Papers - NANASHIMA Atsushi
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Kai K., Hiyoshi M., Imamura N., Hamada T., Yano K., Sato Y., Sakae T., Komi M., Nakamura T., Choijookhuu N., Hishikawa Y., Nanashima A.
Internal Medicine 62 ( 8 ) 1107 - 1115 2023.4
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Internal Medicine
<b>Objective </b>The extracellular volume (ECV) calculated based on contrast-enhanced computed tomography (CT) has been reported as a novel imaging parameter reflecting the morphological change of fibrosis in several parenchymal organs. Our retrospective study assessed the validity of the ECV fraction for diagnosing pancreatic fibrosis and the appropriate imaging condition as the "equilibrium phase". <b>Methods </b>In 27 patients undergoing multiphasic CT and subsequent pancreaticoduodenectomy, we investigated pathological fibrotic changes related to the ECV fraction and conducted analyses using the value obtained by subtracting the equilibrium CT value of the portal vein from that of the abdominal aorta (Ao-PV<sub>equilibrium</sub>) to estimate eligibility of the equilibrium phase. <b>Results </b>In all patients, the ECV fraction showed a weak positive correlation with the collagenous compartment ratio (r=0.388, p=0.045). All patients were divided into two groups - the high-Ao-PV<sub>equilibrium</sub> group and low-Ao-PV<sub>equilibrium</sub> group - based on the median value. No significant correlation was found in the high-Ao-PV<sub>equilibrium</sub> group, whereas a significant correlation was observed in the low-Ao-PV<sub>equilibrium</sub> group (r=0.566, p=0.035). <b>Conclusion </b>The ECV fraction is a possible predictive factor for histopathological pancreatic fibrosis. In its clinical application, the eligibility of the "equilibrium phase" may affect the diagnostic capability. It will be necessary to verify the imaging conditions in order to improve the accuracy of the diagnosis.
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Hamada T., Yano K., Kitamura E., Hiyoshi M., Imamura N., Kai K., Tahira K., Kawano F., Ohta Y., Nanashima A.
Asian Journal of Endoscopic Surgery 16 ( 3 ) 567 - 570 2023.3
Authorship：Last author, Corresponding author Language：English Publishing type：Case report Publisher：Asian Journal of Endoscopic Surgery
Laparoscopic hepatectomy is safely performed with minimal invasiveness on patients with recurrent liver tumors after previous hepatectomy. However, it is still difficult to dissect and expose the operative field at the transected edge or plane after open right hepatectomy, even for limited resection by a laparoscopic approach, due to severe adhesion to the surrounding peritoneum or organs. We herein applied the retroperitoneal laparoscopic approach to limited resection of the dorsal surface at the transected edge of Couinaud's segment 6 after previous repeated hepatectomies in a patient with recurrent hepatocellular carcinoma (HCC) by avoiding severe intra-abdominal adhesion. We safely resected recurrent HCC via the retroperitoneal space. This approach is a useful and alternative option for laparoscopy which minimizes the dissecting time and avoids organ injury on the right side of the transected area of the liver after hepatectomy in patients with liver malignancies.
DOI： 10.1111/ases.13185
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Sonazoid-enhanced intraoperative ultrasonography in patients with gall bladder diseases: A preliminary study Reviewed
Nanashima, A., Tanoue, Y., Hamada, T., Hiyoshi, M., Imamura, N., Ishii, M., Yano, K., Kai, K., Sakakibara, Y., Nishimuta, M., Hamada, K. and Nagayasu, T.
Acta Medica Nagasakiensia 66 57 - 64 2023.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal)
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Kai Kengo, Hamada Takeomi, Sato Yuichiro, Hiyoshi Masahide, Imamura Naoya, Yano Koichi, Ikeda Takuto, Ichihara Akiko, Ogata Shogo, Choijookhuu Narantsog, Hishikawa Yoshitaka, Hosokawa Ayumu, Nanashima Atsushi
Journal of Oncology 2023 1440257 - 8 2023.2
Authorship：Last author Language：English Publishing type：Research paper (scientific journal)
Background. Oxaliplatin (OX)-based chemotherapy induces sinusoidal obstruction syndrome (SOS) in the nontumorous liver parenchyma, which can increase the risk of liver resection due to colorectal liver metastasis (CRLM). The extracellular volume (ECV) calculated from contrast-enhanced computed tomography (CT) has been reported to reflect the morphological change of hepatic fibrosis. The present retrospective study aimed to evaluate the ECV fraction as a predictive factor for OX-induced SOS.
