Faculty Profiles - MIYATA Kazushi

下咽頭癌術後の腹臥位胸腔鏡下食道癌手術永久気管孔,両側DP(deltopectoral)皮弁の取り扱いに注意を要した1例

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川上次郎, 深谷昌秀, 宮田一志, 富永健太, 丸尾貴志, 江畑智希

手術 Vol. 75 ( 5 ) page： 905 - 910 2021.4

Language：Japanese Publisher：金原出版(株)

症例は60歳代男性で、下咽頭癌術後7年の上部消化管内視鏡検査で中咽頭癌と胸部上部表在食道癌が指摘された。中咽頭癌に対するELPS(endoscopic laryngopharyngeal surgery)を先行し、その後、食道癌に対するESD(endoscopic submucosal dissection)を予定した。下咽頭癌に対する手術時、術後に永久気管孔壊死と皮弁壊死を繰り返し、右DP(deltopectoral)皮弁再建、さらに左DP皮弁再建が追加された。気管血流を温存することに配慮して術式を立案した。気管支動脈、奇静脈弓のほか、伴走する右気管支動脈の上行枝と下行枝を温存し、大動脈弓から直接分岐する左気管枝動脈も温存し、気管分岐部の郭清を省略した。さらに、腹腔鏡用手補助下胃管を作製、後縦隔経路で胃管を挙上した。頸部は皮弁からの気管孔血流を温存するため、左DP皮弁外縁で切開、遊離空腸-食道吻合部で離断し、残食道を全摘した。その後、吻合部狭窄に対しバルーン拡張を、嚥下機能低下に対し嚥下訓練を行い、術後101日から食事を開始し術後138日に退院した。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00620&link_issn=&doc_id=20210428180019&doc_link_id=10.18888%2Fop.0000002217&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002217&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Repair of gastro-tracheobronchial fistula after esophagectomy for esophageal cancer using intercostal muscle and latissimus dorsi muscle flaps: a case report. International journal

Kazushi Miyata, Masahide Fukaya, Masato Nagino

Surgical case reports Vol. 6 ( 1 ) page： 172 - 172 2020.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Gastro-tracheobronchial fistula after esophagectomy is a rare but life-threatening complication associated with high mortality. Several authors reported postoperative management of tracheobronchial fistula. However, treatment is demanding and challenging, and the strategy is still controversial. CASE PRESENTATION: A 64-year-old man underwent thoracoscopic esophagectomy with two-field lymph node dissection and gastric conduit reconstruction by an intrathoracic anastomosis for esophageal cancer at a local hospital in June 2013. After surgery, a gastro-tracheal fistula and a gastro-bronchial fistula of the left main bronchus were diagnosed, and the patient was referred to our hospital for the management of the gastro-tracheobronchial fistula. CT and bronchoscopy and esophagogastroduodenoscopy performed at our hospital revealed that the gastro-bronchial fistula of the left main bronchus was cured by packing with the omentum from the gastric conduit and the gastro-tracheal fistula located 3 cm above the carina remained open. We concluded that the fistula would not resolve without further surgical procedure. However, such an operation was expected to be difficult and to need much time due to severe adhesion among the gastric conduit and/or trachea, bronchus, lung, and chest wall. Therefore, a two-stage operation was planned for safety and outcome certainty. The first operation was performed to close the fistula in October 2013. The gastric conduit was separated from the trachea and resected; then, the fistula was sutured and covered by intercostal muscle and latissimus dorsi muscle flaps. A month after the first operation, reconstruction with pedunculated jejunum was performed via the percutaneous route. The patient's postoperative course was uneventful. CONCLUSION: If the omentum is not observed between the gastric conduit and the tracheobronchus when a gastro-tracheobronchial fistula occurs after esophagectomy, surgeons should perform surgical treatment because conservative treatment is unlikely to cure. During surgery, the use of two types of muscle flaps, such as the intercostal muscle and the latissimus dorsi muscle flaps, is helpful for the closure of gastro-tracheobronchial fistulas.

