31 results on '"Hiroaki Osakabe"'
Search Results
2. Preoperative cholangitis is associated with increased surgical site infection following pancreaticoduodenectomy
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Chie Takishita, Kenji Katsumata, Hitoe Nishino, Akihiko Tsuchida, Takao Itoi, Yuichi Hosokawa, Yoshito Akagi, Masanori Akashi, Hiroaki Osakabe, and Yuichi Nagakawa
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medicine.medical_specialty ,Microbiological culture ,Cholangitis ,medicine.medical_treatment ,030230 surgery ,Pancreaticoduodenectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Preoperative Care ,Occlusion ,medicine ,Humans ,Surgical Wound Infection ,Risk factor ,Retrospective Studies ,Hepatology ,business.industry ,Incidence (epidemiology) ,Postoperative complication ,Odds ratio ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Pancreatic fistula ,Drainage ,030211 gastroenterology & hepatology ,business - Abstract
BACKGROUND Few reports describe the relationship between preoperative cholangitis and surgical site infections (SSIs) after pancreaticoduodenectomy (PD). We aimed to determine the association between the incidence of preoperative cholangitis and surgical site infection following PD. METHODS The surgical outcomes of 359 patients who underwent PD were compared between patients with (n = 92) and without (n = 267) preoperative cholangitis. Bacterial cultures from the postoperative drainage fluid were examined. Risk factors for postoperative infectious complication were evaluated. RESULTS The incidence of postoperative infectious complications including grade B/C postoperative pancreatic fistula was high among patients with preoperative cholangitis (P
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- 2020
3. Safe exposure of the left renal vein during laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: anatomical variations and pitfalls
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Kenta Suzuki, Shingo Kozono, Kenji Katsumata, Chie Takishita, Akihiko Tsuchida, Hitoe Nishino, Yuichi Nagakawa, Hiroaki Osakabe, and Naoya Nakagawa
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Adult ,Male ,medicine.medical_specialty ,Dissection (medical) ,030230 surgery ,urologic and male genital diseases ,Renal hilum ,Renal Veins ,03 medical and health sciences ,Pancreatectomy ,Renal Artery ,0302 clinical medicine ,Mesenteric Artery, Superior ,medicine.artery ,Multidetector Computed Tomography ,Humans ,Medicine ,Superior mesenteric artery ,Vein ,Pancreas ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Anatomic Variation ,Left renal vein ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,cardiovascular system ,Female ,Laparoscopy ,Surgery ,Radiology ,Safety ,business ,Distal pancreatectomy ,Carcinoma, Pancreatic Ductal - Abstract
The left renal vein is technically difficult to expose during laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma despite being an important landmark for posterior dissection. We hereby propose a novel technique to safely expose the left renal vein while avoiding the associated anatomical pitfalls. The anatomy of the left renal artery and vein was analyzed using multidetector computed tomography. We initially exposed the left renal vein on the left posterior side of the superior mesenteric artery followed by exposure toward the left kidney. We retrospectively examined the perioperative results of this technique in 33 patients who underwent laparoscopic distal pancreatectomy. 15.7% of the patients had an accessory left renal artery coursing cranial to the vein. In 43.1%, the left renal arterial branch ventrally traversed the vein at the renal hilum, thereby posing a risk for arterial injury. The location of the left renal vein varies cranial (17.6%) or caudal (82.4%) to the pancreas. The left renal vein was exposed without any vascular injury using this technique. The median operative time was 259 min, blood loss was 18 mL, and R0 resection rate was 97.0%. The initial exposure of the left renal vein should, therefore, be on the left posterior side of the superior mesenteric artery.
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- 2020
4. Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report
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Hiroaki Osakabe, Kenta Suzuki, Akihiko Tsuchida, Kenji Katsumata, Toru Sakurai, Masanori Akashi, Yuichi Nagakawa, Hitoe Nishino, Naoto Okazaki, and Chie Takishita
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Pancreatic duct ,medicine.medical_specialty ,Magnetic resonance cholangiopancreatography ,medicine.diagnostic_test ,Pancreatoduodenectomy ,Total pancreatectomy ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,Adipose tissue ,Case Report ,lcsh:RD1-811 ,medicine.disease ,Pancreaticoduodenectomy ,medicine.anatomical_structure ,Parenchyma ,medicine ,Fat-replaced pancreatic tissue ,Endocrine system ,Radiology ,Pancreas ,business ,Solid pseudopapillary neoplasm ,Agenesis/Aplasia/Dysplasia/Hypoplasia of pancreatic body and tail ,Calcification - Abstract
Background There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail. Case presentation Contrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery. Conclusions In patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function.
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- 2020
5. International Expert Consensus on Precision Anatomy for minimally invasive distal pancreatectomy: PAM-HBP Surgery Project
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Ugo Boggi, Naoki Ikenaga, Shingo Kozono, Michael L. Kendrick, Goro Honda, Rong Liu, Yoo Seok Yoon, Giammauro Berardi, Yoshiya Ishikawa, F. Kunzler, Yoshiki Murase, Ryota Higuchi, Leon Sakuma, Hitoe Nishino, Go Wakabayashi, Kohei Nakata, Yuichi Nagakawa, Chie Takishita, Chung-Ngai Tang, Jin-Young Jang, Hiroki Yamaue, Shin-E Wang, Masao Tanaka, Brian K. P. Goh, Akihiko Tsuchida, Yoshiharu Nakamura, Jin He, Itaru Endo, Yusuke Watanabe, Chang Moo Kang, Shailesh V. Shrikhande, Hiroaki Osakabe, Anusak Yiengpruksawan, Chinnusamy Palanivelu, Masafumi Nakamura, Kyoichi Takaori, Minoru Tanabe, Giuseppe Zimmitti, Aya Maekawa, Christopher L. Wolfgang, Horacio J. Asbun, David A. Kooby, Ruben Ciria, Zi-Zheng Wang, Mohammed Abu Hilal, Takao Ohtsuka, Daisuke Ban, and Giovanni Maria Garbarino
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medicine.medical_specialty ,Consensus ,consensus ,distal pancreatectomy ,laparoscopic ,minimally invasive ,spleen-preserving ,media_common.quotation_subject ,Anatomical structures ,High resolution ,Pancreatectomy ,Surgical anatomy ,Voting ,medicine ,Humans ,computer.programming_language ,media_common ,Hepatology ,business.industry ,Expert consensus ,Anatomy ,Treatment Outcome ,Laparoscopy ,Pancreatic Neoplasms ,Surgery ,Spleen preserving ,Distal pancreatectomy ,business ,computer ,Delphi - Abstract
Background Surgical views with high resolution and magnification have enabled us to recognize the precise anatomical structures that can be used as landmarks during minimally invasive distal pancreatectomy (MIDP). This study aimed to validate the usefulness of anatomy-based approaches for MIDP before and during the Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (February 24, 2021). Methods Twenty-five international MIDP experts developed clinical questions regarding surgical anatomy and approaches for MIDP. Studies identified via a comprehensive literature search were classified using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Online Delphi voting was conducted after experts had drafted the recommendations, with the goal of obtaining >75% consensus. Experts discussed the revised recommendations in front of the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. Results Four clinical questions were addressed, resulting in 10 recommendations. All recommendations reached at least a 75% consensus among experts. Conclusions The expert consensus on precision anatomy for MIDP has been presented as a set of recommendations based on available evidence and expert opinions. These recommendations should guide experts and trainees in performing safe MIDP and foster its appropriate dissemination worldwide.
