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Hirahara N, Matsubara T, Mizota Y, Ishibashi S, Tajima Y. Prognostic value of preoperative inflammatory response biomarkers in patients with esophageal cancer who undergo a curative thoracoscopic esophagectomy. BMC Surg 2016; 16:66. [PMID: 27650456 PMCID: PMC5028997 DOI: 10.1186/s12893-016-0179-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023] Open
Abstract
Background Several inflammatory response biomarkers, including lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been reported to predict survival in various cancers. The aim of this study is to evaluate the clinical value of these biomarkers in patients undergoing curative resection for esophageal cancer. Methods The LMR, NLR and PLR were calculated in 147 consecutive patients who underwent esophagectomy between January 2006 and February 2015. We examined the prognostic significance of the LMR, NLR, and PLR in both elderly and non-elderly patients. We evaluated the cancer-specific survival (CSS), with the cause of death determined from the case notes or computerized records. Results Univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0014), operation time (p = 0.0209), low LMR (p = 0.0008), and high PLR (p = 0.0232) were significant risk factors for poor prognosis. Meanwhile, TNM pStage (p < 0.0001) and low LMR (p = 0.0129) were found to be independently associated with poor prognosis via multivariate analysis. In non-elderly patients, univariate analyses demonstrated that TNM pStage (p < 0.0001), tumor size (p = 0.0001), operation time (p = 0.0374), LMR (p < 0.0001), and PLR (p = 0.0189) were significantly associated with a poorer prognosis. Multivariate analysis demonstrated that TNM pStage (p = 0.001) and LMR (p = 0.0007) were independent risk factors for a poorer prognosis. In elderly patients, univariate analysis demonstrated that that TNM pStage (p = 0.0023) was the only significant risk factor for a poor prognosis. Conclusions LMR was associated with cancer-specific survival (CSS) of esophageal cancer patients after curative esophagectomy. In particular, a low LMR was a significant and independent predictor of poor survival in non-elderly patients. The LMR was convenient, cost effective, and readily available, and could thus act as markers of survival in esophageal cancer.
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Kawabata Y, Tanaka T, Ishikawa N, Hayashi H, Tajima Y. Modified total meso-pancreatoduodenum excision with pancreaticoduodenectomy as a mesopancreatic plane surgery in borderline resectable pancreatic cancer. Eur J Surg Oncol 2016; 42:698-705. [PMID: 26995116 DOI: 10.1016/j.ejso.2016.02.241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A superior mesenteric artery (SMA)-first approach has been considered to be an efficient technique in pancreaticoduodenectomy when the SMA is a factor of borderline resectable pancreatic head cancer (BRPHC). However, this excellent procedure has limitations in terms of tumor resection with an intact coverage including the pancreatic tumor and the tumor-draining lymphovascular systems and the ability to achieve a complete regional lymphadenectomy. METHODS A modified mesenteric plane procedure has been developed that provides improved regional lymphadenectomy and permits adjustment of the surgical approach, which is based on the direction of the tumor infiltration. RESULTS Of 55 patients taken to surgery, 19 had peritoneal dissemination and/or liver metastasis at staging laparoscopy, and the procedure revealed tumor infiltration to the SMA and/or hepatic artery (HA) in 4 patients. Finally, 32 patients with BRPHC have undergone the procedure between April 2009 and June 2015. Twenty-four of 32 patients (75.0%) had negative resection margins, and the median number of lymph nodes harvested was 34. Lymph nodes around the SMA tested positive for metastasis in 13 patients (40.6%), and those around the HA tested positive for metastasis in 7 patients (21.9%). Complications occurred in 14 patients (43.7%), with no perioperative mortality. Overall survival rates were 65.3% at 1 year and 35.2% at 3 years. CONCLUSIONS Short-term results with the procedure may encourage surgical management for BRPHC.
