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Current use of intraoperative ultrasound in modern liver surgery
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作者 Kai-Jian Chu Yoshikuni Kawaguchi kiyoshi hasegawa 《Oncology and Translational Medicine》 2023年第4期168-175,共8页
Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,esp... Ultrasound plays an important role not only in preoperative diagnosis but also in intraoperative guidance for liver surgery.Intraoperative ultrasound(IOUS)has become an indispensable tool for modern liver surgeons,especially for minimally invasive surgeries,partially substituting for the surgeon’s hands.In fundamental mode,Doppler mode,contrast enhancement,elastography,and real-time virtual sonography,IOUS can provide additional real-time information regarding the intrahepatic anatomy,tumor site and characteristics,macrovascular invasion,resection margin,transection plane,perfusion and outflow of the remnant liver,and local ablation efficacy for both open and minimally invasive liver resections.Identification and localization of intrahepatic lesions and surrounding structures are crucial for performing liver resection,preserving the adjacent vital vascular and bile ducts,and sparing the functional liver parenchyma.Intraoperative ultrasound can provide critical information for intraoperative decision-making and navigation.Therefore,all liver surgeons must master IOUS techniques,and IOUS should be included in the training of modern liver surgeons.Further investigation of the potential benefits and advances in these techniques will increase the use of IOUS in modern liver surgeries worldwide.This study comprehensively reviews the current use of IOUS in modern liver surgeries. 展开更多
关键词 Intraoperative ultrasound(IOUS) Contrast-enhanced intraoperative ultrasound(CE-IOUS) Intraoperative ultrasound cholangiography(IOUSC) Doppler intraoperative ultrasound(Doppler IOUS) Real-time tissue elastography(RTE) Real-time virtual sonography(RVS)
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Controversies regarding and perspectives on clinical utility of biomarkers in hepatocellular carcinoma 被引量:20
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作者 Pei-Pei Song Ju-Feng Xia +4 位作者 Yoshinori Inagaki kiyoshi hasegawa Yoshihiro Sakamoto Norihiro Kokudo Wei Tang 《World Journal of Gastroenterology》 SCIE CAS 2016年第1期262-274,共13页
The prevalence of hepatocellular carcinoma(HCC)worldwide parallels that of persistent infection with the hepatitis B virus(HBV)and/or hepatitis C virus(HCV).According to recommendations by the World Health Organizatio... The prevalence of hepatocellular carcinoma(HCC)worldwide parallels that of persistent infection with the hepatitis B virus(HBV)and/or hepatitis C virus(HCV).According to recommendations by the World Health Organization guidelines for HBV/HCV,alpha-fetoprotein(AFP)testing and abdominal ultrasound should be performed in routine surveillance of HCC every 6 mo for high-risk patients.These examinations have also been recommended worldwide by many other HCC guidelines over the past few decades.In recent years,however,the role of AFP in HCC surveillance and diagnosis has diminished due to advances in imaging modalities.AFP was excluded from the surveillance and/or diagnostic criteria in the HCC guidelines published by the American Association for the Study of Liver Diseases in 2010,the European Association for the Study of the Liver in 2012,and the National Comprehensive Cancer Network in 2014.Other biomarkers,including the Lens culinaris agglutinin-reactive fraction of AFP(AFP-L3),des-γ-carboxyprothrombin,Dickkopf-1,midkine,and micro RNA,are being studied in this regard.Furthermore,increasing attention has focused on the clinical utility of biomarkers as pre-treatment predictors for tumor recurrence and as post-treatment monitors.Serum and tissue-based biomarkers and genomics may aid in the diagnosis of HCC,determination of patient prognosis,and selection of appropriate treatment.However,further studies are needed to better characterize the accuracy and potential role of these approaches in clinical practice. 展开更多
关键词 HEPATOCELLULAR CARCINOMA BIOMARKER GUIDELINE SURVEILLANCE Diagnosis Prognosis
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Late-onset acute rejection after living donor liver transplantation 被引量:5
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作者 Nobuhisa Akamatsu Yasuhiko Sugawara +4 位作者 Sumihito Tamura Junichi Keneko Yuichi Matsui kiyoshi hasegawa Masatoshi Makuuchi 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第41期6674-6677,共4页
AIM: TO investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and stero... AIM: TO investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids. METHODS: Adult living donor liver transplantation recipients (n = 204) who survived more than 6 mo after living donor liver transplantation were enrolled. Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation, tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration. Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median follow-up period was 34 too. RESULTS: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset post-transplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporine-based regimen was significantly associated with LAR.events happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation. 展开更多
关键词 Living donor liver transplantation STEROID Acute rejection
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Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease
