Publications by authors named "Michinori Hamaoka"

23 Publications

  • Page 1 of 1

Intussusception caused by small intestine metastasis of malignant pleural mesothelioma: a case report.

J Surg Case Rep 2021 Feb 22;2021(2):rjab003. Epub 2021 Feb 22.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan.

Malignant pleural mesothelioma (MPM) is an aggressive form of malignant tumor that originates in the pleural mesothelioma and presents as a local disease in the affected hemithorax. Small intestine metastasis is a rare complication. Herein, the case of a patient with jejunal intussusception caused by small intestine metastasis of MPM has been reported. A 72-year-old man with MPM was admitted to our hospital for abdominal pain. Computed tomography revealed small intestine intussusception. An emergency surgery was performed, and the tumor and intussusception were located in the upper jejunum. Histopathological examination of the resected jejunum revealed that the tumor was a small intestinal metastasis of the MPM from the chest wall. This case showed that MPM may metastasize to the small intestine, and metastatic tumors may cause intussusception.
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http://dx.doi.org/10.1093/jscr/rjab003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899189PMC
February 2021

Perforation of the descending colon diverticulum in a patient following recovery from severe COVID-19 pneumonia: a case report.

J Surg Case Rep 2021 Feb 18;2021(2):rjab013. Epub 2021 Feb 18.

Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.

The outcome of surgery in patients who have recovered from severe coronavirus disease 2019 (COVID-19) is unknown. Herein, we present a case of an emergency operation for acute pan-peritonitis due to perforation of the descending colon diverticulum in a patient who recovered from severe COVID-19 pneumonia. A 59-year-old man, who had recovered from severe COVID-19 pneumonia ~6 months previously, developed acute pan-peritonitis due to perforation of a diverticulum in the descending colon. Emergency surgery was performed, and the perforation was sutured and closed. He was discharged from the hospital 13 days postoperatively. There was no relapse of COVID-19 during the perioperative period of peritonitis surgery. General perioperative management may, therefore, be sufficient in patients who have recovered from COVID-19.
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http://dx.doi.org/10.1093/jscr/rjab013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888975PMC
February 2021

Management of acute cholecystitis in patient with cyclic neutropenia: a case report.

Surg Case Rep 2021 Jan 23;7(1):29. Epub 2021 Jan 23.

Department of Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan.

Background: Cyclic neutropenia is a disease that causes a neutropenic decrease in peripheral blood in a cycle of about 21 days. It is a rare hereditary disorder with an estimated incidence of 0.5-1 cases per million population. The absolute neutrophil count can drop to zero, and neutropenic nadir may last for 3-5 days. This is a rare disease, and there are few reports of abdominal surgery in cyclic neutropenia patients; thus, we report this case of neutrophil count fluctuation and perioperative management.

Case Presentation: A 31-year-old man with cyclic neutropenia was transferred to our hospital complaining of right season rib pain, but no rebound tenderness. His C-reactive protein was elevated (4.37 mg/L) and computed tomography revealed a large number of small stones in the gallbladder body and an incarceration in the gallbladder neck. He was diagnosed with acute cholecystitis. Ideally, surgical intervention should have been performed immediately, but because his neutrophil count was 300/μL, endoscopic naso-gallbladder drainage was performed and he was provided antibiotics until his neutrophil count increased to acceptable levels. Three days after admission, his neutrophil count had increased and laparoscopic cholecystectomy was performed. For one week after the operation, antibiotics were administered; he had an uneventful postoperative recovery. He was discharged on the seventh postoperative day and provided an oral antibiotic.

Conclusions: Infection can be serious in patients with cyclic neutropenia, and it is therefore, important to determine the timing of surgery and to apply appropriate perioperative management with drainage and antibiotic administration.
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http://dx.doi.org/10.1186/s40792-021-01117-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826322PMC
January 2021

Obliteration of a Portosystemic Shunt by Hybrid Interventional Radiology Using a Transmesenteric Approach Under Minilaparotomy After Liver Transplantation: A Case Report.

