects. In this study, we propose the Welwalk WW-2000 system, which incorporated a marker-less motion analysis system that detects abnormal gait patterns during exercise using the robotic system. Using this system, it is expected that a gait exercise program can be planned from easily obtainable, objective information. This system detects the features of abnormal gait patterns using the body position coordinates of the subject obtained from three-dimensional, inertial, knee angle, and load sensors. The purpose of this study was to validate the marker-less motion analysis system against marker-based motion analysis systems. One healthy male simulated the seven abnormal gait patterns which occur frequently in stroke patients, with four grades of severity. Spearman's rank correlation coefficients were calculated for the relationship between the abnormal gait pattern parameters calculated by each motion analysis system. The correlations between the two systems ranged from 0.81 to 0.95. Therefore, it was confirmed that the marker-less motion analysis system of the Welwalk WW-2000 was valid.
• Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study.

  Takehiro Noji, Minoru Nagayama, Koji Imai, Yasuyuki Kawamoto, Masaki Kuwatani, Masafumi Imamura, Keikuke Okamura, Yastoshi Kimura, Satoshi Hirano

  Surgery today 50 (11) 1409 - 1417 2020/11 

  PURPOSE: Few studies have focused on conversion surgery for biliary malignancy; thus, it is not clear if this treatment modality can extend the survival of patients with unresectable biliary malignancy. We conducted a multicenter retrospective cohort study to evaluate the surgical outcomes of conversion surgery in this setting and analyze long-term survival. METHODS: We collected clinical data retrospectively on patients who underwent conversion surgery for biliary malignancy. RESULTS: Twenty-four patients met our inclusion criteria. Preoperative chemotherapy regimens or chemoradiation therapy regimens were administered based on the institutional criteria, and surgical procedures were chosen based on tumor location. Morbidity occurred in 16 patients (66.7%), and 1 patient died of liver failure after surgery. The overall 5-year survival rate following initial therapy was 43.2%, and the median survival time was 57.4 months. The corresponding values following surgery were 38.2% and 34.3 months, respectively. The 5-year survival rate of the 24 patients who received both chemotherapy and surgery was significantly better than that of 110 patients treated with chemotherapy only (p < 0.001). CONCLUSION: Conversion surgery for initially unresectable biliary malignancies may be feasible and achieve long-term survival for selected patients.
• Neoadjuvant S-1 With Concurrent Radiotherapy Followed by Surgery for Borderline Resectable Pancreatic Cancer: A Phase II Open-Label Multicenter Prospective Trial (JASPAC05).

  Shinichiro Takahashi, Izumi Ohno, Masafumi Ikeda, Masaru Konishi, Tatsushi Kobayashi, Tetsuo Akimoto, Motohiro Kojima, Soichiro Morinaga, Hirochika Toyama, Yasuhiro Shimizu, Atsushi Miyamoto, Moriaki Tomikawa, Norihisa Takakura, Wataru Takayama, Satoshi Hirano, Takehito Otsubo, Masato Nagino, Wataru Kimura, Keishi Sugimachi, Katsuhiko Uesaka

  Annals of surgery 276 (5) e510-e517  2020/10/15 

  OBJECTIVE: This study assessed whether neoadjuvant chemoradiotherapy (CRT) with S-1 increases the R0 resection rate in borderline resectable pancreatic cancer (BRPC). SUMMARY BACKGROUND DATA: Although a multidisciplinary approach that includes neoadjuvant treatment has been shown to be a better strategy for BRPC than upfront resection, a standard treatment for BRPC has not been established. METHODS: A multicenter, single-arm, phase II study was performed. Patients who fulfilled the criteria for BRPC received S-1 (40 mg/m bid) and concurrent radiotherapy (50.4 Gy in 28 fractions) before surgery. The primary endpoint was the R0 resection rate. At least 40 patients were required, with a one-sided α = 0.05 and β = 0.05 and expected and threshold values for the primary endpoint of 30% and 10%, respectively. RESULTS: Fifty-two patients were eligible, and 41 were confirmed to have definitive BRPC by a central review. CRT was completed in 50 (96%) patients and was well tolerated. The rate of grade 3/4 toxicity with CRT was 43%. The R0 resection rate was 52% among the 52 eligible patients and 63% among the 41 patients who were centrally confirmed to have BRPC. Postoperative grade III/IV adverse events according to the Clavien-Dindo classification were observed in 7.5%. Among the 41 centrally confirmed BRPC patients, the 2-year overall survival rate and median overall survival duration were 58% and 30.8 months, respectively. CONCLUSIONS: S-1 and concurrent radiotherapy appear to be feasible and effective at increasing the R0 resection rate and improving survival in patients with BRPC. TRIAL REGISTRATION: UMIN000009172.
• 主膵管多発狭窄を呈した膵管上皮内病変の1例

  佐々木 貴志, 桑谷 将城, 三橋 智子, 浅野 賢道, 中村 透, 平野 聡, 坂本 直哉

  日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 127回・121回 68 - 68 2020/10
• 消化器悪性疾患に対するconversion surgery 切除不能膵癌に対するconversion surgeryの予後延長効果に関する検討

  浅野 賢道, 中村 透, 平野 聡

  日本消化器病学会雑誌 (一財)日本消化器病学会 117 (臨増大会) A644 - A644 0446-6586 2020/10
• 心嚢ドレナージ術と食道減圧ドレナージ術で保存的に軽快した食道心嚢瘻の一例

  植木 知音, 東嶋 宏泰, 楢崎 肇, 倉島 庸, 海老原 裕磨, 村上 壮一, 七戸 俊明, 若狭 哲, 平野 聡

  日本胸部外科学会定期学術集会 (一社)日本胸部外科学会 73回 ECPA1 - 2 2020/10
• ARF6のエフェクター分子AMAP1の高発現はPD-L1及び線維化の亢進に関わる

  橋本 あり, 蔦保 暁生, 橋本 茂, 畑 宗一郎, 加地 紫苑, 平野 聡, 佐邊 壽孝

  日本癌学会総会記事 79回 PJ14 - 2 0546-0476 2020/10
• 肝門部領域胆管がんの治療戦略 肝門部領域胆管癌に対する手術治療の現状と課題

  平野 聡, 中西 喜嗣, 野路 武寛

  日本癌治療学会学術集会抄録集 58回 SY12 - 3 2020/10
• 膵癌の腫瘍血管内皮細胞におけるbiglycan発現の臨床的意義の検討

  田中 宏典, 間石 奈湖, 森本 浩史, Annan Dorcas A., 中村 透, 樋田 泰浩, 平野 聡, 樋田 京子

  日本癌学会総会記事 79回 PJ14 - 10 0546-0476 2020/10
• 新興感染症に対する外科医の取り組み サージカルスモークに潜む感染リスク

  渡邊 祐介, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 81 (増刊) 172 - 172 1345-2843 2020/10
• これからの外科教育 外科手術におけるカダバートレーニングの実際と将来展望

  七戸 俊明, 海老原 裕磨, 倉島 庸, 村上 壮一, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 81 (増刊) 207 - 207 1345-2843 2020/10
• 外傷手術修練の現状と課題 外傷外科診療におけるHub-and-Spokeシステム確立をめざして 一般外科医に対する外傷診療トレーニング

  村上 壮一, 廣瀬 和幸, 倉島 庸, 渡邊 祐介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 81 (増刊) 276 - 276 1345-2843 2020/10
• Time to Recurrence After Surgical Resection and Survival After Recurrence Among Patients with Perihilar and Distal Cholangiocarcinomas.

  Yoshitsugu Nakanishi, Keisuke Okamura, Takahiro Tsuchikawa, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Aya Matsui, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Hajime Narasaki, Toraji Amano, Toshiaki Shichinohe, Satoshi Hirano

  Annals of surgical oncology 27 (11) 4171 - 4180 2020/10 

  BACKGROUND: The differences between perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC) regarding recurrence and the factors that affect recurrence after surgery are unclear. This study aims to investigate the differences in recurrence patterns between patients with PHCC and those with DCC after surgical resection with curative intent. It also investigates the risk factors associated with recurrence and survival thereafter. PATIENTS AND METHODS: The postoperative courses of 366 patients with extrahepatic cholangiocarcinomas (EHCCs), including 236 with PHCC and 130 with DCC, who underwent surgical resections were investigated retrospectively. RESULTS: During follow-up, tumors recurred in 143 (60.6%) patients with PHCC and in 72 (55.4%) patients with DCC. Overall survival (OS) after surgery, recurrence-free survival (RFS), and OS after recurrence were similar for the patients with PHCC and those with DCC. The cumulative probability of recurrence declined 3 years after surgery in the patients with PHCC and those with DCC. A multivariable analysis determined that, among the patients with PHCC and those with DCC, regional lymph node metastasis was a significant risk factor associated with RFS. Ten patients with PHCC and eight patients with DCC with two or fewer sites of recurrence in a single organ underwent resections. A multivariable analysis determined that recurrent tumor resection was an independent prognostic factor associated with OS after recurrence in the patients with PHCC and those with DCC. CONCLUSIONS: Postoperative survival did not differ between the patients with PHCC and those with DCC. Frequent surveillances for recurrence are needed for 3 years after surgical resection of EHCCs. In selected patients, surgery for recurrent EHCCs might be associated with improved outcomes.
• Pancreatic body and tail cancer and favorable metastatic lymph node behavior on the left edge of the aorta.

  Kimitaka Tanaka, Toru Nakamura, Toshimichi Asano, Yoshitsugu Nakanishi, Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 (7) 1451 - 1457 2020/10 

  BACKGROUND: Lymph node (LN) metastasis in pancreatic body-tail cancer is a poor prognostic factor and the optimal LN dissection area for distal pancreatectomy (DP) remains unclear. Lymphatic flow from the tumors is thought to depend on the tumor sites. We examined LN metastasis frequency based on tumor site and recurrent patterns post-DP. METHODS: With a retrospective, single institutional study, we examined 100 patients who underwent DP as an upfront surgery for pancreatic cancer over 17 years. Tumor sites were classified as tumor confined to pancreatic body (and neck) (Pb(n)); and pancreatic tail (Pt). We compared metastatic LN and recurrence patterns based on tumor site. The median overall survival (OS) and disease-free survival (DFS) were analyzed. RESULTS: LN metastasis occurred in 59/100 (59.0%), with 23 and 25 tumors located in the Pb(n), and Pt, respectively. Those with the tumor in Pt had metastases to #10, #11d/p, and #18 LN mainly. However, the patients with the Pb(n) tumor had metastases to #8a/p, #11p, and #14p/d LN. There was no metastasis to #10 and #11d LN. The OS and DFS were 34 and 15 months, respectively. No significant difference was found in the OS, DFS, and recurrence patterns based on tumor sites. CONCLUSION: Differences in metastatic LN sites were observed in pancreatic body-tail cancer when tumors were confined to the left or right of the left aortic edge. Although it is necessary to validate this finding with a large-scale study, organ-preserving DP might be a treatment option for selected patients depending on the tumor sites.
• Immunological Gene Signature Associated With the Tumor Microenvironment of Pancreatic Cancer After Neoadjuvant Chemotherapy.

  Yuma Hane, Takahiro Tsuchikawa, Toru Nakamura, Kanako C Hatanaka, Tatsuro Saito, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Keisuke Okamura, Toshiaki Shichinohe, Isao Yokota, Yutaka Hatanaka, Satoshi Hirano

  Pancreas 49 (9) 1240 - 1245 2020/10 

  OBJECTIVES: Neoadjuvant chemotherapy (NAC) has improved overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but its effects on immune gene signatures are unknown. Here, we examined the immune transcriptome after NAC for PDAC. METHODS: Resected tumor specimens were obtained from 140 patients with PDAC who received surgery first (n = 93) or NAC (n = 47). Six patients were randomly selected from each group, and RNA was extracted from tumor tissues. We compared 770 immune-related genes among the 2 groups using nCounterPanCancer Immune Profiling (NanoString Technologies, Seattle, Wash). Gene clusters were classified into 14 immune function groups based on gene ontology argolism by nSolver 4.0 software (NanoString Technologies), and corresponding immune cell function scores were compared. RESULTS: Eleven genes (LY86, SH2D1A, CD247, TIGIT, CR2, CD83, LAMP3, CXCR4, DUSP4, SELL, and IL2RA) were significantly downregulated in the NAC group. Gene expression analysis showed that the functions of regulatory T cells, B cells, and natural killer CD56 dim cells were significantly decreased in the NAC group. CONCLUSIONS: Neoadjuvant chemotherapy may suppress regulatory T cells and B-cell function in the PDAC microenvironment. The 11 identified genes could be useful for predicting the efficacy of NAC and could be therapeutic targets for PDAC.
• Outcomes of limited resection for patients with intraductal papillary mucinous neoplasm of the pancreas: A single-center experience.

  Toshimichi Asano, Toru Nakamura, Takehiro Noji, Keisuke Okamura, Takahiro Tsuchikawa, Yuma Ebihara, Yoshitsugu Nakanishi, Kimitaka Tanaka, Aya Matsui, Toshiaki Shichinohe, Satoshi Hirano

  Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 (7) 1399 - 1405 2020/10 

  BACKGROUND: /ObjectivesThe aim of this study was to clarify the oncological outcomes of patients with intraductal papillary mucinous neoplasm (IPMN) who underwent limited resection (LR). METHODS: This retrospective study analyzed the data of 110 patients with IPMN. Patients with IPMN without a history of pancreatitis who had neither tumor infiltration nor regional lymph node swelling on imaging findings underwent LR. We assessed the oncological outcomes of LR for patients with IPMN by comparing the surgical outcomes of LR and standard resection. RESULTS: LR was performed in 50 patients (45.5%), including duodenum-preserving pancreatic head resection (n = 31), middle-pancreatectomy (n = 12), spleen-preserving distal pancreatectomy (n = 3), total parenchymal pancreatectomy (n = 3), and partial resection (n = 1). In the LR group, 18 patients had postoperative complications of Clavien-Dindo classification ≥ IIIa. After histopathological examination, the presence of high-grade dysplasia (HGD) and invasive carcinoma (IC) were observed in nine and three patients, respectively, in the LR group, and eight and 22 patients, respectively, in the standard resection group. There was a significant difference in the histopathological diagnosis of IC between the two groups (p < 0.001). Finally, in the LR group, postoperative recurrences occurred in three patients, and the 5-, 10-, and 15-year disease-specific survival rates were all 97.0%. CONCLUSIONS: For patients with IPMN judged to have no infiltrating lesions based on the detailed imaging examination, LR is acceptable and may be considered as an alternative to standard resection.
• Laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric and perigastric lymph node metastases and pancreatic invasion from melanoma: a case report.

  Yuki Okawa, Yuma Ebihara, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgical case reports 6 (1) 239 - 239 2020/09/29 

  BACKGROUND: In melanoma, completely resectable metastases are surgically resected to expect to prolong relapse-free survival and overall survival. However, distant metastases of melanoma are rarely indicated for surgery because multiple metastases are often observed at diagnosis. We report a case of a man in his 50s who underwent laparoscopic-assisted distal gastrectomy and central pancreatectomy for gastric metastases, lymph node metastases, and pancreatic invasion that could be completely resected. CASE PRESENTATION: A 50-year-old man was diagnosed with malignant melanoma of the left parietal region. After diagnosis, tumor resection and left cervical lymph node dissection were performed, and interferon-β treatment was added as adjuvant therapy. Seventeen months after adjuvant therapy, metastasis of stomach and abdominal lymph nodes from melanoma was diagnosed. And the pancreatic invasion of lymph nodes was suspected. Laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed because pancreatic invasion of melanoma was intraoperatively found. After 9 months of relapse-free survival, abdominal recurrence was observed. Nivolumab and ipilimumab were administered, and recurrent lesions are currently controlled. The patient has survived more than 3 years since metastasis resection. CONCLUSION: In conclusion, laparoscopic-assisted distal gastrectomy and the central pancreatectomy were performed for gastric and perigastric lymph node metastases and pancreatic invasion due to malignant melanoma, and the negative surgical margin was achieved. Although patient selection is required, the central pancreatectomy was a good indication for maintaining exocrine and endocrine function. The development of immune checkpoint inhibitors and molecular-targeted agents may increase gastrointestinal surgery for metastatic melanoma in the future.
• Risk factors for pancreatic fistula grade C after pancreatoduodenectomy: A large prospective, multicenter Japan-Taiwan collaboration study.

  Seiko Hirono, Toshio Shimokawa, Yuichi Nagakawa, Yi-Ming Shyr, Manabu Kawai, Ippei Matsumoto, Sohei Satoi, Hideyuki Yoshitomi, Takehiro Okabayashi, Fuyuhiko Motoi, Ryosuke Amano, Yoshiaki Murakami, Satoshi Hirano, Kazuyuki Kawamoto, Shoji Nakamori, Yan-Shen Shan, Shinjiro Kobayashi, Hiroyuki Nitta, Hiroyoshi Matsukawa, Kazuhisa Uchiyama, Chih-Po Hsu, Chie Kitami, Masakazu Yamamoto, Tsann-Long Hwang, Hiroki Yamaue

  Journal of hepato-biliary-pancreatic sciences 27 (9) 622 - 631 2020/09 

  BACKGROUND/PURPOSE: Grade C postoperative pancreatic fistula (POPF), as defined by International Study Group of Pancreatic Fistula (ISGPF), is the most life-threatening complication after pancreatoduodenectomy (PD). This study aims to evaluate risk factors for Grade C POPF after PD. METHODS: This is a prospective, multicenter study based in Japan and Taiwan. Between December 2014 and May 2017, 3022 patients were enrolled in this study and 2762 patients were analyzed. We analyzed risk factors of Grade C POPF based on the updated 2016 ISGPF scheme (organ failure, reoperation, and/or death). RESULTS: Among 2762 patients, 46 patients (1.7%) developed Grade C POPF after PD. The mortality rate of the 46 patients with Grade C POPF was 37.0%. On the multivariate analysis, six independent risk factors for Grade C POPF were found; BMI ≥ 25.0 kg/m2 , chronic steroid use, preoperative serum albumin <3.0 mg/dL, soft pancreas, operative time ≥480 minutes, and intraoperative transfusion. The c-statistic of our risk scoring model for Grade C POPF using these risk factors was 0.77. The score was significantly higher in Grade C POPF than in Grade B POPF (P < .001) or none/biochemical leak (P < .001). CONCLUSIONS: This prospective study showed risk factors for Grade C POPF after PD.
• 十二指腸乳頭部腫瘍に対する診断と治療戦略 十二指腸乳頭部癌における深達度とリンパ節転移個数による治療戦略

  中西 喜嗣, 平野 聡, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴

  胆道 日本胆道学会 34 (3) 436 - 436 0914-0077 2020/08
• 乳頭膨張型胆管癌と術前診断された胆管上皮内癌の一例

  古川 龍太郎, 桑谷 将城, 三橋 智子, 平田 甫, 瀧新 悠之介, 平田 幸司, 加藤 新, 平野 聡, 坂本 直哉

  胆道 日本胆道学会 34 (3) 528 - 528 0914-0077 2020/08
• 膵臓癌のPD-L1発現と線維化におけるARF6-AMAP1経路の役割

  蔦保 暁生, 橋本 あり, 橋本 茂, 佐邊 壽孝, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 7 2020/08
• 学術研究分野としての外科教育研究

  渡邊 祐介, 倉島 庸, Poudel Saseem, 溝田 朋子, 水沼 謙一, 横山 新一郎, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SSF - 1 2020/08
• 膵頭部低悪性度腫瘍に対する全胆道・十二指腸温存膵頭部実質切除(proximal parenchymal pancreatectomy: PPP)の有用性

  山本 寛之, 浅野 賢道, 中村 透, 野路 武寛, 岡村 圭祐, 土川 貴裕, 中西 喜嗣, 田中 公貴, 福田 純己, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 8 2020/08
• 動脈因子陽性局所進行膵癌における手術成績の検討および集学的治療の意義

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 2 2020/08
• 低悪性度膵腫瘍に対する膵中央切除術の有用性に関する検討

  福田 純己, 浅野 賢道, 中村 透, 野路 武寛, 岡村 圭祐, 土川 貴裕, 中西 喜嗣, 田中 公貴, 山本 寛之, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 DP - 6 2020/08
• 十二指腸乳頭部腫瘍に対する診断と治療戦略 十二指腸乳頭部癌における深達度とリンパ節転移個数による治療戦略

  中西 喜嗣, 平野 聡, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 松井 あや, 田中 公貴

  胆道 日本胆道学会 34 (3) 436 - 436 0914-0077 2020/08
• 肝門部領域胆管癌切除限界の再考 肝門部胆管癌に対して限界点での胆管切離を行い剥離面陽性であった症例の予後

  野路 武寛, 岡村 圭祐, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SY - 4 2020/08
• 術前深達度診断と長期予後から見た十二指腸癌に対する至適術式の検討

  田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 8 2020/08
• 肝門部領域胆管癌の新たなT分類とそのカットオフ値の提案

  大場 光信, 中西 喜嗣, 吉田 雄亮, 田中 公貴, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 祐磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡, 三橋 智子

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 7 2020/08
• 一般外科医がAcute Care Surgery認定外科医として今後も我が国のAcute Care Surgeryを支えるためのシミュレーショントレーニング 献体による外傷手術臨床解剖学的研究会

  村上 壮一, 廣瀬 和幸, 倉島 庸, 渡邊 一永, 金子 司, 青木 佑磨, 吉見 泰典, 楢崎 肇, 中山 智英, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 SF - 3 2020/08
• 膵体尾部切除術のための上腸間膜動脈根部周囲神経叢郭清(Radical nerve plexus resection technique of superior mesenteric artery for distal pancreatectomy)

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 村上 壮一, 海老原 裕磨, 倉島 庸, 野路 武寛, 中西 喜嗣, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 120回 SF - 3 2020/08
• 肝門部領域・遠位胆管癌の再発時期に関する検討

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中村 透, 浅野 賢道, 村上 壮一, 海老原 裕磨, 倉島 庸, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 DP - 6 2020/08
• 茯苓飲合半夏厚朴湯の膵・胆道癌術後摂食障害に対する効果

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 中山 智英, 中村 透, 浅野 賢道, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 金森 怜, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 DP - 4 2020/08
• 切除不能胆道癌に対するConversion Surgeryの検討

  大川 裕貴, 野路 武寛, 岡村 圭祐, 田中 公貴, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 120回 DP - 6 2020/08
• 【膵癌治療の最前線】膵癌に対するDP-CAR

  中村 透, 平野 聡, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 村上 壮一, 倉島 庸, 海老原 裕磨, 野路 武寛, 中西 喜嗣, 田中 公貴, 松井 あや, 渡邊 祐介, 七戸 俊明

  外科 (株)南江堂 82 (9) 927 - 933 0016-593X 2020/08 

  ＜文献概要＞腹腔動脈合併尾側膵切除術(distal pancreatectomy with en-bloc celiac axis resection:DP-CAR)の術式アプローチ,血行改変・再建について,集学的治療が発達した現在の症例選択ならびに手術手技アプローチの基本と変遷,長期予後について概説する.
• ゲノム診療の膵癌臨床への応用 膵癌におけるcirculating tumor DNA(ctDNA)前向き観察研究

  本谷 雅代, 木村 康利, 中村 透, 吉田 誠, 平野 雄大, 川上 裕次郎, 柾木 喜晴, 室田 文子, 佐々木 茂, Pittella-Silva Fabio, Low Siew-Kee, 清谷 一馬, 平野 聡, 中村 祐輔, 仲瀬 裕志

  膵臓 (一社)日本膵臓学会 35 (3) A246 - A246 0913-0071 2020/07
• 【胆膵疾患における栄養サポート】膵頭十二指腸切除術における術後早期回復プログラム(ERAS)を実施するために

  田中 公貴, 平野 聡, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐

  胆と膵 医学図書出版(株) 41 (7) 633 - 637 0388-9408 2020/07 

  ERASプロトコルとは、術後の回復促進に役立つ各種ケアをエビデンスに基づきバンドルとして導入することで、手術侵襲の軽減、安全性の向上、術後の回復促進を達成することを目的としたプログラムである。膵頭十二指腸切除術(pancreaticoduodenectomy:PD)に関するERASガイドラインも報告されており、その効果について明らかになってきた。Metaanalysisの結果から、PDに対するERASの導入により、胃排泄遅延の発生率の低下、全合併症率の低下、術後在院期間の短縮を認めた。一方で、膵液瘻の減少、再入院率や死亡率の低下には寄与しなかった。ERASの効果にも限界があることから、周術期の成績向上にはERASプロトコルの改良とともに手術手技を改善する努力が必要である。また、術後化学療法といった集学的治療の重要性が高まっていることから、癌治療の成績向上や患者QOLの視点に立ったERASプロトコルの確立が今後必要となるだろう。(著者抄録)
• p-NEN診療ガイドラインの問題点 膵神経内分泌腫瘍の外科根治切除術における至適リンパ節郭清の検討

  土川 貴裕, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭佑, 平野 聡

  膵臓 (一社)日本膵臓学会 35 (3) A157 - A157 0913-0071 2020/07
• 膵癌のconversion surgery:課題と展望 切除不能膵癌に対するconversion surgeryにおける至適切除範囲に関する検討

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴

  膵臓 (一社)日本膵臓学会 35 (3) A242 - A242 0913-0071 2020/07
• 臨床解剖学実習の医学部教育カリキュラム導入に向けた取り組み

  村上 壮一, 七戸 俊明, 倉島 庸, サシーム・パウデル, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 石田 稔, 高橋 誠, 渡辺 雅彦, 平野 聡

  医学教育 (一社)日本医学教育学会 51 (Suppl.) 81 - 81 0386-9644 2020/07
• 臨床解剖学実習の医学部教育カリキュラム導入に向けた取り組み

  村上 壮一, 七戸 俊明, 倉島 庸, サシーム・パウデル, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 石田 稔, 高橋 誠, 渡辺 雅彦, 平野 聡

  医学教育 (一社)日本医学教育学会 51 (Suppl.) 81 - 81 0386-9644 2020/07
• 膵癌のconversion surgery:課題と展望 初診時切除不能膵癌に対する非手術療法奏効後切除の前向き観察研究 Prep-04

  元井 冬彦, 中森 正二, 松本 逸平, 里井 壯平, 平野 聡, 川畑 康成, 庄 雅之, 本田 五郎, 木村 康利, 岸和田 昌之, 青笹 季文, 岡野 圭一, 北川 裕久, 村上 義昭, 海野 倫明

  膵臓 (一社)日本膵臓学会 35 (3) A240 - A240 0913-0071 2020/07
• Prognostic impact of the number of metastatic lymph nodes in distal bile duct cancer: An analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  Shin Ishihara, Akihiko Horiguchi, Itaru Endo, Toshifumi Wakaki, Satoshi Hirano, Hiroki Yamaue, Masakazu Yamamoto

  Journal of hepato-biliary-pancreatic sciences 27 (7) 396 - 401 2020/07 

  BACKGROUND: Lymph node metastasis is an important prognostic factor for distal bile duct cancer. The number of lymph node metastases was adopted for nodal classification. However, different cutoff values have been proposed, ranging from two to five. METHODS: A total of 1748 cases who underwent curative surgery with pancreatoduodenectomy for distal bile duct cancer registered in the nationwide biliary tract cancer registry in Japan from 2008 to 2013 were included. Univariate Cox regression was performed to assess the effect of prognostic lymph node metastasis counts on mortality and to determine cutoff values. RESULTS: The overall survival rate after resection was 47.4% at 5 years. Univariate and multivariate analysis found prognostic factors to include lymph node metastasis. The cutoff point was set to two lymph node metastases using the Cox model. There were significant differences in pairwise comparisons between three groups by the number of metastatic lymph node (P < .001 for 0 vs 1-2 and P = .003 for 1-2 vs ≥3). CONCLUSION: Our data suggest lymph node classification as N0 (patients without lymph node metastases), N1 (metastasis in 1-2 regional lymph nodes), and N2 (metastases in ≥3 regional lymph nodes).
• Optimal Treatment for Octogenarians With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Multicenter Retrospective Study.

  Sohei Satoi, Tomohisa Yamamoto, Kazushige Uchida, Tsutomu Fujii, Toshifumi Kin, Satoshi Hirano, Keiji Hanada, Takao Itoi, Yoshiaki Murakami, Hisato Igarashi, Hidetoshi Eguchi, Tamotsu Kuroki, Yasuhiro Shimizu, Masaji Tani, Satoshi Tanno, Yoshihisa Tsuji, Yoshiki Hirooka, Atsushi Masamune, Toshio Shimokawa, Hiroki Yamaue, Kazuichi Okazaki

  Pancreas 49 (6) 837 - 844 2020/07 

  OBJECTIVES: The objective of this study was to clarify the role of pancreatectomy for patients with resectable and borderline resectable pancreatic ductal adenocarcinoma aged 80 years or older using a nationwide audit by the Japan Pancreas Society. METHODS: Data were collected from 39 institutions from 2007 to 2014. The primary endpoint was overall survival, and secondary endpoints were surgical outcomes and predictive factors for prognosis. RESULTS: Data were obtained from 556 octogenarians who underwent pancreatectomy (n = 369, 66%), chemo(radio)therapy (n = 99, 18%), and palliative therapy (n = 88, 16%). Median survival times were 20.6, 18.6, and 8.8 months in each group, respectively. Even after propensity score matching, median survival time in the surgery group (22.8 months) was significantly higher than that in the chemotherapy group (18.5 months; hazard ratio, 0.64 [95% confidence interval, 0.44-0.93]; P = 0.020). Significant independent prognostic factors were body mass index, lymph node metastasis, and tumor diameter in the surgery group, and serum albumin level, American Society of Anesthesiologists classification, body mass index, modified Glasgow prognostic score, second-line chemotherapy, and tumor diameter in the chemotherapy group. CONCLUSIONS: Octogenarians with resectable/borderline resectable pancreatic ductal adenocarcinoma can be recommended for pancreatectomy according to mental and physical fitness for surgical procedures.
• High expression of AMAP1, an ARF6 effector, is associated with elevated levels of PD-L1 and fibrosis of pancreatic cancer.

  Akio Tsutaho, Ari Hashimoto, Shigeru Hashimoto, Soichiro Hata, Shion Kachi, Satoshi Hirano, Hisataka Sabe

  Cell communication and signaling : CCS 18 (1) 101 - 101 2020/06/24 

  BACKGROUND: Not merely the onset of immune evasion, but other factors, such as acidosis and fibrosis, are also major barriers in cancer therapeutics. Dense fibrosis is a hallmark of pancreatic ductal carcinoma (PDAC), in which hyperactivation of focal adhesion kinase (FAK) in tumor cells was shown to be crucial. Double mutations of KRAS/ TP53 are characteristic to PDAC. We previously showed that high protein expression of ARF6 and its downstream effector AMAP1, as well as processes involved in the ARF6 activation by cell surface tyrosine kinase receptors, are major targets of the KRAS/TP53 mutations to promote PDAC invasion, metastasis, and immune evasion. This notion was recaptured by KPC mouse model of human PDAC (LSL-Kras(G12D/+); LSL-Trp53(R172H/+)); Pdx-1-Cre). Mechanistically, the ARF6-AMAP1 pathway is primarily involved in cellular dynamics of PD-L1, β1-integrins, and E-cadherin; and hence modulates cell-adhesion properties when ARF6 is activated. Here, with an aim to understand whether the ARF6-AMAP1 pathway is critically involved in the elevated levels of PD-L1 and fibrosis of PDAC, we analyzed relationship between AMAP1 and these malignant phenotypes. Moreover, because the ARF6 pathway may closely be related to focal adhesion dynamics and hence to FAK, we also investigated whether AMAP1 employs FAK in fibrosis. METHODS: Clinical specimens, as well as KPC cells/tumors and their shAMAP1 or shFAK derivatives were analyzed. RESULTS: Elevated levels of PD-L1 and fibrosis correlated with poor outcome of our patient cohort, to be consistent with previous reports; in which high AMAP1 expression statistically correlated with the elevated PD-L1 and fibrosis. To be consistent, silencing of AMAP1 (shAMAP1) in KPC cells resulted in reduced PD-L1 expression and fibrosis in their tumors. On the other hand, shAMAP1 only slightly affected FAK activation in KPC cells, and phosphorylated FAK did not correlate with enhanced fibrosis or with poor outcome of our patients. CONCLUSIONS: Together with our previous data, our results collectively indicated that the ARF6-AMAP1 pathway, empowered by the KRAS/TP53 mutations, is closely associated with elevated PD-L1 expression and fibrosis of human PDACs, to be recaptured in the KPC mouse model. The ARF6 pathway may promote fibrosis independent of FAK. Video abstract.
• Laparoscopic partial splenectomy for splenic lymphangioma: a case report.

  Kotaro Kimura, Yo Kurashima, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Yuma Ebihara, Takehiro Noji, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Hiromi Kanno-Okada, Satoshi Hirano

  Surgical case reports 6 (1) 140 - 140 2020/06/18 

  BACKGROUND: Lymphangioma is a benign malformation of the lymphatic system and is often found in the neck and axilla, the orbit, the mediastinum, etc. However, isolated splenic lymphangioma is a rare disease in young women, and its treatment is controversial. We report a case of laparoscopic partial splenectomy for isolated splenic lymphangioma in a young woman. CASE PRESENTATION: An 18-year-old woman with mild epigastralgia was admitted to a nearby hospital. Abdominal ultrasound detected a 6-cm mass confined to the upper pole of the spleen; thereafter, she was referred to our department for surgical treatment. Although a benign tumor, we decided to resect it because of her symptoms. To preserve part of the normal spleen, laparoscopic partial splenectomy was performed with a co-axial approach using four ports and a liver retractor in the lithotomy position. After dissection around the spleen hilum, we identified that the tumor was being fed from the splenic vessels of the upper pole and severed the branch. Postoperatively, the patient showed no complications and was discharged on postoperative day 8 without symptoms. Pathological examination revealed splenic lymphangioma, which is rare in young women. No recurrence was seen 1 year after surgery, and a computed tomography scan showed no problems with the remaining spleen. CONCLUSIONS: In our experience of laparoscopic partial splenectomy for a young woman with an isolated splenic lymphangioma, we determined that laparoscopic partial splenectomy is a safe, effective, and valuable option for the treatment of benign splenic tumors.
• Risk factors for dysfunction of preoperative endoscopic biliary drainage for malignant hilar biliary obstruction.

  Ryo Sugiura, Masaki Kuwatani, Shin Kato, Kazumichi Kawakubo, Hirofumi Kamachi, Akinobu Taketomi, Takehiro Noji, Keisuke Okamura, Satoshi Hirano, Naoya Sakamoto

  Journal of hepato-biliary-pancreatic sciences 27 (11) 851 - 859 2020/06/07 [Refereed][Not invited]
   

  BACKGROUND: Few studies have focused on the risk factors for dysfunction of endoscopic biliary drainage (EBD) in preoperative patients with malignant hilar biliary obstruction (MHBO). METHODS: We searched the database between February 2011 and December 2018 and identified patients with MHBO who underwent radical operation. The rate of dysfunction of the initial EBD, risk factors for dysfunction of the initial EBD and survival after surgery were retrospectively evaluated. RESULTS: We analyzed a total of 131 patients [95 males (72.5%); mean age, 69.5(±7.3) years; Bismuth-Corlette classification (BC) I/II/IIIa/IIIb/IV, 50/26/22/17/16; hilar cholangiocarcinoma/gall bladder cancer, 115/16]. Dysfunction of the initial EBD occurred in 28patients (21.4%). The cumulative incidences of dysfunction of the initial EBD in all patients were 18.4%, 38.2% and 47.0% at 30, 60 and 90days, respectively (Kaplan-Meier method). The rate of dysfunction of the initial EBD increased in patients with BC-IV (P=0.03). Multivariate analysis showed that BC-IV and pre-EBD cholangitis were significantly associated with the occurrence of dysfunction of the initial EBD. Survival rates were not significantly different according to the initial biliary drainage methods and presence/absence of the initial EBD dysfunction. CONCLUSIONS: Dysfunction of the initial EBD frequently occurs in patients with the BC-IV and those with pre-EBD cholangitis.
• 智と技の伝承(鏡視外科手術トレーニングの将来像) CSTの実践と今後の課題

  七戸 俊明, 村上 壮一, 倉島 庸, 海老原 裕磨, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  小切開・鏡視外科学会雑誌 (NPO)小切開・鏡視外科学会 11 (1) 38 - 38 2185-2820 2020/06
• 鏡視外科手術における新技術やその評価 内視鏡手術用蛍光スペクトル測定プローブを用いた光線力学的診断について

  海老原 裕磨, 李 黎明, 城崎 友秀, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  小切開・鏡視外科学会雑誌 (NPO)小切開・鏡視外科学会 11 (1) 41 - 41 2185-2820 2020/06
• 胃癌治療ガイドライン(2018年度版)について

  海老原 裕磨, 七戸 俊明, 倉島 庸, 村上 壮一, 平野 聡

  北海道外科雑誌 北海道外科学会 65 (1) 31 - 35 0288-7509 2020/06 

  胃癌治療ガイドライン第5版が2018年1月に刊行され、日常臨床に治療アルゴリズムが改訂された。主な改訂点は、高度リンパ節転移(Bulky N)症例に対する術前化学療法の推奨とM1(StageIV)胃癌に対する治療アルゴリズムの記載、新しい内視鏡的根治度(eCura)分類の記載である。本稿では、胃癌治療ガイドライン第5版の改訂点ならびに次回以降のガイドラインに掲載される可能性のある腹腔鏡下胃切除術、食道胃接合部癌ならびにロボット支援腹腔鏡下胃切除術の最新知見につき解説する。(著者抄録)
• Comparison of Absolute Protein Abundances of Transporters and Receptors among Blood–Brain Barriers at Different Cerebral Regions and the Blood–Spinal Cord Barrier in Humans and Rats

  Yasuo Uchida, Yuta Yagi, Masaki Takao, Mitsutoshi Tano, Mina Umetsu, Satoshi Hirano, Takuya Usui, Masanori Tachikawa, Tetsuya Terasaki

  Molecular Pharmaceutics 17 (6) 2006 - 2020 1543-8384 2020/06/01
• Comparison of pancreaticoduodenectomy and bile duct resection for middle bile duct cancer: A multi-center collaborating study of Japan and Korea.

  Hiroki Hayashi, Jin-Young Jang, Kyung Sik Kim, Jin Sub Choi, Takeshi Takahara, Sung Hoon Choi, Satoshi Hirano, Hee Chul Yu, Syuichiro Uemura, Michiaki Unno

  Journal of hepato-biliary-pancreatic sciences 27 (6) 289 - 298 2020/06 

  BACKGROUND: It is currently unknown whether bile duct segmental resection (BDSR) is an acceptable method for localized middle bile duct cancer (mid-BDC) when R0 resection can be achieved. This study aimed to investigate the short- and long-term outcomes of mid-BDC patients treated with pancreaticoduodenectomy (PD) compared to those for BDSR. METHODS: This was a retrospective, Japanese and Korean multi-center collaboration study based on patients' medical records. RESULTS: A total of 663 patients, including 245 BDSR and 418 PD cases, were enrolled. The incidence of postoperative pancreatic fistula (3.3% vs 44.1%, P < .0001), surgical site infection in the organ space (6.1% vs 17.7%, P < .0001) and clinically problematic morbidities (15.9% vs 32.8%, P < .0001) was significantly higher in the PD group. There was no difference in the mortality rate (0.8% vs 1.7%, P = .3566). Local (33.9% vs 14.4%, P < .0001) and lymph node (22.4% vs 11.0%, P < .0001) recurrence rates were significantly higher in the BDSR group. Relapse-free survival (25.0 vs 34.0 months, P = .0184) and overall survival (41.2 vs 60.1 months, P = .0019) were significantly longer in the PD group. The PD group had significantly better prognosis in stage IA/IB cases (58.3 vs 111.5 months, P = .0067), which were the best indicators for BDSR, even when R0 resection was achieved. In multivariate analysis, BDSR was an independent poor prognostic factor. CONCLUSION: Despite the inferior perioperative short-term outcomes, our data advocate that PD should be the standard procedure for mid-BDCs and that BDSR should be avoided even if R0 resection can be achieved. (UMIN000017914).
• Hemobilia-a rare complication after laparoscopic cholecystectomy.

  Takehiro Abiko, Yuma Ebihara, Motoya Takeuchi, Hiroki Sakamoto, Hisato Homma, Satoshi Hirano

  Surgical case reports 6 (1) 91 - 91 2020/05/05 

  BACKGROUND: Biliary bleeding is a condition reported by Sandblom as hemobilia. The most common cause of hemobilia is iatrogenicity. But it has also been reported as a rare complication after laparoscopic cholecystectomy (LC). CASE PRESENTATION: A man in his 60s underwent a LC. He was taking a direct Xa inhibitor for paroxysmal atrial fibrillation (pAf) and had a history of thrombectomy. There was variation in the bifurcation of the hepatic artery and cystic artery. The right hepatic artery branches from the common hepatic artery by itself, and the cystic artery is double. He complained of right upper quadrant pain, nausea, and vomiting on the third postoperative day (3POD). Non-contrast computed tomography (CT) showed that a high absorption area was found to fill the common bile duct. Contrast CT showed no pseudoaneurysm formation. Ultimately, he was diagnosed with postoperative hemobilia. Angiographic examination selective for the cystic artery branching from the middle hepatic artery revealed leakage of the contrast agent and a micro-pseudoaneurysm. CONCLUSIONS: We encountered a case of hemobilia after LC. In this case, it was presumed that in addition to the chronic inflammatory changes of the gallbladder wall, extraordinary bifurcation of the hepatic artery and the cystic arteries and easy bleeding due to resumption of a direct Xa inhibitor synergistically caused a micro-pseudoaneurysm and postoperative hemobilia. It was difficult to identify the cause of hemobilia by contrast CT alone. Angiographic examination was useful for identifying and treating the causative artery and needs to perform aggressively.
• 糖尿病合併肥満症患者に対する腹腔鏡下スリーブ状胃切除術への術前寛解予測スコアの検討

  小野 渉, 中村 昭伸, 海老原 裕磨, 曹 圭龍, 亀田 玲奈, 亀田 啓, 野本 博司, 渥美 達也, 三好 秀明, 平野 聡

  糖尿病 (一社)日本糖尿病学会 63 (5) 354 - 354 0021-437X 2020/05
• 【進行胆道癌・膵癌の治療限界を打ち破る-症例から学ぶ究極の治療-】進行膵体部癌に対するconversion surgeryとしての胃温存腹腔動脈合併膵全摘術の経験

  浅野 賢道, 中村 透, 野路 武寛, 松井 あや, 平野 聡

  胆と膵 医学図書出版(株) 41 (5) 477 - 485 0388-9408 2020/05 

  局所進行膵体部癌では腹腔動脈幹(CA)や総肝動脈(CHA)、上腸間膜動脈(SMA)といった主要動脈への接触・浸潤をきたしており、局所コントロールを徹底的に追求した術式としての腹腔動脈合併尾側膵切除(distal pancreatectomy with en bloc celiac axis resection:DP-CAR)や腹腔動脈合併膵全摘術(total pancreatectomy with en bloc celiac axis resection:TP-CAR)が適応となる。しかし、DP-CARやTP-CARは極めて高い侵襲性を有した術式であり、その適応にあたっては、膵臓内科医や放射線治療医、膵臓外科医が一丸となって慎重に検討すべきである。(著者抄録)
• Phase I/II Study of Erlotinib to Determine the Optimal Dose in Patients With Non-Small Cell Lung Cancer Harboring Only EGFR Mutations.

  Yuichiro Takeda, Naoki Ishizuka, Kazumi Sano, Satoshi Hirano, Manabu Suzuki, Go Naka, Haruhito Sugiyama

  Clinical and translational science 13 (6) 1150 - 1160 2020/04/21 

  The recommended daily dose of erlotinib was determined for patients with all types of non-small cell lung cancer (NSCLC). We determined the optimal dose (OD) in patients with NSCLC harboring only epidermal growth factor receptor (EGFR) sensitizing mutations. EGFR-tyrosine kinase inhibitor-naïve patients with sensitizing mutations were eligible. Clinical OD was determined in a phase I/II study based on the continual re-assessment method (CRM) of both disease control and dose-limiting toxicity, defined as any toxicity of grade 2 (G2) or higher within 8 weeks. We also determined the pharmacologic OD via a pharmacokinetic (PK) study. Thirty-eight patients were enrolled. Clinical OD was 25 mg/day by the CRM. Median progression-free survival (mPFS) was 9.3 months. In receiver operating characteristic (ROC) analysis of mPFS, the trough concentration ( C min ss ) was ≥ 0.30 μg/mL. The area under the curve (AUC) and C min ss were predicted via population PK (PopPK) or a bootstrap of 100 iterations (PopPK100 ). TOX20 was defined as < 20% duration of any toxicity ≥ G2 during the PFS period. In ROC analysis of mPFS and TOX20 in the PopPK100 study, C min ss was ≥ 0.17 and < 0.32 μg/mL, respectively. In ROC analysis of mPFS and TOX20 in the PopPK100 study, C min ss was ≥ 0.15 and < 0.31 μg/mL, AUC was ≥ 14.4 and < 14.5 μg/mL•hour, and the dosage was ≥ 58.4 and < 58.8 mg/day, respectively. Clinical and pharmacologic ODs were 25 by CRM and 50-60 mg/day by PK, respectively. The proposed starting OD is 50-60 mg/day, with personalized adjustment of 0.15-0.31 μg/mL based on C min ss as determined by PopPK monitoring.
• Signaling adaptor protein Crk is involved in malignant feature of pancreatic cancer associated with phosphorylation of c-Met.

  Satoko Uemura, Lei Wang, Masumi Tsuda, Jun Suzuka, Satoshi Tanikawa, Hirokazu Sugino, Toru Nakamura, Tomoko Mitsuhashi, Satoshi Hirano, Shinya Tanaka

  Biochemical and biophysical research communications 524 (2) 378 - 384 2020/04/02 

  Signaling adaptor protein Crk has been shown to play an important role in various human cancers. Crk links tyrosine kinases and guanine nucleotide exchange factors (GEFs) such as C3G and Dock180 to activate small G-proteins Rap and Rac, respectively. In pancreatic cancer, various molecular targeted therapies have provided no significant therapeutic benefit for the patients so far due to constitutive activation of KRAS by frequent KRAS mutation. Therefore, the establishment of novel molecular targeted therapy in KRAS-independent manner is required. Here, we investigated a potential of Crk as a therapeutic target in pancreatic cancer. Immunohistochemistry on human pancreatic cancer specimens revealed that the patients with high expression of Crk had a worse prognosis than those with low expression. We established Crk-knockdown pancreatic cancer cells by siRNA using PANC-1, AsPC-1, and MIA PaCa-2 cells, which showed decreased cell proliferation, invasion, and adhesion. In Crk-knockdown pancreatic cancer cells, the decrease of c-Met phosphorylation was observed. In the orthotopic xenograft model, Crk depletion prolonged survival of mice significantly. Thus, signaling adaptor protein Crk is involved in malignant potential of pancreatic cancer associated with decrease of c-Met phosphorylation, and Crk can be considered to be a potential therapeutic molecular target.
• 【定番+最新処置のケアの知識をチェック&アップデート↑消化器の治療と検査 サクッと攻略! はやわかりデータベース】(3章)鏡視下手術 膵臓切除術

  田中 公貴, 平野 聡

  消化器ナーシング (株)メディカ出版 (2020春季増刊) 120 - 122 2434-4575 2020/04
• 膵体尾部切除術に伴う門脈合併切除の現状と課題

  金子 司, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 81 (4) 800 - 800 1345-2843 2020/04
• 食道胃接合部癌に対し腹臥位胸腔鏡下Mckeown手術を施行した2例

  大川 裕貴, 海老原 裕磨, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 81 (4) 789 - 790 1345-2843 2020/04
• An Unmodulated Very-Low-Voltage Electrosurgical Technology Creates Predictable and Ultimate Tissue Coagulation: From Experimental Data to Clinical Use

  Yusuke Watanabe, Pascal Fuchshuber, Takafumi Homma, Elif Bilgic, Amin Madani, Naoki Hiki, Ivor Cammack, Takehiro Noji, Yo Kurashima, Toshiaki Shichinohe, Satoshi Hirano

  Surgical Innovation 27 (5) 155335062090461 - 155335062090461 1553-3506 2020/03/18 [Refereed][Not invited]
   

  Objective. We analyzed the underlying principles of an unmodulated very-low-voltage (VLV) mode, designated as “soft coagulation” in hemostasis, and demonstrate its clinical applications. Summary Background Data. While the advantage of the VLV mode has been reported across surgical specialties, the basic principle has not been well described and remains ambiguous. Methods. Characteristics of major electrosurgical modes were measured in different settings. For the VLV mode, the tissue effect and electrical parameters were assessed in simulated environments. Results. The VLV mode achieved tissue coagulation with the lowest voltage compared with the other modes in any settings. With increasing impedance, the voltage of the VLV mode stayed very low at under 200 V compared with other modes. The VLV mode constantly produced effective tissue coagulation without carbonization. We have demonstrated the clinical applications of the method. Conclusions. The voltage of the VLV mode consistently stays under 200 V, resulting in tissue coagulation with minimal vaporization or carbonization. Therefore, the VLV mode produces more predictable tissue coagulation and minimizes undesirable collateral thermal tissue effects, enabling nerve- and function-preserving surgery. The use of VLV mode through better understanding of minimally invasive way of using electrosurgery may lead to better surgical outcomes.
• Clinical Outcomes of Biliary Drainage during a Neoadjuvant Therapy for Pancreatic Cancer: Metal versus Plastic Stents.

  Masaki Kuwatani, Toru Nakamura, Tsuyoshi Hayashi, Yasutoshi Kimura, Michihiro Ono, Masayo Motoya, Koji Imai, Keisuke Yamakita, Takuma Goto, Kuniyuki Takahashi, Hiroyuki Maguchi, Satoshi Hirano

  Gut and liver 14 (2) 269 - 273 2020/03/15 

  Neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.680). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1.000). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.051), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.
• Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis.

  S Poudel, K Miyazaki, S Hirano

  Hernia : the journal of hernias and abdominal wall surgery 2020/03/11 [Refereed][Not invited]
   

  PURPOSE: An aging population has led to an increased number of patients with cardiovascular comorbidities requiring antithrombotic therapy. Perioperatively, surgeons should consider the increased risk of bleeding and thrombotic events in patients continuing or discontinuing these medications. We aimed to analyze the safety of continued antithrombotic therapy during open inguinal hernia repair. METHODS: In this single-center, retrospective study, 4870 adult patients who underwent open inguinal hernia repair surgery by the same surgeon from 2008 January to 2019 March were included. Patients who underwent surgery while continuing antithrombotic therapy were included in the antithrombin group (n = 523) while those who were not under any antithrombotic therapy during the surgery were included in the control group (n = 4333). Using propensity score-matching, we then selected patients from each group with similar backgrounds. Surgery time, anesthesia time, postoperative bleeding, reoperation, and thrombotic event data were compared between the groups. Subgroup analysis based on the type of medications used was performed within the antithrombin group. RESULTS: Ten patients in the antithrombin group and seven patients in the control group experienced postoperative bleeding (p < 0.001). The rate of postoperative bleeding was the highest in patients taking multiple medications. However, most were managed conservatively. Three patients from the antithrombin group experienced thrombotic events postoperatively (p = 0.001). CONCLUSIONS: Patients receiving continued antithrombotic therapy had an increased risk of minor postoperative bleeding; however, they are a high-risk group for thrombotic events.
• Are graduating residents sufficiently competent? Results of a national gap analysis survey of program directors and graduating residents in Japan.

  Saseem Poudel, Satoshi Hirano, Yo Kurashima, Dimitrios Stefanidis, Hirotoshi Akiyama, Susumu Eguchi, Toshihiro Fukui, Masaru Hagiwara, Daisuke Hashimoto, Koya Hida, Tomoko Izaki, Hirotaka Iwase, Shunsuke Kawamoto, Yasuhiro Otomo, Eishi Nagai, Mitsue Saito, Hideki Takami, Yuko Takeda, Masakazu Toi, Hiroki Yamaue, Motofumi Yoshida, Shigetoshi Yoshida, Yasuhiro Kodera

  Surgery today 50 (9) 995 - 1001 2020/03/03 [Refereed][Not invited]
   

  PURPOSE: To evaluate the self-assessed competency of graduating residents (GRs) in Japan upon completion of their residency and to identify the gap between their competency and the competency expected by their program directors (PDs). METHOD: A list of 31 essential surgical procedures was compiled according to the consensus of surgical educators from around the country. A survey with this list was sent to all 909 GRs and their 611 PDs in 2016. The GRs rated their competency to perform these procedures and the PDs were asked to evaluate the expected competency of their GRs using the Zwisch Scale. RESULT: The response rate was 56.3% for the GRs and 76.8% for the PDs. Fewer than half of the GRs who responded felt confident performing ten (32%) of the surgical procedures evaluated. For most procedures, the GRs' self-reported competency was lower than the expectation reported by their PDs. This gap was more than 10% for 13 of the procedures. CONCLUSION: More than half of the GRs in Japan lacked the confidence in their skill to perform one-third of the surgical procedures selected for evaluation in this study. These findings should be used to update the surgical education curriculum in Japan.
• 当科における肝門部領域胆管癌に対する手術治療戦略 成績と課題

  野路 武寛, 岡村 圭祐, 楢崎 肇, 松井 あや, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 126回 41 - 41 2020/03
• 当教室における膵体尾部腫瘍への腹腔鏡下膵切除術の適応と治療成績

  田中 公貴, 岡村 圭祐, 中村 透, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 126回 58 - 58 2020/03
• 【「縫合不全!!」を防ぐ】肝胆膵 肝門部胆道癌における肝内胆管空腸吻合

  田中 公貴, 平野 聡

  臨床外科 (株)医学書院 75 (2) 218 - 221 0386-9857 2020/02 

  ＜文献概要＞ポイント ◆肝内胆管空腸吻合における注意点として,◆胆管枝は切離された直後に支持糸をかけ,"見失い"を防ぐ.◆隣接する胆管同士を縫合形成することで胆管開口部を広く確保する.◆再建する胆管すべてに外瘻用ステントチューブを留置する.
• Metachronous liver metastases after long-term follow-up of endoscopic resection for rectal neuroendocrine neoplasms: a report of three cases.

  Yuma Hane, Takahiro Tsuchikawa, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Yuma Ebihara, Soichi Murakami, Toru Nakamura, Keisuke Okamura, Satoshi Takeuchi, Toshiaki Shichinohe, Satoshi Hirano

  Surgical case reports 6 (1) 22 - 22 2020/01/15 

  BACKGROUND: Rectal neuroendocrine neoplasms (NENs) are rare, but their incidence has increased in recent years. The metastasis rate is low in cases of a tumor diameter < 1 cm or depth of invasion lower than the submucosa; therefore, the European Neuroendocrine Tumor Society (ENETS) and the North American Neuroendocrine Tumor Society (NANETS) consensus guidelines recommend endoscopic resection. Since little has been reported on the long-term prognosis of endoscopic resection for rectal NEN, consensus is lacking regarding the follow-up period after endoscopic resection. CASE PRESENTATION: Here, we report three cases of metachronous liver metastasis after long-term follow-up of endoscopic mucosal resection (EMR) for rectal NEN. The pathological findings indicated a depth lower than the submucosa and complete radical resection in all cases and lymphovascular invasion in only one case. All three cases showed metachronous multiple liver metastases after 9-13 years of follow-up for EMR, despite achieving complete resection and without muscular invasion. CONCLUSIONS: Metachronous liver metastases may occur after long interval following endoscopic resection; thus, long-term follow-up is necessary after endoscopic resection for rectal NEN.
• How to Make of the Operation Record as the Attractive Reading

  Keisuke Okamura, Satoshi Hirano

  Japanese Journal of Gastroenterological Surgery 53 (11) 925 - 931 1348-9372 2020
• The effect of the body mass index on the short-term surgical outcomes of laparoscopic total gastrectomy: A propensity score-matched study.

  Mamoru Miyasaka, Yuma Ebihara, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Yoshihiro Murakami, Katsuhiko Murakawa, Fumitaka Nakamura, Takayuki Morita, Shunichi Okushiba, Satoshi Hirano

  Journal of minimal access surgery 16 (4) 376 - 380 2020 

  PURPOSE: This study aimed to evaluate the relationship between the body mass index (BMI) and the short-term outcomes of laparoscopic total gastrectomy (LTG). SUBJECTS AND METHODS: Data of patients who underwent LTG for gastric cancer at six institutions between 2004 and 2018 were retrospectively collected. The patients were classified into three groups: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2) and high BMI (≥25 kg/m2). In these patients, clinicopathological variables were analysed using propensity score matching for age, sex, the American Society of Anaesthesiologists physical state, clinical stage, surgical method, D2 lymph node dissection, combined resection of other organs, anastomosis method and jejunal pouch reconstruction. The surgical results and post-operative outcomes were compared among the three groups. RESULTS: A total of 82 patients were matched in the analysis of the low BMI and normal BMI groups. There were no differences in operative time (P = 0.693), blood loss (P = 0.150), post-operative complication (P = 0.762) and post-operative hospital stay (P = 0.448). In the analysis of the normal BMI and high BMI groups, 208 patients were matched. There were also no differences in blood loss (P = 0.377), post-operative complication (P = 0.249) and post-operative hospital stay (P = 0.676). However, the operative time was significantly longer in the high BMI group (P = 0.023). CONCLUSIONS: Despite the association with a longer operative time in the high BMI group, BMI had no significant effect on the surgical outcomes of LTG. LTG could be performed safely regardless of BMI.
• Persistent Effect of Gait Exercise Assist Robot Training on Gait Ability and Lower Limb Function of Patients With Subacute Stroke: A Matched Case-Control Study With Three-Dimensional Gait Analysis.

  Yiji Wang, Masahiko Mukaino, Satoshi Hirano, Hiroki Tanikawa, Junya Yamada, Kei Ohtsuka, Takuma Ii, Eiichi Saitoh, Yohei Otaka

  Frontiers in neurorobotics 14 42 - 42 2020 [Refereed][Not invited]
   

  Introduction: Gait exercise assist robot (GEAR), a gait rehabilitation robot developed for poststroke gait disorder, has been shown to improve walking speed and to improve the poststroke gait pattern. However, the persistence of its beneficial effect has not been clarified. In this matched case-control study, we assessed the durability of the effectiveness of GEAR training in patients with subacute stroke on the basis of clinical evaluation and three-dimensional (3D) gait analysis. Methods: Gait data of 10 patients who underwent GEAR intervention program and 10 patients matched for age, height, sex, affected side, type of stroke, and initial gait ability who underwent conventional therapy were extracted from database. The outcome measures were walk score of Functional Independence Measure (FIM-walk), Stroke Impairment Assessment Set total lower limb motor function score (SIAS-L/E), and 3D gait analysis data (spatiotemporal factors and abnormal gait patter indices) at three time points: baseline, at the end of intervention, and within 1 week before discharge. Results: In the GEAR group, the FIM-walk score, SIAS-L/E score, cadence, and single stance time of paretic side at discharge were significantly higher than those at post-training (p < 0.05), whereas the stance time and double support time of the unaffected side, knee extensor thrust, insufficient knee flexion, and external rotated hip of the affected side were significantly lower (p < 005). However, no significant differences in these respects were observed in the control group between the corresponding evaluation time points. Conclusion: The results indicated significant improvement in the GEAR group after the training period, with respect to both clinical parameters and the gait pattern indices. This improvement was not evident in the control group after the training period. The results possibly support the effectiveness of GEAR training in conferring persistently efficient gait patterns in patients with poststroke gait disorder. Further studies should investigate the long-term effects of GEAR training in a larger sample.
• 【IPMN・MCN国際診療ガイドライン総まとめ】術式選択の要点

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 平野 聡

  胆と膵 医学図書出版(株) 41 (1) 53 - 57 0388-9408 2020/01 

  IPMNは腺腫から浸潤癌に至る幅広い悪性度を呈する膵腫瘍であり、適切な切除によって良好な予後が期待できる。浸潤癌病変に対しては領域リンパ節郭清を伴う標準的な切除を行うべきであるが、浸潤成分を伴わない切除対象病変には臓器・機能温存を目的とした縮小手術が適応可能であり、そのためには精度の高い各種modalityを駆使した検討が必要である。縮小手術は術後の消化吸収において有利である反面、必ずしも手技的に容易とはいえず、術後管理にも細心の注意を要するため、現時点ではIPMNに対する診療経験が豊富で膵臓外科に習熟した施設に限定して施行されるべきと考える。また、術式にかかわらず、残膵の異時性多発病変の出現や併存膵癌発生の可能性を念頭に置いた長期の経過観察が重要である。(著者抄録)
• TEVAR後に発症した大動脈食道瘻に対し腹臥位胸腔鏡下食道切除術を施行した1例

  木村 弘太郎, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (2) 299 - 303 2020/01 

  症例は70代,男性。急性大動脈解離(Stanford B型)に対し,前医にて胸部大動脈ステントグラフト内挿術(thoracicendovascular aortic repair;TEVAR)が施行された。術後30日目に発熱を認め,上部消化管内視鏡検査にて上部食道に露出するステントを認めたことから大動脈食道瘻(aortoesophageal fistula;AEF)と診断され,北海道大学病院に紹介となった。本症例に対し段階的な外科治療方針とし,最初に腹臥位胸腔鏡下食道切除術を施行した。次に術後2日目に全弓部下行大動脈人工血管置換術を施行した。今後は全身状態の改善を図り,消化管再建を行う予定である。TEVARは大動脈疾患に対する低侵襲治療として近年,増加傾向にあるが,重篤な合併症としてAEFが報告されている。今回,症例報告に加え教室におけるAEFに対する治療成績を併せて報告する。(著者抄録)
• 腹腔鏡下脾部分切除術を施行し正常脾を温存した大型脾嚢胞の1例

  木村 弘太郎, 倉島 庸, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 25 (1) 49 - 55 1344-6703 2020/01 

  ＜文献概要＞患者は30代,女性.心窩部痛を主訴に近医を受診し,CTで直径8cm大の脾嚢胞を指摘され,当科紹介となった.良性嚢胞と考えられたが腫瘍径が大きく有症状であり手術適応と考えられた.若年女性であることから正常脾を温存する方針とした.腹腔鏡下に脾動静脈本幹・上下極枝をそれぞれ確保し,脾動静脈上極枝のみを切離して虚血域に嚢胞が含まれることを確認したのちに脾実質を切離し,脾上極を摘出した.術後は合併症なく退院となった.病理組織学的検査では上皮性嚢胞の診断であった.脾嚢胞に対する腹腔鏡下脾部分切除術は根治性・低侵襲性に優れ,安全性に考慮したうえで実施可能な有用な術式であると思われた.
• Robot-assisted laparoscopic total gastrectomy for Epstein-Barr virus-associated multiple gastric cancer: A case report.

  Kotaro Kimura, Yuma Ebihara, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Hiromi Kanno-Okada, Satoshi Hirano

  International journal of surgery case reports 75 446 - 450 2020 

  INTRODUCTION: Epstein-Barr virus-associated gastric cancer (EBVaGC) sometimes appears as multiple gastric cancer lesions. Here, we report a case of robot-assisted laparoscopic total gastrectomy (RTG) for a relatively rare disease with four synchronized lesions in EBVaGC and discuss the usefulness of robotic gastrectomy. PRESENTATION OF CASE: A 60-year-old woman was diagnosed with multiple gastric cancer because she had five lesions in the stomach and biopsy showed the presence of adenocarcinoma in four of the five lesions. We performed robot-assisted laparoscopic total gastrectomy on the patient. The histopathological diagnosis was multiple gastric cancer T1bN0M0 pStage IA. The four lesions were positive for the Epstein-Barr virus encoding region in in-situ hybridization and were considered to be EBVaGC. The patient had no sign of recurrence without postoperative therapy for 24 months. DISSCUSSION: EBVaGC was found in about 10% of all gastric cancer cases worldwide. EBVaGC sometimes appears as multiple gastric cancer, suggesting that EBV infection is closely related to the early stages of tumor formation. Total gastrectomy may be necessary for multiple gastric cancer such as EBVaGC, and robotic surgery is useful in total gastrectomy in terms of high-resolution three-dimensional images and using forceps with multi-joint functions. CONCLUSIONS: We performed RTG on a patient with four synchronous lesions of EBVaGC, which is relatively rare. Robot-assisted laparoscopic total gastrectomy is known to be a safe procedure, and we effectively performed total gastrectomy for multiple EBVaGC.
• Role of Dimerized C16orf74 in Aggressive Pancreatic Cancer: A Novel Therapeutic Target.

  Toshihiro Kushibiki, Toru Nakamura, Masumi Tsuda, Takahiro Tsuchikawa, Koji Hontani, Kazuho Inoko, Mizuna Takahashi, Toshimichi Asano, Keisuke Okamura, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Takehiro Noji, Yoshitsugu Nakanishi, Kimitaka Tanaka, Nako Maishi, Katsunori Sasaki, Woong-Ryeon Park, Toshiaki Shichinohe, Kyoko Hida, Shinya Tanaka, Satoshi Hirano

  Molecular cancer therapeutics 19 (1) 187 - 198 2020/01 [Refereed][Not invited]
   

  Over the past 30 years, the therapeutic outcome for pancreatic ductal adenocarcinoma (PDAC) has remained stagnant due to the lack of effective treatments. We performed a genome-wide analysis to identify novel therapeutic targets for PDAC. Our analysis showed that Homo sapiens chromosome 16 open reading frame 74 (C16orf74) was upregulated in most patients with PDAC and associated with poor prognosis. Previously, we demonstrated that C16orf74 interacts with the catalytic subunit alpha of protein phosphatase 3 and plays an important role in PDAC invasion. However, the pathophysiologic function of C16orf74 is still unclear. In this study, through the analysis of C16orf74 interaction, we demonstrate a new strategy to inhibit the growth and invasion of PDAC. C16orf74 exists in the homodimer form under the cell membrane and binds integrin αVβ3 and is also involved in invasion by activating Rho family (Rac1) and MMP2. Considering that this dimeric form was found to be involved in the function of C16orf74, we designed an 11R-DB (dimer block) cell-permeable dominant-negative peptide that inhibits the dimer form of C16orf74. 11R-DB suppressed invasion and proliferation of PDAC cell lines by inhibiting phosphorylation of Akt and mTOR and also by inactivation of MMP2. 11R-DB also showed antitumor effects in an orthotopic xenograft model and peritoneal metastasis model. Thus, this study demonstrates that dimerized C16orf74, present in the cell membrane, is involved in pancreatic cancer invasion and proliferation. In addition, the C16orf74 dimer block cell-permeable peptide (11R-DB) has a potent therapeutic effect on PDAC in vitro and in vivo.
• 鼠径ヘルニア修復術をどう教えるか 技能評価およびフィードバックを基盤とした初心者のための腹腔鏡下鼠径ヘルニア教育

  サシーム・パウデル, 倉島 庸, 田中 公貴, 川瀬 寛, 村上 慶洋, 川原田 陽, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 24 (7) WS30 - 7 1344-6703 2019/12
• 肝門部領域胆管癌に対する術前門脈塞栓後の待機日数と肝不全死亡発生の関連

  木村 弘太郎, 野路 武寛, 田中 公貴, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (12) 2296 - 2297 1345-2843 2019/12
• 胆嚢癌根治術後の経皮経肝胆道ドレナージ瘻孔再発に対し切除を行い長期生存を得られた1例

  青木 佑磨, 岡村 圭祐, 野路 武寛, 中西 喜嗣, 田中 公貴, 中山 智英, 浅野 賢道, 中村 透, 大川 裕貴, 金子 司, 山本 寛之, 倉谷 友崇, 桐山 琴衣, 福田 純己, 渡邊 一永, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (12) 2304 - 2304 1345-2843 2019/12
• 膵頭部癌に対する術前治療の周術期合併症に与える影響

  山本 寛之, 中村 透, 浅野 賢道, 田中 公貴, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (12) 2304 - 2304 1345-2843 2019/12
• 【食道胃接合部癌の診断と外科治療】

  七戸 俊明, 海老原 裕磨, 倉島 庸, 村上 壮一, 平野 聡

  北海道外科雑誌 北海道外科学会 64 (2) 116 - 121 0288-7509 2019/12 

  食道胃接合部(食道筋層と胃筋層の境界、esophagogastric junction:EGJ)の上下2センチの部位を食道胃接合部領域とし、この部位に中心を持つ癌を組織型に関わらず食道胃接合部癌と呼ぶ。長径4cm以下の食道胃接合部癌の治療法については、日本胃癌学会・日本食道学会合同作業部会による後方視的解析に基づいて至適郭清領域が提案されており、腫瘍の部位と郭清領域に応じて様々な術式が選択される。また、前向き試験に基づいたT2以上の進行食道胃接合部癌に対する食道浸潤長に応じた至適郭清領域と術式選択を提案した論文が最近公表された。この内容は今後ガイドラインに反映されると思われる。(著者抄録)
• 技術認定を目指す前に! 安全な手術を行うための初心者向け技能評価による内視鏡外科教育

  倉島 庸, サシーム・パウデル, 渡邊 祐介, 溝田 知子, 楢崎 肇, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 24 (7) IT3 - 5 1344-6703 2019/12
• カダバートレーニングの反回神経周囲郭清の手技向上に対する有用性

  七戸 俊明, 村上 壮一, 海老原 裕磨, 倉島 庸, 吉見 泰典, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 24 (7) SF005 - 4 1344-6703 2019/12
• 食道胃接合部癌に対し腹臥位胸腔鏡下Mckeown手術を施行した2例

  大川 裕貴, 海老原 裕磨, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 24 (7) MO018 - 2 1344-6703 2019/12
• 腹腔鏡下脾部分切除術を施行した脾良性腫瘍の2例

  木村 弘太郎, 倉島 庸, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 24 (7) MO176 - 1 1344-6703 2019/12
• ASO Author Reflections: Current State of Surgical Sarcopenia in Esophageal Cancer.

  Shion Uemura, Toshiaki Shichinohe, Masao Hosokawa, Satoshi Hirano

  Annals of surgical oncology 26 (Suppl 3) 670 - 671 2019/12
• Gait reconstruction using the gait assist robot WPAL in patients with cervical spinal cord injury

  Ikuko Fuse, Satoshi Hirano, Eiichi Saitoh, Yohei Otaka, Shigeo Tanabe, Masaki Katoh, Takeshi Gotoh, Sho Tsunogai, Ayaka Kumagai, Tetsuya Tsunoda, Soichiro Koyama

  Japanese Journal of Comprehensive Rehabilitation Science 10(2019) 88 - 95 2019/11 [Refereed][Not invited]
   

  【目的】頸髄損傷者にWearable Power-Assist Locomotor(WPAL)を使用し,歩行能力を装具使用時と比較した.【方法】頸髄損傷者5名に装具またはWPALを装着し歩行を行わせ,Functional Ambulation Categories(FAC),連続歩行時間・距離,3分間歩行における自覚的運動強度,上肢疲労度およびPhysiological Cost Index(PCI)を評価した.装具とWPAL条件間にて各指標を比較した.【結果】5名中3名でWPAL使用時のFACは装具歩行時よりも高く,2名は同値だった.また,3名で歩行が自立した.連続歩行距離はWPAL使用時に装具使用時よりも有意に長かった(p<0.05).歩行速度・ストライド・ケイデンスは全例WPALで高く,PCIは全例WPALで低かった.【結論】WPALは装具に比較して頸髄損傷者の歩行再建に有用である.(著者抄録)
• 胸部食道扁平上皮癌に対する術前補助化学療法・根治切除術および根治的化学放射線療法についての後方視的検討

  中積 宏之, 村中 徹人, 川本 泰之, 小松 嘉人, 結城 敏志, 中野 真太郎, 澤田 憲太郎, 坂本 直哉, 打浪 雄介, 田口 大志, 白土 博樹, 海老原 裕磨, 七戸 俊明, 平野 聡

  北海道医学雑誌 北海道医学会 94 (2) 120 - 121 0367-6102 2019/11
• 【膵炎大全II〜膵炎・Up to date〜】膵炎各論 腹部外傷による膵損傷(膵炎)

  田中 公貴, 平野 聡

  胆と膵 医学図書出版(株) 40 (臨増特大) 1251 - 1254 0388-9408 2019/11 

  本邦の外傷性膵損傷は発生がまれであることから、外科医が遭遇する機会は限られている。治療法の決定には主膵管損傷の有無が大きくかかわるため、CTよりも診断能が高いとされるERPの実施を常に考慮する必要がある。主膵管損傷のない症例には、非手術的マネージメントが推奨される。一方で、主膵管損傷がある症例では、手術による膵切除(修復)とドレナージが必要となる。膵外傷の症例は多発臓器損傷を伴うことも多いため、全身状態・手術侵襲・臓器損傷の状態を判断しバランスを考えた術式を選択するべきである。外傷性急性膵炎は外傷性膵損傷に合併して生じ、膵腺房細胞の外力による破壊に膵管や胆管内圧の上昇が加わって発症する。基本的な治療方針は急性膵炎に準じて行い、損傷とは別に、ドレナージと膵酵素阻害剤の投与、十分な経静脈栄養が治療の柱となる。(著者抄録)
• 胃癌に対する腹腔鏡下胃全摘術の手術成績におけるBMIの影響 多施設後ろ向き研究

  宮坂 衛, 海老原 裕磨, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 52 (Suppl.2) 132 - 132 0386-9768 2019/11
• 肝門部領域胆管癌に対する術前門脈塞栓後の待機日数と肝不全死亡発生の関連

  木村 弘太郎, 野路 武寛, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 52 (Suppl.2) 196 - 196 0386-9768 2019/11
• 切除不能膵癌に対するconversion surgeryの成績と切除範囲適正化を目指した取り組み

  浅野 賢道, 中村 透, 田中 公貴, 岡村 圭祐, 野路 武寛, 土川 貴裕, 中西 喜嗣, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 52 (Suppl.2) 221 - 221 0386-9768 2019/11
• 当教室における胸腔鏡を用いた食道癌サルベージ手術

  城崎 友秀, 七戸 俊明, 海老原 裕磨, 倉島 庸, 村上 壮一, 平野 聡

  北海道医学雑誌 北海道医学会 94 (2) 124 - 125 0367-6102 2019/11
• [A Case of Bone Marrow Carcinomatosis Arising from Breast Cancer with a Rapidly Progressive Course].

  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Kazuomi Ichinokawa, Hiroyuki Shikishima, Akio Mori, Satoshi Hirano

  Gan to kagaku ryoho. Cancer & chemotherapy 46 (11) 1783 - 1786 0385-0684 2019/11 

  A 67-year-old woman was diagnosed with Stage ⅡA breast cancer(T2N0M0)in 2003. She underwent mastectomy and lymph node dissection. Oral fluoropyrimidine was administered for 3 years as adjuvant chemotherapy. In 2008, the patient was diagnosed with multiple bone metastases and left supraclavicular lymph node metastasis. Radiotherapy was performed on the left first rib and left supraclavicular lymph node. She was treated with chemotherapy and endocrine therapy and bone metastasis therapeutic agent. In 2013, multiple liver metastases were noted and treated with chemotherapy. Liver metastases were well-controlled. Endocrine therapy was continued for bone metastases without visceral metastasis. In 2016, the patient was diagnosed with bone marrow carcinomatosis and died 2 weeks later due to bone marrow carcinomatosis.
• Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2,778 cases.

  Chaudhary RJ, Higuchi R, Nagino M, Unno M, Ohtsuka M, Endo I, Hirano S, Uesaka K, Hasegawa K, Wakai T, Uemoto S, Yamamoto M

  Journal of hepato-biliary-pancreatic sciences 26 (11) 490 - 502 1868-6974 2019/11 [Refereed][Not invited]
   

  BACKGROUND: In Japan, strategies for preoperative management of perihilar cholangiocarcinoma (PHC) have evolved over the last decade; the operative mortality has significantly reduced to <5%. METHODS: A questionnaire was sent to 10 institutions based on their case volume. Questionnaire was based on: (1) preoperative biliary drainage, (2) bile replacement, (3) role of synbiotics, (4) remnant liver volume enhancement, (5) predicted remnant liver function, (6) imaging, (7) nutrition, and (8) role of Inchinkoto. RESULTS: The median case volume was 226 (range 105-889) cases, respectively. Eight institutions preferred endoscopic nasobiliary drainage and two preferred endoscopic biliary stenting for biliary drainage. Nine used bile replacement within 2-3 days of biliary drainage. Four used synbiotics preoperatively. The median cutoff value for future remnant liver volume and serum total bilirubin, at which portal vein embolization (PVE) is done, is <40% and <4 mg/dl. The median interval between PVE and surgery was 3-4 weeks. To predict remnant liver function, indocyanine green retention (n = 8) and clearance rate (n = 2) were mainly used. Five used Inchinkoto to improve liver function. Nine used multidetector computed tomography and direct cholangiography for surgical planning. CONCLUSION: With appropriate preoperative management of PHC, surgical morbidity and mortality can be reduced. This survey can provide recommendations to improve PHC perioperative outcomes.
• Acute compartment syndrome of the lower leg causing cardiac arrest after resection of the right external iliac vein for autologous graft: a case report.

  Koji Hoshino, Toru Nakamura, Mineji Hayakawa, Yusuke Itosu, Hitoshi Saito, Satoshi Hirano, Yuji Morimoto

  JA clinical reports 5 (1) 65 - 65 2019/10/23 

  BACKGROUND: The right external iliac vein (REIV) is often used for portal vein reconstruction in patients undergoing pancreatoduodenectomy with portal-superior mesenteric vein resection. We report a case of cardiac arrest caused by acute lower leg compartment syndrome as a result of REIV resection. CASE PRESENTATION: A 53-year-old man underwent pancreatoduodenectomy with portal vein resection. Hyperkalemia progressed during surgery due to intestinal reperfusion injury, which caused recurrent ventricular arrhythmia required for cardio-pulmonary resuscitation. The surgery was discontinued after resuscitation, and portal vein reconstruction using the REIV was performed 2 days post-operatively. Acute compartment syndrome was diagnosed immediately following the surgery. Hyperkalemia progressed, causing pulseless ventricular tachycardia. Emergent fasciotomy was performed, but right leg dysfunction persisted after discharge. CONCLUSION: REIV resection can cause lower-extremity acute compartment syndrome. The status, including intracompartmental pressure, of the lower extremity should be carefully observed after REIV resection during and after surgery.
• 日本外科学会専門医取得に関する全国アンケート調査から 大学と一般病院、大都市と地方に差があるのか?

  橋本 大輔, サシーム・パウデル, 倉島 庸, 福井 寿啓, 岩瀬 弘敬, 平野 聡, 大木 隆夫, 小寺 泰弘, 外科専門医修練カリキュラム検討ワーキンググループ

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 272 - 272 1345-2843 2019/10
• 安全に胆道癌拡大肝切除を行うための術前・術後管理 胆道癌の拡大肝切除症例に対する術前胆汁菌腫の感受性に基づく周術期抗菌薬選択による感染対策

  田中 公貴, 岡村 圭祐, 平野 聡

  胆道 日本胆道学会 33 (3) 437 - 437 0914-0077 2019/10
• 肝門部領域胆管癌症例における垂直方向進展診断および剥離面陰性化の意義

  野路 武寛, 岡村 圭祐, 中山 智英, 田中 公貴, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  胆道 日本胆道学会 33 (3) 511 - 511 0914-0077 2019/10
• 肝門部領域胆管癌における術後再発時期の検討

  中西 喜嗣, 中山 智英, 田中 公貴, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  胆道 日本胆道学会 33 (3) 569 - 569 0914-0077 2019/10
• 肝道癌に対するconversion surgeryの短期・長期成績

  野路 武寛, 岡村 圭祐, 中山 智英, 田中 公貴, 中西 善嗣, 中村 透, 土川 貴裕, 平野 聡

  胆道 日本胆道学会 33 (3) 572 - 572 0914-0077 2019/10
• 一般外科医の外傷診療スキル調査

  廣瀬 和幸, 村上 壮一, 倉島 庸, 佐藤 暢人, 田中 公貴, 中西 善嗣, 浅野 賢道, 野路 武寛, 海老原 祐磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (1) 131 - 131 2019/10
• 広域搬送に成功した交通外傷の1例

  橋爪 大弥, 村上 壮一, 飯田 圭祐, 中村 有里, 木村 弘太郎, 城崎 友秀, 廣瀬 和幸, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 淺井 悌, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (1) 152 - 152 2019/10
• 徹底した病歴の聞き取りが診断と修復につながった閉鎖孔ヘルニアの1症例(A case of obturator hernia where thorough history-taking led to prompt diagnosis and repair)

  飯田 圭祐, 村上 壮一, 中村 有里, 橋爪 大弥, 吉田 雄亮, 木村 弘太郎, 城崎 友秀, 廣瀬 和幸, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 9 (1) 155 - 155 2019/10
• 心停止を来した急性冠症候群の蘇生・加療後に発症した、非閉塞性腸管虚血の1例

  中村 有里, 村上 壮一, 飯田 圭祐, 橋爪 大弥, 吉田 雄亮, 木村 弘太郎, 城崎 友秀, 廣瀬 和幸, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (1) 163 - 163 2019/10
• 当教室での特発性食道破裂3例に対する手術経験

  木村 弘太郎, 村上 壮一, 吉田 雄亮, 城崎 友秀, 廣瀬 和幸, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (1) 196 - 196 2019/10
• 非閉塞性腸間膜虚血症(NOMI)に対する腸管切除後、open abdominal management(OAM)での管理を行い救命し得た一例

  城崎 友秀, 村上 壮一, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 9 (1) 199 - 199 2019/10
• 当教室における定型化した腹腔鏡下スリーブ状胃切除術

  桐山 琴衣, 海老原 裕磨, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  肥満研究 (一社)日本肥満学会 25 (Suppl.) 267 - 267 1343-229X 2019/10
• 膵頭部癌に対する術前内視鏡的胆管ステント留置術の臨床成績

  平田 甫, 桑谷 将城, 中島 正人, 平田 幸司, 杉浦 諒, 加藤 新, 坂本 直哉, 浅野 賢道, 平野 聡

  胆道 日本胆道学会 33 (3) 548 - 548 0914-0077 2019/10
• Liver,Pancreas,Biliary Tract Cancer 肝・胆・膵癌 肝胆道・膵がんにおけるPre-Operative Down-Sizing Chemotherapyの安全性 閉塞性黄疸を伴った胆・膵癌に対する術前化学療法時のドレナージと安全性

  中西 喜嗣, 中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 田中 公貴, 中山 智英, 平野 聡

  癌と化学療法 (株)癌と化学療法社 46 (10) 1509 - 1512 0385-0684 2019/10
• 効果的な学生教育(産学およびbed side learning) 構成主義にもとづく外科臨床実習の実践 Team Based Practice(TBP)の開発

  村上 壮一, 倉島 庸, 吉見 泰典, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 417 - 417 1345-2843 2019/10
• 経十二指腸乳頭部切除後の縫合不全とその対応

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 田中 公貴, 浅野 賢道, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 444 - 444 1345-2843 2019/10
• 僻地の中規模病院に178名を集めたキッズセミナー その実際と問題点

  村上 壮一, 大柏 秀樹, 楢崎 肇, 中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 452 - 452 1345-2843 2019/10
• インドシアニングリーンおよび5-アミノレブリン酸を用いた胆道癌に対する光線力学的診断法の探索

  野路 武寛, 楢崎 肇, 櫛引 敏寛, 田中 公貴, 中西 善嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 472 - 472 1345-2843 2019/10
• 膵頭部癌に対する術前治療の周術期合併症に与える影響

  山本 寛之, 中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (増刊) 659 - 659 1345-2843 2019/10
• 当教室における腹腔鏡下スリーブ状胃切除術の手術成績

  渡邊 一永, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  肥満研究 (一社)日本肥満学会 25 (Suppl.) 324 - 324 1343-229X 2019/10
• [Ⅲ.Management of Biliary Drainage in Patients Undergoing Neo-Adjuvant Therapy for Biliary or Pancreatic Cancer].

  Yoshitsugu Nakanishi, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Takehiro Noji, Kimitaka Tanaka, Tomohide Nakayama, Satoshi Hirano

  Gan to kagaku ryoho. Cancer & chemotherapy 46 (10) 1509 - 1512 0385-0684 2019/10
• Perforation of small intestinal metastasis of lung adenocarcinoma treated with pembrolizumab: a case report.

  Sato S, Senmaru N, Ishido K, Saito T, Poudel S, Muto J, Syouji Y, Hase R, Hirano S

  Surgical case reports 5 (1) 166 - 166 2019/10 [Refereed][Not invited]
   

  BACKGROUND: Pembrolizumab is an immune checkpoint inhibitor and is an anti-human programmed cell death-1 (PD-1) monoclonal antibody. Pembrolizumab is used for non-small cell lung carcinoma with high programmed cell death ligand-1 (PD-L1) expression. It has been found that better overall survival can be obtained using pembrolizumab compared to the existing chemotherapy. We report a case of perforation of small intestinal metastasis after pembrolizumab treatment. CASE PRESENTATION: A 62-year-old man was treated by pembrolizumab for PD-L1 highly expressed lung adenocarcinoma, with multiple metastasis (small intestinal, lymph nodes, and bone). The treatment was stopped owing to drug-induced pneumonitis. One month after drug withdrawal, the patient visited the emergency department of our hospital with the complaint of severe stomachache. He had a rigid abdomen and generalized tenderness, and computed tomography scans showed free air within the abdomen. We diagnosed bowel perforation and performed emergency surgery. Surgical findings revealed multiple small intestine metastasis and mesenteric lymph node metastasis. Perforation was found in the metastatic site in the jejunum located around 40 cm anal to Treitz's ligament. This perforated part was resected, and functional end-to-end anastomosis was performed using linear staplers. The post-operative course was uneventful. Pathological examination revealed lung adenocarcinoma metastasis at the perforation site, and the effectiveness of pembrolizumab was grade 1b (Japanese Classification of the Colorectal Carcinoma, seventh edition). CONCLUSIONS: This is the first report of perforation of small intestinal metastasis of lung adenocarcinoma after pembrolizumab treatment. Because pembrolizumab causes some side effects, particularly autoimmune side effects, careful attention during treatment is warranted.
• Stage III結腸癌の術後補助化学療法としてのFOLFOX療法の第II相臨床試験 NORTH/HGCSG1003

  岩永 一郎, 結城 敏志, 七戸 俊明, 高橋 典彦, 川本 泰之, 中積 宏之, 久須美 貴哉, 中村 文隆, 原田 一顕, 伊藤 陽一, 坂本 直哉, 平野 聡, 武冨 紹信, 小松 嘉人

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 43 - 43 2019/09
• 門脈臍部背側胆管に嚢状拡張を有する戸谷IVa型先天性胆道拡張症に対する手術術式選択

  野路 武寛, 田中 公貴, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本膵・胆管合流異常研究会プロシーディングス 日本膵・胆管合流異常研究会 42 50 - 50 1883-4116 2019/09
• 膵胆管合流異常症における画像所見の検討

  古川 龍太郎, 桑谷 将城, 平田 甫, 滝新 悠之介, 平田 幸司, 加藤 新, 岡村 圭佑, 平野 聡, 坂本 直哉

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 34 - 34 2019/09
• 胆嚢原発神経内分泌腫瘍の4症例

  滝新 悠之介, 桑谷 将城, 古川 龍太郎, 平田 甫, 平田 幸司, 加藤 新, 坂本 直哉, 岡村 圭祐, 平野 聡, 三橋 智子

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 37 - 37 2019/09
• 組織学的に進展様式を確認しえた表面陥凹型を呈する胎児消化管上皮類似胃癌の一例

  田中 一光, 小野 尚子, 霜田 佳彦, 井上 雅貴, 木脇 佐代子, 石川 麻倫, 大野 正芳, 山本 桂子, 清水 勇一, 坂本 直哉, 海老原 祐磨, 平野 聡, 岡田 宏美, 松野 吉宏

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 49 - 49 2019/09
• 消化器病診療:内科と外科の対照と融合 深達度とリンパ節転移個数による十二指腸乳頭部癌の治療戦略

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 田中 公貴, 中山 智英, 村上 壮一, 海老原 佑磨, 倉島 庸, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 28 - 28 2019/09
• 【外科医育成のためのOff-the-job training(Off-JT)の現状と将来】消化器外科領域のOff-JTの現状

  七戸 俊明, 村上 壮一, 倉島 庸, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 120 (5) 511 - 516 0301-4894 2019/09 

  高度で複雑な手術治療を安全に実施するには手術手技向上のトレーニングが欠かせない.トレーニング方法には従来からあるOn-the-job training(On-JT)のほかに,Off-the-job training(Off-JT)として,シミュレーターや模型を使用したドライラボ,実験動物を用いたウエットラボやアニマルラボ,献体を使用した手術手技研修(Cadaver Surgical Training:CST)などがある.消化器外科領域では,ロボット支援手術の安全な導入のためのcertification制度や,内視鏡外科手術の習熟のためのドライラボやアニマルラボ,日常診療で経験することの少ない救急外科(Acute Care Surgery:ACS)領域でのアニマルラボやCSTなどのOff-JTが取り入れられているが,専門医などの資格認定において必須項目とはされておらず,必ずしもOff-JTが広く普及しているわけではない.本稿では,わが国の消化器外科領域のOff-JTの現状と今後の展望について述べる.(著者抄録)
• 外来経腸栄養管理において投与法及び経口摂取量の入念な聴取が重要であった大動脈食道瘻術後摂食障害の1例

  村上 壮一, 七戸 俊明, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 吉田 ゆか, 熊谷 聡美, 武田 宏司, 平野 聡

  学会誌JSPEN (一社)日本臨床栄養代謝学会 1 (Suppl.) 1376 - 1376 2019/09
• 膵癌ドライバー変異はmRNA翻訳と蛋白質プレニル化を介しARF6が駆動する癌免疫回避を促進する(Pancreatic KRAS/TP53 mutations promote ARF6-based immune evasion via activating mRNA translation and protein prenylation)

  橋本 あり, 橋本 茂, 古川 聖太郎, 蔦保 暁生, 小野寺 康人, 半田 悠, 及川 司, 水上 裕輔, 西川 義浩, 児玉 裕三, 村上 正晃, 平野 聡, 佐邊 壽孝

  日本癌学会総会記事 78回 P - 3033 0546-0476 2019/09
• Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging: Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group (HOPS UR-01).

  Yasutoshi Kimura, Toru Nakamura, Tsuyoshi Hayashi, Masaki Kuwatani, Masayo Motoya, Makoto Yoshida, Masafumi Imamura, Minoru Nagayama, Hiroshi Yamaguchi, Keisuke Yamakita, Takuma Goto, Yusuke Sakuhara, Kuniyuki Takahashi, Hiroyuki Maguchi, Satoshi Hirano, Ichiro Takemasa

  Annals of gastroenterological surgery 3 (5) 523 - 533 2019/09 

  Background and Aim: Effective multidisciplinary approaches for unresectable pancreatic cancer (UR-PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR-PC, focusing on the efficacy of CS. Methods: Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)-based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results: Sixty-six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2-32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017-0.348; P = 0.001). Conclusion: Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR-PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential.
• Two emergency cases of spontaneous esophageal perforation treated using a minimally invasive abdominal and left thoracic approach.

