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医学部 医学科 外科学講座肝胆膵外科学分野 |
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職名 |
助教 |
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外部リンク |
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関連SDGs |
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論文 【 表示 ／ 非表示 】
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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年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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 Atsushi, Imamura Naoya, Hiyoshi Masahide, Tsuchimochi Yuki, Wada Takashi, Hamada Takeomi, Suzuki Yasuyuki, Araki Yuusuke, Hosokawa Ayumu, Kawakami Hiroshi
Cancer diagnosis & prognosis 6 ( 2 ) 291 - 302 2026年3月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Institute of Anticancer Research
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) being more 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 with mural 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 had markedly 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. -
七島 篤志, 今村 直哉, 土持 有貴, 和田 敬, 濵田 剛臣, 鈴木 康人
Cancer diagnosis & prognosis 6 ( 1 ) 52 - 61 2026年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Institute of Anticancer Research
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. -
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年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：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
MISC 【 表示 ／ 非表示 】
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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年1月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌） 出版者・発行元：(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年1月
記述言語：日本語 掲載種別：記事・総説・解説・論説等（学術雑誌） 出版者・発行元：医学図書出版(株)
講演・口頭発表等 【 表示 ／ 非表示 】
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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
開催年月日： 2025年10月29日
記述言語：日本語 会議種別：口頭発表（一般）
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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
開催年月日： 2025年9月19日 - 2025年9月20日
記述言語：日本語 会議種別：口頭発表（一般）
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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)
開催年月日： 2025年8月1日
記述言語：日本語 会議種別：口頭発表（一般）
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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
開催年月日： 2025年2月8日
記述言語：日本語 会議種別：口頭発表（一般）
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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
開催年月日： 2025年1月18日
記述言語：日本語 会議種別：口頭発表（一般）