Transplant Proc 2020 Nov 16;52(9):2762-2766. Epub 2020 Jul 16.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Hepatic encephalopathy that occurs long after liver transplantation (LT) is an uncommon condition. Here, we describe the successful case of a 65-year-old patient who underwent interventional radiology (IVR) using a transmesenteric approach under minilaparotomy for hepatic encephalopathy because of a portosystemic shunt 11 years after ABO-incompatible living donor LT with splenectomy. Enhanced computed tomography confirmed a huge portosystemic shunt and left gastric vein (LGV)-esophageal-azygos vein, which was not treated during LT. Liver stiffness measurements based on transient elastography did not show severe fibrosis in the liver graft. Since the hyperammonemia could not be managed with conventional medical treatment, balloon-occluded retrograde transvenous obliteration (BRTO) was indicated. However, it was difficult to perform because the drainage vein could not be approached from the inferior vena cava (IVC). Surgical shunt ligation was also difficult because of the history of multiple laparotomies. Although intraperitoneal adhesion was severe, the portosystemic shunt was successfully embolized with metallic coils and a plug by IVR using a transmesenteric approach under minilaparotomy. No complications occurred during the operation. His symptoms improved after the operation. The ammonia level and portal flow by ultrasound also improved. He was discharged 14 days after surgery without any complications.
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http://dx.doi.org/10.1016/j.transproceed.2020.06.014DOI Listing
November 2020

PD1 gene polymorphism is associated with a poor prognosis in hepatocellular carcinoma following liver resection, cohort study.

Int J Surg 2020 Aug 29;80:84-90. Epub 2020 Jun 29.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan.

Background: This study examined whether single nucleotide polymorphism (SNP) in programmed cell death protein (PD)-1 is related to the postoperative prognosis of patients with hepatocellular carcinoma (HCC). The immune checkpoint protein PD-1 is an important inhibitor of T cell responses. SNP in the promoter region of PD-1 -606 G/A has been reported to result in high activation and expression of PD-1 associated with cancer risk.

Materials And Methods: We analyzed 321 patients with HCC who underwent hepatectomy between 2010 and 2015. PD-1 SNP was analyzed by polymerase chain reaction, and the prognosis after surgical treatment of patients with HCC was analyzed.

Results: The PD-1 SNP statuses were as follows: 90 AA (28.1%), 163 GA (50.8%), 68 GG (21.2%). The baseline parameters did not statistically differ between the three groups. The overall survival (OS) of patients with the GG genotype was significantly lower than that of those with the other genotypes (P = 0.031). The GG genotype was an independent risk factor for OS (P = 0.009; HR 2.201). There was no significant difference between the GG genotype and other genotypes in recurrent-free survival. The extrahepatic recurrence (EHR) rate of those with the GG genotype was significantly higher than that of those with the other genotypes (P = 0.036). The GG genotype was an independent risk factor for EHR (P = 0.008; HR 2.037).

Conclusions: The PD-1 SNP GG genotype is associated with poor survival and increased EHR in HCC. Furthermore, the GG genotype is an independent predictive factor for OS and EHR.
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http://dx.doi.org/10.1016/j.ijsu.2020.05.007DOI Listing
August 2020

Impact of postoperative bile leakage on long-term outcome in patients following liver resection for hepatocellular carcinoma.

J Hepatobiliary Pancreat Sci 2020 Dec 3;27(12):931-941. Epub 2020 Jun 3.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background/purpose: The incidence of bile leakage after liver resection for hepatocellular carcinoma (HCC) remains a cause for concern. There are limited reports on the impacts of postoperative bile leakage on long-term clinical outcomes. This study aims to evaluate the effects of postoperative bile leakage on recurrence-free survival (RFS) and overall survival (OS).

Methods: A total of 1,178 patients who underwent curative liver resection for HCC between 1986 and 2012 were included in the present study. Postoperative bile leakage was defined using the International Study Group of Liver Surgery definition, and the primary end points of the study were OS and RFS at 5 years.

Results: Forty-three (3.7%) patients had bile leakage following liver resection. The median follow-up was 5 years. A follow-up analysis revealed that patients with bile leakage had poor 5-year rates of OS (41.0% vs 56.4%, P = .013) and RFS (14.6% vs 28.7%, P < .001). Additionally, bile leakage was an independent factor for both OS [hazard ratio (HR) 1.559, P = .022] and RFS (HR 1.517, P = .024). Furthermore, bile leakage was the only factor affecting prognosis among postoperative complications.

Conclusions: Postoperative bile leakage worsens long-term clinical outcomes following liver resection in HCC patients.
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http://dx.doi.org/10.1002/jhbp.750DOI Listing
December 2020

Hepatic epithelioid hemangioendothelioma successfully treated with living donor liver transplantation: A case report and literature review.