Methods. Our study included 26 patients who underwent liver resection for CRLM after OX-based chemotherapy with a preoperative dynamic CT of appropriate quality. We investigated the relationship between the pathological SOS grade and the ECV fraction.
Results. Overall, 26 specimens from the patients were graded with the SOS classification of Rubbia-Brandt et al. as follows: grade 0, n = 17 (65.4%); grade 1, n = 4 (15.4%); and grade 2, n = 5 (19.2%). No specimens showed grade 3 SOS. In a univariate analysis, the ECV fraction in grade 0 SOS was significantly lower than that in grade 1 + 2 SOS (26.3 ± 3.4% vs. 30.6 ± 7.0%; P = 0.025). The cutoff value and AUC value of the ECV fraction to distinguish between grades 0 and 1 + 2 were 27.5% and 0.771, respectively.
Conclusions. Measurement of the ECV fraction was found to be a potential noninvasive diagnostic method for determining early-stage histopathological sinusoidal injury induced by OX-based chemotherapy.DOI： 10.1155/2023/1440257
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Mise Y., Hirakawa S., Tachimori H., Kakeji Y., Kitagawa Y., Komatsu S., Nanashima A., Nakamura M., Endo I., Saiura A.
Journal of Hepato-Biliary-Pancreatic Sciences 30 ( 7 ) 851 - 862 2023.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
Background: Centralization of complex surgeries has made little progress when it only considers the minimum number of surgical procedures. We aim to assess the impact of certification system of Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) on centralization and surgical quality of advanced hepato-pancreatic-biliary (HPB) surgery. Methods: The National Clinical Database was used to review 20 111 patients who underwent pancreatoduodenectomy (PD) and 9666 who underwent advanced hepatectomy defined as hepatectomy of more than one section during 2019 and 2020. JSHPBS certifies hospitals based on the annual number of advanced HPB surgeries and the surgical quality. Minimum numbers of surgeries for board-certified A and B institutions are 50 and 30, respectively. Short-term outcomes were compared among institutions. Results: In 2020, 69.4% (7007/10090) and 72.9% (3433/4710) of patients underwent PD and advanced hepatectomy at board-certified institutions. In-hospital mortality rates after PD was 0.9% at certified A institutions, 1.4% at B institutions, and 2.7% at non-certified institutions (p <.001). The odds ratio (OR) of risk-adjusted mortality after PD compared with non-certified institutions was 0.39 (confidence interval [CI]: 0.30–0.50, p <.001) at certified A institutions, and 0.54 at certified B institutions (CI: 0.40–0.73, p <.001). In-hospital mortality rates after advanced hepatectomy was 1.7% at certified A institutions, 2.3% at B institutions, and 3.2% at non-certified institutions (p <.001). The OR of risk-adjusted mortality after advanced hepatectomy compared with non-certified institutions was 0.57 at certified A institutions (CI: 0.41–0.78, p <.001). Conclusion: The volume- and quality-controlled certification system of JSHBPS reduces surgical mortality after advanced HPB surgeries.
DOI： 10.1002/jhbp.1307
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消化器(外科医)診療の今昔 Reviewed
七島篤志
日州醫事 881 31 - 31 2023.1
Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal)
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Retroperitoneal-first dissection approach at the dorsal space for a huge serous cystic neoplasm of the pancreatic tail: a case report. Reviewed
Nanashima A, Takamori H, Imamura N, Tahira K, Kitamura E, Hiyoshi M, Hamada T, Tsuchimochi Y, Komori H, Kamoto T
Surgical Case Reports 9 ( 1 ) 2 - 6 2023.1
Authorship：Lead author, Corresponding author Language：English Publishing type：Case report
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A case of a galactocele that presented as a mammary mass in a boy Reviewed
Masuya R., Tominaga Y., Nakame K., Nanashima A., Ieiri S.