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He Q, Fujimura H, Fukasawa H, Hashimoto R, Honda Y, Ishikawa T, Iwata T, Kaida S, Kasagi J, Kawano A, Kuwasaki S, Maeda K, Masumoto S, Miyabe M, Miyahara F, Mochizuki K, Muramatsu N, Nakamura A, Nawa K, Ogushi S, Okada Y, Onodera Y, Ozawa K, Sakamoto Y, Sato M, Shimizu H, Sugai H, Suzuki K, Tajima Y, Takahashi S, Taniguchi Y, Tsuchikawa Y, Yamazaki H, Yamazaki R, Yoshida HY. Double neutral pion photoproduction off the proton with FOREST at ELPH. EPJ WEB OF CONFERENCES 2016. [DOI: 10.1051/epjconf/201610904004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Shiraishi S, Nakayama H, Itonaga T, Tajima Y, Okubo M, Mikami R, Tokuuye K. Risk of Symptomatic Radiation Pneumonitis After Thoracic Radiation Therapy in Patients With a Reticular Shadow. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hirahara N, Matsubara T, Hayashi H, Takai K, Fujii Y, Tajima Y. Impact of inflammation-based prognostic score on survival after curative thoracoscopic esophagectomy for esophageal cancer. Eur J Surg Oncol 2015; 41:1308-15. [DOI: 10.1016/j.ejso.2015.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/09/2015] [Accepted: 07/09/2015] [Indexed: 01/06/2023] Open
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Yoshida Y, Yamazaki K, Mizusawa J, Satoh M, Hinoi T, Tsuchida A, Otsuka K, Sato T, Watanabe M, Baba H, Kimura H, Idani H, Kanazawa A, Fukunaga M, Okuda J, Tajima Y, Hasegawa H, Katayama H, Hamaguchi T, Shimada Y. 2129 Predictive factor for toxicities and treatment termination in adjuvant capecitabine therapy for stage III colorectal cancer; based on the data of a randomized trial, JCOG0910. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kusunoki R, Ishihara S, Tada Y, Oka A, Sonoyama H, Fukuba N, Oshima N, Moriyama I, Yuki T, Kawashima K, Ansary MMU, Tajima Y, Maruyama R, Nabika T, Kinoshita Y. Role of milk fat globule-epidermal growth factor 8 in colonic inflammation and carcinogenesis. J Gastroenterol 2015; 50:862-75. [PMID: 25596854 DOI: 10.1007/s00535-014-1036-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/24/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Milk fat globule-epidermal growth factor 8 (MFG-E8) promotes phagocytic clearance of apoptotic cells to maintain normal tissue homeostasis. However, its functions in intestinal inflammation and carcinogenesis are unknown. METHODS Experimental colitis was induced in MFG-E8 knockout (KO) and wild-type (WT) mice by dextran sodium sulfate (DSS) administration. Colon tissues were used for assessments of colitis activity and epithelial proliferation. A mouse colitis-associated cancer (CAC) model was induced by intraperitoneal injection of azoxymethane (AOM) and then the animals were given a single administration of DSS. A sporadic colon cancer model was established by repeated intraperitoneal injections of AOM. The role of MFG-E8 in epithelial proliferation with or without treatment of siRNA targeting α(v)-integrin was examined in vitro using a WST-1 assay. RESULTS The severity of colitis in KO mice was greater than that in WT mice, while the proliferative potential of colonic epithelial cells in KO mice was lower during the regenerative phase. In both CAC and sporadic models, tumor size in KO was lower as compared to WT mice, while decreased tumor incidence was only found in the CAC model. In vitro findings showed that MFG-E8 promotes epithelial cell proliferation, and treatment with a siRNA targeting α(v)-integrin reduced the proliferation of Colon-26 cells stimulated with recombinant MFG-E8. CONCLUSIONS MFG-E8 promotes tumor growth regardless of the presence or absence of colonic inflammation, whereas colon tumor development is initiated by MFG-E8 under inflammatory conditions. These MFG-E8 functions may be dependent on integrin-mediated cellular signaling.
