DOI： 10.1002/ags3.70202

<p>In March 2021, the Japanese TNM Classification for Cancer of the Biliary Tract (JCCB) was revised. This study aimed to validate the 7th edition of JCCB based on long-term outcomes after resection for distal cholangiocarcinoma (DCC). We retrospectively reviewed 107 patients with resected DCC without distant metastasis between 2007 and 2019. Survival curves according to TNM factors were compared between the 6th and 7th editions. The 5-year overall survival (OS) and recurrence-free survival rate (RFS) were 43.4% and 35.5%, respectively. Significant differences in OS were observed between T categories in the 7th edition (T1 <i>vs.</i> T2, <i>p</i> = 0.049; T2 <i>vs.</i> T3, <i>p</i> = 0.027), but not in the 6th. The N classification also showed better prognostic discrimination in both editions, with more refined stratification in the 7th. Stage grouping in the 6th edition failed to show significant OS differences, while the 7th edition demonstrated clear stratification (<i>e.g.</i>, Stage I <i>vs.</i> IIA, <i>p</i> = 0.0274; StageⅡA <i>vs.</i> StageⅡB, <i>p</i> = 0.0043; StageⅡB <i>vs.</i> StageⅢA, <i>p</i> = 0.0108). These findings indicate that the revised T and N classifications in the 7th edition more accurately reflect postoperative prognosis for resected DCC. Overall, our results support the clinical validity and improved prognostic utility of the 7th edition compared with the 6th edition.</p>

DOI： 10.35772/ghm.2025.01106

PubMed

CiNii Research

Publishing type：Research paper (scientific journal)  

DOI： 10.21873/anticanres.17681

PubMed

DOI： 10.15106/j_geka87_881

CiNii Research

＜文献概要＞低侵襲手術が普及した現在でも,大型で進行した肝臓癌を安全に切除するために,あるいは大出血に適切に対応するために,開腹開胸アプローチを「知っておく」ことはすべての肝臓外科医に必須であると考える.本稿ではその基本的な手技とコツを概説する.

Publishing type：Research paper (scientific journal)  

Background/Objectives: Intrahepatic cholangiocarcinoma (iCCA) is subclassified into small- and large-duct types. Small-duct-type iCCAs are associated with a better prognosis, and each subclassification requires different surgical strategies. The efficacy of chemotherapy, including immune checkpoint inhibitors, may vary between subclassifications. However, there are no reports on tumor immune microenvironment (TIME) analyses based on iCCA subclassifications. This study investigated subclassification-specific TIMEs in iCCAs for the purpose of establishing appropriate pharmacotherapy. Methods: A total of 131 resected iCCA cases were analyzed, comprising 73 tumors classified as small-duct-type and 58 as large-duct-type based on pathological evaluation. Immunohistochemical analyses targeting CD8, PD-1, PD-L1, CTLA-4, and S100 protein (a dendritic cell [DC] marker) were performed to investigate the immune-cell status in each subclassification. Results: Large-duct-type iCCA had a significantly higher CD8 expression in tumor-infiltrating cells than small-duct-type ICC. However, the expression of other molecules did not significantly differ between the two tumor types. The proportion of tumors with a high level of S100 protein expression (DC-high group) in tumor-infiltrating cells was significantly higher in small-duct-type ICCs than in large-duct-type iCCAs (30% vs. 1.7%). In small-duct-type iCCAs, the expression levels of CD8, PD-1, PD-L1, and CTLA-4 were significantly higher in the DC-high group than in the DC-low group. Conclusions: We revealed subclassification-specific TIMEs in iCCAs. A subset of small-duct-type iCCAs exhibited strong DC infiltration. In these patients, the tumors may establish an immunosuppressive TIME to evade antitumor immunity triggered by DC-mediated antigen presentation. These findings may contribute to the development of tailored pharmacotherapy for each iCCA subclassification.

