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Faculty of Medicine School of Medicine Department of Surgery, Hepato-Biliary-Pancreas Surgery |
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Related SDGs |
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NANASHIMA Atsushi
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Research Areas 【 display / non-display 】
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Life Science / General surgery and pediatric surgery
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Life Science / Digestive surgery
Papers 【 display / non-display 】
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Surgical Outcomes and Diagnostic Concordance in Patients With Pancreatic Neuroendocrine Tumors Undergoing Pancreatectomy: A Retrospective Cohort Study. Reviewed
Nanashima A, Hiyoshi M, Imamura N, Tsuchimochi Y, Wada T, Hamada T, Suzuki Y, Araki Y
Cancer diagnosis & prognosis 6 ( 1 ) 52 - 61 2026.1
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal)
DOI： 10.21873/cdp.10506
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Nanashima A., Arai J., Imamura N., Hiyoshi M., Tsuchimochi Y., Wada T., Hamada T.
Gland Surgery 14 ( 12 ) 2440 - 2455 2025.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Gland Surgery
Background: Pancreatic anastomosis has been developed, and each anastomosis has its pros and cons. This study investigated the prevalence of postoperative complications, particularly pancreatic fistula (POPF), among five types of pancreatoenteric anastomoses to determine the optimal anastomosis for patients undergoing pancreatectomy. Methods: This study retrospectively and consecutively analyzed the data of 365 patients who underwent pancreatectomy with pancreaticoenteral anastomosis at two academic institutions from 1994 to 2024. Pancreaticogastrostomy via invagination was performed in 24 patients (group PG). For pancreaticojejunal anastomosis, we performed an end-to-end invagination procedure on eight patients (group PJI), two-layer suturing procedure on 96 patients (group PJT), Kakita procedure on 55 patients (group K), and modified Blumgart procedure on 182 patients (group B). Results: Group B had the shortest hospital stay and fastest resumption of oral intake. Groups PG and PJI exhibited higher grade B/C POPF rates and prolonged ascites. The potential benefits of group B included reduced hospitalization period and enhanced recovery owing to decreased POPF rates. Habitual alcohol consumption and high preoperative creatinine levels increased the risk of POPF, whereas external drainage issues and blood loss contributed to prolonged ascites. In particular, habitual alcohol consumption [relative risk (RR) =2.42], group K anastomosis (RR =2.79), soft pancreatic texture (RR =2.48), delayed oral intake (≥4 days; RR =2.78), and complete external drainage (RR =8.68) were independent predictors of POPF. Conclusions: Modified Blumgart procedure is an optimal pancreaticoenteral anastomosis technique for avoiding POPF. Early oral intake has emerged as a protective factor, highlighting its role in improving postoperative outcomes. Surgeons should prioritize intraoperative blood conservation, perioperative nutritional support, and appropriate anastomotic selection to enhance surgical success.
DOI： 10.21037/gs-2025-380
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Managing uncontrolled bleeding in elective surgery: The role of damage control techniques Reviewed
Nanashima A., Wada T., Kawano F., Hamada K., Taniguchi T., Furukawa K.
