研究者業績

守瀬 善一

zenichi morise

基本情報

所属
藤田医科大学 医学部 外科学講座 主任教授
学位
医学博士(慶應義塾大学)

J-GLOBAL ID
201501002764761358
researchmap会員ID
B000247667

論文

 182
  • Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Yuko Chikaishi, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Tsunekazu Hanai, Zenichi Morise
    World journal of surgical oncology 22(1) 215-215 2024年8月22日  
    BACKGROUND: The da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms. METHODS: The present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection. RESULTS: The study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified. CONCLUSIONS: The introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection.
  • Kenichi Nakamura, Mitsuru Nakagawa, Mizuki Ariga, Takahiko Higashiguchi, Yuko Chikaishi, Kazuhiro Matsuo, Aki Nishijima, Tomoyoshi Endo, Kenji Kikuchi, Koji Morohara, Hidetoshi Katsuno, Yoshihiko Tachi, Ichiro Uyama, Koichi Suda, Zenichi Morise
    Surgical case reports 10(1) 189-189 2024年8月16日  
    BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) accounts for only 1-4% of all pancreatic exocrine cancers and has a particularly poor prognosis. The efficacy of chemotherapy for ASCP remains unknown because of the small number of cases, and few studies have evaluated conversion-intended chemotherapy. CASE PRESENTATION: A 76-year-old woman was referred to our hospital because of epigastric pain and nausea. A preoperative contrast-enhanced multidetector row computed tomography (MDCT) scan revealed a 17 × 17 mm low-density tumor with an ill-defined margin at the arterial phase in the pancreatic head. The tumor involved the common hepatic artery, left hepatic artery bifurcated from the common hepatic artery, and gastroduodenal artery, and was in contact with the portal vein. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed an uptake in the pancreatic head but no evidence of distant metastasis. The tumor was diagnosed as an adenocarcinoma of the pancreatic head and staged unresectable because the common and left hepatic arteries were involved. Hence, the patient underwent seven courses of conversion-intended chemotherapy using gemcitabine and nab-paclitaxel for pancreatic ductal adenocarcinoma over 7 months. After chemotherapy, the tumor shrank to 10 × 10 mm on contrast-enhanced MDCT. Consequently, the boundary between the tumor and major vessels of the common and left hepatic arteries and the portal vein became clear, and the involvement of the arteries with the tumor was evaluated to be released. The contact of the tumor to the portal vein also reduced to less than half the circumference of the portal vein. FDG-PET showed decreased accumulation in the tumor. Hence, the tumor was judged resectable, and pancreaticoduodenectomy was performed. The tumor and major blood vessels were easily dissected and R0 resection was achieved. The patient experienced no major complications and was discharged on postoperative day 28. The tumor was revealed as ASCP via pathological examination. The patient is alive and recurrence-free seven months after surgery. This is the first report of successful R0 resection for an initially unresectable ASCP following conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen. CONCLUSIONS: Conversion-intended chemotherapy using gemcitabine and nab-paclitaxel regimen may be effective for ASCP.
  • Takayuki Ochi, Hidetoshi Katsuno, Hiroyuki Kato, Shinya Takagi, Kenji Kikuchi, Kenichi Nakamura, Tomoyoshi Endo, Kazuhiro Matsuo, Hironobu Yasuoka, Akihiro Nishimura, Akihiko Horiguchi, Zenichi Morise
    World journal of surgical oncology 22(1) 85-85 2024年4月3日  
    BACKGROUND: This study aimed to investigate the effect of the use of new lithotomy stirrups-2 on the pressure dispersal on lower limbs, which may lead to the prevention of well-leg compartment syndrome (WLCS) and deep venous thrombosis (DVT), which are the most commonly associated adverse events with laparoscopic and robot-assisted rectal surgery. METHODS: A total of 30 healthy participants were included in this study. The pressure (mmHg) applied on various lower limb muscles when using conventional lithotomy stirrups-1 and new type stirrups-2 was recorded in various lithotomy positions; 1) neutral position, 2) Trendelenburg position (15°) with a 0° right inferior tilt, and 3) Trendelenburg position (15°) with a 10° right inferior tilt. Using a special sensor pad named Palm Q®, and the average values were compared between two types of stirrups. RESULTS: The use of new lithotomy stirrups-2 significantly reduced the pressure applied on the lower limb muscles in various lithotomy positions compared with the use of lithotomy stirrups-1. The most pressured lower limb muscle when using both lithotomy stirrups was the central soleus muscle, which is the most common site for the development of WLCS and DVT. In addition, when using the conventional lithotomy stirrups-1, the pressure was predominantly applied to the proximal soleus muscle; however, when using lithotomy stirrups-2, the pressure was shifted to the more distal soleus muscle. CONCLUSION: These results suggest that the new lithotomy stirrups-2 is useful in reducing the pressure load on leg muscles, especially on the proximal to central soleus, and may reduce the incidence of WLCS and DVT after rectal surgery performed in the lithotomy position. Further clinical studies are needed to determine whether the use of lithotomy stirrups-2 prevents these complications in various clinical settings.
  • 勝野 秀稔, 花井 恒一, 大塚 幸喜, 廣 純一郎, 升森 宏次, 小出 欣和, 松岡 宏, 鄭 栄哲, 諸原 浩二, 菊地 健司, 遠藤 智美, 須田 康一, 前田 耕太郎, 守瀬 善一
    日本外科学会定期学術集会抄録集 124回 SF-7 2024年4月  
  • Kenichi Nakamura, Takahiko Higashiguchi, Yuko Chikaishi, Kazuhiro Matsuo, Tomoyoshi Endo, Koji Morohara, Kenji Kikuchi, Susumu Shibasaki, Hidetoshi Katsuno, Ichiro Uyama, Koichi Suda, Zenichi Morise
    Surgical case reports 10(1) 31-31 2024年2月2日  
    BACKGROUND: Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION: A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS: Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.
  • Victor Lopez-Lopez, Zeniche Morise, Mariano Albadalejo-González, Concepción Gomez Gavara, Brian K.P. Goh, Ye Xin Koh, Sijberden Jasper Paul, Mohammed Abu Hilal, Kohei Mishima, Jaime Arthur Pirola Krürger, Paulo Herman, Alvaro Cerezuela, Roberto Brusadin, Takashi Kaizu, Juan Lujan, Fernando Rotellar, Kazuteru Monden, Mar Dalmau, Naoto Gotohda, Masashi Kudo, Akishige Kanazawa, Yutaro Kato, Hiroyuki Nitta, Satoshi Amano, Raffaele Dalla Valle, Mario Giuffrida, Masaki Ueno, Yuichiro Otsuka, Daisuke Asano, Minoru Tanabe, Osamu Itano, Takuya Minagawa, Dilmurodjon Eshmuminov, Irene Herrero, Pablo Ramírez, José A. Ruipérez-Valiente, Ricardo Robles-Campos, Go Wakabayashi
    Surgical Endoscopy 2024年  
    Background: Artificial intelligence (AI) is becoming more useful as a decision-making and outcomes predictor tool. We have developed AI models to predict surgical complexity and the postoperative course in laparoscopic liver surgery for segments 7 and 8. Methods: We included patients with lesions located in segments 7 and 8 operated by minimally invasive liver surgery from an international multi-institutional database. We have employed AI models to predict surgical complexity and postoperative outcomes. Furthermore, we have applied SHapley Additive exPlanations (SHAP) to make the AI models interpretable. Finally, we analyzed the surgeries not converted to open versus those converted to open. Results: Overall, 585 patients and 22 variables were included. Multi-layer Perceptron (MLP) showed the highest performance for predicting surgery complexity and Random Forest (RF) for predicting postoperative outcomes. SHAP detected that MLP and RF gave the highest relevance to the variables “resection type” and “largest tumor size” for predicting surgery complexity and postoperative outcomes. In addition, we explored between surgeries converted to open and non-converted, finding statistically significant differences in the variables “tumor location,” “blood loss,” “complications,” and “operation time.” Conclusion: We have observed how the application of SHAP allows us to understand the predictions of AI models in surgical complexity and the postoperative outcomes of laparoscopic liver surgery in segments 7 and 8.
