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Application of Indocyanine Green Fluorescence Imaging in Liver Resection
( Norihiro Kokudo ),( Yoshikuni Kawaguchi ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Background: Fluorescence imaging has been recently used for an intraoperative real-time navigation worldwide. The aim of thisreport is to demonstrate liver resection that guided by fluorescence imaging using indocyanine green (ICG) as a fluorescencesource.Method: Three fluorescence imaging systems (PDE-neo, Hamamatsu Photonics; Olympus Medical Systems; PINPOINT, Novadaq)were used. ICG (Diagnogreen; Daiichi Sankyo, Tokyo, Japan) was administered as follows. Liver cancer identification: intravenousICG injection at a dose of 0.5 mg/kg as a routine liver function test within 2 weeks before surgery. Biliary anatomy visualization:intravenous ICG injection (1 mL) or intrabiliary ICG injection (0.025 mg/mL) after intubation in the operating room. Identificationof regions flown by portal vein: ICG injection (0.25 mg = 0.1 mL) to tumor-bearing portal veins after diluting it in 5 mL of indigo-carmine solution (20 mg, Daiichi Sankyo).Results: Liver cancer identification: hepatocellular carcinoma can be identified as fluorescence due to impaired ICG excretionfunction in cancerous tissue compared to non-cancerous tissues. Biliary anatomy visualization: during surgery, the common bileduct was visualized after intrabiliary ICG injection. Identification of regions flown by portal vein: a tumor-bearing hepatic segmentwas visualized by injecting ICG with indigo-carmine under intraoperative ultrasonographic guidance. ICG fluorescence-guidedanatomic liver resection: Portal vein branches feeding the cancer-bearing hepatic segments were visualized longitudinally andpunctured with a 22G needle under IOUS guidance, followed by injection of ICG (0.25 mg 1/4 0.1 mL ICG) diluted in 5 mL ofindigo-carmine solution (20 mg, Daiichi Sankyo).Conclusion: Fluorescence imaging navigation facilitates identification of liver cancer, the bile duct, and hepatic segment andis expected to enhance the safety and efficacy during liver surgery.
Primary Liver Cancer Registry in Japan: How Has It Been Evolving?
( Norihiro Kokudo ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Since 1969, The Liver Cancer Study Group of Japan (LCSGJ) has been conducting nationwide surveys on primary liver cancerpatients every 2 or 3 years. After the 4th survey in 1978, patient data were collected using personal data sheet and the patientswere followed-up until death or the most recent survey. The participating hospitals were LCSGJ member institutions numbering400-600, and these surveys are estimated to cover 1/4 to 1/3 of all liver cancer patients treated in Japan. These surveys werebased on the “General Rules for the Clinical and Pathological Study of Liver Cancer” proposed by LCSGJ and have been servingas valuable big clinical database for the clinical research.According to the most recent report of the 19th follow-up survey (Kudo 2016 Hepatol Res 46:372-), a total of 20,850 primaryliver cancer patients newly registered at 482 medical institutions over a period of 2 years (from 1 January 2006 to 31 December2007). Of these, 94.7% had hepatocellular carcinoma (HCC) and 4.4% had intrahepatic cholangiocarcinoma (ICC). In addition,follow-up data were obtained regarding 34,752 patients who were registered in the previous survey.Patient data collection following Act on the Protection of Personal Information (2003) has been a big issue and we have adoptedelectrical data collecting system since 2004. From 2016, our survey was integrated in National Clinical Database(http://www.ncd.or.jp), the national mega-database collecting more than one million surgical procedures conducted in Japanevery year.
Liver Cancer Working Group Report
Kudo, M.,Han, K. H.,Kokudo, N.,Cheng, A.-L.,Choi, B. I.,Furuse, J.,Izumi, N.,Park, J.-W.,Poon, R. T.,Sakamoto, M. Oxford University Press 2010 Japanese journal of clinical oncology Vol.40 No.suppl1
<P>Hepatocellular carcinoma is a highly prevalent disease in many Asian countries, accounting for 75-80% of victims worldwide. The incidence of hepatocellular carcinoma varies enormously across Asia, but tends to follow the incidences of hepatitis B infection and liver cirrhosis. The incidence and etiology of hepatocellular carcinoma in Japan are different from the rest of Asia, but similar to that in Western countries because hepatitis C infection is the main etiological factor in Japan. Hepatitis B virus vaccination programs are showing great success in reducing hepatitis B virus-related hepatocellular carcinoma. Screening program improves detection of early hepatocellular carcinoma and has some positive impact on survival, but the majority of hepatocellular carcinoma patients in Asia still present with advanced hepatocellular carcinoma. Long-term outcomes following treatment of even early/intermediate or advanced disease are often unsatisfactory because of a lack of effective adjuvant and systemic therapies. Various clinical practice guidelines for hepatocellular carcinoma have been established and are in use. Clinical diagnosis of hepatocellular carcinoma by imaging diagnosis is replacing diagnosis of hepatocellular carcinoma by pathological confirmation. New imaging and treatment techniques are continuously being developed and guidelines should be updated every 3 or 4 years, incorporating new evidence. New molecularly targeted therapies hold great promise. Sorafenib is the first systemic therapy to demonstrate prolonged survival vs. the placebo in patients with advanced hepatocellular carcinoma. Various other new molecularly targeted agents are currently under investigation.</P>
Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma
Kaibori, Masaki,Kon, Masanori,Kitawaki, Tomoki,Kawaura, Takayuki,Hasegawa, Kiyoshi,Kokudo, Norihiro,Ariizumi, Shunichi,Beppu, Toru,Ishizu, Hiroyuki,Kubo, Shoji,Kamiyama, Toshiya,Takamura, Hiroyuki,Kob Wiley (John WileySons) 2017 Journal of hepato-biliary-pancreatic sciences Vol.24 No.11
<P>ConclusionsAnatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0cm in diameter.</P>
Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma
Masaki Kaibori,Masanori Kon,Tomoki Kitawaki,Takayuki Kawaura,Kiyoshi Hasegawa,Noriyuki Kokudo,Shunichi Ariizumi,Toru Beppu,Hiroyuki Ishizu,Shoji Kubo,Toshiya Kamiyama,Hiroyuki Takamura,Tsuyoshi Kobaya 한국간담췌외과학회 2017 한국간담췌외과학회 학술대회지 Vol.2017 No.3