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5. Drug-free remission of immune thrombocytopenic purpura following resection of perihilar cholangiocarcinoma: a case report.

Author

Sakuma, Masayoshi, Takahashi, Daigoro, Kamei, Keitaro, Takayama, Yuichi, Takahashi, Takamasa, Aoyama, Hiroki, Hosoi, Takahiro, and Maeda, Atsuyuki

Subjects
IDIOPATHIC thrombocytopenic purpura, THROMBOPENIC purpura, DISEASE remission, AUTOIMMUNE diseases, CHOLANGIOCARCINOMA
Abstract

Immune thrombocytopenic purpura (ITP) is a rare autoimmune disorder. Although secondary ITP, caused by various underlying diseases, including some malignant tumors, has been reported, instances of ITP resolving after successful treatment of the underlying cause are uncommon and noteworthy. Herein, we present a case of a patient with perihilar cholangiocarcinoma (pCCA) and ITP who achieved drug-free remission of ITP following tumor resection. A 76-year-old man presented with pCCA complicated by ITP. Prednisolone treatment successfully managed his thrombocytopenia, allowing for a left hepatopancreatoduodenectomy. ITP relapse did not occur after discontinuation of prednisolone postoperatively. This case suggests that surgical resection of the underlying malignancy may induce remission of secondary ITP associated with pCCA. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Tranexamic acid and blood loss in pancreaticoduodenectomy: TAC-PD randomized clinical trial

Author

Ishii, Kenta, Yokoyama, Yukihiro, Yonekawa, Yoshihiko, Hayashi, Daisuke, Kinoshita, Fumie, Kuwatsuka, Yachiyo, Okuno, Masataka, Natsume, Seiji, Minami, Takayuki, Sugawara, Gen, Seita, Kazuaki, Sato, Fumiya, Aoba, Taro, Shimizu, Yasuhiro, Kurumiya, Yasuhiro, Maeda, Atsuyuki, Yamaguchi, Ryuzo, Hiramatsu, Kazuhiro, Ebata, Tomoki, Ishii, Kenta, Yokoyama, Yukihiro, Yonekawa, Yoshihiko, Hayashi, Daisuke, Kinoshita, Fumie, Kuwatsuka, Yachiyo, Okuno, Masataka, Natsume, Seiji, Minami, Takayuki, Sugawara, Gen, Seita, Kazuaki, Sato, Fumiya, Aoba, Taro, Shimizu, Yasuhiro, Kurumiya, Yasuhiro, Maeda, Atsuyuki, Yamaguchi, Ryuzo, Hiramatsu, Kazuhiro, and Ebata, Tomoki

Abstract

Background: Tranexamic acid (TXA) may reduce intraoperative blood loss, but it has not been investigated in pancreaticoduodenectomy (PD). Methods: A pragmatic, multicentre, randomized, blinded, placebo-controlled trial was conducted. Adult patients undergoing planned PD for biliary, duodenal, or pancreatic diseases were randomly assigned to TXA or placebo groups. Patients in the TXA group were administered 1 g TXA before incision, followed by a maintenance infusion of 125 mg/h TXA. Patients in the placebo group were administered the same volume of saline as those in the placebo group. The primary outcome was blood loss during PD. The secondary outcomes included perioperative blood transfusions, operating time, morbidity, and mortality. Results: Between September 2019 and May 2021, 218 patients were randomly assigned and underwent surgery (108 in the TXA group and 110 in the placebo group). Mean intraoperative blood loss was 659 ml in the TXA group and 701 ml in the placebo group (mean difference −42 ml, 95 per cent c.i. −191 to 106). Of the 218 patients, 202 received the intervention and underwent PD, and the mean blood loss during PD was 667 ml in the TXA group and 744 ml in the placebo group (mean difference −77 ml, 95 per cent c.i. −226 to 72). The secondary outcomes were comparable between the two groups. Conclusion: Perioperative TXA use did not reduce blood loss during PD.

