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Precision surgery with the genetic assessment for operable pancreatic cancer beyond the radiological assessment alone

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Hepatobiliary Surgery and Nutrition 2021年第2期10卷 261-263页

作者： Hiromitsu Hayashi hideo baba Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamotoJapan

We congratulate Dr.Dreyer and colleagues for their recently published study entitled“Precision oncology in surgery:Patient selection for operable pancreatic cancer”in Annals of Surgery(1).In this unique study,the authors tried to define preoperative clinical and molecular characteristics in order to improve patient selection for operable pancreatic cancer.Pancreatic ductal adenocarcinoma(PDAC)remains the most lethal type of human cancer due to its high chemoresistance and invasiveness(2).In resected PDAC,the median overall survival has increased from 22.1 to 35 months during the past 10 years,largely owing to improvements in adjuvant therapies(3,4).On the other hand,the high recurrence rate even in patients who underwent curative resection,and chemoresistance in the recurrent sites to current systemic chemotherapies(FOLFIRINOX and nab-paclitaxel plus gemcitabine),are major issues in the treatment for unselected PDAC patient populations.Surgical resection offers the only chance of cure,but surgery can be associated with significant morbidity and decreased activity of daily life(ADL),especially in the Whipple procedure(pancreaticoduodenectomy).Recently,the importance of preoperative chemotherapy even in operable PDAC has been increasingly recognized(5).Although molecular markers are being used more frequently to select patients for systemic targeted agents,only imaging modalities are used to stage patients and to assess their suitability for operative resection.Decisions on primary surgery or a neoadjuvant approach are made without evaluation of biological measures of tumor aggressiveness,or of the risk of occult metastatic disease.

关键词： surgery cancer Surgery

Vessels encapsulating tumor clusters in hepatocellular carcinoma:a unique and valuable pathological imaging

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 484-487页

作者： Yo-ichi Yamashita hideo baba Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityChuo-kuJapan

We read with great interest a paper recently published in Hepatology entitled"VETC(vessels encapsulating tumor clusters)is a powerful predictor of aggressive hepatocellular carcinoma(HCC)"written by Renne et al.,a multi-center study from Italy,Korea,and Japan(1).VETC is characterized by the presence of CD34+vessels completely encapsulating tumor clusters in pathological imaging.

关键词： hepatocellular al. pathological

Assessment for the minimal invasiveness of laparoscopic liver resection by interleukin-6 and thrombospondin-1

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World Journal of Hepatology 2022年第1期14卷 234-243页

作者： Takayoshi Kaida Hiromitsu Hayashi Hiroki Sato Shotaro Kinoshita Takashi Matsumoto Yuta Shiraishi Yuki Kitano Takaaki Higashi Katsunori Imai Yo-ichi Yamashita hideo baba Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamoto 860-8556Japan

BACKGROUND Laparoscopic surgery has been introduced as a minimally invasive technique for the treatment of various field.However,there are few reports that have scientifically investigated the minimally invasive nature of laparoscopic liver resection(LLR).AIM To investigate whether LLR is scientifically less invasive than open liver resection.METHODS During December 2011 to April 2015,blood samples were obtained from 30 patients who treated with laparoscopic(n=10,33%)or open(n=20,67%)partial liver resection for liver tumor.The levels of serum interleukin-6(IL-6)and plasma thrombospondin-1(TSP-1)were measured using ELISA kit at four time points including preoperative,immediate after operation,postoperative day 1(POD1)and POD3.Then,we investigated the impact of the operative approaches during partial hepatectomy on the clinical time course including IL-6 and TSP-1.RESULTS Serum level of IL-6 on POD1 in laparoscopic hepatectomy was significantly lower than those in open hepatectomy(8.7 vs 30.3 pg/mL,respectively)(P=0.003).Plasma level of TSP-1 on POD3 in laparoscopic hepatectomy was significantly higher than those in open hepatectomy(1704.0 vs 548.3 ng/mL,respectively)(P=0.009),and have already recovered to preoperative level in laparoscopic approach.In patients with higher IL-6 Levels on POD1,plasma level of TSP-1 on POD3 was significantly lower than those in patients with lower IL-6 Levels on POD1.Multivariate analysis showed that open approach was the only independent factor related to higher level of IL-6 on POD1[odds ratio(OR),7.48;95%confidence interval(CI):1.28-63.3;P=0.02].Furthermore,the higher level of serum IL-6 on POD1 was significantly associated with lower level of plasm TSP-1 on POD3(OR,5.32;95%CI:1.08-32.2;P=0.04)in multivariate analysis.CONCLUSION In partial hepatectomy,laparoscopic approach might be minimally invasive surgery with less IL-6 production compared to open approach.

