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101. Glucocorticoid use and ischemia‐reperfusion injury in laparoscopic liver resection: Randomized controlled trial.

Author

Hasegawa, Yasushi, Nitta, Hiroyuki, Takahara, Takeshi, Katagiri, Hirokatsu, Kanno, Shoji, Umemura, Akira, Akiyama, Yuji, Iwaya, Takeshi, Otsuka, Koki, and Sasaki, Akira

Subjects
HEPATECTOMY, LAPAROSCOPY, STEROIDS
Abstract

Aim: Laparoscopic liver resection (LLR) is increasingly carried out worldwide. However, there are concerns regarding ischemia‐reperfusion injury caused by pneumoperitoneum and the Pringle maneuver. It is not clear whether perioperative use of glucocorticoids lowers the risk of ischemia‐reperfusion hepatic injury in LLR as has been reported for open liver resection. The aim of the present study was to investigate the role of perioperative glucocorticoid use in improving hepatic function and surgical outcomes after LLR. Methods: In this double‐blind, randomized controlled trial (UMIN000013823), we enrolled 130 patients who presented to our institution for LLR between April 2014 and October 2018. Six patients were excluded, resulting in 124 patients being randomized to either the glucocorticoid or the control group. Preoperatively, patients in the glucocorticoid group received 500 mg methylprednisolone in saline solution, patients in the control group saline solution only. Surgical outcomes and blood parameters were compared between the two groups. Results: The Pringle maneuver could not be carried out in 24 patients, resulting in 50 patients in each group being included in the analysis. Postoperatively, total, direct and indirect bilirubin, and C‐reactive protein and interleukin‐6 levels were significantly lower, albumin levels were significantly higher, and prothrombin time was significantly shorter in the glucocorticoid than in the control group. Surgical outcomes were not significantly different between the groups. Conclusion: This first report on preoperative glucocorticoid use in LLR showed that it significantly improved postoperative liver function and thus might enhance the safety of LLR. [ABSTRACT FROM AUTHOR]

Published
2020
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107. PS01.226: FEASIBILITY OF CONVERSION THORACOSCOPIC ESOPHAGECTOMY AFTER TRIPLET CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR T4 ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Author

Akiyama, Yuji, primary, Iwaya, Takeshi, additional, Endo, Fumitaka, additional, Nikai, Haruka, additional, Umemura, Akira, additional, Baba, Shigeaki, additional, Chiba, Takehiro, additional, Kimura, Toshimoto, additional, Takahara, Takeshi, additional, Otsuka, Koki, additional, Nitta, Hiroyuki, additional, Mizuno, Masaru, additional, Kimura, Yusuke, additional, Koeda, Keisuke, additional, and Sasaki, Akira, additional

Published
2018
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108. Procedure of IPOM-Plus technique is shown

Author

Umemura, Akira, primary, Suto, Takayuki, additional, Fujuwara, Hisataka, additional, Nakamura, Seika, additional, Nitta, Hiroyuki, additional, Takahara, Takeshi, additional, Hasegawa, Yasushi, additional, and Sasaki, Akira, additional

Published
2018
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110. PS02.122: PREOPERATIVE CHEMOTHERAPY WITH BIWEEKLY DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Author

Endo, Fumitaka, primary, Akiyama, Yuji, additional, Iwaya, Takeshi, additional, Nikai, Haruka, additional, Umemura, Akira, additional, Baba, Shigeaki, additional, Chiba, Takehiro, additional, Kimura, Toshimoto, additional, Takahara, Takeshi, additional, Otsuka, Koki, additional, Nitta, Hiroyuki, additional, Mizuno, Masaru, additional, Kimura, Yusuke, additional, Koeda, Keisuke, additional, and Sasaki, Akira, additional

Published
2018
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116. Laparoscopic approach for parenchymal liver transection

Author

Ho, Cheng-Maw, primary, Wakabayashi, Go, additional, Yeh, Chi-Chuan, additional, Hu, Rey-Heng, additional, Sakaguchi, Takanori, additional, Hasegawa, Yasushi, additional, Takahara, Takeshi, additional, Nitta, Hiroyuki, additional, Sasaki, Akira, additional, and Lee, Po-Huang, additional