  Sekiya S, Ebihara Y, Yamamura Y, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Asian journal of endoscopic surgery 13 (3) 406 - 409 1758-5902 2019/09 [Refereed][Not invited]
   

  Boerhaave's syndrome is a rare life-threatening disease that requires prompt intervention. Thoracotomy has traditionally been considered the gold standard approach for treatment, but other minimally invasive approaches have recently been reported. Our institute reported the efficacy of minimally invasive abdominal and left thoracic approach in the treatment of patients with esophagogastric junction cancer and introduced it for the treatment of two patients with Boerhaave's syndrome. We intraoperatively sutured the rupture sites and irrigated the pleural cavity using thoracoscopy. Then, after confirming the absence of intraabdominal contamination, we performed jejunostomy or gastrostomy using laparoscopy. Patients' vital signs remained stable intraoperatively, and their postoperative periods were uneventful with no leakage or stricture. The minimally invasive abdominal and left thoracic approach for Boerhaave's syndrome is convenient and useful as it provides excellent visualization of the thoracic and abdominal cavities with the possibility of quickly switching between views.
• ARF6 and AMAP1 are major targets of KRAS and TP53 mutations to promote invasion, PD-L1 dynamics, and immune evasion of pancreatic cancer

  Shigeru Hashimoto, Shotaro Furukawa, Ari Hashimoto, Akio Tsutaho, Akira Fukao, Yurika Sakamura, Gyanu Parajuli, Yasuhito Onodera, Yutaro Otsuka, Haruka Handa, Tsukasa Oikawa, Soichiro Hata, Yoshihiro Nishikawa, Yusuke Mizukami, Yuzo Kodama, Masaaki Murakami, Toshinobu Fujiwara, Satoshi Hirano, Hisataka Sabe

  Proceedings of the National Academy of Sciences of the United States of America 116 (35) 17450 - 17459 0027-8424 2019/08/27 [Refereed][Not invited]
   

  © 2019 National Academy of Sciences. All rights reserved. Although KRAS and TP53 mutations are major drivers of pancreatic ductal adenocarcinoma (PDAC), the incurable nature of this cancer still remains largely elusive. ARF6 and its effector AMAP1 are often overexpressed in different cancers and regulate the intracellular dynamics of integrins and E-cadherin, thus promoting tumor invasion and metastasis when ARF6 is activated. Here we show that the ARF6-AMAP1 pathway is a major target by which KRAS and TP53 cooperatively promote malignancy. KRAS was identified to promote eIF4A-dependent ARF6 mRNA translation, which contains a quadruplex structure at its 5′-untranslated region, by inducing TEAD3 and ETV4 to suppress PDCD4; and also eIF4E-dependent AMAP1 mRNA translation, which contains a 5′- terminal oligopyrimidine-like sequence, via up-regulating mTORC1. TP53 facilitated ARF6 activation by platelet-derived growth factor (PDGF), via its known function to promote the expression of PDGF receptor β (PDGFRβ) and enzymes of the mevalonate pathway (MVP). The ARF6-AMAP1 pathway was moreover essential for PDGF-driven recycling of PD-L1, in which KRAS, TP53, eIF4A/4Edependent translation, mTOR, and MVP were all integral. We moreover demonstrated that the mouse PDAC model KPC cells, bearing KRAS/TP53 mutations, express ARF6 and AMAP1 at high levels and that the ARF6-based pathway is closely associated with immune evasion of KPC cells. Expression of ARF6 pathway components statistically correlated with poor patient outcomes. Thus, the cooperation among eIF4A/4E-dependent mRNA translation and MVP has emerged as a link by which pancreatic driver mutations may promote tumor cell motility, PD-L1 dynamics, and immune evasion, via empowering the ARF6-based pathway and its activation by external ligands.
• Adenocarcinoma arising from an ectopic pancreas in the duodenum: a case report.

  Tsukasa Kaneko, Masanori Ohara, Kunishige Okamura, Aki Fujiwara-Kuroda, Daisuke Miyasaka, Takumi Yamabuki, Ryo Takahashi, Kazuteru Komuro, Masato Suzuoki, Nozomu Iwashiro, Mototsugu Kato, Noriko Kimura, Hiroshi Kijima, Toru Nakamura, Satoshi Hirano

  Surgical case reports 5 (1) 126 - 126 2019/08/06 

  BACKGROUND: The malignant transformation of an ectopic pancreas in the duodenum is extremely rare. Herein, we report a case of an adenocarcinoma that arose from an ectopic pancreas. We also reviewed 14 cases of malignant transformations arising from an ectopic pancreas in the duodenum that were previously published. CASE PRESENTATION: An 81-year-old man with a 1-month history of vomiting was admitted to our institution. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans revealed an obstruction at the first part of the duodenum. A distal gastrectomy was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed adenocarcinoma that arose from an ectopic pancreas (Heinrich type 1). The patient is alive without relapse at 18 months of follow-up. CONCLUSIONS: Adenocarcinoma that arises from an ectopic pancreas should be considered when an obstruction is identified in the duodenum.
• 【外科におけるカテーテル管理のコツ】消化管内留置カテーテル 膵管・胆管再建におけるドレナージカテーテルの留置と管理方法

  土川 貴裕, 平野 聡, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭祐, 三浦 拓己, 吉田 憲央, 島 明日美, 岡田 智之, 榎並 美里, 石川 薫

  外科 (株)南江堂 81 (9) 936 - 939 0016-593X 2019/08 

  ＜文献概要＞膵・胆道癌手術において膵管・胆管吻合再建時に留置するステントチューブは,吻合部の開存性を確保し,また吻合部に曝露される膵液・胆汁などの刺激性の消化液を適切に腸管内(内瘻チューブ),あるいは体外(外瘻チューブ)へ誘導することで吻合部の保護と減圧に寄与する.さらに縫合不全により吻合部に離開が生じた場合にも,吻合の連続性を保つ効果が期待できる.本稿では膵管・胆管吻合再建時に留置するステントチューブについて,その意義とともにわれわれが行っている管理法について解説した.
• Treatment of bleeding from a portion of pancreatojejunostomy after pancreaticoduodenectomy with division of the splenic vein: two case reports.

  Kushiya H, Noji T, Abo D, Soyama T, Tanaka K, Nakanishi Y, Asano T, Nakamura T, Tsuchikawa T, Okamura K, Hirano S

  Surgical case reports 5 (1) 128 - 128 2019/08 [Refereed][Not invited]
   

  BACKGROUND: There is no definitive strategy for gastrointestinal bleeding due to left-sided portal hypertension after pancreaticoduodenectomy (PD) for pancreatic cancer (PC) with concomitant portal vein resection (PVR). CASE PRESENTATION: Case 1: A 70-year-old woman underwent a PD for PC with PVR. Seven years after her surgery, she suffered severe anemia with suspected gastrointestinal bleeding. Computed tomography scan (CT) revealed varices at a portion of the pancreaticojejunostomy (PJ). Angiography revealed that splenic venous flow drained into the varices and then into the portal vein. A diagnosis of bleeding varices of the PJ due to left-sided portal hypertension was made. Following a partial splenic artery embolization, her anemia improved. Case 2: An 80-year-old male underwent a PD for pancreatic head cancer combined with resection of the confluence of the portal and splenic veins with a reconstruction between the portal and superior mesenteric veins. Eighteen months after his surgery, he developed melena with negative endoscopy findings in his large and small bowel. CT revealed varices at the site of the PJ that communicated with the jejunal and portal veins. He underwent obliteration of the varices via a trans-portal-venous approach. As a result, he remained without melena until he died of PC 17 months after the embolization. CONCLUSIONS: Left-sided portal hypertension following a PD with bleeding varices can be treated by interventional radiology with minimal invasiveness.
• Development of a conceptual framework of recovery after abdominal surgery

  Alam R, Montanez J, Law S, Lee L, Pecorelli N, Watanabe Y, Chiavegato LD, Falconi M, Hirano S, Mayo NE, Feldman LS, Fiore JF J

  Surgical Endoscopy 34 (6) 2665 - 2674 0930-2794 2019/08 [Refereed][Not invited]
   

  BACKGROUND: There is a lack of patient-reported outcome measures (PROMs) with robust measurement properties to assess postoperative recovery and support patient-centered care after abdominal surgery. The aim of this study was to establish a conceptual framework of recovery after abdominal surgery to support the development of a conceptually relevant and psychometrically sound PROM. METHODS: Patients from four different countries (Canada, Italy, Brazil, and Japan) participated in qualitative interviews focusing on their lived experiences of recovery after abdominal surgery. Interviews were guided by a previously developed hypothesized conceptual framework established based on a literature review and expert consensus. Interviews were analyzed according to a modified grounded theory approach and transcripts were coded according to the International Classification of Functioning, Disability and Health (ICF). Codes for which thematic saturation was reached were classified into domains of health that are relevant to the process of recovery after abdominal surgery. These domains were organized into a structured diagram. RESULTS: 30 Patients with diverse demographics and surgical characteristics were interviewed (50% female, age 57 ± 18 years, 66% major or major extended surgery). 39 Unique domains of recovery emerged from the interviews, 17 falling under the ICF category of "Body Functions" and 22 under "Activities and Participation". These domains constitute the conceptual framework of recovery after abdominal surgery. CONCLUSIONS: This study provides comprehensive insight into patients' perspectives of the recovery process after abdominal surgery. This conceptual framework will support content validity and provide the pivotal basis for the development of a novel PROM to inform quality improvement initiatives and patient-centered research in abdominal surgery.
• Evaluation methods and impact of simulation-based training in pediatric surgery: a systematic review.

  Yokoyama S, Mizunuma K, Kurashima Y, Watanabe Y, Mizota T, Poudel S, Kikuchi T, Kawai F, Shichinohe T, Hirano S

  Pediatric surgery international 35 (10) 1085 - 1094 0179-0358 2019/08 [Refereed][Not invited]
   

  PURPOSE: The aim of this study was to identify (1) the type of skill evaluation methods and (2) how the effect of training was evaluated in simulation-based training (SBT) in pediatric surgery. METHODS: Databases of PubMed, Cochrane Library, and Web of Science were searched for articles published from January 2000 to January 2017. Search concepts of Medical Subject Heading terms were "surgery," "pediatrics," "simulation," and "training, evaluation." RESULTS: Of 5858 publications identified, 43 were included. Twenty papers described simulators as assessment tools used to evaluate technical skills. Reviewers differentiated between experts and trainees using a scoring system (45%) and/or a checklist (25%). Simulators as training tools were described in 23 papers. While the training's effectiveness was measured using performance assessment scales (52%) and/or surveys (43%), no study investigated the improvement of the clinical outcomes after SBT. CONCLUSION: Scoring, time, and motion analysis methods were used for the evaluation of basic techniques of laparoscopic skills. Only a few SBT in pediatric surgery have definite goals with clinical effect. Future research needs to demonstrate the educational effect of simulators as assessment or training tools on SBT in pediatric surgery.
• ゆるキャライラストで特徴が"サッ"とわかる!消化器疾患ファイル(最終回) 嚢胞性膵疾患

  浅野 賢道, 平野 聡

  消化器ナーシング (株)メディカ出版 24 (7) 658 - 659 2434-4575 2019/07
• 日本外科学会専門医取得に関する全国アンケート調査から地域間格差はあるのか?

  橋本 大輔, サシーム・パウデル, 倉島 庸, 福井 寿啓, 岩瀬 弘敬, 平野 聡, 大木 隆生, 小寺 泰弘, 外科専門医修練カリキュラム検討ワーキンググループ

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 O7 - 5 2019/07
• 【膵手術・膵癌治療の進歩】膵体部癌に対する安全性を考慮した腹腔動脈合併尾側膵切除

  平野 聡, 中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 村上 壮一, 海老原 裕磨, 倉島 庸, 七戸 俊明

  日本外科学会雑誌 (一社)日本外科学会 120 (4) 418 - 424 0301-4894 2019/07 

  腹腔動脈合併尾側膵切除術(Distal pancreatectomy with en bloc celiac axis resection:DP-CAR)は進行膵体尾部癌に対する術式として近年、広く普及してきた。本術式の特殊性は腹腔動脈(CA)の切離によりダイナミックな血行改変が行われる点にある。この特殊性を反映して術後の合併症が高率であることが認識されているが、実際、教室における経験例80例の集計ではClavien-Dindo分類におけるGrade III以上の合併症発生率は40%を超える。本術式では、大動脈上でのCAの処理や、下膵十二指腸動脈(IPDA)から胃十二指腸動脈(GDA)に至る側副血行の温存操作など、手技の確実性を要求される場面が多い。また、術後の虚血性胃症に対しては術前の総肝動脈塞栓の効果は不十分であり、虚血が疑われた症例には左胃動脈の再建で対処すべきと考える。最近、左下横隔動脈や左胃動脈を温存することで虚血が予防できる可能性が示唆されていることから、腫瘍の進展度からみて可能であればこれらの動脈温存を考慮すべきである。(著者抄録)
• 光線力学的診断法の胆膵外科への応用

  野路 武寛, 岡村 圭祐, 楢崎 肇, 海老原 裕磨, 田中 公貴, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P201 - 3 2019/07
• 【膵】膵癌に対するリンパ節郭清の再考 膵体尾部癌における至適リンパ節郭清とは? リンパ節転移範囲と再発形式からの検討

  田中 公貴, 中村 透, 浅野 賢道, 中西 喜嗣, 野路 武寛, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 WS24 - 10 2019/07
• 胆膵領域における異時性多発・重複悪性腫瘍に対する根治術の成績

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 中山 智英, 山本 和幸, 浅野 賢道, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 O16 - 7 2019/07
• 教室におけるStage I膵癌の現状と課題 長期生存例との比較から

  中村 透, 浅野 賢道, 吉見 泰典, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 O21 - 1 2019/07
• 門脈合併切除を伴う膵体尾部切除術の現状と課題

  中山 智英, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P224 - 6 2019/07
• 遠位胆管癌における"Invasive tumor thickness"の妥当性についての検討

  中西 喜嗣, 趙 陽, 荻野 真理子, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 田中 公貴, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P203 - 7 2019/07
• 膵癌腫瘍血管に着目した術前治療効果予測因子の同定と予後の解析

  土川 貴裕, 桑原 尚太, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 O41 - 7 2019/07
• 1週間のローテーション実習を単なる見学に終わらせない工夫 Team Based Practice

  村上 壮一, 倉島 庸, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 健裕, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 大滝 純司, 平野 聡

  医学教育 (一社)日本医学教育学会 50 (Suppl.) 87 - 87 0386-9644 2019/07
• 当科におけるロボット支援下胃癌手術の短期成績に関する検討

  山本 和幸, 海老原 裕磨, 関谷 翔, 城崎 友秀, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P27 - 5 2019/07
• 当科におけるロボット支援腹腔鏡下胃切除術の短期成績

  海老原 裕磨, 山本 和幸, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P27 - 7 2019/07
• Oncologic Emergencyに対する手術戦略 当科37症例の検討

  村上 壮一, 七戸 俊明, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 O5 - 7 2019/07
• 当教室における特発性食道破裂に対する胸腔鏡腹腔鏡併用手術(MALTA)の経験と治療成績

  関谷 翔, 海老原 裕磨, 山本 和幸, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 RS5 - 5 2019/07
• 蛍光スペクトル解析を用いた光線力学的転移診断の臨床応用

  城崎 友秀, 齋藤 崇宏, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 74回 P285 - 6 2019/07
• Outcomes of pancreaticoduodenectomy in patients with chronic hepatic dysfunction including liver cirrhosis: results of a retrospective multicenter study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  Yasuro Futagawa, Katsuhiko Yanaga, Tomoo Kosuge, Machi Suka, Shuji Isaji, Satoshi Hirano, Yoshiaki Murakami, Masakazu Yamamoto, Hiroki Yamaue

  Journal of hepato-biliary-pancreatic sciences 26 (7) 310 - 324 2019/07 

  BACKGROUND: Since there is no reliable evidence on the safety of pancreaticoduodenectomy (PD) in chronic hepatic dysfunction (CHD) including liver cirrhosis (LC), the effects of CHD on patients undergoing PD were investigated. METHODS: This multi-institutional retrospective study analyzed 529 patients with CHD, including 105 patients diagnosed with LC, who underwent PD at 82 high-volume institutions between 2004 and 2013. RESULTS: The in-hospital mortality rate was 5.9%. The incidence of postoperative hepatic decompensation upon discharge and refractory ascites was 10.2% and 8.9%, respectively. For hepatic decompensation, the serum aspartate aminotransferase (AST) of more than 50 IU/l and portal hypertension (PHT) were independent significant risk factors. For refractory ascites, prothrombin activity of <70%, serum AST of more than 50 IU/l and advanced PHT with collaterals were significant risk factors. Five-year overall survival was 57.8% in Child A and 24.8% in Child B patients (P < 0.0001). The Child B/C patients were divided into two groups according to an AST-platelet ratio index (APRI) of 1.0; the APRI of <1.0 yielded a significantly higher survival rate than their counterpart (43.2% vs. 14.7%, P = 0.04). CONCLUSIONS: In addition to PHT, pre-operative evaluation of AST and APRI may be helpful for patient selection for PD in patients with CHD.
• [A Case of Ascending Colon Cancer Probably Arising from a Diverticulum].

  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Takuro Machida, Mayumi Sasaki, Satoshi Hirano

  Gan to kagaku ryoho. Cancer & chemotherapy 46 (7) 1199 - 1201 0385-0684 2019/07 

  A 70's male was admitted to our hospital with complaints of anorexia and abdominal pain. CT showed thickening of the ascending colon. Colonoscopy revealed multiple diverticula of the ascending colon, but no tumor on the mucosa. The patient was diagnosed as a case of diverticulitis of the ascending colon and was advised laparoscopic ileocecal resection. The resected specimen showed wall thickening; however, no remarkable findings were observed, with the exception of multiple diverticula on the mucosal surface. Histological examination showed well-differentiated tubular adenocarcinoma extending into the serosa probably arising from the diverticulum. Chemotherapy was performed after surgery. The patient died due to peritoneal dissemination from the ascending colon cancer 14 months after surgery.
• Downregulated expression of human leukocyte antigen class I heavy chain is associated with poor prognosis in non-small-cell lung cancer.

  Ichinokawa K, Nakanishi Y, Hida Y, Tsuchikawa T, Kato T, Itoh T, Kaji M, Kaga K, Hirano S

  Oncology letters 18 (1) 117 - 126 1792-1074 2019/07 [Refereed][Not invited]
   

  The aim of this study was to clarify the association between expression of human leukocyte antigen (HLA) class I in non-small-cell lung cancer (NSCLC) cells and patient survival. To address this, immunohistochemical staining for HLA class I was performed on specimens from 111 patients with NSCLC, and overall survival curves were compared using the log-rank test. In addition, multivariate analyses were performed using Cox's proportional hazard model. The cases were divided into 5 classes based on the expression of HLA class I heavy chain and β2-microglobulin. The overall survival rate for patients with tumors lacking HLA class I heavy chain (30 cases; 27.0%) was significantly decreased. The multivariate analysis demonstrated that the absence of HLA class I heavy chain was an independent predictor of poor prognosis. There was a trend towards an unfavorable prognosis for patients whose tumors did not express β2-microglobulin (57 cases; 51.4%). Downregulation of HLA class I heavy chain expression was significantly associated with the downregulation of β2-microglobulin. Cases lacking HLA class I heavy chain as well as β2-microglobulin expression (23 cases; 20.7%) had a statistically significant unfavorable prognosis compared with other cases. The present findings demonstrate that the lack of HLA class I heavy chain expression in tumor cells is an independent prognostic factor for poor NSCLC survival, and is likely to exert an important influence on immune surveillance in patients.
• Phase II study of neoadjuvant treatment of sequential S-1-based concurrent chemoradiotherapy followed by systemic chemotherapy with gemcitabine for borderline resectable pancreatic adenocarcinoma (HOPS-BR 01).

  Hayashi T, Nakamura T, Kimura Y, Yoshida M, Someya M, Kawakami H, Sakuhara Y, Katoh N, Takahashi K, Ambo Y, Miura K, Motoya M, Tanaka E, Murakawa K, Yamabuki T, Yamazaki H, Katanuma A, Hirano S, Hokkaido Pancreatic, Study Group, HOPS

  International journal of radiation oncology, biology, physics 105 (3) 606 - 617 0360-3016 2019/07 [Refereed][Not invited]
   

  PURPOSE: Preoperative treatment is recommended for borderline resectable pancreatic ductal adenocarcinoma. However, the standard treatment has not yet been determined. We conducted a multicenter phase 2 study to investigate the efficacy of neoadjuvant treatment of sequential chemoradiation followed by chemotherapy. METHODS AND MATERIALS: All enrolled patients were treated by preoperative chemoradiation (a total dose of 50.4 Gy in 28 fractions and orally administered S-1 at 80 mg/m2 on the day of irradiation) followed by chemotherapy (administration of gemcitabine at 1000 mg/m2/dose on days 1, 8, and 15 in 3 cycles of 4 weeks) and attempted curative resection. The primary outcome was an R0 resection rate among patients who completed preoperative treatment and pancreatectomy. The threshold of the R0 resection rate was defined as 74% based on a previous study of up-front surgery. RESULTS: Forty-five patients were included. Twenty-one patients could not undergo pancreatectomy because of progressive diseases (n = 14), adverse events (n = 5), or consent withdrawal (n = 2), and 4 patients underwent additional resection after dropping out. The resection rates were 53.3% and 62.2% in the per-protocol set (PPS) and full analysis set (FAS) populations, respectively. The R0 resection rates were 95.8% (95% confidence interval, 78.9%-99.9%) and 96.4% (81.7%-99.9%) in the PPS and FAS populations, respectively. The median overall survival and progression-free survival of all the included patients were 17.3 and 10.5 months, respectively. The median survival time of the patients with pancreatectomy was significantly longer than that of the patients without pancreatectomy in the PPS (27.9 vs 12.3 months; P = .001) and FAS populations (32.2 vs 11.8 months; P < .001). CONCLUSIONS: This study revealed that a long duration of preoperative treatment of sequential chemoradiation followed by systemic chemotherapy provides a high rate of R0 resection and sufficient survival time in patients undergoing pancreatectomy.
• Identifying the needs for teaching fundamental knowledge of laparoscopic surgery: a cross-sectional study in Japan.

  Shinichiro Yokoyama, Yusuke Watanabe, Yo Kurashima, Akihiko Oshita, Yuji Nishizawa, Takeshi Naitoh, Fumitaka Nakamura, Satoru Kikuchi, Kazuhiro Noma, Saseem Poudel, Akihiro Suzuki, Yuichi Nishihara, Masaaki Ito, Satoshi Hirano

  Surgical endoscopy 33 (7) 2242 - 2248 0930-2794 2019/07 [Refereed][Not invited]
   

  BACKGROUND: Recently, laparoscopic surgery (LS) has become a more common procedure than traditional open surgery. Although LS-related adverse events have been reported, there is no formal, standardized curriculum to teach the fundamentals of LS in Japan. Understanding surgeons' knowledge regarding LS is crucial for developing an educational curriculum. The purpose of this study was to determine the baseline knowledge on LS of surgeons and surgical trainees in Japan. METHODS: Participants completed 24 multiple-choice questions testing basic cognitive knowledge of LS and a questionnaire regarding the status of laparoscopic education. The examination was developed according to the 13 content domains of the Fundamentals of Laparoscopic Surgery (FLS) program. Scores were compared between post-graduate year (PGY) > 5 and PGY 1-5 participants. Data are expressed as median scores and interquartile ranges. Wilcoxon signed-rank test was used for statistical analysis. RESULTS: A total of 195 surgeons and surgical trainees from 10 teaching hospitals (PGY1-5: 66, PGY > 5: 129) across Japan completed the examination. The median score in the entire cohort was 75 [67; 83] %, with significantly higher scores in the PGY > 5 group compared to the PGY1-5 group (79 [75; 83] % vs. 67 [58; 75] %, p < 0.001). The differences in performance were due to better scores for PGY > 5 group on the sections "equipment," "patient considerations," "abdominal access," "tissue handling," "hemorrhage and hemostasis," "tissue approximation," and "exiting the abdomen." Overall, the median scores in the "energy sources" and "establishment and physiology of the pneumoperitoneum" subsections were lower than in other domains. All participants agreed on the need for fundamental knowledge and a formal educational curriculum. CONCLUSIONS: Compared to experienced surgeons, surgical trainees had lesser knowledge about performing LS. Regardless of the years of experience, there are crucial knowledge gaps in specific areas regarding safe LS that should be addressed by implementing an educational curriculum.
• ゆるキャライラストで特徴が"サッ"とわかる!消化器疾患ファイル(第18回) 膵炎

  浅野 賢道, 平野 聡

  消化器ナーシング (株)メディカ出版 24 (6) 560 - 561 2434-4575 2019/06
• 膵神経内分泌腫瘍の切除適応と切除範囲 教室における膵神経内分泌腫瘍の切除成績および縮小手術の可能性に関する検討

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 平野 聡

  膵臓 (一社)日本膵臓学会 34 (3) A84 - A84 0913-0071 2019/06
• 切除可能・BR膵癌に対する術前治療の最前線 切除可能膵癌に対する術前S-1補助療法の多施設共同第II相臨床試験(HOPS-R01)

  中村 透, 河上 洋, 高橋 邦幸, 木村 康利, 林 毅, 石渡 裕俊, 本谷 雅代, 後藤 拓磨, 山北 圭介, 作原 祐介, 真口 宏介, 平野 聡, 北海道膵癌研究グループ(Hokkaido Pancreatic Cancer Study Group;HOPS)

  膵臓 日本膵臓学会 34 (3) A38 - A39 0913-0071 2019/06
• 再建臓器の評価とそれにもとづく再建法の工夫 当教室における腹腔鏡近赤外光観察システムを用いた腹腔鏡下胃管作成の手術手技

  海老原 裕磨, 城崎 友秀, 山本 和幸, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 73回 54 - 54 2019/06
• 胸腔鏡下に行うサルベージ手術 適応と術式の工夫

  七戸 俊明, 村上 壮一, 海老原 裕磨, 倉島 庸, 山本 和幸, 城崎 友秀, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 73回 130 - 130 2019/06
• 胸腔鏡腹腔鏡併用手術(MALTA)を施行した特発性食道破裂の2症例

  城崎 友秀, 関谷 翔, 海老原 裕磨, 山本 和幸, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本食道学会学術集会プログラム・抄録集 (NPO)日本食道学会 73回 335 - 335 2019/06
• 肺移植未認定施設における肺移植トレーニングプログラムの有用性の検討 北海道での肺移植施設認定への取り組み

  加藤 達哉, 新垣 雅人, 長 靖, 道免 寛充, 樋田 泰浩, 七戸 俊明, 加賀 基知三, 平野 聡, 松居 喜郎

  北海道外科雑誌 北海道外科学会 64 (1) 43 - 50 0288-7509 2019/06 [Refereed][Not invited]
   

  肺移植未認定施設において移植手術手技の修練は課題の一つである。大動物を使った修練は実践的であるものの、倫理的な問題や解剖がヒトと異なるという欠点は否めない。我々はシール法固定献体を用いたカダバートレーニングを併用することによる肺移植シミュレーションとしての有用性を検討した。いずれもドナーより両肺を摘出し、レシピエントに片肺移植を行った。各々の講習前後でトレーニング効果を受講者のアンケートにて分析した。ブタ生体では心拍下の肺動脈カニュレーションや血管吻合が可能となる。シール法固定献体では組織の状態は生体に近く、手技は実際の手術に近い感覚で行える。この2つを組み合わせることで、参加者の肺移植の各行程に対する理解と手術スキルが向上した。献体とブタ生体を組み合わせた肺移植手術トレーニングは肺移植未認定施設におけるトレーニングプログラムとして有用と考えられた。(著者抄録)
• A minimally invasive abdominal and left thoracic approach as a palliative treatment for adenocarcinoma of the esophagogastric junction with severe stenosis: A case report.

  Takeuchi Y, Ebihara Y, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Asian journal of endoscopic surgery 13 (2) 215 - 218 1758-5902 2019/06 [Refereed][Not invited]
   

  We report a novel technique for combined laparoscopy and thoracoscopy for far-advanced adenocarcinoma of the esophagogastric junction (AEG). A 56-year-old man presented with far-advanced AEG, and an esophagogastroduodenoscopy revealed a type 2 lesion that encircled the esophagogastric junction. CT revealed stenosis of the esophagogastric junction, suspected invasion into the left side of the diaphragm, and lymph node metastases in the abdomen. We diagnosed Siewert type II AEG (cT4aN1M0, cStage IIIA) according to the Japanese Classification of Gastric Carcinoma, version 14. Laparoscopic and thoracoscopic proximal gastrectomy and lower esophagectomy with double-tract reconstruction were performed as a palliative resection via a minimally invasive abdominal and left thoracic approach. However, localized peritoneal dissemination was detected. The patient was discharged with no postoperative morbidity. Hence, a minimally invasive abdominal and left thoracic approach provides good visualization, and it is safe for lower esophageal transection and intrathoracic anastomosis in the treatment of locally advanced AEG invading the surrounding tissues.
• Prognostic relevance of tertiary lymphoid organs following neoadjuvant chemoradiotherapy in pancreatic ductal adenocarcinoma.

  Kuwabara S, Tsuchikawa T, Nakamura T, Hatanaka Y, Hatanaka KC, Sasaki K, Ono M, Umemoto K, Suzuki T, Sato O, Hane Y, Nakanishi Y, Asano T, Ebihara Y, Kurashima Y, Noji T, Murakami S, Okamura K, Shichinohe T, Hirano S

  Cancer science 110 (6) 1853 - 1862 1347-9032 2019/06 [Refereed][Not invited]
   

  The efficacy of preoperative neoadjuvant chemoradiotherapy (NAC) in cases of pancreatic cancer with extremely poor prognoses has been reported. In this study, we aimed to identify novel biomarkers that reflect prognoses following chemoradiotherapy using tertiary lymphoid organs (TLO) expressed in the tumor microenvironment. Resected tumor specimens were obtained from 140 pancreatic cancer patients. We retrospectively investigated the clinical relevance of TLO by categorizing patients into those who underwent upfront surgery (surgery first [SF]) and those who received NAC. The immunological elements within TLO were analyzed by immunohistochemistry (IHC). In the IHC analysis, the proportions of CD8+ T lymphocytes, PNAd+ high endothelial venules, CD163+ macrophages and Ki-67+ cells within the TLO were higher in the NAC group than in the SF group. In contrast, the proportion of programmed cell death-1+ immunosuppressive lymphocytes within TLO was lower in the NAC group than in the SF group. The NAC group demonstrated favorable prognoses compared with the SF group. In the multivariate analysis, the TLO/tumor ratio was determined as an independent predictive prognostic factor. In conclusion, the administration of preoperative chemoradiotherapy may influence the immunological elements in the tumor microenvironment and result in favorable prognoses in pancreatic ductal adenocarcinoma patients.
• ゆるキャライラストで特徴が"サッ"とわかる!消化器疾患ファイル(第17回) 膵臓がん

  浅野 賢道, 平野 聡

  消化器ナーシング (株)メディカ出版 24 (5) 468 - 469 2434-4575 2019/05
• 【JSES技術認定取得をめざせ!】臓器別:胃 合格者が語る認定取得の実際 腹腔鏡下幽門側胃切除術,D1+郭清,B-I再建(デルタ吻合)

  山本 和幸, 鈴木 善法, 川原田 陽, 北城 秀司, 奥芝 俊一, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  臨床外科 (株)医学書院 74 (5) 552 - 555 0386-9857 2019/05 

  ＜文献概要＞ポイント ◆技術認定制度の採点方式が減点式であり,各種局面における減点対象を把握しておくこと.◆質の高い手術を提供するために,技術認定制度の要点を認識すること.◆技術認定制度の要点は安全に腹腔鏡下胃切除術を行うためのエッセンスである.
• 腎癌の転移性胃腫瘍に対してLECSを施行した1例

  吉田 雄亮, 山村 喜之, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 清水 亜衣, 三橋 智子, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (5) 1020 - 1020 1345-2843 2019/05
• 門脈合併切除再建を伴う尾側膵切除術後に門脈閉塞を来した2症例

  関谷 翔, 中村 透, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (5) 1024 - 1024 1345-2843 2019/05
• S-1単剤投与による術前化学療法が著効した膵癌の2例

  木村 弘太郎, 浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (5) 1025 - 1025 1345-2843 2019/05
• 肝門部領域胆管癌術後にファーター乳頭部癌を発症した異時性重複癌に対する手術経験

  丹羽 弘貴, 岡村 圭祐, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 三橋 智子, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (5) 1025 - 1025 1345-2843 2019/05
• 右肝動脈・門脈合併切除再建を併施した肝左葉切除・尾状葉・胆管切除術を行った肝門部領域胆管癌の1例

  細井 勇人, 野路 武寛, 岡村 圭祐, 田中 公貴, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (5) 1026 - 1026 1345-2843 2019/05
• Impact of Preoperative Skeletal Muscle Mass and Nutritional Status on Short-and Long-Term Outcomes After Esophagectomy for Esophageal Cancer: A Retrospective Observational Study : Impact of Psoas Muscle Mass and Body Mass on Esophagectomy.

  Toshiaki Shichinohe, Shion Uemura, Satoshi Hirano, Masao Hosokawa

  Annals of surgical oncology 26 (5) 1301 - 1310 2019/05 

  BACKGROUND: Preoperative muscle volume and body mass index (BMI) are associated with postoperative outcomes. Because esophagectomy for esophageal cancer (EC) is associated with high morbidity and because EC has a poor prognosis, this study investigated the association of preoperative skeletal muscle mass and nutritional status with postoperative outcomes. METHODS: The study analyzed 483 patients who underwent esophagectomy from 2009 to 2012. The cross-sectional area of the psoas muscle index (PMI) was measured at the third lumbar vertebral level using computed tomography. Clavien-Dindo classifications were used to analyze postoperative complications. Because skeletal muscle mass varies according to sex, all analyses were performed accordingly (390 males, 93 females). RESULTS: For male patients, BMI was a significant multivariate factor, and PMI, a univariate factor, predicted postoperative complications and overall survival (OS). Using a preoperative nutritional and muscular (PNM) score derived from BMI and PMI results (patients were allocated 1 point if their BMI was < 18.5 kg/m2 and 1 point if their PMI was < 600 mm2/m2, for a possible maximum total of 2 points), male patients were categorized as high risk (score 2), moderate risk (score 1), or low risk (score 0). In the low-risk group, anastomotic leakage was significantly less (p = 0.01), and the 3-year OS was significantly better (p < 0.01). On the other hand, in female patients, neither BMI nor PMI was a significant factor for postoperative outcomes. CONCLUSIONS: For male patients, the PNM score is a promising tool for predicting postoperative outcomes and identifying patients requiring preoperative nutritional intervention and rehabilitation.
• Central pancreatic body-preserving pancreatoduodenectomy for pancreatic head cancer following a combined total gastrectomy and distal pancreatectomy: a case report.

  Umemoto K, Nakamura T, Asano T, Tsuchikawa T, Okamura K, Noji T, Nakanishi Y, Tanaka K, Hirano S

  Surgical case reports 5 (1) 83 - 83 2019/05 [Refereed][Not invited]
   

  BACKGROUND: Following a total pancreatectomy and a total gastrectomy procedure, patients often present with nutritional and diabetes-related disorders, along with a corresponding decrease in their quality of life. Consequently, an appropriate surgical procedure should be selected, with which an R0 resection can be achieved while conserving optimum pancreatic function, in order to prevent adverse sequelae. CASE PRESENTATION: We present a case of a 66-year-old female, with a history of primary gastric cancer, for which, she underwent total gastrectomy combined with a distal pancreatectomy, 21 years ago. She presented to us with a primary cancer of the head of the pancreas. We performed a central pancreatic body-preserving pancreatoduodenectomy, in order to conserve the pancreatic function. Since the splenic artery had already been resected in the earlier surgery, conserving the blood flow to the preserved pancreatic body was an important concern. By utilizing the techniques of preoperative angiography and intraoperative indocyanine green fluorescence imaging, the pancreatic body could be accurately resected while leaving its vascular supply intact and undamaged. Thus, the patient's pancreatic endocrine function could be preserved. CONCLUSIONS: An accurate evaluation of the pancreatic vascular supply enabled the operating surgeon to perform a safe, central pancreatic body-preserving pancreatoduodenectomy, even in patients who have undergone a combined total gastrectomy along with a distal pancreatectomy.
• [The Regulation of PD-L1 Expression in the Tumor Microenvironment Associated with Epithelial-Mesenchymal Transformation].

  Tsuchikawa T, Ueno T, Sasaki K, Tanaka K, Nakanishi Y, Asano T, Noji T, Nakamura T, Okamura K, Shichinohe T, Hirano S

  Gan to kagaku ryoho. Cancer & chemotherapy 46 (5) 855 - 858 0385-0684 2019/05 [Refereed][Not invited]
   

  It has been clear that the clinical responses by applying immune checkpoint inhibitor alone are limited. To better improve this limited clinical response, combinational therapy has been focused. We recently reported the association between EMT related factors and PD-L1 expression in the extrahepatic hilar cholangiocarcinoma, and its role as a surrogate biomarker for patient prognosis. We here report clinical relevance of combinational therapy of HDAC inhibitors and anti-PD-L1 antibody as an immune checkpoint inhibitors.
• Validation Study of Tumor Invasive Thickness for Postoperative Prognosis in 110 Patients Who Underwent Pancreatoduodenectomy for Distal Cholangiocarcinoma at a Single Institution.

  Zhao Y, Nakanishi Y, Ogino M, Oba M, Okamura K, Tsuchikawa T, Nakamura T, Noji T, Asano T, Tanaka K, Hosoi H, Nakayama T, Mitsuhashi T, Dai C, Hirano S

  The American journal of surgical pathology 43 (5) 717 - 723 0147-5185 2019/05 [Refereed][Not invited]
   

  The pT classification of the 8th American Joint Committee on Cancer (AJCC) for distal cholangiocarcinoma (DCC) is classified according to depth of invasion (DOI), which is the distance from the basal lamina to the most deeply advanced tumor cells. The Nagoya group proposed a new T classification for DCC based on invasive tumor thickness (ITT), which is the maximal vertical distance of the invasive cancer component (the ITT grade). In this study, we aimed to validate the ITT grade for the next pT classification of DCC in 110 patients. ITT could be measured in all patients, but DOI could only be measured in 62 (56%) patients. According to ITT grade, patients were classified into grades A to D, as follows: grade A, ITT <1 mm (n=9); grade B, ITT 1 mm or more but <5 mm (n=35); grade C, ITT 5 mm or more but <10 mm (n=40); and grade D, ITT 10 mm or greater (n=26). The median overall survival times in patients with ITT grades A, B, C, and D were 12.8, 5.7, 3.7, and 2.0 years, respectively. ITT grade could discriminate postoperative survivals between grades. On multivariate analysis, ITT grade, regional lymph node metastasis, and distant metastasis were selected as independent prognostic factors. In summary, our results showed that ITT grade was a suitable alternative to DOI for pT classification in the next edition of the AJCC for DCC.
• Synchronous multiple pancreatic cancers developed long after severe postendoscopic retrograde cholangiopancreatography pancreatitis.

  Sugiura R, Kuwatani M, Hirata K, Kato S, Kawamoto Y, Kawakubo K, Mitsuhashi T, Asano T, Hirano S, Sakamoto N

  Endoscopic ultrasound 8 (3) 213 - 214 2303-9027 2019/05 [Refereed][Not invited]
  
• A snapshot of surgical resident training in Japan: results of a national-level needs assessment survey.

  Poudel S, Hirano S, Kurashima Y, Stefanidis D, Akiyama H, Eguchi S, Fukui T, Hagiwara M, Hashimoto D, Hida K, Izaki T, Iwase H, Kawamoto S, Otomo Y, Nagai E, Saito M, Takami H, Takeda Y, Toi M, Yamaue H, Yoshida M, Yoshida S, Kodera Y

  Surgery today 49 (10) 870 - 876 0941-1291 2019/05 [Refereed][Not invited]
   

  PURPOSE: To evaluate the status of surgical training in Japan through a national-level needs assessment. METHODS: A survey was sent to all 909 graduating residents (GRs) and their 611 program directors (PDs) for the year 2016. A working group of surgical educators from around the country was formed under the education committee of the Japan Surgical Society. The survey items were developed by consensus of this working group. The survey investigated the knowledge and problems of the current curriculum, and the status of the current residency training. RESULTS: The response rates were 56.3% of the GRs and 76.8% of the PDs. Among the participants, 47.6% of the GRs and 29.4% of the PDs believed that the residency curriculum did not match the clinical experience. Over 80% of the GRs and PDs agreed on the importance of training outside of the OR, whereas only 13% of the GRs had received such training regularly. Trainees also reported a lower satisfaction rate about the opportunity to train outside of the OR. CONCLUSION: This national-level needs assessment of surgical training in Japan identified several gaps in the curriculum. These results provide valuable data to assist the ongoing efforts for surgical residency curriculum improvement.
• 局所進行膵癌に対する動脈合併切除術-長期成績の観点から見た臨床的意義の再考 腹腔動脈合併尾側膵切除術(DP-CAR)の長期成績 全国アンケート調査の結果から

  平野 聡, 中村 透, 浅野 賢道, 日本膵切研究会

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 PD - 2 2019/04
• 大動脈リンパ節転移を有する切除不能膵癌に対しconversion surgeryを施行した1例

  藤本 沙優, 浅野 賢道, 城崎 友秀, 中西 喜嗣, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 三橋 智子, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 RS - 5 2019/04
• Segmental arterial mediolysis(SAM)による巨大脾動脈瘤に対する手術経験

  松木田 瞭, 岡村 圭祐, 水沼 謙一, 山村 喜之, 真木 健裕, 細井 勇人, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡, 杉本 聡, 新宮 康栄

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 RS - 10 2019/04
• 動脈因子陽性局所進行膵癌に対する動脈合併切除の長期成績に基づいた治療戦略

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 村上 壮一, 倉島 庸, 海老原 裕磨, 七戸 俊明

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 SF - 7 2019/04
• 外科治療成績の向上を目指した感染症対策 胆道再建を伴う肝胆膵手術におけるベストの周術期抗菌薬管理を求めて 術前胆道ドレナージ方法に基づいた至適抗生剤選択の取り組み

  田中 公貴, 中村 透, 中西 喜嗣, 浅野 賢道, 野路 武寛, 土川 貴裕, 岡村 圭祐, 倉島 庸, 海老原 裕磨, 村上 壮一, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 SY - 6 2019/04
• 膵癌におけるartery first approach-長期予後からみた臨床的意義 膵体癌に対する一塊腹腔動脈切除術による膵尾部切除術における右側動脈優先アプローチ(The right sided artery-first approach in distal pancreatectomy with enbloc celiac axis resection for pancreatic body cancer)

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 村上 壮一, 野路 武寛, 倉島 庸, 海老原 裕磨, 中西 喜嗣, 田中 公貴, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 119回 SY - 7 2019/04
• 外傷外科におけるoff-the-job-trainingの現状と課題 献体による外傷手術臨床解剖学的研究会 全国開催と献体外傷手術研究グループ発足について

  本間 宙, 織田 順, 伊藤 正裕, 真弓 俊彦, 佐藤 格夫, 村上 壮一, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 WS - 8 2019/04
• 肝外胆管癌におけるtumor buddingの臨床応用に向けた検討

  荻野 真理子, 中西 喜嗣, 三橋 智子, 畑中 豊, 田中 公貴, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 SF - 3 2019/04
• 肝門部領域胆管癌に対する動脈合併切除・再建手技と成績 顕微鏡下動脈吻合と動門脈シャントを用いた血行再建について

  野路 武寛, 田中 公貴, 中西 善嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 SF - 4 2019/04
• 膵胆道癌の局所免疫環境に着目した周術期治療の効果予測バイオマーカーの探索

  土川 貴裕, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, Ebihara Yuma, Kurashima Yo, 村上 壮一, 中村 透, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 SF - 4 2019/04
• サルベージ手術症例に対する胸腔鏡下食道切除術の手術手技

  七戸 俊明, 村上 壮一, 海老原 裕磨, 倉島 庸, 真木 健裕, 齋藤 崇宏, 城崎 友秀, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 PS - 3 2019/04
• 【術前化学療法、放射線療法と術後感染】膵頭部癌に対する術前治療後の膵頭十二指腸切除における周術期合併症の現状と課題

  中村 透, 田中 公貴, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本外科感染症学会雑誌 (一社)日本外科感染症学会 16 (2) 112 - 117 1349-5755 2019/04 

  近年、膵癌術前治療が増加している。教室の膵頭部癌に対する周術期対策の変遷ならびに手術先行治療と術前治療の周術期合併症を後方視的に検討した。2008年〜2018年の膵頭部癌連続184例では、手術先行治療が94例、術前治療が90例で、最近5年間では72.3%に術前治療が施行された。術前治療群は、年齢が低く、喫煙率が高く、術前Hbが低く、血小板リンパ球比が高値で、手術時間が長く、輸血施行例と門脈合併切除例が多かった。術後合併症頻度はSSIを含め差はなく、Clavien-Dindo IVaが有意に術前治療群で多かった(0.0% vs 5.5%、P=0.02)。全184例をSSIあり群とSSIなし群に分け、リスク因子を検討すると、年齢≧68歳、手術時間≧548分、BMI≧21.5、ALB<3.5g/dLが独立したリスク因子であった。術前治療は、膵頭十二指腸切除のSSIリスク因子とはならなかった。(著者抄録)
• 腹腔鏡下幽門側胃切除術修練における評価ツールを用いた手術パフォーマンス評価

  小林 慎一朗, 倉島 庸, 金高 賢悟, 米田 晃, 平野 聡, 江口 晋

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 119回 PS - 8 2019/04 [Refereed][Not invited]
  
• Postoperative nutritional benefits of proximal parenchymal pancreatectomy for low-grade malignant lesions in the pancreatic head.

  Umemoto K, Tsuchikawa T, Nakamura T, Okamura K, Noji T, Asano T, Nakanishi Y, Tanaka K, Hirano S

  HPB : the official journal of the International Hepato Pancreato Biliary Association 21 (11) 1491 - 1496 1365-182X 2019/04 [Refereed][Not invited]
   

  BACKGROUND: Outcomes of proximal parenchymal pancreatectomy (PPP) as compared to pancreatoduodenectomy (PD) have not been reported. The aim of this study was to describe the short- and long-term outcomes of patients with low-grade pancreatic head lesions who underwent PPP or PD. METHODS: Patients who underwent PPP or PD for low-grade lesions between 2009 and 2017 were included. Operative factors including postoperative complications and nutritional indicators during the first-year postoperatively were compared. RESULTS: A total of 13 and 14 patients underwent PPP and PD respectively. The PPP group demonstrated significantly less intraoperative blood loss and shorter postoperative hospital stay than the PD group. No significant differences were noted in the incidence of postoperative complications between the two groups. Nutritional indices were significantly better in the PPP group at 3 months post-surgery, but these nutritional indices were not significantly different at 6 months and 1-year. None of 12 patients who underwent PPP and did not require biliary resection developed postoperative cholangitis. None of the 12 PPP patients without preoperative diabetes developed impaired glucose tolerance after surgery. DISCUSSION: The complication rate of PPP is equivalent to that of PD. PPP demonstrated better short-term nutritional status than PD. Moreover, preservation of the total duodenum and bile duct may reduce the risk of developing postoperative diabetes and cholangitis.
• 【高度進行消化器癌に対する手術】肝・胆・膵 BR-UR膵癌に対する腹腔動脈合併尾側膵切除(DP-CAR)

  浅野 賢道, 中村 透, 平野 聡

  手術 金原出版(株) 73 (4) 639 - 648 0037-4423 2019/03
• 消化器癌に対する集学的治療 当科における胆道癌に対するconversion surgeryの短期・長期成績

  野路 武寛, 岡村 圭祐, 細井 勇人, 中山 智英, 田中 公貴, 中西 善嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 124回 36 - 36 2019/03
• 消化器癌に対する集学的治療 切除成績に基づいた動脈因子陽性局所進行膵癌に対する治療戦略

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 124回 36 - 36 2019/03
• 胆道癌に対する肝膵同時切除術施行の意義

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 細井 勇人, 中山 智英, 山本 和幸, 中村 透, 浅野 賢道, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 124回 66 - 66 2019/03
• Simultaneous surgical treatment for esophagogastric junctional cancer and splenic artery aneurysm resection with spleen preservation using fluorescence imaging: a case report.

  Miyasaka M, Ebihara Y, Yamamura Y, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Surgical case reports 5 (1) 44 - 44 2019/03 [Refereed][Not invited]
   

  BACKGROUND: Recently, minimally invasive esophagectomy and gastrectomy for esophagogastric junctional (EGJ) cancer using either thoracoscopy or laparoscopy are frequently performed. In the past decade, minimally invasive surgery with laparoscopy for splenic artery aneurysm (SAA) has also been reported. However, patients with both EGJ cancer and SAA are rare. CASE PRESENTATION: A 66-year-old man, who complained of upper abdominal pain, was found to have esophagogastric junctional (EGJ) tumor. He was diagnosed as having Siewert type II adenocarcinoma. In a computed tomography (CT) scan before surgery, a 10-mm aneurysm in the splenic artery was found. Thus, we performed laparo- and thoracoscopic proximal gastrectomy and lower esophagectomy for EGJ cancer and splenic artery aneurysm (SAA) resection with spleen preservation using fluorescence imaging. We confirmed sufficient blood supply to the spleen after surgery with a postoperative CT scan. The blood supply to the spleen was suspected to be from the great pancreatic artery via the pancreas and from the omental branches of the left gastroepiploic artery via the omental artery. CONCLUSION: Simultaneous surgery for EGJ cancer and SAA is rare due to its potential risk, but evaluation of the blood supply for the spleen by using fluorescence imaging can be useful for this procedure.
• Metastatic mixed adenoneuroendocrine carcinoma of the liver successfully resected by hepatic trisectionectomy following chemotherapy: A case report.

  Sato O, Tsuchikawa T, Yamada T, Sato D, Nakanishi Y, Asano T, Noji T, Yo K, Ebihara Y, Murakami S, Nakamura T, Okamura K, Shichinohe T, Mitsuhashi T, Hirano S

  Clinical case reports 7 (3) 491 - 496 2019/03 [Refereed][Not invited]
   

  The chemotherapy guidelines for mixed adenoneuroendocrine carcinoma (MANEC) remain poorly defined, and prognosis remains dismal. In this case, we successfully performed resection after FOLFOX for unresectable metastatic MANEC of the liver. Thus, chemotherapy for adenocarcinoma may be effective for MANEC.
• 高齢者胃癌(80歳以上)に対する腹腔鏡下胃全摘術の治療成績(多施設共同後ろ向き研究)

  城崎 友秀, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡, 中村 文隆, 村川 力彦, 森田 高行, 奥芝 俊一

  日本臨床外科学会雑誌 日本臨床外科学会 80 (2) 435 - 436 1345-2843 2019/02
• 進行胆管癌と術前診断したが術後摘出標本で浸潤癌を認めなかった2例

  丹羽 弘貴, 岡村 圭祐, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 三橋 智子, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (2) 440 - 440 1345-2843 2019/02
• 主膵管と交通を認めた膵serous cystic neoplasmの1例

  吉田 雄亮, 浅野 賢道, 木村 弘太郎, 関谷 翔, 丹羽 弘貴, 城崎 友秀, 横山 新一郎, 斎藤 崇宏, 水沼 謙一, 田中 宏典, 細井 勇人, 真木 健裕, 山村 喜之, 中西 喜嗣, 野路 武寛, 海老原 裕磨, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (2) 440 - 441 1345-2843 2019/02
• 腹腔鏡下脾部分切除術を施行し正常脾を温存した巨大脾嚢胞の一例

  木村 弘太郎, 倉島 庸, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 80 (2) 441 - 441 1345-2843 2019/02
• 当教室における十二指腸腫瘍に対する切除例の検討

  城崎 友秀, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本胃癌学会総会記事 (一社)日本胃癌学会 91回 540 - 540 2019/02
• Jejunal intussusception at the jejunojejunostomy after laparoscopic total gastrectomy: A case report.

  Kushiya H, Ebihara Y, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Asian journal of endoscopic surgery 13 (1) 99 - 102 1758-5902 2019/02 [Refereed][Not invited]
   

  Jejunal intussusception at the jejunojeunostomy after total gastrectomy with Roux-en-Y (RY) reconstruction is rare. We describe a case of jejunal intussusception at the jejunojeunostomy that developed in a 60-year-old woman who had undergone laparoscopic total gastrectomy with RY reconstruction for gastric cancer 4 years ago. The main presenting complaint was recurrent epigastric pain. Abdominal computed tomography showed a typical target sign suspected of antegrade intussusception into a blind loop at the jejunojeunostomy. We performed a laparoscopic operation, which revealed no intussusception or adhesions. We noted that the blind loop of the bilio-pancreatic limb was longer and expanded. We divided the blind loop at the distal side of the jejunojeunostomy and performed suture plication between the bilio-pancreatic limb and alimentary limb. Therefore, the appropriate length of the blind loop and the size of the jejunojeunostomy site should be carefully determined during RY reconstruction.
• Identifying the Essential Portions of the Skill Acquisition Process Using Item Response Theory.

  Poudel S, Watanabe Y, Kurashima Y, Ito YM, Murakami Y, Tanaka K, Kawase H, Shichinohe T, Hirano S

  Journal of surgical education 76 (4) 1101 - 1106 1931-7204 2019/02 [Refereed][Not invited]
   

  OBJECTIVE: Item response theory (IRT) was originally developed to make performance assessments more accurate. However, IRT analysis of the intraoperative performance of surgical trainees could help identify the elements that the trainees find difficult during the skill acquisition process. The aim of this study was to identify the essential portions of the skill acquisition process of a surgical procedure using the IRT.DESIGN: The 24-item assessment checklist was used to evaluate a recorded intra-operative performance of a laparoscopic inguinal hernia repair. The scores were analyzed using IRT to calculate the difficulty and discrimination level of each item.SETTING: Fifteen institutes.PARTICIPANTS: Thirty surgical trainees.RESULTS: A total of 123 assessments were analyzed. The item analysis showed the procedure specific item "traction of peritoneum (difficulty: -0.45; discrimination: 19.37)" and generic items "instrument handling (difficulty: -0.59; discrimination: 3.82)" and "flow of procedure (difficulty: 0.09; discrimination: 3.27)" to be key elements in the skill acquisition process of the procedure.CONCLUSIONS: Key elements in the skill acquisition process of the procedure were quantitatively identified by applying the IRT analysis. This could lead to the use of IRT in designing and developing a more effective training curriculum. ((C) 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
• Development of a novel tool to assess skills in laparoscopic gastrectomy using the Delphi method: the Japanese operative rating scale for laparoscopic distal gastrectomy (JORS-LDG).

  Kurashima Y, Watanabe Y, Hiki N, Poudel S, Kitagami H, Ebihara Y, Murakami S, Shichinohe T, Hirano S

  Surgical endoscopy 33 (12) 3945 - 3952 0930-2794 2019/02 [Refereed][Not invited]
   

  BACKGROUND: Assessment of the performance of laparoscopic gastrectomy is yet unreported, likely because of the complexity of the procedure. We aimed to develop a tool to assess the skills required for laparoscopic distal gastrectomy (LDG) through cognitive task analysis (CTA) and expert consensus using the Delphi method. METHODS: CTA involved the listing of the knowledge and criteria required for completing each step of LDG as subtasks based on interviews by experts and novices and text book, instructional video, and procedural review. The Delphi evaluation method involved anonymous online surveys, conducted to merge the opinions of experts in laparoscopic gastrectomy. The experts were asked to rate (from 1 to 5) the importance of subtasks for skill evaluation and training for LDG using a Likert scale. Consensus among expert viewpoints was determined by the internal consistency of each item using Cronbach's approach. RESULTS: Essential subtasks drafted for the assessment of LDG performance were determined based on the CTA. Thirty-one LDG experts participated in the online-survey with a response rate over 90%. A consensus was achieved after 2 rounds of surveys with a Cronbach alpha of 0.86, and 34 subtasks of LDG were selected. We finally created the Japanese Operative Rating Scale for Laparoscopic Distal Gastrectomy (JORS-LDG) based on the 34 subtasks. CONCLUSIONS: We developed the JORS-LDG using CTA and the Delphi method.
• Gallbladder choledocholithiasis with communicating accessory bile duct diagnosed preoperatively

  Hirotake Abe, Miyoshi Fujita, Masayuki Fukushima, Keisuke Okamura, Takayuki Morita, Satoshi Hirano

  Japanese Journal of Gastroenterological Surgery 52 (8) 441 - 446 1348-9372 2019 

  Although there are relatively many morphologic abnormalities of the biliary system, there is a rare form of communicating accessory bile duct (CABD), with 30 cases reported in Japan as of October 2018. We encountered a case of gallbladder choledocholithiasis that could be classifiable as a CABD by preoperative imaging examination. A 52-year-old woman in whom gallstones had been pointed out 1 year previously, visited our hospital with complaints of epigastralgia and backache and was admitted for surgery. We suspected gallbladder choledocholithiasis and bile duct anomaly with MRCP and DIC-CT. ERCP was performed, and the bile duct where the gallbladder junctions concurred with the right hepatic duct formed a loop. Treatment was performed using endoscopic papillary dissection for collecting bile duct stones and laparoscopic cholecystectomy. CABD is defined as "a bile duct that does not drain a certain liver area and transport between the main bile ducts", and therefore this case was finally diagnosed to be CABD.
• Designing a robotic smart home for everyone, especially the elderly and people with disabilities

  Tanabe S, Saitoh E, Koyama S, Kiyono K, Tatemoto T, Kumazawa N, Kagaya H, Otaka Y, Mukaino M, Tsuzuki A, Ota H, Hirano S, Kanada Y

  Fujita Med J 藤田学園医学会 5 (2) 31 - 35 2189-7247 2019 [Refereed][Not invited]
   

  We initiated the Robotic Smart Home (RSH) project to develop a comfortable, safe home environment for all people, including the elderly and individuals with disabilities. An important consideration when introducing robots into a home environment is the confined living space, the so-called space problem. The RSH project plans to simultaneously develop robots and an architectural design for living spaces to create an optimal home environment that will help elderly people live independently at home for longer periods. The RSH accommodates the following three robotics and assistive systems: mobility and transfer assist system, operational assist system, and information assist system. The mobility and transfer assist system includes three types of devices (lifting type, lateral-transfer type, and suspension type), which can be available to users as appropriate according to the severity of their disability. The operational assist system combines a hand robot with an environmental control system for the convenience of users. An information assist system connects the RSH with remote locations for communication. Inside the RSH, a home automation and monitoring system connected to the Internet of Things provides residents with comfort and security. As part of this project, two RSH centers have been established for effective facility adoption.

• 【胸部・縦郭におけるACSの治療戦略】大動脈食道瘻治療に対する胸腔鏡下食道切除の安全性

  海老原 裕磨, 七戸 俊明, 倉島 庸, 村上 壮一, 松居 喜郎, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 8 (2) 163 - 167 2019/01 

  当院で大動脈食道瘻に対し腹腔鏡下食道切除術(VATS-E)を行った6例(男性5例、女性1例、年齢中央値70歳)の治療成績について報告した。その結果、食道切除前にTEVAR(胸部ステントグラフト)内挿は5例に施行され、うち3例に一期的動脈・消化管再建が施行されていた。VATS-E手術時間の中央値は146分で、全例で開胸移行はなく、切除可能であった。一期的手術を施行した3例は全例が自宅退院したが、分割手術となった3例では全て在院死亡となった。死因の内訳は非閉塞性腸管虚血が2例、上腸間膜動脈血栓症が1例であった。
• ABCG2 expression is related to low 5-ALA photodynamic diagnosis (PDD) efficacy and cancer stem cell phenotype, and suppression of ABCG2 improves the efficacy of PDD.

  Noriko Kawai, Yoshihiko Hirohashi, Yuma Ebihara, Takuma Saito, Aiko Murai, Takahiro Saito, Tomohide Shirosaki, Terufumi Kubo, Munehide Nakatsugawa, Takayuki Kanaseki, Tomohide Tsukahara, Toshiaki Shichinohe, Liming Li, Satoshi Hirano, Toshihiko Torigoe

  PloS one 14 (5) e0216503  2019 

  Photodynamic diagnosis/therapy (PDD/PDT) are novel modalities for the diagnosis and treatment of cancer. The photosensitizer protoporphyrin IX is metabolized from 5-aminolevulinic acid (5-ALA) intracellularly, and PDD/PDT using 5-ALA have been approved in dermatologic malignancies and gliomas. However, the molecular mechanism that defines the efficacy of PDD/PDT is unknown. In this study, we analyzed the functions of ATP-binding cassette (ABC) transporters in PDD using 5-ALA. Most of the human gastrointestinal cancer line cells examined showed a homogenous staining pattern with 5-ALA, except for the pancreatic cancer line PANC-1, which showed heterogeneous staining. To analyze this heterogeneous staining pattern, single cell clones were established from PANC-1 cells and the expression of ABC transporters was assessed. Among the ABC transporter genes examined, ABCG2 showed an inverse correlation with the rate of 5-ALA-positive staining. PANC-1 clone #2 cells showed the highest level of ABCG2 expression and the lowest level of 5-ALA staining, with only a 0.6% positive rate. Knockdown of the ABCG2 gene by small interfering RNAs increased the positive rate of 5-ALA staining in PANC-1 wild-type and clone cells. Interestingly, PANC-1 clone #2 cells showed the high sphere-forming ability and tumor-formation ability, indicating that the cells contained high numbers of cancer stem cells (CSCs). Knockdown or inhibition of ABCG2 increased the rate of 5-ALA staining, but did not decrease sphere-forming ability. These results indicate that gastrointestinal cancer cell lines expressing high levels of ABCG2 are enriched with CSCs and show low rates of 5-ALA staining, but 5-ALA staining rates can be improved by inhibition of ABCG2.
• Impact of tumour budding grade in 310 patients who underwent surgical resection for extrahepatic cholangiocarcinoma.

  Ogino M, Nakanishi Y, Mitsuhashi T, Hatanaka Y, Amano T, Marukawa K, Nitta T, Ueno T, Ono M, Kuwabara S, Yamada T, Hirano S

  Histopathology 74 (6) 861 - 872 0309-0167 2019/01 [Refereed][Not invited]
   

  AIMS: Tumour budding is a risk factor for poor prognosis in various cancers. Tumour buds may present an epithelial-mesenchymal transition (EMT) morphological phenotype. This study aimed to elucidate the prognostic impact of tumour budding grade and its association with clinicopathological and EMT-related features in perihilar cholangiocarcinoma (PHCC) or distal cholangiocarcinoma (DCC). METHODS AND RESULTS: Subjects included 195 PHCC and 115 DCC patients. The numbers of tumour buds in different patients were stratified for postoperative survival using the recursive partitioning technique. Consequently, the numbers of tumour buds in PHCC patients were classified into three grades; namely, low (0-4 buds); intermediate (5-11 buds); and high (≥12 buds); those of DCC patients were classified into two grades; namely, low (0-4 buds) and high (≥5 buds). In both PHCC and DCC patients, high tumour budding grade was associated with poor histological differentiation, higher pT factor, presence of lymphatic, venous, perineural invasion and regional lymph node metastasis. In PHCC patients, residual invasive tumour in the resected margin was also associated with high tumour budding grade. For both PHCC and DCC patients, high tumour budding grade was an independent adverse prognostic factor in multivariate analysis (P < 0001 and P = 0.046, respectively). Immunohistochemical examination revealed that the number of tumour buds increased in patients with tumours showing a mesenchymal profile (negative for E-cadherin and positive for vimentin). CONCLUSIONS: Higher tumour budding grade is associated with invasive clinicopathological features, adverse postoperative prognosis and EMT status in extrahepatic cholangiocarcinoma.
• 食道胃接合部癌と脾動脈瘤を同時切除しICG蛍光法にて脾臓を温存し得た1例

  宮坂 衛, 海老原 裕磨, 山村 喜之, 浅野 賢道, 倉島 庸, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) OS57 - 5 1344-6703 2018/12
• 腹腔鏡下胃全摘後4年目にRoux-en-Y吻合部に発症した順行性腸重積症の1例

  櫛谷 洋樹, 海老原 裕磨, 倉島 庸, 村上 壮一, 浅野 賢道, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP69 - 9 1344-6703 2018/12
• 胸腔鏡下に心膜合併切除を施行した食道癌サルベージ手術の一例

  関谷 翔, 七戸 俊明, 真木 健裕, 海老原 裕磨, 倉島 庸, 村上 壮一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP129 - 10 1344-6703 2018/12
• 当教室におけるロボット支援腹腔鏡下胃切除術の短期成績

  海老原 裕磨, 山村 喜之, 田中 公貴, 中西 善嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) OS151 - 4 1344-6703 2018/12
• 粘液型脂肪肉腫との鑑別を要した膵頭部IPMCの1切除例

  吉田 雄亮, 浅野 賢道, 中村 透, 大場 光信, 荻野 真理子, 中西 喜嗣, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡, 三橋 智子

  北海道外科雑誌 北海道外科学会 63 (2) 157 - 158 0288-7509 2018/12
• 腹腔動脈起始部狭窄を伴う十二指腸乳頭部癌に対して、膵頭十二指腸切除術および正中弓状靱帯切開術を施行した1例

  関谷 翔, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  北海道外科雑誌 北海道外科学会 63 (2) 173 - 173 0288-7509 2018/12
• 当教室における腹腔鏡下脾温存膵体尾部切除術の手術成績

  水沼 謙一, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) OS219 - 7 1344-6703 2018/12
• 新規近赤外線腹腔鏡システムを用いた蛍光スペクトル解析による術中転移診断法の開発と臨床応用

  城崎 友秀, 海老原 裕磨, 齋藤 崇宏, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP32 - 5 1344-6703 2018/12
• 腎癌術後胃転移に対して内視鏡合同腹腔鏡下胃局所切除術を施行した1例

  吉田 雄亮, 山村 喜之, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP55 - 11 1344-6703 2018/12
• 腹腔鏡下脾部分切除術を施行し正常脾を温存した巨大脾嚢胞の一例

  木村 弘太郎, 倉島 庸, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 海老原 裕磨, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP84 - 1 1344-6703 2018/12
• 同時性に4病変を伴ったEBV関連胃癌の1切除例

  岡崎 遼, 海老原 裕磨, 平野 聡, 七戸 俊明, 岡村 圭祐, 土川 貴裕, 中村 透, 村上 壮一, 倉島 庸, 野路 武寛, 浅野 賢道, 中西 喜嗣

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 23 (7) DP112 - 6 1344-6703 2018/12
• 肝胆膵領域における漏れない、狭窄しない吻合法 肝外胆管空腸吻合術

  平野 聡, 岡村 圭祐, 土川 貴裕, 中村 透, 野路 武寛, 浅野 賢道, 中西 善嗣

  日本創傷治癒学会プログラム・抄録集 (一社)日本創傷治癒学会 48回 72 - 72 2018/11
• 【DP(尾側膵切除術)を極める!】DP-CARにおける術式の要点および遠隔成績からみた適応

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 七戸 俊明

  胆と膵 医学図書出版(株) 39 (11) 1269 - 1274 0388-9408 2018/11 

  DP-CARは、局所進行膵体部癌に対して局所コントロールを徹底的に追求した術式であるが、これまでのレジメンに比して抗腫瘍効果の高いFOLFIRINOX療法やGemcitabine+nab-Paclitaxel療法といった新規化学療法の登場により、局所進行膵癌に対する治療戦略が大きく変化しつつある。さらに、教室の検討により、切除不能膵体部癌に対するconversion surgeryとしてのDP-CARの有用性も示唆され、集学的治療の一手段としてDP-CARを認識する必要があると考える。各治療の利点および欠点を熟知することは膵癌専門医にとって必要最低限の素養であり、腫瘍内科医や放射線治療医、膵臓外科医、さらには医師以外の医療スタッフとともに正確に認識して局所進行膵体部癌患者の診療にあたるべきである。(著者抄録)
• 右鎖骨下動脈起始異常と反回神経走行異常を伴う胸部食道癌に対し腹臥位胸腔鏡下手術を施行した2例

  城崎 友秀, 海老原 裕磨, 山村 喜之, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 七戸 俊明, 平野 聡

  北海道医学雑誌 北海道医学会 93 (2) 114 - 115 0367-6102 2018/11
• 【膵癌に関連する血管系IVR】DP-CAR術前の血流改変術

  阿保 大介, 中村 透, 曽山 武士, 森田 亮, 吉野 裕紀, 木村 輔, 金谷 本真, 小泉 富基, 工藤 與亮, 平野 聡

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 33 (3) 229 - 235 1340-4520 2018/11 

  腹腔動脈合併尾側膵切除術(DP-CAR)術前血流改変の目的は、側副血行路を術前に発達させ、術後に予測される胃や肝臓等の虚血性合併症を予防・低減することである。著者らが考案したdual microcatheter-dual interlocking detachable coil technique(DMDI)法を適応する前後の合併症の頻度について比較したところ、DMDI法適応後が有意に合併症が少なかった。1)DP-CARの今までの歴史、2)DP-CARの治療成績、3)DP-CAR術前血流改変、4)DP-CAR術前血流改変の合併症、について概説した。
• Biliary stricture due to a migrated suture after laparoscopic distal gastrectomy.

  Noji T, Kurashima Y, Nakanishi Y, Asano T, Ebihara Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Mitsuhashi T, Hirano S

  Asian journal of endoscopic surgery 11 (4) 399 - 401 1758-5902 2018/11 [Refereed][Not invited]
   

  Benign biliary strictures have a broad spectrum of etiologies. There have been no reported cases, however, of a biliary stricture secondary to a migrated suture after laparoscopic distal gastrectomy (LDG). Here, we report one such case. The patient was a 60-year-old man who underwent LDG with Roux-en-Y reconstruction for early gastric cancer. Pathology revealed early cancer (T1N0M0) with a curative resection. Two years after LDG, the patient was found to have elevated hepatobiliary enzymes. After further workup, the new diagnosis was invasive cholangiocarcinoma (T2N0M0), and the patient underwent pancreaticoduodenectomy. Intraoperatively, a monofilament nylon suture was found in the center of a biliary stricture; this suture was previously used for duodenal closure during LDG. Histologically, the bile duct with stricture showed chronic inflammation and fibrosis. Despite no evidence of invasive carcinoma on pathology, a small lesion of adenocarcinoma in situ was found in the superior common hepatic duct.
• 【食道癌(第2版)-基礎・臨床研究の進歩-】食道癌の治療 外科治療 食道胃接合部癌に対する手術 経裂孔的食道切除術 開腹手術

  七戸 俊明, 海老原 祐磨, 倉島 庸, 村上 壮一, 平野 聡

  日本臨床 (株)日本臨床社 76 (増刊8 食道癌) 300 - 304 0047-1852 2018/10
• 外科領域におけるシミュレーション教育の今 カダバートレーニングの現状と将来 ガイドラインの解説と実例の紹介

  七戸 俊明, 村上 壮一, 倉島 庸, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 284 - 284 1345-2843 2018/10
• Liver、Pancreas、Biliary Tract Cancer 肝・胆・膵癌 外科切除におけるSurgical Margin、R0・R1の臨床的課題 肝門部領域胆管癌切除時の胆管切除断端における組織学的遺残(R1)の評価とその対応

  野路 武寛, 平野 聡, 土川 貴裕, 岡村 圭祐, 中村 透, 浅野 賢道, 中西 喜嗣, 田中 公貴

  癌と化学療法 (株)癌と化学療法社 45 (10) 1423 - 1427 0385-0684 2018/10
• HPDの適応と治療成績:安全性と予後の評価 長期成績からみた胆道癌に対する肝膵同時切除の意義

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 土川 貴裕, 中村 透, 浅野 賢道, 村上 壮一, 海老原 裕磨, 倉島 庸, 細井 勇人, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 285 - 285 1345-2843 2018/10
• 進行胆嚢癌の術式選択と治療成績:いかにして根治を得るか? 当院における進行胆嚢癌に対する治療成績と治療戦略の検討

  田中 宏典, 岡村 圭祐, 野路 武寛, 中西 喜嗣, 浅野 賢道, 中村 透, 海老原 裕磨, 倉島 庸, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 297 - 297 1345-2843 2018/10
• 肝門部領域胆管癌の術式選択と手技:安全性と根治性の確保 肝門部領域胆管癌に対する血管合併切除を伴う肝切除の手技と成績

  関谷 翔, 岡村 圭祐, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 野路 武寛, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 315 - 315 1345-2843 2018/10
• 局所進行切除不能膵癌conversion surgeryの成績:安全性と予後の評価 局所進行切除不能膵癌に対するconversion surgeryの成績と切除範囲縮小化に関する検討

  浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 369 - 369 1345-2843 2018/10
• 主膵管と交通を認めた膵漿液性嚢胞腫瘍(SCN)の1例

  吉田 雄亮, 浅野 賢道, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 荻野 真理子, 大場 光信, 三橋 智子, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 79 (増刊) 527 - 527 1345-2843 2018/10
• [II. Evaluation and Corresponding Histological Persistent in Bile Duct Margins(R1)during Hilar Cholangiocarcinoma Resection].

  Noji T, Hirano S, Tsuchikawa T, Okamura K, Nakamura T, Asano T, Nakanishi Y, Tanaka K

  Gan to kagaku ryoho. Cancer & chemotherapy 45 (10) 1423 - 1427 0385-0684 2018/10 [Refereed][Not invited]
  
• Thymidine Kinase-1は膵癌の腫瘍マーカーならびに治療ターゲットとなる可能性がある(Thymidine Kinase-1 is potential target for tumor marker and therapy of pancreatic cancer)

  中村 透, 浅野 賢道, 高橋 瑞奈, 土川 貴裕, 梅本 一史, 佐々木 勝則, 七戸 俊明, 平野 聡

  日本癌学会総会記事 77回 1090 - 1090 0546-0476 2018/09
• 新専門医制度においてacute care surgeonを育てる 外科専門医制度の中でAcute Care Surgeon教育をどのように組み込むべきか

  村上 壮一, 平野 聡, 山村 喜之, 真木 健裕, 細井 勇人, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 8 (1) 55 - 55 2018/09
• 横行結腸間膜ヘルニア嵌頓の1手術例

  城崎 友秀, 村上 壮一, 斎藤 崇宏, 真木 健裕, 山村 喜之, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 8 (1) 115 - 115 2018/09
• TEVAR後に発症した大動脈食道瘻に対し腹臥位胸腔鏡下食道切除術を施行した一例

  木村 弘太郎, 村上 壮一, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  Japanese Journal of Acute Care Surgery 日本Acute Care Surgery学会 8 (1) 131 - 131 2018/09
• エネルギーデバイスを知る-内視鏡手術の安全のために- エネルギーデバイス再考 より安全な内視鏡外科手術を目指して

  渡邊 祐介, 倉島 庸, 平野 聡

  日本手術医学会誌 日本手術医学会 39 (Suppl.) 42 - 42 1340-8593 2018/09
• 膵癌術前化学放射線療法が局所微小環境に及ぼす変化と予後との関連性(Prognostic relevance and constitutive alteration of TLO following neoadjuvant chemoradiotherapy in Pancreatic cancer)

  桑原 尚太, 土川 貴裕, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本癌学会総会記事 77回 1652 - 1652 0546-0476 2018/09
• Novel prognostic score of postoperative complications after transthoracic minimally invasive esophagectomy for esophageal cancer: a retrospective cohort study of 90 consecutive patients.

  Saito T, Tanaka K, Ebihara Y, Kurashima Y, Murakami S, Shichinohe T, Hirano S

  Esophagus : official journal of the Japan Esophageal Society 16 (2) 155 - 161 1612-9059 2018/09 [Refereed][Not invited]
   

  BACKGROUND: Esophagectomy is the standard treatment for esophageal cancer, but has a high rate of postoperative complications. Some studies reported the various scoring system to estimate the postoperative complications. However, there were according to various surgical methods and included intra- and post-operative factors. Recently, minimally invasive esophagectomy (MIE) is becoming the first-line treatment for esophageal cancer. The aim of this study was to investigate the risk factors of postoperative complications and to establish a useful system for predicting postoperative complications after transthoracic MIE. METHODS: From 2007 to 2015, 90 patients who underwent transthoracic MIE at our department were enrolled. Patients were divided into two groups according to postoperative complication: patients with major complications (n = 32) and without major complications (n = 58). Major complication was defined as ≥ IIIa in the Clavien-Dindo classification. RESULTS: Multivariate analysis identified four independent risk factors for predicting postoperative complications: age [≥ 70 years; odd ratio (OR) 6.88; p = 0.001]; sex (male; OR 5.24; p = 0.031); total protein level (< 6.7 mg/dl; OR 6.51; p = 0.002), and C-reactive protein level (≥ 0.15; OR, 6.58; p = 0.001). These four factors were used to establish a score. The complication rate for scores 0-4 were 0, 11, 36, 71, 100%, respectively. The frequency of major complications was significantly associated with the score (p < 0.001). Receiver operator characteristic curves to predict the score with regard to major complications showed an area under the curve value of 0.798 (95% confidence interval: 0.696-0.871, P < 0.001). CONCLUSIONS: Our novel score may help to decide surgical intervention for esophagectomy and provide appropriate resources for perioperative management.
• Minimally invasive abdominal and left thoracic approach for Siewert type II adenocarcinoma of the oesophagogastric junction: Novel technique for simultaneous combined use of laparoscopy and thoracoscopy.

  Ebihara Y, Kurashima Y, Murakami S, Shichinohe T, Hirano S

  Journal of minimal access surgery 0972-9941 2018/09 [Refereed][Not invited]
  
• Development of a novel training system for laparoscopic inguinal hernia repair.

  Poudel S, Kurashima Y, Kawarada Y, Murakami Y, Tanaka K, Kawase H, Shichinohe T, Hirano S

  Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 28 (4) 1 - 7 1364-5706 2018/09 [Refereed][Not invited]
   

  Background: Laparoscopic inguinal hernia repair is considered technically difficult. Although a simulation-based curriculum has been developed to help trainees, access to simulation training outside North America is limited. This study aimed to develop an educational system for the transabdominal preperitoneal (TAPP) approach based on the TAPP checklist, an assessment tool we had developed and validated earlier. Material and methods: Consensus within the TAPP education working group consisting of local TAPP experts, hernia experts and a surgical educator to develop educational tools and the educational system based on the TAPP checklist. The system was piloted in several institutes, and participants were surveyed on its efficacy. Results: We systematically developed an educational video and training manual explaining each item of the TAPP checklist and conveying basic knowledge of the procedure. We integrated the training tool with evaluation and feedback to develop an educational system. In a pilot study, seven trainees at five hospitals were trained using this system and found it very useful for mastering the TAPP procedure. Conclusions: We have developed a training system for TAPP procedure and successfully implemented it in several hospitals. Further research will focus on the educational value of this tool.
• A Preoperative Prognostic Scoring System to Predict Prognosis for Resectable Pancreatic Cancer: Who Will Benefit from Upfront Surgery?

  Nakamura T, Asano T, Okamura K, Tsuchikawa T, Murakami S, Kurashima Y, Ebihara Y, Noji T, Nakanishi Y, Tanaka K, Shichinohe T, Hirano S

  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 23 (5) 990 - 996 1091-255X 2018/09 [Refereed][Not invited]
   

  BACKGROUND: Upfront surgery is recommended in patients with potentially resectable pancreatic ductal adenocarcinoma (R-PDAC) by National Comprehensive Center Network (NCCN) guidelines. However, even among R-PDACs, there is a subset that demonstrates extremely poor prognosis. The purpose of this study was to identify preoperative prognostic factors for upfront surgical resection of R-PDACs. METHODS: The records of 278 consecutive patients with PDAC who underwent curative resection between 2001 and 2015 in a single institution were retrospectively reviewed. Preoperative factors to predict prognosis in patients with R-PDAC according to the NCCN guidelines were analyzed. RESULTS: Of the 278 patients who underwent resection, 153 R-PDACs received upfront surgery with a median survival time (MST) of 26.4 months. Tumor location (pancreatic head) (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.14-3.40; P = 0.015), preoperative cancer antigen 19-9 (CA19-9) > 100 U/mL (OR 1.92, 1.31-2.80; P = 0.0009), and tumor size > 20 mm (OR 1.50, 1.02-2.19; P = 0.038) were identified as preoperative independent predictive risk factors for poor prognosis in patients with R-PDACs. In the patients with R-PDAC, 5-year survival was 60.7%, 21.5%, and 0% in patients with 0, 1 or 2, and 3 risk factors, respectively. There were significant differences in overall survival between the three groups (P < .0001). CONCLUSIONS: A preoperative prognostic scoring system using preoperative tumor location, tumor size, and CA19-9 enables preoperative prediction of prognosis and facilitates selection of appropriate treatment for resectable pancreatic cancer.
• Near infrared fluorescence light imaging for lymphatic flow toward para-aortic lymph node from the Calot's triangle: A prospective exploratory study.

  Noji T, Narasaki H, Ebihara Y, Tanaka K, Nakanishi Y, Asano T, Nakamura T, Tsuchikawa T, Okamura K, Hirano S

  Photodiagnosis and photodynamic therapy 24 274 - 279 1572-1000 2018/09 [Refereed][Not invited]
   

  BACKGROUND: Metastasis to para-aortic lymph nodes (PAN) in hilar malignancies is considered distant metastasis. Fluorescence imaging using near infrared fluorescence light and indocyanine green (ICG-NIR imaging) are widely employed for identifying the sentinel lymph node, which might be an ideal alternative procedure for whole excisional biopsy of PAN. However, there has been no report about ICG-NIR imaging in hilar malignancies. The purpose of this study was to determine the optimal dose for indocyanine green to detect PAN and to reveal the detection rate of ICG-NIR imaging for lymphatic flow toward regional lymph nodes (RLN) or PAN from the Calot's triangle. PATIENTS AND METHODS: We enrolled 62 patients with hepato-pancreatic-biliary malignancies in this study. The dose of ICG was optimized in the first 15 patients and the detection rate for RLN and PAN was evaluated in the remaining 47. We observed that the optimal administered dose of ICG for detecting fluorescent signals in PAN was 5 mg/mL. RESULTS: Using this dose, RLN and PAN fluorescence were detected in 29 of 42 patients. Fluorescent signals were recorded in the lymph nodes (LN) along the bile duct and the posterior surface of the head of the pancreas. We also detected PAN fluorescent signals on the right side of the aorta around the left renal vein. We recommend 5 mg/ml of ICG to visualize lymphatic flow from the hepatoduodenal ligament to PAN using ICG-NIR imaging. However, because detection rate of RLN and PAN were 69%, respectively, further improvement for this procedure will be necessary for clinical application.
• リンパ節転移個数による肝膵同時切除術を施行した胆道癌の予後の検討

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 中村 透, 浅野 賢道, 田中 公貴, 土川 貴裕, 平野 聡

  胆道 日本胆道学会 32 (3) 631 - 631 0914-0077 2018/08
• 胆汁漏 胆汁瘻に対する治療strategyと晩期胆管狭窄に対する外科的介入

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中村 透, 浅野 賢道, 平野 聡

  胆道 日本胆道学会 32 (3) 479 - 479 0914-0077 2018/08
• Prognostic value of MAGEA4 in primary lung cancer depends on subcellular localization and p53 status.

  Aki Fujiwara-Kuroda, Tatsuya Kato, Takehiro Abiko, Takahiro Tsuchikawa, Noriaki Kyogoku, Masaomi Ichinokawa, Kimitaka Tanaka, Takehiro Noji, Yasuhiro Hida, Kichizo Kaga, Yoshiro Matsui, Hiroaki Ikeda, Shinichi Kageyama, Hiroshi Shiku, Satoshi Hirano

  International journal of oncology 53 (2) 713 - 724 1019-6439 2018/08 [Refereed][Not invited]
   

  Melanoma antigen family A4 (MAGEA4), a cancer/testis antigen, is overexpressed and is thus an immunotherapy target in various malignant tumors, including non-small cell lung cancer. However, whether MAGEA4 induces or inhibits the apoptosis of lung cancer cells remains controversial, as is its prognostic significance, particularly since there is no reliable method with which to detect MAGEA4 specifically. In this study, we optimized assay conditions to detect MAGEA4 based on cells transiently transfected with MAGEA genes, and found that MAGEA4 was expressed in four of eight non-small cell lung cancer cell lines, and in 25.4% of clinical lung cancer specimens. We also found that MAGEA4 overexpression decreased apoptosis, as measured by the levels of cleaved caspase-3 in stably transfected 293F cells. Notably, patients with nuclear MAGEA4, but not p53 expression exhibited a significantly poorer survival than those expressing both nuclear MAGEA4 and p53. Indeed, multivariate analysis identified nuclear MAGEA4 as an independent prognostic factor (P=0.0042), albeit only in the absence of p53. In this study, to the best of our knowledge, we are the first to demonstrate that the function and prognostic value of MAGEA4 depends on its subcellular localization and on the p53 status.
• A comparison of treatment and outcomes of perihilar cholangiocarcinoma between Eastern and Western centers.

  Olthof PB, Miyasaka M, Koerkamp BG, Wiggers JK, Jarnagin WR, Noji T, Hirano S, van Gulik TM

  HPB : the official journal of the International Hepato Pancreato Biliary Association 21 (3) 345 - 351 1365-182X 2018/08 [Refereed][Not invited]
   

  BACKGROUND: Perihilar cholangiocarcinoma (PHC) often requires extensive surgery which is associated with substantial morbidity and mortality. This study aimed to compare an Eastern and Western PHC cohort in terms of patient characteristics, treatment strategies and outcomes including a propensity score matched analysis. METHODS: All consecutive patients who underwent combined biliary and liver resection for PHC between 2005 and 2016 at two Western and one Eastern center were included. The overall perioperative and long-term outcomes of the cohorts were compared and a propensity score matched analysis was performed to compare perioperative outcomes. RESULTS: A total of 210 Western patients were compared to 164 Eastern patients. Western patients had inferior survival compared to the East (hazard-ratio 1.72 (1-23-2.40) P < 0.001) corrected for age, ASA score, tumor stage and margin status. After propensity score matching, liver failure rate, morbidity, and mortality were similar. There was more biliary leakage (38% versus 13%, p = 0.015) in the West. CONCLUSION: There were major differences in patient characteristics, treatment strategies, perioperative outcomes and survival between Eastern and Western PHC cohorts. Future studies should focus whether these findings are due to the differences in the treatment or the disease itself.
• Oncological emergency surgery for metachronous large and small bowel metastases after pancreaticoduodenectomy for pancreatic cancer: a case report.

  Miyasaka M, Noji T, Tanaka K, Nakanishi Y, Asano T, Ebihara Y, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Surgical case reports 4 (1) 99 - 99 2018/08 [Refereed][Not invited]
   

  BACKGROUND: A surgical case of metachronous metastases of pancreatic head cancer (PC) to the large and small bowel is extremely rare. Therefore, there are only a few reports about surgery for intestinal metastases from PC. An oncologic emergency is defined as an acute, potentially life-threatening condition in a cancer patient that developed directly or indirectly because of the malignant disease or cancer treatment. CASE PRESENTATION: A 63-year-old man with PC underwent pancreaticoduodenectomy after receiving neoadjuvant chemotherapy with gemcitabine and S-1. Histopathologically, the tumor was diagnosed as poorly differentiated, tubular adenocarcinoma, with pT2, N0, pStage IB according to the UICC classification, seventh edition. R0 was achieved. Three months after pancreatoduodenectomy, blood tests showed coagulation derangements with high C-reactive protein (CRP 11.30 mg/dl). Computed tomography (CT) scan revealed a 55-mm mass alongside the transverse colon. During 2 weeks of follow-up, the coagulation derangement and elevated CRP persisted. Repeat CT showed that the tumor enlarged to 65 mm, and an additional mass, 25 mm in diameter, was detected in the jejunum. He was hospitalized due to abdominal pain and diarrhea with persistent high fever and was inspected; however, there was no evidence for infections. With the understanding that his life-threatening symptoms were secondary to the underlying malignancy, extirpation of the tumors combined with partial resection of the transverse colon and the jejunum was performed on the eighth day of hospitalization, on an emergency basis. The lesions were identified as large and small bowel metastases from PC because histopathological examination revealed morphological features similar to the primary disease. Immediately after the emergency surgery, the fever resolved and the CRP level normalized. He was discharged and received nab-paclitaxel with gemcitabine chemotherapy for 2 months postoperatively. He selected for best supportive care after this. The patient died due to a relapse with mesenteric lymph node metastasis 7 months after the emergency surgery. CONCLUSION: Surgery as an oncological emergency for selected patients could sometimes contribute to improving patient's quality of life.
• 腹臥位胸腔鏡下食道切除術の縦隔郭清 腹側剥離先行・4ポートによる標準化

  七戸 俊明, 村上 壮一, 海老原 裕磨, 倉島 庸, 宮坂 大介, 山村 喜之, 齋藤 崇宏, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 755 - 755 2018/07
• 消化器外科医学部学生実習における新規アクティブラーニングの開発

  村上 壮一, 倉島 庸, 七戸 俊明, 岡村 圭佑, 土川 貴裕, 中村 透, 海老原 裕磨, 野路 武寛, 大滝 純司, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 181 - 181 2018/07
• 切除不能膵癌に対するconversion surgeryの予後延長効果に関する検討

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 田中 公貴, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 6 - 6 2018/07
• 集学的治療は微小転移を制御できるか? 胆道癌の局所免疫環境から見た微小転移制御の可能性

  土川 貴裕, 上野 峰, 高橋 瑞奈, 中西 喜嗣, 浅野 賢道, 野路 武寛, 中村 透, 岡村 圭祐, 七戸 利明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 640 - 640 2018/07
• ICG検査および予定残肝量からみた胆道癌に対する肝膵同時切除の合併症の検討

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 土川 貴裕, 中村 透, 浅野 賢道, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 706 - 706 2018/07
• 再発胆道癌に対する外科的切除の実際と短期・長期成績

  真木 健裕, 野路 武寛, 田中 公貴, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 73回 872 - 872 2018/07
• 膵癌術前化学放射線治療が局所免疫環境内の異所性リンパ節に与える影響

  桑原 尚太, 土川 貴裕, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本がん免疫学会総会プログラム・抄録集 日本がん免疫学会 22回 94 - 94 2018/07
• Step-by-step training in basic laparoscopic skills using two-way web conferencing software for remote coaching: A multicenter randomized controlled study

  Tomoko Mizota, Yo Kurashima, Saseem Poudel, Yusuke Watanabe, Toshiaki Shichinohe, Satoshi Hirano

  American Journal of Surgery 216 (1) 88 - 92 1879-1883 2018/07/01 [Refereed][Not invited]
   

  Background: Despite its advantages, few trainees outside of North America have access to simulation training. We hypothesized that a stepwise training method using tele-mentoring system would be an efficient technique for training in basic laparoscopic skills. Methods: Residents were randomized into two groups and trained to proficiency in intracorporeal suturing. The stepwise group (SG) practiced the task step-by-step, while the other group practiced comprehensively (CG). Each participant received weekly coaching via two-way web conferencing software. The duration of the coaching sessions and self-practice time were compared between the two groups. Results: Twenty residents from 15 institutions participated, and all achieved proficiency. Coaching sessions using tele-mentoring system were completed without difficulties. The SG required significantly shorter coaching time per session than the CG (p =.002). There was no significant difference in self-practice time. Conclusions: The stepwise training method with the tele-mentoring system appears to make efficient use of surgical trainees' and trainers' time.
• Survival benefit of conversion surgery for patients with initially unresectable pancreatic cancer who responded favorably to nonsurgical treatment.

