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Laparoscopic approach for choledochojejunostomy

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Hepatobiliary & Pancreatic Diseases International 2019年第3期18卷 285-288页

作者： Tomohide Hori Yuki Aisu Michihiro Yamamoto Daiki Yasukawa Taku Iida Shintaro Yagi Kentaro Taniguchi Shinji Uemoto Department of Surgery Shiga General Hospital Moriyama 524-8524 Japan Department of Digestive Surgery Tenriyorodusoudanjyo Hospital Tenri 632-8552 Japan Department of Hepato-Biliary-Pancreatic and Surgery and Transplantation Kyoto University Hospital Kyoto 606-8507 Japan First Department of Surgery Mie University Hospital Tsu 514-8507 Japan

Laparoscopic hepatobiliary and pancreatic (HBP) surgery has been developed slowly because of technical challenges and a protracted learning curve with the exception of laparoscopic cholecystectomy [1]. Surgical treatments for benign diseases of the extrahepatic bile duct (EHBD) are classified according to their therapeutic purpose as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy)[2].

关键词： HBP EHBD Laparoscopic

Cholangiocarcinoma after flow diversion surgery for congenital biliary dilatation: A case report and review of literature

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World Journal of Hepatology 2019年第11期11卷 743-751页

作者： Ryo Ataka Takashi Ito Toshihiko Masui Satoru Seo Takamichi Ishii Satoshi Ogiso Shintaro Yagi Kojiro Taura Shinji Uemoto Department of Hepato-Biliary-Pancreatic Surgery and Transplantation Graduate School of Medicine Kyoto University

BACKGROUND Pancreaticobiliary maljunction(PBM)can be classified into two categories,PBM with congenital biliary dilatation(CBD)or PBM without biliary dilatation,and the management of PBM is often controversial.The treatment for PBM with CBD is prophylactic flow diversion surgery,and some authors have reported that the incidence of cancer after extrahepatic bile duct excision is less than 1%.A very rare case of intrahepatic cholangiocarcinoma 6 years after flow diversion surgery for PBM with CBD is reported.CASE SUMMARY A 30-year-old man was diagnosed as having PBM with CBD,Todani classification type IVA,because of abnormal liver enzyme profiles.He underwent flow diversion surgery and cholecystectomy,and the specimen showed adenocarcinoma foci,pT1,pStage IA.Five and a half years passed without any recurrence of bile duct cancer.However,6 years after his operation,computed tomography showed a gradually growing nodule in the bile duct.Fluorodeoxyglucose positron emission tomography showed high uptake,and magnetic resonance imaging showed restricted diffusion signals.On double balloon enteroscopy,the nodule at the posterior bile duct-jejunum anastomosis was directly visualized,and its biopsy specimen showed adenocarcinoma.The patient underwent right lobectomy and biliary reconstruction.The pathological diagnosis was intraductal papillary neoplasm with high-grade intraepithelial neoplasia,pTis,pN0,pStage 0.The patient’s postoperative course was uneventful,and he has had no recurrence up to the present time.CONCLUSION This case suggests the necessity of careful observation after flow diversion surgery,especially when PBM with CBD is detected in adulthood.

关键词： Congenital biliary dilatation Pancreaticobiliary maljunction Cholangiocarcinoma Recurrence Metachronous neoplasm Case report

Long-term survival after resection of pancreatic cancer:A single-center retrospective analysis

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World Journal of Gastroenterology 2015年第1期21卷 262-268页

作者： Takehito Yamamoto Shintaro Yagi Hiromitsu Kinoshita Yusuke Sakamoto Kazuyuki Okada Kenji Uryuhara Takeshi Morimoto Satoshi Kaihara Ryo Hosotani Department of Surgery Kobe City Medical Center General HospitalHyogo 650-0047Japan Clinical Research Center Kobe City Medical Center General HospitalHyogo 650-0047JapanChief Statistician

AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and < 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P =

关键词： Pancreatic cancer Long-term survival Longterm surv

Ultraviolet-induced alloantigen-specific immunosuppression in transplant immunity

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World Journal of Transplantation 2015年第1期5卷 11-18页

