Papers - NANASHIMA Atsushi
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Right anatomical hepatectomy: pioneers, evolution, and the future Invited Reviewed
Nanashima A., Ariizumi S.I., Yamamoto M.
Surgery Today 50 ( 2 ) 97 - 105 2020.2
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery Today
To identify the pioneers of right anatomical hepatectomy (RAH), and clarify the development of associated operative procedures, concepts, and the future, we reviewed the “hidden” literature published in Eastern and Western countries since the 1940s. We searched the English and non-English literature on RAH through web search engines, text books and documents, and also referred to experts’ comments. Non-English literature, other than in Japanese, was translated. Changes in the anatomical concept, anatomical identification, vascular control technique, approaches, pre-operative management, and other aspects of RAH were analyzed. Honjo and Lortat-Jacob, in 1949 and 1951, respectively, reported the first cases of successful RAH; since then, RAH has been used in the treatment of liver malignancies worldwide. Vascular in-flow control is divided into intrafascial, extrafascial or transfissual access. The anatomical border along the main hepatic veins was proposed for transection, and anterior approaches have been suggested as alternative options in the hazardous situation of right liver rotation. In the laparoscopic era, several procedures and positions have been devised for RAH. In summary, RAH and related anatomical hepatectomy have been established as treatment methods for 70 years, and the future of RAH includes new concepts, approaches, and techniques to optimize patient safety and disease curability.
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Nanashima A, Hiyoshi M, Imamura N, Hamada T, Nishida T, Kawakami H, Ban T, Kubota Y, Nakashima K, Yano K, Wada T, Takeno S, Kai M.
Clinical Journal of Gastroenterology 13 ( 1 ) 102 - 109 2020.2
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2019, Japanese Society of Gastroenterology. The efficacy of adjuvant photodynamic therapy (PDT) using the new photosensitizer, talaporfin sodium (TPS) has been clinically examined in some patients with bile duct carcinoma (BDC). Based on our previous cohorts, a prospective clinical trial was attempted; however, only two cases were ultimately enrolled in 27 months. A 664-nm semiconductor laser (100 J/cm2) was applied through an endoscope to the tumor lesion within 6 h of an intravenous injection of 40 mg/m2 TPS according to the protocol for lung cancer. Case 1 was an 82-y.o. female patient with BDC at the left hepatic duct with biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) was achieved, and the patient did not consent to surgery. She was followed up for 15 months to search for non-surgical treatments and eventually received PDT. Although mild photosensitivity occurred, she was discharged without severe adverse events. Biliary stenosis markedly extended and a PTBD tube was scheduled at 1 month. However, cancer immediately metastasized to the liver and she died 155 days after PDT. Case 2 was a 70-y.o. female with perihilar BDC and multiple biliary stenoses. Multiple biliary stenting was considered to be difficult. She received PDT and no adverse events were observed. Biliary stenoses markedly improved and multiple stenting was successfully performed. On day 132, she died of cancer progression. These two cases demonstrated the safety and efficacy of biliary malignant stenosis soon after PDT; however, long-term survival and a sufficient quality of life were not achieved. The combination of the PDT protocol and system chemotherapy or brachytherapy needs to be examined in clinical trials for advanced stage BDC.
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Kai K., Ikeda T., Sano K., Uchiyama S., Sueta H., Nanashima A.