  Asano T, Hirano S, Nakamura T, Okamura K, Tsuchikawa T, Noji T, Nakanishi Y, Tanaka K, Shichinohe T

  Journal of hepato-biliary-pancreatic sciences 25 (7) 342 - 350 1868-6974 2018/07 [Refereed][Not invited]
   

  BACKGROUND: Conversion surgery (CS) is expected as a new therapeutic strategy for patients with unresectable pancreatic cancer (UR-PC). We analyzed outcomes of CS for patients with UR-PC and evaluated the survival benefit of CS. METHODS: Thirty-four patients diagnosed with UR-PC according to the National Comprehensive Cancer Network guideline underwent CS in our hospital. Resectability was considered by multimodal images in patients who underwent nonsurgical treatment (NST) for more than 6 months. CS was performed only in patients who were judged to be able to undergo R0 resection. RESULTS: Twenty-six patients had locally advanced PC, and eight had distant metastases. The median duration of NST was 9 (range 5-44) months. R0 resection was achieved in 30 patients (88.2%). Six patients (17.6%) showed Evans grade ≥III. Three- and 5-year overall survival (OS) rates from initial treatment were 74% and 56.9%, respectively, with median survival time (MST) of 5.3 years. The actual 5-year OS rate in 19 patients was 47.4% with an MST of 4.0 years. Patients with Evans grade ≥III had a better prognosis than those with Evans grade
• Japanese classification and staging for pancreatic and periampullary cancers

  Satoshi Hirano, Takahiro Tsuchikawa

  Surgery for Pancreatic and Periampullary Cancer: Principles and Practice 23 - 44 2018/06/01
• 当院における肥満2型糖尿病に対する腹腔鏡下スリーブ状胃切除術の導入

  海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本肥満症治療学会学術集会プログラム・抄録集 日本肥満症治療学会 36回 128 - 128 2018/06
• Off-the-job trainingの現況 一般外科医のための、外傷診療Off-the-job trainingの開発

  村上 壮一, 七戸 俊明, 倉島 庸, 岡村 圭祐, 土川 貴裕, 中村 透, 海老原 裕磨, 野路 武寛, 浅野 賢道, 中西 喜嗣, 田中 公貴, 宮坂 大介, 真木 健裕, 山村 喜之, 平野 聡

  日本外傷学会雑誌 (一社)日本外傷学会 32 (2) 231 - 231 1340-6264 2018/06
• DJ-1 is a useful biomarker for invasive extrahepatic cholangiocarcinoma

  Yukiko Tabata, Yoshitsugu Nakanishi, Kanako C. Hatanaka, Yutaka Hatanaka, Takahiro Tsuchikawa, Keisuke Okamura, Takehiro Noji, Toshiaki Shichinohe, Yoshihiro Matsuno, Satoshi Hirano

  Human Pathology 76 28 - 36 1532-8392 2018/06/01 [Refereed][Not invited]
   

  We have previously reported that DJ-1 protein is up-regulated in cholangiocarcinoma compared with non-neoplastic epithelium of the bile duct in a study using liquid-chromatography mass spectrometry–based proteomics. The aim of this study was to clarify whether DJ-1 expression offers a biomarker for patients with invasive extrahepatic cholangiocarcinoma (EHCC) who undergo surgical resection with curative intent. Positive immunohistochemical (IHC) staining of DJ-1 was significantly more frequent in the cytoplasm of 96 invasive EHCCs (n = 28, 29.2%) than in that of 66 non-neoplastic epithelial lesions adjacent to invasive EHCC (n = 7, 10.6% P =.006). No significant difference in clinicopathological features was evident between invasive EHCC patients with negative (n = 68) and positive (n = 28) IHC staining. However, negative IHC staining for DJ-1 in cytoplasm was selected as an independent risk factor for adverse prognosis on multivariate analysis (P =.004, hazard ratio 2.13, 95% confidence interval 1.28–3.57). Serum levels of DJ-1 in 16 invasive EHCC patients with metastasis were compared with 12 invasive EHCC patients without metastasis. Serum levels of DJ-1 tended to be higher in 16 patients with metastasis (median, 40.9 ng/ml) than in 12 patients without (27.6 ng/ml, P =.137). In addition, patients with high serum levels (≥ 40 ng/ml) of DJ-1 tended to have metastasis more frequently than those without (P =.054, Fisher's exact test). We concluded that IHC staining pattern and serum level of DJ-1 in patients with invasive EHCC might be predictive of prognosis and metastasis, respectively.
• Artery-first approach for pancreaticoduodenectomy

  Manabu Kawai, Satoshi Hirano, Hiroki Yamaue

  Journal of Hepato-Biliary-Pancreatic Sciences 25 (6) 319 - 320 1868-6982 2018/06/01 [Refereed][Not invited]
  
• Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study

  Noriaki Kyogoku, Yuma Ebihara, Toshiaki Shichinohe, Fumitaka Nakamura, Katsuhiko Murakawa, Takayuki Morita, Shunichi Okushiba, Satoshi Hirano

  Langenbeck's Archives of Surgery 403 (4) 463 - 471 1435-2451 2018/06/01 [Refereed][Not invited]
   

  Purpose: We used propensity score matching to compare the complication rates after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using a circular or a linear stapler. Methods: We retrospectively enrolled all patients who underwent curative LTG between November 2004 and March 2016. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Clinicopathological characteristics and surgical outcomes were compared. Results: We identified 66 propensity score-matched pairs among 379 patients who underwent LTG. There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. In the circular and linear groups, the rate of all complications (Clavien–Dindo [CD] classification ≥ I 21 vs. 26%, respectively p = 0.538), complications more severe than CD grade III (14 vs. 14%, respectively p = 1.000), and occurrence of EJS leakage and stenosis more severe than CD grade III (5 vs. 2%, p = 0.301 9 vs. 8%, p = 0.753, respectively) were comparable. Conclusions: There is no difference in the postoperative complication rate related to the type of stapler used for EJS after LTG.
• Minimally invasive abdominal and left thoracic approach for esophagogastric junction adenocarcinoma with esophageal diverticulum: A case report.

  Takeuchi Y, Ebihara Y, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Asian journal of endoscopic surgery 12 (2) 167 - 170 1758-5902 2018/06 [Refereed][Not invited]
   

  Controversy remains regarding the optimal resection approach for Siewert type II adenocarcinoma of the esophagogastric junction (EGJ). Furthermore, an esophageal diverticulum, although rare, can complicate surgical procedures. Herein, we report a case of EGJ adenocarcinoma with an esophageal diverticulum that was treated using the minimally invasive abdominal and left thoracic approach (MALTA). A 72-year-old man, with EGJ adenocarcinoma and an epiphrenic diverticulum on esophagogastroduodenoscopy underwent endoscopic submucosal dissection. The pathological diagnosis of the specimen revealed invasion to the lymphatic vessels. Therefore, laparoscopic proximal gastrectomy and thoracoscopic lower esophagectomy with D1 lymph node dissection and double-tract reconstruction of the esophageal diverticulum were performed via MALTA. The patient was discharged without any postoperative morbidity. MALTA provides good visualization for the transection of the lower esophagus in cases of esophageal diverticulum. Moreover, MALTA for adenocarcinoma of the EGJ is technically feasible, even with the presence of a lower esophageal diverticulum.
• Pathological complete response of locally advanced colon cancer after preoperative radiotherapy: a case report and narrative review of the literature.

  Sekiya S, Imamura K, Takeuchi S, Teramura K, Watanabe Y, Tamoto E, Takada M, Kinoshita Y, Anbo Y, Nakamura F, Kashimura N, Noguchi H, Miura K, Hirano S

  Surgical case reports 4 (1) 58 - 58 2018/06 [Refereed][Not invited]
   

  BACKGROUND: The oncological effectiveness of preoperative radiotherapy for locally advanced colon cancer is unclear. We report a case of pathological complete response in a patient with locally advanced ascending colon cancer after preoperative radiotherapy following failure of chemotherapy. CASE PRESENTATION: A 65-year-old Japanese woman presented with malaise and hematochezia. A computed tomography (CT) revealed a tumor in the ascending colon which seemed to infiltrate the adjacent structures. She was diagnosed with locally advanced ascending colon cancer stages T4b, N2a, M0, and IIIC. We selected modified FOLFOX6 with panitumumab as neoadjuvant chemotherapy. However, we discontinued the chemotherapy after the 8th cycle because of disease progression and severe adverse effects. The patient then underwent radiotherapy of 60 Gy in 30 fractions, resulting in significant tumor size reduction. One month after the radiotherapy, we performed a right hemicolectomy with multivisceral resection without complications. Histopathologically, we found no residual cancer cells in the resected specimen. The patient remains alive and has not required additional therapies for 24 months, as there are no signs of recurrence. CONCLUSIONS: The present case suggests that preoperative radiotherapy might be an effective treatment options for locally advanced colon cancer.
• Therapeutic activity of retroviral replicating vector-mediated prodrug activator gene therapy for pancreatic cancer

  Kazuho Inoko, Kei Hiraoka, Akihito Inagaki, Mizuna Takahashi, Toshihiro Kushibiki, Koji Hontani, Hironobu Takano, Shoki Sato, Shintaro Takeuchi, Toru Nakamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Harry E Gruber, Douglas J Jolly, Noriyuki Kasahara, Satoshi Hirano

  Cancer Gene Therapy 25 (7-8) 1 - 12 1476-5500 2018/05/08 [Refereed][Not invited]
   

  Toca 511, a retroviral replicating vector (RRV) encoding the yeast cytosine deaminase (yCD) prodrug activator gene, which mediates conversion of the prodrug 5-fluorocytosine (5-FC) to the anticancer drug 5-fluorouracil (5-FU), is currently being evaluated in Phase II/III clinical trials for glioma, and showing highly promising evidence of therapeutic activity. Here we evaluated RRV-mediated prodrug activator gene therapy as a new therapeutic approach for pancreatic ductal adenocarcinoma (PDAC). RRV spread rapidly and conferred significant cytotoxicity with prodrug in a panel of PDAC cells. Efficient intratumoral replication and complete inhibition of tumor growth upon 5-FC administration were observed in both immunodeficient and immunocompetent subcutaneous PDAC models. Biodistribution of RRV was highly restricted in normal tissues, especially in immunocompetent hosts. Tumor growth inhibition by Toca 511 followed by 5-FC was also confirmed in the orthotopic PDAC model. This study provides the first proof-of-concept for application of Toca 511 and Toca FC (extended release 5-FC) to the treatment of human PDAC, and provided support for inclusion of PDAC in a Phase I study evaluating Toca 511 in various systemic malignancies, (NCT02576665), which has recently been initiated.
• 膵頭部Borderline resectable-A膵癌の現状と課題

  中村 透, 浅野 賢道, 岡村 圭祐, 土川 貴裕, 野路 武寛, 村上 壮一, 海老原 裕磨, 倉島 庸, 中西 喜嗣, 田中 公貴, 七戸 俊明, 平野 聡

  膵臓 (一社)日本膵臓学会 33 (3) 418 - 418 0913-0071 2018/05
• 膵頭十二指腸切除後におけるフルルビプロフェンアキセチルの使用と膵液瘻との関連

  真木 健裕, 中村 透, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 土川 貴裕, 岡村 圭祐, 平野 聡

  膵臓 (一社)日本膵臓学会 33 (3) 431 - 431 0913-0071 2018/05
• 変異型KRAS検出による腹腔洗浄細胞診診断

  小野 雅人, 中村 透, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 水上 裕輔, 平野 聡

  膵臓 (一社)日本膵臓学会 33 (3) 503 - 503 0913-0071 2018/05
• 切除不能膵癌における治療方針-conversion surgeryの是非- 膵癌に対するconversion surgeryの至適切除範囲 術中迅速病理を用いた低侵襲化の試み

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 七戸 俊明

  膵臓 (一社)日本膵臓学会 33 (3) 341 - 341 0913-0071 2018/05
• 膵頭十二指腸切除後ドレーン造影所見と膵液瘻治癒予測

  櫛谷 洋樹, 中村 透, 真木 健裕, 中西 喜嗣, 浅野 賢道, 土川 貴裕, 岡村 圭祐, 平野 聡

  膵臓 (一社)日本膵臓学会 33 (3) 434 - 434 0913-0071 2018/05
• 術前診断に難渋した膵頭部巨大IPMCの1切除例

  城崎 友秀, 浅野 賢道, 中村 透, 中西 喜嗣, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 三橋 智子, 平野 聡

  膵臓 (一社)日本膵臓学会 33 (3) 568 - 568 0913-0071 2018/05
• Educational system based on the TAPP checklist improves the performance of novices: a multicenter randomized trial

  Saseem Poudel, Yo Kurashima, Kimitaka Tanaka, Hiroshi Kawase, Yoichi M. Ito, Fumitaka Nakamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgical Endoscopy and Other Interventional Techniques 32 (5) 2480 - 2487 1432-2218 2018/05/01 [Refereed][Not invited]
   

  Background: Despite recent developments in surgical education, obstacles including inadequate budget, limited human resources, and a scarcity of time have limited its widespread adoption. To provide systematic training for laparoscopic inguinal hernia repair, we had previously developed and validated a checklist to evaluate the recorded performance of transabdominal preperitoneal (TAPP) repair. We had also developed an educational system that included didactic materials based on the TAPP checklist and incorporated remote evaluation and feedback system. The aim of this study was to evaluate the educational impact of the TAPP education system on novice surgeons. Methods: Residents and surgeons from participating hospitals, who had performed 0 or 1 TAPP procedure, were randomly assigned to the intervention group (IG), who trained using this new educational tool, and the control group (CG), who trained using the conventional system. Their surgical videos were rated by blinded raters. All participants performed their first case prior to randomization. The primary outcome was improvement of TAPP checklist score from the first to the third case. Results: Eighteen participants from 9 institutes were recruited for this study. Seven participants in the IG and 5 participants in the CG were included in the final analysis. The participants in the IG demonstrated significant improvement in their TAPP performance (p = 0.044) from their first case to their third case, whereas their counterparts in the CG failed to make any significant progress during the same period (p = 0.581). Conclusion: The new TAPP educational system was effective in improving the TAPP performance of novice surgeons.
• Genomic characterization of biliary tract cancers identifies driver genes and predisposing mutations

  Christopher P. Wardell, Masashi Fujita, Toru Yamada, Michele Simbolo, Matteo Fassan, Rosa Karlic, Paz Polak, Jaegil Kim, Yutaka Hatanaka, Kazuhiro Maejima, Rita T. Lawlor, Yoshitsugu Nakanishi, Tomoko Mitsuhashi, Akihiro Fujimoto, Mayuko Furuta, Andrea Ruzzenente, Simone Conci, Ayako Oosawa, Aya Sasaki-Oku, Kaoru Nakano, Hiroko Tanaka, Yujiro Yamamoto, Kubo Michiaki, Yoshiiku Kawakami, Hiroshi Aikata, Masaki Ueno, Shinya Hayami, Kunihito Gotoh, Shun-ichi Ariizumi, Masakazu Yamamoto, Hiroki Yamaue, Kazuaki Chayama, Satoru Miyano, Gad Getz, Aldo Scarpa, Satoshi Hirano, Toru Nakamura, Hidewaki Nakagawa

  Journal of Hepatology 68 (5) 959 - 969 1600-0641 2018/05/01 [Refereed][Not invited]
   

  Background & Aims: Biliary tract cancers (BTCs) are clinically and pathologically heterogeneous and respond poorly to treatment. Genomic profiling can offer a clearer understanding of their carcinogenesis, classification and treatment strategy. We performed large-scale genome sequencing analyses on BTCs to investigate their somatic and germline driver events and characterize their genomic landscape. Methods: We analyzed 412 BTC samples from Japanese and Italian populations, 107 by whole-exome sequencing (WES), 39 by whole-genome sequencing (WGS), and a further 266 samples by targeted sequencing. The subtypes were 136 intrahepatic cholangiocarcinomas (ICCs), 101 distal cholangiocarcinomas (DCCs), 109 peri-hilar type cholangiocarcinomas (PHCs), and 66 gallbladder or cystic duct cancers (GBCs/CDCs). We identified somatic alterations and searched for driver genes in BTCs, finding pathogenic germline variants of cancer-predisposing genes. We predicted cell-of-origin for BTCs by combining somatic mutation patterns and epigenetic features. Results: We identified 32 significantly and commonly mutated genes including TP53, KRAS, SMAD4, NF1, ARID1A, PBRM1, and ATR, some of which negatively affected patient prognosis. A novel deletion of MUC17 at 7q22.1 affected patient prognosis. Cell-of-origin predictions using WGS and epigenetic features suggest hepatocyte-origin of hepatitis-related ICCs. Deleterious germline mutations of cancer-predisposing genes such as BRCA1, BRCA2, RAD51D, MLH1, or MSH2 were detected in 11% (16/146) of BTC patients. Conclusions: BTCs have distinct genetic features including somatic events and germline predisposition. These findings could be useful to establish treatment and diagnostic strategies for BTCs based on genetic information. Lay summary: We here analyzed genomic features of 412 BTC samples from Japanese and Italian populations. A total of 32 significantly and commonly mutated genes were identified, some of which negatively affected patient prognosis, including a novel deletion of MUC17 at 7q22.1. Cell-of-origin predictions using WGS and epigenetic features suggest hepatocyte-origin of hepatitis-related ICCs. Deleterious germline mutations of cancer-predisposing genes were detected in 11% of patients with BTC. BTCs have distinct genetic features including somatic events and germline predisposition.
• Variations of pulmonary vein drainage critical for lung resection assessed by three-dimensional computed tomography angiography.

  Nobuyuki Shiina, Kichizo Kaga, Yasuhiro Hida, Tsukasa Sasaki, Satoshi Hirano, Yoshiro Matsui

  Thoracic cancer 9 (5) 584 - 588 1759-7706 2018/05 [Refereed][Not invited]
   

  BACKGROUND: It is important to understand pulmonary vein drainage pattern variations and their frequency in order to perform safe anatomical pulmonary resection. METHODS: Variations and frequencies were assessed using three-dimensional computed tomography angiography (3D-CT) in 194 patients. In cases where the tumor or lymph node caused atelectasis or compression of hilar structures, the involved lobes were excluded from the analyses. RESULTS: We confirmed variant drainage patterns in 15/189 (8.0%) patients in the right upper lobe (RUL), 29/189 (15.3%) in the right middle lobe (RML), 18/192 (9.5%) in the right lower lobe (RLL), and 5/187 (2.6%) in the left upper lobe (LUL). There was no variant type in the left lower lobe (LLL). There were 14 (7.4%) cases of anomalous superior posterior pulmonary vein of RUL (V2 ) drainage: V2 draining to the superior pulmonary vein (SPV) (n = 2, 1.1%), V2 to the inferior pulmonary vein (IPV) (n = 7, 3.7%), V2 to the left atrium (LA) (n = 2, 1.1%), and V6 to the apical pulmonary vein of the RLL (n = 3, 1.6%). There was a posterior pulmonary vein, V3 to RML pulmonary vein in one case (0.5%). The RML pulmonary vein drained into the IPV in 14 (7.4%) and into the LA in 15 (7.9%) cases. The right V6 directly drained into the LA in 15 (7.9%) and V6 into the SPV in 3 (1.6%) cases. The lingular pulmonary vein drained into the IPV in one case (0.5%) and into the LA in two cases (1.1%). The inferior lingular pulmonary vein V5 drained into the IPV and into the LA in one case (0.5%), respectively. CONCLUSION: We describe anomalous pulmonary venous drainage patterns and their frequencies particular to anatomic surgical resection. 3D-CT is useful to find such variations.
• Mixed ductal-neuroendocrine carcinoma with unique intraductal growth in the main pancreatic duct.

  Hirata K, Kuwatani M, Mitsuhashi T, Sugiura R, Kato S, Kawakubo K, Yamada T, Asano T, Hirano S, Sakamoto N

  Endoscopic ultrasound 8 (2) 129 - 130 2303-9027 2018/05 [Refereed][Not invited]
  
• The use of broad-spectrum antibiotics reduces the incidence of surgical site infection after pancreatoduodenectomy

  Kimitaka Tanaka, Toru Nakamura, Shungo Imai, Hiroki Kushiya, Daisuke Miyasaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgery Today 48 (9) 1 - 10 1436-2813 2018/04/23 [Refereed][Not invited]
   

  Purpose: The development of surgical site infection (SSI) after biliary reconstruction is highly influenced by the presence of preoperative bacteria in the bile juice. We selected vancomycin and piperacillin/tazobactam (VCM + PIPC/TAZ) as perioperative prophylactic antibiotics for patients undergoing pancreaticoduodenectomy. This study aimed to retrospectively analyze the effectiveness of VCM + PIPC/TAZ compared to cefmetazole. Methods: Seventy-two patients who underwent pancreaticoduodenectomy between April 2015 and March 2017 at our department were evaluated. Forty patients were administered cefmetazole as the perioperative prophylactic antibiotic, and 32 were administered VCM + PIPC/TAZ. The intraoperative VCM blood concentration (incision, biliary reconstruction, and wound closure) was measured during surgery to confirm the hemodynamics. Results: The frequency of SSIs was significantly lower in the VCM + PIPC/TAZ group (8/32 patients) than in the cefmetazole group (20/40 patients, P = 0.031). Postoperatively, significantly fewer patients in the VCM + PIPC/TAZ group (4/32 patients) required ≥ 15 days of additional antibiotic administration compared to those in the cefmetazole group (14/40 patients, P = 0.033). Six of 32 patients in the VCM + PIPC/TAZ group showed redneck syndrome symptoms. There was no significant difference in the VCM blood concentration between patients with and without SSIs. Conclusions: The use of VCM + PIPC/TAZ can reduce the incidence of SSI after pancreaticoduodenectomy and also reduce the need for the additional administration of antibiotics for ≥ 15 days after surgery.
• Prognostic impact of programmed cell death ligand 1 (PD-L1) expression and its association with epithelial-mesenchymal transition in extrahepatic cholangiocarcinoma

  Takashi Ueno, Takahiro Tsuchikawa, Kanako C. Hatanaka, Yutaka Hatanaka, Tomoko Mitsuhashi, Yoshitsugu Nakanishi, Takehiro Noji, Toru Nakamura, Keisuke Okamura, Yoshihiro Matsuno, Satoshi Hirano

  Oncotarget 9 (28) 20034 - 20047 1949-2553 2018/04/13 [Refereed][Not invited]
   

  Extrahepatic cholangiocarcinoma (eCCA) has a poor prognosis. Although the possibility of immunotherapy has been studied, immune checkpoint molecules such as programmed death ligand 1 (PD-L1) in eCCA are not well understood. Epithelialmesenchymal transition (EMT) has recently been shown to regulate PD-L1 expression. Our aims were to assess the clinicopathological significance of tumor-infiltrating lymphocytes (TILs) and tumor PD-L1 expression in eCCA and to compare these immune responses with EMT marker expression. In this retrospective study, we conducted immunohistochemical analyses for 117 patients with eCCA. We stained for CD4, CD8, Foxp3, and PD-L1 as markers reflecting local immune responses, and for E-cadherin, N-cadherin, vimentin, ZEB1, ZEB2, SNAIL, and TWIST as markers associated with EMT. High numbers of CD4+ and CD8+ TILs correlated with nodenegative (P = 0.009 and P = 0.046, respectively) and low SNAIL expression (P = 0.016 and P = 0.022, respectively). High PD-L1 expression was associated with poor histopathological classification (P = 0.034), and low E-cadherin (P = 0.001), high N-cadherin (P = 0.044), high vimentin (P < 0.001) and high ZEB1 (P = 0.036) expression. Multivariate analysis showed that CD4+ TILs, PD-L1 expression and N-cadherin expression were independent prognostic factors (hazard ratio (HR) = 0.61 95% confidence interval (CI) = 0.38-1.00 HR=4.27 95% CI = 1.82-9.39 HR = 2.20 95% CI = 1.18-3.92, respectively). These findings could help to identify potential biomarkers for predicting not only the prognosis, but also the therapeutic response to immunotherapy for eCCA.
• 膵頭十二指腸切除における胃空腸側々吻合は胃内容排出遅延の発症を減少させるか?

  羽根 佑真, 中村 透, 蔦保 暁生, 川村 武史, 宮坂 大介, 中西 善嗣, 浅野 賢道, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 1711 - 1711 2018/04
• 腹腔鏡下鼠径ヘルニア修復術における5mmポート3本での有用性 当院での経験

  サシーム・パウデル, 渡邊 一永, 佐藤 彰記, 大高 和人, 細井 勇人, 東海林 安人, 長谷 龍之介, 仙丸 直人, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 1325 - 1325 2018/04
• 腹臥位胸腔鏡下食道切除術は胸部食道癌の標準術式である

  七戸 俊明, 海老原 裕磨, 倉島 庸, 村上 壮一, 宮坂 大介, 齋藤 崇宏, 野路 武寛, 中村 透, 土川 貴裕, 岡村 圭祐, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 1617 - 1617 2018/04
• R0切除と安全性を追求した当科の肝門部領域胆管癌に対する診断・治療戦略

  野路 武寛, 岡村 圭祐, 川村 武史, 田中 公貴, 中西 善嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 985 - 985 2018/04
• 外科医のトレーニング-技術の継承とは- 術式別技能評価スケールを基盤とした内視鏡外科手術トレーニングプログラムの構築

  倉島 庸, Saseem Poudel, 渡邊 祐介, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 256 - 256 2018/04
• Border line膵癌に対する腹腔動脈合併尾側膵切除術(DP-CAR)の意義 局所進行膵体部癌に対する腹腔動脈合併尾側膵切除術の短期・長期成績

  中村 透, 平野 聡, 浅野 賢道, 野路 武寛, 岡村 圭祐, 土川 貴裕, 村上 壮一, 倉島 庸, 海老原 裕磨, 中西 喜嗣, 田中 公貴, 七戸 俊明

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 603 - 603 2018/04
• UR膵癌に対する治療戦略 切除不能膵癌に対するconversion surgeryの成績と術中迅速病理診断応用の可能性

  浅野 賢道, 平野 聡, 中村 透, 岡村 圭祐, 土川 貴裕, 野路 武寛, 中西 喜嗣, 村上 壮一, 倉島 庸, 海老原 裕磨, 七戸 俊明

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 623 - 623 2018/04
• 胆道癌に対する門脈合併切除を伴う肝膵同時切除の手術成績

  岡村 圭祐, 野路 武寛, 中西 喜嗣, 土川 貴裕, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 浅野 賢道, 田中 公貴, 宮坂 大介, 川村 武史, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 979 - 979 2018/04
• 胆道癌に対する大量肝切除術後の在院死を予測できる新しい肝不全診断基準

  川村 武史, 野路 武寛, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 988 - 988 2018/04
• Siewert type II食道胃接合部癌に対する胸腔鏡・腹腔鏡(Minimally invasive abdominal and left thoracic approach:MALTA)を用いた手術手技

  海老原 裕磨, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 1153 - 1153 2018/04
• 臨床から提唱するIPNBの定義

  中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 野路 武寛, 浅野 賢道, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 2036 - 2036 2018/04
• 消化器外科学教室における急性期外科医・外傷外科医の育成

  村上 壮一, 倉島 庸, 廣瀬 和幸, 川村 武史, 宮坂 大介, 田中 公貴, 中西 喜嗣, 浅野 賢道, 野路 武寛, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 2103 - 2103 2018/04
• 食道癌の術後合併症に対する術前予測スコアの検討

  齋藤 崇宏, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 村上 壮一, 中村 透, 土川 貴裕, 岡村 啓佑, 七戸 俊明, 平野 聡

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 2333 - 2333 2018/04
• 膵頭十二指腸切除術における周術期管理標準化は術後合併症に影響を与えるか? 日本膵切研究会アンケート調査結果報告

  里井 壯平, 山本 智久, 吉富 秀幸, 元井 冬彦, 廣野 誠子, 藤井 努, 和田 慶太, 有光 秀仁, 庄 雅之, 松本 逸平, 平野 聡, 柳本 泰明, 大塚 将之, 海野 倫明, 山上 裕機, 權 雅憲

  日本外科学会定期学術集会抄録集 (一社)日本外科学会 118回 1285 - 1285 2018/04 [Refereed][Not invited]
  
• Two cases of laparoscopic direct spiral closure of large defects in the second portion of the duodenum after laparoscopic endoscopic co-operative surgery

  Saseem Poudel, Yuma Ebihara, Kimitaka Tanaka, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  Journal of Minimal Access Surgery 14 (2) 149 - 153 1998-3921 2018/04/01 [Refereed][Not invited]
   

  Curative endoscopic resection of non-ampullary duodenal lesions, although possible, is challenging. In recent years, although a novel surgical technique named laparoscopic-endoscopic cooperative surgery (LECS), which combines laparoscopic and endoscopic techniques, has made the resection of nonampullary duodenal lesions relatively easier, closure of the defect is still controversial. We report two cases of the duodenal lesion which were closed using a novel technique for primary closure utilising the free wall of the duodenum. Two cases of the duodenal lesion in the second portion of the duodenum were undergone full thickness resection using the LECS technique. The defect is designed spirally to ensure maximum use of the free wall of the duodenum. The mucosal layer is closed using a running suture, and the seromuscular layer is closed using interrupted sutures. The suture line is then reinforced with omentum. There were no intraoperative complications and had uneventful post-operative courses with no leakage, stenosis, or relapse.
• Health-related quality of life of adjuvant chemotherapy with S-1 versus gemcitabine for resected pancreatic cancer: Results from a randomised phase III trial (JASPAC 01).

  Yasuhiro Hagiwara, Yasuo Ohashi, Katsuhiko Uesaka, Narikazu Boku, Akira Fukutomi, Yukiyasu Okamura, Masaru Konishi, Ippei Matsumoto, Yuji Kaneoka, Yasuhiro Shimizu, Shoji Nakamori, Hirohiko Sakamoto, Soichiro Morinaga, Osamu Kainuma, Koji Imai, Naohiro Sata, Shoichi Hishinuma, Hitoshi Ojima, Ryuzo Yamaguchi, Satoshi Hirano, Takeshi Sudo

  European journal of cancer (Oxford, England : 1990) 93 79 - 88 0959-8049 2018/04 [Refereed][Not invited]
   

  BACKGROUND: Adjuvant chemotherapy with S-1 for resected pancreatic cancer demonstrated survival benefits compared with gemcitabine in the JASPAC 01 trial. We investigated the effect of these agents on health-related quality of life (HRQOL) of patients in the JASPAC 01 trial. METHODS: Patients with resected pancreatic cancer were randomly assigned to receive gemcitabine (1000 mg/m2 weekly for three of four weeks for up to six cycles) or S-1 (40, 50, or 60 mg twice daily for four of six weeks for up to four cycles). HRQOL was assessed using the EuroQol-5D-3L (EQ-5D) questionnaire at baseline, months three and six, and every 6 months thereafter. HRQOL end-points included change in EQ-5D index from baseline, responses to five items in the EQ-5D, and quality-adjusted life months up to 24 months. RESULTS: Of randomised 385 patients, 354 patients were included in HRQOL analysis. Mean change in the EQ-5D index was similar in the S-1 and gemcitabine groups within 6 months from treatment initiation (difference, 0.024; P = 0.112), whereas corresponding mean from 12 to 24 months was better in the S-1 group than in the gemcitabine group (difference, 0.071; P < 0.001). Problems in mobility and pain/discomfort were also less frequent in the S-1 group than in the gemcitabine group in that period. Quality-adjusted life months were longer in the S-1 group than in the gemcitabine group (P < 0.001). CONCLUSION: Adjuvant chemotherapy with S-1 does not improve HRQOL within 6 months from treatment initiation but does improve HRQOL thereafter and quality-adjusted life months. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000000655 at UMIN CTR.
• 腹腔鏡下胃全摘における食道空腸吻合法の検討(Circular stapler versus linear stapler after LTG: a propensity score matching method)

  海老原 裕磨, 京極 典憲, 七戸 俊明, 倉島 庸, 村上 壮一, 中村 文隆, 村川 力彦, 森田 高行, 奥芝 俊一, 平野 聡

  日本胃癌学会総会記事 90回 406 - 406 2018/03
• 高齢者胃癌(80歳以上)に対する腹腔鏡下胃全摘術に関する検討 多施設共同後ろ向きコホート観察研究

  宮坂 大介, 海老原 裕磨, 中西 喜嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 中村 文隆, 村川 力彦, 森田 高行, 奥芝 俊一, 平野 聡

  日本胃癌学会総会記事 (一社)日本胃癌学会 90回 508 - 508 2018/03
• Outcome of concomitant resection of the replaced right hepatic artery in pancreaticoduodenectomy without reconstruction

  Toshimichi Asano, Toru Nakamura, Takehiro Noji, Keisuke Okamura, Takahiro Tsuchikawa, Yoshitsugu Nakanishi, Kimitaka Tanaka, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe, Satoshi Hirano

  Langenbeck's Archives of Surgery 403 (2) 195 - 202 1435-2451 2018/03/01 [Refereed][Not invited]
   

  Purpose: It has been reported that preoperative embolization or intraoperative reconstruction of the replaced right hepatic artery (rRHA) in order to secure the arterial blood flow to the liver and biliary tract are useful for patients who have undergone pancreaticoduodenectomy (PD) with concomitant rRHA resection. In this study, the feasibility of concomitant resection of rRHA in PD without preoperative embolization or intraoperative reconstruction were retrospectively evaluated with a particular focus on postoperative complications. Methods: We retrospectively analyzed 323 consecutive patients who underwent PD. Results: In 51 patients (15.8%), an rRHA was detected. Nine of 51 patients underwent combined rRHA resection during PD. Eight patients showed tumor abutment, and one patient had accidental intraoperative damage of the rRHA. Although there were no cases of bilioenteric anastomotic failure, a hepatic abscess occurred in one patient. This patient was treated with percutaneous transhepatic abscess drainage and was cured immediately without suffering sepsis. Postoperative complications of Clavien-Dindo classification ≥ IIIa were found in three patients, and R0 resection was achieved in six. Surgical outcomes showed no significant differences between the rRHA-resected and non-resected groups. Moreover, there were no significant differences in laboratory data related to liver functions between the rRHA-resected and non-resected groups before surgery and on postoperative days 1, 3, 5, and 7. Conclusions: Simple resection of the rRHA following an unintended or accidental injury during PD is not associated with severe morbidity and should be considered as an alternative to a technically difficult reconstruction.
• Serum immunoglobulin E response as a marker for unfavorable prognosis following cholesteryl pullulan-MAGE A4 vaccination

  Takehiro Abiko, Takahiro Tsuchikawa, Kengo Miyauchi, Masataka Wada, Noriaki Kyogoku, Toshiaki Shichinohe, Yoshihiro Miyahara, Shinichi Kageyama, Hiroaki Ikeda, Hiroshi Shiku, Satoshi Hirano

  Oncology Letters 15 (3) 3703 - 3711 1792-1082 2018/03/01 [Refereed][Not invited]
   

  Since 2009, a cancer vaccine clinical trial was conducted with melanoma antigen gene-A4 as an immunogenic agent. The levels of IgG1, IgG2 and IgG3, which are known to be Type 1 T helper cell-associated antibodies, and the levels of IgG4 and IgE, which are known to be Type 2 T helper cell-associated antibodies, were measured and used as biomarkers for predicting therapeutic effect. The results of the present study indicated a strong positive correlation between IgG2 and IgG4, with a correlation coefficient of R=0.808 (P< 0.0001). The survival time of patients in which IgE responses were induced was significantly shorter compared with the survival time of patients with no IgE induction. The results of the present study suggest that caution is required when antigen-specific IgE responses are induced during cancer vaccination therapy.
• Clinical implications of CD4+CD25+Foxp3+regulatory t cell frequencies after chp-mage-a4 cancer vaccination

  Masataka Wada, Takahiro Tsuchikawa, Noriaki Kyogoku, Takehiro Abiko, Kengo Miyauchi, Shintaro Takeuchi, Toshihiko Kuwatani, Toshiaki Shichinohe, Yoshihiro Miyahara, Shinichi Kageyama, Hiroaki Ikeda, Hiroshi Shiku, Satoshi Hirano

  Anticancer Research 38 (3) 1435 - 1444 1791-7530 2018/03/01 [Refereed][Not invited]
   

  Background/Aim: The aim of this study was to explore whether the treatment effect or immune response to a cancer vaccine can be predicted by the percentage of CD4+CD25+Foxp3+ regulatory T cells (Tregs) in peripheral blood mononuclear cells (PBMCs) after vaccination. Patients and Methods: Sixteen patients (9 men, 7 women median age 61.5 years) enrolled in the CHP-MAGE-A4 cancer vaccine clinical trial who had a fixed dose (300 μg of CHP-MAGE-A4 cancer vaccine and 0.5 Klinische Einheit (KE) of OK432 and received at least four vaccinations were investigated. Safety, immune response, and clinical effects were assessed before and after the cancer vaccination. Results: Treg ratios that remained low both before and after vaccination were associated with a good prognosis, and a low Treg/CD4 lymphocyte ratio 7-weeks after the initial vaccination was correlated with a better prognosis. Conclusion: The Treg ratio following vaccination appears to have some utility for predicting patient prognosis.
• The surgical outcome of minimally invasive pharyngo-laryngo-oesophagectomy in prone position.

  Ogino M, Ebihara Y, Homma A, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  Journal of minimal access surgery 15 (2) 98 - 102 0972-9941 2018/03 [Refereed][Not invited]
   

  PURPOSE: Pharyngo-laryngo-oesophagectomy (PLE) which is mainly indicated for cervical oesophageal cancer or synchronous double cancer of the thoracic oesophagus and the pharynx or larynx, is extremely invasive. Since minimally invasive oesophagectomy (MIE) using video-assisted thoracic surgery has become popular recently, the procedure can be adopted to PLE. Moreover, the use of the prone position (PP) in MIEs has been increasing recently because technical advantages and fewer post-operative complications were reported. To assess the validity of PP, this study compared surgical outcomes of minimally invasive PLE (MIPLE) in PP with that in the left lateral decubitus position (LLDP). PATIENTS AND METHODS: This study enrolled consecutive 15 patients that underwent MIPLE with LLDP (n = 7) or PP (n = 8) between January 1996 and October 2016. The patients' background characteristics, operative findings and post-operative complications were examined. RESULTS: Eligible diseases are 5 cases of cervical oesophageal cancer, 9 cases of synchronous double cancer of the thoracic oesophagus and head and neck and 1 case of cervical oesophageal recurrence of the head-and-neck cancer. The patients' background characteristics were not significantly different. During surgery, thoracic blood loss was significantly lower in PP than in LLDP (P = 0.0487). Other operative findings and post-operative complications were not significantly different between the two groups. CONCLUSIONS: In MIPLE, the PP could reduce blood loss due to the two-lung ventilation under artificial pneumothorax and was associated with lower surgical stress than LLDP.
• Long-term survival after repeated resection of metachronous lung metastases from pStage IA pancreatic adenocarcinoma

  Mamoru Miyasaka, Takehiro Noji, Kazuto Ohtaka, Ryohei Chiba, Shoki Sato, Yasuhito Shoji, Ryunosuke Hase, Tatsunosuke Ichimura, Satoshi Hirano, Naoto Senmaru

  Clinical Journal of Gastroenterology 11 (1) 53 - 61 1865-7265 2018/02/01 [Refereed][Not invited]
   

  Case report: A 70-year-old woman with pancreatic ductal adenocarcinoma was initially treated by distal pancreatectomy (DP). Thirty-five months later, another tumor appeared in the pancreatic head and was treated by pancreaticoduodenectomy. Histopathological findings identified both tumors as pancreatic ductal adenocarcinoma pStage IA. Computed tomography (CT) of the chest 16 months after the second pancreatectomy revealed a ground-glass opacity in segment 3 of the right lung. Chest CT 23 months after the second pancreatectomy revealed a nodular shadow in segment 1a of the right lung. Chest CT 39 months after the second pancreatectomy revealed a nodular shadow in segment 5 of the left lung. These lesions were treated by video-assisted thoracoscopic surgery partial resection. Histopathological and immunohistochemical features (positive for cytokeratin (CK)7 and CK20, negative for transcription factor-1) for these three lesions and the secondary pancreatic ductal adenocarcinoma were similar, indicating a diagnosis of lung metastasis from the second pancreatic ductal adenocarcinoma. The patient has remained alive and free of new metastases for 8 years after initial DP, 3 years after the last lung resection. Conclusion: This patient has survived over the long term after undergoing three resections of lung metastases from resected pancreatic ductal adenocarcinoma.
• General surgery education across three continents.

  McIlhenny C, Kurashima Y, Chan C, Hirano S, Domínguez-Rosado I, Stefanidis D

  American journal of surgery 215 (2) 209 - 213 0002-9610 2018/02 [Refereed][Not invited]
   

  Surgical education has seen tremendous changes in the US over the past decade. The Halstedian training model of see one, do one, teach one that governed surgical training for almost 100 years has been replaced by the achievement of the ACGME competencies, milestones, entrustable professional activities (EPAs), and acquisition of surgical skill outside the operating room on simulators. Several of these changes in American medical education have been influenced by educators and training paradigms abroad. In this paper, we review the training paradigms for surgeons in the UK, Japan, and Mexico to allow comparisons with the US training paradigm and promote the exchange of ideas.
• Postoperative Liver Failure Criteria for Predicting Mortality after Major Hepatectomy with Extrahepatic Bile Duct Resection.

  Kawamura T, Noji T, Okamura K, Tanaka K, Nakanishi Y, Asano T, Ebihara Y, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Shichinohe T, Hirano S

  Digestive surgery 36 (2) 158 - 165 0253-4886 2018/02 [Refereed][Not invited]
   

  BACKGROUND: Post-hepatectomy liver failure (PHLF) is a serious complication after major hepatectomy with extrahepatic bile duct resection (Hx with EBDR) that may cause severe morbidity and even death. The purpose of this study was to compare several criteria systems as predictors of PHLF-related mortality following Hx with EBDR for perihilar cholangiocarcinoma (PHCC). METHODS: The study cohort consisted of 222 patients who underwent Hx with EBDR for PHCC. We compared several criteria systems, including previously established criteria (the International Study Group of Liver Surgery (ISGLS) criterion; and the "50-50" criterion), and our institution's novel systems "Max T-Bili" defined as total bilirubin (T-Bili) >7.3 mg/dL during post-operative days (POD) 1-7, and the "3-4-50" criterion, defined as total bilirubin >4 mg/dL and prothrombin time <50% on POD #3. RESULTS: Thirteen patients (5.8%) died from PHLF-related causes. The 3-4-50 criterion showed high positive predictive values (39.1%), the 3-4-50, Max T-Bili, and 50-50 criterion showed high accuracies (91.7, 86.9, and 90.5%, respectively) and varying sensitivities (69.2, 69.2, and 38.5% respectively). CONCLUSIONS: The 3-4-50, Max T-Bili, and 50-50 criterion were all useful for predicting PHLF-related mortality after Hx with EBDR for PHCC.
• Impact of serum carbohydrate antigen 19-9 level on prognosis and prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma.

  Yamada T, Nakanishi Y, Okamura K, Tsuchikawa T, Nakamura T, Noji T, Asano T, Tanaka K, Kurashima Y, Ebihara Y, Murakami S, Shichinohe T, Mitsuhashi T, Hirano S

  Journal of gastroenterology and hepatology 0815-9319 2018/02 [Refereed][Not invited]
   

  BACKGROUND AND AIM: Lymph node metastasis is an important prognostic factor for intrahepatic cholangiocarcinoma (ICC), but accurate preoperative diagnosis is difficult. The aim of this study was to measure the concentration of serum carbohydrate antigen 19-9 (s-CA19-9) as a preoperative predictor of lymph node metastasis. METHODS: In our department, curative-intent hepatectomy for ICC has been performed only once the absence of metastases in para-aortic lymph nodes (PALN) has been confirmed from intraoperative frozen-section pathological examinations. The present study included 13 non-resected ICC patients with PALN metastasis (PALN group) and 44 resected ICC patients without PALN metastasis (non-PALN group). S-CA19-9 was examined to evaluate predictive performance for PALN metastasis and regional lymph node metastasis (pN1) from analysis of the receiver operating characteristic curve. In the non-PALN group, univariate and multivariate analyses for survival were performed on clinicopathological variables. RESULTS: From receiver operating characteristic curve analysis, s-CA19-9 showed good diagnostic accuracy for PALN metastasis (68%; cut-off, 200 U/mL) and pN1 (77%; cut-off, 100 U/mL). In univariate analysis, age (<65 years), s-CA19-9 (≥100 U/mL), portal vein resection, pN1, and positive resection margin (R1) were all identified as significant negative prognostic factors. Five-year survival rates of patients with high s-CA19-9 and pN1 were 6.9% and 7.3%, respectively. In multivariate analysis, high s-CA19-9 and R1 represented independent predictors of poor prognosis. CONCLUSIONS: Preoperative s-CA19-9 appears useful as a biomarker in patients with ICC, for predicting not only lymph node metastasis but also prognosis after surgical resection with curative intent.
• Tertiary lymphoid organs as a good prognostic indicator following neoadjuvant chemo(radio)therapy for pancreatic cancer

  Kuwabara Shota, Tsuchikawa Takahiro, Nakanishi Yoshitsugu, Asano Toshimichi, Noji Takehiro, Kurashima Yo, Ebihara Yuma, Murakami Soichi, Nakamura Toru, Okamura Keisuke, Shichinohe Toshiaki, Hirano Satoshi

  CANCER SCIENCE 109 710  1349-7006 2018/01 [Refereed][Not invited]
  
• Mesh trimming and suture reconstruction for wound dehiscence after huge abdominal intercostal hernia repair: A case report.

  Takeuchi Y, Kurashima Y, Nakanishi Y, Asano T, Noji T, Ebihara Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S

  International journal of surgery case reports 53 381 - 385 2018 [Refereed][Not invited]
   

  INTRODUCTION: Abdominal intercostal hernia repair for huge incisional hernia after thoracoabdominal surgery involves a complex anatomical structure. Hence, it is difficult to apply the laparoscopic approach to large hernias in the lateral upper abdomen. Further the optimal approach to mesh exposure without infection after incisional hernia repair is still controversial. Herein, we describe our experience of repairing a huge abdominal intercostal hernia by mesh trimming and suture reconstruction for wound dehiscence. PRESENTATION OF CASE: A 73-year-old man presented with an incisional hernia in the left flank from just below the eight intercostal space to the transverse umbilical region 6 months after thoracoabdominal aortic aneurysm surgery. Computed tomography revealed an incisional hernia orifice of 17 × 13 cm located on the left flank around the ninth rib. We chose the open approach as treatment because the hernia orifice was large, and we created a mesh placement space in the extraperitoneal cavity and placed expanded polytetrafluoroethylene mesh there with 1-0 nonabsorbable monofilament suture. At postoperative day 26, we observed mesh exposure due to wound dehiscence. Mesh trimming and suture reconstruction for wound dehiscence was performed because there were no signs of wound infection. The postoperative course was uneventful including infection and dehiscence. The patient has been well without recurrence for 14 months since last operation. CONCLUSIONS: Optimal treatment for repair of a large abdominal intercostal hernia with thoracoabdominal location is necessary. Moreover, partial mesh removal may be one of the treatment options for mesh exposure if conditions are met.
• Clinicopathological features and prognosis of advanced biliary carcinoma centered in the cystic duct

  Yoshitsugu Nakanishi, Takahiro Tsuchikawa, Keisuke Okamura, Toru Nakamura, Takehiro Noji, Toshimichi Asano, Kimitaka Tanaka, Toshiaki Shichinohe, Tomoko Mitsuhashi, Satoshi Hirano

  HPB 20 (1) 28 - 33 1477-2574 2018/01/01 [Refereed][Not invited]
   

  Background Whether to classify “advanced (subserosal layer or greater invasion)” biliary carcinoma centered in the cystic duct (BCCD) as gallbladder carcinoma (GBC) or perihilar cholangiocarcinoma (PHCC) remains unclear. Methods The clinicopathological features and overall survival (OS) of patients with advanced BCCD were examined through a comparison with those of patients with advanced PHCC and with GBC. Results 290 patients were classified as 199 PHCC, 44 GBC, and 47 BCCD. Patients with BCCD (median, 23 months) had significantly worse OS than those with PHCC (44 months, p = 0.030). OS of patients with BCCD, all of whom were classified as pT3 or pT4 by the American Joint Committee on Cancer (AJCC) classification of GBC, was similar to 27 patients with pT3 or pT4 GBC (23 months, p = 0.840). When the patients with BCCD were classified by the AJCC classification of PHCC, 36 were classified as pT2. OS among the patients with BCCD classified as pT2 by the PHCC classification (29 months) was significantly worse than that among patients classified as pT2 PHCC (48 months, p = 0.040). Conclusion These findings suggest that advanced BCCD is appropriately classified as a subtype of GBC because it can grow through the serosa.
• The surgical outcomes of totally laparoscopic stomach-partitioning gastrojejunostomy for gastric outlet obstruction: A retrospective, cohort study

  Toshihiro Kushibiki, Yuma Ebihara, Koji Hontani, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 28 (2) e49 - e53 1534-4908 2018 [Refereed][Not invited]
   

  Background: We have reported the effectiveness of laparoscopy-assisted stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (LASPGJ-RY) for gastric outlet obstruction (GOO). The aim of this study was to evaluate the surgical outcomes of totally laparoscopic stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (TLSPGJ-RY) for GOO. Materials and Methods: This retrospective study enrolled 19 consecutive patients with GOO. Surgical outcomes of LASPGJ-RY (LA group n =8) and TLSPGJ-RY (TL group n= 11) between January 2004 and 2015 were compared. The patients' background characteristics, operative findings, postoperative complications, and period to starting postoperative chemotherapy were examined. Results: Eligible cases included 6 patients with gastric cancer, 4 with pancreatic cancer, 4 with duodenal cancer, 4 with urologic malignancies, and 1 with benign duodenal stenosis. The patients' background characteristics were not significantly different. In surgical outcomes, there were no significant differences in operating time, bleeding, complications (≥Clavien-Dindo grade IIIA), and postoperative hospital stay between the groups. The time to resume diet was significantly shorter in the TL group (median, 3 d range, 3 to 6 d) than in the LA group (median, 5 d range, 3 to 7 d P=0.0093), and the number of patients who could receive chemotherapy after surgery was significantly higher in the TL group (P=0.039). Conclusions: TLSPGJ-RY was a safe and feasible gastrojejunostomy procedure for GOO. TLSPGJ-RY might be useful for early resumption of oral intake after surgery.
• Patient-oriented optimal depth of conscious sedation using midazolam during flexible bronchoscopy: A prospective open-labeled single-arm trial

  Yuichiro Takeda, Hibiki Udagawa, Shinji Nakamichi, Yasuto Yoneshima, Motoyasu Iikura, Satoshi Hirano, Go Naka, Haruhito Sugiyama

  Respiratory Investigation 56 (4) 349 - 355 2212-5353 2018 [Refereed][Not invited]
   

  Background: The British Thoracic Society guidelines for diagnostic flexible bronchoscopy (FB) in adults recommend that intravenous sedation should be offered to patients undergoing bronchoscopy. However, it is difficult to determine the adequate depth of sedation for each patient because of inter-individual variability. Methods: This prospective, open-label, single-arm study was conducted in patients undergoing routine bronchus examination with FB. All patients underwent FB under local anesthesia and conscious sedation, with initial administration of 0.03 mg/kg midazolam. The sedation level during FB was objectively assessed using the Ramsay sedation score (RSS). Two hours after the procedure, patients completed a questionnaire about its efficacy and adverse effects using a visual analog scale (VAS). Receiver operating characteristic (ROC) curve analyses were performed to determine the optimal RSS that could improve the subjective efficacy indicated by the VAS. Results: This study enrolled 110 consecutive patients between September 2008 and February 2012. The median total amount of midazolam administered was 1.65 mg per patient. In an analysis of ROC curves between RSS and VAS, the area under the ROC curve for an RSS of 4 against the others was 0.66 (95% CI: 0.54 to 0.77, p = 0.014). The area under the ROC curve was not shown to be statistically significant for RSSs other than 4. Conclusions: The optimal depth of conscious sedation during FB for conventional examination was achieved at an RSS of 4. The patients’ subjective evaluations indicated that a deep level of conscious sedation does not seem necessary for FB.
• Surgical technique and results of intrapancreatic bile duct resection for hilar malignancy (with video)

  Takehiro Noji, Keisuke Okamura, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Satoshi Hirano

  HPB 20 (12) 1145 - 1149 1477-2574 2018 [Refereed][Not invited]
   

  Background: Hilar malignancy can occasionally be associated with high grade dysplasia (HGD) adjacent to invasive malignancy. For patients with HGD extending into the intrapancreatic bile duct, the authors adopted intrapancreatic bile duct resection (IP-BDR). The aims of this study were to compare the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF), distal R0 resection and local recurrence within the distal bile duct remnant for patients undergoing extrahepatic bile duct resection without pancreaticoduodenectomy (with or without IP-BDR). Methods: Patients who presented with hilar malignancy and underwent extrahepatic bile duct resection without pancreaticoduodenectomy between January 2005 and December 2016 were identified and the outcomes retrospectively evaluated. Results: Of 217 patients who met the inclusion criteria 62 (29%) patients underwent IP-BDR. There was a significant difference between patients undergoing standard resection vs. IP-BDR in terms of CR-POPF (5% (8/155) patients: vs 18% (11/62), p < 0.001). There were no significant differences between two groups of R0 status on distal margin (5% (8/155) patients: vs 10% (6/62), p = 0.359). No patient developed recurrence within the residual intrapancreatic bile duct. Discussion: The incidence of CR-POPF after IP-BDR for hilar malignancies was 18%. IP-BDR was associated with CR-POF, but does not appear to alter survival or local recurrence rate.
• Laparoscopic repair with cone-shaped mesh implantation for perineal hernia occurred after laparoscopic abdominoperineal resection.

  Teramura K, Watanabe Y, Takeuchi S, Nakamura F, Hirano S

  International journal of surgery case reports 49 115 - 117 2018 [Refereed][Not invited]
   

  INTRODUCTION: Perineal hernia after abdominoperineal resection (APR) is a rare complication, and no standard surgical procedures are established. We describe a simple laparoscopic mesh implantation technique utilizing a large synthetic flat mesh. PRESENTATION OF CASE: We report a case of perineal hernia after APR. We performed laparoscopic repair using a soft and large synthetic mesh with simple technique. The essence of this technique is that mesh is inserted into the abdominal cavity without trimming and it forms in a conical shape to better adjust to the pelvic cavity. DISCUSSION: The perineal and laparoscopic approaches for perineal hernia repair have been performed most commonly in recent years, but the recurrence rate after repair remains high (24.1%). Using a large mesh could cover the hernial orifice with a sufficient margin, reducing a risk of recurrence caused by shrinkage and slippage of the mesh. CONCLUSION: Our technique utilizing a large, lightweight, synthetic mesh can be practical and useful for perineal hernia repair after laparoscopic APR.
• Proposed Nomogram Predicting the Individual Risk of Malignancy in the Patients With Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas

  Jin-Young Jang, Taesung Park, Selyeong Lee, Yongkang Kim, Seung Yeoun Lee, Sun-Whe Kim, Song-Cheol Kim, Ki-Byung Song, Masakazu Yamamoto, Takashi Hatori, Seiko Hirono, Sohei Satoi, Tsutomu Fujii, Satoshi Hirano, Yasushi Hashimoto, Yashuhiro Shimizu, Dong Wook Choi, Seong Ho Choi, Jin Seok Heo, Fuyuhiko Motoi, Ippei Matsumoto, Woo Jung Lee, Chang Moo Kang, Ho-Seong Han, Yoo-Seok Yoon, Masayuki Sho, Hiroaki Nagano, Goro Honda, Sang Geol Kim, Hee Chul Yu, Jun Chul Chung, Yuichi Nagakawa, Hyung Il Seo, Hiroki Yamaue

  ANNALS OF SURGERY 266 (6) 1062 - 1068 0003-4932 2017/12 [Refereed][Not invited]
   

  Objectives: This study evaluated individual risks of malignancy and proposed a nomogram for predicting malignancy of branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) using the large database for IPMN. Background: Although consensus guidelines list several malignancy predicting factors in patients with BD-IPMN, those variables have different predictability and individual quantitative prediction of malignancy risk is limited. Methods: Clinicopathological factors predictive of malignancy were retrospectively analyzed in 2525 patients with biopsy proven BD-IPMN at 22 tertiary hospitals in Korea and Japan. The patients with main duct dilatation > 10 mm and inaccurate information were excluded. Results: The study cohort consisted of 2258 patients. Malignant IPMNs were defined as those with high grade dysplasia and associated invasive carcinoma. Of 2258 patients, 986 (43.7%) had low, 443 (19.6%) had intermediate, 398 (17.6%) had high grade dysplasia, and 431 (19.1%) had invasive carcinoma. To construct and validate the nomogram, patients were randomly allocated into training and validation sets, with fixed ratios of benign and malignant lesions. Multiple logistic regression analysis resulted in five variables (cyst size, duct dilatation, mural nodule, serum CA19-9, and CEA) being selected to construct the nomogram. In the validation set, this nomogram showed excellent discrimination power through a 1000 times bootstrapped calibration test. Conclusion: A nomogram predicting malignancy in patients with BD-IPMN was constructed using a logistic regression model. This nomogram may be useful in identifying patients at risk of malignancy and for selecting optimal treatment methods. The nomogram is freely available at http://statgen.snu.ac.kr/software/nomogramIPMN.
• Primary malignant melanoma of the esophagus treated with subtotal esophagectomy: a case report

  Shota Kuwabara, Yuma Ebihara, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  BMC SURGERY 17 (1) 122 - 122 1471-2482 2017/12 [Refereed][Not invited]
   

  Background: Primary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis. There are few reports of early-stage cases in which tumor invasion reached the lamina propria or muscularis mucosae, as in the present case. A standard treatment for early-stage PMME has not yet been established. The present study aimed to summarize previous reports and to discuss the indications for surgical treatment of early-stage primary malignant melanoma of the esophagus. Case presentation: A 70-year-old woman with PMME was referred to our hospital. She underwent thoracoscopic and laparoscopic subtotal esophagectomy with lymphadenectomy. The resected specimen showed melanocytosis and junctional activity. Melanoma-specific antigens melan-A, S-100, and HMB45 were detected by immunohistochemical staining. The pathological diagnosis was pT1a-MM, pN0, pM0, and pStage IA. She remains alive without evidence of recurrence 39 months later. Conclusion: Subtotal esophagectomy with regional radical lymphadenectomy could be recommended to patients with early-stage primary malignant melanoma of the esophagus, and curative surgical resection could improve their prognosis.
• 食道癌患者の栄養状態がGLUT-1、HIF-1α発現、SUV値に与える影響についての検討

  上野 峰, 海老原 裕磨, 京極 典憲, 田中 公貴, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡, 三橋 智子, 鯉沼 潤吉

  北海道医学雑誌 北海道医学会 92 (2) 114 - 115 0367-6102 2017/11
• Training with a balance exercise assist robot is more effective than conventional training for frail older adults

  Kenichi Ozaki, Izumi Kondo, Satoshi Hirano, Hitoshi Kagaya, Eiichi Saitoh, Aiko Osawa, Yoichi Fujinori

  GERIATRICS & GERONTOLOGY INTERNATIONAL 17 (11) 1982 - 1990 1444-1586 2017/11 [Refereed][Not invited]
   

  AimTo examine the efficacy of postural strategy training using a balance exercise assist robot (BEAR) as compared with conventional balance training for frail older adults. MethodsThe present study was designed as a cross-over trial without a washout term. A total of 27 community-dwelling frail or prefrail elderly residents (7 men, 20 women; age range 65-85 years) were selected from a volunteer sample. Two exercises were prepared for interventions: robotic exercise moving the center of gravity by the balance exercise assist robot system; and conventional balance training combining muscle-strengthening exercise, postural strategy training and applied motion exercise. Each exercise was carried out twice a week for 6 weeks. Participants were allocated randomly to either the robotic exercise first group or the conventional balance exercise first group. Main outcome measures: preferred and maximal gait speeds, tandem gait speeds, timed up-and-go test, functional reach test, functional base of support, center of pressure, and muscle strength of the lower extremities were assessed before and after completion of each exercise program. ResultsRobotic exercise achieved significant improvements for tandem gait speed (P = 0.012), functional reach test (P = 0.002), timed up-and-go test (P = 0.023) and muscle strength of the lower extremities (P = 0.001-0.030) compared with conventional exercise. ConclusionsIn frail or prefrail older adults, robotic exercise was more effective for improving dynamic balance and lower extremity muscle strength than conventional exercise. These findings suggest that postural strategy training with the balance exercise assist robot is effective to improve the gait instability and muscle weakness often seen in frail older adults. Geriatr Gerontol Int 2017; 17: 1982-1990.
• Laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor located in the second portion of the duodenum: A case report.

  Umemoto K, Nakanishi Y, Murakawa K, Suzuki T, Yamamura Y, Ono K, Hirano S

  Asian journal of endoscopic surgery 10 (4) 411 - 414 1758-5902 2017/11 [Refereed][Not invited]
   

  Gastrointestinal stromal tumors of the duodenum are rare. For benign tumors, premalignant lesions, or malignant potential tumors located in the second portion of the duodenum close to the papilla of Vater, pancreaticoduodenectomy is sometimes performed. A case of laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor at the second portion of the duodenum is reported. The surgical procedure was performed as follows: first, the second portion of the duodenum was separated from the pancreatic head; second, the duodenum was cut off with the linear stapler after having confirmed preservation of the papilla by intraoperative endoscopy; and third, reconstruction was carried out by a side-to-side duodenojejunostomy. Laparoscopic segmental duodenectomy for duodenal gastrointestinal stromal tumors is thought to be advantageous compared with pancreaticoduodenectomy in terms of low burden and organ function preservation. The present procedure is feasible for benign or low-malignant tumors that do not infiltrate outside of the duodenal walls.
• Inner Blood-Retinal Barrier Dominantly Expresses Breast Cancer Resistance Protein: Comparative Quantitative Targeted Absolute Proteomics Study of CNS Barriers in Pig

  Zhengyu Zhang, Yasuo Uchida, Satoshi Hirano, Daisuke Ando, Yoshiyuki Kubo, Seppo Auriola, Shin-ichi Akanuma, Ken-ichi Hosoya, Arto Urtti, Tetsuya Terasaki, Masanori Tachikawa

  MOLECULAR PHARMACEUTICS 14 (11) 3729 - 3738 1543-8384 2017/11 [Refereed][Not invited]
   

  The purpose of this study was to determine absolute protein expression levels of transporters at the porcine inner blood-retinal barrier (BRB) and to compare the transporter protein expression quantitatively among the inner BRB, outer BRB, blood-brain barrier (BBB), and blood-cerebrospinal fluid barrier (BCSFB). Crude membrane fractions of isolated retinal capillaries (inner BRB) and isolated retinal pigment epithelium (RPE, outer BRB) were prepared from porcine eyeballs, while plasma membrane fractions were prepared from isolated porcine brain capillaries (BBB) and isolated choroid plexus (BCSFB). Protein expression levels of 32 molecules, including 16 ATP-binding-cassette (ABC) transporters and 13 solute-carrier (SLC) transporters, were measured using a quantitative targeted absolute proteomic technique. At the inner BRB, five molecules were detected: breast cancer resistance protein (BCRP, ABCG2; 22.8 fmol/mu g protein), multidrug resistance protein 1 (MDR1, ABCB1; 8.70 fmol/mu g protein), monocarboxylate transporter 1 (MCT1, SLC16A1; 4.83 fmol/mu g protein), glucose transporter 1 (GLUT1, SLC2A1; 168 fmol/mu g protein), and sodium potassium adenosine triphosphatase (Na+/K+- ATPase; 53.7 fmol/mu g protein). Other proteins were under the limits of quantification. Expression of MCT1 was at least 17.6-, 11.0-, and 19.2-fold greater than those of MCT2, 3, and 4, respectively. The transporter protein expression at the inner BRB was most highly correlated with that at the BBB (R-2 = 0.8906), followed by outer BRB (R-2 = 0.7988) and BCSFB (R-2 = 0.4730). Sodium-dependent multivitamin transporter (SMVT, SLCSA6) and multidrug resistance-associated protein 1 (MRP1, ABCC1) were expressed at the outer BRB (0.378 and 1.03 fmol/mu g protein, respectively) but were under the limit of quantification at the inner BRB. These findings may be helpful for understanding differential barrier function.
• 術前因子を用いた肝門部領域胆管癌術後死亡予測モデルのvalidation study

  野路 武寛, 植村 慧子, 川村 武史, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 50 (Suppl.2) 524 - 524 0386-9768 2017/10
• 肝門部胆管癌術後の肝不全に対する新しい定義(ISGLSの定義との比較)

  川村 武史, 野路 武寛, 梅本 一史, 荻野 真理子, 佐藤 理, 京極 典憲, 齋藤 博紀, 田中 公貴, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 50 (Suppl.2) 525 - 525 0386-9768 2017/10
• 術前因子を用いた肝門部領域胆管癌術後死亡予測モデルのvalidation study

  野路 武寛, 植村 慧子, 川村 武史, 田中 公貴, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 50 (Suppl.2) 524 - 524 0386-9768 2017/10
• 肝門部胆管癌術後の肝不全に対する新しい定義(ISGLSの定義との比較)

  川村 武史, 野路 武寛, 梅本 一史, 荻野 真理子, 佐藤 理, 京極 典憲, 齋藤 博紀, 田中 公貴, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 50 (Suppl.2) 525 - 525 0386-9768 2017/10
• Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Pancreaticoduodenectomy: Result of a Propensity Score Matching

  Akio Tsutaho, Toru Nakamura, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Takehiro Noji, Yoshitsugu Nakanishi, Kimitaka Tanaka, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Toshiaki Shichinohe, Yoichi M. Ito, Satoshi Hirano

  JOURNAL OF GASTROINTESTINAL SURGERY 21 (10) 1635 - 1642 1091-255X 2017/10 [Refereed][Not invited]
   

  Background Delayed gastric emptying (DGE) is one of the most common morbidities of pancreaticoduodenectomy (PD). The aim of this study was to clarify whether the incidence of DGE can be reduced by side-to-side gastric greater curvature-to-jejunal anastomosis in subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). Methods The clinical data of 253 patients who had undergone PD were examined. Of a total of 188 patients who had undergone SSPPD, a gastrojejunostomy (GJ) was performed with end-to-side anastomosis in 87 patients (SSPPD-ETS group), and a GJ was performed with a greater curvature side-to-jejunal side anastomosis in 101 patients (SSPPD-STS group). After propensity score matching, the matched cohort consisted of 74 patients in each group. The postoperative data were evaluated according to the International Study Group of Pancreatic Surgery grade of DGE. Results The total incidence of DGE was 9.4% in the SSPPD-ETS group and 4% in the SSPPD-STS group, with no significant difference (p = 0.1902). A significant difference was observed between the two groups in the incidence of DGE grade C (p = 0.0426). Conclusions The incidence of total DGE was not reduced statistically in the STS group compared with the ETS group, but reduced DGE grade C. Side-to-side anastomosis might be associated with a reduced incidence of DGE grade C.
• Laparoscopic Resection of a Jejunal Mesenteric Pseudocyst

  Takumi Yamabuki, Masato Suzuoki, Tsuzuku Murakami, Satoshi Hirano

  Case Reports in Gastroenterology 11 (3) 526 - 530 1662-0631 2017/09/06 [Refereed][Not invited]
   

  An unusual case of a jejunal mesenteric pseudocyst treated by laparoscopic resection is reported. A 44-year-old woman was admitted to our hospital with intermittent upper abdominal pain and diarrhea. Physical examination revealed slight periumbilical tenderness, and no masses were palpable. Contrast-enhanced computed tomography showed a 4-cm-sized nonenhancing high-density mass with a heterogeneous pattern on a proximal small bowel loop. Based on these findings, a gastrointestinal stromal tumor accompanied by hemorrhagic and cystic change, a mesenteric hematoma, or a desmoid tumor was diagnosed. Laparoscopy was performed to obtain an accurate diagnosis. Exploration of the abdominal cavity identified a 4-cm mass originating from the mesentery of the jejunum. Segmental resection of the jejunum and its mesentery, including the mass, was performed. Macroscopically, the mass appeared to be a cystic mass of the jejunal mesentery. The mass within the cyst lumen consisted of white clayish material with no specific pathology. The final pathological diagnosis was a mesenteric pseudocyst. The patient had an uneventful postoperative course.
• Laparoscopic proximal gastrectomy with oblique jejunogastrostomy

  Kimitaka Tanaka, Yuma Ebihara, Yo Kurashima, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  LANGENBECKS ARCHIVES OF SURGERY 402 (6) 995 - 1002 1435-2443 2017/09 [Refereed][Not invited]
   

  Background Proximal early gastric cancer is a good indication for totally laparoscopic proximal gastrectomy (TLPG) with double-tract reconstruction (DTR). However, when most of the dietary intake passes through the escape route of the jejunum, the functional benefits of proximal gastrectomy might be similar to those after total gastrectomy. Our DTR procedure was improved for easy passage through the remnant stomach. The purposes of this study were to present a novel technique for intracorporeal DTR using linear staplers after TLPG and to investigate surgical outcomes. Methods DTR was performed using linear staplers only. A side-to-side jejunogastrostomy with twisting of both the remnant stomach and the anal jejunum was performed for the purpose of passing meals through the remnant stomach (an oblique jejunogastrostomy technique). The ten patients who underwent TLPG with DTR from January 2011 to August 2016 in Hokkaido University Hospital were retrospectively reviewed. Their clinicopathological characteristics and surgical and postoperative outcomes were collected and analyzed. Results The median duration of operation was 285 (range 146-440) min. No patients required blood transfusions. The number of dissected lymph nodes was 32 (range 22-56). There were no intraoperative complications, and no cases were converted to open surgery. All the patients were pT1N0M0 stage IA. No anastomotic leakage or complications were detected. Postoperative gastrography after reconstruction showed that contrast medium flowed mainly to the remnant stomach. The average percentage body weight loss was 14.0 +/- 7.1% at 10 months. The average percentage decrease in serum hemoglobin was 5.4 +/- 10.4% at 12 months. Conclusions This novel technique for intracorporeal DTR provided a considerable advantage by the passage of dietary intake to the remnant stomach after LPG.
• Developing better practices at the institutional level leads to better outcomes after pancreaticoduodenectomy in 3,378 patients: domestic audit of the Japanese Society of Pancreatic Surgery

  Sohei Satoi, Tomohisa Yamamoto, Hideyuki Yoshitomi, Fuyuhiko Motoi, Manabu Kawai, Tsutomu Fujii, Keita Wada, Hidehito Arimitsu, Masayuki Sho, Ippei Matsumoto, Satoshi Hirano, Hiroaki Yanagimoto, Masayuki Ohtsuka, Michiaki Unno, Hiroki Yamaue, Masanori Kon

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 24 (9) 501 - 510 1868-6974 2017/09 [Refereed][Not invited]
   

  BackgroundThe aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan. MethodsData were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements 7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. ResultsThe number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio -0.499, P = 0.008) and incisional surgical site infection (odds ratio -0.999, P < 0.001). ConclusionStandardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.
• 5-Aminolevulinic-acid-mediated Photodynamic Diagnosis Enhances the Detection of Peritoneal Metastases in Biliary Tract Cancer in Mice

  Toshihiro Kushibiki, Takehiro Noji, Yuma Ebihara, Koji Hontani, Masato Ono, Shota Kuwabara, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Masahiro Ishizuka, Satoshi Hirano

  IN VIVO 31 (5) 905 - 908 0258-851X 2017/09 [Refereed][Not invited]
   

  Background/Aim: Previous studies on the accuracy of 5-aminolevulinic-acid-mediated photodynamic diagnosis (5-ALA PDD) have been reported for various cancers and brain surgery. However, biliary tract cancer is rare. Therefore, 5-ALA PDD has not been fully evaluated in biliary tract cancers. Small biliary tract cancer lesions such as peritoneal dissemination, liver metastases, and lymph node metastases are negative prognosticators in patients with biliary cancer. The purpose of this exploratory study was to determine if 5-ALA PDD could detect small biliary tract cancer lesions in murine models of biliary cancers. Materials and Methods: Biliary cancer cell lines (TFK-1, HuCCT-1, G415, HuH28, SSP25, RBE, KKU055 and KKU100) and Normal human dermal fibroblast cells were used to evaluate protoporphyrin IX (PpIX) accumulation in vitro. Subcutaneous tumor mice were established using two cell lines (TFK-1 and HuCCT-1). 5-ALA (250 mg/kg) was administered intraperitoneally, and fluorescent 5ALA-PDD was performed 3 h later to evaluate tumoral PpIX accumulation. A murine peritoneal disseminated nodule model was established by intraperitoneal injection of TFK-1 cells. Four weeks later, 5-ALA was administered intraperitoneally, and 5-ALA-PDD was performed 3 h post administration to evaluate PpIX accumulation in the disseminated nodules. The presence of tumor cells in tumors and nodules was confirmed by haematoxylin and eosin staining. Results: Compared TO non-cancerous cell lines, PpIX accumulation was increased in biliary tract cancer cell lines. PpIX accumulation led to a strong fluorescent signal in all subcutaneous tumors. In the murine model of peritoneal dissemination, microdisseminated nodules (< 1 mm) that could not be detected under white light were clearly visible using 5-ALA-PDD. Conclusion: 5-ALA PDD was useful for diagnosis of biliary tract cancer and detection of small peritoneal metastatic lesions in murine models of biliary cancers. Clinical studies and applications of 5-ALA PDD for biliary tract cancer are expected in the future.
• Cervical Castleman's disease mimicking lymph node metastasis of esophageal carcinoma

  Takumi Yamabuki, Masanori Ohara, Mototsugu Kato, Noriko Kimura, Tomohide Shirosaki, Kunishige Okamura, Aki Fujiwara, Ryo Takahashi, Kazuteru Komuro, Nozomu Iwashiro, Satoshi Hirano

  WORLD JOURNAL OF GASTROINTESTINAL ONCOLOGY 9 (9) 397 - 401 1948-5204 2017/09 [Refereed][Not invited]
   

  Castleman's disease (CD) is an uncommon benign lymphoproliferative disorder of unknown etiology. A rare case of cervical CD diagnosed at lymph node dissection for esophageal carcinoma is reported. An esophageal tumor was identified in a 67-year-old man during a follow-up examination after surgery for oral carcinoma. Esophagoscopy revealed a type 1 tumor in the cervical esophagus. Histology of esophagoscopic biopsies indicated squamous cell carcinoma. Contrast-enhanced computed tomography revealed swollen lymph nodes of the right cervical region. No distant metastasis was detected. Esophageal carcinoma, T2N2M0, Stage. A was diagnosed. Neoadjuvant chemotherapy was recommended, but the patient rejected the chemotherapy. The patient underwent laparoscopic-assisted transhiatal esophagectomy. The histopathological diagnosis was moderately differentiated squamous cell carcinoma with pT1bN0M0, Stage. A. On histology, the swollen lymph nodes of the right cervical region revealed CD. The patient's postoperative course was relatively good.
• Overexpression of C16orf74 is involved in aggressive pancreatic cancers

  Toru Nakamura, Toyomasa Katagiri, Shoki Sato, Toshihiro Kushibiki, Koji Hontani, Takahiro Tsuchikawa, Satoshi Hirano, Yusuke Nakamura

  ONCOTARGET 8 (31) 50460 - 50475 1949-2553 2017/08 [Refereed][Not invited]
   

  Clinical outcome of pancreatic ductal adenocarcinoma (PDAC) has not been improved in the last three decades due to the lack of effective molecular-targeted drugs. To identify a novel therapeutic target for PDAC, we have performed genomewide anamysis and found that Homo sapiens chromosome 16 open reading frame 74 (C16orf74) was up-regulated in the vast majority of PDAC. Overexpression of C16orf74 protein detected by immunohistochemical analysis was an independent prognostic factor for patients with PDAC. The knockdown of endogenous C16orf74 expression in the PDAC cell lines KLM-1 and PK-59 by vector-based small hairpin-RNA (shRNA) drastically attenuated the growth of those cells, whereas ectopic C16orf74 overexpression in HEK293T and NIH3T3 cells promoted cell growth and invasion, respectively. More importantly, the endogenous threonine 44 (T44)-phosphorylated form of C16orf74 interacted with the protein phosphatase 3 catalytic subunit alpha (PPP3CA) via the PDIIIT sequence in the PPP3CA-binding motif within the middle portion of C16orf74 in PDAC cells. The overexpression of mutants of C16orf74 lacking the PDIIIT sequence or T44 phosphorylation resulted in the suppression of invasive activity compared with wild-type C16orf74, indicating that their interaction should be indispensable for PDAC cell invasion. These results suggest that C16orf74 plays an important role for PDAC invasion and proliferation, and is a promising target for a specific treatment for patients with PDAC.
• Systematic review of the implementation of simulation training in surgical residency curriculum

  Yo Kurashima, Satoshi Hirano

  SURGERY TODAY 47 (7) 777 - 782 0941-1291 2017/07 [Refereed][Not invited]
   

  Purpose We reviewed the literature regarding the specific methods and strategies for implementing simulation-based training into the modern surgical residency curriculum. Residency programs are still struggling with how best to implement it into their curricula from a practical viewpoint. Methods A systematic review was performed using Ovid MEDLINE, EMBASE, PubMed, PsycINFO, Web of Science, and other resources for studies involving the use of simulation for technical skills training in the surgical residency curriculum. Studies were selected based on the integration of simulation into the curriculum and/or a description of the details of implementation and the resources required. Results In total, 2533 unique citations were retrieved based on this search, and 31 articles met the inclusion criteria. Most simulators were focused on laparoscopic procedures, and training occurred most often in a skills lab. The assessment of skills consisted mostly of speed of task completion. Only 4 studies addressed issues of cost, and 6 programs mentioned human resources without any mention of skills center personnel or administrative support. Conclusion All of the studies described the nature of the simulation training, but very few commented on how it was actually implemented and what was needed from organizational, administrative and logistical perspectives.
• Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction

  Kunishige Okamura, Kimitaka Tanaka, Takumi Miura, Yoshitsugu Nakanishi, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 24 (7) 382 - 393 1868-6974 2017/07 [Refereed][Not invited]
   

  BackgroundThe high frequency of surgical site infections (SSIs) after hepato-pancreato-biliary (HPB) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI. MethodsParticipants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 (UMIN Clinical Trial Registry #00001278). Before surgery, subjects were randomly allocated to a targeted group administered antibiotics based on bile culture results or a standard group administered cefmetazole. The primary endpoint was SSI rates within 30 days after surgery. Secondary endpoint was SSI rates for each operative procedure. ResultsOf the 126 patients, 124 were randomly allocated (targeted group, n = 62; standard group, n = 62). Frequency of SSI after surgery was significantly lower in the targeted group (27 patients, 43.5%) than in the standard group (44 patients, 71.0%; P = 0.002). Among patients who underwent pancreaticoduodenectomy and hepatectomy, SSI occurred significantly less frequently in the targeted group (P = 0.001 and P = 0.025, respectively). ConclusionsThis study demonstrated that preoperative bile culture-targeted administration of prophylactic antibiotics decreased SSIs following HBP surgery with biliary reconstruction.
• Thoracoscopic Esophagectomy in the Prone Position Versus the Lateral Position (Hand-assisted Thoracoscopic Surgery): A Retrospective Cohort Study of 127 Consecutive Esophageal Cancer Patients

  Naoya Fukuda, Toshiaki Shichinohe, Yuma Ebihara, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Yo Kurashima, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Satoshi Hirano

  SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES 27 (3) 179 - 182 1530-4515 2017/06 [Refereed][Not invited]
   

  Purpose:To assess the validity of esophagectomy with the patient in the prone position (PP), the short-term surgical results of PP and hand-assisted thoracoscopic surgery (HATS) were compared.Methods:This study enrolled 127 patients who underwent esophagectomy with HATS (n=91) or PP (n=36) between October 1999 and September 2014. The patients' background characteristics, operative findings, and postoperative complications were examined.Results:The patients' background characteristics were not significantly different. During surgery, total and thoracic blood loss were significantly lower in PP than in HATS (P<0.0001, <0.0001). Other operative findings were not significantly different between the 2 groups. Postoperatively, recurrent nerve palsy was significantly less frequent in PP than in HATS (P=0.049). In the comparison between the recurrent nerve palsy-positive and palsy-negative groups, sex (male) and preoperative respiratory comorbidity (negative) were significantly correlated with recurrent nerve palsy.Conclusions:In thoracoscopic esophagectomy, the PP was associated with lower surgical stress than HATS, with equal operative performance oncologically. The PP could prevent recurrent nerve palsy because of the magnified view effect.
• Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for advanced pancreatic body cancer

  Satoshi Hirano

  Pancreatic Cancer: With Special Focus on Topical Issues and Surgical Techniques 261 - 267 2017/05/04 [Refereed][Not invited]
  
• The impact of margin status determined by the one-millimeter rule on tumor recurrence and survival following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

  Takeo Nitta, Toru Nakamura, Tomoko Mitsuhashi, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Eiji Tamoto, Soichi Murakami, Takehiro Noji, Yo Kurashima, Yuma Ebihara, Yoshitsugu Nakanishi, Toshiaki Shichinohe, Satoshi Hirano

  SURGERY TODAY 47 (4) 490 - 497 0941-1291 2017/04 [Refereed][Not invited]
   

  The tumor-node-metastasis (TNM) classification defines R1 as the presence of tumor cells at the resection margin, while the current Royal College of Pathologists guidelines for pancreaticoduodenectomy specimens regard the presence of tumor cells within 1 mm from the resection margin as R1 (the "1-mm rule"). The aims of this study were to investigate the resection margin status of pancreatic head cancer retrospectively according to both the TNM and 1-mm rule classifications, and to evaluate the postoperative survival and tumor recurrence patterns. A total of 117 patients with pancreatic head cancer were the subjects of this study. R1(1-mm rule) resection was associated with a significantly worse disease-free survival (DFS) than R0(1-mm rule) resection (p = 0.0259), while R1(TNM) had no impact on DFS. R1(1-mm rule) resection margin status correlated with the incidence of tumor recurrence in the liver (p = 0.0483). In a multivariate analysis, R1(1-mm rule) resection was the independent variable for predicting poor DFS (hazard ratio 1.71; p = 0.0289). R1 resection margin status determined by the 1-mm rule may be an independent indicator for predicting disease recurrence, especially liver metastasis. These results may be useful for selecting the appropriate adjuvant therapy protocol and conducting strict surveillance in PDAC patients.
• Impact of 3D in the training of basic laparoscopic skills and its transferability to 2D environment: a prospective randomized controlled trial

  Saseem Poudel, Yo Kurashima, Yusuke Watanabe, Yuma Ebihara, Eiji Tamoto, Soichi Murakami, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 31 (3) 1111 - 1118 0930-2794 2017/03 [Refereed][Not invited]
   

  Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in laparoscopic surgery. However, a few studies have shown the impact of proficiency-based training and transferability of the skills from 2D to 3D system and vice versa. The purpose of this study was to investigate the impact of 2D and 3D environments on the time taken by novice trainees to learn basic laparoscopic skills and the transferability of the skills learnt in one environment to another. Medical students with no prior experience in training of laparoscopic tasks were randomly assigned to 2D or 3D groups. Both groups were trained in peg transfer and intracorporeal suture of Fundamentals of Laparoscopic Surgery (FLS) program until they attained predefined benchmarks. The practice times taken to reach the goal were compared. After they had reached the goal, all the participants were asked to repeat these tasks under both 2D and 3D environments. Their scores in both of the environments were compared. Eighty-eight participants were randomly assigned to 2D (n = 44) or 3D (n = 44) training groups. There was no difference between the backgrounds of both groups. The 3D training group was faster in reaching its goal in both tasks (p < 0.001 and p = 0.007, respectively). After reaching the goal, both groups were faster in the 3D environment in peg transfer (p = 0.04, p = 0.012). In intracorporeal suture, the 2D training group had similar scores in both the environments (p = 0.32), but the 3D group was slower in the 2D environment (p = < 0.001). The 3D environment helped shorten the training time of basic laparoscopic skills to novices. However, the novices trained in the 3D environment failed to transfer their skills to the 2D environment.
• Impact of elemental diet on early recovery after laparoscopic colectomy: findings of a randomized controlled trial

  Toshiaki Shichinohe, Takeshi Sasaki, Shuji Kitashiro, Takayuki Morita, Koichi Ono, Naoto Senmaru, Junichi Ikeda, Tetsufumi Kojima, Noriaki Kyogoku, Hidehisa Yamada, Nagato Sato, Kentaro Kato, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Eiji Tamoto, Takehiro Noji, Toru Nakamura, Keisuke Okamura, Takahiro Tsuchikawa, Satoshi Hirano

  SURGERY TODAY 47 (2) 166 - 173 0941-1291 2017/02 [Refereed][Not invited]
   

  An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.
• Long-term outcome after laparoscopic gastrectomy: a multicenter retrospective study

  Hiroshi Kawase, Yuma Ebihara, Toshiaki Shichinohe, Fumitaka Nakamura, Katsuhiko Murakawa, Takayuki Morita, Shunichi Okushiba, Satoshi Hirano

  LANGENBECKS ARCHIVES OF SURGERY 402 (1) 41 - 47 1435-2443 2017/02 [Refereed][Not invited]
   

  Despite its spread and advances, laparoscopic gastrectomy (LG) for advanced gastric cancer (AGC) remains controversial. The aim of this study was to evaluate the oncologic outcomes and to identify the potential risk factors for recurrence and survival after LG in AGC patients. The medical records of patients who underwent radical LG for histopathologically diagnosed stage IB or more advanced gastric cancer from 2004 to 2012 were collected. The clinicopathologic factors and outcomes were evaluated retrospectively. LG was performed for 300 patients, with a median operative time of 278 min and blood loss of 46 ml. Postoperative morbidity was defined as Clavien-Dindo grades III and IV and occurred in 13 patients (6.3%) in the laparoscopic distal gastrectomy group. The pathologic stage was IB in 109 patients (36.3%), IIA in 77 patients (25.7%), IIB in 48 patients (16.0%), IIIA in 31 patients (10.3%), IIIB in 19 patients (6.3%), and IIIC in 16 patients (5.3%). Median follow-up period was 55.2 months. The 3-year relapse-free survival (RFS) rate was 92.7% for stage IB, 87.0% for IIA, 68.8% for IIB, 64.5% for IIIA, 47.4% for IIIB, and 43.8% for IIIC. The 5-year actual overall survival rate was 91.1% for stage IB, 72.7% for II, and 62.5% for III. Multivariate analysis revealed postoperative complication as an independent risk factor for RFS. LG for AGC was feasible and provided comparable oncologic outcomes with those previously reported. Postoperative complications correlated with poor prognosis. Randomized control trials should be conducted to confirm these results of LG for AGC in the general population.
• Laparoscopic-assisted Rectus Sheath Block as a Novel Technique is Effective and Safe: A Randomized Controlled Trial

  Dai Miyazaki, Toshiaki Shichinohe, Yuma Ebihara, Yo Kurashima, Soichi Murakami, Takehiro Noji, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Satoshi Hirano

  SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES 27 (1) 19 - 23 1530-4515 2017/02 [Refereed][Not invited]
   

  Purpose:We developed laparoscopic-assisted rectus sheath block (LRSB) as a novel technique and report on its safety and effectiveness.Methods:Patients were randomly enrolled to an LRSB or control group (n=19 each). In the LRSB group, after the umbilical wound was closed, local anesthetic was injected transcutaneous at each of 4 sites (3 cm above and below the umbilicus bilaterally) with 10 mL of 0.25% levobupivacaine, laparoscopically. The control group received conventional postoperative pain management. The primary endpoint was visual analogue scale (VAS) pain score at the end of surgery. Secondary endpoints were VAS and Prince Henry pain scale after surgery, number of administrations of analgesics, and side effects of anesthesia.Results:No significant differences in background were seen between groups. VAS at the end of surgery was significantly lower in the LRSB group than in controls (P<0.01). VAS and Prince Henry pain scale were significantly lower in the LRSB group from soon after surgery to postoperative day 2. No complications related to LRSB were encountered.Conclusions:LRSB was particularly effective at the end of surgery and pain scores were significantly lower in the LRSB group long after surgery. Our study shows LRSB is effective and safe for laparoscopic abdominal surgery.
• Hepatobiliary and Pancreatic: A rare case of a well-differentiated neuroendocrine tumor in the bile duct with spontaneous regression diagnosed by EUS-FNA

  I. Sano, M. Kuwatani, R. Sugiura, S. Kato, K. Kawakubo, T. Ueno, Y. Nakanishi, T. Mitsuhashi, H. Hirata, S. Haba, S. Hirano, N. Sakamoto

  Journal of Gastroenterology and Hepatology (Australia) 32 (1) 11  1440-1746 2017/01/01 [Refereed][Not invited]
  
• Differential detection of cytoplasmic Wilms tumor 1 expression by immunohistochemistry, western blotting and mRNA quantification

  Takehiro Maki, Hiroaki Ikeda, Aki Kuroda, Noriaki Kyogoku, Yoshiyuki Yamamura, Yukiko Tabata, Takehiro Abiko, Takahiro Tsuchikawa, Yasuhiro Hida, Toshiaki Shichinohe, Eiichi Tanaka, Kichizo Kaga, Kanako Hatanaka, Yoshihiro Matsuno, Naoko Imai, Satoshi Hirano

  INTERNATIONAL JOURNAL OF ONCOLOGY 50 (1) 129 - 140 1019-6439 2017/01 [Refereed][Not invited]
   

  Wilms tumor 1 (WT1) is considered to be a promising target of cancer treatment because it has been reported to be frequently expressed at high levels in various malignancies. Although WT1-targeted cancer treatment has been initiated, conclusive detection methods for WT1 are not established. The present study aimed to consolidate immunohistochemistry for WT1 with statistical basis. Transfected cells with forced WT1 expression yielded specific western blot bands and nuclear immunostaining; cytoplasmic immunostaining was not specifically recognized. Immunohistochemistry, western blotting, and quantitative reverse transcriptase-polymerase chain reaction were performed in 35 human cell lines using multiple WT1 antibodies and their results were quantified. Relationships among the quantified results were statistically analyzed; the nuclear immunostaining positively correlated with western blot bands and mRNA expression levels, whereas cytoplasmic immunostaining did not. These results indicate that nuclear immunostaining reflects WT1 expression but cytoplasmic immunostaining does not. The nuclear immunostaining was barely (3/541) observed in primary cancer of esophagus, bile duct, pancreas and lung. Although the present study has some limitations, the results indicate that the cytoplasmic immunostaining does not correlate with actual WT1 expression and prompts researchers to carefully evaluate target molecule expression in treatment of cancer.
• Changes in postural strategy during exercise against perturbation using the balance exercise assist robot: A pilot study

  Norihide Itoh, Shigeo Tanabe, Satoshi Hirano, Eiichi Saitoh, Jumpei Kawabata, Daisuke Imoto, Yasuo Mikami, Toshikazu Kubo

  Journal of Physical Therapy Science 29 (1) 16 - 19 0915-5287 2017/01/01 [Refereed][Not invited]
   

  [Purpose] To clarify the changes in postural strategy by evaluating leg joint motion and muscle activity before and after continuous exercise against perturbation using the Balance Exercise Assist Robot (BEAR). [Subjects and Methods] Nine healthy subjects (male 7, female 2 mean age 23 ± 1 years) performed a postural perturbation coping exercise only. In the task, the robot leaned and moved automatically. Participants were instructed to maintain their default upright position and they performed the exercise five times in a row (1 minute/trial). Changes in total movement distance, range of motion of each joint (hip, knee, ankle), and mean activity of each muscle for the first and fifth trials were compared. [Results] The total movement distance of BEAR and range of motion in the hip decreased significantly from the first trial to the last trial. No change in muscle activity was observed in the rectus femoris, biceps femoris, tibialis anterior or gastrocnemius. [Conclusion] The results for exercise against perturbation using BEAR in this study suggest that BEAR may be a promising method to improve the ankle strategy for maintaining a standing posture.
• The features of Gait Exercise Assist Robot: Precise assist control and enriched feedback

  Satoshi Hirano, Eiichi Saitoh, Shigeo Tanabe, Hiroki Tanikawa, Shinya Sasaki, Daisuke Kato, Hitoshi Kagaya, Norihide Itoh, Hitoshi Konosu

  NEUROREHABILITATION 41 (1) 77 - 84 1053-8135 2017 [Refereed][Not invited]
   

  BACKGROUND: In a patient with severe hemiplegia, the risk of the knee giving way is high during the early stage of gait exercise with an ankle-foot orthosis. However, use of a knee-ankle-foot orthosis has many problems such as large amount of assistance and compensatory motions. To resolve these problems, we have engaged in the development of the Gait Exercise Assist Robot (GEAR). OBJECTIVE: To evaluate the improvement efficiency of walk with GEAR in a stroke patient. METHODS: The subject was a 70-year-old man presented with left thalamus hemorrhage and right hemiplegia. The patient underwent exercise with the GEAR 5 days a week, for 40 minutes per day. We evaluated the Functional Independence Measure score for walk (FIM-walk score) every week. The control group consisted of 15 patients aged 20-75 years with hemiplegia after primary stroke, who had equivalent walking ability with the subject at start. As the primary outcome, we defined improvement efficiency of FIM-walk, which was gain of FIM-walk divided the number of required weeks. RESULTS: Improvement efficiency of FIM-walk of the subject was 1.5, while that of control group was 0.48 +/- 3.2 (mean +/- SD). CONCLUSIONS: GEAR is potentially useful for gait exercise in hemiplegic patients.
• Clinical feasibility of gait training with a robotic exoskeleton (WPAL) in an individual with both incomplete cervical and complete thoracic spinal cord injury: A case study

  Shigeo Tanabe, Soichiro Koyama, Eiichi Saitoh, Satoshi Hirano, Kanan Yatsuya, Tetsuya Tsunoda, Masaki Katoh, Takeshi Gotoh, Ayako Furumoto

  NEUROREHABILITATION 41 (1) 85 - 95 1053-8135 2017 [Refereed][Not invited]
   

  BACKGROUND: Patients with tetraplegia can achieve independent gait with lateral-type powered exoskeletons; it is unclear whether medial-type powered exoskeletons allow for this. OBJECTIVE: To investigate gait training with a medial-type powered exoskeleton wearable power-assist locomotor (WPAL) in an individual with incomplete cervical (C5) and complete thoracic (T12) spinal cord injury (SCI). METHODS: The 60-session program was investigated retrospectively using medical records. Upon completion, gait performance was examined using three-dimensional motion analyses and surface electromyography (EMG) of the upper limbs. RESULTS: The subject achieved independent gait with WPAL and a walker in 12 sessions. He continuously extended his right elbow; his left elbow periodically flexed/extended. His pelvic inclination was larger than the trunk inclination during single-leg stance. EMG activity was increased in the left deltoid muscles during ipsilateral foot-contact. The right anterior and medial deltoid muscle EMG activity increased just after foot-off for each leg, as did the right biceps activity. Continuous activity was observed in the left triceps throughout the gait cycle; activity was unclear in the right triceps. CONCLUSIONS: These results suggest the importance of upper limb residual motor function, and may be useful in extending the range of clinical applications for robotic gait rehabilitation in patients with SCI.
• Intraoperative Real-Time Assessment of Liver Function with Near-Infrared Fluorescence Imaging

  Hajime Narasaki, Takehiro Noji, Hideyuki Wada, Yuma Ebihara, Takahiro Tsuchikawa, Keisuke Okamura, Eiichi Tanaka, Toshiaki Shichinohe, Satoshi Hirano

  EUROPEAN SURGICAL RESEARCH 58 (5-6) 235 - 245 0014-312X 2017 [Refereed][Not invited]
   

  Background: Postoperative liver failure is a serious complication after major hepatectomy, and perioperative prediction of its incidence using current technology is still very difficult. Near-infrared (NIR) fluorescence imaging allows quantitative assessment of the fluorescent signal from indocyanine green (ICG) in regions of interest on the liver surface. This method might offer a new promising modality for evaluating regional liver reserve. However, data are lacking regarding the relationship between liver function and fluorescent signals on the liver surface after intravenous ICG injection. This study was conducted to obtain the data necessary to apply NIR fluorescence imaging as a modality for measuring liver function. Materials and Methods: This study included 16 patients who underwent open hepatopancreatobiliary surgery between March 2011 and March 2012. After laparotomy, ICG was injected intravenously at 2.5 mg/L of liver volume, then the fluorescence intensity (FI) and signal-to-background ratio (SBR) in the lateral segment of the liver were assessed for 15 min. Intraoperative blood samples were also obtained to measure the plasma clearance rate of ICG (ICGK). Correlations between ICGK, liver volume, and SBR, as well as between ICGK, liver volume, and rate of change of FI were analyzed. Results: The experimental procedure was performed in all 16 patients. The FI of the liver increased rapidly after ICG injection, then became more gradual, reaching a near-plateau after 15 min. A significant correlation was seen between ICGK and the rate of change of FI up to 15 min (vertical bar rS vertical bar = 0.5725, p < 0.05). Conclusion: This is the first report to show a relationship between liver function and fluorescent signals on the liver surface after intravenous ICG injection. Intraoperative NIR fluorescence imaging with ICG may be useful as a new method for assessing liver function. (C) 2017 S. Karger AG, Basel
• Crizotinib-induced Rectal Perforation with Abscess

  Asako Yanagisawa, Noriko Hayama, Hiroyuki Amano, Makoto Nakamura, Satoshi Hirano, Sukeyuki Nakamura, Hiroshi Tabeta

  INTERNAL MEDICINE 56 (23) 3211 - 3213 0918-2918 2017 [Refereed][Not invited]
   

  An 86-year-old Japanese man was diagnosed with stage IV lung adenocarcinoma. The patient was treated with crizotinib after echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) rearrangement was detected from his pleural effusion. He subsequently developed abdominal pain and rebound tenderness in the right lower abdomen. Contrast-enhanced abdominal CT showed a low-density area in the abdominal cavity. The size of the abscess was decreased by drainage and the administration of antibiotics. Fistulography revealed a fistula from the rectum to the abscess, and a diagnosis of lower intestinal tract perforation with abscess formation was made. Crizotinib was discontinued and treatment with alectinib was initiated. The patient remains under treatment as an outpatient at our department without adverse effects.
• Oncocytic Type Intraductal Papillary Mucinous Neoplasm of the Pancreas with Unusually Low Mucin Production Mimicking Intraductal Tubulopapillary Neoplasm: A Report of a Case Diagnosed by a Preoperative Endoscopic Biopsy

  Yukinari Yoshida, Takao Endo, Eiichi Tanaka, Takefumi Kikuchi, Kimishige Akino, Hiroaki Mita, Yasuyo Adachi, Masahiro Nakamura, Yasushi Adachi, Yoshifumi Ishii, Joe Matsumoto, Satoshi Hirano, Takeo Nitta, Tomoko Mitsuhashi, Yasuo Kato

  INTERNAL MEDICINE 56 (23) 3183 - 3188 0918-2918 2017 [Refereed][Not invited]
   

  We herein report the case of a 78-year-old woman with an intraductal tumor with scant mucin production in a moderately dilated main pancreatic duct that resembled an intraductal tubulopapillary neoplasm (ITPN) on imaging. An endoscopic transpapillary forceps biopsy enabled an accurate preoperative diagnosis of the tumor as an oncocytic type intraductal papillary mucinous neoplasm (IPMN) of the pancreas microscopically showing papillary growth consisting of oncocytic cells with a typical mucin expression profile, although with few intraepithelial lumina containing mucin. This is the first case of an oncocytic type IPMN mimicking an ITPN that was able to be diagnosed preoperatively.
• Identification of novel serum autoantibodies against EID3 in non-functional pancreatic neuroendocrine tumors

  Koji Hontani, Takahiro Tsuchikawa, Takaki Hiwasa, Toru Nakamura, Takashi Ueno, Toshihiro Kushibiki, Mizuna Takahashi, Kazuho Inoko, Hironobu Takano, Satoshi Takeuchi, Hirotoshi Dosaka-Akita, Masaki Kuwatani, Naoya Sakamoto, Yutaka Hatanaka, Tomoko Mitsuhashi, Hideaki Shimada, Toshiaki Shichinohe, Satoshi Hirano

  Oncotarget 8 (63) 106206 - 106221 1949-2553 2017 [Refereed][Not invited]
   

  Pancreatic neuroendocrine tumors (pNETs) are relatively rare heterogenous tumors, comprising only 1-2% of all pancreatic neoplasms. The majority of pNETs are non-functional tumors (NF-pNETs) that do not produce hormones, and as such, do not cause any hormone-related symptoms. As a result, these tumors are often diagnosed at an advanced stage because patients do not present with specific symptoms. Although tumor markers are used to help diagnosis and predict some types of cancers, chromogranin A, a widely used tumor marker of pNETs, has significant limitations. To identify novel NF-pNET-associated antigens, we performed serological identification of antigens by recombinant cDNA expression cloning (SEREX) and identified five tumor antigens (phosphatase and tensin homolog, EP300-interacting inhibitor of differentiation 3 [EID3], EH domain-containing protein 1, galactosidebinding soluble 9, and BRCA1-associated protein). Further analysis using the AlphaLISA® immunoassay to compare serum antibody levels revealed that antibody levels against the EID3 antigen was significantly higher in the patient group than in the healthy donor group (n = 25, both groups). In addition, higher serum anti-EID3 antibody levels in NF-pNET patients correlated with shorter disease-free survival. The AUC calculated by ROC analysis was 0.784 with moderate diagnostic accuracy. In conclusion, serum anti-EID3 antibody levels may be useful as a tumor marker for prediction of tumor recurrence in NF-pNETs.
• Molecular targeting of cell-permeable peptide inhibits pancreatic ductal adenocarcinoma cell proliferation

  Shoki Sato, Toru Nakamura, Toyomasa Katagiri, Takahiro Tsuchikawa, Toshihiro Kushibiki, Kouji Hontani, Mizuna Takahashi, Kazuho Inoko, Hironobu Takano, Hirotake Abe, Shintaro Takeuchi, Masato Ono, Shota Kuwabara, Kazufumi Umemoto, Tomohiro Suzuki, Osamu Sato, Yusuke Nakamura, Satoshi Hirano

  Oncotarget 8 (69) 113662 - 113672 1949-2553 2017 [Refereed][Not invited]
   

  Background: Chromosome 16 open reading frame 74 (C16orf74) is highly expressed in pancreatic ductal adenocarcinoma (PDAC) and is involved in cancer cell proliferation and invasion through binding to calcineurin (CN). Therefore, C16orf74 is a good target for the development of a PDAC treatment. A cell-permeable dominantnegative (DN) peptide that can inhibit the C16orf74/CN interaction was designed to examine whether this peptide can inhibit PDAC cell proliferation in vitro and in vivo. Method: TheDN-C16orf74 peptide, which corresponds to the portion of C16orf74 that interacts with CN, was synthesized, and we assessed its anti-tumor activity in proliferation assays with human PDAC cells and the underlying molecular signaling pathway. Using an orthotopic xenograft model of PDAC, we treated mice intraperitoneally with phosphate-buffered saline (PBS), control peptide, or DNC16orf74 and analyzed the tumor-suppressive effects. Result: DN-C16orf74 inhibited the binding of C16orf74 to CN in an immunoprecipitation assay. DN-C16orf74 suppressed PDAC cell proliferation, and the level of suppression depended on the expression levels of C16orf74 in vitro. DN-C16orf74 also exhibited anti-tumor effects in orthotopic xenograft model. Furthermore, the tumor-suppressive effect was associated with inhibition of the phosphorylation of Akt and mTOR. Conclusion: The cell-permeable peptide DN-C16orf74 has a strong anti-tumor effect against PDAC in vitro and in vivo.
• Metastatic Recurrence of Typical Pulmonary Carcinoid Accompanied by Carcinoid Syndrome, Successfully Treated with Octreotide LAR.

