Mishima, Kohei

写真a

Affiliation

School of Medicine, Department of Surgery (General and Gastroenterological Surgery) ( Shinanomachi )

Position

Instructor
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Books 【 Display / hide 】

  • Laparoscopic Anatomical Liver Resection Technique: The Japanese Experience

    Mishima K., Wakabayashi G., Colorectal Liver Metastasis, 2022.01

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    In the past 30 years, laparoscopic liver resection has made dramatic progress with the establishment of its safety and superiority to open surgery. In recent years, the indications for laparoscopic approach have been gradually expanding in Japan, even for anatomical liver resection. The key surgical techniques in laparoscopic anatomical liver resection are the Glissonean approach and parenchymal transection. Glissonean branches and hepatic veins are confirmed from various anatomical landmarks. Exposure of the hepatic veins is the most important aspect of parenchymal transection and the craniocaudal approach allows for efficient parenchymal transection while avoiding unnecessary bleeding.

  • Laparoscopic Major Hepatectomy and Parenchymal-Sparing Anatomical Hepatectomy

    Mishima K., Wakabayashi G., Igarashi K., Ozaki T., Iasgo Textbook of Multi Disciplinary Management of Hepato Pancreato Biliary Diseases, 2022.01

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    Although laparoscopic liver resection (LLR) has become recognized as the standard treatment worldwide, laparoscopic major hepatectomy (LMH) has yet to become widespread. LMH was first defined as resection of 3 or more segments or the difficult posterosuperior segments (4a, 7, 8) in 2008. Although the definition is still under debate and is not clearly defined, several studies reported that LMH was associated with less blood loss, shorter hospital stays and fewer complications compared with open surgery. According to a nationwide survey of Japanese National Clinical Database, advanced LLR increased from 3.3% of all resections in 2011 to 10.8% in 2017, with its mortality 3.6% in 2011, and 1.0% in 2017. The IWATE criteria can be used to predict the difficulty of LLR from preoperative variables and to appropriately select patients according to the surgeons’ skill level. The learning curve for LMH has been discussed, but conclusive number of cases for the mastery of LMH cannot be decided with variety of studies. Since laparoscopic parenchymal-sparing anatomical liver hepatectomy (Lap-PSAH = segmentectomies and sub-segmentectomies) shares some surgical techniques with LMH, it may help shorten the learning curve of LMH. In conclusion, LMH still remains technically demanding, but it has been gradually developed with the improvement of surgical techniques and the careful expansion of indications.

  • Tokyo guidelines and their limits

    Mishima K., Wakabayashi G., Difficult Acute Cholecystitis Treatment and Technical Issues, 2021.01

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    The first version of Tokyo Guidelines (TG07) for acute cholecystitis was published in 2007 after an international consensus meeting held in 2006. The guidelines have been revised twice in 2013 and 2018 to bridge the gap between the guidelines and real-world clinical practice since then. The updated version of Tokyo Guidelines (TG 18) reflected validation studies of the previous version of TG07 and TG13 and newly published clinical evidence. The guidelines consist of several chapters including: (1) diagnostic criteria and severity grading of acute cholecystitis, (2) flowcharts for management of acute cholecystitis, and (3) surgical management of acute cholecystitis. Although TG18 have been widely used not only in clinical practice but also in numerous research studies of acute cholecystitis, there is still room for discussion about the flowchart for management. Here, we describe the outlines of TG18 and room for its improvement in the future.

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Papers 【 Display / hide 】

  • Neoadjuvant chemotherapy versus upfront surgery for perihilar cholangiocarcinoma: a propensity score matching analysis

    Sonoda K., Abe Y., Chiba N., Nishiyama R., Mihara K., Hayatsu S., Takano K., Takemura R., Kitago M., Hasegawa Y., Hori S., Tanaka M., Mishima K., Nakano Y., Kawachi S., Kitagawa Y.

    HPB 28 ( 5 ) 666 - 675 2026.05

    ISSN  1365182X

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    Background: Neoadjuvant chemotherapy (NAC) may improve outcomes in perihilar cholangiocarcinoma (PHC); however, its efficacy compared with upfront surgery (US) for resectable PHC remains unclear. We compared survival and clinicopathological characteristics between NAC and US in patients with technically resectable PHC, using propensity score matching (PSM). Methods: We retrospectively analyzed 261 patients with resectable PHC who underwent surgical treatment (2016–2024) across multiple institutions. Among them, 50 received NAC and 199 underwent US. The 38 patients receiving NAC were matched 1:1 with patients undergoing US using PSM. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Pathological response to NAC and its association with chemotherapy doses were also evaluated. Results: Before PSM, OS and PFS did not differ significantly between the US and NAC groups. After PSM, OS did not differ significantly between groups, but PFS was significantly longer in the NAC group, where patients with a therapeutic-effect grade ≥1b had better PFS than those with US. Grade ≥1b response was associated with receiving ≥7 NAC doses. Discussion: NAC may improve PFS in selected patients with resectable PHC, especially those showing major pathological responses. Prospective studies should validate these findings and define optimal selection criteria and regimens.

