Presentations -
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Salvage Esophagectomy after Photodynamic Therapy for Secondary Squamous Cell Carcinoma in a Patient with a History of Complete Response to Chemoradiotherapy for Unresectable Advanced Esophageal Neuroendocrine Carcinoma
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.
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河野 文彰, 千代反田 顕, 中目 和彦, 明利 聡瑠, 福島 剛, 佐藤 勇一郎, 山口 秀樹, 池ノ上 実, 宗像 駿, 樋口 和宏, 武野 慎祐, 七島 篤志
Endocrinology Diabetes and Metabolism Case Reports 2025.5.14 Bioscientifica
Event date： 2025.5.14
Language：English Presentation type：Oral presentation (general)
Summary
Spindle epithelial tumor with thymic-like elements (SETTLE) is an extremely rare tumor that occurs primarily in the thyroid gland. Histologically, SETTLE is characterized by the presence of spindle-shaped epithelial cells and glandular structures. However, it is known that diagnosis via fine-needle aspiration cytology can be challenging. SETTLE predominantly occurs in younger individuals and has a less favorable prognosis compared to differentiated thyroid carcinoma. Therefore, ensuring accurate diagnosis and appropriate treatment is crucial. We encountered a case of spindle epithelial tumor with thymus-like differentiation in a 10-year-old patient for whom the preoperative diagnosis was successfully established through fine-needle aspiration cytology, which facilitated appropriate surgical resection. Comprehensive histopathological examination and immunohistochemical analysis are essential to ensure appropriate management and surveillance of SETTLE.
Learning points
A rare thyroid tumor, spindle epithelial tumor with thymic-like elements (SETTLE), was diagnosed preoperatively and treated surgically.
SETTLE presents with characteristic histological features that must be recognized for accurate diagnosis. In addition, diagnosis through cytology is often challenging.
The primary treatment for SETTLE is surgical intervention as radiotherapy and pharmacological treatments are generally not expected to be highly effective.
Radical resection is the only effective treatment, making the selection of the surgical procedure according to the stage of the disease essential. -
Non-Cytotoxic Photodynamic Therapy with Talaporfin Sodium Reduces the Expression of CXCR4 and Enhances Chemotherapeutic Efficacy in Undifferentiated Gastric Cancer Cell Line HGC27
Kai Kengo, Ishizuka Takumi, Matsumoto Jin, Shimamawari Koki, Mori Ryoma, Fidya, Lkham-Erdene Baljinnyam, Kubota Toshiki, Ikenoue Makoto, Higuchi Kazuhiro, Nanashima Atsushi, Hishikawa Yoshitaka
Ａｃｔａ Ｈｉｓｔｏｃｈｅｍｉｃａ ｅｔ Ｃｙｔｏｃｈｅｍｉｃａ 2025.4.26 日本組織細胞化学会
Event date： 2025.4.26
Language：English Presentation type：Oral presentation (general)
Gastric cancer (GC), particularly the undifferentiated type, is frequently associated with peritoneal metastasis, which significantly worsens prognosis due to its resistance to conventional treatments. Photodynamic therapy (PDT) is localized treatment using a photosensitizer (PS) activated by light of a specific wavelength to generate cytotoxic reactive oxygen species that induce cell death. Severe adverse events were reported from clinical trials investigating PDT for peritoneal dissemination conducted until the early 2000s, leaving its safety and clinical effectiveness unestablished. The present study explored whether “non-cytotoxic” PDT using talaporfin sodium (TS) could enhance efficacy of chemotherapeutic agents in undifferentiated GC cell line HGC27. Cell viability was evaluated with MTT assay following TS-PDT, and the synergistic effect between non-cytotoxic TS-PDT and anticancer drug SN-38 was assessed. Changes in expression of drug resistance markers were analyzed through qRT-PCR, Western blotting, and immunocytochemistry. We found that non-cytotoxic TS-PDT enhanced the efficacy of chemotherapy in the undifferentiated GC cell line and reduced the expression of C-X-C chemokine receptor type 4, a key marker associated with GC stem-like properties. These findings highlight the potential of non-cytotoxic TS-PDT as a synergistic treatment approach. We conclude that non-cytotoxic TS-PDT could enhance drug sensitivity and offers a promising therapeutic strategy for GC.
