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国立がん研究センター 東病院

Home > Clinical depts > Department of Hepatobiliary and Pancreatic Surgery

Department of Hepatobiliary and Pancreatic Surgery

Naoto Gotohda, Shin Kobayashi, Motokazu Sugimoto, Masashi Kudo, Taiki Sunakawa, Keisirou Aoki, Masaaki Kagoura, Tsuyoshi Terada,  Shota Kami, Hajime Kamiya, Yoshihiko Kondo, Kazushi Tsuchiya, Ryuhei Noda, Shotaro Horonushi

Introduction

The Department of Hepatobiliary and Pancreatic Surgery consists of five staff surgeons, four chief residents and seven residents. Our department is responsible for the surgical treatment of patients with hepatic, biliary, and pancreatic cancer and duodenal cancer or low-grade malignant tumors. We conduct multidisciplinary treatment in cooperation with the Department of Hepatobiliary and Pancreatic Oncology, the Department of Diagnostic Radiology, and the Department of Radiation Oncology. In addition to conventional open surgery, we perform minimally invasive surgery including laparoscopic and robot assisted surgery for patients with liver and pancreatic tumors.

The Team and What We Do

We work with outpatients five days a week and have approximately 20 inpatients. Staff meetings in which we discuss the treatment strategy or the key points of surgery for patients are held with all members of the department every morning. A Cancer Board is held in cooperation with radiologists and medical oncologists every Tuesday. A pathology conference is held monthly with pathologists. In 2024, 432 patients with hepatobiliary and pancreatic diseases underwent surgical treatment. The main diseases are shown in Table 1. Compared with the number of patients in 2023, the number of patients undergoing surgery in our department was similar (Table 2). We performed many laparoscopic surgeries for liver and pancreatic tumors in 2024.

Table 1. Number of patients

Hepatocellular carcinoma           55
Intrahepatic cholangiocellular carcinoma    10
Other liver tumors   1
Metastatic liver tumors 104
Hilar cholangiocellular carcinoma 7
Extrahepatic cholangiocellular carcinoma 17
Gallbladder cacer    14
Cancer of the ampulla of Vater 19
Other biliary tract tumors 12
Duodenal cancer 6
Other duodenal tumors   11
Pancreatic cancer   106
Other pancreatic tumors 18


Table 2. Type of procedure

Hepatectomy (Laparotomy) 24
Hepatectomy (Laparoscopy or Robot) 144
Hepatectomy with biliary reconstruction 9
Pancreatoduodenectomy (Laparotomy) 101
Pancreatoduodenectomy (Robot) 15
Distal Pancreatectomy (Laparotomy) 30
Distal Pancreatectomy (Robot) 18
Total Pancreatectomy 1
Duodenal partial resection 8
Other resections 42
Laparotomy   40



Research activities

  1. Conversion surgery for pancreatic cancer

Currently, the treatment outcomes of pancreatic cancer patients are improving remarkably with the chemotherapy regimen Gem+nab-PTX or FOLFIRINOX. We attempt conversion surgery for selected patients with borderline resectable or unresectable pancreatic cancer who received chemotherapy. We are exploring what would be a more appropriate duration of chemotherapy and good indications for conversion surgery.

  1. Function-preserving surgery

Pancreas-sparing duodenectomy (PSD) represents an alternative procedure to pancreaticoduodenectomy (PD) for patients with duodenal neoplasms. PSD is a function-preserving surgery and has the advantage over PD of preservation of the pancreas. We are attempting to establish a safe procedure for PSD.

  1. Evaluation of liver function

Postoperative liver failure is one of the fatal complications after major hepatectomy. We usually evaluate liver function using the indocyanine green retention rate at 15 min (ICG15) test. We are developing an alternative evaluation of liver function employing liver-specific magnetic resonance imaging (MRI) with a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) contrast agent instead of using the ICG15 test.