American Journal of Case Reports 21 e920431 2020.2
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：American Journal of Case Reports
© Am J Case Rep, 2020. Objective: Unusual clinical course Background: Stoma prolapse is the full-thickness protrusion of bowel through a stoma, which occurs in 2% to 26% of co-lostomies. However, stoma prolapse complicated by small bowel incarceration is very rare, reported in only 3 cases thus far. To our knowledge, the present case is the first reported case of surgical treatment after preoperative manual reduction for small bowel incarceration. Case Report: A 74-year-old male who had undergone sigmoid end colostomy in the right lower abdomen by Hartmann’s operation for rectal cancer visited our emergency room complaining of severe stoma prolapse. The prolapse was about 20×15×15 cm in size and showed edematous change. Enhanced computed tomography revealed a loop of the small bowel incarcerated within the prolapsed colostomy. After the severe prolapse was reduced to 15×10×10 cm in size with manual compression for small bowel incarceration, an emergency laparotomy made via a circumferential incision revealed a partially necrotic prolapsed sigmoid colon and 15-cm-long red-dish small bowel loop in the abdominal cavity that needed to be preserved. A new sigmoid end colostomy was constructed in the right lower abdomen at the same site as the preoperative stoma. Conclusions: It is important to remember that small bowel can herniate into a stoma prolapse, and when encountering the acute presentation of a large stoma prolapse, manual reduction of the incarcerated small bowel may help in selecting elective versus emergency surgery.
DOI： 10.12659/AJCR.920431
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Nishimuta M., Ikeda T., Ichihara A., Wada T., Nanashima A.
International Journal of Surgery Open 24 8 - 11 2020.2
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Open
© 2020 The Author(s) Introduction: Pouchitis is a late-period complication after ileal pouch-anal (canal) anastomosis in patients with ulcerative colitis (UC). Most pouchitis is controlled with the antimicrobial agents. However, some postoperative pouchitis does not respond to antimicrobial agents, and it is very difficult to treat cases of refractory and severe pouchitis. Presentation of case: A 66-year-old man underwent total proctocolectomy with ileal pouch-anal anastomosis 22 years ago. He repeatedly presented pouchitis over the last five years. The administration of antimicrobial agents had not been effective, and he sustainably suffered from stenosis symptoms at the ileal pouch-anal anastomosis site. Therefore, we decided to excise the diseased ileal pouch by permanent ileostomy according to technique of abdominoperineal resection. The postoperative course was uneventful, and at 6 months after resection, there was no relapse of abdominal symptoms and he reported a better quality of life. Discussion: The cause of pouchitis is still unknown. Oral administration of antimicrobial agents, such as metronidazole and ciprofloxacin are effective for almost pouchitis, but there are some patients of refractory pouchitis. In the cases of refractory pouchitis, the 5-ASA formulation, a steroid enema, immunomodulators, biologics, and plasma pheresis are used. But, despite attempts with these various treatments, there are rare cases that require surgical intervention to excise the diseased ileal pouch. Conclusions: We should consider surgical intervention for severe refractory pouchitis after ileal pouch-anal (canal) anastomosis for UC.
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交通事故による外傷性腹膜炎と鑑別を要した家族性地中海熱の1例 Reviewed
北村英嗣，旭吉雅秀，中尾大伸，市成秀樹，峯 一彦，七島篤志
日本臨床外科学会雑誌 81 ( 2 ) 399 - 403 2020.2
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.3919/jjsa.81.399
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再修復術として腹腔鏡下手術が有用であった右上腰ヘルニアの1例 Reviewed
甲斐健吾，佐野浩一郎，落合貴裕，内山周一郎，末田秀人，七島篤志
日本内視鏡外科学会雑誌 25 ( 1 ) 10 - 15 2020.1
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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中毒性巨大結腸症術後に出血、穿孔をきたしたサイトメガロウイルス腸炎の1例 Reviewed
樋口和宏，河野文彰，田代耕盛，池ノ上実，落合昂一郎，濱廣友華，武野慎祐，前川和也，浅田祐士郎，七島篤志
Japanese Journal of Acute Care Surgery, 9 ( 2 ) 287 - 290 2020.1
Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal)
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Kawano F., Yonekawa T., Yamaguchi H., Shibata N., Tashiro K., Ikenoue M., Munakata S., Higuchi K., Tanaka H., Sato Y., Hosokawa A., Takeno S., Nakamura K., Nanashima A.
