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Affiliation |
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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Nanashima A., Imamura N., Hiyoshi M., Tsuchimochi Y., Wada T., Hamada T., Suzuki Y., Araki Y., Hosokawa A., Kawakami H.
Cancer Diagnosis and Prognosis 6 ( 2 ) 291 - 302 2026.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Cancer Diagnosis and Prognosis
Background/Aim: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a precursor lesion with variable malignant potential. Due to its heterogeneity, optimal treatment strategies remain controversial, especially regarding surgical resection and surveillance indications. We reviewed our institutional outcomes to reassess the current postoperative strategy and refine management guidelines. Patients and Methods: This study retrospectively and consecutively analyzed the data of 49 IPMN patients who underwent pancreatectomy at an academic institution from 2015 to May 2025. Results: Diagnostic mismatch between preoperative and final pathological findings was observed in 39% of cases, with overdiagnosis (downgrade group) beingmore common than underdiagnosis. Overdiagnosed cases were significantly associated with main pancreatic duct dilation (>5 mm) (p=0.012) and elevated amylase levels (p=0.031), while the only upgraded case involved invasive carcinoma withmural nodule and Sonazoid enhancement. Histological grade strongly influenced prognosis: Patients with adenoma or carcinoma in situ showed favorable outcomes (5-year OS ≥89%), whereas those with invasive IPMN hadmarkedly worse survival (5-year OS 36%; p<0.001). Elevated CA19-9 was a significant negative prognostic factor (p=0.031), while lymph node metastasis (p=0.035) and advanced tumor stage (p=0.0014) were also associated with poor outcomes. Tumors located in the pancreatic tail and those classified as mixed-type IPMN tended to have inferior survival, though without statistical significance. Cancer recurrence occurred in 18% of patients, primarily via peritoneal and hepatic routes. Conclusion: Preoperative diagnostic inaccuracies remain common in IPMN, and invasive transformation, elevated CA19-9, lymph node metastasis, and tumor stage are key prognostic factors. A multimodal diagnostic approach is needed to improve risk stratification and guide appropriate surgical management.
DOI： 10.21873/cdp.10528
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Nanashima A., Hiyoshi M., Imamura N., Tsuchimochi Y., Wada T., Hamada T., Suzuki Y., Araki Y.
Cancer Diagnosis and Prognosis 6 ( 1 ) 52 - 61 2026.1
Language：English Publishing type：Research paper (scientific journal) Publisher：Cancer Diagnosis and Prognosis
Background/Aim: Pancreatic neuroendocrine tumors (PanNETs) are heterogeneous neoplasms for which surgical resection remains the only potentially curative therapy. However, preoperative diagnostic accuracy – particularly tumor grading – often varies, complicating treatment decisions. This study evaluated diagnostic concordance between preoperative assessments and postoperative pathology, as well as surgical outcomes and prognostic factors in patients undergoing pancreatectomy for PanNETs. Patients and Methods: We retrospectively reviewed the clinical records of 32 patients who underwent surgical resection for PanNETs. Patient demographics, tumor characteristics, surgical procedures, and postoperative outcomes were analyzed. Preoperative imaging and cytology-based diagnoses were compared with final pathological findings to evaluate diagnostic concordance. Prognostic factors were assessed using Kaplan–Meier survival analysis. Results: Histological grading of resected specimens showed G1 in 53%, G2 in 41%, and G3/NEC in 6%, with a 38% discordance rate from preoperative biopsy. Lymphatic, venous, and perineural invasions were identified in 16%, 44%, and 13% of cases. Lymph node metastasis occurred in 22%. Among 30 patients with follow-up >12 months, eight developed recurrence, most commonly in the liver. The 3-year and 5-year disease-free survival (DFS) rates were 78% and 69%, while overall survival (OS) rates were 96% and 91%. Tumor number >2 and histologic grade G3 were significantly associated with reduced DFS (p<0.05). Lymphatic invasion and metachronous liver metastasis were significantly associated with reduced OS (p<0.01 and p<0.05, respectively). Histological grading mismatch was not associated with survival outcomes. Conclusion: Pancreatectomy for PanNETs is a safe and effective treatment with favorable long-term outcomes. Histological factors such as tumor grade, lymphatic invasion, and tumor number significantly predict recurrence and survival.
DOI： 10.21873/cdp.10506
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Nanashima A., Arai J., Imamura N., Hiyoshi M., Tsuchimochi Y., Wada T., Hamada T.
