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柳本 泰明大学院医学研究科 医科学専攻教授
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■ 論文- BACKGROUND: Systemic inflammation and altered metabolism are essential hallmarks of cancer. We hypothesized that the rapid turnover protein transthyretin (TTR) (half-life: 2-3 days), compared with the conventional marker albumin (21 days), better reflects the inflammatory/metabolic dynamics of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT) and is a useful prognostic marker. METHODS: Serum TTR and albumin levels were measured in 104 consecutive post-NAT PDAC patients before curative resection. The associations of preoperative TTR and albumin levels with overall survival (OS) after pancreatectomy were retrospectively analyzed. RESULTS: The mean (SD) TTR and albumin levels were 21.6 (6.4) mg/dL (normal range: ≥22.0 mg/dL) and 3.9 (0.55) g/dL. A low (<22.0 mg/dL) post-NAT TTR level was associated with an advanced tumor stage and higher CEA and CRP levels. Patients with low TTR levels showed significantly worse OS compared with normal levels (3-year OS 39 % vs. 54 %, P = 0.037), although albumin levels did not. We modified prognostic biomarkers of systemic inflammation/metabolism, such as GPS, PNI, and CONUT scores, using the serum TTR instead of albumin level and successfully showed that modified scores were better associated with OS compared with original scores using serum albumin level. CONCLUSIONS: Our data suggest that the TTR level is a promising prognostic biomarker for PDAC patients after NAT.2024年09月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 24(6) (6), 917 - 924, 英語, 国際誌研究論文（学術雑誌）
- PURPOSE: The technical difficulties of laparoscopic liver resection (LLR) are greatly associated with the location of liver tumors. Since segment 8 (S8) contains a wide area, the difficulty of LLR for S8 tumors may vary depending on the location within the segment, such as the ventral (S8v) and dorsal (S8d) area, but the difference is unclear. METHODS: We retrospectively investigated 30 patients who underwent primary laparoscopic partial liver resection for liver tumors in S8 at Kobe University Hospital between January 2018 and June 2023. RESULTS: Thirteen and 17 patients underwent LLR for S8v and S8d, respectively. The operation time was significantly longer (S8v 203[135-259] vs. S8d 261[186-415] min, P = 0.002) and the amount of blood loss was significantly higher (10[10-150] vs. 10[10-200] mL, P = 0.034) in the S8d group than in the S8v group. No significant differences were observed in postoperative complications or postoperative length of hospital stay. Additionally, intraoperative findings revealed that the rate at which the case performed partial liver mobilization in the S8d group was higher (2[15.4%] vs. 8[47.1%], P = 0.060) and the median parenchymal transection time of the S8d group was longer (102[27-148] vs. 129[37-175] min, P = 0.097) than those in the S8v group, but there were no significant differences. CONCLUSION: The safety of LLR for the S8d was comparable to that of LLR for S8v, although LLR for S8d resulted in longer operative time and more blood loss. THE TRIAL REGISTRATION NUMBER: B230165 (approved at December 26, 2023).2024年08月, Langenbeck's archives of surgery, 409(1) (1), 243 - 243, 英語, 国際誌研究論文（学術雑誌）
- AIM: The IMbrave150 trial revealed that atezolizumab plus bevacizumab (AtezoBv) showed a higher objective response rate (ORR) in patients with advanced hepatocellular carcinoma (HCC). Although conversion therapy after AtezoBv has been recently reported, markers predictive of its efficacy, particularly radiological imaging markers, have not yet been identified. The present study focused on tumor morphological appearance on radiological imaging and evaluated whether it could be associated with AtezoBv efficacy. METHODS: Ninety-five intrahepatic lesions in 74 patients who were given AtezoBv for advanced HCC were recruited for evaluation. The lesions were divided into two groups, simple nodular (SN group) and non-simple nodular (non-SN group), based on the gross morphology on pretreatment imaging, and retrospectively evaluated for treatment response and other relevant clinical outcomes. RESULTS: Assessing the size of individual tumors after treatment, waterfall plots showed that tumor shrinkage in the non-SN group including 56 lesions was higher than that in the SN group comprising 39 lesions. The ORR was significantly higher in the non-SN group (39.3% vs. 15.4%, p = 0.012). Additionally, the median time to nodular progression was longer in the non-SN group (21.0 months vs. 8.1 months, p = 0.119) compared to the SN group. Six patients with non-SN lesions underwent sequential local therapy. CONCLUSIONS: Atezolizumab plus bevacizumab may show increased therapeutic efficacy in patients with tumors with a higher potential for aggressive oncological behavior, such as non-SN lesions. Treatment strategies focusing on conversion therapy may be crucial in patients with non-SN lesions.2024年08月, Hepatology research : the official journal of the Japan Society of Hepatology, 54(8) (8), 773 - 780, 英語, 国際誌研究論文（学術雑誌）
- Owing to the high objective response rate of atezolizumab plus bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC), the concept of sequential conversion to local treatment has recently become mainstream. The conversion concept is mainly applied to Barcelona Clinic for Liver Cancer (BCLC) stage B cases, and radiotherapy is rarely considered as a conversion local treatment. We herein report three patients who were treated with the novel concept of "sequential particle radiotherapy," consisting of Atez/Bev therapy followed by particle radiotherapy (PRT) for HCC with advanced portal vein tumor thrombus (Vp3/4 PVTT). All patients achieved partial response radiologically and were switched to PRT. All patients were recurrence free at 1 year after the introduction of Atez/Bev therapy without any additional treatment. This upcoming combination strategy includes the advocacy of sequential concepts for BCLC stage C cases and the introduction of PRT as a local treatment after Atez/Bev.2024年08月, Surgery today, 54(8) (8), 972 - 976, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND/AIM: Neskeep®, an absorbable polyglycolic acid spacer, has been developed as the optimal material for spacer placement surgery. However, preventing its severe adhesion is a crucial concern. Therefore, we aimed to identify an effective anti-adhesion agent for Neskeep® using rat models. MATERIALS AND METHODS: Animal experiments were performed using 60 rats, which underwent Neskeep® placement on the abdominal wall. Three types of anti-adhesion agents were employed, establishing four subgroups: Seprafilm®, INTERCEED®, AdSpray®, and only Neskeep® (control) groups. Rats were sacrificed on postoperative days 7, 14, and 28 to assess adhesion levels around the Neskeep® Macroscopic visual assessment with the Lauder score and histopathological evaluation were performed to assess the degree of adhesion. RESULTS: There were no significant differences in the proportion of Lauder scores on days 7 and 14 between the four groups. Histological evaluation revealed no significant differences between groups at any observation time. However, the mean Lauder scores at day 28 were 5.0, 1.6, 4.0, and 4.8 in the Neskeep®, Seprafilm®, INTERCEED®, and AdSpray® groups, respectively. The proportion of milder Lauder score was significantly higher in the Seprafilm® group on day 28. CONCLUSION: Seprafilm® may exhibit an anti-adhesive effect when used with Neskeep®.2024年08月, Anticancer research, 44(8) (8), 3349 - 3353, 英語, 国際誌研究論文（学術雑誌）
- PURPOSE: The impact of postoperative bile leak on the prognosis of patients with hepatocellular carcinoma who underwent liver resection is controversial. This study aimed to investigate the prognostic impact of bile leak for patients with hepatocellular carcinoma who underwent liver resection. METHODS: Patients with hepatocellular carcinoma who underwent liver resection between 2009 and 2019 at Kobe University Hospital and Hyogo Cancer Center were included. After propensity score matching between the bile leak and no bile leak groups, differences in 5-year recurrence-free and overall survival rates were evaluated using the Kaplan-Meier method. RESULTS: A total of 781 patients, including 43 with postoperative bile leak, were analyzed. In the matched cohort, 40 patients were included in each group. The 5-year recurrence-free survival rates after liver resection were 35% and 32% for the bile leak and no bile leak groups, respectively (P = 0.857). The 5-year overall survival rates were 44% and 54% for the bile leak and no bile leak groups, respectively (P = 0.216). CONCLUSION: Overall, bile leak may not have a profound negative impact on the prognosis of patients with hepatocellular carcinoma who have undergone liver resection.2024年07月, Langenbeck's archives of surgery, 409(1) (1), 233 - 233, 英語, 国際誌研究論文（学術雑誌）
- Novel adhesives for biological tissues offer an advanced surgical approach. Here, the authors report the development and application of solid-state adhesives consisting of porous hydroxyapatite (HAp) biocompatible ceramics as novel internal organ retractors. The operational principles of the porous solid-state adhesives are experimentally established in terms of water migration from biological soft tissues into the pores of the adhesives, and their performance is evaluated on several soft tissues with different hydration states. As an example of practical medical utility, HAp adhesive devices demonstrate the holding ability of porcine livers and on-demand detachability in vivo, showing great potential as internal organ retractors in laparoscopic surgery.2024年07月, Advanced healthcare materials, 13(19) (19), e2304616, 英語, 国際誌研究論文（学術雑誌）
- Tremelimumab plus durvalumab (Dur/Tre) is the first-line treatment for advanced hepatocellular carcinoma (HCC) worldwide. The present report describes the case of a 68-year-old man diagnosed with advanced HCC and a bile duct tumor thrombus (BDTT) who achieved a complete response to Dur/Tre therapy. The BDTT progressed to the bifurcation of the left and right hepatic ducts. Over time, both the tumors and BDTT progressively decreased in size, and a complete response was confirmed using the Response Evaluation Criteria in Solid Tumors (version 1.1.) 6 months after treatment administration. Subsequently, immune-related adverse events, including type 1 diabetes mellitus and diabetic ketoacidosis, emerged, leading to treatment discontinuation. The patient was undergoing outpatient follow-up in a drug-free state with no signs of recurrence 290 days after the initial administration of Dur/Tre. Although long-term and meticulous observations are required, the present findings could influence the choice of systemic chemotherapy for advanced HCC.2024年07月, Oncology letters, 28(1) (1), 332 - 332, 英語, 国際誌
- INTRODUCTION: Surgical resection is considered an effective cure for biliary tract cancer (BTC); however, the prognosis is unsatisfactory despite improved surgical techniques and perioperative management. The recurrence rate remains high even after curative resection. The efficacy of adjuvant chemotherapy in pancreatic and gastric cancers has been previously reported, and the feasibility of adjuvant therapy with S-1 has recently been reported in patients with resected BTC. We aimed to retrospectively investigate the effects of adjuvant chemotherapy with S-1 on resected advanced BTC. METHODS: We included data from 438 BTC patients who underwent resection between 2001 and 2020. After excluding patients with pTis-pT1 (n = 112) and other exclusion criteria, 266 patients were included in the analysis. RESULTS: After propensity score matching, 48 patients received S-1 adjuvant chemotherapy (S-1 group), and 48 patients received non-S1 adjuvant chemotherapy or underwent surgery alone (Non-S-1 group). The patients in the S-1 group had significantly better overall survival (OS) than those in the non-S-1 group (MST 51 vs 37 months, hazard ratio [HR]:.54, 95% confidence interval [CI]:.30-.98, P = .04). The S-1 group had a significantly better recurrence-free survival (RFS) than the non-S-1 group (94 vs 21 months, HR: .57, 95% CI: .33-.97, P = .03). Subgroup analyses for OS and RFS exhibited the benefits of S-1 in patients aged <75 years and in patients with primary sites of extrahepatic and perineural invasion and curability of R0. DISCUSSION: S-1 adjuvant therapy is promising for improving the postoperative survival of patients with resected advanced BTC, positive nerve invasion, and R0 resection.2024年06月, The American surgeon, 90(6) (6), 1279 - 1289, 英語, 国際誌研究論文（学術雑誌）
- Spontaneous rupture of a primary hepatocellular carcinoma (HCC) is a frequently observed and fatal complication. However, the rupture of lymph node (LN) metastases from HCC is rare. A 79 year-old male with hepatitis B underwent three liver resections for HCC. Two years and 6 months after the last liver resection, enhanced computed tomography (CT) revealed a nodule with a diameter of 3 cm in the lower pole of the spleen. Splenic metastasis of HCC was suspected, and splenectomy was scheduled. During our hospital stay for a urinary tract infection before the scheduled operation, he complained of acute left-sided abdominal pain, and CT showed intra-abdominal hemorrhage due to rupture of the splenic tumor. Emergency splenectomy was performed, and the postoperative course was uneventful. Histopathological examination revealed a poorly differentiated HCC in the lower splenic pole lesion, which contained LN structures. The ruptured lesion was diagnosed as splenic hilar LN metastasis of HCC. Although laparoscopic partial liver resection was performed for intrahepatic recurrence, and atezolizumab plus bevacizumab therapy was administered for peritoneal metastases, the patient was alive 25 months after the splenectomy. Our case suggests that emergency surgery for LN metastatic rupture can achieve hemostasis and lead to improved survival outcomes.2024年06月, Clinical journal of gastroenterology, 17(3) (3), 557 - 562, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP. METHODS: Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value. RESULTS: In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP. CONCLUSIONS: DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP.2024年05月, Surgical endoscopy, 38(5) (5), 2699 - 2708, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: The treatment algorithm for systemic therapies for advanced hepatocellular carcinoma (HCC) has changed dramatically; however, the therapeutic landscape for sequential second-line or later-line treatments, including ramucirumab, remains controversial. This study aimed to investigate the role of ramucirumab for treating HCC. PATIENTS AND METHODS: We retrospectively analyzed data from 17 patients with advanced HCC who received ramucirumab, and 8 of them who received lenvatinib re-administration after ramucirumab treatment failure. RESULTS: The median overall survival of 17 patients treated with ramucirumab was 11.5 months. The median ratios of the 1-month post-treatment α-fetoprotein (AFP) levels and albumin-bilirubin (ALBI) scores to the pre-treatment AFP levels and ALBI scores following ramucirumab treatment were 0.880 and 0.965, respectively. The median ratios of the 1-month post-treatment AFP and ALBI levels to the pre-treatment levels were 1.587 and 0.970 for mALBI grade 1/2a, and 1.313 and 0.936 for mALBI grade 2b/3, respectively. Six of the eight patients who received lenvatinib rechallenge treatment exhibited a decrease in AFP levels one month post-lenvatinib treatment. Deterioration of liver function 3 months post-lenvatinib treatment was noted in five of the eight patients who received lenvatinib rechallenge treatment after ramucirumab. CONCLUSION: Ramucirumab may be equally useful in patients with unresectable HCC who have poor liver function or whose liver function is aggravated by other therapies. Rechallenge treatment with lenvatinib after ramucirumab may be a valid treatment option for HCC.2024年05月, Anticancer research, 44(5) (5), 2055 - 2061, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: This study aimed to evaluate the utility of the albumin-bilirubin grade for predicting the prognosis after repeat liver resection for patients with recurrent hepatocellular carcinoma. PATIENTS AND METHODS: Ninety patients with intrahepatic recurrent hepatocellular carcinoma who underwent repeat liver resection at our institution between 2005 and 2019 were retrospectively analyzed. Cox proportional-hazards regression models evaluated independent preoperative prognostic factors, including the albumin-bilirubin grade. Prognosis differences between patients with albumin-bilirubin grades 1 and 2 were analyzed using the Kaplan-Meier method. RESULTS: Cox proportional-hazards regression analysis revealed that albumin-bilirubin grade 2 (p=0.003) and early recurrence within one year from the initial surgery (p=0.001) were independently associated with poor recurrence-free survival, and albumin-bilirubin grade 2 (p=0.020) was independently associated with poor overall survival. The five-year recurrence-free (31% and 17%, respectively) and overall (86% and 60%, respectively) survival rates after repeat liver resection for patients with albumin-bilirubin grades 1 and 2 were significantly different between groups (both p=0.003). CONCLUSION: The albumin-bilirubin grade is useful for preoperatively predicting favorable survival rates after repeat liver resection for patients with recurrent hepatocellular carcinoma. Patients with an albumin-bilirubin grade 1 are better candidates for surgical treatment of recurrent hepatocellular carcinoma.2024年05月, Anticancer research, 44(5) (5), 2031 - 2038, 英語, 国際誌研究論文（学術雑誌）
- Intrahepatic cholangiocarcinoma (iCCA) has been subclassified by its gross morphology into the mass-forming (MF), periductal-infiltrating (PI), and intraductal growth (IG) types and their combinations. This classification correlates well with clinical features; for example, MF-iCCA has less lymph-node metastasis and a better prognosis than PI-iCCA. According to the recently accumulated evidence from histological investigations, the WHO classification endorsed a subclassification scheme in which iCCA cases are classified into small- and large-duct types. Small-duct iCCA is considered to originate from septal or smaller bile ducts and is characterized by less frequent lymph-node metastasis, a favorable prognosis, and an MF appearance. Large-duct iCCA arises around the second branch of the biliary tree and has more aggressive biology and distinct genetic abnormalities. According to the practice guidelines for iCCA from the Liver Cancer Study Group of Japan and the National Comprehensive Cancer Network, upfront surgery is recommended for iCCA without distant metastasis regardless of the morphological subtype, based on clinical experience. In consideration of the biological heterogeneity of iCCA, the treatment strategy for iCCA needs to be reconsidered based on the WHO subtypes.2024年04月, Surgery today, 英語, 国内誌研究論文（学術雑誌）
- OBJECTIVES: Utilizing Ti and Ti alloys as dental materials established a huge spurt in the field of dentistry. Since implantation is an invasive procedure that involves tissue penetration, infection control is mandatory for increasing the success rate of the implant treatment. In this study, we aimed to assess the impact of the surface physicochemical properties of acid-treated Ti on microorganisms specifically bacteria. METHODS: After investigating the surface morphology and characteristics of acid-treated and untreated Ti sheets, we evaluated their potential to capture Escherichia coli (E. coli.) as well as the latter's survival on the surface of both types of sheets. Finally, we assessed the efficiency of the antibacterial properties exhibited by Ti against the oral microflora. RESULTS: SEM images revealed surface roughening of the acid-treated Ti represented by significantly irregular shape. Moreover, the acid-treated Ti exhibited remarkable hydrophobicity. A quantitative evaluation confirmed that acid-treated Ti has higher bacterial capture and antibacterial properties than untreated Ti. Further experiments showed similar effects of both types of Ti not only on E. coli but also on oral microflora. SIGNIFICANCE: Results suggest that acid treatment of Ti surface is a potent technique for enhancing the antibacterial properties of Ti-derived materials.2024年02月, Dental materials : official publication of the Academy of Dental Materials, 40(2) (2), 318 - 326, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Major hepatectomy (MH) may produce the impaired liver function and affect the feasibility of adjuvant chemotherapy in terms of early period after the surgery, but there have not been detailed investigations. JCOG1202 (UMIN000011688) is a randomized phase III trial demonstrating the superiority of adjuvant S-1 chemotherapy for biliary tract cancer (BTC). The aim of this study is to examine the influence of MH for BTC on adjuvant S-1. MATERIALS AND METHODS: Of the total 424 patients, 207 received S-1 (S-1 arm) while the remaining 217 were not. We compared MH with non-major hepatectomy (NMH) for BTC. RESULTS: In the S-1 arm, 42 had undergone MH, and 165 had undergone NMH. MH had similar pretreatment features to NMH, including the proportion of biliary reconstruction, to NMH, except for a lower platelet count (17.7 vs. 23.4 × 104/mm3, p < 0.0001) and lower serum albumin level (3.5 vs. 3.8 g/dL, p < 0.0001). The treatment completion proportion tended to be lower for MH than for NMH (59.5 % vs. 75.8 %; risk ratio, 0.786 [95 % confidence interval, 0.603-1.023], p = 0.0733), and the median dose intensity was lower as well (88.7 % vs. 99.6 %, p = 0.0358). The major reasons for discontinuation were biliary tract infections and gastrointestinal disorders after MH. The frequency of grade 3-4 biliary tract infection was 19.0 % in MH vs. 4.2 % in NMH. CONCLUSION: The treatment completion proportion and dose intensity were lower in MH than in NMH. Caution should be exercised against biliary tract infections and gastrointestinal disorders during adjuvant S-1 after MH for BTC.2024年02月, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 50(2) (2), 107324 - 107324, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of hepatectomy. The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding. Therefore, we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy. AIM: To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy. METHODS: The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether or not they developed VTE after hepatectomy, as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities. Clinicopathological factors, including demographic data and perioperative D-dimer values, were compared between the two groups. Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value. Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors. RESULTS: In total, 234 patients who underwent hepatectomy were, of whom (5.6%) were diagnosed with VTE following hepatectomy. A comparison between the two groups showed significant differences in operative time (529 vs 403 min, P = 0.0274) and blood loss (530 vs 138 mL, P = 0.0067). The D-dimer levels on postoperative days (POD) 1, 3, 5, 7 were significantly higher in the VTE group than in the non-VTE group. In the multivariate analysis, intraoperative blood loss of > 275 mL [odds ratio (OR) = 5.32, 95% confidence interval (CI): 1.05-27.0, P = 0.044] and plasma D-dimer levels on POD 5 ≥ 21 μg/mL (OR = 10.1, 95%CI: 2.04-50.1, P = 0.0046) were independent risk factors for VTE after hepatectomy. CONCLUSION: Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.2024年01月, World journal of clinical cases, 12(2) (2), 276 - 284, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: The usefulness of gadolinium-ethoxybenzyl diethylenetriamine pentaacetate acid-enhanced magnetic resonance imaging (EOB-MRI) in assessing the functional future remnant liver volume (fFRLV) to predict post-hepatectomy liver failure (PHLF) has been previously reported. Herein, we evaluated the efficacy of this technique in patients with hepatocellular carcinoma (HCC) with a major portal vein tumor thrombus (PVTT). METHODS: This study included 21 patients with PVTT in the ipsilateral first-order branch (Vp3) and 30 patients with PVTT in the main trunk/contralateral branch (Vp4). To evaluate fFRLV, the signal intensity (SI) of the remnant liver was determined on T1-weighted images, using both conventional and newly developed methods. The fFRLV was calculated using the SI of the remnant liver and muscle, remnant liver volume, and body surface area. Preoperative factors predicting PHLF (≥grade B) in HCC patients with Vp3/4 PVTT were evaluated. RESULTS: In the Vp3 group, we found fFRLV area under the receiver-operating characteristic curves (AUCs) above 0.70 (AUC = 0.875, 0.750) using EOB-MRI results calculated using either the plot or whole method. None of the parameters in the Vp4 group had an AUC greater than 0.70. CONCLUSION: The fFRLV calculated by EOB-MRI using the whole method can be as useful as the conventional method in predicting PHLF (≥grade B) for HCC patients with Vp3 PVTT.2024年, Digestive surgery, 41(1) (1), 30 - 36, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Few reports have discussed the association between total tumor volume (TTV) and prognosis in patients with colorectal liver metastases (CRLM). The present study aimed to evaluate the usefulness of TTV for predicting recurrence-free survival and overall survival (OS) in patients receiving initial hepatic resection or chemotherapy, and to investigate the value of TTV as an indicator for optimal treatment selection for patients with CRLM. PATIENTS AND METHODS: This retrospective cohort study included patients with CRLM who underwent hepatic resection (n = 93) or chemotherapy (n = 78) at the Kobe University Hospital. TTV was measured using 3D construction software and computed tomography images. RESULTS: A TTV of 100 cm3 has been previously reported as a significant cut-off value for predicting OS of CRLM patients receiving initial hepatic resection. For patients receiving hepatic resection, the OS for those with a TTV ≥ 100 cm3 was significantly reduced compared with those with a TTV < 100 cm3. For patients receiving initial chemotherapy, there were no significant differences between the groups divided according to TTV cut-offs. Regarding OS of patients with TTV ≥ 100 cm3, there was no significant difference between hepatic resection and chemotherapy (p = 0.160). CONCLUSIONS: TTV can be a predictive factor of OS for hepatic resection, unlike for initial chemotherapy treatment. The lack of significant difference in OS for CRLM patients with TTV ≥ 100 cm3, regardless of initial treatment, suggests that chemotherapeutic intervention preceding hepatic resection may be indicated for such patients.2023年10月, Annals of surgical oncology, 30(11) (11), 6603 - 6610, 英語, 国際誌研究論文（学術雑誌）
- 2023年10月, Annals of surgical oncology, 30(11) (11), 6613 - 6614, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Postoperative cholangitis is a common complication of pancreaticoduodenectomy. Frequent cholangitis impairs patients' quality of life after pancreaticoduodenectomy. However, the risk factors for recurrence of cholangitis remain unclear. Hence, this retrospective study aimed to identify risk factors for recurrence of cholangitis after pancreaticoduodenectomy. METHODS: The medical records of patients who underwent pancreaticoduodenectomy between 2015 and 2019 in our institution were retrospectively reviewed. At least two episodes of cholangitis a year after pancreaticoduodenectomy were defined as 'recurrence of cholangitis' in the present study. Univariate and multivariate analyses were performed. RESULTS: The recurrence of cholangitis occurred in 40 of 207 patients (19.3%). Multivariate analysis revealed that internal stent (external, RR: 2.16, P = 0.026; none, RR: 4.76, P = 0.011), firm pancreas (RR: 2.61, P = 0.021), constipation (RR: 3.49, P = 0.008), and postoperative total bilirubin>1.7 mg/dL (RR: 2.94, P = 0.006) were risk factors of recurrence of cholangitis. Among patients with internal stents (n = 54), those with remnant stents beyond 5 months had more frequent recurrence of cholangitis (≥5 months, 75%; <5 months, 30%). CONCLUSIONS: Internal stents, firm pancreas, constipation, and postoperative high bilirubin levels are risk factors for cholangitis recurrence after pancreaticoduodenectomy. In addition, the long-term implantation of internal stents may trigger cholangitis recurrence.2023年10月, World journal of surgery, 47(10) (10), 2499 - 2506, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The exfoliative cell analyzer, LC-1000, is medical device that utilizes the principles of flow cytometry, and might provide digital diagnostic information for cytology using a different approach from conventional cytomorphology. In this study, wae examined the usefulness of the LC-1000 as a diagnostic support system for intraoperative peritoneal lavage cytology and its prognostic impact for pancreatic (PC) and biliary tract cancer (BTC). METHODS: Patients with PC and BTC who underwent surgical treatment were included. First, we identified useful indicators of LC-1000 and established cutoff values to discriminate positive cytology. Next, we verified the validity of these cutoff values. RESULTS: In the test set (n = 48), of the LC-1000 indicators examined, only MR-CPIx was significantly different between the negative and positive cytology groups, yielding a cutoff value of 0.86. In the validation set (n = 52), the sensitivity, specificity, positive and negative predictive value of the LC-1000 for cytology results was 1.0, 0.49, 0.11 and 1.0, respectively. In patients who had undergone radical resection, recurrence-free survival rate was significantly higher in the LC-1000 negative group than in the positive group in PC, but not in BTC. CONCLUSION: The LC-1000 was useful as digital support system for peritoneal cytology, and it might have potential as a prognostic factor for PC.2023年09月, Journal of hepato-biliary-pancreatic sciences, 30(9) (9), 1119 - 1128, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM), comprising several of the major global clinical nutrition societies, suggested the world's first criteria for diagnosis of the severity of malnutrition. However, the impact of the resulting diagnosis on patient outcomes for those with hepatocellular carcinoma (HCC) following liver resection (LR) has not been investigated. METHODS: A retrospective analysis of 293 patients with HCC who underwent LR between January 2011 and December 2018 was performed. We compared overall survival (OS) and recurrence-free survival (RFS) and evaluated prognostic factors after LR using Cox proportional hazards regression models. RESULTS: Preoperative patient nutritional status, n (%), was classified as follows: normal, 130 (44%), moderate malnutrition, 116 (40%), and severe malnutrition, 47 (16%). The median OS (129 vs. 43 months, p < 0.001) and median RFS (54 vs. 20 months, p = 0.001) were significantly greater in the normal group than in the severe malnutrition group. Multivariate analysis showed that severe malnutrition was a significant risk factor for OS (p = 0.006) and RFS (p = 0.010) after initial LR. CONCLUSION: Severe malnutrition, as diagnosed by the GLIM criteria, is a significant prognostic factor for survival and recurrence in patients with HCC after LR.2023年08月, HPB : the official journal of the International Hepato Pancreato Biliary Association, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Less intra-abdominal adhesions are expected following laparoscopic surgery. Although an initial laparoscopic approach for primary liver tumors may have advantages in patients who require repeat hepatectomies for recurrent liver tumors, this has not been sufficiently investigated. METHODS: Patients who underwent repeat hepatectomies for recurrent liver tumors at our hospital between 2010 and 2022 were retrospectively analyzed. Of 127 patients, 76 underwent laparoscopic repeat hepatectomy (LRH), of whom 34 patients initially underwent laparoscopic hepatectomy (L-LRH) and 42, open hepatectomy (O-LRH). Fifty-one patients underwent open hepatectomy as both the initial and second operation (O-ORH). We analyzed surgical outcomes between L-LRH and O-LRH groups and between L-LRH and O-ORH groups using propensity-matching analysis for each pattern. RESULTS: Twenty-one patients each were included in L-LRH and O-LRH propensity-matched cohorts. The L-LRH group had a lower rate of postoperative complications than the O-LRH group (0 vs 19%, P = 0.036). When we compared surgical outcomes between L-LRH and O-ORH groups in another matched cohort with 18 patients in each group, in addition to the lower rate of postoperative complications, the L-LRH group had additional favorable surgical outcomes including shorter operation time and lower blood loss volume than the O-ORH group (291 vs 368 min, P = 0.037 and 10 vs 485 mL, P < 0.0001). CONCLUSIONS: An initial laparoscopic approach would be favorable for patients undergoing repeat hepatectomies, as it leads to lower risk of postoperative complications. Compared with O-ORH, the advantage of the laparoscopic approach may be enhanced when it is repeatedly adopted.2023年08月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 27(8) (8), 1621 - 1631, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: In pathology, the digitization of tissue slide images and the development of image analysis by deep learning have dramatically increased the amount of information obtainable from tissue slides. This advancement is anticipated to not only aid in pathological diagnosis, but also to enhance patient management. Deep learning-based image cytometry (DL-IC) is a technique that plays a pivotal role in this process, enabling cell identification and counting with precision. Accurate cell determination is essential when using this technique. Herein, we aimed to evaluate the performance of our DL-IC in cell identification. MATERIALS AND METHODS: Cu-Cyto, a DL-IC with a bit-pattern kernel-filtering algorithm designed to help avoid multi-counted cell determination, was developed and evaluated for performance using tumor tissue slide images with immunohistochemical staining (IHC). RESULTS: The performances of three versions of Cu-Cyto were evaluated according to their learning stages. In the early stage of learning, the F1 score for immunostained CD8+ T cells (0.343) was higher than the scores for non-immunostained cells [adenocarcinoma cells (0.040) and lymphocytes (0.002)]. As training and validation progressed, the F1 scores for all cells improved. In the latest stage of learning, the F1 scores for adenocarcinoma cells, lymphocytes, and CD8+ T cells were 0.589, 0.889, and 0.911, respectively. CONCLUSION: Cu-Cyto demonstrated good performance in cell determination. IHC can boost learning efficiencies in the early stages of learning. Its performance is expected to improve even further with continuous learning, and the DL-IC can contribute to the implementation of precision oncology.2023年08月, Anticancer research, 43(8) (8), 3755 - 3761, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The safety and efficacy of laparoscopic liver resection (LLR) have been reported worldwide. However, those of LLR for tumors located in Couinaud's segment 8 are not sufficiently investigated. METHODS: We retrospectively analyzed 108 patients who underwent liver resection for hepatocellular carcinoma (HCC) in segment 8 at Kobe University Hospital and Hyogo Cancer Center between January 2010 and December 2021. The patients were categorized in LLR and open liver resection (OLR) groups, and 1:1 propensity score matching (PSM) was performed to compare surgical outcomes between the groups. RESULTS: Forty-seven and 61 patients underwent LLR and OLR, respectively. After PSM, each group contained 34 patients. There was no significant difference in operation time between the groups (331 min vs. 330 min, P = 0.844). Patients in the LLR group had significantly less blood loss (30 mL vs. 468 mL, P < 0.001) and shorter length of postoperative hospital stay (10 days vs. 12 days, P = 0.015) than those in the OLR group. There was no significant difference in the occurrence of postoperative complications between the groups (12% vs. 9%, P = 0.690). Further, the 1-year cumulative incidence of recurrence was not significantly different between the groups (16% vs. 19%, P = 0.734). CONCLUSIONS: The surgical outcomes and short-term prognosis of LLR were similar or better than those of OLR. LLR could be an effective and safe procedure, even for lesions located in segment 8, which is considered a difficult anatomical location for LLR.2023年07月, Surgical endoscopy, 英語, 国際誌研究論文（学術雑誌）