Clin Case Rep 2020 Jan 17;8(1):108-115. Epub 2019 Dec 17.

Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan.

Hepatic epithelioid hemangioendothelioma is a rare neoplasm with a variable malignant potential and a high risk of recurrence. No general treatment guidelines have been established. Fortunately, we were able to minimize immunosuppressant after liver transplantation because of a full HLA-matched case. There was no recurrence 1 year after treatment.
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http://dx.doi.org/10.1002/ccr3.2558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982499PMC
January 2020

Verification of inflammation-based prognostic marker as a prognostic indicator in hepatocellular carcinoma.

Ann Gastroenterol Surg 2019 Nov 20;3(6):667-675. Epub 2019 Sep 20.

Department of Gastroenterological and Transplant Surgery Graduate School of Biomedical and Health Science Hiroshima University Hiroshima Japan.

Aim: Although inflammation-based markers in cancer have been used for prognostic prediction, the most useful marker for hepatocellular carcinoma (HCC) has not been established. We investigated the usefulness of various inflammation-based markers in HCC patients after hepatectomy.

Methods: A total of 478 patients who underwent initial hepatectomy for HCC from 2009 to 2015 and were diagnosed with pathological HCC were included in this retrospective study. Inflammation-based markers consisted of the C-reactive protein to albumin ratio (CAR), Glasgow prognostic score (GPS), neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio, platelet to lymphocyte ratio and prognostic index. Univariate and multivariate analyses for overall survival (OS) and disease-free survival (DFS) using the Cox proportional hazard model were carried out. Kaplan-Meier analysis and log-rank test were used for comparison of OS and DFS. To reduce influences of selection bias and confounders for stratifying CAR, clinicopathological characteristics of patients were balanced by propensity score matching.

Results: Multivariate analysis identified only high CAR (>0.027) as an indicator of poor OS, and high CAR and high GPS (1-2) as indicators of poor DFS among inflammation-based markers. After propensity score matching, 124 patients each with low CAR and high CAR were matched. High CAR was correlated with both poor OS and DFS.

Conclusion: C-reactive protein to albumin ratio was the most valuable prognostic indicator after hepatectomy for HCC among inflammation-based markers.
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http://dx.doi.org/10.1002/ags3.12286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875930PMC
November 2019

Comparison of new prognostic systems for patients with resectable hepatocellular carcinoma: Albumin-Bilirubin grade and Albumin-Indocyanine Green Evaluation grade.

Hepatol Res 2019 Oct 10;49(10):1218-1226. Epub 2019 Jul 10.

Department of Gastroenterological and Transplant Surgery, Hiroshima University, Hiroshima, Japan.

Aim: We aimed to compare the prognostic abilities of two novel liver function-estimating models, Albumin-Bilirubin (ALBI) and Albumin-Indocyanine Green Evaluation (ALICE) grades, in patients with hepatocellular carcinoma.

Methods: Data of 1270 patients who underwent initial hepatectomy for hepatocellular carcinoma between 1986 and 2016 were retrospectively collected from a multi-institutional database. The prognostic impact of each system was analyzed according to the results of the area under the receiver operating characteristic curve, the Cox regression model and the linear trend χ -test.

Results: The ALBI and ALICE scores, which were obtained before grading status, were significantly correlated (correlation coefficient 0.930; P < 0.001). Both ALBI and ALICE grades stratified well in terms of overall survival, and were found to be independent prognostic factors on multivariate analysis (P < 0.05). The area under the receiver operating characteristic curves for 5-year survival in both groups were equivalent (0.602 vs. 0.614, P = 0.402); however, homogeneity, discriminatory ability, and the Akaike information criterion were superior for the ALICE grade than for the ALBI grade (73.8 vs. 65.7, 43.4 vs. 34.9, and 7204.1 vs. 7212.2, respectively).

Conclusions: Both grading systems could estimate the liver function of patients with hepatocellular carcinoma. Regarding hepatectomy patients, the ALICE grade was a more suitable model than the ALBI grade.
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http://dx.doi.org/10.1111/hepr.13393DOI Listing
October 2019

Experience and outcomes in living donor liver procurement using the water jet scalpel.

J Hepatobiliary Pancreat Sci 2019 Aug 15;26(8):370-376. Epub 2019 Jul 15.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Background: The aim of the present study was to clarify treatment outcomes of living donor liver procurement using the water jet scalpel (WJS).

