DOI： 10.1016/j.radcr.2023.06.012

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Probe-based confocal laser endomicroscopy (pCLE) enables real-time examination of tissue structure. This study investigated pCLE with or without fluorescein sodium for the intraoperative diagnosis of colorectal liver metastasis (CLM) and detection of surgical margins. Thirty-four specimens of CLM and adjacent noncancerous tissue were obtained from 21 patients and examined by pCLE between May 2017 and March 2018. Images were obtained both without and with fluorescein sodium applied to the cut surface and compared with hematoxylin and eosin-stained tissue. Fluorescence intensity (FI) was measured by luminance-analysis software. Without external fluorophores, pCLE visualized 91.2% of CLM tissues as an irregular structure with low autofluorescence and 90.5% of noncancerous liver tissues as a regular structure with high autofluorescence. The median FI was significantly lower in cancer than in benign tissue in patients without chemotherapy [70.4 (51.6-110) vs. 48.3 (39.0-59.4), p = 0.002] and with chemotherapy [67.9 (54.6-89.2) vs. 48.6 (28.8-82.1), p < 0.001]. The border was clearly visible; pCLE with fluorescein sodium clearly showed their morphologies. In summary, our study demonstrated real-time pCLE distinguished CLM and noncancerous tissue by differences in structure and FI regardless of prehepatectomy chemotherapy. Fluorescein spray facilitated clear visualization of differences in the morphology.

DOI： 10.1007/s13577-023-00965-9

PubMed

DOI： 10.3390/cancers15174205

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>The prognosis of patients with resected intrahepatic cholangiocarcinoma (ICC) is still unsatisfactory with the high recurrent rate. We aimed to evaluate risks of recurrence changing over time and the survival benefit of resection for recurrent ICC.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study included patients who underwent hepatectomy for ICC during 1995–2020. Risk factors for recurrence‐free survival (RFS) in patients undergoing initial resection and overall survival (OS) in patients who developed recurrence after initial resection were analyzed. Conditional cumulative incidence of recurrence was assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 169 patients were included in the study and 114 patients (67.5%) developed recurrence. Cumulative analyses showed that the 5‐year recurrence rate was 69.3% at the time of initial resection but decrease to 24.8% in patients free from recurrence at 2 years after initial resection and 2.6% in patients free from recurrence at 4 years. Re‐resection was performed in 26 (22.8%) of 114 patients who developed recurrence. Multivariable Cox proportional hazards model analysis indicated re‐resection (hazard ratio [HR] 0.19; 95% confidence interval [CI] 0.11–0.40, <jats:italic>p</jats:italic> &lt; 0.001), microvascular invasion (MVI) (HR 2.39; CI 1.05–5.40, <jats:italic>p</jats:italic> = 0.037), and disease‐free interval (month) (HR 0.97; CI 0.95–1.00, <jats:italic>p</jats:italic> = 0.067) were significantly associated with longer OS after recurrence.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Although the rate of recurrence remains high, conditional cumulative recurrence rate analysis showed that the rate of recurrence decreased by disease‐free interval. Resection of recurrent ICC was associated with improved OS, particularly among patients with longer disease‐free interval and absence of MVI after initial hepatectomy.</jats:p><jats:p>This article is protected by copyright. All rights reserved.</jats:p></jats:sec>

DOI： 10.1111/hepr.13951

PubMed

DOI： 10.1016/j.asjsur.2023.05.139

PubMed

DOI： 10.1016/j.jiac.2023.06.002

PubMed

DOI： 10.1007/s00423-023-02860-1

PubMed

DOI： 10.3390/cancers15072140

PubMed

DOI： 10.1007/s00428-023-03499-5

PubMed

DOI： 10.1007/s11605-022-05549-w

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Indocyanine green (ICG) is one of the only clinically approved near-infrared (NIR) fluorophores used during fluorescence-guided surgery (FGS), but it lacks tumor specificity for pancreatic ductal adenocarcinoma (PDAC). Several tumor-targeted fluorescent probes have been evaluated in PDAC patients, yet no uniformity or consensus exists among the surgical community on the current and future needs of FGS during PDAC surgery. In this first-published consensus report on FGS for PDAC, expert opinions were gathered on current use and future recommendations from surgeons' perspectives. A Delphi survey was conducted among international FGS experts via Google Forms. Experts were asked to anonymously vote on 76 statements, with ≥70% agreement considered consensus and ≥80% participation/statement considered vote robustness. Consensus was reached for 61/76 statements. All statements were considered robust. All experts agreed that FGS is safe with few drawbacks during PDAC surgery, but that it should not yet be implemented routinely for tumor identification due to a lack of PDAC-specific NIR tracers and insufficient evidence proving FGS's benefit over standard methods. However, aside from tumor imaging, surgeons suggest they would benefit from visualizing vasculature and surrounding anatomy with ICG during PDAC surgery. Future research could also benefit from identifying neuroendocrine tumors. More research focusing on standardization and combining tumor identification and vital-structure imaging would greatly improve FGS's use during PDAC surgery.

DOI： 10.3390/cancers15030652

PubMed

DOI： 10.3390/cancers15020488

PubMed

DOI： 10.1093/jscr/rjac595

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Published empirical data have increasingly suggested that using near-infrared fluorescence cholangiography during laparoscopic cholecystectomy markedly increases biliary anatomy visualization. The technology is rapidly evolving, and different equipment and doses may be used. We aimed to identify areas of consensus and nonconsensus in the use of incisionless near-infrared fluorescent cholangiography during laparoscopic cholecystectomy. METHODS: A 2-round Delphi survey was conducted among 28 international experts in minimally invasive surgery and near-infrared fluorescent cholangiography in 2020, during which respondents voted on 62 statements on patient preparation and contraindications (n = 12); on indocyanine green administration (n = 14); on potential advantages and uses of near-infrared fluorescent cholangiography (n = 18); comparing near-infrared fluorescent cholangiography with intraoperative x-ray cholangiography (n = 7); and on potential disadvantages of and required training for near-infrared fluorescent cholangiography (n = 11). RESULTS: Expert consensus strongly supports near-infrared fluorescent cholangiography superiority over white light for the visualization of biliary structures and reduction of laparoscopic cholecystectomy risks. It also offers other advantages like enhancing anatomic visualization in obese patients and those with moderate to severe inflammation. Regarding indocyanine green administration, consensus was reached that dosing should be on a milligrams/kilogram basis, rather than as an absolute dose, and that doses >0.05 mg/kg are necessary. Although there is no consensus on the optimum preoperative timing of indocyanine green injections, the majority of participants consider it important to administer indocyanine green at least 45 minutes before the procedure to decrease the light intensity of the liver. CONCLUSION: Near-infrared fluorescent cholangiography experts strongly agree on its effectiveness and safety during laparoscopic cholecystectomy and that it should be used routinely, but further research is necessary to establish optimum timing and doses for indocyanine green.

DOI： 10.1016/j.surg.2022.07.012

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Understanding the extent of tumor spread to local lymph nodes is critical to managing early-stage gastric cancer. Recently, fluorescence imaging with indocyanine green has been used to identify and characterize sentinel lymph nodes during gastric cancer surgery, but no published guidelines exist. We sought to identify areas of consensus among international experts in the use of fluorescence imaging with indocyanine green for mapping sentinel lymph nodes during gastric-cancer surgery. METHODS: In this 2-round, online Delphi survey, 27 international experts voted on 79 statements pertaining to patient preparation and contraindications to fluorescence imaging with indocyanine green during gastric cancer surgery; indications; technical aspects; advantages/disadvantages and limitations; and training and research. Methodological steps were adopted during survey design to minimize bias. RESULTS: Consensus was reached on 61 of 79 statements, including giving single injections of indocyanine green into each of the 4 quadrants peritumorally, administering indocyanine green on the same day as surgery, injecting a total of 1 to 5 mL of 5 mg/mL indocyanine green, injecting endoscopically into submucosa, and repeating indocyanine green injections a second time if sentinel lymph node visualization remains inadequate. Consensus also was reached that fluorescence imaging with indocyanine green is an acceptable single-agent modality for sentinel lymph node identification and that the sentinel lymph node basin method is preferred. However, sentinel lymph node dissection should be limited to T1 gastric cancer and tumors ≤4 cm in diameter, and further research is necessary to optimize the technique and render fluorescence-guided sentinel lymph nodes dissection acceptable for routine clinical use. CONCLUSION: Although considerable consensus was achieved, further research is necessary before this technology should be used in routine practice.

DOI： 10.1016/j.surg.2022.06.036

PubMed

DOI： 10.4240/wjgs.v14.i11.1219

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: According to the American Association for the Study of Liver Diseases guidelines, liver resection is not recommended for multiple hepatocellular carcinomas, although it is performed in Asian countries, including Japan. However, the maximum number, location, and recurrence types of tumors have not been reported in detail. METHODS: This retrospective study analyzed data for 1,170 patients who underwent surgical resection for hepatocellular carcinoma between October 2002 and December 2020 in a Japanese tertiary care hospital. Statistical analysis was performed to compare the surgical short-term and long-term outcomes among patients with >3 tumors and those with ≤3 tumors. RESULTS: This study of patients who underwent liver resection identified 775 who had a single tumor and compared overall survival rates with 477 who had multiple hepatocellular carcinomas: 242 had 2 hepatocellular carcinomas, 79 had 3 hepatocellular carcinomas, and 74 had >3 hepatocellular carcinomas. The median survival times based on the number of tumors were 9.74 years for a single tumor, 6.36 years for 2 tumors, 7.21 years for 3 tumors, 3.31 years for 4 tumors, and 3.48 years for 5 tumors. The median survival time was significantly worse in patients with >3 tumors than in those with 3 tumors (P < .0001). Concerning the type of treatments for recurrence, the patients who underwent surgical treatment had significantly better survival after recurrence than patients who underwent other treatments (8.32 vs 3.19 years; P < .001). CONCLUSION: The overall survival after liver resection was significantly worse for patients with >3 tumors than for those with <3 tumors. However, liver resection can be recommended for patients with 2 or 3 hepatocellular carcinomas because an acceptable median survival (>5 years) can be expected.

DOI： 10.1016/j.surg.2022.06.019

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: To determine treatment strategies corresponding to a wide range of pancreatic neuroendocrine neoplasms staging, easier-to-use and detailed prognostic classification is required. METHODS: Patients with pancreatic neuroendocrine neoplasms who underwent curative-intent surgery at the University of Tokyo Hospital between 2000 and 2018 were retrospectively reviewed. The presence or absence of venous and lymphatic invasion was assessed. Multivariable analysis was performed to identify the risk factors of shorter overall survival and recurrence-free survival. Patients were classified into the following 3 groups: a lymphovascular invasion 0 group, whereby both venous and lymphatic invasion were negative; an lymphovascular invasion 1 group, where either of the 2 was positive; and an lymphovascular invasion 2 group, where both were positive. The survival curves and recurrence patterns of the 3 groups were compared. RESULTS: Eighty-nine patients were analyzed. Multivariable analysis revealed that lymphatic invasion and Ki-67 index (≥ 3.0%) were independent prognostic factors of recurrence-free survival (hazard ratio: 5.2 and 3.6). Fifty-three patients were classified as lymphovascular invasion 0, 26 as lymphovascular invasion 1, and 10 as lymphovascular invasion 2. The recurrence-free survival curves of the 3 groups were significantly stratified (10-year recurrence-free survival: 89.1% in lymphovascular invasion 0, 57.1% in lymphovascular invasion 1, and 18.3% in lymphovascular invasion 2). Five-year cumulative liver and lymph node metastasis of lymphovascular invasion 0, lymphovascular invasion 1, and lymphovascular invasion 2 were well stratified at 0% and 3.8%, 15.8% and 23.1%, and 33.3% and 70.0%, respectively. CONCLUSION: Postoperative prognosis of resected pancreatic neuroendocrine neoplasms could be finely classified by venous invasion and lymphatic invasion. Management after curative-intent surgery for pancreatic neuroendocrine neoplasms may be changed by this new classification.

DOI： 10.1016/j.surg.2022.08.009

PubMed

DOI： 10.35772/ghm.2022.01044

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND AND AIM: Prompt differential diagnosis of liver tumors is clinically important and sometimes difficult. A new diagnostic device that combines probe electrospray ionization-mass spectrometry (PESI-MS) and machine learning may help provide the differential diagnosis of liver tumors. METHODS: We evaluated the diagnostic accuracy of this new PESI-MS device using tissues obtained and stored from previous surgically resected specimens. The following cancer tissues (with collection dates): hepatocellular carcinoma (HCC, 2016-2019), intrahepatic cholangiocellular carcinoma (ICC, 2014-2019), and colorectal liver metastasis (CRLM, 2014-2019) from patients who underwent hepatic resection were considered for use in this study. Non-cancerous liver tissues (NL) taken from CRLM cases were also incorporated into the analysis. Each mass spectrum provided by PESI-MS was tested using support vector machine, a type of machine learning, to evaluate the discriminatory ability of the device. RESULTS: In this study, we used samples from 91 of 139 patients with HCC, all 24 ICC samples, and 103 of 202 CRLM samples; 80 NL from CRLM cases were also used. Each mass spectrum was obtained by PESI-MS in a few minutes and was evaluated by machine learning. The sensitivity, specificity, and diagnostic accuracy of the PESI-MS device for discriminating HCC, ICC, and CRLM from among a mix of all three tumors and from NL were 98.9%, 98.1%, and 98.3%; 87.5%, 93.1%, and 92.6%; and 99.0%, 97.9%, and 98.3%, respectively. CONCLUSION: This study demonstrated that PESI-MS and machine learning could discriminate liver tumors accurately and rapidly.

DOI： 10.1111/jgh.15976

PubMed

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgh.15976

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Noninvasive intraductal papillary mucinous neoplasms (IPMNs) theoretically do not metastasize. The purpose of this study is to preoperatively distinguish invasive carcinomas associated with IPMN from noninvasive IPMN. METHODS: A total of 131 patients who underwent surgical resection for IPMN were retrospectively analyzed to identify the predictors of invasive carcinoma, based on the International Association of Pancreatology Consensus Guidelines. RESULTS: Of the 131 patients, 29 (22%) had invasive carcinomas and 102 (78%) had noninvasive IPMN. An enhancing mural nodule (MN) greater than or equal to 5 mm, obstructive jaundice, an abrupt change in the caliber of the pancreatic duct (PD) with distal pancreatic atrophy, and lymphadenopathy were the significant predictors of invasive carcinoma in univariate analysis. The optimal cutoff value for the size of the enhancing MN to differentiate invasive carcinoma was 13 mm. In multivariate analysis, enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were the independent predictors. When all these factors were absent, only 17% were invasive carcinomas. CONCLUSIONS: Enhancing MN greater than or equal to 13 mm, obstructive jaundice, and an abrupt change in the PD caliber were predictive factors for invasive carcinoma. Systematic lymph node dissection may be omitted when a high-risk patient has none of these factors.

DOI： 10.1097/MPA.0000000000002078

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: We assessed whether or not covalently closed circular DNA (cccDNA) levels in the background liver influence the recurrence of hepatocellular carcinoma (HCC) in patients with resolved hepatitis B virus (HBV) infection. METHODS: Among 425 patients who underwent initial hepatectomy for HCC between 2010 and 2018, a retrospective review was performed in 44 with resolved HBV infection. The clinicopathologic characteristics were analyzed for correlation with tumor recurrence. The HBV cccDNA levels were tested via a droplet digital polymerase chain reaction assay. RESULTS: HBV cccDNA was detected in 27 of 44 patients (61%), and the median level was 1.0 copies/1000 ng (range, 0-931.3 copies/1000 ng). Anti-HBc ≥8.9 S/CO was associated with cccDNA detection (odds ratio, 11.08; 95% confidence interval [95% CI], 2.48-49.46; P = 0.002). Twenty-eight patients (64%) developed HCC recurrence after hepatectomy. The overall 3- and 5-year recurrence-free survival rates were 45.7% and 34.3%, respectively.19 HBV cccDNA levels was not significantly associated with HCC recurrence, while the presence of multiple tumors was an independent risk fact or (hazard ratio, 6.53; 95% CI, 2.48-17.19; P < 0.001. CONCLUSION: HBV cccDNA levels did not influence HCC recurrence after hepatectomy. Anti-HBc levels may be used as a surrogate marker for cccDNA.

DOI： 10.1016/j.hpb.2022.06.013

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Although several clinical applications have reported the usefulness of the radical antegrade modular pancreatosplenectomy (RAMPS) procedure for left-sided pancreatic ductal adenocarcinoma, few studies have reported the advantages of RAMPS with respect to the local recurrence (LR) rate. METHODS: As of 2018, 68 and 62 patients underwent RAMPS and standard retrograde pancreatosplenectomy (SRPS). The first recurrence and all subsequent recurrence sites observed on images during a follow-up period and/or chemotherapy. The clinical variables are collected retrospectively. RESULTS: Local recurrence only was found in 5 patients in the RAMPS group (5/68, 7.3%) and in 15 patients in the SRPS group (15/62, 24.2%; p = 0.008) as the first recurrence site. Any chemotherapies were not a risk factor for the incidence of LR. The 5-year cumulative LR rate was significantly lower in patients in the RAMPS group compared with those in the SRPS group (23.6% vs 49.6%; p = 0.019). The 5-year overall survival was 42.2% in the RAMPS group and 33.0% in the SRPS group (p = 0.251). CONCLUSION: The RAMPS procedure for left-sided pancreatic ductal adenocarcinoma may reduce the LR, cumulative LR rates.

DOI： 10.1159/000524927

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are common subepithelial tumors that rarely metastasize to the intracranial space. Because the standard treatment for metastatic intracranial GISTs has not been established, multimodal therapies are needed, especially in the case of skull base metastasis. However, its outcome has not always been favorable. The authors report the longest known surviving case of skull base metastasis of GIST treated with imatinib only. OBSERVATIONS: A 52-year-old male with a history of GIST presented with left facial swelling and numbness. Examinations revealed a 70-mm tumor occupying the left middle cranial fossa and the orbit. The authors performed transnasal endoscopic tumor biopsy for definitive diagnosis and reintroduced imatinib treatment. The tumor significantly decreased in size early after the introduction of imatinib, and symptoms completely disappeared within several weeks. The lesion has remained shrunk radiologically for 63 months, and the patient is continuously being followed up under imatinib treatment. LESSONS: The authors reported a rare case of skull base metastasis of GIST successfully treated solely with systemic therapy with a tyrosine kinase inhibitor, achieving tumor control for over 5 years. This case suggests that tyrosine kinase inhibitors might play a key role in the multidisciplinary treatment for skull base metastases of GIST.

DOI： 10.3171/CASE2257

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed. OBJECTIVE: In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety. METHODS: A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively. RESULTS: Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus. CONCLUSIONS: Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.

DOI： 10.1097/SLA.0000000000004412

PubMed

＜文献概要＞1970年代に幕内らにより開発された術中超音波は,画像解像度やコントラスト分解能,撮像法が進化し,現在では肝切除における必須アイテムとなった。本稿では術中超音波の用途,使用のコツ,応用法に加え,腫瘍診断に有用な術中造影超音波まで,用途別に解説する。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: The effect of pretransplant hepatorenal syndrome (HRS) on the outcomes of living-donor liver transplantation (LDLT) recipients with special reference to the recovery of HRS before LDLT was investigated. METHODS: The rate of HRS was 43.9% (125/285) among the cohort, and the subjects were divided into three groups: those without HRS (No-HRS group, n = 160), those with HRS but recovered following pretransplant renal function restoration treatment (Responders group, n = 55), and those with persistent HRS (Non-responders group, n = 70). RESULTS: While the 1-, 3-, and 5-year patient survival rates were comparable between those with and without HRS (89.6%, 84.7%, and 84.7% vs 95.6%, 92.2%, and 87.5%), the cumulative incidence of the development of posttransplant chronic kidney disease (CKD) was significantly higher in those with HRS (P < .001). In addition, there was a significant difference between Responders and Non-responders in the development of CKD (P = .01). In the Cox regression model, Non-responders (P = .032, HR 1.79 [95% C.I. 1.05-3.03]) and recipient age (P = .014, HR 1.62 [95% C.I. 1.10-2.37]) were independent predictors for the development of CKD after LDLT. CONCLUSION: Living-donor liver transplantation is safe and effective for patients with HRS, and CKD progression could be reduced among those with HRS who responded to renal restoration treatment.

DOI： 10.1002/jhbp.1143

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Optimal strategies for advanced hepatocellular carcinoma (HCC) tumors, such as those with vascular tumor thrombus and those with extrahepatic metastases are unclear. METHODS: A literature review was conducted focusing on conversion surgery for HCC after molecular targeted therapy and therapy using immune checkpoint inhibitors. RESULTS: Upfront surgical resection of advanced HCC tumors has been challenged at some institutions because of lack of promising therapeutic options. Preoperative transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, and radiotherapy in patients with unresectable HCC were developed to improve long-term outcome, but the results were not promising. Nonetheless, the recent advent of molecular targeted therapies and immune check-point inhibitors, enabling frequent tumor responses, has accelerated the use of conversion surgery after these therapies in patients with initially unresectable HCC. Increasing numbers of conversion surgeries after lenvatinib therapy has been reported, and the first prospective clinical trial assessing conversion surgery after lenvatinib therapy in initially unresectable HCC has been commenced. Furthermore, the superiority of combination therapy using atezolizumab and bevacizumab over sorafenib, a conventional first-line drug for unresectable HCC, in terms of overall survival and tumor response has been demonstrated, and the use of this regimen alongside conversion surgery is expected in addition to lenvatinib. CONCLUSION: The literature demonstrated the feasibility of conversion surgery after systemic therapy. Further clinical investigation of surgery after systemic therapy for advanced HCC may be undertaken by clearly distinguishing the tumor status as technically unresectable or oncologically unresectable but technically resectable.

DOI： 10.1002/jhbp.1135

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND/PURPOSE: Current conventional algorithms used for 3-dimensional simulation in virtual hepatectomy still have difficulties distinguishing the portal vein (PV) and hepatic vein (HV). The accuracy of these algorithms was compared with a new deep-learning based algorithm (DLA) using artificial intelligence. METHODS: A total of 110 living liver donor candidates until 2017, and 46 donor candidates until 2019 were allocated to the training group and validation groups for the DLA, respectively. All PV or HV branches were labeled based on Couinaud's segment classification and the Brisbane 2000 Terminology by hepato-biliary surgeons. Misclassified and missing branches were compared between a conventional tracking-based algorithm (TA) and DLA in the validation group. RESULTS: The sensitivity, specificity, and Dice coefficient for the PV were 0.58, 0.98, and 0.69 using the TA; and 0.84, 0.97, and 0.90 using the DLA (P < .001, excluding specificity); and for the HV, 0.81, 087, and 0.83 using the TA; and 0.93, 0.94 and 0.94 using the DLA (P < .001 to P = .001). The DLA exhibited greater accuracy than the TA. CONCLUSION: Compared with the TA, artificial intelligence enhanced the accuracy of extraction of the PV and HVs in computed tomography.

