Papers - NANASHIMA Atsushi
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Nanashima A., Eguchi S., Hisaka T., Kawasaki Y., Yamashita Y.I., Ide T., Kuroki T., Yoshizumi T., Kitahara K., Endo Y., Utsunomiya T., Kajiwara M., Sakoda M., Okamoto K., Nagano H., Takami Y., Beppu T.
Cancers 15 ( 6 ) 1740 2023.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Cancers
Background: This study aims to clarify the perioperative risk factors and short-term prognosis of central bisectionectomy (CB) for hepatocellular carcinoma (HCC). Methods: Surgical data from 142 selected patients out of 171 HCC patients who underwent anatomical CB (H458) between 2005 and 2020 were collected from 17 expert institutions in a single-arm retrospective study. Results: Morbidities recorded by the International Study Group of Liver Surgery (ISGLS) from grade BC post-hepatectomy liver failure (PHLF) and bile leakage (PHBL), or complications requiring intervention were observed in 37% of patients. A multivariate analysis showed that increased blood loss (iBL) > 1500 mL from PHLF (risk ratio [RR]: 2.79), albumin level < 4 g/dL for PHBL (RR, 2.99), involvement of segment 1, a large size > 6 cm, or compression of the hepatic venous confluence or cava by HCC for all severe complications (RR: 5.67, 3.75, 6.51, and 8.95, respectively) (p < 0.05) were significant parameters. Four patients (3%) died from PHLF. HCC recurred in 50% of 138 surviving patients. The three-year recurrence-free and overall survival rates were 48% and 81%, respectively. Conclusions: Large tumor size and surrounding tumor involvement, or compression of major vasculatures and the related iBL > 1500 mL were independent risk factors for severe morbidities in patients with HCC undergoing CB.
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Prognostic value of repeat hepatectomy for hepatocellular carcinoma pationts Reviewed International journal
Nanashima A., Tanoue, Y., Hiyoshi, M., Imamura, N., Yano, K., Hamada, T., Kitamura, E., Kai, K., Tahira, K. and Nagayasu, T.
Anticancer Research 42 ( 9 ) 4553 - 4561 2022.9
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal)
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Novel analysis using magnetic resonance cholangiography for patients with pancreaticobiliary maljunction Invited Reviewed
Nanashima A., Komi M., Imamura N., Yazaki S., Hiyoshi M., Hamada T., Yano K., Nishida T., Enzaki M., Sakae T.
Surgery Today 52 ( 3 ) 385 - 394 2022.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Purpose: We used a novel diagnostic Fourier transform (FT) algorithm of the entire extrahepatic bile duct (EHBD) measured by magnetic resonance cholangiography (MRC) to evaluate subtle deformation of bile duct lumen, indicating the malignant potential of EHBD, in patients with pancreaticobiliary maljunction (PBMJ) and in a comparative group of controls without PBMJ. Methods: From the workstation, the EHBD lumen was traced automatically and a 2D diagram cross section was measured at 0.5 mm-longitudinal intervals. The FT-based integrated power spectral density function value (FTPSDI) of the diameter or area (mm2 or mm4/Hz) and the phase value distribution entropy (PVDE) were also measured. Results: There were 16 patients with undilated PBMJ and 7 with dilated PBMJ. The control group comprised 10 patients with a normal bile duct, 20 with bile duct carcinoma (BDC), and 1 with primary sclerosing cholangitis. Both the diameter and area of the dilated bile ducts and the ducts with early- or advanced-stage BDC were significantly greater than those of the normal duct (p < 0.05). The undilated type of PBMJ tended to have a larger FTPSDI diameter than a normal bile duct, which had a smaller diameter than the dilated type of PBMJ or BDC. BDC had a significantly larger FTPSDI diameter (p < 0.05) and the cutoff value for accuracy was 168 mm2 Hz−1. Conclusion: The novel mathematical FTPSDI is a promising indicator of whether preventive EHBD resection is necessary for patients with PBMJ, which can be widely applied in the early diagnosis of other biliary diseases.
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Kato H., Horiguchi A., Ohtsuka T., Nanashima A., Unno M., Wakai T., Miura F., Isayama H., Hirooka Y., Aoki T., Yamamoto H., Yasuda I., Endo I.
Journal of Hepato-Biliary-Pancreatic Sciences 32 ( 5 ) 339 - 349 2025.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
Purpose: This study aimed to clarify the current treatment status for biliary tract cancers based on data from the National Clinical Database (NCD) in Japan. Methods: Total 3895 cases of biliary tract cancers registered in the NCD during 2021 were included. We identified the rates of resection, R0 resection, postoperative complications, and incidences of lymph node metastasis for gallbladder carcinoma, perihilar cholangiocarcinoma, distal bile duct carcinoma, and ampullary carcinoma. Results: The number of biliary tract cancers registered in the NCD during 2021 was 3895 (1775 in extrahepatic bile duct carcinoma, 1422 in gallbladder carcinoma, and 698 in ampullary carcinoma). In gallbladder carcinoma, the resection (89.59%) and R0 resection rates (87.99%) were favorable, and the complication rate (6.05%) was lower than that of others. However, the postoperative complication rate could be higher in T3–T4 cases and when extrahepatic bile duct resection was performed concomitantly. Lymph node metastasis was frequently seen in 12.60% at the No. 13a lymph node. In perihilar cholangiocarcinoma, the R0 resection (69.82%) and complication rates (16.75%) were significantly lower and higher, respectively. In distal cholangiocarcinoma and ampullary carcinoma, metastasis was observed in approximately 2% and 10% of the dissected No. 16b1 para-aortic lymph nodes, respectively. In conclusion, although short-term surgical outcomes for biliary tract cancers in Japan might be acceptable, the significantly lower R0 resection and higher complication rates of perihilar cholangiocarcinomas indicate additional challenges for surgeons in the future and should continue to be monitored by the Japanese Society of Hepatobiliary and Pancreatic Surgery.
DOI： 10.1002/jhbp.12129
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Imamura, N., Nanashima, A, Tsuchimochi, Y., Hamada, T., Kawakami, H. and Hiyoshi, M.
Gland Surgery 14 ( 4 ) 714 - 725 2025.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Gland Surgery
Background: Neoadjuvant chemotherapy (NAC) has been increasingly used in recent years in patients with pancreatic ductal adenocarcinoma (PDAC). This has forced a change in the practice of preoperative biliary drainage (PBD) is performed in PDAC patients scheduled for pancreatoduodenectomy (PD). What has changed in the NAC era and what is the appropriate method of PBD? To address this question, this study retrospectively reviewed the surgical outcomes and details of PBD in NAC and upfront surgery (US) patients. Methods: The study included consecutive PDAC patients who underwent PD from 2013 to 2021 during the transition from US to NAC, when outcomes were comparable. Clinical factors such as patient background, preoperative examination, surgical procedure, and postoperative complications were compared between the NAC group (40 patients) and the US group (59 patients), and details of PBD such as PBD procedure and adverse events were compared between the NAC and US groups who received PBD (27 NAC patients, 33 US patients). In the comparison test between groups, Fisher’s exact test and Mann-Whitney U test were mainly used. In addition, the outcomes and patency periods of each of the 128 PBD procedures were examined for the 60 patients who underwent PBD. The log-rank test was performed using the Kaplan-Meier method to compare patency period by PBD procedure. Results: There were no differences in patient background between the NAC and US groups. Compared with the US group, the NAC group had higher preoperative albumin (ALB) levels and less blood loss, but there was no difference of postoperative complications (NAC vs. US, 35% vs. 46%, respectively, P=0.29). With respect to PBD, the NAC group had more initial metallic stent (MS) placement (NAC vs. US, 52% vs. 15%, respectively, P=0.009), and fewer PBD-related adverse events (NAC vs. US, 33% vs. 61%, respectively, P=0.04). In a comparison of outcomes by drainage method, the duration of patency was significantly longer with MS placement than plastic stent (PS) placement (median days of patency, MS vs. PS, 68 vs. 15 days, respectively, P<0.001). However, MS placement and PS placement were equally likely to require a delay in the surgical schedule due to PBD-related adverse events (MS vs. PS, 6% vs. 6%, respectively, P>0.99). Conclusions: Prolonged PBD with NAC did not adversely affect surgical outcomes. MS placement provides a long patency period and is currently useful in PBD for PDAC patients undergoing PD after NAC, which requires a prolonged preoperative period. However, MS placement also has adverse events, and further studies are needed.
DOI： 10.21037/gs-2024-507
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Non-Cytotoxic photodynamic therapy with talaporfin sodium reduces the expression of CXCR4 and enhances chemotherapeutic efficacy in undifferentiated Reviewed
Kai,K., Ishizuka, T., Matsumoto, J., K Shimamawari, K., Mori, R., Fidya, Lkham-Erdene, B., Kubota, T., Ikenoue, M., Higuchi, K., Nanashima, A. and Hishikawa, Y.
Acta Histochemica et Cytochemica 58 ( 2 ) 2025.4
Language：English Publishing type：Research paper (scientific journal)
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地方都市施設におけるacute care surgeryのあり方とは？―当院の10年を振り返って見えてきた課題と対策― Reviewed
河野文彰，田代耕盛，池ノ上実，宗像 駿，鈴木康人，武野慎祐，古川貢之，落合秀信，七島篤志
Japanese Journal of Acute Care Surgery 15 ( 1 ) 2025.4
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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非閉塞性腸間膜虚血症（NOMI）の治療戦略 -ICG蛍光造影法を用いた定型化を目指して- Reviewed
落合貴裕，河野文彰，池ノ上実，武野慎祐，七島篤志
Japanese Journal of Acute Care Surgery 2025.4
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.50840/jjacs.15-3
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Kinoshita S., Nakaura T., Yoshizumi T., Itoh S., Ide T., Noshiro H., Hamada T., Kuroki T., Takami Y., Nagano H., Nanashima A., Endo Y., Utsunomiya T., Kajiwara M., Miyoshi A., Sakoda M., Okamoto K., Beppu T., Takatsuki M., Noritomi T., Baba H., Eguchi S.
Hepatology Research 55 ( 4 ) 567 - 576 2025.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Hepatology Research
Aim: Microvascular invasion (MVI) affects the prognosis and treatment of hepatocellular carcinoma (HCC); however, its preoperative diagnosis is challenging. Analysis of computed tomography (CT) images using radiomics can detect MVI, but its effectiveness depends on the imaging conditions. We compared the efficacies of radiomics, clinical, and combined models for predicting MVI in HCC using nonstandardized scanning protocols. Methods: This multicenter study included 533 patients who underwent hepatic resection for HCC. Patients were divided randomly into training (n = 426) and test groups (n = 107). We manually extracted 3D CT features in hepatic arterial, portal venous, and venous phases. The radiomics model was trained by machine learning. A logistic regression model was developed based on clinical information, and a fused model was created integrating clinical information and radiomics prediction score (Rad_Score). We calculated areas under the receiver operating characteristic curves (AUCs) for the radiomics, clinical, and mixed models in the test groups. Results: The clinical model incorporated hepatitis B virus surface antigen, tumor diameter, and log-transformed α-fetoprotein and des-gamma-carboxyprothrombin. The AUCs of the radiomics and clinical models were comparable (p = 0.76). Rad_Score was not an independent significant factor in the fused model (p = 0.40) and its addition did not improve the accuracy of the clinical model alone (p = 0.51). Conclusions: A clinical model is as effective as a CT radiomics model for predicting MVI status in patients with HCC based on real-world scanning data, and integration of both models does not improve the predictive performance compared with a clinical model alone.
DOI： 10.1111/hepr.14149
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Managing uncontrolled bleeding in elective surgery: The role of damage control techniques Reviewed
Nanashima A., Wada T., Kawano F., Hamada K., Taniguchi T., Furukawa K.
International Journal of Surgery Case Reports 128 111040 2025.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
Introduction: The main text introduction expands on the initial introduction by providing a more detailed discussion of massive bleeding in elective surgeries and its challenges. It describes how traditional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. It then introduces DCS as a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure by our two experienced cases presentation. Case 1. A 76-year-old obese male diagnosed with advanced transverse colon cancer with regional balky lymph node metastasis was identified at the root of the regional colic vein trunk. A robotic surgical approach was changed to open laparotomy because of bleeding tendency due to fatty mesentery. During the balky node dissection, the root of the vein was injured and induced massive bleeding during the compressive hemostatic procedure. As the hypotensive control rapidly became quite tricky, DCS by gauze packing and covered by the commercial dressing kit with open abdominal management (OAM). The second look operation, by supporting the Restrictive Endovascular Balloon Occlusion of the Aorta, repaired the superior mesenteric vein's injured parts. He survived for nine months. Case 2. The 72-year-old male patient was diagnosed as solitary 3 cm of hepatocellular carcinoma at S6 with alcoholic liver cirrhosis. The laparoscopic limited hepatic resection was changed to the open laparotomy due to the bleeding tendency at the transected parenchyma. After accomplishing limited resection, massive hepatic venous bleeding occurred; DCS was decided due to continuing hypotension, oozed hemorrhage, and low platelet level with metabolic acidosis by peri-hepatic gauze packing around the right liver. The second look operation for remnant hemostasis and the de-packing with abdominal closure could be achieved without severe events. The postoperative course showed no hepatic failure, and they recovered during a hospital stay. Discussion: It describes how conventional hemostatic procedures are essential but may not always be sufficient, especially in uncontrolled coagulopathy despite aggressive transfusion. DCS is a well-established approach in trauma surgery, emphasizing its role in stabilizing patients with hemorrhagic shock, coagulopathy, hypothermia, and acidosis. The role of DCS is well known even in elective surgery in unforeseen emergency situations such as hemodynamic instability, severe coagulopathy, and prolonged surgery over 24 h. It highlights that DCS can be a lifesaving intervention when unexpected massive bleeding occurs and justifies its use in patients with unstable vital signs or increased intra-abdominal pressure, where prolonged surgery is not feasible. It reinforces that DCS was successfully utilized in the reported cases, leading to favorable second-look operations. Conclusion: The main text introduction is a more comprehensive and structured expansion of the initial introduction. While the initial version introduces the problem concisely, the revised introduction elaborates on the challenges of massive bleeding, the principles of DCS, and its potential role in elective surgeries before transitioning into the case reports.
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Nanashima A., Arai J., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Kawakami H., Sato Y., Takashi W.
Turkish Journal of Surgery 41 ( 1 ) 5 - 18 2025.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
Objective: To elucidate surgical strategies for patients undergoing radical resection, in cases where solitary distant lymph node metastasis is identified intraoperatively, we investigated the prognostic significance of para-aortic lymph node (PALN) metastases and other regional lymph node (RLN) metastases in pancreatic carcinomas (PC) and biliary duct cancers (BDC). Material and Methods: This study retrospectively analyzed data from 181 PC patients and 116 BDC patients who underwent radical resections at two institutions between 1994 and 2021. Results: Among PC patients, metastases were observed in RLN and PALN in 54% and 9% of cases, respectively. Similarly, RLN and PALN metastases were present among BDC patients in 39% and 9% of cases, respectively. Survival analysis revealed that patients with BDC and PALN metastases exhibited significantly reduced disease-free (DFS) and overall survival (OS) compared to those without PALN involvement. Multivariate analysis identified PALN metastasis as an independent predictor of OS in BDC patients (p<0.05), while RLN metastasis was independently associated with DFS (p<0.05). Additional clinicopathological factors associated with PALN and RLN metastases were also identified. Preoperative serum levels of Duke Pancreas II monoclonal antibody were significantly elevated in patients with PALN metastases. Histological findings of lymphatic or perineural infiltration and hepatic or pancreatic invasion were independently associated with RLN metastases. Conclusion: Based on these findings, radical resection may be considered for PC patients with isolated PALN metastases only in the absence of additional adverse prognostic factors. Prospective clinical trials are warranted to further refine the criteria for surgical intervention when solitary PALN metastases are detected intraoperatively.
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Higuchi Kazuhiro, Ikenoue Makoto, Ishizuka Takumi, Kai Kengo, Takahashi Nobuyasu, Kubota Toshiki, Shirouzu Shinichiro, Lkham-Erdene Baljinnyam, Aung Kham Mo, Nakai Michikazu, Sawaguchi Akira, Nanashima Atsushi, Hishikawa Yoshitaka
ACTA HISTOCHEMICA ET CYTOCHEMICA 58 ( 1 ) 9 - 18 2025.2
Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOCIETY OF HISTOCHEMISTRY AND CYTOCHEMISTRY
SET domain bifurcated 1 (SETDB1), a histone H3K9-specific methyltransferase, is crucial for heterochromatin formation and intestinal homeostasis, but its role in intestinal ischemia-reperfusion injury (IRI) remains unclear. This study investigated changes in SETDB1-mediated nuclear chromatin regulation in intestinal epithelial cells (IECs) using an IRI mouse model. Jejunal samples were collected after 75 min of ischemia followed by 24 hr of reperfusion. Sinefungin was administered as a histone methyltransferase inhibitor. Morphologic changes were evaluated using hematoxylin-eosin staining and electron microscopy, and cell-adhesion molecule expression, including ZO-1, E-cadherin, integrin-β4, and laminin, was evaluated using immunohistochemistry. Super-resolution microscopy analyzed intranuclear SETDB1 localization and heterochromatin formation in IECs. IRI-affected jejunum exhibited massive IEC detachment, dilated intercellular spaces, basement membrane damage, and decreased expression of E-cadherin and integrin-β4. Sinefungin prevented these changes, however. The proportion of IECs expressing nuclear SETDB1 throughout the euchromatin was significantly higher in IRI-affected jejunum (77.8%) than sham-treated (3.0%) or sinefungin-treated, IRI-affected jejunum (2.7%). The proportion of IECs with decreased heterochromatin was significantly higher in sinefungin-treated, IRI-affected jejunum (84.3%) than untreated IRI-affected jejunum (15.6%). These findings suggest that SETDB1-mediated chromatin regulation is pivotal in intestinal IRI and represents a potential therapeutic target.
DOI： 10.1267/ahc.24-00061
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Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Ichihara A., Hamada K., Ichiki N., Kai K., Higuchi K.
Translational Cancer Research 14 ( 1 ) 461 - 472 2025.1
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Translational Cancer Research
Background: Progression of chronic liver dysfunction influenced by long-term chemotherapy or repeated hepatectomy might be related to patient overall survival as well as tumor factors in colorectal liver metastasis (CLM) patients. Our aim of this study was to clarify the relationship between fibrotic liver damage and malignant behaviors of CLM malignancy or its long-term survivals by the retrospective cohort study. Methods: We examined the relationship between tumor-related factors or six liver fibrosis-associated parameters, including platelet count, hyaluronic acid (HA), mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S (T4C7), aspartate aminotransferase-to-platelet ratio index (APRI), The fibrosis-4 (Fib-4) index, and clinicopathological parameters, surgical records, and postoperative patient survival in the 45 consecutive patients with CLM who underwent radical hepatectomy. Results: Fibrotic parameters were platelet count of 23.0±8.5 ×104/μL, HA level of 68.9±82.3 ng/mL, M2BPGi of 0.87±0.48 ng/mL, and type IV collagen level of 5.74±3.76 ng/mL. Platelet count was significantly correlated with HA level (P<0.05) and tended to be correlated with M2BPGi levels (P=0.056). HA level was significantly associated with albumin level (P<0.05). Overall survival in this series showed five-year overall survivors after hepatectomy in 44 patients (98%), but cancer-related deaths were observed in only one patient. Patients with higher grades and increased bilirubin levels demonstrated significantly lower cancer-free survival (P<0.05), but fibrotic parameters were not associated with prognostic factors. Conclusions: Fibrotic markers indicating chemotherapy or repeated surgical liver injury were not significant predictive factors reflecting cancer malignant behaviors or patient overall survival, contrary to our hypothesis. The current overall survival status using various modalities for cancer recurrence is satisfactory under our present perioperative management.
DOI： 10.21037/tcr-24-1138
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Islam M.N., Nabekura H., Ueno H., Nishida T., Nanashima A., Sakoda H., Zhang W., Nakazato M.
Scientific Reports 14 ( 1 ) 24782 2024.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Scientific Reports
Liver-expressed antimicrobial peptide 2 (LEAP2) is a peptide that counteracts the hunger hormone ghrelin-induced functions. Recently, we showed that vertical sleeve gastrectomy (VSG) did not alter the serum LEAP2 concentration in individuals with obesity. Here, we investigated the effects of VSG in both chow diet (CD)-fed and high-fat diet (HFD)-fed mice. In CD-fed mice, VSG increased plasma LEAP2 levels and hepatic Leap2 mRNA levels while decreasing body weight, blood glucose levels, and ghrelin levels. Intraperitoneal (ip) administration of ghrelin reversed these changes. These effects were found in both male and female mice. In contrast, VSG or weight loss in HFD-induced obese mice decreased LEAP2 levels. After fasting, the plasma LEAP2 concentration was in the following order: hepatic vein > abdominal aorta > portal vein. A high glucose concentration robustly increased the plasma LEAP2 concentration in the hepatic vein and abdominal aorta but not in the portal vein. In addition, corn oil or palmitate increased LEAP2 expression and secretion. The increase in LEAP2 levels after the meal tolerance test was delayed in the human subjects with diabetes. Our data suggest that various factors (metabolic, hormonal, and nutritional) regulate LEAP2, and the liver is the predominant site for the production and secretion of LEAP2. Furthermore, the interaction between ghrelin and LEAP2 is involved in the pathogenesis of obesity and diabetes.
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経肛門的小腸バルーン内視鏡で術前に病理診断した小腸原発悪性黒色腫の1例 Reviewed
清水一晃，内勢由佳子，市来伸彦，濵田聖暁，市原明子，七島篤志，中村恵理子，都築 諒
日本臨床外科学会雑誌 85 ( 11 ) 1551 - 1555 2024.10
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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Hosokawa A., Tamura H., Ichihara A., Imamura N., Kai K., Fukushima T., Nanashima A., Komohara Y.
Anticancer Research 44 ( 9 ) 4119 - 4125 2024.9
Language：English Publishing type：Case report Publisher：Anticancer Research
Background/Aim: Immune checkpoint inhibitors are effective in treating microsatellite instability-high (MSI-H) metastatic colorectal cancer (CRC). Pathological complete response to immune checkpoint inhibitors for MSI-H metastatic CRC have been described in several reports. Liver metastasis is known to predict resistance to ani-programmed death 1 (PD-1)/PD-1 ligand 1 (PD-L1) therapy in several cancers, including CRC. Case Report: Herein, we report the case of a 23-year-old man with MSI-H colorectal liver metastasis who exhibited a pathological complete response to pembrolizumab following systemic chemotherapies. Pathological examination of the primary lesion revealed strong HLA-class I and HLA-DR expression in cancer cells. Elevated PD-L1 expression was observed in areas of increased CD8-postive T cell infiltration. Additional pathological study of regional lymph nodes showed increased PD-L1 and CD169 expression. Conclusion: A detailed pathological examination revealed PD-L1 expression not only in the primary CRC lesion but also in regional lymph nodes. Recent studies have highlighted the significance of regional lymph nodes in anti-cancer immune responses. Therefore, pathological studies using resected lymph nodes might be beneficial for predicting the response of anti-PD-1/PD-L1 therapy.
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臨床研究 術前治療後に骨盤内臓全摘術を施行した局所進行直腸癌の治療成績 Reviewed
市原明子，市来伸彦，千代反田顕，濵田聖暁，武野慎祐，七島篤志，賀本敏行，細川 歩，陣内 崇，池田拓人
宮崎医師会医学会誌 48 ( 2 ) 129 - 136 2024.9
Language：Japanese Publishing type：Research paper (scientific journal)
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A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen. Reviewed
Masuya R, Nakame K, Munakata S, Takeno S, Nanashima A, Ieiri S
Surgical Case Reports 10 ( 1 ) 177 2024.7
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Acceptance of Virtual Reality Simulation Training for Stoma Care by Healthcare Providers: A Pilot Questionnaire Study After Viewing Prototype Imagings. Reviewed
Kai K, Shinoda H, Takeiri E, Hamada T, Chikubu M, Kodama Y, Higuchi K, Nanashima A
Cureus 16 ( 7 ) e65465 2024.7
Language：English Publishing type：Research paper (scientific journal)
DOI： 10.7759/cureus.65465
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Soyama A., Yamamoto H., Eguchi S., Nanashima A., Kakeji Y., Kitagawa Y., Nakamura M., Endo I.
Journal of Hepato-Biliary-Pancreatic Sciences 31 ( 7 ) 425 - 436 2024.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
Background: Although curative resection with vascular reconstruction improves the prognosis of blood-invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction. Methods: This retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated. Results: Among the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction. Conclusions: The NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.
DOI： 10.1002/jhbp.1435
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Nanashima A., Hamada T., Hiyoshi M., Imamura N., Tsuchimochi Y., Shimizu I., Nagata K., Kawakami H.
Clinical Journal of Gastroenterology 17 ( 3 ) 490 - 496 2024.6
Authorship：Lead author, Corresponding author Language：English Publishing type：Case report Publisher：Clinical Journal of Gastroenterology
Nowadays, the novel molecular targeting chemotherapy provides possibility of safe hepatectomy for progressive hepatocellular carcinoma (HCC). Further, combination of the conventional transarterial chemoembolization (TACE) may add an effect of tumor shrink. We present a successful radical hepatectomy for a large HCC located in segment 1 accompanied with the preoperative Lenvatinib (LEN)-TACE sequential treatment. We present a woman patient without any complaints who had a 7 cm-in-size of solitary HCC compressing vena cava and right portal pedicle. To achieve radical hepatectomy by tumor shrinking, LEN-TACE for 2 months. After confirming downsizing or devascularization of the HCC, we scheduled radical posterior sectionectomy combined with caudate lobectomy according to tumor location and expected future remnant liver volume from three-dimensional computed tomography simulation before surgery. Under the thoraco-abdominal incision laparotomy, we safely achieved scheduled radical hepatectomy without any vascular injuries. The postoperative course was uneventful and no tumor recurrence were observed for 1 year. Histological findings showed the Japan TNM stage III HCC with 70% necrosis. The multi-modal strategy of LEN-TACE followed by radical hepatectomy by confirming downsizing or devascularization in tumor is supposed to be useful and would be a preoperative chemotherapy option, and promising for curative treatment in HCC patients with progressive or large HCC, which may lead to safety by prevention surrounding major vascular injury.
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Masuya R., Muraji T., Harumatsu T., Machigashira S., Iwamoto Y., Ogata M., Takada L., Nishida N., Kedoin C., Nagano A., Matsui M., Murakami M., Sugita K., Yano K., Onishi S., Yamada K., Yamada W., Matsukubo M., Kawano T., Muto M., Nakame K., Kaji T., Nanashima A., Ieiri S.
Surgery Today 54 ( 5 ) 452 - 458 2024.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Purpose: We compared the clinical features of patients with biliary atresia (BA) associated with a bleeding tendency (BT) at the time of the diagnosis with those of patients without a bleeding tendency (NBT). Methods: The patients’ background characteristics, age in days at the first visit, Kasai portoenterostomy (KPE), and postoperative course were retrospectively analyzed. Results: Nine of the 93 BA patients (9.7%) showed a BT, including 7 with intracranial hemorrhaging (ICH), 1 with gastrointestinal bleeding, and 1 with a prothrombin time (PT) of 0%. The age at the first visit was 62 ± 12 days old for BT patients and 53 ± 27 days old for NBT patients (p = 0.4); the age at KPE was 77 ± 9 days old for BT patients and 65 ± 24 days old for NBT patients (p = 0.2); the time from the first visit to surgery was 13 ± 7 days for BT patients and 11 ± 10 days for NBT patients (p = 0.5); and the native liver survival rate was 56% for BT patients and 58% for NBT patients (p = 1), with no significant difference in any of the parameters. The neurological outcomes of survivors of ICH were favorable. Conclusions: Appropriate BT correction allowed early KPE even after ICH, resulting in native liver survival rates comparable to those of NBT patients without significant neurological complications.
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MANGOU (Miyazaki Advanced New General Surgery of University) Wet Lab Training Relieves Anxiety About Surgical Skills in Surgical Education: A Cross-Sectional Study. Reviewed
Hiyoshi M, Kai K, Wada T, Tsuchimochi Y, Nishida T, Hamada T, Yano K, Imamura N, Kawano F, Nanashima A
Cureus 16 ( 5 ) e61273 2024.5
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)
DOI： 10.7759/cureus.61273
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Kai Kengo, Nakashima Koji, Kawakami Hiroshi, Takeno Shinsuke, Hishikawa Yoshitaka, Ikenoue Makoto, Hamada Takeomi, Imamura Naoya, Shibata Tomotaka, Noritomi Tomoaki, Sasaki Fumisato, Nakamura Yoshitaka, Nanashima Atsushi
Internal Medicine 63 ( 7 ) 903 - 910 2024.4
Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Internal Medicine
<b>Introduction </b>Photodynamic therapy (PDT) is a salvage treatment for local failure after chemoradiotherapy for esophageal cancer. Salvage PDT is the treatment available for vulnerable patients with various comorbidities at risk of salvage esophagectomy. This study assessed the impact of the Charlson comorbidity index (CCI) on the outcomes of salvage PDT using talaporfin sodium (TS) for esophageal cancer. <b>Metohds </b>Consecutive patients with esophageal cancer who underwent salvage TS-PDT from 2016 to 2022 were included in this retrospective study. We investigated the local complete response (L-CR), progression-free survival (PFS) and overall survival (OS) and evaluated the relationship between the CCI and therapeutic efficacy. <b>Results </b>In total, 25 patients were enrolled in this study. Overall, 12 patients (48%) achieved an L-CR, and the 2-year PFS and OS rates were 24.9% and 59.4%, respectively. In a multivariate analysis, a CCI ≥1 (p=0.041) and deeper invasion (p=0.048) were found to be significant independent risk factors for not achieving an L-CR. To evaluate the efficacy associated with comorbidities, we divided the patients into the CCI=0 group (n=11) and the CCI ≥1 group (n=14). The rate of an L-CR (p=0.035) and the 2-year PFS (p=0.029) and OS (p=0.018) rates in the CCI ≥1 group were significantly lower than those in the CCI=0 group. <b>Conclusion </b>This study found that the CCI was negatively associated with the efficacy of salvage TS-PDT for esophageal cancer.
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小児血液・悪性固形腫瘍患者に対する鎖骨上アプローチを用いた腕頭静脈穿刺による中心静脈カテーテル挿入術の検討 Reviewed
中目和彦，桝屋隆太，永澤 俊，中川 緑，山田 愛，木下真理子，上村幸代，盛武 浩，家入里志，七島篤志
日本小児外科学会雑誌 60 ( 2 ) 158 - 165 2024.4
Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ochiai T., Nagata K., Hasuike S., Nakamura K., Iwakiri H., Kawakami H.
Translational Cancer Research 13 ( 5 ) 2332 - 2345 2024.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Translational Cancer Research
Background: Progression of chronic liver fibrosis and related increased fibrotic markers are associated with functional liver reserves or patient prognosis as well as tumor factors in hepatocellular carcinoma (HCC) patients. The aim of this study was to newly clarify the relationship between fibrotic markers and HCC malignant behaviors or its long-term postoperative prognosis by the retrospective cohort study. Methods: We examined the relationship between tumor-related factors or six liver fibrosis-associated parameters, including platelet count, hyaluronic acid (HA), Mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S (T4C7), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (Fib-4) index, and clinicopathological parameters, surgical records, and postoperative prognosis in 130 HCC who underwent curative hepatectomy. Results: Histological fibrosis stage 4 as cirrhosis was in 31%. The platelet count significantly decreased in stage 4 fibrosis and correlated with grade B liver damage (P<0.01). HA levels were significantly increased in multiple HCC, stage 4 fibrosis, and grade B liver damage (P<0.01). T4C7 was significantly increased in patients with post-hepatectomy tumor recurrence compared to those without (P<0.01). Additionally, M2BPGi was significantly higher in stage 4 fibrosis and liver damage grade B, and was significantly associated with poor prognosis (P<0.05). Fib-4 index was significantly higher in patients with liver damage B (P<0.05), and T4C7 alone did not correlate with other five fibrosis markers. Stage 4 fibrosis, higher T4C7, higher M2BPGi, and increased tumor size were significantly associated with shorter cancer-free, overall, and cancer-specific survivals. Higher T4C7, non-met Milan criteria, liver damage B, blood transfusion, and curability C were independently associated with cancer-specific survivals (P<0.05). Conclusions: Type IV collagen 7S (T4C7) may reflect not only impaired liver function but also HCC malignant behaviors and patient survivals.
DOI： 10.21037/tcr-24-94
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Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Wada T., Shimizu I., Ochiai T.
Turkish Journal of Surgery 40 ( 4 ) 283 - 295 2024.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
Objective: We examined the relation between several fibrotic markers reflecting liver parenchymal injury and conventional liver function or surgical outcomes in 67 patients with cholangiocarcinoma who underwent biliary drainage for obstructive jaundice followed by surgical resection. Material and Methods: We examined conventional clinicopathological factors, six hepatic fibrosis parameters, including platelet count, hyaluronic acid, Mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S, aspartate aminotransferase-to-platelet ratio index (APRI), and FIB-4 index before hepatectomy, and surgical outcomes or long-term prognosis. Results: Obstructive jaundice was observed in 57% of the patients, a history of biliary diseases in 7.5%, and chronic hepatic injuries in 17.9%. M2BPGi was significantly higher in patients with obstructive jaundice as the primary sign (p< 0.05), the FIB-4 index was significantly correlated with patient age (p< 0.01), and serum hyaluronic acid and T4C7 levels were significantly increased in distal cholangiocarcinoma (CC). No markers were associated with the histological hepatic fibrotic index, tumor-related factors, or postoperative morbidities. Tumor relapse was observed in 37% of patients, and cancer-related death was observed in 25%. A higher FIB-4 index was significantly associated with shorter cancer-free survival (p< 0.05). Cox multivariate analysis showed that bilirubin levels, poor histological cancer differentiation, and absence of fibrotic markers were associated with cancer-free, cancer-specific overall, and overall survival. Conclusion: Although a sufficient relation exists between these markers and elastographic or histological fibrotic indexes, the clinical significance of measuring conventional fibrotic markers might no longer be necessary in future studies.
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Kai K., Hamada T., Sakae T., Sato Y., Hiyoshi M., Inomata M., Suzuki Y., Nakamura S., Azuma M., Nanashima A.
Clinical Journal of Gastroenterology 17 ( 1 ) 198 - 203 2024.2
Authorship：Last author Language：English Publishing type：Case report Publisher：Clinical Journal of Gastroenterology
A 48-year-old woman underwent transcatheter arterial embolization (TAE) for a splenic artery aneurysm, which resulted in a partial splenic infarction in the middle lobe. Five years after TAE, a 20-mm diameter mass in the noninfarcted area of the spleen was detected on imaging, which grew to 25 mm in diameter after 6 months. MRI after gadolinium administration showed a 35 × 34 mm mass within the superior pole and 15 × 12 mm mass within the inferior pole. The patient underwent laparoscopic splenectomy and had an uneventful postoperative recovery. No evidence of recurrence was observed during the 2-year follow-up period after surgery. The mass was pathologically confirmed to be sclerosing angiomatoid nodular transformation (SANT) of the spleen. While some studies hypothesize that SANT is a response to vascular injury or trauma, to the best of our knowledge, there have been no previous reports of SANT occurring after procedures directly affecting splenic blood flow. Additionally, multifocal SANTs are reported to be very rare, accounting for only 4.7% of all reported SANTs of the spleen. We highlight a rare course of SANT of the spleen and discuss the possible relationship between blood flow abnormalities and the appearance of SANT.
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The crucial role of SETDB1 in structural and functional transformation of epithelial cells during regeneration after intestinal ischemia reperfusion injury Reviewed International coauthorship
Ikenoue M., Choijookhuu N., Yano K., Fidya , Takahashi N., Ishizuka T., Shirouzu S., Yamaguma Y., Kai K., Higuchi K., Sawaguchi A., Nanashima A., Hishikawa Y.
Histochemistry and Cell Biology 161 ( 4 ) 325 - 336 2024.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Histochemistry and Cell Biology
Su (var) 3–9, enhancer of seste, trithorax (SET)-domain bifurcated histone lysine methyltransferase (SETDB1) plays a crucial role in maintaining intestinal stem cell homeostasis; however, its physiological function in epithelial injury is largely unknown. In this study, we investigated the role of SETDB1 in epithelial regeneration using an intestinal ischemia/reperfusion injury (IRI) mouse model. Jejunum tissues were sampled after 75 min of ischemia followed by 3, 24, and 48 h of reperfusion. Morphological evaluations were performed using light microscopy and electron microscopy, and the involvement of SETDB1 in epithelial remodeling was investigated by immunohistochemistry. Expression of SETDB1 was increased following 24 h of reperfusion and localized in not only the crypt bottom but also in the transit amplifying zone and part of the villi. Changes in cell lineage, repression of cell adhesion molecule expression, and decreased histone H3 methylation status were detected in the crypts at the same time. Electron microscopy also revealed aberrant alignment of crypt nuclei and fusion of adjacent villi. Furthermore, increased SETDB1 expression and epithelial remodeling were confirmed with loss of stem cells, suggesting SETDB1 affects epithelial cell plasticity. In addition, crypt elongation and increased numbers of Ki-67 positive cells indicated active cell proliferation after IRI; however, the expression of PCNA was decreased compared to sham mouse jejunum. These morphological changes and the aberrant expression of proliferation markers were prevented by sinefungin, a histone methyltransferase inhibitor. In summary, SETDB1 plays a crucial role in changes in the epithelial structure after IRI-induced stem cell loss.
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Hirashita T., Ikenaga N., Nakata K., Nakamura M., Kurahara H., Ohtsuka T., Tatsuguchi T., Nishihara K., Hayashi H., Nakagawa S., Ide T., Noshiro H., Adachi T., Eguchi S., Miyoshi A., Kohi S., Nanashima A., Nagano H., Takatsuki M., Inomata M.
Annals of Gastroenterological Surgery 8 ( 4 ) 681 - 690 2024.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Annals of Gastroenterological Surgery
Background: Distal pancreatectomy (DP) with lymph node (LN) dissection is the standard procedure for pancreatic ductal adenocarcinoma of the tail (Pt-PDAC). However, the optimal surgery including extent of LN dissection is still being debated. The present study investigated the incidence and prognostic impact of LN metastasis on patients suffering from Pt-PDAC. Patients and method: This multicenter, retrospective study involved 163 patients who underwent DP for resectable Pt-PDAC at 12 institutions between 2013 and 2017. The frequency of LN metastasis and the effect of LN dissection on Pt-PDAC prognosis were investigated. Results: There were high incidences of metastases to the LNs along the splenic artery in the patients with Pt-PDAC (39%). The rate of metastases in the LNs along the common hepatic, left gastric, and celiac arteries were low, and the therapeutic index for these LNs was zero. In pancreatic tail cancer located more distally, there were no metastases to the LNs along the common hepatic artery. Multivariate analysis revealed that tumor size was the only independent factor related to recurrence-free survival (HR = 2.01, 95% CI = 1.33–3.05, p = 0.001). The level of pancreas division and LN dissection along the common hepatic artery did not affect the site of tumor recurrence or recurrence-free survival. Conclusions: LN dissection along the hepatic artery for Pt-PDAC has little significance. Distal pancreatic transection may be acceptable in terms of oncological safety, but further examination of short-term outcomes and preservation of pancreatic function is required.
DOI： 10.1002/ags3.12771
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Masuya R., Nakame K., Kai K., Tsuchimochi Y., Hamada T., Imamura N., Hiyoshi M., Nanashima A., Ieiri S.
Asian Journal of Endoscopic Surgery 17 ( 1 ) e13264 2024.1
Language：English Publishing type：Case report Publisher：Asian Journal of Endoscopic Surgery
A 15-year-old girl with recurrent upper abdominal pain was diagnosed with congenital biliary dilatation. Abdominal enhanced computed tomography (CT) showed the anterior segmental branch of the right hepatic artery (RHA) running across the ventral aspect of the dilated common hepatic duct (CHD). Laparoscopic extrahepatic dilated biliary duct excision and Roux-en-Y hepaticojejunostomy were planned. Intraoperatively, the dilated CHD was observed to bifurcate into the ventral and dorsal ducts, between which the anterior segmental branch of the RHA crossed through the CHD. The CHD rejoined on the distal side as one duct. We transected the CHD just above the cystic duct. The patency of the ventral and dorsal sides of the bifurcated CHD was confirmed. Laparoscopic hepaticojejunostomy was performed at the distal side of the rejoined CHD, without sacrificing the anterior segmental branch of the RHA. There was no postoperative blood flow impairment in the right hepatic lobe or anastomotic stenosis.
DOI： 10.1111/ases.13264
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咽頭喉頭頸部食道切除術後フォロー中に診断された胸部食道癌に対して経裂孔的食道切除術を施行した1例 Reviewed
落合貴裕，河野文彰，田代耕盛，武野慎祐，七島篤志
日本外科系連合学会誌 49 ( 4 ) 367 - 373 2024
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Case report
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Nanashima A., Kai K., Hamada T., Munakata S., İmamura N., Hiyoshi M., Hamada K., Shimizu I., Tsuchimochi Y., Tsuneyoshi I.
Turkish Journal of Surgery 39 ( 4 ) 328 - 335 2023.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
We developed a prototype VR platform, VECTORS L&M (VLM), aiming to enhance the understanding of digestive surgery for students, interns, and young surgeons by limiting costs. Its efficacy was assessed via questionnaires before implementation in surgical education. The VLM provides nine-minute VR views of surgeries, from both 180- and 360-degree angles. It was created with L.A.B. Co., Ltd. and incorporates surgery videos from biliary malignancy patients. Following VLM development, a survey was conducted among surgeons who had experienced it. Twenty-eight participants (32% of observers) responded to the survey. A majority (81%) reported positive experiences with the VR content and showed interest in VR video production, though some reported sickness. Most respondents were experienced surgeons, and nearly all believed VR was important for medical education with a mean score of 4.14 on a scale of up to 5. VR was preferred over 3D printed models due to its application versatility. Participants expressed the desire for future VR improvements, such as increased mobility, cloud connectivity, cost reduction, and better resolution. The VLM platform, coupled with this innovative teaching approach, offers experiential learning in intraabdominal surgery, effectively enriching the knowledge of students and surgeons ahead of surgical education and training.
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Terasaki F., Hirakawa S., Tachimori H., Sugiura T., Nanashima A., Komatsu S., Miyata H., Kakeji Y., Kitagawa Y., Nakamura M., Endo I.
Journal of Hepato-Biliary-Pancreatic Sciences 30 ( 12 ) 1304 - 1315 2023.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
Background: The aim of this study was to analyze the nationwide surgical outcome of a left trisectionectomy (LT) and to identify the perioperative risk factors associated with its morbidity. Methods: Cases of LT for hepato-biliary malignancies registered at the Japanese National Clinical Database between 2013 and 2019 were retrospectively reviewed. Statistical analyses were performed to identify the perioperative risk factors associated with a morbidity of Clavien–Dindo classification (CD) ≥III. Results: Left trisectionectomy was performed on 473 and 238 cases of biliary and nonbiliary cancers, respectively. Morbidity of CD ≥III and V occurred in 45% and 5% of cases with biliary cancer, respectively, compared with 26% and 2% of cases with nonbiliary cancer, respectively. In multivariable analyses, biliary cancer was significantly associated with a morbidity of CD ≥III (odds ratio, 1.87; p =.018). In subgroup analyses for biliary cancer, classification of American Society of Anesthesiologists physical status (ASA-PS) 2, portal vein resection (PVR), and intraoperative blood loss ≥30 mL/kg were significantly associated with a morbidity of CD ≥III. Conclusions: Biliary cancer induces severe morbidity after LT. The ASA-PS classification, PVR, and intraoperative blood loss indicate severe morbidity after LT for biliary cancer.
DOI： 10.1002/jhbp.1358
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Measuring intraoperative anesthetic parameters during hepatectomy with inferior vena cava clamping Reviewed
Nanashima A., Hiyoshi M., Imamura N., Hamada T., Tsuchimochi Y., Shimizu I., Ota Y., Furukawa K., Tsuneyoshi I.
Langenbeck's Archives of Surgery 408 ( 1 ) 455 2023.12
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Langenbeck's Archives of Surgery
Purpose: Uncontrollable bleeding remained problematic in anatomical hepatectomy exposing hepatic veins. Based on the inferior vena cava (IVC) anatomy, we attempted to analyze the hemodynamic and surgical effects of the combined IVC-partial clamp (PC) accompanied with the Trendelenburg position (TP). Methods: We prospectively assessed 26 consecutive patients who underwent anatomical hepatectomies exposing HV trunks between 2020 and 2023. Patients were divided into three groups: use of IVC-PC (group 1), no use of IVC-PC (group 2), and use of IVC-PC accompanied with TP (group 3). In 10 of 26 patients (38%), hepatic venous pressure was examined using transhepatic catheter insertion. Results: IVC-PC was performed in 15 patients (58%). Operating time and procedures did not significantly differ between groups. A direct hemostatic effect on hepatic veins was evaluated in 60% and 70% of patients in groups 1 and 3, respectively. Group 1 showed significantly more unstable vital status and vasopressor use (p < 0.01). Blood or fluid transfusion and urinary output were similar between groups. Group 2 had a significantly lower baseline central venous pressure (CVP), while group 3 showed a significant increase in CVP in TP. CVP under IVC-PC seemed lower than under TP; however, not significantly. Hepatic venous pressure did not significantly differ between groups. Systolic arterial blood pressure significantly decreased via IVC-PC in group 1 and to a similar extent in group 3. Heart rate significantly increased during IVC-PC (p < 0.05). Conclusion: IVC-PC combined with the TP may be an alternative procedure to control intrahepatic venous bleeding during anatomical hepatectomy exposing hepatic venous trunks.
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Successful treatment of esophageal perforation due to black esophagus (acute esophageal necrosis): a case report.
Ochiai T, Takeno S, Kawano F, Tashiro K, Nanashima A, Tsuzuki R, Doi K
General thoracic and cardiovascular surgery cases 2 ( 1 ) 96 2023.11
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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.
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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)
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河野 文彰, 武野 慎祐, 田代 耕盛, 池ノ上 実, 七島 篤志
手術 76 ( 8 ) 1323 - 1328 2022.7
Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal) Publisher：金原出版
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Yano Koichi, Choijookhuu Narantsog, Ikenoue Makoto, Fidya, Fukaya Tomohiro, Sato Katsuaki, Lee Deokcheol, Taniguchi Noboru, Chosa Etsuo, Nanashima Atsushi, Hishikawa Yoshitaka
Scientific Reports 12 ( 1 ) 11962 2022.7
Language：English Publishing type：Research paper (scientific journal)
Liver regeneration is an extraordinarily complex process involving a variety of factors; however, the role of chromatin protein in hepatocyte proliferation is largely unknown. In this study, we investigated the functional role of high-mobility group box 2 (HMGB2), a chromatin protein in liver regeneration using wild-type and HMGB2-knockout (KO) mice. Liver tissues were sampled after 70% partial hepatectomy (PHx), and analyzed by immunohistochemistry, western blotting and flow cytometry using various markers of cell proliferation. In WT mice, hepatocyte proliferation was strongly correlated with the spatiotemporal expression of HMGB2; however, cell proliferation was significantly delayed in hepatocytes of HMGB2-KO mice. Quantitative PCR demonstrated that cyclin D1 and cyclin B1 mRNAs were significantly decreased in HMGB2-KO mice livers. Interestingly, hepatocyte size was significantly larger in HMGB2-KO mice at 36–72 h after PHx, and these results suggest that hepatocyte hypertrophy appeared in parallel with delayed cell proliferation. In vitro experiments demonstrated that cell proliferation was significantly decreased in HMGB2-KO cells. A significant delay in cell proliferation was also found in HMGB2-siRNA transfected cells. In summary, spatiotemporal expression of HMGB2 is important for regulation of hepatocyte proliferation and cell size during liver regeneration.
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Masuya, R., Nakame, K., Tahira, K., Kai, K., Hamada, T., Yano, K., Imamura, N., Hiyoshi, M., Nanashima, A. and Satoshi Ieiri
Asian Journal of Endoscopic Surgery 15 ( 3 ) 693 - 696 2022.7
Language：English Publishing type：Case report Publisher：Asian journal of endoscopic surgery
INTRODUCTION: In recent years, dome resection, which preserves the splenic immunological function, has been the primary technique used to treat splenic cysts. We herein report a surgical technique using a needle grasper and indocyanine green (ICG) fluorescence to perform dome resection of a huge nonparasitic splenic cyst in a pediatric patient. PATIENT AND SURGICAL TECHNIQUE: A 13-year-old girl was incidentally diagnosed with a splenic cyst during follow-up for scoliosis. Abdominal enhanced computed tomography (CT) showed a 17 × 14 × 14 cm unifocal cyst. Laparoscopic dome resection was planned. The intraoperative findings showed that the spleen was distended, but there was no apparent prominence of the thin cyst wall on the surface of the spleen. An ICG fluorescence camera overlay revealed poor coloration in the thinning area. We punctured the area and aspirated the cyst contents. We grasped the cyst wall with a percutaneous needle grasper and dissected the cyst wall with a vessel sealing system. We placed anti-adhesion agent at the dissection line to prevent recurrence. DISCUSSION: ICG fluorescence was useful for identifying the thinning area of a splenic cyst. The use of a percutaneous needle grasper facilitated the performance of dome resection of a huge splenic cyst in a pediatric patient with minimal invasiveness and an improved cosmetic outcome.
DOI： 10.1111/ases.13052
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Relationship of immunonutritional factor with changes in liver volume after portal vein embolization Reviewed
Nanashima Atsushi, Hiyoshi Masahide, Imamura Naoya, Hamada Takeomi, Kai Kengo, Tanoue Yukinori, Yano Koichi, Kitamura Eiji, Suzuki Yasuto, Tahira Kousei, Kawano Fumiya, Nagayasu Takeshi
Surgery Open Science 9 117 - 124 2022.6
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal)
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Masuya, R., Matsukubo, M., Nakame, K., Kai, K., Hamada, T., Yano, K., Imamura, N., Hiyoshi, M., Nanashima, A. and Ieiri S.
Surgery Today 82 ( 10 ) 1510 - 1513 2022.5
Language：English Publishing type：Case report Publisher：Surgery Today
We describe a laparoscopic surgical technique using indocyanine green (ICG) fluorescence to identify and preserve rare arterial branching associated with pediatric congenital biliary dilatation. Congenital biliary dilatation with pancreaticobiliary maljunction was diagnosed in a 9-year-old girl, who presented with upper abdominal pain. Abdominal enhanced computed tomography (CT) showed that the accessory right hepatic artery (aRHA) branched from the posterior superior pancreaticoduodenal artery (PSPDA) and flowed through the right aspect of the dilated common bile duct (CBD) directly into the right lobe of the liver. We performed laparoscopic dilated biliary duct resection and hepaticojejunostomy, administering ICG intravenously, at a dose of 0.6 mg/kg. The ICG fluorescence overlay mode showed an aRHA running along the right side of the dilated CBD. The aRHA was dissected from the CBD without injury. After finishing the anastomosis, the beating of the aRHA was preserved, confirming that blood flow had been maintained.
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Masuya, R., Muto, M., Nakame, K., Murakami, M., Sugita, K., Yano, K., Onishi, S., Harumatsu, T., Yamada, K., Yamada, W., Matsukubo, M., Kaji, T., Nanashima, A. and Ieiri, S.
Journal of Laparoendoscopic & Advanced Surgical Techniques 32 ( 5 ) 571 - 575 2022.5
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques
Background and Aim: The distribution of board-certified pediatric surgeons (BCPSs) in Japan is highly biased. While Prefecture M has one of the smallest numbers of BCPSs per pediatric population, neighboring Prefecture K has one of the largest numbers of BCPSs per pediatric population. We examined the effect of BCPSs population on laparoscopic surgery and postoperative management and outcomes. Materials and Methods: We compared postoperative duration to full-dose enteral nutrition, postoperative hospital stay, and complications of neurologically impaired patients who underwent laparoscopic fundoplication in two prefectures from 2006 to 2019. Results: Laparoscopic fundoplication was performed in 17 patients in Prefecture M and 63 in K. The mean operative time was 248.8 ± 79.9 minutes in Prefecture M and 260.8 ± 94.8 in K (P = .64). The median number of days to full-dose enteral nutrition was 11.5 in Prefecture M and 10 in K (P = .29). The median postoperative hospital stay was 14 days in Prefecture M and 15 days in K (P = .38). Postoperative complications occurred in 7 cases in Prefecture M and in 10 in K. The incidence was significantly higher in Prefecture M than in K (P = .041). Conclusion: Areas with insufficient numbers of BCPSs have a higher risk of complications in laparoscopic surgery than areas with sufficient numbers.