International Journal of Surgery Case Reports 128 111040 2025.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
Introduction: The main text introduction expands on the initial introduction by providing a more detailed discussion of massive bleeding in elective surgeries and its challenges. It describes how traditional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. It then introduces DCS as a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure by our two experienced cases presentation. Case 1. A 76-year-old obese male diagnosed with advanced transverse colon cancer with regional balky lymph node metastasis was identified at the root of the regional colic vein trunk. A robotic surgical approach was changed to open laparotomy because of bleeding tendency due to fatty mesentery. During the balky node dissection, the root of the vein was injured and induced massive bleeding during the compressive hemostatic procedure. As the hypotensive control rapidly became quite tricky, DCS by gauze packing and covered by the commercial dressing kit with open abdominal management (OAM). The second look operation, by supporting the Restrictive Endovascular Balloon Occlusion of the Aorta, repaired the superior mesenteric vein's injured parts. He survived for nine months. Case 2. The 72-year-old male patient was diagnosed as solitary 3 cm of hepatocellular carcinoma at S6 with alcoholic liver cirrhosis. The laparoscopic limited hepatic resection was changed to the open laparotomy due to the bleeding tendency at the transected parenchyma. After accomplishing limited resection, massive hepatic venous bleeding occurred; DCS was decided due to continuing hypotension, oozed hemorrhage, and low platelet level with metabolic acidosis by peri-hepatic gauze packing around the right liver. The second look operation for remnant hemostasis and the de-packing with abdominal closure could be achieved without severe events. The postoperative course showed no hepatic failure, and they recovered during a hospital stay. Discussion: It describes how conventional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. DCS is a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. The role of DCS is well known even in elective surgery in unforeseen emergency situations such as hemodynamic instability, severe coagulopathy, and prolonged surgery over 24 h. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure, where prolonged surgery is not feasible. It reinforces that DCS was successfully utilized in the reported cases, leading to favorable second-look operations. Conclusion: The main text introduction is a more comprehensive and structured expansion of the initial introduction. While the initial version introduces the problem concisely, the revised introduction elaborates on the challenges of massive bleeding, the principles of DCS, and its potential role in elective surgeries before transitioning into the case reports.
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Nanashima A., Arai J., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Kawakami H., Sato Y., Takashi W.
Turkish Journal of Surgery 41 ( 1 ) 5 - 18 2025.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
Objective: To elucidate surgical strategies for patients undergoing radical resection, in cases where solitary distant lymph node metastasis is identified intraoperatively, we investigated the prognostic significance of para-aortic lymph node (PALN) metastases and other regional lymph node (RLN) metastases in pancreatic carcinomas (PC) and biliary duct cancers (BDC). Material and Methods: This study retrospectively analyzed data from 181 PC patients and 116 BDC patients who underwent radical resections at two institutions between 1994 and 2021. Results: Among PC patients, metastases were observed in RLN and PALN in 54% and 9% of cases, respectively. Similarly, RLN and PALN metastases were present among BDC patients in 39% and 9% of cases, respectively. Survival analysis revealed that patients with BDC and PALN metastases exhibited significantly reduced disease-free (DFS) and overall survival (OS) compared to those without PALN involvement. Multivariate analysis identified PALN metastasis as an independent predictor of OS in BDC patients (p<0.05), while RLN metastasis was independently associated with DFS (p<0.05). Additional clinicopathological factors associated with PALN and RLN metastases were also identified. Preoperative serum levels of Duke Pancreas II monoclonal antibody were significantly elevated in patients with PALN metastases. Histological findings of lymphatic or perineural infiltration and hepatic or pancreatic invasion were independently associated with RLN metastases. Conclusion: Based on these findings, radical resection may be considered for PC patients with isolated PALN metastases only in the absence of additional adverse prognostic factors. Prospective clinical trials are warranted to further refine the criteria for surgical intervention when solitary PALN metastases are detected intraoperatively.
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Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Ichihara A., Hamada K., Ichiki N., Kai K., Higuchi K.