Gland Surgery 14 ( 12 ) 2440 - 2455 2025.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Gland Surgery
Background: Pancreatic anastomosis has been developed, and each anastomosis has its pros and cons. This study investigated the prevalence of postoperative complications, particularly pancreatic fistula (POPF), among five types of pancreatoenteric anastomoses to determine the optimal anastomosis for patients undergoing pancreatectomy. Methods: This study retrospectively and consecutively analyzed the data of 365 patients who underwent pancreatectomy with pancreaticoenteral anastomosis at two academic institutions from 1994 to 2024. Pancreaticogastrostomy via invagination was performed in 24 patients (group PG). For pancreaticojejunal anastomosis, we performed an end-to-end invagination procedure on eight patients (group PJI), two-layer suturing procedure on 96 patients (group PJT), Kakita procedure on 55 patients (group K), and modified Blumgart procedure on 182 patients (group B). Results: Group B had the shortest hospital stay and fastest resumption of oral intake. Groups PG and PJI exhibited higher grade B/C POPF rates and prolonged ascites. The potential benefits of group B included reduced hospitalization period and enhanced recovery owing to decreased POPF rates. Habitual alcohol consumption and high preoperative creatinine levels increased the risk of POPF, whereas external drainage issues and blood loss contributed to prolonged ascites. In particular, habitual alcohol consumption [relative risk (RR) =2.42], group K anastomosis (RR =2.79), soft pancreatic texture (RR =2.48), delayed oral intake (≥4 days; RR =2.78), and complete external drainage (RR =8.68) were independent predictors of POPF. Conclusions: Modified Blumgart procedure is an optimal pancreaticoenteral anastomosis technique for avoiding POPF. Early oral intake has emerged as a protective factor, highlighting its role in improving postoperative outcomes. Surgeons should prioritize intraoperative blood conservation, perioperative nutritional support, and appropriate anastomotic selection to enhance surgical success.
DOI： 10.21037/gs-2025-380
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Nanashima A., Arai J., Imamura N., Hiyoshi M., Tsuchimochi Y., Wada T.
Translational Cancer Research 14 ( 12 ) 8556 - 8566 2025.12
Language：English Publishing type：Research paper (scientific journal) Publisher：Translational Cancer Research
Background: The underlying etiology of liver disease, such as metabolic dysfunction-associated steatotic liver diseases (MASLDs) or alcohol-related liver injury, significantly affects liver function and regenerative capacity. In hepatocellular carcinoma (HCC) patients undergoing hepatectomy, these background factors may influence postoperative outcomes and long-term survival. This study aimed to evaluate the impact of different etiologies of liver disease on survival outcomes following curative hepatectomy in patients with HCC. Methods: We retrospectively analyzed patients with HCC who underwent curative hepatectomy at two academic institutions. Background liver disease was classified according to etiology, including viral liver disease (VLD), alcohol-related liver disease (ALD), MASLD, and others. Survival outcomes were evaluated and compared across etiological groups at two institutions from 1994 to 2023. Results: Patients with VLD, ALD, and MASLD exhibited significantly elevated rates of advanced liver fibrosis (P<0.001), while vascular involvement was less frequent in MASLD cases. No significant differences in tumor stage, tumor markers, or postoperative complications were found among the etiologies. However, tumor recurrence was significantly more common in the VLD and ALD groups (P<0.001), and HCC-related deaths were most frequent in the VLD and other/unknown groups. MASLD patients presented the most favorable outcomes, with a 5-year recurrence-free survival (RFS) of 54% and a 10-year overall survival (OS) of 100%, significantly better than VLD (RFS 31%, OS 49%; P<0.01). Multivariate analysis revealed that VLD, vascular invasion, R1 margin, and poor liver function were independent predictors of recurrence and poor OS. Conversely, MASLD was not a significant risk factor for recurrence and was independently associated with better survival (P<0.05). Conclusions: MASLD-related HCC represents a distinct clinical entity with relatively indolent tumor behavior and better-preserved liver function. Recognizing the prognostic implications of MASLD-related HCC is essential for optimizing surgical indications and developing etiology-specific treatment strategies.
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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
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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肝がん（手術療法）．
土持有貴
令和7年度第12回宮崎大学がんセミナー
Event date： 2025.10.29
Language：Japanese Presentation type：Oral presentation (general)
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計画的二期的手術にて加療した外傷性膵十二指腸損傷の1例．
荒木裕介，今村直哉，河野文彰，濵田剛臣，土持有貴，和田 敬，鈴木康人，池ノ上実，宗像 駿，樋口和宏，千代反田顕，岩本和樹，武野慎祐，落合秀信，七島篤志
第17回日本Acute Care Suregery学会学術集会
Event date： 2025.9.19 - 2025.9.20
Language：Japanese Presentation type：Oral presentation (general)
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2期的に膵頭十二指腸切除術を施行したウシ外傷の1例．
荒木裕介，今村直哉，土持有貴，和田 敬，鈴木康人，濵田剛臣，河野文彰，池ノ上実，宗像 駿，樋口和宏，千代反田顕，岩本和樹，武野慎祐，落合秀信，七島篤志
令和8年度宮崎県外科医会夏期講習会(日本臨床外科学会地方会)
Event date： 2025.8.1
Language：Japanese Presentation type：Oral presentation (general)
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同時多発した2つの大型肝細胞癌を段階的に治療し2病変とも切除した1例.
山﨑泰司，七島篤志，和田 敬，土持有貴，濵田剛臣，今村直哉
第61回九州外科学会
Event date： 2025.2.8
Language：Japanese Presentation type：Oral presentation (general)
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腫瘤形成型肝内胆管癌における FDG-PET の有用性．
今村直哉，七島篤志，和田 敬，土持有貴，濵田剛臣
第45回九州肝臓外科研究会学術集会
Event date： 2025.1.18
Language：Japanese Presentation type：Oral presentation (general)