Centers & Services

Hepato-Biliary-Pancreatic Surgery Department

What is Hepato-Biliary-Pancreatic Surgery?

We mainly perform treatment, research and education for diseases in the hepato-biliary-pancreatic field.

Our Physicians

Director, Department of Hepato-Biliary-Pancreatic Surgery

Takahito Yagi, Professor
[Hepato-biliary-pancreatic disease, liver transplantation and kidney transplantation]

Staff

Yuzo Umeda Assistant Professor
Ryuichi Yoshida Assistant Professor (Minimally Invasive Care Center)
Daisuke Nobuoka Assistant Professor (Organ Transplant Center)
Takashi Kuise Assistant Professor (Organ Transplant Center)

*Specialty shown in [ ]

Weekly schedule of outpatient physicians

Monday Tuseday Wednesday Thursday Friday
Outpatient physicians Professor, Assistant Professor   Professor, Assistant Professor   Professor, Assistant Professor
Clinical
sections
available
by day
of the
week
AM Transplantation surgery (liver) specialty by organ (esophagogastric,hepato-biliary-pancreatic, colon-anal, and lung)   Transplantation surgery (liver and kidney) specialty by organ (esophageal, Transplantation surgery specialty by organ (gastric, hepato-biliary-pancreatic, hepato-biliary-pancreatic, colon-anal, and lung <gene therapy>)   Transplantation surgery specialty by organ (gastric, hepato-biliary-pancreatic, colon, mammary-endocrine)

Treatment system

  • Department Director: 1
  • Vice Department Director: 1
  • Ward Chief: 1
  • Outpatient Chief: 1
  • Assistant Professor: 5
  • Medical staff and Clinical fellows: 4
  • Liver transplant coordinator: 1

Outpatient clinic days: Mondays, Wednesdays and Fridays (not applicable to emergency care.)

Treatment policy

  • A treatment policy that is the most suitable for each patient is selected in close collaboration with Departments of Gastroenterology, Radiology, and Anesthesiology.
  • Surgical treatment of malignant disease in the hepato-biliary-pancreatic field applying transplantation technology.

Specialties

  • Transplantation therapy including pediatric/adult living-donor or deceased (brain-dead)-donor liver transplantation and deceased-donor kidney transplantation
  • Treatment of liver cancer and pancreaticobiliary cancer
  • Surgical treatment of malignant disease in the hepato-biliary-pancreatic field using vascular surgical procedures

Scope of target diseases

  • End-stage liver disease and acute hepatic failure (such as fulminant hepatitis) that are within the scope of liver transplantation
  • Liver cancer (primary and metastatic)
  • Biliary tract cancer (bile duct cancer and papillary cancer)
  • Pancreatic cancer (surgery and peptide vaccine)
  • Benign diseases such as gallstone (endoscopic surgery) and intrahepatic gallstone
  • Congenital diseases such as pancreaticobiliary malfunction and congenital choledochal cyst
  • Splenectomy and shunting for portal hypertension

Description of medical care

The therapeutic scope of our department includes general surgical disease with specific emphasis on gastroenterological surgery and transplantation surgery. Treatment is performed by a team of specialized surgeons for conduct of a safe surgical operation that is generally regarded as difficult, such as esophageal cancer and hepato-biliary-pancreatic cancer. We also endeavor to perform minimally invasive surgery for aged or high-risk patients as well as function-sparing surgery to maintain QOL.

Hepato-Biliary-Pancreatic Surgery

Resection is actively applied more extensively to liver cancer and bile duct cancer based on liver transplantation technology and its application. Multidisciplinary treatment is performed for far-advanced liver cancer in collaboration with the Departments of Radiology and Gastroenterology. Under such circumstances, there have been an increasingly growing number of cases of resection. We perform over 100 hepatectomy operations per year. We have also performed more than 70 cumulative cases of liver transplantation for liver cancer associated with hepatic failure.
Liver cancer associated with advanced liver cirrhosis for which surgical treatment had not been considered applicable are treated using radiofrequency ablation (RFA) when jaundice is absent and ascites is controlled, yielding good results. There also have been many cases of surgery for pancreatic cancer, yielding long-term survival.
Moreover, we perform over 50 cases annually of pancreaticoduodenectomy, primarily including pancreatic cancer. Pancreatic head cancer and papillary cancer with portal invasion for which surgery had not been considered applicable previously are treated by revascularization, producing long-term survival, while a clinical study with a peptide vaccine for pancreatic cancer is being performed in unresectable cases. We also actively undertake efforts for minimally invasive procedures (mainly endoscopy) in the field.