  • Federica Cipriani, Luca Aldrighetti, Francesca Ratti, Andrew G R Wu, Tousif Kabir, Olivier Scatton, Chetana Lim, Wanguang Zhang, Jasper Sijberden, Davit L Aghayan, Tiing-Foong Siow, Safi Dokmak, Fabricio Ferreira Coelho, Paulo Herman, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Eric C H Lai, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Ho-Seong Han, Tran Cong Duy Long, Qu Liu, Rong Liu, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Brian K P Goh
    Annals of surgical oncology 31(1) 97-114 2024年1月  
    BACKGROUND: Minimally invasive liver resections (MILR) offer potential benefits such as reduced blood loss and morbidity compared with open liver resections. Several studies have suggested that the impact of cirrhosis differs according to the extent and complexity of resection. Our aim was to investigate the impact of cirrhosis on the difficulty and outcomes of MILR, focusing on major hepatectomies. METHODS: A total of 2534 patients undergoing minimally invasive major hepatectomies (MIMH) for primary malignancies across 58 centers worldwide were retrospectively reviewed. Propensity score (PSM) and coarsened exact matching (CEM) were used to compare patients with and without cirrhosis. RESULTS: A total of 1353 patients (53%) had no cirrhosis, 1065 (42%) had Child-Pugh A and 116 (4%) had Child-Pugh B cirrhosis. Matched comparison between non-cirrhotics vs Child-Pugh A cirrhosis demonstrated comparable blood loss. However, after PSM, postoperative morbidity and length of hospitalization was significantly greater in Child-Pugh A cirrhosis, but these were not statistically significant with CEM. Comparison between Child-Pugh A and Child-Pugh B cirrhosis demonstrated the latter had significantly higher transfusion rates and longer hospitalization after PSM, but not after CEM. Comparison of patients with cirrhosis of all grades with and without portal hypertension demonstrated no significant difference in all major perioperative outcomes after PSM and CEM. CONCLUSIONS: The presence and severity of cirrhosis affected the difficulty and impacted the outcomes of MIMH, resulting in higher blood transfusion rates, increased postoperative morbidity, and longer hospitalization in patients with more advanced cirrhosis. As such, future difficulty scoring systems for MIMH should incorporate liver cirrhosis and its severity as variables.
  • Qu Liu, Wanguang Zhang, Joseph J Zhao, Nicholas L Syn, Federica Cipriani, Mohammad Alzoubi, Davit L Aghayan, Tiing-Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Moritz Schmelzle, Johann Pratschke, Chung-Ngai Tang, Charing C N Chong, Kit-Fai Lee, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Thomas Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Mansour Saleh, Daniel Cherqui, Junhao Zheng, Xiao Liang, Alessandro Mazzotta, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Rong Liu, Brian K P Goh
    Annals of surgery 278(6) 969-975 2023年12月1日  
    OBJECTIVE: To compare the outcomes between robotic major hepatectomy (R-MH) and laparoscopic major hepatectomy (L-MH). BACKGROUND: Robotic techniques may overcome the limitations of laparoscopic liver resection. However, it is unknown whether R-MH is superior to L-MH. METHODS: This is a post hoc analysis of a multicenter database of patients undergoing R-MH or L-MH at 59 international centers from 2008 to 2021. Data on patient demographics, center experience volume, perioperative outcomes, and tumor characteristics were collected and analyzed. Both 1:1 propensity-score matched (PSM) and coarsened-exact matched (CEM) analyses were performed to minimize selection bias between both groups. RESULTS: A total of 4822 cases met the study criteria, of which 892 underwent R-MH and 3930 underwent L-MH. Both 1:1 PSM (841 R-MH vs. 841 L-MH) and CEM (237 R-MH vs. 356 L-MH) were performed. R-MH was associated with significantly less blood loss {PSM:200.0 [interquartile range (IQR):100.0, 450.0] vs 300.0 (IQR:150.0, 500.0) mL; P = 0.012; CEM:170.0 (IQR: 90.0, 400.0) vs 200.0 (IQR:100.0, 400.0) mL; P = 0.006}, lower rates of Pringle maneuver application (PSM: 47.1% vs 63.0%; P < 0.001; CEM: 54.0% vs 65.0%; P = 0.007) and open conversion (PSM: 5.1% vs 11.9%; P < 0.001; CEM: 5.5% vs 10.4%, P = 0.04) compared with L-MH. On subset analysis of 1273 patients with cirrhosis, R-MH was associated with a lower postoperative morbidity rate (PSM: 19.5% vs 29.9%; P = 0.02; CEM 10.4% vs 25.5%; P = 0.02) and shorter postoperative stay [PSM: 6.9 (IQR: 5.0, 9.0) days vs 8.0 (IQR: 6.0 11.3) days; P < 0.001; CEM 7.0 (IQR: 5.0, 9.0) days vs 7.0 (IQR: 6.0, 10.0) days; P = 0.047]. CONCLUSIONS: This international multicenter study demonstrated that R-MH was comparable to L-MH in safety and was associated with reduced blood loss, lower rates of Pringle maneuver application, and conversion to open surgery.
  • Junhao Zheng, Xiao Liang, Andrew G R Wu, Tousif Kabir, Olivier Scatton, Chetana Lim, Kiyoshi Hasegawa, Jasper P Sijberden, Davit L Aghayan, Tiing Foong Siow, Safi Dokmak, Paulo Herman, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Zewei Chen, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Eric C H Lai, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Federica Cipriani, Olivier Soubrane, Wanguang Zhang, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Tran Cong Duy Long, Rong Liu, Bjørn Edwin, David Fuks, Mohammad Abu Hilal, Kuo-Hsin Chen, Luca Aldrighetti, Ho-Seong Han, Brian K P Goh
    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 50(1) 107252-107252 2023年11月8日  
    INTRODUCTION: We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies. METHODS: This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021. RESULTS: 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025). CONCLUSION: The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR.
  • Chetana Lim, Olivier Scatton, Andrew G R Wu, Wanguang Zhang, Kiyoshi Hasegawa, Federica Cipriani, Jasper Sijberden, Davit L Aghayan, Tiing-Foong Siow, Safi Dokmak, Paulo Herman, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Eric C H Lai, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Atsushi Sugioka, Ho-Seong Han, Tran Cong Duy Long, Rong Liu, Bjørn Edwin, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Brian K P Goh
    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 49(10) 106997-106997 2023年10月  
    INTRODUCTION: To assess the impact of cirrhosis and portal hypertension (PHT) on technical difficulty and outcomes of minimally invasive liver resection (MILR) in the posterosuperior segments. METHODS: This is a post-hoc analysis of patients with primary malignancy who underwent laparoscopic and robotic wedge resection and segmentectomy in the posterosuperior segments between 2004 and 2019 in 60 centers. Surrogates of difficulty (i.e, open conversion rate, operation time, blood loss, blood transfusion, and use of the Pringle maneuver) and outcomes were compared before and after propensity-score matching (PSM) and coarsened exact matching (CEM). RESULTS: Of the 1954 patients studied, 1290 (66%) had cirrhosis. Among the cirrhotic patients, 310 (24%) had PHT. After PSM, patients with cirrhosis had higher intraoperative blood transfusion (14% vs. 9.3%; p = 0.027) and overall morbidity rates (20% vs. 14.5%; p = 0.023) than those without cirrhosis. After coarsened exact matching (CEM), patients with cirrhosis tended to have higher intraoperative blood transfusion rate (12.1% vs. 6.7%; p = 0.059) and have higher overall morbidity rate (22.8% vs. 12.5%; p = 0.007) than those without cirrhosis. After PSM, Pringle maneuver was more frequently applied in cirrhotic patients with PHT (62.2% vs. 52.4%; p = 0.045) than those without PHT. CONCLUSION: MILR in the posterosuperior segments in cirrhotic patients is associated with higher intraoperative blood transfusion and postoperative morbidity. This parameter should be utilized in the difficulty assessment of MILR.
  • Arimasa Miyama, Yuko Chikaishi, Daigo Kobayashi, Kazuhiro Matsuo, Takayuki Ochi, Kenichi Nakamura, Tomoyoshi Endo, Kenji Kikuchi, Hidetoshi Katsuno, Aki Nishijima, Zenichi Morise
    Surgical case reports 9(1) 161-161 2023年9月12日  
    BACKGROUND: Although most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma. CASE PRESENTATION: A 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery. CONCLUSIONS: This report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.
  • Fabricio Ferreira Coelho, Paulo Herman, Jaime A P Kruger, Andrew G R Wu, Ken-Min Chin, Kiyoshi Hasegawa, Wanguang Zhang, Mohammad Alzoubi, Davit L Aghayan, Tiing-Foong Siow, Olivier Scatton, T Peter Kingham, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Safi Dokmak, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Eric C H Lai, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Mengqiu Yin, Tan-To Cheung, Atsushi Sugioka, Ho-Seong Han, Tran Cong Duy Long, David Fuks, Mohammad Abu Hilal, Kuo-Hsin Chen, Luca Aldrighetti, Bjørn Edwin, Brian K P Goh
    Surgery 174(3) 581-592 2023年9月  
    BACKGROUND: The impact of cirrhosis and portal hypertension on perioperative outcomes of minimally invasive left lateral sectionectomies remains unclear. We aimed to compare the perioperative outcomes between patients with preserved and compromised liver function (noncirrhotics versus Child-Pugh A) when undergoing minimally invasive left lateral sectionectomies. In addition, we aimed to determine if the extent of cirrhosis (Child-Pugh A versus B) and the presence of portal hypertension had a significant impact on perioperative outcomes. METHODS: This was an international multicenter retrospective analysis of 1,526 patients who underwent minimally invasive left lateral sectionectomies for primary liver malignancies at 60 centers worldwide between 2004 and 2021. In the study, 1,370 patients met the inclusion criteria and formed the final study group. Baseline clinicopathological characteristics and perioperative outcomes of these patients were compared. To minimize confounding factors, 1:1 propensity score matching and coarsened exact matching were performed. RESULTS: The study group comprised 559, 753, and 58 patients who did not have cirrhosis, Child-Pugh A, and Child-Pugh B cirrhosis, respectively. Six-hundred and thirty patients with cirrhosis had portal hypertension, and 170 did not. After propensity score matching and coarsened exact matching, Child-Pugh A patients with cirrhosis undergoing minimally invasive left lateral sectionectomies had longer operative time, higher intraoperative blood loss, higher transfusion rate, and longer hospital stay than patients without cirrhosis. The extent of cirrhosis did not significantly impact perioperative outcomes except for a longer duration of hospital stay. CONCLUSION: Liver cirrhosis adversely affected the intraoperative technical difficulty and perioperative outcomes of minimally invasive left lateral sectionectomies.