关键词： Laparoscopic surgery Liver resection Hepatectomy Minimal invasiveness Interleukin-6 Thrombospondin-1

Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: is it time to reconsider the current treatment guidelines?

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Hepatobiliary Surgery and Nutrition 2018年第4期7卷 300-301页

作者： Katsunori Imai hideo baba Department of Gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto Japan

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is responsible for 70–90% of cases (1,2).The presence of macrovascular invasion such as portal vein tumor thrombus (PVTT) or hepatic vein tum... 详细信息

关键词： invasion hepatic thrombus

The gut microbiome, antitumor immunity, and liver cancer

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Hepatobiliary Surgery and Nutrition 2019年第1期8卷 67-68页

作者： Kosuke Mima hideo baba Department of Surgery National Hospital Organization Kumamoto Medical CenterKumamotoJapan Department of Gastroenterological Surgery Graduate School of Medical ScienceKumamoto UniversityKumamotoJapan

Primary liver cancer is one of the leading causes of cancer deaths globally(1).Hepatocellular carcinoma(HCC)is the most common primary liver malignancy,and the major risk factors for HCC include hepatitis B and C,alcohol consumption,non-alcoholic fatty liver disease,and liver cirrhosis(2).The liver is the common site of metastasis from breast,lung,and colorectal cancer,and malignant melanoma(3).

关键词： immunity cancer liver

Safety assessment of dextrin hydrogel adhesion barrier (AdSpray®) for elective laparoscopic cholecystectomy

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第2期5卷 61-65页

作者： Toshiro Masuda Hiroshi Takamori Moeko Kato Chisho Mitsuura Yuta Shiraishi Rumi Itoyama Kenji Shimizu Ryuichi Karashima Hidetoshi Nitta hideo baba Department of Surgery Saiseikai Kumamoto HospitalKumamoto861-4193Japan Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamoto860-0811Japan

Objective:Adhesion barriers have not traditionally been used during laparoscopic cholecystectomy(lapchole),and so there are no data confirming the safety of the dextrin hydrogel adhesion barrier(AdSpray®)for the use during lap-chole.The aim of this prospective study is to investigate the safety of AdSpray®for elective lap-chole.Methods:Between July 2019 and March 2021,we conducted a prospective study at Saiseikai Kumamoto Hospital to assess the safety of applying AdSpray®around the hepatoduodenal ligament,liver surface,and port area after extraction of the gallbladder during elective lap-chole.We assessed patient morbidity,mortality,and laboratory data on postoperative day 1 and at the outpatient follow-up visit.Results:A total of 100 patients(43 men,57 women)received AdSpray®application during elective lapchole at our institution.The mean patient age was 56.5±14.8 y,and the mean body mass index was 25.1±4.8 kg/m2.Preoperative gallbladder drainage was performed in 3(3.0%)patients as conservative treatment for acute cholecystitis.The mean operative time was 91.7±35.1 min,and the median blood loss was 5 mL(range,5e120 mL).Intraoperative gallbladder perforation was observed in 4.0%of patients(n=4).There was no intraoperative bile duct injury.One(1.0%)patient had a postoperative subhepatic fluid collection without bacterial infection.The mean white blood cell count and C-reactive protein level was significantly elevated on postoperative day 1 but returned to preoperative levels by the time of the follow-up visit.All patients were successfully discharged after surgery,and the median postoperative hospital stay was 2 d(range,2e9 d).Conclusion:Applying AdSpray®during elective lap-chole is safe,with an acceptable rate of postoperative complications.

关键词： Adhesion barrier Dextrin hydrogel Laparoscopic cholecystectomy

Recent advances in artificial intelligence for pancreatic ductal adenocarcinoma

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World Journal of Gastroenterology 2021年第43期27卷 7480-7496页

作者： Hiromitsu Hayashi Norio Uemura Kazuki Matsumura Liu Zhao Hiroki Sato Yuta Shiraishi Yo-ichi Yamashita hideo baba Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamoto 860-8556Japan

Pancreatic ductal adenocarcinoma(PDAC)remains the most lethal type of cancer.The 5-year survival rate for patients with early-stage diagnosis can be as high as 20%,suggesting that early diagnosis plays a pivotal role in the prognostic improvement of PDAC cases.In the medical field,the broad availability of biomedical data has led to the advent of the“big data”era.To overcome this deadly disease,how to fully exploit big data is a new challenge in the era of precision medicine.Artificial intelligence(AI)is the ability of a machine to learn and display intelligence to solve problems.AI can help to transform big data into clinically actionable insights more efficiently,reduce inevitable errors to improve diagnostic accuracy,and make real-time predictions.AI-based omics analyses will become the next alterative approach to overcome this poor-prognostic disease by discovering biomarkers for early detection,providing molecular/genomic subtyping,offering treatment guidance,and predicting recurrence and survival.Advances in AI may therefore improve PDAC survival outcomes in the near future.The present review mainly focuses on recent advances of AI in PDAC for clinicians.We believe that breakthroughs will soon emerge to fight this deadly disease using AI-navigated precision medicine.