  • Minimally invasive repeat liver resection in a patient with situs inversus totalis: report of a challenging case

    Colella M., Gaudenzi F., Wakabayashi T., Teshigahara Y., Nie Y., Alomari M., Mishima K., Wakabayashi G.

    Clinical Journal of Gastroenterology 19 ( 1 ) 197 - 202 2026.02

    ISSN  18657257

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    Here we present the first case of both laparoscopic and robot-assisted repeat liver resections in a patient with Situs Inversus Totalis (SIT). The patient is a 69-year-old male who had been diagnosed in 2020, at the age of 65, with a 44 mm hepatocellular carcinoma (HCC) located at segment 4, treated through a laparoscopic left hepatectomy. After a disease-free period of 18 months, he underwent a laparoscopic segment 5 segmentectomy for recurrence. 21 months later, due to new recurrences located at segment 6 and segment 8, he underwent a segment 6 and segment 8 partial resection with robot-assisted approach. Both the laparoscopic liver resections were performed with selective extrahepatic Glissonean approach and ICG negative staining, after accurate 3D preoperative planning. 3D navigation proved crucial as well during the third surgery, which was performed with robot-assisted approach. To our knowledge, this is the first case of laparoscopic and robot-assisted repeat liver surgery in a patient affected by SIT, proving the feasibility of minimally invasive surgery even in extremely complex contexts, especially with the help of innovative tools such as ICG guidance and 3D navigation.

  • Early clinical impact of mesenteric Kocherization in robotic pancreaticoduodenectomy: a propensity score–matched comparative study

    Mishima K., Kawamoto J., Kitago M., Nakano Y., Tanaka M., Hori S., Hasegawa Y., Abe Y., Kitagawa Y.

    Surgical Endoscopy  2026

    ISSN  09302794

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    Background: Although robotic pancreaticoduodenectomy (RPD) offers several technical advantages, prolonged operative time remains a major clinical challenge. Mesenteric Kocherization (MK) has recently been introduced as a technical modification for mobilizing the duodenum and pancreatic head during RPD. The present study evaluated the early clinical impact of MK on operative efficiency and perioperative outcomes. Methods: We retrospectively reviewed 56 consecutive patients who underwent totally robotic pancreaticoduodenectomy between July 2021 and June 2025. Conventional Kocherization (CK) was performed in 36 patients and MK in 20 patients. The primary outcome was total operative time. Secondary outcomes included console time, Kocherization time, estimated blood loss, transfusion, harvested lymph nodes, R0 resection rate, major postoperative complications (Clavien–Dindo ≥ IIIa), time to first oral intake, and 90-day unplanned readmission rate. To reduce selection bias, propensity score matching was performed using a 1:2 allocation (MK:CK). Results: In the full cohort, operative time tended to be shorter in the MK group than in the CK group (560 [516–598] vs. 592 [556–667] min; p = 0.057). Kocherization time was significantly shorter with MK (28 [27–36] vs. 50 [40–58] min; p < 0.001), while estimated blood loss was comparable (p = 0.875). After propensity score matching (MK n = 11; CK n = 22), MK was associated with significantly shorter total operative time (533 [511–575] vs. 580 [557–611] min; p = 0.031) and Kocherization time (28 [24–30] vs. 49 [43–55] min; p < 0.001). Blood loss, R0 resection rate, and major postoperative complications were comparable between groups. Conclusions: Mesenteric Kocherization was associated with improved operative efficiency in RPD, primarily through shortening the resection phase of the procedure while maintaining perioperative safety.