DOI： 10.1186/s40792-020-00936-4

Successful two-stage operation for esophageal necrosis due to proton beam therapy followed by sorafenib in a case of large hepatocellular carcinoma. International journal

Eiji Higaki, Masahide Fukaya, Kazushi Miyata, Ryosuke Kawai, Tetsuya Abe

Surgical case reports Vol. 6 ( 1 ) page： 138 - 138 2020.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Locally advanced hepatocellular carcinoma (HCC), which is unsuitable for standard locoregional therapies, remains a challenge to manage. Among the recently developed treatments, proton beam therapy (PBT) has been reported to achieve good local control. However, in patients with large HCC adjacent to the esophagus, high-dose PBT may rarely lead to radiation-induced esophageal necrosis or perforation. Furthermore, the optimal strategy to safely treat these fatal complications remains unclear. CASE PRESENTATION: A 49-year-old man who was diagnosed with a large (16 cm) HCC in the right lobe with tumor thrombosis in the main trunk of the portal vein (PVTT) received high-dose hypofractionated PBT in another hospital. A total dose of 66 GyE in 10 fractions was administered to the primary tumor and the PVTT. After 5 months, a 1-cm solitary nodule was noted in the upper lobe of the right lung. Therefore, sorafenib was started. About 6 months after the PBT, lower esophageal mucosal inflammation that progressed to an ulcer was noted. About 7 months after the PBT, the lower esophagus developed full-thickness necrosis. Therefore, emergency thoracoscopic esophagectomy was performed, followed by two-stage reconstruction 2 months later. The operation and postoperative clinical course were mostly uneventful, except for a minor anastomotic leakage. The outcome of the primary HCC, including the PVTT, was graded as a complete response, which has been maintained for 51 months after the PBT. CONCLUSION: PBT is a promising option for patients with locally advanced HCC; however, for large tumors adjacent to the esophagus, ischemic esophageal necrosis due to antiangiogenic effects may occur, particularly with the combined use of PBT and sorafenib. In such a life-threatening condition, the thoracoscopic esophagectomy and the two-stage reconstruction are a safe option that can prevent critical postoperative complications due to the poor general condition, effects of PBT on the remnant gastric conduit, and use of sorafenib.

DOI： 10.1186/s40792-020-00902-0

A prospective trial to evaluate treatment effects of a β-hydroxy-β-methylbutyrate containing nutrient for leakage at the anastomotic site after esophagectomy.

特集進行直腸癌のベストプラクティス II. 各論 5.局所再発直腸癌の再発部位を意識した治療戦略

小倉淳司, 上原圭介, 相場利貞, 江畑智希, 横山幸浩, 國料俊男, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 梛野正人

外科 Vol. 82 ( 7 ) page： 742 - 748 2020.6

Mitsuro Kanda, Masahiko Koike, Masahide Fukaya, Kazushi Miyata, Chie Tanaka, Daisuke Kobayashi, Masamichi Hayashi, Suguru Yamada, Goro Nakayama, Kenta Murotani, Michitaka Fujiwara, Masato Nagino, Yasuhiro Kodera

Nagoya journal of medical science Vol. 82 ( 1 ) page： 33 - 37 2020.2

Language：English Publishing type：Research paper (scientific journal)

Anastomotic leakage after esophagectomy is associated with prolonged hospitalization and increased medical cost. Additionally, it sometimes leads to a fatal condition and impaired postoperative quality of life. During the process of wound healing, β-hydroxy-β-methylbutyrate (HMB) is important for collagen biosynthesis. An open-label prospective intervention trial has been designed to evaluate the treatment effect of an enteral nutrient containing HMB with arginine and glutamine (Abound, Abbott Japan Co., Ltd.) for leakage at the anastomotic site after esophagectomy. Patients in whom leakage at the anastomotic site developed within 14 days after esophagectomy are eligible and Abound (24 g) is administered for 14 days through an enteral feeding tube. The target sample size is 10. The primary endpoint is duration between diagnosis and cure of leakage. Surgical procedure, safety, length of fasting, drainage placement and hospital stay, and nutritional status are determined as secondary endpoints. A historical control consisting of 20 patients who had leakage at the anastomotic site after esophagectomy between 2005 and 2018 at Nagoya University Hospital is compared with enrolled patients.