Published
2018
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121. Laparoscopic liver resection for hepatocellular carcinoma with cirrhosis in a single institution

Author

Takahara, Takeshi, Wakabayashi, Go, Nitta, Hiroyuki, Hasegawa, Yasushi, Katagiri, Hirokatsu, Takeda, Daiki, Makabe, Kenji, and Sasaki, Akira

Subjects
Original Article
Abstract

In a statement by the second International Consensus Conference for Laparoscopic Liver Resection (LLR), minor LLR was confirmed to be a standard surgical practice, as it has become adopted by an increasing proportion of surgeons. However, it is unclear whether this applies to the more complex group of patients suffering from cirrhosis. Therefore, the aim of this retrospective study was to compare the feasibility and safety of LLR for hepatocellular carcinoma (HCC) between non-liver cirrhosis (NLC) patients and liver cirrhosis (LC) patients at a single high-volume laparoscopy center.From the beginning of 2000 to the end of 2013, open liver resection (OLR) was performed in 99 HCC patients, and LLR was in 118. The HCC patients who underwent LLR were divided into NLC-LLR (n=60) and LC-LLR (n=58) groups, and we compare the short-term outcomes between them.There was no significant difference in the incidence of blood loss and transfusion requirements between the NLC-LLR group and the LC-LLR group, although wedge resection was mainly performed in the LC-LLR group. There was no significant difference in the complication rate between the two groups, and the remarkable finding was that there was a significantly lower incidence of postoperative ascites in the LC-LLR group than in the NLC-LLR group.According to our experience, it appears that LLR for selected HCC patients with cirrhosis is a feasible and promising procedure that is associated with less blood loss and fewer postoperative complications, especially the incidence of postoperative ascites. Further investigations are clearly warranted.

Published
2015

124. Laparoscopic approach for parenchymal liver transection

Author

Lee Po-Huang, Sasaki Akira, Hasegawa Yasushi, Sakaguchi Takanori, Takahara Takeshi, Hu Rey-Heng, Wakabayashi Go, Nitta Hiroyuki, Yeh Chi-Chuan, and Ho Cheng-Maw

Subjects
Pathology, medicine.medical_specialty, business.industry, Parenchyma, Materials Chemistry, Medicine, business
Published
2018
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127. The First Comparative Study of the Perioperative Outcomes Between Pure Laparoscopic Donor Hepatectomy and Laparoscopy-Assisted Donor Hepatectomy in a Single Institution

Author

Takahara, Takeshi, primary, Wakabayashi, Go, additional, Nitta, Hiroyuki, additional, Hasegawa, Yasushi, additional, Katagiri, Hirokatsu, additional, Umemura, Akira, additional, Takeda, Daiki, additional, Makabe, Kenji, additional, Otsuka, Koki, additional, Koeda, Keisuke, additional, and Sasaki, Akira, additional

Published
2017
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129. Downregulation of ST6GALNAC1 is associated with esophageal squamous cell carcinoma development

Author

Iwaya, Takeshi, primary, Sawada, Genta, additional, Amano, Suburu, additional, Kume, Kohei, additional, Ito, Chie, additional, Endo, Fumitaka, additional, Konosu, Masafumi, additional, Shioi, Yoshihiro, additional, Akiyama, Yuji, additional, Takahara, Takeshi, additional, Otsuka, Koki, additional, Nitta, Hiroyuki, additional, Koeda, Keisuke, additional, Mizuno, Masaru, additional, Nishizuka, Satoshi, additional, Sasaki, Akira, additional, and Mimori, Koshi, additional

Published
2016
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130. ABO-Incompatible Living Donor Liver Transplantation from Hepatitis B Core Antibody Positive Donor to Hepatitis C Liver Cirrhosis Recipient: A Case Report

Author

Umemura, Akira, Nitta, Hiroyuki, Sasaki, Akira, Takahara, Takeshi, Hasegawa, Yasushi, and Wakabayashi, Go

Subjects
Article Subject, parasitic diseases, virus diseases, digestive system diseases
Abstract

