| 1. |
Oda H, Nakamura M, Ueki T, Masayuki Sada, Current status of ambulatory endoscopic thoracic sympathectomy for palmar hyperhidrosis in Japan, Clin Auton Res, 13(2):153-153, 2003.04. |
| 2. |
Kinuko Nagayoshi, Shuntaro Nagai, Yoshihiko Sadakari, Hayato Fujita, Kenji Tsuchihashi, Tatsuya Manabe, Yoshitaka Tanabe, Takashi Ueki, Eishi Baba, Masafumi Nakamura, Phase II Trial of Neoadjuvant Chemotherapy using Triplet without Radiotherapy for Borderline Resectable Advanced Rectal Cancer in Japan (NEUTRAL Trial), Jounal of Clinical Trials, 10.4172/2167-0870.1000351, 8(4):1000351, 2018.04. |
| 3. |
Masafumi Nakamura, Go Wakabayashi, Akihiko Tsuchida, Yuichi Nagakawa, Study group of Precision Anatomy for Minimally Invasive Hepato-Biliary-Pancreatic surgery (PAM-HBP surgery), Precision anatomy for minimally invasive hepatobiliary pancreatic surgery: PAM-HBP Surgery Project, J Hepatobiliary Pancreat Sci., 10.100./jhbp.885, 29(1):1-3
, 2022.04. |
| 4. |
Akihisa Ohno, Nao Fujimori, Toshiya Abe, Masafumi Nakamura, Yoshihiro Ogawa, Bile peritonitis after placement of a metallic stent in endoscopic ultrasound-guided hepaticogastrostomy: A pitfall and the rescue technique, Endoscopy
, 10.1055/a-1937-9781, 55(S01):E94-E95, 2023.04. |
| 5. |
Nakamura M, Takayama T, Takayasu K, Shimada K, Yamamoto J, Kosuge T, Sakamoto M, Yamasaki S, Shimizu S, Makuuchi M, Retroperitoneal Schwannoma mimicking hepatic tumor in the caudate lobe., Jpn J Clin Oncol, 27(4):282-284, 1997.04, We report a 41-year-old woman with a retroperitoneal schwannoma mimicking hepatic tumor in the caudate lobe. Dynamic computed tomography in the early phase showed an enhanced tumor (2.7 cm in diameter) in the Spiegel lobe of the liver, which compressed the inferior vena cava (IVC). We also performed left hepatic angiographic computed tomography, and found that the tumor was less enhanced. The patient underwent laparotomy under a preoperative diagnosis of primary hepatic caudate tumor with faint neovascularity. At surgery, the tumor was found to be located between the left caudate lobe and the IVC, and was resected as being of a retroperitoneal origin. This case illustrates that tumor location must be determined with great care when the mass seems to exist at the dorsal edge of the liver, and especially when the tumor is hypovascular. ". |
| 6. |
Watanabe M, Yamaguchi K, Kobayashi K, Konomi H, Nakamura M, Mizumoto K, Tsuneyoshi M, Tanaka M, Autoimmune pancreatitis diagnosed after pancreatoduodenectomy and successfully treated with low-dose steroid., J Hepatobiliary Pancreat Surg, 14(4):397-400, 2007.04, Abstract
A 69-year-old woman presented with obstructive jaundice and a 30-mm hypoechoic mass in the pancreatic head on ultrasonography. Magnetic resonance imaging (MRI) revealed enlargement of the pancreatic head with dilatation of the upstream main pancreatic duct and no dilatation of the proximal biliary tree. Endoscopic retrograde pancreatography showed a localized irregular narrowing of the main pancreatic duct in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy (PPPD) was performed under the diagnosis of pancreatic head cancer. Histopathological examination showed fibrosis with lymphoplasmacytic infiltration, suggesting the diagnosis of autoimmune pancreatitis (AIP). Serum IgG concentration was within normal limits immediately after the operation but was elevated 4 months later, when MRI showed enlargement of the remnant pancreas, with a peripheral rim of low intensity. Oral administration of prednisolone was initiated, at a dose of 5 mg/day. The serum IgG concentration declined and MRI showed improvement of the pancreatic enlargement and the disappearance of the peripheral rim. AIP has not relapsed for 1 year so far, with the patient being kept on 5 mg/day prednisolone. This communication reports a patient with AIP showing an interesting clinical course.
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| 7. |
Ogino T, Ueda J, Sato N, Takahata S, Mizumoto K, Nakamura M, Oda Y, Tanaka M, Repeated Pancreatectomy for Recurrent Pancreatic Carcinoma after Pylorus-Preserving Pancreatoduodenectomy: Report of Two Patients, Case Rep Gastroenterol, 4(3):429-434, 2010.04, Repeated pancreatectomy for pancreatic carcinoma is extremely rare. We report two such patients who underwent pancreatectomy for carcinoma developing in the pancreatic remnant after pylorus-preserving pancreatoduodenectomy (PpPD) for invasive pancreatic ductal carcinoma. One patient underwent PpPD for invasive pancreatic ductal carcinoma and received adjuvant chemotherapy. Follow-up computed tomography (CT) demonstrated a low-density mass in the remnant pancreas, which was diagnosed as a carcinoma by endoscopic ultrasound-guided fine-needle aspiration cytology 5 years 10 months after PpPD. She underwent curative resection of the remnant pancreas and is alive and well 13 months after the second operation. The other patient underwent PpPD for invasive pancreatic ductal carcinoma. Follow-up CT showed a low-density mass in the remnant pancreas after 2 years 11 months. He received systemic chemotherapy with S-1 for 3 months. The tumor shrank, and the patie
nt underwent curative resection of the remnant pancreas 3 years 1 month after the initial operation. Repeated pancreatectomy may provide a chance of long survival for patients with carcinoma developing in the remnant pancreas after pancreatectomy if the recurrence occurring at long term is limited to the remnant pancreas. |
| 8. |
Mori Y, Ohtsuka T, Tsutsumi K, Yasui T, Sadakari Y, Ueda J, Takahata S, Nakamura M, Tanaka M, Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report
, JOP, 11(4):389-392, 2010.04, CONTEXT: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention.
CASE REPORT: We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies.
CONCLUSIONS: Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection.
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| 9. |
Fujimori N, Nakamura T, Oono T, Igarashi H, Takahata S, Nakamura M, Tanaka M, Hayashi A, Aishima S, Ishigami K, Ogoshi K, Ito T, Takayanagi R, Adenocarcinoma involving the whole pancreas with multiple pancreatic masses, Intern Med, 49(15):1527-1532, 2010.04, A 77-year-old man was referred to our hospital for further investigation of pancreatic masses. Imaging studies revealed hypovascular masses in the pancreatic head and body. Total pancreatectomy was performed under the diagnosis of double primary pancreatic carcinomas. Macroscopic examination revealed 3 nodules: one each in the pancreatic head, body, and tail. Microscopically, all 3 lesions showed similar carcinoma cells, which communicated with each other via the intraductal component, indicating a single large tumor. Incidentally, we also identified an adenocarcinoma of the common bile duct (CBD). The final diagnosis was synchronous double cancer involving the whole pancreas and the CBD.
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| 10. |
Onishi H, Morisaki T, Baba E, Nakamura M, Inaba S, Kuroki H, Matsumoto K, Katano M, Long-term vaccine therapy with autologous whole tumor cell-pulsed dendritic cells for a patient with recurrent rectal carcinoma., Anticancer Res, 31(11):3995-4005, 2011.04, Abstract
We performed continuous dendritic cells (DCs) vaccination to treat a patient with chemotherapy-resistant recurrent rectal carcinoma and lung and bone metastases. A patient has received a total of 66 DC vaccinations at 14-day intervals for 3 years until his death. Necrotic whole tumor cells (WTC) were selected as the tumor-associated antigen source because they showed a greater capacity for DC maturation and interleukin-12 secretion than both necrotic tumor lysate alone and necrotic tumor cell fragment alone. After the sixth vaccination, both skin test and interferon-γ (IFN-γ) enzyme-linked immunospot (ELISPOT) response by peripheral blood T-cells to WTC-pulsed DCs were positive. Importantly, T-cell responses were positive towards DCs pulsed with several synthetic peptides including Carcinoembryonic antigen (CEA), Melanoma associated antigen (MAGE)1 and MAGE3. A biopsy specimen collected from the pelvic bone metastasis after the 6th vaccination showed marked necrotic change of the carcinoma cells, with many infiltrating mononuclear cells. The patient did not show any particular adverse reactions to vaccination such as autoimmune phenomena. Our experience of this case suggests that continuous long-term vaccination with autologous WTC-pulsed DCs can elicit in vivo T-cell response against multiple tumor-associated antigens and induce tumor regression in disease that has proven resistant to intensive chemo- or radiation therapy.
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| 11. |
Kono H, Ohtsuka T, Fujino M, Ideno N, Aso T, Nagayoshi Y, Mori Y, Takahata S, Nakamura M, Ueki T, Tanaka M, Type Ⅱ congenital biliary dilation (biliary diverticulum) with pancreaticobiliary maljunction successfully treated by laparoscopic surgery: report of a case, Clin J Gastroenterol, 5:88-92, 2012.04. |
| 12. |
Shindo K, Ueda J, Toubo T, Nakamura M, Oda Y, Eguchi T, Tanaka M, Primary carcinoid tumor in a retroperitoneal mature teratoma: report of a case, Surg Today, 43(6):694-697, 2013.04, Primary retroperitoneal teratoma in an adult is rare, as is the occurrence of a malignant tumor within a mature teratoma, known as "malignant transformation". A 24-year-old woman was admitted to our hospital for investigation of an abdominal mass. Computed tomography and magnetic resonance imaging revealed a multilocular mass in the right upper abdomen. The tumor consisted of fat, soft tissue, and bone, with a slightly enhanced solid component. The tumor was diagnosed preoperatively as a retroperitoneal mature teratoma with an immature component, and excised. Histologically, it was composed mainly of mature fat, soft tissue, and bone, accompanied by a solid component of prostate-like tissue. In addition, a latent carcinoid tumor was recognized in the middle of the tumor. The tumor was finally diagnosed as a primary carcinoid tumor within the retroperitoneal mature teratoma. The patient has been followed-up for 24 months since her operation without any evidence of recurrence. We report this case to highlight the possibility of malignant transformation in adult retroperitoneal teratoma, even when the preoperative diagnosis is benign mature teratoma.. |
| 13. |
Yamashita K, Okumura H, Oka Y, Urakami A, Shiotani A, Nakashima H, Matsumoto H, Hirai T, Nakamura M, Minimally invasive surgery using intraoperative real-time capsule endoscopy for small bowel lesions., Surg Endosc, 27(7):2337-2341, 2013.04. |
| 14. |
Murakami H, Matsumoto H, Kubota H, Higashida M, Nakamura M, Manabe N, Haruma K, Hirai T, A case of secondary achalasia caused by scar tissue formation after distal gastrectomy.