Translational Cancer Research 14 ( 1 ) 461 - 472 2025.1
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Translational Cancer Research
Background: Progression of chronic liver dysfunction influenced by long-term chemotherapy or repeated hepatectomy might be related to patient overall survival as well as tumor factors in colorectal liver metastasis (CLM) patients. Our aim of this study was to clarify the relationship between fibrotic liver damage and malignant behaviors of CLM malignancy or its long-term survivals by the retrospective cohort study. Methods: We examined the relationship between tumor-related factors or six liver fibrosis-associated parameters, including platelet count, hyaluronic acid (HA), mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S (T4C7), aspartate aminotransferase-to-platelet ratio index (APRI), The fibrosis-4 (Fib-4) index, and clinicopathological parameters, surgical records, and postoperative patient survival in the 45 consecutive patients with CLM who underwent radical hepatectomy. Results: Fibrotic parameters were platelet count of 23.0±8.5 ×104/μL, HA level of 68.9±82.3 ng/mL, M2BPGi of 0.87±0.48 ng/mL, and type IV collagen level of 5.74±3.76 ng/mL. Platelet count was significantly correlated with HA level (P<0.05) and tended to be correlated with M2BPGi levels (P=0.056). HA level was significantly associated with albumin level (P<0.05). Overall survival in this series showed five-year overall survivors after hepatectomy in 44 patients (98%), but cancer-related deaths were observed in only one patient. Patients with higher grades and increased bilirubin levels demonstrated significantly lower cancer-free survival (P<0.05), but fibrotic parameters were not associated with prognostic factors. Conclusions: Fibrotic markers indicating chemotherapy or repeated surgical liver injury were not significant predictive factors reflecting cancer malignant behaviors or patient overall survival, contrary to our hypothesis. The current overall survival status using various modalities for cancer recurrence is satisfactory under our present perioperative management.
DOI： 10.21037/tcr-24-1138
Books 【 display / non-display 】
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消化器難治療癌シリーズV 肝細胞癌
七島篤志（ Role： Joint author , おわりに）
株式会社協和企画 2024.4
Language：Japanese Book type：Scholarly book
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Therapeutic applications: Photodynamic therapy using porphyrin compounds
Hamada T., Nanashima A.（ Role： Sole author）
Fluorescence-Guided Surgery: From Lab to Operation Room 2023.11 （ ISBN:9789811973727, 9789811973710 ）
Language：English Book type：Scholarly book
As a result of recent advances in endoscopes and optical fibers, optical engineering has been introduced to medical treatment in these years. Photodynamic therapy (PDT) is a promising treatment method that irradiates a tumor with a highly tumor-accumulating photosensitive agent and a laser with a specific wavelength and shows a cell-killing effect only on tumor cells with high drug concentration. It has already been applied clinically in the fields of pulmonary and digestive surgery, neurosurgery, ophthalmology, dermatology, and urology. As described in other chapters, photodynamic diagnosis (PDD), which is a method to diagnose the localization of tumors by irradiating biological tissues with light and detecting the fluorescence generated by photosensitive agents accumulated in tumors, is also being actively studied and applied clinically.
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肝胆膵高難度外科手術［Web動画付］第3版
旭吉雅秀，七島篤志（ Role： Joint author , 胆道再建）
医学書院 2023.6
Language：Japanese Book type：Scholarly book
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術中イメージング実践ガイド －ラボからオペ室まで－ Reviewed
濵田剛臣，七島篤志（ Role： Joint author , Ⅲ術中蛍光イメージングの実際[開発編]: 4. 治療への応用(1): ポルフィリン化合物を用いた光線力学的治療）
メジカルビュー 2020.9 （ ISBN:978-4758315371 ）
Total pages：339 Responsible for pages：310-320 Language：Japanese Book type：Scholarly book
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新DS Now No.4 胆道癌･膵癌に対する標準手術−手技修得へのナビゲート− Reviewed
長友謙三，濵田剛臣，七島篤志（ Role： Joint author , 膵体部癌に対する膵体尾部切除術）
メジカルビュー社 2019.8 （ ISBN:978-4-7583-1653-8 ）
Total pages：184 Responsible for pages：136-156 Language：Japanese Book type：Scholarly book
