論文

• The efficacy of wrapping with polyglycolic acid mesh and fibrin glue in preventing clinically relevant pancreatic fistula after minimally invasive distal pancreatectomy (WRAP Study): study protocol for a multicenter randomized controlled trial in Japan.
  Hayato Baba, Atsushi Oba, Kimitaka Tanaka, Takayuki Miura, Daisuke Ban, Motonori Edanami, Yoshiya Ishikawa, Katsuhisa Ohgi, Haruyoshi Tanaka, Ryuta Shintakuya, Naoki Ikenaga, Tetsuya Ijichi, Yoshitaka Kiya, Ryo Muranushi, So Yamaki, Naoki Miyazaki, Shintaro Takeuchi, Shuichi Aoki, Takahiro Mizui, Masayuki Tanaka, Hiroki Ueda, Hideyuki Dei, Hideki Takami, Kenjiro Okada, Kohei Nakata, Yuko Mataki, Hiroaki Osakabe, Kazuto Shibuya, Daisuke Hashimoto, Yosuke Inoue, Satoshi Hirano, Michiaki Unno, Minoru Esaki, Minoru Kitago, Keiichi Akahoshi, Teiichi Sugiura, Tomoki Ebata, Kenichiro Uemura, Masafumi Nakamura, Takao Otsuka, Yuichi Nagakawa, Tsutomu Fujii, Sohei Satoi, Yu Takahashi
  BMC surgery, 24, 1, 314, 314, 2024年10月16日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Postoperative pancreatic fistula (POPF) continues to be the most common complication after distal pancreatectomy (DP). Recent advancements in surgical techniques have established minimally invasive distal pancreatectomy (MIDP) as the standard treatment for various conditions, including pancreatic cancer. However, MIDP has not demonstrated a clear advantage over open DP in terms of POPF rates, indicating the need for additional strategies to prevent POPF in MIDP. This trial (WRAP study) aims to evaluate the efficacy of wrapping the pancreatic stump with polyglycolic acid (PGA) mesh and fibrin glue in preventing clinically relevant (CR-) POPF following MIDP. METHODS: This multicenter, randomized controlled trial will include patients scheduled for laparoscopic or robotic DP for tumors in the pancreatic body and/or tail. Eligible participants will be centrally randomized into either the control group (Group A) or the intervention group (Group B), where the pancreatic stump will be reinforced by PGA mesh and fibrin glue. In both groups, pancreatic transection will be performed using a bioabsorbable reinforcement-attached stapler. A total of 172 patients will be enrolled across 14 high-volume centers in Japan. The primary endpoint is the incidence of CR-POPF (International Study Group of Pancreatic Surgery grade B/C). DISCUSSION: The WRAP study will determine whether the reinforcement of the pancreatic stump with PGA mesh and fibrin glue, a technique whose utility has been previously debated, could become the best practice in the era of MIDP, thereby enhancing its safety. TRIAL REGISTRATION: This trial was registered with the Japan Registry of Clinical Trials on June 15, 2024 (jRCTs032240120).
• Optimal treatment strategy for patients with pancreatic cancer having positive peritoneal cytology: A nationwide multicenter retrospective cohort study supervised by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
  Kyohei Ariake, Masamichi Mizuma, Michiaki Unno, Sohei Satoi, Naoto Yamamoto, Masamichi Hayashi, Manabu Kawai, Hirofumi Akita, Eiji Toyoda, Tsutomu Fujii, Masaru Sasaki, Kenichi Hakamada, Jota Watanabe, Etsuro Hatano, Masaaki Hidaka, Satoshi Hirano, Hiroshi Kurahara, Ippei Matsumoto, Goro Honda, Toshiro Ogura, Masafumi Nakamura, Itaru Endo
  Journal of hepato-biliary-pancreatic sciences, 2024年09月24日, ［国内誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: The aim of this study was to determine the optimal treatment for patients with pancreatic cancer (PaCa) having positive peritoneal cytology (PPC). METHODS: This multicenter retrospective study included patients with PPC treated at 78 high-volume centers between January 2012 and December 2020. Prognoses after resection (S-group) and initiation of nonsurgical treatment (N-group) were compared. Prognostic factors for survival in both groups were analyzed. Detailed characteristics of conversion surgery (CS) in the N-group were evaluated. RESULTS: In total, 568 enrolled patients were classified into an S-group (n = 445) or an N-group (n = 123). Median survival times (MSTs) were 19.0 months and 19.3 months, respectively, with no significant difference in prognosis (p = .845). The intervenable prognostic factors for survival were adjuvant treatment in the S-group (p < .001) and CS in the N-group (p < .001). Following CS, the MST was prolonged to 45.6 months, and peritoneal or liver recurrence decreased considerably. CS can be expected if PPC is diagnosed before neoadjuvant treatment and when combination treatment is initiated. CONCLUSION: Surgical resection may not be beneficial for improving survival when PPC is evident. Chemotherapy aiming for CS may be the optimal treatment for such patients.
• Initial validation of the clinical significance of the NETest in Japanese gastroenteropancreatic neuroendocrine tumor patients.
  Hao Zhang, Takahiro Tsuchikawa, Satoshi Takeuchi, Kenji Hirata, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Shintaro Takeuchi, Masataka Wada, Satoshi Hirano
  Endocrine journal, 71, 9, 873, 880, 2024年09月02日, ［国内誌］
  英語, 研究論文（学術雑誌）, As novel biomarkers for gastroenteropancreatic neuroendocrine tumors (GEPNET) are in demand, we aimed to validate the clinical value of the NETest in Japanese patients. Between 2021 and 2023, blood and clinical data were collected from patients with GEPNET. Among 35 patients (median age: 59 [49-66] years), 27 cases originated from the pancreas and eight from the gastrointestinal tract. Of 69 samples sent to the laboratory, 56 (81.2%) underwent NETest. The diagnostic sensitivity was 97.1%. Among three patients who underwent R0 resection and four treated with peptide receptor radionuclide therapy, the changes in NETest scores closely correlated with disease progression. The NETest demonstrated high diagnostic efficacy and accurate therapeutic monitoring capabilities in a Japanese population.
• Therapeutic activity of retroviral replicating vector-mediated gene therapy in combination with anti-PD-1 antibody in a murine pancreatic cancer model.
  Hiroki Niwa, Toru Nakamura, Hiroki Kushiya, Tomotaka Kuraya, Kazuho Inoko, Akihito Inagaki, Tomohiro Suzuki, Katsunori Sasaki, Takahiro Tsuchikawa, Kei Hiraoka, Toshiaki Shichinohe, Yutaka Hatanaka, Douglas J Jolly, Noriyuki Kasahara, Satoshi Hirano
  Cancer gene therapy, 31, 9, 1390, 1401, 2024年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, Toca 511, a tumor-selective retroviral replicating vector encoding the yeast cytosine deaminase (yCD) gene, exerts direct antitumor effects through intratumoral prodrug 5-fluorocytosine (5-FC) conversion to active drug 5-fluorouracil by yCD, and has demonstrated therapeutic efficacy in preclinical and clinical trials of various cancers. Toca 511/5-FC treatment may also induce antitumor immunity. Here, we first examined antitumor immune responses activated by Toca 511/5-FC treatment in an immunocompetent murine pancreatic cancer model. We then evaluated the therapeutic effects achieved in combination with anti-programmed cell death protein 1 antibody. In the bilateral subcutaneous tumor model, as compared with the control group, enhanced CD8+ T-cell-mediated cytotoxicity and increased T-cell infiltration in Toca 511-untransduced contralateral tumors were observed. Furthermore, the expression levels of T-cell co-inhibitory receptors on CD8+ T-cells increased during treatment. In the bilateral subcutaneous tumor model, combination therapy showed significantly stronger tumor growth inhibition than that achieved with either monotherapy. In an orthotopic tumor and peritoneal dissemination model, the combination therapy resulted in complete regression in both transduced orthotopic tumors and untransduced peritoneal dissemination. Thus, Toca 511/5-FC treatment induced a systemic antitumor immune response, and the combination therapy could be a promising clinical strategy for treating metastatic pancreatic cancer.
• Is multidisciplinary treatment effective for invasive intraductal papillary mucinous carcinoma?
  Seiko Hirono, Ryota Higuchi, Goro Honda, Satoshi Nara, Minoru Esaki, Naoto Gotohda, Hideki Takami, Michiaki Unno, Teiichi Sugiura, Masayuki Ohtsuka, Yasuhiro Shimizu, Ippei Matsumoto, Toshifumi Kin, Hiroyuki Isayama, Daisuke Hashimoto, Yasuji Seyama, Hiroaki Nagano, Kenichi Hakamada, Satoshi Hirano, Yuichi Nagakawa, Shugo Mizuno, Hidenori Takahashi, Kazuto Shibuya, Hideki Sasanuma, Taku Aoki, Yuichiro Kohara, Toshiki Rikiyama, Masafumi Nakamura, Itaru Endo, Yoshihiro Sakamoto, Akihiko Horiguchi, Takashi Hatori, Hirofumi Akita, Toshiharu Ueki, Tetsuya Idichi, Keiji Hanada, Shuji Suzuki, Keiichi Okano, Hiromitsu Maehira, Fuyuhiko Motoi, Yasuhiro Fujino, Satoshi Tanno, Akio Yanagisawa, Yoshifumi Takeyama, Kazuichi Okazaki, Sohei Satoi, Hiroki Yamaue
  Annals of gastroenterological surgery, 8, 5, 845, 859, 2024年09月, ［国内誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC. METHODS: This retrospective multi-institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC. RESULTS: Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19-9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un-matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001). CONCLUSION: Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival.
• Clinical Impact of Weight Loss During Hospitalization on Prognosis After Pancreatic Surgery.
  Shota Kuwabara, Takumi Nakaya, Keita Ishido, Yuma Aoki, Kazuyuki Yamamoto, Yasuhito Shoji, Akira Fukunaga, Tatsunosuke Ichimura, Hiroto Manase, Satoshi Hirano
  Cureus, 16, 9, e69427, 2024年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, Purpose This study aimed to elucidate the relationship between early-stage weight loss (WL) during hospitalization after pancreatic surgery and prognosis and investigate risk factors affecting WL. Methods We included 68 patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) who underwent radical surgery. The %WL value was calculated based on the percentage of body weight at discharge compared with the body weight at admission. High WL was defined as %WL >10%. We initially evaluated the association between %WL and postoperative survival using the Kaplan-Meier method. Subsequently, we analyzed the factors affecting %WL using a logistic regression model. Results In terms of overall survival (OS), the high %WL group exhibited a significantly worse prognosis than the low %WL group (p=0.043). Univariate analysis revealed a hazard ratio of 2.244 (95% confidence interval (CI), 1.006-5.006; p=0.048) for high %WL in relation to overall survival. Multivariate analysis identified an operative time >450 min (odds ratio, 17.8; 95% confidence interval, 1.01-312.42; p=0.049) and postoperative complications (odds ratio, 12.1; 95% confidence interval, 2.01-72.79; p<0.01) as independent risk factors for high %WL. Conclusion Preventing high %WL by streamlining surgical procedures, minimizing postoperative complications, and implementing medical nutritional therapy (MNT) is imperative to improve the prognosis of patients with PDAC.
• Perioperative chemotherapy with nivolumab for HER2-negative locally advanced gastric cancer: a case series.
  Yuta Toji, Shintaro Takeuchi, Yuma Ebihara, Yo Kurashima, Kazuaki Harada, Mariko Hayashi, Hirotake Abe, Hideyuki Wada, Satoko Yorinaga, Toshiaki Shichinohe, Utano Tomaru, Yoshito Komatsu, Satoshi Hirano
  Surgical case reports, 10, 1, 200, 200, 2024年08月28日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Nivolumab with chemotherapy has been transformative for metastatic gastric cancer (GC). The potential of this regimen for local tumor control could be utilized for perioperative chemotherapy in locally advanced GC with bulky tumors or lymph node metastasis involving other organs. CASE PRESENTATION: Five patients with HER2-negative advanced GC were treated with nivolumab and oxaliplatin-based chemotherapy. All patients presented with clinical stage III or IVA GC with tumors in contact with either the pancreas or liver. Following chemotherapy, all tumors demonstrated shrinkage, allowing successful radical gastrectomies including four minimally invasive approach without postoperative complications. Four patients avoided combined resection of other organs. CONCLUSIONS: Perioperative chemotherapy with nivolumab was effective for local disease control in this case series. This regimen could be a promising treatment approach for locally advanced GC; however, its survival benefits should be evaluated in clinical trials.
• Robot-Assisted Surgery for Reversed Intestinal Malrotation with Concurrent Cecal Carcinoma: A Case Report.
  Shota Kuwabara, Yuka Takakuwa, Keita Ishido, Yuma Aoki, Kazuyuki Yamamoto, Yasuhito Shoji, Akira Fukunaga, Tatsunosuke Ichimura, Hiroto Manase, Satoshi Hirano
  The American journal of case reports, 25, e944720, 2024年08月15日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND Reversed intestinal malrotation is an extremely rare disease, with an incidence of 1 in 250 000. In Japan, application of robotic-assisted colorectal cancer surgery is expected to increase. There are no reports of robot-assisted surgery for cecal cancer with reversed intestinal malrotation. CASE REPORT An 84-year-old Japanese man with epigastric pain and abdominal distention was referred to our hospital's Department of Gastroenterology for thorough examination. Colonoscopy revealed a semicircumferential type 2 tumor in the cecum and ascending colon. Gastrografin contrast study showed that the large intestine was entirely on the patient's right side and the small intestine was shifted to the left side. Contrast-enhanced computed tomography revealed enlarged lymph nodes near the tumor, and masses were observed at the liver, which were believed to be metastases. Following examination, reversed intestinal malrotation and concurrent cecal cancer was diagnosed. The patient was referred to our department for surgery and underwent robot-assisted ileocecal resection with D3 lymphadenectomy. The postoperative course was favorable, and patient was discharged on the sixth postoperative day, without complications. According to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th edition, the pathological diagnosis was pT4b (ileum), pN1b, cM1a (H1 [grade A]), and pStage IVa cancer. After considering tumor stage and patient's overall condition in consultation with his family, we decided against palliative systemic therapy. The patient was provided with best supportive care. CONCLUSIONS Robot-assisted surgery might be useful in manipulation of the dissection of adhesions, owing to its capacity for high-resolution 3-dimensional imaging and forceps manipulation, using articulated functions.
• Distinct clinicopathological features of neuroendocrine liver metastases originating from the pancreas and rectum.
  Hao Zhang, Takahiro Tsuchikawa, Satoshi Takeuchi, Hang Deng, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Takehiro Noji, Toru Nakamura, Shintaro Takeuchi, Masataka Wada, Jian Xu, Yu Zhang, Satoshi Hirano
  World journal of surgical oncology, 22, 1, 209, 209, 2024年08月03日, ［国際誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: Survival comparisons among patients with liver metastases from pancreatic and rectal neuroendocrine tumors (NETs) were limited, and the efficacy of observation rules in patients undergoing hepatectomy for neuroendocrine liver metastases (NELMs) was unknown. This study aims to distinguish these characteristics and clarify the effects of the observation rules on NELMs. METHODS: Clinical data were separately collected from patients with pancreatic and rectal NELMs at medical centers in both Japan and China. The Japanese cohort followed the observation rules for the resection of NELMs. A comparative analysis was conducted on clinical characteristics and prognosis features such as overall survival time (OS) and disease-free survival interval (DFS-I). RESULTS: Enrollment included 47 and 34 patients from Japan and China, respectively. Of these, 69 and 12 patients had tumors originating from the pancreas and rectum, respectively. The OS time in patients undergoing primary tumor resection was significantly longer; however, the OS time between the patients undergoing and not undergoing radical resection of liver metastasis was the same. In asynchronous NELMs, patients with rectal (R)-NELMs showed a significantly higher proportion of type III NELMs. Additionally, the median DFS-I of asynchronous R-NELMs was longer than the recommended follow-up time, with 71.4% of them classified as G2. In the Japanese cohort, patients who adhered to the observation rules exhibited a longer median DFS after hepatectomy for NELMs compared with their counterparts. CONCLUSION: Although curative surgery is crucial for primary lesions, personalized approaches are required to manage NELMs. Extended overall follow-ups and shortened follow-up intervals are recommended for G2 stage rectal NETs. The observation rules for NELMs require further validation with a larger sample size.
• Incidence of atrial fibrillation after esophageal cancer surgery with L-carnitine use: a preliminary single-group interventional study.
  Yasushige Shingu, Isao Yokota, Toshiaki Shichinohe, Soichi Murakami, Yuma Ebihara, Yo Kurashima, Satoshi Hirano, Satoru Wakasa
  Surgery today, 54, 8, 892, 898, 2024年08月, ［国内誌］
  英語, 研究論文（学術雑誌）, PURPOSE: We aimed to investigate the POAF rate and blood FABP4 levels after perioperative L-carnitine administration in patients with esophageal cancer. METHODS: L-carnitine (3 g in three divided doses) was administered to 15 patients 2 days before and 3 days after surgery. POAF during the study period and blood FABP4 levels (ELISA) before and after L-carnitine administration were evaluated. Accurate 95% confidence intervals (CI) for POAF incidence and changes in blood FABP4 levels were calculated. The preoperative predicted POAF rate was calculated using an application for esophageal cancer. The correlation between FABP4 levels and the predicted POAF rate was analyzed using Pearson's coefficient (r). RESULTS: Thirteen patients completed this study. The predicted POAF rate was 24% (17%, 34%) (median; interquartile range). The actual incidence of POAF was 7.7% (95% CI: 0.2-36%). Blood FABP4 levels changed from 10.3 to 7.0 ng/mL; the average change was - 3.3 (95% CI: - 6.6 to - 0.1). A positive correlation was found between preoperative FABP4 levels and the predicted POAF rates (r = 0.564). CONCLUSIONS: The POAF rate after esophageal surgery was 7.7% for L-carnitine. L-carnitine may reduce blood FABP4 levels. This preliminary study will contribute to the planning of sample sizes in future randomized trials.
• Clinical practice guidelines for telesurgery 2022 : Committee for the promotion of remote surgery implementation, Japan Surgical Society.
  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, 54, 8, 817, 828, Springer Science and Business Media LLC, 2024年08月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 31, 8, 549, 558, Wiley, 2024年08月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 'IHPBA-APHPBA clinical practice guidelines': international Delphi consensus recommendations for gallbladder cancer.
  Jagannath Palepu, Itaru Endo, Vikram Anil Chaudhari, G V S Murthy, Sirshendu Chaudhuri, Rene Adam, Martin Smith, Philip R de Reuver, Javier Lendoire, Shailesh V Shrikhande, Xabier De Aretxabala, Bhawna Sirohi, Norihiro Kokudo, Wooil Kwon, Sujoy Pal, Chafik Bouzid, Elijah Dixon, Sudeep Rohit Shah, Rodrigo Maroni, Bruno Nervi, Claudio Mengoa, Shekhar Patil, Tomoki Ebata, Shishir K Maithel, Hauke Lang, John Primrose, Satoshi Hirano, Oscar A Guevara, Masayuki Ohtsuka, Juan W Valle, Atul Sharma, Ganesh Nagarajan, Juan Jose Núñez Ju, Gerardo Francisco Arroyo, Sergio Lopez Torrez, Joris Ivo Erdmann, Jean M Butte, Junji Furuse, Seung Eun Lee, António Pedro Gomes, Sang-Jae Park, Jin-Young Jang, Ricardo Oddi, Savio George Barreto, Hiroshi Kijima, Oriana Ciacio, Nagesh S Gowda, William Jarnagin
  HPB : the official journal of the International Hepato Pancreato Biliary Association, 2024年07月25日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: The Delphi consensus study was carried out under the auspices of the International and Asia-Pacific Hepato-Pancreato-Biliary Associations (IHPBA-APHPBA) to develop practice guidelines for management of gallbladder cancer (GBC) globally. METHOD: GBC experts from 17 countries, spanning 6 continents, participated in a hybrid four-round Delphi consensus development process. The methodology involved email, online consultations, and in-person discussions. Sixty eight clinical questions (CQs) covering various domains related to GBC, were administered to the experts. A consensus recommendation was accepted only when endorsed by more than 75% of the participating experts. RESULTS: Out of the sixty experts invited initially to participate in the consensus process 45 (75%) responded to the invitation. The consensus was achieved in 92.6% (63/68) of the CQs. Consensus covers epidemiological aspects of GBC, early, incidental and advanced GBC management, definitions for radical GBC resections, the extent of liver resection, lymph node dissection, and definitions of borderline resectable and locally advanced GBC. CONCLUSIONS: This is the first international Delphi consensus on GBC. These recommendations provide uniform terminology and practical clinical guidelines on the current management of GBC. Unresolved contentious issues like borderline resectable/locally advanced GBC need to be addressed by future clinical studies.
