Language：English   Publishing type：Research paper (scientific journal)  

AIM: To clarify the benefits of robotic-assisted laparoscopic surgery (RALS) regarding short-term outcomes in patients with technically demanding rectal cancer (TDRC). PATIENTS AND METHODS: Between April 2015 and September 2019, 88 TDRC cases were identified from our database, and divided into the RALS (n=32) and conventional laparoscopic surgery (CLS) (n=56) groups. TDRC was defined as mid-rectal tumors presenting at least one of the following risk factors: Male sex, high body mass index, T4 stage, bulky tumor, or low rectal tumor. RESULTS: Patient baseline characteristics were similar in both groups. One and 15 patients developed anastomotic leakage in the RALS and CLS groups (3% vs. 27%, p<0.01), respectively. The postoperative complication rate was lower in the RALS group (19% vs. 43%, p=0.03). Multivariate analysis showed the surgical approach to be an independent predictor for anastomotic leakage. CONCLUSION: RALS has potential advantages to prevent anastomotic leakage complications in patients with TDRC.

DOI： 10.21873/anticanres.14201

PubMed

researchmap

Language：English  

DOI： 10.1007/s10151-019-02081-z

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The benefits of laparoscopic surgery for colorectal cancer have been well established. Several randomized controlled trials have demonstrated similar oncological outcomes between laparoscopic and open surgery for colon cancer. However, whether or not laparoscopic surgery is acceptable in patients with clinical N2 colon cancer is unclear. Therefore, the present study aimed to evaluate the safety and oncological outcomes of laparoscopic surgery for clinical N2 colon cancer. METHODS: This retrospective study assessed a prospective database and identified 262 consecutive patients with clinical N2 colon cancer who underwent either laparoscopic or open primary resection between 2000 and 2016. After propensity-score matching, 162 patients were analyzed. The primary outcome of interest was the 3-year recurrence-free survival rate, and the secondary outcome of interest was the postoperative complication rate. RESULTS: The 3-year recurrence-free survival rate did not differ markedly between the laparoscopic and open surgery groups (77.4% vs. 76.5%, p = 0.620). In addition, the incidence of postoperative complications did not differ markedly between the laparoscopic and open surgery groups (16.6% vs. 24.0%, p = 0.317). CONCLUSIONS: Our findings suggest that laparoscopic surgery is safe and effective for clinical N2 colon cancer. Laparoscopic resection can be considered in patients diagnosed with clinical N2 colon cancer.

DOI： 10.1007/s00595-019-1762-z

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The favorable oncological impact of D3 lymph node dissection after colon cancer surgery has been described previously. However, D3 lymph node dissection is potentially more invasive than conventional D2 lymph node dissection. The oncological merit of D3 lymph node dissection in elderly patients with colon cancer remains unclear. This study aimed to clarify the oncological outcome after D3 lymph node dissection in patients with colon cancer aged > 75 years. METHODS: This is a retrospective cohort analysis using propensity matching method. The study was conducted at a university hospital and two community teaching hospitals in a large urban city. A total of 378 consecutive patients with pathological stage II and stage III colon cancer who underwent primary resection with either D2 or D3 lymph node dissection were retrospectively identified on a prospective database between 2000 and 2015. The primary and secondary outcomes of interests were recurrence-free survival and postoperative complication rate, respectively. RESULTS: After propensity matching, 232 patients were analyzed. The long-term findings showed that the elderly who underwent D3 lymph node dissection had significantly better recurrence-free survival than those who underwent D2 lymph node dissection (p = 0.01). The incidence of postoperative complication was almost similar between the two groups. CONCLUSIONS: D3 lymph node dissection provides better recurrence-free survival than D2 lymph node dissection after primary resection for elderly patients with pathological stage II and stage III colon cancer.

DOI： 10.1007/s00384-018-03233-7

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The safety and feasibility of laparoscopic reoperation for anastomotic leakage remain unclear. METHODS: A total of 3321 patients underwent laparoscopic surgery for primary colorectal cancer at a tertiary referral center from September 2002 to May 2016. Of these, 31 patients who underwent reoperation for treatment of anastomotic leakage were enrolled in this study and divided into two reoperation groups: laparoscopic (n = 15) and open (n = 16). Data regarding patient demographics, operative outcomes, morbidity, length of hospital stay, mortality, and stoma closure after reoperation in the two groups were compared. RESULTS: No significant difference was observed in the primary surgery procedure between the two groups. Estimated blood loss (1 vs 9 mL, P = 0.020), total postoperative complications (26.7% vs 68.8%, P = 0.032), wound infection (0.0% vs 31.2%, P = 0.043), and postoperative hospital stay (18 vs 31 days, P = 0.017) were significantly better in the laparoscopic group than in the open group. Although the rate of stoma closure after reoperation was higher in the laparoscopic group, the difference was not significant (86.7% vs 62.5%, P = 0.220). CONCLUSIONS: Laparoscopic reoperation exhibited better short-term outcomes than open reoperation for selected patients with anastomotic leakage.

DOI： 10.1111/ases.12452

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: To evaluate the safety of laparoscopic colorectal cancer surgery for patients with severe comorbidities. PATIENTS AND METHODS: A total of 203 consecutive patients with severe comorbidities who underwent resection for colorectal cancer were retrospectively divided into laparoscopic and open primary resection groups. An age-adjusted Charlson comorbidity index ≥6 was considered as severe comorbidity. RESULTS: Blood loss (31 g vs. 207 g, p<0.01) and total postoperative complications (10.0% vs. 27.5%, p<0.01) in the laparoscopic group were significantly decreased compared to the open group. Incidence of postoperative ileus (0.0% vs. 7.2%, p=0.06) and length of postoperative hospital stay (11 days vs. 14 days, p=0.08) in the laparoscopic group were improved, though not significantly, compared to the open group. CONCLUSION: Laparoscopic resection for patients with severe comorbidities is safe, and is associated with a lower rate of overall operative complications compared to open surgery.

DOI： 10.21873/anticanres.12310

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT INST ANTICANCER RESEARCH  

Aim: To evaluate the clinical benefit from lateral lymph node dissection for middle and lower rectal cancer. Patients and Methods: A total of 229 patients who underwent bilateral lateral lymph node dissection during resection with curative intent for cT3-4 middle or lower rectal cancer from 2002 to 2013 were retrospectively reviewed. The index of estimated benefit from lymph node dissection for all, and each (common iliac, internal iliac and obturator), lateral lymph nodes were compared with the index for mesenteric lymph nodes (perirectal, intermediate and main lymph nodes). Results: The overall incidence of lateral lymph node metastasis was 14.0%. The index for all lateral lymph nodes (10.6) was lower than perirectal lymph nodes (45.3), but higher than intermediate lymph nodes (4.8). Conclusion: Lateral lymph node dissection provides considerable clinical benefit, similar to the benefit provided by intermediate lymph node dissection.

DOI： 10.21873/anticanres.11598

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Purpose Previous studies from Western countries have shown similar survival outcomes after both open and laparoscopic resections. In Japan, radical D3 dissections performed by open resection have been routinely performed for &gt;= T2- or &gt;= N1-stage cancers, and relatively favorable survival outcomes were obtained. This study compared the survival in patients with Stage I/II colon and upper rectal cancers undergoing laparoscopic and open resection.
Methods A total of 145 patients were initially enrolled. Propensity score matching was applied to assemble a study cohort. D2 lymph node dissection for T1 cancer and D3 for &gt;= T2-and &gt;= N1-stage cancers were applied. The primary outcome measure was the disease-free survival; the cancer-specific and overall survival rates were secondary outcomes.
Results A total of 64 patients were matched for the analysis. The length of hospitalization, postoperative complication rates, number of lymph nodes removed and surgical margins were similar between the groups. The disease-free survival following laparoscopic surgery was better than that following open surgery, but the difference was not statistically significant. Neither the cancer-specific nor overall survival rates following laparoscopic surgery were inferior to those associated with open surgery.
Conclusions The outcomes of the laparoscopic approach were comparable to those for open surgeries accompanied by radical lymph node dissection.

DOI： 10.1007/s00595-014-0954-9

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

A number of studies have evaluated the effects of subcutaneous drainage during digestive surgery. All of the previous studies assessed the usefulness of active-suctioning drain, including two randomized controlled studies which found no benefit for the placement of active-suctioning drains in digestive surgery. The utility of passive drainage has not been evaluated previously. The purpose of this study was to evaluate the efficacy of subcutaneous passive drainage system for preventing surgical site infections during major colorectal surgery.
A total of 263 patients who underwent major colorectal surgery were enrolled in this study. Patients were randomly assigned to receive subcutaneous passive drainage or no drainage. The primary outcome measured was the incidence of superficial surgical site infections. The secondary outcomes measured were the development of hematomas, seromas, and wound dehiscence.
Finally, a total of 246 patients (124 underwent passive drainage, and 122 underwent no drainage) were included in the analysis after randomization. There was a significant difference in the incidence of superficial surgical site infections between patients assigned to the passive drainage and no drainage groups (3.2 % vs 9.8 %, respectively, P = 0.041). There were no cases that developed a hematoma, seroma, or wound dehiscence in either group. A subgroup analysis revealed that male gender, age a parts per thousand yen75 years, diabetes mellitus, American Society of Anesthesiologists (ASA) status a parts per thousand yen2, blood loss a parts per thousand yen100 ml, and open access were factors that were associated with a beneficial effect of subcutaneous passive drainage.
Subcutaneous passive drainage provides benefits over no drainage in patients undergoing major colorectal surgery.

DOI： 10.1007/s00384-013-1810-x

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Chromatin remodeling factors have been the subject of great interest in oncology. However, little is known about their role in pancreatic cancer. The objective of this study was to clarify the clinical significance of the SWItch/sucrose non-fermentable (SWI/SNF) complex in patients with pancreatic cancer. A total of 68 patients with pancreatic cancer who underwent R0, 1 resection were enrolled. Cancer tissues were processed to tissue microarray, then stained immunohistochemically by using antibody of SWI/SNF components
BRM, BRG1, BAF250a, BAF180 and BAF47. The correlation of expression levels and clinicopathological outcomes were analyzed, followed by the multivariate analysis of prognostic factors for overall survival. The expression levels of the SWI/SNF components were categorized as low or high according to the median value of Histoscore. Statistical analysis revealed that BRM expression was related to tumor size, T factor, M factor, lymphatic invasion and stage BRG1 expression to histology and stage BAF180 expression to tumor size and BAF47 expression to lymphatic invasion, respectively. Multivariate Cox proportional hazard analysis showed that high BRM and low BAF180 expression levels were independent predictors of worse survival in patients with pancreatic cancer. High BRM, and low BAF180 were also independent prognostic factors for poor survival in the subgroup with adjuvant gemcitabine. These results suggest that the specific cofactors of SWI/SNF chromatin remodeling complex certainly have roles in pancreatic cancer. High BRM, and low BAF180 are useful biomarkers for poor prognosis in pancreatic cancer.

DOI： 10.3892/ijo.2012.1723

Scopus

PubMed

researchmap

Language：English   Publisher：BAISHIDENG PUBL GRP CO LTD  

The regenerating islet-derived members (Reg), a group of small secretory proteins, which are involved in cell proliferation or differentiation in digestive organs, are upregulated in several gastrointestinal cancers, functioning as trophic or antiapoptotic factors. Regenerating islet-derived type IV (RegIV), a member of the Reg gene family, has been reported to be overexpressed in gastroenterological cancers. RegIV overexpression in tumor cells has been associated with carcinogenesis, cell growth, survival and resistance to apoptosis. Cancer tissue expressing RegIV is generally associated with more malignant characteristics than that without such expression, and RegIV is considered a novel prognostic factor as well as diagnostic marker in some gastroenterological cancers. We previously investigated the expression levels of RegIV mRNA of 202 surgical colorectal cancer specimens with quantitative real-time reverse-transcriptase polymerase chain reaction and reported that a higher level of RegIV gene expression was a significant independent predictor of colorectal cancer. The biologic functions of RegIV protein in cancer tissue, associated with carcinogenesis, anti-apoptosis and invasiveness, are being elucidated by molecular investigations using transfection techniques or neutralizing antibodies of RegIV, and the feasibility of antibody therapy targeting RegIV is being assessed. These studies may lead to novel therapeutic strategies for gastroenterological cancers expressing RegIV. This review article summarizes the current information related to biological functions as well as clinical importance of RegIV gene to clarify the significance of RegIV expression in gastroenterological cancers. (c) 2012 Baishideng. All rights reserved.

DOI： 10.3748/wjg.v18.i27.3502

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: The guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. However, previous studies show conflicting results regarding the prognosis of colorectal mucinous adenocarcinoma. In this study, we described the clinicopathological features of mucinous adenocarcinoma in Japan, to identify optimal therapeutic strategies.
Methods: 144 patients with mucinous and 2673 with non-mucinous adenocarcinomas who underwent primary resection in two major centers in Yokohama, Japan were retrospectively evaluated for clinicopathological features and treatment factors. A multivariate analysis for overall survival followed by the comparison of overall survival using Cox proportional hazard model were performed.
Results: Patients with mucinous adenocarcinoma had larger primary lesions, higher preoperative CEA levels, a deeper depth of invasion, higher rates of nodal and distant metastasis, and more metastatic sites. A multivariate analysis for overall survival revealed a mucinous histology to be an independent prognostic factor. In the subgroup analysis stratified by stage, Patients diagnosed as StageIII and IV disease had a worse survival in mucinous adenocarcinoma than non-mucinous, while survival did not differ significantly in patients diagnosed as Stage0-II disease. In StageIII, local recurrence in rectal cases and peritoneal dissemination were more frequently observed in patients with a mucinous histology.
Conclusions: Our study indentified that mucinous adenocarcinoma was associated with a worse survival compared with non-mucinous in patients with StageIII and IV disease. In rectal StageIII disease with mucinous histology, additional therapy to control local recurrence followed by surgical resection may be a strategical alternative. Further molecular investigations considering genetic features of mucinous histology will lead to drug development and better management of peritoneal metastasis

DOI： 10.1186/1477-7819-10-109

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Background: Regenerating islet-derived family members (Reg) are superfamily of calcium-dependant lectins that are expressed in the proximal gastrointestinal tract and ectopically at other sites in the setting of tissue injury. The regenerating islet-derived family member 4 (RegIV) gene has been reported in various cancers, associating with diverse functions. This study examined the relation of the relative expression of RegIV gene to clinicopathological factors and outcomes in patients with colorectal cancer (CRC).
Methods: We studied surgical specimens of cancer tissue and adjacent normal mucosa obtained from 202 patients with untreated CRC. The relative expression levels of RegIV mRNA in cancer and in normal adjacent mucosa were measured by quantitative real-time reverse-transcriptase polymerase chain reaction.
Results: RegIV gene expression was higher in cancer tissue than in adjacent normal mucosa. The multivariate analysis of clinicopathological factors for 5-year overall survival showed a higher level of RegIV gene expression was a significant independent predictor. Overall survival at 5 years differed significantly between patients with high RegIV gene expression and those with low expression.
Conclusions: Overexpression of the RegIV gene is considered a useful independent predictor of outcomes in patients with CRC. J. Surg. Oncol. 2011;104:205-209. (C) 2011 Wiley-Liss, Inc.

DOI： 10.1002/jso.21906

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Adenomyomatous hyperplasia is rarely found in the extrahepatic bile duct. A 54-year-old man was referred to our center with a diagnosis of extrahepatic bile duct stenosis which had been detected by endoscopic retrograde choloangiopancreatography. Abdominal computed tomography revealed thickening of the wall of the middle extrahepatic bile duct, however no malignant cells were detected by cytology. Since bile duct carcinoma could not be ruled out, we performed resection of the extrahepatic duct accompanied by lymph node dissection. Histopathologically, the lesion was diagnosed as adenomyomatous hyperplasia of the extrahepatic bile duct. Present and previously reported cases showed the difficulty of making a diagnosis of adenomyomatous hyperplasia of the extrahepatic bile duct preoperatively or intraoperatively. Therefore, when adenomyomatous hyperplasia is suspected, a radical surgical procedure according to malignant disease may be necessary for definitive diagnosis. Copyright © 2011 S. Karger AG, Basel.

DOI： 10.1159/000331052

Scopus

PubMed

researchmap

Language：English  

DOI： 10.1007/s00464-024-11004-5

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Indocyanine green fluorescence imaging (ICG-FI) reduces anastomotic leakage (AL) in rectal cancer surgery. However, no studies investigating risk factors for anastomotic leakage specific to the group using ICG-FI have ever previously been conducted. The purpose of this retrospective multicenter study was to ascertain the risk factors for AL in the group using ICG-FI. METHODS: A total of 638 patients who underwent laparoscopic or robotic anterior resection for rectal cancer between April 2018 and March 2023 were included in this study. Patients were divided into two groups: the ICG-FI group (n = 269) and the non-ICG-FI group (n = 369) for comparative analysis. The effects of clinicopathological and treatment-related factors on AL in the ICG-FI group were evaluated using both univariate and multivariate analyses. RESULTS: The incidence of AL in the ICG-FI group was 4.8%. Although there was no significant difference in the incidence of AL between the two groups, it was observed to be lower in the ICG-FI group. A multivariate analysis revealed a preoperative C-reactive protein-to-albumin ratio (CAR) ≥ 0.049 (odds ratio, 3.73; 95% confidence interval, 1.01-13.70; p = 0.048) as an independent risk factor for AL in the ICG-FI group. CONCLUSIONS: In this study, CAR was the only identified risk factor for AL in the ICG-FI group. It was suggested that CAR could be a criterion for early surgical intervention, prior to the escalation of risks, or for considering interventions such as diverting stoma creation.

DOI： 10.1007/s00464-024-10940-6

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) is rapidly spreading. The robotic surgical techniques to approach lateral invasion, such as that of the pelvic plexus, have not yet been established. In this technical note, we present a video illustrating a surgical technique for lateral invasion using our novel technique and discuss its pitfalls. METHOD: We present the case of a 65-year-old man with LARC. Robotic surgery was performed after TNT using the da Vinci Xi Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). The surgical procedure was as follows: (1) D3 lymph node dissection around the inferior mesenteric artery using a medial-to-lateral approach; (2) rectal mobilization; (3) dissection of the ureterohypogastric fascia and ureter; and (4) combined resection of the hypogastric nerve and pelvic plexus. The key surgical point for sidewall invasion is the resection extent. Dividing the resection extent into three areas is important: zone A, which contains the pelvic plexus and is closest to the tumour; zone B, which contains the iliac vessels; and zone C, the most lateral zone, which contains the obturator nerves. This allows organ and function preservation by resecting only the smallest organ that truly requires R0 resection. RESULTS: The operating time was 333 min, console time was 232 min, and blood loss was 0 mL. The circumferential resection margin was 10 mm, and an R0 resection was achieved. CONCLUSION: We introduced a novel approach for robotic surgery after TNT for LARC with sidewall invasion. This technique can be performed safely and may help standardize 'beyond total mesorectal excision'.

DOI： 10.1111/codi.16969

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We investigated the impact of the prognostic nutritional index (PNI) on esophageal cancer survival and recurrence after curative treatment. METHODS: This study included 120 patients who underwent curative surgery followed by the adjuvant treatment for esophageal cancer between 2008 and 2018. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: The PNI of 49 was regarded to be the optimal critical point of classification considering the 1-year, 3-year, and 5-year survival rate. The OS rates at three and five years after surgery were 47.4% and 36.0% in the PNI low group, respectively, and 62.5% and 56.5% in the PNI high group, which amounted to a statistically significant difference (P = 0.020). The RFS rates at three and five years after surgery were 31.0% and 24.8% in the PNI low group, respectively, and 50.9% and 42.8% in the PNI high group, which amounted to a statistically significant difference (P = 0.020). A multivariate analysis demonstrated that the PNI was a significant independent risk factor for the OS and a marginally significant independent risk factor forRFS. CONCLUSION: The PNI was a risk factor for survival in patients who underwent curative treatment for esophageal cancer. It is necessary to develop the effective plan of the perioperative care and the surgical strategy according to the PNI.

DOI： 10.4103/jcrt.JCRT_1595_20

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We evaluated the clinical impact of the Geriatric Nutritional Risk Index (GNRI) in patients who received curative treatment and perioperative adjuvant treatment. We also investigated the association between the GNRI and the clinicopathological features of patients with GC. PATIENTS AND METHODS: This study included 280 patients who underwent curative treatment for GC between 2005 and 2020. The prognosis and clinicopathological parameters of the high-GNRI and low-GNRI groups were compared. RESULTS: In the GNRI-high group, the overall survival (OS) rates at 3 and 5 years after surgery were significantly lower (82.7% and 77.9%, respectively) than those in the GNRI-low group (56.4% and 40.8%). The GNRI was selected for the final multivariate analysis model for OS. The GNRI was also a significant prognostic factor for recurrence-free survival (RFS). The RFS rates at 3 and 5 years after surgery were 79.1% and 74.8%, respectively, in the GNRI-high group, and 48.0% and 38.6% in the GNRI-low group. The GNRI was selected for the final multivariate analysis model for RFS. The GNRI was also found to affect the postoperative clinical course, including postoperative surgical complications and postoperative adjuvant chemotherapy. CONCLUSION: The GNRI may be a promising prognostic and predictive factor for gastric cancer. In the future, the GNRI may be used to select optimal treatment strategies.

DOI： 10.21873/anticanres.16763

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: There are well-known methods for decompressing the colorectal tract before surgery, including transanal decompression tubes (TDT) and self-expanding metallic stents (SEMS). This study aimed to compare the short and long-term results in patients with malignant large bowel obstruction in whom TDT or SEMS were placed before surgery. METHODS: This retrospective observational study enrolled 225 patients with malignant large bowel obstruction in whom TDT or SEMS were placed preoperatively and underwent R0 resection between 2008 and 2020. One-to-two propensity score matching was performed according to patient characteristics. Short- and long-term outcomes were compared. The primary endpoint was relapse-free survival (RFS). The secondary endpoints were the overall survival (OS) and postoperative complication rate. RESULTS: Fifty-seven patients in the TDT group and 114 in the SEMS group were matched. The 3-year RFS rates were 66.7% in the TDT group and 69.9% in the SEMS group (p = 0.54), and the 3-year OS rates were 90.5% in the TDT group and 87.1% in the SEMS group (p = 0.52). No significant differences in the long-term results were observed between the two groups. Regarding short-term results, the SEMS group had significantly fewer stoma construction (p = 0.007) and shorter postoperative hospitalization (p < 0.001). The incidence of postoperative complications (grade ≥ 2) was significantly lower in the SEMS group (p = 0.04). CONCLUSION: No significant differences in the long-term results were observed between the TDT and SEMS group. The SEMS showed significant usefulness in terms of improving short-term outcomes.

DOI： 10.1002/jso.27454

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The C-reactive protein to prealbumin ratio (CPAR) has been proposed and introduced in gastrointestinal cancer management. This study aimed to evaluate the clinical impact of the CPAR in patients with gastric cancer (GC) who received curative treatment. PATIENTS AND METHODS: This study included 447 patients who underwent curative treatment for GC between 2013 and 2017. The prognosis and clinicopathological parameters were compared between patients with high and low CPARs. RESULTS: Overall survival (OS) stratified by each clinical factor was compared using the log-rank test, and a significant difference was observed using a pretreatment CPAR of 5.0. Significant differences were observed in the 3- and 5-year OS rates of the CPAR-low (CPAR <5.0) and CPAR-high (CPAR ≥5.0) groups. The 3- and 5-year OS rates were 92.6% and 87.8%, respectively, in the CPAR-low group and 88.0% and 75.4% in the CPAR-high group. The CPAR was determined to be a significant prognostic factor for OS in a multivariate analysis (p=0.032). Similar results were observed for recurrence-free survival. CONCLUSION: The CAPR is a prognostic factor for GC patients. Therefore, the CAPR may be a promising nutritional biomarker of inflammation that can be applied in the management of GC patients.

DOI： 10.21873/anticanres.16719

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Recently, change in the neutrophil to lymphocyte ratio (cNLR) has been shown to be a promising prognostic inflammation marker in some malignancies. The aim of the present study was to evaluate the clinical impact of the cNLR in gastric cancer patients who received curative gastrectomy. PATIENTS AND METHODS: The present study included 450 patients who underwent curative treatment for gastric cancer between 2013 and 2017 at Kanagawa Cancer Center. The cNLR was defined as follows: cNLR = NLR at 1 month after surgery-NLR at 1 week before surgery. The prognosis and clinicopathological parameters of the increased cNLR and decreased cNLR groups were analyzed. RESULTS: The OS stratified by each clinical factor was compared using the log-rank test, and a significant difference was observed using a cutoff value of cNLR at 0.762. When comparing the patient background factors between the increased cNLR (≥ 0.762) and decreased cNLR (< 0.762) groups, there were no significant differences in age, sex, T status, or N status. In the increased cNLR group, the OS rates at 3 and 5 years after surgery were 87.5% and 77.3%, respectively, while those in the decreased cNLR group were 92.8% and 87.3%, which amounted to a statistically significant difference (p = 0.041). The univariate and multivariate analyses of factors associated with OS showed that cNLR was a significant prognostic factor. When the postoperative course was compared between the two groups, the incidence rates of postoperative surgical complications and other-cause death were significantly higher in the increased cNLR group (p = 0.001 and p = 0.005, respectively). CONCLUSION: The cNLR is one of the significant risk factors in gastric cancer patients. Our results suggested that the changes of inflammation status during perioperative periods might be a promising prognostic factor for gastrointestinal cancer patients.