DOI： 10.1002/jhbp.1080

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: After liver resection, the in-hospital observation periods associated with minimal risks for complications and unplanned readmission remains unclear. This study aimed to assess changes in risks of complications over time. METHODS: Surgical complexity of liver resection was stratified into grades I (low complexity), II (intermediate), and III (high). The cumulative incidence rate and risk factors for complication ≥ Clavien-Dindo grade II (defined as treatment-requiring complications) were assessed. RESULTS: Of 581 patients, grade I, II, and III resections were performed in 81 (13.9%), 119 (20.5%), and 381 patients (65.6%). Complexity grades (I vs. III, hazard ratio [HR] 0.45, P = 0.007; II vs. III, HR 0.60, P = 0.011) and background liver status (HR 1.76, P = 0.004) were risk factors for treatment-requiring complications. The cumulative incidence rate of treatment-requiring complications was higher after grade III resection than grade I resection (38.1% vs. 16.1%, P < 0.001) or grade II resection (38.1% vs. 25.2%, P = 0.019). Without cirrhosis/chronic hepatitis, the cumulative incidence rate of treatment-requiring complications decreased to less than 10% on postoperative day (POD) 3 after grade I resection, POD 5 after grade II resection, and POD 10 after grade III resection. CONCLUSION: Conditional complication risk analysis stratified by surgical complexity may be useful for optimizing in-hospital observation.

DOI： 10.1016/j.hpb.2021.06.419

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is one of the main causes of death after LT, and patient prognosis is reportedly poor. Herein, we report two cases of unresectable HCC recurrences after living donor LT that were treated effectively and safely with lenvatinib. CASE REPORT: Both cases underwent LT for HCC beyond the Milan criteria. About 2 years following LT, HCC recurrences were found and resected. However, unresectable 2nd-recurrences were found several months after surgery. In the first case, a complete response was maintained for 12 months with transarterial chemoembolization and lenvatinib. In the second case, a partial response was maintained for 5 months with lenvatinib. Severe adverse events were not observed in either case. CONCLUSION: The presently reported cases suggest that lenvatinib might be effective for the treatment of unresectable HCC recurrence after LT.

DOI： 10.21873/anticanres.15581

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

INTRODUCTION: For patients who have acute severe cholecystitis, urgent/early biliary drainage followed by delayed/elective laparoscopic cholecystectomy is recommended according to the Tokyo Guidelines 2018. Percutaneous transhepatic gallbladder drainage is an established technique. Recently, transmural gallbladder drainage under the guidance of endoscopic ultrasonography (EUS-GBD) was reported as a safe alternative. During surgery, fluorescence imaging using indocyanine green (ICG) has been increasingly used for visualizing the bile ducts. Herein, we report a sequential treatment approach which ensures safety without impairing normal activities before cholecystectomy: EUS-GBD followed by laparoscopic cholecystectomy using ICG fluorescence imaging. MATERIALS AND SURGICAL TECHNIQUE: A 66-year-old man with acute cholecystitis underwent urgent EUS-GBD and had the drainage tube placement through the duodenum into the gallbladder. During 2.5 months of the waiting period, he had no clinical troubles. After insertion of a laparoscope, we found a structure between the gallbladder and the duodenum. We injected 0.025 mg/mL of ICG into the nasobiliary drainage tube (placed in the gallbladder through the duodenum) and confirmed that the structure was a fistula. After removing the tube, the fistula was divided using a surgical stapler under the guidance of fluorescence imaging. The cystic and common bile ducts were also clearly visualized as fluorescence. DISCUSSION: We reported a safe sequential treatment approach for the patient who required biliary drainage: EUS-GBD followed by laparoscopic cholecystectomy under the guidance of ICG fluorescence imaging. This sequential approach may improve patients' satisfaction with respect to quality of life during the waiting period and may ensure the safety of laparoscopic cholecystectomy.

DOI： 10.1111/ases.12955

PubMed

DOI： 10.1136/bmjsit-2022-000156

PubMed

Publishing type：Research paper (scientific journal)  

<title>Abstract</title><sec>
<title>Background</title>
Probe electrospray ionization-mass spectrometry (PESI-MS) can rapidly visualize mass spectra of small, surgically obtained tissue samples, and is a promising novel diagnostic tool when combined with machine learning which discriminates malignant spectrum patterns from others. The present study was performed to evaluate the utility of this device for rapid diagnosis of colorectal liver metastasis (CRLM).


</sec><sec>
<title>Methods</title>
A prospectively planned study using retrospectively obtained tissues was performed. In total, 103 CRLM samples and 80 non-cancer liver tissues cut from surgically extracted specimens were analyzed using PESI-MS. Mass spectra obtained by PESI-MS were classified into cancer or non-cancer groups by using logistic regression, a kind of machine learning. Next, to identify the exact molecules responsible for the difference between CRLM and non-cancerous tissues, we performed liquid chromatography-electrospray ionization-MS (LC-ESI-MS), which visualizes sample molecular composition in more detail.


</sec><sec>
<title>Results</title>
This diagnostic system distinguished CRLM from non-cancer liver parenchyma with an accuracy rate of 99.5%. The area under the receiver operating characteristic curve reached 0.9999. LC-ESI-MS analysis showed higher ion intensities of phosphatidylcholine and phosphatidylethanolamine in CRLM than in non-cancer liver parenchyma (<italic>P</italic> &lt; 0.01, respectively). The proportion of phospholipids categorized as monounsaturated fatty acids was higher in CRLM (37.2%) than in non-cancer liver parenchyma (10.7%; <italic>P</italic> &lt; 0.01).


</sec><sec>
<title>Conclusion</title>
The combination of PESI-MS and machine learning distinguished CRLM from non-cancer tissue with high accuracy. Phospholipids categorized as monounsaturated fatty acids contributed to the difference between CRLM and normal parenchyma and might also be a useful diagnostic biomarker and therapeutic target for CRLM.


</sec>

DOI： 10.1186/s12885-021-08001-5

Other URL： http://link.springer.com/article/10.1186/s12885-021-08001-5/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Indications for a minimally invasive resections are increasing worldwide, but respecting anatomical planes during intraparenchymal transection is demanding. Intraoperative ICG fluorescence staining of liver parenchyma has been introduced as a tool for real-time intraoperative guidance. The aim of this study is to make a systematic review of the current relevant literature on indications, techniques, and results of laparoscopic anatomical liver resection (LALR) using intraoperative indocyanine green (ICG) fluorescence for positive and negative staining of liver segments in patients affected by liver malignancies. METHODS: Electronic bibliographical databases (MEDLINE and PubMed) were searched according to the PRISMA criteria. English language articles meeting the selection criteria and published until June 2020 were retrieved and reviewed. RESULTS: a total of 86 articles were initially found and 11 articles were finally included in the analysis with a total of 83 patients treated. Sixty-two patients (74.6%) underwent mono-segmentectomies. Thirty-five patients (42.1%) underwent the positive staining technique, and forty-eight patients (57.8%) the negative staining technique. CONCLUSIONS: The positive or negative indocyanine green staining technique with real-time fluorescence guidance is an emerging and promising approach. However, the technique has to be standardized and advantages in terms of oncologic results still need validation in further studies.

DOI： 10.1016/j.hpb.2021.05.006

PubMed

DOI： 10.1016/j.dld.2021.02.009

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The aim of this survey was to assess practices regarding pain management, fluid therapy and thromboprophylaxis in patients undergoing pancreatoduodenectomy on a global basis. METHODS: This survey study among surgeons from eight (inter)national scientific societies was performed according to the CHERRIES guideline. RESULTS: Overall, 236 surgeons completed the survey. ERAS protocols are used by 61% of surgeons and respectively 82%, 93%, 57% believed there is a relationship between pain management, fluid therapy, and thromboprophylaxis and clinical outcomes. Epidural analgesia (50%) was most popular followed by intravenous morphine (24%). A restrictive fluid therapy was used by 58% of surgeons. Chemical thromboprophylaxis was used by 88% of surgeons. Variations were observed between continents, most interesting being the choice for analgesic technique (transversus abdominis plane block was popular in North America), restrictive fluid therapy (little use in Asia and Oceania) and duration of chemical thromboprophylaxis (large variation). CONCLUSION: The results of this international survey showed that only 61% of surgeons practice ERAS protocols. Although the majority of surgeons presume a relationship between pain management, fluid therapy and thromboprophylaxis and clinical outcomes, variations in practices were observed. Additional studies are needed to further optimize, standardize and implement ERAS protocols after pancreatic surgery.

DOI： 10.1016/j.hpb.2021.09.006

PubMed

International / domestic magazine：International journal  

OBJECTIVE: To establish consensus recommendations for the use of fluorescence imaging with indocyanine green (ICG) in hepatobiliary surgery. BACKGROUND: ICG fluorescence imaging has gained popularity in hepatobiliary surgery in recent years. However, there is varied evidence on the use, dosage, and timing of administration of ICG in clinical practice. To standardize the use of this imaging modality in hepatobiliary surgery, a panel of pioneering experts from the Asia-Pacific region sought to establish a set of consensus recommendations by consolidating the available evidence and clinical experiences. METHODS: A total of 13 surgeons experienced in hepatobiliary surgery and/or minimally invasive surgery formed an expert consensus panel in Shanghai, China in October 2018. By the modified Delphi method, they presented the relevant evidence, discussed clinical experiences, and derived consensus statements on the use of ICG in hepatobiliary surgery. Each statement was discussed and modified until a unanimous consensus was achieved. RESULTS: A total of 7 recommendations for the clinical applications of ICG in hepatobiliary surgery were formulated. CONCLUSIONS: The Shanghai consensus recommendations offer practical tips and techniques to augment the safety and technical feasibility of ICG fluorescence-guided hepatobiliary surgery, including laparoscopic cholecystectomy, liver segmentectomy, and liver transplantation.

DOI： 10.1097/SLA.0000000000004718

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The aim of this prospective study was to analyze the impact of abdominal incision type on postoperative pain and quality of life (QOL) in hepatectomy. METHODS: In patients undergoing hepatectomy by open, hybrid, or pure laparoscopic approaches, we classified abdominal incisions as: pure laparoscopic (LAP), midline (MID), J-shaped (J), and J-shaped incision plus thoracotomy (TRC). Postoperative pain was measured on postoperative day (POD) 3, 7, 30, and 90 using a visual analog scale (VAS). QOL was evaluated using the short-form-36 questionnaire preoperatively and on POD 30 and 90. RESULTS: We categorized 165 patients into LAP (n = 9, 5%), MID (n = 21, 13%), J (n = 95, 58%), and TRC (n = 40, 24%) groups. Median VAS scores on PODs 3/7/30/90 were: LAP, 27.5/7.5/10/10; MID, 30/10/15/5; J, 50/27.5/20/10, and TRC, 50/30/30/19. The J and TRC groups had significantly higher VAS scores vs. MID on PODs 3 and 7; the LAP and MID groups did not differ significantly. No significant positive correlations were observed between incision length and postoperative VAS, when we stratified patients into two groups according to the presence or absence of a transverse incision. Physical QOL summary scores did not return to preoperative levels even on POD 90, in patients with an additional transverse incision. Mental QOL summary scores worsened with postoperative complications rather than with abdominal incision type. CONCLUSIONS: Transverse incisions, rather than incision length, led to worse midline incision pain and poorer QOL recovery post-hepatectomy. A hybrid approach may be a considerable option when pure laparoscopic hepatectomy is technically difficult. TRIAL REGISTRATION: This study was registered in the UMIN Clinical Trials Registry (registration number: UMIN000017467; http://www.umin.ac.jp/ctr/index.htm ).

DOI： 10.1007/s00268-021-05992-x

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Glisson invasion by CLM is associated with a risk of margin-positive resection, leading to poor long-term outcomes after hepatectomy. This study was performed to evaluate the efficacy of intraoperative ultrasonography (IOUS) for the diagnosis of Glisson's capsule invasion by colorectal liver metastasis (CLM). METHODS: This prospective study involved 50 consecutive patients undergoing hepatectomy for CLM. Preoperatively, all patients had undergone gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI). During hepatectomy, a contrast agent (perflubutane) was intravenously injected and Glisson invasion was estimated based on three characteristic findings: a tumor thrombus, peripheral dilatation, and border irregularity/caliber change. The diagnostic abilities of the preoperative and intraoperative imaging studies were evaluated based on pathological examinations of resected specimens. RESULTS: Among 187 CLMs resected, pathological examinations proved Glisson invasion in 24 tumors (13%). IOUS revealed a tumor thrombus in 3 tumors (1.6%), peripheral dilatation in 4 (2.1%), and border irregularity and/or caliber change in 24 (12.8%). The sensitivity and specificity of IOUS with any of the above three findings for diagnosis of Glisson invasion was 79% and 96%, respectively, while preoperative EOB-MRI detected Glisson invasion in only four tumors (sensitivity/specificity, 17%/100%). The cutoff value of caliber change for diagnosis of Glisson invasion was set at 140% by receiver operating characteristic analysis. The R0 resection rates were not significantly different between patients with (82%) and without (85%) Glisson invasion. CONCLUSIONS: Identification of characteristic findings (tumor thrombus, peripheral dilatation, and border irregularity/caliber change) by contrast-enhanced IOUS is useful for the prediction of Glisson invasion by CLM.

DOI： 10.1007/s00268-020-05883-7

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

ABSTRACT: One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.

DOI： 10.1097/MD.0000000000025205

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

In hepatobiliary surgery, intraoperative fluorescence imaging can be used for real-time identification of the extrahepatic bile ducts (fluorescence cholangiography), liver cancers, and hepatic segmental boundaries, based on biliary excretion as well as fluorescence property of indocyanine green(ICG). These techniques have mainly been developed in Japan and currently become used worldwide, with the advancement and spread of near-infrared imaging systems for open and laparoscopic surgery. It can be expected that novel photodynamic therapy for liver cancers is developed by applying accumulation of biliary excreted agents like ICG in the cancer tissues not only to intraoperative imaging but also to active treatments.

PubMed

腹腔鏡下胆嚢摘出術(LC)に際し、インドシアニングリーン(ICG)をほぼ1日前に注入しても胆汁内の蛍光は検出可能であるか検証した。当大学病院でLCをICG蛍光ナビゲーション下で行う連続患者20名を前向きに組入れた。そして前半の10名(女性7名、年齢42〜83歳)にはICG 2.5mgを手術当日、挿管後のタイミングで投与した(当日群)。後半の10名(男女同数、年齢47〜80歳)にはICG 0.25mg/kgを手術前日の午後に投与した(前日群)。ICG投与から術中蛍光観察までの時間の中央値は、当日群で27分、前日群で16時間24分であった。LC中に各組織の蛍光強度を測定した場合、当日群に対し前日群では総胆管、肝、肝十二指腸間膜(HDL)の蛍光強度は有意に低かった。しかしながら、総胆管/肝の蛍光強度比の中央値[範囲]は当日群で0.7[0.6〜1.2]、前日群で2.5[0.9〜4.8](P<0.001)、総胆管/HDLの蛍光強度比も1.7[1.4〜2.4]と2.3[1.5〜13.3](P=0.038)となり、いずれも前日群の方が有意に高かった。肝/HDLの蛍光強度比は2.4[1.3〜3]と1.3[0.5〜6]で当日群の方が有意に高かった(P=0.041)。ICGをLCの前日に投与すれば、LC直前に投与した場合に比べ総胆管の背景コントラストが良好になる可能性が示された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: The optimal indocyanine green (ICG) administration protocol for fluorescence cholangiography during laparoscopic cholecystectomy (LC) has yet to be determined. METHODS: A prospective study including 20 cases of ICG fluorescence-navigated LC was conducted. Accordingly, the first 10 patients were administered 2.5 mg of ICG on the day of surgery after intubation (surgery-day group), while the remaining 10 consecutive patients were administered 0.25 mg/kg of ICG on the evening before surgery (one-day-before group). Fluorescence intensity (FI) of each tissue and FI ratios were then compared between both groups. RESULTS: The median interval between observation and ICG administration was 27 minutes and 16 hours 24 minutes in the surgery-day and one-day-before group, respectively. Although FI values for the common bile duct (CBD), liver, and hepatoduodenal ligament (HDL) were significantly lower in the one-day-before group than in the surgery-day group, CBD- , 0.6-1.2 vs 2.5, 0.9 = -4.8; P < .001), and CBD-HDL contrast (1.7, 1.4-2.4 vs 2.3, 1.5-13.3; P = .038) were significantly higher in the one-day-before group than in the surgery-day group. CONCLUSION: ICG administration a day before LC may offer better CBD background contrast compared to administration just prior to surgery.

DOI： 10.1002/jhbp.855

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Fluorescence imaging using indocyanine green (ICG) enables intraoperatively visualizing liver tumors as fluorescent. This study evaluated the doses and timing of ICG administration for visualizing tumors via fluorescence using near-infrared light camera systems. METHODS: Consecutive patients who underwent open liver resection for liver tumors from 2016 to 2017 were included. ICG was intravenously injected one-day before surgery at 0.25 mg-intravenous injection (IV), 1.25 mg-IV, 2.5 mg-IV, or 3.75 mg-IV. No additional ICG was administered when patients underwent ICG (0.5 mg/kg) retention test within 10 preoperative days. The ability of fluorescence imaging to enable identifying liver tumors was compared using the PDE-NEO and PINPOINT. RESULTS: 154 lesions in 82 patients were assessed. The tumor identification rate of PDE-NEO did not differ significantly among dosages. The positive predictive values of PDE-NEO were significantly lower at 3.75 mg-IV (69.0%) than in the control group (92.0%) (p = 0.036) and at 1.25 mg-IV (88.9%) (p = 0.033). The tumor identification rate of PINPOINT was significantly higher at 3.75 mg-IV (82.4%) than at 1.25 mg-IV (60.0%) (p = 0.035). The positive predictive values of PINPOINT did not significantly differ among dosages. CONCLUSION: Administering 2.5 mg of ICG one-day before surgery can enable identifying tumors via fluorescence imaging when the ICG test was not performed within 10 preoperative days.

DOI： 10.1016/j.hpb.2020.06.006

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

The factors associated with hepatitis B virus (HBV) recurrence after living donor liver transplantation (LDLT) have not been fully clarified. The aim of this study was to determine the risk factors associated with HBV recurrence after LDLT. From January 1996 to December 2018, a total of 609 LDLT operations were performed at our center. A retrospective review was performed of 70 patients (male, n = 59; female, n = 11; median age = 54 years) who underwent LDLT for HBV-related liver disease. The virologic and biochemical data, tumor burden, antiviral and immunosuppressive therapy were evaluated and compared between the HBV recurrence and non-recurrence groups. Eleven of 70 patients (16%) developed post-LDLT HBV recurrence. The overall actuarial rates of HBV recurrence at 1, 3, 5, 10, and 20 years were 0%, 13%, 16.7%, 18.8%, and 18.8%, respectively. The median interval between LDLT and HBV recurrence was 57 months (range, 18-124 months). Based on the univariate and multivariate analyses, a serum HBV DNA level of ≥ 4 log copies/mL (hazard ratio [HR], 4.861; 95% confidence interval [95% CI], 1.172-20.165; P = 0.029), and hepatocellular carcinoma (HCC) beyond the Milan criteria (HR, 10.083; 95% CI, 2.749-36.982; P < 0.001) were independent risk factors for HBV recurrence after LDLT. In LDLT patients, high pre-LT HBV DNA levels and HCC beyond the Milan criteria were risk factors for HBV recurrence. With the current expansion of the LT criteria for HCC, we should remain cautious regarding the risk of HBV recurrence, particularly in these groups.

DOI： 10.5582/bst.2020.03336

PubMed

大腸癌の原発巣と、同時性の大腸・肝転移巣への同時切除術を腹腔鏡手術として行うことの有効性を評価した。2006〜2017年に根治手術として上記の同時切除術を施行した患者258名の手術成績を後方視的に評価した。純粋に腹腔鏡のみを用いたアプローチでの施行例であることは、開腹およびハイブリッドなアプローチ法の例と比較して術中出血量が有意に少なく、術後在院日数が有意に短いことと関連していた。純粋な腹腔鏡下肝切除術(LH)が導入された2013年以降のデータを、LH施行の37名(LH群)と開腹/ハイブリッド手術の104名(OH群)に分類して比較評価した。その結果、術中出血量および術後在院日数の点からみた術後成績はLH群の方が良好であることが示された。しかし、直腸癌患者に限定した場合には、術後回復促進の程度に関し両群間で有意差はみられなかった。大腸癌の原発巣と同時性大腸・肝転移巣の同時切除術を腹腔鏡下での単純肝切除術にて行う術式は安全であると結論された。そして同術式は、特に結腸癌患者の場合に術後回復を強化すると考えられた。

Publishing type：Research paper (scientific journal)  

While the significance of acquired genetic abnormalities in the initiation of hepatocellular carcinoma (HCC) has been established, the role of epigenetic modification remains unknown. Here we identified the pivotal role of histone methyltransferase G9a in the DNA damage-triggered initiation of HCC. Using liver-specific G9a-deficient (G9a(Delta Hep)) mice, we revealed that loss of G9a significantly attenuated liver tumor initiation caused by diethylnitrosamine (DEN). In addition, pharmacological inhibition of G9a attenuated the DEN-induced initiation of HCC. After treatment with DEN, while the induction of gamma H2AX and p53 were comparable in the G9a(Delta Hep) and wild-type livers, more apoptotic hepatocytes were detected in the G9a(Delta Hep) liver. Transcriptome analysis identified Bcl-G, a pro-apoptotic Bcl-2 family member, to be markedly upregulated in the G9a(Delta Hep) liver. In human cultured hepatoma cells, a G9a inhibitor, UNC0638, upregulated BCL-G expression and enhanced the apoptotic response after treatment with hydrogen peroxide or irradiation, suggesting an essential role of the G9a-Bcl-G axis in DNA damage response in hepatocytes. The proposed mechanism was that DNA damage stimuli recruited G9a to the p53-responsive element of the Bcl-G gene, resulting in the impaired enrichment of p53 to the region and the attenuation of Bcl-G expression. G9a deletion allowed the recruitment of p53 and upregulated Bcl-G expression. These results demonstrate that G9a allows DNA-damaged hepatocytes to escape p53-induced apoptosis by silencing Bcl-G, which may contribute to the tumor initiation. Therefore, G9a inhibition can be a novel preventive strategy for HCC.