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Curative remnant total pancreatectomy for recurrent pancreatic acinar cell carcinoma: A case report Reviewed
Hiyoshi Masahide, Kai Kengo, Hamada Takeomi, Nanashima Atsushi, Yano Koichi
International Journal of Surgery Case Reports 94 107091 - 107091 2022.5
Authorship：Last author, Corresponding author Language：English Publishing type：Case report
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弓部置換術後の大動脈食道瘻に対し，分割的に食道切除術 と再建，大網充填術を施行し救命した1例 Reviewed
内勢由佳子，田代耕盛，宗像 駿，北村英嗣，濵田朗子，河野文彰，武野慎祐，森 晃佑，阪口修平，石井廣人，古川貢之，七島篤志
Japanese Journal of Acute Care Surgery 12 ( 1 ) 95 - 99 2022.4
Authorship：Last author Language：Japanese Publishing type：Case report
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Asada T., Nakahata S., Fauzi Y.R., Ichikawa T., Inoue K., Shibata N., Fujii Y., Imamura N., Hiyoshi M., Nanashima A., Morishita K.
Anticancer Research 42 ( 4 ) 1763 - 1775 2022.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Pancreatic ductal adenocarcinoma (PDAC) is one of the most common cancers worldwide, with a poor prognosis. Owing to the difficulty of early diagnosis, the aim of this study was to isolate biomarkers from extracellular vesicles (EVs) that can lead to early diagnosis. Materials and Methods: EVs in the culture supernatant were isolated from a pancreatic cancer cell line (PK-1) and expanded by using two-dimensional gel electrophoresis, and protein identification from each spot was performed by using matrix-assisted laser desorption ionization mass spectrometry. The identified proteins were classified and compared with previously reported results for EVs from murine pancreatic cancer PAN02 cells, and their expression specificity was examined using PDAC cell lines and patient-derived PDAC tissues. In addition, the significance of selected biomarker(s) was examined based on the changes in biomarkers in the blood EVs of PDAC patients after surgery. Results: We found that the ITGA6A splice variant was predominantly expressed in several pancreatic cancer cell lines and blood EVs from patients with PDAC, whereas the ITGA6B splice variant was predominantly expressed in EVs from the blood of normal volunteers. In the expression pattern of ITGA6 in EVs from blood samples of two PDAC patients before and after resection surgery, the expression of ITGA6A in EVs significantly decreased after surgery and increased several months before clinical recurrence. Furthermore, the increased expression of ITGA6A in EVs occurred much earlier than that of CA19-9. Conclusion: Determination of ITGA6A expression in blood EVs in PDAC patients could be a useful blood marker for the early diagnosis of PDAC recurrence.
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Biliary atresia: graft-versus-host disease with maternal microchimerism as an etiopathogenesis Reviewed
Masuya R., Muraji T., Harumatsu T., Muto M., Nakame K., Nanashima A., Ieiri S.
Transfusion and Apheresis Science 61 ( 2 ) 103410 2022.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Transfusion and Apheresis Science
Biliary atresia (BA) is an inflammatory disease of the biliary system in newborns and infants. The etiology is largely unknown. Approximately half of BA patients require liver transplantation by 20 years of age, even after surgical correction due to progressive fibrosis of the liver. Regarding the disease mechanism, there is circumstantial evidence to support the hypothesis of graft-versus-host disease because of the existence of maternal cells in the liver (maternal microchimerism, MMC), histopathological similarity of the liver and an intense maternal response to the BA patient with mixed lymphocyte culture. Immune dysregulation with decreased Treg and increased Th1 and Th17 cells are the pathogenic features of BA, which are homologous to the pathogenic features of GvHD. Further elucidation of the etiopathogenetic mechanism of BA is warranted for development of new therapeutic strategies for native liver survival.
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Asada T., Nakahata S., Fauzi Y.R., Ichikawa T., Inoue K., Shibata N., Fujii Y., Imamura N., Hiyoshi M., Nanashima A., Morishita K.
Anticancer Research 42 ( 4 ) 1763 - 1775 2022.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Pancreatic ductal adenocarcinoma (PDAC) is one of the most common cancers worldwide, with a poor prognosis. Owing to the difficulty of early diagnosis, the aim of this study was to isolate biomarkers from extracellular vesicles (EVs) that can lead to early diagnosis. Materials and Methods: EVs in the culture supernatant were isolated from a pancreatic cancer cell line (PK-1) and expanded by using two-dimensional gel electrophoresis, and protein identification from each spot was performed by using matrix-assisted laser desorption ionization mass spectrometry. The identified proteins were classified and compared with previously reported results for EVs from murine pancreatic cancer PAN02 cells, and their expression specificity was examined using PDAC cell lines and patient-derived PDAC tissues. In addition, the significance of selected biomarker(s) was examined based on the changes in biomarkers in the blood EVs of PDAC patients after surgery. Results: We found that the ITGA6A splice variant was predominantly expressed in several pancreatic cancer cell lines and blood EVs from patients with PDAC, whereas the ITGA6B splice variant was predominantly expressed in EVs from the blood of normal volunteers. In the expression pattern of ITGA6 in EVs from blood samples of two PDAC patients before and after resection surgery, the expression of ITGA6A in EVs significantly decreased after surgery and increased several months before clinical recurrence. Furthermore, the increased expression of ITGA6A in EVs occurred much earlier than that of CA19-9. Conclusion: Determination of ITGA6A expression in blood EVs in PDAC patients could be a useful blood marker for the early diagnosis of PDAC recurrence.
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Biliary atresia: graft-versus-host disease with maternal microchimerism as an etiopathogenesis Reviewed
Masuya R., Muraji T., Harumatsu T., Muto M., Nakame K., Nanashima A., Ieiri S.
Transfusion and Apheresis Science 61 ( 2 ) 103410 - 103410 2022.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Transfusion and Apheresis Science
Biliary atresia (BA) is an inflammatory disease of the biliary system in newborns and infants. The etiology is largely unknown. Approximately half of BA patients require liver transplantation by 20 years of age, even after surgical correction due to progressive fibrosis of the liver. Regarding the disease mechanism, there is circumstantial evidence to support the hypothesis of graft-versus-host disease because of the existence of maternal cells in the liver (maternal microchimerism, MMC), histopathological similarity of the liver and an intense maternal response to the BA patient with mixed lymphocyte culture. Immune dysregulation with decreased Treg and increased Th1 and Th17 cells are the pathogenic features of BA, which are homologous to the pathogenic features of GvHD. Further elucidation of the etiopathogenetic mechanism of BA is warranted for development of new therapeutic strategies for native liver survival.
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開腹手術を必要とした経肛門直腸異物の1例 Reviewed
樋口和宏，末田秀人，佐野浩一郎，真方寿人，市来伸彦，七島篤志
宮崎県医師会医学会誌 46 ( 1 ) 42 - 45 2022.3
Authorship：Last author Language：Japanese Publishing type：Case report
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術後1年および5年無再発生存中の大腸MiNENの2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
日本臨床外科学会雑誌 83 ( 3 ) 542 - 549 2022.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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Kawano F., Munakata S., Tashiro K., Ikenoue M., Furukawa K., Ochiai H., Nakamura K., Nanashima A.
Turkish Journal of Surgery 38 ( 1 ) 74 - 80 2022.3
Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：Turkish Journal of Surgery
Objective: To improve knowledge about blast injury for medical student doctors or surgeons. In the modern uncertain era, education and training programs for blast injuries for medical student doctors or surgeons are recently necessary worldwide. Material and Methods: To understand primary corresponding ability to treat blast injuries, leading to improvement of the trauma education curriculum, a retrospective study by a knowledge survey was performed between 2018 and 2019. The subject had the title of Student Doctor (SD) at university. Results: The answers of 183 participants who answered the interview questionnaire with 16 questions were summarized. Although most SDs received basic lectures for trauma medicine and majority of SDs knew about mass casualty incidents and primary treatment, the existence of knowledge on soft targets is limited. One-fourth of the SDs knew the characteristics of blast wounds. Most SDs understood priority triage for a conscious person with massive bleeding from a limb with hemostasis to save lives. The 17% selected cardiopulmonary resuscitation first and 72% of SDs could explain hemorrhagic shock; however, only four could explain adequate hemostatic procedures. Most had no interest regarding necessity of their knowledge in the field of serious blast trauma wounds. Conclusion: Experience in trauma surgery training from stages in SDs and authorized education are important for raising students’ knowledge of unexpected serious blast incidents.
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Nanashima A.
Journal of Hepato-Biliary-Pancreatic Sciences 29 ( 3 ) e15 - e16 2022.3
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
DOI： 10.1002/jhbp.1042
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Kai K, Imamura N, Hiyoshi M, Hamada T, Uchise Y, Hatada H, Kawakami H, Mukai S, Kamoto T, Nanashima A
Asian Journal of Endoscopic Surgery 15 ( 1 ) 211 - 215 2022.1
Authorship：Last author, Corresponding author Language：English Publishing type：Case report Publisher：Asian journal of endoscopic surgery
Pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare. Surgical resection of the lesion is recommended if no residual tumor remains. Although there is no clear standard for surgical procedures, enucleation can be considered for small lesions. Lesion identification is important for enucleation, and contrast-enhanced ultrasound which takes advantage of the characteristics of hypervascular lesions was useful in a 68-year-old woman who underwent a left nephrectomy for RCC 11 years ago that was pathologically diagnosed as clear cell carcinoma. Recent computed tomography checkup showed a hypervascular tumor of 6 mm in the uncinated process and 10 mm in the pancreatic tail. Endoscopic ultrasonography-guided fine-needle aspiration was performed for the tail lesion, a diagnosis of clear cell carcinoma was made, and laparoscopic enucleation of the pancreatic tumors was performed aided by intraoperative contrast-enhanced ultrasound. The postoperative course was uneventful, and no pancreatic fistula occurred.
DOI： 10.1111/ases.12974
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An adult case of a retroperitoneal isolated enteric duplication cyst with the imaging changes over time.
Inomata M, Kai K, Ikeda T, Ichihara A, Masuda R, Kiwaki T, Tanaka H, Kataoka H, Nanashima A
Surgical case reports 7 ( 1 ) 258 2021.12
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)
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Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage Reviewed International journal
Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kai K, Nishida T, Uchise Y, Sakamoto R, Inomata M.
Annals of Hepato-Biliary-Pancreatic Surgery 25 ( 4 ) 477 - 484 2021.11
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Annals of Hepato-Biliary-Pancreatic Surgery
Backgrounds/Aims: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study. Methods: Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera’s PNI was examined as a nutritional parameter. Results: The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications (p < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/mm3. Conclusions: Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.
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悪性腫瘍との鑑別を要したS状結腸憩室炎による結腸膀胱皮膚瘻の1例 Reviewed
市来伸彦，池田拓人，市原明子，濵田朗子，河野文耶，七島篤志
日本臨床外科学会雑誌 82 ( 11 ) 2023 - 2027 2021.11
Authorship：Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Kai K.
Current Oncology 28 ( 5 ) 4067 - 4079 2021.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Current Oncology
The therapeutic and diagnostic modalities of light are well known, and derivative photodynamic reactions with photosensitizers (PSs), specific wavelengths of light exposure and the existence of tissue oxygen have been developed since the 20th century. Photodynamic therapy (PDT) is an effective local treatment for cancer-specific laser ablation in malignancies of some organs, including the bile duct. Although curability for extrahepatic cholangiocarcinoma is expected with surgery alone, patients with unresectable or remnant biliary cancer need other effective palliative therapies, including PDT. The effectiveness of PDT for cholangiocarcinoma has been reported experimentally or clinically, but it is not the standard option now due to problems with accompanied photosensitivity, limited access routes of irradiation, tumor hypoxia, etc. Novel derivative treatments such as pho-toimmunotherapy have not been applied in the field hepatobiliary system. Photodynamic diagnosis (PDD) has been more widely applied in the clinical diagnoses of liver malignancies or liver vascularization. At present, 5-aminolevulinic acid (ALA) and indocyanine green (ICG) dyes are mainly used as PSs in PDD, and ICG has been applied for detecting liver malignancies or vascularization. However, no ideal tools for combining both PDD and PDT for solid tumors, including hepatobiliary malignancies, have been clinically developed. To proceed with experimental and clinical trials, it is necessary to clarify the effective photosensitive drugs that are feasible for photochemical diagnosis and local treatment.
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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.
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Mai Nguyen Nhat Huynh, Yamaguchi Yuya, Choijookhuu Narantsog, Matsumoto Jin, Nanashima Atsushi, Takagi Hideaki, Sato Katsuaki, Tuan Le Quoc, Hishikawa Yoshitaka
ACTA HISTOCHEMICA ET CYTOCHEMICA 53 ( 4 ) 61 - 72 2020.9
Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOCIETY OF HISTOCHEMISTRY AND CYTOCHEMISTRY
Photodynamic therapy (PDT) uses photosensitizer activation by light of a specific wavelength, and is a promising treatment for various cancers; however, the detailed mechanism of PDT remains unclear. Therefore, we investigated the anticancer effect of PDT using a novel phosphorus tetraphenylporphyrin (Ptpp) in combination with light emitting diodes (Ptpp-PDT) in the NOZ human biliary cancer cell line. Cell viability and apoptosis were examined by MTT assay, flow cytometry and TUNEL assay for 24 hr after Ptpp-PDT. MitoTracker and JC-1 were used as markers of mitochondrial localization and membrane potential. The levels of mitochondrial oxidative phosphorylation (OXPHOS) complexes, Bcl-2 family proteins, cytochrome c and cleaved caspase-3 were examined by western blotting and immunohistochemistry. The results revealed that Ptpp localized to mitochondria, and that Ptpp-PDT efficiently decreased cell viability in a dose- and time-dependent manner. JC-1 and OXPHOS complexes decreased, but apoptotic cells increased from 6 to 24 hr after Ptpp-PDT. A decrease in Bcl-xL and increases in Bax, cytochrome c and cleaved caspase-3 were also found from 6 to 24 hr after Ptpp-PDT. Based on these results, we conclude that Ptpp-PDT induces anticancer effects via the mitochondrial apoptotic pathway by altering the Bax/Bcl-xL ratio, and could be an effective treatment for human biliary cancer.
DOI： 10.1267/ahc.20-00002
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Kubota K., Jang J.Y., Nakanuma Y., Jang K.T., Haruyama Y., Fukushima N., Furukawa T., Hong S.M., Sakuraoka Y., Kim H., Matsumoto T., Lee K.B., Zen Y., Kim J., Miyazaki M., Choi D.W., Heo J.S., Endo I., Hwang S., Nakamura M., Han H.S., Uemoto S., Park S.J., Hong E.K., Nanashima A., Kim D.S., Kim J.Y., Ohta T., Kang K.J., Fukumoto T., Nah Y.W., Seo H.I., Inui K., Yoon D.S., Unno M.
Journal of Hepato-Biliary-Pancreatic Sciences 27 ( 9 ) 581 - 597 2020.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
© 2020 Japanese Society of Hepato-Biliary-Pancreatic Surgery Background: The prevalent location and incidence of intraductal papillary neoplasm of the bile duct (IPNB) and invasive carcinoma associated with them have varied markedly among studies due to differences in diagnostic criteria and tumor location. Methods: IPNBs were classified into two types: Type 1 IPNB, being histologically similar to intraductal papillary mucinous neoplasm of the pancreas, and Type 2 IPNB, having a more complex histological architecture with irregular papillary branching or foci of solid-tubular components. Medical data were evaluated. Results: Among 694 IPNB patients, 520 and 174 had Type 1 and Type 2, respectively. The levels of AST, ALT, ALP, T. Bil, and CEA were significantly higher in patients with Type 2 than in those with Type 1. Type 1 IPNB was more frequently located in the intrahepatic bile duct than Type 2, whereas Type 2 was more frequently located in the distal bile duct than Type 1 IPNB (P ' 0.001). There were significant differences in 5-year cumulative survival rates (75.2% vs 50.9%; P ' 0.0001) and 5-year cumulative disease-free survival rates (64.1% vs 35.3%; P ' 0.0001) between the two groups. Conclusion: Type 1 and Type 2 IPNBs differ in their clinicopathological features and prognosis. This classification may help to further understand IPNB.
DOI： 10.1002/jhbp.785
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総合外科学講座の利点を最大限に活用した局所進行食道癌および下咽頭癌の重複癌に対する拡大サルベージ手術 Reviewed
武野慎祐，七島篤志，前田 亮，石井廣人，古川貢之，中村都英
手術 70 ( 10 ) 1499 - 1504 2020.9
Language：Japanese Publishing type：Research paper (scientific journal)
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急性虫垂炎を契機に発見された石灰化を伴う14歳男児の結腸印環細胞癌の1例 Reviewed
長友謙三，池田拓人，甲斐健吾，甲斐真弘，田中俊一，七島篤志
日本臨床外科学会雑誌 81 ( 9 ) 1838 - 1848 2020.9
Authorship：Last author, Corresponding 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 ) 20-0064 - 6 2020.8
Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：Endocrinology, Diabetes and Metabolism Case Reports
© 2020 The authors. 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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Hamada T., Yano K., Wada T., Imamura N., Hiyoshi M., Kondo K., Nanashima A.
World Journal of Surgery 44 ( 8 ) 2770 - 2776 2020.8
Language：English Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
© 2020, Société Internationale de Chirurgie. Background: The role of adjuvant hepatic intra-arterial infusion chemotherapy (HAI) is considered to be a promising option. Methods: We examined treatment effects of adjuvant HAI using cisplatin in 37 hepatocellular carcinoma (HCC) patients with portal vein infiltration (PVI) who underwent hepatectomy in comparison with those in 85 patients who did not. Results: PVI in 89 patients. Increased levels of aspartate transaminase, tumor markers, size and microvessel tumor infiltration (MVI) or cirrhosis, poorly differentiation, non-adjuvant HAI was associated with lower overall survival (p = 0.09). Poor differentiation, MVI and HAI were independently risk factors associated with tumor-free and overall survivals by the multivariate analysis (p < 0.05). Adjuvant HAI tended to show longer survivals in comparison with no-HAI (p = 0.08) and the multivariate analysis revealed significant efficacy of HAI for better prognosis. Conclusion: Adjuvant HAI showed effectiveness on prolonging tumor-free and patient survival in HCC with PVI and is a promising option in the daily clinical practice.
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Kai K., Hidaka H., Nakamura T., Ueda Y., Marutsuka K., Ikeda T., Nanashima A.
Clinical Journal of Gastroenterology 13 ( 4 ) 538 - 544 2020.8
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2019, The Author(s). An 86-year-old woman’s stool sample was positive for blood. Computed tomography (CT) showed wall thickening of the ascending colon at the hepatic flexure. Colonoscopy showed near-complete obturation by colon cancer. Since she was asymptomatic, elective surgery was planned. Laparoscopic right hemicolectomy was performed. Histopathological examination showed poorly differentiated carcinoma cells proliferating in a solid pattern with marked lymphocyte infiltration. The diagnosis was lymphoepithelioma-like carcinoma (LELC) associated with Epstein-Barr virus (EBV) infection; however, EBV-encoded small RNA–in situ hybridization was negative. Microsatellite instability was not assessed. The postoperative course was uneventful and she was discharged on the 15th postoperative day. She remains recurrence-free at 2 years after surgery. Past reports note that colorectal carcinomas with dense lymphoid stroma may be related to LELC or medullary carcinoma (MC). Gastrointestinal LELC is rare, with some reports on LELC of the esophagus and stomach. Reports on LELC of the large intestine are very rare. MC of the large intestine is relatively new concept, firstly described in the WHO Classification of Tumours of the Digestive System 3rd Edition in 2000. We herein present a case of lymphoepithelioma-like carcinoma of the ascending colon and relevant case reports about LELC and MC of the large intestine.
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Hamada Takeomi, Ishizaki Hidenobu, Haruyama Yukihiro, Hamada Roko, Yano Koichi, Kondo Kazuhiro, Kataoka Hiroaki, Nanashima Atsushi
The Tohoku Journal of Experimental Medicine 251 ( 4 ) 303 - 311 2020.8
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Tohoku University Medical Press
Colorectal cancer is the fourth most common malignancy across the world, and over 50% of patients had colorectal liver metastases (CLM). Activated neutrophils and tumor-infiltrating lymphocytes (TILs) are considered to interrupt progression of primary colorectal cancer; however, immunological host reactions to CLM have not been fully elucidated. We thus aimed to explore the prognostic implication of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and TILs in resected metastatic cancer tissues of 29 patients with CLM who underwent hepatectomy. To evaluate local immunological responses in CLM, we examined the infiltration of CD66b+ neutrophils and TILs, such as CD8+ T cells, CD45RO+ T cells, and forkhead box P3+ (FOXP3+) T cells. The presence of fewer than 4 tumors (p = 0.0005), the absence of distant metastasis (p = 0.018), adjuvant anti-cancer chemotherapy (p = 0.0013), and elevated NLR over 4.1 (p = 0.026) were found to be significant parameters related to longer survival after hepatectomy. Further, high numbers of infiltrated CD45RO+ T cells in CLM were significantly associated with longer patient survival (p = 0.020). The numbers of CD45RO+ T cells were correlated with those of CD8+ T cells (p = 0.008). The numbers of peripheral blood neutrophils were negatively correlated with those of CD45RO+ T cells (p = 0.038) and of CD66b+ neutrophils (p = 0.008) in CLM. The present data indicate that elevated peripheral blood NLR and high numbers of intratumoral CD45RO+ T cells are predictive of longer CLM patient survival after hepatectomy among current biomarkers.
DOI： 10.1620/tjem.251.303
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Utility of thoracic cage width in assessing surgical difficulty of minimally invasive esophagectomy in left lateral decubitus position Reviewed International journal
Takeno, S., Tanoue, Y., Hamada, R., Kawano, F., Tashiro, K., Wada, T., Ikenoue, M., Nanashima, A. and Nakamura, K.
Surgical Endoscopy 34 ( 8 ) 3479 - 2486 2020.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Surgical Endoscopy
Background: This study aimed to assess the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position for patients with esophageal cancer from the perspective of short-term outcomes, including operation time, blood loss, and morbidity. Materials and methods: The initial 44 consecutive patients with esophageal cancer who underwent minimally invasive esophagectomy were statistically analyzed retrospectively. Thoracic cage area was measured from preoperative computed tomography as a factor affecting the surgical difficulty of minimally invasive esophagectomy, as well as other patient characteristics. Correlations with short-term outcomes including chest operation time, blood loss, and morbidity rate were then examined. Results: In univariate analyses, smaller area of the upper thoracic cage width correlated with prolonged thoracic procedure time (p = 0.0119) and greater blood loss during thoracic procedures (p = 0.0283), but area of the lower thoracic cage showed no correlations. History of respiratory disease was associated with thoracic procedure time (p < 0.0001), but not blood loss. In multivariate analysis, small area of the upper thoracic cage was independently associated with prolonged thoracic procedure time (p = 0.0253). Small upper thoracic cage area was not directly correlated with morbidity rate, but prolonged thoracic procedure time was associated with increased blood loss (p < 0.0001) and morbidity rate (p = 0.0204). Empirical time reduction (p = 0.0065), but not blood loss, was associated with thoracic procedure time. However, area of the upper thoracic cage did not correlate with empirical case number. In multivariate analysis, area of the upper thoracic cage (p = 0.0317) and empirical case number (p = 0.0193) correlated independently with thoracic procedure time. Conclusion: A small area of the upper thoracic cage correlated significantly with prolonged thoracic procedure time and increased thoracic blood loss for minimally invasive esophagectomy in the left lateral decubitus position, suggesting the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position.
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Yamashita Y.i., Aishima S., Nakao Y., Yoshizumi T., Nagano H., Kuroki T., Takami Y., Ide T., Ohta M., Takatsuki M., Nanashima A., Ishii F., Kitahara K., Iino S., Beppu T., Baba H., Eguchi S.
Hepatology Research 50 ( 7 ) 863 - 870 2020.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Hepatology Research
© 2020 The Japan Society of Hepatology Aim: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a very rare subtype of primary liver carcinoma; therefore, its clinicopathological characteristics have not yet been elucidated in detail. The aim of the study was to reveal the clinicopathological characteristics and prognostic factors of cHCC-CCA after hepatic resection (HR). Methods: A total of 124 patients who underwent curative HR for cHCC-CCA between 2000 and 2016 were enrolled in this multi-institutional study conducted by the Kyushu Study Group of Liver Surgery. Clinicopathological analysis was performed from the viewpoint of patient prognosis. Results: A total of 62 patients (50%) had early recurrence within 1.5 years after HR, including 36 patients (58%) with extrahepatic recurrence. In contrast, just four patients (3%) had late recurrence occurring >3 years after HR. The independent predictors of early recurrence were as follows: des-gamma carboxyprothrombin >40 mAU/mL (odds ratio 26.2, P = 0.0117), carbohydrate antigen 19–9>37 IU/l (odds ratio 18.0, P = 0.0200), and poorly differentiated HCC or CCA (odds ratio 11.2, P = 0.0259). Conclusions: Half of the patients with cHCC-CCA had early recurrence after HR. Preoperative elevation of des-gamma carboxyprothrombin or carbohydrate antigen 19–9 and the existence of poorly differentiated components of HCC or CCA in resected specimens are predictors of its early recurrence.
DOI： 10.1111/hepr.13507
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腹腔鏡下修復術を行った左傍十二指腸ヘルニアの1治療経験：術後炎症性浮腫に伴う腸管通過障害に対してステロイド治療が奏効した1例 Reviewed
中尾大伸，河野文彰，田代耕盛，武野慎祐，池田拓人，中村都英，峯 一彦，七島篤志
日本腹部救急医学会雑誌 40 ( 7 ) 905 - 908 2020.7
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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直腸憩室炎による膀胱瘻に対する腹腔鏡下根治術の1例 Reviewed
濵田朗子，池田拓人，西田卓弘，河野文彰，武野慎祐，七島篤志
日本内視鏡外科学会雑誌 25 ( 3 ) 157 - 162 2020.5
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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AirSeal was useful in laparoscopic surgery for perforated appendicitis during pregnancy Reviewed
9. Kai, K., Ikeda, T., Ichihara, A., Hamada, R., Nagatomo, K., Matsuzawa, S., Ushijima, J., Sameshima, H. and Nanashima, A.
Case Reports from Society of Laparoendoscopic Surgeons e2020.00008 2020.5
Authorship：Last author Language：English Publishing type：Research paper (scientific journal)
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Nanashima A, Imamura N, Hiyoshi M, Hamada T, Yano K, Wada T, Kawakami H, Ban T, Kubota Y, Sato Y, Harada K.
Clinical Journal of Gastroenterology 13 ( 2 ) 233 - 239 2020.4
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy; however, since there are disparities in its histological diagnosis, the operative strategy for typical IPNB has not yet been established. A 69-year-old male was diagnosed with a bile duct mass lesion at the confluence of the cystic duct by ultrasonography without clinical symptoms. Liver functional parameters and tumor markers were within normal ranges. Computed tomography showed an enhanced tumor with no findings of ductal invasion or node metastasis. The tumor was exposed in the hepatic duct lumen and biopsy via SpyGlass DS cholangiography revealed that it was a low-grade papillary lesion, indicating type 1 IPNB. Under preoperative diagnostic modalities, limited resection of the extrahepatic bile duct with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis was type 1 IPNB without node metastasis. The postoperative course was uneventful and a good prognosis is expected at this stage. In the field of biliary surgery, although extended resection is generally performed for bile duct carcinomas, satisfactory limited surgical resection is possible for type 1 IPNB with lower malignant behavior.
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Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Nishimuta M., Shimizu I., Mizutani Y.
Nuclear Medicine Communications 41 ( 4 ) 320 - 326 2020.4
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Nuclear Medicine Communications
© 2020 Wolters Kluwer Health, Inc. All rights reserved. Background The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy. Methods We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction. Results The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications. Conclusion The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.
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Uchihara,T., Yoshida, N., Baba, Y., Nakashima, Y., Kimura, Y., Saeki, H., Takeno, S., Sadanaga, N., Ikebe, M., Morita, M., Toh, Y., Nanashima, A., Maehara, Y., and Baba, H.
World Journal of Surgery 44 ( 3 ) 831 - 837 2020.3
Language：English Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
Background: Anatomical esophageal position may affect the short-term outcomes after minimally invasive esophagectomy (MIE). A previous single-institutional retrospective study suggested that the presence of a left-sided esophagus (LSE) made MIE more difficult and increased the incidence of postoperative complications. Methods: The current study was a multicenter retrospective study of 303 patients with esophageal cancer who underwent MIE at six esophageal cancer high-volume centers in Kyushu, Japan, between April 2011 and August 2016. The patients were divided into the LSE (66 patients) and non-LSE groups (237 patients) based on the esophageal position on computed tomography images obtained with the patients in the supine position. Results: Univariate analysis showed that patients with LSE were significantly older than those with non-LSE (69 ± 8 vs. 65 ± 9 years; P = 0.002), had a significantly greater incidence of cardiovascular comorbidity (65.2% vs. 47.7%; P = 0.013), and a significantly longer operating time (612 ± 112 vs. 579 ± 102 min; P = 0.025). Logistic regression analysis verified that LSE was an independent risk factor for the incidence of pneumonia (odds ratio 3.3, 95% confidence interval 1.254–8.695; P = 0.016). Conclusions: The presence of a LSE can increase the procedural difficulty of MIE and the incidence of morbidity after MIE. Thus, careful attention must be paid to anatomical esophageal position before performing MIE.
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陰圧式一時閉腹デバイス(ABTHERA)の使用経験 Reviewed
宗像 駿，河野文彰，池ノ上実，田代耕盛，森定 淳，金丸勝弘，武野慎祐，中村都英，落合秀信，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 11 - 15 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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神経線維腫症I型に合併した出血性十二指腸GISTの1手術例 Reviewed
奥野佑介，児嶋一司，金丸吉昌，西田卓弘，河野文彰，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 6 - 10 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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活動性出血を来した十二指腸異所性膵の1切除例 Reviewed
長友謙三，甲斐真弘，和田 敬，甲斐健吾，旭吉雅秀，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 20 - 24 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Case report
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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)
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Takeno S., Tanoue Y., Hamada R., Kawano F., Tashiro K., Wada T., Nanashima A.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 25 ( 2 ) 82 - 86 2019.4
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
Approximately half of the patients with esophageal cancer are diagnosed at an advanced stage with inoperable disease. The technique of bypass surgery, which is one of the palliative procedures for esophageal cancer, usually requires the insertion of a drainage tube for clearing secretions from the blind remnant esophagus. Since the artificial drainage tube is sometimes problematic for the patient after discharge from the hospital, drainage tubeless (DRESS) surgery might be preferable. The authors demonstrated the utility of DRESS bypass surgery by adding esophagostomy in the right supraclavicular region in three patients with unresectable esophageal cancer with and without esophago-respiratory fistula. All patients had been able to take per-orally and discharged the hospital. Two of three patients are alive with per-oral intake at 1 year later. This DRESS bypass surgery technique, which has not hardly reported in the literature, could release the patients from the tube trouble after the discharge from the hospital and give the patients the better quality of life.
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Kurahara H., Shinchi H., Ohtsuka T., Miyasaka Y., Matsunaga T., Noshiro H., Adachi T., Eguchi S., Imamura N., Nanashima A., Sakamoto K., Nagano H., Ohta M., Inomata M., Chikamoto A., Baba H., Watanabe Y., Nishihara K., Yasunaga M., Okuda K., Natsugoe S., Nakamura M.
Langenbeck's Archives of Surgery 404 ( 2 ) 167 - 174 2019.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Langenbeck's Archives of Surgery
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.
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術前診断し単孔式腹腔鏡下胆嚢摘出術を施行しえた小児胆嚢捻転症の1例 Reviewed
6. 甲斐健吾，内山周一郎，髙屋 剛，佐野浩一郎，末田秀人，七島篤志
宮崎県医師会医学会誌 43 ( 1 ) 25 - 28 2019.3
Authorship：Last author Language：Japanese Publishing type：Research paper (scientific journal)
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上腸間膜動脈塞栓症術後に発症した虚血性小腸炎に対し，小腸造影検査と術中内視鏡検査が有用だった1例
池ノ上実，田代耕盛，河野文彰，武野慎祐，中村都英，七島篤志
日本腹部救急医学会雑誌 39 ( 3 ) 515 - 518 2019.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
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Motoi F., Satoi S., Honda G., Wada K., Shinchi H., Matsumoto I., Sho M., Tsuchida A., Unno M., Kurata M., Yanagimoto H., Toyama H., Nagakawa Y., Maemura K., Mataki Y., Akahori T., Kinoshita S., Terashima H., Horiguchi A., Ohtsuka Y., Nanashima A., Kanemitsu K., Ohigashi H., Tani M., Takahara T., Shiomi H., Endo I., Suzuki H., Rikiyama T., Ikoma H., Yasunaga M., Nakamura K., Egawa S., Katayose Y., Nakagawa K., Okada K., Ottomo S.
Journal of Gastroenterology 54 ( 2 ) 194 - 203 2019.2
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
© 2018, Japanese Society of Gastroenterology. Background: Neoadjuvant chemotherapy (NAC) represents a promising alternative to pancreatic ductal adenocarcinoma (PDAC) planned resection, but the survival impact remains undefined. To assess the feasibility and survival outcomes of NAC with gemcitabine and S1 (GS) for PDAC planned resection by prospective study. Methods: Patients with resectable or borderline resectable PDAC received 2 cycles of NAC-GS and were offered curative resection followed by gemcitabine adjuvant. The primary endpoint was 2-year overall survival (OS). Adverse events during NAC, radiological and tumor marker responses, resection rate, and surgical safety were evaluated as secondary endpoints (UMIN000004148). Results: We enrolled 104 patients between 2010 and 2012, with 101 patients treated using NAC-GS as the full analysis set (FAS). Of the 101 patients, 88% received the planned 2 cycles of NAC. Grade 3 neutropenia was common (35%). Radiological partial response and decreased carbohydrate antigen 19-9 concentration (> 50% decrease) were noted in 13% and 41%, respectively. R0/1 resections with M0 were performed in 65 patients without surgical mortality. Of the 65 patients, 44 received planned gemcitabine adjuvant for 6 months as the on-protocol cohort. The primary endpoint for the 2-year OS rate was 55.9% in the FAS (n = 101) and 74.6% in the on-protocol cohort (n = 44). Conclusions: NAC-GS was feasible and actively prolonged survival following PDAC planned resection. Randomized control trials are needed to further clarify the survival benefit of NAC-GS in addition to surgery followed by adjuvant therapy.
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Yukinori Tanoue, Atsushi Nanashima, Koichi Yano, Yoshirou Fujii, Masahide Hiyoshi, Naoya Imamura, Takeomi Hamada, Makoto Ikenoue, Takashi Wada, Yoichi Mizutani, Toshinori Hirai.
Nuclear Medicine Communications 40 ( 2 ) 145 - 152 2019.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Nuclear Medicine Communications
© 2018 Wolters Kluwer Health, Inc. All rights reserved. Background The relationship between posthepatectomy complications and liver functional parameters was preliminary reported in a pilot study. The present study sequentially evaluated the clinical significance of maximal removal rate of technetium- 99m -galactosyl human serum albumin (GSAR max ) in the future remnant liver (rGSAR max ) in patients to predict posthepatectomy complications. Methods Between 2010 and August 2017, GSAR max , rGSAR max , their difference (Dif), and the rGSAR max to GSAR max ratio were examined in 247 additional patients who underwent hepatectomy for liver and biliary diseases. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 73 (29.6%) patients. Results The median and mean preoperative GSAR max values were 0.477 and 0.498±0.166 mg/min, respectively; rGSAR max values were 0.341 and 0.366±0.145 mg/min, respectively; Dif values were 0.105 and 0.132±0.111 mg/min, respectively; and the rGSAR max to GSAR max ratio values were 0.774 and 0.746±0.177, respectively. Among these, the GSAR max and rGSAR max values were significantly correlated with the liver functional parameters ICGR15, LHL15, HH15, prothrombin activity, serum hyaluronic acid level, and platelet count (all P<0.01). The rGSAR max values were significantly lower in patients with long-term ascites (P<0.05), and the predictive cutoff values of rGSAR max were 0.290 mg/min; however, the multivariate logistic regression analysis showed that rGSAR max was not independently related to long-term ascites. Conclusion When accompanied by other functional liver reserve parameters, rGSAR max seemed to be an alternative liver functional parameter related to ascites.
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Risk factors for hepatic insufficiency after major hepatectomy in non-cirrhotic patients. Reviewed
Fujii Y, Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T
Asian journal of surgery 42 ( 1 ) 251 - 255 2019.1
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)
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Higuchi K., Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Tsuchimochi Y., Wada T., Tsuchiya K., Kawano F., Ikeda T., Takeno S.
Case Reports in Gastroenterology 13 ( 1 ) 140 - 143 2019
Language：English Publishing type：Research paper (scientific journal) Publisher：Case Reports in Gastroenterology
© 2019 The Author(s). Published by S. Karger AG, Basel. The indocyanine green test is a reliable liver function examination before major hepatectomy, and anaphylaxis is rarely a concern. A 65-year-old male patient without epigastralgia was diagnosed with a 2.2-cm intrahepatic cholangiocarcinoma. He had no history of allergic reactions. Some liver dysfunction was indicated by the laboratory data; however, there was no marked obstructive jaundice and the liver functional reserve was maintained by technetium-99m galactosyl serum albumin. The indocyanine green test was routinely performed, but the patient immediately demonstrated severe anaphylaxis due to indocyanine green administration. He had cardiorespiratory arrest, but recovered after immediate resuscitation. Although acute renal and respiratory failure was significant, the patient recovered at day 10 after the event, and his liver function and other organ functions were improved. Then, the scheduled left hepatectomy with caudate and extrahepatic duct resection was successfully performed without issues. The patient exhibited no allergic response against the administration of antibiotics or other drugs and the postoperative course was uneventful. The patient was discharged on day 17. The tumor was diagnosed as stage III intrahepatic cholangiocarcinoma and R0 resection was accomplished. Preoperative management, including the liver functional loading test, should be carefully carried out before major hepatectomy.
DOI： 10.1159/000499181
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Aortoesophageal fistula: review of trends in the last decade Reviewed
Takeno S., Ishii H., Nanashima A., Nakamura K.
Surgery Today 50 ( 12 ) 1551 - 1559 2019
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
© 2019, Springer Nature Singapore Pte Ltd. We reviewed articles on aortoesophageal fistula (AEF) published between January, 2009 and December, 2018. Postoperative aortic disease was the most common cause of AEF, followed by primary aortic aneurysm, bone ingestion, and thoracic cancer. Thoracic endovascular aortic repair (TEVAR) was the most common initial therapy for primary aortic disease, rather than graft replacement. Secondary AEF developed between 1 and 268 months, and between 1 and 11 months after the initial therapy for aortic disease and thoracic cancer, respectively. TEVAR trended to be preferred over surgery for aortic lesions because of its minimal invasiveness and certified hemostasis. In contrast, esophagectomy was preferred for esophageal lesions to remove the infectious source. A combination of surgery for the aorta (TEVAR, graft replacement or repair) and esophagus (esophagectomy, esophageal stent or repair) was usually adopted. Each graft replacement or esophagectomy was associated with a favorable prognosis for aortic or esophageal surgery, and the combination of graft replacement and esophagectomy generally improved the prognosis remarkably. Antibiotic therapy was given to 65 patients, with 20 receiving multiple antibiotics aimed at strong effects and the type of antibiotic described as broad-spectrum in 29 patients. Meropenem, vancomycin, and fluconazole were the most popular antibiotics used to prevent graft or stent infection. In conclusion, graft replacement and esophagectomy can achieve a favorable prognosis for patients with AEF, but strong, broad-spectrum antibiotic therapy might be required to prevent sepsis after surgery.
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Hamada T., Nanashima A., Hiyoshi M., Ikenoue M., Imamura N., Yano K., Fujii Y., Kubota Y., Ban T., Kawakami H., Sato Y.
International Journal of Surgery Case Reports 42 274 - 279 2018.12
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 Introduction This is a case report on the advances in preoperative endoscopic-guided fine-needle-aspiration (FNA) diagnosis for pancreatic carcinoma to achieve a curative operation even in patients who have a history of total gastrectomy. Case presentation A 65-year-old man, who underwent total gastrectomy for gastric cancer 13 years ago, had discomfort in the left lateral abdomen. A 3-cm hypovascular mass accompanying a large distal pseudocyst in the pancreatic tail was observed on computed tomography. Endoscopic ultrasonography via elevation of the jejunal loop on esophago-jejunostomy also revealed similar lesions, and FNA for the proximal-side hypoechoic mass was successful. The cytological diagnosis with immunohistochemistry was acinar cell carcinoma of the pancreas. Distal pancreatectomy with splenectomy was successfully performed. Histology of the resected specimen also showed the acinar cell carcinoma, similar with preoperative cytology, which involved the splenic vein and had extra-pancreatic extension but no lymph node metastasis. The tumor stage was IIA by the 2009 UICC classification. He had no tumor relapse on imaging follow-up until 12 months after the operation. Discussion There have been marked technical advancements in endoscopic ultrasonography-guided diagnosis, including FNA, even in patients with prior digestive tract surgery. However, the risk of complication is still a concern. Accurate histological diagnosis is useful in the field of pancreatic surgery, especially in cases of rare or small malignant lesions. Conclusion Curative pancreatectomy was possible in a case of acinar cell carcinoma, a rare pancreatic malignancy, which was diagnosed by preoperative endoscopic FNA diagnosis via esophago-jejunostomy after previous total gastrectomy.
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A cohort study on the risk of hepatectomy and pancreatectomy after history of abdominal surgery on other organs.
Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Wada T, Nishida T, Tsuchiya K, Kawano F, Ikeda T, Takeno S
Annals of hepato-biliary-pancreatic surgery 22 ( 4 ) 344 - 349 2018.11
Language：English Publishing type：Research paper (scientific journal)
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Atsushi Nanashima, Naoya Imamura, Masahide Hiyoshi, Koichi Yano,Takeomi Hamada, Teru Chiyotanda, Hiroshi Ito.
International Journal of Surgery Case Reports 53 90 - 95 2018.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Author(s) Introduction: The present case report demonstrated the successfully radical operation (R0) for the highly advanced cholangiocarcinoma involving hilar hepatic arteries and portal vein, The careful preoperative diagnosis to define the adequate resection area and the expert operation was achieved without postoperative severe complications. Presentation of case: A 55-year-old male was admitted to our hospital with obstructive jaundice, and the perihilar cholangiocarcinoma (PC) was found. At the time of finding PC, enhanced computed tomography showed the widely extension and involved the surrounding right hepatic artery (RHA) and bilateral portal veins (PV). According to extension of PC, left trisectionectomy combined resection of RHA and PV trunk was scheduled. By supporting plastic surgeon's procedure, the scheduled R0 operation could be achieved and the patient was discharged without any severe complication but delayed intrahepatic abscess formation. After abscess drainage, he could immediately recovered and tumor relapse was not observed for a couple of months. By carefully preoperative examination, a complicated operation was successfully completed. Discussion: The major hepatectomy with arterio-portal resections and anastomosis for advanced has been challenged at the high-volume center and the improvement of survival seemed to be obtained and, however, operative risk is still remained. This operation could be achieved by the expert surgeons under precise planning or management. Conclusion: The role of HBP surgeons is to challenge aggressive surgery even for patients with highly advanced local extension of PC.
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Primary Hepatic MALT Lymphoma Difficult to Diagnose Preoperatively Reviewed
Wada Takashi, Hiyoshi Masahide, Tsuchimochi Yuki, Hamada Takeomi, Yano Koichi, Imamura Naoya, Fujii Yoshiro, Tanaka Hiroyuki, Nanashima Atsushi
The Japanese Journal of Gastroenterological Surgery 51 ( 10 ) 613 - 621 2018.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
<p>A 79-year-old man was admitted to our institution for examination of a hepatic tumor detected by US during a medical checkup. Plain CT revealed a 2.5-cm low-density area in segment 2 of the liver in which a liver tumor was detected. Contrast-enhanced CT revealed that the tumor was enhanced in the early phase and wash out in the delayed phase. Vascular penetration was observed in the tumor, and swollen lymph nodes were found surrounding the common hepatic artery (CHA). PET-CT showed abnormal accumulation of fluorodeoxyglucose in the liver tumor and lymph nodes surrounding the CHA. Cholangiolocellular carcinoma was suspected, and surgery was performed. However, the pathological findings revealed that the resected tumor was a mucosa-associated lymphoid tissue (MALT) lymphoma. Few cases of primary hepatic MALT lymphoma have been reported, and its diagnosis is too difficult to have no specific imaging features. Hepatic MALT lymphoma is considered to have a good prognosis because there are few reports of metastasis or invasion. Surgical resection is often selected, although there are some cases with recurrence after surgery, so careful postoperative follow-up is needed.</p>
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Rare case of ectopic pancreas presenting with persistent umbilical discharge. Reviewed
Nakame K, Hamada R, Suzuhigashi M, Nanashima A, Ieiri S
Pediatrics international : official journal of the Japan Pediatric Society 60 ( 9 ) 891 - 892 2018.8
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Hidaka M, Eguchi S, Okuda K, Beppu T, Shirabe K, Kondo K, Takami Y, Ohta M, Shiraishi M, Ueno S, Nanashima A, Noritomi T, Kitahara K, Fujioka H
Annals of surgery 271 ( 2 ) 339 - 346 2018.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Annals of Surgery
Objective:The aim of the present study was to evaluate the value of anatomical resection for hepatocellular carcinoma (HCC) with microportal vascular invasion (vp1) between 2000 and 2010.Background:Vascular invasion has been reported as a prognostic factor of liver resection for HCC. Anatomical resection for HCC has resulted in optimum outcomes of eradicating intrahepatic micrometastases through the portal vein, but opposite results have also been reported.Methods:A clinical chart review was performed for 546 patients with HCC with vp1. We retrospectively evaluated the recurrence-free survival (RFS) between anatomical (AR) and nonanatomical resection (NAR). The site of recurrence was also compared between these groups. The influence of AR on the overall survival (OS) and RFS rates was analyzed in patients selected by propensity score matching, and the prognostic factors were identified.Results:A total of 546 patients were enrolled, including 422 in the AR group and 124 in the NAR group. There was no difference in the 5-year OS and RFS rates between the 2 groups. Local recurrence was significantly more frequent in the NAR group than in the AR group. In a multivariate analysis, hepatitis C virus, serum protein induced by vitamin K absence II of 380 mAU/mL or more, tumor diameter of 5 cm or more, and age of 70 years or older were significant predictors of a poor RFS after liver resection. There were no significant differences in the OS or RFS between the AR and NAR groups by a propensity score-matched analysis.Conclusions:Although local recurrence around the resection site was suppressed by AR, AR for HCC with vp1 did not influence the RFS or OS rates after hepatectomy in the modern era.
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Significance of bile duct resection for advanced gallbladder cancer without biliary infiltration.
Fujii Y, Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T
American journal of surgery 2018.7
Language：English Publishing type：Research paper (scientific journal)
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Management of pancreatolithiasis: A nationwide survey in Japan Reviewed
Inui K., Masamune A., Igarashi Y., Ohara H., Tazuma S., Sugiyama M., Suzuki Y., Miyoshi H., Yamamoto S., Takeyama Y., Nakano E., Takuma K., Sakagami J., Hayashi K., Kogure A., Ito T., Mukai T., Maetani I., Nagahama M., Serikawa M., Ueki T., Furuya K., Isayama H., Moriyama I., Shigeno M., Mizukami K., Nanashima A., Oana S., Ikehata A., Watanabe N., Hirooka Y., Ogoshi K., Sasaki Y., Iwata Y., Kudo Y., Nakayama A., Nakamura M.
Pancreas 47 ( 6 ) 708 - 714 2018.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Pancreas
© 2018 Wolters Kluwer Health, Inc. Objectives The aim of this study was to assess prevailing treatment of pancreatolithiasis in Japan. Methods We surveyed clinical data from 1834 patients (1479 men and 355 women) at 125 hospitals. Results Extracorporeal shock-wave lithotripsy (ESWL) was performed alone in 103 patients (5.6%), ESWL plus an endoscopic procedure in 446 (24.3%), endoscopic treatment alone in 261 (14.2%), and surgery in 167 (9.1%). Other treatments were given to 358 (19.5%), whereas 499 (27.2%) received no treatment. Symptoms were relieved in 85.7% after ESWL, 80.8% after endoscopic treatment alone, and 92.8% after surgery. Early complication rates within 3 months after ESWL, endoscopic treatment alone, and surgery were 8%, 4.5%, and 27.1%, respectively. Late complications after ESWL, endoscopic procedures alone, and surgery were 1.7%, 2.5%, and 8.2%, respectively. Symptom relief but also early and late complications were greater after surgery than after ESWL and endoscopic treatment. Among 417 patients undergoing ESWL, 61 (14.6%) required surgery, as did 32 (16%) of 200 patients treated endoscopically. Surgery was required less frequently following initial operative treatment (11/164 patients [6.7%]). Nonsurgical initial treatments were chosen more frequently. Conclusions First-line treatment of pancreatolithiasis should be ESWL with or without endoscopy because of minimal invasiveness and fewer complications.
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Safe Resection of Renal Cell Carcinoma with Liver Invasion Using Liver Hanging Technique Supported by Preoperative Portal Vein Embolization. Reviewed
Fujii M, Kamimura T, Tsukino H, Furukoji E, Sakae T, Yano K, Imamura N, Mukai S, Nanashima A, Kamoto T
Case reports in urology 2018 5139034 2018.6
Language：English Publishing type：Research paper (scientific journal)
DOI： 10.1155/2018/5139034
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Nanashima A., Imamura N., Sumida Y., Hiyoshi M., Hamada T., Nagayasu T.
Anticancer Research 38 ( 4 ) 2343 - 2352 2018.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
© 2018 International Institute of Anticancer Research. All Rights Reserved. Background/Aim: Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy and disparity of its histological diagnosis with related diseases remains. Patients and Methods: Twenty-six cases of IPNB and 12 of papillary adenocarcinomas (PAC) at two Institutes were investigated. Results: The prevalence of biliary dilatation and mucin secretion in the group with IPNB was significantly higher compared to the group with PAC (p<0.01). IPNB was predominantly located in the proximal bile duct compared to the location of PAC (p<0.01). Mis-matching of a second histological diagnosis was observed in 27% of IPNB and 25% of PAC, respectively. The prevalence of tumor relapse was significantly higher in PAC than in IPNB (p<0.05), and the overall survival was significantly better in IPNB than in PAC (p<0.01). Conclusion: Although IPNB is currently defined under histological criteria, morphologies were various and disparity in histological diagnosis for IPNB remains problematic when the clinical strategy is contemplated.
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Kunizaki M., Hamasaki K., Wakata K., Tobinaga S., Sumida Y., Hidaka S., Yasutake T., Miyazaki T., Matsumoto K., Yamasaki T., Sawai T., Hamamoto R., Nanashima A., Nagayasu T.
Anticancer Research 38 ( 3 ) 1807 - 1813 2018.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
© 2018 International Institute of Anticancer Research. All rights reserved. Background/Aim: Identifying useful biomarkers is central to selecting optimal therapeutic strategies for esophageal squamous cell carcinoma (ESCC). Serum p53 antibody (S-p53Ab), squamous cell carcinoma antigen (SCC-Ag), and carcinoembryonic antigen (CEA) were investigated to evaluate the significance of single and combined tumor markers in determining the diagnosis and prognosis of ESCC. Materials and Methods: Serum samples were obtained preoperatively from 133 patients with histologically-confirmed ESCC, including 32 patients with stage I (24.1%). Levels of S-p53Ab were assessed by enzyme-linked immunosorbent assay, using a new version of a highly specific, quantitative kit. The cut-off value for S-p53Ab was 1.3 U/ml. Results: S-p53Ab was detected in 39.1% (52 out of 133) of patients with ESCC, including 40.0% (20 out of 50) of patients with early-stage ESCC. Positive rates for S-p53Ab, CEA, and SCC-Ag among patients with stage I ESCC (n=32) were 40.6%, 12.5%, and 31.3%, respectively. Positivity for S-p53Ab was not associated with positivity for CEA or SCC-Ag (p=0.249 and 0.747, respectively). The positive rate for diagnosis of ESCC increased from 39.1% to 65.4% when S-p53Ab was combined with SCC-Ag in this study. We found no significant correlation between the presence of S-p53Ab in ESCC and overall survival. Conversely, Cox regression analysis revealed that the International Union Against Cancer/TNM classification and systemic inflammation scorewere independent prognostic factors for ESCC in this series (hazard ratio(HR)=3.811, 95% confidence interval(CI)=1.548- 9.378, p=0.004; and HR=2.218; 95% CI=1.087-4.523, p=0.029, respectively). Kaplan–Meier analysis revealed significant differences between patients with elevated S-p53Ab and SCC-Ag and patients with elevated levels of only one or neither of these factors (p=0.009). Conclusion: The diagnostic rate with S-p53Ab was better than that with SCC-Ag and CEA in patients with early-stage ESCC. Combined detection of S-p53Ab and SCC-Ag can markedly improve diagnostic sensitivity and may permit more accurate stratification of patients with ESCC.