Endocrinology, Diabetes and Metabolism Case Reports 2020 ( 1 ) 1 - 6 2020.1
Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Endocrinology, Diabetes and Metabolism Case Reports
A 54-year-old woman was referred to our hospital with a cervical tumor. CT revealed a cervical tumor extending to the upper mediastinum, tracheal deviation and tumor infiltration in the cervical vessels. She was followed-up because no diagnosis of malignancy was made by cytology. However, 2 months later, a CT scan showed enlargement of the tumor and tracheal stenosis, and a surgical biopsy was performed and she was diagnosed with anaplastic thyroid cancer (ATC). The tracheal tube with tracheal stenosis could not be removed due to the rapid growth of the tumor, necessitating management by mechanical ventilation. Due to the difficulty of surgical resection, she was treated with lenvatinib. A lenvatinib solution was made and administered via a nasogastric tube. After lenvatinib treatment, the tumor volume decreased and the tracheal stenosis improved. The tracheal tube was removed and oral intake became possible. She was discharged and received ambulatory lenvatinib therapy. The tumor was significantly reduced in size, but gradually grew and was exposed through the cervical wound 6 months later. Esophageal perforation occurred 10 months after the start of treatment. Lenvatinib was re-administered via a nasogastric tube. Eleven months later, the patient died of massive bleeding from the exposed cervical tumor. Patients with advanced ATC may require management with mechanical ventilation for airway stenosis or with a nasogastric tube for esophageal stenosis and perforation. We experienced a case in which lenvatinib was safely administered via a nasogastric tube while performing mechanical ventilation.
DOI： 10.1530/EDM-20-0064
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Ichihara Akiko, Ikeda Takuto, Nagatomo Kenzo, Nanashima Atsushi, Terada Naoki, Nakamura Eriko
The Japanese Journal of Gastroenterological Surgery 53 ( 10 ) 817 - 825 2020
Language：English Publishing type：Case report Publisher：The Japanese Society of Gastroenterological Surgery
A 75-year-old man who suffered from dysuria with elevated serum prostate specific antigen (PSA) level was diagnosed as having prostate carcinoma by needle biopsy. Upon further examination, Type 2 rectal carcinoma was found in the anterior wall of the lower rectum concurrently. MRI imaging of the pelvis revealed that the prostate carcinoma was adjacent to the anterior wall of the rectum above the anal canal and also close to the rectal carcinoma. CT revealed multiple lymph node metastases of mesorectal, lateral and inguinal lesions and PET-CT showed metastases to some bones. After one cycle of anti-androgen therapy for Stage D prostate carcinoma, the PSA level was normalized and shrinkage of the metastatic lateral lymph node (LLN) was assessed, followed by laparoscopic abdominoperineal resection for the rectal carcinoma. Pathological findings of the rectal cancer showed well-differentiated adenocarcinoma, pT2, pN0, pStage I and the origin of the mesorectal lymph node (MLN) metastasis was prostate carcinoma with neuroendocrine differentiation. Metastatic prostate carcinoma to the MLN is very rare but it is important to keep this unsuspected pattern of lymphatic spread in mind, especially in case of infiltrative high-risk prostate carcinoma.
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Plasma desacyl ghrelin-to-acyl ghrelin ratio is a predictor of postoperative complications and prognosis after pancreaticoduodenectomy. Reviewed
Nishida T, Tsubouchi H, Hamada T, Imamura N, Hiyoshi M, Yano K, Kangawa K, Nakazato M, Nanashima A
Oncology letters 18 ( 5 ) 4974 - 4983 2019.11
Language：English Publishing type：Research paper (scientific journal)
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Hiyoshi M., Yano K., Nanashima A., Ikenoue M., Imamura N., Fujii Y., Hamada T., Nishida T.