DOI： 10.1038/s41419-020-03381-1

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Although diagnostic ultrasound can non-invasively capture the image of abdominal viscera, diagnosis of the continuous ultrasound liver images to detect a liver tumor effectively and to determine whether the detected is benign or malignant is nontrivial. In order to minimize the gaps in diagnostic accuracy depending on doctor's proficiency, we built an automated system to support the ultrasonography of liver tumors by employing deep learning technologies. METHODS: We constructed a neural network model for the automated detection of tumor tissues and blood vessels from the sequential liver ultrasound images. Faster region-based convolutional neural networks (Faster R-CNN) is employed as a base model for the object detection, which can output the detection results in 4 frames per second and enable the system to be particularly suitable for the real time ultrasonography. Moreover, we proposed a new neural network architecture feeding both the current and previous images into Faster R-CNN. For training the models, intraoperative ultrasound images obtained from one hepatocellular carcinoma (HCC) patient were used. The obtained image was a multifaceted observation of the liver and includes one HCC and some blood vessels. We labeled 91 images with the help of a liver specialist. We compared the tumor detection performance of the plain Faster R-CNN model with that of the proposed model. RESULTS: We find that both the models performed well in detecting HCC and blood vessels, after training with 400 epochs using Adam. However, the mean precision of our model reaches 0.549, which is 0.019 better than that of the plain Faster R-CNN, and the mean sensitivity of our model about HCC reaches 0.623±0.385 for 30 scenes of sequential liver ultrasound images, which is also 0.146 better than that of the plain Faster R-CNN model. CONCLUSIONS: The comparison between the proposed model and the plain Faster R-CNN model shows that we achieved better accuracy in tumor detection, in terms of the mean precision as well as the mean sensitivity, with the proposed model.

DOI： 10.21037/hbsn-21-43

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Introduction: Radical resection is the only curative treatment for pancreatic cancer, which is a life-threatening disease. However, it is often not easy to accurately identify the extent of the tumor before and during surgery. Here we describe the development of a novel method to detect pancreatic tumors using a tumor-specific enzyme-activatable fluorescence probe. Methods: Tumor and non-tumor lysate or small specimen collected from the resected specimen were selected to serve as the most appropriate fluorescence probe to distinguish cancer tissues from noncancerous tissues. The selected probe was sprayed onto the cut surface of the resected specimen of cancer tissue to acquire a fluorescence image. Next, we evaluated the ability of the probe to detect the tumor and calculated the tumor-to-background ratio (TBR) by comparing the fluorescence image with the pathological extent of the tumor. Finally, we searched for a tumor-specific enzyme that optimally activates the selected probe. Results: Using a library comprising 309 unique fluorescence probes, we selected GP-HMRG as the most appropriate activatable fluorescence probe. We obtained eight fluorescence images of resected specimens, among which four approximated the pathological findings of the tumor, which achieved the highest TBR. Finally, dipeptidyl-peptidase IV (DPP-IV) or a DPP-IV-like enzyme was identified as the target enzyme. Conclusion: This novel method may enable rapid and real-time visualization of pancreatic cancer through the enzymatic activities of cancer tissues.

DOI： 10.3389/fonc.2021.714527

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Objectives: Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures. Design: Narrative literature review with analysis of IDEAL stage of each field of study. Setting: All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery. Main outcome measures: The IDEAL stage of research evidence was determined for each specialty field using a previously described approach. Results: 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported. Conclusions: Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.

DOI： 10.1136/bmjsit-2021-000088

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

No alternative tissue-engineered vascular grafts for the abdominal venous system are reported. The present study focused on the development of new tissue-engineered vascular graft using a silk-based scaffold material for abdominal venous system replacement. A rat vein, the inferior vena cava, was replaced by a silk fibroin (SF, a biocompatible natural insoluble protein present in silk thread), tissue-engineered vascular graft (10 mm long, 3 mm diameter, n = 19, SF group). The 1 and 4 -week patency rates and histologic reactions were compared with those of expanded polytetrafluoroethylene vascular grafts (n = 10, ePTFE group). The patency rate at 1 and 4 weeks after replacement in the SF group was 100.0% and 94.7%, and that in the ePTFE group was 100.0% and 80.0%, respectively. There was no significant difference between groups (p = 0.36). Unlike the ePTFE graft, CD31-positive endothelial cells covered the whole luminal surface of the SF vascular graft at 4 weeks, indicating better endothelialization. SF vascular grafts may be a promising tissue-engineered scaffold material for abdominal venous system replacement.

DOI： 10.1038/s41598-020-78020-y

PubMed

1996年1月〜2018年12月に当院でB型肝炎ウイルス(HBV)関連肝疾患のため生体肝移植(LDLT)を施行した患者70例(男性59例、女性11性、中央値59歳)を後方視的に評価し、LDLT後のHBV再発のリスク因子について検討した。ウイルス学・生化学データ、腫瘍負荷、抗ウイルス療法、免疫抑制療法の実施の有無などをHBV再発群と非再発群で比較した。その結果、70例のうち11例(16%)でLDLT後にHBV再発が認められた。1年、3年、5年、10年、20年後のHBV再発危険率は各々0%、13%、16.7%、18.8%、18.8%であった。また、LDLTからHBV再発までの期間中央値は57月(18〜124月)であった。単変量および多変量解析により、血清HBV DNA≧4log copies/mL(ハザード比(HR)4.861、95%CI 1.172〜20.165、P=0.029)、およびミラノ基準逸脱の肝細胞癌(HR 10.083、95%CI 2.749〜36.982、P<0.001)が、LDLT後のHBV再発の独立リスク因子であることが判明した。また、LDLT患者では、肝移植前の高HBV DNAレベルとミラノ基準逸脱の肝細胞癌がHBV再発のリスク因子であった。これらの結果より、LDLT後のHBV再発のリスクに留意すべきであることが示唆された。

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12893-020-00781-0

Other URL： http://link.springer.com/article/10.1186/s12893-020-00781-0/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Bile leakage is the most common postoperative complication associated with hepatobiliary and pancreatic surgery. Until now, however, a rapid, accurate diagnostic method for monitoring intraoperative and postoperative bile leakage had not been established. METHOD: Bilirubin levels in drained abdominal fluids collected from 23 patients who had undergone hepatectomy (n = 22) or liver transplantation (n = 1) were measured using a microplate reader with excitation/emission wavelengths of 497/527 nm after applying 5 µM of UnaG to the samples. UnaG was also sprayed directly on hepatic raw surfaces in swine hepatectomy models to identify bile leaks by fluorescence imaging. RESULTS: The bilirubin levels measured by UnaG fluorescence imaging showed favorable correlations with the results of the conventional light-absorptiometric methods (indirect bilirubin: rs = 0.939, p < 0.001; direct bilirubin: rs = 0.929, p < 0.001). Approximate time required for bilirubin measurements with UnaG was 15 min, whereas it took about 40 min with the conventional method at a hospital laboratory. Following administration of UnaG on hepatic surfaces, the fluorescence imaging identified bile leaks not only on the resected specimens but also in the abdominal cavity of the swine hepatectomy models. CONCLUSION: Fluorescence imaging techniques using UnaG may enable real-time identification of bile leaks during hepatectomy and on-site rapid diagnosis of bile leaks after surgery.

DOI： 10.1007/s00268-020-05774-x

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/lt.25798

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/lt.25798

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jhbp.726

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jhbp.726

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jhbp.718

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jhbp.718

腹腔鏡下胆嚢摘出術(LC)の手術難易度予測における術前点滴静注胆嚢造影CT(DIC-CT)の有用性を検討する目的で、LC前にDIC-CT画像が得られた218例を対象に後方視的研究を行った。DIC-CT画像上の造影剤の胆道内流入程度をGrade 0〜3の4段階に分類したところ、Grade 0〜1(胆嚢造影陽性)に比べてGrade 2〜3(胆嚢造影陰性)で手術時間が有意に長く、術中出血量が有意に多かった。多変量解析において、手術時間の独立した予測因子はDIC-CTにおける胆嚢造影陰性、胆嚢壁肥厚、BMI、術前アルカリホスファターゼ、術前C反応性蛋白であった。これら5因子を用いて作成したLC難易度スコア(0〜7点)に基づく難易度の評価グレード(Grade A〜C)は、手術時間の延長と有意な関連を示した。このことから、DIC-CTはLCの手術難易度予測に有用であると結論された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND AND AIM: Lumen-apposing metal stent is widely used for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) nowadays but not approved in many countries and might be unsuitable for elective laparoscopic cholecystectomy (LC) because of its large enterocholecysto fistula. A combination of double pigtail plastic stent (DPPS) and naso-cystic tube (NCT) could overcome these problems. The aim of this study was to estimate the efficacy and safety of this method in patients with acute cholecystitis unfit for urgent cholecystectomy both as bridge to surgery and palliation. METHODS: This was a prospective, single-center feasibility study. EUS-GBD was performed with a 7Fr DPPS followed by an NCT placement. NCT was removed after 1 week. LC was performed 2 or 3 months after EUS-GBD in eligible patients. In patients who did not underwent cholecystectomy, DPPS was left in place. RESULTS: Twenty-three patients were enrolled. Both technical and clinical success rates were 96% (22/23). Early adverse events rate was 13% (3/23), including one bile peritonitis, one intraperitoneal abscess, and one melena. LC was attempted in 12 patients, and conversion to open cholecystectomy was required in three (25%). Neither recurrence of cholecystitis nor late adverse event occurred during 6 months of follow up in 10 patients who did not undergo cholecystectomy. CONCLUSION: EUS-GBD with a combination of DPPS and NCT is considered an effective and safe technique both as bridge to surgery and palliation.

DOI： 10.1111/jgh.15065

PubMed

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jgh.15065

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ases.12802

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00268-019-05315-1

Other URL： http://link.springer.com/article/10.1007/s00268-019-05315-1/fulltext.html

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ases.12712

Other URL： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ases.12712

症例は69歳女性、弓部大動脈人工血管置換術の手術歴があった。当院初診の約1年3ヵ月前に敗血症と脾梗塞で前医入院加療を要した。その後約9ヵ月経過後に突然吐血し、食道静脈瘤破裂の診断で内視鏡的静脈瘤結紮術を施行された。同時に難治性腹水が出現し当院を紹介された。肝炎ウイルス感染の既往や飲酒歴等はなかった。造影CTと造影超音波検査では脾門部の脾動静脈瘻を指摘され、門脈圧亢進の原因と考えられた。治療法として脾動脈塞栓術を検討したが、併存していた腎機能障害や脾膿瘍発症のリスクを考慮し、脾動静脈瘻部位を含む脾臓摘出術を施行した。術後経過は良好で術後第19日に退院した。その後腹水の再貯留と消化管静脈瘤の再発を認めていない。まれな食道静脈瘤破裂と難治性腹水を来した脾動静脈瘻に対し脾臓摘出術を施行した例を経験したため報告する。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11605-019-04203-2

Other URL： http://link.springer.com/article/10.1007/s11605-019-04203-2/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Lysophosphatidylserine (LysoPS) is a lysophospholipid, its generating enzyme, phosphatidylserine-specific phospholipase A1 (PS-PLA1), reportedly plays roles in stomach and colon cancers. Here, we examined the potential roles of LysoPS in hepatocellular carcinoma (HCC). The ninety-seven HCC patients who underwent surgical treatment were enrolled in this study and approved by the institutional review board. Among LysoPS-related enzymes and receptors, increased PS-PLA1 or LysoPS receptor 1 (LPS1) mRNA was observed in HCC tissues compared to non-HCC tissues. PS-PLA1 mRNA in HCC was associated with no clinical parameters, while LPS1 mRNA in HCC was correlated inversely with tumor differentiation. Furthermore, higher serum PS-PLA1 was observed in HCC patients compared to healthy control and correlated with PS-PLA1 mRNA in non-HCC tissues and with serum AST or ALT. Additionally, serum levels of PS-PLA1 were higher in HCC patients with HCV-related liver injury than in those with HBV or non-HBV-, non-HCV-related liver diseases. In conclusion, among LysoPS-related enzymes and receptors, PS-PLA1 and LPS1 mRNA were increased in HCC. Based on the correlation between the serum PS-PLA1 and the mRNA level of PS-PLA1 in non-HCC tissues, the liver may be the main source of serum PS-PLA1, and serum PS-PLA1 levels may be a useful marker for liver injury.

DOI： 10.1038/s41598-020-59590-3

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.surg.2019.08.020

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00464-019-06814-x

Other URL： http://link.springer.com/article/10.1007/s00464-019-06814-x/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases (SLLM) have not been fully investigated. METHODS: Patients undergoing initial hepatectomy for colorectal liver metastases (CLM) from 2005 to 2016 were divided into three groups: patients with isolated CLM undergoing complete resection (Group1, n = 317), SLLM undergoing complete metastasectomy (Group2, n = 33), and SLLM undergoing complete hepatectomy but incomplete lung resection (Group3, n = 20). A staged strategy (hepatectomy followed by lung resection) without interval chemotherapy was mainly applied for SLLM. RESULTS: The 5-year overall survival rate of Group2 was significantly better than that of Group3 (71.7% vs. 10.2%, P < 0.001) and similar to that of Group1 (63.9%, P = 0.779). The 5-year disease-free survival rate was significantly worse in Group2 than Group1 (15.7% vs. 29.0%, P = 0.035). On multivariable analysis, CEA>200 ng/ml was the sole predictor of incomplete resection of lung metastases (odds ratio, 13.7; 95% confidence interval, 1.30-145; P = 0.011). CONCLUSIONS: The prognosis in patients with SLLM who achieve complete metastasectomy is acceptable and might be improved by appropriate selection based on operative indications.

DOI： 10.1016/j.amjsurg.2019.06.007

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00268-019-05205-6

Other URL： http://link.springer.com/article/10.1007/s00268-019-05205-6/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Incisionless near-infrared fluorescent cholangiography (NIFC) is emerging as a promising tool to enhance the visualization of extrahepatic biliary structures during laparoscopic cholecystectomies. METHODS: We conducted a single-blind, randomized, 2-arm trial comparing the efficacy of NIFC (n = 321) versus white light (WL) alone (n = 318) during laparoscopic cholecystectomy. Using the KARL STORZ Image1 S imaging system with OPAL1 technology for NIR/ICG imaging, we evaluated the detection rate for 7 biliary structures-cystic duct (CD), right hepatic duct (RHD), common hepatic duct, common bile duct, cystic common bile duct junction, cystic gallbladder junction (CGJ), and accessory ducts -before and after surgical dissection. Secondary calculations included multivariable analysis for predictors of structure visualization and comparing intergroup biliary duct injury rates. RESULTS: Predissection detection rates were significantly superior in the NIFC group for all 7 biliary structures, ranging from 9.1% versus 2.9% to 66.6% versus 36.6% for the RHD and CD, respectively, with odds ratios ranging from 2.3 (95% CI 1.6-3.2) for the CGJ to 3.6 (1.6-9.3) for the RHD. After dissection, similar intergroup differences were observed for all structures except CD and CGJ, for which no differences were observed. Significant odds ratios ranged from 2.4 (1.7-3.5) for the common hepatic duct to 3.3 (1.3-10.4) for accessory ducts. Increased body mass index was associated with reduced detection of most structures in both groups, especially before dissection. Only 2 patients, both in the WL group, sustained a biliary duct injury. CONCLUSIONS: In a randomized controlled trial, NIFC was statistically superior to WL alone visualizing extrahepatic biliary structures during laparoscopic cholecystectomy. REGISTRATION NUMBER: NCT02702843.

DOI： 10.1097/SLA.0000000000003178

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12957-019-1641-5

Other URL： http://link.springer.com/article/10.1186/s12957-019-1641-5/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

The use of hepatitis B core antibody (anti-HBc)-positive grafts is one strategy for expanding the donor pool for liver transplantation (LT). The aim of this study was to determine the risk factors associated with hepatitis B virus (HBV) recurrence after living donor LT (LDLT) of anti-HBc-positive grafts. From January 1996 to December 2018, a total of 609 LDLT procedures were performed at our center. A retrospective review was performed for 31 patients (23 males and 8 females; median age = 47 years) who underwent LDLT for HBV-unrelated liver disease from anti-HBc-positive donors. The factors associated with HBV recurrence were evaluated and compared between the HBV recurrence and non-recurrence groups. The median follow-up period after LT was 135 months (range, 6-273 months). Four of 31 patients (12.9%) developed post-LT HBV recurrence. All four cases were HBV-naïve patients (anti-HBc-negative and Hepatitis B surface antibody-negative). The median interval between LDLT and HBV recurrence was 42 months (range, 20-51). The overall actuarial rates of HBV recurrence at 1, 3, 5, 10, and 20 years were 0%, 7.2%, 15.7%, 15.7%, and 15.7%, respectively. Although there were no significant differences between the HBV recurrence and non-recurrence groups, HBV recurrence tended to occur in HBV-naïve recipients (P = 0.093). HBV-naïve status may contribute to HBV recurrence after LDLT for HBV-unrelated liver disease from anti-HBc-positive donors. Careful monitoring for serological HBV markers is needed, particularly in this group.

DOI： 10.5582/bst.2019.01283

PubMed

International / domestic magazine：International journal  

Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-seven patients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.

DOI： 10.1159/000501452

PubMed

ドナーがHBc抗体陽性である生体肝移植(LDLT)後に再発したB型肝炎ウイルス(HBV)の治療法を確立するため、HBV再発の危険因子を後ろ向きに調査した。1996〜2018年に行われたLDLT 609件のうち、HBc抗体陽性ドナーのLDLTが行われたHBs抗原陰性患者31例(男性23例、女性8例、中央値43歳)を対象とした。予防投与剤、免疫抑制剤、ワクチン投与の有無、血清モニタリングの結果等を整理し、HBV再発患者とそうでない患者とで比較した。対象患者におけるLDLT後のフォローアップ期間の中央値は135ヵ月であった。分析の結果、4例(12.9%)がLDLT後にHBVを再発しており、その全てにおいてレシピエントはHBc抗体陰性およびHBs抗体陰性(HBVナイーブ)であった。有意差は検出されなかったものの、HBV再発はレシピエント患者がHBVナイーブである場合に起こる傾向が見られた(P=0.093)。HBV未感染の患者はHBc抗体陽性ドナーからのLDLT後にHBVを再発するリスクが高いことから、HBV血清マーカーによるモニタリングが重要であることが示された。

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11605-018-3995-3

Other URL： http://link.springer.com/article/10.1007/s11605-018-3995-3/fulltext.html

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Administration of the selective arginine vasopressin V2 receptor antagonist tolvaptan to cirrhotic patients is controversial. There are no reports of tolvaptan use for patients with far-advanced end-stage liver disease (ESLD) and refractory ascites awaiting liver transplantation. Between 2013 and 2016, 64 patients awaiting adult-to-adult living donor liver transplantation (LDLT) were screened for enrollment. Patients with refractory ascites and on dual conventional diuretics (≥ 50 mg/day of spironolactone and ≥ 20 mg/day of a loop diuretic) were enrolled and assigned to the tolvaptan (TOL) group (n = 10), and low-dose tolvaptan, 3.75 mg/day, was started. The remaining patients who had no or little ascites on conventional diuretic therapy (CDT) were assigned to the CDT group (n = 23). The median model for end-stage liver disease and Child-Pugh scores were 16 (range 7-41) and 10 (7-15), respectively. The median dose of spironolactone in the TOL group was 88 mg (range 50-200) vs. 50 (0-100) in the CDT group (p < 0.01). The median dose of loop diuretics in the TOL group was 70 mg (20-120) vs. 20 (0-80) in the CDT group (p = 0.03). No significant liver damage was detected during tolvaptan therapy. Tolvaptan demonstrated favorable effects in 60% (6/10) of the patients, decreasing the body weight by at least 1.5 kg during the 7 day treatment. These findings suggest that low-dose of tolvaptan may be safe for patients having far-advanced ESLD patients with apparent and refractory ascites taking dual conventional diuretics for a short period before LDLT.

DOI： 10.5582/bst.2019.01072

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.hpb.2018.09.023

2013〜2016年に、成人間生体肝移植(LDLT)待機中の64例の進行性末期肝不全(ESLD)患者から対象者をスクリーニングし、バソプレシンV2受容体拮抗薬トルバプタン(TOL)の投与を予備的に検討した。難治性腹水症を有し2種の利尿薬(スピロノラクトン、ループ利尿薬)を服薬している患者を、TOL群(n=10、平均57歳)として、3.75mg/dayの低用量投与を開始した。難治性腹水症をほとんどまたは全く示さず、従来の利尿剤(CDT)を服用している残りの患者をCDT群(n=23、平均58歳)とした。末期肝不全スコアおよびチャイルドピュースコアの中央値モデルは、それぞれ16(範囲7〜41)および10(範囲7〜15)であった。スピロノラクトンの中央値用量は、TOL群で88mg(範囲50〜200)およびCDT群で50mg(範囲0〜100)であった(p<0.01)。ループ利尿薬の中央値用量は、TOL群で70mg(範囲20〜120)およびCDT群で20mg(範囲0〜80)であった(p<0.03)。また、トルバプタン治療中に肝臓ダメージは観察されず、60%(6/10)の患者に対して良好な効果を示し、7日間の治療期間中に少なくとも1.5kgの体重低下を示した。これらの結果より、低用量のトルバプタンは従来の利尿薬を服用している難治性腹水症を有する進行性ESLD患者に対して、LDLT前の短期間は安全であることが示唆された。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.surg.2018.08.025

Authorship：Lead author   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.soc.2018.08.001

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000501368

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12893-018-0420-5

Other URL： http://link.springer.com/article/10.1186/s12893-018-0420-5/fulltext.html

DOI： 10.1007/s00423-018-1736-4

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.hpb.2018.02.377

Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jso.25128

DOI： 10.1002/jso.25105

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

DOI： 10.5230/jgc.2018.18.e15

PubMed

Publishing type：Research paper (scientific journal)  

Carboxypeptidases (CPs) are a family of hydrolases that cleave one or more amino acids from the C-terminal of peptides or proteins. However, methodology to monitor the activities of CPs is poorly developed. Here, we present the first versatile design strategy to obtain activatable fluorescent probes for CPs by utilizing intramolecular spirocyclization of rhodamine to translate the "aliphatic carboxamide to aliphatic carboxylate" structural conversion catalyzed by CPs into dynamic fluorescence activation. Based on this novel strategy, we developed probes for carboxypeptidases A and B. One of these probes was able to detect pancreatic juice leakage in mice ex vivo, suggesting that its suitability for intraoperative diagnosis of pancreatic fistula. This design strategy should be broadly applicable to CPs, as well as other previously untargetable enzymes, enabling development of fluorescent probes to study various pathological and biological processes.

DOI： 10.1021/jacs.7b11014

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

The clinical course of hepatic eosinophilic abscess (HEA) induced by malignant tumors is not well-known; however, it is considered to be a benign hepatic lesion. HEA is difficult to diagnose by imaging alone and a pathological examination is generally needed, particularly in patients with malignant tumors, because the radiological findings can be similar to those of metastasis. We report a case of multiple HEAs with eosinophilia and sigmoid colon cancer that was difficult to diagnose without a pathological examination. After the resection of the sigmoid colon cancer, the patient's eosinophilia was quickly ameliorated and the HEAs disappeared within 6 months.