Pediatrics International 65 ( 1 ) e15705 2023.1
Language：English Publishing type：Case report Publisher：Pediatrics International
DOI： 10.1111/ped.15705
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Ono S., Adachi T., Ohtsuka T., Kimura R., Nishihara K., Watanabe Y., Nagano H., Tokumitsu Y., Nanashima A., Imamura N., Baba H., Chikamoto A., Inomata M., Hirashita T., Furukawa M., Idichi T., Shinchi H., Maruyama Y., Nakamura M., Eguchi S.
Surgery 172 ( 6 ) 1782 - 1790 2022.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery (United States)
Background: Patients diagnosed with resectable pancreatic ductal adenocarcinoma often experience early recurrence even after upfront R0 resection. This study aimed to define early recurrence and identify preoperative risk factors for early recurrence after upfront pancreaticoduodenectomy in patients with resectable pancreatic ductal adenocarcinoma of the pancreatic head. Methods: This multicenter, retrospective study involved 500 patients who underwent pancreaticoduodenectomy resectable pancreatic ductal adenocarcinoma of the pancreatic head at 10 institutions between 2007 and 2016. Preoperative, intraoperative, and postoperative clinicopathological results were compared between early and non-early recurrence groups. Predictors of early recurrence were determined using statistical analyses. Results: Log-rank tests revealed a significant difference (P < .001) between recurrence within 3 to 6 months and 6 to 9 months. Early recurrence was subsequently defined as recurrence within 6 months. Patients were categorized into early recurrence (n = 104) and non-early recurrence groups (n = 389). The median overall survival of the early and non-early recurrence groups was 8.6 months and 42.6 months (P < .001), respectively. Preoperatively, high carbohydrate antigen 19-9 levels ≥120 U/mL, retroperitoneal invasion, and diabetes mellitus were identified as independent predictive risk factors for early recurrence according to multivariate analysis. Comparing survival rates among patients with 3, 2, 1, or none of these factors, the median overall survival was 17.6 (n = 90), 21.2 (n = 184), 47 (n = 141), and 61.5 (n = 73) months, respectively. Conclusion: The optimal period that defines the early recurrence for resectable pancreatic ductal adenocarcinoma of the pancreatic head is 6 months. Tumor size ≥20 mm, preoperative carbohydrate antigen 19-9 levels ≥120 U/mL, retroperitoneal invasion of the tumor, and the presence of diabetes mellitus are independently associated with early recurrence.
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Nanashima A., Imamura N., Nishida T., Hiyoshi M., Uchise Y., Hamada T., Yano K., Tsuchimochi Y.
Clinical Journal of Gastroenterology 15 ( 6 ) 1169 - 1172 2022.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Case report Publisher：Clinical Journal of Gastroenterology
Multiple cancer patients who achieve long-term survival are sometimes encountered. Multiple carcinogenesis may occur due to genetic or environmental characteristics. We report the case of a 74-year-old woman who was diagnosed with synchronous double carcinoma of the duodenal papilla and gall bladder without clinical symptoms, who underwent postoperative follow-up for familiar adenomatous polyposis coli with multiple colonic adenocarcinomas, ileal adenocarcinoma, left urinary tract neoplasm, and left upper lobe lung adenocarcinoma. Computed tomography also showed an intraductal papillary mucinous neoplasm of the pancreas and a lesion that was suspected to be uterine body carcinoma; however, they did not show any clear malignant behavior. No metastatic lesions of either of these biliary cancers were observed. Based on preoperative diagnostic imaging, subtotal stomach preserving pancreaticoduodenectomy with gall bladder bed liver resection with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis showed early carcinoma of the duodenal papilla and gall bladder pyloric gland adenoma without node metastasis. The postoperative course was uneventful and the patient had a good prognosis without tumor recurrence or new malignant lesions for two years after the last operation, without adjuvant therapy. Six metachronous carcinomas of eight different organ neoplasms were diagnosed, which is rare. This represents the first reported case of ampullary carcinoma in a patient with sextuple cancer.