Published
2024

10. Laparoscopic versus open pancreaticoduodenectomy for ampullary cancer: A retrospective study.

Author

Sakuma, Masayoshi, Maeda, Atsuyuki, Takayama, Yuichi, Takahashi, Takamasa, Aoyama, Hiroki, Takahashi, Daigoro, and Hosoi, Takahiro

Subjects
*PANCREATICODUODENECTOMY, *LAPAROSCOPIC surgery, *LYMPHATIC metastasis, *OVERALL survival, *TUMOR classification, BILIARY tract cancer
Abstract

Introduction: Studies comparing laparoscopic pancreaticoduodenectomy (LPD) with open pancreaticoduodenectomy (OPD) for ampullary carcinoma (AC) are limited. This study aimed to compare short‐ and long‐term outcomes between LPD and OPD for AC. Methods: This study included patients with AC who underwent pancreaticoduodenectomy (PD) with curative intention at Ogaki Municipal Hospital from April 2008 to March 2023. Results: Fifty‐five patients underwent LPD (n = 26) or OPD (n = 29). There were no significant differences in the demographics between the two groups. The LPD group had a significantly longer operative time (268 vs. 225 min), less blood loss (125 vs. 450 mL), and shorter postoperative hospital stay (18 vs. 23 days) than the OPD group. There was no significant difference in the morbidity ratio. Fewer lymph nodes were harvested in the LPD group than OPD group (9.5 vs. 16.0), but there were no significant differences in lymph node metastasis or pathological stages. There were no significant differences in overall survival (OS) or recurrence‐free survival (RFS). The 3‐ and 5‐year OS rates in the LPD group and the OPD group were 63.0% and 54%, 64.8%, and 61.2%, respectively. The 3‐ and 5‐year RFS rates were 57.4% and 57.4%, 58.1%, and 54.4%, respectively. Conclusions: LPD for AC had short‐ and long‐term outcomes comparable with those of OPD. LPD could be considered the standard treatments for AC because of less blood loss and a shorter hospital stay. [ABSTRACT FROM AUTHOR]

Published
2024
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16. A randomised-controlled trial of 1-year adjuvant chemotherapy with oral tegafur–uracil versus surgery alone in stage II colon cancer: SACURA trial

Author

Matsuda, Chu, Ishiguro, Megumi, Teramukai, Satoshi, Kajiwara, Yoshiki, Fujii, Shoichi, Kinugasa, Yusuke, Nakamoto, Yoshihiko, Kotake, Masanori, Sakamoto, Yoshiyuki, Kurachi, Kiyotaka, Maeda, Atsuyuki, Komori, Koji, Tomita, Naohiro, Shimada, Yasuhiro, Takahashi, Keiichi, Kotake, Kenjiro, Watanabe, Masahiko, Mochizuki, Hidetaka, Nakagawa, Yoko, and Sugihara, Kenichi

Published
2018
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17. Updated 5-year survival and exploratory T x N subset analyses of ACTS-CC trial: a randomised controlled trial of S-1 versus tegafur-uracil/leucovorin as adjuvant chemotherapy for stage III colon cancer

Author

Kusumoto, Tetsuya, Ishiguro, Megumi, Nakatani, Eiji, Yoshida, Motoki, Inoue, Tsukasa, Nakamoto, Yoshihiko, Shiomi, Akio, Takagane, Akinori, Sunami, Eiji, Shinozaki, Hiroharu, Takii, Yasumasa, Maeda, Atsuyuki, Ojima, Hitoshi, Hashida, Hiroki, Mukaiya, Mitsuhiro, Yokoyama, Tadashi, Nakamura, Masato, Munemoto, Yoshinori, and Sugihara, Kenichi

Published
2018
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18. Optimal Criteria for G3 (Poorly Differentiated) Stage II Colon Cancer: Prospective Validation in a Randomized Controlled Study (SACURA Trial)

Author

Ueno, Hideki, Ishiguro, Megumi, Nakatani, Eiji, Ishikawa, Toshiaki, Uetake, Hiroyuki, Matsui, Shigeyuki, Teramukai, Satoshi, Murotani, Kenta, Ajioka, Yoichi, Shimazaki, Hideyuki, Maeda, Atsuyuki, Takuma, Kunio, Yoshida, Takefumi, Kambara, Takeshi, Matsuda, Keiji, Takagane, Akinori, Tomita, Naohiro, and Sugihara, Kenichi

Published
2020
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19. Phase III randomised trial comparing 6 vs. 12-month of capecitabine as adjuvant chemotherapy for patients with stage III colon cancer: final results of the JFMC37-0801 study