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Tanoue, Y., Takeno, S., Kawano, F., Tashiro, K., Hamada, R., Miyazaki, Y. and Nanashima, A.
International Journal of Surgery Case Reports 44 24 - 28 2018.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Authors Introduction: An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. Presentation of case: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. Discussion: Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. Conclusion: Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT.
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Mizutani Y, Hirai T, Nagamachi S, Nanashima A, Yano K, Kondo K, Hiyoshi M, Imamura N, Terada T.
Clinical Nuclear Medicine 43 ( 2 ) 77 - 81 2018.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Nuclear Medicine
© 2017 Wolters Kluwer Health, Inc. All rights reserved. Purpose The International Study Group of Liver Surgery (ISGLS) proposed a definition and grading system for posthepatectomy liver failure (PHLF). We evaluated the usefulness of residual liver function estimation using 99m Tc-galactosyl human serum albumin (99m Tc-GSA) for the prediction of PHLF. Methods Patients with liver tumors (n = 136) and scheduled for hepatectomy underwent 99m Tc-GSA scintigraphy. Based on their imaging data, the maximal GSA removal rate (GSA-Rmax)was calculated using multicompartment analysis. We also calculated GSA-Rmax in the predicted residual liver (GSA-RL) whose volume was determined on computed tomography (CT) scans. We compared the age, sex, 15-minute indocyanine green retention rate; albumin, bilirubin, hyaluronic acid, and type 4 collagen levels; the Child-Pugh classification; residual liver volume; residual liver percentage; GSA-Rmax; and GSA-RL in patients with and without PHLF. Univariate and multivariate logistic analyses were used for statistical assessments. Results Of 136 patients, 17 (12.5%) met the ISGLS criteria for PHLF (ISGLS-PHLF). There was a statistically significant difference in the age, albumin level, Child-Pugh classification, residual liver volume, residual liver percentage, GSA-Rmax, and GSA-RL between patients with and without PHLF. Based on multivariate analysis, GSA-RL and the residual liver volume were significant independent predictors of ISGLS-PHLF (P = 0.004 and P = 0.038, respectively). The odds ratio was 149423 for GSA-RL and 1.003 for the residual liver volume. Conclusions GSA-RL calculated using 99m Tc-GSA scintigraphy was the most useful independent predictor for ISGLS-PHLF.
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Clinical significance of the C-reactive protein-to-albumin ratio for the prognosis of patients with esophageal squamous cell carcinoma. Reviewed
Kunizaki M, Tominaga T, Wakata K, Miyazaki T, Matsumoto K, Sumida Y, Hidaka S, Yamasaki T, Yasutake T, Sawai T, Hamamoto R, Nanashima A, Nagayasu T
Molecular and clinical oncology 8 ( 2 ) 370 - 374 2018.2
Language：English Publishing type：Research paper (scientific journal)
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Jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction: A case report Reviewed
Kawano, F., Tashiro, K., Nakao, H., Fujii, Y., Ikeda, T., Takeno, S., Nakamura, K. and Nanashima, A.
International Journal of Surgery Case Reports 44 105 - 109 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Authors Introduction: Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment. Presentation of case: An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high—grade fever occurred on postoperative day 12, after which oral intake became difficult. Discussion: Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception. Conclusion: Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary.
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Nanashima A., Tominaga T., Sumida Y., Tobinaga S., Nagayasu T.
International Journal of Surgery Case Reports 46 56 - 61 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Author(s) Introduction: The indocyanine green-photodynamic eye (ICG-PDE) system is useful to detect small hypervascular liver tumors, hepatocellular carcinoma (HCC), on the liver surface. This system may be also applied to improve determining the location of metastasis or tumor thrombus (TT). We herein report three case reports. ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. Case series: The patient in case 1 exhibited advanced HCC with TT in the portal trunk. The TT in the right portal vein was clearly fluorescent by ICG-PDE and the right portal vein was adequately transected to remove TT. The patient in case 2 exhibited a large HCC in the right liver and the right adrenal gland was simultaneously swollen with enhancement. By confirming the fluorescent spot in the right adrenal gland, the metastasized lesion was completely resected. The patient in case 3 previously underwent central bi-segmentectomy, and lymph node metastasis and TT in the vena cava was observed during one-year follow-up. Although it was difficult to detect the definite margin of these lesions by the outline appearance, both lesions could be clearly observed with strong fluorescence and were completely resected. Discussion and conclusion: ICG-PDE is a useful tool for detecting the precise tumor location even in extrahepatic tumor lesions, such as metastases or tumor thrombus, which is useful for deciding which parts to resect.
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Yano K, Kondo K, Nanashima A, Fujii Y, Imamura N, Hiyoshi M, Hamada T, Tsuchimochi Y, Wada T, Mizutani Y, Hirai T.
Nuclear Medicine Communications 39 ( 1 ) 28 - 34 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Nuclear Medicine Communications
© Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved. Background Prognosis in patients with hepatocellular carcinoma (HCC) is not only influenced by tumor-related factors but also by the background liver functions. The maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-R max) of the remnant liver (rGSA-R max) is a useful candidate for predicting the liver function and clarifying the relationship between the remnant liver functional reserve and tumor-free survival in patients who have undergone hepatectomy. Patients and methods One hundred and sixty-five patients with HCC who underwent curative hepatectomy were divided into three groups of hepatitis B virus (B-HCC; n=42), hepatitis C virus (C-HCC, n=58), and non-B, non-C (NBNC-HCC, n=65). The relationship between rGSA-R max and survival was examined by univariate and multivariate analyses. Results In the C-HCC group, the albumin, or LHL15, level was significantly lower, and alanine aminotransferase, ICGR15, and the prevalence of grade B liver damage were significantly higher than other two groups (P<0.05). GSA-R max or rGSA-R max was not different between the three groups. Lower GSA-R max and rGSA-R max were only significantly associated with lower tumor-free survival in the C-HCC group by the univariate analysis (P<0.05) but not significantly by the multivariate analysis. Conclusion GSA-R max and rGSA-R max reflect the severity of liver dysfunction and furthermore, the lower rGSA-R max is useful as a complementary factor to predict the early HCC recurrence after hepatectomy.
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Nanashima A., Imamura N., Hiyoshi M., Yano K., Hamada T., Chiyotanda T., Nagatomo K., Hamada R., Ito H.
International Journal of Surgery Case Reports 53 85 - 89 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2018 The Author(s) Introduction: This case report describes a successful radical operation for a patient with extensive advanced cholangiocarcinoma who had previously undergone intra-abdominal poly-surgery for advanced gall bladder carcinoma. Careful diagnosis to define the adequate division of the right hepatic duct was performed, and the operation was completed without postoperative complications. Case presentation: A 61-year-old woman was admitted to a hospital for obstructive jaundice, and extra-hepatic cholangiocarcinoma was found. Seven years prior, she underwent poly-surgery, which included cholecystectomy, gastrectomy, and colectomy, for advanced gall bladder carcinoma. Although she did not receive adjuvant chemotherapy, she had no tumor relapse. She was recommended chemo-radiation therapy to treat the cholangiocarcinoma; however, she visited our hospital to inquire the possibility of receiving radical operation. Enhanced computed tomography showed extensive cholangiocarcinoma without distant metastases, which was confirmed by endoscopic biopsy. Since the transected bile duct was without cancer-invasion, which was confirmed by a negative biopsy result, we were able to perform radical left hepatectomy and pancreaticoduodenectomy (HPD). The patient was discharged without any complications. Careful preoperative examination allowed for a complex operation to be successfully completed. Discussion: Complex surgery for advanced hepato-biliary-pancreatic malignancies after poly-surgery is difficult and requires expertise and intensive postoperative care. Conclusion: HPB surgeons should adopt an aggressive policy to treat patients who have undergone previous major abdominal surgery.
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Imamura, N., Nanashima, A., Tsuchimochi, Y., Hamada, T., Yano, K., Hiyoshi, M., Fujii, Y. and Nakamura, K.
International Journal of Surgery Case Reports 42 20 - 23 2018.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Authors Introduction This case report aims to inform pancreatic surgeons about our perioperative management of intrahepatic portal vein thrombosis caused by an obstruction of hepaticojejunostomy (HJ) after pancreaticoduodenectomy (PD). Case presentation A 65-year-old woman was diagnosed with pancreas head carcinoma involving the superior mesenteric vein (SMV). Pancreaticoduodenectomy combined with SMV resection was followed by HJ. Twisting or narrowing was not evident during anastomosis. Total bilirubin values progressively increased to 13 mg/dL on day 5. At that time, we suspected anastomotic occlusion and found complete portal thrombosis of the left liver. Therefore, emergency re-anastomosis of the HJ was followed by thrombectomy, which was not completely successful and did not completely recover initial portal flow. Thrombolytic drugs improved obstructive jaundice, eradicated the organized thrombosis and recovered the portal flow by day 30. The post-operative course was uneventful. Discussion A thrombosis immediately formed in the portal vein due to biliary obstruction of an anastomotic site. We speculated that biliary dilation and related inflammation caused a relative increase in arterial flow and decreased portal flow at the localized part of the umbilical portion. Although early surgical thrombectomy was attempted soon after the primary operation, the organized thrombosis persisted. However, thrombolytic therapy eradicated the thrombosis. Conclusion Careful anastomosis of HJ during PD was necessary to avoid postoperative biliary stricture. This type of complication affects intrahepatic blood flow, particularly via the portal vein. Although immediate re-anastomosis or thrombectomy is applied, organized thrombosis cannot always be surgically removed.
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Tsuchimochi Yuki, Imamura Naoya, Hamada Takeomi, Yano Koichi, Hiyoshi Masahide, Ohuchida Jiro, Fujii Yoshiro, Nanashima Atsushi
The Japanese Journal of Gastroenterological Surgery 51 ( 4 ) 257 - 262 2018
Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
<p>A 51-year-old man was followed up due to hereditary hemorrhagic telangiectasia (HHT). We pointed out a polyposis lesion of the duodenum by gastroscopy. A duodenal polyp located on the opposite side of the major duodenal papilla was diagnosed as adenocarcinoma by biopsy. We also pointed out a polypotic lesion of the colon by colonoscopy. As the polypectomy for colonic polyposis was difficult to treat, we performed subtotal stomach-preserving pancreaticoduodenectomy for the duodenal cancer, and partial resection of the cecum and descending colon for the colonic polyposis. Although the hepatic artery was dilated because of HHT, we safely achieved a curative operation. Histological diagnosis revealed a well differentiated adenocarcinoma in juvenile polyposis (JP) of the duodenal lesion. Juvenile polyps were also seen in the colon. To the best of our knowledge, this is the first case undergoing pancreaticoduodenectomy for combined syndrome of juvenile polyposis and hereditary hemorrhagic telangiectasia in Japan.</p>
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Nanashima A., Sumida Y., Tominaga T., Arai J., Tobinaga S., Wakata K., Murakami G., Hidaka S., Sawai T., Nagayasu T.
Acta Medica Nagasakiensia 61 ( 3 ) 97 - 103 2018
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2018, Nagasaki University School of Medicine. All rights reserved. After pancreaticoduodenectomy (PD), pancreatic duct-to-mucosa anastomosis (PDM) has been usually applied which may prevent risk of pancreatic fistula (PF). In cases with a small pancreatic duct, however, PDM is difficult to complete. Procedures involving the invagination (IV) or complete external tube drainage (CED) are supposed to be alternative options for anastomosis. We retrospectively compared clinical results between PDM and IV or CED in 104 patients with a tiny pancreatic duct who underwent PD. The 77 patients undergoing PDM (the control group) and 27 patients undergoing other procedures, including 19 for CED and 8 for IV, were comparatively examined. Fatty pancreas was commonly observed in CED group. Pancreaticojejunostomy was significantly more frequently applied in CED group, and the operating time in the IV group was significantly longer than in control group (p<0.05). The anastomotic time in CED group tended to be shorter than those in control and IV groups (18 versus 29 and 37 min). The incidences of PF were not significantly different among groups (31% in control, 47% in CED and 14% in IV, respectively); however, a grade B or C level of PF was not observed in the IV group. PDM is often difficult to achieve and inadequate suturing may injure the pancreatic parenchyma in cases of very small pancreatic duct. Re-evaluation of the CED or IV procedure as an alternative option was suggested to be warranted.
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Matsumoto J., Suzuki K., Yasuda M., Yamaguchi Y., Hishikawa Y., Imamura N., Nanashima A.
Bioorganic & Medicinal Chemistry 25 ( 24 ) 6536 - 6541 2017.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Bioorganic and Medicinal Chemistry
© 2017 Elsevier Ltd A series of phosphorus porphyrin complexes ([(RO) 2 P(tpp)]Cl, tpp = tetraphenylporphyrinato group, R = −(CH 2 CH 2 O) m (CH 2 ) n H; 1a: m = 2, n = 2; 1b: m = 2, n = 4; 1c: m = 2, n = 6; 1d: m = 3, n = 6) were used for the photodynamic therapy (PDT) of human biliary cancer cell line (NOZ) when exposed to the irradiation of light emitting diodes (LEDs). A Dulbecco's modified Eagle's medium (DMEM) containing NOZ cells (2000 cell well −1 ) and 1 (0–100 nM) was introduced into a 96-well microplate and incubated for 24 h to accumulate 1 into the NOZ cells and to multiply the NOZ cells until the cell number reached 10 4 cells well −1 . After replacing the DMEM medium containing 1 with a fresh DMEM medium without 1, the plates were irradiated for 30 min at 610 nm. After incubation was performed for 24 h in dark conditions, the cell viability of the NOZ cells was determined using the MTT assay. The half maximum inhibitory concentrations 50 (IC 50 ) of 1a–1d were found to be in the range of 33.7–58.7 nM for NOZ. These IC 50 values for the NOZ were one hundredth the IC 50 value (7.57 μM) for mono-L-aspartyl chlorin e6 (laserphyrin®). Thus, it was found that the PDT activity of 1a–1d was much higher than the mono-L-aspartyl chlorin e6. Similarly, IC 50 vales of 1a–1d for HeLa cells were found to be 27.8–52.5 nM. This showed that 1a–1d had high photodynamic activity in cancer cells. At the same time, it was speculated that an LED is a useful light source for deactivating the cancer cells because it can excite the sensitizers with peak width in their absorption spectra using the light of the specified wave length with band width of 10–20 nm; LEDs provide a homogeneous light distribution for the target cells.
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East meets West: East and West pioneers of "anatomical right hepatectomy" - period of dawn to establishment. Invited Reviewed
Nanashima A, Ariizumi SI, Yamamoto M
Journal of hepato-biliary-pancreatic sciences 2017.12
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Hiyoshi, M., Nanashima, A., Wada, T., Tsuchimochi, Y., Hamada, T., Yano, K., Imamura, N. and Fujii, Y.
Clinical Journal of Gastroenterology 10 ( 6 ) 551 - 557 2017.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2017, Japanese Society of Gastroenterology. Pancreatic cancer patients have a poor prognosis because of a low rate of resection that results from distant metastases or local advancement. We report a successful case of unresectable locally advanced pancreatic cancer in a patient who was curatively resected after combination therapy with nab-paclitaxel (nab-PTX) and gemcitabine (GEM). A 61-year-old man was referred for treatment of a 45-mm pancreatic tail tumor involving the celiac axis, common hepatic artery, and splenic artery that appeared as an abnormal soft-density mass on imaging. This patient’s tumor was defined as unresectable due to local advancement, and, therefore, the powerful combined chemotherapy regimen of nab-PTX with GEM was initiated to allow for possible resection later. After three cycles of chemotherapy, a CT scan revealed that the soft-density mass around the celiac axis and common hepatic artery had dramatically disappeared, and the tumor was then determined to be a resectable lesion. Thus, distal pancreatectomy with en bloc celiac axis resection was performed and curability was achieved. There has been no tumor recurrence or distant metastasis at more than 12 months after surgery, and the patient remains alive at 17 months after initial chemotherapy.
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Significance of liver hanging maneuver for anatomical hepatectomy in patients with a large hepatocellular carcinoma compressing intrahepatic vasculatures. Reviewed
Nanashima A, Sumida Y, Tominaga T, Nagayasu T
Annals of hepato-biliary-pancreatic surgery 21 ( 4 ) 188 - 193 2017.11
Language：English Publishing type：Research paper (scientific journal)
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Accompanying role of hepato-biliary-pancreas surgeon in urological surgery Reviewed
Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Fujii Y., Kawano F., Ikeda T., Takeno S., Nakamura E., Nakamura K., Mukai S., Kamimura T., Kamoto T.
International Journal of Surgery Case Reports 41 215 - 218 2017.10
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s) Introduction The present case reports demonstrated the accompanying surgical support from hepato-biliary-pancreas (HBP) surgeons for urological surgery to secure operative safety because HBP surgeons are well experienced in dissecting techniques for mobilization of the liver or pancreas. We experienced 9 consecutive patients who underwent nephrectomy, adrenectomy or resection of retroperitoneal tumors by urological surgeons. Cardiovascular intervention was also required in cases of long tumor thrombus into the vena cava. Cases All patients had no severe co-existing diseases except the main tumor. Reverse T-shape incision was performed in 7 cases and thoracolaparotomy in two. Dissection and mobilization at the site of severe compression by the urinary tumors were performed in three cases. Partial liver resection was performed for testicular liver metastases in two, and right hepatectomy for right renal cancer was performed in one. Encircling the vena cava and preparation of transection for tumor thrombi were performed in three, and among these, cardiovascular intervention was necessary in two because of extension into the right atrium. During admission, all patient outcomes were uneventful without severe complications. We herein showed the representative two cases of combined surgery. Discussion and conclusion The point of this case report is the coordination between each surgeon and anesthesiologist under precise perioperative planning or management. The role of HBP surgeons is to provide information as a specialist on the operative field for urological or cardiovascular surgery to achieve operative safety.
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Ogihara K., Isomoto H., Kurumi H., Kanda T., Hashisako M., Tabata K., Ishii H., Ohnita K., Yamaguchi N., Akazawa Y., Matsushima K., Takeshima F., Kunizaki M., Hidaka S., Nanashima A., Fukuoka J., Nagayasu T., Nakao K.
Photodiagnosis and Photodynamic Therapy 19 15 - 21 2017.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Photodiagnosis and Photodynamic Therapy
© 2017 Elsevier B.V.Background 5-Aminolevulinic acid is a precursor of photosensitizing protoporphyrin IX and has been applied for photodynamic diagnosis of brain and bladder tumors with few side effects. Although most upper gastrointestinal tumors can be detected during photodynamic diagnosis, some tumors containing signet-ring cells cannot be visualized. Here, we aimed to assess whether proteins involved in the absorbance, activation, and turnover of protoporphyrin IX altered the fluorescence signal in gastric cancer. Methods Aminolevulinic acid-mediated photodynamic diagnosis was performed in 23 lesions from 20 patients using an endoscope equipped with a blue laser light that caused red fluorescence emission of photosensitizing protoporphyrin IX. Red fluorescence signal and intensity was assessed during photodynamic diagnosis procedures. Lesions were resected by endoscopic and/or laparoscopic surgery, and specimens were immunostained and assessed for the expression of ATP-binding cassette sub-family G member 2, oligopeptide transporter-1, and coproporphyrinogen oxidase. Results Photodynamic diagnosis was negative in four cases (17.4%). Three cases of photodynamic diagnosis-negative lesions were signet-ring cell carcinomas, and only one case was differentiated adenocarcinoma (intestinal type). Twenty intestinal type, photodynamic diagnosis-positive lesions showed high expression of coproporphyrinogen oxidase, whereas signet-ring cell carcinomas were all negative. Oligopeptide transporter-1 immunoreactivity was significantly higher in tumors of intestinal type. ATP-binding cassette sub-family G member 2 expression tended to be higher in luminal surface tumors than in intestinal type tumors. Conclusion Aminolevulinic acid-mediated photodynamic diagnosis provided good detection of upper gastrointestinal tumors of intestinal type but not diffuse type tumors, such as signet-ring cell carcinomas, possibly owing to coproporphyrinogen oxidase expression.
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Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy. Reviewed
Fujii, Y., Nanashima, A., Hiyoshi, M., Imamura, N., Yano, K. and Hamada, T.
Annals of gastroenterological surgery 1 ( 3 ) 226 - 231 2017.9
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Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin is correlated with liver functional parameters, but did not predict postoperative morbidity. Reviewed
Yano, K., Nanashima, A., Fujii, Y., Hiyoshi, M., Imamura, N., Hamada, T., Tsuchimochi, Y., Wada, T., Mizutani, Y. and Hirai, T.
Nuclear medicine communications 2017.8
Language：English Publishing type：Research paper (scientific journal)
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Hamada, T., Nanashima, A., Yano, K., Sumida, Y., Hiyoshi, M., Imamura, N., Tobinaga, S., Tsuchimochi, Y., Takeno, S., Fujii, Y. and Nagayasu, T.
International Journal of Surgery 45 149 - 155 2017.7
Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery
© 2017 IJS Publishing Group Ltd Background The VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. Methods Between September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. Results In limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). Conclusions Mild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.
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Kamimura T., Kida K., Takeda M., Sato S., Fujii M., Inoue M., Tsukino H., Mukai S., Nanashima A., Nakamura K., Kamoto T.
Research and Reports in Urology 9 107 - 112 2017.6
Language：English Publishing type：Research paper (scientific journal) Publisher：Research and Reports in Urology
© 2017 Kamimura et al. Clear cell renal cell carcinoma (ccRCC) shows extreme hypervascularity, which may cause significant bleeding during surgery. For this reason, control of arterial blood supply is an important factor in the choice of operative procedure and in avoiding perioperative complications. This case series reports the successful dissection of renal artery in the preliminary stage of laparoscopic procedure in three ccRCC patients with inferior vena cava (IVC) extension. Patient 1 had right renal cell carcinoma (RCC) with level I tumor thrombus through two renal veins, and the renal artery was successfully dissected by retroperitonealscopic approach. Patient 2 had right invasive, immobilized RCC with significant infiltration to IVC and liver. Ligation of renal artery was performed by transperitoneal laparoscopic procedure. Patient 3 had left RCC with level III tumor thrombus and lung metastasis. Ligation of left renal artery and mobilization of peritoneal organs and kidney were performed by transperitoneal laparoscopic surgery. These cases suggest that combined laparoscopic-open surgery for RCC with IVC extension may facilitate early control of arterial blood supply.
DOI： 10.2147/RRU.S134817
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Surgical management of recurrent intrahepatic cholangiocarcinoma: predictors, adjuvant chemotherapy, and surgical therapy for recurrence: A multi-institutional study by the Kyushu Study Group of Liver Surgery. Reviewed
Yamashita YI, Shirabe K, Beppu T, Eguchi S, Nanashima A, Ohta M, Ueno S, Kondo K, Kitahara K, Shiraishi M, Takami Y, Noritomi T, Okamoto K, Ogura Y, Baba H, Fujioka H
Annals of gastroenterological surgery 1 ( 2 ) 136 - 142 2017.6
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Salvage photodynamic therapy accompanied by extended lymphadenectomy for advanced esophageal carcinoma: A case report. Reviewed
Nishida T, Takeno S, Nakashima K, Kariya M, Inatsu H, Kitamura K, Nanashima A
International journal of surgery case reports 36 155 - 160 2017.5
Language：English Publishing type：Research paper (scientific journal)
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Significance of splenectomy for upper gastric carcinoma with invasion to the greater curvature
Nishida T., Nanashima A.
International Surgery 102 ( 5-6 ) 284 - 292 2017.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：International Surgery
© 2017 Nishida et al. This study aimed to clarify the significance of splenectomy (Sp) for upper gastric carcinoma with invasion to the greater curvature. The Japan Clinical Oncology Group (JCOG) conducted a phase III randomized clinical trial (JCOG 0110), where the significance of Sp in total gastrectomy (TG) for upper gastric carcinoma without invasion to the greater curvature was not proved because Sp did not contribute to an improved prognosis. From 1992 to 2010, 167 patients underwent TG for carcinoma of the upper stomach, except for patients with carcinoma of the residual stomach. Among them, 60 patients with tumor invasion to the greater curvature of the upper stomach (Gre group) were enrolled. Within the Gre group, the following factors were compared between the Sp group (n ¼ 30) and non-Sp group (n ¼ 30): patient background, postoperative staging, rate of neoadjuvant chemotherapy, surgical outcomes and rates of R0 resection, morbidity, adjuvant chemotherapy, and overall survival (OS). The Gre group patients were relatively younger, and tumor size and the numbers of Borrmann type 4 tumors, circumferential lesions, undifferentiated type lesions, and advanced cases were significantly larger than those in the non-Gre group. There were also significant differences in patient age and organs resected other than the spleen between the Sp group and non-Sp group. There was no significant difference in OS between the 2 groups. The significance of Sp for upper gastric carcinoma with invasion to the greater curvature was equivocal because the patients received no survival benefit by undergoing Sp.
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Tsuchiya, K., Nanashima, A., Ikeda, T., Minami, S., Nagano, M., Hamada, T., Yano, K. and Fujii, Y.
Clinical Journal of Gastroenterology 10 ( 2 ) 157 - 162 2017.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2017, Japanese Society of Gastroenterology.Colitis-associated colorectal cancer (CAC) is known to occur in long-standing and extensive ulcerative colitis (UC). Furthermore, UC is known to complicate primary sclerosing cholangitis (PSC), which subsequently results in an increased risk of developing cholangiocarcinoma. We report a case of colitis-associated rectal cancer (CARC) accompanied by intrahepatic cholangiocarcinoma (ICC) based on UC and PSC. A 73-year-old man had suffered from UC for 19 years. During surveillance colonoscopy, a tumor was found in the rectum that was pathologically diagnosed as CARC from the resected specimen. Abdominal computed tomography also revealed a localized dilation of the intrahepatic bile duct, and endoscopic retrograde cholangiography revealed a band-like stricture. This remarkable tumor lesion was not observed in the hepatic duct. Left hepatectomy was performed because of the suspicion of possible ICC at the stenosis of the hepatic duct. The presence of ICC was confirmed at the lesion causing the stricture. The pathological diagnosis from the resected specimen was ICC based on PSC. Adjuvant chemotherapy for ICC was performed for 6 months. Neither cancer has recurred for 2.5 years after hepatectomy. Patients with PSC concomitant with UC should be considered a high-risk group for CAC and ICC.
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Tokumitsu T., Sato Y., Sato Y., Yamashita A., Moriguchi-Goto S., Moriguchi-Goto S., Kondo K., Nanashima A., Asada Y.
Cytopathology 28 ( 2 ) 116 - 121 2017.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Cytopathology
© 2016 John Wiley & Sons LtdObjective: Biliary brush cytology is an important diagnostic tool in the evaluation of pancreatobiliary malignancies. However, it is difficult to distinguish between malignant and benign cells. The present study evaluated the utility of immunocytochemical expression of Claudin-18 and Maspin in brushing cytology specimens of pancreatobiliary lesions in the diagnosis of pancreatobiliary malignancies. Methods: The study retrospectively assessed biliary and pancreatic duct brushing cytology specimens of 43 patients whose pancreatobiliary lesions were histologically diagnosed at the University of Miyazaki Hospital. Scanty cellularity slides and cases with no histological confirmation were excluded. Alcohol-fixed and Papanicolaou-stained slides were immunostained with monoclonal antibodies to Claudin-18 and Maspin. Results: Of the 43 patients, 35 (81.4%) were finally histologically diagnosed with invasive adenocarcinomas. The sensitivity of routine cytology for the detection of malignancy was 63%, and the specificity was 100%. The sensitivity of cytology in combination with immunocytochemical expression of Claudin-18 (89%) or Claudin-18 and/or Maspin (97%) was significantly higher than that of cytology alone (P < 0.01). Conclusion: Immunocytochemical staining for Claudin-18 and Maspin improved the diagnostic sensitivity for pancreatobiliary adenocarcinomas.
DOI： 10.1111/cyt.12368
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Clinical Significance of Serum p53 Antibody in the Early Detection and Poor Prognosis of Gastric Cancer. Reviewed
Kunizaki M, Fukuda A, Wakata K, Tominaga T, Nonaka T, Miyazaki T, Matsumoto K, Sumida Y, Hidaka S, Yasutake T, Sawai T, Hamamoto R, Nanashima A, Nagayasu T
Anticancer research 37 ( 4 ) 1979 - 1984 2017.4
Language：English Publishing type：Research paper (scientific journal)
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Beppu T., Imai K., Okuda K., Eguchi S., Kitahara K., Taniai N., Ueno S., Shirabe K., Ohta M., Kondo K., Nanashima A., Noritomi T., Shiraishi M., Takami Y., Okamoto K., Kikuchi K., Baba H., Fujioka H.
Journal of Hepato-Biliary-Pancreatic Sciences 24 ( 3 ) 127 - 136 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
© 2017 Japanese Society of Hepato-Biliary-Pancreatic SurgeryBackground: This multi-institutional study aimed to assess the benefits of anterior approach for right hepatectomy with hanging maneuver (ARH-HM) for hepatocellular carcinoma (HCC) compared with conventional right hepatectomy (CRH). Methods: From January 2000 to December 2012, 306 patients with HCC ≥5 cm were divided into two groups: ARH-HM (n = 104) and CRH (n = 202). Results: After one-to-one propensity score-matched analysis, 72 ARH-HM and 72 CRH patients presented comparable background factors. Patients in the ARH-HM group demonstrated significantly less intraoperative blood loss (480 vs. 1,242 g, P < 0.001) and a lower frequency of red cell concentrate transfusion (21.1% vs. 50.7%, P < 0.001) compared with patients in the CRH group. The 5-year overall survival rate was significantly better in the ARH-HM group compared with the CRH group (50.2% vs. 31.4%, P = 0.021). Limited to patients with HCC ≥10 cm, recurrence-free and overall survival of the ARH-HM group was significantly greater than those of the CRH group. Conclusion: In comparison with CRH, ARH-HM for large HCC can provide better overall survival rates with a decrease in intraoperative blood loss and transfusion rates. Survival impact was evident especially in patients with HCC ≥10 cm.
DOI： 10.1002/jhbp.431
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Nanashima A., Nakashima K., Kawakami H., Ashizuka S., Kubota Y.
Photodiagnosis and Photodynamic Therapy 17 221 - 225 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Photodiagnosis and Photodynamic Therapy
© 2017 Elsevier B.V.The primary goal of nursing care in cases of endoscopic photodynamic therapy (PDT) for digestive tract carcinoma is to prevent phototoxicity by the intravenous administration of photosensitizers. The adequate protocol and management of patients should be conducted under the instruction of expert physicians. Our experiences of administering porfimer sodium and talaporfin sodium during clinical PDT provide insight regarding the specific management protocol of each photosensitizer during an in-hospital stay. We herein report our nursing protocol based on 15 years of experience. Under adequate management, PDT can be safely performed.
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Cytological findings and BCL10 expression in pancreatic acinar cell carcinoma: A Case Report Reviewed
Ohno A., Sato Y., Sato Y., Nakamura E., Nakamura E., Noguchi H., Tokumitsu T., Hiyoshi M., Nanashima A., Asada Y., Asada Y.
Diagnostic Cytopathology 45 ( 3 ) 247 - 251 2017.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Diagnostic Cytopathology
© 2016 Wiley Periodicals, Inc.BCL10 was recently demonstrated to be a biomarker for pancreatic acinar cell carcinoma, but whether altered BCL10 expression can be detected in cell block specimens is unclear. Here, we report a pancreatic acinar cell carcinoma with cytological findings that showed BCL10 expression in a cell block. A 72-year-old man presented with a pancreatic tumor and underwent endoscopic ultrasound-fine needle aspiration (EUS-FNA) with additional passes performed for cell block preparation. The EUS-FNA cytology showed loose cohesive clusters with focal acinar- or gland-like-structures and prominent nucleoli. The preoperative diagnosis was well differentiated adenocarcinoma, and he underwent a pancreaticoduodenectomy. Histological examination revealed an acinar tumor structure with tumor cells staining positive for BCL10 and trypsin. The cell block specimen also demonstrated strong and diffuse BCL10-positive staining. Based on these findings, this tumor was diagnosed as acinar cell carcinoma of the pancreas. This case demonstrates that BCL10 expression within cell blocks facilitates a differential diagnosis of acinar cell carcinoma. Diagn. Cytopathol. 2017;45:247–251. © 2016 Wiley Periodicals, Inc.
DOI： 10.1002/dc.23634
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Takeno S., Yamashita K., Noritomi T., Hoshino S., Yamauchi Y., Yamashita Y., Nanashima A.
International Surgery 102 ( 1-2 ) 58 - 63 2017.1
Language：English Publishing type：Research paper (scientific journal) Publisher：International Surgery
2017 Takeno et al.; Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P ¼ 0.043); wound classification (P ¼ 0.0005); peritonitis (P ¼ 0.019); prolonged operation time (P ¼ 0.0001); increased blood loss (P ¼ 0.019); transfusion (P ¼ 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P ¼ 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P ¼ 0.20), but it tended to be associated with a shorter hospital stay (P ¼ 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.
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A case of multiple synchronous quadruple cancers of the stomach, sigmoid colon, rectum, and pancreas Reviewed
Nanashima A., Tominaga T., Nonaka T., Wakata K., Kunizaki M., Tobinaga S., Sumida Y., Hidaka S., Kinoshita N., Sawai T., Nagayasu T.
International Journal of Surgery Case Reports 35 4 - 7 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The AuthorsIntroduction Multiple primary neoplasms are relatively rare, but their incidence has increased because of aging and improvements in diagnostic imaging. Presentation of case A 67-year-old man presented with epigastric pain. On upper gastrointestinal endoscopy, an ulcer was seen at the gastric angle, and biopsy showed moderately differentiated adenocarcinoma (AC). Colonoscopy demonstrated a 15-mm lesion in the sigmoid colon and a submucosal lesion in the lower rectum. The biopsy showed well differentiated AC and neuroendocrine tumor (NET). In addition, abdominal CT and MRI showed a 14-mm nodular lesion in the pancreatic body suggesting pancreatic duct cancer. Based on the above findings, four synchronous cancers, including the pancreas, stomach, sigmoid colon and rectum, were diagnosed, and surgery was performed. A midline incision was made in the upper abdomen, and a distal gastrectomy, pancreatic body and tail resection, and sigmoidectomy were performed. Trans-anal tumor resection was performed for the rectal lesion. Histopathology showed invasive pancreatic duct cancer, moderately differentiated AC of the stomach, moderately differentiated AC of the sigmoid colon, and NET G1 of the rectum. The patient had no postoperative complications, 4 years 3 months after resection, and he was disease-free from all of the cancers. Discussion The strategy of perioperative diagnosis and treatment for multiple primary tumors is usually difficult. This process was performed by consulting a cancer board, which could be useful as a practice guideline. Conclusion This patient in whom four tumors were completely resected at the same time and who has had a good clinical course was reported.
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Ishii M., Takeno S., Takeno S., Nishida T., Nishida T., Nanashima A., Nanashima A., Kubota Y., Kubota Y., Kawakami H., Kawakami H., Kawakami H., Umekita Y., Akiyama Y.
International Journal of Surgery Case Reports 34 49 - 55 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The AuthorsIntroduction We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature. Presentaion of case A submucosal tumor 45 mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good. Discussion The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation. Conclusion Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
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Imamura N., Nanashima A., Hiyoshi M., Fujii Y.
International Journal of Surgery Case Reports 31 132 - 138 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s)Introduction Large-cell neuroendocrine carcinoma (LCNEC) in the duodenal ampulla of Vater is a rare malignant tumor, with frequent postoperative recurrence and poor prognosis even following complete resection. Effective adjuvant chemotherapy is expected to offer longer survival. Presentation of case We present two patients with LCNEC accompanied by components of tubular adenocarcinoma/adenoma in the duodenal ampulla of Vater who underwent pancreaticoduodenectomy (PD), resulting in longer survival of 1 patient. The first patient was an 81-year-old man in whom a 14-mm protruding solid tumor of the ampulla was observed. Pylorus-preserving PD (PPPD) was performed for the diagnosis of adenocarcinoma of the ampulla, and the final histological diagnosis of the resected specimen was LCNEC with an adenoma component. The patient showed a liver metastasis 4 months after surgery and died of carcinoma after 11 months. The second patient was a 72-year-old man with a 24-mm ulcerative solid tumor of the ampulla. PPPD was also performed in this patient, and the final histological diagnosis was LCNEC with mixed adenocarcinoma component (21%). Adjuvant chemotherapy of cisplatin and etoposide was administered, and the patient survived without tumor relapse for 24 months after surgery. Conclusion In the surgical treatment of LCNEC of the ampulla showing malignant behaviour, an accurate preoperative diagnosis and effective adjuvant chemotherapy after curative resection are necessary for longer survival.
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Horizontal traumatic laceration of the pancreas head: A rare case report Reviewed
Nanashima A., Imamura N., Tsuchimochi Y., Hamada T., Yano K., Hiyoshi M., Fujii Y., Kawano F., MitsuruTamura
International Journal of Surgery Case Reports 31 119 - 123 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2017 The Author(s)Introduction This case report is intended to inform acute care surgeons about treating rare horizontal laceration of the pancreas head caused by blunt trauma. Case presentation A 57-year-old woman who sustained blunt abdominal trauma during a car crash was transported to the emergency center of our hospital with unstable vital signs due to hemorrhagic shock. Computed tomography showed transection of the pancreas head and massive intra-abdominal hemorrhage. She was referred for emergency surgery because of a transient response. Laparotomy at five hours after the accident initially revealed consistent massive bleeding from branches of the superior mesenteric artery and vein, which we resolved by suturing the vessels without damaging the main trunks. A horizontal laceration and complete transection of the pancreatic head were then confirmed but the main pancreatic duct remained intact. The lower part of the pancreatic head including the uncus with the attached part of the duodenum was resected, and the pancreatic stump remaining after transection was fixed by suturing. The jejunal limb was attached to the remnant duodenum by side-to-side functional anastomosis. Although gastric emptying was delayed for one month after surgery, the postoperative course was good and the patient recovered at three months thereafter. The embryonic border of pancreas head accompanied with pancreatic divisum was considered for this laceration without disruption of the main pancreatic duct. Discussion Blunt pancreatic trauma usually causes vertical transection and thus, horizontal transection is considered rare. The embryological anatomical border between the ventral and dorsal pancreas due to pancreatic divisum was supposed to be transected and therefore the main pancreatic duct was not damaged. Conclusion Hemorrhagic shock and rare pancreatic head trauma were treated by appropriate intraoperative management.
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Frequency of CD4+CD161+ T cell and interleukin-10 expression in inflammatory bowel diseases Reviewed
Tsuchiya K., Ikeda T., Batmunkh B., Choijookhuu N., Ishizaki H., Hotokezaka M., Hishikawa Y., Nanashima A.
Acta Histochemica et Cytochemica 50 ( 1 ) 21 - 28 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Histochemica et Cytochemica
© 2017 The Japan Society of Histochemistry and Cytochemistry.Mucosal immune dysregulation associated with T cells plays a critical role in the development of inflammatory bowel diseases (IBD). However, the definite significances of these cells in IBD still remain unclear. Therefore, we investigated the population and expression of CD4+CD161+ T cells in the colonic lamina propria mononuclear cells (LPMCs) in patients with IBD by analyses using flow cytometry and immunohistochemistry. Interleukin-10 (IL-10) mRNA levels in both LPMCs and CD4+ T cells in lamina propria (LP-CD4+ T cells) were measured using a real-time quantitative reverse transcription-polymerase chain reaction. IL-10 production was investigated with immunohistochemistry. The results revealed that the population of CD4+CD161+ T cells was significantly decreased in active ulcerative colitis (UC) compared with inactive UC (P < 0.05). The CD4+CD161+ T cell population was inversely correlated with disease activity in patients with UC (r = −0.6326, P = 0.0055), but there was no significant correlation in those with Crohn’s disease. Overexpression of IL-10 mRNA in both LPMCs and LP-CD4+ T cells were detected in active UC. Immunohistochemistry revealed decreased frequency of CD161+ cells and increased IL-10 positive cells in active UC. The frequency of CD4+CD161+ T cells and IL-10 expression was supposed to be associated with the pathological status of mucosal immunoregulation in IBD.
DOI： 10.1267/ahc.16035
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Nanashima A., Murakami G., Takagi K., Arai J., Sumida Y., Kodama T., Nagayasu T.
Acta Medica Nagasakiensia 61 ( 2 ) 55 - 60 2017
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2017 Nagasaki University Library, All Right Reserved. Aim: Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. In the present clinical study, we examined the relationship between ghrelin level and physiology in patients who had undergone major liver and pancreas surgery. Methods: Serum ghrelin level was measured before and after hepatectomy and pancreatectomy. The relationships between nutritional status and postoperative alterations of parameters including the ghrelin level were examined. Results: In 32 patients, the preoperative plasm acyl-(AG) or des-acyl-ghrelin (DAG) and AG/DAG ratio were not significantly different based on gender, type of operation, age and each disease. AG tended to be correlated with the respiration quotient but this was not statistically significant (p=0.08). AG was significantly negatively correlated with hemoglobin and albumin levels. The postoperative plasma ghrelin level was significantly decreased at day 1 in comparison with preoperative levels (p < 0.05) and recovered to preoperative levels at day 3. There were no significant differences between hepatectomy and pancreatectomy groups, with no changes of postoperative metabolic parameters. Conclusions: Although serum ghrelin level was transiently decreased, this level was immediately recovered and not influenced by the surgical procedures or its invasiveness.
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Hepaticoplasty prevents cholangitis after pancreaticoduodenectomy in patients with small bile ducts Reviewed
Hiyoshi M., Wada T., Tsuchimochi Y., Hamada T., Yano K., Imamura N., Fujii Y., Nanashima A.
International Journal of Surgery 35 7 - 12 2016.11
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery
© 2016 IJS Publishing Group LtdBackground To reduce cholangitis after pancreaticoduodenectomy (PD), we perform ‘hepaticoplasty’, in which the left side of the bile duct is cut to widen the diameter of the bile duct wall before hepaticojejunostomy. The aim of this study was to clarify the usefulness of hepaticoplasty to reduce cholangitis after PD. Methods From January 2002 through December 2010, 161 patients underwent PD and were enrolled in this study. Patient demographics, surgical factors, and clinical and biochemical parameters were evaluated to examine the factors predictive of cholangitis after PD and confirm the usefulness of hepaticoplasty. Results Cholangitis after PD occurred in 13 patients (8.1%). Multivariate analysis revealed that the ratio of the postoperative bile duct diameter to that before surgery was the only independent risk factor for cholangitis after PD (p = 0.0012). In the small bile duct group, in which the diameter was ≤15 mm before surgery (n = 99), hepaticoplasty reduced the narrowing of the bile duct after PD, and no cholangitis occurred. There were no complications related to hepaticoplasty. Conclusions The ratio of postoperative reduction of the bile duct diameter to that before surgery was found to be the only risk factor for cholangitis after PD. Patients with a small bile duct of ≤15 mm in diameter preoperatively might benefit from hepaticoplasty to widen the bile duct diameter and prevent cholangitis after PD.
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Nanashima A., Nanashima A., Sakamoto A., Sakamoto I., Hayashi H., Sumida Y., Murakami G., Arai J., Wada H., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 4 ) 135 - 140 2016.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.To evaluate pancreatic elasticity and tumor diagnosis, we preoperatively investigated the elasticity calculated by a new ultrasonography (US) technique, acoustic radiation force impulse (ARFI). Materials and Methods: We examined ARFI in non-tumorous and tumor regions by push pulse of probe in 30 patients with pancreatic malignancies undergoing pancreatectomy. Measurement of stiffness was indicated as the Vs (mm/sec). Results: The Vs in the non-tumor region was measured in the pancreas head in 17 and in the body in 13 patients. The Vs of pancreatic tumors was measured in 14 of 22 patients (64%). The Vs in pancreatic tumors (2.17±0.95 m/sec.) was significantly higher than that in the non-tumorous pancreas (1.41±0.47 m/sec.) (p<0.01). The Vs of the non-pancreatic regions in the pancreas head and body were not significantly different. The Vs of the non-tumorous pancreas was not associated with patient demographics, laboratory data, the hardness of the pancreatic tissue, or postoperative morbidity. The Vs of the resected pancreatic tumors was not associated with any tumor-related parameters. Conclusions: ARFI imaging elastography can be used to evaluate pancreatic malignant tumor lesion in comparison with the non-tumor lesion.
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Murakami G., Nanashima A., Nanashima A., Nonaka T., Tominaga T., Wakata K., Sumida Y., Akashi H., Okazaki S., Kataoka H., Nagayasu T.
Anticancer Research 36 ( 9 ) 4493 - 4501 2016.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Photodynamic therapy (PDT) is an effective laser treatment for locally treating advanced bile duct carcinoma (BDC). The study's objective was to evaluate the increased cytocidal effect by apoptotic PDT using a novel photosensitizer, glucose-conjugated chlorin, by irradiation of light-emitting diode laser (G-PDT) in comparison with conventional PDT using talaporfin sodium (T-PDT). Materials and Methods: The cytocidal effect of GPDT was compared to that of T-PDT as a control. Tumor viability was determined by an in vitro MTS assay. The percentage of apoptosis-positive cells was examined by triple stain flow cytometry (annexin V, ethidium homodimer III and Hoechst 33342) in the BDC cell line (NOZ cell) in vitro. The change in transplanted tumor volume in vivo (4-week-old male BALB/c mice) was examined 7 days after PDT. Results: Cell death was induced in a light dose-dependent manner by PDT. The laser power was set at 5 Jules/cm2 to obtain half maximal inhibitory concentration (IC50) in T-PDT and GPDT and the concentration of photosensitivity for G-PDT (2.02 g/ml) was lower than that for T-PDT (4.14 g/ml). Both T-PDT and G-PDT showed increased induction rates in comparison to the light only or G-chlorin only. Furthermore, the rate of apoptosis in the G-PDT (92.6%) was increased in comparison to that in the T-PDT (38.9%). The increased rates of tumor volume during the 7 days in both the G-PDT and T-PDT groups were significantly lower than that in the non-PDT group (p<0.01). At day 7, the increased rates of tumor volume in the G-PDT group were significantly lower than that in the T-PDT group (p<0.05). Conclusion: The new G-PDT treatment showed a high prevalence of apoptosis and inhibition of tumor growth in treatment of BDC cells.
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Nanashima A., Takagi K., Murakami G., Arai J., Sumida Y., Nagayasu T., Kodama T.
Acta Medica Nagasakiensia 60 ( 4 ) 153 - 159 2016.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Ghrelin is a peptide that is secreted from the stomach and plays a role in appetite, weight gain, and skeletal muscle composition. Compounded human ghrelin (CHG) is a candidate drug to improve the nutritional status after pancreatic surgery. However, adverse influences of ghrelin in terms of pancreatic fistula (PF) via the stimulation of exocrine secretion after pancreatectomy are a concern. The present study showed the influences of the administration of CHG with PF after distal pancreatectomy in a mouse model. Distal pancreatectomy was performed on 10-week-old male Wistar rats and 3 μg/kg or 30 μg/kg CHG was injected into the inferior vena cava during laparotomy. Ten rats were divided into two groups: a control group (no injection; n=5) and a CHG group (n=5 for each of 3 μg/kg and 30 μg/kg). Changes of body weight, amount of ascites, and the serum and ascetic amylase and lipase levels were examined on days 1, 3, and 7. In the case of administration of 3 μg/kg ghrelin, changes of body weight, amount of ascites, and serum amylase level were not significantly different between the groups during 7 days. Amylase level in ascites in the ghrelin administration group tended to be lower than that in the control group on day 3 (p=0.083), but there was no difference on days 1 and 7. In the case of a high dose of 30 μg/kg ghrelin, levels of weight loss were not significantly different between the groups. Although the lipase level in the serum and ascites tended to be lower in the ghrelin group than in the control group (p=0.08), the amylase levels in serum and ascites were not significantly different between the groups. There was also no remarkable difference in histological appearance between the groups during 7 days after surgery. The administration of CHG did not induce PF after distal pancreatectomy, which might inhibit lipase secretion in ascites. CHG injection can be safely performed after surgery.
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Clinical Value of Serum p53 Antibody in the Diagnosis and Prognosis of Colorectal Cancer. Reviewed
Kunizaki M, Sawai T, Takeshita H, Tominaga T, Hidaka S, To K, Miyazaki T, Hamamoto R, Nanashima A, Nagayasu T
Anticancer research 36 ( 8 ) 4171 - 4175 2016.8
Language：English Publishing type：Research paper (scientific journal)
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Nanashima A., Izumino H., Sumida Y., Tominaga T., Wakata K., Hidaka S., Tsuchiya T., Nagayasu T.
Anticancer Research 36 ( 8 ) 3899 - 3903 2016.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Oxidative stress is defined as an imbalance between the pro-oxidant and antioxidant potential of cells leading to intracellular DNA damage. To clarify the oxidative stress response as a tumor marker, we investigated measurement of urinary 8-hydroxydeoxyguanosine (8-OHdG) levels in hepatobiliary diseases. Materials and Methods: Relationships between urinary 8-OHdG levels and clinicopathological factors were analyzed in 101 patients, including 84 with hepatobiliary malignancies, and 18 healthy volunteers. Co-existing biliary inflammation was detected in 8 patients. Results: Urinary 8-OHdG levels did not correlate with any clinical or liver functional parameters. The existence of inflammation and any tumor-related factor did not correlate with urinary 8-OHdG levels either. Urinary 8-OHdG levels were significantly higher in patients with benign and malignant diseases than in healthy volunteers (p<0.05), but not significantly different between benign and malignant diseases. Among patients with intrahepatic cholangiocarcinoma and gallbladder carcinoma, urinary 8-OHdG levels tended to be higher in patients with lymph node metastasis-positive than in those with lymph node-negative disease (p=0.057). Conclusion: The clinical significance of oxidative DNA damage and increases in its urinary metabolites in patients with hepatobiliary malignancies or inflammatory diseases remain unknown. Further studies are necessary to clarify the relationship between node metastasis and oxidative stress as a prognostic marker.
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Beppu T., Okabe H., Okuda K., Eguchi S., Kitahara K., Taniai N., Ueno S., Shirabe K., Ohta M., Kondo K., Nanashima A., Noritomi T., Okamoto K., Kikuchi K., Baba H., Fujioka H.
Journal of the American College of Surgeons 222 ( 6 ) 1138 - 1148.e2 2016.6
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Surgeons
© 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.Background Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. Study Design Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated. Results Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49). Conclusions Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.
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Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Reviewed
Nanashima A, Nagayasu T
Surgery today 46 ( 4 ) 398 - 404 2016.4
Language：English Publishing type：Research paper (scientific journal)
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Nanashima A., Sumida Y., Murakami G., Sawai T., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 3 ) 109 - 117 2016.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with hepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
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Tominaga T., Takeshita H., Takagi K., Kunizaki M., To K., Abo T., Hidaka S., Nanashima A., Nanashima A., Nagayasu T., Sawai T., Sawai T.
