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Pancreatic Neoplasms: HELP
Articles by Tadahiro Goto
Based on 20 articles published since 2010
(Why 20 articles?)
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Between 2010 and 2020, Tadahiro Goto wrote the following 20 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review [A Case of Pancreatic Metastasis of Osteosarcoma Resected Using Laparoscopic Spleen Preserving Distal Pancreatectomy]. 2016

Toyama, Hirochika / Asari, Sadaki / Goto, Tadahiro / Terai, Sachio / Shirakawa, Sachiyo / Nanno, Yoshihide / Mizumoto, Takuya / Fukumoto, Takumi / Ajiki, Tetsuo / Kido, Masahiro / Tanaka, Motofumi / Matsumoto, Taku / Kinoshita, Hisoka / Kuramitsu, Kaori / Ku, Yonson. ·Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine. ·Gan To Kagaku Ryoho · Pubmed #28133198.

ABSTRACT: A 44-year-old woman underwent surgical resection and received preoperative and postoperative chemotherapy for conventional osteosarcoma in the right fibular head. Three years later, follow-up PET-CT revealed accumulation ofFDG in the tail ofthe pancreas. Contrast-enhanced computed tomography showed a 13mm well-circumscribed hypovascular tumor. EUS showed a heterogeneous solid tumor, which was diagnosed as metastasis ofosteosarcoma to the pancreas. Laparoscopic spleen preserving distal pancreatectomy(LAP-SPDP)was performed. Pathologically, the tumor was diagnosed as metastasis ofconventional osteosarcoma to the pancreas. Cells from pancreas islet tissue were detected in the tumor, suggesting invasion ofthe tumor into the pancreatic body and surrounding adipose tissue. Although postoperative chemotherapy was administered, lung metastasis was detected 1.1 years after surgery. Laparoscopic partial resection of the lung metastasis was performed, and the patient is still alive. Metastasis ofosteosarcoma to the pancreas is rare, and there is no report oflaparoscopic approach as a treatment. Herein, we report a case with several references.

2 Review [A case of metachronous pancreatic cancer that developed 4 years after initial pancreatectomy]. 2013

Ishida, Jun / Matsumoto, Ippei / Shinzeki, Makoto / Asari, Sadaki / Goto, Tadahiro / Tanaka, Masaki / Yamashita, Hironori / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine. ·Gan To Kagaku Ryoho · Pubmed #24393957.

ABSTRACT: A 55-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma( PDAC) in July 2008. The final diagnosis was Stage I PDAC according to the Union for International Cancer Control( UICC) TNM classification. After the operation, adjuvant chemotherapy with gemcitabine was administered for 6 months. The tumor marker level increased at 49 months after the operation, and 18-fluoro-deoxyglucose (FDG)-positron emission tomography( PET) showed FDG accumulation in the remnant pancreas. A hypovascular tumor was revealed in the remnant pancreas on computed tomography( CT). As PDAC was diagnosed without distant metastasis, completion pancreatectomy was performed. Histopathological investigation revealed PDAC with invasion into the muscularis propria of the anastomosed jejunum and splenic plexus. The final diagnosis was T3N0M0 UICC Stage IIA metachronous PDAC. The postoperative course was uneventful. However, multiple liver metastases and local recurrence were detected on CT 2 months after resection, and the patient died 3 months after resection. Most reported cases of metachronous PDACs were diagnosed at an advanced stage despite regular follow-ups after the initial resection. Further investigation is needed to determine the adequate surveillance time and novel therapeutic strategies.

3 Article [Hepatic and Pancreatic Metastases of a Rectal Gastrointestinal Stromal Tumor in a Patient with Long-Term Survival following Combined Therapy-ACase Report]. 2019

Goto, Tadahiro / Sendo, Hiroyoshi / Yamazaki, Takashi / Ishida, Ryo / Yasuda, Takashi / Muramatsu, Sanshiro / Tsukamoto, Yoshihiko / Miyashita, Masaru / Ku, Yonson. ·Dept. of Surgery, Konan Hospital. ·Gan To Kagaku Ryoho · Pubmed #30914540.

