Yasukane Asano

Hepatocyte growth factor promotes remodeling of murine liver fibrosis, accelerating recruitment of bone marrow-derived cells into the liver.

Aim:  Hepatocyte growth factor (HGF) ameliorates liver fibrosis/cirrhosis in animal models, while the participation of bone marrow‐derived cells (BMC) in the repair process of injured organs has recently been reported. In this study we investigated the roles of HGF and BMC in a remodeling process of liver fibrosis.

Hepatocyte growth factor gene transfer with naked plasmid DNA ameliorates dimethylnitrosamine‐induced liver fibrosis in rats

Aim:  Hepatocyte growth factor (HGF) has various biological properties, including antifibrogenic activity. In the present study, we tested the efficacy of HGF gene therapy using naked plasmid DNA in dimethylnitrosamine (DMN)‐induced liver fibrosis in a rat model.

Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy

Postoperative pancreatic fistula (PF) remains a major complication after pancreaticoduodenectomy (PD). We aimed to investigate the predictors of clinically relevant PF after PD.

Parenchyma-preserving hepatectomy based on portal ramification and perfusion of the right anterior section: preserving the ventral or dorsal area

Anatomical hepatectomy aims to eliminate the spread of malignant tumor cells via portal vein systemically. An anatomical concept of the right anterior section (RAS) and preservation of the liver parenchyma within the RAS has been proposed.

Primary squamous cell carcinoma of the liver: an uncommon finding in contrast-enhanced ultrasonography imaging.

Primary squamous cell carcinoma (SCC) of the liver is rare tumor with an unfavorable prognosis. We report a case of advanced primary SCC of the liver arising adjacent to a nonparasitic liver cyst, invading into the right diaphragm and the right lung tissue. Contrast-enhanced ultrasonography (CE-US) demonstrated unique enhancement in the late vascular phase, which was incompatible with those observed in hepatocellular carcinoma, cholangiocellular carcinoma, or metastatic adenocarcinoma. The patient underwent surgical resection of the tumor followed by systemic chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP), while radiation chemotherapy was not applied because of relatively poor performance status. Although postoperative image analysis revealed no recurrence 4 months later, the patient died 13 months after the operation from recurrence. Immunohistological analysis of the resected specimen revealed that this SCC contained many capillary endothelial vessels expressing CD31 or CD34, possibly reflecting the unique imaging pattern in the late vascular phase of CE-US, which has been reported in choangiolocellular carcinoma. In addition, we reviewed which kind of treatment would be suitable for advanced hepatic primary SCC in the literature. From the review, it could be proposed that a combination of radiation therapy, systemic chemotherapy (5-FU and CDDP) and surgical resection, if possible, is appropriate for advanced primary SCC of the liver.

Multifocal Mass Lesions in Autoimmune Pancreatitis

A 59-year-old male patient with jaundice was referred to our hospital because of mass lesions in the pancreatic head and tail. An immunological examination revealed an elevated serum IgG4 level. Computed tomography showed two clear boundary mass lesions in the pancreatic head and tail. Magnetic resonance imaging showed that the mass lesions exhibited low intensity on T1-weighted images and iso-intensity on T2-weighted images. Magnetic resonance cholangiopancreatography showed an obstruction of the main pancreatic duct in the pancreatic head and tail. The possibility of malignant tumors could not be ruled out; therefore, we performed total pancreatectomy. A histopathological examination of the nodular lesions revealed severe lymphoplasmacytic infiltration and inflammatory change around the pancreatic ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the nodules. According to these pathological findings, we diagnosed the patient with IgG4-related multifocal mass lesions of autoimmune pancreatitis (AIP). It is difficult to distinguish between focal type AIP and pancreatic cancer. We herein report a rare case of multifocal mass lesions in AIP and include bibliographical comments.

AB061. P033. A comparison of delayed gastric emptying and nutritional status after pylorus-preserving versus stomach-preserving pancreaticoduodenectomy

