Publications by authors named "Toshimitsu Iwasaki"

Background: Tumor size (TS) is a well-established prognostic factor of pancreatic ductal adenocarcinoma (PDAC). However, whether a uniform treatment strategy can be applied for all resectable PDACs (R-PDACs) and borderline resectable PDACs (BR-PDACs), regardless of TS, remains unclear. This study aimed to investigate the impact of preoperative TS on surgical outcomes of patients with R-PDACs and BR-PDACs.

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Laparoscopic ventral and dorsal segmentectomies 8 are an option for parenchymal-sparing liver resection. However, laparoscopic anatomic posterosuperior liver segment resection is technically demanding because of its deep location and the many variations in the segment 8 Glissonean pedicle (G8). In this study, we describe a hepatic vein-guided approach (HVGA) to overcome these limitations.

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Objective: The aim of the study is to evaluate the influence of cachexia at the time of diagnosis of pancreatic ductal adenocarcinoma (PDAC) on prognosis in patients undergoing surgical resection.

Methods: Patients with data on preoperative body weight (BW) change followed by surgical resection during 2008-2017 were selected. Large BW loss was defined as weight loss >5% or >2% in individuals with body mass index less than 20 kg/m2 within 1 year preoperatively.

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Article Synopsis
  • - Focal nodular hyperplasia (FNH) is a rare, non-cancerous liver tumor often found in young women and may require treatment if there's a risk of it bursting.
  • - A case involving a 22-year-old woman with a large, 15 cm asymptomatic FNH tumor that was protruding from her liver prompted a surgical decision due to rupture risk.
  • - The surgery successfully combined preoperative transcatheter arterial embolization, which reduced the tumor size and controlled bleeding, leading to a safe laparoscopic liver resection, highlighting an effective treatment strategy for similar tumors.
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Background: S-1 adjuvant chemotherapy is the standard treatment in Asia for resectable pancreatic ductal adenocarcinoma. The relative dose intensity of adjuvant chemotherapy influences survival in pancreatic cancer but does not precisely reflect treatment schedule modifications. We investigated the effects of total dose intensity of S-1 adjuvant chemotherapy on the survival of patients with pancreatic cancer and the permissible dose reduction.

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We examined the value of preoperative dual time point (DTP) 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (FDG PET/CT) as a predictor of early recurrence or the outcomes in patients with pancreatic cancer. Standardized uptake values (SUVs) in DTP FDG PET/CT were performed as preoperative staging. SUVmax1 and SUVmax2 were obtained in 60 min and 120 min, respectively.

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Background: The treatment of pancreatic cancer (PDAC) remains clinically challenging, and neoadjuvant therapy (NAT) offers down staging and improved surgical resectability. Abundant fibrous stroma is involved in malignant characteristic of PDAC. We aimed to investigate tissue remodelling, particularly the alteration of the collagen architecture of the PDAC microenvironment by NAT.

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The expression of mesothelin correlates with a poor prognosis in patients with breast cancer. Since mesothelin plays a role in cancer metastasis in association with CA125, we herein examined the expression of mesothelin and CA125, and the clinicopathological meaning and prognosis of the co-expression of mesothelin and CA125 in breast cancer. Our results showed that among 478 patients, mesothelin and CA125 were co-expressed in 48 (10 %), mesothelin only in 75 (16 %), CA125 only in 217 (45 %), and neither in 234 (49 %).

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Article Synopsis
  • The study investigates the impact of metastases to lymph node #14 (LN#14) on the prognosis of patients with pancreatic head cancer who underwent surgery.
  • Among 99 patients analyzed, those with LN#14 metastasis had a significantly lower median overall survival (10.2 months) compared to those without (31.1 months).
  • The findings suggest that LN#14 metastasis is a critical prognostic indicator, independent of other lymph node metastases, highlighting its potential importance in patient outcomes.
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Recent studies have suggested that the interaction of mesothelin (MSLN) and cancer antigen 125 (CA125) enhances tumor metastases. The aim of the present study was to clarify the impact of MSLN and CA125 co-expression on the prognosis of patients with extrahepatic bile duct carcinoma (BDC). Tissue samples from patients who underwent surgical resection between 2007 and 2015 for perihilar or distal BDC were immunohistochemically examined.