  • Zewei Chen, Mengqiu Yin, Junhao Fu, Shian Yu, Nicholas L Syn, Darren W Chua, T Peter Kingham, Wanguang Zhang, Tijs J Hoogteijling, Davit L Aghayan, Tiing Foong Siow, Olivier Scatton, Paulo Herman, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Safi Dokmak, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Eric C H Lai, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Qu Liu, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Daniel Cherqui, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Ho-Seong Han, Tran Cong Duy Long, David Fuks, Mohammad Abu Hilal, Luca Aldrighetti, Kuo-Hsin Chen, Bjørn Edwin, Brian K P Goh
    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 49(8) 1466-1473 2023年8月  
    INTRODUCTION: Currently, the impact of body mass index (BMI) on the outcomes of laparoscopic liver resections (LLR) is poorly defined. This study attempts to evaluate the impact of BMI on the peri-operative outcomes following laparoscopic left lateral sectionectomy (L-LLS). METHODS: A retrospective analysis of 2183 patients who underwent pure L-LLS at 59 international centers between 2004 and 2021 was performed. Associations between BMI and selected peri-operative outcomes were analyzed using restricted cubic splines. RESULTS: A BMI of >27kg/m2 was associated with increased in blood loss (Mean difference (MD) 21 mls, 95% CI 5-36), open conversions (Relative risk (RR) 1.13, 95% CI 1.03-1.25), operative time (MD 11 min, 95% CI 6-16), use of Pringles maneuver (RR 1.15, 95% CI 1.06-1.26) and reductions in length of stay (MD -0.2 days, 95% CI -0.3 to -0.1). The magnitude of these differences increased with each unit increase in BMI. However, there was a "U" shaped association between BMI and morbidity with the highest complication rates observed in underweight and obese patients. CONCLUSION: Increasing BMI resulted in increasing difficulty of L-LLS. Consideration should be given to its incorporation in future difficulty scoring systems in laparoscopic liver resections.
  • Giammauro Berardi, T Peter Kingham, Wanguang Zhang, Nicholas L Syn, Ye-Xin Koh, Bashar Jaber, Davit L Aghayan, Tiing Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Moritz Schmelzle, Johann Pratschke, Eric C H Lai, Charing C N Chong, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, Qu Liu, Rong Liu, Alessandro Ferrero, Giuseppe Maria Ettorre, Federica Cipriani, Franco Pascual, Daniel Cherqui, Junhao Zheng, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Bjørn Edwin, David Fuks, Mohammad Abu Hilal, Luca Aldrighetti, Kuo-Hsin Chen, Brian K P Goh
    Surgery 174(2) 259-267 2023年8月  
    BACKGROUND: Data on the effect of body mass index on laparoscopic liver resections are conflicting. We performed this study to investigate the association between body mass index and postoperative outcomes after laparoscopic major hepatectomies. METHODS: This is a retrospective review of 4,348 laparoscopic major hepatectomies at 58 centers between 2005 and 2021, of which 3,383 met the study inclusion criteria. Concomitant major operations, vascular resections, and previous liver resections were excluded. Associations between body mass index and perioperative outcomes were analyzed using restricted cubic splines. Modeled effect sizes were visually rendered and summarized. RESULTS: A total of 1,810 patients (53.5%) had normal weight, whereas 1,057 (31.2%) were overweight and 392 (11.6%) were obese. One hundred and twenty-four patients (3.6%) were underweight. Most perioperative outcomes showed a linear worsening trend with increasing body mass index. There was a statistically significant increase in open conversion rate (16.3%, 10.8%, 9.2%, and 5.6%, P < .001), longer operation time (320 vs 305 vs 300 and 266 minutes, P < .001), increasing blood loss (300 vs 300 vs 295 vs 250 mL, P = .022), and higher postoperative morbidity (33.4% vs 26.3% vs 25.0% vs 25.0%, P = .009) in obese, overweight, normal weight, and underweight patients, respectively (P < .001). However, postoperative major morbidity demonstrated a "U"-shaped association with body mass index, whereby the highest major morbidity rates were observed in underweight and obese patients. CONCLUSION: Laparoscopic major hepatectomy was associated with poorer outcomes with increasing body mass index for most perioperative outcome measures.
  • Felix Krenzien, Moritz Schmelzle, Johann Pratschke, Linda Feldbrügge, Rong Liu, Qu Liu, Wanguang Zhang, Joseph J Zhao, Hwee-Leong Tan, Federica Cipriani, Tijs J Hoogteijling, Davit L Aghayan, Åsmund Avdem Fretland, Tiing Foong Siow, Chetana Lim, Olivier Scatton, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung Hoon Choi, Jae Hoon Lee, Mikel Gastaca, Marco Vivarelli, Felice Giuliante, Bernardo Dalla Valle, Andrea Ruzzenente, Chee-Chien Yong, Zewei Chen, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Salvatore Gruttadauria, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Kiyoshi Hasegawa, Chung-Ngai Tang, Charing C N Chong, Kit-Fai Lee, Juul Meurs, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Franco Pascual, Daniel Cherqui, Junhao Zheng, Xiao Liang, Olivier Soubrane, Go Wakabayashi, Roberto I Troisi, Tan-To Cheung, Yutaro Kato, Atsushi Sugioka, Safi Dokmak, Mizelle D'Silva, Ho-Seong Han, Phan Phuoc Nghia, Tran Cong Duy Long, Mohammad Abu Hilal, Kuo-Hsin Chen, David Fuks, Luca Aldrighetti, Bjørn Edwin, Brian K P Goh
    Annals of surgery 2023年7月24日  
    OBJECTIVE: To compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments. BACKGROUND: Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in existing literature. METHODS: This is a post hoc analysis of a multicenter database of 5,446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumour features and perioperative characteristics were collected and analysed. Propensity score matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias. RESULTS: A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%) and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate (10 of 449 [2.2%] vs. 54 of 898 [6.0%]; P=0.002), less blood loss (100 mL [IQR; 50-200] days vs. 150 mL [IQR; 50-350]; P<0.001) and a shorter operative time (188 min [IQR; 140-270] vs. 222 min [IQR; 158-300]; P<0.001). These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis - lower open conversion rate (1 of 136 [0.7%] vs. 17 of 272 [6.2%]; P=0.009), less blood loss (100 mL [IQR; 48-200] vs. 160 mL [IQR; 50-400]; P<0.001) and shorter operative time (190 min [IQR; 141-258] vs. 230 min [IQR; 160-312]; P=0.003). Post-operative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset. CONCLUSION: RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss and open conversion rate when compared to LLLR.
  • Zenichi Morise
    Cancers 15(13) 2023年7月6日  
    After the initial reports of laparoscopic liver resection (LLR) in the early 1990s, minimally invasive liver resection has been rapidly developing based on technical and instrumental improvements [...].
  • Shinya Takagi, Zenichi Morise, Hidetoshi Katsuno, Kenji Kikuchi, Kenichi Nakamura, Tomoyoshi Endo, Takayuki Ochi, Kazuhiro Matsuo, Hironobu Yasuoka, Akihiro Nishimura, Aki Nishijima
    Asian journal of endoscopic surgery 16(3) 621-626 2023年7月  
    Inflammatory pseudotumor (IPT) is a rare disease that requires a differential diagnosis from malignancies. We describe a case of hepatic IPT with para-aortic lymphadenopathy, treated with a stepwise strategy of laparoscopic surgery. A 61-year-old woman was referred with a liver lesion. Computed tomography revealed a 13 cm well-defined lesion in segments VII-VI. The patient also had bead-like enlarged lymph nodes from the perihilar to the para-aortic regions. Although percutaneous lymph node biopsy showed no evidence of malignancy, 18 F-fluorodeoxyglucose positron emission tomography revealed accumulation in the lesion and lymph nodes. Lymph nodes were harvested laparoscopically for intraoperative pathological examination. With no evidence of malignancy, laparoscopic liver resection was continuously performed as a diagnostic treatment. The patient was given a pathological diagnosis of IPT and was discharged on the 16th day and is well 2 years after surgery. The minimally invasive laparoscopic approach to diagnostic treatment could be useful with secure advantages.