MISC 【 display / non-display 】
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論説 シン・私の考える～医学教育に使えた名言･格言〜Quotes and aphorisms that could be used in surgical and medical education
七島篤志
宮崎県医師会医学会誌 49 ( 2 ) 117 - 123 2025.9
Authorship：Lead author, Corresponding author Language：Japanese Publishing type：Rapid communication, short report, research note, etc. (scientific journal)
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地方都市施設におけるacute care surgeryのあり方とは？―当院の10年を振り返って見えてきた課題と対策―
河野文彰，田代耕盛，池ノ上実，宗像 駿，鈴木康人，武野慎祐，古川貢之，落合秀信，七島篤志
Japanese Journal of Acute Care Surgery 2025.4
Authorship：Last author Language：Japanese Publishing type：Rapid communication, short report, research note, etc. (scientific journal)
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特集 臓器損傷治療の工夫【手術手技】腹部開放創陰圧治療法システムによるopen abdominal management Invited Reviewed
桝屋隆太, 中目和彦, 宗像 駿, 河野文彰, 武野慎祐, 七島篤志, 家入里志
小児外科 57 ( 2 ) 231 - 235 2025.2
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal)
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【診療】鏡視下甲状腺手術の現状と課題 Invited
河野文彰，池ノ上実，宗像 駿，武野慎祐，七島篤志
宮崎県医師会医学会誌 48 ( 1 ) 42 - 47 2024.11
Authorship：Last author Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal)
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特集【Acute Care Surgery入門-外傷対応の基礎知識】Open abdominal management-若手外科医が知っておくこと Invited Reviewed
河野文彰，池ノ上実，宗像 駿，武野慎祐，七島篤志
臨床外科 79 ( 4 ) 395 - 402 2024.11
Authorship：Last author Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal)
Presentations 【 display / non-display 】
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七島 篤志, 今村 直哉, 土持 有貴, 和田 敬, 濵田 剛臣, 鈴木 康人
Cancer diagnosis & prognosis 2026.1.3 International Institute of Anticancer Research
Event date： 2026.1.3
Language：English Presentation type：Oral presentation (general)
Background/Aim
Pancreatic neuroendocrine tumors (PanNETs) are heterogeneous neoplasms for which surgical resection remains the only potentially curative therapy. However, preoperative diagnostic accuracy - particularly tumor grading - often varies, complicating treatment decisions. This study evaluated diagnostic concordance between preoperative assessments and postoperative pathology, as well as surgical outcomes and prognostic factors in patients undergoing pancreatectomy for PanNETs.
Patients and Methods
We retrospectively reviewed the clinical records of 32 patients who underwent surgical resection for PanNETs. Patient demographics, tumor characteristics, surgical procedures, and postoperative outcomes were analyzed. Preoperative imaging and cytology-based diagnoses were compared with final pathological findings to evaluate diagnostic concordance. Prognostic factors were assessed using Kaplan-Meier survival analysis.
Results
Histological grading of resected specimens showed G1 in 53%, G2 in 41%, and G3/NEC in 6%, with a 38% discordance rate from preoperative biopsy. Lymphatic, venous, and perineural invasions were identified in 16%, 44%, and 13% of cases. Lymph node metastasis occurred in 22%. Among 30 patients with follow-up >12 months, eight developed recurrence, most commonly in the liver. The 3-year and 5-year disease-free survival (DFS) rates were 78% and 69%, while overall survival (OS) rates were 96% and 91%. Tumor number >2 and histologic grade G3 were significantly associated with reduced DFS (p<0.05). Lymphatic invasion and metachronous liver metastasis were significantly associated with reduced OS (p<0.01 and p<0.05, respectively). Histological grading mismatch was not associated with survival outcomes.
Conclusion
Pancreatectomy for PanNETs is a safe and effective treatment with favorable long-term outcomes. Histological factors such as tumor grade, lymphatic invasion, and tumor number significantly predict recurrence and survival. -
七島 篤志, 今村 直哉, 土持 有貴, 和田 敬, 濵田 剛臣
Gland Surgery 2025.12.31 AME Publishing Company
Event date： 2025.12.31
Language：English Presentation type：Oral presentation (general)
Background: Pancreatic anastomosis has been developed, and each anastomosis has its pros and cons. This study investigated the prevalence of postoperative complications, particularly pancreatic fistula (POPF), among five types of pancreatoenteric anastomoses to determine the optimal anastomosis for patients undergoing pancreatectomy.