Annals of Medicine and Surgery 48 17 - 22 2019.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Annals of Medicine and Surgery
© 2019 The Author(s) Background: To evaluate the clinical significance of Mac-2 binding protein glycosylation isomer (M2BPGi), we investigated the relationship between M2BPGi and clinicopathological and surgical parameters and posthepatectomy complications. Materials and methods: We examined M2BPGi in 115 patients with hepatic malignancies undergoing hepatectomy. Significance as an independent prognostic marker was determined with multivariate logistic regression analysis. Results: The mean serum M2BPGi level was 1.14 ± 1.03 C.O.I. (range 0.2–5.79). M2BPGi in the chronic viral hepatitis group (1.42 ± 1.25) was significantly higher than that in the other disease groups (p < 0.05). The M2BPGi level correlated negatively with platelet count, LHL15 and GSA-Rmax (r = −0.36, −0.69 and −0.56, respectively; p < 0.01) but correlated positively with serum hyaluronate level (fibrotic marker), ICGR15 and HH15 (r = 0.52, 0.63 and 0.57, respectively; p < 0.01). In 53 patients examined for histological hepatic fibrosis, the M2BPGi level was highest for hepatic fibrosis stage 4, indicating cirrhosis (2.15 ± 1.56), and was significantly higher than that for stages 0–2 (p < 0.05). M2BPGi level did not correlate significantly with any surgical parameters. The preoperative level correlated significantly only with increased alanine aminotransferase level (r = −0.21, p < 0.05) and was significantly higher in patients with (1.35 ± 0.78) than without (1.11 ± 1.07) hepatectomy-related complications (p < 0.05). Area under the ROC curve analysis for prediction of hepatic fibrosis score 4 showed a cut-off value of 0.78 for M2BPGi to have high sensitivity (90%) and specificity (58%). For postoperative hepatectomy-related complications, only the M2BPGi level (at a cut-off value 0.90) tended to show significance (p = 0.06). Conclusions: The non-invasively measured serum level of M2BPGi reflected impaired liver function or cirrhosis and hepatectomy-related complications after surgery, making it potentially useful as a complementary parameter accompanying other liver function parameters.
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Hiyoshi M., Yano K., Nanashima A., Imamura N., Hamada T., Wada T.
Indian Journal of Gastroenterology 38 ( 5 ) 441 - 449 2019.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Indian Journal of Gastroenterology
© 2019, Indian Society of Gastroenterology. Background: The indocyanine green retention rate at 15 min (ICGR15) is a marker of the liver function and is useful for planning hepatectomy. To clarify the ICGR15 and the related clearance value (ICGK) calculated by a dye-dilution cardiac output flowmetry (DCOF), we examined the correlation and clinical significance of the ICGR15 values determined by DCOF and those determined with the conventional blood sampling (BS) procedure. Methods: We extracted liver function parameters, including the ICGR15 modified value and ICGK, and the extent of hepatectomy from the clinical and surgical records of 63 patients with various liver diseases in whom the ICGR15 (actual value), R15m (mean), and K (clearance rate per minute) were measured by DCOF. Results: All the patients were classified as Child-Pugh grade A. Hepatic complications were observed in 10 (16%) patients, but there was no mortality. The mean values of ICGR15 determined by BS (R15-BS) and DCOF (R15-DCOF) were 12.2 ± 8.1% and 11.2 ± 8.7%, respectively. The mean R15m determined by DCOF (R15m-DCOF) was 15.7 ± 10.2%. Significant differences were observed between R15-BS and R15-DCOF (1.1 ± 4.8%; p = 0.002) and R15m-DCOF (4.0 ± 5.9%; p < 0.001). The difference between R15-BS and R15m-DCOF was greater than that between R15-BS and R15-DCOF. Correlation between R15-BS and R15-DCOF was significant r = 0.839 (p < 0.001). Conclusions: The ICGR15 measured by DCOF shows comparable reliability and stability to the BS method, which is useful for planning hepatectomy.
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Kida K, Terada N, Nakamura E, Mukai S, Nanashima A, Kamoto T
Urology Case Reports 26 100984 2019.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Urology Case Reports
© 2019 A 55-year-old Japanese woman had a large retroperitoneal tumor involving the inferior vena cava (IVC) in the right infrahepatic space. We performed en bloc tumor resection with the right kidney and ipsilateral adrenal gland. Because of the large tumor size, we used a retroperitoneal laparoscopic approach for the posterior dissection and performed renal artery ligation. Following open conversion by a thoracoabdominal anterior approach, the tumor was completely removed without major reconstruction. Pathological examination confirmed a leiomyosarcoma arising from the IVC. Retroperitoneal laparoscopic dissection of the posterior side enabled easy and safe surgery even for a large tumor involving the IVC.