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作者 Yoshikuni Kawaguchi Yasuhiko Sugawara +7 位作者 Nobuhisa Akamatsu Junichi Kaneko Tomohiro Tanaka Sumihito Tamura Taku Aoki Yoshihiro Sakamoto kiyoshi hasegawa Norihiro Kokudo 《World Journal of Hepatology》 CAS 2014年第11期812-817,共6页
Although alcoholic liver disease(ALD) is regarded as a common indication for liver transplantation(LT), debatable issues exist on the requirement for preceding alcoholic abstinence, appropriate indication criteria, pr... Although alcoholic liver disease(ALD) is regarded as a common indication for liver transplantation(LT), debatable issues exist on the requirement for preceding alcoholic abstinence, appropriate indication criteria, predictive factors for alcoholic recidivism, and outcomes following living-donor LT. In most institutions, an abstinence period of six months before LT has been adopted as a mandatory selection criterion. Data indicating that pre-transplant abstinence is an associated predictive factor for alcoholic recidivism supports the reasoning behind this. However, conclusive evidence about the benefit of adopting an abstinence period is yet to be established. On the other hand, a limited number of reports available on living-donor LT experiences for ALD patients suggest that organ donations from relatives have no suppressive effect on alcoholic recidivism. Prevention of alcoholic recidivism has proved to be the most important treatment after LT based on the resultant inferior long-term outcome of patients. Further evaluations are still needed to establish strategies before and after LT for ALD. 展开更多
关键词 ABSTINENCE ALCOHOLIC LIVER disease LIVER transplantation Six-month rule
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Update on the Diagnosis and Treatment of Combined Hepatocellular Cholangiocarcinoma 被引量:2
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作者 Kai-Jian Chu Yoshikuni Kawaguchi +2 位作者 Han Wang Xiao-Qing Jiang kiyoshi hasegawa 《Journal of Clinical and Translational Hepatology》 SCIE 2024年第2期210-217,共8页
Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor.The fifth edition of the World He... Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a unique type of liver tumor that contains both hepatocellular carcinoma and cholangiocarcinoma components within a single tumor.The fifth edition of the World Health Organization classification provides a definition and diagnostic criteria for cHCC-CCA.However,the heterogeneous histomorphology and presentation resulting from variation of the proportion of each component poses challenges for clinical diagnosis and treatment.A diagnosis of cHCC-CCA may be suggested by the synchronous elevation of serum tumor markers for hepatocellular carcinoma and cholangiocarcinoma,a mixed enhancement pattern on imaging,and a discrepancy between the elevation of tumor marker and the imaging enhancement pattern.Histopathological examination using hematoxylin and eosin staining is considered the gold standard for diagnosing cHCC-CCA,and comprehensive examination of resection or biopsy specimens is crucial for an accurate diagnosis.Currently,there is no standard treatment for cHCC-CCA,and surgery is the mainstay.Anatomic hepatectomy with lymphadenectomy is among the recommended surgical procedures.The role of liver transplantation in the management of cHCC-CCA is still uncertain.Transarterial chemoembolization may be effective for unresectable cHCC-CCA,particularly for hypervascular tumors.However,the available evidence does not support systemic therapy for advanced cHCC-CCA.The prognosis of cHCC-CCA is generally poor,and there is no established staging system.Further research is needed to better understand the histogenesis and clinical management of cHCC-CCA.This review provides an overview of the current literature on cHCC-CCA with a focus on its clinical characteristics,pathological diagnosis,and management. 展开更多
关键词 Combined hepatocellular-cholangiocarcinoma Clinical characteristics Imaging characteristics Pathological diagnosis TREATMENT
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Pancreaticoduodenectomy: how to handle a replaced right hepatic artery
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作者 Junichi Kaneko Akihiko Ichida +1 位作者 Yoshikuni Kawaguchi kiyoshi hasegawa 《Hepatobiliary Surgery and Nutrition》 SCIE 2023年第2期280-283,共4页
Hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a... Hepatobiliary pancreatic surgeons sometimes encounter an aberrant(or replaced)right hepatic artery(a-RHA,Hiatt types III-VI)during pancreaticoduodenectomy(PD).Arterial flow cutoff to the a-RHA may be associated with a biliary leak or stenosis at the choledocho-jejunostomy and liver ischemia,resulting in ischemic cholangitis,liver abscess,and sepsis(1). 展开更多
关键词 Pancreaticoduodenectomy(PD) replaced right hepatic artery pancreatic ductal adenocarcinoma(PDAC)
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Automated liver tumor detection in abdominal ultrasonography with a modified faster region-based convolutional neural networks(Faster R-CNN)architecture 被引量:1
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作者 Kenji Karako Yuichiro Mihara +8 位作者 Junichi Arita Akihiko Ichida Sung Kwan Bae Yoshikuni Kawaguchi Takeaki Ishizawa Nobuhisa Akamatsu Junichi Kaneko kiyoshi hasegawa Yu Chen 《Hepatobiliary Surgery and Nutrition》 SCIE 2022年第5期675-683,I0001,共10页