Author

Tomita, Naohiro, Kunieda, Katsuyuki, Maeda, Atsuyuki, Hamada, Chikuma, Yamanaka, Takeharu, Sato, Toshihiko, Yoshida, Kazuhiro, Boku, Narikazu, Nezu, Riichiro, Yamaguchi, Shigeki, Mishima, Hideyuki, Sadahiro, Sotaro, Muro, Kei, Ishiguro, Megumi, Sakamoto, Junichi, Saji, Shigetoyo, and Maehara, Yoshihiko

Published
2019
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23. LPD after RHC for ascending colon cancer

Author

Ohya, Hayato, Maeda, Atsuyuki, Takayama, Yuichi, Takahashi, Takamasa, Aoyama, Hiroki, Hosoi, Takahiro, Seita, Kazuaki, and Kaneoka, Yuji

Subjects
ampulla of Vater, laparoscopy, neoplasms, General Medicine, pancreaticoduodenectomy, colectomy, General Biochemistry, Genetics and Molecular Biology
Abstract

Laparoscopic pancreaticoduodenectomy (LPD) has been widely adopted in institutions with sufficiently skilled practitioners. This technique requires attentive dissection around the superior mesenteric vein (SMV) and artery. Dissection around the SMV and Henle’s trunk is one of the key aspects of right hemicolectomy (RHC) ; adhesions and fibrosis around these vessels may impede LPD in patients with a history of RHC. We encountered three cases of periampullary tumors in patients with a history of RHC who were successfully treated with LPD. Cases 1, 2, and 3 were of 60-, 73-, and 74-year-old men with periampullary tumors. The operative durations in cases 1, 2, and 3 were 316, 267, and 265 min, respectively. The estimated blood loss volumes in cases 1, 2, and 3 were 20, 50, and 720 mL, respectively. The postoperative hospital stay durations in cases 1, 2, and 3 were of 13, 35, and 15 days, respectively. In conclusion, LPD following RHC may be safely completed with laparoscopy.

Published
2023

33. Laparoscopic pancreaticoduodenectomy in patients with a history of right hemicolectomy : A report of three cases

Author

Ohya, Hayato, Maeda, Atsuyuki, Takayama, Yuichi, Takahashi, Takamasa, Aoyama, Hiroki, Hosoi, Takahiro, Seita, Kazuaki, Kaneoka, Yuji, Ohya, Hayato, Maeda, Atsuyuki, Takayama, Yuichi, Takahashi, Takamasa, Aoyama, Hiroki, Hosoi, Takahiro, Seita, Kazuaki, and Kaneoka, Yuji

Abstract

Laparoscopic pancreaticoduodenectomy (LPD) has been widely adopted in institutions with sufficiently skilled practitioners. This technique requires attentive dissection around the superior mesenteric vein (SMV) and artery. Dissection around the SMV and Henle’s trunk is one of the key aspects of right hemicolectomy (RHC) ; adhesions and fibrosis around these vessels may impede LPD in patients with a history of RHC. We encountered three cases of periampullary tumors in patients with a history of RHC who were successfully treated with LPD. Cases 1, 2, and 3 were of 60-, 73-, and 74-year-old men with periampullary tumors. The operative durations in cases 1, 2, and 3 were 316, 267, and 265 min, respectively. The estimated blood loss volumes in cases 1, 2, and 3 were 20, 50, and 720 mL, respectively. The postoperative hospital stay durations in cases 1, 2, and 3 were of 13, 35, and 15 days, respectively. In conclusion, LPD following RHC may be safely completed with laparoscopy.

Published
2023

35. The preoperative prognostic nutrition index is a prognostic indicator for survival in elderly gastric cancer patients after gastrectomy: a propensity score-matched analysis

Author

Takahashi, Takamasa, Kaneoka, Yuji, Maeda, Atsuyuki, Takayama, Yuichi, Fukami, Yasuyuki, and Uji, Masahito

