Showing papers by "Tadahiro Takada published in 2012"

New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo guidelines

Abstract: Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13).

Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial.

Abstract: The value of pancreatoduodenectomy (PD) with extended lymphadenectomy for pancreatic cancer has been evaluated by many retrospective studies and 3 randomized controlled trials (RCT). However, the protocols used and the results found in the 3 RCTs were diverse. Therefore, a multicenter RCT was proposed in 1998 to evaluate the primary end point of long-term survival and the secondary end points of morbidity, mortality and quality of life of patients undergoing standard versus extended lymphadenectomy in radical PD for pancreatic cancer. From March 2000 to May 2003, 112 patients with potentially curable pancreatic head cancer were enrolled and intraoperatively randomized to a standard or extended lymphadenectomy group. No resected patients received any adjuvant treatments. A hundred and one eligible patients were analyzed. Demographic and histopathological characteristics of the two groups were similar. The mean operating time, intraoperative blood loss and number of retrieved lymph nodes were greater in the extended group, but the other operative results were comparable. Although this multicenter RCT was conducted in a strict setting, extended lymphadenectomy in radical PD did not benefit long-term survival in patients with resectable pancreatic head cancer and led to levels of morbidity, mortality and quality of life comparable to those found after standard lymphadenectomy.

A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection: multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery

Abstract: Background/purpose The aim of this study was to create a nomogram to predict the disease-free survival of patients with colorectal liver metastases treated with hepatic resection.

Prognostic factors of acute cholangitis in cases managed using the Tokyo Guidelines

Abstract: Background/purpose In 2007, the Tokyo Guidelines (TG07) working group established diagnostic criteria for assessment of the severity of acute cholangitis. This study aimed to analyze outcomes and identify predictors of mortality in patients with acute cholangitis managed according to the TG07.

Morphometric and immunohistochemical study of cholangiolocellular carcinoma: comparison with non-neoplastic cholangiole, interlobular duct and septal duct

Abstract: Background/purpose The origin of cholangiolocellular carcinoma (CoCC) is still controversial. To solve this problem, morphometric and immunohistochemical features of CoCC were examined.

Whereabouts of an internal short stent placed across the pancreaticojejunostomy following pancreatoduodenectomy

Abstract: It is generally thought that an internal short stent placed across the pancreaticojejunostomy (PJ) following pancreatoduodenectomy (PD) usually passes spontaneously through the rectum thereafter; however, we experienced some patients who presented with pancreatitis and cholangitis owing to delayed defecation of the stent. The purpose of this study was to clarify when the stent eventually became detached from the PJ and how it passed through the body until it was finally defecated. In addition, we also investigated the factors that may prevent such detachment and defecation. This study retrospectively analyzed 57 patients who had had internal short stents placed across the PJ following PD. Defecation from the body, detachment from the PJ, and distal migration of the stent was confirmed by X-ray or computed tomography (CT) during the postoperative course. The cumulative rates of defecation and detachment of the stents, complications in relation to delayed defecation of the stents, and factors predictive of the delayed defecation, delayed detachment, and distal migration of the stents were analyzed. Defecation of the stent was confirmed in 35 patients. The median time to defecation after PD and the cumulative defecation rate at 1 year were 454 days and 41 %, respectively. Acute pancreatitis occurred in 2 patients with the stent remaining in the pancreatic duct. One patient experienced acute cholangitis owing to migration of the stent to the bile duct. Multivariate analysis showed that ≥5 stitches in the duct-to-mucosa anastomosis, stent size of ≥5 Fr, and pancreatic fistula classified as either Grade B or C were independent predictive factors for delayed defecation of the stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed detachment of the stent. A stent size of ≥5 Fr was a risk factor for distal migration of the stent. In more than half of the study patients, internal short stents were not defecated within 1 year. Retrieval of the stent should be considered following the migration of an internal short stent. A stent size of ≥5 Fr was an independent predictive factor for delayed defecation and distal migration of a stent. Five or more stitches in the duct-to-mucosa anastomosis was an independent predictive factor for delayed defecation and detachment of a stent.

Validity of the urinary trypsinogen-2 test in the diagnosis of acute pancreatitis.

Abstract: OBJECTIVES A simple urinary trypsinogen-2 test was evaluated for the diagnosis of acute pancreatitis. METHODS This prospective multicenter study enrolled consecutive patients with acute abdominal pain who presented to the emergency department or who were hospitalized at 1 of 21 medical institutions in Japan. Patients were tested with urinary trypsinogen-2 dipstick test and a quantitative trypsinogen-2 assay, and these values were compared with serum amylase and lipase findings. RESULTS A total of 412 patients were enrolled. The trypsinogen-2 dipstick test was positive in 107 of 156 patients with acute pancreatitis (sensitivity, 68.6%) and in 33 of 256 patients with nonpancreatic abdominal pain (specificity, 87.1%). The sensitivity for the diagnosis of pancreatitis caused by alcohol and gallstones by the dipstick test was 72.2% and 81.8%, respectively, which was much higher than those associated with amylase testing. There are several degrees of positivity within the urinary trypsinogen-2 dipstick test. Modification of the cutoff point such that positive (+) and most positive (++) results were interpreted as a positive result, the specificity and positive likelihood ratio increased to 92.2% and 7.63, respectively. CONCLUSIONS This simple, rapid, easy, and noninvasive urinary trypsinogen-2 test can diagnose or rule out most cases of acute pancreatitis.

