研究等業績 - その他 - 水野　大

Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma.

Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Akira Sasaki

Asian journal of endoscopic surgery     2019年07月

INTRODUCTION: Recent studies have reported that induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil (DCF) is an effective treatment for unresectable, locally advanced esophageal cancer. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) after DCF for initially unresectable esophageal squamous cell carcinoma (ESCC). METHODS: Twenty-three patients with initially unresectable T4 thoracic ESCC underwent TE after induction DCF. RESULTS: The neighboring organs with tumors were the tracheobronchus in nine patients, thoracic aorta in 13, and pericardium and diaphragm in three each (concurrent overlapping invasion occurred in five patients). The mean total operation time was 556.3 ± 107.2 minutes, and the mean time of the thoracic procedure was 258.9 ± 83.9 minutes. The mean total blood loss was 166.2 ± 117.8 mL, and the loss during the thoracic procedure was 33.5 ± 24.6 mL. All patients achieved complete R0 resection under TE. No conversions to open thoracotomy were performed. The postoperative morbidity rate was 34.8%. The postoperative hospital stay was 24.3 (range, 13-38) days. Five patients had recurrence: four had distant metastasis (lung, two; liver, three; and one with overlap), and one had mediastinal lymph node recurrence. No local recurrence was noted at the site of the primary T4 tumor. CONCLUSIONS: TE was safely performed in 23 patients after DCF therapy for locally advanced unresectable ESCC. Induction DCF, followed by TE, could be an alternative treatment for unresectable T4 ESCC.

DOI PubMed

後期高齢者に対する食道癌手術成績における多職種チーム介入の効果

遠藤史隆, 秋山有史, 二階春香, 馬場誠朗, 千葉丈広, 岩谷岳, 木村聡元, 高原武志, 新田浩幸, 大塚幸喜, 水野大, 肥田圭介, 佐々木章

日本外科系連合学会誌   44 ( 3 ) 442   2019年05月

J-GLOBAL

Side‐Overlap法による腹腔鏡下噴門側胃切除後の機能評価

佐藤慧, 秋山有史, 二階春香, 遠藤史隆, 馬場誠朗, 千葉丈広, 木村聡元, 高原武志, 岩谷岳, 大塚幸喜, 新田浩幸, 水野大, 肥田圭介, 佐々木章

日本外科学会定期学術集会(Web) ( (一社)日本外科学会 )  119th   ROMBUNNO.PS‐210‐5 (WEB ONLY) - 210   2019年04月

J-GLOBAL

肺転移を伴う切除不能型肝芽腫に対し、生体肝移植を含む集学的治療で救命し得た1幼児例

小林 めぐみ, 水野 大, 石田 和之, 菅井 有, 佐々木 章

岩手医学雑誌 ( 岩手医学会 )  71 ( 1 ) 21 - 27   2019年04月

近年、肝外病変を伴う切除不能型肝芽腫に対し大量化学療法や外科的切除によって肝外病変をコントロールし肝移植を行った報告があるが、その適応や評価は各施設の判断に委ねられている。今回、多発肺転移を伴う切除不能型肝芽腫に対し、我々が行った肝移植を含む集学的治療について報告する。症例は2歳の女児。発熱を主訴に前医受診し精査でα-fetoprotein(AFP)の異常高値と腹部CTで肝両葉を占居する腫瘤病変を認め当院紹介となった。入院後の精査で肺にも腫瘤状陰影を認め、肝生検より肝芽腫の診断となった。多剤併用化学療法にて肺転移は著明に縮小し、左3区域切除術を施行した。しかし術後早期に残肝再発を認めたため、試験胸腔鏡で肺転移が無いことを確認し生体肝移植を行った。術後経過は良好で現在再発なく外来通院中である。肝芽腫の肺転移の評価には様々な方法があるが末梢病変である本症例は胸腔鏡下手術が非常に有効であった。(著者抄録)

