Masao Fujiwara

Kagawa University, Takamatu, Kagawa, Japan

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Publications (21)58.29 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to assess the short-term outcomes of laparoscopic splenectomy (LS) and liver function at 1 year after splenectomy in the patients with liver cirrhosis. Forty-five patients with liver cirrhosis and hypersplenism underwent LS. We reviewed electronic medical records regarding the liver functional reserve, the etiology of liver cirrhosis, and the presence of hepatocellular carcinoma and esophago-gastric varices. Prospectively collected data of perioperative variables, postoperative complications, and long-term liver function were analyzed. Forty-five patients had a chronic liver disease classified into Child-Pugh classes (A/B/C: 23/20/2). The etiologies of disease were hepatitis C virus infection in 34 patients, hepatitis B virus infection in 4, and others in 7. Fourteen patients underwent procedures in addition to LS, including hepatectomy (n = 7) and devascularization for esophagogastric varices (n = 8). Postoperative complications occurred in 11 patients (24%). Neither postoperative liver failure nor in-hospital mortality occurred. White blood cell and platelet counts determined 7 days, 1 month, and 1 year after LS doubled or increased more than twice compared with the preoperative values (P < .001). One year after LS, patients who had been classified preoperatively into Child-Pugh class B had decreased total serum bilirubin levels (P = .03), and increased prothrombin activity (P = 003) and decreased Child-Pugh scores (P = .001). The Child-Pugh classifications improved in 14 of 18 patients (78%) who had Child-Pugh class B preoperatively. LS is a safe and feasible procedure for hypersplenism in patients with liver cirrhosis. In addition, LS most likely ameliorates liver function at 1 year after LS in patients with Child-Pugh class B liver cirrhosis. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 06/2015; DOI:10.1016/j.surg.2015.05.008 · 3.11 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-1146. DOI:10.1016/S0016-5085(15)33907-X · 13.93 Impact Factor
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    ABSTRACT: The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer.
    Gastric Cancer 05/2014; 18(3). DOI:10.1007/s10120-014-0387-6 · 4.83 Impact Factor
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    ABSTRACT: Soft pancreases are susceptible to developing pancreatic fistula following pancreaticoduodenectomy. To reduce the incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas, we developed a triple secured technique. In this study, we describe the details of this technique and also report on the postoperative outcomes.
    Hepato-gastroenterology 03/2014; 61(130):469-74. · 0.91 Impact Factor
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    ABSTRACT: Stenting for the portal vein may be performed to treat such problems as portal vein stenosis due to pancreaticobiliary cancer and anastomotic stenosis after liver transplantation. Recently, it has also been performed for benign portal vein stenosis. We encountered a case in which a portal vein stent was placed to treat portal vein thrombosis after completion of left hepatic lobectomy for intrahepatic cholangiocarcinoma. An 85-year-old woman was diagnosed as having intrahepatic cholangiocarcinoma in subsegment 2. We performed left hepatic lobectomy and anastomosed the portal vein branch for subsegment 8 to the right branch, because it diverged from the left branch, posing a risk of tumor invasion. Because portal vein thrombus was identified thereafter, we also performed thrombectomy and angioplasty. After the operation, portal vein thrombosis recurred and a catheter was placed in the superior mesenteric vein from the ileocolic vein for accomplishing thrombolytic therapy. While the portal vein was patent initially, it became occluded again. Therefore, we placed a stent in the portal vein, after which the portal vein thrombosis did not recur. No standard criteria for portal vein stenting have been established yet. Herein, we report our findings on portal vein stenting, with a review of the pertinent literature.
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2014; 75(8):2269-2273. DOI:10.3919/jjsa.75.2269
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    ABSTRACT: Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract. The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR. A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared. All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann-Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann-Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001). Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.