, Esophagus, 10(2):118-122, 2013.04. |
| 15. |
Murakami H, Matsumoto H, Kubota H, Higashida M, Nakamura M, Manabe N, Haruma K, Hirai T, A case of long myotomy and fundoplication for diffuse esophageal spasm., Esophagus, 10:273-279, 2013.04. |
| 16. |
Tsuruta A, Kawai A, Oka Y, Okumura H, Matsumoto H, Hirai T, Nakamura M, Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon
, World J Gastroenterol, 10.3748/wjg.v20.i18.5557 , 20(18):5557-5560, 2014.04, Abstract
Persistent ascending or descending mesocolon is an embryological anomaly that occurs during the final process of intestinal development in organogenesis. Specifically, the primitive dorsal mesocolon fails to fuse with the parietal peritoneum in the fifth month of gestation. Herein, we describe a case of ascending colon cancer with persistent ascending and descending mesocolon treated by laparoscopic right hemicolectomy. Preoperative computed tomography imaging of the abdomen demonstrated that the descending colon shifted at the midline of the abdomen and the sigmoid colon was located under the ascending colon. The detailed preoperative imaging examination revealed malpositioning of the large intestine and aided in the procedural planning. Because persistent mesocolon may result in the formation of abnormal adhesions, an accurate preoperative diagnosis is essential. We propose that it is important to consider this anomaly when making the preoperative imaging diagnosis to ensure a safe operation.
KEYWORDS:
Colon cancer; Laparoscopic surgery; Mobile cecum; Persistent ascending mesocolon; Persistent descending mesocolon. |
| 17. |
Date K, Ohtsuka T, Fujimoto T, Gotoh Y, Nakashima Y, Kimura H, Matsunaga T, Mori Y, Mochidome N, Miyazak T, Oda Y, Tanaka M, Nakamura M, GNAS and KRAS mutational analyses of intraductal papillary neoplasms of the pancreas and bile duct developing in the same individual: A case report, Pancreatology, 10.1016/j.pan.2015.09.013 , 15(6):713-716, 2015.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas and intraductal papillary neoplasm of the bile duct (IPNB) are considered as counterparts of each other, and it is suggested that these two entities have similar molecular alteration pathways. However, the occurrence of IPMN of the pancreas and IPNB in the same patient is rare. We report a surgical case of a 69-year-old woman who developed invasive IPMN of the pancreas and underwent pancreatectomy, 6 months after hepatic resection of invasive IPNB. Molecular analysis revealed GNAS/KRAS mutation in both invasive IPMN of the pancreas and IPNB. This is believed to be the first case report investigating GNAS/KRAS mutational status in both IPMN of the pancreas and IPNB developing in the same patient, and these two entities may show similar molecular alternations.
Copyright © 2015 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.
KEYWORDS:
Bile duct neoplasm; GNAS; IPMN; Intraductal papillary neoplasm; KRAS; Pancreas neoplasm. |
| 18. |
Yamasaki A, Onishi H, Yamamoto H, Ienaga J, Nakafusa Y, Terasaka R, Nakamura M, Asymptomatic adenocarcinoma arising from a gastric duplication cyst: A case report, Int J Surg Case Rep, 10.1016/j.ijscr.2016.05.055 , 25:16-20, 2016.04, INTRODUCTION: Duplication of the alimentary tract is a relatively uncommon congenital anomaly and most cases occur in childhood. Malignancy arising from a gastric duplication cyst is extremely rare. We herein report a very rare case of malignant transformation of a gastric duplication cyst.PRESENTATION OF CASE: A 47-year-old asymptomatic Japanese woman was referred to our hospital with a large abdominal mass adhered to the stomach. Since there was a possibility of malignant transformation, complete resection of the cyst and segmental gastrectomy without regional lymphadenectomy were performed.DISCUSSION: To our knowledge,this is the 2ndreport of asymptomatic adenocarcinoma arising froma gastric duplication cyst in the English-language literature. Unfortunately, the patient developed peritoneal metastasis and ascites seven months after the surgery and died.CONCLUSION: From our long-term follow-up experience of this gastric duplication cyst, we recommend making
accurate diagnosis as soon as possible with biopsy using endoscopic ultrasonography. When the disease is diagnosed as malignant, we recommend gastrectomy with lymphadenectomy. Even if the disease is diagnosed as benign, we recommend close observation with imaging modalities.. |
| 19. |
Tsuruta N, Takayoshi K, Arita S, Aikawa T, Ariyama H, Kusaba H, Ohuchida K, Nagai E, Kohashi K, Hirahashi M, Inadomi K, Tanaka M, Sagara K, Okumura Y, Nio K, Nakano M, Nakamura M, Oda Y, Akashi K, Baba E, Systemic chemotherapy with pronounced efficacy and neutropenia in a granulocyte-colony stimulating factor-producing advanced gastric neuroendocrine carcinoma, Oncol Lett, 14(2):1500-1504, 2017.04, An advanced granulocyte-colony stimulating factor (G-CSF)-producing tumor is rare, and it exhibits leukocytosis in association with high serum G-CSF levels. A 67-year-old male with a 1-month history of bloody emesis and black stools was revealed to exhibit leukocytosis, anemia and a high serum concentration of G-CSF. During a gastrointestinal endoscopy, an ulcerating tumor was identified in the stomach. Computed tomography and a fluorodeoxyglucose-positron emission tomography scan demonstrated direct invasion of the gastric tumor into the transverse colon, regional lymphadenopathy, lung nodules and diffuse high uptake of FDG in bone marrow. The histological diagnosis was a G-CSF-producing neuroendocrine carcinoma (NEC) (tumor 4b, node 2, metastasis 1, pulmonary, clinical stage IV). Systemic chemotherapy consisting of cisplatin and irinotecan was started. Common terminology criteria of adverse events grade 3 tumor lysis syndrome and gastric penetration appeared. Grade 4 neutropenia lasted for 10 days despite intensive G-CSF administration. Prominent shrinkage of the primary and the metastatic tumors was observed subsequent to 3 cycles of chemotherapy. Total gastrectomy and resection of the transverse colon were subsequently performed. Systemic chemotherapy was effective for a G-CSF-producing advanced gastric NEC with careful monitoring and appropriate supportive care for severe adverse events.. |
| 20. |
Shindo K, Nagai E, Nabae T, Eguchi T, Moriyama T, Ohuchida K, Manabe T, Ohtsuka T, Oda Y, Hashizume M, Nakamura M, Successful video-assisted thoracoscopic surgery in prone position in patients with esophageal cancer and aberrant right subclavian artery: report of three cases, Surg Case Rep, 10.1186/s40792-017-0360-9., 3
(1):86-86, 2017.04, Abstract
BACKGROUND:
An aberrant right subclavian artery (ARSA) with an associated nonrecurrent right inferior laryngeal nerve (NRILN) is a relatively rare anomaly that occurs at a frequency of 0.3 to 2.0% of the general population. NRILN has been mainly documented in the head and neck region; it has been rarely described in patients with esophageal cancer, especially those undergoing thoracoscopic surgery. Video-assisted thoracoscopic surgery for esophageal cancer (VATS-E) is becoming more widespread as a reliable minimally invasive surgical procedure associated with reduced perioperative complications.
CASE PRESENTATION:
Herein, we report three cases of esophageal cancer with ARSA and NRILN which underwent successful VATS-E. Case 1, a 53-year-old male who had early stage esophageal cancer was performed VATS-E. Upper gastrointestinal (GI) series showed "Bayonet sign" (T1aN0M0, pStageIA in UICC). Case 2, a 75-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E. This case had right thoracic duct and "Bayonet sign" on upper GI series (T1bN2M0, pStage IIIA in UICC). Case3, a 72-year-old male who had advanced esophageal cancer was performed neoadjuvant chemotherapy and following VATS-E (T3N2M0, pStageIIIB in UICC). All of these three cases were performed VATS-E and discharged without any complication.
CONCLUSION:
VATS-E in the prone position is a feasible procedure that can reduce the risk of complications with an enlarged and clear view, and knowledge of this type of anomaly is very important for surgeons who perform esophagectomy.
KEYWORDS:
Aberrant right subclavian artery; Esophageal cancer; Nonrecurrent right inferior laryngeal nerve; Prone position; Video-assisted thoracoscopic surgery. |
| 21. |
Kawamoto M, Onishi H, Koya N, Konomi H, Mitsugi K, Tanaka R, Motoshita J, Morisaki T, Nakamura M, Stage IV gastric cancer successfully treated by multidisciplinary therapy including chemotherapy, immunotherapy, and surgery: a case report, Surg Case Rep, 10.1186/s40792-017-0380-5, 3(1):112, 2017.04, Abstract
BACKGROUND:
The prognosis of stage IV gastric cancer (GC) still remains unfavorable. Multidisciplinary approaches should therefore be considered to improve the survival of patients with stage IV GC. We report here a case of primary GC with potentially unresectable metastasis, successfully treated by a multidisciplinary approach including chemotherapy, immunotherapy, and surgery.
CASE PRESENTATION:
A 74-year-old man presented with multiple left neck masses. Abdominal computed tomography showed a thickened gastric wall and multiple lymphadenopathies including left supraclavicular lymph node. Gastroenterological endoscopy revealed tumor lesions in the gastric cardia. Tumor biopsy indicated a pathological diagnosis of poorly differentiated adenocarcinoma. Open left cervical lymph node biopsy showed histological features identical with the gastric tumor, indicating left clavicle lymph node metastasis of GC. After 2 years of chemo-immunotherapy with S-1/CDDP, paclitaxel, and cytokine-activated killer cells, lesions other than the stomach lesion had regressed to undetectable on imaging studies. The patient then underwent laparoscopy-assisted total gastrectomy with Roux-en-Y reconstruction followed by adjuvant chemo-immunotherapy with paclitaxel and S-1 for 1 year, and immunotherapy with tumor lysate-pulsed dendritic cell-activated killer cells for 5 years. The patient remained well after 5 years and 6 months of follow-up, with no signs of recurrence.