思春期に再発性気胸を契機に発見された先天性嚢胞性腺腫様奇形の1例

早野恵, 水野大, 小林めぐみ, 岩谷岳, 大塚幸喜, 新田浩幸, 秋山有史, 高原武志, 佐々木章

日本小児外科学会雑誌   55 ( 1 ) 174   2019年02月

DOI J-GLOBAL

全葉に病変を有する先天性肺気道奇形の治療方針

早野恵, 水野大, 小林めぐみ, 阿部崇臣, 岩谷岳, 大塚幸喜, 新田浩幸, 秋山有史, 高原武志, 菅野紘暢, 兼子由香, 重枝弥, 友安信, 出口博之, 斎藤元, 佐々木章

日本外科学会定期学術集会(Web)   119th   ROMBUNNO.PS‐040‐1 (WEB ONLY)   2019年

J-GLOBAL

Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy.

Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Kei Sato, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Hiroyuki Nitta, Koki Otsuka, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Akira Sasaki

Journal of thoracic disease   10 ( 12 ) 6854 - 6862   2018年12月

Background: Previous studies have shown that enteral nutrition (EN) helps reduce severe postoperative complications after esophagectomy. However, the incidence of jejunostomy-related complications is approximately 30%. We evaluated the operative outcomes in patients who did not receive EN via feeding jejunostomy after esophagectomy. Methods: We retrospectively reviewed 76 consecutive patients with esophageal cancer who received radical esophagectomy. Operative outcomes were compared between 33 patients who received postoperative EN via feeding jejunostomy (group A; from May 2014 to September 2015) and 43 patients who did not receive EN via feeding jejunostomy (group B; from September 2015 to December 2017). Results: The American Society of Anesthesiologists performance status score of the patients in group B was significantly higher than that of patients in group A (P=0.002). The postoperative morbidity rate was comparable between the two groups (group A, 30.3% vs. group B, 44.2%, P=0.217). No significant between-group differences were observed in the incidence of infectious complications, postoperative hospital stay, readmission within 30 days after discharge, or pneumonia after discharge within 6 months. The incidence of bowel obstruction was significantly higher in group A than in group B (group A, 9.1% vs. group B, 0%, P=0.044). Two patients in group B required nutritional support via total parenteral nutrition due to bilateral vocal cord palsy or pneumonia. Conclusions: Jejunostomy-related bowel obstruction in the patients with feeding jejunostomy was significantly higher than that in the patients without jejunostomy. There was no increase in postoperative complications (including pneumonia) in the patients who did not receive EN via feeding jejunostomy. Our results suggest that routine feeding jejunostomy may not be necessary for all patients undergoing esophagectomy.

DOI PubMed

Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report.

Ryosuke Fujisawa, Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Keisuke Koeda, Akira Sasaki

Surgical case reports   4 ( 1 ) 144 - 144   2018年12月

BACKGROUND: Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia. CASE PRESENTATION: An 81-year-old woman with chest discomfort was admitted to the hospital, where barium esophagography showed a sliding esophageal hiatal hernia and a tumor of the lower esophagus and gastric wall. Esophagogastroscopy confirmed the presence of a huge submucosal tumor that extended from the lower esophagus to the gastric fundus. According to computed tomography, the mediastinal mass measured 12.7 cm and had heterogeneous low-density areas. A submucosal gastric tumor, which we suspected to be a GIST, was diagnosed in association with an esophageal hiatal hernia. Using thoracolaparotomy, we performed a total gastrectomy, a lower esophagectomy, and a Roux-en-Y reconstruction with the jejunum. The presumptive diagnosis was confirmed through immunohistochemical examination; immunostaining yielded results positive for CD34 and c-kit. The patient was discharged from the hospital 13 days after surgery with no complications and remained disease-free at follow-up 24 months after surgery. CONCLUSIONS: GIST should be considered in the differential diagnosis of tumors growing in the mediastinum.

DOI PubMed

Thoracoscopic esophagectomy with total meso-esophageal excision reduces regional lymph node recurrence.

Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Kei Sato, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Akira Sasaki

Langenbeck's archives of surgery   403 ( 8 ) 967 - 975   2018年12月

PURPOSE: We investigated the operative outcomes of thoracoscopic esophagectomy (TE) in the prone position, using the concept of total meso-esophageal excision for esophageal cancer. METHODS: The medical records of 140 consecutive patients with esophageal cancer who underwent radical esophagectomy by TE were reviewed retrospectively, and operative outcomes were compared between patients treated before (non-meso-esophagus; non-ME group) and after (ME group) the introduction of total meso-esophageal excision (ME). RESULTS: There were no significant differences between the groups in postoperative morbidity (non-ME group vs. ME group, 28.3% vs. 41.4%, p = 0.119), 30-day mortality (non-ME group vs. ME group, 0% vs. 1.1%; p = 0.433), and in-hospital mortality (non-ME group vs. ME group, 1.9% vs. 0%, p = 0.199). Although overall survival and relapse-free survival did not differ significantly between the groups, the overall recurrence rate was significantly lower in the ME group than the non-ME group (non-ME group vs. ME group, 43.4% vs. 23%, p = 0.011). In particular, the rate of regional lymph node recurrence in the mediastinum was lower in the ME group (non-ME group vs. ME group, 11.3% vs. 2.3%; p = 0.026). CONCLUSIONS: Our results suggest that the ME procedure might be one of the procedures that reduce regional lymph node recurrence in the mediastinum without any deterioration in short-term outcomes.

DOI PubMed

甲状腺内視鏡手術、良悪性保険収載完了後の更なる発展のために 内視鏡下甲状腺手術における適正な診療報酬改定に向けて

佐々木 章, 大塚 幸喜, 新田 浩幸, 二階 春香, 梅邑 晃, 馬場 誠朗, 木村 聡元, 高原 武志, 秋山 有史, 岩谷 岳, 水野 大

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 )  23 ( 7 ) SY7 - 5   2018年12月

肥満外科治療の現状と展望 糖尿病以外の肥満関連健康障害に対する腹腔鏡下スリーブ状胃切除術の効果

佐々木 章, 新田 浩幸, 大塚 幸喜, 二階 春香, 梅邑 晃, 馬場 誠朗, 木村 聡元, 高原 武志, 秋山 有史, 岩谷 岳, 水野 大

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 )  23 ( 7 ) SY10 - 7   2018年12月

膜を意識した腹臥位胸腔鏡下食道切除術の手術手技と治療成績

秋山 有史, 岩谷 岳, 遠藤 史隆, 二階 春香, 佐藤 慧, 馬場 誠朗, 千葉 丈広, 木村 聡元, 高原 武志, 大塚 幸喜, 新田 浩幸, 水野 大, 木村 祐輔, 肥田 圭介, 佐々木 章

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 )  23 ( 7 ) OS230 - 6   2018年12月

高度進行食道癌患者に対する腹腔鏡下胃瘻造設術の工夫

二階 春香, 秋山 有史, 佐藤 慧, 遠藤 史隆, 馬場 誠朗, 千葉 丈広, 木村 聡元, 高原 武志, 岩谷 岳, 新田 浩幸, 大塚 幸喜, 肥田 圭介, 水野 大, 佐々木 章

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 )  23 ( 7 ) OS147 - 7   2018年12月

鼠径ヘルニアに対するTEPの手術手技の工夫

馬場 誠朗, 秋山 有史, 冨澤 勇貴, 二階 春香, 佐藤 慧, 遠藤 史隆, 千葉 丈広, 木村 聡元, 高原 武志, 岩谷 岳, 新田 浩幸, 大塚 幸喜, 水野 大, 肥田 圭介, 佐々木 章

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 )  23 ( 7 ) OS60 - 8   2018年12月

維持透析症例の生体肝移植 腎障害を併発している症例に対する肝移植

高原 武志, 新田 浩幸, 長谷川 康, 片桐 弘勝, 菅野 将史, 木村 聡元, 秋山 有史, 岩谷 岳, 大塚 幸喜, 肥田 圭介, 水野 大, 佐々木 章

移植 ( (一社)日本移植学会 )  53 ( 総会臨時 ) 254 - 254   2018年09月

Outcomes of esophagectomy after chemotherapy with biweekly docetaxel plus cisplatin and fluorouracil for advanced esophageal cancer: a retrospective cohort analysis.

