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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

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Comprehensive and innovative techniques for laparoscopic choledocholithotomy:A surgical guide to successfully accomplish this advanced manipulation

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World Journal of Gastroenterology 2019年第13期25卷 1531-1549页

作者： Tomohide Hori department of hepato-biliary-pancreatic surgery Kyoto University Graduate School of Medicine

Surgeries for benign diseases of the extrahepatic bile duct(EHBD) are classified as lithotomy(i.e., choledocholithotomy) or diversion(i.e.,choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures,and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy.Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes;however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.

关键词： Laparoscopic surgery Choledocholithotomy Bile duct Laparoscopy General surgery

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Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management

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hepatobiliary & pancreatic Diseases International 2020年第4期19卷 334-341页

作者： Yuichi Masuda Kazuki Yoshizawa Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima Division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of Medicine3-1-1 AsahiMatsumotoNaganoJapan

Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used procedure.Small-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult LDLT.The definition of SFSS slightly varies among transplant physicians.The use of a partial liver graft has risks of SFSS development.Persistent portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main factors.Hence,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this syndrome.Herein,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own experiences.Data sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this review.Results:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and splenectomy.With these techniques,patient outcome has been improved even when using a"small"graft.Other factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various strategies.Conclusions:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill recipients.In the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy to prevent or control sepsis and intensive nutrit

关键词： Liver transplantation Living donor liver transplantation Small-for-size graft Small-for-size syndrome

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Controversies regarding and perspectives on clinical utility of biomarkers in hepatocellular carcinoma

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世界胃肠病学杂志：英文版 2016年第1期22卷 262-274页

作者： Pei-Pei Song Ju-Feng Xia Yoshinori Inagaki Kiyoshi Hasegawa Yoshihiro Sakamoto Norihiro Kokudo Wei Tang hepato-biliary-pancreatic surgery Division Department of SurgeryGraduate School of Medicinethe University of Tokyo

The prevalence of hepatocellular carcinoma(HCC)worldwide parallels that of persistent infection with the hepatitis B virus(HBV)and/or hepatitis C virus(HCV).According to recommendations by the World Health Organization guidelines for HBV/HCV,alpha-fetoprotein(AFP)testing and abdominal ultrasound should be performed in routine surveillance of HCC every 6 mo for high-risk patients.These examinations have also been recommended worldwide by many other HCC guidelines over the past few decades.In recent years,however,the role of AFP in HCC surveillance and diagnosis has diminished due to advances in imaging modalities.AFP was excluded from the surveillance and/or diagnostic criteria in the HCC guidelines published by the American Association for the Study of Liver Diseases in 2010,the European Association for the Study of the Liver in 2012,and the National Comprehensive Cancer Network in 2014.Other biomarkers,including the Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),des-γ-carboxyprothrombin,Dickkopf-1,midkine,and micro RNA,are being studied in this regard.Furthermore,increasing attention has focused on the clinical utility of biomarkers as pre-treatment predictors for tumor recurrence and as post-treatment monitors.Serum and tissue-based biomarkers and genomics may aid in the diagnosis of HCC,determination of patient prognosis,and selection of appropriate treatment.However,further studies are needed to better characterize the accuracy and potential role of these approaches in clinical practice.

关键词： hepatocellular carcinoma Biomarker Guideline Surveillance Diagnosis Prognosis

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Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

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hepatobiliary & pancreatic Diseases International 2020年第2期19卷 147-152页

作者： Masayuki Akita Tetsuo Ajiki Kimihiko Ueno Daisuke Tsugawa Motofumi Tanaka Masahiro Kido Hirochika Toyama Takumi Fukumoto department of hepato-biliary-pancreatic surgery Kobe University Graduate School of MedicineKobe650-0017Japan