  • Laparoscopic versus open liver resection in patients aged at least 80 years: Retrospective propensity score-matched cohort study

    Gómez-Gavara C., Morise Z., López-López V., Kuemmerli C., Esono D., Igarashi K., Mishima K., Kanazawa A., Tanaka S., Kubo S., Nemoto S., Honda G., Monden K., Ueno M., Iwao Y., Gotohda N., Kudo M., Nitta H., Amano S., Díaz-Nieto R., Gordon-Weeks A., Langella S., Ferrero A., Otsuka Y., Kaneko H., Boetto R., Cillo U., D'Souza D., Serrano P.E., Berardi G., Angrisani M., Ettorre G.M., Tabrizian P., Yu A., Goh B.K.P., Minagawa T., Itano O., Asano D., Tanabe M., Di Martino M., Martín-Pérez E., Famularo S., Paoluzzi Tomada E., Torzilli G., Pirola Krüger J.A., Herman P., Giuffrida M., Charco R., Gastaca M., Holowko W., Truant S., Ho K.M., Cheng K.C., Maurette R.J., Blatt L.A., Belda T., Abe Y., Uemura S., Wakabayashi G.

    Bjs Open 9 ( 6 )  2025.12

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    Background Laparoscopic liver resection has been associated with less morbidity than, and similar global outcomes to, open liver resection. There is no robust evidence that these outcomes lead to similar clinical outcomes in patients aged over 80 years. The aim of this study was to analyse the short-term outcomes between open and laparoscopic liver resection in patients over 80 years old. Methods A retrospective analysis was undertaken. The study population comprised patients aged ≥ 80 years who underwent laparoscopic or open liver resection between January 2014 and December 2019, and who presented with resectable malignant tumours. The primary outcome was postoperative morbidity, according to Dindo-Clavien grading. Cox regression models were used to compute hazard ratios and 95% confidence intervals. Propensity score matching (1: 1) was performed to balance the two groups according to independent prognostic factors for morbidity. Results A total of 988 patients were analysed from 34 centres (16 from Asia, 14 from Europe and 4 from America): 487 in the open group and 501 in the laparoscopic group. Independent risk factors associated with severe morbidity were the open approach (hazard ratio 1.59, 95% confidence interval 1.19 to 2.11; P < 0.001), Charlson Co-morbidity Index score > 7 (HR 1.69, 1.26 to 2.27; P < 0.001), more than one resected tumour (hazard ratio 1.55, 1.13 to 2.11; P = 0.006), major hepatectomy (hazard ratio 1.86, 1.22 to 2.83; P = 0.003), and Iwate score ≥ 7 (hazard ratio 1.43, 1.02 to 2.01; P = 0.03). Before propensity score matching, severe morbidity, length of intensive care unit stay, 90-day mortality, length of hospital stay, and readmission were better in the laparoscopic group (P < 0.050). These observations were confirmed after propensity score matching. Conclusion The laparoscopic approach is a safe procedure for elderly patients, with better morbidity and mortality outcomes than the open approach, and should be considered as a default option.

  • Reduced pancreatic fistula rates and comprehensive cost analysis of robotic versus open pancreaticoduodenectomy

    Wakabayashi T., Gaudenzi F., Nie Y., Mishima K., Fujiyama Y., Igarashi K., Teshigahara Y., Mineta S., Bozkurt E., Wakabayashi G.

    Surgical Endoscopy 39 ( 6 ) 3921 - 3929 2025.06

    ISSN  09302794

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    Background: Robotic pancreaticoduodenectomy (RPD) has emerged as a promising surgical approach for the treatment of periampullary neoplasms, offering the potential benefits of minimally invasive surgery. However, the impact of RPD on clinically relevant pancreatic fistula (CR-PF) rates and overall costs compared to open pancreaticoduodenectomy (OPD) remains unclear, limiting its widespread adoption. Methods: This retrospective cohort study was conducted at a high-volume Japanese referral center from 2017 to 2023. A total of 193 patients diagnosed with periampullary neoplasms underwent either RPD (n = 81) or OPD (n = 112). To account for potential selection bias, propensity score matching (PSM) was used to balance patient demographics and clinical characteristics, resulting in two well-matched groups of 60 patients each. Perioperative outcomes, CR-PF rates, and a comprehensive cost analysis were evaluated. Results: RPD resulted in a significantly lower rate of CR-PF (10%) compared to OPD (33.3%) (p = 0.003). Additionally, patients who underwent RPD experienced shorter hospital stays (15 days) compared to those in the OPD group (22.5 days) (p < 0.001). Despite longer operative times for RPD (633 vs. 395 min; p < 0.001), total hospital costs were comparable between the two groups. The higher operative costs associated with RPD were offset by reduced postoperative complications and shorter hospitalization. Conclusions: RPD offers significant clinical advantages, including lower CR-PF rates and reduced hospital stays, without increasing overall hospital costs compared to OPD. These findings support the feasibility and potential benefits of adopting RPD for the management of periampullary neoplasms in clinical practice.

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