  1. Cancer genome screening

We conducted clinical studies for cancer genome screening. For patients with resectable HCC, analysis by blood screening (COSMOS-HCC-01) was started in 2020. For patients with resectable Biliary tract cancer, analysis by blood screening (COSMOS-BTC-01) was started in 2023.

“A multicenter proof of concept study for personalized perioperative therapy based on genetic alteration status for resectable oligometastases from colorectal cancer” (PRECISION study) (UMIN000042490): This is a multicenter prospective observational study to investigate the clinical utility of pre-treatment ctDNA analysis in patients undergoing surgery for colorectal oligometastases, conducted with a grant from AMED (20ck0106629h0001). The main eligibility criterion is patients with previously untreated resectable colorectal oligometastases, and the primary endpoint is the detection rate of pre-treatment ctDNA and the positive rate of BRAF V600E in tissue. The period of accrual and follow-up is two years each, and the study started in March 2021.

Clinical trials

  1. A non-randomized controlled study comparing proton beam therapy and hepatectomy for resectable hepatocellular carcinoma (JCOG1315C). Recruitment started in 2016.
  2. A randomized phase III trial of neoadjuvant gemcitabine and cisplatin and S-1 (GCS) versus surgery first for resectable biliary tract cancer (JCOG1920). Recruitment was started in 2021.
  3. A randomized phase III trial of laparoscopic versus open distal pancreatectomy for pancreatic cancer (JCOG2202). Recruitment was started in 2023.

Education

“Board-certified expert surgeons” have a high level of skill in the field of hepatobiliary-pancreatic surgery. To be qualified as one, surgeons are required to perform a prescribed number of operations under the guidance of a board-certified instructor. The residents of our department are being trained to receive the certification by the end of the chief resident course.

Future prospects

Our goal is the establishment of multidisciplinary treatment for patients with refractory hepatobiliary and pancreatic cancer and the establishment of minimally invasive surgery for patients with pancreatic cancer and liver cancer. We are conducting robot assisted surgery in our field.