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Nanashima A, Komi M, Imamura N, Hiyoshi M, Hamada T, Tsuchimochi Y, Ichiki N, Enzaki M, Azuma M
Cancer Diagnosis & Prognosis 2 ( 6 ) 668 - 680 2022.11
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Cancer Diagnosis and Prognosis
Background/Aim: A novel mathematical diagnostic analysis using Fourier transform (FT) algorithm of the extrahepatic bile duct (BD) using magnetic resonance-cholangiography (MRC) was performed to evaluate irregularities of the bile duct lumen indicating BD cancer (BDC) extension compared to pancreatic head malignancies controls. Patients and Methods: BD lumen was automatically traced, and a 2D-diagram cross-section was measured and a FT-based integrated-power-spectral-density-function value (FTV) of both diameter and area (mm2 and mm4 /Hz) was calculated for cancerous and non-cancerous parts utilizing a computer workstation. Results: FT analysis that was achieved in 59 patients consisted of BDC in 31, pancreatic cancer with biliary stenosis (PC) in 10 and pancreatic neoplasm without stenosis (PN) in 18. FTV-diameter and-area of non-tumorous proximal BD were larger compared to tumor involving BD (p<0.01), and those of the entire BD in BDCs were significantly larger than those in PN (p<0.01). FTV-diameter and-area in proximal BDC-positive were smaller than those in BDC-negative (p<0.05). BDC part was significantly discriminated by the cutoff value (286 mm2 Hz–1 in diameter and 10,311 mm4Hz–1 in area) compared to PC and diagnostic accuracy was over 70% (p<0.01). Conclusion: Novel mathematical MRC FT-analysis is promising for differentiating between BDC and PC with biliary stenosis and can be utilized as an objective diagnostic tool in the future.
DOI： 10.21873/cdp.10158
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A Case of Minute Carcinoma in Situ in the Ascending Colon with Sign of Leser-Trélat Reviewed
Hara Daisuke, Kai Kengo, Ikeda Takuto, Ichihara Akiko, Inomata Mayu, Kanemaru Shiho, Kiwaki Takumi, Kataoka Hiroaki, Nanashima Atsushi
The Japanese Journal of Gastroenterological Surgery 55 ( 11 ) 701 - 708 2022.11
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Case report Publisher：The Japanese Society of Gastroenterological Surgery
A 74-year-old man presented to the dermatology department of our hospital with multiple eruptions with itching. Leser-Trélat was suspected due to a rapid increase in seborrheic keratosis. Colonoscopy revealed a 35-mm multinodular polypoid lesion with a laterally spreading tumor that was partially non-granular. The tumor was diagnosed as carcinoma in adenoma with submucosal invasion. Because of the difficulty of endoscopic en bloc resection, laparoscopic ileocecal resection was performed in our department. A pathologic examination revealed that the resected cancer was a minute carcinoma in situ, of only 500 μm in size. We confirmed that the skin lesions were related to the Leser-Trélat sign, based on improvement of the skin after resection of colon cancer and high expression of epidermal growth factor receptor in the skin lesions. The Leser-Trélat sign, a skin symptom of paraneoplastic dermadromes, is frequently associated with gastrointestinal cancers, such as gastric and colorectal cancer, and is reported to be associated with advanced stage disease. In contrast, reports of the sign in association with early colorectal cancer are rare. Our search of the Japanese literature yielded only 3 cases in which the sign was described in submucosal invasive cancer and none involving intramucosal cancer. We present this case of minute carcinoma in situ in the ascending colon with a Leser-Trélat sign and review the relevant literature to investigate the clinical differences between cases of early and advanced cancer with a Leser-Trélat sign.
