2024/07/28 更新

写真a

ワタナベ ユウスケ
渡邉 雄介
WATANABE YUSUKE
所属
九州大学病院 消化管外科(1) 助教
医学部 医学科(併任)
職名
助教
外部リンク

学位

  • 九州大学,日本

論文

  • Relationship between prognostic impact of N3 lymph node metastasis at the root of the feeding artery and location of colon cancer

    Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kenoki Ohuchida, Kohei Nakata, Toru Nakano, Masafumi Nakamura

    Langenbecks Arch Surg   408 ( 1 )   31   2023年4月

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    記述言語:英語  

    Purpose: To determine whether N3 nodal involvement predicts outcomes and whether its prognostic implications vary with tumor location in patients with Stage III colon cancer (CC).

    Methods: We defined N3 as lymph node metastases near the bases of the major feeding arteries. We retrospectively examined recurrence rates and patterns by tumor location and sites of lymph node metastases in 57 patients with N3 CC who had undergone curative resections between January 2000 and March 2019. Survival analysis was performed to compare the prognoses of patients with and without N3 lymph node metastasis.

    Results: Most N3 patients had large tumors (T ? 3); five had T2 disease. Recurrence occurred quickly in one patient with T2N3M0 disease. Multivariate survival analysis demonstrated that N3 lymph node metastasis is an independent predictor of poor prognosis in Stage III CC patients (P < 0.001). Categorizing N3 patients according to UICC-TNM staging system does not stratify risk of recurrence (P = 0.970). To investigate the impact of tumor location on recurrence risk, we classified N3 CC into two subtypes according to tumor location: metastasis at the base of the superior mesenteric artery in right-sided CC and inferior mesenteric artery in left-sided CC. The former was found to have a statistically significant poorer prognosis than the latter (P = 0.091).

    Conclusion: N3 is a robust prognostic marker in CC patients. Recurrence risk varies by tumor location. N3 right-sided CCs with lymph node metastasis at the base of the superior mesenteric artery have poorer prognoses than do N3 left-sided CCs.

    Keywords: Feeding artery; Inferior mesenteric artery; N3 colon cancer; Superior mesenteric artery; Tumor sidedness.

    DOI: 10.1007/s00423-023-02778-8

  • Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases

    Koji Tamura, Takashi Ueki, Hiromichi Nakayama, Yusuke Watanabe, Masafumi Sada, Kinuko Nagayoshi, Yusuke Mizuuchi, Kenoki Ohuchida, Hitoshi Ichimiya, Masafumi Nakamura

    Langenbecks Arch Surg   408 ( 1 )   36   2023年4月

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    記述言語:英語  

    urpose: A diagnostic and treatment strategy for appendiceal tumors (ATs) has not been established. We aimed to evaluate our treatment strategy in ATs, including laparoscopic surgery (LS), and to identify preoperative malignancy predictors.
    Methods: A total of 51 patients between 2011 and 2021 were retrospectively reviewed. Data, including tumor markers and imaging findings, were compared between carcinoma and non-carcinoma patients. Validity of planned operation was evaluated based on pathological diagnosis.
    Results: Twenty-five patients were diagnosed with carcinoma, 13 with low-grade mucinous neoplasm, and 13 with other diseases. Symptoms were more commonly present in carcinoma patients than in non-carcinoma patients (68.0% vs. 23.1%, p = 0.001). Elevated CEA and CA19-9 were more frequently observed in carcinoma patients than in non-carcinoma patients (p < 0.01 and p = 0.04, respectively). Five carcinoma patients had malignancy on biopsy, compared with zero non-carcinoma patients. Significant differences were noted in the percentages of carcinoma and non-carcinoma patients with solid enhanced mass (41.7% vs. 0%, p < 0.001) and tumor wall irregularity (16.7% vs. 0%, p = 0.03) on imaging. Although the sensitivity was not high, the specificity and positive predictive value of these findings were 100%. Forty-two patients (82.4%) underwent LS as minimally invasive exploratory and/or radical operation, of whom 2 were converted to open surgery for invasion of adjacent organ. No patients had intraoperative complications or postoperative mortality.
    Conclusion: Clinical symptoms, elevated tumor markers, and worrisome features of solid enhanced mass and tumor wall irregularity on imaging can be malignancy predictors. For management of ATs, LS is feasible and useful for diagnosis and treatment.
    Keywords: Appendiceal carcinoma; Appendiceal tumor; LAMN; Laparoscopic surgery; Mucinous neoplasm.