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- 2022
6. Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment
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Tesshi Yamada, Kenta Suzuki, Naoya Nakagawa, Hiroaki Osakabe, Nobuhiko Nakagawa, Yuichi Hosokawa, Chie Takishita, Ichiro Uyama, Kenji Katsumata, Tomoki Shirota, Akihiko Tsuchida, Masayuki Honda, Yuichi Nagakawa, and Shingo Kozono
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Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,pancreatic cancer ,lymph node dissection ,Review ,030230 surgery ,Metastasis ,R0 resection ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,medicine ,Multimodal treatment ,RC254-282 ,Chemotherapy ,business.industry ,Cancer ,superior mesenteric artery ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Pancreaticoduodenectomy ,medicine.disease ,mesopancreas ,adjuvant chemotherapy ,Dissection ,Oncology ,nerve and fibrous tissues ,030220 oncology & carcinogenesis ,Radiology ,pancreaticoduodenectomy ,business ,Pancreatic head cancer - Abstract
Simple Summary Although the survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear, the R0 resection rate is reportedly associated with prognosis. We reviewed the literature that could be helpful in determining the appropriate resection range. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of the anatomical landmarks to determine the appropriate dissection range intraoperatively. Abstract Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.
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- 2021
7. Neuroendocrine carcinoma of the common bile duct associated with congenital bile duct dilatation: a case report
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Yoshitaka Kiya, Masanori Akashi, Yuichi Nagakawa, Ryo Oono, Hiroaki Osakabe, Toshitaka Nagao, Chie Takishita, Kenji Katsumata, Hiroshi Yamaguchi, Akihiko Tsuchida, and Hitoe Nishino
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,RC799-869 ,digestive system ,Gastroenterology ,Bile duct dilatation ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Bile Ducts, Extrahepatic ,Internal medicine ,Case report ,Humans ,Medicine ,Pathological ,Common Bile Duct ,Cisplatin ,Common bile duct ,business.industry ,Large cell neuroendocrine carcinoma ,General Medicine ,Diseases of the digestive system. Gastroenterology ,Hepatology ,Pancreaticoduodenectomy ,Dilatation ,digestive system diseases ,Carcinoma, Neuroendocrine ,Adjuvant chemotherapy ,Irinotecan ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Neuroendocrine carcinoma ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,Differential diagnosis ,business ,Congenital bile duct dilatation ,medicine.drug - Abstract
Background Cholangiocarcinoma is frequently observed in patients with congenital bile duct dilatation (CBDD). Most cholangiocarcinomas are adenocarcinomas. Other types, especially neuroendocrine carcinomas (NECs), are rare. To the best of our knowledge, this is the third reported case of an NEC of the common bile duct associated with CBDD and the first to receive adjuvant chemotherapy for advanced disease. Case presentation A 29-year-old woman presented with upper abdominal pain. Preoperative imaging indicated marked dilatation of the common bile duct and a tumor in the middle portion of the common bile duct. She was suspected of having distal cholangiocarcinoma associated with CBDD and underwent pylorus-preserving pancreaticoduodenectomy. Pathological and immunohistological findings led to a final diagnosis of large-cell NEC (pT3aN1M0 pStageIIB). The postoperative course was uneventful, and she was administered cisplatin and irinotecan every 4 weeks (four cycles) as adjuvant chemotherapy. She has remained recurrence-free for 16 months. Conclusions NEC might be a differential diagnosis in cases of cholangial tumor associated with congenital bile duct dilatation. This presentation is rare and valuable, and to establish better treatment for NEC, further reports are necessary.
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- 2021
8. Why Does Postoperative Pancreatic Fistula Occur After Hand-sewn Parenchymal Closure and Staple Closure in Distal Pancreatectomy?