International Journal of Colorectal Disease 31 ( 2 ) 217 - 225 2016.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Colorectal Disease
© 2015, Springer-Verlag Berlin Heidelberg.Purpose: The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. Methods: The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. Results: Postoperative complications developed in 78 patients (33 %). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). Conclusions: The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
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Intraoperative Diagnosis of Lymph Node Metastasis in Non-small-cell Lung Cancer by a Semi-dry Bot-blot Method. Reviewed
Tomoshige, K., Tsuchiya, T., Otsubo, R., Oikawa, M., Yamasaki, N., Matsumoto, K., Miyazaki, T., Hayashi, T., Kinoshita, N., Nanashima, A. and Nagayasu, T.:
European journal of Cardio-Thoracic Surgery. 49 ( 2 ) 617 - 622 2016.2
Language：English Publishing type：Research paper (scientific journal)
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Intraoperative diagnosis of lymph node metastasis in non-small-cell lung cancer by a semi-dry dot-blot method. Reviewed
Tomoshige K, Tsuchiya T, Otsubo R, Oikawa M, Yamasaki N, Matsumoto K, Miyazaki T, Hayashi T, Kinoshita N, Nanashima A, Nagayasu T
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49 ( 2 ) 617 - 22 2016.2
Language：English Publishing type：Research paper (scientific journal)
DOI： 10.1093/ejcts/ezv118
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肉眼的に明らかな腫瘤性病変を認めなかった陰窩腺由来肛門管癌のPagetoid spreadの1例． Reviewed
土屋和代, 春山幸洋, 石﨑秀信, 南史朗, 柴田直哉, 池田拓人, 七島篤志：
日本大腸肛門病学会雑誌 69 ( 1 ) 20 - 26 2016.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Down-Regulation of Nogo-B Expression as a Newly Identified Feature of Intrahepatic Cholangiocarcinoma. Reviewed
Nanashima, A., Hatachi, G., Tominaga, T., Murakami, G., Takagi, K., Arai, J., Wada, H., Nagayasu, T. and Shimada, Y.：
The Tohoku Journal of Experimental Medicine 238 ( 1 ) 9 - 16 2016.1
Language：English Publishing type：Research paper (scientific journal)
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Inamura Y., Honma K., Kimura D., Miyakoda M., Kimura K., Fukudome K., Nanashima A., Nagayasu T., Yui K.
Acta Medica Nagasakiensia 60 ( 2 ) 77 - 84 2016.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All Rights Reserved. The toll-like receptor 4 (TLR4)-mediated immune response is considered as one of the triggers of acute respiratory distress syndrome. The agonistic monoclonal antibody UT12 specific for the TLR4/MD2 complex induces immune activation in a manner distinct from lipopolysaccharide (LPS). In order to compare the effects of this differential TLR4 signaling activation, we examined immune cell recruitment to the lung following intratracheal inoculation with UT12 and LPS in mice. The increase in pulmonary neutrophils was much higher after LPS treatment compared with UT12 treatment, while CD11bhiCD11＋cells increased to similar levels following both treatments. These changes were MyD88-dependent and TRIF-independent. These differential effects on immune cell recruitment to the lung suggest distinct underlying mechanisms in response to TLR4 stimulation. These findings further indicate that TLR signaling can lead to different outcomes depending on the ligand and activation pathway, which may relate to the complex pathogenesis of inflammatory lung diseases.
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A Case of Adenosquamous Carcinoma of the Distal Extrahepatic Bile Duct Reviewed
KANEMARU Mikio, NANASHIMA Atsushi, SANO Koichiro, SUETA Hideto, UCHIYAMA Shuichiro, MAGATA Hisato, TANAKA Hiroyuki
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 77 ( 3 ) 625 - 630 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Surgical Association
Adenosquamous carcinoma of the extrahepatic biliary tract is a relatively rare disease, and in general, has a poor prognosis. A 73-year-old man with jaundice was referred to our hospital for further examination and possible surgery. Contrast-enhanced abdominal CT showed dilatation of the intra and extrahepatic bile ducts and a contrast-enhancing tumor about 15 mm in diameter in the distal extrahepatic bile duct. ERCP showed the tumor in the distal extrahepatic bile duct and a biopsy revealed the diagnosis of adenosquamous carcinoma of the bile duct, as the tumor contained a mixture of both adenocarcinoma and squamous cell carcinoma components. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Histopathology of the resected specimen confirmed the diagnosis of adenosquamous carcinoma of the bile duct based on the presence of both adenocarcinoma and squamous cell carcinoma components in the tumor. Metastases to the liver were identified 3 months after the surgery and the patient died of acute respiratory failure complicating aspiration pneumonia 6 months after the surgery.
DOI： 10.3919/jjsa.77.625
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Current status and experiences of photodynamic therapy for cholangiocarcinoma worldwide from a surgeon's standpoint Invited Reviewed
Nanashima Atsushi, Sumida Yorihisa, Nagayasu Takeshi, Isomoto Hajime
Tando 30 ( 4 ) 699 - 708 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Biliary Association
Complete surgical resection is only a curable treatment for cholangiocarcinoma. However, postoperative incurable results of remnant cancer at the bile duct or unresectable case and postoperative tumor recurrence are often observed. Although systemic chemotherapy or brachytherapy are selected, evidence of efficacy for local control was not indicated in these modality. While, treatment efficacy and safety by photodynamic therapy (PDT) for unresectable cholangiocarcinoma has been reported since 1988. Since the highly evidence-based clinical trials was reported, PDT was admitted as a useful local control modality to release biliary stricture or prolong survival period clarified worldwide. Although PDT was not developed in Japan, neoadjuvant or chemotherapy-combined PDT or use of new photosensitizer has been recently progressed. As a surgeon's standpoint who professionally experienced PD in Japan, actual managements, current clinical and research status of PDT for cholangiocarcinoma worldwide and the future aspect was summarized and described.
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Tsuchiya Kazuyo, Haruyama Yukihiro, Ishizaki Hidenobu, Minami Shiro, Shibata Naoya, Ikeda Takuto, Nanashima Atsushi
The Japanese journal of proctology 69 ( 1 ) 20 - 26 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japan Society of Coloproctology
A 79-year-old woman with anal itching, bleeding and perianal skin eruption, suggestive of perianal Paget's disease, was presented. Although skin biopsy revealed pagetoid cells in the perianal skin lesion, no macroscopically remarkable tumor lesion was found in the anal canal or in the distal rectum during colonoscopy. Subsequent pathological examination revealed an invasive adenocarcinoma and proliferation of pagetoid cells into the epidermis. Upon immunohistochemical examination, the tumor cells and pagetoid cells were positively stained for cytokeratin 7, 20, and caudal type homeobox 2, however, gross cystic disease fluid protein-15 was negative. On the basis of these findings, the patient was diagnosed as anal canal cancer accompanied by pagetoid spread, and laparoscopic abdominoperineal resection combined with bilateral pelvic lymph node dissection was performed. From the pathological resected specimen, anal canal adenocarcinoma derived from crypt glands invading the internal sphincter muscle accompanied by pagetoid spread was eventually diagnosed. Relapse-free survival for 15 months after curable operation was obtained. It is necessary to keep in mind that anal canal adenocarcinoma without remarkably macroscopic tumor lesions may cause pagetoid spread.
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HAMADA Takeomi, IMAMURA Naoya, TSUCHIMOCHI Yuki, YANO Koichi, HIYOSHI Masahide, OHUCHIDA Jiro, FUJII Yoshiro, HARUYAMA Yukihiro, KATAOKA Hiroaki, NANASHIMA Atsushi
Suizo 31 ( 4 ) 662 - 669 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Pancreas Society
We report a case of local recurrence and liver metastases of solid pseudopapillary neoplasm (SPN) of the pancreas twenty-one years after primary pancreatectomy. The patient was a 61-year-old female who underwent a previous spleen preserving distal pancreatectomy for solid and cystic tumor in 1993. In 2014, liver tumors were detected by ultrasoud screening. Radiological findings revealed that a tumor was composed of solid and cystic portions concomitant with hemorrhage. We carried out a liver biopsy to diagnose SPN. A remnant distal pancreatectomy with splenectomy and limited resection of the all liver metastases was performed. The histological examination revealed a pattern of solid and pseudopapillary neoplasm, which showed similar histological findings to the primary tumor. Immunohistochemical stains are useful to diagnose SPN. Especially, the dot-like staining pattern of CD99, a characteristic finding typically found in SPN. SPN is potentially a low malignant pancreatic neoplasm indicating the better prognosis after complete tumor resection. However, a recurrence of tumor can be expected over a long-term course of 10-20 years. Therefore, life-long long-term follow-up should be necessary for all SPN patients who underwent surgical resection.
DOI： 10.2958/suizo.31.662
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A case of bile duct cancer, 43 years after cholangiojejunostomy for congenital biliary dilatation Reviewed
Tominaga Tetsuro, Nanashima Atsushi, Murakami Goushi, Tobinaga Shuichi, Abo Takafumi, Sumida Yorihisa, Kinoshita Naoe, Nagayasu Takeshi
Tando 30 ( 5 ) 876 - 882 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Biliary Association
We recently encountered a patient who developed bile duct cancer of the porta hepatis, 43 years after cholangiojejunostomy for congenital biliary dilatation (CBD). This 59-year-old woman had undergone cholangiojejunostomy for CBD at 15 years old. She had remained asymptomatic and no long-term follow-up was performed. However, she developed epigastric pain, and was referred to our hospital after intrahepatic stones were diagnosed.Imaging showed an irregular stricture of the left hepatic duct and mucosal erythema and irregularity of the opening of the left hepatic duct and cholangiojejunostomy site. Biopsy revealed moderately differentiated adenocarcinoma. Resection of the left hepatic and caudate lobes and site of cholangiojejunostomy was performed. Histopathological examination showed a nodular, well-differentiated adenocarcinoma (T1bN0M0, stage I) in the bile duct.The patient has remained recurrence-free as of 2 years postoperatively. Cholangiojejunostomy for CBD is associated with high risk of cancer, and the prognosis is poor if cancer develops. Patients who have undergone cholangiojejunostomy for CBD may develop complications involving cancer of the residual bile ducts when conditions such as intrahepatic stones develop, and this possibility needs to be addressed through detailed examinations. Some patients, such as the present patient, have not received periodic surveillance after undergoing surgery for CBD during childhood.
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Nanashima Atsushi, Sumida Yorihisa, Murakami Goushi, Sawai Terumistu, Nagayasu Takeshi
Acta Medica Nagasakiensia 60 ( 3 ) 109 - 117 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：長崎大学医学部
Background: Intermittent occlusion of hepatic inflow, so-called Pringle's maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated withhepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
DOI： 10.11343/amn.60.109
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Tominaga T., Tsuchiya T., Mochinaga K., Arai J., Yamasaki N., Matsumoto K., Miyazaki T., Nagasaki T., Nanashima A., Tsukamoto K., Nagayasu T.
BMC Cancer 16 ( 1 ) 354 - 354 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：BMC Cancer
© 2016 The Author(s).Background: It has been shown that epidermal growth factor receptor (EGFR) mutation status is associated with 5-fluorouracil (5-FU) sensitivity in non-small-cell lung cancer (NSCLC). However, the relationship between EGFR mutation status and dihydropyrimidine dehydrogenase (DPD), a 5-FU degrading enzyme, is unknown. Methods: We elucidated the crosstalk among the EGFR signal cascade, the DPD gene (DPYD), and DPD protein expression via the transcription factor Sp1 and the effect of EGFR mutation status on the crosstalk. Results: In the PC9 (exon19 E746-A750) study, EGF treatment induced up-regulation of both Sp1 and DPD; gefitinib, an EGFR-tyrosine kinase inhibitor (EGFR-TKI), and mithramycin A, a specific Sp-1 inhibitor, suppressed them. Among EGFR-mutated (PC9, HCC827; exon19 E746-A750 and H1975; exon21 L858R, T790M, gefitinib resistant) and -non-mutated (H1437, H1299) cell lines, EGF administration increased DPYD mRNA expression only in mutated cells (p < 0.05). Accordingly, gefitinib inhibited DPD protein expression only in PC9 and HCC827 cells, and mithramycin A inhibited it in EGFR-mutated cell lines, but not in wild-type. FU treatment decreased the level of cell viability more in gefitinib-treated EGFR-TKI sensitive cell lines. Further, combination treatment of FU and mithramycin A suppressed cell viability even in a gefitinib resistant cell line. Conclusions: The EGFR signal cascade regulates DPD expression via Sp1 in EGFR mutant cells. These results might be a step towards new therapies targeting Sp1 and DPD in NSCLC with different EGFR mutant status.
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Nanashima A., Imamura N., Tsuchimochi Y., Hiyoshi M., Fujii Y.
International Journal of Surgery Case Reports 25 66 - 70 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an openaccess article under the CC BY-NC-ND license.Introduction This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. Presentation of case A 63-year-old woman was admitted to our institute's Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient's postoperative course was uneventful. Discussion In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. Conclusion By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.
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Kanemaru Mikio, Nanashima Atsushi, Iwamura Takeshi, Sueta Hideto, Sano Koichiro, Uchiyama Syuichiro, Magata Hisato
The Japanese Journal of Gastroenterological Surgery 49 ( 8 ) 721 - 729 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
<p>Here we report a case of a survivor who twice underwent surgical resection for recurrences. A 67-year-old man underwent total gastrectomy and D2 lymph node dissection for a stage IIIA adenocarcinoma of the esophagogastric junction. Three years later, he underwent partial resection of the liver for metastasis of segment 8 of the liver. One year and 5 months after hepatectomy, he underwent distal pancreatectomy and splenectomy for metastasis of the lymph nodes along the distal splenic artery. At 6 years and 6 months after initial surgery and 2 years after the last surgery, no sign of recurrent cancer has been identified by endoscopical and radiological follow-up examinations. This case report shows the benefit of surgical resection for recurrent cancer of the esophagogastric junction.</p>
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Nanashima A., Nanashima A., Hatachi G., Tominaga T., Murakami G., Takagi K., Arai J., Wada H., Nagayasu T., Sumida Y.
Tohoku Journal of Experimental Medicine 238 ( 1 ) 9 - 16 2015.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Tohoku Journal of Experimental Medicine
© 2016 Tohoku University Medical Press.Nogo-B, located in the endoplasmic reticulum, is an isoform belonging to the reticulon protein family, which is expressed specifically in cholangiocytes and non-parenchymal cells in the liver. Nogo-B expression is down-regulated with the progression of liver fibrosis, but its distinct function in liver malignancies has not been fully clarified. We have hypothesized that Nogo-B expression may be altered in intrahepatic cholangiocarcinoma (ICC), a relatively rare type of primary liver cancer with highly malignant behavior. The present study aimed to investigate the relationship between Nogo-B expression, assessed by immunohistochemical staining, and clinicopathological factors and prognosis in 34 ICC patients. Positive expression was observed in 19 (56%) of 34 ICC specimens: 6 patients (18%) with positivity levels of 1+ (positive cells in 10-50% of cancer cells) and 13 patients (38%) with 2+ (positive cells over 50%). Importantly, the remaining 15 patients (44%) were categorized as negative expression (Nogo-B-positive cells, less than 10%). Conversely, the mass-forming type of ICC tended to express Nogo-B with the degree of 2+ positivity, compared to the periductal infiltration type (p = 0.064), and the mass-forming type showed a better 5-year survival rate (66% vs. 5%) after hepatectomy (p < 0.05). However, the degree of positivity was not associated with tumor relapse rate, disease-free and overall survival, although each of the periductal infiltration type, intrahepatic metastasis, larger tumor size, and lower microvessel counts was associated with lower survival rates. We propose that Nogo-B expression is down-regulated in ICC, the implication of which, however, remains to be investigated.
DOI： 10.1620/tjem.238.9
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Comprehensive Predictors of Portal Pressure from Functional Liver Reserve in Patients Who Underwent Hepatectomy. Reviewed
Nanashima, A., Abo, T., Arai, J., Tsucchiya, T., Miyazaki, T., Takagi, K., Chen, X. and Nagayasu, T.:
Indian Journal of Surgery. 77 ( S3 ) 923 - 929 2015.12
Language：English Publishing type：Research paper (scientific journal)
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Comprehensive Predictors of Portal Pressure from Functional Liver Reserve in Patients Who Underwent Hepatectomy.
Nanashima A, Abo T, Arai J, Tsuchiya T, Miyazaki T, Takagi K, Chen X, Nagayasu T
The Indian journal of surgery 77 ( Suppl 3 ) 923 - 9 2015.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Photodynamic Therapy using Talaporfin Sodium for the Recurrence of Cholangiocarcinoma after Surgical Resction. Reviewed
Shimizu, S., Nakazawa, T., Hayashi, K., Naitoh, I., Miyabe, K., Kondo, H., Nishi, Y., Umemura, S., Hori, Y., Kato, A., Morisaki, T., Nanashima, A., Ohara, H. and Joh, H.:
Internal Medicine. 54 ( 18 ) 221 - 2326 2015.9
Language：English Publishing type：Research paper (scientific journal)
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A favourable prognostic marker for EGFR mutant non-small cell lung cancer: immunohistochemical analysis of MUC5B.
Wakata K, Tsuchiya T, Tomoshige K, Takagi K, Yamasaki N, Matsumoto K, Miyazaki T, Nanashima A, Whitsett JA, Maeda Y, Nagayasu T
BMJ open 5 ( 7 ) e008366 2015.7
Language：Japanese Publishing type：Research paper (scientific journal)
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胃癌に対する5-アミノレブリン酸を用いたレーザー光線力学的内視鏡診断． Reviewed
磯本一, 萩原久美, 妹尾健正, 大仁田賢, 山口直之, 中尾一彦, 七島篤志:
日本レーザー医学会雑誌． 36 ( 2 ) 114 - 118 2015.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocaricinoma： A Multi-Institutional Study br the Kyushu Study Group of Liver Surgery Reviewed
Adachi, T., Eguchi, S., Beppu, T., Ueno, S., Shiraishi, M., Okuda, K., Yamaguchi, Y., Kondo, K., Nanashima, A., Ohta, M., Takami, Y., Noritomi, T., Kitahara, K. and Fujioka, H.:
Annals of Surgical Oncology 22 ( 7 ) 2269 - 6678 2015.7
Language：English Publishing type：Research paper (scientific journal)
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Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery.
Adachi T, Eguchi S, Beppu T, Ueno S, Shiraishi M, Okuda K, Yamashita Y, Kondo K, Nanashima A, Ohta M, Takami Y, Noritomi T, Kitahara K, Fujioka H
Annals of surgical oncology 22 ( 7 ) 2269 - 78 2015.7
Language：Japanese Publishing type：Research paper (scientific journal)
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A variant of multicystic biliary hamartoma presenting as an intrahepatic cystic neoplasm
Tominaga T., Abo T., Kinoshita N., Murakami T., Sato Y., Nakanuma Y., Harada K., Masuda J., Nagayasu T., Nanashima A., Nanashima A.
Clinical Journal of Gastroenterology 8 ( 3 ) 162 - 166 2015.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2015, Springer Japan.A rare case of an intrahepatic multicystic tumor is described. A 26-year-old man visited our hospital because of abdominal discomfort. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a 10 × 7 cm multicystic tumor of the bile duct in the right side of the liver. The gross appearance of the tumor resembled an intraductal papillary neoplasm of the bile duct, and right hepatectomy with regional lymphadenectomy was performed. Histologically, these cystic lesions were composed of variably and irregularly dilated duct structures lined by columnar epithelium resembling bile duct lining. There were no atypical cells and no papillary growth of the epithelial cells. Interestingly, the dilated ducts contained inspissated bile, and the inter-cystic parenchyma contained variable but irregularly distributed and hamartomatous hepatic parenchyma with an abnormal lobular pattern. Though it had atypical features of a hamartoma in some aspects (age, smooth muscle), this case could finally be regarded as a variant of multicystic biliary hamartoma.
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A Vatiant of Multicystic Biiary Hamartoma Presenting as anIntrahepatic Custic Neoplasm. Reviewed
Tominaga, T., Abo, T., Kinoshita, N., Murakami, T., Sato, Y., Nakanuma, Y., Harada, K., Masuda, J., Nagayasu, T. and Nanashima, A.:
Clinical Journal of Gastroenteroogy 8 ( 3 ) 162 - 166 2015.6
Language：English Publishing type：Research paper (scientific journal)
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In vivo Fluorescence Navigation of Gastric and Upper Gastrointestinal Tumors by 5-Aminolevulinic Acid Mediated Photodynamic Diagnosis with a Laser-equipped Video Image Endoscope Reviewed
Isomoto, H., Nanashima, A., Senoo, T., Ogiwara, K., Hashisako, M., Ohnita, K., Yamaguchi, N., Kunizaki, M., Hidaka, S., Fukuda, H., Ishii, H., Matsumoto, K., Minami, H., Akazawa, Y., Takehima, F., Fukuoka, J., Nagayasu, T. and Nakao,K.:
Photodiagnosis and Photodynami Therapy 12 ( 2 ) 201 - 208 2015.6
Language：English Publishing type：Research paper (scientific journal)
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In vivo fluorescence navigation of gastric and upper gastrointestinal tumors by 5-aminolevulinic acid mediated photodynamic diagnosis with a laser-equipped video image endoscope. Reviewed
Isomoto H, Nanashima A, Senoo T, Ogiwara K, Hashisako M, Ohnita K, Yamaguchi N, Kunizaki M, Hidaka S, Fukuda H, Ishii H, Matsushima K, Minami H, Akazawa Y, Takeshima F, Fukuoka J, Nagayasu T, Nakao K
Photodiagnosis and Photodynamic Therapy 12 ( 2 ) 201 - 208 2015.6
Language：English Publishing type：Research paper (scientific journal)
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Current status of photodynamic therapy in digestive tract carcinoma in Japan.
Nanashima A, Nagayasu T
International journal of molecular sciences 16 ( 2 ) 3434 - 40 2015.2
Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.3390/ijms16023434
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Abo T., Nanashima A., Tobinaga S., Hidaka S., Taura N., Takagi K., Arai J., Miyaaki H., Shibata H., Nagayasu T.
European Journal of Surgical Oncology 41 ( 2 ) 257 - 264 2015.2
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
© 2014 Elsevier Ltd. Background To improve the diagnostic accuracy for hepatic tumors on the liver surface, we investigated the usefulness of an indocyanine green-photodynamic eye (ICG-PDE) system by comparison with Sonazoid intraoperative ultrasonography (IOUS) in 117 patients. Hepatic segmentation by ICG-PDE was also evaluated. Methods ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. ICG was injected into portal veins to determine hepatic segmentation. Results Accurate diagnosis of liver tumors was achieved with ICG-PDE in 75% of patients, lower than with IOUS (94%). False-positive and false-negative diagnosis rates for ICG-PDE were 24% and 9%, respectively. New small HCCs were detected in 3 patients. The ICG fluorescent pattern in tumors was strong staining in 41%, weak staining in 13%, rim staining in 20% and no staining in 26%. Hepatocellular carcinoma predominantly showed strong staining (61%), while rim staining predominated in cholangiocellular carcinoma (60%) and liver metastasis (55%). Hepatic segmental staining was performed in 28 patients, proving successful in 89%. Conclusion ICG-PDE is a useful tool for detecting the precise tumor location at the liver surface, identifying new small tumors, and determining liver segmentation for liver resection.
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Current Status of Photodynamic Therapy in DIgestive Tract Carcinoma in Japan． Reviewed
Nanashima, A. and Nagayasu, T.:
International Journal of Molecular Science 16 ( 2 ) 3434 - 3440 2015.2
Language：English Publishing type：Research paper (scientific journal)
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Usefulness of Intraoperative Diagnosis of Hepatic Tumors Located at the Liver Surface and Hepatic Segmental Visualization Using Indocyanine Green-photodynamic Eye Imaging． Reviewed
Abo, T., Nanashima, A., Toibnaga, S., HIdaka, S., Taura, T., Miyaaki, H., Shibata, H. and Nagayasu, T.:
European Journal of Surgical Oncology 41 ( 2 ) 257 - 264 2015.2
Language：English Publishing type：Research paper (scientific journal)
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Clinicopathological characteristics of multiple primary cancers in hepatobiliary and pancreas malignancies.
Nanashima A, Kondo H, Nakashima M, Abo T, Arai J, Ishii M, Hidaka S, Kunizaki M, To K, Takeshita H, Yamasaki N, Tsuchiya T, Nagayasu T
Anticancer research 35 ( 2 ) 1073 - 83 2015.2
Language：Japanese Publishing type：Research paper (scientific journal)
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Short-term Outcomes of Laparoscopic Surgery for Colorectal Cancer in Japan. Reviewed
32 ( 1 ) 32 - 38 2015.1
Language：English Publishing type：Research paper (scientific journal)
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Photodynamic Therapy using Talaporfin Sodium for the Recurrence of Cholangiocarcinoma after Surgical Resection.
Shimizu S, Nakazawa T, Hayashi K, Naitoh I, Miyabe K, Kondo H, Nishi Y, Umemura S, Hori Y, Kato A, Morisaki T, Nanashima A, Ohara H, Joh T
Internal medicine (Tokyo, Japan) 54 ( 18 ) 2321 - 6 2015
Language：Japanese Publishing type：Research paper (scientific journal)
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胃癌に対する５-アミノレブリン酸を用いたレーザー光線力学的内視鏡診断
磯本 一, 荻原 久美, 妹尾 健正, 大仁田 賢, 山口 直之, 中尾 一彦, 七島 篤志
日本レーザー医学会誌 36 ( 2 ) 113 - 118 2015
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：特定非営利活動法人 日本レーザー医学会
我々は胃癌の早期発見とスクリーニングへの応用を目指し，5-アミノレブリン酸（5-ALA）を用いたレーザー光線力学的内視鏡診断（PDD）の有用性を検討している．倫理委員会の承認を得て，当院で治療適応と判断された上部消化管腫瘍症例から本臨床研究に同意の得られた20例を対象とした．治療当日に5-ALAを経口摂取して3時間後にPDDを行った．5-ALA代謝産物のプロトポルフィリンIX（光感受性物質）を励起する特定波長レーザー光を照射可能な内視鏡を試作し，赤色蛍光の検出の有無，切除標本の病理組織像との対比を行った．胃癌23病変中19病変で赤色蛍光が確認できた．PDDに関する有害事象はなく，5-ALA/PDDの有用性と安全性を確認した．
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Short-term outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients.
Tominaga T, Takeshita H, Arai J, Takagi K, Kunizaki M, To K, Abo T, Hidaka S, Nanashima A, Nagayasu T, Sawai T
Digestive surgery 32 ( 1 ) 32 - 8 2015
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Prediction of portal pressure from intraoperative ultrasonography.
Nanashima A, Abo T, Arai J, Tominaga T, Takagi K, Mochinaga K, Furukawa K, Nagayasu T
The Journal of surgical research 192 ( 2 ) 395 - 401 2014.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of evaluating hepatic elasticity using artificial acoustic radiation force ultrasonography before hepatectomy.
Nanashima A, Sakamoto A, Sakamoto I, Hayashi H, Abo T, Wakata K, Murakami G, Arai J, Wada H, Takagi K, Takeshita H, Hidaka S, To K, Nagayasu T
Hepatology research : the official journal of the Japan Society of Hepatology 44 ( 13 ) 1308 - 19 2014.12
Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.1111/hepr.12306
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Three-dimensional printing model of liver for operative simulation in perihilar cholangiocarcinoma.
Takagi K, Nanashima A, Abo T, Arai J, Matsuo N, Fukuda T, Nagayasu T
Hepato-gastroenterology 61 ( 136 ) 2315 - 6 2014.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Video-assisted thoracoscopic lobectomy with the patient in the semi-prone position: initial experience and benefits of lymph node dissection.
Miyazaki T, Nagayasu T, Yamasaki N, Tsuchiya T, Matsumoto K, Tagawa T, Obatake M, Nanashima A, Hidaka S, Hayashi T
General thoracic and cardiovascular surgery 62 ( 10 ) 614 - 9 2014.10
Language：Japanese Publishing type：Research paper (scientific journal)
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The poly(adenosine diphosphate-ribose) polymerase inhibitor PJ34 reduces pulmonary ischemia-reperfusion injury in rats.
Hatachi G, Tsuchiya T, Miyazaki T, Matsumoto K, Yamasaki N, Okita N, Nanashima A, Higami Y, Nagayasu T
Transplantation 98 ( 6 ) 618 - 24 2014.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Clinical significance of vessel-sealing device usage for pancreatectomy: a retrospective cohort study.
Nanashima A, Abo T, Takagi K, Wada H, Arai J, Kunizaki M, To K, Takeshita H, Hidaka S, Nagayasu T
Hepato-gastroenterology 61 ( 134 ) 1767 - 74 2014.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Clinicopathological parameters associated with surgical site infections in patients who underwent pancreatic resection. Reviewed
Nanashima A, Abo T, Arai J, Oyama S, Mochinaga K, Matsumoto H, Takagi K, Kunizaki M, To K, Takeshita H, Hidaka S, Nagayasu T
Hepato-gastroenterology 61 ( 134 ) 1739 - 1743 2014.9
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)
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Recruitment of Young Medical Apprentices (RYOMA) project: a comprehensive surgical education program at a local academic institute in Japan.
Nanashima A, Hidaka S, Nonaka T, Yamasaki N, Tsuchiya T, Matsumoto K, Miyazaki T, Hatachi G, Sumida Y, Sawai T, Yasutake T, Nagayasu T
Journal of surgical education 71 ( 4 ) 587 - 92 2014.7
Language：Japanese Publishing type：Research paper (scientific journal)
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ABCC11/MRP8 Expression in the Gastrointestinal Tract and a Novel Role for Pepsinogen Secretion.
Matsumoto H, Tsuchiya T, Yoshiura K, Hayashi T, Hidaka S, Nanashima A, Nagayasu T
Acta histochemica et cytochemica 47 ( 3 ) 85 - 94 2014.6
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Nanashima A., Abo T., Murakami G., Tominaga T., Takeshita H., Hidaka S., Kunizaki M., Matsumoto H., To K., Miyazaki T., Tsuchiya T., Yamasaki N., Nagayasu T.
Hepato-gastroenterology 61 ( 131 ) 727 - 731 2014.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-gastroenterology
BACKGROUND/AIMS: To clarify improvement of hepatic resection in the recent years, we examined surgical records of 544 patients who underwent hepatectomy in 3 periods between 1994 and 2011 at a single academic institute. METHODOLOGY: Subjects were divided into 3 groups: group 1 (1994-1999, n = 156), group 2 (2000-2006, n = 228) and group 3 (2007-2011, n = 160). Clinical factors, surgical records and post-hepatectomy outcomes during hospitalization were compared between groups. RESULTS: In group 3, patient age was significantly higher and the incidences of alcoholic or fatty liver and obstructive jaundice were significantly higher than in group 1 (p < 0.05). Preoperative liver function was not different between groups, and only prothrombin activity was significantly better in group 1 in comparison with the other groups (p < 0.05). In comparison with group 1, the incidence of resident surgeons as the main operator were significantly higher than in group 3 (p < 0.01). Incidences of laparoscopic hepatectomy and thoraco-abdominal approach were increased in group 3 (p < 0.01). Incidences of combined organ and major vessels resections were significantly higher in group 3 in comparison with group 1 (p < 0.01). Use of omental wrapping and hemostatic devices were significantly more frequent in group 3 than in group 1 (p < 0.01). Surgical records were not different between groups but the red cell transfusion rate in group 3 was significantly lower than in group 1 (p < 0.05). Hospital stay in group 3 was significantly shorter than in group 1. Incidence of hepatectomy-related complication, particularly bile leakage, was significantly lower in group 3 than in group 1 (p < 0.05). CONCLUSIONS: According to this evaluation of different time periods, surgical outcomes have been improved with new surgical procedures and perioperative management.
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Improvement of Surgical Records and Outcomes after Hepatectomy at a Single Academic Institute in Japan.
Nanashima A, Abo T, Murakami G, Tominaga T, Takeshita H, Hidaka S, Kunizaki M, Matsumoto H, To K, Miyazaki T, Tsuchiya T, Yamasaki N, Nagayasu T
Hepato-gastroenterology 61 ( 131 ) 727 - 31 2014.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Future prospects for tissue engineered lung transplantation: decellularization and recellularization-based whole lung regeneration.
Tsuchiya T, Sivarapatna A, Rocco K, Nanashima A, Nagayasu T, Niklason LE
Organogenesis 10 ( 2 ) 196 - 207 2014.4
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High expression of dihydropyrimidine dehydrogenase in lung adenocarcinoma is associated with mutations in epidermal growth factor receptor: implications for the treatment of non--small-cell lung cancer using 5-fluorouracil.
Mochinaga K, Tsuchiya T, Nagasaki T, Arai J, Tominaga T, Yamasaki N, Matsumoto K, Miyazaki T, Nanashima A, Hayashi T, Tsukamoto K, Nagayasu T
Clinical lung cancer 15 ( 2 ) 136 - 144.e4 2014.3
Language：Japanese Publishing type：Research paper (scientific journal)
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How to access photodynamic therapy for bile duct carcinoma.
Nanashima A, Isomoto H, Abo T, Nonaka T, Morisaki T, Arai J, Takagi K, Ohnita K, Shoji H, Urabe S, Senoo T, Murakami G, Nagayasu T
Annals of translational medicine 2 ( 3 ) 23 2014.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Successful Colectomy for Hemorrhagic Colitis with Hemolytic Uremic Syndrome and Acute Encephalopathy due to Escherichia coli O157 Infection.
Tominaga T, Oikawa M, Takeshita H, Kunizaki M, Tou K, Abo T, Hidaka S, Nanashima A, Sawai T, Nagayasu T
Case reports in gastroenterology 8 ( 1 ) 82 - 8 2014.1
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Associated factors with surgical site infections after hepatectomy: predictions and countermeasures by a retrospective cohort study.
Nanashima A, Arai J, Oyama S, Ishii M, Abo T, Wada H, Takagi K, Tsuchiya T, Nagayasu T
International journal of surgery (London, England) 12 ( 4 ) 310 - 4 2014
Language：Japanese Publishing type：Research paper (scientific journal)
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A case of intestinal endometriosis with lymphovascular invasion
Tominaga T., Fukuda D., Takeshita H., To K., Abo T., Hidaka S., Nanashima A., Kinoshita N., Nagayasu T., Sawai T.
Japanese Journal of Gastroenterological Surgery 47 ( 6 ) 351 - 356 2014
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
Endometriosis is a rare disorder characterized by the presence of endometrial mucosa abnormally implanted in locations other than the uterine cavity. A 38-year-old woman who was admitted after complaining of abdominal pain and abdominal distention for three months underwent abdominal CT which revealed a tumor in the ileocecal area. Abdominal pain occurred during the menstrual cycle. Laboratory data revealed elevation of CA125. We performed ileocecal resection. Pathologically, ileocecal endometriosis with lymphovascular involvement was diagnosed. This case of intestinal endometriosis suggested lymhogenic progression. © 2014 The Japanese Society of Gastroenterological Surgery.
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Nanashima A., Abo T., Takagi K., Arai J., To K., Kunizaki M., Hidaka S., Takeshita H., Sawai T., Nagayasu T.
European Journal of Surgical Oncology 40 ( 11 ) 1540 - 1549 2014
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
© 2014 Elsevier Ltd. All rights reserved. Background: Prognostic influences of hepatic transection by an anterior approach using the liver hanging maneuver (LHM) has not been fully clarified. Methods: We examined 233 patients who underwent major hepatectomy with the LHM (n = 75; hepatocellular carcinoma (HCC) in 35, colorectal liver metastasis (CLM) in 10, intrahepatic cholangiocarcinoma (ICC) in 14 and perihilar bile duct carcinoma (BDC) in 16) or without it (n = 158; HCC in 78, CLM in 21, ICC in 31 and BDC in 28). Results: In HCC patients, cancer-positive margin rate, blood loss, transection time and prevalence of posthepatectomy ascites in the LHM group were significantly lower than those in the non-LHM group (p < 0.05). In CLM, transection time in the LHM group was significantly lower than that in the non-LHM group (p < 0.05). In BDC patients, amount of blood loss, transection time and prevalence of ascites in the LHM group were significantly lower than those in the non-LHM group (p < 0.05). In CLM patients, tumor recurrence rate in the non-LHM group was significantly higher than that in the LHM group and disease-free survival in the LHM group was significantly better than that in the non-LHM group in CLM patients and, however, this difference was not observed in a large CLM exceeding 5 cm. However, significant differences of posthepatectomy disease-free and overall survivals were not observed in HCC, ICC and BDC patients. Conclusions: Although advantages of LHM improving surgical records in major anatomical liver resections were clarified, oncological advantages in the long-term survival of LHM was still uncertain in the hepatobiliary malignancies.
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To K., Takeshita H., Wakata K., Tominaga T., Kunizaki M., Abo T., Hidaka S., Nanashima A., Sawai T., Nagayasu T., Oka T.
Acta Medica Nagasakiensia 59 ( 3 ) 103 - 106 2014
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2015, Nagasaki University School of Medicine. All rights reserved. Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer, but it is not generally used for colorectal lesions because of its high risk of adverse events. An unanticipated adverse event of rectal ESD is reported. A 71-year-old man was found to have a laterally spreading tumor at the upper rectum. ESD was performed. During the ESD, rectal perforation occurred, and emergency laparoscopic surgery was performed. At the operation, rectal perforation with retroperitoneal emphysema was detected. Surprisingly, an 8-cm-long, lacerated wound was found at the cecum wall. It was thought to have been caused by heat injury due to ESD. The perforated site was resected, and the laceration of the cecum was repaired by extracorporeal suture. In patients with perforation during ESD, it is essential to keep in mind that other organs might have heat-induced injury, and the patient should be more carefully followed.
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Intratracheal Administration of Recombinant Human Keratinocyte Growth Factor Promotes Alveolar Epithelial Cell Proliferation during Compensatory Lung Growth in Rat.
Furukawa K, Matsumoto K, Nagayasu T, Yamamoto-Fukuda T, Tobinaga S, Abo T, Yamasaki N, Tsuchiya T, Miyazaki T, Kamohara R, Nanashima A, Obatake M, Koji T
Acta histochemica et cytochemica 46 ( 6 ) 179 - 85 2013.12
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Murakami G., Nanashima A., Nonaka T., Isomoto H., Takagi K., Arai J., Hatachi G., Abo T., Nagayasu T.
Acta Medica Nagasakiensia 58 ( 3 ) 73 - 77 2013.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Background: Photodynamic therapy (PDT) is an effective laser treatment for locally advanced carcinoma and is promising as neoadjuvant chemotherapy before surgery. The aim of this study was to clarify the adverse effects of PDT using a photosensitizer, talaporfin sodium (Laserphyrin®), for wound healing. Methodology: For PDT, a laser light with a wavelength of 660 nm and a frequency of 10 Hz with a total energy fluency of 60 J/cm 2 was used. Macroscopic and histological findings of wound healing after PDT were examined in vivo (4-week-old male BALB/c mice). Results: In Model 1, in which skin was cut at 0, 3, 7 days after PDT (n=3, each), wounds were similarly healed 7 days after cutting in all groups, and regenerating epithelium and the number of fibroblasts on histological findings were not different. In Model 2, in which skin defects were created before or after PDT, the size of the defects was larger at day 7 in the groups with skin defects before or after PDT in comparison with groups with no PDT. However, macroscopic wound healing at day 14 was complete in all groups and there were no significant differences among the groups by this point. Histological findings of skin defects at day 14 showed no significant difference in terms of regenerating epithelium and number of fibroblasts in each group with or without PDT. Conclusions: PDT did not influence wound healing and can be safely applied before surgical therapy. © 2006-2012 Nagasaki University Library.
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Functional liver reserve parameters predictive for posthepatectomy complications.
Nanashima A, Abo T, Arai J, Matsumoto H, Kudo T, Nagayasu T
The Journal of surgical research 185 ( 1 ) 127 - 35 2013.11
Language：Japanese Publishing type：Research paper (scientific journal)
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High expression of trimethylated histone H3 at lysine 27 predicts better prognosis in non-small cell lung cancer.
Chen X, Song N, Matsumoto K, Nanashima A, Nagayasu T, Hayashi T, Ying M, Endo D, Wu Z, Koji T
International journal of oncology 43 ( 5 ) 1467 - 80 2013.11
Language：Japanese Publishing type：Research paper (scientific journal)
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A case of perianal desmoplastic small round cell tumor
Tominaga T., Takeshita H., Takagi K., To K., Kunizaki M., Abo T., Hidaka S., Nanashima A., Nagayasu T., Sawai T.
Japanese Journal of Gastroenterological Surgery 46 ( 9 ) 700 - 707 2013.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
Desmoplastic small round cell tumor (DSRCT) is an uncommon, poor prognostic tumor which is found mainly in young adults. A 23-year-old woman was admitted to our hospital with a complaint of anal pain. Pelvic CT revealed a 50-mm tumor in the anal and swollen lymph nodes in the bilateral inguinal region. DSRCT was diagnosed by biopsy, and Mile's operation with bilateral inguinal lymph nodes dissection was performed. Though adjuvant radiation was performed to prevent recurrence of the disease, 6 months later, she experienced multiple distant metastasis. She was treated with multiagent chemotherapy (18 courses of VDC-IE, 13 courses of gemcitabine/docetaxel) which inhibited tumor growth for long periods. Here, we report a case of perianal DSRCT. © 2013 The Japanese Society of Gastroenterological Surgery.
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Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics.
Nanashima A, Abo T, Murakami G, Matsumoto A, Tou K, Takeshita H, Kunizaki M, Hidaka S, Sakamoto I, Hayashi H, Fukuda T, Kudo T, Nagayasu T
Abdominal imaging 38 ( 4 ) 785 - 92 2013.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Comparison of results between pylorus-preserving pancreaticoduodenectomy and subtotal stomach-preserving pancreaticoduodenectomy: report at a single cancer institute.
Nanashima A, Abo T, Sumida Y, Tobinaga S, Nonaka T, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 60 ( 125 ) 1182 - 8 2013.7
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Predictive parameters of intraoperative blood loss in patients who underwent pancreatectomy.
Nanashima A, Abo T, Hamasaki K, Wakata K, Kunizaki M, Nakao K, Tanaka K, Fukuda D, Nagasaki T, Tou K, Takeshita H, Hidaka S, Sawai T
Hepato-gastroenterology 60 ( 125 ) 1217 - 21 2013.7
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Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak?
Nanashima A, Abo T, Shibuya A, Tominaga T, Matsumoto A, Tou K, Kunizaki M, Takeshita H, Hidaka S, Tsuchiya T, Yamasaki N, Nagayasu T
HPB : the official journal of the International Hepato Pancreato Biliary Association 15 ( 7 ) 517 - 22 2013.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Correlation between morphological and functional liver volume in each sector using integrated SPECT/CT imaging by computed tomography and technetium-99m galactosyl serum albumin scintigraphy in patients with various diseases who had undergone hepatectomy.
Nanashima A, Abo T, Tobinaga S, Murakami G, Kido Y, Fukuda T, Tsuchiya T, Matsumoto H, Nagayasu T, Kudo T
Nuclear medicine communications 34 ( 7 ) 652 - 9 2013.7
Language：Japanese Publishing type：Research paper (scientific journal)
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A case of acinar cell carcinoma of the pancreas
Tominaga T., Nanashima A., Abo T., Wakata K., Hamasaki K., Kunizaki M., To K., Hidaka S., Takeshita H., Kinoshita N., Kudo T., Nagayasu T.
Acta Medica Nagasakiensia 58 ( 1 ) 25 - 28 2013.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Background Acinar cell carcinoma (ACC) is a very rare malignancy and represents only 1% to 2% of pancreatic exocrine carcinomas. At the time of diagnosis, 75% of ACC are resectable. Reliable data concerning effective adjuvant chemotherapy has not been established. Case presentation A 30-mm tumor in the pancreatic tail was incidentally discovered by computed tomography in a 71-yearold man. Several swollen lymph nodes were seen around the main tumor. Endoscopic retrograde cholangiopancreatography (ERCP) revealed disruption of the main pancreatic duct. The patient underwent curative resection (R0) with distal pancreatectomy and node dissection. Histopathological examination revealed ACC with lymph node metastases; adjuvant chemotherapy was performed with gemcitabine after surgery. Twelve months later, the patient showed no sign of recurrence. Conclusion The prognosis of ACC is dismal, although compared to ductal adenocarcinoma, the mean survival appears to be longer. Patients with advanced-stage ACC might benefit from gemcitabine-based adjuvant chemotherapy.
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NX-PVKA levels before and after hepatectomy of hepatocellular carcinoma as predictors of patient survival: a preliminary evaluation of an improved assay for PIVKA-II.
Nanashima A, Abo T, Taura N, Shibata H, Ichikawa T, Takagi K, Arai J, Oyama S, Nagayasu T
Anticancer research 33 ( 6 ) 2689 - 97 2013.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Recent advances and significance of intra-arterial infusion chemotherapy in non-resectable colorectal liver metastasis.
Nanashima A, Takeshita H, Abo T, Tou K, Tanaka K, Fukuda D, Kunizaki M, Hidaka S, Sawai T
Journal of gastrointestinal oncology 4 ( 2 ) 164 - 72 2013.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Abo T., Taura N., Shibata H., Ichikawa T., Takagi K., Arai J., Oyama S., Nagayasu T.
Anticancer Research 33 ( 6 ) 2689 - 2698 2013.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Although the protein-induced vitamin K absence or antagonist-II (PIVKA-II) is used as a prognostic marker in hepatocellular carcinoma (HCC), a newly-improved assay, NX-PVKA (PIVKA-II measured using P-11 and P-16 antibodies) and NX-PVKA-R (ratio of PIVKA-II and NXPVKA), are more accurate markers of PIVKA-II. We conducted a prospectively preliminary analysis of the relationship between NX-PVKA-R and clinicopathological parameters and prognosis in 22 patients with HCC who underwent hepatectomy and measured changes of this marker's levels after treatment. Median value of PIVKA-II (80 mAU/ml), NX-PVKA (60 mAU/ml), NX-PVKA-R (1.5) and NX-PVKA-D (difference of markers, 15 mAU/ml) were determined. Tumor relapse was observed in six patients, and the one year relapse-free survival rate was 88%. Correlation between PIVKA-II or alpha-fetoprotein levels and NX-PVKA, NX-PVKA-R or -D levels was significant (p < 0.001). NXPVKA- R was significantly correlated with tumor size (p < 0.05). In patients who underwent pre-treatment before hepatectomy, PIVKA-II, NX-PVKA and NX-PVKA-R tended to be higher than in patients without pre-treatment, but this difference was not significant (p > 0.10). For macroscopic findings, NX-PVKA-R for the confluent-nodular type was significantly higher than that for the simple-nodular type (p < 0.05). The tumor-free survival rate in the group with a high NX-PVKA-R was significantly lower than that in the group with a low NX-PVKA-R group (p < 0.05). In patients with tumor recurrence, postoperative NX-PVKA-R increased again. We conclude that a high value of NX-PVKA-R after hepatectomy for HCC reflects malignant potential and predicts early recur rence in patients with HCC.
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Clinical significances of cancer stem cells markers in patients with intrahepatic cholangiocarcinoma who underwent hepatectomy.
Nanashima A, Hatachi G, Tsuchiya T, Matsumoto H, Arai J, Abo T, Murakami G, Tominaga T, Takagi K, Nagayasu T
Anticancer research 33 ( 5 ) 2107 - 14 2013.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of examining hepatic functional volume using technetium-99m galactosyl serum albumin scintigraphy in hepatocellular carcinoma.
Nanashima A, Abo T, Kudo T, Sakamoto I, Hayashi H, Murakami G, Takeshita H, Hidaka S, Kido Y, Nagayasu T
Nuclear medicine communications 34 ( 5 ) 478 - 88 2013.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Synergic effect of photodynamic therapy using talaporfin sodium with conventional anticancer chemotherapy for the treatment of bile duct carcinoma.
Nonaka Y, Nanashima A, Nonaka T, Uehara M, Isomoto H, Abo T, Nagayasu T
The Journal of surgical research 181 ( 2 ) 234 - 41 2013.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Predictors of intraoperative blood loss in patients undergoing hepatectomy.
Nanashima A, Abo T, Hamasaki K, Wakata K, Kunizaki M, Tou K, Takeshita H, Hidaka S, Sawai T, Tsuchiya T, Nagayasu T
Surgery today 43 ( 5 ) 485 - 93 2013.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Novel powdered anti-adhesion material: preventing postoperative intra-abdominal adhesions in a rat model.
Takagi K, Araki M, Fukuoka H, Takeshita H, Hidaka S, Nanashima A, Sawai T, Nagayasu T, Hyon SH, Nakajima N
International journal of medical sciences 10 ( 4 ) 467 - 74 2013
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Usefulness of vessel-sealing devices combined with crush clamping method for hepatectomy: a retrospective cohort study.
Nanashima A, Abo T, Arai J, Takagi K, Matsumoto H, Takeshita H, Tsuchiya T, Nagayasu T
International journal of surgery (London, England) 11 ( 9 ) 891 - 7 2013
Language：Japanese Publishing type：Research paper (scientific journal)
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Photodynamic therapy using talaporfin sodium (Laserphyrin®) for bile duct carcinoma: a preliminary clinical trial.
Nanashima A, Abo T, Nonaka T, Nonaka Y, Morisaki T, Uehara R, Ohnita K, Fukuda D, Murakami G, Tou K, Kunizaki M, Hidaka S, Tsuchiya T, Takeshita H, Nakao K, Nagayasu T
Anticancer research 32 ( 11 ) 4931 - 8 2012.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Abo T., Nonaka T., Nonaka Y., Morisaki T., Uehara R., Ohnita K., Fukuda D., Murakami G., Tou K., Kunizaki M., Hidaka S., Tsuchiya T., Takeshita H., Nakao K., Nagayasu T.
Anticancer Research 32 ( 11 ) 4931 - 4938 2012.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
The efficacy of adjuvant photodynamic therapy (PDT) using the new photosensitizer, talaporfin sodium (TPS), was assessed in 7 patients with bile duct carcinoma (BDC). The 664-nm semiconductor laser (100 J/ cm 2 ) was applied through endoscopy to the tumor lesion within 6 h after injection of TPS. Cases included three nonresectable and 4 resected BDC with remnant cancer cells at the bile duct stump. Radiated lesions exhibited mild inflammatory responses. Locally advanced tumor occluding bile duct was relieved by PDT and patency was maintained for 16 months. Two patients developed mild photodermatitis but no severe morbidity. One patient died of other disease, and two patients died of liver metastasis within 6 months, but local recurrence was not observed. Three patients maintained cancer-free survival for 6-13 months. One patient survived with good status for 24 months. Adjuvant TPS-PDT is a safe and useful treatment for local control of BDC. Compared to the conventional PDT, the patient's quality of life is remarkably improved.
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Evaluation of surgical resection for gallbladder carcinoma at a Japanese cancer institute.
Nanashima A, Tobinaga S, Abo T, Morisaki T, Uehara R, Takeshita H, Nonaka T, Hidaka S, Takeshima F, Ohnita K, Isomoto H, Kunizaki M, Sawai T, Nakao K, Nagayasu T
Hepato-gastroenterology 59 ( 118 ) 1717 - 21 2012.9
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Three-dimensional fusion images of hepatic vasculature and bile duct used for preoperative simulation before hepatic surgery.
Nanashima A, Abo T, Sakamoto I, Hayashi H, Fukuda T, Tobinaga S, Araki M, Sawai T, Nagayasu T
Hepato-gastroenterology 59 ( 118 ) 1748 - 57 2012.9
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Safety of hepatectomy accompanying combined resection of other organs.
Nanashima A, Abo T, Takeshita H, Yamasaki N, Sawai T, Nagayasu T
Hepato-gastroenterology 59 ( 118 ) 1915 - 20 2012.9
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Relationship between microvessel count and clinicopathological characteristics and postoperative survival in patients with pancreatic carcinoma.
Nanashima A, Shibata K, Nakayama T, Abo T, Nonaka T, Fukuda D, Fukuoka H, Hidaka S, Takeshita H, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 59 ( 118 ) 1964 - 9 2012.9
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Single-incision laparoscopy-assisted subtotal gastrectomy for intractable gastric ulcer: a case report.
Nonaka T, Hidaka S, Takafumi A, Fukuoka H, Takeshita H, Atsushi N, Sawai T, Yasutake T, Nagayasu T
Surgical laparoscopy, endoscopy & percutaneous techniques 22 ( 4 ) e210 - 3 2012.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Extended right hepatectomy for hilar bile duct carcinoma using the modified liver hanging maneuver.
Nanashima A, Tobinaga S, Abo T, Nonaka T, Hidaka S, Takeshita H, Sawai T, Nagayasu T
Hepato-gastroenterology 59 ( 117 ) 1583 - 5 2012.7
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Does fibrin glue prevent biliary and pancreatic fistula after surgical resection?