DOI： 10.2169/internalmedicine.0083-17

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIMS: The resection of hepatic tumors located in the region surrounded by the right hepatic vein (RHV) and the portal pedicles of the right paramedian/lateral sector (the right hepatic core) remains a challenge for liver surgeons. The aim of this study was to demonstrate the surgical techniques and outcomes of our atypical-parenchyma-sparing hepatectomy (atypical-PSH) approach for the removal of tumors in the right hepatic core. METHODS: Perioperative records of 1,179 consecutive patients who had undergone hepatectomy for hepatocellular carcinoma or colorectal liver metastases from January 2006 to December 2014 were retrospectively reviewed. RESULTS: Twenty-six patients (2%) had a tumor in the right hepatic core. Among them, 20 patients underwent atypical-PSH, including the anterior approach (resection of the right paramedian hepatic parenchyma, n = 9), posterior approach (resection of the right lateral hepatic parenchyma, n = 10), and transhepatic approach (tumor enucleation from the raw surfaces along the RHV, n = 1). Their postoperative outcomes were similar to the remaining 6 patients who had undergone right hepatectomy. CONCLUSIONS: Atypical-PSH can be safely applied for the removal of tumors in the right hepatic core. This technique may have potential advantages in preserving hepatic function for postoperative chemotherapy and repeated hepatectomy for future recurrence.

DOI： 10.1159/000485138

PubMed

Publishing type：Research paper (scientific journal)  

Indocyanine green (ICG)-fluorescence imaging has been developed for real-time identification of hepatic tumors and segmental boundaries during hepatectomy. Fusion ICG-fluorescence imaging (real-time visualization of pseudocolor-fluorescence signals on white-light color images) may serve as a reliable navigation tool especially in laparoscopic hepatectomy, in which gross inspection and palpation are limited.
The study population consisted of 41 patients undergoing laparoscopic hepatectomy. Hepatic tumors were identified by fluorescence imaging following the preoperative intravenous administration of ICG (0.5 mg/kg body weight). To visualize hepatic perfusion and segmental boundaries, ICG (1.25 mg) was injected intravenously during surgery, following closure of the proximal portal pedicle. A laparoscopic imaging system, which enabled superimposition of the pseudocolor-fluorescence images on white color images, was used for the fusion ICG-fluorescence imaging.
Among the 53 malignant tumors resected, fusion ICG-fluorescence imaging revealed 45 nodules (85%), including three nodules of colorectal liver metastasis unidentifiable by white-light color images or intraoperative ultrasonography. It also delineated the segmental boundaries on the hepatic raw surfaces as well as on the phrenic/visceral surfaces in all 12 patients evaluated using this technique.
Fusion imaging enhances the feasibility of intraoperative ICG-fluorescence imaging in the identification of hepatic tumors and segmental boundaries. It may therefore help surgeons in the safe and accurate completion of laparoscopic hepatectomies.

DOI： 10.1007/s00464-017-5576-z

PubMed

Indocyanine green fluorescence imaging is a surgical tool with increasing applications in colorectal surgery. This tool has received acceptance in various surgical disciplines as a potential method to enhance surgical field visualisation, improve lymph node retrieval, and decrease the incidence of anastomotic leaks. In colorectal surgery specifically, small studies have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion, and its use might affect the incidence of anastomotic leaks. Controlled trials are ongoing to validate these conclusions. The number of new indications for indocyanine green continues to increase, including innovative options for detecting and guiding management of colorectal metastasis to the liver. These advances could offer great value for surgeons and patients, by improving the accuracy and outcomes of oncological resections.

DOI： 10.1016/S2468-1253(17)30216-9

PubMed

Publishing type：Research paper (scientific journal)  

Duodenal adenocarcinoma (DA) is a rare disease, and the optimal extent of lymphadenectomy and the role of limited resection remain controversial.
The aim of our study was to assess the pattern of regional lymph node spread of DA and to determine the optimal extent of resection.
A total of 65 patients who underwent curative resection for DA at our institution from 1989 through 2015 were included in this study. Clinicopathologic factors associated with long-term outcomes and the patterns of regional node spread per primary tumor location were evaluated.
Fifty-one patients (78%) underwent pancreaticoduodenectomy (PD), with the remainder undergoing limited resection. The median number of retrieved lymph nodes was 24 (range 1-63) and 48% of patients had regional node metastasis. The 5-year overall survival (OS) rate was 67%. In the multivariate analysis, regional node and para-aortic lymph node metastasis were risk factors associated with poorer OS (hazard ratio [HR] 12.1 [p = 0.025], and HR 3.2 [p = 0.045], respectively). While pancreaticoduodenal (#13) and superior mesenteric (#14) lymph node stations were commonly involved by both distal and proximal DA (33 vs. 39% for #13, p = 0.39; and 33 vs. 22% for #14, p = 0.27), the pyloric lymph node station was much less involved by distal DA than proximal DA (0 vs. 37%, p = 0.036).
The pancreaticoduodenal lymph node station was the most commonly involved lymph node in DA, and PD should be the standard operation for DA. Segmental resection should only be reserved for patients with distal DA who are physically unfit for PD.

DOI： 10.1245/s10434-017-6044-7

Publishing type：Research paper (scientific journal)  

Objective Indocyanine green fluorescence-guided surgery (ICG-FGS) has emerged as a potential new imaging modality for improving the detection of hepatic, lymph node (LN), and peritoneal metastases in colorectal cancer (CRC) patients. The aim of this paper is to review the available literature in the clinical setting of ICG-FGS for tumoral detection in various fields of metastatic colorectal disease. Methods PubMed and Medline literature databases were searched for original articles on the use of ICG in the setting of clinical studies on colorectal cancer. The search terms used were “near-infrared fluorescence”, “intraoperative imaging”, “indocyanine green”, “human” and “colorectal cancer”. Results ICG fluorescence imaging (ICG-FI) is clearly supported as an intraoperative technique that allows the detection of additional superficial hepatic metastases of CRC. Data on the role of ICG-FI in the intraoperative detection of peritoneal metastases and LN metastases are scarce but encouraging and ICG-FI could potentially improve the staging and treatment of these patients. Conclusion ICG-FI is a promising imaging technique in the detection of small infraclinic LN, hepatic, and peritoneal metastatic deposits that may allow better staging and more complete surgical resection with a potential prognostic benefit for patients.

DOI： 10.1016/j.ejso.2017.04.015

PubMed

Publishing type：Research paper (scientific journal)  

Background Detection of pancreatic ductal adenocarcinoma (PDAC) in asymptomatic patients is very rare, and the clinical implication of early detection of asymptomatic PDAC remains unclear.
Methods This retrospective study included 569 consecutive patients with PDAC treated in our institution (250 underwent surgical resection and 319 had unresectable PDAC). The patients' demographics, tumor locations, pathologic stages, treatment, and overall survival (OS) were compared between the asymptomatic and symptomatic patients.
Results In total, 163 (29%) patients presented without subjective symptoms. These patients had an earlier stage of PDAC on presentation (p &lt; 0.001), higher resectability rate (64 vs. 36%, p &lt; 0.001), and higher 5-year OS rate (18 vs. 7%, p &lt; 0.001) than patients with symptoms. Among the patients who underwent resection, asymptomatic patients did not have a significantly higher chance of complete resection (88 vs. 78%, p = 0.06) or 5-year OS rate (23 vs. 22%, p = 0.09). However, symptomatic patients more often required complex operations such as concomitant vascular resection and reconstruction (57 vs. 29%, p &lt; 0.001).
Conclusion Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC because of the earlier stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening programs for early detection of PDAC in selected high-risk populations.

DOI： 10.1007/s11605-017-3421-2

Publishing type：Research paper (scientific journal)  

Background: Three-dimensional (3D) imaging has facilitated liver resection with excision of hepatic veins by estimating the liver volume of portal and hepatic venous territories. However, 3D imaging cannot be used for real-time navigation to determine the liver transection line. This study assessed the value of indocyanine green (ICG) fluorescence imaging with hepatic vein clamping for navigation during liver transection. Methods: Consecutive patients who underwent liver resection with excision of major hepatic veins between 2012 and 2013 were evaluated using ICG fluorescence imaging after clamping veins and injecting ICG. Regional fluorescence intensity (FI) values of non-veno-occlusive regions (FINon), veno-occlusive regions (FIVO) and ischaemic regions (FIIS) were calculated using luminance analysing software. Results: Of the 21 patients, ten, four and seven underwent limited resection, monosegmentectomy/sectionectomy and hemihepatectomy respectively, with excision of major hepatic veins. Median veno-occlusive liver volume was 80 (range 30–458) ml. Fluorescence imaging visualized veno-occlusive regions as territories with lower FI compared with non-veno-occlusive regions, and ischaemic regions as territories with no fluorescence after intravenous ICG injection. Median FIIS/FINon was lower than median FIVO/FINon (0·22 versus 0·59
P = 0·002). There were no deaths in hospital or within 30 days, and only one major complication. Conclusion: ICG fluorescence imaging with hepatic vein clamping visualized non-veno-occlusive, veno-occlusive and ischaemic regions. This technique may guide liver transection by intraoperative navigation, enhancing the safety and accuracy of liver resection.

DOI： 10.1002/bjs.10499

PubMed

DOI： 10.1097/SLA.0000000000001309

PubMed

Publishing type：Research paper (scientific journal)  

gamma-Glutamyltranspeptidase (GGT) is upregulated in a variety of human cancers including primary and secondary hepatic tumors. This motivated us to use gamma-glutamyl hydroxymethyl rhodamine green (gGlu-HMRG), a novel fluorophore emitting light at around 520 nm following enzymatic reaction with GGT, as a tool for the intraoperative identification of hepatic tumors. gGlu-HMRG was topically applied to 103 freshly resected hepatic specimens. Fluorescence imaging using gGlu-HMRG identified hepatic tumors with the sensitivity/specificity of 48%/96% for hepatocellular carcinoma, 100%/100% for intrahepatic cholangiocarcinoma, and 87%/100% for colorectal liver metastasis. High gGlu-HMRG fluorescence intensity was positively associated with the incidence of microscopic vascular invasion in HCC and the risk of early postoperative recurrence in CRLM. These results suggest that gGlu-HMRG imaging could not only be a useful intraoperative navigation tool but also provide information related to postoperative disease recurrence.

DOI： 10.1038/s41598-017-03760-3

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/sla.0000000000001336

PubMed

Publishing type：Research paper (scientific journal)  

Distal pancreatectomy with celiac axis resection is one of the most aggressive approaches for the treatment of locally advanced pancreatic cancer with common hepatic artery and/or celiac axis invasion. However, ischemic complications such as ischemic gastropathy and liver failure are problematic. To avoid these complications, we developed left gastric artery-reconstructing distal pancreatectomy with celiac axis resection. We used the middle colic artery for reconstruction. We performed this procedure in 10 patients, using the middle colic artery in three different ways: left branch reconstruction, right branch reconstruction, and reverse reconstruction. On postoperative images, 90% of the reconstructed left gastric arteries were patent. No complications associated with arterial reconstruction occurred. No patients developed ischemic gastropathy or liver failure. The R0 resection rate was 70%. Nine patients underwent adjuvant chemotherapy and seven patients were able to start it within 90 days. Distal pancreatectomy with celiac axis resection combined with reconstruction of the left gastric artery using the middle colic artery is a feasible option and would enhance the safety for carefully selected patients. Multicenter validation is needed to clarify the benefits of this new procedure.

DOI： 10.1007/s11605-017-3366-5

Publishing type：Research paper (scientific journal)  

© 2017, Japanese Society of Gastroenterology. An 82-year-old woman who had been suffering from repeated obstructive jaundice for 7 years was referred to our hospital. Although endoscopic aspiration of the mucin in the common bile duct had been temporally effective, origin of the mucin production had not been detectable. The patient thus had been forced to be on long-term follow-up without curative resection. Endoscopic retrograde cholangioscopy on admission revealed massive mucin in the common bile duct. In addition, an anomalous bile duct located proximal to the gallbladder was identified. Since the lumen of the anomalous duct was irregular and the rest of biliary tree was completely free of suspicious lesions, the anomalous duct was judged to be the primary site. Surgical resection of the segment 4 and 5 of the liver combined with the extrahepatic biliary tract was performed. Pathological diagnosis was compatible to intraductal papillary neoplasm with high-grade intraepithelial dysplasia of the anomalous bile duct. The patient has been free from the disease for 6.5 years after resection. This is the first case of intraductal papillary neoplasm derived from an anomalous bile duct, which was resected after long-term conservative treatment. The present case suggested the slow growing character of natural history of the neoplasm.

DOI： 10.1007/s12328-017-0721-8

PubMed

Other URL： http://link.springer.com/article/10.1007/s12328-017-0721-8/fulltext.html

Publishing type：Research paper (scientific journal)  

The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII.
Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon's left hand. After the hepatectomy, the holes in the diaphragm were sutured closed.
Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109-477) min and 60 (20-310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred.
Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII.

DOI： 10.1007/s00464-016-5107-3

PubMed

Publishing type：Research paper (scientific journal)  

Pancreatoduodenectomy (PD) is the standard yet complicated procedure for periampullary tumors. To introduce a laparoscopic approach for PD (Lap-PD), a robust and objective assessment system to evaluate the quality of this approach is needed. We describe a phase 1 surgical trial of Lap-PD (Registration ID: UMIN000015328) as a triad of surgery, novel self-assessment system, and feedback discussion implementing the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) guidelines.
This was a surgical phase I trial (corresponding to IDEAL stage 1) approved by the Ethics Committee of our hospital. The resection sequence was divided into 10 parts that were assessed and classified into one of four grades of achievement. Evaluation of each part was then integrated, and the whole Lap-PD was categorized into three grades of achievement. We set discontinuance criteria based on historical surgical outcome of open PD. The previous case was discussed before each new case, and measures to overcome problems were implemented. Five patients underwent Lap-PD.
All Lap-PDs were completed laparoscopically and reconstructed via mini-laparotomy. One patient suffered recurrent ileus requiring re-laparotomy to resolve a severe adhesion. After 1 year, no patient suffered disease recurrence or complication. Based on the self-assessment system, four Lap-PDs were successful, whereas one was rated as feasible owing to bleeding requiring conversion of resection sequence.
Our triad system for evaluating Lap-PD could be a useful tool for the safe introduction and maintenance of Lap-PD.

DOI： 10.1007/s00423-016-1466-4

Publishing type：Research paper (scientific journal)  

Background. The feasibility of parenchymal-sparing hepatectomy has yet to be assessed based on the tumor location, which affects the choice of treatment in patients with colorectal liver metastases.
Methods. Sixty-three patients underwent first curative hepatectomy for deep-placed colorectal liver metastases whose center was located &gt;30 mm from the liver surface. Operative outcomes were compared among patients who underwent parenchymal-sparing hepatectomy or major hepatectomy (&gt;= 3 segments).
Results. Parenchymal-sparing hepatectomy and major hepatectomy were performed for deep-placed colorectal liver metastases in 40 (63 %) and 23 (37%) patients, respectively. Resection time was longer in the parenchymal-sparing hepatectomy than in the major hepatectomy group (57 vs 39 minutes) (P = .02) and cut-surface area was wider (120 vs 86 cm(2)) (P &lt; .01). Resected volume was smaller in the parenchymal-sparing hepatectomy than in the major hepatectomy group (251 vs 560 g) (P &lt; .01). No differences were found between the 2 groups for total operation time (306 vs 328 minutes), amount of blood loss (516 vs 400 mL), rate of major complications (10% vs 13 %), and positive operative margins (5 % vs 4 %). Overall, recurrence-free, and liver recurrence-free survivals did not differ between the 2 groups. Direct major hepatectomy without portal venous embolization could not have been performed in 40% of the parenchymal-sparing hepatectomy group (16/40) because of the small liver remnant volume.
Conclusion. Parenchymal-sparing hepatectomy for deep-placed colorectal liver metastases was performed safely without compromising oncologic radicality. Parenchymal-sparing hepatectomy can increase the number of patients eligible for an operation by halving the resection volume and by increasing the chance of direct operative treatment in patients with ill-located colorectal liver metastases.

DOI： 10.1016/j.surg.2016.06.041

Publishing type：Research paper (scientific journal)  

Prophylactic impact of major hepatectomy (MH) on liver recurrence has yet to be clarified in patients with advanced colorectal liver metastases (CLMs).
In our institute, parenchymal-sparing hepatectomy (PSH) is a standard procedure for CLMs consistently throughout initial and repeat resection, and MH is selected only in cases in which CLMs are close to major Glisson's pedicles. We reviewed 145 patients who underwent curative hepatectomy for advanced CLMs (aeyen4 nodules and aecurrency sign50 mm in size) from 1999 to 2012. Surgical outcomes and survival were compared between patients who underwent PSH and MH.
PSH was performed in 113 patients (77.9 %) and MH in 32 (22.1 %) patients with advanced CLMs. Tumor characteristics and short-term outcomes did not differ between the 2 groups. Incidence of positive tumor margin (8.8 % in PSH vs 9.4 % in MH; p = .927) and rates of liver-only recurrence (43.4 % in PSH and 50.0 % in MH; p = .505) did not differ. No significant differences were found in 5-year overall survival (37.0 % in PSH vs 29.4 % in MH, p = .473), recurrence-free survival (7.6 vs 6.8 %, p = .597), and liver recurrence-free survival (21.0 vs 21.3 %, p = .691). A total of 65 patients had liver-only recurrence, for which repeat hepatectomy was performed in 81.5 % (53 of 65) following our parenchymal-sparing approach.
In patients with advanced CLM, PSH does not increase positive surgical margin or liver recurrence in comparison with MH. A parenchymal-sparing approach offers a high rate of repeat resection for liver recurrence (salvageability).

DOI： 10.1245/s10434-016-5278-0

PubMed

Publishing type：Research paper (scientific journal)  

Introduction Use of central vascular ligation during dissection around the superior mesenteric artery (SMA) in pancreaticoduodenectomy (PD) for periampullary malignancies has rarely been documented.
Methods We developed the SMA hanging technique (SHT) to facilitate central vascular ligation during PD. Briefly, SMA dissection was initiated using the supracolic anterior approach, followed by left-sided dissection. The SMA was taped under finger guidance immediately after right-sided dissection. The ligament of Treitz was detached from the SMA during left-sided dissection, facilitating adequate lymph node dissection while preserving the nerve plexus around the SMA. Forty-seven consecutive patients who underwent PD for periampullary malignancies were divided into two groups: 23 underwent SHT and 24 underwent conventional dissection. Patients' clinical results were assessed to evaluate the feasibility and validity of SHT.
Blood loss volume, operation duration, and the incidence of bleeding during SMA dissection were significantly lower in the SHT group than in the conventional group. The short-term and oncological results were similarly acceptable in both groups.
SHT is a feasible and safe technique with acceptable short-term outcomes. We propose the use of this procedure to standardize en bloc dissection around the SMA.

DOI： 10.1007/s11605-016-3214-z

In hepatobiliary surgery, the fluorescence and bile excretion of indocyanine green (ICG) can be used for real-time visualization of biological structure. Fluorescence cholangiography is used to obtain fluorescence images of the bile ducts following intrabiliary injection of 0.025-0.5 mg/mL ICG or intravenous injection of 2.5 mg ICG. Recently, the latter technique has been used in laparoscopic/robotic cholecystectomy. Intraoperative fluorescence imaging can be used to identify subcapsular hepatic tumors. Primary and secondary hepatic malignancy can be identified by intraoperative fluorescence imaging using preoperative intravenous injection of ICG through biliary excretion disorders that exist in cancerous tissues of hepatocellular carcinoma (HCC) and in non-cancerous hepatic parenchyma around adenocarcinoma foci. Intraoperative fluorescence imaging may help detect tumors to be removed, especially during laparoscopic hepatectomy, in which visual inspection and palpation are limited, compared with open surgery. Fluorescence imaging can also be used to identify hepatic segments. Boundaries of hepatic segments can be visualized following injection of 0.25-2.5 mg/mL ICG into the portal veins or by intravenous injection of 2.5 mg ICG following closure of the proximal portal pedicle toward hepatic regions to be removed. These techniques enable identification of hepatic segments before hepatectomy and during parenchymal transection for anatomic resection. Advances in imaging systems will increase the use of fluorescence imaging as an intraoperative navigation tool that can enhance the safety and accuracy of open and laparoscopic/robotic hepatobiliary surgery.

DOI： 10.21037/hbsn.2015.10.01

PubMed

Publishing type：Research paper (scientific journal)  

Studies have demonstrated a relationship between clinical outcomes after curative resection for colorectal cancer (CRC) and gene mutations of the EGFR pathway; however, no studies have examined metastatic CRC (mCRC) patients with metastasectomy. The aim of this study was to evaluate the relationship between gene mutations of EGFR pathway and clinical outcomes after metastasectomy in mCRC patients. A total of 1,053 patients histopathologically confirmed CRC received a genotyping test for the EGFR pathway from February 2012 to October 2013. Detailed information was obtained through review of medical records. Gene mutations of EGFR pathway were analyzed by Luminex assay. Overall survival (OS) and recurrence free survival were estimated by the Kaplan-Meier method and the log-rank test was used to compare the survival outcomes by gene mutation status. A total of 132 patients received metastasectomy. The frequencies of KRAS exon 2, KRAS exon 3.4, NRAS, BRAF, and PIK3CA mutations were 38.6% (51/132), 3.6% (5/132), 5.1% (7/132), 5.1% (7/132), and 8.7% (12/132), respectively. With a median follow-up of 84.1 months (57.2-NA) for a survivor, the 4-year OS rate was 65.6% for mCRC with RAS mutation, and 81.3% for mCRC with wild-type RAS (p &lt; 0.05). We observed a statistically significant correlation for only the RAS mutation and OS. In multivariate analysis, RAS mutation and liver metastasis were independent factors for shorter OS. There were no significant differences between gene mutations of EGFR pathway and recurrence free survival. RAS mutation in mCRC metastasectomy patients was associated with shorter overall survival.

DOI： 10.1002/ijc.30106

PubMed

Publishing type：Research paper (scientific journal)  

Background Laparoscopic deroofing is widely used for the treatment of symptomatic polycystic liver disease (PCLD). However, bile leakage is a common complication of surgical management for PCLD. Until now, indocyanine green fluorescence imaging (IGFI) has played an active role in hepatobiliary surgery. Herein, we report the effective application of a laparoscopic fusion IGFI system, known as PINPOINT, for laparoscopic deroofing.
Methods In this study, we performed laparoscopic deroofing for PCLD using the laparoscopic fusion IGFI system. We conducted the procedure mainly under the normal view mode, occasionally switching to the fusion IGFI mode. First, we confirmed that the liver cysts did not contain bile using the fusion IGFI mode and then used a percutaneous puncture needle to remove the fluid from some of the giant cysts. Second, using the fusion IGFI mode, we were able to detect thin biliary branches and to adjust the division line of the cyst wall accordingly or, occasionally, to ligate the branches. Finally, we searched for and identified unexpected small bile leakage and then closed it using sutures.
Results The laparoscopic fusion IGFI system can simultaneously show fluorescent images, such as cholangiography and the liver parenchyma, on the normal color view. In the fusion IGFI mode, the intrahepatic bile duct and liver parenchyma can be easily discriminated in real time throughout the procedure. Accordingly, the laparoscopic fusion IGFI system is useful for the surgical treatment of PCLD, in which the boundary between the liver cysts and the liver parenchyma can otherwise be difficult to identify. This technique also enables the branches of Glisson's capsule to be identified without any other intervention.
Conclusion The novel application of the laparoscopic fusion IGFI system allows reliable navigation for PCLD surgery.