Herein, we describe an extremely rare experience of a patient with liver cirrhosis from hepatitis C virus (LC-HCV) who underwent an ABO-incompatible living donor liver transplantation (ABO-I-LDLT) using a hepatitis B core antibody (HBc-Ab) positive donor’s liver graft. A 47-year-old Japanese woman with end stage LC-HCV, as a recipient, was preoperatively administered rituximab, mycophenolate mofetil, and steroids without plasma exchange. A routine ABO-I-LDLT procedure was applied using her daughter’s HBc-Ab positive liver graft. Prophylaxis of the hepatitis B virus (HBV) infection using hepatitis B immunoglobulin (HBIG) and entecavir had been properly administered. Three months after the ABO-I-LDLT, HCV hepatitis relapsed. To date, this patient has been under antiviral therapy and prophylaxis of HBV infection using HBIG, while entecavir has been continued. The cognitions and techniques with regard to ABO-I-LDLT, prophylaxis of HBV cross infection, various patterns of immunosuppression, and antiviral therapy for HCV relapse are indispensable in managing a transplant recipient. According to the prophylaxis of HBV cross infection under ABO-I-LDLT, it may be very important to keep the HBs-Ab titer higher than usual for HBV naïve recipients, because severe systemic immunosuppression can cause de novo hepatitis.

Published
2014
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131. Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan

Author

Takahara, Takeshi, primary, Wakabayashi, Go, additional, Konno, Hiroyuki, additional, Gotoh, Mitsukazu, additional, Yamaue, Hiroki, additional, Yanaga, Katsuhiko, additional, Fujimoto, Jirou, additional, Kaneko, Hironori, additional, Unno, Michiaki, additional, Endo, Itaru, additional, Seto, Yasuyuki, additional, Miyata, Hiroaki, additional, Miyazaki, Masaru, additional, and Yamamoto, Masakazu, additional

Published
2016
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133. Investigation of operative outcomes of thoracoscopic esophagectomy after triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for advanced esophageal squamous cell carcinoma.

Author

Akiyama, Yuji, Iwaya, Takeshi, Endo, Fumitaka, Chiba, Takehiro, Takahara, Takeshi, Otsuka, Koki, Nitta, Hiroyuki, Koeda, Keisuke, Mizuno, Masaru, Kimura, Yusuke, and Sasaki, Akira

Subjects
ESOPHAGECTOMY, ESOPHAGEAL surgery, CANCER chemotherapy, TREATMENT of esophageal cancer, ADJUVANT treatment of cancer, ANTINEOPLASTIC agents, CISPLATIN, COMBINED modality therapy, DIGESTIVE organ surgery, ESOPHAGUS, ESOPHAGEAL tumors, FLUOROURACIL, SURVIVAL, THORACOSCOPY, TREATMENT effectiveness, RETROSPECTIVE studies
Abstract

Background: Preoperative chemotherapy with cisplatin and 5-fluorouracil (CF) has become the standard treatment for resectable stage II/III thoracic esophageal carcinoma in Japan. Recently, preoperative triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported to be effective for locally advanced esophageal cancer. Thoracoscopic esophagectomy (TE) has been increasingly accepted worldwide for the treatment of esophageal cancer. We conducted a retrospective study to evaluate the safety and outcomes of TE after DCF therapy for patients with advanced esophageal cancer.Methods: The medical records of 63 consecutive patients with esophageal squamous cell carcinoma who underwent thoracoscopic surgery after chemotherapy were reviewed. Thirty-four patients received neoadjuvant chemotherapy with CF, and 29 received DCF as first-line chemotherapy.Results: The clinical T stage was significantly higher in the DCF group than in the CF group (p < 0.0001), including 17 patients with T4. Lymph node metastasis was more frequent in the DCF group (p = 0.0005), and the clinical stage of the tumor was significantly higher in the DCF group than in the CF group (p = 0.0001). No significant difference existed between the two groups in operation time for the thoracic procedure (DCF 277.2 min vs. CF 302 min). Blood loss during the thoracic procedure was less in the DCF group than in the CF group (DCF 46.9 mL vs. CF 88.8 mL; p = 0.0056). No significant differences existed between the two groups in postoperative morbidity (DCF 34.5% vs. CF 47%) or mortality (DCF 0% vs. CF 2.9%) rates.Conclusions: Our study suggests that TE after DCF therapy for advanced esophageal cancer is as safe as TE after CF therapy. [ABSTRACT FROM AUTHOR]

Published
2018
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134. A novel model for prediction of pure laparoscopic liver resection surgical difficulty.