Nanashima A, Tobinaga S, Kunizaki M, Nonaka T, Takeshita H, Hidaka S, Sawai T, Nagayasu T
Hepato-gastroenterology 59 ( 117 ) 1544 - 7 2012.7
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Distal pancreatectomy with en bloc celiac resection for locally advanced pancreas carcinoma.
Nanashima A, Abo T, Tomonaga T, Fukuda A, Kunizaki M, To K, Takeshita H, Hidaka S, Nagayasu T, Sakamoto I
Hepato-gastroenterology 59 ( 117 ) 1341 - 4 2012.7
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Comparison of postoperative morbidity in elderly patients who underwent pancreatic resection. Reviewed
Nanashima A, Abo T, Nonaka T, Hidaka S, Takeshita H, Morisaki T, Uehara R, Ohnita K, Takeshima F, Isomoto H, Sawai T, Nakao K, Nagayasu T
Hepato-gastroenterology 59 ( 116 ) 1141 - 1146 2012.6
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)
DOI： 10.5754/hge10777
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Portal vein anastomosis with parachute method in hepatectomy and pancreatectomy.
Nanashima A, Abo T, Kunizaki M, Takeshita H, Hidaka S, Sawai T, Nagayasu T
Hepato-gastroenterology 59 ( 116 ) 1000 - 2 2012.6
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Evaluation of surgical resection for pancreatic carcinoma at a Japanese single cancer institute.
Nanashima A, Tobinaga S, Abo T, Hatano K, Takeshita H, Nonaka T, Hidaka S, Tanaka K, Kunizaki M, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 59 ( 115 ) 911 - 5 2012.5
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Usefulness of omental wrapping to prevent biliary leakage and delayed gastric emptying in left hepatectomy.
Nanashima A, Tobinaga S, Abo T, Nonaka T, Kunizaki M, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 59 ( 115 ) 847 - 50 2012.5
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Experience of surgical resection for hilar cholangiocarcinomas at a Japanese single cancer institute.
Nanashima A, Tobinaga S, Abo T, Machino R, Takeshita H, Nonaka T, Hidaka S, Tanaka K, Kunizaki M, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 59 ( 114 ) 347 - 50 2012.3
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Diagnosis of small-bowel metastasis of hepatocellular carcinoma by double-balloon enteroscopy.
Kunizaki M, Hidaka S, Isomoto H, Takeshita H, Nanashima A, Sawai T, Yasutake T, Nagayasu T
International journal of surgery case reports 3 ( 7 ) 263 - 5 2012
Language：Japanese Publishing type：Research paper (scientific journal)
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Perioperative non-tumorous factors associated with survival in HCC patients who underwent hepatectomy.
Nanashima A, Abo T, Hamasaki K, Wakata K, Tominaga T, Hidaka S, Takeshita H, Nagayasu T
Anticancer research 31 ( 12 ) 4545 - 51 2011.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Abo T., Hamasaki K., Wakata K., Tominaga T., Hidaka S., Takeshita H., Nagayasu T.
Anticancer Research 31 ( 12 ) 4545 - 4551 2011.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Aim: To clarify perioperative factors associated with poor survival following hepatectomy. Patients and Methods: Clinical parameters and stress score, including surgical stress score (SSS) and comprehensive risk score (CRS) were examined from 183 hepatocellular carcinoma patients who underwent hepatectomy. Results: Factors associated with tumor relapse were increased blood loss/weight, uncontrolled ascites and grade B liver damage (p < 0.05). Ascites was identified as an independent risk factor by multivariate logistic regression analysis. Increased blood loss/weight, transfusion, high SSS, high CRS, ascites, and grade B liver damage were associated with poor disease-free survival (p < 0.05). Increased blood loss/weight, transfusion, ascites, and grade B liver damage were associated with poor overall survival (p < 0.05), and ascites, transfusion, male sex and grade B liver damage were identified as independent risk factors. Conclusion: Reducing blood loss and avoiding transfusion appear important for improving prognosis. Maintenance of liver function is necessary in cases showing poor liver function and uncontrolled ascites.
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Nanashima A., Abo T., Tobinaga S., Nonaka T., Nakao K., Hidaka S., Takeshita H., Fukuoka H., Sawai T., Yasutake T., Nagayasu T.
Acta Medica Nagasakiensia 56 ( 3 ) 93 - 97 2011.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Laparoscopic surgery is a less invasive treatment option for tumors in the intraabdominal organs; however, the safety and indication of laparoscopic or laparoscopy assisted pancreaticoduodenectomy (LPD) is still controversial. We attempted LPD in four cases for intraductal papillary mucinous neoplasm (IPMN) located in the pancreatic head and we report the surgical records and short-term outcome. LPD was carried out in four patients including three patients with the combined type IPMN and one with the branch type, based on the International Consensus Guidelines. None of the patients had invasive carcinoma based on preoperative imaging diagnosis. Laparoscopic procedures were performed until isolation of the pancreas head and duodenum, and final resection of PD and intestinal reconstruction were performed using small incision laparotomy (7-8cm). The mean total operating time was 882 minutes (820-932 minutes), mean blood loss was 925ml (610-1550ml) and red cell transfusion was not required in any patients. One patient underwent reoperation for bleeding at the pancreaticojejunostomy site at day 1. Mean duration until patients were able to walk was 3.5 days (2-6 days) and duration of use of analgesia was limited to within 7 days. Grade B pancreatic fistula was observed in one patient and jejunal ileus was observed in one patient. There were no deaths. LPD was safely performed and blood loss was limited, although the operating time was long. Postoperative recovery in patients without complications might be better than the conventional PD under laparotomy. Future study is necessary.
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Predictive factor for photodynamic therapy effects on oral squamous cell carcinoma and oral epithelial dysplasia.
Uehara M, Ikeda H, Nonaka M, Sumita Y, Nanashima A, Nonaka T, Asahina I
Archives of oral biology 56 ( 11 ) 1366 - 72 2011.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Tumor marker levels before and after curative treatment of hepatocellular carcinoma as predictors of patient survival.
Nanashima A, Taura N, Abo T, Ichikawa T, Sakamoto I, Nagayasu T, Nakao K
Digestive diseases and sciences 56 ( 10 ) 3086 - 100 2011.10
Language：Japanese Publishing type：Research paper (scientific journal)
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A case report of necrosis of the gastric remnant after distal gastrectomy
Nonaka T., Hidaka S., Fukuoka H., Abo T., Takeshita H., Nanashima A., Sawai T., Yasutake T., Nagayasu T.
Japanese Journal of Gastroenterological Surgery 44 ( 7 ) 829 - 835 2011.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
The patient was a 65-year-old man who had received laparoscopy-assisted high anterior resection for advanced rectal cancer and distal gastrectomy without splenectomy for early gastric cancer at the same time. We could not point out any findings of ischemic change or anastomosis leakage in the early postoperative period. However, on POD 15, gastroscopic examination showed extensive mucosal necrosis mainly around the anastomotic region in the gastric remnant. Based on these findings, we performed total gastrectomy on POD 21. Ischemic necrosis of the gastric remnant is a rare and serious complication of distal gastrectomy. It is hoped that early diagnosis by a gastroscopy in the early postoperative period will help to save patients in which this complication is suspected. © 2011 The Japanese Society of Gastroenterological Surgery.
DOI： 10.5833/jjgs.44.829
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Esophagectomy in a patient with intestinal malrotation and interrupted inferior vena cava
Tominaga T., Hidaka S., Tanaka K., Taguchi T., Nanashima A., Sawai T., Yasutake T., Nagayasu T.
Japanese Journal of Gastroenterological Surgery 44 ( 8 ) 955 - 962 2011.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
A 48-year-old man was referred to us because of a tumor in the esophagus. Abdominal CT and Chest CT revealed multiple abnormalities, intestinal malrotation, interrupted inferior vena cava, dilated azygous vein, and polysplenia. We performed esophagectomy with lymph nodes dissection, splenectomy and, retrosternal reconstruction with a gastric tube. He was discharged on postoperative day 32. It has been reported that patients with intestinal malformation occasionally have some other abnormality, Therefore esophagectomy in such cases could be more difficult. Preoperatively, we defined the abnormalities, and carefully planned the optimal operative procedure and approach. Esophagectomy was successfully performed in this patient with intestinal malrotation. © 2011 The Japanese Society of Gastroenterological Surgery.
DOI： 10.5833/jjgs.44.955
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Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery?
Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, Ichikawa T, Sawai T, Yasutake T, Nakao K, Nagayasu T
Journal of surgical oncology 104 ( 3 ) 284 - 91 2011.9
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Prediction of indocyanine green retention rate at 15 minutes by correlated liver function parameters before hepatectomy.
Nanashima A, Abo T, Tobinaga S, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, Sawai T, Yasutake T, Nagayasu T, Kudo T
The Journal of surgical research 169 ( 2 ) e119 - 25 2011.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Advantages of laserphyrin compared with photofrin in photodynamic therapy for bile duct carcinoma.
Nonaka T, Nanashima A, Nonaka M, Uehara M, Isomoto H, Nonaka Y, Nagayasu T
Journal of hepato-biliary-pancreatic sciences 18 ( 4 ) 592 - 600 2011.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Distal gastrectomy for advanced gastric cancer with vascular anomaly after coronary bypass grafting using the right gastroepiploic artery.
Kunizaki M, Hidaka S, Nonaka T, Takagi K, Tobinaga S, Takeshita H, Nanashima A, Sawai T, Yasutake T, Nagayasu T
American journal of surgery 201 ( 5 ) e35 - 7 2011.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Left hepatectomy accompanied by a resection of the whole caudate lobe using the dorsally fixed liver-hanging maneuver.
Nanashima A, Tobinaga S, Abo T, Sawai T, Nagayasu T
Surgery today 41 ( 3 ) 453 - 8 2011.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Intraductal papillary growth of liver metastasis originating from colon carcinoma in the bile duct: report of a case.
Nanashima A, Tobinaga S, Araki M, Kunizaki M, Abe K, Hayashi H, Harada K, Nakanuma Y, Nakagoe T, Takeshita H, Sawai T, Nagayasu T
Surgery today 41 ( 2 ) 276 - 80 2011.2
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of sonazoid-ultrasonography during hepatectomy in patients with liver tumors: A preliminary study.
Nanashima A, Tobinaga S, Abo T, Kunizaki M, Takeshita H, Hidaka S, Taura N, Ichikawa T, Sawai T, Nakao K, Nagayasu T
Journal of surgical oncology 103 ( 2 ) 152 - 7 2011.2
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Preoperative diagnosis of lymph node metastasis in biliary and pancreatic carcinomas: evaluation of the combination of multi-detector CT and serum CA19-9 level.
Nanashima A, Sakamoto I, Hayashi T, Tobinaga S, Araki M, Kunizaki M, Nonaka T, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Digestive diseases and sciences 55 ( 12 ) 3617 - 26 2010.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Relationship of hepatic functional parameters with changes of functional liver volume using technetium-99m galactosyl serum albumin scintigraphy in patients undergoing preoperative portal vein embolization: a follow-up report.
Nanashima A, Tobinaga S, Abo T, Sumida Y, Araki M, Hayashi H, Sakamoto I, Kudo T, Takeshita H, Hidaka S, Sawai T, Hatano K, Nagayasu T
The Journal of surgical research 164 ( 2 ) e235 - 42 2010.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Evaluation of surgical resection for ampullar carcinoma at Japanese single cancer institute
Nanashima A., Tobinaga S., Abo T., Ohnita K., Norimura D., Yajima H., Takeshita H., Nonaka T., Hidaka S., Takeshima F., Yamaguchi N., Isomoto H., Sawai T., Nakao K., Nagayasu T.
Acta Medica Nagasakiensia 55 ( 1 ) 23 - 28 2010.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Aims: Surgical resection is the only radical treatment option for duodenal ampullar carcinoma (AC) that results in an improved patient prognosis. Method: We examined the demographics, surgical records, and outcome in 23 patients with AC undergoing pancreaticoduodenectomy (PD). Results: Of 23 patients, 17 underwent pylorus preserving PD (PPPD) and 6 underwent PD, including subtotal stomach-preserving PD in 5. D2 lymphadenectomy was performed in 17 patients and D3 lymphadenectomy was performed in 6. The combined resection of the superior mesenteric vein was performed in 1 patient. Postoperative cancer recurrence was observed in 32%, and 6 patients died of cancer. The 3-year tumor-free survival rates were not different between the final stages (p=0.64) and the 5-year cancer-related overall survival rates were not different between stages either (p=0.28). Tumor size?3cm resulted in significantly poorer survival rate compared to smaller tumors (p=0.032). Node metastasis at Group 2, and moderately or poorly differentiated adenocarcinoma were significantly associated with poor survival (p < 0.05); however, cancer infiltration at cut-end margin, degree of node dissection and curability were not associated with overall prognosis. Conclusions: Radical surgical resection showed good patient prognosis; however, new adjuvant chemotherapy is a promising modality to improve patient survival in AC patients with poor prognostic factors. © 2006 Nagasaki University Library.
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Long-term results of chest wall reconstruction with DualMesh.
Nagayasu T, Yamasaki N, Tagawa T, Tsuchiya T, Miyazaki T, Nanashima A, Obatake M, Yano H
Interactive cardiovascular and thoracic surgery 11 ( 5 ) 581 - 4 2010.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function.
Nanashima A, Tobinaga S, Abo T, Nonaka T, Takeshita H, Hidaka S, Sawai T, Nagayasu T
Journal of hepato-biliary-pancreatic sciences 17 ( 6 ) 871 - 8 2010.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Effects of photodynamic therapy for superficial esophageal squamous cell carcinoma in vivo and in vitro.
Kawazoe K, Isomoto H, Yamaguchi N, Inoue N, Uehara R, Matsushima K, Ichikawa T, Takeshima F, Nonaka T, Nanashima A, Nagayasu T, Uehara M, Asahina I, Nakao K
Oncology letters 1 ( 5 ) 877 - 882 2010.9
Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.3892/ol_00000155
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Stepwise education for pancreaticoduodenectomy for young surgeons at a single Japanese institute.
Sumida Y, Nanashima A, Abo T, Tobinaga S, Araki M, Kunizaki M, Nonaka T, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 57 ( 102-103 ) 1046 - 51 2010.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of the combination procedure of crash clamping and vessel sealing for hepatic resection.
Nanashima A, Tobinaga S, Abo T, Nonaka T, Sawai T, Nagayasu T
Journal of surgical oncology 102 ( 2 ) 179 - 83 2010.8
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Measurement of serum marker for bone metastasis (1-CTP) in hepatobiliary and pancreas malignancies.
Nanashima A, Takeshita H, Tobinaga S, Araki M, Sumida Y, Kunizaki M, Tanaka K, Abo T, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 57 ( 101 ) 694 - 7 2010.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Measurement of serum marker for bone metastasis (1-CTP) in hepatobiliary and pancreas malignancies Reviewed
Nanashima A., Takeshita H., Tobinaga S., Araki M., Sumida Y., Kunizaki M., Tanaka K., Abo T., Hidaka S., Sawai T., Yasutake T., Nagayasu T.
Hepato-Gastroenterology 57 ( 101 ) 694 - 697 2010.7
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (1CTP) is a sensitive serum marker for metastatic bone carcinomas and may also be associated with invasiveness of various carcinomas. To clarify the significance of 1CTP in hepato-biliary pancreas malignancies, we examined the relationship between clinicopathological features and serum level of 1CTP. Methodology: The subjects were 75 patients who underwent surgical resections including 27 patients with liver carcinomas, 15 with extra-hepatic biliary carcinomas, 14 pancreatic carcinomas and 19 benign diseases. Results: 1CTP level tended to be higher in the malignant diseases than in benign diseases but this difference was not significant (p=0.065). Compared to benign adenoma, 1CTP level in the malignant diseases was significantly higher (p=0.049). 1CTP level tended to be higher in patients with cholangitis compared to those with no inflammation or benign tumors (p=0.065). 1CTP was not correlated with any tumor markers. 1CTP was not associated with node status and vascular infiltrations. 1CTP level tended to be lower in patients with poor differentiation. Conclusions: Serum level of 1CTP might be a predictive marker for hepatobiliary pancreas malignancies but also reflects the degree of co-existing cholangitis. © H.G.E. Update Medical Publishing S.A.
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Expression of keratinocyte growth factor and its receptor in rat tracheal cartilage: possible involvement in wound healing of the damaged cartilage.
Abo T, Nagayasu T, Hishikawa Y, Tagawa T, Nanashima A, Yamayoshi T, Matsumoto K, An S, Koji T
Acta histochemica et cytochemica 43 ( 3 ) 89 - 98 2010.6
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Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy.
Nanashima A, Tobinaga S, Kunizaki M, Miuma S, Taura N, Takeshita H, Hidaka S, Sawai T, Nakao K, Nagayasu T
Journal of surgical oncology 101 ( 7 ) 557 - 63 2010.6
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Analysis of apoptotic effects induced by photodynamic therapy in a human biliary cancer cell line.
Nonaka T, Nanashima A, Nonaka M, Uehara M, Isomoto H, Asahina I, Nagayasu T
Anticancer research 30 ( 6 ) 2113 - 8 2010.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of measuring hepatic functional volume using technetium-99m galactosyl serum albumin scintigraphy in hilar bile duct carcinoma.
Nanashima A, Tobinaga S, Abo T, Sakamoto I, Hayashi H, Sawai T, Takeshita H, Hidaka S, Nagayasu T
Clinical journal of gastroenterology 3 ( 3 ) 174 - 8 2010.6
Language：Japanese Publishing type：Research paper (scientific journal)
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A case of intrahepatic clear cell cholangiocarcinoma.
Toriyama E, Nanashima A, Hayashi H, Abe K, Kinoshita N, Yuge S, Nagayasu T, Uetani M, Hayashi T
World journal of gastroenterology 16 ( 20 ) 2571 - 6 2010.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Selecting treatment for hepatocellular carcinoma based on the results of hepatic resection and local ablation therapy.
Nanashima A, Tobinaga S, Masuda J, Miyaaki H, Taura N, Takeshita H, Hidaka S, Sawai T, Nakao K, Nagayasu T
Journal of surgical oncology 101 ( 6 ) 481 - 5 2010.5
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Down-regulation of microRNA 10a expression in esophageal squamous cell carcinoma cells.
Inoue N, Isomoto H, Matsushima K, Hayashi T, Kunizaki M, Hidaka S, Machida H, Mitsutake N, Nanashima A, Takeshima F, Nakayama T, Ohtsuru A, Nakashima M, Nagayasu T, Yamashita S, Nakao K, Kohno S
Oncology letters 1 ( 3 ) 527 - 531 2010.5
Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.3892/ol_00000093
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Relationship between period of survival and clinicopathological characteristics in patients with hepatocellular carcinoma who underwent hepatectomy.
Nanashima A, Abo T, Tobinaga S, Kunizaki M, Hidaka S, Nonaka T, Miuma S, Taura N, Miyaaki H, Nakashima M, Sawai T, Nakao K, Nagayasu T
Hepato-gastroenterology 57 ( 99-100 ) 540 - 6 2010.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Comparison of outcome of hepatectomy with thoraco-abdominal or abdominal approach.
Nanashima A, Tobinaga S, Abo T, Takeshita H, Hidaka S, Sawai T, Nagayasu T
Hepato-gastroenterology 57 ( 98 ) 336 - 43 2010.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Peyer's Patches in the Terminal Ileum in Ulcerative Colitis: Magnifying Endoscopic Findings.
Ishii H, Isomoto H, Shikuwa S, Hayashi T, Inoue N, Yamaguchi N, Ohnita K, Nanashima A, Ito M, Nakao K, Kohno S
Journal of clinical biochemistry and nutrition 46 ( 2 ) 111 - 8 2010.3
Language：Japanese Publishing type：Research paper (scientific journal)
DOI： 10.3164/jcbn.09-77
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[Evaluation of local coagulation therapy with hepatectomy for liver metastases].
Tobinaga S, Nanashima A, Araki M, Hidaka S, Kunizaki M, Takeshita H, Sawai T, Yasutake T, Nagayasu T
Gan to kagaku ryoho. Cancer & chemotherapy 36 ( 12 ) 2042 - 4 2009.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Evaluation of local coagulation therapy with hepatectomy for liver metastases
Tobinaga S., Nanashima A., Araki M., Hidaka S., Kunizaki M., Takeshita H., Sawai T., Yasutake T., Nagayasu T.
Japanese Journal of Cancer and Chemotherapy 36 ( 12 ) 2042 - 2044 2009.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Cancer and Chemotherapy
Hepatectomy is accepted as the standard therapy in patients with resectable liver metastases. In recent years, the techniques such as microwave coagulation therapy (MCT) and radiofrequency ablation therapy (RFA) have been developed, so we have many options to treat. We evaluated nineteen subjects with cases of liver metastases who underwent ther-moablative procedures with or without hepatectomy. RFA and MCT were used in 6 cases and 2 cases, respectively. In other 11 cases, they received a combined therapy: RFA + hepatectomy in 5 cases, and MCT + hepatectomy in 6 cases. Ther-moablative therapy was used for 39 metastatic tumors. The mean tumor size was 13.7 mm, and a local recurrence was observed in 8 nodules (21 %). No significant differences were observed in DFS and OS between thermoablative therapy and hepatectomy. Many patients with liver metastases received a repeated treatment, so we have to care about the remnant liver function. We conclude that thermoablative therapy with hepatectomy seems to be a less invasive procedure and effective therapy.
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Double liver hanging manoeuvre for central hepatectomy.
Nanashima A, Tobinaga S, Araki M, Nonaka T, Abo T, Hidaka S, Takeshita H, Sawai T, Nagayasu T
HPB : the official journal of the International Hepato Pancreato Biliary Association 11 ( 6 ) 529 - 31 2009.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Simultaneous hepatic and pulmonary resection for metastatic colonic carcinoma under thoraco-laparotomy with right oblique incision: case report.
Nanashima A, Sumida Y, Yamasaki N, Takeshita H, Tagawa T, Tobinaga S, Araki M, Kunizaki M, Sawai T, Nagayasu T
Hepato-gastroenterology 56 ( 94-95 ) 1362 - 5 2009.9
Language：Japanese Publishing type：Research paper (scientific journal)
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A case report of solitary hamartomatous polyp of the Appendix
Nonaka T., Fukuoka H., Takeshita H., Sawai T., Hayashi T., Hidaka S., Nanashima A., Yasutake T., Nagayasu T.
Japanese Journal of Gastroenterological Surgery 42 ( 9 ) 1523 - 1527 2009.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
We report a very rare case of hamartomatous polyp of the appendix. A 60-year-old man admitted for an appendiceal tumor found in endoscopy was also found to have a tumor with a stalk in the cecum. Barium enema studied showed polypoid lesions at the cecum, with enhanced computed tomography (CT) indicating a tumor. Based on these findings, we conducted laparoscopy-assisted ileocecal resection. Histologically, the tumor was not malignant and the polypoid showed excessive hyperplasia and a prominent core consisting of branching bands of smooth muscle derived from the muscularis mucosae. The polyp was diagnosed as a hamartomatous polyp. © 2009 The Japanese Society of Gastroenterological Surgery.
DOI： 10.5833/jjgs.42.1523
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Cholecystitis caused by a fish bone.
Kunizaki M, Kusano H, Azuma K, Fukuoka H, Araki M, Hidaka S, Nanashima A, Sawai T, Yasutake T, Nagayasu T
American journal of surgery 198 ( 2 ) e20 - 2 2009.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Relationship between microvessel count and postoperative survival in patients with intrahepatic cholangiocarcinoma. Reviewed
Nanashima A, Shibata K, Nakayama T, Tobinaga S, Araki M, Kunizaki M, Takeshita H, Hidaka S, Sawai T, Nagayasu T, Tagawa T
Annals of surgical oncology 16 ( 8 ) 2123 - 2129 2009.8
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)
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Clinical significance of microvessel count in patients with metastatic liver cancer originating from colorectal carcinoma.
Nanashima A, Shibata K, Nakayama T, Tobinaga S, Araki M, Kunizaki M, Takeshita H, Hidaka S, Sawai T, Nagayasu T, Yasutake T
Annals of surgical oncology 16 ( 8 ) 2130 - 7 2009.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Evaluation of new prognostic staging systems (SLiDe score) for hepatocellular carcinoma patients who underwent hepatectomy.
Nanashima A, Omagari K, Sumida Y, Abo T, Fukuoha H, Takeshita H, Hidaka S, Tanaka K, Sawai T, Yasutake T, Nagayasu T, Mizuta Y, Ohba K, Ohnita K, Kadokawa Y
Hepato-gastroenterology 56 ( 93 ) 1137 - 40 2009.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Omagari K., Sumida Y., Abo T., Fukuoka H., Takeshita H., Hidaka S., Tanaka K., Sawai T., Yasutake T., Nagayasu T., Mizuta Y., Ohba K., Ohnita K., Kadokawa Y.
Hepato-Gastroenterology 56 ( 93 ) 1137 - 1140 2009.7
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: A new prognostic staging system, the SLiDe (S, stage; Li, liver damage; De, des-gamma-carboxy prothrombin) score was recently proposed. We examined 207 HCC patients following hepatic resection to determine the usefulness of this staging system for HCC patients after surgery. Methodology: Disease-free and overall survival rates were calculated according to the Kaplan-Meier method, and differences between groups were tested for significance using the log-rank test. Results: Regarding disease-free survival, there were no significant differences in survival between SLiDe score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.01) and between 2-3 vs 4-5 (p < 0.01). Regarding overall survival, there were no significant differences in survival between score 0 vs 1, between score 2 vs 3, and between score 4 vs 5. There were significant differences between 0-1 vs 2-3 (p < 0.05) and between 2-3 vs 4-5 (p < 0.01). Conclusions: The SLiDe score, a staging system that combines tumor factors, a tumor marker and hepatic function, might be a better predictor of prognosis in HCC patients who have undergone hepatic resection. © H.G.E. Update Medical Publishing S.A.
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Characteristics of bile duct carcinoma with superficial extension in the epithelium.
Nanashima A, Sumida Y, Tobinaga S, Abo T, Takeshita H, Sawai T, Hidaka S, Fukuoka H, Nagayasu T
World journal of surgery 33 ( 6 ) 1255 - 8 2009.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Clinical significance of portal vein embolization before right hepatectomy.
Nanashima A, Sumida Y, Abo T, Nonaka T, Takeshita H, Hidaka S, Sawai T, Yasutake T, Sakamoto I, Nagayasu T
Hepato-gastroenterology 56 ( 91-92 ) 773 - 7 2009.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Treatment of concomitant gastric varices in patients with hepatocellular carcinoma at a single Japanese institute.
Nanashima A, Sumida Y, Abo T, Shibata K, Tomoshige K, Takeshita H, Hidaka S, Fukuoka H, Mochinaga K, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 56 ( 91-92 ) 857 - 60 2009.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Three-dimensional cholangiography applying C-arm computed tomography in bile duct carcinoma: a new radiological technique.
Nanashima A, Abo T, Sakamoto I, Makino K, Sumida Y, Sawai T, Nagayasu T
Hepato-gastroenterology 56 ( 91-92 ) 615 - 8 2009.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Araki M., Tobinaga S., Kunizaki M., Hidaka S., Shibata K., Mochinaga K., Sawai T., Isomoto H., Ohnita K., Uehara M., Nagayasu T.
European Journal of Surgical Oncology 35 ( 5 ) 504 - 509 2009.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
Aim: Cancer death in the early period after hepatectomy still occurs in patients with colorectal liver metastasis (CLM). We examined the relationship between clinicopathological parameters and survival periods in 130 CLM patients who underwent hepatectomy. Patients/methods: Patients were divided into four groups: Group 1 (5-year survivors without tumor relapse), Group 2 (survivors at 2-5 years), Group 3 (cancer death at 2-5 years), and Group 4 (cancer death within 2 years). Results: A short surgical margin was frequent in Group 4 compared to Group 1 (31 vs. 78%, P < 0.05). Primary node-positive status, absence of fibrous pseudo-capsular formation, higher Clinical Risk Score, and tumor recurrence within 12 months were frequent in Group 4 (P < 0.05). Multivariate analysis revealed a short surgical margin (HR; 3.5) and early tumor relapse (HR; 5.9) as independently significant related parameters (P < 0.05). Conclusions: Sufficient surgical margins and careful follow-up for early tumor relapse may be important for improving postoperative outcomes for CLM patients. © 2009 Elsevier Ltd. All rights reserved.
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Clinical significance of measuring urinary sulfated bile acids in adult patients with hepatobiliary diseases.
Nanashima A, Obatake M, Sumida Y, Abo T, Yamane Y, Nomura M, Yuhio I, Sawai T, Takeshita H, Hidaka S, Yasutake T, Nagayasu T
Hepato-gastroenterology 56 ( 90 ) 299 - 302 2009.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Vascular transection using endovascular stapling in hepatic resection.
Nanashima A, Sumida Y, Oikawa M, Murakami G, Abo T, Hidaka S, Takeshita H, Sawai T, Nagayasu T
Hepato-gastroenterology 56 ( 90 ) 498 - 500 2009.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness and limitation of laparoscopic assisted hepatic resections: a preliminary report.
Nanashima A, Sumida Y, Oikawa M, Nonaka T, Abo T, Takeshita H, Hidaka S, Fukuoka H, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 56 ( 90 ) 447 - 51 2009.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Trisectionectomy for large hepatocellular carcinoma using the liver hanging maneuver
Nanashima A., Sumida Y., Abo T., Takeshita H., Hidaka S., Sawai T., Yasutake T., Nagayasu T.
European Journal of Surgical Oncology 35 ( 3 ) 326 - 330 2009.3
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
Background/Purpose: Large liver tumors often expand and severely compress intrahepatic vessels. In cases of the trisectionectomy for such tumors, however, it is difficult to adequately expose the transection planes. The liver hanging maneuver (LHM) is a useful technique for hemihepatectomy and an adequate transection plane might be also required in trisectionectomy. Methods: LHM procedure is basically followed by the Belghiti's method. A nasogastric tube was used for hanging. At the hepatic hilum, the tube was placed between the liver and Glisson's pedicle. Results: We report here the application of LHM for right and left trisectionectomy in patients with a large hepatoma in two cases. In case of a right trisectionectomy for a large tumor compressing the umbilical Glisson's pedicle, an adequate transection plane was obtained using the LHM because the resected and remnant livers rotated to the other side upon lifting the tube during transection. In case of a left trisectionectomy for a large hepatic tumor compressing the right hepatic vein, an adequate transection plane along the right hepatic vein was obtained using LHM as well. Conclusions: LHM is a useful surgical application for right and left trisectionectomy in patients with large liver tumors compressing the cut plane. © 2008 Elsevier Ltd. All rights reserved.
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An experience of treatment of postoperative biliary stricture at a single Japanese institute.
Nanashima A, Abo T, Sumida Y, Nonaka T, Tanaka K, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 56 ( 89 ) 43 - 6 2009.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness of measuring hepatic functional volume using Technetium-99m galactosyl serum albumin scintigraphy in bile duct carcinoma: report of two cases.
Nanashima A, Sumida Y, Abo T, Sakamoto I, Ogawa Y, Sawai T, Takeshita H, Hidaka S, Nagayasu T
Journal of hepato-biliary-pancreatic surgery 16 ( 3 ) 386 - 93 2009
Language：Japanese Publishing type：Research paper (scientific journal)
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Relationship between pattern of tumor enhancement and clinicopathologic characteristics in intrahepatic cholangiocarcinoma.
Nanashima A, Sumida Y, Abo T, Oikawa M, Murakami G, Takeshita H, Fukuoka H, Hidaka S, Nagayasu T, Sakamoto I, Sawai T
Journal of surgical oncology 98 ( 7 ) 535 - 9 2008.12
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Mihara Y., Nakayama T., Nanashima A., Kuroki T., Onizuka S., Ito M., Naruke Y., Hayashi T., Sanefuji H., Sekine I.
Acta Medica Nagasakiensia 53 ( 4 ) 89 - 95 2008.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Extrahepatic bile duct cancer is a high mortal malignancy. Angiopoietin (Ang) and its receptor Tie, which are known to contribute to angiogenesis, have recently been reported to participate in the proliferation and differentiation of malignant tumor cells. The aim of this study is to investigate the expression and the significance of Ang-1, 2 and Tie-2 in extrahepatic bile duct carcinoma cells. We used immunohistochemistry to study 119 cases of surgically resected human extrahepatic bile duct carcinoma, and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) to confirm the expression of Ang-1, 2 and Tie-2 mRNA. Among these 119 cases, 52 (43.7%), 50 (42.0%) and 89 (74.8%) cases showed positive staining for Ang-1, 2 and Tie-2, respectively, in bile duct carcinoma cells. In 38 cases of normal mucosa, 6 (15.8%), 10 (26.3%) and 9 (23.7%) cases were positive for Ang-1, 2 and Tie-2, respectively. The positivity for Ang-1 and Tie-2 in normal mucosa was significantly different from all carcinomas (p < 0.01 and p < 0.001, respectively). We found no significant correlation between Ang-1 and Ang-2 expression and other clinicopathological factors such as histological differentiation, grade of tumor invasion or survival rate after surgery. In contrast, Tie-2 expression correlated significantly with degree of desmoplasia, cancer stage and survival of patients. RT-PCR analyses of five surgically resected tumor samples and three human bile duct cancer cell lines all showed positive expression of Ang-1, 2 and Tie-2 mRNAs. High expressions of Ang-1, 2 and Tie-2 in human extrahepatic bile duct carcinoma cells suggested that Ang-Tie system may be involved in the progression of human bile duct cancer.
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Surgical experiences of intraductal papillary mucinous neoplasms of the pancreas at a single Japanese institute: characteristics of malignant histology.
Nanashima A, Sumida Y, Abo T, Oikawa M, Takeshita H, Hidaka S, Sawai T, Yasutake T, Kinoshita N, Hayashi T, Nagayasu T
Hepato-gastroenterology 55 ( 88 ) 2238 - 41 2008.11
Language：Japanese Publishing type：Research paper (scientific journal)
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A modified grading system for post-hepatectomy metastatic liver cancer originating from colorectal carcinoma.
Nanashima A, Sumida Y, Abo T, Tobinaga S, Takeshita H, Hidaka S, Yasutake T, Nagayasu T, Mine M, Sawai T
Journal of surgical oncology 98 ( 5 ) 363 - 70 2008.10
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Nanashima A., Sumida Y., Abo T., Nagasaki T., Tabinaga S., Fukuoka H., Takeshita H., Hidaka S., Tanaka K., Sawai T., Yasutake T., Nagayasu T.
Acta Chirurgica Belgica 108 ( 5 ) 532 - 537 2008.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Chirurgica Belgica
Aims : Anatomic resection, i.e., systematic removal of a liver segment confined by portal branches, is theoretically effective in eradicating intrahepatic metastasis of hepatocellular carcinoma (HCC). The procedure may reduce tumour recurrence and enhance survival of HCC patients. To determine the significance of anatomic resection for HCC patients, we retrospectively conducted a comparative analysis between anatomic (AR) and non-anatomic liver resection (NAR) in 113 Japanese HCC pa tients with a solitary tumour, a tumour located within one segment, absence or invasion of distal to second order branches of the portal vein, and absence or invasion of peripheral branches of the hepatic vein. Methods : Patients were divided into two groups, AR group (n = 49) and NAR group (n = 64). Results : The prevalence of liver damage Grade B in the NAR group was significantly greater than in the AR group (p < 0.05). Tumour-free and overall survival following liver resection was not significantly different between AR and NAR groups. In the NAR group, tumour-free and overall survival in patients with tumour exposure at the surgical margin was significantly lower than with a surgical margin greater than 0 mm (not exposed) (p < 0.05). Survival between the AR and NAR groups without tumour exposure at the surgical margin was similar. Conclusions : Anatomic resection is the theoretical aim. In HCC patients with impaired liver functions, limited liver resection without tumour exposure may provide longer tumour-free and overall survival.
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A case of intraductal papillary neoplasm of the bile duct with stromal invasion.
Nanashima A, Sumida Y, Tomoshige K, Takeshita H, Shibata K, Sawai T, Yasutake T, Kinoshita N, Hayashi T, Nakanuma Y, Nagayasu T
Case reports in gastroenterology 2 ( 3 ) 314 - 20 2008.9
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An experience of hepatopancreatoduodenectomy in patients with hepatobiliary malignancies.
Nanashima A, Nagasaki T, Sumida Y, Abo T, Tobinaga S, Takeshita H, Nonaka T, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 86-87 ) 1691 - 4 2008.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Usefulness and application of the liver hanging maneuver for anatomical liver resections.
Nanashima A, Sumida Y, Abo T, Nagayasu T, Sawai T
World journal of surgery 32 ( 9 ) 2070 - 6 2008.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Preoperative assessment of liver metastasis originating from colorectal carcinoma: is super paramagnetic iron oxide particles-magnetic resonance imaging (SPIO-MRI) useful for screening?
Nanashima A, Takeshita H, Sawai T, Sumida Y, Abo T, Tanaka K, Nonaka T, Sengyoku H, Hidaka S, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 86-87 ) 1750 - 3 2008.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Takeshita H., Sawai T., Sumida Y., Abo T., Tanaka K., Nonaka T., Sengyoku H., Hidaka S., Yasutake T., Nagayasu T.
Hepato-Gastroenterology 55 ( 86-87 ) 1750 - 1753 2008.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: Recently, early detection of liver tumors has been possible with improvement of various imaging techniques, and practical selection of imaging is clinically necessary to distinguish metastatic liver carcinoma (MLC) from colorectal carcinoma. Methodology: We retrospectively examined the diagnostic accuracy of enhanced computed tomography (eCT) and super paramagnetic iron oxide particles magnetic resonance imaging (SPIO-AMI) for 110 MLC lesions in 47 patients who underwent hepatic resection at a single Japanese cancer institute between 2000 and 2006, Sensitivity and positive predictive value (PPV) of both imaging techniques in comparison with resected specimens were analyzed. Fourteen cases were synchronous liver metastasis, which were resected simultaneously. Results: On a per patient basis, both eCT and SPIO-MRI showed a sensitivity of 85.1% 1 (40 of 47 patients) and PPV was 100%, respectively. On a per lesion basis, a sensitivity of SPIO-MRI (98/110 lesions; 89%) tended to be higher than that of eCT (92 of 110 lesions; 84%), but not statistically different (p=0.32). PPV, of SPIO-MRI (98 of 99 lesions; 99%) was not different from that of eCT (92 of 93; 99%). Twelve lesions in 7 patients that were not detected by both imaging methods were small lesions. PPV for liver cyst and non-timorous lesions was 99% by both imaging methods. Two liver cysts could be clearly diagnosed by SPIO-MRI only. Conclusions, We found no superiority of diagnosis with SPIO-MRI, which may not be conceptually useful for preoperative screening for MLC from colorectal carcinomas. SPIO-MRI may be useful to detect non-cancerous lesions as an adjuvant diagnostic tool with eCT. © H.G.E. Update Medical Publishing S.A., Athens-Stuttgart.
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Relationship between microvessel count and post-hepatectomy survival in patients with hepatocellular carcinoma.
Nanashima A, Nakayama T, Sumida Y, Abo T, Takeshita H, Shibata K, Hidaka S, Sawai T, Yasutake T, Nagayasu T
World journal of gastroenterology 14 ( 31 ) 4915 - 22 2008.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Nakayama T., Sumida Y., Abo T., Takeshita H., Shibata K., Hidaka S., Sawai T., Yasutake T., Nagayasu T.
World Journal of Gastroenterology 14 ( 31 ) 4915 - 4922 2008.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：World Journal of Gastroenterology
Aim: To elucidate the relationship between the microvessel count (MVC) by CD34 analyzed by immunohistochemical method and prognosis in hepatocel lular carcinoma (HCC) pat ients who underwent hepatectomy based on our preliminary study. Methods: We examined relationships between MVC and clinicopathological factors in 128 HCC patients. The modified Japan Integrated Staging score (mJIS) was applied to examine subsets of HCC patients. Results: Median MVC was 178/mm2, which was used as a cut-off value. MVC was not significantly associated with any clinicopathologic factors or postoperative recurrent rate. Lower MVC was associated with poor disease-free and overall survivals by univariate analysis (P = 0.039 and P = 0.087, respectively) and lower MVC represented an independent poor prognostic factor in disease-free survival by Cox's multivariate analysis (risk ratio, 1.64; P = 0.024), in addition to tumor size, vascular invasion, macroscopic finding and hepatic dysfunction. Significant differences in disease-free and overall survivals by MVC were observed in HCC patients with mJIS 2 (P = 0.046 and P = 0.0014, respectively), but not in those with other scores. Conclusion: Tumor MVC appears to offer a useful prognostic marker of HCC patient survival, particularly in HCC patients with mJIS 2. © 2008 The WJG Press. All rights reserved.
DOI： 10.3748/wjg.14.4915
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Clinicopathological features of "intraductal papillary neoplasm of the bile duct" and patient outcome after surgical resection.
Nanashima A, Kinoshita N, Nakanuma Y, Zen Y, Sumida Y, Abo T, Hidaka S, Takeshita H, Yasutake T, Hayashi T, Nagayasu T
Hepato-gastroenterology 55 ( 85 ) 1167 - 73 2008.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Anatomic resection of segments 5, 6 and 7 of liver for hepatocellular carcinoma: prior control of right paramedian Glisson.
Nanashima A, Sumida Y, Abo T, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 84 ) 1077 - 80 2008.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Hepatectomy and pancreatectomy with combined vascular resection in patients with hepato-biliary and pancreas diseases at a single cancer institute.
Nanashima A, Yamaguchi H, Sumida Y, Abo T, Tobinaga S, Tanaka K, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 84 ) 873 - 8 2008.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Yamaguchi H., Sumida Y., Abo T., Tobinaga S., Tanaka K., Takeshita H., Hidaka S., Sawai T., Yasutake T., Nagayasu T.
Hepato-Gastroenterology 55 ( 84 ) 873 - 878 2008.5
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: In advanced cancers of hepatobiliary and pancreatic lesions, major vascular resection and reconstruction are necessary to accomplish curative resection, which may provide better patient outcomes. Methodology: Surgical records, morbidity and mortality, and prognosis were examined in patients with combined vascular resection. Thirty-six patients underwent 18 hepatectomies and 18 pancreatectomies. Results: In 18 patients who underwent hepatic resection, the resected vessels were the portal vein (PV) in 10, vena cava or hepatic vein in 9 and right hepatic artery (RHA) in 3. An artificial graft was used in 2 to replace the vena cava. Vascular bypass was performed in 5 patients. Morbidity was due to biliary stricture in 1 patient and adult respiratory distress syndrome in another who died during hospital stay. Fourteen (82%) had cancer recurrence, of whom 12 died of cancer, one died of other disease, and 2 survived cancer-free. The 5-year survival was 28%. In 18 patients who underwent pancreatectomy, resected vessels were PV in 18 and RHA in 1. An artificial graft was used in 3 and vascular passive bypass was performed in 6. One patient died of sepsis after total pancreatectomy during hospital stay. Eleven (64%) had cancer recurrence, of whom 11 died of cancer, 2 died of other disease, and 4 survived cancer-free. The 3-year survival was 27%. Conclusions: Complete surgical resection (R0) combined with main vascular resection could be safely performed in many patients with disease of the hepatobiliary and pancreas, which achieved longer survival in some patients even in the advanced stage. © H.G.E. Update Medical Publishing S.A.
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Resection of segments 4, 5 and 8 for a cystic liver tumor using the double liver hanging maneuver. Reviewed
Nanashima A, Sumida Y, Abo T, Nonaka T, Sengyoku H, Sawai T, Yasutake T, Nagayasu T
Case Reports in Gastroenterology 2 ( 1 ) 60 - 66 2008.3
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Clinicopathology and prognosis of mucinous gastric carcinoma.
Hidaka S, Tanaka K, Takeshita H, Sumida Y, Fukuoka H, Abo T, Yano H, Nanashima A, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 82-83 ) 791 - 4 2008.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Surgical treatment and adjuvant chemotherapy in hepatocellular carcinoma patients with advanced vascular involvement.
Nanashima A, Sumida Y, Abo T, Nagasaki T, Ohba K, Kinoshita H, Tobinaga S, Kenji T, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 82-83 ) 627 - 32 2008.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Principle of perioperative management for hepatic resection and education for young surgeons.
Nanashima A, Sumida Y, Abo T, Tanaka K, Takeshita H, Hidaka S, Yano H, Sawai T, Obatake M, Yasutake T, Nagayasu T
Hepato-gastroenterology 55 ( 82-83 ) 587 - 91 2008.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Principle of perioperative management for hepatic resection and education for young surgeons
Nanashima A., Sumida Y., Abo T., Tanaka K., Takeshita H., Hidaka S., Yano H., Sawai T., Obatake M., Yasutake T., Nagayasu T.
Hepato-Gastroenterology 55 ( 82-83 ) 587 - 591 2008.3
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: An expert technique and special anatomical or physiological knowledge are needed in the field of hepatic surgery compared to other abdominal surgeries. The establishment of basic policy and operative techniques for hepatectomy and stepwise training for young hepatic surgeons are necessary. Methodology: We scheduled hepatic resection based on the indocyanine green retention rate at 15 minutes and volumetric analysis. Limited resection or preoperative portal vein embolization was often performed. Results: Between 1994 and December 2005, 338 hepatectomies were performed. Operative procedures included limited or segmental resection in 215 and hemihepatectomy or more extended hepatectomy in 123. Hyperbilirubinemia or hepatic failure after hepatectomy was observed in 15 (4%) and hospital death in 10 (3%). Although death from hepatic failure was observed in 9 of 152 (6%) between 1994 and 1999, the mortality rate has been improved since 2000 (1 of 186 [0.5%]). Senior residents start training with step by step hepatectomy from partial resection to sectionectomy. Hemi-hepatectomy for normal liver is finally permitted after technical consolidation. More complicated hepatectomy must be performed by experienced teaching surgeons. Conclusions: Competent operative techniques under experienced surgeons and the achievement of safe resection at each stage are the educational policy for hepatectomy. © H.G.E. Update Medical Publishing S.A.
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Selection of treatment modality for hepatocellular carcinoma according to the modified Japan Integrated Staging score.
Nanashima A, Masuda J, Miuma S, Sumida Y, Nonaka T, Tanaka K, Hidaka S, Sawai T, Nagayasu T
World journal of gastroenterology 14 ( 1 ) 58 - 63 2008.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Masuda J., Miuma S., Sumida Y., Nonaka T., Tanaka K., Hidaka S., Sawai T., Nagayasu T.
World Journal of Gastroenterology 14 ( 1 ) 58 - 63 2008.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：World Journal of Gastroenterology
Aim: To compare the prognosis of patients who underwent hepatectomy and ablation using the modified Japan Integrated Staging score (mJIS). Methods: We examined the clinicopathologic records and patient outcomes in 278 HCC patients including 226 undergoing hepatectomy and 52 undergoing ablation therapy. Results: Cirrhosis was more frequent in the ablation group. Tumor size, number and presence of vascular invasion were significantly higher in the operation group compared to the ablation group. The local recurrence rate adjacent to treated lesions was significantly higher in the ablation group compared to the operation group (P < 0.05). The 3- and 5-year survival rates in the ablation and the operation group were 66% and 78%, and 50% and 63%, respectively, but not significantly different. Over 50% survival rates were observed in patients with a mJIS score of 0-2 in both groups. However, survival rates with a score of 3-5 in both groups were significantly lower. Conclusion: According to the mJIS system, both local treatments could be selected for patients with a score of 0-2. However, for patients with a score more than 3, liver transplantation might be a better option in patients with HCC. © 2008 WJG. All rights reserved.
DOI： 10.3748/wjg.14.58
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Patient outcome and prognostic factors in intrahepatic cholangiocarcinoma after hepatectomy.
Nanashima A, Sumida Y, Abo T, Nagasaki T, Takeshita H, Fukuoka H, Sawai T, Tanaka K, Yasutake T, Nagayasu T
Hepato-gastroenterology 54 ( 80 ) 2337 - 42 2007.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Patient outcome and prognostic factors in intrahepatic cholangiocarcinoma after hepatectomy
Nanashima A., Sumida Y., Abo T., Nagasaki T., Takeshita H., Fukuoka H., Sawai T., Tanaka K., Yasutake T., Nagayasu T.
Hepato-Gastroenterology 54 ( 80 ) 2337 - 2342 2007.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: The present study was designed to provide a systematic analysis of prognosis of patients who underwent hepatic resection for intrahepatic cholangiocarcinoma (ICC). Methodology: Subjects were 36 consecutive ICC patients who had undergone hepatic resection between 1994 and 2005. The analyzed factors included various clinicopathological and surgical parameters, counts of microvessel stained for CD34 and expression of proliferative cell nuclear antigen. Results: The 1, 2, 3-year disease-free survival rates after surgery were 33, 18, and 0% and the 1, 3 and 5-year overall survival rates were 45, 29, and 8%. High CEA levels (≥10ng/mL), excessive intraoperative blood loss (≥1000mL) and presence of neighboring peritoneal dissemination were significantly associated with shorter disease-free survival (p < 0.05). High CEA levels, periductal invasion type, excessive intraoperative blood loss and non-fibrotic liver were significant factors associated with shorter overall survival (p < 0.05). Multivariate Cox proportional hazards regression model identified high CEA values, periductal invasive type, excessive intraoperative blood loss and non-fibrotic liver as significant and independent determinants of poor prognosis. Conclusions: Hepatic resection with minimal blood loss followed by close follow-up is a suitable strategy for management of ICC patients with poor prognostic factors. © H.G.E. Update Medical Publishing S.A.
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Clinicopathological characteristics of patients with hepatocellular carcinoma after hepatectomy: relationship with status of viral hepatitis.
Nanashima A, Abo T, Sumida Y, Takeshita H, Hidaka S, Furukawa K, Sawai T, Yasutake T, Masuda J, Morisaki T, Nagayasu T
Journal of surgical oncology 96 ( 6 ) 487 - 92 2007.11
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Laparotomy wound and anastomotic recurrences after resection for cecum cancer: A case report
Nakagoe T., Sawai T., Tsuji T., Tanaka K., Nanashima A., Shibasaki S., Yamaguchi H., Yasutake T., Ayabe Y.
Hepato-Gastroenterology 54 ( 79 ) 2037 - 2039 2007.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
We report herein the case of a 46-year-old man who developed recurrences in both the incisional laparotomy wound of the abdominal wall and the stapled anastomotic site following ileo-colonic resection for cecum cancer. The patient had initially undergone laparoscopic surgery but had converted to conventional open surgery. Intestinal reconstruction had been performed by stapled functional end-to-end anastomosis between the ileum and ascending colon. The implantation of exfoliated cancer cells during the operation may have caused recurrence. © H.G.E. Update Medical Publishing S.A.
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Ets-1 proto-oncogene as a potential predictor for poor prognosis of lung adenocarcinoma.
Yamaguchi E, Nakayama T, Nanashima A, Matsumoto K, Yasutake T, Sekine I, Nagayasu T
The Tohoku journal of experimental medicine 213 ( 1 ) 41 - 50 2007.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Right paramedian sectoriectomy using the double liver hanging maneuver.
Nanashima A, Sumida Y, Abo T, Yasutake T, Nagayasu T
Surgery 142 ( 3 ) 430 - 1 2007.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Ets-1 proto-oncogene as a potential predictor for poor prognosis of lung adenocarcinoma
Yamaguchi E., Nakayama T., Nanashima A., Matsumoto K., Yasutake T., Sekine I., Nagayasu T.
Tohoku Journal of Experimental Medicine 213 ( 1 ) 41 - 50 2007.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Tohoku Journal of Experimental Medicine
The protooncogene Ets-1 is a transcription factor that is known to regulate certain matrix metallo-proteinases and plasminogen activator, which have been associated with malignant behaviors in solid carcinomas. We hypothesized that Ets-1 expression is also associated with tumor progression and a worse prognosis in lung carcinoma patients. To clarify the role of the Ets-1 proto-oncogene, the expression of Ets-1 in non-small cell lung carcinomas using 156 paraffin-embedded specimens was determined in surgically resected tissue samples. Immunohistochemical staining showed Ets-1 expression in 82 cases of 150 carcinomas (53%): 36 of 52 (69%) squarnous cell carcinomas, 41 of 96 (43%) adenocarcinomas, and 5 of 8 (63%) other carcinomas. In adenocarcinomas, a higher proportion of acinar type expressed Ets-1 compared to papillary or alveolar type (p < 0.05). The proportion of adenocarcinoma that expressed Ets-1 increased with poorer histologic differentiation of the adenocarcinoma (p < 0.05). Ets-1 positive adenocarcinomas had a larger mean size than Ets-1 negative adenocarcinomas (p < 0.01). In adenocarcinoma patients, expression of Ets-1 was associated with disease-free (p = 0.09) and overall survivals (p < 0.05) after lung resection. Such relationship was not observed among squamous cell carcinoma patients. Our findings indicate that Ets-1 expression is related to histopathological differentiation, morphogenesis, and tumor progression of lung adenocarcinomas. Ets-1 appears to be a useful predictor of poor prognosis after surgical resection in lung adenocarcinoma patients. Ets-1 expression could be used to evaluate the malignant behaviors of lung adenocarcinomas. © 2007 Tohoku University Medical Press.
