Lea Matsuoka

University of Southern California, Los Ángeles, California, United States

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Publications (30)121.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The diagnosis of side-branch intraductal papillary mucinous neoplasms (IMPNs) is increasingly more common, but their appropriate management is still evolving. We recently began performing laparoscopic hand-assisted enucleation or duodenal-sparing pancreatic head resection for these lesions with vigilant postoperative imaging. Seventeen patients with pancreatic cystic lesions were included in this single-center retrospective review from January 1, 2008 to March 30, 2013. Indication for surgical intervention was growth in size of the cyst, symptoms, cyst size >3 cm, and/or presence of a mural nodule. Twelve patients underwent laparoscopic hand-assisted enucleation, and 5 patients underwent laparoscopic hand-assisted pancreatic head resection. The mean age of patients was 64 years old. The most common presenting symptom was abdominal pain. The indication for surgical intervention was growth in the cyst or symptoms in the majority of patients. Fourteen lesions were in the head/uncinate, two were in the pancreatic body, and one was in the tail. Final pathology was consistent with side-branch IPMN in 13 patients (1 with focal adenocarcinoma). Three patients had serous cysts, and 1 had a mucinous cyst. Three patients developed pancreatic leaks, which were controlled with intraoperative placed drains, whereas 1 patient required additional drain placement. Median time from surgery to latest follow-up imaging is over 2 years. No patients have developed recurrent cysts or adenocarcinoma. Duodenal-sparing pancreatic head resection or pancreatic enucleation for patients with presumed side-branch IPMN is a safe and efficacious option, in terms of both operative outcomes and postoperative recurrence risk.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2015; 25(8). DOI:10.1089/lap.2014.0669 · 1.34 Impact Factor
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    ABSTRACT: Knowledge of risk factors for posttransplant complications is likely to improve patient outcomes. Few large studies of all early postoperative complications after deceased donor liver transplantation (DDLT) exist. Therefore, we conducted a retrospective, cohort study of 30 days complications, their risk factors and impact on outcomes after DDLT. Three centers contributed data for 450 DDLT performed from January 2005 through December 2009. Data included donor, recipient, transplant and outcome variables. All 30 day postoperative complications were graded by Clavien's system. Complications per patient and severe (≥ grade III) complications were primary outcomes. Death within 30 days, complications occurrence, and length of stay (LOS), graft and patient survival were secondary outcomes. Multivariate associations of risk factors with complications and complications with LOS, graft and patient survival were examined. Mean number of complications/patient was 3.3±3.9. At least one complication occurred in 79.3% and severe complications in 62.8% of recipients. Mean LOS was 16.2±22.9 days. Graft and patient survival at 1 and 3 years were 84% and 74% and 86% and 76%, respectively. Hospitalization, critical care, ventilatory support and renal replacement therapy prior to and transfusions during transplant and not the model for end stage liver disease score were the significant predictors of complications. Both number and severity of complications had a significant impact on LOS, graft and patient survival. Structured reporting of risk-adjusted complications rates after DDLT is likely to improve patient care and transplant center benchmarking. Despite the accomplished reductions in transfusions during DDLT, opportunities exist for further reductions. With increasing transplantation of sicker patients reduction in complications would require multi-disciplinary efforts and institutional commitment. Pretransplant risk characteristics for complications must factor in during payer contracting. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    Liver Transplantation 05/2015; 21(9). DOI:10.1002/lt.24181 · 4.24 Impact Factor
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    ABSTRACT: Pancreatic pseudocyst is a relatively common occurrence resulting from acute or chronic pancreatitis. However, a rare subset of these patients present with a pseudocyst fistulizing into the portal vein. We present the case of a 58 year-old woman with a rapidly expanding pancreatic pseudocyst with portal venous fistulization causing portal vein thrombosis, in addition to biliary and duodenal obstruction. The patient underwent surgical decompression with a cyst-gastrostomy and was well until one week post-operatively when she experienced massive gastrointestinal hemorrhage leading to her death. A review of the literature is presented and a treatment algorithm to manage patients with pancreatic pseudocyst to portal vein fistula is proposed. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.