• Three Molecular Developmental Pathways of Remnant Pancreatic Cancer after Resection: A Nationwide Project Study of Japan Pancreas Society.
  Shuji Suzuki, Yuko Omori, Yusuke Ono, Katsuya Hirose, Taito Itoh, Hidenori Karasaki, Mitsugi Shimoda, Yuichi Nagakawa, Ryota Higuchi, Itaru Endo, Toshiki Rikiyama, Michiaki Unno, Tsutomu Fujii, Yuki Sunagawa, Hidetoshi Eguchi, Hideki Sasanuma, Takahiro Akahori, Keiichi Okano, Masaji Tani, Satoshi Hirano, Yasuhiro Shimizu, Minoru Kitago, Shugo Mizuno, Tomohisa Yamamoto, Masayuki Furukawa, Masayuki Ohtsuka, Motokazu Sugimoto, Akira Matsushita, Kenichi Hakamada, Hisato Igarashi, Tamotsu Kuroki, Satoshi Tanno, Yoshihisa Tsuji, Atsushi Masamune, Kazuhiro Mizumoto, Yoshiki Hirooka, Hiroki Yamaue, Kazuichi Okazaki, Sohei Satoi, Yoshifumi Takeyama, Yusuke Mizukami, Toru Furukawa
  Annals of surgery, 2024年07月17日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: This study aimed to clarify the molecular mechanism of remnant pancreatic cancer (PC) development after primary PC resection. SUMMARY BACKGROUND DATA: Molecular mechanisms of the development of remnant PCs following primary PC resection are largely unknown. METHODS: Forty-three patients undergoing remnant PC resection after primary PC resection between 2001 and 2017 at 26 institutes were retrospectively analyzed. Clinicopathological features and molecular alterations detected by targeted amplicon sequencing of 36 PC-associated genes were evaluated. RESULTS: These patients showed significantly lower body mass indices and higher hemoglobin A1c values at remnant PC resection than at primary PC resection. A comparison of the molecular features between primary and remnant PCs indicated that remnant PCs were likely to develop via three different molecular pathways: successional, showing identical and accumulated alterations (n=14); phylogenic, showing identical and distinct alterations (n=26); and distinct, showing independent distinctive alterations (n=3). The similarity of gene alterations was associated with time to the remnant PC development (r=－0.384, P=0.0173). Phylogenic pathways were significantly associated with the intraductal spread of carcinoma (P=0.007). Patient survival did not differ significantly depending on these molecular pathways. CONCLUSION: Molecular profiling uncovered three pathways for the development of remnant PCs, namely, successional, phylogenic, and distinct pathways. The vast majority of remnant PCs are likely to be molecularly associated with primary PCs either in the successional or phylogenic way. This information could impact the design of a strategy for monitoring and treating remnant PCs.
• 解剖実習からCSTへ ベテラン医師に対する臨床解剖教育　　　　　　　　　　　　　　　
  村上 壮一, 七戸 俊明, 倉島 庸, 海老原 裕磨, 本間 宙, 平野 聡
  医学教育, 55, Suppl., 103, 103, (一社)日本医学教育学会, 2024年07月
  日本語
• Factors Affecting Nonfunctioning Small Pancreatic Neuroendocrine Neoplasms and Proposed New Treatment Strategies.
  Susumu Hijioka, Daiki Yamashige, Minoru Esaki, Goro Honda, Ryota Higuchi, Toshihiko Masui, Yasuhiro Shimizu, Masayuki Ohtsuka, Yusuke Kumamoto, Akio Katanuma, Naoto Gotohda, Hirofumi Akita, Michiaki Unno, Itaru Endo, Yukihiro Yokoyama, Suguru Yamada, Ippei Matsumoto, Takao Ohtsuka, Satoshi Hirano, Hiroaki Yasuda, Manabu Kawai, Taku Aoki, Masafumi Nakamura, Daisuke Hashimoto, Toshiki Rikiyama, Akihiko Horiguchi, Tsutomu Fujii, Shugo Mizuno, Keiji Hanada, Masaji Tani, Takashi Hatori, Tetsuhide Ito, Masataka Okuno, Shingo Kagawa, Hiroshi Tajima, Tatsuya Ishii, Motokazu Sugimoto, Shunsuke Onoe, Hideki Takami, Ryoji Takada, Takayuki Miura, Yusuke Kurita, Keiko Kamei, Yuko Mataki, Kazuichi Okazaki, Yoshifumi Takeyama, Hiroki Yamaue, Sohei Satoi
  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 22, 7, 1416, 1426, 2024年07月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND & AIMS: Despite previously reported treatment strategies for nonfunctioning small (≤20 mm) pancreatic neuroendocrine neoplasms (pNENs), uncertainties persist. We aimed to evaluate the surgically resected cases of nonfunctioning small pNENs (NF-spNENs) in a large Japanese cohort to elucidate an optimal treatment strategy for NF-spNENs. METHODS: In this Japanese multicenter study, data were retrospectively collected from patients who underwent pancreatectomy between January 1996 and December 2019, were pathologically diagnosed with pNEN, and were treated according to the World Health Organization 2019 classification. Overall, 1490 patients met the eligibility criteria, and 1014 were included in the analysis cohort. RESULTS: In the analysis cohort, 606 patients (59.8%) had NF-spNENs, with 82% classified as grade 1 (NET-G1) and 18% as grade 2 (NET-G2) or higher. The incidence of lymph node metastasis (N1) by grade was significantly higher in NET-G2 (G1: 3.1% vs G2: 15.0%). Independent factors contributing to N1 were NET-G2 or higher and tumor diameter ≥15 mm. The predictive ability of tumor size for N1 was high. Independent factors contributing to recurrence included multiple lesions, NET-G2 or higher, tumor diameter ≥15 mm, and N1. However, the independent factor contributing to survival was tumor grade (NET-G2 or higher). The appropriate timing for surgical resection of NET-G1 and NET-G2 or higher was when tumors were >20 and >10 mm, respectively. For neoplasms with unknown preoperative grades, tumor size >15 mm was considered appropriate. CONCLUSIONS: NF-spNENs are heterogeneous with varying levels of malignancy. Therefore, treatment strategies based on tumor size alone can be unreliable; personalized treatment strategies that consider tumor grading are preferable.
• 肝胆膵 局所進行胆道癌・膵癌手術における門脈・動脈再建の工夫 当科における肝門部領域胆管癌に対する肝動脈・門脈同時切除再建症例の手技と周術期成績　　　　　　　　　　　　　　　
  田中 公貴, 武内 慎太郎, 和田 雅孝, 松井 あや, 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, 79回, 452, 453, (一社)日本消化器外科学会, 2024年07月
  日本語
• 切除不能膵癌に対するconversion surgeryにおける術後再発の検討　　　　　　　　　　　　　　　
  浅野 賢道, 平野 聡, 中村 透, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 和田 雅孝, 武内 慎太郎
  日本消化器外科学会総会, 79回, 725, 725, (一社)日本消化器外科学会, 2024年07月
  日本語
• 折り鶴トレーニングの臨床効果と普及への課題　　　　　　　　　　　　　　　
  松井 あや, 武内 慎太郎, 和田 雅孝, 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, 79回, 752, 752, (一社)日本消化器外科学会, 2024年07月
  日本語
• 肝外胆管癌におけるケモカインレセプター(CCR7)のEMTを介した悪性度への関与に関する検討　　　　　　　　　　　　　　　
  大場 光信, 中西 喜嗣, 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, 79回, 2048, 2048, (一社)日本消化器外科学会, 2024年07月
  日本語
• 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年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy.
  Thomas F Stoop, Atsushi Oba, Y H Andrew Wu, Laurel E Beaty, Kathryn L Colborn, Boris V Janssen, Mohammed H Al-Musawi, Salvador Rodriguez Franco, Toshitaka Sugawara, Oskar Franklin, Ajay Jain, Akio Saiura, Alain Sauvanet, Alessandro Coppola, Ammar A Javed, Bas Groot Koerkamp, Braden N Miller, Claudia E Mack, Daisuke Hashimoto, Damiano Caputo, Dyre Kleive, Elisabetta Sereni, Giulio Belfiori, Hirofumi Ichida, Jacob L van Dam, Jeanne Dembinski, Keiichi Akahoshi, Keith J Roberts, Kimitaka Tanaka, Knut J Labori, Massimo Falconi, Michael G House, Motokazu Sugimoto, Minoru Tanabe, Naoto Gotohda, Paul S Krohn, Richard A Burkhart, Rohan G Thakkar, Rupaly Pande, Safi Dokmak, Satoshi Hirano, Stefan K Burgdorf, Stefano Crippa, Stijn van Roessel, Sohei Satoi, Steven A White, Thilo Hackert, Trang K Nguyen, Tomohisa Yamamoto, Toru Nakamura, Vismaya Bachu, William R Burns, Yosuke Inoue, Yu Takahashi, Yuta Ushida, Zohra V Aslami, Caroline S Verbeke, Arantza Fariña, Jin He, Johanna W Wilmink, Wells Messersmith, Joanne Verheij, Jeffrey Kaplan, Richard D Schulick, Marc G Besselink, Marco Del Chiaro
  JAMA network open, 7, 6, e2417625, 2024年06月03日, ［国際誌］
  英語, 研究論文（学術雑誌）, IMPORTANCE: Preoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma, leading to pathological complete response (pCR) in a small subset of patients. However, multicenter studies with in-depth data about pCR are lacking. OBJECTIVE: To investigate the incidence, outcome, and risk factors of pCR after preoperative chemo(radio)therapy. DESIGN, SETTING, AND PARTICIPANTS: This observational, international, multicenter cohort study assessed all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy (with or without radiotherapy) in 19 centers from 8 countries (January 1, 2010, to December 31, 2018). Data collection was performed from February 1, 2020, to April 30, 2022, and analyses from January 1, 2022, to December 31, 2023. Median follow-up was 19 months. EXPOSURES: Preoperative chemotherapy (with or without radiotherapy) followed by resection. MAIN OUTCOMES AND MEASURES: The incidence of pCR (defined as absence of vital tumor cells in the sampled pancreas specimen after resection), its association with OS from surgery, and factors associated with pCR. Factors associated with overall survival (OS) and pCR were investigated with Cox proportional hazards and logistic regression models, respectively. RESULTS: Overall, 1758 patients (mean [SD] age, 64 [9] years; 879 [50.0%] male) were studied. The rate of pCR was 4.8% (n = 85), and pCR was associated with OS (hazard ratio, 0.46; 95% CI, 0.26-0.83). The 1-, 3-, and 5-year OS rates were 95%, 82%, and 63% in patients with pCR vs 80%, 46%, and 30% in patients without pCR, respectively (P < .001). Factors associated with pCR included preoperative multiagent chemotherapy other than (m)FOLFIRINOX ([modified] leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin) (odds ratio [OR], 0.48; 95% CI, 0.26-0.87), preoperative conventional radiotherapy (OR, 2.03; 95% CI, 1.00-4.10), preoperative stereotactic body radiotherapy (OR, 8.91; 95% CI, 4.17-19.05), radiologic response (OR, 13.00; 95% CI, 7.02-24.08), and normal(ized) serum carbohydrate antigen 19-9 after preoperative therapy (OR, 3.76; 95% CI, 1.79-7.89). CONCLUSIONS AND RELEVANCE: This international, retrospective cohort study found that pCR occurred in 4.8% of patients with resected localized pancreatic adenocarcinoma after preoperative chemo(radio)therapy. Although pCR does not reflect cure, it is associated with improved OS, with a doubled 5-year OS of 63% compared with 30% in patients without pCR. Factors associated with pCR related to preoperative chemo(radio)therapy regimens and anatomical and biological disease response features may have implications for treatment strategies that require validation in prospective studies because they may not universally apply to all patients with pancreatic adenocarcinoma.
• Transabdominal impalement injury by an iron pipe - A case report.
  Yuki Itagaki, Nagato Sato, Ritsu Ohmine, Takuya Ikushima, Tsukasa Kaneko, Tomohide Shirosaki, Hironori Tanaka, Hirofumi Morimoto, Naoya Fukuda, Yasuaki Iimura, Satoshi Hirano
  Trauma case reports, 51, 101010, 101010, 2024年06月, ［国際誌］
  英語, Impalement injuries are rare and complex problems, often involving multiple organ injuries. An 18-year-old male was admitted to our emergency department after a car accident. Positioned in the right-side recumbent position, he had a 4.5 cm diameter pipe penetrating from his left abdomen to his back. Given the pipe's length exceeding the CT gantry's capacity, further imaging tests were not feasible. Consequently, the patient proceeded directly to the operating room without preoperative imaging. Before laparotomy, a left thoracotomy was conducted for aortic cross-clamping, anticipating uncontrollable bleeding during pipe removal. The subsequent laparotomy, with the patient in the right-side recumbent position, revealed the pipe impaling through the mesentery of the descending colon without evident major vessel injury. The pipe was cautiously extracted. The patient was subsequently discharged on day 26. The absence of imaging feasibility emphasized that current hemodynamic stability does not rule out the potential for significant vessel injury. Therefore, the sequential approach of left thoracotomy for aortic cross-clamping followed by laparotomy emerges as a potentially beneficial strategy in cases of transabdominal impalement. The impalement injury requires our preparedness and flexibility, which should be tailored to the individual case.
• [A Case of Hormone Receptor-Positive Recurrent Breast Cancer Successfully Treated with Low-Dose Ethinyl Estradiol].
  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Satoshi Hirano
  Gan to kagaku ryoho. Cancer & chemotherapy, 51, 6, 651, 653, 2024年06月, ［国内誌］
  日本語, 研究論文（学術雑誌）, The patient, an 83-year-old woman, was diagnosed with ER- and PgR-positive left breast cancer(T2N0M0, Stage ⅡA) at the age of 68. At the time, she underwent preoperative chemotherapy followed by Bp+Ax and postoperative radiotherapy to the conserved breast. She also received endocrine therapy as adjuvant therapy. At the age of 73, she underwent radiotherapy for multiple bone metastases and left axillary lymphadenectomy due to left axillary lymph node recurrence. After surgery, she received 4 regimens of endocrine therapy over a period of 5 years and 1 month for bone metastases. At the age of 79, S-1 was administered for pulmonary metastasis which continued for the next 2 years and 8 months. At the age of 81, palbociclib+letrozole were administered for 1 year and 8 months owing to the progression of bone metastases. At the age of 83, she developed liver metastases and was administered ethinyl estradiol, starting at 1.5 mg/day and continued at a reduced dose of 0.5 mg/day for 9 months. The reduction in tumor markers after treatment initiation was rapid, and there were no serious adverse events. Ethinyl estradiol was useful for maintaining QOL in this elderly patient with recurrent breast cancer.
• 【肝門部胆管癌～診断と治療の標準化へ向けて～】周術期管理 肝門部胆管癌術後予防的抗菌薬の選択 治療抗菌薬の使用法,切り替えのタイミング
  野路 武寛, 福田 純己, 岡村 国茂, 田中 公貴, 平野 聡
  胆と膵, 45, 6, 589, 592, 医学図書出版(株), 2024年06月
  日本語, 術後合併症と死亡率の高い肝門部胆管癌手術における術後抗菌薬の選択と投与期間にフォーカスし概説する。なお,肝門部胆管癌症のみを対象にした臨床研究報告が稀少であるため,本稿には膵頭十二指腸切除術(PD)症例を対象にした報告も含めた。既存のガイドラインでは,第2世代セフェムを中心とする抗菌薬が推奨されているが,近年の研究結果からは,術後感染性合併症(SSI)の原因菌はEnterococcus属などのグリコペプチド系抗菌薬ににみ感受性を有する細菌が多く認められ,起炎菌は周術期に行った胆汁培養結果と高率に一致することが明らかになった。われわれは術前胆汁培養結果に合わせた抗菌薬投与が術後SSIを有意に減少させることを明らかにした。近年米国でPD症例を用いた抗菌薬選択タゾバクタム・ピペラシリン合剤を用いた症例群が第2世代セフェムを用いた群よりもSSIの発生が有意に少なかった。投与期間については,術後2日と4日を比較した臨床試験の結果から,術後2日間とするのが望ましい。(著者抄録)
• Robotic spleen‑preserving suprapancreatic and splenic hilar lymph node dissection using the preemptive retropancreatic approach in total gastrectomy for gastric cancer.
  Yuma Ebihara, Yo Kurashima, Toshiaki Shichinohe, Satoshi Hirano
  Updates in surgery, 2024年05月17日, ［国際誌］
  英語, 研究論文（学術雑誌）, Advanced gastric cancer that has not invaded the greater curvature is a good indication for total gastrectomy (TG) with spleen-preserving suprapancreatic and splenic hilar lymph node dissection (LND). However, the suprapancreatic and splenic hilar LND increases the area of dissection of the pancreas, and prolonged pressure drainage of the pancreas is required to maintain a clear operative view. This can lead to an increased risk of postoperative pancreatic complications. To report the efficacy of our novel preemptive retropancreatic approach (PRA) for the suprapancreatic and splenic hilar LND in robotic TG (RTG). We report our experience with nine patients with gastric cancer who underwent spleen-preserving splenic hilar LND using PRA during RTG at Hokkaido University from October 2018 to November 2021. The PRA involves initial dissection of the left side of the retropancreatic space, followed by the release of the adherence between the retroperitoneum surface and the pancreas (fusion fascia), which provides a good operative field and prevents contact with the pancreas during the suprapancreatic and splenic hilar LND in RTG. The median operating time was 488 min (254-564 min). The median intraoperative bleeding was 55 mL (0-115 mL). One patient had postoperative complications (above grade II of the Clavien-Dindo classification), but there were no postoperative pancreatic complications. The spleen-preserving suprapancreatic and splenic hilar LND using PRA could help to reduce the postoperative pancreatic complications associated with RTG.Trial registration number and date of registration The Hokkaido University Hospital institutional review board approved the data collection and analysis. The trial registration number and date of registration are No. 021-0022 and July 26, retrospectively registered.
• Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial.
  Satoshi Hirano, Eiichi Saitoh, Daisuke Imoto, Takuma Ii, Tetsuya Tsunoda, Yohei Otaka
  Journal of neuroengineering and rehabilitation, 21, 1, 76, 76, 2024年05月14日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. METHODS: An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. RESULTS: A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively). CONCLUSIONS: The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. TRIAL REGISTRATION: This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
• Effects of communication delay in the dual cockpit remote robotic surgery system.
  Yoshiya Takahashi, Kenichi Hakamada, Hajime Morohashi, Yusuke Wakasa, Hiroaki Fujita, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori
  Surgery today, 54, 5, 496, 501, 2024年05月, ［国内誌］
  英語, 研究論文（学術雑誌）, PURPOSE: To evaluate the impact of dual cockpit telesurgery on proctors and operators, and acceptable levels of processing delay for video compression and restoration. METHODS: Eight medical advisors and eight trainee surgeons, one highly skilled per group, performed gastrectomy, rectal resection, cholecystectomy, and bleeding tasks on pigs. Using the Medicaroid surgical robot hinotori™, simulated delay times (0 ms, 50 ms, 100 ms, 150 ms, and 200 ms) were inserted mid-surgery to evaluate the tolerance level. Operative times and dual cockpit switching times were measured subjectively using 5-point scale questionnaires (mSUS [modified System Usability Scale], and Robot Usability Score). RESULTS: No significant difference was observed in operative times between proctors and operators (proctor: p = 0.247, operator: p = 0.608) nor in switching times to the dual cockpit mode (p = 0.248). For each survey setting, proctors tended to give lower ratings to delays of ≥ 150 ms. No marked difference was observed in the operator evaluations. On the postoperative questionnaires, there were no marked differences in the mSUS or Robot Usability Score between the proctors and operators (mSUS: p = 0.779, Robot Usability Score: p = 0.261). CONCLUSION: Telesurgery using a dual cockpit with hinotori™ is practical and has little impact on surgical procedures.
