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Hepato-Biliary-Pancreatic Medicine
This department provides medical care in a two-team system comprising the “Liver Team” and the “Pancreato-Biliary Team.”
The “Liver Team” provides treatments for the liver, including percutaneous radiofrequency ablation (RFA), mainly for liver cancer (primary liver cancer, metastatic liver cancer), while the “Pancreato-Biliary Team” provides treatments specializing in diseases of the pancreas and biliary tract (gallbladder and bile duct). The Team aims to provide highly specialized medical care for each disease and organ.
Liver Team
（1）Overview
Our department primarily performs percutaneous RFA for liver cancer (primary liver cancer, metastatic liver cancer). RFA is a treatment method where an electrode probe of approximately 1.5 mm is inserted into tumor to necrotize the tumor through dielectric heating with radio-frequency waves around the electrode. The treatment is conducted under local anesthesia and takes approximately one hour.
“Hepatocellular carcinoma,” the most common type of liver cancer, is most often caused by hepatic cirrhosis from infection with the hepatitis B or hepatitis C viral infections. Hence, patients with hepatocellular carcinoma often also have decreased hepatic function, and their prognosis is greatly influenced by not only cancer treatment, but also how well hepatic function is preserved.
Furthermore, because the rate of recurrence of hepatocellular carcinoma after treatment is high, treatment at the time of recurrence should be considered, and hepatic function needs to be preserved as much as possible.
Given these characteristics of hepatocellular carcinoma, the fact that RFA does not require resection of the liver and places a little physical burden on patients is a major advantage of the treatment.
In addition, our department not only offers treatment but is also actively involved in diagnosing hepatic cancer. The Center also offers diagnosis and treatment of hepatic diseases in general such as liver tumors, hepatic cysts, viral hepatitis, and non-alcoholic steatohepatitis (NASH).
（2）Policy
Speedy process from diagnosis to discharge
Our department is committed to quickly diagnosing and treating hepatic cancer with a sense of speed; if treatment is indicated, it will be performed on the earliest possible schedule.
For example, if the treatment were determined to be suitable based on tests conducted during the outpatient consultation on Monday, at the earliest, the patient would be admitted two days later on Wednesday, receive RFA on Thursday and a post-procedure CT scan on Friday. If there were no issues, the patient would be discharged on Saturday. Depending on the patient, there are cases where RFA is conducted in the afternoon of the same day that the patient is admitted for hospitalization. As hospitalization schedules are determined according to the condition of each individual patient, some patients may be discharged in as little as three days.
*Example of the shortest possible treatment schedule
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday |
|---|---|---|---|---|---|---|
| Outpatient consultation, tests such as ultrasounds |
Admission | RFA | Post-procedure CT scan | Discharge from hospital | Home care and convalescence |
The department places importance on the speedy procedures (testing/diagnosis – hospitalization – treatment – discharge) because if there is an extended period of time until treatment, the cancer may progress during the time and grow. Conducting treatment as soon as possible has major advantages for both patients and for us as medical professionals.
We will continue to practice “testing and treatment without waiting time,” never deferring treatment.
No Limit—Never give up as long as there is the possibility of treatment
Our department has the policy of conducting “No Limit” treatment that is not held back by limits.
In the Clinical Practice Guidelines for Hepatocellular Carcinoma of the Japan Society of Hepatology, RFA is recommended for hepatic cancer with “tumor diameter of 3 cm or less and 3 tumors or less.” Hence, RFA is not conducted in most cases of hepatic cancer with tumors greater than the above size and number.
Our department offers medical care in accordance with the standards indicated in the Guidelines; however, when we determine that RFA will improve the patient’s survival rate even slightly, RFA is conducted even in deviation from the standards of the Guidelines.
In addition, after addressing the risks, our department conducts RFA on dialysis patients and patients who have undergone a pacemaker implantation who are considered to have high risk for RFA.
No two people in this world are the same. Therefore, applying uniform treatment indications for all patients does not enable treatment suited to individual patients.
As long as patients wish to “live longer,” we will never give up. In the spirit of “No Limit,” we will pursue the optimal treatment for each and every patient.
（3）Characteristics
RFA (percutaneous radiofrequency ablation) performed for metastatic liver cancer
When cancer that occurred somewhere other than the liver metastasizes to the liver, it is referred to as metastatic hepatic cancer. Our department actively conducts RFA on metastatic hepatic cancer, and many patients travel a great distance to us.
＜RFA results at our department＞
RFA using artificial pleural effusion and artificial ascites
By using artificial pleural effusion and artificial ascites, RFA can be conducted on cancers in locations where it is difficult to conduct RFA.
The artificial pleural effusion method involves artificially injecting water (5% glucose solution) into the thoracic cavity, and is used when the lungs block visualization of the tumor on ultrasound because the tumor is located just under the diaphragm. In addition, this method is used when there is a risk of procedural accidents such as pneumothorax owing to puncturing the lungs located in the puncture route for the tumor, even if the tumor is visualized.