Methods: This single-center, retrospective cohort study included 40 living donors who underwent liver procurement from January 2014 to December 2018. One living donor who underwent posterior segmentectomy was excluded. Clinical data and outcomes after surgery for 20 WJS donors and 19 Cavitron Ultrasonic Surgical Aspirator (CUSA) donors were compared.

Results: Preoperative and excised graft data did not differ significantly between the WJS and CUSA groups. Operation time (P = 0.025) and parenchymal transection time (P = 0.007) were significantly shorter in the WJS group. There was no difference between the groups in terms of short-term outcomes after surgery. Multivariate analysis revealed that WJS offered significant advantages over CUSA in terms of shortening parenchymal transection time (P = 0.017).

Conclusion: Living donor liver procurement using WJS contributes to shortening of parenchymal transection time while maintaining the same level of safety as when using CUSA.
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http://dx.doi.org/10.1002/jhbp.643DOI Listing
August 2019

Successful Resection of Solitary Abdominal Wall Metastasis of Sarcomatous Intrahepatic Cholangiocarcinoma.

Case Rep Gastroenterol 2019 Jan-Apr;13(1):66-72. Epub 2019 Feb 14.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, Hiroshima, Japan.

Sarcomatous intrahepatic cholangiocarcinoma (ICC) is a rare histological variant of ICC that is composed of both adenocarcinoma (ICC component) and sarcomatous components. Surgery is believed to be the primary treatment, and some reports describe primary resection. However, due to the aggressive malignancy of sarcomatous ICC, there is no report regarding resection of a metastatic lesion. In this report, we present the case of a 75-year-old woman admitted to our hospital with the chief complaint of weight loss. Various imaging techniques demonstrated a single mass in the liver and cecum. A cecal gastrointestinal stromal tumor accompanied by liver metastasis was suspected, and ileocecal resection was performed for diagnostic purposes. However, the tumor was present in the abdominal wall rather than in the cecum. The tumor was resected and diagnosed as undifferentiated sarcoma. We suspected the liver tumor was a series of lesions, so we performed hepatectomy. As the tumor was composed of both adenocarcinoma and sarcomatous components, it was diagnosed as sarcomatous ICC. The histological findings of the abdominal wall tumor were similar to those of sarcomatous ICC, so we diagnosed the abdominal wall tumor as a solitary metastasis of sarcomatous ICC. In this case, solitary metastasis was observed, and we were able to resect both the primary and metastatic lesions. This case illustrates that when solitary metastasis can be seen in sarcomatous ICC, radical resection is possible.
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http://dx.doi.org/10.1159/000496917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547282PMC
February 2019

Clinical significance of glypican-3-positive circulating tumor cells of hepatocellular carcinoma patients: A prospective study.

PLoS One 2019 29;14(5):e0217586. Epub 2019 May 29.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

The utility of glypican-3 (GPC3) expression for the detection of circulating tumor cells (CTCs) in hepatocellular carcinoma (HCC) patients has not been elucidated. The aim of this study was to identify associations between the presence of GPC3-positive CTCs and clinicopathological factors of these patients, furthermore, to evaluate whether CTC can predict microscopic portal vein invasion (mPVI). This study was done on 85 patients who underwent hepatectomy as the first-line treatment and whose preoperative imaging showed no evidence of macroscopic PVI and distant metastases. Peripheral blood was collected from all patients immediately before surgery. Cells were purified initially by density gradient centrifugation followed by immunomagnetic positive enrichment based upon the expression of GPC3. The numbers of CTCs contained in the enriched samples were enumerated via flow cytometry. Protocol validation using HepG2 cells spiked into 8.0 mL of blood from a healthy volunteer indicated that we were able to recover 12.1% of the tumor cells. A median number of 3 CTCs (range: 0-27) was detected in the 8.0 mL of peripheral blood of the 85 analyzed HCC patients. Thirty-three patients had CTCs ≥5, and these patients had a higher incidence of mPVI (p < 0.001), a lower disease-free survival (p = 0.015), and a lower overall survival (p = 0.047) than those with CTCs <5. Multivariate analysis identified CTCs ≥5 as an independent predictor of mPVI (p < 0.001). In conclusion, preoperative GPC3-positive CTCs ≥5 was a risk factor of mPVI and poor prognosis, and therefore may be a useful biomarker for HCC patient outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217586PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541303PMC
January 2020

Independent risk factors that predict bile leakage after hepatectomy for hepatocellular carcinoma: Cohort study.