DOI： 10.1007/s12029-023-00976-7

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Recently, change in the C-reactive protein/albumin ratio (CAR) has become a promising prognostic marker in some malignancies. The aim of the present study was to evaluate the clinical impact of change in the CAR in gastric cancer patients who received curative resection. METHOD: The present study included 458 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The prognosis and clinicopathological parameters were compared between patients who showed a high-change in CAR and those who showed a low-change in CAR. RESULTS: The OS stratified by each clinical factor was compared using a log-rank test, and a significant difference was observed using a 0.05 change in CAR. When the patient background factors were compared between the high-change (change in CAR ≥ 0.05) and low-change (change in CAR < 0.05) groups, the median age, sex ratio, T factor, and N factor were similar. In the low-change group, the OS rates at 3 and 5 years after surgery were 94.1% and 87.6%, respectively, which amounted to a significant difference from the low-change group, with rates of 83.6 and 77.5% in the high-change group. In the low-change group, the RFS rates at 3 and 5 years after surgery were 90.1% and 85.1%, respectively, while those in the high-change group 77.6 and 75.2%. The univariate and multivariate analyses of factors associated with OS and RFS showed that the change in CAR was a significant prognostic factor. CONCLUSIONS: The change in CAR is a significant risk factor and promising prognostic factor for gastric cancer patients.

DOI： 10.1007/s12029-023-00970-z

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: During surgery for mid-transverse colon cancer (MTC), surgeons often face the dilemma of whether to mobilize the hepatic or splenic flexure. There is no established optimal minimally invasive surgical procedure for MTC. METHODS: We present our novel minimally invasive surgical technique, called the 'moving the left colon' technique for MTC, along with a video demonstration. The procedure involves four main steps: (i) mobilization of the splenic flexure using a medial-to-lateral approach, (ii) dissection of lymph nodes around the middle colic artery from the left side of the superior mesenteric artery approach, (iii) separation of the pancreas and transverse mesocolon and (iv) 'moving the left colon' and performing an intracorporeal anastomosis. By mobilizing the splenic flexure, anatomical landmarks are revealed, which enables safer dissection. Combining this technique with intracorporeal anastomosis allows for a safe and easy anastomosis. RESULTS: Between April 2021 and January 2023, a single-skilled colorectal surgeon performed laparoscopic transverse colectomies using our new approach on three consecutive patients with MTC. The patients had a median age of 75 years (range 46-89 years). The median operative time was 194 min (range 193-228 min) and blood loss was 8 mL (range 0-20 mL). None of the patients experienced any perioperative complications and the median postoperative hospital stay was 6 days. CONCLUSION: We introduced a novel approach for laparoscopic surgery for MTC. This technique can be performed safely and may help standardize minimally invasive surgery for MTC.

DOI： 10.1111/codi.16653

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study compared the surgical outcomes between laparoscopic colectomy (LC) and open colectomy (OC) for mid-transverse colon cancer (MTC). METHODS: This multicenter retrospective study compared the short- and long-term surgical outcomes for patients with advanced MTC (T3 and T4 with or without nodal involvement) who underwent LC or OC between January 2008 and December 2019 using a propensity score-matched analysis. RESULTS: A total of 177 patients with advanced MTC were enrolled. After matching, 58 cases for the OC and LC groups were selected. No significant differences in age, sex, tumor progression, or procedure type (extended resection or segmental resection) existed between groups. The LC group had significantly less blood loss (20 mL vs. 50 mL, p=0.048) and a shorter postoperative hospital stay (8 days vs. 12 days, p<0.001) than the OC group. Postoperative complications (Clavien-Dindo grade ≥ 2) occurred in 27.6% and 25.9% of the OC and LC groups respectively (p=1). Three patients (5.2%) and one patient (1.7%) of the OC and LC groups respectively developed anastomotic leakage (p=0.62). Re-operation was required in five patients (8.6%) in the OC group and one patient (1.7%) in the LC group (p=0.21). No surgery-related deaths occurred in either group. The 3-year overall survival rates (stage II: LC 100% vs. OC 92.8%, p=0.15; stage III: 88.9% vs. 84.3%, p=0.88, respectively) were similar between the two groups. CONCLUSION: LC is a minimally invasive technique with lesser blood loss, shorter postoperative hospital stays, and oncologic equivalence to OC. Hence, LC is useful for MTC treatment. TRIAL REGISTRATION: UMIN000042676.

DOI： 10.1007/s00423-023-02963-9

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Mucinous gastric carcinoma (MGC) has a poor prognosis. Due to the differences in clinicopathology factors between MGC and non-MGC (NMGC), it is difficult to compare them. In this study, we compared the clinicopathological characteristics and prognosis of MGC and NMGC patients. PATIENTS AND METHODS: For gastric carcinoma (GC), 3,042 gastrectomy patients were included in the study and divided into the MGC (n=86) and NMGC (n=2,956) groups. The characteristics and prognoses of patients in both groups were compared before and after (both groups, n=86) propensity score matching. RESULTS: Significant differences were observed in the tumor location (upper) (MGC group: 28.0% vs. NMGC group: 24.7%, p=0.003), tumor diameter (median) [65 mm (8-200 mm) vs. 40 mm (2-75 mm), p<0.001], lymph node metastasis (70.9% vs. 37.3%, p<0.001), venous invasion (57.0% vs. 40.4%, p<0.001), and lymphatic invasion (62.8% vs. 34.9%, p<0.001) before propensity score matching. The 5-year overall survival (OS) (70.9% vs. 76.2%, p=0.006) and cancer-specific survival (CSS) (75.5% vs. 82.4%, p=0.014) rates were significantly lower in the MGC group. After propensity score matching, there were no significant differences in either the 5-year OS (70.9% vs. 73.7%, p=0.230) or CSS (75.5% vs. 75.7%, p=0.587) rates. In addition, no substantial difference was observed in either of the recurrence forms. CONCLUSION: MGC is rare and usually diagnosed at a more advanced stage. However, MGC and NMGC have similar prognoses.

DOI： 10.21873/anticanres.16456

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Reports of redo laparoscopic colorectal resection (Re-LCRR) are scarce. In order to evaluate the safety and short-term outcomes of Re-LCRR, we performed a matched case-control analysis of patients who underwent this procedure for colorectal cancer. METHOD: This was a retrospective, monocentric study that included patients who underwent Re-LCRR for colorectal cancer between January 2011 and December 2019 at our institution. The patients were compared to a 2:1 matched sample. Matching was conducted based on age, sex, BMI, surgical procedure, and clinical stage. RESULT: Twenty-nine patients underwent Re-LCRR (RCRR group) and were compared to 58 patients selected by matching who underwent LCRR as primary resection (PCRR group). The median of age of the 29 patients of RCRR group was 75 (IQR 56-81) years and the RCRR group included 14 males. The median operative time of the RCRR group was 167 (IQR 126-232) minutes, and the median intraoperative blood loss was 5 (IQR 2-35) ml. In the RCRR group, there were no cases that required conversion to laparotomy. The short-term outcomes of the two groups did not differ to a statistical extent with respect to operative time (p = 0.415), intraoperative blood loss (p = 0.971), rate of conversion to laparotomy (p = 0.477), comorbidity (p = 0.215), and postoperative hospital stay (p = 0.809). No patients in either group experienced postoperative anastomotic leakage or required re-operation due to postoperative complications, and there was no procedure-related death. However, in terms of oncological factors, although there was no difference in the number of cases with a positive radical margin between the two groups (p = 1.000), the number of harvested lymph nodes in the RCRR group was significantly lower than that in the PCRR group (p = 0.015) and the RCRR group included 10 cases with less than 12 harvested lymph nodes. CONCLUSION: Re-LCRR is associated with good short-term results and can be safely performed; however, the number of harvested lymph nodes is significantly reduced in comparison to primary resection cases, and further studies are needed to evaluate its long-term prognosis.

DOI： 10.1007/s00384-023-04439-0

PubMed

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study is to evaluate the effect of preoperative endoscopic tattooing using India ink (ETI) on the number of retrieved lymph nodes (LNs) dissected during laparoscopic surgery for stage I right-sided colon cancer (RCC). METHODS: This single-center, retrospective study included stage I RCC patients who underwent laparoscopic surgery between January 2010 and December 2021. The clinicopathological background and number of LNs retrieved were compared between patients managed with and without ETI. A multiple linear regression analysis was used to examine the effect of independent variables on the LN yield. RESULTS: A total of 169 patients were enrolled. Of these, 89 patients (52.7%) were classified into the ETI group, and 80 (47.3%) were classified into the no-ETI group. There were no significant differences in age, sex, body mass index, or tumor progression between the two groups. A univariate analysis showed that the number of LNs retrieved was significantly higher in female (26 vs. 24, p = 0.026), with tumor localization in the ascending or transverse colon (20 in the cecum, 26 in the ascending colon, 27 in the transverse colon, p < 0.001), and with preoperative ETI (28 vs. 21, p < 0.001). In a multivariate linear regression analysis, female sex (p = 0.0011), D3 lymphadenectomy (p = 0.046), and preoperative ETI (p = 0.012) were independently associated with the LN yield. CONCLUSION: In laparoscopic surgery for stage I RCC, preoperative ETI increased the number of LNs retrieved and allowed for appropriate staging.

DOI： 10.1007/s00384-023-04381-1

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

We present a case of benign esophageal leiomyoma with video-assisted thoracic enucleation. A 39-year-old woman was found to have an abnormal shadow in the mediastinum on a chest X-ray on a medical check-up. Chest CT performed for the purpose of close examination revealed a tumor with a size of 62×33 mm from the middle intrathoracic esophagus to the lower esophagus. Upper gastrointestinal endoscopy revealed a left half-circumferential elastic soft submucosal bulge in the thoracic middle-lower esophagus. Endoscopic ultrasonographic fine-needle aspiration biopsy(EUS-FNA)was performed, and immunostaining showed positive muscular markers SMA, but negative for CD34, c-kit, and S-100, and the diagnosis was esophageal leiomyoma. Therefore, thoracoscopic-assisted esophageal leiomyoma resection was performed. Postoperative immunohistological examination showed positive for SMA and Desmin, and the diagnosis was leiomyoma.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本胃癌学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study was to clarify the usefulness of indocyanine green fluorescence imaging (ICG-FI) in the assessment of intestinal vascular perfusion in patients who receive intracorporeal anastomosis (IA) in colon cancer surgery. METHODS: This was a single-center, retrospective study using propensity score matching. We compared the surgical outcomes of colon cancer patients who underwent laparoscopic colonic resection with IA or external anastomosis (EA) with the intraoperative evaluation of anastomotic perfusion using ICG-FI from January 2019 to July 2021. The detection rate of poor anastomotic perfusion by ICG-FI was examined. RESULTS: A total of 223 patients were enrolled. After matching, 69 patients each were classified into the IA and EA groups. There were no significant differences in age, sex, body mass index, tumor localization, or progression between the two groups. The operation time was similar (172 min vs. 171 min, p = 0.62) and the amount of bleeding was significantly lower (0 ml vs. 2 ml, p = 0.0023) in the IA group. The complication rates (grade ≥ 2) of the two groups were similar (14.5% vs. 11.6%, p = 0.59). ICG-FI identified four patients (5.8%) with poor anastomotic perfusion in the IA group, but none in the EA group (p = 0.046). All four patients with poor perfusion in the IA group underwent additional resection; none of these patients developed postoperative complications. CONCLUSION: Poor anastomotic perfusion was detected in 5.8% of cases who underwent laparoscopic colon cancer surgery with IA. ICG-FI is useful for evaluating anastomotic perfusion in IA in order to prevent AL.

DOI： 10.1007/s00384-023-04307-x

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The prognostic nutritional index (PNI) has been reported as an immunonutritional index that can easily evaluate nutritional status and immunocompetence from blood tests. The purpose of this study was to investigate the usefulness of PNI as a prognostic factor in postoperative gastric cancer patients. PATIENTS AND METHODS: In this retrospective cohort study, we evaluated 258 patients with pStage I-III gastric cancer who underwent radical resection at Yokohama City University Hospital, from 2015 to 2021. To examine the association with prognosis, we analyzed clinicopathological factors including PNI (<47/≥47), age (<75/≥75), sex (male/female), depth (pT1/≥pT2), lymph node metastasis (pN+/pN-), lymphatic invasion (ly+/ly-), vascular invasion (v+/v-), histological type (enteric/spread) and postoperative complications. RESULTS: In univariate analysis, PNI (p<0.001), depth of tumor invasion (p<0.001), lymph node involvement (p<0.001), age (p=0.002), lymphatic invasion (p<0.001), vascular invasion (p<0.001), and postoperative complications (p=0.003) were associated with overall survival. In multivariate analysis, PNI (HR=2.100, 95% confidence interval 1.225-3.601, p=0.007), tumor invasion, lymph node metastasis, and postoperative complications were shown as poor prognostic factors for overall survival. CONCLUSION: PNI is an independent prognostic factor for overall and recurrence-free survival in postoperative gastric cancer patients. PNI could be implemented in clinical practice to identify patients at higher risk for poor outcomes.

DOI： 10.21873/invivo.13207

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We investigated the influence of the preoperative Oral Health Assessment Tool (OHAT) score on the outcomes of patients with esophageal cancer after curative surgery. PATIENTS AND METHODS: This study included 90 patients with esophageal cancer who underwent curative surgery and who were screened with the OHAT between 2008 and 2021. The OHAT consists of eight categories with three possible scores. The risk factors for 5-year overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Patients were divided into healthy (n=42) and unhealthy (n=48) groups. The OHAT score was identified as a significant risk factor for postoperative pneumonia (11.9% vs. 43.8%, p=0.001) and postoperative hospital stay (20.5 days vs. 50.1 days, p=0.042). The 5-year OS rate after surgery was 71.2% in the healthy group and 43.2% in the unhealthy group, which was a significant difference (p=0.015). A multivariate analysis showed that a high OHAT score was a significant independent factor for 5-year OS (p=0.034). CONCLUSION: The OHAT score was a useful prognostic marker in patients who underwent curative surgery for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

DOI： 10.21873/invivo.13327

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The platelet-to-lymphocyte ratio (PLR) is a promising prognostic marker in some malignancies. The present study evaluated the clinical impact of the PLR in patients with gastric cancer who underwent curative resection. PATIENTS AND METHODS: This study included 258 patients who underwent curative treatment for gastric cancer between 2005 and 2020. The prognosis and clinicopathological parameters between the high- and low-PLR statuses were analyzed. RESULTS: The overall survival (OS) stratified by each clinical factor was compared using the log-rank test, and a significant difference was observed using a pretreatment PLR of 150. When comparing the patient backgrounds between the high-PLR (PLR≥150) and low-PLR (PLR<150) groups, there were no significant differences between the two groups. The OS rates at 3 and 5 years after surgery were significantly higher at 70.8% and 60.4%, respectively, for the high-PLR group than at 83.6% and 79.7%, respectively, for the low-PLR group. Univariate and multivariate analyses of the OS showed that the PLR was a significant prognostic factor. In addition, when comparing the first recurrence sites, there were significant differences in peritoneal recurrence. CONCLUSION: The PLR is a significant risk factor for gastric cancer, making it a promising prognostic factor for patients with gastric cancer.

DOI： 10.21873/invivo.13379

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis and reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. PATIENTS AND METHODS: Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row. The duodenum was investigated because it is frequently observed during gastrectomy. Suture failure was evaluated in cases with and without peristalsis. RESULTS: The study population included 49 patients [male, n=32; female, n=17; median age, 71 (42-82) years]. Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). CONCLUSION: A new definition to evaluate duodenal peristalsis was established. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.

DOI： 10.21873/invivo.13281

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

According to the risk classification of recurrence, the standard treatment for gastrointestinal stromal tumor(GIST)is complete surgical resection and postoperative adjuvant therapy with imatinib; however, the usefulness of neoadjuvant therapy is unclear. We report a case of giant GIST in the pelvis suspectedly having bladder infiltration that was radically resected and underwent preoperative imatinib therapy. A 52-year-old man visited a clinic because of abdominal pain, fever, and frequent urination. An abdominal mass was determined, and the patient was referred to our hospital for detailed examination and treatment. Contrast-enhanced CT revealed a 17 cm diameter irregular mass from the lower navel to the pelvis, and the bladder boundary was partially unclear. Transrectal biopsy was performed using endoscopic ultrasonography, and according to the Fletcher classification, a high-risk GIST was diagnosed. After preoperative imatinib therapy of 400 mg/day was administered for 3 months, surgery was performed. The tumor was strongly adhered to the bladder, but no invasion was observed, and partial small intestine resection was performed. The surgical margin was negative without capsule damage. On day 34 postoperatively, imatinib therapy was resumed, and as of 1 year postoperatively, the course is well without recurrence.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 74-year-old man presented with a metastatic brain tumor in the right parietal lobe observed through an MRI scan. Lower gastrointestinal endoscopy revealed that the tumor was located in the rectum. He was diagnosed with Stage Ⅳb rectal cancer(cT4aN1bM1b[BRA, SKN]). After prior stereotactic radiotherapy for brain metastases, the patient underwent rectal amputation and D3 dissection as management for the primary tumor. His postoperative course was uneventful, and he was discharged from the hospital 33 days postoperatively. He displayed partial response with capecitabine plus L-OHP therapy, and chemotherapy was terminated due to the development of renal dysfunction. On follow-up, elevated tumor markers, enlarged left mediastinal lymph nodes, and FDG accumulation on PET-CT were observed. Despite initiating UFT/UZEL therapy, the patient was judged to have progressive disease. The patient was then administered 5-FU plus l-LV plus CPT-11. However, this was later discontinued due to the development of hyperammonemia. The patient was placed on follow-up observation due to the decrease in his tumor markers and the disappearance of his enlarged lymph nodes. He is still alive seven years after his initial diagnosis. We report a case of a patient with rectal cancer that metastasized to the brain and the skin. He was successfully managed with multidisciplinary therapy. A relevant literature discussion is also included.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Preoperative sarcopenia is associated with various cancers and affects the long-term prognosis of patients. After gastrectomy for gastric cancer, dynamic changes in body composition occur, and sarcopenia becomes more apparent after surgery than before surgery. However, the relationship between sarcopenia in the early postoperative period and long-term survival is not fully understood. The aim of this study was to determine the effects of surgical sarcopenia on long-term outcomes of patents with gastric cancer. PATIENTS AND METHODS: We included 408 patients who underwent curative gastrectomy (distal or total gastrectomy) for gastric cancer at the Kanagawa Cancer Center from December 2013 to November 2017. Sarcopenia was defined using the skeletal muscle index (SMI), using computed tomography (CT) one month after gastrectomy. We compared the long-term outcomes between patients with and without sarcopenia. RESULTS: The 5-year overall survival (OS) rates were 83.2% and 91.4% in the surgical and non-surgical sarcopenia groups, respectively. The hazard ratio (HR) of surgical sarcopenia for OS was 2.410 (95% confidence interval (CI)=1.321-4.396). In addition, surgical sarcopenia was associated with non-cancer-related deaths and deaths from other cancers. CONCLUSION: Patients with surgical sarcopenia after gastrectomy should be carefully monitored not only for gastric cancer recurrence but also for the occurrence of other diseases, including other cancers.

DOI： 10.21873/anticanres.15957

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The current expectancy of long-term survival of patients with pathological stage (pStage) III gastric cancer (GC) is not satisfactory. However, neoadjuvant chemotherapy (NAC) is expected to improve survival rates in these patients. An appropriate pretherapeutic diagnostic strategy is necessary for selecting patients who are eligible for NAC. Surgical findings can often identify serosal invasion or metastatic lymphadenopathy, thereby facilitating the selection of candidates for NAC. Therefore, we aimed to evaluate the accuracy and potential of surgical staging in improving the management and survival of patients with GC. PATIENTS AND METHODS: We assessed the accuracy of surgical staging in comparison to preoperative staging using data from patients who underwent gastrectomy for GC. In addition, differences in survival after using the surgical staging criterion were assessed. RESULTS: A total of 915 patients were evaluated in this study. The sensitivity of surgical staging in detecting pStage III in the surgical T4N0-3 plus surgical T3N1-3 group was satisfactory (79.3%). The proportion of patients with pStage I using the surgical staging criterion was 7.8%. CONCLUSION: Surgical staging using laparoscopy or laparotomy may assist in selecting candidates for enrollment in clinical trials for NAC.

DOI： 10.21873/anticanres.15750

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Postoperative complications are associated with increased recurrence in colorectal cancer (CRC). We investigated the impact of infectious complications on the recurrence of CRC and overall survival after curative surgery in a single study group. PATIENTS AND METHODS: In total, 1,668 patients who underwent radical resection for CRC in Yokohama City University, Yokohama Minami Kyosai Hospital, and Kanagawa Cancer Center between 2011 and 2019 were reviewed. Patients were classified into those with infectious complications (IC group) and those without infectious complications (Non-IC group). The risk factors for recurrence-free survival (RFS) and overall survival (OS) were analyzed. RESULTS: Postoperative complications were found in 560 of the 1,668 patients (33.5%), and IC, which occurred in 312 patients (18.7%), included pneumonia, anastomotic leakage, and intraperitoneal abscess. The 5-year OS rates in the Non-IC and IC groups were 95.5% and 90.4%, respectively, while the 5-year RFS rates were 74.4% and 68.1%, respectively. The multivariate analysis demonstrated that postoperative IC were significant independent risk factors for OS and RFS. CONCLUSION: The presence of postoperative IC after CRC resection is associated with decreased long-term survival. The surgical procedure, surgical strategy, and perioperative care should be carefully planned in order to avoid causing IC.

DOI： 10.21873/anticanres.15755

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The laparoscopic surgery approach for mid-transverse colon cancer (MTC) varies depending on tumor characteristics and the guidelines implemented by each surgeon; the optimal surgical procedure for MTC has not been established. This study aimed to compare the surgical outcomes of laparoscopic extended right hemicolectomy (Lap-ERHC) and laparoscopic transverse colectomy (Lap-TC) for MTC. METHODS: This was a multicenter, retrospective study. We surveyed eight hospitals, by questionnaire, on MTC surgery policies and retrospectively compared the short- and long-term surgical outcomes for patients with MTC who underwent Lap-ERHC or Lap-TC between January 2008 and December 2019. RESULTS: A total of 129 patients were enrolled, of whom 35 underwent Lap-ERHC and 94 underwent Lap-TC. There were no significant differences in tumor progression between the two groups. Operation time was significantly longer (202 min vs. 185 min, p = 0.026). We observed a higher complication rate (≥ grade 3) in the Lap-ERHC group than in the Lap-TC group (11.4% vs. 3.2%, p = 0.086). Three patients (8.6%) who underwent Lap-ERHC developed anastomotic leakage; none of the patients who underwent Lap-TC had this complication (p = 0.018). The 3-year overall survival rates (stage I: 100% vs. 91.9%, p = 0.64; stage II: 100% vs. 95.5%, p = 0.46; stage III: 100% vs. 88.2%, p = 0.91, respectively) were similar between the two groups. CONCLUSION: Lap-ERHC for MTC has the same long-term outcomes as Lap-TC. However, Lap-ERHC for MTC has a higher complication rate. Therefore, Lap-TC may be recommended for patients with MTC. TRIAL REGISTRATION: UMIN000042674.

