Nobuyuki Takemura

The University of Tokyo, Edo, Tōkyō, Japan

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Publications (14)32.77 Total impact

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    ABSTRACT: Presence of hepatic vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT. Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analyzed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral hepatic vein, including microscopic invasion (pHVTT), tumor thrombosis in a major hepatic vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified. The median survival times (MSTs) in the pHVTT and mHVTT groups were 5.27 and 3.95 years, respectively (P=0.77), and the median time to recurrence (TTR) was 1.06 and 0.41 years, respectively (P=0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39 years and 0.25 year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44 years, P=0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, P=0.024) and R 1/2 resection (RR 2.08, P=0.017) as risk factors for the overall survival CONCLUSIONS: Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function.
    Journal of Hepatology 05/2014; · 9.86 Impact Factor
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    ABSTRACT: Fluorescence imaging using indocyanine green (ICG) has recently been applied to laparoscopic surgery to identify cancerous tissues, lymph nodes, and vascular anatomy. Here we report the application of ICG-fluorescence imaging to visualize the boundary between the liver and subserosal tissues of the gallbladder during laparoscopic full-thickness cholecystectomy. A patient with a potentially malignant gallbladder lesion was administered 2.5-mg intravenous ICG just before laparoscopic full-thickness cholecystectomy. Intraoperative fluorescence imaging enabled the real-time delineation of both extrahepatic bile duct anatomy and hepatic parenchyma throughout the procedure, which resulted in complete removal of subserosal tissues between liver and gallbladder. Safe and feasible ICG-fluorescence imaging can be widely applied to laparoscopic hepatobiliary surgery by utilizing a biliary excretion property of ICG.
    Asian Journal of Endoscopic Surgery 05/2014; 7(2).
  • Nihon Naika Gakkai Zasshi 01/2014; 103(1):70-7.
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    ABSTRACT: To clarify the prognostic impact of the hepatitis C virus (HCV) genotype after curative resection for hepatocellular carcinoma (HCC).A total of 199 patients who underwent a curative hepatic resection for HCV-related HCC were reviewed. The clinical outcomes were compared between patients infected with HCV genotype 1b (n = 160) and those infected with other genotypes (n = 39).With a comparable median HCV viral load (6.0 vs. 5.8 log10 IU/mL, p = 0.17), the 3-year recurrence-free survival (RFS) rates (25 vs. 20 %, p = 0.65) and the 5-year overall survival (OS) rates (72 vs. 65 %, p = 0.73) were similar between the two groups. A multivariate analysis confirmed that HCV viral load of +1.0 log10 IU/mL [hazard ratio (HR), 1.48], major vascular invasion (HR, 3.20), recurrent tumor (HR, 1.77), and preoperative des-gamma carboxyprothrombin level >40 mAu/mL (HR, 1.64) were independent predictors of tumor recurrence, while the HCV genotype was not a significant risk factor. When the population was stratified according to the HCV viral load, a significant difference was observed in the RFS rate for both genotype 1b (p = 0.003) and the other genotypes (p = 0.037) at HCV viral load of 5.3 log10 IU/mL.The HCV genotype does not affect the surgical outcomes of patients with HCC. A lower HCV viral load is advantageous regardless of the HCV genotype.
    Hepatology International 01/2014; 8(1). · 2.64 Impact Factor
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    ABSTRACT: The efficacy of repeat hepatectomy for recurrent hepatocellular carcinoma and colorectal liver metastases is widely accepted. However, the benefits of such treatment for intrahepatic recurrence of gastric cancer liver metastasis remain unknown. This study sought to clarify the survival benefit for patients undergoing repeat hepatectomy for gastric cancer liver metastasis. A total of 73 patients underwent hepatectomy for gastric cancer liver metastasis from January 1993 to January 2011. Macroscopically curative surgery was performed in 64 patients. Among them, repeat hepatectomy was performed in 14 of the 37 patients with intrahepatic recurrence. Among these 14 patients, clinicopathologic factors were evaluated by univariate and multivariate analysis to identify the factors affecting survival. The overall 1-, 3-, and 5-year survival rates after a second hepatectomy were 71, 47, and 47 %, respectively. The median survival was 31 months. Operative morbidity and mortality rates of repeat hepatectomy were 29 and 0 %, respectively. Multivariate analysis identified the duration of the disease-free interval as the only independent significant factor predicting better survival. In selected patients, repeat hepatectomy for recurrent gastric cancer liver metastasis may offer the same chance of cure as the primary hepatectomy. Disease-free intervals exceeding 12 months predict good patient survival after repeat hepatectomy.