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Nishi T, Kawabata Y, Ishikawa N, Araki A, Yano S, Maruyama R, Tajima Y. Intraductal papillary mucinous carcinoma of the pancreas associated with pancreas divisum: a case report and review of the literature. BMC Gastroenterol 2015; 15:78. [PMID: 26152300 PMCID: PMC4495851 DOI: 10.1186/s12876-015-0313-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/30/2015] [Indexed: 01/15/2023] Open
Abstract
Background Pancreas divisum, the most common congenital anomaly of the pancreas, is caused by failure of the fusion of the ventral and dorsal pancreatic duct systems during embryological development. Although various pancreatic tumors can occur in patients with pancreas divisum, intraductal papillary mucinous neoplasm is rare. Case presentation A 77-year-old woman was referred to our hospital because she was incidentally found to have a cystic tumor in her pancreas at a regular health checkup. Contrast-enhanced abdominal computed tomography images demonstrated a cystic tumor in the head of the pancreas measuring 40 mm in diameter with slightly enhancing mural nodules within the cyst. Endoscopic retrograde pancreatography via the major duodenal papilla revealed a cystic tumor and a slightly dilated main pancreatic duct with an abrupt interruption at the head of the pancreas. The orifice of the major duodenal papilla was remarkably dilated and filled with an abundant extrusion of mucin, and the diagnosis based on pancreatic juice cytology was “highly suspicious for adenocarcinoma”. Magnetic resonance cholangiopancreatography depicted a normal, non-dilated dorsal pancreatic duct throughout the pancreas. The patient underwent a pylorus-preserving pancreaticoduodenectomy under the diagnosis of intraductal papillary mucinous neoplasm with suspicion of malignancy arising in the ventral part of the pancreas divisum. A pancreatography via the major and minor duodenal papillae on the surgical specimen revealed that the ventral and dorsal pancreatic ducts were not connected, and the tumor originated in the ventral duct, i.e., the Wirsung’s duct. Microscopically, the tumor was diagnosed as intraductal papillary mucinous carcinoma with microinvasion. In addition, marked fibrosis with acinar cell depletion was evident in the ventral pancreas, whereas no fibrotic change was noted in the dorsal pancreas. Conclusion Invasive ductal carcinomas of the pancreas associated with pancreas divisum usually arise from the dorsal pancreas, in which the occurrence of pancreatic cancer may link to underlying longstanding chronic pancreatitis in the dorsal pancreas; however, the histopathogenesis of intraductal papillary mucinous neoplasm in this anomaly is a critical issue that warrants further investigation in future.
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Tajima Y, Nakayama H, Itonaga T, Shiraishi S, Okubo M, Mikami R, Sugahara S, Tokuuye K. Dosimetric evaluation of compensator intensity modulation-based stereotactic body radiotherapy for Stage I non-small-cell lung cancer. Br J Radiol 2015; 88:20150122. [PMID: 25996577 DOI: 10.1259/bjr.20150122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the dosimetry of compensator intensity modulation-based stereotactic body radiotherapy (SBRT) [non-coplanar intensity-modulated radiotherapy (ncIMRT)], its use was compared with that of three-dimensional conformation-based SBRT, for patients with Stage I non-small-cell lung cancer (NSCLC). METHODS 21 consecutive patients with Stage I NSCLC were treated with ncIMRT or SBRT at Tokyo Medical University. To compare the two techniques, ncIMRT and SBRT plans for each patient were generated, where the planning target volume (PTV) coverages were adjusted to be equivalent to each other. The prescribed dose was set as 75 Gy in 30 fractions. PTV coverage, conformity index, conformation number (CN) and homogeneity index (HI) were used to compare the two strategies. RESULTS There was no statistically significant difference between PTV coverage for the 100%, 95% and 90% dose levels in the SBRT plan and those in the ncIMRT plan. The CN values were 0.53 ± 0.13 in the SBRT plan and 0.72 ± 0.10 in the ncIMRT plan. These values were significantly better than those of the SBRT plan (p < 0.001). The HI in the ncIMRT plan was 1.04 ± 0.03%, which was also significantly better than that of SBRT. CONCLUSION The ncIMRT plan provided superior conformity and reduced the doses to the lung for patients with Stage I NSCLC. ADVANCES IN KNOWLEDGE The delivery technique with compensator intensity modulation-based SBRT was evaluated. Concerning target motion, this is thought to be more robust and safer than SBRT for early-stage NSCLC.
