医学部附属病院

細川 勇

ホソカワ イサム  (Isamu Hosokawa)

基本情報

所属
千葉大学 医学部附属病院
学位
医学博士(2014年3月 千葉大学)

researchmap会員ID
R000023066

経歴

 4

論文

 240
  • Takanori Konishi, Shigetsugu Takano, Tsukasa Takayashiki, Daisuke Suzuki, Nozomu Sakai, Isamu Hosokawa, Takashi Mishima, Hitoe Nishino, Kensuke Suzuki, Shinichiro Nakada, Masayuki Ohtsuka
    Annals of surgical oncology 2024年6月26日  
    BACKGROUND: Although some clinical trials have demonstrated the benefits of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC), its optimal candidate has not been clarified. This study aimed to detect predictive prognostic factors for resectable PDAC patients who underwent upfront surgery and identify patient cohorts with long-term survival without neoadjuvant therapy. PATIENTS AND METHODS: A total of 232 patients with resectable PDAC who underwent upfront surgery between January 2008 and December 2019 were evaluated. RESULTS: The median overall survival (OS) time and 5-year OS rate of resectable PDAC with upfront surgery was 31.5 months and 33.3%, respectively. Multivariate analyses identified tumor diameter in computed tomography (CT) ≤ 19 mm [hazard ratio (HR) 0.40, p < 0.001], span-1 within the normal range (HR 0.54, p = 0.023), prognostic nutritional index (PNI) ≥ 44.31 (HR 0.51, p < 0.001), and lymphocyte-to-monocyte ratio (LMR) ≥ 3.79 (HR 0.51, p < 0.001) as prognostic factors that influence favorable prognoses after upfront surgery. According to the prognostic prediction model based on these four factors, patients with four favorable prognostic factors had a better prognosis with a 5-year OS rate of 82.4% compared to others (p < 0.001). These patients had a high R0 resection rate and a low frequency of tumor recurrence after upfront surgery. CONCLUSIONS: We identified patients with long-term survival after upfront surgery by prognostic prediction model consisting of tumor diameter in CT, span-1, PNI, and LMR. Evaluation of anatomical, biological, nutritional, and inflammatory factors may be valuable to introduce an optimal treatment strategy for resectable PDAC.
  • Kentaro Togasaki, Isamu Hosokawa, Tsukasa Takayashiki, Shigetsugu Takano, Masayuki Ohtsuka
    Surgery 175(4) 947-954 2024年4月  
    BACKGROUND: The relationship between the course of the segment 4 hepatic artery and proximal ductal margin status in the right hepatectomy (H15678-B) for perihilar cholangiocarcinoma is unclear. This study aimed to evaluate proximal ductal margin status according to the course of the segment 4 hepatic artery in patients with perihilar cholangiocarcinoma treated with right hepatectomy. METHODS: Consecutive patients with perihilar cholangiocarcinoma who underwent a right hepatectomy between January 2006 and August 2021 were retrospectively reviewed. The course of the segment 4 hepatic artery was classified based on the positional relationship with the umbilical portion of the left portal vein into R-UP and L-UP types. The R-UP type had the segment 4 hepatic artery running along the right caudal position of the umbilical portion of the left portal vein, whereas the L-UP type had the segment 4 hepatic artery running along the left cranial position of the umbilical portion of the left portal vein, with or without another branch running along the right caudal position of the umbilical portion of the left portal vein. Proximal ductal margin status after the right hepatectomy was compared between types. RESULTS: Among 102 patients, 72 (70.5%) were R-UP type, and 30 (29.5%) were L-UP type. Rates of negative proximal ductal margin were higher with the L-UP type (27/30, 90.0%) than with the R-UP type (51/72, 70.8%; P = .04). On multivariate analysis, Bismuth-Corlette type II and IIIa (risk ratio 4.13, 95% confidence interval 1.52-11.5; P = .005) and L-UP type (risk ratio 4.03, 95% confidence interval 1.18-18.8; P = .04) were independent predictors of negative proximal ductal margin after a right hepatectomy for perihilar cholangiocarcinoma. CONCLUSION: For the course of the segment 4 hepatic artery, L-UP type rather than R-UP type might be anatomically advantageous for achieving negative proximal ductal margin in a right hepatectomy for perihilar cholangiocarcinoma.
  • Yoshitaka Shimamaki, Isamu Hosokawa, Tsukasa Takayashiki, Shigetsugu Takano, Itaru Sonoda, Masayuki Ohtsuka
    Surgical case reports 10(1) 35-35 2024年2月9日  
    BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer. Cases when found are often advanced with vascular invasion, and radical resection is often difficult. Despite curative resection, the postoperative recurrence rate of patients with histological lymph node metastasis is high, and their prognosis is poor. Therefore, there is an urgent need to establish multidisciplinary treatment that combines chemotherapy and surgical resection. The efficacy of neoadjuvant chemotherapy (NAC) for locally advanced ICC is unclear. In this report, a case of locally advanced ICC in which pathological complete response (pCR) was achieved after NAC is described. CASE PRESENTATION: A 79-year-old woman was admitted to a local hospital with appetite loss. Computed tomography showed a 100 × 90 mm low-contrast tumor in the left hepatic lobe and segment 1 with invasion to the inferior vena cava (IVC), and several lymph nodes along the left gastric artery and lesser curvature were enlarged. Therefore, she was treated with a combined chemotherapy regimen of gemcitabine and cisplatin. After four courses, the tumor size decreased to 30 × 60 mm without invasion to the IVC. Left hepatectomy extending to segment 1 with bile duct resection combined with middle hepatic vein resection (H1234-B-MHV), dissection of regional lymph nodes and pyloroplasty were performed. After radical resection, pCR was achieved. She is alive with no evidence of disease, 2 years after surgery. CONCLUSIONS: In this case, a patient with locally advanced ICC achieved pCR to NAC. NAC may be effective for ICC. Patients who achieve pCR may have a better prognosis.
  • Takanori Konishi, Shigetsugu Takano, Tsukasa Takayashiki, Satoshi Kuboki, Daisuke Suzuki, Nozomu Sakai, Isamu Hosokawa, Takashi Mishima, Hitoe Nishino, Shinichiro Nakada, Masayuki Ohtsuka
    Langenbeck's archives of surgery 409(1) 11-11 2023年12月18日  
    PURPOSE: Systemic chemotherapy is generally used for metastatic pancreatic cancer; however, pulmonary resection may be a treatment option for lung oligometastases from pancreatic cancer. The current study aimed to clarify the oncological outcomes and clinical benefits of pulmonary resection for lung metastases. METHODS: Of 510 patients who underwent pancreatic resection for pancreatic cancer, 44 patients with recurrence of isolated lung metastases and one patient with simultaneous lung metastases were evaluated. RESULTS: Of the 45 patients, 20 patients were selected as candidates for pulmonary resection based on clinical factors such as recurrence-free interval (RFI) from pancreatectomy to lung metastases, number of lung metastases, and serum CA19-9 level. The post-recurrent survival of patients with pulmonary resection was significantly better than that of patients without pulmonary resection. Fourteen of the 20 patients with pulmonary resection developed tumor recurrence with a median disease-free survival (DFS) of 15 months. Univariate analyses revealed that an RFI from pancreatectomy to lung metastases of ≥28 months was associated with better DFS after pulmonary resection. Of the 14 patients with an RFI of ≥28 months, pulmonary resection resulted in prolonged chemotherapy-free interval in 12 patients. Furthermore, repeat pulmonary resection for recurrent tumors after pulmonary resection led to further cancer-free interval in some cases. CONCLUSIONS: Although many patients had tumor recurrence after pulmonary resection, pulmonary resection for lung metastases from pancreatic cancer may provide prolonged cancer-free interval without the need for chemotherapy. Pulmonary resection should be performed for the patients with a long RFI from pancreatectomy to lung metastases.
  • Takashi Mishima, Shigetsugu Takano, Tsukasa Takayashiki, Satoshi Kuboki, Daisuke Suzuki, Nozomu Sakai, Isamu Hosokawa, Takanori Konishi, Hitoe Nishino, Shinichiro Nakada, Yusuke Kouchi, Takashi Kishimoto, Masayuki Ohtsuka
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2023年12月2日  
    BACKGROUND: The indication for surgical resection of intraductal papillary mucinous neoplasms (IPMNs) is defined by imaging features, such as mural nodules. Although carbohydrate antigen (CA) 19-9 was selected as a parameter for worrisome features, no serum biomarkers were considered when deciding on surgical indications in the latest international consensus guideline. In this study, we assessed whether clinical factors, imaging findings, and serum biomarkers are useful in predicting malignant IPMNs. METHODS: A total of 234 resected IPMN cases in Chiba University Hospital from July 2005 to December 2021 were retrospectively analyzed. RESULTS: Among the 234 patients with resected IPMNs diagnosed by preoperative imaging, 117 were diagnosed with malignant pathologies (high-grade dysplasia and invasive IPMNs) according to the histological classification. In the multivariate analysis, cyst diameter ≥30 mm; p = 0.035), enhancing mural nodules on multidetector computed tomography (≥5 mm; p = 0.018), and high serum elastase-1 (≥230 ng/dl; p = 0.0007) were identified as independent malignant predictors, while CA19-9 was not. Furthermore, based on the receiver operator characteristic curve analyses, elastase-1 was superior to CA19-9 for predicting malignant IPMNs. Additionally, high serum elastase-1 levels (≥230 ng/dl; p = 0.0093) were identified as independent predictors of malignant IPMNs in patients without mural nodules on multidetector computed tomography (MDCT) in multivariate analysis. CONCLUSION: The serum elastase-1 level was found to be a potentially useful biomarker for predicting malignant IPMNs.