Int J Surg 2018 Sep 20;57:1-7. Epub 2018 Jul 20.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Background: Bile leakage is a major cause of morbidity after hepatectomy. This study aimed to identify the predictive factors for bile leakage after hepatectomy.

Materials And Methods: Between January 2011 and December 2016, 556 patients underwent a liver resection for hepatocellular carcinoma with curative intent, and were enrolled to participate in this study. The incidence of postoperative bile leakage (POBL) was determined and the predictive factors for POBL were identified using univariate and multivariate analysis.

Results: POBLs occurred in 28 patients (5.0%). The multivariate analysis identified a history of stereotactic body radiotherapy, a body mass index <20 kg/m, Child-Pugh class B cirrhosis, a central hepatectomy, and an operation time ≥375 min as risk factors that were associated with POBL. When the study cohort was grouped according to the number of the predictive factors present, the incidence of POBL increased as the number of the extant independent predictive factors increased. The POBL rate was 45.0% in patients with ≥3 predictive factors.

Conclusion: We determined that POBL was associated with operative mortality and identified five independent predictive factors associated with POBL. Risk stratification using these predictive factors may be useful for identifying patients at a high risk of POBL.
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http://dx.doi.org/10.1016/j.ijsu.2018.07.005DOI Listing
September 2018

Utility of hepatobiliary scintigraphy for recurrent reflux cholangitis following choledochojejunostomy: A case report.

Int J Surg Case Rep 2018 9;42:104-108. Epub 2017 Dec 9.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan. Electronic address:

Introduction: Reflux cholangitis is a frequent complication of Roux-en-Y choledochojejunostomy.

Presentation Of Case: A 68-year-old male underwent left lobectomy of the liver, bile duct resection and choledochojejunostomy for intrahepatic cholangiocarcinoma located in Segment 2 of the liver, 40mm in diameter with a lymph node metastasis 5 years ago. He had frequent recurrences of postoperative reflux cholangitis and hepatic abscesses and was treated with antibiotics each time. Postoperative adjuvant chemotherapy was scheduled, but due to recurrent cholangitis it was difficult. Although double balloon endoscopy for endoscopic retrograde cholangiography was performed, no stenosis was found in the choledochojejunostomy anastomosis, and no defect suspected of calculus and stenosis were found by contrast. Antibiotics had to be administered for a long time because it recurred when antibiotics were discontinued. This time, a tumor 2.0cm in diameter was detected in segment 7 of the liver on follow - up computed tomography. The preoperative diagnosis was recurrent Intrahepatic cholangiocarcinoma. Hepatobiliary scintigraphy was carried out in preparation for concomitant treatment of his reflux cholangitis. Retention in the blind loop of the choledochojejunostomy was retarded, and the excretion was delayed. Therefore, hepatectomy and resection of the blind loop were performed. We confirmed improvement of stasis in the blind loop on postoperative hepatobiliary scintigraphy. The postoperative course was uneventful, and antibiotics were not required.

Discussion: Hepatobiliary scintigraphy may be able to clarify the mechanism underlying reflux cholangitis.

Conclusion: Hepatobiliary scintigraphy was useful for the treatment of recurrent reflux cholangitis in this case.
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http://dx.doi.org/10.1016/j.ijscr.2017.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730426PMC
December 2017

Hepatectomy after down-staging of hepatocellular carcinoma with portal vein tumor thrombus using chemoradiotherapy: A retrospective cohort study.

Int J Surg 2017 Aug 1;44:223-228. Epub 2017 Jul 1.

Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan; Liver Research Project Center, Hiroshima University, 734-8553, 1-2-3, Kasumi, Hiroshima, Japan.

Background: This study evaluates the survival benefit and safety of hepatectomy after down-staging by 3-dimensional conformal radiation therapy (3D-CRT) for major portal vein tumor thrombus (PVTT) combined with hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC).

Methods: Fifty-two patients with unresectable advanced HCC treated with HAIC combined with 3D-CRT for PVTT, from January 2002 to March 2015, were analyzed in this retrospective study. Hepatectomy was offered to patients if, based on radiologic findings, all gross lesions were considered resectable. The safety of hepatectomy was investigated and overall survival (OS) was compared between the resection group (n = 7) and non-resection group (n = 43).

