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Department of Hepatobiliary and Pancreatic Surgery

Masaru Konishi, Shinichiro Takahashi, Naoto Gotohda, Yuichiro Kato, Kazuhiko Kitaguchi, Yasunori Nishida, Yusuke Nakayama

Introduction

The recent development of various diagnostic techniques has led to the detection of an increasing number of early-stage and borderline malignancies, and for such patients, a limited resection preserving organ function is indicated. However, some diseases, such as invasive ductal pancreatic cancer, advanced gallbladder cancer, and hilar cholangiocarcinoma, remain a difficult challenge for surgeons and are still associated with dismal long-term prognoses. Recently, chemotherapy for hepatobiliary and pancreatic malignancies has been developed. In line with this development, several studies on adjuvant hemotherapy for malignancies with dismal prognoses have been conducted.

With the refinements in laparoscopic instruments and advances in surgical experience, laparoscopic surgery is a safe alternative for selected patients with hepatobiliary pancreatic neoplasms, and has fulfilled its indications. In our division, laparoscopic hepatectomies have been performed since 2002, and laparoscopic distal pancreatectomies since 2011.

Routine activities

Our group is composed of four attending surgeons, three chief residents, and four residents. The outpatient clinic is open five days a week. Staff meetings are held three times a week during which treatment strategies from medical and surgical points of view are discussed. A case conference on imaging diagnosis is conducted every Tuesday in cooperation with radiologists and medical oncologists, and a pathology conference is held every month with pathologists. In 2015, 253 patients with hepatobiliary and pancreatic diseases underwent surgical treatment including 51 laparoscopic hepatectomies and nine laparoscopic distal pancreatectomies.

Research activities

Sarcopenia is a newly identified marker of frailty. We assess whether preoperative sarcopenia has an impact on clinically relevant postoperative pancreatic fistula (POPF) formation. A total of 266 consecutive patients who underwent a pancreaticoduodenectomy (PD) between from 2010 and 2014 were enrolled in this retrospective study. Skeletal muscle mass was measured using preoperative computed tomography images. This study concluded that preoperative sarcopenia was identified as a strong and independent risk factor for clinically relevant POPF formation after PD.

Clinical trials

  • JASPAC04 is a randomized phase II study on neoadjuvant chemotherapy using combination therapy with gemcitabine and S-1 vs. S-1 and concurrent radiotherapy in patients with resected pancreatic cancer. Recruitment started in 2014.
  • JASPAC05 is a phase II study on neoadjuvant S-1 and concurrent radiotherapy for patients with borderline resectable pancreatic cancer. Recruitment started in 2012.
  • JCOG1202 (ASCOT) is a phase III study to compare S-1 with surgery alone as adjuvant chemotherapy for patients with curatively resected biliary tract cancer including Intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, gallbladder cancer and ampullary cancer. Recruitment started in 2013.
  • JCOG0605 is a randomized phase III trial to compare FOLFOX with surgery alone as adjuvant chemotherapy for patients with curatively resected liver metastasis from colorectal cancer. Recruitment is on-going.

Education

‘Board certified expert surgeons’ is a high level of skill in the field of hepato-biliary-pancreatic surgery. To be qualified as a board certified surgeon, surgeons are required to perform a prescribed number of operations under the guidance of a board certified instructor. The residents of our department are training to get their certifications by the end of the chief resident course.

  • Table 1. Number of new patients Table 2. Type of procedure
  • Table 3. Survival rates

List of papers published in 2015

Journal

  1. Sugimoto M, Takahashi S, Kobayashi T, Kojima M, Gotohda N, Satake M, Ochiai A, Konishi M. Pancreatic perfusion data and post-pancreaticoduodenectomy outcomes. J Surg Res, 194:441-449, 2015
  2. Kato Y, Takahashi S, Gotohda N, Konishi M. Risk factors for malignancy in branched-type intraductal papillary mucinous neoplasms of the pancreas during the follow-up period. World J Surg, 39:244-250, 2015
  3. Kitaguchi K, Kato Y, Kojima M, Okubo S, Takahashi D, Okada R, Nakayama Y, Nishida Y, Gotohda N, Takahashi S, Konishi M. A resected case of intraductal tubulopapillary neoplasm of the pancreas: report of a case. Int Surg, 100:281-286, 2015
  4. Kitaguchi K, Gotohda N, Yamamoto H, Kato Y, Takahashi S, Konishi M, Hayashi R. Intraoperative circulatory management using the FloTrac™ system in laparoscopic liver resection. Asian J Endosc Surg, 8:164-170, 2015
  5. Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T. Longterm and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci, 22:711-720, 2015
  6. Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T. Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci, 22:721-727, 2015
  7. Okano K, Hirao T, Unno M, Fujii T, Yoshitomi H, Suzuki S, Satoi S, Takahashi S, Kainuma O, Suzuki Y. Postoperative infectious complications after pancreatic resection. Br J Surg, 102:1551-1560, 2015
  8. Gotohda N, Yamanaka T, Saiura A, Uesaka K, Hashimoto M, Konishi M, Shimada K. Impact of energy devices during liver parenchymal transection: a multicenter randomized controlled trial. World J Surg, 39:1543-1549, 2015