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Hirahara N, Matsubara T, Hayashi H, Takai K, Fujii Y, Tajima Y. Significance of prophylactic intra-abdominal drain placement after laparoscopic distal gastrectomy for gastric cancer. World J Surg Oncol 2015; 13:181. [PMID: 25962503 PMCID: PMC4440503 DOI: 10.1186/s12957-015-0591-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background Unnecessary intra-abdominal drain insertion must be avoided, but little is known about the value of prophylactic drainage following laparoscopic distal gastrectomy (LDG). In this study, we investigated the significance of prophylactic drain placement after LDG for gastric cancer. Methods Seventy-eight consecutive patients with gastric cancer who underwent LDG in our department were retrospectively analyzed. The patients were divided into two groups according to the insertion of a prophylactic intra-abdominal drain following LDG. The ‘drain group’ comprised 45 patients with routine use of a prophylactic intra-abdominal drain, and the ‘no-drain group’ comprised 33 patients who did not undergo placement of an intra-abdominal drain. Results There were no significant differences in terms of the mean age of the patients, male/female ratio, body mass index, and concurrent diseases between the drain group and the no-drain group. In addition, there were no significant differences in the tumor location, tumor diameter, depth of the tumor, nodal metastasis, and tumor stage between the two groups. All patients in each group were successfully treated with R0 surgery, and no patient required conversion to open surgery. Surgery-related factors, including lymph node dissection and operative time, were similar in the drain group and the no-drain group. A comparison of the amount of intraoperative blood loss between patients with and without postoperative complications revealed that patients who experienced postoperative complications had a significantly larger amount of blood loss than those without postoperative complications. A comparison of operative times between patients with and without surgery-related postoperative local complications revealed that patients who experienced surgery-related postoperative local complications had a significantly longer operative time than those without surgery-related postoperative local complications. Analysis of operative times in each group revealed that patients with surgery-related postoperative local complications had a significantly longer operative time than those without surgery-related postoperative local complications in the no-drain group. Conclusions Intraoperative factors such as the operative time and the amount of intraoperative blood loss affected the occurrence of postoperative complications following LDG. A prophylactic drain may thus be useful in patients at higher risk and in those with a longer operative time or massive intraoperative bleeding.
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Kawabata Y, Hayashi H, Takai K, Kidani A, Tajima Y. Superior mesenteric artery-first approach in radical antegrade modular pancreatosplenectomy for borderline resectable pancreatic cancer: a technique to obtain negative tangential margins. J Am Coll Surg 2015; 220:e49-54. [PMID: 25840548 DOI: 10.1016/j.jamcollsurg.2014.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/27/2014] [Accepted: 12/29/2014] [Indexed: 01/04/2023]
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Hirahara N, Matsubara T, Hayashi H, Takai K, Fujii Y, Tajima Y. Easy and secure closure of petersen's defect after laparoscopic distal gastrectomy with Roux-en-Y reconstruction. J Laparoendosc Adv Surg Tech A 2014; 25:55-9. [PMID: 25531205 DOI: 10.1089/lap.2014.0402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Previously it has reported that the incidence of internal hernia can be decreased by closing Petersen's defect, but the perfect closure method, in fact, has not been discovered yet. In this study we have developed an easy and reliable method for closing Petersen's defect in the Roux-en-Y reconstruction after a laparoscopic distal gastrectomy. MATERIALS AND METHODS We performed intracorporeal Roux-en-Y reconstruction after laparoscopic distal gastrectomy with antiperistaltic gastrojejunostomy. The greater omentum is placed on the cranial side of the transverse colon through the defect between the elevated jejunum and the transverse mesocolon. Anastomosis is performed of the transverse mesocolon attached to the transverse colon, the greater omentum is passed through the Petersen's defect, and the stump of the mesojejunum is attached to the elevated jejunum by an interrupted suture. Petersen's defect is spread and straightened to stabilize the visual field. The thread is inserted first at the base of the stump of the elevated mesojejunum, next to the greater omentum, which has passed through Petersen's defect, and then to the transverse mesocolon to set the starting point of continuous suture. The stitches of continuous suture are sewn toward the transverse colon. Petersen's defect is closed completely. RESULTS We performed this technique in 37 patients. All procedures were completed without intraoperative complication or conversion to laparotomy. During the follow-up period, none of the patients developed complications related to the internal hernia, such as Petersen's hernia. CONCLUSIONS We have indicated a novel, easy, and secure closure procedure of Petersen's defect following laparoscopic distal gastrectomy with Roux-en-Y reconstruction.