DOI： 10.1620/tjem.213.41
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Comparative study of anastomosis in pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy.
Nanashima A, Sumida Y, Abo T, Shindo H, Fukuoka H, Tanaka K, Takeshita H, Hidaka S, Sawai T, Yasutake T, Nagayasu T
Hepato-gastroenterology 54 ( 76 ) 1243 - 6 2007.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Clinicopathological and intraoperative parameters associated with postoperative hepatic complications.
Nanashima A, Sumida Y, Abo T, Tanaka K, Takeshita H, Hidaka S, Yano H, Sawai T, Obatake M, Yasutake T, Nagayasu T
Hepato-gastroenterology 54 ( 75 ) 839 - 43 2007.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Surgical treatments in cystic diseases of the liver: experience at a single center in Japan.
Nanashima A, Sumida Y, Abo T, Nagasaki T, Sawai T, Takeshita H, Hidaka S, Tanaka K, Yasutake T, Omagari K, Yoshimi K, Yanagi K, Nagayasu T
Hepato-gastroenterology 54 ( 75 ) 849 - 53 2007.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Advantages of thoracoabdominal approach by oblique incision for right-side hepatectomy.
Nanashima A, Sumida Y, Tobinaga S, Shindo H, Shibasaki S, Ide N, Tokunaga T, Tagawa T, Nakamura A, Nagayasu T
Hepato-gastroenterology 54 ( 73 ) 148 - 51 2007.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Thoracoscopy-assisted radiofrequency ablation liver cancer. Report of three cases.
Nanashima A, Sumida Y, Shindo H, Hidaka S, Tanaka K, Obatake M, Sawai T, Yasutake T, Nakamura A, Tagawa T, Nagayasu T
Hepato-gastroenterology 54 ( 73 ) 241 - 5 2007.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Thoracoscopy-assisted radiofrequency ablation for liver cancer. Report of three cases
Nanashima A., Sumida Y., Shindo H., Hidaka S., Tanaka K., Obatake M., Sawai T., Yasutake T., Nakamura A., Tagawa T., Nagayasu T.
Hepato-Gastroenterology 54 ( 73 ) 241 - 245 2007.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
To achieve complete ablation of liver cancer in the hepatic dome, thoracoscopy-assisted radiofrequency ablation was attempted in three patients. Under general anesthesia and left lateral position, a thoracoport site was placed in the 6th intercostal space and a small thoracotomy was placed in the 7th intercostal space. In all three cases, the liver cancer was located in the hepatic dome of segment 7/8 and the tumor could not be fully observed on the lung echogram. In Case 1, saline was infused into the thoracic cavity under thoracoscopic observation and percutaneous ablation was safely performed. In Cases 2 and 3, the right diaphragm was opened, guided by ultrasonography, and the electrode was inserted into this working space via the thoracotomy site. At day 7, complete ablation was confirmed by computed tomography. All patients recovered and were discharged after a short hospital stay without severe complications. Tumor recurrence has not been observed in any patient at this stage. For liver cancer located in the right subphrenic dome of the liver, thoracoscopy-assisted ablation is a safe and useful option particularly in patients with poor hepatic function. © H.G.E. Update Medical Publishing S.A.
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The right colon patch graft procedure for extensive intestinal aganglionosis
Obatake M., Nomura M., Inamura Y., Tanaka K., Miyazaki T., Nagasaki T., Nanashima A., Taura Y., Irie T., Yasutake T., Nagayasu T.
Acta Medica Nagasakiensia 51 ( 4 ) 129 - 132 2006.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Extensive intestinal aganglionosis is rare and very difficult to diagnose and treat. The condition is often fatal. A 6-month-old boy who had undergone ileostomy for extensive intestinal aganglionosis was referred to our department. We applied an aganglionic right colon onlay patch to the aganglionic intestine to enhance absorption of water and electrolytes. Three months after the ileocolostomy, the definitive operation, a Swenson-type procedure, was performed. The mesocolon to the onlay patch could be divided because blood supply was adequate from the ileal mesentery via the intestinal wall. Postoperatively, the onlay patch segment appeared normal on colonoscopy and bowel habit was improved. Although the patient still requires parenteral nutrition support due to the short bowel, the right colon onlay patch procedure enables him to be cared for at home and provides an opportunity for normal growth and development.
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A case of recurrent ampullar carcinoma undergoing photodynamic therapy after surgical resection
Sumida Y., Nanashima A., Abo T., Nagasaki T., Hidaka S., Takeshita H., Fukuoka H., Tanaka K., Sawai T., Yasutake T., Nagayasu T., Matsuo T., Shimizu K.
Acta Medica Nagasakiensia 51 ( 3 ) 111 - 114 2006.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
We report a successful treatment of photodynamic therapy in patients with remnant ampullar carcinoma who underwent local resection of duodenal papilla. A 56-year-old male patient showed ampullar carcinoma without invading pancreas or duodenum. Pancreatic body and tail were obviously atrophic and local resection of duodenal papilla was performed at associated hospital 3 months ago. However, a resected specimen showed the remnant carcinoma at the edge, and the follow-up endoscopy showed a protruding tumor in the resected portion. Similar to the resected specimen, endoscopic biopsy showed a well differentiated adenocarcinoma in this tumor. Since additional resection was difficult because of the pancreatic function, photodynamic therapy with laser beam of 630 nm wavelength by eximer dye laser (4 mJ/pulse, 40 Hz) was applied to the ampullar carcinoma through endoscope for consecutive two days. Follow-up endoscopy performed 4 weeks after photodynamic therapy showed a remarkable reduction of the tumor, and no cancer tissue was observed by a biopsy. Ablation with argon beam laser was additionally applied to the remnant mass region. Tumor recurrence was not observed for 8 months after photodynamic therapy.
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Nanashima A., Sumida Y., Abo T., Mazume H., Ikari H., Nagasaki T., Takeshita H., Sawai T., Hidaka S., Tanaka K., Yasutake T., Nagayasu T.
Acta Medica Nagasakiensia 51 ( 3 ) 105 - 110 2006.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Extent of hepatectomy for liver tumor is often limited in case the patient has an impaired liver function. We report here our experience in 2 patients with carcinoma involving hilar bile duct who have undergone limited liver resection. Case 1. 76-year-old male, who have had hepatitis C cirrhosis, showed in segment 4 a hepatocellular carcinoma of 4 cm in diameter. The tumor involved the right and left main hepatic ducts and obstructive jaundice was progressed. The patient had liver and respiratory dysfunctions and, therefore, limited resection of lower segments 4 and 5 and resection of hilar hepatic duct and the common bile duct were performed to avoid postoperative morbidity including liver failure. Histopathological diagnosis showed the tumor invasion and thrombus in major hepatic ducts and severe fibrosis in non-cancerous liver. In spite of long-term ascites, gastrointestinal bleeding or sepsis, liver functions were relatively maintained and the patient was discharged 3 months after surgery. Case 2. 64-year-old male, who had obstructive jaundice, showed a carcinoma in the common hepatic duct. After biliary drainage, however, liver dysfunction was not improved for a long period. The common hepatic duct including gall bladder was resected, and superficial spreading of the tumor to the right and left main bile duct was confirmed by the pathologic examination. Therefore, limited hepatic resection of lower segments 4 and 5 and resection of main hepatic ducts were additionally undergone. Although bile leakage of left hepatic duct occurred for 1 month, hepatic function was reserved and the patient was discharged 2 months after surgery. In conclusion, hepatic resection may be limited even in patient with carcinoma invading hilar bile duct in case the hepatic functional reserve is poor for major hepatectomy.
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Congenital intrathoracic kidney with right Bochdalek defect.
Obatake M, Nakata T, Nomura M, Nanashima A, Inamura Y, Tanaka K, Nagayasu T
Pediatric surgery international 22 ( 10 ) 861 - 3 2006.10
Language：Japanese Publishing type：Research paper (scientific journal)
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Sumida Y., Yamashita H., Inoue M., Ohsawa K., Sato H., Nanashima A., Nagayasu T.
Acta Medica Nagasakiensia 51 ( 2 ) 51 - 56 2006.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine essential for delayed hypersensitivity in vivo, and is involved in bronchiolitis obliterans and late rejection in lung transplantation. We tested here whether neutralization of MIF using anti-MIF antibody prevents such a response. We examined the MIF mRNA expression level and changes in allograft tracheal epithelium and intraluminal obstruction in a rat allograft model. Lewis rat (RT1 I ) underwent heterotopic tracheal transplantation from Brown Norway rats (RT1 n ) in the omentum. Anti-MIF antibody was injected in the peritoneum. Rats were divided into three groups (non-treated allograft, allograft treated with normal rabbit IgG and allograft treated with anti-MIF antibody). Implants were harvested on days 7 or 21 for histological analysis. MIF mRNA expression was higher in the allograft at days 7 and 21 than in the isograft. The epithelium in non-treated allograft was almost absent at day 7. The epithelial height in the anti-MIF-treated graft was higher than that in normal IgG-treated grafts. The intraluminal space was mostly replaced by granulation tissue at day 21 in the untreated group. The proportion of obliterans was lowest in the anti-MIF group, the second lowest in the untreated group and the third lowest in the normal IgG-treated grafts, and the difference was significant (p < 0.001) between the first two groups. Our results indicate that anti-MIF antibody suppresses allogenic tracheal rejection.
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Decrease of telomeres and increase of interstitial telomeric sites in chromosomes of short-term cultured gastric carcinoma cells detected by fluorescence in situ hybridization.
Kashima K, Nanashima A, Yasutake T, Sawai T, Tsuji T, Hidaka S, Akama F, Miyashita K, Tagawa Y, Nagayasu T
Anticancer research 26 ( 4B ) 2849 - 55 2006.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Relationship between CT volumetry and functional liver volume using technetium-99m galactosyl serum albumin scintigraphy in patients undergoing preoperative portal vein embolization before major hepatectomy: a preliminary study.
Nanashima A, Yamaguchi H, Shibasaki S, Morino S, Ide N, Takeshita H, Tsuji T, Sawai T, Nakagoe T, Nagayasu T, Ogawa Y
Digestive diseases and sciences 51 ( 7 ) 1190 - 5 2006.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Parameters associated with changes in liver volume in patients undergoing portal vein embolization.
Nanashima A, Sumida Y, Shibasaki S, Takeshita H, Hidaka S, Sawai T, Shindou H, Abo T, Yasutake T, Nagayasu T, Sakamoto I
The Journal of surgical research 133 ( 2 ) 95 - 101 2006.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Shibasaki S., Sakamoto I., Sueyoshi E., Sumida Y., Abo T., Nagasaki T., Sawai T., Yasutake T., Nagayasu T.
Liver International 26 ( 5 ) 587 - 594 2006.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Liver International
Background: Hepatic blood flow was associated with degree of hepatic damage. Measurements of blood flow using ultrasonography (US) may vary due to any observer's and patient's conditions. The utility of magnetic resonance imaging (MRI) flowmetry in portal and hepatic veins was assessed. Patients and methods: Using the phase-contrast method, the mean flow velocity of portal (PVF) and hepatic vein (HVF) were determined by MRI and US in 75 consecutive patients with liver diseases, including 58 patients undergoing hepatectomy. The correlations between these paramet ers and clinicopathological findings were examined. Results: PVF and HVF measured by MRI flowmetry were 12.8±4.5 and 14.7±5.3 cm/s, respectively. There was no significant correlation of both flows between MRI and US. PVF correlated significantly with portal pressure (r=-0.722; P < 0.05). There was a negative correlation between HVF and histological activity index score (r=-0.366; P < 0.05). PVF and HVF were lower in patients with cirrhosis and higher staging score (2-4) and PVF was lower in patients with higher grading score (2-3; P < 0.05). PVF and HVF were not significantly associated with postoperative complications. Conclusions: Our results suggest that MRI flowmetry is a potentially useful tool for measurement of hepatic blood flow and recommend its use for estimation of liver cirrhosis-associated impairment. © 2006 Blackwell Munksgaard.
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Nanashima A., Sumida Y., Abo T., Takeshita H., Tanaka K., Sawai T., Yasutake T., Omagari K., Nagayasu T.
Acta Medica Nagasakiensia 51 ( 1 ) 27 - 30 2006.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
The Tokyo score, a new prognostic staging system consisting of albumin, bilirubin, and size and number of tumor has recently been proposed. To evaluate its usefulness, we examined the survival of 213 patients of hepatocellular carcinoma who had undergone hepatectomy. Disease-free and overall survival rates were calculated and difference in these rates between patients with different Tokyo scores was tested for significance using log-rank test. Regarding disease-free survival, there was a significant difference in survival between patients with Tokyo score of 0 and 1 (p < 0.05); however, there was no significant difference among patients with Tokyo score of 1, 2, 3 and 4. Regarding overall survival, there were a significant difference between patients with Tokyo score 0 and 1 (p < 0.01); however, there was no significant difference among patients with Tokyo score of 1, 2, 3 and 4. The 3- and 5-year disease-free survival rates in patients with Tokyo score of 0 were 61% and 46% respectively, and the 3- and 5-year overall survival rates in them were 97% and 81%, respectively. Survival in patients with Tokyo score of 0 was significantly better than in those with Tokyo score of 1. The Tokyo score, a simple staging system that combines tumor factors and hepatic function, might be a good predictor of prognosis for patients of early-stage hepatocellular carcinoma with hepatectomy.
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Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct.
Nanashima A, Sumida Y, Tamaru N, Nakanuma Y, Abo T, Tanaka K, Sawai T, Yasutake T, Nagayasu T, Hayashi T, Fukuda Y
Journal of gastroenterology 41 ( 5 ) 495 - 9 2006.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Factors affecting survival after bronchoplasty and broncho-angioplasty for lung cancer: single institutional review of 147 patients.
Nagayasu T, Matsumoto K, Tagawa T, Nakamura A, Yamasaki N, Nanashima A
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 29 ( 4 ) 585 - 90 2006.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Sumida Y., Tobinaga S., Shibata K., Shindo H., Obatake M., Shibasaki S., Ide N., Nagayasu T.
HPB 8 ( 2 ) 137 - 141 2006.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：HPB
Background. α-Fetoprotein (AFP) has been used as a marker for hepatocellular carcinoma (HCC). However, AFP levels are often high in patients with chronic hepatitis or cirrhosis. Protein-induced vitamin K absence or antagonist II (PIVKA-II) is more sensitive for the diagnosis of HCC and prediction of patient survival. Changes in these markers after treatment may reflect treatment curability and patient outcome. Methods. We conducted a retrospective analysis of prognosis of 63 HCC patients with high preoperative levels of AFP and PIVKA-II who underwent hepatectomy and examined the relationship between postoperative changes in both markers at 1 month and patient survival. Subjects were divided into three groups according to changes in these tumour markers after hepatectomy: normalization (N) group, decreased but still above the normal level (D) group and unchanged (U) group. Results. There were no significant differences in the numbers of patients who developed tumour recurrence between changes in AFP and PIVKA-II. Survival analysis showed no significant differences in tumour-free and overall survivals between groups with respect to AFP level. The PIVKA-II-N group showed significantly better tumour-free and overall survival compared with the D and U groups (p < 0.01). Multivariate analysis that included other prognostic factors identified changes in PIVKA-II level as a significant and independent prognostic factor associated with overall survival. Discussion. Although changes in AFP did not correlate with patient prognosis, normalization of PIVKA-II was significantly associated with good patient survival after hepatectomy. Normalization of PIVKA-II after hepatectomy reflected the efficacy of treatment and is a suitable predictor of prognosis in HCC patients. © 2006 Taylor & Francis.
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Modified Japan Integrated Staging is currently the best available staging system for hepatocellular carcinoma patients who have undergone hepatectomy.
Nanashima A, Sumida Y, Abo T, Shindou H, Fukuoka H, Takeshita H, Hidaka S, Tanaka K, Sawai T, Yasutake T, Nagayasu T, Omagari K, Mine M
Journal of gastroenterology 41 ( 3 ) 250 - 6 2006.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Clinical significance of double staining of MIB-1 and AgNORs in primary breast carcinoma.
Kidogawa H, Nanashima A, Yano H, Matsumoto M, Yasutake T, Nagayasu T
Anticancer research 25 ( 6B ) 3957 - 62 2005.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Oncological outcome of ultra-low anterior resection with total mesorectal excision for carcinoma of the lower third of the rectum: Comparison of intrapelvic double-stapled anastomosis and transanal coloanal anastomosis.
Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Takeshita H, Nanashima A, Akamine S, Yamaguchi H, Yasutake T
Hepato-gastroenterology 52 ( 66 ) 1692 - 7 2005.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Ishikawa H., Sawai T., Tsuji T., Takeshita H., Nanashima A., Akamine S., Yamaguchi H., Yasutake T.
Hepato-Gastroenterology 52 ( 66 ) 1692 - 1697 2005.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: The purpose of this study was to determine whether the type of ultra-low anterior resection (intrapelvic double-stapled anastomosis or transanal hand-sewn coloanal anastomosis) with total mesorectal excision for primary adenocarcinoma of the lower third of the rectum affects survival and recurrence after curative surgery. Methodology: This retrospective study included 112 patients who underwent curative surgery achieved by ultra-low anterior resection in combination with either intrapelvic anastomosis using a double-stapling technique (DST group; n=82) or transanal hand-sewn coloanal anastomosis (CAA group; n=30). Univariate and corrected (multivariate regression) analyses were used to evaluate data. Median follow-up was 51.2 months for patients alive at the conclusion of this study. Results: Disease-free and disease-specific survivals, and the frequency and location of recurrence after surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-free survival or in the development of both local and distant recurrences after surgery. Tumor-related factors (stage or histologic grade) were significant predictors of oncological outcome. Conclusions: The type of ultra-low anterior resection (DST or CAA) did not affect survival and recurrence after curative resection for carcinoma of the lower third of the rectum. © H.G.E. Update Medical Publishing S.A.
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Nanashima A., Omagari K., Tobinaga S., Shibata K., Sumida Y., Mine M., Morino S., Shibasaki S., Ide N., Shindou H., Nagayasu T.
European Journal of Surgical Oncology 31 ( 8 ) 882 - 890 2005.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
Aims: In a previous pilot study, we reported the usefulness of the modified the Cancer of the Liver Italian Program (CLIP) score for patients with hepatocellular carcinoma (HCC). To determine the best staging system for predicting the survival of HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 210 Japanese HCC patients who underwent hepatic resection. Methods: We compared the survival as predicted by various staging systems, including tumour node metastasis (TNM) stage of the American Joint Commission on Cancer (AJCC) and the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), CLIP score and our modified CLIP score using protein induced by vitamin K absence or antagonist II (PIVKA-II). Results: Univariate analysis showed that discrimination of disease-free survival in the early and advanced stages by the JIS score and modified CLIP score was clearer than by the Japanese or AJCC TNM or the original CLIP score. Discrimination between stages of overall survival by all staging systems was significant. Multivariate analysis showed th at the JIS, CLIP and modified CLIP scores were better staging systems for predicting survival than the Japanese and AJCC TNM. The modified CLIP score showed the lowest Akaike information criteria statistical value for disease-free and overall survival, which means the best discrimination ability for patient survival compared with the JIS score and CLIP score. Conclusions: A staging system that combines tumour factors, sensitive tumour marker(s) and hepatic function is the best predictor of prognosis of HCC patients. © 2005 Elsevier Ltd. All rights reserved.
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Comparative analysis of postoperative morbidity according to type and extent of hepatectomy.
Nanashima A, Yamaguchi H, Shibasaki S, Ide N, Morino S, Sumida Y, Tsuji T, Sawai T, Nakagoe T, Nagayasu T
Hepato-gastroenterology 52 ( 63 ) 844 - 8 2005.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Hepatocellular carcinoma in a male patient with early stage (stage I) primary biliary cirrhosis.
Kadokawa Y, Omagari K, Ohba K, Kitamura S, Ohara H, Takeshima F, Mizuta Y, Nanashima A, Yamaguchi H, Kohno S
Internal medicine (Tokyo, Japan) 44 ( 3 ) 207 - 11 2005.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Hepatocellular carcinoma in a male patient with early stage (stage I) primary biliary cirrhosis
Kadokawa Y., Omagari K., Ohba K., Kitamura S., Ohara H., Takeshima F., Mizuta Y., Nanashima A., Yamaguchi H., Kohno S.
Internal Medicine 44 ( 3 ) 207 - 211 2005.3
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Internal Medicine
The true incidence of hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) remains undetermined due to limited epidemiological studies and some conflicting results. Some studies indicated that in PBC, male gender, cirrhosis, hepatitis C virus (HCV) superinfection, and history of blood transfusion are associated with the development of HCC, and the occurrence of HCC in the early stage of PBC is rare. We present herein a 75-year-old male patient with stage I PBC who developed oropharyngeal squamous cell carcinoma, followed by HCC and duodenal adenocarcinoma without hepatitis B or C virus infection. While it could be argued that the concurrence of HCC and stage I-PBC in our patient was coincidental, patients with early stage PBC should be strictly followed up as cirrhotic patients with PBC by monitoring the serum concentration of tumor markers for HCC and appropriate imaging methods.
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Adjuvant photodynamic therapy for bile duct carcinoma after surgery: a preliminary study.
Nanashima A, Yamaguchi H, Shibasaki S, Ide N, Sawai T, Tsuji T, Hidaka S, Sumida Y, Nakagoe T, Nagayasu T
Journal of gastroenterology 39 ( 11 ) 1095 - 101 2004.11
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Yamaguchi H., Omagari K., Nakazaki T., Aritomi T., Hatano K., Sumida Y., Shibasaki S., Ide N., Nakagoe T., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 3 ) 87 - 91 2004.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p < 0.001). Larger tumors and vascular involvement in the hepatectomy group were significantly more frequent than in the ablative therapy group (p < 0.001 and p=0.002, respectively). The multivariate Cox regression analysis indicated no significant difference either in the time to the first recurrence of tumor after surgery or in mortality between ablative therapy and hepatectomy. By making full use of various modalities in each specialty, the satisfactory HCC treatment could be achieved at this stage.
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Factors influencing proper clinical evaluation of depth of tumor invasion in gastric cancer
Tanaka K., Yasutake T., Hidaka S., Takeshita H., Shibasaki S., Tsuji T., Nanashima A., Sawai T., Yamaguchi H., Nakagoe T., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 3 ) 93 - 97 2004.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
The purpose of this study was to elucidate the factors that influence the clinical evaluation of the depth of tumor invasion in patients with T1 (tumor invasion of mucosa or submucosa) gastric cancer. The depth of tumor invasion was determined in 593 patients with gastric cancer. Patients were divided into two groups based on the agreement between clinical and pathological evaluation of depth of tumor invasion. Of 320 patients with clinical T1 gastric cancer, consistent diagnoses were made in 308 (96.2%) patients (consistent diagnosis group) while inconsistent diagnoses were made in 12 (3.8%) patients (inconsistent diagnosis group). In the clinical T1 gastric cancer, multivariate logistic regression analysis revealed that the disagreement between the clinical and pathological evaluation of the depth of tumor invasion was independently related to two variables; tumor location (upper stomach) and maximum tumor diameter (≥30 mm). For clinical T1 gastric cancer with ≥30 mm in maximum tumor diameter located in the upper stomach, caution should be exercised when selecting therapy.
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Nanashima A., Sumida Y., Morino S., Yamaguchi H., Tanaka K., Shibasaki S., Ide N., Sawai T., Yasutake T., Nakagoe T., Nagayasu T.
European Journal of Surgical Oncology 30 ( 7 ) 765 - 770 2004.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
Aims. The new Japanese staging system for hepatocellular carcinoma (HCC), the Japan integrated staging (JIS) score, accounts for both Child-Pugh classification and Japan tumour node metastasis (TNM) staging. However, in HCC patients who undergo hepatectomy, liver function is relatively good and a better prognostic classification of hepatic function is necessary. Methods. The present study was designed to analyse the modified JIS score using liver damage grade by the Liver Cancer Study Group of Japan instead of the Child-Pugh classification (using the category indocyanine green retention rate at 15 min [ICGR15] instead of encephalopathy), and to compare the Japan TNM stage in 101 patients who underwent resection of HCC. Results. The liver damage grade showed significantly better discrimination of disease-free and overall survival than did the Child-Pugh classification. The modified JIS score system showed significant differences of disease-free and overall survivals in each score and this system was superior for discriminating survivals compared with the TNM staging. Conclusions. The combined staging system of hepatic function, particularly ICGR15, and tumour stage provides a better prediction of prognosis. The JIS score using the liver damage grade was a useful predictor of prognosis of HCC patients who underwent hepatic resection. © 2004 Elsevier Ltd. All rights reserved.
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Differences in prognosis of colorectal cancer patients based on the expression of sialyl Lewisa, sialyl Lewisx and sialyl Tn antigens in serum and tumor tissue.
Akamine S, Nakagoe T, Sawai T, Tsuji T, Tanaka K, Hidaka S, Shibasaki S, Nanashima A, Yamaguchi H, Nagayasu T, Yasutake T
Anticancer research 24 ( 4 ) 2541 - 6 2004.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Akamine S., Nakagoe T., Sawai T., Tsuji T., Tanaka K., Hidaka S., Shibasaki S., Nanashima A., Yamaguchi H., Nagayasu T., Yasutake T.
Anticancer Research 24 ( 4 ) 2541 - 2546 2004.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Purpose: To clarify the differences in prognosis of colorectal cancer patients based on the expression of sialyl Lewis a , sialyl Lewis x and sialyl Tn antigens in serum and tumor tissue. Patients and Methods: Preoperative serum levels (by radioimmunoassay) and tumor tissue expression (by immunohistochemistry) of these antigens were simultaneously determined in 52 patients. For each antigen, patients were classified into one of four groups: Group S - /T - , S - /T + , S + /T - and S + /T + . (S denotes serum, T denotes tumor tissue, and negative and positive represent expression). Results: For sialyl Lewis a antigen, the survival time of Group S + /T + was significantly shorter than Group S - /T - or Group S - /T + (p=0.027 or p=0.032, respectively). For sialyl Lewis x antigen, the survival time of Group S - /T + was significantly shorter than Group S-/T- (p = 0.048). Conclusion: Increased expressions of sialyl Lewisa antigen in serum and sialyl Lewis x antigen in tumor tissue may be associated with poor prognosis in colorectal cancer patients.
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Nanashima A., Yasutake T., Sawai T., Hidaka S., Tsuji T., Tagawa Y., Nakagoe T., Tomita M., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 1-2 ) 25 - 32 2004.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
To clarify the relationship with development of colorectal cancer, we investigated chromosomal aberrations in 715 specimens of the colorectal neoplasm by cytogenetic analysis. A gain of chromosome 17 was observed in the transitional epithelium around non-polypoid carcinomas, although the normal epithelium exhibited diploidy. Most tubular adenomas were diploid, however, loss of chromosome 11 and gain of chromosome 17 were increased in adenomas in association with an increased villous component. DNA aneuploidy, aneusomy and p53 deletion were predominantly observed in carcinomas, even in early cancers. Alterations of chromosomes 11 and 18 reflected different tumor morphologies in the early carcinomas. Gains of chromosomes 11, 17 and 18, and deletion of chromosomes 11 and 17p and p53 became more frequent following an increase in the depth of invasion. Aneusomy of chromosome 11 was a risk factor for patient survival after operation. Gains of chromosome 20 and 20q13.2 were associated with liver metastasis. Aneusomy and translocations of chromosome 17 and the p53 locus were predominantly observed in patients with multiple cancers and hereditary non-polyposis colorectal cancer. Our results indicate that in the process of development of colorectal carcinomas, specific chromosomal aberrations might be related to each step of development, or an alternative pathway of de novo carcinogenesis.
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Primary bile duct cystadenocarcinoma with direct invasion to the gastric wall
Tanaka K., Yasutake T., Hidaka S., Takeshita H., Shibasaki S., Tsuji T., Nanashima A., Sawai T., Yamaguchi H., Yamasaki K., Nakagoe T., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 1-2 ) 59 - 62 2004.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Bile duct cystadenocarcinomas are rare cystic neoplasms of the liver. A 70-year-old woman with a cystadenocarcinoma with the invasion to the stomach as a submucosal tumor is presented. There were unrepresentative findings in a pre-operative examination, and it was difficult to distinguish whether this cystic tumor was malignant or benign. The tumor in the stomach was diagnosed as submucosal prior to operation, but was revealed as an invasive tumor from a bile duct cystadenocarcinoma in a left lobe of the liver during surgery. As it metastasized to the stomach and spread intraductally, a left lobectomy was performed. The operation was noncurative but the patient has been alive for 19 months since.
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Yasutake T., Hidaka S., Tanaka K., Jibiki M., Shibasaki S., Tsuji T., Nanashima A., Sawai T., Yamaguchi H., Nakagoe T., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 1-2 ) 63 - 66 2004.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Gastrointestinal stromal tumors (GISTs) are common form of submucosal tumors of the stomach. Treatment of recurrent GISTs had been unsuccessful because of resistance to chemotherapy and radiotherapy. Recently, GISTs were reported to markedly respond to the molecular target agent, imatinib mesylate. We present here a patient with recurrent GIST and c-kit mutation who was successfully treated with imatinib mesylate. A 66-year-old man underwent partial gastrectomy because of GIST. The tumor was 3 cm in size and positive for KIT expression. One year after the excision, spiral computed tomography (CT) scan revealed four intra-peritoneal recurrence lesions measuring 7, 4, 3 and 2 cm in diameter. One week after the CT scan, we started treatment with imatinib mesylate at 400 mg/day, which resulted within two months in 40% decrease in the sum of the longest diameter. The reduction of tumor size continued for more than 6 months. Analysis of the c-kit mutation of the primary tumor revealed the deletion of 18 bases in exon 11 (codon 551-557), while other exons showed no mutation. In this report, we showed the effectiveness of imatinib mesylate therapy for the recurrence of GIST, especially with c-kit mutation in exon 11.
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Taniguchi Y., Tagawa Y., Yasutake T., Nanashima A., Yamasaki N., Nakamura A., Sawai T., Tagawa T., Nagayasu T.
Acta Medica Nagasakiensia 49 ( 1-2 ) 33 - 38 2004.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
This study was designed to provide quantitative analysis using flow cytometry (FCM) and immunohistochemical analysis (IH) for p53 protein in 85 patients who underwent pulmonary resection for non-small cell lung carcinoma (NSCLC). We also examined the relationship among numerical aberrations of chromosome 17 and p53 locus, clinicopathological parameters and patient prognosis in NSCLC. PAb 1801 was used as the primary antibody for p53 and the Fluorescence Index (F.I.) was calculated by FCM. Fiffy-six patients (66%) showed a higher F.I (≧0.5), and had a higher rate of lymph node metastasis, more advanced stage and poor survival, while a positive expression of p53 protein by IH was associated with no clinicopathologic factors or patient survival. The F.I. of p53 protein was significantly higher in cases with imbalanced numbers between chromosome 17 and the p53 locus, particularly in patients with higher F.I. This indicated that quantitative analysis by FCM was the most useful method to detect the over-expression of p53 protein compared to that by IH. Higher F.I. (≧0.5) is a prognostic indicator for predicting malignant behavior and poor survival in patients with NSCLC.
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Relationship between indocyanine green test and technetium-99m galactosyl serum albumin scintigraphy in patients scheduled for hepatectomy: Clinical evaluation and patient outcome.
Nanashima A, Yamaguchi H, Shibasaki S, Morino S, Ide N, Takeshita H, Sawai T, Nakagoe T, Nagayasu T, Ogawa Y
Hepatology research : the official journal of the Japan Society of Hepatology 28 ( 4 ) 184 - 190 2004.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Japanese Journal of Gastroenterological Surgery 37 ( 1 ) 92 - 97 2004.2
Language：Japanese Publishing type：Case report
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Additional radical surgery after colonoscopic snare polypectomy for T1 colorectal cancer: use of the minilaparotomy approach.
Nakagoe T, Sawai T, Tsuji T, Hidaka S, Tanaka K, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T
International surgery 89 ( 1 ) 10 - 4 2004.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Numerical aberrations of chromosome 17 and the p53 locus in small hepatocellular carcinomas.
Yano H, Nanashima A, Hidaka S, Haseba M, Tanaka K, Yamaguchi H, Nakagoe T, Tagawa Y, Nagayasu T
Anticancer research 24 ( 1 ) 111 - 5 2004.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Numerical Aberrations of Chromosome 17 and the p53 Locus in Small Hepatocellular Carcinomas
Yano H., Nanashima A., Hidaka S., Haseba M., Tanaka K., Yamaguchi H., Nakagoe T., Tagawa Y., Nagayasu T.
Anticancer Research 24 ( 1 ) 111 - 115 2004.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
To investigate numerical aberrations of chromosome 17 and the p53 locus in early stages of hepatocellular carcinoma (HCC), 12 fresh-frozen specimens of small HCCs (less than 30 mm in size) were examined by dual-color fluorescence in situ hybridization. We used a chromosome 17 alpha-satellite DNA probe and a p53 locus-specific DNA probe. We also performed immunohistochemical analysis for p53 protein in the same cases. Gain of chromosome 17 was the most frequently observed anomaly, present in 58% of cases, and deletion of the p53 locus was observed in 50% of cases. The combination of chromosome 17 gain and p53 locus deletion was observed in 33.3% of cases. However, overexpression of p53 protein was not observed in any specimens. Our results suggest that gain of chromosome 17 and deletion of the p53 locus could represent early genetic events, prior to overexpression of p53 protein due to mutation, in early stage HCC.
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Immunohistochemical analysis of tumor biological factors in hepatocellular carcinoma: relationship to clinicopathological factors and prognosis after hepatic resection.
Nanashima A, Yano H, Yamaguchi H, Tanaka K, Shibasaki S, Sumida Y, Sawai T, Shindou H, Nakagoe T
Journal of gastroenterology 39 ( 2 ) 148 - 54 2004
Language：Japanese Publishing type：Research paper (scientific journal)
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Survival and recurrence after a sphincter-saving resection and abdominoperineal resection for adenocarcinoma of the rectum at or below the peritoneal reflection: a multivariate analysis.
Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Tanaka K, Hidaka S, Nanashima A, Yamaguchi H, Yasutake T
Surgery today 34 ( 1 ) 32 - 9 2004
Language：Japanese Publishing type：Research paper (scientific journal)
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Preoperative serum hyaluronic acid level as a good predictor of posthepatectomy complications.
Nanashima A, Yamaguchi H, Tanaka K, Shibasaki S, Tsuji T, Ide N, Hidaka S, Sawai T, Nakagoe T, Nagayasu T
Surgery today 34 ( 11 ) 913 - 9 2004
Language：Japanese Publishing type：Research paper (scientific journal)
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Minilaparotomy approach for the resection of laterally spreading tumors of the colon.
Nakagoe T, Sawai T, Tsuji T, Tanaka K, Shibasaki S, Hidaka S, Nanashima A, Yamaguchi H, Yasutake T
Surgery today 34 ( 9 ) 737 - 41 2004
Language：Japanese Publishing type：Research paper (scientific journal)
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Minilaparotomy approach for removal of a large colonic lipoma: report of two cases.
Nakagoe T, Sawai T, Tsuji T, Tanaka K, Nanashima A, Shibasaki S, Yamaguchi H, Yasutake T
Surgery today 34 ( 1 ) 72 - 5 2004
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Hisamatsu T., Sawai T., Tohyama H., Nakagoe T., Nagayasu T.
Japanese Journal of Gastroenterological Surgery 37 ( 5 ) 614 - 618 2004
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
A 69-year old man was admitted to our hospital with upper abdominal pain caused by the reflux esophagitis. An abdominal CT scan showed a 4cm cystic liver tumor in segment S7/8, and colonoscopy revealed an 8mm early flat-type (IIa + IIc) cancer with central depression and fold convergence in the recto-sigmoid area. Invasive colorectal carcinoma with liver metastasis was suspected, and high anterior resection of the rectum with D2 lymphadenectomy and partial hepatectomy were performed simultaneously. Histological examination revealed the moderately differentiated adenocarcinoma with slight invasion of the submucosal layer (sm1) and venous infiltration, but no lymph node metastasis. The liver tumor with central necrosis showed histological findings similar to those of the primary colorectal carcinoma. The pathological TNM stage according to the system of the Japanese Society for Cancer of the Colon and Rectum was stage IV, and surgical curability was B. We consider this case to be rare and valuable because of its rarity.
DOI： 10.5833/jjgs.37.614
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Increased serum levels of interleukin-6 in malnourished patients with colorectal cancer.
Nakagoe T, Tsuji T, Sawai T, Tanaka K, Hidaka S, Shibasaki Si, Nanashima A, Ohbatake M, Yamaguchi H, Yasutake T, Sugawara K, Inokuchi N, Kamihira S
Cancer letters 202 ( 1 ) 109 - 15 2003.12
Language：Japanese Publishing type：Research paper (scientific journal)
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Increased serum levels of interleukin-6 in malnourished patients with colorectal cancer
Nakagoe T., Tsuji T., Sawai T., Tanaka K., Hidaka S., Shibasaki S., Nanashima A., Ohbatake M., Yamaguchi H., Yasutake T., Sugawara K., Inokuchi N., Kamihira S.
Cancer Letters 202 ( 1 ) 109 - 115 2003.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Letters
Peri-operative serum levels of interleukin-6 (IL-6) were determined in 62 patients who underwent resection of colorectal cancer to clarify the relationship between nutritional status and IL-6 response. Patients were divided into two groups based on creatinine height index: malnourished group (n=13) and normally nourished group (n=49). The preoperative median serum level of IL-6 in the malnourished group was significantly higher than in the normally nourished group (P=0.041). The postoperative median serum level of IL-6 in the malnourished group also tended to be higher. In conclusion, the peri-operative IL-6 response may be activated in malnourished colorectal cancer patients. © 2003 Elsevier Ireland Ltd. All rights reserved.
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Nakagoe T., Ishikawa H., Sawai T., Tsuji T., Hidaka S., Tanaka K., Takeshita H., Ohbatake M., Nanashima A., Akamine S., Yamaguchi H., Yasutake T., Nagayasu T., Kamihira S.
Acta Medica Nagasakiensia 48 ( 3-4 ) 129 - 133 2003.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
The aim of this study was to clarify whether or not pre-operative serum levels of sialyl Lewis a (CA19-9), sialyl Lewisx (SLX), and sialyl Tn (STN) antigens are predictors for diffuse type gastric cancer. Eighty-two patients with diffuse type and 96 patients with intestinal type cancers were studied. Univariate logistic regression analysis showed that the following factors were significantly associated with diffuse type cancer: high levels of serum STN, young age ( < 62 years), female gender, tumor in the middle stomach, macroscopic type 3/type 4 cancer, presence of lymphatic invasion, peritoneal dissemination, stage III/IV, and non-curative resection. Multivariate analysis revealed that diffuse type cancer was independently related to young age ("62 years), female gender, tumor in the middle stomach, and macroscopic type 3/type 4 cancer. In conclusion, none of the preoperative serum levels of CA19-9, SLX, and STN were predictors for diffuse type cancer.
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Nakagoe T., Yamaguchi E., Tanaka K., Sawai T., Tsuji T., Shibasaki S., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
Annals of Surgical Oncology 10 ( 2 ) 163 - 170 2003.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Annals of Surgical Oncology
Background: The aim of this study was to clarify the prognostic value of distal intramural spread of tumor for survival and recurrence in patients with rectal cancer. Methods: Microscopic distal intramural spread was examined in 134 consecutive specimens of resected rectal cancer. Correlations among distal intramural spread, established clinicopathologic factors, and patients' prognoses were examined by univariate and multivariate analyses. American Joint Committee on Cancer classification and stage groupings were used for tumor assessment. Results: Thirty-three patients (24.6%) had distal intramural spread. Multivariate logistical regression analysis revealed that T3/T4 and M1 were independent predictive variables for the presence of distal intramural spread. Patients with distal intramural spread had a shorter disease-specific or disease-free survival time after curative surgery than those without distal intramural spread (P = .0003 and P = .0006, respectively). Most patients with distal intramural spread developed distant recurrence. Cox's regression with multiple covariates showed that distal intramural spread is an independent factor in predicting distant recurrence and worse outcomes after curative surgery in patients with rectal cancer. Conclusions: Distal intramural spread is an independent risk factor for distant metastasis and poor prognosis in patients with rectal cancer. © 2003 The Society of Surgical Oncology, Inc.
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Resected or Remnant Liver Volume and Standard Liver Volume Ratio in Patients with Major Hepatectomy
Nanashima A., Yamaguchi H., Shibasaki S., Morino S., Sumida Y., Ide N., Taguchi T., Nakagoe T., Nagayasu T.
Acta Medica Nagasakiensia 48 ( 3-4 ) 125 - 128 2003.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
To clarify the relationship between resected (RSV) or remnant hepatic volume (RMV) in major hepatectomy, and standard liver volume (SLV) and its clinical significance, the RSV/SLV, RMV/SLV and the volume of regeneration (RGV)/RMV were examined in 41 patients including 19 with chronic hepatitis and 5 with obstructive jaundice who underwent lobectomy or extended lobectomy. The hepatic function was maintained in all patients. SLV was calculated by the body-surface area using Urata's formula. RGV was calculated by subtracting the RMV from the remnant liver volume at day 28 after hemi-hepatectomy. Measurement of the hepatic volume was performed by computed tomography. The means of RSV, RMV, RGV and SLV were 591±173, 459±119, 667±129 and 1128=129cm3, respectively. The means of RSV/SLV, RMV/SLV and RGV/RMV were 0.52±0.14, 0.41±0.12 and 1.54±0.47, respectively. RGV was inversely correlated with RMV/SLV (p<0.001) but not with the other parameters. RSV/SLV and RMV/SLV were not associated with long-term ascites and hepatic failure. The tendency of these results was similar in each patient with a normal liver, obstructive jaundice and chronic viral hepatitis. If the hepatic functional reserve is maintained, a liver with lower hepatic volume has potentially sufficient regeneration even in patients with an injured liver.
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Tsuji T., Hidaka S., Sawai T., Nakagoe T., Yano H., Haseba M., Komatsu H., Shindou H., Fukuoka H., Yoshinaga M., Shibasaki S., Nanashima A., Yamaguchi H., Yasutake T., Tagawa Y.
Clinical Cancer Research 9 ( 10 I ) 3700 - 3704 2003.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Clinical Cancer Research
Thymidylate synthase (TS) is the target enzyme of 5-fluoropyrimidines. The TS gene promoter enhancer region (TSER) possesses tandem, repeated, regulatory sequences that are polymorphic in humans. This polymorphism has been reported to influence TS expression in vitro and in vivo. In this study, we assessed whether or not the TSER genotype is an efficacious marker for tumor sensitivity to 5-fluorouracil (5-FU)-based oral adjuvant chemotherapy for colorectal cancer. One hundred and thirty-five Japanese patients who received curative resection and 5-FU-based oral adjuvant chemotherapy were studied. TSER genotypes of the tumors were analyzed by PCR. The numbers of repeated sequences of representative bands were determined by direct sequence. The genotypes of two-/two-repeats (TSER 2/2), two-/three-repeats (TSER 2/3), three-/ three-repeats (TSER 3/3) and three-/five-repeats (TSER 3/5) were found in 11 (8.1%), 32 (23.7%), 85 (63.0%), and 7 (5.2%) tumors, respectively. Patients were classified into two groups: TSER 2/2 or 2/3 group; and the TSER 3/3 group. The relationship between the TSER genotype group and disease-free intervals was analyzed by univariate and multivariate analyses. Five-year disease-free survivals of the TSER 2/2 or 2/3 group and the TSER 3/3 group were 77% and 75%, respectively (P = 0.89). Multivariate analysis revealed that stage was the only independent prognostic factor and that the TSER genotype did not have a prognostic significance (hazard ratio for TSER 3/3, 0.91; P = 0.84). In conclusion, TSER genotype is not an efficacious marker for tumor sensitivity to 5-FU-based oral adjuvant chemotherapy for Japanese colorectal cancer patients after curative resection.
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Polymorphism in the thymidylate synthase promoter enhancer region is not an efficacious marker for tumor sensitivity to 5-fluorouracil-based oral adjuvant chemotherapy in colorectal cancer.
Tsuji T, Hidaka S, Sawai T, Nakagoe T, Yano H, Haseba M, Komatsu H, Shindou H, Fukuoka H, Yoshinaga M, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T, Tagawa Y
Clinical cancer research : an official journal of the American Association for Cancer Research 9 ( 10 Pt 1 ) 3700 - 4 2003.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Surgical treatment for right pleural effusions caused by pancreaticopleural fistula.
Shibasaki S, Yamaguchi H, Nanashima A, Tsuji T, Jibiki M, Sawai T, Yasutake T, Nakagoe T, Ayabe H
Hepato-gastroenterology 50 ( 53 ) 1678 - 80 2003.9
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Tanaka K., Yamaguchi H., Shibasaki S., Morino S., Yoshinaga M., Sawai T., Nakagoe T., Ayabe H.
Digestive Diseases and Sciences 48 ( 8 ) 1517 - 1522 2003.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Diseases and Sciences
This study was designed to provide a histopathological analysis focusing on fibrosis (staging) and necroinflammatory reaction (grading, hepatitis activity index: HAI) in noncancerous liver tissue, and mitotic index (MI) in cancerous liver tissue to predict prognosis in 81 patients with chronic hepatitis or cirrhosis who underwent hepatectomy for hepatocellular carcinoma (HCC). The incidence of grade 2/3 and higher HAI was higher in patients with viral hepatitis C. The incidence of grade 2/3 was associated with vascular invasion of HCC, postoperative liver dysfunction, and cancer recurrence. Higher MI (≥5) was significantly associated with vascular invasion, poor histological differentiation, and recurrence rate (P < 0.05). Multivariate analysis showed that higher grade was the factor strongly associated with cancer recurrence (odds ratio: 10.621, P = 0.006). Higher MI correlated with overall patient survival (P < 0.05) by univariate analysis. Grading and MI are the useful prognostic markers for predicting tumor recurrence and patient survival.
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Nakagoe T., Ishikawa H., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T.
Surgical Endoscopy and Other Interventional Techniques 17 ( 8 ) 1298 - 1304 2003.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgical Endoscopy and Other Interventional Techniques
Background: The aim of this study is to determine whether gasless, video endoscopic transanal-rectal tumor excision (gasless VTEM) is a valid treatment for rectal carcinoid and laterally spreading tumors (LST). Methods: Eighty-four patients with an adenoma, adenocarcinoma (Tis/T1), or carcinoid tumor of the rectum were divided into three groups: (i) LST (n = 17 patients), (ii) carcinoid (n = 11), and (iii) control with other types of tumors (n = 56). Results: The LST group had a longer median operating time than in the control group, whereas the carcinoid group had a shorter operating time. Two patients (11.7%) in LST group developed peritoneal entry during the operation, while 2 patients (3.6%) in the control group experienced postoperative complications. During a median follow-up length of 55.2 months, one patient in the LST group developed a recurrence. Conclusions: Gasless VTEM is a simple, minimally invasive procedure used to treat LST and carcinoid tumors of the rectum. However, resection for the LST group had a high risk of peritoneal entry during operation.
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Fibrosis and inflammatory activity in noncancerous tissue and mitotic index of cancer tissue in patients with hepatocellular carcinoma: relationship to clinicopathological factors and prognosis after hepatic resection.
Nanashima A, Tanaka K, Yamaguchi H, Shibasaki S, Morino S, Yoshinaga M, Sawai T, Nakagoe T, Ayabe H
Digestive diseases and sciences 48 ( 8 ) 1517 - 22 2003.8
Language：Japanese Publishing type：Research paper (scientific journal)
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The relationship between circulating interleukin-6 and carcinoembryonic antigen in patients with colorectal cancer.
Nakagoe T, Tsuji T, Sawai T, Tanaka K, Hidaka S, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T, Sugawara K, Inokuchi N, Kamihira S
Anticancer research 23 ( 4 ) 3561 - 4 2003.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Yoshinaga M., Yamaguchi H., Shibasaki S., Ide N., Jo K., Nakagoe T.
Acta Medica Nagasakiensia 48 ( 1-2 ) 23 - 27 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
This study was designed to provide an immunohistochemical analysis of tumor biological factors in 28 patients who underwent hepatectomy for cholangiocellular carcinoma (CCC). Analyzed factors were microvessel counts (stained by CD34) and proliferating cell nuclear antigen (PCNA). PCNA L.I. was correlated with serum level of CA19-9, which was correlated with a higher recurrence rate and shorter patient survivals. Microvessel counts were negatively correlated with tumor size. Furthermore, the microvessel count in CCC with mass-forming (MF) plus periductal infiltrating (PI) type associated with poorer survivals, was significantly lower compared to that of CCC with MF type or PI type. Neither microvessel counts nor PCNA L.I. were associated with any other clinicopathologic factors or cancer recurrence. The five-year overall and cancer-free survival rates were 26% and 13%, respectively. Patients with MF plus PI type, poorer differentiated carcinoma, stage 4A and higher CA19-9 level had shorter cancer-free and overall survivals after hepatectomy (p < 0.05). Cancer-free and overall survivals in patients with lower microvessel counts tended to be slightly worse but were not significantly different. Although tumor microvessel count and proliferating activity were correlated with prognostic clinicopathologic parameters, both factors might not be prognostic markers for predicting CCC recurrence and patient survival.
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Changes of branched chain amino acids and tyrosine ratio (BTR) after hepatectomy
Nanashima A., Yamaguchi H., Shibasaki S., Abo T., Morino S., Yoshinaga M., Sawai T., Tanaka K., Hidaka S., Tsuji T., Nakagoe T., Ayabe H.
Acta Medica Nagasakiensia 48 ( 1-2 ) 29 - 33 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
To clarify the clinical usefulness of measuring branched chain amino acids and tyrosine ratio (BTR), which is correlated with Fischer's ratio, we examined the serum BTR level in 33 patients with liver diseases. Serum levels of branched-chain amino acids (BCAAs) and tyrosine were measured by the new enzymatic method, which costs inexpensive and is immediate compared to measuring Fischer's ratio. BTR was calculated as ratio of concentration of BCAA to tyrosine. BTR was correlated with levels of albumin, transaminase and cholinesterase and was lower in patients with chronic viral hepatitis, Child B cirrhosis and portal hypertension. In 19 patients who underwent hepatic resection included 8 for major hepatectomy, resected volume, blood loss, operation time and background of liver diseases were not associated with changes of BTR after hepatectomy. In patients with prolonged jaundice, postoperative BTR level was significantly lower between day 1 and 7 after hepatectomy. We concluded that serum BTR level was correlated with poor liver function and monitoring of BTR levels after hepatectomy may be useful to evaluate degree of hepatic damage after liver surgery.
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Nakagoe T., Sawai T., Tsuji T., Tanaka K., Hidaka S., Nanashima A., Shibasaki S., Yamaguchi H., Yasutake T.
Acta Medica Nagasakiensia 48 ( 1-2 ) 81 - 84 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Management of a rectovaginal fistula (RVF) following low circular-stapled colorectal anastomosis is difficult and often unsatisfactory. We report herein the case of a 66-year-old woman who developed a RVF following low anterior resection using the double-stapling technique for rectal cancer. The RVF spontaneously closed with nonoperative treatment that included simple observation without dietary restrictions. The spontaneous closure occurred within approximately 25 days. Minimally symptomatic patients may be candidates for nonoperative treatment.
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Preoperative serum level of CA19-9 predicts recurrence after curative surgery in node-negative colorectal cancer patients.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H, Arisawa K
Hepato-gastroenterology 50 ( 51 ) 696 - 9 2003.5
Language：Japanese Publishing type：Research paper (scientific journal)
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The use of a mini-laparotomy in total abdominal colectomy for mucosal ulcerative colitis.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Hepato-gastroenterology 50 ( 51 ) 704 - 8 2003.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K.