ABSTRACT: A 68-year-old woman underwent Miles' surgery with a diagnosis of a rectalgastrointestinalstromaltumor (GIST)in 2004. In 2005 and 2006, she developed liver metastases that were surgically removed, but once again in June 2006, she presented with liver metastasis, and imatinib therapy(400mg/day)was administered. In October 2016, she was diagnosed with progression of liver metastasis, and a tumor in the pancreatic body was identified on a CT scan. The patient was referred to our institution for treatment. We performed right hepatectomy and distalpancreatectomy in January 2017. Immunohistochemically, the recurrent tumor was positive for c-kit and CD34, and the diagnosis of GIST was confirmed. The pathological diagno- sis was a high-risk GIST showing 43mitoses per 50 high-power fields. Imatinib therapy(400mg/day)was administered after surgery. She is currently alive without recurrence.

4 Article [A Case of Pancreatic Cancer with Multiple Lymph Node Swelling Caused by Sarcoidosis]. 2017

Goto, Tadahiro / Toyama, Hirochika / Asari, Sadaki / Terai, Sachio / Mukubou, Hideyo / Shirakawa, Sachiyo / Nanno, Yoshihide / Mizumoto, Takuya / Kinoshita, Hisoka / Tanaka, Motofumi / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Dept. of Surgery, Konan Hospital. ·Gan To Kagaku Ryoho · Pubmed #29394809.

ABSTRACT: A 69-year-old woman who was identified the tumor of the pancreas tail by CT scan for postoperative inspection of breast cancer. Pancreas tail cancer with para-aortic lymph node metastases was diagnosed by close inspection. She consulted a different hospital to receive their second opinion. She was diagnosed of sarcoidosis from points with lymphadenopathy in hilar region and para-aorta for 3 years and uveitis. The patient was referred to our institution for treatment. We performed distal pancreatectomy in March, 2014. No.16 lymph nodes were cancer-negative, but lymph nodes around the pancreas were cancer positive. Abdominal CT, 9 months after surgery, showed lymph node swelling. We recommended a definitive diagnosis by EUS-FNA, but she refused the inspection. She was checked by CT scan regularly afterwards and is alive without recurrence 39 months after the operation. Diagnosis for lymph node metastases is difficult for a malignant tumor when the sarcoidosis coexisted.

5 Article Baseline plasma chromogranin A levels in patients with well-differentiated neuroendocrine tumors of the pancreas: A potential predictor of postoperative recurrence. 2017

Nanno, Yoshihide / Toyama, Hirochika / Matsumoto, Ippei / Otani, Kyoko / Asari, Sadaki / Goto, Tadahiro / Ajiki, Tetsuo / Zen, Yoh / Fukumoto, Takumi / Ku, Yonson. ·Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: toyama@med.kobe-u.ac.jp. · Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan. · Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan. ·Pancreatology · Pubmed #28043759.

ABSTRACT: BACKGROUND: The present study aimed to elucidate prognostic values of baseline plasma chromogranin A (CgA) concentrations in patients with resectable, well-differentiated pancreatic neuroendocrine tumors (PNETs). METHODS: Preoperative CgA levels in 21 patients with PNET were correlated with clinicopathological factors and patients' survival. RESULTS: Plasma CgA levels ranged 2.9-30.8 pmol/mL (median 6.0), and were significantly elevated in patients with post-operative recurrence (P = 0.004). Using the receiver operating characteristic curve, the optimal cutoff value to predict tumor recurrence was determined as 17.0 pmol/mL. This threshold identified patients with recurrence with 60% sensitivity, 100% specificity, and 90% overall accuracy. Patients with higher CgA levels showed worse recurrence-free survival than those with low CgA levels, both in total (P < 0.001) and in G2 patients (P = 0.020). CONCLUSIONS: Combined plasma CgA concentrations and WHO grading may assist in better stratification of PNET patients in terms of the risk of recurrence.

6 Article Internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy: Report of a case. 2017

Nanno, Yoshihide / Goto, Tadahiro / Toyama, Hirochika / Asari, Sadaki / Terai, Sachio / Shirakawa, Sachiyo / Mizumoto, Takuya / Ueda, Yuki / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. ·Asian J Endosc Surg · Pubmed #27863050.

ABSTRACT: We report a case of an internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy. The patient was a 58-year-old man with an intraductal papillary mucinous neoplasm of the pancreatic body who underwent laparoscopic distal pancreatectomy. During surgery, an approximately 5-cm defect in the transverse mesocolon was inadvertently made. The defect was not closed as it was thought to be large enough to preclude incarceration. However, the patient developed a bowel obstruction 2 months postoperatively. Laparotomy revealed that a loop of the proximal jejunum herniated through the defect and was adherent to the stapled pancreatic stump. An additional loop of the jejunum was herniated through the narrowed mesenteric defect. To our knowledge, this is the first case of an internal hernia through a transverse mesocolon defect after laparoscopic distal pancreatectomy.