CONCLUSION:
Therapeutic combinations including immunotherapy may thus allow surgery to be performed in patients previously considered unsuitable for surgical intervention, potentially leading to a clinical cure, as in the current case.. |
| 22. |
Aso A, Ihara E, Nakamura K, Sudovykh I, Ito T, Nakamura M, Ikeda T, Takizawa N, Oka Y, Shimizu S, Solid pseudopapillary neoplasm of the pancreas in young male patients: three case reports, Case Rep Gastrointest Med, 10.1155/2017/9071678, 2017:1-4, 2017.04, Abstract
A preoperative diagnosis of solid pseudopapillary neoplasms (SPNs) in young male patients is difficult to achieve using radiological images. We herein present three cases of young male patients with relatively small SPNs. Endoscopic ultrasound (EUS) showed well-encapsulated, smooth-surfaced, heterogeneous solid lesions in all patients, and all preoperative diagnoses were achieved by EUS-guided fine needle aspiration (EUS-FNA). The final pathological diagnosis after surgery was an SPN with a Ki-67 labeling index of |
| 23. |
Kai M, Kubo M, Kawaji H, Kurata K, Mori H, Yamada M, Nakamura M, QOL-enhancing surgery for patients with HER2-positive metastatic breast cancer, BMJ Support Palliat Care, 10.1136/bmjspcare-2018-001622., 9(2):151-154, 2018.04. |
| 24. |
Tsuchihashi K, Arita S, Fujiwara M, Iwasaki K, Hirano A, Yoshihiro T, Nio K, Koga Y, Esaki M, Ariyama H, Kusaba H, Moriyama T, Ohuchida K, Nagai E, Nakamura M, Oda Y, Akashi K, Baba E, Metastatic esophageal carcinosarcoma comprising neuroendocrine carcinoma, squamous cell carcinoma, and sarcoma, Medicine, 10.1097/MD.0000000000012796., 97(41):e12796, 2018.04, Abstract
RATIONALE:
Esophageal carcinosarcoma generally comprises 2 histological components: squamous cell carcinoma (SqCC) and sarcoma. Esophageal carcinosarcoma comprising 3 components is extremely rare and no reports have described therapeutic effects for this disease with metastasis.
PATIENT CONCERNS:
A 76-year-old man with dysphagia presented to a local clinic. Gastrointestinal endoscopy revealed a polypoid tumor in the middle esophagus and he was referred to our hospital.
DIAGNOSIS AND INTERVENTIONS:
Thoracoscopic esophagectomy with super-extended (D3) nodal dissection and gastric tube reconstitution was performed, which resulted in carcinosarcoma comprising neuroendocrine carcinoma (NEC), SqCC, and sarcoma. Pathological stage was T1bN1M0 stage IIB according to the TNM Classification of Malignant Tumors-7th edition. The NEC component was observed in lymph node. At 47 days after surgery, lymph nodes, liver, and bone metastasis appeared, and tumor markers such as ProGRP and NSE were elevated. Combination chemotherapy with cisplatin and etoposide (EP) adapted to NEC was performed.
OUTCOMES:
The patient showed complete response within 4 cycles of chemotherapy. However, the disease recurred 5.5 months after the final course of EP chemotherapy.
LESSONS:
A therapeutic strategy based on assessment of which component caused metastasis might be important for metastatic carcinosarcoma comprising 3 components, although more accumulation of data about the efficacy of chemotherapy is necessary. Moreover, elucidation of the mechanisms underlying generation of carcinosarcoma is expected in the future.
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| 25. |
Hirono S, Kawai M, Okada K, Fujii T, Sho M, Satoi S, Amano R, Eguchi H, Mataki Y, Nakamura M, Matsumoto I, Baba H, Tani M, Kawabata Y, Nagakawa Y, Yamada S, Murakami Y, Shimokawa T, Yamaue H, MAPLE-PD trial (Mesenteric Approach vs. Conventional Approach for Pancreatic Cancer during Pancreaticoduodenectomy): study protocol for a multicenter randomized controlled trial of 354 patients with pancreatic ductal adenocarcinoma, Trials, 10.1186/s13063-018-3002-z , 19(1):613, 2018.04, Abstract
BACKGROUND:
The mesenteric approach is an artery-first approach to pancreaticoduodenectomy for pancreatic cancer, which starts with the dissection of connective tissues around the superior mesenteric artery. The procedure aims for early confirmation of resectability by checking the surgical margin around the superior mesenteric artery first during the operation. It also aims to decrease intraoperative blood loss by early ligation of the inferior pancreaticoduodenal artery and to increase R0 rate by complete clearance of the lymph nodes around the superior mesenteric artery and pancreatic head plexus II, the most favorable positive margin site for pancreatic ductal adenocarcinoma. Furthermore, it aims to avoid the spread of cancer cells during operation (nontouch isolation technique). The MAPLE-PD (Mesenteric Approach vs. Conventional Approach for Pancreatic Cancer during Pancreaticoduodenectomy) trial investigates whether the mesenteric approach can prolong the survival of patients with pancreatic ductal adenocarcinoma who undergo pancreaticoduodenectomy compared with the conventional approach.
METHODS/DESIGN:
The MAPLE-PD trial is a Japanese multicenter randomized controlled trial that compares the surgical outcomes between the mesenteric and conventional approaches to pancreaticoduodenectomy. Patients with pancreatic ductal adenocarcinoma scheduled to undergo pancreaticoduodenectomy are randomized before operation to either a conventional approach (arm A) or a mesenteric approach (arm B). In arm A, the operation starts with Kocher's maneuver. At the final step of the removal procedure, the connective tissues around the superior mesenteric artery are dissected. In arm B, the operation starts with dissection of the connective tissues around the superior mesenteric artery and ends with Kocher's maneuver. In total, 354 patients from 15 Japanese high-volume centers will be randomized. The primary endpoint is overall survival by intention-to-treat analysis. Secondary endpoints include intraoperative blood loss, R0 rate, and recurrence-free survival.
DISCUSSION:
If the MAPLE-PD trial shows the oncological benefits of the mesenteric approach for patients with pancreatic ductal adenocarcinoma, this procedure may become a standard approach to pancreaticoduodenectomy.
TRIAL REGISTRATION:
ClinicalTrials.gov, NCT03317886 . Registered on 23 October 2017. University Hospital Medical Information Network Clinical Trials Registry, UMIN000029615 . Registered on 15 January 2018.
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| 26. |
Kawamoto M, Wada Y, Koya N, Takami Y, Saitsu H, Ishizaki N, Tabata M, Onishi H, Nakamura M, Morisaki T, Long-term survival of a patient with recurrent gallbladder carcinoma, treated with chemotherapy, immunotherapy, and surgery: a case report, Surg Case Rep, 10.1186/s40792-018-0512-6 , 4(1):115, 2018.04, Abstract
BACKGROUND:
Gallbladder cancer (GBC) is one of the refractory diseases. Multidisciplinary approach including immunotherapy for such cancers has received much attention in recent years.
CASE PRESENTATION:
A 59-year-old man underwent an extended cholecystectomy for GBC (pathological stage II, T2 N0 M0, [per UICC 7th edition]) that was incidentally found during cholelithiasis surgery, and was then treated with adjuvant gemcitabine (GEM). Three months later, when a recurrence-suspected lesion was detected in segment 5 (S5) of his liver, we started adoptive immunotherapies with cytokine-activated killer (CAK) cell infusions, combined with chemotherapy. After a year of adjuvant immunochemotherapy, the S5 lesion disappeared on imaging, but lesions suspected metastatic recurrence again appeared in S7 and S8 at 4 years and 6 months post-surgery, for which GEM and cisplatin (CDDP) were administered as second-line chemotherapy. Immunochemotherapy produced stable disease (per RECIST) for 9 months, when tumor growth was detected; open microwave coagulo-necrotic therapy (MCN) was performed for these lesions. Three years after MCN, a solitary liver metastasis was detected in S4. MCN was conducted again, and peritoneal dissemination was found intraoperatively. A month after the second MCN, the patient's carcinoembryonic antigen (CEA) level had increased. Therefore, GEM and tegafur-gimeracil-oteracil potassium (TS-1) were administered as third-line chemotherapy. We also switched the adoptive immunotherapy for tumor-associated antigen-pulsed dendritic cell-activated killer (DAK) cell immunotherapy. After nine courses of GEM and TS-1 administration, CEA had decreased to a normal level. At the time of reporting, 9 years and 6 months have passed since the initial surgery, and 18 months have passed since the peritoneal metastasis was detected. GEM and CDDP are currently administered as fourth-line chemotherapy because of re-increased CEA. Although an undeniable metastasis was found in his para-aortic lymph node, this patient visits our clinic regularly for immunotherapy.
CONCLUSION:
We here report a rare case of long-term survival of recurrent GBC well controlled by multidisciplinary therapy. Immunotherapy may be a promising modality among multidisciplinary methods for advanced cancer.