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Ishijima M, Nakayama H, Itonaga T, Tajima Y, Shiraishi S, Okubo M, Mikami R, Tokuuye K. Patients with severe emphysema have a low risk of radiation pneumonitis following stereotactic body radiotherapy. Br J Radiol 2014; 88:20140596. [PMID: 25490255 DOI: 10.1259/bjr.20140596] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the risk of radiation pneumonitis (RP) after stereotactic radiotherapy (SBRT) for patients presenting with severe pulmonary emphysema. METHODS This study included 40 patients with Stage I non-small-cell lung cancer who underwent SBRT, 75 Gy given in 30 fractions, at the Tokyo Medical University, Tokyo, Japan, between February 2010 and February 2013. The median age of the patients was 79 years (range, 49-90 years), and the male:female ratio was 24:16. There were 20 T1 and 20 T2 tumours. 17 patients had emphysema, 6 had slight interstitial changes on CT images and the remaining 17 had no underlying lung disease. The level of emphysema was classified into three groups according to the modified Goddard's criteria (severe: three patients, moderate: eight patients and mild: six patients). Changes in the irradiated lung following SBRT were evaluated by CT. RESULTS On CT images, RP was detected in 34 (85%) patients, and not in 6 (15%) patients, during a median observation period of 313 days. Of the six patients, three had severe emphysema and three had no underlying lung disease. Patients with severe emphysema had lower risk of RP than those with moderate emphysema (p = 0.01), mild emphysema (p = 0.04) and no underlying lung disease (p = 0.01). CONCLUSION Patients with severe emphysema had a low risk of RP following SBRT. ADVANCES IN KNOWLEDGE Little is known about the association between RP and pulmonary emphysema. Patients with severe emphysema had lower risk of RP than those with no underlying lung disease.
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Hayashi H, Kawabata Y, Fujii T, Hattori S, Yamamoto Y, Eiji H, Takashi S, Tajima Y. 445. Validation of POSSUM scoring system in abdominal surgery for patients with malignant diseases: A multi-institutional analysis. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hirahara N, Matsubara T, Kidani A, Hyakudomi R, Fujii Y, Tajima Y. A novel technique to minimize deformation of the stomach in laparoscopic partial gastrectomy for intraluminal gastric GISTs. J Laparoendosc Adv Surg Tech A 2014; 24:707-11. [PMID: 25181572 DOI: 10.1089/lap.2014.0184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The laparoscopic approach would be difficult to perform without causing deformation of the stomach in managing gastrointestinal stromal tumors (GISTs) of the intraluminal type, especially in those that are located in the posterior gastric wall or around the gastroesophageal junction and the pylorus, because intraluminal GISTs usually require an excessive resection of the gastric wall for cure. We present a novel surgical technique for successful management of intraluminal gastric GISTs that minimizes deformation of the stomach regardless of tumor location. MATERIALS AND METHODS The operating surgeon handles the tumor by holding tissue surrounding the tumor and performs seromyotomy using an ultrasonically activated device along the outer edge of the tumor. The tumor gradually protrudes like an extraluminal tumor as the seromyotomy proceeds. When seromyotomy along the tumor comes up to the point where the tumor sufficiently turns over the gastric serosa, the tumor looks like a pedunculated extraluminal GIST. Two seromuscular sutures are applied to close the exfoliated seromuscular layer. The tips of two seromuscular sutures are held and then pulled up toward the ventral side so that the staple line is aligned in line with the minor axis of the stomach. Finally, complete tumor removal with minimal seromuscular resection is accomplished by applying a linear stapler. RESULTS All patients resumed oral ingestion on the day after surgery and showed no signs of anastomotic constriction or obstruction. CONCLUSIONS Our laparoscopic procedure for gastric GISTs is simple and allows us easy and precise removal of the tumor and closure of the gastric wall with minimum necessary resection, regardless of the location and growth form of the tumors.