Hepato-Gastroenterology 50 ( 51 ) 696 - 699 2003.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: We hypothesize that a subset of node-negative colorectal cancer patients exists that is at high risk for recurrence after curative surgery. Preoperative serum levels of sialyl Lewisa (CA19-9), sialyl Lewisx (SLX), sialyl Tn (STN), and carcinoembryonic (CEA) antigens were analyzed for their value in predicting for such a group. Methodology: One-hundred-forty-five patients with node-negative, T1-4, M0 colorectal cancers were divided into groups of low or high serum antigen levels. Disease-free interval served as the endpoint in evaluating the prognostic strength of each variable. Results: Twenty-seven patients (18.6%) were included in the high group for CA19-9 antigen, 11 (7.6%) for SLX, 13 (9.0%) for STN, and 51 (35.2%) for CEA. The median follow-up was 62.1 months. As compared to those with low levels, patients with elevated CA19-9 had a shorter disease-free interval (P=0.0026). No significant difference in disease-free interval was noted between low and high groups of SLX, STN, and CEA antigens. Cox regression analysis identified elevated serum CA19-9 level as a predictor for decreased disease-free interval, independent of T-stage or tumor location. Conclusions: Elevated preoperative serum levels of CA19-9 may serve as a useful marker in identifying patients with node-negative colorectal cancers at high risk for recurrence after surgery.
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Nakagoe T., Tanaka K., Yasutake T., Sawai T., Tsuji T., Nanashima A., Shibasaki S., Yamaguchi H., Ayabe H.
Digestive Surgery 20 ( 2 ) 141 - 146 2003.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Surgery
Background/Aims: The aim of this study was to clarify long-term outcomes of endoscopic mucosal resection (EMR) using a modified Buess technique for mucosal gastric cancer. Methods: The procedure included en bloc mucosal resection using a Buess-type rectoscope into the gastric lumen via a temporary gastrostomy under video camera guidance. We reviewed 5 patients who underwent this procedure between 1995 and 1997 with a single mucosal cancer of the stomach that was unsuitable for en bloc excision by endoscopic snare diathermy. Results: All tumors were superficial elevated types (type 0-IIa) located in the middle third and posterior wall of the stomach. Median maximum tumor diameter was 2.2 (range 1.1-3.5) cm. There was no operative mortality. One patient developed a hemorrhagic gastric ulcer postoperatively. All tumors histologically showed curative potential of the mucosal resection without margin involvement. During a median follow-up period of 64 (50-77) months, none of the patients developed local recurrence. One patient had an early gastric cancer that metachronously developed at another stomach site. Conclusion: Intragastric EMR using a modified Buess technique appears to be a useful treatment for cure of mucosal gastric cancer for a limited group of patients unsuitable for complete en bloc excision by endoscopic snare diathermy. Copyright © 2003 S. Karger AG, Basel.
DOI： 10.1159/000069391
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Gasless video endoscopic transanal excision of rectal tumors incompletely removed by colonoscopic snare polypectomy.
Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Journal of laparoendoscopic & advanced surgical techniques. Part A 13 ( 2 ) 99 - 103 2003.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Distal intramural spread is an independent prognostic factor for distant metastasis and poor outcome in patients with rectal cancer: a multivariate analysis.
Nakagoe T, Yamaguchi E, Tanaka K, Sawai T, Tsuji T, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Annals of surgical oncology 10 ( 2 ) 163 - 70 2003.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach.
Nakagoe T, Sawai T, Tsuji T, Shibazaki S, Jibiki M, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
World journal of surgery 27 ( 2 ) 197 - 202 2003.2
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Sawai T., Tsuji T., Shibazaki S., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
World Journal of Surgery 27 ( 2 ) 197 - 202 2003.2
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
This study compares surgical outcomes for local resection of rectal tumors by two approaches: (1) gasless, video-endoscopic transanalrectal tumor excision (gasless VTEM); and (2) a conventional posterior approach. Gasless VTEM involves a modification of transanal endoscopic microsurgery (TEM) that incorporates a standard laparoscopic video camera without a CO 2 insufflation system. A series of 42 patients with 45 rectal tumors (9 adenomas, 36 adenocarcinomas) who underwent gasless VTEM between 1993 and 2000 were studied prospectively. The control group consisted of 26 similar patients who underwent conventional surgery (transsacral or transsphincteric approach) between 1985 and 1993. Age, gender ratio, tumor localization, maximum tumor diameter, and histology for the cases and the controls were similar, whereas operating time and blood loss were significantly greater in the control group (p < 0.001 and p < 0.001, respectively). The postoperative intervals until able to walk, urinary catheter removal, solid food intake, and discharge from hospital were significantly shorter in the gasless VTEM group (p < 0.001, p = 0.002, p < 0.001, and p < 0.001, respectively); analgesic requirements were significantly less (p < 0.001). There was no operative mortality in either group. Postoperative complications developed significantly less frequently in the gasless VTEM group than in the control group (7.1% vs. 38.5%; p = 0.003). During the median follow-up length of 73.3 months, no patient developed tumor recurrence in the gasless VTEM group, whereas one patient did in the control group. In conclusion, gasless VTEM is less invasive and allows shorter hospitalizations and reduced complications than the conventional posterior approach, thereby providing an attractive alternative for selected patients.
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Genetic analysis of radiation-associated rectal cancer.
Tsuji T, Sawai T, Nakagoe T, Hidaka S, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Tagawa Y
Journal of gastroenterology 38 ( 12 ) 1185 - 8 2003
Language：Japanese Publishing type：Research paper (scientific journal)
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Successful resection of a duodenal fistula complicated with recurrent Crohn's disease at the site of previous ileocolonic anastomosis: report of a case.
Nakagoe T, Sawai T, Tsuji T, Nanashima A, Shibasaki S, Yamaguchi H, Yasutake T
Surgery today 33 ( 7 ) 537 - 41 2003
Language：Japanese Publishing type：Research paper (scientific journal)
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Hisamatsu T., Nanashima A., Izumikawa K., Haga H., Hayakawa T., Hara K., Izumikawa K.
Japanese Journal of Gastroenterological Surgery 36 ( 11 ) 1587 - 1592 2003
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
A 76-year old man with a history of chronic viral hepatitis and obstinate constipation was admitted to our hospital with severe abdominal distension. The patient had no remarkable abdominal pain or signs of any inflammatory disorders. An abdominal X-ray film showed massive intra-abdominal free-air, but no signs of ulceration or perforation were found in an upper GI series. However, a 3cm multi-cystic lesion was found in the lower intestines, protruding into the abdominal cavity next to the site of the massive free-air, ascites observed on CT images. Pneumatosis cystoides intestinalis (PCI) was thought to be the most probable diagnosis, and an emergency laparoscopy was performed to rule out the possibility of intestinal perforation and relieve the patient's symptoms. A laparoscopy examination revealed multiple cystic lesions in the terminal ileum, ascites, and a liver with the appearance of chronic hepatitis; no evidence of intestinal perforation was seen even in the area of the multiple cystic lesions. Other PCI in the colon was observed by postoperative colonoscopy. The patient recovered without any complications. Although conservative therapy has been described as a common initial treatment for patients with PCI, our experience suggests that performing a laparoscopy examination may be useful not only for confirming the diagnosis, but for reducing the massive pneumoperitoneum resulting from severe constipation in patients with PCI.
DOI： 10.5833/jjgs.36.1587
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Nanashima A.
Acta Medica Nagasakiensia 47 ( 3-4 ) 127 - 131 2002.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
The author has experienced to practice the clinical works of cadaveric liver transplantation at a single transplantation center in Australia between 1999 and 2000. Hepatic arterial thrombosis causes higher rates of morbidity and mortality after liver transplantation. To know the associated factors, pathogenesis and patient outcome, data of 99 adult patients who underwent liver transplantation by the database for past two years were analysed. Ten patients (10%) had hepatic arterial thrombosis (HAT group). In donor demographics, brain death caused by cerebral stroke in the HAT group (90%) was significantly more than that in the non HAT group (49%) (p < 0.05). The mean amount of blood transfusion in the HAT group (26665ml) was significantly greater than that in the control group (15606ml) (p < 0.05). The mean hepatic arterial flow measured by Doppler flowmeter in the HAT group (214ml/min.) was lower than that in the control group (399ml/min) (p < 0.01). The rate of in-hospital death or retransplantation caused by severely biliary abscess with hepatic infarction or graft failure in the HAT group (40%) tended to be higher compared to the control group (13%) (p=0.053). In conclusion, decrease of bleeding and blood transfusion, and obtaining the adequate arterial blood flow during operation were important to prevent hepatic arterial thrombosis causing higher morbidity and mortality after liver transplantation.
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Nakagoe T., Ishikawa H., Sawai T., Tsuji T., Tanaka K., Hidaka S., Shibasaki S., Nanashima A., Yamaguchi H., Yasutake T.
Acta Medica Nagasakiensia 47 ( 3-4 ) 139 - 144 2002.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Purpose. The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival after non-curative surgery. Methods. This retrospective study included 42 patients who underwent non-curative surgery by the following two types of operation between 1989 and 1998: (1) SSR (n=19 patients) included low anterior resection with either double-stapling technique (n=16) or transanal coloanal anastomosis (n=3); (2) APR (n=23). 'Non-curative' resection implied 'Curability B' and 'Curability C' defined by the Japanese Classification of Colorectal Carcinoma. Outcome measure was disease-specific survival. Univariate and multivariate Cox's regression analyses were used to evaluate data. Median follow-up was 17.2 months at study conclusion. Results. Disease-specific survival after non-curative surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-specific survival after surgery. One variable - 'Curability' - was significant predictor of outcome after surgery. Conclusions. The type of operation (SSR or APR) did not affect survival after non-curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.
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Nakagoe T., Fukushima K., Sawai T., Tsuji T., Jibiki M., Nanashima A., Tanaka K., Yamaguchi H., Yasutake T., Ayabe H., Ishikawa H.
Journal of Experimental and Clinical Cancer Research 21 ( 3 ) 363 - 369 2002.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Experimental and Clinical Cancer Research
Early gastric cancer can be divided morphologically into two categories, penetrating growth type-A (Pen-A type) and other growth types (non-Pen-A types). Sialyl Lewis x antigen has been demonstrated to play an important role in tumor metastasis by serving as a functional ligand in the cell adhesion system. The aim of this study is to ascertain whether or not sialyl Le x antigen expression correlates with tumor growth patterns of early gastric carcinoma. An immunohistochemical assay was performed using monoclonal antibody CSLEX1 in 12 Pen-A type and 79 non-Pen-A type cancers. Scoring was based on the percentage of immunoreactive cells: negative, low expression (≤25%), and high expression ( > 25%). Lymph node metastasis was found more frequently in Pen-A type than non-Pen-A type cancers (P=0.0004). Furthermore, sialyl Le x antigen high expression was detected more often in Pen-A type cancers (7 out of 12; 58.3%) than non-Pen-A type cancers (13 out of 79; 16.5 %) (P=0.0036). Multivariate logistic regression analysis showed that these variables are related independently to the Pen-A type and the non-Pen-A type tumor growth patterns. These data suggest that the difference in sialyl Le x antigen expression between the Pen-A type and non-Pen-A type tumor growth patterns of early gastric cancer may, at least partially, reflect different biological behavior during tumor progression.
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[CPT-11 hepatic arterial injection plus oral UFT administration for liver metastasis of rectal cancer--report of two cases].
Sawai T, Tsuji T, Yamashita H, Hidaka S, Fukuoka H, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Nakagoe T, Ayabe H
Gan to kagaku ryoho. Cancer & chemotherapy 29 ( 8 ) 1469 - 73 2002.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Sawai T., Tsuji T., Yamashita H., Hidaka S., Fukuoka H., Shibasaki S., Tanaka K., Nanashima A., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H.
Japanese Journal of Cancer and Chemotherapy 29 ( 8 ) 1469 - 1473 2002.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Cancer and Chemotherapy
The first patient was a 51-year-old male who had 5-fluorouracil-resistant recurrent rectal cancer with multiple liver metastases. He was given our new combination chemotherapy consisting of hepatic arterial injection of CPT-11 (20 mg/body) on day 1 and day 2 and oral administration of UFT (300 mg/day) on days 3 to 6 of a 7 day cycle starting in January 2001. Six weeks after the beginning of chemotherapy, the liver metastatic lesions were reduced. He is now living with outpatient treatment. The second patient was a 76-year-old male who had initial recurrent rectal cancer with multiple liver metastases. Thirty-two weeks after the same chemotherapy, the metastatic lesions had completely disappeared. Twelve months have passed since this chemotherapy, and we have not found any recurrent tumor. While significant antitumor effects were observed, there were few adverse events in either patient. These results suggest that combined chemotherapy of CPT-11 by hepatic arterial injection and oral administration of UFT is an effective treatment for liver metastases of rectal cancer.
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Nanashima A., Pillay P., Verran D., Painter D., Nakasuji M., Crawford M., Shi L., Ross A.
Transplantation Proceedings 34 ( 4 ) 1231 - 1235 2002.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Transplantation Proceedings
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Minilaparotomy approach to terminal ileal Crohn's disease.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
World journal of surgery 26 ( 6 ) 721 - 5 2002.6
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K., Ishikawa H.
Anticancer Research 22 ( 1 A ) 451 - 458 2002.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Preoperative serum levels of sialyl Lewisa(CA19-9), sialyl Lewisx(SLX) and sialyl Tn (STN) antigens in 180 patients with gastric cancer were examined to establish predictive factors for serum levels of these antigens compared with carcino-embryonic antigen (CEA). The patients were divided into low and high antigen groups. Multivariate logistic regression analysis revealed the following independent predictive factors for high antigen levels [odds ratio]: liver metastasis for CA19-9 [4.40], SLX [9.90], STN [39.65] and CEA [5.14]; peritoneal dissemination for SLX [4.78] or STN [13.01]; venous invasion for CEA [3.56]; lymph node metastasis for CA19-9 [4.51]. In addition, high CA19-9 levels were independently related to lymph node metastasis in patients with stage I or II tumors. In conclusion, high serum levels of CA19-9, SLX and STN are associated with liver metastasis, while high serum levels of SLX and STN are associated with peritoneal dissemination. In addition, high serum CA19-9 levels may represent an independent predictor for lymph node metastasis.
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Nakagoe T., Fukushima K., Tanaka K., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K.
Journal of Experimental and Clinical Cancer Research 21 ( 1 ) 107 - 113 2002.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Experimental and Clinical Cancer Research
This study aimed to determine whether sialyl Lewis a (Le a ), sialyl Lewisx (Le x ), or sialyl Tn antigen expression could identify a subset of node-negative colorectal cancer patients that are at high risk for recurrence after curative surgery. Tumor tissue samples from 90 patients with node-negative colorectal cancer, who had undergone surgical resection, were analyzed immunohistochemically for the expression of each antigen. Patients were classified as having low or high antigen expression depending on whether more or less than 40% of the field showed positive staining. The main outcome measure for each variable was disease-free interval. Sialyl Le a , sialyl Le x , and siaiyl Tn antigens were expressed in 53 (58.9%), 41 (45.6%), and 34 (37.8%) carcinomas, respectively. The median follow-up was 83.5 months. Patients with high sialyl Lex x expression had shorter disease-free intervals than those with low sialyl Le x expression (P=0.0041); the expression of sialyl Le x or sialyl Tn antigens did not show a significant relationship with disease-free survival. Cox's regression analysis revealed that sialyl Le x expression was an independent predictor for disease-free survival, separate from T factor or tumor location. High sialyl Le x expression may be useful in identifying a subset of node-negative colorectal cancer patients who are at high risk for recurrence.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K., Ishikawa H.
Journal of Clinical Gastroenterology 34 ( 4 ) 408 - 415 2002.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Clinical Gastroenterology
Sialyl Lewis a (CA19-9) and sialyl Lewis x antigens (SLX) may play a role in tumor metastasis by serving as functional ligands in the cell adhesion system. The authors examined preoperative serum levels of CA19-9 and SLX in 218 patients who underwent resection for gastric cancer to determine their prognostic value. The patients were divided into two groups, termed the low and high antigen groups, based on a value selected as a diagnostic cutoff. Correlation between the antigen serum levels, various established clinicopathologic factors, and prognosis were studied by univariate and multivariate analysis. The disease-specific interval for high CA19-9 and SLX groups was significantly shorter than that of their respective low groups (p = 0.0024 and p < 0.0001, respectively). Patients with stage III/IV tumors who had high serum SLX levels had shorter disease-specific intervals than those with low serum levels (p = 0.0017). A Cox's regression analysis revealed a high serum SLX level as an independent factor for worse outcome. In addition, logistic regression analysis revealed that a high serum SLX level was an independent predictor for liver metastasis. In conclusion, an elevated preoperative serum SLX level was a predictor for poor outcome after resection for gastric cancer, whereas CA19-9 was not.
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Difference in prognostic value between sialyl Lewis(a) and sialyl Lewis(x) antigen levels in the preoperative serum of gastric cancer patients.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H, Arisawa K, Ishikawa H
Journal of clinical gastroenterology 34 ( 4 ) 408 - 15 2002.4
Language：Japanese Publishing type：Research paper (scientific journal)
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[Liver transplantation for hepatocellular carcinoma: experience at an Australian transplantation unit].
Nanashima A
Nihon Geka Gakkai zasshi 103 ( 4 ) 381 - 5 2002.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Liver transplantation for hepatocellular carcinoma: experience at an Australian transplantation unit Reviewed
Nanashima A.
Journal of Japan Surgical Society 103 ( 4 ) 381 - 385 2002.4
Authorship：Lead author Language：Japanese Publishing type：Case report
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A case report of intestinal perforation causing by dialysis-related amyloidosis
Takashi T., Terumitsu S., Shinichi S., Atsushi N., Masaaki J., Hiroyuki Y., Tohru Y., Tohru N., Hiroyoshi A., Kuniko A.
Japanese Journal of Gastroenterological Surgery 35 ( 2 ) 176 - 179 2002.3
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
We experienced a case with an intestinal perforation resulting from dialysis-related amyloidosis. A fifty-six-year old women who had been receiving hemodialysis for twenty-three years underwent an operation for bilateral carpal tunnel syndrome and destructive spondyloarthropathy. She had experienced the onset of diarrhea four months earlier, and was operated on for perforative peritonitis. The middle part of the small intestine contained a 16 × 8 mm hole. Partial resection of the small bowel and end-to-end anastomosis was performed. A pathological examination revealed an amyloid deposit in a perivascular area of the submucosal layer, and immunohistochemistry for β2-microglobulin was positive. She was diagnosed as having dialysis-related amyloidosis. Anastomotic leakage occurred early during the post-operative day. She was died five months later because of a sepsis.
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Nakagoe T., Sawai T., Tuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y.
Digestive Diseases and Sciences 47 ( 2 ) 322 - 330 2002.2
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Diseases and Sciences
We examined the immunohistochemical expression of sialosyl-Tn antigen in the colorectal cancer tissues of 116 patients who underwent curative resection to determine the association between patient prognosis and the expression of sialosyl-Tn in two different tissues: carcinoma and transitional mucosa. Negative or positive expression of sialosyl-Tn in the carcinoma and transitional mucosal tissues were denoted as CA-or CA+and TM-or TM+, respectively. Patients were classified into one of four groups: CA-/TM-, CA-/TM+, CA+/TM-, and CA+/TM+. CA-/TM-was observed in 13 patients and CA-/TM+, CA+/TM-, or CA+/TM+was observed in 103 patients. The difference in five-year survival between the CA-/TM-group and all the other groups was statistically significant (P = 0.0457), and multivariate analysis showed that sialosyl-Tn expression in at least one of the two tissues was an independent prognostic factor. We conclude that the evaluation of sialosyl-Tn expression in carcinoma as well as transitional mucosa is useful for predicting survival in colorectal cancer patients.
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Increased expression of sialyl Lewis(x) antigen as a prognostic factor in patients with stage 0, I, and II gastric cancer.
Nakagoe T, Fukushima K, Sawai T, Tsuji T, Jibiki Ma, Nanashima A, Tanaka K, Yamaguchi H, Yasutake T, Ayabe H, Arisawa K, Ishikawa H
Cancer letters 175 ( 2 ) 213 - 21 2002.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Fukushima K., Sawai T., Tsuji T., Jibiki M., Nanashima A., Tanaka K., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K., Ishikawa H.
Cancer Letters 175 ( 2 ) 213 - 221 2002.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Letters
Immunohistochemically detected expression of sialyl Lewis x (Le x ) antigen was analyzed in 101 stage 0-II gastric cancers to clarify its prognostic value after curative gastrectomy. Patients with a high-expression of sialyl Le x antigen within their tumors had shorter disease-specific intervals than those with negative- or low-expressing tumors (P < 0.0001). This difference was noted particularly in stage I-B or II disease. Multivariate Cox's regression analysis revealed sialyl Le x antigen expression to be an independent predictor of disease-specific survival (Hazard ratio=9.10). In conclusion, the increased expression of sialyl Le x antigen may serve as a prognostic factor after curative surgery for stages 0-II gastric cancer. © 2002 Elsevier Science Ireland Ltd. All rights reserved.
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Predictive factors for preoperative serum levels of sialy Lewis(x), sialyl Lewis(a) and sialyl Tn antigens in gastric cancer patients.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H, Arisawa K, Ishikawa H
Anticancer research 22 ( 1A ) 451 - 8 2002.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Analysis of tumor morphology in metastatic colorectal cancer: does this classification have any clinical significance?
Nanashima A, Yamaguchi H, Sawai T, Shibasaki S, Yasutake T, Tsuji T, Hidaka S, Jibiki M, Nakagoe T, Ayabe H
Journal of gastroenterology 37 ( 10 ) 791 - 7 2002
Language：Japanese Publishing type：Research paper (scientific journal)
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Application of argyrophilic nucleolar organizer region (AgNOR) staining for cytology of biliary tract carcinomas.
Nanashima A, Yamaguchi H, Nishizawa-Takano JE, Hatano K, Shibasaki S, Sawai T, Yasutake T, Obatake M, Nakagoe T, Ayabe H
Journal of hepato-biliary-pancreatic surgery 9 ( 4 ) 485 - 9 2002
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Pillay P., Crawford M., Nakasuji M., Verran D., Painter D.
Journal of Hepato-Biliary-Pancreatic Surgery 8 ( 6 ) 557 - 563 2001.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Surgery
Background/Purpose. We investigated the causes and examined patient outcomes following the postrevascularization syndrome (PRS) during orthotopic liver transplantation (OLTx). Methods. PRS was defined as a fall in the mean arterial pressure at 5 min after revascularization to less than 70% of the baseline and lasting for 5 min. Data from 100 adult patients who underwent OLTx between January 1998 and September 2000 were analyzed. Analyzed data included donor and recipient demographic data, recipient operative and postoperative courses, and recipient outcome. Results. Twenty-nine patients (29%) exhibited PRS during OLTx (PRS group). There was a higher incidence of older donors ( > 50 years) in the PRS group (48% vs 23%; P < 0.05). Postrevascularization hyperkalemia and metabolic acidosis were observed in both the PRS and non-PRS groups. Transaminase and lactate levels after revascularization were significantly higher in the PRS group (P < 0.05). Alkaline phosphatase and gamma-glutamyl transpeptidase levels on day 7 tended to be higher in the PRS group; although the difference was not significant (p ≥ 0.05). Serum creatinine was significantly elevated on day 7 in the PRS group (P < 0.01). Conclusions. Our results indicate that PRS following OLTx tended to be more common in liver allografts from older donors and was associated with posttransplantation liver and renal dysfunction.
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Colectomy for colon cancer via a 7-cm minilaparotomy
Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
Surgery Today 31 ( 12 ) 1113 - 1115 2001.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
We herein describe our technique for performing a colectomy to resect colon cancer via a 7-cm minilaparotomy using conventional surgical techniques and instruments. By moving the minilaparotomy wound laterally as well as either caudad or cephalad, the mobilization of the relevant segment of the bowel loop was thus made possible. To ensure an adequate visualization of the operative field during a dissection of the lymph nodes, an Omni-Tract retractor system was used. The division of the colonic mesentery, transection of the affected bowel, and bowel anastomosis were performed extracorporeally or at the level of the incision. This same operation was successfully performed in 102 patients with colon cancer. We conclude that a colectomy for colon cancer via a 7-cm minilaparotomy is an attractive alternative to a conventional full laparotomy in selected patients.
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Early outcome after minilaparotomy for the treatment of rectal cancer
Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
European Journal of Surgery 167 ( 9 ) 705 - 710 2001.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgery
Objective: To compare early outcomes of the minilaparotomy approach to the resection of rectal cancer with those of conventional laparotomy. Design: Retrospective study. Setting: University hospital, Japan. Subjects: 18 patients who had complete resection through a minilaparotomy and 20 who had a conventional laparotomy served as the study and the control groups, respectively. Patients who were overweight or morbidly obese (body mass index ≥25) were excluded from the study. Interventions: Complete resection through a skin incision less than 7 cm in length, or a conventional incision. Main outcome measures: Early postoperative outcomes. Results: Postoperative time intervals to standing, walking, passing flatus, and removal of the urinary catheter, and analgesic requirements were significantly less in the minilaparotomy group (p = 0.007, p = 0.004, p = 0.02, p = 0.002, and p = 0.05, respectively). Conclusions: The minilaparotomy for complete resection of rectal cancer is less invasive than conventional laparotomy, and provides an attractive alternative in highly selected patients who are not overweight.
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Sawai T., Nanashima A., Tsuji T., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H., Tagawa Y.
Journal of Experimental and Clinical Cancer Research 20 ( 3 ) 401 - 405 2001.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Experimental and Clinical Cancer Research
Recently, two different mechanisms of genetic instability have been demonstrated in the carcinogenesis of colorectal cancer. Microsatellite instability is an important genetic event for carcinogenesis in hereditary non-polyposis colorectal cancer, proximal colon cancer, and multiple colorectal carcinoma. To examine the association among chromosomal instability and multiple primary malignancies (MPM) in colorectal cancer, fluorescence in situ hybridization using a chromosome 17-specific probe, p53 cosmid probe, and/or an alpha satellite DNA probe was performed in 184 patients with colorectal cancer. The proportion of aneusomy 17 in MPM was significantly higher than that of single cancers (SC) (46.1±8.0% and 39.0±10.3%, respectively; p < 0.01). Multiple numerical aberrations of chromosome 17 in MPM occurred more often than those of SC (64.3% and 22.9%, respectively; p < 0.01). The mean frequency of p53 deletion was also higher in MPM (70.4±16.7%) compared with SC (53.4±18.1%, p < 0.05). The frequency of chromosome 17 translocation was significantly greater in tumors with MPM (4/6; 67%) than in SC (3/23; 13%, p < 0.05). The frequency of p53 locus translocation was also significantly greater in tumors with MPM (4/6; 67%) than in SC (0/23; 0%, p < 0.01). These results suggested that numerical and structural aberrations of chromosome 17 and the p53 locus are important genetic events associated with carcinogenesis in non-familial colorectal cancer with MPM.
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Minilaparotomy wound edge protector (Lap-Protector): A new device
Nakagoe T., Sawai T., Tsuji T., Nanashima A., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Shimomura K.
Surgery Today 31 ( 9 ) 850 - 852 2001.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Laparoscopic-assisted or minimally invasive surgery involving minilaparotomy is occasionally complicated by infection of the minilaparotomy wound caused by intestinal bacteria. Furthermore, when this procedure is performed to excise colorectal or gastric cancer, tumor recurrence may develop in the minilaparotomy wound. In an attempt to minimize the risk of these complications, we developed a new, easy-to-use device which we named the "Lap-Protector." Minilaparotomy was performed using the Lap-Protector in 28 patients with colon cancer and eight patients with early gastric cancer who underwent minimally invasive surgery between January and September, 1999. During a median follow-up period of 15.9 (range 12.4-21.0) months, none of the 36 patients showed any sign of wound infection or tumor recurrence in the minilaparotomy wound. These results indicated that the Lap-Protector is a safe and useful device that may help to prevent infections and cancer cell contamination of the minilaparotomy wound.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Kurosaki N., Ayabe H., Arisawa K.
Cancer Detection and Prevention 25 ( 3 ) 299 - 308 2001.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Detection and Prevention
In this study, we examined the preoperative serum levels of sialyl Lewisa, sialyl LewisX, sialyl Tn, and carcinoembryonic antigen in 243 colorectal cancer patients in order to clarify the role of these antigens as prognostic factors after curative surgery. The patients were divided into two groups: low and high antigen groups (lower and higher than a selected diagnostic-based cut-off value). Patients with high serum levels of sialyl Lewisa and carcinoembryonic antigen had shorter disease-free intervals than those with low serum levels of the respective antigen, although sialyl Lewisx and sialyl Tn showed no significant differences. Multivariate analysis revealed that three independent prognostic variables, including depth of tumor invasion, lymph node metastasis, and serum sialyl Lewisa level, did prove to have value in predicting disease-free interval. In conclusion, among the four antigens examined in this study, the preoperative serum level of sialyl Lewisa is the only independent prognostic variable for recurrence after curative resection of colorectal cancer.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Kurosaki N., Yasutake T., Ayabe H., Arisawa K.
Journal of Experimental and Clinical Cancer Research 20 ( 1 ) 85 - 90 2001.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Experimental and Clinical Cancer Research
Two types of colorectal cancer with distinct morphologies have been described in recent studies: polypoid growth type (PG-type) and non-polypoid growth type (NPG-type). We hypothesize that the morphologic differences may correspond to additional biological distinctions. Ratios of sialyl Lewis a (CA19-9), sialyl Lewis x (SLX), or carcinoembryonic antigen (CEA) in the venous blood drainage from the tumor to that of the respective antigen in the peripheral venous blood (d/p ratio) was examined in order to ascertain whether or not the ratio is correlated with either the PG-type or NPG-type colorectal tumor growth pattern. Blood samples from 118 patients with colorectal cancer were obtained from a peripheral vein and from the tumor drainage vein during surgical excision of the tumor. Statistical tests were conducted by univariate and multivariate (logistic regression) analyses. Among the cancers examined there were 17 PG-type (14.4%) and 101 NPG-type (85.6%). NPG-type cancers had a higher frequency of moderately differentiated adenocarcinoma cells and T3/T4 tumors than PG-type cancers (P < 0.0001 and P < 0.0001, respectively). NPG-type cancers had a more advanced stage than PG-type cancers (P=0.0007). The d/p ratio of SLX in NPG-type cancers was significantly higher than that in PG-type cancers (P=0.028). Multivariate logistic regression analysis showed that three variables, namely histologic type, T factor, and d/p ratio of SLX, were independently related to tumor growth patterns. In conclusion, NPG-type cancers are characterized by a high SLX d/p ratio, which may be at least partly responsible for a different tumor progression pattern compared to other cancer types.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Kurosaki N., Yasutake T., Ayabe H.
Journal of Gastroenterology 36 ( 3 ) 166 - 172 2001.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
Preoperative serum levels of sialyl Lewis a (CA 19-9), sialyl Lewis x (SLX), and sialyl Tn (STN) antigens in colorectal cancer patients were examined to establish predictive factors for serum levels of these antigens compared with carcinoembryonic antigen (CEA). A total of 308 patients who underwent resection for a colorectal cancer were divided into low and high antigen groups (higher or lower than a selected diagnostic-based cutoff value). The cutoff values were 37 U/ml for CA19-9, 38 U/ml for SLX, 45 U/ml for STN, and 2.5 ng/ml for CEA. The American Joint Committee on Cancer Classification and Stage grouping was used to classify the tumors. Statistical tests were conducted using univariate and multivariate logistic regression analyses. For CA19-9, 81 patients (26.3%) were assigned to the high antigen group; for SLX, 39 (12.7%); for STN, 33 (10.7%); and for CEA, 133 (43.2%). Multivariate logistic regression analysis revealed that predictive factors associated with high antigen levels were female sex (odds ratio [OR], 1.78 vs male sex), T4 (OR, 3.26 vs T1/T2), and M1 (OR, 3.35 vs MO) for CA19-9; M1 (OR, 6.40 vs MO) for SLX; mucinous carcinoma (OR, 8.45 vs well differentiated adenocarcinoma) and M1 (OR, 8.24 vs MO) for STN; and mucinous carcinoma (OR, 7.21 vs well differentiated adenocarcinoma), T3/T4 (OR, 3.84/ 4.18, respectively, vs T1/T2), and M1 (OR, 6.39 vs MO) for CEA. In conclusion, high serum levels of CA19-9, SLX, and STN are strongly associated with distant metastasis. In addition, high serum levels of CA19-9 may be an independent predictor for female gender and T4, and high serum levels of STN may be an independent predictor for mucinous carcinoma.
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Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure
Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Yasutake T., Kurosaki N., Ayabe H., Ishikawa H.
Surgery Today 31 ( 3 ) 204 - 209 2001.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Extended resection, comprising extended right hemicolectomy, splenectomy, and distal pancreatectomy, has been advocated for carcinoma of the splenic flexure because the lymphatic drainage at this site is variable. The present study addresses the problems associated with selecting the most appropriate operative procedure to achieve cure of splenic flexure cancers. We conducted a retrospective review of 27 patients with splenic flexure cancer who underwent curative resection. Left partial colectomy was performed in 20 patients and partial resection of the transverse/descending colon was performed in 7 patients. The combined resection of adjacent organs due to tumor adherence was performed in three patients. The spleen and distal pancreas were the organs most frequently resected among a collective total of six adjacent organs. The median duration of follow-up was 60.9 months after resection for splenic flexure cancer. No patient developed local recurrence. There was no significant difference in 5-year survival between patients with splenic flexure cancers and those with colon cancers at other sites. In conclusion, splenic flexure cancer resected by left partial colectomy or partial resection of the transverse/descending colon without routine extended resection was not associated with a worse prognosis than colon cancers at other sites.
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Nakagoe T., Fukushima K., Nanashima A., Sawai T., Tsuji T., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y.
Journal of Gastroenterology and Hepatology (Australia) 16 ( 2 ) 176 - 183 2001.2
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)
Background and Aims: Colorectal tumors can be classified based on their growth pattern into the polypoid growth-type (PG-type) and non-polypoid growth-type (NPG-type). To ascertain whether there is any relationship between the expression of particular blood group-related antigens (A, B, H, Lewis (Le) a , sialyl Le a , Le x , sialyl Le x ) in a colorectal tumor, and a tumor having polypoid or non-polypoid growth, we examined 78 PG-type and NPG-type colorectal cancers. Methods: Fourteen PG-type and 64 NPG-type colorectal carcinomas were subjected to immunohistochemical analyses by using monoclonal antibodies against A, B, H, Le a , sialyl Le a , Le x and sialyl Le x . Results: The patients with NPG-type carcinomas had a significantly younger age of onset, significantly smaller maximal tumor diameter, significantly higher rate of lymph node metastasis and significantly worse prognosis than those with PG-type carcinomas. Among the 32 tumors of patients with blood type A or AB, isoantigen A was expressed in a significantly larger percentage of NPG-type carcinomas than PG-type carcinomas (95.8 vs 62.5%, respectively; P=0.014). Among all 78 tumors, sialyl Le x antigen was expressed in a significantly larger percentage of NPG-type than PG-type carcinomas (90.6 vs 64.3%, respectively; P=0.010). Multivariate analysis using the logistic regression model revealed that isoantigen A and sialyl Le x expression were independent predictive risk factors for the development of NPG-type colorectal carcinoma. Conclusions: These data suggest that the expression of isoantigen A and sialyl Le x in a colorectal carcinoma partially determines whether the tumor will have polypoid or non-polypoid growth. © 2001 Blackwell Science Asia Pty Ltd.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K.
Tumor Biology 22 ( 2 ) 115 - 122 2001.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Tumor Biology
The serum levels of sialyl Lewisa (CA19-9), sialyl Lewisx (SLX), sialyl Tn (STN) and carcinoembryonic antigen (CEA) in peripheral venous blood and tumor drainage venous blood of colorectal cancer patients were examined to determine their value as prognostic factors after surgery. Blood samples were obtained from the peripheral vein and from the tumor drainage vein from 124 colorectal cancer patients during surgical excision of the tumor. The patients were divided into high-antigen and low-antigen groups for each antigen in each location. Serum levels of SLX, STN and CEA in tumor drainage venous blood (d-SLX, d-STN and d-CEA, respectively) were significantly higher than in peripheral venous blood (p-SLX, p-STN and p-CEA, respectively). The survival time after surgery for patients with high d-SLX or d-CEA levels and low levels of the same antigen in peripheral venous blood was significantly shorter than the survival time for those patients with low levels of antigen at both sites (p = 0.0003 or p = 0.0406, respectively). Cox's regression analysis revealed that a high d-SLX or high d-CEA level was an independent prognostic variable for patient survival. In conclusion, determining d-SLX or d-CEA is more useful than p-SLX or p-CEA in predicting the outcome for colorectal cancer patients. Copyright © 2001 S. Karger AG, Basel.
DOI： 10.1159/000050605
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Nanashima A., Yamaguchi H., Fukuda T., Sakamoto I., Kuroda A., Sawai T., Nakagoe T., Ayabe H.
Journal of Gastroenterology and Hepatology (Australia) 16 ( 1 ) 87 - 92 2001
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)
Background: To evaluate pancreatic exocrine function, we measured the changes in T 2 enhanced hydrograhic intensity on magnetic resonance (MR) images of the pancreas following an injection of secretin, which is representative of the changes in duodenal fluid volume. Methods: The subjects were 10 patients with normal pancreatic function (N > 70% detected by using a pancreatic function diagnostant test) and 12 patients with hypo-function, including those with mild hypo-function (MH, 50-70%, six patients) and severe hypo-function (SH < 50%, six patients). Results: In the N group, T 2 enhanced intensity of the pancreas increased to a maximum value (more than 10% compared with baseline) within 5 min of stimulation, then gradually decreased. No significant difference in the response was observed between the head and body of the pancreas. Changes in the MH group were similar to those of the N group. In contrast, significantly lower changes in T 2 enhanced intensity were observed in SH group, relative to both the N and MH group (P < 0.05). The amount of secretin-induced increase in duodenal fluid after 16 min was not significantly different among the three groups. Furthermore, an evaluation of the residual pancreatic tissue after a pancreatoduodenectomy was also feasible. Conclusions: Our results indicate that the MR-secretin test is useful for the evaluation of severe pancreatic exocrine dysfunction. The diagnostic test is simple, direct and non-invasive. © 2001 Blackwell Science Asia Pty Ltd.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K., Ishikawa H.
European Journal of Surgical Oncology 27 ( 8 ) 731 - 739 2001
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：European Journal of Surgical Oncology
Aims: To clarify the prognostic value of preoperative serum levels of sialyl Tn antigen (STN) for survival of gastric cancer patients. Methods: Pre-operative serum levels of STN, sialyl Lewis a antigen (CA19-9) and carcinoembryonic antigen (CEA) were examined in 180 patients who underwent resection of gastric cancer. Patients were divided into high and low antigen groups on the basis of a selected diagnostic-based cut-off value. Correlation between high antigen serum levels, established clinicopathologic factors and prognosis was examined by univariate and multivariate analysis. Results: Twenty-eight patients (15.6%) were classified as high STN; 37 (20.6%) as high CA19-9; and 33 (18.3%) as high CEA. The survival time of the high STN, CA19-9 or CEA group was shorter than that of the respective low-antigen group (P < 0.0001, P=0.0008 or P=0.0002, respectively). Patients with stage III/IV tumours with high STN had a shorter survival time that those with low STN (P=0.0004). Cox's regression with multiple covariates showed that high serum STN is an independent factor predicting a worse outcome in gastric cancer patient s. Multiple logistic regression analysis revealed that high serum STN is an independent predictor for the development of liver metastasis. Conclusions: Pre-operative high serum levels of STN predict both liver metastasis and poor prognosis after resection for gastric cancer. © 2001 Harcourt Publishers Ltd.
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Nanashima A., Yamaguchi H., Shibasaki S., Sawai T., Yamaguchi E., Yasutake T., Tsuji T., Jibiki M., Nakagoe T., Ayabe H.
Journal of Gastroenterology and Hepatology (Australia) 16 ( 10 ) 1158 - 1163 2001
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)
Background and Aim: The serum hyaluronic acid (HA) concentrations reflect the degree of hepatic fibrosis and sinusoidal endothelial cell damage. The HA concentrations were examined to evaluate liver damage during the perioperative period of hepatectomy. Methods: The HA level of serum samples from 79 patients who underwent a hepatectomy was measured, and the results were compared to conventional liver function tests, the degree of fibrosis, liver regeneration and complications. Results: Hyaluronic acid concentrations correlated with the severe fibrosis or histological activity index, and also correlated with liver function tests including transaminase level, platelet counts, prothrombin time activity, indocyanine green retention rate at 15 min (ICG R15), liver activity at 15 min by technetium-99m galactosyl human serum albumin scintigraphy (LHL 15), and portal pressure. The HA level postoperatively correlated with liver function, especially with total bilirubin. Hyaluronic acid levels at day 28 postoperatively correlated with ICG R15 and LHL 15. The hyaluronic acid level before surgery and at day 28 postoperatively correlated with the regeneration of remnant liver in major hepatectom y. The HA levels were significantly higher in patients with hepatic failure or prolonged ascites. Conclusion: Our results indicate that the measurement of the HA level is useful for monitoring liver damage or predicting complications associated with liver surgery. ©2001 Blackwell Science Asia Pty Ltd.
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Nanashima A., Yamaguchi H., Sawai T., Yamaguchi E., Kidogawa H., Matsuo S., Yasutake T., Tsuji T., Jibiki M., Nakagoe T., Ayabe H.
Digestive Diseases and Sciences 46 ( 8 ) 1623 - 1628 2001
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Diseases and Sciences
The present study was designed to provide a systemic analysis of prognosis in 62 patients who underwent hepatic resection for colorectal liver metastasis. The analyzed factors included microvessel counts stained by CD34 and expression of two adhesion molecules, E-cadherin and CD44 variant exon 6-(v6) in these tumors. No significant factors related to recurrence were identified and only negative expression of CD44v6 tended to correlate with recurrence (P = 0.075). A short disease-free period to recurrence was noted in patients with high CEA levels (>10 ng/ml) and H2/3 classification. A short surgical margin, H2/3 classification, high microvessel counts (>60/field, ×200), and negative expression of CD44v6 and E-cadherin tended to be associated with poor prognosis. A high microvessel count was the most significant prognostic factor by multivariate Cox proportional hazards regression model. Hepatic resection without tumor exposure and a careful follow-up in cases identified with poor prognostic factors are necessary.
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Treatment of surgical site infection with aqua oxidation water: Comparison with povidone iodine
Nanashima A., Yamaguchi H., Sawai T., Tsuji T., Shibasaki S., Matsuo S., Jibiki M., Yasutake T., Nakagoe T., Ayabe H.
Acta Medica Nagasakiensia 46 ( 1-2 ) 33 - 37 2001
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Aqua oxidation water is a new disinfectant with a bactericidal activity based on high oxidation-reduction potential and acidity. We compared the effectiveness of aqua oxidation water and povidone iodine against the surgical Site infection (SSI). The bacteriological effect against several organisms and the efficacy of both disinfectants were almost similar. However, the duration of treatment with aqua oxidation water was shorter than that with the povidone iodine in healed wounds (p<0.05) and the number of patients treated with aqua oxidation water who reported pain was smaller than that with povidone iodine (p<0.05). Our results indicated that aqua oxidation water useful and effective for the treatment of incurable SSI.
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Prognostic value of circulating sialyl Tn antigen in colorectal cancer patients
Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Kurosaki N., Yasutake T., Ayabe H., Tagawa Y.
Anticancer Research 20 ( 5 C ) 3863 - 3869 2000.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
To examine the prognostic value of assessing the concentration of circulating sialyl Tn antigen (STN) after surgery, we determined serum STN levels in peripheral venous blood (designated 'p-') in 308 colorectal cancer patients and what we have termed the 'd-p gradient' (obtained by subtracting the serum concentration in peripheral venous blood from that in the tumor's drainage venous blood) in 144 patients. The prognostic value of STN and carcinoembryonic antigen (CEA) was compared. Patients were divided into low or high p-antigen groups and low, intermediate, or high d-p gradient groups. Univariate and multivariate analyses revealed that high STN d-p gradient, high p-CEA, or high CEA d-p gradient were each independent variables for poor patient outcome after surgery, separate from stage. In conclusion, a high STN d-p gradient was a predictor of poor outcome after resection for colorectal cancer, while p-STN was not independent of stage.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Kurosaki N., Yasutake T., Ayabe H., Tagawa Y.
Cancer Letters 159 ( 2 ) 159 - 168 2000.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Letters
Subtraction values, (i.e. values obtained by subtracting the serum titer of sialyl Lewis a (CA19-9) and sialyl Lewis(x) (SLX) antigens in peripheral venous blood from the serum titer of the same antigen in the tumor's drainage venous blood) were determined in order to clarify whether or not such values for these specific antigens (d-CA19-9 and d-SLX) are prognostic factors after resection for colorectal cancer. The blood samples were obtained from 144 colorectal cancer patients during surgical excisions of the tumors. Univariate and multivariate analyses revealed that d-SLX level was an independent prognostic factor, separate from stage, while d-CA19-9 level did not have any additional prognostic value. In conclusion, a high d-SLX level is a predictor of poor outcome after surgery. (C) 2000 Elsevier Science Ireland Ltd.
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Nakagoe T., Nanashima A., Sawai T., Tuji T., Yamaguchi E., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y.
Oncology 59 ( 2 ) 131 - 138 2000.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Oncology
Colorectal tumors can be classified based on their growth pattern into the polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). We examined sialyl Tn antigen expression in advanced colorectal carcinomas that were classified as PG-type and NPG-type cancers in order to ascertain whether or not su ch expression correlates with other biologically and clinically important differences. A total of 94 advanced colorectal carcinomas were examined for sialyl Tn antigen expression, which was immunohistochemically detected by the monoclonal antibody TKH2. Univariate and multivariate analyses using logistic regression models were performed. Forty carcinomas (42.6%) were negative and 54 (57.5%) were positive for sialyl Tn antigen. Eighteen carcinomas (19.2%) were of PG type and 76 (80.8%) of NPG type. NPG- type cancers had a higher proportion of positive lymph node metastasis than PG-type cancers. Furthermore, sialyl Tn antigen was less often detected in NPG-type cancers (39 of 76; 51.3%) than in PG-type cancers (15 of 18; 83.3%; p = 0.0167). Multivariate analysis showed that two variables, lymph node metastasis and sialyl Tn antigen expression in carcinoma, were independently related to tumor growth patterns, that is NPG type and PG type. These data suggest that the difference in sialyl Tn antigen expression between two kinds of tumor growth patterns of advanced colorectal carcinomas, PG type and NPG type, may reflect different biological behaviors during tumor progression. Copyright (C) 2000 S. Karger AG, Basel.
DOI： 10.1159/000012150
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Ishikawa H.
Journal of Gastroenterology 35 ( 7 ) 528 - 535 2000.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
The clinicopathological characteristics and outcome of splenic flexure cancer after surgery have yet to be fully elucidated. The aim of the current study was, therefore, to establish predictive factors related to splenic flexure cancer and outcome after surgery. We compared the clinicopathological characteristics and outcome of 34 patients with splenic flexure cancers (which represents 3.7% of the total number of colon cancers in our series) with those of 418 patients with right colon and 475 patients with left colon cancers by univariate and multivariate analyses, using logistic regression analysis and Cox's proportional hazards model. Splenic flexure cancers had a high risk of obstruction (26.5% of patients), and had a more advanced stage and lower cure rate than left colon cancers. Logistic regression analysis revealed that two independent factors, colonic obstruction and the presence of distant metastases, were related to the splenic flexure tumor site. Splenic flexure cancer patients had a poorer outcome than those with left colon cancer (P = 0.0361). However, there was no difference in survival between patients with splenic flexure, those with right colon cancer and those with left colon cancer who underwent curative surgery. Cox's regression analysis revealed that neither the site of splenic flexure nor colonic obstruction was an independent prognostic factor. In conclusion, splenic flexure cancer is characterized by a high risk of obstruction and the presence of distant metastases. However, after curative resection, splenic flexure cancer has a similar outcome to colon cancer at other sites. In addition, neither the splenic flexure site nor colonic obstruction had an independent influence on patient survival after surgery.
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Differences in 20q13.2 copy number between colorectal cancers with and without liver metastasis
Hidaka S., Yasutake T., Takeshita H., Kondo M., Tsuji T., Nanashima A., Sawai T., Yamaguchi H., Nakagoe T., Ayabe H., Tagawa Y.
Clinical Cancer Research 6 ( 7 ) 2712 - 2717 2000.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Clinical Cancer Research
Frequent gains of 20q have been identified recently in many neoplasias, including breast, bladder, ovarian, pancreatic, and colon cancers. A high level of 20q13.2 amplification is associated with poor prognosis in breast cancer. We investigated the copy number of the 20q13.2 region including the ZNF217 oncogene in 17 nonmetastatic colorectal cancers (CRCs), 18 primary CRC tumors with liver metastasis, and 18 metastatic lesions by two-color fluorescence in situ hybridization to evaluate the significance of an increased copy number of 20q13.2 in CRC, especially in those cases with liver metastasis. The frequency of increased relative copy number of the 20q13.2 region was higher in primary and liver metastatic lesions of CRC than in CRC lesions without liver metastasis. In particular, a high-level increase ( > 3.0- fold) in the relative copy number of 20q13.2 was observed in 2 of 18 (11%) primary CRC lesions with liver metastasis, 7 of 18 (39%) liver metastatic lesions, and in none of the cases of primary CRC without liver metastasis. The absolute and relative copy number of chromosome 20q13.2 was higher in CRCs with metastasis than in CRCs without metastasis. The percentage of cells with high-level 20q13.2 amplification was also higher in both lesions with metastasis per specimen than without metastasis. Our results suggest that the level of 20q13.2 amplification correlates with the metastatic potential and tumor progression of CRC. The results also suggest that 20q13.2 amplification with ZNF217 is associated with increased metastatic potential.
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Tagawa Y.
Annals of Surgical Oncology 7 ( 4 ) 289 - 295 2000.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Annals of Surgical Oncology
Background: To investigate colorectal cancer-related carbohydrate antigen release and distribution, we evaluated serum levels of sialyl Le a (CA19-9) and sialyl Le(x) antigen (SLX) in blood samples obtained from both a peripheral vein and a tumor's draining vein. Methods: Blood samples were obtained during surgery from 126 patients. Based on these samples, patients were placed into a high-antigen group, with a concentration above a selected cutoff value, or into a low-antigen group, with a tumor marker concentration below that same value. The blood samples obtained from peripheral veins were designated by the 'p' prefix, and samples from drainage veins were designated by the 'd.' Results: Serum d-SLX levels were significantly higher than p-SLX levels (P < .0001), although there was no difference between those of d-CA19- 9 and p-CA19-9. Only 1 (3.6%) of 28 patients in the high d-CA19-9 group had a low p-CA19-9. In contrast, 6 (33.3%) of 18 patients in the high d-SLX group had low p-SLX levels (P = .0103). Correlations between pathological variables and either p-CA19-9 levels or d-CA19-9 levels were similar. However, both distant metastasis and venous invasion d id prove to be independent variables related to d-SLX levels, as shown by logistic regression analysis. Conclusions: SLX may drain predominantly via the draining veins of colorectal tumors into portal circulation, whereas CA19-9 may drain via another route.
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Increased expression of sialyl Le(x) antigen in non-polypoid growth type of colorectal carcinoma
Nakagoe T., Fukushima K., Nanashima A., Sawai T., Tsuji T., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y.
Cancer Letters 151 ( 2 ) 209 - 216 2000.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Letters
Colorectal carcinoma can be morphologically divided into two different categories, namely polypoid growth (PG-type) and non-polypoid growth (NPG-type). To ascertain whether the expression of sialyl Le(x) antigen correlates with biologically and clinically important differences, an immunohistochemical assay was performed in 30 PG-type and 119 NPG-type cancers. In contrast to PG-type, the characteristics of the NPG-type include (1) an increased expression of sialyl Le(x); (2) a high rate of lymph node metastasis; (3) a high proportion of moderately differentiated adenocarcinoma cells; (4) young age of onset. It is concluded that differences in sialyl Le(x) expression between the PG-type and NPG-type cancers may be at least partly responsible for different tumor progression behavior. Copyright (C) 2000 Else vier Science Ireland Ltd.
