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Surgical treatment of hepatocellular carcinoma: Evidence-based outcomes

World Journal of Gastroenterology 2008年第5期14卷 685-692页

作者： Shintaro Yamazaki tadatoshi takayama Department of Digestive Surgery Nihon University School of Medicine Tokyo 173-8610 Japan

Surgeons may be severely criticized from the perspective of evidence-based medicine because the majority of surgical publications appear not to be convincing. In the top nine surgical journals in 1996, half of the 175 publications refer to pilot studies lacking a control group, 18% to animal experiments, and only 5% to randomized controlled trials (RCT). There are five levels of clinical evidence:level 1 (randomized controlled trial), level 2 (prospective concurrent cohort study), level 3 (retrospective historical cohort study), level 4 (pre-post study), and level 5 (case report). Recently, a Japanese evidence-based guideline for the surgical treatment of hepatocellular carcinoma (HCC) was made by a committee (Chairman, Professor Makuuchi and five members). We searched the literature using the Medline Dialog System with four Keywords:HCC, surgery, English papers, in the last 20 years. A total of 915 publications were identified systematically reviewed. At the first selection (in which surgery-dominant papers were selected), 478 papers survived. In the second selection (clearly concluded papers), 181 papers survived. In the final selection (clinically significant papers), 100 papers survived. The evidence level of the 100 surviving papers is shown here:level-1 papers (13%), level-2 papers (11%), level-3 papers (52%), and level-4 papers (24%);therefore, there were 24% prospective papers and 76% retrospective papers. Here, we present a part of the guideline on the five main surgical issues:indication to operation, operative procedure, peri-operative care, prognostic factor, and post-operative adjuvant therapy.

关键词： Indication to operation Hepatocellular carcinoma Operative procedure Peri-operative care Prognostic factors

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Prospective validation to prevent symptomatic portal vein thrombosis after liver resection

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World Journal of Hepatology 2022年第5期14卷 1016-1024页

作者： Nao Yoshida Shintaro Yamazaki Moriguchi Masamichi Yukiyasu Okamura tadatoshi takayama Department of Digestive Surgery Nihon University School of MedicineTokyo 1738610Japan

BACKGROUND Portal vein thrombosis(PVT)after liver resection is rare but can lead to lifethreatening liver *** prospective study evaluated patients using contrastenhanced computed tomography(E-CT)on the first day after liver resection for early PVT detection and *** To evaluate patients by E-CT on the first day after liver resection for early PVT detection and immediate *** Patients who underwent liver resection for primary liver cancer from January 2015 were enrolled.E-CT was performed on the first day after surgery in patients undergoing anatomical resection,multiple resections,or with postoperative bile leakage in the high-risk group for *** PVT was detected,anticoagulant therapy including heparin,warfarin,and edoxaban was administered.E-CT was performed monthly until PVT *** The overall incidence of PVT was 1.57%(8/508).E-CT was performed on the first day after surgery in 235 consecutive high-risk patients(165 anatomical resections,74 multiple resections,and 28 bile leakages),with a PVT incidence of 3.4%(8/235).Symptomatic PVT was not observed in the excluded *** analyses revealed that sectionectomy was the only independent predictor of PVT[odds ratio(OR)=12.20;95%confidence interval(CI):2.22-115.97;P=0.003].PVT was found in the umbilical portion of 75.0%(6/8)of patients,and sectionectomy on the left side showed the highest risk of PVT(OR=14.10;95%CI:3.17-62.71;P<0.0001).CONCLUSION Sectionectomy on the left side should be chosen with caution as it showed the highest risk of PVT.E-CT followed by anticoagulant therapy was effective in managing early-phase PVT for 2 mo without adverse events.

关键词： Portal vein thrombosis Liver resection Anatomical resection Anticoagulant therapy Hepatocellular carcinoma Umbilical potion

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Adhesiolysis for Liver Resection in a Patient with a Reconstructed Stomach Tube after Esophagectomy

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Journal of Cancer Therapy 2020年第6期11卷 371-376页

作者： Shigeru Fujisaki Motoi Takashina Kenichi Sakurai Ryouichi Tomita tadatoshi takayama Department of Surgery Fujisaki Hospital Tokyo Japan Division of Digestive Surgery Nihon University School of Medicine Tokyo Japan Department of Surgery Nippon Dental University Tokyo Japan

To our knowledge this is the first report to provide a detailed description of surgical procedure for adhesiolysis and hepatectomy in patients who have undergone esophagectomy and reconstruction. We performed a hepatic resection of the left medial segment in a patient with a reconstructed stomach tube after esophagectomy for the esophageal carcinoma. The reconstructed stomach tube overlapped with the left medial segment of the liver and the hepatoduodenal ligament and was extensively and strongly adhered to them. It is important for clinicians to know how to perform the detachment procedure successfully in order to secure a surgical field for liver resection without damaging the fragile reconstructed gastric tube. In order to avoid vascular injury of the stomach tube, it was decided that detachment around the hepatoduodenal ligament preceded detachment of the stomach tube from the liver. After complete separation of the hepatoduodenal ligament from the stomach tube, the hepatoduodenal ligament was encircled with tape. Subsequently, adhesiolysis was performed between the stomach tube and the liver. Finally, parenchymal transection was performed using the intermittent hepatic inflow occlusion and crush clamping techniques to dissect the parenchyma. The patient was discharged two weeks after surgery without complication.