关键词： Pancreatic cancer Pancreatic ductal adenocarcinoma Artificial intelligence Machine learning Precision medicine

Self-expanding metal stent placement and pathological alterations among obstructive colorectal cancer cases

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 704-717页

作者： Keisuke Kosumi Kosuke Mima Kosuke Kanemitsu Takuya Tajiri Toru Takematsu Yuki Sakamoto Mitsuhiro Inoue Yuji Miyamoto Takao Mizumoto Tatsuo Kubota Nobutomo Miyanari hideo baba Department of Gastroenterological Surgery Kumamoto UniversityKumamoto 860-8556Japan Department of Surgery National Hospital Organization Kumamoto Medical CenterKumamoto 860-0008Japan Department of Gastroenterological Surgery Graduate School of Medical SciencesKumamoto UniversityHonjo 860-8556KumamotoJapan

BACKGROUND Experimental studies suggest that self-expanding metal stents(SEMSs)enhance the aggressive behavior of obstructive colorectal cancer.The influence of SEMS placement on pathological alterations remains to be elucidated.AIM To determine whether SEMS placement is associated with molecular or pathological features of colorectal carcinoma tissues.METHODS Using a nonbiased molecular pathological epidemiology database of patients with obstructive colorectal cancers,we examined the association of SEMS placement with molecular or pathological features,including tumor size,histological type,American Joint Committee on Cancer(AJCC)-pTNM stage,and mutation statuses in colorectal cancer tissues compared with the use of transanal tubes.A multivariable logistic regression model was used to adjust for potential confounders.RESULTS SEMS placement was significantly associated with venous invasion(P<0.01),but not with the other features examined,including tumor size,disease stage,mutation status,and lymphatic invasion.In both the univariable and multivariable models with adjustment for potential factors including tumor location,histological type,and AJCC-pT stage,SEMS placement was significantly associated with severe venous invasion(P<0.01).For the outcome category of severe venous invasion,the multivariable odds ratio for SEMS placement relative to transanal tube placement was 19.4(95%confidence interval:5.24–96.2).No significant differences of disease-free survival and overall survival were observed between SEMS and transanal tube groups.CONCLUSION SEMS placement might be associated with severe venous invasion in colorectal cancer tissue,providing an impetus for further investigations on the pathological alterations by SEMSs in colorectal cancer development.

关键词： Bridge to surgery Colorectal carcinoma Obstruction Stent Venous invasion

Ectopic hepatocellular carcinoma mimicking a retroperitoneal tumor:A case report

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World Journal of Gastroenterology 2020年第18期26卷 2268-2275页

作者： Yuki Adachi Hiromitsu Hayashi Toshihiko Yusa Toru Takematsu Kazuki Matsumura Takaaki Higashi Kensuke Yamamura Takanobu Yamao Katsunori Imai Yo-ichi Yamashita hideo baba Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamoto 8608556Japan

BACKGROUND An ectopic hepatocellular carcinoma(EHCC)arises from the ectopic liver which is defined as a hepatic organ or tissue not connected to surrounding tissues.EHCC is a rare disease and it is difficult to diagnose preoperatively.Furthermore,the clinical features are not fully elucidated.CASE SUMMARY A retroperitoneal tumor(6 cm)was located at the dorsal side of the pancreas head on abdominal ultrasonography in an 81-year old woman positive for hepatitis C virus antibody.Contrast enhanced-computed tomography and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging showed viable HCC patterns with early enhancement and delayed washout.The tumor markers-serum alphafetoprotein and alpha-fetoprotein-L3%-were increased to 30.1 ng/m L and83.1%,respectively.Protein induced by vitamin K absence or antagonist-Ⅱwas within normal levels(17 m AU/m L).Positron emission tomography-computed tomography showed strong accumulation into the tumor(Standardized Uptake Value max:13.8),and the tumor cytology following endoscopic ultrasoundguided fine needle aspiration showed poorly differentiated carcinoma.Tumor extirpation was performed,and operative findings showed that the retroperitoneal tumor was disconnected from the pancreas and the liver.Swollen lymph nodes near the tumor were histologically normal.On histological examination,the tumor was finally diagnosed as EHCC with Arginase-1 positive expression.CONCLUSION We report our experience of a rare EHCC which was difficult to diagnose,and we present a review of the literature.

关键词： Ectopic hepatocellular carcinoma Differential diagnosis Retroperitoneal tumor Case report