• 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• Prognostic value of combined psoas muscle mass and controlling nutritional status in patients with pancreatic ductal adenocarcinoma: a retrospective cohort study.
  Shota Kuwabara, Yuta Takeuchi, Osamu Sato, Tomoko Mizota, Masaomi Ichinokawa, Katsuhiko Murakawa, Yuma Aoki, Keita Ishido, Koichi Ono, Satoshi Hirano
  BMC surgery, 24, 1, 116, 116, 2024年04月20日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Pancreatic ductal carcinoma (PDAC) is an extremely poor prognostic disease. Even though multidisciplinary treatment for PDAC has developed, supportive therapies, such as nutritional therapy or perioperative rehabilitation to sustain and complete aggressive treatment, have not yet been well-established in PDAC. The aim of this study was to elucidate the relationship between the combined index using psoas muscle mass index (PMI) values and controlling nutritional status (CONUT) score and prognosis. METHODS: We included 101 patients diagnosed with PDAC who underwent radical pancreatectomy with regional lymphadenectomy. The cut-off value was set at the first quartile (male, 6.3 cm2/m2; female 4.4 cm2/m2), and patients were classified into high PMI and low PMI groups. A CONUT score of 0 to 1 was classified as the normal nutritional status group, and 2 or more points as the malnutritional status group. Patients were further divided into three groups: high PMI and normal nutrition (good general condition group), low PMI and low nutrition (poor general condition group), and none of the above (moderate general condition group). We performed a prognostic analysis of overall survival (OS), stratified according to PMI values and CONUT scores. RESULTS: In the poor general condition group, the proportion of elderly people over 70 years of age was significantly higher than that in the other groups (p < 0.001). The poor general condition group had a significantly worse prognosis than the good and moderate general condition groups (p = 0.012 and p = 0.037). The 5-year survival rates were 10.9%, 22.3%, and 36.1% in the poor, moderate, and good general condition groups, respectively. In multivariate analysis, poor general condition, with both low PMI and malnutrition status, was an independent poor prognostic factor for postoperative OS (hazard ratio 2.161, p = 0.031). CONCLUSIONS: The combination of PMI and CONUT scores may be useful for predicting the prognosis of patients with PDAC after radical surgery.
• Field experiment of a telesurgery system using a surgical robot with haptic feedback.
  Mitsuhiko Ota, Eiji Oki, Tomonori Nakanoko, Yasushi Tanaka, Satoshi Toyota, Qingjiang Hu, Yu Nakaji, Ryota Nakanishi, Koji Ando, Yasue Kimura, Yuichi Hisamatsu, Koshi Mimori, Yoshiya Takahashi, Hajime Morohashi, Takahiro Kanno, Kotaro Tadano, Kenji Kawashima, Hironobu Takano, Yuma Ebihara, Masaki Shiota, Junichi Inokuchi, Masatoshi Eto, Tomoharu Yoshizumi, Kenichi Hakamada, Satoshi Hirano, Masaki Mori
  Surgery today, 54, 4, 375, 381, 2024年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, PURPOSE: To verify the usefulness of haptic feedback in telesurgery and improve the safety of telerobotic surgery. METHODS: The surgeon's console was installed at two sites (Fukuoka and Beppu; 140 km apart), and the patient cart was installed in Fukuoka. During the experiment, the surgeon was blinded to the haptic feedback levels and asked to grasp the intestinal tract in an animal model. The surgeon then performed the tasks at each location. RESULTS: No marked differences in task accuracy or average grasping force were observed between the surgeon locations. However, the average task completion time was significantly longer, and the system usability scale (SUS) was significantly lower rating for remote operations than for local ones. No marked differences in task accuracy or task completion time were observed between the haptic feedback levels. However, with haptic feedback, the organ was grasped with a significantly weaker force than that without it. Furthermore, with haptic feedback, experienced surgeons in robotic surgery tended to perform an equivalent task with weaker grasping forces than inexperienced surgeons. CONCLUSION: The haptic feedback function is a tool that allows the surgeon to perform surgery with an appropriate grasping force, both on site and remotely. Improved safety is necessary in telesurgery; haptic feedback will thus be an essential technology in robotic telesurgery going forward.
• 外科医が基礎研究を行う意義-PhysiologyとOncologyの観点から- 膵癌immunochemotherapy実現への道筋 術前治療による微小環境修飾の臨床的不均一性と組織学的不均一性の解明　　　　　　　　　　　　　　　
  武内 慎太郎, 中村 透, 土川 貴裕, 和田 雅孝, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 平野 聡
  日本外科学会定期学術集会抄録集, 124回, SY, 8, (一社)日本外科学会, 2024年04月
  日本語
• 切除不能膵癌における集学的治療の現状と課題 切除不能膵癌に対するconversion surgeryの長期成績および主要動脈温存手術の妥当性の検討　　　　　　　　　　　　　　　
  浅野 賢道, 平野 聡, 中村 透, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴, 和田 雅孝, 武内 慎太郎
  日本外科学会定期学術集会抄録集, 124回, WS, 5, (一社)日本外科学会, 2024年04月
  日本語
• 肝胆膵癌手術中のトラブルシューティング 高難易度肝胆膵手術での予期せぬ術中大量出血により2期的手術の周術期管理　　　　　　　　　　　　　　　
  田中 公貴, 武内 慎太郎, 和田 雅孝, 松井 あや, 中西 喜嗣, 浅野 賢道, 野路 武寛, 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, 124回, WS, 4, (一社)日本外科学会, 2024年04月
  日本語
• 門脈塞栓術施行症例の術後肝不全発生症例解析結果による肝門部胆管癌診療の今後の方向性　　　　　　　　　　　　　　　
  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, 平野 聡
  日本外科学会定期学術集会抄録集, 124回, SF, 5, (一社)日本外科学会, 2024年04月
  日本語
• 術前化学療法後の膵癌手術症例における術前ヘモグロビン値の術後アウトカムに与える影響　　　　　　　　　　　　　　　
  和田 雅孝, 中村 透, 武内 慎太郎, 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, 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, 124回, SF, 6, (一社)日本外科学会, 2024年04月
  日本語
• 肝外胆管癌のリンパ節転移過程におけるEMT関連タンパク発現に関する検討　　　　　　　　　　　　　　　
  林 真理子, 中西 喜嗣, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 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, 124回, PS, 2, (一社)日本外科学会, 2024年04月
  日本語
• 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, 39, Suppl., 304, 304, (一社)日本インターベンショナルラジオロジー学会, 2024年04月
  日本語
• 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, 38, 2, 227, 227, (一社)日本外傷学会, 2024年04月
  日本語
• Concurrent targeting of GSK3 and MEK as a therapeutic strategy to treat pancreatic ductal adenocarcinoma.
  Junki Fukuda, Shinya Kosuge, Yusuke Satoh, Sho Sekiya, Ryodai Yamamura, Takako Ooshio, Taiga Hirata, Reo Sato, Kanako C Hatanaka, Tomoko Mitsuhashi, Toru Nakamura, Yoshihiro Matsuno, Yutaka Hatanaka, Satoshi Hirano, Masahiro Sonoshita
  Cancer science, 115, 4, 1333, 1345, Wiley, 2024年04月, ［国際誌］
  英語, 研究論文（学術雑誌）, Abstract
  
  Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies worldwide. However, drug discovery for PDAC treatment has proven complicated, leading to stagnant therapeutic outcomes. Here, we identify Glycogen synthase kinase 3 (GSK3) as a therapeutic target through a whole‐body genetic screening utilizing a ‘4‐hit’ Drosophila model mimicking the PDAC genotype. Reducing the gene dosage of GSK3 in a whole‐body manner or knocking down GSK3 specifically in transformed cells suppressed 4‐hit fly lethality, similar to Mitogen‐activated protein kinase kinase (MEK), the therapeutic target in PDAC we have recently reported. Consistently, a combination of the GSK3 inhibitor CHIR99021 and the MEK inhibitor trametinib suppressed the phosphorylation of Polo‐like kinase 1 (PLK1) as well as the growth of orthotopic human PDAC xenografts in mice. Additionally, reducing PLK1 genetically in 4‐hit flies rescued their lethality. Our results reveal a therapeutic vulnerability in PDAC that offers a treatment opportunity for patients by inhibiting multiple targets.
• 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, Springer Science and Business Media LLC, 2024年03月17日
  研究論文（学術雑誌）
• 80歳以上のResectable膵癌症例に対する治療成績　　　　　　　　　　　　　　　
  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 裕磨, 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, 85, 3, 432, 432, 日本臨床外科学会, 2024年03月
  日本語
• 同時性多発肝転移を伴う膵神経内分泌腫瘍に対する原発巣切除後に薬物治療を行い長期生存中の1例　　　　　　　　　　　　　　　
  室井 論大, 土川 貴裕, 林 真理子, 武内 慎太郎, 和田 雅孝, 三浦 巧, 岡村 国茂, 田中 公貴, 松井 あや, 中西 義嗣, 浅野 賢道, 野路 武寛, 倉島 庸, 海老原 裕磨, 村上 壮一, 中村 透, 七戸 俊明, 平野 聡
  日本臨床外科学会雑誌, 85, 3, 432, 432, 日本臨床外科学会, 2024年03月
  日本語
• 最新技術を用いた消化器診療 ロボット支援下膵切除手術における新規導入後の手術成績と脾温存手術の比較検討　　　　　　　　　　　　　　　
  田中 公貴, 武内 慎太郎, 和田 雅孝, 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, 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, 134回・128回, 36, 36, 日本消化器病学会-北海道支部, 2024年03月
  日本語
• 膵頭部巨大単純性嚢胞に対して膵頭十二指腸切除を施行した1例　　　　　　　　　　　　　　　
  高岡 憲敬, 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, 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, 134回・128回, 58, 58, 日本消化器病学会-北海道支部, 2024年03月
  日本語
• 切除不能膵癌のコンバージョン治療の最前線 切除不能膵癌に対するconversion surgeryの功罪
  浅野 賢道, 平野 聡, 中村 透, 土川 貴裕, 野路 武寛, 中西 喜嗣, 松井 あや, 田中 公貴
  日本消化器病学会雑誌, 121, 臨増総会, A145, A145, (一財)日本消化器病学会, 2024年03月
  日本語
• 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, 31, 3, 2090, 2100, 2024年03月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• ASO Author Reflections: Impact of Neutrophil Extracellular Traps on Extrahepatic Cholangiocarcinomas.
  Hiroyuki Yamamoto, Yoshitsugu Nakanishi, Satoshi Hirano
  Annals of surgical oncology, 31, 2, 1272, 1273, 2024年02月, ［国際誌］
  英語, 研究論文（学術雑誌）
• Esophageal perforation due to soft coagulation heat injury after right lower lobectomy: A case report.
  Akira Fukunaga, Takuya Ikushima, Yuma Aoki, Shota Kuwabara, Tatsuya Kato, Satoshi Hirano
  International journal of surgery case reports, 115, 109247, 109247, 2024年02月, ［国際誌］
  英語, INTRODUCTION: Soft coagulation is a hemostatic system of electrosurgical units that automatically regulates its output to avoid carbonization or incision. This system is widely used in invasive procedures, including thoracic surgery. Few reports exist on the harmful effects of these devices. Herein, we encountered a case of an esophagopleural fistula caused by soft coagulation. PRESENTATION OF CASE: A 74-year-old man with a history of bladder cancer was diagnosed with a tumor in the right lower lung lobe 2.5 cm in diameter. A thoracoscopic right lower lobectomy with lymph node dissection was performed. During surgery, hemostasis using soft coagulation was performed on the right wall of the lower esophagus. Eight days after surgery, thoracoscopic empyema curettage and drainage were performed. Three days after the second surgery, an esophageal fistula was identified. Suturing for the esophageal fistula and omentoplasty were performed. Suture failure occurred and an esophagobronchial fistula developed after the third surgery, which was reduced by drainage, antibiotics, and enteral nutrition. The fistula was finally addressed by fibrin glue filling in its cavity. DISCUSSION: Soft coagulation helps manage hemostasis and contributes to safe surgery. However, it may cause severe complications owing to the unpredictable spread of heat denaturation. It is suspected that delayed esophageal perforation was caused by an unnoticed heat injury to the deeper layer of the esophageal wall. CONCLUSION: There have been no reports of esophagus injury caused by soft coagulation exept for our experience. Although soft coagulation is a useful device owing to its excellent hemostatic capacity, the spread of heat denaturation may cause unpredictable tissue damage. Extra caution should be observed when using this device for hemostasis.
• Immuno-genomic analysis reveals eosinophilic feature and favorable prognosis of female non-smoking esophageal squamous cell carcinomas.
  Yuki Okawa, Shota Sasagawa, Hiroaki Kato, Todd A Johnson, Koji Nagaoka, Yukari Kobayashi, Akimasa Hayashi, Takahiro Shibayama, Kazuhiro Maejima, Hiroko Tanaka, Satoru Miyano, Junji Shibahara, Satoshi Nishizuka, Satoshi Hirano, Yasuyuki Seto, Takeshi Iwaya, Kazuhiro Kakimi, Takushi Yasuda, Hidewaki Nakagawa
  Cancer letters, 581, 216499, 216499, 2024年01月28日, ［国際誌］
  英語, 研究論文（学術雑誌）, Most of esophageal squamous cell carcinoma (ESCC) develop in smoking males in Japan, but the genomic etiology and immunological characteristics of rare non-smoking female ECSS remain unclear. To elucidate the genomic and immunological features of ESCC in non-smoking females, we analyzed whole-genome or transcriptome sequencing data from 94 ESCCs, including 20 rare non-smoking female cases. In addition, 31,611 immune cells were extracted from four ESCC tissues and subject to single-cell RNA-seq. We compared their immuno-genomic and microbiome profiles between non-smoking female and smoking ESCCs. Non-smoking females showed much better prognosis. Whole-genome sequencing analysis showed no significant differences in driver genes or copy number alterations depending on smoking status. The mutational signatures specifically observed in non-smoking females ESCC could be attributed to aging. Immune profiling from RNA-seq revealed that ESCC in non-smoking females had high tumor microenvironment signatures and a high abundance of eosinophils with a favorable prognosis. Single-cell RNA-sequencing of intratumor immune cells revealed gender differences of eosinophils and their activation in female cases. ESCCs in non-smoking females have age-related mutational signatures and gender-specific tumor immune environment with eosinophils, which is likely to contribute to their favorable prognosis.
• Ensuring communication redundancy and establishing a telementoring system for robotic telesurgery using multiple communication lines.
  Yusuke Wakasa, Kenichi Hakamada, Hajime Morohashi, Takahiro Kanno, Kotaro Tadano, Kenji Kawashima, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori
  Journal of robotic surgery, 18, 1, 9, 9, 2024年01月11日, ［国際誌］
  英語, 研究論文（学術雑誌）, Assuring communication redundancy during the interruption and establishing appropriate teaching environments for local surgeons are essential to making robotic telesurgery mainstream. This study analyzes robotic telesurgery with telementoring using standard domestic telecommunication carriers. Can multiple carriers guarantee redundancy with interruptions? Three commercial optical fiber lines connected Hirosaki University and Mutsu General Hospitals, 150 km apart. Using Riverfield, Inc. equipment, Hirosaki had a cockpit, while both Mutsu used both a cockpit and a surgeon's console. Experts provided telementoring evaluating 14 trainees, using objective indices for operation time and errors. Subjective questionnaires addressed image quality and surgical operability. Eighteen participants performed telesurgery using combined lines from two/three telecommunication carriers. Manipulation: over 30 min, lines were cut and restored every three minutes per task. Subjects were to press a switch when noticing image quality or operability changes. Mean time to task completion was 1510 (1186-1960) seconds: local surgeons alone and 1600 (1152-2296) seconds for those under remote instructor supervision, including expert intervention time. There was no significant difference (p = 0.86). The mean error count was 0.92 (0-3) for local surgeons and 0.42 (0-2) with remote instructors. Image quality and operability questionnaires found no significant differences. Results communication companies A, B, and C: the A/B combination incurred 0.17 (0-1) presses of the environment change switch, B/C had 0, and C/A received 0.67 (0-3), showing no significant difference among provider combinations. Combining multiple communication lines guarantees communication redundancy and enables robotic telementoring with enhanced communication security.
• Long-term outcomes of single-incision laparoscopic colectomy for right-sided colon cancer utilising a craniocaudal approach.
  Mamoru Miyasaka, Shuji Kitashiro, Mamoru Takahashi, Yuki Okawa, Sho Sekiya, Daisuke Saikawa, Koichi Teramura, Satoshi Hayashi, Yoshinori Suzuki, Joe Matsumoto, Masaya Kawada, Yo Kawarada, Kichizo Kaga, Shunichi Okushiba, Satoshi Hirano
  Journal of minimal access surgery, 2024年01月09日, ［国際誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: This study aimed to evaluate the short- and long-term outcomes of single-incision laparoscopic colectomy (SILC) for right-sided colon cancer (CC) using a craniocaudal approach. PATIENTS AND METHODS: The data of patients who underwent SILC for right-sided CC at our hospital between January 2013 and December 2022 were retrospectively collected. Surgery was performed using a craniocaudal approach. Short- and long-term operative outcomes were analysed. RESULTS: In total, 269 patients (127 men, 142 women; median age 74 years) underwent SILC for right-sided CC. The cases included ileocaecal resection (n = 138) and right hemicolectomy (n = 131). The median operative time was 154 min, and the median operative blood loss was 0 ml. Twenty-seven cases (10.0%) required an additional laparoscopic trocar, and 9 (3.3%) were converted to open surgery. The Clavien-Dindo classification Grade III post-operative complications were detected in 7 (2.6%) cases. SILC was performed by 25 surgeons, including inexperienced surgeons, with a median age of 34 years. The 5-year cancer-specific survival (CSS) was 96.1% (95% confidence interval [CI] 91.3%-98.2%), and CSS per pathological disease stage was 100% for Stages 0-I and II and 86.2% (95% CI 71.3%-93.7%) for Stage III. The 5-year recurrence-free survival (RFS) was 90.6% (95% CI 85.7%-93.9%), and RFS per pathological disease stage was 100% for Stage 0-I, 91.7% (95% CI 80.5%-96.6%) for Stage II and 76.1% (95% CI 63.0%-85.1%) for Stage III. CONCLUSIONS: SILC for right-sided CC can be safely performed with a craniocaudal approach, with reasonable short- and long-term outcomes.
• Exhaustion, rather than lack of infiltration and persistence, of CAR-T cells hampers the efficacy of CAR-T therapy in an orthotopic PDAC xenograft model.
  Yuta Takeuchi, Yizheng Wang, Katsunori Sasaki, Osamu Sato, Takahiro Tsuchikawa, Linan Wang, Yasunori Amaishi, Sachiko Okamoto, Junichi Mineno, Yoshifumi Hirokawa, Kanako C Hatanaka, Yutaka Hatanaka, Takuma Kato, Hiroshi Shiku, Satoshi Hirano
  Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 170, 116052, 116052, 2024年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, Chimeric antigen receptor T-cell (CAR-T) therapy has demonstrated impressive success in the treatment of patients with hematologic tumors yet achieved very limited efficacy for solid tumors due to hurdles unique to solid tumors. It is also noted that the tumor microenvironment composition varies between tumor type, which again imposes unique set of hurdles in each solid tumor. Therefore, elucidation of individual hurdles is key to achieving successful CAR-T therapy for solid tumors. In the present study, we employed an orthotopic human PDAC xenograft model, in which quantitative, spatial and functional dynamics of CAR-T cells in tumor tissues were analyzed to obtain insights into ways of overcoming PDAC related hurdles. Contrary to previous studies that demonstrated a limited persistency and infiltration of CAR-T cells in many solid tumors, they persist and accumulated in PDAC tumor tissues. Ex vivo analysis revealed that CAR-T cells that had been recovered at different time points from mice bearing an orthotopic PDAC tumor exhibited a gradual loss of tumor reactivity. This loss of tumor reactivity of CAR-T cells was associated with the increased expression of AMP-activated protein kinase and Mitofusin 1/ Dynamin-related protein 1 ratio.