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What should acute care surgery be like in regional facilities?
Kawano Fumiaki, Tashiro Kousei, Ikenoue Makoto, Munakata Shun, Suzuki Yasuto, Takeno Shinsuke, Furukawa Kouji, Ochiai Hidenobu, Nanashima Atsushi
Japanese Journal of Acute Care Surgery 2025.4.10 The Japanese Society for the Acute Care Surgery
Event date： 2025.4.10
Language：Japanese Presentation type：Oral presentation (general)
We looked back on the 10 years of acute care surgery 〈ACS） at our department and discussed what type of ACS is required in facilities in regional cities. In our department, the emergency and critical care unit started in 2012, which required major changes in the surgical emergency treatment system. At the regional level, we focused on maintaining the existing emergency system, and we established a system in which severe injuries and trauma cases were concentrated in our department. At the facility level, ACS team was formed with existing surgeons to facilitate trauma care and actively intervene in trauma care. In addition, to maintain the team, we improved the on-call system and implemented complete division of labor in perioperative management. At the individual level, we performed daily surgical tasks with a specialty to maintain surgical skills and motivation. In addition, we made efforts to encourage young surgeons and residents to intervene in the practice in order to foster the Acute care surgeons. In this way, we believe that ACS in regional cities can be established by maintaining the existing emergency system and having existing surgeons create a system that is suited to the facilities.
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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
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 2025.2.25 東京医学社
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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べきこと
河野 文彰, 池ノ上 実, 宗像 駿, 武野 慎祐, 七島 篤志
臨床外科 2024.11.20 株式会社医学書院
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連載 外科医の私論 起きて半畳寝て一畳,どこにいても手術は一つ
七島 篤志
外科 2024.8.1 南江堂
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Nakame Kazuhiko, Masuya Ryuta, Nakazawa Shun, Nakagawa Midori, Yamada Ai, Kinoshita Mariko, Kamimura Sachiyo, Moritake Hiroshi, Ieiri Satoshi, Nanashima Atushi
Journal of the Japanese Society of Pediatric Surgeons 2024.4.20 The Japanese Society of Pediatric Surgeons
Event date： 2024.4.20
Language：Japanese Presentation type：Oral presentation (general)
<i>Purpose</i>: Central venous catheters (CVCs) are used in the treatment of pediatric hematological and oncological diseases. Recently, the ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation with in-plane views has been described as a safe central venous catheterization technique.<i>Methods</i>: A retrospective study was performed on patients who underwent US-guided tunneled CVC insertion into the internal jugular vein with out-of-plane views (IJV group) and the brachiocephalic vein with in-plane views (BCV group). The patients’ background characteristics, surgical outcomes, and complications were compared retrospectively.<i>Results</i>: A total of 40 tunneled CVCs (IJV group: n = 15, BCV group: n = 25) were inserted in 34 patients. The patients’ background characteristics were not significantly different between the two groups. The operative times were 30 min (range: 27–33 min) in the IJV group and 25.8 min (range: 22–27 min) in the BCV group. The BCV group had a significantly shorter operative time (p = 0.0026). Intraoperative complications were observed in one patient (6.7%) in the IJV group and none of the patients in the BCV group. Complications during maintenance were observed in 10 patients (66.7%) in the IJV group and 17 patients (68%) in the BCV group. Catheter-related bloodstream infection was noted in 10 patients (66.7%) in the IJV group and 12 patients (52%) in the BCV group; these infection rates were not significantly different. The periods of CVC implantation were 273 days (172–363.5 days) in the IJV group and 152 days (101–280 days) in the BCV group, which were not significantly different.<i>Conclusions</i>: A real-time US-guided supraclavicular approach to brachiocephalic catheterization was considered a safe technique for pediatric patients with hematological and oncological diseases.