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Kennoki N, Nakayama H, Itonaga T, Tajima Y, Shiraishi S, Okubo M, Mikami R, Sugahara S, Tokuuye K. Preliminary Results of Feasibility and Toxicities in Intensity Modulated Radiation Therapy With Gemcitabine and S-1 for Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kawabata Y, Nishi T, Tanaka T, Tajima Y. Safety and Feasibility of a Pancreaticoduodenectomy with Total Meso-Pancreatoduodenum Excision: Analysis in Various Periampullary Disorders. HEPATO-GASTROENTEROLOGY 2014; 61:821-827. [PMID: 26176080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS This study aimed to evaluate the safety and feasibility of a pancreaticoduodenectomy with total meso-pancreatoduodenum excision (tMPDe) as an new anatomical concept. METHODOLOGY A total of 90 patients underwent PD for various periampullary diseases. Of these, 52 patients received a conventional PD (cPD), while 38 patients underwent a tMPDe. Surgical outcomes were compared between the two study groups. RESULTS Operative time was equivalent in the two groups; however, the estimated blood loss (cPD, 1360 ml; tMPDe, 995 ml; median, P = 0.026) and blood transfusion rate (cPD, 63%; tMPDe, 31% ; P = 0.001) were significantly decreased in tMPDe. Morbidity had no significant difference between cPD and tMPDe, and tMPDe showed no characteristic complications. With regard to oncological aspects, tMPDe was superior to cPD. Risk factors analysis revealed the operative time (P = 0.003), estimated blood loss (P < 0.001), and blood transfusion (P < 0.001) to be significant predictive risk factors for postoperative morbidity but not tMPDe procedure (P = 0.794). CONCLUSIONS tMPDe is safe and superior to cPD because it is a bloodless operation with a good oncological outcome: We concluded that tMPDe should be adaptable to various periampullary diseases, including benign and low-grade malignant disorders.
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Hirahara N, Matsubara T, Hyakudomi R, Hari Y, Fujii Y, Tajima Y. Laparoscopic stomach-partitioning gastrojejunostomy with reduced-port techniques for unresectable distal gastric cancer. J Laparoendosc Adv Surg Tech A 2014; 24:177-82. [PMID: 24555860 DOI: 10.1089/lap.2013.0417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The improvement of quality of life is of great importance in managing patients with far-advanced gastric cancer. We report a new cure and less invasive method of creating a stomach-partitioning gastrojejunostomy in reduced-port laparoscopic surgery for unresectable gastric cancers with gastric outlet obstruction. MATERIALS AND METHODS A 2.5-cm vertical intraumbilical incision was made, and EZ Access (Hakko Co., Ltd., Tokyo, Japan) was placed. After pneumoperitoneum was created, an additional 5-mm trocar was inserted in the right upper abdomen. A gastrojejunostomy was performed in the form of an antiperistaltic side-to-side anastomosis, in which the jejunal loop was elevated in the antecolic route and anastomosed to the greater curvature of the stomach using an endoscopic linear stapler. The jejunal loop together with the stomach was dissected with additional linear staplers just proximal to the common entry hole so that a functional end-to-end gastrojejunostomy was completed. At the same time, the stomach was partitioned using a linear stapler to leave a 2-cm-wide lumen in the lesser curvature. Subsequently, jejunojejunostomy was performed 30 cm distal to the gastrojejunostomy, and the stomach-partitioning gastrojejunostomy resembling Roux-en Y anastomosis was completed. RESULTS All patients resumed oral intake on the day of operation. Neither anastomotic leakage nor anastomotic stricture was observed. CONCLUSIONS Our less invasive palliative operation offers the utmost priority to improve quality of life for patients with unresectable gastric cancer.
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Itonaga T, Nakayama H, Tajima Y, Shiraishi S, Mikami Y, Okubo M, Sugahara S, Tokuyye K. EP-1424: Can dynamic susceptibly MRI be a potential imaging biomarker after radiotherapy? Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kawabata Y, Ishikawa N, Moriyama I, Tajima Y. What is an adequate surgical management for pTis and pT1 early ampullary carcinoma? HEPATO-GASTROENTEROLOGY 2014; 61:12-17. [PMID: 24895785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS The aim of this study is to identify an adequate surgical management for early ampullary carcinoma (AC). METHODOLOGY We retrospectively reviewed a total of 51 patients who underwent a curative pancreaticoduodenectomy (PD) for various stages of AC. RESULTS A pathological early AC was defined as pTis and pT1 in this study. Of the 51 AC patients, 7, 13, 17, 13 and 1 were confirmed to be pTis, pT1, pT2, pT3, and pT4, respectively. The incidence of lymph node metastasis in pTis and pT1 patients was 0% and 0%, respectively, while the incidence of lymphatic invasion was 0% and 38.5%, respectively. These two pathological factors significantly correlated with the advancement of tumor invasion. Multivariate analysis demonstrated that lymph node metastasis and lymphatic invasion were the only significant independent predictors of survival. In 20 early AC patients, tumor recurrence was detected in 2 (10%) cases in which the tumor stage was pT1, and lymphatic invasion was evident. CONCLUSIONS Although PD is the gold standard operation for all ACs, less invasive surgery, such as ampullectomy, could be indicated for patients with pTis AC following a strict preoperative evaluation of tumor staging.