Preface I: Highly advanced surgery in the hepatobiliary and pancreatic field

Abstract: The Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) was established in 1989. It was different from other societies in the concept of its inauguration, that is, it was founded for the purpose of educating and bringing forth surgeons capable of safely and reliably performing highly advanced surgery in the hepatobiliary and pancreatic field. At the meeting of the board of directors and the general meeting of the 16th JSHBPS held in Osaka in May, 2004, I declared, as the President of the Society, the establishment of the board certification system for expert surgeons. I will briefly explain the actual training system for HBP surgery in Japan. All new doctors after graduation from medical school in Japan are required to undergo 2 years of obligatory initial postgraduate clinical training in internal medicine, emergency medicine, pediatrics, and surgery. After this initial training, trainees advance to training in a specialty of their choice. Those who wish to become board-certified hepatobiliary-pancreatic (HBP) surgeons must undergo 4 to 5 years of specialty training in HBP surgery, while at the same time undergoing training 4 or 5 years toward board certification in gastroenterological surgery. To be a boardcertified surgeon in gastroenterology one must demonstrate competence in procedures such as routine gastrectomy and colectomy. During training in gastroenterological surgery, HBP surgical fellows must perform 50 highly advanced surgical operations in the field of HBP and submit a video recording of the procedures to the board. The video recording is evaluated by three board-certified instructors at other institutes. Currently, there currently are 400 boardcertified instructors at 190 board-certified training institutes in Japan. The first 12 board certifications in HBP surgery were awarded in 2011. These 12 new HBP specialists will go on to train the next generation of young HBP surgical fellows. In this collection of articles on highly advanced surgery in the hepatobiliary and pancreatic field, surgical and anatomical knowledge and surgical techniques in the liver, biliary tract, and pancreas are carefully presented by HBP expert surgeons. Dos and don’ts are also included. The surgical techniques introduced here are being practiced in the higher levels of board-certified institutions (HBP field) in Japan. It is expected that acquisition of such techniques and their practice in actual situations will improve the medical level in this field, contribute to social welfare, and enable further advances in HBP surgery.

Gallbladder cancer involving the extrahepatic bile duct.

Abstract: To the Editor: W e read with great interest the article by Nishio et al.1 The retrospective study revealed that the 5-year survival rate and median survival time, for 73 patients with gallbladder cancer (GBC) with pathologic extrahepatic biliary invasion (pEBI) after surgery, were 23% and 1.5 years, respectively, and that 12 patients with pEBI survived beyond 5 years. As the authors described, biliary surgeons know that the outcome for patients with GBC with invasion of an adjacent organ is poor even after R0 resecton.2–4 We found the results of the study interesting; however, it seems that there are a few issues to be discussed. First, there is no clear definition of pEBI in this article. There seems to be overlap and confusion between pEBI and pathological hepatoduodenal ligament invasion. In 3 studies listed in Table 5 of this study, the term “hepatoduodenal ligament invasion” was used rather than “pEBI.”3–5 A few previous reports analyzed GBC spread to the side of the hepatoduodenal ligament.6,7 Shimizu et al7 analyzed 50 patients with GBC extending into the subserosa and beyond, who underwent radical surgery and reported that pathological hepatoduodenal ligament invasion was present in 30 of the 50 patients, and that 25 of these patients had cancer cells in the wall of the extrahepatic bile duct itself. This means pathological hepatoduodenal ligament invasion does not always accompany pEBI. Strictly speaking, these 2 forms of GBC infiltration should be distinguished. Second, we have an interest in the surgical outcomes of patients according to the degree and type of pBEI. Previously, we analyzed 147 patients with advanced GBC by classifying them into F0 (n = 50), F1 (n = 38), F2 (n = 38), and F3 (n = 23) according to the number of positive histopathologic factors, consisting of direct invasion to the liver,

Portal vein resection in pancreaticoduodenectomy (with video)

Abstract: Superior mesenteric vein (SMV) resection during pancreaticoduodenectomy (PD) for pancreatic cancer was first reported by Moore in 1951. In Japan, utilization of portal vein resection (PVR) became popular beginning in the late 1970s and has resulted in an improved resection rate for pancreatic cancer. Outcomes of PVR differ according to the reported year and institution. In a recent report of meta-analysis, there was no difference in outcomes after PVR if R0 (negative surgical margins) resection was possible. Pancreatic surgery including vascular resection must be re-evaluated in light of recent advances in diagnostic imaging and surgical techniques, lower mortality and morbidity after PVR, and improvements in adjuvant and neo-adjuvant therapy. Isolated portal vein involvement should not be a contraindication to resection. Portal vein resection should be considered after appropriate patient selection based on an accurate diagnosis, provided that safe R0 resection is possible. We describe technical details and considerations for PVR during PD in this paper.