- Transarterial chemoembolization (TACE) is performed for pancreatic neuroendocrine tumor (PanNEN) liver metastases; however, the safety and efficacy of TACE procedures, especially for patients who have undergone previous pancreatic surgery, have not been established. We reviewed 48 TACE procedures (1-6 procedures/patient) performed on 11 patients with PanNEN liver metastases, including 16 TACE procedures (4-6 procedures/patient) for 3 patients with a history of biliary-enteric anastomosis. The overall tumor objective response rate was 94%. The incidence of Clavien‒Dindo grade ≥ 2 complications was 1/16 (6%) and 1/32 (3%), and the median time to untreatable progression was 31 (14-41) and 27 (2-60) months among patients with and without a history of biliary-enteric anastomosis, respectively. Although validation is needed in future studies, our experiences have shown that TACE treatment is a viable treatment option for PanNEN liver metastases, even after biliary-enteric anastomosis with experienced teams and careful patient follow-up.2023年06月, Surgery today, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Optimal management of non-functioning pancreatic neuroendocrine tumors (PanNETs) ≤20 mm is controversial. The biological heterogeneity of these tumors poses challenges when deciding between resection and observation. METHODS: In this multicenter, retrospective cohort study, we analyzed all patients (n = 78) who underwent resection of non-functioning PanNETs ≤20 mm at three tertiary medical centers from 2004 to 2020 to assess the utility of preoperatively available radiological features and serological biomarkers of non-functioning PanNETs in choosing an optimal surgical indication. The radiological features included non-hyper-attenuation pattern on enhancement computed tomography (CT; hetero/hypo-attenuation) and main pancreatic duct (MPD) involvement, and serological biomarkers included elevation of serum elastase 1 and plasma chromogranin A (CgA) levels. RESULTS: Of all small non-functioning PanNETs, 5/78 (6%) had lymph node metastasis, 11/76 (14%) were WHO grade II, and 9/66 (14%) had microvascular invasion; 20/78 (26%) had at least one of these high-risk pathological factors. In the preoperative assessment, hetero/hypo-attenuation and MPD involvement were observed in 25/69 (36%) and 8/76 (11%), respectively. Elevated serum elastase 1 and plasma CgA levels were observed in 1/33 (3%) and 0/11 (0%) patients, respectively. On multivariate logistic regression analysis, hetero/hypo-attenuation (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.7-22.2) and MPD involvement (OR 16.8, 95% CI 1.6-174.3) were significantly associated with the high-risk pathological factors. The combination of the two radiological worrisome features correctly predicted non-functioning PanNETs with high-risk pathological factors, with about 75% sensitivity, 79% specificity, and 78% accuracy. CONCLUSIONS: This combination of radiological worrisome features can accurately predict non-functioning PanNETs that may require resection.2023年06月, Annals of surgical oncology, 30(6) (6), 3493 - 3500, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Intracholecystic papillary neoplasm (ICPN) is one of the precursors of gallbladder cancer defined in the 2010 World Health Organization classification of tumors. We herein report ICPN with pancreaticobiliary maljunction (PBM), which is a high-risk factor for biliary cancer. CASE PRESENTATION: A 57-year-old female presented with abdominal pain. Computed tomography showed a swollen appendix and gallbladder nodules with bile duct dilatation. Endoscopic ultrasonography revealed a gallbladder tumor spreading into the cystic duct confluence accompanying PBM. Based on papillary tumors around the cystic duct detected using the SpyGlass DS II Direct Visualization System (SpyGlass DS), ICPN was suspected. We performed extended cholecystectomy, extrahepatic bile duct resection, and appendectomy with a diagnosis of ICPN and PBM. The pathological diagnosis was ICPN (90 × 50 mm) with high-grade dysplasia spreading into the common bile duct. The absence of residual cancer in the resected specimen was pathologically confirmed. P53 staining was totally negative in both the tumor and normal epithelium. The overexpression of CTNNB1 was not observed. CONCLUSIONS: We encountered a patient with a very rare gallbladder tumor, ICPN with PBM. SpyGlass DS contributed to a precise assessment of the extent of the tumor as well as a qualitative diagnosis.2023年06月, Clinical journal of gastroenterology, 16(3) (3), 476 - 481, 英語, 国内誌研究論文（学術雑誌）
- 2023年06月, Annals of surgical oncology, 30(6) (6), 3503 - 3504, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: Recently, the Global Leadership Initiative on Malnutrition (GLIM), which includes the world's leading clinical nutrition societies, proposed the first global diagnostic criteria for malnutrition. However, the association between malnutrition diagnosed by the GLIM criteria and prognosis in patients with resected extrahepatic cholangiocarcinoma (ECC) remains unknown. This study aimed to investigate the predictive validity of the GLIM criteria for the prognosis of patients with resected ECC. PATIENTS AND METHODS: Between 2000 and 2020, 166 patients who underwent curative-intent resection for ECC were retrospectively analyzed. Prognostic significance of preoperative malnutrition diagnosed by the GLIM criteria was investigated using a multivariate Cox proportional hazards model. RESULTS: Eighty-five (51.2%) and 46 (27.7%) patients were diagnosed with moderate and severe malnutrition, respectively. Increased malnutrition severity tended to be correlated with increased lymph node metastasis rate (p-for-trend=0.0381). The severe malnutrition group had worse 1-, 3-, and 5-year overall survival rates than the normal (without malnutrition) group (82.2% vs. 91.2%, 45.6% vs. 65.1%, 29.3% vs. 61.5%, respectively, p=0.0159). In multivariate analysis, preoperative severe malnutrition was an independent predictor for poor prognosis (hazard ratio=1.68, 95% confidence interval=1.06-2.66, p=0.0282), along with intraoperative blood loss >1,000 ml, lymph node metastasis, perineural invasion, and curability. CONCLUSION: Severe preoperative malnutrition diagnosed by the GLIM criteria was associated with poor prognosis in patients who underwent curative-intent resection for ECC.2023年05月, Anticancer research, 43(5) (5), 2299 - 2308, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Post-transplantation weight control is important for long-term outcomes; however, few reports have examined postoperative weight change. This study aimed to identify perioperative factors contributing to post-transplantation weight change. METHODS: Twenty-nine patients who underwent liver transplantation between 2015 and 2019 with an overall survival of >3 years were analyzed. RESULTS: The median age, model for end-stage liver disease score, and preoperative body mass index (BMI) of the recipients were 57, 25, and 23.7, respectively. Although all but one recipient lost weight, the percentage of recipients who gained weight increased to 55% (1 month), 72% (6 months), and 83% (12 months). Among perioperative factors, recipient age ≤50 years and BMI ≤25 were identified as risk factors for weight gain within 12 months (P < .05), and patients with age ≤50 years or BMI ≤25 recipients gained weight more rapidly (P < .05). The recovery time of serum albumin level ≥4.0 mg/dL was not statistically different between the 2 groups. The weight change during the first 3 years after discharge was represented by an approximately straight line, with 18 and 11 recipients showing a positive and negative slope, respectively. Body mass index ≤23 was identified as a risk factor for a positive slope of weight gain (P <.05). CONCLUSIONS: Although postoperative weight gain implies recovery after transplantation, recipients with a lower preoperative BMI should strictly manage body weight as they may be at higher risk of rapid weight increase.2023年04月, Transplantation proceedings, 55(4) (4), 924 - 929, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: The chemotherapeutic landscape for hepatocellular carcinomas (HCCs) has changed dramatically with the availability of several treatment options. This study aimed to assess the long-term outcomes of lenvatinib treatment and analyze its feasibility in the sequential treatment of HCCs. PATIENTS AND METHODS: Eighty-five consecutive patients who received lenvatinib for unresectable HCCs were investigated retrospectively. Survival was assessed based on when the patients were first radiologically diagnosed with progressive disease. Among those with radiologically diagnosed stable or progressive disease at 3 months after lenvatinib administration, the cutoff α-fetoprotein (AFP) ratio (ratio of the AFP level after lenvatinib treatment to the pretreatment AFP level) that was predictive of survival was determined using receiver operating characteristic analysis. RESULTS: The median survival time (MST) was significantly worse among patients diagnosed with progressive disease at 1 month after treatment than among those diagnosed at 2-3 or 3-4 months after treatment [MSTs at 1, 2-3, and 3-4 months: 2.2, 10.2, and 17.3 months, respectively (p<0.001)]. An AFP ratio of 1.36 (computed using the AFP level at 3 months after lenvatinib treatment) was significantly predictive of survival in patients with stable or progressive disease (26.3 vs. 11.3 months, p=0.0024). CONCLUSION: The prognosis of patients on lenvatinib who develop early progressive disease is dismal. Thus, their treatment should be ceased or switched. The 3-month AFP ratio of 1.36 may be a potentially useful cutoff for considering a switch to other treatments in patients radiologically diagnosed with stable or progressive disease.2023年02月, Anticancer research, 43(2) (2), 911 - 918, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: S-1 has shown promising efficacy with a mild toxicity profile in patients with advanced biliary tract cancer. The aim of this study was to evaluate whether adjuvant S-1 improved overall survival compared with observation for resected biliary tract cancer. METHODS: This open-label, multicentre, randomised phase 3 trial was conducted in 38 Japanese hospitals. Patients aged 20-80 years who had histologically confirmed extrahepatic cholangiocarcinoma, gallbladder carcinoma, ampullary carcinoma, or intrahepatic cholangiocarcinoma in a resected specimen and had undergone no local residual tumour resection or microscopic residual tumour resection were randomly assigned (1:1) to undergo observation or to receive S-1 (ie, 40 mg, 50 mg, or 60 mg according to body surface area, orally administered twice daily for 4 weeks, followed by 2 weeks of rest for four cycles). Randomisation was performed by the minimisation method, using institution, primary tumour site, and lymph node metastasis as adjustment factors. The primary endpoint was overall survival and was assessed for all randomly assigned patients on an intention-to-treat basis. Safety was assessed in all eligible patients. For the S-1 group, all patients who began the protocol treatment were eligible for a safety assessment. This trial is registered with the University hospital Medical Information Network Clinical Trials Registry (UMIN000011688). FINDINGS: Between Sept 9, 2013, and June 22, 2018, 440 patients were enrolled (observation group n=222 and S-1 group n=218). The data cutoff date was June 23, 2021. Median duration of follow-up was 45·4 months. In the primary analysis, the 3-year overall survival was 67·6% (95% CI 61·0-73·3%) in the observation group compared with 77·1% (70·9-82·1%) in the S-1 group (adjusted hazard ratio [HR] 0·69, 95% CI 0·51-0·94; one-sided p=0·0080). The 3-year relapse-free survival was 50·9% (95% CI 44·1-57·2%) in the observation group compared with 62·4% (55·6-68·4%) in the S-1 group (HR 0·80, 95% CI 0·61-1·04; two-sided p=0·088). The main grade 3-4 adverse events in the S-1 group were decreased neutrophil count (29 [14%]) and biliary tract infection (15 [7%]). INTERPRETATION: Although long-term clinical benefit would be needed for a definitive conclusion, a significant improvement in survival suggested adjuvant S-1 could be considered a standard of care for resected biliary tract cancer in Asian patients. FUNDING: The National Cancer Center Research and the Ministry of Health, Labour, and Welfare of Japan.2023年01月, Lancet (London, England), 401(10372) (10372), 195 - 203, 英語, 国際誌研究論文（学術雑誌）
- Successful Management of Refractory Autoimmune Hemolytic Anemia with Cold Agglutinin Disease with Splenectomy: A Case Report with Review of Literature.BACKGROUND: Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia characterized by agglutination of red blood cells at temperatures below the normal core body temperature. In patients with CAD, splenectomy is not indicated because of its low therapeutic effect on hemolytic anemia induced by extravascular hemolysis. Herein, we report a case of refractory hemolytic anemia with CAD successfully managed with splenectomy. CLINICAL CASE: A 60-year-old man visited a municipal hospital with the chief complaint of fatigue. He was found to have hemolytic anemia and icterus with increased cold agglutination and was diagnosed with CAD. Malignant lymphoma was suspected as the underlying disease; however, no clear underlying disease was identified. Hemolytic anemia progressed during the subsequent winter seasons, and he was treated with temperature control, warming, and weekly blood transfusions. However, despite the blood transfusions, his hemoglobin level did not improve during the summer 2 years after diagnosis, and his previously observed splenomegaly had progressed. He was referred to our department, and a splenectomy was performed to diagnose any occult malignant lymphoma and improve the refractory hemolytic anemia. Because histopathological examination revealed no evidence of malignant lymphoma, a diagnosis of primary CAD was made. The hemolytic anemia improved, and no blood transfusion was required after splenectomy. CONCLUSIONS: Splenectomy significantly improved the patient's refractory hemolytic anemia due to primary CAD. Thus, it may be an effective treatment option in such cases, although further cases and studies are required to evaluate the effects of splenectomy.2023年01月, The Kobe journal of medical sciences, 68(1) (1), E30-E34, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Bile leakage is a major complication after liver transplantation and remains as a significant source of morbidity and mortality. In 2011, the International Study Group of Liver Surgery (ISGLS) defined bile leakage as a drain/serum bilirubin ratio ≥3. However, to our knowledge there is no literature assessing serum and drain bilirubin concentrations after liver transplantation. The aim of this study was to describe the natural postoperative changes in serum and drain fluid bilirubin concentrations in patients after liver transplantation. METHODS: We included 32 patients who underwent liver transplantation at Kobe University Hospital from January 2007 to December 2020. We enrolled 34 living donors who had no complications as the control group. RESULTS: The recipient serum total/direct bilirubin concentration were higher compared with the donors from postoperative day (POD) 1 to 5 with a statistical difference (P < .05). The recipient drain/serum total bilirubin ratio was lower than donors on POD 3 (0.89 ± 0.07 vs 1.53 ± 0.07: P < .0001), which was also confirmed by the recipient drain/serum direct bilirubin ratio (0.64 ± 0.10 vs 1.18 ± 0.09: P < .0001). On POD 3, the drain fluid volume (647.38 ± 89.47 vs 113.43 ± 86.8 mL: P < .001) and serum total bilirubin concentration (6.73 ± 0.61 vs 1.23 ± 0.60 mg/dL: P < .001) was higher in the recipients than in donors. Categorized in 2 groups, the higher drain fluid volume and bilirubin concentration recipients showed lower drain/serum total bilirubin ratio compared with the other group (P = .03) CONCLUSION: The drain/serum bilirubin ratio in the transplanted patients could be calculated lower compared with the hepatectomy patients because of high drain fluid volume and hyperbilirubinemia. Great care should be taken when assessing the bile leakage in liver transplant recipients using the ISGLS definition.2023年01月, Transplantation proceedings, 55(1) (1), 184 - 190, 英語, 国際誌研究論文（学術雑誌）
- Right-sided ligamentum teres (RSLT) is a rare congenital anomaly in which the fetal umbilical vein is connected to the right paramedian trunk of the portal vein. An 80-year-old woman underwent curative sigmoidectomy for sigmoid cancer 3 years prior to presentation. After 1 year, small solitary liver metastasis was noted in segment 4. Because the patient experienced recurrence of the same lesion after chemotherapy and radiofrequency ablation, she was referred to our hospital. CT revealed an anomaly of the liver with RSLT, classified as an independent posterior branch type. The tumor in the left paramedian section was located in the right umbilical portion (RUP), and BDTT was advanced to the common bile duct. Because the estimated future remnant liver volume was 35.2%, transileocecal portal vein embolization (PVE) for the portal branches from the RUP increased it to 43.5% in 3 weeks. Left trisectionectomy with extrahepatic bile duct resection and hepaticojejunostomy were performed. The patient was discharged on postoperative day 75. We successfully performed a left trisectionectomy after PVE in a patient with RSLT. Understanding the vascular and biliary anomalies of patients with RSLT is essential. When the future remnant liver is small, PVE can be considered for safe hepatectomy.2022年12月, Clinical journal of gastroenterology, 15(6) (6), 1130 - 1135, 英語, 国内誌研究論文（学術雑誌）
- INTRODUCTION: With the aging of the population in Japan, gallbladder cancer (GBC) in the elderly is increasing. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of surgical resection in GBC patients ≥75 years of age. METHODS: A retrospective single center analysis of patients who had undergone surgical resection for GBC between 2000 and 2019 was carried out. Patients aged ≥75 years (elderly group, n = 24) or <75 years (younger group, n = 50) were compared. RESULTS: Both younger and elderly patients exhibited similar clinicopathological characteristics, but comorbidity in the latter was significantly greater, as was the frequency of less invasive surgery. Nonetheless, the incidence of postoperative complications was similar in elderly and younger patients. The proportion of patients receiving adjuvant chemotherapy was lower in the elderly. Overall survival of elderly and younger patients was not significantly different (65.0 vs 62.4% at 5 years, P = .600). In multivariate analysis, residual tumor status but not age was an independent prognostic factor. DISCUSSION: This study demonstrated that appropriate surgical treatment of elderly GBC patients was safe and effective, despite their having more comorbidities and lower rates of adjuvant chemotherapy than younger patients.2022年11月, The American surgeon, 31348221136570 - 31348221136570, 英語, 国際誌研究論文（学術雑誌）
- (株)医薬情報研究所, 2022年11月, 新薬と臨牀, 71(11) (11), 1234 - 1234, 日本語
- (株)医薬情報研究所, 2022年11月, 新薬と臨牀, 71(11) (11), 1234 - 1234, 日本語進行肝細胞癌におけるconversion surgeryの妥当性
- 医学図書出版(株), 2022年11月, 胆と膵, 43(11) (11), 1589 - 1592, 日本語【膵・胆管合流異常-先天性胆道拡張症の最新トピックス-】術後遺残胆管癌の診断と治療
- BACKGROUND: Anatomic liver resection (ALR) has been established to eliminate the tumor-bearing hepatic region with preservation of the remnant liver volume for liver malignancies. Recently, laparoscopic ALR has been widely applied; however, there are few reports on laparoscopic segmentectomy 2. This study aimed to present the standardization of laparoscopic segmentectomy 2 with surgical outcomes. METHODS: This study included seven patients who underwent pure laparoscopic segmentectomy 2 by the Glissonean approach from January 2020 to December 2021. Four of them had hepatocellular carcinoma, two had colorectal liver metastasis, and one had hepatic angiomyolipoma, which was preoperatively diagnosed with hepatocellular carcinoma. In all patients, preoperative three-dimensional (3D) simulation images from dynamic CT were reconstructed using a 3D workstation. The layer between the hepatic parenchyma and the Glissonean pedicle of segment 2 (G2) was dissected to encircle the root of G2. After clamping or ligation of the G2, 2.5 mg of indocyanine green was injected intravenously to identify the boundaries between segments 2 and 3 with a negative staining method under near-infrared light. Parenchymal transection was performed from the caudal side to the cranial side according to the demarcation on the liver surface, and the left hepatic vein was exposed on the cut surface if possible. RESULTS: The mean operative time for all patients was 281 min. The mean blood loss was 37 mL, and no transfusion was necessary. Estimated liver resection volumes significantly correlated with actual liver resection volumes (r = 0.61, P = 0.035). After the operation, one patient presented with asymptomatic deep venous and pulmonary thrombosis, which was treated with anticoagulant therapy. The mean length of hospital stay was 8.9 days. CONCLUSION: Laparoscopic segmentectomy 2 by the Glissonean approach is a feasible and safe procedure with the preservation of the nontumor-bearing segment 3 for liver tumors in segment 2.2022年11月, Surgical endoscopy, 36(11) (11), 8600 - 8606, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: Atezolizumab plus bevacizumab and lenvatinib are the key drugs in the current systemic chemotherapeutic regimen for hepatocellular carcinoma (HCC). Studies have reported the potential effectiveness of lenvatinib introduction after an atezolizumab plus bevacizumab treatment; however, the therapeutic effectiveness of a lenvatinib rechallenge after an atezolizumab plus bevacizumab treatment remains unclear. PATIENTS AND METHODS: Thirteen consecutive patients who were rechallenged with lenvatinib after clinical failure following treatments with lenvatinib and atezolizumab plus bevacizumab were included. A comparative study was conducted on the duration and treatment efficacy of the first and second lenvatinib treatments and on the pre- and post-treatment liver function. RESULTS: The median ratios of the 1-month post-treatment alpha-fetoprotein (AFP) levels to the pretreatment AFP levels were 0.750 and 0.667 for the first and second lenvatinib treatments, respectively, without significant difference (p=0.9327). Meanwhile, the median ratios of the 1-month post-treatment albumin-bilirubin (ALBI) scores to the pretreatment ALBI scores were 1.063 and 0.827 for the first and second lenvatinib treatments, respectively, with significant difference (p=0.015). The median duration of the second lenvatinib treatment was significantly shorter than that of the first lenvatinib treatment [2.8 months (range=0.9-4.7 months) vs. 8.7 months (range=3.1-29.7 months)]. CONCLUSION: Lenvatinib re-administration after atezolizumab plus bevacizumab treatment can act as a double-edged sword, as it exerts an anti-tumor effect while being associated with potential liver function deterioration. However, this treatment sequence can be useful, and requires careful monitoring of the transitions in the liver function and the patient's performance status.2022年11月, Anticancer research, 42(11) (11), 5479 - 5486, 英語, 国際誌研究論文（学術雑誌）
- 2022年10月, Annals of surgical oncology, 30(1) (1), 383 - 383, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Laparoscopic caudate lobe resection is a challenging procedure. Several researchers have reported the safety of laparoscopic liver resections;1.Transl Gastroenterol Hepatol. 1:56;2.Asian J Endosc Surg. 12:232-236;3.Ann Surg Oncol. 26:2980; however, a standardized procedure has not yet been established. Herein, we present a video showing laparoscopic Spiegel lobectomy in a patient with 6-cm hepatocellular carcinoma (HCC) using a novel approach. PATIENT AND METHODS: A 63-year-old man with a caudate lobe HCC was referred to our hospital. Computed tomography showed a 5 × 6 cm2 HCC located in the Spiegel lobe, which profoundly displaced the inferior vena cava (IVC) to the lower right side, and mobilization of the Spiegel lobe was considered difficult. To perform the dissection between the Siegel lobe and IVC safely, we performed parenchymal transection along the ventral side of the IVC initially. The Spiegel lobe was then dislocated to the left side of the IVC. We dissected the left lateral side of the IVC, including the proper hepatic vein draining the caudate lobe and the left IVC ligament with a safe operative field, and successfully removed the Spiegel lobe with large HCC. RESULTS: The operation time was 383 min. The blood loss was 10 mL. The patient was discharged on the seventh postoperative day without any complications. Histopathological examination revealed well-differentiated HCC with a negative surgical margin. CONCLUSIONS: Laparoscopic medial-to-lateral approach with initial parenchymal transection at the medial side of the Spiegel lobe followed by dissection of the left lateral side of the IVC is considered as a safe and effective procedure for large tumors in the Spiegel lobe.2022年10月, Annals of surgical oncology, 30(1) (1), 381 - 382, 英語, 国際誌研究論文（学術雑誌）
- 2022年09月, Surgery today, 53(1) (1), 158 - 158, 英語, 国内誌
- Endoscopic papillectomy for early ampullary tumors is considered a minimally invasive and useful alternative to pancreatoduodenectomy; however, its indications remain unclear. This study aimed to clarify the advantages of endoscopic papillectomy by investigating the clinical outcomes of patients who underwent endoscopic papillectomy or pancreatoduodenectomy for early ampullary tumors. Patients diagnosed with early ampullary tumors (adenoma, Tis, T1a) who underwent endoscopic papillectomy or pancreatoduodenectomy between June 2008 and October 2019 were included, and their clinical outcomes were analyzed. Seventy-four patients (34 patients with adenomas and 40 patients with adenocarcinomas) were divided into two groups, namely endoscopic papillectomy (n = 43) and pancreatoduodenectomy (n = 31). The estimated 5-year overall survival rate of all early ampullary tumors was 92%. Complete resection rate was significantly lower for endoscopic papillectomy patients versus pancreatoduodenectomy patients (48.8% vs. 100%; p < 0.001). Recurrence was more common in the endoscopic papillectomy group compared to the pancreatoduodenectomy group (16.3% vs. 3.2%; p = 0.128), but all recurrences were controllable by endoscopic treatment. The median length of hospital stay for the endoscopic papillectomy group was significantly shorter compared to the endoscopic papillectomy group (11 days vs. 42 days; p < 0.001). The Comprehensive Complication Index was significantly lower in the endoscopic papillectomy group compared to the pancreatoduodenectomy group (14.8 vs 22.6%; p = 0.002). Endoscopic papillectomy for early ampullary tumors is useful and may be an alternative treatment for pancreatoduodenectomy in selected cases.2022年09月, Scientific reports, 12(1) (1), 15134 - 15134, 英語, 国際誌研究論文（学術雑誌）
- (株)東京医学社, 2022年09月, 小児外科, 54(9) (9), 877 - 879, 日本語
- AIM: Sorafenib was previously considered a first-line treatment for hepatocellular carcinoma (HCC) patients with macroscopic portal vein tumor thrombus (PVTT). This case-matched analysis was performed to evaluate the best first-line treatment for HCC in patients with macroscopic PVTT. METHODS: The HCC patients with Vp2 (PVTT invaded into a second-order portal branch), Vp3 (first-order portal branch), and Vp4 (main trunk or contralateral portal vein) PVTT who underwent hepatectomy and those treated with sorafenib were included. Treatment results were compared between the two modalities for each PVTT category, and a propensity analysis was performed for patients with Vp3 and Vp4 (Vp3/4). RESULTS: The median survival times (MSTs) of patients with Vp2, Vp3, and Vp4 PVTT who underwent hepatectomy were 21.4, 13.6, and 14.9 months, respectively; the MSTs for those with Vp2, Vp3, and Vp4 PVTT who received sorafenib treatment were 6.9, 5.5, and 3.6 months, respectively, with a significant difference. In a propensity-matched cohort of patients with Vp3/4 PVTT (36 patients in each), the MST of patients who underwent hepatectomy (15.1 months) was significantly better than the patients treated with sorafenib (4.5 months). CONCLUSION: Hepatectomy can be associated with prolonged survival in HCC patients with macroscopic PVTT.2022年09月, Journal of hepato-biliary-pancreatic sciences, 30(3) (3), 303 - 314, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: In this study, we aimed to develop and validate a nomogram to predict overall survival (OS) and recurrence-free survival (RFS) in patients who underwent curative resection of ampulla of Vater (AOV) cancer. This is the first study for nomograms in AOV cancer patients using retrospective data based on an international multicenter study. METHODS: A total of 2007 patients with AOV adenocarcinoma who received operative therapy between 2002 January and 2015 December in Korea and Japan were retrospectively assessed to develop a prediction model. Nomograms for 5-year OS and 3-year RFS were constructed by dividing the patients who received and who did not receive adjuvant therapy after surgery, respectively. Significant risk factors were identified by univariate and multivariate Cox analyses. Performance assessment of the four prediction models was conducted by the Harrell's concordance index (C-index) and calibration curves using bootstrapping. RESULTS: A total of 2007 and 1873 patients were collected for nomogram construction to predict 5-year OS and 3-year RFS. We developed four types of nomograms, including models for 5-year OS and 3-year RFS in patients who did not receive postoperative adjuvant therapy, and 5-year OS and 3-year RFS in patients who received postoperative adjuvant therapy. The C-indices of these nomograms were 0.795 (95% confidence interval [CI]: 0.766-0.823), 0.712 (95% CI: 0.674-0.750), 0.804 (95% CI: 0.7778-0.829), and 0.703 (95% CI: 0.669-0.737), respectively. CONCLUSIONS: This predictive model could help clinicians to choose optimal treatment and precisely predict prognosis in AOV cancer patients.2022年08月, Journal of hepato-biliary-pancreatic sciences, 30(3) (3), 360 - 373, 英語, 国内誌研究論文（学術雑誌）
- Patients undergoing chemotherapy suffer from taste disorders that affect the quality of life (QOL). In this study, a randomized, double-blind, placebo-controlled trial was conducted to explore the effectiveness of AHCC®, a standardized extract of cultured Lentinula edodes mycelia, for chemotherapy-related adverse events and taste disorders in patients with gastrointestinal cancer. Patients who received chemotherapy were randomized to receive either placebo or AHCC®. The study endpoints were the incidence of anemia and taste disorders assessed with changes in nutritional parameters. Ninety-eight patients with pancreatic ductal adenocarcinoma (PDAC) were enrolled in this study, with 55 patients randomly assigned to the AHCC® group and 43 to the placebo group. The incidence of grades 2-3 anemia in the AHCC® group who were receiving chemotherapy was not significantly different compared to that of the placebo group (Risk difference; -3.1% [95% confidence intervals (CI): -22.8% to 16.9%], p = 0.8392). In the AHCC® group, the occurrence of taste disorders during chemotherapy was significantly lower, and the nutritional parameters were significantly improved compared to those in the placebo group (Risk difference; 28.6% [95% CI: 7.5% to 47.8%], p = 0.0077). AHCC® appears to prevent taste disorders in patients with advanced PDAC who were receiving chemotherapy. AHCC® is expected to enable patients who need chemotherapy to improve nutritional status and their QOL.2022年08月, Nutrition and cancer, 75(1) (1), 1 - 11, 英語, 国際誌研究論文（学術雑誌）
- Stapling is the standard method for pancreatic transection during laparoscopic distal pancreatectomy. Although most surgeons use a 60 mm cartridge stapler, space limitations created by laparoscopic surgery make the instrument difficult to handle, especially during pancreatic transection at the neck. Therefore, we currently use a 45 mm cartridge stapler for laparoscopic pancreatic transection at the neck. Between October 2019 and December 2020, we performed pancreatic transection using a 45 mm cartridge stapler in 27 patients. Fifteen patients experienced biochemical leakage, but no patients developed clinically relevant pancreatic fistula. The compactness of the 45 mm cartridge has several benefits: (1) less space is required for flexing, opening, and closing the device; (2) it enables easy insertion of the lower jaw behind the pancreas, even if the dissected space behind the pancreas is narrow; (3) less obstruction of the surgeons' view prevents accidental injury to the surrounding tissues and vessels. These benefits may enable safe pancreatic transection.2022年07月, Surgery today, 53(1) (1), 153 - 157, 英語, 国内誌研究論文（学術雑誌）
- Portal vein thrombosis (PVT) is a lethal complication of hepatectomy if not properly treated. An 81-year-old woman diagnosed with postoperative PVT after right hepatectomy and caudate lobectomy for perihilar cholangiocarcinoma. Elevation of serum total bilirubin levels, D-dimer levels, and glossy ascites appeared on postoperative day 5 (POD5), and a contrast-enhanced CT confirmed PVT. Thrombi were found from the umbilical portion of the portal vein to the superior mesenteric vein. There were signs of acute liver failure due to thrombi obstructing the portal vein. Therefore, emergent catheter thrombus aspiration was performed under laparotomy. An aspiration catheter was inserted into the superior mesenteric vein from the ileocolic vein. We performed direct aspiration thrombectomy, followed by anticoagulant administration using urokinase via the catheter. Partial recanalization of the portal vein and superior mesenteric vein was observed. To dissolve residual thrombi, edoxaban administration was started on POD6. Contrast-enhanced CT 16 days after her additional operation showed the thrombi had completely disappeared. The patient was discharged on POD76. She had no recurrence of PVT over the next 6 months. Combination therapy of early intervention using aspiration catheter and systemic anticoagulant medication was useful for severe postoperative PVT accompanied with liver failure.2022年06月, Clinical journal of gastroenterology, 15(5) (5), 981 - 987, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Resecting liver tumors located in Couinaud's segment VII is challenging; the efficacy and safety of laparoscopic liver resection for segment VII lesions compared to open liver resection remain unclear. METHODS: Medical records of 84 patients who underwent liver resection of segment VII at Kobe University Hospital and Hyogo Cancer Center between 2010 and 2021 were retrospectively analyzed. Surgical outcomes were compared between laparoscopic liver resection and open liver resection groups using propensity matching analysis. RESULTS: Thirty-one and 53 patients underwent laparoscopic liver resection and open liver resection, respectively. After propensity matching, 29 patients were included in each group. The laparoscopic liver resection group had a significantly longer operation time (407 vs. 305 min, P = 0.002), lower blood loss (100 vs. 230 mL, P = 0.004), and higher postoperative alanine aminotransferase levels (436 vs. 252 IU/L, P = 0.008) than the open liver resection group. In patients with liver cirrhosis, the proportion of patients with postoperative liver-specific complications was higher in the laparoscopic liver resection group than in the open liver resection group (57% vs 11%, P = 0.049), although there was no significant difference in postoperative liver-specific complication rates between the groups in patients without liver cirrhosis. CONCLUSIONS: For liver resection of segment VII, laparoscopic liver resection led to higher postoperative liver damage than open liver resection. Open liver resection may be better for patients with liver cirrhosis to avoid postoperative liver-specific complications. Laparoscopic liver resection could be an acceptable procedure for patients without liver cirrhosis, with some merits such as less blood loss.2022年06月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(11) (11), 2274 - 2281, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a high recurrence rate even after curative resection. Lung recurrence may have better outcomes than other recurrences. However, its detailed clinicopathological features are unclear. We investigated the clinicopathological features and risk factors for lung recurrence after pancreatectomy for PDAC. METHODS: The study included 161 patients with potentially and borderline resectable PDAC who had undergone R0 or R1 pancreatectomy between January 2008 and December 2016. We retrospectively examined the prognosis and predictors for lung recurrence after curative resection. RESULTS: Seventeen patients (10.6%) had isolated lung recurrence. The median overall and recurrence-free survivals were 38.0 and 16.1 months, respectively. In multivariate analysis, para-aortic lymph node (PALN) metastasis (p = 0.006) and female sex (p = 0.027) were independent factors for lung recurrence. CONCLUSION: Lung recurrence had a better prognosis than other recurrences. PALN metastasis and female sex are independent risk factors for lung recurrence after curative resection for PDAC.2022年03月, Asian journal of surgery, 46(1) (1), 207 - 212, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: Atezolizumab plus bevacizumab therapy is the new standard treatment option for advanced hepatocellular carcinoma (HCC). The clinical details and sequential course after atezolizumab plus bevacizumab therapy remain to be determined. PATIENTS AND METHODS: Thirty-four consecutive patients who received atezolizumab plus bevacizumab therapy were evaluated. Their clinical outcomes were assessed according to liver function classified by modified albumin-bilirubin (ALBI) grade 1 and 2a (1/2a) versus 2b and treatment line (first-line versus second- or later-line). Furthermore, the treatment sequence after atezolizumab plus bevacizumab therapy was also assessed. RESULTS: The objective response and disease control rates were 15.6% and 93.8%, respectively. The median proportions of ALBI scores at 1, 2, and 3 months relative to the baseline scores were 0.94, 0.97, and 0.93, respectively. The median proportions of α-fetoprotein (AFP) scores at 1, 2, and 3 months relative to the baseline scores were 0.98, 1.12, and 1.83, respectively. There were no significant differences in the changes in the proportions of AFP and ALBI scores according to both liver function and treatment line. Twelve patients were administered lenvatinib treatment after the failure of atezolizumab plus bevacizumab therapy. The proportions of AFP and ALBI scores at 1 month relative to the baseline scores were 0.55 and 0.81, respectively. CONCLUSION: Atezolizumab plus bevacizumab therapy can be effective for advanced HCC irrespective of the patients' liver function and treatment line. Lenvatinib administration after atezolizumab plus bevacizumab therapy can be effective, although special attention should be paid to the deterioration of liver function.2022年03月, Anticancer research, 42(3) (3), 1403 - 1412, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Immune checkpoint inhibitors prolong the survival of non-small cell lung cancer (NSCLC) patients. Although it has been acknowledged that there is some correlation between the efficacy of anti-programmed cell death-1 (PD-1) antibody therapy and immunohistochemical analysis, this technique is not yet considered foolproof for predicting a favorable outcome of PD-1 antibody therapy. We aimed to predict the efficacy of nivolumab based on a comprehensive analysis of RNA expression at the gene level in advanced NSCLC. METHODS: This was a retrospective study on patients with NSCLC who were administered nivolumab at the Kansai Medical University Hospital. To identify genes associated with response to anti-PD-1 antibodies, we grouped patients into responders (complete and partial response) and non-responders (stable and progressive disease) to nivolumab therapy. Significant genes were then identified for these groups using Welch's t-test. RESULTS: Among 42 analyzed cases (20 adenocarcinomas and 22 squamous cell carcinomas), enhanced expression of MAGE-A4, BBC3, and OTOA genes was observed in responders with adenocarcinoma, and enhanced expression of DAB2, HLA-DPB,1 and CDH2 genes was observed in responders with squamous cell carcinoma. CONCLUSIONS: This study predicted the efficacy of nivolumab based on a comprehensive analysis of mRNA expression at the gene level in advanced NSCLC. We also revealed different gene expression patterns as predictors of the effectiveness of anti PD-1 antibody therapy in adenocarcinoma and squamous cell carcinoma.2022年02月, BMC cancer, 22(1) (1), 154 - 154, 英語, 国際誌研究論文（学術雑誌）