DOI： 10.1007/s00384-022-04128-4

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The efficacy of fluorouracil + oxaliplatin + irinotecan with bevacizumab (FOLFOXIRI + BV) has been verified for metastatic colorectal cancer (mCRC). In clinical practice, the original (O-FOLFOXIRI + BV) and modified dose settings (M-FOLFOXIRI + BV) are adopted for Asian patients. We aimed to compare the real-world efficacy and safety of these two regimens. METHODS: This retrospective cohort study reviewed clinical data of all consecutive mCRC patients treated with FOLFOXIRI + BV at a cancer centre in Japan. One hundred patients were divided into two groups: one that received O-FOLFOXIRI + BV (group O, n = 30) and another that received M-FOLFOXIRI + BV (group M, n = 70). Progression-free survival (PFS) was set as the primary endpoint, with overall survival (OS), overall response rate (ORR), and safety as secondary endpoints. RESULTS: PFS was superior in group M (median PFS; 8.7 vs. 11.5 months, P = 0.098). The use of O-FOLFOXIRI + BV emerged as an independent risk factor of poor PFS (hazard ratio = 2.155, P = 0.012). Both ORR (43.3 vs. 65.7%, P = 0.047) and OS (median OS; 17.9 vs. 27.0 months, P = 0.127) were more favourable in group M. Grade ≥ 3 adverse events were more frequently observed in group O (90 vs. 74.3%, P = 0.108), whereas dose intensity was higher in group M because a shorter duration was required for cytotoxic drug administration (2.9 vs. 2.6 weeks/course, P = 0.051) in the induction term. CONCLUSION: We found that M-FOLFOXIRI + BV had more favourable efficacy and safety than O-FOLFOXIRI + BV, which may be a better fit for Asian patients and can be potentially used as an alternative for upfront chemotherapy for mCRC.

DOI： 10.1007/s00384-021-04064-9

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Previous randomized controlled trials demonstrated similar oncological outcomes between laparoscopic-assisted (LA) and open (OP) colectomy; however, patients with transverse colon cancer were not analyzed. The aim of this study was to confirm the oncological safety and the advantages of the short- and long-term results of LA surgery for transverse colon cancer in comparison to OP surgery. MATERIALS AND METHODS: The study data were retrospectively collected from the databases of four hospitals. Patients with transverse colon cancer who underwent LA or OP R0 or R1 resection were registered. RESULTS: Among the 204 patients, 149 underwent OP colectomy and 55 underwent LA colectomy. The median follow-up period was 43 months. The rate of conversion to OP resection was 7.3%. The 5-year overall survival rate of the LA group was higher than that of the OP surgery group for all-stage patients (97.5% vs. 91.1%, P = 0.108), and it was similar in Stage II and Stage III patients (94.1% vs. 94.2%, P = 0.510). The LA group had significantly lower blood loss and a significantly longer operative time in comparison to the OP surgery group. Furthermore, the postoperative hospital stay was significantly shorter (9 vs. 13 days, P = 0.001) and the incidence of Grade ≥III complications was lower in the LA group (3.7% vs. 14.8%, P = 0.031). CONCLUSION: We concluded that LA surgery for transverse colon cancer is oncologically safe and yields better short-term results in comparison to OP surgery.

DOI： 10.4103/jcrt.JCRT_946_20

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

In recent years, the radial incision and cutting(RIC)method has been developed as a treatment for intractable anastomotic stenosis after esophageal cancer surgery, and its usefulness is attracting attention. We report a case in which the RIC method was effective for endoscopic balloon dilatation-resistant anastomotic stenosis. The case was a 69-year-old woman. Transthoracic esophagectomy with three-field lymph node dissection, and narrow gastric tube reconstruction through antethoracic route, were performed for middle thoracic esophageal cancer. The patient suffered from Grade Ⅲa anastomotic leakage, but was discharged relieved. After discharge, the patient needed regular endoscopic balloon dilation for against intractable anastomotic stenosis. RIC was performed for the patient. Although stenosis relapsed after the RIC, the pain during balloon dilatation improved and oral intake can be continued without surgery. The required interval of dilatation was about 2 weeks before RIC, but it has been gradually extended to about 4 weeks after 1 year after the RIC. Moreover, oral intake and body weight of the patient were increased. The RIC method may be useful for intractable anastomotic stenosis after esophageal cancer surgery, and further case accumulation is needed.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The number of patients who have cardiovascular-morbidities and use antiplatelet and/or anticoagulation therapy is rapidly growing worldwide. The present study evaluated the safety and feasibility of gastrectomy for gastric cancer in patients who received antiplatelet and/or anticoagulation therapy in the perioperative period. PATIENTS AND METHODS: Cases were selected from the medical records of consecutive patients who were diagnosed with gastric cancer and underwent complete resection at the Kanagawa Cancer Center from 2013 to 2017. The patients were divided into the antiplatelet and/or anticoagulation treatment group and the non-antiplatelet and/or anticoagulation treatment group. RESULTS: Five hundred and six patients underwent gastrectomy for gastric cancer and were analyzed in the present study. Among them, 62 patients (12.3%) received anticoagulation therapy (anticoagulation group). When the anticoagulation and non-anticoagulation groups were compared, although there were some differences in patient background factors, the surgical findings, perioperative clinical course, and details of postoperative complications were similar. The incidence of postoperative bleeding was 0.8% (4/506) in all patients. The incidence of postoperative bleeding was 1.6% (1/62) in the anticoagulation group and 0.7% (3/446) in the non-anticoagulation group. Preoperative anticoagulation therapy was not identified as a significant independent risk factor for postoperative bleeding. CONCLUSION: These results suggest that curative gastrectomy for gastric cancer is safe and feasible, regardless of the perioperative use of antiplatelet and/or anticoagulation treatment. In addition, the perioperative use of antiplatelet and/or anticoagulation treatment was not a significant risk factor for postoperative bleeding after gastrectomy for gastric cancer.

DOI： 10.21873/anticanres.15375

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Population aging results in increasing numbers of elderly persons undergoing surgery for colorectal cancer. We sought to identify objective preoperative indicators of outcomes, with a view toward development of safe, effective treatments for such patients. PATIENTS AND METHODS: The study included 99 patients aged 80 years or more, who were treated surgically for stage I- III colorectal cancer. Preoperative nutritional status was compared retrospectively between those who suffered postoperative complications (n=40) and those who did not (n=59). RESULTS: Univariate analysis revealed low prealbumin (PreAlb) concentration (p=0.032) and low platelet-to-lymphocyte ratio (p=0.116) as risk factors for postoperative complications. Multivariate analysis showed preoperative PreAlb concentration to be an independent risk factor (OR=0.884; 95% confidence interval=0.791-0.989; p=0.024) associated with postoperative length of hospital stay (coef.=-0.336, p=0.002). CONCLUSION: PreAlb, a rapid turnover protein, shows promise as a simple predictor of postoperative complications in elderly patients treated for colorectal surgery.

DOI： 10.21873/anticanres.15338

PubMed

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: D3 lymph node dissection (LND) for stage II and III colon cancer has been shown to improve prognosis, however, it generally increases surgical stress. Studies have reported that the C-reactive protein/albumin ratio (CAR) may be a useful inflammatory-nutritional biomarker to predict postoperative complications and poor prognosis for with various types of cancer. Our purposes were to assess the short- and long-term outcomes of D3 LND in patients with a high preoperative CAR (≥ 0.04). PATIENTS AND METHODS: This was a retrospective cohort analysis reviewing a prospectively collected database of Yokohama City University and three affiliated hospitals. A total of 449 patients with stage II or III colon cancer with high CAR who underwent primary resection with D2 or D3 LND were identified between 2008 and 2020. The primary and secondary outcomes of interests were the 3-year recurrence-free survival and postoperative complication rates. RESULTS: After propensity matching, 230 patients were evaluated. There was no significant difference between the D3 and D2 groups in the rate of postoperative complications overall (14.8% versus 11.3%, p=0.558), however, the incidence of anastomotic leakage tended to be greater in the D3 group (9.6% versus 2.6%, p=0.050). The long-term findings showed that there was no significant difference between the two groups (3-year recurrence-free survival rate: 77.2% versus 77.2%, p=0.880). CONCLUSION: D3 LND did not improve survival outcomes for patients with colon cancer with a poor CAR in this study. D2 LND may be a treatment option for patients with stage II-III colon cancer with a high preoperative CAR.

DOI： 10.21873/anticanres.15326

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Background: Although minimally invasive surgery for colorectal cancer, whether performed as standard laparoscopic or robotic surgery, has been established as an oncologically safe procedure, postoperative urinary dysfunction and sexual dysfunction remain matters of concern, even when so-called nerve-sparing surgery is performed. We have hypothesized that Raman spectroscopy can be used intraoperatively as a non-invasive label-free means of objective identification of the pelvic nerves, and we conducted a preliminary study by applying a newly developed handheld Raman spectrometer to surgical specimens. Methods: Samples of nervous tissue, colon cancer tissue, and tissues from surrounding pelvic organs were obtained from 25 patients undergoing colectomy. Raman spectra were obtained by irradiation with the Progeny™ Raman spectrometer. We looked for characteristic Raman shifts to distinguish nervous tissue from cancer tissue. To improve discrimination between nervous tissue and other tissues, the spectral data were subjected to principal component analysis. Results: We detected characteristic differences in the spectra at 1,309 cm-1, 1,442 cm-1, and 1,658 cm-1. A significant difference was detected at 1,442 cm-1, and accuracy of the modality for identification of nervous tissue was 75%. The addition of principle component analysis (4 components) yielded 100% sensitivity, 85% specificity, and 90%, notably increasing accuracy from 75% to 90% in discriminating between nervous tissue and cancer tissue. Conclusions: Raman spectroscopy holds promise for non-invasive intraoperative recognition of nervous tissue. We expect the modality to become a powerful clinical tool, compensating for the lack of tactile feedback intrinsic to minimally invasive colectomy and thus thwarting the risk of postoperative urinary and/or sexual dysfunction.

DOI： 10.21037/tcr-21-587

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The chemokine receptors C-X-C chemokine receptor type 4 (CXCR4) and C-C chemokine receptor type 7 (CCR7) play an important role in the invasion and metastasis of cancer. This study investigated the relationship between relative expression of CXCR4 and CCR7 mRNA, clinicopathological factors, and outcomes in patients with colorectal cancer (CRC). PATIENTS AND METHODS: We studied 202 patients who underwent surgery for CRC. The expression levels of CXCR4 and CCR7 mRNA in cancerous tissue were measured using quantitative real-time reverse-transcriptase polymerase chain reaction. RESULTS: High CCR7 mRNA expression levels in CRC tissues were positively associated with tumour size and were more frequently associated with cancer of the rectum than of the colon. Moreover, outcomes were significantly poorer in patients with high CCR7 mRNA expression than in those with low expression. On multivariate Cox regression analysis, a higher CCR7 mRNA expression level was a significant independent predictor of poorer overall survival in patients with CRC. CONCLUSION: Overexpression of CCR7 mRNA may be a useful independent prognostic factor in patients with CRC.

DOI： 10.21873/anticanres.15259

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Naples prognostic score (NPS) is a scoring system based on albumin, cholesterol concentration, lymphocyte-to-monocyte ratio, and neutrophil-to-lymphocyte ratio reflecting host systemic inflammation, malnutrition, and survival for several malignancies. This study was designed to assess the prognostic significance of NPS in patients with locally advanced esophageal squamous cell carcinoma (ESCC) and to compare its prognostic accuracy with that of other systemic inflammatory and nutritional index. METHODS: We retrospectively examined 165 patients with locally advanced ESCC who underwent neoadjuvant therapy followed by curative resection between January 2011 and September 2019. Patients were divided into three groups based on their NPS before neoadjuvant therapy (Group 0: NPS = 0; Group 1: NPS = 1-2; Group 2: NPS = 3-4). We compared the clinicopathological characteristics and survival rates among the groups. RESULTS: The 5-year recurrence-free survival (RFS) and overall survival (OS) rates were significantly different between the groups (P < 0.001). The NPS was superior to other systemic inflammatory and nutritional index for predicting prognoses, as determined using area under the curves (P < 0.05). Multivariate analysis demonstrated that the NPS was a significant predictor of poor RFS (Group 1: hazard ratio [HR] 1.897, P = 0.049; Group 2: HR 3.979, P < 0.001) and OS (Group 1: HR 2.152, P = 0.033; Group 2: HR 3.239, P = 0.006). CONCLUSIONS: The present study demonstrated that NPS was an independent prognostic factor in patients with locally advanced ESCC and more reliable and accurate than the other systemic inflammatory and nutritional index.

DOI： 10.1245/s10434-020-09549-5

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1245/s10434-021-10301-w

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: This study aimed to evaluate the prognostic significance of PLA2G2A expression in patients with locally advanced gastric cancer (GC). PATIENTS AND METHODS: PLA2G2A expression levels in cancerous tissue specimens and adjacent normal mucosa obtained from 134 patients with stage II/III GC who received adjuvant chemotherapy with S-1 after curative resection were measured using real-time quantitative polymerase chain reaction. Subsequently, the associations of PLA2G2A expression with clinicopathological features and survival were evaluated. RESULTS: No association was observed between clinicopathological features and PLA2G2A expression levels. Overall survival was significantly longer in patients with high PLA2G2A expression levels (p=0.022). Multivariate analysis revealed that PLA2G2A expression was a significant, independent prognostic factor (hazard ratio=0.136; 95% confidence interval=0.0185-0.992; p=0.049). CONCLUSION: PLA2G2A mRNA expression may serve as a useful prognostic marker in patients with locally advanced GC who receive curative surgery and adjuvant chemotherapy with S-1.

DOI： 10.21873/anticanres.15146

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Laparoscopic gastrectomy has become a standard procedure for treatment of gastric cancer, and hence, the opportunity for trainees to perform open gastrectomies may decrease. We investigated whether laparoscopic distal gastrectomy, performed by surgical trainees without sufficient experience performing open gastrectomies, was feasible and safe. PATIENTS AND METHODS: We compared short-term outcomes in patients when laparoscopic distal gastrectomies were performed by experienced trainees (ET group; n = 124) and inexperienced trainees (IT group; n = 98) from 2013 to 2019. RESULTS: The operation time was significantly shorter in the ET group (median time: 253 minutes vs 286 minutes, P < 0.001). The incidence of grade ≥ 2 postoperative complications did not differ significantly between the groups. In the multivariate analysis, experience performing open gastrectomies was not an independent predictor of postoperative complications. CONCLUSION: Laparoscopic distal gastrectomies performed by trainees, with insufficient experience performing open gastrectomies, are as feasible and safe as that performed by ET.

DOI： 10.1111/ases.12901

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The lymph node (LN) ratio (LNR) has been proposed as a sensitive prognosticator in patients with esophageal squamous cell carcinoma (ESCC), especially when the number of LNs harvested is insufficient. We investigated the association between the LNR and survival in patients with locally advanced ESCC who received neoadjuvant chemotherapy (NAC) and explored whether the LNR is a prognosticator in these patients when stratified by their response to NAC. METHODS: We retrospectively reviewed 199 locally advanced ESCC patients who received curative resection after NAC between January 2011 and December 2019. The predictive accuracy of the adjusted X-tile cut-off values for LNR of 0 and 0.13 was compared with that in the Union for International Cancer Control pathological N (UICC pN) categories. The association between survival rate and clinicopathological features was examined. RESULTS: Multivariate analysis identified that the LNR was an independent risk factor for recurrence-free survival [RFS; hazard ratio (HR) 6.917, p < 0.001] and overall survival (OS) (HR 4.998, p < 0.001). Moreover, even when stratified by response to NAC, the LNR was a significant independent risk factor for RFS and OS (p < 0.001). The receiver operating characteristic curves identified that the prognostic accuracy of the LNR tended to be better than that of the UICC pN factor in all cases and responders. CONCLUSION: The LNR had a significant prognostic value in patients with locally advanced ESCC, including in those who received NAC.

DOI： 10.1245/s10434-021-10240-6

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The lymph node (LN) ratio (LNR) and the log odds of positive LNs (LODDS) have been proposed as sensitive prognosticators in patients with primary gastric cancer, especially in patients with an insufficient number of harvested LNs. We investigated the association of LNR and LODDS with survival in patients with remnant gastric cancer (RGC) and explored whether these staging methods are prognostic factors in patients with an insufficient number of harvested LNs. METHODS: The present study retrospectively examined 95 patients with RGC who received gastrectomy between January 2000 and December 2018. The patients were classified according to the adjusted X-tile cutoff for LNR and LODDS. The association between survival rates and clinicopathological features was investigated. The predictive accuracy of the LNR and LODDS was compared with that of the Union for International Cancer Control pathological N factor. RESULTS: Multivariate analysis revealed that the LNR and LODDS were independent risk factors for recurrence-free survival (RFS) [hazard ratio (HR) 2.623, p = 0.020; HR 3.404, p = 0.004, respectively] and overall survival (OS) (HR 3.694, p = 0.003; HR 2.895, p = 0.022, respectively) in patients with RGC. Moreover, even in patients with 15 or fewer harvested LNs, only the LNR was a significant independent risk factor for RFS (HR 21.890, p < 0.001) and OS (HR 6.597, p = 0.002). The receiver operating characteristic curves revealed that the prognostic accuracy of the three methods was comparable (p > 0.05). CONCLUSION: LNR has significant prognostic value for patients with RGC, including those with an insufficient number of harvested LNs.

DOI： 10.1245/s10434-020-09433-2

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Stanniocalcin2 (STC2) is associated with proliferation, invasion, and metastasis in various cancers. We examined the clinical significance of STC2 mRNA expression in patients with colorectal cancer (CRC). PATIENTS AND METHODS: Relative expression levels of STC2 mRNA in CRC tissues and corresponding normal mucosa obtained from 202 patients were measured using quantitative real-time reverse transcriptase-polymerase chain reaction. RESULTS: Expression of STC2 mRNA was higher in the cancer tissue than in the adjacent normal mucosa. STC2 mRNA expression in cancer tissues was associated with tumour size, liver metastasis, venous invasion, and lymph node metastasis. High expression of STC2 mRNA was significantly associated with poorer postoperative survival (p=0.0003). Multivariate analysis showed that high expression of STC2 mRNA was an independent predictor of postoperative survival. CONCLUSION: High expression of STC2 mRNA in CRC tissue may be a useful prognostic marker in patients with CRC.

DOI： 10.21873/anticanres.14983

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

The patient was a 59‒year‒old woman. In 2005, she underwent low anterior resection plus D2 dissection for rectal cancer (pT4aN2aM0, pStage Ⅲb). In 2007, she underwent hepatic S8 subsegment resection for liver metastasis. After that, FOLFIRI therapy was performed as chemotherapy for recurrence of the right upper lung lobe and para‒aortic lymph node(PALN). CR was once obtained in both(of)PALN and lung, but PALN re‒expansion and left ovary enlargement were observed in 2009, and resection of PALN plus left ovariectomy was performed. Histological examination showed PALNs were metastases from rectal cancer and the ovary was benign. Eleven years after the first operation, she stayed alive without recurrence.

PubMed

researchmap

Language：English   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A multi-institutional phase II study was conducted to evaluate the efficacy and safety of preoperative docetaxel, cisplatin and S-1 therapy in marginally resectable advanced gastric cancer. METHODS: Patients with macroscopic type 4, large macroscopic type 3 and bulky lymph node metastasis received two cycles of preoperative docetaxel, cisplatin and S-1 therapy (docetaxel 40 mg/m2 and cisplatin 60 mg/m2 on day 1, and S-1 80 mg/m2 for 14 days, every 4 weeks). The primary endpoint was the pathological response rate, with an expected value of 65%. RESULTS: Thirty-one patients were enrolled in this study. The pathological response rate was 54.8%, and it was higher than the threshold value but lower than the expected rate. The R0 resection rate was 93.5%. The frequencies of grade 3-4 toxicities during docetaxel, cisplatin and S-1 therapy were 41.9% for neutropenia, 6.5% for febrile neutropenia and 32.3% for nausea/vomiting. Grade 2 and 3 surgical morbidities occurred in 23.3 and 6.7% of the patients, respectively. CONCLUSIONS: Preoperative docetaxel, cisplatin and S-1 therapy was feasible in terms of chemotherapy-related toxicities and surgical morbidity, but the effect did not achieve the expected value. The association between the pathological response rate and survival will be evaluated in the final analysis of this clinical trial.

DOI： 10.1093/jjco/hyaa221

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to investigate the short-term and oncological impact of the Endoscopic Surgical Skill Qualification System (ESSQS) by the Japan Society for Endoscopic Surgery on the operator performing laparoscopic surgery for colon cancer. METHODS: This retrospective cohort study was based on medical records from a multicentre database. A total of 417 patients diagnosed with stage II/III colon and rectosigmoid cancer treated with curative resection were divided into two groups according to whether they were operated on by qualified surgeons (Q group, n=352) or not (NQ group, n=65). Through strict propensity score matching, 98 cases (49 in each group) were assessed. RESULTS: Operative time was significantly longer in the NQ group than in the Q group (199 vs. 168 min, p=0.029). The amount of blood loss, post-operative complications, and duration of hospitalisation were similar between both groups. No mortality was observed. One conversion case was seen in the NQ group. The 3-year recurrence-free survival rate was 86.6% in the NQ group and 88.2% in the Q group, which was not statistically significant (log-rank p=0.966). CONCLUSION: Direct operation by ESSQS-qualified surgeons contributed to a shortened operation time. Under an organised educational environment, almost equivalent safety and oncological outcomes are expected regardless of the surgeon's qualifications.

DOI： 10.1186/s12957-021-02155-z

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The aim of this study is to reveal the vascular branching variation in SFC (splenic flexure cancer) patients using the preoperative three-dimensional computed tomography angiography with colonography (3D-CTAC). METHODS: We retrospectively analyzed patients with SFC who underwent preoperative 3D-CTAC between January 2014 and December 2019. RESULTS: Among 1256 colorectal cancer (CRC) patients, 96 (7.6%) manifested SFC. The arterial branching from the superior mesenteric artery (SMA) was classified into five patterns, as follows: (type 1A) the left branch of middle colic artery (LMCA) diverged from middle colic artery (MCA) (N = 47, 49.0%); (2A) the LMCA diverged from the MCA and the accessory middle colic artery (AMCA) (N = 26, 27.1%); (3A) the LMCA independently diverged from the SMA (N = 16, 16.7%); (4A) the LMCA independently diverged from the SMA and AMCA (N = 3, 3.1%); (5A) only the AMCA and the LMCA was absent (N = 4, 4.1%). Venous drainage was classified into four patterns, as follows: (type 1V) the SFV flows into the inferior mesenteric vein (IMV) then back to the splenic vein (N = 50, 52.1%); (2V) the SFV flows into the IMV then back to the superior mesenteric vein (SMV) (N = 19, 19.8%); (type 3V) the SFV independently flows into the splenic vein (N = 3, 3.1%); (type 4V) the SFV is absent (N = 24, 25.0%). CONCLUSION: 3D-CTAC could reveal accurate preoperative tumor localization and vascular branching. These classifications should be helpful in performing accurate complete mesocolic excision and central vessel ligation for SFC.

DOI： 10.1007/s00384-020-03773-x

PubMed

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

症例は57歳男性.検診異常に対し施行した上部消化管内視鏡で胃癌が疑われ,当科紹介となった.精査の結果,上部消化管内視鏡で胃体中下部小彎に2型病変を認め,また腹部造影CTで胃病変と一塊となった多数のリンパ節腫大と腹部造影MRIで多発肝転移(S6,S7)を認めた.LM,Less,Type2,46mm,pap-tub1-tub2,HER2 score3,cT4aN2(bulky N)H1(M1 HEP)P0CY0,cStage IVの切除不能進行胃癌と診断し,XP+trastuzumab(capecitabine 1500mg/m2 1日2回14日間,CDDP 80mg/m2/日day 1投与,trastuzumab 8mg/kg day 1投与:3週1コース)併用化学療法を施行した.腎障害のため3コース目からCDDPは中止としたが,1コース施行後にPR,6コース施行後にPET-CTで原発巣,リンパ節転移,肝転移はいずれも集積を認めずCRと判定し,ycT3(SS)N0M0,ycStage IIAと診断した.Conversion Surgeryの適応として,開腹幽門側胃切除,D2郭清,oux-en-Y再建術を施行した.術後病理診断では化学療法の組織学的効果判定はGrade 3であった.術後補助化学療法としてX+trastuzumaを4コース施行したが,術後2年3ヵ月無再発生存中である.Conversion Surgeryの適切なタイミング,適格基準については一定の見解は得られていないが,今後の症例の蓄積,検討や前向き研究によりさらなる予後改善が期待される.(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01499&link_issn=&doc_id=20210521300002&doc_link_id=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2263&url=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2263&type=%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%EF%BC%9A%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%E5%AD%A6%E8%A1%93%E6%A9%9F%E9%96%A2%E3%83%AA%E3%83%9D%E3%82%B8%E3%83%88%E3%83%AA&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(公社)神奈川県医師会  

researchmap

Language：Japanese   Publisher：(公社)神奈川県医師会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of the present study was to determine the utility of the C-reactive protein-to-albumin ratio (CAR) for predicting the overall survival (OS) in locally advanced colorectal cancer (CRC) patients. PATIENTS AND METHODS: This retrospective multicenter study was performed using data from a prospectively maintained database of pathological Stage II or III patients undergoing CRC surgery at the Yokohama City University, Department of Surgery, and its affiliated institutions between April 2000 and March 2016. The risk factors for the OS were identified. RESULTS: A CAR of 0.03 was considered to be the optimal cutoff point for classification based on the 1-, 3-, and 5-year survival rates and receiver operating characteristic curve. The OS rates at 3 and 5 years after surgery were 92.4% and 85.7% in the CAR-low group, respectively, and 86.7% and 81.1% in the CAR-high group. A multivariate analysis showed that the CAR was a significant independent risk factor for the OS. When comparing the patients' demographic and clinical characteristics between the CAR ≤0.03 and >0.03 groups, the incidence of patients who received adjuvant chemotherapy and the incidence of postoperative complications were significantly different between the two groups. CONCLUSION: The present study showed that the preoperative CAR was a risk factor for the OS in patients who underwent surgery for CRC. To improve the patients' survival, CAR might be a useful tool for devising treatment strategies.

