Papers - NANASHIMA Atsushi
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Proctoring system of pediatric laparoscopic surgery for choledochal cyst Reviewed
Murakami M., Yamada K., Onishi S., Harumatsu T., Baba T., Kuda M., Miyoshi K., Koga Y., Masuya R., Kawano T., Muto M., Hayashida M., Nakame K., Shinyama S., Kuwabara J., Tatsuta K., Yanagi Y., Hirose R., Shono T., Migita M., Kaji T., Takatsuki M., Nanashima A., Matsufuji H., Ieiri S.
Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A 33 ( 11 ) 1109 - 1113 2023.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques
Background: Endoscopic surgery also has been becoming widespread in the field of pediatric surgery. However, most disease treated by pediatric surgery in a single institution are small number of cases. Besides, the variety of operative procedures that need to be performed in this field is quite wide. For these reasons, pediatric surgeons have limited opportunities to perform endoscopic surgery. Therefore, it is difficult to introduce advanced endoscopic surgery at a single local hospital. To educate pediatric surgeons in local hospitals, for widespread advanced pediatric endoscopic surgery safely, and to eliminate the need for patient centralization, we have introduced a proctoring system. We compared the surgical results of our institution, a center hospital, with other local institutions, to investigate the feasibility of our proctoring system. Methods: The experienced pediatric surgeon of our institution visits local hospitals to provide onsite coaching and supervises pediatric surgeons on the learning curve. All patients who underwent laparoscopic cyst excision and hepaticojejunostomy for choledochal cysts, one of the advanced pediatric endoscopic surgeries was retrospectively reviewed. Results: Thirty-four cases were evaluated (14 cases in our institution, 20 cases in 9 other institutions). The procedures of all 34 cases were performed by surgeons with 0-2 cases of experience in the procedure. There were no open conversion cases. There was no significant difference in the operative date. There was 1 case (6.7%) of postoperative complications during hospitalization at our institution and 3 cases (14.3%) at other institutions (P = .47). Two cases of late complications (13.3%) occurred at our institution, whereas 6 cases (28.6%) occurred at other institutions (P = .28). Conclusion: With the proctoring system, the performance and completion of advanced pediatric endoscopic surgery at local institutions was feasible. This has important implications given the ever-growing demand for pediatric endoscopic surgery and the increasing need for competent pediatric endoscopic surgeons.
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Nanashima A., Nagayasu T., Yamasaki N., Tsuchiya T., Matsumoto K., Tagawa T., Arai J.
The American Journal of Case Reports 24 e941668 2023.11
Authorship：Lead author Language：English Publishing type：Case report Publisher：American Journal of Case Reports
Objective: Background: Case Report: Conclusions: Rare disease Prostate cancer (PC) often metastasizes after primary resection, and long-term survival following surgical removal of multiple pulmonary metastases is rare. We present a case of a surgeon who demonstrated long-term survival after overcoming repeated surgical challenges for multiple pulmonary metastases from PC. Twenty-six years ago, a 62-year-old man initially reported discomfort during urination. A prostate examination revealed mildly elevated prostate-specific antigen (PSA) levels. Six months later, PC was diagnosed, and a radical prostatectomy was performed, revealing moderately differentiated adenocarcinoma but no vessel infiltration. At 9 years after the operation, three 10-mm nodules were detected in the right lung. Then, surgical biopsy by wedge pulmonary resection revealed metastatic PC, and therefore, right lower lobectomy including all nodules was planned. Although postoperative maintenance with luteinizing hormone–releasing hormone agonists kept the low PSA levels for 3 years, other newly limited metastases were observed in the opposite left lung, necessitating more surgeries of partial left lung resection. Six years later, a third lung metastasis was detected, as well as mild increases in the tumor size and PSA level, and the patient died 26 years after the initial PC intervention because of malnutrition for 1 year after sustaining bone compression fractures due to a fall, and not due to PC progression. Repeated surgical resections for slow-growing metastatic pulmonary PC was an alternative treatment that facilitated favorable survival and a good quality of life for 26 years in the present case.
DOI： 10.12659/AJCR.941668
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Tokumitsu Y., Nagano H., Yamashita Y.i., Yoshizumi T., Hisaka T., Nanashima A., Kuroki T., Ide T., Endo Y., Utsunomiya T., Kitahara K., Kawasaki Y., Sakota M., Okamoto K., Takami Y., Kajiwara M., Takatsuki M., Beppu T., Eguchi S.
Hepatology Research 53 ( 9 ) 878 - 889 2023.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Hepatology Research
Aim: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in the posterosuperior segments (PS) have generally been considered more difficult than those for HCC in anterolateral segments (AL), but may be safe and feasible for selected patients with accumulated experience. In the present study, we investigated the effectiveness of LLR for single nodular HCCs ≤3 cm located in PS. Methods: In total, 473 patients who underwent partial liver resection for single nodular HCCs ≤3 cm at the 18 institutions belonging to the Kyusyu Study Group of Liver Surgery from January 2010 to December 2018 were enrolled. The short-term outcomes of laparoscopic partial liver resection and open liver resection (OLR) for HCCs ≤3 cm, with subgroup analysis of PS and AL, were compared using propensity score-matching analysis. Furthermore, results were also compared between LLR-PS and LLR-AL. Results: The original cohort of patients with HCC ≤3 cm included 328 patients with LLR and 145 with OLR. After matching, 140 patients with LLR and 140 with OLR were analyzed. Significant differences were found between groups in terms of volume of blood loss (median, 55 vs. 287 ml, p < 0.001), postoperative complications (0.71 vs. 8.57%, p = 0.003), and postoperative hospital stay (median, 9 vs. 14 days, p < 0.001). The results of subgroup analysis of PS were similar. Short-term outcomes did not differ significantly between LLR-PS and LLR-AL after matching. Conclusions: Laparoscopic partial resection could be the preferred option for single nodular HCCs ≤3 cm located in PS.
DOI： 10.1111/hepr.13929
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33 ( 5 ) 518 - 521 2023.5
Language：English Publishing type：Research paper (scientific journal)
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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.