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Risk factors for occult metastasis detected by inflammation-based prognostic scores and tumor markers in biliary tract cancer

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World Journal of Clinical Cases 2021年第32期9卷 9770-9782页

作者： Yu Hashimoto Tetsuo Ajiki hiroaki yanagimoto Daisuke Tsugawa Kenta Shinozaki Hirochika Toyama Masahiro Kido Takumi Fukumoto Department of Surgery Division of Hepato-Biliary-Pancreatic SurgeryKobe University Graduate School of MedicineKobeHyogo 650-0017Japan

BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after *** laparoscopy may help avoid unnecessary ***,which category of BTC is amenable with staging laparoscopy remains *** To clarify the risk factors for occult metastasis in patients with *** Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively *** patients were divided into two groups,according to resection or exploratory laparotomy(EL).Preoperative laboratory data,including inflammation-based prognostic scores and tumor markers,were compared between the two *** importance of detected risk factors was also *** A total of 236 patients were enrolled in this ***-six(11%)patients underwent *** the EL patients,there were 16 cases of occult metastasis(7 liver metastases and 9 abdominal disseminations).Serum carcinoembryonic antigen level,carbohydrate antigen 19-9 level,neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group,and these factors were *** these factors,carcinoembryonic antigen>7 ng/mL was the most useful to predict occult metastasis in *** patients have more than three of these positive factors,the rate of occult metastasis *** Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC;based on these factors,staging laparoscopy may reduce the rate of EL.

关键词： Biliary tract cancer Staging laparoscopy Neutrophil-lymphocyte ratio Modified Glasgow prognostic score Carbohydrate antigen 19-9 Carcinoembryonic antigen

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Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

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World Journal of Clinical Cases 2024年第2期12卷 276-284页

作者： Taiichiro Miyake hiroaki yanagimoto Daisuke Tsugawa Masayuki Akita Riki Asakura Keisuke Arai Toshihiko Yoshida Shinichi So Jun Ishida Takeshi Urade Yoshihide Nanno Kenji Fukushima Hidetoshi Gon Shohei Komatsu Sadaki Asari Hirochika Toyama Masahiro Kido Tetsuo Ajiki Takumi Fukumoto Division of Hepato-Biliary-Pancreatic Surgery Department of SurgeryKobe University Graduate School of MedicineKobe 650-0017HyogoJapan

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of *** use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative ***,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after *** To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after *** The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively *** were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower *** factors,including demographic data and perioperative D-dimer values,were compared between the two *** operating characteristic curve analysis was performed to determine the D-dimer cutoff *** and multivariate analyses were performed using logistic regression analysis to identify significant *** In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE *** the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after *** Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the

关键词： Hepatectomy Malignant tumor Postoperative complication D-dimer Early diagnosis Venous thromboembolism

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Implementation of an educational program for pancreaticoduodenectomy in a university hospital: a retrospective observational study

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Journal of Pancreatology 2021年第2期4卷 99-105页

作者： Sohei Satoi Tomohisa Yamamoto So Yamaki Satoshi Hirooka Daisuke Hashimoto Tatsuma Sakaguchi Hironori Ryota Rintaro Yui Kazuto Sakuramoto Hideyuki Matsushima hiroaki yanagimoto Hideyoshi Toyokawa Taku Michiura Kentaro Inoue Mitsugu Sekimoto Department of Surgery Kansai Medical UniversityOsakaJapan

Objective:No ideal training system exists for pancreaticoduodenectomy(PD).We developed an educational system that uses an objective structured assessment of technical ***:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University *** total score on the task checklist(21 parameters)for measuring technical performance during PD by self assessment and instructor assessment was compared between junior(JN)and hepatobiliary pancreatic(HBP)trainees at a university *** outcomes of 303 PDs(2007-2013)were also compared among JN trainees,HBP trainees,and instructors,and the present position of the trainees was *** study was approved by the institutional review board of Kansai Medical University on May 26,***:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD(P<.001).The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 *** total score curves rose to the right in the JN group,scores in the HBP group were stable,at 70 or higher,which correlated with the instructor *** 90-day and 30-day mortality rates were 1.6%and 0.3%,*** and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the *** of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic ***:These results indicated good construct validity of the task checklist *** program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

关键词： Educational program Morbidity Mortality OSATS Pancreaticoduodenectomy

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