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| 27. |
Palanivelu C, Takaori K, Abu Hilal M, Kooby DA, Wakabayashi G, Agarwal A, Berti S, Besselink MG, Chen KH, Gumbs AA, Han HS, Honda G, Khatkov I, Kim HJ, Li JT, Duy Long TC, Machado MA, Matsushita A, Menon K, Min-Hua Z, Nakamura M, Nagakawa Y, Pekolj J, Poves I, Rahman S, Rong L, Sa Cunha A, Senthilnathan P, Shrikhande SV, Gurumurthy SS, Sup Yoon D, Yoon YS, Khatri VP, International Summit on Laparoscopic Pancreatic Resection (ISLPR) "Coimbatore Summit Statements", Surg Oncol, 10.1016/j.suronc.2017.12.001, 27(1):A10-A15, 2018.04, Abstract
The International Summit on Laparoscopic Pancreatic Resection (ISLPR) was held in Coimbatore, India, on 7th and 8th of October 2016 and thirty international experts who regularly perform laparoscopic pancreatic resections participated in ISPLR from four continents, i.e., South and North America, Europe and Asia. Prior to ISLPR, the first conversation among the experts was made online on August 26th, 2016 and the structures of ISPLR were developed. The aims of ISPLR were; i) to identify indications and optimal case selection criteria for minimally invasive pancreatic resection (MIPR) in the setting of both benign and malignant diseases; ii) standardization of techniques to increase the safety of MIPR; iii) identification of common problems faced during MIPR and developing associated management strategies; iv) development of clinical protocols to allow early identification of complications and develop the accompanying management plan to minimize morbidity and mortality. As a process for interactive discussion, the experts were requested to complete an online questionnaire consisting of 65 questions about the various technical aspects of laparoscopic pancreatic resections. Two further web-based meetings were conducted prior to ISPLR. Through further discussion during ISPLR, we have created productive statements regarding the topics of Disease, Implementation, Patients, Techniques, and Instrumentations (DIPTI) and hereby publish them as "Coimbatore Summit Statements".. |
| 28. |
Tsuruta S, Ohishi Y, Fujiwara M, Ihara E, Ogawa Y, Oki E, Nakamura M, Oda Y, Gastric hepatoid adenocarcinomas are a genetically heterogenous group; most tumors show chromosomal instability, but MSI tumors do exist, Gastroenterology, 10.1016/j.humpath.2019.03.006 , 88:27-38, 2019.04, Abstract：The Cancer Genome Atlas Research Network classified gastric adenocarcinoma into four molecular subtypes: (1) Epstein-Barr virus-positive (EBV), (2) microsatellite-instable (MSI), (3) chromosomal instable (CIN), and (4) genomically stable (GS). The molecular subtypes of gastric hepatoid adenocarcinomas are still largely unknown. We analyzed 52 hepatoid adenocarcinomas for the expression of surrogate markers of molecular subtypes (MLH1, p53, and EBER in situ hybridization) and some biomarkers (p21, p16, Rb, cyclin D1, cyclin E, β-catenin, Bcl-2, IMP3, ARID1A and HER2), and mutations of TP53, CTNNB1, KRAS, and BRAF. We analyzed 36 solid-type poorly differentiated adenocarcinomas as a control group. Hepatoid adenocarcinomas were categorized as follows: EBV group (EBER-positive), no cases (0%); MSI group (MLH1 loss), three cases (6%); "CIN or GS" (CIN/GS) group (EBER-negative, MLH1 retained), 49 cases (94%). In the CIN/GS group, most of the tumors (59%) had either p53 overexpression or TP53 mutation and a coexisting tubular intestinal-type adenocarcinoma component (90%), suggesting that most hepatoid adenocarcinomas should be categorized as a true CIN group. Hepatoid adenocarcinomas showed relatively frequent expressions of HER2 (score 3+/2+: 21%/19%). Hepatoid adenocarcinomas showed shorter survival, more frequent overexpressions of p16 (67%) and IMP3 (98%) than the control group. None of hepatoid adenocarcinomas had KRAS or CTNNB1 mutations except for one case each, and no hepatoid adenocarcinomas had BRAF mutation. In conclusion, gastric hepatoid adenocarcinomas are a genetically heterogenous group. Most hepatoid adenocarcinomas are "CIN," but a small number of hepatoid adenocarcinomas with MSI do exist. Hepatoid adenocarcinomas are characterized by overexpressions of p16 and IMP3.
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| 29. |
Oyama K, Ohuchida K, Shindo K, Moriyama T, Hata Y, Wada M, Ihara E, Nagai S, Ohtsuka T, Nakamura M, Thoracoscopic Surgery Combined With Endoscopic Creation of a Submucosal Tunnel for a Large Complicated Esophageal Leiomyoma, Surgical case report, 10.1186/s40792-020-00854-5, 6(1):92, 2020.04. |
| 30. |
Noguchi H, Nakagawa K, Ueki K, Tsuchimoto A, Kaku K, Okabe Y, Nakamura M, Response to Treatment for Chronic-active T Cell-mediated Rejection in Kidney Transplantation: A Report of 3 Cases, Transplant Direct, 10.1097/TXD.0000000000001079
, 6(12):e628, 2020.04. |
| 31. |
Tsutsumi C, Moriyama T, Ohuchida K, Shindo K, Nagai S, Yoneda R, Fujiwara M, Oda Y, Nakamura M, Numerous lymph node metastases in early gastric cancer without preoperatively enlarged lymph nodes: a case report, Surg Case Rep, 10.1186/s40792-020-0795-2, 6(1):30, 2020.04, Background: According to the 2018 Japanese gastric cancer treatment guidelines (ver. 5), a reduced extent of lymphadenectomy (D1 or D1+) is indicated for cT1 N0 tumors that do not meet the criteria for endoscopic resection. However, early gastric cancer with multiple lymph node metastases is not unknown, and cases have been reported. We report a case of a patient with early gastric cancer and numerous nodal metastases who underwent laparoscopic proximal gastrectomy based on a preoperative diagnosis of T1 N0.
Case presentation: A 69-year-old woman underwent emergent endoscopic hemostasis for massive hematemesis of the stomach, and endoscopic examination showed ulceration with a visible vessel. Pathological biopsy examination of the ulcer identified poorly differentiated adenocarcinoma with signet ring cells. The patient was diagnosed with early gastric cancer that was not indicated for endoscopic resection because of the ulceration and histological type. Endoscopic ultrasound showed that the third layer was poorly demarcated at the ulcer scar, indicating invasion to the submucosal layer. Computed tomography did not reveal enlarged lymph nodes or distant metastasis. The preoperative diagnosis was early gastric cancer of the fundus without nodal metastasis, and laparoscopic proximal gastrectomy with D1+ lymphadenectomy was performed. The initial postoperative pathological diagnosis was intramucosal carcinoma without lymphovascular invasion; however, the presence of 26 lymph node metastases was revealed unexpectedly. Additional pathological examination of more resected specimens transected every 2-3 mm revealed that only one lesion contained a small number of cancer cells in the lymphatic duct below the muscularis mucosa.
Conclusions: We report a case of early gastric cancer with 26 nodal metastases in which lymph node involvement was not identified prior to surgery. These findings indicate that the extent of lymphadenectomy and the surgical procedure should be carefully decided even in cT1 N0 early gastric cancer when several risk factors for lymph node metastasis are present.
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| 32. |
Nagai S, Nagayoshi K, Mizuuchi Y, Fujita H, Ohuchida K, Ohtsuka T, Imai R, Nakamura M, Laparoscopic spacer placement for recurrent sacral chordoma before carbon ion radiotherapy: A case report, Asian J Endosc Surg, 10.1111/ases.12792, 13(4):582-585, 2020.04, Abstract
Recently, several scholars have demonstrated the efficacy of carbon ion radiotherapy (CIRT). To treat abdominal or pelvic tumors by CIRT, it is necessary to separate the tumor from the adjacent organs. Surgical placement of a GORE-TEX sheet as a spacer has been reported as a separation method. Usually, surgical spacer placement is done by open surgery. Here, we report a case of surgical spacer placement undertaken by a "pure" laparoscopic procedure. A 47-year-old man with recurrent sacral chordoma was referred for surgical spacer placement before CIRT. Laparoscopic dissection of the rectum and placement of a GORE-TEX sheet as a spacer were successfully performed. Surgical spacer placement by a pure laparoscopic procedure was safe and effective, and it seems to play an important part before CIRT.. |
| 33. |
Harada Y, Kubo M, Kai M, Yamada M, Zaguirre K, Ohgami T, Yahata H, Ohishi Y, Yamamoto H, Oda Y, Nakamura M, Breast metastasis from pelvic high‑grade serous adenocarcinoma: a report of two cases, Surg Case Rep, 10.1186/s40792-020-01090-7
, 6(1):317, 2020.04, Abstract
ackground: Metastatic tumors to the breast reportedly account for 0.5% to 2.0% of all malignant breast diseases. Such metastatic tumors must be differentiated from primary breast cancer. Additionally, few reports have described metastases of gynecological cancers to the breast. We herein report two cases of metastasis of pelvic high-grade serous adenocarcinoma to the breast.
Case presentation: The first patient was a 57-year-old woman with a transverse colon obstruction. Colostomy was performed, but the cause of the obstruction was unknown. We found scattered white nodules disseminated throughout the abdominal cavity and intestinal surface. Follow-up contrast-enhanced computed tomography (CT) showed an enhanced nodule outside the right mammary gland. Core needle biopsy (CNB) of the right breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. We diagnosed the patient's condition as breast and lymph node metastasis of a high-grade serous carcinoma of the female genital tract. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed. The second patient was a 71-year-old woman with a medical history of low anterior resection for rectal cancer at age 49, partial right thyroidectomy for follicular thyroid cancer at age 53, and left lower lung metastasis at age 57. Periodic follow-up CT showed peritoneal dissemination, cancerous peritonitis, and pericardial effusion, and the patient was considered to have a cancer of unknown primary origin. Contrast-enhanced CT showed an enhanced nodule in the left mammary gland with many enhanced nodules and peritoneal thickening in the abdominal cavity. CNB of the left breast mass was conducted, and immunohistochemical staining of the mass suggested a high-grade serous carcinoma of female genital tract origin. After chemotherapy for stage IVB peritoneal cancer, tumor reduction surgery was performed.
Conclusions: We experienced two rare cases of intramammary metastasis of high-grade serous carcinoma of female genital tract origin. CNB was useful for confirming the histological diagnosis of these cancers that had originated from other organs. A correct diagnosis of such breast tumors is important to ensure quick and appropriate treatment.
Keywords: Breast metastasis; Core needle biopsy; Hereditary breast and ovarian cancer syndrome; Peritoneal cancer
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| 34. |
Shindo K, Ohuchida K, Moriyama T, Kinoshita F, Koga Y, Oda Y, Eto M, Nakamura M, A rare case of PSA-negative metastasized prostate cancer to the stomach with serum CEA and CA19-9 elevation: a case report, Surg Case Rep, 10.1186/s40792-020-01074-7, 6(1):303, 2020.04, Abstract
Background: Metastatic cancer to the stomach is relatively rare. Prostate-specific antigen (PSA) is a reliable biomarker used in the screening and management of patients with prostate cancer. However, it is difficult to definitively diagnose a PSA-negative metastatic gastric tumor of prostate cancer because the cancer sometimes resembles primary gastric cancer in clinical images. It is also difficult to distinguish metastatic cancer from primary cancer even in the pathological examination of biopsy samples when the lesion is poorly differentiated adenocarcinoma. There is a possibility that the characteristics of the cancer are changed during treatment such as chemotherapy or radiation therapy. Therefore, careful consideration is required for surgical indication.