- INTRODUCTION: Although the relationship between systemic inflammatory responses and prognosis has been known in various cancers, it remains unclear which scores are most valuable for determining the prognosis of extrahepatic cholangiocarcinoma. We aimed to verify the usefulness of various inflammation-based scores as prognostic factors in patients with resected extrahepatic cholangiocarcinoma. METHODS: We analyzed consecutive patients undergoing surgical resection for extrahepatic cholangiocarcinoma at our institution between January 2000 and December 2019. The usefulness of the following inflammation-based scores as prognostic factor was investigated: Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutrition index (PNI), C-reactive protein to albumin ratio (CAR), controlling nutritional status (CONUT), and prognostic index (PI). RESULTS: A total of 169 patients were enrolled in this study. Of the nine scores, CAR and CONUT indicated prognostic value. Furthermore, multivariate analysis for overall survival revealed that high CAR (>0.23) was an independent prognostic factor (HR: 1.816, 95%CI: 1.135-2.906, p=0.0129), along with lymph node metastasis and curability. There was no difference in tumor staging and short-term outcomes between the low CAR (≤ 0.23) and high CAR groups. CONCLUSIONS: CAR was the most valuable prognostic score in patients with resected extrahepatic cholangiocarcinoma.2022年01月, Digestive surgery, 39(2-3) (2-3), 65 - 74, 英語, 国際誌研究論文（学術雑誌）
- (株)癌と化学療法社, 2022年01月, 癌と化学療法, 49(1) (1), 80 - 82, 日本語
- INTRODUCTION: Although the primary treatment option for hilar cholangiocarcinoma (HC) has been surgical resection, most patients present with unresectable advanced tumors at the time of diagnosis. Particle therapy (PT) holds great potential for HC, even though the anatomical proximity to the gastrointestinal tract prevents delivering a radical dose to the tumor. Space-making PT (SMPT), consisting of spacer placement surgery and subsequent PT, has been developed to minimize complications and maximize the therapeutic benefit of dose escalation for HC. This study aimed to conduct a dosimetric evaluation and examine the effectiveness of SMPT for the treatment of HC. METHODS: Between 2007 and 2018, 12 patients with unresectable HC treated with SMPT were enrolled. The treatment outcomes and effectiveness of spacer placement surgery were evaluated through analyses of pre- and post-surgical parameters of dose-volume histograms. RESULTS: All patients completed the planned SMPT protocol. The median survival time was 29.6 months, and the 1- and 3-year overall survival rates were 82.5% and 45.8%, respectively. The mean V95% value (volume irradiated with 95% of the planned treatment dose) of the gross tumor volume and clinical target volume after spacer placement surgery improved to 98.5% and 96.6% from preoperative values of 85.6% and 78.1%, respectively (p = 0.0196 and p = 0.0053, respectively). Grade 3 or higher adverse events after SMPT were seen in 6 patients. DISCUSSION/CONCLUSION: SMPT led to improvements in dosimetric parameters and showed good feasibility and excellent outcomes. SMPT can be a promising novel alternative for unresectable HC.2022年, Digestive surgery, 39(2-3) (2-3), 99 - 108, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: Small proline-rich protein 1A (SPRR1A) is recognized as a squamous differentiation marker but is also upregulated in some non-squamous cancers. However, its expression in pancreatic ductal adenocarcinoma (PDAC) has not been investigated. This study elucidated the expression of SPRR1A in PDAC and its effect on the prognosis and malignant behavior of PDAC. METHODS: We examined the SPRR1A expression by immunohistochemistry in 86 surgical PDAC cases and revealed the relationship between its expression and the prognosis of the PDAC patients. Furthermore, we overexpressed SPRR1A in pancreatic cancer cell lines (PK-1 and Panc-1) and assessed the phenotype and gene expression changes in vitro. RESULTS: Among the 84 cases, excluding 2 with squamous differentiation, 31 (36.9%) had a high SPRR1A expression. The overall survival (median 22.1 months vs. 33.6 months, p = 0.0357) and recurrence-free survival (median 10.7 months vs. 15.5 months, p = 0.0298) were significantly lower in the high-SPRR1A-expression group than in the low-SPRR1A-expression group. A multivariate analysis indicated that a high SPRR1A expression (HR 1.706, 95% CI 1.018 to 2.862, p = 0.0427) and residual tumor status (HR 2.687, 95% CI 1.487 to 4.855, p = 0.00106) were independent prognostic factors. The analysis of TCGA transcriptome data demonstrated that the high-SPRR1A-expression group had a significantly worse prognosis than the low-SPRR1A-expression group, which supported our data. SPRR1A overexpression in PK-1 and Panc-1 did not result in remarkable changes to in vitro phenotypes, such as the cell proliferation, chemo-resistance, EMT, migration or global gene expression. CONCLUSION: Increased expression of SPRR1A is associated with a poor prognosis in PDAC and may serve as a novel prognostic marker. However, our in vitro study suggests that the SPRR1A expression may be a consequence, not a cause, of the aggressive behavior of PDAC.2022年, PloS one, 17(5) (5), e0266620, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Endoscopic duodenal stent placement is an alternative technique to gastrojejunostomy for gastric outlet obstruction due to pancreatic cancer. We compared the efficacy of endoscopic duodenal stent placement with that of gastrojejunostomy for treating patients with pancreatic cancer who are candidates for intensive combination chemotherapies as the first line of treatment. METHODS: This retrospective observational study included 100 patients from 18 institutions in Japan. Inclusion criteria were as follows: (1) cytologically or histologically confirmed adenocarcinoma of the pancreas, (2) good performance status, (3) gastric outlet obstruction scoring system score of 0-1 and (4) no history of treatment for pancreatic cancer. RESULTS: There was no significant difference in the background characteristics of patients in the endoscopic duodenal stent placement (n = 57) and gastrojejunostomy (n = 43) groups. The median overall survival in the endoscopic duodenal stent placement and gastrojejunostomy groups was 5.9 and 6.0 months, respectively. Clinical success was achieved in 93 cases; the median time to food intake resumption was significantly shorter in the endoscopic duodenal stent placement group (median: 3 days, n = 54) than in the gastrojejunostomy group (median: 5 days, n = 43). Chemotherapy was introduced in 63% of the patients in both groups after endoscopic duodenal stent placement or gastrojejunostomy. Chemotherapy was started earlier in the endoscopic duodenal stent placement group (median: 14 days) than in the gastrojejunostomy (median: 32 days) group. CONCLUSIONS: Endoscopic duodenal stent placement showed similar or better clinical outcomes than gastrojejunostomy. Thus, it might be a promising option in patients with good performance status.2021年12月, Japanese journal of clinical oncology, 52(2) (2), 134 - 142, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Hepatocellular carcinoma (HCC) with major portal vein tumor thrombus (Vp4 PVTT) is an extremely advanced tumor with limited treatment options. Systemic chemotherapy is the only recommended treatment option, and atezolizumab plus bevacizumab has recently emerged as a first-line treatment option. CASE PRESENTATION: We describe the case of an 82-year-old man with unresectable advanced HCC with Vp4 PVTT who achieved a significant response to atezolizumab plus bevacizumab treatment. A single administration of atezolizumab plus bevacizumab ensured significant anti-tumor effects (regression in the tumor size and PVTT, portal vein recanalization, and serum alfa-fetoprotein levels decreased from 90,770 to 89 ng/mL). The patient continued with atezolizumab monotherapy, and after nine consecutive regimens, there was no apparent sign of residual tumor. CONCLUSIONS: This case demonstrates the powerful anti-tumor effect of atezolizumab plus bevacizumab treatment for advanced HCC with Vp4 PVTT, suggesting that these agents can be a promising treatment option for such refractory tumors.2021年12月, BMC gastroenterology, 21(1) (1), 470 - 470, 英語, 国際誌研究論文（学術雑誌）
- (株)癌と化学療法社, 2021年12月, 癌と化学療法, 48(13) (13), 2008 - 2010, 日本語
- (株)癌と化学療法社, 2021年12月, 癌と化学療法, 48(13) (13), 2011 - 2013, 日本語
- A 68-year-old man who had undergone distal gastrectomy for gastric cancer 3 years previously, presented to our hospital for examination of dilatation of the main pancreatic duct on follow-up computed tomography and magnetic resonance cholangiopancreatography. After examination, he was diagnosed with early-stage pancreatic cancer and distal pancreatectomy (DP) was planned. With informed consent, we performed indocyanine green (ICG) fluorography during DP and digital subtraction angiography (DSA) of vessels supplying the remnant stomach immediately before and after DP. On ICG fluorography, the remnant stomach gradually became fluoresced starting at the area of the lesser curvature, and the fluorescence eventually intensified over the entire area of the remnant stomach to the same brightness as that of the liver and duodenum. On DSA following DP, the terminal branches of the left inferior phrenic artery (LIPA) were distributed to more than half of the area of the remnant stomach, centering around the proximal area. It is useful to confirm blood flows to the remnant stomach by ICG fluorography using a near-infrared imaging camera during DP. We found that the LIPA played an important role in maintaining the blood supply to the remnant stomach in the absence of the left gastric artery and splenic artery.2021年12月, Clinical journal of gastroenterology, 14(6) (6), 1749 - 1755, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Effects of pancreatectomy on glucose tolerance have not been clarified, and evidence regarding the difference in postoperative glucose tolerance between pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) is lacking. STUDY DESIGN: This prospective, single-center observational study analyzed 40 patients undergoing PD and 29 patients undergoing DP (Clinical trial registry number UMIN000008122). Glucose tolerance, including insulin secretion (Δ C-peptide immunoreactivity, ΔCPR) and insulin resistance (homeostasis model assessment of insulin resistance, HOMA-IR) were assessed before and 1 month after pancreatectomy using the oral glucose tolerance test (OGTT) and glucagon stimulation test. We assessed long-term hemoglobin A1c (HbA1c) levels in patients, with a follow-up time of 3 years. RESULTS: Percentages of patients diagnosed with abnormal OGTT decreased after PD (from 12 [30%] to 7 [17.5%] of 40 patients, p = 0.096); however, they increased after DP (from 4 [13.8%] to 8 [27.6%] of 29 patients, p = 0.103), although the changes were not statistically significant. ΔCPR decreased after both PD (from 3.2 to 1.0 ng/mL, p < 0.001) and DP (from 3.3 to 1.8 ng/mL, p < 0.001). HOMA-IR decreased after PD (from 1.10 to 0.68, p < 0.001), but did not change after DP (1.10 and 1.07, p = 0.42). Median HbA1c level was higher after DP than after PD for up to 3 years, but the differences were not statistically significant. CONCLUSIONS: In comparisons of pre- and 1 month post-pancreatectomy data, glucose tolerance showed improvement after PD, whereas it worsened after DP. Insulin secretion decreased after both PD and DP. Insulin resistance improved after PD, but did not change after DP. Further studies are warranted to clarify mechanisms of improved insulin resistance after PD.2021年12月, Journal of the American College of Surgeons, 233(6) (6), 753 - 762, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Although liver transplantation is widely accepted as the therapeutic strategy for end-stage liver failure, complication of hepatic venous outflow obstruction remains lethal. Currently, ensuring a single wide orifice in both the graft and recipient inferior vena cava has been proposed to avoid hepatic venous outflow obstruction with no theoretical concept. METHODS: We herein report a standardization technique for the reconstruction of the hepatic vein based on the causal analysis. RESULTS: During the put-in process, the graft must be positioned in contact with the recipient diaphragm and slightly pushed to the cranial direction to simulate the state after abdominal closure. Because there is no extra space between the graft and diaphragm, the graft could not rotate about the anastomotic site of the inferior vena cava toward the diaphragm after abdominal closure as the intestinal pressure increases, and accordingly hepatic venous outflow obstruction does not develop. CONCLUSIONS: With this concept, all transplant surgeons can successfully and easily perform hepatic vein reconstruction without total clamping of the inferior vena cava and without outflow block.2021年12月, Transplantation proceedings, 53(10) (10), 2934 - 2938, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Radiological detection of small liver metastasis or peritoneal metastasis is still difficult, and some patients with biliary tract cancer (BTC) are unresectable after laparotomy. Staging laparoscopy may help avoid unnecessary laparotomy. However, which category of BTC is amenable with staging laparoscopy remains unclear. AIM: To clarify the risk factors for occult metastasis in patients with BTC. METHODS: Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively reviewed. The patients were divided into two groups, according to resection or exploratory laparotomy (EL). Preoperative laboratory data, including inflammation-based prognostic scores and tumor markers, were compared between the two groups. Prognostic importance of detected risk factors was also evaluated. RESULTS: A total of 236 patients were enrolled in this study. Twenty-six (11%) patients underwent EL. Among the EL patients, there were 16 cases of occult metastasis (7 liver metastases and 9 abdominal disseminations). Serum carcinoembryonic antigen level, carbohydrate antigen 19-9 level, neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group, and these factors were prognostic. Among these factors, carcinoembryonic antigen > 7 ng/mL was the most useful to predict occult metastasis in BTC. When patients have more than three of these positive factors, the rate of occult metastasis increases. CONCLUSION: Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC; based on these factors, staging laparoscopy may reduce the rate of EL.2021年11月, World journal of clinical cases, 9(32) (32), 9770 - 9782, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: Sarcopenia has been reported to be a significant prognostic factor in patients with hepatocellular carcinoma in recent years. This study aimed to clarify the prognostic significance of sarcopenia in advanced hepatocellular carcinoma treated with reductive hepatectomy. PATIENTS AND METHODS: We retrospectively analyzed 93 patients who underwent reductive hepatectomy for advanced hepatocellular carcinoma. RESULTS: Median survival time of the sarcopenia group (16.4 months) was significantly shorter than that of the non-sarcopenia group (20.4 months). The overall survival rates at 1, 3, and 5 years of the sarcopenia group were significantly lower than those of the non-sarcopenia group (57.9%, 8.6%, and 2.9% vs. 67.3%, 29.2%, and 15.7%, respectively; p=0.035). On multivariate analysis, sarcopenia was a significant risk factor of overall survival (hazard ratio=1.60, 95% confidence interval=1.00-2.56, p=0.049). CONCLUSION: Sarcopenia was a significant prognostic factor of survival after reductive hepatectomy in advanced hepatocellular carcinoma.2021年11月, Anticancer research, 41(11) (11), 5775 - 5783, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Optimal treatment strategies for advanced hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) remain controversial. Therefore, this study aimed to assess the impact and predictive factors of hepatectomy for HCC with macroscopic PVTT. METHODS: This study included 100 patients who presented with intraoperatively confirmed PVTT extending to the first portal branch (Vp3), main portal trunk, or opposite-side portal branch (Vp4) between June 2000 and December 2019. Their postoperative outcomes and predictive factors for survival were evaluated. RESULTS: Of the 100 patients, 37 (37%) and 63 (63%) had Vp3 and Vp4 PVTTs, respectively. Moreover, 42 (42%) and 58 (58%) patients underwent R0/1 and R2 hepatectomies, respectively. The median survival time (MST) of all patients with Vp3/4 PVTT was 14.5 months; the 1- and 3-year overall survival rates were 59.6 and 16.8%, respectively. The MSTs of patients with Vp3 and Vp4 PVTTs were 16.1 and 14.3 months, respectively (P = 0.7098). The MSTs of patients who underwent R0/1 and R2 hepatectomies were 14.3 and 14.9 months, respectively (P = 0.3831). All assessed tumor factors (including the Vp status [Vp3 or Vp4], type of resection [R0/1 or R2], intrahepatic maximal tumor size, intrahepatic tumor number, and the existence of extrahepatic metastasis) did not influence the overall survival significantly. CONCLUSIONS: Tumor factors, such as the presence of a Vp3/4 PVTT, have a strong impact on survival; however, other multiple tumor factors have a limited impact. Hepatectomy can be an effective treatment option for HCC with Vp3/4 PVTT, and its indications should be considered.2021年10月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 英語, 国際誌研究論文（学術雑誌）
- Close attachment of soft tissues onto implantable devices inside the body is regarded as an optimal condition for preventing complications (e.g., infections and abscess formation around implants, and the migration of small injectable devices). We have recently reported that an α-type commercially pure Ti (CpTi) film after a long-term acid treatment and air drying showed a remarkable soft tissue adhesiveness immediately (i.e., within a few seconds) after the attachment onto soft tissues. Herein, we conducted acid treatment for (α + β)-type Ti-6Al-4V alloys and compared their mechanical properties and the immediate soft-tissue adhesiveness with α-type CpTi. The acid treatment for Ti-6Al-4V also promoted immediate soft-tissue adhesion, although the treatment was less effective than for CpTi. The tensile strength of acid-treated Ti-6Al-4V was much higher than that of acid-treated CpTi or human skin tissues, although the degree of hydrogen embrittlement was more severe than that for CpTi. These results suggest that the small amount of Al in the major α phase and/or the minor β phase of Ti-6Al-4V has a significant influence not only on the mechanical properties but also on the immediate soft-tissue adhesiveness of Ti-based solid-state adhesives after the acid treatment.2021年10月, Journal of materials chemistry. B, 9(39) (39), 8348 - 8354, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/AIM: While there is increasing evidence supporting the role of several first- and second-line treatment regimens for advanced hepatocellular carcinomas (HCC), the clinical relevance of rechallenge treatment with previously administered drugs, however, remains to be explored. PATIENTS AND METHODS: Five consecutive patients with advanced HCC who received lenvatinib rechallenge treatment after ramucirumab were assessed. RESULTS: All patients were clinically diagnosed with failure after ramucirumab treatment, and the frequencies of ramucirumab administration before lenvatinib re-administration ranged from 3 to 11. The alfa-fetoprotein level in four of five patients decreased 1 month after the lenvatinib rechallenge. Radiological findings via the modified Response Evaluation Criteria in Solid Tumors showed stable diseases in four patients and a partial response in one. CONCLUSION: Rechallenge treatment with lenvatinib after ramucirumab can be effective, and may be a treatment option for HCC in cases wherein the disease progressed after an initial response to lenvatinib treatment.2021年09月, Anticancer research, 41(9) (9), 4555 - 4562, 英語, 国際誌研究論文（学術雑誌）
- Invasive micropapillary carcinoma (IMPC) is a rare distinct histopathological subtype, characterized by the presence of carcinoma cells displaying reverse polarity. Only limited clinicopathological information is available regarding pancreatic IMPC. The aim of the present study was to clarify the clinicopathological features of pancreatic IMPC and the usefulness of protein kinase C (PKC)ζ immunostaining for the detection of reverse polarity. We reviewed 242 consecutive surgically resected specimens of pancreatic ductal adenocarcinoma and selected samples with an IMPC component. Clinicopathological characteristics were compared between the IMPC and non-IMPC groups. Immunohistochemical staining for PKCζ was performed using an autostainer. In total, 14 cases had an IMPC component (5.8%). The extent of IMPC component ranged from 5 to 20%. There were no significant differences in tumor location, T category, lymph node metastatic status, preoperative carbohydrate antigen 19-9 level, resection status and overall survival between the IMPC and non-IMPC groups. Immunostaining for PKCζ clearly showed reverse polarity of the neoplastic cells of IMPC. Although previous reports have shown that the presence of an IMPC component (>20% of the tumor) indicated poor prognosis, the present study demonstrated that presence of IMPC <20% did not suggest a worse prognosis.2021年07月, Oncology letters, 22(1) (1), 525 - 525, 英語, 国際誌研究論文（学術雑誌）
- Indication of Surgical Hepatectomy for the Patients of Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombosis.The prognosis of hepatocellular carcinoma (HCC) presenting with inferior vena cava tumor thrombus (IVCTT) is extremely poor. The aim of this study was to reveal the postoperative course and to identify patients who have survived surgical hepatectomy among HCC patients with IVCTT. Between January 2006 and December 2018, 643 patients underwent surgical hepatectomy for HCC at Kobe University Hospital. Among them, 20 patients were categorized as Vv3 according to the Japanese staging system. We retrospectively collected detailed data on these patients. The statistical, clinical, and pathological data were recorded prospectively and analyzed retrospectively. The median survival time was 9.8 months. Among all patients, 11 (55%) achieved R0 resection, and only two survivors were from this group. The number of tumors (solitary vs. multiple; p=0.050) and pathological Vp (pVp0 vs. other; p=0.009) were identified as risk factors for overall survival in the univariate analysis. In the multivariate analysis, pathological Vp (pVp0 vs. other; p=0.037) was identified as a significant prognostic factor for survival. Pathological Vp affected overall survival among IVCTT patients; the median survival time was 53.7 months with pVp0, 10.2 months with pVp1, and 8.8 months with pVp2-4 (p=0.035). For patients with IVCTT, surgical hepatectomy should be indicated only for those who do not have portal vein invasion and could achieve R0 resection.2021年06月, The Kobe journal of medical sciences, 67(1) (1), E10-E17, 英語, 国内誌研究論文（学術雑誌）
- (株)日本臨床社, 2021年04月, 日本臨床, 別冊(肝・胆道系症候群III) (肝・胆道系症候群III), 33 - 34, 日本語【肝・胆道系症候群(第3版)-その他の肝・胆道系疾患を含めて-肝外胆道編】肝外胆管(胆管、胆嚢管、総胆管) 腫瘍 胆管腺扁平上皮癌・扁平上皮癌
- BACKGROUND/AIM: Few studies have established a definite conclusion regarding the limitation of surgical treatment for patients with Barcelona Clinic Liver Cancer (BCLC) stage B and C hepatocellular carcinoma (HCC). PATIENTS AND METHODS: A retrospective analysis was performed on 717 consecutive patients who underwent initial hepatectomy for HCC. RESULTS: Reductive hepatectomy was performed in 103 patients, with a median survival time (MST) of 18.0 months. Total bilirubin and albumin levels were identified as independent prognostic factors. The predictive score of these factors ranged from 0 to 2. Subsequent local treatment was performed in 91.0, 75.0, and 25.0% of patients who scored 0, 1, and 2, respectively. The MST for patients with a score of 0, 1, and 2 was 20.1, 14.8, and 2.7 months, respectively, with a significant difference. CONCLUSION: Patients with BCLC stage B and C could be properly treated with reductive hepatectomy and subsequent local treatments.2021年04月, Anticancer research, 41(4) (4), 1975 - 1983, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Chemoradiotherapy is a treatment option for locally advanced pancreatic cancer. However, the efficacy of induction chemotherapy prior to chemoradiotherapy is uncertain. The aim of this randomized, multicentre phase II study is to evaluate the efficacy and safety of chemoradiotherapy with and without induction chemotherapy to determine the significance of induction chemotherapy. METHODS: Patients with locally advanced pancreatic cancer were randomly assigned to the chemoradiotherapy arm (Arm A) or induction chemotherapy followed by the chemoradiotherapy arm (Arm B). Patients in Arm A underwent radiotherapy with concurrent S-1. Patients in Arm B received induction gemcitabine for 12 weeks, and thereafter, only patients with controlled disease underwent the same chemoradiotherapy as Arm A. After chemoradiotherapy, gemcitabine was continued until disease progression or unacceptable toxicity in both arms. The primary endpoint was overall survival. RESULTS: Amongst 102 patients enrolled, 100 were eligible for efficacy assessment. The probability of survival was greater in Arm B in the first 12 months, but the trend was reversed in the following periods (1-year survival 66.7 vs. 69.3%, 2-year survival 36.9 vs. 18.9%). The hazard ratio was 1.255 (95% confidence interval 0.816-1.930) in favour of Arm A. Gastrointestinal toxicity was slightly more frequent and three treatment-related deaths occurred in Arm A. CONCLUSIONS: This study suggested that the chemoradiotherapy using S-1 alone had more promising efficacy with longer-term survival, compared with induction gemcitabine followed by chemoradiotherapy for locally advanced pancreatic cancer. CLINICAL TRIAL REGISTRATION: The study was registered at the UMIN Clinical Trials Registry as UMIN000006811.2021年02月, Japanese journal of clinical oncology, 51(2) (2), 235 - 243, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND/OBJECTIVES: Pancreatic neuroendocrine carcinoma (PanNEC)-G3 often presents along with genetic abnormalities such as KRAS, RB1, and TP53 mutations. However, the association between these genetic findings and response to chemotherapy and prognosis has not been clarified. This study aimed to clarify the clinicopathological features of PanNEC-G3. METHODS: We performed a subgroup analysis of the Japanese PanNEN-G3 study (multicenter, retrospective study), which revealed that Rb loss and KRAS mutation were predictors of the response to platinum-based regimen in PanNEN-G3. We re-classified WHO grades of PanNENs using the 2017 WHO classification and then analyzed the clinicopathological features and prognostic factors in 49 patients with PanNEC-G3. RESULTS: The rates of Rb loss and KRAS mutation in PanNEC-G3 were 54.5% and 48.7%, respectively. Patients with Rb loss and/or KRAS mutation showed a higher response rate to first-line platinum-based regimen than those without Rb loss or KRAS mutation (object response rate 70.0% vs 33.3%, odds ratio 9.22; 95% CI 1.26-67.3, P = 0.029), but tended to have shorter overall survival rates than those without Rb loss or KRAS mutation (median 239 vs 473 days, hazard ratio 2.11; 95% CI 0.92-4.86, P = 0.077). CONCLUSIONS: Patients with PanNEC-G3 have varied clinical outcomes for platinum-based regimen. When grouped based on Rb loss and KRAS mutation, there seemed to be two groups with distinct prognoses and responses to the platinum-based regimen. PanNEC-G3 could, therefore, be classified into two distinct groups based on immunohistochemical and genetic findings.2020年10月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 20(7) (7), 1421 - 1427, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Traditionally, the treatment options for unresectable locally advanced (UR-LA) and metastatic (UR-M) pancreatic ductal adenocarcinoma (PDAC) are palliative chemotherapy or chemoradiotherapy. The benefits of surgery for such patients remains unknown. The present study investigated clinical outcomes of patients undergoing conversion surgery (CS) after chemo(radiation)therapy for initially UR-PDAC. METHODS: We recruited patients with UR-PDAC who underwent chemo(radiation)therapy for initially UR-PDAC between April 2006 and September 2017. We analyzed resectability of CS, predictive parameters for overall survival, and early recurrence (within six months). RESULTS: A total of 468 patients (108 with UR-LA and 360 with UR-M PDAC) were enrolled in this study, of whom, 17 (15.7%) with UR-LA and 15 (4.2%) with UR-M underwent CS. The median survival time (MST) and five-year survival of patients who underwent CS was 37.2 months and 34%, respectively; significantly better than non-resected patients (nine months and 1%, respectively, p < 0.0001). MST did not differ according to UR-LA or UR-M (50.5 vs. 29.0 months, respectively, p = 0.53). Early recurrence after CS occurred in eight patients (18.8%). Lymph node metastasis, positive washing cytology, large tumor size (>35 mm), and lack of postoperative adjuvant chemotherapy were statistically significant predictive factors for early recurrence. Moreover, the site of pancreatic lesion and administration of postoperative adjuvant chemotherapy were statistically significant prognostic factors for overall survival in the patients undergoing CS. CONCLUSION: Conversion surgery offers benefits in terms of increase survival for initially UR-PDAC for patients who responded favorably to chemo(radiation)therapy when combined with postoperative adjuvant chemotherapy.2020年05月, Cancers, 12(6) (6), 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Although total tumour volume (TTV) may have prognostic value for hepatic resection in certain solid cancers, its importance in colorectal liver metastases (CRLM) remains unexplored. This study investigated its prognostic value in patients with resectable CRLM. METHOD: This was a retrospective review of patients who underwent hepatic resection for CRLM between 2008 and 2017 in a single institution. TTV was measured from CT images using three-dimensional construction software; cut-off values were determined using receiver operating characteristic (ROC) curve analyses. Potential prognostic factors, overall survival (OS) and recurrence-free survival (RFS) were determined using multivariable and Kaplan-Meier analyses. RESULTS: Some 94 patients were included. TTV cut-off values for OS and RFS were 100 and 10 ml respectively. Right colonic primary tumours, primary lymph node metastasis and bilobar liver metastasis were included in the multivariable analysis of OS; a TTV of 100 ml or above was independently associated with poorer OS (hazard ratio (HR) 6·34, 95 per cent c.i. 2·08 to 17·90; P = 0·002). Right colonic primary tumours and primary lymph node metastasis were included in the RFS analysis; a TTV of 10 ml or more independently predicted poorer RFS (HR 1·90, 1·12 to 3·57; P = 0·017). The 5-year OS rate for a TTV of 100 ml or more was 41 per cent, compared with 67 per cent for a TTV below 100 ml (P = 0·006). Corresponding RFS rates with TTV of 10 ml or more, or less than 10 ml, were 14 and 58 per cent respectively (P = 0·009). A TTV of at least 100 ml conferred a higher rate of unresectable initial recurrences (12 of 15, 80 per cent) after initial hepatic resection. CONCLUSION: TTV was associated with RFS and OS after initial hepatic resection for CRLM; TTV of 100 ml or above was associated with a higher rate of unresectable recurrence.2020年04月, BJS open[Epub ahead of print], 英語, 国際誌[査読有り]
- BACKGROUND: The albumin-bilirubin (ALBI) grade, stratified from the ALBI score, may have prognostic value in patients with hepatocellular carcinoma. We aim to evaluate the prognostic abilities of the ALBI score/grade among living-donor liver transplantation patients. METHODS: We retrospectively collected data of 81 patients who underwent living-donor liver transplant at Kobe University Hospital between June 2000 and October 2018. The efficacy of the ALBI score/grade as a prognostic factor was assessed and compared with that of the well-established Model for End-Stage Liver Disease (MELD) score. MAIN FINDINGS: Multivariate analysis indicated that recipient age (P = .003), donor age (P = .003), ALBI score ≥ -1.28 (P = .002), and ALBI grade III (P = .004) were independently associated with post-transplant survival. A high MELD score was not associated with post-transplant survival in univariate or multivariate analyses. Although there was no significant difference in the overall survival rate relative to recipient and donor age, ALBI score/grade was significantly associated with the 1- and 5-year survival rates (P = .023, P = .005). ALBI scores specifically detected fatal complications of post-transplant graft dysfunction (P = .031) and infection (P = .020). CONCLUSION: ALBI score/grade predicted patient survival more precisely than the MELD score did, suggesting that it is a more useful prognostic factor compared to the MELD score in living-donor liver transplantation cases.2020年04月, Transplantation proceedings, 52(3) (3), 910 - 919, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: The present study aimed to assess the clinical features of patients who received lenvatinib treatment for unresectable hepatocellular carcinoma (HCC). METHODS: The clinical characteristics, adverse events, and radiological responses were evaluated for 51 consecutive patients. RESULTS: Of the study subjects, 37 patients had Child-Pugh class A (CPA) liver function, and 14 patients had Child-Pugh class B (CPB) liver function. The overall response rates in the CPA and CPB groups were 42.9% and 25.0%, respectively, and disease control rates were 82.9% and 83.3%, respectively, without significant difference (p = 0.2621 and 0.9697). There was no significant difference between CPA and CPB groups regarding the incidence of adverse events, except for hepatic coma. No significant difference was observed in the relative dose intensity between the CPA and CPB groups, for the first month, 1-2 months, or 2-3 months (p = 0.2368, 0.9368, and 0.9293). CONCLUSION: The comparable outcomes between the CPA and CPB groups suggest the acceptability of lenvatinib treatment in patients with impaired liver function, at least in the acute phase. With careful follow-up, the dose can be relatively intensified, even in patients with impaired liver function and this may contribute to offering comparable treatment.2020年03月, HPB : the official journal of the International Hepato Pancreato Biliary Association, 22(10) (10), 1450 - 1456, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: This study evaluated the prognosis of hepatocellular carcinoma (HCC) patients with extrahepatic metastases who can undergo hepatectomy. METHODS: A total of 32 patients who underwent hepatectomy for HCC with extrahepatic metastases, including lymph node and/or distant metastases were recruited for this study. RESULTS: Fourteen patients had lymph node metastasis only, 16 had distant metastasis only, and 2 had both metastasis types during preoperative diagnosis. The 3-year overall survival (OS) rate of all patients was 17.9%, and the median survival time (MST) was 11.8 months. Univariate analysis revealed that intrahepatic maximal tumor size, intrahepatic tumor number, and intrahepatic tumor control after hepatectomy were significant factors influencing OS (p < 0.05). Multivariate analysis revealed that independent risk factors for OS were intrahepatic maximal tumor size and intrahepatic tumor number (p < 0.05). The MST and 3-year OS rate of patients with maximal tumor size <100 mm and intrahepatic tumor number ≤2 were 39.0 months and 51.9%, respectively. CONCLUSIONS: Hepatectomy is not recommended for HCC patients with extrahepatic metastasis with ≥3 intrahepatic tumors, even when all intrahepatic tumors can be eliminated via hepatectomy. Aggressive surgery may be justified for HCC patients with ≤2 intrahepatic tumors and maximal tumor size <100 mm, irrespective of vascular invasion.2020年, Digestive surgery, 37(5) (5), 411 - 419, 英語, 国際誌研究論文（学術雑誌）
- (株)医薬情報研究所, 2019年11月, 新薬と臨牀, 68(11) (11), 1429 - 1429, 日本語
- LESSONS LEARNED: The triple combination chemotherapy of SOXIRI (S-1/oxaliplatin/irinotecan) in patients with unresectable pancreatic ductal adenocarcinoma was an effective treatment that appeared to be better tolerated than the widely used FOLFIRINOX regimen.SOXIRI regimen may provide an alternative approach for advanced pancreatic cancer. BACKGROUND: In our previous phase I study, we determined the recommended dose of a biweekly S-1, oxaliplatin, and irinotecan (SOXIRI) regimen in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). This phase II study was conducted to assess the safety and clinical efficacy in patients with unresectable PDAC. METHODS: Patients with previously untreated metastatic and locally advanced PDAC were enrolled. The primary endpoint was response rate (RR). Secondary endpoints were adverse events (AEs), progression-free survival (PFS), and overall survival (OS). Patients received 80 mg/m2 of S-1 twice a day for 2 weeks in alternate-day administration, 150 mg/m2 of irinotecan on day 1, and 85 mg/m2 of oxaliplatin on day 1 of a 2-week cycle. RESULTS: Thirty-five enrolled patients received a median of six (range: 2-15) treatment cycles. The RR was 22.8% (95% confidence interval [CI]: 10.4-40.1); median OS, 17.7 months (95% CI: 9.8-22.0); and median PFS, 7.4 months (95% CI: 4.2-8.4). Furthermore, the median OS in patients with distant metastasis was 10.1 months, whereas that in patients with locally advanced PDAC was 22.6 months. Major grade 3 or 4 toxicity included neutropenia (54%), anemia (17%), febrile neutropenia (11%), anorexia (9%), diarrhea (9%), and nausea (9%). There were no treatment-related deaths. CONCLUSION: SOXIRI is considered a promising and well-tolerated regimen in patients with unresectable PDAC.2019年06月, The oncologist, 24(6) (6), 749-e224, 英語, 国際誌[査読有り]
