Papers - NANASHIMA Atsushi
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胃穿孔による汎発生腹 Reviewed
桝屋隆太，中目和彦，楯真由美，黒木 純，河野文彰，市原明子，池田拓人，武野慎祐，七島篤志，家入里志
日本小児外科学会雑誌 57 ( 6 ) 1002 - 1007 2021.10
Language：Japanese Publishing type：Research paper (scientific journal)
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Spontaneous common bile duct perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction in an adult: a case report. Reviewed
Sakamoto R, Kai K, Hiyoshi M, Imamura N, Yano K, Hamada T, Nishida T, Kawano F, Sakurahara D, Uchise Y, Yamamoto K, Kataoka H, Nanashima A
Surgical case reports 7 ( 1 ) 205 2021.9
Language：English Publishing type：Research paper (scientific journal)
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Masuya R., Miyoshi K., Nakame K., Nanashima A., Ieiri S.
International Journal of Surgery Case Reports 86 106300 2021.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
Introduction: The right hepatic artery crossing the ventral side of the common hepatic duct is a relatively frequent abnormality. This aberrant right hepatic artery not only interferes with dissection of the common bile duct and hepaticojejunostomy for choledochal cyst but can also cause postoperative anastomotic stenosis. Case presentation: A 14-year-old patient presented with upper abdominal pain and was diagnosed with a choledochal cyst (Type IVA in Todani Classification) and pancreaticobiliary maljunction. Abdominal enhanced computed tomography showed aberrant right hepatic artery located at the ventral side of the common hepatic duct. Laparoscopic choledochal cyst resection and hepaticojejunostomy were planned. Intraoperative findings also showed the aberrant right hepatic artery crossing the common hepatic duct ventrally as detected on preoperative computed tomography. Laparoscopic dorsal side repositioning of the aberrant right hepatic artery was performed because it appeared to compress the common hepatic duct and risked causing postoperative anastomotic stenosis. We performed laparoscopic hepaticojejunostomy by replacing the aberrant right hepatic artery dorsally to facilitate suturing and prevent postoperative anastomotic stenosis. The postoperative course was uneventful, with no findings suggestive of anastomotic stenosis. Discussion: The abnormality of the right hepatic artery is reported to be a primary cause of anastomotic stenosis after hepaticojejunostomy. Once anastomotic stenosis or stricture develops, it is often difficult to treat. The prevention of the stenosis is important. Conclusions: In choledochal cyst with aberrant right hepatic artery, dorsal repositioning is effective for preventing postoperative anastomotic stenosis and cholestasis.
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Case Series: Rare resected eight cases of duodenal adenocarcinomas Reviewed
Nanashima, A., Tanoue, Y., Imamura, N., Hiyoshi, M., Yano, K., Hamada, T., Nishida, T., Kai, K., Suzuki, Y., Sato, Y., Nakashima, K., Hosokawa A. and Nagayasu, T.
International Journal of Surgery Case Reports 86 Article 106384 2021.9
Authorship：Lead author Publishing type：Research paper (scientific journal)
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HIYOSHI Masahide, NANASHIMA Atsushi
Nippon Shokakibyo Gakkai Zasshi 118 ( 8 ) 736 - 741 2021.8
Authorship：Corresponding author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterology
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宮崎大学医学部附属病院におけるがんゲノム医療の現状と今後の課題 Reviewed
西田卓弘，伊井美奈代，落合昂一郎，中島孝治，福島 剛，佐藤勇一郎，山口昌俊，七島篤志，細川 歩
宮崎県医師会医学会誌 2021.8
Publishing type：Research paper (scientific journal)
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A 3D quantitative MRC modeling images detected case of intrahepatic biliary stricture diseases Reviewed
Nanashima A., Komi M., Mavar M., Ferreira C., O'Donoghue P., Goldfinger M., Langford C., Imamura N.
Case Reports in Gastroenterology 15 ( 2 ) 680 - 688 2021.7
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Case Reports in Gastroenterology
In the future, the application of quantitative imaging and computational analysis will reduce the burden on radiologists. We herein report 8 pilot cases both with and without intrahepatic biliary stricture (IHBS) diseases which have been analyzed with the novel analytical system MRCP+ (Perspectum Ltd., Oxford, UK). The colored and well-visualized 3D models of the entire biliary trees could be obtained in all 8 cases. Three representative cases did not show dilated regions in the intrahepatic bile ducts. Cases diagnosed as a pancreatico-biliary maljunction showed slightly increased dilated visualization in the extrahepatic duct. Except in a case with severe stenosis resulting from hepatolithiasis, the number of visualized intrahepatic bile ducts tended to be decreased and the volume of biliary tree and the total length of stricture and dilatation were also decreased. However, the number of IHBS or dilatation was unchanged. The number of strictures obtained by MRCP+ and the subjective counts of stenosis from a radiologist was not found to be correlated. In a case of severe stenosis at the left lateral bile duct, the number of intrahepatic biliary dilatations was increased. The latest computerized 3D modeling technology was found to be useful in visualizing the alteration of intraluminal diameter of the entire biliary trees at a glance, which can provide the automatic diagnosis of IHBS diseases at an earlier phase.
