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Article ; Online: Jejunal vein tributary analysis and intraoperative clamp testing in avoiding congestion after pancreatoduodenectomy.

Oyama, Hideyuki / Takahashi, Yuki / Minegishi, Yuzo / Nakamura, Akihiro / Tanaka, Kuniya

2024 Volume 409, Issue 1, Page(s) 79

Abstract: Purpose: Although venous drainage of the jejunal loop may be maintained after sacrifice of jejunal vein tributaries during pancreatoduodenectomy, risk of severe jejunal mesenteric congestion following division of these tributaries can be difficult to ... ...

Abstract	Purpose: Although venous drainage of the jejunal loop may be maintained after sacrifice of jejunal vein tributaries during pancreatoduodenectomy, risk of severe jejunal mesenteric congestion following division of these tributaries can be difficult to predict. This study considered how best to predict safety of jejunal vein tributary dissection. Methods: Preoperative imaging findings and results of intraoperative clamp tests of jejunal vein tributaries during pancreatoduodenectomy were analyzed in 121 patients with hepatobiliary and pancreatic disease to determine whether this information adequately predicted safety of resecting superior mesenteric vein branches. Results: Jejunal vein tributaries caudal to the inferior border of the pancreatic uncinate process tended to be fewer when tributaries cranial to this landmark were more numerous. Tributaries cranial to the border drained a relatively wide expanse of jejunal artery territory in the jejunal mesentery. The territory of jejunal tributaries cranial to the inferior border of the pancreas did not vary according to course of the first jejunal vein branch relative to the superior mesenteric artery. One patient among 30 (3%) who underwent intraoperative clamp tests of tributaries cranial to the border showed severe congestion in relation to a venous tributary coursing ventrally to the superior mesenteric artery. Conclusion: Jejunal venous tributaries drained an extensive portion of jejunal arterial territory, but tributaries located cranially to the inferior border of the pancreas could be sacrificed without congestion in nearly all patients. Intraoperative clamp testing of these tributaries can identify patients whose jejunal veins must be preserved to avoid congestion.
MeSH term(s)	Humans ; Pancreaticoduodenectomy/adverse effects ; Mesenteric Veins/surgery ; Pancreas/surgery ; Portal Vein/surgery ; Mesenteric Artery, Superior/surgery
Language	English
Publishing date	2024-03-01
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-024-03276-1
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Article: Resection versus transplantation for hepatocellular carcinoma exceeding Milan criteria within increasing donor shortage.

Tanaka, Kuniya

Hepatobiliary surgery and nutrition

2017 Volume 6, Issue 4, Page(s) 280–283

Language	English
Publishing date	2017-08-10
Publishing country	China (Republic : 1949- )
Document type	Editorial ; Comment
ZDB-ID	2812398-0
ISSN	2304-389X ; 2304-3881
ISSN (online)	2304-389X
ISSN	2304-3881
DOI	10.21037/hbsn.2017.03.14
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Article ; Online: Modified ALPPS procedures: more safety through less invasive surgery.

Tanaka, Kuniya

Langenbeck's archives of surgery

2017 Volume 402, Issue 4, Page(s) 563–574

Abstract: Purpose: Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, increased morbidity and mortality remain serious problems. Many modified procedures have been ... ...

Abstract	Purpose: Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been advocated for treating advanced liver tumors, increased morbidity and mortality remain serious problems. Many modified procedures have been devised to improve patient safety, but some confusion persists as to benefits and risks. Methods: Modifications to ALPPS as originally reported were reviewed to clarify their contributions to safety and their clinical relevance. Results: A variety of modifications are explained and considered. Modifications mainly aim to reduce adhesions, prevent tumor spread, avoid devascularization during liver splitting, and reduce surgical severity. Such changes aiming to increase safety and reduce invasiveness are needed to avoid high morbidity and mortality rates with this innovative procedure. However, these modified procedures still require more meaningful statistical comparisons of outcome. Conclusions: Prospective controlled studies are needed to confirm which modified procedures should be adopted in a standardized manner as an alternative to the original ALPPS. Further, we need to further explore mechanisms of liver regeneration, functional recovery, histopathologic changes of hepatocytes, and blood distribution during ALPPS simultaneously to developing and evaluating modifications of the procedure.
Language	English
Publishing date	2017-06
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-017-1588-3
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Article: Zinc supports liver regeneration after partial resection.

Takahashi, Yuki / Oyama, Hideyuki / Nakamura, Akihiro / Minegishi, Yuzo / Tanaka, Kuniya

Turkish journal of surgery

2023 Volume 39, Issue 4, Page(s) 344–353

Abstract: Objectives: Safe removal of extensive liver tumor burdens depends on regeneration of the remnant liver, which requires a large amount of zinc over a short period of time. We studied how zinc influences regeneration.: Material and methods: We measured ...