DOI： 10.18999/nagjms.82.1.33

The impact of cervical lymph node dissection on acid and duodenogastroesophageal reflux after intrathoracic esophagogastrostomy following transthoracic esophagectomy.

Soichiro Asai, Masahide Fukaya, Kazushi Miyata, Keita Itatsu, Ryoji Miyahara, Kazuhiro Furukawa, Tomoki Ebata, Masato Nagino

Surgery today Vol. 49 ( 12 ) page： 1029 - 1034 2019.12

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: The aim of this study was to evaluate the impact of cervical lymph node dissection on acid reflux and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy. METHODS: Thirty-one patients receiving transthoracic esophagectomy with gastric tube reconstruction by intrathoracic esophagogastrostomy were divided into the following two groups: a two-field lymph node dissection group (2F group) and a three-field lymph node dissection group (3F group). All patients underwent 24-h pH and bilirubin monitoring and gastrointestinal endoscopy at 1 year after surgery. The 24-h pH and bilirubin monitoring results, endoscopic findings, and reflux symptoms were compared between the 2 groups. RESULTS: No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) patients in the 3F group (p = 0.007). DGER was found in 2 patients (13%) in the 2F group and in 8 (53%) in the 3F group (p = 0.023). Four patients (25%) in the 2F group and 9 (60%) in the 3F group (p = 0.048) had reflux esophagitis. CONCLUSION: Cervical lymph node dissection increases acid reflux and DGER and can lead to an increase in the incidence of reflux esophagitis in patients undergoing intrathoracic esophagogastrostomy.

DOI： 10.1007/s00595-019-01835-4

Thoracoscopically Resected Esophageal Duplication Cyst with High Value of Serum CA19-9 at the First Visit—Report of a Case—

Esophageal reconstruction using a pedicled jejunum following esophagectomy for metastatic esophageal stricture from breast cancer in a patient with previous pancreatoduodenectomy

Asai Soichiro, Fukaya Masahide, Fujieda Hironori, Igami Tsuyoshi, Tsunoda Nobuyuki, Salcatoku Yayoi, Kamei Yuzuru, Miyata Kazushi, Nagino Masato

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 81 ( 4 ) page： 679 - 685 2019.11

Repeated episodes of thoracic empyema after spontaneous esophageal rupture

Sakatoku Yayoi, Fukaya Masahide, Kawaguchi Koji, Fujieda Hironori, Miyata Kazushi, Nagino Masato

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 81 ( 4 ) page： 693 - 699 2019.11

画像診断と病理食道平滑筋腫

兵藤良太, 岩野信吾, 長縄慎二, 宮田一志, 島田聡子

画像診断 Vol. 39 ( 7 ) page： 662 - 663 2019.5

ASAI Soichiro, FUKAYA Masahide, HIGAKI Eiji, MIYATA Kazushi, MIURA Yasutomo, NAGINO Masato

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 80 ( 4 ) page： 700 - 706 2019

Language：Japanese Publisher：Japan Surgical Association

A 41-year-old man with chest pain visited a nearby hospital in February 2017. Chest CT scan detected a mediastinal cystic tumor, and he was referred to our hospital for further examination and treatment. In the blood test, the serum CA19-9 level was as high as 5,960 U/ml, and upper gastrointestinal endoscopy showed a submucosal bulging with bluish purple mucosa encircling the half of the lumen in the middle to lower esophagus.Ultrasound endoscopy visualized the lesion as a tumor with mosaic pattern contents, indicating the presence of hematoma. CT scan showed an 83 × 41 × 115 mm bilocular cystic lesion in the anterior surface of the esophagus which compressed and narrowed the esophagus. Although it was diagnosed as esophageal cyst, he had chest pain and dysphagia, and so cystectomy using thoracoscopy was performed in March. The postoperative course was uneventful and he was discharged on the 10th postoperative day. Histologically, pseudostratified epithelium was found on the inner surface of the cyst and the cystic wall had two muscular layers. Duplication cyst was thus diagnosed.