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Hiroaki Osakabe, Yosuke Hijikata, Tomoki Shirota, Ryoko Soya, Yatsuka Sahara, Takaaki Matsudo, Yuichi Hosokawa, Yuichi Nagakawa, Kenji Katsumata, Tetsushi Nakajima, Nao Kobayashi, Akihiko Tsuchida, Chie Takishita, and Tetsuo Ishizaki
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medicine.medical_specialty ,Necrosis ,Pancreatic Fistula ,03 medical and health sciences ,Dogs ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Surgical Stapling ,Surgical Wound Dehiscence ,Parenchyma ,Pressure ,medicine ,Animals ,Pancreas ,Pancreatic duct ,business.industry ,Suture Techniques ,Blood flow ,equipment and supplies ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Remnant pancreas ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Distal pancreatectomy ,Hand sewn - Abstract
Hand-sewing (HS) and stapling are common parenchymal closure techniques after distal pancreatectomy. However, these methods cannot completely prevent postoperative pancreatic fistula (POPF). The mechanisms of POPF formation after closure are unknown. We performed distal pancreatectomy in mongrel dogs to identify the mechanisms of POPF formation after HS and staple closure. We measured the closed pancreatic duct burst pressures and examined the histology of the remnant pancreas. The after staple-closure burst pressures depended on stapler height; lower pressures were associated with greater stapler heights. Post-HS closure burst pressures were significantly higher than those at each stapler height (P
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- 2019
9. Causative bacteria associated with a clinically relevant postoperative pancreatic fistula infection after distal pancreatectomy
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Yuichi Hosokawa, Yuichi Nagakawa, Shingo Kozono, Tomoki Shirota, Hitoe Nishino, Naoya Nakagawa, Kenta Suzuki, Chie Takishita, Kenji Katsumata, Tetsuo Ishizaki, Akihiko Tsuchida, Masanori Akashi, and Hiroaki Osakabe
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Adult ,Male ,medicine.medical_specialty ,Microbiological culture ,Time Factors ,Staphylococcus ,030230 surgery ,Corynebacterium ,Gastroenterology ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Pancreatectomy ,Postoperative Complications ,Pancreatic Juice ,Risk Factors ,Internal medicine ,Pseudomonas ,Medicine ,Ascitic Fluid ,Humans ,Surgical Wound Infection ,Amylase ,Aged ,Aged, 80 and over ,Univariate analysis ,biology ,business.industry ,Incidence (epidemiology) ,Incidence ,Streptococcus ,General Medicine ,Bacterial Infections ,Contamination ,Middle Aged ,medicine.disease ,Point of delivery ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Pancreatic juice ,Amylases ,biology.protein ,Surgery ,Female ,business - Abstract
Clinically relevant postoperative pancreatic fistulas (CR-POPF) occurring after distal pancreatectomy often cause intra-abdominal infections. We monitored the presence of bacterial contamination in the ascitic fluid after distal pancreatectomy to clarify the bacterial origin of intra-abdominal infections associated with CR-POPF. In 176 patients who underwent distal pancreatectomy, ascitic fluid bacterial cultures were performed on postoperative days (POD) 1–4 and when the drainage fluid became turbid. The association between postoperative ascitic bacterial contamination and CR-POPF incidence was investigated. CR-POPF occurred in 18 cases (10.2%). Among the patients with CR-POPF, bacterial contamination was detected in 0% on POD 1, in 38.9% on POD 4, and in 72.2% on the day (median, day 9.5) when the drainage fluid became turbid. A univariate analysis revealed a significant difference in ascitic bacterial contamination on POD 4 (p
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- 2021
10. Incidence of anastomotic stricture after hepaticojejunostomy with continuous sutures in patients who underwent laparoscopic pancreaticoduodenectomy
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Tetsuo Ishizaki, Akihiko Tsuchida, Yuichi Nagakawa, Kenji Katsumata, Hiroaki Osakabe, Hitoe Nishino, Yutaka Hayashi, Naoya Nakagawa, Chie Takishita, Kenta Suzuki, and Shingo Kozono
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Jejunostomy ,Constriction, Pathologic ,030230 surgery ,Anastomosis ,Balloon ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Cholangiography ,Postoperative Complications ,Suture (anatomy) ,Risk Factors ,Medicine ,Humans ,Retrospective Studies ,medicine.diagnostic_test ,Sutures ,business.industry ,Bile duct ,Incidence (epidemiology) ,Incidence ,Hazard ratio ,Anastomosis, Surgical ,Suture Techniques ,General Medicine ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,Bile Ducts ,business ,Tomography, X-Ray Computed ,Follow-Up Studies - Abstract
Laparoscopic hepatojejunostomy (HJ) with continuous sutures is commonly performed in laparoscopic pancreaticoduodenectomy (LPD). This study aimed to investigate the long-term surgical outcomes of HJ in LPD. We retrospectively evaluated 103 consecutive patients who underwent pancreaticoduodenectomy via laparoscopic HJ with continuous suturing using multifilament (n = 48) or monofilament-absorbable sutures (n = 47). During follow-up, anastomotic stricture of HJ was identified in 8 (7.8%) patients via balloon enteroscopy-assisted cholangiography. The median time from surgery to confirmation of stricture formation was 7.6 months (range 3.6–19.4). The incidence of HJ stricture was significantly higher in patients with a thin bile duct (diameter
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- 2020
11. Clinical impact of pancreaticoduodenectomy for pancreatic cancer with resection of the secondary or later branches of the superior mesenteric vein
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Chie Takishita, Hitoe Nishino, Masanori Akashi, Hiroaki Osakabe, Yuichi Hosokawa, Akihiko Tsuchida, Masayuki Honda, and Yuichi Nagakawa
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medicine.medical_specialty ,medicine.medical_treatment ,Adenocarcinoma ,Mesenteric Vein ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Mesenteric Veins ,Pancreatic cancer ,Adjuvant therapy ,Medicine ,Humans ,Superior mesenteric vein ,Hepatology ,business.industry ,Portal Vein ,medicine.disease ,Thrombosis ,Surgery ,Pancreatic Neoplasms ,Stenosis ,Treatment Outcome ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Purpose To evaluate the feasibility of pancreaticoduodenectomy with resection of the second jejunal vein (J2V) for pancreatic ductal adenocarcinoma (PDAC). Methods Among 114 patients with PDAC undergoing pancreaticoduodenectomy with portal-superior mesenteric vein resection (PVR), surgical outcomes, and prognoses of 10 patients with resection of J2V or later branches of the superior mesenteric vein (J2VR) were compared to 104 patients with PVR above J2V (standard PVR). The reconstruction methods in the J2VR group were reviewed. Results There were no significant differences in the operative time (470 vs 435 min), morbidity (30% vs 27%), presence of portal vein stenosis (10% vs 5%) or thrombosis (10% vs 1%), and induction of adjuvant therapy (80% vs 88%) between the J2VR and standard PVR groups, although blood loss was higher in the J2VR group (1184 vs 494 ml; P = .002). R0 proportion and 2-year survival rates were not significantly worse in the J2VR group compared to the standard PVR group (90 and 88%; 67 and 45%, respectively). At least one branch of the superior mesenteric vein was reconstructed in the J2VR group. Conclusion Pancreaticoduodenectomy with J2VR for PDAC can be safely performed with a satisfactory overall survival rate.