Background:Although diagnostic ultrasound can non-invasively capture the image of abdominal viscera,diagnosis of the continuous ultrasound liver images to detect a liver tumor effectively and to determine whether the ... Background:Although diagnostic ultrasound can non-invasively capture the image of abdominal viscera,diagnosis of the continuous ultrasound liver images to detect a liver tumor effectively and to determine whether the detected is benign or malignant is nontrivial.In order to minimize the gaps in diagnostic accuracy depending on doctor’s proficiency,we built an automated system to support the ultrasonography of liver tumors by employing deep learning technologies.Methods:We constructed a neural network model for the automated detection of tumor tissues and blood vessels from the sequential liver ultrasound images.Faster region-based convolutional neural networks(Faster R-CNN)is employed as a base model for the object detection,which can output the detection results in 4 frames per second and enable the system to be particularly suitable for the real time ultrasonography.Moreover,we proposed a new neural network architecture feeding both the current and previous images into Faster R-CNN.For training the models,intraoperative ultrasound images obtained from one hepatocellular carcinoma(HCC)patient were used.The obtained image was a multifaceted observation of the liver and includes one HCC and some blood vessels.We labeled 91 images with the help of a liver specialist.We compared the tumor detection performance of the plain Faster R-CNN model with that of the proposed model.Results:We find that both the models performed well in detecting HCC and blood vessels,after training with 400 epochs using Adam.However,the mean precision of our model reaches 0.549,which is 0.019 better than that of the plain Faster R-CNN,and the mean sensitivity of our model about HCC reaches 0.623±0.385 for 30 scenes of sequential liver ultrasound images,which is also 0.146 better than that of the plain Faster R-CNN model.Conclusions:The comparison between the proposed model and the plain Faster R-CNN model shows that we achieved better accuracy in tumor detection,in terms of the mean precision as well as the mean sensitivity,with the proposed model. 展开更多
关键词 LIVER deep learning ULTRASONOGRAPHY object detection hepatocellular carcinoma(HCC)
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Validation of novel Japanese indication criteria and biomarkers among living donor liver transplantation recipients with hepatocellular carcinoma - a single center retrospective study 被引量:1
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作者 Akihiko Ichida Nobuhisa Akamatsu kiyoshi hasegawa 《Hepatoma Research》 2020年第8期101-111,共11页
Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)va... Aim:To validate a novel Japanese indication criteria for liver transplantation(LT)for hepatocellular carcinoma(HCC),i.e.,the 5-5-500 criteria(nodule size≤5 cm in diameter,nodule number≤5,and alfa-fetoprotein(AFP)value≤500 ng/mL)and the Japanese double eligibility criteria(DEC)(patients meeting the Milan or the 5-5-500 criteria)in the University of Tokyo cohort.The usefulness of biomarkers in predicting the recurrence of HCC was also verified.Methods:The overall survival and recurrence rates of patients meeting the Milan,5-5-500,and the Japanese DEC were compared among 153 patients who underwent living donor LT(LDLT)between 1996 and 2019.A receiver-operating characteristics curve analysis was conducted to evaluate the usefulness of AFP,lens culinaris agglutinin-reactive fraction of AFP,des-gamma-carboxy prothrombin,neutrophil-lymphocyte ratio,and the platelet-lymphocyte ratio to detect recurrence.Results:The 5-year recurrence rate for all patients,those meeting the Japanese DEC,5-5-500 criteria,and the Milan criteria was 10.9%,9.2%,7.4%,and 7.6%,respectively.Compared with the conventional Milan criteria,the 5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1%and 11.4%.Among five biomarkers,the area under the curve value of AFP was the highest(0.852).Conclusion:The results suggest that the 5-5-500 criteria and the Japanese DEC are the appropriate selection criteria for patients with HCC in LDLT.Among five biomarkers investigated,AFP was most reliable to predict HCC recurrence,which justified the utilization of AFP in the 5-5-500 criteria and the Japanese DEC. 展开更多
关键词 Indication criteria of liver transplantation for hepatocellular carcinoma the 5-5-500 criteria the Japanese double eligibility criteria alfa-fetoprotein the lens culinaris agglutinin-reactive fraction of alfa-fetoprotein the des-gamma-carboxy prothrombin the neutrophil-lymphocyte ratio the platelet-lymphocyte ratio
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Management of neuroendocrine liver metastasis:Searching for new prognostic factor and appraising repeat hepatectomy
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作者 Junichi Arita Sho Kiritani kiyoshi hasegawa 《Hepatobiliary Surgery and Nutrition》 SCIE 2021年第3期410-412,共3页
Gastro-enteric and pancreatic neuroendocrine neoplasm(NEN)is categorized as a borderline malignant tumor and was historically called carcinoid,meaning carcinoma-mimicking.NEN tumors usually grow slower than most carci... Gastro-enteric and pancreatic neuroendocrine neoplasm(NEN)is categorized as a borderline malignant tumor and was historically called carcinoid,meaning carcinoma-mimicking.NEN tumors usually grow slower than most carcinoma tumors originating from visceral organs;however,some metastasize to lymph nodes or the liver,and are potentially life-threatening. 展开更多
关键词 ORGANS METASTASIS LIVER NEOPLASM
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