    World Journal of Surgery 08/2013; · 2.23 Impact Factor
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    ABSTRACT: Liver resection is now widely accepted as a potentially curative treatment for colorectal liver metastasis. However, the efficacy of surgical resection for gastric cancer liver metastasis(GLM)remains unclear. Based on our 18-year experience with 64 patients who underwent curative hepatectomy for GLM, we discuss the indication and efficacy of surgical resection for GLM. From January 1993 to January 2011, 73 patients underwent hepatectomy for GLM in the Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital(Japanese Foundation for Cancer Research), Japan. The actuarial1 -, 3-, and 5-year overall survival rates and 1-, 3-, and 5-year recurrence-free survival rates of those 64 patients who achieved curative resections were 84, 50, and 37%, and 42, 27, and 27%, respectively. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor(>5 cm in diameter)were found to be independent indicators of poor prognosis. Based on the multivariate analysis results, all patients were divided into three groups no poor prognostic factor(n=38), one poor prognostic factor(n=24), and two poor prognostic factors(n=2). The actuarial overall survival rates of each group were 63, 36, and 0% at 3 years, and 53, 15, and 0% at 5 years. GLM patients having hepatic tumors with the maximum diameter of <5 cm, and without serosalinvasion of the primary gastric cancer, are the best candidates for hepatectomy.
    Gan to kagaku ryoho. Cancer & chemotherapy 12/2012; 39(13):2455-9.
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    ABSTRACT: The indication for hepatectomy in cases of gastric cancer liver metastases (GLM) remains unclear and it remains controversial whether surgical resection is beneficial for GLM. The objective of this retrospective study was to clarify the indications for and benefit of hepatectomy for GLM. Seventy-three patients underwent hepatectomies for GLM from January 1993 to January 2011. Macroscopically complete (R0 or R1) resection was achieved in 64 patients. Among them, 32 patients underwent synchronous hepatectomy with gastrectomy and the remaining 32 patients underwent metachronous hepatectomy. Repeat hepatectomy was done in 14 patients for resectable intrahepatic recurrences. Clinicopathological factors were evaluated by univariate and multivariate analyses among patients who received macroscopically complete resection for those affecting survival. The overall 1-, 3-, and 5-year survival rates after macroscopically complete (R0 or R1) liver resection (n = 64) for GLM were 84, 50, and 37 %, respectively, with a median survival of 34 months. Univariate analysis identified serosal invasion of the primary gastric cancer and blood transfusions during surgery as poor prognosis indicators. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor (>5 cm in diameter) were found to be independent indicators of poor prognosis. GLM patients with the maximum diameter of hepatic tumors of <5 cm and without serosal invasion of the primary gastric cancer are the best candidate for hepatectomy.
    Langenbeck s Archives of Surgery 05/2012; 397(6):951-7. · 1.89 Impact Factor
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    ABSTRACT: The clinical implications of peritoneal lavage cytology (CY) status in patients with potentially resectable pancreatic cancer have not been established. We retrospectively reviewed clinical data from 254 consecutive patients who underwent macroscopically curative resection for pancreatic cancer from February 2003 to December 2010 in our institution. Correlations between CY status and survival and clinicopathological findings were investigated. Of the 254 patients, 20 were CY+ (7.9 %). There were no significant differences between CY+ and CY- patients in background data (age, sex, the level of preoperative tumor marker, and adjuvant chemotherapy). Patients with positive serosal invasion were more likely to be CY+ than those with negative serosal invasion (P < 0.001) by univariate analysis. The median overall survival of CY+ patients and CY- patients was 23.8 months (95 % CI = 17.6-29.8) and 26.5 months (95 % CI = 20.7-32.3), respectively (P = 0.302). The median recurrence-free survival of CY+ and CY- patients was 8.1 months (95 % CI = 0.0-17.9) and 13.5 months (95 % CI = 11.5-15.5), respectively (P = 0.089). CY+ status without other distant metastasis does not necessarily preclude resection in patients with pancreatic cancer.
    World Journal of Surgery 05/2012; 36(9):2187-91. · 2.23 Impact Factor
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    ABSTRACT: Although the use of single-incision laparoscopic cholecystectomy (SILC) is spreading rapidly, this technique has disadvantages. It does not allow for sufficient surgical views to be obtained or for intraoperative radiographic cholangiography to be performed. Fluorescent cholangiography using a preoperative intravenous injection of indocyanine green (ICG) may be useful for identifying the biliary tract during both SILC and conventional laparoscopic cholecystectomy. For seven patients undergoing SILC, 1 ml of ICG (2.5 mg) was administered by intravenous injection before the surgery. The prototype fluorescent imaging system consisted of a xenon light source and a 30° laparoscope (diameter, 10 mm) equipped with a charge-coupled device camera capable of filtering out light with wavelengths shorter than 810 nm. The laparoscope was introduced through an umbilical trocar. Fluorescent cholangiography then was performed by changing the color images to fluorescent images using a foot switch during dissection of the triangle of Calot. Fluorescent cholangiography identified the confluence between the cystic duct and the common hepatic duct in all seven patients before and throughout the dissection of the triangle of Calot. The interval from the injection of ICG to the first obtained fluorescent cholangiography before dissection of the triangle of Calot ranged from 35 to 75 min. Fluorescent cholangiography enabled real-time identification of the extrahepatic bile ducts during SILC without necessitating catheterization of the bile duct. Such properties of fluorescent cholangiography are expected to be helpful for ensuring the safety of SILC and expanding the indications for the procedure.