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Kawabata Y, Nishi T, Tanaka T, Yano S, Tajima Y. Distal Pancreatectomy Utilizing a Flexible Stapler Closure Eliminates the Risk of Pancreas-Related Factors for Postoperative Pancreatic Fistula. Eur Surg Res 2013; 50:71-9. [DOI: 10.1159/000349977] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/17/2013] [Indexed: 11/19/2022]
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97
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Hirahara N, Edamatsu T, Fujieda A, Fujioka M, Wada T, Tajima Y. Protein-bound polysaccharide-K induces apoptosis via mitochondria and p38 mitogen-activated protein kinase-dependent pathways in HL-60 promyelomonocytic leukemia cells. Oncol Rep 2013; 30:99-104. [PMID: 23604455 DOI: 10.3892/or.2013.2412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/15/2013] [Indexed: 11/06/2022] Open
Abstract
Protein-bound polysaccharide-K (PSK) is extracted from Coriolus versicolor (CM101). PSK is a biological response modifier (BRM), and its mechanism of action is partly mediated by modulating host immune systems; however, recent studies showed antiproliferative activity of PSK. Therefore, we examined the mechanism underlying the antiproliferative activity of PSK using seven different human malignant cell lines (WiDr, HT29, SW480, KATOIII, AGS, HL-60 and U937), and PSK was found to inhibit the proliferation of HL-60 cells most profoundly. Therefore, HL-60 cells were used to elucidate the mechanism of the antiproliferative activity. Western blotting was performed to detect phosphorylated p38 mitogen-activated protein kinase (MAPK). A p38 MAPK inhibitor, SB203580, was used to examine the roles in PSK-induced apoptosis and growth inhibition. Flow cytometry was performed for mitochondrial membrane potential detection. PSK activated caspase-3 and induced p38 MAPK phosphorylation. Co-treatment with SB203580 blocked PSK-induced apoptosis, caspase-3 activation and growth inhibition. PSK induced apoptosis via the mitochondrial pathway. The depolarization of mitochondria induced by PSK was reversed by co-treatment with SB203580. The present study revealed that PSK induced apoptosis in HL-60 cells via a mitochondrial and p38 MAPK-dependent pathway.
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98
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Nishino R, Fukuyama T, Tajima Y, Miyashita L, Watanabe Y, Ueda H, Kosaka T. Prior oral exposure to environmental immunosuppressive chemicals methoxychlor, parathion, or piperonyl butoxide aggravates allergic airway inflammation in NC/Nga mice. Toxicology 2013; 309:1-8. [PMID: 23583882 DOI: 10.1016/j.tox.2013.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immunosuppressive environmental chemicals may increase the potency of allergens and thereby play a role in the development of respiratory tract allergies, such as allergic rhinitis and asthma. OBJECTIVES We investigated the association between environmental immunosuppressive chemicals and the allergic airway inflammation development. METHODS We used a mouse model of ovalbumin (OVA)-induced allergic airway inflammation. NC/Nga mice were exposed orally to pesticides parathion (an organophosphate compound) or methoxychlor (an organochlorine compound), or to an insecticide synergist piperonyl butoxide, prior to OVA intraperitoneal sensitization and inhalation challenge. We assessed serum IgE levels, B-cell counts, cytokine production, IgE production in hilar lymph nodes, eosinophil counts, chemokine levels in bronchoalveolar lavage fluid, and cytokine gene expression in the lung. RESULTS Exposure to environmental immunosuppressive chemicals markedly increased serum IgE - IgE-positive B-cells, IgE and cytokines in lymph nodes - eosinophils and chemokines in BALF - IL-10a and IL-17 in the lung. CONCLUSIONS Allergic airway inflammation can be aggravated by prior exposure to immunosuppressive environmental chemicals.