DOI： 10.3390/cancers17132082

PubMed

DOI： 10.18888/op.0000004501

CiNii Research

＜文献概要＞転移性肝癌の治療方法はその原発巣によって異なり,大腸癌や神経内分泌腫瘍(G1,G2)はその治療成績が良好なことから根治切除が標準治療となっている。一方で,それ以外の原発巣からの肝転移の治療方法は未だcontroversialである。そのなかでも,乳癌および卵巣癌,子宮癌では肝転移が全身転移の一部として認められることが多く,切除の適応となりにくいのが現状である。

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

BACKGROUND: Maintaining an independent life after hepatopancreaticobiliary surgery is a major goal of elderly people. This prospective study aimed to identify the risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery in elderly individuals. METHODS: Between February 2023 and December 2023, independently living elderly individuals aged ≥65 years who were scheduled for hepatopancreaticobiliary surgery and approved for preoperative evaluation of frailty at 5 institutions were registered. Frailty was evaluated the "Kihon Checklist," which is a phenotypic frailty index. Postoperative loss of independence was defined as hospitalization, need for nursing care, and/or transfer to a rehabilitation facility at 90 days and/or mortality within 90 days. RESULTS: Of the 201 registered patients, 58 (28.9%) were classified as frail, and 21 (10.4%) developed postoperative loss of independence. Univariate and multivariate analyses indicated that frailty (P =.03), cerebrovascular and/or neurological diseases (P =.04), and open surgery (P =.02) were independent risk factors for postoperative loss of independence after hepatopancreaticobiliary surgery. Among the patients with postoperative loss of independence, 2.8% had no applicable risk factors, and 31.4% had ≥2 of these factors (P <.001). The incidence of postoperative loss of independence was 9.4% in the frail patients who underwent minimally invasive surgery (MIS) and 30.8% in those who underwent open surgery (P = .050). CONCLUSION: Postoperative loss of independence was predictable among elderly patients identified as frail using the Kihon Checklist after hepatopancreaticobiliary surgery. MIS for elderly individuals with frailty may reduce the risk of postoperative loss of independence.

DOI： 10.1016/j.gassur.2025.102102

PubMed

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

BACKGROUND/OBJECTIVES: Intrahepatic cholangiocarcinoma (ICC) is subclassified into small and large duct types. Although these subclassifications may help determine the appropriate treatment strategy, subclassification diagnosis currently depends on postoperative pathological examinations. This study aimed to establish a nomogram to predict ICC subclassifications. METHODS: This study included 126 patients with ICC who underwent liver resection. The participants were divided into small and large duct-type ICC groups. A nomogram to predict large duct-type ICC was developed using four diagnostic imaging findings: rim-type enhancement in the early phase, an absence of tumor enhancement in the early phase, the presence of peripheral biliary dilatation due to tumor invasion, the presence of penetrating Glisson's vessels in the tumor, and two laboratory test results: serum gamma-glutamyl transpeptidase and carbohydrate antigen 19-9 levels. Nomogram performance was also assessed. Moreover, the bootstrap method and calibration plots were used to assess nomogram validity. RESULTS: Seventy and fifty-six patients were pathologically diagnosed with small and large duct-type ICCs, respectively. The area under the curve of the established nomogram was 0.93 and remained 0.91 after Harrell's bias correction. The sensitivity and specificity of the nomogram developed using the Youden index were higher than those of any of the characteristic imaging findings. Calibration plots demonstrated a strong association between the nomogram and the actual data. CONCLUSIONS: We developed a novel preoperative nomogram to predict large duct-type ICC. This nomogram can be clinically useful for predicting the subclassifications of ICCs and may contribute to the establishment of a more appropriate treatment strategy for ICC.