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Article Synopsis
  • Long-term outcomes for patients with bile duct cancer after surgery are generally poor, especially following tumor recurrence, with current standard treatment being gemcitabine and cisplatin (GC) therapy.
  • A case study of a 65-year-old man showed promising results using carbon ion radiotherapy (CIRT) after initial GC therapy was effective, leading to reduced tumor size and improved survival for extended periods.
  • Despite multiple treatments and temporary stabilization, the patient ultimately experienced tumor regrowth and passed away 81 months post-surgery, highlighting the ongoing challenges in managing advanced bile duct cancer.
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Background: Sickle cell disease (SCD) is a monogenic disease characterized by sickle hemoglobin (HbS). Patients homozygous for HbS experience symptoms resulting from sickled erythrocytes no later than adolescence. However, heterozygous HbS carriers, or those with the so-called sickle cell trait (SCT), may undergo surgery without their hemoglobinopathy being known.

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Aberrant right hepatic arteries are sometimes involved in pancreatic head tumors or accidentally damaged during surgical procedures, which could result in postoperative complications. The risk of such injury has been discussed in patients undergoing pancreatoduodenectomy; however, no reports describe the influence of this anomaly in distal pancreatectomy. We report a patient with pancreatic body cancer with an accessory right hepatic artery following a very unique route.

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Sarcoidosis is a multisystemic granulomatous disease. It is rarely isolated in the spleen. The present report describes a case of isolated splenic sarcoidosis that was diagnosed histologically following laparoscopic splenectomy.

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Background: Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumorigenesis of ICPNs remains unclear.

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Mesothelin is expressed in various types of malignant tumors. The present study immunohistochemically investigated mesothelin expression and its clinicopathological significance in each subtype of breast cancer, with special reference to its cellular localization, in particular, membrane mesothelin expression. Using tissue specimens from 482 patients with breast cancer, immunohistochemistry was used to study mesothelin expression and help classify its localization as membrane or cytoplasmic expression.

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Background: The TNM (Tumor, Node, Metastasis) classification of the 8th Union for International Cancer Control and the 6th Japanese classification of biliary tract cancer were made on the premise that the prognostic effect of each regional lymph node station is similar. However, some studies have reported different effects of lymph node metastasis location on post-resection prognosis. This study aimed to investigate outcome following radical resection of ampullary carcinoma according to station of lymph node metastasis.

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A 69-year-old man was referred to our hospital because of appetite loss. Imaging showed a nodular tumor in the perihilar bile duct and a second flat lesion in the distal bile duct. Right hepatopancreaticoduodenectomy was performed, and the histopathological findings demonstrated that the perihilar and distal lesions were moderately and poorly differentiated adenocarcinoma, respectively, and anatomically separated.

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Background: Metronidazole (MNZ) has been clearly established as a medication for amebic liver abscess. In uncomplicated cases, surgical drainage should be avoided. We report a case of amebic liver abscess refractory to MNZ that was successfully treated using preoperative computed tomography (CT) and percutaneous and surgical drainage with intraoperative ultrasonography (IOUS).

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Article Synopsis
  • The study aimed to find a reliable way to determine when to safely remove drains after pancreaticoduodenectomy (PD) by analyzing factors related to postoperative pancreatic fistula (CR-POPF) on the third day after surgery (POD3).
  • Researchers reviewed data from 300 patients who underwent PD and identified that specific levels of drain amylase and C-reactive protein on POD3 could predict the likelihood of developing CR-POPF.
  • The study concluded that if patients had drain amylase levels below 350 IU/l and C-reactive protein levels below 14 mg/dl on POD3, it was safe to remove drains early, with a high predictive accuracy of 89% for preventing complications.
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Article Synopsis
  • The Japanese guidelines recommend everolimus or sunitinib as first-line treatments for unresectable pancreatic neuroendocrine tumors (PNETs), with streptozocin (STZ) as an alternative.
  • A 50-year-old patient with PNET and multiple liver metastases showed a significant response to third-line treatment with STZ after failing to respond to everolimus and sunitinib.
  • The situation highlights the need for further research to identify the optimal order of anti-cancer drugs and their effectiveness for treating PNET, as treatment responses can vary significantly.
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Introduction: Aberrant subvesical bile ducts are rare structural anomaly located in the peri-hepatic gallbladder fossa. This duct poses the risk for intraoperative bile duct injury resulting in clinically relevant bile leakage.

Presentation Of Case: Aberrant subvesical bile duct was detected by preoperative magnetic resonance cholangiopancreatography in a 52-year old woman with gallbladder polypoid tumor harboring the risk to be gallbladder cancer.

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Neural invasion is one of the malignant features contributing to locally advanced and/or metastatic disease progression in patients with pancreatic ductal adenocarcinoma (PDAC). Few studies exist on the distribution and state of nerve fibers in PDAC tissue and their clinicopathological impacts. The aim of the present study was to investigate the clinicopathological characteristics and prognostic value of intrapancreatic neural alterations in patients with PDAC.

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