DOI： 10.4103/jcrt.JCRT_355_19

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Resection of the primary lesion with radical lymph node dissection is the most promising treatment avenue for patients with cancer. On the other hand, these procedures often induce excessive intraoperative blood loss (IBL) and require perioperative blood transfusion. The influence of IBL on the long-term postoperative outcomes of patients with digestive cancer is controversial. We investigated the impact of IBL on survival and recurrence after curative surgery in patients with colorectal cancer (CRC) in a single study group. PATIENTS AND METHODS: In total, 1,597 patients who underwent radical resection for CRC at three group hospitals between 2000 and 2019 were reviewed. Patients were classified into a group with high IBL (≥200 ml) or low IBL (<200 ml). The risk factors for disease-free (DFS) and overall (OS) survival were analyzed. RESULTS: A total of 489 and 1,108 patients were classified into the high and low IBL groups, respectively. The OS and DFS rates at 5 years after surgery were 89.3% and 63.4%, respectively, for the high IBL group and 96.9% and 77.8% for the low IBL group; these differences were statistically significantly (p<0.001). The multivariate analysis demonstrated that IBL was a significant independent risk factor for OS and DFS. CONCLUSION: The amount of IBL was associated with significant differences in the OS and DFS of patients with stage II/III CRC who received curative resection. The surgical procedure, surgical strategy, and perioperative care should be carefully planned to avoid causing IBL.

DOI： 10.21873/invivo.12649

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: Recent studies have reported that the albumin-to-globulin ratio (AGR) may be a useful inflammatory-nutritional biomarker to predict postoperative complications and poor prognosis in various types of patients with cancer. However, its prognostic value in patients with esophageal cancer is still unclear. We aimed to examine the utility of the AGR for predicting the short- and long-term outcomes in patients with esophageal cancer who underwent curative resection. PATIENTS AND METHODS: This was a retrospective cohort analysis reviewing the medical records of consecutive patients who underwent esophagectomy for clinical stage I to III esophageal cancer at Yokohama City University. A total of 105 patients were identified between 2005 and 2018. The overall survival (OS), recurrence-free survival (RFS), and postoperative complication rates were compared between patients with high AGR (>1.48) and those with low AGR (≤1.48) group. RESULTS: A total of 57 and 48 patients were classified into the high and low AGR groups, respectively. There was no significant difference between the two groups in the rate of overall postoperative complications of more than Clavien-Dindo grade 3 (50.9% vs. 54.2%, p=0.85). The long-term findings showed that 5-year OS and RFS rates were significantly better for the group with a high AGR (67.2% vs. 33.8%, p<0.001 and 51.6% vs. 28.5%, p=0.003, respectively). CONCLUSION: This study suggests that a low preoperative AGR is a risk factor for poor RFS and OS in patients who are planning to undergo curative surgery for esophageal cancer. AGR may be a useful biomarker for establishing treatment strategies to improve patients' survival.

DOI： 10.21873/invivo.12658

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We investigated the impact of the pre-surgical C-reactive protein-to-albumin ratio (CAR) on survival and recurrence after curative treatment for gastric cancer. PATIENTS AND METHODS: This study included 481 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: A CAR of 0.05 was regarded as the optimal critical point of classification considering the 3- and 5-year survival rates and patients were divided according to their CAR. The OS rates at 3 and 5 years after surgery were significantly higher at 92.5% and 87.9%, respectively, in the low-CAR group compared with 84.9% and 71.9%, respectively, in the high-CAR group. The corresponding RFS rates were 89.1% and 85.5%, and 81.0% and 72.2%, respectively, also a significant difference. A multivariate analysis demonstrated that the CAR was a significant independent risk factor for the OS and marginally significant independent risk factor for the RFS. In addition, the incidences of pancreatic fistula and abdominal abscess were significantly higher and the rate of introduction of adjuvant chemotherapy significantly lower in the high-CAR group. CONCLUSION: The CAR was a risk factor influencing survival in patients who underwent curative treatment for gastric cancer. An effective perioperative care plan and surgical strategy need to be developed according to the CAR.

DOI： 10.21873/invivo.12648

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Cancer stem cells (CSCs) are reported to associated with cancer metastasis, relapse, and chemoresistance. This study examined the clinical significance of the expression of two CSC markers, the transporter associated with antigen processing 1 (TAP1) and the Delta-like 4 (DLL4) protein, in patients with locally advanced GC. PATIENTS AND METHODS: This study was performed using samples obtained from 413 pathological stage II/III GC patients after curative gastrectomy. We examined TAP1 and DLL4 expression using immunohistochemical analysis with tissue microarray and examined the association between TAP1 or DLL4 expression, clinicopathological factors and survival. RESULTS: High TAP1 expression was associated with better overall survival compared to low TAP1 expression (p=0.004). Furthermore, in multivariate analysis, high TAP1 expression was defined as a predictive factor for good survival. There was no significant difference between DLL4 expression and clinicopathological features and overall survival. CONCLUSION: TAP1 expression may be a useful prognostic marker in patients with locally advanced GC.

DOI： 10.21873/invivo.12562

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: We investigated the risk factors for recurrence in high risk stage II colorectal cancer patients over 75 years old. Methods: This study included 79 patients who underwent primary colorectal surgery at Minami Kyousai Hospital from January 2015 to June 2019. The inclusion criteria were as follows: (1) age over 75 years old, (2) histologically confirmed stage II colorectal adenocarcinoma after curative surgery, and (3) no other active malignancy. A Cox proportional hazards model was used to identify the risk factors for recurrence. Results: The recurrence free survival rates at 1, 2, and 3 years after surgery were 92.6%, 78.8%, and 61.9%. The risk factors for recurrence were tumor location and lymph-node dissection. Conclusion: This study revealed that left-sided colorectal cancer and under D2 dissection are risk factors for recurrence of stage II colorectal cancer in the elderly. Patients with these risk factors should be considered for adjuvant chemotherapy.

DOI： 10.4993/acrt.29.5

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We hypothesised that the prognostic nutrition index (PNI) is useful for evaluating host immunity and response to immune checkpoint inhibitors. We investigated the effect of PNI on nivolumab monotherapy efficacy in advanced or recurrent gastric cancer (GC) or gastro-oesophageal junction cancer (GOC) patients. PATIENTS AND METHODS: We retrospectively examined 110 patients, divided them into a high-PNI group and a low-PNI group, and compared treatment efficacy, adverse events (AEs), and survival between the groups. RESULTS: Median overall survival (OS) was significantly longer in the high-PNI group than in the low-PNI group (205 vs. 109 days; p<0.001). Multivariate analysis revealed that low PNI was an independent risk factor for OS (hazard ratio=2.398; 95% confidence interval=1.384-4.154; p=0.002). The overall response rate and frequency of AEs were not significantly different between the groups. CONCLUSION: PNI could be a useful prognostic factor in GC or GOC patients undergoing nivolumab monotherapy.

DOI： 10.21873/invivo.12292

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: This study was designed to investigate gender-related differences in changes in bone metabolism after gastric cancer surgery. PATIENTS AND METHODS: We prospectively recruited 47 patients (38 males and 9 females) who had early gastric cancer. The bone mineral density (BMD), serum levels of 1,25-dihydroxy vitamin D (1,25(OH)2VD), 25-hydroxy vitamin D (25(OH)VD), and estradiol (E2) were measured before and after surgery. RESULTS: BMD significantly decreased 12 months after surgery by median degrees of 3.4% and 3.9% in male and female patients, respectively (p<0.001 and p=0.023). There was no significant difference between both genders in the rate of change in BMD after surgery. The serum E2 level in male patients significantly increased by a median value of 22 pg/ml 12 months after gastrectomy (p=0.030). Both the serum 25(OH)VD and 1,25(OH)2VD levels remained nearly within the normal range throughout the observation period in both male and female patients. CONCLUSION: BMD significantly decreased within 12 months after gastrectomy in both male and female patients with gastric cancer, and there was no significant gender-related difference in the rate of change in BMD.

DOI： 10.21873/invivo.12510

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Background: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on the pancreatic cancer survival and recurrence after curative surgery followed by adjuvant chemotherapy. Patients and Methods: This study included 155 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. Results: An ACCI of 8 was regarded as the optimum critical point of classification considering the 1-, 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 25.7% and 19.0% in the ACCI-low group, respectively, and 7.6% and 0% in the ACCI-high group, which amounted to a statistically significant difference (P = 0.019). The RFS rates at 3 and 5 years after surgery were 17.3% and 13.8% in the ACCI-low group, respectively, and 7.1% and 0% in the ACCI-high group, which amounted to a marginally statistically significant difference (P = 0.104). A multivariate analysis showed that the ACCI was a significant independent risk factor for both the OS and RFS. Conclusions: The ACCI was a risk factor for the OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. An effective plan is needed for determining the optimum surgical strategy according to the ACCI.

DOI： 10.4103/jcrt.JCRT_440_18

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 63-year-old-woman was diagnosed with gastric cancer cStage ⅠA after ESD, and then, underwent robot-assisted distal gastrectomy. She vomited on the postoperative day 2 and then was inserted nasogastric tube. The amount of drainage from the tube was increased on the postoperative day 5, therefore, abdominal computed tomography scan was performed, which showed herniation of small bowel at the 8 mm port site in the left upper abdomen. The emergent surgery was performed because of difficulty in manual reduction. Intraoperative findings showed that small intestine was incarcerated at the left 8 mm port-site. The intestine was released by incising the fascia of hernia orifice, then, the fascia was repaired. There was no recurrence of gastric cancer and port-site hernia for 34 months after surgery. In general, the fascia of over 10 mm port site is sutured and closed to avoid port-site hernia, however, it is unclear whether the fascia of 8 mm port-site should be closed after robotic surgery. Since we experienced this case, we have also performed fascia suture on the 8 mm port-site in all cases. And then, we could prevent occurrence of port-site hernia in the 8 mm port-site.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A case of 69-year-old man underwent resection for the plantar surface of left foot malignant melanoma and received a sentinel biopsy of left inguinal lymph node. Two years and 10 months later, a mass of 30 mm in diameter in the ileum was detected by contrast-enhanced computed tomography, which showed abnormal uptake using FDG positron emission tomography. The partial intestinal resection was performed, and then, the mass was diagnosed as metastasis of malignant melanoma by pathological examination. Malignant melanoma is highly malignant disease that frequently shows distant metastasis. Although the malignant melanoma with distant metastasis shows poor prognosis, previous studies reported the prognosis could be improved when the patient could receive curative resection for single intraabdominal metastasis. Therefore, surgical resection should be considered for the single metastasis of malignant melanoma. We report a case of malignant melanoma with ileum metastasis resected curatively with literature review.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Background: Intractable ascites secondary to malignant disease deteriorates patients' quality of life. The purpose of this study was to evaluate the safety and efficacy of percutaneous peritoneovenous (Denver) shunt in treating intractable malignant ascites in cancer patients. Materials and Methods: Thirty-five patients who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from October 2014 to 2017 were retrospectively analyzed. The demographic characteristics, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analyses were performed. Results: The sites of primary tumor were pancreatic cancer in 19 patients, bile duct cancer in 8, gallbladder cancer in 5, breast cancer in 2, and peritoneal malignant mesothelioma in 1. Palliation of abdominal distention was achieved in 29 patients (82.9%). Postoperative complications of Grade 2 or higher were seen in 11 patients (31.4%), and Grade 5 complications were observed in three patients (8.6%). Patients with a high American Society of Anesthesiologists (ASA) grade and high ascites drainage volume had a significantly higher incidence of postoperative complications than a low ASA grade and low ascites drainage volume, and a multivariate logistic analysis showed that the intraoperative ascites drainage volume was an independent risk factor for all complications. Conclusions: The Denver shunt for malignant ascites is useful for improving patients' quality of life if the indications are selected properly. Drainage of intraoperative ascites was a risk factor for postoperative complications after the Denver shunt technique in cancer patients with malignant ascites. Further experience and discussion are necessary to establish the patient selection criteria.

DOI： 10.4103/jcrt.JCRT_606_18

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

上腸間膜動脈症候群(Superior mesenteric artery syndrome:SMA症候群)は急性腹症を示す稀な疾患であり、若年の痩せ型の女性に多いとされる。今回我々は、腹部大動脈人工血管置換術(SMA再建施行)の若年男性に発症したSMA症候群を経験した。症例は19歳男性、Marfan症候群類縁疾患患者であり、胸腹部大動脈瘤に対して腹部大動脈人工血管置換術(CEA・SMA再建)を行った既往がある。昼食後に突然の腹痛・嘔気・嘔吐が出現し、当院救急外来を受診した。単純CT検査で、十二指腸水平脚がSMAと腹部大動脈に挟まれて狭小化し、胃・十二指腸の拡張および液体貯留を認めたことから、SMA症候群と診断した。腸管減圧、絶食、補液などの保存的治療を施行したが改善はみられず、空腸・十二指腸吻合を行った。術後SMA症候群の再発はなく、外来経過観察中である。今回、腹部人工血管置換術後に生じたSMA症候群であり、稀な疾患である為文献的考察も交えて報告する。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01499&link_issn=&doc_id=20210215390002&doc_link_id=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2108&url=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2108&type=%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%EF%BC%9A%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%E5%AD%A6%E8%A1%93%E6%A9%9F%E9%96%A2%E3%83%AA%E3%83%9D%E3%82%B8%E3%83%88%E3%83%AA&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Glioma-associated oncogene 1 (GLI1) is an important transcription factor in the hedgehog signalling pathway and tumour formation. We evaluated the clinical significance of GLI1 expression as a prognostic factor in patients with locally advanced gastric cancer (GC). PATIENTS AND METHODS: GLI1 expression levels were measured by quantitative real-time polymerase chain reaction analysis of cancerous and adjacent normal mucosa specimens obtained from 142 patients with Stage II/III GC administered adjuvant chemotherapy with S-1 after curative resection. The associations of GLI1 expression with clinicopathological features and survival were evaluated. RESULTS: Clinicopathological features and GLI1 expression showed no association. Overall survival was significantly poorer in the high compared to the low GLI1 expression group (p=0.04). Multivariate analysis revealed that GLI1 expression was a significant independent prognostic factor [p=0.019, hazard ratio (HR)=1.94, 95% confidence interval (CI)=1.70-3.38]. CONCLUSION: GLI1 expression may be a useful prognostic marker in patients with locally advanced GC.

DOI： 10.21873/anticanres.14599

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of this study was to evaluate the impact of postoperative infectious complications on long-term outcomes after curative resection of gastric cancer. PATIENTS AND METHODS: Patients who underwent curative gastrectomy with lymphadenectomy for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015 were retrospectively selected from medical records. Clinicopathological factors between patients with and without infectious complications were compared. Prognostic factors of long-term survival were analyzed by univariate and multivariate Cox proportional hazards analyses. RESULTS: A total of 2,254 patients were eligible for inclusion in the present study. Fifty-eight patients had postoperative infectious complications (IC group); 2,196 had no postoperative infectious complications (NC group). In the IC group, the median age (p=0.031), body mass index (p=0.004), American Society of Anesthesiologists physical status (p=0.006) and percentage of male patients (p<0.001) were higher in comparison to the NC group. The operation time was longer (p<0.001) and the incidence of intestinal-type histology was higher (p=0.017) in the IC group. The 5-year overall survival rates of the IC and NC groups were 59.8% and 83.2%, respectively (p<0.001). Univariate and multivariate analyses demonstrated that postoperative infectious complications were a significant risk factor for poorer overall survival (hazard ratio=2.38; 95% confidence interval=1.47-3.85, p<0.001). CONCLUSION: Perioperative management is necessary to reduce the incidence of postoperative infectious complications and improve the survival of patients after curative resection of gastric cancer.

DOI： 10.21873/anticanres.14404

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.asjsur.2019.09.001

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Several immune-inflammatory markers are associated with cancer progression. The purpose of the present study was to clarify the influence of the preoperative C-reactive protein-to-albumin ratio (CRP/ALB ratio) on survival of patients with esophageal cancer and recurrence after curative resection. PATIENTS AND METHODS: The preoperative CRP/ALB ratio was evaluated in 122 patients who underwent radical resection for esophageal cancer from 2005 to 2018. The correlations between the CRP/ALB ratio and cancer-specific overall (OS), recurrence-free (RFS) survival and the clinicopathological status were analyzed. RESULTS: The optimal cut-off value of the CRP/ALB ratio determined using receiver operating characteristic curve analysis was 0.04. Patients were divided into two groups based on this cut-off value: the low CRP/ALB group (n=59) and the high CRP/ALB group (n=50). The OS rate at 5 years after surgery was significantly lower in the group with high CRP/ALB at 40.5% whilst it was 63.5% in the low CRP/ALB group (p=0.005). The corresponding RFS rates at 5 years after surgery were 32.5% and 48.3%, respectively, which was a statistically significant difference (p=0.007). A multivariate analysis showed that a high CRP/ALB ratio was a significant independent risk factor for poorer cancer-specific OS and RFS. CONCLUSION: The preoperative CRP/ALB ratio was a strong prognostic marker for patients with esophageal cancer. The surgical strategy, including procedure and perioperative care should be carefully planned for patients with a high CRP/ALB ratio.

DOI： 10.21873/anticanres.14205

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: We retrospectively evaluated the blood coagulation activity using the D-dimer level in the early period after gastrectomy and investigated whether postoperative hypercoagulation affects tumor recurrence and long-term survival in gastric cancer patients. METHODS: The study involved 650 patients who underwent curative resection for gastric cancer at Kanagawa Cancer Center between July 2009 and July 2013. They were divided into a low-D-dimer group (LD group) and high-D-dimer group (HD group) according to the median D-dimer level on postoperative day (POD) 7. The risk factors for overall survival (OS) and relapse-free survival (RFS) were identified. RESULTS: Of the 448 enrolled patients, 218 were classified into the LD group and 230 into the HD group. The 5-year OS rates after surgery were 90.8% and 81.3% in the LD and HD groups, respectively (p < 0.001). The 5-year RFS rates after surgery were 89.9% and 76.1% in the LD and HD groups, respectively (p < 0.001). A high D-dimer level on POD 7 (≥ 4.9 μg/ml) was identified as an independent predictive factor for both the OS (hazard ratio [HR] 1.955, 95% confidence interval [CI] 1.158-3.303, p = 0.012) and RFS (HR 2.182, 95% CI 1.327-3.589, p = 0.002). Furthermore, hematological recurrence was significantly more frequent in the HD group than in the LD group (p = 0.014). CONCLUSION: A high D-dimer level on POD 7 may predict tumor recurrence and the long-term survival in patients who undergo gastrectomy for locally advanced gastric cancer. Patients with an elevated postoperative D-dimer level need careful observation and diagnostic imaging to timely detect tumor recurrence.

DOI： 10.1007/s10147-019-01603-x

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of the present study was to evaluate the clinical impact of the perioperative use of antiplatelet/anticoagulation therapy for postoperative bleeding after esophagectomy for esophageal cancer. PATIENTS AND METHODS: Patients were selected from the medical records of consecutive patients who were diagnosed with primary esophageal adenocarcinoma or squamous cell carcinoma and who underwent complete resection at Yokohama City University from January 2005 to September 2018. The patients were divided into the antiplatelet/anticoagulation treatment group and the non-treatment group. We compared the safety and feasibility of esophagectomy between two groups. RESULTS: One hundred and twenty-two patients underwent esophagectomy for esophageal cancer and were analyzed in the present study. Among them, 18 (14.8%) received anti-thrombotic therapy (anticoagulation group). The incidence of postoperative bleeding in patients overall was 8.2% (10/122). The incidence of postoperative bleeding in the anticoagulation group was 22.2% (4/18), while that in the non-anticoagulation group was 5.8% (6/104). Preoperative anticoagulation therapy was identified as a significant independent risk factor for postoperative bleeding (hazard ratio=4.673, 95% confidence interval=1.170-18.519; p=0.029). CONCLUSION: The perioperative use of anti-thrombotic therapy was a significant risk factor for postoperative bleeding after esophagectomy for esophageal cancer. Thus, when patients receive perioperative antiplatelet/anticoagulation treatment, careful attention is required after esophagectomy due to their increased risk of postoperative bleeding.

DOI： 10.21873/anticanres.14204

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: We examined whether the perioperative systemic inflammation score (SIS), which describes systemic inflammation and/or malnutrition, affected the tumor recurrence and survival in advanced gastric cancer patients. PATIENTS AND METHODS: The study retrospectively analyzed 160 patients with stage II/III gastric cancer who underwent curative resection at the Kanagawa Cancer Center. The SIS was evaluated before surgery, one week after surgery and one month after surgery, as determined by the serum albumin level (cut-off value=4.0 g/dl) and lymphocyte-to-monocyte ratio (cut-off value=4.44). RESULTS: A high SIS at one month after surgery was identified as an independent predictor for overall survival [hazard ratio (HR)=2.143, p=0.020] and showed a marginal significance for the relapse-free survival (HR=1.814, p=0.053) in multivariate analyses. CONCLUSION: The SIS at one month after surgery is a useful biomarker for predicting the long-term outcome in patients with advanced gastric cancer.

DOI： 10.21873/anticanres.14095

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The short- and long-term outcomes of esophagectomy for esophageal cancer were fully evaluated in patients older than 75 years of age. PATIENTS AND METHODS: The present study selected patients who received esophagectomy for esophageal cancer. Patients were divided into non-elderly patients [age <75 years (non-elderly group)] and elderly patients [age ≥75 years (elderly group)]. The postoperative surgical morbidity, postoperative 30-days mortality, recurrence-free survival (RFS), and overall survival (OS) rates were evaluated between the non-elderly group and elderly group. RESULTS: One hundred twenty-two patients were evaluated in this study. Ninety-eight patients and 24 patients were classified into the non-elderly group and elderly group, respectively. The postoperative surgical complication rates in the non-elderly and elderly groups were 71.4% and 75.0%. There was not a statistically significant difference between the two groups (p=0.710). Mortality was observed in 1 patient in the elderly group (4.2%) due to cardiovascular disease. Significant differences were observed in the five-year OS and RFS rates of the elderly and non-elderly groups (55.4% vs. 29.7%, p=0.0017 and 42.2% vs. 21.2%, p=0.0334, respectively). CONCLUSION: Although the rate of postoperative surgical complications after esophagectomy for esophageal cancer was almost equal in the elderly and the non-elderly patients, significant differences were observed in the mortality and long-term outcomes of the two groups. Thus, the surgical strategy and perioperative care must be carefully planned for esophageal cancer patients older than 75 years of age.

DOI： 10.21873/anticanres.14047

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

高齢者大腸癌症例では併存疾患や臓器機能低下など身体的制限から、臨床的にリンパ節郭清を縮小する傾向にある。高齢者大腸癌手術におけるリンパ節郭清度が予後に与える影響について検討を行った。pT2以深またはリンパ節転移陽性であった137例を対象とした。5年全生存率(overall survival:OS)、5年無再発生存率(relapse free survival:RFS)はそれぞれ74.1%、63.9%であった。OSに対する予後因子の検討では、リンパ節郭清度が独立した予後因子であった。傾向スコアマッチングによる43例ずつでの長期成績の検討では、5年OS(D3群87.2% vs縮小群58.2%、p=0.02)、5年RFS(77.8% vs 46.4%、p=0.03)で、いずれもD3群が縮小群よりも有意に予後良好であった。高齢者大腸癌手術においてD3リンパ節郭清は予後の向上に寄与する可能性が示唆された。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20200220310013&doc_link_id=%2Fab8gtkrc%2F2020%2F004702%2F014%2F0259-0261%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004702%2F014%2F0259-0261%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

The effectiveness of lymph node dissection tends to be reduced clinically in elderly patients with colorectal cancer because of physical limitations, such as comorbidities and organ dysfunction. We investigated the influence of the level of lymph node dissection on the prognosis of elderly patients with colorectal cancer. A total of 137 patients with pT2 or more-advanced tumors or lymph node metastasis were retrospectively studied. The 5-year overall survival(OS)andrelapse free survival(RFS) rates were 74.1% and 63.9%, respectively. Lymph node dissection was an independent prognostic factor in the examination of prognostic factors of OS. In the propensity-matchedcohort, the 5-year OS rates were 87.2% and5 8.2%(p=0.02), and the 5-year RFS rates were 77.8% and4 6.4%(p=0.03)in the D3 andred ucedgroups, respectively. The D3 group hada significantly better prognosis than the reduced group. D3 lymph node dissection might contribute to the improvement of prognosis in elderly people with colorectal cancer.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We investigated the clinical influence of anastomotic leak (AL) on esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into those with AL and those without. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: AL was found in 44 out of the 122 patients (36.1%). The respective OS rates at 3 and 5 years after surgery were 43.9% and 40.2% in the AL group and 63.9% and 53.2% in the non-AL group, which were significantly different (p=0.0049). In contrast, the respective RFS rates at 3 and 5 years after surgery were 44.8% and 29.8%, and 44.9% and 42.4%, which were not significantly different (p=0.2306). A multivariate analysis showed that AL was a significant independent risk factor for both poorer OS and RFS in patients who underwent curative surgery for esophageal cancer. CONCLUSION: To improve survival of patients with esophageal cancer, the surgical procedure, perioperative care and surgical strategy must be carefully planned in order to prevent AL.