- BACKGROUND: The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively. METHODS: We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS). RESULTS: Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3. CONCLUSION: The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.2019年05月, Annals of surgical oncology, 26(5) (5), 1385 - 1393, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- AIM: Follicular pancreatitis is a recently recognised, distinct clinicopathological entity characterised by the presence of many intrapancreatic lymphoid follicles with reactive germinal centres. However, the clinicopathological and immunological features and causes have not yet been established. We assessed the clinicopathological and immunological profiles of patients with follicular pancreatitis who underwent surgery. METHODS AND RESULTS: This study included three patients with pancreatic masses (age range = 62-75 years; women:men: 1:2). A histopathological study of the resected pancreatic masses revealed abundant lymphoid follicles with reactive germinal centres in both periductal regions and diffusely within the parenchyma. No storiform fibrosis, obliterative phlebitis or granulocytic epithelial lesions were observed. The immunohistochemical examination revealed an IgG4/IgG-positive plasma cell ratio <30% in all patients. Podoplanin (Th17 marker)-expressing lymphocytes were present in the lymphoid follicles of those with follicular pancreatitis, whereas these were absent in normal lymph nodes and in lymphoid follicles of those with IgG4-related autoimmune pancreatitis (AIP). An RNA digital counting assay clearly demonstrated that the expression counts of 20 genes, including dendritic cells and lymphoid follicles markers, and related cytokines were significantly higher in follicular pancreatitis than in IgG4-related AIP (P < 0.01). The expressions of CCR6 and IL23A, which are genes related to Th17, were high. CONCLUSIONS: This study shows that follicular pancreatitis is a histopathologically and immunologically distinct disease entity of pancreatitis and is characterised by upregulated Th17 expression.2019年04月, Histopathology, 74(5) (5), 709 - 717, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVE: Adipophilin is a lipid droplet-associated protein, and its expression has been correlated with aggressive clinical behavior in some types of carcinomas, though its role in pancreatic ductal adenocarcinoma (PDAC) has not been clarified. This study aimed to evaluate the role of adipophilin in PDAC. METHODS: By immunohistochemical staining using tissue microarrays, we analyzed the expression profiles of adipophilin in 181 consecutive PDAC patients who underwent macroscopic margin-negative resection from January 2008 to December 2015. Overall survival (OS) and recurrence-free survival (RFS) were compared based on adipophilin expression, and the risk factors for OS, RFS, and early recurrence (within 6 months) were analyzed. RESULTS: Of the 181 evaluated patients, 51 (28.2%) were positive for adipophilin expression. A histopathological grade of 3 (p = 0.0012), higher CA19-9 level (p = 0.0016), and R1 status (p = 0.028) were significantly associated with adipophilin-positive patients who had significantly poor OS and RFS compared to those associated with adipophilin-negative patients (p = 0.0007 and p = 0.0022, respectively). They also showed a significantly higher incidence of early recurrence (p = 0.030), based on multivariate analyses. CONCLUSIONS: Adipophilin is a potential independent prognostic marker for PDAC.2019年04月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 19(3) (3), 443 - 448, 英語, 国際誌[査読有り]
- BACKGROUND: Carbohydrate antigen (CA) 19-9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19-9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19-9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma. METHODS: Between 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [≤37 U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [> 37 U/ml] before neoadjuvant therapy but decreased levels [≤37 U/ml] afterwards), and Non-responder group (elevated levels [> 37 U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups. RESULTS: The Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P = 0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P = 0.934). According to the analysis of the receiver operating characteristic curve, the CA19-9 cut-off level defined as no elevation after neoadjuvant therapy was ≤103 U/ml. The multivariate analysis revealed that a CA19-9 level ≤ 103 U/ml, (P = 0.010, hazard ratio: 1.711; 95% confidence interval: 1.133-2.639), tumor size ≤27 mm (P = 0.040, 1.517; (1.018-2.278)), a lack of lymph node metastasis (P = 0.002, 1.905; (1.276-2.875)), and R0 status (P = 0.045, 1.659; 1.012-2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P = 0.058, P = 0.700 and P = 0.350, respectively). CONCLUSIONS: Decreased CA19-9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.2019年03月, BMC cancer, 19(1) (1), 252 - 252, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- One obstacle in diagnostic pathology is the harmonization of one drug-one diagnostic tests for programmed death ligand-1 (PD-L1). There are many challenges in accurate comparisons of diagnostic tests, such as differences in the titer of each antibody, detection system and dynamic range of visualization. Our previously developed digital immunostaining technique is highly sensitive and quantitative with the ability to quantify particles that bind in a one-to-one fashion with antibody in each cell. Determining the differences in the titer of each antibody with digital immunostaining may be beneficial for future harmonized analysis. To demonstrate the accuracy of digital immunostaining, the present study compared the number of particles with ELISA and nCounter data from five cell lines. NCI-H460 exhib-ited the highest level of PD-L1 protein, followed by A549, PC-3, NCI-H1299, and NCI-H446 cells. In addition, the PD-L1 mRNA values determined by nCounter corresponded with the order of the protein levels determined by ELISA. The present study revealed that digital immunostaining for PD-L1 was highly associated with ELISA and nCounter data. Among the four antibodies tested, the titer of all but SP142 coincided with ELISA and nCounter data. These results indicated that our digital immunostaining technique may be beneficial for future harmonized analysis.2019年03月, Molecular and clinical oncology, 10(3) (3), 391 - 396, 英語, 国際誌[査読有り]
- 2019年02月, JOURNAL OF CLINICAL ONCOLOGY, 37(4) (4), 英語
- 2019年02月, JOURNAL OF CLINICAL ONCOLOGY, 37(4) (4), 英語
- (公社)日本医学放射線学会, 2019年02月, Japanese Journal of Radiology, 37(Suppl.) (Suppl.), 36 - 36, 日本語巨大な胆嚢癌肉腫の1例
- BACKGROUND: Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated. METHODS: Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups. RESULTS: Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019). CONCLUSIONS: Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.2019年02月, World journal of surgery, 43(2) (2), 634 - 641, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- INTRODUCTION: The increased visceral fat in patients with obesity can increase the technical difficulty of surgery. This study was performed to evaluate a preoperative 20-day very low-calorie diet for obesity before laparoscopic gastrectomy for gastric cancer. METHODS: This prospective single-center study involved patients with obesity who were planning to undergo laparoscopic gastrectomy for gastric cancer. Obesity was defined according to the Japanese criteria: BMI ≥25 kg/m2 or waist circumference ≥85 cm in men and ≥90 cm in women. The patients underwent a preoperative 20-day very low-calorie diet and received nutritional counseling. Weight loss, body composition, visceral fat mass, and operative outcomes were evaluated. RESULTS: Thirty-three patients were enrolled from September 2013 to August 2015. Their median age was 71 years, and 78.8% were men. Their median bodyweight and BMI were 72.3 kg (range, 53.8-82.5 kg) and 26.0 kg/m2 (range, 23.5-31.0 kg/m2 ), respectively. The patients achieved a mean weight loss of 4.5% (95% confidence interval [CI]: 3.8-5.1), corresponding to 3.2 kg (95%CI: 2.7-3.7 kg). Body fat mass was significantly decreased by a mean of 2.5 kg (95%CI: 1.9-3.1), whereas skeletal muscle mass was unaffected (mean: -0.20 kg [95%CI: -0.55-0.15]). The visceral fat mass reduction rate was high as 16.8% (range, 11.6%-22.0%). All patients underwent laparoscopic gastrectomy as planned. Severe postoperative morbidity (Clavien-Dindo grade ≥III) was seen in only one patient (3.0%). CONCLUSION: The preoperative 20-day very low-calorie diet weight loss program is promising for the treatment of obesity before laparoscopic gastrectomy for gastric cancer.2019年01月, Asian journal of endoscopic surgery, 12(1) (1), 43 - 50, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Post-operative pancreatic fistula (POPF) is one of the most common and serious complications after pancreaticoduodenectomy (PD). The aim of this study is to retrospectively compare clinically relevant (CR) POPF and other complications after pacreaticojejunostomy (PJ) after modified Kakita (m-Kakita) or modified Blumgart (m-Blumgart) anastomoses without stenting in a single institution. METHODS: One hundred twenty-eight patients underwent PJ using m-Kakita anastomoses (two interrupted penetrating sutures) between January 2009 and December 2011. One hundred eighteen patients underwent m-Blumgart anastomoses (two transpancreatic/jejunal seromuscular sutures to cover the pancreatic stump with jejunal serosa) between January 2014 and December 2015. Demographics, clinical characteristics, and post-operative mortality and morbidity were retrospectively compared between the two groups. RESULTS: There were no significant differences in demographics or clinical characteristics between the two groups except operative time. A significantly lower rate of CR-POPF was found in the m-Blumgart group relative to the m-Kakita group (10% vs. 19%, p = 0.038). Univariate and multivariate analyses revealed that the m-Blumgart anastomosis and fistula risk category (Negligible, Low) were independently protective against CR-POPF (p < 0.05). CONCLUSION: This retrospective single-center study demonstrated that the modified Blumgart method without pancreatic duct stenting was associated with a lower rate of CR-POPF.2019年01月, Asian journal of surgery, 42(1) (1), 343 - 349, 英語, 国際誌[査読有り]
- BACKGROUND: There is no consensus on the optimal treatment of T1b gallbladder cancer (GBC) due to the lack of evidence and the difficulty of anatomy and pathological standardization. METHODS: A total of 272 patients with T1b GBC who underwent surgical resection at 14 centers with specialized hepatobiliary-pancreatic surgeons and pathologists in Korea, Japan, Chile, and the United States were studied. Clinical outcomes including disease-specific survival (DSS) rates according to the types of surgery were analyzed. RESULTS: After excluding patients, the 237 qualifying patients consisted of 90 men and 147 women. Simple cholecystectomy (SC) was performed in 116 patients (48.9%) and extended cholecystectomy (EC) in 121 patients (51.1%). The overall 5-year DSS was 94.6%, and it was similar between SC and EC patients (93.7% vs. 95.5%, P = 0.496). The 5-year DSS was similar between SC and EC patients in America (82.3% vs. 100.0%, P = 0.249) as well as in Asia (98.6% vs. 95.2%, P = 0.690). The 5-year DSS also did not differ according to lymph node metastasis (P = 0.688) or tumor location (P = 0.474). CONCLUSIONS: SC showed similar clinical outcomes (including recurrence) and survival outcomes as EC; therefore, EC is not needed for the treatment of T1b GBC.2018年12月, Journal of hepato-biliary-pancreatic sciences, 25(12) (12), 533 - 543, 英語, 国内誌[査読有り]
- 医学図書出版(株), 2018年11月, 胆と膵, 39(11) (11), 1207 - 1210, 日本語【DP(尾側膵切除術)を極める!】尾側膵切除術における膵断端処理法
- OBJECTIVES: Multiple programmed cell death ligand-1 (PD-L1) immunohistochemistry assays are currently used as companion or complementary diagnostic tools for anti-programmed cell death-1 immunotherapies. We aimed to characterize two PD-L1 immunohistochemistry assays (Dako 22C3 and 28-8) for non-small cell lung cancer (NSCLC) in clinical laboratories. MATERIALS AND METHODS: Surgical specimens from 420 patients with pathological stages IA to IIIA NSCLC were investigated. The archived samples were freshly cut into 5-μm-thick sections stained with antibodies 22C3 and 28-8, and tumoral PD-L1 expression was evaluated in two clinical laboratories, respectively. Overall, positive, and negative percent agreement (OPA, PPA, and NPA, respectively) at specified PD-L1 cutoffs were calculated to assess the concordance between 22C3 and 28-8 assays. RESULTS: Tumoral PD-L1 expression of ≥ 1% was detected by either 22C3 or 28-8 assays in 176 cases (41.9%), whereas 22C3 revealed a significantly higher tumoral PD-L1 expression compared to 28-8 (median 30% vs. 10%, p < 0.0001). OPA was 89.0, 90.2, and 91.9% at 1, 25, and 50% cutoff levels. When 22C3 was compared to a standard assay 28-8, the PPA was 85.5, 98.3, and 94.9%, whereas NPA was 91.0, 89.0, and 91.6% at 1, 25, and 50%. On the other hand, when 28-8 was compared to 22C3, PPA was 84.4% at 1%, but it decreased to 58.3 and 53.6% at 25 and 50%; whereas NPA remained high (91.7, 99.7, and 99.4% at 1, 25 and 50%, respectively). CONCLUSION: Our analysis revealed that, despite the high OPA, there was discordance in the PPA between 22C3 as a standard assay and 28-8 as a comparator assay at 25% and 50% PD-L1 cutoff levels, indicating that the results of 28-8 could be translated to those of 22C3 but not vice versa.2018年11月, Lung cancer (Amsterdam, Netherlands), 125, 230 - 237, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Objectives: The aim of this dual-center randomized controlled trial was to determine the optimal duration of antimicrobial prophylaxis in patients treated with pancreaticoduodenectomy (PD) who underwent preoperative biliary drainage (PBD) but were without cholangitis. Background: Some reports showed that PBD in patients undergoing pancreatectomy increased the rate of perioperative complications. However, no clinical trial has evaluated the optimal duration of antimicrobial prophylaxis with a focus on patients who underwent PD following PBD. Methods: A total of 82 patients who underwent PD between March 2012 and December 2016 were randomly assigned to either a 1-day group (n = 40), in which cefozopran (CZOP) as antimicrobial prophylaxis was given only on the day of surgery, or a 5-day group (n = 42), in which CZOP was given for 5 consecutive days beginning on the day of surgery. We evaluated the incidence of infectious and other complications after PD. Results: Outcomes were significantly better in the 1-day group compared with the 5-day group (P < 0.05) in terms of the incidence of overall infectious complications (15% vs 36%, respectively), intra-abdominal abscess (3% vs 21%, respectively), clinically relevant postoperative pancreatic fistula (8% vs 24%, respectively), and Clavien-Dindo grade III-V complications (10% vs 31%, respectively). Duration of postoperative hospital stay was significantly shorter in the 1-day group (10 days vs 15 days, P = 0.018). Anaerobic bacteria and methicillin-resistant cocci were isolated from the drainage fluid only among patients in the 5-day group. Conclusion: Single-day prophylactic use of CZOP is appropriate for patients who undergo PD following PBD without preoperative cholangitis.2018年11月, Annals of gastroenterological surgery, 2(6) (6), 442 - 450, 英語, 国内誌[査読有り]
- (株)篠原出版新社, 2018年08月, 癌の臨床, 64(2) (2), 97 - 102, 日本語【腹膜播種治療の今】膵癌腹膜転移の診断と治療
- (株)メディカルレビュー社, 2018年08月, 膵・胆道癌Frontier, 7(2) (2), 64 - 71, 日本語膵・胆道癌高齢患者に対する積極的抗癌治療
- (株)ライフメディコム, 2018年06月, カレントテラピー, 36(6) (6), 588 - 588, 日本語【膵疾患の診断と治療-21世紀の進歩とUp-to-date】Key words 膵癌のconversion surgery
- (株)医学書院, 2018年06月, 臨床外科, 73(6) (6), 724 - 730, 日本語【こうやって教える・学ぶ 高難度消化器外科手術-新エキスパートへの登竜門】肝胆膵 Soft pancreasに対する開腹膵頭十二指腸切除術
- Mixed adenoneuroendocrine carcinoma (MANEC) is defined as a tumor that has morphologically recognizable both adenocarcinoma and neuroendocrine carcinoma components comprising at least 30% of either components. MANEC occurring in the ampulla of Vater is extremely rare, and only 16 cases have been reported in the English language literature. In the present report, we describe the first case of MANEC of the ampulla of Vater with immunocytochemical analyses. An 82-year-old Japanese male was incidentally found to have a tumorous lesion in the ampulla of Vater. Endoscopic ultrasound-fine needle aspiration (EUS-FNA) of the tumor was performed. The Papanicolaou smear demonstrated the presence of different three components. The most dominant component was cohesive clusters of small round cells with round to oval nuclei with powdery chromatin and scant cytoplasm, which corresponded to small cell carcinoma. The second component was an adenocarcinoma, which was composed of irregularly overlapping clusters of tall columnar cells with large round to oval nuclei containing conspicuous nucleoli. The third component was an adenoma, which was comprised of flat cohesive clusters of columnar cells without atypia. Immunocytochemical analyses demonstrated that synaptophysin was expressed in the small round cells, and cdx-2 was expressed in all three components. Accordingly, a cytodiagnosis of MANEC with adenoma component was made. Preoperative diagnosis of ampullary MANEC is difficult. However, this report clearly demonstrates three different components in the EUS-FNA cytological specimen. Therefore, we suggest that cytological examination is a useful method for diagnosis of MANEC of the ampulla of Vater.2018年06月, Diagnostic cytopathology, 46(6) (6), 540 - 546, 英語, 国際誌[査読有り]
- 2018年05月, JOURNAL OF CLINICAL ONCOLOGY, 36(15) (15), 英語
- (株)へるす出版, 2018年05月, 消化器外科, 41(6) (6), 897 - 902, 日本語【膵癌に挑む】膵切除後膵液瘻の予防と対策
- (株)日本メディカルセンター, 2018年05月, 臨床消化器内科, 33(7) (7), 946 - 949, 日本語【膵癌update】トピックス 腹膜播種の化学療法 腹膜転移膵癌の化学療法
- 日本胆膵病態・生理研究会, 2018年05月, 胆膵の病態生理, 34(1) (1), 13 - 16, 日本語切除不能膵癌における栄養と炎症から見た治療成績とConversion surgery予測因子としてのHigh Sensitivity modified Glasgow Prognostic Scoreの有効性の検討
- BACKGROUND/OBJECTIVE: Although single-incision laparoscopic cholecystectomy (SILC) has no advantage over conventional laparoscopic cholecystectomy (LC), except for better cosmesis, few reports have discussed the criteria for SILC. The aim of this study was to evaluate the suitability of our criteria for SILC. METHODS: During the study period, SILC was performed at our institution under the following criteria. The inclusion criteria were elective surgery, age of < 60 years, and body mass index of < 30 kg/m2. The exclusion criteria were a thick gallbladder wall, history of choledocholithiasis, previous abdominal surgery, and serious concomitant disease. We reviewed data regarding consecutive patients who underwent LC at our institution from November 2009 to March 2016. The data were assessed with respect to patient characteristics, operative data, and postoperative outcomes. RESULTS: A total of 1093 patients underwent elective LC, and 232 (21.2%) of these patients underwent SILC using our criteria. Fourteen patients (6.0%) who underwent SILC required extra ports. Among the patients aged < 60 years, 50.2% (232/462) underwent SILC. There were few adverse events, including intra- and postoperative complications, among the patients who underwent SILC. CONCLUSION: The above-mentioned criteria are safe, necessary, and sufficient for SILC over conventional LC.2018年05月, Asian journal of surgery, 41(3) (3), 216 - 221, 英語, 国際誌[査読有り]
- (一社)日本病理学会, 2018年04月, 日本病理学会会誌, 107(1) (1), 316 - 316, 日本語Follicular pancreatitis3例の臨床病理学的特徴及び網羅的遺伝子解析
- 大道学館出版部, 2018年03月, 臨牀と研究, 95(3) (3), 304 - 306, 日本語十二指腸乳頭部癌における至適リンパ節郭清に関する検討
- PURPOSE: To determine the recommended dose (RD) of gemcitabine (GEM) plus S-1 (GS) in curatively resected biliary tract cancer (BTC) patients without major hepatectomy. METHODS: A standard 3 + 3 dose-escalation design was used with planned dose levels (mg/m2) of GEM (administered intravenously on days 1 and 8) and S-1 (administered orally twice daily on days 1-14, with a 1-week rest, every 3 weeks for up to 24 weeks) of 1000/80 (Level 2), 1000/65 (Level 1), 800/65 (Level - 1), and 800/50 (Level - 2). RESULTS: Thirty-one patients (17 men and 14 women; median age, 70 years) were enrolled. Level 1 was chosen as the starting dose. Three of seven patients developed dose-limiting toxicities at Level 1 and the dose was de-escalated to Level - 1. Five of 12 patients developed Grade 4 neutropenia at Level - 1 and the dose was de-escalated to Level - 2. One patient developed Grade 4 neutropenia at Level - 2. Another patient was unable to receive the day 8 dose due to Grade 3 neutropenia at Level - 2. Level - 1 was confirmed as the maximum tolerated dose and Level - 2 the RD for this regimen. The 1- and 2-year recurrence-free survival rates were 77.0 and 54.0%, respectively. The recurrence-free survival rate of patients in the GS completion group was significantly higher than that of the GS discontinuation group. CONCLUSIONS: Level - 2 was confirmed as the RD (GEM 800 mg/m2 and S-1 50 mg/m2) for GS adjuvant chemotherapy in curatively resected BTC patients without major hepatectomy.2018年03月, Cancer chemotherapy and pharmacology, 81(3) (3), 461 - 468, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- We investigated the efficacy of a Wilms' tumor gene 1 (WT1) vaccine combined with gemcitabine (GEMWT1) and compared it with gemcitabine (GEM) monotherapy for advanced pancreatic ductal adenocarcinoma (PDAC) in a randomized phase II study. We randomly assigned HLA-A*02:01- or HLA-A*24:02-positive patients with advanced PDAC to receive GEMWT1 or GEM. We assessed WT1-specific immune responses via delayed-type hypersensitivity (DTH) to the WT1 peptide and a tetramer assay to detect WT1-specific cytotoxic T lymphocytes (WT1-CTL). Of 91 patients enrolled, 85 were evaluable (GEMWT1: n = 42; GEM: n = 43). GEMWT1 prolonged progression-free survival [PFS; hazard ratio (HR), 0.66; P = 0.084] and improved overall survival rate at 1 year (1-year OS%; GEMWT1: 35.7%; GEM: 20.9%). However, the difference in OS was not significant (HR: 0.82; P = 0.363). These effects were particularly evident in metastatic PDAC (PFS: HR 0.51, P = 0.0017; 1-year OS%: GEMWT1 27.3%; GEM 11.8%). The combination was well tolerated, with no unexpected serious adverse events. In patients with metastatic PDAC, PFS in the DTH-positive GEMWT1 group was significantly prolonged, with a better HR of 0.27 compared with the GEM group, whereas PFS in the DTH-negative GEMWT1 group was similar to that in the GEM group (HR 0.86; P = 0.001). DTH positivity was associated with an increase in WT1-CTLs induced by the WT1 vaccine. GEM plus the WT1 vaccine prolonged PFS and may improve 1-year OS% in advanced PDAC. These clinical effects were associated with the induction of WT1-specific immune responses. Cancer Immunol Res; 6(3); 320-31. ©2018 AACR.2018年03月, Cancer immunology research, 6(3) (3), 320 - 331, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- (株)南江堂, 2018年01月, 外科, 80(1) (1), 51 - 56, 日本語【進行消化器癌のconversion surgery】膵臓癌 切除不能膵癌
- OBJECTIVES: We retrospectively investigated the operative outcomes of patients who underwent distal pancreatectomy (DP) for invasive pancreatic ductal adenocarcinoma (PDAC) located at the body and tail. METHODS: Data from 395 patients with PDAC who underwent DP with margin-negative resection (R0 or R1) were collected from seven high-volume centers in Japan from 2001 to 2012. Among them, 72 patients underwent DP with en-bloc celiac axis resection (DP-CAR). The remaining 323 patients underwent conventional DP with splenectomy (DP-S). To determine the efficacy of DP-CAR, clinicopathological data were compared between the DP-CAR and the DP-S groups. RESULTS: The DP-S group consisted mainly of patients with resectable disease (93%), and conversely, all patients in the DP-CAR group had borderline resectable or unresectable disease. The overall morbidity was significantly higher in the DP-CAR group than in the DP-S group (63% vs 47%, respectively; P = 0.017). The median survival time (MST) of the DP-CAR group was significantly shorter than that of the DP-S group (17.5 vs 28.6 months, respectively; P = 0.004). However, the MST of patients in the DP-CAR group (n = 61, 85%) who received adjuvant therapy was significantly longer than that of patients in the DP-S group (n = 65, 20%) who underwent R1 resection (21.9 vs 16.7 months, respectively; P = 0.024). CONCLUSION: DP-CAR followed by adjuvant chemotherapy provided an acceptable overall survival rate in patients with highly advanced PDAC, but should be performed with great caution because of high morbidity. Patients with a high risk of positive surgical margins with DP-S may be candidates for DP-CAR.2018年01月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 18(1) (1), 106 - 113, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Celsius Publishing House, 2017年12月, Journal of Translational Medicine and Research, 22(4) (4), 334 - 341, 英語[査読有り]研究論文（学術雑誌）
- PURPOSE: The safety and efficacy of reinforced staplers during distal pancreatectomy (DP) remain controversial because of the small sample size. This multicenter single-arm prospective study aims to evaluate the safety and efficacy of reinforced staplers with bioabsorbable material during DP. METHODS: Between October 2014 and August 2015, 121 patients scheduled for DP were enrolled in this study at 11 institutions in Japan. The primary endpoint was the incidence of clinically relevant pancreatic fistula. Protocol treatment was defined as "distal pancreatectomy using reinforced staplers." RESULTS: Per-protocol analysis of 105 patients was performed; 16 of the patients were excluded based on discontinuation of protocol treatment criteria. Clinically relevant pancreatic fistula occurred in 13 (12.4%) of 105 patients. The overall morbidity rate was 29.5% (31 of 105 patients) and severe complication (Clavien classification IIIa or more) was 10.5% (11/105). Mortality rate was 0%, although reoperations were performed on two patients (1.9%). Multivariate logistic regression analysis of independent risk factors for clinically relevant pancreatic fistula after DP using reinforced stapler closure was operative time more than 240 min (P = 0.047, odds ratio 5.79), registration numbers less than 10 (P = 0.046, odds ratio 13.01), and staple line hemorrhage (P = 0.003, odds ratio 16.34). CONCLUSION: This study confirms the safety of reinforced staplers for pancreatic stump closure during DP. However, the efficacy of reinforced staplers for decreasing clinically relevant pancreatic fistula could not be drawn from this study. TRIAL REGISTRATION: This prospective study was registered with ClinicalTrials.gov (NCT02270554) and UMIN Clinical Trial Registry (UMIN000015384).2017年12月, Langenbeck's archives of surgery, 402(8) (8), 1197 - 1204, 英語, 国際誌[査読有り]
- (株)医学書院, 2017年11月, 臨床外科, 72(12) (12), 1318 - 1322, 日本語【徹底解説!ここが変わった膵癌診療-新規約・ガイドラインに基づいて】膵癌集学的治療の最前線 切除不能膵癌に対するconversionsurgery
- 医学図書出版(株), 2017年11月, 胆と膵, 38(11) (11), 1249 - 1253, 日本語【局所進行膵癌の治療限界に挑む】局所進行切除不能膵癌のconversion surgeryへのタイミング
- BACKGROUND: Even though most patients who undergo resection of pancreatic adenocarcinoma have T3 disease with extra-pancreatic tumor extension, T3 disease is not currently classified by tumor size. The aim of this study was to modify the current TNM classification of pancreatic adenocarcinoma to reflect the influence of tumor size. METHODS: A total of 847 consecutive pancreatectomy patients were recruited from multiple centers. Optimum tumor size cutoff values were calculated by receiver operating characteristics analysis for tumors limited to the pancreas (T1/2) and for T3 tumors. In our modified TNM classification, stage II was divided into stages IIA (T3aN0M0), IIB (T3bN0M0), and IIC (T1-3bN1M0) using tumor size cutoff values. The usefulness of the new classification was compared with that of the current classification using Akaike's information criterion (AIC). RESULTS: The optimum tumor size cutoff value distinguishing T1 and T2 was 2 cm, while T3 was divided into T3a and T3b at a tumor size of 3 cm. The median survival time of the stages IIA, IIB, and IIC were 44.7, 27.6, and 20.3 months, respectively. There were significant differences of survival between stages IIA and IIB (P = 0.02) and between stages IIB and IIC (P = 0.03). The new classification showed better performance compared with the current classification based on the AIC value. CONCLUSIONS: This proposed new TNM classification reflects the influence of tumor size in patients with extra-pancreatic tumor extension (T3 disease), and the classification is useful for predicting mortality.2017年11月, World journal of surgery, 41(11) (11), 2867 - 2875, 英語, 国際誌[査読有り]
- 2017年10月, ANNALS OF ONCOLOGY, 28, 英語Comparison Study of PD-L1 Immunohistochemistry Assays with 22C3 and 28-8: Analysis on 147 Surgically Resected NSCLC
- (株)南江堂, 2017年10月, 外科, 79(10) (10), 949 - 954, 日本語【消化器癌腹膜播種の最新知見】膵癌における腹腔内化学療法
- PURPOSE: We examined the clinical significance of duodenogastric regurgitation (DGR) as a late complication in the long-term follow-up after hepaticoduodenostomy (HD) as a reconstruction surgery for congenital biliary dilatation (CBD). METHODS: Seventeen patients with CBD were retrospectively analyzed for late complications (mean follow-up, 16.8 years). All patients had undergone total resection of the extrahepatic bile duct followed by HD. DGR was identified using endoscopic examination, intraluminal bile monitoring, and liver scanning. RESULTS: DGR was found in all 17 patients by endoscopic examination and intraluminal bile monitoring. Fourteen of the 17 (82.4%) patients with DGR had experienced abdominal symptoms since a mean of 6.9 years postoperatively. Liver scanning also revealed apparent DGR in all 14 symptomatic patients. We converted 7 of the 14 patients to hepaticojejunostomy reconstruction at a mean of 13.0 years after the initial excisional surgery. Their symptoms were completely relieved postoperatively. CONCLUSIONS: DGR is an important complication after HD. Examination of patients for the development of DGR is an essential part of long-term follow-up in patients with CBD who have undergone HD as a reconstruction surgery. Conversion surgery is recommended in patients with DGR accompanied by long-term abdominal symptoms. LEVELS OF EVIDENCE: Level IV.2017年10月, Journal of pediatric surgery, 52(10) (10), 1621 - 1624, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Primary hepatic neuroendocrine carcinomas are extremely rare. Because of the rarity of PHNEC, its clinical features and treatment outcomes are not well understood. A proper diagnosis and the correct therapeutic approach therefore remain clinically challenging. CASE PRESENTATION: A 67-year-old man was admitted to our department because of a liver tumor. Computed tomography revealed a single liver tumor 50 mm in diameter and located in the S3 region. Biopsy and imaging findings resulted in a diagnosis of primary hepatic neuroendocrine carcinoma. Left lateral segmentectomy was performed. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, and CD56. Ki-67 was positive in > 90% of the tumor cells. The final diagnosis was primary hepatic neuroendocrine carcinoma. The patient suffered two episodes of lymph node recurrence. Nonetheless, the tumor was excised to prolong survival. Thus, after lymphadenectomy, he received adjuvant chemotherapy for 6 months. Two years after surgery, the patient remains alive and in good general condition. CONCLUSIONS: In most cases, primary hepatic neuroendocrine carcinoma, while extremely rare, has a poor prognosis. At present, surgical resection is a priority for curative treatment, but in patients with recurrence, combined therapies are recommended.2017年09月, Surgical case reports, 3(1) (1), 102 - 102, 英語, 国際誌[査読有り]
- (株)南江堂, 2017年09月, 外科, 79(9) (9), 838 - 843, 日本語【急性腹症に対する低侵襲アプローチ-適応と手技】急性胆嚢炎
- BACKGROUND: The aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan. METHODS: Data were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements ≥7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. RESULTS: The number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio -0.499, P = 0.008) and incisional surgical site infection (odds ratio -0.999, P < 0.001). CONCLUSION: Standardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.2017年09月, Journal of hepato-biliary-pancreatic sciences, 24(9) (9), 501 - 510, 英語, 国内誌[査読有り]
- Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable responses to platinum-based chemotherapy. Recent studies indicated that PanNEN-G3 includes well-differentiated neuroendocrine tumor with G3 (NET-G3). Here, we examined the clinicopathologic and molecular features of PanNEN-G3 and assessed the responsiveness to chemotherapy and survival.Experimental Design: A total of 100 patients with PanNEN-G3 were collected from 31 institutions, and after central review characteristics of each histologic subtype [NET-G3 vs. pancreatic neuroendocrine carcinoma (NEC-G3)] were analyzed, including clinical, radiological, and molecular features. Factors that correlate with response to chemotherapy and survival were assessed.Results: Seventy patients analyzed included 21 NETs-G3 (30%) and 49 NECs-G3 (70%). NET-G3 showed lower Ki67-labeling index (LI; median 28.5%), no abnormal Rb expression (0%), and no mutated KRAS (0%), whereas NEC-G3 showed higher Ki67-LI (median 80.0%), Rb loss (54.5%), and KRAS mutations (48.7%). Chemotherapy response rate (RR), platinum-based chemotherapy RR, and prognosis differed significantly between NET-G3 and NEC-G3. Chemotherapeutic outcomes were worse in NET-G3 (P < 0.001). When we stratified PanNEN-G3 with Rb and KRAS, PanNENs-G3 with Rb loss and those with mutated KRAS showed significantly higher RRs to platinum-based chemotherapy than those without (Rb loss, 80% vs. normal Rb, 24%, P = 0.006; mutated KRAS, 77% versus wild type, 23%, P = 0.023). Rb was a predictive marker of response to platinum-based chemotherapy even in NEC-G3 (P = 0.035).Conclusions: NET-G3 and NEC-G3 showed distinct clinicopathologic characteristics. Notably, NET-G3 does not respond to platinum-based chemotherapy. Rb and KRAS are promising predictors of response to platinum-based chemotherapy for PanNEN-G3, and Rb for NEC-G3. Clin Cancer Res; 23(16); 4625-32. ©2017 AACR.2017年08月, Clinical cancer research : an official journal of the American Association for Cancer Research, 23(16) (16), 4625 - 4632, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis. For the development of more effective immunotherapies, it is first necessary to elucidate the immunological escape mechanisms. In this study, we applied our recently developed highly sensitive immunostaining method employing fluorescent phosphor-integrated dot (PID) nanoparticles to evaluate the prevalence of programmed death ligand 1 (PD-L1) in patients with PDAC. METHODS: This study included 42 patients with PDAC who underwent pancreatectomy. We evaluated PD-L1 expression in these patients using PID staining and correlated PD-L1 expression level with each patient's clinico-pathological features. RESULTS: PD-L1 expression was detected in 61.9% (26/42) of the patients with PDAC by PID staining. There was a significant difference in overall survival between PD-L1-positive and PD-L1-negative patients [hazard ratio (HR) 2.07, 95% confidence interval (CI) 1.00-4.54; P = 0.049]. Among CD8+-tumor-infiltrating lymphocyte-positive cases, the overall survival of PD-L1-positive patients was significantly poorer than that of PD-L1-negative patients (HR 3.84, 95% CI 1.59-10.35; P = 0.003). Univariate and multivariate analyses indicated that PD-L1 expression was an independent predictive poor prognostic factor in patients with PDAC. CONCLUSIONS: PD-L1 expression appears to be an important prognostic factor in patients with PDAC who underwent surgical resection.2017年08月, International journal of clinical oncology, 22(4) (4), 726 - 733, 英語, 国内誌[査読有り]
- BACKGROUND: Post-operative pancreatic fistula (POPF) is one of the most common causes of death following pancreaticoduodenectomy (PD). The aim of this study was to evaluate the clinical effect of a long-internal stent on the development of POPF in patients with a main pancreatic duct diameter of 3 mm or less. STUDY DESIGN: Patients (N = 108) with a main pancreatic duct (≤3 mm) who underwent PD were included in this single-institution historical control study. Between January 2012 and December 2013, 54 patients had undergone PJ with a long-internal stent across the duct-to-mucosa anastomosis (long-stent group), and between February 2009 and December 2011, 54 patients had undergone PJ without a stent (control). RESULTS: There was no significant difference between groups (long-stent vs control) in the incidence of POPF (70% vs. 56%, p = 0.110) and grade B/C POPF (26% vs. 26%, p = 1.000). Univariate analysis identified body mass index, extent of blood loss and soft pancreatic parenchyma as risk factors related to POPF. Multivariate analysis identified extent of blood loss and soft pancreatic parenchyma as significant risk factors. CONCLUSION: Placement of a long-internal stent during PJ did not reduce POPF after PD in patients with a main pancreatic duct of small diameter.2017年06月, International journal of surgery (London, England), 42, 158 - 163, 英語, 国際誌[査読有り]
- BACKGROUND: We evaluated the clinical efficacy of intravenous (i.v.) and intraperitoneal (i.p.) paclitaxel (PTX) combined with S-1 in patients with chemotherapy-naïve pancreatic ductal adenocarcinoma (PDAC) with peritoneal metastasis. METHODS: Forty-nine patients were diagnosed with peritoneal metastasis during 2007-2014; 29 received gemcitabine or S-1-based chemo(radio)therapy from 2007 to 2011 (control group), and the remaining 20 received i.v. (50 mg/m2 ) and i.p. (20 mg/m2 ) PTX on days 1 and 8, and S-1 at 80 mg/m2 per day for 14 consecutive days, followed by 7 days of rest from 2012 to 2014 (study group). RESULTS: The median survival time in the study group was significantly longer than that in the control group (20 vs. 10 months, respectively; P = 0.004). At 1 year after initial treatment, a significant difference in ascites development on CT was found between the study (5/20 patients) and the control group (18/29 patients, P = 0.009). The frequency of objective response (9/20 patients) and conversion surgery (6/20 patients) in the study group was higher than those in the control group (8/29 and 2/29, respectively). Patients who underwent conversion surgery had improved survival in both groups. CONCLUSION: Implementation of the S-1+i.v./i.p. PTX regimen was closely associated with improved overall survival in PDAC patients with peritoneal metastasis.2017年05月, Journal of hepato-biliary-pancreatic sciences, 24(5) (5), 289 - 296, 英語, 国内誌[査読有り]
- PURPOSE: Non-inferiority for overall survival (OS) following alternate-day treatment with the oral anticancer drug S-1 compared with standard daily treatment was assessed in Japanese patients with unresectable advanced pancreatic cancer in a multicenter, randomized, phase II study. This trial was registered at the UMIN Clinical Trials Registry (no. 000008604). METHODS: Chemotherapy-naïve patients with locally advanced or metastatic pancreatic cancer were randomly assigned 2:1 to treatment with alternate-day (twice daily on alternate days from days 1 through 42 of a 42-day cycle) or daily (twice daily on days 1 through 28 of a 42-day cycle) treatment with S-1. The primary endpoint was OS. Secondary endpoints were progression-free survival (PFS), time to treatment failure, response rate, quality of life assessments, and safety. RESULTS: A total of 190 patients were enrolled, of which 185 were included in the final analysis (alternate-day: 121; daily: 64). Median OS was 9.4 for the alternate-day group and 10.4 months for the daily group [hazard ratio (HR), 1.19; 95% credible interval, 0.86 to 1.64], indicating that non-inferiority of alternate-day treatment to daily treatment was not demonstrated. Median PFS was 3.0 for the alternate-day group and 4.2 months for the daily group (HR, 1.65; 95% credible interval, 1.20-2.29). The incidence of anorexia, fatigue, neutrophils, pigmentation, and pneumonitis was lower in alternate-day treatment compared with daily treatment. CONCLUSION: S-1 for advanced pancreatic cancer should be taken daily as recommended, based on the decreased OS and PFS and marginal improvement in safety observed in the alternate-day group.2017年04月, Cancer chemotherapy and pharmacology, 79(4) (4), 813 - 823, 英語, 国際誌[査読有り]