  Yanagisawa A, Hirano S, Shimizu S, Hiroishi T, Shikano K, Hayama N, Fujita T, Amano H, Nakamura M, Nakamura S, Tabeta H

  Case reports in oncological medicine 2017 1564819  2090-6706 2017 [Refereed][Not invited]
  
• Distal Pancreatectomy with en Bloc Celiac Axis Resection (Modified Appleby Procedure) for Locally Advanced Pancreatic Body Cancer: A Single-Center Review of 80 Consecutive Patients

  Toru Nakamura, Satoshi Hirano, Takehiro Noji, Toshimichi Asano, Keisuke Okamura, Takahiro Tsuchikawa, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Yoshitsugu Nakanishi, Kimitaka Tanaka, Toshiaki Shichinohe

  ANNALS OF SURGICAL ONCOLOGY 23 (Suppl 5) S969 - S975 1068-9265 2016/12 [Refereed][Not invited]
   

  Background. Recently, distal pancreatectomy with en bloc celiac axis resection (DP-CAR) or modified Appleby procedure for locally advanced pancreatic body cancer is increasingly reported. However, actual long-term survival data are still unknown. Methods. This study retrospectively reviewed 80 consecutive patients with pancreatic body cancer who underwent DP-CAR at a single institution. Results. The study included 40 men and 40 women with a median age of 65 years (range, 44-85 years). A pancreatic fistula was the most common complication, occurring in 47 patients (57.5 %). Other complications with a high incidence were ischemic gastropathy (23 patients, 28.8 %) and delayed gastric emptying (20 patients, 25 %). According to the Clavien-Dindo classification, the major complications, defined as complications of grade 3 or higher, were observed in 33 patients (41.3 %), and the in-hospital mortality involved four patients (5 %). For all 80 patients, the 1-, 2-, and 5-year overall survivals (OSs) were respectively 81.1, 56.9, and 32.7 %, and the median survival time was 30.9 months. The actual 5-year survival for the 61 patients whose surgery was performed five or more years earlier was 27.9 % (17 of 61). The 1-, 2-, and 5-year OSs for the patients who underwent preoperative therapy (100, 90, and 78.8 %) were significantly better than for those who underwent upfront surgery (77.9, 51.5, and 26.7 %; P < 0.0001). Conclusions. The findings show DP-CAR to be a valid procedure for treating locally advanced pancreatic body cancer, which might contribute more to patients' survival when performed as part of multidisciplinary treatment.
• Time-dependent transition of the immunoglobulin G subclass and immunoglobulin E response in cancer patients vaccinated with cholesteryl pullulan-melanoma antigen gene-A4 nanogel

  Noriaki Kyogoku, Hiroaki Ikeda, Takahiro Tsuchikawa, Takehiro Abiko, Aki Fujiwara, Takehiro Maki, Yoshiyuki Yamamura, Masaomi Ichinokawa, Kimitaka Tanaka, Naoko Imai, Yoshihiro Miyahara, Shinichi Kageyama, Hiroshi Shiku, Satoshi Hirano

  ONCOLOGY LETTERS 12 (6) 4493 - 4504 1792-1074 2016/12 [Refereed][Not invited]
   

  A phase I+II clinical trial of vaccination with MAGE-A4 protein complexed with cholesteryl pullulan melanoma antigen gene-A4 nanogel (CHP-MAGE-A4) is currently underway in patients with MAGE-A4-expressing cancer. In the present study, the primary phase I endpoint was to test the safety of the administration of 300 pig CHP-MAGE-A4 with and without OK-432. Another aim of the study was to clarify the details of the specific humoral immune response to vaccination. The 9 patients enrolled for phase I were vaccinated 6 times, once every 2 weeks: 3 patients with 100 pig and 3 patients with 300 pig CHP-MAGE-A4, and 3 patients with 300 pig CHP-MAGE-A4 plus 0.5 clinical units of OK-432. Toxicities were assessed using Common Terminology Criteria for Adverse Events v3.0. Clinical response was evaluated by modified Response Evaluation Criteria in Solid Tumours. Immunological monitoring of anti-MAGE-A4-specific antibodies was performed by ELISA of pre- and post-vaccination patient sera. The 6 vaccinations produced no severe adverse events. Stable disease was assessed in 4/9 patients. Anti-MAGE-A4 total immunoglobulin (Ig)G titers increased in 7/9 patients. Efficacious anti-MAGE-A4 IgG1, 2 and 3 antibody responses were observed in 7/9 patients. Among them, positive conversions to T helper 2 (Th2)-type antibody responses (IgG4 and IgE) were observed after frequent vaccination in 4/7 patients. The Th2 conversion was possibly associated with undesirable clinical observations, including progressive disease and the appearance of a new relapse lesion. The present study suggested that frequent vaccinations activated a Th2-dominant status in the cancer patients. The identification of a time-dependent IgG subclass and IgE antibody production during vaccination protocols may be a useful surrogate marker indicating a potentially undesirable change of the immunological environment for an effective antitumor immune response in cancer patients.
• Conversion therapy for pancreatic cancer with peritoneal metastases using intravenous and intraperitoneal paclitaxel with S-1.

  Kitayama H, Tsuji Y, Kondo T, Sugiyama J, Hirayama M, Yamamoto K, Kawarada Y, Oyamada Y, Hirano S

  Molecular and clinical oncology 5 (6) 779 - 782 2049-9450 2016/12 [Refereed][Not invited]
   

  Combination chemotherapy consisting of systemic and intraperitoneal agents against peritoneal metastases from several types of cancer has shown promising results. We herein report a case in which combination therapy with intravenous and intraperitoneal paclitaxel with S-1 converted an unresectable pancreatic cancer with peritoneal metastases into a resectable one. The patient was a 65-year old woman with recurrent pancreatitis for 5 months. Endoscopic ultrasonography-guided fine-needle aspiration revealed minute epithelial masses composed of cells with irregular nuclei in the pancreatic body. The patient underwent abdominal surgery, but no excision was performed, as two peritoneal metastases in the bursa omentalis were detected. Combination therapy was initiated, consisting of intravenous and intraperitoneal paclitaxel with S-1 as a single-center clinical trial. The regimen consisted with 2-week administration of S-1 (80 mg per day) followed by 1 week of rest, intravenous paclitaxel 50 mg/m2, and intraperitoneal paclitaxel 20 mg/m2 by a peritoneal access device on days 1 and 8. Over the seven cycles of the chemotherapy, the primary lesion did not change in size, and peritoneal lavage cytology remained negative. After confirming the disappearance of the peritoneal lesions by exploratory laparoscopy, the patient underwent distal pancreatectomy combined with resection of the transverse mesocolon and stomach wall. Thus, the 2-way chemotherapy of intravenous and intraperitoneal paclitaxel with S-1 was well-tolerated and was able to convert pancreatic cancer with peritoneal metastases to resectable disease.
• 肝門部領域癌に対する肝動脈合併切除の成績 プロペンシティスコアマッチ解析による検討

  野路 武寛, 土川 貴裕, 岡村 圭祐, 中西 喜嗣, 浅野 賢道, 中村 透, 田中 公貴, 海老原 裕磨, 倉島 庸, 村上 壮一, 七戸 俊明, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 49 (Suppl.2) 195 - 195 0386-9768 2016/11
• Clinical impact of chemotherapy to improve tumor microenvironment of pancreatic cancer

  Takahiro Tsuchikawa, Shintaro Takeuchi, Toru Nakamura, Toshiaki Shichinohe, Satoshi Hirano

  WORLD JOURNAL OF GASTROINTESTINAL ONCOLOGY 8 (11) 786 - 792 1948-5204 2016/11 [Refereed][Not invited]
   

  A perioperative multimodal strategy including combination chemotherapy and radiotherapy, in addition to surgical resection, has been acknowledged to improve patient prognosis. However chemotherapy has not been actively applied as an immunomodulating moda-lity because of concerns about various immuno-suppressive effects. It has recently been shown that certain chemotherapeutic agents could modify tumor micro-environment and host immune responses through several underlying mechanisms such as immunogenic cell death, local T-cell infiltration and also the eradication of immune-suppressing regulatory cells such as regulatory T cells (Tregs) and myeloid-derived suppressor cells. With the better understanding of the cell components in the tumor microenvironment and the effect of chemotherapy to improve tumor microenvironment, it has been gradually clear that the chemotherapeutic agents is two-edged sword to have both immune promoting and suppressing effects. The cellular components of the tumor microenvironment include infiltrating T lymphocytes, dendritic cells, regulatory T cells, tumor associated macrophages, myeloid derived suppressor cells and cancer associated fibroblasts. Based on the better understanding of tumor microenvironment following chemotherapy, the treatment protocol could be modified as personalized medicine and the prognosis of pancreas cancer would be more improved utilizing multimodal chemotherapy. Here we review the recent advances of chemotherapy to improve tumor microenvironment of pancreatic cancer, introducing the unique feature of tumor microenvironment of pancreatic cancer, interaction between anti-cancer reagents and these constituting cells and future prospects.
• Preoperative diagnosis of portal vein invasion in pancreatic head cancer: appropriate indications for concomitant portal vein resection

  Koichi Teramura, Takehiro Noji, Toru Nakamura, Toshimichi Asano, Kimitaka Tanaka, Yoshitsugu Nakanishi, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 23 (10) 643 - 649 1868-6974 2016/10 [Refereed][Not invited]
   

  Background The surgical indications for patients with pancreatic head cancer (PHC) with clinical portal vein (PV) invasion (cPV) remain controversial. The present study aimed to determine the ability of computed tomography (CT) to diagnose pathological PV involvement (pPV) in PHC. Methods We evaluated the morphological features (length and circumference) and two sets of diagnostic criteria for cPV determined from preoperative CT findings of 112 consecutive patients who underwent pancreatoduodenectomy for PHC. This study is listed in the UMIN Clinical Trials Registry (UMIN-CTR; No: UMIN000016827). Results Five patients were excluded because enhanced CT data were missing. Morphological features have low diagnostic ability for pPV. We diagnosed 67 patients with cPV based on our diagnostic criteria and those of Klauss, and 42 of them had pPV. The negative predictive values of these diagnostic criteria for pPV were satisfactory (>95%) and the positive predictive value was relatively low (61.2%). Postoperative survival could be predicted based on the cPV type. Conclusion An accurate diagnosis of pPV based on morphological features determined by preoperative CT is difficult. However, preoperative CT appears useful for selecting patients with PHC who could be candidates for pancreaticoduodenectomy with or without PV resection.
• Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

  Satoshi Hayama, Kazuto Ohtaka, Yasuhito Shoji, Tatsunosuke Ichimura, Miri Fujita, Naoto Senmaru, Satoshi Hirano

  JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS 20 (4) 1086-8089 2016/10 [Refereed][Not invited]
   

  Background and Objectives: Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors. Methods: One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S). Results: In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%; P = .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P = .034 and P = .004). Conclusion: In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.
• Development and validation of a checklist for assessing recorded performance of laparoscopic inguinal hernia repair

  Saseem Poudel, Yo Kurashima, Yo Kawarada, Yusuke Watanabe, Yoshihiro Murakami, Yoshiyuki Matsumura, Hiroaki Kato, Kyosuke Miyazaki, Toshiaki Shichinohe, Satoshi Hirano

  AMERICAN JOURNAL OF SURGERY 212 (3) 468 - 474 0002-9610 2016/09 [Refereed][Not invited]
   

  BACKGROUND: Despite a need for video assessment for the performance transabdominal preperitoneal procedure (TAPP), the present assessment tools have not been validated for the use of evaluation of the recorded performance. We aimed to develop a checklist for the evaluation of the recorded performance of TAPP. METHODS: The TAPP checklist was developed by hernia experts from multiple institutes. Thirty unedited TAPP videos were rated by 3-blinded hernia experts. Inter-rater reliability and construct and concurrent validities were evaluated. RESULTS: The inter-rater reliability for 3 raters was .75 (95% confidence interval .60 to .86). The median total score of each group demonstrated a significant difference among experienced (>50 TAPP), intermediate (>= 10 TAPP, <50), and novice (<10 TAPP) surgeons (P < .001). The checklist score showed a high correlation with TAPP experience and previously validated global scale for laparoscopic inguinal hernia repair. CONCLUSIONS: The TAPP checklist is a valid metrics for the assessment of the recorded TAPP performance. (C) 2015 Elsevier Inc. All rights reserved.
• Risk factors for a high Comprehensive Complication Index score after major hepatectomy for biliary cancer: a study of 229 patients at a single institution

  Yoshitsugu Nakanishi, Takahiro Tsuchikawa, Keisuke Okamura, Toru Nakamura, Eiji Tamoto, Takehiro Noji, Toshimichi Asano, Toraji Amano, Toshiaki Shichinohe, Satoshi Hirano

  HPB 18 (9) 735 - 741 1365-182X 2016/09 [Refereed][Not invited]
   

  Background: The Comprehensive Complication Index (CCI) is a new tool to evaluate the postoperative condition by calculating the sum of all complications weighted by their severity. The aim of this study was to identify independent risk factors for a high CCI score (>= 40) in 229 patients after major hepatectomies with biliary reconstruction for biliary cancers. Methods: The CCI was calculated online via www.assessurgery.com. Independent risk factors were identified by multivariable analysis. Results: 57 (25%) patients were classified as having CCI >= 40. On multivariable analysis, volume of intraoperative blood loss (>= 2.5 L) (p = 0.004) and combined pancreatoduodenectomy (PD) (p = 0.006) were independent risk factors for CCI >= 40. A high level of maximum serum total bilirubin was identified as independent risk factors for a high volume of intraoperative blood loss. Liver failure (p = 0.046) was more frequent in patients with combined PD than in those without. Discussion: Patients who undergo preoperative external biliary drainage for severe jaundice might have impaired production of coagulation factors. When blood loss during liver transection becomes difficult to control, surgeons should consider various strategies, such as second-stage biliary or pancreatic reconstruction. In patients planned to undergo major hepatectomy with combined PD, preoperative portal vein embolization is mandatory to prevent postoperative liver failure.
• CD40 Expression in Human Esophageal Squamous Cell Carcinoma Is Associated with Tumor Progression and Lymph Node Metastasis

  Yoshiyuki Matsumura, Kei Hiraoka, Keidai Ishikawa, Yasuhito Shoji, Takehiro Noji, Koji Hontani, Tomoo Itoh, Toru Nakamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Satoshi Hirano

  ANTICANCER RESEARCH 36 (9) 4467 - 4475 0250-7005 2016/09 [Refereed][Not invited]
   

  Background: The co-stimulatory molecule cluster of differentiation 40 (CD40) is widely expressed in various types of malignant tumors, but its role remains unclear. The purpose of this study was to investigate the relationship between CD40 expression and clinicopathological variables in patients with esophageal squamous cell carcinoma (ESCC), as well as the function of CD40 expressed on ESCC tumor cells in vitro. Materials and Methods: Tumor specimens of patients who underwent surgical resection for ESCC were immunohistochemically analyzed for CD40 expression. Results: Of the 122 specimens, 45 (37%) were positive for CD40. Significant positive correlation was found between CD40 expression and p-stage (p=0.0011), histopathological grade (p=0.0143), pT-classification (p=0.0011), and pN-classification (p=0.0007). Survival of patients with stage III and IV disease with positive CD40 expression was significantly shorter than that of those with negative expression (log-rank test, p=0.0422). In in vitro analysis, while the addition of recombinant human CD154 did not inhibit growth, it did induce a significant increase in interleukin 6 production in ESCC cell lines. Conclusion: These results suggest that functional expression of CD40 on tumor cells might play an important role in tumor progression and lymph node metastasis in ESCC.
• Concomitant hepatic artery resection for advanced perihilar cholangiocarcinoma: a case-control study with propensity score matching

  Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Kimitaka Tanaka, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Toshiaki Shichinohe, Satoshi Hirano

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 23 (7) 442 - 448 1868-6974 2016/07 [Refereed][Not invited]
   

  BackgroundWhether concomitant hepatic artery resection (HAR) improves the prognosis for advanced perihilar cholangiocarcinoma remains controversial. The aim of the present study was to compare short- and long-term surgical results of HAR versus standard resection (SR) for perihilar cholangiocarcinoma using propensity score matching. MethodsAmong 209 patients with perihilar cholangiocarcinoma patients who underwent resection in our department, 28 patients underwent HAR, and the remaining 181 patients underwent SR. To adjust for differences in clinicopathological factors, including difficulty in surgery, between groups, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 24 patients per group. The study protocols were approved by our institutional review board (015-0365), enrolled in UMIN-CTR (No: UMIN000019927), and conducted according to the Declaration of Helsinki. ResultsNo significant differences were seen in overall incidence of postoperative complications (Clavien-Dindo classification IIIa: 37.5% in SR group vs. 62.5% in HAR group; P=0.080), except for postoperative liver abscess formation (P=0.020). Five-year overall survival rates were 30.3% and 20.4%, respectively. No significant difference in overall survival rate was apparent between the SR and HAR groups (P=0.150). ConclusionDespite being a demanding procedure, concomitant HAR appears feasible for selected patients with perihilar cholangiocarcinoma.
• Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01)

  Katsuhiko Uesaka, Narikazu Boku, Akira Fukutomi, Yukiyasu Okamura, Masaru Konishi, Ippei Matsumoto, Yuji Kaneoka, Yasuhiro Shimizu, Shoji Nakamori, Hirohiko Sakamoto, Soichiro Morinaga, Osamu Kainuma, Koji Imai, Naohiro Sata, Shoichi Hishinuma, Hitoshi Ojima, Ryuzo Yamaguchi, Satoshi Hirano, Takeshi Sudo, Yasuo Ohashi

  LANCET 388 (10041) 248 - 257 0140-6736 2016/07 [Refereed][Not invited]
   

  Background Although adjuvant chemotherapy with gemcitabine is standard care for resected pancreatic cancer, S-1 has shown non-inferiority to gemcitabine for advanced disease. We aimed to investigate the non-inferiority of S-1 to gemcitabine as adjuvant chemotherapy for pancreatic cancer in terms of overall survival. Methods We did a randomised, open-label, multicentre, non-inferiority phase 3 trial undertaken at 33 hospitals in Japan. Patients who had histologically proven invasive ductal carcinoma of the pancreas, pathologically documented stage I-III, and no local residual or microscopic residual tumour, and were aged 20 years or older were eligible. Patients with resected pancreatic cancer were randomly assigned (in a 1: 1 ratio) to receive gemcitabine (1000 mg/m(2), intravenously administered on days 1, 8, and 15, every 4 weeks [one cycle], for up to six cycles) or S-1 (40 mg, 50 mg, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14 day rest, every 6 weeks [one cycle], for up to four cycles) at the data centre by a modified minimisation method, balancing residual tumour status, nodal status, and institutions. The primary outcome was overall survival in the two treatment groups, assessed in the per-protocol population, excluding ineligible patients and those not receiving the allocated treatment. The protocol prespecified that the superiority of S-1 with respect to overall survival was also to be assessed in the perprotocol population by a log-rank test, if the non-inferiority of S-1 was verified. We estimated overall and relapse-free survival using the Kaplan-Meier methods, and assessed non-inferiority of S-1 to gemcitabine using the Cox proportional hazard model. The expected hazard ratio (HR) for mortality was 0.87 with a non-inferiority margin of 1.25 (power 80%; one-sided type I error 2.5%). This trial is registered at UMIN CTR (UMIN000000655). Findings 385 patients were randomly assigned to treatment between April 11, 2007, and June 29, 2010 (193 to the gemcitabine group and 192 to the S-1 group). Of these, three were exlcuded because of ineligibility and five did not receive chemotherapy. The per-protocol population therefore consisted of 190 patients in the gemcitabine group and 187 patients in the S-1 group. On Sept 15, 2012, following the recommendation from the independent data and safety monitoring committee, this study was discontinued because the prespecified criteria for early discontinuation were met at the interim analysis for efficacy, when all the protocol treatments had been finished. Analysis with the follow-up data on Jan 15, 2016, showed HR of mortality was 0.57 (95% CI 0.44-0.72, p(non-inferiority)<0.0001, p<0.0001 for superiority), associated with 5-year overall survival of 24.4% (18.6-30.8) in the gemcitabine group and 44.1% (36.9-51.1) in the S-1 group. Grade 3 or 4 leucopenia, neutropenia, aspartate aminotransferase, and alanine aminotransferase were observed more frequently in the gemcitabine group, whereas stomatitis and diarrhoea were more frequently experienced in the S-1 group. Interpretation Adjuvant chemotherapy with S-1 can be a new standard care for resected pancreatic cancer in Japanese patients. These results should be assessed in non-Asian patients.
• Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model

  Saseem Poudel, Yo Kurashima, Toshiaki Shichinohe, Shuji Kitashiro, Eiji Kanehira, Satoshi Hirano

  JOURNAL OF MINIMAL ACCESS SURGERY 12 (3) 214 - 219 0972-9941 2016/07 [Refereed][Not invited]
   

  BACKGROUND: The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. MATERIALS AND METHODS: The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. RESULTS: All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. CONCLUSION: The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures.
• Prognostic impact of the site of portal vein invasion in patients with surgically resected perihilar cholangiocarcinoma

  Yoshitsugu Nakanishi, Takahiro Tsuchikawa, Keisuke Okamura, Toru Nakamura, Eiji Tamoto, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Takehiro Noji, Toshimichi Asano, Toshiaki Shichinohe, Satoshi Hirano

  SURGERY 159 (6) 1511 - 1519 0039-6060 2016/06 [Refereed][Not invited]
   

  Background. The aim of this study was to determine the impact of the site of portal vein invasion on survival after hepatectomy for perihilar cholangiocarcinoma. Methods. This study classified 168 patients undergoing resection for perihilar cholangiocarcinoma histologically as without portal vein resection or tumor invasion to the portal vein (PV0), with tumor invasion to unilateral branches of the portal vein (PVt3), or with tumor invasion to the main portal vein or its bilateral branches, or to unilateral second-order biliary radicals with contralateral portal vein involvement (PVt4). Patients in PVt4 were subclassified into the A-M group (cancer invasion limited to the tunica adventitia or media) or the I group (cancer invasion reaching the tunica intima). Results. Of the patients, 121 were in PV0, 21 were in PVt3, and 26 were in PVt4. There was no difference in survival between the PVO and PVt3 groups (P = .267). The PVt4 group had a worse prognosis than the PVt3 group (P = .046). In addition, the A-M (n = 19) and I subgroups (n = 7) of PVt4 had worse prognoses than the PVO or PVt3 groups (P = .005 and < .001, respectively). All patients in the I subgroup of PVt4 died within 9 months after resection. On multivariate analysis, PVt4 (P = .029) was identified as an independent prognostic factor. Conclusions. In perihilar cholangiocarcinoma, postoperative survival was no different between patients with and without ipsilateral portal vein invasion, although patients with tumor invasion to the main or contralateral branches of the portal vein, especially with tunica intima invasion, had extremely poor prognoses.
• Whole-genome mutational landscape and characterization of noncoding and structural mutations in liver cancer (vol 48, pg 500, 2016)

  Akihiro Fujimoto, Mayuko Furuta, Yasushi Totoki, Tatsuhiko Tsunoda, Mamoru Kato, Yuichi Shiraishi, Hiroko Tanaka, Hiroaki Taniguchi, Yoshiiku Kawakami, Masaki Ueno, Kunihito Gotoh, Shun-ichi Ariizumi, Christopher P. Wardell, Shinya Hayami, Toru Nakamura, Hiroshi Aikata, Koji Arihiro, Keith A. Boroevich, Tetsuo Abe, Kaoru Nakano, Kazuhiro Maejima, Aya Sasaki-Oku, Ayako Ohsawa, Tetsuo Shibuya, Hiromi Nakamura, Natsuko Hama, Fumie Hosoda, Yasuhito Arai, Shoko Ohashi, Tomoko Urushidate, Genta Nagae, Shogo Yamamoto, Hiroki Ueda, Kenji Tatsuno, Hidenori Ojima, Nobuyoshi Hiraoka, Takuji Okusaka, Michiaki Kubo, Shigeru Marubashi, Terumasa Yamada, Satoshi Hirano, Masakazu Yamamoto, Hideki Ohdan, Kazuaki Shimada, Osamu Ishikawa, Hiroki Yamaue, Kazuki Chayama, Satoru Miyano, Hiroyuki Aburatani, Tatsuhiro Shibata, Hidewaki Nakagawa

  NATURE GENETICS 48 (6) 700 - 700 1061-4036 2016/06 [Refereed][Not invited]
  
• Clinical relevance of antigen spreading pattern induced by CHP-MAGE-A4 cancer vaccination

  Kengo Miyauchi, Takahiro Tsuchikawa, Masataka Wada, Takehiro Abiko, Noriaki Kyogoku, Toshiaki Shichinohe, Yoshihiro Miyahara, Shinichi Kageyama, Hiroaki Ikeda, Hiroshi Shiku, Satoshi Hirano

  IMMUNOTHERAPY 8 (5) 527 - 540 1750-743X 2016/05 [Refereed][Not invited]
   

  Aim: To investigate the antigen spreading pattern in the CHP-MAGE-A4-vaccinated patients and analyze the clinical relevance of antigen spreading pattern as a surrogate marker of patient survival. Materials & methods: 12 patients who had been injected with 300 mu g of CHP-MAGE-A4 and 0.5 Klinische Einheit of OK-432 in more than five vaccinations were analyzed. Results: Increases in the anti-MAGE-A4-specific antibody response were observed in eight patients (66.7%), compared with six patients (50%) for anti-NY-ESO-1 and five patients (41.7%) for anti-MAGE-A3 after five vaccinations. We identified frequent antigen spreading following MAGE-A4 vaccinations without associations with the clinical response or patient prognosis. Conclusion: Antigen spreading pattern might reflect tumor shrinkage as a response to treatment and treatment history (clinical trial registration number: UMIN000001999).
• Whole-genome mutational landscape and characterization of noncoding and structural mutations in liver cancer

  Akihiro Fujimoto, Mayuko Furuta, Yasushi Totoki, Tatsuhiko Tsunoda, Mamoru Kato, Yuichi Shiraishi, Hiroko Tanaka, Hiroaki Taniguchi, Yoshiiku Kawakami, Masaki Ueno, Kunihito Gotoh, Shun-ichi Ariizumi, Christopher P. Wardell, Shinya Hayami, Toru Nakamura, Hiroshi Aikata, Koji Arihiro, Keith A. Boroevich, Tetsuo Abe, Kaoru Nakano, Kazuhiro Maejima, Aya Sasaki-Oku, Ayako Ohsawa, Tetsuo Shibuya, Hiromi Nakamura, Natsuko Hama, Fumie Hosoda, Yasuhito Arai, Shoko Ohashi, Tomoko Urushidate, Genta Nagae, Shogo Yamamoto, Hiroki Ueda, Kenji Tatsuno, Hidenori Ojima, Nobuyoshi Hiraoka, Takuji Okusaka, Michiaki Kubo, Shigeru Marubashi, Terumasa Yamada, Satoshi Hirano, Masakazu Yamamoto, Hideki Ohdan, Kazuaki Shimada, Osamu Ishikawa, Hiroki Yamaue, Kazuki Chayama, Satoru Miyano, Hiroyuki Aburatani, Tatsuhiro Shibata, Hidewaki Nakagawa

  NATURE GENETICS 48 (5) 500 - + 1061-4036 2016/05 [Refereed][Not invited]
   

  Liver cancer, which is most often associated with virus infection, is prevalent worldwide, and its underlying etiology and genomic structure are heterogeneous. Here we provide a whole-genome landscape of somatic alterations in 300 liver cancers from Japanese individuals. Our comprehensive analysis identified point mutations, structural variations (STVs), and virus integrations, in noncoding and coding regions. We discovered mutational signatures related to liver carcinogenesis and recurrently mutated coding and noncoding regions, such as long intergenic noncoding RNA genes (NEAT1 and MALAT1), promoters, CTCF-binding sites, and regulatory regions. STV analysis found a significant association with replication timing and identified known (CDKN2A, CCND1, APC, and TERT) and new (ASH1L, NCOR1, and MACROD2) cancer-related genes that were recurrently affected by STVs, leading to altered expression. These results emphasize the value of whole-genome sequencing analysis in discovering cancer driver mutations and understanding comprehensive molecular profiles of liver cancer, especially with regard to STVs and noncoding mutations.
• Identification of a highly immunogenic mouse breast cancer sub cell line, 4T1-S

  Hirotake Abe, Haruka Wada, Muhammad Baghdadi, Sayaka Nakanishi, Yuu Usui, Takahiro Tsuchikawa, Toshiaki Shichinohe, Satoshi Hirano, Ken-ichiro Seino

  HUMAN CELL 29 (2) 58 - 66 1749-0774 2016/04 [Refereed][Not invited]
   

  Cancer vaccines serve as a promising clinical immunotherapeutic strategy that help to trigger an effective and specific antitumor immune response compared to conventional therapies. However, poor immunogenicity of tumor cells remains a major obstacle for clinical application, and developing new methods to modify the immunogenicity of tumor cells may help to improve the clinical outcome of cancer vaccines. 4T1 mouse breast cancer cell line has been known as poorly immunogenic and highly metastatic cell line. Using this model, we identified a sub cell line of 4T1-designated as 4T1-Sapporo (4T1-S)-which shows immunogenic properties when used as a vaccine against the same line. In 4T1-S-vaccinated mice, subcutaneous injection of 4T1-S resulted in an antitumor inflammatory response represented by significant enlargement of draining lymph nodes, accompanied with increased frequencies of activated CD8 T cells and a subpopulation of myeloid cells. Additionally, 4T1-S vaccine was ineffective to induce tumor rejection in nude mice, which importantly indicate that 4T1-S vaccine rely on T cell response to induce tumor rejection. Further analysis to identify mechanisms that control tumor immunogenicity in this model may help to develop new methods for improving the efficacies of clinical cancer vaccines.
• Intraluminal continuous decompression and drainage using a vacuum pump for controlling cervical anastomotic leakage after a three-field esophagectomy with a gastric pull-up

  Toshiaki Shichinohe, Yuma Ebihara, Soichi Murakami, Yo Kurashima, Naoya Fukuda, Saseem Poudel, Dai Miyazaki, Takahiro Tsuchikawa, Satoshi Hirano

  ESOPHAGUS 13 (2) 229 - 233 1612-9059 2016/04 [Refereed][Not invited]
   

  Anastomotic leakage is one of the major complications that can occur after an esophagectomy. We report on the advantages of a computer-controlled portable vacuum pump system, Thopaz(A (R)), for intraluminal continuous decompression and drainage in the non-surgical management of cervical anastomotic leakage. Continuous decompression with negative pressure of 20 cm H2O was set at the anastomotic leakage point by a naso-gastric tube or a trans-gastric decompression tube. The drainage effect was confirmed by swallowing contrast media under fluoroscopy. Three successive cases with postoperative anastomotic leakage received this treatment. The treatments were successful without complication and the leakages were healed 7, 15, and 17 days after the treatments, respectively. The management of anastomotic leakage using the portable pump system was beneficial in bringing about a prompt healing with minimum intervention. To further demonstrate the advantage of this procedure over conventional treatments, a larger data set and clinical trials are required.
• A new prognostic scoring system using factors available preoperatively to predict survival after operative resection of perihilar cholangiocarcinoma

  Hiroki Saito, Takehiro Noji, Keisuke Okamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Satoshi Hirano

  SURGERY 159 (3) 842 - 851 0039-6060 2016/03 [Refereed][Not invited]
   

  Background. Perihilar cholangiocarcinoma has one of the poorest prognoses of all cancers. However, mortality and morbidity rates after surgical resection are 0-15% and 14-66%, respectively. Additionally, the 5-year overall survival rates are reported at 22-40%. These findings indicate that only selected patients achieve satisfactory beneficial effects from operative treatment. This retrospective study sought to investigate preoperatively available prognostic factors and establish a new preoperative staging system to predict survival after major hepatectomy of perihilar cholangiocarcinoma. Patients and methods. We evaluated 121 consecutive patients who underwent operative exploration for perihilar cholangiocarcinoma. Results. Univariate and multivariate analysis using the identified preoperative factors revealed that 4 factors (platelet lymphocyte ratio [PLR] > 150, serum C-reactive protein [CRP) levels > 0.5 mg/dL, albumin levels < 3.5 g/dL, and carcinoembryonic antigen [CEA] levels > 7.0 ng/mL) were independent prognostic factors of postoperative survival. These 4 preoperative factors were allocated 1 point each. The total score was defined as the Preoperative Prognostic Score (PPS). Patients with a PPS of 0, 1, 2, or 3/4 had a 5-year survival of 84.3 %, 51.3 %, 46.4%, and 0%, respectively. There were also differences in the 5-year survival according to the PPS (0 vs I =.013] and 2 vs 3/4 [I) <.001]). Patients with a total PPS of 3/4 had a dismal prognosis, with a median survival of 11.3 months. Conclusion. A new preoperative scoring system using pm, serum CRP, albumin, and CEA levels could predict postoperative survival resection of perihilar cholangiocarcinoma.
• Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm

  Kimitaka Tanaka, Tetsufumi Kojima, Etsuo Hiraguchi, Hideaki Hashida, Takehiro Noji, Satoshi Hirano

  JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES 26 (3) 180 - 184 1092-6429 2016/03 [Refereed][Not invited]
   

  Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.
• Stromal Palladin Expression Is an Independent Prognostic Factor in Pancreatic Ductal Adenocarcinoma

  Daisuke Sato, Takahiro Tsuchikawa, Tomoko Mitsuhashi, Yutaka Hatanaka, Katsuji Marukawa, Asami Morooka, Toru Nakamura, Toshiaki Shichinohe, Yoshihiro Matsuno, Satoshi Hirano

  PLOS ONE 11 (3) e0152523  1932-6203 2016/03 [Refereed][Not invited]
   

  It has been clear that cancer-associated fibroblasts (CAFs) in the tumor microenvironment play an important role in pancreatic ductal adenocarcinoma (PDAC) progression. However, how CAFs relate to the patients' prognosis and the effects of chemoradiation therapy (CRT) has not been fully investigated. Tissue microarrays (TMAs) representing 167 resected PDACs without preoperative treatment were used for immunohistochemical studies (IHC) of palladin, alpha-smooth muscle actin (SMA), and podoplanin. Correlations between the expression levels of these markers and clinicopathological findings were analyzed statistically. Whole sections of surgical specimens from PDACs with and without preoperative CRT, designated as the chemotherapy-first group (CF, n = 19) and the surgery-first group (SF, n = 21), respectively, were also analyzed by IHC. In TMAs, the disease-specific survival rate (DSS) at 5 years for all 167 cases was 23.1%. Seventy cases (41.9%) were positive for palladin and had significantly lower DSS (p = 0.0430). alpha-SMA and podoplanin were positive in 167 cases (100%) and 131 cases (78.4%), respectively, and they were not significantly associated with DSS. On multivariable analysis, palladin expression was an independent poor prognostic factor (p = 0.0243, risk ratio 1.60). In the whole section study, palladin positivity was significantly lower (p = 0.0037) in the CF group (5/19) with a significantly better DSS (p = 0.0144) than in the SF group (16/22), suggesting that stromal palladin expression is a surrogate indicator of the treatment effect after chemoradiation therapy.
• Concomitant neoplasms in the skin and stomach unveil the role of type IV collagen and E-cadherin in mucin core protein 5AC expression in vivo.

  Hata H, Natsuga K, Kitamura S, Imafuku K, Yamaguchi Y, Ebihara Y, Shichinohe T, Hirano S, Shimizu H

  The British journal of dermatology 174 (2) 395 - 397 1365-2133 2016/02 [Refereed][Not invited]
   

  Hata H, Natsuga K, Kitamura S, Imafuku K, Yamaguchi Y, Ebihara Y, Shichinohe T, Hirano S, Shimizu H, The British journal of dermatology, 2016, vol. 174, no. 2, pp. 395-397
• Surgeons have knowledge gaps in the safe use of energy devices: a multicenter cross-sectional study

  Yusuke Watanabe, Yo Kurashima, Amin Madani, Liane S. Feldman, Minoru Ishida, Akihiko Oshita, Takeshi Naitoh, Kazuhiro Noma, Keigo Yasumasa, Hiroshi Nagata, Fumitaka Nakamura, Koichi Ono, Yoshinori Suzuki, Nobuhisa Matsuhashi, Toshiaki Shichinohe, Satoshi Hirano

  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 30 (2) 588 - 592 0930-2794 2016/02 [Refereed][Not invited]
   

  Despite the widespread use of surgical energy devices and the potential for rare but serious complications, pilot data from North America suggest that surgeons and surgical trainees have knowledge gaps in their safe use. The purpose of this study was to determine baseline knowledge of general surgeons and surgical trainees regarding the safe use of electrosurgery (ES) across varying levels of experience in Japan. Participants completed a 35-item multiple-choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES' Fundamental Use of Surgical Energy (TM) curriculum. Sections of the examination included: "principles of ES," "ES-related adverse events," "monopolar and bipolar devices," and "pediatric considerations and interference with implantable devices." Scores were compared between PGY > 5 and PGY 1-5 participants. A total of 145 general surgeons and surgical trainees of all years after medical school (PGY 1-5: 57, PGY > 5: 88) from ten academic and five community hospitals completed the assessment (mean age 35; 91 % male). The mean score in the entire cohort was 58 +/- A 12 % (range 23-83 %), with significantly higher scores in the PGY > 5 group compared to the PGY 1-5 group (60 +/- A 11 vs. 53 +/- A 12 %, p < 0.01). Among all participants, 92 % were not familiar with best practices when using ES on patients with a pacemaker; 44 % believe that ES uses thermal energy from cautery; 19 % did not know how to manage an operating room fire; 16 % thought that a dispersive electrode should be cut to fit a child; and 27 % believe that insulation failure in minimally invasive surgical instruments is mostly visible under careful inspection. General surgeons and trainees at all levels have knowledge gaps in the safe and effective use of energy devices, regardless of years of experience. There is a need for educational curricula to help address these gaps and contribute to safer surgery.
• Where do we start? The first survey of surgical residency education in Japan

  Yo Kurashima, Yusuke Watanabe, Yuma Ebihara, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano

  AMERICAN JOURNAL OF SURGERY 211 (2) 405 - 410 0002-9610 2016/02 [Refereed][Not invited]
   

  BACKGROUND: Currently, Japan does not have a national standardized program for surgical residency. Therefore, surgical education information and strategies are not shared among teaching hospitals. This was the first study aiming to clarify the current situation of surgical residency in Japan. METHODS: A questionnaire survey investigating the present situation of surgical residency was sent to the 76 teaching hospitals in Hokkaido Prefecture, Japan. RESULTS: The response rate was 64.5%. Data from the 36 hospitals with active residency programs were analyzed. Most of the program directors (79.4%) were in charge of educational work for less than 5 hours per week. Although half of the hospitals had skills laboratories or simulation centers, only 2 used them routinely for their residency program. Half of the hospitals evaluated the residents' competency and the quality of their educational programs. CONCLUSIONS: Structured programs and evaluation systems have not been integrated well into surgical residency in Japan. (C) 2016 Elsevier Inc. All rights reserved.
• Identification of a highly immunogenic mouse breast cancer sub cell line, 4t1-s

  Hirotake Abe, Haruka Wada, Muhammad Baghdadi, Sayaka Nakanishi, Yuu Usui, Takahiro Tsuchikawa, Toshiaki Shichinohe, Satoshi Hirano, Ken-Ichiro Seino

  Human Cell 29 (2) 58 - 66 1749-0774 2016 [Refereed][Not invited]
   

  Cancer vaccines serve as a promising clinical immunotherapeutic strategy that help to trigger an effective and specific antitumor immune response compared to conventional therapies. However, poor immunogenicity of tumor cells remains a major obstacle for clinical application, and developing new methods to modify the immunogenicity of tumor cells may help to improve the clinical outcome of cancer vaccines. 4T1 mouse breast cancer cell line has been known as poorly immunogenic and highly metastatic cell line. Using this model, we identified a sub cell line of 4T1—designated as 4T1-Sapporo (4T1-S)—which shows immunogenic properties when used as a vaccine against the same line. In 4T1-S-vaccinated mice, subcutaneous injection of 4T1-S resulted in an antitumor inflammatory response represented by significant enlargement of draining lymph nodes, accompanied with increased frequencies of activated CD8 T cells and a sub-population of myeloid cells. Additionally, 4T1-S vaccine was ineffective to induce tumor rejection in nude mice, which importantly indicate that 4T1-S vaccine rely on T cell response to induce tumor rejection. Further analysis to identify mechanisms that control tumor immunogenicity in this model may help to develop new methods for improving the efficacies of clinical cancer vaccines.
• Differing susceptibility to autophagic degradation of two LC3-binding proteins: SQSTM1/p62 and TBC1D25/OATL1

  Satoshi Hirano, Takefumi Uemura, Hiromichi Annoh, Naonobu Fujita, Satoshi Waguri, Takashi Itoh, Mitsunori Fukuda

  AUTOPHAGY 12 (2) 312 - 326 1554-8627 2016 [Refereed][Not invited]
   

  MAP1LC3/LC3 (a mammalian ortholog family of yeast Atg8) is a ubiquitin-like protein that is essential for autophagosome formation. LC3 is conjugated to phosphatidylethanolamine on phagophores and ends up distributed both inside and outside the autophagosome membrane. One of the well-known functions of LC3 is as a binding partner for receptor proteins, which target polyubiquitinated organelles and proteins to the phagophore through direct interaction with LC3 in selective autophagy, and their LC3-binding ability is essential for degradation of the polyubiquitinated substances. Although a number of LC3-binding proteins have been identified, it is unknown whether they are substrates of autophagy or how their interaction with LC3 is regulated. We previously showed that one LC3-binding protein, TBC1D25/OATL1, plays an inhibitory role in the maturation step of autophagosomes and that this function depends on its binding to LC3. Interestingly, TBC1D25 seems not to be a substrate of autophagy, despite being present on the phagophore. In this study we investigated the molecular basis for the escape of TBC1D25 from autophagic degradation by performing a chimeric analysis between TBC1D25 and SQSTM1/p62 (sequestosome 1), and the results showed that mutant TBC1D25 with an intact LC3-binding site can become an autophagic substrate when TBC1D25 is forcibly oligomerized. In addition, an ultrastructural analysis showed that TBC1D25 is mainly localized outside autophagosomes, whereas an oligomerized TBC1D25 mutant rather uniformly resides both inside and outside the autophagosomes. Our findings indicate that oligomerization is a key factor in the degradation of LC3-binding proteins and suggest that lack of oligomerization ability of TBC1D25 results in its asymmetric localization at the outer autophagosome membrane.
• Aggressive Surgery for Locally Advanced Gallbladder Cancer with Obstructive Jaundice: Result of a Prospective Study

  Yuya Nasu, Satoshi Hirano, Takahiro Tsuchikawa, Toshiaki Shichinohe

  DIGESTIVE SURGERY 33 (3) 213 - 219 0253-4886 2016 [Refereed][Not invited]
   

  Objective: The aim of this study was to clarify the clinical impact of our departmental policy for advanced gallbladder cancer (GBC) even with obstructive jaundice. Methods: Obstructive jaundice was defined as serum T-bil >= 2.0 mg/dl. Between 1998 and 2008, 112 patients with GBC were scheduled for surgical resection with curative intent. Thirty-six patients were converted to palliative surgery or exploration alone because of advanced disease. After excluding pathological T1 (UICC) patients (n = 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n = 37) and non-jaundiced group (n = 28). Surgical procedures were conducted based on our departmental guidelines concerning each type of infiltration of GBC. Results: Bile duct resection and major hepatectomy were performed more frequently in patients with jaundice. Although patients in jaundiced group had more advanced disease, 5-year overall survival rates of the patients with or without jaundice were 27 vs. 31% (p = 0.742), which was not statistically significant. Conclusions: Aggressive surgery might improve long-term survival in patients with locally advanced GBC even in the condition of obstructive jaundice with no distant metastasis. (C) 2016 S. Karger AG, Basel
• Peroral video cholangioscopic findings in a biliary intraductal mucinous cystic neoplasm

  Hiroshi Kawakami, Yoshimasa Kubota, Kimitoshi Kubo, Daisuke Sato, Tomoko Mitsuhashi, Satoshi Hirano, Naoya Sakamoto

  ENDOSCOPY 48 E152 - E153 0013-726X 2016 [Refereed][Not invited]
  
• A prospective, multicenter phase II trial of low-dose erlotinib as maintenance treatment after platinum doublet chemotherapy for advanced non-small cell lung cancer harboring EGFR mutation

  Satoshi Hirano, Go Naka, Yuichiro Takeda, Motoyasu Iikura, Noriko Hayama, Asako Yanagisawa, Hiroyuki Amano, Makoto Nakamura, Sukeyuki Nakamura, Hiroshi Tabeta, Haruhito Sugiyama

  Chinese Clinical Oncology 5 (6) 77  2304-3873 2016 [Refereed][Not invited]
   

  Background: Maintenance therapy with full-dose erlotinib for patients with advanced non-small cell lung cancer (NSCLC) has demonstrated a significant overall survival (OS) benefit. However, 150 mg/day of erlotinib seems too toxic as maintenance therapy. This study aimed to evaluate the efficacy and safety of low-dose erlotinib (25 mg/day) as maintenance treatment after platinum doublet chemotherapy in NSCLC harboring epidermal growth factor receptor (EGFR) mutation. Methods: Activated EGFR-mutation-positive NSCLC patients who did not progress after first-line platinum-doublet chemotherapy, ≥20 and ≤85 years old, with performance status (PS) 0-3 were included in this study. Low-dose erlotinib (25 mg/day) was administered until disease progression. The primary endpoint was overall response rate (ORR). Secondary endpoints included progression-free survival (PFS), OS, and safety. The required sample size was 40 patients. Results: The study was stopped early, after achieving only 28% of planned enrollment, due to poor accrual. Between April 2011 and May 2014, 11 patients (male/female, 5/6 median age, 72 years PS 0/1, 8/3 stage IV/relapse after surgery, 9/2 exon 19 deletions/L858R, 7/4) were enrolled and accessible in this study. Partial response (PR) was observed in 6 patients (56%). Median PFS was 14.9 months [95% confidence interval (CI), 2.7-27.1 months] and median OS was not calculable. Toxicities were generally mild. Only one patient developed grade 3 aspartate aminotransferase (AST)/alanine aminotransferase (ALT) elevation. Eight patients developed grade 1 skin rash. No treatment-related deaths were observed. Eight patients progressed, and recurrences included brain metastases (n=3), local recurrence (n=2), local recurrence plus brain metastasis (n=1), bone metastasis (n=1), and pulmonary metastasis (n=1). Conclusions: The study was stopped early due to poor accrual. However, our study suggests that maintenance therapy with low-dose erlotinib might be useful and tolerable in selected NSCLC patients harboring EGFR mutation.
• Totally laparoscopic gastrectomy for gastric cancer after endoscopic submucosal dissection: a propensity score matching analysis

  Yuma Ebihara, Shunichi Okushiba, Yo Kurashima, Takehiro Noji, Toru Nakamura, Soichi Murakami, Eiji Tamoto, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  LANGENBECKS ARCHIVES OF SURGERY 400 (8) 967 - 972 1435-2443 2015/12 [Refereed][Not invited]
   

  Purpose A recently developed endoscopic mucosal resection (EMR) procedure, endoscopic submucosal dissection (ESD), makes en bloc resection possible for mucosal cancer regardless of lesion size. ESD involves deeper and wider dissection of the gastric wall and may therefore increase the difficulty of subsequent totally laparoscopic gastrectomy (TLG) and the risk of complications. However, the influence of ESD on subsequent TLG has yet to be demonstrated. The purpose of the present study was to clarify the influence of ESD on subsequent TLG. Methods Between March 2006 and December 2013, we retrospectively collected data of 38 patients undergoing TLG with ESD (ESD group) and propensity score-matched 38 patients undergone TLG without ESD (non-ESD group) for treatment of gastric cancer at Tonan Hospital and Hokkaido University Hospital. The covariates for propensity score matching were as follows: age, sex, American Society of Anesthesiologists score, body mass index, and type of surgery. Clinicopathologic characteristics and surgical outcomes were compared between the two groups. Results Operative times for TLG in ESD group and non-ESD group were 228.2 +/- 53.9 and 228.1 +/- 52.7 min (P=0.989), and blood loss was 45.7 +/- 83.0 and 71.3 +/- 74.5 g, respectively (P=0.161). There were no significant differences between the groups of ESD and non-ESD in postoperative recovery and postoperative complications. In totally laparoscopic distal gastrectomy (TLDG), the patients with ESD-resected specimens of more than 50 mm in diameter had significantly longer operative times (P=0.009). Conclusions In this study, TLG is a feasible procedure treatment of gastric cancer regardless of ESD. However, TLDG is more difficult in cases where the ESD-resected specimen is more than 50 mm in diameter.
• Inhibition of Eph receptor A4 by 2,5-dimethylpyrrolyl benzoic acid suppresses human pancreatic cancer growing orthotopically in nude mice

  Hironobu Takano, Toru Nakamura, Takahiro Tsuchikawa, Toshihiro Kushibiki, Kouji Hontani, Kazuho Inoko, Mizuna Takahashi, Shoki Sato, Hirotake Abe, Shintaro Takeuchi, Nagato Sato, Kei Hiraoka, Hiroshi Nishihara, Toshiaki Shichinohe, Satoshi Hirano

  ONCOTARGET 6 (38) 41063 - 41076 1949-2553 2015/12 [Refereed][Not invited]
   

  Ephrin receptor A4 (EphA4) is overexpressed in human pancreatic adenocarcinoma (PDAC) and activate cell growth. Recent studies have identified small molecules that block EphA4. In this study, we investigated the correlation between EphA4 expression and the prognosis of patients with PDAC. We also examined the cytostatic efficacy of 2,5-dimethylpyrrolyl benzoic acid (compound 1), a small molecule that blocks EphA4, in PDAC cells. Overall survival of patients with EphA4 positivity was significantly shorter than that of patients with EphA4 negativity (P = 0.029). In addition, multivariate analysis revealed that EphA4 expression was an independent prognostic factor in PDAC patients (P = 0.039). Compound 1 showed a cytostatic efficacy in PDAC cells expressing EphA4 in vitro and in vivo. Our study indicated that compound 1 suppressed both EphA4 and Akt phosphorylations, and induced apoptosis in PDAC cells expressing EphA4. In conclusion, compound 1 has a high potential as a therapeutic agent for patients with PDAC.
• A case of stomal variceal hemorrhage successfully treated using sclerotherapy

  Mariko Ogino, Yoshinori Suzuki, Kazuyuki Yamamoto, Yo Kawarada, Shunichi Okushiba, Satoshi Hirano

  Journal of Japanese Society of Gastroenterology 112 (12) 2144 - 2151 0446-6586 2015/12/01 [Refereed][Not invited]
   

  A 72-year-old man underwent transverse colostomy for sigmoid colon cancer with multiple liver metastases. Subsequent chemotherapy effectively reduced liver metastases, and sigmoidectomy was performed. However, the liver metastases recurred and the patient developed stomal varices due to portal hypertension. To control the resulting massive variceal bleeding, we performed percutaneous sclerotherapy through a varicose vein, which was puncutured directly under ultrasound (US) guidance. Although the patient recovered from variceal bleeding, he eventually died due to the primary cancer.
• Early and long-term morbidity after minimally invasive total laryngo-pharyngo-esophagectomy with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision

  Akihiro Homma, Yuji Nakamaru, Hiromitsu Hatakeyama, Takatsugu Mizumachi, Satoshi Kano, Jun Furusawa, Tomohiro Sakashita, Toshiaki Shichinohe, Yuma Ebihara, Satoshi Hirano, Hiroshi Furukawa, Toshihiko Hayashi, Yuhei Yamamoto, Satoshi Fukuda

  EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY 272 (11) 3551 - 3556 0937-4477 2015/11 [Refereed][Not invited]
   

  Total laryngo-pharyngo-esophagectomy (TLPE) with gastric pull-up reconstruction is still considered to be associated with major complications and a significant risk of in-hospital death. Minimally invasive esophagectomy, avoiding thoracotomy and laparotomy, has been increasingly performed for esophageal malignancies with the hope of reducing mortality and morbidity, such as pulmonary complications. The aim in this study was to assess early and long-term morbidity as well as treatment outcomes in patients treated with TLPE with gastric pull-up reconstruction via thoracoscopy, laparoscopy and cervical incision. From 2004 to 2013, 10 patients with a median age of 64 years (range 47-71 years) underwent minimally invasive TPLE with gastric pull-up reconstruction. Seven of the 10 patients had previously received radiotherapy. As for early postoperative complications, no patient died during the early postoperative period, and pneumonia was observed in 1, skin necrosis in 1, pseudomembranous enterocolitis in 1, arrhythmia in 2, hemorrhage in the neck in 2, anastomotic leakage in the neck in 3, and tracheal necrosis in 6 patients. Three patients developed tracheostomal stenosis as a long-term postoperative complication, and an anastomotic stricture was observed in one patient. All patients were able to achieve oral intake, but 3 patients required feeding tube support. In conclusion, postoperative systemic complications during the early postoperative period were considered to be acceptable, although wound complications such as tracheal necrosis and anastomotic leakage were commonly observed. Therefore, this minimally invasive procedure might help reduce mortality and morbidity in patients requiring TLPE with gastric pull-up reconstruction.
• Laparoscopic reduction and repair for incarcerated obturator hernia: comparison with open surgery

  S. Hayama, K. Ohtaka, Y. Takahashi, T. Ichimura, N. Senmaru, S. Hirano

  Hernia 19 (5) 809 - 814 1248-9204 2015/10/01 [Refereed][Not invited]
   

  Purpose: Transabdominal preperitoneal (TAPP) repair for obturator hernia (OH) is not well established. Therefore, we evaluated the efficacy of TAPP for OH repair compared with open surgery. Methods: We retrospectively analyzed patients who underwent surgery for OH at our hospital between 2006 and 2011. Since 2009, we have used TAPP repair for OH instead of open surgery. The clinical results of TAPP repair were compared with those of open surgery performed before 2008. Results: Six patients with OH were treated by TAPP repair occult contralateral OH was found by laparoscopic exploration in three (50 %) patients and was simultaneously repaired. Bowel incarceration was reduced by water pressure through Nelaton catheter in all but one patient. Bowel resection was performed in two patients after the laparoscopic assessment. For incarcerated OH, five of six cases were repaired using synthetic mesh, and the remaining case was addressed with simple peritoneal closure. Before 2008, six patients with OH underwent open surgery. The background of patients was comparable in the TAPP group and the open surgery group. There were no deaths in either group, but one metachronous contralateral OH occurred in the open surgery group within a short time frame, whereas none occurred in the TAPP group. Conclusions: TAPP repair, including the inspection of the viability of the incarcerated intestine and protective reduction and assessment of the entire groin area is an effective and minimally invasive strategy for OH patients.
• Efficacy of Botulinum Toxin A Treatment for Pes Varus during Gait

  Hiroki Tanikawa, Hitoshi Kagaya, Eiichi Saitoh, Kenichi Ozaki, Satoshi Hirano, Norihide Itoh, Junya Yamada, Yoshikiyo Kanada

  JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 24 (10) 2416 - 2422 1052-3057 2015/10 [Refereed][Not invited]
   

  Background: The efficacy of botulinum toxin A (BoNTA) injection on spasticity is usually measured using Modified Ashworth Scale (MAS), but this only evaluates muscle tone at rest and has poor reliability. There are no reports that quantitatively evaluate pes varus during walking after botulinum treatment. The purpose of this study was to evaluate the efficacy of BoNTA injection on pes varus during gait using 3-dimensional motion analysis. Methods: Twenty-four hemiplegic patients with spastic pes varus deformity during gait received BoNTA injection into lower limb muscles. MAS score, comfortable overground gait velocity, and pes varus angle during treadmill walking were evaluated before, 2, 6, and 12 weeks after the injection. Five healthy subjects were also recruited to develop the pes varus/valgus angle as a normal reference. Results: The median MAS scores were significantly lower at 2 and 6 weeks after the injection. The maximum pes varus angle during the swing phase was significantly lower at 2, 6, and 12 weeks after the injection. It was significantly lower at 6 weeks after the injection during stance phase. The comfortable overground gait velocity was also improved after the injection. However, 2 patients experienced pain during gait and their pes varus angle increased during the follow-up period. Conclusions: BoNTA injection improved pes varus angle during gait. Evaluating motion in addition to spasticity at rest is recommended because improvements in limb function do not always parallel improvements in spasticity at rest.
• Hilar cholangiocarcinoma with intratumoral calcification: A case report

  Kazuho Inoko, Takahiro Tsuchikawa, Takehiro Noji, Yo Kurashima, Yuma Ebihara, Eiji Tamoto, Toru Nakamura, Soichi Murakami, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  WORLD JOURNAL OF GASTROENTEROLOGY 21 (38) 10926 - 10930 1007-9327 2015/10 [Refereed][Not invited]
   

  This report describes a rare case of hilar cholangiocarcinoma with intratumoral calcification that mimicked hepatolithiasis. A 73-year-old man presented to a local hospital with a calcified lesion in the hepatic hilum. At first, hepatolithiasis was diagnosed, and he underwent endoscopic stone extraction via the trans-papillary route. This treatment strategy failed due to biliary stricture. He was referred to our hospital, and further examination suggested the existence of cholangiocarcinoma. He underwent left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. Pathological examination revealed hilar cholangiocarcinoma with intratumoral calcification, while no stones were found. To the best of our knowledge, only one case of calcified hilar cholangiocarcinoma has been previously reported in the literature. Here, we report a rare case of calcified hilar cholangiocarcinoma and reveal its clinicopathologic features.
• 【門脈枝塞栓術・結紮術のすべて】肝門部胆管癌に対する門脈枝塞栓術

  中西 喜嗣, 平野 聡, 岡村 圭祐, 土川 貴裕, 田本 英司, 中村 透, 村上 壮一, 海老原 裕磨, 倉島 庸, 野路 武寛, 浅野 賢道, 七戸 俊明

  外科 (株)南江堂 77 (8) 892 - 895 0016-593X 2015/08 

  肝門部胆管癌における門脈枝塞栓術(portal vein embolization:PVE)について総説する.肝門部胆管癌においては,閉塞性黄疸による黄疸肝状態であることが多く,PVE施行前に予定残肝側の胆道ドレナージを行うことが必要である.肝切除とともに肝外胆管切除・再建,リンパ節郭清が必須であり,膵頭十二指腸切除,門脈や肝動脈切除・再建などが必要となることもある.すなわち,肝門部胆管癌における肝切除は肝細胞癌や転移性肝癌に対するそれと比較して,減黄がなされたとしても切除肝の状態が不良である可能性が高いこと,手術がもたらす侵襲度も大きいため,PVE適応基準としての残肝率(ratio of the future liver remnant volume/ total liver volume:%FLR)はより大きめに設定するべきであり,%FLR<40%とする施設が多い.(著者抄録)
• Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy

  Toru Nakamura, Yoshiyasu Ambo, Takehiro Noji, Naoya Okada, Minoru Takada, Toru Shimizu, On Suzuki, Fumitaka Nakamura, Nobuichi Kashimura, Akihiro Kishida, Satoshi Hirano

  JOURNAL OF GASTROINTESTINAL SURGERY 19 (8) 1425 - 1432 1091-255X 2015/08 [Refereed][Not invited]
   

  One of the most common morbidities of pancreaticoduodenectomies is delayed gastric emptying (DGE). The recent advent of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) attempts to lessen this troublesome complication; however, the incidence of DGE still remains to be 4.5-20 %. This study aims to evaluate whether the incidence of DGE can be reduced by the side-to-side gastric greater curvature-to-jejunal anastomosis in comparison with the gastric stump-to-jejunal end-to-side anastomosis in SSPPD. Between October 2007 and September 2012, a total of 160 consecutive patients who had undergone SSPPD were analyzed retrospectively. In the first period (October 2007-March 2010), gastrojejunostomy was performed with end-to-side anastomosis in 80 patients (SSPPD-ETS group). In the second period (April 2010-September 2012), gastrojejunostomy was performed with the greater curvature side-to-jejunal side anastomosis in 80 patients (SSPPD-STS group). The postoperative data were collected prospectively in a database and reviewed retrospectively. The incidence of DGE was 21.3 % in the SSPPD-ETS group and 2.5 % in the SSPPD-STS group (P = 0.0002). According to the classification of the International Study Group of Pancreatic Surgery (ISGPS), the incidence of DGE of grades A, B, and C were 5, 5, and 7 in the SSPPD-ETS group and 0, 2, and 0 in the SSPPD-STS group, respectively. The overall morbidity and postoperative hospital stay of the two groups were not significantly different. The greater curvature side-to-side anastomosis of gastrojejunostomy is associated with a reduced incidence of DGE after SSPPD.
• Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy

  Kazuho Inoko, Yuma Ebihara, Keita Sakamoto, Noriyuki Miyamoto, Yo Kurashima, Eiji Tamoto, Toru Nakamura, Soichi Murakami, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES 25 (4) E122 - E125 1530-4515 2015/08 [Refereed][Not invited]
   

  Background:Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series.Methods:Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery.Results:All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma.Conclusions:In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.
• Septic shock-related acute esophageal necrosis and stenosis: three cases of acquired esophageal stenosis presenting a similar clinical course

  Toshiaki Shichinohe, Yuma Ebihara, Soichi Murakami, Yo Kurashima, Taro Kuramae, Motoshi Kanai, Joe Matsumoto, Takahiro Tsuchikawa, Masanobu Kusano, Satoshi Hirano

  ESOPHAGUS 12 (3) 304 - 308 1612-9059 2015/07 [Refereed][Not invited]
   

  We present a case of acute esophageal necrosis (AEN) and two acquired esophageal stenosis cases which showed a similar clinical course after an episode of septic shock. Extensive stenosis of the distal esophagus developed in all cases, which were refractory to dilation therapy and required surgical intervention. The etiology of the latter two cases was deduced from the stenosis after septic shock-induced AEN. Since the diagnosis of AEN is based on its characteristic endoscopic findings which can only be confirmed at the onset of the disease, we therefore called these cases "septic shock-related esophageal stenosis" or abbreviated to "septic esophageal stenosis". Further study of similar cases is required for understanding the etiology and management of AEN and the relevant disorder which may cause esophageal stenosis.
• Chemotherapy-Derived Inflammatory Responses Accelerate the Formation of Immunosuppressive Myeloid Cells in the Tissue Microenvironment of Human Pancreatic Cancer

  Shintaro Takeuchi, Muhammad Baghdadi, Takahiro Tsuchikawa, Haruka Wada, Toru Nakamura, Hirotake Abe, Sayaka Nakanishi, Yuu Usui, Kohtaro Higuchi, Mizuna Takahashi, Kazuho Inoko, Syoki Sato, Hironobu Takano, Toshiaki Shichinohe, Ken-ichiro Seino, Satoshi Hirano

  CANCER RESEARCH 75 (13) 2629 - 2640 0008-5472 2015/07 [Refereed][Not invited]
   

  Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic malignancies. PDAC builds a tumor microenvironment that plays critical roles in tumor progression and metastasis. However, the relationship between chemotherapy and modulation of PDAC-induced tumor microenvironment remains poorly understood. In this study, we report a role of chemotherapy-derived inflammatory response in the enrichment of PDAC microenvironment with immunosuppressive myeloid cells. Granulocyte macrophage colony-stimulating factor (GM-CSF) is a major cytokine associated with oncogenic KRAS in PDAC cells. GM-CSF production was significantly enhanced in various PDAC cell lines or PDAC tumor tissues from patients after treatment with chemotherapy, which induced the differentiation of monocytes into myeloid-derived suppressor cells (MDSC). Furthermore, blockade of GM-CSF with monoclonal antibodies helped to restore T-cell proliferation when cocultured with monocytes stimulated with tumor supernatants. GM-CSF expression was also observed in primary tumors and correlated with poor prognosis in PDAC patients. Together, these results describe a role of GM-CSF in the modification of chemotherapy-treated PDAC microenvironment and suggest that the targeting of GM-CSF may benefit PDAC patients' refractory to current anticancer regimens by defeating MDSC-mediated immune escape. (C)2015 AACR.
• A New Technique for Making the Aberdeen Knot in Laparoscopic Surgery

  Dai Miyazaki, Yuma Ebihara, Satoshi Hirano

  JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES 25 (6) 499 - 502 1092-6429 2015/06 [Refereed][Not invited]
   

  Introduction: Laparoscopic knot-tying is an advanced skill. The traditional square knot or surgeon's knot is often used at the end of a continuous suture line in laparoscopic surgery. The Aberdeen knot has been shown to be stronger and more secure than the surgeon's knot for ending a suture line but is rarely used in laparoscopic surgery. We have developed a new technique to make the Aberdeen knot laparoscopically. Materials and Methods: At the end of a continuous suture line, the needle-attached end of the suture is held with a right-handed instrument and passed through the instrument into the loop of the last suture. The left-handed instrument is passed through the triangle made by the inserted suture, the right-handed instrument, and the loop through which the suture is inserted. The suture held by the right-handed instrument is then pulled, closing that loop and creating a new one on the left-handed instrument. The right-handed instrument is passed into the loop, and the same technique is then repeated two or more times. To finish the knot, the needle-attached end is passed through the loop, and the knot is tied. Discussion and Conclusions: Laparoscopic suturing and knotting are difficult, particularly in single-port laparoscopic surgery, where the angle between working instruments is narrow. Furthermore, knotting the end of a continuous suture is difficult when the thread becomes short. In all of these situations, this technique is able to facilitate and simplify knot-tying. No special instruments are required to make a laparoscopic Aberdeen knot.
• Potential risk of residual cancer cells in the surgical treatment of initially unresectable pancreatic carcinoma after chemoradiotherapy

  Hironobu Takano, Takahiro Tsuchikawa, Toru Nakamura, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  WORLD JOURNAL OF SURGICAL ONCOLOGY 13 209  1477-7819 2015/06 [Refereed][Not invited]
   

  Background: With development of chemoradiotherapy for pancreatic carcinoma, borderline resectable or initially unresectable cases sometimes become operable after long-term intensive chemoradiotherapy. However, there is no established strategy for adjuvant surgery with respect to whether the surgical resection should be extensive or downsized accordingly with diminished disease areas following response to chemoradiotherapy. Methods: The clinical and pathological aspects of 18 patients with initially unresectable pancreatic cancer who underwent adjuvant surgery after chemo(radio)therapy in our department from 2007 were evaluated. Results: Overall survival from initial treatment was much better for patients with R0 resection than for patients with R1/2 resection. In two of three patients who had complete improvement of plexus (PL) invasion after chemo(radio) therapy, there had still remained pathological plexus invasion. It was shown that tumors did not shrink continuously from the tumor front, but parts remained discontinuously at the distal portion in the process of tumor regression by chemo(radio)therapy. Conclusions: In adjuvant surgery for patients with locally advanced pancreatic cancer, the potential risk of residual cancer in the regression area following chemoradiotherapy should be considered. Achieving R0 resection will lead to an improved prognosis, and it is necessary to consider how well the extent of resection is after a favorable response to chemoradiotherapy.
• Pigment epithelium-derived factor inhibits the growth of human esophageal squamous cell carcinoma by suppressing neovascularization.

  Kadoya M, Tamoto E, Shichinohe T, Hirano S

  [Hokkaido igaku zasshi] The Hokkaido journal of medical science 90 (1) 17 - 29 0367-6102 2015/05 [Refereed][Not invited]
  
• Is there a Benefit from Additional Arterial Resection of Ductal Cancer of the Pancreas?