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Fujise N., Nanashima A., Taniguchi Y., Matsuo S., Hatano K., Matsumoto Y., Tagawa Y., Ayabe H.
Lung Cancer 27 ( 1 ) 19 - 26 2000.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Lung Cancer
The expression of Cathepsin B (CB) and matrix metalloproteinase-9 (MMP-9) in extirpated tissues of adenocarcinomas in non-small cell lung cancer from 90 cases was investigated immunohistologically, and the correlations between the extent of the expression and the clinicopathological features were assessed for investigaiting the process of tumor metastasis. It is important to reveal the mechanisms of destruction of the basal membrane and infiltration of tumor cells at the primary lesion. Sections were obtained from 10%-formalin-fixed and paraffin-embedded tissues. They were reacted with an anti-human CB polyclonal antibody or an anti-human MMP-9 polyclonal antibody. Of 90 patients, 58 (64.4%) and 39 (48.3) cases were found to be positive for CB and MMP-9 expression, respectively. A significantly higher extent of the CB expression was observed in the tissues of patients who showed postoperative recurrence of the tumor (P=0.013). Especially, a similar observation was obtained among early cases of T1N0 (P=0.023). In contrast, no such tendency was demonstrated in the expression profile of MMP-9. Furthermore, the enzyme expressions were compared among different types of metastases. Patients with higher extents of CB expression tended to show significantly higher rates of hematogenous and intrapulmonary metastases (P=0.023 and P=0.010, respectively). However, there was no significant correlation between MMP-9 expression and the prognostic factor of the patients. Therefore, we suggested that evaluation of CB expression in the tumor tissue might be useful as a postoperative prognostic factor of pulmonary adenocarcinoma. Especially, early cancer of T1N0 cases showing higher expression of CB may need postoperative adjuvant chemotherapy. Copyright (C) 2000 Elsevier Science Ireland Ltd.
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Nakagoe T., Fukushima K., Nanashima A., Sawai T., Tsuji T., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y., Arisawa K.
Canadian Journal of Gastroenterology 14 ( 9 ) 753 - 760 2000
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Canadian Journal of Gastroenterology
Background: Altered expression of blood group-related carbohydrate antigens such as sialyl Lewis (Le)(x) antigen in tumours is associated with tumour progression behaviour and subsequent prognosis. However, the prognostic value of the expression of Le-related antigens in colorectal tumours remains unclear. Purpose: To clarify the prognostic value of Le a , sialyl Le a , Le(x) and sialyl Le(x) expression in colorectal carcinomas as prognostic factors after surgery. Patients and Methods: Colorectal carcinoma samples from 101 patients with primary colorectal carcinoma who underwent surgical resection were subject to immunohistochemica l analyses for Le a , sialyl Le a , Le(x) and sialyl Le(x) expression with the respective monoclonal antibodies. Results: Le a , sialyl Le a , Le(x) and sialyl Le(x) were expressed in 69 (68.3%), 73 (72.3%), 66 (65.4%) and 76 (75.3%) carcinomas, respectively. The patients with sialyl Le(x)-expressing tumours had more advanced cancer than those with nonsialyl Le(x)-expressing tumours (P=0.0029). The survival time after surgery of patients with Le(x)- or sialyl Le(x)-expressing tumours was significantly shorter than the survival time of those with non-Le(x)- or nonsialyl Le(x)-expressing tumours, respectively (P=0.023 and P=0.0001, respectively). Cox's regression analysis revealed that Le(x) and sialyl Le(x) expression, separate from stage and histological type, were prognostic variables for patient survival (hazard ratio [HR] for sialyl Le(x)-positive expression to sialyl Le(x)-negative expression 2.90; HR for Le(x)-positive expression to Le(x)-negative expression 12.76 in stage I/IV, 0.63 in stage II and 1.69 in stage III). Conclusions: Le(x) expression and sialyl Le(x) expression in colorectal carcinomas are each associated with poor prognosis. These variables should be considered in the design of future trials.
DOI： 10.1155/2000/149851
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Nakagoe T., Nanashima A., Sawai T., Tuji T., Ohbatake M., Jibiki M., Yamaguchi H., Yasutake T., Ayabe H., Matuo T., Tagawa Y.
Journal of Cancer Research and Clinical Oncology 126 ( 7 ) 375 - 382 2000
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Cancer Research and Clinical Oncology
The deletion of blood group ABH isoantigens on tumor tissues has been reported to be an adverse prognostic marker for patients with various solid tumors. In the present study, we evaluated the prognostic value of altered expression of ABH i soantigens in colorectal carcinomas. Using monoclonal antibodies, the expression of A, B, and H antigens was assessed by immunohistochemistry on paraffin-embedded carcinoma samples from 82 patients who had undergone surgery for colorectal cancer. ABH isoantigens were found to be deleted in 36 carcinomas (43.9%) and expressed in 46 (56.1%). Univariate and multivariate analysis using a logistic regression model revealed that N factor (lymph node metastasis) and blood group type were independently related to the expression of ABH isoantigens. In contrast to previous reports on other cancers, patients whose colorectal carcinomas express ABH isoantigens had a poorer prognosis than those whose carcinomas showed deletion of ABH isoantigens (P = 0.0008). The expression of ABH isoantigens was an independent prognostic variable, in addition to T (depth of tumor invasion), N, and M (distant metastasis) factors, as shown by means of Cox regression analysis. In conclusion, the expression of ABH isoantigens in carcinoma tissue is an important poor prognostic factor in patients with colorectal cancer. This variable needs to be considered in the design of future trials of therapy.
DOI： 10.1007/PL00008485
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Ohbatake M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Tagawa Y.
Journal of Cancer Research and Clinical Oncology 126 ( 9 ) 542 - 548 2000
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Cancer Research and Clinical Oncology
Recent studies delineated two different patterns of tumor growth in colorectal carcinoma characterized as polypoid and nonpolypoid (PG-type and NPG-type, respectively). We quantified serum sialyl Lewis (Le)a(CA19-9), sialyl Le(x) (SLX), sialyl Tn (STN), and carcinoembryonic antigen (CEA) in 269 colorectal cancer patients to establish whether their levels correlated with any biological or clinical differences between PG-type and NPG-type cancer. Patients were divided into high and low antigen groups (higher or lower than a selected diagnostic-based cut-off value) and compared. Statistical testing was by univariate and multivariate (logistic regression) analyses. Forty-seven (17.5%) patients with PG-type and 222 (82.5%) with NPG-type cancer were studied. In contrast to NPG-type, the characteristics of the PG-type cancers included a low rate of lymph node metastasis and a high serum STN level. In contrast-to a low STN level, a high STN level was independently related to the presence of distant metastasis in patients with PG-type cancer, and also to the presence of distant metastasis and large-sized tumor in patients with NPG-type cancer. These data suggest that differences in STN levels in the serum of patients with PG-type or NPG-type colorectal carcinomas may be at least partly responsible for different tumor progression behavior.
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A case of intramural gastric metastasis from ascending colon cancer
Sawai T., Tsuji T., Nanashima A., Jibiki M., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H., Yamasaki K.
Japanese Journal of Gastroenterology 96 ( 11 ) 1285 - 1289 1999.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterology
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Nanashima A., Yamaguchi H., Sawai T., Yasutake T., Tsuji T., Jibiki M., Yamaguchi E., Nakagoe T., Ayabe H.
Journal of Gastroenterology and Hepatology (Australia) 14 ( 10 ) 1004 - 1009 1999.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)
Background: Adhesion molecules are closely involved in the development and growth of metastatic tumours. Methods: We examined the expression of two adhesion molecules in liver metastatic tumours originating from colorectal carcinomas and correlated the expression of E-cadherin (EC) and CD44 variant exon 6 (v6) in these tumours with prognosis after hepatic resection. We examined 39 primary colorectal and 44 liver metastatic tumours obtained from 39 patients and 30 non-metastatic colorectal carcinomas as controls. The expression of EC in primary colorectal carcinomas of the metastasis group was significantly lower than in the non-metastasis group (P < 0.05). The expression of EC was low in metastatic liver tumours. Results: The expression of CD44v6 in primary colorectal carcinomas of the metastasis group was significantly higher than in the non-metastasis group (P < 0.01). Expression of CD44v6 was high in metastatic liver tumours. However, there was no correlation between the expression of EC and CD44v6 or between each of these molecules and clinicopathological features of primary and metastatic tumours. Negative expression of EC and CD44v6 was a poor prognostic factor for survival after hepatic resection. Conclusions: Our results indicate that the lack of expression of EC and CD44v6 in liver metastases of colorectal cancer is associated with poor survival after surgery.
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Expression of multidrug resistance protein in metastatic colorectal carcinomas
Nanashima A., Yamaguchi H., Matsuo S., Sumida Y., Tsuji T., Sawai T., Yasutake T., Nakagoe T., Ayabe H.
Journal of Gastroenterology 34 ( 5 ) 582 - 588 1999.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
To clarify the relationship between multidrug resistance protein (MRP) and clinicopathologic features, the influence of adjuvant chemotherapy, and prognosis of patients who underwent resection of metastatic liver carcinomas originating from colorectal carcinomas, we examined the expression of MRP in tumor tissues by immunostaining. Specimens of 38 primary colorectal tumors and 44 metastatic liver tumors of colorectal origin were examined (metastatic group). We also examined 28 nonmetastatic colorectal carcinomas. The percentages of nonmetastatic tumors and of primary and metastatic tumors of the metastasis group that expressed MRP were similar. MRP expression in primary and metastatic tumors did not correlate with any clinicopathologic features. The use of adjuvant chemotherapy after operation for primary colorectal carcinomas was associated with increased MRP expression among metastatic liver tumors. Expression of MRP in the tumor did not influence the prognosis or survival rate after resection of primary or metastatic tumors. Our data suggest that MRP expression in metachronous liver metastases from colorectal carcinomas may be induced by administration of anticancer drugs but is not associated with clinicopathologic features of the tumor, liver metastasis, or prognosis.
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Yamaguchi K., Omagari K., Kinoshita H., Yoshioka S., Furusu H., Takeshima F., Nanashima A., Yamaguchi H., Kohno S.
Journal of Clinical Gastroenterology 29 ( 2 ) 207 - 209 1999.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Clinical Gastroenterology
The authors report a rare case of hepatocellular carcinoma (HCC) that developed 6 years after a sustained and complete response to interferon (IFN) therapy for chronic hepatitis C. A 61-year-old Japanese man presented with a mass in the liver that was diagnosed as HCC. Six years earlier he was treated with IFN-α and responded successfully to therapy, with sustained normalization of serum aminotransferases and eradication of serum hepatitis C virus (HCV)-ribonucleic acid (RNA). HCV-RNA was also not detected in the resected tumorous and nontumorous liver tissues. The findings suggest that all patients with chronic HCV infection should be followed closely for as long as possible for the potential development of HCC even after a complete and sustained response to IFN treatment.
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Nakagoe T., Sawai T., Tuji T., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
Journal of Surgical Oncology 71 ( 3 ) 196 - 197 1999.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Surgical Oncology
DOI： 10.1002/(SICI)1096-9098(199907)71:3<196::AID-JSO11>3.0.CO;2-R
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High serum concentrations of sialyl Tn antigen in carcinomas of the biliary tract and pancreas
Nanashima A., Yamaguchi H., Nakagoe T., Matsuo S., Sumida Y., Tsuji T., Sawai T., Yamaguchi E., Yasutake T., Ayabe H.
Journal of Hepato-Biliary-Pancreatic Surgery 6 ( 4 ) 391 - 395 1999.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Surgery
Sialyl-Tn (STn) antigen is a cancer-associated carbohydrate antigen expressed in cancers of the digestive tract. In the present study, we compared the serum level of STn antigen in 14 patients with benign diseases of the biliary tract and pancreas, 15 patients with bile duct cancers, and 9 patients with cancer of the pancreas. High levels of serum STn ( > 45 U/ ml) were frequently detected in patients with carcinoma of the biliary tract (53.3%) or pancreas (55.6%), compared with the detection of high levels in those with benign diseases (14.3%; P < 0.05). Serum levels of STn did not correlate with the presence of jaundice, cholangitis, or pancreatitis, or with the level of carcinoembryonic antigen (CEA) or carbohydrate antigen (CA) 19-9. In cancer tissues, the expression of STn antigen detected by immunostaining correlated significantly with serum STn (P < 0.05). Our results indicate that measurement of serum STn level may be potentially useful for the diagnosis of carcinomas of the biliary tract and pancreas, particularly when combined with other tumor markers such as CEA or CA19-9. © Springer-Verlag 1999.
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Nanashima A., Yamaguchi H., Shibasaki S., Sawai T., Yasutake T., Tsuji T., Nakagoe T., Ayabe H.
Journal of Gastroenterology and Hepatology (Australia) 14 ( 1 ) 61 - 66 1999.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology and Hepatology (Australia)
In this study, we determined the proliferation indices of liver metastatic tumours originating from colorectal carcinomas using Ki67 and argyrophil nucleolar organizer region associated pro- reins (AgNOR) stain. We examined the primary and metastatic tumours in 27 patients with liver metastasis and eight cases with non-metastatic colorectal carcinoma as a control. The number of AgNOR dots in metastatic tumours was significantly higher than in the respective primary tumours of the metastasis group or in non-metastatic colorectal carcinomas. The Ki67 labelling index was similar in all groups. The Ki67 labelling index and AgNOR counts did not correlate with each other. There was no significant relationship between proliferation indices and the duration of the disease-free period following hepatic resection for metastases or with prognosis after hepatectomy. We conclude that Ki67 and AgNOR are not useful indicators of prognosis in patients who undergo operation for liver metastasis of colorectal carcinomas.
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A case of node-positive, Is-type rectal cancer measuring 5mm in diameter
Sawai T., Tsuji T., Nanashima A., Jibiki M., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H.
Japanese Journal of Gastroenterological Surgery 32 ( 9 ) 2292 - 2295 1999
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
A 49-year-old man who had undergone cholecystectomy for cholecystolithiasis visited our hospital for lower abdominal pain and diarrhea. A colonoscopy revealed a protruded lesion with a double elevation, measuring 5 mm in diameter in the upper rectum, 10 cm from the anal verge. Under the diagnosis of tubular adenoma, the lesion was removed by endoscopic polypectomy. Histological findings showed moderately differentiated adenocarcinoma invasion to the submucosa (sm), and was markedly suggestive of submucosal vertical margin involvement. Four weeks after the polypectomy, low anterior resection with dissection of group 1 and group 2 lymph nodes were performed. Although there was no residual carcinoma, metastases were found in three of the 16 dissected nodes. The present case illustrates that minute protruded colorectal carcinomas can have SM invasion, and that the double elevation is useful in diagnosing the massive SM invasion of these lesions.
DOI： 10.5833/jjgs.32.2292
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Left-sided predominance and family history of malignancy in colorectal cancer with DNA multiploidy
Sawai T., Tsuju T., Nanashima A., Jibiki M., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H., Tagawa Y.
Japanese Journal of Gastroenterological Surgery 32 ( 11 ) 2526 - 2531 1999
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
The purpose of this study was to evaluate the relationship between DNA multiploidy and tumor characteristics of colorectal cancer. Flow cytometric quantification of nuclear DNA content was performed on freshly frozen tissue from 245 patients who underwent surgical resection from 1990 to 1996, at First Department of Surgery, Nagasaki University School of Medicine. The cases were classified into three groups according to DNA ploidy pattern as follows: 1) Dd group, 78 cases (31.8%) with DNA diploidy; 2) Dm group, 36 cases (14.7%) with DNA multiploidy; 3) Da group, 131 cases (53.5%) with DNA aneuploidy except for DNA multiploidy. The Dm group was associated with left colon (compared with Dd group, p=0.0069), absence of metastasis (compared with Da group, p=0.0095), and positive family history of extracolonic malignancy (compared with Dd and Da groups, p=0.031 and p=0.044, respectively). Of the 245 patients, 71 cases were randomly examined by fluorescence in situ hybridization for detection of numerical aberration of chromosome 17. The frequency of chromosomal aberration was lower in the Dm group than in the Da group (p=0.0068).
DOI： 10.5833/jjgs.32.2526
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Nakagoe T., Sawai T., Tuji T., Nanashima A., Yamaguchi H., Yasutake T., Ayabe Y.
Surgery Today 29 ( 5 ) 443 - 445 1999
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
The management of postoperative rectovaginal fistula (RVF) after low anterior resection for rectal cancer is difficult and the results are often unsatisfactory. Among 140 patients with rectal cancer who underwent low anterior resection with a double-stapled anastomosis at our hospital between 1986 and 1996, 4 (2.9%) developed RVF as a postoperative complication. The RVF developed gradually from 9 to 128 days after low anterior resection. We describe herein our technique of using a modified transvaginal approach for RVF repair with a diverting colostomy. In all four patients, the RVFs were completely eradicated with reestablishment of intestinal continuity and did not recur during the mean follow-up period of 29.5 months, ranging from 12 to 67 months. This report serves to demonstrate that emerging RVFs secondary to stapled anastomosis in low anterior resection for rectal cancer must be recognized, and that a modified transvaginal approach provides an effective method of repair.
DOI： 10.1007/BF02483037
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Nakagoe T., Sawai T., Tuji T., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
Surgery Today 29 ( 4 ) 395 - 397 1999
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
Small-bowel obstruction remains one of the most frequent complications after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Of particular concern is small-bowel adhesion to the pelvic dead space that causes afferent limb obstruction, sometimes necessitating laparotomy. In this report, we describe a technique using an omental pedicle graft (OPG) to fill the pelvic dead space to prevent small-bowel obstruction and the resulting afferent limb obstruction after IPAA. The OPG is created from the left half of the omentum, while maintaining the blood supply from the left gastroepiploic vessels. The omentum is placed into the pelvis along the left paracolic gutter from where the colon has been resected. It is then passed over the pelvic brim and placed behind and along the bilateral sides of the ileal pouch, filling the space. This modified technique was employed in the treatment of four patients with chronic ulcerative colitis, none of whom developed any signs of small-bowel obstruction.
DOI： 10.1007/BF02483074
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Nanashima A., Yamaguchi H., Tsuji T., Yamaguchi E., Sawai T., Yasutake T., Nakagoe T., Ayabe H.
Surgical Endoscopy 12 ( 12 ) 1381 - 1385 1998.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgical Endoscopy
Background: Differences in the physiological stress response to pneumoperitoneal (PP) and gasless abdominal wall-lifting (AWL) procedures used for laparoscopic cholecystectomy have not been properly evaluated. Methods: We compared leukocyte count, interleukin-6 (IL-6) levels, arterial blood gases, creatinine clearance, plasma renin activity, cardiothoracic ratio, and clinical outcome in 27 patients without systemic complications who underwent laparoscopic cholecystectomy, including 11 by AWL and 16 by PP. Results: Transient leukocytosis and high IL-6 levels were observed at POD 1 (postoperative day) in both groups, but both values returned to baseline by POD 2. IL-6 levels correlated significantly with operation time (p < 0.01). Changes in blood gases, creatinine clearance, plasma renin activity, and cardiothoracic ratio were not different for the two groups. The clinical outcome was similar for both groups. Conclusions: Our results indicate that both PP and AWL are appropriate for patients without serious complications.
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Significance of angiogenic factors in liver metastatic tumors originating from colorectal cancers
Nanashima A., Ito M., Sekine I., Naito S., Yamaguchi H., Nakagoe T., Ayabe H.
Digestive Diseases and Sciences 43 ( 12 ) 2634 - 2640 1998.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Diseases and Sciences
We examined the expression of vascular endothelial growth factor (VEGF) and microvessel counts expressed by CD34 staining in 39 patients with primary and 44 patients with metastatic liver tumors of metastatic colorectal carcinoma, and 29 patients with nonmetastatic colorectal carcinoma as control in order to determine their value in the evaluation of prognosis and recurrence after hepatectomy. Microvessel counts in primary colorectal carcinomas of the metastatic group were significantly higher than those in control (P < 0.05). Neither factor correlated with any clinicopathological feature of primary or metastatic liver carcinomas. Higher microvessel counts in metastatic liver tumors tended to be associated with a shorter disease- free interval to second recurrence in the remaining liver (P = 0.069) and were significantly associated with poor prognosis after hepatectomy (P < 0.05). We conclude that microvessel count is an important marker of liver metastatasis and prognosis in patients with colorectal carcinoma treated with hepatectomy.
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Tagawa Y., Nanashima A., Tsuji T., Sawai T., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H.
Journal of Gastroenterology 33 ( 5 ) 670 - 677 1998.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
The incidence of non-familial multiple primary cancer in colorectal cancer patients has increased in recent years in Japan. To clarify the characteristic genetic aberrations in such multiple cancers, we examined structural chromosomal aberrations by fluorescence in situ hybridization, using chromosome 17-specific and p53 cosmid DNA probes. We established short-term cultures of 78 surgical specimens and were able to obtain observable metaphase spreads in 23 single colorectal cancer specimens and in 6 colorectal cancer specimens from patients with double primary cancers. The frequency of chromosome 17 and/or p53 locus translocation was significantly greater in tumors with double cancer than in single colorectal cancers (P < 0.05 and P < 0.01, respectively). These aberrations in double cancers frequently appeared even at an early Dukes' stage (A and B) of colorectal carcinoma. Our results suggest that translocation of chromosome 17 and the p53 locus may be specific genetic events probably associated with carcinogenesis of multiple primary cancers in colorectal cancer.
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Sawai T., Sasano O., Tsuji T., Nanashima A., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H., Tagawa Y.
Journal of Gastroenterology 33 ( 4 ) 495 - 499 1998.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
Numerical aberrations of chromosome 17 and nuclear DNA content were compared in patients with hereditary non-polyposis colorectal cancer (HNPCC) and those with sporadic colorectal cancer (SCRC). During a period of 22 years, 30 cases (3.2%) from 28 families satisfied the Japanese clinical criteria of HNPCC. Using freshly frozen tissue samples, we investigated chromosomal aberration with fluorescence in situ hybridization with alpha satellite DNA probe for chromosome 17. Flow cytometric quantification of nuclear DNA content showed DNA aneuploidy in 9 of 15 patients (60.0%) with HNPCC and in 160 of 234 patients (68.4%) with SCRC; there was no significant difference between HNPCC and SCRC. The mean proportion of nuclei with aneusomy 17 (numerical chromosome aberration index: NCAI) in 14 patients with HNPCC was significantly higher than that in 42 patients with SCRC (46.8 ± 5.0% vs 39.0 ± 10.3%, P < 0.01). NCAI increased in proportion with the progression of the disease in SCRC (26.1% in stage I, 33% in stage II, 38.8% in stage IIIa, 42.7% in stage IIIb, and 46.2% in stage IV, P < 0.01), whereas NCAI in HNPCC was high in all stages (43.5%-49.2%). The proportion of patients with multiple numerical aberration of chromosome 17 was significantly higher in HNPCC (9/14) than among SCRC (11/42). Our data suggest that chromosome 17 is present in an unstable condition in HNPCC.
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Nakagoe T., Fukushima K., Tuji T., Sawai T., Nanashima A., Yamaguchi H., Yasutake T., Hara S., Ayabe H., Matuo T., Kamihira S.
Cancer Detection and Prevention 22 ( 6 ) 499 - 505 1998
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Detection and Prevention
The expression of blood group antigens A, B, and H, as well as sialylated and nonsialylated forms of Lewis(a) and Lewis(x), was studied using immunohistochemical methods in normal and tumor tissues in the following cohort of patients: 51 patients with primary breast carcinoma, 13 with metastatic lymph node lesions, and 16 with benign tumors of the breast. As a control, normal tissue was obtained from a similar group of 22 patients with breast cancer. The noncancerous tissues expressed the same A/B/H antigens as the patients' red blood cells and also usually expressed Lewis-related antigens. Seventy-six percent of primary carcinomas failed to express the appropriate A/B/H antigens, and in one blood group A patient the tumor tissue expressed B antigen. In the metastatic lesions, Lewis(a)/sialyl Lewis(a) expression was reduced when compared with the primary tumors, but Lewis(x)/sialyl Lewis(x) antigens were still expressed. These results suggest a possible relationship between the metastatic behavior of the tumor and expression of the blood group antigens.
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Preoperative estimation of lymphatic vessel invasion on gastric carcinoma
Yasutake T., Terada R., Yamaguchi E., Tsuji T., Nanashima A., Sawai T., Yamaguchi H., Nakagoe T., Ayabe H., Tagawa Y.
Japanese Journal of Gastroenterological Surgery 31 ( 10 ) 2171 - 2175 1998
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
Preoperative estimation of lymphatic invasion by gastric carcinoma was attempted by using clinicopathological or cell and molecular biological methods. In 1129 cases of gastric carcinoma, the size of cancers with lymphatic invasion (71 mm) was significantly (p<0.001) greater than that of cancers without lymphatic invasion (43 mm). Stainability of nm23 was relatively low in cases of positive for lymphatic invasion. Simultaneous attempts to detect of proliferating cell nuclear antigen (PCNA) and numerical chromosomal aberrations were also performed in 100 cases of gastric carcinoma. PCNA was detected by the immunofluorescence method using anti-PCNA antibody (PC-10) after acetone-ethanol fixatin. Numerical chromosomal aberrations were detected by fluorescence in situ hybridization (FISH) using the probe for chromosome 17 centromere. The frequency of the cells with positive PCNA staining that had numerical aberration of chromosome 17 was significantly (p = 0.0001) higher in the cases with lymphatic invasion (15.3%), compared to the cases without lymphatic invasion (9.0). The percentage of the cells that were PCNA-negative with numerical chromosomal aberrations was unrelated to lymphatic invasion. These results revealed that lymphatic vessel invasion is not induced by chromosome aberration or the cell cycle alone, but by a combination of both of them. This method can be performed preoperatively. The results also indicated that tumor size and tha rate of PCNA positivity with numerical aberration of chromosome 17 could be a marker for lymphatic invasion of gastric carcinoma.
DOI： 10.5833/jjgs.31.2171
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Right-sided predominance of superficial early cancers in synchronous multiple colorectal carcinomas
Sawai T., Tsuji T., Yamaguchi E., Nanashima A., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H.
Journal of the Japan Society of Colo-Proctology 51 ( 8 ) 567 - 572 1998
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of the Japan Society of Colo-Proctology
Between 1989 and 1996, there were 54 patients with synchronous multiple colorectal carcinomas identified in an operative series of 569 patients in the First Department of Surgery, Nagasaki University School of Medicine, for a frequency of 9.6 percent. When comparing the mean age of patients, sex distribution, histological stage, the incidence of extra colonic malignancies, and family history of malignancies in a first degree relatives, there was no significant difference between the group with and without synchronous carcinomas. The anatomical distribution of tumors in the group with synchronous carcinomas revealed a higher percentage of tumors located on right-sided colon (p < 0.05). There were higher incidences of superficial tumors, early carcinomas, well differentiation, and associated adenomatous polyps in the group with synchronous carcinomas (p < 0.00001, respectively). In 74 tumors of early colorectal carcinomas, superficial tumors were significantly more often in right-sided tumors than in left-sided-tumors (p < 0.0002). Non-polypoid growth carcinomas were also more often in right-sided- tumors than in left-sided tumors (p < 0.05). These results suggest the importance of preoperative pancolonoscopy for the identification of early carcinomas and adenomatous polyps in patients with colorectal cancer especially with right-sided tumors.
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Safety of repeated total hepatic inflow occlusion during liver resection
Yamaguchi H., Nanashima A., Hatano K., Shibasaki S., Matsuo S., Sawai T., Yasutake T., Nakagoe T., Ayabe H.
Acta Hepatologica Japonica 39 ( 11 ) 812 - 819 1998
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Hepatologica Japonica
To evaluate the effect on liver due to repeated total hepatic inflow occlusion with Pringle maneuver during liver resection, we analyzed changes in hepatic venous blood of the remaining liver in 16 patients undergoing partial hepatectomy. These patients were divided into two groups as follows : chronic liver disease group consisted of the patients with cirrhosis and/or chronic hepatitis, and normal liver group consisted of the patients with no any chronic liver disease. No significant decreases were found in oxygen saturation (SvO2) between before the first clamping and 15 min after that in both group. Although HVKBR and AKBR decreased significantly 15 min after the first clamping in the chronic liver disease group, they return to the initial levels within the following 5 min of declamping. No significant differences were found in SvO2, lipid peroxide, HVKBR and AKBR between before the first clamping and 5 min after the final declamping in both groups. However, pH and HCO3-significantly decreased and PvCO2significantly increased 5 min after the final declamping in the chronic liver disease group. These results suggested that intermittent total hepatic inflow occlusion during liver surgery induces negligible or no liver damage in the patients with chronic liver disease. However, this procedure may induce a significant metabolic acidosis in these patients.
DOI： 10.2957/kanzo.39.812
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Nanashima A., Nakagoe T., Sawai T., Nakamura S., Yamaguchi H., Yasutake T., Kusano H., Ayabe H.
Diseases of the Colon and Rectum 40 ( 10 SUPPL. ) 1997.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Diseases of the Colon and Rectum
PURPOSE: Sialyl Tn (STn) antigen is a cancer-associated carbohydrate antigen expressed in cancers of the digestive tract. We compared the proportion of specimens of flat-type colorectal cancers expressing STn with that of polypoid cancers, by examining the immunohistochemical reactivity of STn in various morphologic types of early and advanced colorectal cancers. METHODS: A total of 111 biopsies from the colorectal area were examined for STn expression, including 11 adenomas, 58 early cancers, and 42 advanced cancers. Each section was stained immunohistochemically for STn antigen. In each section, we examined STn expression in the cancer area, adjacent mucosa, and normal epithelium. RESULTS: STn expression was detected in 90.9 percent of adenomas, 36.2 percent of early cancers (T1), 64.3 percent of advanced cancers ( > T1), and 52 percent of mucosa adjacent to cancer. The morphology of cancer tissue did not influence the number of specimens exhibiting STn antigen expression in mucosa adjacent to cancer cells. STn antigen was rarely expressed in flat or depressed-type early cancers (T1; 7.1 percent), and the expression was higher in moderately than in well-differentiated adenocarcinomas. In advanced cancers ( > T1), a similar proportion of protruding and small ulcerative cancers expressed STn. CONCLUSION: Our results suggest that the low expression of STn antigen in flat-type cancers may be the result of different mechanisms of cellular transformation during carcinogenesis from the usual adenoma-carcinoma sequence in colorectal neoplasms.
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Analysis of p53 gene deletions in colorectal cancers using fluorescence in situ hybridization
Nanashima A., Tagawa Y., Yasutake T., Taniguchi Y., Sawai T., Nakagoe T., Ayabe H.
Surgery Today 27 ( 11 ) 999 - 1004 1997.11
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Surgery Today
To examine the relationship between the incidence of p53 gene deletion in each nucleus and the clinico-pathological features in colorectal cancers, we performed a cytogenetic study using fluorescence in situ hybridization (FISH). FISH was performed on 5 adenomas and 38 colorectal cancers that had been resected surgically. The nucleus, in which the copy number of the p53 signal was lower than that of chromosome 17, was determined as a deletion of the p53 gene. The mean frequency of the deletion of p53 in adenomas and cancers were 7.8% ± 3.0% and 57.0% ± 19.0%, respectively. Numerical aberrations of chromosome 17 or a deletion of p53 were also detected in DNA diploidy. The mean frequency of the deletion of p53 in 32 cases with aneusomy of chromosome 17 (65.7% ± 14.5%) was significantly higher than that in cases of disomy (51.1% ± 19.3%, P < 0.05). Even though this frequency was high in the early stage, it was not associated with any specific histopathological features. This frequency was also higher in double primary cancers (70.4% ± 16.7%) compared with single colorectal cancers (53.4% ± 18.1%) (P < 0.05). Using FISH, our results demonstrated that the clonal deletion of the p53 locus is an early genetic event of colorectal cancers and that a high incidence of p53 deletion may influence the occurrence of double primary cancers.
DOI： 10.1007/BF02385778
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Tagawa Y., Yasutake T., Sawai T., Nanashima A., Jibiki M., Morinaga M., Akama F., Nakagoe T., Ayabe H.
Clinical Cancer Research 3 ( 9 ) 1587 - 1592 1997.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Clinical Cancer Research
Numerical chromosome aberrations by interphase cytogenetic analysis have been reported in a few samples of colorectal neoplasms. No studies have defined a distinct relationship between these aberrations and clinicopathological features. To investigate the chromosome aberrations as a marker of invasiveness or prognosis, we conducted an interphase cytogenetic study using fluorescence in situ hybridization and examined 142 colerectal neoplasms consisting of 15 adenomas and 127 cancers. The target chromosomes were chromosomes 11 and 17. We also evaluated the nuclear DNA content as detected by flow cytometry, analyzed the relationship between the frequency of aneusomy and clinicopathological features, and examined the survival rate in these patients. The loss of chromosome 11 was observed in 31% of adenomas, whereas in cancers DNA aneuploidy was observed in 63% of cases, a gain of chromosome 17 was observed in 63% of cases, and a gain of chromosome 11 was observed in 42% of cases. Numerical chromosome aberrations in diploid DNA were also observed. Increased depth of invasion (≤T 3 ) and advanced Dukes' stage (≤B) of malignant tumors were associated with a higher frequency of a gain of chromosome 11 (P < 0.01 and P < 0.05, respectively). Increased depth of invasion (≤T 2 ) in cancers was associated with a higher frequency of a gain of chromosome 17 (P < 0.05). Multivariate analysis of postoperative survival showed that a loss or gain of chromosome 11 was independently associated with a poor prognosis (P < 0.05). Numerical chromosome aberrations appear prior to the alteration of nuclear DNA content as detected by flow cytometry and influence the progression of colorectal cancers. Aneusomy of chromosome 11 is associated with poor postoperative prognosis of primary colorectal cancers.
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Sawai T., Sasano O., Shibazaki S., Shibata Y., Tsuji T., Nanashima A., Yamaguchi H., Yasutake T., Hara S., Tagawa Y., Nakagoe T., Ayabe H.
Human cell : official journal of Human Cell Research Society 10 ( 3 ) 193 - 198 1997.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Human cell : official journal of Human Cell Research Society
Fluorescence in situ hybridization with biotinylated repetitive DNA probe specific for the centromeric region of chromosome 17 (p17H8: Oncor) was applied to suspended nuclei which were isolated by Shutte's method from formalin-fixed paraffin-embedded tissue. The tissues were obtained from surgically resected specimens from nine patients with non-small cell lung carcinoma. The isolated nuclei were prepared with 0.05% pepsin/0.1NHCl for 15 minutes at 37 degrees C. Subsequently, these were immersed in 70% acetic acid for 10 seconds at room temperature. After heat denature with hybridization mixture which contained 3 mu 1 DNA probe for 10 minutesat 70 degrees C, 1 x 10(6) nuclei were incubated overnight at 37 degrees C. After washing with 60% formamide/2 x SSC, the hybridized probes were labeled by FITC conjugated avidin. A number of centromeric signals of chromosome 17 wasevaluated by fluorescence microscopy (BH-2, Olympus). Furthermore, a probe-related FITC intensity was quantified using flow cytometry (FACScan, Becton Dickinson). As the results, there was good correlation between a relative fluorescence intensity determined by flow cytometry and a relative fluorescence signal by fluorescence microscopy (p < 0.05).
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Gain of chromosome 20 is a frequent aberration in liver metastasis of colorectal cancers
Nanashima A., Yamaguchi H., Yasutake T., Sawai T., Kusano H., Tagawa Y., Nakagoe T., Ayabe H.
Digestive Diseases and Sciences 42 ( 7 ) 1388 - 1393 1997.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Diseases and Sciences
To investigate the characteristics of the numerical chromosome aberrations in liver metastasis of colorectal cancers, fluorescence in situ hybridization (FISH) for chromosomes 8, 18, 14/22, and 20 was performed in 18 specimens of primary regions and 18 of metastatic regions in liver metastasis of colorectal cancers compared with 15 of non-liver metastatic cancers. Among these numerical aberrations, the gain of chromosome 20, especially copy numbers exceeding three, was frequently observed in primary and metastatic cancers. Among these numerical aberrations, the gain of chromosome 20, especially copy numbers exceeding three, was frequently observed in primary and metastatic regions of liver metastasis groups compared with that of the non-liver metastasis group (P < 0.05). The incidences of gain of chromosome 20 in both regions of the liver metastasis group were higher than that of the non-liver metastasis group (P < 0.05). The gain of chromosome 20 is a frequent aberration in primary and metastatic regions in patients with liver metastatic colorectal cancers and may be available as a genetic marker for the diagnosis or prediction of liver metastasis.
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Deletion of chromosome 11 and development of colorectal carcinoma
Nanashima A., Tagawa Y., Yasutake T., Fujise N., Kashima K., Nakagoe T., Ayabe H.
Cancer Detection and Prevention 21 ( 1 ) 7 - 11 1997.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cancer Detection and Prevention
The deletion of chromosome 11q is observed frequently in tumors of the large intestine. To investigate the relationship between aberrations of chromosome 11 and histopathological features of colorectal carcinoma, we examined the frequency of chromosome aberrations using fluorescence in situ hybridization to 29 short-term cultured cells from surgical specimens. Numerical aberrations were not related to any factors. The deletion of chromosome 11 was frequently observed in larger (≤5 cm) and more invasive tumors (≤T3 category) (p < 0.05). Furthermore, the incidence of aberrations tended to increase in Dukes' B. Although translocation of chromosome 11 was also found in 17% of cases, it was not associated with histopathological features. Our findings indicate that the deletion of chromosome 11 is closely related to the progression of colorectal carcinoma.
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Aneusomy of chromosome 18 is associated with the development of colorectal carcinoma Reviewed
Nanashima A., Tagawa Y., Yasutake T., Sawai T., Tuji T., Sasano O., Nakagoe T., Ayabe H.
Journal of Gastroenterology 32 ( 4 ) 487 - 491 1997.8
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
Specific loss of heterozygosity of chromosome 18 has been observed frequently in advanced colorectal carcinoma and is closely associated with its development. We investigated the prevalence of numerical aberrations of chromosome 18 in 44 specimens of colorectal carcinomas, using fluorescence in situ hybridization. We also examined the relationship between aneusomy of chromosome 18 and the clinicopathological features of these tumors. Aneusomy of the specimens (monosomy and polysomy) was determined when the same aneusomic population was detected in more than 15% of the nuclei. The frequency of monosomy and polysomy of chromosome 18 in colorectal carcinomas was 43% (19/44) and 29% (12/44), respectively. The prevalence of monosomy and polysomy 18 was significantly higher in cancers with invasion exceeding category T2 compared with T1 (P < 0.01), and with tumor size exceeding 20 mm in diameter compared with tumors less than 20 mm (P < 0.05). However, the prevalence of aneusomy 18 was not associated with other clinico-pathological features. The mean survival period and the 5-year survival rate after operation in patients with aneusomy 18 was not different from findings for those with disomy 18. Our results indicate that aneusomy of chromosome 18 is associated with the development of colorectal carcinoma; however, it is not a useful indicator of postoperative prognosis.
DOI： 10.1007/BF02934087
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Sawai T., Sasano O., Tsuji T., Nanashima A., Yasutake T., Kusano H., Tagawa Y., Nakagoe T., Ayabe H.
Japanese Journal of Gastroenterology 94 ( 7 ) 464 - 468 1997.7
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterology
Numerical aberration of chromosome 17 of 14 cases of colorectal carcinoma with multiple primary cancer (multiple cancer) was compaired with that of 35 cases of colorectal carcinoma without any other cancer (single cancer). Fluorescence in situ hybridization with p17H8 was performed on touch smear from fresh materials. The proportion of aneusomy 17 (NCAI numerical chromosome aberration index) in multiple cancers was significantly higher than that of single cancers (37.7±10.5% VS 46.1±8.0% ;p < 0.01). Although NCAI of single cancers conformed to cancer progression (26.1±4.7% in Dukes A, 33.1±7.1% in Dukes B, 39.9±6.9% in Dukes C, and 45.7±12.0% in Dukes D), that of multiple cancers was high in all stages (44.7±7.3%, 44.4±6.8%, 50.4±11.2%, and 49.6±5.6%, respectively). Furthermore, the multiple numerical aberration of chromosome 17 in multiple cancers was more often than that of single cancers (64.3% VS 22.9% ;p < 0.01).
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Intragastric endoscopic surgery using the transanal endoscopic microsurgery technique
Nakagoe T., Sawai T., Uchikawa T., Nanashima A., Yamaguchi H., Yasutake T., Kusano H., Ayabe H.
British Journal of Surgery 84 ( 6 ) 1997.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：British Journal of Surgery
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Tagawa Y., Nanashima A., Yasutake T., Hatano K., Nishizawa-Takano J., Ayabe H.
Cytometry 27 ( 4 ) 327 - 335 1997.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Cytometry
We studied differences in chromatin patterns and the spatial localization of centromeres of chromosome 11 during the cell cycle between normal peripheral blood lymphocytes (PBL) and human promyelocytic leukemia cells (HL-60) using fluorescence in situ hybridization. The pericentromeres in both cells were located at the periphery during Gq (quiescent) phase, but moved towards the nuclear center in G1 and mid-S phase. During G2, the pericentromeres of PBL continued to move towards the nuclear center whereas those of HL-60 returned to the periphery. The angle defining the spatial location of two pericentromeres, in reference to the center of the nucleus, increased in PBL cells from a mean of 67°during Gq phase to 106°during G1 phase (P < 0.01), and the two pericentromeres remained wide apart throughout the entire cell cycle. In HL-60, the angle also increased during G1, but then decreased during mid-S and G2 phases. Both cells exhibited pericentromeric signals during Gq that were round and compact, and the entire chromatin was loosely condensed. The signal became more loose and dispersed during the G1 and mid-S phases. The pericentromere signal varied during G2 and was generally rod-like or bipartite with condensation of the entire chromatin or chromosome-like. Our results suggest that subtle but important differences in spatial localization of pericentromeres are present during the interphase between normal PBL and HL-60 cells.
DOI： 10.1002/(SICI)1097-0320(19970401)27:4<327::AID-CYTO3>3.0.CO;2-9
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Cytogenetic analysis of gallbladder neoplasms using fluorescence in situ hybridization (FISH)
Nanashima A.
Journal of Hepato-Biliary-Pancreatic Surgery 4 ( 4 ) 431 - 435 1997.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Surgery
To characterize the numerical chromosome aberrations in gallbladder neoplasms, we examined surgically resected tissues using fluorescence in situ hybridization. The aberrations in 15 specimens of adenocarcinomas and 2 adenomas were compared with those in 4 samples of adenomyomatosis and 17 samples of normal epithelium. We calculated the frequency of aneusomy and determined the chromosome indexes (mean number of chromosomes per nucleus) of chromosomes 17 and 18. The pattern of DNA ploidy was analyzed by flow cytometry. In normal epithelium, adenomyomatosis and adenomas, DNA aneuploidy was not observed, while 13 (87%) carcinomas showed DNA aneuploidy, including 2 specimens with multiploidy. No numerical aberrations were observed in normal epithelium and adenomyomatosis. A numerical gain of chromosome 17 was observed in a single adenoma and in 10 (66%) carcinomas. A numerical gain of chromosome 18 was observed in 6 (40%) carcinomas, but not in other tissues. The chromosome index of chromosome 17 was significantly higher in adenomas and carcinomas (2.45 ± 0.60 and 2.29 ± 0.14, respectively) compared with normal epithelium. Our cytogenetic findings did not correlate with any histopathologic features of carcinomas. Our results indicated that the gains of chromosome 17 and 18 represented early chromosomal alterations in gallbladder neoplasms and were maintained in advanced carcinomas. © Springer-Verlag 1997.
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Nanashima A., Tagawa Y., Morinaga M., Kusano H., Nakagoe T., Ayabe H.
Journal of Gastroenterology 31 ( 6 ) 793 - 800 1996.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
Quantitative analysis by fluorescence in situ hybridization (FISH) on thin paraffin-embedded tissue sections, using specific probes for chromosomes 11, 17, and 18 was employed in various morphological types of early and advanced colorectal cancer to clarify tumor cytogenetics. The chromosome index (CI) was calculated as a quantitative measure of the chromosome copy number. Compared with the CI of normal epithelium, the CI of chromosome 11 in villous components of adenomas or polypoid early cancers was decreased, while the CI in flat type or advanced colorectal cancers, conversely, was increased (P < 0.05). The CI of chromosome 17 in villous components of adenomas and all cancers was higher than that of normal epithelium (P < 0.05), but the differences were not significant. In protruding advanced cancers, the CI of chromosome 18 was significantly decreased (P < 0.01) compared to the CI of normal epithelium. There was no significant chromosomal heterogeneity between the superficial and the deepest layer in each cancer. In mucosa adjacent to sessile and flat type cancers, the CI of chromosome 17 was significantly higher than the CI in normal epithelium or adenomas (P < 0.05). These results suggest that numerical chromosome aberrations are associated with the histological type of adenoma and the morphological diversity of cancer in the colorectum, and that chromosome 17 abnormality occurs in mucosa adjacent to sessile and flat cancers.
DOI： 10.1007/BF02358604
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Nanashima A., Tagawa Y., Nakagoe T., Nishizawa-Takano J., Hatano K., Uchikawa T., Matsumoto Y., Taniguchi Y., Fujise N., Ayabe H.
Journal of Gastroenterology 31 ( 5 ) 646 - 653 1996.10
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Gastroenterology
The biological characteristics associated with the morphological diversity of colorectal cancers were investigated to elucidate the causes of this diversity. We examined the proliferative and infiltrating activity of tumor cells, indicated by the mean number of Ag nucleolar organizer region associated proteins (NORs) per nucleus (MNA) and the immunohistochemical response to cathepsin B(CB), in various morphological types of early and advanced colorectal cancers. We examined 73 colorectal cancers obtained by endoscopic and surgical resection. MNA values for sessile and flat-elevated cancers were greater than the values for pedunculate, subpedunculate, and flat-or-depressed early cancers (sessile, P < 0.05). In advanced cancers invading the muscularis propria, protruding cancers showed significantly higher MNA values than small ulcerative cancers (P < 0.01). CB expression increased significantly with the progression of colorectal cancers (P < 0.01), but was not related to morphological diversity in early and advanced cancers. In both sessile and flat cancers, CB expression was higher in moderately differentiated than in well differentiated adenocarcinomas. These results indicate that, in colorectal cancers, protruding early cancers without stalks and protruding advanced cancers have higher proliferative activity than pedunculate or flat early cancers and small ulcerative advanced cancers, respectively, and that CB expression is not associated with morphological diversity, but with depth of invasion and histological differentiation.
DOI： 10.1007/BF02347611
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A case of advanced colon cancer measuring 8 mm in diameter
Sawai T., Sasano O., Tsuji T., Nakamura S., Nanashima A., Uchikawa T., Yamaguchi H., Yasutake T., Kusano H., Tagawa Y., Nakagoe T., Ayabe H., Fukuda Y.
Journal of the Japan Society of Colo-Proctology 49 ( 4 ) 323 - 326 1996
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of the Japan Society of Colo-Proctology
A 68 year-old male who had underwent sigmoidectomy for colon cancer on April 6, 1992 was admitted to our hospital. Colonoscopy revealed a small flat-elevated lesion with converging folds of the ascending colon. On preoperative evaluation of a massive invasion to the submucosal layer, right hemicolectomy was performed on September 8, 1994. Macroscopic examination of the resected specimen showed a slightly elevated tumor with converging folds, measuring 5 x 8 mm in diameter. Histopathology revealed a well differentiated adenocarcinoma invading to the subserosal layer. No residual adenomatous tissue was identified, and no metastasis was found in 14 lymph nodes. The proliferating activity of thin small advanced colon cancer was determined by double staining technique of Ki-67 and argyrophilic nucleolar organizer resions (AgNOR) using formalin-fixed paraffin-embedded sections. Labeling index of Ki-67 monoclonal antibody (MIB 1) was 7.3 %. Although the Ki-67 negative cells had low AgNOR counts (mean 2.50), the Ki-67 positive cells had high AgNOR counts (mean 9.98 per nucleus).
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Sawai T., Tagawa Y., Nakagoe T., Yasutake T., Uchikawa T., Nanashima A., Morinaga M., Yamaguchi H., Kusano H., Ayabe H., Tomita M., Miura T.
GASTROENTEROLOGICAL ENDOSCOPY 37 ( 8 ) 1593 - 1599 1995
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：GASTROENTEROLOGICAL ENDOSCOPY
Numerical aberrations of chromosomes # 11 and #17 were evaluated in 22 colorectal carcinomas using endoscopic biopsy specimens by fluorescence in situ hybridization (FISH) with repetitive satellite DNA probes. The patients who were admitted to our hospital for surgical treatment included 7 women and 15 men. The mean age of onset was 67.6 years old (range, 33 to 83). FISH revealed numerical aberrations in 10 out of 20 (50%) on chromosome 11, and 15 out of 22 (68%) on chromosome 17. There were monosomy 11 in 3, trisomy 11 in 7, monosomy 17 in 1, trisomy 17 in 10, and tetrasomy 17 in 4. Although there was no particular relationship between the numerical chromosome instability of #11 and clinicopathologic parameters of colorectal carcinomas, that of #17 was significantly higher in patients with lymph node metastasis (34.0±8.2%VS42.0±10.3%, p<0.05). These results suggested that numerical chromosome instability of #17 may be a marker of lymph node metastasis of colorectal carcinomas, and FISH using endoscopic biopsy specimens was a useful technique for preoperative detection of numerical chromosome aberrations. © 1995, Japan Gastroenterological Endoscopy Society. All rights reserved.
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Morinaga M., Tagawa Y., Yasutake T., Miyashita K., Sawai T., Matsumoto Y., Nanashima A., Hatano K., Uchikawa T., Fujise N.
Japanese Journal of Cancer and Chemotherapy 21 Suppl 1 75 - 81 1994.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Cancer and Chemotherapy
The authors have performed fluorescence in situ hybridization (FISH) in tissue sections of archival paraffin-embedded blocks of seven cases in adenoma and ten cases in carcinoma in order to clarify which chromosomal aberration occurred in association with multi-step carcinogenesis in colorectal carcinomas, using alpha-satellite DNA probes to chromosome 11 and 17, D11Z1 and D17Z1, respectively. Monosomy of chromosome 11 was most frequented (5/7, 71.4%) in adenoma, and trisomy of chromosome 17 was predominant (9/10, 90.0%) in carcinoma. The numerical chromosomal aberrations can be already detected at the stage of adenoma, and monosomy of chromosome 11 was mainly observed in adenoma. Furthermore, malignant transformation arising from adenoma accounted for most of the trisomic change in chromosome 17. Consequently, applying the FISH technique to tissue sections from archival paraffin embedded specimen, it would be possible to distinguish between the cancerous and non-cancerous regions in view of chromosomal numerical aberrations. The authors emphasized that intratumoral heterogeneity could be elucidated at the chromosomal level.
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Shimoyama T., Kusano H., Miyashita K., Matsumoto Y., Hatano K., Nanashima A., Uchikawa T., Fujise N., Taniguchi Y., Itoyanagi N., Shimizu T., Nakagoe T., Miura T., Tomita M., Makiyama K.
GASTROENTEROLOGICAL ENDOSCOPY 35 ( 2 ) 1993
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：GASTROENTEROLOGICAL ENDOSCOPY
Our case is a 73 year-old man. Barium enema and colonoscopy showed a nodular tumor like ha around the appendiceal orifice. Histologically, biopy specimens revealed a tubular adenoma with severe atypia. Ileocecal resection was done. Macroscopically, the lesion was a well demarcated falt tumor 35×60mm in size with nodular-aggregated surface around the appendiceal orifice. Histological examination revealed carcinoma in adenoma. In microangiography, the stalk vessels was noted in the nodular area, and the vascular patterns in the flat elevated lesion were similar to the mucosal vessels. This is a rare case in the location of the tumor, and the multiple hyperplastic polyps in the stomach were associated. © 1993, Japan Gastroenterological Endoscopy Society. All rights reserved.
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Shimoyama T., Azuma K., Shinkai K., Hayashida K., Kida H., Shimizu T., Kusano H., Terada R., Taniguchi Y., Nanashima A., Uchikawa T., Nakamura A., Nakagoe T., Miura T., Tomita M., Kawaguchi A.
Journal of the Japan Society of Colo-Proctology 46 ( 7 ) 878 - 885 1993
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of the Japan Society of Colo-Proctology