Abstract	Objectives: Safe removal of extensive liver tumor burdens depends on regeneration of the remnant liver, which requires a large amount of zinc over a short period of time. We studied how zinc influences regeneration. Material and methods: We measured perioperative serum zinc concentrations after liver cancer diagnosis in 77 patients undergoing hepatectomy to determine how serum zinc affected short-term outcomes and remnant liver regeneration. Results: Serum zinc concentration at diagnosis showed no correlation with inflammatory or nutritional parameters except for a weak correlation with the lymphocyte-to-monocyte ratio. When patients were divided into a high pre-hepatectomy zinc group (≥75 µg/dL, n= 39, H group) and a low zinc group (<75 µg/dL, n= 38, L group), short-term results such as mortality (p> 0.999), morbidity (p= 0.490), and hospital stay (p= 0.591) did not differ between groups. However, hypertrophy in the future liver remnant after hepatectomy in the H group (127.7 ± 24.7% of original volume) was greater than in the L group (115.9 ± 16.7%, p= 0.024). In a subgroup of patients with extended hepatectomy, hypertrophy was 130.9 ± 26.8% in the H group vs. 116.4 ± 16.5% in the L group (p= 0.037). Conclusion: Greater serum zinc at diagnosis was associated with greater hypertrophy in the future liver remnant.
Language	English
Publishing date	2023-12-29
Publishing country	Turkey
Document type	Journal Article
ISSN	2564-6850
ISSN	2564-6850
DOI	10.47717/turkjsurg.2023.6260
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Article ; Online: How to do repeat hepatectomy for remnant liver recurrence using diaphragmatic incision for right liver mobilization.

Nakamura, Akihiro / Togo, Shinji / Tanaka, Kuniya

ANZ journal of surgery

2022 Volume 93, Issue 1-2, Page(s) 342–343

Abstract: In addition to difficulties with parenchymal resection reflecting anatomic disorientation arising from rotation of the liver remnant that accompanies regeneration, repeat resections typically involve difficult and protracted lysis of adhesions. We ... ...

Abstract	In addition to difficulties with parenchymal resection reflecting anatomic disorientation arising from rotation of the liver remnant that accompanies regeneration, repeat resections typically involve difficult and protracted lysis of adhesions. We describe our technique for facilitating right liver mobilization even in the presence of severe adhesions. Lysis of dense retroperitoneal adhesions posterior to the right liver can be performed safely by incising the diaphragm to facilitate manipulations to mobilize the right liver.
MeSH term(s)	Humans ; Hepatectomy/methods ; Diaphragm/surgery ; Liver Neoplasms/surgery ; Surgical Wound/surgery
Language	English
Publishing date	2022-10-27
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18128
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Article: [Long-Term Follow-Up of Patients Who Received Chemotherapy with S-1 and Docetaxel after Relatively Curative Surgery for Advanced Gastric Cancer Including Non-Curative Factors].

Nemoto, Hiroshi / Tanaka, Kuniya

Gan to kagaku ryoho. Cancer & chemotherapy

2020 Volume 47, Issue 11, Page(s) 1583–1587

Abstract: There is no known recommended chemotherapy after radical surgery for gastric cancer for patients who have non-curative disease. We defined positive peritoneal cytology(CY1), resection margin involvement, pathological peritoneal metastasis (pP1)and pN3b ... ...

Abstract	There is no known recommended chemotherapy after radical surgery for gastric cancer for patients who have non-curative disease. We defined positive peritoneal cytology(CY1), resection margin involvement, pathological peritoneal metastasis (pP1)and pN3b as clinical non-curative factors and administered adjuvant chemotherapy with S-1 and docetaxel(DOC) (80 mg/m2 day 1-14 of S-1 for 2 weeks with 40 mg/m2 of DOC on day 1, every 3 weeks). This regimen lasted for 1 year; however, if chemotherapy could be continued after this period, we used S-1 only. We reported the results of 11 cases who received this treatment. Patients: There were 6 total gastrectomies and 5 distal gastrectomies. Clinical non-curative factors were 5 pP1, 5 pN3b, 3 CY1 and 1 resection margin involvement. Results: At the end of adjuvant therapy there were 6 completions, 4 recurrences, and 1 patient with side effects. The main adverse event of Grade 3 or greater was neutropenia (46%). The recurrence rate was 63.6%. Types of relapse included 6 disseminations and 1 patient with lymph node involvement. One-, 3-, and 5-year survival rates were 100%, 72.7% and 72.7%, respectively, and the RFS was 64.0 months. Conclusion: S-1 and DOC adjuvant chemotherapy produced good results and may serve as a therapy of choice for patients with advanced gastric cancer with non-curative factors after a relatively curative resection.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemotherapy, Adjuvant ; Docetaxel/therapeutic use ; Follow-Up Studies ; Gastrectomy ; Humans ; Neoplasm Recurrence, Local ; Patients ; Stomach Neoplasms/drug therapy ; Stomach Neoplasms/surgery
Chemical Substances	Docetaxel (15H5577CQD)
Language	Japanese
Publishing date	2020-12-02
Publishing country	Japan
Document type	Journal Article
ZDB-ID	604842-0
ISSN	0385-0684
ISSN	0385-0684
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Article ; Online: Failure of peritoneal lavage to prevent operative site infection and peritoneal tumor recurrence in pancreatic surgery.

