Koichi Yano

Preoperative maximal removal rate of technetium-99m-galactosyl-human serum albumin of the remnant liver is associated with postoperative tumor relapse in hepatitis C virus-related hepatocellular carcinoma

Background Prognosis in patients with hepatocellular carcinoma (HCC) is not only influenced by tumor-related factors but also by the background liver functions. The maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) of the remnant liver (rGSA-Rmax) is a useful candidate for predicting the liver function and clarifying the relationship between the remnant liver functional reserve and tumor-free survival in patients who have undergone hepatectomy. Patients and methods One hundred and sixty-five patients with HCC who underwent curative hepatectomy were divided into three groups of hepatitis B virus (B-HCC; n=42), hepatitis C virus (C-HCC, n=58), and non-B, non-C (NBNC-HCC, n=65). The relationship between rGSA-Rmax and survival was examined by univariate and multivariate analyses. Results In the C-HCC group, the albumin, or LHL15, level was significantly lower, and alanine aminotransferase, ICGR15, and the prevalence of grade B liver damage were significantly higher than other two groups (P<0.05). GSA-Rmax or rGSA-Rmax was not different between the three groups. Lower GSA-Rmax and rGSA-Rmax were only significantly associated with lower tumor-free survival in the C-HCC group by the univariate analysis (P<0.05) but not significantly by the multivariate analysis. Conclusion GSA-Rmax and rGSA-Rmax reflect the severity of liver dysfunction and furthermore, the lower rGSA-Rmax is useful as a complementary factor to predict the early HCC recurrence after hepatectomy.

Curative distal pancreatectomy in patients with acinar cell carcinoma of pancreas diagnosed by endoscopic aspiration via esophago-jejunostomy: A successful case report

Highlights • This is a rare report of acinar cell carcinoma of pancreas diagnosed preoperatively.• Accurate histological diagnosis was performed by endoscopic FNA via jejunal loop after gastrectomy.• Accurate histological diagnosis is useful in the field of pancreatic surgery, especially in cases of rare or small malignant lesions.

Intrahepatic portal vein thrombosis due to postoperative biliary obstruction successfully treated by a partial thrombectomy combined with thrombolytic drug therapy

Highlights • Portal vein thrombosis due to constriction of hepaticojejunostomy is rarely occured, in which increased biliary pressure by obstructive jaundice decreased portal flow.• Re-anastomosis and postoperative thromolytic therapy recovered occluded portal flow.

Safe Resection of Renal Cell Carcinoma with Liver Invasion Using Liver Hanging Technique Supported by Preoperative Portal Vein Embolization

In cases of RCC with liver involvement, partial hepatectomy is known to provide a better chance of survival for patients. For this reason, complete resection with clear surgical margin is thought to be necessary to achieve favorable outcome. Anterior liver hanging maneuver was extremely useful during hemihepatectomy in this rare type of RCC. A 63-year-old male was diagnosed with a large right renal cell carcinoma. The tumor measured 10 cm in diameter with tumor thrombus toward the inferior vena cava (IVC). In addition, we observed direct infiltration to the liver. We attempted a preoperative portal vein embolization (PVE) to preserve residual liver volume and function after right lobectomy. After PVE the resected volume decreased from 921 cm3 (71%) to 599 cm3 (53.4%). During the procedure, a nasogastric tube was placed in the retrohepatic space for liver hanging maneuver according to the original Belghitis maneuver after dissection of the renal artery and vein. After hepatic parenchymal transection exposing vena cava, the right hepatic veins were safely transected using vascular stapler; right nephrectomy and hemihepatectomy were performed. The patient recovered without postoperative hepatic or urinary complications and has remained free of local recurrence and any de novo metastasis for 18 months.

Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin is correlated with liver functional parameters, but did not predict postoperative morbidity

Background Recently, posthepatectomy complications have been predicted by advances of new liver functional parameters, and the technetium-99m-galactosyl human serum albumin (GSA) liver scintigraphy has been applied widely for this purpose. We evaluated the clinical significance of the regional maximal removal rate (GSA-Rmax) in patients with various liver diseases as predictors of posthepatectomy complications. Patients and methods Between 2012 and March 2016, we examined 200 patients who underwent hepatectomy for liver and biliary diseases. The patients’ background liver conditions included chronic viral liver diseases in 147 patients, normal liver in 44 patients, and others in nine patients. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 69 (35%) patients. A multivariate logistic analysis was carried out to detect the predictive parameters for complications. Results The median and mean preoperative GSA-Rmax was 0.420 and 0.448±0.148 mg/min, respectively. The GSA-Rmax was significantly correlated with liver functional parameters of ICGR15, LHL15, HH15, platelet count, prothrombin activity, and serum hyaluronic acid level (P<0.01), and was significantly correlated with postoperative total bilirubin level and C-reactive protein level (P<0.05). With respect to patient outcomes, GSA-Rmax was significantly lower in patients with long-term ascites (P<0.05). The predictive cutoff value for posthepatectomy long-term ascites for GSA-Rmax was 0.421 mg/min. However, the multivariate logistic regression analysis identified that a higher serum hyaluronic acid level and a lower platelet count were significant, independent factors, but not lower GSA-Rmax. Conclusion GSA-Rmax is one of the liver functional parameters and is a complementary parameter to predict postoperative hyperbilirubinemia, inflammatory responses, and ascites when 99mTc-GSA scintigraphy is performed.