  Satoshi Hirano, Takahiro Tsuchikawa

  Pancreatic Cancer, Cystic Neoplasms and Endocrine Tumors: Diagnosis and Management 59 - 61 2015/04/07 [Refereed][Not invited]
   

  Locally far advanced pancreatic ductal adenocarcinoma frequently involves surrounding major arteries. Even when there is no radiological evidence of arterial encasement, there may be perineural tumor infiltration of the nerve plexuses surrounding them and this may contribute to a positive resection margin and local recurrence. A number of studies have suggested that patients who have undergone surgery for locally advanced pancreatic cancer with arterial resection of the hepatic artery or the superior mesenteric artery have a poor prognosis. Borderline resectable or unresectable pancreatic cancer may become resectable when treated preoperatively with intensive chemotherapy or chemoradiotherapy with or without arterial resection. The perioperative outcome and survival after the surgery with arterial resection has still been poor compared with those patients without arterial resection, except where there has been a sustained response to neoadjuvant treatment. An R0 resection also can be achieved in patients with pancreatic ductal adenocarcinoma involving the body of the pancreas with major arterial encasement, with distal pancreatectomy and en bloc resection of the celiac axis in selected cases. Prospective randomized controlled neoadjuvant studies will be necessary to demonstrate the effectiveness of this strategy.
• The key role of calreticulin in immunomodulation induced by chemotherapeutic agents

  Yoshiyuki Yamamura, Takahiro Tsuchikawa, Kengo Miyauchi, Shintaro Takeuchi, Masataka Wada, Toshihiko Kuwatani, Noriaki Kyogoku, Aki Kuroda, Takehiro Maki, Toshiaki Shichinohe, Satoshi Hirano

  INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 20 (2) 386 - 394 1341-9625 2015/04 [Refereed][Not invited]
   

  It has recently been shown that certain chemotherapeutic agents can improve host immune responses. The present study aimed to demonstrate the mechanism by which chemotherapeutic agents modify the tumor microenvironment and induce tumor-specific immune responses. Three mouse cancer cell lines [CT26 mouse colon cancer cells, B16 melanoma cells and Lewis lung carcinoma (LLC)], 5 human carcinoma cell lines (human esophageal squamous cell carcinoma cell lines TE8 and HEC46 and the human pancreatic carcinoma cell lines PK-9, AsPC-1 and SUIT-2) and 5 chemotherapeutic agents [mitoxantrone (MIT), mitomycin C(MMC), 5-fluorouracil (5FU), camptothecin (CPT-11) and cisplatin (CDDP)] that are frequently used in a clinical setting for cancer treatment were utilized to investigate the surface expression level of calreticulin and HLA class I after exposure to chemotherapeutic agents. Increased calreticulin (CRT) expression on the surface of mouse cell lines and, moreover, increased surface expression levels of both CRT and HLA class I in all human cell lines were observed in cells treated by the chemotherapeutic agents as compared with non-treated cells. The surface expression level of CRT was significantly correlated with the HLA class I expression level in all human cell lines. In conclusion, chemotherapeutic drugs can improve the immunogenicity of cancer cells in a cell-specific manner through the mechanism of translocation of CRT.
• Resection and Reconstruction of the Hepatic Artery for Advanced Perihilar Cholangiocarcinoma: Result of Arterioportal Shunting

  Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Toru Nakamura, Eiji Tamoto, Toshiaki Shichinohe, Satoshi Hirano

  JOURNAL OF GASTROINTESTINAL SURGERY 19 (4) 675 - 681 1091-255X 2015/04 [Refereed][Not invited]
   

  The clinical impact of concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma remains unclear. Microvascular anastomosis is typically used for arterial reconstruction, but we have proposed arterioportal shunting (APS) as an alternative procedure. The aims of this retrospective study were to evaluate concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma patients, to evaluate the safety and survival impact of APS, and to evaluate whether APS offers a good alternative to microvascular reconstruction. Thirty-nine patients with perihilar cholangiocarcinoma who required arterial reconstructions were retrospectively evaluated. No significant difference was seen in overall incidence of postoperative complications between groups, but the incidence of liver abscess formation was significantly higher in the APS group. The cumulative 5-year survival rate was 15 % in patients undergoing concomitant arterial resection and reconstruction for perihilar cholangiocarcinoma. No significant differences in survival were identified between the microvascular (MV) and APS groups. Cumulative 5-year survival rates were 18 % in the MV group and 11 % in the APS group. Concomitant arterial resection and reconstruction are feasible for patients with perihilar cholangiocarcinoma. Microvascular reconstruction should be used as the first-line strategy for these patients, with APS indicated only when the artery is unable to be microscopically anastomosed.
• Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

  Masaru Miyazaki, Hideyuki Yoshitomi, Shuichi Miyakawa, Katsuhiko Uesaka, Michiaki Unno, Itaru Endo, Takehiro Ota, Masayuki Ohtsuka, Hisafumi Kinoshita, Kazuaki Shimada, Hiroaki Shimizu, Masami Tabata, Kazuo Chijiiwa, Masato Nagino, Satoshi Hirano, Toshifumi Wakai, Keita Wada, Hiroyuki Iasayama, Takuji Okusaka, Toshio Tsuyuguchi, Naotaka Fujita, Junji Furuse, Kenji Yamao, Koji Murakami, Hideya Yamazaki, Hiroshi Kijima, Yasuni Nakanuma, Masahiro Yoshida, Tsukasa Takayashiki, Tadahiro Takada

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 22 (4) 249 - 273 1868-6974 2015/04 [Refereed][Not invited]
   

  Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidence-based approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and amobile application of this guideline are available via http://www.jshbps.jp/en/guideline/biliary-tract2.html.
• Concomitant major vessel resection in pancreatic adenocarcinoma

  Takahiro Tsuchikawa, Satoshi Hirano, Toru Nakamura, Keisuke Okamura, Eiji Tamoto, Toshiaki Shichinohe

  POSTGRADUATE MEDICINE 127 (3) 273 - 276 0032-5481 2015/04 [Refereed][Not invited]
   

  Increasing evidence has contraindicated extended radical dissection of pancreatic adenocarcinoma (PC). With the recent improvement of perioperative management techniques and multimodal treatment strategy for PC, concomitant major vessel resection and reconstruction has thus been aggressively attempted in association with comparatively better pathologically negative surgical margins and postoperative survival. We have discussed the clinical relevance of concomitant major vessel resection mainly focusing on indications for such resection with borderline resectable tumor associated with chemoradiotherapy, distal pancreatectomy with en bloc celiac axis resection for pancreatic body and tail cancer, and adjuvant surgery for initially unresectable pancreatic cancer.
• 教育を目的とした腹腔鏡下幽門側胃切除認知タスク分析および技能評価スケール開発

  倉島 庸, 比企 直樹, 渡邊 祐介, 本多 通孝, 海老原 裕磨, 村上 壮一, 田本 英司, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本胃癌学会総会記事 (一社)日本胃癌学会 87回 316 - 316 2015/03
• Advances in the surgical treatment of hilar cholangiocarcinoma

  Takahiro Tsuchikawa, Satoshi Hirano, Keisuke Okamura, Joe Matsumoto, Eiji Tamoto, Soichi Murakami, Toru Nakamura, Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe

  EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY 9 (3) 369 - 374 1747-4124 2015/03 [Refereed][Not invited]
   

  With the improvement of perioperative management and surgical techniques as well as the accumulation of knowledge on the oncobiological behavior of bile duct carcinoma, the long-term prognosis of hilar cholangiocarcinoma has been improving. In this article, the authors review the recent developments in surgical strategies for hilar cholangiocarcinoma, focusing on diagnosis for characteristic disease extension, perioperative management to reduce postoperative morbidity and mortality, surgical techniques for extended curative resection and postoperative adjuvant therapy.
• A Case of Endobronchial NUT Mid line Carcinoma with Intraluminal Growth

  Sho Watanabe, Satoshi Hirano, Sohtaro Mine, Akihiko Yoshida, Toru Motoi, Satoshi Ishii, Go Naka, Yuichiro Takeda, Toru Igari, Haruhito Sugiyama, Nobuyuki Kobayashi

  ANTICANCER RESEARCH 35 (3) 1607 - 1612 0250-7005 2015/03 [Refereed][Not invited]
   

  Background: NUT midline carcinoma (NMC) is a rare, lethal form of differentiated squamous cell carcinoma characterized by chromosomal rearrangement of the NUT gene. Its highly aggressive nature commonly leads to unresectable and metastatic lesions. Case Report: We report on a case of endobronchial NMC in a middle-aged man who was treated by bronchoscopic electrocautery followed by Ewing sarcoma-based chemotherapy with concurrent chemoradiotherapy. The patient's disease continued to be stable 31 months after diagnosis. Review: NMC is a challenging disease entity, which is difficult to diagnose and treat, and has a dismal overall survival. Most cases of NMC are widely metastatic or unresectable when diagnosed. Discussion: This is the first reported case that involves intraluminal tumour growth of NMC and demonstrates the effectiveness of early intensive local therapy aided by bronchoscopic techniques.
• Detailed Analysis of Extra-Pancreatic Nerve Plexus Invasion in Pancreatic Body Carcinoma Analyzed by 50 Consecutive Series of Distal Pancreatectomy with En-Bloc Celiac Axis Resection

  Takahiro Tsuchikawa, Satoshi Hirano, Toru Nakamura, Keisuke Okamura, Eiji Tamoto, Soichi Murakami, Yo Kurashima, Yuma Ebihara, Toshiaki Shichinohe

  HEPATO-GASTROENTEROLOGY 62 (138) 455 - 458 0172-6390 2015/03 [Refereed][Not invited]
   

  Background/Aims: Advanced pancreatic body carcinoma frequently accompany extra-pancreatic nerve plexus (PL) invasion, one of the poor indicator of patient prognosis. The present study aimed to reveal the progress of the PL invasion from cancer of the pancreas body toward the root of the celiac artery (CA) and superior mesenteric artery (SMA) followed by investigation of the relevance of diagnostic accuracy Methodology: Resected specimens from 50 consecutive patients who underwent distal pancreatectomy with en bloc celiac axis resection (DP-CAR) were pathologically analyzed for the direction of PL invasion. Diagnostic accuracy on CT imaging were also investigated. Results: Thirty seven of the 50 patients (74%) were positive for PL invasion around the CHA,SPA,CA and SMA. In terms of the diagnostic accuracy, positive predictive values for the PL invasion were 35%, 36%, 43% and 81% for the SPA, CHA, CA and SMA, respectively. Among 21 patients and 23 patients with PL invasion around CHA and SPA, 13 and 6 patients also accompanied PL invasion around CA, respectively. Conclusions: Carcinoma of the pancreatic body is found to frequently accompany PL invasion around CA. Under the limitation of low diagnostic accuracy, DP-CAR might be feasible operation that increase's the possibility of R0 resection.
• 腹腔動脈幹合併切除兼尾側膵切除術後に生じた胸腹部大動脈瘤切迫破裂に対し上腸間膜動脈塞栓+腹部分枝再建+ステントグラフト内挿で救命した1例

  曽山 武士, 作原 祐介, 高橋 文也, 安井 太一, 阿保 大介, 工藤 興亮, 久保田 卓, 松居 喜郎, 田中 栄一, 平野 聡

  Japanese Journal of Radiology (公社)日本医学放射線学会 33 (Suppl.) 7 - 7 1867-1071 2015/02
• Prediction of pancreatic anastomotic failure after pancreatic head resection using preoperative diffusion-weighted MR imaging

  Noriyuki Miyamoto, Satoshi Yabusaki, Keita Sakamoto, Yasuka Kikuchi, Rie Mimura, Fumi Kato, Noriko Oyama-Manabe, Bunya Takahashi, Takeshi Soyama, Daisuke Abo, Yusuke Sakuhara, Kohsuke Kudo, Hiroki Shirato, Toru Nakamura, Takahiro Tsuchikawa, Keisuke Okamura, Satoshi Hirano

  JAPANESE JOURNAL OF RADIOLOGY 33 (2) 59 - 66 1867-1071 2015/02 [Refereed][Not invited]
   

  To determine whether the preoperative pancreatic apparent diffusion coefficient (ADC) can be used to predict the development of postoperative pancreatic anastomotic failure (PAF). We retrospectively examined the cases of 79 patients who underwent pancreatic head resection between January 2010 and October 2013. The patients underwent 1.5-T MR imaging including diffusion-weighted imaging before surgery. The main pancreatic duct diameter (MPD), the pancreatic parenchymal thickness (PT), and the ADC of the pancreatic remnant parenchyma were measured. Two radiologists blinded to the patients' outcomes performed the measurements. The imaging parameters were compared between the patients who developed PAF and those who did not. The cut-off ADC for the development of PAF was calculated with a receiver operating characteristic analysis. The imaging parameters were highly correlated between the two observers. The MPD and PT did not differ significantly among the patients. The mean pancreatic ADCs were significantly higher in the patients with PAF than in those without PAF. An ADC higher than 1.50 x 10(-3) mm(2)/s (Az = 0.719, observer-1) or 1.35 x 10(-3) mm(2)/s (Az = 0.752, observer-2) was optimal for predicting the development of postoperative PAF. Measuring the preoperative non-tumorous pancreatic ADC may be useful for the prediction of a postoperative PAF.
• The significance of metastasectomy in patients with metastatic renal cell carcinoma

  Haruka Miyata, Nobuo Shinohara, Norihiro Murahashi, Kunihiko Tsuchiya, Naoto Miyajima, Satoru Maruyama, Takashige Abe, Kichizo Kaga, Satoshi Hirano, Katsuya Nonomura

  Acta Urologica Japonica 61 (2) 49 - 54 0018-1994 2015/02/01 [Refereed][Not invited]
   

  We conducted a retrospective study to clarify the clinical significance of metastasectomy in patients with metastatic renal cell carcinoma (mRCC). Of 83 mRCC patients who were treated at our hospital between 2005 and 2010, 19 patients who underwent metastasectomy during the treatment course were the subjects of the present study. By the purpose and timing of metastasectomy, we classified the 19 patients into three groups: (1) patients who immediately underwent metastasectomy at diagnosis of metastasis (primary group), (2) patients who underwent resection of clinically problematic metastatic lesions for the relief of their symptoms (palliative group), and (3) patients who underwent complete resection of all metastatic lesions after sufficient systemic therapies (consolidation group). In the primary group (n = 5), four patients had lung metastasis and one had metastases to limbs and the adrenal gland. Overall survival at 3 years was 100%. In the palliative group (n = 4), 3 patients underwent resection of brain metastasis and one underwent resection of skin metastasis. The symptoms associated with metastasis clearly improved. In the consolidation group (n= 10), the metastasized organ was the lung in 5 patients, pancreas in 4, and liver in one. Preoperative systemic therapy included sunitinib or sorafenib in 5 patients, interferon-α in 4, and S-l in one. After metastasectomy, systemic therapies were discontinued in 9 patients, 4 of whom did not experience RCG recurrence, with a median follow-up of 35 months. Overall survival at 3 years was 60%. Metastasectomy would be a good treatment option in patients with mRCC.
• Surgery for recurrent biliary carcinoma: results for 27 recurrent cases

  Takehiro Noji, Takahiro Tsuchikawa, Tomoko Mizota, Keisuke Okamura, Toru Nakamura, Eiji Tamoto, Toshiaki Shichinohe, Satoshi Hirano

  WORLD JOURNAL OF SURGICAL ONCOLOGY 13 82  1477-7819 2015/02 [Refereed][Not invited]
   

  Background: Various chemotherapies have been used as best practice to treat recurrent biliary malignancies. Conversely, relatively few surgeries have been described for recurrent extrahepatic biliary carcinoma (RExBC), so whether surgery for RExBC is feasible has remained unclear. This retrospective study was conducted to evaluate the feasibility of surgery for RExBC. Methods: From February 2000 to January 2014, a total of 27 patients, comprising 18 patients with extrahepatic cholangiocarcinoma and 9 patients with gallbladder carcinoma, met our criteria for radical resection of RExBC (resection group). Sites of recurrence consisted of liver metastases (ten patients), local/percutaneous transhepatic cholangio drainage (PTCD) fistula recurrence (eight patients), bile duct recurrence (six patients), and lymph node recurrence (one patient). To evaluate the survival impact of resection, we compared 123 RExBC patients (resection group) with patients who received palliative care (palliative group). Results: Morbidity and mortality rates in the resection group were 6.6% and 0%, respectively. Overall cumulative 5-year survival rates were 23.5% in the resection group and 0% in the palliative group. Median survival time was 21.6 months in the resection group and 9.5 months in the palliative group, showing a significant difference (p < 0.01). No significant differences in cumulative survival were seen between extrahepatic cholangiocarcinoma and gallbladder carcinoma in the resection group. In addition, no significant differences were seen between liver metastases, bile duct recurrence, and local/percutaneous transhepatic biliary drainage (PTBD) fistula recurrence in the resection group. Conclusions: Surgery appears feasible for RExBC and offers longer survival for selected patients.
• Surgical resection of solid gallbladder adenocarcinoma presenting as a large mass: report of a case

  Satoshi Hayama, Satoshi Hirano, Nagato Sato, Yuma Ebihara, Yo Kurashima, Soichi Murakami, Eiji Tamoto, Toru Nakamura, Joe Matsumoto, Takahiro Tsuchikawa, Eiichi Tanaka, Toshiaki Shichinohe

  WORLD JOURNAL OF SURGICAL ONCOLOGY 13 29  1477-7819 2015/02 [Refereed][Not invited]
   

  This report describes a case of a patient with a large solid gallbladder adenocarcinoma that was completely resected through aggressive surgery. The patient was a 57-year-old woman who had been diagnosed with advanced gallbladder cancer, had no indications for surgical resection and was scheduled to undergo systemic chemotherapy. She presented to our hospital for a second opinion. At the time of assessment, her tumor was large but was well-localized and had not invaded into the surrounding tissues, indicating that surgical resection was a reasonable option. Subsequently, the tumor was completely extracted via right hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct. Histopathologically, the tumor was a solid adenocarcinoma. Although there are relatively few reports in the literature regarding solid gallbladder adenocarcinoma, well-localized growth appears to be a characteristic feature. On the basis of a tumor's progression behavior, aggressive surgical treatment might be indicated even when the tumor has grown to a considerable size.
• A Case of Gastric Glomus Tumor Diagnosed Preoperatively as Primary Gastric Neuroendocrine Tumor

  UMEMOTO Kazufumi, MURAKAWA Katsuhiko, SUZUKI Tomohiro, YAMAMURA Yoshiyuki, ONO Koichi, HIRANO Satoshi

  Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 日本臨床外科学会 76 (8) 1896 - 1900 1345-2843 2015 

  A 41-year-old woman underwent an upper gastrointestinal contrast examination during a medical checkup, indicating gastric submucosal tumor. She visited our hospital for further examination. Upper gastrointestinal endoscopy revealed an elevated lesion covered with healthy mucosa in the gastric antrum, and she was diagnosed with neuroendocrine tumor (NET)-G1 by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA).
  Surgery for laparoscopic gastric local excision was performed alongside intraoperative ultrasonography. Histological findings showed poorly atypical uniform round cells proliferating between rich vasculature, and gastric glomus tumor was diagnosed based on the results of immunostaining. Glomus tumors are non-epithelial tumors that frequently occur under the skin of the limbs and trunk. Although onset in the gastrointestinal tract is rare, when they do occur, many are primary gastric tumors. In light of the rarity of the tumor and the histological features, these tumors are difficult to diagnose, but EUS-FNA and immunostaining are the most important methods for diagnosis. We feel that in surgery for gastric glomus tumors, laparoscopic gastric local excision may be an appropriate surgical technique, and combined use of intraoperative ultrasonography or intraoperative gastrointestinal endoscopy offers the potential for safer surgical procedures.
• A Case of Resection for a Solitary Hepatic Metastasis from Breast Cancer 13 Years after Quadrantectomy

  FURUKAWA Shotaro, OKAMURA Keisuke, FUJITA Miyoshi, NAKAYAMA Tomohide, MORITA Takayuki, HIRANO Satoshi

  Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 日本臨床外科学会 76 (9) 2120 - 2124 1345-2843 2015 

  We report a case of solitary hepatic metastasis from breast cancer. A 79-year-old female patient underwent quadrantectomy with axillary lymph node dissection when she was 66 years old. The pathologic diagnosis was invasive ductal adenocarcinoma, scirrhous carcinoma, pT1N1M0, ER and PgR positive. Radiotherapy was performed, followed by chemotherapy and endocrine therapy. Since the age of 76 years, her serum CEA level was occasionally elevated. A solitary hepatic tumor in segment 4 was found on ultrasonography 13 years after mastectomy. Although the enhanced pattern on CT and MRI was atypical, the lesion was diagnosed as intrahepatic cholangiocarcinoma. Because left hepatic duct invasion was suspected based on endoscopic retrograde cholangiography, left hepatectomy and left caudate lobectomy were performed. The histopathological findings were compatible with a solid tubular or papillo-tubular carcinoma of the breast. The lesion was both ER and PgR positive. Therefore, we finally diagnosed the lesion as hepatic metastasis from breast cancer. The patient has been alive for three years after hepatectomy. Because hepatic metastasis often presents as multiple lesions, few patients undergo hepatectomy. However, hepatectomy can be a therapeutic option as it could prolong survival in patients with solitary hepatic metastasis from breast cancer.
• O16-7 TBAC針と50mlシリンジを用いた新たな組織様検体採取の試み(気管支鏡生検,病理診断,Oralセッション16,第38回日本呼吸器内視鏡学会学術集会)

  天野 寛之, 柳澤 麻子, 巴山 紀子, 中村 純, 平野 聡, 中村 祐之, 多部田 弘士

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 37 S203  2015
• P37-2 2度目の気管支鏡で診断がついた肺放線菌症の1例(内科症例7,Posterセッション37,第38回日本呼吸器内視鏡学会学術集会)

  中村 純, 柳澤 麻子, 巴山 紀子, 天野 寛之, 平野 聡, 中村 祐之, 多部田 弘士, 一ノ瀬 修二, 内田 修

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 37 S315  2015
• Whole-genome mutational landscape of liver cancers displaying biliary phenotype reveals hepatitis impact and molecular diversity

  Akihiro Fujimoto, Mayuko Furuta, Yuichi Shiraishi, Kunihito Gotoh, Yoshiiku Kawakami, Koji Arihiro, Toru Nakamura, Masaki Ueno, Shun-ichi Ariizumi, Ha Hai Nguyen, Daichi Shigemizu, Tetsuo Abe, Keith A. Boroevich, Kaoru Nakano, Aya Sasaki, Rina Kitada, Kazihiro Maejima, Yujiro Yamamoto, Hiroko Tanaka, Tetsuo Shibuya, Tatsuhiro Shibata, Hidenori Ojima, Kazuaki Shimada, Shinya Hayami, Yoshinobu Shigekawa, Hiroshi Aikata, Hideki Ohdan, Shigeru Marubashi, Terumasa Yamada, Michiaki Kubo, Satoshi Hirano, Osamu Ishikawa, Masakazu Yamamoto, Hiroki Yamaue, Kazuaki Chayama, Satoru Miyano, Tatsuhiko Tsunoda, Hidewaki Nakagawa

  NATURE COMMUNICATIONS 6 6120  2041-1723 2015/01 [Refereed][Not invited]
   

  Intrahepatic cholangiocarcinoma and combined hepatocellular cholangiocarcinoma show varying degrees of biliary epithelial differentiation, which can be defined as liver cancer displaying biliary phenotype (LCB). LCB is second in the incidence for liver cancers with and without chronic hepatitis background and more aggressive than hepatocellular carcinoma (HCC). To gain insight into its molecular alterations, we performed whole-genome sequencing analysis on 30 LCBs. Here we show, the genome-wide substitution patterns of LCBs developed in chronic hepatitis livers overlapped with those of 60 HCCs, whereas those of hepatitis-negative LCBs diverged. The subsequent validation study on 68 LCBs identified recurrent mutations in TERT promoter, chromatin regulators (BAP1, PBRM1 and ARID2), a synapse organization gene (PCLO), IDH genes and KRAS. The frequencies of KRAS and IDHs mutations, which are associated with poor disease-free survival, were significantly higher in hepatitis-negative LCBs. This study reveals the strong impact of chronic hepatitis on the mutational landscape in liver cancer and the genetic diversity among LCBs.
• Pathological characteristics of intraductal polypoid neoplasms of bile ducts in Thailand

  Takeo Nitta, Yasuni Nakanuma, Yasunori Sato, Satoshi Hirano, Chawalit Pairojkul

  INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 8 (7) 8284 - 8290 1936-2625 2015 [Refereed][Not invited]
   

  Intraductal papillary or tubular neoplasms of the bile duct have recently been proposed as one of the preinvasive lesions of cholangiocarcinoma. Herein, a total of 50 cases of intraluminal polypoid neoplasms of the bile ducts experienced in Khon Kaen University Hospital in Thailand were pathologically examined. These cases presumably had a history of infection of Opisthorchis viverrini. These neoplasms were histologically composed of high-grade intraepithelial neoplasm showing a tubular and/papillary pattern without invasion (20 cases), and with minimal and considerable invasion (15 and 15 cases, respectively). They were histologically classifiable into papillary type (10 cases), tubular type (20 cases) and papillotubular type (20 cases), and were phenotypically classifiable into gastric (17 cases), intestinal (17 cases) and pancreatobiliary types (16 cases). It was found that cases of papillary type and gastric or intestinal phenotype were less invasive, while those of tubular or papillotubular type and pancreatobiliary phenotype were more invasive. In conclusion, intraductal polypoid neoplasms in Thailand were well-differentiated papillary and/or tubular neoplasms including those with no or minimal invasion, and histological and phenotypic subclassifications seem to be useful for evaluation of the aggressive pathological behaviors of these neoplasms.
• PD後膵空腸吻合部静脈瘤破裂に対しPTOにて止血した1例

  原田 太以佑, 阿保 大介, 作原 祐介, 曽山 武士, 安井 太一, 寺江 聡, 田中 栄一, 平野 聡

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 29 (4) 426 - 426 1340-4520 2014/12
• 肝仮性動脈瘤を直接穿刺し治療した1例

  高橋 文也, 阿保 大介, 志村 亮祐, 曽山 武士, 作原 祐介, 工藤 與亮, 海老原 裕磨, 田中 栄一, 平野 聡

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 29 (4) 429 - 429 1340-4520 2014/12
• 腹腔動脈幹合併切除兼尾側膵切除術後に生じた胸腹部大動脈瘤切迫破裂に対し上腸間膜動脈塞栓+腹部分枝再建+ステントグラフト内挿で救命した1例

  曽山 武士, 作原 祐介, 高橋 文也, 安井 太一, 阿保 大介, 工藤 興亮, 久保田 卓, 松居 喜郎, 田中 栄一, 平野 聡

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 29 (4) 430 - 430 1340-4520 2014/12
• Protection of Cone Photoreceptor M-Opsin Degradation with 9-Cis-beta-Carotene-Rich Alga Dunaliella bardawil in Rpe65(-/-) Mouse Retinal Explant Culture

  Taku Ozaki, Mitsuru Nakazawa, Takashi Kudo, Satoshi Hirano, Kaori Suzuki, Sei-ichi Ishiguro

  CURRENT EYE RESEARCH 39 (12) 1221 - 1231 0271-3683 2014/12 [Refereed][Not invited]
   

  Purpose: RPE65, a retinal pigment epithelium-specific 65-kDa protein, plays a critical role in the visual cycle of the eye. Rpe65(-/-) mice develop vision loss due to a lack of 11-cis-retinal, degradation of M-opsin and mislocalization of S-opsin. Several studies have suggested that 9-cis-b-carotene, a precursor of 9-cis-retinal and all-trans-retinal, could have therapeutic applications in vision loss. We therefore examined whether Dunaliella bardawil, a 9-cis-beta-carotene-rich alga, protects against the degradation of M-opsin using Rpe65(-/-) mouse retinal explant cultures. Methods: The eyes of three-week-old Rpe65(-/-) and C57BL/6 J mice were enucleated, and the corneas were removed. The eyecups were incubated with culture medium in the absence or presence of D. bardawil for 6 h to 4 days. Localizations of M-opsin proteins in the retina were observed immunohistochemically. Expression levels of M-opsin, S-opsin and rhodopsin proteins were evaluated by Western blot analysis. Results: In C57BL/6 J mouse retina, no change was observed in localization and expression levels of M-opsin in the explant culture system. In Rpe65(-/-) mouse retina, the amount of M-opsin protein was decreased in the photoreceptor outer segment after 6 h to 4 days of culture. However, the presence of D. bardawil significantly ameliorated this decrease. In contrast, expression levels of S-opsin and rhodopsin were unchanged in the presence of the explant culture. Conclusions: These results demonstrate that D. bardawil treatment protects against M-opsin degradation in Rpe65(-/-) mouse retina and suggest that D. bardawil has therapeutic potential for retinal degeneration caused by Rpe65 gene mutation, such as Leber congenital amaurosis and retinitis pigmentosa.
• Impact of the tumor microenvironment in predicting postoperative hepatic recurrence of pancreatic neuroendocrine tumors

  Shoki Sato, Takahiro Tsuchikawa, Toru Nakamura, Nagato Sato, Eiji Tamoto, Keisuke Okamura, Toshiaki Shichinohe, Satoshi Hirano

  ONCOLOGY REPORTS 32 (6) 2753 - 2759 1021-335X 2014/12 [Refereed][Not invited]
   

  The disease frequency of pancreatic neuroendocrine tumors (PNETs) has been growing, and postoperative hepatic recurrence (PHR) is one of the factors affecting patient prognosis. The present study aimed to investigate biomarkers of PNETs in the primary disease site to predict PHR using immunohistochemical analysis for tumor-infiltrating lymphocytes (TILs: CD3, CD8 and CD45RO), human leukocyte antigen (HLA) class I, alpha-thalassemia/mental retardation X-linked (ATRX), death domain-associated protein (DAXX), mammalian target of rapamycin (mTOR) and phospho-mTOR (p-mTOR). Correlations were analyzed between TILs and the biomarkers, clinicopathological features and prognosis. Sixteen patients with PNETs who underwent radical surgery at our hospital were reviewed. We analyzed the correlation between PHR and immunohistochemical characteristics, and also between disease-free survival (DFS) or overall survival (OS) and the immunohistochemical characteristics. We found that PHR was associated with the expression patterns of DAXX and p-mTOR. No association was found between PHR and patient background, TILs or other biomarkers. DFS was found to be associated with ATRX, DAXX and p-mTOR. OS was associated only with p-mTOR. In conclusion, ATRX, DAXX and p-mTOR are useful molecular biomarkers for predicting PHR in patients who undergo radical surgery for PNETs. Use of these biomarkers will enable earlier decisions on which patients may benefit from adjuvant therapy.
• Giant primary angiosarcoma of the small intestine showing severe sepsis

  Mizuna Takahashi, Masanori Ohara, Noriko Kimura, Hiromitsu Domen, Takumi Yamabuki, Kazuteru Komuro, Takahiro Tsuchikawa, Satoshi Hirano, Nozomu Iwashiro

  WORLD JOURNAL OF GASTROENTEROLOGY 20 (43) 16359 - 16363 1007-9327 2014/11 [Refereed][Not invited]
   

  Primary malignant tumors of the small intestine are rare, comprising less than 2% of all gastrointestinal tumors. An 85-year-old woman was admitted with fever of 40. and marked abdominal distension. Her medical history was unremarkable, but blood examination showed elevated inflammatory markers. Abdominal computed tomography showed a giant tumor with central necrosis, extending from the epigastrium to the pelvic cavity. Giant gastrointestinal stromal tumor of the small intestine communicating with the gastrointestinal tract or with superimposed infection was suspected. Because no improvement occurred in response to antibiotics, surgery was performed. Laparotomy revealed giant hemorrhagic tumor adherent to the small intes-tine and occupying the peritoneal cavity. The giant tumor was a solid tumor weighing 3490 g, measuring 24 cm x 17.5 cm x 18 cm and showing marked necrosis. Histologically, the tumor comprised spindle-shaped cells with anaplastic large nuclei. Immunohistochemical studies showed tumor cells positive for vimentin, CD31, and factor.-related antigen, but negative for c-kit and CD34. Angiosarcoma was diagnosed. Although no postoperative complications occurred, the patient experienced enlargement of multiple metastatic tumors in the abdominal cavity and died 42 d postoperatively. The prognosis of small intestinal angiosarcoma is very poor, even after volume-reducing palliative surgery. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
• 消化管穿孔をきたした腸管症型T細胞性リンパ腫の2例

  河合 典子, 岩井 和浩, 佐藤 暢人, 狭間 一明, 松井 あや, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 75 (10) 2783 - 2788 1345-2843 2014/10 

  消化管穿孔をきたした腸管症型T細胞性リンパ腫(enteropathy-associated T-cell lymphoma,以下EATL)の2例を経験した.症例は53歳および74歳のいずれも男性で,穿孔性腹膜炎の術前診断で緊急手術を施行した.穿孔部位は1例は小腸と結腸の多発穿孔であり,もう1例は小腸のみの穿孔であった.いずれも病変部の切除を行ったが,前者は第11病日に死亡し,後者は術後に化学療法を施行できたものの,原病の増悪により術後5ヵ月で死亡した.本邦報告63例の集計でもEATLは極めて予後不良であったが,わずかに長期生存例も認めた.長期生存を可能にするためには病変の可及的全切除と術後早期の化学療法が必須であると考えられた.(著者抄録)
• 認知タスク分析による腹腔鏡下幽門側胃切除術の視覚・言語化と技能評価スコアの開発

  倉島 庸, 渡邊 祐介, サシーム・パウデル, 海老原 裕磨, 村上 壮一, 田本 英司, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 19 (7) 288 - 288 1344-6703 2014/10
• 曖昧な理解のまま使用していませんか? エネルギーデバイスに関する知識の実態調査

  渡邊 祐介, 倉島 庸, Amin Madani, 石田 稔, 鈴木 善法, 中村 文隆, 大野 耕一, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 19 (7) 497 - 497 1344-6703 2014/10
• 遠隔トレーニングを可能にするスマートフォン向け内視鏡外科手術トレーナー「Tr-BOX」の開発

  溝田 知子, 渡邊 祐介, 倉島 庸, Enani Ghada, Paudel Saseem, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 19 (7) 498 - 498 1344-6703 2014/10
• TAPPチェックリストを用いた腹腔鏡下鼠径ヘルニア修復術(TAPP)手技および評価者教育セミナー

  サシーム・パウデル, 倉島 庸, 渡邊 祐介, 村上 慶洋, 川原田 陽, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 19 (7) 610 - 610 1344-6703 2014/10
• 腹腔鏡下に根治手術を施行した再発巨大鼠径ヘルニアの1例

  佐藤 大介, 竹林 徹郎, 福田 直也, 中西 喜嗣, 平野 聡

  臨牀と研究 大道学館出版部 91 (10) 1353 - 1356 0021-4965 2014/10 

  44歳男。右被殻出血により入院中、左陰嚢腫大を認めた。重度の左片麻痺と左鼠径部からの陰嚢腫大を認め、下端は右膝関節下に到達していた。腹部CTにて左陰嚢内は、左鼠径管より連続するS状結腸と腸間膜脂肪の脱出を認めた。以上より、S状結腸を内容とする左巨大鼠径ヘルニアと診断した。脳外科での治療を優先し、2ヵ月後、巨大ヘルニアによる歩行困難があった。脳出血後より全身状態が良好ではなく、高度肥満のため、腹腔鏡下で視野を確保できない可能性が高かったこと、ヘルニア内容物環納後の腹腔内圧上昇が気腹のため助長される恐れがあったことから、前方アプローチにて手術を行った。術中所見は外鼠径ヘルニアI-3と診断した。術後経過は良好に見えたが、術後7ヵ月後頃より左鼠径部の再膨隆を認め、左陰嚢は大腿中点以遠まで腫大していた。腹部CTでは、左陰嚢内に突出するS状結腸を内容物とするヘルニア嚢を認めた。左巨大鼠径ヘルニアの再発と診断し、再手術は腹腔鏡下鼠径ヘルニア根治術を施行した。術中所見は左外鼠径ヘルニアI-3Recと診断した。術後は経過良好で術後2年間、再発は認めなかった。
• Post-operative depletion of platelet count is associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy: a case-control study from the results of 220 cases of intrahepatic cholangiojejunostomy

  Takehiro Noji, Takahiro Tsuchikawa, Yuma Ebihara, Toru Nakamura, Kentaro Kato, Joe Matsumoto, Eiichi Tanaka, Toshiaki Shichinohe, Satoshi Hirano

  BMC SURGERY 14 81  1471-2482 2014/10 [Refereed][Not invited]
   

  Background: Post-operative anastomotic insufficiency following major hepato-biliary surgery has significant impacts on the post-operative course. Recent reports have revealed that platelets play an important role in liver regeneration and wound healing. From these experimental and clinical results on platelet function, we hypothesized that post-operative platelet depletion (to < 10 x 10(4)/mu L) would be associated with delayed liver regeneration as well as anastomotic insufficiency of intrahepatic cholangiojejunostomy. However, little information is available regarding correlations between platelet count and these complications. The purposes of the present study were, firstly, to evaluate the incidence of anastomotic insufficiency following intrahepatic cholangiojejunostomy and, secondly, to evaluate whether platelet depletion represents a risk factor for anastomotic insufficiency in intrahepatic cholangiojejunostomy. Methods: Participants in this study comprised 220 consecutive patients who underwent intrahepatic cholangiojejunostomy following hepato-biliary resection for biliary malignancies between September 1998 and December 2010. Anastomotic insufficiency was confirmed by cholangiographic demonstration of leakage from the anastomosis using contrast medium introduced via a biliary drainage tube or prophylactic drain placed during surgery. Results: Anastomotic insufficiency of the intrahepatic cholangiojejunostomy occurred in 13 of 220 patients (6%). Thirteen of the 220 patients, including one with anastomotic insufficiency, died during the study. Uni-and multivariate analyses both revealed that platelet depletion on post-operative day 1 (< 10 x 10(4)/mu L) correlated with anastomotic insufficiency. Conclusion: Post-operative platelet depletion was closely associated with anastomotic insufficiency following intrahepatic cholangiojejunostomy. This correlation has been established, but the underlying mechanisms have not.
• 膵癌は化学療法投与環境下でMyeloid derived suppressor cellの形成を促進する(Pancreatic cancer facilitates myeloid derived suppressor cell formation under chemotherapy treated conditions)

  武内 慎太郎, 土川 貴裕, 和田 はるか, 中村 透, 七戸 俊明, 清野 研一郎, 平野 聡

  日本癌学会総会記事 73回 E - 2042 0546-0476 2014/09
• 胆管癌に対する肝膵同時切除の臨床的意義についての検討

  佐藤 暢人, 松本 譲, 中西 喜嗣, 松村 祥幸, 倉島 庸, 海老原 裕磨, 中村 透, 田本 英司, 村上 壮一, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 75 (9) 2628 - 2628 1345-2843 2014/09
• Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma

  Satoshi Hirano, Eiichi Tanaka, Takahiro Tsuchikawa, Joe Matsumoto, Hiroshi Kawakami, Toru Nakamura, Yo Kurashima, Yuma Ebihara, Toshiaki Shichinohe

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 21 (8) 533 - 540 1868-6974 2014/08 [Refereed][Not invited]
   

  Due to advances in endoscopic equipment and techniques, preoperative endoscopic biliary drainage (EBD) has been developed to serve as an alternative to percutaneous transhepatic biliary drainage (PTBD). This study sought to clarify the benefit of EBD in comparison to PTBD in patients who underwent radical resections of hilar cholangiocarcinoma. One hundred and forty-one patients underwent radical surgery for hilar cholangiocarcinoma between 2000 and 2008 were retrospectively divided into two groups based on the type of preoperative biliary drainage, PTBD (n = 67) or EBD (n = 74). We investigated if the different biliary drainage methods affected postoperative survival and mode of recurrence after median observation period of 82 months. The survival rate for patients who underwent EBD was significantly higher than those who had PTBD (P = 0.004). Multivariate analysis revealed that PTBD was one of the independent factors predictive of poor survival (hazard ratio: 2.075, P = 0.003). Patients with PTBD more frequently developed peritoneal seeding in comparison to those who underwent EBD (P = 0.0003). PTBD was the only independent factor predictive of peritoneal seeding. In conclusion, EBD might confer an improved prognosis over PTBD due to prevention of peritoneal seeding, and is recommended as the initial procedure for preoperative biliary drainage in patients with hilar cholangiocarcinoma.
• Evaluation of commercially available reagents as a reference material for intramolecular carbon isotopic measurements of acetic acid

  Keita Yamada, Makiko Kikuchi, Alexis Gilbert, Naohiro Yoshida, Nariaki Wasano, Ryota Hattori, Satoshi Hirano

  RAPID COMMUNICATIONS IN MASS SPECTROMETRY 28 (16) 1821 - 1828 0951-4198 2014/08 [Refereed][Not invited]
   

  RATIONALE: Recent advances in analytical techniques for the intramolecular carbon isotopic ratio measurement of some organic compounds have provided important information on carbon cycles in biochemistry, organic geochemistry and food chemistry. These advances have made it necessary to prepare intramolecular isotopic reference materials (RMs) to use for inter-laboratory calibration and/or inter-calibration among different analytical methods. METHODS: We evaluated the feasibility of preparing RMs using commercially available reagents for intramolecular carbon isotopic ratio measurement of acetic acid. The intramolecular carbon isotopic distribution of nine acetic acid and four sodium acetate reagents was determined with high precision using off-line pyrolysis combined with gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS). We also evaluated the potential alteration in the isotopic signature of acetic acid reagents by evaporation. RESULTS: The intramolecular carbon isotopic distributions for the acetic acid and sodium acetate reagents were determined with a precision of better than 0.45 parts per thousand. We found that the isotopic values of these reagents spanned the carbon isotopic range of acetic acid in biological and environmental samples. We also found that the isotope fractionation associated with the evaporation of acetic acid occurs solely on the methyl position, the carboxyl position being unaffected. CONCLUSIONS: These commercially available reagents will be used as RMs in the future for inter-laboratory calibration and/or inter-calibration with another intramolecular isotopic measurement technique, namely quantitative C-13 NMR. In cases where acetic acid is being used as a RM, its storage must be carefully controlled to prevent evaporation. Copyright (C) 2014 John Wiley & Sons, Ltd.
• 高齢者胆道癌に対する肝切除症例の検討

  米森 敦也, 平野 聡, 岡村 圭祐, 土川 貴裕, 松本 譲, 中村 透, 海老原 裕磨, 倉島 庸, 中西 喜嗣, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 69回 O - 2 2014/07
• 進行胆嚢癌に対する進展様式に応じた適切な術式選択

  松本 譲, 平野 聡, 岡村 圭祐, 土川 貴裕, 中村 透, 田本 英司, 中西 喜嗣, 中島 誠一郎, 米森 敦也, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 69回 RS - 6 2014/07
• 肝内胆管および肝外胆管へ樹枝状に発育した胆道Mucinous Cystic Neoplasmの1切除例

  佐藤 大介, 松本 譲, 大森 優子, 中西 喜嗣, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 三橋 智子, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 69回 P - 6 2014/07
• Pathological Confirmation of Para-Aortic Lymph Node Status as a Potential Criterion for the Selection of Intrahepatic Cholangiocarcinoma Patients for Radical Resection with Regional Lymph Node Dissection

  Tomohide Nakayama, Takahiro Tsuchikawa, Toshiaki Shichinohe, Toru Nakamura, Yuma Ebihara, Satoshi Hirano

  WORLD JOURNAL OF SURGERY 38 (7) 1763 - 1768 0364-2313 2014/07 [Refereed][Not invited]
   

  Para-aortic lymph node (PAN) metastasis traditionally has been defined as distant metastasis. Many studies suggest that lymph node metastasis in intrahepatic cholangiocarcinoma (ICC) is one of the strongest prognostic factors for patient survival; however, the status of the PAN was not examined separately from regional lymph node metastasis in these reports. Here, we investigated whether regional lymph node metastasis without PAN metastasis in ICC can be classified as resectable disease and whether curative resection can have a prognostic impact. Between 1998 and 2010, a total of 47 ICC patients underwent hepatic resection and systematic lymphadenectomy with curative intent. We routinely dissected the PANs and had frozen-section pathological examinations performed intraoperatively. If PAN metastases were identified, curative resection was abandoned. We retrospectively investigated the prognostic factors for patient survival after curative resection for ICC without PAN metastases, with particular attention paid to the prognostic impact of lymphadenectomy. Univariate analysis identified concomitant portal vein resection, concomitant hepatic artery resection, intraoperative blood loss, intraoperative transfusion, and residual tumor as significant negative prognostic factors. However, lymph node status was not identified as a significant prognostic factor. The 14 patients with node-positive cancer had a survival rate of 20 % at 5 years. Based on multivariate analysis, intraoperative transfusion was an independent prognostic factor associated with a poor prognosis (risk ratio = 4.161; P = 0.0056). Regional lymph node metastasis in ICC should be classified as resectable disease, because the survival rate after surgical intervention was acceptable when PAN metastasis was pathologically negative.
• Evaluation of the delta-shaped anastomosis in laparoscopic distal gastrectomy: midterm results of a comparison with Roux-en-Y anastomosis

  Hidehiko Kitagami, Mamoru Morimoto, Masashi Nozawa, Kenichi Nakamura, Shinya Tanimura, Katsuhiko Murakawa, Yoshihiro Murakami, Kenji Kikuchi, Hajime Ushigome, Leo Sato, Minoru Yamamoto, Yasunobu Shimizu, Tetsushi Hayakawa, Moritsugu Tanaka, Satoshi Hirano

  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 28 (7) 2137 - 2144 0930-2794 2014/07 [Refereed][Not invited]
   

  Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and published, whereas only a limited number of reports are available on the utility of the delta-shaped anastomosis (Delta). This study compared Delta and Roux-en-Y anastomoses (RY), with the aim to clarify the utility of Delta. Stage 1 gastric cancer patients who had undergone LDG with Delta (group D, n = 68) and those who had undergone LDG with RY (group RY, n = 60) were compared in terms of operative outcomes, postoperative clinical symptoms, gastrointestinal fiberscopic findings, and changes in body weight. Both the operative and anastomotic times were significantly shorter in group D (230 and 13 min, respectively) than in group RY (258 and 38 min, respectively) (p < 0.001). Among the complications observed at the anastomotic site, obstruction was seen in one group D patient and two group RY patients but was relieved with conservative management. Postoperative clinical symptoms were reported for 26.4 % of the group D patients but had decreased to 5.9 % 1 year later. Group RY yielded similar results. Upper gastrointestinal fiberscopy performed 1 year postoperatively showed no intergroup differences in the incidence of gastritis or residual retention and a significantly more frequent occurrence of bile reflux in group D. Postoperative weight changes did not differ between the two groups. Delta reconstruction after LDG is a safe and effective procedure that is totally laparoscopic, less time consuming, and associated with a favorable postoperative course and a better quality of life.
• Proposal of a new staging system for mass-forming intrahepatic cholangiocarcinoma: a multicenter analysis by the Study Group for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery

  Takahiro Uenishi, Shunichi Ariizumi, Taku Aoki, Tomoki Ebata, Masayuki Ohtsuka, Eiichi Tanaka, Hiroshi Yoshida, Satoru Imura, Masaki Ueno, Norihiro Kokudo, Masato Nagino, Satoshi Hirano, Shoji Kubo, Michiaki Unno, Mitsuo Shimada, Hiroki Yamaue, Masakazu Yamamoto, Masaru Miyazaki, Tadahiro Takada

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 21 (7) 499 - 508 1868-6974 2014/07 [Refereed][Not invited]
   

  Background Recently, the Liver Cancer Study Group of Japan (LCSGJ) staging system for intrahepatic cholangiocarcinoma (ICC) was followed by a proposal of the American Committee on Cancer (AJCC)/International Union Against Cancer (UICC) system. The present study aimed to assess the accuracy of both systems to predict survival after curative resection for mass-forming ICC and to establish a new staging system based on survival analysis results. The present study was conducted as a project study of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Methods Clinical data from 233 patients who underwent curative resection for mass-forming ICC were retrospectively reviewed. Survival analysis was performed to identify predictors of postoperative outcomes, and a new staging system was established. The survival stratification of our proposed system was compared with two previous staging systems. Results A N0M0 cohort analysis demonstrated that tumor size, tumor number, and vascular invasion were independently associated with survival after curative resection for mass-forming ICC, whereas serosal and periductal invasion were not. Of patients with nodal metastases, patients with T4 tumor had significantly lower overall survival rate than patients with T1, T2, or T3 tumor. Thus, we proposed a new staging system as follows: serosal invasion was excluded from the LCSGJ T categories, and patients with nodal metastases were divided into stage IVA or IVB according to T classification. The new system better stratified survival after curative resection for mass-forming ICC than the two previous systems. Conclusions The AJCC/UICC staging system failed to stratify the Japanese patients with mass-forming ICC. The new staging system provided better survival prediction in the patients who underwent curative resection for mass-forming ICC, although further studies are necessary to evaluate the impact of tumor size on survival.
• [On the occasion of carrying feature article under the title of "Current status of surgical intervention for biliary tract cancer"].

  Hirano S

  Nihon Geka Gakkai zasshi 115 (4) 180  0301-4894 2014/07 [Refereed][Not invited]
  
• ワクチン効果の異なるマウス乳がん細胞株の比較・検討によるワクチン効果増強因子の検索

  阿部 紘丈, 和田 はるか, 林 えりか, 山中 弘之, 武内 慎太郎, 平野 聡, 清野 研一郎

  日本がん免疫学会総会プログラム・抄録集 日本がん免疫学会 18回 155 - 155 2014/06
• 絶対に漏れない胆道再建のコツ 複数の吻合孔をもつ胆管空腸吻合のコツと実際

  岡村 圭祐, 平野 聡, 七戸 俊明, 土川 貴裕, 松本 譲, 中村 透, 海老原 裕麿, 倉島 庸, 田本 英司, 村上 壮一, 浅野 賢道, 中西 喜嗣, 佐藤 暢人, 野路 武寛, 金井 基錫, 東海林 安人, 中島 誠一郎, 米森 敦也, 宮崎 大, 佐藤 大介

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 26回 375 - 375 2014/06
• 胆道悪性腫瘍症例に対する術前門脈塞栓術の適応についての検討

  中西 喜嗣, 松本 譲, 佐藤 暢人, 浅野 賢道, 野路 武寛, 田本 英司, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 26回 436 - 436 2014/06
• 高齢者胆管癌に対する肝切除症例の検討

  米森 敦也, 平野 聡, 岡村 圭祐, 土川 貴裕, 松本 譲, 中村 透, 海老原 裕磨, 倉島 庸, 田本 英司, 村上 壮一, 野路 武寛, 浅野 賢道, 中西 喜嗣, 佐藤 暢人, 七戸 俊明

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 26回 454 - 454 2014/06
• 膵管stent tubeを指標に部分切除を行った膵solidpseudopapillary neoplasmの1例

  本谷 康二, 松本 譲, 米森 敦也, 中島 誠一郎, 東海林 安人, 市ノ川 一臣, 蔵前 太郎, 金井 基錫, 佐藤 暢人, 中西 喜嗣, 浅野 賢道, 村上 壮一, 田本 英司, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 26回 571 - 571 2014/06
• Surgical Outcome of Hilar Plate Resection: Extended Hilar Bile Duct Resection Without Hepatectomy

  Takehiro Noji, Takahiro Tsuchikawa, Keisuke Okamura, Toshiaki Shichinohe, Eiichi Tanaka, Satoshi Hirano

  JOURNAL OF GASTROINTESTINAL SURGERY 18 (6) 1131 - 1137 1091-255X 2014/06 [Refereed][Not invited]
   

  We have done curative or palliative extended extrahepatic bile duct resection at the level of the hilar plate for selected patients with cholangiocarcinoma with hilar spreading, calling this procedure "hilar plate resection" (HPR), but the results of evaluating the clinical benefits of HPR for cholangiocarcinoma with hilar spreading have not been reported. Fifty-two patients with cholangiocarcinoma underwent HPR: the curative procedure was performed in 28 patients (cHPR group) and the palliative in 24 patients (pHPR group). In the same period, 128 patients with cholangiocarcinoma underwent major hepatectomy with intrahepatic cholangiojejunostomy (Hx group). These groups were compared in terms of post-operative complications and survival. There were no significant differences in the rate of patients with post-operative complications and in post-operative hospital stay. The overall cumulative 5-year survival rates for each procedure (Hx group, cHPR group and pHPR group) were 40, 38 and 11 %, respectively. There was no significant difference between the Hx and cHPR groups in survival rates (p = 0.87). In conclusion, HPR appears to be safe and feasible for selected patients with cholangiocarcinoma. However, the indications for HPR should be restricted.
• Stimulation through very late antigen-4 and-5 improves the multifunctionality and memory formation of CD8(+) Tcells

  Hayato Hosoi, Hiroaki Ikeda, Naoko Imai, Chisaki Amaike, Linan Wang, Yuki Orito, Makiko Yamane, Hiroaki Ueno, Mitsuko Ideno, Ikuei Nukaya, Tatsuji Enoki, Junichi Mineno, Kazutoh Takesako, Satoshi Hirano, Hiroshi Shiku

  EUROPEAN JOURNAL OF IMMUNOLOGY 44 (6) 1747 - 1758 0014-2980 2014/06 [Refereed][Not invited]
   

  Tcells express multiple integrin molecules. The significance of signaling through these molecules on acquisition of T-cell effector functions and memory formation capacity remains largely unknown. Moreover, the impact of stimulation through these signals on the generation of Tcells for adoptive immunotherapy has not been elucidated. In this study, using a recombinant fragment of fibronectin, CH-296, we demonstrated that stimulation via very late Ag (VLA)-4 and VLA-5 in human and BALB/c mouse CD8+ Tcells, in combination with TCR stimulation, enhances effector multifunctionality and in vivo memory formation. Using TCR-transgenic mouse-derived CD8+ Tcells expressing TCR specific for the syngeneic CMS5 fibrosarcoma-derived tumor Ag, we showed that stimulation by CH-296 improved the ability of tumor-specific CD8+ Tcells to inhibit CMS5 tumor growth when adoptively transferred into hosts with progressing tumors. Improved antitumor effects were associated with decreased infiltration of Foxp3+CD4+ Treg cells in tumors. These results suggest that stimulation via VLA-4 and VLA-5 modulates the qualities of effector Tcells and could potentially increase the efficacy of adoptive therapy against cancer.
• Clinical Significance of Adjuvant Surgical Resection for Initially Unresectable Pancreatic Cancer Responsive to Arterial Infusion Chemotherapy

  Tadashi Doi, Hisato Homma, Takehide Akiyama, Shinichi Mezawa, Minoru Takahashi, Motoo Ohi, Shingo Tanaka, Kazuhiro Morii, Katsuhisa Kogawa, Motoya Takeuchi, Kenichirou Hirata, Satoshi Hirano

  HEPATO-GASTROENTEROLOGY 61 (131) 828 - 833 0172-6390 2014/05 [Refereed][Not invited]
   

  Background/Aims: We have reported a clinically meaningful local-control effect and a hepatic metastatic tumor-regression effect of transcatheter peripancreatic arterial embolization-hepatic and splenic arterial infusion chemotherapy (TPPAE-HSAIC) for unresectable advanced pancreatic cancer. The aim of this study was to evaluate the clinical significance, of adjuvant surgical resection after TPPAE-HSAIC. Methodology: We assessed histopathological findings and outcomes of 6 patients who underwent surgical resection of tumors judged to be radically resectable after attaining tumor down-staging or long-term tumor control following TPPAE-HSAIC for pancreatic cancer initially diagnosed as unresectable. Results: Clinical stage at the initial diagnosis was T4N0M0 Stage III in 4 patients and T4N0M1 Stage IV in 2 patients. The durations of TPPAE-HSAIC ranged from 5 to 46 months with a median of 19 months. An R0 resection was performed in 5 of the 6 patients (83%) and pathological down-staging, from the viewpoint of clinical stage, was observed in 4 patients. Of the 5 patients with R0 resection, one died from a postoperative complication at 7 months and another from pulmonary metastasis at 30 months post-operatively, while the other 3 patients have survived for 45 to 83 months to date. Conclusions: If surgical resection of pancreatic cancer initially diagnosed as unresectable can be carried out in patients responding favorably to TPPAE-HSAIC, the likelihood of long-term survival might be increased.
• Validation of histological diagnostic methods for detecting endothelin B receptor expression

  Naoya Fukuda, Takahiro Tsuchikawa, Akira Fukunaga, Hiroshi Kawase, Naotake Homma, Toru Nakamura, Toshiaki Shichinohe, Satoshi Hirano

  ONCOLOGY REPORTS 31 (4) 1561 - 1566 1021-335X 2014/04 [Refereed][Not invited]
   

  Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. Recently, it was reported that the endothelin B receptor (ETBR) of tumor endothelial cells prevents antitumor immunity. However, the immunohistochemistry (IHC) conditions required to detect ETBR expression remain unclear. The aim of the present study was to confirm the appropriate conditions for IHC for ETBR using ETBR cDNA and transfectant cells and to assess ETBR expression in PDAC patients. An ETBR-expressing cell was established as an objective positive control and the detectability of ETBR expression was evaluated using several types of anti-ETBR antibodies. ETBR mRNA expression was then studied. Finally, ETBR expression was examined in human PDAC tissue using IHC. As a result, four different anti-ETBR antibodies recognized the cell surface ETBR appropriately. A non-specific reaction was shown in the detection of ETBR in normal human tissues. ETBR mRNA expression was weakly detected only in the adrenal gland. No biologically significant correlation was observed in the ETBR-IHC of human PDAC sections. In conclusion, it is necessary to perform IHC using an appropriate control to assess the tissue expression of ETBR.
• Thoracoscopic Enucleation of Esophageal Submucosal Tumor by Prone Position Under Artificial Pneumothorax by CO2 Insufflation

  Toshiaki Shichinohe, Kentaro Kato, Yuma Ebihara, Yo Kurashima, Takahiro Tsuchikawa, Joe Matsumoto, Toru Nakamura, Eiichi Tanaka, Satoshi Hirano

  SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES 24 (2) E55 - E58 1530-4515 2014/04 [Refereed][Not invited]
   

  Recently, the usefulness of the prone position for thoracoscopic esophagectomy has been demonstrated. Thoracoscopic resection of an esophageal submucosal tumor using a prone position also offers advantages over a lateral decubitus position. We describe 2 cases operated on using the prone position for the resection of esophageal submucosal tumor. Case 1 was a 35-year-old man, who was diagnosed with a 50x20 mm leiomyoma in the middle thoracic esophagus, and underwent right thoracoscopic tumor enucleation. Case 2 was a 61-year-old female, who had 45x30 mm esophageal schwannoma in the lower thoracic esophagus with symptoms of dysphagia, and underwent left thoracoscopic tumor enucleation. No complication was observed in both cases. Thoracoscopic esophageal submucosal resection with prone position may add the merits to conventional decubitus position, such as superior visualization, and less bleeding. The side of incision should be determined according to the location of the tumor and anatomic rationality.
• 胆管内乳頭状腫瘍(IPNB)の診断と外科的治療の選択 Intraductal papillary neoplasm of the bile duct(IPNB)の臨床病理学的因子の検討

  佐藤 大介, 中西 喜嗣, 松本 譲, 田本 英司, 海老原 祐磨, 倉島 庸, 中村 透, 土川 貴裕, 七戸 俊明, 田中 栄一, 三橋 智子, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 115 (臨増2) 203 - 203 0301-4894 2014/03
• 北海道の地域外科医療維持のためのシステム構築に向けた取り組み 人材・情報循環による地域医療の標準化

  村上 壮一, 平野 聡, 田本 英司, 野路 武寛, 浅野 賢道, 中西 喜嗣, 佐藤 暢人, 七戸 俊明, 倉島 庸, 田中 栄一, 土川 貴裕, 松本 譲, 中村 透, 海老原 裕磨, 蔵前 太郎, 東海林 安人, 市ノ川 一臣, 中島 誠一郎, 松村 祥幸, 芦立 嘉智, 宮崎 大

  日本外科学会雑誌 (一社)日本外科学会 115 (臨増2) 374 - 374 0301-4894 2014/03
• いわゆる「1mmルール」に基づく局所癌遺残度の予後因子としての重要性 当科における膵頭部癌117例での検討

  新田 健雄, 中村 透, 浅野 賢道, 中西 喜嗣, 海老原 裕磨, 倉島 庸, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 115 (臨増2) 513 - 513 0301-4894 2014/03
• 胆道悪性腫瘍に対する胆道再建を伴う肝切除230例におけるClavien-Dindo Grade IIIa以上合併症発生危険因子の検討

  中西 喜嗣, 松本 譲, 海老原 裕磨, 倉島 庸, 中村 透, 土川 貴裕, 岡村 圭祐, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 115 (臨増2) 595 - 595 0301-4894 2014/03
• 胆道乳頭状腫瘍におけるIPNB、ICPNの診断基準の検討

  佐藤 大介, 三橋 智子, 畑中 豊, 中西 喜嗣, 平野 聡, 松野 吉宏

  日本病理学会会誌 (一社)日本病理学会 103 (1) 263 - 263 0300-9181 2014/03
• 脂肪組織と石灰化成分を内部に含有した胆嚢癌の1例

  桑谷 将城, 河上 洋, 川久保 和道, 工藤 大樹, 阿部 容子, 羽場 真, 田中 栄一, 平野 聡, 三橋 智子, 坂本 直哉

  胆道 日本胆道学会 28 (1) 73 - 80 0914-0077 2014/03 [Not refereed][Not invited]
   

  症例は71歳、男性。近医における腹部超音波検査で2年前より指摘されていた胆嚢底部の腫瘤性病変の増大がみられたため、精査目的に当科に紹介となった。各種画像診断により、腫瘤性病変は約20mm大であり、辺縁はほぼ平滑で、内部には脂肪成分が含まれていることが明らかとなった。良性病変も示唆されたが、表面に不整な顆粒状粘膜を伴い、増大傾向にある亜有茎性の腫瘤性病変であり、漿膜側に腫瘤内部への引きつれを伴うことから、胆嚢癌を第一に考え、胆嚢摘出術を施行した。腫瘍内部には脂肪組織と石灰化成分を含有し、腫瘍中心の不整な癌性腺管の周囲には著明な線維化と毛細血管の増生やフィブリンの析出がみられた。胆嚢底部には、炎症性変化に伴う漿膜下脂肪織の引きつれがみられ、その結果、腫瘍内部に脂肪組織を含有したものと考えられた。脂肪組織および石灰化成分を含有する胆嚢癌は非常にまれであり、術前の診断を困難にする要因であった。(著者抄録)
• A new preoperative prognostic scoring system to predict prognosis in patients with locally advanced pancreatic body cancer who undergo distal pancreatectomy with en bloc celiac axis resection: A retrospective cohort study

  Takumi Miura, Satoshi Hirano, Toru Nakamura, Eiichi Tanaka, Toshiaki Shichinohe, Takahiro Tsuchikawa, Kentaro Kato, Joe Matsumoto, Satoshi Kondo

  SURGERY 155 (3) 457 - 467 0039-6060 2014/03 [Refereed][Not invited]
   

  Background. Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) provides good local control for locally advanced pancreatic body cancer, but early recurrence still occurs. In this study, we aimed to establish a new scoring system to predict prognosis using preoperative factors in patients with locally advanced pancreatic body cancer who undergo DP-CAR. Methods. Prognostic factors were analyzed using various data collected retrospectively from 50 consecutive patients' who underwent DP-CAR. Using these preoperative factors, a scoring system to predict prognosis was established. Results. Multivariate analysis identified intraoperative blood loss >= 940 mL; hazard ratio [HR 25.179; P = .0003), preoperative platelet counts (<150 X 10(9)/L; HR, 7.433; P = .0043), preoperative Greactive protein (CRP) levels (>= 0.4 mg/dL; HR, 7.064; P = .0018), and preoperative carbohydrate antigen 19-9 (CAI9-9) levels (>= 300 U/mL; HR, 8.197; P = .0053) as independent adverse prognostic factors. For the 3 preoperative factors, preoperative platelet counts <150 X 10(9)/L, preoperative CRP levels >= 0.4 mg/dL, and preoperative CA19-9 levels >= 300 U/mL were allocated 1 point each. The total score was defined as the Preoperative Prognostic Score (PPS). The estimated disease-specific 1- and 5-year survival rates for the 26 patients with PPSO were 95.7%, and 49.1%, respectively, and for the 15 patients with PPS1, they were 86.7% and not available, respectively. The median survival times for PPSO and PPS1 were 50.6 and 22.3 months, respectively. In contrast, in the 9 patients with PPS2/3, 1- and 5-year survival rates were 33.3% and 0%, respectively, and median survival time was only 7.7 months. Conclusion. A new prognostic scoring system using the preoperative platelet count, CRP, and CA19-9 enables preoperative prediction of prognosis and facilitates selection of appropriate treatment for borderline resectable cases of locally advanced pancreatic body cancer
• [Wobbling of surgical education due to the current vogue of endoscopic surgery].

  Hirano S

  Nihon Geka Gakkai zasshi 一般社団法人日本外科学会 115 (2) 55 - 55 0301-4894 2014/03 [Refereed][Not invited]
  
• 肝動脈コイル塞栓後に発生した肝内仮性動脈瘤に対するIVR止血の経験

  宮崎 大, 松本 譲, 海老原 裕磨, 佐藤 暢人, 蔵前 太郎, 松村 祥幸, 村上 壮一, 田本 英司, 倉島 庸, 中村 透, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡, 高橋 文也, 阿保 大介

  日本腹部救急医学会雑誌 (一社)日本腹部救急医学会 34 (2) 517 - 517 1340-2242 2014/02
• Use of Maximum Standardized Uptake Value on Fluorodeoxyglucose Positron-emission Tomography in Predicting Lymph Node Involvement in Patients with Primary Non-small Cell Lung Cancer

  Jun Muto, Yasuhiro Hida, Kichizo Kaga, Kazuto Ohtaka, Shozo Okamoto, Nagara Tamaki, Reiko Nakada-Kubota, Satoshi Hirano, Yoshiro Matsui

  ANTICANCER RESEARCH 34 (2) 805 - 810 0250-7005 2014/02 [Refereed][Not invited]
   

  Aim: Surgical resection is a standard therapeutic approach for some cases of non-small cell lung cancer (NSCLC). Fluorodeoxyglucose positron-emission tomography (FDG-PET) is now widely used in clinical diagnosis and staging of various types of cancers, including NSCLC. We investigated whether the maximum standardized uptake value (SUVmax) of primary tumors is useful in predicting the extent of lymph node involvement. Patients and Methods: We retrospectively evaluated 354 patients with NSCLC who underwent surgery following FDG-PET and computed tomographic (CT) scans in our hospital. Logistic regression analyses were used to assess associations between categories (age, sex, tumor size, SUVmax, serum Squamous cell carcinoma-related antigen (SCC), cytokeratin 19 fragment (CYFRA), carcinoembryonic antigen (CEA), Brinkman index and histologic type. Differences in SUVmax of primary tumors between positive and negative lymph node involvement were examined by Mann Whitney U-test. Results: SUVmax of primary tumors in patients without lymph node involvement was significantly lower than in those with involvement, in both adenocarcinoma and squamous cell carcinomas (median, 2.2 vs. 4.9 in adenocarcinoma and 5.0 vs. 8.1 in squamous cell carcinoma, p<0.001 for both). Among node-positive cases, the lowest primary tumor SUVmax. was 1.24 in an adenocarcinoma and 2.05 in a squamous cell carcinoma. However, primary tumor SUVmax, and extent of lymph node metastases showed no significant differences between pN1 and pN2, single and multiple lymph node involvement, or single and multiple station involvement. Conclusion: A low primary tumor SUVmax in NSCLC may help identify patients with no lymph node involvement. However, SUVmax does not discriminate between minimal and extended lymph node involvement.
• A Case of Pulmonary Mucosa-associated Lymphoid Tissue Lymphoma with Remarkable Granulomatous Reaction Diagnosed Using Video-assisted Thoracoscopic Surgery

  Watanabe Sho, Takeda Yuichiro, Ishii Satoshi, Naka Go, Hirano Satoshi, Sugiyama Haruhito, Kobayashi Nobuyuki

  The Journal of the Japan Society for Respiratory Endoscopy 特定非営利活動法人 日本呼吸器内視鏡学会 36 (2) 158 - 164 2014 

  Background. A case of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma shows diverse patterns of radiological and pathological findings with inflammatory changes. Case. A 54-year-old woman was referred to our hospital for examination of a solitary mass in the right lower lung field. The mass showed increased fluorine-18-fluorodeoxyglucose accumulation on positron emission tomography. Transbronchial biopsy (TBB) of the mass was performed, when the endobronchial ultrasonography probe was located adjacent to the lesion. Pathological examination of the TBB specimen indicated foamy macrophage infiltration into the alveolar space, findings suggestive of organizing pneumonia. Because of the inconsistency between the radiological and pathological findings, malignancy could not be ruled out, and therefore, video-assisted thoracoscopic surgery (VATS) was performed. On examination of the VATS specimen, the resected mass showed neoplastic lymphocytic infiltration, forming a tumor with marked granulomatous reaction. The final diagnosis was pulmonary MALT lymphoma with granulomatous reaction based on immunohistochemical staining and in-situ hybridization results. Additional treatment was not administered because the patient was classified as having stage IE disease. Conclusion. Diagnosis of pulmonary MALT lymphoma with granulomatous reaction based on TBB specimens should be made with caution. VATS should be considered when pathological findings are inconsistent with the clinical course or imaging findings in a patient suspected of having pulmonary MALT lymphoma.
• O7-6 EBUS-GS法において迅速細胞診の併用は生検の診断率向上に寄与するか(EBUS-GS,一般演題(口演),第37回日本呼吸器内視鏡学会学術集会)

  平野 聡, 中村 祐之, 山岸 一貴, 中村 純, 多部田 弘士

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 36 S150  2014
• Diagnostic Performance of Transabdominal Ultrasound to the Right Hepatic Artery and Perineural Invasion in Patients with Extrahepatic Bile Duct Cancer

  Satoh Megumi

  Japanese Journal of Medical Ultrasound Technology Japanese Society of Sonographers 39 (1) 22 - 30 1881-4506 2014 

  Purpose: The purpose of this study was to estimate the diagnostic value of transabdominal ultrasound (US) in right hepatic artery invasion (Arh) and perineural invasion (pn) by comparison with pathological findings.
  Subjects and Methods: Between March 2008 and March 2011, 31 extra bile duct carcinoma patients were enrolled in this study (23 men and 8 women; average age 67.4±10.3 years old) who had undergone excision of the right hepatic lobe. According to the B-mode US findings, stenosis of the right hepatic artery (RHA) by the tumor was diagnosed made as Arh positive, and when the RHA was surrounded by the weak low echoic lesion and disappearance of the boundary echo were found, the diagnosis was made as pn positive.
  Results and Discussion: There were two subjects for which US depiction of RHA was poor (representing 6.5% of the subjects). Pathological diagnoses of Arh and pn were: positive, 7 and 14, negative, 22 and 15.
  Respective diagnostic values of Arh and pn were: sensitivity, 85.7% and 64.3%; specificity, 90.9% and 93.3%; accuracy, 89.7% and 79.3%; respective positive predictive values were 75.0% and 90.0%; and respective negative predictive values were 95.2% and 73.7%. One false negative and two false positive diagnoses of Arh were obtained. The false negative subject of Arh was a micro invasion of the tunica adventitia of the RHA. The two false positive subjects were the tortuous RHA, which mimicked an invasion. Five false negatives were found in diagnosing pn, in which more than half of each RHA was surrounded by a low echoic lesion. In diagnosing Arh, obvious stenosis of the lumen, and diagnosing pn, more than half of the RHA surrounded by the weak low echoic lesion, would be a sign of positive invasion.
  Conclusion: The diagnostic performance of US was judged to be good in evaluating RHA invasion and somewhat good in perineural invasion.
• Proposal to modify the International Union Against Cancer staging system for perihilar cholangiocarcinomas

  T. Ebata, T. Kosuge, S. Hirano, M. Unno, M. Yamamoto, M. Miyazaki, N. Kokudo, S. Miyagawa, T. Takada, M. Nagino

  British Journal of Surgery 101 (2) 79 - 88 0007-1323 2014/01 [Refereed][Not invited]
   

  Background The International Union Against Cancer (UICC) staging system for perihilar cholangiocarcinoma changed in 2009. The aim of this study was to validate and optimize the UICC system for these tumours. Methods This retrospective study was conducted in eight Japanese hospitals between 2001 and 2010. Perihilar cholangiocarcinoma was defined as a cholangiocarcinoma that involves the hilar bile duct, independent of the presence or absence of a liver mass component. The stratification ability of the UICC tumour node metastasis (TNM) system was compared with that of a modified system. Results Of 1352 patients, 35·9, 44·8 and 12·6 per cent had Bismuth type IV tumours, nodal metastasis (N1) and distant metastasis (M1) respectively. T4 tumours (43·2 per cent) and stage IVA (T4 Nany M0 36·3 per cent) disease were most common. Survival was not significantly different between patients with T3 versus T4 tumours (P = 0·284). Survival for patients with stage IVA disease was comparable to that for patients with stage IIIB tumours (T1-3 N1 M0) (P = 0·426). Vascular invasion, pancreatic invasion, positive margin, N1 and M1 status were identified as independent predictors of survival. When Bismuth type IV tumours were removed from the T4 determinants and N1 tumours grouped together, the modified grouping had a higher linear trend χ2 and likelihood ratio χ2 compared with the original system (245·6 versus 170·3 respectively and 255·8 versus 209·3 respectively). Conclusion The present data suggest that minimal modification with removal of Bismuth type IV tumours from the T4 determinants and bundling of N1 disease may enhance the prognostic ability of the UICC system. However, this requires validation on an independent data set. Seems to improve staging © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.
• Prognostic significance of epithelial-mesenchymal transition-related markers in extrahepatic cholangiocarcinoma: comprehensive immunohistochemical study using a tissue microarray.

  Nitta T, Mitsuhashi T, Hatanaka Y, Miyamoto M, Oba K, Tsuchikawa T, Suzuki Y, Hatanaka K.C, Hirano S, Matsuno Y

  British journal of cancer Nature Publishing Group 111 (7) 1363 - 1372 0007-0920 2014 [Refereed][Not invited]
   

  Background: Epithelial-mesenchymal transition (EMT) is characterised by the loss of cell-to-cell adhesion and gaining of mesenchymal phenotypes. Epithelial-mesenchymal transition is proposed to occur in various developmental processes and cancer progression. 'Cadherin switch', a process in which cells shift to express different isoforms of the cadherin transmembrane protein and usually refers to a switch from the expression of E-cadherin to N-cadherin, is one aspect of EMT and can have a profound effect on tumour invasion/metastasis. The aim of this study was to investigate the clinicopathological significance of EMT-related proteins and cadherin switch in extrahepatic cholangiocarcinoma (EHCC). Methods: We investigated the association between altered expression of 12 EMT-related proteins and clinical outcomes in patients with EHCC (n = 117) using immunohistochemistry on tissue microarrays. Results: Univariate and multivariate analyses revealed that, in addition to N classification (P = 0.0420), the expression of E-cadherin (P = 0.0208), N-cadherin (P = 0.0038) and S100A4 (P = 0.0157) was each an independent and a significant prognostic factor. We also demonstrated that cadherin switch was independently associated with poor prognosis (P = 0.0143) in patients with EHCC. Conclusions: These results may provide novel information for selection of patients with EHCC who require adjuvant therapy and strict surveillance.
• Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma

  Eiji Tamoto, Satoshi Hirano, Takahiro Tsuchikawa, Eiichi Tanaka, Masaki Miyamoto, Joe Matsumoto, Kentaro Kato, Toshiaki Shichinohe

  HPB 16 (1) 56 - 61 1365-182X 2014/01 [Refereed][Not invited]
   

  ObjectivesTo assess the safety and feasibility and discuss the oncological impact of a portal vein resection using the no-touch technique with a hepatectomy for locally advanced hilar cholangiocarcinoma. Patients and MethodsFrom 2005 to March 2009, 49 patients with hilar cholangiocarcinoma underwent a major right-sided hepatectomy with curative intent. Portal vein resection was performed using the no-touch technique in 36 patients (PVR group) but the portal vein was not resected in the other 13 patients (NR group). Peri-operative data and histological findings were compared between the two groups. Moreover, tumour recurrence and survival rates after surgery were calculated and compared for each group. ResultsAlthough the tumours of the patients in the PVR group were more locally advanced, the residual tumour status and tumour recurrence rate were similar and there was no significant difference in long-term survival between the two groups: 5-year survival rates in the PVR and NR groups were 59% and 51%, respectively (P = 0.353). In-hospital mortality was encountered in 2 of the 49 patients. ConclusionA portal vein resection using the no-touch technique with a right-sided hepatectomy had a positive impact on survival and is feasible in terms of long-term outcomes with acceptable mortality.
• Autophagy may promote carcinoma cell invasion and correlate with poor prognosis in cholangiocarcinoma

  Takeo Nitta, Yasunori Sato, Xiang Shan Ren, Kenichi Harada, Motoko Sasaki, Satoshi Hirano, Yasuni Nakanuma

  INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 7 (8) 4913 - 4921 1936-2625 2014 [Refereed][Not invited]
   

  The role of autophagy in cholangiocarcinoma is poorly understood. This study investigated its involvement in cholangiocarcinoma, focusing on carcinoma cell invasion and prognostic significance using cholangiocarcinoma cell lines, CCKS1 and HuCCT1, and human tissues of hilar and extrahepatic cholangiocarcinoma. Nutrient starvation induced the expression of LC3-II and the formation of LC3 puncta in both CCKS1 and HuCCT1, suggesting the occurrence of autophagy. The induction of autophagy was accompanied by the increased expression of an autophagy-related protein, Ambra1, in the cells. Under starvation conditions, the invasive activity of both cells was significantly increased, and a lysosomal inhibitor, chloroquine, attenuated this increased invasive activity. Transforming growth factor-beta 1 (TGF-beta 1), known as an inducer of epithelial-mesenchymal transition (EMT), increased the invasive activity of both cells, and chloroquine also significantly reduced TGF-beta 1-induced cell invasion. Immunohistochemical staining using cholangiocarcinoma tissues showed that the expression of Ambra1 positively correlated with the expression of Snail, one of the major transcriptional factors of EMT. In addition, overexpression of Ambra1 significantly correlated with lymph node metastasis and poor survival rate of the patients. These results suggest that the occurrence of autophagy may be associated with a malignant phenotype and poor prognosis in cholangiocarcinoma, and autophagy is possibly involved in EMT-related cholangiocarcinoma cell invasion.
• Surgical resection of colorectal recurrence of gastric cancer more than 5 years after primary resection

  Takehiro Noji, Yoshiyuki Yamamura, Jun Muto, Aki Kuroda, Junkichi Koinuma, Tatsuya Yoshioka, Katsuhiko Murakawa, Setsuyuki Otake, Satoshi Hirano, Koichi Ono

  International Journal of Surgery Case Reports 5 (12) 954 - 957 2210-2612 2014 [Refereed][Not invited]
   

  INTRODUCTION Intestinal metastasis from gastric cancer is rare, although the most common cause of secondary neoplastic infiltration of the colon is gastric cancer. However, little data is available on recurrence or death in patients with gastric cancer surviving > 5 years post-gastrectomy. Here we report two cases of lower intestinal metastasis from gastric cancer > 5 years after primary resection and discuss with reference to the literature. PRESENTATION OF CASE Case 1: A 61-year-old man with a history of total gastrectomy for gastric cancer 9 years earlier was referred to our hospital with constipation and abdominal distention. We diagnosed primary colon cancer and subsequently performed extended left hemicolectomy. Histological examination revealed poorly differentiated adenocarcinoma resembling the gastric tumor he had 9 years earlier. The patient refused postoperative adjuvant chemotherapy and remained alive with cancerous peritonitis and skin metastases as of 17 months later. Case 2: A 46-year-old woman with a history of total gastrectomy for gastric cancer 9 years earlier presented with constipation. She also had a history of Krukenberg tumor 3 years earlier. We diagnosed metastatic rectal cancer and subsequently performed low anterior resection and hysterectomy. Pathological examination revealed poorly differentiated tubular adenocarcinoma, resembling the gastric tumor. The patient remained alive without recurrence as of 17 months later. DISCUSSION We found 19 reported cases of patients with resection of colon metastases from gastric cancer. Median disease-free interval was 74 months. CONCLUSION Resection of late-onset colorectal recurrence from gastric cancer appears worthwhile for selected patients.
• 近赤外線イメージングによって同定した大動脈周囲領域リンパ節に転移を認めた広範囲胆管癌の一例

  佐藤 大介, 松本 譲, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 中村 透, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 74 (12) 3504 - 3504 1345-2843 2013/12
• One-stage radical operation of aortoesophageal fistula -Combination of VATS esophagectomy and open aortic surgery: Report of a case

  Toshiaki Shichinohe, Satoru Wakasa, Suguru Kubota, Kentaro Kato, Yuma Ebihara, Yo Kurashima, Takahiro Tsuchikawa, Eiichi Tanaka, Yoshiro Matsui, Satoshi Hirano

  Esophagus 10 (4) 280 - 284 1612-9059 2013/12 [Refereed][Not invited]
   

  Aortoesophageal fistula is a rare but fatal disease of thoracic surgery. We present a case of a 74-year-old male with aortoesophageal fistula. The patient underwent successful one-stage surgical treatment by video-assisted esophagectomy with esophageal reconstruction by gastric conduit and open aortic graft replacement subsequent to a temporary thoracic endovascular aortic repair. © 2013 The Japan Esophageal Society and Springer Japan.
• 胸腔鏡下肺葉切除を先行し二期的切除を行った高度肺気腫合併食道・肺重複癌の1例

  久保田 玲子, 樋田 泰浩, 加賀 基知三, 平岡 圭, 本間 直健, 野口 美紗, 松居 嘉郎, 七戸 俊明, 平野 聡

  北海道外科雑誌 北海道外科学会 58 (2) 210 - 210 0288-7509 2013/12 [Refereed][Not invited]
  
• Outcome Analysis of F-18-Fluorodeoxyglucose Positron-Emission Tomography in Patients with Lung Cancer After Partial Volume Correction

  Kazuto Ohtaka, Yasuhiro Hida, Kichizo Kaga, Shozo Okamoto, Tohru Shiga, Nagara Tamaki, Jun Muto, Reiko Nakada-Kubota, Satoshi Hirano, Yoshiro Matsui

  ANTICANCER RESEARCH 33 (11) 5193 - 5198 0250-7005 2013/11 [Refereed][Not invited]
   

  Background: This study aimed to evaluate the necessity for the partial volume effect (PVE) correction of the maximum standardized uptake value (SUVmax) in F-18-fluorodeoxyglucose positron-emission tomography (FDG-PET) for predicting outcome in patients with non-small cell lung cancer (NSCLC). Patients and Methods: A total of 191 patients, with tumor diameters ranging from 10-37 mm, underwent pre-operative FDG-PET and curative resection. The SUVmax (Pre-SUV) of the primary tumor was corrected (Cor-SUV) using a recovery coefficient curve based on phantom experiments. Results: The 5-year overall survival (OS) and disease-free survival (DFS) of the patients with high Pre-SUVs were lower than those with low Pre-SUVs (p<0.001 and p=0.002, respectively). The 5-year OS and DFS of patients with high Cor-SUVs were significantly lower than those with low Cor-SUVs (p<0.001 and p=0.005, respectively). Conclusion: Even without PVE correction, SUVmax was able to predict for outcome in patients with NSCLC.
• 【肝胆膵手術の適応決定-術式選択からみた術前・術中診断の要点-】 胆嚢癌 積極的外科切除と術前・術中診断の重要性

  浅野 賢道, 平野 聡, 田中 栄一, 土川 貴裕, 松本 譲, 七戸 俊明

  手術 金原出版(株) 67 (11) 1601 - 1606 0037-4423 2013/10 [Not refereed][Not invited]
  
• Comparative study of deoxynivalenol, 3-acetyldeoxynivalenol, and 15-acetyldeoxynivalenol on intestinal transport and IL-8 secretion in the human cell line Caco-2

  Tomoyuki Kadota, Hiroko Furusawa, Satoshi Hirano, Osamu Tajima, Yoichi Kamata, Yoshiko Sugita-Konishi

  TOXICOLOGY IN VITRO 27 (6) 1888 - 1895 0887-2333 2013/09 [Refereed][Not invited]
   

  The effects of the trichothecene mycotoxin deoxynivalenol (DON) and its acetylated derivatives, 3-acetyldeoxynivalenol (3ADON) and 15-acetyldeoxynivalenol (15ADON) on human intestinal cell Caco-2 were investigated by the studies of transepithelial transport, gene expression, and cytokine secretion. Permeability across a Caco-2 cell monolayer was evaluated by transport study. Transport rates were ranked as DON, 3ADON < 15ADON in apical-basolateral direction. 15ADON showed the highest permeability, induced the highest decrease in transepithelial electrical resistance (TEER), and prompted significant Lucifer Yellow permeability. These results showed that 15ADON affect paracellular barrier function extremely. In addition, gene expressions induced by toxins were screened by DNA microarray for investigating cellular effect on Caco-2 cell. The most remarkable gene induced by DON and 15ADON was inflammatory chemokine IL-8 and thus mRNA expression and secretion of IL-8 were analyzed by PCR and ELISA. Both DON and acetylated DONs could induce mRNA expression and production of IL-8. In particular, ELISA assay showed that the ability to produce IL-8 was ranked as 3ADON < DON < 15ADON. Our results indicated that 15ADON caused the highest permeability and highest IL-8 secretion among DON, 3ADON, and 15ADON in human intestinal cell. (c) 2013 Elsevier Ltd. All rights reserved.
• Histopathologic Characterization of Lung Adenocarcinoma in Relation to Fluorine-18-fluorodeoxyglucose Uptake on Positron Emission Tomography

  Hiromitsu Domen, Yasuhiro Hida, Shozo Okamoto, Kanako C. Hatanaka, Yutaka Hatanaka, Kichizo Kaga, Nagara Tamaki, Satoshi Hirano, Yoshihiro Matsuno

  JAPANESE JOURNAL OF CLINICAL ONCOLOGY 43 (9) 874 - 882 0368-2811 2013/09 [Refereed][Not invited]
   

  Fluorine-18-fluorodeoxyglucose uptake on positron emission tomography is reported to have prognostic significance in patients after resection of lung adenocarcinoma. However, its relationship with histopathologic features remains unknown. We conducted a retrospective analysis of 205 patients who had undergone surgical resection of primary lung adenocarcinoma (1.0 cm) after preoperative fluorine-18-fluorodeoxyglucose-positron emission tomography between January 1999 and December 2008 at Hokkaido University Hospital. Fluorine-18-fluorodeoxyglucose uptake was measured by the maximum standardized uptake value. A histopathologic review was performed according to the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification, and various histopathologic factors were evaluated semi-quantitatively. Correlations between these clinicopathologic factors and the maximum standardized uptake value (high 2.0 vs low 2.0) were analyzed. Univariate analysis of clinicopathologic factors demonstrated that the following were significantly correlated with a high maximum standardized uptake value: an elevated carcinoembryonic antigen level, larger tumor size, upgraded pT, pN, pStage, non-lepidic histology, abundant fibroblastic/hyalinized stroma, necrosis, presence of pleural involvement, lymphatic and vascular invasion and more intra- and extracellular mucin. Multivariate analysis demonstrated that a tumor size of 2.0 cm, non-lepidic histology and abundant fibroblastic/hyalinized stroma were significantly correlated with the high maximum standardized uptake value. More histopathologic factors are known to correlate with poor prognosis in lung adenocarcinomas showing high maximum standardized uptake values than in those showing low maximum standardized uptake values. Therefore, prognostication of patients with a resectable lung adenocarcinoma on the basis of preoperative fluorine-18-fluorodeoxyglucose uptake is histopathologically valid. Such observations may also help us to clarify the pathobiological mechanism responsible for the increased fluorine-18-fluorodeoxyglucose uptake in lung adenocarcinomas with a poor prognosis.
• Operative and perioperative management experience for hepatobiliary malignancies following ERCP-related pancreatitis

  Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Joe Matsumoto, Takehiro Noji, Toshiaki Shichinohe

  Hepato-Gastroenterology 60 (126) 1360 - 1364 0172-6390 2013/09 [Refereed][Not invited]
   

  Background/Aims: There have been few papers on how to treat hepatobiliary malignancies after ERCP-related pancreatitis focusing on the timing of the operation and postoperative complications. The aim of this study was to clarify the relationship among the time after the pancreatitis, the complexity of the operation, and the characteristic postoperative complications. Methodology: The clinicopathological characteristics of five patients with hepatobiliary malignancies who had a prior history of ERCP-related pancreatitis were analyzed. Results: The five patients included two with extrahepatic bile duct carcinomas, two with ampulla of Vater carcinomas, and one with intrahepatic hilar cholangiocarcinoma. The median time to the operation from pancreatitis was 31 (16-116) days. The median operation time and blood loss were 661 (576-924) min and 3695 (2730-7240) mL, respectively. Various postoperative complications were seen in all cases including acute respiratory distress syndrome and infection of peripancreatic necrosis. The postoperative mortality rate was 0%, with a morbidity rate of 100%. R0 operations were performed in all five cases. Conclusions: Surgery for hepatobiliary malignancies after ERCP-related pancreatitis appears to have a high morbidity rate. The surgery must strike a balance between curability of the malignancy and safety with respect to the frequent postoperative complications. © H.G.E. Update Medical Publishing S.A.
• 胆嚢癌の術前診断で切除を行った黄色肉芽腫性胆嚢炎の1例

  佐藤 彰記, 松本 譲, 松村 祥幸, 中西 喜嗣, 田本 英司, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  胆道 日本胆道学会 27 (3) 538 - 538 0914-0077 2013/08
• 膵頭十二指腸切除施行6年後に胆管空腸吻合部再発を来した胆管癌に対して左三区域切除を施行した1例

  佐藤 大介, 中西 喜嗣, 松本 譲, 松村 祥幸, 倉島 庸, 海老原 祐磨, 中村 透, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  胆道 日本胆道学会 27 (3) 583 - 583 0914-0077 2013/08
• Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  Sohei Satoi, Hiroki Yamaue, Kentaro Kato, Shinichiro Takahashi, Seiko Hirono, Shin Takeda, Hidetoshi Eguchi, Masayuki Sho, Keita Wada, Hiroyuki Shinchi, A Hon Kwon, Satoshi Hirano, Taira Kinoshita, Akimasa Nakao, Hiroaki Nagano, Yoshiyuki Nakajima, Keiji Sano, Masaru Miyazaki, Tadahiro Takada

  Journal of hepato-biliary-pancreatic sciences 20 (6) 590 - 600 1868-6974 2013/08 [Refereed][Not invited]
   

  PURPOSE: A multicenter survey was conducted to explore the role of adjuvant surgery for initially unresectable pancreatic cancer with a long-term favorable response to non-surgical cancer treatments. METHODS: Clinical data including overall survival were retrospectively compared between 58 initially unresectable pancreatic cancer patients who underwent adjuvant surgery with a favorable response to non-surgical cancer treatments over 6 months after the initial treatment and 101 patients who did not undergo adjuvant surgery because of either unchanged unresectability, a poor performance status, and/or the patients' or surgeons' wishes. RESULTS: Overall mortality and morbidity were 1.7 and 47 % in the adjuvant surgery group. The survival curve in the adjuvant surgery group was significantly better than in the control group (p < 0.0001). The propensity score analysis revealed that adjuvant surgery was a significant independent prognostic variable with an adjusted hazard ratio (95 % confidence interval) of 0.569 (0.36-0.89). Subgroup analysis according to the time from initial treatment to surgical resection showed a significant favorable difference in the overall survival in patients who underwent adjuvant surgery over 240 days after the initial treatment. CONCLUSION: Adjuvant surgery for initially unresectable pancreatic cancer patients can be a safe and effective treatment. The overall survival rate from the initial treatment is extremely high, especially in patients who received non-surgical anti-cancer treatment for more than 240 days.
• Inhibitory Peptide of Mitochondrial mu-Calpain Protects against Photoreceptor Degeneration in Rhodopsin Transgenic S334ter and P23H Rats

  Taku Ozaki, Sei-ichi Ishiguro, Satoshi Hirano, Ayaka Baba, Tetsuro Yamashita, Hiroshi Tomita, Mitsuru Nakazawa

  PLOS ONE 8 (8) e71650  1932-6203 2013/08 [Refereed][Not invited]
   

  Mitochondrial mu-calpain and apoptosis-inducing factor (AIF)-dependent photoreceptor cell death has been seen in several rat and mouse models of retinitis pigmentosa (RP). Previously, we demonstrated that the specific peptide inhibitor of mitochondrial mu-calpain, Tat-mu CL, protected against retinal degeneration following intravitreal injection or topical eye-drop application in Mertk gene-mutated Royal College of Surgeons rats, one of the animal models of RP. Because of the high rate of rhodopsin mutations in RP patients, the present study was performed to confirm the protective effects of Tat-mu CL against retinal degeneration in rhodopsin transgenic S334ter and P23H rats. We examined the effects of intravitreal injection or topical application of the peptide on retinal degeneration in S334ter and P23H rats by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay, electroretinogram (ERG), immunohistochemistry for AIF, and histological staining. In S334ter rats, we found that intravitreal injection or topical application of the peptide prevented photoreceptor cell death from postnatal (PN) 15 to 18 days, the time of early-stage retinal degeneration. Topical application of the peptide also delayed attenuation of ERG responses from PN 28 to 56 days. In P23H rats, topical application of the peptide protected against photoreceptor cell death and nuclear translocation of AIF on PN 30, 40, and 50 days, as the primary stages of degeneration. We observed that topical application of the peptide inhibited the thinning of the outer nuclear layer and delayed ERG attenuations from PN 30 to 90 days. Our results demonstrate that the mitochondrial mu-calpain and AIF pathway is involved in early-stage retinal degeneration in rhodopsin transgenic S334ter and P23H rats, and inhibition of this pathway shows curative potential for rhodopsin mutation-caused RP.
• 腹腔動脈合併尾側膵切除における術後合併症の現状と対策 教室における連続74例の経験から

  中村 透, 平野 聡, 浅野 賢道, 海老原 裕磨, 倉島 庸, 加藤 健太郎, 土川 貴裕, 松本 譲, 田中 栄一, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 O - 5 2013/07
• 進行胆嚢癌に対する手術適応(切除限界)と標準術式確立に向けて 進行胆嚢癌に対する進展様式に立脚した合理的切除手術

  田中 栄一, 平野 聡, 松本 譲, 中西 善嗣, 中村 透, 浅野 賢道, 加藤 健太郎, 海老原 裕磨, 倉島 庸, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 PD - 2 2013/07
• 術後早期の血小板数は、胆管切除を伴う肝切除術後の合併症発生に関連している

  野路 武寛, 土川 貴裕, 中西 善継, 浅野 賢道, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 田中 栄一, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 O - 3 2013/07
• Co-axial settingによる腹腔鏡下膵頭十二指腸切除術の標準化

  海老原 裕磨, 加藤 健太郎, 浅野 賢道, 倉島 庸, 中村 透, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 O - 4 2013/07
• 肝門部胆管癌の外科治療戦略と術前術後補助療法の意義 当科における肝門部胆管癌の治療戦略と手術成績

  松本 譲, 中西 喜嗣, 松村 祥幸, 浅野 賢道, 中村 透, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 SY - 2 2013/07
• 粘液産生胆管腫瘍11例の検討

  中西 喜嗣, 松本 譲, 松村 祥幸, 浅野 賢道, 中村 透, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 RS - 2 2013/07
• ICG蛍光イメージングによって同定した大動脈周囲リンパ節に転移を認めた広範囲胆管癌の1例

  佐藤 大介, 松本 譲, 松村 祥幸, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴弘, 田中 栄一, 七戸 俊明, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 P - 8 2013/07
• 膵Intraductal Papillary Mucinous Neoplasm(IPMN)の手術適応と至適術式 分枝型IPMN(BD-IPMN)に対する手術適応および外科治療戦略

  浅野 賢道, 平野 聡, 中村 透, 中西 喜嗣, 海老原 裕磨, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明

  日本消化器外科学会総会 (一社)日本消化器外科学会 68回 WS - 6 2013/07
• 【リンパ節転移と郭清-癌腫別の意義】 肝胆膵領域におけるリンパ節転移と郭清の意義

  浅野 賢道, 平野 聡, 中村 透, 中西 喜嗣, 海老原 裕磨, 倉島 庸, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明

  外科 (株)南江堂 75 (7) 731 - 737 0016-593X 2013/07 [Not refereed][Not invited]
   

  リンパ節転移は,肝胆膵領域の悪性腫瘍にとってもっとも強力な予後不良因子の一つである.リンパ節転移の有無のみではなくlymph node ratioなどのlymph node statusやリンパ節微小転移に関する検討が広く行われることにより,これまでの病期分類とは異なるより詳細な予後予測が可能となりつつある.今後,さらにより高いエビデンスレベルの検討を重ね,新たなリンパ節転移診断・治療体系の構築が期待される.(著者抄録)
• 胆管を肝門板まで切除する「肝門板切除術」の治療成績

  野路 武寛, 平野 聡, 田中 栄一, 中西 善嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 339 - 339 2013/06
• 膵癌の浸潤に関わる新規遺伝子CBPCIを標的とした膵癌治療法の開発 細胞膜透過性ペプチドの応用

  中村 透, 平野 聡, 土川 貴裕, 浅野 賢道, 松本 譲, 田中 栄一

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 507 - 507 2013/06
• HPDの適応と治療成績 胆管癌に対する肝膵同時切除の臨床的意義についての検討

  松本 譲, 平野 聡, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 中村 透, 海老原 裕磨, 倉島 庸, 浅野 賢道, 中西 喜嗣, 松村 祥幸

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 247 - 247 2013/06
• 胆道再建の工夫 肝管空腸吻合におけるロープウェイ式縫合糸操作の有用性

  中西 喜嗣, 松本 譲, 田中 栄一, 土川 貴裕, 加藤 健太郎, 中村 透, 浅野 賢道, 松村 祥幸, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 285 - 285 2013/06
• 腫瘍進展範囲の診断が困難であった中部胆管癌の1例

  佐藤 大介, 松本 譲, 松村 祥幸, 中西 喜嗣, 浅野 賢, 倉島 庸, 海老原 祐磨, 中村 透, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 420 - 420 2013/06
• 術前化学療法後に肝左3区域切除兼動・門脈合併切除再建にて根治的手術を施行し得た肝門部胆管癌の1例

  高野 博信, 松本 譲, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 中村 透, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 421 - 421 2013/06
• 異時性多発性に発症した胆管内乳頭腫瘍(IPNB)の1例

  岡村 国茂, 松本 譲, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 中村 透, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 424 - 424 2013/06
• 十二指腸乳頭部癌切除例の検討

  松村 祥幸, 松本 譲, 中西 喜嗣, 中村 透, 浅野 賢道, 海老原 裕磨, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 25回 530 - 530 2013/06
• 局所進行切除不能膵体部癌の化学(放射線)療法奏功例に対するAdjuvant DP-CAR

  中村 透, 平野 聡, 浅野 賢道, 中西 喜嗣, 松本 譲, 加藤 健太郎, 土川 貴裕, 田中 栄一

  膵臓 (一社)日本膵臓学会 28 (3) 459 - 459 0913-0071 2013/06
• 腹腔動脈合併尾側膵切除術(DP-CAR)後に壊死性胆嚢炎を来たした1例

  高野 博信, 松本 譲, 中西 喜嗣, 浅野 賢道, 倉島 庸, 海老原 裕磨, 中村 透, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  北海道外科雑誌 北海道外科学会 58 (1) 80 - 80 0288-7509 2013/06
• Gallbladder bed resection or hepatectomy of segments 4a and 5 for pT2 gallbladder carcinoma: Analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery

  Akihiko Horiguchi, Shuichi Miyakawa, Shin Ishihara, Masaru Miyazaki, Masayuki Ohtsuka, Hiroaki Shimizu, Keiji Sano, Fumihiko Miura, Tetsuo Ohta, Masato Kayahara, Masato Nagino, Tsuyoshi Igami, Satoshi Hirano, Hiroki Yamaue, Masaji Tani, Masakazu Yamamoto, Takehiro Ota, Mitsuo Shimada, Yuji Morine, Hisafumi Kinoshita, Masafumi Yasunaga, Tadahiro Takada

  Journal of Hepato-Biliary-Pancreatic Sciences 20 (5) 518 - 524 1868-6974 2013/06 [Refereed][Not invited]
   

  Purpose: Hepatectomy of segments 4a and 5 (S4a+5) is the recommended treatment for pT2 gallbladder cancer. However, gallbladder bed resection is also occasionally used. Using nationwide data from the Japanese Biliary Tract Cancer Registry and a questionnaire survey, we retrospectively compared these 2 methods of treatment. Method: The study involved 85 patients with pT2, pN0 gallbladder cancer (55 treated with gallbladder bed resection, and 30, with S4a+5 hepatectomy). The prognosis and mode of tumor recurrence following treatment were analyzed retrospectively, with overall survival as the endpoint. Results: The 5-year survival rate did not differ significantly between the 2 groups. Univariate analysis showed that bile duct resection and perineural tumor invasion were significant prognostic factors, but the extent of hepatectomy, location of the major intramural tumor, regional lymph node excision, and histological type were not. Multivariate analysis identified perineural tumor invasion as a significant prognostic factor. Recurrence occurred most frequently in both lobes than S4a+5 of the liver following gallbladder bed resection. Conclusion: In the present study of cases of Japanese Biliary Tract Cancer Registry, it was not possible to conclude that S4a+5 hepatectomy was superior to gallbladder bed resection. © 2013 Japanese Society of Hepato-Biliary- Pancreatic Surgery and Springer Japan.
• Randomized phase III clinical study comparing postoperative UFT/LV, UFT plus LV/UFT and UFT plus LV plus PSK/UFT plus PSK as adjuvant therapy for curatively resected stage III colorectal cancer HGCSG-CAD study

  Shichinohe Toshiaki, Komatsu Yoshito, Akazawa Kohei, Yuki Satoshi, Fukushima Hiraku, Ohno Kouichi, Nakamura Fumitaka, Kusumi Takaya, Morita Takayuki, Senmaru Naoto, Kumagai Naoko, Hirano Satoshi

  JOURNAL OF CLINICAL ONCOLOGY 31 (15) 0732-183X 2013/05/20 [Refereed][Not invited]
  
• 【肝門部胆管癌の治療戦略2013】肝門部胆管癌の根治手術に必要な術前画像診断 特に進展度診断と胆管分離限界点の同定について

  松本 譲, 平野 聡, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 中村 透, 浅野 賢道, 中西 喜嗣, 松村 祥幸

  外科 (株)南江堂 75 (5) 463 - 467 0016-593X 2013/05 

  肝門部胆管癌の根治手術では,肝側胆管断端を癌陰性にすることが重要である.胆管癌は大別して浸潤型と限局型に分類でき,手術術式決定に必要な進展範囲診断方法が両者でまったく異なる.前者には近接する門脈や肝動脈などの重要な脈管へ浸潤する「垂直方向への進展」を中心に,後者には胆管の長軸方向に沿った「水平方向への進展」を複数のモダリティによって詳細に検討し,進展範囲の診断を行う.その後,各種肝切除術式に固有の「胆管分離限界点」の概念を理解し,適切な術式を立案することで確実に切除断端の癌陰性化を図ることが,胆道外科医には必須のスキルといえる.(著者抄録)
• Novel aspects of preoperative chemoradiation therapy improving anti-tumor immunity in pancreatic cancer

  Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Joe Matsumoto, Kentaro Kato, Toru Nakamura, Yuma Ebihara, Toshiaki Shichinohe

  CANCER SCIENCE 104 (5) 531 - 535 1347-9032 2013/05 [Refereed][Not invited]
   

  Pancreatic cancer is an aggressive cancer with poor prognosis. Little is known about the immune response in the tumor microenvironment after chemotherapy for initially unresectable tumor. The purpose of this study was to investigate the immunological effects of chemoradiation therapy in the tumor microenvironment of pancreatic adenocarcinoma. Seventeen patients with pancreatic adenocarcinoma with and without preoperative chemoradiation therapy were retrospectively analyzed using immunohistochemical methods for HLA class I heavy chain, CD4+, CD8+, CD45RO+ and Foxp3+ T cell infiltrations. Seven of the 17 study patients received preoperative chemoradiation therapy. There were no statistically significant differences in the number of CD4+ and CD8+ T cell infiltrations in the tumor microenvironment. However, the number of Foxp3+ T cell infiltrations was significantly lower in the neoadjuvant chemoradiation therapy group. The HLA class I expression status was the same between the two groups. In conclusion, preoperative chemoradiation therapy in pancreatic adenocarcinoma is useful for reducing regulatory T cell levels in combination with its direct cytotoxic effects.
• New Invagination Procedure for Pancreaticojejunostomy Using Only Four Sutures: Reply

  Yoshitsugu Nakanishi, Masanori Ohara, Misa Noguchi, Hiromitsu Domen, Kazuteru Komuro, Satoshi Hirano

  WORLD JOURNAL OF SURGERY 37 (5) 1180 - 1180 0364-2313 2013/05 [Refereed][Not invited]
  
• Differences in risk factors between patterns of recurrence in patients after curative resection for advanced gastric carcinoma

  Yoshitsugu Nakanishi, Masanori Ohara, Hiromitsu Domen, Toshiaki Shichinohe, Satoshi Hirano, Masanori Ishizaka

  WORLD JOURNAL OF SURGICAL ONCOLOGY 11 98  1477-7819 2013/05 [Refereed][Not invited]
   

  Background: Recurrence patterns in patients who have undergone curative gastrectomy for advanced gastric carcinoma can be classified as peritoneal, hematogenous, or lymphatic. The aim of this study was to clarify differences in risk factors between these different types of recurrence pattern. Methods: Postoperative courses, including sites of recurrence and periods between surgery and recurrence, of patients who had undergone curative gastrectomy for advanced gastric carcinoma (more than pT2 invasion) were surveyed in detail. Clinicopathological factors were examined as potential independent risk factors for each recurrence pattern, based on recurrence-free survival, using multivariate analysis. Results: Multivariate analysis identified depth of tumor invasion (pT4 vs. pT2/3; hazard ratio (HR), 7.05; P < 0.001), number of lymph node metastases (pN2/3 vs. pN0/1; HR, 4.02; P = 0.001), and histological differentiation (G3/4 vs. G1/2; HR, 2.22; P = 0.041) as independent risk factors for peritoneal metastasis. The number of lymph node metastases (HR, 26.21; P < 0.001) and venous vessel invasion (HR, 5.09; P = 0.001) were identified as independent risk factors for hematogenous metastasis. The number of lymph node metastases (HR, 6.00; P = 0.007) and depth of tumor invasion (HR, 4.70; P = 0.023) were identified as independent risk factors for lymphatic metastasis. Conclusions: This study clarified differences in risk factors between various patterns of recurrence. Careful examination of risk factors could help prevent oversight of recurrences and improve detection of recurrences during follow-up. The number of lymph node metastases represents an independent risk factor for all three patterns of recurrence; thus, patients with multiple lymph node metastases warrant particular attention.
• 【前腸系ステム細胞】腫瘍性疾患の疾患理解 IPMNとIPNB 前腸由来臓器に発生する乳頭状腫瘍の疾患理解

  中西 喜嗣, 中沼 安二, 河上 洋, 松本 譲, 新田 健雄, 佐藤 保則, 平野 聡

  肝・胆・膵 (株)アークメディア 66 (4) 691 - 700 0389-4991 2013/04
• Method for the validation of immunohistochemical staining using SCID mouse xenografts: Expression of CD40 and CD154 in human non-small cell lung cancer

  Keidai Ishikawa, Masaki Miyamoto, Tatsuya Yoshioka, Masatoshi Kadoya, Li Li, Roshan Mishra, Kazuomi Ichinokawa, Yasuhito Shoji, Yoshiyuki Matsumura, Yasuhiro Hida, Kichizo Kaga, Tatsuya Kato, Mitsuhito Kaji, Toshiro Ohbuchi, Tomoo Itoh, Hirotoshi Dosaka-Akita, Yoshiro Matsui, Satoshi Hirano

  ONCOLOGY REPORTS 29 (4) 1315 - 1321 1021-335X 2013/04 [Refereed][Not invited]
   

  This report proposes a concept for the standardization of immunohistochemical evaluation. Immunohistochemical staining has several problems associated with the sensitivity of the technical process and standardization of the assessment of potent staining. We provided data focusing on this concept through immunostaining for CD154 in non-small cell lung cancer (NSCLC). We used two types of anti-CD154 antibody as primary antibodies in immunohistochemical staining, as previously reported. Western blot analysis confirmed strong CD154 expression in the cultured cell line PC10, but not in LK2. We also assessed CD154 expression in SCID mouse xenografts of these cell lines. SCID xenograft data on western blot analysis were consistent with those of cultured cell lines. These xenografts could thus be used as positive or negative tissue controls for CD154 immunostaining. Primary antibodies should therefore be confirmed as recognizing target lesions, while control tissue specimens should be objectively confirmed as having target products using another experimental method. Our method would allow results to be unified at more than one laboratory and could act as an objective control assessment method in immunohistochemistry.
• Limited resection and two-staged lobectomy for non-small cell lung cancer with ground-glass opacity

  Kazuto Ohtaka, Yasuhiro Hida, Kichizo Kaga, Tatsuya Kato, Jun Muto, Reiko Nakada-Kubota, Satoshi Hirano, Yoshiro Matsui

  JOURNAL OF CARDIOTHORACIC SURGERY 8 111  1749-8090 2013/04 [Refereed][Not invited]
   

  Background: Lung tumors showing ground-glass opacities on high-resolution computed tomography indicate the presence of inflammation, atypical adenomatous hyperplasia, or localized bronchioloalveolar carcinoma. We adopted a two-staged video-assisted thoracoscopic lobectomy strategy involving completion lobectomy for localized bronchioloalveolar carcinoma with an invasive component according to postoperative pathological examination by permanent section after partial resection. Methods: Forty-one patients with undiagnosed small peripheral ground-glass opacity lesions underwent partial resection from 2001 to 2007 in Hokkaido University Hospital. Localized bronchioloalveolar carcinoma was classified according to the Noguchi classification for adenocarcinoma. Malignant lesions other than Noguchi types A and B were considered for completion lobectomy and systemic mediastinal lymphadenectomy. Perioperative data of completion video-assisted thoracoscopic lobectomies were compared with data of 67 upfront video-assisted thoracoscopic lobectomies for clinical stage IA adenocarcinoma performed during the same period. Results: Postoperative pathological examination revealed 35 malignant and 6 non-malignant diseases. Histologically, all of the malignant diseases were adenocarcinomas of Noguchi type A (n = 7), B (n = 9), C (n = 18), and F (n = 1). Eleven of 19 patients (58%) with Noguchi type C or F underwent two-staged video-assisted thoracoscopic lobectomy. Three patients refused a second surgery. There was no cancer recurrence. The two-staged lobectomy group had a significantly longer operative time and more blood loss than the upfront lobectomy group. There was no surgical mortality or cancer recurrence. Conclusions: Two-staged lobectomy for undiagnosed small peripheral ground-glass opacity lesions showed satisfactory oncological results. However, low compliance for and invasiveness of the second surgery are concerns associated with this strategy.
• [Novel development in multimodal therapy for advanced pancreatic and biliary cancer: adjuvant surgery for initially unresectable lesion].