Ishihara, Mai / Nakamura, Akihiro / Takahashi, Yuki / Minegishi, Yuzo / Matsuo, Kenichi / Tanaka, Kuniya

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 333

Abstract: Background: Although intraoperative peritoneal lavage often is performed routinely with the aim of reducing peritoneal contamination, evidence of lavage benefit in elective pancreatic surgery is limited.: Methods: We retrospectively classified ... ...

Abstract	Background: Although intraoperative peritoneal lavage often is performed routinely with the aim of reducing peritoneal contamination, evidence of lavage benefit in elective pancreatic surgery is limited. Methods: We retrospectively classified patients who had undergone pancreatic surgery to groups given or not given peritoneal lavage, then comparing clinical results. This saline lavage was performed at the end of the operation. The primary endpoint was rate of surgical site infection. Frequency of peritoneal recurrence also was evaluated. Results: Among all 104 patients in the study, incidence of infectious complications in the lavage group (n = 65) was significantly higher than in the non-lavage group (n = 39; 35% vs. 15%, P = 0.041), while incidences of postoperative complications overall and surgical site infection did not differ between lavage (80% and 26%) and non-lavage groups (67% and 10%, P = 0.162 and 0.076, respectively). Among 63 patients undergoing pancratoduodenectomy, frequencies of positive bacterial cultures of drainage fluids on postoperative days 1 and 3 were greater in the non-lavage group (P < 0.001 and P = 0.012), but surgical site infection was significantly more frequent in the lavage group (P = 0.043). Among patients with pancreatic and biliary cancers, lavage did not affect frequency of peritoneal recurrence. Conclusion: Intraoperative lavage did not prevent surgical site infection or peritoneal recurrence of pancreatobiliary cancer.
MeSH term(s)	Humans ; Peritoneal Neoplasms/surgery ; Peritoneal Lavage ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Retrospective Studies ; Neoplasm Recurrence, Local/epidemiology
Language	English
Publishing date	2023-08-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-03080-3
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Article ; Online: Prognostic implications of histologic growth patterns and tumor-infiltrating macrophages in colorectal liver metastases.

Takahashi, Yuki / Matsuo, Kenichi / Shiozawa, Toshimitsu / Suzuki, Kaori / Shimizu, Hiroaki / Tanaka, Kuniya

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 6

Abstract: Purpose: Histopathologic patterns at the invasion fronts of tumors predict metastatic potential and prognosis in several cancers. We examined whether such patterns at the interface between colorectal liver metastases and hepatic parenchyma have similar ... ...

Abstract	Purpose: Histopathologic patterns at the invasion fronts of tumors predict metastatic potential and prognosis in several cancers. We examined whether such patterns at the interface between colorectal liver metastases and hepatic parenchyma have similar prognostic value. Methods: Microscopic growth patterns at edges of metastases including desmoplasia, pushing borders, and replacement of hepatocytes were retrospectively analyzed with respect to surgical outcomes in 142 patients who underwent hepatectomy for colorectal metastases. Results: Patterns included desmoplasia in 58 patients (41%), hepatocyte replacement in 41 (29%), and pushing borders in 43 (30%). Maximum metastasis diameter and serum carcinoembryonic antigen concentration in patients showing desmoplastic tumor growth were lower than those in others (P < 0.05 and P < 0.01). Disease-free survival and overall survival were better in patients showing desmoplastic growth, while a non-desmoplastic tumor growth pattern showed a negative influence. More cluster of differentiation (CD) 68-positive M1 macrophages and fewer CD206-positive M2 macrophages were demonstrated at interfaces of tumors with hepatic parenchyma when desmoplasia was present, although markers for proliferative activity (MIB1 index) and metastatic potential (E-cadherin expression) appeared uninfluenced by desmoplasia. Conclusion: Better long-term results were associated with metastatic tumors showing desmoplastic growth patterns at invasion fronts, which may reflect local immune state in a prognostically useful manner.
MeSH term(s)	Humans ; Prognosis ; Colorectal Neoplasms/pathology ; Retrospective Studies ; Liver Neoplasms/pathology ; Hepatectomy ; Macrophages/pathology
Language	English
Publishing date	2023-01-04
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-022-02741-z
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Article ; Online: Percutaneous transhepatic gallbladder drainage versus endoscopic gallbladder stenting for managing acute cholecystitis until laparoscopic cholecystectomy.