    Surgical Endoscopy 11/2013; 28(2). DOI:10.1007/s00464-013-3266-z · 3.31 Impact Factor
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    ABSTRACT: Background and study aim: A reliable full-thickness suturing device is necessary for pure natural orifice transluminal endoscopic surgery (NOTES). The present study focused on assessing the reliability of a new suturing device. Methods: A total of 60 single sutures were tested to close 5-cm incisions in 8-cm square pieces of resected swine stomach. Each incision was sutured by an over-the-scope clip (OTSC; n = 20), a single hand-sewn stitch (n = 20), or a single triple-arm-bar suturing system (TBSS) stitch. The maximum pulling force durability (MPD) of each suture was tested. To assess the reliability of the TBSS for endoscopic full-thickness resection (EFTR), 60 EFTRs of 50 mm diameter were performed on excised swine stomachs. After EFTR, full-thickness sutures were made using 3-stitch OTSCs (n = 20), 10-stitch hand-sewn sutures (n = 20), or 10-stitch TBSS sutures (n = 20). Outcomes were the MPD test for both single stitch and multiple stitch applications and the suturing time for single-stitch sutures.Results: In the single-stitch MPD tests, there were significant differences between OTSCs and hand-sewn sutures (P = 0.0002) and between OTSCs and TBSS sutures (P = 0.0001), but no significant difference between hand-sewn and TBSS sutures. The multiple-stitch sutures revealed significant differences between OTSCs and hand-sewn sutures (P = 0.0039), and between OTSCs and TBSS sutures (P = 0.013). There was no significant difference between hand-sewn and TBSS sutures. There were significant differences in suture times between OTSC, hand-sewn sutures, and TBSS sutures (P < 0.05). Conclusions: Both single-stitch and multiple-stitch sutures using TBSS have similar strength to hand-sewn sutures. TBSS is a reliable suturing device.
    Endoscopy 08/2013; 45(8):649-54. DOI:10.1055/s-0033-1344156 · 5.20 Impact Factor
  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2013; 74(2):411-414. DOI:10.3919/jjsa.74.411
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    ABSTRACT: von Hippel-Lindau (VHL) disease is an inherited neoplasia syndrome frequently complicated by neuroendocrine tumors and multiple cysts in the pancreas. We report two familial cases (a son and his mother) of VHL disease with multicentric pancreatic tumors for which a middle-preserving pancreatectomy was required.A 33-year-old male with pancreatic tumors and multiple cysts in the head and tail of the pancreas, and bilateral adrenal tumors underwent a middle-preserving pancreatectomy and bilateral adrenalectomy. On histopathology, pancreatic endocrine tumors, serous cysts, and adrenal pheochromocytomas were diagnosed. On genetic examination VHL disease was diagnosed.A 60-year-old female (the patient's mother) was found to have pancreatic tumors and multiple cysts in the head and tail of the pancreas. Genetic testing was done, and a VHL genetic mutation was found. The patient had a middle-preserving pancreatectomy. On histopathology, endocrine tumors and serous microcystic adenoma were diagnosed.
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2013; 74(5):1366-1371. DOI:10.3919/jjsa.74.1366
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    ABSTRACT: BACKGROUND: Delayed gastric emptying (DGE) is a common complication following left-sided hepatectomy. The goal of this study was to clarify the clinical implications of an omental flap wrapping procedure that includes fixation to the cut surface of the liver to reduce the incidence of DGE after left-sided hepatectomy. METHODS: The study included 50 consecutive patients who underwent left-sided hepatectomy between January 2000 and July 2011. Clinicopathologic risk factors for DGE after left-sided hepatectomy were identified using univariate and multivariate models. The incidence of DGE, digestive symptoms, and postoperative complications were compared between two groups: 25 patients treated with the omental flap wrapping and fixation procedure and 25 patients who did not receive such a flap. RESULTS: A univariate analysis revealed that a lack of the omental flap, the lymph node clearance, and use of left hemihepatectomy were associated with postoperative DGE. The multivariate analysis indicated that the lack of the omental flap was the only independent significant factor associated with the DGE (odds ratio, 21.23; p = 0.0002). There was a significant difference in the incidence of DGE between the patients with (4 %) and without an omental flap (36 %). The incidence of gastric distension and the use of prokinetic drugs were also significantly lower in patients with an omental flap than in patients without the flap, and patients with an omental flap resumed a solid diet significantly earlier. CONCLUSIONS: This retrospective single-center study revealed that it was possible to reduce the incidence of DGE using a procedure involving omental flap wrapping with fixation to the cut surface of the liver after left-sided hepatectomy.