DOI： 10.21873/anticanres.13972

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: To evaluate the outcomes of curative resection for Borrmann type IV gastric cancer through an analysis of the clinical, surgical and pathological data and through identifying which of these prognostic factors are associated with survival. PATIENTS AND METHODS: We retrospectively analyzed 2798 patients who had undergone excision of the primary lesion and 122 patients with type IV gastric cancer undergoing curative resection (R0 or 1) at Yokohama City University Hospital and Kanagawa Cancer Center between November 1995 and May 2016. RESULTS: Borrmann type IV gastric cancer had more advanced and unfavorable clinicopathological factors compared to other types. The 5-year overall survival rate was 28%, and the median survival was 21.8 months. The overall survival rate was influenced by the depth of invasion, lymph node metastasis, peritoneal lavage cytology (CY), stage and intraoperative blood loss. Of these, independent prognostic factors were intraoperative blood loss (<400 vs. ≥400 ml, risk ratio 1.64; p=0.045) and CY (0 vs. 1, risk ratio 2.25; p=0.004). CONCLUSION: The control of intraoperative bleeding had a positive impact on the survival of patients receiving curative resection for Borrmann type IV gastric cancer.

DOI： 10.21873/anticanres.13967

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. CONCLUSION: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI.

DOI： 10.21873/invivo.12103

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We performed a retrospective multi-center cohort analysis to compare the outcomes of laparoscopic surgery vs. open surgery for obstructive colon cancer. PATIENTS AND METHODS: A total of 455 patients with colon cancer with ileus underwent surgery at Yokohama City University Hospital and four related institutions from April 2000 to March 2016. RESULTS: There were 414 cases in the open surgery group and 41 cases in the laparoscopic surgery group with no marked differences in the gender or age. The postoperative complication rate, according to the Clavien-Dindo classification, was lower in the laparoscopic group compared to the open surgery group. The postoperative hospital stay was 16 days in the open surgery group and 9 days in the laparoscopic surgery group (p=0.004). Among the various factors examined, the operation approach was identified as a statistically significant independent risk factor for postoperative complications (p=0.015). CONCLUSION: Preoperative treatment for colon cancer with ileus and elective laparoscopic surgery are thought to be useful for achieving curative treatment, avoiding colostomy, and shortening the length of hospital stay.

DOI： 10.21873/invivo.12105

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The present study aimed to identify risk factors for anastomosis leak (AL) after esophagectomy for esophageal cancer. PATIENTS AND METHODS: One-hundred twenty-two patients who underwent esophagectomy for esophageal cancer between 2008 and 2018 were included. The rate of AL was measured based on the definition of leak as adapted from the Surgical Infection Study Group. To identify the risk factors for AL, logistic regression analysis was used. RESULTS: AL was found in 44 of the 122 patients (36.1%). Among the factors examined, the lymph node dissection status (p=0.007) and preoperative serum albumin level (p=0.022) were significant independent risk factors for AL. The incidence of AL was 26.7% (20 of 75) among patients who received 2-field lymph node dissection and 51.1% (24 of 47) among those who received 3-field lymph node dissection. The incidence of AL was 29.9% (23 of 77) in the preoperative serum albumin levels ≥4.0 g/dl group and 46.7% (21 of 45) in the serum albumin levels <4.0 g/dl group. CONCLUSION: Lymph node dissection status and preoperative serum albumin levels were risk factors for AL in patients who received esophagectomy for esophageal cancer.

DOI： 10.21873/invivo.11849

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The short- and long-term outcomes of gastrectomy in elderly patients with gastric cancer have not been fully evaluated. PATIENTS AND METHODS: Patients who underwent gastrectomy were classified into two groups: Non-elderly patients (<80 years old) and elderly patients (≥80 years old). The surgical morbidity, overall and cancer-specific survival in the two groups were compared. RESULTS: A total of 411 patients were evaluated. The rate of overall complication was 29.4% in the non-elderly and 32.4% in the elderly (p=0.699). In the elderly, the overall and cancer-specific survival rates at 5 years after surgery were inferior to those of the younger group (59.8% vs. 66.7%, p=0.103 and 67.9% vs. 78.2%, p=0.028, respectively). CONCLUSION: The short-term outcomes after gastrectomy were almost equal for the two groups in the present study. The prognosis was poor in elderly patients, especially those with advanced gastric cancer.

DOI： 10.21873/invivo.12090

PubMed

researchmap

Publishing type：Research paper (scientific journal)  

© 2020 International Institute of Anticancer Research. All rights reserved. Background/Aim: Tumor microenvironments consist of many types of immune cells, in which regulatory T-cells (Tregs) are supposed to play important roles to suppress antitumor immunity. Regional lymph nodes are essential for antitumor immunity in colorectal cancer (CRC). In this study, we compared the diversity of phenotypes of T-cells in normal tissue and regional lymph nodes in order to determine the immunosuppressive mechanism of lymph node metastasis of CRC. Patients and Methods: Fifty patients were enrolled in this study, and paired samples (tumor tissue, normal tissue, and three regional lymph node samples and as well as non-regional lymph node samples) were obtained from each patient. In each paired-sample set, the proportions of different immune cell types and T-cells expressing immune checkpoint molecules were compared using flow cytometry. Results: Higher proportions of Tregs [7.58% (4.94%-13.87%) vs. 1.79% (0.03%-5.36%), p<0.001] and lower proportions of INFγ- producing CD4-positive T (iCD4+) cells [21.49% (12.08%- 27.35%) vs. 26.55% (15.65%-37.63%), p<0.001] were observed in tumor tissue than in normal mucosa. Parts of regional lymph nodes nearest the tumor had a greater proportion of Tregs [5.86% (4.18%-7.69%)] and lower proportions of iCD4+ [5.94% (3.51%-9.04%)] and INFγ- producing CD8-positive T (iCD8+) cells [21.93% (14.92%- 35.90%)] than distant parts of regional lymph nodes and nonregional lymph nodes. Both immune-suppressing molecules (CTLA-4 and PD-1) and immune-promoting molecules (OX-40 and ICOS) tended to be highly expressed in tumor tissue and local lymph nodes. Conclusion: In patients with CRC, regional lymph nodes, especially the parts nearest the tumor, had a higher proportion of Tregs and other suppressive immunophenotypes of T-cells than those located more distantly.

DOI： 10.21873/invivo.11848

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: Minimally invasive esophagectomy theoretically has advantages over open esophagectomy. The purpose of the present study was to compare the short-and long-term outcomes of patients who underwent video-assisted thoracoscopic esophagectomy (VATE) or conventional open esophagectomy (OE) for esophageal carcinoma. Methods: A total of 122 patients who underwent radical esophagectomy via VATE (VATE group, N = 87) and OE (OE group, N = 35) for esophageal carcinoma between 2005 and 2018 were retrospectively enrolled in this study, and the postoperative outcomes were compared. Results: The OE group had younger patients and more patients who received neo-adjuvant therapy that the VATE group. The procedure time in the OE group was also shorter than that in the VATE group (8.22 vs. 10.28 h, P &lt
0.001). Intraoperative blood loss was similar between the groups (P = 0.775). There were no significant differences in the total number of dissected lymph nodes between the groups (OE: 33, VATE: 37, P = 0.482). The incidence of severe complications was lower in the VATE group than in the OE group (44.8% vs. 65.7%, P = 0.037). With a median follow-up of 26 months, the 3-year overall survival and disease-free survival were similar between the two groups. Conclusion: VATE for esophageal carcinoma is associated with more favorable short-term outcomes and equal oncological outcomes compared with OE.

DOI： 10.4993/acrt.28.97

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The current study aimed to identify the safety and efficacy of Hartmann's procedure (HP) among elderly patients (age ≥80 years) with rectal cancer. PATIENTS AND METHODS: Data on surgical outcome, survival rate, and incidence of stoma reversal were retrospectively compared between patients aged over 80 years who underwent anterior resection (AR) and HP. RESULTS: In total, 79 elderly patients underwent rectal cancer surgery. Of these patients, 54 (68.4%) underwent AR and 25 (31.6%) HP. The two groups did not differ significantly in terms of age, nutrient status, and tumor characteristics. Eight (14.8%) patients who underwent AR and six (24.0%) who underwent HP presented with intra-abdominal complications (p=0.35). The overall survival and recurrent-free survival rates between the two groups did not differ. CONCLUSION: HP for elderly patients with rectal cancer has similar complication rates to AR, and achieved similar oncological outcomes.

DOI： 10.21873/invivo.12213

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pancreatic cancer is a fatal disease with a poor prognosis. Pancreatic cancer is often unresectable at the time of diagnosis, so the analysis of risk factors in patients with indications for surgery is important. We investigated the impact of intraoperative blood loss (IBL) on survival and recurrence in patients with stage II/III pancreatic cancer after curative surgery. PATIENTS AND METHODS: This study included 76 patients who underwent curative surgery for stage II/III pancreatic cancer between 2007 and 2012. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: IBL of 1,000 ml was considered to be the optimal cut-off value for classification based on a receiver operating characteristic (ROC) curve analysis. The OS rates at 5 years after surgery in the groups with low and high IBL were 36.6% and 11.4%, respectively, which was a statistically significant difference (p=0.003). The RFS rates at 1 year after surgery were 49.8% and 24.6%, respectively, which was a significant difference (p=0.045). A multivariate analysis demonstrated that IBL was a significant independent risk factor for OS. CONCLUSION: IBL is an independent prognostic factor after curative resection of stage II/III pancreatic cancer. The reduction of bleeding during surgery is necessary to improve the results of pancreatic cancer surgery.

DOI： 10.21873/invivo.11931

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The aim of the present study was to evaluate the optimal number of harvested LNs (LNs) in patients who were LN metastasis-negative after curative esophagectomy for esophageal cancer. PATIENTS AND METHODS: Sixty-one patients who underwent curative surgery for esophageal cancer between 2005 and 2017 and diagnosed as lymph node metastasis-negative were included in this study. RESULTS: The 5-year overall survival rates were 27.8% for 0-20 harvested LNs, 35.7% for 21-30 harvested LNs, 79.4% for 31-40 harvested LNs, and 85.2% for ≥41 harvested LNs. Thirty harvested LNs was regarded as the optimal critical point of classification, considering the 5-year OS rate. The number of harvested LNs was selected as a significant prognostic factor in both univariate and multivariate analyses. The respective 3- and 5-year OS rates were 50.3% and 36.7% for <30 harvested LNs and 82.4% and 82.4% for ≥30 harvested LNs (p=0.003). CONCLUSION: Thirty or more harvested LNs was a significant prognostic factor in patients with metastasis-negative LNs after curative esophagectomy for esophageal cancer. Therefore, the number of harvested LNs might be useful for predicting the LN metastasis status in esophageal cancer.

DOI： 10.21873/invivo.12001

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: To compare long- and short-term outcomes of laparoscopic surgery with those of open surgery for patients with colorectal cancer and body mass index over 25 kg/m2 Patients and Methods: This multicentre, retrospective study analysed clinical records and identified 178 patients with body mass index over 25 kg/m2 who underwent surgery for colon and rectosigmoid cancer between 2000 and 2016. After applying propensity score matching, 96 patients were finally included. The primary outcome was the 3-year recurrence-free survival rate, and the secondary outcomes were short-term results during and after surgery. RESULTS: The 3-year recurrence-free survival rates were similar for the laparoscopic and open surgery groups. The laparoscopic surgery group had longer operative times but less blood loss and shorter periods of hospital stay. There were no differences in incidence of postoperative complications. CONCLUSION: Laparoscopic and open surgeries had similar long-term outcomes for obese patients. Laparoscopic surgery is an effective option for this population.

DOI： 10.21873/invivo.12011

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We investigated the clinical impact of the lymph node ratio (LNR) on overall survival (OS) and recurrence-free survival (RFS) in esophageal cancer patients who underwent curative surgery. PATIENTS AND METHODS: One hundred twenty patients who underwent curative surgery for esophageal cancer between 2005 and 2017 were included in this study. The LNR was defined as the ratio of the number of metastatic lymph nodes (LNs) to the total number of harvested LNs. RESULTS: A lymph node ratio of 10% was regarded as the optimal critical point for classification based on the overall survival rate. The 3-year and 5-year OS rates were 65.5% and 57.0%, respectively, in the LNR<10% group, and 11.8% and 0% in the LNR≥10% group; the difference was statistically significant (p<0.001). The 3-year and 5-year RFS rates were 52.6% and 44.6%, respectively, in the LNR<10% group, and 0% and 0% in the LNR>10% group; the difference was also statistically significant (p<0.001). When comparing the sites of first relapse, the incidence of distant lymph node metastasis in the LNR>10% group was significantly higher than that in the LNR<10% group. CONCLUSION: The LNR was a risk factor for both OS and RFS in patients who underwent curative surgery for esophageal cancer.

DOI： 10.21873/invivo.12012

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 61-year-old man had a sudden severe abdominal pain and visited our hospital. He was diagnosed with intestinal perforation, given the peritoneal irritation symptoms, the thickening of the intestinal wall and free air as shown on enhanced abdominal computed tomography. He then underwent emergent surgery. A tumor with small perforation was found on the intestine about 15 cm distant from the terminal ileum. Partial resection of the ileum was performed. Microscopically, a type 2 tumor of 70×50mm in diameter, was observed in the resected intestine. The tumor was diagnosed as diffuse large B-cell lymphoma via immunochemical staining. He received 6courses of R-CHOP therapy after surgery without recurrence. A primary intestinal malignant lymphoma is easily perforated, which lead to poor prognosis of the patient. We report a case of perforated intestinal malignant lymphoma, which was induced to remission by multidisciplinary therapy.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は73歳、男性。1999年9月、C型肝炎に対するインターフェロン治療後のフォローアップ中に、肝後区域(S6)に腫瘍を認めた。S6亜区域切除を施行し、術後病理組織学的検査で肝細胞癌(hepatocellular carcinoma:HCC)、moderately differentiated carcinoma、pT2N0M0、pStage II(UICC TNM第7版)と診断された。その後、二度の再発を認め、肝動脈化学塞栓療法(TACE)、経皮的エタノール注入療法(PEI)、ラジオ波焼灼療法(RFA)などの局所療法を行った。2009年4月、肝後区域(S7)に三度目の再発を認め、RFAを試みたが適切な穿刺ルートが得られなかったため、開胸下経横隔膜穿刺でRFAを行った。術後3年で肝外側区域(S2/3)に再発を認めたが、初発から約16年の長期生存が得られた。経皮的なRFAが施行できない症例に対し、開胸下経横隔膜穿刺でのRFAが奏効した症例を経験したので、若干の文献的考察を加え報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20200117590018&doc_link_id=%2Fab8gtkrc%2F2019%2F004613%2F018%2F1963-1965%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004613%2F018%2F1963-1965%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は61歳、男性。突然の激しい腹痛を認め当院救急外来を受診した。来院時、腹膜刺激症状を認め、腹部造影CT検査で不整な小腸壁肥厚とfree airを認めた。小腸穿孔の診断で緊急手術を施行した。術中所見では回盲部より約15cmの回腸に腫瘤を触知し、同部に約5mmの穿孔を認め穿孔部小腸を切除した。切除した小腸に70×50mm大の2型腫瘍を認め、免疫化学染色の結果、びまん性大細胞型B細胞性リンパ腫と診断した。術後R-CHOP療法を6コース施行し、再発なく経過した。小腸原発悪性リンパ腫は穿孔を来す頻度が高く、また穿孔例の予後は不良である。今回われわれは、小腸穿孔を契機に小腸原発悪性リンパ腫と診断し、集学的治療で寛解し得た1例を経験したので文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20200117590021&doc_link_id=%2Fab8gtkrc%2F2019%2F004613%2F021%2F1972-1974%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004613%2F021%2F1972-1974%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

The patient was a 73-year-old man. A liver tumor was found in the posterior segment(S6)during the follow-up period post the interferon treatment for hepatitis C in September 1999. An S6 sub-segmentectomy was performed. The tumor was diagnosed as a moderately differentiated carcinoma, hepatocellular carcinoma(HCC)with pT2N0M0, pStage Ⅱ(UICC TNM 7th edition). The tumor recurred twice post-surgery. The recurrent tumors were treated with local therapies such as transcatheter arterial chemoembolization(TACE), percutaneous ethanol injection(PEI)and radiofrequency ablation(RFA). The third recurrence was found in the posterior segment(S7)in April 2009. RFA was unsuccessful because an appropriate puncture route could not be found. Then, a transdiaphragmatic RFA under thoracotomy was performed as an alternative treatment, which led to an optimal outcome. We report a case of HCC that could not be treated with percutaneous RFA but with a transdiaphragmatic RFA under thoracotomy.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

Primary carcinoma of the vermiform appendix is a rare neoplasm, and its treatment strategy has not yet been established. We retrospectively analyzed 8 cases of primary carcinoma of the vermiform appendix from 2007 to 2017. Six cases were male and two were female, with a median age of 60.5 years. Ileocecal resection and right hemicolectomy were performed in 7 cases and 1 case, respectively. Regarding pathological staging, 5 cases were of pStage Ⅱ, 2 were of pStage Ⅲa, and 1 was of pStage Ⅳ. Three cases had recurrences after curative resection. The postoperative median overall survival time was 45 months. Three cases with a tumor diameter of 20mm were alive without any recurrence; however, 3 of 5 cases with a tumor diameter of B21mm had recurrences. Although only 1 of 3 cases with adjuvant chemotherapy(pStage Ⅲa case)had recurrence, 2 of 4 cases without adjuvant chemotherapy, including a pStage Ⅱ case, had recurrences. Early diagnosis, surgery, and adjuvant chemotherapy could improve the long-term outcomes of patients with primary carcinoma of the vermiform appendix.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は76歳、男性。既往歴および家族歴に特記事項はない。現病歴は、2017年11月に検診目的の上部消化管内視鏡検査で胃前庭部後壁に半周性の隆起病変を認め、生検で胃癌が検出された。胃癌、cT1aN0M0の診断で、12月に内視鏡的粘膜下層剥離術(ESD)を施行した。ESD施行後の病理結果では粘膜下層への浸潤を認め非治癒切除であった。このため、2018年3月に追加切除として腹腔鏡下幽門側胃切除(D1郭清)およびBillroth I再建を施行した。経過良好にて術後10病日に自宅退院、以降外来フォローの方針となった。術後14病日に上腹部痛、炎症増悪で再入院となった。抗菌薬投与などの内科的治療を行ったが、炎症反応高値遷延、腎機能障害、尿潜血を認めた。血管炎関連の腎炎などを疑い精査の結果、抗GBM抗体型急速進行性腎炎の診断となった。今回、早期胃癌に対して腹腔鏡下幽門側胃切除術後に急速進行性糸球体腎炎を発症した1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20191025460034&doc_link_id=%2Fab8gtkrc%2F2019%2F004610%2F035%2F1626-1628%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004610%2F035%2F1626-1628%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

This is a case of a 76-year-old man who had no significant past medical or family history. In the current medical history, in November 2017, upper gastrointestinal endoscopy showed a semicircular protruding lesion in the posterior wall of the gastric antrum, and gastric cancer was diagnosed following biopsy. Endoscopic submucosal dissection(ESD)was performed in the same year for the treatment of gastric cancer(cT1aN0M0). Pathological findings after ESD treatment showed invasion into the submucosa requiring non-curative resection. For this reason, laparoscopic pylorus side gastrectomy(D1 dissection)and Billroth Ⅰ reconstruction were performed as additional procedures in March 2018. The patient was discharged on the 10th postoperative day and was followed-up on an outpatient basis. On the postoperative day 14, he was re-admitted with complaints of upper abdominal pain and exacerbation of inflammation. Medical treatment, such as antibiotic administration was followed, however, a high degree of inflammatory response, renal dysfunction, and occult blood in urine were observed. Because of suspicion of vasculitis-related nephritis, the case was diagnosed as anti-GBM antibody type rapid progressive nephritis. We came across a case of rapidly progressive glomerulonephritis after laparoscopic pylorus side gastrectomy performed for early gastric cancer, and hence, We will review the related literature.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of altered consciousness related to hyperammonemia due to FOLFIRI plus bevacizumab therapy in a patient with recurrent colorectal cancer and renal dysfunction.A 76-year-old man received third-line chemotherapy for left mediastinal lymph node metastasis.He complained of diarrhea on the evening of the same day, and mental confusion on day 3 of the first FOLFIRI therapy.He had a JCS of Ⅲ(200).The laboratory results revealed a marked hyperammonemia.5 - fluorouracil(5-FU)-induced hyperammonemia was diagnosed and the patient was ventilated and managed with branchedchain amino acid solutions, lactulose, and hemodialysis in the ICU.After hemodialysis, the blood ammonia level reduced to the normal limits, and the symptoms of encephalopathy resolved on the following day.He was discharged home on the 19th day of hospitalization.5 -FU-containing therapy should be carefully administered in patients with renal dysfunction.Herein, we report a case of 5-FU-induced hyperammonemia with literature considerations.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

Appendiceal mucinous neoplasm has a risk for pseudomyxoma peritonei caused by appendiceal perforation.It has been reported that laparoscopic surgery is more risky than open surgery.We investigated 4 patients who underwent laparoscopic surgery for appendiceal mucinous neoplasm.The median age was 69.5(49-85).There were 3 males and 1 female.Three cases of partial laparoscopic resection of the cecum and 1 case of ileocecal resection with lymph node dissection were performed. The pathology was low-grade mucinous neoplasm in all cases.The median hospital stay was 6 days, and there were no postoperative complications(CD Grade 3 or higher)or hospital death.As for long-term results, peritoneal pseudomyxoma developed in 1 case, which had already ruptured at the time of surgery.There were no recurrences in other cases.This result suggests that laparoscopic surgery for appendiceal mucinous neoplasm is safe with optimal selection of the procedure and a protective technique.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

This case involved a 42-year-old woman who had no remarkable findings in terms of case history and family history. Upper gastrointestinal series performed during a medical examination revealed ulcerative lesions in the anterior wall of the stomach body. Upper gastrointestinal endoscopy was performed, and a submucosal tumor with a maximum diameter of 50mm accompanied by an ulcerative lesion was found in the anterior wall of the lower part of the stomach. She was diagnosed with a schwannoma based on endoscopic ultrasonography-guided fine needle aspiration, and we received consultation for surgical purpose. Surgery was performed with laparoscopic partial resection of the stomach and lymph nodes in the lesser curvature of the stomach. She was discharged on the 7th day after the surgery. The postoperative pathologic findings showed no nuclear fissure or atypia with a diagnosis of a schwannoma and no lymph node metastasis. Gastric schwannoma is a rare disease that arises from Schwann cells of the Auerbach's plexus of the gastric wall muscularis and comprises 0.1-0.2% of all stomach tumors. Preoperative diagnosis is often extremely difficult, and there are reports of malignancy. Treatments and surgical methods should be carefully considered. Herein, we encountered a case of a resected giant gastric schwannoma by laparoscopic surgery, which is reported with a literature review.