7 Article Pancreatic Duct Involvement in Well-Differentiated Neuroendocrine Tumors is an Independent Poor Prognostic Factor. 2017

Nanno, Yoshihide / Matsumoto, Ippei / Zen, Yoh / Otani, Kyoko / Uemura, Jun / Toyama, Hirochika / Asari, Sadaki / Goto, Tadahiro / Ajiki, Tetsuo / Okano, Keiichi / Suzuki, Yasuyuki / Takeyama, Yoshifumi / Fukumoto, Takumi / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan. ippeimm@gmail.com. · Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Gastroenterological Surgery, Kagawa University Faculty of Medicine, Takamatsu, Kagawa, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan. ·Ann Surg Oncol · Pubmed #27822631.

ABSTRACT: BACKGROUND: The biological behavior of well-differentiated neuroendocrine tumors of the pancreas (PNETs) is difficult to predict. This study was designed to determine whether involvement of the main pancreatic duct (MPD) serves as a poor prognostic factor for PNETs. METHODS: The involvement of the MPD in PNETs was defined as ductal stenosis inside the tumor mass associated with distal MPDs more than twofold larger in diameter than the proximal ducts. We examined the correlation between MPD involvement and other clinicopathological parameters, including nodal metastasis and recurrence-free survival, in 101 patients treated consecutively at three referral centers in Japan. All patients underwent surgical resection. RESULTS: MPD involvement was observed in 13 of the 101 cases (13%) and was associated with multiple unfavorable clinicopathological features (e.g., larger tumor size, higher histological grade, more frequent nodal metastasis, and higher recurrence rates). Patients with MPD involvement also showed significantly worse recurrence-free survival than did those without ductal involvement (P < 0.001), with a 5 years recurrence-free rate of 41%. On multivariate analysis, MPD involvement was significantly associated with nodal metastasis [odds ratio (OR) 16; 95% confidence interval (CI) 3.8-89; P < 0.001] and recurrence (OR 8.0; 95% CI 1.7-46; P = 0.009). The radiology-pathology correlation revealed that stenosis of the MPD was due to periductal and/or intraductal tumor invasion. Cases with MPD involvement had microscopic venous invasion (P = 0.010) and perineural infiltration (P = 0.002) more frequently than did those with no ductal infiltration. CONCLUSIONS: MPD involvement in PNETs may serve as an imaging sign indicating an aggressive clinical course.

8 Article Microscopic venous invasion in patients with pancreatic neuroendocrine tumor as a potential predictor of postoperative recurrence. 2016

Nanno, Yoshihide / Toyama, Hirochika / Otani, Kyoko / Asari, Sadaki / Goto, Tadahiro / Terai, Sachio / Ajiki, Tetsuo / Zen, Yoh / Fukumoto, Takumi / Ku, Yonson. ·Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: toyama@med.kobe-uc.ac.jp. · Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan. ·Pancreatology · Pubmed #27350059.

ABSTRACT: BACKGROUND: Microscopic venous and lymphatic invasion is a known prognostic factor for various cancers, but its prognostic relevance for pancreatic neuroendocrine tumors (PNETs) is unclear. METHODS: Thirty-two consecutive patients with PNET who had complete resection were included in this study. Venous and lymphatic invasion was identified on elastic tissue or immunohistochemical staining, and correlated with other clinicopathological factors, including recurrence-free survival. RESULTS: Venous and lymphatic invasion was identified in nine (28%) and three (9%) patients, respectively. Tumors with venous invasion were of significantly larger size, higher Ki-67 index, and higher mitotic counts. Patients with venous invasion showed significantly worse prognosis than those without venous invasion (P = 0.001). Five of nine patients (56%) with venous invasion had tumor recurrence, while a relapse was found in one case in patients without venous invasion (n = 23). Lymphatic invasion was not correlated with any other clinicopathological parameters including lymph node metastasis and recurrence-free survival. Predictive factors for recurrence in univariate analysis included microscopic venous invasion, tumor size ≥ 20 mm, non-functionality, and WHO grades. In multivariate analysis where WHO grades and microscopic venous invasion were applied, venous invasion remained a significant predictor of poor recurrence-free survival (P = 0.021). CONCLUSIONS: Microscopic venous invasion may serve as a predictive factor for tumor recurrence in patients with resectable PNET. The combination of WHO grades and microscopic venous invasion may assist in the stratification of the patients for risk of tumor recurrence.

