詳細

中居　卓也 （ナカイ　タクヤ）

  • 医学科　臨床教授
Last Updated :2024/04/25

コミュニケーション情報 byコメンテータガイド

  • コメント

    肝細胞癌治療は腹腔鏡下肝切除から血管合併肝切除まで行い、進行再発には癌ワクチン療法を実施している。切除不能な転移性肝癌や胆道癌（胆嚢癌など）には化学療法併用した肝切除治療を専門とする。

  • 報道関連出演・掲載一覧

    ＜報道関連出演・掲載一覧＞ ●2016/5/26 　毎日放送「ちちんぷいぷい」 　胆のうがんについて

研究者情報

学位

  • 医学博士（1997年03月 近畿大学）

ホームページURL

J-Global ID

研究キーワード

  • DNA マイクロアレイ   小腸移腸   グルタミン   NK activity   小腸移植   HVGD   rejection   CTL activity   ラット小腸移植   NKT cell   rat   GVHD   Chimerism   FK506   肝再生   アメリカ   肝癌ワクチン治療   ヨーロッパ   免疫治療   

現在の研究分野（キーワード）

    肝細胞癌治療は腹腔鏡下肝切除から血管合併肝切除まで行い、進行再発には癌ワクチン療法を実施している。切除不能な転移性肝癌や胆道癌（胆嚢癌など）には化学療法併用した肝切除治療を専門とする。

研究分野

  • ライフサイエンス / 消化器外科学
  • ライフサイエンス / 外科学一般、小児外科学

経歴

  • 2019年10月 - 現在  近畿大学医学部臨床教授
  • 2011年 - 2019年09月  近畿大学医学部准教授

研究活動情報

論文

  • Terufumi Yoshida; Kazuko Sakai; Masaki Kaibori; Mitsuaki Ishida; Shogo Tanaka; Shoji Kubo; Takuya Nakai; Marco De Velasco; Hideyuki Matsushima; Koji Tsuta; Mitsugu Sekimoto; Kazuto Nishio
    Oncology Letters 27 3 2024年01月
  • Masato Ota; Koji Komeda; Hiroya Osaka Iida; Masaki Ueno; Hisashi Kosaka; Takeo Nomi; Shogo Tanaka; Takuya Nakai; Daisuke Hokutou; Masataka Matsumoto; Fumitoshi Hirokawa; Sang-Woong Lee; Masaki Kaibori; Shoji Kubo
    Annals of surgical oncology 30 5 2818 - 2819 2023年05月
  • Masato Ota; Koji Komeda; Hiroya Iida; Masaki Ueno; Hisashi Kosaka; Takeo Nomi; Shogo Tanaka; Takuya Nakai; Daisuke Hokutou; Masataka Matsumoto; Fumitoshi Hirokawa; Sang-Woong Lee; Masaki Kaibori; Shoji Kubo
    Annals of surgical oncology 30 5 2807 - 2815 2023年05月 
    BACKGROUND: Complex hepatocellular carcinoma (HCC) prognostic biomarkers have been reported in various studies. We aimed to establish biomarkers that could predict prognosis, and formulate a simple classification using non-invasive preoperative blood test data. METHODS: We retrospectively identified 305 patients for a discovery cohort who had undergone HCC-related hepatectomy at four Japanese university hospitals between January 1, 2011 and December 31, 2013. Preoperative blood test parameter optimal cut-off values were determined using receiver operating characteristic curve analysis. Cox uni- and multivariate analyses were used to determine independent prognostic factors. Risk classifications were established using classification and regression tree (CART) analysis. Validation was performed with 267 patients from three other hospitals. RESULTS: In multivariate analysis, α-fetoprotein (AFP, p < 0.001), protein induced by vitamin K absence or antagonist-II (PIVKA-II, p = 0.006), and C-reactive protein (CRP, p < 0.001) were independent prognostic factors for overall survival (OS). AFP (p = 0.007), total bilirubin (p = 0.001), and CRP (p = 0.003) were independent recurrent risk factors for recurrence-free survival (RFS). CART analysis results formed OS (CRP, AFP, and albumin) and RFS (PIVKA-II, CRP, and total bilirubin) decision trees, based on machine learning using preoperative serum markers, with three risk classifications. Five-year OS (low risk, 80.0%; moderate risk, 56.3%; high risk, 25.2%; p < 0.001) and RFS (low risk, 43.4%; moderate risk, 30.8%; high risk, 16.6%; p < 0.001) risks differed significantly. These classifications also stratified OS and RFS risk in the validation cohort. CONCLUSION: Three simple risk classifications using preoperative non-invasive prognostic factors could predict prognosis.
  • Shumpei Satoi; Yutaka Kimura; Rie Shimizu; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Takaaki Murase; Keiko Kamei; Ippei Matsumoto; Takuya Nakai; Yoshifumi Takeyama
    Surgery today 2023年04月 
    PURPOSE: Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. METHODS: The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. RESULTS: After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). CONCLUSIONS: The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.
  • 80歳以上の高齢者に対する肝切除後治療成績 術後1年後に自立生活を困難にする要因の解析
    田中 肖吾; 飯田 洋也; 上野 昌樹; 米田 浩二; 北東 大督; 中居 卓也; 小坂 久; 生駒 久視; 野田 剛広; 新川 寛二; 前平 博充; 速水 晋也; 廣川 文鋭; 石沢 武彰; 海堀 昌樹
    日本臨床外科学会雑誌 83 増刊 S231 - S231 日本臨床外科学会 2022年10月
  • Takeo Nomi; Masaki Kaibori; Shogo Tanaka; Fumitoshi Hirokawa; Daisuke Hokuto; Takehiro Noda; Masaki Ueno; Takuya Nakai; Hisashi Ikoma; Hiroya Iida; Kosuke Matsui; Koji Komeda; Shinya Hayami; Hidetoshi Eguchi; Masataka Matsumoto; Ryo Morimura; Hiromitsu Maehira; Takahiro Yoshikawa; Shoji Kubo
    Journal of hepato-biliary-pancreatic sciences 30 3 283 - 292 2022年08月 [査読有り]
     
    OBJECTIVE: This multicenter study aimed to compare the short- and long-term outcomes of laparoscopic (LRLR) versus open repeat liver resection (ORLR) for recurrent hepatocellular carcinoma (HCC) using propensity score matching (PSM). Despite the expanding indications for laparoscopic liver resection, limited data regarding the outcomes of LRLR have previously been reported. METHODS: This study included patients who underwent repeat liver resection for recurrent HCC. Patients were divided into the LRLR and ORLR groups, and their short- and long-term outcomes were compared via PSM. RESULTS: There were 256 and 130 patients in the ORLR and LRLR groups, respectively. After PSM, 64 patients were included in each group. Intraoperative blood loss was significantly less in LRLR than in ORLR (56 vs 208 ml, P < .001). Postoperative complications of Clavien-Dindo IIIa or more were significantly less in LRLR than in ORLR (3.1% vs 15.6%, P = .030). The length of hospital stay was notably shorter in LRLR than in ORLR (9 vs 12 days, P < .001). Survival rates after repeat liver resection at 1, 3, and 5 years, respectively, were comparable at 93.4%, 81.9%, and 63.5% for ORLR and at 94.8%, 80.7%, and 67.3% for LRLR (P = .623). Subgroup analysis of patients who underwent wedge resection in repeat liver resection revealed that the postoperative complication rate was notably lower in LRLR than in ORLR (7.2% vs 21.8%, P = .030). CONCLUSION: LRLR for recurrent HCC is a viable option due to its better short-term outcomes and comparable long-term outcomes compared to ORLR.
  • Hiroji Shinkawa; Fumitoshi Hirokawa; Masaki Kaibori; Daijiro Kabata; Takeo Nomi; Masaki Ueno; Hisashi Ikoma; Takuya Nakai; Hiroya Iida; Shogo Tanaka; Koji Komeda; Hisashi Kosaka; Daisuke Hokuto; Shinya Hayami; Ryo Morimura; Masataka Matsumoto; Hiromitsu Maehira; Shigekazu Takemura; Shoji Kubo
    Surgery 171 5 1311 - 1319 2022年05月 [査読有り]
     
    BACKGROUND: Laparoscopic liver resection for hepatic lesions is increasingly performed worldwide. However, parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments is very technically demanding. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection and open liver resection for hepatic lesions in the right posterosuperior segments. METHODS: In total, 617 patients who underwent liver resection of hepatic lesions in the right posterosuperior segments (segment Ⅶ or Ⅷ) at 8 centers were included in this study. We lessened the impact of confounders through propensity score matching, inverse probability weighting, and double/debiased machine learning estimations. RESULTS: After matching and weighting, the imbalance between the 2 groups significantly decreased. Compared with open liver resection, laparoscopic liver resection was associated with a lower volume of intraoperative blood loss and incidence of postoperative complications in the matched and weighted cohorts. After surgery, the incidence of pulmonary complication and cardiac disease was lower in the laparoscopic liver resection group than in the open liver resection group in both the matched and weighted cohorts. The odds ratios of laparoscopic liver resection for postoperative complications in the matched and weighted cohorts were 0.49 (95% confidence interval, 0.29-0.83) and 0.40 (95% confidence interval, 0.25%-0.64%), respectively. The double/debiased machine learning risk difference estimator for postoperative complications of laparoscopic liver resection was -19.8% (95% confidence interval, -26.8% to -13.4%). CONCLUSION: Parenchyma-sparing laparoscopic liver resection for hepatic lesions in the right posterosuperior segments had clinical benefits, including lower volume of intraoperative blood loss and incidence of postoperative complications.
  • Yasuo Otsuka; Ken Kamata; Tomoko Hyodo; Takaaki Chikugo; Akane Hara; Hidekazu Tanaka; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Yasutaka Chiba; Tomohiro Watanabe; Takuya Nakai; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo
    Surgical endoscopy 36 5 3254 - 3260 2022年05月 
    BACKGROUND: The value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for T-staging in patients with extrahepatic bile duct cancer was evaluated. METHODS: This single-center, retrospective study included consecutive patients with extrahepatic bile duct cancer who underwent surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced CT (CE-CT) examinations between June 2014 and August 2017. The capacity of these modalities for T-staging of extrahepatic bile duct cancer was evaluated by assessing invasion beyond the biliary wall into the surrounding tissue, gallbladder, liver, pancreas, duodenum, portal vein system (portal vein and/or superior mesenteric vein), inferior vena cava, and hepatic arteries (proper hepatic artery, right. and/or left. hepatic artery). Blind reading of EUS, CH-EUS, and CE-CT images was performed by two expert reviewers each. RESULTS: 38 patients were eligible for analysis, of which eight had perihilar bile duct cancer and 30 had distal bile duct cancer. Postoperative T-staging was T1 in 6, T2 in 16, and T3 in 16 cases. CH-EUS was superior to CE-CT for diagnosing invasion beyond the biliary wall into surrounding tissue (92.1% vs. 45.9%, P = 0.0002); the ability to detect invasion to other organs did not differ significantly between the two modalities. The accuracy of CH-EUS for T-staging of tumors was better than that of CE-CT (73.7% vs. 39.5%, P = 0.0059). CH-EUS tended to have a better accuracy than EUS for the diagnosis of invasion beyond the biliary wall into the surrounding tissue (92.1% vs. 78.9%, P = 0.074) and T-staging (73.7% vs. 60.5%, P = 0.074). CONCLUSION: CH-EUS is useful for T-staging of extra hepatic bile duct cancer, especially in terms of invasion beyond the biliary wall into the surrounding tissue.
  • Hiroji Shinkawa; Fumitoshi Hirokawa; Masaki Kaibori; Takeo Nomi; Masaki Ueno; Hisashi Ikoma; Takuya Nakai; Hiroya Iida; Shogo Tanaka; Koji Komeda; Hisashi Kosaka; Daisuke Hokuto; Shinya Hayami; Ryo Morimura; Masataka Matsumoto; Hiromitsu Maehira; Shigekazu Takemura; Shoji Kubo
    Asian journal of endoscopic surgery 15 3 539 - 546 2022年02月 [査読有り]
     