Prediction of Posthepatectomy Liver Failure Proposed by the International Study Group of Liver Surgery: Residual Liver Function Estimation With 99mTc-Galactosyl Human Serum Albumin Scintigraphy

Purpose The International Study Group of Liver Surgery (ISGLS) proposed a definition and grading system for posthepatectomy liver failure (PHLF). We evaluated the usefulness of residual liver function estimation using 99mTc-galactosyl human serum albumin (99mTc-GSA) for the prediction of PHLF. Methods Patients with liver tumors (n = 136) and scheduled for hepatectomy underwent 99mTc-GSA scintigraphy. Based on their imaging data, the maximal GSA removal rate (GSA-Rmax)was calculated using multicompartment analysis. We also calculated GSA-Rmax in the predicted residual liver (GSA-RL) whose volume was determined on computed tomography (CT) scans. We compared the age, sex, 15-minute indocyanine green retention rate; albumin, bilirubin, hyaluronic acid, and type 4 collagen levels; the Child-Pugh classification; residual liver volume; residual liver percentage; GSA-Rmax; and GSA-RL in patients with and without PHLF. Univariate and multivariate logistic analyses were used for statistical assessments. Results Of 136 patients, 17 (12.5%) met the ISGLS criteria for PHLF (ISGLS-PHLF). There was a statistically significant difference in the age, albumin level, Child-Pugh classification, residual liver volume, residual liver percentage, GSA-Rmax, and GSA-RL between patients with and without PHLF. Based on multivariate analysis, GSA-RL and the residual liver volume were significant independent predictors of ISGLS-PHLF (P = 0.004 and P = 0.038, respectively). The odds ratio was 149423 for GSA-RL and 1.003 for the residual liver volume. Conclusions GSA-RL calculated using 99mTc-GSA scintigraphy was the most useful independent predictor for ISGLS-PHLF.

Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver‐to‐spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group. Individual prevalence of NAFLD at 1 month, 6 months and 1 year after surgery was 12%, 21% and 15%. Significantly different factors by univariate analysis were as follows: 1 month: age, sex, total protein (TP), total cholesterol (TC) and copper (Cu); 6 months: sex, disease, surgical method, portal vein resection (PVR), frequency of defecation, TC and Cu; 1 year: age, sex, disease, surgical method, PVR, frequency of defecation, TP and Cu. Risk factors by multivariate analysis were as follows: 1 month: not elderly age, female sex and a decrease in Cu; 6 months: female sex and a decrease in Cu; 1 year: a decrease in Cu. NAFLD after PD frequently developed in women with a decrease in serum Cu and was influenced by various factors related to poor digestion and absorption associated with pancreatic exocrine insufficiency.

Questionnaire survey on work motivations of gastrointestinal and hepatobiliary pancreatic surgeons enrolled in a Japanese national interdisciplinary program

Among young residents, there seems to be a decreasing desire to become surgeons, resulting in a decrease in the number of surgeons. There is concern regarding a shortage of hepatobiliary pancreatic (HBP) surgery residents in Japan. A questionnaire survey was designed to assess the work motivations of Japanese gastrointestinal (GI) and HBP surgeons.

Abstract 3169: Influence of systemic and local immune response on overall survival after hepatic resection of colorectal liver metastasis

Background: Colorectal cancer progression is dependent on complex interactions between the tumor and the host. Tumor infiltrating lymphocytes (TIL) have been reported as a prognostic factor in colorectal cancer. The aim of this study was to assess the prognostic value of pre-operative systemic immune biomarkers and TIL in patients with resectable colorectal liver metastases (CLM). Methods: Clinicopathological data were reviewed for patients (n = 31) underwent hepatic resections for CLM between 2000 and 2008. Prognostic variables are factors of the primary lesion, factors of the metastatic lesion, and factors of host inflammatory biomarkers measured from routine pre-operative blood tests (modified Glasgow Prognostic Score and neutrophil to lymphocyte ratio (NLR)). Univariate and multivariate analyses for prognostic factors were performed. To evaluate the local immune responses for resected metastatic lesion, immunohistochemical analysis was performed. The immune subsets were CD8+ T cells, CD45RO+ T cells, Fork head box p3+ (FOXP3+) T cells, and CD66b+ neutrophils. Results: The number of metastases ≥ 4, extrahepatic metastasis, adjuvant chemotherapy, and raised NLR > 4.1 were correlated with cancer-specific survival in univariate analysis. On multivariate analysis, the number of metastases ≥ 4, adjuvant chemotherapy, and elevated NLR remained independent prognostic indicators (metastases ≥ 4: HR = 0.09, CI = 0.01-0.56, p = 0.0102, adjuvant chemotherapy: HR = 0.08, CI = 0.01-0.39, p = 0.0025, NLR: HR = 0.11, CI = 0.01-0.99, p = 0.0494). Accumulation of CD45RO+ T cells and FOXP3+ T cells in the metasatic tumors were significantly associated with favorable survival in patients with resectable CLM (P = 0.02 and 0.04, respectively). Conclusions: The results of the present study show that the NLR has prognostic value in patients who conduct a hepatic resection for CLM. Moreover, accumulation of CD45RO+ T cells and FOXP3+ T cells in metastatic lesions are independent favorable prognostic factor. Based on the present results and previously literature, systemic immune response including NLR and local immune response may be promising as prognostic factor of patients with resectable CLM. Citation Format: Takeomi Hamada, Ishizaki Hidenobu, Yukihiro Haruyama, Rouko Hamada, Koichi Yano, Kazuhiro Otani, Yoshiro Fujii, Kazuhiro Kondo, Hiroaki Kataoka. Influence of systemic and local immune response on overall survival after hepatic resection of colorectal liver metastasis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3169. doi:10.1158/1538-7445.AM2015-3169