MISC

 47
  • 西野 仁惠, 高屋敷 吏, 高野 重紹, 鈴木 大亮, 酒井 望, 細川 勇, 三島 敬, 小西 孝宜, 鈴木 謙介, 仲田 真一郎, 永川 裕一, 大塚 将之
    消化器外科 47(6) 717-728 2024年6月  
  • 高屋敷 吏, 高野 重紹, 鈴木 大亮, 酒井 望, 細川 勇, 三島 敬, 小西 孝宜, 西野 仁惠, 鈴木 謙介, 仲田 真一郎, 大塚 将之
    胆と膵 45(6) 651-655 2024年6月  
    血行再建術を伴う肝門部領域胆管癌手術は,肝胆膵外科高度技能手術においてもっとも高難易度の手術であるが,一方で標準的な手技の一つとして安全に施行する技術を取得しておくことも胆道外科医にとって重要といえる。動脈再建時には,吻合血管の口径,長さ,再建時の屈曲の程度などを考慮して,再建動脈を選択する。原則としては端々吻合を行うが,再建距離が長く直接吻合が難しい場合や,吻合に緊張がかかる場合には,胃十二指腸動脈や右胃大網動脈などを用いて再建することもある。門脈再建においては,その切除長が長い場合にはグラフト間置による再建が必要になり,その種類には外腸骨静脈,外頸静脈,左腎静脈グラフトなどいくつかの種類がある。動脈再建などで協力をあおぐ他診療科(心臓血管外科,形成外科など)と再建方法のシミュレーションを十分に行っておくことも,安全な手術を完遂するために重要である。血管合併切除・再建術後の周術期対策として,ドップラーエコーによる定期的な血流の確認と,出血や血栓症を疑った場合の遅滞のないdynamic CT撮影が必要である。(著者抄録)
  • 細川 勇, 大野 達矢, 高屋敷 吏, 高野 重紹, 鈴木 大亮, 酒井 望, 三島 敬, 小西 孝宜, 西野 仁惠, 鈴木 謙介, 仲田 真一郎, 大塚 将之
    胆と膵 45(5) 499-504 2024年5月  
    高齢者肝門部領域胆管癌に対する拡大肝切除は増加傾向にあり,手術を施行した高齢者(75歳以上)と非高齢者(75歳未満)でその短期成績,長期成績は同等である。ただ,高齢者肝門部領域胆管癌に対する拡大肝切除に関しては,そのリスク評価とそれに基づいた手術適応には定まったものはなく,また予後に関しても,既存の因子では測定しえない高齢者特有の問題があることが示唆されるため,引き続き検討していく必要がある。(著者抄録)
  • 酒井 望, 高屋敷 吏, 高野 重紹, 鈴木 大亮, 細川 勇, 三島 敬, 小西 孝宣, 鈴木 謙介, 西野 仁恵, 仲田 真一郎, 大塚 将之
    日本外科学会定期学術集会抄録集 124回 SF-3 2024年4月  
  • 小西 孝宜, 高野 重紹, 高屋敷 吏, 鈴木 大亮, 酒井 望, 細川 勇, 三島 敬, 鈴木 謙介, 西野 仁恵, 仲田 真一郎, 大塚 将之
    日本外科学会定期学術集会抄録集 124回 SF-2 2024年4月  

共同研究・競争的資金等の研究課題

 4