• 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, 17, 1, e13246, 2024年01月, ［国内誌］
  英語, 研究論文（学術雑誌）, The purpose of this study is to evaluate the performance of tele-robotic distal gastrectomy (tele-RDG) with lymph node dissection (LND) using a novel Japanese-made surgical robot hinotori™ (Medicaroid, Kobe, Japan) in a cadaver with a presumptive gastric cancer. The Cadaveric Anatomy and Surgical Training Laboratory (CAST-Lab.) at Hokkaido University and Kushiro City General Hospital (KCGH) are connected by a guaranteed type line (1 Gbps), and the distance between the two facilities is 250 km. A patient cart was installed at CAST-Lab, and a surgeon cockpit was installed at KCGH. Tele-RDG with D2 LND was performed on an adult human cadaver. In all surgical processes, the communication environment was stable without image degradation, and the mean round trip time was 40 milliseconds (36.5-55 milliseconds). For tele-RDG with D2 LND, the operation time was 199 minutes without any technical problems. Tele-RDG using hinotori™ was feasible and similar to local robotic RDG.
• 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, 38, 3, 221, 221, (一社)日本インターベンショナルラジオロジー学会, 2024年01月
  日本語
• 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, 31, 1, 90, 96, Springer Science and Business Media LLC, 2024年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Cancer-free resection (R0) is one of the most important factors for the long-term survival of biliary carcinoma. For some patients with widespread invasive cancer located between the hilar and intrapancreatic bile duct, hepatopancreaticoduodenectomy (HPD) is considered a radical surgery for R0 resection. However, HPD is associated with high morbidity and mortality rates. Furthermore, previous reports have not shown lymph node metastasis (LNM) status, such as the location or number, which could influence the prognosis after HPD. In this study, first, we explored the prognostic factors for survival, and second, we evaluated whether the LNM status (number and location of LNM) would influence the decision on surgical indications in patients with widely spread biliary malignancy. METHODS: We retrospectively reviewed the medical records of 54 patients who underwent HPD with hepatectomy in ≥2 liver sectors from January 2003 to December 2021 (HPD-G). We also evaluated 54 unresectable perihilar cholangiocarcinoma patients who underwent chemotherapy from January 2010 to December 2021 (CTx-G). RESULTS: R0 resection was performed in 48 patients (89%). The median survival time (MST) and 5-year overall survival rate of the HPD-G and CTx-G groups were 36.9 months and 31.1%, and 19.6 months and 0%, respectively. Univariate and multivariate analyses showed that pathological portal vein involvement was an independent prognostic factor for survival (MST: 18.9 months). Additionally, patients with peripancreatic LNM had worse prognoses (MST: 13.3 months) than CTx-G. CONCLUSIONS: Patients with peripancreatic LNM or PV invasion might be advised to be excluded from surgery-first indications for HPD.
• The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society.
  Hideki Takami, Yasuhiro Kodera, Hidetoshi Eguchi, Minoru Kitago, Kenta Murotani, Satoshi Hirano, Yuko Kitagawa, Norihiko Ikeda, Masaki Mori
  Surgery today, 54, 1, 41, 52, 2024年01月, ［国内誌］
  英語, 研究論文（学術雑誌）, PURPOSE: A collapse in regional healthcare through the maldistribution of physicians has been a long-debated issue in Japan and amidst this situation, a new system of board certification was initiated. The Japan Surgical Society (JSS) conducted a nation-wide survey to grasp the current distribution of surgeons in Japan, and their roles. METHODS: All 1976 JSS-certified teaching hospitals were invited to respond to a web-based questionnaire. The responses were analyzed to seek a solution to the current issues. RESULTS: Responses to the questionnaire were received from 1335 hospitals. The surgical departments of medical universities serve as an internal labor market and were the source of surgeons for most hospitals. More than 50% of teaching hospitals throughout the country claimed a shortage of surgeons even in well-populated prefectures such as Tokyo and Osaka. Hospitals rely on surgeons to cover the deficits in medical oncology, anesthesiology, and emergency medicine. These additional responsibilities were identified as significant predictors of a shortage of surgeons. CONCLUSIONS: Surgeon shortage is a serious issue throughout Japan. Given the limited number of surgeons and surgical trainees, hospitals should make every effort to recruit specialists in the additional fields where surgeons are filling the gaps and allow surgeons to engage more in surgery.
• Tailoring the Use of Central Pancreatectomy Through Prediction Models for Major Morbidity and Postoperative Diabetes: International Retrospective Multicenter Study.
  Eduard Antonie van Bodegraven, Sanne Lof, Leia Jones, Béatrice Aussilhou, Gao Yong, Wei Jishu, Rosa Klotz, Dario Missael Rocha-Castellanos, Ippei Matsumato, Charles de Ponthaud, Kimitaka Tanaka, Esther Biesel, Emmanuele Kauffmann, Traian Dumitrascu, Yuichi Nagakawa, Pablo Martí-Cruchaga, Geert Roeyen, Alessandro Zerbi, Mara Goetz, Vincent de Meijer, Patrick Pessaux, Povilas Ignatavicius, Ihsan Demir, Mario Giuffrida, Bobby Tingstedt, Marco Vito Marino, Sotiris Mastoridis, Maximilian Brunner, Isabel Mora-Oliver, Cecilia Bortolato, Aisté Gulla, Thomas Apers, Hélène Hermand, Yusuke Mitsuka, Irinel Popescu, Ugo Boggi, Uwe Wittel, Satoshi Hirano, Sébastien Gaujoux, Keiko Kamei, Carlos Fernández-Del Castillo, Thilo Hackert, Jiang Kuirong, Miao Yi, Alain Sauvanet, Marc Besselink, Mohammad Abu Hilal, Safi Dokmak
  Annals of surgery, 2023年12月11日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: To develop a prediction model for major morbidity and endocrine dysfunction after CP which could help in tailoring the use of this procedure. SUMMARY BACKGROUND DATA: Central pancreatectomy (CP) is a parenchyma-sparing alternative to distal pancreatectomy for symptomatic benign and pre-malignant tumors in body and neck of the pancreas CP lowers the risk of new-onset diabetes and exocrine pancreatic insufficiency compared to distal pancreatectomy but it is thought to increase the risk of short-term complications including postoperative pancreatic fistula (POPF). METHODS: International multicenter retrospective cohort study including patients from 51 centers in 19 countries (2010-2021). Primary endpoint was major morbidity. Secondary endpoints included POPF grade B/C, endocrine dysfunction, and the use of pancreatic enzymes. Two risk model were designed for major morbidity and endocrine dysfunction utilizing multivariable logistic regression and internal and external validation. RESULTS: 838 patients after CP were included (301 (36%) minimally invasive) and major morbidity occurred in 248 (30%) patients, POPF B/C in 365 (44%), and 30-day mortality in 4 (1%). Endocrine dysfunction in 91 patients (11%) and use of pancreatic enzymes in 108 (12%). The risk model for major morbidity included male sex, age, BMI, and ASA score≥3. The model performed acceptable with an area under curve (AUC) of 0.72(CI:0.68-0.76). The risk model for endocrine dysfunction included higher BMI and male sex and performed well (AUC:0.83 (CI:0.77-0.89)). CONCLUSIONS: The proposed risk models help in tailoring the use of CP in patients with symptomatic benign and premalignant lesions in the body and neck of the pancreas and are readily available via www.pancreascalculator.com.
• Real-time telementoring with 3D drawing annotation in robotic surgery.
  Tomonori Nakanoko, Eiji Oki, Mitsuhiko Ota, Naoki Ikenaga, Yuichi Hisamatsu, Takeo Toshima, Takahiro Kanno, Kotaro Tadano, Kenji Kawashima, Kenoki Ohuchida, Hajime Morohashi, Yuma Ebihara, Koshi Mimori, Masafumi Nakamura, Tomoharu Yoshizumi, Kenichi Hakamada, Satoshi Hirano, Norihiko Ikeda, Masaki Mori
  Surgical endoscopy, 37, 12, 9676, 9683, 2023年12月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: In telementoring, differences in teaching methods affect local surgeons' comprehension. Because the object to be operated on is a three-dimensional (3D) structure, voice or 2D annotation may not be sufficient to convey the instructor's intention. In this study, we examined the usefulness of telementoring using 3D drawing annotations in robotic surgery. METHODS: Kyushu University and Beppu Hospital are located 140 km apart, and the study was conducted using a Saroa™ surgical robot by RIVERFIELD Inc. using a commercial guarantee network on optical fiber. Twenty medical students performed vertical mattress suturing using a swine intestinal tract under surgical guidance at the Center for Advanced Medical Innovation Kyushu University. Surgical guidance was provided by Beppu Hospital using voice, 2D, and 3D drawing annotations. All robot operations were performed using 3D images, and only the annotations were independently switched between voice and 2D and 3D images. The operation time, needle movement, and performance were also evaluated. RESULTS: The 3D annotation group tended to have a shorter working time than the control group (25.6 ± 63.2 vs. - 36.7 ± 65.4 min, P = 0.06). The 3D annotation group had fewer retries than the control group (1.3 ± 1.7 vs. - 1.1 ± 0.7, P = 0.006), and there was a tendency for fewer needle drops (0.4 ± 0.7 vs. - 0.5 ± 0.9, P = 0.06). The 3D annotation group scored significantly higher than the control group on the Global Evaluate Assessment of Robot Skills (16.8 ± 2.0 vs. 22.8 ± 2.4, P = 0.04). The 3D annotation group also scored higher than the voice (13.4 ± 1.2) and 2D annotation (16.2 ± 1.8) groups (3D vs. voice: P = 0.03, 3D vs. 2D: P = 0.03). CONCLUSION: Telementoring using 3D drawing annotation was shown to provide good comprehension and a smooth operation for local surgeons.
• 門脈ガス血症に伴い縦隔内動脈にガスを認め保存的に加療し得た1例
  青木 佑磨, 野路 武寛, 田中 公貴, 松井 あや, 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
  Japanese Journal of Acute Care Surgery, 13, 1, 67, 72, (一社)日本Acute Care Surgery学会, 2023年12月
  日本語, 患者は90歳代,男性。意識障害と血圧低下を主訴に救急外来に搬送された。血液生化学検査では低ナトリウム血症を認め,腹部造影CT検査では著明な門脈ガス血症,左側結腸の造影不良・腸管気腫,腹水貯留を認めた。血液検査では炎症反応の上昇はみられず,腹膜刺激症状も認めなかった。胸部単純CT検査では腕頭動脈・左鎖骨下動脈内にもガスを認めた。虚血性腸炎に起因する無症候性の門脈ガス血症,動脈内ガスと診断したが保存加療の方針とし,入院加療を行った。低ナトリウム血症の改善に伴い意識レベルは改善し,第18病日の腹部造影CT検査では門脈ガス血症や腹水の改善がみられた。その後、症状の再燃を認めず,退院となった。(著者抄録)
• Validation study for prognostic scoring system for perihilar cholangiocarcinoma surgery using preoperative factors.
  Yuma Aoki, Takehiro Noji, Kimitaka Tanaka, Aya Matsui, Yoshitsugu Nakanishi, Toshimichi Asano, Toru Nakamura, Takahiro Tsuchikawa, Satoshi Hirano
  Langenbeck's archives of surgery, 408, 1, 430, 430, 2023年11月08日, ［国際誌］
  英語, 研究論文（学術雑誌）, PURPOSE: Recently, systemic inflammatory responses (SIR) have been shown to play a pivotal role in the development and progression of cancer. We previously reported that four factors, serum carcinoembryonic antigen (> 7 ng/dL), serum albumin (< 3.5 g/dL), C-reactive protein (> 0.5 mg/dL), and platelet-lymphocyte ratio (PLR; > 150), were independent prognostic factors after perihilar cholangiocarcinoma (PHCC) surgery. We also advocated a prognosis predictive preoperative prognostic score (PPS) using these four factors and showed that PPS could predict patients' prognosis on survival. This retrospective study sought to validate preoperatively available prognostic factors for survival after major hepatectomy as reported previously, including PPS for PHCC. METHODS: We retrospectively validated our PPS score and reported SIR scoring systems using the data of 125 consecutive patients who underwent PHCC surgery from January 2010 to November 2020. RESULTS: PPS was an independent preoperative prognostic factors for survival. The T and N categories were independent prognostic factors. Other SIR scores were not independent preoperative factors in the univariate analysis. Among SIR scores, only the PPS was found to be associated with OS and disease-free survival. The PPS was also associated with histopathological factors (T and N categories). CONCLUSION: PPS could be useful in predicting long-term survival after PHCC and may be a more useful scoring system than other SIR systems.
• Postoperative Prognosis According to Pathologic Categorization of Desmoplastic Reaction in Patients with Extrahepatic Cholangiocarcinoma.
  Yusuke Yoshida, Yoshitsugu Nakanishi, Tomoko Mitsuhashi, Hiroyuki Yamamoto, Mariko O Hayashi, Mitsunobu Oba, Takeo Nitta, Takashi Ueno, Toru Yamada, Masato Ono, Shota Kuwabara, Yutaka Hatanaka, Satoshi Hirano
  Annals of surgical oncology, 30, 12, 7348, 7357, 2023年11月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Recent studies have demonstrated the importance of desmoplastic reaction (DR) in predicting postoperative prognosis for patients with colorectal carcinoma. However, the impact of DR on the prognosis of extrahepatic cholangiocarcinomas (EHCCs) is not established. This study aimed to clarify the associations of pathologic DR categories with clinicopathologic factors and postoperative prognosis of perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC). METHODS: A pathologic review of 174 patients with PHCC and 109 patients with DCC who underwent surgical resection was performed. The patients were classified into three DR categories (immature, intermediate, and mature) based on the histologic features within the fibrotic stroma in the invasive front. The association between DR categories and the distribution of fibroblasts with anti-α-smooth muscle actin (SMA) expression, seeming to be tumor-promoting cancer-associated fibroblasts (CAFs), was evaluated in 191 tissue microarray specimens of EHCCs. RESULTS: Intermediate/immature DR categories were significantly associated with a more invasive nature, including higher pT and pN stages and more tumor buds than the mature category in both PHCC and DCC. The DR categories could stratify overall survival (OS) and relapse-free survival (RFS) in both PHCC and DCC patients. In the multivariate analysis, the DR category was an independent prognostic factor for OS and RFS in both PHCC and DCC (p < 0.001). The mature and immature DR categories were significantly associated respectively with the confined and pervasive distribution of fibroblasts with α-SMA expression. CONCLUSION: In patients with EHCCs, DR categorization was an independent prognostic factor reflecting the distribution of tumor-promoting CAFs in the invasive front.
• 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).
  Teiichi Sugiura, Hirochika Toyama, Akira Fukutomi, Hirofumi Asakura, Yuriko Takeda, Kouji Yamamoto, Satoshi Hirano, Sohei Satoi, Ippei Matsumoto, Shinichiro Takahashi, Soichiro Morinaga, Makoto Yoshida, Yasunaru Sakuma, Hidetaka Iwamoto, Yasuhiro Shimizu, Katsuhiko Uesaka
  Journal of hepato-biliary-pancreatic sciences, 30, 11, 1249, 1260, 2023年11月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• Novel Benchmark Values for Open Major Anatomic Liver Resection in Non-cirrhotic Patients: A Multicentric Study of 44 International Expert Centers.
  Richard X Sousa Da Silva, Eva Breuer, Sadhana Shankar, Shoji Kawakatsu, Wacław Hołówko, João Santos Coelho, Heithem Jeddou, Teiichi Sugiura, Mohammed Ghallab, Doris Da Silva, Genki Watanabe, Florin Botea, Nozomu Sakai, Pietro Addeo, Stylianos Tzedakis, Fabian Bartsch, Kaja Balcer, Chetana Lim, Fabien Werey, Victor Lopez-Lopez, Luciana Peralta Montero, Rodrigo Sanchez Claria, Jennifer Leiting, Neeta Vachharajani, Eve Hopping, Orlando J M Torres, Satoshi Hirano, Daan Andel, Jeroen Hagendoorn, Alicja Psica, Matteo Ravaioli, Keun Soon Ahn, Tim Reese, Leonardo A Montes, Ganesh Gunasekaran, Cándido Alcázar, Jin Hong Lim, Muhammad Haroon, Qian Lu, Antonio Castaldi, Tatsuya Orimo, Beat Moeckli, Teresa Abadía, Luis Ruffolo, Josefina Dib Hasan, Francesca Ratti, Emmanuele F Kauffmann, Roeland F de Wilde, Wojciech G Polak, Ugo Boggi, Luca Aldrighetti, Lucas McCormack, Roberto Hernandez-Alejandro, Alejandro Serrablo, Christian Toso, Akinobu Taketomi, Jean Gugenheim, Jiahong Dong, Faisal Hanif, Joon Seong Park, José M Ramia, Myron Schwartz, Diego Ramisch, Michelle L De Oliveira, Karl J Oldhafer, Koo Jeong Kang, Matteo Cescon, Peter Lodge, Inne H M Borel Rinkes, Takehiro Noji, John-Edwin Thomson, Su Kah Goh, William C Chapman, Sean P Cleary, Juan Pekolj, Jean-Marc Regimbeau, Olivier Scatton, Stéphanie Truant, Hauke Lang, David Fuks, Philippe Bachellier, Masayuki Ohtsuka, Irinel Popescu, Kiyoshi Hasegawa, Mickaël Lesurtel, René Adam, Daniel Cherqui, Katsuhiko Uesaka, Karim Boudjema, Hugo Pinto-Marques, Michał Grąt, Henrik Petrowsky, Tomoki Ebata, Andreas Prachalias, Ricardo Robles-Campos, Pierre-Alain Clavien
  Annals of surgery, 278, 5, 748, 755, 2023年11月01日, ［国際誌］
  英語, 研究論文（学術雑誌）, OBJECTIVE: This study aims at establishing benchmark values for best achievable outcomes following open major anatomic hepatectomy for liver tumors of all dignities. BACKGROUND: Outcomes after open major hepatectomies vary widely lacking reference values for comparisons among centers, indications, types of resections, and minimally invasive procedures. METHODS: A standard benchmark methodology was used covering consecutive patients, who underwent open major anatomic hepatectomy from 44 high-volume liver centers from 5 continents over a five-year period (2016-2020). Benchmark cases were low-risk non-cirrhotic patients without significant co-morbidities treated in high-volume centers (≥30 major liver resections/year). Benchmark values were set at the 75th percentile of median values of all centers. Minimum follow-up period was 1 year in each patient. RESULTS: Of 8044 patients, 2908 (36%) qualified as benchmark (low risk) cases. Benchmark cutoffs for all indications include R0 resection ≥78%; liver failure (grade B/C) ≤10%; bile leak (grade B/C) ≤18%; complications ≥grade 3 and CCI® ≤46% and ≤9 at 3 months, respectively. Benchmark values differed significantly between malignant and benign conditions so that reference values must be adjusted accordingly. Extended right hepatectomy (H1,4-8 or H4-8) disclosed higher cutoff for liver failure, while extended left (H1-5,8 or H2-5,8) were associated with higher cutoffs for bile leaks, but had superior oncologic outcomes, when compared to formal left hepatectomy (H1-4 or H2-4). The minimal follow up for a conclusive outcome evaluation following open anatomic major resection must be 3 months. CONCLUSION: These new benchmark cut-offs for open major hepatectomy provide a powerful tool to convincingly evaluate other approaches including parenchymal-sparing procedures, laparoscopic/robotic approaches, and alternative treatments, such as ablation therapy, irradiation or novel chemotherapy regimens.
• 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, 53, 11, 1275, 1285, 2023年11月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• Right hepatectomy under cardiopulmonary bypass for hepatocellular carcinoma with inferior vena cava tumor thrombus: a case report.