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Nanashima, A., Takamori, H., Imamura, N., Furukawa, K., Hiyoshi, M., Hamada, T., Yano, K., Tsuchimochi, Y. and Kamoto, T.
American Journal of Case Reports 23 e938009 - e938009 2022.10
Authorship：Lead author, Corresponding author Language：English Publishing type：Case report Publisher：American Journal of Case Reports
Objective: Background: Case Report: Conclusions: Rare disease Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignancy, and complete resection may provide better patient survival. Hepatectomy for intrahepatic tumor recurrence has not been previously reported. A 58-year-old woman underwent resection of an IVC-LMS with en bloc nephrectomy, adrenalectomy, and retroperitoneal soft tissue resection without IVC reconstruction 3 years 8 months ago. Twenty-nine months after the primary operation, a solitary intrahepatic liver tumor was found adjacent to the right and middle hepatic veins during imaging follow-up. The patient was diagnosed with LMS recurrence. As her liver functional parameters permitted major hepatectomy, right hepatectomy combined with resection of the vena cava wall leaving a tumor-free margin and securing the confluence of the middle hepatic vein were successfully accomplished via an anterior approach, without adverse events. Intrahepatic metastasis of LMS invading the vena cava wall has been diagnosed historically. Her postoperative course was uneventful, and at 1-year follow-up after the second surgery, she was observed to have no tumor relapse without any adjuvant treatment. Previous reports have shown that IVC-LMS is often observed, and operative risk or prognosis is based on the extension of the LMS toward the hepatic veins or cardiac atrium. Radical hepatectomy for recurrent IVC-LMS has not been previously reported, and our case experience revealed that a challenging surgical intervention resulting in complete tumor removal can provide good survival outcomes.
DOI： 10.12659/AJCR.938009
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Circulating maternal chimeric cells have an impact on the outcome of biliary atresia Reviewed
Masuya R., Muraji T., Kanaan S.B., Harumatsu T., Muto M., Toma M., Yanai T., Stevens A.M., Nelson J.L., Nakame K., Nanashima A., Ieiri S.
Frontiers in Pediatrics 10 1007927 2022.9
Language：English Publishing type：Case report Publisher：Frontiers in Pediatrics
Introduction: We aimed to quantify the DNA of maternal chimeric (MC) cells in the peripheral blood of the BA patients and investigated the impact on the outcome. Methods: Patients with progressive jaundice because of no bile flow, which necessitated liver transplantation, or who showed inadequate bile flow with or without episodes of cholangitis and progressive hepatic fibrosis and portal hypertension were classified into the poor group. Those with adequate bile flow with completely normal liver function tests beyond 2 years were classified into the good group. The qPCR were separately carried out in buffy coat samples and plasma samples, targeting the non-inherited maternal HLA alleles in the DNA samples. Results: MC-DNA was present in the buffy coat (10–328 gEq per 106 host cells) in seven patients. There was no MC-DNA in the remaining five patients. MC-DNA (214–15,331 gEq per 106 host cells) was observed in the plasma of five patients. The quantity of MC-DNA in the buffy coat showed a significant difference between the two prognostic groups (p = 0.018), whereas there was no significant difference in the quantity of MC-DNA in plasma (p = 0.205). MC-DNA in the buffy coat was significantly associated with the outcome (p = 0.028), whereas MC-DNA in the plasma did not influence the outcome (p = 0.56). Conclusions: Poor outcomes in BA were correlated with circulating maternal chimeric lymphocytes.
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Prognostic value of repeat hepatectomy for hepatocellular carcinoma pationts Reviewed
Nanashima A., Tanoue Y., Hiyoshi M., Imamura N., Yano K., Hamada T., Kitamura E., Kai K., Tahira K., Nagayasu T.