DOI： 10.3390/cancers17101690

PubMed

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

AIM: Hepatitis C virus (HCV) infection is a risk factor of intrahepatic cholangiocarcinoma (ICC). However, the impact of HCV infection control status on prognosis after surgery for ICCs is still unclear. METHODS: This multicenter retrospective study included patients who underwent curative resection for ICCs. The sera of 56 patients tested positive for anti-HCV antibody and negative for hepatitis B surface antigen (HCV group). Additionally, the sera of 358 patients tested negative for anti-HCV antibody and hepatitis B surface antigen (NBNC group). In the HCV group, 33 of 56 patients achieved sustained virologic response (SVR) for HCV (SVR group), whereas 23 patients did not (non-SVR group). To investigate the prognostic impact of HCV infection control status in the whole study cohort and in patients with solitary ICC without lymph node metastasis (StN0 study cohort), the postoperative prognosis of the SVR, non-SVR, and NBNC groups was compared. RESULTS: In the whole study cohort, there were no significant differences in terms of recurrence-free survival (RFS) or overall survival among the three groups. Based on the multivariate Cox regression analysis, non-SVR was an independent unfavorable prognostic factor of RFS. In the StN0 study cohort, the non-SVR group had a significantly lower RFS than the NBNC and SVR groups. Based on the multivariate analysis, non-SVR was an independent unfavorable prognostic factor of RFS. CONCLUSIONS: The achievement of SVR for HCV infection in patients with HCV infection-related ICCs is associated with a better RFS after surgery for HCV-related ICCs, particularly solitary ICC without lymph node metastasis.

DOI： 10.1111/hepr.14150

PubMed

2014年に大阪の印刷会社で1,2-ジクロロプロパン(DCP)やジクロロメタン(DCM)の長期曝露による職業性胆管癌が17例報告されたた。本研究では、その後同社で新たに確認された症例をまとめ、曝露状況と発癌との関連を検討した。同社のカラープルーフ部門で勤務し、DCP/DCMに曝露された従業員95名のうち、2015～2023年に新たに胆管癌と診断された5例(診断時年齢41～52歳、男性4例、女性1例)を対象とした。DCP累積曝露量は1503～3433ppm/年、曝露期間は6.1～15.2年であった。全例でγ-GTP上昇がみられた。画像検査では腫瘍による閉塞を伴わない肝内胆管拡張が3例に認められた。全例に慢性胆管障害が存在した。前癌病変である胆管上皮内腫瘍が4例、胆管内乳頭状腫瘍が3例で確認された。治療は膵頭十二指腸切除1例、肝切除4例で、4例はS-1による補助化学療法を受け、再発例ではニボルマブが奏効した。1例は進行例で化学療法とステント治療を行ったが5ヵ月で死亡した。

肝内胆管癌(ICC)患者におけるHCV感染制御状態が術後予後に与える影響を多施設後ろ向き研究で検討した。治癒切除を施行したICC患者414例(男性271例、女性143例、年齢中央値72歳)を、抗HCV抗体およびB型肝炎表面抗原陰性群358例(NBNC群)と抗HCV抗体陽性でB型肝炎表面抗原陰性群56例(HCV群)に分け、さらにHCV群をHCVへの持続的ウイルス学的奏効(SVR)達成群33例(SVR群)と非達成群23例(非SVR群)の3群に分けて、HCV感染制御状況の予後予測への影響を全研究コホートおよびリンパ節転移のない孤立性ICC患者群291例(StN0研究コホート)で検討した。全研究コホートでは、無再発生存率(RFS)および全生存率は3群間で有意差はなかった。多変量Cox回帰分析では、非SVR群はRFSの独立予後不良因子であった。StN0研究コホートでは、非SVR群のRFSは他2群よりも有意に低く、多変量解析では非SVR群はRFSの独立予後不良因子であった。HCV感染関連ICC患者におけるHCVへのSVR達成は、HCV関連ICC患者、特にリンパ節転移のない孤立性ICC患者において術後RFS改善と関連していた。

DOI： 10.15106/j_geka87_583

CiNii Research

＜文献概要＞・膵液漏は膵切除術後の代表的な合併症の一つであり,grade B/Cへの重症化により致死的合併症につながる可能性がある.・重度膵液漏発生のリスク評価に基づいて,術中ドレーンを留置するかどうかの判断および術後の早期抜去を含め,適切なドレーン管理を行う必要がある.・Grade B膵液漏に進行した場合,ドレナージの最適化,薬物治療,絶食などによりさらなる重症化を防ぐ手立てを講じるべきである.