    BACKGROUND: This study aimed to determine the risk factors for severe postoperative complications in patients undergoing pure laparoscopic liver resection (LLR) for tumors in the right posterosuperior (PS) segments. METHODS: The study included 289 patients who underwent parenchyma-sparing pure LLR for tumors in the right PS segments at eight treatment centers between January 2009 and December 2019. RESULTS: Multivariate analysis revealed tumor size ≥3 cm (P = .016), segmentectomy (P = .044), and liver cirrhosis (P = .029) as independent risk factors for severe postoperative complications. The severe complication rates (2.7% vs 12.1%, P = .0025), median intraoperative blood loss (100 mL vs 150 mL, P = .001), and median operation time (248 minutes vs 299.5 minutes, P = .0013) were lower in the patients without all these three risk factors than those with at least one risk factor. The median length of postoperative hospital stay was shorter in patients with no risk factors than those with at least one risk factor (9 days vs. 10 days, P = .001). CONCLUSIONS: Tumor size ≥3 cm, segmentectomy, and liver cirrhosis were the risk factors for severe postoperative complications after parenchyma-sparing pure LLR for tumors in the right PS segments. Patients without these three risk factors would be appropriate candidates for safely performing parenchyma-sparing pure LLR in the right PS segments at the outset.
  • 動脈結紮術を施行した未破裂第一空腸動脈瘤の1例
    山田 淳史; 松本 逸平; 松本 正孝; 吉田 雄太; 登 千穂子; 川口 晃平; 李 東河; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本臨床外科学会雑誌 82 増刊 S863 - S863 日本臨床外科学会 2021年10月
  • 弓状靱帯狭窄症による前上膵十二指腸動脈瘤コイル塞栓後に生じた十二指腸狭窄に対する1手術例
    松本 正孝; 松本 逸平; 吉田 雄太; 山田 淳史; 登 千穂子; 川口 晃平; 李 東河; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本臨床外科学会雑誌 82 増刊 S1208 - S1208 日本臨床外科学会 2021年10月
  • Masaki Ueno; Koji Komeda; Hisashi Kosaka; Takuya Nakai; Takeo Nomi; Hiroya Iida; Shogo Tanaka; Hisashi Ikoma; Kenji Matsuda; Fumitoshi Hirokawa; Masataka Matsumoto; Daisuke Hokuto; Haruki Mori; Ryo Morimura; Masaki Kaibori; Hiroki Yamaue; Shoji Kubo
    International journal of surgery (London, England) 94 106106 - 106106 2021年09月 
    BACKGROUND: Synchronous colorectal liver metastasis (SCRLM) is at an advanced tumor stage and requires multidisciplinary treatments. Neoadjuvant chemotherapy (NAC) is thought to be an effective treatment modality, but its prognostic impact is still unclear. MATERIALS AND METHODS: Patients with resectable SCRLM presented to eight university hospitals between 2007 and 2017 were retrospectively reviewed. Propensity score matching (PSM) was performed to adjust baseline characteristics between patients who received NAC with those who underwent up-front hepatectomy. The prognostic impact of NAC was then evaluated. RESULTS: The cohort comprised of 320 patients: 151 patients received NAC and the remaining 169 patients underwent up-front hepatectomy. After a 1:1 ratio of PSM, 102 patients per group were selected. Within the PSM cohort, 66% patients had multiple liver tumors, with 15% having five or more liver tumors. The median survival (95% confidence interval) periods for patients with and without NAC in the PSM cohort were 88.5 (68.4 - not reached) and 84.2 (52.1 - not reached) months, respectively (P = 0.51). On multivariate analysis, the postoperative events in these patients including operative complications and use of adjuvant chemotherapy after hepatectomy were prognostic factors with hazards (95% confidence interval) being 1.88 (1.18-2.98) and 0.65 (0.42-1.01), respectively. CONCLUSION: This PSM study was restricted to patients with SCRLM and relatively advanced tumor stagings. NAC did not show any significant prognostic impact. While operative complications had a significant prognostic impact, use of adjuvant chemotherapy after hepatectomy had only a marginal prognostic impact. Reconsideration of indications for NAC is needed.
  • Hiroya Iida; Masaji Tani; Fumitoshi Hirokawa; Masaki Ueno; Takehiro Noda; Shigekazu Takemura; Takeo Nomi; Takuya Nakai; Masaki Kaibori; Shoji Kubo
    Annals of gastroenterological surgery 5 5 701 - 710 2021年09月 [査読有り]
     
    Background: Although several risk factors for incisional hernia after hepatectomy have been reported, their relationship to different wound sites has not been investigated. Therefore, this study aimed to examine the risk factors for incisional hernia according to various wound sites after hepatectomy. Methods: Patients from the Osaka Liver Surgery Study Group who underwent open hepatectomy using combinations of vertical and horizontal incisions (J-shaped incision, reversed L-shaped incision, reversed T-shaped incision, Mercedes incision) between January 2012 and December 2015 were included. Incisional hernia was defined as a hernia occurring within 3 y after surgery. Abdominal incisional hernia was classified into midline incisional hernia and transverse incisional hernia. The risk factors for each posthepatectomy incisional hernia type were identified. Results: A total of 1057 patients met the inclusion criteria. The overall posthepatectomy incisional hernia incidence rate was 5.9% (62 patients). In the multivariate analysis, the presence of diabetes mellitus and albumin levels <3.5 g/dL were identified as independent risk factors. Moreover, incidence rates of midline and transverse incisional hernias were 2.4% (25 patients), and 2.3% (24 patients), respectively. In multivariate analysis, the independent risk factor for transverse incisional hernia was the occurrence of superficial or deep incisional surgical site infection, and interrupted suturing for midline incisional hernia. Conclusions: Risk factors for incisional hernia after hepatectomy depend on the wound site. To prevent incisional hernia, running suture use might be better for midline wound closure. The prevention of postoperative wound infection is important for transverse wounds, under the presumption of preoperative nutrition and normoglycemia.
  • 局所進行切除不能膵癌に対するConversion surgeryのタイミング〜内科と外科の連携〜 当院における局所進行切除不能膵癌に対するconversion surgeryの短期・長期成績の検討
    吉田 雄太; 松本 逸平; 川口 晃平; 松本 正孝; 李 東河; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 鎌田 研; 山雄 健太郎; 竹中 完; 竹山 宜典
    膵臓 36 3 A146 - A146 (一社)日本膵臓学会 2021年08月
  • Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Lee Dongha; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Surgery today 52 2 260 - 267 2021年07月 
    PURPOSE: Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the "slow firing method" using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP. METHODS: This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas. RESULTS: Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10 days. Preoperative diabetes (13.6 vs. 0.2%, P = 0.044) and thickness of the pancreas ≥ 15 mm (13.8% vs. 0%, P = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8-29) min. CONCLUSION: The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.
  • Hiroya Iida; Masaji Tani; Koji Komeda; Takeo Nomi; Hideyuki Matsushima; Shogo Tanaka; Masaki Ueno; Takuya Nakai; Hiromitsu Maehira; Haruki Mori; Kosuke Matsui; Fumitoshi Hirokawa; Masaki Kaibori; Shoji Kubo
    HPB : the official journal of the International Hepato Pancreato Biliary Association 24 1 101 - 115 2021年06月 
    BACKGROUND: We aimed to investigate whether a novel biomarker incorporating albumin, lymphocytes, and CRP can predict the prognosis for hepatocellular carcinoma (HCC) after hepatectomy. METHODS: Between January 2011 and December 2013, 384 patients who underwent hepatectomy in four university hospitals in Japan were investigated as a discovery cohort. The CRP-Albumin-Lymphocyte (CALLY index) was defined as (Albumin × Lymphocyte)/(CRP × 104). Patients with a CALLY index ≥5 (n = 200) were compared to those with an index <5 (n = 184). Next, validation was performed using 267 patients from three other university hospitals (external validation cohort). RESULTS: The number of TNM Stage III and IV patients was significantly higher in the CALLY <5 group than the ≥5 group (p = 0.003). There was a significant difference in the 5-year survival rate (CALLY ≥5: 71% vs. <5: 46%; p < 0.001). Multivariate analysis identified the CALLY index as an independent factor of overall survival. Similarly, there was a significant difference in the 5-year survival rate between the CALLY ≥5 (73%) and <5 (48%) groups (p < 0.001), and the CALLY index was identified as an independent prognostic factor in the external validation cohort. CONCLUSION: The CALLY index derived from CRP, albumin, and lymphocyte values is a promising predictive biomarker for postoperative prognosis of patients with HCC.
  • 尾側膵切除術における新しい縫合糸を用いたバイクリルメッシュ、膵貫通マットレス法の有効性の検討 Transpancreatic mattress double suture(TPMD suture)の有効性について
    吉田 雄太; 松本 逸平; 川口 晃平; 松本 正孝; 李 東河; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本外科学会定期学術集会抄録集 121回 PS - 1 (一社)日本外科学会 2021年04月
  • 腹腔鏡下膵頭十二指腸切除術の安全な導入と手術手技
    松本 逸平; 吉田 雄太; 川口 晃平; 松本 正孝; 李 東河; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本外科学会定期学術集会抄録集 121回 PS - 8 (一社)日本外科学会 2021年04月
  • 肝内胆管拡張を伴う進行肝内胆管癌に対する肝左葉切除術
    武部 敦志; 吉田 雄太; 川口 晃平; 松本 正孝; 李 東河; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 松本 逸平; 中居 卓也; 竹山 宜典
    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
  • 当院における切除可能膵癌に対する術前治療症例の検討
    李 東河; 松本 逸平; 亀井 敬子; 川口 晃平; 吉田 雄太; 松本 正孝; 村瀬 貴昭; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本外科学会定期学術集会抄録集 121回 PS - 8 (一社)日本外科学会 2021年04月
  • 転移性肝癌に対する最適な治療戦略-術前化学療法後の手術デザイン- 切除可能大腸癌肝転移における術前化学療法の有用性 多施設共同後方視的検討から
    廣川 文鋭; 上野 昌樹; 中居 卓也; 海堀 昌樹; 野見 武男; 飯田 洋也; 田中 肖吾; 米田 浩二; 小坂 久; 速水 晋也; 北東 大督; 久保 正二; 内山 和久
    日本外科学会定期学術集会抄録集 121回 WS - 7 (一社)日本外科学会 2021年04月
  • 大腸癌肝転移の肝切除治療にかかわる化学療法の予後改善効果 Clinical risk scoreから見た検討
    中居 卓也; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 大東 弘治; 上田 和毅; 所 忠男; 肥田 仁一; 川村 純一郎; 竹山 宜典; 奥野 清隆
    日本大腸肛門病学会雑誌 74 2 95 - 95 (一社)日本大腸肛門病学会 2021年02月
  • 大腸癌肝転移の肝切除治療にかかわる化学療法の予後改善効果 Clinical risk scoreから見た検討
    中居 卓也; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 大東 弘治; 上田 和毅; 所 忠男; 肥田 仁一; 川村 純一郎; 竹山 宜典; 奥野 清隆
    日本大腸肛門病学会雑誌 74 2 95 - 95 (一社)日本大腸肛門病学会 2021年02月
  • Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Dongha Lee; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Surgery today 51 1 70 - 78 2021年01月 
    PURPOSE: The purpose of this study was to determine the factors influencing conversion from laparoscopic distal pancreatectomy (LDP) to open surgery, and the effect of such conversion on the outcome. METHODS: This retrospective single-center study included 70 consecutive patients undergoing LDP. The primary endpoint was the rate of conversion to open surgery during LDP. The secondary endpoints were determining the reasons for conversion to open surgery, with detailed analyses of these cases and a comparison of the surgical outcome with and without conversion. RESULTS: Seven patients (10%) required conversion to open surgery during LDP. Pancreatic ductal adenocarcinoma (PDAC) was identified as a risk factor for conversion (p = 0.010). The reasons for conversion included technical difficulty (two bleeding, one severe adhesion) and pancreatic stump-related issues (two margin-positive, two stapling failures). Although the overall morbidity rate (29 vs. 11%, p = 0.48) and the rate of clinically relevant postoperative pancreatic fistula (14 vs. 5%, p = 0.82) were no different for the patients with or without open conversion, the postoperative hospital stay was significantly longer in the former (median 15 vs. 10 days, p = 0.03). CONCLUSIONS: Careful preoperative assessment is required when planning LDP for PDAC. Although conversion to open surgery does not result in failure of LDP, efforts to reduce the duration of postoperative hospital stay and the occurrence of complications are desirable to improve the outcome of LDP.
  • 膵体尾部切除後膵液瘻低減を可能としたバイクリルメッシュと新規マットレス縫合糸による新しい膵断端処理法
    亀井 敬子; 松本 逸平; 吉田 雄太; 川口 晃平; 村瀬 貴昭; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本消化器外科学会総会 75回 P300 - 3 (一社)日本消化器外科学会 2020年12月
  • 膵臓 悪性
    亀井 敬子; 松本 逸平; 川口 晃平; 吉田 雄太; 村瀬 貴昭; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 53 Suppl.2 317 - 317 (一社)日本消化器外科学会 2020年11月
  • 膵臓 悪性
    松本 逸平; 吉田 雄太; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 53 Suppl.2 319 - 319 (一社)日本消化器外科学会 2020年11月
  • 膵臓 良性
    村瀬 貴昭; 松本 逸平; 吉田 雄太; 川口 晃平; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 筑後 孝章; 竹山 宜典
    日本消化器外科学会雑誌 53 Suppl.2 324 - 324 (一社)日本消化器外科学会 2020年11月
  • Hiroya Iida; Masaki Kaibori; Fumitoshi Hirokawa; Yoshihiro Inoue; Masaki Ueno; Kousuke Matsui; Morihiko Ishizaki; Shogo Tanaka; Shigekazu Takemura; Takeo Nomi; Daisuke Hokutou; Takehiro Noda; Hidetoshi Eguchi; Takuya Nakai; Hiromitsu Maehira; Haruki Mori; Masaji Tani; Shoji Kubo
    Asian Pacific journal of cancer prevention : APJCP 21 10 2903 - 2911 2020年10月 [査読有り]
     