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- 2020
12. Effect of Muscle Mass Loss After Esophagectomy on Prognosis of Oesophageal Cancer
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Soichiro Morinaga, Yota Shimoda, Kenji Katsumata, Keisuke Komori, Takashi Ogata, Kazuki Kano, Yoshihiro Ota, Manabu Shiozawa, Takashi Oshima, Haruhiko Cho, Hiroaki Osakabe, Hayato Watanabe, Takaki Yoshikawa, Akihiko Tsuchida, Takanobu Yamada, Tsutomu Hayashi, and Hirohito Fujikawa
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Male ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Gastroenterology ,Disease-Free Survival ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,Pathological ,Aged ,Retrospective Studies ,business.industry ,Hazard ratio ,Cancer ,Retrospective cohort study ,General Medicine ,Esophageal cancer ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Muscular Disorders, Atrophic ,Esophagectomy ,Oncology ,Multivariate Analysis ,Female ,Esophagogastric Junction ,business ,Bioelectrical impedance analysis ,Follow-Up Studies - Abstract
BACKGROUND/AIM To assess the prognostic effect of muscle loss after esophagectomy and before discharge. PATIENTS AND METHODS This study retrospectively analysed 159 consecutive patients with oesophageal and gastroesophageal junction cancer who underwent esophagectomy between August 2011 and October 2015. Body composition was evaluated one week before surgery and at discharge using a bioelectrical impedance analyser. RESULTS The median rate of muscle mass loss (RMML) was 4.38% (range=-3.3 to +18.8). Patients with increased RMML had significantly poorer outcomes of overall survival than those with decreased RMML (p=0.015). On multivariate analysis, RMML [≥4.38, hazard ratio (HR)=2.033, 95% confidence interval (CI)=1.018-5.924, p=0.044) and pathological tumour depth (≥2, HR=3.099, 95%CI=1.339-7.172, p=0.008) were selected as independent prognostic factors. CONCLUSION RMML after esophagectomy is indicative of poor prognosis in patients with esophageal cancer.
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- 2020
13. Relationship Between the Waiting Times for Surgery and Survival in Patients with Gastric Cancer
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Takanobu Yamada, Takashi Oshima, Yuta Kumazu, Koji Oba, Shinsuke Nagasawa, Kentaro Hara, Munetaka Masuda, Tsutomu Hayashi, Yasushi Rino, Yota Shimoda, Masato Nakazono, Takashi Ogata, Takaki Yoshikawa, and Hiroaki Osakabe
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Male ,medicine.medical_specialty ,Time Factors ,Waiting Lists ,Adenocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Gastrectomy ,Stomach Neoplasms ,medicine ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Proportional hazards model ,business.industry ,Hazard ratio ,Cancer ,Retrospective cohort study ,Vascular surgery ,Middle Aged ,medicine.disease ,Surgery ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Cohort study ,Abdominal surgery - Abstract
Surgery for gastric cancer should be performed as soon as possible after diagnosis. However, sometimes the waiting time for surgery tends to be longer. The relation between the waiting time for surgery and survival in patients with gastric cancer remains to be fully investigated. This retrospective, single-center cohort study evaluated patients with gastric cancer who underwent curative surgery from 2006 through 2012 at Kanagawa Cancer Center in Japan. Patients who received neoadjuvant chemotherapy were excluded. The waiting time for surgery was defined as the time between the first visit and surgery. We investigated whether the waiting time for surgery has a linear negative impact on outcomes by using a Cox regression model with clinical prognostic factors. In total, 801 patients were eligible. The median waiting time was 45 days (range 10–269 days). The restricted cubic spline regression curve showed that the adjusted time-specific hazard ratios of waiting times did not indicate a linear negative trend on survival between 20 and 100 days (p = 0.759). In the Cox model with a quartile of waiting times, waiting times in the 32–44-day group, 43–62-day group, and ≥63 day groups were not associated with poorer overall survival as compared with the ≤31 day group (HR: 1.01, 95% CI 0.63–1.60, p = 0.984, HR: 1.17, 95% CI 0.70–1.94, p = 0.550, HR: 1.06, 95% CI 0.60–1.88, p = 0.831, respectively). There was no negative relation between the waiting time for surgery (within 100 days) and survival in patients with gastric cancer.
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- 2020
14. Surgical Outcomes of Pancreaticoduodenectomy for Pancreatic Cancer with Proximal Dorsal Jejunal Vein Involvement
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Takao Itoi, Tomoki Shirota, Akihiko Tsuchida, Yatsuka Sahara, Chie Takishita, Hiroshi Yamaguchi, Tetsushi Nakajima, Atsushi Sofuni, Keiichiro Inoue, Hiroaki Osakabe, Kazuhiro Saito, Kenji Katsumata, Takayoshi Tsuchiya, Yosuke Hijikata, Yuichi Hosokawa, and Yuichi Nagakawa
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Pancreaticoduodenectomy ,03 medical and health sciences ,Mesenteric Veins ,0302 clinical medicine ,medicine.artery ,Pancreatic cancer ,medicine ,Humans ,Neoplasm Invasiveness ,Superior mesenteric artery ,Superior mesenteric vein ,Vein ,Pathological ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Vascular Neoplasms ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Duodenum ,Female ,030211 gastroenterology & hepatology ,Pancreas ,business ,Carcinoma, Pancreatic Ductal - Abstract
The proximal jejunal vein which branches from the dorsal side of the superior mesenteric vein (SMV) usually drains the inferior pancreatoduodenal veins (IPDVs) and contacts the uncinate process of the pancreas. We focused on this vein, termed the proximal dorsal jejunal vein (PDJV), and evaluated the anatomical classification of the PDJV and surgical outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) with PDJV involvement (PDJVI). The jejunal veins that branch from the dorsal side of the SMV above the inferior border of the duodenum are defined as PDJVs. We investigated 121 patients who underwent upfront pancreaticoduodenectomy for PDAC between 2011 and 2017; PDJVs were resected in all patients. The anatomical classification of PDJV was evaluated using multidetector computed tomography. Surgical and prognostic outcomes of pancreticoduodenectomy for PDAC with PDJVI were evaluated. The PDJVs were classified into seven types depending on the position of the first and second jejunal veins relative to the superior mesenteric artery. In all patients, the morbidity and mortality rates were 15.7 and 0.8%, respectively. The rates for parameters including SMV resection, presence of pathological T3–4, R0 resection, and 3-year survival were 46.2, 92.3, 92.3, and 61.1%, respectively, when there was PDJVI (n = 13). When there was no PDJVI (n = 108), the rates were 60.2, 93.5, 86.1, and 58.3%, respectively. Overall, there were no significant differences. Pancreaticoduodenectomy with PDJV resection is feasible for PDAC with PDJVI and satisfactory overall survival rates are achievable. It may be necessary to reconsider the resectability of PDAC with PDJVI.