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特集 必携 消化器･一般外科医のための外科解剖アトラス Ⅰ 食道･胃 １ 食道癌頸部リンパ節郭清に必要な局所解剖
武野 慎祐, 河野 文彰, 田代 耕盛, 池ノ上 実, 七島 篤志, 井手 慎介
手術 2024.3.31 金原出版
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SHIMIZU Ikko, UCHISE Yukako, ICHIKI Nobuhiko, HAMADA Kiyoaki, ICHIHARA Akiko, NANASHIMA Atushi, NAKAMURA Eriko, TSUZUKI Ryou
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 2024 Japan Surgical Association
Event date： 2024
Language：Japanese Presentation type：Oral presentation (general)
The patient was an 82-year-old woman. Blood tests showed progression of anemia, and CT was performed, which was suspicious for small bowel tumor. Small bowel series showed an elevated lesion in the ileum. Transanal small bowel balloon endoscopy revealed an elevated lesion with an irregular surface in the ileum, which was biopsied and diagnosed as malignant melanoma. There was no history of undergoing excision of skin tumors, and no primary lesions other than small bowel lesions were found on dermatological examination of the body surface and PET-CT. The patient was referred to our department with a diagnosis of primary malignant melanoma of the small intestine and underwent surgery. A tumor was found 190 cm proximal to the end of the ileum, invading the preperitoneum of the bladder. Partial resection of the small intestine, combined peritoneal resection, and regional lymph node dissection were performed. The patient's postoperative course was uneventful, and he was discharged on the 11th postoperative day. The patient has been followed up without recurrence after surgery.
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Nanashima Atsushi, Tanoue Yukinori, Hamada Takeomi, Hiyoshi Masahide, Imamura Naoya, Ishii Mitsutoshi, Yano Koichi, Kai Kengo, Sakakibara Yuka, Nishimuta Masato, Hamada Kiyoaki, Nagayasu Takeshi
Acta Medica Nagasakiensia 2023.3.1 長崎大学医学部
Event date： 2023.3.1
Language：English Presentation type：Oral presentation (general)
Background. Ultrasonography using Sonazoid, a novel contrast agent containing microbubbles, is a useful diagnostic modality for intrahepatic mass lesions with specific characteristics in two phases: contrast enhancement of early vascular perfusion and perfusion defect of the lesion in the late phase. To improve the diagnostic accuracy of intraoperative ultrasonography (IOUS) in biliary neoplasms, particularly gall bladder, we investigated the usefulness of the Sonazoid contrast agent in a preliminary study.
Subjects and Methods. We examined IOUS images of 23 patients with gall bladder disease. Sonazoid was administered intravenously, and early arterial and venous phase images of the tumor were obtained during laparotomy.
Results. Tumors included the localized type of adenomyomatosis in the fundus of the gallbladder (GAM) in seven patients as benign controls, adenomatous diseases in three, and gallbladder carcinoma (GC) in 13. Sonazoid IOUS scanning was performed in all patients, with no adverse effects. Although GC showed high enhancement in 77% of the tumors, GAM and adenoma also showed mild enhancement in more than half of them. Pseudo-positivity was observed in one case of hyperplastic polyps, and pseudo-negativity was observed in two patients. Cholesterol polyps and a suspicious lesion of liver metastasis by the computed tomography were not enhanced with Sonazoid treatment.
Conclusion. Although there remains a problem of pseud-positivity in the intracystic lesions, Sonazoid IOUS may be a useful tool to detect vascularity and its location or extension of gallbladder diseases; however, neither significance of differential diagnosis with benign diseases nor other clinical significance was found. -
The 14th Congress of Japan Society for The Acute Care Surgery: A Congress Report
Nanashima Atsushi, Kawano Fumiaki, Ochiai Hidenobu, Nagano Takehiko
Japanese Journal of Acute Care Surgery 2023 The Japanese Society for the Acute Care Surgery
Event date： 2023
Language：Japanese Presentation type：Oral presentation (general)
We herein describe the congress report regarding the 14th Congress of Japan Society for The Acute Care Surgery held in Aoshima, Miyazaki between September 30th and October 1st in 2022.