9 Article Second primary pancreatic ductal carcinoma in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma: High cumulative incidence rates at 5 years after pancreatectomy. 2016

Ishida, Jun / Toyama, Hirochika / Matsumoto, Ippei / Asari, Sadaki / Goto, Tadahiro / Terai, Sachio / Nanno, Yoshihide / Yamashita, Azusa / Mizumoto, Takuya / Ueda, Yuki / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. Electronic address: tymhr@me.com. · Department of Surgery, Kinki University Faculty of Medicine, 377-2 Onohigashi, Osakasayama 589-8511, Japan. ·Pancreatology · Pubmed #27237099.

ABSTRACT: OBJECTIVES: The aim of this study was to determine the incidence rate and clinical features of second primary pancreatic ductal carcinoma (SPPDC) in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma (PDC). METHODS: Data of patients undergoing R0 resection for PDC at a single high-volume center were reviewed. SPPDC was defined as a tumor in the remnant pancreas after R0 resection for PDC, and SPPDC met at least one of the following conditions: 1) the time interval between initial pancreatectomy and development of a new tumor was 3 years or more; 2) the new tumor was not located in contact with the pancreatic stump. We investigated the clinical features and treatment outcomes of patients with SPPDC. RESULTS: This study included 130 patients who underwent surgical resection for PDC between 2005 and 2014. Six (4.6%) patients developed SPPDC. The cumulative 3- and 5-year incidence rates were 3.1% and 17.7%, respectively. Four patients underwent remnant pancreatectomy for SPPDC. They were diagnosed with the disease in stage IIA or higher and developed recurrence within 6 months after remnant pancreatectomy. One patient received carbon ion radiotherapy and survived 45 months. One patient refused treatment and died 19 months after the diagnosis of SPPDC. CONCLUSIONS: The incidence rate of SPPDC is not negligible, and the cumulative 5-year incidence rate of SPPDC is markedly high. Post-operative surveillance of the remnant pancreas is critical for the early detection of SPPDC, even in long-term survivors after PDC resection.

10 Article Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. 2016

Asari, Sadaki / Matsumoto, Ippei / Toyama, Hirochika / Shinzeki, Makoto / Goto, Tadahiro / Ishida, Jun / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. sasari@med.kobe-u.ac.jp. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. ·Surg Today · Pubmed #26108488.

ABSTRACT: PURPOSE: The therapeutic strategy for borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) has remained unestablished because the preoperative prognostic factors have not been determined. METHODS: One hundred eighty-four consecutive PDAC patients who underwent upfront surgery with a curative resection between January 2000 and June 2013 at Kobe University Hospital were retrospectively studied. The PDAC patients were stratified into resectable (R)-PDAC (n = 147) and BR-PDAC patients (n = 37). We evaluated the independent prognostic significance of the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) in the BR-PDAC patients. RESULTS: BR-PDAC patient survival was significantly worse than R-PDAC patient survival (median survival time: 22.1 months vs. 24.3 months; 5-year survival rate 6 vs. 21 %; P = 0.042). The median survival in BR-PDAC patients with a preoperative NLR of >3 (n = 12) was 10.2 months, while that in patients with preoperative NLR of ≤3 (n = 25) was 24.9 months (P = 0.002). Moreover, the median survival in BR-PDAC patients with a preoperative PLR of >225 (n = 8) was 10.2 months, while that in patients with a preoperative PLR of ≤225 (n = 29) was 24.7 months (P = 0.003). Preoperative NLR >3 (HR = 2.980, 95 % CI 1.251-6.920; P = 0.015) and PLR >225 (HR = 3.050, 95 % CI 1.169-7.468; P = 0.024) were independent prognostic factors in BR-PDAC patients. CONCLUSIONS: Higher preoperative NLR and PLR can be independent predictive risk factors in BR-PDAC patients following curative resection.

11 Article [A Case of Invasive Intraductal Papillary Mucinous Carcinoma, Penetrating the Stomach, Colon, and Jejunum]. 2015

Goto, Tadahiro / Toyama, Hirochika / Asari, Sadaki / Terai, Sachio / Kinoshita, Hisoka / Matsumoto, Taku / Kuramitsu, Kaori / Tanaka, Motofumi / Takebe, Atsushi / Kido, Masahiro / Matsumoto, Ippei / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine. ·Gan To Kagaku Ryoho · Pubmed #26805374.