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- 2018
15. Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy
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Akihiko Tsuchida, Hiroaki Osakabe, Chie Takishita, Kenji Katsumata, Yosuke Hijikata, Tetsushi Nakajima, Masafumi Nakamura, Tomoki Shirota, Yuichi Hosokawa, Yatsuka Sahara, and Yuichi Nagakawa
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Dissection (medical) ,030230 surgery ,Pancreaticoduodenectomy ,Veins ,03 medical and health sciences ,0302 clinical medicine ,Mesenteric Artery, Superior ,Pancreatic tumor ,medicine.artery ,Multidetector Computed Tomography ,medicine ,Humans ,Superior mesenteric artery ,Superior mesenteric vein ,Aged ,Aged, 80 and over ,business.industry ,Inferior pancreaticoduodenal artery ,Middle Aged ,medicine.disease ,SMA ,Surgery ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Anatomic Landmarks ,business ,Abdominal surgery - Abstract
Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method. The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups. Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively; p = 0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%). This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times.
- Published
- 2018
16. A Case of Bowel Obstruction due to a Small Intestinal GIST with Hepatic Portal Venous Gas, which was Treated by Elective Surgery
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Akihiro Mimuro, Akihiko Tsuchida, Kazushige Ito, Yasuharu Hayashida, Sumito Hoshino, Hiroaki Osakabe, Yu Takagi, and Yousuke Hijikata
- Subjects
Bowel obstruction ,medicine.medical_specialty ,business.industry ,medicine ,Elective surgery ,Small Intestinal GIST ,medicine.disease ,Hepatic portal ,business ,Surgery - Published
- 2017
17. Precise anatomical resection based on structures of nerve and fibrous tissue around the superior mesenteric artery for mesopancreas dissection in pancreaticoduodenectomy for pancreatic cancer
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Yoshitaka Kiya, Yatsuka Sahara, Iwao Sato, Akihiko Tsuchida, Yuichi Nagakawa, Hiroaki Osakabe, Hiroshi Yamaguchi, Shuang-Qin Yi, Yoko Miwa, and Chie Takishita
- Subjects
Diarrhea ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,Autopsy ,Adenocarcinoma ,Metastasis ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Mesenteric Artery, Superior ,Pancreatic cancer ,medicine.artery ,Medicine ,Humans ,Mesentery ,Superior mesenteric artery ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,business.industry ,Nerve plexus ,SMA ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Feasibility Studies ,030211 gastroenterology & hepatology ,Female ,Anatomic Landmarks ,business - Abstract
BACKGROUND The aim of the present study was to investigate the feasibility of resection based on the nerve and fibrous tissue (NFT) structures around the superior mesenteric artery (SMA) for resectable pancreatic adenocarcinoma (R-PDAC) patients. METHODS NFTs around the SMA were classified into four "intensive NTFs area" with spreading the NFTs around the SMA and three SMA nerve plexus regions without branching nerves according to autopsy findings. Complete dissection of four "intensive NTFs areas" was performed by pre-exposing three SMA nerve plexus regions without branching nerves as "dissection-guiding points" with SMA nerve plexus preservation (NFT-based resection). Among 157 R-PDAC patients undergoing pancreaticoduodenectomy, surgical outcomes of 78 patients with NFT-based resection were compared with 59 patients with half-SMA nerve plexus dissection and 20 patients without NFTs dissection. RESULTS In the NFT-based resection group, 76.5% had tumor involvement and metastasis in each intensive NTFs area. Operative time, blood loss, and postoperative diarrhea rate were significantly lower in NFT-based resection than in half-SMA nerve plexus group (321 vs 390 min; P
- Published
- 2019
18. Sharing Landmarks for Setting a Cutting Line Leads to Safe Laparoscopic Pancreaticoduodenectomy
- Author
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Hiroaki Osakabe, Y. Hosokawa, Masanori Akashi, Hitoe Nishino, Akihiko Tsuchida, Yuichi Nagakawa, Chie Takishita, T. Nakajima, and Kenji Katsumata
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,Medicine ,Line (text file) ,business ,Laparoscopic pancreaticoduodenectomy - Published
- 2021
19. Blumgart method using LAPRA-TY clips facilitates pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy
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Tomoki Shirota, Yosuke Hijikata, Tetsuo Ishizaki, Akihiko Tsuchida, Chie Takishita, Hitoe Nishino, Kenji Katsumata, Masanori Akashi, Yuichi Hosokawa, Yatsuka Sahara, Hiroaki Osakabe, Yuichi Nagakawa, and Tetsushi Nakajima
- Subjects
Male ,medicine.medical_specialty ,Blumgart method ,medicine.medical_treatment ,minimally invasive pancreatic surgery ,Anastomosis ,pancreaticojejunostomy ,Pancreaticoduodenectomy ,Pancreatic Fistula ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Suture (anatomy) ,Quality Improvement Study ,laparoscopic pancreaticoduodenectomy ,medicine ,Humans ,030212 general & internal medicine ,CLIPS ,computer.programming_language ,business.industry ,Open surgery ,Anastomosis, Surgical ,Suture Techniques ,General Medicine ,Middle Aged ,Surgical Instruments ,medicine.disease ,laparoscopic surgery ,Surgery ,Treatment Outcome ,Pancreatic fistula ,LAPRA-TY ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,business ,Pancreatic stump ,computer ,Laparoscopic pancreaticoduodenectomy ,Research Article - Abstract
The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy. We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group). The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39–79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53–105 min, P
- Published
- 2020
20. Surgical resection of neuroendocrine tumors of the pancreas (pNETs) by minimally invasive surgery: the laparoscopic approach
- Author
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Tomoki Shirota, Tetsushi Nakajima, Yuichi Hosokawa, Yuichi Nagakawa, Hiroaki Osakabe, Yatsuka Sahara, Akihiko Tsuchida, Yosuke Hijikata, Kenji Katsumata, and Chie Takishita
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Perioperative ,Review Article ,Neuroendocrine tumors ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatectomy ,Invasive surgery ,medicine ,Endocrine system ,030211 gastroenterology & hepatology ,business ,Pancreas - Abstract
Neuroendocrine tumors of the pancreas (pNETs) are a rare group of neoplasms that originate from the endocrine portion of the pancreas. Tumors that either secrete or do not secrete compounds, resulting in symptoms, can be classified as functioning and non-functioning pNETs, respectively. The prevalence of such tumors has recently increased due to the use of more sensitive imaging techniques, such as multidetector computed tomography, magnetic resonance imaging and endoscopic ultrasound. The biological behavior of pNETs varies widely from indolent, well-differentiated tumors to those that are far more aggressive. The most effective and radical treatment for pNETs is surgical resection. Over the last decade, minimally invasive surgery has been increasingly used in pancreatectomy, with laparoscopic pancreatic surgery (LPS) emerging as an alternative to open pancreatic surgery (OPS) in patients with pNETs. Non-comparative studies have shown that LPS is safe and effective. In well-selected groups of patients with pancreatic lesions, LPS was found to results in good perioperative outcomes, including reduced intraoperative blood loss, postoperative pain, time to recovery, and length of hospital stay. Despite the encouraging results of studies from highly specialized centers with extensive experience, no randomized trials to date have conclusively validated these findings. Indications for minimally invasive LPS for patients with pNETs remain unclear. This review presents the current state of LPS for pNETs.