- 2017年02月, Surgery, 161(2) (2), 565 - 566, 英語, 国際誌[査読有り]
- OBJECTIVE: To evaluate the clinical efficacy and tolerability of intravenous (i.v.) and intraperitoneal (i.p.) paclitaxel combined with S-1, "an oral fluoropyrimidine derivative containing tegafur, gimestat, and otastat potassium" in chemotherapy-naive pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal metastasis. BACKGROUND: PDAC patients with peritoneal metastasis (peritoneal deposits and/or positive peritoneal cytology) have an extremely poor prognosis. An effective treatment strategy remains elusive. METHODS: Paclitaxel was administered i.v. at 50 mg/m and i.p. at 20 mg/m on days 1 and 8. S-1 was administered at 80 mg/m/d for 14 consecutive days, followed by 7 days of rest. The primary endpoint was 1-year overall survival (OS) rate. The secondary endpoints were antitumor effect and safety (UMIN000009446). RESULTS: Thirty-three patients who were pathologically diagnosed with the presence of peritoneal dissemination (n = 22) and/or positive peritoneal cytology (n = 11) without other organ metastasis were enrolled. The tumor was located at the pancreatic head in 7 patients and the body/tail in 26 patients. The median survival time was 16.3 (11.47-22.57) months, and the 1-year survival rate was 62%. The response rate and disease control rate in assessable patients were 36% and 82%, respectively. OS in 8 patients who underwent conversion surgery was significantly higher than that of nonsurgical patients (n = 25, P = 0.0062). Grade 3/4 hematologic toxicities occurred in 42% of the patients and nonhematologic adverse events in 18%. One patient died of thrombosis in the superior mesenteric artery. CONCLUSIONS: This regimen has shown promising clinical efficacy with acceptable tolerability in chemotherapy-naive PDAC patients with peritoneal metastasis.2017年02月, Annals of surgery, 265(2) (2), 397 - 401, 英語, 国際誌[査読有り]
- BACKGROUND: The efficacy of neoadjuvant chemoradiotherapy (NACRT) and subset of pancreatic ductal adenocarcinoma (PDAC) patients who are most likely to benefit from this strategy remain elusive. The aim of this study was to investigate the effects of NACRT in patients with resectable (R) or borderline resectable (BR) adenocarcinoma of the pancreatic head. BR diseases were classified into two groups: lesions involving exclusively the portal vein system (BR-PV) and those abutting the major artery (BR-A). METHODS: A total of 504 patients treated with curative intent for PDAC were analyzed (R, n = 273; BR-PV, n = 129; BR-A, n = 102). Patients who underwent upfront surgery and those who underwent NACRT followed by surgery were compared using propensity score-matched and inverse probability of treatment-weighted analyses (UMIN000019719). RESULTS: No significant differences were noted in the incidences of curative resection among the three categories (R, BR-PV and BR-A). Propensity score-weighted logistic regression analysis revealed that the incidence of pathologically positive resection margins was reduced by NACRT only for BR patients. Among the propensity score-matched patients, NACRT rather than upfront surgery significantly prolonged the median survival time of BR-PV patients (28.4 vs. 20.1 months; P = 0.044) but not that of R-PDAC patients (28.6 vs. 33.7 months; P = 0.960). NACRT prolonged the median survival time of BR-A patients (18.1 vs. 10.0 months; P = 0.046), but the results remained unsatisfactory. CONCLUSIONS: These findings suggest that NACRT improves R0 rates and increases the survival of patients with BR-PV adenocarcinoma of the pancreatic head but not that of patients with R-PDAC.2017年01月, Journal of gastroenterology, 52(1) (1), 81 - 93, 英語, 国内誌[査読有り]
- Clinical outcomes of pancreatic ductal adenocarcinoma resection following neoadjuvant chemoradiation therapy vs. chemotherapy.PURPOSE: We compared the clinical outcomes of pancreatic ductal adenocarcinoma (PDAC) resection after neoadjuvant chemoradiation therapy (NACRT) vs. chemotherapy (NAC). METHODS: The study population comprised 81 patients with UICC stage T3/4 PDAC, treated initially by NACRT with S-1 in 40 and by NAC with gemcitabine + S-1 in 41. This was followed by pancreatectomy with routine nerve plexus resection in 35 of the patients who had received NACRT and 32 of those who had received NAC. We compared the survival curves and clinical outcomes of these two groups. RESULTS: The rates of clinical response, surgical resectability, and margin-negative resection were similar. The NACRT group patients had significantly higher rates of Evans stage ≥IIB tumors (29 vs. 0 %, respectively, p = 0.010) and negative lymph nodes (49 vs. 16 %, respectively, p = 0.021) than the NAC group patients. There was no difference in disease-free survival between the groups, but the disease-specific survival of the NAC group patients was better than that of the NACRT group patients (p = 0.034). Patients undergoing pancreatectomy with nerve plexus resection following NACRT had significantly higher rates of intractable diarrhea and ascites but consequently received significantly less adjuvant chemotherapy and therapeutic chemotherapy for relapse. CONCLUSION: NACRT followed by pancreatectomy with nerve plexus resection is superior for achieving local control, but postoperative diarrhea and ascites may prohibit continuation of adjuvant chemotherapy or chemotherapy for relapse (UMIN4148).2017年01月, Surgery today, 47(1) (1), 84 - 91, 英語, 国内誌[査読有り]
- Acute median arcuate ligament syndrome after pancreaticoduodenectomy.Median arcuate ligament syndrome (MALS) has been reported in 2-7.6 % of patients undergoing pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and treated radiologically or surgically before or during PD. MALS can have an acute postoperative onset after PD even if all preoperative and intraoperative evaluations are normal particularly in young patients.In this report, we present a second case of severe hepatic cytolysis secondary to MALS that developed acutely and the first patient who required acute division of the median arcuate ligament after PD.2016年12月, Surgical case reports, 2(1) (1), 113 - 113, 英語, 国際誌[査読有り]
- OBJECTIVES: We aimed to identify risk factors for latent distant organ metastasis in patients with radiographically defined locally advanced (RDLA) pancreatic ductal adenocarcinoma (PDAC). METHODS: RDLA disease was defined as unresectable disease without distant organ metastasis based on resectability status by NCCN guidelines. Between January 2005 and November 2015, 110 consecutive patients underwent staging laparoscopy to rule out latent distant metastasis. Univariate and multivariate analyses were performed to identify risk factors for latent distant organ metastasis or peritoneal metastasis (PM), defined as peritoneal dissemination and/or positive peritoneal lavage cytology (PPC). RESULTS: Latent distant organ metastasis was diagnosed by staging laparoscopy in 62 patients. PPC was found in 23%, peritoneal dissemination in 19%, and liver metastasis in 15%. Univariate analysis showed tumor location, preoperative CA 19-9 level and tumor size, and multivariate analysis revealed tumor size >55 mm and CA 19-9 level >60 IU/ml as risk factors for latent distant metastasis. Multivariate analysis showed pancreas body-tail tumors and tumor size >42 mm as risk factors for PM; 65.4% of pancreas body-tail tumors >42 mm had PM. CONCLUSIONS: Patients with large pancreas body-tail tumors and high CA 19-9 level are at greater risk for latent distant organ metastasis or PM, and should undergo staging laparoscopy routinely for accurate diagnosis (UMIN000023125).2016年12月, Journal of hepato-biliary-pancreatic sciences, 23(12) (12), 750 - 755, 英語, 国内誌[査読有り]
- PURPOSE: The aim of this pilot study is to confirm the safety and efficacy of neoadjuvant therapy and also treatment duration efficacy using modified FOLFIRINOX for patients with borderline resectable pancreatic cancer (BRPC). METHODS: The study is a prospective multicenter pilot trial conducted on patients with BRPC. Intervention for clinical trials: Modified FOLFIRINOX (without bolus 5-FU and LV, also decreased the dose of irinotecan; FIRINOX) was given to the first five patients in the 4-cycle group of the regimen and next five patients in the 8-cycle group. The primary end point was the toxicity of the therapy and one of the secondary end points were the optimal duration. RESULTS: The overall rate of grade 3 and 4 events was 80 %: 3 patients (60 %) in the four-cycle group and five patients (100 %) in the eight-cycle group had grade 3 or 4 adverse events. There was no incidence of serious adverse effect such as febrile neutropenia, sepsis, liver abscess or uncontrollable diarrhea. There was no clinically relevant morbidity presented in patients who underwent surgery. R0 rates by intention to treat were 60.0 % in the four-cycle group and 40 % in the eight-cycle group (P = 0.999). The histopathologic treatment effect based on the Evans grade revealed grade I (n = 1), IIa (n = 3) in the four-cycle group and grade I (n = 2), IIa (n = 1) in the eight-cycle group. CONCLUSIONS: FIRINOX therapy was feasible and safe for strictly selected patients with BRPC. Four cycles of FIRINOX would be sufficient for patients with BRPC as neoadjuvant therapy.2016年10月, Cancer chemotherapy and pharmacology, 78(4) (4), 719 - 26, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVE: The aim of this study was to reappraise the clinical role of total pancreatectomy with curative intent in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: In 2001 to 2011 database from 7 institutions in Japan, 45 (3.1%) of 1451 patients with PDAC underwent total pancreatectomy (TP group), and 885 patients underwent pancreaticoduodenectomy (PD group). A matched-pairs group consisted of 45 patients matched for age, sex, year, resectability status, and neoadjuvant therapy (matched-PD group). Clinicopathological data, overall survival, and disease-free survival were compared between groups. RESULTS: Clinical features of the TP group revealed higher-stage disease, greater surgical stress, a higher frequency of lymph node metastasis, and a lower adjuvant chemotherapy completion rate compared with the PD group (P < 0.05). Overall survival and disease-free survival in the TP group were significantly worse than those in the PD group (P < 0.05). Multivariate analysis revealed resectability status, neoadjuvant therapy, blood transfusion, lymph node metastasis, and adjuvant therapy to be significant prognostic factors. No differences in mortality and morbidity rates were observed between the 2 groups. A matched-pairs analysis revealed similar surgical outcomes and overall survival. CONCLUSIONS: The surgical outcome of total pancreatectomy for patients with PDAC is acceptable. When margin-negative resection is expected, total pancreatectomy should not be abandoned in the modern era.2016年08月, Pancreas, 45(7) (7), 1003 - 9, 英語, 国際誌[査読有り]
- PURPOSE: We report a duodenal stump reinforcement procedure in laparoscopic distal gastrectomy with Roux-en-Y reconstruction. METHODS: We retrospectively reviewed the data of 223 patients who underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer. We compared 2 groups: group NR (not reinforced, n=102, June 2009 to December 2011) when we did not perform reinforcement of the duodenal stump, and group R (reinforced, n=121, January 2012 to July 2014) when we did the reinforcement. The duodenum was divided with an endoscopic linear stapler. In group R, the duodenal staple line was reinforced by hand-sewn Lembert's sutures. RESULTS: There were no significant differences between group NR and R in patients' characteristics. Duodenal stump leakage occurred in 2 patients in group NR (2.0%). By contrast, in R group, no patients had duodenal stump leakage or fistula. CONCLUSIONS: Duodenal stump leakage can be avoided by using reinforcement with Lembert's sutures.2016年08月, Surgical laparoscopy, endoscopy & percutaneous techniques, 26(4) (4), 338 - 42, 英語, 国際誌[査読有り]
- 2016年07月, Surgery, 160(1) (1), 252 - 254, 英語, 国際誌[査読有り]
- 2016年05月, JOURNAL OF CLINICAL ONCOLOGY, 34(15) (15), 英語[査読有り]
- 2016年05月, JOURNAL OF CLINICAL ONCOLOGY, 34(15) (15), 英語[査読有り]
- 2016年04月, GASTROENTEROLOGY, 150(4) (4), S319 - S319, 英語[査読有り]
- 医学図書出版(株), 2016年03月, 胆と膵, 37(3) (3), 265 - 269, 日本語【イラストでみる最新の胆・膵消化管吻合術】膵体尾部切除術における膵断端処理 膵尾側断端膵管胃粘膜吻合法の実際と治療成績
- BACKGROUND: The aim of this randomized controlled trial (RCT) was to investigate whether pancrelipase protects against nonalcoholic fatty liver disease (NAFLD) development after pancreatoduodenectomy in patients with pancreatic cancer better than conventional pancreatic enzyme supplementation. METHODS: A total of 57 patients were randomly assigned to the study group (n = 29; pancrelipase replacement therapy) or the control group (n = 28; conventional pancreatic enzyme supplementation). NAFLD was defined as a liver-to-spleen attenuation ratio less than 0.9 on CT. Clinical and laboratory findings were also assessed. RESULTS: NAFLD was observed in 6/29 patients (21%) in the study group, and 11/28 patients (39%) in the control group, but this was not a statistically significant difference. In the control group, crossover to pancrelipase replacement therapy upon NAFLD diagnosis produced improvement in five out of 10 patients. Multivariate analysis showed that advanced age and extended resection were independent risk factors for NAFLD development. CONCLUSION: This RCT did not show a significant protective effect of pancrelipase replacement therapy over conventional pancreatic enzyme supplementation on NAFLD development after pancreatoduodenectomy for pancreatic cancer. Further studies are clearly required to investigate the etiology of and new therapeutic strategies for treatment-resistant NAFLD (UMIN 000019817).2016年03月, Journal of hepato-biliary-pancreatic sciences, 23(3) (3), 167 - 73, 英語, 国内誌[査読有り]
- BACKGROUND: The optimal therapeutic strategy for very elderly pancreatic cancer patients remains to be determined. The aim of this study was to clarify the role of pancreatic resection in patients 80 years of age or older. METHODS: A retrospective multicenter analysis of 1401 patients who had undergone pancreatic resection for pancreatic cancer was performed. The patients aged ≥ 80 years (n = 99) were compared with a control group <80 years of age (n = 1302). RESULTS: There were no significant differences in the postoperative complications and mortality between the two groups. However, the prognosis of octogenarians was poorer than that of younger patients for both resectable and borderline resectable tumors. Importantly, there were few long-term survivors in the elderly group, especially among those with borderline resectable pancreatic cancer. A multivariate analysis of the prognostic factors in the very elderly patients indicated that the completion of adjuvant chemotherapy was the only significant factor. In addition, preoperative albumin level was the only independent risk factor for a failure to complete adjuvant chemotherapy. CONCLUSION: This study demonstrates that the postoperative prognosis in octogenarian patients was not good as that in younger patients possibly due to less frequent completion of adjuvant chemotherapy.2016年03月, Journal of hepato-biliary-pancreatic sciences, 23(3) (3), 188 - 97, 英語, 国内誌[査読有り]
- (株)医学書院, 2016年02月, 臨床外科, 71(2) (2), 206 - 210, 日本語潜在性腹膜転移膵癌治療におけるconversion surgeryの役割
- (株)ヴァンメディカル, 2016年02月, 消化器の臨床, 19(1) (1), 62 - 66, 日本語【胆道癌・膵癌に対する化学療法の最前線】膵癌 腹膜転移を有する膵癌に対する化学療法
- BACKGROUND: The aim of current study is to verify usefulness of staging laparoscopy (stag-lap) for patient's selection and to find prognostic factors in patients with radiographically defined locally advanced (RD-LA) pancreatic ductal adenocarcinoma (PDAC). METHODS: The LA disease was defined as an unresectable disease without distant organ metastasis based on resectability status of NCCN guideline in this study. Stag-lap was performed in 67 patients with RD-LA (2007-2012) which were divided into 4 groups according to metastatic site: group CY (peritoneal fluid or washing cytology positive and without any distant organ metastasis); group P (peritoneal dissemination); group L (liver metastasis); group LA (peritoneal fluid or washing cytology negative and without any distant organ metastasis). Clinical backgrounds, survival curves, and prognostic factors were investigated. RESULTS: There were 16 patients in CY group (24%), 13 patients in P group (19%), 10 patients in L group (15%), and 28 patients in LA group (42%). Median survival time was 13 months in CY group and 11 months in LA group, which was significantly better than 7 months in P group, respectively (p<0.05). The rate of emergence of ascites in LA was significantly better than in CY or P groups (p<0.05). Multivariate analysis showed that the presence of partial response and administration of second-line chemotherapy were significantly independent prognostic factors. CONCLUSIONS: The majority of PDAC patients with RD-LA had occult distant organ metastasis. Clinical features and survival curves were different depending on the site of occult distant organ metastasis. Administration of second-line chemotherapy and responsiveness to chemotherapy were associated with favorable prognosis. Staging laparoscopy should be routinely performed in patients with RD-LA PDAC (UMIN000019936).2016年01月, World journal of surgical oncology, 14(1) (1), 14 - 14, 英語, 国際誌[査読有り]
- BACKGROUND: The objective of this study was to determine the recommended dose (RD) of a biweekly S-1, oxaliplatin, and irinotecan (SOXIRI) regimen in patients with unresectable pancreatic ductal adenocarcinoma. METHODS: This phase I study used a traditional "3+3" dose-escalation design, with four dose levels. A dose-escalation schedule consisted of two doses of S-1 (60 and 80 mg/m(2) twice daily) for 2 weeks in alternate-day administration, three doses of irinotecan (125, 150, and 180 mg/m(2)) on day 1, and a single dose of oxaliplatin (85 mg/m(2)) on day 1 of a 2-week cycle. Dose-limiting toxicities (DLTs) were assessed in the first four cycles to determine the maximum tolerated dose. This clinical study was registered at UMIN000014339. RESULTS: Fifteen patients received this regimen (median, eight cycles; range 4-12). At dose level 3 (S-1, 80 mg/m(2); irinotecan, 150 mg/m(2)), 2/6 patients experienced DLTs of grade 3 fatigue and grade 4 neutropenia. At dose level 4, all three patients experienced DLTs: grade 3 fatigue (n = 1) and grade 4 neutropenia (n = 2). The RD was 80, 85, and 150 mg/m(2) of S-1, oxaliplatin, and irinotecan, respectively. We found the following: response rate, 47 %; disease control rate, 80%; median progression-free survival, 6.7 months; overall survival, 13.4 months. CONCLUSIONS: The SOXIRI regimen's RD is 80, 85, and 150 mg/m(2) of S-1, oxaliplatin, and irinotecan, respectively.2016年01月, Cancer chemotherapy and pharmacology, 77(1) (1), 35 - 41, 英語, 国際誌[査読有り]
- The present study was conducted to determine whether active hexose correlated compound (AHCC), a functional food extracted from cultured basidiomycetes, possesses the potential to attenuate adverse events in unresectable pancreas ductal adenocarcinoma (PDAC) patients receiving chemotherapy. Unresectable PDAC patients receiving gemcitabine treatment (GEM) as the first-line chemotherapy were prospectively divided into 2 groups according to AHCC intake (AHCC group, n = 35) or not (control group, n = 40). The patients in the AHCC group ingested 6.0 g of AHCC for 2 mo. Hematological and nonhematological toxicity was compared between the AHCC and control groups. The C-reactive protein (CRP) elevation and albumin decline of the AHCC group were significantly suppressed as compared to the control group during the GEM administration (P = 0.0012, P = 0.0007). Patients in the AHCC group had less frequency of taste disorder caused by GEM (17% vs. 56%, P = 0.0007). Frequency of grade 3 in the modified Glasgow Prognostic Score (mGPS) during chemotherapy was found significantly less in the AHCC group (14%) than the control group (53%, P = 0.0005). AHCC intake can be effective in reducing the adverse events associated with chemotherapy and may contribute to maintaining the QOL of patients with PDAC during GEM administration.2016年, Nutrition and cancer, 68(2) (2), 234 - 40, 英語, 国際誌[査読有り]
- BACKGROUND: This study aimed to evaluate the impact of preoperative biliary drainage (PBD) on the long-term survival of patients with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy (PD). METHODS: A multicenter observational study was performed using a common database of patients with resected PDAC from seven high-volume surgical institutions in Japan. RESULTS: Of 932 patients who underwent PD for PDAC, 573 (62 %) underwent PBD, including 407 (44 %) who underwent endoscopic biliary drainage (EBD) and 166 (18 %) who underwent percutaneous transhepatic biliary drainage (PTBD). The patients who did not undergo PBD and those who underwent EBD had a significantly better overall survival than those who underwent PTBD, with median survival times of 25.7 months (P < 0.001), 22.3 months (P = 0.001), and 16.7 months, respectively. Multivariate analysis showed that seven clinicopathologic factors, including the use of PTBD but not EBD, were independently associated with poorer overall survival. Furthermore, patients who underwent PTBD more frequently experienced peritoneal recurrence (23 %) than those who underwent EBD (10 %; P < 0.001) and those who did not undergo PBD (11 %; P = 0.001). Multivariate analysis demonstrated that the independent risk factors for peritoneal recurrence included surgical margin status (P < 0.001) and use of PTBD (P = 0.004). CONCLUSIONS: Use of PTBD, but not EBD, was associated with a poorer prognosis, with an increased rate of peritoneal recurrence among patients who underwent PD for PDAC.2015年12月, Annals of surgical oncology, 22 Suppl 3, S1238-46, 英語, 国際誌[査読有り]
- (株)メディカルレビュー社, 2015年10月, 膵・胆道癌Frontier, 5(2) (2), 60 - 67, 日本語GEM+nab-PTXとFOLFIRINOXの使用経験と今後の展望
- BACKGROUND: The aim of this study was to evaluate the validity of preoperative resectability status, as defined by the National Comprehensive Cancer Network (NCCN), from the viewpoint of overall survival. METHODS: A total of consecutive 704 patients with pancreatic head carcinoma who underwent pancreatoduodenectomy with upfront surgery at seven Japanese hospitals between 2001 and 2012 were evaluated retrospectively. According to the NCCN definition of preoperative resectability status, tumors were divided into resectable tumors without vascular contact (R group), resectable tumors with portal or superior mesenteric vein (PV/SMV) contact of ≦180° (R-PV group), borderline resectable(BR) tumors with PV/SMV contact of >180° (BR-PV group), and BR tumors with arterial contact (BR-A group). The relationship between the NCCN definition of preoperative resectability status and overall survival was analyzed. RESULTS: Of the 704 patients, 389, 114, 145, and 56 were classified into the R group, the R-PV group, the BR-PV group, and the BR-A group, respectively. Overall survival of the BR-PV and BR-A groups was significantly worse than that of the R group and R-PV groups (P < 0.05), although there was no significant difference in overall survival between the R group and the R-PV group (P = 0.310). Multivariate analysis revealed that PV/SMV contact of >180° (P = 0.008) and arterial contact (P < 0.001) were independent prognostic factors of overall survival. CONCLUSION: From the viewpoint of overall survival, the NCCN definition of preoperative resectability status was valid.2015年09月, World journal of surgery, 39(9) (9), 2306 - 14, 英語, 国際誌[査読有り]
- 2015年08月, Journal of the American College of Surgeons, 221(2) (2), e15-9, 英語, 国際誌[査読有り]
- (株)アークメディア, 2015年07月, 肝・胆・膵, 71(1) (1), 55 - 61, 日本語【新 膵癌治療-アブラキサン・FOLFIRINOXをどう使うか】切除不能進行膵癌の化学療法 潜在性腹膜転移を有する膵癌患者に対するS-1+パクリタキセル経静脈・腹腔内併用療法
- BACKGROUND: The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the postoperative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery. METHODS: Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis. RESULTS: In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p < 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein invasion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without. CONCLUSIONS: Some pancreatic cancer patients with metastatic PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients.2015年06月, Journal of gastroenterology, 50(6) (6), 694 - 702, 英語, 国内誌[査読有り]
- 2015年05月, JOURNAL OF CLINICAL ONCOLOGY, 33(15) (15), 英語Interim safety analysis of a randomized phase II trial comparing alternate-day oral therapy using S-1 with the standard regimen as a first-line treatment for patients with advanced pancreatic cancer
- 2015年05月, PANCREATOLOGY, 15(3) (3), 240 - 246, 英語[査読有り]研究論文（学術雑誌）
- 2015年04月, GASTROENTEROLOGY, 148(4) (4), S1182 - S1182, 英語Randomized Clinical Trial of Duct-to-Mucosa Pancreaticogastrostomy of Pancreatic Stump Versus Hand-Sewn Closure After Distal Pancreatectomy
- (株)メディカルレビュー社, 2015年03月, 膵・胆道癌Frontier, 5(1) (1), 44 - 47, 日本語期待される最新研究 腹膜転移を有する膵癌に対するS-1+PTX経静脈・腹腔内併用療法の研究
- PURPOSE: Gemcitabine/cisplatin combination therapy has been the standard palliative chemotherapy for patients with advanced biliary tract cancer (BTC). We aimed to evaluate the efficacy and safety of adding S-1 to gemcitabine/cisplatin combination therapy for patients with advanced BTC. METHODS: Patients with histologically or cytologically confirmed unresectable or recurrent BTC were eligible for inclusion. The primary end point was overall survival. Based on the results of our preceding phase I study, gemcitabine and cisplatin were administered intravenously at doses of 1,000 or 25 mg/m(2), respectively, on day 1, and oral S-1 was administered daily at a dose of 80 mg/m(2) on days 1-7 every 2 weeks. This study was registered with ClinicalTrials.gov (NCT01284413) and the UMIN Clinical Trials Registry (ID 000004468). RESULTS: Fifty patients enrolled between October 2011 and August 2012 were evaluated. After a median follow-up of 15.1 months (range 2.4-24.4 months), the median overall survival time was 16.2 months [95% confidence interval (CI) 10.2-22.2 months], and the one-year overall survival rate was 59.9% (95% CI 46.2-73.5%). The grade 3-4 hematological toxicities were as follows: neutropenia (32%), anemia (32%), thrombocytopenia (10%), and febrile neutropenia (4%). The common grade 3-4 non-hematological toxicities were biliary tract infection (14%), anorexia/nausea (10%), and fatigue (8%). CONCLUSIONS: Gemcitabine/cisplatin/S-1 combination chemotherapy offered a promising survival benefit with manageable toxicity in patients with advanced BTC. A randomized phase III trial to investigate the efficacy of this regimen compared to gemcitabine/cisplatin combination therapy in patients with advanced BTC is now underway (UMIN000014371/NCT02182778).2015年02月, Cancer chemotherapy and pharmacology, 75(2) (2), 293 - 300, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVE: The objective of the present study was to reappraise the clinical value of peritoneal washing cytology (CY) in 984 pancreatic ductal adenocarcinoma patients who underwent margin-negative resection. METHODS: In a 2001-2011 database from seven high-volume surgical institutions in Japan, 69 patients (7%) had positive CY (CY+ group) indicative of M1 disease and 915 patients had negative CY (CY- group). Clinicopathological data and survival were compared between groups. RESULTS: Significant correlations between CY+ and high CA19-9 level, pancreatic body and tail cancer, lymph node metastasis, and a lower frequency of R0 resection were observed. Overall survival (OS) of CY+ patients was significantly worse than that of CY- patients (median survival time [MST], 16 vs. 25 months; 3-year OS rate, 6 vs. 37%; p < 0.001). CY+ patients had a significantly higher rate of post-operative peritoneal carcinomatosis than CY- patients (48 vs. 21%; p < 0.001). Administration of adjuvant chemotherapy did not provide a favorable survival outcome to CY+ patients. The current study showed that patients with M1 disease had acceptable MST after margin-negative resection and a high incidence of peritoneal carcinomatosis within 3 years after surgery, resulting in decreased long-term survival. The development of a new strategy to control peritoneal carcinomatosis when surgical resection is performed in such patients is required.2015年01月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 19(1) (1), 6 - 14, 英語, 国際誌[査読有り]
- (株)医学書院, 2014年10月, 臨床外科, 69(11) (11), 318 - 320, 日本語【ERAS時代の周術期管理マニュアル】術中・術後合併症とその管理 感染系・その他 腹腔内膿瘍
- BACKGROUND: The long-term prognosis for localized pancreatic cancer (PC) remains poor. Three randomized trials (GEST phase III, JACCRO PC-01 phase II and GEMSAP phase II) evaluated gemcitabine (Gem) with or without S-1 for patients with metastatic and locally advanced PC. A pooled analysis based on published data examined whether Gem with S-1 (GS) is superior to Gem alone in overall survival (OS) in patients with locally advanced PC. METHODS: Data were extracted on 193 patients: 31 (JACCRO), 28 (GEMSAP), and 134 (GEST). OS was used for primary endpoint and progression-free survival (PFS) was used for secondary endpoint. A general variance-based method was used to estimate the pooled HR and 95% CI between GS (n = 96) and Gem (n = 97). RESULTS: Meta-analysis demonstrated that the overall risk of death was significantly different between the two chemotherapies (hazard ratio = 0.673, 95% confidence interval: 0.488-0.929, P = 0.016). The median PFSs for GS and GEM in the JACCRO, GEMSAP, and GEST studies were 12.0, 12.6, and 10.7 months, and 4.1, 8.1, and 6.2 months, respectively (P = 0.001). The random-effect pooled estimate for 165 patients showed the objective response rate (ORR) in the GS group (28.4%) was better in the Gem group (8.3%, P = 0.001). CONCLUSIONS: GS improved ORR, PFS and OS in patients with locally advanced PC over Gem alone. GS could become one of the front-line chemotherapeutic agents.2014年10月, Journal of hepato-biliary-pancreatic sciences, 21(10) (10), 761 - 6, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: Standardized adjuvant therapy is not performed after major hepatectomy for biliary tract cancer (BTC) because of frequent adverse events, which may be caused by insufficient liver function. Therefore, the aim of this multicenter study (KHBO1003) was to determine the safety protocol for adjuvant chemotherapy after major hepatectomy. METHODS: Within 12 weeks of R0 or R1 major hepatectomy (hemihepatectomy or trisectionectomy) for BTC, the following adjuvant chemotherapy was performed for 6 months: 800-1,000 mg/m(2) gemcitabine on days 1, 8, and 15 and then every 3-4 weeks or 40-80 mg/m(2)/day S-1 on days 1-28 and every 3-6 weeks. Major dose-limited toxicity (DLT) was defined as grade 4 hematotoxicity, grade 3/4 febrile neutropenia, grade 3/4 non-hematotoxicity, skipped gemcitabine on days 8 and 15, or halting the course at or after 14 days. Dose-escalation and de-escalation decisions were based on the continual reassessment method. Every three patients were alternately assigned to each arm. RESULTS: Thirty-three patients (14 intrahepatic bile duct, 1 gall bladder, 18 extrahepatic bile duct) were enrolled in this study from February 2011 to July 2012 (n = 18 gemcitabine, n = 15 S-1). At 10% of DLT, the recommended dose was 1,000 mg/m(2) gemcitabine biweekly and 80 mg/m(2)/day S-1 on days 1-28 and every 6 weeks. Major DLT and adverse drug reactions were neutropenia. No grade 3 or 4 non-hematological adverse events were noted. CONCLUSION: We determined RDs for gemcitabine and S-1 adjuvant chemotherapy after major hepatectomy with a DLT that does not exceed 10%.2014年10月, Cancer chemotherapy and pharmacology, 74(4) (4), 699 - 709, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND: The purpose of the present study was to analyze the survival benefit and safety of adjuvant surgery in patients with initially unresectable pancreatic cancer following chemo(radio)therapy. METHODS: The 130 patients with unresectable pancreatic cancer treated during 2006 to 2013 were divided into a study group (15 patients) with planned adjuvant surgery, and a control group (115 patients with locally advanced disease) without adjuvant surgery. RESULTS: The study group of 15 patients had shrunken tumor, decreased tumor marker, and maintained performance status after 9 months (range 5-18 months) of chemo(radio)therapy. Thirteen patients had curative resection and two patients were not resected. The remaining controls of 115 patients did not undergo surgical resection due to poor response to chemo(radio)therapy or performance status. The median survival time in the study group was better than in the control group (36 vs. 9 months, P < 0.001). The mortality and morbidity rates in the study group were 0% and 46% respectively, in spite of concomitant organ resections in 77%. CONCLUSION: Patients who had adjuvant surgery had significant improvement of survival without increase in morbidity and mortality, relative to patients with locally advanced disease. Thus, adjuvant surgery may provide the promising results in this group who responded favorably to initial chemo(radio)therapy in unresectable pancreatic cancer.2014年09月, Journal of hepato-biliary-pancreatic sciences, 21(9) (9), 695 - 702, 英語, 国内誌[査読有り]
- OBJECTIVE: The aim of this study was to investigate the synergistic inhibitory effects of gemcitabine and losartan, angiotensin II type 1 (AT1) receptor blockers, on an orthotopic rat pancreatic cancer model. METHODS: The rat orthotopic pancreatic cancer model was prepared using DSL-6A/C cells, a rat ductal pancreatic adenocarcinoma cell line. The rats were treated with gemcitabine alone (100 mg/kg per week), losartan alone (100 mg/kg per day), or gemcitabine plus losartan. RESULTS: Survival was significantly improved by treatment with gemcitabine (89.6 ± 21.8 days) or losartan (76.9 ± 18.7 days) alone compared with that in the control group (59.6 ± 13.4 days; P < 0.05). Treatment with gemcitabine plus losartan further prolonged the survival time to 102.6 ± 16.5 days compared with that in the control group (P < 0.0001). Gemcitabine or losartan significantly and dose-dependently reduced the proliferation of DSL-6A/C cells in vitro. Both drugs inhibited pancreatic vascular endothelial growth factor expression compared with that in the control group (P < 0.05). CONCLUSIONS: The results of this study indicate that combined treatment with gemcitabine and losartan significantly improved the survival of rats with orthotopic pancreatic cancer by inhibiting vascular endothelial growth factor synthesis and suppressing cancer cell proliferation via AT1 receptor blockade. Thus, an AT1 receptor blocker in combination with gemcitabine might improve the clinical outcomes of patients with advanced pancreatic cancer.2014年08月, Pancreas, 43(6) (6), 886 - 90, 英語, 国際誌[査読有り]
- BACKGROUND: The most common postoperative complication after distal pancreatectomy (DP) is still postoperative pancreatic fistula (POPF), which is closely associated with other major complications and remains an unsolved problem. METHODS: This retrospective study included 47 consecutive patients who underwent a distal pancreatectomy with (DP-PG group, n = 21) or without (DP group, n = 26) duct-to-mucosa pancreaticogastrostomy from June 2010 to May 2012. Clinical data including POPF-related complications (POPF, fluid collection, intra-abdominal abscess, bleeding and delayed gastric emptying) as a primary endpoint were compared between the two groups. RESULTS: The frequencies of POPF-related complications as well as overall POPF and complications in the DP-PG group were lower than in the DP group (P = 0.037, P < 0.001, respectively). The 30 days morbidity after hospital discharge in the DP-PG group was less than in the DP group (P = 0.014). In both groups median hospital stay was similar. Although additional time needed for pancreaticogastrostomy was 35 (20-55) min, there was no difference in operative times. Patients in the DP group had a higher medical cost for hospitalization than the DP-PG group (P = 0.048). CONCLUSION: Pancreaticogastrostomy as an additional procedure following distal pancreatectomy was associated with a reduced rate of POPF-related complications that resulted in relatively lower medical cost for hospitalization.2014年07月, Journal of hepato-biliary-pancreatic sciences, 21(7) (7), 473 - 8, 英語, 国内誌[査読有り]
- BACKGROUND: Postoperative nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has recently become recognized. However, the pathoetiology of postoperative NAFLD is largely unknown. Furthermore, the optimal treatment has not been established. The aim of this prospective study was to clarify whether pancrelipase, which contains digestive pancreatic enzymes, could reverse NAFLD. METHODS: A collaborative clinical trial has been conducted (UMIN000006841). A total of 30 patients who developed NAFLD after PD were prospectively treated with pancrelipase. NAFLD was defined and evaluated by the liver-to-spleen attenuation ratio on computed tomography (CT). Clinical symptoms and laboratory findings were also assessed. RESULTS: The mean liver-to-spleen CT ratio before surgery in 30 patients was 1.233. It declined to 0.453 at diagnosis of NAFLD. It was significantly improved by the treatment and the CT ratios at 1, 3 and 6 months after treatment were 0.762, 0.958 and 0.904, respectively (vs. pretreatment, P < 0.001). The mild liver dysfunction was also improved. Total protein, albumin and total cholesterol levels were significantly improved by the treatment. Importantly, relatively severe diarrhea seen in 11 patients was also ameliorated. CONCLUSIONS: Pancrelipase has a significant beneficial impact on NAFLD after PD. Maldigestion after pancreatic surgery may be a main cause for the development of postoperative NAFLD.2014年03月, Journal of hepato-biliary-pancreatic sciences, 21(3) (3), 186 - 92, 英語, 国内誌[査読有り]