  • Jacob Ghotbi, Davit Aghayan, Åsmund Fretland, Bjørn Edwin, Nicholas L Syn, Federica Cipriani, Mohammed Alzoubi, Chetana Lim, Olivier Scatton, Tran Cong Duy Long, Paulo Herman, Fabricio Ferreira Coelho, Marco V Marino, Vincenzo Mazzaferro, Adrian K H Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Alejandro Mejia, James O Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C N Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Franco Pascual, Daniel Cherqui, Xiao Liang, Alessandro Mazzotta, Go Wakabayashi, Mariano Giglio, Roberto I Troisi, Ho-Seong Han, Tan-To Cheung, Atsushi Sugioka, Kuo-Hsin Chen, Rong Liu, Olivier Soubrane, David Fuks, Luca Aldrighetti, Mohammad Abu Hilal, Brian K P Goh
    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 49(7) 1209-1216 2023年1月20日  
    BACKGROUND: Minimal invasive liver resections are a safe alternative to open surgery. Different scoring systems considering different risks factors have been developed to predict the risks associated with these procedures, especially challenging major liver resections (MLR). However, the impact of neoadjuvant chemotherapy (NAT) on the difficulty of minimally invasive MLRs remains poorly investigated. METHODS: Patients who underwent laparoscopic and robotic MLRs for colorectal liver metastases (CRLM) performed across 57 centers between January 2005 to December 2021 were included in this analysis. Patients who did or did not receive NAT were matched based on 1:1 coarsened exact and 1:2 propensity-score matching. Pre- and post-matching comparisons were performed. RESULTS: In total, the data of 5189 patients were reviewed. Of these, 1411 procedures were performed for CRLM, and 1061 cases met the inclusion criteria. After excluding 27 cases with missing data on NAT, 1034 patients (NAT: n = 641; non-NAT: n = 393) were included. Before matching, baseline characteristics were vastly different. Before matching, the morbidity rate was significantly higher in the NAT-group (33.2% vs. 27.2%, p-value = 0.043). No significant differences were seen in perioperative outcomes after the coarsened exact matching. After the propensity-score matching, statistically significant higher blood loss (mean, 300 (SD 128-596) vs. 250 (SD 100-400) ml, p-value = 0.047) but shorter hospital stay (mean, 6 [4-8] vs. 6 [5-9] days, p-value = 0.043) were found in the NAT-group. CONCLUSION: The current study demonstrated that NAT had minimal impact on the difficulty and outcomes of minimally-invasive MLR for CRLM.
  • Zenichi Morise, Hidetoshi Katsuno, Kenji Kikuchi, Tomoyoshi Endo, Kazuhiro Matsuo, Yukio Asano, Akihiko Horiguchi
    Cancers 15(2) 2023年1月9日  
    Recurrence of liver cancers after liver resection (LR), such as recurrences of hepatocellular carcinoma and colorectal liver metastases, is often treated with repeat LR (RLR) as the only curative treatment. However, RLR is associated with an increased risk of complications. The indications for the currently emerging laparoscopic LR and its advantages and disadvantages for repeat treatment are still under discussion. Our multi-institutional propensity-score matched analyses of laparoscopic vs. open RLRs for hepatocellular carcinoma showed the feasibility of laparoscopic RLR with comparable short- and long-term outcomes. Small blood loss and low morbidity was observed in selected patients treated using laparoscopic RLR in which total adhesiolysis can be dodged, with speculations that laparoscopic minor repeated LR can minimize functional deterioration of the liver. However, there are several disadvantages, such as easily occurring disorientation and difficulty in repeated wide-range dissection of Glissonian pedicles. Recently emerging small anatomical resection, indocyanine green fluorescence-guided surgery, and robot-assisted surgery are promising tools for the further development of laparoscopic RLR. This review discusses how laparoscopic RLR, as a powerful unique local therapy causing less damage to the residual liver and surrounding structures, could contribute to the outcomes of repeated treatments for cancers and its future perspectives.
  • Zenichi Morise
    World journal of gastroenterology 28(43) 6090-6098 2022年11月21日  
    Hepatocellular carcinoma (HCC) patients have chronic liver disease with functional deterioration and multicentric oncogenicity. Liver surgeries for the patients should be planned on both oncological effects and sparing liver function. In colorectal patients with post-chemotherapy liver injury and multiple bilateral tumors, handling multiple tumors in a fragile/easy-to-bleed liver is an important issue. Liver surgery for biliary tract cancers is often performed as a resection of large-volume functioning liver with extensive lymphadenectomy and bile duct resection/reconstruction. Minimally invasive liver surgery (MILS) for HCC is applied with the advantages of laparoscopic for cases of cirrhosis or repeat resections. Small anatomical resections using the Glissonian, indocyanine green-guided, and hepatic vein-guided approaches are under discussion. In many cases of colorectal liver metastases, MILS is applied combined with chemotherapy owing to its advantage of better hemostasis. Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion. In the case of biliary tract cancers, MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing. A robot-assisted procedure for dissection of major vessels and handling fragile livers may have advantages, and well-simulated robot-assisted procedure may decrease the difficulty for biliary tract cancers.
  • Tomoyoshi Endo, Hidetoshi Katsuno, Kenji Kikuchi, Takayuki Ochi, Kazuhiro Matsuo, Kazumitsu Suzuki, Hironobu Yasuoka, Yuko Nakano, Mitsuru Nakagawa, Makoto Kuroda, Zenichi Morise
    Surgical case reports 8(1) 179-179 2022年9月26日  
    BACKGROUND:  Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor, is a benign, non-neoplastic vascular lesion that is characterized by reactive proliferation of papillary endothelial cells associated with a thrombus. These lesions typically develop in the vascular regions of the head and neck, oral cavity, or extremities; however, other organ systems have been affected. IPEH in the gastrointestinal tract is rare, with only a few cases reported to date. Thus, the pathogenesis and clinical features of IPEH in the gastrointestinal tract are not entirely understood. Moreover, the local excision of certain subtypes of IPEH can be curative; this makes timely diagnosis essential. We present the case of a patient with IPEH in the cecum that was discovered while investigating the cause of severe anemia. CASE PRESENTATION: A 29-year-old woman visited a general practitioner (GP) with the complaint of abdominal pain. She was diagnosed with acute appendicitis and was prescribed antibiotics. After treatment, her abdominal pain disappeared. However, she was found to be severely anemic (hemoglobin level, 6.5 g/dl). To determine the cause of her anemia, the GP referred her to our hospital for further examination and treatment. Computed tomography scan revealed cecal wall thickening. Further, a lower gastrointestinal endoscopy revealed a 2-cm raised mass-like lesion in the cecum. This lesion was pathologically identified as an inflammatory granuloma. The cause of her anemia was determined to be bleeding from the lesion in the cecum. She underwent laparoscopic ileocecal resection. Histopathological examination of the surgical specimen revealed a spongy structure comprising many small papillary fibrous tissues lined by a typical monolayer endothelium. Further, immunohistochemical analysis showed that the cells of the endothelium monolayer expressed CD31, CD34. The Ki-67 labeling index was < 1%. Based on these findings, the lesion was identified as an IPEH in the cecum. The patient's postoperative course was uneventful, and there was no evidence of recurrence during the 1.3 years of follow-up. CONCLUSIONS:  IPEH rarely arises within the abdominal cavity. Surgery remains the only treatment for IPEH and is associated with an excellent prognosis and a low recurrence rate. More aggressive lesions such as angiosarcoma should be excluded when considering the histologic diagnoses of IPEH, and expert pathologic review is vital. This is the first report of IPEH occurring in the cecum and represents a novel cause of gastrointestinal bleeding which the clinician should consider when evaluating a patient with atypical or difficult gastrointestinal bleeding sources.
  • Nikdokht Rashidian, Mariano C Giglio, Isabelle Van Herzeele, Peter Smeets, Zenichi Morise, Adnan Alseidi, Roberto I Troisi, Wouter Willaert
    HPB : the official journal of the International Hepato Pancreato Biliary Association 24(12) 2086-2095 2022年7月21日  
    BACKGROUND: Virtual reality (VR) is increasingly used in surgical education, but evidence of its benefits in complex cognitive training compared to conventional 3-dimensional (3D) visualization methods is lacking. The objective of this study is to assess the impact of 3D liver models rendered visible by VR or desktop interfaces (DIs) on residents' performance in clinical decision-making. METHOD: From September 2020 to April 2021, a single-blinded, crossover randomized educational intervention trial was conducted at two university hospitals in Belgium and Italy. A proficiency-based stepwise curriculum for preoperative liver surgery planning was developed for general surgery residents. After completing the training, residents were randomized in one of two assessment sequences to evaluate ten real clinical scenarios. RESULTS: Among the 50 participants, 46 (23 juniors/23 seniors) completed the training and were randomized. Forty residents (86.96%) achieved proficiency in decision-making. The accuracy of virtual surgical planning using VR was higher than that using DI in both groups A (8.43 ± 1.03 vs 6.86 ± 1.79, p < 0.001) and B (8.08 ± 0.9 vs 6.52 ± 1.37, p < 0.001). CONCLUSION: Proficiency-based curricular training for liver surgery planning successfully resulted in the acquisition of complex cognitive skills. VR was superior to DI visualization of 3D models in decision-making. GOV ID: NCT04959630.