  Hirano S

  [Hokkaido igaku zasshi] The Hokkaido journal of medical science 88 (2-3) 55 - 57 0367-6102 2013/04 [Refereed][Not invited]
  
• 進行胆道癌に対するR0手術の理論と実践 肝門部浸潤を有する胆管癌に対してR0手術を目指すための要点

  中村 透, 田中 栄一, 松本 譲, 土川 貴裕, 加藤 健太郎, 中西 善嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 佐々木 剛志, 福島 正之, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 173 - 173 0301-4894 2013/03
• 膵・胆道術後合併症に対するリカバリーショット 起きてしまったらどうする 術後出血、術後胆道狭窄

  田中 栄一, 中村 透, 土川 貴裕, 松本 譲, 加藤 健太郎, 海老原 裕磨, 浅野 賢道, 中西 善嗣, 倉島 庸, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 247 - 247 0301-4894 2013/03
• 【肝胆膵疾患;「予後」の変遷】膵疾患 膵癌の予後の変遷

  中西 喜嗣, 河上 洋, 松本 譲, 中村 透, 浅野 賢道, 土川 貴裕, 田中 栄一, 平野 聡

  肝・胆・膵 (株)アークメディア 66 (3) 507 - 516 0389-4991 2013/03
• 腹腔鏡下膵頭十二指腸切除術の安全性確保のための取り組み

  海老原 裕磨, 加藤 健太郎, 中西 喜嗣, 浅野 賢道, 倉島 庸, 中村 透, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 489 - 489 0301-4894 2013/03
• 肝門部領域胆道癌における肝3区域・尾状葉切除における術後合併症危険因子の検討

  中西 喜嗣, 松本 譲, 田中 栄一, 浅野 賢道, 海老原 裕磨, 中村 透, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 662 - 662 0301-4894 2013/03
• 胆管癌に対する肝膵同時切除の臨床的意義についての検討

  松本 譲, 平野 聡, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 中村 透, 海老原 裕磨, 倉島 庸, 浅野 賢道, 中西 喜嗣

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 663 - 663 0301-4894 2013/03
• 膵神経内分泌腫瘍に対する積極的切除を基本とする集学的治療の有用性評価

  浅野 賢道, 土川 貴裕, 中村 透, 中西 喜嗣, 海老原 裕磨, 加藤 健太郎, 松本 譲, 田中 栄一, 七戸 俊明, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 114 (臨増2) 832 - 832 0301-4894 2013/03
• Asthma Control Can Be Maintained after Fixed-Dose, Budesonide/Formoterol Combination Inhaler Therapy is Stepped Down from Medium to Low Dose

  Masayuki Hojo, Tomonori Mizutani, Motoyasu Iikura, Satoshi Hirano, Nobuyuki Kobayashi, Haruhito Sugiyama

  ALLERGOLOGY INTERNATIONAL 62 (1) 91 - 98 1323-8930 2013/03 [Refereed][Not invited]
   

  Background: In cases using a budesonide/formoterol combination inhaler, many patients are started on fixed-dose treatment at 640/18 mu g (4 puffs) daily, but there are no guidelines yet regarding the step-down method when control has been maintained. Methods: Patients with moderate asthma treated with either budesonide 400 mu g and salmeterol 100 mu g (GINA step3 group) or salmeterol/fluticasone 250 at 2 puffs (GINA step4 group) were enrolled and started on therapy of budesonide/formoterol 4 puffs. Thereafter, step-down to 2 puffs was performed if either of the following criteria was met at 8-week intervals: fractional exhaled nitric oxide (FeNO) <= 28 ppb plus asthma control test (ACT) score a >= 22, or ACT score a >= 24 at 3 consecutive visits regardless of FeNO level. Thereafter, changes in ACT score, the number of acute exacerbations and reliever use, and FeNO level were monitored through 48th week. Results: Fifty-one patients, 27 in step3 group and 24 in step4 group, underwent step-down. ACT scores and the number of reliever use remained stable in both groups even after step-down. In contrast, FeNO levels increased gradually in step4 group, whereas in the step3 group they increased immediately after step-down. Step-down was considered to be safely performed because the numbers of reliever use and those of moderate or more severe exacerbations during the 48-week period has not changed significantly compared to before step-down. Conclusions: If complete control of asthma, not only of clinical symptoms but also airway inflammation, is achieved by 3-6 months of fixed-dose budesonide/formoterol 4 puffs/day, it should be possible to safely perform step-down to 2 puffs/day.
• Asthma Control Can Be Maintained after Fixed-Dose, Budesonide/Formoterol Combination Inhaler Therapy is Stepped Down from Medium to Low Dose

  Masayuki Hojo, Tomonori Mizutani, Motoyasu Iikura, Satoshi Hirano, Nobuyuki Kobayashi, Haruhito Sugiyama

  ALLERGOLOGY INTERNATIONAL 62 (1) 91 - 98 1323-8930 2013/03 [Refereed][Not invited]
   

  Background: In cases using a budesonide/formoterol combination inhaler, many patients are started on fixed-dose treatment at 640/18 mu g (4 puffs) daily, but there are no guidelines yet regarding the step-down method when control has been maintained. Methods: Patients with moderate asthma treated with either budesonide 400 mu g and salmeterol 100 mu g (GINA step3 group) or salmeterol/fluticasone 250 at 2 puffs (GINA step4 group) were enrolled and started on therapy of budesonide/formoterol 4 puffs. Thereafter, step-down to 2 puffs was performed if either of the following criteria was met at 8-week intervals: fractional exhaled nitric oxide (FeNO) <= 28 ppb plus asthma control test (ACT) score a >= 22, or ACT score a >= 24 at 3 consecutive visits regardless of FeNO level. Thereafter, changes in ACT score, the number of acute exacerbations and reliever use, and FeNO level were monitored through 48th week. Results: Fifty-one patients, 27 in step3 group and 24 in step4 group, underwent step-down. ACT scores and the number of reliever use remained stable in both groups even after step-down. In contrast, FeNO levels increased gradually in step4 group, whereas in the step3 group they increased immediately after step-down. Step-down was considered to be safely performed because the numbers of reliever use and those of moderate or more severe exacerbations during the 48-week period has not changed significantly compared to before step-down. Conclusions: If complete control of asthma, not only of clinical symptoms but also airway inflammation, is achieved by 3-6 months of fixed-dose budesonide/formoterol 4 puffs/day, it should be possible to safely perform step-down to 2 puffs/day.
• A case of serous cystadenoma of the pancreas communicating with the main pancreatic duct synchronously diagnosed with pancreatic ductal carcinoma

  Mizuna Takahashi, Naoto Senmaru, Hiroshi Kawase, Ryo Takahashi, Hiroyuki Kuroda, Masahiro Maeda, Miri Fujita, Satoshi Hirano

  Journal of Japanese Society of Gastroenterology 110 (3) 449 - 455 0446-6586 2013/03 [Refereed][Not invited]
   

  A 65-year-old woman who had been followed up for a cystic lesion of the tail of the pancreas was found to have cancer of the body of the pancreas. ERP showed stenosis of the main pancreatic duct (MPD) with dilatation of the distal side of the duct, and communication between the cystic lesion and MPD. She underwent distal pancreatectomy under a diagnosis of intraductal papillary-mucinous neoplasm associated with cancer of the body of the pancreas. Clinicopathologic investigation revealed that the diagnosis of the cystic lesion was serous cystadenoma having the communication with MPD. It was also indicated by the histopathologic findings that inflammatory changes of MPD caused by stenosis might contribute to the development of serous cystadenoma.
• Modified duodenum-preserving pancreas head resection for low-grade malignant lesion in the pancreatic head

  Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Joe Matsumoto, Toru Nakamura, Yuma Ebihara, Toshiaki Shichinohe, Masaki Miyamoto

  PANCREATOLOGY 13 (2) 170 - 174 1424-3903 2013/03 [Refereed][Not invited]
   

  Background/objectives: Our institution has utilized a duodenum-preserving pancreas head resection (DPPHR) procedure for management of low-grade malignant lesions within the head of the pancreas, but this has resulted in a higher rate of postoperative complications, including pancreatic fistula and ischemic bile duct injury. To avoid these complications we recently modified DPPHR to resect all the parenchyma around the pancreatic head and to preserve the epicholedochal plexus around the bile duct. The goal of this study was to investigate outcomes with postoperative complications and disease control following this modified procedure. Methods: Twenty-one consecutive patients underwent DPPHR between 1994 and 2011. Patients were retrospectively classified into one of two groups: the conventional DPPHR group (cDPPHR) or the modified DPPHR group (mDPPHR). Perioperative factors and postoperative complications were compared between these two groups. Results: The median age of the 21 patients was 61(23-77) years, and the median follow-up period was 51 months. Intra-operational blood loss was significantly smaller and duration of hospital stay was significantly shorter in the mDPPHR group than in the cDPPHR group, respectively. The rate of pancreatic fistula was markedly lower in the mDPPHR group (2/13; 15%) than in the cDPPHR group (7/8; 88%) (P = 0.0022). For neoplastic lesions, the surgical margin was negative in all cases, and local recurrence has not occurred in either group. Conclusions: For selected patients, modified DPPHR may provide clinical benefits in terms of less complications associated with shorter hospital stay. Copyright (C) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
• 十二指腸第2部・膵実質全摘術を施行した多発IPMNの1例

  岡村 国茂, 田中 栄一, 吉岡 達也, 福島 正之, 浅野 賢道, 中村 透, 海老原 裕磨, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 74 (2) 598 - 598 1345-2843 2013/02
• 【肝胆膵腹腔鏡下手術の秘策;合併症・偶発症回避のコツ】腹腔鏡下胆嚢・胆管摘出術 腹腔鏡下胆嚢摘出術における胆管損傷の回避と修復

  海老原 裕磨, 野路 武寛, 中西 喜嗣, 浅野 賢道, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  消化器外科 (株)へるす出版 36 (2) 197 - 201 0387-2645 2013/02
• 診断時切除不能高度進行胆道癌に対する積極的adjuvant surgeryの導入

  浅野 賢道, 松本 譲, 加藤 健太郎, 宮崎 大, 岡村 国茂, 中西 喜嗣, 佐々木 剛志, 福島 正之, 倉島 庸, 海老原 裕磨, 中村 透, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 74 (2) 584 - 584 1345-2843 2013/02
• 十二指腸出血を伴う腎細胞癌膵転移症例に対する準緊急的膵全摘術の一例

  本谷 康二, 平野 聡, 七戸 俊明, 宮本 正樹, 田中 栄一, 土川 貴裕, 松本 譲, 加藤 健太郎, 海老原 裕磨, 浅野 賢道, 中西 喜嗣, 中村 透, 福島 正之, 吉岡 達也, 岡村 国茂

  日本臨床外科学会雑誌 日本臨床外科学会 74 (2) 596 - 596 1345-2843 2013/02
• 膵頭十二指腸切除術中に高度の胃静脈還流不全を呈した1例

  中村 透, 宮崎 大, 岡村 国茂, 吉岡 達也, 中西 喜嗣, 福島 正之, 浅野 賢道, 海老原 裕磨, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 74 (2) 597 - 597 1345-2843 2013/02
• 門脈バイパス法施行下に切除した門脈内腫瘍栓を形成した退形成性膵管癌の1例

  福島 正之, 宮崎 大, 岡村 国茂, 吉岡 達也, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 74 (2) 597 - 597 1345-2843 2013/02
• 腹腔鏡下胃切除術におけるリンパ節郭清のコツ 上部進行胃癌に対する脾摘を伴う完全腹腔鏡下胃全摘術D2郭清 11d、10郭清のコツ

  海老原 裕磨, 七戸 俊明, 加藤 健太郎, 中西 喜嗣, 浅野 賢道, 倉島 庸, 中村 透, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡

  日本胃癌学会総会記事 (一社)日本胃癌学会 85回 203 - 203 2013/02
• 【術後の血管系合併症-その診断と対策】 肝動脈血栓閉塞による術後急性肝虚血に対する治療戦略

  浅野 賢道, 平野 聡, 田中 栄一, 土川 貴裕, 松本 譲, 加藤 健太郎, 海老原 裕磨, 中村 透, 七戸 俊明

  臨床外科 (株)医学書院 68 (2) 182 - 185 0386-9857 2013/02 [Not refereed][Not invited]
   

  ＜ポイント＞肝動脈の血栓閉塞は比較的稀な術後合併症ではあるが,対応が遅れると致命的になる可能性が高く,迅速な診断および適切な治療が要求される.治療法としては,抗凝固療法による保存的治療,interventional radiologyによるステント留置または選択的血栓溶解療法,外科的治療がある.外科的治療法として,安全性に関してさらなる検討の余地はあるものの門脈部分動脈化(APS)が一手段となりうると考える.(著者抄録)
• Clinical evaluation of the feasibility of minimally invasive surgery in esophageal cancer.

  Miyasaka D, Okushiba S, Sasaki T, Ebihara Y, Kawada M, Kawarada Y, Kitashiro S, Katoh H, Miyamoto M, Shichinohe T, Hirano S

  Asian journal of endoscopic surgery 6 (1) 26 - 32 1758-5902 2013/02 [Refereed][Not invited]
  
• Correction: Inhibitory Peptide of Mitochondrial μ-Calpain Protects against Photoreceptor Degeneration in Rhodopsin Transgenic S334ter and P23H Rats.

  Ozaki T, Ishiguro SI, Hirano S, Baba A, Yamashita T, Tomita H, Nakazawa M

  PloS one 9 8 2013 [Refereed][Not invited]
  
• Simultaneous near-infrared fluorescence imaging of the bile duct and hepatic arterial anatomy for image-guided surgery

  Eiichi Tanaka, Yoshitomo Ashitate, Aya Matsui, Hajime Narsaki, Hideyuki Wada, John V. Frangioni, Satoshi Hirano

  Frontiers of Gastrointestinal Research 31 86 - 91 0302-0665 2013 [Refereed][Not invited]
   

  Two independent wavelengths of a near-infrared (NIR) fluorescent light probe are currently available in the clinical setting. These enable us to simultaneously see two different anatomies and/or functions. Many reports are available showing that NIR fluorescence imaging and merged imaging of normal light and NIR light are useful for intraoperative image guidance. Dual-channel NIR fluorescence imaging has already been reported. It has potential to provide easy-to-understand, real-time, intraoperative imaging in more detail than single-channel NIR fluorescence imaging. Indocyanine green (ICG), of which the fluorescence wavelength is about 800 nm, and methylene blue (MB), of which the fluorescence wavelength is about 700 nm, can be used for the probe of NIR fluorescence imaging with the use of an appropriate NIR camera. The FLARE (Fluorescence-Assisted Resection and Exploration) system provides simultaneous dual-channel fluorescence imaging. The results of the initial preclinical trial of dual-channel NIR imaging for a cardiac application have been published as well as the simultaneous visualization of bile ducts and hepatic arteries in the preclinical setting. Both ICG and MB eliminate into bile after intravenous injection. The nonmetabolized elimination of both ICG and MB can detect fluorescence out of the bile. Intravenous injection of ICG, MB, and their combination can visualize the hepatic arteries and bile ducts in a different phase. MB has a lower extinction coefficient than ICG, i.e. ICG is a brighter fluorescence material than MB. However, ICG has poor liver-bile duct signal contrast because ICG accumulates in the liver rapidly and persistently. Furthermore, MB can visualize the bile duct more rapidly after intravenous injection than ICG because MB shows faster elimination into bile after intravenous injection. This technology has potential to provide appropriate intraoperative image guidance that can enable us to perform surgery more safely and precisely in a clinical situation. Copyright © 2013 S. Karger AG, Basel.
• Design of the Wearable Power-Assist Locomotor (WPAL) for paraplegic gait reconstruction

  Shigeo Tanabe, Eiichi Saitoh, Satoshi Hirano, Masaki Katoh, Tomohiko Takemitsu, Akihito Uno, Yasuhiro Shimizu, Yoshihiro Muraoka, Toru Suzuki

  Disability and Rehabilitation: Assistive Technology 8 (1) 84 - 91 1748-3107 2013/01 [Refereed][Not invited]
   

  Purpose: To develop and clinically evaluate a novel assistive walking system, the Wearable Power-Assist Locomotor (WPAL). Methods: To evaluate the performance of WPAL, a clinical trial is conducted with four paraplegic patients. After fitting the WPAL, patients learned to use the WPAL. The length and duration of independent walking was measured and compared to conventional orthosis (Primewalk). Results: After training, all patients were able to stand, sit, and walk independently with the WPAL. Compared to a conventional orthosis (Primewalk), the duration and distance of independent ambulation increased. The physiological cost index (PCI), perceived exertion and EMG of upper extremities decreased. Conclusions: WPAL might greatly enhance the possibility of restoration gait to paraplegic patients. Implications for Rehabilitation WPAL is developed to provide independent and comfortable walking for spinal cord injury patients. WPAL is less demanding physically than conventional orthosis (Primewalk). Even patients who cannot walk independently with conventional orthosis might be able to do so with WPAL. © 2013 Informa UK, Ltd.
• Preliminary Trial of Postural Strategy Training Using a Personal Transport Assistance Robot for Patients With Central Nervous System Disorder

  Kenichi Ozaki, Hitoshi Kagaya, Satoshi Hirano, Izumi Kondo, Shigeo Tanabe, Norihide Itoh, Eiichi Saitoh, Toshio Fuwa, Ryo Murakami

  ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 94 (1) 59 - 66 0003-9993 2013/01 [Refereed][Not invited]
   

  Objective: To examine the efficacy of postural strategy training using a personal transport assistance robot (PTAR) for patients with central nervous system disorders. Design: Single-group intervention trial. Setting: Rehabilitation center at a university hospital. Participants: Outpatients (N=8; 5 men, 3 women; mean age, 50 +/- 13y) with a gait disturbance (mean time after onset, 34 +/- 29mo) as a result of central nervous system disorders were selected from a volunteer sample. Interventions: Two methods of balance exercise using a PTAR were devised: exercise against perturbation and exercise moving the center of gravity. The exercises were performed twice a week for 4 weeks. Main Outcome Measures: Preferred and tandem gait speeds, Functional Reach Test, functional base of support, center of pressure (COP), muscle strength of lower extremities, and grip strength were assessed before and after the completion of the exercise program. After the exercise program, enjoyment of exercise was investigated via a visual analog scale questionnaire. Results: After the program, statistically significant improvements were noted for tandem gait speeds (P=.009), Functional Reach Test (P=.003), functional base of support (P=.014), and lower extremity muscle strength (P<.001-.042). On the other hand, preferred gait speeds (P=.151), COP (P=.446-.714), and grip power (P=.584) did not change. Finally, subjects rated that this exercise was more enjoyable than traditional balance exercises. Conclusions: Dynamic balance and lower extremity muscle strength were significantly improved in response to postural strategy training with the PTAR. These results suggest that postural strategy training with the PTAR may contribute to fall prevention of patients with a balance disorder. Archives of Physical Medicine and Rehabilitation 2013;94:59-66 (C) 2013 by the American Congress of Rehabilitation Medicine
• Pancreatic ductal adenocarcinomas with multiple large cystic structures: A clinicopathologic and immunohistochemical study of seven cases

  Takeo Nitta, Tomoko Mitsuhashi, Yutaka Hatanaka, Satoshi Hirano, Yoshihiro Matsuno

  Pancreatology 13 (4) 401 - 408 1424-3911 2013 [Refereed][Not invited]
   

  Background/objectives: Pancreatic ductal adenocarcinoma (PDA) with cystic change is classified into several types according to the features of the cysts however, those tumors do not constitute a uniform group, and the classification is controversial. In this study, we have described a series of cystic PDAs that show distinctive and previously unreported morphologic and immunohistochemical features. Methods: We analyzed 200 cases of PDA treated surgically at a single institution, and extracted the clinical and histopathological features of 7 tumors showing multiple large cystic (MLC) structure. Results: Preoperative radiographic images revealed a multilocular mass in the pancreas which was similar to intraductal papillary mucinous neoplasm or mucinous cystic neoplasm. These tumors were associated with more than 5 large cystic structures and numerous intratumoral microcysts lined by epithelial cells with various degrees of atypia. The average maximal diameter of the cysts (3.7 cm) was much larger than that of previously reported. Immunohistochemically, the cyst-lining epithelia were almost negative for mucin core protein (MUC) 1, MUC2, and MUC6, and showed only focal staining for MUC5AC. Maspin, CEA, and p53 were strongly positive, and the Ki-67 labeling index was high in both cells in solid areas and cyst-lining epithelia. Conclusion: We considered the MLC structures in PDA to be a mixture of ectatic neoplastic glands and retention cysts with ductal cancerization or pancreatic intraepithelial neoplasia (PanIN) however, they might represent a new entity of cystic PDA because of the unusually large size of the dilated cysts. Copyright © 2013, IAP and EPC.
• Wearable Power-Assist Locomotor (WPAL) for supporting upright walking in persons with paraplegia

  Shigeo Tanabe, Satoshi Hirano, Eiichi Saitoh

  NEUROREHABILITATION 33 (1) 99 - 106 1053-8135 2013 [Refereed][Not invited]
   

  BACKGROUND: Due to physical and psychosocial issues associated with long-term sitting in a wheelchair, devising new ways to facilitate upright mobility is a key issue in rehabilitation medicine. Wearable Power-Assist Locomotor (WPAL) is a motorized orthosis and is developed for providing independent and comfortable walking for paraplegic patients. METHODS: The WPAL consists of a wearable robotic orthosis and custom walker. To facilitate alternate usage with a wheelchair, the wearable robotic orthosis is based on a medial system with motors located at the bilateral hip, knee and ankle joints to reduce the increase in heart rate during gait. The gait parameters include stride length, toe clearance height, swing time, double support time, etc. (gait speed: up to 1.3 km/h). Independent gait with the walker can be learned through a five-stage gait exercise sequence. The first two stages are stepping and gait exercises with parallel bars. The third stage is gait exercise on treadmill. The subsequent two stages are gait exercise with walker. RESULTS: Seven motor-complete paraplegic patients (spinal cord functional levels: T6-T12) participated. Through a series of exercises, all users achieved independent gait on a level floor (Functional Ambulation Categories: 4). The mean duration and distance of consecutively walking were 14.1 +/- 11.4minutes and 165.6 +/- 202.6 m, respectively. The most competent user was able to walk continuously for as long as 40 minutes and 640 m whereas only for 6 minutes and 107 m with a conventional orthosis. CONCLUSIONS: These results suggest that WPAL might be useful device for supporting upright walking in persons with paraplegia.
• 蛍光スペクトル測定による鏡視下センチネルリンパ節同定法の開発

  海老原 裕磨, 阿部 紘丈, 和田 秀之, 佐々木 剛志, 浅野 賢道, 福島 正之, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡, 白銀 玲, 李 黎明

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 17 (7) 340 - 340 1344-6703 2012/12
• 胸腔鏡下食道切除術においてen blocに縦隔リンパ節郭清を行うための工夫

  七戸 俊明, 加藤 健太郎, 海老原 裕磨, 倉島 庸, 福島 正之, 佐々木 剛志, 土川 貴裕, 松本 譲, 浅野 賢道, 中西 喜嗣, 中村 透, 吉岡 達也, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 17 (7) 362 - 362 1344-6703 2012/12
• 当科における腹腔鏡下膵体尾部切除術

  和田 秀之, 海老原 裕磨, 岡村 国茂, 中西 喜嗣, 吉岡 達也, 佐々木 剛志, 浅野 賢道, 福島 正之, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 17 (7) 558 - 558 1344-6703 2012/12
• 乳房外パジェト病術後の大動脈周囲リンパ節(16b1)再発に対し腹腔鏡下リンパ節郭清を施行した1例

  福島 正之, 海老原 裕磨, 七戸 俊明, 阿部 紘丈, 岡村 国茂, 中西 喜嗣, 浅野 賢道, 佐々木 剛志, 倉島 庸, 松本 譲, 加藤 健太郎, 土川 貴裕, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 17 (7) 663 - 663 1344-6703 2012/12
• 食道胃接合部癌に対し腹腔鏡下下部食道胃全摘および腹臥位による胸腔内食道空腸吻合術を施行した1例

  佐藤 理, 七戸 俊明, 海老原 裕磨, 阿部 紘丈, 岡村 国茂, 中西 喜嗣, 浅野 賢道, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡

  北海道外科雑誌 北海道外科学会 57 (2) 148 - 152 0288-7509 2012/12 

  食道胃接合部癌症例に対して鏡視下アプローチで下部食道胃全摘および腹臥位での胸腔内食道空腸吻合術を施行したので報告する。症例は60歳代男性。半年程前より続く食後の胸焼けと体重減少を主訴に近医を受診した。精査の結果、食道胃接合部癌と診断され、手術目的に当科入院となった。手術は仰臥位での腹腔鏡操作に引き続き、腹臥位気胸下に下縦隔郭清と胸腔鏡下下部食道-空腸吻合術を施行した。術後経過は良好で術後第26病日に退院となった。完全鏡視下手術は開胸手術に比べ低侵襲であり、拡大視効果によって正確なリンパ節郭清を行うことができると考えられた。また視野展開や吻合の利便性から、腹臥位での胸腔鏡操作は有用なアプローチ法だと考えられた。(著者抄録)
• 食道胃接合部癌に対し腹腔鏡下下部食道胃全摘、腹臥位による胸腔内食道空腸吻合術を施行した1例

  佐藤 理, 海老原 裕磨, 阿部 紘丈, 岡村 国茂, 中西 喜嗣, 佐々木 剛志, 浅野 賢道, 福島 正之, 倉島 庸, 中村 透, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  北海道外科雑誌 北海道外科学会 57 (2) 158 - 158 0288-7509 2012/12
• 多発膵SPNに対し膵温存手術を施行しえた1例

  宮崎 大, 中村 透, 岡村 国茂, 佐々木 剛志, 吉岡 達也, 中西 喜嗣, 福島 正之, 浅野 賢道, 倉島 庸, 松本 譲, 海老原 裕磨, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡, 宮川 博之

  北海道外科雑誌 北海道外科学会 57 (2) 185 - 186 0288-7509 2012/12
• Ganglioneuroblastoma arising within a retroperitoneal mature cystic teratoma.

  Hayama S, Ohmi M, Yonemori A, Yamabuki T, Inomata H, Nihei K, Hirano S

  World journal of clinical oncology 3 (12) 155 - 158 2012/12 [Refereed][Not invited]
  
• 【肝内胆管癌と細胆管細胞癌】治療 肝門浸潤を伴う肝内胆管癌の外科治療

  田中 栄一, 中山 智英, 土川 貴裕, 松本 譲, 加藤 健太郎, 中西 善嗣, 中村 透, 浅野 賢道, 海老原 裕磨, 倉島 庸, 平野 聡

  外科 (株)南江堂 74 (11) 1174 - 1178 0016-593X 2012/11 

  肝門浸潤を伴う肝内胆管癌は肝門部胆管癌同様、肝葉切除+尾状葉切除+肝外胆管切除が基本手術となる。リンパ節転移は予後不良であるが、当科の成績では大動脈周囲リンパ節(PAN)転移は少なからず存在し、PAN転移のないものに切除適応を限定すると、PAN陰性・リンパ節転移陽性例の切除成績は肝門部胆管癌でリンパ節転移陽性例と同等である。肝門浸潤を伴う肝内胆管癌の場合、PAN転移の有無で症例の選別を行ったほうがよい可能性があり、この点で肝門部胆管癌との区別に意義がある可能性がある。(著者抄録)
• Multidisciplinary Treatment Strategy for Advanced Pancreatic Neuroendocrine Tumors - A Single Center Experience

  Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Joe Matsumoto, Toshiaki Sichinohe

  HEPATO-GASTROENTEROLOGY 59 (120) 2623 - 2626 0172-6390 2012/11 [Refereed][Not invited]
   

  Background/Aims: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. Little is known about the mode of recurrence and long term prognosis after resection. We aimed to evaluate the surgical indication, especially for the patients with concomitant multiple liver metastases or extreme local invasions. Methodology: The overall survival (OS) and the disease free survival (DFS) were statistically analyzed for twenty one patients with PNETs who underwent surgical intervention in our institute. The patients were divided into 2 groups, G1 NET (grade 1 neuroendocrine tumor: n=11) and G2 NET (grade 2 neuroendocrine tumor: n=10), according to WHO 2010 classification. The radical operation was indicated if curative resection were expected to be achievable. Otherwise, alternative multi-disciplinary treatments were introduced especially for the hepatic metastasis or repeated recurrences. Results: Median follow-up period was 37 months (range 7-69). OS was 100% at 3 years and 86% at 5 years. DFS was 62% at 3 years and 39% at 5 years. Disease recurrence developed more frequently in G2 NET, compared to G1 NET. However, there was statistically no difference for the OS between these two groups. Conclusions: Appropriate radical operation with multi-disciplinary treatments could contribute to the patients' survival in the treatment strategy of PNETs.
• Coupling Reaction of Indolepyruvic Acid by StaD and Its Product: Implications for Biosynthesis of Indolocarbazole and Violacein

  Shumpei Asamizu, Satoshi Hirano, Hiroyasu Onaka, Hiroyuki Koshino, Yoshitsugu Shiro, Shingo Nagano

  CHEMBIOCHEM 13 (17) 2495 - 2500 1439-4227 2012/11 [Refereed][Not invited]
  
• Video-assisted thoracoscopic left lower lobectomy in a patient with lung cancer and a right aortic arch

  Hideyuki Wada, Yasuhiro Hida, Kichizo Kaga, Ryunosuke Hase, Kazuto Ohtaka, Jun Muto, Nakada-Kubota Reiko, Satoshi Hirano, Yoshiro Matsui

  JOURNAL OF CARDIOTHORACIC SURGERY 7 120  1749-8090 2012/11 [Refereed][Not invited]
   

  A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch.
• Result of distal pancreatectomy with en-bloc celiac axis resection for locally advanced pancreatic body cancer

  NASU Yuya, HIRANO Satoshi, TANAKA Eiichi, TSUCHIKAWA Takahiro, KATO Kentaro, MATSUMOTO Joe, EBIHARA Yuma, SHICHINOHE Toshiaki

  Suizo Japan Pancreas Society 27 (5) 668 - 673 0913-0071 2012/10/25 

  We perform distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) without arterial reconstruction for locally advanced cancer of the pancreatic body involving the common hepatic artery and/or celiac axis with perineural invasion in the nerve plexus surrounding the arteries. DP-CAR has been performed in patients in whom the gastroduodenal artery and superior mesenteric artery could be preserved. Between April 1998 and December 2009, 53 patients underwent DP-CAR in our institution. The surgical margins were histologically clear (R0) in 49 (92%) patients. The postoperative morbidity rate was 62%. Estimated overall 1- and 3-year survival rates were 76% and 37%, respectively, and the median survival was 25 months. After surgery, contrary to expectations, postoperative diarrhea was not severe but mild. Moreover, preoperative intractable abdominal and/or back pain disappeared immediately. In principle, since 2006, patients who have undergone DP-CAR also received postoperative adjuvant chemotherapy. Patients could achieve a favorable general status with in about 2 months after DP-CAR enough to be able to start adjuvant chemotherapy. To shorten the period before chemotherapy, adequate management of symptoms should be performed in order to decrease the postoperative morbidity rate.
  
• 【化学療法の進歩に伴う進行膵胆道癌の手術適応】化学(放射線)療法施行後に切除を行った診断時切除不能膵・胆道癌症例の検討

  加藤 健太郎, 平野 聡, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一

  癌の臨床 (株)篠原出版新社 58 (5) 267 - 271 0021-4949 2012/10 

  化学(放射線)療法施行後に切除を行った診断時切除不能膵・胆道癌症例の治療成績からadjuvant surgeryの妥当性を検討した。診断時切除不能と診断され、化学(放射線)療法が奏効し根治切除が可能となり、切除を施行した膵胆道癌22例を対象とした。治療の最良効果はPRが12例、SDが10例であった。投与方法は静注化学療法が11例、動注化学療法が4例、化学放射線療法が7例であった。合併症は11例に発生し、膵液瘻5例、創感染3例、血栓症3例、高ビリルビン血症、腹腔内膿瘍、カテーテル感染がそれぞれ1例であった。周術期死亡例は一例もなかった。合併症の中で化学療法が原因と思われるものはなかった。全症例の手術後の3年全生存率は57%で、生存期間中央値は48ヵ月であった。疾患別では膵癌が5年生存率61%、胆道癌は44%であり疾患による生存率の差はなかった。
• 肝門部胆管癌の治療戦略 当科における肝門部胆管癌の治療戦略と手術成績

  岡村 国茂, 松本 譲, 中西 喜嗣, 浅野 賢道, 福島 正之, 倉島 庸, 中村 透, 海老原 裕磨, 加藤 健太郎, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 73 (増刊) 359 - 359 1345-2843 2012/10
• 膵IPMNの手術適応と術式 当科における分枝型IPMNの縮小手術の適応と治療成績

  浅野 賢道, 中村 透, 岡村 国茂, 中西 喜嗣, 倉島 庸, 海老原 裕磨, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 73 (増刊) 405 - 405 1345-2843 2012/10
• 切除不能膵癌の化学(放射線)療法奏功例に対するadjuvant治療としての切除療法

  中村 透, 浅野 賢道, 岡村 国茂, 中西 喜嗣, 倉島 庸, 海老原 裕磨, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 73 (増刊) 475 - 475 1345-2843 2012/10
• The pharmacokinetics and long-term therapeutic effects of gefitinib in patients with lung adenocarcinoma harboring the epidermal growth factor receptor(EGFR)mutation.

  Hirano S, Sano K, Takeda Y, Ishii S, Naka G, Iikura M, Izumi S, Hojo M, Sugiyama H, Kobayashi N, Kudo K

  Gan to kagaku ryoho. Cancer & chemotherapy 39 (10) 1501 - 1506 0385-0684 2012/10 [Refereed][Not invited]
  
• [Proceeding of preoperative treatment to jaundice caused by biliary tract cancer].

  Hirano S, Tanaka E, Tsuchikawa T, Matsumoto J, Kato K, Ebihara Y, Nakamura T, Shichinohe T

  Gan to kagaku ryoho. Cancer & chemotherapy 39 (10) 1478 - 1482 0385-0684 2012/10 [Refereed][Not invited]
  
• 【いわゆる良性腫瘍のマリグナントプログレッション】胆道系腫瘍:大型胆管・付属腺での良性腫瘍/低異型度悪性腫瘍と癌化 胆管付属腺に発生するIPNBと悪性化

  中西 喜嗣, 大原 正範, 中沼 安二, 新田 健雄, 平野 聡

  肝・胆・膵 (株)アークメディア 65 (3) 495 - 502 0389-4991 2012/09
• Endoscopic Nasobiliary Drainage Should be Initially Selected for Preoperative Biliary Drainage in Patients with Perihilar Bile Duct Cancer

  Hiroshi Kawakami, Masaki Kuwatani, Kazunori Eto, Taiki Kudo, Eiichi Tanaka, Satoshi Hirano

  WORLD JOURNAL OF SURGERY 36 (9) 2265 - 2266 0364-2313 2012/09 [Refereed][Not invited]
  
• Comparison of IRMS and NMR spectrometry for the determination of intramolecular C-13 isotope composition: Application to ethanol

  Alexis Gilbert, Ryota Hattori, Virginie Silvestre, Nariaki Wasano, Serge Akoka, Satoshi Hirano, Keita Yamada, Naohiro Yoshida, Gerald S. Remaud

  TALANTA 99 1035 - 1039 0039-9140 2012/09 [Refereed][Not invited]
   

  Isotopic C-13 NMR is a relatively recent technique which allows the determination of intramolecular C-13 isotope composition at natural abundance. It has been used in various scientific fields such as authentication, counterfeiting or plant metabolism. Although its precision has already been evaluated, the determination of its trueness remains still challenging. To deal with that issue, a comparison with another normalized technique must be achieved. In this work, we compare the intramolecular C-13 isotope distribution of ethanol from different origins obtained using both Isotope Ratio Mass Spectrometry (IRMS) and Nuclear Magnetic Resonance (NMR) spectrometry techniques. The IRMS approach consists of the oxidation of ethanol to acetic acid followed by the degradation of the latter for the analysis of each fragments formed. We show here that the oxidation of ethanol to acetic acid does not bring any significant error on the determination of the site-specific delta C-13 (delta C-13(i)) of ethanol using the IRMS approach. The difference between the data obtained for 16 samples from different origins using IRMS and NMR approaches is not statistically significant and remains below 0.3 parts per thousand(m. These results are encouraging for the future studies using isotopic NMR, especially in combination with the IRMS approach. (C) 2012 Published by Elsevier B.V.
• 腫瘍血管内皮におけるBiglycanの機能解析(Biglycan is a specific marker and an autocrine angiogenic factor of tumor endothelial cells)

  大賀 則孝, 山本 和幸, 樋田 泰浩, 秋山 廣輔, 間石 奈湖, 川本 泰輔, 北山 和子, 大澤 崇宏, 平野 聡, 篠原 信雄, 近藤 正信, 樋田 京子

  日本癌学会総会記事 71回 86 - 86 0546-0476 2012/08 [Refereed][Not invited]
  
• Clinically Relevant Pancreas-Related Infectious Complication After Pancreaticoenteral Anastomosis Could Be Predicted by the Parameters Obtained on Postoperative Day 3

  Takehiro Noji, Toru Nakamura, Yoshiyasu Ambo, On Suzuki, Fumitaka Nakamura, Akihiro Kishida, Satoshi Hirano, Satoshi Kondo, Nobuichi Kashimura

  PANCREAS 41 (6) 916 - 921 0885-3177 2012/08 [Refereed][Not invited]
   

  Objectives: Pancreatic fistula or pancreas-related infectious complications are one of the most common surgical complications after pancreatic surgery. The aims of this study were, first, to reveal the risk factors for clinically relevant pancreas-related infectious complications and, second, to identify those risk factors that are obtainable within the first 3 postoperative days. Methods: One hundred seven consecutive patients who underwent pancreaticoenteral anastomosis between October 2007 and November 2010 were enrolled. Results: There were 36 patients with clinical pancreas-related infectious complications among 107 in this series of patients. Univariate and multivariate analyses revealed that a narrow main pancreatic duct diameter (<3 mm) was an independent risk factor for clinically relevant pancreas-related infectious complication. Univariate and multivariate analyses also revealed that a body temperature of 38 degrees C or higher on postoperative day 3 (POD3), a leukocyte count of 9.8 x 10(9)/L or greater on POD3, and a drain fluid amylase level of 3000 IU/L or higher on POD3 were significant predictive factors for clinically relevant pancreas-related infectious complication for 58 patients with a narrow main pancreatic duct. Conclusions: In view of the clinical variables obtained on POD3, such as amylase levels in drain effluent, body temperature, and leukocyte count, clinically relevant pancreas-related infections could be predicted well.
• Metachronous pancreatic acinar cell carcinoma discovered in early stage during follow-up of breast cancer: Report of a case

  Satoshi Hayama, Makoto Ohmi, Atsuya Yonemori, Takumi Yamabuki, Hitoshi Inomata, Kazuyoshi Nihei, Satoshi Hirano

  Clinical Journal of Gastroenterology 5 (4) 257 - 260 1865-7257 2012/08 [Refereed][Not invited]
   

  We present an extremely rare case of earlystage acinar cell carcinoma of the pancreas. A 49-year-old woman, who had undergone radical surgery for breast cancer 3 years earlier, was suspected to have a rib metastasis during follow-up. She also had a family history of cancer. No accumulation was seen in the left rib on 18F-fluorodeoxyglucose positron emission tomography with computed tomography, but incidental high uptake into the pancreatic head suggested malignant pancreatic tumor. The tumor was completely resected by pancreatoduodenectomy, and pancreatic acinar cell carcinoma was demonstrated histopathologically. To the best of our knowledge, this is the first reported case of a pancreatic acinar cell carcinoma smaller than 1 cm to be detected by 18F-fluorodeoxyglucose positron emission tomography and computed tomography. © 2012 Springer.
• Isolated intramedullary spinal artery aneurysm

  Nobuyoshi Takashima, Hiroyuki Murai, Satoshi Hirano, Masafumi Oya

  NEUROLOGY 79 (6) 608 - 609 0028-3878 2012/08 [Refereed][Not invited]
  
• Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis.

  Izumi S, Iikura M, Hirano S

  The New England journal of medicine 367 (9) 870; author reply 870 - 1 0028-4793 2012/08 [Refereed][Not invited]
  
• Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis.

  Izumi S, Iikura M, Hirano S

  The New England journal of medicine 367 (9) 870; author reply 870 - 1 0028-4793 2012/08 [Refereed][Not invited]
  
• Preoperative Biliary Drainage for Hilar Cholangiocarcinoma

  KAWAKAMI Hiroshi, KATO Mototsugu, HIRANO Satoshi, SAKAMOTO Naoya

  Gastroenterological Endoscopy Japan Gastroenterological Endoscopy Society 54 (7) 1975 - 1990 0387-1207 2012/07/20 

  The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 5% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and to perform major surgery only after recovery of the hepatic function. However, no definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus has been reached regarding which PBD method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting and endoscopic nasobiliary drainage in patients with HCA. Recently, a few Japanese high-volume centers have recommended EBD of the future remnant lobe for PBD in patients expected to undergo definitive surgery for HCA. This review summarizes the purpose, transition, current situation, and future of PBD in HCA patients undergoing PBD.
• Feasibility of a dual microcatheter-dual interlocking detachable coil technique in preoperative embolization in preparation for distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer

  Daisuke Abo, Yu Hasegawa, Yusuke Sakuhara, Satoshi Terae, Tadashi Shimizu, Khin Khin Tha, Eiichi Tanaka, Satoshi Hirano, Satoshi Kondo, Hiroki Shirato

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 19 (4) 431 - 437 1868-6974 2012/07 [Refereed][Not invited]
   

  To describe the feasibility of a dual microcatheter-dual interlocking detachable coil (DMDI) technique for preoperative embolization of the common hepatic artery (CHA) in preparation for distal pancreatectomy with en bloc celiac axis resection (DP-CAR) for locally advanced pancreatic body cancer. From January 2007 to December 2009, 26 patients underwent embolization of the CHA by the DMDI technique. We compared the results with those of 37 patients in whom the CHA was embolized by conventional techniques from August 1998 to February 2007. With the DMDI technique, no coil migration or other embolization-related complications occurred. The success rate was 100%. The rate of embolization-related complications was significantly lower in the DMDI embolization group (0%) than in the conventional embolization group (24.3%) (P = 0.008). The frequency of improper positioning of the embolic material necessitating its removal during DP-CAR was significantly lower in the DMDI embolization group (10%) than in the conventional embolization group (37.5%) (P = 0.044). The DMDI technique allows the development of collateral pathways, reduces the surgeon's burden in ligating the distal CHA, and prevents coil migration. For these reasons, we believe that this technique is feasible for embolization of the CHA in preparation for DP-CAR for locally advanced pancreatic body cancer.
• Endoscopic ultrasound-guided transmural drainage for pancreatic fistula or pancreatic duct dilation after pancreatic surgery

  Manabu Onodera, Hiroshi Kawakami, Masaki Kuwatani, Taiki Kudo, Shin Haba, Yoko Abe, Shuhei Kawahata, Kazunori Eto, Yuya Nasu, Eiichi Tanaka, Satoshi Hirano, Masahiro Asaka

  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 26 (6) 1710 - 1717 0930-2794 2012/06 [Refereed][Not invited]
   

  Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods At the authors' hospital, 262 patients underwent surgery involving pancreatic resection from April 2005 to March 2010. In 90 of these patients (34%), a grade B or C postoperative pancreatic fistula developed that required additional treatment. The authors performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilation of the main pancreatic duct visible by EUS. Percutaneous drainage was provided for 18 patients (6.8%). The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analysis. Results In all six cases, EUS-TD was performed successfully without complications. Five of the six patients were successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for both EUS-TD and percutaneous drainage. Both the short- and long-term clinical success rates for EUS-TD were 100% and those for percutaneous drainage were 61.1 and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091 vs. long-term success, P = 0.403). However, the time to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in the current series. Conclusions The EUS-TD approach appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered as first-line therapy for pancreatic fistulas visible by EUS.
• Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

  Takehiro Noji, Masaki Miyamoto, Kanako C. Kubota, Toshiya Shinohara, Yoshiyasu Ambo, Yoshihiro Matsuno, Nobuichi Kashimura, Satoshi Hirano

  WORLD JOURNAL OF SURGICAL ONCOLOGY 10 106  1477-7819 2012/06 [Refereed][Not invited]
   

  Background: Lymph node metastasis is one of the most important prognostic factors for extra-hepatic bile duct carcinoma (ExHBDC). Extra capsular lymph node involvement (ExCLNI) is the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The prognostic impact of ExCLNI has been shown to be significant mainly in head and neck malignancies. Recently, the prognostic impacts of ExCLNI have evaluated in gastrointestinal malignancies. However no data is available regarding the incidence and prognostic significance of extra-capsular lymph node involvement (ExCLNI) in resectable ExHBDCs. The aim of the present study is first to evaluate the incidence of ExCLNI in surgically-treated ExHBDCs and second, to determine the prognostic impact of ExCLNI in patients with surgically-treated ExHBDCs. Methods: A total of 228 patients (110 cases of hilar cholangiocarcinoma and 118 cases of distal cholangiocarcinoma) with surgically-treated ExHBDCs were included in this retrospective study. ExCLNI was defined as the extension of cancer cells through the nodal capsule into the perinodal fatty tissue. The existence of ExCLNI and its prognostic value were analyzed as a subgroup of lymph node metastasis. Results: ExCLNI was detected in only 22% of patients with lymph node metastasis of surgically-treated ExHBDC. The presence of ExCLNI correlated with distal cholangiocarcinoma (p = 0.002). On univariate analysis for survival, perineural invasion, vascular invasion, histological grade, and lymph node metastasis were statistically significant factors. On multivariate analysis, only lymph node metastasis was identified as a significant independent prognostic factor in patients with resectable ExHBDC. Subgroups of lymph node metastasis including the presence of ExCLNI, location of lymph node metastasis, and the number of lymph node metastasis had no statistically significant impact on survival. Conclusion: ExCLNI was present in only 22% of the LNM (7% of overall patients) in patients with surgical treated ExHBDCs. And ExCLNI would have no impact on the survival of patients with surgically-treated ExHBDCs.
• The Immunological Impact of Neoadjuvant Chemotherapy on the Tumor Microenvironment of Esophageal Squamous Cell Carcinoma

  Takahiro Tsuchikawa, Masaki Miyamoto, Yoshiyuki Yamamura, Toshiaki Shichinohe, Satoshi Hirano, Satoshi Kondo

  ANNALS OF SURGICAL ONCOLOGY 19 (5) 1713 - 1719 1068-9265 2012/05 [Refereed][Not invited]
   

  Esophageal cancer is an aggressive cancer with poor prognosis. However, little is known about the immune response in the tumor microenvironment after neoadjuvant chemotherapy. To investigate the immunological impact of neoadjuvant chemotherapy in the tumor microenvironment of esophageal squamous cell carcinoma. Eighteen patients with esophageal squamous cell carcinoma with and without neoadjuvant chemotherapy were analyzed using immunohistochemical methods for human leukocyte antigen (HLA) class I heavy chain, CD4-, CD8-, and Foxp3-positive cell infiltration. The number of CD4 T cells in the stroma and within the cancer nest was significantly higher in the neoadjuvant chemotherapy group. The number of CD8 T cells in the stroma was significantly higher in the neoadjuvant chemotherapy group. HLA class I expression was more downregulated in the control group compared with the neoadjuvant chemotherapy group. Neoadjuvant chemotherapy utilizing 5-fluorouracil and cisplatin in esophageal squamous cell carcinoma is useful to induce CD4 and CD8 T lymphocytes in the tumor microenvironment and to maintain HLA class I expression levels in combination with its direct cytotoxic effects.
• The prognosis after curative resection of gallbladder cancer with hilar invasion is similar to that of hilar cholangiocarcinoma

  Yuya Nasu, Eiichi Tanaka, Satoshi Hirano, Takahiro Tsuchikawa, Kentaro Kato, Joe Matsumoto, Toshiaki Shichinohe, Satoshi Kondo

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 19 (3) 274 - 280 1868-6974 2012/05 [Refereed][Not invited]
   

  Gallbladder cancer (GBC) often invades the hepatic hilum and even small tumors can cause obstructive jaundice. Operative intervention for GBC with obstructive jaundice is sometimes not recommended because it is associated with a poor prognosis. However, the extended procedure is recommended for patients with hilar cholangiocarcinoma (HC). We therefore compared the postoperative survival of patients with GBC invading the hepatic hilum with that with HC. Between 1998 and 2008, 27 patients with GBC invasion of the hepatic hilum (hGBC) and 124 with HC underwent surgical resection with curative intent in the Department of Surgical Oncology, Hokkaido University Graduate School of Medicine. This study included patients with GBC without peritoneal dissemination and liver or para-aortic lymph node metastasis. Extended right hemihepatectomy and extrahepatic bile duct resection comprise the treatment of choice for GBC with hilar invasion (hGBC). We aimed to achieve R0 outcomes by aggressive vascular resection and/or concomitant resection of directly invaded organs around the GBC along with extended right hemihepatectomy. We analyzed 27 patients with hGBC (age 58-83 years; median 71 years; male:female 13:14) and 124 with HC (age 45-80 years; median 69 years; male:female 94:30). The 3- and 5-year survival rates of 43 and 24% for hGBC and 58 and 38% for HC, respectively, did not differ significantly (p = 0.14). Preoperative obstructive jaundice was a complication in 22 (81%) and 95 (77%) patients with hGBC and HC, respectively. The 5-year survival rates were 40 and 36%, respectively, which did not differ significantly (p = 0.61). The 5-year survival rates after extended right hemihepatectomy to resect the tumor with curative intent were 34 and 34% for hGBC and HC, which did not differ significantly (p = 0.14). The prognosis after curative resection of GBC with hilar invasion is similar to that of HC in selected patients. Aggressive surgery for advanced GBC with hilar invasion might increase survival rates.
• Surgical Strategy for Liver Metastases of Neuroendocrine Tumors

  Takahiro Tsuchikawa, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Joe Matsumoto, Tomohide Nakayama, Yukiko Tabata, Toshiaki Shichinohe

  HEPATO-GASTROENTEROLOGY 59 (115) 921 - 923 0172-6390 2012/05 [Refereed][Not invited]
   

  Background/Aims: Little information is available about the long-term prognosis after hepatectomy for liver metastases of neuroendocrine tumors (NETs). To clarify the prognosis for liver metastases of NETs after hepatectomy and to identify a practical and useful surgical indication for hepatic metastases of NETs. Methodology: Twenty-four patients with NET were divided into 2 groups: the nHM group (patients without hepatic metastasis, n=13) and the HM group (patients with hepatic metastasis or recurrences, n=11). Hepatectomy was indicated for metastases or disease recurrences in the liver if R0 resection was expected to be achievable. Patient clinicopathological features, mode of recurrences and treatment for them were evaluated retrospectively. Results: The median follow-up period for the 24 patients was 34 months (range 7-69) and the disease specific survival rate was 82% at 5 years. DSS at 5 years did not differ between patients with and without hepatic recurrence (91% vs. 75% respectively, p=0.6144), even though the histological grade and the MIB-1 index were higher in the HM group. Conclusions: Patient prognosis was acceptable following our policy of hepatectomy for NET liver metastases. Survival could be improved by intensive multimodal treatment.
• Techniques of biliary reconstruction following bile duct resection (with video)

  Satoshi Hirano, Eiichi Tanaka, Takahiro Tsuchikawa, Joe Matsumoto, Toshiaki Shichinohe, Kentaro Kato

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 19 (3) 203 - 209 1868-6974 2012/05 [Refereed][Not invited]
   

  In several clinical situations, including resection of malignant or benign biliary lesions, reconstruction of the biliary system using the Roux-en-Y jejunum limb has been adopted as the standard procedure. The basic technique and the procedural knowledge essential for most gastroenterological surgeons are described in this article, along with a video supplement. Low complication rates involving anastomotic insufficiency or stricture can be achieved by using proper surgical techniques, even following small bile duct reconstruction. Using the ropeway method to stabilize the bile duct and jejunal limb allows precise mucosa-to-mucosa anastomosis with interrupted sutures of the posterior row of the anastomosis. Placement of a transanastomotic stent tube is the second step. The final step involves suturing the anterior row of the anastomosis. In contrast to the lower extrahepatic bile duct, the wall of the hilar or intrahepatic bile duct can be recognized within the fibrous connective tissue in the Glissonean pedicle. The portal side of the duct should be selected for the posterior wall during anastomosis owing to its thickness. Meticulous inspection to avoid overlooking small bile ducts could decrease the chance of postoperative intractable bile leakage. In reconstruction of small or fragile branches, a transanastomotic stent tube could work as an anchor for the anastomosis.
• Laparoscopic pancreaticoduodenectomy combined with minilaparotomy

  On Suzuki, Satoshi Kondo, Satoshi Hirano, Eiichi Tanaka, Kentaro Kato, Takahiro Tsuchikawa, Tomoyuki Yano, Keisuke Okamura, Toshiaki Shichinohe

  SURGERY TODAY 42 (5) 509 - 513 0941-1291 2012/05 [Refereed][Not invited]
   

  Laparoscopic pancreatic surgery is evolving rapidly; however, the surgical treatment of periampullary tumors is still fraught with challenges, such as technical difficulty and the appropriateness of oncologic treatment for these patients. We describe how we performed laparoscopic pancreaticoduodenectomy (LPD) combined with minilaparotomy successfully in six consecutive patients. This procedure consisted of two surgical phases: safe laparoscopic surgery, including the Kocher maneuver, tunneling behind the pancreatic neck, and dissecting along the uncinate process with magnified vision; and a secure open approach with complete skeletonization of the hepatoduodenal ligament and alimentary tract reconstruction, performed similarly to conventional pancreaticoduodenectomy, under direct visualization through the minilaparotomy. By performing this procedure, we combined a safe and secure minilaparotomy approach under direct vision with a less invasive laparoscopic approach providing a magnified image. Our experience demonstrates that LPD combined with minilaparotomy is technically feasible for selected patients with periampullary tumors.
• 原発性肺腺癌における術前血清CYFRA値と予後との関連に関する検討

  武内 慎太郎, 加藤 達哉, 樋田 泰浩, 加賀 基知三, 中田 玲子, 大高 和人, 武藤 潤, 井上 玲, 平野 聡, 松居 喜郎

  日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 26 (3) O02 - 02 0919-0945 2012/04 [Refereed][Not invited]
  
• 病理病期III悪性胸膜中皮腫切除症例の検討

  中田 玲子, 樋田 泰浩, 加賀 基知三, 加藤 達哉, 井上 玲, 大高 和人, 武藤 潤, 平野 聡, 松井 喜郎

  日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 26 (3) O13 - 05 0919-0945 2012/04 [Refereed][Not invited]
  
• 横隔膜交通症手術における交通部同定法としての気腹法の有用性

  井上 玲, 樋田 泰浩, 加賀 基知三, 武藤 潤, 大高 かずと, 加藤 達哉, 加藤 弘明, 成田 吉明, 樫村 暢一, 平野 聡, 松居 喜郎

  日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 26 (3) O29 - 03 0919-0945 2012/04 [Refereed][Not invited]
  
• 原発巣へのFDG集積による非浸潤性非小細胞肺癌の判定

  武藤 潤, 樋田 泰浩, 加賀 基知三, 加藤 達哉, 大高 和人, 井上 玲, 中田 玲子, 平野 聡, 松居 喜郎

  日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 26 (3) P16 - 02 0919-0945 2012/04 [Refereed][Not invited]
  
• Down-regulation of Human Leukocyte Antigen class I heavy chain in tumors is associated with a poor prognosis in advanced esophageal cancer patients

  Kimitaka Tanaka, Takahiro Tsuchikawa, Masaki Miyamoto, Takehiro Maki, Masaomi Ichinokawa, Kanako C. Kubota, Toshiaki Shichinohe, Satoshi Hirano, Soldano Ferrone, Hirotoshi Dosaka-Akita, Yoshihiro Matsuno, Satoshi Kondo

  INTERNATIONAL JOURNAL OF ONCOLOGY 40 (4) 965 - 974 1019-6439 2012/04 [Refereed][Not invited]
   

  The HLA class I antigen processing machinery (APM) plays a crucial role in the anticancer immune response. The aim of this study was to assess the clinical significance of APM components in esophageal cancer. A total of 11 esophageal cancer cell lines were evaluated by Western blot analysis for 13 HLA class I APM components. There was a different expression pattern among cancer cell lines for HLA class I heavy chain (HLA-HC), beta 2 microglobulin, Tapasin, TAP-1, TAP-2, LMP-7 and LMP-10. Immunohistochemical staining utilizing a tissue microarray method for HLA class I APM expression showing different expression patterns among cell lines was performed for 95 surgical specimens from patients with esophageal cancer. Prognostic factors were the down-regulation of HLA-HC, and the up-regulation of 132 microglobulin and TAP-1 in the cancer tissues. Multivariate analysis using a Cox regression model indicated that the down-regulation of HLA-HC, and up-regulation of TAP-1 in cancer tissues are independent, unfavorable prognostic factors (hazard ratio, 2.361 and 2.297; P=0.0141 and 0.0145, respectively). Although there was no significant difference in survival for selected p-stage I and II patients (n=54) in all APM components, only down-regulation of HLA-HC was an unfavorable prognostic factor by a Cox regression model for selected p-stage III and IV patients (n=41). In conclusion, the current results suggest that the down-regulation of HLA-HC in tumors is especially associated with a poor prognosis among advanced esophageal cancer patients.
• New Invagination Procedure for Pancreaticojejunostomy Using Only Four Sutures

  Yoshitsugu Nakanishi, Masanori Ohara, Misa Noguchi, Hiromitsu Domen, Kazuteru Komuro, Satoshi Hirano

  WORLD JOURNAL OF SURGERY 36 (4) 892 - 897 0364-2313 2012/04 [Refereed][Not invited]
   

  Pancreaticoenterostomy remains one of the most stressful parts of pancreatoduodenectomy. We introduce herein a new convenient and secure invagination procedure for pancreaticojejunostomy. We performed our new procedure during pancreatoduodenectomy in 15 consecutive patients (7 men, 8 women). The features of the procedure are as follows. First, it is performed using only four sutures. Second, the pancreas stump is invaginated into the jejunum, mainly by two sutures that penetrate the parenchyma and are continuously purse-string sutured to the jejunum. Third, all needle holes on the surface of the pancreas are covered with the jejunal wall. Eight patients were classified as showing no pancreatic fistula, and seven displayed a grade A fistula, according to the International Study Group on Pancreatic Fistula criteria. The median operating time for these 15 patients using the present procedure was about 60 min shorter than that for the previous nine patients who underwent duct-to-mucosa pancreaticogastrostomy in our hospital. The present method allows pancreaticojejunostomy to be performed swiftly and conveniently.
• Preoperative percutaneous transhepatic portal vein embolization with ethanol injection.

  Yusuke Sakuhara, Daisuke Abo, Yu Hasegawa, Tadashi Shimizu, Toshiya Kamiyama, Satoshi Hirano, Daisuke Fukumori, Takeshi Kawamura, Yoichi M Ito, Khin Khin Tha, Hiroki Shirato, Satoshi Terae

  AJR. American journal of roentgenology 198 (4) 914 - 22 0361-803X 2012/04 [Refereed][Not invited]
   

  OBJECTIVE: The purpose of this article is to evaluate the feasibility and efficacy of preoperative percutaneous transhepatic portal vein embolization with ethanol injection. MATERIALS AND METHODS: We retrospectively evaluated 143 patients who underwent percutaneous transhepatic portal vein embolization. Hypertrophy of the future liver remnant was assessed by comparing the volumetric data obtained from CT image data before and after percutaneous transhepatic portal vein embolization. The evaluation of effectiveness was based on changes in the absolute volume of the future liver remnant and the ratio of the future liver remnant to the total estimated liver volume. RESULTS: Ten of 143 patients (7.0%) underwent additional embolization because of recanalization and insufficient hypertrophy of the future liver remnant. The mean increase in the ratio of the future liver remnant was 33.6% (p < 0.0001), and the mean ratio of future liver remnant to total estimated liver volume increased from 34.9% to 45.7% (p < 0.0001). Although most of the patients complained of pain after ethanol injection, they were gradually relieved of pain in a few minutes by conservative treatment. Fever (38-39°C) was reported after 47 of 151 (31.1%) percutaneous transhepatic portal vein embolization sessions and was resolved within a few days. Transient elevation of the liver transaminases was observed after the procedures and resolved within about a week. Major complications occurred in nine of 151 (6%) percutaneous transhepatic portal vein embolization sessions, but no patients developed hepatic insufficiency or severe complications precluding successful resection. One hundred twenty patients underwent hepatic resection, and two patients developed hepatic failure after surgery. CONCLUSION: Preoperative percutaneous transhepatic portal vein embolization with ethanol is a feasible and effective procedure to obtain hypertrophy of the future liver remnant for preventing hepatic failure after hepatectomy.
• 十二指腸乳頭部癌および中下部胆管癌の治療戦略におけるpitfall 中下部胆管癌の上流側進展度診断における経乳頭的検査の有用性

  渡邊 祐介, 土川 貴裕, 野路 武寛, 松永 明宏, 加藤 健太郎, 松本 譲, 七戸 俊明, 田中 栄一, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 113 (臨増2) 246 - 246 0301-4894 2012/03
• 膵頭十二指腸切除における新規膵空腸吻合

  中西 喜嗣, 大原 正範, 野口 美紗, 道免 寛充, 小室 一輝, 岩代 望, 石坂 昌則, 平野 聡

  日本外科学会雑誌 (一社)日本外科学会 113 (臨増2) 697 - 697 0301-4894 2012/03
• 多発性大型嚢胞形成を伴う通常型膵癌7例の臨床病理学的検討

  新田 健雄, 三橋 智子, 畑中 豊, 山田 洋介, 高桑 恵美, 久保田 佳奈子, 平野 聡, 松野 吉宏

  日本病理学会会誌 (一社)日本病理学会 101 (1) 263 - 263 0300-9181 2012/03 [Refereed][Not invited]
  
• AIDS治療中に気管支鏡検査にて確定診断された肺カポジ肉腫の2症例

  推名 健太郎, 朝尾 哲彦, 市川 晶博, 渡辺 翔, 飯倉 元保, 森野 英里子, 石井 聡, 高崎 仁, 仲 剛, 平野 聡, 泉 信有, 竹田 雄一郎, 放生 雅章, 杉山 温人, 小林 信之

  気管支学 (NPO)日本呼吸器内視鏡学会 34 (2) 196 - 196 0287-2137 2012/03 [Refereed][Not invited]
  
• Biglycan is a specific marker and an autocrine angiogenic factor of tumour endothelial cells.

  Yamamoto K, Ohga N, Hida Y, Maishi N, Kawamoto T, Kitayama K, Akiyama K, Osawa T, Kondoh M, Matsuda K, Onodera Y, Fujie M, Kaga K, Hirano S, Shinohara N, Shindoh M, Hida K

  British journal of cancer 6 106 (6) 1214 - 1223 0007-0920 2012/03 [Refereed][Not invited]
  
• Important technical remarks on distal pancreatectomy with en-bloc celiac axis resection for locally advanced pancreatic body cancer

  Eiichi Tanaka, Satoshi Hirano, Takahiro Tsuchikawa, Kentaro Kato, Joe Matsumoto, Toshiaki Shichinohe

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 19 (2) 141 - 147 1868-6974 2012/03 [Refereed][Not invited]
   

  Background We have already reported the feasibility, safety, and excellent long-term results of distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) for locally advanced pancreatic body cancer. An international standard for the surgical technique of DP-CAR has yet to be established. Methods DP-CAR was carefully performed in 42 patients in Hokkaido University Hospital from 1998 to July 2007. Arterial blood flow alteration and collateral flow development toward the liver and stomach was obtained following preoperative routine transcatheter arterial embolization of the common hepatic artery. The right-sided approach to the superior mesenteric artery and celiac artery, and the preservation of the inferior pancreatoduodenal artery during the dissection of the plexus around the pancreatic head, are the key techniques in DP-CAR. Results The operative morbidity and mortality were 43 and 4.8%, respectively. R0 resection could be done in 39 (93%) patients. Median operation time and intraoperative blood loss were 478 min and 1030 ml, respectively. Ischemic gastropathy was complicated in 5 (12%) patients, but liver abscess was found in only one patient and no liver failure was encountered. Conclusions We emphasize again the feasibility and safety of DP-CAR; it should be a treatment of choice for locally advanced pancreatic body cancer.
• Early Enteral Feeding After Distal Pancreatectomy May Contribute to Chyle Leak

  Takehiro Noji, Toru Nakamura, Yoshiyasu Ambo, On Suzuki, Fumitaka Nakamura, Akihiro Kishida, Satoshi Hirano, Satoshi Kondo, Nobuichi Kashimura

  PANCREAS 41 (2) 331 - 333 0885-3177 2012/03 [Refereed][Not invited]
  
• EGFR-TKIによる既治療肺腺癌に対するEGFR-TKIと殺細胞性抗癌剤による併用療法の効果

  平野 聡, 竹田 雄一郎, 平石 尚久, 東野 茉莉, 中道 真仁, 石井 聡, 仲 剛, 飯倉 元保, 泉 信有, 杉山 温人, 小林 信之

  癌と化学療法 (株)癌と化学療法社 39 (2) 213 - 219 0385-0684 2012/02 

  目的:EGFR-TKIによる既治療肺腺癌に対してEGFR-TKIと殺細胞性抗癌剤による併用療法の効果を検討する。方法:2008年5月～2010年12月にEGFR-TKIと殺細胞性抗癌剤の併用療法が行われた肺腺癌8例について奏効率、病勢制御率、無増悪生存期間、治療成功期間、全生存期間について後方視的に検討した。結果:EGFR遺伝子の検索を行った7例のうちEGFR遺伝子変異を有していた症例は6例、なし1例であった。前治療数の中央値は5レジメンであり、全症例がgefitinib、erlotinibのいずれもの治療歴を有していた。8例のうちSD6例(うち3例は血液毒性で後に継続困難)、PD2例で病勢制御率は75%、治療成功期間中央値は42日、無増悪生存期間は84日、併用療法開始後の生存期間中央値は495日であった。結論:EGFR-TKIと殺細胞性抗癌剤の併用療法は症例によっては有用な治療法の選択肢の一つとなり得ると考えられた。(著者抄録)
• 経皮ドレナージが困難な術後膵液瘻に対する超音波内視鏡ガイド下内瘻術の経験

  山本 和幸, 平野 聡, 田中 栄一, 古川 聖太郎, 那須 裕也, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 近藤 哲

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 45 (2) 197 - 202 0386-9768 2012/02 

  症例は79歳の男性で,膵頭部癌に対し亜全胃温存膵頭十二指腸切除術を施行した.術後9日目に膵・空腸吻合部ドレーン排液のアミラーゼ値の上昇を認め,膵液瘻と診断した.経皮ドレナージを継続し膵液瘻は改善したため,術後26日目にドレナージチューブを抜去した.術後36日目に発熱,腹痛を認め,CTで膵・空腸吻合部近傍に液体貯留を認めたため,膵液瘻の再燃と診断した.ドレナージの適応と判断したが,経皮的穿刺は腹壁直下に小腸が存在するため困難であった.経胃的超音波内視鏡下にドレナージを試み,内瘻チューブの留置に成功した.その後,自他覚的所見の改善が得られ,CTで膵・空腸吻合部近傍の液体貯留の消失が確認されたため,内瘻チューブ留置後29日目に退院となった.退院後3週間目に内瘻チューブの自然脱落を認めたが,術後9ヵ月後の現在も無症状で良好に経過している.(著者抄録)
• [Efficacy of combination therapy with EGFR-TKI and cytotoxic drug in lung adenocarcinoma already treated with EGFR-TKI].

  Satoshi Hirano, Yuichiro Takeda, Yoshihisa Hiraishi, Mari Higashino, Shinji Nakamichi, Satoru Ishii, Go Naka, Motoyasu Iikura, Shinyu Izumi, Haruhito Sugiyama, Nobuyuki Kobayashi

  Gan to kagaku ryoho. Cancer & chemotherapy 39 (2) 213 - 9 0385-0684 2012/02 [Refereed][Not invited]
   

  UNLABELLED: OBJECITVE: To assess the efficacy of combination therapy with EGFR-TKI and a cytotoxic drug in lung adenocarcinoma already being treated with EGFR-TKI. METHODS: Eight patients with adenocarcinoma who were treated with combination therapy of EGFR-TKI and a cytotoxic drug between April 2008 and December 2010 were retrospectively evaluated for response rate, disease-control rate, progression-free survival(PFS), time-to-treatment-failure(TTF)and overall survival(OS). RESULTS: Among the 7 patients with tumor samples available, EGFR-mutations were detected in six.The median number of prior therapy regimens received by the patients was 5.All the patients had been treated before with both gefitinib and erlotinib.Among 8 patients, six showed stable disease, including three patients intolerant because of severe hematological toxicities, and 2 with progressive disease.The disease-control rate was 75%, and median TTF, PFS, and OS were 42 days, 84 days, and 495 days, respectively. CONCLUSION: Combination therapy with EGFR-TKI and a cytotoxic drug after the failure of EGFR-TKI may be a useful therapeutic option for selected patients.
• W1-1 胸腔鏡所見分類の重要性 : 診断に苦慮した症例を中心に(胸腔鏡所見分類,ワークショップ1,第35回日本呼吸器内視鏡学会学術集会)

  石井 聡, 竹田 雄一郎, 伊藤 秀幸, 宇田川 響, 清家 彩子, 仲 剛, 飯倉 元保, 平野 聡, 杉山 温人, 小林 信之

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 34 (Special) S121  0287-2137 2012
• 超音波による肝外胆管癌の右肝動脈および神経叢浸潤診断能の検討

  佐藤 恵美, 西田 睦, 工藤 悠輔, 井上 真美子, 表原 里実, 堀江 達則, 小野寺 祐也, 平野 聡, 河上 洋, 工藤 大樹, 三橋 智子, 仲 知保

  超音波検査技術抄録集 一般社団法人 日本超音波検査学会 37 S129 - S129 2012
• 超音波検査による膵管癌の上腸間膜動脈周囲神経叢浸潤の診断能の検討

  工藤 悠輔, 西田 睦, 佐藤 恵美, 井上 真美子, 表原 里実, 堀江 達則, 岩井 孝仁, 和田 妙子, 小野寺 祐也, 平野 聡, 三橋 智子, 清水 力

  超音波検査技術抄録集 一般社団法人 日本超音波検査学会 37 S139 - S139 2012
• 31. 局所麻酔下胸腔鏡にて診断に至ったMALTの1例(第139回 日本呼吸器内視鏡学会関東支部会)

  市川 晶博, 石井 聡, 平野 聡, 推名 健太郎, 朝尾 哲彦, 渡辺 翔, 城臺 孝之, 纐纈 力也, 佐藤 彩野, 宇田川 響, 石原 園子, 平嶋 純子, 森野 英里子, 高崎 仁, 仲 剛, 飯倉 元保, 泉 信有, 放生 雅章, 竹田 雄一郎, 杉山 温人, 小林 信之

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 34 (2) 199 - 199 2012
• O20-3 気管支鏡検査時のミダゾラムによる意識下鎮静法の検討(麻酔,一般口演20,第35回日本呼吸器内視鏡学会学術集会)

  宇田川 響, 竹田 雄一郎, 中道 真仁, 佐野 和美, 市川 晶博, 渡辺 翔, 石井 聡, 飯倉 元保, 仲 剛, 平野 聡, 泉 信有, 杉山 温人, 小林 信之

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 34 S177  2012
• O21-3 細径ガイドシース併用による細気管支肺生検時の出血量減少の効果(合併症,一般口演21,第35回日本呼吸器内視鏡学会学術集会)

  渡辺 翔, 平野 聡, 竹田 雄一郎, 飯倉 元保, 仲 剛, 石井 聡, 宇田川 響, 佐藤 彩野, 泉 信有, 杉山 温人, 小林 信之

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 34 S179  2012
• Portal vein resection and reconstruction prior to hepatic dissection for bismuth Type IV hilar cholangiocarcinoma with stenosis of the portal bifurcation

  Takeo Nitta, Satoshi Hirano, Joe Matsumoto, Kentaro Kato, Takahiro Tsuchikawa, Eiichi Tanaka, Toshiaki Shichinohe

  Japanese Journal of Gastroenterological Surgery 45 (11) 1091 - 1097 0386-9768 2012 [Refereed][Not invited]
   

  A woman in her forties presented with elevation of the hepatobiliary enzymes during a medical checkup. She was referred to our hospital and further examinations showed stenosis of the common hepatic bile duct and the bifurcation of the portal vein and perineural infiltration of the right hepatic artery, yielding a diagnosis of Bismuth type IV hilar cholangiocarcinoma with infiltration of the bifurcation of the portal vein. Because the hilar cholangiocarcinoma involved the bifurcation of the portal vein, she seemed to need emergency treatment to secure the liver blood supply. Her left hepatic volume was sufficient for right hepatectomy and caudate lobectomy. Preoperative laboratory data showed the serum total bilirubin value to be normal and no elevation of the serum level of biliary enzymes. We performed resection of the right and caudate lobes with the portal vein and bile duct and reconstruction. We performed portal vein resection and reconstruction prior to hepatic dissection. Although it is generally acknowledged that the portal vein should be resected after the hepatic dissection is completed and that portal reconstruction is performed after removal of the specimen, the hilar cholangiocarcinoma with infiltration of the portal vein to the future-remnant liver as in this case, urgently needs securing of the liver blood supply, therefore the surgical maneuver of portal vein resection and reconstruction before hepatic dissection seems valid from the point of view of patient safety. © 2012 The Japanese Society of Gastroenterological Surgery.
• Effective endoscopic ultrasound-guided transgastric drainage in a case of subcutaneous intractable postoperative pancreatic fistula

  Kazuyuki Yamamoto, Satoshi Hirano, Eiichi Tanaka, Shotaro Hurukawa, Yuya Nasu, Kentaro Kato, Joe Matsumoto, Takahiro Tsuchikawa, Toshiaki Shichinohe, Satoshi Kondo

  Japanese Journal of Gastroenterological Surgery 45 (2) 197 - 202 0386-9768 2012 [Refereed][Not invited]
   

  We report a case with postoperative pancreatic fistula successfully treated by endoscopic transgastric drainage. A 79-year-old man with cancer of the head of the pancreas underwent subtotal stomach-preserving pancreatoduodenectomy. On postoperative day 9, based on a high amylase level in drainage fluid, we suspected postoperative pancreatic fistula. The drainage tube was withdrawn on the 26th postoperative day after confirming closure of the fistula. He complained of upper abdominal pain and fever on the 36th postoperative day. CT scan revealed an abdominal fluid collection 2.5 cm in diameter around the pancreatojejunostomy. As percutaneous drainage was abandoned due to the presence of the small bowel between the abdominal wall and the lesion, endoscopic ultrasound (EUS)-guided transgastric drainage was attempted. Immediately after the procedure, the patient recovered and became asymptomatic. Since EUS-guided transgastric drainage for postoperative pancreatic fistula appears to be safe and feasible, it is an option for selected patients. © 2012 The Japanese Society of Gastroenterological Surgery.
• Increased risk of nontuberculous mycobacterial infection in asthmatic patients using long-term inhaled corticosteroid therapy

  Masayuki Hojo, Motoyasu Iikura, Satoshi Hirano, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  RESPIROLOGY 17 (1) 185 - 190 1323-7799 2012/01 [Refereed][Not invited]
   

  Background and objective: The risk of pneumonia is increased among COPD patients using inhaled corticosteroids (ICS). However, there is uncertainty regarding the association between long-term use of ICS and exacerbations of respiratory tract infections among asthmatic patients. Methods: A case-control nested cohort study was performed to assess the association of asthma with nontuberculous mycobacterium (NTM) infection. Results: Among this cohort of 464 asthmatic patients, 14 experienced complications due to NTM infections, of which eight were caused by Mycobacterium avium-intracellulare complex, three by M. kansasii, one by M. terrae and the remaining two by unclassifiable scotochromogens. Asthmatic patients with NTM infections were older (67.1 +/- 8.6 vs 58.8 +/- 12.3 years, P < 0.01) and had more severe airflow limitation (FEV1%, 60.6 +/- 10.3 vs 72.3 +/- 18.3, P < 0.03) than those without NTM infections. All except one had received ICS treatment for more than 5 years, and 12 of the 14 patients used inhaled fluticasone propionate daily (four patients at a dose of 400 mu g/day and eight patients at a dose > 800 mu g/day). Conclusions: These findings suggest that the risk of NTM infection may be greater in asthmatic patients who are older, have more severe airflow limitation and receive higher doses of ICS therapy.
• Pulmonary vein thrombosis after video-assisted thoracoscopic left upper lobectomy

  Kazuto Ohtaka, Yasuhiro Hida, Kichizo Kaga, Yasuaki Iimura, Nobuyuki Shiina, Jun Muto, Satoshi Hirano

  JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 143 (1) E3 - E5 0022-5223 2012/01 [Refereed][Not invited]
  
• 胸腔鏡下食道癌手術 合理的で安全な手技とその成績(手技の工夫) すべての胸部食道癌手術を胸腔鏡で施行するには、 HATSとProneの使い分け

  七戸 俊明, 加藤 健太郎, 土川 貴裕, 松永 明宏, 早馬 聡, 松本 譲, 鈴木 善法, 金古 裕之, 野路 武寛, 竹本 法弘, 寺村 紘一, 岡村 国茂, 渡邊 祐介, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 16 (7) 209 - 209 1344-6703 2011/12
• 最良のトレーニングシステムは何か(結紮・その他) 単孔式手術導入へのステップ solo surgeryとreduced port surgery

  渡邊 祐介, 北城 秀司, 奥芝 俊一, 竹本 法弘, 早馬 聡, 鈴木 善法, 野路 武寛, 松永 明宏, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 16 (7) 266 - 266 1344-6703 2011/12
• 胸腔鏡手術におけるステープリングディバイスの適切な選択と使用方法 胸腔鏡下中下部食道切除術における胸腔内吻合の際のステープリングデバイスの選択

  加藤 健太郎, 七戸 俊明, 渡邊 祐介, 岡村 国茂, 寺村 紘一, 早馬 聡, 松永 明宏, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 16 (7) 288 - 288 1344-6703 2011/12
• Development of a simultaneous liquid chromatography/tandem mass spectrometric method for the determination of type B trichothecenes, their derivatives, and precursors in wheat

  Tomoyuki Kadota, Makoto Kimura, Satoshi Hirano, Osamu Tajima, Takashi Nakajima, Yoichi Kamata, Yoshiko Sugita-Konishi

  RAPID COMMUNICATIONS IN MASS SPECTROMETRY 25 (23) 3481 - 3490 0951-4198 2011/12 [Refereed][Not invited]
   

  A method coupling liquid chromatography with tandem mass spectrometry (LC/MS/MS) was developed for the simultaneous quantitative determination of trichothecenes, nivalenol, deoxynivalenol, deoxynivalenol-3-glucoside, fusarenon-X, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, isotrichodermin, calonectrin, 3-deacetylcalonectrin, 15-deacetylcalonectrin, 3,15-diacetylnivalenol, 4,15-diacetylnivalenol, 3,15-diacetyldeoxynivalenol, and 3,4,15-triacetylnivalenol. The analytical parameters of trichothecenes and their derivatives were optimized to enable their highly sensitive detection. Evaluation of clean-up procedures using Multisep #226 and #227 indicated that Multisep #227 was more suitable for their simultaneous detection in wheat. In performance validation studies using the LC/MS/MS method with Multisep #227 cleanup, good recoveries ranging from 84% to 115% with relative standard deviations from 0.4% to 7.2% were measured. The limits of detection and quantification ranged from 0.03 to 1.4 ng.g(-1) and from 0.1 to 4.7 ng.g(-1), respectively. The effect of matrices using matrix-matched calibration was estimated to range from 80% to 117% after Multisep #227 cleanup. Multisep #227 clean-up procedure with matrix-free standard calibration achieved accurate quantification without having a considerable effect on matrix compounds. Using the developed method, several trichothecene derivatives and precursors were detected in fungally inoculated wheat samples. The developed LC/MS/MS method is a practical technique that can be used for the quantification of trichothecenes in wheat. This study is the first report of an analytical method used for the simultaneous quantification of major trichothecenes, their derivatives and precursors. Copyright (C) 2011 John Wiley & Sons, Ltd.
• [A case of chylothorax in which thoracoscopy under local anesthesia and thoracic duct scintigraphy were useful to locate the leakage site].

  Ishiii S, Takeda Y, Kubota K, Hirano S, Hojo M, Sugiyam H, Kobayashi N

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 49 (12) 976 - 980 1343-3490 2011/12 [Refereed][Not invited]
  
• 体外式超音波検査による肝外胆管癌の右肝動脈浸潤に関する診断能の検討

  佐藤 恵美, 西田 睦, 工藤 悠輔, 井上 真美子, 表原 里実, 堀江 達則, 小野寺 祐也, 平野 聡, 河上 洋, 久保田 佳奈子, 仲 知保

  超音波医学 (公社)日本超音波医学会 38 (6) 680 - 680 1346-1176 2011/11
• 肺癌と活動性非結核性抗酸菌症に対し癌化学療法と抗酸菌治療の同時加療を行った1例

  藤田 雄, 石井 聡, 平野 聡, 竹田 雄一郎, 杉山 温人, 小林 信之

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 49 (11) 855 - 860 1343-3490 2011/11 

  症例は55歳男性。2004年10月に胸部X線にて右肺尖部に空洞病変を認め、精査にて肺Mycobacterium avium complex(MAC)症と診断されたが、治療を希望せず経過観察となっていた。2009年7月に労作時呼吸困難が出現、胸部X線にて左胸水を認め、精査にて左上葉原発肺腺癌T2aN0M1a stage IVの診断となった。右肺尖部には肺MAC症による既知の空洞病変を認めた。排菌量が多いことより肺MAC症に対しては2週間のリファンピシン、エタンブトール、クラリスロマイシン、ストレプトマイシンによる治療を先行し、後に肺癌に対してカルボプラチン+ペメトレキセド投与を開始し、両者の病勢制御を得ることができた。現在、抗酸菌症に対する治療を継続しているものの再燃は認めていない。過去に両者合併症例の癌化学療法に言及した報告は少なく、肺MAC症の増加に伴い今後もさらなる検討が必要と考えられた。(著者抄録)
• [A case of lung cancer complicated with active non-tuberculous mycobacterium (NTM) infection successfully treated with anti-cancer agents and anti-NTM agents].