- BACKGROUND: The aim of this study was to retrospectively compare morbidity and mortality before and after introduction of a new departmental policy for patients who undergo distal pancreatectomy. METHODS: We have introduced the use of an ultrasonically-activated device in distal pancreatectomy, an "early removal of drains" policy and perioperative management using a clinical pathway since May 2006. Group A consisted of 52 consecutive patients from 2000 to February 2006. Group B consisted of 57 consecutive patients from May 2006 to 2010. RESULTS: Although there was no difference in the fluid collection rate within 30 postoperative days (Group A, 44% vs. Group B, 35%), the rates of intra-abdominal abscess (A, 19% vs. B, 4%) and grade 3/4 of the Clavien classification (A, 23% vs. B, 9%) in Group B were significantly lower than in Group A (P < 0.05). Time of drain removal (median 3 days vs. 8 days) and length of in-hospital stay (median 8 days vs. 17 days) in Group B were significantly shorter than in Group A (P < 0.001). CONCLUSION: The implementation of new departmental guidelines for distal pancreatectomy was closely associated with a low frequency of intra-abdominal abscess and grade 3/4 Clavien score, resulting in a shorter in-hospital stay.2014年01月, Journal of hepato-biliary-pancreatic sciences, 21(1) (1), 72 - 7, 英語, 国内誌[査読有り]
- PURPOSE: Based on the results of first-line chemotherapy for advanced pancreatic cancer, S-1 was confirmed to be non-inferior to gemcitabine. However, the recommended regimen of 4 weeks of administration followed by 2 weeks of drug withdrawal frequently causes adverse effects. On the other hand, we experienced in clinical practice that alternate-day administration of S-1 reduced adverse effects and were tolerable for advanced pancreatic cancer patients unwilling to continue the standard daily administration. We therefore conducted a multicenter cooperative prospective study to compare daily with alternate-day administration of S-1 for advanced pancreatic cancer. METHODS: Patients with advanced pancreatic cancer were eligible for enrollment in this trial. S-1 was administered at a dose of 40-60 mg twice daily, calculated according to body surface area, on Monday, Wednesday, Friday, and Sunday. Each treatment cycle was 42 days. The primary end point was overall survival (OS). Secondary end points were safety, response rate (RR), progression-free survival (PFS), and time to treatment failure (TTF). RESULTS: Forty-eight patients were evaluable for response. OS as the primary end point was 8.4 months (95 % CI 5.4-10.8), and the 1-year survival rate was 29.2 %. PFS was 5.5 months, and TTF was 3.9 months. RR was 10.4 %, and the disease control rate was 79.2 %. Grade 3/4 hematological and non-hematological toxicities were minor. All of these adverse reactions were tolerable and reversible. CONCLUSIONS: The current data demonstrate the mitigation of adverse effects with alternate-day administration of S-1, and this appears to be a more sustainable option for advanced pancreatic cancer.2014年01月, Cancer chemotherapy and pharmacology, 73(1) (1), 97 - 102, 英語, 国際誌[査読有り]
- Clinical impact of preoperative cholangitis after biliary drainage in patients who undergo pancreaticoduodenectomy on postoperative pancreatic fistula.The objective of this study was to examine whether the development of cholangitis after preoperative biliary drainage (PBD) can increase the incidence of postoperative pancreatic fistula (POPF). The study population included 185 consecutive patients who underwent pancreaticoduodenectomy from April 2006 to March 2011. All patients were divided into two groups, which consisted of a "no PBD" group (73 patients) and a PBD group (112 patients). Moreover, the PBD group was divided into a "cholangitis" group (21 patients) and a "no cholangitis" group (91 patients). Clinical background, clinical outcome, and postoperative complications were compared between groups. All patients received prophylactic antibiotics using cefmetazole until 1 or 2 days postoperatively. There was no difference between noncholangitis and non-PBD groups except the frequency of overall POPF. Clinically relevant POPF and drain infection occurred in the cholangitis group significantly more than in the noncholangitis group (P < 0.05). Univariate and multivariate analyses showed that development of preoperative cholangitis after preoperative biliary drainage and small pancreatic duct (less than 3 mm diameter) were independent risk factors for clinically relevant POPF. The frequency of clinically relevant POPF was 8 per cent (eight of 99) in patients without two risk factors, 19 per cent (15 of 80) in patients with one risk factor, and 50 per cent (three of six) in patients with both risk factors. The development of preoperative cholangitis after PBD was closely associated with the development of clinically relevant POPF under the limited use of prophylactic antibiotics.2014年01月, The American surgeon, 80(1) (1), 36 - 42, 英語, 国際誌[査読有り]
- BACKGROUND: Recent meta-analyses concluded that antibiotic prophylaxis is not warranted in low-risk laparoscopic cholecystectomy. However, most trials in the meta-analyses had a relatively small sample size and were statistically underpowered. In addition, many of the trials mentioned potential cost savings owing to the elimination of prophylactic antibiotics. However, no trial has statistically estimated the cost effectiveness. To evaluate the results of meta-analyses, we conducted a randomized controlled trial on the role of prophylactic antibiotics in low-risk laparoscopic cholecystectomy with an adequate sample size. METHODS: From March 2007 to May 2013, at the Department of Surgery, Kansai Medical University, patients who were scheduled for elective laparoscopic cholecystectomy were randomly assigned to one of two arms: those who were and were not administered prophylactic antibiotics. The primary endpoint was the occurrence of postoperative infections and secondary endpoints were postoperative hospital stay and medical costs. FINDINGS: During the study period, 518 patients were assigned to the Antibiotics group and 519 to the No antibiotics group. Occurrences of surgical site infections, distant infections and overall infections were significantly lower in the Antibiotics group than in the No antibiotics group (0.8 vs. 3.7%, p = 0.001, OR: 0.205 (95%CI: 0.069 to 0.606); 0.4 vs. 3.1%, p = 0.0004, OR: 0.122 (95%CI: 0.028 to 0.533); 1.2 vs. 6.7%; p<0.0001, OR: 0.162 (95%CI: 0.068 to 0.389), respectively). The postoperative hospital stay was significantly shorter in the Antibiotics group (mean, SD: 3.69±1.56 vs. 4.07±3.00; p = 0.01) and the postoperative medical costs were significantly lower in the Antibiotics group (mean, SD: $766±341 vs. 832±670; p = 0.047). Multivariable analysis showed that independent risk factors for postoperative infectious complications were no prophylactic antibiotics (p<0.0001) and age 65 or older (p = 0.006). CONCLUSIONS: Perioperative administration of prophylactic antibiotics should be recommended in laparoscopic cholecystectomy to prevent postoperative infectious complications and to reduce medical costs. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000003749.2014年, PloS one, 9(9) (9), e106702, 英語, 国際誌[査読有り]
- CONTEXT: Lymphoepithelial cysts of the pancreas are a rare disease of true pancreatic cysts, the cause of which is unknown. The differential diagnosis is broad and includes many benign and malignant cystic lesions of the pancreas and surrounding organs. A combination of imaging modalities and fine needle aspiration might narrow the differential diagnosis. However, the final diagnosis can only be achieved with certainty after resection of the cyst. CASE REPORT: The present case report is a lymphoepithelial cyst of the pancreas that was resected laparoscopically. A 53-year-old man was incidentally found to have a cystic tumor in the tail of the pancreas after undergoing an abdominal ultrasound, which showed a 41x33 mm cystic mass in the pancreatic tail. He had no abdominal symptoms. Laparoscopic distal pancreatectomy and splenectomy were performed. Histologic examination revealed a lymphoepithelial cyst. CONCLUSION: Herein, we discuss the diagnostic difficulties and management decisions that face surgeons treating pancreatic cysts.2013年11月, JOP : Journal of the pancreas, 14(6) (6), 664 - 8, 英語, 国際誌[査読有り]
- [Asymptomatic longterm survival in a patient with sigmoid colon lymph node metastasis with cancerous ascites of unknown origin].A 63-year-old man bearing a palpable tumor had a lymph node metastasis adjacent to the sigmoid colon that was detected by computed tomography and positron emission tomography. The sigmoid colon and enlarged lymph nodes were surgically resected, and cancerous ascites were present. Pathologically, the tumor in the lymph node was a poorly-differentiated adenocarcinoma that was positive for CA19-9 as well as CK7(-/+), CK20(+/-), VEGF(+), p 53(+)and MIB-1 (>10%). We treated this case as a pancreatic or bile duct carcinoma due to the patient's markedly elevated serum levels of CA19-9 and SPan-1. However, we could not make a conclusive diagnosis. Gemcitabine-based chemotherapy was administered, and the patient had no signs of recurrence for 24 months after the operation. Then, a recurrence was identified by imaging studies, and the chemotherapy was changed to paclitaxel and carboplatin. The patient had stable disease until tumor regrowth was identified 38 months after the operation, chemotherapy was then stopped. However, at 48 months after the operation, the patient remains well and has no symptoms. Our case suggests that surgery and the appropriate choice of anticancer drugs may contribute to the long-term survival of patients with cancer of an unknown primary origin.2013年08月, Gan to kagaku ryoho. Cancer & chemotherapy, 40(8) (8), 1119 - 22, 日本語, 国内誌[査読有り]
- PURPOSE: Gemcitabine (GEM)-based chemotherapy has been used worldwide as the first-line treatment for advanced biliary tract cancer (BTC). However, no standard regimens have been established yet for patients with GEM-refractory BTC. A previous phase II trial of S-1 as a first-line treatment in patients with advanced BTC revealed promising activity of this drug. The present study was conducted to evaluate the efficacy and safety of S-1 in patients with GEM-refractory BTC. METHODS: The subjects were patients with pathologically proven BTC who had shown disease progression while receiving GEM-based chemotherapy. Each treatment cycle consisted of administration of S-1 orally at the dose of 40 mg/m(2) twice daily for 28 days, followed by a rest period of 14 days. The primary endpoint of this study was objective response, and the secondary endpoints were the toxicity, progression-free survival (PFS), and overall survival (OS). RESULTS: Forty patients were assessed for efficacy and safety from 8 hospitals in Japan between June 2007 and September 2008. There were 3 cases of confirmed partial response (7.5 %) and 22 patients (55 %) of stable disease. The median PFS and OS were 2.5 and 6.8 months, respectively. Toxicity was generally mild, and the most common grade 3 or 4 toxicities were anorexia (10.0 %), anemia (7.5 %), mucositis (7.5 %), hypoalbuminemia (5.0 %), and pneumonia (5.0 %). There were no treatment-related deaths. CONCLUSIONS: Monotherapy with S-1 was well tolerated, but showed modest efficacy in patients with GEM-refractory BTC.2013年05月, Cancer chemotherapy and pharmacology, 71(5) (5), 1141 - 6, 英語, 国際誌[査読有り]
- PURPOSE: The present phase III study was designed to investigate the noninferiority of S-1 alone and superiority of gemcitabine plus S-1 compared with gemcitabine alone with respect to overall survival. PATIENTS AND METHODS: The participants were chemotherapy-naive patients with locally advanced or metastatic pancreatic cancer. Patients were randomly assigned to receive only gemcitabine (1,000 mg/m(2) on days 1, 8, and 15 of a 28-day cycle), only S-1 (80, 100, or 120 mg/d according to body-surface area on days 1 through 28 of a 42-day cycle), or gemcitabine plus S-1 (gemcitabine 1,000 mg/m(2) on days 1 and 8 plus S-1 60, 80, or 100 mg/d according to body-surface area on days 1 through 14 of a 21-day cycle). RESULTS: In the total of 834 enrolled patients, median overall survival was 8.8 months in the gemcitabine group, 9.7 months in the S-1 group, and 10.1 months in the gemcitabine plus S-1 group. The noninferiority of S-1 to gemcitabine was demonstrated (hazard ratio, 0.96; 97.5% CI, 0.78 to 1.18; P < .001 for noninferiority), whereas the superiority of gemcitabine plus S-1 was not (hazard ratio, 0.88; 97.5% CI, 0.71 to 1.08; P = .15). All treatments were generally well tolerated, although hematologic and GI toxicities were more severe in the gemcitabine plus S-1 group than in the gemcitabine group. CONCLUSION: Monotherapy with S-1 demonstrated noninferiority to gemcitabine in overall survival with good tolerability and presents a convenient oral alternative for locally advanced and metastatic pancreatic cancer.2013年05月, Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 31(13) (13), 1640 - 8, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- BACKGROUND/PURPOSE: In June 2004, a critical pathway for patients undergoing pancreaticoduodenectomy (PD) was introduced. The objective of this study was to determine the clinical value of critical pathway implementation. METHODS: 256 consecutive patients who underwent PD between 2000 and 2010 were divided into 4 groups by date of operation as follows; group A (n = 77), the pre-pathway group; group B (n = 51), the CP implementation group who were managed according to departmental guidelines; group C (n = 78), the group who had no stenting in the reconstruction of PD; and group D (n = 50), the group who had reinforcement of the pancreaticojejunostomy. The success rates of clinical outcomes and post-operative morbidity were compared between each group, year by year and every 50 patients. RESULTS: The success rates of clinical outcomes, including the timings of nasogastric tube removal, discontinuation of prophylactic anti-microbial agent, drain removal, starting oral intake, and patient discharge, were significantly improved in group B relative to group A, and in group C relative to group B. There were no significant differences in mortality and morbidity between any of the groups. All clinical outcomes reached a plateau at 2-3 years or 100-150 patients' operations after critical pathway implementation. CONCLUSIONS: Long-term use of a critical pathway is associated with improved clinical outcomes. A certain period of time or volume of patients is needed for this improvement in clinical outcomes to reach a plateau, which indicates achieving standardization of peri-operative management.2013年03月, Journal of hepato-biliary-pancreatic sciences, 20(3) (3), 271 - 8, 英語, 国内誌[査読有り]
- BACKGROUND: To investigate the behavior of activated pancreatic stellate cells (PSCs), which express alpha-smooth muscle actin (α-SMA), and pancreatic cancer cells in vivo, we examined the expression of α-SMA-positive myofibroblast-like cells in pancreatic cancer tissue after treatment with gemcitabine (GEM) using a Lewis orthotopic rat pancreatic cancer model. METHODS: The effect of GEM on DSL-6A/C1 cell proliferation was determined by cell counting method. The orthotopic pancreatic cancer animals were prepared with DSL-6A/C cells, and treated with GEM (100 mg/kg/weekly, for 3 weeks). At the end of treatment, α-SMA expression, fibrosis, transforming growth factor (TGF)-β1 and vascular endothelial growth factor (VEGF) were evaluated by histopathological and Western blot analyses. RESULTS: DSL-6A/C1 cell proliferation was significantly reduced by co-culturing with GEM in vitro. Survival time of pancreatic cancer animals (59.6 ± 13.4 days) was significantly improved by treatment with GEM (89.6 ± 21.8 days; p = 0.0005). Alpha-SMA expression in pancreatic cancer tissue was significantly reduced after treatment with GEM (p = 0.03), however, there was no significant difference in Sirius-red expression. Expression of VEGF was significantly reduced by GEM treatment, but the expression of TGF-β1 was not inhibited. CONCLUSION: GEM may suppress not only the tumor cell proliferation but also suppress PSCs activation through VEGF reduction.2013年02月, Journal of hepato-biliary-pancreatic sciences, 20(2) (2), 206 - 13, 英語, 国内誌[査読有り]
- Absence of cystic duct leakage using locking clips in 1017 cases of laparoscopic cholecystectomy.Cystic duct leakage with metal clips persists after laparoscopic cholecystectomy (LC). The aim of the study is to evaluate the preventive effect of locking clips on leaks from the cystic duct stump after LC as an alternative to metal clips. Locking clips were routinely used to close the cystic duct in LC. A total of 1101 patients who underwent LC were retrospectively assessed from a database of the surgical department at our university hospital. A main outcome measurement is bile leakage after LC. From January 2006 to April 2011, 1053 LCs were performed. Of these, the cystic duct was closed with locking clips in 1017 cases, and no bile leaks from the cystic duct were observed in any of these 1017 cases. Locking clips should be routinely used to close the cystic duct in preference to metallic clips to reduce postoperative bile leaks after LC.2012年11月, The American surgeon, 78(11) (11), 1228 - 31, 英語, 国際誌[査読有り]
- Ultrasonic scalpel for gastric cancer surgery: a prospective randomized study.BACKGROUND: The aim of the study was to evaluate the potential advantages of the ultrasonic scalpel compared with the conventional technique in gastric cancer surgery. METHODS: Patients with resectable adenocarcinoma of the stomach were randomly assigned to ultrasonic scalpel or conventional technique. We used the HARMONIC FOCUS (Ethicon Endo-Surgery, Inc.) as ultrasonic scalpel. RESULTS: Between February 2010 and December 2010, 60 patients with resectable gastric cancer were enrolled into the study. Operative time was significantly shorter with the ultrasonic arm than with the conventional arm (median 238.5 vs. 300.5 min; P = 0.0004). Blood loss was also significantly lower in the ultrasonic arm than in the conventional arm (median 351.0 vs. 569.5 ml; P = 0.016). Clavien-Dindo grades of postoperative complications were similar in the two groups. From a questionnaire survey of operators, the ultrasonic scalpel significantly reduced the stress of lymph node dissection (3.67 vs. 2.87; P = 0.0006). However, in assisting surgeons, the contributions to surgery, study, and technical improvement of the ultrasonic group were lower than in the conventional group. CONCLUSIONS: This study shows that the ultrasonic scalpel is a reliable and safe tool for open gastric cancer surgery.2012年10月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(10) (10), 1840 - 6, 英語, 国際誌[査読有り]
- 医学図書出版(株), 2012年09月, 胆と膵, 33(9) (9), 759 - 764, 日本語【胆膵領域におけるDPCと電子カルテ時代に対応したクリニカルパス】膵頭十二指腸切除術クリニカルパスによる周術期管理の変遷
- OBJECTIVE: Pancreatic cancer is a malignant neoplasm with poor prognosis that might be associated with defective immune function. We aimed to determine the influence on survival of circulating myeloid dendritic cells (c-m-DCs), circulating lymphoid DCs (c-l-DCs), and DCs within the tumor tissue in patients with pancreatic cancer. PATIENTS AND METHODS: Between December 2001 and June 2006, of a total of 110 patients with ductal adenocarcinoma of the pancreas, 42 underwent pancreatectomy, and 68 had unresectable disease. Numbers of c-m-DCs and c-l-DCs were assessed by flow cytometry, and DCs in the tumor tissue by immunohistochemical staining with anti-fascin mAb. RESULTS: The percentage of the c-m-DCs subset in pancreatic cancer patients was significantly lower than in healthy volunteers, and the similar finding was observed between patients who underwent surgical resection and non-resection. Patients with a high percentage of c-m-DCs or with many DCs accumulated in the cancer tissue survived longer than patients with a low percentage or low number in peripheral blood or the tumor, respectively. Moreover, there was a positive correlation between c-m-DCs within peripheral blood mononuclear cells and the number of DCs per field in the cancer tissue. CONCLUSIONS: Preoperative c-m-DCs levels in the PBMC of patients with pancreatic cancer and DCs counts in the cancer tissue can be a prognostic factor after surgical resection. Modulating the distribution of DCs may be an effective therapy in pancreatic cancer patients with a dismal prognosis.2012年04月, The Journal of surgical research, 173(2) (2), 299 - 308, 英語, 国際誌[査読有り]
- OBJECTIVES: Regulatory T cells (Treg) can inhibit immune responses mediated by T cells. The aim of this study was to evaluate the prevalence of Treg in peripheral blood mononuclear cells from patients with pancreatic cancers in relation to their clinical outcomes. METHODS: Among a total of 100 patients with ductal adenocarcinoma of the pancreas, 40 underwent pancreatectomy and 60 had unresectable disease. Their peripheral blood mononuclear cells were evaluated to determine the proportion of CD4CD25 (FoxP3) T cells, as a percentage of the total CD4 cells, by flow cytometric analysis. RESULTS: The percentage of Treg in the patients with pancreatic cancer was significantly lower than that in the healthy volunteers (P = 0.048), and the patients who underwent surgical resection had lower Treg levels than those with unresectable disease (P = 0.040). Patients in the resected group with a higher percentage of Treg survived longer (P = 0.021). Treg in patients who remained disease free at postoperative 12 months significantly decreased compared to that of the postoperative period (P = 0.009). CONCLUSION: A relative increase in Treg may be related to immunosuppression and tumor progression in patients with pancreatic cancer. The immunological monitoring of Treg may be useful to predict the prognosis for patients with pancreatic cancer.2012年04月, Pancreas, 41(3) (3), 409 - 15, 英語, 国際誌[査読有り]
- OBJECTIVE: The aim of this study was to compare short-term surgical results in pancreatic cancer patients who underwent surgical resection after neo-adjuvant chemoradiation therapy (NACRT) using S-1. METHODS: The study population comprised 77 patients with pancreatic cancer between 2006 and 2010. Out of 34 patients who underwent staging laparoscopy between 2008 and 2010, 31 patients without occult distant organ metastasis underwent chemoradiation and of whom 30 underwent pancreatectomy (NACRT group). Of the other 43 patients, 36 underwent surgical resection in 2006-2008, followed by adjuvant therapy (adjuvant group). The primary endpoint was frequency of pathological curative resection (R0). RESULTS: The new regimen of NACRT was feasible and safe. Twenty-eight of 30 (93%) patients in the NACRT group had R0 resection, which was significantly higher than in the adjuvant group (21 of 36 patients, 58%, p = 0.005). The number and extent of metastatic lymph nodes in the NACRT group (1 (0-25), N0/1; 18 of 38) was significantly lower than in the adjuvant group (2 (0-19), N0/1; 23 of 30), p = 0.0363). The frequency of intractable ascites in the NACRT group (eight of 30) was significantly higher than in the adjuvant group (two of 36, p = 0.035). CONCLUSION: Neo-adjuvant chemoradiation therapy using S-1 followed by pancreatectomy can improve the rate of pathologically curative resection and reduces the number and extent of lymph node metastasis.2012年04月, Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(4) (4), 784 - 92, 英語, 国際誌[査読有り]
- 2012年03月, Pancreas, 41(2) (2), 333 - 5, 英語, 国際誌[査読有り]
- The role of circulating dendritic cells in patients with unresectable pancreatic cancer.AIM: Pancreatic cancer is a malignant neoplasm with a poor prognosis that might be associated with defective immune function. In this study, we aimed to clarify the role of circulating myeloid dendritic cells (cmDCs) and lymphoid (cl) DCs in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: This study covered the period from January 2001 to December 2009, and involved 104 patients with unresectable pancreatic cancer. We measured the number of cmDCs and clDCs using flow cytometry before and after chemotherapy, chemoradiotherapy and immuno-chemotherapy. RESULTS: The percentage of the cmDC subset in the unresectable pancreatic cancer patients was significantly lower than in healthy volunteers (p=0.006). There was no difference in the cmDC subset between patients with distant organ metastasis and locally advanced pancreatic cancer. The patients with a high percentage (≥0.23%) of cmDC subset survived longer than patients with a low percentage (<0.23%) (p=0.0030). Multivariate analysis showed that cmDC was the only independent prognostic factor (p=0.0059). The percentage of cmDC subset was significantly increased after immuno-chemotherapy (p=0.0055). CONCLUSION: A high level of cmDCs is associated with better survival rate and is an independently favorable prognostic factor in patients with unresectable pancreatic cancer. It is likely that immunochemotherapy increases the number of cmDCs.2011年11月, Anticancer research, 31(11) (11), 3827 - 34, 英語, 国際誌[査読有り]
- OBJECTIVES: To examine whether the use of the new ultrasonically curved shear (UCS) can reduce the number of surgical stitches, extent of blood loss, and operation time in (pylorus-preserving) pancreaticoduodenectomy (PD) for periampullary cancer. METHODS: The study population comprised 26 consecutive patients who underwent PD for periampullary cancer. Intraoperative data, including number of stitches used, was prospectively collected. Results from 13 patients who underwent conventional PD (Group A) were compared with those from 13 patients who underwent PD using UCS (Group B). RESULTS: There were no significant differences in baseline characteristics between the two patient groups. The extent of blood loss in Group B was significantly less than in Group A (p < 0.0001). Although there was no difference in total operation time, the time spent on hilar lymph node dissection was significantly shorter in Group B patients than in Group A patients (p = 0.0189). The number of surgical stitches used was significantly less in Group B patients than in Group A patients (p < 0.0001). There were no incidences of post-pancreatectomy hemorrhage. CONCLUSION: The use of the new UCS was safe and associated with the economical benefit of fewer surgical stitches as well as reduced blood loss.2011年07月, Journal of hepato-biliary-pancreatic sciences, 18(4) (4), 609 - 14, 英語, 国内誌[査読有り]
- OBJECTIVE: The aims of this study were to verify whether the selective use of staging laparoscopy can prevent unnecessary laparotomy and to find a surrogate marker for surgical unresectability in patients with potentially or borderline resectable pancreatic cancer. METHODS: Group A consisted of consecutive 33 patients evaluated between 2005 and 2006 and who directly underwent open laparotomy for planned surgical resection. Group B consisted of consecutive 61 patients evaluated between 2007 and 2009 and of whom 16 patients (26%) had a staging laparoscopy due to the presence of high-risk markers of unresectability defined as carbohydrate antigen 19-9 level 150 U/mL or greater and tumor size 30 mm or greater. RESULTS: The frequency of unnecessary laparotomies for occult distant organ metastasis was significantly different between groups A and B (18% and 3%, respectively; P = 0.021). Of 16 patients who underwent staging laparoscopy in group B, 5 patients (31%) had occult metastases. The multivariate analysis showed that the presence of high-risk markers and extrapancreatic plexus invasion on multidetector-row computed tomography were significant independent risk factors for unresectability. CONCLUSIONS: The presence of high-risk markers was associated with surgical unresectability in patients with potentially or borderline resectable pancreatic cancer. The selective use of staging laparoscopy decreased the frequency of unnecessary laparotomy by detecting minute metastases.2011年04月, Pancreas, 40(3) (3), 426 - 32, 英語, 国際誌[査読有り]
- OBJECTIVES: To examine whether pressure-tight reinforcement of pancreaticojejunostomy (PJ) using polyglycolic acid (PGA) mesh and fibrin glue sealant can reduce the incidence of postoperative pancreatic fistula (POPF). METHODS: The study population included 128 consecutive patients who underwent pancreaticoduodenectomy between September 2006 and January 2010. Postoperative mortality and morbidity among 50 patients who underwent reinforcement of PJ anastomosis using PGA mesh and fibrin glue were compared with 78 patients (historical controls). RESULTS: The 2 groups demonstrated no significant differences in frequencies of overall or septic complications, reoperation, or in-hospital death. No significant difference in the frequency of POPF, delayed gastric emptying, or intra-abdominal abscess was found between groups. There was no difference between the 2 groups in the number of necessary interventions, and no bleeding complications or POPF-related mortality occurred. The median length of postoperative in-hospital stay between the 2 groups was similar: 13 days (range, 8-101 days) versus 14 days (range, 8-61 days). Similar findings were observed in a subgroup analysis consisting of patients with a pancreatic duct diameter smaller than 3 mm. CONCLUSION: This retrospective single-center study showed that reinforcement of PJ anastomosis using PGA mesh and fibrin glue provided no significant benefit in reducing the frequency of POPF.2011年01月, Pancreas, 40(1) (1), 16 - 20, 英語, 国際誌[査読有り]
- Characteristics of severe adverse events after peptide vaccination for advanced cancer patients: Analysis of 500 cases.The purpose of this study was to investigate severe adverse events (SAEs) after therapeutic peptide vaccination for advanced cancer patients. We investigated SAEs following personalized peptide vaccinations in 500 advanced cancer patients, including 174 prostate, 74 colon, 51 pancreatic and 43 gastric cancer patients. The number of vaccination cycles varied widely, from 3 to 112. The severity of adverse events was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3, and events with a grade of >3 were defined as SAEs and were evaluated by the Institutional Safety Evaluation Committee. A total of 215 SAEs in 102 patients were recorded during the vaccine trials. The main causes for these events were cancer progression (152 SAEs in 78 patients), combined cancer treatments other than vaccination (35 in 21 patients), diseases other than cancer (20 in 19 patients), peptide vaccines (6 in 6 patients) and suicide (1 in 1 patient). The 6 vaccine-related SAEs, all grade 3, consisted of skin reactions at each injection site, cellulitis around the injection site, edemas of the head and neck regions, colitis, rectal bleeding and bladder-vaginal fistulae. Both cellular and humoral responses to the vaccinated peptides were highly boosted in all 6 of these patients, indicating the involvement of augmented immune responses in these SAEs. The clinical responses in these 6 patients consisted of 2 partial responses and 4 stable diseases. The majority of SAEs after peptide vaccination for advanced cancer patients were caused by cancer progression. The appearance of vaccine-related SAEs, except inflammatory injection site reactions, was unexpected, and fortunately the incidence was very low. Our results suggest that physicians should be on guard for these rare SAEs associated with augmented immune responses.2011年01月, Oncology reports, 25(1) (1), 57 - 62, 英語, 国際誌[査読有り]
- Assessment of immunological biomarkers in patients with advanced cancer treated by personalized peptide vaccination.To investigate immunological biomarkers to predict overall survival of advanced cancer patients under treatment with personalized peptide vaccination, correlations between overall survival and biomarkers, including cytotoxic T lymphocyte (CTL) and immunoglobulin G (IgG) responses to the vaccinated peptides, were investigated in 500 advanced cancer patients who received personalized peptide vaccination from October 2000 to October 2008. The best clinical response was assessed for in 436 patients, 43 patients (10%) had partial response, 144 patients (33%) had stable disease and 249 patients (57%) had progressive, with a median overall survival of 9.9 months. Both lymphocyte counts prior to the vaccination (P = 0.0095) and increased IgG response (P = 0.0116) to the vaccinated peptides, along with performance status (P < 0.0001), well correlated with overall survival. To confirm the superiority of IgG response to CTL response, the samples from advanced castration-resistant prostate cancer patients who survived more than 900 days (n=20) and those who died within 300 days (n=23) were analyzed further. As a result, both the numbers of peptides, to which increased IgG responses were observed, and the fold increases in IgG levels were significantly higher in long-term survivors (P = 0.000282 and P = 0.00045). In contrast, CTL responses were not statistically different between the two groups. Both lymphocyte numbers and IgG response were thus suggested to be biomarkers of cancer vaccine for advanced cancer patients.2010年12月, Cancer biology & therapy, 10(12) (12), 1266 - 79, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Primary splenic mucinous cystadenocarcinoma (MCCa) is extremely rare, and only six cases appear to have been reported previously. We present herein a case of primary splenic MCCa resulting in pseudomyxoma peritonei (PMP). A 66-year-old Japanese woman presented to a hospital with a chief complaint of upper abdominal pain and a 7-year history of splenic cyst. Cyst rupture was noted on computed tomography, and splenectomy was performed. The abdominal cavity was filled with a large amount of gelatinous ascites, with the appearance of PMP. On the cut surface, multiple cysts containing mucinous material were found within and outside the spleen. Microscopically, splenic parenchyma was occupied by large mucinous pools focally lined with mucinous epithelial cells and mesothelial cell-like cells, which were considered benign. Outside the spleen, a low-grade MCCa component was found. No ectopic pancreatic or intestinal tissue was identified. Although most PMP cases are known to be caused by low-grade mucinous appendiceal tumor, the present case represents the first report of a splenic MCCa resulting in PMP.2010年12月, Medical molecular morphology, 43(4) (4), 235 - 40, 英語, 国内誌[査読有り]
- [The effect of sorafenib and intermittent hepatic arterial infusion chemotherapy using cisplatin for advanced hepatocellular carcinoma with portal vein tumor thrombus--a pilot study].UNLABELLED: We evaluated the effect of sorafenib and intermittent hepatic arterial infusion chemotherapy (HAIC) using cisplatin for unresectable advanced hepatocellular carcinoma (HCC). METHODS: 5 patients (4 male/1 female, median age: 73.0 years) with unresectable advanced HCC including portal vein tumor thrombus were treated with soraenib (400 mg/body, day 1-28) and cisplatin (20 mg/m2 HAIC, day 1, 8, 15). We assess efficacy and safety after 1 course of this therapy. RESULTS: Grade 3 adverse events occurred in 2 patients (1 serum bilirubin and aspartate aminotransferase (AST) elevation, 1 serum bilirubin elevation and hepatic encephalopathy). Grade 2 adverse events occurred in 4 patients (1 hypertension and nertropenia, 1 hypertension and thrombocytopenia, 1 hypertension and serum amylase elevation, and 1 abdominal pain). Grade 3 adverse events were improved by suspending this therapy, and completion of this therapy was achieved in all patients. After one course of this therapy, the clinical response was rated as 1 partial response (PR), 3-stable disease (SD), and 1 progressive disease (PD). CONCLUSION: Sorafenib and intermittent HAIC using cisplatin for unresectable advanced HCC was expected to be safe and effective treatment.2010年11月, Gan to kagaku ryoho. Cancer & chemotherapy, 37(12) (12), 2679 - 82, 日本語, 国内誌[査読有り]
- [Efficacy of surgical resection following the neoadjuvant chemoradiation therapy for obtaining long-term survivors in patients with pancreatic cancer].We explored the outcome of the multi-disciplinary management for obtaining long-term survivors in patients with pancreatic cancer that extended beyond the pancreas. This single-institution experience indicates that surgical resection following the neoadjuvant chemoradiation (NACRT) therapy is able to increase the resectability rate with clear margins and to decrease the rate of metastatic lymph nodes, resulting in improved prognosis of curative cases with pancreatic cancer that extended beyond the pancreas.2010年11月, Gan to kagaku ryoho. Cancer & chemotherapy, 37(12) (12), 2271 - 3, 日本語, 国内誌[査読有り]
- A phase II study of personalized peptide vaccination combined with gemcitabine for non-resectable pancreatic cancer patients.We evaluated the safety of, and clinical and immune responses to personalized peptide vaccination with gemcitabine (GEM) as the first line therapy in patients with non-resectable pancreatic cancer. Pre-vaccination peripheral blood mononuclear cells (PBMCs) and plasma were prepared to examine cellular and humoral responses to 14 and 16 peptides in human leukocyte antigen (HLA)-A24+ or -A2+ patients, respectively. Only the reactive peptides (maximum of 4) were administered weekly at 3 mg/peptide. GEM was administered at 1000 mg/m(2) per week for 3 weeks, followed by 1 week of rest. Twenty-one patients with untreated and non-resectable pancreatic cancer were enrolled. The combination therapy was generally well tolerated. Boosting of cellular and humoral responses to the vaccinated peptides was observed in the post-vaccination (eighth) PBMCs and plasma from 14 of 18 and 13 of 18 patients tested, respectively. The best clinical responses were 7 cases of partial response, 9 cases of stable disease, and 5 cases of progressive disease. Median survival time of all 21 patients was 9.0 months (95% CI, 6-15.5 months) with a one year survival rate of 38%. Immune boosting in both cellular and humoral responses was well correlated with overall survival with a hazard ratio of 0.2 (95% CI, 0.06-0.73; log-rank p=0.0239). These results suggest a potential clinical benefit of this combination therapy for non-resectable pancreatic cancer patients as the first line therapy. Further exploration of this approach is warranted.2010年09月, Oncology reports, 24(3) (3), 795 - 801, 英語, 国際誌[査読有り]
- OBJECTIVES: After standardization of the perioperative management of pancreaticoduodenectomy, we retrospectively compared results in nonstented pancreaticojejunostomy with external-stented pancreaticojejunostomy. METHODS: The study population included 129 consecutive patients who underwent pancreaticoduodenectomy between 2004 and 2008. The postoperative mortality and morbidity were compared between 51 patients with restrictive use of external stenting (group A) and 78 patients without external stenting (group B). The patient with a pancreatic duct of less than 3 mm in diameter was 31% in group A and 46% in group B. RESULTS: There were no differences in postoperative morbidity and mortality between the 2 groups. Although the frequency of overall postoperative pancreatic fistula development was significantly higher in group B than in group A (44% vs 27%, P = 0.0004), there was no difference in grade B/C postoperative pancreatic fistula rate (group A: 5.9% vs group B: 14.1%). The length of in-hospital stay in group B was significantly shorter than group A (13 vs 24 days, P < 0.0001). There were no differences in postoperative morbidity and mortality between subgroups that were consisted of patients with small pancreatic duct diameter. CONCLUSION: This retrospective single-center study showed that nonstented duct-to-mucosa anastomosis was a safe procedure and was associated with a shortened in-hospital stay.2010年03月, Pancreas, 39(2) (2), 165 - 70, 英語, 国際誌[査読有り]