  Hiroki Kushiya, Yoshiyasu Ambo, Minoru Takada, Takahiko Masuda, Shuichi Naraoka, Satoshi Hirano
  Surgical case reports, 9, 1, 175, 175, 2023年10月03日, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: The prognosis of hepatocellular carcinoma (HCC) with vascular invasion is extremely poor, especially in patients with tumor thrombus (TT) of the inferior vena cava (IVC), which is an oncological emergency with a high risk of sudden death due to TT extension or migration. Herein, we describe a case of HCC with TT of the IVC that rapidly extended into the right atrium (RA), in which right hepatectomy was performed under cardiopulmonary bypass. CASE PRESENTATION: A 64-year-old man was diagnosed with HCC with IVC TT, and right hepatic lobectomy was scheduled. While awaiting surgery, he complained of respiratory distress and rushed to the emergency room. The TT had reached the RA, and the patient was in a state of oncologic emergency. We requested the cooperation of the cardiovascular surgery department, and under artificial cardiopulmonary support, the right atrium was incised, and a part of the TT was removed. The IVC was clamped to prevent tumor dispersal, and right hepatic lobectomy was performed. The remaining thrombus was excised along with the right lobe of the liver by incising the IVC. There were no serious postoperative complications, and the patient is alive 1 year and 5 months postoperatively. CONCLUSION: Hepatic resection with cardiopulmonary bypass could be an option for HCC with TT reaching the RA.
• 1時間半の長時間搬送により当院に搬入された、腹腔内大量出血の一生存例　　　　　　　　　　　　　　　
  高岡 憲敬, 岡村 国茂, 三浦 巧, 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
  Japanese Journal of Acute Care Surgery, 13, Suppl., 118, 118, (一社)日本Acute Care Surgery学会, 2023年10月
  日本語
• 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年09月06日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 胆嚢癌孤立性膵転移の1例
  小菅 信哉, 野路 武寛, 郷 雅, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 中村 透, 土川 貴裕, 三橋 智子, 平野 聡
  日本消化器外科学会雑誌, 56, 9, 487, 495, (一社)日本消化器外科学会, 2023年09月
  日本語, 症例は54歳の男性で,膵・胆管合流異常症に合併する胆嚢癌に対して胆嚢全層切除,肝外胆管切除,リンパ節郭清,胆管空腸吻合術を施行された.病理組織学的診断は中分化型腺癌,pT2,ly0,v1,pN0,pStage IIであった.術後2年10ヵ月,腹部超音波検査にて膵体部に不整形で遷延性の造影効果を伴う11mm大の低エコー腫瘤を認めた.超音波内視鏡下穿刺生検を施行し,腺癌の組織診断を得た.膵体部癌cT3N0M0 cStage IIAと診断し,尾側膵切除を施行した.病理組織診断では膵体部に2ヶ所の病変を認め,いずれの病変も低分化から中分化型の腺癌の所見であった.HE染色および免疫染色検査での形態・形質が既往の胆嚢癌の病理組織学的検査所見と一致していたため,胆嚢癌膵転移と診断した.術後18ヵ月現在,無再発生存中である.転移性膵腫瘍の多くが腎細胞癌,肉腫,大腸癌,悪性黒色腫からの転移であり,胆嚢癌の膵転移は極めてまれである.胆嚢癌の孤立性膵転移について報告する.(著者抄録)
• 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, (一社)日本癌学会, 2023年09月
  英語
• 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, (一社)日本癌学会, 2023年09月
  英語
• 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年09月, ［国際誌］
  英語, 研究論文（学術雑誌）
• Cadaver surgical training and research using donated cadavers in the field of surgery in Japan: an overview of reports from 2012 to 2021.
  Toshiaki Shichinohe, Hiroshi Date, Etsuro Hatano, Eiji Kobayashi, Masako Hiramatsu, Satoshi Hirano, Yoshimitsu Izawa, Yasuhiro Shirakawa
  Surgery today, 53, 8, 984, 991, 2023年08月, ［国内誌］
  英語, 研究論文（学術雑誌）, PURPOSE: Subsequent to the publication of "Guidelines for cadaver dissection in education and research of clinical medicine" in 2012, cadaver surgical training (CST) was implemented in various surgical fields across Japan. This article summarizes the recent progress made in the implementation of CST using donated cadavers, and its associated research, focusing on the field of surgery, and discusses its future direction. METHODS: All reports from 2012 to 2021 registered with the CST Promotion Committee of the Japan Surgical Society were analyzed. There were 292 (24.9%) programs in the field of surgery, including acute care surgery, out of a total of 1173 programs overall. Data were classified by the purpose of implementations and fields of surgery, with subclassification by organ, costs and participation fees. RESULTS: CST and its research were introduced in 27 (33.3%) of a total 81 universities. The total number of participants was 5564 and the major (80%) purpose of the program was to advance surgical techniques. When classified by objectives, 65, 59 and 11% were for mastering operations for malignant disease, minimally invasive surgery, and transplantation surgery, respectively. CONCLUSION: CST in the field of surgery is increasing progressively in Japan, but still with disproportionate dissemination. Further efforts are needed to achieve full adoption.
• Comprehension of fundamental knowledge about pediatric endoscopic surgery: a cross-sectional study in Japan.
  Shinichiro Yokoyama, Yo Kurashima, Satoshi Ieiri, Atsuyuki Yamataka, Hiroomi Okuyama, Hiroo Uchida, Tetsuya Ishimaru, Satoshi Hirano
  Surgical endoscopy, 37, 8, 6408, 6416, 2023年08月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Pediatric endoscopic surgery has become an alternative to conventional techniques with the development of medical equipment. However, there is no formal, standardized curriculum for pediatric endoscopic surgery, and its requirement remains elusive. The purpose of this study is to determine the baseline knowledge of pediatric surgeons that is considered essential for pediatric laparoscopic and thoracoscopic surgery. METHODS: Sixteen web-based multiple-choice questions based on the fundamental cognitive knowledge of pediatric endoscopic surgery were administered. The questions were created based on the fields covered by the Fundamentals of Laparoscopic Surgery ™ (FLS) certification examination blueprints and eight specific diseases of pediatric surgery. Pediatric surgeons and pediatric surgical trainees participated in this study voluntarily. RESULTS: A total of 122 surgeons participated through the Japanese Society of Pediatric Surgeons. The response rate was 95% (122/128). The total mean examination score of all participants was 79.4% (77.3-81.4%). There were no significant differences in total scores between the board-certified pediatric surgeons without an endoscopic surgical skill qualification and the non-board-certified pediatric surgeons (80.4% vs. 77.1%, p = 0.12). The endoscopic surgical skill-qualified surgeons had significantly higher percentages of correct responses in specific subjects than board-certified pediatric surgeons and surgeons without pediatric board certification (94.3% vs. 82.9%, p = 0.02; 94.3% vs. 77.5%, p = 0.0002). The FLS original subjects' scores were not significantly different among them. The mean score of surgeons who had experienced more than 200 cases of endoscopic surgery, including adult cases, was 83.2% (80.4-85.9%). CONCLUSIONS: A knowledge gap exists between surgeons, board-certified pediatric surgeons, and endoscopic surgical skill-qualified surgeons in Japan. In the field of pediatric surgery, an effective formal curriculum, such as FLS, is required to help address this vast knowledge gap for the safe conduct of endoscopic surgeries.
• Robot-assisted laparoscopic total gastrectomy for gastric cancer with common hepatic artery passed behind the portal vein: A case report.
  Yuto Sakurai, Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, Satoshi Hirano
  International journal of surgery case reports, 109, 108561, 108561, 2023年08月, ［国際誌］
  英語, INTRODUCTION: It is essential to identify variations of celiac artery (CA) and common hepatic artery (CHA), using preoperative computed tomography (CT) imaging, for safe gastrectomy and lymph node dissection in gastric cancer (GC) surgery. We report a relatively rare case with the CHA passing behind the portal vein (PV), in which we performed robot-assisted total gastrectomy (RTG) after chemotherapy as conversion surgery. CASE PRESENTATION: A 78-year-old man with GC was referred for conversion surgery. Three-dimensional CT angiography revealed an anomalous CHA passing behind the PV. The anomaly corresponded to type I according to Adachi's classification, and the patient underwent robot-assisted laparoscopic total gastrectomy D2 lymphadenectomy (RTG D2) with Roux-en-Y reconstruction. The operation time was 543 min, blood loss was 115 ml, and no intraoperative complications occurred. The postoperative course was uneventful. CLINICAL DISCUSSION: A word of caution during the surgical procedure entails the manipulation of the suprapancreatic lymph node dissection. Initially, it is crucial to identify the anterior surface of the portal vein (PV) and the nerve plexus surrounding the common hepatic artery (CHA). After completely dissecting the entire circumference, the PV is secured using vascular tape. By gently pulling the vascular tape towards the ventral aspect, a safe execution of lymph node dissection no.8 and 12 on the dorsal side of the PV can be accomplished. Meticulous handling of the anatomical abnormalities observed in the preoperative images may prevent unintended hemorrhage. CONCLUSION: We report a case with vascular anomalies in which RTG D2 was performed successfully as a conversion surgery.
• 【胆膵疾患診療～病理医との対話～】胆道疾患 肝側胆管断端術の術中迅速診断を行わない肝門部領域胆管癌手術の成績
  野路 武寛, 武内 慎太郎, 和田 雅孝, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 中村 透, 土川 貴裕, 平野 聡
  胆と膵, 44, 8, 713, 717, 医学図書出版(株), 2023年08月
  日本語, 教室では肝側胆管断端を胆管切離の肝側の最深部である「胆管分離限界点」で切離を行う立場から,術中の肝側胆管断端の迅速病理診断は行わない方針としている。この方針によって行った2004～2020年の肝門部領域胆管癌210例(肝膵同時切除例を除く)では肝側胆管断端の浸潤癌陽性が5例(2.4%),上皮内癌陽性が10例(4.8%)であり,194例(92%)で肝側胆管断端を癌陰性として切除可能であった。術中迅速診断をもとに追加切除を行った場合の長期予後に与える影響に関する研究はいくつか行われているが,その予後延長効果は上皮内癌による断端陽性例でリンパ節転移を伴わない比較的早期の症例でのみ認められる可能性が高い。しかし,実際に上皮内癌陽性と術中判断しても,追加切除を適応すべきか否かの判断は困難と考えられる。術前進展度診断を十分に行い,かつ常に「胆管分離限界点」で肝側胆管の切離を行うことで肝側胆管断端の比較的高いR0切除率を得られることから,本方針は妥当性があると考えている。(著者抄録)
• 「難治性胆汁漏に対する治療」 肝門部胆管癌術後の胆汁漏に対する治癒経過からみたドレナージの工夫
  田中 公貴, 野路 武寛, 平野 聡
  胆道, 37, 3, 426, 426, (一社)日本胆道学会, 2023年08月
  日本語
• 胆嚢癌同時性肝転移に対しconversion surgeryを施行した1例
  武内 慎太郎, 和田 雅孝, 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, 平野 聡, 桑谷 将成, 郷 雅, 三橋 智子
  胆道, 37, 3, 653, 653, (一社)日本胆道学会, 2023年08月
  日本語
• 重複胆管に発生した肝門部領域胆管癌の1例
  内藤 善, 野路 武寛, 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, 平野 聡
  胆道, 37, 3, 732, 732, (一社)日本胆道学会, 2023年08月
  日本語
• 肝門部領域胆管癌術後の遺残膵内胆管拡張を契機に発見された十二指腸乳頭部癌の1例
  熊谷 健太郎, 野路 武寛, 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, 平野 聡
  胆道, 37, 3, 738, 738, (一社)日本胆道学会, 2023年08月
  日本語
• Telesurgery and telesurgical support using a double-surgeon cockpit system allowing manipulation from two locations.
  Eiji Oki, Mitsuhiko Ota, Tomonori Nakanoko, Yasushi Tanaka, Satoshi Toyota, Qingjiang Hu, Yu Nakaji, Ryota Nakanishi, Koji Ando, Yasue Kimura, Yuichi Hisamatsu, Koshi Mimori, Yoshiya Takahashi, Hajime Morohashi, Takahiro Kanno, Kotaro Tadano, Kenji Kawashima, Hironobu Takano, Yuma Ebihara, Masaki Shiota, Junichi Inokuchi, Masatoshi Eto, Tomoharu Yoshizumi, Kenichi Hakamada, Satoshi Hirano, Masaki Mori
  Surgical endoscopy, 37, 8, 6071, 6078, 2023年08月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Although several studies on telesurgery have been reported globally, a clinically applicable technique has not yet been developed. As part of a telesurgical study series conducted by the Japan Surgical Society, this study describes the first application of a double-surgeon cockpit system to telesurgery. METHODS: Surgeon cockpits were installed at a local site and a remote site 140 km away. Three healthy pigs weighing between 26 and 29 kg were selected for surgery. Non-specialized surgeons performed emergency hemostasis, cholecystectomy, and renal vein ligation with remote assistance using the double-surgeon cockpits and specialized surgeons performed actual telesurgery. Additionally, the impact of adding internet protocol security (IPsec) encryption to the internet protocol-virtual private network (IP-VPN) line on communication was evaluated to address clinical security concerns. RESULTS: The average time required for remote emergency hemostasis with the double-surgeon cockpit system was 10.64 s. A non-specialized surgeon could safely perform cholecystectomy or renal vein ligation with remote assistance. Global Evaluative Assessment of Robotic Skills and System Usability Scale scores were higher for telesurgical support-assisted surgery by a non-specialized surgeon using the double-surgeon cockpits than for telesurgery performed by a specialized surgeon without the double-cockpit system. Adding IPsec encryption to the IP-VPN did not have a significant impact on communication. CONCLUSION: Telesurgical support through our double-surgeon cockpit system is feasible as first step toward clinical telesurgery.
• 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, Korean Society of Acute Care Surgery, 2023年07月31日
  研究論文（学術雑誌）, 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.
• Construction of redundant communications to enhance safety against communication interruptions during robotic remote surgery.
  Hajime Morohashi, Kenichi Hakamada, Takahiro Kanno, Kotaro Tadano, Kenji Kawashima, Yoshiya Takahashi, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori
  Scientific reports, 13, 1, 10831, 10831, 2023年07月04日, ［国際誌］
  英語, 研究論文（学術雑誌）, It is important to ensure the redundancy of communication during remote surgery. The purpose of this study is to construct a communication system that does not affect the operation in the event of a communication failure during telesurgery. The hospitals were connected by two commercial lines, a main line and a backup line, with redundant encoder interfaces. The fiber optic network was constructed using both guaranteed and best-effort lines. The surgical robot used was from Riverfield Inc. During the observation, a random shutdown and restoration process of either line was conducted repeatedly. First, the effects of communication interruption were investigated. Next, we performed a surgical task using an artificial organ model. Finally, 12 experienced surgeons performed operations on actual pigs. Most of the surgeons did not feel the effects of the line interruption and restoration on still and moving images, in artificial organ tasks, and in pig surgery. During all 16 surgeries, a total of 175-line switches were performed, and 15 abnormalities were detected by the surgeons. However, there were no abnormalities that coincided with the line switching. It was possible to construct a system in which communication interruptions would not affect the surgery.
• Vascular anatomical study of persistent descending mesocolon in patients undergoing laparoscopic surgery for colorectal cancer.
  Takeo Nitta, Atsushi Ikeda, Sosuke Sumikawa, Kuniaki Sasaki, Hidehiko Kitagami, Takaya Kusumi, Yasunori Nishida, Masao Hosokawa, Satoshi Hirano
  Asian journal of endoscopic surgery, 16, 3, 465, 472, 2023年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: Persistent descending mesocolon (PDM) is a rare congenital atypia of fixation of the descending colon, and currently, very few detailed studies exist on its vascular anatomy. This study was conducted to evaluate the features of the vascular anatomy of PDM to help avoid intraoperative lethal injury and subsequent postoperative complications in laparoscopic colorectal surgery. METHODS: We retrospectively analyzed the data of 534 patients who underwent laparoscopic left-sided colorectal surgery. PDM was diagnosed using preoperative axial computed tomography (CT) view. The vascular anatomical features were compared between PDM and non-PDM cases based on three-dimensional (3D)-CT angiography findings. Additionally, the perioperative short-term outcomes of laparoscopic surgery in the 534 patients were also compared between PDM and non-PDM cases. RESULTS: Of the total 534 patients, 13 patients (2.4%) presented with PDM. No branching pattern of the inferior mesenteric artery (IMA) specific to PDM was found. In the running direction of the IMA and sigmoidal colic artery (SA), the midline-shift of IMA and the right-shift of SA were significantly more in PDM than in non-PDM cases, respectively (38.5% vs. 2.5%, P ≤ .0001; 61.5% vs. 4.6%, P ≤ .0001). The perioperative short-term outcomes of laparoscopic surgery in the 534 patients were similar between PDM and non-PDM cases. CONCLUSION: Because changes in the direction of the vascular running are often observed due to adhesions and shortening of the mesentery in PDM cases, performing a detailed preoperative evaluation of vascular anatomy using imaging modalities such as 3D-CT angiography is important.
• [A Case of Breast Carcinoma That Changed Subtype to Squamous Cell Carcinoma after Chemotherapy].
  Kazuya Konishi, Jun Araya, Makoto Nagabuchi, Takashi Sakamoto, Jiro Ogino, Satoshi Hirano
  Gan to kagaku ryoho. Cancer & chemotherapy, 50, 7, 825, 827, 2023年07月, ［国内誌］
  日本語, 研究論文（学術雑誌）, Metaplastic carcinoma is a rare histological malignancy, often triple-negative, and has a poor prognosis. Here, we report a case of breast cancer in which the primary lesion degenerated into squamous cell carcinoma(triple negative)after drug treatment for invasive ductal carcinoma(Luminal type). The patient was a 41-year-old woman who was diagnosed with Stage Ⅳ left breast cancer T2N2bM1(HEP)(ER 90%, PR 70%, HER2 2+, FISH-)at another hospital and participated in the PATHWAY study(tamoxifen plus goserelin plus palbociclib/placebo). Since the primary lesion and liver metastasis increased in size, the study was discontinued after 8 weeks. She was treated at our hospital thereafter, with capecitabine plus cyclophosphamide, palbociclib plus fulvestrant plus leuprorelin, paclitaxel plus bevacizumab, eribulin, EC therapy, and docetaxel. However, both the primary lesion and liver metastasis increased. In particular, the increase in primary lesion size was remarkable, and the QOL significantly reduced due to bleeding and exudation. Biopsy performed during docetaxel treatment revealed metaplastic/squamous cell carcinoma(ER-, PR-, HER2 0, Ki-67 90-100%)histopathological findings. BRCA and microsatellite instability tests were negative, and PDL1 expression was less than 1%. Although Mohs ointment was used, tumor bleeding, exudate, and stink were poorly controlled, and the patient experienced painful symptoms due to the weight of the tumor. Therefore, left mastectomy plus pectoralis major muscle resection was performed. The patient died one month after the operation.