    BACKGROUND: Hepatic resection (HR) is not recommended for intermediate-stage hepatocellular carcinoma (HCC) by the Barcelona Clinic Liver Cancer criteria. We examined the prognostic factors of HR for intermediate-stage HCC and developed new HR criteria for intermediate-stage HCC. METHODS: A total of 110 patients who underwent HR without any prior treatment for intermediate-stage HCC between January 2007 and December 2012 were enrolled at eight university hospitals. The outcomes and prognostic factors of HR were evaluated to develop new HR criteria. RESULTS: In terms of tumor size and number, the most significant prognostic factors were within the up-to-seven criteria. Furthermore, serum albumin level ≥35 g/L and serum alpha-fetoprotein (AFP) level.
  • 周術期合併症は大腸癌同時性肝転移切除後の予後に影響する
    上野 昌樹; 米田 浩二; 小坂 久; 野見 武男; 飯田 洋也; 田中 肖吾; 中居 卓也; 松田 健司; 廣川 文鋭; 北東 大督; 海堀 昌樹; 谷 眞至; 内山 和久; 山上 裕機; 久保 正二
    日本臨床外科学会雑誌 81 増刊 325 - 325 日本臨床外科学会 2020年10月
  • 胆管癌切除後の異時性胆管癌に対する2切除例の報告
    村瀬 貴昭; 武部 敦志; 吉田 雄太; 川口 晃平; 松本 正孝; 李 東河; 亀井 敬子; 里井 俊平; 松本 逸平; 中居 卓也; 木村 雅友; 竹山 宜典
    日本臨床外科学会雑誌 81 増刊 543 - 543 日本臨床外科学会 2020年10月
  • Yuta Yoshida; Ippei Matsumoto; Tomonori Tanaka; Kentaro Yamao; Akihiro Hayashi; Keiko Kamei; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Mamoru Takenaka; Yoshifumi Takeyama
    Surgical case reports 6 1 222 - 222 2020年09月 
    BACKGROUND: Pancreatic pleural effusion and ascites are defined as fluid accumulation in the thoracic and abdominal cavity, respectively, due to direct leakage of the pancreatic juice. They usually occur in patients with acute or chronic pancreatitis but are rarely associated with pancreatic neoplasm. We present here an extremely rare case of pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct, leading to pancreatic pleural effusion. CASE PRESENTATION: A 51-year-old man complained of dyspnea. Left-sided pleural effusion was detected on the chest X-ray. Pleural puncture was performed, and the pleural fluid indicated a high amylase content (36,854 IU/L). Hence, the patient was diagnosed with pancreatic pleural effusion. Although no tumor was detected, the computed tomography (CT) scan showed a pseudocyst and dilation of the main pancreatic duct in the pancreatic tail. Magnetic resonance cholangiopancreatography showed a fistula from the pseudocyst into the left thoracic cavity. Endoscopic retrograde pancreatic drainage was attempted; however, it failed due to stenosis in the main pancreatic duct in the pancreatic body. Endoscopic ultrasound revealed a hypoechoic mass measuring 15 × 15 mm in the pancreatic body that was not enhanced in the late phase of contrast perfusion and was thus suspected to be an invasive ductal carcinoma. The patient underwent distal pancreatectomy with splenectomy and the postoperative course was uneventful. Histopathological examination confirmed a neuroendocrine tumor of the pancreas (NET G2). The main pancreatic duct was compressed by the tumor. Increased pressure on the distal pancreatic duct by the tumor might have caused formation of the pseudocyst and pleural effusion. To the best of our knowledge, this is the first case report of pancreatic pleural effusion associated with a neuroendocrine tumor. CONCLUSIONS: Differential diagnosis of a pancreatic neoplasm should be considered, especially when a patient without a history of pancreatitis presents with pleural effusion.
  • Ippei Matsumoto; Keiko Kamei; Takaaki Murase; Yuta Yoshida; Kohei Kawaguchi; Masataka Matsumoto; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Journal of hepato-biliary-pancreatic sciences 27 9 632 - 639 2020年09月 
    BACKGROUND/PURPOSE: To determine the short- and long-term results of surgical treatments for chronic pancreatitis (CP) at a high-volume center in Japan. METHODS: The records of 151 consecutive patients undergoing surgery for CP were retrospectively reviewed. Selection of surgical procedures used had been according to the Japanese Clinical Practice Guidelines for CP 2015. Long-term (≥1 year) follow-up was performed in 100 patients (median of 37 months). RESULTS: Surgical drainage procedures were performed in 107 patients (Frey operation in 81, longitudinal pancreaticojejunostomy in 26), pancreatic resection in 37 (subtotal stomach-preserving pancreaticoduodenectomy in 11, distal pancreatectomy in 26), and other procedures in six. The rates of postoperative mortality and morbidity were 1% and 26%, respectively. The rates of complete and partial pain relief were 62% and 37%. The frequency of occurrence of severe morbidity was significantly higher after pancreatic resection than in patients receiving drainage procedures (13% vs 2%, P = .019). The rate of new-onset diabetes was also significantly higher after resection than drainage (60% vs 25%, P = .017). CONCLUSIONS: Surgical treatment for painful chronic pancreatitis can be safe and effective. An optimal procedure should guarantee pain relief and preserve a maximum of pancreatic function.
  • 松本 正孝; 松本 逸平; 吉田 雄太; 山雄 健太郎; 川口 晃平; 村瀬 貴昭; 大本 俊介; 亀井 敬子; 里井 俊平; 竹中 完; 武部 敦志; 中居 卓也; 竹山 宜典
    膵臓 35 3 A337 - A337 (一社)日本膵臓学会 2020年07月
  • Iwasaki Toshimitsu; Matsumoto Masataka; Satoi Shumpei; Yoshida Yuta; Kawaguchi Kohei; Kamei Keiko; Takebe Atsushi; Matsumoto Ippei; Nakai Takuya; Takeyama Yoshifumi Takeyama
    International Journal of Surgery Research and Practice 7 2 2020年04月 [査読有り]
  • Atsushi Ishihara; Shogo Tanaka; Masaki Ueno; Hiroya Iida; Masaki Kaibori; Takeo Nomi; Fumitoshi Hirokawa; Hisashi Ikoma; Takuya Nakai; Hidetoshi Eguchi; Hiroji Shinkawa; Shinya Hayami; Hiromitsu Maehira; Toshihiko Shibata; Shoji Kubo
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 25 1 134 - 144 2020年03月 [査読有り]
     
    BACKGROUND: Hepatic resection often results in delirium in preoperatively self-sufficient elderly people. The association of frailty with postoperative delirium remains unclear, and preoperative risk assessment, including frailty, of postoperative delirium has not been established. METHODS: This prospective multicenter study included 295 independently living patients aged ≥ 65 years scheduled for initial hepatic resection. All patients answered the phenotypic frailty index Kihon Checklist, which is a self-reporting list of 25 questions, within a week before surgery. The risk factors for postoperative delirium were investigated. Patients who scored ≥ 4 in the Intensive Care Delirium Screening Checklist were designated as having postoperative delirium. RESULTS: Delirium developed after liver resection in 22 of 295 patients (7.5%). Total Kihon Checklist score (≥ 6 points), age (≥ 75 years), and serum albumin concentration (≤ 3.7 g/dL) were the independent risk factors for postoperative delirium. The proportion of patients with postoperative delirium was 0% in those with no applicable risk factors, 3.2% in those with one applicable risk factor, 12.0% in those with two applicable risk factors, and 40.9% in those with all three factors (p < 0.001). The area under the receiver operating characteristic curve for this risk assessment for predicting postoperative delirium was 0.842. CONCLUSION: The use of these three factors for preoperative risk assessment may be effective in predicting and preparing for delirium after hepatic resection in elderly patients.
  • Takeo Nomi; Fumitoshi Hirokawa; Masaki Kaibori; Masaki Ueno; Shogo Tanaka; Daisuke Hokuto; Takehiro Noda; Takuya Nakai; Hisashi Ikoma; Hiroya Iida; Koji Komeda; Morihiko Ishizaki; Shinya Hayami; Hidetoshi Eguchi; Masataka Matsumoto; Ryo Morimura; Hiromitsu Maehira; Masayuki Sho; Shoji Kubo
    Surgical endoscopy 34 2 658 - 666 2020年02月 [査読有り]
     
    BACKGROUND: The frequency of liver resection in elderly patients has been increasing. However, data are limited regarding the safety of laparoscopic liver resection (LLR) compared with that of open liver resection (OLR) for hepatocellular carcinoma (HCC) in elderly patients. The present study aimed to compare short-term outcomes between LLR and OLR in elderly patients with HCC using propensity score matching. METHODS: The study included 630 patients (age, ≥ 75 years) who underwent liver resection for HCC at nine liver centres between April 2010 and December 2017. Patients were divided into LLR and OLR groups, and perioperative outcomes were compared between the groups. In addition, subgroup analysis was performed according to age (75-79 and ≥ 80 years). RESULTS: Of the 630 patients, 221 and 409 were included in the LLR and OLR groups, respectively. After propensity score matching, 155 patients were included in each group. Intraoperative blood loss and the transfusion, post-operative overall complication and major complication rates were lower in the matched LLR than the matched OLR group (P < 0.001, P = 0.004, P < 0.001 and P < 0.001, respectively). Moreover, post-operative pulmonary and cardiovascular complications were less frequent in the matched LLR group (P = 0.008 and P = 0.014, respectively). In subgroup analysis, among octogenarians, the post-operative major complication rate was lower and hospital stay was shorter in the matched LLR than the matched OLR group (P < 0.001 and P < 0.001, respectively). CONCLUSION: LLR for HCC is associated with good short-term outcomes in patients aged ≥ 75 years compared with OLR. LLR is safe and feasible in selected octogenarians with HCC.
  • 【慢性膵炎診療2020】治療・予後 膵石の内視鏡治療vs.外科治療 最近の知見
    松本 逸平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 三長 孝輔; 竹中 完; 竹山 宜典
    肝・胆・膵 80 2 355 - 362 (株)アークメディア 2020年02月 [査読有り]
  • 膵全摘術後の栄養障害とその対策
    松本 逸平; 吉田 雄太; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 庭野 史丸; 廣峰 義久; 馬場谷 成; 中居 卓也; 池上 博司; 竹山 宜典
    外科と代謝・栄養 54 5 126 - 126 日本外科代謝栄養学会 2020年
  • Masataka Matsumoto; Ippei Matsumoto; Keiko Kamei; Yuta Yoshida; Kohei Kawaguchi; Takaaki Murase; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Gan to kagaku ryoho. Cancer & chemotherapy 47 1 108 - 110 2020年01月 
    A 62 year-old female presenting with shortness of breath and severe anemia(Hb level 4.4 g/dL)was diagnosed with tumor bleeding and duodenal cancer by gastrointestinal endoscopy.Computed tomography scan revealed multiple liver metastases.After admission, the Hb level dropped from 9.1 g/dL to 5.1 g/dL in one night, and emergency pancreaticoduodenectomy( PD)was performed to control the bleeding.The postoperative course was uneventful, and the patient was discharged on postoperative day(POD)16.Systemic chemotherapy was initiated 1 month after surgery, but the patient died from the disease 13 months after surgery.Emergency PD could be a treatment option in patients with uncontrolled tumor bleeding and fatal conditions.
  • バイクリルメッシュと貫通マットレス縫合による新しい尾側膵切除後膵断端処理法の有用性
    松本 逸平; 吉田 雄太; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 52 Suppl.2 130 - 130 (一社)日本消化器外科学会 2019年11月
  • Yuta Yoshida; Ippei Matsumoto; Masataka Matsumoto; Kohei Kawaguchi; Takaaki Murase; Keiko Kamei; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Journal of hepato-biliary-pancreatic sciences 26 11 510 - 516 2019年11月 
    BACKGROUND: Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains the most common surgical complication. We have developed a novel stump closure technique after DP using transpancreatic mattress suture with Vicryl mesh (TMV) and reported our initial findings. The purpose of this study is to evaluate the efficacy of TMV compared to the conventional handsewn stump closure technique (CHS). METHODS: This retrospective single-center study included 165 consecutive patients who underwent open DP from January 2010 to May 2018. Of these, 71 patients underwent DP using TMV after September 2014 and 94 patients underwent DP with CHS. The surgical outcomes were compared between the two groups. RESULTS: Clinically relevant POPF rate in the TMV group was significantly lower than that in the CHS group (5.6% vs. 17.2%, P = 0.027). Morbidity rate was higher in the CHS group than that in the TMV group (16.9% vs. 27.7%, P = 0.104). In the multivariate analysis, absence of additional organ resection (OR 3.57; 95% CI 1.18-10.43; P = 0.025) and TMV (OR 0.24; 95% CI 0.07-0.73; P = 0.010) were identified as independent preventing factors for clinically relevant POPF. CONCLUSION: TMV can be an effective stump closure technique for preventing POPF after DP.
  • 長期予後が期待できる多発肝細胞癌に対する新たな切除基準
    飯田 洋也; 海堀 昌樹; 廣川 文鋭; 井上 善博; 上野 昌樹; 松井 康輔; 石崎 守彦; 田中 肖吾; 竹村 茂一; 野見 武男; 北東 大督; 野田 剛広; 江口 英利; 中居 卓也; 前平 博充; 森 治樹; 谷 眞至; 久保 正二
    日本消化器外科学会雑誌 52 Suppl.2 181 - 181 (一社)日本消化器外科学会 2019年11月
  • 80歳以上の高齢者に対する肝切除後自立生活に困難を来たす要因に関する多施設共同研究
    田中 肖吾; 飯田 洋也; 上野 昌樹; 廣川 文鋭; 野見 武男; 中居 卓也; 海堀 昌樹; 生駒 久視; 江口 英利; 新川 寛二; 前平 博充; 速水 晋也; 井上 善博; 久保 正二
    日本消化器外科学会雑誌 52 Suppl.2 263 - 263 (一社)日本消化器外科学会 2019年11月
  • 野見 武男; 廣川 文鋭; 海堀 昌樹; 上野 昌樹; 田中 肖吾; 北東 大督; 野田 剛広; 中居 卓也; 生駒 久視; 飯田 洋也; 米田 浩二; 石崎 守彦; 速水 晋也; 庄 雅之; 久保 正二
    日本外科感染症学会雑誌 16 5 506 - 506 (一社)日本外科感染症学会 2019年10月
  • QOL評価の現状と問題点 術前フレイル判定は肝切除後QOL低下の予測因子になりうるのか 多施設前向き研究による検討
    田中 肖吾; 飯田 洋也; 上野 昌樹; 廣川 文鋭; 野見 武男; 中居 卓也; 海堀 昌樹; 生駒 久視; 江口 英利; 新川 寛二; 前平 博充; 速水 晋也; 久保 正二
    日本臨床外科学会雑誌 80 増刊 372 - 372 日本臨床外科学会 2019年10月 [査読有り]
  • Shogo Tanaka; Hiroya Iida; Masaki Ueno; Fumitoshi Hirokawa; Takeo Nomi; Takuya Nakai; Masaki Kaibori; Hisashi Ikoma; Hidetoshi Eguchi; Hiroji Shinkawa; Hiromitsu Maehira; Shinya Hayami; Shoji Kubo
    Annals of surgery 274 3 e253-e261  2019年08月 [査読有り]
     