    DOI: 10.1007/s00423-023-02807-6

  • Predictive factors for early recurrence after pancreaticoduodenectomy in patients with resectable pancreatic head cancer: A multicenter retrospective study

    Shinichiro Ono, Tomohiko Adachi, Takao Ohtsuka, Ryuichiro Kimura, Kazuyoshi Nishihara, Yusuke Watanabe, Hiroaki Nagano, Yukio Tokumitsu, Atsushi Nanashima, Naoya Imamura, Hideo Baba, Akira Chikamoto, Masafumi Inomata, Teijiro Hirashita, Masayuki Furukawa, Tetsuya Idichi, Hiroyuki Shinchi, Yuichiro Maruyama, Masafumi Nakamura, Susumu Eguchi

    surgery   172 ( 6 )   1782 - 1790   2022年4月

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    記述言語:英語  

    Background: Patients diagnosed with resectable pancreatic ductal adenocarcinoma often experience early recurrence even after upfront R0 resection. This study aimed to define early recurrence and identify preoperative risk factors for early recurrence after upfront pancreaticoduodenectomy in patients with resectable pancreatic ductal adenocarcinoma of the pancreatic head.
    Methods: This multicenter, retrospective study involved 500 patients who underwent pancreaticoduodenectomy resectable pancreatic ductal adenocarcinoma of the pancreatic head at 10 institutions between 2007 and 2016. Preoperative, intraoperative, and postoperative clinicopathological results were compared between early and non-early recurrence groups. Predictors of early recurrence were determined using statistical analyses.
    Results: Log-rank tests revealed a significant difference (P < .001) between recurrence within 3 to 6 months and 6 to 9 months. Early recurrence was subsequently defined as recurrence within 6 months. Patients were categorized into early recurrence (n = 104) and non-early recurrence groups (n = 389). The median overall survival of the early and non-early recurrence groups was 8.6 months and 42.6 months (P < .001), respectively. Preoperatively, high carbohydrate antigen 19-9 levels ≥120 U/mL, retroperitoneal invasion, and diabetes mellitus were identified as independent predictive risk factors for early recurrence according to multivariate analysis. Comparing survival rates among patients with 3, 2, 1, or none of these factors, the median overall survival was 17.6 (n = 90), 21.2 (n = 184), 47 (n = 141), and 61.5 (n = 73) months, respectively.
    Conclusion: The optimal period that defines the early recurrence for resectable pancreatic ductal adenocarcinoma of the pancreatic head is 6 months. Tumor size ≥20 mm, preoperative carbohydrate antigen 19-9 levels ≥120 U/mL, retroperitoneal invasion of the tumor, and the presence of diabetes mellitus are independently associated with early recurrence.

    DOI: 10.1016/j.surg.2022.08.004

  • Application of a novel surgical difficulty grading system during laparoscopic cholecystectomy

    Koji Asai, Yukio Iwashita, Tetsuji Ohyama, Itaru Endo, Taizo Hibi, Akiko Umezawa, Kenji Suzuki, Manabu Watanabe, Masanao Kurata, Yasuhisa Mori, Masaharu Higashida, Yusuke Kumamoto, Junichi Shindoh, Masahiro Yoshida, Goro Honda, Takeyuki Misawa, Yuta Abe, Yuichi Nagakawa, Naoyuki Toyota, Shigetoshi Yamada, Shinji Norimizu, Naoki Matsumura, Naohiro Sata, Hiroki Sunagawa, Masahiro Ito, Yutaka Takeda, Yoshiharu Nakamura, Toshiki Rikiyama, Ryota Higuchi, Takeshi Gocho, Yuki Homma, Teijiro Hirashita, Hideyuki Kanemoto , Masashi Nozawa, Yusuke Watanabe, Atsushi Kohga, Takehisa Yazawa, Hiroshi Tajima, Shin Nakahira, Tadafumi Asaoka, Ryuji Yoshioka, Junya Fukuzawa, Shuichi Fujioka, Taigo Hata, Hidenori Haruta, Yukio Asano, Ryohei Nomura, Joe Matsumoto, Noriaki Kameyama, Atsushi Miyoshi, Hidejiro Urakami, Yasuji Seyama, Takanori Morikawa, Yoichi Kawano, Hisashi Ikoma, Dal Ho Kim Kin, Tadahiro Takada, Masakazu Yamamoto