• 膵神経内分泌腫瘍のバイオマーカーの展望 Multigene liquid biopsy NETestの有用性の検証
  武内 慎太郎, 土川 貴裕, 藤井 正和, 和田 雅孝, 田中 公貴, 松井 あや, 中西 善嗣, 浅野 賢道, 野路 武寛, 中村 透, 平野 聡
  膵臓, 38, 3, A195, A195, (一社)日本膵臓学会, 2023年07月
  日本語
• Borderline resectable膵癌術前治療施行症例における予後予測因子の検討
  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, 和田 雅孝, 武内 慎太郎, 平野 聡
  膵臓, 38, 3, A312, A312, (一社)日本膵臓学会, 2023年07月
  日本語
• 【肝胆膵】胆道癌取扱い規約第7版に基づいた遠位胆管癌の治療成績の再評価 遠位胆管癌におけるInvasive tumor thickness測定値の予後予測因子としての有用性　　　　　　　　　　　　　　　
  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, 和田 雅孝, 武内 慎太郎, 平野 聡
  日本消化器外科学会総会, 78回, WS27, 10, (一社)日本消化器外科学会, 2023年07月
  日本語
• 【肝胆膵】肝膵同時切除術の安全性と長期予後向上を目指した取り組み 肝膵同時切除における膵消化管再建法の選択およびリンパ節転移状態による手術適応決定　　　　　　　　　　　　　　　
  野路 武寛, 武内 慎太郎, 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
  日本消化器外科学会総会, 78回, WS28, 2, (一社)日本消化器外科学会, 2023年07月
  日本語
• 【肝胆膵】切除可能膵癌に対する術前化学療法の至適戦略 術前治療症例の予後因子から考察する切除可能膵癌に対する周術期治療のネクストステージ　　　　　　　　　　　　　　　
  武内 慎太郎, 中村 透, 浅野 賢道, 和田 雅孝, 田中 公貴, 松井 あや, 中西 善嗣, 野路 武寛, 土川 貴裕, 平野 聡
  日本消化器外科学会総会, 78回, WS30, 5, (一社)日本消化器外科学会, 2023年07月
  日本語
• 長期術前治療後局所進行膵癌に対する切除成績および予後予測因子の検討　　　　　　　　　　　　　　　
  浅野 賢道, 平野 聡, 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
  日本消化器外科学会総会, 78回, O40, 4, (一社)日本消化器外科学会, 2023年07月
  日本語
• 膵体部癌に対する脾臓温存膵体尾部切除術による脾門リンパ節郭清の省略　　　　　　　　　　　　　　　
  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, 土川 貴裕, 七戸 俊明, 平野 聡
  日本消化器外科学会総会, 78回, P227, 4, (一社)日本消化器外科学会, 2023年07月
  日本語
• 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, 54, Suppl., 70, 70, (一社)日本医学教育学会, 2023年07月
  日本語
• 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, 83, 16, OF1, OF12, American Association for Cancer Research (AACR), 2023年06月28日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 44, 6, 495, 499, 医学図書出版(株), 2023年06月
  日本語, 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)
• 【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, 44, 6, 495, 499, 医学図書出版(株), 2023年06月
  日本語, 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)
• 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, 173, 6, 1374, 1380, 2023年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, Springer Science and Business Media LLC, 2023年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, Although robotic telesurgery is growing in popularity, the benefits of telesurgery compared to local surgery are unclear. This study aimed to evaluate the performance of robotic tele-cholecystectomy with a commercial line using the Saroa™ (Riverfield, Inc., Tokyo, Japan) system. The operation rooms of the Hokkaido University Hospital and Kushiro City General Hospital were connected using a best effort-type line (1 Gbps), with a distance of 250 km between the two hospitals. In this experimental single-blind randomized crossover trial, eight expert robotic surgeons performed robotic cholecystectomy in an artificial organ model using the Saroa™ system and were randomized to begin with either local surgery or telesurgery. All surgeons were assessed on task completion time, total path length of the right- and left- hand forceps and camera, Global Evaluative Assessment of Robotic Skills (GEARS), Global Operative Assessment of Laparoscopic Skills (GOALS), and System and Piper Fatigue Scale-12 (PFS-12). In all experiments, the communication environment was stable and the mean communication delay was 8 ms (3-31 ms). All tele-cholecystectomies were performed safely. There was no significant difference in completion time (P = 0.495), score of GEARS (P = 0.258), GOALS (P = 0.180), or PFS-12 (P = 0.528) between local surgery and telesurgery. The total path of the forceps tended to be longer in tele-cholecystectomy, particularly with significantly longer left-hand forceps total path length (P = 0.041). Robotic tele-cholecystectomy using a commercial line can be performed safely as same as local robotic surgery, but the total path of the left-hand forceps was prolonged in robotic tele-cholecystectomy due to overshoot. Therefore, a solution for overshooting will be required in the future.
• 【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, 77, 6, 961, 967, 金原出版(株), 2023年05月
  日本語
• 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, 37, 2, 161, 161, (一社)日本外傷学会, 2023年05月
  日本語
• Invasive thymoma metastases to the pancreas: A case report.
  Shinya Otsuka, Kei Hiraoka, Noriko Kimura, Satoshi Hirano, Tatsuya Kato, Masato Suzuoki
  International journal of surgery case reports, 105, 108004, 108004, 2023年04月, ［国際誌］
  英語, INTRODUCTION AND IMPORTANCE: Thymoma is the most common type of tumor that develops in the thymic epithelial cells. Although thymomas can invade surrounding organs in the chest cavity, extrathoracic metastasis is very rare, and little is known about the prognosis and effective treatments for such tumors. Herein, we report a case of an invasive thymoma metastasizing to the pancreas after incomplete resection. CASE PRESENTATION: A 47-year-old man presented to our hospital with an anterior mediastinal mass. Although a thymic tumor was suspected, complete resection was not achieved because the tumor had invaded the pulmonary artery trunk, superior pulmonary vein, and left brachiocephalic vein. The pathological diagnosis was a Type B3 thymoma. The patient underwent chemotherapy and radiotherapy after surgery. Three years after surgery, computed tomography indicated a pancreatic mass suggestive of pancreatic cancer. Distal pancreatectomy was performed after neoadjuvant chemotherapy and radiotherapy. The pancreatic mass was diagnosed as Type B3 thymoma metastasis. Thirteen months after surgery for the pancreatic lesion, the patient underwent resection of the bilateral lung metastases. CLINICAL DISCUSSION: To the best of our knowledge, only four cases of metastatic thymic tumors in the pancreas have been reported. All patients who underwent surgical resection for pancreatic metastasis survived for >6 months including our case. CONCLUSION: In cases of thymic tumors with metastasis to extra-thoracic organs, complete resection of the metastatic lesions can contribute to prolonged survival.
• 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, 38, Suppl., 205, 205, (一社)日本インターベンショナルラジオロジー学会, 2023年04月
  日本語
• 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, 38, Suppl., 205, 205, (一社)日本インターベンショナルラジオロジー学会, 2023年04月
  日本語
• 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, 38, Suppl., 205, 205, (一社)日本インターベンショナルラジオロジー学会, 2023年04月
  日本語
• 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, 38, Suppl., 205, 205, (一社)日本インターベンショナルラジオロジー学会, 2023年04月
  日本語
• 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, 123回, SY, 6, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, SF, 5, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, SF, 6, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, DP, 4, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, DP, 7, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, DP, 5, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, DP, 8, (一社)日本外科学会, 2023年04月
  日本語
• 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, 123回, SP, 6, (一社)日本外科学会, 2023年04月
  日本語
• Verification of delay time and image compression thresholds for telesurgery.
  Yoshiya Takahashi, Kenichi Hakamada, Hajime Morohashi, Harue Akasaka, Yuma Ebihara, Eiji Oki, Satoshi Hirano, Masaki Mori
  Asian journal of endoscopic surgery, 16, 2, 255, 261, 2023年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: Telerobotic surgery relies on communication lines, causing delays, and video information requires pre-transmission compression. Such delays and video degradation will continue to be unavoidable making communication conditions verification essential. Understanding the network specification values required for telerobotic surgery entails determining acceptable levels of delay and degradation due to the video compression and restoration processes during surgery. METHODS: The hinotori™ surgical robot from Medicaroid was used. Eight surgeons, skilled in robotic surgery, performed gastrectomy or rectal resection on pigs. Image compression (bitrate: 120, 60, 30, 20, 10 Mbps) was random, changing encoder settings during surgery, and delay times (30, 50, 100, 150 milliseconds) were pseudo-randomly inserted, changing emulator settings. Acceptable video levels were evaluated. Subjective evaluations by surgeons and evaluators regarding image degradation and operability, and objective evaluations of image degradation and operability were given five-point ratings. RESULTS: Regarding delay time, 30 and 50 millisecond periods garnered average ratings of 3.6 and 4.0, respectively, signifying that surgery was feasible. However, at 100 and 150 millisecond, average ratings were 2.9 and 2.3, respectively, indicating surgery was not feasible for the most part in these cases. The average rating for image compression was 4.0 or higher for bitrates of 20, 30, 60, and 120 Mbps, suggesting that surgery is possible even at bitrates as low as 10 Mbps, with an average rating of 4.0. CONCLUSION: In remote robotic surgery using the hinotori™, image compression and delay time are largely acceptable, so surgery can be safely performed.
• Emergency administration of fibrinogen concentrate for haemorrhage: systematic review and meta-analysis.
  Yuki Itagaki, Mineji Hayakawa, Yuki Takahashi, Satoshi Hirano, Kazuma Yamakawa
  World journal of emergency surgery : WJES, 18, 1, 27, 27, 2023年03月30日, ［国際誌］
  英語, 研究論文（学術雑誌）, INTRODUCTION: The occurrence of massive haemorrhages in various emergency situations increases the need for blood transfusions and increases the risk of mortality. Fibrinogen concentrate (FC) use may increase plasma fibrinogen levels more rapidly than fresh-frozen product or cryoprecipitate use. Previous several systematic reviews and meta-analyses have not effectively demonstrated FC efficacy in significantly improving the risk of mortality and reducing transfusion requirements. In this study, we investigated the use of FC for haemorrhages in emergency situations. METHODS AND ANALYSIS: In this systematic review and meta-analysis, we included controlled trials, but excluded randomized controlled trials (RCTs) in elective surgeries. The study population consisted of patients with haemorrhages in emergency situations, and the intervention was emergency supplementation of FC. The control group was administered with ordinal transfusion or placebo. The primary and secondary outcomes were in-hospital mortality and the amount of transfusion and thrombotic events, respectively. The electronic databases searched included MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials. RESULTS: Nine RCTs in the qualitative synthesis with a total of 701 patients were included. Results showed a slight increase in in-hospital mortality with FC treatment (RR 1.24, 95% CI 0.64-2.39, p = 0.52) with very low certainty of the evidence. There was no reduction in the use of red blood cells (RBC) transfusion in the first 24 h after admission with FC treatment (mean difference [MD] 0.0 Unit in the FC group, 95% CI - 0.99-0.98, p = 0.99) with very low certainty of the evidence. However, the use of fresh-frozen plasma (FFP) transfusion significantly increased in the first 24 h after admission with FC treatment (MD 2.61 Unit higher in the FC group, 95% CI 0.07-5.16, p = 0.04). The occurrence of thrombotic events did not significantly differ with FC treatment. CONCLUSIONS: The present study indicates that the use of FC may result in a slight increase in in-hospital mortality. While FC did not appear to reduce the use of RBC transfusion, it likely increased the use of FFP transfusion and may result in a large increase in platelet concentrate transfusion. However, the results should be interpreted cautiously due to the unbalanced severity in the patient population, high heterogeneity, and risk of bias.
• 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年03月21日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 132回・126回, 67, 67, 日本消化器病学会-北海道支部, 2023年03月
  日本語
• 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, 132回・126回, 67, 67, 日本消化器病学会-北海道支部, 2023年03月
  日本語
• 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, 132回・126回, 67, 67, 日本消化器病学会-北海道支部, 2023年03月
  日本語
• 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, 132回・126回, 67, 67, 日本消化器病学会-北海道支部, 2023年03月
  日本語
• Dedifferentiated liposarcoma primary to the chest wall with spontaneous shrinking: report of a case.
  Yuki Itagaki, Akira Fukunaga, Hironobu Takano, Kazuyuki Yamamoto, Kohei Nishigami, Tatsunosuke Ichimura, Hiroto Manase, Masahiko Obata, Tatsuya Kato, Satoshi Hirano
  Surgical case reports, 9, 1, 26, 26, 2023年02月15日, ［国際誌］
  英語, 研究論文（学術雑誌）, An 80-year-old man presented to our emergency department complaining of a mass on the right side of his chest and pain in the right flank of his back. A chest computed tomography (CT) scan showed a relatively heterogenous oval-shaped tumor measuring 7.5 × 6.0 cm eroded to the 8th rib, with slightly dense fluid accumulation inside and calcification of the tumor wall. A 1-month follow-up CT scan showed spontaneous shrinkage of the tumor. The tumor was completely excised from the thoracic wall and the wall was reconstructed with a polytetrafluoroethylene mesh. Pathological examination showed coagulation necrosis in the chest wall tumor, but immunohistochemical staining revealed murine double minute 2- and Cyclin-dependent kinase 4-positive cells with irregular nuclear size and bizarre morphology. Therefore, dedifferentiated liposarcoma (DDLPS) was the final pathological diagnosis. Remarkable infiltration of CD8+ lymphocytes into the tumor was observed, along with a 90% positive ratio for programmed cell death-ligand 1. The patient has been followed-up for 1 year without any recurrence, despite not receiving any additional treatment. Liposarcoma is one of the most common types of soft tissue sarcomas; however, spontaneous regression of primary DDLPS arising from the chest wall is extremely rare. Herein, we report a case of DDLPS primary to the chest wall with spontaneous regression, probably due to a spontaneously induced T cell response.
• 【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, 85, 2, 196, 201, (株)南江堂, 2023年02月
  日本語, ＜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, 43, 2, 343, 343, (一社)日本腹部救急医学会, 2023年02月
  日本語
• 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, 43, 2, 425, 425, (一社)日本腹部救急医学会, 2023年02月
  日本語
• 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, 43, 2, 473, 473, (一社)日本腹部救急医学会, 2023年02月
  日本語
• 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年02月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2023年02月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• Tumor Growth Suppression of Pancreatic Cancer Orthotopic Xenograft Model by CEA-Targeting CAR-T Cells.
  Osamu Sato, Takahiro Tsuchikawa, Takuma Kato, Yasunori Amaishi, Sachiko Okamoto, Junichi Mineno, Yuta Takeuchi, Katsunori Sasaki, Toru Nakamura, Kazufumi Umemoto, Tomohiro Suzuki, Linan Wang, Yizheng Wang, Kanako C Hatanaka, Tomoko Mitsuhashi, Yutaka Hatanaka, Hiroshi Shiku, Satoshi Hirano
  Cancers, 15, 3, 2023年01月18日, ［国際誌］
  英語, 研究論文（学術雑誌）, Chimeric antigen receptor engineered T cell (CAR-T) therapy has high therapeutic efficacy against blood cancers, but it has not shown satisfactory results in solid tumors. Therefore, we examined the therapeutic effect of CAR-T therapy targeting carcinoembryonic antigen (CEA) in pancreatic adenocarcinoma (PDAC). CEA expression levels on the cell membranes of various PDAC cell lines were evaluated using flow cytometry and the cells were divided into high, medium, and low expression groups. The relationship between CEA expression level and the antitumor effect of anti-CEA-CAR-T was evaluated using a functional assay for various PDAC cell lines; a significant correlation was observed between CEA expression level and the antitumor effect. We created orthotopic PDAC xenograft mouse models and injected with anti-CEA-CAR-T; only the cell line with high CEA expression exhibited a significant therapeutic effect. Thus, the therapeutic effect of CAR-T therapy was related to the target antigen expression level, and the further retrospective analysis of pathological findings from PDAC patients showed a correlation between the intensity of CEA immunostaining and tumor heterogeneity. Therefore, CEA expression levels in biopsies or surgical specimens can be clinically used as biomarkers to select PDAC patients for anti-CAR-T therapy.
• The preoperative SOFA score and remnant small intestine length are postoperative risk factors for mortality in patients with non-occlusive mesenteric ischemia: a case-control study.
  Kazufumi Umemoto, Kentaro Kato, Takumi Yamabuki, Minoru Takada, Yoshiyasu Ambo, Fumitaka Nakamura, Satoshi Hirano
  Acute medicine & surgery, 10, 1, e821, 2023年, ［国際誌］
  英語, 研究論文（学術雑誌）, AIM: Non-occlusive mesenteric ischemia (NOMI) is a fatal condition with a low survival rate in most cases. The risk factors for perioperative mortality in NOMI cases are unclear. The purpose of this study was to define the risk factors for mortality in patients with NOMI undergoing surgery. METHODS: Thirty-eight consecutive patients who underwent surgery for NOMI at Teine Keijinkai Hospital between 2012 and 2020 were included in the study. Patient information, including age, sex, physical findings, comorbidities, laboratory data, and computed tomography and surgical findings were retrospectively analyzed. RESULTS: Of the 38 patients, 18 (47%) died before discharge. Significant univariate predictors of mortality were a high Sequential Organ Failure Assessment (SOFA) score, high lactate level, low blood pH, and short intestinal length after surgery. In the multivariate analysis, a high SOFA score (odds ratio 1.33, P = 0.036) and short intestine length after surgery (odds ratio 34.7, P = 0.003) were identified as independent risk factors for perioperative mortality. CONCLUSION: The preoperative SOFA score and postoperative residual intestinal length may be predictors of death in NOMI surgical patients, not age and the content of comorbidities.
• Laparoscopic cholecystectomy after transcatheter arterial embolisation for haemobilia due to a pseudoaneurysm in the gallbladder: A case report.
  Yuki Itagaki, Kazuyuki Yamamoto, Tomoki Kikuchi, Hironobu Takano, Kohei Nishigami, Akira Fukunaga, Tatsunosuke Ichimura, Hiroto Manase, Satoshi Hirano
  SAGE open medical case reports, 11, 2050313X231166777, 2023年, ［国際誌］
  英語, Pseudoaneurysms of the cystic artery are a rare but significant complication of acute cholecystitis. Laparoscopic cholecystectomy may be a safe alternative to open cholecystectomy in such cases. We report the case of a female patient in her seventies, who presented with anaemia, jaundice, and hepatic dysfunction during hospitalisation for right knee pyogenic arthritis. The patient had no pain in the right upper quadrant. Her serum haemoglobin level was 6.5 g/dL, and upper gastrointestinal endoscopy revealed no abnormalities. Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography revealed bloody bile. An endoscopic biliary drainage tube was inserted at the discretion of the gastroenterology department. Contrast-enhanced computed tomography revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder. On the same day, the endoscopic biliary drainage tube was replaced with an endoscopic nasobiliary drainage tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction. The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery and coil embolisation was performed at the periphery of the cystic artery. Uninterrupted laparoscopic cholecystectomy was performed. Although laparoscopic cholecystectomy is difficult when bleeding is uncontrolled, it was safely performed following haemostasis using transcatheter arterial embolisation. Laparoscopic cholecystectomy is feasible in haemodynamically stable patients with cystic artery pseudoaneurysms after transcatheter arterial embolisation.
• パンクレリパーゼ製剤が有効であった、慢性偽性腸閉塞を伴う全身性強皮症に対し小腸切除を行った1例　　　　　　　　　　　　　　　
  村上 壮一, 七戸 俊明, 東嶋 宏泰, 武田 真太郎, 田中 公貴, 松井 あや, 中西 喜嗣, 浅野 賢道, 海老原 裕磨, 野路 武寛, 倉島 庸, 中村 透, 土川 貴裕, 平野 聡
  学会誌JSPEN, 5, Suppl.1, 930, 930, (一社)日本栄養治療学会, 2023年
  日本語
• 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, 2023年
  研究論文（学術雑誌）, 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.
• 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, 75, 1, 149, 158, 2023年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2023年01月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2023年01月, ［国際共著］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 67, 2, 190, 191, 北海道外科学会, 2022年12月
  日本語
• 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, 27, 7, 1951, 1951, (一社)日本内視鏡外科学会, 2022年12月
  日本語
• 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, 67, 2, 192, 192, 北海道外科学会, 2022年12月
  日本語
• 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, 67, 2, 194, 194, 北海道外科学会, 2022年12月
  日本語
• 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年12月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年12月, ［国際誌］
  英語, 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.
• Retroviral Replicating Vector Toca 511 (Vocimagene Amiretrorepvec) for Prodrug Activator Gene Therapy of Lung Cancer.
  Hiroki Kushiya, Kei Hiraoka, Tomohiro Suzuki, Kazuho Inoko, Akihito Inagaki, Hiroki Niwa, Katsunori Sasaki, Toru Nakamura, Takahiro Tsuchikawa, Toshiaki Shichinohe, Douglas J Jolly, Noriyuki Kasahara, Satoshi Hirano
  Cancers, 14, 23, 2022年11月25日, ［国際誌］
  英語, 研究論文（学術雑誌）, Therapeutic efficacy of retroviral replicating vector (RRV)-mediated prodrug activator gene therapy has been demonstrated in a variety of tumor models, but clinical investigation of this approach has so far been restricted to glioma and gastrointestinal malignancies. In the present study, we evaluated replication kinetics, transduction efficiency, and therapeutic efficacy of RRV in experimental models of lung cancer. RRV delivering GFP as a reporter gene showed rapid viral replication in a panel of lung cancer cells in vitro, as well as robust intratumoral replication and high levels of tumor transduction in subcutaneous and orthotopic pleural dissemination models of lung cancer in vivo. Toca 511 (vocimagene amiretrorepvec), a clinical-stage RRV encoding optimized yeast cytosine deaminase (yCD) which converts the prodrug 5-fluorocytosine (5-FC) to the active drug 5-fluorouracil (5-FU), showed potent cytotoxicity in lung cancer cells upon exposure to 5-FC prodrug. In vivo, Toca 511 achieved significant tumor growth inhibition following 5-FC treatment in subcutaneous and orthotopic pleural dissemination models of lung cancer in both immunodeficient and immunocompetent hosts, resulting in significantly increased overall survival. This study demonstrates that RRV can serve as highly efficient vehicles for gene delivery to lung cancer, and indicates the translational potential of RRV-mediated prodrug activator gene therapy with Toca 511/5-FC as a novel therapeutic strategy for pulmonary malignancies.