关键词： Detachment of Adhesions Liver Resection Reconstructed Stomach Tube

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Role of surgical resection for hepatocellular carcinoma based on Japanese clinical guidelines for hepatocellular carcinoma

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World Journal of Hepatology 2015年第2期7卷 261-269页

作者： Hisashi Nakayama tadatoshi takayama Department of Digestive Surgery Nihon University School of Medicine

In the Algorithm for Diagnosis and Treatment in the Japanese Evidence-Based Clinical Practice Guidelines for Hepatocellular Carcinoma, the treatment strategy is determined by three major factors: liver function and the number and size of tumors. The algorithm is quite simple, consisting of fewer components than the Barcelona-Clinic Liver Cancer staging system. In this article, we describe the roles of the treatment algorithmin hepatectomy and perioperative management of hepatocellular carcinoma.

关键词： Hepatocellular carcinoma Guideline Liverresection Treatment algorithm

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Long-Term Survival after Resection for Primary Undifferentiated Pleomorphic Sarcoma of the Jejunum with Lymph Node Metastases: Case Report

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Journal of Cancer Therapy 2017年第12期8卷 1079-1085页

作者： Shigeru Fujisaki Motoi Takashina Kenichi Sakurai Ryouichi Tomita tadatoshi takayama Department of Surgery Fujisaki Hospital Tokyo Japan Division of Digestive Surgery Nihon University School of Medicine Tokyo Japan Division of Breast and Endocrine surgery Nihon University School of Medicine Tokyo Japan Department of Surgery Nippon Dental School at Tokyo Tokyo Japan

Primary undifferentiated pleomorphic sarcoma (UPS) of the small intestine is extremely rare. The prognosis of UPS is basically poor, and particular, when accompanied with metastatic lesions. This paper reports the case of a long-term survivor of primary UPS of the jejunum with lymph node metastases and a skip lesion in the jejunum. The patient was a 50-year-old Japanese man who presented with a chief complaint of breathlessness. Small bowel X-ray series revealed an approximately 4-cm size with protruded lesion (image shows a filling defect) in the proximal jejunum. Based on a presumptive diagnosis of the hemorrhagic small bowel tumor, he underwent a laparotomy. A tumor was observed in the jejunum at approximately 90-cm from the Treitz ligament;some swollen mesenteric lymph nodules were also observed. Segmental resection of the jejunum was performed 20-140 cm from the Treitz ligament. A complete surgical excision with en-bloc regional lymph node dissection was performed. The final histopathological diagnosis was UPS of the jejunum with metastatic lymph nodes and a skip lesion in the jejunum. The postoperative course was uneventful. The patient was not given adjuvant chemotherapy and was discharged on postoperative day 16. He is currently well without any evidence of recurrence for >10 years after the operation.

关键词： Undifferentiated Pleomorphic Sarcoma Jejunum Metastatic Lymph Nodes

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Management before hepatectomy for hepatocellular carcinoma with cirrhosis

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World Journal of Hepatology 2015年第20期7卷 2292-2302页

作者： Hisashi Nakayama tadatoshi takayama Department of Digestive Surgery Nihon University School of Medicine

The global distribution of hepatocellular carcinoma(HCC) varies markedly among regions, and patients in East Asia and Central Africa account for about 80% of all cases. The risk factors are hepatitis B, hepatitis C, alcohol, and etc. The risk of carcinogenesis further increases with progression to hepatic cirrhosis in all liver disorders. Radical treatment of HCC by liver resection without causing liver failure has been established as a safe approach through selection of an appropriate range of resection of the damaged liver. This background indicates that both evaluation of hepatic functional reserve and measures against concomitant diseases such as thrombocytopenia accompanying portal hypertension, prevention of rupture of esophageal varices, reliable control of ascites, and improvement of hypoalbuminemia are important issues in liver resection in patients with hepatic cirrhosis. We review the latest information on perioperative management of liver resection in HCC patients with hepatic cirrhosis.

关键词： Hepatocellular carcinoma Liver resection Liver cir

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Long-Term Survival of Resected Pancreatic Carcinoma Which Was Coincidentally Detected at the Occurrence of Incarcerated Inguinal Hernia: A Case Report

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Journal of Cancer Therapy 2018年第6期9卷 516-521页

作者： Shigeru Fujisaki Motoi Takashina Ryouichi Tomita Ken-Ichi Sakurai tadatoshi takayama Department of Surgery Fujisaki Hospital Tokyo Japan Department of Surgery Nippon Dental University Tokyo Japan Division of Breast and Endocrine Surgery Nihon University School of Medicine Tokyo Japan Division of Digestive Surgery Nihon University School of Medicine Tokyo Japan

Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately underwent manipulative treatment followed by hernioplasty on the next day. Upon the first visit, a pancreatic tumor was accidentally detected in CT images in the pancreatic tail. About approximately a month, abdominal CT revealed a slightly developed tumor;accordingly, distal pancreatectomy with lymph node dissection was performed. The patient was histopathologically diagnosed with tubular adenocarcinoma, and his final pathological stage was ypT2, pN0, cM0, Stage Ib, based on the TNM classification of malignant tumors (8th edition). For postoperative six months, he was treated with adjuvant chemotherapy using gemcitabine (1000 mg/m2). Remarkably, the patient reported no recurrence and has been alive for postoperative 7.5 years, thereby attaining excellent outcomes for accidentally detected pancreatic carcinoma at the occurrence of an incarcerated inguinal hernia.