    Pancreatology 11/2014; 15(1). DOI:10.1016/j.pan.2014.11.005 · 2.84 Impact Factor
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    ABSTRACT: Background: Transgastric debridement of walled off pancreatic necrosis (WOPN) is a surgical treatment option for patients requiring pancreatic debridement for necrotizing pancreatitis. The reported experience with surgical transgastric pancreatic debridement is limited, however, the lower incidence of postoperative pancreatic fistulae with this procedure compared to other options warrants further evaluation of this technique. Method: Retrospective chart review. Results: Twenty-two patients underwent transgastric debridement with a cystogastrostomy for clinically symptomatic WOPN from January 1, 2005 to July 31, 2013. Eight cases were performed laparoscopically and 14 were performed by an open approach. The mean patient age was 50.9 (50.9 ± 14.5) and the median American Society of Anesthesiologist score was 3. The most common etiology for pancreatitis was gallstones and the median time from attack of pancreatitis to definitive surgical management was 60 days (range 22-300 days). Median operative time was 182 min (range 85-327 min) with 100 cc (range 20-500 cc) of blood loss. In seven patients the necrosis was infected and in 15 patients the necrosis was sterile as determined by the intraoperative culture of the necrotic material. The overall significant morbidity (Clavien type 3 or greater) was 13.6 % and the mortality was 0 %. The incidence of postoperative pancreatic fistula was 0 %. 20 patients (90 %) were symptom free during a median follow-up of 12 months. Conclusion: In selected patients with clinically symptomatic WOPN, surgical transgastric pancreatic debridement appears to be a safe procedure with a low morbidity and mortality. The low incidence of postoperative pancreatic fistulae warrants further evaluation.
    Surgical Endoscopy 07/2014; 29(3). DOI:10.1007/s00464-014-3700-x · 3.26 Impact Factor
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    ABSTRACT: Liver transplantation (LT) in patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, electrolyte and coagulation abnormalities. Continuous renal replacement therapy (CRRT) has been previously shown to ameliorate these problems. We describe the safety and clinical outcomes of intraoperative hemodialysis (IOHD) during LT in a group of high MELD patients. We performed a retrospective study at our institution who received IOHD from 2002-2012. From the 737 patients transplanted, 32 % received IOHD. Mean calculated MELD score was 37, with 38% having a MELD ≥ 40. Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplant, the majority being on CRRT. Patients on average received 35 units of blood products, 5 liters of crystalloid without significant change in hemodynamics or electrolytes. Average urine output was 450 cc and average fluid removal with dialysis was 1.58 L. Ninety day patient and dialysis-free survival was 90 and 99%, respectively. One year patient survival based on pre-transplant renal replacement status or MELD status was not statistically different. This is the first large study to demonstrate the safety and feasibility of IOHD in a cohort of critically ill high MELD patients undergoing LT with good patient and renal outcomes. Liver Transpl , 2014. © 2014 AASLD.
    Liver Transplantation 07/2014; 20(7). DOI:10.1002/lt.23867 · 4.24 Impact Factor
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    ABSTRACT: Many centers perform aggressive liver resection for patients with cholangiocarcinoma, because improved survival has been reported after resection with negative margins. Patients with extensive tumor burden sometimes require trisectionectomy for clearance of disease with increased risk of liver insufficiency and postoperative complications. A retrospective review was conducted examining records for 62 patients who were taken to the operating room for cholangiocarcinoma from January 1, 2000, to March 31, 2010. Thirty-eight patients underwent surgical resection: 17 patients underwent trisectionectomy and 21 patients underwent liver resections. No statistically significant differences were found between patients who underwent liver resection compared with those who underwent trisectionectomy with regard to demographics or complications. Pathology was rereviewed by a single pathologist, and no statistically significant differences were found between the two groups in any of the recorded pathology results. No significant differences in survival were found between the two groups. The median survival for liver resection patients was 2.9 years and for trisegmentectomy patients was 2.8 years. Complete resection with negative margins remains the current surgical goal in the treatment for cholangiocarcinoma. Performing trisectionectomy in an effort to clear all disease is safe with comparable outcomes to patients needing less extensive liver resections.
    The American surgeon 06/2014; 80(6):544-548. · 0.82 Impact Factor