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A Case of the External Iliac Vein Injury Caused by a Stab Wound
Hamada Roko, Kawano Fumiaki, Munakata Shun, Tashiro Kousei, Takeno Shinsuke, Ochiai Hidenobu, Nanashima Atsushi
Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) 2022.7.31 Japanese Society for Abdominal Emergency Medicine
Event date： 2022.7.31
Language：Japanese Presentation type：Oral presentation (general)
We report a case of injury of the external iliac vein caused by a stab wound. A 55-year-old man presented with a piece of wood stuck in his right abdomen. Physical examination revealed that he was in a state of shock and he was urgently transferred to our emergency department. We suspected gastrointestinal perforation and right external iliac arteriovenous injury based on the findings of CT, and decided to perform emergency surgery. Intraoperative exploration revealed that a piece of wood had penetrated the small intestine and the right external iliac vein. We controlled bleeding by compression and repaired the veins. After the operation, right external iliac vein thrombosis was observed, which resolved with anticoagulant therapy. Traumatic iliac vein injury is relatively rare, but since it is often fatal, prompt and appropriate treatment is necessary.
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河野 文彰, 武野 慎祐, 田代 耕盛, 池ノ上 実, 七島 篤志
手術 2022.7.15 金原出版
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Uchise Yukako, Tashiro Kousei, Munakata Shun, Kitamura Eiji, Hamada Roko, Kawano Fumiaki, Takeno Shinsuke, Mori Kousuke, Sakaguchi Shuhei, Ishii Hirohito, Furukawa Koji, Nanashima Atsushi
Japanese Journal of Acute Care Surgery 2022 The Japanese Society for the Acute Care Surgery
Event date： 2022
Language：Japanese Presentation type：Oral presentation (general)
A 73 y.o.-male underwent the arch aortic replacement for type A acute aortic dissection. Two years after operation, the computed tomography showed the rupture of thoracic aortic aneurysm and thoracic endovascular aortic repair （TEVAR） was urgently performed. Aorto-esophageal fistula （AEF） subsequently occurred at day 5 after TEVAR. Therefore, we urgently performed esophagectomy under right thoracotomy with accompanied fistulectomy, followed by omentopexy and esophageal reconstruction using gastric conduit 12 days later. To secure AEF patients, the immediate bleeding and infectious control is required. Although urgent artificial blood vessel replacement with esophagectomy with fistulectomy of AEF is desirable, the strategy of surgical intervention depends on the patient’s organ functions or systemic status. Omentopexy is an effective option to reinforce the postoperative infectious control and, additionally, the intraoperative ICG fluorescence angiography may improve to evaluate the omental vascularity by our experience.
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ICHIKI Nobuhiko, IKEDA Takuto, ICHIHARA Akiko, HAMADA Roko, OTA Yusuke, NANASHIMA Atsushi
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 2022 Japan Surgical Association
Event date： 2022
Language：Japanese Presentation type：Oral presentation (general)
Two cases of mixed neuroendocrine carcinoma and non-neuroendocrine neoplasm (MiNEN) are presented. A 50-year-old woman noticed an abdominal mass. Transverse colon cancer [cT3N2bM0 cStage IIIc] was diagnosed by computed tomography and colonoscopy. Right hemi-colectomy and lymphadenectomy were performed. Pathological examination showed combined features of adenocarcinoma and neuroendocrine carcinoma. The pathological diagnosis was MiNEN, pT3N0M0 pStage IIa. The patient received 8 courses of adjuvant CapeOX chemotherapy. At 12-month follow-up, the patient was well with no evidence of recurrence. A 72-year-old man was found to be positive for fecal occult blood. Colonoscopy showed a sigmoid colon polyp. The patient underwent endoscopic mucosal resection (EMR) of the polyp. The pathological diagnosis was MiNEN with deep submucosal (SM) invasion. Based on these findings, additional resection (laparoscopic sigmoidectomy and D3 lymph node dissection) was performed. The pathological diagnosis was MiNEN, pT1bN1M0 pStage IIIa. However, the patient did not wish to receive chemotherapy. At 60-month follow-up, the patient was well, with no evidence of recurrence. Although the prognosis of MiNEN is quite poor, multidisciplinary treatment resulted in a relatively good course. These cases are reported with a review of the literature.