DOI： 10.3919/jjsa.80.700

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Docetaxel, cisplatin and fluorouracil as neoadjuvant chemotherapy for esophageal cancer with prophylactic pegfilgrastim

Maeda Osamu, Koike Masahiko, Fukaya Masahide, Miyata Kazushi, Iwata Naoki, Nagino Masato, Kodera Yasuhiro, Ando Yuichi

ANNALS OF ONCOLOGY Vol. 29 2018.10

特集消化器癌に対する最新の集学的治療戦略 II. 各論 6.胆道癌の集学的治療戦略

江畑智希, 水野隆史, 横山幸浩, 伊神剛, 山口淳平, 尾上俊介, 深谷昌秀, 上原圭介, 宮田一志, 相場利貞, 梛野正人

外科 Vol. 80 ( 8 ) page： 851 - 858 2018.7

The management for Clavien-Dindo grade Ⅲ・Ⅳ complications after hepatectomy with extrahepatic bile duct resection

Sugawara Gen, Yokoyama Yukihiro, Ebata Tomoki, Igami Tsuyoshi, Yamaguchi Junpei, Onoe Shunsuke, Kokuryo Toshio, Tsunoda Nobuyuki, Fukaya Masahide, Uehara Keisuke, Miyata Kazushi, Aiba Toshisada, Nagino Masato

Journal of Japan Society for Surgical Infection Vol. 15 ( 3 ) page： 201 - 208 2018.6

Language：Japanese Publisher：Japan Society for Surgical Infection

【Aim】To report the course and management for Clavien-Dindo gradeⅢ・Ⅳ complications after hepatectomy with extrahepatic bile duct resection.【Patient】428 consecutive patients who underwent hepatobiliary resection with cholangiojejunostomy between January 2009 and December 2015 were analyzed retrospectively.【Results】There were 278 men and 150 women, with a median age of 68 years (range 29-89 years) . The cases of Grade Ⅲ complications were 229, and those of Ⅳ were 28. Compared with Grade Ⅲ, the rate of male patients, the incidence of preoperative bacteremia of patients with Grade Ⅳ was significantly higher. Compared with Grade Ⅲ, the incidence of combined vascular resection of patients with Grade Ⅳ was significantly higher, operative time was longer, and blood loss was much more. Compared with Grade Ⅲ, the incidence of incisional SSI, pneumoniae, and postoperative bacteremia of patients with Grade Ⅳ was significantly higher. The amount of blood loss more than 1,500mL, presence of pneumoniae, and bacteremia were recognized as a risk factor of postoperative hepatic failure. 【Conclusion】 The management and control for Clavien-Dindo grade Ⅲ complications leads to prevention of occurrence of Grade Ⅳ complications.

DOI： 10.24679/gekakansen.15.3_201

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胆道再建を伴う肝切除後のClavien-Dindo Grade III・IV症例に対する感染管理