- Published
- 2018
21. Safe zone for left renal vein exposure during laparoscopic radical antegrade modular pancreatosplenectomy for pancreatic cancer
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Yuichi Nagakawa, Masanori Akashi, Yatsuka Sahara, Masayuki Otsuka, Hitoe Nishino, Chie Takishita, Kenji Katsumata, Hiroaki Osakabe, Akihiko Tsuchida, and Yosuke Hijikata
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Pancreatic cancer ,Gastroenterology ,Medicine ,Left renal vein ,business ,medicine.disease ,Surgery - Published
- 2019
22. Usefulness of multi-3-dimensional computed tomograms fused with multiplanar reconstruction images and peroral cholangioscopy findings in hilar cholangiocarcinoma
- Author
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Takao Itoi, Tetsushi Nakagima, Takayoshi Tsuchiya, Kyo Bunso, Yuichi Hosokawa, Yuichi Nagakawa, Akihiko Tsuchida, Kazuhiko Kasuya, Hiroshi Kuwabara, and Hiroaki Osakabe
- Subjects
Adult ,Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Intrahepatic bile ducts ,Resection ,Cholangiocarcinoma ,Diagnosis, Differential ,Endoscopic imaging ,Imaging, Three-Dimensional ,Cholangiography ,Multidetector Computed Tomography ,Preoperative Care ,Biopsy ,medicine ,Humans ,Endoscopy, Digestive System ,Aged ,Retrospective Studies ,R0 resection ,Aged, 80 and over ,Hepatology ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Middle Aged ,Multiplanar reconstruction ,Biliary Tract Surgical Procedures ,Bile Ducts, Intrahepatic ,Bile Duct Neoplasms ,Surgery, Computer-Assisted ,Female ,Surgery ,Radiology ,Tomography ,business ,Follow-Up Studies - Abstract
Multiplanar reconstruction (MPR) images are used for assessing horizontal and vertical extent of hilar cholangiocarcinoma, while peroral cholangioscopy (POCS) is used for diagnosing ductal spread and mapping biopsy. We fused conventional 3-dimensional computed tomography (3DCT) with MPR images and POCS findings for preoperative assessment of cholangiocarcinoma. The extent of cancer was assessed using MPR images, which were plotted and fused onto 3DCT cholangiography. In addition, the results of mapping biopsy performed under POCS were marked on virtual endoscopic imaging and transferred onto a 3DCT image. Once an angiographic CT image was fused, a multi-3DCT image was created. The incision line was determined based on these images. Multi-3DCT images were created for 13 patients with hilar cholangiocarcinoma. Of 10 patients who underwent POCS, superficial spread was observed in two. Resection was performed in 12 patients. In two cases, the cut end of the intrahepatic bile duct was positive, resulting in 83.3% diagnostic accuracy for horizontal spread. In all patients, the estimated number of bile ducts was the same as the number of the actual resections. R0 resection was achieved in 10 patients (83.3%). Multi-3DCT imaging proved useful in diagnosing longitudinal ductal spread of hilar cholangiocarcinoma.
- Published
- 2014
23. PS02.196: STUDY OF BODY COMPOSITION CHANGE AFTER ESOPHAGECTOMY
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Yuta Kumazu, Shinsuke Nagasawa, Hiroaki Osakabe, Takashi Ogata, Tsutomu Hayashi, Masato Nakazono, Takanobu Yamada, Kentaro Hara, and Takaki Yoshikawa
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medicine.medical_specialty ,Esophagectomy ,business.industry ,medicine.medical_treatment ,Internal medicine ,Gastroenterology ,medicine ,General Medicine ,business ,Composition (language) - Abstract
Background Esophageal cancer surgery with lymphadenectomy is known as a cause of weight loss during perioperative period, but the change of body composition is unclear. Methods The aim of study is to clarify the influence of body composition change after esophagectomy. 144 patients(51 cases without NAC and 93 cases with NAC: 98 cases with less than G2 perioperative complications and 46 cases with G2 or more perioperative complications: 36 cases with recurrence and 108 cases without recurrence were included) of esophageal cancer who underwent esophagectomy with lymphadenectomy from August 2011 to December 2016 and evaluated body composition examination before operation and after operation(1, 3, 6 month) were included in this study. We compared the change of body composition between with or without preoperative chemotherapy, postoperative complication, and recurrence. Results The weight loss rate at discharging hospital, 1,3,6 month after discharge for without NAC group/with NAC group was 3.3/3.8%, 7.8/6.8%, 10.1/9.2%, 11.1/9.1% (NS), and the lean body mass reduction rate was 4.1/4.5%, 7.1/6.6%, 6.5/6.7% (N.S.), 6.6/4.3% (P Conclusion Due to postoperative complications after esophagectomy, the rate of weight loss increased from hospital discharge to 6 months after discharge. Particularly, lean body mass was reduced within 3 months. So, we may have a strategy such as continuing enteral nutrition even after discharge for complicated cases. Disclosure All authors have declared no conflicts of interest.