Transplantation

Organ transplantation is the field on which our medical school department has mainly focused. We have performed 110 and 97 cases of living-donor and deceased-donor kidney transplantation, respectively, as well as renal failure surgery in dialysis patients simultaneously.
We have performed live-donor partial liver transplantation since 1996. Live-donor liver transplantation has been performed in 360 patients with end-stage hepatic failure in collaboration with the Departments of Gastroenterology, Pediatrics, and Anesthesiology, producing good results with a 1-year survival rate of 85% and a 5-year survival rate of 79%. Additionally, we have experienced 26 cases of deceased (brain-dead) donor liver transplantation (the 4th largest program in Japan) since the amendment of the organ transplantation law in July 2010, saving the lives of many patients with fulminant hepatitis, which had been difficult before, through the close cooperation of medicine and surgery, and taking pride in post-transplantation survival rates as high as 100% for pediatric biliary atresia. We have also performed deceased (brain-dead) donor simultaneous liver and kidney transplantation in 2012, which became the first successful case of lifesaving in Japan. We also are a certified institution for deceased (brain-dead) donor small intestine transplantation (since 2000).
Six National University Consortium in Liver Transplant Professionals Training Program has started as a part of University Reform Program Promotion by the Ministry of Education, Culture, Sports and Science from 2014. In this consortium, Okayama University is now playing a key role on the training of transplant surgeons, pathologists and coordinators because of rich cases and experience.
For patients who want liver transplantation

For outpatient visits

  • Our outpatient clinic is open in the mornings on Mondays, Wednesdays and Fridays. A visit on Friday is recommended for examination and consultation for liver transplantation or simultaneous liver and kidney transplantation.
  • For return visits, the next visit date is registered. A reservation card is given after examination.
  • For emergency, a duty doctor is always on call in the inpatient ward. Direct ward phone number: 086-235-7857
  • Additionally, one can call medical school department phone/fax number for consultation for outpatient visits and hospital admissions. Our Outpatient Clinic Chief or Ward Chief will call you back.
    Phone: 086-235-7257 Fax: 086-221-8775

Highly advanced/special medical treatments

Technology covered by health insurance programs

  • Living-donor (deceased donor) partial liver transplantation (pediatric and adult)
  • Live-donor (deceased donor) kidney transplantation
  • Deceased (brain-dead) donor simultaneous liver and kidney transplantation
  • Surgery for liver cancer, biliary tract cancer and pancreatic cancer (hepatectomy, pancreaticoduodenectomy, distal pancreatectomy, with (or without) revascularization)
  • Laparoscopic surgery (cholecystectomy, splenectomy, hepatectomy, and pancreatectomy)
  • Pediatric malignant tumor surgery (such as liver transplantation for advanced pediatric hepatoblastoma)
  • Resection of cancer associated with invasion into the inferior vena cava and reconstruction of the inferior vena cava
  • Malignant retroperitoneal tumor (such as liposarcoma)

Techniques conducted as a clinical trial or research studies

  • Antiviral drugs
  • Oral anti-liver cancer drugs
  • Hemostatic materials for liver surgery
  • Immunosuppressants
  • Pancreatic cancer peptide vaccine therapy
  • Comparative study of hepatectomy and radiofrequency in liver cancer
  • Chemotherapy for metastatic liver cancer

Techniques performed in clinical studies

  • Preoperative splenic artery embolization for patients with advanced portal hypertension
  • Mechanisms and treatment related to acquisition of insulin resistance after pancreatic surgery
  • Role of donor dendritic cells in hepatitis C recurrence after transplantation
  • Change in dendritic cell activity in the difference in rejection by recipients
  • Nutritional intervention in surgery (including liver transplantation)
  • Non-microscopic arterial reconstruction in partial liver transplantation
  • Small intestine transplantation

Techniques performed as medical treatments at a patient's own expense

  • Liver transplantation for liver cancer that exceeds the Milan criteria

Main methods for testing and explanation

Fields other than transplantation

  • Liver cancer treatment: We perform about 100 hepatectomy operations per year. Highly advanced liver cancer for which surgery was not considered applicable can also be surgically resected by revascularization using transplantation technology. The surgical mortality in hepatectomy in the last 10 years is 0.2%. Therefore hepatectomy can be characterized as an extremely safe surgical technique. We employ a method of hepatectomy for resection by blood vessel branching considering the route of metastasis (systematic resection). Systematic resection is used in more than 80% of patients. In fact, the cumulative 5-year survival rate of primary hepatectomy patients (309 cases) during the last 10 years is 67.9% (including Stage IVa), reflecting good results.
  • Pancreatic cancer treatment: We perform over 50 cases of pancreaticoduodenectomy per year. About 1/3 of them are conducted to treat pancreatic ductal cancer with poor prognosis, most of which are Stage Iva, judged to be inoperable because of vascular invasion. For such cases, the advanced pancreatic cancer is resected using vascular surgery technology. Therefore, the combined portal vein resection rate is higher than 60%, and arterial reconstruction is also often performed. Moreover, radiotherapy and chemotherapy are performed in cooperation with Departments of Medicine and Radiology. A clinical study of a state-of-the-art peptide vaccine is also underway.