DOI： 10.1159/000518020
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Kawano F., Tashiro K., Ikenoue M., Munakata S., Nakao H., Mizuno T., Mori H., Ikeda T., Takeno S., Furukawa K., Tomita M., Endo G., Ochiai H., Nakamura K., Nanashima A.
Surgery Today 51 ( 6 ) 1001 - 1009 2021.6
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery Today
© 2021, Springer Nature Singapore Pte Ltd. Purposes: Balancing scheduled surgery and trauma surgery is difficult with a limited number of surgeons. To address the issues and systematize education, we analyzed the current situation and the effectiveness of having a trauma team in the ER of a regional hospital. Methods: This retrospective study analyzed the demographics, traumatic variables, procedures, postoperative morbidities, and outcomes of 110 patients who underwent trauma surgery between 2012 and 2019. The trauma team was established in 2016 and our university hospital Emergency Room (ER) opened in 2012. Results: Blunt trauma accounted for 82% of the trauma injuries and 39% of trauma victims were transported from local centers to our institute. The most frequently injured organs were in the digestive tract and about half of the interventions were for hemostatic surgery alone. Concomitant treatments for multiple organ injuries were performed in 31% of the patients. The rates of postoperative severe complications (over Clavien–Dindo IIIb) and mortality were 10% and 13%, respectively. Fourteen (12.7%) of 24 patients who underwent damage-control surgery died, with multiple organ injury being the predominant cause of death. Conclusion: Systematic education or training of medical students and general surgeons, as well as the co-operation of the team at the regional academic institute, are necessary to overcome the limited human resources and save trauma patients.
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A Case of Resection of a Pancreatic Mucinous Cystic Neoplasm in a Man with Acute Pancreatitis Reviewed
Wada Takashi, Hiyoshi Masahide, Shimizu Ikko, Nagatomo Kenzo, Hamada Roko, Kitamura Eiji, Hamada Takeomi, Yano Koichi, Imamura Naoya, Nanashima Atsushi
The Japanese Journal of Gastroenterological Surgery 54 ( 5 ) 328 - 336 2021.5
Authorship：Corresponding author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
A 50-year-old man was admitted to our hospital with a chief complaint of abdominal pain. Abdominal CT showed a 17-mm unilocular cystic lesion in the pancreatic tail and dilation of the main pancreatic duct distal to the lesion. The pancreatic parenchyma was swollen. The fat tissue density around the pancreas was increased and indicative of pancreatitis. There was no communication between the main pancreatic duct and the cystic lesion based on MRCP, and endoscopic ultrasound showed a unilocular cystic lesion with no solid components or septal structure. The patient was diagnosed as having a retention cyst and acute pancreatitis, and received conservative therapy. Because of recurrence of pancreatitis due to stenosis of the main pancreatic duct caused by the cystic lesion, laparoscopic-assisted distal pancreatectomy was performed. The lesion was a bilocular cyst, and histopathologically, ovarian-type stroma was observed in the cystic wall. Thus, the lesion was diagnosed as a mucinous cystic adenoma. Pancreatic mucinous cystic neoplasms in males are less frequent than in females, but if suspicious findings are found on imaging, this disease should be considered in the differential diagnosis.
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Otsuka I., Kida K., Terada N., Kiwaki T., Nanashima A., Kamoto T.
International Journal of Surgery Case Reports 81 105763 2021.4
Language：English Publishing type：Case report Publisher：International Journal of Surgery Case Reports
Introduction: Pheochromocytoma surgery is generally challenging for surgeons and anesthesiologists for cardiovascular complications. Presentation of case: A 54-year-old Japanese man was found to have a large right pheochromocytoma infiltrating the posterior part of his liver and vena cava and multiple lung metastases. After retroperitoneal laparoscopic dissection of the dorsal side of the tumor and ligation of the feeding vessels, total resection of the primary tumor, extended posterior sectional hepatectomy, and partial vena cava resection were performed by open surgery via a thoracoabdominal approach. Abundant congestive bleeding with instability of vital signs occurred during transection. It could be finally controlled by dissect the remnant feeding artery in the inmost space. Prior control of arterial in-flow enabled successful completion of the planned surgical procedure. The patient has now survived for 27 months since resection of the primary lesion. Conclusion: Ligation of the feeding arteries to this hypervascular catecholamine-releasing tumor via a retroperitoneal laparoscopic approach prior to performing combined organ resection facilitated successful excision of this large malignant pheochromocytoma.
