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The impact of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)on liver tumors with unusual indications

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 477-480页

作者： Kensuke Yamamura toru beppu Tatsunori Miyata Shinichi Akahoshi Takatoshi Ishiko Department of Surgery Yamaga City Medical CenterYamagaJapan Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamotoJapan

An associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been developed as a novel surgical technique for patients with insufficient future liver remnant volume even after portal vein embolization(PVE)±hepatic arterial or venous embolization or conventional two-stage hepatectomy(TSH)(1-5).ALPPS was thought to be a breakthrough but high-risk procedure;however,it recently became a safer technique after the developing phase(1-3).Conversion surgery is strongly recommended for patients with initially unresectable liver tumors that are deemed resectable by systemic chemotherapy or hepatic arterial chemotherapy/embolization(6,7).The primarily targeted diseases are colorectal liver metastases(CRLM)and hepatocellular carcinoma(HCC).ALPPS is indicated for patients undergoing not only primary surgery but also conversion surgery.

关键词： ALPPS chemotherapy hepatectomy

Prognostic Impact of Surgical Margin Width in Hepatectomy for Colorectal Liver Metastasis

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 705-717页

作者： Katsunori Sakamoto toru beppu Kohei Ogawa Kei Tamura Masahiko Honjo Naotake Funamizu Yasutsugu Takada Department of Hepato-Biliary-Pancreatic and Breast Surgery Ehime University Graduate School of MedicineToon EhimeJapan Department of Surgery Yamaga City Medical CenterKumamotoJapan

As for resection for colorectal liver metastasis (CRLM), secur-ing an adequate surgical margin is important for achieving a better prognosis. However, it is often difficult to achieve ade-quate margins for the resection of CRLM. So the current sur-vival impact of sub-centi/millimeter surgical margins in he-patectomy for CRLM should be evaluated. In the current era of multidisciplinary treatment options, this review focused on the prognostic impact of a sub-centi/millimeter surgical margin width in hepatectomy for CRLM. We systematically reviewed retrospective studies that clearly described the sur-gical margin width for hepatectomy for CRLM. We selected studies conducted since 2000 that involved patients diag-nosed as having CRLM. We focused on studies that investi-gated not only surgical margins, but also microscopic surgical curability such as R0 (microscopically complete resection) or R1 (microscopically incomplete resection), which clearly de-scribe their definitions. Based on our literature review, 1, 2, or 5 mm was considered the minimum surgical margin width for hepatectomy for CRLM. Although a surgical margin width of 1 mm is acceptable for hepatectomy for CRLM, submil-limeter margins, which are defined as R1 in many reports, are only acceptable for limited patients such as those who have undergone preoperative chemotherapy. Zero-mm mar-gins are also acceptable in limited patients such as those who show a good response to preoperative chemotherapy. New chemotherapy agents have been reported to reduce the prognostic impact of a narrow surgical margin width. The incidence of margin recurrence, which is a major concern regarding R1 resection of CRLM, is about 20-30% according to the majority of earlier reports. As evaluations of the actual prognostic impact of the surgical margin remain difficult, fur-ther study is warranted.

关键词： Surgical margin Colorectal liver metastasis Chemotherapy.

A novel comprehensive ALPPS preoperative risk assessment (CAPRA) score is beneficial in creating a treatment strategy for advanced liver malignancy

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Hepatobiliary Surgery and Nutrition 2023年第2期12卷 287-290页

作者： Kensuke Yamamura toru beppu Tatsunori Miyata Hirohisa Okabe Katsunori Imai Takatoshi Ishiko Department of Surgery Yamaga City Medical CenterYamagaJapan Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamotoJapan

Curability and safety are essential for patients with advanced liver malignancy undergoing extended liver *** the future liver remnant(FLR)volume is insufficient,portal embolization with or without hepatic arterial or venous embolization or a conventional two-stage hepatectomy(TSH)can be performed(1,2).Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)was introduced in 2007.