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術前に判明した右肝動脈の破格を伴う先天性胆道拡張症に対する腹腔鏡手術の工夫
桝屋 隆太, 中目 和彦, 三好 きな, 松久保 眞, 土持 有貴, 濵田 剛臣, 今村 直哉, 旭吉 雅秀, 七島 篤志, 家入 里志
日本膵・胆管合流異常研究会プロシーディングス 2022 日本膵・胆管合流異常研究会
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A Case of Acute Gastric Volvulus Resulting in Panperitonitis Due to Gastric Perforation
Masuya Ryuta, Nakame Kazuhiko, Tate Mayumi, Kurogi Jun, Kawano Fumiaki, Ichihara Akiko, Ikeda Takuto, Takeno Shinsuke, Nanashima Atsushi, Ieiri Satoshi
Journal of the Japanese Society of Pediatric Surgeons 2021.10.20 The Japanese Society of Pediatric Surgeons
Event date： 2021.10.20
Language：Japanese Presentation type：Oral presentation (general)
The patient was a two-year-old girl who had been treated for recurrent vomiting for three days. She was brought to our hospital after her previous doctor suspected gastrointestinal perforation due to sudden abdominal distension. When she arrived at our hospital, her face was pale, her vitality was poor, and she had a peripheral cold sensation. Her pulse rate was 200/min, her blood pressure was 60/42 mmHg, her respiratory rate was 43/min, and she was in shock. Contrast-enhanced computed tomography (CT) of the abdomen showed a large amount of free air and ascites along with findings of gastric volvulus. Emergency laparoscopic surgery was performed. The gastric volvulus was corrected laparoscopically. Because the site of perforation was challenging to identify, we changed the procedure to open laparotomy. A pinhole perforation was found at the upper gastric corpus due to detachment of the omentum. Wedge-shaped resection was performed around the perforation, and the stomach was fixed to the abdominal wall. No migrating spleen was observed. The postoperative recovery from disseminated intravascular coagulation and improvement of gastric peristalsis took a few days, but she gradually improved. She was discharged on the 19th postoperative day. Since her discharge from the hospital, there has been no recurrence of volvulus. There have been several reports on gastric perforation associated with acute gastric volvulus. Since there have been some reports of death due to the rapid and severe onset of symptoms, a prompt diagnosis and treatment are required.
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ICHIKI Nobuhiko, IKEDA Takuto, ICHIHARA Akiko, HAMADA Roko, KAWANO Fumiya, NANASHIMA Atsushi
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 2021 Japan Surgical Association
Event date： 2021
Language：Japanese Presentation type：Oral presentation (general)
A 70-year-old man presented to our hospital with abdominal fullness. Severe stenosis of the sigmoid colon and a dilated colon were confirmed using abdominal computed tomography. The cause of the obstruction was unclear. Transverse colostomy was performed. Three months after the surgery, a colovesicocutaneous fistula formed. We considered colon cancer ; however, colonoscopy in our hospital showed several diverticula in the sigmoid colon and no malignancy. We diagnosed a colovesicocutaneous fistula secondary to sigmoid colon diverticulitis and performed high anterior resection and partial cystectomy with fistulotomy. The pathological diagnosis was diverticulosis, and there was no malignancy. We encountered a case of colovesicocutaneous fistula due to diverticulosis that required differentiation from cancer.