Case presentation: A 60-year-old male underwent radical prostatectomy and subsequent radiation therapy for advanced prostate cancer (pT3N1M0) 10 years previously, and hormone therapy was started for metachronous multiple bone metastasis 10 months before. Upper gastrointestinal endoscopy revealed an irregular depressed lesion with a convergence of folds at the greater curvature of the upper gastric body. Biopsy showed poorly differentiated adenocarcinoma that was negative for PSA upon immunohistochemistry. He had high serum carcinoembryonic antigen (CEA) (946.1 ng/ml) and carbohydrate antigen 19-9 (CA19-9) (465.1 U/ml) levels with no elevation of PSA (0.152 ng/ml). The tumor was diagnosed as primary gastric cancer based on the clinical imaging and pathological examination of the biopsy sample including the PSA staining. Based on the diagnosis, laparoscopic proximal gastrectomy with lymphadenectomy was performed. However, pathological examination of the resected specimen revealed poorly differentiated adenocarcinoma that was positive for other prostate markers such as androgen receptor. Thus, the patient was diagnosed with metastasized prostate cancer to the stomach.
Conclusions: We report a case of metastatic gastric cancer of prostate cancer 10 years after radical prostatectomy. In the present case, it was difficult to diagnose a metastatic gastric tumor of prostate cancer preoperatively, because of its resemblance to primary gastric cancer without PSA expression and no serum PSA elevation. Although a rare case entity, it is important to consider the possibility of a metastatic gastric tumor when the surgical indication is determined in cases with another co-existing cancer.
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| 35. |
Akiko Shimazaki, Takuma Hashimoto, Masaya Kai, Tetsuzo Nakayama, Mai Yamada, Karen Zaguirre, Kentaro Tokuda, Makoto Kubo, Ken Yamaura, Masafumi Nakamura, Surgical treatment for breast cancer in a patient with erythropoietic protoporphyria and photosensitivity: a case report, Surgical Case Reports, 10.1186/s40792-020-01068-5, 7(1):1, 2021.04, Abstract
Background: Erythropoietic protoporphyria (EPP) is a rare disorder of heme synthesis. Patients with EPP mainly show symptoms of photosensitivity, but approximately 20% of EPPs are associated with the liver-related complications. We report a case of breast cancer in a 48-year-old female patient with EPP in whom meticulous perioperative management was required in order to avoid complications resulting from this disease.
Case presentation: The patient was diagnosed with EPP at the age of 33 and had a rich family history of the disease. For right breast cancer initially considered as TisN0M0 (Stage 0), the right mastectomy and sentinel lymph node biopsy were performed, while the final stage was pT1bN0M0, pStage I. In the perioperative period, we limited the drug use and monitored light wavelength measurements. Besides, we covered surgical lights, headlights, and laryngoscope's light with a special polyimide film that filtered the wavelength of light causing dermal photosensitivity. After the surgery, any emerging complications were closely monitored.
Conclusions: The surgery, internal medicine, anesthesiology, and operation departments undertook all possible measures through close cooperation to ensure a safe surgery for the patient with a rare condition.
Keywords: Breast cancer surgery; Erythropoietic protoporphyria (EPP); Photosensitivity.. |
| 36. |
Akihisa Ohno, Nao Fujimori, Masami Miki, Takamasa Oono, Hisato Igarashi, Ryota Matsuda, Yutaka Koga, Yoshinao Oda, Takao Ohtsuka, Masafumi Nakamura, Tetsuhide Ito, Yoshihiro Ogawa, Collision of a pancreatic ductal adenocarcinoma and a pancreatic neuroendocrine tumor associated with multiple endocrine neoplasm type 1 , Clinical Journal of Gastroenterology, 10.1007/s12328-020-01234-0
, 14(1):358-363, 2021.04, Abstract
A 54-year-old man with pancreatic head tumor had undergone pancreaticoduodenectomy and was diagnosed with pancreatic neuroendocrine tumor (P-NET) associated with sporadic multiple endocrine neoplasm type 1. Five years after the resection, P-NET recurred and liver metastases were observed. He was treated with a somatostatin analog. Eleven years after the resection, computed tomography revealed a new pancreatic hypodense and hypovascular mass adjacent to the P-NET that was diagnosed as pancreatic adenocarcinoma via endoscopic ultrasound-guided fine-needle aspiration. He underwent a total remnant pancreatectomy. Pathological examination showed that the lesion was constituted by a pancreatic ductal adenocarcinoma (PDAC) and a neuroendocrine tumor. Additionally, the invasive ductal carcinoma collided with the neuroendocrine tumor. Both PDAC and P-NET cells were observed in the collision area. We could observe the onset of PDAC during the treatment of P-NET. Moreover, we are the first to report the case of a collision of pancreatic endocrine and exocrine tumors diagnosed preoperatively.
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| 37. |
Keigo Ozono, Takashi Nakaike, Daisuke Himeji, Sayaka Moriguchi, Kousuke Marutsuka, Kiichiro Beppu, Masafumi Nakamura, Video-assisted Thoracoscopic Lobectomy in a Patient with Congenital Factor XI Deficiency, Journal of Cancer Science & Therapy, 10.37421/1948-5956.22.14.514, 2022.04. |
| 38. |
Keisuke Kawasaki, Shinichiro Kawatoko, Takehiro Torisu, Yusuke Mizuuchi, Toshimi Iura, Hiroshi Ohtani, Katsuki Okamura, Hidetaka Yamamoto, Masafumi Nakamura, Takanari Kitazono, Idiopathic myointimal hyperplasia of mesenteric veins depicted by barium enema examination, and conventional and magnifying colonoscopy, Clin J Gastroenterol, 10.1007/s12328-022-01647-z, 15(4):734-739, 2022.04, A 71-year-old man was admitted to our institution complaining of abdominal pain and constipation. Barium enema examination revealed narrowing, cobble stoning, and longitudinal ulcerations in the sigmoid colon and upper rectum. Conventional colonoscopy, magnifying narrow-band imaging endoscopy, and magnifying chromoendoscopy revealed edematous mucosa, longitudinal ulcerations with luminal narrowing, and multiple pseudopolyps. The histologic examination of the biopsy specimens showed thick-walled (arterialized) capillaries and subendothelial fibrin deposits in the mucosa and submucosa. Based on a preoperative diagnosis of idiopathic myointimal hyperplasia of mesenteric veins (IMHMV), he underwent a laparoscopic resection of the sigmoid colon and upper rectum. The histologic examination of the resected specimens showed marked proliferation of venous walls with marked myointimal thickening and luminal occlusion from the submucosa to the mesentery
throughout the entire resected tissue section. The final diagnosis was IMHMV.
Keywords: Endoscopy; IMHMV; Idiopathic myointimal hyperplasia of mesenteric veins; MIVOD; Mesenteric inflammatory veno-occlusive disease.. |
| 39. |
Masaya Kai, Makoto Kubo, Sawako Shikada, Saori Hayashi, Takafumi Morisaki, Mai Yamada, Yuka Takao, Akiko Shimazaki, Yurina Harada, Kazuhisa Kaneshiro, Yusuke Mizuuchi, Koji Shindo, Masafumi Nakamura, A novel germline mutation of TP53 with breast cancer diagnosed as Li-Fraumeni syndrome, Surg Case Rep, 10.1186/s40792-022-01546-y, 8(1):197, 2022.04, TP53 is a tumor suppressor gene and, when dysfunctional, it is known to be involved in the development of cancers. Li-Fraumeni syndrome (LFS) is a hereditary tumor with autosomal dominant inheritance that develops in people with germline pathogenic variants of TP53. LFS frequently develops in parallel to tumors, including breast cancer. We describe a novel germline mutation in TP53 identified by performing a multi-gene panel assay in a breast cancer patient with bilateral breast cancer.
Keywords: Breast cancer; Genetic medicine; Genetic testing; Hereditary cancer; Li–Fraumeni syndrome; Multi-gene panel assay; TP53 pathogenic variant.. |
| 40. |
Sayuri Hayashida, Naoki Ikenaga, Kohei Nakata, So Nakamura, Toshiya Abe, Noboru Ideno, Makoto Endo, Shoko Noguchi, Yoshinao Oda, Masafumi Nakamura, Repeated robotic pancreatectomy for recurrent pancreatic metastasis of mesenchymal chondrosarcoma: A case report, Asian J Endosc Surg, 10.1111/ases.13240, 16(4):795-799, 2023.04, Abstract
Mesenchymal chondrosarcoma is a rare subset of sarcomas accounting for 3%-10% of all cases of chondrosarcomas. Radical resection is the only curative strategy, even in patients with metastatic tumors. However, data regarding treatment strategies remain limited owing to the small number of cases. Herein, we report a patient who underwent repeated robotic pancreatectomy for recurrent pancreatic metastasis originating from extraskeletal mesenchymal chondrosarcoma of the pelvis. First, robotic pancreaticoduodenectomy with a reconstruction of pancreaticogastrostomy was performed for synchronous pancreatic metastasis 5 months after the primary resection of mesenchymal chondrosarcoma. Ten months after robotic pancreaticoduodenectomy, tumor recurrence was observed at the tail end of the pancreas, which was removed by reperforming robotic distal pancreatectomy. Given the precise tissue manipulation that can be achieved with robotic articulated forceps, the peripheral splenic artery and pancreas were easily isolated and divided in close proximity to the tumor. The central part of the pancreas was preserved. Robotic surgery allowed safe and effective resection of the reconstructed remnant pancreas. The patient survived for 28 months after primary tumor resection. Repeated pancreatectomy with minimally invasive techniques is a feasible and curative treatment for metastatic mesenchymal chondrosarcoma.
Keywords: mesenchymal chondrosarcoma; robotic distal pancreatectomy; robotic pancreaticoduodenectomy.. |
| 41. |
Sanshiro Hatai, Keizo Kaku, Shinsuke Kubo, Yu Sato, Hiroshi Noguchi, Yasuhiro Okabe, Naoki Ikenaga, Kohei Nakata, Masafumi Nakamura, Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension: a report of two cases, Surgical Case Reports, 10.1186/s40792-023-01773-x, 9(1):200, 2023.04, Background:
Left-sided portal hypertension including gastric venous congestion may be caused by ligating the splenic vein during pancreaticoduodenectomy with portal vein resection or total pancreatectomy. The usefulness of reconstruction with the splenic vein has been reported in such cases. However, depending on the site of the tumor and other factors, it may be impossible to leave sufficient length of the splenic vein, making anastomosis difficult. We report two patterns of reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension.
Case presentation:
The first patient was a 79-year-old man who underwent pancreaticoduodenectomy for pancreatic cancer. The root of the splenic vein was infiltrated by the tumor, and we resected this vein at the confluence of the portal vein. Closure of the portal vein was performed without reconstruction of the splenic vein. To prevent left-sided portal hypertension, we anastomosed the right gastroepiploic vein to the middle colic vein. Postoperatively, there was no suggestion of left-sided portal hypertension, such as splenomegaly, varices, and thrombocytosis.
