TOTTORI UNIVERSITY HOSPITAL

• Head of department
  Yoshiyuki Fujiwara

To contribute to local medicine by fostering specialists with high-level skills

First Surgery is composed of Gastrointestinal Surgery and Pediatric Surgery, and Gastrointestinal Surgery has four groups namely 1) upper digestive tract, 2) lower digestive tract, 3) liver transplantation, and 4) gallbladder, pancreas, and spleen. Our policy is "to contribute to local medicine by nurturing specialists with high-level skills such as certified endoscopic surgeons, high-level hepato-biliary-pancreatic surgeons, and experts in esophagus surgery," and we are trying to make our facility a higher-volume center with better endoscopic surgery and with surgery for esophagus/pancreatic cancer.

Fields of expertise

• Esophagus cancer:1) Prone position thoracic surgery for esophagus 2) Chemoradiotherapy
• Stomach cancer: 1) Operation: Laparoscopic gastrectomy, robotic surgery 2) Specific treatment: NAC
• Colorectal cancer: 1) Operation: Laparoscopic colectomy, robotic surgery 2) Specific treatment: Laparoscopic ISR
• Liver cancer: 1) Operation: Hepatectomy, Laparoscopic hepatectomy 2) Specific treatment: Living donor liver transplantation
• Pancreatic cancer: 1) Operation: Pancreaticoduodenectomy 2) Specific treatment: Laparoscopic pancreatectomy
• Other: Laparoscopic splenectomy, retroperitoneal lumpectomy and molecular- targeted drug therapy

Diseases of interests

All digestive cancers, splenic disease including inflammatory bowel disease, gallstone, liver cirrhosis, idiopathic thrombocytopenic purpura

• Laparoscopic surgery

Principal treatment

Esophagus cancer: We treat about 20 cases per year and most of them are thoracoscopic esophagectomy treatment for esophageal gastrointestinal stromal tumor. This protocol is beneficial to for reducing post-operative pain.
Gastric cancer, GIST: We treat about 100 cases per year and 60% of them are laparoscopic surgery. For gastric cancer, we perform robotic surgery in some cases. For extremely advanced gastric cancer, we provide pre-operative chemotherapy and aim for curative surgery (NAC treatment).

Bowel cancer: We perform about 100 cases of bowel cancer surgery per year. Two-thirds of bowel cancer patients receive laparoscopic surgery. For rectal cancer, we provide chemoradiotherapy to shrink the tumor to conserve the anus after the surgery (intersphincteric resection, ISR).

Liver transplantation: We perform about 50 cases of hepasectomy for hepatocellular carcinoma, metastatic liver cancer, and cholangiocarcinoma. When appropriate, we perform hepasectomy using a laparoscope. We consider living liver transplantation as a therapeutic option for hepatocellular carcinoma with decompensated liver cirrhosis complication.

Biliopancreatic diseases: There are many cases of pancreatic cancer, biliary cancer, and bile duct cancer and we perform about 30 cases of pancreaticoduodenectomy. When appropriate, we perform pancreatectomy using a laparoscope.

Retroperitoneal tumor: We perform surgery and provide a molecular-targeted drug for large retroperitoneal tumor.

Surgery on benign diseases: We perform surgery trying to leave as small a scar as possible (SILS surgery).