关键词： Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) comprehensive ALPPS preoperative risk assessment(CAPRA)score mortality

Does laparoscopic liver resection for colorectal liver metastases provide a true survival benefit compared with open liver resection?

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Hepatobiliary Surgery and Nutrition 2020年第5期9卷 657-660页

作者： Shinichi Akahoshi toru beppu Yasuhisa Mori Koichi Kinoshita Nobutaka Sato Ken Kikuchi Department of Surgery Yamaga City Medical CenterKumamotoJapan Department of Surgery and Oncology Graduate School of Medical SciencesKyushu UniversityFukuokaJapan Adviser Sakurajuji HospitalKumamotoJapan

The recent Southampton consensus guideline and two previous international consensus meetings held in Louisville and Morioka in 2008 and 2014,respectively have recommended laparoscopic liver resection(LLR)as a standard procedure for selected patients with colorectal liver metastases(CRLM)(1-3).The Oslo-CoMet and LapOpHuva studies are the only two randomized controlled trials(RCTs)that have provided solid evidence showing that LLR is a safer,less invasive,and more cost-effective approach with higher health-related quality of life and oncological outcomes equivalent to those of open liver resection(OLR)for patients with CRLM(4-6).

关键词： resection colorectal metastases

Cutaneous metastases secondary to pancreatic cancer

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World Journal of Gastrointestinal Oncology 2012年第7期4卷 176-180页

作者： Kei Horino Hiroshi Takamori Yoshiaki Ikuta Osamu Nakahara Akira Chikamoto Takatoshi Ishiko toru beppu Hideo Baba Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University 1-1-1 Honjo Kumamoto 860-8556 Japan

AIM: To evaluate prognoses after cutaneous metastases, derived from pancreatic cancer. METHODS: We treated two patients with cutaneous metastases from pancreatic cancer. We reviewed 40 reported patients in addition to our cases and analyzed clinical features of cutaneous metastases from pancreatic cancer. RESULTS: The median survival time (MST) was 5 mo after diagnoses of cutaneous metastases. The cumulative 2-year survival rate was 3.5%. The most frequent site of cutaneous metastases was the umbilicus. The MST of patients who were treated with chemotherapy or chemoradiotherapy (CRT) was 6.5 mo, which was statistically longer in comparison to patients without treatment. Prognoses of cutaneous metastases are similar to other metastatic sites from pancreatic cancer. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic ***: The prognoses of cutaneous metastases are similar to other metastatic pancreatic cancers. Receiving chemotherapy or CRT was the only prognostic factor of cutaneous metastases from pancreatic cancer.

关键词： Cutaneous Metastasis Pancreas Cancer Prognosis

Perforation of the duodenum during the retrograde cholangiopancreatography treated without surgery

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Case Reports in Clinical Medicine 2012年第2期1卷 23-25页

作者： Akira Tsuji Daisuke Hashimoto Tetsu Ozaki Akira Chikamoto toru beppu Hideo Baba Department of Gastroenterological Surgery Kumamoto University Graduate School of Medical Sciences Kumamoto Japan Department of Gastroenterology and Hepatology Kumamoto University Graduate School of Medical Sciences Kumamoto Japan

Perforation after endoscopic retrograde cholan- giopancreatography (ERCP) is a rare but severe complication. Management of ERCP-associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. We describe the case who developed perforation of the duodenum and gas in the retroperitoneal cavity after ERCP. There was no sign of peritonitis, pancreatitis or sepsis. The patient was treated by conservative therapy without operation, and finally, fully re- covered from perforation.

关键词： ERCP Complication Perforation Conservative Therapy

Curative resection of leiomyosarcoma with resection and reconstruction of inferior vena cava

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Case Reports in Clinical Medicine 2013年第6期2卷 335-337页

作者： Yashiro Motooka Daisuke Hashimoto Hisashi Sakaguchi Akira Chikamoto toru beppu Michio Kawasuji Hideo Baba Department of Cardiovascular Surgery Kumamoto University Graduate School of Medical Sciences Kumamoto Japan Department of Gastroenterological Surgery Kumamoto University Graduate School of Medical Sciences Kumamoto Japan Department of Gastroenterological Surgery Kumamoto University Graduate School of Medical Sciences Kumamoto Japan

Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, and it needs complete surgical resection for cure. In addition, the reconstruction of IVC is necessary in many cases. Herein, we indicate the case of a 57-year-old female with leiomyosarcoma in segment I of the IVC, which grew deep into vascular lumen. She underwent complete en bloc resection of the tumor and IVC reconstruction by an artificial pericardium patch.