关键词： Pancreatic Carcinoma Incarcerated Inguinal Hernia Long-Term Survival

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Metachronous Double Primary Gastric and Colorectal Cancer: Is Prognosis Better with Gastric or Colorectal Cancer Occurring First?

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Journal of Cancer Therapy 2013年第3期4卷 720-725页

作者： Mitsugu Kochi Masashi Fujii Noriaki Kanamori Yoshiaki Mihara Tomoya Funada Hidenori Tamegai Megumu Watanabe Yuriko takayama Hiroshi Suda tadatoshi takayama Department of Digestive Surgery Nihon University School of Medicine Tokyo Japan

The purpose of this study was to investigate the clinicopathological features of gastric precedence (GP) and colorectal precedence (CP) metachronous double primary gastric and colorectal cancer (MDPGCC) and determine the biological significance of these two types of malignancy in making a prognosis. Between January 1990 and December 2009, 4523 patients underwent surgical treatment or chemotherapy, but no endoscopic resection for gastric or colorectal cancer. From this group, we selected those patients in whom another gastric or colorectal primary cancer developing from another origin had been diagnosed. For classification as MDPGCC there had to be an interval of 6 months or more before a secondary diagnosis of gastric or colorectal cancer. Among 4523 patients treated for gastric or colorectal cancer, MDPGCC was diagnosed in 54 patients (1.2%). The selected patients were classified into a GP (n = 30) or CP group (n = 24). No statistically significant differences were observed between the two groups with regard to sex, age, operation, location or histological type. No differences were observed in rates of surgery between the two groups. No notable difference was observed in the year-by-year incidence of GP- and CP-MDPGCC as calculated from the date of surgery or chemotherapy for the secondary gastric or colorectal cancer. The 5-year survival rate in the GP- and CP-MDPGCC groups was 84.7% and 83.3%, respectively. No significant difference was observed between the GP- and CP-MDPGCC groups (P = 0.9). There is no significant difference in prognosis between GP- and CP-MDPGCC.

关键词： Colorectal Cancer Gastric Cancer Metachronous Double Primary Cancer Prognosis

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Improving recognition of hepatic perivascular epithelioid cell tumor:Case report and literature review

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World Journal of Gastroenterology 2015年第17期21卷 5432-5441页

作者： Toshiya Maebayashi Katsumi Abe Takuya Aizawa Masakuni Sakaguchi Naoya Ishibashi Osamu Abe tadatoshi takayama Hisashi Nakayama Shunichi Matsuoka Kazushige Nirei Hitomi Nakamura Masahiro Ogawa Masahiko Sugitani Department of Radiology Nihon University School of MedicineItabashi-kuTokyo 173-8610Japan Department of Digestive Surgery Nihon University School of MedicineItabashi-kuTokyo 173-8610Japan Department of Gastroenterology and Hepatology Nihon University School of MedicineItabashi-kuTokyo 173-8610Japan Department of Pathology Nihon University School of MedicineItabashi-kuTokyo 173-8610Japan

A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver *** diagnostic imaging studies could not rule out malignancy,the patient underwent partial resection of segment 3 of the *** lesion pathologically showed eosinophilic proliferation,in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A,thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor(PEComa).A PEComa arising from the liver is relatively ***,the name ‘PEComa' has not yet been widely recognized,and the same disease entity has been called epithelioid angiomyolipoma(EAML),further diminishing the recognition of *** addition,PEComa imaging findings mimic those of malignant liver tumors,and clinically,this tumor tends to ***,a PEComa is difficult to *** conducted a systematic review of PEComa and EAML cases and discuss the results,including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors.

关键词： Angiomyolipoma Tuberous sclerosis Melan-A Perivascular epithelioid cell tumor Humanmelanoma black 45 Imaging

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Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?

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World Journal of Hepatology 2016年第26期8卷 1110-1115页

作者： Mariko Kumagawa Naoki Matsumoto Yukinobu Watanabe Midori Hirayama Takao Miura Hiroshi Nakagawara Masahiro Ogawa Shunichi Matsuoka Mitsuhiko Moriyama tadatoshi takayama Masahiko Sugitani Division of Gastroenterology and Hepatology Department of MedicineNihon University School of Medicine Division of Gastroenterology andHepatology Department of Digestive SurgeryNihon University School of Medicine Department of Pathology Nihon University School of Medicine

Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.

关键词： Hepatocellular adenoma Contrast-enhanced ultrasonography Serum amyloid A Serum amyloid A-positive hepatocellular neoplasms Alcoholic cirrhosis

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