  Fujita Y, Ishii S, Hirano S, Takeda Y, Sugiyama H, Kobayashi N

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 49 (11) 855 - 860 1343-3490 2011/11 [Refereed][Not invited]
  
• 鏡視下に行う食道癌に対するサルベージ手術症例の検討

  加藤 健太郎, 七戸 俊明, 岡村 国茂, 寺村 紘一, 三浦 巧, 寺本 賢一, 村上 壮一, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 44 (Suppl.2) 126 - 126 0386-9768 2011/10
• 門脈-下大静脈バイパスを用いて原発巣を切除しえた門脈腫瘍栓を伴う膵神経内分泌腫瘍の1例

  渡邊 祐介, 田中 栄一, 竹本 法弘, 早馬 聡, 鈴木 善法, 野路 武寛, 松永 明宏, 加藤 健太郎, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 72 (10) 2741 - 2741 1345-2843 2011/10
• 手術・そこが知りたい!(食道癌手術における106recLの郭清) 106recL-tbLリンパ節郭清における、側臥位・腹臥位のアプローチの違いを問わない、確実な視野展開のための手順

  七戸 俊明, 加藤 健太郎, 土川 貴裕, 松永 明宏, 早馬 聡, 松本 譲, 野路 武寛, 鈴木 善法, 竹本 法弘, 寺村 紘一, 岡村 国茂, 渡邊 祐介, 田中 栄一, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 72 (増刊) 402 - 402 1345-2843 2011/10
• 手術・そこが知りたい!(肝・胆・膵領域の手術における血行再建術) 肝門部胆管癌に対する肝動脈・門脈合併切除の手術手技

  田中 栄一, 平野 聡, 土川 貴裕, 松本 譲, 加藤 健太郎, 野路 武寛, 鈴木 善法, 竹本 法弘, 松永 明宏, 早馬 聡, 渡邊 祐介, 楢崎 肇, 那須 裕也, 寺村 紘一, 岡村 国茂

  日本臨床外科学会雑誌 日本臨床外科学会 72 (増刊) 406 - 406 1345-2843 2011/10
• FEEAによる食道胃管吻合

  渡邊 祐介, 七戸 俊明, 竹本 法弘, 早馬 聡, 鈴木 善法, 野路 武寛, 松永 明宏, 加藤 健太郎, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 72 (増刊) 517 - 517 1345-2843 2011/10
• 腫瘍血管内皮におけるBiglycanの機能解析(Biglycan is angiogenic factor stimulating cell migration of tumor endothelium)

  山本 和幸, 大賀 則孝, 樋田 泰浩, 北山 和子, 間石 奈湖, 大澤 崇宏, 川本 泰輔, 近藤 美弥子, 秋山 広輔, 加賀 基知三, 平野 聡, 進藤 正信, 樋田 京子

  日本癌学会総会記事 70回 125 - 126 0546-0476 2011/09 [Refereed][Not invited]
  
• 非小細胞肺癌におけるMAGE-A4・p53発現とアポトーシスとの関連についての検討(Nucleic MAGE-A4 promotes apoptosis in p53-overexpressing cancer cells of non-small cell lung carcinoma)

  黒田 晶, 宮本 正樹, 安孫子 剛大, 土川 貴裕, 京極 典憲, 真木 健裕, 山村 喜之, 樋田 泰浩, 加賀 基知三, 平野 聡, 池田 裕明, 珠玖 洋, 近藤 哲

  日本癌学会総会記事 70回 258 - 259 0546-0476 2011/09 [Refereed][Not invited]
  
• 4種固形癌におけるWT1の発現解析(WT1 expression in solid cancers of 4 different organs Identification of a Novel Protein Isoform Derived from)

  真木 健裕, 宮本 正樹, 土川 貴裕, 京極 典憲, 黒田 晶, 山村 喜之, 安孫子 剛大, 樋田 泰浩, 七戸 俊明, 田中 栄一, 加賀 基知三, 平野 聡, 近藤 哲

  日本癌学会総会記事 70回 356 - 356 0546-0476 2011/09 [Refereed][Not invited]
  
• Intramolecular Carbon Isotope Distribution of Acetic Acid in Vinegar

  Ryota Hattori, Keita Yamada, Makiko Kikuchi, Satoshi Hirano, Naohiro Yoshida

  JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 59 (17) 9049 - 9053 0021-8561 2011/09 [Refereed][Not invited]
   

  Compound-specific carbon isotope analysis of acetic acid is useful for origin discrimination and quality control of vinegar. Intramolecular carbon isotope distributions, which are each carbon isotope ratios of the methyl and carboxyl carbons in the acetic acid molecule, may be required to obtain more detailed information to discriminate such origin. In this study, improved gas chromatography pyrolysis gas chromatography combustion isotope ratio mass spectrometry (GC-Py-GC-C-IRMS) combined with headspace solid-phase microextraction (HS-SPME) was used to measure the intramolecular carbon isotope distributions of acetic acid in 14 Japanese vinegars. The results demonstrated that the methyl carbons of acetic acid molecules in vinegars produced from plants were mostly isotopically depleted in (13)C relative to the carboxyl carbon. Moreover, isotopic differences (delta(13)C(carboxyl) - delta(13)C(methyl)) had a wide range from -0.3 to 18.2 parts per thousand, and these values differed among botanical origins, C3, C4, and CAM plants.
• A case of yellow nail syndrome with dramatically improved nail discoloration by oral clarithromycin

  Manabu Suzuki, Atsuto Yoshizawa, Haruhito Sugiyama, Yasunori Ichimura, Akane Morita, Jin Takasaki, Gou Naka, Satoshi Hirano, Shinyu Izumi, Yuichiro Takeda, Masayuki Hoji, Nobuyuki Kobayashi, Koichiro Kudo

  Case Reports in Dermatology 3 (3) 251 - 258 1662-6567 2011/09 [Refereed][Not invited]
   

  An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM. Copyright © 2011 S. Karger AG.
• 全脳照射後に多発脳出血を認めた肺腺癌の1例

  中道 真仁, 平野 聡, 東野 茉莉, 宇田川 響, 佐藤 彩野, 石原 園子, 寺田 純子, 石井 聡, 森野 英里子, 仲 剛, 飯倉 元保, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 51 (4) 280 - 280 0386-9628 2011/08
• Pemetrexedによる薬剤性間質性肺炎が考えられた1例

  藤田 雄, 平野 聡, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 51 (4) 237 - 242 0386-9628 2011/08 

  背景。Pemetrexedは悪性胸膜中皮腫および進行期非小細胞肺癌を適応疾患とした複数の葉酸代謝酵素を同時に阻害する抗癌剤である。近年、特に肺癌領域においてその重要性が増している。一般に薬剤副作用が少ないと言われているが、現在までにpemetrexedによる薬剤性間質性肺炎の報告がいくつかなされている。症例。症例は76歳女性。労作時呼吸困難を主訴に当院入院となり、胸部X線にて右大量胸水を認めた。精査にて肺腺癌(T3N0M1a)と診断された。1st lineとしてpemetrexed単剤治療を開始。3コース目第10病日より労作時呼吸困難および乾性咳嗽を認め、胸部CTで左肺優位にびまん性すりガラス陰影と小葉間隔壁の肥厚を認めた。気管支肺胞洗浄にてリンパ球分画上昇と経気管支肺生検にて胞隔炎の所見を認めた。またpemetrexedに対する薬剤リンパ球刺激試験が陽性であった。ステロイド加療にて自覚症状と画像所見の改善を認め、臨床経過からpemetrexedによる薬剤性間質性肺炎と診断した。結論。非小細胞肺癌に用いたpemetrexedによる薬剤性間質性肺炎の1例を経験した。Pemetrexedは今後、特に非小細胞肺癌において使用頻度の増加が予想され、投与の際は稀ではあるが時に重症ともなり得る薬剤性間質性肺炎の合併に注意すべきと考えられた。(著者抄録)
• 気管支鏡検査を施行した造血幹細胞移植後肺合併症の臨床的特徴に関する検討 非移植例との比較

  藤田 雄, 平野 聡, 竹田 雄一郎, 泉 信有, 石井 聡, 仲 剛, 飯倉 元保, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (4) 241 - 249 0287-2137 2011/07 

  背景.造血幹細胞移植(hematopoietic stem cell transplantation:HSCT)に伴う肺病変は、頻度が高く時に致死的な経過となる。それらは感染症と非感染症に大別されるが、その鑑別は難しく診断のために気管支鏡検査が重要となることも多い。目的/方法.血液悪性腫瘍に伴う肺病変の特徴を調べ、特にHSCTの治療歴が与える影響を調査することを目的とした。当院にて過去10年間に血液悪性疾患治療中に出現した胸部異常陰影に対し気管支鏡検査を施行した42例(移植群13例、非移植群29例)について、基礎疾患、胸部画像所見、気管支鏡検査結果およびその肺病変の転帰を中心に後方視的に比較検討した。結果.基礎疾患は、移植群では白血病が、非移植群では多発性骨髄腫が最多であった。肺病変の確定診断は、移植群では12例(92.3%)、非移植群では21例(72.4%)において得られていた。原因疾患として、移植群では非感染症が8例(61.5%)と多く、一方非移植群では感染症が15例(51.7%)と多く、両群に有意差を認めた(p=0.02;χ2 test)。また、いずれの群においても非感染症は予後不良な傾向があった。全例において気管支鏡検査に伴う重大な合併症を認めず、移植群では9例(69.2%)、非移植群では15例(51.7%)において気管支鏡検査結果に基づき適切な治療が選択され肺病変の改善が得られていた。結論.血液疾患経過中の胸部異常陰影では移植治療歴を考慮することが診断の一助となる可能性がある。(著者抄録)
• 【胸部外科診療に役立つ疾患別最新データ】呼吸器領域 降下性壊死性縦隔炎

  加賀 基知三, 樋田 泰浩, 平野 聡

  胸部外科 (株)南江堂 64 (8) 752 - 757 0021-5252 2011/07 [Refereed][Not invited]
  
• [Descending necrotizing mediastinitis].

  Kichizo Kaga, Yasuhiro Hida, Satoshi Hirano

  Kyobu geka. The Japanese journal of thoracic surgery 64 (8 Suppl) 752 - 7 0021-5252 2011/07 [Refereed][Not invited]
   

  Descending necrotizing mediastinitis (DNM) is a life-threatening condition, in which infection arising from deep neck tissue spreads downwards into the mediastinum. Contrast-enhanced cervico-thoracic computed tomography (CT) scan is vital for appreciate of the extent and location of mediastinal involvement. Treatment of DNM begins with intravenous administration of a broad-spectrum antibiotic covering both aerobes and anaerobes. Immediate transcervical drainage and debridement with or without transthoracic mediastinal drainage should be considered. Transthoracic mediastinal drainage has to be performed when the mediastinal infection has spread below the carina and/or the Th4 vertebra. Moreover, it is important to determine whether additional drainage is required by evaluation using regular CT imaging. The overall reported mortality rate since 1960 has been 31%, but from 1999 to 2008 it has been 15.5%.
• Role of Radiotherapy for Local Control of Asymptomatic Adrenal Metastasis From Lung Cancer

  Yoshiko Oshiro, Yuichiro Takeda, Satoshi Hirano, Hideyuki Ito, Takashi Aruga

  AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS 34 (3) 249 - 253 0277-3732 2011/06 [Refereed][Not invited]
   

  Introduction: Several studies have reported improved survival after adrenalectomy in patients with adrenal metastases from lung cancer. In this study, we evaluated the clinical results of radiotherapy performed for local control in patients with this disease. Materials and Methods: We retrospectively reviewed 19 patients with adrenal metastasis from lung cancer, who were treated by radiation therapy between 1999 and 2008. The patients included 18 men and 1 woman, and had a mean age of 63 years. Adrenal metastasis was defined as synchronous and metachronous in 11 and 8 patients, respectively. All tumors were asymptomatic with a median size of 30 mm, and were treated with doses of 30 to 60 Gy (median, 45 Gy) in 1 to 27 fractions (median, 10 fractions). Results: The estimated overall 1-, 2- and 5-year survival rates for all patients were 56%, 33%, and 22%, respectively. More favorable prognosis was observed for patients with a metachronous metastasis, with overall 1-, 2-, and 5-year survival rates following adrenal irradiation of 83%, 56%, and 56%, respectively. Conclusion: Our results indicate that radiotherapy may contribute to survival of patients with adrenal metastasis from lung cancer. We suggest that radiotherapy is a treatment option that can be used in addition to surgical resection.
• 肺癌との鑑別が困難であった異物肉芽腫の1例

  石原 園子, 平野 聡, 竹田 雄一郎, 中道 真仁, 平石 尚久, 寺田 純子, 杉山 栄里, 東野 茉莉, 藤田 雄, 入來 豊久, 宇田川 響, 齋藤 善也, 佐藤 彩野, 山地 玲奈, 石井 聡, 仲 剛, 飯倉 元保, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (3) 215 - 215 0287-2137 2011/05
• 結核とアスペルギルスにより気管狭窄を来した1例

  東野 茉莉, 飯倉 元保, 佐藤 彩野, 齋藤 善也, 宇田川 響, 入來 豊久, 藤田 雄, 石原 園子, 中道 真仁, 平石 尚久, 石井 聡, 仲 剛, 平野 聡, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (3) 216 - 216 0287-2137 2011/05
• 喘息合併患者の気管支鏡検査において前処置が検査後喘鳴に与える効果に関する検討

  石原 園子, 平野 聡, 竹田 雄一郎, 石井 聡, 中道 真仁, 平石 尚久, 平嶋 純子, 杉山 栄里, 東野 茉莉, 藤田 雄, 佐藤 彩野, 宇田川 響, 仲 剛, 飯倉 元保, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (Suppl.) S220 - S220 0287-2137 2011/05
• 当院で経験したBALT lymphoma 3例についての検討

  平石 尚久, 飯倉 元保, 平野 聡, 宇田川 響, 佐藤 彩野, 杉山 栄里, 藤田 雄, 石原 園子, 中道 真仁, 石井 聡, 仲 剛, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (Suppl.) S236 - S236 0287-2137 2011/05
• 膵頭十二指腸切除術後膵液瘻に対する非観血的内瘻化

  阿保 大介, 長谷川 悠, 作原 祐介, 森田 亮, 曽山 武士, 白土 博樹, 寺江 聡, 清水 匡, 田中 栄一, 平野 聡, 近藤 哲

  IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 26 (2) 235 - 235 1340-4520 2011/05
• [Indications for and postoperative problems of distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer].

  Takada M, Kondo S, Hirano S, Miura T

  Nihon Geka Gakkai zasshi 一般社団法人日本外科学会 112 (3) 177 - 181 0301-4894 2011/05 [Refereed][Not invited]
  
• Distal Pancreatectomy and Portal Vein Resection without Vascular Reconstruction for Endocrine Tumors with Massive Intraportal Growth: Report of a Case

  Takahiro Tsuchikawa, Satoshi Kondo, Satoshi Hirano, Eiichi Tanaka, Ryousuke Kawasaki, Kentaro Kato, Joe Matsumoto, Toshiaki Shichinohe

  HEPATO-GASTROENTEROLOGY 58 (107) 1029 - 1031 0172-6390 2011/05 [Refereed][Not invited]
   

  Pancreatic endocrine tumors (PETs) are relatively rare. Owing to their slow growing characteristics, an aggressive surgical approach has been considered to improve patients' survival. A case of PET with portal vein (PV) thrombus, successfully treated by distal pancreatectomy with concomitant PV resection and removal of PV tumor thrombus, preserving collateral pathways, is reported.
• HIV感染症合併胸腺癌にADOC療法を施行した1例

  入來 豊久, 石井 聡, 宇田川 響, 佐藤 彩野, 山地 玲奈, 斎藤 善也, 石原 園子, 杉山 栄里, 藤田 雄, 東野 茉莉, 寺田 純子, 平石 尚久, 中道 真仁, 森野 英里子, 高崎 仁, 仲 剛, 平野 聡, 飯倉 元保, 竹田 雄一郎, 杉山 温人, 小林 信之, 泉 信有, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 51 (2) 157 - 157 0386-9628 2011/04
• Survival-related clinical factors of patients with advanced non-small cell lung cancer after 2000

  Satoru Ishii, Yuichiro Takeda, Satoshi Hirano, Go Naka, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  Japanese Journal of Cancer and Chemotherapy 38 (3) 405 - 410 0385-0684 2011/03/15 [Refereed][Not invited]
   

  Purpose: To find new survival-related clinical factors in patients with non-small cell lung cancer (NSCLC) after 2000. Patients and method: Two hundred one patients were registered with primary NSCLC from years 2000 to 2005. One hundred eighty-six patients were pathologically diagnosed with NSCLC (all patients in the group). These patients were reviewed after wards in order to find any new survival-related clinical factors. Results: One hundred forty-nine patients had adenocarcinoma. Median age was 68 years old, and median performance status (PS) was 1. Fifty-nine patients were treated with gefitinib, which is an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TK1). In initial treatment, 22 patients were given gefitinib, and 37 patients after secondary treatment. Sixteen patients were managed with the best supportive care, and 12 patients were not allowed to know their precise treatment. These 28 patients were excluded from the all patients group i. e., the treated patients group. In multivariate analysis of this group, the PS, the treatment by gefitinib, the number of metastasized organs, and the serum total bilirubin were independent survival-related clinical factors. The median survival time without use of gefitinib was 46 weeks, and the survival times in first-line or more than first-line were 40 or 105 weeks, respectively (p=0.01). Conclusion: In addition to PS, the number of metastasized organs, and serum total bilirubin, treatment by gefitinib was considered to be one of the survival-related clinical factors in unselected patients with NSCLC.
• 結核感染の診断におけるQFT-2GとQFT-Goldの比較

  小林 信之, 中道 真仁, 森野 英里子, 高崎 仁, 石井 聡, 仲 剛, 飯倉 元保, 平野 聡, 杉山 温人, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 49 (増刊) 170 - 170 1343-3490 2011/03
• EBUS-GSで診断がつかず、EBUS-TBNAで診断が確定した腎細胞癌の1例

  斎藤 善也, 石井 聡, 平野 聡, 佐藤 彩野, 山地 玲奈, 入来 豊久, 宇田川 響, 石原 園子, 杉山 栄里, 藤田 雄, 東野 茉莉, 寺田 純子, 平石 尚久, 中道 真仁, 森野 英里子, 高崎 仁, 仲 剛, 飯倉 元保, 竹田 雄一郎, 杉山 温人, 小林 信之, 泉 信有, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 33 (2) 129 - 129 0287-2137 2011/03
• 原発性肺癌に対する放射線化学療法施行例における放射線肺臓炎発症の予測因子に関する検討

  石原 園子, 平野 聡, 竹田 雄一郎, 中道 真仁, 平石 尚久, 杉山 栄里, 東野 茉莉, 藤田 雄, 仲 剛, 飯倉 元保, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 49 (増刊) 196 - 196 1343-3490 2011/03
• 血液悪性腫瘍経過中に合併した肺病変の臨床的検討 造血幹細胞移植例と非移植例との比較

  藤田 雄, 平野 聡, 竹田 雄一郎, 泉 信有, 石井 聡, 高崎 仁, 仲 剛, 飯倉 元保, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 49 (増刊) 307 - 307 1343-3490 2011/03
• 皮膚筋炎に生じた非小細胞肺癌に対する加療中に急性増悪した間質性肺炎の1例 本邦報告例の臨床的検討

  藤田 雄, 平野 聡, 米嶋 康臣, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 49 (2) 108 - 115 1343-3490 2011/02 

  症例は72歳男性。咳嗽を主訴に前医受診。通院中に顔面皮疹、両側前腕の筋肉痛と挙上困難を認めるようになり、血清creatine kinase(CK)およびaldolase上昇、筋電図にて筋原性変化あり、三角筋生検より炎症細胞浸潤を認め皮膚筋炎と診断した。抗Jo-1抗体は陰性であった。さらに胸部CTでは右S6の結節影と両下葉のスリガラス影を認めた。全身精査および経過より皮膚筋炎に合併した間質性肺炎および非小細胞肺癌(T1bN3M0、stageIIIB)と診断した。carboplatin/paclitaxelおよびステロイド内服加療にて腫瘍縮小と皮膚筋炎の症状改善を認めたにもかかわらず、経過中に間質性肺炎の急性増悪にて死亡した。3者の合併は極めて稀であるが、合併時の肺癌治療において間質性肺炎の病勢は皮膚・筋症状とは全致せず、腫瘍縮小と相関しないことがあり注意が必要である。(著者抄録)
• [A case of acute exacerbation of interstitial pneumonia complicated with dermatomyositis during treatment for lung cancer, and literature review].

  Fujita Y, Hirano S, Yoneshim Y, Izumi S, Takeda Y, Sugiyama H, Kobayashi N, Kudo K

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 49 (2) 108 - 115 1343-3490 2011/02 [Refereed][Not invited]
  
• Thoracoscopy Under Local Anesthesia Diagnosed Carcinomatous Pleuritis in a Case of Recurrent Kidney Cancer 18 Years After Initial Surgery

  Ishii Satoru, Takeda Yuichiro, Hirano Satoshi, Nakamichi Shinji, Naka Go, Iikura Motoyasu, Itou Hideyuki, Kobayashi Nobuyuki, Kudo Koichiro

  The Journal of the Japan Society for Respiratory Endoscopy 特定非営利活動法人 日本呼吸器内視鏡学会 33 (5) 326 - 330 0287-2137 2011 

  Background. We report a case of parietal pleural metastasis that recurred with pleural effusion 18 years after nephrectomy due to kidney cancer, and which was successfully diagnosed by thoracoscopy under local anesthesia. There are few case reports of a diagnosis of delayed metastasis discovered more than 10 years after nephrectomy. Case. A 76-year-old man who presented with a chief complaint of dyspnea was admitted for further evaluation and treatment. Radiographic findings displayed left pleural effusion, and thoracocentesis was performed. Although the obtained pleural effusion appeared exudative, his cytology was negative. Thus, no diagnosis was made. Since the patient had experienced nephrectomy due to left kidney cancer 18 years previously, it was necessary to distinguish pleural metastasis from kidney cancer in the differential diagnosis. We performed thoracoscopy under local anesthesia to confirm the diagnosis. Examination of the thoracic cavity revealed white, botryoid, lesions protruding from the diaphragm. Their surfaces were red with many fine blood vessels, and the tissue was relatively soft, enabling easy biopsy. The pathologic results of the biopsy revealed tumor cells with clear bodies which formed cell nests. Comparison of this with the surgical specimens of kidney cancer obtained 18 years earlier, showed the 2 to appear identical. Therefore, a final diagnosis of pleural metastasis of kidney cancer was made. Conclusion. We report a rare case of carcinomatous pleuritis that recurred 18 years after nephrectomy due to kidney cancer, which was successfully diagnosed by thoracoscopy under local anesthesia.
• W2-1 胸腔鏡所見分類作成を目指して(胸腔鏡所見分類作成をめざして,胸腔鏡手技・所見検討委員会企画,ワークショップ2,第34回日本呼吸器内視鏡学会学術集会)

  石井 聡, 竹田 雄一郎, 伊藤 秀幸, 清家 彩子, 仲 剛, 平野 聡, 飯倉 元保, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 33 S150  2011
• P2-6 びまん性肺疾患診断に対するガイドシース併用による経気管支肺生検時の出血量減少の効果(IgG4関連肺疾患/びまん性,ポスター2,第34回日本呼吸器内視鏡学会学術集会)

  平野 聡, 竹田 雄一郎, 仲 剛, 佐藤 彩野, 宇田川 響, 石原 園子, 平嶋 純子, 石井 聡, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 33 S230  2011
• P4-5 非悪性腫瘍に対するEBUS-GS法の有用性の検討(EBUS-GS,ポスター4,第34回日本呼吸器内視鏡学会学術集会)

  佐藤 彩野, 石井 聡, 宇田川 響, 石原 園子, 平嶋 純子, 仲 剛, 平野 聡, 飯倉 元保, 泉 信有, 竹田 雄一郎, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 33 S234  2011
• Rheumatic Pleurisy Diagnosed by Thoracoscopy Under Local Anesthesia

  Ishii Satoru, Takeda Yuichiro, Hirano Satoshi, Nakamichi Shinji, Yoneshima Yasuto, Naka Go, Iikura Motoyasu, Itou Hideyuki, Kobayashi Nobuyuki, Kudo Koichiro

  The Journal of the Japan Society for Respiratory Endoscopy 特定非営利活動法人 日本呼吸器内視鏡学会 33 (2) 99 - 103 0287-2137 2011 

  Background. There are some reports of a final diagnosis of rheumatic pleurisy obtained by thoracoscopy under general anesthesia, but reports on thoracoscopy under local anesthesia are rare, and thus we present this case report. Case. A 40-year-old man, chief complaints of cough and arthralgia was admitted in December, 2008. Radiographic findings displayed right pleural effusion. In addition to his typical rheumatic symptoms of arthralgia and morning stiffness, his laboratory data disclosed both elevated CCP antibody (1295.8U/ml) and rheumatoid factor (111.9IU/ml). Accordingly, he was given a diagnosis of rheumatoid arthritis. Thoracocentesis revealed an elevated adenosine deaminase level 86.8IU/l. However, in order to differentiate rheumatic pleurisy from tuberculous pleurisy, we performed thoracoscopy under local anesthesia. The parietal pleura was diffusely hypertrophic with granular nodules. Biopsy of the lesion revealed rheumatoid nodules, resulting in a final diagnosis of rheumatic pleurisy. Conclusion. We encountered a case in which thoracoscopy under local anesthesia was efficacious in the diagnosis of rheumatic pleurisy.
• A Case of Lung Adenocarcinoma with Multiple Intracranial Hemorrhages of Brain Metastases After Whole-brain Radiation Therapy

  Nakamichi Shinji, Hirano Satoshi, Asao Tetsuhiko, Takeda Yuichiro, Sugiyama Haruhito, Kobayashi Nobuyuki

  JJLC The Japan Lung Cancer Society 51 (7) 825 - 829 0386-9628 2011 

  Background. Whole-brain radiation therapy (WBRT) is widely applied in cases of brain metastases of non-small cell lung cancer (NSCLC) . However, there are few case reports on hemorrhages of brain metastases occurring after WBRT. Case. A 63-year-old woman was given a diagnosis of stage IV (T4N0M1b) lung adenocarcinoma about 4 years previously, and received chemotherapy regimens and gamma knife radiosurgery. However, her brain metastases exacerbated and she received WBRT in November 2010 and docetaxel monotherapy in December 2010. Two weeks after completing WBRT, she experienced dysarthria and an MRI showed multiple hemorrhages within brain metastases. Over a period of careful observation, these hemorrhages repeatedly alternated between improvement and exacerbation. Conclusion. Radiotherapy for metastatic brain tumors is considered to suppress hemorrhagic events of brain metastases. However, multiple intracranial hemorrhages of brain metastases occurred after WBRT in the present case. The accumulation of further studies of similar cases is necessary to identify the exact mechanism of these hemorrhages.
  
• 内因性のangiographically occult arteriovenous malformation破裂による脳内出血が原因と考えられた重症多発外傷の一症例

  那須裕也, 松本譲, 三浦巧, 七戸俊明, 田中栄一, 平野聡, 早川峰司, 澤村淳, 丸藤哲, 近藤哲

  日本救急医学会雑誌 22 (2) 62 - 69 0915-924X 2011 [Refereed][Not invited]
  
• 肺腺癌に対するGefitinibの後治療としてのErlotinibと殺細胞性抗癌剤の効果の比較

  平野 聡, 竹田 雄一郎, 石井 聡, 仲 剛, 飯倉 元保, 泉 信有, 東野 茉莉, 平石 尚久, 中道 真仁, 寺田 純子, 石原 園子, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (5) 536 - 536 0386-9628 2010/10
• 膵頭十二指腸切除後の膵液瘻発生における危険因子の検討

  中山 智英, 川村 武史, 三浦 巧, 斉藤 博紀, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡, 近藤 哲

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 43 (Suppl.2) 353 - 353 0386-9768 2010/10
• Gefitinib投与により尿蛋白量の経時的観察を行った膜性腎症合併肺腺癌の一例

  藤田 雄, 石井 聡, 平野 聡, 石原 園子, 杉山 栄里, 東野 茉莉, 平石 尚久, 中道 真仁, 仲 剛, 飯倉 元保, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (5) 503 - 503 0386-9628 2010/10
• 原発性肺癌に対する放射線化学療法施行例における放射線肺臓炎発症の予測因子に関する検討

  石原 園子, 平野 聡, 竹田 雄一郎, 中道 真仁, 平石 尚久, 杉山 栄里, 東野 茉莉, 藤田 雄, 仲 剛, 飯倉 元保, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (5) 550 - 550 0386-9628 2010/10
• ペメトレキセド使用肺腺癌患者におけるGrade 3/4の骨髄抑制が出現した患者背景の検討

  平石 尚久, 仲 剛, 竹田 雄一郎, 石原 園子, 杉山 栄里, 東野 茉莉, 藤田 雄, 中道 真仁, 石井 聡, 平野 聡, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (5) 613 - 613 0386-9628 2010/10
• 肺癌治療中に腸管気腫症を呈した2症例の検討

  東野 茉莉, 平野 聡, 上村 光弘, 藤田 雄, 杉山 栄里, 石原 園子, 平石 尚久, 中道 真仁, 石井 聡, 仲 剛, 飯倉 元保, 毛利 篤人, 濱元 陽一郎, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (5) 727 - 727 0386-9628 2010/10
• 胸腔鏡手術の標準化にむけて 三次元再構築CTによる区域解剖にもとづく胸腔鏡手術の標準化

  加賀 基知三, 樋田 泰浩, 飯村 泰昭, 椎名 伸行, 大高 和人, 武藤 潤, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 15 (7) 281 - 281 1344-6703 2010/10 [Refereed][Not invited]
  
• 胸腔鏡下で存在部位の同定困難な肺小腫瘤に対する術前マーキング法 ゴールドマーカーを用いた仮想内視鏡ナビゲーション下術前マーキング法

  大高 和人, 加賀 基知三, 樋田 泰浩, 飯村 泰昭, 椎名 伸行, 武藤 潤, 岡村 国茂, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 15 (7) 294 - 294 1344-6703 2010/10 [Refereed][Not invited]
  
• 二窓法による胸腔鏡下縦隔リンパ節郭清における視点・展開・操作

  加賀 基知三, 樋田 泰浩, 飯村 泰昭, 椎名 伸行, 大高 和人, 武藤 潤, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 15 (7) 652 - 652 1344-6703 2010/10 [Refereed][Not invited]
  
• 臨床病理学的因子にもとづいた膵内分泌腫瘍の外科治療方針の検討

  土川 貴裕, 平野 聡, 田中 栄一, 加藤 健太郎, 川崎 良輔, 松本 譲, 松井 あや, 田畑 祐希子, 川村 武史, 中山 智英, 三浦 巧, 斉藤 博紀, 七戸 俊明, 久保田 佳奈子, 松野 吉宏, 近藤 哲

  日本消化器病学会雑誌 (一財)日本消化器病学会 107 (臨増大会) A956 - A956 0446-6586 2010/09
• 非小細胞肺癌と活動性非結核性抗酸症に対し癌化学療法と抗酸菌治療を並行して行った1例

  藤田 雄, 石井 聡, 平野 聡, 石原 園子, 杉山 栄里, 東野 茉莉, 寺田 純子, 平石 尚久, 中道 真仁, 高崎 仁, 仲 剛, 飯倉 元保, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (4) 385 - 385 0386-9628 2010/08
• 胆道癌におけるHPDの治療成績

  川村 武史, 田中 栄一, 斎藤 博紀, 中山 智英, 三浦 巧, 松井 あや, 加藤 健太郎, 土川 貴裕, 平野 聡, 近藤 哲

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 9 - 9 2010/07
• 膵頭十二指腸切除における門脈再建の手技

  加藤 健太郎, 近藤 哲, 松井 あや, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 79 - 79 2010/07
• 膵管内乳頭粘液性腫瘍(IPMN)に対する当科の手術適応と手術成績

  安孫子 剛大, 田中 栄一, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 平野 聡, 近藤 哲

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 89 - 89 2010/07
• 肝門部胆管癌における経口胆道鏡による進展度診断

  齋藤 博紀, 田中 栄一, 加藤 健太郎, 松本 譲, 川崎 亮輔, 松井 あや, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 97 - 97 2010/07
• 安全な肝切除への工夫 肝門部胆管癌に対する肝切除術

  川崎 亮輔, 近藤 哲, 平野 聡, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 松本 譲, 松井 あや, 川村 武史

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 126 - 126 2010/07
• 当科における乳頭部腫瘍に対する治療戦略

  大高 和人, 田中 栄一, 土川 貴裕, 加藤 健太郎, 川崎 亮輔, 松本 譲, 松井 あや, 川村 武史, 平野 聡, 近藤 哲

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 552 - 552 2010/07
• Omalizumab投与後に喘息症状の悪化を来たした一例

  東野 茉莉, 飯倉 元保, 石原 園子, 杉山 栄里, 藤田 雄, 寺田 純子, 中道 真仁, 平石 尚久, 石井 聡, 仲 剛, 平野 聡, 竹田 雄一郎, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギーの臨床 (株)北隆館 30 (8) 756 - 757 0285-6379 2010/07
• 高度局所進行胆道癌に対する治療戦略 肝動脈・門脈合併切除再建を伴う肝切除

  松井 あや, 田中 栄一, 平野 聡, 川村 武史, 斉藤 博紀, 中山 智英, 安孫子 剛大, 大高 和人, 近藤 哲

  日本消化器外科学会総会 (一社)日本消化器外科学会 65回 43 - 43 2010/07
• Rapid detection of nivalenol and deoxynivalenol in wheat using surface plasmon resonance immunoassay

  Tomoyuki Kadota, Yoko Takezawa, Satoshi Hirano, Osamu Tajima, Chris M. Maragos, Takashi Nakajima, Toshitsugu Tanaka, Yoichi Kamata, Yoshiko Sugita-Konishi

  ANALYTICA CHIMICA ACTA 673 (2) 173 - 178 0003-2670 2010/07 [Refereed][Not invited]
   

  A surface plasmon resonance (SPR) immunoassay using a monoclonal antibody was developed to measure nivalenol (NIV) and deoxynivalenol (DON) contamination in wheat. A highly sensitive and stable DON-immobilized sensor chip was prepared, and an SPR detection procedure was developed. The competitive inhibition assay used a monoclonal antibody that cross-reacts with NIV and DON. The half maximal inhibitory concentration (IC(50)) values of the SPR assay were 28.8 and 14.9 ng mL(-1) for NIV and DON, respectively. The combined responses of NIV and DON in wheat were obtained using a simultaneous detection assay in a one-step cleanup procedure. NIV and DON were separated using a commercial DON-specific immunoaffinity column (IAC) and their responses were obtained using an independent detection assay. Spiked tests using these toxins revealed that recoveries were in the range 91.5-107% with good relative standard deviations (RSDs) (0.40-4.1%) and that detection limits were 0.1 and 0.05 mg kg(-1) for NIV and DON, respectively. The independent detection using IAC showed detection limits of 0.2 and 0.1 mg kg(-1) for NIV and DON, respectively. SPR analysis results were correlated with those obtained using a conventional LC/MS/MS method for wheat co-contaminated with NIV and DON. These results suggested that the developed SPR assay is a practical method to rapidly screen the NIV and DON co-contamination of wheat and one of a very few immunoassays to detect NIV directly. (c) 2010 Elsevier B.V. All rights reserved.
• イマチニブの術前補助療法により腫瘍が縮小し完全切除し得たGISTの2例

  室田 千晶, 七戸 俊明, 川村 武史, 斉藤 博紀, 中山 智英, 松井 あや, 三浦 巧, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 田中 栄一, 平野 聡, 近藤 哲

  北海道外科雑誌 北海道外科学会 55 (1) 65 - 66 0288-7509 2010/06
• 肝右葉切除後に発生する肝静脈の血流不全例の検討

  川村 武史, 田中 栄一, 武藤 潤, 室田 千晶, 斎藤 博紀, 中山 智英, 三浦 巧, 松井 あや, 松本 譲, 川崎 亮輔, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  北海道外科雑誌 北海道外科学会 55 (1) 69 - 69 0288-7509 2010/06
• Measurement of the Isotope Ratio of Acetic Acid in Vinegar by HS-SPME-GC-TC/C-IRMS

  Ryota Hattori, Keita Yamada, Hiroki Shibata, Satoshi Hirano, Osamu Tajima, Naohiro Yoshida

  JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 58 (12) 7115 - 7118 0021-8561 2010/06 [Refereed][Not invited]
   

  Acetic acid is the main ingredient of vinegar, and the worth of vinegar often depends on the fermentation of raw materials. In this study, we have developed a simple and rapid method for discriminating the fermentation of the raw materials of vinegar by measuring the hydrogen and carbon isotope ratio of acetic acid using head space solid-phase microextraction (HS-SPME) combined with gas chromatography high temperature conversion or combustion-isotope ratio mass spectrometry (GC-TC/C-IRMS). The measurement of acetic acid in vinegar by this method was possible with repeatabilities (1 sigma) of +/- 5.0 parts per thousand for hydrogen and +/- 0.4 parts per thousand, for carbon, which are sufficient to discriminate the origin of acetic acid. The fermentation of raw materials of several vinegars was evaluated by this method.
• 修練医の立場から見た指導医の姿勢

  田中 栄一, 平野 聡, 近藤 哲, 土川 貴裕, 加藤 健太郎, 松本 譲, 川崎 亮輔, 川村 武史, 中山 智英, 三浦 巧, 齋藤 博紀, 松井 あや

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 135 - 135 2010/05
• 膵頭十二指腸切除に伴う門脈再建方法と成績

  大高 和人, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 川崎 亮輔, 松本 譲, 松井 あや, 川村 武史, 斎藤 博紀, 三浦 巧, 中山 智英, 安孫子 剛大, 平野 聡, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 202 - 202 2010/05
• 急性膵炎・慢性膵炎の外科治療 急性膵炎に対する鏡視下手術の経験

  安孫子 剛大, 田中 栄一, 大高 和人, 川村 武史, 齋藤 博紀, 中山 智英, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 平野 聡, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 212 - 212 2010/05
• 拡大肝切除の術前評価と肝不全予防 肝門部胆管癌における経乳頭的アプローチによる進展度診断

  齋藤 博紀, 田中 栄一, 川村 武史, 三浦 巧, 中山 智英, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 215 - 215 2010/05
• 膵切除術後合併症の治療 膵頭十二指腸切除後の膵液瘻発生risk factorの検討

  中山 智英, 川村 武史, 三浦 巧, 斎藤 博紀, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 216 - 216 2010/05
• 神経内分泌腫瘍肝転移の治療 神経内分泌腫瘍肝転移に対する治療方針の検討

  土川 貴裕, 平野 聡, 田中 栄一, 加藤 健太郎, 川崎 亮輔, 松本 譲, 松井 あや, 田畑 佑希子, 川村 武史, 中山 智英, 三浦 巧, 斉藤 博紀, 七戸 俊明, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 236 - 236 2010/05
• 巨大肝血管腫に対する肝右3区域切除の経験

  寺村 紘一, 田中 栄一, 安孫子 剛大, 大高 和人, 川村 武史, 斉藤 博紀, 中山 智英, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 263 - 263 2010/05
• 局所進行膵体部癌に対する腹腔動脈合併膵尾側切除(DP-CAR)

  三浦 巧, 平野 聡, 川村 武史, 斉藤 博紀, 中山 智英, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 355 - 355 2010/05
• ガイドシース併用による経気管支肺生検時の出血量減少の効果

  平野 聡, 竹田 雄一郎, 仲 剛, 飯倉 元保, 泉 信有, 石井 聡, 藤田 雄, 堀尾 雄甲, 平石 尚久, 平嶋 純子, 中道 真仁, 水谷 友紀, 市村 康典, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 32 (Suppl.) S119 - S119 0287-2137 2010/05
• 気管支鏡検査時のミダゾラムによる静脈内意識下鎮静法の検討

  中道 真仁, 竹田 雄一郎, 米嶋 康臣, 佐野 和美, 藤田 雄, 堀尾 雄甲, 平嶋 純子, 平石 尚久, 水谷 友紀, 石井 聡, 飯倉 元保, 仲 剛, 平野 聡, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 32 (Suppl.) S130 - S130 0287-2137 2010/05
• 血液悪性腫瘍治療中の胸部異常影における造血幹細胞移植例と非移植例の比較検討

  藤田 雄, 平野 聡, 竹田 雄一郎, 堀尾 雄甲, 中道 真仁, 平嶋 純子, 平石 尚久, 水谷 友紀, 飯倉 元保, 仲 剛, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 32 (Suppl.) S165 - S165 0287-2137 2010/05
• EBUS-GSを用いた気管支鏡検査 within・adjacentの場合 何回生検すれば診断率が向上するか

  石井 聡, 竹田 雄一郎, 平野 聡, 藤田 雄, 中道 真仁, 平石 尚久, 平嶋 純子, 水谷 友紀, 仲 剛, 飯倉 元保, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 32 (Suppl.) S173 - S173 0287-2137 2010/05
• 膵低悪性度病変に対する膵中央切除

  松井 あや, 田中 栄一, 平野 聡, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 川崎 亮輔, 松本 譲, 川村 武史, 斉藤 博紀, 中山 智英, 安孫子 剛大, 大高 和人, 近藤 哲

  日本肝胆膵外科学会・学術集会プログラム・抄録集 (一社)日本肝胆膵外科学会 22回 195 - 195 2010/05
• 膵頭十二指腸切除後に発症した上腸間膜動脈仮性瘤に対してcovered stent留置にて止血し得た1例

  三浦 巧, 平野 聡, 川村 武史, 斉藤 博紀, 中山 智英, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 近藤 哲, 阿保 大介, 作原 祐介, 白土 博樹

  日本臨床外科学会雑誌 日本臨床外科学会 71 (5) 1375 - 1375 1345-2843 2010/05
• 非小細胞肺癌に対する化学療法が奏効しながらも間質性肺炎が増悪した皮膚筋炎の1例

  藤田 雄, 平野 聡, 柳下 薫寛, 石原 園子, 杉山 栄里, 東野 茉莉, 平石 尚久, 中道 真仁, 市村 康典, 水谷 友紀, 石井 聡, 飯倉 元保, 仲 剛, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 50 (2) 241 - 241 0386-9628 2010/04
• 臨床諸問題 局所麻酔下胸腔鏡が施行された胸水ADA高値の症例の検討

  石井 聡, 竹田 雄一郎, 中道 真仁, 平石 尚久, 寺田 純子, 高崎 仁, 仲 剛, 平野 聡, 飯倉 元保, 泉 信有, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 48 (増刊) 116 - 116 1343-3490 2010/03
• 巨大な腫瘍栓の形態で発育した下大静脈原発平滑筋肉腫の1切除例

  古川 聖太郎, 田中 栄一, 那須 裕也, 山本 和幸, 川村 武史, 齋藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 71 (3) 869 - 869 1345-2843 2010/03
• ICG蛍光法を用いて肝亜区域切除術を施行した肝細胞癌の1例

  齋藤 博紀, 田中 栄一, 三浦 巧, 川村 武史, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 71 (3) 870 - 870 1345-2843 2010/03
• 肝左葉切除および動脈、門脈合併切除にて根治切除可能であった肝門部胆管癌の1例

  山本 和幸, 田中 栄一, 那須 裕也, 齊藤 博紀, 川村 武史, 三浦 巧, 中山 智英, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 71 (3) 871 - 871 1345-2843 2010/03
• 当院における肺多形癌5例の検討

  柳下 薫寛, 竹田 雄一郎, 寺田 純子, 堀尾 雄甲, 藤田 雄, 杉山 栄里, 石原 園子, 東野 茉莉, 中道 真仁, 平石 尚久, 市村 康典, 水谷 友紀, 石井 聡, 高崎 仁, 仲 剛, 飯倉 元保, 平野 聡, 泉 信有, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 48 (増刊) 197 - 197 1343-3490 2010/03
• 進行非小細胞肺癌の新しい予後因子

  水谷 友紀, 竹田 雄一郎, 東野 茉莉, 堀尾 雄甲, 藤田 雄, 杉山 栄里, 柳下 薫寛, 石原 園子, 寺田 純子, 中道 真仁, 平石 尚久, 市村 康典, 石井 聡, 飯倉 元保, 仲 剛, 平野 聡, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 48 (増刊) 273 - 273 1343-3490 2010/03
• Nonlocal Interactions Are Responsible for Tertiary Structure Formation in Staphylococcal Nuclease

  Shingo Kato, Hironari Kamikubo, Satoshi Hirano, Yoichi Yamazaki, Mikio Kataoka

  BIOPHYSICAL JOURNAL 98 (4) 678 - 686 0006-3495 2010/02 [Refereed][Not invited]
   

  Rapid molecular collapse mediated by nonlocal interactions is believed to be a crucial event for protein folding To investigate the role of nonlocal interactions in tertiary structure formation, we performed a nonlocal interaction substitution mutation analysis on staphylococcal nuclease (SNase) Y54 and 1139 of wild-type (WT) SNase and Delta 140-149 were substituted by cysteine to form intramolecular disulfide bonds, respectively called WT-SS and Delta 140-149-SS Under physiological conditions, the reduced form of Delta 140-149-SS appears to assume a denatured structure, in contrast, the oxidized form of Delta 140-149-SS forms a native-like structure From this result, we conclude that the C-terminal region participates in a nonlocal interaction that is indispensable for the native structure Although the oxidized form of WT-SS assumes a more compact denatured structure under acidic conditions than the WT, the kinetic measurements reveal that the refolding reactions of both the reduced and oxidized forms of WT-SS are similar to those of the WT, suggesting that an intact nonlocal interaction is established within the dead time (22 ms) On the basis of these results, we propose that the native nonlocal contact established at the early stage of the folding process facilitates further secondary structure formation
• [A case of dermatomyositis becoming symptomatic after recurrence of small cell lung cancer].

  Yoneshima Y, Hirano S, Morino E, Takeda Y, Sugiyama H, Kobayashi N, Kudo K

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 48 (2) 118 - 122 1343-3490 2010/02 [Refereed][Not invited]
  
• A germ cell tumor with a cavity containing an air-fluid level

  Sakae Mori, Satoshi Hirano, Yuichiro Takeda, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  Japanese Journal of Lung Cancer 50 (1) 41 - 46 0386-9628 2010 

  Background. Although germ cell tumors have a high sensitivity to anticancer drugs, it is not always easy to complete chemotherapy without some delay. We report a case of germ cell tumor (embryonal carcinoma) accompanied by an abscess caused by bacterial infection in a metastatic lung tumor. Chemotherapy was completed and complete remission obtained through long-term administration of antibiotics and drainage of the lung abscess. Case. A 37-year-old man was referred to our hospital with pyrexia and dyspnea, and lung cancer was suspected at the referring hospital. A chest X-ray film showed a 10-cm mass with a cavity and an air-fluid level in the left lower lung field and multiple nodular shadows in the bilateral lungs. Immunohistologically, the tumor was demonstrated to be embryonal carcinoma, positive for CD30 and placental alkaline phosphatase (pALP). At the same time, bacterial infection of the cavitary lesion was demonstrated. Continuous drainage and administration of antibiotics was performed and 4 courses of BEP therapy (bleomycin + etoposide + cisplatin) were started. Finally, complete remission was obtained. Conclusion. Chemotherapy for a germ cell tumor can be effective, using adequate management for infection, even if it is accompanied by severe bacterial infection like a lung abscess. © 2010 The Japan Lung Cancer Society.
• P1-5-6 当院の成人気管支喘息患者における治療薬及びコントロール状態の推移に関する検討(P1-5気管支喘息治療3,一般演題,第22回日本アレルギー学会春季臨床大会)

  東野 茉莉, 放生 雅章, 飯倉 元保, 平野 聡, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 59 (3) 385 - 385 2010
• P1-8-6 気管支喘息のコントロール状態と生活習慣・環境との関連(P1-8気管支喘息管理,一般演題,第22回日本アレルギー学会春季臨床大会)

  飯倉 元保, 小林 信之, 市村 康典, 平野 聡, 泉 信有, 有岡 宏子, 放生 雅章, 杉山 温人, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 59 (3) 392 - 392 2010
• P26-3 当院におけるomalizumab導入症例の臨床的検討(P26 抗IgE抗体,ポスター,第60回日本アレルギー学会秋季学術大会)

  東野 茉莉, 飯倉 元保, 平野 聡, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 59 (9) 1469 - 1469 2010
• A Case of Epithelioid Hemangioendothelioma Diagnosed by Bronchoscopy

  Hirano Satoshi, Takeda Yuichiro, Mizutani Tomonori, Morii Sakae, Yoneshima Yasuto, Hanada Shigeo, Ishii Satoru, Naka Go, Iikura Motoyasu, Izumi Shinyu, Kobayashi Nobuyuki, Kudo Koichiro

  The Journal of the Japan Society for Respiratory Endoscopy 特定非営利活動法人 日本呼吸器内視鏡学会 32 (2) 186 - 190 0287-2137 2010 

  Background. Epithelioid hemangioendothelioma (EHE) is a rare low grade malignant tumor which was originally described as intravascular bronchioloalveolar tumor (IVBAT). Most of the reported cases of pulmonary EHE were diagnosed by open lung biopsy or thoracoscopic lung biopsy and it is considered to be difficult to diagnose with bronchoscopy. Case. A 31-year-old man was referred to our hospital for bilateral multiple nodular shadows detected on a medical checkup. Computed tomography also showed multiple small bilateral lung field nodules and calcification was noted in the largest tumor in the right upper lobe. Transbronchial biopsy was performed after confirming that the distal end of the guide sheath reached the right B^3ai tumor by endobronchial ultrasonography. The tumor was diagnosed as EHE. Conclusion. Some cases of EHE can be diagnosed with bronchoscopy.
• A SURVEY OF PERIOPERATIVE ASTHMATIC ATTACK AMONG PATIENTS WITH BRONCHIAL ASTHMA UNDERWENT GENERAL ANESTHESIA

  Ie Kenya, Yoshizawa Atsuto, Hirano Satoru, Izumi Sinyuu, Hojo Masaaki, Sugiyama Haruhito, Kobayasi Nobuyuki, Kudou Kouichirou, Maehara Yasuhiro, Kawachi Masaharu, Miyakoshi Kouichi

  Japanese Journal of Allergology 一般社団法人 日本アレルギー学会 59 (7) 831 - 838 0021-4884 2010 

  Background: We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. Methods: We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. Results: The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. Conclusion: We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.
• Outcomes for video-assisted thoracoscopic lobectomy for clinical stage I lung cancer

  Kichizo Kaga, Yasuhiro Takahashi, Yasuhiro Hida, Kenjiro Misu, Nobuyuki Shiina, Satoshi Hirano, Satoshi Kondo

  Japanese Journal of Chest Diseases 69 (4) 289 - 294 0385-3667 2010 [Refereed][Not invited]
  
• 腹腔動脈幹合併尾側膵切除後の虚血性胃症を保存的に治癒しえた1例

  那須 裕也, 田中 栄一, 山本 和幸, 三浦 巧, 齋藤 博紀, 川村 武史, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  北海道外科雑誌 北海道外科学会 54 (2) 162 - 162 0288-7509 2009/12
• 膵頭十二指腸切除術後の膵液瘻から大網壊死を来たし治療に難渋した3症例の検討

  中山 智英, 楢崎 肇, 寺村 紘一, 川村 武史, 齋藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡, 近藤 哲

  北海道外科雑誌 北海道外科学会 54 (2) 163 - 163 0288-7509 2009/12
• 縫合不全、狭窄の少ないリニアステープラーによる食道吻合法

  七戸 俊明, 加藤 健太郎, 土川 貴裕, 松本 譲, 川崎 亮輔, 松井 あや, 川村 武史, 三浦 巧, 齋藤 博紀, 田中 栄一, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 258 - 258 1344-6703 2009/12
• 膵低悪性度病変に対する腹腔鏡補助下尾側膵切除術の適応と手術手技

  加藤 健太郎, 近藤 哲, 田中 栄一, 斉藤 博記, 中山 智英, 三浦 巧, 松井 あや, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 573 - 573 1344-6703 2009/12
• 膵solid-pseudopapillary tumorに用手補助腹腔鏡下尾側膵切除+副腎摘出術を施行した1例

  那須 裕也, 田中 栄一, 松本 譲, 山本 和幸, 川村 武史, 齋藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 577 - 577 1344-6703 2009/12
• I期肺癌に対する胸腔鏡下区域切除術 肺癌に対する胸腔鏡下区域切除について

  加賀 基知三, 樋田 泰浩, 三栖 賢次郎, 椎名 伸行, 安孫子 剛大, 大高 和人, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 215 - 215 1344-6703 2009/12 [Refereed][Not invited]
  
• 原発性肺癌に対する胸腔鏡下肺切除術の長期成績

  三栖 賢次郎, 加賀 基知三, 樋田 泰浩, 椎名 伸行, 安孫子 剛大, 大高 和人, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 507 - 507 1344-6703 2009/12 [Refereed][Not invited]
  
• 転移性肺腫瘍に対する胸腔鏡下手術の検討

  安孫子 剛大, 加賀 基知三, 樋田 泰浩, 三栖 賢次郎, 椎名 伸行, 大高 和人, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 509 - 509 1344-6703 2009/12 [Refereed][Not invited]
  
• COPDを合併した食道癌に対して鏡視下食道切除後に術後気胸を呈した1例

  三浦 巧, 七戸 俊明, 樋田 泰浩, 加藤 健太郎, 川崎 亮輔, 松本 譲, 三栖 賢次郎, 土川 貴裕, 田中 栄一, 加賀 基知三, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 14 (7) 570 - 570 1344-6703 2009/12 [Refereed][Not invited]
  
• 膵頭十二指腸切除術術後における膵液瘻およびSSI発生の危険因子の検討

  中山 智英, 川村 武史, 斎藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 平野 聡, 近藤 哲

  日本外科感染症学会雑誌 (一社)日本外科感染症学会 6 (5) 510 - 510 1349-5755 2009/11
• 18年後に再発が確認された腎細胞癌胸膜転移の1例

  中道 真仁, 石井 聡, 竹田 雄一郎, 石原 園子, 柳下 薫寛, 杉山 栄里, 藤田 雄, 堀尾 雄甲, 東野 茉莉, 寺田 純子, 平石 尚久, 市村 康典, 水谷 友紀, 高崎 仁, 仲 剛, 平野 聡, 飯倉 元保, 放生 雅章, 杉山 温人, 小林 信之, 泉 信有, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 31 (6) 420 - 420 0287-2137 2009/11
• Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer

  H. Kawakami, M. Kuwatani, K. Etoh, S. Haba, H. Yamato, K. Shinada, Y. Nakanishi, E. Tanaka, S. Hirano, S. Kondo, K. Kubota, M. Asaka

  ENDOSCOPY 41 (11) 959 - 964 0013-726X 2009/11 [Refereed][Not invited]
   

  Background and study aims: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) of 2 cm or more, which makes radical resection more difficult. This retrospective case review compares the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDC. Patients and methods: Forty-four consecutive patients with LBDC diagnosed between April 2004 and October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32%). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. Results: In six cases it was not possible to pass the cholangioscope through the tumor sites. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three cases in which ERC was negative were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22%, 77%, and 100% of cases, respectively. Conclusions: The presence of extensive ITS was correctly detected in 80% of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy not only of the presence or absence but also of the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15% of cases.
• Safety of combined resection of the middle hepatic artery in right hemihepatectomy for hilar biliary malignancy

  Satoshi Hirano, Satoshi Kondo, Eiichi Tanaka, Toshiaki Shichinohe, Takahiro Tsuchikawa, Kentaro Kato

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 16 (6) 796 - 801 0944-1166 2009/11 [Refereed][Not invited]
   

  In patients with hilar biliary malignancies, preservation of the middle hepatic artery (MHA, segment IV artery) where it runs close to the tumor in the hepatic hilum may lead to resection with positive margins. This retrospective study assessed the safety of combined resection of the MHA with right hemihepatectomy, caudate lobectomy, and bile duct resection for hilar biliary malignancies. Of 61 patients with hilar biliary malignancies who underwent right hemihepatectomy, we classified the branching patterns of the MHA according to the origins and courses in the hilum. The MHA was resected without reconstruction in 16 patients in whom the artery ran close to the tumor. We compared the perioperative outcomes in these patients with those of patients who did not undergo resection of the artery. Anatomically, the MHA ran on the right side of the umbilical portion of the portal vein in 40 (66%) patients. Perioperative data for the patients who underwent combined resection were similar to those in whom the MAH was preserved. There were no postoperative complications that could be directly related to the arterial resection. Combined resection of the MHA during right hemihepatectomy for hilar biliary malignancies has a safe perioperative course.
• 局所麻酔下胸腔鏡診断の有用性と限界

  石井 聡, 竹田 雄一郎, 伊藤 秀幸, 中道 真仁, 仲 剛, 平野 聡, 飯倉 元保, 長阪 智, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 49 (5) 666 - 666 0386-9628 2009/10
• 当科における肝門部胆管癌に対する外科治療戦略

  土川 貴裕, 平野 聡, 田中 栄一, 七戸 俊明, 加藤 健太郎, 松本 譲, 川崎 亮輔, 松井 あや, 川村 武史, 斉藤 博紀, 三浦 巧, 那須 裕也, 山本 和幸, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 387 - 387 1345-2843 2009/10
• 膵頭十二指腸切除(PD)後における膵液瘻発生のrisk factorの検討

  中山 智英, 田中 栄一, 川村 武史, 三浦 巧, 斉藤 博紀, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 389 - 389 1345-2843 2009/10
• 腹腔鏡下尾側膵切除術の検討

  加藤 健太郎, 近藤 哲, 田中 栄一, 那須 裕也, 山本 和幸, 川村 武史, 斎藤 博紀, 三浦 巧, 松井 あや, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 390 - 390 1345-2843 2009/10
• 膵頭部低悪性度病変に対する十二指腸胆道温存膵頭部切除の手術手技

  田中 栄一, 平野 聡, 土川 貴裕, 加藤 健太郎, 松本 譲, 川崎 亮輔, 松井 あや, 川村 武史, 三浦 巧, 中山 智英, 齋藤 博紀, 那須 裕也, 山本 和幸, 七戸 俊明, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 392 - 392 1345-2843 2009/10
• 膵胃吻合と膵空腸吻合の膵液漏および術後膵萎縮の検討

  齋藤 博紀, 田中 栄一, 川村 武史, 三浦 巧, 中山 智英, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 392 - 392 1345-2843 2009/10
• 肝左葉尾状葉切除術における門脈合併切除再建のコツ

  山本 和幸, 田中 栄一, 古川 聖太郎, 那須 裕也, 川村 武史, 齊藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 452 - 452 1345-2843 2009/10
• 広範囲胆管癌に対する肝右葉切除術兼膵頭十二指腸切除術、門脈合併切除再建

  川崎 亮輔, 近藤 哲, 平野 聡, 田中 栄一, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 松本 譲, 松井 あや, 川村 武史, 齋藤 博紀, 三浦 巧, 那須 裕也, 山本 和幸

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 454 - 454 1345-2843 2009/10
• 肝静脈のドレナージ領域を指標とした選択的肝領域切除 Venous-drainage-guided selective hepatectomy

  松本 譲, 田中 栄一, 平野 聡, 七戸 俊明, 土川 貴裕, 加藤 健太郎, 川崎 亮輔, 松井 あや, 川村 武史, 齋藤 博紀, 三浦 巧, 那須 裕也, 山本 和幸, 古川 聖太郎, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 456 - 456 1345-2843 2009/10
• 術前の超音波内視鏡下針生検(EUS-FNA)が診断・治療に有用であった膵尾部嚢胞性腫瘤の1例

  島田 岳洋, 田中 栄一, 中山 智英, 川村 武史, 斎藤 博紀, 三浦 巧, 松井 あや, 川崎 亮輔, 松本 譲, 加藤 健太郎, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 669 - 669 1345-2843 2009/10
• 巨大な腫瘍栓の形態で発育した下大静脈原発平滑筋肉腫の2切除例

  古川 聖太郎, 田中 栄一, 那須 裕也, 山本 和幸, 川村 武史, 齋藤 博紀, 三浦 巧, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 849 - 849 1345-2843 2009/10
• 尾側膵切除(DP)における膵切離方法と膵液瘻の検討

  三浦 巧, 平野 聡, 川村 武史, 斉藤 博紀, 中山 智英, 松井 あや, 加藤 健太郎, 川崎 亮輔, 松本 譲, 土川 貴裕, 七戸 俊明, 田中 栄一, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 894 - 894 1345-2843 2009/10
• 上皮成長因子受容体遺伝子変異を有する肺腺癌症例におけるゲフィチニブの前治療、および後治療の治療成績

  平野 聡, 竹田 雄一郎, 石井 聡, 仲 剛, 飯倉 元保, 泉 信有, 市村 康典, 水谷 友紀, 東野 茉莉, 平石 尚久, 中道 真仁, 寺田 純子, 石原 園子, 柳下 薫寛, 杉山 栄里, 藤田 雄, 堀尾 雄甲, 杉山 温人, 小林 信之, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 49 (5) 765 - 765 0386-9628 2009/10
• 近赤外線蛍光を用いたセンチネルリンパ節同定における工夫

  松井 あや, 田中 栄一, 七戸 俊明, 平野 聡, 近藤 哲, Fangioni John

  日本臨床外科学会雑誌 日本臨床外科学会 70 (増刊) 477 - 477 1345-2843 2009/10
• [Surgical treatment for locally advanced pancreas cancer].

  Miura T, Kondo S, Hirano S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Kawasaki R, Matsumoto J

  Gan to kagaku ryoho. Cancer & chemotherapy 36 (10) 1644 - 1647 0385-0684 2009/10 [Refereed][Not invited]
  
• 気管内腫瘍の生検にてBALT lymphomaの診断に至った2例

  平石 尚久, 飯倉 元保, 石原 園子, 柳下 薫寛, 杉山 栄里, 藤田 雄, 堀尾 雄甲, 東野 茉莉, 寺田 純子, 中道 真仁, 市村 康典, 水谷 友紀, 石井 聡, 高崎 仁, 仲 剛, 平野 聡, 竹田 雄一郎, 放生 雅章, 杉山 温人, 小林 信之, 泉 信有, 工藤 宏一郎

  気管支学 (NPO)日本呼吸器内視鏡学会 31 (5) 340 - 341 0287-2137 2009/09
• 全身化学療法が効果を示した癌性髄膜炎の1例

  市村 康典, 平野 聡, 寺田 純子, 平石 尚久, 中道 真仁, 森井 栄, 花田 豪郎, 石井 聡, 竹田 雄一郎, 杉山 温人, 小林 信之, 森田 あかね, 泉 信有, 工藤 宏一郎

  肺癌 (NPO)日本肺癌学会 49 (3) 330 - 330 0386-9628 2009/06
• 当院結核外来に活動性結核疑いで紹介された患者の診断方法に関する検討

  水谷 友紀, 放生 雅章, 中道 真仁, 花田 豪郎, 石井 聡, 高崎 仁, 仲 剛, 平野 聡, 飯倉 元保, 泉 信有, 竹田 雄一郎, 杉山 温人, 小林 信之, 工藤 宏一郎

  結核 (一社)日本結核・非結核性抗酸菌症学会 84 (5) 468 - 468 0022-9776 2009/05
• ゲフィチニブ継続投与困難症例における薬物動態の特徴の検討

  平野 聡, 佐野 和美, 竹田 雄一郎, 寺田 純子, 平石 尚久, 中道 真仁, 水谷 友紀, 市村 康典, 花田 豪郎, 森井 栄, 米嶋 康臣, 石井 聡, 高崎 仁, 仲 剛, 河野 正和, 飯倉 元保, 泉 信有, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 47 (増刊) 110 - 110 1343-3490 2009/05
• 癌性髄膜炎の治療成績の検討

  市村 康典, 平野 聡, 竹田 雄一郎, 平石 尚久, 寺田 純子, 中道 真仁, 水谷 友紀, 花田 豪郎, 森井 栄, 米嶋 康臣, 石井 聡, 河野 正和, 高崎 仁, 仲 剛, 飯倉 元保, 泉 信有, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 47 (増刊) 205 - 205 1343-3490 2009/05
• 間質性肺炎の活動性評価におけるPET-CTの有用性の検討

  中道 真仁, 杉山 温人, 平石 尚久, 寺田 純子, 市村 康典, 水谷 友紀, 花田 豪郎, 米嶋 康臣, 森井 栄, 石井 聡, 河野 正和, 飯倉 元保, 仲 剛, 高崎 仁, 平野 聡, 泉 信有, 竹田 雄一郎, 放生 雅章, 小林 信之, 工藤 宏一郎

  日本呼吸器学会雑誌 (一社)日本呼吸器学会 47 (増刊) 282 - 282 1343-3490 2009/05
• Prognostic impact of para-aortic lymph node micrometastasis in patients with regional node-positive biliary cancer

  A. Yonemori, S. Kondo, Y. Matsuno, T. Ito, E. Tanaka, S. Hirano

  BRITISH JOURNAL OF SURGERY 96 (5) 509 - 516 0007-1323 2009/05 [Refereed][Not invited]
   

  Background: The presence of para-aortic lymph node metastasis in biliary cancer has a negative impact on prognosis. The relevance of para-aortic lymph node micrometastasis is unknown. Methods: A total of 546 para-aortic lymph nodes from 49 patients with biliary cancer with positive regional nodes and negative para-aortic nodes were immunostained with epithelial marker CAM5.2 (specific for cytokeratins 7 and 8). Immunostained tumour foci were classified as micrometastases or isolated tumour cells (ITCs) according to their size (larger or smaller than 0.2 mm). Results: CAM5.2-positive occult carcinoma cells in para-aortic lymph nodes were detected in nine (18 per cent) of 49 patients and in 18 (3.3 per cent) of 546 para-aortic nodes. There was no difference in postoperative survival between patients with and without CAM5.2-positive para-aortic nodes (P = 0.978), but survival for five patients with micrometastases was significantly worse than that for four patients with only ITCs (P = 0.047). Conclusion: In patients with regional node-positive and para-aortic node-negative biliary cancer, and occult cancer cells in para-aortic lymph nodes, prognosis was significantly worse in those with micrometastases than in patients with only ITCs. An efficient method of intraoperative detection of para-aortic lymph node micrometastases larger than 0.2 mm is needed.
• Adenovirus-mediated eukaryotic initiation factor 4E binding protein-1 in combination with rapamycin inhibits tumor growth of pancreatic ductal adenocarcinoma in vivo

  Roshan Mishra, Masaki Miyamoto, Tatsuya Yoshioka, Keidai Ishikawa, Yoshiyuki Matsumura, Yasuhito Shoji, Kazuomi Ichinokawa, Tommo Itoh, Toshiaki Shichinohe, Satoshi Hirano, Satoshi Kondo

  INTERNATIONAL JOURNAL OF ONCOLOGY 34 (5) 1231 - 1240 1019-6439 2009/05 [Refereed][Not invited]
   

  Over-expression of eIF4E indicates a poor prognosis in different tumors. In the present study, we investigated the frequency of eIF4E, 4E-BP1 and phosphorylated 4E-BP1 expression in PDAC cell lines, gastric carcinoma (GC) cell lines and human embryonic pancreatic cells, as well as gene therapy using translation repressor gene 4E-BP1 in combination with the mTOR inhibitor rapamycin. We also assessed the significance of eIF4E expression in 80 PDAC cases. Combination therapy of adenovirus vector-delivered 4E-BP1 gene and rapamycin was administered to determine their growth inhibition effect in vitro and in vivo in mice. Our study revealed that all PDAC cell lines, GC cell lines and human embryonic pancreas-derived cells expressed the 25-kDa eIF4E protein (MIAPaca-2 cells also expressed the 13-kDa protein 4E-BP1). The 80 PDAC specimens showed a heterogeneous pattern of eIF4E staining. No significant correlation between eIF4E expression and TNM classification was found. Adenovirus vectors Ad-4E-BP1 and Ad-GFP efficiently showed transgenic expression with hyperphosphorylation of 4E-BP1; however, insignificant growth inhibition of the PDAC and GC cell lines was observed. Combination therapy with rapamycin significantly inhibited proliferation and tumor growth in vitro as well as in vivo. Therefore, combination of Ad 4E-BP1 and rapamycin may be a more effective adjuvant therapy.
• [Case of repeated hemoptysis successfully treated with bronchial artery embolization with N-butyl cyanoacrylate].

  Tamiya H, Hirano S, Morii S, Hanada S, Beika Y, Ishii S, Miyano S, Naka G, Izumi S, Takeda Y, Yoshizawa A, Hojo M, Sugiyama H, Kobayashi N, Kudo K

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 47 (5) 427 - 431 1343-3490 2009/05 [Refereed][Not invited]
  
• Role of CT in Detecting Malignancy during Follow-Up of Patients with Branch-Type IPMN of the Pancreas

  Satoshi Hirano, Satoshi Kondo, Eiichi Tanaka, Toshiaki Shichinohe, On Suzuki, Michio Shimizu, Tomoo Itoh

  HEPATO-GASTROENTEROLOGY 56 (90) 515 - 518 0172-6390 2009/03 [Refereed][Not invited]
   

  Background/Aims: This retrospective study evaluated the suitability of computed tomography (CT) to detect malignancy while following patients with branch-type IPMN, most of which are benign and may be treated with observation alone. Methodology: Forty-two surgical specimens resected from patients with a diagnosis of branch-type IPMN were pathologically classified as benign (n=26), which included hyperplasia and adenoma, or malignant (n=16), including moderate dysplasia or adenocarcinoma. It was compared the differences in the sizes of the tumor and main pancreatic duct (MPD) and the presence of mural nodules on CT between the groups. Results: In the malignant group, it was observed a larger tumor size (47.8 us. 23.8mm; p=0.001) and increased dilation of the MPD (9.3 us. 5.0 mm; p=0.001) than those seen in the benign group. The accuracy of CT diagnosis of mural nodules, however, was only 62%. Tumor diameter >= 40mm or MPD diameter >= 10mm predicted malignancy with a sensitivity and negative predictive value of 93.8% and 95.7%, respectively. Conclusions: Either tumor size or MPD dilation detected by CT could predict the majority of malignant branch-type IPMNs. Increases in these morphological characteristics on CT images during the follow-up period would be an accurate method to predict a diagnosis of malignancy.
• 好酸球性肺炎、細気管支炎を繰り返した気管支喘息の一例

  寺西 裕, 市村 康典, 石平 尚久, 寺田 純子, 中道 真仁, 水谷 友紀, 森井 栄, 米嶋 康臣, 石井 聡, 高崎 仁, 仲 剛, 泉 信有, 飯倉 元保, 平野 聡, 竹田 雄一郎, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギーの臨床 (株)北隆館 29 (1) 90 - 90 0285-6379 2009/01
• MS19-#1 当センターにおける成人喘息のコントロール状態と治療の推移(気管支喘息-診断と管理5-疫学と実態調査-,第59回日本アレルギー学会秋季学術大会)

  飯倉 元保, 小林 信之, 市村 康典, 平野 聡, 泉 信有, 有岡 宏子, 放生 雅章, 杉山 温人, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 58 (8) 1258 - 1258 2009
• 29.乳び胸の診断に至った1例(第129回日本呼吸器内視鏡学会関東支部会)

  石井 聡, 竹田 雄一郎, 石原 園子, 柳下 薫寛, 杉山 栄里, 藤田 雄, 堀尾 雄甲, 東野 茉莉, 寺田 純子, 平石 尚久, 中道 真仁, 市村 康典, 水谷 友紀, 高崎 仁, 仲 剛, 平野 聡, 飯倉 元保, 放生 雅章, 杉山 温人, 小林 信之, 泉 信有, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 31 (5) 342 - 342 2009
• OR14-4 当院における気管支鏡診断困難な肺悪性腫瘍の特徴について(仮想内視鏡1,一般口演14,第32回日本呼吸器内視鏡学会学術集会)

  平野 聡, 竹田 雄一郎, 花田 豪郎, 森井 栄, 米嶋 康臣, 水谷 友紀, 石井 聡, 仲 剛, 飯倉 元保, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 31 S114  2009
• PO6-1 当院における局所麻酔下胸腔鏡の検討 : 導入1年間の経過について(VATS,ポスター6,第32回日本呼吸器内視鏡学会学術集会)

  石井 聡, 竹田 雄一郎, 中道 真仁, 水谷 友紀, 仲 剛, 飯倉 元保, 平野 聡, 長阪 智, 桑田 裕美, 泉 信有, 伊藤 秀幸, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 31 S151  2009
• 90 当センターにおける好酸球性細気管支炎3例の検討(T細胞・B細胞・好酸球,一般演題,第21回日本アレルギー学会春季臨床大会)

  市村 康典, 小林 信之, 杉山 温人, 平石 尚久, 寺田 純子, 中道 真仁, 水谷 友紀, 石井 聡, 飯倉 元保, 平野 聡, 泉 信有, 放生 雅章, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 58 (3) 411 - 411 2009
• 31 外来ドロップアウト患者における気管支喘息コントロールに関する検討(気管支喘息-管理4,一般演題,第21回日本アレルギー学会春季臨床大会)

  飯倉 元保, 平石 尚久, 寺田 純子, 中道 真仁, 市村 康典, 水谷 友紀, 米嶋 康臣, 石井 聡, 平野 聡, 泉 信有, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 58 (3) 396 - 396 2009
• MS11-5 局所麻酔下胸腔鏡にてリウマチ性胸膜炎の診断に至った1例(MS11 自己免疫疾患・リウマチ性疾患・免疫不全症,ミニシンポジウム11,第21回日本アレルギー学会春季臨床大会)

  巴山 紀子, 石井 聡, 米嶋 康臣, 平石 尚久, 寺田 純子, 中道 真仁, 市村 康典, 水谷 友紀, 飯倉 元保, 平野 聡, 泉 信有, 山下 裕之, 放生 雅章, 杉山 温人, 小林 信之, 三森 明夫, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 58 (3) 380 - 380 2009
• A case of lung adenocarcinoma successfully treated with dose-reescalated gefitinib after resistance was acquired

  Satoshi Hirano, Kazumi Sano, Sakae Morii, Akane Morita, Yuichiro Takeda, Kiminori Uruga, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  Japanese Journal of Cancer and Chemotherapy 36 (8) 1333 - 1336 0385-0684 2009 [Refereed][Not invited]
   

  Gefitinib is a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, and it shows favorable antitumor activity against chemorefractory non-small cell lung cancer (NSCLC), especially with EGFR gene mutations. On the other hand, patients with NSCLC have few treatment options available if they acquire resistance to gefitinib or severe adverse events occur. We report a 73-year-old small woman diagnosed with NSCLC who was treated with gefitinib (250 mg/day) every other day or by 7-days-on followed by 7-days-off therapy dose schedule after severe paronychia appeared. The best response was stable disease (SD), which lasted 9 months. Dose reescalation of gefitinib to 250 mg/day was chosen after progression of disease was demonstrated. Most lesions decreased in size again and this lasted for more than 5 months. EGFR gene analysis showed point mutation of codon 861 in exon21 (L861Q). On the other hand, T790M was not detected. These observations suggest the possibility that treatment with dose-escalated gefitinib might be useful even after resistance to initial dose of gefitinib is acquired if initial treatment shows a favorable clinical response.
• 非小細胞肺癌症例においてHLA Class IH鎖分子発現低下は予後不良因子である(Cases of NSCLC that have down-regulated expression of HLA class I heavy chain show poor prognoses)

  市之川 一臣, 宮本 正樹, 石川 慶大, 加藤 達哉, 吉岡 達也, ローシャン・ミシュラ, 東海林 安人, 樋田 泰浩, 加賀 基知三, 平野 聡, 加地 苗人, 近藤 哲

  日本癌学会総会記事 67回 217 - 217 0546-0476 2008/09 [Refereed][Not invited]
  
• トレーニングキットおよびブタ心肺ブロックを用いた胸腔鏡手術トレーニング

  加賀 基知三, 樋田 泰浩, 川田 将也, 新関 浩人, 市之川 正臣, 平野 聡, 近藤 哲

  日本内視鏡外科学会雑誌 (一社)日本内視鏡外科学会 13 (7) 361 - 361 1344-6703 2008/09 [Refereed][Not invited]
  
• 胆管癌手術における胆管断端癌陽性の取扱い 肝門部胆管癌の進展様式に基づいた病理学的断端の取扱いと手術治療成績

  田中 栄一, 平野 聡, 中西 喜嗣, 土川 貴裕, 加藤 健太郎, 七戸 俊明, 近藤 哲

  胆道 日本胆道学会 22 (3) 352 - 352 0914-0077 2008/08
• Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases

  Yoshitsugu Nakanishi, Yoh Zen, Hiroshi Kawakami, Kanako Kubota, Tomoo Itoh, Satoshi Hirano, Eiichi Tanaka, Yasuni Nakanuma, Satoshi Kondo

  MODERN PATHOLOGY 21 (7) 807 - 816 0893-3952 2008/07 [Refereed][Not invited]
   

  Extrahepatic bile duct carcinoma occasionally presents with intraepithelial spread for a considerable area around the main tumor. In this study, we compared clinicopathological features of extrahepatic bile duct carcinoma with and without extensive intraepithelial spread (>= 20mm from the main tumor). Out of 117 cases of extrahepatic bile duct carcinoma, 21 (18%) were found to have extensive intraepithelial spread. Those cases were pathologically characterized by a papillary or nodular main tumor, a more differentiated histological grade, less deep invasion, and infrequent portal vein or hepatic invasion in comparison with cases without intraepithelial spread. Areas of intraepithelial spread histologically consisted of low-papillary growth (17 cases, 81%) and completely flat growth (4 cases, 19%) of carcinoma cells. The former histology corresponded to a macroscopic granular mucosa, whereas the latter growth was hardly detected by gross examination. Immunohistochemically, in 16 of 21 cases (76%), at least one of p53, CEA, and MUC1 was expressed in both the main tumor and the spreading area. Interestingly, patients with intraepithelial spread had a better postoperative prognosis than those without intraepithelial spread (P=0.009). However, three patients had anastomotic recurrence 54-130 months after surgery. In conclusion, intraepithelial-spreading bile duct carcinoma is characterized by papillary or nodular main lesions, a more differentiated histological grade, and less invasiveness. The presence of intraepithelial spread was not an indicator of a poor prognosis, but carcinoma in situ at the bile duct stump could cause late anastomotic recurrence after surgery.
• 人工肺管理下における気管支形成術により救命し得た小児外傷性気管支断裂の1例

  川瀬 寛, 宮本 正樹, 木下 桂一, 樋田 泰浩, 大竹 節之, 加賀 基知三, 平野 聡, 森川 利昭, 近藤 哲

  日本呼吸器外科学会雑誌 (NPO)日本呼吸器外科学会 22 (2) 180 - 185 0919-0945 2008/03 

  9歳男児、交通外傷によりJCS200で当院へ救急搬送された。搬入時、前胸部から頸部にかけ広範囲にわたり皮下気腫を認め、血液ガス分析ではpCO2 124.0torr,pO2 61.5torrであった。胸部CT上、気管分岐直後の右主気管支の連続性が追えず、右主気管支断裂を疑った。重度の呼吸不全を伴っていたため人工肺(ECMO)下での緊急手術を行った。右後側方開胸で確認すると、右主気管支の完全断裂を認めた。端々吻合を行ったが、他に中枢側に気管分岐部損傷を認めた。術中に酸素化能の低下を認め、手術継続は不可能と判断した。初回術後2日目に胸骨正中切開によるアプローチで損傷部の気管形成を行い44日目に歩行退院となった。重度の呼吸不全を伴った小児気管支断裂症例に対し、CTでの診断からECMO下での2度の手術まで、迅速かつ集学的な治療により救命可能であった。(著者抄録)
• Crystal structure of VioE, a key player in the construction of the molecular skeleton of violacein

  Satoshi Hirano, Shumpei Asamizu, Hiroyasu Onaka, Yoshitsugu Shiro, Shingo Nagano

  JOURNAL OF BIOLOGICAL CHEMISTRY 283 (10) 6459 - 6466 0021-9258 2008/03 [Refereed][Not invited]
   

  Violacein and the indolocarbazoles are naturally occurring bisindole products with various biological activities, including antitumor activity. Although these compounds have markedly different molecular skeletons, their biosynthetic pathways share the same intermediate "compound X," which is produced from L-tryptophan via indole-3-pyruvic acid imine. Compound X is a short-lived intermediate that is spontaneously converted to chromopyrrolic acid for indolocarbazole biosynthesis, whereas VioE transforms compound X into protodeoxyviolaceinic acid, which is further modified by other enzymes to produce violacein. Thus, VioE plays a key role in the construction of the molecular skeleton of violacein. Here, we present the crystal structure of VioE, which consists of two subunits, each of which forms a structure resembling a baseball glove. Each subunit has a positively charged pocket at the center of the concave surface of the structure. Mutagenesis analysis of the surface pocket and other surface residues showed that the surface pocket serves as an active site. We have also solved the crystal structure of a complex of VioE and phenylpyruvic acid as an analogue of a VioE-substrate complex. A docking simulation with VioE and the IPA imine dimer, which is proposed to be compound X, agreed with the results from the mutational analysis and the VioE-phenylpyruvic acid complex structure. Based on these results, we propose that VioE traps the highly reactive substrate within the surface pocket to suppress CPA formation and promote protodeoxyviolaceinic acid formation caused by proximity and orientation effects.
• Video-assisted esophagectomy for esophageal cancer

  Toshiaki Shichinohe, Satoshi Hirano, Satoshi Kondo

  SURGERY TODAY 38 (3) 206 - 213 0941-1291 2008/03 [Refereed][Not invited]
   

  Video-assisted surgery for esophageal cancer is an advanced surgical technique. It has been developed on the basis of the concept of minimally invasive surgery. Given that there are several options regarding the operative procedures for thoracic esophageal cancer, several laparoscopic approaches have been proposed. The first video-assisted thoracoscopic esophagectomy through a right thoracoscopic approach and the first transhiatal esophagectomy were reported in the early 1990s. A mediastinoscope-assisted esophagectomy has also been reported as a substitute for a blunt dissection of the esophagus. Moreover, a video-assisted Ivor-Lewis esophagectomy by right thoracotomy with intrathoracic anastomosis has also been performed. Furthermore, laparoscopic gastric mobilization and gastroplasty are also widely accepted substitutions for open laparotomy. This article reviews the literature on the laparoscopic approaches for esophageal cancer.
• P17-6 気管支異物7症例の検討(異物,ポスター17,第31回日本呼吸器内視鏡学会学術集会)

  花田 豪郎, 平野 聡, 竹田 雄一郎, 米嶋 康臣, 森井 栄, 森田 あかね, 水谷 友紀, 鈴木 学, 仲 剛, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 30 S203  2008
• OR11-4 当院におけるバーチャル気管支鏡使用下気管支鏡検査の成績について(仮想気管支鏡・極細経気管支鏡,一般口演11,第31回日本呼吸器内視鏡学会学術集会)

  平野 聡, 竹田 雄一郎, 花田 豪郎, 森井 栄, 森田 あかね, 米嶋 康臣, 水谷 友紀, 鈴木 学, 仲 剛, 泉 信有, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 30 S158  2008
• P217 当院における非結核性抗酸菌症を合併した気管支喘息患者の検討(気管支喘息管理2,第20回日本アレルギー学会春季臨床大会)

  米嶋 康臣, 放生 雅章, 平野 聡, 泉 信有, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 57 (3) 435 - 435 2008
• MS13-5 当院におけるWegener肉芽腫の10例の検討(血管炎,第20回日本アレルギー学会春季臨床大会)

  鈴木 学, 放生 雅章, 平野 聡, 泉 信有, 吉澤 篤人, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 57 (3) 375 - 375 2008
• P28 当センターの成人喘息患者における治療ステップとコントロール状態(気管支喘息疫学・統計,第20回日本アレルギー学会春季臨床大会)

  市村 康典, 小林 信之, 水谷 友紀, 平野 聡, 泉 信有, 竹田 雄一郎, 吉澤 篤人, 放生 雅章, 杉山 温人, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 57 (3) 387 - 387 2008
• 278 職場で発生したポリマーフューム熱の2例(職業アレルギー2,第58回日本アレルギー学会秋季学術大会)

  森井 栄, 吉澤 厚人, 仲 剛, 高崎 仁, 泉 信有, 平野 聡, 竹田 雄一郎, 放生 雅章, 杉山 温人, 小林 信之, 正田 良介, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 57 (9) 1516 - 1516 2008
• A case of mucin-producing cholangiocarcinoma with inflammatory wall thickening and reduction in size at 5 months

  Yuya Nasu, Satoshi Kondo, Satoshi Hirano, Toshiaki Shichinohe, Yoshitsugu Nakanishi, Tomoo Itoh

  Japanese Journal of Gastroenterology 105 (1) 68 - 73 0446-6586 2008 [Refereed][Not invited]
   

  We experienced a case of mucin-producing cholangiocarcinoma with inflammatory wall thickening for 5 months. A 46-year-old man who had a stomach punch ulcer, was found to have a cyst by chance on CT. After 5 months, the diameter of the cyst on CT had decreased, the wall thickness increased and the border was unclear. We diagnosed mucin-producing cholangiocarcinoma and found it invading the surrounding liver. So we conducted left hepatectomy and caudate lobectomy. Pathologically, mucin-producing cholangiocarcinoma was confirmed, but the wall thickening was due to inflammation not cancer invasion.
• Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment

  Satoshi Kondo, Tadahiro Takada, Masaru Miyazaki, Shuichi Miyakawa, Kazuhiro Tsukada, Masato Nagino, Junji Furuse, Hiroya Saito, Toshio Tsuyuguchi, Masakazu Yamamoto, Masato Kayahara, Fumio Kimura, Hideyuki Yoshitomi, Satoshi Nozawa, Masahiro Yoshida, Keita Wada, Satoshi Hirano, Hodaka Amano, Fumihiko Miura

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 15 (1) 41 - 54 0944-1166 2008/01 [Refereed][Not invited]
   

  The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%-60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.
• Autoimmune pancreatitis associated with hemorrhagic pseudocysts: A case report and literature review

  Hiroshi Kawakami, Masaki Kuwatani, Keisuke Shinada, Hiroaki Yamato, Satoshi Hirano, Satoshi Kondo, Atsuya Yonemori, Tomoo Itoh, Yoshihiro Matsuno, Masahiro Asaka

  INTERNAL MEDICINE 47 (7) 603 - 608 0918-2918 2008 [Refereed][Not invited]
   

  Autoimmune pancreatitis (AIP) is a new category of pancreatic diseases. All? associated with pseudocysts is rare; only 8 cases have been reported in the literature. A 63-year-old man was admitted to our department because of upper left abdominal pain and back pain. Various imaging studies demonstrated swelling of the tail of the pancreas with hemorrhagic pseudocysts. The patient underwent a surgical operation. A pancreatogram of the specimen revealed total occlusion of the main pancreatic duct in the tail of the pancreas. Histopathological examination revealed that it was AIP with hemorrhagic pseudocysts.
• Three cases of groove pancreatic carcinoma in which endoscopic ultrasonography was useful for diagnosis before surgery

  Masaki Kuwatani, Hiroshi Kawakami, Hiroaki Yamato, Keisuke Shinada, Eiichi Tanaka, Satoshi Hirano, Satoshi Kondoh, Tomoo Itoh, Masahiro Asaka

  Japanese Journal of Gastroenterology 105 (7) 1061 - 1069 0446-6586 2008 [Refereed][Not invited]
   

  We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonograghy revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.
• Pancreatic Metastasis from Renal Cell Carcinoma with Intraportal Tumor Thrombus

  Hiroshi Kawakami, Masaki Kuwatani, Hiroaki Yamato, Keisuke Shinada, Satoshi Hirano, Satoshi Kondo, Atsuya Yonemori, Yoshihiro Matsuno, Masahiro Asaka

  INTERNAL MEDICINE 47 (22) 1967 - 1970 0918-2918 2008 [Refereed][Not invited]
   

  A 68-year-old woman with a history of renal cell carcinoma (RCC) resected curatively 12 years previously was admitted to our department for scrutiny of pancreatic tumors. Various imaging studies demonstrated heterogeneously well-enhanced masses in the head and tail of the pancreas. The well-enhanced mass in the head of the pancreas was connected with the tumor thrombus in the portal vein. To differentially diagnose the multiple pancreatic lesions, we performed endoscopic ultrasound-guided fine-needle aspiration biopsy (EUSFNAB). Histopathologic findings of the EUS-FNAB specimens were similar to those of the renal clear cell carcinoma previously resected. The patient underwent a surgical operation with segmental resection of the portal vein with the preoperative diagnosis of RCC metastasis to the pancreas with intraportal growth. Histopathological examination of the resected specimen revealed that the masses in the pancreas were multiple pancreatic metastases with intraportal tumor thrombus of RCC. The pancreas is a rare target for metastasis. This is a rare case of pancreatic metastasis from RCC with intraportal extension, and is the first preoperatively definitely diagnosed case using EUS-FNAB.
• Villous adenoma arising in choledochocele

  Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Masahiro Asaka, Satoshi Hirano, Satoshi Kondo

  GASTROINTESTINAL ENDOSCOPY 66 (6) 1231 - 1232 0016-5107 2007/12 [Refereed][Not invited]
  
• A case of spontaneous regression of small cell lung cancer with progression of paraneoplastic sensory neuropathy

  Satoshi Hirano, Yoshifumi Nakajima, Eriko Morino, Yuji Fujikura, Makoto Mochizuki, Yuichiro Takeda, Haruhito Sugiyama, Nobuyuki Kobayashi, Keiko Tanaka, Koichiro Kudo

  LUNG CANCER 58 (2) 291 - 295 0169-5002 2007/11 [Refereed][Not invited]
   

  We report here a rare case of small cell lung cancer (SCLC) accompanied by a partial spontaneous regression with a progression of paraneoplastic sensory neuropathy (PSN). A 55-year-old woman was admitted to our hospital with dry cough and progressive numbness in the distal extremities over 1 month. She was diagnosed as small cell lung cancer associated with paraneoplastic sensory neuropathy. About 1 month later, partial spontaneous regression of tumor with a progression of paraneoplastic sensory neuropathy was observed. A complete response was achieved through chemotherapy and concurrent radiotherapy. As the tumor size decreased, her neurological symptoms improved. A short interval between onset of PSN and the start of therapy may be essential for successful treatment for not only SCLC but also PSN. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
• 肝外胆管にまで広範囲に粘膜下壁内進展した肝内胆管癌の1例

  小野寺 学, 河上 洋, 桑谷 将城, 上林 実, 平野 聡, 近藤 哲, 中西 喜嗣, 伊藤 智雄, 浅香 正博

  胆道 日本胆道学会 21 (4) 527 - 533 0914-0077 2007/10 

  73歳男性。患者は近医にて血清19-9値の上昇、腹部CT上の肝腫瘤性病変を指摘され、著者らの施設へ紹介となった。入院時、肝・胆道系酵素の上昇を認め、腹部CT・MRCP・IDUS・内視鏡的逆行性胆管造影検査にて左肝内胆管癌と上中部胆管癌の重複癌が疑われた。肝左葉尾状葉切除、肝外胆管合併切除、門脈楔状切除、右肝動脈切除、再建術を行なった結果、病理組織学的に本症例は肝外胆管まで広範囲に粘膜下壁内進展した胆管浸潤型肝内胆管癌と最終的に診断された。術後は経過良好で、現在、1年2ヵ月経過で無再発生存中である。
• Pulmonary lymphoma developed during long-term methotrexate therapy for psoriasis

  Manabu Suzuki, Satoshi Hirano, Hideyuki Ito, Daisuke Matsubara, Kazuo Kubota, Yuichiro Takeda, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  RESPIROLOGY 12 (5) 774 - 776 1323-7799 2007/09 [Refereed][Not invited]
   

  Low dose weekly administration of methotrexate has been thought to be effective for both rheumatoid arthritis (RA) and psoriasis. However, there is a possibility that methotrexate therapy may be oncogenic. This report presents a case of pulmonary lymphoma developed during long-term methotrexate therapy for psoriasis. Physicians should be aware that Epstein-Barr virus-associated lymphoproliferative disorders that occur during treatment with methotrexate are not specific to patients with RA.
• 浸潤性乳癌患者におけるMMP-1の高発現は無病期間及び全生存率のリスクファクターである(High MMP-1 Expression is a Risk Factor for Disease-Free and Overall Survivals in Patients with Invasive Breast Carcinoma)

  程 紹強, 多田 光宏, 樋田 泰浩, 浅野 賢道, 蔵前 太郎, 竹本 法弘, 浜田 淳一, 宮本 正樹, 平野 聡, 近藤 哲, 守内 哲也

  日本癌学会総会記事 66回 429 - 429 0546-0476 2007/08 [Refereed][Not invited]
  
• 食道扁平上皮癌において制御性T細胞数はCD8/CD4比と密接に関連する(Regulatory T Cell Numbers Strongly Correlate with the CD8/CD4 Ratio in Esophageal Squamous Cell Carcinoma)

  吉岡 達也, 宮本 正樹, 石川 慶大, 樋田 泰浩, 七戸 俊明, 平野 聡, 近藤 哲

  日本癌学会総会記事 66回 551 - 551 0546-0476 2007/08 [Refereed][Not invited]
  
• Primary acinar cell carcinoma of the ampulla of Vater

  Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Satoshi Hirano, Satoshi Kondo, Yoshitsugu Nakanishi, Tomoo Itoh, Masahiro Asaka

  JOURNAL OF GASTROENTEROLOGY 42 (8) 694 - 697 0944-1174 2007/08 [Refereed][Not invited]
   

  Acinar cell carcinoma of the pancreatobiliary system is a relatively rare malignant neoplasm arising usually in the pancreatic parenchyma. We experienced a 68-year-old woman who presented with obstructive jaundice due to an ampullary mass 1.0cm in diameter, detected by abdominal computed tomography and endoscopic examination. The patient underwent a curative surgical operation, and histopathological examination revealed that the tumor was confined to the ampulla of Vater with no continuity to the pancreatic parenchyma. The tumor cells showed acinar or tubular arrangement with eosinophilic to basophilic granular cytoplasm, findings identical to those of acinar cell carcinoma of the pancreas. Immunohistochemically, the tumor cells were positive for lipase. From these findings, we concluded that the tumor was primary acinar cell carcinoma arising in the ampulla of Vater, probably originating from heterotopic pancreatic tissue. This is the first reported case of primary acinar cell carcinoma in the ampulla of Vater.
• Molecular basis for autoregulatory interaction between GAE domain and hinge region of GGA1

  Michio Inoue, Tomoo Shiba, Kentaro Ihara, Yusuke Yamada, Satoshi Hirano, Hironari Kamikubo, Mikio Kataoka, Masato Kawasaki, Ryuichi Kato, Kazuhisa Nakayama, Soichi Wakatsuki

  TRAFFIC 8 (7) 904 - 913 1398-9219 2007/07 [Refereed][Not invited]
   

  Golgi-localizing, gamma-adaptin ear domain homology, ADP ribosylation factor-binding (GGA) proteins and the adaptor protein (AP) complex, AP-1, are involved in membrane traffic between the trans Golgi network and the endosomes. The gamma-adaptin ear (GAE) domain of GGAs and the gamma 1 ear domain of AP-1 interact with an acidic phenylalanine motif found in accessory proteins. The GAE domain of GGA1 (GGA1-GAE) interacts with a WNSF-containing peptide derived from its own hinge region, although the peptide sequence deviates from the standard acidic phenylalanine motif. We report here the structure of GGA1-GAE in complex with the GGA1 hinge peptide, which revealed that the two aromatic side chains of the WNSF sequence fit into a hydrophobic groove formed by aliphatic portions of the side chains of conserved arginine and lysine residues of GGA1-GAE, in a similar manner to the interaction between GGA-GAEs and acidic phenylalanine sequences from the accessory proteins. Fluorescence quenching experiments indicate that the GGA1 hinge region binds to GGA1-GAE and competes with accessory proteins for binding. Taken together with the previous observation that gamma 1 ear binds to the GGA1 hinge region, the interaction between the hinge region and the GAE domain underlies the autoregulation of GGA function in clathrin-mediated trafficking through competing with the accessory proteins and the AP-1 complex.
• 画像ガイド下手術のための新たな術中近赤外蛍光画像化システム(A Novel, Intraoperative Near-Infrared Fluorescence Imaging System for Image-Guided Surgery)

  田中 栄一, Frangioni John V., Flaumenhaft Robert, 平野 聡, 七戸 俊明, 樋田 泰浩, 加賀 基知三, 近藤 哲

  日本外科学会雑誌 108 (臨増2) 186 - 186 0301-4894 2007/03
• 表層拡大型肝外胆管癌23例の臨床病理学的検討

  中西 喜嗣, 全 陽, 伊藤 智雄, 河上 洋, 平野 聡, 中沼 安二, 近藤 哲

  日本外科学会雑誌 (一社)日本外科学会 108 (臨増2) 524 - 524 0301-4894 2007/03
• [A case of primary mediastinal choriocarcinoma in which FDG-PET was performed for the evaluation of the treatment].

