Tracheal resection and reconstruction for esophageal cancer with tracheal invasion using tissue engineering technology

• Project/Area Number: 17K10587
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Digestive surgery
• Research Institution: Osaka University
• Principal Investigator: Yamasaki Makoto 大阪大学, 医学系研究科, 准教授 (50444518)
• Co-Investigator(Kenkyū-buntansha): 山本 昌明 大阪大学, 医学部附属病院, 医員 (20724280) ; 中島 清一 大阪大学, 医学系研究科, 特任教授(常勤) (30432537) ; 小田切 数基 大阪大学, 医学部附属病院, 医員 (30781794) ; 百瀬 洸太 大阪大学, 医学部附属病院, 医員 (50749752) ; 田中 晃司 大阪大学, 医学部附属病院, 助教 (70621019) ; 牧野 知紀 大阪大学, 医学系研究科, 助教 (80528620)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,550,000 (Direct Cost: ¥3,500,000、Indirect Cost: ¥1,050,000); Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2018: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000); Fiscal Year 2017: ¥1,950,000 (Direct Cost: ¥1,500,000、Indirect Cost: ¥450,000)
• Keywords: 気管再建 / 食道癌 / 気管再生

Outline of Final Research Achievements

First, tracheal reconstruction was examined using autologous cartilage tissue. The results showed that tracheal covering with auricular cartilage in large animals was sufficiently applicable to both airway sealing and pressure resistance, but since tracheal covering by autologous cartilage tissue is limited in size and shape, it is not always possible to clinically apply it for all cases.
We are conducting experiments toward reconstruction with a metal material, Mg, as a biocompatible absorbent material. The safety of large animals was confirmed as an alternative to securing the airway for circumcision of the trachea, and it was confirmed that the airway could be secured in the short term without any problems in air sealing and pressure resistance.

Academic Significance and Societal Importance of the Research Achievements

気管浸潤をきたしたT4食道癌は極めて予後不良であり、根治切除を行わないことをガイドラインで推奨している。一方、当科で同症例に対する気管合併切除に対する有用性について検討を行い、3年生存率36%と長期予後を望める結果を報告した (Disease of Esophagus 2020)。本報告では気管切除後に永久気管孔を造設しており、発声機能の消失を余儀なくされ、術後のQOLの著しい低下は否めない。そこで、本研究のように気管の再建を伴う手術が可能となれば極めて臨床的意義の大きな治療法となる。

Research Products

• [Journal Article] Tracheal resection and anterior mediastinal tracheostomy in the multidisciplinary treatment of esophageal cancer with tracheal invasion (2020)
  • Author(s): Makoto Yamasaki, Kotaro Yamashita, Takuro Saito, Koji Tanaka, Tomoki Makino, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Masaaki Motoori, Yutaka Kimura, Masaki Mori, Yuichiro Doki
  • Journal Title: Disease of Esophagus Volume: - Issue: 5
  • DOI: 10.1093/dote/doz101
  • Peer Reviewed
• [Presentation] T4b食道癌に対する外科手術 (2019)
  • Author(s): 山﨑 誠、牧野知紀、田中晃司、宮崎安弘、高橋剛、黒川幸典、中島清一、森正樹、土岐祐一郎
  • Organizer: 第119回日本外科学会定期学術集会
  • Invited
• [Presentation] Salvage 手術としての気管合併切除、縦隔気管孔造設術 (2019)
  • Author(s): 山﨑 誠、牧野知紀、田中晃司、山下公太郎、土岐祐一郎
  • Organizer: 第71回日本気管食道科学会総会
  • Invited
• [Presentation] The challenge to the limit of surgery for T4b esophageal cancer (2019)
  • Author(s): 山﨑 誠、牧野知紀、田中晃司、山下公太郎、土岐祐一郎
  • Organizer: 第72回日本胸部外科学会定期学術集会
  • Invited
• [Presentation] T4b食道癌に対するメスの限界は？ (2019)
  • Author(s): 山﨑 誠
  • Organizer: 第94回中国四国外科学会総会
  • Invited
• [Presentation] Surgical resection combined with infiltrating organs as a salvage treatment (2018)
  • Author(s): 山崎誠
  • Organizer: 第72回日本食道学会学術集会
  • Invited