    OBJECTIVE: To establish a preoperative risk assessment method for loss of independence after hepatic resection. SUMMARY BACKGROUND DATA: Hepatic resection often results in loss of independence in preoperatively self-sufficient elderly people. Elderly patients should therefore be carefully selected for surgery. METHODS: In this prospective, multicenter study, 347 independently-living patients aged ≥65 years, scheduled for hepatic resection, were divided into study (n = 232) and validation (n = 115) cohorts. We investigated the risk factors for postoperative loss of independence in the study cohort and verified our findings with the validation cohort. Loss of independence was defined as transfer to a rehabilitation facility, discharge to residence with home-based healthcare, 30-day readmission for poor functionality, and 90-day mortality (except for cancer-related deaths). RESULTS: In the study cohort, univariate and multivariate analyses indicated that frailty, age ≥ 76 years, and open surgery were independent risk factors for postoperative loss of independence. Proportions of patients with postoperative loss of independence in the study and validation cohorts were respectively 3.0% and 0% among those with no applicable risk factors, 8.1% and 12.5% among those with 1 applicable risk factor, 25.5% and 25.0% among those with 2 applicable risk factors, and 56.3% and 50.0% among those with all 3 factors applicable (P < 0.001 for both cohorts). Areas under the receiver operating characteristic curves for the study and validation groups were 0.777 and 0.783, respectively. CONCLUSIONS: Preoperative risk assessments using these 3 factors may be effective in predicting and planning for postoperative loss of independence after hepatic resection in elderly patients.
  • Frailな患者に対する消化器外科手術 術前フレイル判定は肝切除後の加齢に関連した合併症の予測因子になりうる 多施設前向き研究による検討
    田中 肖吾; 上野 昌樹; 飯田 洋也; 海堀 昌樹; 野見 武男; 廣川 文鋭; 生駒 久視; 中居 卓也; 江口 英利; 久保 正二
    日本消化器外科学会総会 74回 WS18 - 8 (一社)日本消化器外科学会 2019年07月
  • Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Toshimitsu Iwasaki; Atsushi Takebe; Takuya Nakai; Yoshifumi Takeyama
    Surgery today 49 5 394 - 400 2019年05月 
    PURPOSE: The purpose of the study was to compare the outcomes of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and low-grade malignant lesions to determine the safety and efficacy of LDP. METHODS: This retrospective comparative study included 67 consecutive patients who underwent LDP (n = 32) and ODP (n = 35) for benign or low-grade malignant lesions of the pancreas from January 2012 to March 2017. Thirty-five patients who were eligible for LDP in the ODP group were carefully selected. The clinical outcomes were compared in an intention-to-treat analysis. RESULTS: LDP was associated with significantly less operative blood loss (182 ± 232 vs. 505 ± 376 ml, P < 0.001) but a longer operation time (327 ± 89 vs. 173 ± 48 min, P < 0.001), than ODP. There were no significant differences between the 2 groups in the overall morbidity rates defined by Clavien-Dindo classification ≥ grade II (13% vs. 11%), clinically relevant postoperative pancreatic fistula rates (6% vs. 9%), and lengths of postoperative hospital stay (11 vs. 11 days). CONCLUSION: The study showed that LDP was safe and feasible. LDP should be considered as the first-line treatment for benign and low-grade malignant lesions in the left side of the pancreas.
  • 多発肝細胞癌に対する肝切除の多施設共同研究 長期予後が期待できる新たな切除基準
    飯田 洋也; 海堀 昌樹; 廣川 文鋭; 井上 義博; 上野 昌樹; 松井 康輔; 石崎 守彦; 田中 肖吾; 竹村 茂一; 野見 武男; 北東 大督; 野田 剛広; 江口 英利; 中居 卓也; 前平 博充; 森 治樹; 谷 眞至; 久保 正二
    日本外科学会定期学術集会抄録集 119回 SF - 1 (一社)日本外科学会 2019年04月
  • Toshimitsu Iwasaki; Yoshifumi Takeyama; Yuta Yoshida; Kohei Kawaguchi; Masataka Matsumoto; Takaaki Murase; Keiko Kamei; Atsushi Takebe; Ippei Matsumoto; Takuya Nakai
    International journal of surgery case reports 61 115 - 118 2019年 
    INTRODUCTION: Aberrant subvesical bile ducts are rare structural anomaly located in the peri-hepatic gallbladder fossa. This duct poses the risk for intraoperative bile duct injury resulting in clinically relevant bile leakage. PRESENTATION OF CASE: Aberrant subvesical bile duct was detected by preoperative magnetic resonance cholangiopancreatography in a 52-year old woman with gallbladder polypoid tumor harboring the risk to be gallbladder cancer. During open cholecystectomy with full thickness dissection, the aberrant duct was identified by intraoperative fluorescent cholangiography (IFC), and dissected safely. DISCUSSION: Aberrant subvesical bile ducts are mostly found unexpectedly as intra and/or postoperative bile leakage, and remain an important cause of bile duct injuries after laparoscopic cholecystectomy. IFC, which offers real-time imaging of biliary anatomy, has a potential to overcome these problems. CONCLUSION: We performed cholecystectomy by using IFC to identify the aberrant subvesical bile duct. To the best of our knowledge, this is the first report showing the fluorescence image of an aberrant subvesical bile duct in a state of nature.
  • Hiroya Iida; Masaki Kaibori; Hiroshi Wada; Fumitoshi Hirokawa; Takuya Nakai; Masahiko Kinoshita; Michihiro Hayashi; Hidetoshi Eguchi; Shoji Kubo
    Molecular and clinical oncology 9 5 545 - 552 2018年11月 [査読有り]
     
    The aim of the present study was to retrospectively identify prognostic factors for long-term cumulative survival following liver resection in patients with primarily unresectable colorectal cancer who had previously received conversion therapy. A multicentre study was designed to ascertain the appropriate indication for conversion therapy. The study included 34 patients who underwent conversion therapy at 5 university hospitals. Patients' background, operative factors, recurrence rate and survival rate were evaluated, and factors influencing therapy outcomes were identified. The median duration of preoperative chemotherapy was 3 months and the response rate was 39.8%. Upon resection, the median tumour size was 47 mm and the median number of tumours was 4. The recurrence-free and cumulative survival rates 5 years after liver resection were 13.7 and 39.3%, respectively. Postoperative complications developed in 12 patients. A response rate >40% was indicated with regards to the assessed prognostic factors for long-term cumulative survival following liver resection and an absence of postoperative complications was noted. It was revealed that conversion therapy should be considered prior to liver resection, particularly for patients with response rates exceeding 40%. Absence of postoperative complications is also an independent predictor of long-term cumulative survival after liver resection. In light of these findings, it was consisted that an optimal response rate >40% could be used as an indicator for surgical resection in conversion therapy. In addition, meticulous intra- and postoperative managements are important for decreasing postoperative complications and improving long-term cumulative survival.
  • 膵全摘術の治療成績
    松本 逸平; 吉田 雄太; 川口 晃平; 松本 正孝; 村瀬 貴昭; 岩崎 寿光; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 51 Suppl.2 376 - 376 (一社)日本消化器外科学会 2018年11月
  • Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Tosiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Takaaki Chikugo; Yasutaka Chiba; Takuya Nakai; Yoshifumi Takeyama; Andrea Lisotti; Pietro Fusaroli; Masatoshi Kudo
    Gastroenterological Endoscopy 60 1611 - 1620 2018年09月 
    Copyright© 2018 Japan Gastroenterological Endoscopy Society. All rights reserved. Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions. Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images. Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82％, 100％, and 95％, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100％, 99％, and 99％, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61-87％, 71-88％, and 74-86％, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90％, 98 ％, and 96％, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis. Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.
  • Shogo Tanaka; Masaki Ueno; Hiroya Iida; Masaki Kaibori; Takeo Nomi; Fumitoshi Hirokawa; Hisashi Ikoma; Takuya Nakai; Hidetoshi Eguchi; Shoji Kubo
    Journal of hepato-biliary-pancreatic sciences 25 8 377 - 387 2018年08月 [査読有り]
     
    BACKGROUND: Age-related events, such as cardiopulmonary complications, delirium, transfer to a rehabilitation facility, and dependency are a major problem after hepatic resection in the elderly. This prospective multicenter study aimed to preoperatively evaluate frailty in the elderly according to a phenotypic frail index, named the "Kihon Checklist (KCL)," to predict "age-related events" after hepatic resection. METHODS: Between May 2016 and September 2017, 217 independently living patients who consented among all patients aged ≥65 years who planned to undergo hepatic resection were included in the study. Preoperative frailty was defined as a total KCL score ≥8. We analyzed clinical characteristics and outcomes, including age-related events (major respiratory and cardiac complications, delirium medication needed, transfer to rehabilitation facility, and dependency) between patients with and without frailty. RESULTS: Of the 217 patients, 63 and 154 were classified into the frail and non-frail groups, respectively. The incidences of age-related events (31.7% vs. 7.8%, P < 0.001) were higher in the frail group. Multivariate analysis indicated that frailty (P < 0.001, hazard ratio 5.16) and resection of ≥2 sectors (P = 0.014, hazard ratio 2.98) were independent risk factors for age-related events. CONCLUSIONS: Frailty evaluated by KCL in the elderly can predict postoperative age-related events after hepatic resection.
  • 大塚 康生; 鎌田 研; 竹中 完; 石川 嶺; 岡本 彩那; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 筑後 孝章; 兵頭 朋子; 中居 卓也; 竹山 宜典; 工藤 正俊
    胆道 32 3 567 - 567 日本胆道学会 2018年08月
  • 胃癌肝転移に対する肝切除の検討 大阪府内6病院研究
    米田 浩二; 林 道廣; 海堀 昌樹; 中居 卓也; 江口 英利; 田中 肖吾; 廣川 文鋭; 内山 和久; 久保 正二
    日本外科学会定期学術集会抄録集 118回 330 - 330 (一社)日本外科学会 2018年04月
  • 幕谷 悠介; 松本 逸平; 大本 俊介; 筑後 孝章; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 中居 卓也; 竹中 完; 工藤 正俊; 竹山 宜典
    日本消化器外科学会雑誌 51 2 114 - 121 (一社)日本消化器外科学会 2018年02月 [査読有り]
     
    膵・胆管合流異常に合併した共通管内乳頭状腫瘍の1例を報告する.症例は75歳の男性で,6ヵ月間に2度の急性膵炎を発症し保存的加療で軽快した.急性膵炎の原因精査および加療目的で当院へ紹介となった.ERCPでは膵・胆管合流異常を認め,共通管内に7mmの結節様陰影欠損像を認めた.上部内視鏡検査では乳頭部からの粘液排出は認めず,超音波内視鏡検査では共通管内に乳頭状の腫瘍が描出された.造影CTでは膵頭部に拡張した共通管と内部に増強効果を持つ8mmの腫瘤を認めた.尾側の主膵管の拡張は認めなかった.膵・胆管合流異常に合併した共通管内乳頭状腫瘍と診断し,亜全胃温存膵頭十二指腸切除術を施行した.病理肉眼所見では共通管内に発育する有茎性の乳頭状腫瘍で,組織像は管状構造増生を主体とする腺腫であった.免疫組織学的染色ではMUC1,MUC2陰性,MUC5AC陽性で胃型腺腫と最終診断した.(著者抄録)
  • Hiroshi Wada; Hidetoshi Eguchi; Hiroaki Nagano; Shoji Kubo; Takuya Nakai; Masaki Kaibori; Michihiro Hayashi; Shigekazu Takemura; Shogo Tanaka; Yasuyuki Nakata; Kosuke Matsui; Morihiko Ishizaki; Fumitoshi Hirokawa; Koji Komeda; Kazuhisa Uchiyama; Masanori Kon; Yuichiro Doki; Masaki Mori
    Surgery today 48 1 73 - 79 2018年01月 [査読有り]
     
    PURPOSE: The influence of allogenic blood transfusion on the postoperative outcomes of hepatocellular carcinoma (HCC) surgery remains controversial. This study aims to clarify the clinical impacts of perioperative allogenic blood transfusion on liver resection outcome in HCC patients. METHODS: We analyzed data collected over 5 years for 642 patients who underwent hepatectomy for HCC at one of the five university hospitals. We investigated the impact of allogenic blood transfusion on postoperative outcome after surgery in all patients and in 74 matched pairs, using a propensity score. RESULTS: Of the 642 patients, 198 (30.8%) received perioperative allogenic blood transfusion (AT group) and 444 (69.2%) did not (non-AT group). Overall survival was lower in the AT group than in the non-AT group in univariate (P < 0.001) and multivariate analyses (risk ratio 1.521, P = 0.011). After matching the different distributions using propensity scores, perioperative blood transfusion was found to be a poor prognostic factor for HCC patients. CONCLUSIONS: In this multi-center study, perioperative blood transfusion was an independent factor for poor prognosis after curative surgery for primary HCC in the patient group and in pairs matched by propensity scores.
  • Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Tosiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Takaaki Chikugo; Yasutaka Chiba; Takuya Nakai; Yoshifumi Takeyama; Andrea Lisotti; Pietro Fusaroli; Masatoshi Kudo
    Digestive Endoscopy 30 1 98 - 106 2018年01月 
    © 2017 Japan Gastroenterological Endoscopy Society Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions. Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images. Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61–87%, 71–88%, and 74–86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis. Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.
  • 亀井 敬子; 松本 逸平; 幕谷 悠介; 川口 晃平; 松本 正孝; 村瀬 貴昭; 里井 俊平; 中居 卓也; 鎌田 研; 今井 元; 筑後 孝章; 竹山 宜典
    癌と化学療法 44 12 1191 - 1193 (株)癌と化学療法社 2017年11月 [査読有り]
     
