Kyushu University Academic Staff Educational and Research Activities Database
List of Reports
Masafumi Nakamura Last modified date:2020.01.17

Professor / Dept. Surgery and Oncology / Department of Clinical Medicine / Faculty of Medical Sciences

1. Oda H, Nakamura M, Ueki T, Sada M, Current status of ambulatory endoscopic thoracic sympathectomy for palmar hyperhidrosis in Japan., Clin Auton Res, 13(2):153-153, 2003.04.
2. 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. ".
3. 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.
4. 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.
5. 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
, Journal of the pancreas, 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.

6. 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.

7. 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.
8. 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.
9. 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..
10. 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.
11. 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.
12. 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.
13. 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.
Colon cancer; Laparoscopic surgery; Mobile cecum; Persistent ascending mesocolon; Persistent descending mesocolon.
14. 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.
Bile duct neoplasm; GNAS; IPMN; Intraductal papillary neoplasm; KRAS; Pancreas neoplasm.
15. 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, International journal of surgery case reports, 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..
16. 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, ONCOLOGY LETTERS, 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..
17. 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, Surgical Case Reports, 10.1186/s40792-017-0360-9., 3
(1):86-86, 2017.04, Abstract
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.
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.
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.
Aberrant right subclavian artery; Esophageal cancer; Nonrecurrent right inferior laryngeal nerve; Prone position; Video-assisted thoracoscopic surgery.
18. 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, Surgical Case Reports, 10.1186/s40792-017-0380-5, 3(1):112, 2017.04, Abstract
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.

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.

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..
19. 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 <2%. SPNs should be considered even in young male patients. EUS with EUS-FNA could be a useful diagnostic modality for SPNs even in young male patients..
20. 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, Jun;9(2)::151-154, 2018.04.
21. 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 (Baltimore)., 10.1097/MD.0000000000012796., 97(41):e12796, 2018.04, Abstract
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.
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.
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.
The patient showed complete response within 4 cycles of chemotherapy. However, the disease recurred 5.5 months after the final course of EP chemotherapy.
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.
22. 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
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.
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.
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:, NCT03317886 . Registered on 23 October 2017. University Hospital Medical Information Network Clinical Trials Registry, UMIN000029615 . Registered on 15 January 2018.
23. 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
Gallbladder cancer (GBC) is one of the refractory diseases. Multidisciplinary approach including immunotherapy for such cancers has received much attention in recent years.
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.
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.
24. 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"..
25. 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, Human Pathology, 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.
26. 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.
27. 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.
28. 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.


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.


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 < 0.001); lower rates of intraoperative transfusion (P = 0.020), clinical grade of pancreatic fistula (International Study Group on Pancreatic Fistula grade B and C; P < 0.001), and morbidity (P < 0.001); and shorter hospital stay (P = 0.001), but a longer operative time (P < 0.001).


Laparoscopic distal pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy.
29. 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.


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.


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 < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR.


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.
30. 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.
31. 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 ?, Annals of Gastroenterological Surgery, 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..
32. 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..
33. 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.
34. 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.
35. 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
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.
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.
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.
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
36. 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, SurgeryToday, 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