- Published
- 2018
24. Efficacy of postoperative adjuvant chemotherapy using S-1 in elderly patients with resectable pancreatic cancer
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Hiroaki Osakabe, Akihiko Tsuchida, Yosuke Hijikata, Yuichi Nagakawa, Yatsuka Sahara, Kenji Katsumata, Hitoe Nishino, Akashi Masanori, and Chie Takishita
- Subjects
Resectable Pancreatic Cancer ,Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,Adjuvant chemotherapy ,Internal medicine ,Gastroenterology ,medicine ,business - Published
- 2019
25. A novel classification of mesopancreas based on the anatomical structure of nerve and fibrous tissue as new landmark in pancreaticoduodenectomy for pancreatic and periampullary cancer
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Y. Hosokawa, Hiroaki Osakabe, Chie Takishita, Yatsuka Sahara, Yuichi Nagakawa, T. Nakajima, Akihiko Tsuchida, Yosuke Hijikata, T. Shirota, and N. Kobayashi
- Subjects
medicine.medical_specialty ,Landmark ,Hepatology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Fibrous tissue ,Pancreaticoduodenectomy ,people.cause_of_death ,medicine ,Periampullary cancer ,Radiology ,business ,people - Published
- 2018
26. Enteral feeding during preoperative chemotherapy for patients with local advanced esophageal cancer: A feasibility study
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Masato Nakazono, Takaki Yoshikawa, Hiroaki Osakabe, Tsutomu Hayashi, Takanobu Yamada, Yuta Kumazu, Shinsuke Nagasawa, Takashi Ogata, and Kentaro Hara
- Subjects
Cancer Research ,medicine.medical_specialty ,Oral ingestion ,Oncology ,business.industry ,Internal medicine ,medicine ,Advanced esophageal cancer ,Preoperative chemotherapy ,business ,Enteral administration ,Gastroenterology - Abstract
e16012Background: During preoperative chemotherapy, appropriate nutritional support is necessary. Especially advanced esophageal cancer patients sometimes have a difficulty of oral ingestion. In Ja...
- Published
- 2018
27. The feasibility and safety of laparoscopy-assisted distal gastrectomy that was performed by trainee supervised by a technically qualified surgeon
- Author
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Masato Nakazono, Hiroaki Osakabe, Takashi Ogata, Yuta Kumazu, Shinsuke Nagasawa, Takanobu Yamada, Tsutomu Hayashi, Kentaro Hara, and Takaki Yoshikawa
- Subjects
Cancer Research ,medicine.medical_specialty ,Oncology ,medicine.diagnostic_test ,business.industry ,Distal gastrectomy ,General surgery ,Medicine ,Laparoscopic gastrectomy ,business ,Laparoscopy - Abstract
183 Background: The laparoscopic gastrectomy is becoming widespread. But acquisition of its technique is challenging. We investigated whether supervision by a technically qualified surgeon (QS) affects the feasibility and safety of laparoscopic gastrectomy performed by trainee (TR). Methods: The outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer performed by QS group and TR group between 2013 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries that ware performed by trainee as the teaching assistant. Results: All patient characteristics were not different between QS group and TR group, except of BMI (median BMI 23.9 vs 22.2, p = 0.01). Although operation time of TR group was longer than that of QS group (median time: 248 min. vs 285 min., p = 0.01), Blood loss and number of harvested lymph nodes were not different. One patient (0.3%) in QS group and two patients (0.4%) in TR group required conversion to open surgery (p = 0.58). Postoperative complication, that was defined by Clavien-Dindo classification grade 3 and more, occurred in four patients (11.4%) in QS group and nine patients (5.4%) in TR group (p = 0.25). Complication in QS group were anastomotic leakage (n = 2) and abdominal abscess (n = 2), whereas that in TR group were anastomotic leakage (n = 3), anastomotic stenosis (n = 2), pancreatic fistula (n = 1), bowel obstruction (n = 1), pneumothorax (n = 1), and cerebral hemorrhage (n = 1). One patient in QS group (2.9%) and four patients in TR group (2.4%) underwent reoperation (p = 1.00). Postoperative mortality occurred in one cases in TR group (0.01%). Conclusions: The laparoscopy-assisted distal gastrectomy of TR group supervised by QS was feasible and safe procedure as well as that of QS group.
- Published
- 2018
28. Volume reduction rate of the primary tumor as an objective clinical measure to evaluate efficacy of neoadjuvant chemotherapy for esophageal squamous cell carcinoma
- Author
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Masato Nakazono, Hiroaki Osakabe, Shinsuke Nagasawa, Takaki Yoshikawa, Yuta Kumazu, Takashi Ogata, Yasushi Rino, Tsutomu Hayashi, Kentaro Hara, Munetaka Masuda, and Takanobu Yamada
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Standard treatment ,medicine.disease ,Esophageal squamous cell carcinoma ,Primary tumor ,Internal medicine ,medicine ,Volume reduction ,business - Abstract
42 Background: Neoadjuvant chemotherapy (NAC) followed by surgery is a standard treatment for esophageal squamous cell carcinoma (ESCC) in Japan. Efficacy of NAC on the primary tumor is clinically evaluated during NAC and before surgery and is pathologically examined after surgery. Clinical evaluation of the primary tumor is sometimes difficult because primary tumor is nonmesurable lesion and is usually evaluated subjectively, while pathological finding is objective and a gold standard to evaluate efficacy of NAC. In the present study, we tried to evaluate clinicaly efficacy objectively by calcurating tumor volume by esophagography and concordance between volume reduction rate and pathological efficacy. Methods: This retrospective study examined 53 patients who fullfilled the following criteria; (1) thoracic ESCC, (2) underwent resection following NAC between January 2011 and February 2017, and (3) T2-3N0 before surgey. Clinically, volume of the primary tumor was calculated by multiplying length and thickness in the lateral view of esophagography. Pathological efficacy was examined by the proportion of the tumor disappearance of the primary tumor and was classified as Grade 0-1 when degeneration area was < 2/3, Grade 2 when those area was > 2/3 and < 3/3, and Grade 3 when there was no residual tumor. Volume reduction rate calculrated by the difference of pre- and post-NAC was compared by stratifying pathological grade. Results: T2/T3 was 23/30, respectively. Regimen of neoadjuvant chemotherapy was 5-FU/CDDP in 50 patients,docetaxel/5-FU/CDDP in 1,and 5-FU/CDDP and Radiotherapy in 2. Overall volume reduction rate was 58.9% in median (range -127-100%). Pathological response (Grade 0-1/2/3) was 28/18/4, respectively. Median volume reduction rate (range) was 38.5% (-127-100%) in Grade 0-1, 72.2% (21.7-100%) in Grade 2, and 91.1% (75.5-100%) in Grade 3, which was significantly different (p < 0.01). Conclusions: The volume reduction rate of the primary tumor was correlated with pathological efficacy, suggesting that volume reduction rate could be a objective measure to evaluate efficacy of neoadjuvant chemotherapy for ESCC.