DOI： 10.1007/s00464-015-4526-x

PubMed

Publishing type：Research paper (scientific journal)  

A method to completely prevent postoperative pancreatic fistula (PF) in distal pancreatectomy (DP) is lacking. Hence, prophylactic abdominal drains could be used to prevent PF from developing into life-threatening complications.
In 152 consecutive patients undergoing DP, three drains were placed routinely toward the pancreatic stump, supra-pancreatic space, and left subphrenic space. Abdominal drains were removed after surgery gradually based on amylase levels and positivity for bacterial infection in abdominal fluids.
Postoperative symptomatic PF occurred in 57 of 152 patients (37.5 %). Prevalence of severe postoperative complications (Clavien-Dindo grade a parts per thousand yenIIIa) was 16 %, with surgery-associated mortality observed in one patient (0.7 %). Prevalence of infection in drained abdominal fluids increased gradually and was &gt; 10 % on postoperative day (POD)-7. Severe postoperative complications led to longer postoperative hospital stays and higher treatment costs. Multivariate analyses revealed that a body mass index a parts per thousand yen25 kg/m(2), serum albumin level a parts per thousand currency sign3.8 g/dL, and white blood cell count at POD-3 a parts per thousand yen15,000/mu L were independent predictors for development of severe postoperative complications.
Use of prophylactic abdominal drains in DP seems to be effective for preventing PF from developing into fatal complications. However, definitive criteria should be established for enhancing safety and cost efficiency of DP through selective use and early removal of prophylactic drains.

DOI： 10.1007/s00268-015-3399-4

PubMed

J-GLOBAL

Publishing type：Research paper (scientific journal)  

The clinical course of hepatectomy in patients with preexisting bilioenteric anastomosis (BEA) is poorly understood. The aim of this study was to evaluate the potential influence of preexisting BEA on organ/space surgical site infection (SSI) after hepatectomy.
We analyzed consecutive hepatectomies performed between March 2005 and January 2015. Patients' background, operative results, and complications were compared between hepatectomies with and without preexisting BEA.
Twenty-two hepatectomies with preexisting BEA were identified among 1745 hepatectomies. The rate of organ/space SSI was much higher in hepatectomies with preexisting BEA than in those without preexisting BEA (40.9 vs. 6.4 %, P &lt; 0.001). Multivariate analyses identified four variables as independent factors associated with organ/space SSI: liver-directed chemotherapy [odds ratio 5.06 (95 % confidence interval 2.29-10.54), P &lt; 0.001], operative time a parts per thousand yen 300 min [2.40 (1.30-4.54), P = 0.006], estimated blood loss a parts per thousand yen 500 ml [2.34 (1.26-4.31), P &lt; 0.001], and preexisting BEA [12.08 (4.54-31.32), P &lt; 0.001]. A higher rate of organisms from intestinal flora was detected in organ/space SSI after hepatectomies with preexisting BEA (77.8 vs. 21.3 % without BEA, P = 0.002). Analysis of hepatectomies with preexisting BEA identified selection of antibiotics for prophylaxis as the sole risk factor for organ/space SSI (P = 0.049 for cefazolin versus other antibiotics targeting intestinal flora).
Preexisting BEA is an independent risk factor for the development of organ/space SSI after hepatectomy. Antibiotics targeting intestinal flora are strongly recommended for prophylaxis of infectious complications.

DOI： 10.1007/s00268-015-3340-x

PubMed

Publishing type：Research paper (scientific journal)  

Objective:To establish a strategy for surgical resection of hepatic malignancies confined to segment VII.Background:Various surgical procedures can be used to resect hepatic malignancies in segment VII, the deepest region of the liver, by open and/or laparoscopic approaches: nonanatomic wedge resection (WR), segmentectomy VII, right lateral sectionectomy (RLS), and right hepatectomy.Methods:WR and segmentectomy VII were applied as first-line surgical procedures for colorectal liver metastasis (CRLM) and hepatocellular carcinoma (HCC), respectively. RLS and right hepatectomy were indicated only when tumor infiltration to the proximal Glissonian sheath was suspected. Operative outcomes were evaluated in 200 consecutive patients who underwent hepatic resection for HCC (n = 120) or CRLM (n = 80).Results:WR, segmentectomy VII, RLS, and right hepatectomy were performed in 104 (52.0%), 57 (28.5%), 22 (11.0%), and 17 (8.5%) patients, respectively. Local hepatectomy (WR and segmentectomy VII) led to shorter operation times and lower blood loss volumes than did extensive hepatectomy (RLS and right hepatectomy). Thoracotomy was performed in half of the WR and two-thirds of the segmentectomy VII procedures. The availability of a laparoscopic approach was 40% (8 patients) after its application in October 2012.Conclusions:Even for hepatic malignancies located in segment VII, WR and segmentectomy should be prioritized over extensive hepatectomy to preserve the postoperative functional hepatic volume. Full mobilization of the right liver and a good surgical field provided by a large thoracoabdominal or abdominal incision or a laparoscopic approach are key factors for safe performance of deep hepatic transection.

DOI： 10.1097/SLA.0000000000001118

Publishing type：Research paper (scientific journal)  

Although sphingosine 1-phosphate (S1P) has been reported to play an important role in cancer pathophysiology, little is known about S1P and hepatocellular carcinoma (HCC). To clarify the relationship between S1P and HCC, 77 patients with HCC who underwent surgical treatment were consecutively enrolled in this study. In addition, S1P and its metabolites were quantitated by LC-MS/MS. The mRNA levels of sphingosine kinases (SKs), which phosphorylate sphingosine to generate S1P, were increased in HCC tissues compared with adjacent non-HCC tissues. Higher mRNA levels of SKs in HCC were associated with poorer differentiation and microvascular invasion, whereas a higher level of SK2 mRNA was a risk factor for intra-and extra-hepatic recurrence. S1P levels, however, were unexpectedly reduced in HCC compared with non-HCC tissues, and increased mRNA levels of S1P lyase (SPL), which degrades S1P, were observed in HCC compared with non-HCC tissues. Higher SPL mRNA levels in HCC were associated with poorer differentiation. Finally, in HCC cell lines, inhibition of the expression of SKs or SPL by siRNA led to reduced proliferation, invasion and migration, whereas overexpression of SKs or SPL enhanced proliferation. In conclusion, increased SK and SPL mRNA expression along with reduced S1P levels were more commonly observed in HCC tissues compared with adjacent non-HCC tissues and were associated with poor differentiation and early recurrence. SPL as well as SKs may be therapeutic targets for HCC treatment.

DOI： 10.1371/journal.pone.0149462

PubMed

Publishing type：Part of collection (book)  

Anatomic liver resection is established in treating hepatocellular carcinoma or other malignancies to achieve curability and functional preservation. However, the conventional demarcation technique marks only the organ surface and sometimes fails to execute a completely valid demarcation. In this chapter, we describe the efficacy of anatomical liver resection guided by fused images comprising a macroscopic view and indocyanine green fluorescence imaging (IGFI). This method called as fusion IGFI employs a fluorescence imaging system (HyperEye Medical System, Mizuho Ikakogyo Co., LTD, Japan) able to fuse images from the macroscopic and near-infrared ray views on a single monitor. Fusion IGFI includes three approaches of staining, i.e., IV method, PV method, and vein-oriented method, and is a safe imaging technique for anatomic liver resection that attained valid three-dimensional parenchymal demarcation with better feasibility and clearer demarcation than conventional demarcation technique.

DOI： 10.1007/978-4-431-55528-5_26

Publishing type：Part of collection (book)  

This chapter covers assessments of hepatic vessel reconstruction using fluorescence imaging techniques with administration of indocyanine green (ICG) during liver transplantation (LT). Recent advancements in surgical techniques, postoperative management, and immunosuppression have improved the safety of LT. The intraoperative modality to survey reconstructed hepatic vessels is limited mainly to ultrasound. We herein describe ICG fluorescence imaging technique to assess reconstruction of hepatic vessels during LT.

DOI： 10.1007/978-4-431-55528-5_33

Publishing type：Research paper (scientific journal)  

Navigation with fluorescence guidance has emerged in the last decade as a promising strategy to improve the efficacy of oncologic surgery. To achieve routine clinical use, the onus is on the surgical community to objectively assess the value of this technique. This assessment may facilitate both Food and Drug Administration approval of new optical imaging agents and reimbursement for the imaging procedures. It is critical to characterize fluorescence-guided procedural benefits over existing practices and to elucidate both the costs and the safety risks. This report is the result of a meeting of the International Society of Image Guided Surgery (www.isigs.org) on February 6, 2015, in Miami, Florida, and reflects a consensus of the participants' opinions. Our objective was to critically evaluate the imaging platform technology and optical imaging agents and to make recommendations for successful clinical trial development of this highly promising approach in oncologic surgery.

DOI： 10.2967/jnumed.115.158915

PubMed

J-GLOBAL

Publishing type：Research paper (scientific journal)  

Despite increasing popularity of single-incision laparoscopic cholecystectomy (SILC), indication criteria assuring safety of SILC has yet to be established. In the present study, the subjects consisted of 146 consecutive patients undergoing conventional laparoscopic cholecystectomy (CLC) or SILC. SILC was indicated after excluding patients who met following criteria: age &gt; 75 years, obesity, operative scar, cardiopulmonary diseases, acute cholecystitis, choledocholithiasis and abnormal bile duct anatomy. Thirty-four patients were excluded from the SILC candidates (moderate/high-risk CLC group). Among the 112 potential candidates, SILC was indicated for 23 patients (21%, SILC group) and the remaining 89 patients (79%) underwent CLC (low-risk CLC group). In the SILC group, operation time was longer than in the low-risk CLC group (171 [113-286] vs. 126 [72-240] min, p &lt; 0.01), but the periods requiring painkiller was shorter. That led to reduced length of hospital stay compared to low-risk CLC group (2 [2-4] vs. 4 [2-12] days, p &lt; 0.01). Between the low-risk CLC and moderate/high-risk CLC group, operation time was significantly longer and amount of blood loss was larger in the latter group. No complications were encountered in the SILC group. SILC can be indicated safely as far as appropriate criteria is adopted for excluding patients in whom complicated laparoscopic procedures are needed.

DOI： 10.5582/bst.2015.01143

PubMed

J-GLOBAL

DOI： 10.1053/j.gastro.2015.07.068

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jamcollsurg.2015.05.005

Publishing type：Research paper (scientific journal)  

Objectives: To investigate the feasibility and prognostic benefits of third or more hepatectomy (third or more Hx) for recurrent hepatocellular carcinoma.
Background: Second hepatectomy (second Hx) has been accepted as an effective treatment of recurrent hepatocellular carcinoma after first hepatectomy (first Hx). However, the feasibility and efficacy of third or more Hx have not been adequately assessed.
Methods: Data were reviewed from 1340 patients with hepatocellular carcinoma who underwent curative hepatectomy. Among them, 941, 289, and 110 underwent first Hx, second Hx, and third or more Hx, respectively. Surgical outcomes and long-term survival were compared among the groups.
Results: Surgical duration was significantly longer in third or more Hx (median, 6.4 hours) than in second Hx (median, 5.9 hours). Postoperative bile leakage and wound infection were more frequently observed in third or more Hx versus second Hx (12.5% vs 6.2%, [P = 0.04] and 2.9% vs 0.4% [P = 0.03], respectively). Three and 5-year disease-free survival rates were 36.8% and 27.1% in first Hx, 24.4% and 17.9 % in second Hx, and 26.1% and 12.8% in third or more Hx, respectively (P &lt; 0.01 [first Hx vs third Hx], P = 0.95 [second Hx vs third or more Hx]). The 5-year overall survival rates from each resection were similar among the groups (65.3%, 60.5%, 68.2%, respectively). The 5- and 10-year overall survival rates from initial hepatectomy in patients who received third or more Hx were 91.4% and 75.5%, respectively.
Conclusions: Third or more Hx is technically demanding in terms of surgical duration and morbidity compared with second Hx. However, aggressive repeat resection offers a survival similar to second Hx, leading to cumulative long-term survival from initial resection.

DOI： 10.1097/SLA.0000000000000882

Publishing type：Research paper (scientific journal)  

To evaluate the clinical and technical factors affecting the ability of fluorescence cholangiography (FC) using indocyanine green (ICG) to delineate the bile duct anatomy during laparoscopic cholecystectomy (LC).
Application of FC during LC began after laparoscopic fluorescence imaging systems became commercially available.
In 108 patients undergoing LC, FC was performed by preoperative intravenous injection of ICG (2.5 mg) during dissection of Calot's triangle, and clinical factors affecting the ability of FC to delineate the extrahepatic bile ducts were evaluated. Equipment-related factors associated with bile duct detectability were also assessed among 5 laparoscopic systems and 1 open fluorescence imaging system in ex vivo studies.
FC delineated the confluence between the cystic duct and common hepatic duct (CyD-CHD) before and after dissection of Calot's triangle in 80 patients (74%) and 99 patients (92%), respectively. The interval between ICG injection and FC before dissection of Calot's triangle was significantly longer in the 80 patients in whom the CyD-CHD confluence was detected by fluorescence imaging before dissection (median, 90 min; range, 15-165 min) than in the remaining 28 patients in whom the confluence was undetectable (median, 47 min; range, 21-205 min; P &lt; 0.01). The signal contrast on the fluorescence images of the bile duct samples was significantly different among the laparoscopic imaging systems and tended to decrease more steeply than those of the open imaging system as the target-laparoscope distance increased and porcine tissues covering the samples became thicker.
FC is a simple navigation tool for obtaining a biliary roadmap to reach the "critical view of safety" during LC. Key factors for better bile duct identification by FC are administration of ICG as far in advance as possible before surgery, sufficient extension of connective tissues around the bile ducts, and placement of the tip of laparoscope close and vertically to Calot's triangle.

DOI： 10.1097/MD.0000000000001005

Publishing type：Research paper (scientific journal)  

A 65-year-old male with a pancreatic neuroendocrine tumor presenting with a duodenal ulcer was referred to our department. The tumor involved the common hepatic artery, gastroduodenal artery, left hepatic artery and the right posterior hepatic artery, but not the right anterior hepatic artery originating from the superior mesenteric artery. The hepatic arteries, except the aberrant right anterior hepatic artery, were embolized using coils 18 days before the surgery. The patient underwent pancreaticoduodenectomy with resection of the tumor-encased hepatic arteries, while preserving the aberrant artery. The patient was discharged uneventfully on postoperative day 13 with no ischemic complications. A histopathological examination revealed a grade 2 pancreatic neuroendocrine tumor according to the classification of the World Health Organization, and the surgical margin was negative. The patient developed hepatic metastases 16 months after surgery; hence, hepatic resection was performed. The present surgical strategy is applicable in patients with relatively low-grade pancreatic malignancies involving major hepatic arteries.

DOI： 10.1007/s00595-014-0837-0

PubMed

Publishing type：Part of collection (book)  

Clinical application of fluorescence-guided surgery using indocyanine green has been expanded with the advances in imaging techniques and distribution of fluorescence imaging systems on the market. We describe the history of the development and characteristics of fluorescence imaging systems for clinical use that are currently available in Japan: PDE, HyperEye Medical System, and other prototype laparoscopic imaging systems.

DOI： 10.1007/978-3-319-15678-1_7

Publishing type：Part of collection (book)  

It has recently been found that human hepatocellular carcinoma (HCC) preferentially takes up indocyanine green (ICG) in the clinical setting. We assessed the effectiveness of photodynamic therapy (PDT) using ICG and near-infrared (NIR) laser for HCC. HuH-7 (a well-differentiated human HCC) cell line was transplanted subcutaneously into mice. Mice were divided into groups: ICG administration only (ICG+ NIRa) and ICG and NIR laser exposure (ICG+ NIR+) at day 0. Mean tumor volume was significantly different between the ICG+ NIR+ group and the ICG+ NIR' group by day 9 (p &lt
0.01). PDT suppressed HuH-7 human HCC cell line tumor growth.

DOI： 10.1007/978-3-319-15678-1_19

Publishing type：Part of collection (book)  

This chapter covers a recent important topic relevant to fluorescence imaging techniques with administration of indocyanine green (ICG), which are reportedly useful and have been applied to liver resection and liver transplantation. Despite recent advances in preoperative imaging study enabling estimation of the regional liver volume, the functional decrease in the region without venous drainage remains unclear. We herein describe ICG-fluorescence imaging technique evaluating regional portal uptake in the liver during surgery and clinical application for liver resection and liver transplantation to improve the safety of hepatobiliary surgery.

DOI： 10.1007/978-3-319-15678-1_14

Publishing type：Research paper (scientific journal)  

Abstract Introduction Portal vein thrombosis (PVT) after liver transplantation (LT) is one of serious complications and reportedly ranges from 2% to 13%. PVT impairs the blood perfusion to the grafts and causes the graft dysfunction. Presentation of case A 60-year-old female underwent living-donor LT with the left liver graft for end-stage liver disease related to chronic hepatitis C. After reperfusion, Indocyanine green (ICG)-fluorescence imaging was performed to confirm the graft perfusion, which pointed out an insufficient perfusion on the surface of segment 4. Following intraoperative ultrasonography revealed thrombus in the portal vein of segment 4, which was successfully removed by heparinized saline flush. Discussion The most of patients with PVT developed graft failure and resulted in retransplantation. This enhances the importance of the surveillance for PVT in the postoperative period as well as the intraoperative period. However, the modality to identify PVT during surgery is limited mainly to intraoperative ultrasound. ICG-fluorescence imaging can visualize regions with impaired hepatic perfusion due to PVT in real time during LT in addition to visualization of hepatic flows of reconstructed vessels and evaluation of regions with venous occlusion. Conclusion ICG-fluorescence imaging can be simply performed with single ICG injection and is expected to have potential roles to enhance the safety of LT.

DOI： 10.1016/j.ijscr.2015.07.031

Publishing type：Research paper (scientific journal)  

This chapter covers recent important topics relevant to ensuring safe liver resection. In particular, preoperative and intraoperative techniques, such as 3-dimensional CT, intraoperative ultrasonography with contrast agent and fluorescence imaging using indocyanine green are reportedly useful and have been applied to liver resection and liver transplantation. We, herein, describe the performance of liver resection under the guidance of these techniques and present tips for more accurate intraoperative tumor detection and safer surgical procedures. (C) 2015 S. Karger AG, Basel

DOI： 10.1159/000438498

PubMed

Publishing type：Research paper (scientific journal)  

Telaprevir (TVR), a direct -acting protease inhibitor, was recently reported to improve treatment efficacy when used in combination with peg-interferon (PEG-IFN) and ribavirin (RBV) as triple therapy for HCV in non-transplant patients. The aim of the present study was to investigate the feasibility of TVR-based triple therapy among Japanese living donor liver transplant (LDLT) recipients who had been resistant to dual treatment with PEG-IFN and RBV. Among 133 HCV-positive LDLT recipients, 8 null responders during or after dual treatment with PEG-IFN and RBV were finally indicated for TVR-based triple therapy after treatment. All 8 patients had been resistant to dual treatment with PEG-IFN and RBV. While the cyclosporine trough level was well controlled with an 80% dose reduction during TVR administration, the end - of - treatment response rate was only 25% (2/8), with 63% (5/8) of patients developing anemia that required a blood transfusion and 50% (4/8) of patients developing leukopenia that required filgrastim. Dose reduction or treatment discontinuation was required in all cases. Based on the poor efficacy and the unacceptable high rate of cytopenic events, TVR-based triple therapy is not indicated for those resistant to dual treatment with PEG-IFN and RBV.

DOI： 10.5582/bst.2014.01101

Publishing type：Research paper (scientific journal)  

Recently, fluorescence imaging following the preoperative intravenous injection of indocyanine green has been used in clinical settings to identify hepatic malignancies during surgery. The aim of this study was to evaluate the ability of photoacoustic tomography using indocyanine green as a contrast agent to produce representative fluorescence images of hepatic tumors by visualizing the spatial distribution of indocyanine green on ultrasonographic images. Indocyanine green (0.5 mg/kg, intravenous) was preoperatively administered to 9 patients undergoing hepatectomy. Intraoperatively, photoacoustic tomography was performed on the surface of the resected hepatic specimens (n = 10) under excitation with an 800 nm pulse laser. In 4 hepatocellular carcinoma nodules, photoacoustic imaging identified indocyanine green accumulation in the cancerous tissue. In contrast, in one hepatocellular carcinoma nodule and five adenocarcinoma foci (one intrahepatic cholangiocarcinoma and 4 colorectal liver metastases), photoacoustic imaging delineated indocyanine green accumulation not in the cancerous tissue but rather in the peri-cancerous hepatic parenchyma. Although photoacoustic tomography enabled to visualize spatial distribution of ICG on ultrasonographic images, which was consistent with fluorescence images on cut surfaces of the resected specimens, photoacoustic signals of ICG-containing tissues decreased approximately by 40% even at 4 mm depth from liver surfaces. Photoacoustic tomography using indocyanine green also failed to identify any hepatocellular carcinoma nodules from the body surface of model mice with non-alcoholic steatohepatitis. In conclusion, photoacoustic tomography has a potential to enhance cancer detectability and differential diagnosis by ultrasonographic examinations and intraoperative fluorescence imaging through visualization of stasis of bile-excreting imaging agents in and/or around hepatic tumors. However, further technical advances are needed to improve the visibility of photoacoustic signals emitted from deeply-located lesions.

DOI： 10.1371/journal.pone.0112667

PubMed

Publishing type：Research paper (scientific journal)  

Solitary hepatocellular carcinoma (HCC) is a good candidate for surgical resection. However, the significance of the size of the tumor in solitary HCC remains unclear.
The aim of this study was to evaluate the impact of tumor size on overall and recurrence-free survival of patients with solitary HCC.
We retrospectively reviewed 616 patients with histologically confirmed solitary HCC who underwent curative surgical resection between 1994 and 2010. The characteristics and prognosis of patients with HCC were analyzed stratified by tumor size.
A total of 403 patients (65 %) had tumors &lt; 5 cm, 172 (28 %) had tumors between 5 and 10 cm, and 41 (7 %) had tumors &gt; 10 cm. The incidence of microvascular invasion, satellite nodules, and advanced tumor grade significantly increased with tumor size. The 5-year overall and recurrence-free survival rates of HCC &lt; 5 cm were 69.6 % and 32 %, respectively, which were significantly better than those of HCC between 5 and 10 cm (58 % and 26 %, respectively) and HCC &gt; 10 cm (53 % and 24 %, respectively). On multivariate analysis, cirrhosis (p = 0.0307), Child-Pugh B (p = 0.0159), indocyanine green retention rate at 15 min &gt; 10 % (p = 0.0071), microvascular invasion (p &lt; 0.0001), and satellite nodules (p = 0.0009) were independent predictors of poor survival, whereas tumor size &gt; 5 cm was not.
Although recurrence rates are high, surgical resection for solitary HCC offers good overall survival. Tumor size was not a prognostic factor. Solitary large HCC &gt; 10 cm would be a good candidate for hepatectomy as well as solitary HCC between 5 and 10 cm.