ABSTRACT: A 69-year-old woman was admitted to a nearby clinic complaining of abdominal pain. Abdominal CT showed a 10 cm diameter huge cystic lesion in the body and tail of the pancreas. The patient was referred to our institution for treatment. Endoscopic ultrasonography (EUS) revealed a cystic mass with a solid lesion. Endoscopic retrograde pancreatography(ERP) demonstrated mucous at the opening of the papilla of Vater and dilatation of the pancreatic duct with a solid nodule. Contrast radiography revealed a fistula from the tumor to the jejunum. A biopsy specimen from the lesion showed adenocarcinoma. Intraoperative findings showed a tumor occupying the pancreas body and tail with suspected invasion to the stomach, jejunum, and transverse colon. We performed distal pancreatectomy with partial resection of stomach, jejunum, and colon. Pathological findings showed an invasive type of IPMC, with invasion to the subserosal layer of the stomach and colon and the mucous layer of the jejunum. While IPMC is recognized as a slow growing malignancy, some cases of invasive carcinoma with fistulation into adjacent organs have been reported. To our knowledge, a case of IPMC penetrating to 3 adjacent organs is rare.

12 Article Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: A multi-center retrospective study. 2015

Matsumoto, Ippei / Murakami, Yoshiaki / Shinzeki, Makoto / Asari, Sadaki / Goto, Tadahiro / Tani, Masaji / Motoi, Fuyuhiko / Uemura, Kenichiro / Sho, Masayuki / Satoi, Sohei / Honda, Goro / Yamaue, Hiroki / Unno, Michiaki / Akahori, Takahiro / Kwon, A-Hon / Kurata, Masanao / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. Electronic address: ippeimm@gmail.com. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Institute of Biomedical and Health Sciences, Department of Surgery, Hiroshima University, Hiroshima, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Nara Medical University, Nara, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Kansai Medical University, Hirakata, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. ·Pancreatology · Pubmed #26467797.

ABSTRACT: BACKGROUND/OBJECTIVE: Although surgical resection remains the only chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The purpose of this study is to determine the preoperative predictive factors for ER after upfront surgical resection. METHODS: Between 2001 and 2012, 968 patients who underwent upfront surgery with R0 or R1 resection for PDAC at seven high-volume centers in Japan were retrospectively reviewed. ER was defined as relapse within 6 months after surgery. Study analysis stratified by resectable (R) and borderline resectable (BR) PDACs was conducted according to the National Comprehensive Cancer Network guidelines. RESULTS: ER occurred in 239 patients (25%) with a median survival time (MST) of 8.8 months. Modified Glasgow prognostic score = 2 (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.05-3.95; P = 0.044), preoperative CA19-9 ≥300 U/ml (OR 1.94, 1.29-2.90; P = 0.003), and tumor size ≥30 mm (OR 1.72, 1.16-2.56; P = 0.006), were identified as preoperative independent predictive risk factors for ER in patients with R-PDAC. In the R-PDAC patients, MST was 35.5, 26.3, and 15.9 months in patients with 0, 1 and ≥2 risk factors, respectively. There were significant differences in overall survival between the three groups (P < 0.001). No preoperative risk factors were identified in BR-PDAC patients with a high rate of ER (39%). CONCLUSIONS: There is a high-risk subset for ER even in patients with R-PDAC and a simple risk scoring system is useful for prediction of ER.

13 Article Postoperative Serum Albumin Level is a Marker of Incomplete Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma. 2015

Matsumoto, Ippei / Tanaka, Masaki / Shirakawa, Sachiyo / Shinzeki, Makoto / Toyama, Hirochika / Asari, Sadaki / Goto, Tadahiro / Yamashita, Hironori / Ishida, Jun / Ajiki, Tetsuo / Fukumoto, Takumi / Shimokawa, Mototsugu / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan, ippeimm@gmail.com. ·Ann Surg Oncol · Pubmed #25487967.