  • Gastroenterology 05/2014; 146(5):S-1070. DOI:10.1016/S0016-5085(14)63901-9 · 16.72 Impact Factor

  • Gastroenterology 05/2014; 146(5):S-1077. DOI:10.1016/S0016-5085(14)63929-9 · 16.72 Impact Factor
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    ABSTRACT: Adequate portal vein inflow is critical to successful orthotopic liver transplantation. While an end-to-end donor to recipient portal vein anastomosis is fashioned in the majority of liver transplant recipients, approximately 2% of recipients will require a complex vascular reconstruction due to inadequate recipient portal vein inflow. In this series, we describe our experience with five patients in which porto-variceal anastomosis was used to treat extensive porto-mesenteric thrombosis. Charts for patients who underwent liver transplantation from January 1, 2006, to December 31, 2011, were reviewed for patients requiring porto-variceal anastomosis. Five patients had extensive porto-splenomesenteric thrombosis requiring utilization of a varix as portal inflow. An iliac vein graft was utilized in four patients, and a direct anastomosis was performed in one patient. The patient with the direct anastomosis required revision with the use of an iliac vein graft the following day. Follow-up imaging documented portal vein patency at a minimum of three months post-transplant. No patients suffered post-operative variceal hemorrhage and all five patients are alive with a functional primary graft at a median follow-up of 2.3 yr. A porto-variceal anastomosis should be feasible in the majority of patients with extensive porto-mesenteric thrombosis with excellent durability.
    Clinical Transplantation 11/2013; 28(1). DOI:10.1111/ctr.12278 · 1.52 Impact Factor

  • Annual Meeting of the Society-for-the-Advancement-of-Blood-Management; 08/2013
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    ABSTRACT: Patients with Model for End-Stage Liver Disease (MELD) scores of 40 or higher are at high risk for liver transplantation. In some regions, the organ donor shortage has resulted in a substantial increase in the number of patients who underwent transplantation with MELD scores of 40 or higher. The objective of this study was to characterize the outcomes of liver transplantation in these patients. A single-center retrospective study evaluating the outcome of liver transplantation in 38 consecutive patients achieving a MELD score of 40 or higher from January 1, 2006, to November 30, 2010, was conducted. Patient and graft survivals and independent risk factors for postoperative death or graft loss were determined. Kaplan-Meier-based 1-, 2-, and 3-year patient survival rates were 89%, 82%, and 77% with 1-, 2-, and 3-year graft survival rates of 84%, 75%, and 70.3%, respectively. One of three recipients was on a vasopressor before transplantation, and 13% were mechanically ventilated. Renal replacement therapy was used before operation in 90% of the recipients. Postoperative length of stay averaged 38 days. There was a 42% incidence of postoperative bacteremia and an 18% incidence of bile duct stricture within 6 months. Univariate analysis identified admission-to-transplantation time and recipient diabetes as risk factors for graft failure and patient death. Multivariate analysis confirmed recipient diabetes as a risk factor for patient survival and admission-to-transplantation time of more than 15 days as a risk factor for graft survival. Acceptable outcomes are achievable after liver transplantation in patients with MELD scores of 40 or higher but come at high pretransplantation and posttransplantation resource utilization.
    Transplantation 02/2013; 95(3):507-12. DOI:10.1097/TP.0b013e3182751ed2 · 3.83 Impact Factor
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    ABSTRACT: PURPOSE/AIM Review biliary tract embryology, normal anatomy and specific variants that may be encountered on magnetic resonance cholangiopancreatography (MRCP) Discuss how variant biliary anatomy can affect planning for endoscopic and surgical interventions Provide examples of complications that can arise from unrecognized biliary variants CONTENT ORGANIZATION Introduction Overview of embryologic development of the biliary system Indications for and value added by MRCP Cases of conventional and variant biliary anatomy presented in quiz format. Each case will include: Discussion of anatomy and the impact/effect of the specific variants on clinical management and surgical planning; Interventions including endoscopic retrograde cholangio-pancreatography (ERCP), cholecystectomy, and liver transplantation; Surgical management issues that will be presented in the surgeons’ own words through the use of avi interviews Examples of post-intervention complications from overlooked variant anatomy Summary SUMMARY After viewing this exhibit, the participant will: Recognize common biliary anatomic variants on MRCP images Understand the importance of these variants in endoscopic and surgical management Be aware of potential complications from unrecognized variant biliary anatomy
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: Human Cytomegalovirus is a commonly identified herpesvirus that establishes a state of latent infection in the majority of the population by adulthood. A coordinated immune response involving both the innate and adaptive immune system prevents active viral replication and disease. Cellular immunity appears particularly important to control of viremia requiring both a CMV-specific CD4+ and CD8+ T cell response. Solid organ transplant recipients are particularly susceptible to CMV related disease due to the immunosuppression necessary to prevent organ rejection, with patients receiving T cell depleting therapies being at highest risk. The deleterious outcomes of CMV in organ transplant recipients result from both direct cytopathic and indirect immune-modulatory effects of CMV viral replication. The recognition of the negative effects of CMV in solid organ transplantation has resulted in the routine prophylaxis of organ recipients with antiviral nucleoside analogues. The appropriate duration of therapy is still controversial although guidelines do exist. The ability to assay an individual immune response to CMV should allow for tailored duration of therapy in the future.
    Current Medicinal Chemistry 09/2012; 19(35). DOI:10.2174/092986712804485845 · 3.85 Impact Factor
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    ABSTRACT: Purpose: Ocular melanoma is a rare disease with a strong predilection for the liver. Systemic and locoregional treatments for metastatic ocular melanoma have had disappointing results, with an average survival of 5-7 months. Resection and/or radiofrequency ablation (RFA) of liver lesions were attempted to improve the patient outcomes. Methods: Eight patients with liver metastasis from ocular melanoma underwent surgery and/or RFA at the University of Southern California, University Hospital from 1 January 2001 to 31 December 2009. Their charts were retrospectively reviewed. Results: All patients had undergone eye enucleation as the primary treatment. Four patients had all metastatic liver lesions addressed: one patient underwent left lateral segmentectomy and three patients had combinations of left lateral segmentectomies, wedge resections and RFA of two to four lesions. Two patients underwent surgical biopsies for diagnosis, one patient was unresectable and one patient underwent RFA of a dominant lesion. The median survival was 36 months. The median survival of patients who underwent surgery alone or in conjunction with RFA to address all liver lesions was 46 months. Conclusions: There are few reports of RFA for metastatic ocular melanoma. RFA of liver lesions in addition to resection can perhaps lead to improved survival and may play a critical role in the future management of this disease.
    Surgery Today 07/2012; 43(4). DOI:10.1007/s00595-012-0244-3 · 1.53 Impact Factor