Methods: This study retrospectively and consecutively analyzed the data of 365 patients who underwent pancreatectomy with pancreaticoenteral anastomosis at two academic institutions from 1994 to 2024. Pancreaticogastrostomy via invagination was performed in 24 patients (group PG). For pancreaticojejunal anastomosis, we performed an end-to-end invagination procedure on eight patients (group PJI), two-layer suturing procedure on 96 patients (group PJT), Kakita procedure on 55 patients (group K), and modified Blumgart procedure on 182 patients (group B).
Results: Group B had the shortest hospital stay and fastest resumption of oral intake. Groups PG and PJI exhibited higher grade B/C POPF rates and prolonged ascites. The potential benefits of group B included reduced hospitalization period and enhanced recovery owing to decreased POPF rates. Habitual alcohol consumption and high preoperative creatinine levels increased the risk of POPF, whereas external drainage issues and blood loss contributed to prolonged ascites. In particular, habitual alcohol consumption [relative risk (RR) =2.42], group K anastomosis (RR =2.79), soft pancreatic texture (RR =2.48), delayed oral intake (≥4 days; RR =2.78), and complete external drainage (RR =8.68) were independent predictors of POPF.
Conclusions: Modified Blumgart procedure is an optimal pancreaticoenteral anastomosis technique for avoiding POPF. Early oral intake has emerged as a protective factor, highlighting its role in improving postoperative outcomes. Surgeons should prioritize intraoperative blood conservation, perioperative nutritional support, and appropriate anastomotic selection to enhance surgical success. -
七島 篤志
Annals of Gastroenterological Surgery 2025.9.9 Wiley
Event date： 2025.9.9
Language：English Presentation type：Oral presentation (general)
Aim
We aimed to refine treatment strategies for resected cases of pancreatic ductal adenocarcinoma in patients with unexpectedly uncovered postoperative noncurative factors while also evaluating the effectiveness of neoadjuvant and adjuvant chemotherapy.
Methods
We retrospectively analyzed clinicopathological and follow-up data from 1068 PDAC patients who underwent surgical resection at 13 Kyushu Study Group institutions (January 2016–December 2020). Patients were categorized into two groups: without (Group A) or with (Group B) unexpected postoperative noncurative factors. Kaplan–Meier analysis assessed disease-free and overall survival, while univariate and multivariate analyses using the Cox proportional hazards model identified prognostic factors.
Results
Group B (n = 44) had poorer survival than Group A (n = 981) (16.8 vs. 38.6 months; p < 0.001). The noncurative factors were associated with poor disease-free survival (hazard ratio, 1.544; 95% confidence interval, 1.067–2.179; p = 0.022) but not overall survival (hazard ratio, 1.332; 95% confidence interval, 0.910–1.950; p = 0.140). In Group B, patients receiving adjuvant chemotherapy had better disease-free survival (6.8 months vs. 3.4 months; p = 0.092), However, no significant difference was observed in overall survival. Furthermore, patients in Group B who received adjuvant chemotherapy had a worse prognosis compared to both Group A patients who received chemotherapy and those who did not. Preoperative therapy did not improve disease-free survival or overall survival in cases with postoperative noncurative factors.