PubMed

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は60歳、男性。IgG4関連腎臓病と自己免疫性膵炎に対して、ステロイド内服加療中であった。盲腸癌の診断で、腹腔鏡下回盲部切除術を施行した。術前CTでは後腹膜線維症の所見は認めなかったが、間質性腎炎のため右腎前面で後腹膜-結腸間膜間に限局的な脂肪織濃度上昇を認めた。術中所見はCT所見に一致した範囲で、十二指腸前面の限局的な癒着を認めた。本症例において、術前CTと実際の手術で線維化の程度や範囲が一致していたことから、IgG4関連疾患患者の手術における組織の線維化は術前CTで予測できる可能性が示唆された。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20191025460048&doc_link_id=%2Fab8gtkrc%2F2019%2F004610%2F049%2F1668-1670%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004610%2F049%2F1668-1670%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

Undifferentiated cancer of the small intestine has a poor prognosis and has rarely been reported.We report a case of undifferentiated intestinal carcinoma.A 55-year-old man presented with epigastralgia in December 2018. Blood test results showed a high degree of anemia.Contrast -enhanced abdominal CT showed a small intestinal tumor with a diffuse thickened wall along with multiple liver metastases.Capsule endoscopy revealed a bleeding tumor.It was diagnosed as carcinoma by transhepatic-ultrasound-guided core needle biopsy.Given the preoperative diagnosis of intestinal carcinoma, we resected the tumor along with a part of the small intestine and the enlarged lymph nodes.The pathological diagnosis was undifferentiated intestinal carcinoma.The patient was discharged on the 6th postoperative day after surgery.He was scheduled to receive postoperative chemotherapy.There was no evidence of undifferentiated intestinal carcinoma.Herein, we review case reports from the literature.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

BACKGROUND: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. CASE PRESENTATION: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. CONCLUSIONS: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

腎機能障害を併存した再発大腸癌患者に対するFOLFIRI+bevacizumab療法により高アンモニア血症および意識障害を来した症例を経験したので報告する。症例は76歳、男性。直腸癌術後、左縦隔リンパ節転移に対するthird-lineの化学療法として治療を開始した。投与当日帰宅後より下痢を認め、3日目に意識障害があり当院に救急受診となった。来院時のJCSは200であり、血中アンモニア値は800μg/dL以上と異常高値を認め、高アンモニア血症に伴う意識障害と診断した。ICUに入室し人工呼吸器管理を行い、高アンモニア血症に対して分枝鎖アミノ酸製剤、ラクツロース投与および高度代謝性アシドーシスに対して血液透析を開始した。透析後、血中アンモニア値は37μg/dLと速やかに改善を認めた。翌日にはJCS10まで意識レベルは改善し、第19日目に自宅退院となった。腎機能障害を伴う症例に対して5-fluorouracil併用療法は慎重に投与すべきと考えられ文献的考察を併せ報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20191025460036&doc_link_id=%2Fab8gtkrc%2F2019%2F004610%2F037%2F1632-1634%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004610%2F037%2F1632-1634%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

虫垂粘液産生腫瘍は良性腫瘍に分類されるが、穿破を契機に腹膜偽粘液腫を来すリスクがあり、腹腔鏡下手術の安全性は確立されていない。当科関連施設で虫垂粘液産生腫瘍に対して腹腔鏡下手術を行った4例を後ろ向きに調査した。年齢の中央値は69.5(49〜85)歳、男性3例、女性1例であった。術式は盲腸部分切除3例、リンパ節郭清を伴う回盲部切除が1例。1例で腹腔内観察時、すでに穿破および周囲への腹膜偽粘液腫を認めたが、その他の症例において術中操作による穿破はなかった。病理診断は全例で低異型度虫垂粘液性腫瘍(low-grade mucinous neoplasm)であった。術後合併症(Clavien-Dindo分類Grade 3以上)は認めず、在院日数の中央値は6日であった。長期成績は、手術時すでに穿破していた1例を除き再発を認めなかった(観察期間中央値14.8ヵ月)。虫垂粘液産生腫瘍に対する腹腔鏡下手術は、選択肢の一つになり得ると考えられる。さらなる症例集積が必要である。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20191025460038&doc_link_id=%2Fab8gtkrc%2F2019%2F004610%2F039%2F1638-1640%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004610%2F039%2F1638-1640%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は42歳、女性。既往歴に特記事項はない。今回、検診で施行した上部消化管造影検査で胃体部前壁に潰瘍性病変を指摘された。上部消化管内視鏡検査を施行し、胃体下部前壁に潰瘍病変を伴う最大径50mmの粘膜下腫瘍を認めた。内視鏡下穿刺吸引細胞診で神経鞘腫の診断となり、手術目的に当科紹介受診となった。手術は、腹腔鏡下胃部分切除術および胃小彎のリンパ節を摘出した。術後経過良好で7日目に退院した。術後病理所見は神経鞘腫の診断で核分裂像や異型性を認めず、リンパ節転移も認めなかった。胃神経鞘腫は胃壁筋層のアウエルバッハ神経叢のシュワン細胞から生じ、全胃腫瘍の0.1〜0.2%とまれな疾患である。術前診断が極めて困難な場合が多くまた悪性の報告もあり、治療、手術方式は慎重に検討すべきである。今回、胃原発の巨大神経鞘腫を腹腔鏡下手術で切除した1例を経験したので、若干の文献的考察を加え報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20191025460046&doc_link_id=%2Fab8gtkrc%2F2019%2F004610%2F047%2F1662-1664%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004610%2F047%2F1662-1664%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a long-surviving case of malignant peritoneal mesothelioma requiring 4 operations in 5 years. A 63-year-old man was diagnosed with gastrointestinal stromal tumor(GIST)that was excised for the first time in June 2011. The pathological diagnosis was malignant peritoneal mesothelioma. Thereafter, we excised recurrences of the tumor in the hepatic hilum in December 2011. Similar operations were performed in March 2012 and August 2015 because of tumors in the small bowel mesentery and the segment 8 of the liver. The pathological diagnosis was malignant peritoneal mesothelioma. It is an extremely rare variant of malignant peritoneal mesothelioma. There is no record of multiple excision of malignant peritoneal mesothelioma for recurrences. In this case, the cause of long survival was considered to be the excision of recurrent tumors.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: We investigated the impact of Beppu's nomogram on colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. PATIENTS AND METHODS: This study included 43 patients who underwent primary hepatic resection for colorectal liver metastasis at the Kanagawa Cancer Center from June 2006 to March 2011. The patients were classified as having a Beppu's nomogram score ≤9 (low-risk group) or ≥10 (high-risk group). The risk factors for the disease-free survival (DFS) were identified. RESULTS: The respective DFS rates at 1, 2, and 3 years after surgery were 72.0%, 43.3%, and 17.3% in the low-risk group and 27.8%, 16.7%, and 8.3% in the high-risk group, the difference being significant (p=0.009). The multivariate analysis showed that Beppu's nomogram score ≥10 was a significant independent risk factor for the DFS. CONCLUSION: Beppu's nomogram score was an independent prognostic factor for colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Thus, Beppu's nomogram might be a useful tool for predicting the risk of recurrence after hepatectomy, even in the era of newly-developed chemotherapy.

DOI： 10.21873/invivo.11603

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. RESULTS: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. CONCLUSION: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.

DOI： 10.21873/anticanres.13392

PubMed

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

症例は67歳、男性。アルコール性肝障害の精査目的で腹部CT施行したところ、2ヶ所の巨大未破裂脾動脈瘤を指摘され手術目的に当科紹介受診となった。精査の結果、脾動脈瘤は2ヶ所あり、それぞれの瘤径は57×40mmと50×50mmといずれも50mmを超える巨大な未破裂脾動脈瘤であった。動脈瘤が複数個あり、かつ各々の瘤径から血管内治療ではなく外科的治療を選択した。手術は開腹脾臓摘出術および脾動静脈瘤切除を施行した。術後は経過良好で6日目に退院した。脾動脈瘤は比較的まれな疾患で、多くの症例が無症状で発見されることが多い。一方で、脾動脈瘤の大きさは20mm程度の報告が多く、50mmを超える症例の報告は少ない。今回、2ヶ所で50mm大を超える巨大未破裂脾動脈瘤の一例を経験したので、若干の文献的考察を加え報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01499&link_issn=&doc_id=20190913400004&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001724%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001724%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 66-year-old woman diagnosed with advanced Stage Ⅳ gastric cancer(T4aN3M1[LYM])received RAM plus wPTX as third-line chemotherapy(ramucirumab 8mg/kg on the 1st and 15th day, paclitaxel 80mg/m2 on the 1st, 8th, and 15th day).After receiving 3 courses of this treatment, para-aortic lymphadenopathy had diminished but anemia had progressed because of tumor hemorrhage.Six weeks after the last administration of RAM, an open distal gastrectomy with D1 plus lymph node dissection and Billroth Ⅰ reconstruction was performed.The patient was discharged on the 9th day after surgery without complications such as postoperative bleeding and delayed wound healing.RAM plus wPTX therapy was restarted 6 weeks after the operation.Postoperative late complication there is no adverse event including adenocarcinoma and continues the same therapy at present.The perioperative treatment under the use of angiogenesis inhibitor has risk of postoperative bleeding and wound healing delay and includes surgery timing of treatment may be difficult.In our case, surgery was performed 6 weeks after the final administration of RAM.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

In a 65-year-old woman, anemia was observed during outpatient follow-up after right lung cancer surgery, and upper gastrointestinal endoscopy was performed for examination.Gastrointestinal endoscopy revealed a Type 2 tumor on the small curvature in the middle part of the stomach, and she was diagnosed with gastric cancer.Distal gastrectomy with D2 lymph node dissection and BillrothⅠ reconstruction was performed for the gastric cancer.There were no postoperative complications, and she was discharged on the ninth day after surgery.The pathological diagnosis was gastric cancer, ML, Less, Type 2, 67×55×15 mm, muc>sig>por, pT4a(SE)N2M0, fStage ⅢB.S -1 adjuvant chemotherapy was administered, but then discontinued in the second course due to the development of adverse events.Reflux symptoms appeared after the surgery, and her dietary intake was poor.Her body weight and serum albumin level at 3 and 5 months after surgery were 51 kg and 52.5 kg, respectively, and 3.2 g/dL and 2.7 g/dL, respectively.Because there was no improvement in the reflux symptom, oral administration of acotiamide hydrochloride was initiated 7 months after the surgery.After initiating oral intake of acotiamide hydrochloride, her dietary intake improved, and her body weight and serum albumin level at 11 and 15 months after surgery were 54 kg and 57 kg, respectively, and 3.0 g/dL and 2.7 g/dL, respectively.Peritoneal recurrence was observed 23 months after surgery, and her oral intake decreased, but the recurrence of reflux symptoms was not observed.Acotiamide hydrochloride could be an option for the treatment of reflux symptoms after gastrectomy.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は66歳、女性。胃癌Stage IV[T4aN3M1(LYM)]に対してthird-lineのRAM+wPTX療法(ramucirumab 8mg/kg 1、15日目に投与、paclitaxel 80mg/m2 1、8、15日目に投与)3コース終了時に腫瘍出血に伴う貧血の進行を認め、RAM最終投与から6週間目に開腹幽門側胃切除(D1+リンパ節郭清、Billroth I法再建)を施行し、術後出血や創傷治癒遅延などの合併症なく術後9日目に軽快退院となった。その後、術後1ヵ月後よりRAM+wPTX療法を再開することができた。血管新生阻害薬使用下での手術は術後出血や創傷治癒遅延のリスクがあり、手術を含めて治療のタイミング決定に難渋することがある。今回、RAM最終投与から6週間後に手術を行い、術後早期からRAMを再開できた1例を経験した。今後さらなる症例の集積により、周術期のRAM使用や安全性の検討が必要と考えられた。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20190320430049&doc_link_id=%2Fab8gtkrc%2F2019%2F004603%2F050%2F0586-0588%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004603%2F050%2F0586-0588%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。身長159cm、体重59kg。肺癌術後で外来経過観察中に貧血を認め、精査目的に上部消化管内視鏡検査を施行し、胃癌の診断となった。幽門側胃切除、D2郭清、Billroth I(B-I)再建術を施行した。術後診断は胃癌、ML、Less、Type 2、67×55×15mm、muc>sig>por、pT4a(SE)N2M0、fStage IIIBであった。術後S-1補助化学療法施行中の外来通院時に逆流症状を認め、食事摂取不良であった。術後3ヵ月、5ヵ月での体重はそれぞれ51kg、52.5kgおよび血清Alb値が3.2g/dL、2.7g/dLであり、低栄養となっていた。術後7ヵ月で逆流症状の改善を認めなかったため、アコチアミド塩酸塩の内服を開始した。内服開始後、逆流症状と食事摂取量が改善し、術後11ヵ月、15ヵ月での体重はそれぞれ54kg、57kgおよび血清Alb値が3.0g/dL、2.7g/dLとなった。術後23ヵ月目で腹膜播種再発を来し食事摂取不良となったが、逆流症状の再燃は認めなかった。胃切除術B-I再建後の逆流症状に対して、アコチアミド塩酸塩が治療選択肢となる可能性が示唆された。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20190320430052&doc_link_id=%2Fab8gtkrc%2F2019%2F004603%2F053%2F0595-0597%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004603%2F053%2F0595-0597%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Body weight, especially lean body mass, significantly decreases after gastrectomy. Postoperative surgical complications are a major risk factor for changes in body weight and body composition after gastrectomy. However, the influence of postoperative surgical complications after gastrectomy on body weight and body composition changes remains unclear. PATIENTS AND METHODS: This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Their body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, and at 1 week, 1 month and 3 months after surgery. Patients were classified as those with surgical complications and those without. RESULTS: Eight hundred and eighty-eight patients (156 in the group with complications and 732 in the group without) were entered in the present study. When comparing the two groups, the patients' background and surgical factors significantly differed, while the pathological findings were similar. The body weight losses at 1 week, 1 month, and 3 months after surgery were 3.8%, 7.0%, and 10.4%, respectively, in those with complications, and 3.3%, 5.6%, and 6.8%, respectively, in the group without, with p-values of 0.001, 0.002, and 0.001, respectively. The corresponding lean body mass losses were 3.7%, 6.5%, and 6.8%, and 3.2%, 4.2%, and 3.5%, respectively, with p-values of 0.001, 0.001, and 0.001, respectively. CONCLUSION: Decreases in body weight and lean body mass after gastrectomy were more serious in the patients with surgical complications than in those without. To maintain body weight and lean body mass in patients with surgical complications, additional care or treatments are needed.

DOI： 10.21873/anticanres.13215

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

症例は74歳男性。2010年2月に食道胃接合部腺癌(cT3N1M0、Stage IIB)に対して噴門側胃切除、D1+リンパ節郭清および下縦隔郭清、腸瘻造設術を施行した。術後よりプロトンポンプ阻害薬の内服を開始していたが、術後5ヵ月目から逆流性食道炎及び反復性の食道胃吻合部潰瘍を発症し、その後増悪と緩解を繰り返していた。今回、2018年3月に胸痛を主訴に近医を受診した。同院で施行したCT検査で心嚢内の液体貯留を認め、胃心嚢瘻が疑われたため当院へ緊急搬送となった。当院で施行したCT検査では食道胃残吻合部よりやや頭側に食道壁から心嚢への瘻孔を認めた。さらに、上部消化管内視鏡検査では食道胃吻合部潰瘍に6mmほどの瘻孔を認めた。反復性食道潰瘍に伴う食道心嚢瘻の診断で、内視鏡的経鼻心嚢ドレナージ・絶食・補液・抗菌薬等の保存的治療の方針となった。治療経過は良好で、第11病日に上部消化管造影検査で胃心嚢瘻を認めず、経鼻心嚢ドレナージチューブを抜去した。第18病日に上部消化管内視鏡検査では食道胃吻合部潰瘍は瘢痕化を認めた。第31病日に自宅退院軽快退院となった。今回、反復する食道胃吻合部潰瘍を契機に食道心嚢瘻を発症した症例に対して、内視鏡的経鼻心嚢ドレナージ術を主体とする保存的治療で救命できた1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01499&link_issn=&doc_id=20190711360004&doc_link_id=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F1793&url=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F1793&type=%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%EF%BC%9A%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%E5%AD%A6%E8%A1%93%E6%A9%9F%E9%96%A2%E3%83%AA%E3%83%9D%E3%82%B8%E3%83%88%E3%83%AA&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：神奈川県医師会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 63-year-old man was admitted to our hospital for examination and treatment of a pancreatic head tumor detected at a nearby hospital. After CT, EUS-FNA, and PET-CT, he was diagnosed with unresectable pancreatic cancer with liver metastasis. After 9 courses of gemcitabine and nab-paclitaxel therapy, the primary tumor was dramatically reduced in size and the liver metastasis had disappeared. He underwent subtotal stomach-preserving pancreaticoduodenectomy. The postoperative diagnosis according to the General Rules of the Study of Pancreatic Cancer(7th edition)was Ph, TS1(15mm), adenosquamous carcinoma, ypT3, ypRP1, ypPL1, R0, ypN0(0/29), M0, CY0, ypStage ⅡA. The histological response was Grade 2. The patient remains alive without recurrence 5 months after surgical resection.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は63歳、男性。CTにて膵頭部腫瘍を指摘され、精査加療目的に当院を紹介受診した。組織診断のためにEUS-FNAを実施しadenosquamous carcinomaの結果であった。PET-CTで肝S4とS7にFDGの異常集積を認め、遠隔転移を有する切除不能膵癌と診断し、化学療法としてgemcitabine+nab-paclitaxel療法を実施した。化学療法を9コース実施し、CTで原発巣の著明な縮小とPET-CTでの肝転移の消失を認めたため、根治切除として亜全胃温存膵頭十二指腸切除術を行った。病理所見は、Ph、TS1(15mm)、adenosquamous carcinoma、ypT3、ypRP1、ypPL1、R0、ypN0(0/29)、M0、CY0、組織学的効果判定はGrade 2でypStage IIAであった。術後5ヵ月間再発なく経過している。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20190121300045&doc_link_id=%2Fab8gtkrc%2F2019%2F004601%2F046%2F0169-0171%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004601%2F046%2F0169-0171%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

Background: The aim of this study was to determine whether or not the short- and long-term outcomes were affected by the age-adjusted Charlson comorbidity index (ACCI) in patients who underwent curative resection for gastric cancer. Methods: The patients were retrospectively selected from among the medical records of consecutive patients who underwent curative gastrectomy with nodal dissection for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015. Results: A total of 2254 patients were eligible for inclusion in the present study. One thousand six hundred fifty-six patients had an ACCI of <6 points (ACCI low group), while 598 had a score of ≥6 points (ACCI high group). The median age (p<0.001) and American Society of Anesthesiologists physical status (ASA-PS) score (p<0.001) of the ACCI high group were higher in comparison to the ACCI low group. The incidence of surgical complications in the ACCI high group was significantly higher than that in the ACCI low group (12.0% vs. 7.2%, p<0.001). Univariate and multivariate analyses demonstrated that an ACCI high classification was a significant risk factor for postoperative complications. In addition, the 5-year OS rates of the ACCI low and ACCI high groups were 85.4% and 74.1%, respectively. The difference was statistically significant (p<0.001). The univariate and multivariate analyses demonstrated that an ACCI high classification was a significant prognostic factor for OS. Conclusions: Our results support that a high ACCI value is an independent risk factor for the short- and long-term outcomes of patients with gastric cancer. To improve the survival of patients with gastric cancer, it is necessary to carefully plan the perioperative care and the surgical strategy according to the ACCI.

DOI： 10.7150/jca.35465

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: The present study explored whether or not the Oral Health Assessment tool (OHAT) score is a risk factor of postoperative pneumonia after esophagectomy for esophageal cancer. Methods: This study included 47 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for postoperative pneumonia. Results: Postoperative pneumonia was found in 18 of the 47 patients (38.3%). Among the various factors examined (age, gender, preoperative chemotherapy status, operative type, operative duration, blood loss, lymph node dissection, alcohol habit, OHAT score), the OHAT score (p = 0.006) and age (p = 0.040) were identified as significant independent risk factors for postoperative pneumonia in univariate and multivariate analyses. The incidence of postoperative pneumonia was 5% (1 of 20) in the OHAT ≤2 group and 51.9% (14 of 27) in the OHAT ≥3 group. Conclusion: The OHAT score is a risk factor for postoperative pneumonia in patients who have undergone curative esophagectomy for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

DOI： 10.4993/acrt.27.31

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Body weight, especially lean body mass, significantly decreases after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, and reduced mobility, which can reduce the quality of life and induce associated toxicity or reduce compliance with adjuvant chemotherapy. Such risks can be particularly high in elderly patients with gastric cancer. However, whether or not changes in the weight and body composition differ between elderly and non-elderly patients remains unclear. PATIENTS AND METHODS: This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, at 1 week after surgery, and at 1 and at 3 months after surgery. Patients were classified as elderly (≥80 years) or non-elderly (<80 years). RESULTS: Eight-hundred and eighty-eight patients (84 elderly and 804 non-elderly) were entered into the present study. Patient background, surgical and clinicopathological factors, and surgical complications did not significantly differ between the two groups. Body weight loss at 1 week, and at 1 and 3 months after surgery, defined as the decrease from the preoperative value, were -2.8%, -6.5%, and -9.0%, respectively, in the elderly and -3.5%, -6.0%, and -8.1%, respectively, in the non-elderly patients (p=0.111, 0.125, and 0.153, respectively). The corresponding losses of lean body mass were -2.6%, -6.0%, and -6.4%, respectively, in the elderly and -3.5%, -4.9%, and -4.7%, respectively, in the non-elderly patients, with p-values of 0.056, 0.036, and 0.029, respectively. CONCLUSION: Decreases in lean body mass after gastrectomy were greater in elderly than in non-elderly patients. In order to maintain lean body mass among elderly patients, additional care and treatments are needed.

DOI： 10.21873/invivo.11463

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Background: The predictive roles of secreted protein acidic and rich in cysteine (SPARC) in pancreatic ductal adenocarcinoma (PDAC) patients after curative resection have not been clarified. We investigated the correlations between the SPARC expression and the postoperative prognosis. Methods: We retrospectively analyzed the clinical data from consecutive patients who underwent curative resection for pancreatic cancer in our institution from 2005 to 2014. Stromal SPARC expression was analyzed by immunohistochemistry on tumor tissue microarrays (TMAs) from the patients. Results: A total of 179 patients were enrolled to this study. The median follow-up period of the present study was 62.1 months. Seventy patients had positive SPARC expression (39.1%). There were no significant differences between the positive SPARC-positive group and the SPARC-negative group. In the survival analysis, there was a significant difference between the SPARC-positive and SPARC-negative groups in the 5-year overall survival (OS) rates after surgery, which were 8.1% and 19.8%, respectively (p=0.0316). A univariate analysis showed that the SPARC expression, size of tumor, lymph node metastasis, and residual tumor were possible prognostic factors. A multivariate analysis showed that the SPARC expression (hazard ratio [HR]: 1.44, 95% confidence interval [CI]: 1.017-2.051), lymph node metastasis (HR: 2.019, 95% CI: 1.318-3.091), and residual tumor (HR: 1.648, 95% CI: 1.132-2.401) were independent prognostic factors. Conclusions: The stromal SPARC expression in resectable pancreatic cancer patients might be useful as a prognostic marker.

DOI： 10.7150/jca.28660

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Aims: We previously demonstrated that a loss of lean body mass loss at one month after gastrectomy was an independent risk factor for the continuation of adjuvant chemotherapy with S-1. However, it is unclear whether or not lean body mass loss after gastrectomy leads to a poor survival through poor compliance to adjuvant chemotherapy with S-1. Methods: The recurrence free survival (RFS) overall survival (OS) and were examined in 115 patients who underwent curative gastrectomy and were pathologically diagnosed with stage II or III gastric cancer and who received postoperative adjuvant chemotherapy with S-1 between May 2011 and September 2016. Results: The median follow-up period was 40.6 months. The RFS rates at 5 years after surgery were 57.8% in the lean body mass loss ≥5% group and 73.5% in the lean body mass loss <5% group. The univariate and multivariate analyses for the disease free survival (RFS) demonstrated that a lean body mass loss >5% was a significant risk factor. The OS rates at 5 years after surgery were 72.0% in the lean body mass loss ≥5% group and 77.3% in the lean body mass loss <5% group. The OS was slightly worse in the lean body mass loss ≥5% group than in the lean body mass loss <5% group (p=0.2062). Conclusions: The lean body mass loss at one month, which is closely associated with poor S-1 compliance, was an important risk factor for the RFS. A prospective cohort study is necessary to confirm whether or not the lean body mass loss affects the gastric cancer survival.