    J Hepatobiliary Pancreat Sci   29 ( 7 )   758 - 767   2022年4月

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    記述言語:英語  

    Background: Prevention of bile duct injury and vasculo-biliary injury while performing laparoscopic cholecystectomy (LC) is an unsolved problem. Clarifying the surgical difficulty using intraoperative findings can greatly contribute to the pursuit of best practices for acute cholecystitis. In this study, multiple evaluators assessed surgical difficulty items in unedited videos and then constructed a proposed surgical difficulty grading.
    Methods: We previously assembled a library of typical video clips of the intraoperative findings for all LC surgical difficulty items in acute cholecystitis. Fifty-one experts on LC assessed unedited surgical videos. Inter-rater agreement was assessed by Fleiss's κ and Gwet's agreement coefficient (AC).
    Results: Except for one item ("edematous change"), κ or AC exceeded 0.5, so the typical videos were judged to be applicable. The conceivable surgical difficulty gradings were analyzed. According to the assessment of difficulty factors, we created a surgical difficulty grading system (agreement probability = 0.923, κ = 0.712, 90% CI: 0.587-0.837; AC2 = 0.870, 90% CI: 0.768-0.972).
    Conclusion: The previously published video clip library and our novel surgical difficulty grading system should serve as a universal objective tool to assess surgical difficulty in LC.
    Keywords: acute cholecystitis; bile duct injury; laparoscopic cholecystectomy; surgical difficulty; vasculobiliary injury.

    DOI: 10.1002/jhbp.1068

  • Cross-sectional area of psoas muscle as a predictive marker of anastomotic failure in male rectal cancer patients: Japanese single institutional retrospective observational study

    Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kohei Nakata, Kenoki Ohuchida, Toru Nakano, Masafumi Nakamura

    Annals of Coloproctology   38 ( 5 )   353 - 361   2022年4月

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    記述言語:英語  

    Purpose: Preoperative sarcopenia worsens postoperative outcomes in various cancer types including colorectal cancer. However, we often experienced postoperative anastomotic leakage in muscular male patients such as Judo players, especially in rectal cancer surgery with lower anastomosis. It is controversial whether the whole skeletal muscle mass impacts the potential for anastomotic failure in male rectal cancer patients. Thus, the purpose of this study was to clarify whether skeletal muscle mass impacts anastomotic leakage in rectal cancer in men.

    Methods: We reviewed the medical charts of male patients suffering from rectal cancer who underwent colo-procto anastomosis below the peritoneal reflection without a protective diverting stoma. We measured the psoas muscle area and calculated the psoas muscle index.

    Results: One hundred ninety-seven male rectal cancer patients were enrolled in this study. The psoas muscle index was significantly higher in patients with anastomotic leakage (P<0.001). Receiver operating characteristic curve determined the optimal cut-off value of the psoas muscle index for predicting anastomotic leakage as 812.67 cm2/m2 (sensitivity of 60% and specificity of 74.3%). Multivariate analysis revealed that high psoas muscle index (risk ratio [RR], 3.933; P<0.001; 95% confidence interval [CI], 1.917-8.070) and super low anastomosis (RR, 2.792; P=0.015; 95% CI, 1.221-6.384) were independent predictive factors of anastomotic leakage.

    Conclusion: This study showed that male rectal cancer patients with a large psoas muscle mass who underwent lower anastomosis had a higher rate of postoperative anastomotic leakage.

    Keywords: Anastomotic leak; Lower colo-anorectal anastomosis; Psoas muscle index; ROC curve; Rectal neoplasms.

    DOI: 10.3393/ac.2022.00122.0017

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書籍等出版物

  • The validity of the surgical indication for intraductal papillary mucinous neoplasm of the pancreas advocated by the 2017 revised International Association of Pancreatology consensus guidelines

    Watanabe Y, Endo S, Nishihara K, Ueda K, Mine M, Tamiya S, Nakano T, Tanaka M

    2018年4月 

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    担当ページ:Surg Today,48(11):1011-1019   記述言語:英語  