Conclusion
Cases with noncurative factors had significantly poorer prognoses than those without. In the present study, effective adjuvant chemotherapy for these patients could not be demonstrated. Therefore, thorough preoperative and intraoperative evaluation of noncurative factors is crucial to prevent futile surgery. -
Araki Yusuke, Takeno Shinsuke, Ikenoue Makoto, Tashiro Kosei, Kawano Fumiaki, Ochiai Takahiro, Shimizu Ikko, Chiyotanda Teru, Tahira Kosei, Ota Yusuke, Nakashima Koji, Nanashima Atsushi
Nihon Kikan Shokudoka Gakkai Kaiho 2025.6.10 The Japan Broncho-esophagological Society
Event date： 2025.6.10
Language：English Presentation type：Oral presentation (general)
Esophageal neuroendocrine carcinoma (NEC) is a relatively rare esophageal malignancy with high histological grade and poor prognosis. Chemotherapy with or without radiation is recommended because NEC is often detected at an advanced stage and the recurrence rate is relatively high. For esophageal cancer, photodynamic therapy (PDT) is indicated after chemoradiotherapy (CRT), and salvage surgery is rarely performed afterwards. We report here a case in which PDT and salvage surgery were performed for secondary esophageal squamous cell carcinoma after esophageal NEC showed complete response to CRT. Eighteen months before this presentation, a 71-year-old woman underwent CRT for esophageal NEC (cT4b (trachea) N2M0 Stage IV) and no residual lesion was detected. Upper gastrointestinal endoscopy revealed multiple superficial-type squamous cell carcinomas in the esophagus at 25, 26, and 38 cm from the incisors. The lesion 38 cm from the incisors had invaded to the submucosal layer and the others represented in situ carcinomas. PDT was performed twice for all lesions, but residual tumor remained at 38 cm from the incisors. Ivor Lewis esophagectomy was performed because the earlier NEC had invaded to the trachea before CRT. Intraoperative findings included edema and scarring of the esophageal wall. The postoperative course was good and the patient was discharged on postoperative day 23.
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Characteristics of distal bile duct cancer preoperatively diagnosed as pancreatic head cancer
Hiyoshi Masahide, Nanashima Atsushi, Sato Yuichiro
Tando 2025.5.31 Japan Biliary Association
Event date： 2025.5.31
Language：Japanese Presentation type：Oral presentation (general)
We investigated the differences among patients with distal bile duct cancer with severe pancreatic invasion and were preoperatively diagnosed with pancreatic head cancer (Pre-PDAC group), patients with typical distal bile duct cancer (BDC group), and patients with pancreatic head cancer (PDAC group). Among 69 patients with distal bile duct cancer, 15 (21.7%) did not undergo surgical resection, and 54 (78.3%) underwent pancreaticoduodenectomy. Among the resected cases, 9 (16.7%) were classified as Pre-PDAC. The median survival time (MST) in the Pre-PDAC group was 20.9 months, significantly poorer than 106.8 months in the BDC group. No significant difference in MST was observed between the non-resected group (12.0 months), the Pre-PDAC group (20.9 months), and the PDAC group (32.9 months). The 2-year relapse-free survival rate was significantly lower in the Pre-PDAC group (25.0%) than in the BDC group (60.0%), and liver metastasis was frequently observed upon recurrence.
Works 【 display / non-display 】
Grant-in-Aid for Scientific Research 【 display / non-display 】
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PDP効果に基づく胃癌腹膜播種に対する簡便かつ安全な光治療の開発
Grant number：24K11937 2024.04 - 2027.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
Authorship：Coinvestigator(s)
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GVHD誘導マウスでのサイトカイン阻害による胆道閉鎖症の炎症標的型治療法の開発
Grant number：23K08052 2023.04 - 2026.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
桝屋 隆太
Authorship：Coinvestigator(s)
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クリック反応技術と軸配位子糖鎖連結ポルフィリン錯体を融合した革新的PDTの開発
Grant number：22K08806 2022.04 - 2025.03
独立行政法人日本学術振興会 科学研究費基金 基盤研究(C)
七島篤志
Authorship：Principal investigator
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FDG PET腫瘍診断と腫瘍遺伝子変異の関連に基づくテーラーメイド医療の開発
Grant number：26461857 2014.04 - 2017.03
科学研究費補助金 基盤研究(C)
Authorship：Coinvestigator(s)
FDG PET腫瘍診断と腫瘍遺伝子変異の関連に基づくテーラーメイド医療の開発
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臨床実用を目指した癌幹細胞標的光線力学的療法の基礎研究
Grant number：26461045 2014.04 - 2017.03
科学研究費補助金 基盤研究(C)
Authorship：Coinvestigator(s)
臨床実用を目指した癌幹細胞標的光線力学的療法の基礎研究