Results: OS was significantly higher in the resection group than in the non-resection group. Results of multivariate analysis identified conversion to surgery (hazard ratio, 0.35; 95% confidence interval, 0.10-0.99; P = 0.048) as an independent factor influencing OS. There were no serious postoperative complications and no case of mortality in patients who underwent hepatectomy.

Conclusions: Our findings suggest that hepatectomy after down-staging by 3D-CRT for PVTT combined with HAIC for advanced HCC is safe and results in good long term outcome.
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http://dx.doi.org/10.1016/j.ijsu.2017.06.082DOI Listing
August 2017

Application of endobronchial ultrasonography in laparoscopic liver segmentectomy in an animal model.

Asian J Endosc Surg 2017 May;10(2):209-212

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Introduction: This study investigated whether laparoscopic ultrasound-guided segment staining and real-time ultrasound-guided hepatectomy, with endobronchial ultrasonography equipped with a guide sheath, would be useful for laparoscopic liver segmentectomy in a porcine model.

Material And Surgical Technique: The abdominal cavity (in two pigs) was reached via a 12-mm umbilical trocar. An artificial tumor was created by radiofrequency ablation within the intended resection area. Portal vein puncture and staining were performed by the endobronchial ultrasonography-guided method. The targeted portal branch was successfully visualized and punctured with a needle through an equipped guide sheath. After targeted segment staining, the liver parenchyma was resected with a bipolar energy device; the regional Glisson's sheath was ligated and cut, and a surgical specimen was extracted. Real-time endobronchial ultrasonography from the cut surface provided information vital for preserving the surgical margin. All procedures were performed laparoscopically.

Discussion: This study demonstrated the technical feasibility of laparoscopic ultrasound-guided portal vein staining and safe surgical resection during laparoscopic liver segmentectomy.
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http://dx.doi.org/10.1111/ases.12346DOI Listing
May 2017

Influence of higher BMI for hepatitis B- and C-related hepatocellular carcinomas.

Langenbecks Arch Surg 2017 Aug 22;402(5):745-755. Epub 2017 May 22.

Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8557, Japan.

Purpose: Although obesity is associated with hepatocellular carcinoma (HCC) development, its impact on the surgical outcomes of patients with hepatitis B virus (HBV)-and hepatitis C virus (HCV)-related HCC remains unclear.

Methods: We retrospectively analyzed 714 patients with HCC who underwent curative hepatectomy. Among them, the HBV-related HCC group (n = 125) and HCV-related HCC group (n = 426) were subdivided according to the presence of body mass index (BMI) ≥ 25 kg/m. The surgical outcomes were compared.

Results: The 5-year overall survival rate after hepatectomy in the HBV-related HCC group was significantly better than that in the HCV-related HCC group. The 5-year overall survival rates of the HBV-related HCC with and without BMI ≥ 25 kg/m groups were 65 and 85%, respectively. The 5-year overall survival rates in the HCV-related HCC with and without BMI ≥ 25 kg/m groups were 75 and 65%, respectively. The HBV-related HCC with BMI ≥ 25 kg/m groups had a significantly worse prognosis than the HBV-related HCC without BMI ≥ 25 kg/m groups, while the HCV-related HCC with BMI ≥ 25 kg/m groups had a significantly better prognosis than the HCV-related HCC without BMI ≥ 25 kg/m groups. Multivariate analysis revealed that BMI ≥ 25 kg/m was the positive and negative prognostic factor for the surgical outcomes of patients with HBV- and HCV-related HCC, respectively.

Conclusions: BMI ≥ 25 kg/m negatively affected the surgical outcomes of patients with HBV-related HCC and positively affected those of patients with HCV-related HCC.
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http://dx.doi.org/10.1007/s00423-017-1589-2DOI Listing
August 2017

Significance of the Glasgow Prognostic Score for patients with colorectal liver metastasis.

Int J Surg 2017 Jun 5;42:209-214. Epub 2017 May 5.

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 734-8551, 1-2-3, Kasumi, Hiroshima, Japan.

Background: Systemic inflammation and nutritional status are strongly associated with tumor progression. Inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS), reflect these states and are predictive in patients with several types of advanced cancers. The aim of this study was to evaluate the significance of GPS in patients with colorectal liver metastasis (CRLM).

Patients And Methods: Study subjects were 134 patients with CRLM who underwent initial radical liver resection at Hiroshima University Hospital between January 2000 and December 2013. Univariate and multivariate analyses were performed to identify variables associated with overall and recurrence-free survival following liver resection in two groups based on GPS.