Tanaka, Kuniya / Takano, Yuichi / Kigawa, Gaku / Shiozawa, Toshimitsu / Takahashi, Yuki / Nagahama, Masatsugu

Asian journal of endoscopic surgery

2023 Volume 17, Issue 1, Page(s) e13253

Abstract: Introduction: Gallbladder drainage by methods such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic gallbladder stenting (EGBS) is important in the early management of moderate to severe acute cholecystitis.: Methods: In ... ...

Abstract	Introduction: Gallbladder drainage by methods such as percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic gallbladder stenting (EGBS) is important in the early management of moderate to severe acute cholecystitis. Methods: In patients undergoing laparoscopic cholecystectomy (LC) for acute cholecystitis after a month or more of gallbladder drainage, the clinical course was compared between patients initially treated with PTGBD or EGBS. Results: Among 331 patients undergoing LC for cholecystitis between 2018 and 2022, 43 first underwent 1 or more months of gallbladder drainage. The median interval between drainage initiation and LC was 89 days (range, 28-261) among 34 patients with PTGBD and 70 days (range, 62-188) among nine with EGBS (p = 0.644). During this waiting period, PTGBD was clamped in six patients and removed in five. Cholecystitis relapsed in three PTGBD patients (9%) and four EGBS patients (44%; p = 0.026). Relapses were managed with medications. Cholecystectomy duration (p = 0.022), intraoperative blood loss (p = 0.026), frequency of abdominal drain insertion (p = 0.023), and resort to bailout surgery such as fundus-first approaches (p = 0.030) were significantly greater in patients with EGBS. Postoperative complications were somewhat likelier (p = 0.095) and postoperative hospital stays were longer (p = 0.007) in the EGBS group. Conclusion: Among patients whose LC was performed 1 or more months after initiation of drainage, daily living during the waiting period associated with drainage was well supported by EGBS, but LC and the postoperative course were more complicated than in PTGBD patients.
MeSH term(s)	Humans ; Gallbladder/surgery ; Cholecystectomy, Laparoscopic/methods ; Cholecystitis, Acute/surgery ; Cholecystitis/surgery ; Drainage/methods ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2023-10-14
Publishing country	Japan
Document type	Journal Article
ZDB-ID	2503256-2
ISSN	1758-5910 ; 1758-5902
ISSN (online)	1758-5910
ISSN	1758-5902
DOI	10.1111/ases.13253
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Article ; Online: Full-Circumference Prosthetic Grafts for Replacing a Retrohepatic Inferior Vena Cava Segment During Hepatectomy for Tumor.

Suzuki, Kaori / Takahashi, Yuki / Shiozawa, Toshimitsu / Matsuo, Kenichi / Shimizu, Hiroaki / Tanaka, Kuniya

The American surgeon

2023 Volume 90, Issue 4, Page(s) 607–615

Abstract: Background: Although hepatectomy including inferior vena cava (IVC) resection is becoming more common, some details remain uncertain such as use of artificial materials to replace a tumor-involved, damaged, or narrowed retrohepatic IVC segment.: ... ...

Abstract	Background: Although hepatectomy including inferior vena cava (IVC) resection is becoming more common, some details remain uncertain such as use of artificial materials to replace a tumor-involved, damaged, or narrowed retrohepatic IVC segment. Methods: Surgical outcomes of 12 patients who underwent hepatectomy with IVC resection including reconstruction using synthetic tubular grafts were investigated to clarify safety and feasibility. Results: Operative time (median, 573 min; range, 268 to 774) and the blood loss (1076 mL; 155 to 2960) were acceptable. In-hospital mortality was 8% (1/12), and morbidity was 42% (5/12). Among the 12 patients, 2 were planned to undergo IVC reconstruction without an artificial graft. In one patient, prosthetic repair was adopted because of massive bleeding from the IVC wall during dissection of tumor from the IVC. In the other, severe stricture became evident during attempted direct closure of the partially resected IVC wall. Discussion: Ongoing experience has increased our acceptance of combined liver and IVC resection. We believe that segmental IVC resection and reconstruction with a prosthetic tubular graft could be chosen more frequently in managing liver tumors suspected to involve the IVC.
MeSH term(s)	Humans ; Hepatectomy ; Vena Cava, Inferior/surgery ; Veins ; Liver Neoplasms/surgery
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231204910
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