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

BACKGROUND/OBJECTIVES: Indocyanine green (ICG) fluorescence imaging is widely utilized for visualizing hepatic tumors, hepatic segmentation, and biliary anatomy, improving the safety and curability of cancer surgery. However, its application for perfusion assessment in hepatobiliary and pancreatic (HBP) surgery has been less explored. METHODS: This study evaluated outcomes of patients undergoing HBP surgery with vascular reconstruction from April 2022 to August 2024. During surgery, ICG (1.25-5 mg/body) was administered intravenously to assess the need and quality of vascular reconstruction via fluorescence imaging. RESULTS: Among 30 patients undergoing hepatectomies and/or pancreatectomies, ICG fluorescence imaging was used in 16 cases (53%) to evaluate organ and vascular perfusion. In two hepatectomy cases with consideration of reconstruction of the middle hepatic veins, sufficient fluorescence intensities in drainage areas led to the avoidance of middle hepatic vein reconstruction. In 14 cases requiring vascular reconstruction, fluorescence imaging visualized smooth blood flow through anastomotic sites in 11 cases, while insufficient signals were observed in 3 cases. Despite this, re-do anastomoses were not indicated because the fluorescence signals in the targeted organs were adequate. Postoperative contrast-enhanced computed tomography confirmed satisfactory blood perfusion in all cases. CONCLUSIONS: Real-time blood flow assessment using ICG fluorescence imaging provides valuable information for intraoperative decision-making in HBP surgeries that require vascular reconstruction of major vessels, such as hepatic arteries, veins, and the portal system.

DOI： 10.3390/cancers17050868

PubMed

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

The activation of hepatic stellate cells (HSCs) from a quiescent state is a cause of liver fibrosis and a therapeutic target. HSCs are resident mesenchymal cells located in the space of Disse, exhibiting specialized morphological characteristics such as a stellate shape, large lipid droplets, and direct adhesions to hepatocytes via microprojections called HSC spines. Morphological alterations in HSCs play a crucial role in initiating their activation. However, the mechanisms regulating these changes remain unexplored. In this study, we analyzed the morphological alterations associated with HSC activation in vivo using carbon tetrachloride treatment and identified the key factors regulating these changes in vitro. Following carbon tetrachloride treatment, HSCs exhibited shortened cell processes and HSC spines, adopting an oval shape. Subsequently, the HSCs underwent further morphological changes into two activated forms: flattened and complex shapes. In vitro, activation of cell division cycle 42 (Cdc42) maintained the morphological characteristics of quiescent HSCs. Cdc42 activation in HSC cell lines inhibited the expression of markers associated with activated HSCs. Cdc42 inhibitor treatment in vivo prevented quiescent HSCs from maintaining their morphological characteristics and hindered activated HSCs from reverting to the quiescent state. In addition, HSCs around fibrotic areas in the human liver exhibited morphological alterations indicative of early activation. These findings demonstrate that Cdc42 is a crucial regulator of morphological and molecular alterations associated with HSC activation, identifying it as a novel target for the development of therapeutic agents against liver fibrosis.NEW & NOTEWORTHY The activation of hepatic stellate cells from a quiescent state is a cause and a therapeutic target for liver fibrosis. Morphological alterations in the hepatic stellate cells play a critical role in initiating their activation. However, the mechanisms that regulate these alterations remain unexplored. Our results indicate that cell division cycle 42 is a crucial regulator of hepatic stellate cell activation and a novel target for the development of therapeutic agents against liver fibrosis.