- OBJECTIVES: The results of surgical therapy alone for pancreatic cancer are disappointing. We explored surgical results after neoadjuvant chemoradiation therapy (NACRT) for patients with pancreatic cancer that extended beyond the pancreas. METHODS: Sixty-eight consecutive patients with pancreatic cancer who underwent pancreatic resection were included. Twenty-seven patients underwent surgical resection after NACRT (NACRT group). The other 41 patients were classified as surgery-alone group. Surgical results were compared in patients who underwent curative resection (R0/1) who were followed up for at least 25 months and underwent no adjuvant therapy. RESULTS: A lower frequency of lymph node metastasis was observed in the NACRT group (P < 0.05). The frequency of residual tumor grading in the NACRT group was significantly different from that in surgery-alone (R0/1/2%, 52/15/33 vs 22/51/27; P = 0.0040). In R0/1 cases, overall survival and disease-free survival rates in the NACRT group (n = 18) were significantly longer than in surgery-alone (n = 30, P < 0.05). The rate of local recurrence in the NACRT group was significantly less than in surgery-alone (11% vs 47%, P = 0.0024). CONCLUSIONS: This single-institution experience indicates that NACRT is able to increase the resectability rate with clear margins and to decrease the rate of metastatic lymph nodes, resulting in improved prognosis of curative cases with pancreatic cancer that extended beyond the pancreas.2009年04月, Pancreas, 38(3) (3), 282 - 8, 英語, 国際誌[査読有り]
- OBJECTIVES: Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in perioperative managements of pancreaticoduodenectomy. METHODS: Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In June 2004, the following new departmental guidelines were introduced: (1) modified Kakita method of pancreaticojejunostomy, (2) omental wrapping, (3) early removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were determined. RESULTS: Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = 0.019). Occurrence of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P = 0.0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = 0.0133). Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed gastric emptying. CONCLUSIONS: The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been reduced because of the introduction of a new guideline.2008年08月, Pancreas, 37(2) (2), 128 - 33, 英語, 国際誌[査読有り]
- OBJECTIVES: To retrospectively evaluate the efficacy and tolerability of 5-fluorouracil and low-dose cisplatin (FP)-based preoperative concurrent chemoradiotherapy (PCRT) and gemcitabine (GEM)-based PCRT in patients with potentially resectable pancreatic cancer. METHODS: Between December 2000 and December 2004, 32 patients with potentially resectable pancreatic cancer were treated with PCRT. All patients received external beam radiotherapy (total dose of 40 Gy) for 4 weeks. Concurrently, chemotherapy was performed intravenously with continuous 5-fluorouracil 200 mg/m2/d and intermittent cisplatin bolus 3 to 6 mg/m2/d for 4 weeks (Arm FP-PCRT, n = 14) or weekly GEM 400 mg/m2 for 3 weeks (Arm GEM-PCRT, n = 18). The patients were restaged 3 to 4 weeks after the end of PCRT and explored for resection in cases without distant metastases. RESULTS: The 3-year survival rates and median survival were 29.4% and 20.5 months for the resected patients (n = 24) and 0% and 5.5 months for unresected patients (n = 8), respectively (P < 0.0001). The 1-, 2-, 3-year survival rates and median survival were 87.5%, 62.5%, 33.3%, and 26 months for the resected patients treated with FP-PCRT and 75%, 40%, 26.7%, and 19.9 months for the resected patients treated with GEM-PCRT (respectively; P = not significant). Most of the toxicities of both regimens were slight and were in grade1 to 2. Grade 1 to 3 leukopenia (43% vs 100%) and thrombocytopenia (0% vs 39%) were significantly different between the FP-PCRT and GEM-PCRT patients. CONCLUSIONS: The PCRT regimens in this article enabled selection of 24 of 32 patients for surgery and resulted in encouraging survival results and acceptable toxicities.2008年01月, Pancreas, 36(1) (1), e26-32, 英語, 国際誌[査読有り]
- BACKGROUND/AIMS: Our policy for the surgical treatment of hepatocellular carcinoma (HCC) has been to minimize the extent of liver resection using a microwave tissue coagulator (MTC) and to not perform Pringle's maneuver for the prevention of ischemic injury to the liver routinely. We verify the safety of liver resection using MTC in HCC patients with poor liver functional reserve, and clarify the long-term outcome of HCC patients who underwent curative resection using MTC. METHODOLOGY: One hundred sixty-eight patients who underwent curative resection using MTC between 1992 and 2001 were divided into two groups according each patient's score in the Indocyanin Green Retension 15 Test (ICG-R15 test). The high (ICG-R15 values>20) and low ICG-R15 groups (ICG-R15 values<20) included 100 and 68 HCC patients, respectively. Clinical characteristics of each group were evaluated, and operative mortality and morbidity, as well as overall and disease-free survival rates, were compared between the two groups to determine risk factors for overall and disease-free survival. RESULTS: Although there were significant differences in liver function-related parameters between the low and high ICG-R15 groups, no differences in surgical or tumor factors were found. No patients in this study developed post-operative liver failure, and there was no significant difference in morbidity between the low and high ICG-R15 groups. The overall survival rate of the low ICG-R15 group was significantly longer than the high ICG-R15 group (p=0.0003). Cox's multivariate analysis showed that an ICG-R15 value less than 20 was the only significant independent factor for overall survival. Disease-free survival rates in the low ICG-R15 group were significantly longer than in the high ICG-R15 group (p=0.0007). Multivariate analysis showed that serum albumin level and number of tumors were significant independent factors for disease-free survival. CONCLUSION: The long-term outcome of HCC patients with low ICG-R15 following curative resection using MTC was acceptable. This procedure was safe even for patients with high ICG-R15.2008年, HPB : the official journal of the International Hepato Pancreato Biliary Association, 10(4) (4), 289 - 95, 英語, 国際誌[査読有り]
- The aim of this study was to evaluate the effects of active hexose correlated compound (AHCC) intake on immune responses by investigating the number and function of circulating dendritic cells (DCs) in healthy volunteers. Twenty-one healthy volunteers were randomized to receive placebo or AHCC at 3.0 g/day for 4 wk. The number of circulating cluster of differentiation (CD)11c(+) DCs (DC1) and CD11c(-) DCs (DC2) were measured. Allogeneic mixed-leukocyte reaction (MLR) was performed. Natural killer (NK) cell activity and the proliferative response of T lymphocytes toward mitogen (phytohemagglutinin [PHA]) were measured. We also measured cytokine production stimulated by lipopolysaccharide [interleukin (IL)-2, IL-4, IL-6, IL-10, interferon gamma-gamma, tumor necrosis factor-alpha). The AHCC group (n = 10) after AHCC intake had a significantly higher number of total DCs compared to that at baseline and values from control subjects (n = 11). The number of DC1s in the AHCC group after intake was significantly higher than at baseline. DC2s in the AHCC group were significantly increased in comparison with controls. The MLR in the AHCC group was significantly increased compared to controls. No significant differences in PHA, NK cell activity, and cytokine production were found between groups. AHCC intake resulted in the increased number of DCs and function of DC1s, which have a role in specific immunity.2008年, Nutrition and cancer, 60(5) (5), 643 - 51, 英語, 国際誌[査読有り]
- Circulating dendritic cells and development of septic complications after pancreatectomy for pancreatic cancer.OBJECTIVE: To investigate whether circulating dendritic cells in patients with pancreatic cancer is a risk factor for septic complications after pancreatectomy. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Forty-one patients with pancreatic cancer who underwent pancreatectomy from May 2001 to July 2005. Patients were divided into 2 groups depending on whether or not they had a development of postoperative septic complications. MAIN OUTCOME MEASURES: Dendritic cell, natural killer cell, and CD4(+) T-cell, and CD8(+) T-cell counts were measured preoperatively in each patient. Clinicopathologic parameters and immune parameters for each patient, operation, and tumor were compared between the 2 groups. Preoperative risk factors for postoperative septic complications were determined using logistic regression analysis. RESULTS: Circulating dendritic cell count before pancreatectomy in patients with septic complications postoperatively for pancreatic cancer was significantly lower than in patients without septic complications. Multivariate analysis indicated that preoperative circulating dendritic cell count was the only predictive value among the diverse clinical parameters tested in relation to the development of septic complications. Notably, when the circulating dendritic cell count was less than 10.0 x 10(3)/mL in the peripheral blood, the risk of developing postoperative septic complications markedly increased. In such cases, the sensitivity, specificity, positive predictive value, and negative predictive value of total circulating dendritic cell count were as high as 80%. CONCLUSION: In patients with pancreatic cancer, low preoperative circulating dendritic cell count (< 10.0 x 10(3)/mL) is a significant risk factor for the development of septic complications after pancreatectomy.2007年12月, Archives of surgery (Chicago, Ill. : 1960), 142(12) (12), 1151 - 7, 英語, 国際誌[査読有り]
- Increased levels of IgG antibodies against peptides of the prostate stem cell antigen in the plasma of pancreatic cancer patients.One of the longstanding challenges in the treatment of pancreatic cancer, the fifth most common cancer worldwide, is to establish a simple and reliable diagnostic marker for the disease. This study examined whether or not the plasma levels of IgG antibodies (IgGs) reactive to peptides derived from the prostate stem cell antigen (PSCA), which is highly expressed in pancreatic cancer cells, were elevated in patients with pancreatic cancer. Fifty-seven kinds of peptides encoded by PSCA were tested for their reactivity to plasma IgGs of pancreatic cancer patients. The results showed that the levels of IgGs specific to each of the 10 different peptides in the plasma of pancreatic cancer patients were significantly higher than those of non-cancer subjects. Eighty percent of subjects with and 18% of subjects without pancreatic cancer were diagnosed as having pancreatic cancer, respectively, when those cases showing significantly elevated levels of IgGs against at least one of the three peptides of PSCA at positions 2-11, 85-95, and 109-118 were judged as positive for pancreatic cancer. These results indicate that the measurement of IgGs reactive to these PSCA-derived peptides can provide novel information on the host-tumor interaction in pancreatic cancer, and could potentially be used as a new diagnostic tool to screen for pancreatic cancer.2007年07月, Oncology reports, 18(1) (1), 161 - 6, 英語, 国際誌[査読有り]
- Immunological evaluation of personalized peptide vaccination with gemcitabine for pancreatic cancer.The aim of the present study was to investigate the safety and immune responses of personalized peptide vaccination when administered with gemcitabine (GEM) in advanced pancreatic cancer (APC) patients. Thirteen patients with APC were enrolled. Pre-vaccination with peripheral blood mononuclear cells and plasma was carried out to examine cellular and humoral responses to 25 or 23 peptides in human leukocyte antigen A24+(+) or A2++(+) patients, respectively. Only the reactive peptides (maximum of four) were then administered weekly at three different dose settings: 1, 2 and 3 mg of peptide. GEM was administered at 1000 mg/m(2) per week for 3 weeks, followed by 1 week of rest. The combination therapy was well tolerated. Grade 3 toxicities were: anemia (three patients), neutropenia (two patients) and thrombocytopenia (two patients). Of these 13 patients, 11 (85%) showed clinical responses, such as reduction in tumor size and/or level of tumor markers. Augmentation of peptide-specific cytotoxic T lymphocyte activity against pancreatic cancer cells was observed at each dose level, whereas the increment of peptide-specific IgG antibodies was dependent on peptide dose. GEM did not inhibit the immune responses induced by personalized peptide vaccinations, and this new type of immunochemotherapy combination is recommended for further clinical study in APC patients.2007年04月, Cancer science, 98(4) (4), 605 - 11, 英語, 国際誌[査読有り]
- Clinical impact of multidetector row computed tomography on patients with pancreatic cancer.OBJECTIVES: This study was designed to compare multidetector row computed tomography (MDCT) and CT-assisted hepatic arteriography (CTHA)/CT during arterial portography (CTAP)/angiography/contrast-enhanced CT (CECT) findings prospectively for accuracy in the detection of liver metastasis and vascular involvement of the tumor. METHODS: The study included 43 patients with pancreatic cancer who were evaluated from September 2002 to December 2003. These patients underwent preoperative evaluation by angiography/CTHA/CTAP/CECT (7-mm thickness) and by MDCT (1.25-mm thickness). RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of liver metastasis diagnosis were all superior using MDCT relative to CTHA/CTAP. The diagnostic accuracy of liver metastasis for patients with tumors less than 10 mm in diameter was particularly superior with MDCT relative to CTHA/CTAP. The surgical and pathological findings of vascular involvement were more accurately diagnosed by MDCT than by CTHA/CTAP/angiography/CECT. Although MDCT findings were generally similar to surgical findings of vascular involvement, MDCT overestimated the incidence of pathological vascular involvement. CONCLUSIONS: Multidetector row CT imaging can potentially offer more accurate staging of pancreatic cancer and may be useful to surgeons both in preoperative planning and for intraoperative guidance.2007年03月, Pancreas, 34(2) (2), 175 - 9, 英語, 国際誌[査読有り]
- 2006年11月, Surgery, 140(5) (5), 836 - 7, 英語, 国際誌Using an internal thoracic artery holder in pancreaticojejunostomy.[査読有り]
- Agenesis of the gallbladder with hypoplastic cystic duct diagnosed at laparoscopy.An 86-year-old man was admitted to our department with complaints of intermittent upper abdominal pain. Ultrasonography of the abdomen showed dilated extrahepatic bile ducts containing stones; however, the gallbladder was not clearly identified. Magnetic resonance cholangiopancreatography showed dilated extrahepatic ducts and choledocholithiasis without gallbladder visualization. The stone extraction was performed with endoscopic sphincterotomy. Three-dimensional images using spiral-computed tomography after intravenous-infusion cholangiography clearly demonstrated an obstruction of the cystic duct. The patient was scheduled for laparoscopic cholecystectomy. At laparoscopy, the gallbladder fossa was not identified on the undersurface of the liver. Despite a thorough examination of the intrahepatic (left-sided within the lesser omentum), retroperitoneal, retrohepatic (within the falciform ligament), retroduodenal, and retropancreatic areas using laparoscopic ultrasonography, the gallbladder was not found. After careful dissection of the hepatoduodenal ligament, the dilated extrahepatic bile duct and a 1-cm length of hypoplastic cystic duct were found. Gallbladder agenesis is usually accompanied by the lack of the cystic duct. The present case is the third report of gallbladder agenesis with a patent or hypoplastic cystic duct.2006年08月, Surgical laparoscopy, endoscopy & percutaneous techniques, 16(4) (4), 251 - 4, 英語, 国際誌[査読有り]
- Surgical influence of pancreatectomy on the function and count of circulating dendritic cells in patients with pancreatic cancer.BACKGROUND: Dendritic cells (DCs) are important for an immune surveillance. Myeloid DCs (DC1) are important for an effective antitumor immune system. The function and count of circulating DC1 (cDC1) in hosts with a malignant tumor would be defective. This study focused on analyzing the immunological features of cDC1 in patients with pancreatic cancer during the perioperative period. MATERIALS AND METHODS: Thirty-two pancreatic cancer patients who underwent pancreatectomy and 18 age-matched healthy individuals as controls were enrolled in this study. The perioperative cDC count, the stimulatory capacity of cDC1 against allogeneic T cells and TGF-beta1 level in the serum were measured. The cDC count was measured at 12 months after the operation. RESULTS: The preoperative cDC1/cDC2 ratio, cDC1 count, and stimulatory capacity of cDC1 were impaired in patients in comparison to controls (P<0.05). The serum TGF-beta1 level was significantly higher in patients than controls (P<0.001). The stimulatory capacity of cDC1 recovered after pancreatectomy (P<0.05). The serum TGF-beta1 level significantly decreased after the operation (P<0.05); however, they were still significantly higher than controls (P<0.05). Although the cDC1/cDC2 ratio and the cDC1 count did not increase after the pancreatectomy, they recovered as the controls' level at 12 months after the pancreatectomy in disease-free patients (P<0.05) and the serum TGF-beta1 level in those patients at 12 months after the operation significantly decreased compared with those at the postoperative period (P<0.05). CONCLUSION: Surgical resection of pancreatic cancer could be associated with improved cDC1 function. When a patient remained disease free, the recovery of cDC1 counts was observed approximately 12 months after pancreatectomy. Further strategy will be needed to improve immune function in patients with pancreatic cancer.2006年07月, Cancer immunology, immunotherapy : CII, 55(7) (7), 775 - 84, 英語, 国際誌[査読有り]
- Clinical monitoring of innate cellular immunity of monocytes/macrophages by tumor necrosis factor alpha productivity in whole blood stimulated by lipopolysaccharide in patients with pancreatic cancer.OBJECTIVE: The aim of this study was to evaluate the tumor necrosis factor alpha (TNF-alpha) releasing capacity in whole blood stimulated by lipopolysaccharide (LPS) in patients with pancreatic cancer during the perioperative period, and before and after chemotherapy. METHODS: The current study involved a total of 39 patients with pancreatic cancer (PC), who were further divided into a PC-Op group (n = 16, underwent pancreatectomy) and a PC-chemo group (n = 23, received chemotherapy). The control groups consisted of patients with hepatocellular carcinoma (n = 27, HCC group) and with benign diseases (n = 15, control group). Serial changes in TNF-alpha in whole blood stimulated by LPS were compared in various clinical settings. RESULTS: Preoperative TNF-alpha levels in the PC-Op group were significantly lower than those in the HCC and control groups (P = 0.034). The TNF-alpha variable surgical index (s-index) was defined as the ratio of the preoperative TNF-alpha level to postoperative level in the PC-Op and HCC groups. Although the TNF-alpha s-index in the PC-Op group was significantly decreased on postoperative day 1 and recovered on postoperative day 3 (P < 0.002), there were no significant changes in the TNF-alpha s-index in the HCC group. The TNF-alpha variable chemotherapeutic index (c-index) was defined as the ratio of the TNF-alpha level before to that after chemotherapy in the PC-chemo group. The TNF-alpha c-index in all 7 patients was reduced to less than 0.3 until leukopenia appeared. Patients who had an increase in TNF-alpha production (TNF-alpha c-index >1.0) on day 3 or 7 after chemotherapy had significantly better cumulative survival than those with no increase (P < 0.033). CONCLUSIONS: TNF-alpha production stimulated by LPS in the whole blood of patients with pancreatic cancer was low. Surgical stress and depressed immunocompetence might induce such profound decreases. A method of assessing the capability of leukocytes, particularly macrophages, to produce TNF-alpha could be useful for prognostis and for monitoring immunocompetence in patients with pancreatic cancer who have undergone chemotherapy.2006年07月, Pancreas, 33(1) (1), 31 - 7, 英語, 国際誌[査読有り]
- Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer.OBJECTIVES: The pancreaticoduodenectomy with extended resection has been frequently performed in patients with pancreatic cancer in Japan. One result of this additional surgical stress may be that postoperative complications in patients with pancreatic cancer are more frequent than in patients with periampullary cancer. METHODS: The 198 patients with pancreatic and periampullary cancer underwent pancreaticoduodenectomy. The operative mortality and morbidity between patients with pancreatic and periampullary cancer were compared, and the risk factors of postoperative complications and in-hospital death were determined. RESULTS: Patients with pancreatic and periampullary cancer made up 52% and 48% of total patients. The duration of surgery and volume of intraoperative blood loss were significantly higher in patients with pancreatic cancer than in patients with periampullary cancer. Additional organ resections were frequently performed in patients with pancreatic cancer. However, significantly lower morbidity rates were observed in patients with pancreatic cancer. Among all complications evaluated, pancreatic fistula and abdominal abscess were found less frequently in patients with pancreatic cancer. Logistic regression analyses showed a positive correlation between periampullary cancer and an increased risk of complications, pancreatic fistula, and abdominal abscess. The in-hospital mortality rate has significantly reduced since 2000. When pancreatic fistula was clinically diagnosed, we immediately started a closed lavage using continuous administration of natural saline at 1000 to 4000 mL/d, after exchange of a nasogastric tube drain. CONCLUSION: Pancreaticoduodenectomy for patients with pancreatic cancer can be a safe procedure in spite of surgical stress. Further surgical strategies will be needed to reduce postoperative complications, especially in patients with periampullary cancer.2006年07月, Pancreas, 33(1) (1), 45 - 52, 英語, 国際誌[査読有り]
- Development of a new diagnostic tool for pancreatic cancer: simultaneous measurement of antibodies against peptides recognized by cytotoxic T lymphocytes.One of the longstanding challenges in the treatment of pancreatic cancer, the fifth most common cancer worldwide, is to establish a simple and reliable diagnostic marker for the disease. This study examined whether or not the simultaneous measurement of plasma levels of IgG antibodies (IgGs) reactive to peptides recognized by cytotoxic T lymphocytes was useful for screening of pancreatic cancer. Sixty-three kinds of peptides were tested for their reactivity to plasma IgGs of pancreatic cancer patients with Luminex system followed by discriminatory analysis of the results using the Statistical Discovery Software. Under these circumstances, 83% of subjects with pancreatic cancer and 12% of healthy donors were diagnosed as having pancreatic cancer, respectively. These results suggest that the simultaneous measurement of IgGs reactive to these peptides could potentially be useful as a new diagnostic tool to screen for pancreatic cancer.2006年, The Kurume medical journal, 53(3-4) (3-4), 63 - 70, 英語, 国内誌[査読有り]
- 2005年07月, Hepato-Gastroenterology, 52(64) (64), 1180 - 1185Clinical outcome of 214 liver resections using microwave tissue coagulation[査読有り]研究論文（学術雑誌）
- Impaired function of circulating dendritic cells in patients with pancreatic cancer.PURPOSE AND EXPERIMENTAL DESIGN: Dendritic cells (DCs) are important for immune surveillance and play a central role in protection against infection and malignancy. DCs comprise two subsets: DC1 (myeloid DC) and DC2 (lymphoid DC). The aim of this study is to determine whether the number and/or function of circulating DCs were decreased in patients with pancreatic cancer and to evaluate the effects of these changes in patients with locally advanced pancreatic cancer before and after chemoradiotherapy (CRT). We examined the circulating DC number and function using the peripheral blood from 29 patients with pancreatic cancer and 20 healthy control subjects. In patients who underwent CRT (n = 20), blood samples were taken before and after CRT. DCs were tested for the ability to stimulate allogeneic T lymphocytes in mixed leukocyte reaction (MLR). CD4/8, NK activity, PHA, and TGF-beta1 were also measured. RESULTS: The number and allostimulatory activity of circulating DC1s in patients were significantly lower than those in controls. In the patients who underwent CRT, the allostimulatory activity of DC1s at post-CRT was significantly increased as compared to those at pre-CRT. The level of TGF-beta1 was also significantly decreased at post-CRT as compared to pre-CRT. There were no changes in CD4/8, NK activity and proliferative response of T lymphocytes at the peri-CRT period. CONCLUSION: These data indicate that the number and function of circulating DCs were impaired in patients with pancreatic cancer. Chemoradiotherapy, however, improved DC function, which might be related to decreased immunosuppressive cytokine levels.2005年01月, Clinical immunology (Orlando, Fla.), 114(1) (1), 52 - 60, 英語, 国際誌[査読有り]
- 2004年09月, Transplantation Proceedings, 36(7) (7), 1985 - 1987, 英語[査読有り]研究論文（国際会議プロシーディングス）
- 2004年, Japanese Journal of Gastroenterological Surgery, 37(12) (12), 1813 - 1818[査読有り]研究論文（学術雑誌）
- 2003年04月, Pancreas, 26(3) (3), 243 - 249, 英語[査読有り]研究論文（学術雑誌）
- BioMedical Press, 2000年, Shock, 13(6) (6), 492 - 496, 英語[査読有り]研究論文（学術雑誌）
- Biliary Tract Cancer AR Conference, 2024年12月, 日本語, 国内会議座長（ディスカッション）その他
- Biliary Tract Cancer AR Conference, 2024年12月, 日本語, 国内会議座長（講演）その他
- APA/JPS/CAP/IAP 2024, 2024年12月, 英語, 国内会議Comprehensive analysis of altered lipid and amino acid metabolism in patients undergoing pancreatoduodenectomy口頭発表（一般）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議胆嚢摘出既往のある再肝切除症例における腹腔鏡アプローチの有用性に関する検討口頭発表（一般）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議糖原病Ia型に併発した多発肝細胞癌線腫の1切除例口頭発表（一般）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議Fontan循環における腹腔鏡下肝切除術の経験口頭発表（一般）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議3Dシミュレーション画像は真のリアルタイムナビゲーションになっているか？シンポジウム・ワークショップパネル（公募）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除術の短期・長期成績に関する検討シンポジウム・ワークショップパネル（公募）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議40歳肝胆膵外科医の腹腔鏡下膵切除の実際シンポジウム・ワークショップパネル（公募）
- 第37回日本内視鏡外科学会総会（JSES2024）, 2024年12月, 日本語, 国内会議ロボット支援下膵切除導入の経験とフィードバックシンポジウム・ワークショップパネル（公募）
- 第86回日本臨床外科学会総会, 2024年11月, 日本語, 国内会議進行肝細胞癌に対するアテゾリズマブ・ベバシズマブ併用療法によるcancer free/drug freeを目指した治療戦略シンポジウム・ワークショップパネル（公募）
- 第86回日本臨床外科学会総会, 2024年11月, 日本語, 国内会議腹腔鏡下肝切除技術認定取得への道シンポジウム・ワークショップパネル（公募）
- 第66回日本消化器病学会大会（JDDW2024）, 2024年10月, 英語, 国際会議Postoperative complications assessed by the comprehensive complication index (CCI) are associated with early recurrence after curative resection for biliary tract cancerポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 英語, 国際会議Clinical Significance of Laparoscopic 0-mm Margin Liver Resection for Vascular in Patients with Hepatocellular Carcinomaポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議吸収性スペーサー併用粒子線治療後に局所再発した後腹膜平滑筋肉腫に対して2回目の吸収性スペーサー留置術および粒子線治療を行った1例ポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議左側門脈圧亢進症に対する門脈ステントの有用性についてポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議胆道癌術後S-1術後補助療法施行例におけるGLIM基準の予後因子としての有用性に関する検討ポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議胆道癌に対するS-1術後補助化学療法と術後早期再発との関連ポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議膵頭十二指腸切除術後の血中必須脂肪酸の推移およびPD後NAFLDとの関係ポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議進行肝細胞癌に対する薬物療法を中心とした集学的治療ポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議膵癌術後再発病変に対する外科的切除は予後延長に寄与するのかポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議主要脈管近接腫瘍に対する腹腔鏡下Parenchymal-sparing hepatectomyポスター発表
- 第22回日本消化器外科学会（JDDW2024）, 2024年10月, 日本語, 国内会議肝細胞癌症例における肝切除術後胆汁漏の予後への影響についての検討ポスター発表
- 胆道癌学術講演会, 2024年10月, 日本語, 国内会議新時代の胆道癌治療～手術から薬物治療まで～口頭発表（一般）
- 第60回日本胆道学会学術集会, 2024年10月, 日本語, 国内会議胆道癌肝切除後の肝不全：アシアロシンチの有用性口頭発表（一般）
- 第58回近畿肝癌談話会, 2024年10月, 日本語, 国内会議腫瘍学的切除可能性分類定義に基づいた肝切除・薬物療法成績の検討口頭発表（一般）
- 第60回日本移植学会総会, 2024年09月, 日本語, 国内会議家族性低βリポ蛋白血症に伴う非代償性肝硬変に対して脳死肝移植術を施行した1例ポスター発表
- 第60回日本移植学会総会, 2024年09月, 日本語, 国内会議肝移植後 MASLD 発症を予測する因子に関する観察研究ポスター発表
- 第60回日本移植学会総会, 2024年09月, 日本語, 国内会議当院における high MELD score 肝不全に対する肝移植の治療成績シンポジウム・ワークショップパネル（公募）
- 第47回日本膵・胆管合流異常研究会, 2024年09月, 日本語, 国内会議膵・胆管合流異常に合併した2型 IPNB に相当する胆嚢内乳頭状腫瘍の1例口頭発表（一般）
- ELSA2024, 2024年08月, 英語, 国際会議Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy口頭発表（一般）
- 第30回日本肝がん分子標的治療研究会, 2024年07月, 日本語, 国内会議デュルバルマブ・トレメリムマブ併用療法導入初期の治療成績から薬物療法の最適な se-quence を考える口頭発表（一般）
- 第55回日本膵臓学会大会, 2024年07月, 日本語, 国内会議局所進行切除不能膵癌に対するスペーサー留置術後の陽子線治療の成績と展望口頭発表（一般）
- 第55回日本膵臓学会大会, 2024年07月, 日本語, 国際会議膵癌に対する膵切除術における膵断端の癌遺残に関する検討シンポジウム・ワークショップパネル（公募）
- 第55回日本膵臓学会大会, 2024年07月, 日本語, 国際会議膵頭十二指腸切除術後の脂質アミノ酸代謝の変化の解明シンポジウム・ワークショップパネル（公募）
- 統合医療機能性食品国際学会 第32回年会 （ICNIM2024）, 2024年07月, 日本語, 国際会議胆管癌オルガノイドを用いた AHCC®の癌細胞に対する有用性の検討ポスター発表
- 統合医療機能性食品国際学会 第32回年会 （ICNIM2024）, 2024年07月, 日本語, 国内会議公開シンポジウム口頭発表（一般）
- The 14th Asia-Pacific Primary Liver Cancer Expert Meeting 2024 (APPLE), 2024年07月, 英語, 国内会議Textbook outcomes in initial liver resection for hepatocellular carcinoma: a study with malnutrition grade by the GLIM criteria.ポスター発表
- The 14th Asia-Pacific Primary Liver Cancer Expert Meeting 2024 (APPLE), 2024年07月, 英語, 国内会議Clinical significance of hepatectomy for Hepatocellular Carcinoma Associated with Lymph Node and/or Distant Metastasesポスター発表
- The 14th Asia-Pacific Primary Liver Cancer Expert Meeting 2024 (APPLE), 2024年07月, 英語, 国内会議Laparoscopic Liver Resection after Pancreaticoduodenectomyポスター発表
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議80 歳以上の高齢膵癌患者に対する膵頭十二指腸切除術の短期成績と長期成績について口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議当科における吸収性スペーサー留置術 48 例の検討口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議乳頭型胆管癌と比較した胆管内乳頭状腫瘍(IPNB)の画像所見口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議先天性胆道拡張症 術後合併症の検討口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議進行肝細胞癌に対する cancer free, drug free を目指した治療戦略の意義口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議肝細胞癌における腹腔鏡下 SM0 肝切除の有用性に関する検討口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議切除後再発リスク分類と大腸癌肝転移の集学的治療戦略口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議消化器外科医夫婦がキャリア形成を続けるためにした工夫口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議膵頭十二指腸切除術後の脂肪肝発症とその生理学的機序解明の試み口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議肝細胞癌に対する幕内基準外肝右葉切除後における術後肝不全発症の危険因子の検討口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議術後難治性胆管狭窄症例に対する治療経験口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議当科における進行胆道癌に対する conversion surgery の経験口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議局所進行膵癌に対する動脈剥離手技と動脈・門脈再建手技口頭発表（一般）
- 第79回日本消化器外科学会総会, 2024年07月, 日本語, 国内会議胆嚢摘出術既往のある再肝切除症例における開腹，腹腔鏡アプローチの手術成績の比較口頭発表（一般）
- 第60回日本肝癌研究会, 2024年07月, 日本語, 国内会議進行肝細胞癌に対するアテゾリズマブ・ベバシズマブ療法による cancer free、 drug free を目指した治療戦略口頭発表（一般）
- 第60回日本肝癌研究会, 2024年07月, 日本語, 国内会議肝細胞癌における肝切除術後胆汁漏関連因子の予後への影響に関する検討口頭発表（一般）
- 第60回日本肝癌研究会, 2024年07月, 日本語, 国内会議腫瘍学的切除可能性分類定義に基づいた肝切除・薬物療法成績の検討シンポジウム・ワークショップパネル（公募）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Comparison of laparoscopic partial liver resection for the superior and the inferior areas of segment 4口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Efficacy of the bile leak test using contrast-enhanced intraoperative ultrasonic cholangiography in liver resection: A prospective study口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Short- and long-term outcomes after pancreatectomy for pancreatic cancer in octogenarian口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議A Novel Navigation Technology for Liver Surgery Using Spectral Imaging口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Our Surgical Techniques for Pancreatic Cancer with Arterial Contact口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Nightmare for a 16-year-old man who presented with undiagnosed severe diabetes-induced NOMI and required a total pancreatectomy and massive enterectomy口頭発表（一般）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Clinical significance of hepatectomy for hepatocellular carcinoma associated with lymph node and/ or distant metastasesシンポジウム・ワークショップパネル（公募）
- 第36回日本肝胆膵外科学会・学術集会, 2024年06月, 英語, 国内会議Treatment outcomes of hepatectomy and systemic chemotherapy based on the oncological criteria of resectabilityシンポジウム・ワークショップパネル（公募）
- 第46回日本癌局所療法研究会, 2024年06月, 日本語, 国内会議腹腔鏡下膵頭十二指腸切除術で R0 手術となった胆管原発神経内分泌癌の1切除例口頭発表（一般）
- Biliary surgery meeting in Hyogo, 2024年06月, 日本語, 国内会議座長（講演1）その他
- EAES2024, 2024年06月, 英語, 国際会議Laparoscopic SM0 liver resection for hepatocellular carcinoma adjacent to the hepatic hilumポスター発表
- 第42回日本肝移植学会学術集会, 2024年06月, 日本語, 国内会議当施設の脳死ドナー肝摘出手技習得における Cadaver Surgical Training の有用性シンポジウム・ワークショップパネル（指名）
- 第42回日本肝移植学会学術集会, 2024年06月, 日本語, 国際会議肝移植後の MASLD 発症を予測する因子に関する検討口頭発表（一般）
- 第42回日本肝移植学会学術集会, 2024年06月, 日本語, 国内会議当院の脳死肝移植における Japan Risk Index の検討口頭発表（一般）
- 第110回日本消化器病学会総会, 2024年05月, 日本語, 国内会議大腸癌肝転移におけるRAS遺伝子情報と肝転移巣局在の関連性口頭発表（一般）
- Hyogo BTC Conference 2024, 2024年04月, 英語, 国内会議座長その他
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議当科における吸収性スペーサー留置術 45 例の検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議胆道癌術後 S-1 術後補助療法施行例における GLIM 基準の予後因子としての有用性に関する検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議当院における肝 S8 背側/腹側領域に対する腹腔鏡下肝部分切除術の手術成績ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議胆道癌における再発時期と再発様式についての検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議進行肝細胞癌における腫瘍肉眼形態とアテゾリズマブ・ベバシズマブ併用療法の治療効果に関する検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議肝切除における術中超音波胆道造影法を併用したリークテストの有用性ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議外科医が長く働き続けられるための当院での取り組みポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議肝門部胆管癌における術後肝不全・難治性腹水ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議大腸癌肝転移における切除後再発リスク分類と集学的治療戦略ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議肝細胞癌に対する肝右葉切除後における術後肝不全発症の危険因子の検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議肥満症例での肝 S7 切除における腹腔鏡下アプローチのメリットについてポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議高齢遠位胆管癌患者に対する高難度手術成績の検討ポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議進行胆道癌に対する Conversion surgeryポスター発表
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議胆道癌に対する膵頭十二指腸切除術における GLIM 基準低栄養が術後合併症へ与える影響の検討口頭発表（一般）
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議膵頭十二指腸切除術後外分泌不全に対する治療バイオマーカーの探索口頭発表（一般）
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議開腹および腹腔鏡下膵体尾部切除のドレーンアミラーゼ値による適切なドレーン管理の検討口頭発表（一般）
- 第124回日本外科学会定期学術集会, 2024年04月, 日本語, 国内会議肝細胞癌薬物療法における sequential 局所治療の位置づけシンポジウム・ワークショップパネル（公募）
- 日本ERAS®学会第2回学術集会, 2024年04月, 日本語, 国内会議ERAS プロトコルの術前経口補水に分枝鎖アミノ酸飲料は有用か？シンポジウム・ワークショップパネル（公募）
- The 33rd Annual Meeting the Asian Pacific Association for the Study of the Liver (APASL2024), 2024年03月, 英語, 国内会議Utility of ALBI grade for predicting prognoses in patients who underwent repeat hepatectomyポスター発表
- The 33rd Annual Meeting the Asian Pacific Association for the Study of the Liver (APASL2024), 2024年03月, 英語, 国際会議Multidisciplinary treatment strategy for macroscopic portal vein tumor thrombusポスター発表
- The 33rd Annual Meeting the Asian Pacific Association for the Study of the Liver (APASL2024), 2024年03月, 英語, 国際会議Association between tumor morphology and efficacy of atezolizumab plus bevacizumab for advanced HCC口頭発表（一般）
- The 33rd Annual Meeting the Asian Pacific Association for the Study of the Liver (APASL2024), 2024年03月, 英語, 国際会議A comparative study of laparoscopic liver resection for the segment 4 superior and inferior area口頭発表（一般）
- 第51回近畿肝臓外科研究会, 2024年02月, 日本語, 国際会議主要脈管近接腫瘍に対する腹腔鏡下肝切除口頭発表（一般）
- 肝胆膵エビデンス Update 2024 Winter, 2024年02月, 日本語, 国際会議司会（Session2）その他
- 第56回制癌剤適応研究会, 2024年02月, 日本語, 国内会議GC+ デュルバルマブ療法が奏功し根治的肝切除術を施行し得た胆嚢癌術後肝転移再発の 1 例口頭発表（一般）
- 第7回日本サルコーマ治療研究学会学術集会, 2024年02月, 日本語, 国内会議後腹膜腫瘍に対するスペーサー手術+粒子線治療成績と今後の課題シンポジウム・ワークショップパネル（公募）
- 第7回日本サルコーマ治療研究学会学術集会, 2024年02月, 日本語, 国内会議後腹膜腫瘍に対するスペーサー手術+粒子線治療(Space-making particle therapy)の現状と今後の展望口頭発表（一般）
- 日本消化器病学会近畿支部第120回例会, 2024年01月, 日本語, 国内会議胆道再建既往の肝切除症例における術後感染性合併症口頭発表（一般）
- 日本消化器病学会近畿支部第120回例会, 2024年01月, 日本語, 国内会議GLIM基準低栄養は胆道癌に対する膵頭十二指腸切除術後合併症リスクを増加させる口頭発表（一般）
- 日本消化器病学会近畿支部第120回例会, 2024年01月, 日本語, 国内会議門脈輪状膵症例に対するロボット支援下膵頭十二指腸切除術の1例シンポジウム・ワークショップパネル（公募）
- 日本消化器病学会近畿支部第120回例会, 2024年01月, 日本語, 国内会議座長（ランチョンセミナー2）その他
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議腹腔鏡下肝 S8 部分切除術における背側領域と腹側領域での手術成績比較口頭発表（一般）
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議肝細胞癌に対する腹腔鏡下 SM0 resection の短期成績口頭発表（一般）
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議肝門部に近接する肝細胞癌に対する腹腔鏡下肝部分切除術口頭発表（一般）
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議当科における肝 S1 病変に対する腹腔鏡手術の有効性と安全性の検討口頭発表（一般）
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議肝臓外科におけるロボット支援化手術導入への悩み口頭発表（一般）
- 第36回日本内視鏡外科学会総会, 2023年12月, 日本語, 国内会議ロボット支援下手術の拡大視野で得られた門脈輪状膵症例におけるSMA神経叢に関する知見シンポジウム・ワークショップパネル（公募）
- 第85回日本臨床外科学会総会, 2023年11月, 日本語, 国内会議アテゾリズマブ＋ベバシズマブ併用療法によりコンバージョン手術を施行し得た切除不能肝 細胞癌の2例ポスター発表
- 第85回日本臨床外科学会総会, 2023年11月, 日本語, 国内会議吸収性スペーサー留置術35例の検討ポスター発表
- 第85回日本臨床外科学会総会, 2023年11月, 日本語, 国内会議肝細胞癌薬物療法を外科医が行う意義口頭発表（一般）
- 第85回日本臨床外科学会総会, 2023年11月, 日本語, 国内会議肝細胞癌薬物療法後コンバージョン治療の可能性シンポジウム・ワークショップパネル（公募）
- 第85回日本臨床外科学会総会, 2023年11月, 日本語, 国内会議座長（一般示説）その他
- 第15回膵臓内視鏡外科研究会, 2023年11月, 日本語, 国内会議ロボット支援下膵手術における剥離・切離法の試行錯誤口頭発表（一般）
- 第15回膵臓内視鏡外科研究会, 2023年11月, 日本語, 国内会議ロボット支援下膵頭十二指腸切除を行った門脈輪状膵の１例口頭発表（一般）
- 第17回肝臓内視鏡外科研究会, 2023年11月, 日本語, 国内会議腹腔鏡下肝 S8 部分切除術の手術手技の肝（キモ）～ S8 腹側・背側領域の比較を含めて～シンポジウム・ワークショップパネル（公募）
- 第65回日本消化器病学会大会（JDDW2023), 2023年11月, 日本語, 国内会議胆道癌における再発時期と再発形式の検討ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議肝外胆管癌における術前骨格筋量減少の術後早期再発への影響ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議The feasibility of laparoscopic liver resection with 0-mm surgical margin for hepatocellular carcinomaポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議吸収性スペーサー留置術33例の検討ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議局所進行切除不能膵癌に対するスペーサー留置術後の陽子線治療の有用性についてポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議肝門部胆管癌術後の術後胆汁漏の検討ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議肝切除術後の門脈血栓症に対するエドキサバンの治療成績ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議胆管非拡張型膵・胆管合流異常に対する胆嚢摘出後に胆管径は変化するかポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議膵癌術後再発に対する治療戦略の現状と展望ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議初回肝切除への腹腔鏡アプローチ適応による再肝切除時のメリットについてポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議当院における術後胆管狭窄症例に対する対応と検討ポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国内会議根治を目指した肝細胞癌薬物療法と局所療法のコンビネーションポスター発表