ABSTRACT: BACKGROUND: Adjuvant chemotherapy (AC) is recommended as a standard treatment after curative resection in patients with pancreatic adenocarcinoma (PA). Although patients who failed to complete AC had significantly worse survival compared with those who completed AC for cancers in various organs, the effects of complete AC on survival in patients with PA have not been investigated. The purpose of this study was to clarify the impact of complete AC on PA patient survival and to identify independent risk factors for incomplete AC. METHODS: Medical records of 236 consecutive PA patients who planned to undergo surgical resection with curative intent between January 2000 and September 2012 at Kobe University Hospital were retrospectively reviewed. Of these, the complete AC (n = 75) and the incomplete AC (n = 30) groups due to adverse events were compared. RESULTS: Patient survival was significantly better in the complete AC group than in the incomplete AC group (median survival time 48.9 vs. 17.9 months; 5-year survival rate 42.7 vs. 17.1 %; p < 0.0001). Preoperative white blood cell count and postoperative serum albumin level were identified as independent risk factors for incomplete AC. By receiver operating characteristic curve analysis, the cutoff value of postoperative serum albumin level was 3.1 mg/dL. CONCLUSIONS: PA patients who completed AC had significantly better survival than those who failed to complete AC. Postoperative serum albumin level is a marker for failure to complete AC. Further prospective studies are needed to determine whether perioperative nutritional intervention could increase AC completion rate and improve prognosis in PA patients.

14 Article [Hassab's operation for left-sided portal hypertension after pancreatoduodenectomy]. 2014

Goto, Tadahiro / Matsumoto, Ippei / Shinzeki, Makoto / Toyama, Hirochika / Asari, Sadaki / Ueta, Azusa / Ishida, Jun / Nanno, Yoshihide / So, Shinichi / Kinoshita, Hisoka / Matsumoto, Taku / Kuramitsu, Kaori / Tanaka, Motofumi / Takebe, Atsushi / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medical Sciences. ·Gan To Kagaku Ryoho · Pubmed #25731474.

ABSTRACT: Here, we report a case of Hassab's operation for left-sided portal hypertension after pancreatoduodenectomy. A 69-year old man underwent pancreatoduodenectomy for pancreatic cancer in 2006 in which the splenic vein was ligated near the portal vein and then divided. The patient suffered repeated episodes of anemia between 2010 and 2013. However, we could not identify the bleeding site at that time. In 2011, local recurrence was detected. Disease progression occurred despite chemotherapy treatment, which was then discontinued. The left-sided portal hypertension gradually progressed, and the collateral vessels became dilated. In 2014, he was examined in our department for gastrointestinal bleeding. An upper gastrointestinal endoscopy revealed bleeding from gastric varices. Gastrointestinal bleeding ceased after endoscopic injection sclerotherapy ( EIS) was performed; however, the bleeding recurred. Balloon retrograde transvenous occlusion (BRTO) could not be performed because blood flow was not detected within the gastro-renal shunt. An emergency surgery was performed. Surgical splenectomy and devascularization (Hassab's operation) were performed. After surgery, the gastric body varices and gastrointestinal anastomosis disappeared and the bleeding did not occur. He is currently receiving outpatient treatment.

15 Article [A case of adjuvant surgery for a patient with initially unresectable locally advanced pancreatic cancer (LAPC) with a favorable response to S-1 chemotherapy]. 2014

Ueta, Azusa / Toyama, Hirochika / Goto, Tadahiro / Matsumoto, Ippei / Shinzeki, Makoto / Asari, Sadaki / Ishida, Jun / Nanno, Yoshihide / Tsugawa, Daisuke / Kuramitsu, Kaori / Tanaka, Motofumi / Takebe, Atsushi / Okazaki, Taro / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Okuno, Tatsuya / Kokubun, Mayu / Ito, Tomoo / Ku, Yonson. ·Dept. of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine. ·Gan To Kagaku Ryoho · Pubmed #25731462.

ABSTRACT: A 67-year-old man was admitted to our hospital with a complaint of epigastric discomfort. A 29-mm hypovascular tumor was detected in the head of the pancreas by abdominal computed tomography imaging. As the superior mesenteric artery (SMA) was also involved, we diagnosed the tumor as unresectable pancreatic cancer. With S-1 chemotherapy, a radiological partial response was seen. After 4 courses of chemotherapy, a subtotal-stomach-preserving-pancreatoduodenectomy with dissection of the nerve plexus surrounding the SMA was performed. Although the tissue surrounding the SMA was hard, invasion of the SMA was not detected. Microscopic investigation revealed a few moderately differentiated adenocarcinoma cells in the fibrous tissue and the nerve fibers of pancreas. No cancer cells were found at the edges of the surgical specimen. The patient underwent R0 resection and a pathological evaluation showed Grade III tumor according to the Evans classification. After surgery, S-1 was interrupted because of diarrhea and local recurrence appeared 4 months postoperatively. For improving the prognosis of patients with pancreatic cancers, surgical intervention is often performed in patients with initially unresectable pancreatic cancers who have "long-term" favorable responses to chemotherapy or chemoradiotherapy. However, because of the possibility of relatively good prognosis with nonsurgical treatment for such patients and also the demerits of surgical stress, it is important to carefully consider the adjuvant surgery option.