作者： Tomohide Hori Kagemasa Kuribayashi Kanako Saito Linan Wang Mie Torii Shinji Uemoto Taku Iida Shintaro Yagi Takuma Kato Department of Hepato-Pancreato-Biliary and Transplant Surgery Kyoto University Graduate School of MedicineKyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Graduate School of MedicineTsu 514-8507 Japan Department of Hematology and Medical Oncology Mie University Graduate School of MedicineTsu 514-8507 Japan

After the first observation of the immunosuppressive effects of ultraviolet(UV) irradiation was reported in 1974, therapeutic modification of immune responses by UV irradiation began to be investigated in the context immunization. UV-induced immunosuppression is via the action of regulatory T cells(Tregs). Antigen-specific Tregs were induced by high-dose UV-B irradiation before antigen immunization in many studies, as it was considered that functional alteration and/or modulation of antigen-presenting cells by UV irradiation was required for the induction of antigen-specific immunosuppression. However, it is also reported that UV irradiation after immunization induces antigen-specific Tregs. UV-induced Tregs are also dominantly transferable, with interleukin-10 being important for UV-induced immunosuppression. Currently, various possible mechanisms involving Treg phenotype and cytokine profile have been suggested. UV irradiation accompanied by alloantigen immunization induces alloantigen-specific transferable Tregs, which have potential therapeutic applications in the transplantation field. Here we review the current status of UV-induced antigen-specific immunosuppression on the 40th anniversary of its discovery.

关键词： Alloantigen Ultraviolet irradiation Donorspecific immunosuppression Interleukin-10 Regulatory T cells

Assessment of cardiac output in liver transplantation recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 362-366页

作者： Tomohide Hori Chiduru Yamamoto Shintaro Yagi Taku Iida Kentaro Taniguchi Takashi Hasegawa Koichiro Yamakado Yukinobu Hori Kan Takeda Kazuo Maruyama Shinji Uemoto Department of Hepato-Pancreato-Biliary Surgery and Transplantation Kyoto University Hospital54 Shogoinkawara- choSakyo-kuKyoto606-8507Japan Department of Hepatobiliary Pancreatic Surgery Mie University Hospital2-174 EdobashiTsu CityMie Prefecture514-8507 Japan Department of Anesthesiology and Critical Care Medicine Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Department of Radiology Mie University Graduate School of Medicine2-174 EdobashiTsu CityMie Prefecture514-8507Japan Nagoya Economic University Graduate School of Law 61-1 UchikuboInuyama City Aichi Prefecture 484-8504Japan

BACKGROUND:Liver cirrhosis causes peculiar systemic hemodynamics,and accurate evaluation of systemic hemodynamic state is important for cirrhotic recipients who underwent living donor liver transplantation(LDLT). We investigated the clinical advantages of a novel non- invasive method for measuring systemic hemodynamic parameters using indocyanine green(ICG). METHODS:Twenty-eight LDLT recipients were evaluated. Simultaneous measurements of cardiac output(CO)using Swan-Ganz catheters and pulse dye densitometry(PDD) were performed every 12 hours after LDLT.A total of 155 sets of simultaneous CO measurements were obtained. RESULTS:The CO values obtained by PDD correlated well with those obtained by the invasive catheter technique.In addition,none of the recipients developed any side-effects, and we verified the safety of repeated ICG injections.ICG is safe,even for repeated use over time in the same recipient. Moreover,PDD can measure the blood volume(BV).CONCLUSIONS:Since the cirrhotic systemic hemody- namics characterized by high CO and large BV remains, even after LDLT,the ability to measure CO and BV in a non-invasive,simple and real-time manner using PDD has advantages for cirrhotic LDLT recipients.