  • Tomoyoshi Endo, Zenichi Morise, Hidetoshi Katsuno, Kenji Kikuchi, Kazuhiro Matsuo, Yukio Asano, Akihiko Horiguchi
    Frontiers in Oncology 12 950283-950283 2022年7月11日  
    We had reported the novel concept of “caudal approach in laparoscopic liver resection” in 2013. In the first report, the caudal approach of laparoscopic transection–first posterior sectionectomy without prior mobilization of the liver in the left lateral position was described. Thereafter, 10 complex laparoscopic extended posterior sectionectomies with combined resection of the right hepatic vein or diaphragm were performed using the same approach. In the present study, the short-term outcomes of these cases and 42 cases of laparoscopic sectionectomies or hemi-hepatectomies (excluding left lateral sectionectomy) were compared. There was no statistically significant difference between the groups in terms of patients’ backgrounds, diseases for resection, preoperative liver function, tumor number and size, as well as outcomes, operation time, intraoperative blood loss, morbidity, conversion to laparotomy, and post-operative hospital stay. Even complex laparoscopic extended posterior sectionectomy was safely performed using this procedure. This approach has the technical benefits of acquiring a well-opened transection plane between the resected liver fixed to the retroperitoneum and the residual liver sinking to the left with the force of gravity during parenchymal transection, and less bleeding from the right hepatic vein due to its higher position than the inferior vena cava. Furthermore, it has an oncological benefit similar to that of the anterior approach in open liver resection, even in posterior sectionectomy. The detailed procedure and general conceptual benefits of the caudal approach to laparoscopic liver resection for repeated multimodal treatment for hepatocellular carcinoma are described.
  • Hidetoshi Katsuno, Tsunekazu Hanai, Tomoyoshi Endo, Zenichi Morise, Ichiro Uyama
    Surgery Today 52(6) 978-985 2022年6月  
    Although meta-analyses and systematic reviews have clarified the benefits of robotic surgery, few studies have focused on robotic rectal surgery (RRS) and the use of Endowrist® instruments. Therefore, we evaluated RRS using the double bipolar method (DBM) and compared its short-term outcomes with those of RRS using the single bipolar method (SBM). This study enrolled 157 consecutive patients and all procedures were performed by the same surgeon and recorded through short video clips. We analyzed the patient demographics and short-term clinical outcomes. Although this observational study has several limitations, the console time for total mesorectal excision using the DBM was significantly shorter than that using the SBM. Although the DBM did not demonstrate a specific learning curve, it was a safe and feasible procedure even for patients with advanced disease. Further studies are needed to evaluate the cost-effectiveness of the DBM.
  • Zenichi Morise, Luca Aldrighetti, Giulio Belli, Francesca Ratti, Tan To Cheung, Chung Mau Lo, Shogo Tanaka, Shoji Kubo, Yukiyasu Okamura, Katsuhiko Uesaka, Kazuteru Monden, Hiroshi Sadamori, Kazuki Hashida, Kazuyuki Kawamoto, Naoto Gotohda, KuoHsin Chen, Akishige Kanazawa, Yutaka Takeda, Yoshiaki Ohmura, Masaki Ueno, Toshiro Ogura, Kyung Suk Suh, Yutaro Kato, Atsushi Sugioka, Andrea Belli, Hiroyuki Nitta, Masafumi Yasunaga, Daniel Cherqui, Nasser Abdul Halim, Alexis Laurent, Hironori Kaneko, Yuichiro Otsuka, Ki Hun Kim, Hwui-Dong Cho, Charles Chung-Wei Lin, Yusuke Ome, Yasuji Seyama, Roberto I Troisi, Giammauro Berardi, Fernando Rotellar, Gregory C Wilson, David A Geller, Olivier Soubrane, Tomoaki Yoh, Takashi Kaizu, Yusuke Kumamoto, Ho-Seong Han, Ela Ekmekcigil, Ibrahim Dagher, David Fuks, Brice Gayet, Joseph F Buell, Ruben Ciria, Javier Briceno, Nicholas O'Rourke, Joel Lewin, Bjorn Edwin, Masahiro Shinoda, Yuta Abe, Mohammed Abu Hilal, Mohammad Alzoubi, Minoru Tanabe, Go Wakabayashi
    Cancers 14(11) 2022年5月24日  
    Whether albumin and bilirubin levels, platelet counts, ALBI, and ALPlat scores could be useful for the assessment of permanent liver functional deterioration after repeat liver resection was examined, and the deterioration after laparoscopic procedure was evaluated. For 657 patients with liver resection of segment or less in whom results of plasma albumin and bilirubin levels and platelet counts before and 3 months after surgery could be retrieved, liver functional indicators were compared before and after surgery. There were 268 patients who underwent open repeat after previous open liver resection, and 224 patients who underwent laparoscopic repeat after laparoscopic liver resection. The background factors, liver functional indicators before and after surgery and their changes were compared between both groups. Plasma levels of albumin (p = 0.006) and total bilirubin (p = 0.01) were decreased, and ALBI score (p = 0.001) indicated worse liver function after surgery. Laparoscopic group had poorer preoperative performance status and liver function. Changes of liver functional values before and after surgery and overall survivals were similar between laparoscopic and open groups. Plasma levels of albumin and bilirubin and ALBI score could be the indicators for permanent liver functional deterioration after liver resection. Laparoscopic group with poorer conditions showed the similar deterioration of liver function and overall survivals to open group.
  • Arimasa Miyama, Zenichi Morise, Luca Aldrighetti, Giulio Belli, Francesca Ratti, Tan-To Cheung, Chung-Mau Lo, Shogo Tanaka, Shoji Kubo, Yukiyasu Okamura, Katsuhiko Uesaka, Kazuteru Monden, Hiroshi Sadamori, Kazuki Hashida, Kazuyuki Kawamoto, Naoto Gotohda, KuoHsin Chen, Akishige Kanazawa, Yutaka Takeda, Yoshiaki Ohmura, Masaki Ueno, Toshiro Ogura, Kyung-Suk Suh, Yutaro Kato, Atsushi Sugioka, Andrea Belli, Hiroyuki Nitta, Masafumi Yasunaga, Daniel Cherqui, Nasser Abdul Halim, Alexis Laurent, Hironori Kaneko, Yuichiro Otsuka, Ki-Hun Kim, Hwui-Dong Cho, Charles Chung-Wei Lin, Yusuke Ome, Yasuji Seyama, Roberto I Troisi, Giammauro Berardi, Fernando Rotellar, Gregory C Wilson, David A Geller, Olivier Soubrane, Tomoaki Yoh, Takashi Kaizu, Yusuke Kumamoto, Ho-Seong Han, Ela Ekmekcigil, Ibrahim Dagher, David Fuks, Brice Gayet, Joseph F Buell, Ruben Ciria, Javier Briceno, Nicholas O'Rourke, Joel Lewin, Bjorn Edwin, Masahiro Shinoda, Yuta Abe, Mohammed Abu Hilal, Mohammad Alzoubi, Minoru Tanabe, Go Wakabayashi
    Cancers 13(13) 2021年6月25日  
    Less morbidity is considered among the advantages of laparoscopic liver resection (LLR) for HCC patients. However, our previous international, multi-institutional, propensity score-based study of emerging laparoscopic repeat liver resection (LRLR) failed to prove this advantage. We hypothesize that these results may be since the study included complex LRLR cases performed during the procedure's developing stage. To examine it, subgroup analysis based on propensity score were performed, defining the proximity of the tumors to major vessels as the indicator of complex cases. Among 1582 LRLR cases from 42 international high-volume liver surgery centers, 620 cases without the proximity to major vessels (more than 1 cm far from both first-second branches of Glissonian pedicles and major hepatic veins) were selected for this subgroup analysis. A propensity score matching (PSM) analysis was performed based on their patient characteristics, preoperative liver function, tumor characteristics and surgical procedures. One hundred and fifteen of each patient groups of LRLR and open repeat liver resection (ORLR) were earned, and the outcomes were compared. Backgrounds were well-balanced between LRLR and ORLR groups after matching. With comparable operation time and long-term outcome, less blood loss (283.3±823.0 vs. 603.5±664.9 mL, p = 0.001) and less morbidity (8.7 vs. 18.3 %, p = 0.034) were shown in LRLR group than ORLR. Even in its worldwide developing stage, LRLR for HCC patients could be beneficial in blood loss and morbidity for the patients with less complexity in surgery.