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自験例22例から検討した門脈ガス血症の手術適応 Reviewed
7. 甲斐健吾，甲斐真弘，田中俊一，七島篤志
日本腹部救急医学会雑誌 39 ( 6 ) 999 - 1005 2019.9
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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右肝動脈及び門脈合併切除再建を伴う肝左三区域・尾状葉・胆管切除術を行った肝門部領域胆管癌の1例 Reviewed
今村直哉，七島篤志，濵田剛臣，矢野公一，旭吉雅秀，伊東 大
宮崎県医師会医学会誌 43 ( 2 ) 149 - 156 2019.9
Language：Japanese Publishing type：Research paper (scientific journal)
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A rare case of rectal cancer with perianal metastasis: a case report Reviewed
Ikeda T., Nanashima A., Ichihara A., Kitamura E., Nagatomo K., Tanaka H.
World Journal of Surgical Oncology 17 ( 1 ) 149 2019.8
Language：English Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgical Oncology
© 2019 The Author(s). Background: Cancer metastasis from colon cancer to an anal fistula is very rare. We herein reported a rare case in which local excision was performed for metastatic anal fistula cancer originating from rectal cancer. Case presentation: A 68-year-old man was referred to our institution with a diagnosis of rectal cancer. He had complained of anal fistula for 5 years. Based on a recent history of cerebral infarction, Hartmann's operation was performed to treat the rectal cancer after the administration of preoperative chemotherapy for 3 months. However, 1 month after Hartmann's operation, the anal fistula was found to have worsened. Pelvic magnetic resonance imaging (MRI) revealed tumor formation at the perianal lesion. Metastatic anal fistula cancer originating from the rectal cancer was diagnosed based on the examination of the biopsied tissue. We selected local excision because the anal tumor had not invaded the surrounding tissue. There has been no recurrence in the 31 months after the curative operation. Conclusion: Metastatic cancer should be ruled out when treating left-sided colon cancer with anal fistula. Local excision is one possible treatment for metastatic anal fistula cancer.
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A rare case of simultaneous rectal and gastric carcinomas accompanied with inferior mesenteric arterioportal fistula: case report.
Kai K, Sano K, Higuchi K, Uchiyama S, Sueta H, Nanashima A
Surgical Case Reports 5 ( 1 ) 82 2019.5
Authorship：Last author Language：English Publishing type：Research paper (scientific journal)
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Ban T, Kawakami H, Kubota Y, Nanashima A, Yano K, Sato Y
Internal Medicine 58 ( 9 ) 1267 - 1271 2019.5
Language：English Publishing type：Research paper (scientific journal) Publisher：一般社団法人 日本内科学会
Even in the era of <i>Helicobacter pylori</i> eradication and proton pump inhibitors, peptic ulcer remains an important disease. Stricture due to a duodenal ulcer in the healing stage is a well-known etiology of benign gastric outlet obstruction. However, a duodenal ulcer-induced submucosal tumor-like change with gastric outlet obstruction is a very rare manifestation. We herein present a rare case of a patient with deteriorating symptoms of gastric outlet obstruction caused by an unusual manifestation of a lumen-occupying protruding duodenal ulcer mimicking a submucosal tumor.
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Efficacy of Hepatic Segmental Visualization Using Indocyanine Green Photodynamic Eye Imaging. Reviewed International journal
Nanashima A, Yano K, Tobinaga S
World Journal of Surgery 43 ( 5 ) 1305 - 1312 2019.5
Language：English Publishing type：Research paper (scientific journal)
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Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute. Reviewed
Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Hamada R, Nagatomo K, Ikenoue M, Tobinaga S, Nagayasu T
Annals of hepato-biliary-pancreatic surgery 23 ( 2 ) 168 - 173 2019.5
Language：Japanese Publishing type：Research paper (scientific journal)