    症例は67歳、女性。上腸間膜動静脈浸潤および遠隔リンパ節転移を伴う膵頭部癌に対し、S-1による化学療法を施行した。2コース終了後に腫瘍マーカーの正常化、主病変の著明な縮小を認めた。化学療法を継続したが、増悪所見を認めず治療開始から8ヵ月後に亜全胃温存膵頭十二指腸切除術を施行した。切除後の病理診断では、主腫瘍は著明な線維性変化と軽度異型細胞をわずかに認めるのみでリンパ節転移も認めず、組織学的完全奏効と診断した。術後10ヵ月現在、無再発生存中である。(著者抄録)
  • Keiko Kamei; Ippei Matsumoto; Yusuke Makutani; Kohei Kawaguchi; Masataka Matsumoto; Takaaki Murase; Shumpei Satoi; Takuya Nakai; Ken Kamata; Hajime Imai; Takaaki Chikugo; Yoshifumi Takeyama
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1191 - 1193 2017年11月 [査読有り]
     
    We present a case ofa 67-year-old woman with Stage IV pancreatic head cancer with invasion to the superior mesenteric vein and artery, and distant lymph node metastases. The patient received S-1 mono-chemotherapy. After 2 courses of chemotherapy, the tumor marker was decreased to the normal levels, and the tumor size was dramatically reduced with undetectable lymph node metastases on CT. As the disease status was maintained following chemotherapy, the patient underwent subtotal stomach preserving pancreaticoduodenectomy, 8 months after initiation of the chemotherapy. Histopathologically, no cancer cells were found in the main tumor and dissected lymph nodes. Final diagnosis was made with pathological complete response. The patient was alive without recurrence for 10 months after surgery.
  • 大腸癌肝転移おけるNAC後肝切除症例のTNIを用いた臨床病理学的予後解析による術後化学療法の指針
    中居 卓也; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 松本 逸平; 竹山 宜典
    日本消化器外科学会雑誌 50 Suppl.2 272 - 272 (一社)日本消化器外科学会 2017年10月
  • フライ手術後に一過性可逆性脳症を発症した慢性膵炎急性増悪症例
    里井 俊平; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 松本 逸平; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 50 Suppl.2 422 - 422 (一社)日本消化器外科学会 2017年10月
  • 化学療法が奏功した切除不能胆道癌に対する多施設共同研究からみたConversion surgeryの治療成績
    松本 正孝; 中居 卓也; 竹山 宜典; 飯田 洋也; 上野 昌樹; 生駒 久視; 野見 武; 江口 英利; 海堀 昌樹; 林 道廣; 久保 正二
    日本臨床外科学会雑誌 78 増刊 675 - 675 日本臨床外科学会 2017年10月
  • Hiroya Iida; Masaki Kaibori; Shogo Tanaka; Shigekazu Takemura; Hiroshi Wada; Fumitoshi Hirokawa; Takuya Nakai; Michihiro Hayashi; Hidetoshi Eguchi; Shoji Kubo
    World journal of surgery 41 4 1082 - 1088 2017年04月 [査読有り]
     
    BACKGROUND AND OBJECTIVES: We determined the rates of initial lymph node metastasis following curative resection of mass-forming type-intrahepatic cholangiocarcinoma (ICC) in patients with and without hepatitis virus infection. METHODS: We enrolled 87 patients between January 2000 and December 2013 with ICC without preoperative lymph node metastasis and without lymph node dissection. Patients included 32 who were seropositive for hepatitis B or C virus (virus group) and 55 who had no evidence of hepatitis virus infection (nonvirus group). Postsurgical outcomes and initial recurrence of the groups were compared, and we identified the risk factors for lymph node metastasis as initial recurrence. RESULTS: Platelet counts and prothrombin activities were significantly lower in the virus group compared with those of the nonvirus group. The number of patients with chronic hepatitis or liver cirrhosis was significantly higher in the virus group compared with the nonvirus group as well as their respective rates of recurrence-free survival. One patient (3%) in the virus group and 14 patients (25%) in the nonvirus group had lymph node metastasis as initial recurrence (p = 0.007). Multivariate analysis revealed that the absence of hepatitis virus infection as an independent risk factor (p = 0.047). CONCLUSION: Hepatitis virus-associated mass-forming-type ICC confers a low risk of lymph node metastasis as initial postoperative recurrence.
  • 肥満若年男性から発生した肝細胞腺腫が悪性転化した1例
    幕谷 悠介; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 松本 逸平; 中居 卓也; 竹山 宜典
    日本外科学会定期学術集会抄録集 117回 RS - 4 (一社)日本外科学会 2017年04月 [査読有り]
  • Wing Yee Kwok; Satoru Hagiwara; Naoshi Nishida; Tomohiro Watanabe; Toshiharu Sakurai; Hiroshi Lda; Yasunori Minami; Masahiro Takita; Tomohiro Minami; Mina Lwanishi; Hirokazu Chishina; Masashi Kono; Kazuomi Ueshima; Yoriaki Komeda; Tadaaki Arizumi; Eisuke Enoki; Takuya Nakai; Tsutomu Kumabe; Osamu Nakashima; Fukuo Kondo; Masatoshi Kudo
    ONCOLOGY 92 Suppl 1 16 - 28 2017年 
    The patient was a 20-year-old male in whom a hepatic hyper vascular mass accompanied by intratumoral hemorrhage was detected on examination for epigastric pain. Based on the enlargement of the mass and diagnostic imaging, hepatocellular adenoma (HCA) was suspected and hepatectomy was performed. The lesion was diagnosed as malignant transformation of P-catenin-activated HCA. There are only few reports of cases with malignant transformation of HCA in Japan; it is necessary to accumulate cases to investigate it. (C) 2016 S. Karger AG, Basel
  • Shogo Tanaka; Masaki Kaibori; Masaki Ueno; Hiroshi Wada; Fumitoshi Hirokawa; Takuya Nakai; Hiroya Iida; Hidetoshi Eguchi; Michihiro Hayashi; Shoji Kubo
    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 20 12 2021 - 2034 2016年12月 [査読有り]
     
    BACKGROUND: While spontaneously ruptured hepatocellular carcinoma (HCC) has a poor prognosis, the true impact of a rupture on survival after hepatic resection is unclear. METHODS: Fifty-eight patients with ruptured HCC and 1922 with non-ruptured HCC underwent hepatic resection between 2000 and 2013. To correct the difference in the clinicopathological factors between the two groups, propensity score matching (PSM) was used at a 1:1 ratio, resulting in a comparison of 42 patients/group. We investigated outcomes in all patients with ruptured HCC and compared outcomes between the two matched groups. RESULTS: Of the 58 patients with ruptured HCC, 7 patients (13 %) died postoperatively. Overall survival (OS) rate at 5 years after hepatic resection was 37 %. Emergency hepatic resection was an independent risk factor for in-hospital death and Child-Pugh class B for unfavorable OS in multivariate analysis. Clinicopathological variables were well-balanced between the two groups after PSM. No significant differences were noted in incidence of in-hospital death (ruptured HCC 12 % vs non-ruptured HCC 2 %, p = 0.202) or OS rate (5/10-year; 42 %/38 % vs 67 %/30 %, p = 0.115). CONCLUSION: Emergency hepatic resection should be avoided for ruptured HCC in Child-Pugh class B patients. Rupture itself was not a risk for unfavorable surgical outcomes.
  • Masaki Kaibori; Hiroyuki Nitta; Michihiro Hayashi; Shigekazu Takemura; Hiroaki Nagano; Kosuke Matsui; Hisashi Ikoma; Takuya Nakai; Masafumi Yasunaga; Masahiro Kido; Takeshi Aoki; Toshiki Rikiyama; Keiji Sano; Atsushi Kudo; Satoshi Katagiri; Yuichiro Otsuka; Tamotsu Kuroki; Takeo Nomi; Koichi Yano; Itaru Endo; Masaki Ueno; Akishige Kanazawa; Hiroaki Terajima; Saiho Ko; Goro Honda; Yasuji Seyama; Hiroki Sunagawa; Tsukasa Aibara
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 23 11 697 - 702 2016年11月 [査読有り]
     
    BackgroundAmong young residents, there seems to be a decreasing desire to become surgeons, resulting in a decrease in the number of surgeons. There is concern regarding a shortage of hepatobiliary pancreatic (HBP) surgery residents in Japan. A questionnaire survey was designed to assess the work motivations of Japanese gastrointestinal (GI) and HBP surgeons. MethodsQuestionnaires assessing seven domains related to motivation (aptitude, satisfaction/dissatisfaction, knowledge/skill, evaluation/approval, self-management, community/expectation from other parties, and emotion) were sent to GI and HBP surgeons throughout Japan. Differences between HBP and GI surgeons were analyzed. ResultsResponses were received from 27 institutions in Japan between May and August 2014. Mid-career and senior HBP surgeons (11-20years after graduation) working in university hospitals were significantly less satisfied with their work than GI surgeons (P=0.036). Evaluation/approval factors were significantly lower in senior HBP surgeons than in GI surgeons 16-20years after graduation (P=0.048). ConclusionsThe future satisfaction of young residents seeking to become HBP surgeons should be enhanced, providing an appealing workplace for young residents and preventing discontinuation by mid-career and senior surgeons.
  • Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takuya Nakai; Yoshifumi Takeyama
    INTERNATIONAL SURGERY 101 11-12 550 - 553 2016年11月 [査読有り]
     
    Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.
  • 膵胆管合流異常症に合併した胆管内乳頭状腫瘍の1例
    幕谷 悠介; 松本 逸平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 中居 卓也; 竹山 宜典
    日本臨床外科学会雑誌 77 増刊 680 - 680 日本臨床外科学会 2016年10月 [査読有り]
  • Masaki Ueno; Takuya Nakai; Michihiro Hayashi; Fumitoshi Hirokawa; Hiroaki Nagano; Hiroshi Wada; Masaki Kaibori; Kosuke Matsui; Shogo Tanaka; Hiroki Yamaue; Shoji Kubo
    SURGERY 160 3 661 - 670 2016年09月 [査読有り]
     
    Background. Local recurrence is a specific problem after radiofrequency ablation of small hepatocellular carcinoma, and additional treatment is an important issue. We aimed to investigate the outcome of salvage hepatectomy in patients who develop local, recurrent hepatocellular carcinoma after treatment with radiofrequency ablation. Methods. From 2001-2013, we reviewed 58 patients from 6 university hospitals with local, recurrent hepatocellular carcinoma who underwent salvage hepatectomy after their initial radiofrequency ablation treatment. Pathologic characteristics and prognostic factors influencing overall survival were analyzed. Results. Noncurative resection, des-gamma carboxy prothrombin levels >40 mAU/mL, and multiple preceding treatments before salvage hepatectomy were negative prognostic factors for overall survival. The 5-year survivals for the prognostic factors were 0 %, 24 %, and 30%, respectively, after salvage hepatectomy, and 0%, 54%, and 54% after initial radiofrequency ablation treatment, respectively. As for the pathologic finding of local, recurrent hepatocellular carcinoma after radiofrequency ablation, vascular invasion was observed frequently in patients with increases in des-gamma carboxy prothrombin levels and with multiple preceding treatments before salvage hepatectomy with a frequency of 59% and 53 %, respectively (P < .01 and .05). Conclusion. Noncurative resection, increases in serum des-gamma carboxy prothrombin, and multiple preceding treatments were prognostic factors for subsequent salvage hepatectomy; nevertheless, survival outcomes were still acceptable when a curative salvage hepatectomy was performed. Increases in serum des-gamma carboxy prothrombin and multiple preceding treatments were positive predictors for pathologic vascular invasion. These factors should be taken into consideration when selecting treatment modalities for locally recurrent hepatocellular carcinoma following radiofrequency ablation. Repetition of unsuccessful, loco-regional treatment would appear to decrease the potential survival.
  • Ippei Matsumoto; Yoshifumi Takeyama; Keiko Kamei; Shumpei Satoi; Yasuyuki Nakata; Hajime Ishikawa; Takaaki Murase; Masataka Matsumoto; Takuya Nakai
    JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 223 2 E1 - E5 2016年08月 [査読有り]
  • 膵仮性嚢胞内出血を繰り返す血友病B併存患者に対し、安全に脾合併尾側膵切除と周術期管理を施行し得た1例
    村瀬 貴昭; 石川 原; 松本 正孝; 中多 靖幸; 亀井 敬子; 里井 俊平; 松本 逸平; 中居 卓也; 法里 慧; 井上 宏昭; 中尾 慎一; 竹山 宜典
    日本肝胆膵外科学会・学術集会プログラム・抄録集 28回 555 - 555 (一社)日本肝胆膵外科学会 2016年06月
  • 破裂肝癌の治療成績に関する多施設共同研究
    田中 肖吾; 飯田 洋也; 上野 昌樹; 和田 浩志; 廣川 文鋭; 中居 卓也; 林 道廣; 江口 英利; 海堀 昌樹; 久保 正二; 大阪肝臓外科臨床研究検討会
    日本肝胆膵外科学会・学術集会プログラム・抄録集 28回 577 - 577 (一社)日本肝胆膵外科学会 2016年06月
  • 松本逸平; 亀井敬子; 松本正孝; 村瀬貴昭; 中多靖幸; 里井俊平; 石川原; 廣峰義久; 庭野史丸; 川畑由美子; 中居卓也; 池上博司; 竹山宜典
    胆膵の病態生理 32 1 39 - 42 2016年06月
  • 膵液瘻低減を目指したバイクリルメッシュとマットレス縫合を用いた新しい尾側膵切除後膵断端処理法(第1報)
    松本 逸平; 村瀬 貴昭; 亀井 敬子; 中多 靖幸; 里井 俊平; 石川 原; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 48 Suppl.2 239 - 239 (一社)日本消化器外科学会 2015年10月
  • 準緊急手術を行った難治性膵性腹水の3例
    亀井 敬子; 松本 逸平; 村瀬 貴昭; 中多 靖幸; 里井 俊平; 石川 原; 中居 卓也; 竹山 宜典
    日本消化器外科学会雑誌 48 Suppl.2 273 - 273 (一社)日本消化器外科学会 2015年10月
  • Takuya Nakai; Hajime Ishikawa; Tadao Tokoro; Kiyotaka Okuno
    WORLD JOURNAL OF SURGERY 39 6 1527 - 1556 2015年06月 [査読有り]
     