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Tashiro K., Takeno S., Kawano F., Kitamura E., Hamada R., Ikenoue M., Munakata S., Nanashima A., Nakamura K.
Endoscopy 53 ( 3 ) 288 - 292 2021.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Endoscopy
© 2020. Thieme. All rights reserved. Background Treatment of anastomotic leakage in reconstruction after esophagectomy remains challenging. This report presents a new endoscopic filling method for persistent fistula after failure of conservative treatment of leakage caused by anastomotic insufficiency. Methods 10 of 14 patients, in whom post-esophagectomy leakage had failed to resolve after 2 weeks of conservative treatment, underwent endoscopic filling with polyglycolic acid (PGA) sheet and fibrin glue into the anastomotic leakage site, using a delivery tube and endoscopic catheter, respectively. Results Each patient underwent jejunostomy, to secure nutrition. The leakage was resolved in all 10 patients. The mean number of PGA - fibrin glue procedures was 1.7.The mean period from the first application to the resumption of oral intake was 31.6 days, from the final application it was 14.7 days. Conclusions The reported filling method offers a new endoscopic approach for persistent fistula after esophagectomy when conservative treatment of leakage has failed.
DOI： 10.1055/a-1200-8199
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Nanashima A., Imamura N., Hiyoshi M., Yano K., Hamada T., Nishida T., Sakurahara D., Sakamoto R., Uchise Y., Wada T., Nagatomo K.
International Surgery 105 ( 1-3 ) 659 - 666 2021.3
Authorship：Lead author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：International Surgery
Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database Risk Calculator (NCD-RC) was examined. Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies. The cutoff value for high-risk mortality was set at 5%. Patients were divided into 4 groups: (1) no severe complications and low predictive mortality rate (woML), (2) severe complications or mortality, and low mortality rate (wML), (3) no severe complications and high mortality rate (woMH), and (4) severe complications or mortality, and high mortality rate (wMH). Results: Morbidity higher than Clavien Dindo III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and 2 (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (P , 0.01). Age, elderly patients, diseases, and comorbidity did not significantly differ among groups. Although bile leakage was common in group wML, there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and 2 died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.
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切除可能性分類に基づいた膵癌の当院での治療成績の検討 Reviewed
今村直哉，七島篤志，濵田剛臣，矢野公一，旭吉雅秀
宮崎県医師会医学会誌 45 ( 1 ) 1 - 7 2021.3
Language：Japanese Publishing type：Research paper (scientific journal)
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A rare case of intrahepatic cholangiocarcinoma with tumor thrombus in the bile duct Reviewed
Nanashima A., Tominaga K., Yonei A., Sekiya R., Oshikawa S., Sato Y., Wake N., Akiba J.
Clinical Journal of Gastroenterology 14 ( 1 ) 275 - 282 2021.2
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2020, Japanese Society of Gastroenterology. Intrahepatic cholangiocarcinoma (ICC) is a refractory liver malignancy; however, as its histological characteristics have been clarified, a good operative strategy for the subtypes of ICC can be expected. A 72-year-old woman was diagnosed with a large primary liver cancer with biliary tumor thrombus (BTT) and obstructive jaundice. An enhanced imaging modality showed hypervascular ICC or combined hepatocellular carcinoma (HCC). As her liver functional parameters permitted major hepatectomy, preoperative biliary drainage was performed, followed by a radical left hepatectomy accompanied by tumor thrombectomy with D2 lymphadenectomy. During the operation, the BTT was found to have widely spread into the right hepatic duct and the common bile duct and was histologically diagnosed as an adenocarcinoma. As ductal cancer invasion was not macroscopically observed, the planned operation was completed. The postoperative histological diagnosis was determined by discussion to be a rare mass-forming ICC with BTT. Her postoperative course was uneventful, and a 1-year survival without tumor relapse was observed with adjuvant chemotherapy. In the field of biliary surgery, although advanced ICC still has a poor prognosis, curable surgical intervention is possible for specific findings, such as BTT and HCC with BTT.