Author

Wakabayashi, Go, Hasegawa, Yasushi, Nitta, Hiroyuki, Takahara, Takeshi, Katagiri, Hirokatsu, Umemura, Akira, Makabe, Kenji, and Sasaki, Akira

Subjects
LAPAROSCOPIC surgery complications, PREDICTION models, SURGICAL excision, HEPATECTOMY, LIVER surgery, PREOPERATIVE risk factors
Abstract

Background: Extending the clinical indications for laparoscopic liver resection (LLR) should be carefully considered based on a surgeon's experience and skill. However, objective indexes to help surgeons assess the estimated difficulty of LLR are scarce. The aim of our study was to develop the first objective numerical rating scale to predict the surgical difficulty of various LLR procedures.Methods: We performed a retrospective review of the operative outcomes of 187 patients who underwent a pure LLR. First, the value of preoperative factors for predicting surgical time was evaluated by multivariate linear regression analyses, and a scoring system was constructed. Next, the integrity of our predictive linear model was evaluated against the documented operative outcomes for patients forming our study group.Results: Four predictive factors were identified and scored based on the weighted contribution of each factor predicting surgical time: extent of resection (scored 0, 2, or 3); location of tumor (scored 0, 1, or 2); obesity (scored 0 or 1); and platelet count (scored 0 or 1). The scores were summed to classify surgical difficulty into three levels: low (total score ≤1); medium (total score 2-3); and high (total score ≥4). Operative outcomes, including surgical time, volume of blood loss, length of hospital stay, and rate of morbidity, were significantly different between the three surgical difficulty levels.Conclusion: Our novel model will be useful for surgeons to predict the difficulty of an LLR procedure relative to their own experience and skill. [ABSTRACT FROM AUTHOR]

Published
2017
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136. Safely extending the indications of laparoscopic liver resection: When should we start laparoscopic major hepatectomy?

Author

Wakabayashi, Go, Hasegawa, Yasushi, Nitta, Hiroyuki, Takahara, Takeshi, Katagiri, Hirokatsu, Baba, Shigeaki, Takeda, Daiki, Makabe, Kenji, and Sasaki, Akira

Subjects
HEPATECTOMY, LAPAROSCOPIC surgery, SAFETY, PATIENTS, LEARNING curve, CUSUM technique, LAPAROSCOPY, LEARNING, RETROSPECTIVE studies, SURGICAL blood loss
Abstract

Background: Laparoscopic major hepatectomy (LMH) is an innovative procedure that is still in the exploration phase. Although new surgical techniques have learning curves, safety should be maintained from the onset. This retrospective study was conducted to evaluate the safe introduction of LMH.Methods: We retrospectively reviewed data from 245 consecutive patients who underwent pure laparoscopic liver resection. Patients were divided into three groups: Phase I, the first 64 cases, all minor hepatectomies; Phase II, cases from the first LMH case to the midmost of the LMH cases (n = 69, including 22 LMHs); Phase III, the most recent 112 cases, including 22 LMHs. Patient characteristics and surgical results were evaluated, and the learning curve was analysed with the cumulative sum (CUSUM) method.Results: The first LMH was adopted after sufficient preparatory experience was gained from performing 64 minor hepatectomies. In cases of LMH, there were no significant differences in the surgical time between Phases II and III (356 vs. 309 min; P = 0.318), morbidity rate (22.7 vs. 31.8 %; P = 0.736), or major morbidity rate (18.2 vs. 9.1 %; P = 0.664); however, estimated blood loss was significantly reduced from Phase II to Phase III (236 vs. 68 mL; P = 0.018). The CUSUM for morbidity also showed similar outcomes through Phases II and III.Conclusion: There is a learning curve associated with laparoscopic liver resection. To maintain a low morbidity rate, 60 laparoscopic minor hepatectomies could provide adequate experience before the adoption of LMH. [ABSTRACT FROM AUTHOR]

Published
2017
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147. Pure Laparoscopic Donor Hepatectomy: Right Posterior Section Graft.