关键词： Leiomyosarcoma Inferior Vena Cava Reconstruct

The Number of Positive Tumor Marker Status Is Beneficial for the Selection of Therapeutic Modalities in Patients with Hepatocellular Carcinoma

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 165-168页

作者： toru beppu Shigeki Nakagawa Hidetoshi Nitta Hirohisa Okabe Takayoshi Kaida Katsunori Imai Hiromitsu Hayashi Yuki Koga Kunitaka Kuramoto Daisuke Hashimoto Yo-ichi Yamashita Akira Chikamoto Takatoshi Ishiko Hideo Baba Department of Surgery Yamaga City Medical Center Kumamoto Japan Department of Gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto Japan Department of Gastroenterological Surgery Graduate School of Life Sciences Kumamoto University Kumamoto Japan

Hepatic resection (HR) and radiofrequency ablation (RFA) are popular local therapies for early-stage hepatocellular carcinoma (HCC).Alpha-fetoprotein,Lens culinaris agglutininreactive fraction of alpha-fetoprotein,and des-c-carboxy prothrombin are well-known and useful tumor markers for *** positive number status of these tumor markers has recently been demonstrated as beneficial for predicting outcome for HCC patients treated with local *** the normal ranges reported have differed by institution,the positivity of tumor markers is consistent and can easily be *** and Wakayama's group clearly demonstrated the following:1) Regardless of the degree of tumor stage,a triple-positive tumor marker profile can predict poor outcome in HCC patients undergoing HR;2) For RFA alone,HCC patients with double-and triple-positive status,having less than three lesions and lesions ≤3 cm in diameter show comparably insufficient outcomes;3) For HCC patients with lesions ≤5 cm in Child-Pugh grade A,HR is preferred over RFA;4) Microvascular invasion rates increased even in the double-positive patients,while poorly differentiated HCC was frequently observed only in the triple-positive patients;and 5) RFA with chemoembolization,anatomical liver resection,and postoperative adjuvant chemoembolization or hepatic arterial chemotherapy might improve the outcome for patients with highly malignant HCC with multiple positive tumor ***,the impacts of these therapies still need to be evaluated in prospective comparative studies.

关键词： Triple-positive tumor markers Double-positive tumor markers Hepatocellular carcinoma Hepatic resection Radiofrequency ablation Alpha-fetoprotein Des-γ-carboxy prothrombin Lens culinaris agglutinin reactive fraction of alpha-fetoprotein

Pancreatic pseudocyst-portal vein fistula

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Open Journal of Gastroenterology 2012年第3期2卷 143-144页

作者： Kei Horino Hiroshi Takamori Yoshiaki Ikuta Akira Chikamoto Takatoshi Ishiko toru beppu Hideo Baba Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan

Pancreatic pseudocyst-portal vein fistulae are extremely rare, and cause serious complications, including life-threatening sepsis. We report a 57-year-old man with pancreatic pseudocyst who was admitted to our hospital complaining of prolonged abdominal pain. A pancreatic duct tube was placed into the main pancreatic duct, as the pseudocyst was communicated to the pancreatic duct. He fell into septic shock state two weeks later. An ultrasonography-guided percutaneous drainage of the pseudocyst was performed. The amylase level of drained pus was 80,000 U/l. Pancreatic pseudocyst-portal vein fistula was demonstrated by fisterography. Symptoms disappeared immediately after drainage. No recurrence was observed afterward.

关键词： Pancreatic Pseudocyst Fistula Pancreatitis Portal Vein Drainage