The second case was a 63-year-old woman who underwent total pancreatectomy for pancreatic cancer. The splenic vein-superior mesenteric vein confluence was infiltrated by the tumor, and we resected the portal vein, including the confluence. End-to-end anastomosis was performed without reconstruction of the splenic vein. We also divided the left gastric vein, left gastroepiploic vein, right gastroepiploic vein, and right gastric vein, which resulted in a lack of drainage veins from the stomach and severe gastric vein congestion. We anastomosed the right gastroepiploic vein to the left renal vein, which improved the gastric vein congestion. Postoperatively, imaging confirmed short-term patency of the anastomosis site. Although the patient died because of tumor progression 8 months after the surgery, no findings suggested left-sided portal hypertension, such as varices. Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy is useful to
prevent left-sided portal hypertension.. |
| 42. |
Masahiro Yamamoto, Yusuke Mizuuchi, Koji Tamura, Masafumi Sada, Kinuko Nagayoshi, Kohei Nakata, Kenoki Ohuchida, Yoshinao Oda, Masafumi Nakamura, Nonmass-forming type anorectal cancer with pagetoid spread: A report of two cases, Asian J Endosc Surg, 10.1111/ases.13217, 16(4):747-752, 2023.04, Pagetoid spread (PS) of anorectal cancer is relatively rare and associated with poor prognosis. While a primary tumorous lesion is usually obvious in most PS cases, we experienced two cases of nonmass-forming type anorectal cancer with PS. It remains challenging to decide strategies. In both cases, histological findings of a perianal skin biopsy showed proliferation of atypical cells that were positive for cytokeratin (CK) 7, CK20, and caudal type homeobox 2 and negative for Gross cystic disease fluid protein 15, suggesting PS. Abdominoperineal resection (APR) with extensive anal skin resection was performed in both patients. The pathological diagnosis in each was nonmass-forming type anorectal cancer with PS. Neither has experienced recurrence in postoperative courses. Even nonmass-forming type anorectal cancer with PS could have high malignant potentials. APR with lymph nodes dissection and wide skin excision and regular surveillance might be necessary.
Keywords: anal canal cancer; nonmass-forming type; pagetoid spread.. |
| 43. |
Kiyotaka Mizoguchi, Kinuko Nagayoshi, Yusuke Mizuuchi, Koji Tamura, Masafumi Sada, Kohei Nakata, Kenoki Ouchida, Masafumi Nakamura, A case report of sigmoid colon cancer with the inferior mesenteric artery directly originating from the superior mesenteric artery, Surg Case Rep, 10.1186/s40792-023-01671-2, 9(1):89, 2023.04, Background: There are few reports describing the unusual origin of the inferior mesenteric artery (IMA). We report a rare case of advanced sigmoid colon cancer with the IMA arising from the superior mesenteric artery.
Case presentation: A 59-year-old man with diarrhea and abdominal distention was diagnosed with advanced sigmoid colon cancer. Colonoscopy revealed a semi-circumferential cancer lesion in the sigmoid colon. Enhanced CT scan and CT angiography showed that the IMA directly originated from the superior mesenteric artery at the level of the second lumbar vertebra. PET-CT suggested metastases in the para-intestinal lymph nodes and the liver, but not in the central lymph nodes along the IMA. Preoperative diagnosis was sigmoid colon cancer cT4aN2aM1a cStage IVA(UICC, 8th edition). We performed laparoscopic complete resection as the radical treatment of the primary region prior to resection of the liver metastases. Intraoperative findings showed that the IMA was running parallel to the abdominal aorta; meanwhile, the colonic autonomic nerve was supplied from the lumbar splanchnic nerve at the caudal side of the duodenum. Central lymph nodes around the colonic autonomic nerve were dissected en bloc with the regional lymph nodes. Pathological radical resection including the regional lymph nodes metastasis was achieved. Two months later, complete resection of the liver metastasis was performed. After the adjuvant chemotherapy, no recurrence was observed 1.5 years after the liver resection was performed.
Conclusions: Preoperative confirmation of the anatomy helped us to safely complete radical surgery in a patient with unusual bifurcation of the IMA.
Keywords: IMA anomaly; Laparoscopic low anterior resection; Sigmoid colon cancer.. |
| 44. |
Keigo Ozono, Kiwa Son, Kenta Momii, Yoshihiro Morifuji, Naoki Ikenaga, Masafumi Nakamura, Severe hemothorax due to traumatic fracture of thoracic vertebra, Surg Case Rep, 10.1186/s40792-024-01819-8, 10(1):26, 2024.04, Background: Hemothorax occurs in approx. 0.4% of all chest injury patients, but hemothorax due to a thoracic vertebral fracture is rare.
Case presentation: A 76-year-old Japanese man was transported to our hospital for right hemothorax due to a car accident. We performed emergency hemostasis surgery and tried to stop the bleeding by several methods, but it was difficult to control the bleeding because the bleeding point was an artery branch that runs in front of the vertebral body.
Conclusion: It is important to be aware that a fractured vertebra can damage the aorta's arterial branch and follow a severe course.. |
| 45. |
Hiroha Tokui, Hideaki Yahata, Yasuhiro Okabe, Naomi Magarifuchi, Shoji Maenohara, Kazuhisa Hachisuga, Hiroshi Tomonobe, Keisuke Kodama, Hiroshi Yagi, Masafumi Yasunaga, Ichiro Onoyama, Kazuo Asanoma, Yoshinao Oda, Masafumi Nakamura & Kiyoko Kato, Complete reduction surgery of a huge recurrent adult granulosa cell tumor after neoadjuvant chemotherapy, Int Cancer Conf J, 10.1007/s13691-024-00659-5, 13:162-166, 2024.04, Adult granulosa cell tumors are rare, accounting for only 3–5% of all ovarian tumors. Adult granulosa cell tumors have late recurrences, for which complete resection is an effective option. We report a patient who underwent complete resection of a huge recurrent adult granulosa cell tumor after neoadjuvant chemotherapy. A 72-year-old woman underwent primary surgery for an adult granulosa cell tumor 19 years earlier. A huge recurrent tumor, 11 × 10 cm in size, was noted to elevate the hepatic hilum, inferior vena cava, and right renal vein. The recurrent tumor was too large to resect, thus paclitaxel and carboplatin were administered as neoadjuvant chemotherapy. The tumor shrank to 6 × 5 cm after 6 cycles of chemotherapy, then complete tumor extirpation with resection of the right kidney and temporary scission of inferior vena cava was performed. The patient was alive and well without evidence of a recurrence 1 y postoperatively. Paclitaxel and carboplatin, as neoadjuvant chemotherapy, might be an effective treatment option to achieve complete reduction surgery. This is the first report demonstrating the effectiveness of paclitaxel and carboplatin for huge recurrent adult granulosa cell tumor.. |
| 46. |
Yo Sato, Yusuke Watanabe, Takafumi Morisaki, Saori Hayashi, Yoshiki Otsubo, Yurina Ochiai, Kimihisa Mizoguchi, Yuka Takao, Mai Yamada, Yusuke Mizuuchi, Masafumi Nakamura, Makoto Kubo, Beckwith-Wiedemann syndrome with juvenile fbrous nodules and lobular breast tumors: a case report and review of the literature, Surg Case Rep., 10.1186/s40792-024-01865-2, 10(64), 2024.04, Background:Beckwith?Wiedemann syndrome (BWS) is a genomic imprinting disorder caused by diverse genetic and/or epigenetic disorders of chromosome 11p15.5. BWS presents with a variety of clinical features, including overgrowth and an increased risk of embryonal tumors. Notably however, reports of patients with BWS and breast tumors are rare, and the association between these conditions is still unclear. Insulin-like growth factor-2 (IGF2) expression is known to be associated with the development of various cancers, including breast cancer, and patients with BWS with specific subtypes of molecular defects are known to show characteristic clinical features and IGF2 overexpression.
Case presentation:A 17-year-old girl who had been diagnosed with BWS based on an umbilical hernia, hyperinsulinemia, and left hemihypertrophy at birth, visited our department with a gradually swelling left breast. Her left breast was markedly larger than her right breast on visual examination. Imaging examinations showed two tumors measuring about 10 cm each in the left breast, and she was diagnosed with juvenile fibroadenoma following core needle biopsy. The two breast tumors were removed surgically and the patient remained alive with no recurrence. The final diagnosis was juvenile fibroadenoma without malignant findings. Immunohistochemical staining using IGF2 antibody revealed overexpression of IGF2 in the cytoplasm of ductal epithelial cells. Because of her clinical features and IGF2 overexpression, molecular defects of 11p15.5 including a possible genetic background of paternal uniparental disomy of chromosome 11 or hypermethylation of imprinting center 1 was suspected.
Conclusions:In this case, overexpression of IGF2 suggested a possible relationship between BWS and breast tumors. Moreover, the characteristic clinical features and IGF2 staining predicted the subtype of 11p15.5 molecular defects in this patient.. |
| 47. |
Murakami H, Matsumoto H, Ueno D, Kawai A, Ensako T, Kaida Y, Abe T, Kubota H, Higashida M, Nakashima H, Oka Y, Okumura H, Tsuruta A, Nakamura M, Hirai T, Current status of multichannel electrogastrography and examples of its use., J Smooth Muscle Res, 49:78-88, 2013.04. |
| 48. |
Ohtsuka T, Nakamura M, Tanaka M, Superior mesenteric artery-first approach with the first jejunal vein-oriented mesenteric excision in pasncreatoduodenectomy, Surgical Practice, 19(1):29-32, 2014.04. |
| 49. |
Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, Tajima H, Kumamoto Y, Satoi S, Kwon M, Toyama H, Ku Y, Yoshitomi H, Nara S, Shimada K, Yokoyama T, Miyagawa S, Toyama Y, Yanaga K, Fujii T, Kodera Y, Study Group of JHBPS and JSEPS, Tomiyama Y, Miyata H, Takahara T, Beppu T, Yamaue H, Miyazaki M, Takada T, Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching, J Hepatobiliary Pancreat Sci, 22(10):731-736, 2015.04, BACKGROUND:
Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching.
METHODS:
We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis.
RESULTS:
After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P
CONCLUSIONS:
Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy.
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| 50. |
Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T, Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study, J Hepatobiliary Pancreat Sci, 22(10):721-727, 2015.04, BACKGROUND:
The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups.