- Published
- 2018
29. Feasibility study of preoperative chemotherapy for patients with advanced esophageal cancer with or without naso-gastric ED tube for enteral feeding
- Author
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Kentaro Hara, Masato Nakazono, Hiroaki Osakabe, Tsutomu Hayashi, Takanobu Yamada, Takaki Yoshikawa, Yuta Kumazu, Shinsuke Nagasawa, and Takashi Ogata
- Subjects
Cancer Research ,medicine.medical_specialty ,Oncology ,business.industry ,Standard treatment ,medicine ,Advanced esophageal cancer ,Preoperative chemotherapy ,Tube (fluid conveyance) ,Swallow food ,business ,Enteral administration ,Surgery - Abstract
184 Background: Advanced esophageal cancer patients sometimes have a difficulty to swallow food. On the other hand, standard treatment for resectable advanced esophageal cancer patients is surgery after 2 course preoperative chemotherapy of CDDP-5-FU (JCOG 9907). So we usually use naso-gastric ED tube for patients with difficulty of oral intake during preoperative chemotherapy to administrate adequate nutrition. But there is no report of the safety of this trial. Methods: The aim of this study is to clarify the safety of using ED tube during preoperative chemotherapy and compare the nutritional status between using ED tube or not. From Jan 2012 to June 2017, 122 patients were undergone esophagectomy with 2 course of preoperative chemotherapy, and 14 patients were treated with ED tube for nutrition(Group A) and 108 patients without ED tube(Group B). We evaluated the changes of nutritional status and postoperative complication as an indicator of safety. Results: Changes before and after preoperative chemotherapy(GroupA/B): average of body weight: 53.1→50.8/58.1→57.0, BMI: 20.0→19.2/22.0→21.6, TP: 6.7→6.9/7.3→6.9, alb: 3.5→3.8/4.3→4.2, pre-alb: 20.1→21.7/24.8→23.4, RBP: 2.77→3.33/3.15→3.23. Adverse events during chemotherapy: 1 case of Grade 3 hematologic toxicity and 1 case of Grade 2 non-hematologic toxicity were found at Group A(14.2%), and 11 cases of Grade 3 hematologic toxicity and 8 cases of Grade 2 non-hematologic toxicity were found at Group B(17.61%)(p = 0.758). Postoperative complications (clavien-dindo classification, Grade3 or more): 2 cases were observed at Group A(14.2%), and 21 cases were observed at Group B(19.4%)(p = 0.62). Conclusions: Preoperative chemotherapy with ED tube for nutrition was safe and effective to maintain the preoperative nutritional status.
- Published
- 2018
30. Prognostic impact of interval between diagnosis and surgery in patients with gastric cancer
- Author
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Hiroaki Osakabe, Shinsuke Nagasawa, Takanobu Yamada, Kentaro Hara, Tsutomu Sato, Masato Nakazono, Munetaka Masuda, Yuta Kumazu, Takaki Yoshikawa, Yasushi Rino, Tsutomu Hayashi, Toru Aoyama, and Takashi Ogata
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Internal medicine ,Cancer cell ,Medicine ,Cancer ,Interval (graph theory) ,In patient ,business ,medicine.disease - Abstract
24 Background: Patients with gastric cancer should receive treatment for the cure as soon as possible because cancer cells are considered to grow and metastasize quickly. However, patients sometimes have to wait for the treatment because of further examinations of comorbidity, social background, and limited medical resources. It remained unclear whether interval between diagnosis and surgery is a risk factor for the survival. Methods: This retrospective single-center study examined 801 patients who visited outpatient clinic for gastric cancer and underwent curative surgery from 2006 to 2012 at Kanagawa Cancer Center in Japan. The patients who received neoadjuvant chemotherapy were excluded. Interval was defined as the time from the date of the first visit to the date of surgery. Interval was divided by the median and was classified to the early (less than median) and the late (exceeding the median) groups. Survival was analyzed by separating clinical T1 and T2-4. Results: 461 patients had clinical T1 and 340 had clinical T2-4. Median interval was 55 days (15-269 days) in clinical T1 and 35 days (10-148 days) in clinical T2-4, respectively. In clinical T1, 5-year survival rate was 93.1% in the early group and 91.2% in the late group (p = 0.456). In clinical T2-4, 5-year survival rate was 77.8% in the early group and 78.9% in the late group (p = 0.864). In the multivariate analysis, significant independent risk factors were over 75 years of age and clinical T4, and clinical N+, over 75 years of age in clinical T1, and over 75 years of age and clinical T4 in clinical T2-4. Interval was not significant factor both in clinical T1 (HR: 1.242, 95%CI 0.641-2.407 p = 0.522) and in clinical T2-4 (HR: 1.078, 95%CI 0.672-1.729 p = 0.756). Conclusions: Interval between diagnosis and surgery did not have a negative impact on the prognosis in patients with gastric cancer. Necessary interval for the clinical practice would be acceptable.
- Published
- 2018
31. Laparoscopic pancreaticoduodenectomy with extended lymph node dissection
- Author
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Hiroaki Osakabe, Yuichi Hosokawa, Kazuhiko Kasuya, Tetsushi Nakazima, Hiroshi Kuwabara, Yuchi Nagakawa, and Akihiko Tsuchida
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Endocrinology, Diabetes and Metabolism ,General surgery ,Gastroenterology ,medicine.disease ,Primary disease ,Surgery ,law.invention ,Dissection ,medicine.anatomical_structure ,Randomized controlled trial ,Median follow-up ,Pancreatic fistula ,law ,Medicine ,Lymph ,business ,Lymph node ,Laparoscopic pancreaticoduodenectomy - Abstract
s / Pancreatology 13 (2013) S1–S80 S63 ml). There was no conversion to open. 2 patients had developed pancreatic fistula (Grade A), which resolved spontaneously. In five of 7 patient (71.4%), R0 resection could be achieved, but the remaining two patients showed R1 resection. The mean numbers of retrieved lymph nodes were 17 (range, 9w40). The average postoperative hospital stay was 17.4 days (range, 7w47 days). Median follow up was 12 months (range, 6w33months). Peritoneal recurrence occurred in 2 patients. One of them died by primary disease. The remaining 5 patients are alive without recurrence. Conclusions: LDP for PDAC can be feasible, safe, and effective in highly selected patients. Clearly, a prospective, randomized study is needed to elucidate appropriate indications and effects of the present procedure.
- Published
- 2013
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