关键词： liver transplantation indocyanine green pulse dye densitometry blood volume cardiac output liver cirrhosis

Impact of lymph node micrometastasis in hilar bile duct carcinoma patients

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World Journal of Gastroenterology 2006年第16期12卷 2549-2555页

作者： Kentaro Taniguchi Taku Iida Tomohide Hori Shintaro Yagi Hiroshi Imai Taizo Shiraishi Shinji Uemoto First Department of Surgery Mie University School of Medicine2-174EdobashiTsu CityMie Prefecture514-8507Japan Second Department of Pathology Mie University School of Medicine2-174EdobashiTsu CityMie Prefecture514-8507Japan

瞄准：组织化学地在门胆汁管癌(HBDC ) 并且到检验微转移和 VEGF-C 表示到免疫评估结果的临床的意义。方法：从有节点否定的 HBDC 的 25 个病人的 361 个地区性的淋巴节点的一个总数是对 cytokeratins 与抗体染色的免疫 8 和 18 (凸轮 5... 详细信息

瞄准：组织化学地在门胆汁管癌(HBDC ) 并且到检验微转移和 VEGF-C 表示到免疫评估结果的临床的意义。方法：从有节点否定的 HBDC 的 25 个病人的 361 个地区性的淋巴节点的一个总数是对 cytokeratins 与抗体染色的免疫 8 和 18 (凸轮 5.2 ) ，并且免疫 VEGF-C 的组织化学的染色在 34 个主要 resected 肿瘤被执行。结果：淋巴节点微转移在 6 被检测(24%) 25 个病人并且 10 (2.8%) 361 个淋巴节点。没有，有微转移的病人比那些显示出显著地更差的幸存率(P = 0.025 ) 。VEGF-C 表示是积极的在里面(50%) 17 与淋巴节点转移 34 HBDC，并且显著地相关(P = 0.042 ) 并且显微镜的静脉的侵略(P = 0.035 ) 。结论：免疫组织化学地检测了微转移影响的淋巴节点，这被建议 HBDC 的结果。VEGF-C 表示高度在 HBDC 与淋巴节点转移被相关并且可能因此是一个有用预言者。

关键词：淋巴结冲击刺激肿瘤转移胆管癌

Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis

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World Journal of Gastroenterology 2007年第44期13卷 5918-5925页

作者： Tomohide Hori Shintaro Yagi Taku Iida Kentaro Taniguchi Kentaro Yamagiwa Chiduru Yamamoto Takashi Hasegawa Koichiro Yamakado Takuma Kato Kanako Saito Linan Wang Mie Torii Yukinobu Hori Kan Takeda Kazuo Maruyama Shinji Uemoto Departments of Hepatobiliary Pancreatic Surgery Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Cellular and Molecular Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Hepatobiliary Pancreatic and Transplant Surgery Kyoto University Hospital 54 Kawahara-cho Shogoin Sakyo-ku Kyoto 606-8507 Japan Department of Anesthesiology and Critical Care Medicine Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Radiology Mie University Hospital 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Medical Oncology and Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Nagoya Economic University Graduate School of Law 61-1 Uchikubo Inuyama City Aichi Prefecture 484-8504 Japan

AIM: To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT. METHODS: Systemic hemodynamics, indocyanine green (ICG) elimination rate (KICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the timerequired for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function. RESULTS: Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow. CONCLUSION: We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.

关键词：肝硬化肝移植高血压内脏

Malignant pheochromocytoma:Hepatectomy for liver metastases

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World Journal of Gastrointestinal Surgery 2013年第11期5卷 309-313页

作者： Tomohide Hori Kentaro Yamagiwa Tadataka Hayashi Shintaro Yagi Taku Iida Kentaro Taniguchi Yoshifumi Kawarada Shinji Uemoto Divisions of Hepato-Pancreato-Biliary Transplant and Pediatric SurgeryDepartment of SurgeryKyoto University HospitalKyoto 606-8507Japan First Department of Surgery Mie University HospitalTsuMie Prefecture514-8507Japan Second Department of Surgery Hamamatsu University HospitalHamamatsuShizuoka431-3192Japan