• 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, 29, Suppl.1, 677, 677, (一社)日本集中治療医学会, 2022年11月
  日本語
• 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, 44, 6, 457, 457, (NPO)日本呼吸器内視鏡学会, 2022年11月
  日本語
• 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, 44, 6, 457, 457, (NPO)日本呼吸器内視鏡学会, 2022年11月
  日本語
• 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年11月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年11月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2022年11月01日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• Inguinal single-port approach of endoscopic component separation for abdominal wall defects: A case series.
  Mamoru Miyasaka, Yo Kawarada, Yoshiyuki Yamamura, Shuji Kitashiro, Shunichi Okushiba, Satoshi Hirano
  Annals of medicine and surgery (2012), 82, 104611, 104611, 2022年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: The component separation (CS) technique is widely used for abdominal wall defects, particularly in infected wounds. CS is associated with many wound complications due to subcutaneous blood flow disturbance. Endoscopic component separation (ECS) has fewer wound complications compared to CS and has been performed recently. However, there are various port required placements for ECS, and this technique requires proficiency. One approach for ECS is the inguinal single-port approach, which can be performed from an inguinal incision similar to that used in open surgery for inguinal hernias. CASE PRESENTATION: We performed ECS with an inguinal single-port approach in three older adults. All patients had abdominal wall defects with infection at the central abdominal wound site. A 2-3-cm incision was created in the middle of the inguinal ligament, and a single-port surgical device with two 5-mm trocars was placed in the incision. The external oblique muscle was separated from the internal oblique muscle, and the external oblique aponeurosis was released. The muscle flap of the abdominal wall was moved to the central line. Tension-free abdominal wall closure was possible using a one-handed approach. CONCLUSIONS: ECS, which has fewer wound complications, requires proficiency. This procedure is a simple and easy-to-perform procedure using an inguinal incision that surgeons are familiar with.
• 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, 55, Suppl.2, 257, 257, (一社)日本消化器外科学会, 2022年10月
  日本語
• 膵癌におけるanatomical resection 膵体部癌に対する脾門リンパ節郭清の省略と脾温存手術の手技　　　　　　　　　　　　　　　
  田中 公貴, 松井 あや, 浅野 賢道, 中村 透, 中西 喜嗣, 野路 武寛, 土川 貴裕, 平野 聡
  日本臨床外科学会雑誌, 83, 増刊, S179, S179, 日本臨床外科学会, 2022年10月
  日本語
• 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, 83, 10, 1840, 1840, 日本臨床外科学会, 2022年10月
  日本語
• 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, 75回, ECPA1, 1, (一社)日本胸部外科学会, 2022年10月
  日本語
• 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, 55, Suppl.2, 257, 257, (一社)日本消化器外科学会, 2022年10月
  日本語
• 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, 98, 2, 629, 629, (一社)日本内分泌学会, 2022年10月
  日本語
• 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年09月29日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年09月15日, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年09月11日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 43, 9, 891, 895, 医学図書出版(株), 2022年09月
  日本語, 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, 45, 83, 83, 日本膵・胆管合流異常研究会, 2022年09月
  日本語
• 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, 71, 3, 225, 225, (一社)日本農村医学会, 2022年09月
  日本語
• 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, 12, Suppl., 144, 144, 日本Acute Care Surgery学会, 2022年09月
  日本語
• 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, 131回・125回, 28, 28, 日本消化器病学会-北海道支部, 2022年09月
  日本語
• 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, 36, Suppl.1, 172, 172, (一社)日本糖尿病合併症学会, 2022年09月
  日本語
• 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, 12, Suppl., 109, 109, 日本Acute Care Surgery学会, 2022年09月
  日本語
• 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年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年09月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 65, 8, 473, 473, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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, 65, 8, 474, 474, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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, 65, 8, 474, 474, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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, 8, Suppl.1, 158, 158, (一社)日本骨粗鬆症学会, 2022年08月
  日本語
• Acute Care Surgery概論　　　　　　　　　　　　　　　
  村上 壮一, 平野 聡
  消化器外科, 45, 8, 929, 935, (株)へるす出版, 2022年08月
  日本語
• 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, 65, 8, 473, 473, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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, 65, 8, 474, 474, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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, 65, 8, 474, 474, (一社)日本糖尿病学会, 2022年08月
  日本語
• 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年08月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年08月, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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, Springer Science and Business Media LLC, 2022年08月, ［国際誌］
  英語, 研究論文（学術雑誌）, BACKGROUND: Pancreatic ductal adenocarcinoma (PDA) is a fatal cancer for which even unfavorable clinicopathological factors occasionally fail to preclude long-term survival. We sought to establish a scoring system that utilizes measurable pre-intervention factors for predicting survival following surgical resection. METHODS: We retrospectively analyzed 34 patients who died from short-term recurrences and 32 long-term survivors among 310 consecutively resected patients with PDA. A logistic regression model was used to define factors related to clinical parameters, molecular profiles of 18 pancreatic cancer-associated genes, and aberrant expression of major tumor suppressors. RESULTS: Carbohydrate antigen 19-9 (CA19-9) had the best ability to classify patients with short-term recurrence and long-term survivors [odds ratio 21.04, 95% confidence interval (CI) 4.612-96.019], followed by SMAD4 and TP53 mutation scoring (odds ratio 41.322, 95% CI 3.156-541.035). Missense TP53 mutations were strongly associated with the nuclear expression of p53, whereas truncating mutations were associated with the absence of nuclear p53. The former subset was associated with a worse prognosis. The combination of aberrant SMAD4 and mutation types of TP53 exhibited a better resolution for distinguishing patients with short-term recurrences from long-term survivors (compared with the assessment of the number of mutated KRAS, CDKN2A, TP53, and SMAD4 genes). Calibration of mutation scores combined with CA19-9 in a logistic regression model setting demonstrated a practical effect in classifying long survivors and patients with early recurrence (c-statistic = 0.876). CONCLUSIONS: Genetic information, i.e., TP53 mutation types and SMAD4 abnormalities, combined with CA19-9, will be a valuable tool for improving surgical strategies for pancreatic cancer.
• 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, 2022年08月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 77回, O13, 1, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, P157, 3, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, RS16, 6, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, O29, 5, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 53, Suppl., 147, 147, (一社)日本医学教育学会, 2022年07月
  日本語
• 【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, 77回, WS15, 5, (一社)日本消化器外科学会, 2022年07月
  日本語
• 【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, 77回, PD4, 3, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, O13, 1, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, P157, 3, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, RS16, 6, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, P230, 7, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, S12, 3, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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, 77回, O29, 5, (一社)日本消化器外科学会, 2022年07月
  日本語
• 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年07月, ［国内誌］
  英語, 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年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 97, 3, 235, 240, 2022年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2022年07月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年06月29日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年06月15日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 84, 7, 757, 764, (株)南江堂, 2022年06月
  日本語, ＜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, 39, Suppl.1, S128, S128, (一社)日本内分泌外科学会, 2022年06月
  日本語
• 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, 67, 1, 63, 67, 北海道外科学会, 2022年06月
  日本語, 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年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2022年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年05月27日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月27日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 47, 3, 475, 475, 日本外科系連合学会, 2022年05月
  日本語
• 【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, 84, 5, 647, 654, (株)アークメディア, 2022年05月
  日本語
• 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, 42, 4, 541, 544, (一社)日本腹部救急医学会, 2022年05月
  日本語, 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年05月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2022年05月, ［国内誌］
  英語
• 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, 2022年05月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 65, Suppl.1, S, 139, (一社)日本糖尿病学会, 2022年04月
  日本語
• 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, 65, Suppl.1, S, 288, (一社)日本糖尿病学会, 2022年04月
  日本語
• 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, 122回, SF, 5, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, PD, 1, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 7, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 8, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 3, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 6, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 7, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 2, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, SF, 6, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, RS, 4, (一社)日本外科学会, 2022年04月
  日本語
• 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, 122回, WS, 1, (一社)日本外科学会, 2022年04月
  日本語
• 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年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年04月01日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 2022年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年03月26日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年03月22日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 130回・124回, 75, 75, 日本消化器病学会-北海道支部, 2022年03月
  日本語
• 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, (一社)日本胃癌学会, 2022年03月
  英語
• 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, 83, 3, 599, 599, 日本臨床外科学会, 2022年03月
  日本語
• 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, 130回・124回, 57, 57, 日本消化器病学会-北海道支部, 2022年03月
  日本語
• 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年03月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年02月24日, ［国際誌］
  英語
• 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年02月12日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, MDPI AG, 2022年02月05日
  研究論文（学術雑誌）, 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年02月05日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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/ ).
• 【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, 84, 2, 163, 171, (株)南江堂, 2022年02月
  日本語, ＜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.
• 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, 2022年02月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 52, 52, Springer Science and Business Media LLC, 2022年10月20日, ［国際誌］
  英語, 研究論文（学術雑誌）, PURPOSE: Telesimulation, whereby learners telecommunicate and use simulator resources to receive education at an off-site location, has been used to educate surgical trainees about how to perform basic surgical procedures. However, it has not yet been used for advanced surgical procedures. We aimed to develop a telesimulation curriculum to teach a common laparoscopic procedure called transabdominal preperitoneal (TAPP) repair and to explore the feasibility of its use. METHODS: Learning objectives were created to develop a telesimulation curriculum that included didactic telelecture and telesimulation training. Pre-tests and post-tests to assess the didactic materials were developed and assessed among surgeons with various experiences. We assessed the feasibility of the telelecture and telesimulation separately. Pre-tests, post-tests, and questionnaires were used to assess the telelectures. We created a TAPP repair telesimulation system and checked for problems during training. Trainees were assessed to determine their skill improvement using previously published assessment tools and questionnaires. RESULTS: A didactic telelecture was developed based on the learning objectives using an expert consensus and pilot-tested among five participants. After the lecture, their test scores improved and they expressed positive opinions about the usefulness of telelectures. The TAPP repair telesimulation training was pilot-tested among three trainees. No technical problems occurred during training. All trainees improved their skills after the telesimulation training and agreed that the training was useful for learning the TAPP repair procedure. CONCLUSIONS: We systematically developed a telesimulation curriculum for the TAPP repair procedure and demonstrated its feasibility among learners.
• 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年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年01月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年01月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［国内誌］
  英語, 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, 26, 7, CSY11, 1, (一社)日本内視鏡外科学会, 2021年12月
  日本語
• 【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, 76, 13, 1498, 1504, (株)医学書院, 2021年12月
  日本語, ＜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, 26, 7, PD12, 6, (一社)日本内視鏡外科学会, 2021年12月
  日本語
• 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, 26, 7, SP11, 2, (一社)日本内視鏡外科学会, 2021年12月
  日本語
• 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年12月, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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年12月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年12月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 54, Suppl.2, 155, 155, (一社)日本消化器外科学会, 2021年11月
  日本語
• 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, 11, 1, 112, 112, 日本Acute Care Surgery学会, 2021年11月
  日本語
• 【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, 32, 12, 1234, 1234, (一社)日本救急医学会, 2021年11月
  日本語
• 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, 11, 1, 88, 88, 日本Acute Care Surgery学会, 2021年11月
  日本語
• 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, 11, 1, 124, 124, 日本Acute Care Surgery学会, 2021年11月
  日本語
• 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, 11, 1, 124, 124, 日本Acute Care Surgery学会, 2021年11月
  日本語
• 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, 54, Suppl.2, 155, 155, (一社)日本消化器外科学会, 2021年11月
  日本語
• 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年11月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年11月01日, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年11月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 82, 増刊, S253, S253, 日本臨床外科学会, 2021年10月
  日本語
• 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, 3, Suppl.1, 843, 843, (一社)日本臨床栄養代謝学会, 2021年10月
  日本語
• 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, 82, 10, 1940, 1940, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S62, S62, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S253, S253, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S432, S432, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S1272, S1272, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S12, S12, 日本臨床外科学会, 2021年10月
  日本語
• 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, 82, 増刊, S13, S13, 日本臨床外科学会, 2021年10月
  日本語
• 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年10月, ［国際誌］
  英語, 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年10月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年09月28日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年09月20日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 3, 1, 98, 98, 日本メディカルイラストレーション学会, 2021年09月
  日本語
• 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, 129回・123回, 27, 27, 日本消化器病学会-北海道支部, 2021年09月
  日本語
• 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, 129回・123回, 46, 46, 日本消化器病学会-北海道支部, 2021年09月
  日本語
• 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年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年09月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 36, 3, A257, A257, (一社)日本膵臓学会, 2021年08月
  日本語
• 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, 36, 3, A156, A156, (一社)日本膵臓学会, 2021年08月
  日本語
• 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, 35, 3, 429, 429, (一社)日本胆道学会, 2021年08月
  日本語
• 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, 35, 3, 478, 478, (一社)日本胆道学会, 2021年08月
  日本語
• 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, 36, 3, A156, A156, (一社)日本膵臓学会, 2021年08月
  日本語
• 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年08月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年08月01日, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年07月20日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年07月19日, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 76回, P017, 5, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, P055, 2, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, P231, 4, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, PD6, 2, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 83, 8, 917, 927, 南江堂, 2021年07月01日
• 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, 76回, P017, 5, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, P055, 2, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, P231, 4, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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, 76回, PD6, 2, (一社)日本消化器外科学会, 2021年07月
  日本語
• 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年07月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2021年07月, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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.
• 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年06月23日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 75, 7, 1147, 1152, 金原出版(株), 2021年06月
  日本語
• 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年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年06月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月27日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月24日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月17日, ［国際誌］
  英語, 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年05月06日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 64, Suppl.1, I, 4, (一社)日本糖尿病学会, 2021年05月
  日本語
• 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, 64, Suppl.1, P, 6, (一社)日本糖尿病学会, 2021年05月
  日本語
• 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, 35, 2, 230, 236, (一社)日本胆道学会, 2021年05月
  日本語
• 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年05月, ［国際誌］
  英語, 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, 44, 6, 937, 942, (株)へるす出版, 2021年05月
  日本語
• 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, 35, 2, 230, 236, 日本胆道学会, 2021年05月
  日本語
• 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月01日, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年04月23日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 121回, CST, 4, (一社)日本外科学会, 2021年04月
  日本語
• 【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, 83, 5, 412, 416, (株)南江堂, 2021年04月
  日本語
• 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, 121回, NES, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, SY, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 2, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, SF, 4, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PS, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PS, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, NES, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, SY, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, SF, 4, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PS, 3, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PS, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 2, (一社)日本外科学会, 2021年04月
  日本語
• 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, 121回, PD, 5, (一社)日本外科学会, 2021年04月
  日本語
• 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, 2021年04月
  研究論文（学術雑誌）, 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年04月, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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年04月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年04月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年04月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年03月04日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年03月04日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 75, 3, 333, 338, 金原出版(株), 2021年03月
  日本語
• 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, 25, 7, BSP2, 1, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 25, 7, BSP2, 4, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 25, 7, BSP4, 3, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 25, 7, WS19, 1, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 128回・122回, 51, 51, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 53, 53, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 73, 73, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 25, 7, WS19, 1, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 128回・122回, 37, 37, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 48, 48, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 51, 51, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 52, 52, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 128回・122回, 52, 52, 日本消化器病学会-北海道支部, 2021年03月
  日本語
• 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, 25, 7, BSP2, 1, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 25, 7, BSP2, 4, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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, 25, 7, BSP4, 3, (一社)日本内視鏡外科学会, 2021年03月
  日本語
• 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年03月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2021年03月, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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年02月10日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年02月01日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020).
  Naoto Morimura, Yasumitsu Mizobata, Manabu Sugita, Satoshi Takeda, Tetsuro Kiyozumi, Tomohisa Shoko, Yoshiaki Inoue, Yasuhiro Otomo, Atsushi Sakurai, Yuichi Koido, Seizan Tanabe, Tetsu Okumura, Fumihiro Yamasawa, Hideharu Tanaka, Tomoya Kinoshi, Koki Kaku, Kiyoshi Matsuda, Nobuya Kitamura, Tatsuya Hayakawa, Yasuhiro Kuroda, Yumiko Kuroki, Junichi Sasaki, Jun Oda, Masataka Inokuchi, Toru Kakuta, Satoru Arai, Noriaki Sato, Hiroyuki Matsuura, Masahiro Nozawa, Toshio Osamura, Kazunori Yamashita, Hiroshi Okudera, Akihiko Kawana, Tsugumichi Koshinaga, Satoshi Hirano, Erisa Sugawara, Michihiro Kamata, Yasuhito Tajiri, Mototsugu Kohno, Michiyasu Suzuki, Hiroyuki Nakase, Eiichi Suehiro, Hiroaki Yamase, Hiroshi Otake, Hiroshi Morisaki, Akiko Ozawa, Sho Takahashi, Kotaro Otsuka, Kiyokazu Harikae, Kazuo Kishi, Hiroshi Mizuno, Hideaki Nakajima, Hiroki Ueta, Masao Nagayama, Migaku Kikuchi, Hiroyuki Yokota, Takeshi Shimazu, Tetsuo Yukioka
  Acute medicine & surgery, 8, 1, e626, 2021年, ［国際誌］
  英語, 研究論文（学術雑誌）, Mass gatherings are events characterized by "the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community." Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.
• [Treatment strategies for perforative complications caused by biliopancreatic endoscopy].
  Satoshi Hirano
  Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology, 118, 8, 703, 708, 2021年, ［国内誌］
  日本語, 研究論文（学術雑誌）
• 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, 17, 4, 576, 579, 2021年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, Wolters Kluwer Medknow Publications, 2021年07月01日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年01月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年12月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 75回, RSV5, 5, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P007, 5, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P014, 4, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P052, 4, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P333, 7, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 74回, 75, 75, (NPO)日本食道学会, 2020年12月
  日本語
• 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, 74回, 319, 319, (NPO)日本食道学会, 2020年12月
  日本語
• 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, 74回, 339, 339, (NPO)日本食道学会, 2020年12月
  日本語
• 【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, 75, 13, 1452, 1456, (株)医学書院, 2020年12月
  日本語, ＜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, 75回, PD6, 5, (一社)日本消化器外科学会, 2020年12月
  日本語
• [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, 75回, PD5, 3, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, O17, 1, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P257, 4, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P266, 5, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P307, 2, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 75回, P324, 1, (一社)日本消化器外科学会, 2020年12月
  日本語
• 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, 45, 5, 490, 490, 日本外科系連合学会, 2020年12月
  日本語
• 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, 36回, 61, 61, (一社)日本皮膚悪性腫瘍学会, 2020年12月
  日本語
• 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, 45, 5, 550, 550, 日本外科系連合学会, 2020年12月
  日本語
• 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年12月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年11月18日, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 53, Suppl.2, 123, 123, (一社)日本消化器外科学会, 2020年11月
  日本語
• 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, 53, Suppl.2, 300, 300, (一社)日本消化器外科学会, 2020年11月
  日本語
• 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, 36, Suppl.I, [JMSB3, 1], (一社)日本産科婦人科内視鏡学会, 2020年11月
  日本語
• 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, 43, 72, 72, 日本膵・胆管合流異常研究会, 2020年11月
  日本語
• 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, 2020年11月
  研究論文（国際会議プロシーディングス）, © 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年11月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年11月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 127回・121回, 68, 68, 日本消化器病学会-北海道支部, 2020年10月
  日本語
• 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, 117, 臨増大会, A644, A644, (一財)日本消化器病学会, 2020年10月
  日本語
• 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, 73回, ECPA1, 2, (一社)日本胸部外科学会, 2020年10月
  日本語
• 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, (一社)日本癌学会, 2020年10月
  英語
• 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, (一社)日本癌治療学会, 2020年10月
  英語
• 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, (一社)日本癌学会, 2020年10月
  英語
• 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, 81, 増刊, 172, 172, 日本臨床外科学会, 2020年10月
  日本語
• 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, 81, 増刊, 207, 207, 日本臨床外科学会, 2020年10月
  日本語
• 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, 81, 増刊, 276, 276, 日本臨床外科学会, 2020年10月
  日本語
• 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年10月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 492, 498, SAGE Publications, 2020年10月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年09月29日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年09月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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年09月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 34, 3, 436, 436, 日本胆道学会, 2020年08月
  日本語
• 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, 34, 3, 528, 528, 日本胆道学会, 2020年08月
  日本語
• 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, 120回, SF, 7, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SSF, 1, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SF, 8, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SF, 2, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, DP, 6, (一社)日本外科学会, 2020年08月
  日本語
• 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, 34, 3, 436, 436, 日本胆道学会, 2020年08月
  日本語
• 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, 120回, SY, 4, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SF, 8, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SF, 7, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, SF, 3, (一社)日本外科学会, 2020年08月
  日本語
• 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, (一社)日本外科学会, 2020年08月
  英語
• 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, 120回, DP, 6, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, DP, 4, (一社)日本外科学会, 2020年08月
  日本語
• 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, 120回, DP, 6, (一社)日本外科学会, 2020年08月
  日本語
• 【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, 82, 9, 927, 933, (株)南江堂, 2020年08月
  日本語, ＜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, 35, 3, A246, A246, (一社)日本膵臓学会, 2020年07月
  日本語
• 【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, 41, 7, 633, 637, 医学図書出版(株), 2020年07月
  日本語, 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, 35, 3, A157, A157, (一社)日本膵臓学会, 2020年07月
  日本語
• 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, 35, 3, A242, A242, (一社)日本膵臓学会, 2020年07月
  日本語
• 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, 51, Suppl., 81, 81, (一社)日本医学教育学会, 2020年07月
  日本語
• 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, 51, Suppl., 81, 81, (一社)日本医学教育学会, 2020年07月
  日本語
• 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, 35, 3, A240, A240, (一社)日本膵臓学会, 2020年07月
  日本語
• 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年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年07月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年06月24日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年06月18日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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.