16 Article A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status. 2014

Matsumoto, Ippei / Shinzeki, Makoto / Asari, Sadaki / Goto, Tadahiro / Shirakawa, Sachiyo / Ajiki, Tetsuo / Fukumoto, Takumi / Suzuki, Yasuyuki / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. ·J Surg Oncol · Pubmed #24619624.

ABSTRACT: BACKGROUND AND OBJECTIVES: Pylorus-preserving pancreatoduodenectomy (PPPD) has been associated with a high incidence of delayed gastric emptying (DGE). There are few studies comparing DGE associated with PPPD and subtotal stomach-preserving pancreatoduodenectomy (SSPPD). Moreover, differences between the procedures with respect to long-term results have not been reported. A prospective randomized study was conducted to compare perioperative complications and long-term nutritional status with PPPD and SSPPD. METHODS: One hundred patients with periampullary lesions were randomized to receive either PPPD (n = 50) or SSPPD (n = 50). All patients were followed up for 3 years after surgery or to the time of recurrence to evaluate nutritional status for the study. The effects of the procedure, age, and malignancy on changes in nutritional indicators were estimated with linear mixed models. This study was registered at UMIN Clinical Trials Registry (UMIN 000012337). RESULTS: The incidence of DGE assessed by the International Study Group of Pancreatic Surgery was 20% with PPPD and 12% with SSPPD (P = 0.414). There were no significant differences between the two procedures on postoperative serum albumin levels, serum total cholesterol levels, and body mass index during the 3-year follow-up period. CONCLUSIONS: SSPPD is equally effective in DGE occurrence rate and long-term nutritional status comparing to PPPD.

17 Article 18-Fluorodeoxyglucose positron emission tomography does not aid in diagnosis of pancreatic ductal adenocarcinoma. 2013

Matsumoto, Ippei / Shirakawa, Sachiyo / Shinzeki, Makoto / Asari, Sadaki / Goto, Tadahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Kitajima, Kazuhiko / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University, Graduate School of Medicine, Kobe, Japan. imatsu@med.kobe-u.ac.jp ·Clin Gastroenterol Hepatol · Pubmed #23353642.

ABSTRACT: BACKGROUND & AIMS: There are no accurate and reliable tools for diagnosis of early stage pancreatic ductal adenocarcinoma (PDA) or small metastatic lesions. It is also a challenge to differentiate PDA from focal mass-forming pancreatitis (FMP). There is controversy regarding the efficacy of 18-fluorodeoxyglucose positron-emission tomography (FDG-PET) in the diagnosis of PDA. We investigated whether FDG-PET provides information that, combined with data from other imaging techniques, can aid in decision making for patients with suspected PDA. METHODS: We performed a retrospective analysis of data collected from 232 consecutive patients with suspected PDA at Kobe University Hospital from January 2006 through June 2012. All patients underwent a diagnostic imaging protocol that included multidetector row computed tomography, superparamagnetic iron oxide-enhanced magnetic resonance imaging, and FDG-PET. Based on endoscopic ultrasonography, fine-needle aspiration biopsy, or endoscopic retrograde cholangiopancreatography analyses, 218 patients had PDA (89 underwent resection and 129 did not) and 14 patients had FMP (8 had focal mass-forming chronic pancreatitis and 6 had focal mass-forming autoimmune pancreatitis). RESULTS: FDG-PET detected 50% of stages 0 and I, 91.9% of stage II, 100% of stage III, and 96.8% of stage IV tumors. Detection was affected significantly by tumor size (P = .024) and T stage (P = .023) in resected tumors. Multidetector row computed tomography detected significantly more liver metastases than FDG-PET. Few para-aortic lymph node or peritoneal metastases were detected by FDG-PET. FDG-PET correctly identified 11 of the 14 patients with FMP (5 of 8 with focal mass-forming chronic pancreatitis and 6 of 6 with focal mass-forming autoimmune pancreatitis). CONCLUSIONS: FDG-PET is not effective in detecting early stage PDA and small metastases, or in differentiating PDA from FMP. Combining FDG-PET with current diagnostic techniques for PDA did not provide any decisive information, therefore it should not be included in this analysis.