- 第21回日本消化器外科学会大会（JDDW2023）, 2023年11月, 日本語, 国際会議肝外胆管癌切除後S-1補助化学療法例におけるGLIM基準の有用性に関する検討ポスター発表
- IASGO-CME Advanced Post-Graduate Course in Kobe 2023, 2023年11月, 英語, 国際会議Association between tumor morphology and efficacy of atezolizumab plus bevacizumab for advanced hepatocellular carcinomaポスター発表
- 7th Kansai-Yeungnam HBP Surgeons Meeting, 2023年10月, 日本語, 国際会議Proton radiotherapy as a treatment strategy to increase survival in locally advanced pancreatic cancer in the body and tail: a retrospective studyポスター発表
- 7th Kansai-Yeungnam HBP Surgeons Meeting, 2023年10月, 日本語, 国内会議Risk Factors for Recurrence of Cholangitis After Pancreaticoduodenectomy and Comparison of Stents in Hepaticojejunostomyポスター発表
- 第59回日本移植学会総会, 2023年09月, 日本語, 国内会議肝移植後の経時的な体重変化を予測する因子についての観察研究ポスター発表
- 第59回日本移植学会総会, 2023年09月, 日本語, 国内会議脳死肝移植・肝グラフト採取術手技習得における Cadaver Surgical Training の有用性口頭発表（一般）
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議胆道癌術後補助化学療法施行例における早期再発のリスク因子の検討ポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議当科で経験した無石性胆嚢炎症例の臨床像ポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議胆道癌に対するS-1術後補助化学療法と再発時期の関連ポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議肝門部領域胆管癌の術前胆管像の評価：ENBD造影CTを用いて肝管から尾状葉枝までポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議当院における肝切除術後胆汁漏症例の検討ポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議IPMNに併存した十二指腸乳頭部上皮内癌の1例ポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議切除不能胆道癌に対する真の集学的治療を求めてポスター発表
- 第59回日本胆道学会学術集会, 2023年09月, 日本語, 国内会議座長（デジタルポスター36）その他
- 4th World Congress of International Laparoscopic liver Society（ILLS）, 2023年09月, 日本語, 国際会議A comparative study of laparo-scopic liver resection for the segment 8 dorsal and ventral area口頭発表（一般）
- 4th World Congress of International Laparoscopic liver Society（ILLS）, 2023年09月, 日本語, 国際会議Short-term impact of laparoscopic liver resection with 0-mm surgical margin for HCC口頭発表（一般）
- 4th World Congress of International Laparoscopic liver Society（ILLS）, 2023年09月, 日本語, 国際会議Acceptability of Laparoscopic Liver Resection of Segment I: A Retrospective Study口頭発表（一般）
- 4th World Congress of International Laparoscopic liver Society（ILLS）, 2023年09月, 日本語, 国際会議Laparoscopic segmentectomy2 versus left lateral sectionecto-my for liver tumors in segment2口頭発表（一般）
- 45th ESPEN Congress, 2023年09月, 日本語, 国際会議Impact of malnutrition diagnosed by the GLIM criteria on postoperative complications after pancreaticoduodenectomy for biliary tract cancerポスター発表
- 45th ESPEN Congress, 2023年09月, 日本語, 国際会議Impact of malnutrition diagnosed by the GLIM criteria on outcome of elderly patients with hepatocellular carcinoma after liver resectionポスター発表
- 第46回日本膵・胆管合流異常研究会, 2023年09月, 日本語, 国内会議膵・胆管合流異常に発生した膵管内乳頭粘液性腺癌の1切除例口頭発表（一般）
- 第57回近畿肝癌談話会, 2023年08月, 日本語, 国内会議根治を目指した肝細胞癌薬物療法シークエンス口頭発表（一般）
- 第59回日本肝癌研究会, 2023年07月, 日本語, 国内会議根治を目指した肝細胞癌薬物療法シークエンス口頭発表（一般）
- 第54回日本膵臓学会大会, 2023年07月, 日本語, 国内会議当院における膵神経内分泌腫瘍のバイオマーカー探索の試みシンポジウム・ワークショップパネル（公募）
- 第54回日本膵臓学会大会, 2023年07月, 日本語, 国内会議高齢者に対する膵全摘, 残膵全摘の短期・長期成績についてシンポジウム・ワークショップパネル（公募）
- 第54回日本膵臓学会大会, 2023年07月, 日本語, 国内会議Solid - pseudopapillary neoplasm（SPN）に対する至適術式シンポジウム・ワークショップパネル（公募）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議門脈腫瘍栓を伴う肝細胞癌患者における EOB-MRI を用いた機能的残肝容積測定による術後肝不全予測法口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議胆道癌時期別に見た再発様式の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議肝外胆管癌切除後の早期再発および長期予後と GLIM 基準により診断した低栄養の関連性の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議肝細胞癌肉眼分類とアテゾリズマブ・ベバシズマブ併用療法の治療効果に関する検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議大腸癌肝転移における全腫瘍体積を用いた適切な治療戦略に関する検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議吸収性スペーサー留置術 28 例の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議局所進行切除不能膵癌に対するスペーサー留置術後の粒子線治療の有用性について口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議胆管癌早期再発におけるリスク因子の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議当科におけるゴアテックスシートを用いた非吸収性スペーサー留置術の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議膵頭十二指腸切除術前後の血中必須脂肪酸の推移口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議当院における急性胆嚢炎症例の治療成績と TG18 の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議肝細胞癌肝切除症例における術前サルコペニアが予後に与える影響口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議ENBD 胆管造影 CT を用いた胆管尾状葉枝の評価口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議切除後再発リスクから見た大腸癌肝転移の治療戦略口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議肝細胞癌患者における肝切除後肝不全が中長期的肝機能と再発に与える影響口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議内側アプローチによる腹腔鏡下 Spiegel 葉切除口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議肝門部領域胆管癌術後肝不全症例の検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議切除可能膵癌に対する術前化学療法症例の成績と問題点口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議脳死肝移植・肝グラフト採取術手技習得のための Cadaver Surgical Training の有用性口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議腹腔鏡下膵頭十二指腸切除の導入と定型化への工夫口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議膵体尾部癌における膵切離位置，総肝動脈周囲リンパ節郭清についての検討口頭発表（一般）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議Preoperative serum transthyretin level predicts survival in PDAC patients receiving pancreatectomyシンポジウム・ワークショップパネル（公募）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議Vp3/4 肝細胞癌に対する集学的治療シンポジウム・ワークショップパネル（公募）
- 第78回日本消化器外科学会総会, 2023年07月, 日本語, 国内会議進行胆道癌に対する集学的治療戦略シンポジウム・ワークショップパネル（公募）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議A study for infectious complication of hepatectomies in patients with preexisting bilioenteric anastomosisポスター発表
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Association between morphologic appearance in CT/MRI and efficacy of atezolizumab plus bevacizumab for advanced hepatocellular carcinomaポスター発表
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Intracholecystic papillary neoplasm (ICPN) with pancreaticobiliary maljunction (PBM): Comparison with normal gallbladder cancer with PBMポスター発表
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Successful biliary drainage using hybrid EUS-BD for stricture of choledochojejunostomyポスター発表
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Intended destination for a board certified surgeon under 45口頭発表（一般）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Prognostic significance of malnutrition diagnosed by the GLIM criteria for resected extrahepatic cholangiocarcinoma: A single-center retrospective study口頭発表（一般）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議The optimal treatment strategy of therapeutic intervention using total tumor volume in patients with colorectal liver metastases口頭発表（一般）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Improvement in stapler pancreatic transection to reduce pancreatic fistula after laparoscopic distal pancreatectomy: twelve-year experience at a single high-volume center口頭発表（一般）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Reappraisal of malignant risk assessment for small (≦20 mm) non-functioning pancreatic neuroendocrine tumorsシンポジウム・ワークショップパネル（公募）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Anterior approach for open rigththepatectomy for huge hepatocellular carcinomaシンポジウム・ワークショップパネル（公募）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Our surgical technique of vascular dissection and resection for locally advanced pancreatic cancerシンポジウム・ワークショップパネル（公募）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Legitimacy of systemic chemotherapy for unresectable hepatocellular carcinoma aiming conversion hepatectomyシンポジウム・ワークショップパネル（公募）
- 第35回日本肝胆膵外科学会学術集会, 2023年06月, 日本語, 国内会議Moderators(Oral 18)その他
- The 31st International Congress of the European Association for Endoscopic Surgery (EAES), 2023年06月, 日本語, 国際会議Impact of Sarcopenia as a Prognostic Factor on Laparoscopic or Open Hepatectomy for Hepatocellular Carcinomaポスター発表
- The 31st International Congress of the European Association for Endoscopic Surgery (EAES), 2023年06月, 日本語, 国際会議Laparoscopic liver resection after pancreaticoduodenectomy口頭発表（一般）
- 第107回北播外科医会, 2023年06月, 日本語, 国内会議胆道がん治療 新時代の幕開け口頭発表（招待・特別）
- 第68回国際外科学会日本部会総会, 2023年06月, 日本語, 国内会議Investigation of the relationship between complications after pancreaticoduodenectomy for distal cholangiocarcinoma and malnutrition diagnosed by the GLIM criteria口頭発表（一般）
- 第45回日本癌局所療法研究会, 2023年06月, 日本語, 国内会議腹腔動脈狭窄を伴う十二指腸乳頭部癌に対し膵頭十二指腸切除術を施行した１例口頭発表（一般）
- 第41回日本肝移植学会学術集会, 2023年06月, 日本語, 国内会議脳死肝移植に初めて参加した経験から得られた移植医療に対する抱負口頭発表（一般）
- 第41回日本肝移植学会学術集会, 2023年06月, 日本語, 国内会議当科における MELD スコア制導入後の脳死肝移植希望登録患者に関する検討シンポジウム・ワークショップパネル（公募）
- 日経メディカル配信関西地区座談会, 2023年05月, 日本語, 国内会議『肝内胆管癌に対するがんゲノム診断の実装』その他
- ILTS2023, 2023年05月, 日本語, 国際会議The factors of predicting over-time weight increase after liver transplantationポスター発表
- ILTS2023, 2023年05月, 日本語, 国際会議Indication of liver transplantation in the treatment of newly categorized acute-on-chronic liver failure in Japanポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議肝外胆管癌切除後の早期再発予測におけるGLIM基準の有用性ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議大腸癌肝転移における予後予測因子としての全腫瘍体積の有用性と，適切な化学療法導入時期に関する観察研究ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議当科における吸収性スペーサー留置術22例の臨床経過ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議術前化学療法後に切除を施行したBR-A膵癌，UR-LA膵癌における早期再発risk因子の検討ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 国内会議胆道癌における術後静脈血栓症と血漿Dダイマーの関連性の検討ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 国内会議当科における非吸収性スペーサー留置術の治療成績と今後の課題ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議術前NLR値と胆嚢癌の予後との関連ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議肝細胞癌切除症例におけるGLIM基準と予後の関連ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議十二指腸乳頭部癌におけるC-reactive protein to albumin ratio（CAR）の予後への影響ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議右肝葉切除を施行した肝門部領域胆管癌の再考；左側からの切除の可能性ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議治療成績から見た大腸癌肝転移における切除可能性分類と治療戦略ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議肝門部領域胆管癌に対する術前門脈塞栓術施行例の検討ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議肝移植後長期成績向上のために，何が必要かポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議局所進行膵癌に対する外科治療ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議肝外胆管癌切除後予後因子としてのGLIM基準の有用性に関する検討ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議ロボット支援下膵体尾部切除導入期に直面する技術的問題点ポスター発表
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議胆道癌に対するS-1術後補助化学療法と早期再発の関連口頭発表（一般）
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議Under 40外科医が専門医取得の次に目指すものシンポジウム・ワークショップパネル（公募）
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議進行肝細胞癌に対するConversion surgeryの妥当性シンポジウム・ワークショップパネル（公募）
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議膵癌患者における術前低栄養の評価とその臨床的役割シンポジウム・ワークショップパネル（公募）
- 第123回日本外科学会定期学術集会, 2023年04月, 日本語, 日本国, 国内会議初回再発形式からみる表在性肝細胞癌に対する非系統的切除術の妥当性に関する検討シンポジウム・ワークショップパネル（公募）
- 胆道癌治療のNewStandard -胆道癌治療の免疫療法- in 兵庫, 2023年04月, 日本語, 日本国, 国内会議胆道癌周術期治療における最新の話題口頭発表（一般）
- 第109回日本消化器病学会総会, 2023年04月, 日本語, 日本国, 国内会議術前骨格筋量減少が肝外胆管癌切除後の長期予後に与える影響に関する観察研究口頭発表（一般）
- 第109回日本消化器病学会総会, 2023年04月, 日本語, 日本国, 国内会議進行肝細胞癌薬物療法における転移部位別奏効率の検討口頭発表（一般）
- 第109回日本消化器病学会総会, 2023年04月, 日本語, 日本国, 国内会議肝胆膵領域におけるAIを用いた手術支援技術の現状と展望口頭発表（一般）
- 第109回日本消化器病学会総会, 2023年04月, 日本語, 日本国, 国内会議食道胃静脈瘤に対するHassab手術が術後肝機能に与える影響についての検討口頭発表（一般）
- 第59回日本腹部救急医学会総会, 2023年03月, 日本語, 日本国, 国内会議当科における無石性胆嚢炎症例の手術成績口頭発表（一般）
- 第59回日本腹部救急医学会総会, 2023年03月, 日本語, 日本国, 国内会議膵尾側温存の意義シンポジウム・ワークショップパネル（公募）
- TAIHO Web Lecture on Biliary Tract and Pancreatic Cancer, 2023年01月, 日本語, 日本国, 国内会議最前線の外科医が考える化学療法～胆道癌編～口頭発表（一般）
- 第50回近畿肝臓外科研究会, 2023年01月, 日本語, 日本国, 国内会議当科肝臓外科における術中ナビゲーションの現状と展望口頭発表（一般）
- ASCO 2023 Gastrointestinal Cancers Symposium, 2023年01月, 英語, アメリカ合衆国, 国際会議Risk factors for early relapse in patients with biliary tract cancers who underwent curative resection: An exploratory subgroup analysis of JCOG1202.ポスター発表
- 第39回近畿肝移植検討会, 2022年12月, 日本語, 国内会議脳死肝移植登録待機中管理に難渋した一例口頭発表（一般）
- 第35回日本内視鏡外科学会総会, 2022年12月, 日本語, 国内会議当院における腹腔鏡下膵頭十二指腸切除の導入口頭発表（一般）
- 第35回日本内視鏡外科学会総会, 2022年12月, 日本語, 国内会議ロボット支援膵切除時代における技術認定制度の役割と問題点シンポジウム・ワークショップパネル（公募）
- 第35回日本内視鏡外科学会総会, 2022年12月, 日本語, 国内会議当施設での亜区域切除のアプローチ法シンポジウム・ワークショップパネル（公募）
- Transplantation Science Symposium(TSS) Asian Regional Meeting 2022, 2022年11月, 英語, 国際会議The Factors of Predicting Over-Time Weight Increase After Liver Transplantation口頭発表（一般）
- 第14回膵臓内視鏡外科研究会, 2022年11月, 日本語, 国内会議ロボット支援下膵体尾部切除導入期に直面する諸問題シンポジウム・ワークショップパネル（公募）
- 第14回膵臓内視鏡外科研究会, 2022年11月, 日本語, 国内会議門脈輪状膵を併存した症例に対する腹腔鏡下膵切除術の経験口頭発表（一般）
- 第14回膵臓内視鏡外科研究会, 2022年11月, 日本語, 国内会議腹腔鏡下膵体尾切除術の膵頚部切離における 45mm カートリッジの有用性シンポジウム・ワークショップパネル（公募）
- 第35回日本外科感染症学会総会学術集会, 2022年11月, 日本語, 国内会議胆道癌に対する術前胆汁返還の SSI に対する意義シンポジウム・ワークショップパネル（公募）
- JDDDW2022, 2022年10月, 英語, 国内会議The usefulness of total tumor volume as a prognostic factor with colorectal cancer liver metastasesポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議肝S8病変に対する腹腔鏡下肝切除術適応の有効性ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議肝切除後の術後静脈血栓塞栓症の発症における予測スコアの有用性の検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議当科における非吸収性スペーサー留置術の成績と今後の課題ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議膵頭十二指腸切除術後の早期胆管炎リスク因子の検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議再発形式からみる表在性肝細胞癌に対する非解剖学的切除術の妥当性の検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議初発単発肝細胞癌に対する肝切除と粒子線治療成績の比較検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議胆嚢癌におけるInflammation-based prognostic scoresの予後への影響ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議血清D-dimer値を用いた膵切除後静脈血栓症予測ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議食道癌術後の膵癌に対する膵切除6例の検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議肝動脈化学塞栓療法を中心とした膵神経内分泌腫瘍肝転移に対する集学的治療ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議肝細胞癌に対するmajor hepatectomy後の術後肝不全発症早期予測における術後1日目CRP低値の有用性ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議肝S7切除における腹腔鏡手術と開腹手術の手術成績の比較ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議胆管癌の術後早期再発症例の検討ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議進行肝細胞癌におけるConversion surgeryの妥当性ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議非乳頭部十二指腸癌に対する手術成績ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議腹腔鏡下膵体尾部切除における45mmカートリッジを用いた膵切離ポスター発表
- 第20回消化器外科学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議進行胆道癌に対する集学的治療の役割シンポジウム・ワークショップパネル（公募）
- 第64回消化器病学会大会（JDDW2022）, 2022年10月, 日本語, 国内会議Intermediate HCCに対する集学的アプローチポスター発表
- 第60回癌治療学会学術集会, 2022年10月, 日本語神戸大学における肝癌集学的治療の現状シンポジウム・ワークショップパネル（公募）
- 第60回癌治療学会学術集会, 2022年10月, 日本語, 国内会議膵・胆道癌の腹腔洗浄細胞診における、剥離細胞分析装置 LC-1000 の有用性に関する研究口頭発表（一般）
- 第58回日本移植学会総会, 2022年10月, 日本語, 国内会議コロナ禍における肝移植医療の現状と課題口頭発表（一般）
- 第58回日本移植学会総会, 2022年10月, 日本語, 国内会議移植医療における働き方改革推進の現状と課題口頭発表（一般）
- 第58回日本胆道学会学術集会, 2022年10月, 日本語, 国内会議胆管非拡張型膵・胆管合流異常に対する胆嚢摘出後胆管径の推移について口頭発表（一般）
- 第58回日本胆道学会学術集会, 2022年10月, 日本語, 国内会議進行胆道癌における化学療法の現状と限界シンポジウム・ワークショップパネル（公募）
- 第23回神戸外科フォーラム, 2022年10月, 日本語, 国内会議特別講演Ⅰ口頭発表（招待・特別）
- 第14回日本Acute Care Surgery学会学術集会, 2022年09月, 日本語, 国内会議がん化学療法中の急性胆嚢炎症例の検討ポスター発表
- 日本蛍光ガイド手術研究会第５回学術集会, 2022年09月, 日本語, 国内会議ICG蛍光法を用いた腹腔鏡下肝S2亜区域切除術シンポジウム・ワークショップパネル（公募）
- 第45回日本膵・胆管合流異常研究会, 2022年09月, 日本語, 国内会議胆管非拡張型膵・胆管合流異常に対する胆嚢摘出後の胆管径の変化に関する検討（第2報）口頭発表（招待・特別）
- APASL Oncology 2022, 2022年09月, 日本語, 国際会議Hepatic Resection versus Particle Therapy for Single Hepatocellular Carcinoma as An Initial Treatment: A Multicenter Propensity Score Matched Analysisポスター発表
- 第56回近畿肝癌談話会, 2022年08月, 日本語, 国内会議進行肝細胞癌における Conversion surgery の妥当性口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議大腸癌肝転移における予後予測因子としての全腫瘍体積の有用性口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議漿液性膵嚢胞腫瘍(SCN)内部の主膵管にHigh grade PanINを合併した1例口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議肝切除における術後静脈血栓症診断における血清Dダイマー測定の有用性口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議膵頭十二指腸切除術後の早期胆管炎リスク因子の検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議当科における吸収性スペーサー留置術の検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議C型肝炎ウイルスの治療後SVR群，RNA陽性群における肝癌切除例の比較検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議肝外胆管癌におけるInflammation-based scoresの予後への影響口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議腹腔鏡で診断しえた膵癌EUS-FNA後のNeedle Tract Seedingの1例口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議膵全摘，残膵全摘後の残胃関連合併症について口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議腹腔鏡下肝S2亜区域切除術の定型化口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議肝細胞癌に対する肝右葉切除後の術後肝不全発症早期予測における術後1日目C反応性蛋白低値の有用性口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議遠位胆管癌におけるサルコペニアの意義についての検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議当院での切除可能膵癌患者に対する治療成績口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議肝左背側領域における系統的腹腔鏡下肝切除のknack & pitfalls口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議開腹肝切除術後の腹腔鏡下再肝切除術適応の妥当性についての検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議脾動静脈根部に近接する膵体部癌に対する腹腔鏡下膵体尾部切除口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議生体肝移植・肝門部領域胆管癌術後胆管狭窄症例の検討口頭発表（一般）
- 第77回日本消化器外科学会総会, 2022年07月, 日本語, 国内会議コロナ禍において発展を遂げた肝移植医療の現状と課題シンポジウム・ワークショップパネル（公募）
- The 30th Annual Meeting of International Congress on Nutrition and Integrative Medicine (統合医療機能性食品国際学会 第 30 回年会）（ICNIM2022）, 2022年07月, 日本語, 国際会議The efficacy of a standardized extract of cultured Lentinula edodes mycelia for chemotherapy-related taste disorders in patients with pancreatic cancer:A double-blind, placebo-controlled randomized trial口頭発表（一般）
- 第53回日本膵臓学会大会・第26回国際膵臓学会, 2022年07月, 日本語, 国内会議Survival outcome of chemotherapy-concurrent proton radiotherapy for non-metastatic locally advanced pancreatic cancer口頭発表（一般）
- 第53回日本膵臓学会大会・第26回国際膵臓学会, 2022年07月, 日本語, 国内会議Diagnosis and treatment strategy of patients with early-stage(Stage 0/IA) pancreatic cancer口頭発表（一般）
- 第53回日本膵臓学会大会・第26回国際膵臓学会, 2022年07月, 日本語, 国内会議Our standardized technique of laparoscopic distal pancreatectomy for pancreatic cancerシンポジウム・ワークショップパネル（公募）
- 第40回日本肝移植学会学術集会, 2022年07月, 日本語, 国内会議肝移植後の経時的体重変化を予測する因子に関する観察研究口頭発表（一般）
- 第40回日本肝移植学会学術集会, 2022年07月, 日本語, 国内会議当科における MELD スコア制導入後の脳死肝移植希望登録患者に関する検討口頭発表（一般）
- 第40回日本肝移植学会学術集会, 2022年07月, 日本語, 国内会議当施設における脳死下臓器摘出時互助制度の現状と課題シンポジウム・ワークショップパネル（公募）
- EAES2022, 2022年07月, 日本語, 国際会議Standardization of laparoscopic anatomic liver resection of segment 2 by glissonean approach口頭発表（一般）
- 第47回日本外科系連合学会学術集会, 2022年06月, 日本語, 国内会議当科における吸収性スペーサー留置術 15 例の検討口頭発表（一般）
- 第47回日本外科系連合学会学術集会, 2022年06月, 日本語, 国内会議門脈腫瘍栓のみを認めた肝細胞癌に対して集学的治療が奏功した１例口頭発表（一般）
- 第47回日本外科系連合学会学術集会, 2022年06月, 日本語, 国内会議粒子線治療を目的とした仙骨脊索腫に対する吸収性スペーサー留置術の経験口頭発表（一般）
- 第47回日本外科系連合学会学術集会, 2022年06月, 日本語, 国内会議腹部悪性腫瘍に対するネスキープ留置術の外科的経験シンポジウム・ワークショップパネル（公募）
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Impact of Delayed Gastric Emptying After Pancreatoduodenectomy on Postoperative Nutritional Statusポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Spontaneous rupture of splenic hilar lymph node metastasis from hepatocellular carcinoma: a rare case reportポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Risk factors of refractory cholangitis after pancreaticoduodenectomyポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Low levels of C-reactive protein on postoperative day 1 are an early predictor for posthepatectomy liver failure in hepatocellular carcinoma patients undergoing right hepatectomyポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Current role of atezolizumab plus bevacizumab therapy in the sequential treatment of unresectable hepatocellular carcinomaポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Utility of plasma serum D-dimer for diagnosis of venous thromboembolism after hepatectomyポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Efficacy analyses of neoadjuvant treatment for patients with “resectable” pancreatic ductal adenocarcinomaポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Laparoscopic Spleen Preserving Distal Pancreatectomy with Splenic Vessels Preservationポスター発表
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 日本語, 国内会議いざ胆道癌 新たな時代の幕開け公開講演，セミナー，チュートリアル，講習，講義等
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議The usefulness of total tumor volume as a prognostic factor in patients with colorectal cancer liver metastasesシンポジウム・ワークショップパネル（公募）
- 第34回日本肝胆膵外科学会・学術集会, 2022年06月, 英語, 国内会議Multidisciplinary approach for advanced hepatocellular carcinomaシンポジウム・ワークショップパネル（公募）
- 第9回若手消化器外科腹腔鏡セミナー, 2022年06月, 日本語, 国内会議開会の挨拶その他
- 第49回近畿肝臓外科研究会, 2022年05月, 日本語, 国内会議肝門部領域胆管癌術後門脈血栓塞栓症に対して経回結腸静脈アプローチにて門脈血栓摘除術を施行した一例口頭発表（一般）
- 第108回日本消化器病学会総会, 2022年04月, 日本語, 国内会議肝移植後の経時的体重変化を予測する因子に関する検討口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語肝細胞癌における肝右葉切除術後1日目のC反応性蛋白低値は術後肝不全発症の早期予測に有用である[招待有り]口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語解剖学的特徴を活かした腹腔鏡下尾状葉切除口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議肝門部領域胆管癌の術後早期再発症例の検討ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議肝胆道癌における肝切除後静脈血栓塞栓症とDダイマーの関連性の検討ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議高齢者胆嚢癌においても外科切除は有用かポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議当科における吸収性スペーサー留置の成績と今後の課題ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議膵癌における術前 Rapid Turnover Protein 測定の臨床的役割ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議若年性膵癌症例の検討ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議腹腔鏡下肝 S7 切除の手術成績の検討ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議膵頭十二指腸切除後患者に対するアミノ酸製剤を用いた術後栄養療法の有用性ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議当院における術前補助療法後に切除を施行したBR膵癌と conversion 手術を施行した UR-LA 膵臓の治療成績の比較ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議当院における切除不能肝細胞癌に対するレンバチニブの治療成績ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議高度進行肝細胞癌に対し減量肝切除を実施した症例におけるサルコペニアと予後に関する検討ポスター発表
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議膵切除後血漿 D-dimer の推移と術後静脈血栓症診断における意義口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議膵・胆道癌における剥離細胞分析装置 LC-1000 の腹水細胞診支援システムとしての臨床応用可能性に関する探究的研究口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議胆道癌切除例における 28-8 抗体を用いた PD-L1 発現解析と予後に関する検討口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議膵頭十二指腸切除術後の早期胆管炎リスク因子の検討口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議大腸癌肝転移における予後予測因子としての全腫瘍体積の有用性に関する検討口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議肝細胞癌の腫瘍位置と初回再発形式に関する検討口頭発表（一般）
- 第122回日本外科学会定期学術集会, 2022年04月, 日本語, 国内会議当院における切除不能肝細胞癌に対するラムシルマブ治療成績の検討口頭発表（一般）
- 15th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA), 2022年03月, 英語, 国際会議Intraoperative Assessment of the Demarcation Line and Intersegmental/Sectional Planes in Liver Surgeryポスター発表
- 第113回大阪胆道疾患研究会, 2022年03月, 日本語座長（一般演題）その他
- SAGES 2022 Annual Meeting, 2022年03月, 英語, 国際会議Laparoscopic anatomic liver resection if segment 2 by glissonean approachポスター発表
- 日本消化器病学会近畿支部第116回例会, 2022年02月, 日本語, 国内会議膵中央切除後に多発残膵再発をきたし残膵全摘術を施行した膵胆道型(pancreatobiliary type）IPMCの一例口頭発表（一般）
- 第38回近畿肝移植検討会, 2021年12月, 日本語, 国内会議新型コロナ感染拡大が肝移植にもたらした影響と問題点口頭発表（一般）
- 第34回日本内視鏡外科学会総会, 2021年12月, 日本語, 国内会議Glissoneanアプローチを用いた腹腔鏡下肝S2亜区域切除口頭発表（一般）
- 第34回日本内視鏡外科学会総会, 2021年12月, 日本語, 国内会議腹腔鏡下肝S7切除の手術成績の検討口頭発表（一般）
- 第34回日本内視鏡外科学会総会, 2021年12月, 日本語, 国内会議尾状葉切除における手術手技の工夫シンポジウム・ワークショップパネル（公募）
- 第34回日本内視鏡外科学会総会, 2021年12月, 日本語, 国内会議腹腔鏡下膵頭十二指腸切除導入の経験口頭発表（一般）
- 第83回日本臨床外科学会総会, 2021年11月, 日本語, 国内会議門脈腫瘍栓を疑い門脈合併切除を施行した膿瘍形成・門脈血栓を伴うpT1a膵頭部癌の1例口頭発表（一般）
- 第83回日本臨床外科学会総会, 2021年11月, 日本語, 国内会議肝切除術におけるDemarcation lineとIntersegmental planeナビゲーションシンポジウム・ワークショップパネル（公募）
- 第83回日本臨床外科学会総会, 2021年11月, 日本語, 国内会議コロナ禍において推進すべき肝移植医療の現状と課題シンポジウム・ワークショップパネル（公募）
- 第83回日本臨床外科学会総会, 2021年11月, 日本語, 国内会議幽門側胃切除後の膵体尾部切除における残胃温存実現可能性の検討口頭発表（一般）
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議大腸癌肝転移における予後予測因子としての全腫瘍体積の有用性に関する検討ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議腹部悪性腫瘍に対する粒子線治療適応拡大を可能とする新規素材吸収性スペーサーの開発と臨床応用ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議当院でのレンバチニブ治療症例の検討ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議膵癌術前治療が及ぼす骨格筋量変化と手術成績に関する検討ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議膵頭十二指腸切除後に孤立性門脈内再発をきたした膵神経内分泌腫瘍の1例ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議肝細胞癌再発に対する肝切除後の再発リスク因子の検討ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議高齢者に対する胆嚢癌手術の検討ポスター発表
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議進行胆道癌に対する集学的治療の検討シンポジウム・ワークショップパネル（公募）
- 第19回消化器外科学会大会（JDDW2021）, 2021年11月, 日本語, 国内会議膵癌患者における膵切除後の耐糖能の変化についての検討ポスター発表
- 第57回日本胆道学会学術集会, 2021年10月, 日本語, 国内会議総胆管嚢腫に対する胆管切除術後に発症した胆管癌の１例口頭発表（一般）
- 第57回日本胆道学会学術集会, 2021年10月, 日本語, 国内会議胆道癌におけるSystematic inflammation-based scoresの意義口頭発表（一般）
- 第57回日本胆道学会学術集会, 2021年10月, 日本語, 国内会議座長（口演65）その他
- 第52回日本膵臓学会大会, 2021年09月, 日本語, 国内会議膵頭十二指腸切除後動脈出血と門脈狭窄に対して肝動脈、門脈ステントで救命した一例シンポジウム・ワークショップパネル（公募）
- 第52回日本膵臓学会大会, 2021年09月, 日本語, 国内会議膵神経内分泌腫瘍における血液バイオマーカーの検索シンポジウム・ワークショップパネル（公募）
- 第57回日本移植学会総会, 2021年09月, 日本語, 国内会議移植医療における働き方改革の推進シンポジウム・ワークショップパネル（公募）
- 第44回日本膵・胆管合流異常研究会, 2021年09月, 日本語, 国内会議総胆管嚢腫に対する嚢腫胆管切除術後の膵内胆管に発癌を認めた1例口頭発表（一般）
- 第48回日本膵切研究会, 2021年08月, 日本語, 国内会議司会（ポスター15）その他
- 第57回日本肝癌研究会, 2021年07月, 日本語, 国内会議術前検査施行後に自然退縮を来した肝細胞癌5例の手術経験口頭発表（一般）
- 第57回日本肝癌研究会, 2021年07月, 日本語, 国内会議術前サルコペニアと高度進行肝細胞癌に対する減量切除症例との関連について口頭発表（一般）
- 第57回日本肝癌研究会, 2021年07月, 日本語, 国内会議DAA 治療後肝癌に対する肝切除症例の検討口頭発表（一般）
- 第57回日本肝癌研究会, 2021年07月, 日本語, 国内会議肝細胞癌再発に対する腹腔鏡手術適応の予後への影響について口頭発表（一般）
- 第57回日本肝癌研究会, 2021年07月, 日本語, 国内会議高度進行肝細胞癌に対する集学的アプローチ口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議寒冷凝集素症による難治性溶血性貧血に対して脾摘術により治療効果を得た1例口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議膵癌切除後の肺再発に関する臨床病理学的特徴とリスク因子口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議高度進行肝細胞癌に対する減量切除症例におけるサルコペニアの検討口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議胆道癌患者における潜在性遠隔転移の危険因子の検討口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議術前診断が困難であった特殊な組織型を呈した膵癌の1切除例口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議膵神経内分泌腫瘍の予後予測因子に基づいた治療戦略シンポジウム・ワークショップパネル（公募）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議膵体尾部切除後の膵液瘻が膵癌の長期予後に与える影響について口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議肝臓外科におけるDemarcation lineとIntersegmental/sectional planeシンポジウム・ワークショップパネル（公募）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議肝S7病変に対する腹腔鏡手術適応の妥当性に関する検討口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議遠位胆管癌の術後早期再発症例の検討口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議高度進行肝細胞癌に対する減量切除術の有用性の検討シンポジウム・ワークショップパネル（公募）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議治癒切除後胆道癌の予後予測因子における術前炎症・栄養スコアの有用性の検討口頭発表（一般）
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議座長（一般演題205）その他
- 第76回日本消化器外科学会総会, 2021年07月, 日本語, 国内会議膵癌における術後合併症と予後の検討口頭発表（一般）
- 第39回日本肝移植学会学術集会, 2021年06月, 日本語, 国内会議肝移植後の経時的な体重変化を予測する因子に関する検討口頭発表（一般）
- 第39回日本肝移植学会学術集会, 2021年06月, 日本語, 国内会議肝移植後長期生存を得られたレシピエントにおける年齢の及ぼす影響シンポジウム・ワークショップパネル（公募）
- 第33回日本肝胆膵外科学会学術集会, 2021年06月, 英語, 国内会議Delayed initiation of S-1 adjuvant chemotherapy impairs survival in patients with surgical resection for resectable pancreatic cancer口頭発表（一般）
- 第33回日本肝胆膵外科学会学術集会, 2021年06月, 英語, 国内会議Prognosis after total pancreatectomy and total remnant pancreatectomy for pancreatic cancer口頭発表（一般）
- 第33回日本肝胆膵外科学会学術集会, 2021年06月, 英語, 国内会議Present status of outpatient clinic for transplant patientsシンポジウム・ワークショップパネル（公募）
- 第33回日本肝胆膵外科学会学術集会, 2021年06月, 英語, 国内会議Impact of hepatectomy for advanced hepatocellular carcinoma with major portal vein tumor thrombusシンポジウム・ワークショップパネル（公募）
- 第33回日本肝胆膵外科学会学術集会, 2021年06月, 英語, 国内会議Long term survival following resection for ampullary carcinomaシンポジウム・ワークショップパネル（公募）
- 第43回日本癌局所療法研究会, 2021年05月, 日本語, 国内会議腎細胞癌の異時性単発肝転移に対し分子標的薬治療後に腹腔鏡下肝切除術を施行した 1 例口頭発表（一般）
- 第43回日本癌局所療法研究会, 2021年05月, 日本語, 国内会議高齢者胆嚢癌において R0 切除は有用かシンポジウム・ワークショップパネル（公募）
- 第43回日本癌局所療法研究会, 2021年05月, 日本語, 国内会議足底原発の未分化多形肉腫膵転移に対して腹腔鏡下尾側膵切除を行った一例口頭発表（一般）
- 第43回日本癌局所療法研究会, 2021年05月, 日本語, 国内会議腹腔鏡下膵体尾部切除後、needle tract seeding による胃壁再発をきたした膵癌の1例口頭発表（一般）
- 第43回日本癌局所療法研究会, 2021年05月, 日本語, 国内会議膵癌に対する亜全胃温存膵頭十二指腸切除術後の挙上空腸間膜再発に切除を施行した1例口頭発表（一般）
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議膵管内乳頭粘液性癌に対する亜全胃温存膵頭十二指腸切除術後に細胆管癌を発症し，肝切除後胆汁瘻を合併した1例ポスター発表
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議治癒切除後の胆道癌における，Controlling Nutritional Status（CONUT）scoreの術前予後因子としての有用性の検討口頭発表（一般）
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議高齢者胆嚢癌における切除の意義についての検討ポスター発表
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議切除不能肝門部領域胆管癌に対するスペーサ手術および粒子線治療口頭発表（一般）
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議肝細胞癌再発に対する腹腔鏡下再肝切除適応の条件についての検討ポスター発表
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議術前分枝鎖アミノ酸飲料の使用は肝胆膵外科手術中の乳酸産生を抑制するポスター発表
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議切除を企図し得るカテゴリとしての切除可能境界膵癌の再検討口頭発表（一般）
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議高齢者に対する肝門部領域胆管癌手術の検討ポスター発表
- 第121回日本外科学会定期学術集会, 2021年04月, 日本語, 国内会議進行胆道癌に対する集学的治療とConversion Surgeryの意義ポスター発表
- 第33回日本内視鏡外科学会, 2021年03月, 英語, 国内会議Oncological outcomes of laparoscopic distal pancreatectomy for pancreatic cancerシンポジウム・ワークショップパネル（公募）
- 日本消化器病学会近畿支部第114回例会, 2021年02月, 日本語, 国内会議十二指腸乳頭部癌のリンパ節転移の意義と予測スコアの検討（多施設共同後ろ向き観察研究）シンポジウム・ワークショップパネル（公募）
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Contrast-Enhanced Intraoperative ultrasonic cholangiography for real time biliary navigation in hepatobiliary surgeryシンポジウム・ワークショップパネル（公募）
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Predictive factor of postoperative early recurrence of gallbladder cancerポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議A resected case of IgG4-related sclerosing cholecystitis mimicking gallbladder cancerポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Gastric conduit-preserving pancreatoduodenectomy with right gastroepiploic vessels reconstruction for pancreatic ductal adenocarcinoma after esophagectomyポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議The improvement of rate of surgical site infection by preoperative bile replacement in pancreatic and biliary tract cancer with biliary drainageポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Multiple resections for isolated lung metastases originated from pancreatic cancer: report a case.ポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Pancreaticoduodenectomy for the bifid pancreasポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Stapler pancreatic transection with short (45mm) cartridge during laparoscopic distal pancreatectomy –Easy handling compared to 60mm cartridgeシンポジウム・ワークショップパネル（公募）
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Late-onset severe intraabdominal hemorrhage after salvage pancreaticoduodenectomy for patient with proton beam therapy: a case report.シンポジウム・ワークショップパネル（公募）
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議The outcomes of surgical resection for locally recurrent bile duct cancerポスター発表
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議Clinical significance of hepatectomy for hepatocellular carcinoma associated with lymph node and/or distant metastases口頭発表（招待・特別）
- 第32回日本肝胆膵外科学会, 2021年02月, 英語, 国内会議A novel scoring system for the prediction of lymph node metastasis in ampullary carcinoma口頭発表（招待・特別）
- 日本外科代謝栄養学会第57回学術集会, 2020年12月, 日本語, 国内会議閉塞性黄疸患者に対する胆汁返還と周術期合併症発症との関連性を検討する第Ⅱ相臨床試験シンポジウム・ワークショップパネル（公募）
- 第56回日本肝癌研究会, 2020年12月, 日本語, 国内会議肝外転移を有する高度進行肝細胞癌に対する肝切除術の意義シンポジウム・ワークショップパネル（公募）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議肝細胞癌術後長期生存例の検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議膵・胆道癌における術前胆道返還の有用性の検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議神戸大学における膵移植症例の検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議膵頭部癌切除後の局所再発に対するリスク因子の検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議下大静脈腫瘍栓合併肝細胞癌に対する手術症例における予後規定因子の検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議膵体尾部切除術の術後膵液瘻リスク層別化による適切な周術期管理についてシンポジウム・ワークショップパネル（公募）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議膵癌に対するICG蛍光法を用いた審査腹腔鏡の有用性シンポジウム・ワークショップパネル（公募）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議切除不能進行胆嚢癌に対する化学療法後conversion surgery施行例の検討口頭発表（招待・特別）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議肝機能不良・肝細胞癌症例に対するレンバチニブ治療成績の検討口頭発表（招待・特別）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議DAA治療後肝癌に対する肝切除例の検討シンポジウム・ワークショップパネル（公募）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議肝移植後長期予後を目指した現状と課題;肝移植外来における多職種連携の必要性口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議十二指腸乳頭部癌におけるリンパ節転移に対する予測スコアの検討口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議肝悪性疾患の再発に対する腹腔鏡下再肝切除口頭発表（一般）
- 第75回日本消化器外科学会総会, 2020年12月, 日本語, 国内会議当科における膵癌に対する腹腔鏡下膵体尾部切除の標準手技と腫瘍学的評価シンポジウム・ワークショップパネル（公募）
- 第43回日本膵・胆管合流異常研究会, 2020年11月, 日本語, 国内会議膵・胆管合流異常に Intracystic papillary neoplasm を合併し,SpyGlass が術式決定に有用であった 1 例口頭発表（招待・特別）
- 第18回日本消化器外科学会大会（JDDW2020）, 2020年11月, 日本語, 国内会議切除可能膵癌における術後S-1補助化学療法の開始時期と予後との検討ポスター発表
- 第18回日本消化器外科学会大会（JDDW2020）, 2020年11月, 日本語, 国内会議高齢肝門部領域胆管癌患者に対する肝切除術の検討ポスター発表
- 第56回日本移植学会総会, 2020年11月, 日本語, 国内会議当科におけるアルコール性肝障害に対する肝移植後再飲酒に関する検討シンポジウム・ワークショップパネル（公募）
- 第56回日本移植学会総会, 2020年11月, 日本語, 国内会議急性肝不全患者に対する肝移植を見据えた院内および他施設との連携体制の現状と課題シンポジウム・ワークショップパネル（公募）
- 第56回日本移植学会総会, 2020年11月, 日本語, 国内会議HLA one way 0 mismatched donor からの SPK 後 GVHD の経験シンポジウム・ワークショップパネル（公募）
- 第82回日本臨床外科学会総会, 2020年10月, 日本語, 国内会議膵頭十二指腸切除後の良性門脈狭窄による挙上空腸静脈瘤出血に対して門脈ステント留置を行った2例口頭発表（一般）
- 第82回日本臨床外科学会総会, 2020年10月, 日本語, 国内会議移殖適応疾患の変遷によるこれからの肝癌に対する肝移植治療シンポジウム・ワークショップパネル（公募）
- 第82回日本臨床外科学会総会, 2020年10月, 日本語, 国内会議胆嚢総胆管結石に対する内視鏡的戴石後の胆嚢摘出時における術中胆道造影の必要性シンポジウム・ワークショップパネル（公募）
- 第82回日本臨床外科学会総会, 2020年10月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除の当科の標準手技シンポジウム・ワークショップパネル（公募）
- 第56回日本腹部救急医学会総会, 2020年10月, 日本語, 国内会議胆嚢周囲膿瘍形成を伴う急性胆嚢炎の1例ポスター発表
- 第56回日本腹部救急医学会総会, 2020年10月, 日本語, 国内会議出血性胆嚢炎の1手術例口頭発表（一般）
- 第56回日本腹部救急医学会総会, 2020年10月, 日本語, 国内会議急性胆嚢炎における重症例をどうするか？～心血管手術後の急性胆嚢炎手術～口頭発表（一般）
- 第56回日本胆道学会学術集会, 2020年10月, 日本語, 国内会議胆嚢癌腹壁再発に対する3回の外科的切除を施行し得た1例口頭発表（一般）
- 第56回日本胆道学会学術集会, 2020年10月, 日本語, 国内会議胆嚢癌との鑑別が困難であり，外科的切除を行ったIgG4関連胆嚢炎の1例口頭発表（一般）
- 第56回日本胆道学会学術集会, 2020年10月, 日本語, 国内会議十二指腸乳頭部腫瘍に対する診断と治療戦略シンポジウム・ワークショップパネル（公募）
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議膵頭十二指腸切除術後の挙上空腸静脈瘤出血に対してハイブリッド手術室で静脈瘤塞栓および門脈ステント留置を行った1例その他
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議十二指腸乳頭部癌の切除例における術後膵液瘻の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議狭心症治療歴のある肝細胞癌患者の切除症例の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議心疾患患者に発症した急性胆嚢炎手術症例に対するTokyo Guideline 18での評価ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議膵癌肺転移に対する切除例の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議PALN陽性膵癌切除症例の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議超高齢者に対する肝細胞癌の高難度肝切除術の治療成績の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議切除可能な大腸癌肝転移の治療における全腫瘍体積の有用性についての検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除の短期，長期成績についてポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議肝硬変合併肝細胞癌に対する腹腔鏡下肝切除の有用性についての検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議高齢胆道癌患者に対する高難度手術成績の検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議腹部悪性腫瘍に対する粒子線治療適応拡大を目指した新規素材吸収性スペーサーの開発シンポジウム・ワークショップパネル（公募）
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議脳死移植における働き方改革を実現するためになすべき移植医の環境整備ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議肝癌粒子線治療後局所再発に対するサルベージ切除例の特徴と問題点シンポジウム・ワークショップパネル（公募）
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議十二指腸乳頭部癌における臨床病理学的検討ポスター発表
- 第120回日本外科学会定期学術集会, 2020年08月, 日本語, 国内会議食道癌術後の膵頭部癌に対しmicrosurgeryによる右胃大網動静脈再建を行い胃管温存膵頭十二指腸切除を施行した2例シンポジウム・ワークショップパネル（公募）
- 日本消化器病学会近畿支部第112回例会, 2020年02月, 日本語, 国内会議膵癌切除後の初回再発形式の違いによる予後の検討ポスター発表
- 日本消化器病学会近畿支部第112回例会, 2020年02月, 日本語, 国内会議肝細胞癌根治切除例における慢性C型肝炎に対するDAA治療の検討ポスター発表
- 第48回近畿肝臓外科研究会, 2020年02月, 日本語, 国内会議当院における腹腔鏡下再肝切除の工夫口頭発表（一般）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議当科における腹腔鏡下膵体尾部切除の開腹移行例の検討シンポジウム・ワークショップパネル（公募）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議初回切除部に対する再発部位から見た再発肝細胞癌に対する腹腔鏡手術適応の有効性について口頭発表（一般）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議胆管非拡張型膵・胆管合流異常に対する腹腔鏡下胆嚢摘出後の胆管径の変化に関する検討口頭発表（一般）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議当院における腹腔鏡下脾温存膵体尾部切除術の手術手技と治療成績口頭発表（一般）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議当施設における腹腔鏡下肝切除の適応口頭発表（一般）
- 第32回日本内視鏡外科学会総会, 2019年12月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除（LDPD2）の標準手技と短期成績口頭発表（一般）
- 第11回膵臓内視鏡外科研究会, 2019年12月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除の短期、長期成績についてシンポジウム・ワークショップパネル（公募）
- 第11回膵臓内視鏡外科研究会, 2019年12月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除術におけるリンパ節郭清の定型化シンポジウム・ワークショップパネル（公募）
- 第11回膵臓内視鏡外科研究会, 2019年12月, 日本語, 国内会議D2郭清を伴う腹腔鏡下膵体尾部切除術における術野展開の工夫口頭発表（一般）
- 第13回肝臓内視鏡外科研究会, 2019年12月, 日本語, 国内会議肝硬変合併肝細胞癌に対する腹腔鏡下肝切除の有用性についての検討口頭発表（一般）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議難治性胆汁漏後の胆管狭窄に対して狭窄部穿刺が有効であった一例ポスター発表
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議進行肝細胞癌に対する減量切除術の有用性の検討口頭発表（招待・特別）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議心臓血管外科手術後に発症した急性胆嚢炎に対するTG18での評価口頭発表（一般）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議膵癌切除症例の肺再発に関する検討口頭発表（一般）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議子宮平滑筋肉腫膵転移に対して腹腔鏡下脾温存尾側膵切除術を施行した１例ポスター発表
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議脾動脈瘤胃穿破に対するTAE後に広範な脾梗塞を来すも保存的に加療しえた１例ポスター発表
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議肝細胞癌におけるArl4c発現の臨床的意義についての検討シンポジウム・ワークショップパネル（公募）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議経口胆道鏡が診断に有効であった胆管内乳頭状腫瘍（IPNB）の一切除例口頭発表（一般）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議腹部悪性腫瘍に対する粒子線治療適応拡大を目指した新規素材吸収性スペーサーの開発シンポジウム・ワークショップパネル（公募）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議肝細胞癌術後遠隔転移再発に対するソラフェニブ投与後の長期生存例シンポジウム・ワークショップパネル（公募）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議当科における十二指腸乳頭部腫瘍切除例における検討口頭発表（招待・特別）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議肝細胞癌の下大静脈腫瘍栓に対する外科切除シンポジウム・ワークショップパネル（公募）
- 第81回日本臨床外科学会総会, 2019年11月, 日本語, 国内会議出血性合併症に苦慮した膵癌に対する化学陽子線療法後サルベージ手術の１例シンポジウム・ワークショップパネル（公募）
- 第57回日本癌治療学会学術集会, 2019年10月, 日本語, 国内会議そこがポイント緩和ケア ～進行がんとの付き合い方～公開講演，セミナー，チュートリアル，講習，講義等
- 第14回膵癌術前治療研究会, 2019年10月, 日本語, 国内会議座長 (一般演題4(ポスター))その他
- 第14回膵癌術前治療研究会, 2019年10月, 日本語, 国内会議当科における切除可能膵癌に対する術前療法の検討シンポジウム・ワークショップパネル（公募）
- 第55回日本移植学会総会, 2019年10月, 日本語, 国内会議生体肝移植後の難治性胆管吻合部狭窄に対して施行した磁石圧迫吻合術の長期成績ポスター発表
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議座長（Young Investigator Session 7）その他
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議術前に肝細胞癌と鑑別困難であった肝 pseudolymphoma の一例口頭発表（一般）
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議脾動脈瘤胃穿破にてTAE後の広範な脾梗塞に対し保存的加療を行った１例口頭発表（一般）
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議腹腔鏡下脾温存尾側膵切除術を施行した子宮平滑筋肉腫膵転移の1例口頭発表（一般）
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議肝切除後10年以上長期生存した症例の検討口頭発表（一般）
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議下大静脈腫瘍栓を有する進行肝細胞癌に対する当科での治療成績口頭発表（一般）
- 日本消化器病学会近畿支部第111回例会, 2019年10月, 日本語, 国内会議十二指腸乳頭部癌切除例における臨床病理学的検討口頭発表（一般）
- 第55回日本胆道学会学術集会, 2019年10月, 日本語, 国内会議胆道癌に対する術後補助療法の意義シンポジウム・ワークショップパネル（公募）
- 第55回日本胆道学会学術集会, 2019年10月, 日本語, 国内会議胆管癌再発に対して膵頭十二指腸切除術を施行した2症例の検討ポスター発表
- 第55回日本胆道学会学術集会, 2019年10月, 日本語, 国内会議肝門部領域胆管癌に対する右側・左側肝切除の選択公開講演，セミナー，チュートリアル，講習，講義等
- 第202回近畿外科学会, 2019年09月, 日本語, 国内会議術前検査で胆嚢癌との鑑別に難渋した慢性胆嚢炎の一例口頭発表（一般）
- 近畿内視鏡外科研究会第32回大会, 2019年09月, 日本語, 国内会議膵癌に対する腹腔鏡下膵体尾部切除の定型化と工夫シンポジウム・ワークショップパネル（公募）
- 第42回日本膵・胆管合流異常研究会, 2019年09月, 日本語, 国内会議胆管非拡張型膵・胆管合流異常に対する胆嚢摘出後の胆管径の変化に関する検討シンポジウム・ワークショップパネル（公募）
- 第68回近畿膵疾患談話会, 2019年09月, 日本語, 国内会議局所進行膵体部癌に対するスペーサー留置後粒子線療法の現状と課題シンポジウム・ワークショップパネル（公募）
- 第38回 Microwave Surgery 研究会, 2019年09月, 日本語, 国内会議肝細胞癌に対する腹腔鏡下肝切除術における CUSA 法と Clamp Crush 法の手術短期成績の検討シンポジウム・ワークショップパネル（公募）
- 第54回近畿肝癌談話会, 2019年07月, 日本語, 国内会議進行肝細胞癌に対する減量肝切除術の有用性の検討口頭発表（一般）
- 第37回日本肝移植学会, 2019年07月, 日本語, 国内会議急性肝不全に対する多職種連携治療戦略シンポジウム・ワークショップパネル（公募）
- 第37回日本肝移植学会, 2019年07月, 日本語, 国内会議生人間生体肝移植における、術前ALBIスコアを用いた予後予測に関する検討シンポジウム・ワークショップパネル（公募）
- 第37回日本肝移植学会, 2019年07月, 日本語, 国内会議脳死肝移植における多職種連携体制の構築。 今後何が必要か？シンポジウム・ワークショップパネル（公募）
- 第31回日本肝胆膵外科学会・学術集会, 2019年06月, 英語, 日本国, 国内会議Moderator(Poster 70)その他