• 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, 11, 1, 38, 38, (NPO)小切開・鏡視外科学会, 2020年06月
  日本語
• 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, 11, 1, 41, 41, (NPO)小切開・鏡視外科学会, 2020年06月
  日本語
• 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, 65, 1, 31, 35, 北海道外科学会, 2020年06月
  日本語, 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, American Chemical Society (ACS), 2020年06月01日
  研究論文（学術雑誌）
• 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年06月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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年05月05日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 63, 5, 354, 354, (一社)日本糖尿病学会, 2020年05月
  日本語
• 【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, 41, 5, 477, 485, 医学図書出版(株), 2020年05月
  日本語, 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年04月21日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年04月02日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2020春季増刊, 120, 122, (株)メディカ出版, 2020年04月
  日本語
• 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, 81, 4, 800, 800, 日本臨床外科学会, 2020年04月
  日本語
• 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, 81, 4, 789, 790, 日本臨床外科学会, 2020年04月
  日本語
• 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年03月15日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年03月11日, ［査読有り］, ［国際誌］
  英語, 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.
• 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, 126回, 41, 41, 日本消化器病学会-北海道支部, 2020年03月
  日本語
• 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, 126回, 58, 58, 日本消化器病学会-北海道支部, 2020年03月
  日本語
• 【「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, 75, 2, 218, 221, (株)医学書院, 2020年02月
  日本語, ＜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年01月15日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Japanese Society of Gastroenterological Surgery, 2020年
  英語, 研究論文（学術雑誌）
• 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Frontiers Media SA, 2020年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 41, 1, 53, 57, 医学図書出版(株), 2020年01月
  日本語, 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, 9, 2, 299, 303, 日本Acute Care Surgery学会, 2020年01月
  日本語, 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, 25, 1, 49, 55, (一社)日本内視鏡外科学会, 2020年01月
  日本語, ＜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年, ［国際誌］
  英語, 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年01月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 24, 7, WS30, 7, (一社)日本内視鏡外科学会, 2019年12月
  日本語
• 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, 80, 12, 2296, 2297, 日本臨床外科学会, 2019年12月
  日本語
• 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, 80, 12, 2304, 2304, 日本臨床外科学会, 2019年12月
  日本語
• 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, 80, 12, 2304, 2304, 日本臨床外科学会, 2019年12月
  日本語
• 【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, 64, 2, 116, 121, 北海道外科学会, 2019年12月
  日本語, 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, 24, 7, IT3, 5, (一社)日本内視鏡外科学会, 2019年12月
  日本語
• 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, 24, 7, SF005, 4, (一社)日本内視鏡外科学会, 2019年12月
  日本語
• 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, 24, 7, MO018, 2, (一社)日本内視鏡外科学会, 2019年12月
  日本語
• 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, 24, 7, MO176, 1, (一社)日本内視鏡外科学会, 2019年12月
  日本語
• 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年12月, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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, (一社)回復期リハビリテーション病棟協会, 2019年11月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 【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, 94, 2, 120, 121, 北海道医学会, 2019年11月
  日本語
• 【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, 40, 臨増特大, 1251, 1254, 医学図書出版(株), 2019年11月
  日本語, 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, 52, Suppl.2, 132, 132, (一社)日本消化器外科学会, 2019年11月
  日本語
• 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, 52, Suppl.2, 196, 196, (一社)日本消化器外科学会, 2019年11月
  日本語
• 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, 52, Suppl.2, 221, 221, (一社)日本消化器外科学会, 2019年11月
  日本語
• 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, 94, 2, 124, 125, 北海道医学会, 2019年11月
  日本語
• [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, 2019年11月, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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, 2019年11月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年10月23日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 80, 増刊, 272, 272, 日本臨床外科学会, 2019年10月
  日本語
• 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, 33, 3, 437, 437, 日本胆道学会, 2019年10月
  日本語
• 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, 33, 3, 511, 511, 日本胆道学会, 2019年10月
  日本語
• 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, 33, 3, 569, 569, 日本胆道学会, 2019年10月
  日本語
• 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, 33, 3, 572, 572, 日本胆道学会, 2019年10月
  日本語
• 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, 9, 1, 131, 131, 日本Acute Care Surgery学会, 2019年10月
  日本語
• 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, 9, 1, 152, 152, 日本Acute Care Surgery学会, 2019年10月
  日本語
• 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, 日本Acute Care Surgery学会, 2019年10月
  英語
• 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, 9, 1, 163, 163, 日本Acute Care Surgery学会, 2019年10月
  日本語
• 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, 9, 1, 196, 196, 日本Acute Care Surgery学会, 2019年10月
  日本語
• 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, 9, 1, 199, 199, 日本Acute Care Surgery学会, 2019年10月
  日本語
• 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, 25, Suppl., 267, 267, (一社)日本肥満学会, 2019年10月
  日本語
• 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, 33, 3, 548, 548, 日本胆道学会, 2019年10月
  日本語
• 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, 46, 10, 1509, 1512, (株)癌と化学療法社, 2019年10月
  日本語
• 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, 80, 増刊, 417, 417, 日本臨床外科学会, 2019年10月
  日本語
• 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, 80, 増刊, 444, 444, 日本臨床外科学会, 2019年10月
  日本語
• 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, 80, 増刊, 452, 452, 日本臨床外科学会, 2019年10月
  日本語
• 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, 80, 増刊, 472, 472, 日本臨床外科学会, 2019年10月
  日本語
• 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, 80, 増刊, 659, 659, 日本臨床外科学会, 2019年10月
  日本語
• 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, 25, Suppl., 324, 324, (一社)日本肥満学会, 2019年10月
  日本語
• [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, 2019年10月, ［国内誌］
  日本語, 研究論文（学術雑誌）
• 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年10月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 125回, 43, 43, 日本消化器病学会-北海道支部, 2019年09月
  日本語
• 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, 42, 50, 50, 日本膵・胆管合流異常研究会, 2019年09月
  日本語
• 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, 125回, 34, 34, 日本消化器病学会-北海道支部, 2019年09月
  日本語
• 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, 125回, 37, 37, 日本消化器病学会-北海道支部, 2019年09月
  日本語
• 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, 125回, 49, 49, 日本消化器病学会-北海道支部, 2019年09月
  日本語
• 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, 125回, 28, 28, 日本消化器病学会-北海道支部, 2019年09月
  日本語
• 【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, 120, 5, 511, 516, (一社)日本外科学会, 2019年09月
  日本語, 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, 1, Suppl., 1376, 1376, (一社)日本臨床栄養代謝学会, 2019年09月
  日本語
• 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, 日本癌学会, 2019年09月
  英語
• 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年09月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 2019年09月, ［査読有り］, ［国内誌］
  英語, 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, 2019年08月27日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, © 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年08月06日, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 81, 9, 936, 939, (株)南江堂, 2019年08月
  日本語, ＜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年08月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年08月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年08月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 24, 7, 658, 659, (株)メディカ出版, 2019年07月
  日本語
• 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, 74回, O7, 5, (一社)日本消化器外科学会, 2019年07月
  日本語
• 【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, 120, 4, 418, 424, (一社)日本外科学会, 2019年07月
  日本語, 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, 74回, P201, 3, (一社)日本消化器外科学会, 2019年07月
  日本語
• 【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, 74回, WS24, 10, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, O16, 7, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, O21, 1, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, P224, 6, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, P203, 7, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, O41, 7, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 50, Suppl., 87, 87, (一社)日本医学教育学会, 2019年07月
  日本語
• 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, 74回, P27, 5, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, P27, 7, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, O5, 7, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, RS5, 5, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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, 74回, P285, 6, (一社)日本消化器外科学会, 2019年07月
  日本語
• 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年07月, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 2019年07月, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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, 2019年07月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年07月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年07月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 24, 6, 560, 561, (株)メディカ出版, 2019年06月
  日本語
• 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, 34, 3, A84, A84, (一社)日本膵臓学会, 2019年06月
  日本語
• 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, 34, 3, A38, A39, 日本膵臓学会, 2019年06月
  日本語
• 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, 73回, 54, 54, (NPO)日本食道学会, 2019年06月
  日本語
• 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, 73回, 130, 130, (NPO)日本食道学会, 2019年06月
  日本語
• 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, 73回, 335, 335, (NPO)日本食道学会, 2019年06月
  日本語
• 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, 64, 1, 43, 50, 北海道外科学会, 2019年06月, ［査読有り］
  日本語, 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, 2019年06月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 2019年06月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 24, 5, 468, 469, (株)メディカ出版, 2019年05月
  日本語
• 【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, 74, 5, 552, 555, (株)医学書院, 2019年05月
  日本語, ＜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, 80, 5, 1020, 1020, 日本臨床外科学会, 2019年05月
  日本語
• 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, 80, 5, 1024, 1024, 日本臨床外科学会, 2019年05月
  日本語
• 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, 80, 5, 1025, 1025, 日本臨床外科学会, 2019年05月
  日本語
• 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, 80, 5, 1025, 1025, 日本臨床外科学会, 2019年05月
  日本語
• 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, 80, 5, 1026, 1026, 日本臨床外科学会, 2019年05月
  日本語
• 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年05月, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年05月, ［査読有り］, ［国内誌］
  日本語, 研究論文（学術雑誌）, 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, 2019年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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, 2019年05月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 119回, PD, 2, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, RS, 5, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, RS, 10, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, SF, 7, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, SY, 6, (一社)日本外科学会, 2019年04月
  日本語
• 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, (一社)日本外科学会, 2019年04月
  英語
• 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, 119回, WS, 8, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, SF, 3, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, SF, 4, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, SF, 4, (一社)日本外科学会, 2019年04月
  日本語
• 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, 119回, PS, 3, (一社)日本外科学会, 2019年04月
  日本語
• 【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, 16, 2, 112, 117, (一社)日本外科感染症学会, 2019年04月
  日本語, 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, 119回, PS, 8, (一社)日本外科学会, 2019年04月, ［査読有り］
  日本語
• 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, 2019年04月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 73, 4, 639, 648, 金原出版(株), 2019年03月
  日本語
• 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, 124回, 36, 36, 日本消化器病学会-北海道支部, 2019年03月
  日本語
• 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, 124回, 36, 36, 日本消化器病学会-北海道支部, 2019年03月
  日本語
• 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, 124回, 66, 66, 日本消化器病学会-北海道支部, 2019年03月
  日本語
• 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年03月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年03月, ［査読有り］, ［国際誌］
  英語, 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, 80, 2, 435, 436, 日本臨床外科学会, 2019年02月
  日本語
• 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, 80, 2, 440, 440, 日本臨床外科学会, 2019年02月
  日本語
• 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, 80, 2, 440, 441, 日本臨床外科学会, 2019年02月
  日本語
• 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, 80, 2, 441, 441, 日本臨床外科学会, 2019年02月
  日本語
• 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, 91回, 540, 540, (一社)日本胃癌学会, 2019年02月
  日本語
• 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, 2019年02月, ［査読有り］, ［国内誌］
  英語, 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, ELSEVIER SCIENCE INC, 2019年02月, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, 2019年02月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Japanese Society of Gastroenterological Surgery, 2019年
  日本語, 研究論文（学術雑誌）, 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, 5, 2, 31, 35, 藤田学園医学会, 2019年, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）,

  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, 8, 2, 163, 167, 日本Acute Care Surgery学会, 2019年01月
  日本語, 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年, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2019年01月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 23, 7, OS57, 5, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP69, 9, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP129, 10, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, OS151, 4, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 63, 2, 157, 158, 北海道外科学会, 2018年12月
  日本語
• 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, 63, 2, 173, 173, 北海道外科学会, 2018年12月
  日本語
• 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, 23, 7, OS219, 7, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP32, 5, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP55, 11, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP84, 1, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 23, 7, DP112, 6, (一社)日本内視鏡外科学会, 2018年12月
  日本語
• 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, 48回, 72, 72, (一社)日本創傷治癒学会, 2018年11月
  日本語
• 【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, 39, 11, 1269, 1274, 医学図書出版(株), 2018年11月
  日本語, 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, 93, 2, 114, 115, 北海道医学会, 2018年11月
  日本語
• 【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, 33, 3, 229, 235, (一社)日本インターベンショナルラジオロジー学会, 2018年11月
  日本語, 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, 2018年11月, ［査読有り］, ［国内誌］
  英語, 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, 76, 増刊8 食道癌, 300, 304, (株)日本臨床社, 2018年10月
  日本語
• 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, 79, 増刊, 284, 284, 日本臨床外科学会, 2018年10月
  日本語
• 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, 45, 10, 1423, 1427, (株)癌と化学療法社, 2018年10月
  日本語
• 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, 79, 増刊, 285, 285, 日本臨床外科学会, 2018年10月
  日本語
• 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, 79, 増刊, 297, 297, 日本臨床外科学会, 2018年10月
  日本語
• 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, 79, 増刊, 315, 315, 日本臨床外科学会, 2018年10月
  日本語
• 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, 79, 増刊, 369, 369, 日本臨床外科学会, 2018年10月
  日本語
• 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, 79, 増刊, 527, 527, 日本臨床外科学会, 2018年10月
  日本語
• [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, 2018年10月, ［査読有り］, ［国内誌］
  日本語, 研究論文（学術雑誌）
• 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, (一社)日本癌学会, 2018年09月
  英語
• 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, 8, 1, 55, 55, 日本Acute Care Surgery学会, 2018年09月
  日本語
• 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, 8, 1, 115, 115, 日本Acute Care Surgery学会, 2018年09月
  日本語
• 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, 8, 1, 131, 131, 日本Acute Care Surgery学会, 2018年09月
  日本語
• 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, 39, Suppl., 42, 42, 日本手術医学会, 2018年09月
  日本語
• 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, 日本癌学会, 2018年09月
  英語
• 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, 2018年09月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 2018年09月, ［査読有り］
• 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, 2018年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 32, 3, 631, 631, 日本胆道学会, 2018年08月
  日本語
• 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, 32, 3, 479, 479, 日本胆道学会, 2018年08月
  日本語
• 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, 2018年08月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年08月, ［査読有り］, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年08月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 73回, 755, 755, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 73回, 181, 181, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 73回, 6, 6, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 73回, 640, 640, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 73回, 706, 706, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 73回, 872, 872, (一社)日本消化器外科学会, 2018年07月
  日本語
• 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, 22回, 94, 94, 日本がん免疫学会, 2018年07月
  日本語
• 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, Elsevier Inc., 2018年07月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年07月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, Springer Singapore, 2018年06月01日
  英語, 論文集(書籍)内論文
• 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, 36回, 128, 128, 日本肥満症治療学会, 2018年06月
  日本語
• 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, 32, 2, 231, 231, (一社)日本外傷学会, 2018年06月
  日本語
• 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, W.B. Saunders, 2018年06月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Blackwell Publishing Asia, 2018年06月01日, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）
• 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, Springer Verlag, 2018年06月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年06月, ［査読有り］, ［国内誌］
  英語, 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年06月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Nature Publishing Group, 2018年05月08日, ［査読有り］, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 33, 3, 418, 418, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, 33, 3, 431, 431, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, 33, 3, 503, 503, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, 33, 3, 341, 341, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, 33, 3, 434, 434, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, 33, 3, 568, 568, (一社)日本膵臓学会, 2018年05月
  日本語
• 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, Springer New York LLC, 2018年05月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Elsevier B.V., 2018年05月01日, ［査読有り］, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年05月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）
• 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, Springer Tokyo, 2018年04月23日, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, Impact Journals LLC, 2018年04月13日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 118回, 1711, 1711, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 1325, 1325, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 1617, 1617, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 985, 985, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 256, 256, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 603, 603, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 623, 623, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 979, 979, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 988, 988, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 1153, 1153, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 2036, 2036, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 2103, 2103, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 2333, 2333, (一社)日本外科学会, 2018年04月
  日本語
• 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, 118回, 1285, 1285, (一社)日本外科学会, 2018年04月, ［査読有り］
  日本語
• 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, Medknow Publications, 2018年04月01日, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, 2018年04月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, (一社)日本胃癌学会, 2018年03月
  英語
• 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, 90回, 508, 508, (一社)日本胃癌学会, 2018年03月
  日本語
• 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, Springer Verlag, 2018年03月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Spandidos Publications, 2018年03月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, International Institute of Anticancer Research, 2018年03月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年03月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Springer Tokyo, 2018年02月01日, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, 2018年02月, ［査読有り］, ［国際共著］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年02月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年02月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 2018年01月, ［査読有り］
• 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年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Elsevier B.V., 2018年01月01日, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Lippincott Williams and Wilkins, 2018年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Elsevier B.V., 2018年, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, Elsevier B.V., 2018年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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年, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, LIPPINCOTT WILLIAMS & WILKINS, 2017年12月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, BIOMED CENTRAL LTD, 2017年12月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, 92, 2, 114, 115, 北海道医学会, 2017年11月
  日本語
• 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, WILEY, 2017年11月, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, 2017年11月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, AMER CHEMICAL SOC, 2017年11月, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, 50, Suppl.2, 524, 524, (一社)日本消化器外科学会, 2017年10月
  日本語
• 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, 50, Suppl.2, 525, 525, (一社)日本消化器外科学会, 2017年10月
  日本語
• 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, 50, Suppl.2, 524, 524, (一社)日本消化器外科学会, 2017年10月
  日本語
• 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, 50, Suppl.2, 525, 525, (一社)日本消化器外科学会, 2017年10月
  日本語
• 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, SPRINGER, 2017年10月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, S. Karger AG, 2017年09月06日, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, SPRINGER, 2017年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, WILEY, 2017年09月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, INT INST ANTICANCER RESEARCH, 2017年09月, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, BAISHIDENG PUBLISHING GROUP INC, 2017年09月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, IMPACT JOURNALS LLC, 2017年08月, ［査読有り］
  英語, 研究論文（学術雑誌）, 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, SPRINGER, 2017年07月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, WILEY, 2017年07月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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, LIPPINCOTT WILLIAMS & WILKINS, 2017年06月, ［査読有り］, ［国際誌］
  英語, 研究論文（学術雑誌）, 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, Springer Berlin Heidelberg, 2017年05月04日, ［査読有り］
  英語, 論文集(書籍)内論文
• 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, SPRINGER, 2017年04月, ［査読有り］, ［国内誌］
  英語, 研究論文（学術雑誌）, 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)