    Hepatectomy is the most effective treatment for patients with colorectal liver metastasis (CRLM). However, the procedure is also associated with a high risk of recurrence, and adjuvant chemotherapy for postoperative recurrence remains controversial. We investigated the efficacy of adjuvant chemotherapy for CRLM with the clinical risk score (CRS) proposed by Fong et al. Patients with CRLM who were treated, without preoperative chemotherapy, between 1992 and 2012 were classified as having low CRS (score of 0-1), intermediate CRS (2-3), or high CRS (4-5). The efficacy of adjuvant chemotherapy was retrospectively analyzed for each CRS subgroup. Of the 161 patients who underwent hepatectomy, 100 received adjuvant chemotherapy (group A) and 61 did not (group N). For intermediate CRS, 5-year disease free survival (DFS) was significant different between the groups (group A: n = 61; 33.9 % vs. group N: n = 39; 23.2 %, P = 0.008) and 5-year overall survival (OS) of group A was higher than group N (53.5 vs. 36.5 %, P = 0.048), respectively. For both low CRS and high CRS, 5-year DFS and OS were similar between the groups. Multivariate analysis of DFS identified prognostic factors as major resection for low CRS (P = 0.02) and adjuvant chemotherapy for intermediate CRS (P = 0.015). Similarly, multivariate analysis of OS identified major resection for low CRS (P = 0.05) and adjuvant chemotherapy for intermediate CRS (P = 0.05). High CRS was not identified prognostic factor. Adjuvant chemotherapy for CRLM was effective in intermediate CRS patients. In low CRS patients, adjuvant chemotherapy may not be necessary, but adequate surgical resection is important.
  • Akihiro Kogita; Yasumasa Yoshioka; Kazuko Sakai; Yosuke Togashi; Shunsuke Sogabe; Takuya Nakai; Kiyotaka Okuno; Kazuto Nishio
    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS 458 1 52 - 56 2015年02月 [査読有り]
     
    Intra- and inter-tumor heterogeneity may hinder personalized molecular-target treatment that depends on the somatic mutation profiles. We performed mutation profiling of formalin-fixed paraffin embedded tumors of multi-regional colon cancer and characterized the consequences of intra- and inter-tumor heterogeneity and metastasis using targeted re-sequencing. We performed targeted re-sequencing on multiple spatially separated samples obtained from multi-regional primary colon carcinoma and associated metastatic sites in two patients using nextgeneration sequencing. In Patient 1 with four primary tumors (P1-1, P1-2, P1-3, and P1-4) and one liver metastasis (H1), mutually exclusive pattern of mutations was observed in four primary tumors. Mutations in primary tumors were identified in three regions; KARS (G13D) and APC (R876*) in P1-2, TP53 (A161S) in P1-3, and KRAS (G12D), PIK3CA (Q546R), and ERBB4 (T272A) in P1-4. Similar combinatorial mutations were observed between P1-4 and H1. The ERBB4 (T272A) mutation observed in P1-4, however, disappeared in H1. In Patient 2 with two primary tumors (P2-1 and P2-2) and one liver metastasis (H2), mutually exclusive pattern of mutations were observed in two primary tumors. We identified mutations; KRAS (G12V), SMAD4 (N129K, R445*, and G508D), TP53 (R175H), and FGFR3 (R805W) in P2-1, and NRAS (Q61K) and FBXW7 (R425C) in P2-2. Similar combinatorial mutations were observed between P2-1 and H2. The SMAD4 (N129K and G508D) mutations observed in P2-1, however, were nor detected in H2. These results suggested that different clones existed in primary tumors and metastatic tumor in Patient 1 and 2 likely originated from P1-4 and P2-1, respectively. In conclusion, we detected the muti-clonalities between intra- and inter-tumors based on mutational profiling in multi-regional colon cancer using next-generation sequencing. Primary region from which metastasis originated could be speculated by mutation profile. Characterization of inter- and inter-tumor heterogeneity can lead to underestimation of the tumor genomics landscape and treatment strategy of personal medicine. (C) 2015 Published by Elsevier Inc.
  • Masaki Kaibori; Junzo Shimizu; Michihiro Hayashi; Takuya Nakai; Morihiko Ishizaki; Kosuke Matsui; Yong Kook Kim; Fumitoshi Hirokawa; Yasuyuki Nakata; Takehiro Noda; Keizo Dono; Akinori Nozawa; Masanori Kwon; Kazuhisa Uchiyama; Shoji Kubo
    Surgery (United States) 157 1 37 - 44 2015年01月 [査読有り]
     
    Background Postoperative bile leakage can be a serious complication after hepatic resection. Few studies have analyzed patients according to the time of onset of bile leakage. We analyzed differences between patients with early- and late-onset bile leakage after hepatic resection and assessed clinical characteristics and outcomes in patients with late-onset leakage. Methods Between 2008 and 2010, 1,009 patients underwent hepatic resection at 4 participating university hospitals and 2 community hospitals. Fifty-two patients (5.1%) with postoperative bile leakage were divided into an early-onset group (< 2 weeks after surgery, n = 34) and a late-onset group (≥2 weeks after surgery, n = 18). Patient characteristics and outcomes were collected prospectively and analyzed retrospectively. Results The proportion of patients who underwent intra-abdominal placement of a drainage catheter was significantly less in the late-onset group than the early-onset group. All 18 patients in the late-onset group developed intra-abdominal infection, and 2 died of sepsis. The proportion of patients who underwent invasive treatment (abdominal paracentesis, endoscopic biliary drainage, or second hepatic resection) was significantly greater in the late-onset group than in the early-onset group. The time to resolution of bile leakage was significantly greater in the late-onset group than the early-onset group. Conclusion Patients should be monitored carefully for bile leakage for several weeks after hepatic resection, because late-onset bile leakage can cause serious complications. Intra-abdominal infection should also be treated as soon as possible, because it may induce refractory bile leakage with serious complications.
  • Fumitoshi Hirokawa; Shoji Kubo; Hiroaki Nagano; Takuya Nakai; Masaki Kaibori; Michihiro Hayashi; Shigekazu Takemura; Hiroshi Wada; Yasuyuki Nakata; Kosuke Matsui; Morihiko Ishizaki; Kazuhisa Uchiyama
    SURGERY 157 1 27 - 36 2015年01月 [査読有り]
     
    Background. The benefits of anatomic resection in patients with small (<5 cm), solitary hepatocellular carcinomas remain unclear. Outcomes were therefore evaluated in patients who underwent anatomic resection or nonanatomic resection of small solitary hepatocellular carcinomas. Methods. Factors affecting overall survival and disease-free survival were investigated in 330 patients who underwent curative hepatectomy for solitary (<= 5 cm) hepatocellular carcinomas without macroscopic vascular invasion. In addition, a propensity score matching model with 330 patients was constructed to overcome bias, with subgroups analyzed by tumor diameter (<3 cm and 3-5 cm). Results. ICG-R15 >= 25% was confirmed as being independently associated with poorer overall survival and disease-free survival. One-to-one matching of preoperative characteristics yielded 72 pairs of patients receiving anatomic resection and nonanatomic resection, with long-term outcomes, including overall survival and disease-free survival, being similar in these 2 groups. Subgroup analysis showed that, in patients with tumors <3 cm in diameter, short-term outcomes were better in the nonanatomic resection group than in the anatomic resection group, including significantly reduced operation time (P = 02), blood loss (P = .01), blood transfusion (P < .01), complications (particularly bile leakage and abdominal abscess) (P = .04), and postoperative hospital stay (P < .01). Conclusion. Anatomic resection was not superior to nonanatomic resection in survival outcomes in patients with solitary small hepatocellular carcinomas without macroscopic vascular invasion. Rather, postoperative short-term outcomes were more favorable with nonanatomic resection.
  • Masaki Kaibori; Shoji Kubo; Hiroaki Nagano; Michihiro Hayashi; Takuya Nakai; Ishizaki Morihiko; Kosuke Matsui; Takahiro Uenishi; Shigekazu Takemura; Hiroshi Wada; Marubashi Shigeru; Koji Komeda; Fumitoshi Hirokawa; Yasuyuki Nakata; Kazuhisa Uchiyama; Masanori Kwon
    HEPATO-GASTROENTEROLOGY 61 135 2028 - 2034 2014年10月 [査読有り]
     
    Aims: We performed a retrospective analysis to evaluate the short and long-term impact of simultaneous prophylactic cholecystectomy with hepatectomy in these patients. Methods: We identified 642 patients who Underwent curative hepatocellular carcinoma resecion between 2001 and 2005 at five university hospitals. One hundred and twenty-five hepatocellular carcinoma patients who received left lateral sectionectomy or partial resection in the left lateral and Spiegel lobes were identified and followed. They were divided into two groups, 74 with and 51 without simultaneous cholecysItectomy. None of these patients had gallbladder stones or polyps at preoperative diagnosis. Results: Although not statistically significant, the operating time was longer and blood loss was greater in the cholecystectomy group. Patients in the cholecystectomy group had a significantly higher postoperative morbidity rate. Surgical; complications according to the Clavien classification; differed significantly between the two groups. Variables. significantly associated with complications in the unit variate and multivariate analyses were simultaneous cholecystectomy and operative blood loss >=. 1000 ml. Conclusion: Simultaneous cholecystectomy of the as, ymptomatic gallbladder with curative resection of he patocellular carcinoma in the left lateral section or Spielgel lobe resulted in higher postoperative complications Consequently, the gallbladder should be preserved except in cases of gallbladder stones or polyps.
  • Koji Komeda; Michihiro Hayashi; Shoji Kubo; Hiroaki Nagano; Takuya Nakai; Masaki Kaibori; Hiroshi Wada; Shigekazu Takemura; Masahiko Kinoshita; Chikato Koga; Masataka Matsumoto; Tatsuma Sakaguchi; Yoshihiro Inoue; Fumitoshi Hirokawa; A-Hon Kwon; Kazuhisa Uchiyama
    World journal of surgery 38 10 2692 - 7 2014年10月 
    BACKGROUND: Although several studies have reported the outcomes of surgery for the treatment of liver metastases of gastric cancer (GLM), indications for liver resection for gastric metastases remain controversial. This study was designed to identify prognostic determinants that identify operable hepatic metastases from gastric cancer and to evaluate the actual targets of surgical therapy. METHODS: Retrospective analysis was performed on outcomes for 24 consecutive patients at five institutions who underwent gastrectomy for gastric cancer followed by curative hepatectomy for GLM between 2000 and June 2012. RESULTS: Overall 5-year survival and median survival were 40.1 % and 22.3 months, respectively. Uni- and multivariate analyses showed that liver metastatic tumour size less than 5 cm was the most important predictor of overall survival (OS, p = 0.03). Four patients survived >5 years. Repeat hepatectomy was performed in three patients. Two of these patients have remained disease-free since the repeat hepatectomy. CONCLUSIONS: GLM patients with metastatic tumour diameter less than 5 cm maximum are the best candidates for hepatectomy. Hepatic resection should be considered as an option for gastric cancer patients with liver metastases.
  • Naoshi Nishida; Takafumi Nishimura; Takuya Nakai; Hirokazu Chishina; Tadaaki Arizumi; Masahiro Takita; Satoshi Kitai; Norihisa Yada; Satoru Hagiwara; Tatsuo Inoue; Yasunori Minami; Kazuomi Ueshima; Toshiharu Sakurai; Masatoshi Kudo
    DIGESTIVE DISEASES 32 6 658 - 663 2014年 [査読有り]
     
    Objective: To clarify the progression pattern of abnormal DNA methylation during the development of hepatocellular carcinoma (HCC) using a comprehensive methylation assay. Methods: We used an Infinium HumanMethylation450 BeadChip array that can analyze >485,000 CpG sites distributed throughout the genome for a comprehensive methylation study of 117 liver tissues consisting of 59 HCC and 58 noncancerous livers. Altered DNA nnethylation patterns during tumor progression were also analyzed. Results: We identified 38,330 CpG sites with significant differences in methylation levels between HCCs and noncancerous livers (DM-CpGs) using strict criteria. Of the DM-CpGs, 92% were hypomethylated and only 3,051 CpGs (8%) were hypermethylated in HCC. The DM-CpGs were more prevalent within intergenic regions with isolated CpGs. In contrast, DM-CpGs that were hypermethylated in HCC were predominantly located within promoter regions and CpG islands (p < 0.0001). The association between methylation profiles of DM-CpGs and tumor size was statistically significant, especially in hepatitis C virus (HCV)-positive cases (p = 0.0001). Conclusions: We clarified the unique characteristics of DM-CpGs in human HCCs. The stepwise progression of alterations in DNA methylation was a common feature of HCV-related hepatocarcinogenesis. (C) 2014 S. Karger AG, Basel
  • 大学病院における周術期肺血栓塞栓症のリスクマネジメント
    保田 知生; 岩間 密; 武本 智樹; 村瀬 貴昭; 松本 正孝; 加藤 寛章; 中多 靖幸; 亀井 敬子; 石川 原; 杉浦 史哲; 中居 卓也; 安田 卓司; 光冨 徹哉; 竹山 宜典; 奥野 清隆
    日本臨床外科学会雑誌 74 増刊 308 - 308 日本臨床外科学会 2013年10月
  • Takuya Nakai; Kiyotaka Okuno; Hiroshi Kitaguchi; Hajime Ishikawa; Mitsuo Yamasaki
    World Journal of Surgery 37 8 1919 - 1926 2013年08月 [査読有り]
     