DOI： 10.1152/ajpcell.00987.2024

PubMed

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

INTRODUCTION: This study aimed to evaluate the association of obesity and diabetes mellitus (DM) comorbidity with hepatocellular carcinoma (HCC) recurrence and survival. METHODS: We investigated 1,644 patients who underwent hepatic resection for solitary HCC without vascular invasion using computed tomography. Patients were categorized into four groups according to the combination of obesity and DM comorbidities: OB (+) or (-) and DM (+) or (-). Postoperative cumulative recurrence rates within and beyond 2 years and beyond 5 years were assessed. RESULTS: Multivariate Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (HRs) of reduced recurrence-free survival was 1.10 (95% confidence interval [CI]: 0.91-1.33; p = 0.31), 0.94 (95% CI: 0.78-1.12; p = 0.48), and 1.24 (95% CI: 1.01-1.54; p = 0.045) in the OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups compared with the OB(-)DM(-) group, respectively. Additionally, the corresponding adjusted HRs of reduced overall survival were 0.93 (p = 0.57), 0.97 (p = 0.76), and 1.38 (p = 0.013) for OB(+)DM(-), OB(-)DM(+), and OB(+)DM(+) groups, respectively. No significant difference in the early recurrence rate was determined among the four groups. The OB(+)DM(+) group demonstrated an increased risk for late recurrence beyond 2 years and 5 years postoperatively compared with the OB(-)DM(-) group (HR: 1.51; p = 0.024 and HR: 2.53; p = 0.046, respectively). The OB(+)DM(-) and OB(-)DM(+) groups demonstrated an increased risk for late recurrence beyond 5 years postoperatively (HR: 3.83; p < 0.001 and HR: 1.95; p = 0.037, respectively). CONCLUSIONS: Obesity and DM coexistence increased late recurrence and worsened prognosis in patients with HCC undergoing hepatic resection. The results help surgeons develop possible different surveillance protocol and need to focus on diabetes/obesity control during life-long surveillance for patients with HCC.

DOI： 10.1159/000540858

PubMed

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

<p> After the report of 17 patients with occupational cholangiocarcinoma caused by long-term exposure to high concentrations of 1,2-dichloropropane and/or dichloromethane in a printing company in Osaka in 2014, additional five patients were diagnosed to have such cholangiocarcinoma. Cholangiocarcinoma was detected during regular health examination or follow-up for liver dysfunction in four of the five patients. Nearly all five patients presented with clinicopathological findings such as an elevated γ-glutamyl transpeptidase activity at the diagnosis, regional dilatation of intrahepatic bile ducts without tumor-induced obstruction, chronic bile duct injury, and precancerous/early cancerous lesions (biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct) at various sites of the bile duct. These findings were similar to those of the previous 17 patients. In total, cholangiocarcinoma developed in 22 of 95 workers exposed to 1,2-dichloropropane in the printing company. Of 22 patients with cholangiocarcinoma, 18 patients were members of 19 high exposure workers (≥1,500 ppm-yr). These findings strengthen further the theory that 1,2-dichloropropane causes occupational cholangiocarcinoma. Regular health examination of workers exposed to 1,2-dichloropropane and/or dichloromethane is necessary to detect such cholangiocarcinoma because the potential of the carcinogenesis risk persists over the long term.</p>

DOI： 10.2486/indhealth.2024-0159

PubMed

CiNii Research

PubMed

症例は77歳,男性。造影CT検査で軟部影がSMAに180度未満に接触し,SMVに広範囲の浸潤を認める膵頭部癌の診断(cT4cN0cM0,cStage III)で,術前化学療法(切除不能の可能性も考えGnP療法を選択した)施行後,亜全胃温存膵頭十二指腸切除術(SSPPD)+門脈合併切除再建を施行した。intestinal derotation法を施行しSMAへの浸潤所見はなく,術前画像検査で同様に浸潤が疑われたJ2Aも温存可能であった。また,複雑な門脈再建(グラフトを要し,J1V+J2VのJ3V+ICVへの再吻合が必用)に関しては心臓血管外科との合同手術で施行可能であった。摘出標本病理結果はypT3,ypN1a,M0,ypStage IIB,R0であった。手術が可能であり,術後合併症は認めず,術19日目に退院となった。intestinal derotation法による手術アプローチと他科との合同手術により,高度局所進行膵癌に対しても安全に根治手術を施行することが可能であり,有用であった。(著者抄録)