  • 鈴木 和光, 柴崎 晋, 松尾 一勲, 菊地 健司, 鶴 安浩, 後藤 愛, 梅木 祐介, 中村 謙一, 田中 毅, 稲葉 一樹, 須田 康一, 守瀬 善一, 宇山 一朗
    日本外科学会定期学術集会抄録集 121回 SF-5 2021年4月  
  • 松尾 一勲, 柴崎 晋, 鈴木 和光, 鶴 安浩, 後藤 愛, 梅木 祐介, 中村 謙一, 田中 毅, 菊地 健司, 須田 康一, 稲葉 一樹, 守瀬 善一, 宇山 一朗
    日本外科学会定期学術集会抄録集 121回 PS-6 2021年4月  
  • R. I. Troisi, G. Berardi, Z. Morise, F. Cipriani, S. Ariizumi, C. Sposito, V. Panetta, I. Simonelli, S. Kim, B. K.P. Goh, S. Kubo, S. Tanaka, Y. Takeda, G. M. Ettorre, N. Russolillo, G. C. Wilson, M. Cimino, R. Montalti, M. C. Giglio, K. Igarashi, C. Y. Chan, G. Torzilli, T. T. Cheung, V. Mazzaferro, H. Kaneko, A. Ferrero, D. A. Geller, H. S. Han, A. Kanazawa, G. Wakabayashi, L. Aldrighetti, M. Yamamoto
    The British journal of surgery 108(2) 196-204 2021年3月12日  
    BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS: Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS: Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION: Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
  • 勝野 秀稔, 花井 恒一, 升森 宏次, 小出 欣和, 松岡 宏, 蘆田 啓吾, 廣 純一郎, 田島 陽介, 遠藤 智美, 鄭 栄哲, 菊地 健司, 松尾 一勲, 鈴木 和光, 守瀬 善一, 宇山 一朗
    日本内視鏡外科学会雑誌 25(7) SY18-3 2021年3月  
  • Shimpei Furuta, Ichiro Uyama, Zenichi Morise
    Fujita medical journal 7(2) 50-53 2021年  
    OBJECTIVES: Neoadjuvant chemotherapy (NAC) is widely accepted as a potential treatment for advanced gastric cancer (AGC). Laparoscopic gastrectomy (LG) has recently been performed for advanced gastric cancer and could lead to improved adherence to multimodal treatment. In the present study, we compared the feasibility and outcomes of LG in patients with or without NAC in our institution. METHODS: We assessed patients who underwent LG with (n=185) or without (n=1204) NAC between 1997 and 2013. We used propensity score matching to evaluate perioperative short-term outcomes and long-term outcome. RESULTS: We used propensity score matching by patient background and treatment-rerated factors to establish two groups of 157 patients with or without NAC. There were no significant differences in perioperative short-term outcomes or long-term outcome between the groups. CONCLUSIONS: LG for selected patients with NAC is feasible and safe but has no long-term survival benefit.
  • Masashi Isetani, Satoshi Arakawa, Zenichi Morise, Norihiko Kawabe, Hidetoshi Nagata, Yukio Asano, Akihiko Horiguchi
    Fujita medical journal 7(4) 111-116 2021年  
    OBJECTIVES: We evaluated the clinical outcomes of transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure in adults. METHODS: One-hundred-and-thirty-one consecutive adults with acute appendicitis were treated with the intention of performing transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure from July 2012 to December 2017. The procedure completion rate and outcomes were examined. To evaluate the risk factors for conversion, the background data were compared between the patients in whom the procedure was completed versus those in whom the procedure was uncompleted. RESULTS: The procedure was completed in 113 of 131 patients (86.3%). Single-site surgery was completed in 117 patients (89.3%). The median operation time was 79 (range 30-270) minutes and median intraoperative blood loss was 10 (range 0-394) ml. Postoperative complications occurred in 17 patients (13.0%). Postoperative hospital stay was 6 (range 1-27) days. The 18 patients in whom the procedure could not be completed comprised four patients in whom the stapler was used for intraabdominal stump closure, and 14 patients who were converted to multiport laparoscopic surgery or open surgery. Multivariate analysis showed that the independent risk factors for conversion were age, preoperative abscess, and peri-appendiceal fat density. Receiver operating characteristic curve analysis showed that the cutoff value of peri-appendiceal fat density for conversion was -40.51 Hounsfield units. CONCLUSIONS: Transumbilical single-incision laparoscopic appendectomy with extracorporeal hand-sewn stump closure was safe in adults with acute appendicitis. The risk factors for conversion were age ≥60 years, preoperative abscess, and peri-appendiceal fat density ≥-40.51 Hounsfield units.
  • Yuko Kijima, Munetsugu Hirata, Naomichi Higo, Hiroko Toda, Yoshiaki Shinden, Zenichi Morise, Shoji Natsugoe
    Gland Surgery 10(5) 1792-1799 2021年  
    A 39-year-old gravida 1 para 1 pregnant Japanese woman underwent skin-sparing mastectomy and axillary lymph node dissection with immediate breast reconstruction (IBR) using a tissue expander (TE) at 32 weeks of pregnancy under general anesthesia. Inserted TE (300 cc) was expanded during breast feeding while the volume was 240 cc of the resected breast tissue. One month after delivery, 2 months after surgery, the contralateral healthy breast increased in size and the inframammary line was deviated toward a caudal site which was larger than 300 cc-inflated TE. She stopped breast feeding to receive a systemic chemotherapy after one months-breast feeding. At 3 months after delivery, the healthy breast size was smaller than the 250 cc-expanded breast and both the inframammary lines were at the same level. She was diagnosed local recurrence 3 month-postoperatively, so we resected the recurrent lesion and exchanged TE to silicon breast implant immediately. Finally, a good symmetry was obtained after insertion of the 220 cc SBI. At an IBR using TE, we should know the dynamic change of breast volume and the level of inframammary line of the healthy breast during those phases of pregnancy, delivery, and nursing.
  • 佐藤 美信, 小出 欣和, 遠山 邦宏, 守瀬 善一, 宇山 一朗
    癌と化学療法 47(13) 1753-1755 2020年12月  
    腹膜反転部以下に腫瘍下縁を有し、根治度Aの手術を施行した直腸癌のうちstage II再発例(23例)をstage II無再発例(126例)と比較し、次にstage III再発例89例と比較した。多変量解析で男性と術前血清CA19-9高値がstage IIの再発危険因子であった。stage IIの初再発形式は局所の占める割合(47.8%)がstage III(29.2%)に比べて多い傾向にあった。stage II再発例の発見動機はstage IIIに比べて血清腫瘍マーカー値の割合が低かった。stage II再発例の手術率は60.9%でstage IIIに比べて有意に高率であった。stage II再発例の初回手術後の予後(5年生存率43.1%)はstage III(25.4%)に比べて有意に良好で、stage II再発例の再発予後はstage IIIに比べて良好な傾向にあった。stage II再発例の治療成績は良好であり、画像診断を中心とした確実な術後サーベイランスが予後改善に有効と考えられた。(著者抄録)
  • 佐藤美信, 小出欣和, 遠山邦宏, 守瀬善一, 宇山一朗
    癌と化学療法 47(13) 1753-1755 2020年12月  
  • Zenichi Morise
    Laparoscopic Surgery 4 2020年10月  
    Although reports for laparoscopic liver resection (LLR) on intrahepatic cholangiocarcinoma (ICC) are increasing, its major challenges are in lymph node (LN) dissection and bile duct reconstruction. Here we present a case report of advanced ICC, who underwent combined minimally invasive surgery. A 70-year-old man with a 9.5 cm mass and bile duct dilatation on the right liver was referred to our department. The findings of endoscopic retrograde cholangiography showed obstruction of the right branch of bile duct and stenosis on hilar portion of the main duct. Combined minimally invasive surgery of LLR and LN dissection and bile duct reconstruction through a small laparotomy was performed under the diagnosis of ICC. An 8-cm caudal-cranial incision on the right upper abdomen was placed. Through the incision, LN dissection and bile duct divisions were performed. After inserting a wound protector devise with a surgical glove to the incision, trocar ports and CO2-pneumoperitonium were introduced. Transection of the liver was performed on the Rex-Cantlie line exposing inferior vena cava (IVC) and the resected right liver was removed, both laparoscopically. Bile duct reconstruction with Roux-en-Y hepatico-jejunostomy was performed through the small laparotomy. The patient recovered uneventfully. He survived for 6.5 years, with the recurrence at 4 years, after the surgery and died of the disease. We believe this is one of the choices for advanced ICC, which has needs for LN dissection and bile duct reconstruction.