菅原元, 横山幸浩, 江畑智希, 伊神剛, 山口淳平, 尾上俊介, 國料俊男, 角田伸行, 深谷昌秀, 上原圭介, 宮田一志, 相場利貞, 梛野正人

日本外科感染症学会雑誌 Vol. 15 ( 3 ) page： 201 - 208 2018.6

Language：Japanese Publisher：(一社)日本外科感染症学会

【目的】胆道再建を伴う肝切除術後のClavien-Dindo Grade III・IV症例の経過について検討すること。【対象と方法】2009年から2015年の7年間における胆道再建を伴う肝切除施行例428例を対象として、Grade III・IV症例の患者背景・術式・術後合併症および治療経過について比較検討した。肝不全発症の危険因子についても検討した。【結果】Grade IV症例はIII症例に比較して、右肝切除施行および血管合併切除併施症例が多く、出血量が多かった。術後合併症では肺炎・敗血症の発症が多く、平均在院期間は長かった。肝不全発症の危険因子は出血量1,500mL以上、肺炎・敗血症の発症であった。Grade III・IV症例ともに治療法は、腹腔内のドレナージ状況を良好に保つこと、全身性の感染症が疑われる際は抗菌薬を追加投与することが基本となる。【結論】Clavien-Dindo Grade III症例に対する感染管理を徹底することが、Clavien-Dindo Grade IV症例の発症予防につながる。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J04188&link_issn=&doc_id=20180925370001&doc_link_id=%2Fdg9srgif%2F2018%2F001503%2F001%2F0201-0208%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg9srgif%2F2018%2F001503%2F001%2F0201-0208%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Peritonitis after percutaneous endoscopic gastrojejunostomy for levodopa–carbidopa intestinal gel treatment despite concomitant use of gastropexy

Tsuboi T., Watanabe H., Funasaka K., Takebayashi M., Miyata K., Katsuno M.

Neurology and Clinical Neuroscience Vol. 6 ( 2 ) page： 64 - 66 2018.3

Publisher：Neurology and Clinical Neuroscience

A 58-year-old man with Parkinson's disease experienced peritonitis after percutaneous endoscopic gastrojejunostomy (PEG-J) for levodopa–carbidopa intestinal gel treatment despite concomitant use of gastropexy. Although gastropexy reduces complications including peritonitis, clinicians should consider structural characteristics of PEG-J devices and patients’ anatomical differences. We recommend that suture threads are removed 2–4 weeks after PEG-J and that the PEG-J tube length outside the body is routinely recorded to assess tube dislocation.

DOI： 10.1111/ncn3.12183

The Impact of the Location of Esophagogastrostomy on Acid and Duodenogastroesophageal Reflux After Transthoracic Esophagectomy with Gastric Tube Reconstruction and Intrathoracic Esophagogastrostomy. International journal

Hiroaki Usui, Masahide Fukaya, Keita Itatsu, Kazushi Miyata, Ryoji Miyahara, Kohei Funasaka, Masato Nagino

World journal of surgery Vol. 42 ( 2 ) page： 599 - 605 2018.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The aim of this study was to evaluate the impact of the location of esophagogastrostomy on acid and duodenogastroesophageal reflux (DGER) in patients undergoing gastric tube reconstruction and intrathoracic esophagogastrostomy. METHODS: Thirty patients receiving transthoracic esophagectomy without cervical lymph node dissection and gastric tube reconstruction by intrathoracic anastomosis were enrolled. All patients underwent 24-h pH and bilirubin monitoring and gastrointestinal endoscopy one year after surgery. Patients were divided into three groups according to esophagogastrostomy location: group A (n = 9), above the top of the aortic arch; group B (n = 15), between the top and bottom of the aortic arch; and group C (n = 6), below the bottom of the aortic arch. The relations among the esophagogastrostomy location, 24-h pH and bilirubin monitoring results, endoscopic findings, and reflux symptoms were investigated. RESULTS: No acid reflux into the remnant esophagus was observed in group A, whereas it was observed in three of 15 patients (20%) in group B and in two of six patients (33%) in group C (P = 0.139). No DGER was found in group A, whereas DGER was observed in eight (53%) patients in group B and all patients in group C (P < 0.001). Reflux esophagitis was observed in one patient (11%) in group A, five patients (33%) in group B, and all patients in group C (P = 0.002). CONCLUSION: In gastric tube reconstruction via intrathoracic anastomosis, esophagogastrostomy should be performed above the top of the aortic arch to prevent postoperative DGER and reduce the incidence of reflux esophagitis.

DOI： 10.1007/s00268-017-4186-1