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YONEZAWA Emi, TAKENO Shinsuke, KAWAKAMI Hiroshi, MIIKE Tadashi, SAKAMOTO Kazuki, NODA Takaho, SUZUKI Sho, YAMAMOTO Shojiro, KAWANO Fumiaki, NANASHIMA Atsushi
GASTROENTEROLOGICAL ENDOSCOPY 63 ( 1 ) 31 - 37 2021.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Gastroenterological Endoscopy Society
<p>A 40-year-old man presented to the emergency room of our hospital with precordial pain after eating chicken for dinner. Computed tomography showed a high-density linear shadow of 40 mm in length in the lower esophagus. Mediastinal emphysema was noted around the mediastinal tip of the foreign body. The patient was diagnosed with bilateral perforation of the lower esophagus by chicken bone, and was referred to our department. After making preparations for on-site surgical backup, endoscopic removal of the foreign body was attempted. Upper endoscopy showed bilateral perforation of the side walls of the lower esophagus. We attempted to remove the foreign body, which was adjacent to the descending aorta, with a grasping forceps from the left side. The foreign body was pulled into the attachment and extracted without aortic injury. Esophageal perforation was managed conservatively and curatively. The patient was discharged 20 days after endoscopic extraction without surgery. Esophageal perforation may cause severe or fatal complications. A foreign body in the esophagus is often removed surgically. Furthermore, in the case of esophageal perforation by a sharp foreign object, severe bleeding may occur during endoscopic extraction. Therefore, it is necessary to devise a technique for endoscopic extraction.</p>
DOI： 10.11280/gee.63.31
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腸間膜に穿通した空腸憩室症の1例 Reviewed
市来伸彦，末田秀人，佐野浩一郎，真方寿人，樋口和宏，七島篤志
臨牀と研究 98 ( 1 ) 114 - 117 2021.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy Reviewed
Nanashima A., Tanoue Y., Sakae T., Tsuneyoshi I., Hiyoshi M., Imamura N., Hamada T., Yano K., Nishida T., Ishii M., Nagayasu T., Nakamura K.
Surgery Today 51 ( 12 ) 1953 - 1968 2021
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Purpose: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. Methods: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. Results: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. Conclusion: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.
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Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy Reviewed
Hiyoshi M., Wada T., Tsuchimochi Y., Hamada T., Yano K., Imamura N., Fujii Y., Nanashima A.
Indian Journal of Surgery 82 ( 5 ) 841 - 847 2020.10
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Indian Journal of Surgery
© 2020, Association of Surgeons of India. Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is a worrisome and life-threatening complication. The aim of this study was to clarify the risk factors and to find the early detective method of POPF after DP. From January 2010 through December 2014, 37 patients underwent DP and were enrolled in this study to examine the factors predictive of clinical POPF after DP. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline 2016. Biochemical leakage occurred in 14 (37.8%) patients, grade B POPF in 16 (43.2%) patients, and no grade C POPF in any patient. Clinical POPF (grade B/C) occurred in 43.2% of patients. Multivariate analysis revealed pancreatic thickness ≥ 14 mm to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the drain lipase ≥ 800 IU/L on postoperative day 4 could distinguish clinical POPF from non-clinical POPF effectively. Sensitivity, specificity, and accuracy were 93.8%, 70.0%, and 80.6% respectively. Pancreatic thickness ≥ 14 mm was the independent preoperative predictive risk factors for POPF. A drain lipase level of ≥800 IU/L on POD 4 was useful to find clinical POPF after DP.
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直腸間膜内リンパ節転移を来した神経内分泌分化型前立腺癌と同時性直腸癌重複の1例 Reviewed
市原明子，池田拓人，長友謙三，七島篤志，寺田直樹，中村恵理子
日本消化器外科学会雑誌 53 ( 10 ) 817 - 825 2020.10
Language：Japanese Publishing type：Research paper (scientific journal)
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Kai K., Hamada T., Hiyoshi M., Imamura N., Yano K., Nagano M., Kai M., Hidaka T., Shimoda K., Haruyama Y., Kataoka H., Nanashima A.
International Journal of Surgery Case Reports 76 19 - 24 2020.9
Authorship：Last author Language：English Publishing type：Case report Publisher：International Journal of Surgery Case Reports
© 2020 The Author(s) Introduction: Gallbladder involvement in lymphoma is extremely rare, and only 68 cases have been reported in the English literature so far. We experienced a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder arising 8 years after DLBCL of the right testis. Presentation of case: A 68-year-old man underwent orchiectomy for malignant lymphoma of the right testis pathologically diagnosed as DLBCL 8 years ago. Systemic surveillance incidentally revealed a gallbladder tumour, and elective resection of the gallbladder bed of the liver was performed under a preoperative diagnosis of gallbladder cancer. The histopathological examination revealed DLBCL. At re-evaluation 3 months after surgery, he was diagnosed as having DLBCL involving the stomach. There had been no recurrence for 39 months after chemotherapy and radiation, but he suffered from a poor general condition due to protein-losing enteropathy and died of infection. Discussion: We compiled and analysed reported cases of malignant lymphomas involving the gallbladder in terms of background, symptoms, imaging findings, and prognosis. Compared to MALT lymphoma, DLBCL was significantly more involved in other organs simultaneously or heterochronously (p = 0.004). Conclusion: Gallbladder lymphoma should be added to the differential diagnosis of gallbladder tumours, especially when clinical findings are not consistent with the typical course of gallbladder carcinoma and cholecystitis.