  • Roy S Herbst, Giuseppe Giaccone, Filippo de Marinis, Niels Reinmuth, Alain Vergnenegre, Carlos H Barrios, Masahiro Morise, Enriqueta Felip, Zoran Andric, Sarayut Geater, Mustafa Özgüroğlu, Wei Zou, Alan Sandler, Ida Enquist, Kimberly Komatsubara, Yu Deng, Hiroshi Kuriki, Xiaohui Wen, Mark McCleland, Simonetta Mocci, Jacek Jassem, David R Spigel
    The New England journal of medicine 383(14) 1328-1339 2020年10月1日  
    BACKGROUND: The efficacy and safety of the anti-programmed death ligand 1 (PD-L1) monoclonal antibody atezolizumab, as compared with those of platinum-based chemotherapy, as first-line treatment for patients with metastatic non-small-cell lung cancer (NSCLC) with PD-L1 expression are not known. METHODS: We conducted a randomized, open-label, phase 3 trial involving patients with metastatic nonsquamous or squamous NSCLC who had not previously received chemotherapy and who had PD-L1 expression on at least 1% of tumor cells or at least 1% of tumor-infiltrating immune cells as assessed by the SP142 immunohistochemical assay. Patients were assigned in a 1:1 ratio to receive atezolizumab or chemotherapy. Overall survival (primary end point) was tested hierarchically according to PD-L1 expression status among patients in the intention-to-treat population whose tumors were wild-type with respect to EGFR mutations or ALK translocations. Within the population with EGFR and ALK wild-type tumors, overall survival and progression-free survival were also prospectively assessed in subgroups defined according to findings on two PD-L1 assays as well as by blood-based tumor mutational burden. RESULTS: Overall, 572 patients were enrolled. In the subgroup of patients with EGFR and ALK wild-type tumors who had the highest expression of PD-L1 (205 patients), the median overall survival was longer by 7.1 months in the atezolizumab group than in the chemotherapy group (20.2 months vs. 13.1 months; hazard ratio for death, 0.59; P = 0.01). Among all the patients who could be evaluated for safety, adverse events occurred in 90.2% of the patients in the atezolizumab group and in 94.7% of those in the chemotherapy group; grade 3 or 4 adverse events occurred in 30.1% and 52.5% of the patients in the respective groups. Overall and progression-free survival favored atezolizumab in the subgroups with a high blood-based tumor mutational burden. CONCLUSIONS: Atezolizumab treatment resulted in significantly longer overall survival than platinum-based chemotherapy among patients with NSCLC with high PD-L1 expression, regardless of histologic type. (Funded by F. Hoffmann-La Roche/Genentech; IMpower110 ClinicalTrials.gov number, NCT02409342.).
  • 松尾 一勲, 菊地 健司, 鈴木 和光, 鶴 安浩, 後藤 愛, 中村 謙一, 柴崎 晋, 勝野 秀稔, 須田 康一, 稲葉 一樹, 守瀬 善一, 宇山 一朗
    日本臨床外科学会雑誌 81(増刊) 567-567 2020年10月  
  • 勝野 秀稔, 守瀬 善一, 菊地 健司, 花井 恒一, 宇山 一朗
    日本癌治療学会学術集会抄録集 58回 WS26-5 2020年10月  
  • Aki Sakurai, Toshiharu Sasaki, Shigeo Kato, Masamichi Hayashi, Sei-Ichiro Tsuzuki, Takuma Ishihara, Mitsunaga Iwata, Zenichi Morise, Yohei Doi
    The New England journal of medicine 383(9) 885-886 2020年8月27日  査読有り
  • 佐藤 美信, 宇山 一朗, 花井 恒一, 升森 宏次, 小出 欣和, 勝野 秀稔, 守瀬 善一
    日本外科学会定期学術集会抄録集 120回 DP-3 2020年8月  
  • 佐藤 美信, 宇山 一朗, 花井 恒一, 升森 宏次, 小出 欣和, 勝野 秀稔, 守瀬 善一
    日本外科学会定期学術集会抄録集 120回 DP-3 2020年8月  
  • Yuko Kijima, Munetsugu Hirata, Naotomo Higo, Hiroko Toda, Zenichi Morise, Yoshiaki Shinden, Shoji Natsugoe
    Surgery today 50(12) 1707-1711 2020年6月10日  査読有り
    The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We herein report a useful technique to obtain symmetry of the breast shape and a level inframammary line and nipple-areola, which achieved excellent results. Six Japanese patients with early breast cancer located on the upper area of the breast were enrolled into this study. A triangle-shaped area of skin was removed together with cancerous and healthy-surrounding breast tissue. Two crescents were designed and de-epithelialized in the directions of 9 o'clock and 3 o'clock. The width of the crescent was decided to be the same as a half or the length of the base of a triangle to be removed. After partial mastectomy, the inner and outer glandular flaps were horizontally sutured. The operations were simple to perform and were not associated with any postoperative complications. Oncoplastic breast surgery combining partial mastectomy with triangular skin resection and re-centralization of the nipple-areola was useful for patients with breast cancer on the upper quadrant area of non-ptotic breasts.
  • 佐藤 美信, 宇山 一朗, 花井 恒一, 升森 宏次, 小出 欣和, 守瀬 善一
    日本腹部救急医学会雑誌 40(2) 397-397 2020年2月  
  • Giammauro Berardi, Zenichi Morise, Carlo Sposito, Kazuharu Igarashi, Valentina Panetta, Ilaria Simonelli, Sungho Kim, Brian K P Goh, Shoji Kubo, Shogo Tanaka, Yutaka Takeda, Giuseppe Maria Ettorre, Gregory C Wilson, Matteo Cimino, Chung-Yip Chan, Guido Torzilli, Tan To Cheung, Hironori Kaneko, Vincenzo Mazzaferro, David A Geller, Ho-Seong Han, Akishige Kanazawa, Go Wakabayashi, Roberto Ivan Troisi
    Journal of hepatology 72(1) 75-84 2020年1月  査読有り
    BACKGROUND & AIMS: Treatment allocation in patients with hepatocellular carcinoma (HCC) on a background of Child-Pugh B (CP-B) cirrhosis is controversial. Liver resection has been proposed in small series with acceptable outcomes, but data are limited. The aim of this study was to evaluate the outcomes of patients undergoing liver resection for HCC in CP-B cirrhosis, focusing on the surgical risks and survival. METHODS: Patients were retrospectively pooled from 14 international referral centers from 2002 to 2017. Postoperative and oncological outcomes were investigated. Prediction models for surgical risks, disease-free survival and overall survival were constructed. RESULTS: A total of 253 patients were included, of whom 57.3% of patients had a preoperative platelet count <100,000/mm3, 43.5% had preoperative ascites, and 56.9% had portal hypertension. A minor hepatectomy was most commonly performed (84.6%) and 122 (48.2%) were operated on by minimally invasive surgery (MIS). Ninety-day mortality was 4.3% with 6 patients (2.3%) dying from liver failure. One hundred and eight patients (42.7%) experienced complications, of which the most common was ascites (37.5%). Patients undergoing major hepatectomies had higher 90-day mortality (10.3% vs. 3.3%; p = 0.04) and morbidity rates (69.2% vs. 37.9%; p <0.001). Patients undergoing an open hepatectomy had higher morbidity (52.7% vs. 31.9%; p = 0.001) than those undergoing MIS. A prediction model for surgical risk was constructed (https://childb.shinyapps.io/morbidity/). The 5-year overall survival rate was 47%, and 56.9% of patients experienced recurrence. Prediction models for overall survival (https://childb.shinyapps.io/survival/) and disease-free survival (https://childb.shinyapps.io/DFsurvival/) were constructed. CONCLUSIONS: Liver resection should be considered for patients with HCC and CP-B cirrhosis after careful selection according to patient characteristics, tumor pattern and liver function, while aiming to minimize surgical stress. An estimation of the surgical risk and survival advantage may be helpful in treatment allocation, eventually improving postoperative morbidity and achieving safe oncological outcomes. LAY SUMMARY: Liver resection for hepatocellular carcinoma in advanced cirrhosis (Child-Pugh B score) is associated with a high rate of postoperative complications. However, due to the limited therapeutic alternatives in this setting, recent studies have shown promising results after accurate patient selection. In our international multicenter study, we provide 3 clinical models to predict postoperative surgical risks and long-term survival following liver resection, with the aim of improving treatment allocation and eventually clinical outcomes.