    DOI: 10.1007/s00595-018-1691-2

講演・口頭発表等

  • ロボット手術の特性からみた低侵襲膵切除の出血コントロール -inflow-outflow controlによるトラブルシューティング-

    池永直樹, 仲田興平, 阿部俊也, 渡邉雄介, 井手野昇, 永吉絹子, 水内祐介, 野口浩司, 加来啓三, 岡部安博, 進藤幸治, 大内田研宙, 中村雅史

    第124回日本外科学会  2024年4月 

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    開催年月日: 2024年4月

    開催地:名古屋市   国名:日本国  

  • 安全な膵癌手術のための画像診断 ~術前から術後まで~

    仲田興平, 阿部俊也, 渡邉雄介, 井手野昇, 池永直樹, 藤田展宏, 岡本大佑, 石神康生, 中村雅史

    第83回日本医学放射線学会総会  2024年4月 

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    開催年月日: 2024年4月

    開催地:横浜市   国名:日本国  

    近年、膵癌は切除可能膵癌、切除可能境界膵癌、切除不能膵癌に区別され、それぞれ治療法が異なり正確な進展度範囲は重要である。当科で放射線科、内科と共に週1回のカンファレンスを行い各症例に対して以下の項目を中心に詳細な検討を行って頂いている。 術前進展度診断;門脈、上腸間膜動脈、肝動脈、脾動脈への浸潤の程度、有無を、また術前補助療法症例に関しては、効果判定に関してそれぞれ検討を行い、最適なタイミングでの切除を心がけている。手術手技に視点をおくと、動脈系の破格、Celiac Stenosis、Circumportal pancreasの有無などの評価を行っている。術後に関しても合併症の早期発見は非常に重要であり、膵液瘻、それに伴う動脈瘤の有無の評価を行って頂いている。 2010年から2023年に行った当科の膵頭十二指腸切除術の死亡率は0.12%(1/831)と良好な結果をもたらしているが、これは術前診断から術後の合併症診断、治療までが外科、放射線科、内科により適切に行なわれる総合力の高さによるものと考えている。

  • 先天性胆道拡張症に対するロボット支援下手術

    仲田興平, 井手野 昇, 阿部俊也, 渡邉雄介, 池永直樹, 中村雅史

    第12回腹腔鏡下胆道手術研究会  2024年2月 

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    開催年月日: 2024年2月

    開催地:東京都   国名:日本国  

    <背景> 本邦ではロボット支援下総胆管拡張症手術は2022年4月に保険収載されたばかりであり、本邦の施設の多くは導入前、もしくは導入初期であると思われる。当科では1996年に成人初の先天性胆道拡張症手術を開始、2020年までに45例行っている。また、2020年からは当院倫理委員会承認下にロボット支援下総胆管拡張症手術を開始、現在までに10例の症例を経験している。今回ロボット支援下手術の成績を検討、また、その手技を共覧する。 <方法> 2020年12月から2023年11月の間に行なった10例のロボット支援下総胆管拡張症手術の成績を検討した。 <結果> 10例の年齢の中央値は28歳であった。10例中3例はHybrid手術(腹腔鏡下に切除)、7例は完全ロボット支援下に行われた。手術時間、出血量、入院期間中央値はそれぞれ422分(252 to 600 分), 48g (1 to 107 g) and 8 日(7 to 19 日)であった。10名中1名に胆汁漏を認め、別の1名は術後10ヶ月目に胆管空腸吻合部の狭窄を認めたためバルーン拡張術を行なった。 <結論> ロボット支援下総胆管拡張症手術は安全に導入ができていると考えられるが、今後合併症をいかにして減らすかを工夫しながら進めていきたい。