Background:pancreaticoduodenectomy(PD)is a standardized strategy for patients with middle and distal bile duct cancers.The aim of this study was to compare clinicopathological features of bile duct segmen-tal resection(BDR)with PD in patients with extrahepatic cholangiocarcinoma.Methods:Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR(n=21)or PD(n=84)with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study.Results:Patients who underwent PD were significantly younger than those receiving BDR.The frequency of preoperative jaundice,biliary drainage and cholangitis was not significantly different between the two groups.The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs.421 min,and 770 vs.402 mL;both PClavien-DindoⅢa)were observed in the PD group(46%vs.10%,P<0.01).Postoperative hospital stay was also longer in that group(30 vs.19 days,P=0.02).Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33%in BDR and 48%in PD,P=0.24).The rate of R0 resection was significantly higher in the PD group(80%vs.38%,P<0.01).Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62%vs.38%,P=0.04).Although 5-year overall survival rates were similar in both groups(44%for BDR and 51%for PD,P=0.72),in patients with T1 and T2,the BDR group tended to have poorer prognosis(44%vs.68%at 5-year,P=0.09).Conclusions:BDR was comparable in prognosis to PD in middle bile duct cancer.Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.

关键词： Cholangiocarcinoma Middle bile duct resection pancreaticoduodenectomy

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Impact of endothelial nitric oxide synthase activation on accelerated liver regeneration in a rat ALPPS model

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World Journal of Gastroenterology 2023年第5期29卷 867-878页

作者： Hitoshi Masuo Akira Shimizu Hiroaki Motoyama Koji Kubota Tsuyoshi Notake Takahiro Yoshizawa Kiyotaka Hosoda Koya Yasukawa Akira Kobayashi Yuji Soejima Division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumoto 390-8621Japan

BACKGROUND Although the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)induces more rapid liver regeneration than portal vein embolization,the mechanism remains unclear.AIM To assess the influence of inflammatory cytokines and endothelial nitric oxide synthase(eNOS)activation on liver regeneration in ALPPS.METHODS The future liver remnant/body weight(FLR/BW)ratio,hepatocyte proliferation,inflammatory cytokine expression,and activation of the Akt-eNOS pathway were evaluated in rat ALPPS and portal vein ligation(PVL)models.hepatocyte proliferation was assessed based on Ki-67 expression,which was confirmed using immunohistochemistry.The serum concentrations of inflammatory cytokines were measured using enzyme linked immune-solvent assays.The Akt-eNOS pathway was assessed using western blotting.To explore the role of inflammatory cytokines and NO,Kupffer cell inhibitor gadolinium chloride(GdCl3),NOS inhibitor N-nitro-arginine methyl ester(L-NAME),and NO enhancer molsidomine were administered intraperitoneally.RESULTS The ALPPS group showed significant FLR regeneration(FLR/BW:1.60%±0.08%,Psurgery.In the ALPPS group,serum interleukin-6 expression was suppressed using GdCl3 to the same extent as that in the PVL group.However,the FLR/BW ratio and Ki-67 labeling index were significantly higher in the ALPPS group administered GdCl3(1.72%±0.19%,P<0.05;22.25%±1.30%,P<0.05)than in the PVL group(1.33%±0.11%and 12.78%±1.55%,respectively).Phospho-Akt Ser473 and phospho-eNOS Ser1177 levels were enhanced in the ALPPS group compared with those in the PVL group.There was no difference between the ALPPS group treated with L-NAME and the PVL group in the FLR/BW ratio and Ki-67 labeling index.In the PVL group treated with molsidomine,the FLR/BW ratio and Ki-67 labeling index increased to the same level as in the ALPPS group.CONCLUSION Early induction of inflammatory cytokines may not be pivotal for accelerated FLR regeneration a

关键词： Hepatectomy Nitric oxide Liver regeneration Cytokines NG-Nitroarginine methyl ester Molsidomine

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Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center

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hepatobiliary & pancreatic Diseases International 2023年第2期22卷 140-146页

作者： Xiu-Ping Zhang Shuai Xu Zhi-Ming Zhao Qu Liu Guo-Dong Zhao Ming-Gen Hu Xiang-Long Tan Rong Liu Faculty of hepato-biliary-pancreatic surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China department of Liver transplantation and hepatobiliary surgery Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China

Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.