  • Norihiko Kawabe, Takahiko Higashiguchi, Hironobu Yasuoka, Toki Kawai, Kenshiro Kamio, Takayuki Ochi, Chihiro Hayashi, Masahiro Shimura, Shinpei Furuta, Satoshi Arakawa, Yuka Kondo, Yukio Asano, Hidetoshi Nagata, Masahiro Ito, Akihiko Horiguchi, Zenichi Morise
    Fujita medical journal 6(1) 21-26 2020年  
    Hepatocellular adenoma (HCA) is a benign hepatocyte-derived epithelial tumor. HCA is associated with oral contraceptive use among Caucasian populations. We report a case of hepatocellular adenoma with a pedunculated protuberance and high protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels, which made diagnosis challenging. The patient was a 22-year-old woman. In a medical check-up, a high γ-GTP level was detected and a 115-mm solid mass was found in her lower abdomen via abdominal ultrasonography. A blood test showed a high PIVKA-II level. Abdominal CT showed a tumor in the lower abdomen. Contrast-enhanced CT showed a blood vessel thought to be the left hepatic artery connecting to the mass, and a blood vessel thought to be the left hepatic vein returning from the mass to the inferior vena cava. In EOB-MRI, uneven enhancement was observed after contrast imaging, but washout in the equilibrium phase was unclear. Parenchymal hepatocyte phases showed a pale, non-uniform, high signal. These findings indicated that the tumor was derived from the left lobe of the liver and was suggestive of HCC. Surgical resection was then performed. A pathological examination led to a diagnosis of HCA, corresponding to unclassified HCA. The WHO classification of tumors of the digestive system based on an immunohistological examination includes HNF1α-inactivated HCA, β-catenin-activated HCA, inflammatory HCA, and unclassified HCA. In summary, our patient had a large HCA with pedunculated protrusion into the extrahepatic pelvic cavity. This case was challenging to diagnose because of abnormally high PIVKA-II levels, and it was resected laparoscopically.
  • 竹松 百合子, 松原 章江, 柴崎 晋, 守瀬 善一, 稲葉 一樹, 須田 康一, 加藤 悠太郎, 花井 恒一, 杉岡 篤, 宇山 一朗
    外科と代謝・栄養 54(5) 104-104 2020年  
  • Zenichi Morise
    Annals of Gastroenterological Surgery 4(5) 485-489 2020年  
    © 2020 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery Recurrence of liver cancers inside the liver are often treated with liver resection (LR). However, increased risks of complications and conversion during operation were reported in laparoscopic repeat LR (LRLR). The indication is still controversial. One multi-institutional propensity score matching analysis of LRLR vs open repeat LR for hepatocellular carcinoma, two propensity score matching analyses for colorectal metastases, and two meta-analyses including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, metastases, and other tumors have been reported to date. LRLR was reported with better to comparable short-term and similar long-term outcomes. Furthermore, the shorter operation time and the smaller amount of intraoperative bleeding for LRLR was reported for the patients who had undergone laparoscopic rather than open LR as an earlier procedure. The speculations are presented, that complete dissection of adhesion can be dodged and laparoscopic minor repeated LR can minimize the liver functional deterioration in cirrhotic patients. LRLR, as a powerful local therapy, could contribute to the long-term outcomes of those with deteriorated liver function. However, the procedure is now in its developing stage worldwide and further accumulation of experiences and evaluation are needed.
  • Z. Morise, L. Aldrighetti, G. Belli, F. Ratti, A. Belli, D. Cherqui, M. Tanabe, G. Wakabayashi, T. T. Cheung, C. M. Lo, S. Tanaka, S. Kubo, Y. Okamura, K. Uesaka, K. Monden, H. Sadamori, K. Hashida, K. Kawamoto, N. Gotohda, K. H. Chen, A. Kanazawa, Y. Takeda, Y. Ohmura, M. Ueno, T. Ogura, K. S. Suh, Y. Kato, A. Sugioka, H. Nitta, M. Yasunaga, N. A. Halium, A. Laurent, H. Kaneko, Y. Otsuka, K. H. Kim, H. D. Cho, C. C.W. Lin, Y. Ome, Y. Seyama, R. I. Troisi, G. Berardi, F. Roteller, G. C. Wilson, D. A. Geller, O. Soubrane, T. Yoh, T. Kaizu, Y. Kumamoto, H. S. Han, E. Ekmekcigil, I. Dagher, D. Fuks, B. Gayet, J. F. Buell, R. Ciria, J. Briceno, N. O'Rourke, J. Lewin, B. Edwin, M. Shinoda, Y. Abe, M. Abu Hilal, M. Alzoubi
    British Journal of Surgery 107(7) 889-895 2020年  査読有り
    © 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: In the absence of randomized controlled data and even propensity-matched data, indications for, and outcomes of, laparoscopic repeat liver resection for hepatocellular carcinoma (HCC) remain uncertain. This study aimed to clarify the current indications for laparoscopic repeat liver resection for HCC, and to evaluate outcomes. Methods: Forty-two liver surgery centres around the world registered patients who underwent repeat liver resection for HCC. Patient characteristics, preoperative liver function, tumour characteristics, surgical method, and short- and long-term outcomes were recorded. Results: Analyses showed that the laparoscopic procedure was generally used in patients with relatively poor performance status and liver function, but favourable tumour characteristics. Intraoperative blood loss (mean(s.d.) 254(551) versus 748(1128) ml; P < 0·001), duration of operation (248(156) versus 285(167) min; P < 0·001), morbidity (12·7 versus 18·1 per cent; P = 0·006) and duration of postoperative hospital stay (10·1(14·3) versus 11·8(11·8) days; P = 0·013) were significantly reduced for laparoscopic compared with open procedures, whereas survival time was comparable (median 10·04 versus 8·94 years; P = 0·297). Propensity score matching showed that laparoscopic repeat liver resection for HCC resulted in less intraoperative blood loss (268(730) versus 497(784) ml; P = 0·001) and a longer operation time (272(187) versus 232(129); P = 0·007) than the open approach, and similar survival time (12·55 versus 8·94 years; P = 0·086). Conclusion: Laparoscopic repeat liver resection is feasible in selected patients with recurrent HCC.
  • Nikdokht Rashidian, Wouter Willaert, Isabelle Van Herzeele, Zenichi Morise, Adnan Alseidi, Roberto I. Troisi, Saleh Alabbad, Maria B. Doyle, Javier Briceño-Delgado, Fulvio Calise, Eugene P. Ceppa, Kuo Hsin Chen, Daniel Cherqui, Tan T. Cheung, Charles C.W. Lin, Sean Cleary, Choon H. David Kwon, Ismael Dominguez-Rosado, Alessandro Ferrero, Susanne G. Warner, Gian L. Grazi, Chet Hammill, Ho Seong Han, Paul Hansen, Scott Helton, Osamu Itano, Ali Jafarian, Rohan Jeyarajah, Hironori Kaneko, Yutaro Kato, Shoji Kubo, Jun Li, Valerio Lucidi, Pietro Majno, Erin Maynard, Roberto Montalti, Silvio Nadalin, Hiroyuki Nitta, Yuichiro Otsuka, Fernando Rotellar, Benjamin Samstein, Olivier Soubrane, Atsushi Sugioka, Minoru Tanabe, Guido Torzilli, Aude Vanlander, Go Wakabayashi
    HPB 22(10) 1429-1441 2020年  査読有り
    © 2020 International Hepato-Pancreato-Biliary Association Inc. Background: In general surgery residency, hepatobiliary training varies significantly across the world. The aim of this study was to establish an international consensus among hepatobiliary surgeons on components of a hepatobiliary curriculum for general surgery residents. Methods: A three-round modified Delphi technique was employed. Fifty-two hepatobiliary surgeons involved in general surgery training programs were invited. An initial questionnaire was developed by a group of experts in hepatobiliary and educational research after a systematic literature review. It comprised 90 statements about knowledge, technical skills, attitudes, and postoperative care. Panelists could add or alter items. The survey was delivered electronically and the panel was instructed to score the items based on 5-point Likert scale. Consensus was reached when at least 80% of panelists agreed on a statement with Cronbach's alpha value >0.8. Results: Forty-one (79%) experts have participated. Sixteen panelists are based in Asia, 14 in Europe, and 11 in the Americas. Eighty percent of all proposed skills (81/101) were considered fundamental including knowledge (39/43), technical skills (16/32), attitude (15/15), and postoperative care (11/11). Conclusion: An international consensus was achieved on components of a hepatobiliary curriculum. Acquiring broad knowledge is fundamental during residency. Advanced liver resection techniques require specialized hepatobiliary training.

MISC

 614

書籍等出版物

 12
  • 守瀬善一ほか, 監修-肝臓内視鏡外科研究会, 編集-金子弘真,若林剛 (担当:共著, 範囲:第I章 適応と基本手技 8 肝の授動)
    南山堂 2019年12月 (ISBN: 9784525313616)
  • Zenichi Morise et al., Editor-Heather Gilbert (担当:共著)
    2019年
  • 守瀬善一ほか, 監修-北野, 正剛, 編集-田邉稔,池田徳彦,坂井義治 (担当:共著, 範囲:総論 第15章 外科と免疫)
    医学書院 2019年1月 (ISBN: 9784260036306)
  • 守瀬善一ほか, 編集-北野正剛,田邉稔,池田徳彦, 監修-畠山勝義 (担当:共著, 範囲:総論 第15章 外科と免疫)
    医学書院 2016年2月 (ISBN: 9784260021487)
  • 守瀬 善一 (担当:共著, 範囲:X-ray diagnosis with a bloating agent for foreign object ingestion)
    Baishideng Publishing Group Inc, 2015年