METHODS:
Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups.
RESULTS:
The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P
CONCLUSION:
Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications.
. |
| 51. |
Tanaka M, Tomikawa M, Nakamura M, Nakamura Y, Misawa T. Akahoshi T, Kinjyo N, Sumiyoshi H, Tsutsumi K, Tsutsumi N, Nakashima H, Higashida M, Fujiwara Y, Matsushita A, Matsumoto M, JSES Guideline. Gastroenterological Surgery: Pancreas, Asian J Endosc Surg, 8(3):239-245(3):239-245, 2015.04. |
| 52. |
Nakamura M, Miyasaka Y, Sadakari Y, Date K, Ohtsuka T
, Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines ?, Ann Gastroenterol Surg, 10.1002/ags3.12012, 1(2):90-98, 2017.04, Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm.. |
| 53. |
Miyasaka Y, Mori Y, Nakata K, Ohtsuka T, Nakamura M, Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy, Surg Today, 47(4):416-424, 2017.04, Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreat
oenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP.. |
| 54. |
Miyasaka Y, Ohtsuka T, Velasquez VV, Mori Y, Nakata K, Nakamura M, Surgical management of the cases with both biliary and duodenal obstruction, Gastrointest Interv, 7:74-77, 2018.04. |
| 55. |
Miyasaka Y, Nakamura M, Wakabayashi G, Pioneers in laparoscopic hepato-biliary-pancreatic surgery, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.506, 25(1):109-111, 2018.04. |
| 56. |
Tsuchimoto A, Masutani K, Omoto K, Okumi M, Okabe Y, Nishiki T, Ota M, Nakano T, Tsuruya K, Kitazono T, Nakamura M, Ishida H, Tanabe K, Kidney transplantation for treatment of end-stage kidney disease after haematopoietic stem cell transplantation: case series and literature review, Clin Exp Nephrol, 10.1007/s10157-018-1672-1 , 23(4):561-568, 2018.04, Abstract
BACKGROUND:
The safety of kidney transplantation (KT) for end-stage kidney disease (ESKD) after haematopoietic stem cell transplantation (HSCT) for haematological disease has not been investigated thoroughly.
METHODS:
In this retrospective multicentre study, we investigated the clinical courses of six ESKD patients that received KT after HSCT for various haematological diseases. Data for six such patients were obtained from three institutions in our consortium.
RESULTS:
Two patients with chronic myeloid leukaemia, one with refractory aplastic anaemia and another one with acute lymphocytic leukaemia received bone marrow transplantation. One patients with acute lymphocytic leukaemia received umbilical cord blood transplantation, and one with mantle cell lymphoma received peripheral blood stem cell transplantation. The patients developed ESKD at a median of 133 months after HSCT. Two patients who received KT and HSCT from the same donor were temporarily treated with immunosuppressive drugs. The other patients received KT and HSCT from different donors and were treated with antibody induction using our standard regimens. For one patient with ABO-incompatible transplantation, we added rituximab, splenectomy, and plasmapheresis. In the observational period at a median of 51 months after KT, only one patient experienced acute T-cell-mediated rejection. Four patients underwent hospitalization because of infection and fully recovered. No patient experienced recurrence of their original haematological disease. All patients survived throughout the observational periods, and graft functions were preserved.
CONCLUSIONS:
Despite the high infection frequency, survival rates and graft functions were extremely good in patients compared with previous studies. Therefore, current management contributed to favourable outcomes of these patients
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| 57. |
Ohtsuka T, Tomosugi T, Kimura R, Nakamura S, Miyasaka Y, Nakata K, Mori Y, Morita M, Torata N, Shindo K, Ohuchida K, Nakamura M, Clinical assessment of the GNAS mutation status in patients with intraductal papillary mucinous neoplasm of the pancreas, Surg Today, 10.1007/s00595-019-01797-7 , 49(11):887-893, 2019.04, Abstract
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by cystic dilation of the pancreatic duct, caused by mucin hypersecretion, with slow progression via the adenoma-carcinoma sequence mechanism. Mutation of GNAS at codon 201 is found exclusively in IPMNs, occurring at a rate of 41-75%. Recent advances in molecular biological techniques have demonstrated that GNAS mutation might play a role in the transformation of IPMNs after the appearance of neoplastic cells, rather than in the tumorigenesis of IPMNs. GNAS mutation is observed frequently in the intestinal subtype of IPMNs with MUC2 expression, and less frequently in IPMNs with concomitant pancreatic ductal adenocarcinoma (PDAC). Research has focused on assessing GNAS mutation status in clinical practice using various samples. In this review, we discuss the clinical application of GNAS mutation assessment to differentiate invasive IPMNs from concomitant PDAC, examine the clonality of recurrent IPMNs in the remnant pancreas using resected specimens, and differentiate pancreatic cystic lesions using cystic fluid collected by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), duodenal fluid, and serum liquid biopsy samples
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| 58. |
Asbun JH, Moekotte LA, Vissers LF, Kunzler F, Cipriani F, Alseidi A, D'Angelica IM, Balduzzi A, Bassi C, Björnsson B, Boggi U, Callery PM, Chiaro DM, Coimbra JF, Conrad C, Cook A, Coppola A, Dervenis C, Dokmak S, Edil HB, Edwin B, Giulianotti CP, Han HS, Hansen DP, Heijde N, Hilst J, Hester AC, Hogg EM, Jarufe N, Jeyarajah DR, Keck T, Kim CS, Khatkov EI, Kokudo N, Kooby AD, Korrel M, Leon JF, Lluis N, Lof S, Machado AM, Demartines N, Martinie BJ, Merchant BN, Molenaar QI, Moravek C, Mou YP, ,Nakamura M, Nealon HW, Palanivelu C, Pessaux P, Pitt AH, Polanco MP, Primrose Nj, Rawashdeh A, Sanford ED, Senthilnathan P, Shrikhande VS, Stauffer AJ, Takaori K, Talamonti SM, Tang NC, Vollmer MC, Wakabayashi G, Walsh RM, Wang SE, Zinner JM, Wolfgang LC, Zureikat HA, Zwart JM, Conlon CK,Kendrick LM, Zeh JH, Hilal AM, Besselink GM, The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection , Ann Surg, 10.1097/SLA.0000000000003590
, 271(1):1-14, 2020.04, Abstract
Objective: The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019).
Summary background data: MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking.
Methods: The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology.
Results: After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety.
Conclusion: The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery.
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| 59. |
Ideno N, Mori Y, Nakamura M, Ohtsuka T, Early Detection of Pancreatic Cancer: Role of Biomarkers in Pancreatic Fluid Samples, Diagnostics, 10.3390/diagnostics10121056
, 10(12):1056, 2020.04, Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths worldwide. Most patients with PDAC present with symptomatic, surgically unresectable disease. Therefore, the establishment of strategies for the early detection is urgently needed. Molecular biomarkers might be useful in various phases of a strategy to identify high-risk individuals in the general population and to detect high-risk lesions during intense surveillance programs combined with imaging modalities. However, the low sensitivity and specificity of biomarkers currently available for PDAC, such as carbohydrate 19-9 (CA19-9), contribute to the late diagnosis of this deadly disease. Although almost all classes of biomarker assays have been studied, most of them are used in the context of symptomatic diseases. Compared to other body fluids, pancreatic juice and duodenal fluid are better sources of DNA, RNA, proteins, and exosomes derived from neoplastic cells and have the potential to increase the sensitivity/specificity of these biomarkers. The number of studies using duodenal fluid with or without secretin stimulation for DNA/protein marker tests have been increasing because of the less-invasiveness in comparison to pancreatic juice collection by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Genomic analyses have been very well-studied, and based on PDAC progression model, mutations detected in pancreatic juice/duodenal fluid seem to indicate the presence of microscopic precursors and high-grade dysplasia/invasive cancer. In addition to known proteins overexpressed both in precursors and PDACs, such as CEA and S100P, comprehensive proteomic analysis of pancreatic juice from patients with PDAC identified many proteins which were not previously described. A novel technique to isolate exosomes from pancreatic juice was recently invented and identification of exosomal microRNA's 21 and 155 could be biomarkers for diagnosis of PDAC. Since many studies have explored biomarkers in fluid samples containing pancreatic juice and reported excellent diagnostic accuracy, we need to discuss how these biomarker assays can be validated and utilized in the strategy of early detection of PDAC.
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| 60. |
Kohei Nakata, Masafumi Nakamura, The current status and future directions of robotic pancreatectomy, Ann Gastroenterol Surg., 10.1002/ags3.12446, 5(4):467-476, 2021.04. |
| 61. |
Yoshihiro Miyasaka, Takao Ohtsuka, Masafumi Nakamura, Minimally invasive surgery for pancreatic cancer , Surgery Today, 10.1007/s00595-020-02120-5
, 51(2):194-203, 2021.04, Abstract
Pancreatic cancer is the most lethal malignancy of the digestive organs. Although pancreatic resection is essential to radically cure this refractory disease, the multi-organ resection involved, as well as sequelae such as glucose tolerance insufficiency and severe complications impose a heavy burden on these patients. Since the late twentieth century, minimally invasive surgery has become more popular for the surgical management of digestive disease and pancreatic cancer. Minimally invasive pancreatic resection (MIPR), including pancreaticoduodenectomy and distal pancreatectomy, is now a treatment option for pancreatic cancer. Some evidence suggests that MIPR for pancreatic cancer provides comparable oncological outcomes to open surgery, with some advantages in perioperative outcomes. However, as this evidence is retrospective, prospective investigations, including randomized controlled trials, are necessary. Because neoadjuvant therapy for resectable or borderline-resectable pancreatic cancer and conversion surgery for initially unresectable pancreatic cancer has become more common, the feasibility of MIPR after neoadjuvant therapy or as conversion surgery requires further assessment. It is expected that progress in surgical techniques and devices, as well as the standardization of surgical procedures and widespread educational programs will improve the outcomes of MIPR.
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| 62. |
Yuichi Nagakawa, Yusuke Watanabe, Shingo Kozono, Ugo Boggi, Chinnusamy Palanivelu, Rong Liu, Shin-E Wang, Jin He, Hitoe Nishino, Takao Ohtsuka, Daisuke Ban, Kohei Nakata, Itraru Endo, Akihiko Tsuchida, Masafumi Nakamura, , Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.905, 29(1):114-123, 2022.04, Background: Minimally invasive pancreaticoduodenectomy (MIPD) has recently been safely performed by experts, and various methods for resection have been reported. This review summarizes the literature describing surgical approaches for MIPD.