DOI： 10.1007/s00268-014-2704-y

PubMed

Publishing type：Research paper (scientific journal)  

Background: The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival.Methods: Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted.Results: Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6-month graft survival rates were 88.9% (95% confidential intervals [CI], 70.7-96.4), and 85.2% (95% CI, 66.5-94.3), respectively, in the reoperation group (n = 27), and 95.2% (95% CI, 88.0-98.2), and 92.9% (95% CI, 85.0-96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36-month overall survival rates were 96.3% (95% CI, 77.9-99.5), and 88.3% (95% CI, 69.3-96.2), respectively, in the reoperation group, and 89.3% (95% CI, 80.7-94.3) and 88.0% (95% CI, 79.2-93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59).Conclusions: Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.

DOI： 10.1371/journal.pone.0109731

Publishing type：Research paper (scientific journal)  

BACKGROUND: We sought to evaluate whether pancreatic elasticity, measured using acoustic radiation force impulse (ARFI) imaging, can determine the degree of pancreatic fibrosis and risk of pancreatic fistula (PF) in patients undergoing pancreatic resection. Although soft pancreatic texture is a reliable predictor of postoperative PF, noninvasive, quantitative methods of assessing pancreatic hardness have not been established.
STUDY DESIGN: Shear wave velocity (SWV) of the pancreas was preoperatively measured by ARFI imaging in 62 patients undergoing pancreatic resection. Correlations of SWV with pathologic degree of fibrosis in the resected pancreas, exocrine function of the remnant pancreas, and the incidence of postoperative PF were determined.
RESULTS: The SWV was positively correlated with the degree of pancreatic fibrosis (Spearman's rank correlation coefficient [rho] = 0.660, p &lt; 0.001) and inversely correlated with postoperative amylase concentrations and daily output of pancreatic juice. The incidence of postoperative PF was significantly higher in the 32 patients with soft (SWV &lt; 1.54 m/s) than in the 30 with hard (SWV &gt;= 1.54 m/s) pancreata (63% vs 17%, p &lt; 0.001). Multivariate analysis showed that a soft pancreas (SWV &lt; 1.54 m/s) was an independent predictor of postoperative PF (odds ratio 38.3; 95% CI 5.82 to 445; p = 0.001).
CONCLUSIONS: Pancreatic elasticity on preoperative ARFI imaging accurately reflected the pathologic degree of fibrosis and exocrine function of the pancreas, enabling surgeons to adopt appropriate surgical procedures according to the risk of postoperative PF in each patient undergoing pancreatic resection. (C) 2014 by the American College of Surgeons

DOI： 10.1016/j.jamcollsurg.2014.07.940

Publishing type：Research paper (scientific journal)  

Although laparoscopic hepatectomy has increasingly been used to treat cancers in the liver, the accuracy of intraoperative diagnosis may be inferior to that of open surgery because the ability to visualize and palpate the liver surface during laparoscopy is relatively limited. Fluorescence imaging has the potential to provide a simple compensatory diagnostic tool for identification of cancers in the liver during laparoscopic hepatectomy.
In 17 patients who were to undergo laparoscopic hepatectomy, 0.5 mg/kg body weight of indocyanine green (ICG) was administered intravenously within the 2 weeks prior to surgery. Intraoperatively, a laparoscopic fluorescence imaging system obtained fluorescence images of its surfaces during mobilization of the liver.
In all, 16 hepatocellular carcinomas (HCCs) and 16 liver metastases (LMs) were resected. Of these, laparoscopic ICG fluorescence imaging identified 12 HCCs (75 %) and 11 LMs (69 %) on the liver surfaces distributed over Couinaud's segments 1-8, including the 17 tumors that had not been identified by visual inspections of normal color images. The 23 tumors that were identified by fluorescence imaging were located closer to the liver surfaces than another nine tumors that were not identified by fluorescence imaging (median [range] depth 1 [0-5] vs. 11 [8-30] mm; p &lt; 0.001).
Like palpation during open hepatectomy, laparoscopic ICG fluorescence imaging enables real-time identification of subcapsular liver cancers, thus facilitating estimation of the required extent of hepatic mobilization and determination of the location of an appropriate hepatic transection line.

DOI： 10.1007/s00464-014-3468-z

PubMed

Publishing type：Research paper (scientific journal)  

Background: Controversy exists as to whether autotaxin (ATX) may be importantly associated with pathophysiology of hepatocellular carcinoma (HCC). Methods: We evaluated serum ATX levels and its mRNA expression in consecutive 148 HCC patients treated with radiofrequency ablation (RFA) and 30 patients with hepatic resection. Results: Although increased serum ATX levels were observed in almost all the patients treated with RFA, they were not reduced after RFA. Furthermore, serum ATX levels were associated not with tumor burden but with the parameters predicting for liver fibrosis, such as liver stiffness values. Then, in surgically-treated patients, there was no significant correlation between serum ATX levels and ATX mRNA expression levels in HCC tissues. Notably, ATX mRNA expression levels in HCC tissues were not higher than those in peri-tumorous tissues. Finally, serum ATX levels in surgically-treated HCC patients were rather correlated with ATX mRNA expression levels in peri-tumorous tissues as well as with liver fibrosis stage. Conclusion: The increase in serum ATX levels in HCC patients may not be caused by abundant ATX production in HCC tissues but by fibrosis in the background livers. © 2014 Elsevier B.V.

DOI： 10.1016/j.cca.2014.03.006

PubMed

Publishing type：Research paper (scientific journal)  

There seems to be a consensus in regard to the initial treatment of small hepatocellular carcinomas (HCCs): either percutaneous ablation or liver resection should be selected. Liver resection provides for excellent local control, which is one of the most important factors to be considered in the treatment of HCC. However, percutaneous ablation has the advantage of less invasiveness, which allows for repeated sessions of ablation. However, there has been a longstanding debate on which of the two therapeutic modalities might be superior in individual cases with various tumor-related and liver function factors. Although it is practically difficult to conduct randomized controlled trials (RCTs) to compare these two therapeutic modalities, there have been four RCTs published in English, which we focus on in this review article. We discuss the aforementioned unsolved problem according to the results of these RCTs, in addition to the results of a large-scale cohort study and the recommendations of clinical practice guidelines.

DOI： 10.1245/s10434-014-3585-x

PubMed

Publishing type：Research paper (scientific journal)  

Background: Controversy exists as to whether autotaxin (ATX) may be importantly associated with pathophysiology of hepatocellular carcinoma (HCC).
Methods: We evaluated serum ATX levels and its mRNA expression in consecutive 148 HCC patients treated with radiofrequency ablation (RFA) and 30 patients with hepatic resection.
Results: Although increased serum ATX levels were observed in almost all the patients treated with RFA, they were not reduced after RFA. Furthermore, serum ATX levels were associated not with tumor burden but with the parameters predicting for liver fibrosis, such as liver stiffness values. Then, in surgically-treated patients, there was no significant correlation between serum ATX levels and ATX mRNA expression levels in HCC tissues. Notably, ATXmRNA expression levels in HCC tissues were not higher than those in peri-tumorous tissues. Finally, serum ATX levels in surgically-treated HCC patients were rather correlated with ATX mRNA expression levels in peri-tumorous tissues as well as with liver fibrosis stage.
Conclusion: The increase in serum ATX levels in HCC patients may not be caused by abundant ATX production in HCC tissues but by fibrosis in the background livers. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.cca.2014.03.006

PubMed

DOI： 10.1111/ases.12083

PubMed

Publishing type：Research paper (scientific journal)  

ObjectivesThe aim of this study was to identify factors that predict the failure of a no drain' policy in laparoscopic hepatectomy.
MethodsSurgical outcomes in 342 consecutive patients undergoing laparoscopic hepatectomy were reviewed. Drains were placed only for the following predefined criteria: (i) intraoperative bile leak; (ii) bilioenteric anastomosis, and (iii) increased risk for postoperative bleeding (no drain' policy). Factors leading to need for postoperative drainage or reoperation were evaluated.
ResultsDrains were placed in 44 patients (drainage group). Postoperatively, additional procedures were required in five (11.4%) patients in the drainage group and in 18 (6.0%) patients in the no-drainage group. Multivariate analysis suggested that blood loss of &gt;400ml [odds ratio (OR) 4.50, 95% confidence interval (CI) 1.41-14.2; P = 0.010] and preoperative chemotherapy (OR = 2.24, 95% CI 0.82-6.48; P = 0.120) may increase the risk for need for postoperative procedures when intraoperative prophylactic drainage is not used.
ConclusionsProphylactic drainage during liver resection should be considered not only in the presence of uncontrollable bile leak or concern for postoperative bleeding risk, but also in patients who have undergone neoadjuvant chemotherapy and those in whom intraoperative blood loss is &gt;400ml. Otherwise, a no drain' policy is safe and would enhance the advantages of minimally invasive liver surgery.

DOI： 10.1111/hpb.12165

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10620-013-2982-5

Publishing type：Research paper (scientific journal)  

Imaging detection of liver cancers and identification of the bile ducts during surgery, based on the fluorescence properties of indocyanine green, has recently been developed in liver surgery. The principle of this imaging technique relies on the intravenous administration of indocyanine green before surgery and the illumination of the surface of the liver by an infrared camera that simultaneously induces and collects the fluorescence. Detection by fluorescence is based on the contrast between the (fluorescent) tumoral or peritumoral tissues and the healthy (non-fluorescent) liver. Results suggest that indocyanine green fluorescence imaging is capable of identification of new liver cancers and enables the characterization of known hepatic lesions in real time during liver resection. The purpose of this paper is to present the fundamental principles of fluorescence imaging detection, to describe successively the practical and technical aspects of its use and the appearance of hepatic lesions in fluorescence, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver surgery

DOI： 10.1007/s00535-012-0709-6

Publishing type：Research paper (scientific journal)  

Liver resection is the mainstay of curative treatment for localized hepatocellular carcinoma (HCC). However, the impact of surgery for HCC on quality of life (QOL) has not been well assessed.
Health-related QOL was assessed using the Short Form-36 questionnaire in 108 patients who underwent a liver resection for HCC between January 2004 and January 2008. The QOL assessment was scheduled before and every 3 months after the operation. Patients were divided into two groups based on patient-, tumor-, and surgery-related variables. The physical component summary (PCS) and mental component summary (MCS) were compared between the two groups.
Altogether, 69 patients (64 %) completed the consecutive QOL assessments until 6 months after surgery. At 3 months, the PCS scores were significantly lower for women and for patients who had undergone thoracotomy than among men (p = 0.010) and patients who had not undergone thoracotomy (p = 0.048), respectively. No significant differences in any of the PCS scores were observed at 6 months. No significant differences in the MCS scores were observed between the groups throughout the investigation, and improvement relative to the preoperative status was observed at 6 months.
Physical impairments in the QOL after surgery had returned to the baseline at 6 months, and the postoperative mental QOL improved relative to the preoperative state. The surgical candidates were expected to have a satisfactory QOL regardless of the preoperative status and surgical outcomes. A thoracoabdominal approach had a transient negative impact on the physical health status.

DOI： 10.1007/s00268-013-2342-9

Publishing type：Research paper (scientific journal)  

Single nucleotide polymorphisms of interleukin-28B (IL28B) rs8099917 are reported to be associated with virologic clearance in interferon-and ribavirin -based treatment for hepatitis C virus (HCV)-infected patients. We examined virologic response in accordance with IL28B polymorphisms in our living donor liver transplantation series under a preemptive interferon and RBV treatment approach. Adequate DNA samples from both the recipient and donor for the study of single nucleotide polymorphisms of IL28B were available from 96 cases and were the subjects of the present study. Various clinical factors related with virologic response including early virologic response (EVR) and sustained virologic response (SVR) were examined. Totally 51% presented with EVR and 44% achieved SVR. Presence of the major allele (TT) in either the recipient or the donor corresponded to SVR of 53% and 48%. Presence of the minor allele (TG or GG) corresponded to SVR of 26% and 32%. Multivariate analysis revealed that genotype of HCV or EVR, but not IL28B polymorphisms in either the recipient or donor, was an independent factor for achieving SVR. When virologic response to treatment was incorporated into analysis, the impact of IL28B polymorphism on virological clearance remained relative to other factors and was not significantly independent.

DOI： 10.1371/journal.pone.0090462

PubMed

Publishing type：Research paper (scientific journal)  

Background: Although clinical applications of intraoperative fluorescence imaging of liver cancer using indocyanine green (ICG) have begun, the mechanistic background of ICG accumulation in the cancerous tissues remains unclear. Methods: In 170 patients with hepatocellular carcinoma cells (HCC), the liver surfaces and resected specimens were intraoperatively examined by using a near-infrared fluorescence imaging system after preoperative administration of ICG (0.5 mg/kg i.v.). Microscopic examinations, gene expression profile analysis, and immunohistochemical staining were performed for HCCs, which showed ICG fluorescence in the cancerous tissues (cancerous-type fluorescence), and HCCs showed fluorescence only in the surrounding non-cancerous liver parenchyma (rim-type fluorescence). Results: ICG fluorescence imaging enabled identification of 273 of 276 (99 %) HCCs in the resected specimens. HCCs showed that cancerous-type fluorescence was associated with higher cancer cell differentiation as compared with rim-type HCCs (P &lt
0.001). Fluorescence microscopy identified the presence of ICG in the canalicular side of the cancer cell cytoplasm, and pseudoglands of the HCCs showed a cancerous-type fluorescence pattern. The ratio of the gene and protein expression levels in the cancerous to non-cancerous tissues for Na+/taurocholate cotransporting polypeptide (NTCP) and organic anion-transporting polypeptide 8 (OATP8), which are associated with portal uptake of ICG by hepatocytes that tended to be higher in the HCCs that showed cancerous-type fluorescence than in those that showed rim-type fluorescence. Conclusions: Preserved portal uptake of ICG in differentiated HCC cells by NTCP and OATP8 with concomitant biliary excretion disorders causes accumulation of ICG in the cancerous tissues after preoperative intravenous administration. This enables highly sensitive identification of HCC by intraoperative ICG fluorescence imaging. © 2013 Society of Surgical Oncology.

DOI： 10.1245/s10434-013-3360-4

PubMed

Publishing type：Research paper (scientific journal)  

To clarify the prognostic impact of the hepatitis C virus (HCV) genotype after curative resection for hepatocellular carcinoma (HCC).
A total of 199 patients who underwent a curative hepatic resection for HCV-related HCC were reviewed. The clinical outcomes were compared between patients infected with HCV genotype 1b (n = 160) and those infected with other genotypes (n = 39).
With a comparable median HCV viral load (6.0 vs. 5.8 log(10) IU/mL, p = 0.17), the 3-year recurrence-free survival (RFS) rates (25 vs. 20 %, p = 0.65) and the 5-year overall survival (OS) rates (72 vs. 65 %, p = 0.73) were similar between the two groups. A multivariate analysis confirmed that HCV viral load of +1.0 log(10) IU/mL [hazard ratio (HR), 1.48], major vascular invasion (HR, 3.20), recurrent tumor (HR, 1.77), and preoperative des-gamma carboxyprothrombin level &gt; 40 mAu/mL (HR, 1.64) were independent predictors of tumor recurrence, while the HCV genotype was not a significant risk factor. When the population was stratified according to the HCV viral load, a significant difference was observed in the RFS rate for both genotype 1b (p = 0.003) and the other genotypes (p = 0.037) at HCV viral load of 5.3 log(10) IU/mL.
The HCV genotype does not affect the surgical outcomes of patients with HCC. A lower HCV viral load is advantageous regardless of the HCV genotype.

DOI： 10.1007/s12072-013-9507-3

PubMed

Publishing type：Research paper (scientific journal)  

Background Photodynamic therapy (PDT) has not been reported for human hepatoma, because cancer cells only weakly take up the photosensitizer. Indocyanine green (ICG) is a photosensitizer normally excreted into the bile, and bile excretion is impaired in human hepatomas. We examined whether human hepatoma cell lines preferentially take up the ICG and then assessed the effectiveness of PDT using ICG and near-infrared (NIR) laser.
Methods HuH-7 and HepG2 human hepatoma cell lines were transplanted subcutaneously into mice. Developing HuH-7 and HepG2 tumors were confirmed that preferentially took up the ICG in 24 h after ICG was administered to mice via tail vein. The HuH-7 tumor showed a high tumor-to-background fluorescence intensity ratio, 255: 1, whereas fluorescence intensity of HuH-7 is increased twofold compared to HepG2. HuH-7 cell transplanted mice were divided into three groups: ICG administration only (ICG+NIR-, n = 8), ICG and NIR laser exposure (ICG+NIR+, n = 12), and NIR laser exposure only (ICG-NIR+, n = 5).
Results Mean tumor volume in the ICG+NIR- and ICG-NIR+ groups increased steadily. In contrast, mean tumor volume in the ICG+NIR+ group did not change between days 0 and 3. Mean tumor volume did not differ significantly between the ICG-NIR+ and ICG-NIR-groups, but was significantly different between the ICG+NIR+ group and both the ICG-NIR+ and ICG+ NIR- groups (p &lt; 0.01).
Conclusions ICG is preferentially taken up by HuH-7 and HepG2 human hepatoma cell line tumors. The tumor-to-background ratio of HuH-7 tumors, in particular, was extremely high. PDT with NIR laser irradiation suppressed HuH-7 human hepatoma cell line tumor growth.

DOI： 10.1007/s00535-013-0775-4

PubMed

DOI： 10.1159/000343853

PubMed

Publishing type：Research paper (scientific journal)  

Introduction. There are several variations in the morphologic characteristics of the extrahepatic biliary system. A hepaticocystic duct is one of the rare variations. Case presentation. A 69-year-old Asian man underwent a cholecystectomy for cholelithiasis. His cystic duct was not detected during surgery. An intraoperative cholangiography revealed that his common hepatic ducts drained directly into the neck of his gallbladder. There was no common bile duct, as evidenced by the union of the common hepatic and cystic ducts. Conclusion: Knowledge of anomalies related to the extrahepatic biliary system is important for decreasing the severe morbidity and mortality that may result from a failure to recognize the anomaly. © 2013 Harada et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1752-1947-7-279

PubMed

Publishing type：Research paper (scientific journal)  

Indocyanine green (ICG) fluorescent imaging has been used effectively to identify hepatocellular carcinoma (HCC) in intraoperative setting. However, whether extrahepatic metastatic lesions from HCC can also be detected by this imaging is unknown.
This study was conducted on 17 patients with suspected extrahepatic HCC metastases in the lung (n = 3), adrenal gland (n = 1), lymph node (n = 7), peritoneum (n = 5) and both lymph node and peritoneum (n = 1). ICG was administered intravenously at a dose of 0.5 mg/kg prior to operation for liver function evaluation. Intraoperative ICG fluorescent imaging was performed with a near-infrared light camera system. The surgical specimens were also examined in all cases for the presence of ICG fluorescence.
Of 28 lesions for which ICG fluorescence was examined intraoperatively, 24 lesions exhibited fluorescence and were proved to be HCC metastases pathologically. Five of them were newly identified by ICG fluorescent imaging. The other four lesions included two HCC metastases and two benign tumors. Of 33 suspicious metastatic lesions extirpated, 26 lesions emitting fluorescence from the specimen were all metastatic HCC. The other 7 lesions consisted of 6 benign tumors and one HCC metastasis. Accordingly, the positive predictive value of in vivo and ex vivo ICG fluorescent imaging were both 100 %, while the negative predictive value of those methods were 50 and 86 %, respectively.
Extrahepatic metastases from HCC exhibited ICG fluorescence when illuminated by near-infrared light, indicating their capability to transport ICG. This imaging can be a useful tool for intraoperative detection of metastasis in HCC patients.

DOI： 10.1007/s00535-012-0709-6

PubMed

DOI： 10.1016/j.jhep.2013.05.004

PubMed

Publishing type：Research paper (scientific journal)  

Background Pancreatic fistula (PF) remains the most serious complication after digestive surgery. It is difficult to prevent because of the inability to visualize the leakage of pancreatic juice during surgery or to evaluate the protease activity of leaked fluid, which is responsible for PF formation. Methods The fluorescence intensities of a chymotrypsin probe (glutamyl-phenylalanine hydroxymethyl rhodamine green with added trypsin) in pancreatic juice and in intestinal or abdominal fluids drained after pancreatic resection were evaluated. The chymotrypsin probe was sprayed on to filter papers that had been placed on the resected pancreatic stump in patients undergoing pancreaticoduodenectomy or central pancreatectomy. The ability of this technique to visualize the leakage of pancreatic juice and predict postoperative PF formation was assessed. Results The fluorescence intensity of the chymotrypsin probe in 76 fluid samples correlated positively with amylase levels (r s = 0·678, P &lt
0·001). The fluorescence patterns of the pancreatic stump were classified grossly into the three types: duct (fluorescence signal visualized only on the stump of the main pancreatic duct, 16 patients), diffuse (ductal stump and surrounding pancreatic parenchyma, 7) and negative (no fluorescence signal, 7). Symptomatic PFs developed in 13 of 23 patients with duct- or diffuse-type fluorescence, but in none of the seven patients with negative-type fluorescence (P = 0·008). Conclusion The chymotrypsin probe enabled determination of the protease activity in drained pancreatic fluid samples and allowed real-time visualization of pancreatic juice leakage during surgery. New technique to diagnose pancreatic fistula © 2013 British Journal of Surgery Society Ltd. Published by John Wiley &amp
Sons, Ltd.

DOI： 10.1002/bjs.9185

PubMed

DOI： 10.1002/lt.23657

PubMed

Publishing type：Research paper (scientific journal)  

Purpose Hepatitis C virus (HCV) infection has been recognized as a potent risk factor for the postoperative recurrence of hepatocellular carcinoma (HCC). However, little is known about the impact of HCV viral load on surgical outcomes. The study objective was to investigate clinical significance of HCV viral load on long-term outcomes of HCC. Patients and Methods Three hundred seventy patients who were classified as Child-Pugh class A and underwent curative liver resections for HCV-related HCC were divided into low and high viral load groups (≤ or &gt
5.3 log10IU/mL) based on the results of a minimum P value approach to predict moderate to severe activity of hepatitis
the clinical outcomes were then compared. Results The 5-year recurrence-free survival rate was 36.1% in the low viral load group and 12.4% in the high viral load group (P &lt
.001). The 5-year overall survival rate was 76.6% in the low viral load group and 57.7% in the high viral load group (P &lt
.001). Multivariate analysis confirmed significant correlation between high viral load and tumor recurrence with a hazard ratio of 1.87 (95% CI, 1.41 to 2.48
P &lt
.001). Subanalysis revealed that the favorable results in the low viral load group were not attributed to whether or not serologic eradication of HCV was obtained both in primary and recurrent lesions. Conclusion Low HCV viral load predicts better long-term surgical outcomes in patients with HCC regardless of the serologic eradication of HCV. © 2013 by American Society of Clinical Oncology.

