Masaaki Okihara

Predicting hepatic failure with a new diagnostic technique by preoperative liver scintigraphy and computed tomography: a pilot study in 123 patients undergoing liver resection

BackgroundA novel index, total liver LU15, has been identified as a surrogate marker for liver function. We evaluated the ability of preoperative remnant liver LU15 values to predict postoperative hepatic failure.MethodsPreoperative risk factors for postoperative hepatic failure and remnant liver LU15 were evaluated in 123 patients undergoing liver resection for several diseases from September 1st, 2007 to December 1st, 2016. We calculated the remnant liver LU15 value from the total liver LU15 value and the functional remnant liver ratio. Risk factors for postoperative hepatic failure was determined by univariate and multivariate analysis.ResultsHepatic failure grade B/C developed postoperatively in six patients of seven patients within Makuuchi criteria / without criteria for remnant liver LU15. Operative time (p = 0.0242) and criteria for remnant liver LU15 (p = 0.0001) were prognostic factors for hepatic failure according to the univariate analysis. And criteria for remnant liver LU15 (p = 0.0009) was only prognostic factor by multivariate analysis.ConclusionBased on the findings form this pilot study, it appears that patients with a remnant liver LU15 value of 13 or less may have a high risk of postoperative hepatic failure.

Increased expression of HOXB9 in hepatocellular carcinoma predicts poor overall survival but a beneficial response to sorafenib

At advanced stages of hepatocellular carcinoma (HCC), the multikinase inhibitor sorafenib is the only effective treatment. Surrogate markers that predict the biological and clinical efficacy of sorafenib may help tailor treatment on an individual patient basis. In the present study, the clinical significance of the expression of HOXB9, a transcriptional factor, in HCC was assessed. Increased HOXB9 expression in HCC was found to be positively correlated with the expression of angiogenic factors, increased vascular invasion and was found to be associated with poor overall patient survival. Sorafenib treatment effectively suppressed the expression of angiogenic factors and activation of the Raf/MEK/ERK pathway in HOXB9-expressing HCC cell lines. Consistent with these findings, HCC patients, whose cancer expressed high levels of HOXB9, exhibited increased overall survival upon sorafenib treatment. Collectively, these results suggest that HOXB9 expression in HCC could be a surrogate marker for a beneficial response to sorafenib treatment.

Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples

PurposePostoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery.MethodsConsecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors.ResultsA total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25.ConclusionsSubcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.

Efficacy of Modified Technique in Pancreatojejunostomy to PreventPostoperative Pancreatic Fistula after Pancreatoduodenectomy

Introduction: In pancreatoduodenectomy (PD), postoperative pancreatic fistula (POPF) remains the single most important cause of morbidity. We present a modification for duct to mucosa pancreaticojejunostomy. Materials and Methods: Total 134 patients, who had undergone PD or pylorus preserving PD (PPPD) between November 2007 and October 2013 at our institution, were analyzed. From April 2012 to December 2014, 53 consecutive patients underwent PD or PPPD by the new modified technique and 81 patients by the former technique before March 2012. The preoperative demographics and clinical information were retrospectively obtained from both groups and were analyzed along with risk factors of POPF. Moreover, risk factors for POPF grade B/C were analysed by univariate and multivariate analysis. Results: Operation procedures were pylorus preserving PD in 119 and PD in 15. Incidence of POPF grade B/C was 11% in the new method, which was significantly lower than in the former method (38%) (p=0.0135). Moreover, risk factors for POPF grade B/C in univariate analysis were texture of pancreas (p=0.0004), dilatation of pancreatic duct (p=0.0100), and anastomosis method (p=0.0135). In multivariate analysis, risk factors were texture of pancreas (p=0.0010) and anastomosis method (p=0.053). Conclusions: The new technique in pancreticojejunostomy was safe and reliable with low POPF grade B/C rate.