  • Journal of Hepatology 04/2012; 56:S88-S89. DOI:10.1016/S0168-8278(12)60221-9 · 11.34 Impact Factor
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    ABSTRACT: Alexopoulos SP, Merrill M, Kin C, Matsuoka L, Dorey F, Concepcion W, Esquivel C, Bonham A. The impact of hepatic portoenterostomy on liver transplantation for the treatment of biliary atresia: Early failure adversely affects outcome. Abstract: The most common indication for pediatric LTx is biliary atresia with failed HPE, yet the effect of previous HPE on the outcome after LTx has not been well characterized. We retrospectively reviewed a single-center experience with 134 consecutive pediatric liver transplants for the treatment of biliary atresia from 1 May 1995 to 28 April 2008. Of 134 patients, 22 underwent LTx without prior HPE (NPE), while 112 patients underwent HPE first. HPE patients were grouped into EF, defined as need for LTx within the first year of life, and LF, defined as need for LTx beyond the first year of life. NPE and EF groups differed significantly from the LF group in age, weight, PELD, and ICU status (p < 0.05) with NPE having the highest PELD and ICU status. Patients who underwent salvage LTx after EF following HPE had a significantly higher incidence of post-operative bacteremia and septicemia (p < 0.05), and subsequently lower survival rates. One-year patient survival and graft survival were as follows: NPE 100%, EF 81%, and LF 96% (p < 0.05); and NPE 96%, EF 79%, and LF 96% (p < 0.05). Further investigation into the optimal treatment of biliary atresia should focus on identifying patients at high risk of EF who may benefit from proceeding directly to LTx given the increased risk of post-LTx bacteremia, sepsis, and death after failed HPE.
    Pediatric Transplantation 03/2012; 16(4):373-8. DOI:10.1111/j.1399-3046.2012.01677.x · 1.44 Impact Factor
  • Lea Matsuoka · Rick Selby · Yuri Genyk ·
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    ABSTRACT: There have been significant advances made over the years in the areas of critical care, anesthesia, and surgical technique, which have led to improved mortality rates and survival after resection for pancreatic cancer. The standard of care is currently PD or PPPD for pancreatic cancers of the head, uncinate process, or neck and DP for pancreatic cancers of the body or tail. Resections are performed with the goals of negative margins and minimal blood loss, and referral to high-volume centers and surgeons is encouraged. However, 5-year survival rate after curative resection still remains at less than 20%. In an effort to improve survival and extend the limits of resectability, many centers have attempted extended lymphadenectomy and portal venous and even arterial resection and reconstruction. Extended lymphadenectomy has not led to improved survival for these patients. Portal vein resection has increased the number of patients amenable to resection, with equivalent survival rates compared with those of standard resections. Portal vein invasion is thus no longer considered a contraindication to resection at many large centers. Resection and reconstruction of involved arteries have been rarely performed and are currently not considerations for most patients. It is likely that future improvements in survival lie in the realm of adjuvant therapy. As chemotherapeutic and other tumor-directed agents continue to evolve and advance, this will hopefully lead to improved survival for patients undergoing surgical resection for pancreatic cancer.
    Gastroenterology clinics of North America 03/2012; 41(1):211-21. DOI:10.1016/j.gtc.2011.12.015 · 2.82 Impact Factor
  • Lea Matsuoka · Dilip Parekh ·