  Shukuya T, Hirano S, Takeda Y, Ito H, Hurihata K, Sugiyama H, Kobayashi N, Kudo K

  Nihon Kokyuki Gakkai zasshi = the journal of the Japanese Respiratory Society 45 (2) 174 - 179 1343-3490 2007/02 [Refereed][Not invited]
   

  A 61-year-old man visited another hospital with chief complaints of dry cough, appetite loss and body weight loss. On chest X ray film and CT, right supraclavicular and mediastinal lymph nodes were swollen. For further examination, he was referred to our hospital and diagnosed as primary mediastinal choriocarcinoma. We conducted surgery after four cycles of chemotherapy using cisplatin, etoposide and bleomycin. After chemotherapy, residual tumors were found on chest CT. In FDG-PET some parts of the residual tumors seen on CT showed much less uptake and the others showed similar uptake. Histologically the areas showing similar uptake contained more viable cells, and the other areas showing less uptake almost completely consisted of necrotic tissue. We believe FDG-PET can be useful to evaluate the viability of tumors after chemotherapy in extra gonadal choriocarcinoma in the mediastinum.
• 397 全身麻酔手術を受けた気管支喘息患者の臨床的検討(気管支喘息-長期管理4,一般演題(デジタルポスター),第57回日本アレルギー学会秋季学術大会)

  家 研也, 水谷 友紀, 田宮 浩之, 森井 栄, 森田 あかね, 篠原 有香, 鈴木 学, 平野 聡, 泉 信有, 吉澤 篤人, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 56 (8) 1176 - 1176 2007
• 395 気管支喘息発作で入院した患者の入院期間と最近の臨床的傾向(気管支喘息-長期管理4,一般演題(デジタルポスター),第57回日本アレルギー学会秋季学術大会)

  森田 あかね, 水谷 友紀, 田宮 浩之, 森井 栄, 篠原 有香, 鈴木 学, 平野 聡, 泉 信有, 吉澤 篤人, 放生 雅章, 杉山 温人, 小林 信之, 工藤 宏一郎

  アレルギー 一般社団法人 日本アレルギー学会 56 (8) 1175 - 1175 2007
• P13-5 高度な形質細胞浸潤を伴う気管支粘膜病変を認めたMikulicz病の一例(全身性疾患に伴う肺疾患, 第30回日本呼吸器内視鏡学会学術集会)

  森井 栄, 平野 聡, 篠原 有香, 仲 剛, 泉 信有, 竹田 雄一郎, 杉山 温人, 山下 裕行, 小林 信之, 工藤 宏一郎

  気管支学 特定非営利活動法人 日本呼吸器内視鏡学会 29 S184  2007
• Primary cholesterol hepatolithiasis associated with cholangiocellular carcinoma: A case report and literature review

  Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Satoshi Hirano, Satoshi Kondo, Yoshitsugu Nakanishi, Tomoo Itoh, Masahiro Asaka

  INTERNAL MEDICINE 46 (15) 1191 - 1195 0918-2918 2007 [Refereed][Not invited]
   

  Hepatolithiasis associated with cholangiocellular carcinoma is occasionally a calcium bilirubinate stone. Primary cholesterol hepatolithiasis associated with cholangiocellular carcinoma is rare; only 6 cases have been reported in the literature. A 55-year-old man was admitted to our hospital because of an elevated level of carbohydrate antigen 19-9. Various imaging studies demonstrated a mass in the segment VII of the liver. The patient underwent a curative surgical operation. Histopathological examination revealed that it was cholangiocellular carcinoma located in the periphery of the liver. A cholesterol stone was present, encircled by the cholangiocellular carcinoma. Minor inflammatory changes were observed around the stone.
• A case of minocycline-induced pneumonitis with bilateral pleural effusion

  Satoko Arai, Yuka Shinohara, Yasuyuki Kato, Satoshi Hirano, Atsuto Yoshizawa, Masaaki Hojyo, Nobuyuki Kobayashi, Haruhito Sugiyama, Koichiro Kudo

  Japanese Journal of Allergology 56 (10) 1293 - 1297 0021-4884 2007 [Refereed][Not invited]
   

  A 51-year-old man was admitted to our hospital with fever, dry cough and dyspnea. He had taken minocycline for 11 days because of urinary tract infection. Chest X-ray on admission showed diffuse reticular shadows in bilateral lung fields with bilateral pleural effusion. Cessation of minocycline led to spontaneous improvement of symptoms and radiographic findings. The lymphocyte stimulation test for minocycline with peripheral blood and pleural effusion were negative. After provocation test with minocycline, he developed fever and dry cough and bilateral ground glass opacity appeared on his chest X-ray. He was diagnosed as minocycline-induced pneumonitis and recovered rapidly following corticosteroid therapy.
• A case of solitary fibrous tumor originated from the pleura of the diaphragm

  MATSUMURA Yoshiyuki, MORIKAWA Toshiaki, OOTAKE Setsuyuki, ISHIKAWA Keidai, SATO Nagato, HIRANO Satoshi, KONDO Satoshi

  The Journal of the Japanese Association for Chest Surgery 特定非営利活動法人日本呼吸器外科学会 20 (7) 59 - 64 0919-0945 2006/11/15 

  We report a case of solitary fibrous tumor originated from the pleura of the diaphragm. A 76-year-old woman was admitted because of an abnormal shadow on chest X-ray. CT scan revealed a solid giant mass in the right thoracic cavity and she was diagnosed as SFT by needle biopsy. After embolization of the right inferior phrenic artery, which was the main feeding artery to the tumor, operation was performed. The tumor was 21×17×10cm in size and weighed 2070g. Histologically, the tumor was diagnosed as SFT without malignancy. The postoperative course was uneventful, and she was discharged on the 11th day after surgery. The patient has been followed up for 1 year and 9 months with no evidence of reccurence. We experienced a rare case of SFT originated from the pleura of the diaphragm. The tumor is apt to be discovered after becoming giant. MRI was useful for close inspection of the area surrounding the diaphragm.
• Structural basis of ubiquitin recognition by mammalian Eap45 GLUE domain

  Satoshi Hirano, Nobuhiro Suzuki, Thomas Slagsvold, Masato Kawasaki, Daniel Trambaiolo, Ryuichi Kato, Harald Stenmark, Soichi Wakatsuki

  Nature Structural and Molecular Biology 13 (11) 1031 - 1032 1545-9993 2006/11 [Refereed][Not invited]
   

  ESCRT-II, a complex that sorts ubiquitinated membrane proteins to lysosomes, localizes to endosomes through interaction between the Vps36 subunit's GLUE domain and phosphatidylinositides (PIs). In yeast, a ubiquitin (Ub)-interacting NZF domain is inserted in Vps36 GLUE, whereas its mammalian counterpart, Eap45 GLUE, lacks the NZF domain. In the Eap45 GLUE-Ub complex structure, Ub binds far from the proposed PI-binding site of Eap45 GLUE, suggesting their independent binding. © 2006 Nature Publishing Group.
• 門脈内腫瘍栓および膵管内腫瘍進展を伴った悪性膵内分泌腫瘍の1例

  桑谷 将城, 河上 洋, 斉藤 克憲, 平野 聡, 近藤 哲, 中西 喜嗣, 伊藤 智雄, 浅香 正博

  日本消化器病学会雑誌 (一財)日本消化器病学会 103 (臨増大会) A1009 - A1009 0446-6586 2006/09
• Development of an automated large-scale protein-crystallization and monitoring system for high-throughput protein-structure analyses

  Masahiko Hiraki, Ryuichi Kato, Minoru Nagai, Tadashi Satoh, Satoshi Hirano, Kentaro Ihara, Norio Kudo, Masamichi Nagae, Masanori Kobayashi, Michio Inoue, Tamami Uejima, Shunichiro Oda, Leonard M. G. Chavas, Masato Akutsu, Yusuke Yamada, Masato Kawasaki, Naohiro Matsugaki, Noriyuki Igarashi, Mamoru Suzuki, Soichi Wakatsuki

  ACTA CRYSTALLOGRAPHICA SECTION D-BIOLOGICAL CRYSTALLOGRAPHY 62 (Pt 9) 1058 - 1065 0907-4449 2006/09 [Refereed][Not invited]
   

  Protein crystallization remains one of the bottlenecks in crystallographic analysis of macromolecules. An automated large-scale protein-crystallization system named PXS has been developed consisting of the following subsystems, which proceed in parallel under unified control software: dispensing precipitants and protein solutions, sealing crystallization plates, carrying robot, incubators, observation system and image-storage server. A sitting-drop crystallization plate specialized for PXS has also been designed and developed. PXS can set up 7680 drops for vapour diffusion per hour, which includes time for replenishing supplies such as disposable tips and crystallization plates. Images of the crystallization drops are automatically recorded according to a preprogrammed schedule and can be viewed by users remotely using web-based browser software. A number of protein crystals were successfully produced and several protein structures could be determined directly from crystals grown by PXS. In other cases, X-ray quality crystals were obtained by further optimization by manual screening based on the conditions found by PXS.
• 原発性肺癌切除症例における術前CYFRAと臨床病理学的因子の解析

  福田 直也, 加賀 基知三, 樋田 泰浩, 長 靖, 菊地 健司, 松井 あや, 宮本 正樹, 七戸 俊明, 平野 聡, 近藤 哲

  北海道外科雑誌 北海道外科学会 51 (1) 74 - 74 0288-7509 2006/06
• Surgical treatment of liver metastases from pancreatic cancer

  Hidehisa Yamada, Satoshi Hirano, Eiichi Tanaka, Toshiaki Shichinohe, Satoshi Kondo

  HPB 8 (2) 85 - 88 1365-182X 2006/04 [Refereed][Not invited]
   

  Pancreatic cancer is a disease with a poor prognosis. Most patients are diagnosed at an advanced and unresectable stage. Even if the primary cancer is radically removed, postoperative recurrence frequently occurs. Generally, metastatic liver tumors from pancreatic cancer are not indicated for surgical treatment. Here we evaluate the results of performing hepatectomy for liver metastases of pancreatic cancer. In our institute, six patients with liver metastases from pancreatic cancer were treated by partial hepatectomy. Overall 1-, 3- and 5-year survival rates of six patients after hepatectomy were 66.7%, 33.3% and 16.7%, respectively, and one patient was alive for 65.4 months. Performing a hepatectomy for liver metastases of pancreatic cancer, when combined with a pancreas resection, was recently considered to be a safe operation, and one that might offer prolonged survival for highly selected patients with curative resection of liver metastases. In the future, it will be necessary to develop new multi-modality therapies to improve the prognosis of pancreatic cancer. © 2006 Taylor & Francis.
• 癌に対する血管新生標的治療の現状と将来 抗血管新生療法の標的としての腫瘍関連内皮細胞(Tumor-associated Endothelial Cells as Targets of Anti-angiogenic Therapy)

  樋田 泰浩, 樋田 京子, Klagsbrun Michael, 宮本 正樹, 平野 聡, 加賀 基知三, 大竹 節之, 七戸 俊明, 近藤 哲

  日本外科学会雑誌 107 (臨増2) 60 - 60 0301-4894 2006/03 [Refereed][Not invited]
  
• Double-sided ubiquitin binding of Hrs-UIM in endosomal protein sorting

  Satoshi Hirano, Masato Kawasaki, Hideaki Ura, Ryuichi Kato, Camilla Raiborg, Harald Stenmark, Soichi Wakatsuki

  Nature Structural and Molecular Biology 13 (3) 272 - 277 1545-9993 2006/03 [Refereed][Not invited]
   

  Hrs has an essential role in sorting of monoubiquitinated receptors to multivesicular bodies for lysosomal degradation, through recognition of ubiquitinated receptors by its ubiquitin-interacting motif (UIM). Here, we present the structure of a complex of Hrs-UIM and ubiquitin at 1.7-Å resolution. Hrs-UIM forms a single α-helix, which binds two ubiquitin molecules, one on either side. These two ubiquitin molecules are related by pseudo two-fold screw symmetry along the helical axis of the UIM, corresponding to a shift by two residues on the UIM helix. Both ubiquitin molecules interact with the UIM in the same manner, using the Ile44 surface, with equal binding affinities. Mutational experiments show that both binding sites of Hrs-UIM are required for efficient degradative protein sorting. Hrs-UIM belongs to a new subclass of double-sided UIMs, in contrast to its yeast homolog Vps27p, which has two tandem single-sided UIMs. © 2006 Nature Publishing Group.
• 肝静脈と胆管内に腫瘍塞栓を伴った肝細胞癌の1例

  田畑 佑希子, 狭間 一明, 松井 あや, 鈴木 温, 七戸 俊明, 齋藤 克憲, 竹内 幹也, 仙丸 直人, 原 敬志, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 67 (2) 498 - 498 1345-2843 2006/02
• 4ヵ月の経過で画像上に大きな変化を認めた粘液産生肝内胆管癌の1例

  那須 裕也, 平野 聡, 鈴木 温, 狭間 一明, 齋藤 克憲, 竹内 幹也, 仙丸 直人, 原 敬志, 七戸 俊明, 加賀 基知三, 近藤 哲, 中西 喜嗣, 伊藤 智雄

  日本臨床外科学会雑誌 日本臨床外科学会 67 (2) 499 - 499 1345-2843 2006/02
• 横隔膜,肺,下大静脈浸潤をきたした肝内胆管癌の1切除例

  武藤 潤, 仙丸 直人, 長 靖, 狭間 一明, 鈴木 温, 斉藤 克憲, 竹内 幹也, 樋田 泰浩, 原 敬志, 大竹 節之, 七戸 俊明, 加賀 基知三, 平野 聡, 近藤 哲, 伊藤 智雄

  日本臨床外科学会雑誌 日本臨床外科学会 67 (2) 499 - 499 1345-2843 2006/02 [Refereed][Not invited]
  
• 原発性肺腫瘍と術前CEAとの病理組織学的検討

  三井 潤, 加賀 基知三, 大竹 節之, 樋田 泰浩, 長 靖, 道免 寛充, 鯉沼 潤吉, 菊地 健司, 福田 直也, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 67 (2) 506 - 506 1345-2843 2006/02 [Refereed][Not invited]
  
• 肺癌におけるFDG-PETのSUV値と臨床病理学的因子の検討

  道免 寛充, 加賀 基知三, 大竹 節之, 樋田 泰浩, 長 靖, 鯉沼 潤吉, 菊地 健司, 福田 直也, 平野 聡, 近藤 哲

  日本臨床外科学会雑誌 日本臨床外科学会 67 (2) 506 - 506 1345-2843 2006/02 [Refereed][Not invited]
  
• [New approach to the treatment of biliary cancer].

  Kondo S, Hirano S, Tanaka E, Shichinohe T, Saito K, Takeuchi M

  Nihon rinsho. Japanese journal of clinical medicine 64 Suppl 1 458 - 462 0047-1852 2006/01 [Refereed][Not invited]
  
• Squamous papillomas in the trachea and main bronchi found in a Cowden's disease patient

  Takehito Shukuya, Satoshi Hirano, Haruhito Sugiyama, Nobuyuki Kobayashi, Koichiro Kudo

  INTERNAL MEDICINE 45 (16) 987 - 988 0918-2918 2006 [Refereed][Not invited]
  
• Strategies for multiple intraductal papillary-mucinous neoplasms of the pancreas

  HIRANO Satoshi, KONDO Satoshi, HARA Takashi, TAKEUCHI Motoya, SAITOH Katsunori, SENMARU Naohito

  Suizo Japan Pancreas Society 20 (6) 517 - 521 0913-0071 2005/12/29 

  Our strategy of surgical treatment of multiple IPMNs includes only borderline lesions (moderate dysplasia) or malignant ones, while the remaining tumors are observed closely without any surgical interventions as long as possible. Multiple non-invasive and benign tumors should be excised with combinations of some minimized surgical procedures. In such procedures, it is important to achieve complete resection of the tumor. A limited indication of total pancreatectomy remains for patients with apparently diffuse IPMNs because of the compromised postoperative insulin management and deterioration of quality of life. The utilization of intra-operative ultrasound with precise preoperative information about the tumor enhances a complete resection of tumor. Reconstruction of the pancreatic duct must be performed in pancreaticogastrostomy, which could allow the use of endoscopic investigations for recurrent or new IPMNs.
• Heterotypic interaction of CRTAM with Necl2 induces cell adhesion on activated NK cells and CD8(+) T cells

  N Arase, A Takeuchi, M Unno, S Hirano, T Yokosuka, H Arase, T Saito

  INTERNATIONAL IMMUNOLOGY 17 (9) 1227 - 1237 0953-8178 2005/09 [Refereed][Not invited]
   

  NK cells and CD8(+) T cells exhibit cytotoxicity and cytokine production upon recognizing target cells through cell-cell interaction. We screened the molecules involved in the recognition and regulation of these cells using cDNA subtraction between naive and activated NK cells. We identified class I-restricted T cell-associated molecule (CRTAM), a two Ig domain-bearing surface receptor, as a molecule rapidly and transiently expressed on NK cells and CD8(+) T cells upon activation. CRTAM is expressed as a dimer on the cell surface, and its expression is transcriptionally regulated. Using an expression-cloning system, we then further identified Nectin-like (Necl) molecule 2, a three Ig domain-containing receptor, as a ligand of CRTAM. While Necl2 mediates homotypic interaction, CRTAM interacts with Necl2 but not with CRTAM itself. The heterotypic CRTAM-Necl2 interaction has a higher affinity than the homotypic Necl2 interaction. Although there was no clear alteration in the cytotoxic function of the NK cells and CD8(+) T cells against the Necl2-expressing target cells, T cells expressing CRTAM tightly bound to Necl2-expressing cells. CRTAM(+) cells did not induce homotypic aggregation but they did exert strong heterotypic binding with Necl2(+) cells, which was inhibited by the addition of the CRTAM-Ig fusion protein. These results suggest that the heterotypic interaction between CRTAM and Necl2 plays an important role in the adhesion, interaction or migration of NK cells and CD8(+) T cells upon stimulation.
• Long-term efficacy of distal splenorenal shunt with splenopancreatic and gastric disconnection for esophagogastric varices in patients with idiopathic portal hypertension

  R Hase, S Hirano, S Kondo, S Okushiba, T Morikawa, H Katoh

  WORLD JOURNAL OF SURGERY 29 (8) 1034 - 1037 0364-2313 2005/08 [Refereed][Not invited]
   

  Idiopathic portal hypertension (IPH) requires invasive measures to prevent rupture and bleeding of esophagogastric varices. However, the long-term results of shunt surgery for IPH have not been reported. In particular, the pros and cons of surgery that preserves the spleen and its long-term hematologic effects have not been described.The records of 15 patients who underwent distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for IPH between 1983 and 1998 was reviewed retrospectively. One patient died within 3 years of surgery, for a 3-year survival rate of 93%; the 10-year survival rate was 64%. Three patients (18%) suffered rebleeding from esophagogastric varices. The white blood cell and platelet counts were higher 3-5 years and 7-13 years postoperatively compared with preoperative values. Four of five patients who underwent postoperative computed tomography had a smaller spleen postoperatively. DSRS with SPGD provides long-term hemostasis for esophagogastric variceal bleeding in IPH and alleviates hypersplenism. DSRS with SPGD is an effective treatment for patients with IPH in whom long-term survival is expected.
• 初回手術12年目に再発した表層拡大進展型胆管癌の1例

  中西 喜嗣, 近藤 哲, 森川 利昭, 平野 聡, 安保 義恭, 田中 栄一

  日本消化器外科学会雑誌 (一社)日本消化器外科学会 38 (7) 1205 - 1205 0386-9768 2005/07
• Eap45 in mammalian ESCRT-II binds ubiquitin via a phosphoinositide-interacting GLUE domain

  T Slagsvold, R Aasland, S Hirano, KG Bache, C Raiborg, D Trambaiolo, S Wakatsuki, H Stenmark

  JOURNAL OF BIOLOGICAL CHEMISTRY 280 (20) 19600 - 19606 0021-9258 2005/05 [Refereed][Not invited]
   

  Ubiquitination serves as a key sorting signal in the lysosomal degradation of endocytosed receptors through the ability of ubiquitinated membrane proteins to be recognized and sorted by ubiquitin-binding proteins along the endocytic route. The ESCRT-II complex in yeast contains one such protein, Vps36, which harbors a ubiquitin-binding NZF domain and is required for vacuolar sorting of ubiquitinated membrane proteins. Surprisingly, the presumptive mammalian ortholog Eap45 lacks the ubiquitin-binding module of Vps36, and it is thus not clear whether mammalian ESCRT-II functions to bind ubiquitinated cargo. In this paper, we provide evidence that Eap45 contains a novel ubiquitin-binding domain, GLUE (GRAM-like ubiquitin-binding in Eap45), which binds ubiquitin with similar affinity and specificity as other ubiquitin-binding domains. The GLUE domain shares similarities in its primary and predicted secondary structures to phosphoinositide-binding GRAM and PH domains. Accordingly, we find that Eap45 binds to a subset of 3-phosphoinositides, suggesting that ubiquitin recognition could be coordinated with phosphoinositide binding. Furthermore, we show that Eap45 colocalizes with ubiquitinated proteins on late endosomes. These results are consistent with a role for Eap45 in endosomal sorting of ubiquitinated cargo.
• Long-term survival after curative left hepatectomy for mucin-producing cholangiocarcinoma: Report of a case

  T Tsuchikawa, S Kondo, S Hirano, E Tanaka, Y Anbo, T Morikawa, S Okushiba, N Otsuka, T Itoh, H Katoh

  SURGERY TODAY 35 (3) 256 - 258 0941-1291 2005/03 [Refereed][Not invited]
   

  Cholangiocarcinomas are rarely mucinproducing. We report a case of mucin-producing cholangiocarcinoma successfully treated by curative left hepatectomy, resulting in long-term survival, with no evidence of tumor recurrence 111 months after resection. Immunohistochemical studies revealed a pattern of MUC-1 negativity and MUC-2 positivity, suggesting low malignant potential.
• Elucidation of information encoded in tryptophan 140 of staphylococcal nuclease

  S Hirano, H Kamikubo, Y Yamazaki, M Kataoka

  PROTEINS-STRUCTURE FUNCTION AND BIOINFORMATICS 58 (2) 271 - 277 0887-3585 2005/02 [Refereed][Not invited]
   

  We investigated the role of W140 in the folding of Staphylococcal nuclease. For this purpose, we constructed the 19 possible substitution mutations at residue 140. Only three mutants, W140F, W140H, and W140Y, adopted native-like structures under physiological conditions and showed native-like enzymatic activities. In contrast, the other 16 mutants took on compact unfolded structures under physiological conditions and the enzymatic activities of these mutants were decreased to approximately 70% of wild-type levels. These 16 mutants maintained substrate-induced foldability. These results strongly indicate that the side-chain information encoded by residue 140 is essential to maintain a stable native structure, and that this residue must be an aromatic side chain. The order of thermal stability was wild type > W140H > W140F = W140Y. Therefore, the five-membered nitrogen-containing ring of the indole is thought to bear the essential information. In the crystal structure of staphylococcal nuclease, the five-membered ring is at the local center of the C-terminal cluster through hydrophobic interactions. This cluster plays a key role in the interaction connecting the C-terminal region and the N-terminal P-core. Mutants other than W140H, W140F, and W140Y lost the ability to form the local core, which caused the loss of the long-range interactions between the C-terminal and N-terminal regions. Inhibitor or substrate binding to these mutants compensates for the lack of long-range interactions generated by W140. (C) 2004 Wiley-Liss, Inc.
• Intraductal papillary-mucinous tumors arising in Santorini's duct: Clinicopathologic features and the treatment of choice

  S Hirano, S Kondo, Y Ambo, E Tanaka, T Morikawa, S Okushiba, H Katoh

  WORLD JOURNAL OF SURGERY 29 (2) 208 - 211 0364-2313 2005/02 [Refereed][Not invited]
   

  Almost all reported cases of intraductal papillary-mucinous tumors of the pancreas (IPMTs) originate from Wirsung's duct (WD), the main pancreatic duct, or their branches. IPMTs arising from Santorini's duct (SD) and its branches have rarely been reported. This article presents the clinicopathologic features of IPMTs originating in SD and its branches. Of 36 IPMTs resected in our institution, 5 originated in the region of SD: 3 in SD and 2 from its branches. Both SD and WD were dilated in all cases on radiographic and ultrasonographic studies. The maximum diameter of SD, determined by computed tomography or ultrasonography, was larger than that of WD in all cases. Seven reports of IPMT arising from SD have been published. Four lesions originated from SD and the others from its branches. Overall, 9 of 12 lesions (75%) were considered malignant. In conclusion, the coexistence of an IPMT and a dilated SD suggests an origin in the SD. These tumors have a high malignant potential and should be excised.
• 新生児の先天性嚢胞性腺腫様奇形 (1型CCAM) に対し胸腔鏡下中葉切除術を施行した一例(胸腔鏡手術 (2), 第22回日本呼吸器外科学会総会)

  中島 誠一郎, 森川 利昭, 石川 慶大, 大竹 節之, 平野 聡, 近藤 哲

  日本呼吸器外科学会雑誌 特定非営利活動法人 日本呼吸器外科学会 19 (3) 338 - 338 2005
• Superficially spreading cholangiocarcinoma

  Motoki Abe, Satoshi Kondo, Satoshi Hirano, Yoshiyasu Ambo, Eiichi Tanaka, Katsunori Saito, Toshiaki Morikawa, Shunichi Okushiba, Hiroyuki Katoh

  International Journal of Gastrointestinal Cancer 35 (1) 89 - 94 0169-4197 2005 [Refereed][Not invited]
   

  Cholangiocarcinoma of a raised, elevated type, not an infiltrative type, may be accompanied with superficial spread in the contiguous mucosa. We report a case of an extrahepatic cholangiocarcinoma that showed a specific cholangiographic finding of extensive superficial spread. The patient was a 62-yr-old man. Cholangiography revealed an elevated lesion in the middle of the bile duct, which was surrounded by irregularity of the bile duct wall extensively. We accurately diagnosed the tumor extent by percutaneous transhepatic cholangioscopy and achieved radical resection without hepatic resection. The margins were tumor-negative by microscopy. In conclusions, it is important to accurately diagnose the extent of superficial spread preoperatively by cholangioscopy and biopsy, and decide the resecting lines to make margins tumor-negative. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved.
• Esophageal pemphigus vulgaris with carcinoma: postoperative steroid therapy based on pemphigus-related antibodies

  O Takahashi, S Okushiba, S Kondo, T Morikawa, S Hirano, M Miyamoto, T Shichinohe, T Hara, Y Kawarada, K Saito, M Takeuchi

  DISEASES OF THE ESOPHAGUS 18 (6) 413 - 417 1120-8694 2005 [Refereed][Not invited]
   

  A 71-year-old man had been treated as an outpatient for pemphigus vulgaris. Endoscopic examination disclosed an ulcerated lesion in the middle of the esophagus. A biopsy specimen was diagnosed pathologically as squamous cell carcinoma. At surgery, the esophageal mucosa beyond the resection margin appeared edematous and blistered. We carried out anastomosis with sutures rather than staples at the site where the epithelium was least damaged, to minimize likelihood of anastomotic breakdown from poor blood flow. Histopathologic examination of the resected specimen additionally showed blisters and acantholytic cells throughout the esophageal mucosa, so esophageal pemphigus was diagnosed in addition to carcinoma. The patient's general condition deteriorated from worsening of pemphigus. We initiated steroid therapy, making adjustments according to changes in titers of anti-intercellular bridge antibody and antibodies to the cell adhesion molecules (desmoglein 1 and 3). Fever and extensive blistering subsided dramatically, and the patient was discharged in good condition on hospital day 103. When performing esophagectomy in the presence of esophageal pemphigus, the anastomosis must be fashioned cautiously because any mechanical stress can abrade the friable edematous esophageal mucosa. While steroid therapy is known to be effective for pemphigus vulgaris, our findings indicate that in patients with postoperative deterioration of their general condition, marked improvement can be obtained by using antibody titers to guide timing and dose in steroid administration.
• Superficially spreading cholangiocarcinoma.

  Abe M, Kondo S, Hirano S, Ambo Y, Tanaka E, Saito K, Morikawa T, Okushiba S, Katoh H

  International journal of gastrointestinal cancer 35 (1) 89 - 94 1537-3649 2005 [Refereed][Not invited]
  
• Appraisal of DSRS with SPGD for esophagogastric varices: A retrospective comparative study according to the underlying liver diseases

  S Hirano, S Kondo, Y Ambo, E Tanaka, T Morikawa, S Okushiba, H Katoh

  HEPATO-GASTROENTEROLOGY 52 (61) 152 - 155 0172-6390 2005/01 [Refereed][Not invited]
   

  Background/Aims: The differences in long-term results of distal splenorenal shunt with splenopancreatic and gastric disconnection (DSRS with SPGD) for portal hypertension of different etiologies including non-cirrhotic portal hypertension have yet to be reported. The data are important to determine the indications and contraindications for this procedure. Methodology: Records of 54 patients of esophagogastric varices who survived 3 years or longer after DSRS with SPGD operation were reviewed. Patients were divided into three groups based on underlying liver disease; posthepatitic cirrhosis (HQ group, alcoholic cirrhosis (AC) group, and idiopathic portal hypertension (IPH) group. Results: The only serious long-term complication of DSRS with SPGD was portal thrombosis in two patients in the IPH group. Postoperative bleeding occurred in two cases of each group; one in IPH group was the only variceal bleeding and others were bleeding from portal hypertensive gastropathy. Hepatocellular carcinoma (HCC) was developed in 28.6% patients in both the HC group and Ad group. In all the cases, treatment for HCC was accomplished without aggravation of the varices. The cumulative survival rate was similar in the three groups, and no patient died of gastrointestinal bleeding. Conclusions: A favorable outcome was achieved by DSRS with SPGD operation both in the patients with cirrhosis or IPH. Underlying liver disease is not a factor when considering DSRS with SPGD for portal hypertension.
• Pancreas-preserving biliary amputation with pancreatic diversion: A new surgical technique for complete resection of the intrapancreatic biliary system

  S Kondo, S Hirano, Y Ambo, E Tanaka, T Morikawa, S Okushiba, H Katoh

  HEPATO-GASTROENTEROLOGY 51 (59) 1255 - 1258 0172-6390 2004/09 [Refereed][Not invited]
   

  Pancreatoduodenectomy is not optimal for organ preservation in patients with mucosal carcinoma of the choledochus. When the lesion spreads near the papilla of Vater, pancreas-preserving,biliary amputation may be indicated to achieve complete resection of the biliary system. The first successful case is reported here with technical considerations. First, the pancreatic neck was divided and a tube was inserted into the main pancreatic duct beyond the papilla. The choledochus was dissected downward with division of the posterior pancreatoduodenal vessels. The main pancreatic duct was isolated with the aid of palpation of the tube, and was then ligated and divided. Subsequent dissection was performed to the level of the duodenal mucosa, which was incised circularly. The duodenal defect was then closed. The elevated jejunum. was interposed between the pancreatic stumps and bilateral pancreaticojejunostomies were created. The procedure was successfully performed in a patient with superficially spreading cholangiocarcinoma. Postoperative bile leak and pancreatic fistula were controlled with medical management. The patient is currently well without tumor recurrence 19 months after surgery. Her glucose tolerance, which was moderately impaired preoperatively, has been maintained. Pancreas-preserving biliary amputation has been developed as an organ-preserving procedure alternative to pancreatoduodenectomy. Indications, methods of pancreatic reconstruction, and long-term results require further study.
• Forty consecutive resections of Hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins - Results of a prospective study

  S Kondo, S Hirano, Y Ambo, E Tanaka, S Okushiba, T Morikawa, H Katoh

  ANNALS OF SURGERY 240 (1) 95 - 101 0003-4932 2004/07 [Refereed][Not invited]
   

  Objective: Our objective was to perform a prospective study of surgical treatment of hilar cholangiocarcinoma according to newly established guidelines for performing safe and curative resections. Summary Background Data: The poor survival rate after resection of hilar cholangiocarcinoma is considered to be mainly the result of in-hospital death and positive ductal margins. Methods: Between July 1999 and December 2002, 40 of 42 surgically explored patients with hilar cholangiocarcinoma underwent resection. They were managed with preoperative biliary decompression, portal embolization.. cholangiographic evaluation, and a choice of surgical procedures and techniques. Results: Hospital or 30-day mortality and morbidity rates were 0% and 48%, respectively. Hepatic failure was not encountered. Histopathologic examination revealed no positive ductal margins in all 40 patients, but 2 showed positive separation margins from the right hepatic artery. The overall 3-year survival rate and median survival time were 40% and 27 months. Survival of patients with Bismuth type III or IV tumors or of patients who underwent right hepatectomy was significantly better. Survival of patients who underwent concomitant vascular resection was similar to survival of those who did not. Univariate analysis indicated the type of hepatectomy, histopathologic grade. Bismuth classification, concomitant hepatic artery resection, and International Union Against Cancer stage as significant prognostic factors. Conclusions: No postoperative mortality and no positive ductal margins were achieved according to the above guidelines in a high-volume expert center. Long-term results, however, have not been significantly improved. A survival analysis of the patient series with homogeneous conditions derived from a short study period suggests the need for additional strategies including right hepatectomy for Bismuth type I or 11 tumors.
• Embolization of the replaced common hepatic artery before surgery for pancreatic head cancer: Report of a case

  N Miyamoto, Y Kodama, H Endo, T Shimizu, K Miyasaka, E Tanaka, Y Anbo, S Hirano, S Kondo, H Katoh

  SURGERY TODAY 34 (7) 619 - 622 0941-1291 2004/07 [Refereed][Not invited]
   

  We report the case of a patient with pancreatic head cancer, whose replaced common hepatic artery (RCHA) arose from the superior mesenteric artery (SMA). We performed preoperative embolization of the RCHA, after which the liver blood flow was well maintained by the left gastric artery. The patient underwent a radical operation involving en bloc resection of the RCHA without any serious complications.
• Gastric tube-preserving pancreatoduodenectomy after esophagectomy and reconstruction using the gastric tube: Report of a case

  H Uehara, S Kondo, S Hirano, Y Ambo, E Tanaka, H Katoh

  SURGERY TODAY 34 (7) 623 - 625 0941-1291 2004/07 [Refereed][Not invited]
   

  We herein present the case of an intraductal papillary mucinous tumor of the pancreas resected by a gastric tube-preserving pancreatoduodenectomy in a patient who underwent an esophagectomy and reconstruction using the gastric tube. To preserve the gastric tube, the gastroduodenal artery and right gastroepiploic vein must be successfully skeletonized and preserved. In the present case, the vascular anatomy was clarified not only two-dimensionally with the use of selective abdominal angiography, but also three-dimensionally with the use of helical computed tomography. After precisely identifying the location of the tumor in relation of the blood vessels, it was confirmed that a gastric tube-preserving pancreatoduodenectomy was feasible. A detailed analysis of the vascular anatomy should be carried out by helical computed tomography preoperatively. When the radicality of tumor resection is not compromised, a gastric tube-preserving pancreatoduodenectomy can be recommended, due to the fact that it is considered to be less invasive.
• Role of hepatectomy in the treatment of hilar bile duct carcinoma

  T Tsuchikawa, S Kondo, S Hirano, E Tanaka, Y Anbo, T Morikawa, S Okushiba, H Katoh

  SURGERY TODAY 34 (5) 405 - 408 0941-1291 2004/05 [Refereed][Not invited]
   

  Purpose. To clarify the role of hepatic resection in the surgical treatment of hilar bile duct carcinoma. Methods. Between 1980 and 1997, 68 patients underwent surgery for hilar bile duct carcinoma. The patients were divided into a hepatectomy group (n = 40) and a nonhepatectomized group (n = 28) depending on whether they underwent resection of the bile duct confluence in combination with hepatectomy, or alone, respectively. Background data, operative morbidity and mortality, and survival were retrospectively compared between the two groups. Results. There were no significant differences in morbidity and mortality, or in postoperative survival between the two groups (the 5-year survival rates being 20.6% in the hepatectomized group and 7.1% in the nonhepatectomized group; P = 0.0806). However, patients who underwent curative resection had significantly better postoperative survival than those who underwent noncurative resection (P = 0.048). Hepatectomy provided a significantly better cancer-free margin than bile duct resection alone (P = 0.0296). Conclusions. Although a countermeasure must be taken to decrease mortality, the introduction of hepatectomy with bile duct resection would provide a better cancer-free surgical margin than bile duct resection alone for hilar bile duct carcinoma. Curative resection contributed to long-term survival in this series.
• Ischemic gastropathy after distal pancreatectomy with celiac axis resection

  S Kondo, H Katoh, S Hirano, Y Ambo, E Tanaka, Y Maeyama, T Morikawa, S Okushiba

  SURGERY TODAY 34 (4) 337 - 340 0941-1291 2004/04 [Refereed][Not invited]
   

  Purpose. Stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries is a radical operation performed for locally advanced cancer of the pancreatic body. However, it is not known whether the collateral pathways that develop immediately from the superior mesenteric artery to the gastroduodenal and hepatic arteries provide sufficient blood flow to support the hepatobiliary system and the stomach. This article examines the ischemic gastropathy that can occur after this procedure and identifies the predisposing conditions. Methods. Between 1997 and 2001, nine patients underwent stomach-preserving distal pancreatectomy with en bloc resection of the celiac, common hepatic, and left gastric arteries. Concomitant resection of the right gastric artery or gastroduodenal artery was performed due to cancer infiltration in three patients. Results. Irregular, shallow, and wide ulcerations thought to be ischemic in origin developed in these three patients, but all the ulcerations healed in 1-2 weeks with antiulcer medication. None of the other six patients had evidence of gastric ischemia. Conclusions. Ischemic gastropathy is rare after distal pancreatectomy with celiac axis resection alone; however, division of additional arteries supplying the stomach may predispose to ischemic gastropathy.
• Genome-wide cDNA microarray analysis of gene expression profiles in pancreatic cancers using populations of tumor cells and normal ductal epithelial cells selected for purity by laser microdissection

  T Nakamura, Y Furukawa, H Nakagawa, T Tsunoda, H Ohigashi, K Murata, O Ishikawa, K Ohgaki, N Kashimura, M Miyamoto, S Hirano, S Kondo, H Katoh, Y Nakamura, T Katagiri

  ONCOGENE 23 (13) 2385 - 2400 0950-9232 2004/03 [Refereed][Not invited]
   

  To characterize molecular mechanism involved in pancreatic carcinogenesis, we analysed gene-expression profiles of 18 pancreatic tumors using a cDNA microarray representing 23 040 genes. As pancreatic ductal adenocarcinomas usually contain a low proportion of cancer cells in the tumor mass, we prepared 95% pure populations of pancreatic cancer cells by means of laser microbeam microdissection, and compared their expression profiles to those of similarly purified, normal pancreatic ductal cells. We identified 260 genes that were commonly upregulated and 346 genes that were downregulated in pancreatic cancer cells. Because of the high degree of purity in the cell populations, a large proportion of genes that we detected as upregulated or downregulated in pancreatic cancers were different from those reported in previous studies. Comparison of clinicopathological parameters with the expression profiles indicated that altered expression of 76 genes was associated with lymph-node metastasis and that of 168 genes with liver metastasis. In addition, expression levels of 30 genes were related to the recurrence of disease. These genome-wide expression profiles should provide useful information for finding candidate genes whose products might serve as specific tumor markers and/or as molecular targets for treatment of patients with pancreatic cancer.
• Arterioportal shunting as an alternative to microvascular reconstruction after hepatic artery resection

  S Kondo, S Hirano, Y Ambo, E Tanaka, T Kubota, H Katoh

  BRITISH JOURNAL OF SURGERY 91 (2) 248 - 251 0007-1323 2004/02 [Refereed][Not invited]
   

  Background: Portal vein and hepatic artery resection and reconstruction may be required in radical surgery for biliary cancer. Microvascular reconstruction requires special equipment and training, and may be difficult to accomplish when the arterial stump is small, when there are multiple vessels or when the stump lies deep within the wound. This study examined the feasibility and safety of arterioportal shunting as an alternative to arterial reconstruction. Methods: Over 30 months, ten patients with biliary cancer (six bile duct and four gallbladder carcinomas) underwent radical surgery with en bloc resection of the hepatic artery and end-to-side arterioportal reconstruction between the common hepatic or gastroduodenal artery and the portal trunk. Results: No patient died. Complications included bile leakage in two patients and liver abscess in one. Routine angiography performed 1 month after surgery revealed shunt occlusion in three patients. Once the existence of hepatopetal arterial collaterals had been confirmed in the remaining patients, the shunt was occluded by coil embolization. Conclusion: Arterioportal shunting appears to be a safe alternative to microvascular reconstruction after hepatic artery resection. However, the safety of the procedure and its potential to increase the cure rate require further assessment in a larger series with a longer follow-up.
• O-020 胸腔鏡手術導入後11年間の呼吸器外科手術の変遷(胸腔鏡)(一般口演4)

  森川 利昭, 小西 和哉, 大竹 節之, 加地 苗人, 平野 聡, 田中 栄一, 奥芝 俊一, 近藤 哲, 加藤 紘之

  日本呼吸器外科学会雑誌 特定非営利活動法人 日本呼吸器外科学会 18 (3) 305 - 305 2004
• P-308 両側同時呼吸器手術における胸腔鏡アプローチの検討(胸腔鏡2)(一般示説32)

  小西 和哉, 中西 善嗣, 大竹 節之, 加地 苗人, 平野 聡, 森川 利昭, 奥芝 俊一, 近藤 哲, 加藤 紘之

  日本呼吸器外科学会雑誌 特定非営利活動法人 日本呼吸器外科学会 18 (3) 413 - 413 2004
• Venous-drainage-guided selective hepatectomy: A novel approach to liver surgery

  S Kondo, H Katoh, S Hirano, Y Ambo, E Tanaka, K Saito, T Noji, S Okushiba, T Morikawa, K Taira, H Hishiyama

  HEPATO-GASTROENTEROLOGY 51 (55) 1 - 3 0172-6390 2004/01 [Refereed][Not invited]
   

  Selective hepatectomy under the guidance of hepatic venous drainage has not yet been developed because hepatic venous occlusion alone produces no visible congested area. Now that this area can be identified by simultaneous occlusion of the hepatic vein and artery, venous-drainage-guided selective hepatectomy is considered feasible. Because the congested area becomes dysfunctional or atrophic due to the absence of portal blood supply, it can be regarded as a first candidate for preventive resection in livers that may bear latent tumors. We report here a novel approach to selective hepatectomy. Segment 4 hepatectomy and ventral hemisectorectomy of segments 5 + 8, with middle hepatic vein resection, was undertaken in a patient with hepatocellular carcinoma. After hepatic dissection between segments 2 + 3 and 4, the root of the middle hepatic vein was isolated. Test clamping of the middle hepatic vein and proper hepatic artery demonstrated a discolored area. Hepatic dissection was performed along the discolored border towards the hepatic hilum, exposing the right anterior portal pedicle with division of the ventral branches. The middle hepatic vein was finally divided. Selective hepatectomy was successfully performed without transfusion or complications. Venous-drainage-guided selective hepatectomy is feasible with acceptable perioperative results.
• Outcome of duodenum-preserving resection of the head of the pancreas for intraductal papillary-mucinous neoplasm

  S Hirano, S Kondo, Y Ambo, E Tanaka, T Morikawa, S Okushiba, H Katoh

  DIGESTIVE SURGERY 21 (3) 242 - 245 0253-4886 2004 [Refereed][Not invited]
   

  Background: The standard surgical procedure for intraductal papillary-mucinous neoplasm of the pancreatic head is pylorus-preserving pancreatoduodenectomy. A less extensive resection may be justified because most intraductal papillary-mucinous neoplasms are benign or of low-grade malignancy. Aims and Methods: The outcome of duodenum-preserving pancreatic head resection with preservation of the main bile duct was evaluated retrospectively in 13 patients with a branch-type intraductal papillary-mucinous neoplasm in the head of the pancreas and with a median ( range) follow-up of 60.0 (0.3 - 99.5) months. Results: Post-operative complications included anastomotic leakage (n = 3), bile duct perforation ( n = 1), intra-abdominal bleeding ( n = 3), delayed gastric emptying ( n = 2) and death ( n = 2). All the resection margins were clear of tumour on histological examination. Ten of 11 patients maintained over 90% of their pre-operative body weight. Glucose tolerance improved in 4 of 11 evaluable patients, was unchanged in 6 and worsened in 1 patient. Biliary scintigraphy showed that bile flow was delayed compared with that before surgery (8.8 +/- 1.1 vs. 19.6 +/- 4.6 min; p = 0.03). Neither recurrence nor metastasis was observed. Conclusion: The results of duodenum-preserving pancreatic head resection for branch duct-type intraductal papillary-mucinous neoplasm were satisfactory and provided a good quality of life. Copyright (C) 2004 S. Karger AG, Basel.
• 初回手術12年後に再発した中部胆管粘膜内癌の1例

  中西 喜嗣, 近藤 哲, 安保 義恭, 阿部 元輝, 野路 武寛, 田中 栄一, 平野 聡, 森川 利昭, 奥芝 俊一, 加藤 紘之

  日本臨床外科学会雑誌 日本臨床外科学会 64 (11) 2941 - 2941 1345-2843 2003/11
• Isolated paracaval subsegmentectomy of the caudate lobe of the liver

  S Kondo, H Katoh, S Hirano, Y Ambo, E Tanaka, S Okushiba, T Morikawa

  LANGENBECKS ARCHIVES OF SURGERY 388 (3) 163 - 166 1435-2443 2003/07 [Refereed][Not invited]
   

  Background: The caudate lobe of the liver is divided into three subsegments based on the portal blood supply: the Spiegel lobe, the paracaval portion (S1r), and the candate process. An isolated paracaval (S1r) subsegmentectomy is indicated for a small hepatocellular carcinoma localized within S1r. Because this challenging procedure has not been described, we report the details of successful surgical technique. Methods: The portal pedicle isolation technique provides easy access to the S1r portal pedicle. A tape is passed along the midline of the anterior surface of the vena cava and its lower end is passed through the caudate parenchyma dorsoventrally to establish a landmark for the left border of S1r. A liver-splitting anterior approach is used to open the interlobar plane widely to the precaval tape. As exposing the vena cava and the root of the right hepatic vein, parenchymal dissection is advanced to the right and then, upward. Results: The procedure was performed successfully in a 51-year-old man with hepatitis B who had a 2-cm hepatocellular carcinoma in S1r. Blood loss was 645 ml. Conclusions: An isolated paracaval subsegmentectomy of the caudate lobe can be performed successfully, although it is likely to remain an uncommonly used procedure.
• FALS(Finger-Assisted Laparoscopic Surgery)下に胃全摘術を行った早期多発胃癌の1例

  石川 慶大, 奥芝 俊一, 浅野 賢道, 七戸 俊明, 川原田 陽, 北城 秀司, 上野 孝男, 大竹 節之, 加地 苗人, 田中 栄一, 安保 義恭, 平野 聡, 森川 利昭, 近藤 哲, 加藤 紘之

  北海道外科雑誌 北海道外科学会 48 (1) 73 - 73 0288-7509 2003/06
• Portal vein resection and reconstruction prior to hepatic dissection during right hepatectomy and caudate lobectomy for hepatobiliary cancer

  S Kondo, H Katoh, S Hirano, Y Ambo, E Tanaka, S Okushiba

  BRITISH JOURNAL OF SURGERY 90 (6) 694 - 697 0007-1323 2003/06 [Refereed][Not invited]
   

  Background: Hepatobiliary cancer invading the hilar bile duct often involves the portal bifurcation. Portal vein resection and reconstruction is usually performed after completion of the hepatectomy. This retrospective study assessed the safety and usefulness of portal vein reconstruction prior to hepatic dissection in right hepatectomy and caudate lobectomy plus biliary reconstruction, one of the common procedures for radical resection. Methods: Clinical characteristics and perioperative results were compared in patients who underwent right hepatectomy and caudate lobectomy plus biliary reconstruction with (ten patients) and without (11 patients) portal reconstruction from September 1998 to March 2002. Results: All ten portal vein reconstructions were completed successfully before hepatic dissection; the portal cross-clamp time ranged from 15 to 41 (median 22) min. Blood loss, blood transfusion during the operation, postoperative liver function, morbidity and length of hospital stay were similar in the two groups. No patient suffered postoperative hepatic failure or death. Conclusion: This study demonstrates that portal vein reconstruction does not increase the morbidity or mortality associated with right hepatectomy and caudate lobectomy with biliary reconstruction. This approach facilitates portal vein reconstruction for no-touch resection of hepatobiliary cancer invading the hilar bile duct.
• Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body

  S Kondo, H Katoh, S Hirano, Y Ambo, E Tanaka, S Okushiba, T Morikawa

  LANGENBECKS ARCHIVES OF SURGERY 388 (2) 101 - 106 1435-2443 2003/04 [Refereed][Not invited]
   

  Background: Locally advanced cancer of the pancreatic body involving the celiac and/or common hepatic arteries is often considered unresectable. Radical distal pancreatectomy with en bloc resection of these arteries without reconstruction was recently introduced to treat these tumors. However, experience is still limited. This study reviewed the safety and utility of the operation. Patients and methods: We retrospectively studied the charts of 13 patients who underwent radical distal pancreatectomy. Results: Unplanned arterial reconstruction was required in three patients due to accidental injury. The postoperative mortality rate was 0% despite a morbidity rate of 62%. Patient's intractable abdominal and/or back pain was completely relieved immediately after surgery. Contrary to expectations, postoperative diarrhea was mild. The surgical margins, including the retroperitoneum, were clear histologically (R0 resection) in all patients. The 1- and 2-year survival rates were 51% and 14%, respectively, and median survival was 12.2 months. The site of recurrence was the liver in six patients and retroperitoneum in one. Conclusions: Distal pancreatectomy with en bloc resection of the celiac artery is feasible and safe, offers a high resectability rate, and has dramatic analgesic effect. Local control of disease is excellent despite frequent hepatic recurrence.
• IgE-mediated activation of NK cells through Fc gamma RIII.

  Arase N, Arase H, Hirano S, Yokosuka T, Sakurai D, Saito T

  Journal of immunology (Baltimore, Md. : 1950) 170 (6) 3054 - 3058 0022-1767 2003/03 [Refereed][Not invited]
   

  NK cells express FcγRIII (CD16), which is responsible for IgG-dependent cell cytotoxicity and for production of several cytokines and chemokines. Whereas FcγRIII on NK cells is composed of both FcγRIIIα and FcRγ chains, that on mast cells is distinct from NK cells and made of FcγRIIIα, FcRβ, and FcRγ. Mast cells show degranulation and release several mediators, which cause anaphylactic responses upon cross-linking of FcγRIII as well as FcεRI with aggregated IgE. In this paper, we examined whether IgE activates NK cells through FcγRIII on their cell surface. We found that NK cells produce several cytokines and chemokines related to an allergic reaction upon IgE stimulation. Furthermore, NK cells exhibited cytotoxicity against IgE-coated target cells in an FcγRIII-dependent manner. These effects of IgE through FcγRIII were not observed in NK cells from FcRγ-deficient mice lacking FcγRIII expression. Collectively, these results demonstrate that NK cells can be activated with IgE through FcγRIII and exhibit both cytokine/chemokine production and Ab-dependent cell cytotoxicity. These data imply that not only mast cells but also NK cells may contribute to IgE-mediated allergic responses.
• Middle colic artery-gastroepiploic artery bypass for compromised collateral flow in distal pancreatectomy with celiac artery resection

  S Kondo, Y Ambo, H Katoh, S Hirano, E Tanaka, S Okushiba, T Morikawa, H Igawa, Y Yamamoto, T Sugihara

  HEPATO-GASTROENTEROLOGY 50 (50) 305 - 307 0172-6390 2003/03 [Refereed][Not invited]
   

  Background/Aims: Radical distal pancreatectomy with en-bloc resection of the common hepatic, celiac, and left gastric arteries for pancreatic body cancer that involves these arteries does not routinely require arterial reconstruction because the collateral pathways via the pancreatoduodenal arcades from the superior mesenteric artery are recruited immediately. However, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and may lead to fatal complications. This article describes the middle colic artery-gastroepiploic artery bypass as an emergent salvage procedure for restoring collateral flow. Methodology: The inferior pancreatoduodenal artery was accidentally injured in 2 of 9 patients who underwent the radical procedure between 1997 and 2001. Microvascular anastomosis between the left branch of the middle colic artery and the gastroepiploic artery in an end-to-side fashion was employed. Results: The pulsation of the gastroepiploic artery and the color of the stomach recovered immediately after completion of the middle colic artery-gastroepiploic artery bypass. No ischemia-related complication developed. postoperatively. Postoperative angiography showed the middle colic artery-gastroepiploic artery bypass supplying arterial flow to the liver, stomach, duodenum, and pancreas. Conclusions: The middle colic artery-gastroepiploic artery bypass is an excellent alternative restoring compromised collateral flow via the pancreatoduodenal arcades when microsurgical technique is available.
• 当科における左側肺癌に対する胸腔鏡下肺葉切除症例の検討

  大竹 節之, 森川 利昭, 加地 苗人, 上野 孝男, 角谷 昌俊, 山吹 匠, 平野 聡, 奥芝 俊一, 近藤 哲, 加藤 紘之

  日本呼吸器外科学会雑誌 特定非営利活動法人 日本呼吸器外科学会 17 (3) 365 - 365 2003
• 胸腔鏡手術の導入による原発性肺癌治療成績への影響

  森川 利昭, 加地 苗人, 大竹 節之, 上野 孝男, 平野 聡, 田中 栄一, 奥芝 俊一, 近藤 哲, 加藤 紘之

  日本呼吸器外科学会雑誌 特定非営利活動法人 日本呼吸器外科学会 17 (3) 277 - 277 2003
• Significance of selective shunt operation for portal hypertension

  加藤 紘之, 平野 聡, 近藤 哲

  Japanese Journal of Portal Hypertension 日本門脈圧亢進症学会 9 (2) 93 - 97 1344-8447 2003 

  シャントは閉じるべきか, 開くべきかについて, 選択的シャント形成の立場から述べた.選択的シャントの意義は, 静脈瘤破裂の危険性を有するいわば悪玉シャントをその危険性のない善玉シャントに変換させることにある.しかし, 善玉と考え形成したシャントに多量の門脈血が流入すると肝性脳症を引き起こし長期生存を不可能にする悪玉シャントになり得るので, 食道・胃上部のみを限定的low pressure zoneとするdistal spleno renal shunt with spleno pancreatic and gastric disconnection (DSRS with SPGD) を施行すべきである.
• Long-Term Survival after Radical Resection of Advanced Pancreatic Cancer: A Case Report with Special Reference to CD8+ T-Cell Infiltration

  Motoki Abe, Satoshi Kondo, Satoshi Hirano, Yoshiyasu Ambo, Eiichi Tanaka, Toshiaki Morikawa, Shunichi Okushiba, Hiroyuki Katoh

  International Journal of Gastrointestinal Cancer 33 (2-3) 107 - 110 0169-4197 2003 [Refereed][Not invited]
   

  A 65-yr-old man who underwent pancreaticoduodenectomy with portal vein resection for pancreatic cancer is alive 8 yr after surgery. Originally, computed tomography (CT) revealed an 8-cm tumor in the pancreatic head. The tumor had infiltrated the portal vein, but grew expansively, so there was neither biliary obstruction nor jaundice. Pancreaticoduodenectomy with resection of the portal vein was performed for pancreatic cancer. Many tumor-infiltrating lymphocytes were seen within cancer cell nests on routine histopathology. We performed immunostaining for CD8, and found that a large number of the lymphocytes were CD8+ T cells. The patient's prognosis was considered poor because the tumor was large and had infiltrated the portal vein. We suspect that long-term survival may be related to the response of CD8+ T cells to the cancer.
• Long-term survival after radical resection of advanced pancreatic cancer: a case report with special reference to CD8+ T-cell infiltration.

  Abe M, Kondo S, Hirano S, Ambo Y, Tanaka E, Morikawa T, Okushiba S, Katoh H

  International journal of gastrointestinal cancer 33 (2-3) 107 - 110 1537-3649 2003 [Refereed][Not invited]
  
• Carcinoma of the cystic duct remnant with direct colonic invasion.

  Noji T, Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Katoh H

  International journal of gastrointestinal cancer 34 (2-3) 117 - 120 1537-3649 2003 [Refereed][Not invited]
  
• Role of C-terminal region of Staphylococcal nuclease for foldability, stability, and activity

  S Hirano, K Mihara, Y Yamazaki, H Kamikubo, Y Imamoto, M Kataoka

  PROTEINS-STRUCTURE FUNCTION AND BIOINFORMATICS 49 (2) 255 - 265 0887-3585 2002/11 [Refereed][Not invited]
   

  The role of the C-terminal region of Staphylococcal nuclease (SNase) was examined by deletion mutation. Deletions up to eight residues do not affect the structure and function. The structure and enzymatic activity were partially lost by deleting Ser141-Asn149 (Delta141-149), and deletion of Trp140-Asn149 (Delta140-149) resulted in further loss of structure and activity. A 13-residue deletion showed the same effect as the 10-residue deletion. Both Ser141Gln and Ser141Ala mutations for an eight-residue deletion mutant did not alter properties as well as Ser141Ala for full-length SNase. In contrast, Trp140Ala mutation for Delta141-149 shows the same effect as the deletion of Trp140. Trp140Ala mutation for full-length SNase causes the loss of native structure. These observations indicate the significance of the 140th and the 141st residues. The side-chain of the 140th residue is required to be tryptophan; however, the backbone of the 141st residue is solely critical for foldability, but the side-chain information is not crucial. All of the mutants that take a non-native conformation show enzymatic activity and inhibitor-induced folding, suggesting that foldability is required for the activity. (C) 2002 Wiley-Liss, Inc.
• Primary sclerosing cholangitis associated with autoimmune pancreatitis

  T Ichimura, S Kondo, Y Ambo, S Hirano, M Ohmi, S Okushiba, T Morikawa, M Shimizu, H Katoh

  HEPATO-GASTROENTEROLOGY 49 (47) 1221 - 1224 0172-6390 2002/09 [Refereed][Not invited]
   

  We present 2 cases of primary sclerosing cholangitis complicated with autoimmune pancreatitis with narrowing of the pancreatic duct. In both cases, endoscopic retrograde cholangiography showed the characteristic findings of primary sclerosing cholangitis. In addition, positivity for autoantibody, hypergamma-globulinemia and narrowing of the pancreatic duct shown on endoscopic retrograde pancreatography were noticed in both. They were thus diagnosed as autoimmune pancreatitis. Whereas it is well known that primary sclerosing cholangitis is often complicated with chronic. pancreatitis, it has rarely been studied whether, the chronic pancreatitis is autoimmune pancreatitis or not. In English literature, possibly 7 equivalent cases have been reported so far. In those cases, the onset was in the post-prime of life, and the disease was frequently accompanied with Sjogren's syndrome, but not with ulcerative colitis; frankly the nature of the disease was slightly different from what has traditionally been thought as a typical primary sclerosing cholangitis. In primary sclerosing cholangitis complicated with autoimmune pancreatitis, the autoimmune mechanism seems to be much involved, and, thus steroid therapy might be effective as in Case 2 in our series.
• A case of pulmonary adenocarcinoma accompanied by superior vena caval thrombosis in a patient with Peutz-Jeghers syndrome

  S Hirano, Y Takiguchi, H Igari, K Hiroshima, M Shingyoji, R Watanabe, T Moriya, N Tanabe, K Tatsumi, T Kuriyama

  JAPANESE JOURNAL OF CLINICAL ONCOLOGY 32 (8) 307 - 309 0368-2811 2002/08 [Refereed][Not invited]
   

  A case of lung adenocarcinoma and extensive deep vein thrombosis in a patient with Peutz-Jeghers syndrome (PJS) is presented. A 31-year-old Chinese man complained of shoulder pain and swelling of the right arm. A series of diagnostic procedures revealed a primary adenocarcinoma in, the left upper lobe with cervical and supraclavicular lymph node metastases accompanied by deep vein thrombosis in the superior vena cava and right jugular vein. In addition, typical pigmentation of the lips and oral mucosa and multiple hamartomas in the stomach, duodenum and colon led to the diagnosis of PJS. PJS is known to be associated with increased risk of malignancies, especially in the gastrointestinal tract, breast, genitals and pancreas. As bronchoscopic examination showed no hamartomatous lesions in the bronchi, the development of primary lung cancer in this young patient might be independent of any hamartomatous lesion and might be associated with some genetic factors relating to PJS.
• Staged hepatectomy following arterial embolization for ruptured hepatocellular carcinoma

  T Takebayashi, S Kondo, Y Ambo, S Hirano, M Omi, T Morikawa, S Okushiba, H Katoh

  HEPATO-GASTROENTEROLOGY 49 (46) 1074 - 1076 0172-6390 2002/07 [Refereed][Not invited]
   

  Background/Aims: While hemostasis by transcatheter arterial embolization is often the first choice in the initial treatment of ruptured hepatocellular carcinoma, post-transcatheter arterial embolization. treatment has not fully been established. We studied the prognoses of ruptured hepatocellular carcinoma cases where hepatectomy was possible after transcatheter arterial embolization. Methodology: We retrospectively reviewed 10 cases of ruptured hepatocellular carcinoma which had been treated in our institution between 1989 and 1998. In all the 10 cases, emergency transcatheter arterial embolization was performed, which successfully achieved hemostasis. Results: Following the achievement of hemostasis by transcatheter arterial embolization, hepatectomy was carried out in 5 cases after evaluation of general condition, functional liver reserve and extent of tumor spread. There was neither operative nor hospital death. One-year and 3-year survival rates were 100% and 40%, respectively, and 50% survival time was 36 months. In the other 5 patients, hepatectomy was decided to be impossible after evaluation of general condition, functional liver reserve and extent of tumor spread; all of them died within 0.5-10 months after transcatheter arterial embolization. Conclusions: Among the patients with ruptured hepatocellular carcinoma, those in which hepatectomy was decided to be possible after evaluation of general condition, functional liver reserve and extent of tumor spread, following successful hemostasis by transcatheter arterial embolization, had fairly good prognoses.
• Treatment of Budd-Chiari syndrome with percutaneous transluminal angioplasty: Report of a case

  M Suzuoki, S Kondo, Y Ambo, S Hirano, M Omi, S Okushiba, H Katoh

  SURGERY TODAY 32 (6) 559 - 562 0941-1291 2002 [Refereed][Not invited]
   

  We report the successful treatment of Budd-Chiari syndrome (BCS) due to an obstruction of the hepatic veins. A 19-year-old man developed bleeding esophageal and gastric varices, and a large amount of ascites was thus caused by portal hypertension. BCS complicated by an obstruction of the major hepatic veins was diagnosed after examinations. We performed percutaneous transluminal angioplasty (PTA). This resulted in a great improvement of BCS, a marked decrease in the pressure of the hepatic veins, and the disappearance of ascites. Restenosis occurred at 1 year and 5 years after the initial angioplasty, for which PTA was repeatedly performed. Nine years after the initial treatment, no stenosis has been observed and the patient has shown a favorable outcome.
• Vedge resection of the portal bifurcation concomitant with left hepatectomy plus biliary reconstruction for hepatobiliary cancer

  Satoshi Kondo, Hiroyuki Katoh, Satoshi Hirano, Yoshiyasu Ambo, Eiichi Tanaka, You Kawarada, Matsuhito Kaji, Setsuyuki Ohtake, Shunichi Okushiba, Toshiaku Morikawa

  Journal of Hepato-Biliary-Pancreatic Surgery 9 (5) 603 - 606 0944-1166 2002 [Refereed][Not invited]
   

  Background/Purpose. We report our experience performing wedge resection of the portal bifurcation and transverse suture closure in patients undergoing left hepatectomy and caudate lobectomy plus biliary reconstruction for hepatobiliary cancer. Methods. The procedure was performed in three patients with hilar or intrahepatic cholangiocarcinoma. After confirming that tumor invasion of the portal bifurcation was not circumferential, the portal trunk and the right posterior and right anterior portal branches were isolated and clamped. Wedge resection of the portal bifurcation was performed, taking care to secure a clear surgical margin. The edges of the portal vein were approximated, using guy-sutures in the dorsal and ventral edges and a temporary central guy-suture, and portal reconstruction was carried out using a continuous transverse suture. After unclamping, good portal flow was confirmed by color Doppler ultrasonography. Results. The procedure was completed successfully in all three patients the average time of portal vein occlusion was 15 min. Two patients had postoperative complications: bile leakage and wound infection, but no patient developed postoperative hepatic failure or died. The three patients are alive without recurrence at 2, 11, and 22 months after the operation. Conclusions. Wedge resection of the portal bifurcation is easier and simpler than using a venous patch or performing segmental resection.
• Intraductal oncocytic papillary neoplasm of the pancreas shows strong positivity on FDG-PET.

  Noji T, Kondo S, Hirano S, Ambo Y, Tanaka E, Katoh C, Tsukamoto E, Tamaki N, Katoh H

  International journal of gastrointestinal cancer 32 (1) 43 - 46 1537-3649 2002 [Refereed][Not invited]
  
• DIC-CT findings of biliary cystadenocarcinoma communicating with the bile duct: A case report

  J Matsumoto, S Kondo, S Okushiba, T Morikawa, H Sugiura, M Omi, S Hirano, Y Ambo, H Katoh

  HEPATO-GASTROENTEROLOGY 48 (40) 1005 - 1006 0172-6390 2001/07 [Refereed][Not invited]
   

  Among the intrahepatic cystic diseases except Caroli's disease, only biliary cystadenoma/cystadenocarcinoma may communicate with the bile duct. We present a case of biliary cystadenocarcinoma in which drip infusion cholangiographic-computed tomography demonstrated communication between an intrahepatic cyst and the biliary system preoperatively. Drip infusion cholangiographic-computed tomography, a simple and noninvasive examination, is useful for differentiating biliary cystadenoma/cystadenocarcinoma from other intrahepatic cystic lesions.
• Treatment of hepatocellular carcinoma occurring after distal splenorenal shunt for esophagogastric varices

  S Hirano, S Kondo, M Omi, Y Anbo, H Katoh

  HEPATO-GASTROENTEROLOGY 48 (40) 1110 - 1113 0172-6390 2001/07 [Refereed][Not invited]
   

  Background/Aims: Whereas endoscopic therapy is hardly effective, distal splenorenal shunt is expected to have permanent hemostatic effects on the esophagogastric varices complicated with hepatocellular carcinoma and to sustain favorable general condition of the patient. In this study, we examined the effects of the shunt in the patients who developed hepatocellular carcinoma during the follow-up of the shunt operation. Methodology: Among the patients who had undergone distal splenorenal shunt operation for portal hypertension caused by cirrhosis, we selected only those who developed hepatocellular carcinoma during the follow-up, and then we reviewed our treatment of hepatocellular carcinoma. Results: Hepatocellular carcinomas developed postoperatively in 12 out of 59 patients with the shunt operation. At onset of the carcinomas, the varices were well controlled with no risk of bleeding; and the liver function was reasonably maintained and pancytopenia was alleviated, compared to those at shunt operation. We performed hepatectomy in 4 cases and nonoperative therapies in 8 cases. After the therapies, no variceal bleeding occurred. Those therapies caused minor complications but no death. Conclusions: Distal splenorenal shunt is a useful therapy for postcirrhotic esophagogastric varices as it enables us to safely perform therapies for the hepatocellular carcinomas that develop during the follow-up period.
• Radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for advanced cancer of the pancreatic body: A preliminary report on perfect pain relief

  Satoshi Kondo, Hiroyuki Katoh, Makoto Omi, Satoshi Hirano, Yoshiyasu Ambo, Eiichi Tanaka, Shunichi Okushiba, Toshiaki Morikawa, Michio Kanai, Takashi Yano

  Journal of the Pancreas 2 (3) 93 - 97 1590-8577 2001/05 [Refereed][Not invited]
   

  Objective. The purpose of this study was to report the effect of radical distal pancreatectomy with en bloc resection of the celiac artery, plexus, and ganglions for locally advanced cancer of the pancreatic body on intractable abdominal and/or back pain and to explore the histopathologic mechanism of this pain. Patients. Five patients with pancreatic body cancer involving the celiac and/or common hepatic artery underwent this radical surgery intended to cure the cancer. Design. A retrospective analysis was performed. Main outcome measures. Surgical magnitude, postoperative pain control, postoperative outcome, and histopathologic findings were studied. Results. Arterial reconstruction, gastrointestinal reconstruction, and blood transfusions were unnecessary. The organ deficit was limited to the distal pancreas, spleen and left adrenal gland. There was no postoperative mortality. Postoperative complications occurred in four patients, who were successfully managed with medical treatment. This led to prolonged hospital stays. The intractable preoperative abdominal and/or back pain was completely relieved immediately after surgery in all patients. Perfect pain control has been maintained from surgery to the last follow-up. Histopathologic examination of the surgical specimens revealed cancer invasion of the celiac plexus in all patients. Conclusions. This operation offers not only disease radicality but also perfect pain relief. The survival benefit has not yet been fully defined.
• Surgical closure of the gastrorenal shunt with distal splenorenal shunt operation for portosystemic encephalopathy

  K Kato, S Kondo, S Hirano, M Omi, Y Ambo, S Okushiba, H Katoh

  HEPATO-GASTROENTEROLOGY 48 (39) 840 - 841 0172-6390 2001/05 [Refereed][Not invited]
   

  A 67-year-old woman was admitted to our institution hepatic encephalopathy. Careful examination revealed a large gastrorenal shunt. On an occlusion test of the gastrorenal shunt using a balloon catheter, portal vein pressure increased to as high as 26cm H2O from the pretest value of 17.5cm H2O. From the significant increase of portal vein pressure, it thought that simple closure of the shunt could cause postoperative formation of an esophageal varix and its rupture. We thus performed shunt closure with distal splenorenal shunt with splenopancreatic and gastric disconnection to prevent the hazard. In treating the encephalopathy caused by a spontaneous shunt, it is one of the options to perform distal splenorenal shunt with splenopancreatic and gastric disconnection in addition to shunt closure if a remarkable increase of portal vein pressure is observed by the shunt occlusion test.
• Biliary cystadenocarcinoma with superficial spread to the extrahepatic bile duct

  J Matsumoto, S Kondo, S Okushiba, T Morikawa, H Sugiura, A Omi, S Hirano, Y Ambo, H Katoh, M Fujita, M Shimizu

  HEPATO-GASTROENTEROLOGY 48 (39) 647 - 649 0172-6390 2001/05 [Refereed][Not invited]
   

  We report a case of biliary cystoadenocarcinoma of the liver with superficial spread to the extrahepatic bile duct. Preoperative endoscopic retrograde cholangiography revealed communication between a 4.5-cm cyst in segment 4 of the liver and the bile duct. From the findings obtained by peroral cholangioscopy and intraoperative cholangioscopy, the granular mucosa in the bile duct was diagnosed as superficially spreading cancer. The right posterior segmental bile duct and the right anterior segmental bile duct were resected at the point where the spread of cancer was no longer traceable and left lobectomy plus caudate lobectomy was carried out. This achieved radical resection, leaving the resected margin of the bile duct free from cancer. Histopathologically, well-differentiated papillary adenocarcinoma was found on the inner surface of the cyst, and the cancer had superficially spread from the cyst to the extrahepatic bile duct via the 2.5-mm diameter communication between the cyst and bile duct. The cancer was limited only to the mucosal layer all over the lesion. When performing radical surgery for biliary cystadenocarcinoma, it is recommended that cholangioscopy be performed to examine whether the cancer has superficial spread to the extrahepatic bile duct or not. Bile duct resection should be carried out, depending on the extent of the superficial spread, so that the resected margin of the bile duct is free from cancer.
• Solitary true cyst of the pancreas in an adult: Report of a case

  Osamu Takahashi, Satoshi Kondo, Satoshi Hirano, Yoshiyasu Ambo, Eiichi Tanaka, Toshiaki Morikawa, Shunichi Okushiba, Hiroyuki Kato

  International Journal of Gastrointestinal Cancer 30 (3) 165 - 170 0169-4197 2001 [Refereed][Not invited]
   

  Background: Solitary true cyst of the pancreas is rare in adults, and the differential diagnosis of cystic lesions of the pancreas is challenging. Aim of the Study: To describe a solitary true cyst of the pancreas in an adult and discuss the differential diagnosis. Methods: A 50 yr old woman presented with a mass lesion in the right upper quadrant of the abdomen. Abdominal computed tomography showed a cystic lesion, with a maximum diameter of 12 cm, between the inferior surface of the liver and the ascending colon. The cyst was homogenous and had smooth edges. On magnetic resonance imaging, a unilocular cyst was seen that was low intensity on T1-weighted images and very high intensity on T2-weighted images. No connection between the cyst and the pancreatic ductal system was demonstrated on endoscopic retrograde cholangiopancreatography. Laparotomy was performed with a presumptive diagnosis of cystic tumor of the pancreas. Results: On pathologic examination, the cyst was serous and was lined with a single layer of normal cuboidal epithelium that was periodic acid Schiff stain negative. Meticulous examination failed to identify honeycomb-like microcysts characteristic of serous cystadenoma. The final diagnosis was a solitary true cyst of the pancreas. Conclusion: The differential diagnosis of solitary true cyst from other cystic lesion of the pancreas usually is based on histology. Particular care must be taken to distinguish this lesion from macrocystic serous cystadenoma.
• Portal venous dilatation and stenting for bleeding jejunal varices: Report of two cases

  K Hiraoka, S Kondo, Y Ambo, S Hirano, M Omi, S Okushiba, H Katoh

  SURGERY TODAY 31 (11) 1008 - 1011 0941-1291 2001 [Refereed][Not invited]
   

  We present two patients who underwent a portal stent placement for bleeding jejunal varices of the afferent loop caused by extrahepatic portal venous stenosis. Case 1 involved a 66-year-old woman who developed bleeding jejunal varices due to extrahepatic portal venous stenosis 1 year after a pancreaticoduodenectomy with intraoperative radiation therapy. Percutaneous transhepatic balloon dilatation and stent placement were performed. Since undergoing the procedure, no bleeding has occurred. Case 2 concerned a 44-year-old woman who had a rupture and bleeding of jejunal varices 16 years after a choledocojejunostomy. Stenosis was observed from the right and left branches of the portal vein to its intrahepatic branches. Both balloon dilatation and stent placement were attempted. However, the stent could not be fully inserted into the intrahepatic portal vein. Portal stent placement is less invasive and radical, and therefore should be attempted for the treatment of extrahepatic portal venous stenosis. However, there are limits to its application if the stenosis extends to the intrahepatic branches of the portal vein.
• Solitary true cyst of the pancreas in an adult - Report of a case

  O Takahashi, S Kondo, S Hirano, Y Ambo, E Tanaka, T Morikawa, S Okushiba, H Kato

  JOURNAL OF GASTROINTESTINAL CANCER 30 (3) 165 - 170 1941-6628 2001 [Refereed][Not invited]
   

  Background: Solitary true cyst of the pancreas is rare in adults, and the differential diagnosis of cystic lesions of the pancreas is challenging. Aim of the Study: To describe a solitary true cyst of the pancreas in an adult and discuss the differential diagnosis. Methods: A 50 yr old woman presented with a mass lesion in the right upper quadrant of the abdomen. Abdominal computed tomography showed a cystic lesion, with a maximum diameter of 12 cm, between the inferior surface of the liver and the ascending colon. The cyst was homogenous and had smooth edges. On magnetic resonance imaging, a unilocular cyst was seen that was low intensity on T1-weighted images and very high intensity on T2-weighted images. No connection between the cyst and the pancreatic ductal system was demonstrated on endoscopic retrograde cholangiopancreatography. Laparotomy was performed with a presumptive diagnosis of cystic tumor of the pancreas. Results: On pathologic examination, the cyst was serous and was lined with a single layer of normal cuboidal epithelium that was periodic acid Schiff stain negative. Meticulous examination failed to identify honeycomb-like microcysts characteristic of serous cystadenoma. The final diagnosis was a solitary true cyst of the pancreas. Conclusion: The differential diagnosis of solitary true cyst from other cystic lesion of the pancreas usually is based on histology. Particular care must be taken to distinguish this lesion from macrocystic serous cystadenoma.
• A case of noncystic branch duct-type carcinoma in situ of the pancreas

  HK Islam, S Kondo, M Shimizu, Y Ambo, M Omi, S Hirano, H Katoh

  PANCREAS 22 (1) 99 - 101 0885-3177 2001/01 [Refereed][Not invited]
  
• Hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer

  S Kondo, H Katoh, M Omi, S Hirano, Y Ambo, E Tanaka, M Kaji, S Ohtake, K Itoh, H Yamada, S Okushiba, T Morikawa

  HEPATO-GASTROENTEROLOGY 47 (36) 1501 - 1503 0172-6390 2000/11 [Refereed][Not invited]
   

  Background/Aims: There have been no reports comparing surgical results of hepatectomy for metastases between breast cancer origin and colorectal cancer origin. The aim of the present study was to compare the both and to clarify the survival benefit brought by hepatectomy for metastases from breast cancer. Methodology: Between 1990 and 1999, 6 patients with hepatic metastases from breast cancer and 94 patients with those from colorectal cancer underwent hepatectomy with curative intent. All patients in the breast-cancer-origin group received adjuvant chemotherapy following hepatectomy, however, fewer patients (55% of the 94 patients) did in the colorectal-cancer-origin group (P=0.034). Results: Morbidity and mortality rates after hepatectomy in patients with hepatic metastases from breast cancer were 0% and 0%, respectively, and those in patients with metastases from colorectal cancer were 12% and 1%, respectively. Postoperative survival curves in the both groups were similar. Three- and five-year survival rates in the breast-cancer-origin group were 60% and 40%, respectively, and those in the colorectal-cancer-origin group were 54% and 42%, respectively. Conclusions: When appropriate adjuvant chemotherapy is performed, hepatectomy for metastases from breast cancer offers the survival benefit similar to that in hepatic metastases from colorectal cancer.
• Endocrine cell carcinoma of the gallbladder with anomalous pancreaticobiliary ductal junction

  Y Nakakubo, S Kondo, M Omi, S Hirano, Y Anbo, T Morikawa, S Okushiba, H Katoh, M Shimizu

  HEPATO-GASTROENTEROLOGY 47 (36) 1538 - 1540 0172-6390 2000/11 [Refereed][Not invited]
   

  We experienced a case or endocrine cell carcinoma or the gallbladder with anomalous pancreaticobiliary ductal junction. It is well known that anomalous pancreaticobiliary ductal junction has potentiality to cause gallbladder cancer and that most of the cases are papillary adenocarcinoma or well-differentiated adenocarcinoma. The direct relationship between endocrine cell carcinoma of the gallbladder and anomalous pancreaticobiliary ductal junction has not been elucidated.
• Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer

  S Kondo, H Katoh, T Shimizu, M Omi, S Hirano, Y Ambo, S Okushiba, T Morikawa

  HEPATO-GASTROENTEROLOGY 47 (35) 1447 - 1449 0172-6390 2000/09 [Refereed][Not invited]
   

  Background/Aims: To assess preliminary results of preoperative embolization of the common hepatic artery in preparation for distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for carcinoma of the body of the pancreas involving these arteries. Methodology: Four patients underwent the embolization with coils 1-7 (median: 5) days before surgery. A detachable coil was used to obtain the best position of the first coil as an anchor in 3 patients. Results: Immediately after embolization, collateral pathways developed from the superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in all 4 patients; however, they were relatively poor in one patient. There were no complications after embolization. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery, although it had been compromised sometimes in previous cases without embolization. There were no ischemia-related complications in the 2 patients who underwent radical surgery. Conclusions: Preoperative embolization of the common hepatic artery is a safe technique and has the potential to enlarge the collateral pathways by the time of distal pancreatectomy with en bloc resection of the celiac artery and prevent postoperative fatal ischemia-related complications.
• Therapeutic effects of distal splenorenal shunt in patients with fundic gastric varices

  安保 義恭, 近藤 哲, 金谷 聡一郎, 近江 亮, 平野 聡, 奥芝 俊一, 加藤 紘之

  Japanese Journal of Portal Hypertension 日本門脈圧亢進症学会 6 (1) 55 - 57 1344-8447 2000 

  孤立性胃静脈瘤に対してシャント手術 (DSRS法) を行った.内視鏡的ドプラ血流計 (EMDS) で孤立性胃静脈瘤の血行動態上の特徴を検索するとともに, 手術前後の変化からシャント術の意義を評価した.孤立性胃静脈瘤7例の術前のEMDSでは, 血流は胃宵窪部から胃体部に向かう方向で, 平均最大血流速度は30.0cm/sであった.これは食道胃静脈瘤 (n=8) の最大速度17.0cm/sより有意に速かった.孤立性胃静脈瘤4例のシャント手術前後の血行動態の変化は血流方向は新たな脾腎シャントへ向かう方向で, 流速は術前最大27cm/sから術後6cm/sへ低下した.内視鏡上も静脈瘤は縮小し, 術後の再発例も認めず治療効果が高かった.DSRS法は胃周囲血行郭清による静脈瘤への供血路遮断と新たな脾腎シャントによる胃上部領域の選択的減圧が可能で, 有効肝血流を維持しつつ再出血が制御できる特徴があり孤立性胃静脈瘤の有用な治療法のひとつと考えられた.
• Nonfunctioning endocrine tumor of the pancreas with extrapancreatic growth and cyst formation: Report of a case

  K Kato, S Kondo, Y Ambo, M Omi, S Hirano, T Morikawa, S Okushiba, H Katoh, M Fujita, M Shimizu

  SURGERY TODAY-THE JAPANESE JOURNAL OF SURGERY 30 (7) 651 - 654 0941-1291 2000 [Refereed][Not invited]
   

  We report a case of nonfunctioning endocrine tumor of the pancreas with extrapancreatic growth and cyst formation. A 48-year-old woman was admitted to our hospital with an upper abdominal mass, which was detected during a routine medical checkup. The preoperative diagnosis was a solid cystic tumor of the pancreas. The tumor, which measured about 7 cm in diameter, arose from the head of the pancreas and had a thin stalk, measuring about 1 cm in diameter. The histopathological diagnosis was a malignant nonfunctioning endocrine tumor of the pancreas. Cyst formation occurred in 67% of the reported cases with extrapancreatic growth in Japan. It is speculated that the cyst formation in this disease is related to the large size of the tumor and to the extrapancreatic growth.
• Cystic mediastinal tumor ; a clinical study

  HIRANO Satoshi, MOTOHARA Toshiji, NISHIBE Toshiya, NARITA Yoshiaki, OHKUBO Tetsuyuki, TAKAHASHI Toshiyuki, DOHKE Mitsuru, OKUSHIBA Shunichi, SHIMOZAWA Eiji, KATOH Hiroyuki

  The Journal of the Japanese Association for Chest Surgery 特定非営利活動法人日本呼吸器外科学会 11 (1) 13 - 19 0919-0945 1997/01/15 

  From 1962 to 1993 mediastinal tumor was diagnosed in 242 patients in our institute, we studied 83 of them (34.3%) with a histopathologic diagnosis of "cystic tumor".
  The majority (about 80%) were cystic teratoma, congenital cyst or thymic cyst. Only 2 cases (2.4%) were diagnosed as malignant, both were cystoadenocarcinomas arising in the posterior mediastinum.
  Thirty percent of the patients had symptoms mainly chest pain, and the others were asymptomatic, but had abnormal routine chest Roentgenograms. The lager tumors such as teratoma and mesenchymal tumors tended to cause symptoms.
  For the diagnosis of cystic tumor, MRI was more accurate (90%) than CT scan (67.6%). Tumor markers in the cyst fluid were measured. Some selected tumors showed a non-specific high level of certain markers, such as CEA or CA19-9.
• Expanded polytetrafluoroethylene grafts for portal vein replacement: Use of omentum wrap to promote graft healing

  Toshiya Nishibe, Yoshiaki Satoh, Nozomu Iwashiro, Satoshi Hirano, Setsuyuki Ohtake, Hideki Ohkashiwa, Satoshi Watanabe, Hiroyuki Katoh, Yasuhiro Okuda, Tatsuzo Tanabe

  Surgery Today 27 (2) 149 - 153 0941-1291 1997 [Refereed][Not invited]
   

  This study was designed to reexamine the healing process of expanded polytetrafluoroethylene (EPTFE) grafts with standard porosity (30 μm) and high porosity (60 μm) in portal vein replacement, and to evaluate the effect of an omentum wrap, which has certain functions that promote healing, on graft healing. These grafts, either wrapped by the omentum or not, were placed as portal vein replacements in 24 mongrel dogs. After 1 month, the grafts were retrieved and examined for patency, thrombus-free areas, thickness of the pseudointima, and the total number of cells growing into the graft wall. There were no statistical differences in the patency rates. The high-porosity grafts had a significantly larger thrombus-free area, a thicker pseudointima, and a larger growth of cells than the standard-porosity grafts. The omentum wrap significantly increased the thrombus-free area and stimulated a larger growth of cells in both grafts. The high-porosity grafts plus omentum demonstrated a thrombus-free area of 82.2% vs 27.3% in the standard-porosity grafts. In addition, the migration of fibroblasts and macrophages was most evident in the high-porosity grafts wrapped by the omentum. In conclusion, graft healing enhancement was observed in the high- porosity EPTFE grafts wrapped by the omentum. It is thus suggested that transmural cellular migration plays an important role in the process of graft healing.
• Use of intraoperative ultrasonography for thoracoscopic partial lobectomy for lung tumor.

  Nishibe Toshiya, Narita Yoshiaki, Iwashiro Nozomu, Takeyama Satoshi, Hirano Satoshi, Satoh Kohsaku, Satoh Yoshiaki, Okushiba Shun-ichi, Katoh Hiroyuki

  The Journal of the Japanese Association for Chest Surgery 特定非営利活動法人日本呼吸器外科学会 8 (1) 30 - 34 0919-0945 1994 

  Thoracoscopic partial lobectomy aided by intraoperative ultrasonography was performed in three patients with lung tumors. The diagnosis was probable lung cancer in two and metastasis from a renal pelvic tumor in one. The location of the tumor was determined by intraoperative ultrasonography which allowed us to remove 1-2 cm of tissue surrounding each tumor.
  The use of intraoperative ultrasonography in thoracoscopic partial lobectomy for lung tumor is valuable in the location of tumors and in decision of the amount to resect. It extends the indications for thoracoscopic surgery to lung tumors which are normally not resectable by thoracoscopy since intraoperative visual examination of the pleura surface dose not reveal them.
• Surgery for pancreatobiliary carcinoma in the elderly

  H. Katoh, S. Hirano, K. Satoh

  Japanese Journal of Geriatrics 31 (1) 33 - 37 0300-9173 1994 [Refereed][Not invited]
   

  Between January, 1980 and December, 1992, 256 patients underwent resection of pancreatobiliary carcinoma. Sixty eight of these patients were more than 70 years old and are the subject of this review. The morbidity rate for pancreatic cancer patients undergoing pancreaticoduodenectomy was 50%. The five years survival rate was 15%. The morbidity rate for biliary cancer patients undergoing major resection was 40%. The five year survival rate was 40%. The data presented demonstrate that extended operation for pancreatic cancer should not be performed in the elderly patients but major resection for biliary cancer can be performed, even in elderly patients, with a low but somewhat increased mortality risk. Methods of estimating risk factor for elderly patients are required.