There are three main purposes of the artificial ascites method.
- To separate the cancer from the digestive tract or other neighboring organs, preventing procedural accidents due to heat injury.
- To separate the cancer on the surface of the liver from the peritoneum, improve visualization on the ultrasound, and alleviate the pain that accompanies ablation
- To separate the lesion from the diaphragm, improve visualization on the ultrasound, and alleviate pain
By using artificial pleural effusion and artificial ascites in this way, the department is working to ensure that even patients who have been considered unfit for RFA.
Facilities and treatment environment dedicated to RFA
In our department, RFA is conducted not in an operating room or outpatient treatment room, but in a treatment room dedicated to RFA. As there are no restrictions such as being unable to use an operating room due to the operating schedules of other clinical departments, the treatment date can be quickly determined, which is an advantage.
The accuracy of RFA is significantly influenced according to the devices used. Hence, the Center has built a system to help maintain the accuracy of treatment by introducing ultrasonic diagnostic equipment, an RFA system, and other devices.
Extensive number of RFA cases
Our department conducts RFA on 6122 cases of hepatic cancer (number of treatments conducted from 2006 to 2024).
By accruing further experience in the future, the Center intends to provide treatment to many patients who need RFA.
For those who wish to undergo percutaneous radiofrequency ablation (RFA)
If you are diagnosed with hepatic cancer at another hospital or clinic and wish to seek treatment at our hospital, please bring a referral letter and visit us. Early treatment intervention is crucial for hepatic cancer. We would like you to tell us about the details of diagnosis, and then we will talk about the treatment policy, such as whether RFA is indicated.
Message to patients who visit us
Staff members of our department actively conduct academic society activities and research, exchange information with other medical institutions, and work to enhance their skills individually to provide care that is prompt and of higher quality than what is currently provided to as many patients as possible. Also, the comprehensive medical checkup provided by our hospital includes “Pancreas, gallbladder, and bile duct cancer course” for the early detection of cancer of the pancreas and biliary tract.
The Liver Team uses a referral system. The staff member of our department conducts the initial outpatient consultations on the days of outpatient consultations. Therefore, patients with a referral letter (patient referral document) will be able to smoothly receive the medical examination if visiting the hospital on Monday, Wednesday, and Thursday.
Takuma Teratani, Director
Pancreato-Biliary Team
（1）Overview
The Pancreato-Biliary Team provides care specializing in diseases of the pancreas and biliary tract (gallbladder and bile duct). Pancreatic diseases handled by our Team include malignant diseases such as pancreatic cancer and pancreatic neuroendocrine tumors (P-NET) and benign diseases such as acute/chronic pancreatitis. Gallbladder diseases comprise malignant tumors, such as bile duct cancer, gallbladder cancer, and duodenal papilla cancer, and benign diseases, such as cholelithiasis and acute cholecystitis.
Pancreatic cancer and biliary tract cancer are difficult to diagnose and treat, and are known to have poor treatment outcomes among the all types of cancer. To overcome these cancers, we emphasize the improvement of testing and treatment technologies with the aim of increasing early detection and enhancing treatment outcomes.
（2）Policy
The greatest goal of our team is the early detection and early treatment of pancreatic cancer. To overcome pancreatic cancer, known for having a poor survival rate, we conduct tests/diagnoses using CTs and endoscopic ultrasound (EUS), striving for treatment intervention at a stage where resection is possible.
（3）Characteristics
Detailed examinations for early detection of pancreatic cancer
There are cases where small pancreatic cancers cannot be seen with regular CTs alone. For this reason, our Team conducts tests that combine Dynamic CT of the Pancreas, MRCP (magnetic resonance cholangiopancreatography), and EUS (endoscopic ultrasonography) with the aim of detecting small pancreatic cancers that are in the operable stage.
【Description of Tests】
- Dynamic CT of the Pancreas: A test where a contrast agent is injected and abdominal cross-section images are taken several times. By taking CT images of the same area after a certain amount of time, differences in movement of the contrast agent can be seen between the normal and diseased tissues.
- MRCP: A test where the bile duct and pancreatic duct are examined using an MRI device. Because it can be conducted without the use of a contrast agent, it places minimal stress on the body.
- EUS: A test where ultrasound is applied to organs such as the pancreas from close range by inserting an endoscope with an ultrasound device attached, instead of applying from outside of the body.
Rapid Diagnosis using EUS-FNA
EUS-FNA (endoscopic ultrasound-guided fine needle aspiration) is a testing method where lesion tissue is harvested using an endoscope with a small ultrasound emitting device attached to the tip.
When pancreatic cancer or gastrointestinal submucosal tumor is suspected based on the imaging tests, a definitive diagnosis can be made with a pathological diagnosis that examines tissue collected by EUS-FNA. Because EUS-FNA is performed by inserting an endoscope through the mouth, it is less invasive than the previous laparoscopic diagnosis requiring an incision in the abdomen. The minimum duration of hospitalization is 2 nights and 3 days, as shown in the table.