关键词： Robotic pancreaticoduodenectomy Nomogram Long-term prognosis pancreatic ductal adenocarcinoma

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Derivation and validation of a preoperative prognostic model for resectable pancreatic ductal adenocarcinoma

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hepatobiliary & pancreatic Diseases International 2023年第2期22卷 160-168页

作者： Shuai Xu Xiu-Ping Zhang Guo-Dong Zhao Wen-Bo Zou Zhi-Ming Zhao Qu Liu Ming-Gen Hu Rong Liu Faculty of hepato-biliary-pancreatic surgery The First Medical CenterChinese PLA General HospitalBeijing 100853China department of Liver transplantation and hepatobiliary surgery Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinan 250021China

Background: The prognosis of patients with pancreatic ductal adenocarcinoma(PDAC) remains poor even after radical pancreaticoduodenectomy(PD). The study aimed to develop and validate a novel preoperative prognostic model to accurately predict the long-term survival of patients with PDAC.Methods: Patients with PDAC of pancreatic head from Chinese PLA General Hospital were included. The preoperative PDAC model with contour plots was developed using a non-linear model in the training cohort and then tested in the validation cohort.Results: Of 421 patients who met the inclusion criteria, 280 were in the training cohort and 141 in the validation cohort. Contour plots for preoperative PDAC model were established to visually predict the survival probabilities of these patients, based on preoperative carbohydrate antigen 19-9, preoperative fibrinogen to albumin ratio and pain symptoms. This model stratified patients into low-and high-risk groups with distinctly different long-term survival in the training cohort [median overall survival(OS)32.1 vs. 17.5 months;median recurrence-free survival(RFS) 19.3 vs. 10.0 months, both P pancreatic head. Besides, the model can screen high-risk patients with poor prognosis, which may provide references for personal treatment strategies in the future.

关键词： pancreatic ductal adenocarcinoma pancreaticoduodenectomy Contour plot Overall survival Recurrence-free survival

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Added value of indocyanine green fluorescence imaging in liver surgery

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hepatobiliary & pancreatic Diseases International 2022年第4期21卷 310-317页

作者： Nobuyuki Takemura Kyoji Ito Fuyuki Inagaki Fuminori Mihara Norihiro Kokudo department of surgery Hepato-Biliary Pancreatic Surgery DivisionNational Center for Global Health and Medicine1-21-1 ToyamaShinjyuku-kuTokyo162-8655Japan

Recently,indocyanine green(ICG)fluorescence imaging has been widely used as a substitute for cholangiography in hepatobiliary surgery,to detect hepatic tumors,for accurate anatomical hepatectomy,and to increase the safety and accuracy of minimally invasive(laparoscopic and robotic)hepatectomy.The clinical relevance of this method has been increasing gradually,as new procedures develop in this field.Various important roles and the latest added value of ICG fluorescence imaging in liver surgery are discussed in this report.

关键词： Florescence imaging Indocyanine green hepatocellular carcinoma Colorectal metastasis Hepatectomy Minimally invasive surgery

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Management of hepatitis B virus infection during treatment for hepatitis B virus-related hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第27期21卷 8249-8255页

作者： Shoji Kubo Shigekazu Takemura Shogo Tanaka Hiroji Shinkawa Takayoshi Nishioka Akinori Nozawa Masahiko Kinoshita Genya Hamano Tokuji Ito Yorihisa Urata department of hepato-biliary-pancreatic surgery Osaka City University Graduate School of Medicine

Although liver resection is considered the most effective treatment for hepatocellular carcinoma(HCC), treatment outcomes are unsatisfactory because of the high rate of HCC recurrence. Since we reported hepatitis B e-antigen positivity and high serum hepatitis B virus(HBV) DNA concentrations are strong risk factors for HCC recurrence after curative resection of HBV-related HCC in the early 2000 s, many investigators have demonstrated the effects of viral status on HCC recurrence and post-treatment outcomes. These findings suggest controlling viral status is important to prevent HCC recurrence and improve survival after curative treatment for HBV-related HCC. Antiviral therapy after curative treatment aims to improve prognosis by preventing HCC recurrence and maintaining liver function. Therapy with interferon and nucleos(t)ide analogs may be useful for preventing HCC recurrence and improving overall survival in patients who have undergone curative resection for HBV-related HCC. In addition, reactivation of viral replication can occur after liver resection for HBV-related HCC. Antiviral therapy can be recommended for patients to prevent HBV reactivation. Nevertheless, further studies are required to establish treatment guidelines for patients with HBVrelated HCC.

关键词： Chronic hepatitis B Liver resection hepatocellularcarcinoma Antiviral therapy Nucleos(t)ide analogs

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