  • 膵癌に対する低侵襲膵頭十二指腸切除術-precision anatomyを意識したmesenteric approach-

    仲田興平, 阿部俊也, 渡邉雄介, 井手野昇, 池永直樹, 永吉絹子, 水内祐介, 進藤幸治, 大内田研宙, 中村雅史

    第36回日本内視鏡外科学会総会  2023年12月 

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    開催年月日: 2023年12月

    開催地:横浜市   国名:日本国  

    <背景> 当科では現在までに95例のMIPD<LPD(28例)、RPD(67例)>を行っている、MIPDに必要な解剖を紹介、当院で行っている膵癌に対する術式に関して紹介する。 <方法> 門脈に接する膵癌に対してはmesenteric approachを行うことがある。本操作では中結腸動脈をメルクマールとしてSMAを同定する。SMA周囲を根部に向かって剥離を行い、その後treitz靭帯を切離する。Treitz靭帯は半数以上が十二指腸背側にも付着しており前方のみならず、背側からも確実に切離する。可能であればSMA,SMVの間でIPDAもしくは1st JAを切離するがこの時注意すべきは1st JVである、1stJVは殆どがSMA背側を走行しているため、出血に注意する。膵を離断後は、Hanging maneuverを利用してSMV右側から腹側を展開して剥離を行う。 <結果> 95例のMIPD中、膵癌に対するRPD は現在までに27例 施行した(stage 0 10例、IA 6例、IIA 5例、IIB 6例)。手術時間中央値および出血量中央値はそれぞれ733分(437分-863分)、235g (0-1050g)であった。長期成績に関しては、観察期間中央値21ヶ月(1-59ヶ月)であり、1例に再発を認めたが、そのほかの症例に関しては無再発生存中である。

  • 当科での低侵襲膵頭十二指腸切除術の導入 -開腹手術と比較して-

    阿部俊也, 仲田興平, 渡邉雄介, 井手野昇, 池永直樹, 中村雅史

    第36回日本内視鏡外科学会総会  2023年12月 

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    開催年月日: 2023年12月

    開催地:横浜市   国名:日本国  

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MISC

  • Beckwith-Wiedemann syndrome with juvenile fbrous nodules and lobular breast tumors: a case report and review of the literature

    Yo Sato, Yusuke Watanabe, Takafumi Morisaki, Saori Hayashi, Yoshiki Otsubo, Yurina Ochiai, Kimihisa Mizoguchi, Yuka Takao, Mai Yamada, Yusuke Mizuuchi, Masafumi Nakamura, Makoto Kubo

    Surg Case Rep.   2024年4月

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    記述言語:英語  

    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.

    DOI: 10.1186/s40792-024-01865-2

  • 保存的治療で軽快した空腸憩室炎穿通による腹腔内膿瘍の1 例

    大河原一真, 渡邉雄介, 中山宏道, 植木隆, 大城戸政行

    日臨外会誌   2023年4月

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    記述言語:日本語  

    DOI: DOIなし

  • Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: A systematic review

    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,

    J Hepatobiliary Pancreat Sci   2022年4月

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    記述言語:英語   掲載種別:記事・総説・解説・論説等(学術雑誌)  

    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.

    DOI: 10.1002/jhbp.905

  • 【胆膵領域の臨床試験Up to date~これを読めば世界が見える~】胆膵疾患に対する腹腔鏡下膵切除術の現状

    渡邉雄介, 仲田興平, 井手野昇, 森泰寿, 池永直樹, 中村雅史

    胆と膵   2021年4月

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    記述言語:日本語   掲載種別:記事・総説・解説・論説等(学術雑誌)  

  • Advanced Hepatocellular Carcinoma in which Gallbladder Invasion Mimicked Primary Gallbladder Neoplasm

    Koji Tamura, Toshifumi Gushima, Hiromichi Nakayama, Reiko Yoneda, Yusuke Watanabe, Hiroshi Kono, Hirofumi Yamamoto, Takashi Ueki, Masayuki Okido, Hitoshi Ichimiya

    Archives of Clinical Case Reports   2021年4月

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    記述言語:英語  

    DOI: DOI無し

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学術貢献活動

  • 座長

    10th Reduced Port Surgery Forum(第15回単孔式内視鏡手術研究会・第24回Needlescopic Surgery Meeting) (セッション:主題関連16 肝胆膵 4)  ( 北九州市 ) 2023年8月

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    種別:大会・シンポジウム等 

  • 座長

    第54回日本膵臓学会大会 (セッション:一般演題40:メディカルスタッフ2)  ( 福岡市 ) 2023年7月

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    種別:大会・シンポジウム等 

  • 座長

    第11回膵臓内視鏡外科研究会 (セッション:腹腔鏡下尾側膵切除術における膵上縁での視野展開および脾動脈確保の工夫)  ( 横浜市 ) 2019年12月

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    種別:大会・シンポジウム等 

  • 座長

    第29回九州内視鏡下外科手術研究会 (セッション:要望演題7 私の秘技)  ( 福岡市 ) 2019年9月

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    種別:大会・シンポジウム等 

  • 座長

    第1回北九州肝胆膵外科フォーラム (セッション:第1回北九州肝胆膵外科フォーラム)  ( 北九州市 ) 2016年10月

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    種別:大会・シンポジウム等