DOI： 10.7150/jca.30697

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、男性。Stage IV(ypT3N3aM1)、胃癌の診断でドセタキセル/シスプラチン/S-1療法を2コース施行した。2014年6月、胃全摘および脾臓摘出術を施行、術後S-1補助化学療法を施行したが、9月に大動脈周囲リンパ節に再発を認めイリノテカン/シスプラチン療法を開始した。2015年2月、再発リンパ節の増大を認め、パクリタキセル療法に変更、5月に手指のしびれ(Grade 2)を認め、オキサリプラチン/S-1療法に変更した。2016年2月、腹水貯留が著明となり、化学療法を中止した。その後、外来通院を継続し再発リンパ節の増大を認めたが、全身状態は良好であったため再度化学療法施行の方針とした。2017年2月からラムシルマブ/パクリタキセル療法を開始し、経過中に有害事象として好中球減少(Grade 2)を認めたが、パクリタキセルの減量のみでラムシルマブの減量は行わず治療継続できた。その後、再発リンパ節の縮小および腹水の減少を認めた。ラムシルマブ/パクリタキセル療法開始後1年経過した現在も外来通院中である。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20190107600122&doc_link_id=%2Fab8gtkrc%2F2018%2F004513%2F122%2F2156-2158%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004513%2F122%2F2156-2158%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

This is a case of a 70-year-old man. Two courses of docetaxel/cisplatin/S-1 combination therapy were administered after clinical trial registration with diagnosis of Stage Ⅳ gastric cancer(ypT3N3aM1). In June 2014, gastrectomy and splenectomy were performed. Postoperative S-1 adjuvant chemotherapy was administered; however, in September 2014, aorticl ymph node metastasis was diagnosed as recurrent. After recurrence, irinotecan/cisplatin therapy was administered. In February 2015, recurrent lymph node metastasis increased, and chemotherapy was changed to paclitaxel. In May 2015, numbness (Grade 2)of the fingers was observed, and treatment was changed to oxaliplatin/S-1. In February 2016, storage of ascites became remarkable; therefore, chemotherapy was discontinued as per policy. After that, we continued outpatient visit and observed increased recurrent lymph node metastasis on image evaluation; however, as the patient's general condition was good, chemotherapy was restarted. Ramucirumab/paclitaxel therapy started in February 2017. During the course of treatment, neutropenia(Grade 2)was observed as an adverse event, but therapy continuation was possible without loss of ramucirumab only with loss of paclitaxel. Thereafter, the recurrence of lymph node metastasis was reduced, and the ascites accumulation decreased. Until now, 1 year after the start of ramucirumab/paclitaxel therapy, the patient still visits the outpa- tient clinic.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (international conference proceedings)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 74-year-old woman was found to have a hepatic mass based on CT findings. She was diagnosed as having cecum cancer, and it was difficult to distinguish whether the hepatic mass was liver metastasis or biliary cystadenocarcinoma. We proceeded with the surgery for cecum cancer, and laparoscopic ileocecal resection with D3 lymph node dissection was performed. The histopathological diagnosis was mucinous adenocarcinoma, and the pathological stage was T3N2H1P0M1a, Stage IV. After the surgery, her CEA level was elevated, and we diagnosed the hepatic mass as a liver metastasis. A CapeOX plus bevacizumab regimen was administered but was discontinued for 2 courses due to the development of adverse effects and her decision. Gd-EOB-DTPA-enhanced MRI revealed a multilocular and tabulated mass, which was a low-intensity area in T1WI and high-intensity area in T2WI, and the mass had no significant contrast effects. These images were unspecific for liver metastasis of colorectal cancer, and we performed segmental 6 hepatectomy for diagnosis and curative surgery. A histopathological diagnosis of liver metastasis of cecum cancer was made. Here, we report a case of liver metastasis of colorectal cancer that was undifferentiated from biliary cystadenocarcinoma.

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

切除不能進行胃癌に対する標準治療は全身化学療法であるが、生存期間の中央値は10ヵ月程度で予後は不良である。今回、卵巣転移を契機に切除不能進行胃癌と診断し集学的治療を施行し長期生存が得られた1例を経験したので、若干の文献的考察を加えて報告する。症例は69歳、女性。2011年に卵巣腫瘍を指摘され、右付属器摘出術と大網切除術を施行した。病理結果は低分化腺癌および印環細胞癌で転移性が強く疑われた。2012年2月に上部消化管内視鏡で胃体上部から幽門部にかけて4型の腫瘍を認めた。胃癌卵巣転移Stage IV[T4aN0M1(ovary)]の診断となった。原発巣のHER2が陽性であったため、2012年3月からXP+HER(capecitabine 1,000mg/m21日2回14日間、CDDP 80mg/m21日目に3週毎、trastuzumab 8mg/kg 1日目に3週毎)を施行した。化学療法8コース施行後の画像検査で遠隔転移所見はなく、また上部消化管内視鏡検査も原発巣の縮小を認めた。画像所見から原発巣切除は可能と判断し、2012年12月に診断的腹腔鏡施行後に開腹胃全摘およびD2リンパ節郭清術を施行した。術後病理はStage IV(pT4aN0M1)の診断となった。術後2013年2月から微小転移の制御目的にcapecitabine(1,000mg/m21日2回14日間)療法を12ヵ月施行し、以後外来経過観察となった。その後、再発や転移所見を認めずに経過したが、2017年1月に直腸に全周性の狭窄病変を認め、画像上腹膜播種再発の診断となった。2017年2月に人工肛門造設術(S状結腸、双口式)を施行し、現在外来化学療法を施行し通院生存中である。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20181022460024&doc_link_id=%2Fab8gtkrc%2F2018%2F004510%2F025%2F1489-1491%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004510%2F025%2F1489-1491%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は32歳、女性。上部消化管穿孔術後、2015年から不全型ベーチェット病の診断でプレドニゾロンを内服中であった。2017年3月、穿孔後経過観察中の上部消化管内視鏡で胃前庭部大穹後壁に径15mmの0-IIc病変を認め、生検で印環細胞癌が検出された。胃癌、cT1aN0M0の診断で、適応拡大病変として4月に内視鏡的粘膜下層剥離術(ESD)を施行した。病理結果で粘膜下層への浸潤を認め非治癒切除であったため、6月に追加切除として腹腔鏡下幽門側胃切除(D1+郭清)およびBillroth I再建を施行した。本症例の術前の留意点としては、カプセル内視鏡検査を含め全腸管の潰瘍病変の検索を行ったこと、術中の留意点としては金属ステープラーによる器械刺激で潰瘍形成や縫合不全のリスクが高くなるため再建を手縫い吻合で行ったことである。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20181022460040&doc_link_id=%2Fab8gtkrc%2F2018%2F004510%2F041%2F1536-1538%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004510%2F041%2F1536-1538%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は59歳、女性。健康診断で異常所見を指摘され施行した上部消化管内視鏡で胃前庭小彎側に2型腫瘤を認め、当院へ紹介受診となった。精査で進行胃癌[L、less、type 2、tub1、cT3N2H0P0M1(LYM:#16、Virchow)、Stage IV]と診断した。S-1(80mg/m2、day 1〜21)/CDDP(60mg/m2、day 8)(3週投与2週休薬)を開始し、4コース施行後の評価でcT3N1H0P0M0、Stage IIIAと判断した。開腹幽門側胃切除(D2郭清)およびB-I再建+#16サンプリング(#16b1lat、#16a2int)を施行した。病理結果はL、less、type 1、por1/2、pT2N2H0P0M0CY0(#16b1lat、#16a2intにも転移を示す所見なし)、pStage IIIBであった。補助化学療法としてS-1(80mg/m2、day 1〜28)(4週投与2週休薬)を開始した。術後6ヵ月(S-1 3コース施行後)のcomputed tomography(CT)で#16b1int腫大あり、リンパ節再発の診断でweekly paclitaxel(80mg/m2、day 1、8、15)(3週投与1週休薬)に変更した。術後1年3ヵ月(weekly paclitaxel 9コース施行後)の画像評価で腫大リンパ節は消失し、complete responseと判断した。術後5年9ヵ月(weekly paclitaxel 54コース)まで施行し化学療法を中止した。術後6年0ヵ月現在、無再発で外来通院中である。今回、傍大動脈リンパ節転移を伴う進行胃癌に対して集学的治療が奏効し長期生存を得られた1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20181022460042&doc_link_id=%2Fab8gtkrc%2F2018%2F004510%2F043%2F1543-1545%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004510%2F043%2F1543-1545%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

Although chemotherapy is the standard treatment for unresectable advanced gastric cancer, its prognosis is poor and the median survival time is only around 10 months. With some literature consideration, we report that ovarian metastasis triggered the diagnosis of unresectable advanced gastric cancer with long-term survival through multidisciplinary treatment. This is the case of a 69-year-old woman, who was diagnosed with ovarian tumor and underwent right extracorporectomy and omentum resection in 2011. Pathological diagnosis suspected adenocarcinoma. In February 2012, EGD found a type 4 tumor in the upper portion of the pyloric area of the stomach. She was diagnosed with gastric cancer with Stage IV(T4aN0M1 [ovary])ovarian metastasis. Because the primary tumor was HER2 positive, XP plus HER therapy(capecitabine 1,000mg/m2 twice a day for 14 days, CDDP 80mg/m2 every 3 weeks on the first day, and trastuzumab 8 mg/kg every 3 weeks on the first day)was administered since March 2012. No metastasis was found in the imaging examination after 8 courses of chemotherapy, and we also confirmed the reduction of the primary tumor in the EGD. Based on the images, primary resection was already possible. In December 2012, after a diagnostic laparoscopy, total gastrectomy with D2 lymph node dissection was performed. Postoperative pathology was diagnosed as Stage IV(pT4aN0M1). To control postoperative micrometastasis, capecitabine therapy(1,000mg/m2 twice a day for 14 days)was administered for 12 months starting from February 2013. Then, recurrence and metastasis were not observed during follow-up. However, in January 2017, a circumstellar stenotic tumor was found in the rectum and was diagnosed as recurrence of peritoneal dissemination through images. In February 2017, artificial ostomy(in the sigmoid colon, double-mouth type)was made. Then, the patient underwent an outpatient chemotherapy, with hospital visits, and she survives.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 59-year-old woman was diagnosed with advanced gastric cancer with para-aortic and Virchow's lymph node metastases (L, Less, type 2, tub1, cT3N2H0P0M1[LYM: #16, Virchow's]). Four courses of S-1(80mg/m / 2, days 1-21)and CDDP(60mg/ m2, day 8)were administered. After the chemotherapy, CT showed that the primary tumor and para-aortic and Virchow's lymph nodes had reduced in size. The clinical stage was ycT3N1H0P0M0, stage III A. The patient underwent distalgastrectomy, D2 dissection, and sampling of the para-aortic lymph nodes(#16b1lat, #16a2int). The pathological diagnosis was L, less, type 1, por1/2, pT2N2H0P0M0CY0, pStage III B. The patient was treated with S-1(80mg/m2, days 1-28)as adjuvant chemotherapy. After 3 courses had been administered(6 months after the resection), swelling of a para-aortic lymph node (#16b1int)was detected using CT. Based on the diagnosis of recurrence in the lymph node, weekly paclitaxel(80mg/m2, days 1, 8, and 15)was administered. After receiving 9 courses of weekly paclitaxel, the swelling of the lymph node disappeared, and the response evaluation was complete response. She discontinued the chemotherapy 5 years and 9 months after the surgery. To date, she has survived more than 6 years after surgery without recurrence. We report a long-surviving patient with advanced gastric cancer with para-aortic lymph node metastasis who received combined modality therapy.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

We report of a long-surviving patient with retroperitoneal liposarcoma that required 6 surgeries in 16 years. A 62-year-old man was diagnosed with liposarcoma, which was first excised in 2001. Thereafter, we excised recurrences in the retroperitoneum with the left kidney in February 2004. We excised recurrences with the left half of the colon in November 2007 and February 2010 and recurrences with a part of the intestine in November 2014. This time, we excised recurrences under the right abdominal rectus muscle and near the left half of the colon. The pathological diagnosis was well-differentiated liposarcoma. There is currently no evidence of recurrence 16 years after the first recurrence excision. In this case, active excision of recurrences and identification of high-grade dedifferentiated-type liposarcomas were factors of long survival.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 32-year-old woman with a history of undergoing upper gastrointestinal surgery was administered prednisolone for abortive Behçet's disease since 2015. In March 2017, upper gastrointestinal endoscopy revealed a 0-IIc type early stage gastric carcinoma at the posterior wall of the gastric antrum. The pathological diagnosis was signet-ring cell carcinoma. This gastric carcinoma was classified as cT1aN0M0; therefore, endoscopic submucosal dissection(ESD)was performed for the expanded indication lesion in April 2017. The pathological diagnosis after ESD indicated the need for non-curative resection; thus, laparoscopy-assisted distal gastrectomy and Billroth I anastomosis were performed in July 2017. A transient anastomotic structure was admitted after this surgery, but she was discharged from the hospital lighthearted. A preoperative important aspect was the careful examination of all intestinal tracts for ulcer lesions, and an intraoperative important aspect was hand-sewn anastomosis because using a metallic stapler conferred a high risk of ulcer lesions and suture failure. We encountered a case wherein laparoscopy-assisted distal gastrectomy was performed in a patient with abortive Behçet's disease, early stage gastric carcinoma, and a history of undergoing upper gastrointestinal surgery.

PubMed

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は62歳、男性。2001年に脂肪肉腫の診断で初回手術を施行、その後5回再発を認め、2004年2月下行結腸外側の腫瘍摘出術および左腎臓摘出術、2007年11月左総腸骨動脈周囲の腫瘍摘出術、2010年2月S状結腸下行結腸移行部の腫瘍摘出術、2014年11月左側結腸腫瘍摘出術および結腸左半切除術と小腸部分切除術を施行した。病理結果は主に高分化型であった。今回、2016年11月経過観察中の腹部CT検査で右腹直筋下と左半結腸切除部近傍に軟部組織腫瘤を認めた。脂肪肉腫再発の診断で手術の方針となった。右腹直筋下腫瘤と左半結腸切除部近傍の腫瘤摘出術を行い、病理結果では高分化型脂肪肉腫再発と診断された。初回手術から16年以上が経過した現在生存中である。本症例では、術後複数回の局所再発を認めたが積極的な再切除を行ったこと、また組織学的に悪性度の低い高分化型を多く認めたことが長期生存を得られた要因と考える。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20181022460030&doc_link_id=%2Fab8gtkrc%2F2018%2F004510%2F031%2F1507-1509%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004510%2F031%2F1507-1509%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は74歳、女性。検診のCTで肝腫瘤を指摘された。精査の結果、盲腸癌を認め、肝腫瘤は肝転移と肝嚢胞腺癌の鑑別が困難であった。原発巣に対する手術を先行する方針とし、腹腔鏡下回盲部切除術を施行した。病理診断で主組織型は粘液癌であり、病期はT3N2H1P0M1a、Stage IVであった。CEA上昇もあり、肝転移と考えCapeOX+bevacizumab療法を開始したが、Grade 2の有害事象を認め本人の希望により2コースで中止した。Gd-EOB-DTPA造影MRIでは、腫瘍はT1WI低信号、T2WI高信号の多房性分葉状の形態を示し、有意な造影増強効果はなかった。大腸癌肝転移としては非典型的な所見であり、診断加療目的に肝S6部分切除を施行した。病理の結果、原発巣と同様に粘液癌主体であり、大腸癌肝転移と診断した。今回われわれは、肝嚢胞腺癌との鑑別に難渋した大腸癌肝転移の1例を経験したので報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20181022460033&doc_link_id=%2Fab8gtkrc%2F2018%2F004510%2F034%2F1516-1518%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004510%2F034%2F1516-1518%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

症例は62歳男性。既往歴に高血圧、糖尿病、心筋梗塞、心房細動があった。2012年7月、突然の心窩部痛と嘔吐を認め、当院へ救急搬送された。血液検査では代謝性アシドーシス、腹部造影CTでは上腸間膜動脈領域の血流障害と腸管拡張を認めた。上腸間膜動脈閉塞症と診断し、同日緊急手術を施行した。術中所見では、Treitz靱帯より30cmの空腸から上行結腸口側1/3までの腸管が広範に壊死していたため、小腸亜全摘と回盲部切除を行った。術後は短腸症候群による重度の下痢と栄養障害を認めたが、NSTの早期介入とグルタミン・ファイバー・オリゴ糖(GFO)療法を中心とした栄養療法を行い、術後65日で完全経口栄養が可能となった。残存小腸が50cm未満の短腸症候群では、経口摂取のみでの栄養維持が困難であるとされているが、今回われわれは残存小腸30cmで完全経口栄養が可能となった短腸症候群の1例を経験したため、文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01499&link_issn=&doc_id=20190603300008&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001571%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001571%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: The tight junction protein claudin is abnormally regulated in several human cancers. In particular, claudin-4 is frequently overexpressed in several neoplasias, including breast, pancreatic, ovarian, and prostate cancers. This study examined the relationship of the relative expression of the claudin-4 gene to the clinicopathological factors and outcomes in patients with colorectal cancer (CRC). Methods: We studied surgical specimens of cancer tissue and adjacent normal mucosa obtained from 202 patients with untreated CRC. The relative expression of claudin-4 mRNA in cancer and in normal adjacent mucosa was measured by quantitative real-time reverse-transcriptase polymerase chain reaction. Results: The claudin-4 expression was higher in cancer tissue than in adjacent normal mucosa. The claudin-4 expression was related to the cancer location. The overall survival at five years differed significantly between patients with a high claudin-4 expression and those with a low expression. Conclusion: The overexpression of claudin-4 was considered a useful predictor of outcomes in patients with CRC.

DOI： 10.4993/ACRT.26.82

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background/Aim: Postoperative delirium is a common complication which is associated with increased postoperative mortality and morbidity. The aim of this study was to evaluate the incidence and predictors of postoperative delirium using data from a phase II clinical trial. Patients and Methods: We analyzed the cases that were enrolled in randomized clinical trial to evaluate TJ-54 (Yokukansan, a traditional Japanese medicine [Kampo]) for the prevention and/or treatment of postoperative delirium (UMIN000005423). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was used to diagnose postoperative delirium. Results: A total of 167 patients were registered, delirium was observed in 9% of them. High age over 80 and low MMSE less than 27 were identified as significant independent risk factors. Conclusion: Surgeon should pay attention to the possible development of postoperative delirium in patients aged over 80 with a low MMSE less than 27 in performing surgery for gastrointestinal malignancies.

DOI： 10.4993/acrt.26.95

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The present study investigated the impact of the lymph node ratio (LNR) on survival and recurrence in patients with pancreatic cancer after curative surgery followed by adjuvant chemotherapy. PATIENTS AND METHODS: This study included 189 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: A lymph node ratio of 0.1 was considered to be the optimal cut-off point for classification based on the 3-year and 5-year survival rates. The OS rates at three and five years after surgery were 34.4% and 28.2% in the LNR <0.1 group, respectively, and 23.1% and 5.8% in the LNR ≥0.1 group, which amounted to a statistically significant difference (p=0.003). The RFS rates at one and three years after surgery were 26.6% and 20.5% in the LNR <0.1 group, respectively, and 8.0% and 0% in the LNR ≥0.1 group, which was a significant difference (p=0.001). A multivariate analysis demonstrated that the LNR was a significant independent risk factor for both the OS and RFS. CONCLUSION: The LNR was a risk factor for overall survival in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. It is necessary to develop strategies to effectively utilize the lymph node metastasis status.

DOI： 10.21873/anticanres.12801

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Previous studies have shown that laparoscopic colorectal cancer surgery is highly safe and effective compared to laparotomy. However, whether laparoscopic colorectal cancer surgery can be safely performed in patients with severe comorbidities remains unclear. The aim of this study was to evaluate the safety of laparoscopic colorectal cancer surgery in patients with severe comorbidities. PATIENTS AND METHODS: A total of 82 consecutive patients with colorectal cancer who underwent laparoscopic surgery were retrospectively divided into two groups according to whether they had severe comorbidity (50 patients) or non-severe comorbidity (32 patients). An age-adjusted Charlson comorbidity index of ≥6 was defined as severe comorbidity. RESULTS: Operative time, blood loss, and rate of conversion to laparotomy did not differ between the groups. Postoperative complications and the length of the postoperative hospital stay also did not differ significantly between the groups. CONCLUSION: Laparoscopic colorectal cancer surgery is feasible and safe, even in patients with severe comorbidities.

DOI： 10.21873/anticanres.12659

PubMed

researchmap

Language：Japanese   Publisher：横浜市立大学医学会  

症例は68歳、女性。2017年7月、右鼠径部腫瘤を主訴に当科受診した。現病歴は、2007年からの右鼠径部の膨隆を自覚していたが、経過観察していた。今回、2017年7月ごろから腫瘤の増大を認めたため受診となった。来院後の検査所見のComputed tomography(以下CT)で右鼠径部の嚢胞性病変を認めた。嚢胞は内部均一であり腹腔内との交通を認めないことからNuck管水腫の診断となった。本症例では腹腔内との連続を認めずヘルニアの合併も否定できないため前方アプローチによる手術を選択した。手術所見は外鼠径輪から突出する形で弾性軟な嚢胞性腫瘤を認め、嚢胞は腹腔内との連続性は認めなかった。子宮円索を高位結紮し切離して腫瘤を摘出、内ヘルニア門は1横指弱であり補強目的にmesh-plug法を施行した。病理組織学的所見でもNuck管水腫であり、子宮内膜症や癌の合併は認めなかった。Nuck管水腫はまれな疾患であり、その発生頻度は女児で0.1%と推定されている。またその多くは思春期までの小児期に診断されており成人での報告はさらに少ない。今回成人女性に発生したNuck管水腫は、きわめて珍しい症例であり、文献的考察と合わせて報告する。(著者抄録)

researchmap

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01499&link_issn=&doc_id=20180718460002&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001339%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001339%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.26.17

Scopus

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Yokohama City University  

A 68-year-old woman presented to our department with a eomplaint of right inguinal swelling. She had a 10-year history of right inguinal swelling. She came to our hospital because the mass was increasing in size over the last month. Computed tomography showed a right inguinal, homogeneous, cystic mass without communication to the peritoneal cavity. Surgery was performed with a diagnosis of a hydrocele of the canal of Nuck. On intraoperative examination, the cystic mass did not connect to the peritoneal cavity. The mass was resected, and the internal inguinal ring was closed with a mesh-plug by the anterior approach. On histopathology, the diagnosis was a hydrocele of the canal of Nuck with no malignancy and no endometriosis. A hydrocele of the canal of Nuck is rare and occurs in children before adolescence, but it is much rarer in adults. A rare case of an adult hydrocele of the canal of Nuck is reported.

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.26.46

Scopus

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Verlag  

Purpose: The purpose of this study was to identify the size criteria of lateral lymph node metastasis in lower rectal cancer both in patients who underwent preoperative CRT and those who did not. Methods: This study enrolled 150 patients who underwent resection for primary lower rectal adenocarcinoma with lateral lymph node dissection between 2013 and 2015. Patients were divided into two groups: the CRT group, treated with preoperative chemoradiotherapy before surgery, and the non-CRT group, treated with surgery alone. The short-axis diameter of each dissected lateral lymph node was measured. Receiver-operating characteristic curves were generated to reveal the optimal cutoff values for determining lateral lymph node metastasis in both groups. Results: In the non-CRT group (n = 131), the ROC curve demonstrated that the optimal cutoff value for determining metastasis was 6.0 mm, with a sensitivity of 78.5% and specificity of 82.9%, and the AUC was 0.845. In comparison, in the CRT group (n = 19), the optimal cutoff value was 5.0 mm, with a sensitivity of 71.4% and specificity of 85.3% and an AUC of 0.836. Conclusion: The cutoff size for determining lateral lymph node metastasis was smaller in the CRT group than in the non-CRT group.

DOI： 10.1007/s00384-017-2873-x

Scopus

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。胃癌(L.、less、type2、tub1、cT3、cN0、cH0、cP0、cM0、CY0、cStage IIA)の診断で、胃切除の治療方針となった。手術は幽門側胃切除術(D2郭清)およびBillroth I法再建を施行した。病理結果はML、less、type2、tub1、pT3、ly:1、v:1、N0、H0、P0、M0、CY0、pStage IIAであった。術後補助療法は施行せず、外来経過観察となった。術後5年目の腹部造影CT検査で臍部での再発を疑われ、生検の結果、胃癌臍転移の診断となった。再発後、S-1(80mg/m2、day 1〜21)/CDDP(60mg/m2、day 8、3週投与2週休薬)を7コース投与したが、有害事象(下痢:Garde 3)のため中止となった。その後、paclitaxel(80mg/m2、day 1、8、15:3週投与1週休薬)を33コース施行した。臍転移は画像上CRとなり、他臓器への転移もみられなかった。再発後3年以上経過した現在も外来通院中である。今回、化学療法が奏効し長期生存が得られた胃癌術後臍転移の1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00296&link_issn=&doc_id=20171221480115&doc_link_id=%2Fab8gtkrc%2F2017%2F004412%2F115%2F1393-1395%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2017%2F004412%2F115%2F1393-1395%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Para-aortic lymph node (PALN) metastasis from colorectal cancer is rare and often not suitable for surgery. However, in selected patients, radical resection may bring about longer survival. The aim of this study was to evaluate long-term outcomes of resection of left-sided colon or rectal cancer with simultaneous PALN metastasis.
The study included 2122 patients with left-sided colon or rectal cancer (30 patients with and 2092 patients without PALN metastasis) who underwent resection with curative intent between 2002 and 2013. Clinicopathological characteristics, long-term outcomes of resection, and factors related to poor postoperative survival in patients with PALN metastasis were investigated.
Of a total of 2122 total patients, 16 of 50 patients (32.0%) with lymph node metastasis at the root of the inferior mesenteric artery had PALN metastasis. The 5-year overall survival rates for 18 patients who underwent R0 resection and 12 patients who did not were 29.1 and 10.4%, respectively (p = 0.017). Factors associated with poor postoperative survival among patients who underwent R0 resection were presence of conversion therapy, lack of adjuvant chemotherapy, carcinoembryonic antigen &gt; 20 ng/mL, and lateral lymph node metastasis in rectal cancer patients. The 5-year recurrence-free survival rate was 14.8%.
Although recurrence was frequent, R0 resection for left-sided colon or rectal cancer with PALN metastasis was associated with longer survival than R1/R2 resection. Furthermore, the 5-year overall survival rate in the R0 group was relatively favorable for stage IV. Therefore, R0 resection may prolong survival compared with chemotherapy alone in selected patients.