    Surgery Today 12/2012; 43(12). DOI:10.1007/s00595-012-0446-8 · 1.21 Impact Factor
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    Surgery 12/2012; 155(1). DOI:10.1016/j.surg.2012.10.008 · 3.11 Impact Factor
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    ABSTRACT: Although extraperitoneal colostomy is often performed to prevent postoperative parastomal hernia formation following an open abdominoperineal resection of lower rectal cancer, it has not been widely employed laparoscopically because of the difficulty associated with the extraperitoneal route. This paper describes a laparoscopic extraperitoneal sigmoid colostomy using the Endo Retractâ„¢ Maxi instrument. This surgical technique is easy, and helps to prevent the development of parastomal hernias.
    Surgery Today 11/2012; 43(5). DOI:10.1007/s00595-012-0403-6 · 1.21 Impact Factor
  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2012; 73(7):1759-1763. DOI:10.3919/jjsa.73.1759
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    ABSTRACT: BACKGROUND/PURPOSE: A consistent predictor for pancreatic fistula (PF) development in the early period after pancreatic resection is still lacking. PATIENTS AND METHODS: A total of 54 consecutive patients undergoing pancreatic resection were enrolled between June 2007 and April 2010. Pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were performed in 38 and 16 patients, respectively. For the purpose of finding an early predictor for PF development, we investigated drain amylase levels (d-Amy, IU/mL), drain output volume (d-Vol, mL/day) and drain amylase output (Amy-V, IU/day) on postoperative days (POD) 1 and 3. Amy-V was calculated as the product of d-Amy and d-Vol, and was expressed as the sum of values obtained from all drains. In addition, the ratio of d-Amy or Amy-V on POD3 to that on POD1 was calculated as the persisting ratio in each patient. RESULTS: The overall incidence of clinical PF (International Study Group on Pancreatic Fistula Grade B and C) was 16.7%, occurring in 13.1% after PD and 25% after DP. All PF occurred in cases with a remnant pancreas of soft texture. There was no significant difference in d-Amy, d-Vol, or Amy-V on POD1 and POD3 between patients with and without clinical PF. The persisting ratio of Amy-V was significantly lower in patients without clinical PF compared to those with clinical PF (P = 0.029). Furthermore, the persisting ratio of Amy-V was significantly lower in patients with Grade A PF compared to those with Grade B PF (P = 0.03). CONCLUSION: The persisting ratio of drain amylase output is a new significant predictive factor for clinical PF development.
    Journal of Hepato-Biliary-Pancreatic Sciences 05/2011; 18(6). DOI:10.1007/s00534-011-0393-6 · 2.31 Impact Factor
  • Suizo 01/2011; 26(4):544-548. DOI:10.2958/suizo.26.544
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    ABSTRACT: The appropriate closure of the pancreatic remnant after a distal pancreatectomy remains controversial. To describe a safer and simple distal pancreatectomy using an endopath stapler, with special emphasis on the slow parenchymal flattening technique. The slow parenchymal flattening technique (SFT) for a distal pancreatectomy using an endopath stapler (Echelon 60) was applied to avoid a destruction of pancreas capsule and parenchyma for a soft friable pancreas. In this technique, the pancreas was gently compressed with an atraumatic intestinal clamp for a few minutes prior to the stapling dissection. Then, the closure jaw of endopath stapler was closed carefully and slowly taking more than 5 minutes at the fixed speed before dissection. SFT using the Echelon 60 was performed for 22 consecutive patients who required a distal pancreatectomy. Only one patient (4.5%) developed a symptomatic pancreatic fistula (ISGPF classification grade B). There were no mortalities or severe pancreatic fistula (ISGPF classification grade C) in this series. The SFT using the Echelon 60 can be performed easily, which enables surgeons to achieve confident pancreas stump without any tissue injury.