Abstract

The incidence of gastric cancer (GC) in elderly patients has increased, and it is important for predicting prognosis for those patients. The prognostic nutrition index (PNI), which is a indicator of nutrition status, is useful for the assessment of prognosis for various cancers. The aim of this propensity score-matched study was to investigate the significance of the PNI for predicting the long-term outcome of GC patients who were 80 years old or older. This study included 127 elderly GC patients who underwent gastrectomy. The optimal cutoff value for the PNI score was defined using a receiver operating curve analysis. For the analysis of long-term outcomes, 86 patients were selected by propensity score matching. The long-term outcomes and prognostic factors after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. The cutoff value for the PNI score was set at 46.5. Among the 86 patients, 30 patients died due to noncancer-related disease. The 5-year cancer-specific survival rates of patients with a PNI score < 46.5 and PNI score ≥ 46.5 were 73.5% and 84.6%, respectively (P= 0.832). The 5-year overall survival rates of patients with a PNI score < 46.5 and PNI score ≥ 46.5 were 38.2% and 49.3%, respectively (P= 0.004). According to the multivariate analysis, the PNI score (HR 2.15; 95% CI 1.37–3.94; P= 0.013) and pathological stage (HR 2.16; 95% CI 1.02–4.61; P = 0.045) were independent prognostic factors. The PNI is a promising assessment tool for predicting OS in elderly GC patients.

Published
2024
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36. Feasibility of laparoscopic cholecystectomy for acute cholecystitis beyond 72 h of symptom onset

Author

Onoe, Shunsuke, Kaneoka, Yuji, Maeda, Atsuyuki, Takayama, Yuichi, and Fukami, Yasuyuki

Abstract

Laparoscopic cholecystectomy (LC) performed for acute cholecystitis (AC) is usually advised within 72 h of symptom onset. This study aimed to evaluate the outcomes of LC beyond 72 h after presentation. A total of 94 patients underwent LC for AC between January 2012 and February 2015: 70 underwent early LC (ELC, operation within 72 h of symptom onset) and 24 underwent late LC (LLC, beyond 72 h). The outcomes of the groups were compared. Preoperative C-reactive protein (CRP) levels were significantly higher in the LLC group [9.81 (0.41–38.00) mg/dL] compared to the ELC group [1.05 (0.05–24.20) mg/dL; P= 0.001]. Between-group differences were also observed in operative time, blood loss, and postoperative hospital stay [ELC, 76 (37–141) minutes, 10 (1–650) ml and 4 (3–12) days; LLC, 89 (48–234) minutes, 40 (1–3500) ml, and 6 (4–35) days; P=0.048, 0.007, and <0.001]. The conversion rate of laparoscopic to open cholecystectomy was significantly higher in the LLC group (17%) than the ELC group (1%; P=0.014). Univariate analysis identified LLC, CRP ≥10 mg/dL, and failure to create a critical view of safety as risk factors for conversion to open surgery, while operative time ≥90 min and blood loss ≥100 ml were risk factors for complications. LLC is associated with longer operation times, greater blood loss, longer hospital stays and higher conversion rates than ELC. Using a high CRP value as a criterion for selecting a surgical procedure, whether open or laparoscopic, would decrease the conversion rate of LLC, which may reduce operation times and blood loss.

Published
2024
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37. Salvage anastomosis for postoperative chronic pancreatic fistula

Author

Kawakatsu, Shoji, Kaneoka, Yuji, Maeda, Atsuyuki, and Fukami, Yasuyuki

Abstract

Salvage anastomosis for postoperative chronic pancreatic fistula is challenging, and its safety and surgical outcomes remain unclear. Four patients with postoperative chronic pancreatic fistulas who underwent surgical interventions in our institute were retrospectively reviewed. A re-pancreatojejunostomy was performed in two patients with a disruption of the pancreatojejunostomy and a dilated main pancreatic duct of the remnant pancreas. A fistulojejunostomy was performed in the remaining two patients with a duct disruption after necrosectomy for necrotic severe acute pancreatitis and non-dilated main pancreatic duct. The median duration from the onset of the pancreatic fistula to the surgical intervention was 4.5 months (range 4–6 months). The median operation time was 151 min (range 38–257 min) and the median blood loss was 200 mL (range 5–350 mL). According to the Clavien–Dindo classification, one patient had grade 0, two patients had grade I, and one patient had grade II (wound infections). The median length of hospital stay was 22 days (range 21–28 days). There were no recurrences of pancreatic fistulas. Salvage anastomosis according to the simple radiologic classification for postoperative chronic pancreatic fistulas is a safe and effective procedure.

Published
2024
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