Results: There was no significant relationship between overall survival and GPS. Recurrence-free survival was significantly poorer in patients with GPS 1-2 than in those with GPS 0 (p < 0.01). In multivariate analysis for recurrence-free survival, moderate histologic differentiation, carcinoembryonic antigen level ≥10 ng/mL, and GPS 1-2 were identified as independent prognostic factors.

Conclusion: We suggest that GPS is an important predictor of recurrence following liver resection in patients with CRLM, and it should be considered one of the evaluation criteria for liver resection.
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http://dx.doi.org/10.1016/j.ijsu.2017.04.068DOI Listing
June 2017

Predictive Independent Factors for Extrahepatic Metastasis of Hepatocellular Carcinoma Following Curative Hepatectomy.

Anticancer Res 2017 05;37(5):2625-2631

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.

Aim: The aim of this study was to investigate the prognostic factors associated with extrahepatic metastasis of primary hepatocellular carcinoma (HCC).

Patients And Methods: We retrospectively analyzed 559 patients with HCC who underwent curative hepatectomy. We divided the patients into no recurrence (NoR), intrahepatic early recurrence (IHER), intrahepatic late recurrence (IHLR), and extrahepatic recurrence (EHR) groups. We compared the non-metastatic group (IHLR and NoR) with the metastatic group (IHER and EHR) and also compared IHER with EHR to determine risk factors for EHR.

Results: There were 252, 163, 109, and 35 patients with NoR, IHER, IHLR, and EHR, respectively. For the EHR group, the independent risk factor was vascular invasion. The EHR group had better liver function and worse tumor factors.

Conclusion: Vascular invasion is predictive of extrahepatic metastasis of HCC.
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http://dx.doi.org/10.21873/anticanres.11609DOI Listing
May 2017

Prediction of recurrence following hepatectomy in patients with hepatitis C virus infection-related hepatocellular carcinoma who achieved a sustained virological response.

Hepatol Res 2017 Oct 24;47(11):1186-1195. Epub 2017 Apr 24.

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

Aim: The risk of hepatitis C virus infection-related hepatocellular carcinoma (HCC) is lower, with a better prognosis, in patients who achieve a sustained virological response (SVR) than in those who do not. We aimed to identify risk factors of post-hepatectomy HCC recurrence in patients who achieved a SVR.

Methods: This retrospective study included 349 HCC patients who underwent an initial radical hepatectomy at our institution between January 2005 and December 2014. Sixty-eight patients had achieved a SVR (the SVR group) and 281 patients had not (the non-SVR group). Clinical characteristics and long-term outcomes were compared between the two groups. Univariate and multivariate analyses identified variables associated with recurrence-free survival in the SVR group.

Results: Post-hepatectomy overall and recurrence-free survival rates were significantly higher in the SVR group than the non-SVR group (P < 0.01 and <0.05, respectively). Univariate analysis of post-hepatectomy recurrence-free survival in the SVR group revealed multiple significant factors: aspartate aminotransferase, 25 IU/L or more (P = 0.01); indocyanine green retention rate at 15 min, 20.0% or less (P < 0.05); hepatic vascular invasion (P < 0.05); and an interval of months or less between achieving a SVR and hepatectomy (P < 0.01). Multivariate analysis confirmed an interval of 30 months or less between achieving a SVR and hepatectomy as an independent prognostic factor of recurrence-free survival (hazard ratio, 2.30; 95.0% confidence interval, 1.04-5.13; P < 0.05).

Conclusion: The interval between achieving a SVR and hepatectomy is an important predictor of recurrence in hepatitis C virus infection-related HCC patients who achieved a SVR.
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http://dx.doi.org/10.1111/hepr.12896DOI Listing
October 2017

Clinical characteristics and prognosis of non-B, non-C hepatocellular carcinoma: The impact of patient sex on disease-free survival - A retrospective cohort study.

Int J Surg 2017 Mar 1;39:206-213. Epub 2017 Feb 1.

Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8557, Japan.

Background: The number of patients with hepatocellular carcinoma (HCC) negative for both hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (HCVAb) has increased recently. The purpose of the present study was to investigate the clinical characteristics and prognoses of non-B non-C HCC (NBNC-HCC) patients.