DOI： 10.1200/JCO.2012.44.3234

PubMed

Publishing type：Research paper (scientific journal)  

Background & Aims: Although recent advances in preoperative imaging have enabled accurate estimation of the regional liver volume with venous occlusion, the extent of functional decrease in such regions remains unclear. In this study, the portal uptake function in postoperative veno-occlusive regions and non-veno-occlusive regions was evaluated by intraoperative fluorescent imaging after intravenous injection of indocyanine green (ICG).Methods: In 22 liver resection patients and 23 recipients and 18 donors of liver transplantation, fluorescent intensity on the remnant liver or the liver graft was evaluated in real time following intravenous injection of ICG (0.0025 mg per 1 ml of remnant liver volume).Results: Plateau ICG concentrations were significantly lower in the veno-occlusive regions (C-VO) than in the non-veno-occlusive regions (C-Non) in liver resection patients (median [range], 0.75 [0.29-2.0] mu g/ml vs. 3.0 [0.46-6.4] mu g/ml p <0.001), donors (0.69 [0.29-1.9] mu g/ml vs. 2.4 [0.46-6.4] mu g/ml, p <0.001), and recipients (0.75 [0.34-1.8] mu g/ml vs. 1.8 [0.54-6.4] mu g/ml, p <0.001). Distributions of the C-VO/C-Non and the ratio of the hepatic uptake rate constant in the veno-occlusive regions to that in non-veno-occlusive regions were both around 40% (mean +/- standard deviation, 0.36 +/- 0.17 and 0.42 +/- 0.16, respectively). When the functional remnant liver volume was calculated as a sum of non-veno-occlusive regions and veno-occlusive regions multiplied by C-VO/C-Non, its ratio to the total liver volume was correlated with the improved postoperative/preoperative ratio of prothrombin time.Conclusions: Portal uptake function in veno-occlusive regions is approximately 40% of that in non-veno-occlusive regions. Intraoperative ICG-fluorescent imaging enables real-time evaluation of the extent of the functional decrease in veno-occlusive regions, enhancing accurate estimation of the hepatic functional reserve for determining the surgical indications and procedures. (C) 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jhep.2012.09.028

Publishing type：Research paper (scientific journal)  

Background: Liver resection remains the mainstay of curative treatment for liver malignancies. A variety of preoperative assessments and surgical techniques have improved the short-and long-term outcomes of liver resection in patients with liver tumors. Recently, laparoscopic hepatectomies have been increasingly performed. The aim of the present study is to survey the current practice of liver surgery in high-volume centers in the world. Methods: A questionnaire on the preoperative assessment for liver surgery, open hepatectomy, and laparoscopic hepatectomy was sent to 94 liver centers in the world. Results: Forty-two centers (45%) responded to this survey (29 Asian, 9 European, and 4 North American centers). All but one of the centers evaluated the future liver remnant (FLR) volume, and 95% of them performed preoperative portal vein embolization to increase the FLR volume. In half of the centers, the required FLR volume was over 30% in patients with normal liver and 50% in patients with cirrhotic liver. To reduce the intraoperative blood loss, half of the centers routinely used Pringle's maneuver, and 85% restricted the intraoperative fluid infusion to reduce the central venous pressure. More than 10 laparoscopic hepatectomies were performed per year in 62% of the centers, and more than 30 were performed in 26%, respectively. Laparoscopic major hepatectomies were performed in 24%. Two-thirds answered that the laparoscopic approach would be feasible in donor hepatectomy. Conclusion: The evaluation of FLR volume in patients with normal or cirrhotic liver and the usage of preoperative portal vein embolization have become essential practice in more than 90% of the centers. Reduced blood loss has been achieved using Pringle's maneuver, restriction of fluid infusion, and a variety of surgical devises. The laparoscopic approach is increasingly extended to major hepatectomy or donor hepatectomy. Copyright (C) 2013 S. Karger AG, Basel

DOI： 10.1159/000346225

Publishing type：Research paper (international conference proceedings)  

Introduction A high recurrence rate of hepatocellular carcinoma (HCC) remains a significant concern. The risk factors for recurrence were analysed and the optimal surgical approaches were investigated. Methods The subjects comprised 280 consecutive patients with primary solitary HCC measuring &lt
5 cm in diameter, who underwent curative resections. Multivariate analysis was conducted to identify the risk factors for post-operative recurrence, and the clinical significance of an anatomic resection was evaluated. Results Multivariate analysis identified HCV infection, a des-gamma-carboxyprothrombin level &gt
100 mAU/ml, underlying cirrhosis, the presence of microvascular invasion, the presence of micrometastases and non-anatomic resection as being significant risk factors for post-operative recurrence. The 5-year recurrence rate was 56.7% in the anatomic resection (AR) group and 74.7% in the non-AR group. The 5-year survival rate was 82.2% in the AR group and 71.9% in the non-AR group. Local recurrence within the same segment was observed in 25% of the patients of the non-AR group. The prognostic superiority of AR was confirmed only in patients with histopathological evidence of microvascular invasion and/or micrometastases, and in patients having a solitary HCC measuring 2 to 5 cm in diameter. Conclusions Anatomic resection may decrease local recurrence and improve the surgical outcomes in solitary HCC measuring 2 to 5 cm in diameter. © 2012 International Hepato-Pancreato-Biliary Association.

DOI： 10.1111/j.1477-2574.2012.00552.x

PubMed

Publishing type：Research paper (scientific journal)  

Fluorescence imaging using indocyanine green (ICG) enables highly sensitive identification of hepatocellular carcinoma (HCC) by allowing visualization of impaired biliary excretion of ICG in differentiated HCC tissues and/or in noncancerous liver parenchyma around the tumor. In this technique, ICG is administered intravenously at the dose of 0.5 mg/kg for routine liver function testing within 2 weeks prior to surgery. Intraoperatively, liver cancer can be easily identified by fluorescence imaging of the liver surface prior to resection and on the resected specimen. Intraoperative ICG fluorescence imaging is useful for detecting superficially located small HCCs and confirming that these lesions have been removed with sufficient surgical margins. The present technique also enables identification of new lesions of HCC that have not been diagnosed preoperatively
however, additional resection should be considered only after re-evaluation by visual inspection and palpation or intraoperative ultrasonography because the positive predictive values of such newly detected lesions are 50% or lower, especially when the ICG is administered on the day before the surgery in patients with liver cirrhosis. Copyright © 2013 S. Karger AG, Basel.

DOI： 10.1159/000348601

Publishing type：Research paper (scientific journal)  

Recently, fluorescence imaging using indocyanine green (ICG) has been used clinically to visualize the vascular/lymphatic anatomy and cancerous tissues in real time during surgery. Potentially, among the best indications for ICG fluorescence imaging are hepatobiliary and pancreatic diseases since not only the fluorescent property of ICG but also its biliary excretion property can be utilized for imaging. In fact, ICG fluorescence imaging is already being used in clinical settings to identify the anatomy of the bile duct during laparoscopic surgery as well as open surgery in cases of liver cancer. 5-aminolevulinic acid is another fluorescent probe that has been administered to humans for identification of malignant glioma, bladder cancer and epidermal tumor, although its application to hepatobiliary and pancreatic diseases has rarely been evaluated. Preclinically, numerous kinds of novel fluorescent probes are being developed to improve the sensitivity and specificity of ICG fluorescence imaging, making in vivo fluorescence imaging one of the most active research fields in the world. Copyright © 2013 S. Karger AG, Basel.

DOI： 10.1159/000348600

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/jgh.12095

PubMed

Publishing type：Research paper (scientific journal)  

Recently, fluorescence imaging using indocyanine green (ICG) has been applied to hepatobiliary surgery. Herein, the clinical applications of ICG fluorescence imaging in cases of liver transplantation are described. First, concomitant use of fluorescence cholangiography following intrabiliary injection of ICG by conventional radiographic cholangiography is useful for determination of the division point of the hepatic duct during donor surgery. Secondly, fluorescence angiography can be used to evaluate the hepatic blood flow after venous reconstruction in recipient surgery. Lastly, ICG fluorescence imaging enables simple and easy evaluation of the portal uptake function in hepatic regions with venous occlusion caused by the division of the major hepatic vein tributaries, information about which is helpful for surgeons to determine the operative indication and need for venous reconstruction, not only in liver transplantation, but also in major hepatic resections for malignancy. Copyright © 2013 S. Karger AG, Basel.

DOI： 10.1159/000348604

Publishing type：Research paper (scientific journal)  

Objective: To evaluate the surgical techniques necessary to complete total laparoscopic segmentectomy (LS) of all liver segments (I-VIII).
Background: When compared to open surgery, preservation of functional hepatic volume may be more difficult during laparoscopic hepatectomy. LS is a possible alternative to hemihepatectomy, but laparoscopic surgical techniques to complete anatomically accurate segmentectomy have not yet been well established.
Methods: Data of a total of 342 consecutive patients who underwent laparoscopic hepatectomy were reviewed. LS was defined as complete removal of the Couinaud's segment, in which the corresponding hepatic veins are exposed on the raw surface. The laparoscopic approach was facilitated by using intraoperative ultrasonography for each segment and by placing intercostal trocars to expose the root of the right hepatic vein for segmentectomy VII and VIII.
Results: LS was completed in 62 patients: 36 segmentectomies (from I-VIII), 16 bisegmentectomies of the right lobe, and 10 subsegmentectomies were performed. Conversion to open surgery was required in 3 patients (IVa, VI, and VII). When 26 LS of the superior/posterior hepatic (sub) segments (I, IVa, VII, and VIII) were compared with the remaining 36 LS, the former group required a longer operation time (240 [132-390] minutes vs 155 [90360]) minutes, P &lt; 0.01) and showed an increased amount of blood loss (350 [20-1500] mL vs 100 [10-1100] mL, P = 0.02).
Conclusions: LS is feasible and has become an essential surgical technique that can minimize the loss of functional liver volume without reducing curability, although further technical advancements are needed to enhance the accuracy of the resection, especially for the superior/posterior segments.

DOI： 10.1097/SLA.0b013e31825ffed3

PubMed

Publishing type：Research paper (scientific journal)  

Background: For safe laparoscopic cholecystectomy, surgeons must possess detailed knowledge of the anatomy of the bile duct and arterial system as seen through a laparoscope.
Study Design: We developed an indocyanine green (ICG) reinjection technique for use in fluorescent angiography. Here, we evaluated the efficacy of the ICG reinjection technique in fluorescent angiography in discriminating the arterial system with the concomitant use of fluorescent cholangiography.
Results: Twenty-eight patients were enrolled in the study. All patients underwent laparoscopic cholecystectomy without complication. After reinjection of ICG during surgery, fluorescence of the cystic artery was visualized in 25 patients (89%).
Conclusions: Fluorescent angiography using this ICG reinjection technique might enhance the safety of laparoscopic cholecystectomy.

DOI： 10.1097/SLE.0b013e3182570240

PubMed

Publishing type：Research paper (scientific journal)  

Although the use of single-incision laparoscopic cholecystectomy (SILC) is spreading rapidly, this technique has disadvantages. It does not allow for sufficient surgical views to be obtained or for intraoperative radiographic cholangiography to be performed. Fluorescent cholangiography using a preoperative intravenous injection of indocyanine green (ICG) may be useful for identifying the biliary tract during both SILC and conventional laparoscopic cholecystectomy.
For seven patients undergoing SILC, 1 ml of ICG (2.5 mg) was administered by intravenous injection before the surgery. The prototype fluorescent imaging system consisted of a xenon light source and a 30A degrees laparoscope (diameter, 10 mm) equipped with a charge-coupled device camera capable of filtering out light with wavelengths shorter than 810 nm. The laparoscope was introduced through an umbilical trocar. Fluorescent cholangiography then was performed by changing the color images to fluorescent images using a foot switch during dissection of the triangle of Calot.
Fluorescent cholangiography identified the confluence between the cystic duct and the common hepatic duct in all seven patients before and throughout the dissection of the triangle of Calot. The interval from the injection of ICG to the first obtained fluorescent cholangiography before dissection of the triangle of Calot ranged from 35 to 75 min.
Fluorescent cholangiography enabled real-time identification of the extrahepatic bile ducts during SILC without necessitating catheterization of the bile duct. Such properties of fluorescent cholangiography are expected to be helpful for ensuring the safety of SILC and expanding the indications for the procedure.

DOI： 10.1007/s00464-011-1616-2

PubMed

DOI： 10.1016/j.jamcollsurg.2011.03.006

PubMed

DOI： 10.1007/s00268-010-0676-0

PubMed

Publishing type：Research paper (scientific journal)  

Background: Although intraoperative cholangiography has been recommended for avoiding bile duct injury during laparoscopic cholecystectomy, radiographic cholangiography is time consuming and may itself cause injury to the bile duct. Recently, a novel fluorescent cholangiography technique using the intravenous injectionn of indocyanine green (ICG) has been developed. Methods: In 52 patients undergoing laparoscopic cholecystectomy, 2-5 mg ICG was injected intravenously 30 min before the patient entered the operating room or following intubation. A fluorescent imaging system, which consisted of a xenon light source and a laparoscope with a charge-coupled device camera that could filter out light wavelengths below 810 nm, was used. Fluorescent cholangiography was performed during dissection of Calot's triangle, and its ability to delineate biliary anatomy was compared with that of preoperative cholangiography. Results: Fluorescent cholangiography delineated the cystic duct in all 52 patients, and the cystic duct-common hepatic duct junction was visible before dissection of Calot's triangle in 50 patients. Fluorescent imaging also identified all accessory bile ducts that had been diagnosed before surgery in eight patients. Conclusion: Fluorescent cholangiography enables real-time identification of biliary anatomy during dissection of Calot's triangle. This simple technique may become standard practice for avoiding bile duct injury during laparoscopic cholecystectomy, replacing radiographic cholangiography. Copyright © 2010 British Journal of Surgery Society Ltd.

DOI： 10.1002/bjs.7125

PubMed

Publishing type：Research paper (scientific journal)  

We introduce recent advances in surgical techniques and perioperative management in liver resection for hepatocellular carcinoma (HCC).
Our approaches to further enhancing the efficacy of resection for HCC, based on our presentation at "The 6th International Meeting of Hepatocellular Carcinoma: Eastern and Western Experiences" held in Seoul in December 2008, are presented, along with a review of recent advances in this field reported from eastern Asia.
In our series, liver resection enabled a 5-year overall survival rate of close to 60%, even among patients with multiple HCCs and those with portal hypertension in a background of Child-Pugh class A cirrhosis. Favorable long-term results were obtained by the precise evaluation of liver function using the indocyanine green (ICG) test and the application of perioperative treatments for gastroesophageal varices and severe thrombocytopenia. Furthermore, promising novel techniques have been applied to increase the efficacy of HCC resection, including the preoperative simulation of liver resection, using three-dimensional computed tomography, a "peeling-off" technique for resecting HCC with macroscopic portal venous tumor thrombus, ICG-fluorescent imaging, predeposit autologous plasma transfusion, and laparoscopic liver resection.
The safety and accuracy of liver resection for HCC has been continuously enhanced by advances in surgical techniques and perioperative care. Given that the resection of HCC offers a satisfactory overall survival rate for patients with portal hypertension and those with oligonodular multiple tumors, the surgical indications can now be expanded to include such second-best candidates.

DOI： 10.1007/s00534-009-0231-2

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jamcollsurg.2010.02.052

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of this study was to evaluate the safety of predeposit autologous plasma donation (PAPD) and its efficacy in avoiding allogenic blood transfusions and albumin infusion in liver resection for hepatocellular carcinoma.
STUDY DESIGN: PAPD was adopted in 20 patients in whom liver function remained within Child-Pugh&apos;s class A and an indocyanine green retention rate at 15 minutes was &lt;= 15% (PAPD group). Up to 1,200 mL of autologous fresh frozen plasma was collected through three blood donation sessions. Allogenic blood transfusion rates, albumin infusion rates, and postoperative courses were compared between the PAPD group and a historic control (no PAPD) group (n = 36).
RESULTS: Serum albumin levels after the last blood donation session were not significantly different from those before PAPD. The prothrombin activity even increased through the blood donation sessions (from median 80.9% [range 70.0% to 100%] to median 89.2% [range 71.2%, to 100%]; p &lt; 0.001). Allogenic blood transfusion rate and albumin infusion rate were lower in the PAPD group than in the no PAPD group (11% versus 75%; p &lt; 0.001 and 16% versus 47%; p = 0.038, respectively). Wastage rate of the autologous fresh frozen plasma products was 9%.
CONCLUSIONS: PAPD was safe in patients with underlying liver disease and can be beneficial in simulating the liver synthetic function in advance of operation. Autologous fresh frozen plasma transfusion was effective for avoiding allogenic blood products in liver resection for hepatocellular carcinoma. (J Am Coll Surg 2009;209:206-214. (C) 2009 by the American College of Surgeons)

DOI： 10.1016/j.jamcollsurg.2009.03.004

PubMed

Publishing type：Research paper (scientific journal)  

BACKGROUND: We have often encountered difficulties in identifying small liver cancers during surgery. Fluorescent imaging using indocyanine green (ICG) has the potential to detect liver cancers through the visualization of the disordered biliary excretion of ICG in cancer tissues and noncancerous liver tissues compressed by the tumor. METHODS: ICG had been intravenously injected for a routine liver function test in 37 patients with hepatocellular carcinoma (HCC) and 12 patients with metastasis of colorectal carcinoma (CRC) before liver resection. Surgical specimens were investigated using a near-infrared light camera system. Among the 49 subjects, the 26 patients examined during the latter period of the study (20 with HCC and 6 with metastasis) underwent ICG-fluorescent imaging of the liver surfaces before resection. RESULTS: ICG-fluorescent imaging identified all of the microscopically confirmed HCCs (n=63) and CRC metastases (n=28) in surgical specimens. Among the 63 HCCs, 8 tumors (13%, including 5 early HCCs) were not evident grossly unless observed by ICG-fluorescent imaging. Five false-positive nodules (4 large regenerative nodules and 1 bile duct proliferation) were identified among the fluorescent lesions. Well-differentiated HCCs appeared as uniformly fluorescing lesions with higher lesion-to-liver contrast than that of moderately or poorly differentiated HCCs (162.6 [71.1-218.2] per pixel vs 67.7 [-6.3-211.2] per pixel, P&lt;.001), while CRC metastases were delineated as rim-fluorescing lesions. Fluorescent microscopy confirmed that fluorescence originated in the cytoplasm and pseudoglands of HCC cells and in the noncancerous liver parenchyma surrounding metastases. ICG-fluorescent imaging before resection identified 21 of the 41 HCCs (51%) and all of the 16 metastases that were examined. CONCLUSIONS: ICG-fluorescent imaging enables the highly sensitive identification of small and grossly unidentifiable liver cancers in real time, enhancing the accuracy of liver resection and operative staging. Cancer 2009;115:2491-504. (C) 2009 American Cancer Society.

DOI： 10.1002/cncr.24291

PubMed

DOI： 10.1001/archsurg.2009.9

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1016/j.jamcollsurg.2008.09.024

PubMed

Publishing type：Research paper (scientific journal)  

Objectives: To identify risk factors for a massive amount of ascites after liver resection to treat hepatocellular carcinoma and to evaluate our postoperative management strategy.
Design: Case-control study.
Setting: University hospital.
Patients: Two hundred three patients who underwent liver resection to treat hepatocellular carcinoma between January 1, 2003, and December 31, 2004.
Main Outcome Measures: Presence or absence of a large number of ascites (LA), defined as postoperative daily ascitic fluid drainage exceeding 10 mL per kilogram of body weight, and operative morbidity, mortality, and treatment costs.
Results: A large number of ascites developed in 31 patients (15%). Multivariate analysis revealed that blood loss greater than 1000 mL (relative risk, 6.38; 95% confidence interval, 2.19-20.7; P=.001) and preoperative platelet count less than 100 x 10(3)/mu L (4.75; 1.75-13.1; P=.002) independently increased the risk of LA. In patients with LA, urinary output on postoperative days 1 to 3 was significantly lower than in patients without LA, and daily ascitic fluid volume tended to peak on postoperative day 7. No operative mortality was related to liver failure; however, patients with LA required a larger volume of fresh frozen plasma than those without LA (median [range], 1600 [0-16800] mL vs 480 [0-5760] mL; P&lt;.001), resulting in higher hospital costs.
Conclusions: Large blood loss and low platelet count were independent risk factors for LA. Although it was possible to safely manage postoperative ascites using routine administration of diuretic agents and fresh frozen plasma, step-by-step trials are required to reduce the need for transfusion of fresh frozen plasma.

DOI： 10.1001/archsurg.2008.511

PubMed

Background. Although portal venous tumor thrombus (PVTT) is regarded as an ominous prognostic factor in patients with hepatocellular carcinoma (HCC), the optimal treatment method for maximizing both safety and long-term outcome has not yet been discussed. We describe a surgical technique in which the venous wall is peeled off from the PVTT
Methods. In the peeling off (110) technique, the portal venotomy was placed after adequate vascular control of portal flow. The PVTT was dissected from the portal venous wall and removed through the opening. Macroscopically residual PVTTs intruding into tiny branches were meticulously extracted. This procedure was compared with the en bloc resection of PVTT. Between 1995 and 2006, 49 patients underwent curative hepatic resections for HCC with macroscopic PVTT; these patients were classified according to whether the PO technique (n = 20) or the en bloc technique (n = 29) had been utilized. Both the short- and long term results were compared between the 2 groups.
Results. No mortalities occurred in either group. Both the 5-year overall survival and the recurrence-free survival rates of the PO group were comparable with those of the en bloc group (39% vs 41% [P =. 90] and 23% vs 18% [P = .89], respectively). No local recurrences or regrowth of the PVTT occurred in either group.
Conclusion. Our procedure is useful for removing PVTT extending beyond the bifurcation or into other sectors that should. be preserved in terms of liver function and enables a more conservative resection than an en bloc technique without sacrificing curability. (Surgery 2009;145:9-1.9.)

DOI： 10.1016/j.surg.2008.09.005

PubMed

Publishing type：Research paper (scientific journal)  

Background & Aims: The surgical indications for multiple hepatocellular carcinomas (HCCs) and for HCC with portal hypertension (PHT) remain controversial. Methods: We reviewed 434 patients who had undergone an initial resection for HCC and divided them into a multiple (n = 126) or single (n = 308) group according to the number of tumors. We also classified 386 of the patients into a PHT group (n = 136) and a no-PHT (n = 250) group according to whether they had PHT (defined by the presence of esophageal varices or a platelet count of &lt; 100,000/mu L in association with splenomegaly). Results: Among Child-Pugh class A patients, the overall survival rates in the multiple group were 58% at 5 years, and 56% in the PHT group, which were lower than those in the single group (68%, P=.035) and the no-PHT group (71%, P=.008). Among Child-Pugh class B patients with multiple HCCs, the 5-year overall survival rate was 19%. Multivariate analyses revealed that the presence of multiple tumors was an independent risk factor for postoperative recurrence (relative risk, 1.64; 95% confidence interval, 1.23-2.18; P=.001). A second resection resulted in satisfactory overall survival after the diagnosis of recurrence in the multiple (73% at 3 years) or PHT (73%) groups, as well as in the single (79%) or no PHT (81%) groups. Conclusions: Resection can provide survival benefits even for patients with multiple tumors in a background of Child-Pugh class A cirrhosis, as well as in those with PHT.