DOI： 10.1007/s00384-017-2806-8

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Background The therapeutic benefits of extraperitoneal colostomy with laparoscopic surgery remain unclear. The aim of this study was to investigate the relationship between the route for stoma creation with laparoscopic surgery and stoma-related complications, especially parastomal hernia (PSH).
Methods From January 2007 to March 2015, a total of 59 patients who underwent laparoscopic abdominoperineal resection or Hartmann procedure were investigated. Patient demographic and treatment characteristics, including stoma-related complications, were analyzed retrospectively.
Results Transperitoneal and extraperitoneal colostomy were performed in 29 and 30 patients, respectively. Median follow-up duration was 21 months (range: 2-95). Patient demographic and treatment characteristics were comparable between the transperitoneal group (TPG) and the extraperitoneal group (EPG). PSH developed in 12 (41 %) patients in TPG, and 4 (13 %) patients in EPG (p = 0.020). The incidence of other stoma-related complications and non-stoma-related complications did not differ significantly between TPG and EPG. No patient characteristics except for transperitoneal route for stoma creation were associated with PSH development.
Conclusions The extraperitoneal route for stoma creation is associated with a significantly lower incidence of PSH development after laparoscopic surgery. Whenever possible, extraperitoneal colostomy should be recommended, even with laparoscopic surgery.

DOI： 10.1007/s00464-016-5198-x

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The short-term outcomes of laparoscopic-assisted surgery for colorectal cancer (LAC) have not been fully evaluated in elderly patients. The aim of this study was to compare the short term surgical outcomes of LAC between the patients older than 75 years and those with non-elderly patients. METHODS: This retrospective multi-institutional study selected patients who underwent LAC between April 2013 and March 2014 at Yokohama City University Hospital and its related general hospitals. The patients were categorized into two groups: elderly patients (>75 years of age: group A) and non-elderly patients (<75 years of age: group B). Surgical outcomes and post operative complications were compared between the two groups. RESULTS: A total of 237 patients were evaluated in the present study. Eighty-four patients were classified into group A, and 153 into group B. Preoperative clinicopathological outcomes demonstrated no significant differences except for the ASA score. When comparing the surgical outcomes between group A and group B, the rate of conversion to open procedure (3.6% vs 5.2%, P = 0.750), median operation time (232 min vs 232 min, P = 0.320), median blood loss (20 ml vs 12 ml, P = 0.350). The differences were not significantly different in the surgical outcomes. The incidences of > grade 2 post operative surgical complications were similar between two groups ((19.0% vs 15.7%, p = 0.587). No mortality was observed in this study. The length of postoperative hospital stay was also similar (10 days vs 10 days, p = 0.350). CONCLUSIONS: The present study suggested that LAC is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for colon cancer surgery.

DOI： 10.1186/s12893-017-0229-7

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Gastroenterological Surgery  

Purpose: To clarify the relationship between prophylactic antibiotics and perineal wound infection by examining the causative bacteria and risk factors for perineal wound infection following abdominoperineal resection (APR) for rectal and anal canal cancer. Methods: We examined causative bacteria in 43 patients given a diagnosis of perineal wound infection among 173 patients who underwent APR between October 2002 and November 2013. The prophylactic antibiotic given during this period was cefmetazole (CMZ), which was converted to ampicillin/ sulbactam (ABPC/SBT) from November 2013. Next, we analyzed risk factors for perineal wound infection in 203 patients treated between October 2002 and April 2015 through univariate and multivariate analyses. Results: The most common causative bacteria in perineal wound infections were Staphylococcus species in 72.1% of cases, followed by Enterococcus species, which are not susceptible to CMZ, in 34.9%. The incidence of perineal wound infection caused by the type of prophylactic antibiotic was found in 43 patients (24.9%) in the CMZ group and 3 patients (10.0%
P=0.097) in the ABPC/SBT group, indicating a lower tendency in the latter group. The results of multivariate analysis identified age (≥70 years), diabetes (present), and prophylactic antibiotics (CMZ group) as independent risk factors for perineal wound infection. Conclusions: Our findings suggest that the prophylactic antibiotics ABPC/SBT suppress the onset of retroperitoneal space infection to a greater degree than CMZ following APR.

DOI： 10.5833/jjgs.2016.0066

Scopus

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.25.88

Scopus

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

There is a high rate of leakage after laparoscopic lower anterior resection(Lap-LAR).We examined the safety of Lap-LAR at community hospitals.We investigated 54 patients who underwent Lap-LAR at the 10 hospitals related to the Department of Surgery at Yokohama City University between April 2013 and March 2014.T he median patient age was 67 years, and 32 patients were men.Forty -eight(88%)cases were higher than pathological Grade T3, and 37(69%)patients had undergone D3 lymph node dissection.A diverting stoma(DS)was created in 13(24%)patients.An anus drain was placed in 23 (40%)patients.The clinical anastomotic leakage rate(13%)is comparable with the rate of the DS study(12.9%).The rate of anastomotic leakage was acceptable.Lap -LAR at a community hospital could be safely performed for rectal cancer by making appropriate case choices and implementing preventive measures against anastomotic leakage.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Institute of Anticancer Research  

Aim: The aim of this study was to confirm the predictive/prognostic value of the preadjuvant Glasgow Prognostic Score (GPS) and carbohydrate antigen (CA) 19-9 level in pancreatic cancer patients receiving adjuvant gemcitabine (GEM) after surgery. Patients and Methods: A total of 67 resected pancreatic cancer patients, treated with adjuvant GEM, were included. The GPS and CA19-9 level were calculated prior to administration of adjuvant therapy and were found to correlate with the outcomes and rate of early recurrence. Results: An elevated preadjuvant GPS or CA19-9 level was significantly associated with a shorter overall survival (OS) (p=0.003 and p&lt
0.001, respectively). Either an elevated GPS or CA19-9 level predicted early recurrence and the combined use of these two factors improved the ability to predict early recurrence, with a specificity and accuracy up to 0.958 and 0.821, respectively. Conclusion: Both an elevated preadjuvant GPS and CA19-9 level, when used alone, are significant predictors of poor outcomes in pancreatic cancer patients receiving adjuvant GEM. The combined use of these parameters improves the ability to predict early recurrence in such patients.

Scopus

PubMed

researchmap

Language：Japanese   Publisher：Japanese College of Surgeons  

A 44-year-old female was admitted to the hospital complaining of a palpable and painful tumor in her right lower abdomen. Abdominal computed tomography showed an intussusception caused by the tumor in the small intestine. During an emergency operation, the intussusception was observed to have been induced by an invaginated Meckel diverticulum. We resected about 10cm of the small intestine 50cm proximal to the terminal ileum. There was no gastrointestinal tissue found during the pathological examination. We finally diagnosed this patient with an intussusception caused by an inverted Meckelʼs diverticulum including no gastrointestinal tissue, which is a rare case.

DOI： 10.4030/jjcs.40.81

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015308083

Language：Japanese   Publisher：Japan Surgical Association  

Purpose : The purpose of this study was to clarify the disposition status and safety of an internal short stent placed across a pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD).<BR>Patients and Methods : This study retrospectively analyzed 91 patients who had internal short stent placement across the PJ following PD. The disposition of the stent was confirmed by computed tomography (CT). The cumulative rates of the stents remaining, complications due to delayed defecation of the stents, and factors predictive of defecation were analyzed.<BR>Results : The median time to defecation after PD and the cumulative remaining rate at 1 year were 244 days and 47.4%, respectively. There were no independent predictive factors for defecation. Acute pancreatitis occurred in 1 patient, probably associated with migration of the stent in the pancreatic duct, but it was relieved conservatively.<BR>Conclusions : An internal short stent placed across the PJ following PD often remained in the body, but there were no severe complications.

DOI： 10.3919/jjsa.75.3225

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2015126665

Language：Japanese   Publisher：The Japan Society of Coloproctology  

This study was conducted to evaluate the prognostic factors of patients with primary tumor resection in non-resectable stage IV colorectal cancer. One hundred seventy- seven non-curative stage IV cases, who underwent primary tumor resection from 2000 to 2010, were enrolled in this study. In univariate analysis, preoperative CEA(=>5ng/m<I>l</I>), with H2 or 3 liver metastasis, there were more than 2 sites of remote metastasis, venous invasion, no targeted therapy and the overall survival time (OS) was significantly shorter. In multivariate analysis, with H2 or 3 liver metastasis, there were more than 2 sites of remote metastasis, no targeted therapy and there were independent poor prognostic factors in non-resectable stage IV colorectal cancer with primary tumor resection. In subgroup analysis, OS was improved in patients with H2 or 3 liver metastasis by using targeted therapy, but not improved in H0 or 1 liver metastasis. Targeted therapy may improve prognosis in patients with non-resectable stage IV colorectal cancer, in particular those who have advanced liver metastasis.

DOI： 10.3862/jcoloproctology.66.585

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2013331554

Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Background: We evaluated the methylation patterns of histone H3 lysine 27 (H3K27), H3 lysine 36 (H3K36) and the expression of H3K27 methylase EZH2 in patients with colorectal carcinomas with metachronous liver metastasis to search for biomarkers identifying these patients.
Methods: Double 2-mm core tissue microarrays were made from 54 paraffin-embedded samples of primary colorectal adenocarcinomas and corresponding liver metastases and examined using an immunohistochemical analysis of dimethylation and trimethylation in H3K27, H3K36 and EZH2. Positive tumor cell staining for each histone modification (H-score) was used to classify patients into low- and high-staining groups, which were then examined to identify any correlations between the clinicopathological parameters and the clinical outcomes.
Results: The H-scores of H3K27me2 were lower in the liver metastases than in the corresponding primary tumors, while the H-scores of H3K36me2 were higher in the liver metastases than in the corresponding primary tumors (P &lt; 0.001). H3K27me2 in the primary tumors correlated with tumor size (P = 0.016), H3K36me2 in the primary tumors correlated with histological type (P = 0.038), and H3K36me3 in the primary tumors correlated with lymph node metastasis (P = 0.017). In addition, lower levels of H3K27me2 in the primary tumors correlated with poorer survival rates (P = 0.039). The multivariate survival analysis showed that the H3K27me2 status is an independent prognostic factor for colorectal cancer patients (P = 0.047).
Conclusions: Our findings suggest that the methylation level of H3K27me2 detected with immunohistochemistry may be an independent prognostic factor for metachronous liver metastasis of colorectal carcinomas. (C) 2013 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2013.02.023

Web of Science

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Yokohama City University  

This study was conducted to evaluate the prognostic factors in cases of primary tumor resection for stage IV colorectal cancer. Two hundred forty-four stage IV patients who underwent primary tumor resection during 2000 to 2010 were enrolled in this study. The background factors included 171 cases of colon cancer, 73 of rectal cancer, 173 of liver metastasis (38 of H3 liver metastasis), 55 of lung metastasis, 70 of peritoneal dissemination, 14 of other remote metastasis (remote lymph nodes, bones, adrenal glands, brain), and 72 cases with more than 2 sites of remote metastasis. The survival rate was 34.2% in 3 years, 19.4% in 5 years, and the median survival time was 707 days. In univariate analysis, macroscopic types other than types 1 or 2, regional lymph node metastasis, H3 liver metastasis, lung metastasis, cases with more than 2 sites of remote metastasis, and Cure C cases, overall survival time (OS) was significantly shorter. In multivariate analysis, regional lymph node metastasis, H3 liver metastasis, more than 2 sites of remote metastasis, Cure C cases were independently poor prognostic factors in stage IV colorectal cancer with primary tumor resection. Curative resection may be associated with longer OS in stage IV colorectal cancer.

Scopus

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Yokohama City University  

Aim: The aim of this study was to clarify the usefulness of anti-EGFR antibody for metastatic colorectal cancer in our department. Patients and Methods: A total of 64 patients (39 receiving cetuximab and 25 receiving panitumumab) who were treated with anti-EGFR antibody between 2009 and 2012 were enrolled in the study. The treatment results were retrospectively evaluated. Results: Twenty-four patients received first-line therapy
14, second-line therapy
and 26, third-line or later therapy. Response rate was 34. 7%, disease control rate was 61. 2%, and progression-free survival was 6. 0 months. There was no significant difference in the treatment results between cetuximab and panitumumab (p=0. 89). Conclusion: Treatment with anti-EGFR-antibody showed a low response rate, but favorable disease control rate and safety.

Scopus

researchmap

Language：Japanese   Publisher：The Japan Society of Coloproctology  

The aim of this study was to clarify the risk factors associated with recurrence in Stage IIIa colon and rectosigmoid cancer. Method: A retrospective review of 236 cases of grossly radical colectomy for Stage IIIa colon and rectosigmoid cancer during the period between 1990 and 2007.<BR>Results: The overall recurrence rate was 22.0% (52/236 cases). Univariate analysis identified three risk factors for recurrence: preoperative CEA (>=5.0 ng/m<I>l</I>) (p=0.033), size of tumor (>=40mm) (p=0.042), and depth of tumor invasion (>=SE) (p=0.008). Multivariate analysis selected three dependent risk factors for recurrence: presence of venous invasion, presence of lymphatic invasion, and depth of tumor invasion (>=SE) (HR 1.830, 2.316, 2.156, 95% CI 1.009-3.320, 1.206-4.449, 1.204-3.863, p=0.0467, 0.0117, 0.0098). Conclusion: This study suggested that we should consider active postoperative adjuvant chemotherapy such as oxaliplatin for Stage IIIa colon and rectosigmoid cancer with venous invasion, lymphatic invasion, or tumor depth of SE or SI.

DOI： 10.3862/jcoloproctology.66.157

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2013169235

Language：English   Publishing type：Research paper (scientific journal)  

Background: To search for biomarkers identifying pancreatic cancer patients likely to benefit from adjuvant gemcitabine chemotherapy, we investigated the status of several histone modifications in pancreatic tumors and their relationship to clinicopathological features and outcomes. Methods: Sixty one pancreatic cancer patients, primarily treated by surgical removal of tumors, were involved in the study. Thirty patients completed postoperative adjuvant gemcitabine, and in 31 it was discontinued. Tumor specimens were examined using immunohistochemistry for di- and tri-methylation of histone H3 lysine 4 (H3K4me2 and H3K4me3), dimethylation and acetylation of histone H3 lysine 9 (H3K9me2 and H3K9ac), and acetylation of histone H3 lysine 18 (H3K18ac). Positive tumor staining for each histone modification was used to classify patients into low- and high-staining groups, which were examined for relationships to clinicopathological features and clinical outcomes. Results: High expression of H3K4me3 was related to the well and moderately differentiated tumor histological type (p = 0.012) and low expression of H3K4me2 was related to the presence of perineural invasion (p = 0.007). No cellular histone modifications were associated with overall or disease-free survival of patients as a whole. In the subgroup analyses, a low level of H3K4me2 was significantly associated with worse disease free survival in patients that completed adjuvant gemcitabine (p = 0.0239). Univariate and multivariate hazard models also indicated that a low level of H3K4me2 was a significant independent predictor of disease-free survival (p = 0.007). Conclusion: H3K4me2 was found to be a predictor of response to adjuvant gemcitabine in Asian patients with pancreatic cancer. © 2012 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2012.08.008

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The phosphatase of regenerating liver-3 (PRL-3) is over expressed in several human cancers and associated with tumor progression, invasion and metastasis. However, the correlation between PRL-3 expression and clinical outcome in colorectal cancer (CRC) has not been investigated. This study examined the relationship between the relative expression of the PRL-3 gene to the clinicopathological factors and outcomes in patients with CRC. Methodology: Surgical specimens of cancer tissue and adjacent normal mucosa. were obtained from 202 patients with untreated CRC. The relative expression level of PRL-3 mRNA in cancer and in the normal adjacent mucosa was measured using the quantitative real-time reverse-transcriptase PCR. Results: PRL-3 expression was higher in cancer tissue than in the adjacent normal mucosa. The tumor location and liver metastasis were found to be related to the PRL-3 expression level. The overall survival differed significantly between patients with high PRL-3 expression and those with low expression. Conclusions: High expression of the PRL-3 gene might be a useful predictor of poor postoperative outcome in patients with CRC.

DOI： 10.5754/hge11996

Web of Science

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT INST ANTICANCER RESEARCH  

Pancreatic metastasis from colorectal cancer is rare, and accounts for less than 2% of all pancreatic metastases. There have been no studies that have reported the differences in the sensitivity to chemotherapy between the primary lesion and the pancreatic metastasis in colorectal cancer. We experienced a rare example of pancreatic metastasis from colorectal cancer, and report here the difference in the sensitivity to the antitumor drug. A 68-year-old female underwent colectomy for rectal carcinoma with a mass in the pancreatic tail and the liver. The patient also underwent a distal pancreatectomy and a segmental liver resection at the same time. v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) and tumor protein 53 (TP53) gene mutation analyses, in addition to the histopathological examinations, revealed tumors of the liver and the pancreatic tail as being metastases from the primary carcinoma. We employed a collagen gel droplet-embedded culture drug sensitivity test for both the primary lesion and the pancreatic metastasis. The sensitivity to oxaliplatin and FOLFOX (5-flurouracil, folinic acid and oxaliplatin) were lower in the pancreatic metastasis compared to the primary lesion. In conclusion, pancreatic metastasis from colorectal malignancy is rare, and the present results suggest that there are potential differences in the sensitivity to chemotherapy between the primary colorectal tumor and its pancreatic metastasis.

Web of Science

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

The clinical efficacy and safety of CPT-11+CDDP therapy were studied retrospectively in 34 patients with advanced and recurrent gastric cancer. The overall response rate was 5. 9%; MST was 209 days. The adverse effects observed were grade 3 in 7 patients(20. 6%). CPT-11+CDDP therapy could be useful and safe as third-line chemotherapy.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

researchmap

Language：Japanese   Publisher：(一社)日本胃癌学会  

researchmap

Language：Japanese   Publisher：(株)癌と化学療法社  

今回われわれは、根治切除不能胃癌に対しS-1+docetaxel(DOC)を先行投与し、根治切除し得た3症例を経験したので報告する。S-1+DOC併用療法のレジメンはS-1(80mg/m2 day 1〜7、day 15〜21)、DOC(40mg/m2 day 1、15)とし、2コースごとに評価を行い切除可能と診断された症例に対し手術を施行した。症例1:73歳、男性。cT4a、No.11pにbulkyなリンパ節腫大を認め根治切除不能と診断した症例に対し、S-1+DOC併用療法を2コース施行後、原発巣縮小と著明なリンパ節縮小を認め、胃全摘術を施行。根治度A、組織学的治療効果判定はGrade 1bであった。症例2:65歳、男性。cT4a、No.12aにbulkyなリンパ節腫大を認め根治切除不能と診断した症例に対し、S-1+DOC併用療法を2コース施行後、原発巣縮小とリンパ節の著明な縮小が得られ、幽門側胃切除術を施行。根治度B、組織学的治療効果判定はGrade 2であった。症例3:76歳、女性。cT4b(panc)で切除不能と診断した症例に対し、S-1+DOC併用療法を4コース施行し、原発巣がcT4aとなったため胃全摘術を施行。根治度B、組織学的治療効果判定はGrade 1bであった。根治切除不能胃癌に対するbiweekly S-1+DOC併用療法は有用な治療法の一つであると考えられた。(著者抄録)

researchmap

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20110317470021&doc_link_id=%2Fab8gtkrc%2F2011%2F003803%2F021%2F0443-0448%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2011%2F003803%2F021%2F0443-0448%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

We report three cases of advanced gastric cancer successfully treated by combination therapy of S-1 and docetaxel (DOC). We administered S-1 orally at 80 mg/m² on days 1 to 7 and days 15 to 21, and DOC intravenously at 40 mg/m² on day 1 and 15, and evaluation was conducted every two courses. Case 1: A 73-year-old man with gastric cancer of cT4a, accompanied with bulky N2 lymph node metastasis, was treated with two courses of S-1 and DOC. Partial response was confirmed, followed by total gastrectomy, which revealed his histological grade to be 1b. Case 2: A 65-year-old man with gastric cancer of cT4a, accompanied with bulky lymph node metastasis, was treated with two courses of S-1 and DOC. Partial response was confirmed, followed by distal gastrectomy, which revealed his histological grade to be 1b. Case 3: A 76-year-old woman with gastric cancer of cT4b (panc), was treated with four courses of S-1 and DOC. After that, the main tumor was judged to be cT4a, followed by total gastrectomy, which revealed her histological grade to be 1b. Combined S-1 and DOC chemotherapy is an effective regimen for the treatment of unresectable gastric cancer.

PubMed

researchmap

Language：Japanese   Publisher：The Japan Society of Coloproctology  

The subject was a 56-year-old female. Ulcerative colitis was found when she was 33 years old. In September 2005, abdominoperineal resection with ileostomy was performed for rectal cancer. The pathological examination showed pAI (vagina), pN2, ly2, v3 and pM1 (bilateral inguinal nodes) stage IV. FOLFIRI therapy was performed for bilateral inguinal node metastases. Within four months, the subject showed complete remission and serum CEA level was normalized. Chemotherapy was continued thereafter, but tumor markers were elevated. Therefore, PET was performed in August 2007. The results showed a high-accumulation area in the adductor of the left thigh. Adenocarcinoma was diagnosed by aspiration biopsy cytology, and rectal cancer metastasis to the left thigh was diagnosed. Excision of the tumor together with the adductor of the left thigh was performed. Pathologically, it was low differentiated adenocarcinoma and was diagnosed as metastasis from rectal cancer. After surgery, the CEA was normalized and the subject has survived without relapse (27 months after excision of metastasis to the left thigh). We report this rare case of metastasis of colon cancer to skeletal muscle.

DOI： 10.3862/jcoloproctology.64.24

CiNii Books

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：日本外科系連合学会  

researchmap

Language：Japanese   Publisher：(一社)日本胃癌学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Gastroenterological Surgery  

Introduction: The effect of subcutaneous Penrose drain(PD)insertion in superficial surgical site infection(s-SSI)has not been reported comprehensively. To evaluate effectiveness, we implanted the PD subcutaneously in all cases at high s-SSI risk. Materials and Methods: From April to August 2008, all cases at high s-SSI risk, i.e.) classified into wound class III or IV, or II accompanied by at least 20-mm-thick subcutaneous fat, were subjected to subcutaneous PD implantation and checked for s-SSI occurrence based on risk, wound class, and their totality, followed by comparison with the incidence from November 2007 to March 2008. Results: From April to August 2008, 50 high-risk subjects had a s-SSI incidence of 8.0%. Previous s-SSI incidence from November 2007 to March 2008 was 42.6%. Prophylactic subcutaneous drainage thus significantly decreased in high-risk patients at high risk(p&lt
0.001)and in each classified group and totality, i.e.) ClassII: 9.18% vs. 1.87%, p=0.044, ClassIII: 32.0% vs. 6.90%, p=0.032, ClassIV: 50.0% vs. 10.0%, p&lt
0.001, total: 9.91% vs. 1.97%, p&lt
0.001. Conclusion: The Penrose drain, costing just a few dollars, demonstrates definite potential as an effective means for preventing s-SSI. © 2010 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.43.221

Scopus

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 31-year-old woman was admitted to our hospital because of cervical and axillar lymph node swelling. A chest X-ray film showed many nodular shadows and a cavity in the left upper lung field. The tuberculin test was positive. Transbronchial lung biopsy and cervical lymph node biopsy were done. Examination of the biopsy specimens revealed epithelial granulomas with caseous necrosis. Thus, pulmonary tuberculosis with systemic lymph node swelling was diagnosed. Examinations during the patient's hospital stay showed that she was not an immunocompromised host. Pulmonary tuberculosis with systemic lymph node swelling occurs only rarely in a non- immunocompromised host.

Scopus

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.26.31

Scopus

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese  

CiNii Books

researchmap

Other Link： http://search.jamas.or.jp/link/ui/2016286298

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books

researchmap

Language：Japanese   Publisher：一般社団法人日本外科学会  

CiNii Books