Annual Report 2018
Department of Hepatobiliary and Pancreatic Surgery
Naoto Gotohda, Shinichiro Takahashi, Shin Kobayashi, Motokazu Sugimoto, Masaru Konishi, Satoshi Okubo, Masashi Kudo, Ryo Morisue, Toshiyuki Suzuki, Masatake Taniguchi, Sho Yasuta, Naoki Yagi, Ryuji Komine
Introduction
The Department of Hepatobiliary and Pancreatic Surgery consists of five staff surgeons, two senior residents and six junior resident surgeons. Our department is responsible for the surgical treatment of patients with hepatic, biliary, and pancreatic 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. We also conduct less invasive surgery: laparoscopic surgery for patients with liver cancer and pancreatic cancer.
The Team and What We Do
We work with outpatients five days a week and have about 20 inpatients. Staff meetings in which we discuss the treatment strategy or the points of surgery for patients are held with staff in the Department of Hepatobiliary and Pancreatic Oncology triweekly. The Cancer Board is held in cooperation with radiologists and medical oncologists every Tuesday. The pathology conference is held with pathologists every month. In 2018, 304 patients with hepatobiliary and pancreatic diseases underwent surgical treatment. The main diseases are shown in Table 1. Compared with the number of patients in 2017, the number of patients undergoing surgery in our department increased (Table 2). Laparoscopic surgery for liver cancer and pancreas cancer is expanding rapidly in Japan. We performed laparoscopic hepatectomy (Lap-H) and distal pancreatectomy for more than 100 cases in 2018. We are establishing the position of the leading hospitals regarding Lap-H and organizing Lap-H seminars in our hospital to generalize the safe procedure of Lap-H.
Research activities
- 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 try to perform conversion surgery for selected patients with borderline resectable or unresectable pancreatic cancer who received chemotherapy. We are currently evaluating good indications for conversion surgery. - Function-preserving surgery
Pancreas sparing duodenectomy (PSD) represents an alternative procedure to pancreaticoduodenectomy (PD) for patients with duodenal neoplasms. PSD is a less invasive procedure and has the advantage over PD of preservation of the pancreas. We are trying to establish a safe procedure for PSD. - Evaluation of the liver functio
Postoperative liver failure is one of the fatal complications after major hepatectomy. We usually evaluate the liver function using the test of Indocyanine green retention rate at 15min (ICG15). We are developing an alternative evaluation of the liver function using liverspecific magnetic resonance imaging (MRI) with the contrast agent of Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOBDTPA) instead of using the test of ICG15.
Clinical trials
- A Phase III trial of S-1 versus observation in patients with resected biliary tract cancer (JCOG1202). Recruitment finished in 2018.
- Randomized phase II trial of chemoradiotherapy with S-1 versus gemcitabine and S-1 combination therapy as neoadjuvant treatment in patients with resectable pancreatic cancer (JASPAC04). Recruitment started in 2014.
- Non-randomized controlled study comparing proton beam therapy and hepatectomy for resectable hepatocellular carcinoma (JCOG1315C). Recruitment started in 2016.
- Japanese trial - A Global study to evaluate the potential benefit of adjuvant chemotherapy for small bowel adenocarcinoma (JCOG1502C). Recruitment started in 2017.
- Comparison of Berizym and Pancrelipase for the effect of suppressing onset of hepatic seatosis after pancreaticoduodenectomy (ESOP Trial). Recruitment started in 2016.
- Randomized phase II/III study of gemcitabine and nab-paclitaxel therapy versus S-1 and concurrent radiotherapy as neoadjuvant treatment for Borderline resectable pancreatic cancer (GABARNANCE Trial). Recruitment started in 2017.
- Investigator-Initiated Clinical Trial of Nivolumab Monotherapy and Subsequent Radical Surgery Following Preoperative Chemoradiotherapy in Patients with Microsatellite Stable Locally Advanced Rectal Cancer (EPOC 1504). Recruitment started in 2018
Education
The 'Board-certified expert surgeon' is a high level of skill in the field of Hepato-biliarypancreatic surgery. To be qualified as a boardcertified surgeon, 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 get the certifications by the end of the chief resident course.
Future prospects
The establishment of multidisciplinary treatment for patients with refractory hepatobiliary and pancreatic cancer and the establishment of less invasive surgery for patients with pancreatic cancer and liver cancer is our goal.
List of papers published in 2018
Journal
1. Nakachi K, Konishi M, Ikeda M, Mizusawa J, Eba J, Okusaka T, Ishii H, Fukuda H, Furuse J. A randomized Phase III trial of adjuvant S-1 therapy vs observation alone in resected biliary tract cancer: Japan Clinical Oncology Group Study (JCOG1202, ASCOT). Jpn J Clin Oncol, 48:392-395, 2018
2. Hagiwara Y, Ohashi Y, Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, Kaneoka Y, Shimizu Y, Nakamori S, Sakamoto H, Morinaga S, Kainuma O, Imai K, Sata N, Hishinuma S, Ojima H, Yamaguchi R, Hirano S, Sudo T. Health-related quality of life of adjuvant chemotherapy with S-1 versus gemcitabine for resected pancreatic cancer: Results from a randomised phase III trial (JASPAC 01). Eur J Cancer, 93:79-88, 2018
3. Okubo S, Gotohda N, Sugimoto M, Nomura S, Kobayashi S, Takahashi S, Hayashi R, Konishi M. Abdominal skin closure using subcuticular sutures prevents incisional surgical site infection in hepatopancreatobiliary surgery. Surgery, 164:251-256, 2018
4. Nakachi K, Konishi M, Ikeda M, Shimada K, Okusaka T, Saiura A, Ishii H, Sugiyama M, Furuse J, Sakamoto H, Shimamura T, Ohta T. Feasibility study of postoperative adjuvant chemotherapy with S-1 in patients with biliary tract cancer. Int J Clin Oncol, 23:894- 899, 2018
5. Komai Y, Gotohda N, Matsubara N, Takeda H, Yuasa T, Inoue M, Yamamoto S, Yonese J. Preliminary Kidney Parenchymal Ligation Using Endoloop Ligatures-A Simple Method to Achieve a Trifecta in Laparoscopic Partial Nephrectomy Without Hilar Clamping for Polar Complex Tumors. Urology, 121:182-188, 2018
6. Takahashi D, Kojima M, Sugimoto M, Kobayashi S, Takahashi S, Konishi M, Gotohda N, Nagino M. Pathologic Evaluation of Surgical Margins in Pancreatic Cancer Specimens Using Color Coding With Tissue Marking Dyes. Pancreas, 47:830-836, 2018
7. Kudo M, Gotohda N, Sugimoto M, Kobayashi T, Kojima M, Takahashi S, Konishi M, Hayashi R. Evaluation of liver function using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging based on a three-dimensional volumetric analysis system. Hepatol Int, 12:368-376, 2018
8. Okubo S, Mitsunaga S, Kato Y, Kojima M, Sugimoto M, Gotohda N, Takahashi S, Hayashi R, Konishi M. The prognostic impact of differentiation at the invasive front of biliary tract cancer. J Surg Oncol, 117:1278-1287, 2018
9. Takahashi D, Kojima M, Suzuki T, Sugimoto M, Kobayashi S, Takahashi S, Konishi M, Gotohda N, Ikeda M, Nakatsura T, Ochiai A, Nagino M. Profiling the Tumour Immune Microenvironment in Pancreatic Neuroendocrine Neoplasms with Multispectral Imaging Indicates Distinct Subpopulation Characteristics Concordant with WHO 2017 Classification. Sci Rep, 8:13166, 2018