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    ABSTRACT: Laparoscopic pancreas surgery has undergone rapid development over the past decade. Although acceptability among traditional surgeons has been low, emerging specialty centers are reporting excellent outcomes for advanced and complex operations, such as pancreaticoduodenectomy. A note of caution is necessary: These outstanding results are from skilled surgeons, many of whom are pioneers in the field, who have overcome the learning curve over many years of innovation. As the procedures gain wider practice, outcomes need to be carefully watched because many of these procedures are extremely demanding technically. Although many have suggested that controlled, randomized studies comparing laparoscopic pancreatic resections with open resections are necessary to establish the efficacy of laparoscopic procedure, the cumulative data on the safety and efficacy of the laparoscopic procedure argues against such an approach. The logistic difficulties of conducting such studies will be considerable given patient preferences, the need for multicenter studies, and the rapid adoption of the laparoscopic procedure among experienced pancreatic surgeons. A more reasonable approach to truly evaluate the safety of these procedures is the establishment of a national registry that can measure progress of the field and record outcomes in the wider, nonspecialty community. Hepatobiliary training programs should also establish a minimal standard of training for many of the advanced procedures, such as the pancreaticoduodenectomy, so that the benefit of laparoscopic surgery can be made available outside of just a few specialty centers.
    Gastroenterology clinics of North America 03/2012; 41(1):77-101. DOI:10.1016/j.gtc.2011.12.006 · 2.82 Impact Factor
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    ABSTRACT: The intra-aortic balloon pump (IABP) can be used transiently to improve cardiac function mechanically, in patients with severe cardiomyopathy and heart failure refractory to medical therapy. In the field of surgery, the IABP is most commonly used for patients with myocardial infarction, congestive heart failure, or other chronic cardiac conditions, who are undergoing cardiac surgery. Conversely, it is rarely used in hepatobiliary surgery, with only two reports found in the literature, excluding cases of emergency cholecystectomy. We describe how we used an IABP successfully during surgery to repair a transected bile duct in a patient with peripartum cardiomyopathy.
    Surgery Today 02/2012; 42(8):793-6. DOI:10.1007/s00595-012-0150-8 · 1.53 Impact Factor
  • Lea Matsuoka · Jose L Almeda · Rod Mateo ·
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    ABSTRACT: The purpose of this article is to describe the current use of pulsatile kidney perfusion during organ preservation and the effects on kidney allograft outcomes and utilization. As of spring 2008, there were 75 629 candidates on the kidney waiting list in the USA according to United Network for Organ Sharing data. In 2006, a total of 1815 deceased donor expanded criteria donors kidneys were transplanted, and approximately 80% of those kidneys had cold ischemic time of over 12 h. The utilization of kidney pulsatile perfusion varies extensively throughout the USA with rates of 7-12% in our institution. Data on the use of pulsatile hypothermic perfusion for kidneys during organ preservation are limited and mostly retrospective. Most authors agree that pulsatile perfusion is safe and leads to a decrease in delayed graft function, especially for marginal kidneys from extended criteria or deceased donors. The long-term effects of delayed graft function on graft survival remain to be seen. With the recent large-sampled international prospective randomized trial recently completed, we may see more kidneys pulsatile perfused. This may lead to an increase in the utilization of otherwise discarded kidneys, though these data are difficult to extrapolate.
    Current opinion in organ transplantation 09/2009; 14(4):365-9. DOI:10.1097/MOT.0b013e32832dbd1c · 2.88 Impact Factor

Publication Stats

290 Citations
121.64 Total Impact Points


  • 2009-2015
    • University of Southern California
      • • Department of Surgery
      • • Keck School of Medicine
      Los Ángeles, California, United States
  • 2006
    • University of California, Los Angeles
      • Department of Surgery
      Los Angeles, California, United States