Materials And Methods: From January 2000 to December 2013, 154 patients with NBNC-HCC and 560 patients with HBsAg or HCVAb positive (BC)-HCC who underwent curative resection were analyzed retrospectively. The clinical features of NBNC-HCC and BC-HCC were compared, and the prognoses of NBNC-HCC patients were analyzed.

Results: In comparison to patients with BC-HCC, patients with NBNC-HCC had better liver function but higher pathological tumor stages. The disease-free survival (DFS) duration was significantly higher in patients with NBNC-HCC than it was in those with BC-HCC. In patients with NBNC-HCC, aspartate aminotransferase ≥40 IU/L, albumin level <3.5 g/dL, and multiple tumors were independent risk factors of overall survival; and male sex and multiple tumors were independent risk factors of DFS.

Conclusion: Patients with NBNC-HCC had significantly longer DFS durations than those with BC-HCC. The patient sex had an impact on the postsurgical outcomes of patients with NBNC-HCC in DFS.
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http://dx.doi.org/10.1016/j.ijsu.2017.01.110DOI Listing
March 2017

Evaluation of the risk factors and prognostic factors of hepatectomy for hepatocellular carcinoma in patients aged 80 years or more.

J Hepatobiliary Pancreat Sci 2017 Jan 9;24(1):58-64. Epub 2017 Jan 9.

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Background: The risk factors of postoperative complications and prognostic factors of hepatocellular carcinoma in patients aged ≥80 years have not yet been defined. We aimed to identify these factors in this patient population.

Methods: This single-center, retrospective cohort study included 625 patients who underwent curative hepatectomy from January 2004 to December 2013. Elderly patients were defined as those aged ≥80 years. Clinicopathological data and outcomes after hepatectomy for 60 elderly patients and 565 non-elderly patients were compared.

Results: The elderly group had more comorbidities than the non-elderly group. Liver function, surgical data, tumor factors, the incidence of postoperative complications, disease-free survival rate, and overall survival rate did not differ significantly between the two groups. Results of multivariate analysis showed that the levels of cholinesterase, total cholesterol, and hemoglobin A1c were predictors of complications in the elderly group. The Child-Pugh grade, protein induced in vitamin K absence or antagonists-II level, and multiple tumors were significantly associated with disease-free survival.

Conclusions: Although elderly patients had more comorbidities, their postoperative complications and prognosis were comparable to those of the non-elderly patients. Hepatectomy may be justified for elderly patients, but it is important to evaluate levels of cholinesterase, total cholesterol, and hemoglobin A1c preoperatively.
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http://dx.doi.org/10.1002/jhbp.413DOI Listing
January 2017

Efficacy of repeat hepatectomy for recurrence following curative hepatectomy for colorectal liver metastases: A Retrospective Cohort Study of 128 patients.

Int J Surg 2016 Dec 11;36(Pt A):96-103. Epub 2016 Oct 11.

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 kasumi, Minami-Ku, Hiroshima, 734-8557, Japan.

Background: Despite improvements in surgery and chemotherapy, most patients develop recurrence after initial hepatectomy for colorectal liver metastasis (CRLM). Following initial hepatectomy for CRLM, patterns and surgical management of recurrence have not been widely reported.

Materials And Methods: We identified 128 patients who underwent hepatic resection for CRLM between January 2000 and December 2012. Demographics, operative data, site of recurrence, and long-term survival data were collected and analyzed. Patients were stratified into 3 groups based on their site of recurrence as intrahepatic, intra- and extrahepatic, and extrahepatic. In addition, the influence of potential factors on overall survival (OS) in patients with only liver relapse was analyzed through univariate and multivariate analysis.

Results: After curative initial hepatectomy, 87 (68.0%) patients had a recurrence: 33 in the intrahepatic group, 11 in the intra- and extrahepatic group, and 43 in the extrahepatic group. The OS for the intra- and extrahepatic group was significantly lower than that for the intrahepatic group. In the intrahepatic group, disease-free interval (DFI) < 12 months and non-repeat hepatectomy were independent poor prognostic factors. Carcinoembryonic antigen (CEA) at the time of hepatectomy was significantly higher in DFI < 12 group than in the DFI ≥ 12 group.

Conclusion: Patterns of recurrence following initial hepatectomy for CRLM have important implications for OS. In the intrahepatic recurrence group, short DFI was correlated with high CEA at hepatectomy, and was a poor prognostic factor.
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http://dx.doi.org/10.1016/j.ijsu.2016.10.004DOI Listing
December 2016