Background: This study was performed to compare the incidence of delayed gastric emptying (DGE), postoperative outcome and long-term nutritional status between pyloruspreserving pancreaticoduodenectomy (PPPD) and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD). Methods: We retrospectively analyzed 133 patients who undergoing PPPD (n=89) or SSPPD (n=44) between March 2011 and December 2015. All cases of duodenojejunostomy in PPPD and gastrojejunostomy in SSPPD were performed antecolically. The postoperative nutritional status was explored by changes ratio in the body weight, serum total protein and serum albumin for 1 year after surgery. Results: The overall incidence of the DGE was 12%. The incidence of DGE was 13.5% (grade A: 5.6%, grade B: 4.5%, grade C: 3.4%) in PPPD group and 9.1% (grade A: 4.5%, grade B: 4.5%, grade C: 0%) in SSPPD group, and was no significant differences in both groups. The mean postoperative hospital stay was 42.8 days in the PPPD group and 37.2 days in the SSPPD group, and was no significant differences in both groups. The body weight ratio was decreased at 6 months after surgery in the SSPPD group, whereas it continued to decrease at 9 months after surgery in the PPPD group. It was gradually increased 9 months later after surgery in SSPPD group, and it was increased 12 months later after surgery in PPPD group. The serum total protein ratio and serum albumin ratio were decreased at 3 months after surgery and were gradually increased 6 months later after surgery in both groups. There were no significant differences with regard to postoperative body weight ratio, serum total protein ratio and serum albumin ratio in both groups for 1 year after surgery. Conclusions: SSPPD is equivalent outcomes in incidence of DGE and in postoperative long-term nutritional status comparing PPPD.

A Surgical Case of Synchronous Double Primary Cancers of the Bile Duct and Pancreas

Abstract A 54-year-old female was seen at another hospital because of jaundice. CT showed an unclear boundary and a poorly enhanced mass lesion in the pancreatic body, measuring 28 mm in diameter. MRCP showed stenosis of the lower bile duct and the main pancreatic duct in the pancreatic body and slight dilatation of the main pancreatic duct in the pancreatic tail. According to these findings, the preoperative diagnosis was synchronous double cancers of primary lower bile duct cancer and pancreatic body cancer. We performed pylorus-preserving pancreaticoduodenectomy with splenic artery and vein resection. A histopathological examination revealed that the lower bile duct tumor was moderately differentiated tubular adenocarcinoma, and the pancreatic body tumor was moderately differentiated tubular adenocarcinoma. These two tumors showed no histopathological continuity. According to these pathological findings, we diagnosed the patient with synchronous double cancers of primary lower bile duct cancer and panc...

Hepatectomy for Hilar Cholangiocarcinoma with Right-Sided Ligamentum Teres Using a Hepatectomy Simulation System

Right-sided ligamentum teres (RSLT) is a rare congenital anomaly often accompanied by variation of the hepatic vasculature. We herein report a surgical case of a hilar cholangiocarcinoma with RSLT in whom preoperative hepatectomy simulation proved useful for understanding the anatomical structure of the liver. A 78-year-old male with obstructive jaundice was referred to our department for further examination. The patient was suspected of having a hilar cholangiocarcinoma originating from the left hepatic bile duct by contrast-enhanced computed tomography (CT), and CT also showed right umbilical portion (RUP). Three-dimensional images of the hepatic vasculature and biliary system reconstructed using a hepatectomy simulation system suggested that all portal branches ramified from RUP were right paramedian branches, and three leftward portal branches from these ran parallel to the peripheral bile ducts confluent with the left hepatic bile duct, where the tumor was present. Hepatic resection of part of the ventral area of the right paramedian sector and left hemiliver was performed along the demarcation line drawn after clamping the portal branches; the ratio of estimated liver resection volume was 28.9%. After the operation, bile leakage occurred. However, the leakage was treated with percutaneous drainage alone, and the patient was discharged 77 days after the operation. The patient is doing well without any signs of recurrence 21 months after the operation. The vascular and biliary anatomy in patients with RSLT is complicated and should be evaluated in detail preoperatively using a hepatectomy simulation system.

Laparoscopic Resection of an Epithelial Cyst in an Intrapancreatic Accessory Spleen

An epithelial cyst in an intrapancreatic accessory spleen (ECIAS) is rare. We herein report a case of a patient with ECIAS who underwent laparoscopic surgery. A 57-year-old woman was referred to our hospital because of a pancreatic tail tumor. She was asymptomatic, and a physical examination revealed no remarkable abnormalities. The levels of the tumor marker carbohydrate antigen 19-9 (CA19-9) and s-pancreas-1 antigen (SPan-1) were elevated. Ultrasonography showed a well-defined homogeneous cystic tumor. Computed tomography showed a well-demarcated cystic tumor in the pancreatic tail. Magnetic resonance imaging showed that the cystic tumor exhibited low intensity on T1-weighted images and high intensity on T2-weighted images. The cystic tumor was diagnosed as mucinous cystic neoplasm preoperatively. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. A histopathological examination revealed the cyst wall to be lined by stratified squamous epithelium within splenic parenchyma, and the ultimate diagnosis was ECIAS. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. ECIAS is very difficult to diagnose preoperatively. Laparoscopic surgery is a safe and minimally invasive procedure for patients with difficult-to-diagnose pancreatic tail tumor suspected of having low-grade malignancy.