    Background: Hepatic arterial infusion (HAI) or systemic chemotherapy has been used to treat unresectable colorectal liver metastases. The prognosis of the disease in recent years has been improved because chemotherapy is performed before hepatectomy to reduce tumor size (conversion therapy). The purpose of this study was to investigate the safety and efficacy of conversion therapy following HAI immunochemotherapy. Methods: Hepatic arterial infusion of 5-fluorouracil (5-FU)/polyethylene glycol (PEG)-IFNα-2a was performed in 21 patients. The primary endpoint was the safety of HAI and hepatectomy. The secondary endpoints were response rate, rate of conversion to hepatectomy, survival rate, and prognostic factors. Results: With regard to side effects, drugs were discontinued temporarily in one patient because of a decrease in white blood cell count however, other patients continued chemotherapy. The response rate with HAI was 61.9 %, and the conversion rate was 38.1 %. Hepatectomy was completed successfully without mortality. Median progression-free survival (PFS) was 11.5 months (with and without conversion, 16.7 and 4.8 months, respectively p = 0.021). Median overall survival was 34.6 months (with and without conversion, 48.4 and 26.6 months, respectively p = 0.003). Prognosis was poor when the number of metastatic tumors was ≥10 [PFS: hazard ratio (HR) 32.21, p = 0.003 overall survival (OS): HR 9.13, p = 0.07], but prognosis improved after hepatectomy (OS: HR 0.08, p = 0.09). Conclusions: Hepatic arterial infusion immunochemotherapy with 5-FU/PEG-IFNα-2a was performed safely without major side effects. Prognosis is expected to improve after successful conversion to hepatectomy. © 2013 Société Internationale de Chirurgie.
  • 大本 俊介; 北野 雅之; 工藤 正俊; 中居 卓也; 竹山 宜典
    胆道 27 3 600 - 600 日本胆道学会 2013年08月
  • 【肝疾患の病態に及ぼす血小板の意義】 肝細胞癌術後長期無再発生存のための術前および術後血小板数維持の意義
    海堀 昌樹; 松井 康輔; 石崎 守彦; 權 雅憲; 上西 崇弘; 竹村 茂一; 久保 正二; 和田 浩志; 丸橋 繁; 永野 浩昭; 米田 浩二; 廣川 文鋭; 林 道廣; 内山 和久; 中多 靖幸; 土師 誠二; 中居 卓也
    消化器内科 57 2 196 - 202 (有)科学評論社 2013年08月 
    肝細胞癌術後長期無再発生存のための術前および術後血小板数維持について検討した。肝癌根治切除および退院後外来での追跡可能940例を対象とした。32例が入院死となり、肝癌術後10年無再発経過症例は74例であった。術前血小板数は、有意に無再発群が高値であった。術後10年時血小板数も有意に無再発群が高値であった。術後10年時の血清type IV collagen 7S値は無再発群で有意に低値を示した、再発群は術後10年時の血清AFP値が有意に高値であった。再発群では手術後10年間に50%が静脈瘤増悪、無再発群は5%のみに増悪を認めた。無再発群においては60例中2例が他病死であった。再発群14例の無再発期間中央値および平均無再発期間はそれぞれ11.0年および11.6年であった。10年間無再発以降の再発に対する独立予後因子は、術前血清アルブミン値4.0g/dl以下および血小板数15万以下であった。
  • Masaki Kaibori; Shoji Kubo; Hiroaki Nagano; Michihiro Hayashi; Seiji Haji; Takuya Nakai; Morihiko Ishizaki; Kosuke Matsui; Takahiro Uenishi; Shigekazu Takemura; Hiroshi Wada; Shigeru Marubashi; Koji Komeda; Fumitoshi Hirokawa; Yasuyuki Nakata; Kazuhisa Uchiyama; A-Hon Kwon
    WORLD JOURNAL OF SURGERY 37 4 820 - 828 2013年04月 [査読有り]
     
    Background The present study aimed to clarify the clinicopathologic features of long-term disease-fee survival after resection of hepatocellular carcinoma (HCC). Methods This retrospective study identified 940 patients who underwent curative resection of HCC between 1991 and 2000 at five university hospitals. Seventy-four patients with 10 years of recurrence-free survival were identified and followed up. They were divided into two groups, 60 recurrence-free and 14 with recurrence after a 10-year recurrence-free period. Results Overall survival rates of recurrence and non-recurrence groups were 68 and 91 % at 16 years, and 34 and 91 % at 20 years (p = 0.02), respectively. There were five (36 %), and two deaths (3 %), respectively, after 10 recurrence-free years. A second resection for recurrence was performed in four patients (29 %), and mean survival was 15.3 years after the first hepatectomy. Although three patients in the non-recurrence group (5 %) developed esophageal and/or gastric varices, seven patients in the recurrence group (50 %) developed varices during 10 years (p < 0.0001). In multivariate analysis, preoperative and 10-year platelet count was identified as a favorable independent factor for maintained recurrence-free survival after a 10-year recurrence-free period following curative hepatic resection of HCC. Conclusions Recurrence of HCC may occur even after a 10-year recurrence-free period. Long-term follow-up after resection of HCC is important, and should be life-long. Patients with higher preoperative and 10-year platelet counts are more likely to have long-term survival after resection. A low platelet count, related to the degree of liver fibrosis, is a risk factor for recurrence and survival of HCC after curative resection.
  • Keiko Kamei; Takeo Yasuda; Shumpei Satoi; Hajime Ishikawa; Hiroki Sakamoto; Masayuki Kitano; Takaaki Chikugo; Takuya Nakai; Yoshifumi Takeyama
    Clinical journal of gastroenterology 6 2 156 - 9 2013年04月 
    Cystic lesions of the pancreas are sometimes difficult to diagnose. We report a case of a gastric duplication cyst (GDC) of the pancreas in an adult. A 45-year-old woman was admitted to our department for the investigation of anemia. Abdominal ultrasonography revealed a large cystic lesion, measuring about 40 × 70 mm with calcification in the tail of the pancreas. Contrast-enhanced computed tomography of the abdomen revealed a non-enhanced cystic lesion with non-enhanced wall. Endoscopic retrograde pancreatography revealed a mild extended main pancreatic duct and an aberrant pancreatic duct, but there was no communication with the cyst. We could not deny the malignancy, so distal pancreatectomy was performed. The pathological examination revealed that the inner wall of the cyst consisted of columnar epithelium and smooth muscle layer. Immunohistochemical analysis revealed the columnar epithelium to be immunopositive for cytokeratin 7 (CK7) and immunonegative for cytokeratin 20 (CK20) and the glands to be immunonegative for CK 7 and immunopositive for CK 20. Therefore, a diagnosis of GDC of the pancreas was made. On imaging, a GDC usually mimics a pancreatic pseudocyst or a cystic neoplasm of the pancreas. Therefore, even though it is rare, a GDC should be considered in the differential diagnosis of cystic tumors of the pancreas.
  • Takeo Yasuda; Keiko Kamei; Mariko Araki; Yasuyuki Nakata; Hajime Ishikawa; Mitsuo Yamazaki; Hiroki Sakamoto; Masayuki Kitano; Takuya Nakai; Yoshifumi Takeyama
    Case reports in gastroenterology 7 2 322 - 6 2013年 
    A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He was pointed out to have alcoholic chronic pancreatitis. Laboratory data showed inflammation and slightly elevated serum direct bilirubin and amylase. An abdominal computed tomography demonstrated huge fluid collection, multiple pancreatic pseudocysts and pancreatic calcification. The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, endoscopic pancreatic stent insertion was attempted but was unsuccessful, so surgical treatment (Frey procedure and cystojejunostomy) was performed. During the operation, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum), but no ascites was found. His postoperative course was uneventful and he shows no recurrence of the fluid. Pancreatic ascites is thought to result from the disruption of the main pancreatic duct, the rupture of a pancreatic pseudocyst, or possibly leakage from an unknown site. In our extremely rare case, the pancreatic pseudocyst penetrated into the hepatoduodenal ligament with communication to the common bile duct, and the fluid flowed into the round ligament of the liver and next into the extraperitoneal space.
  • Keiko Kamei; Takeo Yasuda; Takuya Nakai; Yoshifumi Takeyama
    Case reports in gastroenterology 7 3 433 - 7 2013年 
    We report a rare case of adenocarcinoma of the duodenum arising from Brunner's gland. A 70-year-old man with a history of hypertension was referred to us with the complaint of abdominal discomfort. Upper gastrointestinal endoscopy revealed an irregular elevated mucosa and a submucosal tumor with delle in the duodenal bulb. Biopsy specimens revealed adenocarcinoma (the former) and hyperplasia (the latter). We could not agree with the patient about performing pancreaticoduodenectomy, so under the diagnosis of primary duodenal carcinoma, we performed resection of the bulbus and the antrum. Pathological examination showed that one of the tumors was consistent with normal Brunner's glands, Brunner's gland hyperplasia and adenocarcinoma arising from Brunner's glands. The patient's postoperative course was good, but 15 months after, he developed lymph node recurrence at the site of the pancreas head. Under the diagnosis of lymph node metastasis of duodenal cancer, we performed pancreaticoduodenectomy this time. Pathological examination confirmed our preoperative diagnosis. The patient remained well after the surgery for 2 years.
  • Yasuyuki Nakata; Seiji Haji; Hajime Ishikawa; Takeo Yasuda; Takuya Nakai; Yoshihumi Takeyama; Hitoshi Shiozaki
    SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES 20 6 E189 - E192 2010年12月 [査読有り]
     
    Radiofrequency ablation (RFA) is a commonly used local therapy for hepatocellular carcinoma (HCC). However, for tumors located adjacent to the Glisson's capsule in the hepatic hilar region, RFA may cause bile duct injury and may be difficult to perform using the standard procedure. We describe 2 HCC cases in which RFA was performed laparoscopically under general anesthesia while cooling bile ducts to prevent bile duct injury. An endoscopic nasobiliary drainage tube was preoperatively inserted, through which chilled saline was rapidly infused during laparoscopic RFA for HCC adjacent to the Glisson's capsule in the hepatic hilar region. The patient was discharged from hospital without intraoperative or postoperative complications. Follow-up contrast-enhanced CT revealed complete tumor cauterization and no evidence of late bile duct stenosis. This procedure is performed under general anesthesia and, unlike those performed under local anesthesia, is associated with minimal stress to patients and minimal risk of bile duct injury.
  • Hiroshi Kitaguchi; Takuya Nakai; Takehito Yoshifuji; Kazuki Ueda; Tadao Tokoro; Jinichi Hida; Kiyotaka Okuno
    Japanese Journal of Cancer and Chemotherapy 37 2 339 - 342 2010年 [査読有り]
     
    The patient was a 55-year-old female who had multiple liver metastases of rectal cancer. This patient underwent hepatic arterial infusion chemotherapy after low anterior resection for rectal cancer. Hepatic arterial infusion was discontinued due to severe diarrhea, and the administration of UFT (300 mg/day) and LV (75 mg/day) was then begun. The carcinoembryonic antigen (CEA) level was normalized immediately after the start of this administration. One year later, liver metastases disappeared on computed tomography (CT) and a complete response (CR) was achieved. No adverse events were noted, and CR was maintained for 2 years. This therapy can serve as one of the chemotherapies for advanced colorectal cancer.
  • Motohiro Imano; Takao Satou; Tatsuki Itoh; Yoshifumi Takeyama; Atsushi Yasuda; Ying-Feng Peng; Masayuki Shinkai; Seiji Haji; Chikao Yasuda; Takuya Nakai; Takushi Yasuda; Haruhiko Imamoto; Kiyotaka Okuno; Hitoshi Shiozaki; Harumasa Ohyanagi
    AMERICAN SURGEON 76 1 91 - 95 2010年01月 [査読有り]
     
    Mucin glycoproteins from the gallbladder epithelium are thought to contribute to the matrix or nucleus of gallstones and other biomineralization systems. The involved acidic glycoproteins have been reported in bile and gallstones. In addition, osteopontin (Opn) is a noncollagenous acidic bone matrix glycoprotein that possesses calcium-binding properties. To investigate the role of Opn in pigment gallstone formation, the involvement of Opn in pigment gallstone formation was studied immunohistochemically in the gallbladder wall and in the stones. Staining for Opn was strongly positive in the epithelium of stone-laden gallbladders and in their stones. The stone-laden gallbladders were infiltrated by macrophages, which intensely stained for Opn. Sections of the pigment stones, under low magnification, showed a lamellar pattern of Opn immunolabeling and showed a reticular pattern under high magnification. Our results indicate that Opn, an acidic glycoprotein from the gallbladder epithelium, seems to be involved in lithiasis. Opn from macrophages and/or the epithelium seems to help form the matrix protein.
  • Hajime Ishikawa; Takuya Nakai; Kazuki Ueda; Seiji Haji; Yoshifumi Takeyama; Harumasa Ohyanagi
    Surgical laparoscopy, endoscopy & percutaneous techniques 19 5 e221-4  2009年10月 
    Epidermoid cysts are the most common type of cutaneous cyst. However, their occurrence in the deep abdominal wall has not yet been reported. Here, we present the case of a 60-year-old woman who developed an epidermoid cyst in the deep abdominal wall, which was resected laparoscopically. The patient presented with right upper quadrant abdominal pain on admission to our hospital. Computed tomography revealed cholecystolithiasis and an incidentally identified well-defined hypoattenuating mass (62 x 47 x 65 mm) in the deep abdominal wall on the left side of the navel. We performed laparoscopic complete resection of the abdominal wall tumor followed by cholecystectomy. The excised specimen was a cyst covered with a smooth thin membrane and contained sludge. Histopathologic examination revealed an epidermoid cyst. This is a very rare case with no previous reports on a similar type of epidermoid cyst.
  • Yasunori Minami; Toshihiko Kawasaki; Masatoshi Kudo; Seiji Haji; Osamu Shiraishi; Takashi Kawabe; Chikao Yasuda; Takuya Nakai; Yoshihumi Takeyama; Hitoshi Shiozaki
    HEPATO-GASTROENTEROLOGY 54 80 2358 - 2360 2007年12月 [査読有り]
     