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99
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Monma H, Harashima N, Inao T, Okano S, Tajima Y, Harada M. The HSP70 and autophagy inhibitor pifithrin-μ enhances the antitumor effects of TRAIL on human pancreatic cancer. Mol Cancer Ther 2013; 12:341-51. [PMID: 23371857 DOI: 10.1158/1535-7163.mct-12-0954] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
TRAIL and agonistic death receptor-specific antibodies can induce apoptosis in cancer cells with little cytotoxicity to normal cells. To improve TRAIL-induced antitumor effects, we tested its effectiveness in combination with pifithrin (PFT)-μ, which has the potential to inhibit HSP70 function and autophagy, both of which participate in TRAIL resistance in cancer cells. Among the four human pancreatic cancer cell lines tested, MiaPaca-2, Panc-1, and BxPC-3 cells showed varying sensitivities to TRAIL. In MiaPaca-2 and Panc-1 cells, knockdown of HSP70 or beclin-1, the latter an autophagy-related molecule, by RNA interference augmented TRAIL-induced antitumor effects, decreasing cell viability, and increasing apoptosis. On the basis of these findings, we next determined whether the TRAIL-induced antitumor effects could be augmented by its combination with PFT-μ. The combination of TRAIL plus PFT-μ significantly decreased the viability and colony-forming ability of MiaPaca-2 and Panc-1 cells compared with cells treated with either agent alone. When applied alone, PFT-μ increased Annexin V(+) cells in both caspase-dependent and -independent manners. It also promoted TRAIL-induced apoptosis and arrested cancer cell growth. Furthermore, PFT-μ antagonized TRAIL-associated NF-κB activation in cancer cells. In a xenograft mouse model, combination therapy significantly inhibited MiaPaca-2 tumor growth compared with treatment with either agent alone. The results of this study suggest protective roles for HSP70 and autophagy in TRAIL resistance in pancreatic cancer cells and suggest that PFT-μ is a promising agent for use in therapies intended to enhance the antitumor effects of TRAIL.
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Hirahara N, Matsubara T, Hari Y, Fujii Y, Wake H, Tajima Y. Secure hemostasis in transhiatal esophagectomy for esophageal cancer with gauze packing. World J Surg Oncol 2012; 10:276. [PMID: 23253358 PMCID: PMC3557199 DOI: 10.1186/1477-7819-10-276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 11/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transhiatal esophagectomy for esophageal cancer implies blind manipulation of the intrathoracic esophagus. We report a secure hemostatic method with gauze packing in transhiatal esophagectomy. METHODS The gauze-packing technique is utilized for hemostasis just after removal of the thoracic esophagus during transhiatal esophagectomy. After confirming cancer-free margins, the abdominal esophagus and cervical esophagus are transected. A vein stripper is inserted into the oral-side stump of the esophagus and led to exit from the abdominal-side stump of the esophagus. The vein stripper and the oral stump of the esophagus are affixed by silk thread. A polyester tape is then affixed to the vein stripper, as the polyester tape is left in the posterior mediastinum after removal of the esophagus toward the abdominal side. The polyester tape on the cervical side is ligated with gauze and the polyester tape is removed toward the abdominal side. The oral stump of gauze and new additional gauze are affixed. As the first gauze is pulled out from the abdominal side, the second gauze gets drawn from the cervical wound into the mediastinum. The posterior mediastinum is finally packed with gauze and possible bleeding at this site undergoes a complete astriction. The status of hemostasis with the gauze packing is checked by an observation of color and bloodstain on the gauze. RESULTS Between January 2005 and February 2012, 13 consecutive patients with esophageal cancer underwent a transhiatal esophagectomy with the gauze-packing hemostatic technique. Hemostasis at the posterior mediastinum was performed successfully and quickly in all cases with this method, requiring up to four pieces of gauze for a complete hemostasis. Median required time for hemostasis was 1219 (range 1896 to 1293) seconds and estimated blood loss was 20.4 (range 15 to 25) ml during gauze packing. CONCLUSIONS Our technique could minimize bleeding after the removal of the thoracic esophagus. The gauze-packing method is a simple and easy technique for secure hemostasis when performing a transhiatal esophagectomy.
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