*Sample hospitalization for testing (shortest case)
| Weekday 1 | Weekday 2 | Weekday 3 |
|---|---|---|
| Admission | EUS-FNA | If there are no issues with the morning blood draw, the patient resumes eating lunch and is discharged after lunch. |
| Fasting for a day |
Treatment System for Urgent Cholecystitis and Cholangitis
Biliary tract infections such as cholecystitis and cholangitis are one of highly urgent illnesses where medical care and treatment after onset are important. Our Team has prepared a structure enabling ERCP (endoscopic retrograde cholangiopancreatography) testing regardless of whether it is during or outside regular consultation hours, with physicians, nurses, and co-medical staff working together to ensure that we are able to respond to these kinds of urgent diseases. This enables patients requiring treatment to receive same-day treatment and procedures upon coming to the hospital.
◆Main tests
◆Main disease
Cancer
- Pancreatic cancer 【Find more about pancreatic cancer】
- Biliary tract cancer 【Find more about biliary tract cancer】
Other
- Gallbladder polyp(471KB)
- Cholelithiasis(640KB)
- Cholangitis(631KB)
- Cholecystitis(720KB)
- Pancreatic cyst(541KB)
（4）Message to patients who visit us
Pancreato-Biliary Team specializes in the treatment of biliary and pancreatic diseases. This is an area where diagnosis and treatment are difficult. In fact, pancreatic cancer and biliary tract cancer are currently ranked the worst and second worst in terms of survival rate. Diagnosis and treatment of the biliary and pancreatic region require special endoscopic techniques such as ERCP and EUS, which are different from those used in ordinary gastroscopy. Therefore, very few doctors specialize in this region.
In April 2016, Pancreato-Biliary Team, Hepato-Biliary-Pancreatic Medicine, NTT Medical Center Tokyo, renewed its members. We have been conducting comprehensive care from diagnosis to treatment and chemotherapy and achieving high-level team care. In addition, Pancreato-Biliary Team is actively involved in academic society activities, deploying clinical research, interacting with other institutions to enhance the level of medical care, and engaging in our daily consultations and care to perform high quality treatment for as many people as possible.
The main goal of our team is early diagnosis and treatment of pancreatic cancer. We use EUS and computed tomography (CT) to detect and diagnose pancreatic cancer at the earliest stage possible for surgery and request Surgery for the procedure.
EUS plays a major role in this as disease screening. The detection rate of small pancreatic cancer is 80% or less even with CT but is 90% or more with EUS (some papers show that the detection rate of pancreatic cancer of 2 cm or smaller is 50% with CT). Actually, pancreatic cancer that is not clearly detected with CT can be detected with EUS, and there are many patients who have undergone early treatment for pancreatic cancer.
We strive to diagnose and treat pancreatic cancer quickly and with low risk after the tumor is found. The diagnosis of pancreatic cancer can be made quickly, 3 days at the shortest, and can be done in a low-risk (fewer complications) and minimally invasive manner because EUS-FNA (EUS-guided fine needle aspiration) can be used for the diagnosis instead of the conventional ERCP (ERCP is performed only when necessary). We have a system of working closely with the Surgery Department to shorten the waiting period for surgery, thereby decreasing the risk of cancer progressing while waiting. In addition, we strive to provide prompt treatment for patients with inoperable advanced pancreatic cancer. We perform a blood test and contrast-enhanced CT scan in an outpatient visit on the first day and then perform EUS-FNA on hospitalization the following day. Treatment with anticancer drugs can be started after receiving the pathology results, and it possible to start the treatment within a week from the first visit.
The endoscopic pancreaticobiliary procedures at our Team have been increasing, and we have received many referrals to conduct ERCP, which is difficult to conduct at other hospitals. We also provide treatments such as biliary drainage, cyst drainage, and abscess drainage with EUS daily. Our hospital has equipment such as endoscopic equipment, and our Team has treated lesions that were thought difficult to be treated in the past. We have added a brief description of each disease and the results at our hospital on our website. Please feel free to contact us at any time with a referral letter if you are concerned about pancreatic cancer or have questions about your treatment strategy.
To medical institutions
We always welcome patient referrals. If you have patients who need highly specialized medical care, such as those who have difficulty in intubation of bile ducts with ERCP or those who need pancreaticobiliary drainage (EUS-BD [EUS-guided biliary drainage] or EUS-PD [EUS-guided pancreatic duct drainage]) with FNA or EUS, please refer them to Yuji Fujita, in charge of the outpatient consultation for new patients in Hepato-Biliary-Pancreatic Medicine, on Tuesday mornings. In some cases, pancreatic and gallbladder tumors that are not clear can be diagnosed by observing them with EUS. We can also quickly respond to your requests about EUS. Please contact our hospital immediately if you have patients with cholangitis or other conditions that require urgent care. We are basically always available to deal with them.
Yuji Fujita