Malignant pheochromocytoma accounts for approximately 10% of pheochromocytoma cases. The main site of distant metastasis is the liver. Hypertensive crisis due to catecholamine oversecretion is potentially fatal. We present a case of malignant pheochromocytoma with multiple liver metastases. A 60-year-old female with repeated hypertensive episodes was diagnosed with malignant pheochromocytoma. She underwent a left adrenalectomy and partial hepatectomy with resection of segment 6. Catecholamine levels remained high after surgery and she received repeated cycles of chemotherapy. Four months after surgery, multiple liver metastases were detected. In spite of ongoing chemotherapy, catecholamine levels eventually became uncontrollable. Serum and urine noradrenaline andvanillylmandelic acid levels increased, but adrenaline and dopamine levels stayed within the normal range. Preoperative liver imaging revealed multiple metastases in all segments except segment 4. Percutaneous transhepatic portal vein embolization(PTPE) of the right and lateral branches of the portal vein was performed. The functional liver volume of segment 4 increased after PTPE. Right hepatectomy, lateral segmentectomy and partial resection of segment 1 were performed 10 mo after the initial surgery. Intraoperative ultrasonography detected two small tumors in segment 4, which were treated with intraoperative microwave coagulation therapy. Noradrenaline levels normalized immediately after the second hepatectomy. As there was increased telomerase activity in the resected specimen, she received adjuvant chemotherapy. She remained in good health for 2 years. However, further metastases eventually occurred and she subsequently died due to a brain hemorrhage. Hepatectomy may be a therapeutic option for reduction of tumor mass in pheochromocytoma with liver metastases.

关键词： Malignant pheochromocytoma Liver metastasis Mass reduction Percutaneous transhepatic portal vein embolization Hepatectomy

Carcinoembryonic antigen-producing adrenal adenoma resected using combined lateral and anterior transperitoneal laparoscopic surgery

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World Journal of Gastroenterology 2007年第45期13卷 6094-6097页

作者： Tomohide Hori Kentaro Taniguchi Masashi Kurata Kenji Nakamura Kenji Kato Yoshifumi Ogura Makoto Iwasaki Shinya Okamoto Koichiro Yamakado Shintaro Yagi Taku Iida Takuma Kato Kanako Saito Linan Wang Yoshifumi Kawarada Shinji Uemoto Department of Hepatobiliary Pancreatic Surgery Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Surgery Matsusaka City Hospital 1550 Tono-machi Matsusaka City Mie Prefecture 515-8544 Japan Department of Anesthesiology Matsusaka City Hospital 1550 Tono-machi Matsusaka City Mie Prefecture 515-8544 Japan Department of Surgery Iwasaki Hospital 333 Isshinden-cho Tsu City Mie Prefecture 514-0114 Japan Department of Cardiology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Radiology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Hepatobiliary Pancreatic and Transplant Surgery Kyoto University Graduate School of Medicine 54 Kawahara-cho Shogoin Sakyo-ku Kyoto 606-8507 Japan Department of Cellular and Molecular Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan Department of Medical Oncology and Immunology Mie University Graduate School of Medicine 2-174 Edobashi Tsu City Mie Prefecture 514-8507 Japan

A 74-year-old woman presented with symptoms consistent with hyperadrenocorticism and hyperca- techolaminism. She had a cushingoid appearance and her cortisol level was elevated. Her serum dopamine and noradrenalin levels were also elevated. Computed tomography detected a left adrenal mass measuring 3.5 cm × 3.0 cm in diameter. Metaiodobenzylguanidine scintigraphy was negative. Unexpectedly, the serum Serum carcinoembryonic antigen (CEA) level waselevated. Fluorodeoxyglucose positron emission tomography showed increased uptake in the adrenal tumor only, with a maximum standardized uptake value of 2.8. Selective venography and blood sampling revealed that the concentrations of cortisol, catecholamines and CEA were significantly elevated in the vein draining the tumor. A diagnosis of CEA-producing benign adenoma was made. After preoperative management, we performed a combined lateral and anterior transperitoneal laparoscopic adrenectomy. Her vital signs remained stable during surgery. Histopathological examination revealed a benign adenoma. Her cortisol, catecholamine and CEA levels normalized immediately after surgery. We present, to the best of our knowledge, the first case of CEA-producing adrenal adenoma, along with a review of the relevant literature, and discuss our laparoscopic surgery techniques.

关键词：肾上腺肿瘤腹腔镜临床表现治疗