List of papers published

Journal

  1. Hijioka S, Yamashige D, Esaki M, Honda G, Higuchi R, Masui T, Shimizu Y, Ohtsuka M, Kumamoto Y, Katanuma A, Gotohda N, Akita H, Unno M, Endo I, Yokoyama Y, Yamada S, Matsumoto I, Ohtsuka T, Hirano S, Yasuda H, Kawai M, Aoki T, Nakamura M, Hashimoto D, Rikiyama T, Horiguchi A, Fujii T, Mizuno S, Hanada K, Tani M, Hatori T, Ito T, Okuno M, Kagawa S, Tajima H, Ishii T, Sugimoto MTakami H, Takada R, Miura T, Kurita Y, Kamei K, Mataki Y, Okazaki K, Takeyama Y, Yamaue H, Satoi S; Japan Pancreas Society Clinical Research Promotion Committee Group (Corporate Authorship). Factors Affecting Nonfunctioning Small Pancreatic Neuroendocrine Neoplasms and Proposed New Treatment Strategies. Clin Gastroenterol Hepatol. 2024 22(7): 1416-1426.e5..       
  2. Stoop TF, Oba A, Wu YHA, Beaty LE, Colborn KL, Janssen BV, Al-Musawi MH, Franco SR, Sugawara T, Franklin O, Jain A, Saiura A, Sauvanet A, Coppola A, Javed AA, Groot Koerkamp B, Miller BN, Mack CE, Hashimoto D, Caputo D, Kleive D, Sereni E, Belfiori G, Ichida H, van Dam JL, Dembinski J, Akahoshi K, Roberts KJ, Tanaka K, Labori KJ, Falconi M, House MG, Sugimoto M, Tanabe M, Gotohda N, Krohn PS, Burkhart RA, Thakkar RG, Pande R, Dokmak S, Hirano S, Burgdorf SK, Crippa S, van Roessel S, Satoi S, White SA, Hackert T, Nguyen TK, Yamamoto T, Nakamura T, Bachu V, Burns WR, Inoue Y, Takahashi Y, Ushida Y, Aslami ZV, Verbeke CS, Fariña A, He J, Wilmink JW, Messersmith W, Verheij J, Kaplan J, Schulick RD, Besselink MG, Del Chiaro M. Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy. JAMA Netw Open. 2024 7(6): e2417625.             
  3. Lopez-Lopez V, Morise Z, Albaladejo-González M, Gavara CG, Goh BKP, Koh YX, Paul SJ, Hilal MA, Mishima K, Krürger JAP, Herman P, Cerezuela A, Brusadin R, Kaizu T, Lujan J, Rotellar F, Monden K, Dalmau M, Gotohda N, Kudo M, Kanazawa A, Kato Y, Nitta H, Amano S, Valle RD, Giuffrida M, Ueno M, Otsuka Y, Asano D, Tanabe M, Itano O, Minagawa T, Eshmuminov D, Herrero I, Ramírez P, Ruipérez-Valiente JA, Robles-Campos R, Wakabayashi G. Explainable artificial intelligence prediction-based model in laparoscopic liver surgery for segments 7 and 8: an international multicenter study. Surg Endosc. 2024 38(5): 2411-2422.         
  4. Lopez-Lopez V, Morise Z, Albaladejo-González M, Gavara CG, Goh BKP, Koh YX, Paul SJ, Hilal MA, Mishima K, Krürger JAP, Herman P, Cerezuela A, Brusadin R, Kaizu T, Lujan J, Rotellar F, Monden K, Dalmau M, Gotohda N, Kudo M, Kanazawa A, Kato Y, Nitta H, Amano S, Valle RD, Giuffrida M, Ueno M, Otsuka Y, Asano D, Tanabe M, Itano O, Minagawa T, Eshmuminov D, Herrero I, Ramírez P, Ruipérez-Valiente JA, Robles-Campos R, Wakabayashi G. Correction: Explainable artificial intelligence prediction-based model in laparoscopic liver surgery for segments 7 and 8: an international multicenter study. Surg Endosc. 2024 38(5): 2912-2913.         
  5. Lopez-Lopez V, Morise Z, Gomez Gavara C, Gero D, Abu Hilal M, Goh BK, Herman P, Clavien PA, Robles-Campos R, Wakabayashi G; Laparoscopic Liver Surgery Multicenter Study Group. Global Outcomes Benchmarks in Laparoscopic Liver Surgery for Segments 7 and 8: International Multicenter Analysis. J Am Coll Surg. 2024 239(4): 375-386.        
  6. Sunakawa T, Kitaguchi D, Kobayashi S, Aoki K, Kujiraoka M, Sasaki K, Azuma L, Yamada A, Kudo M, Sugimoto M, Hasegawa H, Takeshita N, Gotohda N, Ito M. Deep learning-based automatic bleeding recognition during liver resection in laparoscopic hepatectomy. Surg Endosc. 2024 38(12): 7656-7662.    
  7. Sunakawa T, Kobayashi S, Kudo M, Sugimoto M, Kobayashi T, Gotohda N. Pancreas-sparing tumor resection for peripancreatic paraganglioma: a case series of six patients. J Surg Case Rep. 2024 (7): rjae205.  
  8. Igata Y, Kudo M, Kojima M, Kami S, Aoki K, Satake T, Kobayashi T, Sugimoto M, Kobayashi S, Konishi M, Gotohda N. Conversion surgery after gemcitabine and cisplatin plus durvalumab for advanced intrahepatic cholangiocarcinoma: A case report. World J Clin Cases. 2024 12(34): 6721-6727.             
  9. Une N, Kobayashi S, Kudo M, Sugimoto M, Kitaguchi D, Hasegawa H, Ando K, Ikeda K, Nishizawa Y, Tsukada Y, Ito M, Gotohda N. Predictive risk factors for resection surface-related complications after laparoscopic simultaneous resection of primary colorectal tumor and synchronous liver metastases: a single-center retrospective study. Surg Endosc. 2024 38(9): 5006-5016.