Author

Hasegawa, Yasushi, Nitta, Hiroyuki, Takahara, Takeshi, Katagiri, Hirokatsu, Kanno, Shoji, Umemura, Akira, and Sasaki, Akira

Subjects
VENA cava inferior, HEPATIC veins, HEPATECTOMY, HOSPITAL admission & discharge, LAPAROSCOPIC surgery, NEPHRECTOMY, LIVER surgery, LIVER tumors, LAPAROSCOPY
Abstract

Background: The use of laparoscopic liver resection (LLR) is widespread owing to its several advantages, especially smaller incision (Kaneko et al., Ann Gastroenterol Surg 1:33-43, 1; Ciria et al., Surg Endosc 34:349-360, 2). However, both posterior sectionectomy and donor hepatectomy are extremely difficult procedures to perform in LLR (Hasegawa et al., Ann Gastroenterol Surg 2:376-382, 3; Soubrane and Kwon, J Hepatobiliary Pancreat Sci 24:E1-E5, 4; Takahara et al., Transplantation 101:1628-1636, 5; Lee et al., Clin Transplant 33:e13683, 6; Hong et al., Surg Endosc 33:3741-3748, 7; Rhu et al., J Hepatobiliary Pancreat Sci 27:16-25, 8). Moreover, the right posterior section graft procurement is also difficult even in open laparotomy procedure (Sugawara et al., Transplantation 73:111-114, 9; Hwang et al., Liver Transpl 10:1150-1155, 10; Hori, Kirino, and Uemoto, Hepatol Res 45:1076-1082, 11; Kusakabe et al., Liver Transpl 26:299-303, 12). The pure laparoscopic donor posterior sectionectomy has not been reported yet. Therefore, we aimed to introduce a novel procedure through a video clip.Methods: The donor was placed in the semi-left lateral decubitus position with the reverse Trendelenburg position using a bean bag device. The right liver was mobilized, and the right hepatic vein was exposed. To adopt the liver hanging maneuver, a tape was inserted between the middle and right hepatic veins along the inferior vena cava. The posterior Glissonean pedicle was encircled and controlled, and the liver parenchyma was completely transected using the liver hanging maneuver. The vessels to the posterior section were respectively isolated. The posterior branches of the hepatic duct, hepatic artery, and portal vein were cut. The right hepatic vein was divided, and the graft liver was retrieved via a suprapubic incision. This study was approved by institutional ethics board (No. MH2019-119), and informed consent was taken from the patient.Results: The overall surgical time was 503 min, and the blood loss was 400 mL. No complications were observed, and the donor was discharged from the hospital on postoperative day 11.Conclusion: This is the first report of pure laparoscopic donor hepatectomy of the posterior section graft. This procedure is more difficult than other laparoscopic donor hepatectomies because it involves parenchymal transection in the right intersectional plane and dissection of the posterior branches of hilar vessels. [ABSTRACT FROM AUTHOR]

Published
2021
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150. Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using retroperitoneal-first laparoscopic approach (Retlap): A novel minimally invasive approach for determining resectability and achieving tumor-free resection margins of locally advanced pancreatic body cancer

Author

Kiguchi, Gozo, Sugioka, Atsushi, Uchida, Yuichiro, Mii, Satoshi, Kojima, Masayuki, Takahara, Takeshi, Kato, Yutaro, Suda, Koichi, and Uyama, Ichiro

Abstract

Conventional open distal pancreatectomy with en bloc celiac axis resection (DP-CAR) using the ventral approach is technically challenging, highly invasive, and not easy to ensure ample dorsal surgical margins. Hence, we describe a novel minimally invasive strategy for DP-CAR using the retroperitoneal-first laparoscopic approach (Retlap), i.e., Retlap DP-CAR, for locally advanced pancreatic body cancer (LAPC), and assess its utility.

Published
2022
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