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Faculty of Medicine School of Medicine Department of Surgery, Hepato-Biliary-Pancreas Surgery |
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Assistant Professor |
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External Link |
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Related SDGs |
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TSUCHIMOCHI Yuki
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Papers 【 display / non-display 】
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Imamura N., Nanashima A., Tsuchimochi Y., Hamada T., Kawakami H., 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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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
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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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
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 ×10<sup>4</sup>/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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Nanashima, A., Hiyoshi, M., Imamura, N., Hamada, T., Tsuchimochi, Y., Wada, T., Shimizu, I. and Ochia, T.
Translational Cancer Research 40 ( 4 ) 283 - 295 2024.12
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.
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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
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.
MISC 【 display / non-display 】
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腹部良性疾患に対する外科治療の最前線：胆道良性狭窄．(共著)
大内田次郎，七島篤志，土持有貴，濱田剛臣，矢野公一，今村直哉，旭吉雅秀，藤井義郎
外科 78 ( 1 ) 49 - 53 2016.1
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal) Publisher：(株)南江堂
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新たに定義された“肝門部領域胆管癌”の診断と治療: 術前胆道ドレナージ-経皮経肝胆道ドレナージ-. (共著)
藤井義郎，濱田朗子，西田卓弘，土持有貴，濱田剛臣，矢野公一，今村直哉，土屋和代，河野文彰，旭吉雅秀，大内田次郎，池田拓人，七島篤志
胆と膵 37 ( 1 ) 71 - 74 2016.1
Language：Japanese Publishing type：Article, review, commentary, editorial, etc. (scientific journal) Publisher：医学図書出版(株)
Presentations 【 display / non-display 】
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当科の肝細胞癌に対する腹腔鏡下肝切除．
矢野公一，濱田剛臣，和田 敬，土持有貴，今村直哉，旭吉雅秀，藤井義郎，七島篤志
第2回宮崎肝癌研究会 (宮崎)
Event date： 2017.3.16
Language：Japanese Presentation type：Oral presentation (general)
Venue：宮崎
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シンポジウム 我々の考える適応と標準術式―肝細胞がんに対する腹腔鏡下肝切除：当科の肝細胞癌に対する腹腔鏡下肝切除 ．
矢野公一，濱田剛臣，和田 敬，土持有貴，今村直哉，旭吉雅秀，藤井義郎，七島篤志
第38回九州肝臓外科研究会学術集会 (宮崎)
Event date： 2017.1.28
Language：Japanese Presentation type：Oral presentation (general)
Venue：宮崎
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肝静脈からの出血に対し下大静脈 clamp で出血コントロールを行い切除した肝細胞癌の 1例 ．
和田 敬，土持有貴，濱田剛臣，矢野公一，今村直哉，旭吉雅秀，藤井義郎，七島篤志，中村都英
第38回九州肝臓外科研究会学術集会 (宮崎)
Event date： 2017.1.28
Language：Japanese Presentation type：Oral presentation (general)
Venue：宮崎
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nab-PTX+GEMによる化学療法後にDP-CARで根治切除した局所進行膵体部癌の1例．
旭吉雅秀，七島篤志，和田 敬，濵田剛臣，土持有貴，矢野公一，今村直哉，藤井義郎
第14回宮崎消化器癌治療研究会 (宮崎)
Event date： 2016.12.2
Language：Japanese Presentation type：Oral presentation (general)
Venue：宮崎
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パネルディスカッション 胆・膵癌の病理検査と現状の課題:当教室での膵体尾部癌に対する術前組織診断の現状と課題．
今村直哉，七島篤志，緒方祥吾，宮崎康幸，土持有貴，濱田剛臣，矢野公一，旭吉雅秀，藤井義郎
第102回日本消化器内視鏡学会九州支部例会 (熊本)
Event date： 2016.11.25 - 2016.11.26
Language：Japanese Presentation type：Symposium, workshop panel (public)
Venue：熊本