DOI： 10.1053/j.gastro.2008.02.091

PubMed

Publishing type：Research paper (scientific journal)  

Intussusception occurs rarely in adults compared with children, and in the case of adults, some organic disease, such as a benign or malignant tumor, can be found at the leading edge of the intussusception in about 90% of adult cases. This study reports a case of adult intussusception in which the stump of the jejunal loop in a Roux-en-Y bilioenteric reconstruction acted as a leading tip of the intussusception.

International / domestic magazine：International journal  

DOI： 10.1097/SLA.0b013e3181640207

PubMed

Publishing type：Research paper (scientific journal)  

Background/Aims: Some studies have shown the reduction of portal blood flow in-patients with occult hepatic metastases, which may lead to a decrease in the liver volume. The aim of this study was to assess volumetric changes of the liver with occult colorectal metastases.
Methodology: Sixty-three consecutive patients with colorectal cancer who underwent curative resection were studied retrospectively. The ratio of the preoperative computerized tomography (CT)-estimated liver volume to the standard liver volume (CV/SV ratio) was calculated as a uniform parameter to compare the volume between the liver with and without occult hepatic metastases.
Results: The CT-estimated liver volume was 841 102 (mean SD) mL in 8 patients who subsequently developed overt hepatic metastases during a 2-year follow-up and 1145 +/- 232mL in 55 patients without metastases (p=0.0004). The CV/SV ratio was significantly smaller in patients with metachronous hepatic metastases than in those without (0.78 +/- 0.09 versus 1.02 +/- 0.14;p &lt; 0.0001).
Conclusions: The results suggest the possibility that the liver with occult colorectal metastases decreases in size before metastatic tumors develop to be detectable with conventional imaging techniques. The measurement of the CV/SV ratio may be of value in detecting occult hepatic metastases from colorectal cancer.

PubMed

Publishing type：Research paper (scientific journal)  

Background: Controversy exists regarding which approach is preferable among types of biliary drainage for obstructive jaundice before major hepatectomy: selective biliary drainage (SBD) only on the future remnant liver (FRL) or total biliary drainage (TBD).
Methods: There were 42 consecutive patients who underwent SBD (n = 15) or TBD (n = 27) for obstructive jaundice caused by a hepatobiliary malignancy, and subsequent portal vein embolization (PVE) before extended hemiliepatectomy. The hypertrophy ratio, defined as the ratio of the FRL volume after PVE to that before PVE, was evaluated. The bilirubin clearance also was calculated.
Results: The hypertrophy ratio was higher in patients with SBD than in those with TBD (median, 128%; range, 111-152% vs median, 121%; range, 102-138%; P = .013). The bifirubin clearance of FRL with SBD was markedly improved after PVE compared with that in patients with TBD.
Conclusions: SBD is superior to TBD in promoting hypertrophy of the FRL induced by PVE and in guaranteeing good liver function before major hepatectomy. (c) 2007 Excerpta Medica Inc. All rights reserved.

DOI： 10.1016/j.amjsurg.2006.07.015

PubMed

Publishing type：Research paper (scientific journal)  

To resect a small liver tumor located in the paracaval portion, we adopted transhepatic enucleation, i.e. enucleation of the tumor from the transected plane along the main portal fissure. In contrast to caudate lobectomy, this procedure can save dissection around the liver and vena cava, which would increase operation time and blood loss especially in repeat surgery after removal of Couinaud's segment VII or the right lateral sector. It can also minimize the liver parenchymal volume to be resected. The transhepatic enucleation would be a safe and recommendable surgical technique for a small paracaval tumor in repeat resection and/or in patients with poor liver functional reserve. Copyright (C) 2007 S. Karger AG, Basel.

DOI： 10.1159/000108322

PubMed

Publishing type：Research paper (scientific journal)  

Epithelioid hemangioendothelioma (EH) of the liver is a rare tumor, generally considered to have low-grade malignancy. Little is known about its clinical behavior and the therapeutic strategy is not established. We report the case of a 36-year-old woman who underwent living donor liver transplantation for EH with splenic metastases and died of recurrence 8 months later. To determine if transplantation improves the prognosis of patients with EH, we must re-evaluate its indications.

DOI： 10.1007/s00595-006-3292-8

Publishing type：Research paper (scientific journal)  

A 73-year-old man presented for further evaluation of a gallbladder polyp, 5 years after left radical nephrectomy for renal cell carcinoma (RCC). Computed tomography revealed a 2-cm enhancing pedunculated turnout within the gallbladder. Open simple cholecystectomy was performed and the rumour was histologically confirmed as a metastasis of the RCC to the gallbladder. The patient is alive and disease-free, 2 years after cholecystectomy. Of the reported 23 patients with metastatic RCC of the gallbladder, nine patients were reported to be cancer-free with the longest follow-up interval of 6 years after cholecystectomy. Although metastasis of RCC is a rare differential diagnosis of gallbladder tumours, simple cholecystectomy may offer a chance of long-term survival for patients with RCC.

DOI： 10.1016/S1015-9584(09)60074-9

PubMed

Publishing type：Research paper (scientific journal)  

The extent of donor hepatectomy may affect splenic hypertrophy and platelet count. The subjects were 50 live liver donors. The ratio of the graft weight to total liver volume (GW/TLV) and the splenic hypertrophy ratio, expressed as the splenic volume one month after surgery divided by that before surgery, were calculated. The platelet count one month after surgery was divided by that before surgery to determine the rate of the platelet count decrease. The correlation of GW/TLV to the splenic hypertrophy ratio and the rate of the platelet count decrease were examined. The median (range) GW/TLV was 54 (28-71)%. The splenic hypertrophy ratio and the rate of the platelet count decrease was 133 (99-191)% and 92 (71-129)%, respectively. GW/TLV positively correlated with the splenic hypertrophy ratio (Spearman's correlation coefficient (r(s))=0.448, p=0.001), and negatively correlated with the rate of the platelet count decrease (r(s)=-0.471, p &lt; 0.001). Multivariate analysis revealed that GW/TLV influenced the splenic hypertrophy ratio [adjusted odds ratio (OR), 12.0; 95% confidence interval (CI), 1.32-9.04; p=0.01] and the ratio of the platelet count decrease (adjusted OR, 11.6; 95% CI, 1.40-8.33; p=0.01). Larger graft procurement might place living liver donors at higher risk for post-operative thrombocytopenia.

DOI： 10.1111/j.1399-0012.2005.00474.x

PubMed

Publishing type：Research paper (scientific journal)  

Conversion of the main immunosuppressive agent from tacrolimus to cyclosporine (CyA) is a valuable rescue therapy for the severe adverse effects of tacrolimus. We report our experience of the conversion in living donor liver transplantation, in which tacrolimus therapy was converted to CyA. There are few reports describing the optimal initial dose of orally administered CyA (PO CyA) after intravenously administered CYA (IV CYA). We retrospectively investigated the ratio of CyA blood concentrations at 12 hours after the initiation of PO CyA to that just before the conversion, and the ratio of the initial dose of PO CyA to the total dose of IV CyA administered during the 12 hours before the conversion. Linear regression analysis revealed a close correlation between these ratios (y = 2.7 + 5.8x, r = 0.73; P = .002). We recommend that, to maintain a similar trough level of CyA during conversion in liver transplantation, Neoral should be initiated at a ninefold greater dose than the total dose of IV CyA administered during the 12 hours before conversion.

DOI： 10.1016/j.transproceed.2005.11.029

Publishing type：Research paper (scientific journal)  

Some studies have shown reduced portal blood flow in patients with occult hepatic metastases, which may lead to decreased liver volume. A retrospective study was conducted in patients undergoing curative resection for colorectal (n = 63) or gastric (it = 52) cancer. The ratio of the preoperative computed tomography (CT)-estimated liver volume to the standard liver volume (CV/SV ratio) was calculated. The mean +/- SD CT-estimated liver volume was 858 +/- 109 in 14 patients who subsequently developed hepatic metastases and 1173 +/- 230 ml in 101 patients without metastases (p &lt; 0.0001). The CV/SV ratio was smaller in patients with metachronous hepatic metastases than in those without (0.78 +/- 0.08 vs. 1.02 + 0.13; p &lt; 0.0001). The results suggest that the liver with occult metastases decreases in size before metastases develop that are detectable using conventional imaging techniques. The CV/SV ratio may be of value in detecting occult hepatic metastases from colorectal and gastric cancer.

DOI： 10.1007/s00268-005-7888-8

PubMed

Total pages：124  

ASIN

Total pages：173  

ASIN

Total pages：178  

ASIN

＜文献概要＞肝胆膵外科手術において,自動縫合器は系統的肝切除における肝門部Glisson一括切離や主肝静脈切離,膵体尾部切除における膵切離などに幅広く使用されている.2014年以降には電動式ステープラも登場したが,不適切な使用法などに伴うマイナートラブルも含めると自動縫合器のミスファイヤに遭遇することは決して少なくない.本稿では,肝胆膵外科手術で使用される自動縫合器の適切な使用法,ミスファイヤに対する予防策および発生時の対処法について述べる.

Other URL： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00393&link_issn=&doc_id=20230629020017&doc_link_id=10.15106%2Fj_geka85_950&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka85_950&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

近年,インドシアニングリーン(ICG)の近赤外蛍光特性を利用した蛍光イメージング技術が普及している。肝切除においては(1)肝の表層に位置する腫瘍の蛍光標識,(2)門脈の血流分布に基づく肝区域の可視化,(3)胆汁排泄を利用した蛍光胆管造影,が報告されており,正確な肝切除を行ううえで必須のナビゲーションツールになりつつある。本稿では,肝切除におけるICG蛍光イメージングについて,基本的事項と応用法を概説する。(著者抄録)

＜文献概要＞肝実質離断は主に超音波破砕吸引器,超音波凝固切開装置およびベッセルシーリングシステムなどを用いてなされることが多い.エネルギーデバイスの発達により,肝実質離断は"誰でも安全・確実に,素早く"実施できるようになったと考えられるが,各機器の性能を十分に発揮するには,その特徴と適切な使用法を理解する必要がある.特に超音波破砕吸引器はほかの腹部外科手術で使用される機会に乏しく,基本事項の理解が必須である.

Other URL： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00393&link_issn=&doc_id=20230414270009&doc_link_id=10.15106%2Fj_geka85_363&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka85_363&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

＜文献概要＞ポイント ◆職業性胆管癌は,塩素系有機溶剤の高濃度・長期曝露による化学発癌である.◆広範囲の肝内外胆管に慢性胆管傷害,前癌病変(胆管上皮層内腫瘍および胆管内乳頭状腫瘍)が認められ,同部ではDNA損傷が引き起こされている.◆通常の胆管癌の約30倍に相当する高い腫瘍遺伝子変異量を有し,胆管癌でPD-L1の発現が確認されている.

Other URL： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01539&link_issn=&doc_id=20221229330019&doc_link_id=10.11477%2Fmf.1407214011&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407214011&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

＜文献概要＞ポイント ◆肝切除術後感染症には背景にある肝硬変などの慢性肝疾患,糖尿病などの併存疾患,高齢などの因子が深く関わっている.◆肝切除術後合併症の一つである胆汁漏と,手術操作や術中出血量などの術中因子は腹腔内感染の発生要因である.◆肝切除術後感染症の対策には,周術期の適切な全身管理と確実な手術操作が重要である.

肝動脈化学塞栓療法やソラフェニブなどの従来の非外科的治療はその効果も限定的であり、これらを用いたconversion surgeryは報告数も限られていた。一方、近年使用可能になったレンバチニブやアテゾリズマブ・ベバシズマブ併用療法はその高い奏効率からconversion surgeryでの役割も期待されている。とくにアテゾリズマブ・ベバシズマブ併用療法は進行肝細胞癌患者の約5%でRECISTでの評価によるcomplete responseを達成したと報告されており、その抗腫瘍効果は目を見張るものがある。一方で、レンバチニブとの比較ではその効果発現は緩徐であり、免疫チェックポイント阻害薬に特有のpseudoprogressionやhyperprogressionにも注意が必要である。Conversion surgeryにふみきるタイミングや奏効しなかった場合に他の治療に切り替えるタイミング、正確な治療効果判定は難しいケースも多い。今後の症例数の蓄積とともにこれらの課題が克服され、進行肝細胞癌の治療成績向上につながることが期待される。(著者抄録)

腹腔鏡下胆嚢摘出術は低侵襲、早期回復、美容面での利点があげられるが、およそ0.5%に発生すると報告されている医原性胆道損傷が問題となる。インドシアニングリーン(indocyanine green:ICG)に近赤外光を照射すると蛍光を呈する性質を利用した蛍光イメージングが手術に応用されている。とくにICGは静脈注射後に肝臓にとりこまれ100%胆汁に排出されることから蛍光による胆管描出に応用可能である。2.5mgのICGを手術直前に静脈注射することがもっとも汎用されているプロトコールと考えられるが、背景の肝臓も蛍光を呈することから胆管/背景肝の蛍光比の低下による胆管の識別能の低下が問題となる。そのため、われわれのグループは手術前の夕方(前日およそ16時)に0.025mgのICGを静注することで背景肝の蛍光を低減させ、胆管/背景肝の蛍光比を上昇させることで胆管の識別能を改善可能であることを報告した。また胆管に直接ICGを注入する方法は胆管のみ蛍光として描出可能でさらに胆管の視認性は向上すると考えられる。ICG蛍光イメージングは剥離操作前に胆管解剖を蛍光として描出・確認することが可能となり、胆管損傷の回避に有用と考える。ICGの投与経路、投与量、投与タイミングを工夫することで蛍光による胆管の識別能を向上させることが可能である。(著者抄録)

本邦で行われたPrep-02/JSAP05試験の結果をもとに,切除可能膵癌に対する術前化学療法が広く行われるようになり,無再発生存期間,生存期間の延長が期待される一方で,有害事象による治療延期から切除の機会を逸する可能性もあり,術前治療を安全に施行することが重要である.当院のT3切除可能膵癌に対する術前ゲムシタビン+S-1(GS)併用療法22例の検討では,術前化学療法のGrade 3以上の有害事象は好中球減少56.5%,発熱性好中球減少症4.3%,血小板減少8.7%に加えて,口腔粘膜炎8.7%,皮疹4.3%を認めた.有害事象による術前化学療法中止例も17.4%にみられたが,術前化学療法中止例を含め,全例で外科切除に至った.R0切除率は95.7%という結果であった一方で,Grade 3以上の好中球減少,口腔粘膜炎や皮疹がみられ,適切な有害事象管理が求められることに留意が必要である.(著者抄録)

肝胆道外科領域では、indocyanine green(ICG)の蛍光特性と胆汁排泄性を利用して術中蛍光イメージングで肝外胆管の解剖や肝癌の位置、肝区域境界を描出することができる。これらの技術の多くは本邦で開発され、開腹および腹腔鏡下手術用イメージング装置の性能向上と普及に伴って国内外で広く活用されるようになった。今後、蛍光プローブが肝癌に集積する性質を術中診断だけでなく、直接的な治療に応用する新技術が開発されることが期待される。(著者抄録)

＜文献概要＞大腸癌肝転移に対する再肝切除は予後改善に寄与する.特に多発の大腸癌肝転移では初回切除で治癒にいたることは少なく,再肝切除の重要性が高い.一方で,初回切除腫瘍数の多い場合の再肝切除は,(1)初回手術の離断面が広く癒着が広範囲である,(2)肝切除と肝再生による肝臓の変形があるため,肝切除はむずかしくなると考えられる.進行多発大腸癌肝転移に対する再肝切除の際に心がけている手技と要点を紹介する.

肝胆膵外科では,indocyanine green(ICG)が持つ蛍光特性と胆汁排泄性の両者を利用することにより,本剤を蛍光プローブとして用いた術中イメージングを1)肝外胆管の描出(蛍光胆道造影),2)肝癌の同定,3)肝区域の描出,4)組織血流評価,などの多様な用途に応用することができる.これらの方法はいずれも簡便かつ高感度であり,特に触診による情報が得られにくい腹腔鏡下手術における術中ナビゲーション技術として国内外で普及しつつある.同時に,標的特異性の高い新規蛍光プローブや,高画質化や蛍光強度の測定に対応した新型の撮像装置も盛んに開発されている.さらに,腫瘍に蛍光プローブが集積する現象を術中診断だけでなく光線力学的療法などの治療に応用する技術の検討も進んでいる.今後,外科医と研究者,エンジニアが積極的に情報交換を行うことにより,術中蛍光イメージングが「簡便で便利」な診断法に留まらず,肝胆膵手術の治療成績向上に直結する技術に発展することが期待されている.(著者抄録)

＜文献概要＞腹腔鏡下膵頭十二指腸切除(LPD)の導入にあたっては,まず自施設が「施設基準」を満たしているか確認し,National Clinical Database(NCD)の術前登録に参加する準備を整える必要がある.保険診療上の本術式の適応は「脈管の合併切除やリンパ節郭清切除が必要でないもの」と定められるが,各施設においては病理および解剖学的な観点から切除適応を明記するとともに,開腹移行の条件もあらかじめ検討しておくべきである.LPDの術式は定型化されているとはいいがたいが,事前に手術手順を定め,手術後には各ステップの所要時間や達成度を評価することが,手術成績の向上と安定につながると考えられる.今後,ロボット支援手術などの新規技術の導入により,再建を含めて開腹と同等かそれ以上の精度で手術を実施できれば,膵切除においても低侵襲手術の意義が強調されていく可能性がある.

＜文献概要＞1990年代初頭から現在まで肝切除に関する研究は飛躍的にすすみ,手技の安定化や術後の安全性は一定の目標に達したといってよい.これらの進歩には多数のランダム化比較試験(RCT)の実績が大きく関与している.肝切除患者の周術期管理について検証したRCTを検索したところ70本余が合致した.これらを,ドレーン留置,enhanced recovery after surgery(ERAS),手術部位感染(SSI)対策,術後鎮痛法,肝庇護薬剤,術中輸液・麻酔,栄養・免疫賦活剤,閉腹時操作に分けて得られた結果をまとめた.

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

This text presents the experiences of leading researchers and surgeons with different fluorescence methods. Chapters range from basic science of fluorescence to current clinical applications and new horizons. The first few chapters describe the historical evolution and physical principles of fluorescence and provide the foundation for the reader to understand the current scope and limits of its use in surgery. The second section focuses on the clinical applications of intraoperative fluorescence imaging including subsections on fluorescence cholangiography, applications to hepatectomy, lymph node navigation, applications to GI tract and pelvic surgery and identification of cancer tissues. The third section focuses on new frontiers including fluorescence probes, imaging systems and applications to photodynamic therapy. Authored by leaders in the development of fluorescent methods worldwide, Fluorescence Imaging for Surgeons: Concepts and Applications will have an impact on numerous medical specialists including general surgeons, colorectal and minimally-invasive surgeons and surgical oncologists. Researchers will find the book to be an invaluable resource on the latest advances in the utilization of nanoparticles and fluorescent probes.

DOI： 10.1007/978-3-319-15678-1

DOI： 10.1007/978-3-319-15678-1

DOI： 10.1097/SLA.0000000000000816

PubMed

Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.1007/s00268-013-2297-x

Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

DOI： 10.1002/jhbp.55

Indocyanine green (ICG) fluorescence has been used for imaging purposes for more than half a century
First employed by ophthalmologists for visualizing the retinal artery in the late 1960s, the application of ICG fluorescence imaging has since been continuously expanded. Recently, advances in imaging technologies have led to renewed attention regarding the use of ICG in the field of hepatobiliary surgery, as a new tool for visualizing the biliary tree and liver tumors. This book introduces cutting-edge knowledge about fluorescence imaging techniques using both ICG and other new promising chemicals. After an introductory chapter on the history and basic technique of fluorescence imaging for hepatobiliary-pancreatic surgery, various clinical applications of ICG fluorescence imaging are discussed. These range from the identification of various malignancies to the use of imaging in surgery. The last part of this publication is dedicated to an outlook on near-future technology.

DOI： 10.1159/isbn.978-3-318-02293-3

Publishing type：Research paper, summary (international conference)  

Publishing type：Book review, literature introduction, etc.  

Hepatocellular carcinoma (HCC) is the third leading cause of cancer mortality worldwide. Developed on a pathological liver in 90% of cases, theoretically liver transplantation is its best treatment because it cures both malignancy and cause of malignancy, the underlying pathological liver. Cadaveric donors are the main source of liver in Western countries as France and living donors are the rules in Eastern countries as Japan. Because organ shortage could impact choices in HCC treatments, it was interesting to compare a Western and Eastern surgeon's points of view about treatment of HCC to assess if the source of organs has modified therapeutic strategies. Hence, aim of this work was to compare points of view of two hepatobiliary and transplant surgeons specialized in the treatment of HCC in France and Japan concerning five keys points that are decisive to choose one of the two curative treatments in HCC on pathological liver: liver resection or liver transplantation. These questions included the definition of an oncological treatment of HCC, the assessment of liver function, the treatment of HCC recurrences, the incidence of pathological information on therapeutic strategy and potentials futures therapeutics strategies. © 2012 Elsevier Masson SAS. Tous droits réservés.

DOI： 10.1016/j.jchirv.2012.04.004

Publishing type：Book review, literature introduction, etc.  

Recently, fluorescence imaging using indocyanine green (ICG) has been applied to hepatobiliary surgery, not only to visualize the bile ducts, but also to identify liver cancer during surgery. In this technique, ICG is administered intravenously at a dose of 0.5 mg/kg body weight for routine liver function testing before surgery. Intraoperatively, liver cancer can be readily identified by fluorescence imaging on the liver surface before resection and on the cut surface of the resected specimen. This is achieved by visualizing fluorescence from the area of impaired bile excretion in hepatocellular cancer tissue and in the liver parenchyma surrounding metastatic liver cancers. Liver cancer navigation surgery, first developed in Japan, is also possible, and it represents one of the few fluorescence imaging techniques for cancer that have reached the stage of clinical application; with further developments in basic research, fluorescence imaging is expected to become an indispensable technique for the diagnosis and treatment of liver cancer. Copyright (C) 2012 S. Karger AG, Basel

DOI： 10.1159/000339017

Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

CiNii Article

Publishing type：Rapid communication, short report, research note, etc. (scientific journal)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

Publishing type：Research paper, summary (international conference)  

DOI： 10.1111/j.1440-1746.2006.04554.x

property_type：Patent 

Application no：特願2007-281552 

Announcement no：特開2009-106191 

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