18 Article [A case of interstitial lung disease associated with gemcitabine treatment in a patient with locally advanced pancreatic cancer following proton beam radiotherapy]. 2012

Tanaka, Masaki / Matsumoto, Ippei / Shinzeki, Makoto / Toyama, Hirochika / Asari, Sadaki / Goto, Tadahiro / Shirakawa, Sachiyo / Yamashita, Hironori / Sawa, Hidehiro / Ueno, Kimihiko / Takahashi, Masanori / Tsuchida, Shinobu / Kido, Masahiro / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Dept. of Surgery, Kobe University Graduate School of Medicine, Japan. ·Gan To Kagaku Ryoho · Pubmed #23268009.

ABSTRACT: A 69-year-old woman who had locally advanced pancreatic cancer underwent proton beam radiotherapy(67.5 GyE/25 Fr) concurrent with gemcitabine chemotherapy (GEM 800 mg/m2 day 1, 8) at Hyogo Ion Beam Medical Center, followed by GEM chemotherapy (1,000 mg/m2 day 1, 8, 15/28 day)at Kobe University Hospital. She visited our hospital because she was suffering from dyspnea 212 days after first administration of GEM. A chest computed tomography revealed that infiltrations were spreading in the bilateral lung fields. A bronchoscopy showed diffuse alveolar hemorrhage. We diagnosed GEM related interstitial lung disease with diffuse alveolar hemorrhage. We introduced steroid pulse therapy (methylprednisolone 1 g/day) for 3 days followed by oral prednisolone (40 mg/day), which was tapered gradually. She recovered and was discharged on the 24th day after admission.

19 Article Repeating regional acute pancreatitis in the head of the pancreas caused by intraductal papillary mucinous neoplasms in the tail: report of a case. 2012

Asari, Sadaki / Matsumoto, Ippei / Toyama, Hirochika / Shinzeki, Makoto / Goto, Tadahiro / Shirakawa, Sachiyo / Yamada, Isamu / Ajiki, Tetsuo / Fukumoto, Takumi / Ito, Tomoo / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. sasari@med.kobe-u.ac.jp ·Surg Today · Pubmed #22327284.

ABSTRACT: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a distinct entity characterized by papillary proliferations of mucin-producing epithelial cells with excessive mucin production and cystic dilatation of the pancreatic ducts. The clinical presentation often involves recurrent episodes of pancreatitis associated with the temporal obstruction of the main pancreatic duct caused by the hypersecretion of mucin. We herein describe a case in which the patient repeatedly experienced the occurrence of idiopathic acute pancreatitis in the head of the pancreas over a 9-year period, and who was ultimately was cured by distal pancreatectomy for IPMNs in the pancreatic tail. This case illustrates the potential pitfalls in the diagnosis of IPMNs owing to a discrepancy between the site of pancreatitis and that of the IPMN. The possible mechanisms linking acute pancreatitis with the formation of IPMNs are also reviewed.

20 Article A focal mass-forming autoimmune pancreatitis mimicking pancreatic cancer with obstruction of the main pancreatic duct. 2011

Matsumoto, Ippei / Shinzeki, Makoto / Toyama, Hirochika / Asari, Sadaki / Goto, Tadahiro / Yamada, Isamu / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan. imatsu@med.kobe-u.ac.jp ·J Gastrointest Surg · Pubmed #21584824.

ABSTRACT: INTRODUCTION AND BACKGROUND: Autoimmune pancreatitis (AIP) is a rare disease that closely mimics pancreatic cancer (PC) in its presentation. It is very important for clinicians to distinguish one from the other because their treatment and prognosis are vastly different. Typical radiological imaging findings, in particular observation of diffusely or segmentally narrowed main pancreatic duct (MPD) with an irregular wall by endoscopic retrograde cholangiopancreatography (ERCP), are essential for making the diagnosis of AIP. On the other hand, MPD obstruction is one of the most frequent features on ERCP. CASE REPORT: We report a rare case of a patient with focal mass-forming AIP strongly suspected of being PC because of MPD obstruction on ERCP. CONCLUSION: It was difficult to distinguish PC from AIP with current diagnostic modalities. We will continue to make an effort to distinguish between the two disorders to prevent unnecessary surgery.