Methods: A systematic literature search of PubMed (MEDLINE) was conducted for studies reporting robotic and laparoscopic pancreaticoduodenectomy; the reference lists of review articles were searched. Of 444 articles yielded, 23 manuscripts describing the surgical approach to dissect around the superior mesenteric artery (SMA), including hand-searched articles, were assessed.
Results: Various approaches to dissect around the SMA have been reported. These approaches were categorized according to the direction toward the SMA when initiating dissection around the SMA: anterior approach (two articles), posterior approach (four articles), right approach (16 articles), and left approach (three articles). Thus, many reports used the right approach. Most articles provided a technical description. Some articles showed the advantage of their method in a comparison study. However, these were single-center retrospective studies with a small sample size.
Conclusions: Various approaches for MIPD have been reported; however, few authors have reported the advantage of their methods compared to other methods. Further discussion is needed to clarify the appropriate surgical approach to the SMA during MIPD.
Keywords: artery-first approach; laparoscopic pancreaticoduodenectomy; minimally invasive pancreaticoduodenectomy; robot-assisted pancreaticoduodenectomy; superior mesenteric artery.. |
| 63. |
Daisuke Ban, Giovanni Maria Garbarino, Yoshiya Ishikawa, Goro Honda, Jin-Young Jang, Chang Moo Kang, Aya Maekawa, Yoshiki Murase, Yuichi Nagakawa, Hitoe Nishino, Takao Ohtsuka, Anusak Yiengpruksawan, Itaru Endo, Akihiko Tsuchida, Masafumi Nakamura, Surgical approaches for minimally invasive distal pancreatectomy: A systematic review, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.902, 29(1):151-160, 2022.04, ackground: Minimally invasive distal pancreatectomy (MIDP) was initially performed for benign tumors, but recently its indications have steadily broadened to encompass other conditions including pancreatic malignancies. Thorough anatomical knowledge is mandatory for precise surgery in the era of minimally invasive surgery. However, expert consensus regarding anatomical landmarks to facilitate the safe performance of MIDP is still lacking.
Methods: A systematic literature search was performed using keywords to identify articles regarding the vascular anatomy and surgical approaches/techniques for MIDP.
Results: All of the systematic reviews revealed that MIDP was not associated with an increase in postoperative complications. Moreover, most showed that MIDP resulted in less blood loss than open surgery. Regarding surgical approaches for MIDP, a standardized stepwise procedure improved surgical outcomes, including blood loss, operative time, and major complications. There are two approaches to the splenic vessels, superior and inferior; however, no study has ever directly compared them with respect to clinical outcomes. The morphology of the splenic artery affects the difficulty of approaching the artery's root. To select an appropriate dissecting layer when performing posterior resection, thorough knowledge of the anatomy of the fascia, left renal vein/artery, and left adrenal gland is needed.
Conclusions: In MIDP, a standardized approach and precise knowledge of anatomy facilitates safe surgery and has the advantage of a shorter learning curve. Anatomical features and landmarks are particularly important in cases of radical MIDP and splenic vessel preserving MIDP.
Keywords: laparoscopic distal pancreatectomy; minimally invasive pancreatectomy; spleen-preserving; surgical approach; vascular anatomy.. |
| 64. |
Hitoe Nishino, Giuseppe Zimmitti, Takao Ohtsuka, Mohammed Abu Hilal, Brian K P Goh, David A Kooby, Yoshiharu Nakamura, Shailesh V Shrikhande, Yoo-Seok Yoon, Daisuke Ban, Yuichi Nagakawa, Kohei Nakata, Itaru Endo, Akihiko Tsuchida, Masafumi Nakamura, Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.903, 29(1):136-150, 2022.04, Background: Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP.
Methods: A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology.
Results: Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro-inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found.
Conclusions: The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.
Keywords: distal pancreatectomy; laparoscopic; minimally invasive; spleen-preserving distal pancreatectomy; vascular anatomy.. |
| 65. |
Kohei Nakata, Ryota Higuchi, Naoki Ikenaga, Leon Sakuma, Daisuke Ban, Yuichi Nagakawa, Takao Ohtsuka, Horacio J Asbun, Ugo Boggi, Chung-Ngai Tang, Christopher L Wolfgang, Hitoe Nishino, Itaru Endo, Akihiko Tsuchida, Masafumi Nakamura, , Precision anatomy for safe approach to pancreatoduodenectomy for both open and minimally invasive procedure: A systematic review, J Hepatobiliary Pancreat Sci, 10.1002/jhbp.901, 29(1):99-113, 2022.04, Background: Minimally invasive pancreatoduodenectomy (MIPD) has recently gained popularity. Several international meetings focusing on the existing literature on MIPD were held; however, the precise surgical anatomy of the pancreas for the safe use of MIPD has not yet been fully discussed. The aim of this study was to carry out a systematic review of available articles and to show the importance of identifying the anatomical variation in pancreatoduodenectomy.
Methods: In this review, we described variations in surgical anatomy related to MIPD. A systematic search of PubMed (MEDLINE) was conducted, and the references were identified manually.
Results: The search strategy yielded 272 articles, with 77 retained for analysis. The important anatomy to be considered during MIPD includes the aberrant right hepatic artery, first jejunal vein, first jejunal artery, and dorsal pancreatic artery. Celiac artery stenosis and a circumportal pancreas are also important to recognize.
Conclusions: We conclude that only certain anatomical variations are associated directly with perioperative outcomes and that identification of these particular variations is important for safe performance of MIPD.
Keywords: anatomical variation; minimally invasive pancreatoduodenectomy; pancreatic resection; pancreatoduodenectomy; surgical anatomy.. |
| 66. |
Tomohiko Shinkawa, Kenoki Ohuchida, Masafumi Nakamura, Heterogeneity of Cancer-Associated Fibroblasts and the Tumor Immune Microenvironment in Pancreatic Cancer, Cancers, 10.3390/cancers14163994, 14(16):3994, 2022.04. |
| 67. |
Maarten Korrel, Sanne Lof, Adnan A Alseidi, Horacio J Asbun, Ugo Boggi, Melissa E Hogg, Jin-Young Jan, Masafumi Nakamura, Marc G Besselink, Mohammad Abu Hilal, , Framework for Training in Minimally Invasive Pancreatic Surgery: An International Delphi Consensus Study, J Am Coll Surg
, 10.1097/XCS.0000000000000278, 235(3):383-390, 2022.04, Background: Previous reports suggest that structured training in minimally invasive pancreatic surgery (MIPS) can ensure a safe implementation into standard practice. Although some training programs have been constructed, worldwide consensus on fundamental items of these training programs is lacking. This study aimed to determine items for a structured MIPS training program using the Delphi consensus methodology.
Study design: The study process consisted of 2 Delphi rounds among international experts in MIPS, identified by a literature review. The study committee developed a list of items for 3 key domains of MIPS training: (1) framework, (2) centers and surgeons eligible for training, and (3) surgeons eligible as proctor. The experts rated these items on a scale from 1 (not important) to 5 (very important). A Cronbach's α of 0.70 or greater was defined as the cut-off value to achieve consensus. Each item that achieved 80% or greater of expert votes was considered as fundamental for a training program in MIPS.
Results: Both Delphi study rounds were completed by all invited experts in MIPS, with a median experience of 20 years in MIPS. Experts included surgeons from 31 cities in 13 countries across 4 continents. Consensus was reached on 38 fundamental items for the framework of training (16 of 35 items, Cronbach's α = 0.72), centers and surgeons eligible for training (19 of 30 items, Cronbach's α = 0.87), and surgeons eligible as proctor (3 of 10 items, Cronbach's α = 0.89). Center eligibility for MIPS included a minimum annual volume of 10 distal pancreatectomies and 50 pancreatoduodenectomies.
Conclusion: Consensus among worldwide experts in MIPS was reached on fundamental items for the framework of training and criteria for participating surgeons and centers. These items act as a guideline and intend to improve training, proctoring, and safe worldwide dissemination of MIPS.
Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.. |
| 68. |
Mohammad Abu Hilal, Tess M E van Ramshorst, Ugo Boggi, Safi Dokmak, Bjørn Edwin, Tobias Keck, Igor Khatkov, Jawad Ahmad, Hani Al Saati, Adnan Alseidi, Juan S Azagra, Bergthor Björnsson, Fatih M Can, Mathieu D'Hondt, Mikhail Efanov, Francisco Espin Alvarez, Alessandro Esposito, Giovanni Ferrari, Bas Groot Koerkamp, Andrew A Gumbs, Melissa E Hogg, Cristiano G S Huscher, Benedetto Ielpo, Arpad Ivanecz, Jin-Young Jang, Rong Liu, Misha D P Luyer, Krishna Menon, Masafumi Nakamura, Tullio Piardi, Olivier Saint-Marc, Steve White, Yoo-Seok Yoon, Alessandro Zerbi, Claudio Bassi, Frederik Berrevoet, Carlos Chan, Felipe J Coimbra, Kevin C P Conlon, Andrew Cook, Christos Dervenis, Massimo Falconi, Clarissa Ferrari, Isabella Frigerio, Giuseppe K Fusai, Michelle L De Oliveira, Antonio D Pinna, John N Primrose, Alain Sauvanet, Alejandro Serrablo, Sameer Smadi, Ali Badran, Magomet Baychorov, Elisa Bannone, Eduard A van Bodegraven, Anouk M L H Emmen, Alessandro Giani, Nine de Graaf, Jony van Hilst, Leia R Jones, Giovanni B Levi Sandri, Alessandra Pulvirenti, Marco Ramera, Niki Rashidian, Mushegh A Sahakyan, Bas A Uijterwijk, Pietro Zampedri, Maurice J W Zwart, Sergio Alfieri, Stefano Berti, Giovanni Butturini, Fabrizio Di Benedetto, Giuseppe M Ettorre, Felice Giuliante, Elio Jovine, Riccardo Memeo, Nazario Portolani, Andrea Ruzzenente, Roberto Salvia, Ajith K Siriwardena, Marc G Besselink, Horacio J Asbun, Collaborators, The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS), Ann Surg, 10.1097/SLA.0000000000006006, 279(1):45-57, 2024.04, Objective:
To develop and update evidence- and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.
Summary Background Data:
Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update.
Methods:
Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, the AGREE II-GRS tool for methodological guideline quality assessment, and external validation by a Validation Committee.
Results:
Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the two-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic and 31 on general MIPS covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee.
Conclusions:
The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers and medical societies.. |