    Background/Aims: Patients with hepatic malignancies are often poor candidates for resection because of the lack of hepatic reserve as a result of coexisting cirrhosis or the presence of multiple tumors. The purpose of this study was to determine the safety and efficacy of open intraoperative radiofrequency ablation of unresectable hepatic malignancies with size larger than 4cm in diameter and/or more than three in number. Methodology: Between May 2000 and September 2003, 30 patients (24 men, 6 women; age range, 5972 years; mean age, 63 years) with 51 hepatic malignancies. The maximal diameter of all tumors ranged from 1.0 to 10cm (mean +/- SD, 3.2 +/- 1.8). Results: All tumors achieved necrosis completely in a. single session. The mean follow-up from the initial ablation in this study was 18.9 +/- 10.1 months (range, 0-41). The 1-, 2 and 3-year overall survival rates were 86.1%, 71.6% and 71.6%, respectively. The 1-, 2 and 3-year disease-free survival rates were 70.9%, 37.6% and 25.1%, respectively. Conclusions: Open radiofrequency ablation is a safety and efficient approach for hepatic malignancies sized more than 4cm in diameter and/or located more than three in number.
  • Takuya Nakai; Takashi Kawabe; Osamu Shiraishi; Kiyotaka Okuno; Hitoshi Shiozaki
    HEPATO-GASTROENTEROLOGY 53 72 947 - 949 2006年11月 [査読有り]
     
    Background/Aims: The incidence of delayed gastric emptying after pylorus-preserving pancreatico-duodenectomy has been reported to be 30% to 70%. Methodology: Between January 1996 and December 2002, 43 patients underwent pylorus-preserving pancreaticoduodenectomy, involving pylorotomy, in the First Department of Surgery, Kinki University School of Medicine. The first step in pylorotomy is to cut the duodenal stump obliquely. The next is incision of the pyloric sphincter along its inferior aspect. The incidences of postoperative complications and changes in body weight were collated retrospectively. Results: Delayed gastric emptying was observed in 4 patients (9.3%). However, this complication did not last more than 1 month in any patients. Two patients (4.7%) developed reflux esophagitis 1 month after surgery, but this complication had resolved by 6 months. Weight gain was noted beginning 3 months after surgery. Conclusions: Pylorus-preserving pancreaticoduodenectomy involving pylorotomy may reduce the incidence of delayed gastric emptying and preserve the long-term quality of life more than similar procedures.
  • Takuya Nakai; Osamu Shiraishi; Takashi Kawabe; Hideo Ota; Hiroaki Nagano; Hitoshi Shiozaki
    WORLD JOURNAL OF SURGERY 30 7 1338 - 1343 2006年07月 [査読有り]
     
    Introduction: The etiologic and prognostic factors for non-B, non-C hepatocellular carcinoma (HCC), which is defined by its seronegativity for both hepatitis B surface antigen and hepatitis C virus (HCV) antibody, remain unclear. Methods: Nonneoplastic liver tissue from 46 patients with non-B, non-C HCC were examined for hepatitis B virus (HBV) DNA and HCV RNA using in situ hybridization. Recurrence-free survival rates were compared between patients showing high or low HBV DNA expression. Other potential prognostic factors were examined as well. Results: HBV DNA was detected in nonneoplastic liver specimens from 35 patents (76.1%), whereas HCV RNA was not detected in any case. In patents with high HBV DNA group expression, recurrence-free survival rates at 1 and 5 years after onset were 68.8% and 13.8%, respectively; those with low expression had higher rates of 89.2% and 59.2%, respectively. Multivariate analysis identified high tumor stage (P = 0.042) and high HBV DNA expression (p = 0.014) as independent negative prognostic factors. Conclusions: In many patients with non-B, non-C HCC, HBV DNA in the liver appears to be involved in the carcinogenesis, with intense HBV DNA expression predicting poor outcome for patients with these cancers.
  • 大腸癌肝転移の治療戦略
    中居 卓也; 奥野 清隆
    消化器科 42 6 572 - 577 科学評論社 2006年06月 
    大腸癌肝転移、特に両葉多発肝転移治療に従来であれば肝切除不可能で肝動注化学療法が適応とされる症例に、肝切除にRFAを併用させたり、肝動注後腫瘍が縮小し肝切除可能となれば切除し、その両者の予後は3年生存率30%以上に改善した。RFAの局所制御能は肝細胞癌と同じで3cm以下の腫瘍が適応とされた。
  • 肥田 仁一; 奥野 清隆; 吉藤 竹仁; 松崎 智彦; 服部 高史; 上田 和毅; 石丸 英三郎; 中居 卓也; 所 忠男; 塩﨑 均
    日本外科系連合学会誌 31 1 48 - 53 2006年02月 
    サイクロスポリン(CS)持続静注療法は大腸全摘回避のために選択されるがPneumocystis carinii (PC)肺炎が4例報告されている。ステロイド抵抗性潰瘍性大腸炎に大腸全摘か、CSで手術を回避すべきかは論点であるが、CSに反応せず大腸全摘となる時はPC肺炎発生を認識すべし。
  • 経皮経肝的嚢胞ドレナージが奏功した膵性胸水を伴う縦隔内仮性膵嚢胞の一例
    城田 哲哉; 大柳 治正; 竹山 宜典; 川邊 高史; 保田 知生; 土師 誠二; 中居 卓也; 塩﨑 均
    膵臓 20 3 323 - 323 2005年06月
  • 南 康範; 鄭 浩柄; 畑中 絹代; 井上 達夫; 坂口 康浩; 萩原 智; 上嶋 一臣; 福永 豊和; 工藤 正俊; 土師 誠二; 中居 卓也; 大柳 治正
    胆と膵 26 3 279 - 283 医学図書出版(株) 2005年03月 
    ラジオ波焼灼術(RFA)は高い局所制御能から肝細胞癌の局所治療として用いられており,外科治療と共に根治性の高い治療法として位置づけられている.しかし,全ての肝細胞癌がRFAで治療可能である訳ではない.肝細胞癌治療には外科切除,RFA,経カテーテル的治療など複数の選択肢があり,治療法選択には病期や肝予備能に基づいて内科・外科・放射線科など各科を横断したトータル・マネージメントが必要である.基本的に内科より外科治療が考慮される症例として, 1)外科治療の根治性がより高い場合, 2)経皮的RFAが困難な場合, 3)合併症が危惧される場合が挙げられるが,臨床の場で大切なことは内科と外科との意見交換からコンセンサスを築くことである(著者抄録)
  • 肝切除時、胆汁漏の予防
    中居 卓也; 川邊 高史; 白石 治; 塩﨑 均
    Hepato-Gastroenterology 51 1286 - 1288 2004年08月 
    肝切除の合併症である胆汁漏を予防するため胆道ドレナージを用いたが、発生率に変化はないが入院期間は短縮された。
  • 中居 卓也; 康 謙三; 川邊 高史; 白石 治; 奥野 清隆; 安富 正幸
    World Journal of Surgery 26 6 700 - 703 2002年06月 
    HBc抗体陽性肝癌の臨床的特徴は、腫瘍径が大きい進行例を認めるが5cm以下であれば比較的予後は良好であり、HBc抗体のスクリーニングを含めた早期発見が予後改善に繋がると考える。
  • 奥野 清隆
    J. Am. Coll. Surg. 189 300 - 304 1999年 [査読有り]
  • 高度手術侵襲後の臓器障害に係わるparameter変化とUlinastatin投与効果
    中居 卓也; 川辺 高史; 黒田 幸作; 香山 仁志; 重岡 宏典; 田中 晃; 康 謙三; 奥野 清隆; 安富 正幸
    臨牀と研究 75 8 1868 - 1872 大道学館出版部 1998年08月 
    手術侵襲後のSIRS状態や,MODの発症にはIL-8によるPMNEの放出が強く係わり,臓器障害の発生予防にはUlinastatin投与は重要と考えられた
  • 川辺高史; 中居卓也; 進藤勝久; 安富正幸
    Microsurgery 18 5 344 - 347 1998年 [査読有り]
     
    A venous cuff technique was applied only for venous drainage in orthotopic small bowel transplantation of rats. Rates of technical failure (death within 4 days) and in clinical signs were compared between the groups with (group A) and without (group B) venous cuff technique. Technical failures with and without venous cuff technique were 5% and 25%, respectively. Mean survival days, excluding deaths from technical failure, were 9.2 +/- 2.3 in group A and 8.1 +/- 2.6 days in group B. No significant differences were observed in mean survival days or in weight loss between the two groups. Acute rejection was the cause of death in both groups. Since the model with venous cuff technique showed low mortality, it could be widely employed in small bowel transplantation studies. (C) 1998 Wiley-Liss, Inc.
  • ラットにおける完全同種小腸移植後の拒絶反応および移植片対宿主病におけるNK細胞およびCTL活性(英語）
    川辺高史; 中居卓也; 奥野清隆; 進藤勝久ら
    Acta Med Kinki Univ 23 1,2 23 - 29 1998年 [査読有り]

MISC

共同研究・競争的資金等の研究課題

  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2011年 -2013年 
    代表者 : 石川 原; 奥野 清隆; 竹山 宜典; 中居 卓也
     
    ゲノム解析により発見された肝癌において発現している新規癌抗原（WDRPUH, FOXM1, MELK,HJURP)由来HLA-A2402拘束性エピトープペプチドとアジュバントを混合した癌ワクチン療法を行った。五人に施行し、一人に腫瘍縮小効果を認め、一人にSDと癌の進行が制御された。一人に食道静脈瘤からと思われる出血grade2を認めたが、ワクチンの効果による出血ではないと判断した。また、皮膚の硬結も認めた。grade２を超える有害事象は認めなかった。
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 1999年 -2001年 
    代表者 : 中居 卓也; 川辺 高史; 奥野 清隆; 安富 正幸
     
    最近では免疫学的アプローチから肝再生機構が研究され、肝切除後モデルにおいて再生の初期には自己障害性リンパ球が出現しMHCclassI及びH抗原の発現が増強、肝内でもCD8陽性細胞(CTL)浸潤が証明されていた。われわれが行った小腸移植研究において、小腸移植モデルは経門脈性にgraftの抗原提示細胞が肝内に移行され、拒絶反応が示される面で、肝再生の環境と近似し、肝と小腸の免疫学的臓器相関が証明されたことから、肝再生現象を自己細胞に対する拒絶反応と考えた。しかし、肝切除モデルにおいては、肝再生時の小腸と肝臓のCTL、NK activityや、小腸と肝臓に特異的に分布する胸腺外分化T細胞(NKTcell)の動態に差はなかった。一方、肝再生促進治療の臨床応用として肝切除モデルにグルタミン濃度(0%、2%、4%)の異なる調整飼料を与えた結果、術後7日目の肝再生を表すLBR(体重に対する残存肝重量の割合)は配合率2%が0%、4%と比較して増加していた。NK activityは配合率2%が有意に高値を示したことから、至適グルタミン配合率は2%であるが、dose dependentに肝再生能の促進はないと考えられた。次に、in vivoにおける肝再生メカニズムの検証を行うべく、癌関連遺伝子の解析に数千から数万種類のDNA発現を短時間同時に解折するDNAマイクロアレイシステムを応用し・肝再生に関わる細胞増殖因子や、細胞周期調節因子、転写調節因子など検討し、transcription factorであるSTAT3,C/EBPsやBcl-x、IGF等の活性化が示唆された。
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 1996年 -1997年 
    代表者 : 中居 卓也; 陣内 浩喜; 船井 貞往
     
    fully allogenicなラット小腸移植ではrejectionとGVHDが認められる。しかし,そのrejectionやGVHDの免疫学的機序は未だ明らかにされていない。本実験ではBrown-NorwayからLewis ratへのvenous cuff techniqueを用いた同所性小腸移植を行い、FK506投与後のGVHDとrejectionの発生とhostの生存期間を検討した。また、術後肝、脾、graft腸間膜リンパ節(MLN),hostMLNのリンパ球を採取、NK、CTL活性を測定し免疫学的変化も解析した。FK506無投与では全例にrejectionの発症を認めた。FK5060.5mg/kg/day投与ではTemporary GVHDを認めたが、rejectionもなくhostは100日以上生存した。一方、FK5061.0mg/kg/day投与ではGVHDの発症はなかったが、chronic rejectionを認め術後80日前後に死亡した。免疫学的にはacute rejectionではNK、CTL活性が高値を維持し、Temporary GVHDはNK活性がCTL活性より高いレベルになったとき認められ。それらの免疫学的変化は局所の肝、graftMLNで現れた。FK506はNK、CTL活性の両者を抑制するが、投与量によって抑制効果が異なることが考えられた。同所性ラット小腸移植においてGVHD、rejectionの発症はNK、CTL活性の両方が関与し発症すると考えられた。

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