十分な術前治療を行い奏効がえられた症例に対し,動脈合併切除を併施することでenblocに膵癌が摘出しうる症例は,昨今の化学療法・放射線治療の向上により増えつつある。腹腔動脈合併切除を伴う膵体尾部切除(DP-CAR)は一般的術式となりつつあるが,肝動脈合併切除ならびに再建を伴う膵切除の安全性はいまだ十分なエビデンスが乏しい。われわれは臨床試験として,主要動脈浸潤を伴う膵癌に対する膵切除の安全性と有効性の検証を行ってきた。これらの中で,動脈合併切除さらに再建を伴う膵切除を経験してきた。その中で得られた経験をもとに動脈合併切除を伴う膵切除の周術期管理について述べる。(著者抄録)

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

A 77-year-old man was diagnosed pancreatic head cancer(cT4cN0cM0, cStage Ⅲ)with a contrasting-enhanced CT scan showing soft-tissue shadow in contact with the SMA less than 180 degrees and extensive invasion of the SMV. After neoadjuvant chemotherapy(GnP was selected due to the possibility of unresectability), subtotal stomach-preserving pancreaticoduodenectomy( SSPPD)with resection and reconstruction portal vein was performed. Intestinal derotation procedure in combination with surgery, and there was no evidence of SMA invasion, and J2A, which was also suspected to be invaded on preoperative imaging, could be preserved. The complicated portal vein reconstruction(long reconstruction distance requiring grafting and reanastomosis of J1V+J2V to J3V+ICV)could be performed in a joint operation with cardiovascular surgery. The pathological results of the excised specimen showed that ypT3, ypN1a, M0, ypStage ⅡB, and R0 surgery were feasible, and the patient was discharged on the 19th day after surgery without any postoperative complications. The surgical approach using the intestinal derotation procedure and joint surgery with other departments were useful in safely performing surgery for highly locally advanced pancreatic cancer.

PubMed

DOI： 10.15106/j_geka86_1342

CiNii Research

＜文献概要＞肝胆膵領域手術において,腹腔鏡下胆嚢摘出術(LC)での胆道損傷や血管合併切除再建を伴う膵切除術における胃や肝臓の血流障害は重大な合併症の一つである.インドシアニングリーン(ICG)による蛍光イメージングを用いることにより,術中リアルタイムに胆管の走行の描出や動門脈の血流評価を行うことができ,これらの合併症の回避につながると考えられる.

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

Background: Previous studies have attempted to establish predictive models for post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) undergoing liver resection. However, a versatile and useful predictive model for PHLF remains to be developed. Therefore, we aimed to develop predictive models for PHLF based on type IV collagen 7s domain (7s collagen) in patients with HCC. Methods: We retrospectively collected data from 972 patients with HCC who had undergone initial curative liver resection between February 2000 and December 2020 at our hospital. Multivariate logistic regression analysis using a restricted cubic spline was performed to evaluate the effect of 7s collagen on the incidence of PHLF. A nomogram was developed based on 7s collagen. Results: PHLF grades B or C were identified in 104 patients (11%): 98 (10%) and 6 (1%) PHLF grades B and C, respectively. Multivariate logistic regression analysis revealed that the preoperative serum level of 7s collagen was significantly associated with a proportional increase in the risk of PHLF, which was confirmed in both laparoscopic and open liver resections. A nomogram was developed based on 7s collagen, with a concordance index of 0.768. The inclusion of 7s collagen values in the predictive model increased the predictive accuracy. Conclusion: The findings highlight the efficacy of the serum level of 7s collagen as a predictive factor for PHLF. Our novel nomogram using 7s collagen may be useful for predicting the risk of PHLF.