Anticancer Research 42 ( 9 ) 4553 - 4561 2022.9
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: The potential for repeat hepatectomy has been increasing in hepatocellular carcinoma (HCC) patients. Patients and Methods: To assess its significance, we examined the clinical features, surgical records, and survival of 279 HCC patients who underwent hepatectomy as primary treatment. Patients were divided into three groups: single hepatectomy without HCC relapse in 97 patients (Group 1), single hepatectomy with HCC relapse in 133 patients (Group 2) and repeat hepatectomy for HCC relapse in 49 patients (Group 3). Group 3 was divided into three subgroups. Multiple, larger size (>5 cm), and confluent nodular HCC. Results: Child–Pugh B patients were significantly higher in Group 2 (p<0.01). The prevalence of histological vascular involvement was significantly higher in Group 2 than in the other groups (p<0.01). Although Group 2 showed significantly poorer survival (p<0.01), the 10-year overall survival in Groups 1 and 3 was over 70% but not different between groups. The relapse-free survival period was significantly correlated with overall survival, and patients with a cancer-free period of over 36 months showed significantly better 10-year survival rates than those with a period of less than 36 months (p<0.01). Patients undergoing 3 or more repeat hepatectomies also showed good survival periods. Conclusion: Careful follow-up and proper decision-making in terms of repeat hepatectomy with multimodal treatments including novel chemotherapies upon assessment of postoperative tumor relapse are important in HCC patients to prolong survival.
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Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm Reviewed
Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Kitamura E., Kawano F.
Turkish Journal of Surgery 38 ( 3 ) 215 - 220 2022.9
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
Objective: Hepatic transection through an anterior approach is required to successfully complete anatomical hepatectomy for large liver malignancies. The liver hanging maneuver (LHM) is an alternative procedure for transection on an adequate cut plane and may reduce intraoperative bleeding and transection times. Material and Methods: We examined the medical records of 24 patients with large liver malignancies (>5 cm) who had undergone anatomical hepatic resection with LHM (n= 9) or without LHM (n= 15) between 2015 and 2020. Patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcomes were retrospectively compared between the LHM and non-LHM groups. Results: The prevalence of tumors >10 cm was significantly higher in the LHM group than in the non-LHM group (p< 0.05). Furthermore, LHM was significantly performed to right and extended right hepatectomies in the background normal liver (p< 0.05). Although transection times did not significantly differ between the two groups, the amount of intraoperative blood loss was slightly lower in the LHM group than in the non-LHM group (1.566 mL vs. 2.017 mL), and blood transfusion was not needed for patients in the LHM group. Post-hepatectomy liver failure and bile leakage were not observed in LHM. However, the length of hospitalization was slightly shorter in the LHM group than in the non-LHM group. Conclusion: LHM is useful for transecting an adequately cut plane in hepatectomy for liver tumors over 5 cm-in-size located on the right side and achieves better outcomes.
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深部子宮内膜症を合併する腸管子宮内膜症に腹腔鏡下低位前方切除術を施行した一例 Reviewed
市来伸彦，池田拓人，市原明子，濵田朗子，大田勇輔，七島篤志
宮崎県医師会医学会誌 46 ( 2 ) 165 - 169 2022.9
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Case report
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ロボット支援下直腸切除術の導入−宮崎県内初症例の報告− Reviewed
濵田聖暁，市原明子，市来伸彦，清水一晃，河野文彰，武野慎祐，七島篤志，南村圭亮
宮崎県医師会医学会誌 46 ( 2 ) 194 - 196 2022.9
Authorship：Corresponding author Language：Japanese Publishing type：Case report
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Surgical outcomes of laparoscopic versus open repeat liver resection for liver cancers: A report from a nationwide surgical database in Japan Reviewed
Kaibori, M., Ichihara, N., Miyata, H., Kakeji, Y., Nanashima, A., Kitagawa, Y., Yamaue, H., Yamamoto, M. and Endo, I.
Journal of Hepato-Biliary-Pancreatic Sciences 29 ( 8 ) 833 - 842 2022.8
Language：English Publishing type：Research paper (scientific journal)
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木片の杙創による右外腸骨静脈損傷を認めた1例 Reviewed
濵田朗子，河野文彰，宗像 駿，田代耕盛，武野慎祐，落合貴裕，七島篤志
日本腹部救急医学会雑誌 42 ( 5 ) 595 - 598 2022.7
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)