Yuji Akiyama, Akira Sasaki, Fumitaka Endo, Haruka Nikai, Satoshi Amano, Akira Umemura, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Hiroyuki Nitta, Koki Otsuka, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Takeshi Iwaya

World journal of surgical oncology   16 ( 1 ) 122 - 122   2018年07月

BACKGROUND: Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can cause severe adverse events, including neutropenia and febrile neutropenia. The feasibility of DCF therapy is a concern, particularly for elderly patients, patients with moderate organ disorders, and patients suffering from malnutrition caused by dysphagia or insufficient oral intake. We introduced a biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and outcome of an esophagectomy after bDCF therapy for patients with advanced esophageal squamous cell carcinoma. METHODS: Fifty-nine patients with esophageal carcinoma underwent an esophagectomy after DCF or bDCF therapy as primary chemotherapy. DCF was administered to 37 patients in the DCF group, whereas bDCF was administered to 22 patients in the bDCF group. RESULTS: Patients in the bDCF group were significantly older than those in the DCF group (p = 0.016). Heart and pulmonary comorbidities were significantly more common in the bDCF than in the DCF group (p < 0.001 and p = 0.039, respectively). Grade 3 or 4 neutropenia was less frequent in the bDCF than in the DCF group (40.9 vs. 81.1%, p = 0.002). Anorexia was more frequent in the DCF group than in the bDCF group (18.9 vs. 0%, p = 0.030). The clinical response rate of the bDCF group was significantly higher than that of the DCF group (86.4 vs. 62.2%, p = 0.047). There was no significant between-group difference in the postoperative morbidity rate (bDCF 45.5% vs. DCF 32.4%) or in the histological therapeutic effect. CONCLUSION: The results demonstrate that primary bDCF therapy for high-risk patients with advanced esophageal cancer is feasible and safe in both chemotherapeutic and perioperative periods without a reduction in the efficacy of DCF therapy.

DOI PubMed

十二指腸乳頭部癌に対する膵頭十二指腸切除術の短期成績及び長期成績の検討

高清水 清治, 高原 武志, 木村 聡元, 秋山 有史, 岩谷 岳, 大塚 幸喜, 新田 浩幸, 肥田 圭介, 水野 大, 佐々木 章

日本消化器外科学会総会 ( (一社)日本消化器外科学会 )  73回   690 - 690   2018年07月

膵異所性脂肪沈着と血中循環脂肪は糖尿病の重症度を反映するか?

梅邑 晃, 佐々木 章, 新田 浩幸, 二階 春香, 馬場 誠朗, 木村 聰元, 高原 武志, 秋山 有史, 岩谷 岳, 大塚 幸喜, 肥田 圭介, 水野 大, 石垣 泰

日本肥満症治療学会学術集会プログラム・抄録集 ( 日本肥満症治療学会 )  36回   120 - 120   2018年06月

膵異所性脂肪沈着と血中循環脂肪は糖尿病の重症度を反映するか?

梅邑 晃, 佐々木 章, 新田 浩幸, 二階 春香, 馬場 誠朗, 木村 聰元, 高原 武志, 秋山 有史, 岩谷 岳, 大塚 幸喜, 肥田 圭介, 水野 大, 石垣 泰

日本肥満症治療学会学術集会プログラム・抄録集 ( 日本肥満症治療学会 )  36回   120 - 120   2018年06月

ポートを減らすか、細径か、単孔か? 適切なreduced port surgeryを目指して

川上 亜紀子, 須藤 隆之, 藤原 久貴, 梅邑 晃, 遠藤 史隆, 木村 聰元, 高原 武志, 秋山 有史, 岩谷 岳, 木村 祐輔, 新田 浩幸, 大塚 幸喜, 肥田 圭介, 水野 大, 佐々木 章

日本外科系連合学会誌 ( 日本外科系連合学会 )  43 ( 3 ) 497 - 497   2018年05月