DOI： 10.3390/cancers16101938

PubMed

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

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is subclassified into small and large duct types. The impact of these subclassifications for identifying appropriate surgical strategies remains unclear. PATIENTS AND METHODS: This study included 118 patients with ICC who underwent liver resection. Based on the pathological examination results, the participants were divided into the small duct-type ICC group (n = 64) and large duct-type ICC group (n = 54). The clinicopathological features and postoperative outcomes were compared between the two groups to investigate the impact of subclassification for selecting appropriate surgical strategies. RESULTS: Ten patients in the small duct-type ICC group had synchronous or metachronous hepatocellular carcinoma. The large duct-type ICC group had higher proportions of patients who underwent major hepatectomy, extrahepatic bile duct resection, portal vein resection, and lymph node sampling or dissection than the small duct-type ICC group. The large duct-type ICC group had significantly higher incidences of lymph node metastasis/recurrence and pathological major vessel invasion than the other. The small duct-type ICC group exhibited significantly higher recurrence-free and overall survival rates than the large duct-type ICC group. Further, the large duct-type ICC group had a significantly higher incidence of lymph node metastasis/recurrence than the small duct-type ICC at the perihilar region group. CONCLUSIONS: Suitable surgical strategies may differ between the small and large duct-type ICCs. In patients with large duct-type ICCs, hepatectomy with lymph node dissection and/or biliary reconstruction should be considered, whereas hepatectomy without these advanced procedures can be suggested for patients with small duct-type ICCs.

DOI： 10.1245/s10434-023-14833-1

PubMed

DOI： 10.18888/op.0000003804

CiNii Research

DOI： 10.15106/j_geka86_73

CiNii Research

＜文献概要＞近年,インドシアニングリーン(ICG)の近赤外蛍光特性を活用した蛍光ガイド手術が普及している.肝胆道外科手術においては,(1)蛍光胆管造影,(2)腫瘍の蛍光標識,(3)門脈の血流分布に基づく肝区域の可視化で活用することができ,正確な手術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,肝胆道外科手術における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.

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

BACKGROUND: sFrailty affects short-term outcomes after liver resection in elderly patients. However, frailty's effects on long-term outcomes after liver resection in elderly patients with hepatocellular carcinoma (HCC) are unknown. METHODS: This prospective, single-center study included 81 independently living patients aged ≥65 years scheduled to undergo liver resection for initial HCC. Frailty was evaluated according to the Kihon Checklist, a phenotypic frailty index." We investigated and compared postoperative long-term outcomes after liver resection between patients with and without frailty. RESULTS: Of the 81 patients, 25 (30.9%) were frail. The proportion of patients with cirrhosis, high serum alpha-fetoprotein level (≥200 ng/mL), and poorly differentiated HCC was higher in the frail group than in the nonfrail group (n = 56). Among the patients with postoperative recurrence, the incidence of extrahepatic recurrence was higher in the frail group than in the nonfrail group (30.8% vs. 3.6%, P = 0.028). Moreover, the proportion of patients who underwent repeat liver resection and ablation for recurrence who met the Milan criteria tended to be lower in the frail group than in the nonfrail group. Although there was no difference in disease-free survival between the two groups, the overall survival rate in the frail group was significantly worse than that in the nonfrail group (5-year overall survival: 42.7% vs. 77.2%, P = 0.005). Results of the multivariate analysis indicated that frailty and blood loss were independent prognostic factors for postoperative survival. CONCLUSION: Frailty is associated with unfavorable long-term outcomes after liver resection in elderly patients with HCC.

DOI： 10.1016/j.asjsur.2023.05.139

PubMed