    Surgical Endoscopy 03/2011; 25(8):2631-6. · 3.43 Impact Factor
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    ABSTRACT: Background:  Accurate knowledge of the surgical anatomy of the caudate lobe is indispensable in the performance of liver surgery. Although previous cast studies have provided much useful overall information about the locations of the caudate veins, little is known about how to establish the exact locations of the caudate and short hepatic veins prior to surgery. Objectives:  This study was conducted as a practical morphometric analysis of the caudate veins using preoperative enhanced computed tomography (CT) and intraoperative ultrasound (IOUS). Methods:  From July 2003 to October 2005, 116 donor hepatectomies were performed for adult living donor liver transplantation. The numbers and locations of visible caudate veins were examined pre- and intraoperatively using CT and IOUS. Results:  In the 116 patients, a total of 152 caudate veins were detected, which were classified as being of either typical (n= 135) or non-typical (n= 17) type. One caudate vein was detectable in 83 patients (72%), two in 30 patients (26%) and three in three patients (3%). A total of 67% of caudate veins detected by IOUS and 70% detected by CT were located on the ventral 60 ° of the inferior vena cava (IVC). The remaining veins were scattered on both lateral sides. Conclusions:  Preoperative CT and IOUS were useful in providing morphometric information of sizable caudate veins. Precise information on these veins is essential for the safe dissection of the caudate lobe from the IVC in advanced liver surgery.
    HPB 11/2010; 12(9):619-24. · 1.94 Impact Factor
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    ABSTRACT: We report a 49-year-old man with unresectable intrahepatic cholangiocarcinoma (ICC) who was treated with oral tegafur-uracil (UFT) chemotherapy and survived for over a decade. In 1995, the patient was admitted to our institution after a large tumor in his left liver was detected using computed tomography (CT). The tumor was diagnosed as ICC, and a laparotomy was performed; however, the tumor was too advanced to perform a curative resection. The cancer had spread to the lymph nodes in the hepatoduodenal ligament and on the posterior surface of the pancreas head. A curative resection was abandoned, and oral UFT chemotherapy was started immediately after the laparotomy. The tumor remained almost unchanged until 2001 with only UFT administration; however, its size gradually increased to 7.8 cm in diameter. External-beam radiotherapy (50.4 Gy) was performed, and the tumor's size decreased to 6.3 cm in diameter. Eleven years have now passed since the laparotomy, and the patient continues to lead a normal daily life working as a banker. The cumulative dose of UFT has reached 2511 g without any significant adverse effects. This case suggests that oral UFT might suppress the progression of ICC, contributing to this patient's 11-year survival period.
    Hepato-gastroenterology 01/2008; 55(88):1997-9. · 0.77 Impact Factor
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    ABSTRACT: Hepatitis B surface antigen-negative and hepatitis B core antibody-positive grafts were considered unsuitable for transplantation. The number of potential recipients for liver transplantation now exceeds that of potential donor organs, which has led us to reevaluate the feasibility of these grafts. Several strategies involving prophylactic administration of hepatitis B immunoglobulin and/or lamivudine to transplant recipients have been proposed. At the University of Tokyo, we have continued to use hepatitis B immunoglobulin monoprophylaxis with zero recurrence. In this article we report our experience with the use of hepatitis B surface antigen-negative/hepatitis B core antibody-positive grafts with hepatitis B immunoglobulin monotherapy. We conducted a review of the literature regarding the feasibility of these grafts to reconfirm optimal prophylactic strategies for preventing de novo hepatitis B virus infection in transplant recipients.
    Digestive Diseases and Sciences 11/2007; 52(10):2472-7. · 2.26 Impact Factor
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    ABSTRACT: The mortality rate of fulminant hepatic failure was high until liver transplantation was presented as a potential therapy. We encountered a patient with hyperacute fulminant hepatic failure due to hepatitis B virus infection. Living donor liver transplantation was planned but abandoned because her brain edema progressed too rapidly to complete the donor evaluation. The present case reveals the limitation of living donor liver transplantation as a treatment for hyperacute fulminant hepatic failure.
    Bioscience trends 08/2007; 1(1):7-9. · 1.58 Impact Factor
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    ABSTRACT: The incidence of hepatic venous stenosis is higher in partial liver transplantation. New methods for hepatic venous reconstruction in left liver transplantation, which secure wide anastomosis, were devised and are reported here. In the graft, the right side of the middle hepatic vein or the left side of the left hepatic vein was cut longitudinally and a rectangular-shaped vein patch was attached for venoplasty. In the recipient, after the left and middle hepatic veins were joined, the right side of the middle hepatic vein was cut toward the closed right hepatic vein, making a horizontal cavotomy for anastomosis. Of 92 patients who underwent conventional hepatic vein reconstruction, 3 were complicated by hepatic venous stenosis (median follow-up 43 months). By contrast, there were no hepatic vein complications in the 20 patients who underwent the new technique (7 months). The current method appears to be technically feasible for outflow reconstruction in left liver graft transplantation.
    Liver Transplantation 04/2005; 11(3):356-60. · 3.94 Impact Factor