    Hepato-gastroenterology 01/2010; 57(102-103):1309-13. · 0.91 Impact Factor
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    ABSTRACT: Chemoresistance is a serious problem in pancreatic cancer, but the mechanism of resistance and strategies against the resistance have not been elucidated. We examined the potential of the phosphatidylinositol 3-kinase (PI3K)/Akt inhibitor LY294002 to enhance the anti-tumor effect of cisplatin and investigated the mechanism of chemoresistance in pancreatic cancer cells using a combination therapy of cisplatin and LY294002, both in vitro and in vivo. Cisplatin and LY294002, individually or in combination, were given to AsPC-1 and PANC-1 cell lines. Tumor growth, DNA fragments, and Akt phosphorylation were examined in vitro. To examine the therapeutic effect of cisplatin and LY294002, individually or combination an AsPC-1 tumor xenograft model was prepared for in vivo study. Cisplatin induced growth inhibition and Akt phosphorylation in pancreatic cancer cells. LY294002 also inhibited cell proliferation but without showing Akt phosphorylation. However, the combination therapy markedly increased cleavage of caspase-3 and cytoplasmic histone-associated DNA fragments compared to the results with cisplatin alone. In the in vivo study, blocking the PI3K/Akt cascade with LY294002 increased the efficacy of cisplatin-induced inhibition of tumor growth in nude mice, suppressing half the tumor growth with cisplatin alone. There were no detectable side effects in mice treated with combination therapy. Our studies suggest that the PI3K/Akt pathway plays an important role in cisplatin resistance of pancreatic cancer cells. The augmentation of cisplatin with PI3K/Akt inhibitor may resolve the chemoresistance problem of cisplatin, and this might be a plausible strategy for achieving tolerance for chemotherapeutic agents in pancreatic cancer therapy.
    Journal of Experimental & Clinical Cancer Research 12/2008; 27(1):76. DOI:10.1186/1756-9966-27-76 · 4.23 Impact Factor
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    ABSTRACT: Hepatic ischemia-reperfusion (I/R) injury occurs in the settings of transplantation, trauma, and elective liver resection. Ischemic preconditioning has been used as a strategy to reduce inflammation and organ damage from I/R of the liver. However, the mechanisms involved in this process are poorly understood. We examined the role of the phosphatidylinositol 3 (PI3) kinase/Akt-signaling pathway during hepatic ischemic preconditioning (IPC). Prior to a prolonged warm ischemic insult, BALB/c mice were subjected to a 20-minute IPC period consisting of 10 minutes of ischemia and 10 minutes of reperfusion. Mice undergoing IPC demonstrated a significantly greater level and earlier activation of Akt in the liver compared with control animals. IPC also resulted in markedly less hepatocellular injury and improved survival compared with control animals. Akt activation associated with hepatic IPC suppressed the activity of several modulators of apoptosis, including Bad, glycogen synthase kinase beta, and caspase-3. In addition, IPC also inhibited the activities of c-Jun N-terminal kinase and nuclear factor kappaB after I/R. Pretreatment of mice with PI3 kinase inhibitors completely abolished Akt phosphorylation and the protective effects seen with IPC. In conclusion, these results indicate that the PI3 kinase/Akt pathway plays an essential role in the protective effects of IPC in hepatic I/R injury. Modulation of this pathway may be a potential strategy in clinical settings of ischemic liver injury to decrease organ damage.
    Hepatology 09/2006; 44(3):573-80. DOI:10.1002/hep.21298 · 11.19 Impact Factor
  • K Izuishi · M Fujiwara · MA Hossain · H Usuki · H Maeta
    Transplantation Proceedings 03/2003; 35(1):575-6. DOI:10.1016/S0041-1345(02)03790-9 · 0.95 Impact Factor
  • K Izuishi · M Fujiwara · MA Hossain · H Usuki · H Maeta
    Transplantation Proceedings 03/2003; 35(1):132-3. DOI:10.1016/S0041-1345(02)03789-2 · 0.95 Impact Factor